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Home My WebLink About3030 AIRWAY AVE - Building Permits(714) 754-5273 • Fax (714) 7544856 •=www.ci.costa-mesa 9bTRICAL PERMIT 77 FAIR DRIVE; COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 3030 AIRWAY AV RIP CURL 42708302 ROSS,BERT 17992 COWAN IRVINE CAi ISSUED BY: /;�i,. `., 'Phone: 949-474-0555 t / h Zip 92614 GENERAL-LIFE`INSURANCE'COMPANY;,�,`,-%, -RCIAL GROUP Phone: I DR BLDG G Zip: 92616-2339 \ f ALARM COINC '� \,`�• '. `:IRVINE; CA�� /rf d� ONE TECHNOLOG' r .,Contractor:,: THE(GREATER }� Address 17992 COWAN ;J i IRVINE, CAJ` Status: ISSUED Applied: 05/18/2005 Issued: 05/18/2005 Phone 949-474-0555 Zip: 92614 .1 4--- t License: 469046 K , ' - alb f" 71,^ 7 SCOPE OF PERMIT A , il,-: i '{, I 11 t INSTALLATION OF'A CCTV,,SYSTEM �ACCESSCONTROL SYSTEM AND INTRUSION ALARM SYSTEM.,.{_ �rP• ' .3 LOW VOLTAGE EQUIPMENT NO OTHER WORK AUTHORIZED WITH THIS PERMIT,%'"" -- FEE.SUMMARY= 'rL - uan TISSUE FEE t li .$23.50 M Temp DistSystem / Lighting Temp service test $0.00 Busway/ 100:8.- ' Res. a/c package ��•,• $0.00 StandingSeetidn'— New Res (1-2 units) $0.00 0 , Misc Electrical Equipment New Res 3+units `'' ' ,(, ) / \\ $0.00 0 ' Trahsformers up to 1 kva/kw Pool/ Spa �' ' - $0.00 0 "' up to 10 kva/kw Lighting Flxts�x$0.00 0 - up 0S0 kva/kw Recept Outlets$0;00,, I 0.�' - !. up to,,100 kva/kwL__ Switches Woo'-,"! 0 - .:........ over 100 kva/kw"'v RNon es ReslAppl \\\ J�/ ' $0.00, Q\ \ 0 ° ( - \=, Low Voltage,Equipment' pp '�v $000 \ \�0�, o J -o Low Yolt,Wiririg5ystem LCkt Service to 200a \.,\-,.. + $0 OO,�j \ 0`r t• Misc. Conduit Service to 1000a "'~�t x$0:00 0'"�"mow . Misc Conducto>�� Service over 1000a . �>;� $0.110•'/ / ' %0�� _ _ -Circus (genorride) Motors to 1 h \ - :$0:00\_ �� 0- / Circus (mach -ride oraights) Motors to 10hp �,$0.00- �• 0 ;` .? J,- i`, 3--Chdstmas-Tree'Stand Motors to 50hp $0.001 -J_ 0�-.1 I -- ,Fireworks Stand'.l, ' Motors to 100hp $0.00- >`'0 - i "� t;Other ,Electrical -Fee Motors over 100hp $0.00 0__ - - i,,• ��,,. Communication drops `c = - -e-, • p $0.00 0� - -, l Investigation Feer.. --"� Sub panel to 200a $0.00 0 ---.—Plao-Check'Fee Quantity $0.00 0 Jif f t -$0.00 0' ,,'' :$0.00 0, � ,f J ,$0.00 $0.00 $000.'y(0 $0 00 0 i $54.60 A 3 $0.00 o r $0.00`, Gg', �$0.00j 0'U $0:00 �0'j C$0.00 ;'� 0 - $0.00/,�0 $0.00" 0 $0.00 $0.00 'NOTICE: The.work authorizedby this permit shall comply with all applicable handicap access, requirements' under Californiastatutesand related regulations: (Ord. No. 92728; § 1, 12-21-92) EXPIRATION: This.pennit shall automaticallyexpire and become voidif work is not commenced. within 180 days; or if work is suspended or abandoned for a period of 180 days. .INSPECTIONS: In orderfor the work,authorized.underthis•permit to be considered. legal, such'work must comply with all applicable codes, and all ' requiredinspections and final approvalmust be obtained: Failure to obtain inspections and final approval.will.result in the expiration of this permit. FOR INSPECTIONS CALL:. (714) 75445626 2446.46(6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: _ I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self.Insure forworkers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the —work for which this permit is issued. - ( I have and will maintain Workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this'permt is issued. My workers' compensation Insa carrier and policy number are: �'yy��,..� _ �Carrier�iA coR'QOYZ(a'C�, �y�SL��A1C-E r r 1�hzJT Polyy umber. S� 0vM1lM.��I (This section need not ba cornpleted if the permit is valued at one hundred dollars ($100) or less.) (� ❑ I certify that in the performance of the workfor which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensallon laws of Cs' d agree that it 1 should become subject to the workers' compensation provisions f Sect n 3700 of the Labor Code, 1 shall forthwith complyag6.turb . 51 Applicant S_igneture.-c Date:. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER' CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am li s r pr mons of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus! ass and Professions Code, and my license is in full force and effect. Lick r CIassJ1 F Conuac[ods.Signeture� - Date�15<1 v CONSTRUCTION LENDING AGENCY: ❑ I hereby affimn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or pregent or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, .or 200 cubic feet of compressed gas at standard temperature and pressure). .........................................................._...................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......................................i......................................................................................................................................................................................................................................................................................... .......................prase .. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire . Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a2 plication apermit for such construction or modification from the South Coast Alt Quality Management District or from any other air pollution control district or agency? IJ Yes L-1 No (Section 65850.2 of the Califomla Government Code requires that the requested information be furnished on applications for non-residential building permits). .... .......................................................................................................................................................-................................................................................................................................................................................................. _.................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No _(It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................._.__._...................._._.__............... ...,,........-........... .................................................... ........ ....................... .............................................................. ...... ............. ..... ....................... .......................... ........ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No . ........................................................................................................................................................................................................................................................................................................................................................................................... 6 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply With all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. lgnature Of Legal Owner(s) NOS Date AnNOcAuthorize l,Apphcant „- (Date CODE f. INSPECTIONTYPE - "Qej[ RIIIIIELS - ` CODE d INSPECTIONTYPE jldjf, Irk 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Root 210 Final Electrical'' 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 _Final Factory Fire Place 220 Final Planning Approval I 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildingJOccupency City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. P. O. Box 1200 Costa Mesa, California The Building located at 3030 AIRWAY AVENUE has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2 Occupancy. Use of Building OFFICEMAREHOUSE Legal Description 427-083-02 (See reverse side for Metes and Bounds! E59668 Building Permit No R59636 Electrical Permit No. E60742 Plumbing Permit No. P59733 Mechanical Permit No. M59742 Number of apartments FIRE SPRINKLER No. F60297 ISSUED TO: ROSENBERG REAL ESTATE EQUITY FUM WEST—V 1301 DOVE STREET STE. 460 Building Official and/or guest rooms TONY C'DeBACA by r NEWPORT BEACH CA 92660 Date MARCH 91 1993 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 101546 rev. 1/83 White � Owner; Canary - Numerical File; Pink - Bldg. Permit File r City of'Cost Mesa Development Services Department Building Safely Division CERTIFICATE OF OCCUPANCY No. 000315 P. O. Box 1200 Costa Mesa, California The Building located at 1r)-tn A;.,.-, . �.,.. has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 0_11 Occupancy. Use of Building Tr: --,,pie-....-...:.... _ �.ec:..-. Legal Description e)7_n01)_nn (See reverse side for Metes and Bounds) e $ it Building Permit No--ocln Electrical Permit No. ncn^ Plumbing Permit No. nc'ln Mechanical Permit No. Cr'9520/ 14-957 Number of apartmentst --0 and%or guest rooms 0 ISSUED TO: T17,111 t Buildin//g'Offiiciialx =� by/,.' � z. Date ro `— • % - � 4" This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File CITY OF COSTA MESA BUILDING DIVISION to 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us PERMIT TYPE: B_COMBO Sub Type: COM_ALT FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER: BC10-00189 JOB ADDRESS: 3030 AIRWAY AV CM APN: 42708302 Zoning: , Vicinity: Const Type: V -B SQ. FT: 12750 STATUS: ISSUED DATE ISSUED: 06/29/2010 ISSUED BY: RMD Suite/Unit: Primary Occ: Valuation: $80,000.00 SCOPE OF WORK: 20513SF INTERIOR TO CREATE A NEW TENANT SPACE FOR A NEW FUTURE TENANT. WORK TO INCLUDE THE CONSTRUCTION OF A NEW NON LOEAD BEARING DEMISING WALL, NEW EXTERIOR OPENING FOR EXIT, NEW NON LOAD BEARING WALLS TO CREATE RESTROOMS IN NEW TENANT SPACE, OFFICE AREAS, REPLACE EXISTING STORE FRONT WINDOWS WITH NEW ENTRY DOOR. 1 FAU < 100 K BTU, 5 ALTER/REPAIR COOLING/HEAT, 1 HOOD, 3 VENT FANS, 6 LIGHT FIXTS, 50 OUTLETS, 30 SWITCHES, 1 MOTOR TO 1 HP, RELOCATE 6 SUB PANELS, 2 FLOOR DRAINS, 1 P -TRAP, 1 COMM SINK, 2 TRAP PRIMER, 1 URINAL, 2 WASH BASINS, 3 WATER CLOSETS, 3 WATER HEATERS. OWNER: CONNECTICUT GENERAL LIFE INSURANCE COMPANY COMMERCIAL GROUP - Unit: IRVINE, CA Phone: City/State/Zip: ONE TECHNOLOGY DR BLDG G APPLICANT: DE LA ROSA, FLORENCIO Address: Phone: 714-920-6298 City/State/zZip: CONTRACTOR: OWNER -BUILDER. 1616 Phone: Address: Unit: Cell: - City/State: ARCHITECT: ANDREW PEREZ License No.C23848 ENGINEER: License No. COMBINATION PERMIT FEE SUMMARY 200 Building Plan Check: $554.94 Building Fees: $853.75 Electrical Fees: $291.05 Mechanical Fees: $139.40 Plumbing Fees: $170.50 SMIP Residential: $0.00 SMIP Commercial: $16.80 Bldg Std Admin Fund $4.00 TOTAL FEES: $2,030.44 License No. 000000 Address: INSIGNIA Unit: : ZipCode PHONE:949-756-1363 PHONE: 'Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday- 7:00amthru 7:00 pm. Saturdays- 9:00 am thm 6:00 pm. Prohibited all hours- Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODEI INSPECTION TYPE DAN INn11Al CODE 0 INSPECTION TYPE DAT� INnnAts 1616 Pool System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 , Final Demolition 250 Final Building/Occupancy I t a WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This sector need ret t e oorrrvefed t the pemul k waruedat one hurMred cbCars ($100) a less ) Policy Number: rIns"n 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, and agree that if I should become subject to t Corkers' compensation provisions of Section 3700 of th e-1 s II nhwith comply with these provisions. A p' n'yr&gTdl�ie - Dele�.� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lit. # Class # Contractor's Signature Date CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): Q.,1,,ac owner of the property, or my employees with wages as their sole m�ensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not appy to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: so -as lurwl Owner ID verified by d�riiverse. E] Yes El N(; rw"'"'er'sL CI a set No. ®I) Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Ari 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. :71/Z o4 gal (ST- V bale zz ve- -air zea &caitFs- /r0111 ".- CITY OF COSTA MESA o F, BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 0r � FOR INSPECTIONS CALL: (714) 754-5626 ''^� "` F10-00100 Job Address: 3030 AIRWAY AV Suite: Vicinity: SUBTYPE: OVERHEAD Parcel Nunmber: 42708302 Applicant: HELLER, DENNIS Address: 1170 E FRUIT STREET SATNA ANA, CA FIRE SUPRESSION PERMIT Phone: 714-836-4800 Zip: 92701 Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address %INSIGNIA COMMERCIAL GROUP IRVINE, CA Phone: ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 Contractor: FIRE SAFETY FIRST Address: 1170 E FRUIT ST Phone: 714-8364800 SANTA ANA, CA Zip: 92701 License: 599761 SCOPE OF PERMIT: BC10-00189 RIPCURL ADD AND RELOCATE 24 SP HEADS AND ADD 7 UPRIGHT SP HEADS. FEE SUMMARY Add'I Inspection Fees: $0.00 Total Fees: $218.00 Status: ISSUED Applied: 07/29/2010 Issued: 07/29/2010 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE/. INSPECTION TYPE DATE IN AL CODES INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical -=1 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Buildmg/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: / IZEader— 04 _rHI WL==ST (The; section need ror M oormpetaJf the perrx is mit ed at one hurMietl Mlars (Sreol b k55.1 PolficIY,.Number. W SD 18 15-1 e/ o 4, ❑ 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, and agree that if I should become subK ct to the workers' compensation provisions of Section 3700 of the LaborC I shall forthly with these provisions. Appirant's'Sghature �e} WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CBratatlar:s Sigalihe (�.°°!°a CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: SignaWre Gate OWNER -BUILDER DECLARATIONS: I hereby affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contmctor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305746 (W07) Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Tile 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applirant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? (]Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S nature of Legal Opaer(5) Dale �nplyrlwthoneN'Appit:inl.�— - r—Oate—�„� 00 CITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 - www.ci.costa-mesa.ca.us PERMIT TYPE: B_COMBO Sub Type: COM_ALT FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC10-00156 JOB ADDRESS: 3030 AIRWAY AV -CM APN: 42708302 Zoning: , Vicinity: Const Type: V -B SQ. FT: 0 STATUS: ISSUED DATE ISSUED: 01/9/0�6/2011 ISSUED BY: F ---t 6 Suite/Unit: Primary Occ: Valuation: $34,000.00 SCOPE OF WORK: RELOCATION OF A 6,600 SF GARMENT RAIL SUPPORT PLATFORM SYSTEM FOR "RIP CURL". 134 LIGHT FIXTS. MISC ELEC EQUIP. PLNG. APPROVAL BASED ON: THE VERTICAL RACK SYSTEM IS NOT SUBJECT TO FAR STANDARDS BASED ON THE FACT THE SYSTEM IS (1) INDEPENDENT OF THE BUILDING, (2) THE "FLOORING" IS MESH, (3) THE PLATFORM IS AN INTEGRAL PART OF THE SHELVING SYSTEM AND IS NOT DESIGNED TO BE USED INDEPENDENT OF THE OVERALL SYSTEM, (4) THE USE OF THE SYSTEM IS FOR STORAGE PRIOR TO SHIPPING. CONDITION OF APPROVAL: THE STORAGE SYSTEM SHALL BE REMOVED IF/WHEN RIP CURL OR A SUCCESSIVE COMPANY IS REPLACED BY A NON -SIMILAR USE. OWNER: CONNECTICUT GENERAL LIFE INSURANCE COMPANY COMMERCIAL GROUP Unit: IRVINE, CA Phone: City/State/Zip: ONE TECHNOLOGY DR BLDG G APPLICANT: CRAIG, IAN Phone: 562.981.3363 CONTRACTOR: RICHARD WHITELEY Phone: 562-208-7761 Cell: ARCHITECT: ENGINEER: ABOLHASSANI, ALI COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMTP Commercial: Bldg Std Admin Fund TOTAL FEES: -Refer to fee receipts for all fees paid for project Address: City/State/zZip: License No. 829656 Address: P O BOX 1959Unit: City/State: LOS ALAMITOS, CA License No. License No.68381 $78.43 $482.65 $165.12 $0.00 $0.00 $0.00 $7.14 $2.00 $735.34 Address: %INSIGNIA Unit: ZipCode 90720 PHONE: PHONE:714-632-7330 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday -7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours -Sundays and the following Federal holidays: 40rlrF- The Nayx Yi41a &Qi( 11 WtF1WW y,*W19PGM*jr1o6tDayi 6potra8(WhTh kk$:ghdoqpBapqLricbMbrip#rot"Syalifornia statutes and relate( equlations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE J. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1,266 Pool Spa Final 200 Final Re -Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DATE INTMALS CODES INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INTMALs 1A_ t— I-7 rT � WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: (This section need notbecompleted ddtthe plermit is i,aluedyall one hundred dollars (8100) or less.) Policy Number: ��7 %Y ! J 3 J ❑ 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, and agree that if I should become subjec to the wor rs' compensation provisions of Section 3700 of the= I shall f Ith comply with these provisionss Apply ianature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # � r, l /0 5G Class # ontrActgnature ' Data CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this pernit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: .r 3107) i 'Sgnalure" i `i 305]-46(310]) Owner ID verified by driver , license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of docufhent, i.e:'- property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section'25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? [J Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until fn3{ inspection. S Wir ofLe9�erls) �Iat��/ And/or AutM1 ,itWAPPIicarn Dale (714) 754-5273 • Fax (714) 754-4856 • www.d.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 SIGN PERMIT Job Address: 3030 AIRWAY AV Suite: Vicinity: Parcel Nunmber: 42708302 Zoning: Applicant: DENMAN, RICK Address: $83.25 SMIP Com: $0.50 Phone: Other:., $0.00 Zip: Owner: , ' EASTRICH NO 158 Address CORPORATION - ATTN PATRICK SULLIVAN Phone: %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: SIGNS AND SERVICES Address: 10980 BOATMAN AVE. STANTON,CA Arch / Eng : Address: POWER -ONE.". Phone: (714)761-8200 Zip: 90680 License: 624675 Phone: Zip: License: SGUI't U INSTALL A NON -ILLUMINATED SIGN COVER (FACE FEE SUMMARY Plan Check: $54.11 $0.00 Permit: $83.25 SMIP Com: $0.50 Other:., $0.00 $0.00 Inspection: $0.00 ., $0.00 i Total: " \ $137.86 DdL Status: ISSUED V1 Ak L /1Alied: 08/16/2000 1 Issued: 08/16/2000 ISSUED BY: TO AN EXISTING MONUMENT PLANNING & ZONING NOTES: Calc Valuation: , $2,200.00 Claimed Valuation: $2,200.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. - - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2a (aroo) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. My workers' compensation Insurance carrier and policy number are: Carrier: 421LzA71-C5Vf20JJ N47//i/10`A'[.- / NS. CO. Policy Number: Oz [z OL7 I& I 70 (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I cenity, 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 lawsomia, and ayygLLLaa that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisi� p�� DO Applicant Signature: a •-^�'Ln'1�l/ir'� Date: WARNING: FAILURE TO SECURE WORKERS' ONJPENSVON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINXL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: S 9 f 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lia a (0 2 (> 7 S C Class s C— �{'S Contractor's Signature: J�'I-.�L�tiw� Date: i L ,/a0 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per writ subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ElI hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will 6e made in connection with work authorized by this permit, and that no building structure,.scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ A5 owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted ebove,.unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Pernit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Coda, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to registei acutely hazardous materials with the Fire Department. ......_ ........... ..... _._...................................................'--"..._..........__..._.....................................................__.............................__....................................._.__.....___............................._............__..............__............—. 6 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No .................................................................................. .................................. ...........................................................................................................-............................................................. .................................... ....................................................... ... 5 Oe65 or will the applicant or present or future building occupant require for the work which is the subject of this Ripplication aporfor such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! mll Yes L -I No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). .........._.......................................................................................................... ............................................ ............................................................................ .....................................................................I................_...................................................... 6 WIII any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .........._..................... ................................ ......._.............................................. _._...................................... ...... ..................... __........................... _... ___....................................................................... ___............. _._............................. _......... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............_..._......................_............................ _... _.__—_....__—__................_...._._—.................__......................__._................_.._....__...__............_.—........__.__...___......__.. 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORVAT10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) $/`�/C'ODate E— o And/Or Authorized Applicant I Date CODE 0. INSPECTION PE INTITAL$ LQRL INSPECTION] YPPE PAM NTITy,6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place —//q— 220 Final Planning Approval 203 Final Sign 2 .EEI 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: GAS PIPING FOR HVAC Parcel Number: 42708302 Applicant. LYNESS, KIRK. - 0 Address: 2781 SATURN' SUITE -D/;. ' BREA, CA �A , INSTALL GAS PIPING FOR NEW HVAC UNITS FOR "POWER ONE". Owner: EASTRICH NO 158 Address:, CORPORATION -" ' 'A1TN'PATRICK SULLIVAN - - %ALDRICH EASTMAN & WALTCH Phone: (714)524-8984 Zip: 92823 Phone: Zip: 90017 Status: ISSUED )ppRed: 06/22/2001 Issued: 08/22/2001 ISSUED BY: Contractor: )SANTA FE PLUMBING Address: 2781 SATURN SUITE D BREA,CA - - _ Phone: (714) 524-8984 Zip: 92823 License: 751147 r ' SCOPE OF PERMIT INSTALL GAS PIPING FOR NEW HVAC UNITS FOR "POWER ONE". 'REF: B01-00938' FEE SUMMARY - Quantity -Quantity, ISSUE FEE $23.50 - `- - -' Repair / Alt Absorbtion Unit $0.00 0 1 Inst FAU <100 k BTU $0.00 0 Repair /-Alt Refrigeration 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 Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys > 100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping . � $6.15 1 _ -. Up to 3,hp / 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp7 500 k BTU $0.00 0 Hood w/Mach Exhaust, '$0.00, 0 '' 15 To 30 hp /1,000 k BTU $0.00 0 VAV Box . '$0.00 _ -'0 - 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $0:00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 - ,., Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 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 Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace - $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee , , $0.00 - Plan Check Fee $0.00 ' Reinspection Fee $0.00 TOTAL CALCULATED FEES $29.65 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit./ FOR INSPECTIONS CALL: (714) 7545626 244648 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I have and will maintain workers' oompensation insurance, as required by section 3700 of the Labor Code, for the performance of the work far which this perrnit is issued. My workers' corn nsat n Insu!$nce carne%and policy number are: Certie'��c.11�7 IPolicy� C9G ^L9/ (Mils section need not be completed If the permit is valued atone hundred dollars ($100) or less.) ❑ 1 certify that in the perfortnan A 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' compensallon laws of IIt rile, tl agree that III Ibuld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr s. Applicant Signature: SAC�� l��vl � LDaz'e. WARNING: FAILURE TO SEC(RE WORKERS' COMPENSATISN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE ($100,000), IN ADOPTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that'I"arn licensed under provLsIons of Chapter 9 (commencing with Section 7000) of Division � ff the business and Professions Code, and my license Is in full force and effect. LIcrB rClass.q, `ractors S� Ignet ConLDate:� CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: O W NER-BUILDER; DECLARATIONS: I hereby affirm that under penalty of penury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county -which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that fie or/she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or, that he or she Is exempt therefrom and the basis for the alleged exemption. Any violatlon of Section 7031.5 by any applicant for a perr4l subjects the applicant to a civil penalty -of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL 00 THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professlons Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Vedfication of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feel in depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tile 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). .....................—_.......................................................��.._....................___..........__............__...................._....................__ __.. ....................... ._.........._........._......—_ 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). . ......................._....................._.............................................................................................. ......................... _...................................................................................... ........................................... _........................... ._................................................. 3 Does or will the applicant or present Or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 I1 an RMPP is presently required, has Section 25534 of the California ...... and Safety Code been fully complied with? ❑Yes ❑�fJo 5 Does or will the applicant or present or future building occupant require for the work conch Is the subject ofthis a plication e8No for such construction or modification on from the South Coast Air Quality Management District or from any other air polluticontrol district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ....._._...............__....._.............._...___..................._--- .._....._....................._.__................__..._.........._.__............._.._....._.........__..._.__.—._._....................._.......__............._..........__.... 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety . Code). . ............. ...................._._.................................. ___...................... .................................. _....................... .......................... _.......................... __.................................._..... _.._.............................. _............. __.............. ..._........... .__.... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescrbed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........_ ................. ........... _............................ __..__................... ................................... -_................... __.................... _............................ _....... ........................_.__..............._................................... _............. _............. ._........... ..._..... B (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty at perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for insp alion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. dre Legal s) Date IFIWOr Authorized ApplMant LData_1 CODE 1, INSPECTION TIDE PAIS IILDALS CODES INSPECTION TYPE 2511 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing / 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAYAV Status: ISSUED Suite No , . _ Applied: 05/17/2005 Vicinity: REPCURL Issued: 05/17/2005 Parcel Nunmber: 42708302 Applicant: MARTIN,RODNEY ? 4 ISSUED BY: Address: 3809 S MAIN ST Phone: 714-444-2120 SANTA ANA' A -i1 Zip 92707 Owner CONNECTICUT GENERAL=LIFE INSURANCE COMPANYv�„ Address " %INSIGNIA COMMERCIAL GROUP IRVINE CAPhone:- "� ONE TECHNOLOGY DR BLDG G Zip: 92618-2339`; A: Contractor: " Stv1ART SYSTEM COMMUNICATION ;.: - Address: 3809 S MAIN ST�� Phone; 714-444-,2120 - •-SANTA ANA.._'_� /, Zip: 92707 License: 753932 , ,t SCOPE OF PERMIT/ C4 1, 75,816:SF INTERIOR T,I1FOR'RIPCURL' IN_THE OFFICE; BREAKROOM AND RESTROOMS. REF _ %OS-�:eo5-003361 - 73 COMMUNICATION DROPS. �y -"FEE SUMMARY Quantity / Quantity ISSUE FEE�$23.50 Temp Dist System / Lighting $0.00 0-, Temp service test $0.00 Busway /100 ft,_ $0.00 0 Res. a/c package $0.00 Standing Section " $0.00 0 - New Res (1-2 units) $0.00 0 "7Misc Electrical Equipment $0.00 - 0 New Res (3+units)` $0.00 0 Transformers up to 1 kva/kw $0.00 0 - Pool /Spa --$0.00 0up to 10 kva/kw $0 00 j -' 0 Lighting Fixts 1 $0.00 0 ° up to 50 kva/kw $0 00 ! 0 j r Recept Gullets�� •'� $0.00; 1 "-0'.............. up -to 100 kva/kw'?�T- _$0.00 0 • / Switches , , $0.00 _ ` 0- ° „ _ .. 100 kva/kw ; $0:00 0 - - over Non Res Appl �'-^ V / '! $0,00 �� 0 �. % " Low VoltageEqulpment _..5: j!�$0.00�!/ 0 Res Appl $0A0, �:, O� _ _ - Low Volt Wiring System`LCkt� $0.00 ��0 Service to 200a $000 0�`-" �,. Misc. Conduit ti / $0._00;, 0 Service to 1000a ,� $0 00 0 Misc. ConductoG- J i �� $0 00 �0; Service over t000a - - - ` $0.00 / 0 _ Circus (geri or ride)- ` $0.00 0 ' Motors to 1hp �-'$0,00 0�.- Circus (mech ride or lights) U $0.00: "0 Motors to 10hp $0.00 0 - - 'Christrtias Tree Starid'� �: $0.00; 0 Motors to 50hp $0.00 -- �0 -- Fireworks Stand. -` " %i/ $0.00 0 Motors to 100hp $0.00_ - 0 Other Electrical Fee '„-� - $0.00 Motors over 1 00h $0.00 0',`--_� Communication drops $58.69 73 ... -Investigation Fee $0.00 Sub panel to 200a $0.00 0 - -Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 t NOTICE: The work authorized by this -permit shall .comply with.all applicable handicap access reqs regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shallautomatically expire and become void If work is not commenced within for a period of 180 days. INSPECTIONS: In order for the work authorizedunder this.pernit'to be considered legal, such worts required inspections and final approval mustbe obtained.- Failure to obtain inspections and final appy FOR INSPECTIONS CALL: (714) 754-5626 244646 tsrool statutes and related if work is suspended or abandoned st,comply with all applicable codes, and all will result in the expiration of this permit. DECLARATIONS WORKERS' COMPENSATION DECLARATION: " I hereby affirm under penalty of perjury one of the following declarations: f ' ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the w rk for which this permit is issued. h�an�mlrkkers' canpensation insurance, as required by settlor3700 of Ne Labor Gude, for the pertormanca of the work for which this permit Ln Issued. Insurer 1d� terrier antl policy number ere:'�'� �j cam, e '♦ TS Policv.HOffiber' \ IJ � 1-� 0 ) -I � o `� (This seted it the permit is valued at one hundretl doll.,. ($100) or less.) ❑ 1 certify that in the performance of the work for -which this permit is issued; I shall not employ any person in any manner so as to become subject to the workers' r($, iews of CBI la, and agree that if I Should become subject to the workers' compensaf visions o1 Section 3700 of the Labor Code, I Shell forthwith �e59pra1ti Ions. li [�w) 1WARO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO IMINAL PENALTIE ANDTHOUCO,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31080E THE LABOR CODE, II•lTEREST, AND ATTOFiNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby Ilcansed under provisions of Chapter 9 (commencing with Section 7000) of Di ' " n 3 of the Busine and Professions Code, and my license is in full force a act. Uc. # %—� Cant, or' re: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she I5 exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031-5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as Owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucenss Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cenify that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). ..............................................................................................................................................................................._......................................................_............................................................................................... ..................... .............. _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................_........................................................................................................................ ............................................................................................ 4 If en RMPP Is presentty required, hes Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant Air or present or future building occupant require for the work which is the subage of this a plication aaQermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or .Parti? � Yes u No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). .............................._..............................._..._...........__.._..................._�........................._........................_..........................................................._..................................... ................................................ _................._..........__. ..... _..... YP ty p ... .. 6 WIII en an of the fecili to be constructed under This permit be within 1000 feet from the outer boundaries of a school? Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................ ................................................................ ............................................................. ... ... ....................................................... ..................................................................... _.... ........ _..-.................... .............'--"' 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes [_1 No ........................ ..................... _. .....___............................_.............................._ ......................... ......................... .................................... .................._...................................................... ................ _................ "........................... ...... ..... 8 (II'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cortily that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to comply with all state laws and city ordinances relating to building constmolion; and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to occupy or allow occupancy`of any building authorized by this permit until final inspection. S' nature Of Legal Owner(s) _ e _ • .Fri .r Date And/ o' CODE I. INSPECTIONTYPE' - PATE - INTMAL9 "CODE l INSPECTION TYPE ISL$. 1616 Fixed System Final Fire Prevention - " 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning'Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax(714)754-4856 • www.cl.costa-mesa-clB4NLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3030 AIRWAY AV Suite: Vicinity: Primary Occ: B Eat<50/ Office/ Bar<50 Parcel Number: 42708302 Applicant: JEFF HALL Address: Type of Construction: V -N Zoning: Phone: 714-632-8333 Zip: ISSUED BY: Status: ISSUED Applied: 12/28/2006 Issued: 12/28/2006 Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address %INSIGNIA COMMERCIAL GROUP Plan Check: $81.41 IRVINE, CA= - Phone: Calc Valuation: $6,000.00 Permit: ONE TECHNOLOGY DRIBLDG G Zip: 92618-2339 Contractor: SPS INC $0.00 Address: 3000 E MIRALOMA AV SMIP Com: $1.26 - Phone: 714-632-8333 $0.00 ANAHEIM, CA Zip: 92806 License: 309472 Arch : Total: $207.92 Eng: RICHARD PLUMP Address: Address: 914 E KATELLA Phone: Phone: 714-385-1835 - ANAHEIM, CA Zip: License: 92805 License: C52696 SCOPE OF PERMIT ROOF PURLINS REPAIR FOR "RIP CURL WAREHOUSE' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 FEE SUMMARY Plan Check: $81.41 Calc Valuation: $6,000.00 Permit: $125.25 Claim Valuation: $6,000.00 SMIP Res: $0.00 SMIP Com: $1.26 Other: $0.00 Inspection: $0.00 Total: $207.92 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front ;'0-0 Rear. '0-0 Left 0-0 . Right 0-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: . 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensatlon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' COmpensallon Inurance carder and policy number are: 1p Carder: S -L.4 �l7yK � Policy Number. o0 uLA `1O— a VD4. (chis section need not be completed if Ne pemat is valued of one hundred dollars ($100) or less.) ❑ 1 cartity, 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 0Illomla, pq ee the III should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. I/ -/.1U7 ++ \\ pp Applicant Signature: / Date: WARNING: FAILURE TO SECURE WORKSMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE "RED THOUSAND DOL ARE ($100,000), IN ADDIT THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS EES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section7000) 01 Division 3 of the Business�nd Professions Code, and my license Is in full force and effect. tic. a 3 O'TUl !/ Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation two (5) or more feel in depth Into which a person is required to descend, will be made In connection with work authorfzed by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Cade). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........._.�.._....__—....._...._.___..._......._...—_..._... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hezertlous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Cade, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 65 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does �r will th❑e applicant or present or future building occupant need to prepare en RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, carWlcation and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. a If an RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with?❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject c ? a Yestion aUermil for such construction or modification from me South Coast Air Duality Management District or from any other air pollution control district or agency? � Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any pert of the facility to be COnS[rudetl under This permit be within 1000 feet from the outer boundaries of a school? L] Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It a permit from the South Coast Air Duality Management is Heal or other air pollution control 303 be n agency is required for the work which is the subject of this application, have all 01 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No B (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cartify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ature Of Legal Owner(s) ��Date 17 `r�D�Uln And/Or Authorized Applicant Date CODE t, INSPECTION lltC INTmAL¢ CODE( INSPECTION TYPE gAjF INTITEL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy %i (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3030 AIRWAY AV SCOPE OF PERMIT Status: ISSUED Suite: PLNG. APPROVAL BASED ON: - - Applied: 04/22/2005 Vicinity: STORAGE RACKS • / THE USE OF THE SYSTEM IS FOR STORAGE PRIOR TO SHIPPING. Issued: 06/30/2005 Primary Doc: F2 Type of Construction: V -N FEE SUMMARY Parcel Number: 42708302 Zoning: Claim Valuation:, $140,000.00 SMIPRes ,,V'$0.00 SMIP Com:\,$29.40/-. Other: \�$0:00� Inspection: $000_,� �/r • � - ' �- -� ' Applicant: JIM SAENZ - ; ISSUED BY: Address: T • Phone: 562-944-8067 Zip: 90670 - - Owner: CONNECTICUT -GENERAL' LIFE INSURANCE COMPANY - Address '%INSIGNIACOMMERCIAL- GROUP IRVINE,CA•. _ Phone: - - -, i <' ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 Contractor: RAYMOND -HANDLING SOLUTIONS INC Address: 10261 MATERN PL ' Phone: 562-944-8067 SANTA FE SPRINGS, CA - Zip: 90670 License:,, 842707 - Arch.: - - - - -Eng:. Address: - . Address_" .Phone: - Phone: Zip: License: License: SCOPE OF PERMIT INSTALLATION OF 2 STORY STORAGE RACKS FOR'RIPCURL'. REF: B05-00336 PLNG. APPROVAL BASED ON: - - CONVEYOR/RACWCATWALK SYSTEM IS NOT SUBJECT TO FAR STANDARDS BASED ON THE FACT THE SYSTEM IS (1) INDEPENDENT OF THE BUILDING (2) THE CATWALK IS AN INTEGRAL PART OF THE SHELVING SYSTEM AND IS NOT DESIGNED TO BE USED INDEPENDENT OF.,THE OVERALL SYSTEM, (3)�r • / THE USE OF THE SYSTEM IS FOR STORAGE PRIOR TO SHIPPING. THE STORAGE SYSTEM SHALL BE REMOVED IF/WHEN,RIP •CURL OR A SUCCESSIVE COMPANY IS REPLACED BY A NON -SIMILAR USE. i FEE SUMMARY Plan Check: $791.54 _��=. Calc Valuation: $140,000.00 Permit.: $1,217.75 : Claim Valuation:, $140,000.00 SMIPRes ,,V'$0.00 SMIP Com:\,$29.40/-. Other: \�$0:00� Inspection: $000_,� �/r • � - ' �- -� ' , Total: $2,038.69 �.. �.. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-26, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 2446-0 (8100) .:a DECLARA TIONS WORKAS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by secdon 3700 of t Labor Code, for the performance of the work for which this permit B issued. My workers' compensation insurance tamer and policy number are: /� / Caner: (—/ T• /Ci'46 /N,NQ.4Nt^E Policy Number: T OP6l 71J W (This section need not be completed if the pemdr Is valued of one hundred dollars ($100) or lass.) ❑ 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' compensatlon laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. _ Applicant Signature: �4 Date: �/30�4i WARNING: FAILURE TO SECUR NSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CML RNES UP TO ONE HUNDRED THOUSAND DOILARE(ft00,000), IN ADOITQK TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR ODDE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotl0, an my license is in NIL- force um force and effect. Lic. a 270 Clens a C/- /c DAz/ 1 D��Y Contractor's Signature: �. Date: oC ! CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she V licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of net more than five hundred dollars ($500).): ❑ 1, as owner of the property. or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit. and that no building structure. scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TIVe 8, California Administrable Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and comfy, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any we time during a reportod year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stands temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code. with some excepdons, requires registration with the Costs Mase Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materiels equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 O �r will the applicant or present or future building occupant need to prepare fln RMPP (Risk Management end Prevention Program for acutely hazardous materials)? (Section 25534 Toff the California Health and Safety Code provides that the Costa Masa Fire Department may require the preparation, codification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Salary Code been fully compiled with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building o from a other for the work which Is the subject this a plication aUamut for such alnsiructian or modification from the South Coast Air Dually from Management District or any air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residentlal building permits). 6 Will any pen o1 the ledliy to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes', the facility ec must meet the requirement of Stions 25534 and 42303 of the California Health and Safety Code). ... ........._..._..........................._—._____.__.................. ...._._....._........�___._.___. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Callfomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......... __....._._...._....,_.............._._........................._..........................._.................... ....... _.................. _.._........... ,.._..� 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cenity that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Infomletion given Is correct. I agree to comply with all state laws and city ordinances relating to building construcilon, and authorize representatives of the City of Costa Masa to enter upon the above-described property for inspection purposes. I agree net to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s)Date e�z61-7110,-- lK d/Or Authorized Applicant Date CODE f. INSPECTION TYPE tis¢ INTMAINSPECTIONTYPE gdjE IN11111AL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retalning Well 212 Final Fire Preventlon 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 260 Final Building/Occupancy ,Zr I I J (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3030 AIRWAY AV Status: ISSUED Suite: Applied: 06/25/2001 Vicinity: INTERIOR T.I. Issued: 08/03/2001 Parcel Number: 42708302 Zoning: Applicant: APELDOORN, FRANK ISSUED BY: Address: 1587 BENTLEY DR - - - SUTIE 101 Phone: (909) 340-2200 _ CORONA, CA' Zip: 92879 - Owner: EASTRICH NO =158 Address CORPORATION ATTN-PATRICK SULLIVANPhone: - - - - %aALDRICH,EASTMAN & WALTCH Zip: 90017 Contractor: SIGNATURE -INTERIORS INC Address: 1587 BENTLEY DR " SUITE 101 Phone: -(909) 340-2200 CORONA; CA - Zip: 92879 % ' License: 723386 - - Arch : ROBERT BORDERS AND ASSOC. Eng: MVP ENGINEERING INC Address: 5030 CAMPUS DR - Address: - Phone: 949-851-1317 Phone: NEWPORT BEACH, CA Zip: 92660 -License: C4918 License: 35137 _ SCOPE OF PERMIT 10,920 SOFT INTERIOR T.I. FOR 'POWER ONE" FEE SUMMARY Plan Check: $882.54 Calc Valuation: $165,000.00 Permit: $1,357.75 - - — Claim Valuation: $165,000.00 SMIP Res: $0.00 SMIP Com: $34.65 Other: $0.00 Inspection: $0.00 Total: $2,274.94 - PLANNING & ZONING SETBACKS, MAINSTRUCTURE Front 0-0 Rear 0-0 Left 0-0 . Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right` 0-0 PARKING Existing: ", 0 Required: o Proposed: 0 NOTES: - - - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit FOR INSPECTIONS CALL: (714) 754-5626 2"646 ISM) V DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following decorations: ❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensatlon, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I hive and wlll maintain workers' componsation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this pertnit is Issued. y workers'co ! com ns fon lnsurenco erP�d II numDe(ere: _ •Cartier: SNZr- olicy Numbeer: ��,I r��7-O ��00 �(Thls section need not be completed if themVt Is vitIlbod at one It boli! /ars (S 100) or less.) ❑ I certify that in the perform ce a work for ich thi "it I d, I sh II not employ any person In any manner so as to become subject to the workers' compensation laws of C a rid agree t t it I sh Id beco ubject a workers' compensation provlslons of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. A p ni Signature: CDalei 3 WARNIND: FAILURE TO SECURE WO (ERS' COMPENSATION COM—, IS UNLAWFUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE (5100,000), IN DITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Sme OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am II nsed under provisions of C 9 ening with Section 7000) of Division 3 of.the Businessghe Professions Code, and my license is In full force and effect.Lic ;N.M Class ? 7 Contractor's Slgnalure: Dale: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued, (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any cry or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a perrnit subjects the applicant to a cMl penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does riot apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Ves ❑ No Drivers License No. Expires: Verification of Ownership by (type o1 document. Le. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cordly that no excavation five (5) or more feat In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title S. California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e penult to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certlty a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costs Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hezartlous metedals?__U Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceplions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will theeepppllcant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Rection 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, Certification and filing with the Fire partment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required, hes Section 25534 of the .....mia Health end Salary Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building strict r from a require for the work which Is the toragency? subject c this a Yes ape No for such construction or motll0cation from the South Coast Air Quality Management District or from any other air pollution control district or egoncy? � Ven ❑ Na (Section 65850.2 of the California Government Code requires that the requested inlommition be furnished on applications for non-residential building penults). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the Outer boundaries of a school? ❑Yes ❑ No (if *yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....._.._._................__._�....._ _............___............. __........ _....... _...................................... ............................... __.......... _..... — ........... ___.._ 7 If a permit from the South Coast Air Oualiry Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? []Yes [INo ........................................_............................_....................__...._..........___............................................................................................__....................�.._.._.__._...._ B (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the InlOrmation given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I Certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and cry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described prop y for inspection purposes. g 90 not copy or allow occupancy of any building authorized by this permit until final Inspection. Sign ego or Date oj� AndtOr Au o zed Applicant 11 ate - COPE 1, N5PkCT10NTYP PAA INTMA COOEI INSPECTION TYPE 2&3 il{TULAl$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Elochlcal 201 Final BlocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupency Q (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 3030 AIRWAYAV Suite: Vicinity: Parcel Number: 42708302 Applicant: AUSTIN, BARBARA Address: 1642 S CLEMENTINE ST', Other: ANAHEIM; CA �. Owner:,'EASTRICH NO 158 - Address CORPORATION . 'ATTN PATRICK SULLIVAN - %ALDRICH EASTMAN & WALTCH Contractor:' PACIFIC FIRE SUPPRESSION Address: 1642 S. CLEMENTE ST Zoning: Phone: (714)502-0211 Zip: 92802 Phone: Zip: 90017 Phone: _(714)502-0211 Status: ISSUED Applied: 07/09/2001 Issued: 08/08/2001 ISSUED BY: ANAHEIM, CA Zip: 92802 License: 423418 SCOPE OF PERMIT REF: 801-00938. "POWER -ONE" TENANT IMPROVEMENT. 93 SPINKLER HEADS.-, Plan Check: $90.51 Permit: $139.25 Other: $0.00 Total: $229.76 FEE SUMMARY ' Calc Valuation: $6,610.00 Claimed Valuation: $6,610.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2449<6 (6/00) DECLARAVONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate, of consort to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' cp carrier insurance, as required antl by section 3700 of the Labor Code, for the performance of the work for which NH permit is Issued. "My workers' co�m, ea,nsayLo�n Insu� carrier and polity number are: / Carver: � t o n IS -{—( ) n) � —Policy Number: �.- �6 2 –??M0 (This sectiones be completed it the permit Is valued at one hundred dollars ($100) or less.) �s–�--'-- ❑ 1 certify that in the Portoan q Of the work or which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws o Ilfo 14, and ogre het if I sh Ild become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr Isicn ,Applicant Signature: Date: �• d u 1 _WARNING: FAILURE TO SECURE WORKERS' COMPENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I pf hereby affirm that am [IQensed and r p[avlsions pter 9 (commencing with Section 7000) of Division 3 of.the.Business and Profes ions Code, and my license Is in full forceandeHect!.L1c.a- �S bassa–� � Contractors Signature: I r CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or sho is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a perri� subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sac. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own omployees, 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, Scaffolding. falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened relesse of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materiels equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................ ....................... .... ................................ __...................... _.___............................. _.... ....................................................................... ................................................................... _..............................._................................._...... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials aqua to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................. ._.................... __............................. ................................................................................................................... ..._.................. _._............ __............. .._...... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................__..__........................_..............................................____._................__...........................__......................_......................................................... ..............._................._._.........__...._._....._._. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ NO ........................................._............................_...........................................__..........................._..............................._...................._.._..........................................................................._.__..............._.............�.......__._.......... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication ayPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! UYGS U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ......................... 8 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (It yes-, the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). .................................. .._........................_...__.._..........._._..._..__.._.._.....................__.........................__........................................................................................................................... ........_.............. _........... ......_.......... �._... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is regwired for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No .............................................................................................................................................................................................................................................................................................................................................. . ................ . .................. _. 8 (If yes-, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. SI ria re 1 Lz 11 c?'! And/Oir Authonze _ pllantt _ Date CODE t. INSPECTION TYPEc� PAIE It�ALS CODE: INSPECTION TYPE gSTE IIS 1616 Fixed System Final Fire Prevention %,3 tYO i 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical �^ 201 Final Block/Retaining Well 212 Final Fire Prevention USG I 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: Parcel Number: 42708302 Applicant: TEMP AIR HEATING& A/C Address: 601 W LAMBERT,RD- ,' , i Phone: (714)870-7281 LA HABRACA _ Zip: 90631 �- Owner: EASTRICH'N0158 Address: CORPORATION Contractor: Address: ATTN PATRICK SULLIVAN Phone: %ALDRICHEASTMAN & WALTCH Zip: 90017 TENT ,AIR HEATING & A/C 601 W LAMBERT RD LA HABRA CA _Phone: (714)870-7281 -Zip: 90631 License: 363290 Status: ISSUED Applied: 08/06/2001 Issued: 08/06/2001 ISSUED BY: SCOPE OF PERMIT REF SOI -00938 FOR POWER ONE. 3 GAS ELECTRICGAGPACKAGED UNITS. 2 FIRE DAMPERS, 2 AIR HANDLERS >10000 CFM. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/ Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Meth Exhaust VAV Box Vent Fan / Single Duct Appliance , Fire Dampers Smoke Dampers Inst or Relocate Appl_Vent Air Handlers < 10000cfm Air Handlers> 10000cfm Floor Furnace Floor or Suspend Heater FEESUMMARY Quantity Repair/ Alt Absorbtion Unit Quantity $23.50- Repair / Alt Refrigeration Unit $44.40 3 -- - $0.00 0 $0.00 0 $0.00 0 $44.40 3 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00. 0 $0.00 0 $0.00 0 . ,$14.50. 2 $0.00 0 $0.00 0 - $0.00 , 0- $36-20 '2 $0.00' 0 $0.00 0 Quantity Repair/ Alt Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems ' Up to 3 hp 1100 k BTU - $0.00 0 3 To 15 hp/500k BTU $0.00 0 15 To 30 lip / 1,000 k BTU $0.00 0' 30 To 50 hp /1,750 k BTU $0.00 .0 Over 50 hp / Over 1J50 BTU $0.00 0 Boilers Up to 3 hp - - $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp - $0.00 0 30 to 50 hp .. $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee ' Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $163.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically explre and become void If work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit FOR INSPECTIONS CALL: (714) 7545626 / 244646 (8/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. I have and will maintain workers' compensafbn Insurance, M required by section 3700 of the Labor Code, for the pertorrnanco of the work for which this permit is Issued. My r A ompensetioa I surenca cartiat and policy number are: W G� 1 229 0-00 Career: Policy Number: (This section need not tedif e permit Is valued atone hundred dollars ($100) or less.) ❑ 1 the n the perto nc of the WO T this pe Is Issued, I shall not employ any pons I n a anner so es to become subject to the workers' compen to laws of lifo a and ag e d hould c me subject to the workers' compensatlo vislo sol Sec tin 370 f the Labor Code, I shall forthwith Nese pplicant Sig ur Date: WARM LURE TO SECURE WORKERS' ENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANE PLOYER T RIMINAJ PEJ ES AND CML FINES UP TO ONE HUNDRED D OOl1ARE (5100,000), IN ADDMON T THE OF OOMPENSATION, DAMAGES AS PROVIDED FOR IN SE OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. LICENr C RS DEC LA ATION: I here that I Isco sod un r provisions f Ch _ I action 7000) of Division' of 1 wn and 'rens Code, and my license Is i]tull for act. U. ass a C nitsignal re: Date: CONISTRID6TION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pemr4' subjects the applicant to a civil penalty of not =to than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sac. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cade: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification o1 Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cantly that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tlile 8, California Administrative Cade). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....._.............................................___...........__.__—..-..._......._.....__................__._....................................._.___.�........_._.._.. .._._.._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity o1 acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does �r will th❑a applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully compiled with? ❑Yes ❑ No 5 Does or will the applicant orpresent or future building occupant require for the work which Is the subject of this a plication eggertnit for such construction or motliflcallon from the South Coast Air Quality Management District or from any other air pollution control district or agency? LiYes u No (Section 65850.2 of the California Government Cade requires that the requested information be fumished on applications for non-residen0al building permits). 8 Will any pert of the fadlity to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 a a permit from mll South Coast Air Quality Management a Heal or other air pollution control 303 be or agency u required for the work which is the subject of this epplicatlOn, have all of the disclosures; prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (II yes', anach certificate of compliance frwn the appropriate air pollution control oRcar). CERTIFICATE OF COMPLIANCE: 1 cenity, that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is o comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-0escn property for ins ction purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S Mger s Date n plicant D e CODE 1. INSPECTIONTYPE gdiE INMIA CODE# INSPECTIONTYPE p ��VMAUS 1616 Fixed System Final Fire Prevention 206 Final Mechanical LANt 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Relalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Il (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708302 Applicant: JACOBI, TERRI Address: 4700 SAN JACINTO TERRACE Issued: 08/08/2001 FALLBROOK, CA Quantity - _ - - Quantity " ISSUE FEE Owner: 'EASTRICH NO 158- Temp Dist System / Lighting $0.00 Address ,CORPORATION $0.00 ATTN PATRICK SULLIVAN Busway /100 It %ALDRICH EASTMAN & WALTCH Phone: (760)728-3833 Zip: 92028 Phone: Zip: 90017 Status: ISSUED Applied: 08/08/2001 Issued: 08/08/2001 ISSUED BY: contractor: JACOBI ELECTRIC INC Address: 4700 SAN JACINTO TERRACE .Phone: (760)728-3833 ' FALLIBROOK, CA ' " _ Zip: 92028 , License: 564251 _. SCOPE OF PERMIT , ELECTRICAL PERMIT FOR'INTERIOR OFFICE T.I. FOR "POWER ONE". INSTALL 46 LIGHTING - FIXTURES, 64 RECEPTACLE OUTLETS; & 33 SWITCHES'. - - - I COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ont. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46 (600) FEE SUMMARY Quantity - _ - - Quantity " ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $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 $0.00 0 New Res (3+units) $0.00 0 :Transformers up to 1 kva/kw $0.00 "0 Pool / Spa ", $0.00 0 :'-� ' " ................ up to 10 kva/kw $0.00 0 Lighting Fixts $40.98 46 __ .............up to 50 kva/kw $0.00 0 Recept Outlets $54.12 64 - .................up to 100 kva/kw $0.00 0 Switches - $31.49 33 ..................over 100 kva/kw $0.00 0 Non Res Appl , $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 Low Volt Wiring System / Ckt $0,00 0 Service to 200a $0.00 .. 0'" Misc. Conduit $0.00 0 Service to 1000a $0.00" ., -0 Misc. Conductor $0.00 0 Service over 1000a $0.00- 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 ' 0 Circus (mech ride or lights) $0.00 0 " Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 - 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 - -_ 0 Communication drops 50.00 0 Investigation Fee $0.00 Sub panel to 200a S0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits S0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $150.09 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ont. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46 (600) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I ave and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the _ ork for which this permit Is Issued. ,Y--1 haw and will maintain workers' tort tlon Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers'Oc nsa n Insuran uder tl a7 l number are: Cirri& "_\ ,d`/�. Policy Number: (This section need no be m Bred d the permit la-velued a1 one hundred dollars ($100) or less.) ❑ 1 certity that In the pertornance of the work for which this permit Is Issued, I shall not employ any person in an manner so a to b��-LLLµµµ��_+ no subject to the workers' compensation laws of California, and agree ih hould become ub(ect to the workers' compensation provisions IS cC QO of the I�ebor Code, I shell forthwith comply with the rovis* Appgda`mt Signature: (—Date:— WARNING: FAILURE TO SECURE WORKERS' COMPENsiim RAGE IS UNLAWFUL AND SHALL SUBJECT AN EKPLOYER TO CRIA9NAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COS17 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3ma OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed u d r n hapter 9 (commencing with Section 7000) of Division 3 of the Business TO sinsode, and my license is in full r — force and effect. Uc. p _ tClass a Contractors Signetur. Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby all irm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a Dem+' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Ucense No. Expires: Verification of Ownership by (type of document, i.e. - property In bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authodzed by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standar temperature and pressure). ...................................................................................._.................................................._........................._........................ir'a"........................._.................................._...._.._...._..._............. ..........___..............................._................._....... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous meterials7 ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. ........................ .......................................... ......._......................................................................................... ".................... _......................... _................................. ._....................................................... __..................................................... _............ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes j_-1 ;T' (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................................................................................................................................................................................................................................................................................................................................................................... 4 If en RMPP Is presently requireq has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [:1No .. .......................................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building Occupant require for the work which Is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? u Ves U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...................................._............................._..._........._...........................................__........................ ..................... _................................................._................ 8 WIII any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑Ves ❑ No ............................... ... ....................................... ........ ....................................................................................... ... ............................. ................. ...........:........................... .................................................................. .......................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit ntil net inspection. ign e ) k D And/Or Auth dze p�jfcant It:Dat, CODE A. INSPECTION TYPE DAIF ICITIIIIALS CODE r INSPEcnONTYPE 2&U INTIUALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �Q � 200 Final Re -Roof 210 Final Electrical" 4 201 Final Block/Retaining Well 212 Final Fire Prevention / 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708302 Applicant: RICKER,JERRY Address: 30440 ANACONDA CT- ISSUED ��- Phone: 909-699-8771 TEMECULA, CA '-" - Zip: 92591 $0.00 $0.00 $0.00 0 $0.00 0 Owner: ; EASTRICH NO 158'" - 0 - Address CORPORATION 0 ATTN PATRICK SULLIVAN Phone: - %ALDRICH EASTMAN 8 WALTCH Zip: 90017 i -� .......:........up to 10 kva/kw Contractor: J L RELECTRIC Address: 30440 ANACONDA CT ' TEMECULA, CAS" ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl, Res Appl Service to 200a�-� - Service to 1000a Service over 1000a Motors to Ihp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole .-Phone:909-699-8771 Zip: 92591 , License: 585692 Status: ISSUED Applied: 08/03/2001 Issued: 08/03/2001 ISSUED BY: (_42L . SCOPE OF PERMIT REF 801-00938. FOR POWER ONE.'INSTALL SERVICE 'UP TO'4000'AMP. NO.OTHER WORK IS c AUTHORIZED UNDER THIS PERMIT:'- Quantity - $23.50 - o � $0.00 $0.00 $0.00 0 $0.00 0 SCOPE OF PERMIT REF 801-00938. FOR POWER ONE.'INSTALL SERVICE 'UP TO'4000'AMP. NO.OTHER WORK IS c AUTHORIZED UNDER THIS PERMIT:'- $0.00- v, 0 , $0.00- (; $30.50 -11" - $435.05 $372.90 3 $0.00 0 $0.00 0 -$0,00', , 0 $0:00 0 $74.50 _1- $0.00 _-O, " $0.00 0 ` $0.00 0 $0.00 0 $0.00 0 $0.00 0 EESUMMARY Quantity - $23.50 - $0.00 % $0.00 $0.00 $0.00 0 $0.00 0 $0.00 0 - $0.00 0 $0.00 0 $000 ...-.0: - - $0.00- v, 0 , $0.00- (; $30.50 -11" - $435.05 $372.90 3 $0.00 0 $0.00 0 -$0,00', , 0 $0:00 0 $74.50 _1- $0.00 _-O, " $0.00 0 ` $0.00 0 $0.00 0 $0.00 0 $0.00 0 EESUMMARY - Quantity % Temp Dist System / Lighting $0.00 0 ' Busway /100 ft $0.00 0 " Standing Section $0.00 0 Misc Electrical Equipment $0.00 0 -Transformers up to 1 kva/kw $0.00 0,' -� .......:........up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 .................up to 100 kva/kw . $0.00", 0 , ..................over 100 kva/kw $74.50 1 Low Voltage Equipment $0.00; , '0 Low Volt Wiring System I Ckt $0.00 ,.0-/' Misc. Conduit - $236.60 13' Misc, Conductor , - $0.00" 0 Circus (gen or ride) $0.00 0 Circus (mech ride or lights) _$0.00 0 -' Christmas Tree Stand $0.00: 0 Fireworks Stand 0 Other Electrical Fee $0.00, - Investigation Fee - - $0.00 _ "Plan Check Fee - $0.00 - Reinspection Fee $0.00 TOTAL CALCULATED FEES $1,247.55 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 susl for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appl required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiral FOR INSPECTIONS CALL: (714) 7545626 EL:F_L+II bD1 related orabandoned Ns codes, and all of this permit. DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. gK I have and will maintain workerscompensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. y workers' compensation Insurance carder and policy number are: Carrier: Policy Number. (This section need not be compLml.'Oand e permit Is valuetl et one ntlretl tlollers ($100) orlow.) I certify that In the performthe work for which emit Is Issued, I shell not employ any person in any manner so as to become subject to the workers' compensatlor laws ai Calagree that I d become subject to the workers' compensatlon provisions of Section 3700 of the Labor Code, I shall forthwith rovislo cant Slgnetu 8—'3 — WARN URE TO SECUR ORKE ' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM VER TO C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED D CdlARE (EtoD,c00 ADDI ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI A HE LABOR CODE, IMEREST, AND ATTORNEY'S FEES, LICENSED CO A DE ARATIO J: I he y e CO I em li sad under provl ns at Chapte ommencing with Section 7000) usineu end Professions Code, and my license Is in full ce a effect. Lic, fi 585 Class C— /0 Cont ctors Sign e: Date 8-3-01 E TRUCTION LENDING AGENCY:1 hereby affirm that there is a construction I Inagency for the Derformanco of the work for which this permit is Issued. (Sec. 3097, Civil Cada). rs Name: Lenders Address: ture: Date: OWNER-BUILDER DECLARATIONS: I hereby affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Loomis Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolesslons.Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a dvll penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sac. 7044, Business and Piofessions Code: The Contractors Liconse Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his orherown 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,.Ihe owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property in bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavatlon five (5) or more feet in depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: DIAsion of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant Or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). ....................................................... .................................................................... ....................................................... ................. .......................... .... ............................... .............................................................. ...................................................I......... 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some excetlons, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). es or will ............. ipli__.......................nt orf._._...........ildi..............___...................___.................._.....................___.....................__................................................._......._.._..____..............._............_............... 3 Does or will theap plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutety hazardous meterials)7 ❑ Yes ❑ fJ0 (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require lir the work which Is the surfed Of This a plication a ertnit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes � No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applicatlons for non-residential building permits). ........................................................................................................................................................................................................................................................................................ ........................................................................................ 6 Will any pan of the facility, to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................._............... ......... _...................................._....................................._...................... .._...............__.................__..................._............................................._............. _..... ___................ __........ _— ............ _ 7 If a permit from the South Coast Air Quell ty Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _.__.__.___....._....____._._...........___.._—__.....____..........—_.__..____.__—__._.._........... _—__._................... ___.._ .......... __........ __....... __ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR ON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I ag ea to comply with all state laws n Iry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-descr ted property for inspection; o s. I agree not to occupy Or allow occupancy of any building authorized by this permit until final inspection. Signal al Owner(s) 8Date ' 3 -0 1 A A Icent Date COPE I,gSTE INTITIA CODE INSPECTION TYPE ILS 1616 FId Sys m Final Fire Prevention 206 Final Mechanical 1266 P Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupency r� (714) 754-5273 • Fax (714) 754-4856 • Wnvw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Status: ISSUED Suite No Applied: 07/12/2001 Vicinity: POWER ONE (SOUTH SIDE OF PROP) Issued: 07/12/2001 Parcel Nunmber: 42708302 Applicant: RICKER, JERRY LEE ISSUED BY: Address: 30440 ANACONDA CT - - Phone: 909-699-8771 TEMECULA, CA Zip: 92591 Owner: EASTRICH NO 158 Address CORPORATION ATTN PATRICK SULLIVAN Phone. %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: J L R ELECTRIC Address: 30440 ANACONDA CT - Phone: 909-699-8771 TEMECULA, CA Zip: 92591 Qu antity, License: 585692 SCOPE OF PERMIT, ELEC PERMIT FOR U/G CONDUIT FOR FUTURE SERVICE FOR "POWER ONE," 1 CONDUIT REF: B01-00938 & E01-00392 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (600) FEE SUMMARY,. - UMMARYnQuantity Qu antity, _- , f - - Quantity ; ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway/100 it, ,• .$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 .$0.00 '161 ' New Res (3+6nits),- $0.00 0 ,. Transformers up to 1 kva/kw $0.00'10 Pool / Spa ,, $0.00 0 ................up to 10 kva/kw $0.00 , / ! 0 Lighting Fixts, $0.00 0...:.., ...'....,.up to 50 kva/kw _ $0.00' / 0, - Recept Outlets $0.00 �. ,; - -- 0 - _ ...................up to 100 kva/kw-' -' '.$0.00' 0 Switches $000x` - 0 . . ....... ......:over 100 kva/kw -$0.00: 0 �. Non Res Appl Res Appl $0.00\ V 0 0� Low Voltage Equipment - % $0.00., - =$0.00 0 - $0.00, Low Volt Wiring System/ Ckt 0 Service to 200a�\ .$O.00J�_�0�-��,- Misc.Conduit _,�� ry18.20�' Service to 1000a • woo / , ; 0— - Misc. Conductor'.= ' '%$0A0 / 0 j� Service over 1000a $0.00', 0 -� �� Circus ( gen dr ride), , :$0.00 , 0 Motors to 1 hp - - $0.00 0 _ Circus (mech ride or lights) �, ' `-$0.00' .- , 0 Motors to 10hp ,_$0.00- 0 Christmas Tree Stand` ,$0.00 0 Motors to 50hp $0.00° . 0 ' Fireworks Stand - � $0.00 0 Motors to 100hp $0.00 ��'�-U- 'Other Electrical Fee_ Motors over 100hp $0.00 0 Communication drops $0.00 0 - _ �, , InvestigatioriFee - $0.00 Sub panel to 200a $0.00 0 - - Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $41.70 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (600) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fallowing declarations: ❑ I have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the pedonnance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation inwrara;e, as required by section 3700 of the Labor Code, for the perform a of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Cartier: I Policy Number: (Thi section need nolbeli ed it the parmli is lued et one hundred dollars ($100) crless.) I carflfy chef In tCo of Ina coo hich this permit is Issued, I shall not employ any person in any manner so es to become subject to the workers' compensationlmla, end that II I should become subject to the workers'compensation provisions of Section 3700 of the Labor Cade, I shall fonhwlth comply with the.Applicant Signature: Date:WARNING: FAILURE TORS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUSUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE (5D ON TO THE COST OF OOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS C ATION: I hereby affirm that I am Ilcens under provisionsdfh.pter 9 (commencing with Section 7000) 01 Division 3 of the Business and Professions Code, and my license Is in full force and effect. Llc. a Class P Contractor's Signature: Onto: CONSTRUCTION LENDING AG Y: ❑ 1 hereby affirm that there is e Mnslition lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DNLslon 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a chill penalty of not more than two hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 o1 completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID vediied by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type o1 document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this Permit. and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tllle 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Divislon of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................__.........................._................................................_._..___..............._............................._........................_....._..........................................................................._........................._.............__._.......__ 2 Does or will the eDDlicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................... _... ...................._._..._._._.__.._._�._____..._—._.............._.._.................__........................._.._�_._._—.__..._—._..._..�___.—_ 3 ❑ Yes or will th❑e applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Section 25534 of the Cellfomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ......................_.................................__._..........................................................._..._..........__...................................................................................................................................................................................._..................._...................._ 4 II an RMPP is presentty required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No .........._...___..__..._.__..._.............__.....__...........................................................__............. —__—_._ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................__._.........._..__ ___...__._........_...__.._..................__........._..................__._..... ......__ permit 6 Will any par of the facility to be constructed under this peit be within 11X10 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .........._._..............._ .__ ............... ..... _........... _......................... _.... _............................................. __..................... __..._..__.___ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed Dy Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .........__.._._........_....._____.___............_._........................ _.__......__—..._....__._—_.__.__________ 8 (If yes-, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I canity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and cl y ordinances relating to building Construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described prop t for inspection purpos 6 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature al Owner(s) Date ?-/2-O And/Or'Authorized Appiftant Date CODE P. gd1F ILLS UM INSPECTION TYPE gb¢, INTITIAL$ 1616 Fixed Sys m Final Fire Prevention 206 Final Mechanical 1266 Pool Spa inal 208 Final Plumbing 200 Final Re- cof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 FinaLDemolition 250 Final Building/Occupancy J (714) 754-5273 • Fax (714) 754.4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3030 AIRWAY AV Suite: Vicinity: WAREHOUSE & BREAK ROOM Status: ISSUED Applied: 09/19/2000 Issued: 11/01/2000 Parcel Number: 42708302 Zoning: Applicant:, RASMUSSEN, GARY ISSUED BY: Address: 1787 W POMONA RD STE A Phone: 909-734-0419 CORONA, CA Zip: 91720 Owner: EASTRICH NO 158 Address CORPORATION ATTN PATRICK SULLIVAN Phone: %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: RKS SERVICES INC Address: 1787 WEST POMONA RD STE A Phone: 909-734-0419 CORONA, CA Zip: 8&720 e ZP-FD License: 709994 Arch : RENGEL & CO ARCHITECTS Eng: Address: 333 EL CAMINO REAL Address: Phone: (714) 835-3333 Phone: TUSTIN, CA Zip: 92780 License: License: SCOPE OF PERMIT INTERIOR 14715.6SF INTERIOR TI, (13945.3 WAREHOUSE AND 770.3SF OFFICE TI), CONSTRUCT 252SF CANOPY AT THE REAR OF BUILDING. FOR HC POWER. FEE SUMMARY Plan Check: $1,461.30 Calc Valuation: Permit: $2,248.15 Claim Valuation: SMIP Res: $0.00 SMIP Com: $67.99 Other: $0.00 Inspection: $0.00 Total: $3,777.44 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: $323,750.00 $323,750.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2sae4e la�ap WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following deciarabons: ❑ 1 have and will maintain a certi8oate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit I6 issued. Ly I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: e ✓� !1 Policy Number: N 66 r .1 1�' A (This section need not be completed i/ theloatmit is valued at one hundred dollars ($150) or iess.) ❑ I certity, that in the performance o1 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. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. _ Applicant Signature: n r /` Date: D!3 WARNING: FAILURE TO SEC4E RKERT COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR,,!a AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,0031114 ADDITION TO THE DOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Uc. N A io ir 99 Class a Contractors Signature: Date: CONSTRUCTION LENDIN AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lenders Name: Lander's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is IicOnsed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DMsion 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as Owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of docuni i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (S) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such portion has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Masa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet. of compressed gas at standard temperature and pressure). ........_........_..............__.__..............istr.........._......................................................................................._.. ............_..... ..__.......... ___...___ 2 Does or will the applicant or prosent or f4ture builtling ocwpant need to file a registration form for eatery hazardous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code. with same exCeptlonm, requires registration with the Costa Mase Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperelum and pressure). .......... _.............. .......... ...._........................___._._.......... ......._......._.__....—..._.................. __......................... __.......................................................................................... _.............. _................ __...... _......... _ 3 ❑ es will th❑e applicant or present Of future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? (Zion 25534 of the California Health and Safety Code provides that the Casts Mesa Fire Department may require the preparation, certification and filing with the Fire Drtment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................._............................... ..__...................... .......................................___..............................._.................................._....... ........................................ ...... ............................_....................._...........�.............___. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..........................&r....................................................._.............................................................__...................................................................................................................................................-......._..............................._..............__................. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this ,application a emit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................... .................. _.................... _......_.._..................................—._........-..................... _...................................... ......... ..................................... ............................................_..............+_...._...._ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......... .w. th........................___._.........ant..................._.....-....................................................................................................e......................__.......the......__...................._ 7 a a permit from the South Coast Air Oescri Management District or other ell pollution control district or agency is required for the work which is the subject of thio application, have all of the disclosures prescribed by Callfomia Health and Safety Code Section 42303 been made? ❑Yes ❑ No 6 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: i certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) Date IIIN l as And/Or Authorized Applicant Dale CODE 0. INSPECTIONPTYPE gA¢, lKIID9L5 CODE INSPECTION TYPE 2AM IiTITIAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Black/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �r� 204 Final Demolition 250 Final Building/Occupancy 'Y 1 t (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.'dd LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3030 AIRWAY AV Suite: Vicinity: WAREHOUSE Parcel Number: 42708302 Zoning: Status: ISSUED Applied: 09/15/2000 Issued: 10/17/2000 a Applicant: FLORES, LOUIE „ ISSUED BY: Address: Phone: 562-944-8067 Zip: Owner: EASTRICH NO 158 - Address ,CORPORATION ' ATTN PATRICK SULLIVAN Phone: - - - %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: Address: Phone: " Zip: - - Licenser Arch': Eng: RACK DESIGN &ENGINEERING CO" Address: A Address: Phone: .. Phone: Zip: .- License: _ License: C053524 INSTALL AN APPROXIMATELY '16''HIGH RACKING SYSTEM BETWEEN THE RACKS PROPOSED. Plan Check: $274.33 Permit: $422.05 SMIP Res: $0.00 SMIP Com: ,' $5.82 Other:, „$0.00 /Yt Ur t CKMI I _ -M INSIDE AN EXISTING INDUSTRIAL BUILDING. NO CATWALK FEE SUMMARY Calc Valuation: $27,7001.00 Inspection: Total: $70i.20, PLANNIN SETBACKS�_�- MAINSTRUCTURE,Front 0-0� Rear 0=0 L ACCESSORY Front 0-0 Rear 0-0 L PARKING Existing: 0:_ Required: 0 NOTES: - „ am aluaL on: $27,700.00 & ZONING - �.' -0-0 - Right 0-0,/ 0-0 Right �070' )posed: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (6=) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issuetl. � ❑ I have and will maintain wo cars' compo atinsuranca, as required by section 3700 of the Labor Code, for the performance of Ih for iCh 'CpenJt is Issued. My workers' compensaIW ren, rder I policy number are: Carder: Policy Number: (This section need not be completed If th mmit Is valued at one hundred dollars($100) or less.) ❑ 1 certify that in the performance of work r which this pernit is issued, I shall not employ any person in any manner so as to become s act to the workers' compensation laws of al omia, an0_agr thia`t If I should become subject to the workers' compensation provisions of Section 3700 of the Der Code, I shall forthwith comply with these pr Ions. i ��f (Applicant Signatu . Date: -WARNING: FAIL E T ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES D CML FINES UP TO ONE HUNDRED THOUSAND (E100,000)), IN ADDRION TO%E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed der provisions o(c ing of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Uc. x f r wi S tion 7000 Class p -ConlrodofsStgnature� Date:4/ 7,fl7v CONSTRUCTION NDING AGE CY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of Property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. It, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......__.................wi.......................canto...._.._....._.............................lding occupant istr__........................_.........................................._._.........................................................__......................_...........__ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazartlous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................................................................................................................I.......... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costs Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................._........................................,............................................................................................................ 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [I No ..............................................___..................................._.........................__.................................__..........................._............................._.........._............................................._._._.........................._._......................................................_.... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this 92plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑ No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................................................................................................................................................................................................................................................................................... _............................ _...................................................................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is regwired for the work which is the subject of this application, have all of the disclosures prescribetl by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ............ ................................................_........................................._..................................... _..........................._..............................._..............................._................................................................ .................. _................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cedify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature O caner /D / /+ _ Date r And/ Authorized Applican� Date CODE I. INSPECTION�NTYPEPE 2AM INTITAL6 CODE I INSPECTIONTYPE 2M INTMALH 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �7Y 204 Final Demolition 250 Final Building/Occupancy ' A7x (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708302 Applicant: BAUER, JERRY Address: Phone: Quantity Zip: Owner: EASTRICH NO 158 Temp Dist System / Lighting Address CORPORATION Temp service test $0.00 ATTN PATRICK SULLIVAN Phone: $0.00 ' %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: CANYON ELETRIC COMPANY Address: 603 CHIPWOOD ST Phone: (714)639.1302 ORANGE CA Zip: 92869 License: 617082 ISSUED BY: Status: ISSUED Applied: 07/12/2000 Issued: 08/07/2000 SCOPE OF PERMIT ELECTRICAL SERVICE AND SUB PANELS FOR NEW TENANT (HC POWER). 1 SERVICE OVER 1000a, 4 SUB PANELS TO 200a, 3. STANDING SECTIONS, 1 TRANSFORMER OVER 100 kva/kw. COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46 (600) - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 ' Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package $0.00 Standing Section $48.75 3 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 . . ...............:up to 10 kva/kw $0.00- 0 Lighting Fixts $0.00 0 .................up to 50 kva/kw $0.00 0 . Recept Outlets $0.00 - .0 ..............i:.up to 100 kva/kw• $0.00 0 . Switches "', $0.00 0 ..................over 100 kva/kw $74.50 1 Non Res Appl $0.00 .. 0 Low Voltage Equipment " $0.00" 0 Res Appl $0.00 - 0 ,- - Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00. 0.. - - Misc. Conduit $0.00 - 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 "- Service over 1000a $124.30 1 Circus ( gen or ride) $0.00. 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 1 Ohp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 1 00h $0.00 - 0 Other Electrical Fee ".$0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $122.00 4 Plan Check Fee $196.53 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $589.58 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46 (600) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workerscompensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) 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 C ' mitt nd agree that if I should become subject to the workers' compensation previsions of Section 3700 of the Labor Code, I shall forthwith comply with these pr io p Applicant Signature: Date: WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI—MINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLFRE (5100 ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3m6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pro scions Code, and my license Is in full force and effect. Lic. N sZ Class N — � Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a constmction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or that he or she 1s exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to lite a registration form for, acutely hazartlous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costs Masa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ._..................._.................._........................................ ..... .................................................... _............................_............................._....................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................ ............ ......... ...................................................................................................................... ................................... .................................... ....................._................. ..................... ....................... _................ 4 Ii en RMPP Is presently required. has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No _............__..........................__....._......_.................................................. _.__..............._—_......................._....................___..................................._...___—_..........._.............._.........................._.... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? UYes U No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building perntts). ...............................parto..............cili................._........................................._............................__....................__................................................i................_............ _................. __....... __.............. 8 Will any part of the facility to be canslmcted under this pertnll be within 1000 feel from the outer esof a school? ❑Ves ❑ No (it -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). ..............................__................................._._...................................._..__........................_.............................._._.._............___._.............................................................._............_.._......._.........._..__ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 423D3 been made? ❑ Yes ❑ No - ............__..................._._........................_....__..._.._................._..........__..__........_....._._...._.............__.....__....__...._........_.__..._..............__.___...__.._....... —_....... — ..... _.._ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Signa re Of Legal Owner(s) %% ate / 7 /J e",2And/Or Authorized Applicant 7 �- Date 000E Ii INSPECTION TYPE PAIS INTITIA5 CODE# INSPECTIONTYPE PAIS QRIDBLS 1616 Fixed System Final Fire Prevention 2D6 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical -kliq1tv 4 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2G4 Final Demolition 250 Final Building/Occupancy pw (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: HC POWER (WAREHOUSE & BREAK ROOM) Parcel Nunmber: 42708302 Applicant: RA$MUSSEN, GARY Address: 1787 WEST POMONA RD STE A STE A Phone: 909-734-0419 CORONA, CA CORONA, CA Zip: 92880 Owner: EASTRICH NO 158 709994 Address CORPORATION 0 Temp service test ATTN PATRICK SULLIVAN Phone: Busway /100 ft %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: RKS SERVICES INC Address: 1787 WEST POMONA RD STE A Phone: 909-734-0419 CORONA, CA Zip: 91720 ISSUE FEE License: 709994 ISSUED BY: Status: ISSUED Applied: 11/01/2000 Issued: 11/01/2000 SCOPE OF PERMIT INTERIOR 14,715.6 SO FT TI FOR "HC POWER" IN THE WAREHOUSE & BREAK ROOM (OFFICE). 7 FIXTURES, 16 OUTLETS. REF: B00-01472 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and firlal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6100) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $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 $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................ up to 10 kva/kw $0.00. 0 Lighting Fixts $7.70 7 .................up to 50 kva/kw $0.00 0 Recept Outlets $17.60 16 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to I00hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $48.80 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and firlal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6100) DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the —/ work for which this permit is issued. {.f I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: / Carrier: �. / A I I I i I/ Policy Number: _ N 6 O S fit! 5- S A (This section need not be comp/aced i1 the ermit is valued at one hundred dollars ($100) or less.) ❑ I Certify that in the performance of the work for which this permit Is issued, I shall not employ any personim any manner so as to become subject to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, I shall forthwith comply with these provisions Applicant Signature: Date:/�/ �On WARNING: FAILURE TOS UR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI-LARE ($100, , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N 7692 qL j Class a A Contractors Signature: Date: CONSTRUCTION LENDING ENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered forests (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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-builder will have the burden of proving that he or she did,,not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ r building Occupant need to file a registration torte for acute) hazardous materials? Yes No ................................................................................................... ..... 2 Does or will the applicant or present or future b 9 p g y ❑ ❑ (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................................................................................................................................................................................................................................... .................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costd Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...............................................ro-s.................................................................................................................................................................................................................................. ............................................................................................ 4 It an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Ves ❑ No ..................................................................................................................... ildi............................................................................................................................................................................................................................................difi............... 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication aOp NO for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control distract or agency? � Yes ONO (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ....................................................................................................................................................................................................................................................................................... ....................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (It yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................_........................................................-...................................................................................................................................................................................................-........................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safely Code Section 42303 been made? ❑ Yes ❑ No .............................................................................................................................................................-............. .......... .................................... ................................... ..................................................................... - ........................................................ B (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) Date And/Or Authorized Applicant / Date CODE it, INSPECTION TYPE X11: I L CODE I INSPECTIONTYPE 2AN INTFRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 . Final Plumbing may' 200 Final Re-Root 210 Final Electrical 201 Final BIOck/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy . (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 3030 AIRWAY AV Status: ISSUED Suite No STE A Applied: 11/01/2000 CORONA, CA Zip: 91720 Issued: 11/01/2000 Vicinity: HC POWER (WHSE & BREAK RM) Parcel Nunmber: 42708302 ISSUED BY: -� Applicant: RASMUSSEN, GARY QTY Address: 1787 WEST POMONA RD QTY ISSUE FEE STE A Phone: 909-734-0419 Laundry Tub / Washer CORONA, CA Zip: 92880 0 Owner: EASTRICH NO 158 Address CORPORATION ATTN PATRICK SULLIVAN Phone: %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: RKS SERVICES INC SCOPE OF PERMIT INTERIOR 14,715.6 SQ FT TI FOR "HC POWER" IN THE WAREHOUSE & BREAK ROOM (OFFICE). 1 KITCHEN SINK. REF: 800.01472 Address: 1787 WEST POMONA RD STE A Phone: 909-734-0419 CORONA, CA Zip: 91720 License: 709994 Arch / Eng : Address: Phone: Zip: License: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46(6/00) SCOPE OF PERMIT INTERIOR 14,715.6 SQ FT TI FOR "HC POWER" IN THE WAREHOUSE & BREAK ROOM (OFFICE). 1 KITCHEN SINK. REF: 800.01472 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Scda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $o.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, servicelmop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $33.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46(6/00) DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the ,,,/work for which this permit Is Issued. eG 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and polity number are: Carder: Policy Number: N e 0-5/65"'1- A (This secti�^ed nARlet/ the mit is valued at one hundred dollars ($100) or less.) ❑ 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, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these provisions Applicant /Q� Applicant Signature: Data: ( WARNING: FAILURE TO S R ORKERS' ODMPENSA1noN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR IV INALIP TIES AND CML FINES UP TOONE HUNDRED THOUSAND DOU ARE Ist , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WO6 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn that I am Ilconsed urWerprovlslons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. 4 Z;Z9 9Y y Class 0 Contractors Signature: Date: CONSTRUCTION LENDING GENCY: ❑ 1 hereby affiml that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DMslon 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a penult subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized Dy this peril, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the dMsion. Signature: Data: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, .or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materiels? ❑Ves ❑ No (Sectlon 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................__............................._._................................._.............................__............................... _._................................................................................... _................ _.............. _............ _......... _. 3 Does or will theapplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, codification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................... ................... _........................... _...... _................................................ _......... _...................................... ......................................... ........ ....................................................... I.................... _.................. _ .......... _....... _.......... _. 4 II en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Alf Quality Management District or from any other air pollution control district or agency? Ves U No (Section 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................... _..................................._...................................................................................... .................. ............................................. .........._..........._..................._..............__........._...... 6 Will an ry p y pan of the facility to be constructed under This ertnit be within 1IXX) feat from the outer bountleries of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution anon 4 district or agency is required for the work which H the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been maria? ❑Ves ❑ No 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZAT10N OF ENTRY: I cortity under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mese to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature Of Legal Owner(s) Date i/4. /00 Md/Or Authorized Applicant —I ' I Dale CODE P. INSPEOTION TYPE fidM INTRIALS CODE INSPECTION TYPE 2M ISL$ 1616 Fixed System Final Fire Prevention 206 Final Mochanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BIocWRetaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: WAREHOUSE Parcel Nunmber: 42708302 Applicant: RICKER, JERRY Address: 30440 ANACONDA CT Phone: 909-699-8771 TEMECULA, CA Zip: 92591 Owner: EASTRICH NO 158 Address CORPORATION ATTN PATRICK SULLIVAN Phone: %ALDRICH EASTMAN & WALTCH Zip: 90017 Contractor: J L R ELECTRIC Address: 30440 ANACONDA CT Phone: 909-699-8771 TEMECULA, CA Zip: 92591 License: 585692 ISSUED BY: SCOPE OF PERMIT ELEC PERMIT TO ADD TWO 225 AMP LOAD CENTERS 480 & 208 VOLT37 2 MISC ELEC EQUIP, 4 MISC CONDUITS (RACEWAYS, MISC CONDUIT FUTURES), 2 MISC CONDUCTORS (FEEDERS). NOTE: NO BRANCH CIRCUITS AT THIS TIME. Status: ISSUED Applied: 11/30/2000 Issued: 11/30/2000 COMMENTS / SPECIAL CONDITIONS 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, 1241.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work auttlorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7645626 2"6-46 (SM) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $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 $36.40 2 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 .................up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 0 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $72.80 4 Service to 1000a $0.00 0 Misc. Conductor $36.40 2 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 - Plan Check Fee $84.55 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $253.65 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS 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, 1241.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work auttlorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7645626 2"6-46 (SM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following dedarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be c plefed if The permit is v usd atone hundred dollars (S 1370) or lass.) $ I certify that in the pert rmence of the work hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of allfomia, and agre at if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provi Ions. 11-30-00 7 Applicant Signature: Date: (1 — 3 O — O O WARNING: FAILURE TO SECURE E 'COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), I DITI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DE TON: I hereby affirm that I am licensed un er provisions of Cher commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. Lic. a O S8 S Class a C/ o Contractors Signature: An Date: CONSTRUCTION LENDING AGElJCV ❑ 1 hereby affirm that there is e cslnlcfion lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Dale: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _......................................__.........................._..__........._.........................ildi............_.._..................o file __..................ionf........................._—............................................_........................._.................__............_...._.......... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................... .................. .......... _........................................................................... _..... ...................... ___............................... _...................... _........... ... ...... ................. .......... .... _............................................. _.............................. __........ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? E] Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................is. ''ro.o"n'.t'ly"........................................................................................................................................................................................................................................................o"""............................................................. 4 II en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No ..................................................................................................................... ildi........................................................................................................................................................................................................................................... difi................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this ,application apertnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes L -I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................... ...... ............................................................................................................................................................................... ..........................:............................................. .................... 6 WIII any pertof the laciliry to De constructed under This permit be within 1000 feet from the outer boundaries of a school? ❑Yes � No (If 'eyes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............ . ....................... _..___.................................. __... ............................................... ..... ........................ _.................................... _.................................... _....................................... ................................................... _.............. I.._..................... 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................ _............................................................................................. _................................................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE O COMPLIANCE AND AUTHOR ON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree comply with all stele laws d ry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe roperty for inspection pure . I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. All Signal ur gal Owners) ate �r/- d - O O And/Of Authorized Applicant Data CODE I, gAjE INTITALS CODE INSPECTION TYPE PAR jL�L$ 1618 TFIXySIPmFinal Fire Prevention 206 Final Mechanical 1266 Final 208 Final Plumbing 200 oof 210 Final Electrical Jul. a f ad 7 201 Final BlocWRetalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy S PRO4ELT.AODRE35: •�330t30-AIR -A1Y AV UNIT: OWNER'S NAME: rAOSENB ERG REAL ESTATE ADDRESS: E?pUITY FUND WEST -V % OSENBERG RE E?UITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCWENGINEER: ROBERT BORDER§ S ASSOC REG.ii C4918 ADDRESS: 5030 CAMPUS DR UNIT: N.B. CA 92660 PERMITTEE: GENTOSI BROTHERS (714)474-2333 ADDRESS: 42 CORPERATE PARK 200 IRVINE CA 92714 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chaplet 9lcommencing wall Section 7000) of Division 3 of the Business and Professions Code and my cense is in lull I and effect. CITY MC.:''0••xx32232QSTgTELIC.:26871Q LASS: Dale:.%(,7'a/'� J Signature: _ _ _ WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure or a certificate of Workers' rxindensation IJ�su�[[a�RLce�q(d cent ed copy thereof (Section 3800. Lab. 11.10 NO.: gun V L 25 i i EXP. GATE: 7 I O I/93 .COMPANY: FAIRMONT ❑ Certified copy is hereby furnished, d Certified copy is file w e ci Bo' ing 'sion. _ Date: /!'1 —��q Z/ Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: O Is section need trot be amp eted if the permit is for one hundred ($100) or less). 1 certify that in the performance of the walk fpr which this permit is issued, I shall not employ any person in any manner sup as to became subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: N, after making this declaration, you shoutd became subject to the workers' Compensation provisions of the Labor 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 which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: ENLARGE TRUCK RAMP MECH ROOM SNCL W/O ROOF OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for Such permit to file a signed statement that hetshe is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 700(j1 of Division 3 of the Business and Professions Cade) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (3500). I. as owner of the prapeny or my employees with wages as their Safe compensation, will do the walk, and the structure is not intended or offered for sale (Section 704, Business and Professional Code: The Contractors' Slate License Law does not apply to an owner cl a properly who builds or improves thereon, and who was such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. IL 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 for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of propert who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Workers Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. to, itut reason. Date: Owner I do hetet/ certify that I am aware of and understand the requirements at CaNtomia Neallh and Safety Cade 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 permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale. Applicant: I hereby certify that I have read this application and state that the ab ion is car ree to oomply.wiih all city and county aldmaM25 and state lawsfeldflag to bllNaing ConshuddnM t rintm faster, as of city to enter upon the above mantlened property for inspection purposes. Dale: AQ Signature: r Driver's License or Social Security x: 164146 White—BUnI ina: Green—Code Enforcement: Canerv—Aoolicanll Pink—Revenue: Goldenrod—Assessor +r !1 CITY OF COSTA MESA - BUILDING PER+7IT PE -AM NO: 8 0]9636 PERMIT'NO: B 059636 PLAN CHECK NO: 03172-92 A GOVT: N SUPP: N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : ADD 600SF MECH ROOM, 72065SF T.I. SQ FT: 222,425 CLAIM VALUE: 2,500,000,00 CALC-VALUE: 729,526.50 GROUP OCC: B-2 / COMMENTS: 72025SF OFFICE/WAREHOUSE T.I. Z O N I N G S E T B A R E Q U C K S I R E M E N T 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 RE • PROV: PARCEL; 42708302 Z,VE: MP REF NO: PLANNING N TES> INT, ALT TO EXISTING IND, OFFICE BLDG, AND ADDITION OF 600 S1 FT, MAINT, FACILITY, #### {(-#iE"iEjf#x#iEHt#i{;x##ic###1(if##############?E##'####1E iF x'x##x###7P X,*' Yr#iE#IS3F### D E V.-g,L .!F M.E- S E R V I C E S R E Q U I R E M E N`T S ZONING APPROVEDY DATE 0 2/ BUILDING APPROVED/ By : DATE: APPLICATION I§EVIEDy;BY: DATE: ####ie'##########i¢#N•je###R"RR n -.'R A -Rx A'R .RR.. :t h%RA A'ieRRRRx RRR%4(#######'#'#RR - ATX.t .## LEGALIZATION -N F E E S U MjM A';t)Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MEC5AAJC FIRE zSM,IP�ES GRADING PERMIT 2,729,50 i ;f 1 n SMI/NON"�RES ISSUE FEEPLAN 443,55 = r) 53.2('• BUILDING -DIV-> PERMIT ISSUE PLAT-C�ECK TOTAL I PAID' � DUE TOTALS ---- > 2882,70 0,00 •.443,55 .3326;;25 ('932;6`25✓ .00 REVENUE DIVISION TOTALS--> COLL•EC'TEG> !;• 28,82;R'A70 OVERPSHOR:[':;' 00 BLDG PMT PLUMBING ELECTRIC MECHANIC1,'. AFI'I.E SMTP /TOT GD-I�{C �)D AN -CHECK 2729,50 :. `153,20 I N D I V I D UAL, F E 0 TYPE QTY D E S C R I P T I N, ' UNIT COST ' (T/OTAL COST SFC 00 SFC 18400 600 WAR -TYPE IITOR VYNF; �a-N 1 `• -AVER %' 22;,R 10 201' i ~• X113, 320.00 SFC 53675 WAR -INT, ALTER TYPEIII V -N AVER 4,44 238,317,00 SFC 72075 E U -COMMERCIAL AIR;CONb /-AVERe 3.;,45 248,658.75 SFC 600 E U -COMMERCIAL SPRINKLER OST,,) --AVER/ 1.,'65 990,00 SFC 721 E U -ALT COMM. SPRINKLER SYS,-, -AVER ,/; 433 23 784,75 000 SFC 5TER BY VALUE COt MERCIAL:' iNOZONE_. 1-.00 5, 000.00 SEND OF F$ES;, ; -,> It CONSTRUCTION AND PLANNINI. PvOL & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location o. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r. S. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd, 57. APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20..Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22: Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing Z/((f 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat(!? 75. Dry Chemical 27. Frame and Flashing (,f� 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL i i 29. Insulation ��_ ( 78. FIRE PREY. FINAL 30. Drywall Nailing ,�//A; �! !' r HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 'rel Notes: 4; f 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test ` ��• �" 36. Hood or Canopy r 37. Final Factory Fireplace ; 38. Final Plumbing /f n 3,000-,'n+ S 39, Water Service -Final J 40. Gas Service -Final I.I 41. Solar Domestic -Final I } 42. Backflow Preventer 43. Backflow Irrigation ;/, C-�• /fir 3a 44. Landscape Irrigation System 45. Sound Attenuation /J / ! . CNy1�p4�.A•� S 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING '3/��p' _Corr / z_ �=�/ 2�`/'�% 48. FINAL PLANNING 49. Electric Release to Edison _ - t 50. Gas Release to Southern California Gas CD I 51. CERTIFICATE OF OCCUPANCY No. Date PHO.IECi ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST -V %ROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCH/ENGINEER: ROBERT BORDERL. S ASSOC REG.NO.: C4g18 ADDRESS: 5030 CAMPUS DR UNIT: N.H. CA 92660 PERMITTEE: AIR CONDITIONING CO. INC. (818)244-6571 ADDRESS: 6265 SAN FERNANDO kb GLENDALE CA 91201 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Protessions Cade my license is in full force and effect. CITY LIC.: 014 4 0 3 STATE LIC.: 1 2 g 6 CLASS: C-20 Date'. ��/ "'>d%'^fj- good WORKERS' COMPENSATION DECLARATION. her y affirm that have a certificate consent to self -in re certificate of Workers' 'Compensation Insurance. or a certified copy Cher f eclion 3800, Lab. C). POLICYNO.: WC207418500 EXP. DATE: 10 /01 /93 COMPANY: TRANSPORTATION Certified Copy is hereby furnished. Q Certifg;OTI is filed with the City Building Division. Date' EXEMPTION FROM WORKERS' COMPENSAi BECLA ION:• )This section need not be completed if the perm Is a a hundred ($1f10) or less). I certify that in the performance of the work for wbi This permit is issued, I shall not employ any perso anner so as to become subject to the Workers' Compensation Laws of 111fornia. Date'. Signature'. NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor 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 which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Cade'. Any city of county which requires a permit to construct, alter, improve, demolish, or 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 and Professions Code) or that he/she is exempt therefrom and di basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code. The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through 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 for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code- The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section. a. 8 P. C. for this reason: Date: _ -_ Owner I do hereby certlty 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 permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date. Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction a by authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. } Dai 4 Driver's License or Social Security a' 164146 Whue—Building, Green—Code Enforcement: Canary—Applicant; Pink—Revenue: Goldenrod—Assessor IF r CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: M 059742 PLAN CHECK N0; N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: MEC JOB DESCRIPTION ; ADD 600SP MECH ROOM, 72065SF T.I. CLAIM VALUE; CALC-VALUE: PERM NO: M 059742 GOVT; N SUPP: N PURPOSE: OTH SQ FT; GROUP OCC; B-2 / COMMENTS: RE: B59636 PRIMARY BLDG, PERMIT. Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN F'RNT: FT IN REAR; FT I LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REO: PROV: PARCEL: 42708302 ZNE; REF NO: PLANNING NCOITES> 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 i DATE; BUILDING APPROVED BY DATE: APPLICATION ISSUED BY0 ' DATE; 9 �: -iF########ii####3F######-!E xxfrx'x ft frx trx rxv.:m xir le it- xit^ yr fexetx er fr xxih#########z+t ft atx it-r.•xfr ##:FiE}Ez1EiE#'.F#######'Ic'##•i(•#il-####if#######%####�Li(•###`:#####•######%#############iC###### LEGALIZATION;N F E E SU M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRRII MECHANIC FIRE SMIP/RES GRADING PERMIT 288 00 15t SMIP/NUN-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE 91AN-CHECK TOTAL PAID DUE TOTALS ---- > 288.00 15.00` '0 00 303,00 -11 303,00 ,00 ! 11 1 REVENUE DIVISION TOTALS--> COL ECTEp 303,00 OVER/SHORT; 00' BLDG PMT PLUMBING ELECTRIC MM CgAgLC FIRE' SMIP/TOT GRADING PLAN -CHECK 30.3:40 I N D I V I D U AL ' ESE E EIREAKDOWN TYPE QTY D E S C R I P T I'0 N UNIT COST TOTAL COST MEC 1 REFRIGERATION SYSTr1M,, >} 100 K BT'U/H 11,00 11,00 MEC 26 VAV BOX f 6,50 169,00 MEC 6 VENTILATION FAN CONN TO'SINGLE DUCT 4,50 27,00 MEC 4 INST/REL AIR HANDL,UNST) 0-10000 CFM 6,50: 26,00 MEC 5 INST/REL AIR HANDL. UNIT,j> 10000 CFM 11,00 55,00 :El OF FEES r CONSTRUCTION AND PLANNING APPROVALS PermitDate Inspector _PO .SPA, APPROVALS Permit # Date Inspector 1. Temporary Electrical Service prPole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement _ 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO,COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgmd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60.- Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical Final 15. Rough 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil 23. Gas, Pipe -Rough & Test 72, Underground Flush . 24. Roof Framing-. 73. Undergrnd. Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 11 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 79, FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED 32. Electrical Power, Meter -Final / (/9.P_ lel 33.. Final Electric 34. Final Heating &Air Conditioning .� Notes:MAZ~ WCTS Th 0001.. IA& � 3/1.3 G7.(, (N�4'T�- o t -L (Loop cAc- ao 35. Final Gas Pipe -Test r`zfk 41,4- ApmiL per- L4" 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing { 39. Water Service -Final r 40. Gas Service -Final 41. Solar Domestic -Final l 42. Backflow Preventer j 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING { 46. FINAL PLANNING { 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: EQQUITY FUND WEST -V 2ROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCH/ENGINEER: ROBERT BORDER§ & ASSOC REC.NO.: C4918 ADDRESS: 5030 CAMPUS DR UNIT: NEWPORT -BEACH CA 92660 PERMITTEE: CAUSEY ELECTRIC (714)855-9610 ADDRESS: 3 VANDERVILT IRVINE CA 92718 LJCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: 01 7 7 r 4 STATE LIC.: 3 310 6 a11,�[��(�{/(/,,CLASSSS; C -1 Date: Signature: /e' _ / fC WORKERS' LOMPEN ATION DECLARATION: I hereby alfirm that I have a certificate Of consentlo self -insure of a certificate of Workers' Compensation Insurancer a certified copy thereof (Section 3000. Lab. C). POLICY NO.:WP80S84204 EXP. DATE: 10/01/93 COMPANY: FIREMAN' S FUND ❑ Certified copy is6hereby furnished. © Certified copy is lil with the city BuilAg Dale: ie Z ]4— Applicant: X. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section nel net be completed if me permit is for we hundred (5700) or less(. 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 WorkersCompensation Laws of California. Date: Signature: NOTICE: II. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply win 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 which this permit is issued (Section 3097, Civ. C), LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve. demolish, or 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 and Professions Code( or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ❑ structure Is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors State License Law does not apply to an owner of a propeny who builds or improves thereon, and who does such work himself/herself or through 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 to, the purpose of sale). I. as owner of the propert . am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Us License Law does rout apply to an owner of propend who builds or improves thereon and who contracts for such projects with a contracto(s) license pursuant to the Contractors' State License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: 8, 8 P. C. for this reason: Date: Owner 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 stale codes and the requirementsfor a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby eerily that I have read this application and state that the above information is c if ct. l ree to comply with all city and county ordmances and state lam relating to building construction and hereby authorize represtinta 6 of city to enter upon the above-mentioned properly for inspection purposes. Date: Signature. Driver's license or Social Security a: $ 1641.46 White—Duddmg: Gmen—Code Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor 'CITY PERMIT NO: E 059668 CONSTRUCTION TYPE: VN SPR • OF COSTA MESA - BUILDING PERMIT PLAN CHECK NO: N PERMIT TYPE: ELE JOB DESCRIPTION : ADD 600SF MECH ROOM, 72065SF T.I CLAIM VALUE: CALC-VALUE: PERM NO: E 0596b8 GOVT: N SUPP: N PURPOSE: OTH SQ FT: GROUP OCC: B-2 / COMMENTS: THE "VERIFONE CO," / RE:B59636 Z O N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT, FT IN LEFT: FT IN RGHT: FT IN PARKING RE • PROV: PARCEL: 42708302 ZNE: REF NO: PLANNING N TES> > ##############!F##%####iE##ie#####K'dE######################3t#iE-1F###1F#####i(•# 1E###%#### 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 i' DATE: BUILDING APPROVED BY : �'`• DATE: APPLICATION ISSUED BY: G9'L/yct..� DATE: (0 .2 ###LICA#####ISUED ###ir'iiiriF: xre it T #x xxiF a�iF x•iv# �cx vlT.Irx-xTrxxic—x#x###3k##Z# vx c rxx xx LEGALIZATION:N F E S .0 M- M-.A.•R Y (^ STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRICt MEOIjANIC"' FIRE SMIP/RES GRADING PERMIT 785,:30 vA �.:5.0� ;• ,�rT `• 7' SMIP/NON-RES PLAN ISSUE FEE 1,5,00:' , r BUILDING -DIV-> PERMIT ISSUE PLAN-O;ECK TOTAL PAID DUE TOTALS ---- > 785.30 15,00 0,00 00,30 800,30 ,00 REVENUE DIVISION TOTALS--> COLLECTED:' 800,30 'OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 800.30 r/ 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 1'6 N. 'UNIT COST TOTAL COST ELE 20 FIXTURES, LIGHTING 1 -ST 20 EA, ,75 15,00 ELE 674 FIXTURES LIGHTING, ADDITIONAL EA, ,4S 303,30 ELE 20 RECEPT/OftLET 1 ST 20 EA, ,75 15,00 ELE 310 RECEPT/OUTLET ADDITIONAL A, ,45 229,50 ELE 20 RECEPT/SWITCH 1 ST 20" tA 75 15,00 ELE 40 RECEPT/SWITCH ADDITIONAL;, cEA:. + , 4� e 3 't0 ELE 13 SUB -PANEL , -•' lr":T r; 11,0'D 3, ELE 3 MOTOR /POWR APPARATUS ' 0. 4, =/ 1 , b.1 AIi0:, t ELE 5 MOTOR/POWR APPARATUS �1J,'1!--YO•,0;��f. 7.� 1 37, END Of- FEE9� i `� OCT 2 2 1992 lir" CITY OF COSTA MESA CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement" 3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. -+ 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK it. Property Sewer Line & House;Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final " 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation I 78, FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test �j/ "` !�'- �' '� 80. FOOD CERTIFICATE ISSUED Notes:�QfA4, v / - ;-_y?- (` 9/1 10%, �[ 36. Hood or Canopy Z - (-�j 7- 37. Final Factory Fireplace 37. 38. Final Plumbing Z -7-3 --Ct L Q 39. Water Service-Final l q 40. Gas Service-Final 2250�Z n 41. Solar Domestic-Final 41. i 42. Backflow Preventer i 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations r 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING � `:. 49. Electric Release to Edison I ' - 50e Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3030 AIRWAY AV UNIT' OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: ERUITY FUND WEST—V 81�OSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCH/ENGINEER: ROBERT BORDERS & ASSOC RED.NO.:C4918 ADDRESS: 5030 CAMPUS DR UNIT: N.B. CA 92660 PERMITTEE: GENTOSI BROTHERS (714)474-2333 ADDRESS: 42 CORPERATE PARK 200 IRVINE CA 92714 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and nly license is in full force and effect. CITY LIC.: 032232 STATE LIC.: 26871Vt1ha c ss: B — Date: —46 —a) -� L Signature: — WORKERS' COMPENSATION DECLARATION: I hereby affira certificate of consent to self -insure or a certificate of Workers' JDm sation Insurance. or a certified copy thereof (Section 3800. Lab. C). hIC NO. 30028882 EXP. DATE: 07/01/93 COM ANY: FAIRMONT Cartifietl copy is hereby furnished ® Certified copy is file h or Atli Divi bion. Dale: lo— P'1 -i2 Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). 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 WorkersCompensation Laws of California. Date: Signature: NOTICE: If, after making this declaration, you should became subject to the Workers' Compensation provisions of the Labor 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 which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: ENLARGE TRUCK RAMP OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the workand the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State license Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through 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 for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business El and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section. B. & P, C. for this reason. Date'. Owner: 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 permit for construction or modification tram the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: hereby s and That I have read This application and state that the alio S correct agree goodly u with an city and county ordinances and stale laws relating i building construction and hereby Ifo rear en fives I this city ter upon the city and comentioned ty property for inspection purposes ' Date'. It 9-1-rZ Signature: Driver's License or Social Security a: 164146 White—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Gobenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: GRA 059635 PERMIT NO: GRA 059635 PLAN CHECK NO: 03173-92. A GOVT: N SUPP: N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: GRA PURPOSE: ALT JOB DESCRIPTION GRADING FOR NEW EQUIP ROOM & TRUCK RAMP SQ FT: CLAIM VALUE: 5,000,00 CALC—VALUE: GROUP OCC: B-2 / COMMENTS: 72025SF OFFICE/WAREHOUSE T,I, Z 0 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; 42708302 ZNE: REF NO:PLANNING N TES> > 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 i ZONING APPROVED BY DATE: ` Z BUILDING APPROVED BY ; DATE: /I- 2 F rj APPLICATION ISSUED BY: DATE,c 2/ PII#LTL#II#####C###I##CPI##I###II#II##P%P%PI-.'I##PLT%#L####LL###LL1�, :T•iELL#LL%##I LEGALIZATION:N F E E S U M M A R Y STRUCT,[iJ4A�'{SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIPr%I2ES GRADING PERMIT PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS ---- > 15.00 3,00 0,00 REVENUE DIVISION TOTALS—> COLLECTED; BLDG PMT PLUMBING ELECTRIC MECHANIC SMI/NONrRES 15.00 3.00 TOTAL PAID DUE 18,00 18,00 .00 18,00 OVER/SHORT;00 FIRE' SMIP/TUT GRADING PLAN—CHECK 18.00 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 UNIT COST TOTAL COST NO FEES WERE SELECTED FOR THIS PERMIT CONSTRUCTION AND PLANNIN1__ APPROVALS Permit*# Date Inspector iL & SPA APPROVALS Permit # Date Inspector, 1. TemporaryElectrical Service or Pole- 52. Pool &!Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms. 4. Electrical Conduit -Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement. - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd„ Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, D Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor -Final -' 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14, Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling - 69. POOOSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT t APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 000 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation I 78. FIRE PREV. FINAL 30. Drywall Nailing .� I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 1 j 79. FINAL INSPECTION 32. Electrical Power Meter -Final _ 80. FOOD CERTIFICATE ISSUED 33. Final Electric j Notes: 34. Final Heating & Air Conditioning I i i 35. Final Gas Pipe -Test 36. Hood or Canopy i I 37. Final Factory Fireplace 38. Final Plumbing 1 I 139. Water Service -Final 40. Gas Service -Final 41, Solar Domestic -Final ' i 42. Backflow Preventer I ! 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - �- 49. Electric Release to Edison 50. Gas Release to Southern California Gas OD • ' ! 51. CERTIFICATE OF OCCUPANCY No. Date Ir PRDJECT ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: ERqUITY FUND WEST -V % OSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCHIENGINEER: ROBERT BORDERS 6 ASSOC REG.ND.: C 4 9 18 ADDRESS: 5030 CAMPUS DR UNIT: N.B. CA 92660 PERMITTEE: UNITED FIRE PROTECTION (714)550-0886 ADDRESS: 1736 E. BORCHARD SANTA ANA CA 92705 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under previsions of Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: 036699 STATE LIC -A 70399 CLASS: C-16 Date: IZ'IV'aZ. Signature: �r WLOU.Ce--7— WORBERS' COMPENSATION DECLARATION: I hereby affirm that I have a cenillocate of consent to self -insure or a certificate of Workers' Compensation Insuranc or ceNlie f copy thereof (Section 3800. Lao. C1 ISICYNO.:94524� EXP. DATE: 05/01/93 'COMPANY: REPUBLIC IND, ❑ Certified copy is hereby furnished. Unified copy is [led .0 the cicity 'Building gDDivision, Date: I Z' I U " Z— Applicant: EKEMPIION FROM WORKERS' COMPENSATION DECLARATION: (This section need nor be mrlgkted if the central is to are hundred ($700) or Iecs). I cemfy that in the performance of the work for which this permit is lipped. I shall not employ any person in any manner s0 as to become subject to the Workers Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration, you should become spbject to me Workers' Compensation provisions of the Labor Code. you must forthwith comply vdth such PreviSiOM Of this perrnit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency far the performance 01 the work for which this permit is issued (Section 3097, Cry, C). LENDER: ADDRESS: ENLARGE TRUCK RAMP MECH ROOM SNCL W/O ROOF OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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 and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty 01 not more than live hundred dollars (1144l I, as owner of the property 9r my empployees with wages as their sole compensation, will do the work, and the 7 structure is not intended or offered for sale (3action 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselliberself or through his or her own employees. provided that each improvements are not blended or offered for sale. II, however the building or improvement is sold within one year of completion. the owner will have the burden of proving halide did not build or improve ler the purpose at salel. I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business 1:1 and Professions Code: The Contractors' State License Law does not apply to an owner o1 property who builds or improves thereon and who Contracts for such projects with a mtracter(S) license pursuant to the Contractorti State License Law). I am aware that proof of their Woron's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C, for this reason: n.no 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 luture building occupant wiNwill not (circle one) need to comply with said stale codes and the requirements for a permit for conshuchon or moddicalion from the Air Quality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and County ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property lar inspection purposes. Date. �1 Z - l0 —97 Z_ Signature: Driver's License or Social Security n: 164146 While—Building: Green—Code Enforcement; Canary,ApplicanC Pink—Revenue; Goldenrod—Assessor 'CITY OF.COSTA MESA - BUILDING PERMIT PERM NO: F 06029 PERMIT NO: F 060297 PLAN CHECK NO: 04463-92 L GOVT: N SUPP: N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: FIR PURPOSE: OTH JOB DESCRIPTION FIRE SPRINKLER ALTERATIONS / T.I. SQ FT: CLAIM VALUE: 25,000.00 CALC-VALUE: GROUP OCC: B-2 / COMMENTS: 72025SF OFFICE/WAREHOUSE T.I. FOR "VERIFONE" RE: B59636 xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REO• PROV: PARCEL: 42708302 ZNE: REF NO: PLANNING N TES> > x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx D E V E L O P M E N T S E R V I C E S R E 0 U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; \ DATE: 5;2 - APPLICATION ISSUED BY:. DATE; / 1 /o x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx x x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx LEGALIZATION:N F E E rS U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 252 00 9152 SMIP/NON-RES PLAN 163.80 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 252.00 0.00 163.80 415.80 415,80 .00 REVENUE DIVISION TOTALS--> COLLECTED: 252.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 252.00 x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx 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 Nr UNIT COST TOTAL COST FIR 252 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 252.00 END OF FEES CONSTRUCTION AND PLANNING P ' & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Po 1?, 52. Pool & Equipment Location h 2. Soil Pipe:Undrgrnd. - 53. -Steel Reinforcement =3. IectfhatCondujt,tJtilitY-0ndrgrn&' �5q4'. Forms Eiectr&z.CDndrdtrUndrgrnd. 55. Electrical Bonding Sigel R•einfdreeg(ent- Y 56. Rough Plumbing & Pressure Test :6.3itec{tit 6t.t3FEAGrnd. - �. APPROVAL TOCOVER•GUNITE r,]�1tlhg'•= '- ; 58. Electrical Conduit-Undrgrnd. ,_� p1LMjatioti. ,;.59. Gas Pipe, O Undrgrnd., Test a. wq-rl'et Pi e,Undtgrhd. X60. Backwash tines, P -Trap, C1 Undrgrnd. J6.1,. , 10: Sic'ucturat Floor System APPROVAL TO DECK 11. Propect Sev0rlinen& HocheConrttction ��, Backwash & Receptor -Final 12. Sewer -Clap -c c 63. Heater & Vent -Final 13. Roof Drainrc �_ 64. Plumbing System - Final 14. Rough Plumb(rj§ •� 65. Electrical -Final 15. Roughtectrica(-Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring S1gn 68. APPROVED FOR PLASTERING 18. Rough Electrical, -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - br APPROVA'L'S.:)CPeronit # 20.TRough action/ Fraeplace 1 x r < t * Q n '7^ + -DuCIs, injStryctAt F... •� a 0. Underground Hydro - 22. DUCK, Ventflea tin-� S m S" ¢e <.=71. ProductLPIPI.1 O'G2s O'Oil 23!::�a;`PipRoucjh &•-fest i �S 'Li't t 1,72. Underground Flush;, �,J7• ,Z .. 24:• -Root F,fiming u; E E- ••� > k x-73,"UndergrniP.Storat]eTank OGas 00il 25. Roof, Sttccathing ` x • r i M - �' ` ` .' i' - 74overheac!'Aydro_ v a > -u � 26. cT-Bar Ceiling (Stir Lral) &:Mono_ coat .n 75 s Dry Chemical - - - 27;Tra a apo FJ'sh�1,, '{' -` r 76: Dry Stand ' 'e Y .� M R T r r p!D X28. Lat ing Sing- y.Z i ^ > X 77 7 FIXED SYkTEMEFINAL ��.�•3 `29. InsulationrxL aT •• > 78�7FIRE PREV. FINAL -30. Drywall Naihng HEA LTH(DEPT. REQUIREMENT - r 31. Plaster Blown Col.' ^_ � :r : ` ', � r79"FINAL INSPECTION - ` ;. F 37. ElectricagPovverMetar,;Finah a :_ 80.;FOOD CERTIFhCATE ISSUED 33,� 'Not es: � r -34.-Fin Heating& Av.nd oitignj09g C x _ < v zl�Ol'Z�Par7Jj,f1. N�l6t�' b�J �L1'�5'Plp 35..rFinel Ga Pipe-Testi y ` Y R _ i .36.`Ho d otlano - -37.-Final Factory Fire plabe » _ , to Plumbing -- -38.jinal Tri '] •y ,_ -. G39.•=Water S&vice-Finaf^ •_ C40. -,Gas Servipe-Finals �, w ; r n t x - - •L41,,Solar Domestic -Final s L" •.-o,-. 42. Backflow PreventtrY, ` `ry K ' -_ \ 43. Backflow Irrlgation< r aa - ,44. Landscape IYiigaypn Systemr,;,r; r - < x .. ';45. -.Sound Attenuation, Y T - 7 •r .t err r a - •L `46. Handicap.Requlatidps K s •, _a 47. FwAL STRUCTURE & BUILDING, r J T 48: FINIAL PLANNIN _ r'- -49. Elegiric Release to Edison 50. Gas Release to Southern California Gas Co : `51. CERTIFICATEOF,,OCCUPANCY No. Date ROJEr1 ABDRESS: 3030 AIRWAY AV UNIT: R DWNENSNAME: ROSENBERG REAL ESTATE ADDNESS:EQpUITY FUND WEST—V %ROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCH/ENGINEER: ROBERT BORDER§ 6 ASSOC REG.No.:C4918 aoBREss:5030 CAMPUS DR UNIT: NEWPORT BEACHCA 92660 PERMITTEE:CAUSEY ELECTRIC (714)855-9610 ADDRESS: 3 VANDERVILT IRVINE CA 92718 LICENSED CONTRACTOR DECLARATION: I hereby alfirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITYLIC.:017754 STATE 1.16.331 CLASSIC 10 •9a{e:.�as/q3 Signature:_ _— WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensatiol-tP"ff94e2f&40pY thereof (Section 3800. Lobb / 01 /93 COMP No.:FIREMAN' S FUND EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. l'J Certified copy i"dY Buiion. q if or in th EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need hot be completed if the permit is fo hundred (S100) or tess6 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 became subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: If, after making this declaration, you should become subject to the WorkeR' Compensation provisions of the Labor Cade, you most 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 which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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 and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (3500). 1, asowner of the property or my empGloyees with wages as their sole compensation, will do the work. and the 7 structure is not intended or offered for safe (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or allered for sate. 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 for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: nam I do hereby eerily that I a 25534 and that l or any fun permit for construction or these provisions. Owner: m aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and ure building occupant will/will not (circle one) need to comply with said state codes and the requirements for a modification from me Air Ouahty Management District. Residential construction applications are exempt from Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorus representabv s of this city to enter upon the above mentioned Pernik to m5pecu n purposes. S Suruture' fT p4lJ_i�41 Driver s License or Social Security .: 1641-46 While—Bmldmg; Green—Cone Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 060742 PLAN CHECK NO: N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ADD 600SF MECH ROOM, 72065SF T.I. SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / COMMENTS: THE "VERIFONE CO," / RE:B59636 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk Z 0 N I N GS E R T E B Q A U C I K R S E M E N T 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: 42708302 ZNE: REF NO: PLANNING NOTES> DUE TOTALS ---- > 77,00 4,50 0,00 81,50 81,50 > REVENUE DIVISION TOTALS--> COLLECTED: 81,50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING 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 kif kilkkkkkkkiF I N D I V I D U A L F E E DATE: BUILDING APPROVED BY : APPLICATION ISSUED BY: k kkkkkkkkkkkkkkkkkk LEGALIZATION:N BLDG PMT PLUMBING _ DATE: DATE: if ak if if k ik it k it iE iF iF if if fF it it 1F iEit if iF iF iE k fl 1l9l9lif kit k if it iF it if iF it it iF iF iF k it if if il1F F E E S U M M A R Y STRUCTURAL SEGMENT:N ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 77,00 SO% SMIP/NON—RES PLAN ISSUE FEE 4,50 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 77,00 4,50 0,00 81,50 81,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 81,50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 81,50 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkilk kkkkkkkkkkiEkkkkkkkifkkkilk kif kilkkkkkkkiF 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 UNIT COST TOTAL COST . ELE 5 MISC CONDUCTOR NOT LISTED REQ PERMIT 11,00 ELE 2 MISC CONDUIT NOT LISTED REQ PERMIT 11,00 END OF FEES 5500 22, , 00 IR CONSTRUCTION AND PLANNING- 110 APPROVALS Permit #_1 � Date Inspector - -� L & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - .3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Ondrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 0.' Electrical UFER.Grnd. 57, APPROVAL TO COVER-GUNITE 7: Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Uncirgrnd., Test •$ Water Pipe-Undrgrnd. " I 60, Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sevier Line & House Connection , 62. Backwash & Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 1 14. Rough Plumbing I 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 APPROVALS Permit 4#- 20, Rough factory Fireplace - 21. Ducts,,in Structure • 21. T 70. Undergra9p Hydro 22 Ducts, Vent anpg 71. Produa i3ipin9"0Gas G) oil 23: Gas Pipe -Rough &Test 72. Underground Ftu'sh 24. Robf Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing •. 74. Overhead Hydro 26. T -Bar Ceiling iStructurall &`Nonocoat _ ',' 75. Dry Chemical > 27. Frame and Flashing _ 76. Dry Stanflpipe 28. Lathing & Siding . - - ; . 77T FIXED SYSTEM FINAL 29. Insulation �'• 78. FIRE PREV. FINAL - 30. Drywall Nailing ' I HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION 132. Electrical Powerneter-Final 33. Final Electric 80•. FOOD CERTIFICATE ISSUED NDtes: _ r 34. Final Heating & Air Conditioning 35. Final Gas Pipe•Tssi 4 I 36. Hood of Canopy _ _ - 37_ Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final - - i' i - --- 40. Gas Service -Final _ 41. Solar Domestic -Final - i - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System i -- 45. Sound Attanuation ti _ 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING r 48. FINAL PLANNING . 49. Electric Release to Edison . 50. Gas Release to Southern California Gas CAD 1 1 51. CERTIFICATE OF OCCUPANCY No. Date RNOJECT ADDRESS— UNIT: owx3n3O AIRWAY AV .AODREsS."aOSENBERG REAL ESTATE EOUITY FUND WEST—V MROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEAPORT BEACH CA 92660 ARCH/ENGINEER: ROBERT BORDERS 6 ASSOC REG.NO.: 04918 ADDRESS: 5030 CAMPUS DR UNIT: N. B. CA 92660 PERMITTEE: 3 AND P PLJMBING (714)283-3343 ADoflcss: 22801 SAVI RANCH PARK AY B YORBA LINDA A 92687 LICENSED CONTRACTOR DECLARATION: I hereby alfirm me 1 am li sad un r provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,1hat rise is i lull force effect. CITY LIC.: ()127R8/�aTAT�Euc�.:32355c s: r- -Bete:7�� ,tj_'h _-LliVIlalure: WORK RSE ' COMPENSATIDB DECIA RATION: I hereby aflirhave a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a carolled copy thereof (SectiLab. C). PGLICYNO.: 440-92UNIT4631 EXP.DATE: 1r' '31193 1MPANY: STATE FUND Confined copy is hereby furnished. Q Certified copy is til n t dty Budd wision. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: 1 is section need not be crompleled if the per(nb is for one hundred (8100) or less). 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. �� l Date: Signature: — NOTICE: II, after making this declaration. you should become subject to the Workers' Compensationtmovisions of the Labor Code. you musl.forthwith comply with such provisions or this permit shag be -deemed revoked. -- CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: MECH ROOM ENCL W/O ROOF OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prim to its issuance. also requires the giddicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I. as owner of the property or my empployees with wages as their sole compensation, will do the work, and the n structure is not intended or offered for sale (5ecllon 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through 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 for the purpose of sale). I. as owner of the property, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for Such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be prolided to me. ❑ I am exempt under Section: B. S P. C. for this reason. Date: Owner: I do hereby certify that I am aware of and understand the regVirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant w illwill not (circle one) need to comply with said state codes and the requirements for a pernut for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: — I hereby certify that I have read this application and state that the ordinances and stale laws relating to building construction and here) Property lot inspection purposes. �E a e. `✓ 2_ �.YgnefOre: Driver's License or Social Security a: ; I agree to comply with all city and county this city to enter upon the above-mentioned 164"G White—Building: Green—Code Enforcement: Canary—Apphoent; Pink—Revenue: GWdenrod—Assessor CITY Or' COSTA MESA — BUI:.D-XG PERMIT PERM�NO: P 059733 PERMIT NO: P 039733 PLAN C1:ECK NO: V GOT': N SUPP: ,N CONSTRUCTION TYPE: VN SPR PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION ; ADD 600SF MECH ROOM, 72065SF T.I. SQ FT: CLAIM VALUE: 50,000.00 CALC—VALUE: GROUP OCC: B-2 / COMMENTS: REF:B59636 Z O N I N GS ERTEBQAUCIKRSE N. E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: F1• IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REO• PROV: PARCEL: 42708302 ZNE: REF NO: PLANNING N TES> > 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; BUILDING APPROVED BY ? DATE; APPLICATION ISSUED BY: J DATE; a y LEGALIZATION:N F E E •S - M M A R Y S'T'RUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTA•IIC': MECHANIC FIRE SMTP/RES GRADING PERMIT 412.00 — 25� !;' '�. SMIP/NON—RES PLAN ISSUE FEE 20,00 BUILDING—DIV—> PERMIT ISSUE p�AL}—CBECK TOTAL PAID DUE TOTALS ---- > 412.00 20,00 '{ X0,00 432,00 432,00 .00 REVENUE DIVISION TOTALS--> COI;'LECT$D: 432.00 OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK co I N D I V I D U A IE =, F' E E B R E A K D O W N TYPE QTY D E S C R I P T I b N 1; UNIT COST TOTAL COST PLU 1 SINK, KITCHEN I— ,,; ^ 7,00 7.00 PLU 22 WASH BASIN 7,00 154.00 PLU 15 WATER CLOSET (TOILET.) 7,00 105.00 PLU 1 WATER HEATER AND/OR VENT 7,00 7.00 PLU 1 GAS PIPING SYS OF' i1 TO 4 OUTLETS 5,00 5.00 PLU 1 DRINKING FOUNTAINS-' 7,00 7.00 . PLU 6 FLOOR DRAINS 7,00 42,00• PLU 1 SEWER, CONNECTION 'TO.,BUILDING EACH 15,00 15,00 PLU 4 SINKS, FLOOR 7,00 28.00 PLU 3 SINKS SERVICE / MOP" 7.00 21.00 PLU 3 URINALS, WALL 7.00 21.00 C*7 CONSTRUCTION AND PLANNING f APPROVALS Permit # Date Inspector PC SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - r 52. Pool & Equipment Location - <. Soil Pipe-Undrgrnd. -,� jf-�Y`t'z LOD 53. Steel Reinforcement :3. Electrical Conduit Utility-Undrgrnd. t 54. Forms "4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd.- i 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation r 59. Gas Pipe, 0 Undrgrnd., Test �9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 12. Sewer Cap 1 ,//y/arLj 62. Backwash & Receptor -Final 63. Heater & Vent -Final " 13. Roof Drains 1. 64. Plumbing System -Final 14. Rough Plumbing �/,//X/Y(i 0460 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 13 Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank GGas 00iI 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat. "• 79. FINAL INSPECTION 32. Electrical Power Meter -Final j 1 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:11-q-QZ U4��C OCL 'tOt t2Hb 34. Final Heating & Air Conditioning �; [�L �(jf _GIiG •�1 z .'j• C Z [2, Pt.tfbf., OK fll 35. Final Gas Pipe -Test 7 36. Hood or Canopy - 37. Final Factory Fireplace , 38. Final Plumbing 39. Water Service -Final (�If3, I Lliter 40. Gas Service -Final - 41. Solar Domestic -Final I i 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison I- 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PRb1ECT ADfIRESS: ._ UNIT: OWNER'S NAME: ' ADDRESS: ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: ADDRESS: IICEN5E0 CONTRACTOR DECLARATION: I hereby affirm that I am licensed unser provisions of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code. and my license is in lull force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 380D. Lab. C). POLICY NO.: EXP. DATE: NIPANY: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I canny 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 WorkersCompensation Laws of California. Date: Signature: NOTICE: IL after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions at 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 which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, after, improve, demolish, or repair any structure. prior to its issuance, arm 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 and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my amyloyees with wages as their sole compensation, will do the work, and the 7J structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through 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 for the purpose of sale(. I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business El am Professions Code: The Contractors' State License Law does not appy to an owner of pmpefry who builds or improves thereon and who contracts for such projects with a contracbr(s) license pursuant to the Contractors' State License Law(. I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby cendy that I am aware of and understand the requirements of Califorma Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wil ill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Durably Management District. Residential construction applications are exempt from these provisions. Dale'. Applicant: I hereby cendy that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Dale: Signature: Driver's License or Social Security e: 1641.46 While—Buildmp: Green—Cade Enforcement Canary—Aoolicant Pink—Revenue: Goldenrop—Assassnr I PERMIT NO: P 059733 PLAN CHECK NO: 04226-92 N PAGE: 2 *#xiF#IE ie 3EiErtXE�E*�G#x**#3kiEiFRtx36#T��i4iFiE 3hiFiFiF3ex�#aEaE#*Br TE#x�#+r#u�� x-�L#�#*�EuiF#�E•##tt*x�*yEux##��E TYPE QTY D E S C R I P T I O N UNIT COST END OF FEES y i .e z 'J TOTAL COST I. CONSTRUCTION AND PLANNING r� APPROVALS Permit# Date Inspector PC : SPA APPROVALS Permit# Date Inspector_ • r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location Soil Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54, Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE t 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd, 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: f q3 M107. pzrA. 6,;4 Ok__c" 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test )) 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF BUILDING: JV.3U AlKWHY AV UNIT: OWNERS NAME IF IUIOWN: ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST -V %ROSENBERG.RE EQUITY 1301. DOVE ST SUITE 460 NEWPORT BEACH,CA 92660 ADPL. M UNO ADDREs ARCHITECT OR ENf9NEER: EUGENE BIRNBAUM & ASSOC LIc.No.: S628 ( ARCILORMIS ADDRESS: 1626 SILVERLAKE BL UNIT: L.A. CA 99026 mNTRAcTowsNoe: P. R. EQUIPMENT (619)441-0570 CONIHACTOR'S IUUUNG P. O. BOX 9005 #249 ADDRE9s: LA MESA CAuaxo., 702243 91941 UNIT, LICENSED CONTRACTORS DECLARATION: I hereby alfirm under pensEy of perjury that I son Icanaed unci« melfe em s d Chapter 9 (commenceW with Section )000) of Damian 3 of the Business and Pefassions Code, and my license is in full face and eHed. Cm uc.ho.: uc.ci.Aes: C-61 UC.No.: 702243 EXP: LK z 9 CodmdOn d_ gg�4 WNER BUILDER DECLARATION: I hereby affirm under pemiy of perjury that I am exempt from the Coarectw License Law or the fdbws, rescan (Section 7031.5 Business and professions Code: AM city or county which repu'ves a peram tp construct. emu, impress, demdah, or repair any structure, prior to res esuence, also requires the applicam for such perms to We a ignW eWamsm that he or she is licensed punuent to the provisiosa of the Contractors License Law (Chapler 9 (osmmeraiM asbh Section )000) of Damien 3 of the Business analhalf« professions Codej or l he she a exempt therehom and the basis for IM allotted exemplion. My violmdw cn San 7031 5 by any m care for a permit subjects the applicant to a call penalty of rat more than We hundred dollars (M]). ❑ 1, as awmer of IM propend or my employees with wattles as their We compensation, will do the scull, and the structure a not intended «Mored for axle (Section 70x4, Business sell Professions Code: The Contractors License Law does not appy to an bwrerof woparty who builds «improves thereon, and who does such sort Nmseff or herself «1hr«rph he or her own empkryess, provided that such improvements are not intended Cr ofCa sid for sok. 0, hoax aer, IM wiloiM or imprommw a add smitin one Year of compecion. the ..m bt dear len have the I mden of pmviM he « she did out wild or impeae for the purpose of Clue). ❑ I. as canner of the property. am exdasiaey centimmV assn U®rwd conmct«s Ce compress this project (Swan lou, Business coif Prome.l. Code: The Ceramics. License Law doss not appy to en owner of property who weds or mr pnwfs tMnson and caw cromrace, for such reenacts am a contract«la) (card pueuam to IM Contrww LMaasa Lew). ❑ I an exempt under Section: B. d P.C.. far Nm rumen: Data: Omer: I do hereby chary that I am aware of and umm atard the requirements of California Heath and Safety Code Sections 85505. 25533, end 2553x, and that I or my Mum wiloiM occupant will I will not (circa one) need to comply with will stale codes and 1M requirements for a permit l«consuuctionormalifiWionhontMA'v�y «_ ement Distrits. Rssidermal construction appiratioesremmoml from Chase proxvis . Dere: Applicant: WORKER'S COMPENSATION DECLARATION: I thereby affirm lad« penury of penjsy ons of the blowing dedaetiom: ❑ I nae. and w:i mew.:. a eenAiceta d ponsenl m sstlinsum b<wakes' asnparrwion. as pnwided f« M Sadim 3700 d tM labor cod., f« tM pulormunce d Ina wok fpr wNgn this pmdl is iasnee. j I haae.rd asii this per w«kee• ecmMy wean insumnoe, as rewired W s.ctcm 3700 d tit. Lab« code, k. tM performer a tM • wok f«which the permit m Hued. Mr wakens l Carder: µinsCV er ankInmbar ee: EXPIRES policy Number. —9 01/01/96 f7his swion need n« be completed / the parent is for ons hunded dates, I$IWI or Casa.) ❑ I candy that in IM performance of IM work for which this pemG is aeued, I "I not employ any peeon in any manner so as to become subject to the scdirs' c«npenaetion awe of CaIB«m s. and roes use B 1 shouts became subject Io 1M worbri c«eener/'y�^gpro'^/�'�/^}� ddSSedlon 37M of the Lab« Code, I mad f assn comp/OM1 Illase prat: Daze: / aJ / 4 J Applicant: M71 " /�_ Waun1n0: FAR. re sue wonrw' ceexemaedon eoaerepe 1. unlewM, arayshall arelsou m errployr to crommu P . arM nd1 Cliffs w e om hundmd thousud rimae f$10a DA In add/can m Ise coat of rnnnenaatbn, damagfs as pminesal Air In Sacd. 3)09 of de Labor Cob, Interest end tiftnI /ass. CONSTRUCTION LENDING AGENCY: I Mneby affirm under penalty of perjury ims Cham is construction conction Candi, Marcy W the Mrform«re of the sok for shich the permit m issued (Section 3091. Ca. C). LENDER'S NAME: LENDER'S ADDRESS: I cenily that I have mad thb application end pate Chet IM above iof«melion is comes. l Mee to comply with all dry end county «diners ud eW We masa Mtlip to building toastrurv«r and hereby autM¢e napreasntafnes of Che dIy to W. upon IM pe part, for inspection purposes. RUELL REEVES R/xig<CzPeat Name nDose: smature d DwnedApWAPpiavcommd« /7�J r (5151-4!1AP) Whim-ButMiq d Safety; Orem-Flu: Cumny-Appicam; Nnk-Remnw: Goldenrod-Maeaaor CITY OF COSTA MESA - BUILDING PERMIT COMMENTS: NO ALTERATION WORK, ONLY RACKS RELOCATION IN 11VERIFONE1r WAREHOUSE 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 --------- FRN)': FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708302 ZNE: MP REF NO: PLANNING NOTES> 101-121 HIGH RACK & SHELVING TO BE INSTALLED INSIDE WARE- > HOUSE PORTION OF EX. INDUSTRIAL BUILDING. 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 R DATE: Offi2 CIC BUILDING APPROVED BY : DATE-.' �y APPLICATION ISSUED BY: DATE: -1 �/i �✓ *it-k•iE*xit***iE iE ie ie ii if*it ie i6 it*'iF iF'iF 3F �F 7�3F �F3F"iF iF"iF'iF 3F iFiF F7F iF �3F iF7F7F3i£iF1F 3F iF it if iE*i6*iE** .iE �E LEGALIZATION:N F E E S U M M A R Y STRUCTURAI;SEGMENT:Y "BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RE i GRADING PERMIT 72.00 PLAN 46.80 SMIP/NON-RES �+- • 90 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN_�CHECK TOTAL PAID DUE TOTALS ---- > 72.90 0.00 '46.80 119.70 119.70 .00 y REVENUE DIVISION TOTALS--> COLLECTED: 72.90 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 72.00 �' 90 ')E 3E i(' iE')E IE iE 3F 3E iE-)E iE IE 9f 3E 9E �E IE lE ♦E fE iE iF iE *')E if iE fE lE * * iE 4E iE fE fE ♦E * iE if * * 1E 1E iE 1E 1E If 1f ii 3E iE iE k Ib iE * 1E * ♦E 9E * 9E * 3E iE 9E )E iE i{ iE lE iE iE 1f iE iE iE I N D I V I D U A L' IF,E E B R E A K D 0 W N TYPE QTY D E S C R I P T I 01,1NJI"/ UNIT COST TOTAL COST SFC 4300 STRUCTURAL BY VALUE',PER $1.00 1.00 4,300.00 END OF FEES l 01 QOi91 n34-:'019003? T -IT T - DATE: C9y 12y : 1TIt4S il:y (PERM NO: B 0741711 PERMIT NO: B 074171 PLAN CHECK NO: 03464-95 L GOVT: N SUPP: 11 CONSTRUCTION TYPE: VN SPR PERMIT TYPE: SIR PURPOSE: ALT JOB DESCRIPTION RELOCATE 12FT HIGH PALLET RACKS SQ FT: 4,300 CLAIM VALUE: 4,300.00 CALC-VALUE: 4,300.00 GROUP OCC: B-2 / COMMENTS: NO ALTERATION WORK, ONLY RACKS RELOCATION IN 11VERIFONE1r WAREHOUSE 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 --------- FRN)': FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708302 ZNE: MP REF NO: PLANNING NOTES> 101-121 HIGH RACK & SHELVING TO BE INSTALLED INSIDE WARE- > HOUSE PORTION OF EX. INDUSTRIAL BUILDING. 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 R DATE: Offi2 CIC BUILDING APPROVED BY : DATE-.' �y APPLICATION ISSUED BY: DATE: -1 �/i �✓ *it-k•iE*xit***iE iE ie ie ii if*it ie i6 it*'iF iF'iF 3F �F 7�3F �F3F"iF iF"iF'iF 3F iFiF F7F iF �3F iF7F7F3i£iF1F 3F iF it if iE*i6*iE** .iE �E LEGALIZATION:N F E E S U M M A R Y STRUCTURAI;SEGMENT:Y "BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RE i GRADING PERMIT 72.00 PLAN 46.80 SMIP/NON-RES �+- • 90 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN_�CHECK TOTAL PAID DUE TOTALS ---- > 72.90 0.00 '46.80 119.70 119.70 .00 y REVENUE DIVISION TOTALS--> COLLECTED: 72.90 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 72.00 �' 90 ')E 3E i(' iE')E IE iE 3F 3E iE-)E iE IE 9f 3E 9E �E IE lE ♦E fE iE iF iE *')E if iE fE lE * * iE 4E iE fE fE ♦E * iE if * * 1E 1E iE 1E 1E If 1f ii 3E iE iE k Ib iE * 1E * ♦E 9E * 9E * 3E iE 9E )E iE i{ iE lE iE iE 1f iE iE iE I N D I V I D U A L' IF,E E B R E A K D 0 W N TYPE QTY D E S C R I P T I 01,1NJI"/ UNIT COST TOTAL COST SFC 4300 STRUCTURAL BY VALUE',PER $1.00 1.00 4,300.00 END OF FEES l 01 QOi91 n34-:'019003? T -IT T - DATE: C9y 12y : 1TIt4S il:y CONSTRUCTION AND PLANNIN. APPROVALS Permit # Date Inspector JL &SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location..• 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement 3. Electrical Conduit Utility•Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITE l 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0-tfndrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Copnection 62. Backwash & Receptor-Final• 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # > 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank ❑ Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating Air Conditioning 35. final Gas Pipe-Test 80. FOOD CERTIFICATE ISSUED Notes: 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plurnbiog 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING / I 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date PROJECTE: 3030 AIRWAY AV AD NAME: UNIT: OWNER'S E: ROSENBERG REAL ESTATE aoGREss:EQUITY FUND WEST—V %ROSENBERG RE EQQUITY 1301 +4 NEWPORT BEACH ,CA 492 ,AflCN/ENGINEER: A660flEC.NO.: ' ADDRESS: UNIT: PERMITTEE: BROWER/BRATTAIN (909)734-0216 ADDRESS: 6982 WALLACE RD CORONA CA 91719 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) at Division 3 of the Business and Professions Code, and my license is in full farce and effect. CITY LIC.: G STATE LIC. 3332121 CLASS: B Date: —( Signature: \�� WORKERS'COMPENSATION DECLARATION: Iherebyath that l have acertifk f consent to self -insure or a cirVicate of Workers' Compensation Insurance, or a certified copy thereof (E,'echon 3800. Lab. Q. POLICY NO.: EXP. DATE: COMPANY: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION:,, (This seared need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of the work for which INS permit is issued, I shall not emplo any person in any manner so as to become subject to the Workers' Go m enation Laws of Califorma,� Date: � — D " � Signature:—lkb.�I � NOTICE: If, alter making this declaration. you 5hould6ecorre subject to theers Compensation provisions of the Labor Code, you must forthwith comply with such pmvgions or flys permit shall lifted revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm Ilial there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Qv. Q. ,�• LENDER: ••/" ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Stale License Law for the following reason (Section 7031.5 Buvness and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to fire a signed statement that he/she is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Iherelrom and the basis for the alleged exemption. Any violation at Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). I. as owner of the property or my emplCyees with wages as their sole compensation, will do the Work, and the ❑ structure is not intended or offered lot sale (Section 7044, Business and Professional Cade: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselAherself or through r his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or i improvement is sold within one year of completion, the owner will have the burden of proving he/she did not bind 0r improve lot the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who conitcls lot such projects with a COntractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. lot this reason: Date: Owner: I do hereby certify mat I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533. and 25534 and that I or any lulure building occupant wiWwill not (circle one) need to comply with Said state codes and the requirements for a permit for construction or modification from theAirAir OYabty Management District. Residential construction applications are exempt from Mem provisions, Date. Applicant: I hereby utility that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building Construction and hereby auRrOr¢e representatives of this city to enter upon the above mentioned property for inspection purposes. Date: �q^ Cli Signal Driver's License or Social Security x: 164146 While—Building; Green—Cade Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — SIGN PERMIT PERM NO: SB 062533 PERMIT NO: SB 062533 PLAN CHECK NO: 02044-93 S GOVT; N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: SIR SIG PURPOSE: OTH JOB DESCRIPTION ; CAST—IN PLACE CONCRETE MONUMENT SIGN SQ FT: CLAIM VALUE: 3,000.00 CALC—VALUE: 3,000.00 GROUP OCC: B-2 / COMMENTS: THE "VERIFONE" CO. S I G N I N F O R M A T I O N DISTRICT: 2 TYPE: GROUND ILLUMINATION: NON CATEGORY: NEW DIMENSIONS: 3FT OOIN X 8FT OOIN AREA: 24,OOSOFT LETTER HT: 20" STREET FRONTAGE 1: 300.00 STREET 1: AAIRWAY AV STREET FRONTAGE 2: 0,00 STREET 2: PARCEL: 42708302 ZONE: MP LOCATION > FRONT: X REAR: BUSINESS NAME: VERIFONE > LEFT: RIGHT: O T H E R T O T A L S G R O U N D -S I G --N.. THIS ACTIVITY 24.00SQFT OVERALL HEIGHT: 4FT _ OIN THIS SITE : 24,OOS FT GROUND CLEARANCE: OFT OIN\ ITEMS OF INFO : 2 PLANTER AREA: 100,00SQFT ITEMS FOR ACTIVITY: 2 BLDG SET BACK: 20FT COPY VERBIAGE : VERIFONE THE TRANSACTION AUTOMATION COMPANY + LOGO PLANNING NOTES: *BEit****it**k*iE1E*ititBr***iF*BEiFiE3rBtiE*iFiEiEiFk**kiE**BE 9E*kitiEBEBEiE*k*iFiF9E�*****9EEEBtBEBEk***BES**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 ZONING APPROVED BY DATE: — BUILDING APPROVED BY :—) DATE: b APPLICATION ISSUED BY: ' DATE, LEGA IBFif1EBFON:N*iEM iFiEk iFiF BE BESTRUCTUR iEY LEGALIZATION:N F E E S U M --M R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING PERMIT 54.00 24.00 SMIP/N63—RES PLAN 35.10 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 78.63 0.00 - 35.10 113.73 113.73 .00 REVENUE BLDGDIVISION PMT PLUMBING ELECTRICOMECHANIC SIGNS SMIPO/TOT/SGRADING PLAN—CHECK 54,00 .24.00 .63 35.10 k ikk ik kif if Bf*****iEklF BE k iF BE iFk iE iE if kif*its**x*�ltBF**�**,RtsEiF�r�t�+tsrsriEsr �FiE�EiFit*it iFi%iEiL'iL'SFst�riE'1E'ieiFiL'iF'iE�t iF i%iL' I N D I V I D U A L F EE B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST NO FEES WERE SELECTED FOA THIS PERMIT EXPIRED Incompate Inspectbis i '' 01 00140662-00140665 T O T 113.73 ' DATE' 06/09/93 TIME: 13:09 CONSfp.UCTIZ;N AND PLANNING APPRi)VALS Permit# Date 1. Temporary Electrical Service or Pole r 2. Soil Pipe•Undrgrnd.- 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. -5. Steel Reinforcement L6, Eiectriial UFER Grnd. V. Fnot, Ags 8. Foundation 77 77 !!! 9, Wat- g` pe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line -& Hoose Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing 15. Rough Electrical -Conduit 16. Rough Electric Wiring 77. Rough Wiring Sign 18. Rough Eiectrical-T Bar Ceiling 19. Rough Heating & Air Conditioning, 20. ,Rough FactorrV Fireplace -`•' - - = 21. Ducts, iA Strbcture' r s 22.. Duets, Ventj.1, ng _ - C _ 23. Gas Pipe -"Rough & Test -,A-s 24.:Ro6fFriiming 25. Roof Sheathing 26. -T-Bar Ceiling (Strugturall'-&-[v1o•po al `- 27. frame and FtashiN- c r 28. Lathing•& Siding 29. Insulation 30. Drywall Nailing 31. Plaster Browtr Coat `-32. Electrical Pourer Mefer-Ftrpl - - .3l -Final Eleytric 34. Final Heating:& Aii;Cl5nditioning < "85. -Final Gas Pipe -Test 36. Hood or Canopy `37. final Factory Fireptaw _ =A 38. Finai Plumbing - - �- Inspector PO & SPA APPROVALS Permit # �1 52. Pool & Equipment Location 40. Gas Service -Final f' - >r 53. Steel Reinforcement I 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE_ A' 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, 0 Undrgrnd., Test 60. Backwash Lines, P -Trap, 0 Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor -Final r 63. Heater & Vent -Final 64. Plumbing System - Final 65. Electrical -Final 66. Solar System -Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPA SYSTEMS FINAL ,j i : F1RE DEPT. REQPIR sMENT APPROSALS r PEr'm' r ' Date I Inspector r I '-'70.',_4J�c[ergroUnd Hy.73fe 71/ >oiuct Piping d4* 0 bit - 1, r, cr ?72:lUnOrground Flush= r. } -,. 773._dndergrnd. Storag?rank triaS -011 >74: Dverhega Mydro L - ,75."My Ch`61r 41,y c,. - < 76:tOry Standpipe < = A p .r •�7-. ;IXED.§YSTEM FjNALtC; 8. -IRE AEV. FINAL ° t ` I ,�HEALTWDEPT.REQUIREMENT ,< 9. 11 iNAL INSPECTI&N- 110,- 'Ui1D CERTIFICATE ISvUED `7' Notp_,_i%�yc L �-Ij S Q Ali - Iw 39.`9Vater Service -Final �1 II 40. Gas Service -Final f' - >r - T I - 41. Solar Domestic-FiQ - 42. -Backflow Preventer - 43. Backflow Irr.igation', r44. Landscape Irrigation System -45. Sound AtteltuatiorL 46. Handicap.Regulations 47. FINAL STRUCTURE&$OUILDING r' 48. FINAL PLANNING ' -49. Electric Release to Eclisc,m 50. Gas Release to Southern California Gas Go 51. CERTIFICATE OF OCCUPANCY Date �1 r v r s 71 PROJECTS NAME 3030 AIRWAY AV UNIT: OWNER''NAME: S ROSENBERG REAL ESTATE agOREss: EQUITY FUND WEST—V %ROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 ARCHIENGINEER: NEWPORT BEACH,CA 92660 REG.NO.: ADDRESS: UNIT: PERMITTEE: CALIFORNIA WIRE PRODUCTS (714)371-7730 ADDRESS: 1128 WEST BRADFORD CIRCLE CORONA CA 91720 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Invasion 3 of the Business and Profession ode. and my license is in full force and effect. CITY LIC.. CnqiS 3, 51. 7 STATE LIC.: 70 2 4 CLASS: C '3 Dare: _{_/_*5/--A— Signature: _ _ WORKERS' COMPENSATION DECLARATION: I hereby affirm tharl have acen Is of consent to self -insure or a certificate of Workers' Compensation Insurance. or a terrified copy thereof (Section 3000, Lab. C). POLICY NO.: WCP13476 EKP.DATE: 07/01/92 -COMPANY. CITATION Candice copy is hereby furnished, ❑ Ce X etl copy is riled with the city Building DiviAion. TI d / Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section neetl completed if the permit is for one hundred ($100) or less). I eerily 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 became subject to the Workers' Compensation Laws of California. Date'. Signature: NOTICE: If. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you most 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 which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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 and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (1500). I, as owner of the property or my em lenses with wages as their sole compensation, will do the work, and the 1:1 structure is not intended or o0ered for Sale(5ectlon 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon. and who does such work himself/herself or through 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 ar improve for the purpose of sale). I. as owner of the property. am excluded contracting with licensed contractors to construct the project (Section 7044, Business ❑ am, Professgns Code: The Contractors' Into License Law does not appy to an owner of property who bmlds or Program thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law)_ 1 am aware that proof at their Worker's Compensation insurance should be Provided to me. ❑ I am exempt under Section: B. & P. C. for this reason: Date: _ _ Owner I do hereby cendy 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 permit lot construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale. Applii I hereby certify that I have read this applicatio no stale that the above information is correct. I agree to comply with all city and unly ordinances and state laws relating to building detraction and hereby authorize representatives of this city to enter upon the above-ry ntioned property for nssIpeclidn p nooses. x,•^ 1 ' ' i/ Date: f_3L. I'l Signature: Driver s License or Social Security a: V 1641.46 While—Building: Green—Coco Enforcement: Canary—Apphcant: Pink—Revenue: Goldervod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: 3 053153 PERMIT NO: B 053153 PLAN CHECK NO: 02822-91 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT SOB DESCRIPTION WOVEN WIRE SECURITY STORAGE COMPARTMENTS SQ FT: 7,000 CLAIM VALUE: 7,000,00 CALC—VALUE: 7,000,00 GROUP OCC: B-2 / COMMENTS: STORAGE CAGES WITHIN BUILD+E#1E RE:*B52640 Z O N I N G S E T B A C K S R E Q U I R E M E N T 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 RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708302 ZNE: MP REF NO: PANNING N TES> INTERIOR RENOVATION TO ADD WOVEN WIRE SECURITY STORAGE > COMPARTMENTS. D E V E L l M E N T S E R V I C E S R E Q U I R E M E N T S 7.ONING APPROVED BY L( DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE:— #####################Ih7FlFiF3F3F7FTF�iFR'TFreR'ifi'r iFTF7i3F�{iF3FF�iF' '�'R'iF'ifSf7FR 1E##IF#iE##iF•if x ## ##iF7F###iE#if###iF#iE##i(-##%#i(•#ie#iF#%iF iF �f 9F#9E##if#3F iF##3F ie###iF 3F 3F#######iE iE if#3f#3E###3i##if##3F 3F fF i( LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE vSMIP/RES GRADING PERMIT 90,00 —SMIP/NON—RES PLAN 58,50 1,47 ISSUE FEE BUILDING --DIV—> PERMIT ISSUE PLAN—CHECK TOTAL. PAID DUE TOTALS ---- > 91,47 0,00 58.50 149.97', ?e149,97 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 149.97 OVER`/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP%TOT :GRADING PLAN—CHECK 90.00 1.47 '": 58.50 ####!c#################################ic######it#iF it#if#)E##If###kE�##ii•3c ii#af #3E#3e 3E##}y.## 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 UNIT COST TOTAL COST SFC 7000 ALTER BY VALU�' COMMERCIAL NOZONE 1,00 7,000,00 ). END OF FEES EXPIRED r* Incomplete Inspections Date ;±t DVE: 07/3101 TInE: 12:3: a� CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector Pool 'A APPROVALS Pe.._+# Date Inspector 1. Temporary Electrical Service -or Pole -^ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement Vj 3. Electrical Conduit Utility-Undrgrnd. ._ 54. Forms-� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 1` 9. Water Pipe-Undrgrnd. j ' �'• 60. Backwash Lines, P -Trap, ❑Undrgrnd. i --� 10. Structural Floor System ', / 61. APPROVAL TO DECK .( . 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap - S 63. Heater & Vent -Final r 13. Roof Drains ., _ .� 64. Plumbing System - Final 14. Rough Plumbing- 65. Electrical -Final �1 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring { r 67. Fencing &Access Approval 71 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1, 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Dil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing �. HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ) 79. FINAL INSPECTION 32. Electrical Power Meter -Final I i 80. FOOD CERTIFICATE ISSUED 33. Final Electric j 1 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37..Final Factory Fireplace ,L 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final s l 42. Backflow Preventer + fewnspectioru 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' i 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST—V tROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH CA 92660 ARCHIENGINEER: CAIFORNIA WIRD PRODUCTS REG.f NONFA ADDRESS: 1128 WEST BRADFORD CIRCLE UN CORONA CA 91720 PERMITTEE: CALIFORNIA WIRE PRODUCTS (714)371-7730 ADDRESS: 1128 WEST BRADFORD CIRCLE CORONA CA 91720 LICENSED CONTRACTOR DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and effect. CITY uC.:053537 STATE LIC.: 270248 CLASS: 23 , Date: -7.131 Ct I Signature: —I_ WORKERS' COMPENSATION COMPENSATION DECLARATION: I hereby affirm that I have ificate of consent to self -insure or a certificate of Workers Compensation Insurance. or a certified copy thereof (Section 3800. Lab. Q. POLICY 11I WCP13476 EXP. DATE: 07/01/92 COMPANY: CITATION Cenified copy is hereby Imnished. ❑ Certified copy is filed wind the dty Building Division. I vane: C l I Applicant. I A Al a IN& Lt /✓� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section not be completed it the permit is for am hundred 151001 or less). I cenily 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 WorkersCompensation Laws of California. Dane: Signature: NOTICE: If, after making this declaration. you should became subject to the Workers' Compensation provisions of the Labor 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 which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05269 PERMIT NO: B 052640 PLAN CHECK NO: 02255-91 L GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION WOVEN WIRE SECURITY STORAGE COMPARTMENTS SQ FT: 15,000 CLAIM VALUE: 15,000,00 CALL—VALUE: 15,000,00 GROUP OCC: B-2 / COMMENTS: STORAGE CAGES BUILT WITHIN BUILDING. IEkak 9k if Bt Rf 1E JF BE RF RE R6 ie 4E*ar iEMil9F�-k ie Jt Jf it��yr+r�r�r�Eyryr�yryr yr �t**�E yEyP*�E+ryr�E�E yE Tr�F�r*��E+r��PRE yP��P��yr yr*Sr Tr�E**�6� Z O N I N G S E T B A C K SR E Q U I R E M E N T 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 RIGHT: FT IN PARKING REO• ; PROVPARCEL: 42708302 ZNE: MG REF NO; PLANNING N TES> INSTALL SECURITY CAGES INSIDE AN EXISTING INDUSTRIAL BLDG. > MSE#*IP*iE BElEBE iFif BE IE*iP 9f iE iE iE iE itiE 3l iE iE iE 9t it iE 9f iPiP***iEiE 9E****kkil iE REiEiE 9t 9E 9P 9f*BE iE**i1- BP 9tiE REk96*9E i1 -***BE flit RP RE BE BE D E V E L O P M E N T /S E R V I C Ec SSRR E Q U I R E M E N T S ZONING APPROVED BY,�'� _� T�—� DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: E: DATfJ 3 11- Rf kiP if**BE Bf BP**BFiF**k**iE** E: iE Bf*iF9E1t BEif*BE*iEiF RtiE**SP**IE it it RE 7EBt BE Rt RE**iE BE IFiEk IE iEiERL•9t iF/�9f*iP**9E BE JP i1-*kiE 9f*****iFiF 9E IF 31- iEif kBtMk*9f 9r RtiL•*** LEGALIZATION:N F E E S`U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 162.00 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 PLAN 105.30 / 3.15 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($5001. ISSUE FEE ll I, as owner of the progeny or my employees with wages as that( sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL . -PAID DUE ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' Slate License Law TOTALS ---- > 165.15 0.00 105.3O 270.45 2 70.4.5 ,.r .00 does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself Or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or :x 1 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 • 270.45 OVER /SHORT :00 tot the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I, as owner of the property, am exclusivelcontracting with licensed contractors to construct the project (Section 7044, Business 162.00 3.15 , 105.30 ❑ and Professions Code: The Contractors' Into License Law does not apply to an owner of propertyy who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors' late License Law). l am aware {EfeBF*MiE 11- BE RE iFiE lEkiE {t iE {t M{t if fill 1l iF{e{t{e{eMif{F{EiE i1-{Eik{L•{t{E1!{F.)(.*{p*yL{{**{llik{E{EiE{E{(*{E{({E{EiF{E{(.{e{t. that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N ❑ I am exempt under Section: B. S P. C. for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Date: Owner: SFC 15000 ALTER BY VALUE COMMERCIAL NOZONE 1.00 15,000.00 1 do hereby cenily that I am aware o1 and understand the requirements of California Health and Safety Code Sections 25505, 25533, and END OF FEES 25534 and that I or any future building occupant will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modilicalion from the Air Duality Management District. Residential construction applications are exempt from these proviei0ns. EXPIRED Date: Applicant: Incomplete Inspections I hereby cattily that I have read this application and state that the above information is correct. l agree to comply with all city and county Ordinances and state taws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned " properly Ion inspection purposes. 1 I _ -•� . 1�—!�„��t �-- ( y Oat Sig Date: Z��I � I Signature. /I � h 01 000911II7—i.009!1�9 T^,"� a Drivers Li cense or'Social Secunhif: .7 DATE: 07/03.'91 711 IE ll:dx 1641-46 Whia—Build ng: Green—Code Enforcement; Canary—Applicant) Pink—Revenue; Goldenrod—Assessor CONSTRUCTION AND PLANNING POO PA APPROVALS Permit # � Date Inspector APPROVALS Permit # Date Inspector �. 1. Temporary Electrical Servie'tikx Poler, j 52. Pool & Equipment Location r - _ - 2. Soil Pipe-Undrg nd.A 53. Steel Reinforcement `^ 3::-�t`ec'tri altCor fufi_Ulilityl7ndrgrnd_ 54. Forms y 4: ElectriyaCls�•oridnitdrgrnd. r :i,. 55. Electrical Bonding - ;trSjei-fictnfrce€nt - 56. Rough Plumbing &Pressure Test 5`6..5_Elecirical4JFER6rnd. t- 57. APPROVAL TO COVER-GUNITE ?'T ftier "' �I-C el ' 58. Electrical Conduit-Undrgrnd. � 8�.;,F04tidet on- n"{' IL •1 59. Gas Pipe, 0 Undrgrnd., Test 93. NJH P? •'' n(pZhd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. � er 1 . Siructural Ioariystem �' ^ 1 61. APPROVAL TO DECK 1.1-. Prop ilt4SevSe Dne•& House'„Connection •-� 62. Backwash &Receptor -Final . I 12. Sewer;£ap'_- 63. Heater & Vent -Final •o, 13. Roof Drains- - -� _`� + 64. Plumbing System - Final ^I 14. Rough Plum6irfg -•� 65. Electrical -Final 15. Rough E%ctica7-Conduit 66. Solar System -Final 16. Rough Mctrict Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrirg•I-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. ITEOUIREMENT - tr L' -at- a; iP,pPROVACS11�.�erRSit # '� •'• '*' 20 j'Ro h Dcto'ry replace !'= t,:'� F. C (7 a x 21. Dues, in-Structute" x '-' J 7x . - H 70. , .• dergrotII+ y�jro „ • x 22. Ducts, Ventttatir% i ^S 'x - _ Vi -1'A %71. Produc • p'pi�tg ©1 s 0`Oil .. -, 23. ; Gas Pip �Rou�h & est i t>; .-+x x' .r I . Ch-✓ - -.72. Undergropf5f Flus df - 24�7Roaf Framing -Y I .1 tr Y 73!be_Ta nk'PGas (IV] Undergrnd:Stor }� h S a 25. Rogf Sht thing =.` �, v .,'�''� :� ••J> Nx 74,''- er6ad YlydrtC'-p 26. T-8af Ceiling (Structural) &'Nlonecoat -' '! 'r 7 •q'� " 75;Ory Chemical ry 27.:Trame arld F,9shi ol `u r •D x s =+� 76-�ry S�ano�!be a �' x x to a [g _28. Lathingl Sslingj* .: _<X s;� s .K 77q FIXED UY TEM 5I NA LY ^ '29. Insulati'o`n 0 �Cu •n t 78y FIRE PREY. FI�Al_ z*O r �> u- 30. Drywall^_Nai1Tg' x ; a t . - MEAL -(H -b EPTtt R£OYIRBMENT I 31. Plaster BrowaCoatis v ,.•' +' 79i" FINAL Iltt?CTI(N ,..r ,^ u32.:Electriin}Poaver161ete4Finali ' to z+. 80,gFOODCERTFI LATE ISSUED r 3. I E(c tri^ C1 - Naies: S' ':rf lY" .iv rn I w`6 I .-:Y it -Fin e) Heating&ICS q ` (,onditi nmg; : , i , ••5T 352.inal Gas Pips -Test* x ^o -'.S tr ..^•p _a(3.THoed o(:Canopy7 = ^ ' !r'- aN 1 I "'37 =Fida"1 Factory Fire0acD^ ' `S t•^ ' �o * tg I tar - ;1 ,� *' . -38&irtal Plumbing N, .... wrt .r • �- i) I x ;j I T to •'7 _ - -,39!,Water ServicerFinat: i cn +� •!I I �� • :� Ir t .r. D }. - ; to, uz .'i bas '' It ;f LiJ ' ,'40. Ser Ice-k`oinal .r, Ig �L+T'p• S.- Y Er , f• s C o -• .. :,: 41. Solar D6mes7ic-Finals C1 ••!-� *• +' 4a• * ' -42. Backflow PreventerCu 'K •-„_ ' C, C: x g.x • �; ,_ 43. BackfloGti Irijyation' 'r•S•c . x y w1 „44. LandscRe I rigatiw Systenfm r;F >; 1.n C, J 0 ;. ru y s45:=Sound Attenuation s 1'15 .r M In 'rl:e :e T oT11�te ibsPe J46_Handicaq Regulations r 05 '. ".I ; x z 47 FINAL STRUCTURE & BLALDING 'I SY 48 FINALP.LANNIN i' ' t'"t'• p ; j v ` - 1 r-49 _*Electric Release to:Edison -"t . i[I -+ ? -! -� T50.,Gas-Release to Sodhern Califufnia Gas Co :-51. CERTIFICATE OF.00CUPANCY Y s r^ to a No. Date PROJECT ADDRESS: 30310 AIRWAY AV UNIT: Dili NAME: ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST—V %ROSENBERG RE E UITY 1301 DOVE ST SU TE 460 NEWPORT BEACH,CA 92660 ARCHIENGINEffl: REG.NO.: ADDRESS: UNIT: PERMITTEE: GENTOSI BROTHERS (714)474-2333 ADDRESS: 42 CORPERATE PARK 200 IRVINE CA 92714 LICENSED CONTRACTOR DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. an y license is in full force and effect. CITYLIC.: 03223 suTE IC.:268719 S: B Date: — Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. or a call copy thereof (Section 3000. Lab. C . POLICYNO.: 80028882 EXP.OATE: 87/01/93 COMPANY: FAIRMONT Certified CODY is hereby furnished. Certified copy is fit (t/hp�m Building Division. Dale: �/ — f S �/ Z Applicant: lC, fLl'✓yLl-i EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). 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. Date: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Codeyou must forthwith comply with such provisions or INS 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 which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that helshe is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the 1:1structure is not intended or offered tar sale (Section 7D44, Business and Professional Code : The Contractors' State License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, 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 for the purpose of sale). Lp I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ` ❑ and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts lot such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: n.r. Owner: 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 wilNwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the AirOallty Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state that the ve information is c0RP ct. I agree to comply with all city and county ordinances and state laws relating to building construction and h cru repres rAalivos of this city to�nter upon the above-mentioned property too,, inspection purposes. C / Date: /'-/S �S Signature: Iff Driver's License or Social Security n: 164146 White—Buildina: Green—Cotle Enforcement: Canarv—Aoobcant: Pink—Revenue; Godenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 059091 PERMIT NO: B 059091 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE; 2 PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION T/OFF REROOF W/BUILT UP SQ FT; 20,000 CLAIM VALUE: 20,000.00 CALC—VALUE; 20,000,00 GROUP OCC: B-2 / COMMENTS: T/OFF REROOF W/ BUILT UP %##X -IF X#Sit #x#####feel ##################'1E#####x-#####-#k###'X )F##'###"X####'##X### Z O N I N G S E T B A C K S R E Q U I R E M E N T 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 RE • PROV: PARCEL: 42708302 ZNE: REF NO: PLANNING N TES> 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:'''. BUILDING APPROVED BY : DATE: t APPLICATION ISSUED BY: — DATE: t r LEGALIZATION;N F E E ,S M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRS MECHANIC FIRE SMIP'/RE$ GRADING PERMIT 207.00 SMIP PLAN ^ 4.200—RES T; ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 211.20 0.00 0.00 211.20 211.20 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 211.20 OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 207.00 = `+ 4.20 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. UNIT COST TOTAL COST SFC 20000 REROOF BY VALUE COMMERCIAL NOZONE 1.00 20,000.00 END OF FEES 3 49 3 • CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POG SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location + 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test _ 9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection' 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding i 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing 1 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: Ammilbe"G- E q- 34. Final Heating & Air Conditioning I I 35. Final Gas Pipe -Test 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING y(! g 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co I ,i 51. CERTIFICATE OF OCCUPANCY No. Date M PRDJECT ADDRESS: 3030 AIRWAY AV OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: E((��UITY FUND WEST—V ROSENBERG RE EQQUITY 1301 DOVE ST SUITE 460 ARCH/ENGDIEER:NEWPORT BEACH,CA 92660 ADDRESS: REG.NO.: UNIT: UNIT: PERMITTEE: CDI ELECTRIC INC. (310)924-6808 ADDRESS: 17117 ROSETOH AVE ARTESIA CA 90701 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am &enseo under provisions of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code. and my license is S, uMorce and effect. CITY 1u1c: 4812p STATE uc.:422855 D SC -10 Date:` nSignature:_ _ _ WORKERS' COMPENSATION DECLARATION: I hereby affirm that l havesificateofCWsenl to sell-insureora certificate ofWorkers' Compensation Insurance, or a conduct copy thereof (Section 3800, Lab. POLICYNO.:WCS 8000425-05 EXP. DATE: 10/01/93 COMPAIi CAS INDEM EX I Cerufied copy is hereby famished. XJ Certified copy, i ed v - the city Building Division. Date: 1-7"43 Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (Ris rot be competed if the permit is lar one hundred (5103) or kess). I Cortlly that in the performance of the wort for which this permit 6 issu .1 stall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: IL atter making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or itis permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction leading agency for the pehormaoce of the work for which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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 7003) of Division 3 of the Business and Professions Code) or that he/she R exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the El structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' Slate License Law does not apply to an owner at a properly who builds Or improves thereon, and who does such work himsell/herself or Inought nis 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 for the purpose of sale). as owner of the property, am exclusive] y contracting Coln licensed contractors to construct the project (Section 7044, Business Eland Prolessions Cade: The Contractors' State License Law does rat appy to an owner at Crude who builds Or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). 1 am aware that Waal of their Worker's Compensation insurance should be provided to no. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale, Owner I do hereby Oe My that I am aware of and understand the requirements at California Health and Safety Code Sections 25505, 25533, and 25534 antl that I or any future building occupant will not (circle One) need to Comply win Said state codes and the requirements for a permit for construction or modification tram the Air Ouabty Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state in the above i lion is correct. I agree to comply with all city and County aminances and state laws relating to building constructions hrebyaa orverepresentatives of this day to enter upon the above-mentioned property for inspection purpose,. Daae. '. 1 .41 3 Signatur . Driver's License or Social Security 4: 1641-46 White—Building: Green—Code Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 060575 PERMIT NO; E 060575 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTION TYPE; PERMIT TYPE; ELE PURPOSE; OTH JOB DESCRIPTION ; INSTALL SIX ELECTRIC MOTORS FOR CONVEYOR SQ FT; CLAIM VALUE; 10,000.00 CALC—VALUE; GROUP OCC; B-2 / COMMENTS; THE "VERIFONE" CO. kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk 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 RES: PROV; PARCEL; 42708302 ZNE; REF NO; PLANNING N TES> > k kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk D E V E L O P M E N T S E V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY ; DATE; APPLICATION ISSUED BY; DATE; k kkkkkkkkkkkitkkkkkkkkk kkkkkkkkkk kk kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 18 00 �0% SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 18.00 15.00 0.00 33.00 33.00 .00 REVENUE DIVISION TOTALS--> COLLECTED- 33.00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 33.00 kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk 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 UNIT COST ELE 6 MOTOR/POWR APPARATUS 0.0 — 1.0 HP 3.00 END OF FEES m TOTAL COST 18.00 C^k CONSTRUCTION AND PLANNING POC SPA Date APPROVALS Permit #� Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Seryice or Pole;, - �_ 52. Pool & Equipment Location 2..Sgi)pipe-Undr9crld,.• j 53, Steel Reinforcement I ' •� = $. _EreeTritat Conduit Utility-Undrgrnd; • 54. Forms e d4ljctr[Eal Condwt-Updrgrnd. - 55. Electrical Bonding r it, Reinforcefiie _,*�-= 56. Rough Plumbing & Pressure Test _ iec4nyal UFER Z;rnd. 57. APPROVAL TO COVER-GUNITE w ,� ,r a 7„Foot'%tgs j 58. Electrical Conduit.Undrgrnd. _ 8,0wriootion -•t ,.'' e i... 59. Gas Pipe, 0 Undrgrnd., Test r 11=Wa of Pipe-Undrgrnd. '• Y .� 60. Backwash Lines, P -Trap, 0 Undrgrnd. - � . I.zq S(ru Aral Floor System, �r.� 61. APPROVAL TO DECK it. Pro�Zt_.y Sewer Line;& House Connection 62. Backwash & Receptor -Final 12. Sewer,Cap -- I 63. Heater & Vent -Final 18► Roof Drains. 64. Plumbing System - Final i 14. Rough Plumbing l 65. Electrical -Final 15. Rough Electricol-Conduit i 66. Solar System -Final 16, Rough Electri8ANiring j 67. Fencing & Access Approval 17. Rough Wiring 9gn z 68. APPROVED FOR PLASTERING 18. Rough ElectriczaiT Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19._Rotggh Hearin &Air Conditioning VOUIREMENT _ ' - - 20 ftoq9h FLactgt�Y F�rgpla e z ` - 21:-D4ts, if StrBdtUnX 7- v- Uiidergir7GS -,Hydro x -70. 22.s-0ucis, Ykntilating = y 2 _ X71. ProductRlpirg 0(9as C,Oil .y 23. Gas^Pipe-Routjh &-Fest ��_> -� -i• •: J K u• _72. Undergro&nd FI si+") x - _ 24.`floof Framing = - z X73=Undergrnd Storal}_Tank ]Gas 005 _.K> 25. Ro&t Sgathing > T �• > .� iJ +: + 74: Overhead Hydro=• 26..T -Bae Ceiling (StcLctural) &RApnpcoat R -_ `' �� ;. 75.7gDry Cherrlycal • j x `' • 27,.Frame and F•t3shing - (- :• a z : 76. Dry Stand it:e .28. Lathingt SgingT ; r :'� '- r j « 777FIXED S${EffrINAL s • C: 29. Insulation _• _ * Z ( 78SFIRE PREY. FINE, V T30. DrywallUNaitf�g - ``''' = LjFALTttD�PTxRE0U1REMENT 1131. Plaster Brown Coate ;r79. FINAL INSI?ECTIOSV •• , �32P�lectrlctil Porvaer MePr-Final; ` $O.-TOOD CERTIFI'�C-ANTE IS$4D S >33_ iQ' E[ectri>;._Nowa" 1 y - f :^'. x -- C g .030-16ting=&Ai)Conditiohiag ?ego- .35i*inel Gas Pipe-Testi _37. Final F34tory Fireplace -38. Fina) Plumbing Cs x ru _ r'39. Water Service -Final ` T ( ai0. Gas Sero7ce-Final .:. a 1. Solar Da`�estic-Final `.� •• a .:.t i .;; �. .� _ *_ 42. Backflocsi Preventer, -_ CV - I i-- 43. Backflow Irrgation k ,� �` - ,44. Landscg�e lerigatlon SystemL' * " �' -" �" - CU n, w,= -7 X .. ''45. Sound AttepUatiori :' F ;r, .i « v46. •Handicap Regulations - 4 r T ' 147. r1=1ii} tL STRaCTURE & BUaDING 48:: -FINAL PLANNING I I, r;� t n ti I 17 9. Electric Release to clison ' 'S 50. -Gas Release to Southern California Gas Co � rt = �o 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME: ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST—V %ROSENBERG RE E UITY 1301 DOVE ST SU TE 460 NEWPORT BEACH,CA 92660 ARCHIENGINEER: SEI ZMI C REG.NO.: C 2 5 9 6 9 ADDRESS: 14180 LIVE OAK AV UNIT: I BALDWIN PARK CA 91706 PERMITTEE: ERECTIONS UNLIMITED (213)585-1902 ADDRESS: 5939 RUGBY AVE D HUNTINGTON PARK CA 9255 LICENSED CONTRACTOR DECLARATION: I hereby affirm I I a I rated under provi n of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code, and erase i . Ifor effect. CITY LIC.: STATE LIC.: 36757 s . Dale'/ Signature: _ WORKE 5'CO N ATIDNDECLABATION: Thereby affir hall have a ceniliwt consent to sell -insured enilicale of Workers' Compensation f�{sy��$cgE cft�ilie py thereof (Section 3801. Lab ) POLICY NO.: 61M � §V Ll EXP. DAT 2/01/ 9 COMPANY: STATE FUND 01hatm opy is reby furnished. [N Cendied copy a f with I again 'Sion. DatApplicant: EKEORKERS' COMPENSATION DECLARATION: section need not be canpailad if is la we hundret(5f00) or less). I cet e performance of the work for which this permit is issued. I shall not employ airy rmn in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. after making this declaration. you should became subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a Construction lending agency for the performance of the work lar which this permit is issued (Sectioe 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any City 01 County which requires a permit to Construct, alter, improve, demolish, or 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 at the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Busier am and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty at act more than live hundred Odgers ($5110). I. as Owner of the property at my emgpyees with wages as their Sale compensation, will do the work, and the ❑ structure is not intended or Offered for Sale (Section 7074, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who Colds or improves thereon, and he does such work himself7hersell or through his or her own employees, provided that such improvements are not intended Or offered for sale. It, however the building or improvement is mid within one year of Completion, the owner wi0 have the burden of proving he/she did not hard or improve for the purpose of Sale). 1. as Owner of the propen4am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State Litenm Law does nod apply to an owner of propewho bueds or improves thereon rly and who Contracts for such projects with a conlractor(s) license pursuant to the Contractors' $late License Law). I am aware that proof of their Worker's Compensation insurance should be provided to race. ❑ I am exempt under Section: S. 8 P. C. lot this reason: Date: Owner I do hereby certify that I am aware Of and understand the requirements at California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (cirde one) need to comply with mid state codes and the requirements far a permit far Construction or modification tram the Air Beauty Management Distinct. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby cendy that l have read this application and state that the ordinances and §Iale laws sling to building construction and here propeIV tour i D2dtion muses. Dai¢: Signature i sill social Security «: comply with all city and county enter upon the ahove-mentioned 1641.4fi Wnue—Ruibino: Green—Cade Enforcement: Canary—ADalicam: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06044 PERMIT NO: B 060443 PLAN CHECK NO: 04466-92 L GO T: N S P CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION : INSTALL PALLET RACKS SQ FT: 52,000 CLAIM VALUE: 52,000.00 CALC—VALUE: 52,000.00 GROUP OCC: B-2 / COMMENTS: REFER TO PC# 3172-92A FOR STRUCTURAL PLANS xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Z O N I N G S E T B A C K S R E Q U I R E M E N T 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: 42708303 ZNE: MP REF NO: PLANNING N TES> INSTALL 14' HIGH STORAGE SHELVES INSIDE AN EXISTING INDUST. > BLDG, NO FLOOR AREA BETWEEN SHELVES PROPOSED. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*7t+F+Fxxxxxxxx D E V E L O P M EN 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: LT / ` Z Z3 112111.. L BUILDING APPROVED BY : DATE: /�L APPLICATION ISSUED BY: DATE: x xxxxxxxxxxxxxxxxxxxxx xxxxxxxxxx xx x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx'xxxxxxxxxxxxxxxfFxxxxxxxxxxxxxxx LEGALIZATION:N F E E S U M M A R Y STRUCTURAL, SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 423.50 SMIP/NON—RES PLAN 275.28 10.92 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 434.42 0.00 275.28 709.70 709.70 .00 REVENUE DIVISION TOTALS--> COLLECTED: 434.42 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 423,50 10.92 x xxxxxxxxxxxxxxxxxxx9lMxxxxxxxxxxxxxxxxxxxxxxxxxkxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx 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 UNIT COST TOTAL COST SFC 52000 ALTER BY VALUE COMMERCIAL NOZONE 1,00 52,000.00 END OF FEES CONSTRUCTION AND PLANNING APPROVALS Permit #�- Date Inspector PO. y SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. ,Pool & Equipment Location 2. Soil Pipe•Undrgrnd. ", 53. 'Steel Reinforcement 3; -Electrical Conduit Utility-Und}grnd' 54. Forms 4. Electrical Conduit-Undrgrnd. -- 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . 6. Electrical UFER_Griid. 57. APPROVAL TO COVER-GUNITE 7. F6otings -. 58. Electrical Conduit-Undrgrnd. ' ,8.. F,¢vndation 59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & Houswrgnnection , ; 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbipg 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 i 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT r,. 1 ; 1 APPROVALS Permit # .i ' t 20. Rough Eactory Fireplace ` r T * r 21. Ducts, in Structure; I •• � `,70. Underground Hydro 22. Ducts, Ventilating = .. 71, Product Pipi)tg O Gas Q Oil 23'.Gas Pipe;Rough &'last Cr. +72. Underground Flush. •` + 24. -Roof Framing - r-• -73.,Undergrnd.Storage'Tank OGas 00il 25. Roof Sheathing • - '� , 74-: Overhead Hydro 26:_T -Bar Ceiling (Structural) & Monocoat _ 75; Dry Chemical - 27. Frame and Flaship� 76. Dry Standpipe i 28. Lathing & Siding a 77.FIXED SYSTEM FINAL '29. Insulation ° 7$.: FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat` 'I 79. FINAL INSPECTION 32: Electrical Power Meter. -Final l .80. FOOD CERTIFAOATE ISSUED 33. Final Electric •' Notes:. .:34. Final Heating & AirgConditioning: i 35. Final Gas Pipe -Test' 36. Hood or Canopy 37. Final Factory Fireplace .38, Final Plumbing 39. Water Service -Final - - - 40. Gas Service -Final 41. Solar Domestic-Final�_ 42. Backflow Preventer 43. Backflow Irrigation - - 44. Landscape Irrigati6n System •.45: Sound Attenuation _46. Handicap Regulations 47. ,FINAL STRUCTURE &BUILDING F -i- - I' 48. FINAL PLANNING e 49'. Electric Release to Edison 50. Gas Release to Southern California Gas Co t, 51. CERTIFICATE OF, OCCUPANCY NO. Date PROJECT ADDRESS: 3030 AIRWAY AV UNIT: OWNER'S NAME:ROSENBERG REAL ESTATE ADDRESS: EQUITY FUND WEST—V %ROSENBERG RE E UITY 1301 DOVE ST SU TE 460 NEWPORT BEACH, CA 92660 ABcxlExcINEER: NEG.NO.: ADDNESS:ASHTON VANCE b ASS`O� 25 o�I' 987 4. FOOTHILL BL CLAREMONT CA 91711 PERMITTEE: AWNINGS UNLIMITED, INC, (714)533-4772 ADDRESS: 1773 W. LINCOLN F ANAHEIM CA 92801 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.:580083 CLASS: C -U Date: 1-z`�—�17 Signature: �C� WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a Candidate of consent to sell -insure or a certificate of Workers' Compensation Insurance. or a certified copy thereat (Section 3800. Lab. C). POLICY NO.:1277359-92 EXP.OATE: 12/01/93 COMPANY:STATE FUND Certified copy is hereby furnished. 91 Certified copy is filed with the city Building Division. Dale: 023 Applicanti'�Ly�/ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This seClion need am be Completed if the permit is for one hundred (5100) or less). 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 suOject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: Il. after making this declaration, you should become subject IO the Workers' Compensation provisions Of the Labor 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 which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or 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' Slate License Law (Chapter 9 (Commenting with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Iherehom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500). I, as owner Of the property or my empployers with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered lot sale(Secuon 7044, Business and Professional Code: The Contractors' Slate License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/hersell or through 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 for the purpose of sale). I, as owner of the property. am exclusivelyy contracting with licensed contractors TO construct the project (,Section 7044, Business ❑ and Professions Cede: The Contractors' Slate License Law does not apply to an owner of prOpert who builds or improves thereon and who contracts for Such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. '❑ I am exempt under Section: B. 8 P. C. for this reason. Date: ` Owner: 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 ar any load building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dare: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stare laws relating to building construction and hereby authorue representatives of this city to enter upon the above-mentioned property lar inspection purposes Date: ,>2—.� 7 Signature,XIKL+�— f Driver's License or Social Security a: 1641-46 White—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT --------- PERM NO: B 061130 PERMIT NO: B 061130 PLAN CHECK NO: 00614-93 S GOVT: N SUPP; N CONSTRUCTION 'TYPE: PERMIT TYPE: STR RGHT: FT PURPOSE: ALT JOB DESCRIPTION : INSTALL AWNINGS IN FOUR (4) LOCATIONS SQ FT: 11,000 CLAIM VALUE: 11,000,00 CALC-VALUE: 11,000,00 GROUP OCC: B-2 / COMMENTS: FOR THE "VERIFONE CO," / FOUR LOCATIONS ON ONE BUILDING, %%x%%%�F%*�F�F�F%%��L%�r�%Trx %� x%� %*�F*%%%%� TE �E%�F %%%%x*� %xx %�F*�E �6>E � %x �Fx� %�F*�F FRF x *%%x•Tc �F�F�ETF�F% Z 0 N I N GS E R T E B Q A U C I K R S E M E N T 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 REO• PROV: PARCEL: 42708302 ZNE: MG REF NO; PLANNING N TES> ADD AWNINGS TO AN EXISTING INDUSTRIAL BUILDING, D E V E L O P M EEN T S E R V I C E S R E Q U I R E M E N 'T-' S ZONING APPROVED BY : 6L E . DATE: 2�2�I�43 BUILDING APPROVED BY : S APPLICATION ISSUED BY: LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 126,00 PLAN 81.90 DATE: STRUCTURAL'SEGMENT:Y il FIRE SMIP/RES GRADING SMIP/NON-RES 2,31 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 128,31 0,00 81,90 210,21 210,21 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 210,21 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 126,00 2.31 81,90 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 UNIT COST TOTAL COST SFC 11000 ALTER BY VALUE COMMERCIAL NOZONE 1,00 11,000,00 END OF FEES CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POI. S SPA APPROVALS Permit#" - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 66• Electrical Grnd. 57. APPROVALTO COVER-GUNITE 7.. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10, Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65, Electrical -Final I 15. Rough Electrical -Conduit 66, Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval I 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding i 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing - 1 I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat _ 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning I, 35. Final Gas Pipe -Test ' 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing - 39. Water Service -Final 40. Gas Service -Final i 41. Solar Domestic -Final I 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING I 49. Electric Release to Edison i - ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ,v PROJECT ADDRESS: 3030 AIR>:AY AV UNIT: OWNER'SNAME: RREE WEST—V -INC AD DRESS:IIROSENBERG RE EQUITY 1301 DOVE ST SUITE 460 NEWPORT BEACH,CA 92660 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: THE BAKER COMPANY (714)835-8j72 ADDRESS: 1202 HUNTER SANTA ANA CA 92705 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. an se $ in full force �and effect. CITY LIC.: 4'] -4q STATE LIC.: 4 CLASS: _n f 4 S ig 9 2 c- 441e: / 4.3 Signature: _ _ WORKER COMPENSATION DECLARATION: hereby a m that I have a certificate of consent to sell -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof ( clion 38DO. Lab. C). POLICY ND.: WC 7115194 3 24 EXP. DATE: 07/0 1 / 9 3 COMPANY: CNA INS CO ❑ Celified cop is hereby furnished./[o Climbed py is file ith the pity Buildi Division. Applicant: EXEMPTION ROM A KERS' COMPENSATION DECLARATIO (This section need not be completed it the permit is for one hundred (500) or less). I cerufy that in the performance of the work for which 1 permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Cali rnia. Date: Signature: NOTICE: II. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cone. 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 which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby alfirm that I am exempt Irom the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct. atter, improve. demolish. or 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 ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cool or that be/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500). I, as owner of the property or my employees wild wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale(Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property, who builds or improves thereon, and who does such work himsetNhersell or through 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 for the purpose of sale). I, as owner of the propel. am exclusive[ y contracting with licensed contractors to construct the project (Section 7044, Business El and Professions Code: The Contractors' State License Law does not apply to an owner of proper%who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Stale License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: a. B P. C. for this reason: Date: Owner Ido hereby coldly that l am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any loon building occupant Al not (circle one) need to comply with Said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and stall ordinances and slate laws relating to budding consiruclio properly fof on purD ses. sale: Signature: Driver's License or Social Security •: 164146 Wrlje—Rulldmg: Green—Cede is correct.) agree to comply wild all city and county itativepjof this city to enter upon the above' mentioned Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: F 062229 PERMIT NO: F 062229 PLAN CHECK NO: 01626-93 S GOVT: N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: OTH JOB DESCRIPTION BACKFLOW RETROFIT CLAD VALUE: 3,600.00 CALC-VALUE: SQ FT: GROUP OCC: B-2 / COMVENTS: THE "VERIFONE BUILDING" Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING FRNT: ^T IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGFT• FT IN LEFT: FT IN RGHT: FT IN PARKING REO: PROV: PARCEL: 42708303 ZNE: REF NO: PLANNING N TES> > 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: BUDDING APPROVED BY DATE: ��/^^-- APPLICATION ISSUED BYDATE _3 ( Ir 7� APPLICATION#ISSUE#####.... T#'aiF# i # #iFx x t ########## ;'3i• lF £## ALPIIIUNINLILIPIPAIIIPI#IIUTA###U###IIIII#LII#U##UIII#I#TPIIUPUNU##########IRU# LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING PERMIT 63.00 658 SMIP/NON-RES PLAN 40.95 ISSUE FEE BUILDING -DIV->( `-PEPYIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 63.UC 0.00 40.95 103.95 103.95 •00 REVENUE DIVISION TOTALS- > COLLECTED: 63.00 OVER/SHORT: 00 BLDG PMT PLUMBING ECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN -CHECK 63.00 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 UNIT COST TOTAL COST FIR 63 FIRE EQUIP FEE (FROM BLDG VAL TABLE) END OF FEES 1.00 63.00 01 00139344-00139340 TOT 63.00 , DATE: 05/17/93 TINE: 14:34 CONSTRUCTION AND PLANNING" APPROVALS Permit # Date Inspector nr Pu -JL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Servicer -or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - r -' 53. Steel Reinforcement , - 3. Electrical Conduit Utility-Uh8rgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding% 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrica! LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd- 8, Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. •- 10. Structural Floor System 61, APPROVAL TO DECK 11. Property Sewer Line & House,Connection ,.} 62. 8ackwash & Receptor -Final 12. Sewer Cap " - 63. Heater &Vent -Final 13. Roof Drains - 64. Plumbing System -Fina! - 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 ElectricakT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 23. Gas Pipa-Rough & Test 71. Product Piping 0Gas 0Oil 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank 0 Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 30. Drywall Nailing 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notas: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Oomestic-Final f• 42. Backflow Preventer 43. Backflow Irrigation a '•r' 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING r •� 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date MMq Applt�...-___......,\ Anm heavy Dor er liber...:__ CY�OF COSTA MESA PE3g�coIT NO.- 4;0- to^O-•!'l. . NO. LOT N (`N$'Rucn!DNP,ERMIT C> - s� 4'tj5 -Project Addiess `' O CU, TYPE OF CONSTRUCTION 0NEW EJ ADD _�4LALTERAT Applicant's Mailing'AQJ are/�/S_Q ,/ - 11 CONVERSION 11 DEMOLISH ❑ OTHER Owner's Name W'T-�' _ Ph..neL T DESCRIPTION OF WO Address 1_1a�� S3/5-33 Z declarations. REPAIR TYPE OF PERMIT GRADING FOUNDATION. IC11 STRUCTURAL Arch/Eng. Lice Se No El g'ELECTRICAL PLUMBING MECHANICAL (� Address�s ❑ OTHER PROJECT DESCRIPTION SO. FT.0 , OCCUP Contracto6OPhone.Ypp��yyN 5f� . Date Signature Address(mailing) ` p� 0 -' jib -1 City License No. Qor_ 9 - _ CONSTRUCTION TVP- UATION$ ZONE ✓-N GRADING U.YDS. A( - Floor Sinks _ LICENSED CONTRACTOR DECLARATION Remarks: comply with, such .ENDI G, or this Oermit'shall be deemetl revoked. CONSTRUCTION_LENDING,-AGENCW - 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing 1 hereby affirm that there is a construction lending agency for the performance of the workfor hlahst his permit is, issued. -(Section, 3097 Civ. C.) _ , Lender's Name- _ with section 7000) of Division 3 of the Business and Professions Code, and I my license is Inall II forcea�qv} f�e�t� st �n Cl- `(�.•...�.c.-K sT3�•JGN^-'s'< �� ense No. X4.7 %3 fC - O , Slgndl ire �A . WORKERS' COMPENSATION p�C ARA N - of P—Trap P - PLUMBIN - Bar Sink Showers _ Backflow Preventer Service Sink - the Contractor'SLLlcense Law (Chapter 9 (commencing, with Section 70 00)of Division 3 of the Business and Professions Cotle). or that he/she f exempt I hereby affirm that I have a cer4UiCa to co sen nsure or a certificate of Workers' Compensation Insurance,.or a certified copy there (Section Backflow Irrigation Sewer Cap: ' .- 3800, Lab.,��C r/� �` _ O,J Po licy Noompany . 11 Ce rtifled copy1s hereby furnished. - Bathtubs ` Sewer Connection License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own Cer }letlfq py-itf with the cit di • Date/%"T c' Appllcenn _Lt N _ Clarifiers '+- Solar Collectors pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). EXEMPTION FROM WORKERS' OMPE SAT DECLARAT N (This section need_not be comp) ed If per It for one huncir ($100) or Dishwasher '$olar'Piping , less). ,.� P. - I certify that In the performance n the work for which this permit Is t to t I shall not employ any person In any manner so as to become subject to the Drinking Fountains 9„ Floor Drains to Workers' Compensation Laws California. , Date Signature 2 NOTICE: If, 'm enationralkn this declaration, you should become subject to Floor Sinks _ Workers' Compensation prions) ons of.the labor Code, you must forthwith ith Gas Service Outlets comply with, such .ENDI G, or this Oermit'shall be deemetl revoked. CONSTRUCTION_LENDING,-AGENCW - Interceptors' 1 hereby affirm that there is a construction lending agency for the performance of the workfor hlahst his permit is, issued. -(Section, 3097 Civ. C.) Kitchen Sink - Lender's Name- _ Lender's Address OWNER BUILDER DECLARATION - - Z Lavatories - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5.Business and Professional Code: Any city or .unly which requires a permlt'lo construct, alter, improve, demolish or repair P—Trap P 'Roof Drains' _ iy structure, prior to Its Issuance, also requires the applicant for such permit file a signed statement that he/she IS licensed pursuant to the provisions of - the Contractor'SLLlcense Law (Chapter 9 (commencing, with Section 70 00)of Division 3 of the Business and Professions Cotle). or that he/she f exempt therefrom and the basis for the alleged exemption. Any viola t ion of Section Reinspection Fee $25 7031.5 by any applicant for a permitsubjects-the applicant to a civil lLenalty of not more than five hundred dollars ($500). U I, as owner of the property or my employees with wages' as their sole compensation will do the work, and the structure is not Intended or offeredfor sale (Section 7044, Business and Professional Code: The Contractor's , Boiler - License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own Duct- Under Ground employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). Duct - Structural I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code:7) The Contractor's License Law does not apply. to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). ❑ lam exempt under Section B. & P. C. for this reason Duct - Ventilating p{ xhaust System,cv Multiple Firepl/Fact. Blt. ICBO Date Owner Heating System & Ducting I hereby cert lfy that I have read his appuwtion antl state that the above _s—_... : _ _:.. 00-100,000 BTU ❑100,000BTI Signature �'e- Drivers' (temp—,6 SS CMF 0865-46 rev. 7/83 FEES Solar Tank. Swimming -Pool w/Spam .4 Urinal i 2 We ter Closet; Water Heater : L Water Service -- Zoning`APProved'BY 7 Date Application Approved By ' Issue Fee $ 3 4NICAL FEE Hood or Type ❑ CanOPy Type l l ❑', Refrigeration System`` 0-100,000 BTU X00,000 BT System Repair/Alteration upon the above-mentioned property for I Date// -9—S Reinspection Fee $25 Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 •_r \ L _ qj _ � 5=2D I i /09l7 771 Pr A.P. # 427 S Main Building: E T Front• B Rear A C Right ' K S Left Ping' Ref. # Parking Req./Provid Use of Building: Planning Notes: .7 Automatic Washer, Cooking -Unit Dishwasher Dryers ❑Gas❑EI Fan. I Fixtures r— �. p 2 Zone Accessory Building: Park.Fees $ ^ . r ELECTRICAL Outlets 7 Switches -� Garbage Disposal Generator 00-5 KW 135-15 KW Transformer Z 15-50K W 0,56'- 6W' i I Meter -❑up to 100 amps -- .Motors LJ 0-1 HP 1�?11 %, - 8 ,Ina Solar'❑9-15 HP ❑16-15+ Microwave Pole'Light Standing Sections Trash Compactor 71 Vs N G R E O U .. R E M E INT Reinspection Fee 1 $25 .Issue Fee $ 3 'PUBLIC SERVICES REQUIREMENTY.. - Zoning`APProved'BY Date Application Approved By A_ ppli(xtion Issued By - Dat � 4 - SUMMARY OF FEES /�•w BUILDING PERMIT $ 00 SMIP $ PLAN CHECK $' PERMIT PLUMBING $ •' 23.00 'ISSUANCE $ , ;PLAN CHECK $ ENERGY P.C. $ ELECTRICAL $ 2r ci0 GRADING $ PLAN CHECK $ MICROFILM $ MECHANICAL $ — � /• J 7 22 TOTAL FEE $ • PLAN CHECK $'f!2 l AV / / CONSTRUCTION AND PLANNI. APPROVALS Permit 4# 1. Temporary Electrical Service or Pole Date Inspector .OL & SPA APPROVALS Permit# 52. Pool & Equipment Location Date Inspector 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms (1. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test 6." Electrical LIFER Grnd. 57.'APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 16. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. ,Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection i� �; 62. Backwash & Receptor -Final 12. Sewer Cap .63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical=Conduit .,�[ 66. Solar System -Final 16. Rough Electric Wiring , C� 67. Fencing & Access Approval 1 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling )! 69. POOL/SPA SYSTEMS FINAL 19. Rough,l-leating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 1. Ducts, in Structure _ 70. Underground Hydro 4x.22. Ducts,, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush ,f4. Roof Framing 73. Undergrnd. Storage Tank El Gas 0Oi1 5. Roof Sheathing 1. 74. Overhead Hydro if 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .27. Frame and Flashing- gj 76. Dry'Standpipe 28. Lathing-& Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. -FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final ,80'. ;FOOQ'CERTIFICATE ISSUED 33. Final Electric• iNotes: •• - •• ' 34. Final Heating & Air Conditioning ZZ -V //� B 35. Final Gas Pipe -Test lr, p �-� ` Q!o •wq C, N 36. Hood or Canopy 37. Final Factory"Fireplace 38. Final Plumbing Z- 39. Water Service -Final F " 40. Gas Service -Final 41. Solar Domestic -Final ` caq 42. Backflow Preventer 43. Backflow Irrigation ' J: 44. ,Landscape Irrigation System , 45. Sound' Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING T 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release toSouthern'CaliforniaGas Cd 51. CERTIFICATE OF OCCUPANCY No. Date •V^ 1 Applicant to fill In all spaces except those wftn....aeavy border lines and sign all appropriate declarations. CITAOF COSTA MESA 'CONSTRUCTION PERMIT Project Address 030 /a / K W .9 bJ V/5 Applicant's Mailing Address �' 6 U %' (1 C k /� R 'P A, Owner's Name - LIV /ti Q L�/ `—S /' phone3 HS -3 3c+% Address 303✓:ia(TCWAvl AV'Ti Arch/Eng. License No. Address Contractor's Nam Phone$-' �jq0 Address (mailing) k 60 . T UC N , 'dA -C /T 05 2i1'�r City License No. ' S. 3 8-5-- y n.s 5 LICENSED CONTRACTOR DECLARATION I -hereby affirm that I am licensed under provisions of'Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ';cense Class G _ig at Licen a N B ate / /"/ L'f `Sr •i Signature T�rT �sfi/ e WORKERS' COMPENSATION DECLARATION ' I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of -Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. ZSR-�I - ;4 Company 140P'1 /l G.ANQ �ry'I Certified copy is hereby furnished. 114 Cer IBetl/copy�is {fled with the city Building Division. Date a'/ 3 Applicant EXEMPTION FROM WORKERS'•COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). r 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers'. Compensation pr0vls1onS'0f the 'Labor Code, you must forthwith comply with such provisions -or-this -_permit shall be deemed revoked. CONSTRUCTION. LENDING AGENCY - a I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is - issued (Section .3097 Civ. C.) Lenders' Name. Lender's Address OWNER BUILDER DECLARATION - I hereby_ affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professional Code: Any city or �ounty which requires a permit to construct, alter. Improve, demolish or repair Division 3 of the Business and Professions Code) or that heshe Is exempt therefrom and the basis for the alleged exemption. Any viola Ion of Section 7031.5 by_ any applicant for a permit subjects the applicant to a civil l�enalty of not more than five hundred dollars ($500). I, as owner of the property or -my employee; with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to anowner of a property who builds or Improves thereon, and ;Who does such work himself/herself or through 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 com- pletion, the owner, will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). L1 'I am exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have read this application and state that the above information is'correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter, upon the above-mentioned Property for ur inspection os. Signature Js+�. Date 6 _ 7S;;144 I Accessory Building: Z TYPE OF CONSTRUCTION LJ NEW LJ ADO Ll ALTERATION El REPAIR — ,CONVERSION ❑ DEMOLISH ❑ OTHER. - A.P. DE)CRIPTI-� N OF WORK lJ V Ac's, L^^• - S Main Building: R E Q U TYPE OF PERMIT RADING FOUNDATION ❑ STRUCTURAL Y Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB $ $ $ $ $ $ 'CASr.S-a ❑ BOTHER Rear , N ELECTRICAL Right ' PROJECT DESCRIPTION SQ. FT. OCCUPANCY K - CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS: ACRES Ping. Ref. # Remarks: ' Parking Req./Provided Pole Light Use of Building: PLUMBING FEES Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories - P—Trap _ 'Roof Drains l -Reinspection Fee,. S25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Multiple 0, Firepl/Fact. Bit. ICBO # Heating System & Ducting 00.100,000 BTU 0100,000 BTL Drivers' License or 55 1P Reinspection Fee r I. $25 CMF 0865-46 rev. 7/83 White '- Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor . - u Showers . Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank , Swimming Pool w/Spa Urinal .Water Closet Water Heater Water Service j Issue Fee- I IANICAL Hood or Type 1' ❑ Canopy Typell ❑ Washer Cooking Unit Dishwasher Fan' F.A.U. - I Fixtures Device Boxes 1 Outlets Switches Garbage Disposal - Generator 065 KW $3 E10-100,60OBTU 0100,0008T System Repair/Alteration i Issue Fee Zone Accessory Building: Z $ 3 O N I N Date Date G R E Q U Park.Fees $ - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK $ $ $ $ $ $ $ $ SUMMARY OF FEES / �r OD %•.5-O SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ 'CASr.S-a R , E M E N ELECTRICAL S .FEES Transformer 0 15150 KW 0 50+ KW ' Meter Dup to 100 amps - Meter Dover 100 amps ' Sub Panel Motors 00-1 HP ❑1'h-8 _ 1 Ina Solar.F-19-15 HP 016-15+ ' Microwave Pole Light Range Sign Standing Sections 15 KW Trash Compactor Reinspection Fee 1 $25 1 Issue Fee $ 3 FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By Application Issued By Date Date - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK $ $ $ $ $ $ $ $ SUMMARY OF FEES / �r OD %•.5-O SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ 'CASr.S-a - $ 3 CONSTRUCTION AND PLANNINu- APPROVALS Permit# Date Inspector - ,JL & SPA APPROVALS Permit # Date Inspector - 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location " 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62.. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical -Final 15. Rough 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. -Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 4)28: Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning . ,?/ y f' Qu;/T• 35. Final Gas Pipe -Test 36. Hood or Canopy - .37. Final Factory Fireplace 38. Final Plumbing '39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - '42. Backflow Preventer s - `43. Backyflow Irrigation• 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY,. No Date Applicant -� CIT.Y OF COSTA MESA, - - - - -' to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ ,: - 7812 ,4%Q2/;04 -- 103.62 , IL PERMIT. NO. 'TRACT NO. - LOT NO. BLDG.NO. CONSTRUCTIONPERMIT /Z O Y ' Project Address �^,t ,A ' O - 1 4 'Applicant's Mailing Address=�{u.�j' y Owner's Name 1/111- .ST S IZ Pho..5i5� _4.ZO.1. Address: 3[i2 CJ /��-(,V 1, �/ cosrn t�2F_>�Q,2 c.36b TYPE OF CONSTRUCTION- . ,NEW ADD ALTERATION REPAIR .❑ CONVERSION ❑ DEMOLISH ❑ O'T—H�E1R ,�1 DE CRIPTION OF WORK b•-'-'�-.`Pl1 i�[2 !1? �LQNJ I ,� G � - j .F 14 1 A1'i"T7 Cli S �5 '1—�M A'.p. # Zone OL7•� — O� SMai n Building: - Accessory Building: 2 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL El I TENANT ❑ ELECTRICAL ❑ PLUMBING El MECHANICAL LJ OTHER - PROJECT DESCRIPTION SQ. FT. �4�.5 OCCUPANCY CON STRUCTION TYPE �'IQG Sys Z1vI VALUATION$��,o'lQl�.C� ZONE GRADING CU.YDS: ACRES E T Front '' .. -Q N —1 Arch/Eng: License No. Address, - - B A Rear N K Right - Q ' `^zt)� "1 Contractor's Name RM /L1E/NICAL CO Phodevx� �s l Address (mailing) �oY. �%.o 'OMT e_A C/�.,��e� Q. City License No. S Left !E. Ping. Ref: .# Park.Fees $ i Q U Remarks: Parking Req./Provided I tl _ "O LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the -Business and Professions Code, and my license is in full force and effect. „r ense Class 'C. T• License Nod?3o,17A?r_-,I L, T Signature WORKERS' COMPENSATION DECLARATION _ Use of Building: R E PLUMBING FEES Planning Notes: M E ear Sink Showers N Backflow Preventer Service Sink - - Backflow Irrigation Sewer Cap r T S ELECTRICAL i FEES I affirm that have a certificatete of consent to self -insure or a certificate of Workers' Compensation Insurance„ or a certified copy thereof (Section 3800, Lab. C,18.�5�_ �G/ —fl-' ,1 Policy No. �i Company Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer ❑ 15-50 KW , Certifietl copy is filed with the clt4L ull�g `I�sion. ,Date =�-f Ll Applicant A- ❑ 50 + KW Construction Pole Sub. ClarifiersSolar Collectors _ ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or Dishwasher Solar Piping Cooking Unit - Meter ❑up to 100 amps Drinking Fountains g Solar Tank _ ' Dishwasher - Meter ❑over 100 amps less). I certify that in they person In n the work for which this permit is t to t, I shall not employ any person in any manner so as to become subject to the Workers' Compensation, Laws California. - Floor Drains Swimming Pool w/Spa ), Dryers ❑Gas ❑Electric Sub Panel Date Signature NOTICE: If,iafter making this declaration, you should become subject to'the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or Lthls- permit shall- be deemed, revoked: CONSTRUCTION LENDING AGENCY FIOorSinks .`- •- - 'Urinal' -'` ''" - -' Fan - Motors E]0-1'HP �1'/a-6 1 t Gas Service Outlets. - Water Closet F.A.U. Inc Solar E19-15 HP 016-15+t _ Interceptors Water Heater • I' Fixtures Microwave I hereby affirm that there Is a construction lending agency tor.the performance of the work for which this permit is Issued .(Section' 3097 Civ. C.), Lender's Name - _- _ _ Kitchen;Sink; Water Service - Device Boxes Pole Light; - Lender's Address, __ - OWNER BUILDER DECLARATION - Lavatories - - - ' - Outlets Range - 1 - 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason' (Section 7031.5 Business and Professional Code: Any city or ; unty which requires a permit to construct; alter, Improve, demolish orrepair. y structure, prior to Its Issuance, also requires the applicant for such permit file a signed Statement that he/she is licensed pursuant to the provlsions,of' the Contractor's License Law. (Chapter 9 (commencing with Section 7000) of Division 3 of the : Business and Professions Code) or. that he/she-is-exerg pt p -,Trap, p. - - - l- ' Switches Sign •. ' i _ v - Roof,Drain's ° x - _ ., Garbage Disposal i Standing Sections ) 1 - L. -.) I �, - I - t.,� - r Generator.00-5 KW �5-15 KW Trash Compactor P therefrom -and the' basis for.the alleged exemption. Any violation of,Sectl on " ,7031:5 by any applicant for a permit subjects the - applicant to a civil •eenalty of.not more than five hundred dollars ($500): , • - 1 I, 'as owner of. the property or my employees. with wages'm their sole compensation will do the work, and the structure -Is not Intended or offered for sale (Section 7044, Business and Professional. Code:, The Contractor's License Law does not apply to an owner of a property who builds or Improves - thereon,, and .who .does such work himself herself or through his or her own / 9 emplo des, provided that such Improvements are not Intended or offered for �' g p sale. I however, the building or Improvement is sold within one Yearlof com- pletion, the owner, will have ;the burden of proving he/she tlitl not build or im- . move for the purpose of sale)'. i — ' Reinspection Fee - $25' Iaue Fee _ -$ 3 .. . Reinspection Fee $25 Iaue,Fee ) $'3� * , MECHANICAL FEES' PUBLIC SERVICES REQUIREMENTS: r 1 Zoning Approved BY Data Building'Approved By Date._ "_--'`µ/ , Application hued By Dat 1 Boiler , - ' '• i Hood or ' Type I.❑ 1 Canopy Type II , ❑ _ - Y - '` - Duct'- Under'Ground. - 1 Duct - Structural 1 - ,. Refrigeration System i `j LJ I, as owner of the property, am exclusively contracting with licensed con- tractorsto constructthe project (Section 7044, Business and Professions Cotle:. Al The Contractor's License law oes not apply to an owner of property who dd builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law): i ❑ Ilam exempt unEer Section B. & P. C. for this reason '- 1 Duct ,-_0:100,000 9- BTU ❑100,000:BTU _„ 1 SUMMARY OF FEES c�%� BUILDING PERMIT $ v5 SMIP' i$ • y �" I PLAN CHECK '$ T 0/ �•� P.ERMIT 1 ' j I PLUMBING $ ISSUANCE '$ PLAN CHECK 25% ,$ ENERGY P.C. ;$ I GRADING '$ ELECTRICAL $ , $ + MICROFILM '$ ' PLAN CHECK 50% 77 MECHANICAL I '$ i TOTAL FEE $ PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ x'' 1 = System Repair/Alteration Firepl/Fact. Bit. ICBO # 1 1 r , Date Owner I hereby certify that I- have read this application and state that the above �" Information Is correct. I agree to comply with all city and county or tlinan<es and,state laws relating to building construction,' and hereby authorize repre- I sentatives of this , city. to enter upon the above-mentioned property for Inspection purposes. � /�� .�� Signature °`Tn;M 'ii9. p RA Date 7//.(/d T Drivers' Licansa or ss - Heating System & Ducting ❑Q700, I00�BTU•�100,000 BT t 1 - P ,; - U'i r - t ) (y =- Reinspection Fee daue Fee. -i3 $ 3 CMF 0865-46 rev. 1 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor IIAND PLANNING r '•. - - - L-& SPA : , _ :; ,; _, o - ,APPROVALS Permit Date �Inspector -'-APPROVQLS•,�'Permit# -- o = •Date' IrispectoE! 1. Temporary Electrical Service or Pole 52: Pool &Equipment Location- - I' i •_ 2. Soil Pipe-Undrgrnd.. 53,: Steel Reinforcement - 3'i Electrical Conduit Utility=Undrgrnd: - ' 54. Forms - - _ t '- • 'r�' i. �F 4. Electrical Conduit-Undrgrnd; 55: Electrical-Bonding` - -- ,•<�'-. " '- ' 5, Steel Reinforcement r- _ - - 56. Rough' Plumbing-& Pressure Test , 6. Electrical LIFER Grnd., ;, . 57.-APPROVALTOCOVER-GUNITE: 7. Footings '. . 58. Electrical ConduiLUndrgrnd. B. Foundation' 59. Gas Pipe, ❑,Undrgrnd., Test _ 9. Water Pipe-Undrgrnd:.- ' 60. Backwash. Lines, P;Trap,'O Undrgrnd. - 10. Structural Floor System - ' 61. APPROVAL TO DECK- _- - -. 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final• 12. Sewer Cap; - ,-' `• -63. Heater &Vent-Final 13. Roof Drains Plumbing System-.Final- a' 14. Rough Plumbing - 65. Electrical`-Final` " - • `�" 15. Rough Electrical-Conduit r - - - -- 66. Solar System-Final ;- 46. Rough Electric Wiring - 67: Fencing &'Access Approval _ 17., Rough Wiring Sign ;� , 6& APPROVED FOR PLASTERING •- - 18, Rough Electrical-T Bar Ceiling X69. POOL/SPA SYSTEMS FINAL -- - 19.: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT t ' I APPROVALS 'Permit # 20: Rough Factory Fireplace 21. Ducts, in- Structure . , - 70.' Underground Hydro 22 Ducts, Ventilating .` 71. Product Piping OGas ]Oil i 23. Gas Pipe-Rough & Test ' 72. Underground Flush r24. Roof Framing 73.1 Undergrnd. Storage Tank El Gas _0 Oil 25. Sheathing 74. Overhead Hydro - _Roof 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry,Chemical 27. Frame and Flashing - 76. Dry Standpipe f 28. Lathing & Siding 77. FI ED SYSTEM FINAL 29. Insulation REPREV. FINAL c. 30. Drywall Nailing t HEALTH DEPT. REQUIREMENT t 31. Plaster Brown Coat 1 79. FINAL INSPECTION ' i 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ..-33. Final Electric _ Notes: 34. Final Heating &'Air Conditioning 35. Final Gas Pipe-Test 36. Hood oro Canopy' - , . -r - - ; r 37. Final,'Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final, 41. Solar Domestic-Final - -- _ , .- - - - - -i -- �- - - -• __ 1'1 42, Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System i 45. Sound Attenuation' 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING 48. Special' Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - - - - - - --- -, f } - -, -- • - No.-`Date. - --`- i --'-�- - -- - �-' '- _ _. --� "l • d_ �� ( Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _-:-Y OF COSTA MESA, - - - - - p MIT NO. "" ' TRACT NO. "LOT N - BLD . CONSTRUCTION PERMIT —7 ' Project Add ress � cit 3CF it Lln/W V Ii1VE - TYPE OF CONSTRUCTION- - NEW ADD ALTERATION Lj and a permit suolects-tne applicant to a tars as'owner of thea property or ensation, will do the work, and ale,(Section •7044 Business at License Law does not apply to an owner Of a property, who bunds or Improves thereon,land who does such work-himself/herself or through 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 com- pletion, the owner. will have the burden of proving he/she did not build or im- nove for the purpose of sale). LJ I, as owner of the property, am exclusively contracting with licensetl con- tract ors to construct the project(Section 7044, Business and Professions Code: _The Contractor's License Law does not apply to an owner of property who builds or improves thereon, -and who contracts for such projects with a con- tractors) license pursuant todhe Contractor's License Law). ❑"I am exempt under Section B. & P. C. for this reason Date Owner' I hereby certify that I have read this application and state that the above Information is correct. I agree to comply -with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter, upon the above-mentioned property for Inspection pur Signature Date :r nspaction Pee 1 $25 - t Boiler Duct- Under Ground . Duct - Structural Duct - Ventilating Exhaust System 11 Multiple ElFirepl/Fact. Blt. ICBO;# ! Heating System & Ducting C30-100,000 BTU El100,000 BT Drivers' Llcens I I Reinspection Fee I $25 r 7 CMF 0865-46 rev. 7A3 White - ulldingl Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee • . $ 3 iANICAL , FEE Hood or Type; ❑ - Canopy Type 11 ❑ Refrigeration System - 00-100,000 BTU ❑ 100,000 BTU Issue Fee • - $ 3 0302 ]2/07/E 64.02 ,Tl A.P. # -14 7_1- Applicant's Mailing Address SIA^lff I Sh -REPAIR, ❑ CONVERSION : ❑ DEMOLISH ❑ OTHER' S Owner's'Name LA4_L,0 ' Wli;� en004MPhone 544- DESCRIPTION -OF WORK _ -.. Address '3L»%,e•� ' IA 1121..M�1 1f1N� _> ' 3130:1 .TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL' 1:1 TENANT' El ELECTRICAL ❑PLUMBING El MECHANICAL r ❑ BOTHER -PROJECT DESCRIPTION SQ. FT. 1313 OCCUPANCY C O N ST RUCTI ON TYPE - 'VALUATION$ 2SOD _ ZONE - GRADING CU.YDS. ACRES Front Arch/Eng.I rA s.RTC_I�C" License No. �,(�z'�-fo �0 Address, (i�Qiv(S NOIi1W Nt.IR 3L V 10-, 5,0S . r.A Contractor's Nam, ^906'7C7 Address (mai ling) ' / S. 175 CN 66s •3OVO ^7O.0 0 City License No. Remarks: ' LICENSED CONTRACTOR DECLARATION - - 1 hereby affirm that I am licensed under provisions Of Charter 9 (commencing O .. with section 7000) of Division 3 Of the Business and Professions Code, and my license is in full force and effect. ❑'eme Class' 0 Licnse o.23 SO'7o Sate - Signature ' WORK SSATION DEC A ION - I C PLUMBING FEES Bar Sink ! Showers ;t G ' Backflow Preventer Service Sink F Left - I hereby affirm that I have a certificate o nsent to se nsure of a certificate lo of Workers' -Compensation Insurance,. or -a-certified; copy thereof- (Section - - Backflow Irrigation Sewer Cap E 3800, Lab, c r�.�s , POIicY No. l 29� ComPanY —� • A� . A. I _ Bathtubs Sewer Connection- j - Certified copy is hereby furnished. X19--II�,Certif' of p is filed with the city BtyJd' g.Q visi n. I Date Applicant I Clarifiers f Solar Collectors ,L - -- Dishwasher- - f' Solar Piping; . EXEMPT FRO MWORKERS'CO MP ION.DE L RATION-.. (This section need not be completed if the pe rt is for on ndred ($100) or less). - I certify that I. the performance of the work far which this permit is issued I shall not employ any person in any manner so las to become subject to tee Workers', Compensation Laws of California. - - Drinking Fountains Solar Tank f II - Planning • Notes:Tlili Floor Drains' Swimming Pool w/Spa 1 _ Date Signature ' - NOTICE: If, after making this declaration, you should become subject to the , Workers'r CompensationProvisionsof the Labor Code, you must forthwith comply (with; such -provisions or this, permit.shall shall be deemed revoked. CONSTRUCTION LENDING:AGENCY % '` 1 `•-:- Floor Sinks ! Urinal ' Or , , Gas Service -Outlets ,Water Closet - -' - - - Interceptors • Water Heater - I hereby affirm that there is a' construction lending agency for the performance of the work for which this permit is issued, (Section. 309] Civ. C.) Kitchen Sink - _ Water,Service - Lender's Name : - - Lender's 'Address I ' _ OWNER BUILDER DECLARATION - I hereby affirm that I am'exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or L¢VatOfl es a p-TrP' FEES county which requires a permit to construct, alter, improve, demolish or-repairI Transformer ❑ 15-50 KW Construction Pole Sub. any structure, prior to its issuance, also requires the applicant for such permit :Roof'Dralns• " ' , - Cooking Unit- .to file a siened statementthathe/she is licensed pursuant to the provisions of _ - - Dishwasher and a permit suolects-tne applicant to a tars as'owner of thea property or ensation, will do the work, and ale,(Section •7044 Business at License Law does not apply to an owner Of a property, who bunds or Improves thereon,land who does such work-himself/herself or through 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 com- pletion, the owner. will have the burden of proving he/she did not build or im- nove for the purpose of sale). LJ I, as owner of the property, am exclusively contracting with licensetl con- tract ors to construct the project(Section 7044, Business and Professions Code: _The Contractor's License Law does not apply to an owner of property who builds or improves thereon, -and who contracts for such projects with a con- tractors) license pursuant todhe Contractor's License Law). ❑"I am exempt under Section B. & P. C. for this reason Date Owner' I hereby certify that I have read this application and state that the above Information is correct. I agree to comply -with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter, upon the above-mentioned property for Inspection pur Signature Date :r nspaction Pee 1 $25 - t Boiler Duct- Under Ground . Duct - Structural Duct - Ventilating Exhaust System 11 Multiple ElFirepl/Fact. Blt. ICBO;# ! Heating System & Ducting C30-100,000 BTU El100,000 BT Drivers' Llcens I I Reinspection Fee I $25 r 7 CMF 0865-46 rev. 7A3 White - ulldingl Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee • . $ 3 iANICAL , FEE Hood or Type; ❑ - Canopy Type 11 ❑ Refrigeration System - 00-100,000 BTU ❑ 100,000 BTU Issue Fee • - $ 3 0302 ]2/07/E 64.02 ,Tl A.P. # -14 7_1- Zone - S Main Building: Accessory Building: Z TN Front B A Rear- O .. .. 1 N C Right C1 p 1f - G S Left - - 3�f d- - , E Ping. Ref. # Park. Fees $ j - O U Parkin Req./Providetl 9 -� ed - 5 t— ' ,L , . Useof Building: V12_ /&&i[, R E Planning • Notes:Tlili _ M E -rn\r k Or -. T S ELECTRICAL FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. r 1:150+KW Cooking Unit- - - Meter ❑up to 100amps— - --- - - Dishwasher 'Meter ❑over 100 amps: .Dryers ❑Gas ❑Electric ,'Sub Panel 'Fan: _ f Mot6rs❑0-1 HP ❑1'/:-8 F.A.U. .Inc. Solar E19-15 HIS ❑16-151 'Fixtures Microwave Device Boxes Pole Light Outlets ' Range Switches , Sign - Garbage Disposal Standing Sections - Generator ❑0-5 KW ❑5-15 KW Trash Compactor Reinspection Fee $25 Issue Fee $ 3 PUBLIC SERVICES REO IRE S: f - Zoning Approved By V'Date Z Application Approved ey Date A lication Issued 6 PP Y Dat rK S MMARY OF FEES 8. S� PERMIT PLAN CHECK ` $ SMIP $ AS" 0 'a' PERMIT $ aSC7 , PLUMBING $ ISSUANCE $ PLAN CHECK $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK $ - MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK $ CONSTRUCTION AND PLA NI,' . APPROVALS Permit# Date' - Inspector rvOL &SPA -APPROVALS Permit# Date Inspector _1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. _ 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ..4: Electrical'Cond uit-Undrgrnd. 55. Electrical Bonding - • 5; bteel Reinforcement .. 56. Rough Plumbing & Pressure Test 6. Electrical -UFER Grind. - 57. APPROVAL TO COVER-GUNITE 7. Footings ,p 58. Electrical Conduit-Undrgrnd. 8: Foundation - • 59., Gas Pipe, 0 Undrgrnd., Test 9. WaterrPipe-Undrgrnd, 60. Backwash Lines, P -Trap, 0 Undrgrnd• 10, Structural Floor System '. 61. APPROVAL TO DECK 11. Property Sewer Line &' House Connection 62. Backwash &Receptor -Final 12: Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains. -� 64. Plumbing System - Final' - 14: Rough Plumbing, 65. Electrical -Final 15. Rough Electrical -Conduit - `- 66. Solar System -Final - y 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 APPROVALS Permit # 20. -Rough Factory Fireplace 21(. Ducts, in Structure 70. Underground Hydro 2 Ducts, Ventilating 71. Product Piping 0Gas 0Oil .. 23'. Gas Pipe -Rough &Test 72. Underground Flush 24. Roof Framing -' 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75.- Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL Z -/s 30. Drywall Nailing` HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat; 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric i Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - .. 38. Final Plumbing ;.. 39. Water Service -Final 40. Gas•Service-Final ! '. 41. Solar Domestic -Filial 42. Backflow Pteventer 43. Backflow Irrigation i 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - •, � - 47. FINAL STRUCTURE & B`UILDING - 48. Special Requirements Comb feted 49. Electric Release to Edison 50. Gas Release to Southern Ca`Iifornia Gas Co - -' ,r 51. CERTIFICATE OF OCCUPANCY No. Date CITY•OFCOSTA MESA - CONSTRUCT.ION PERMIT Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 8554 II/04/E33 95,72 l PERMIT -- 'TRACT NO. LOT N07 -BLD . Project Address LJ TYPE'.OF CONSTRUCTION Ll NEW - LV ADD LJ,ALTERATION - REPAIR- ' M " Add ZZoo a ❑ CONVERSION -.❑ DEMOLISH. ❑ OTHER - I hereby affirm that there is a,construction lending agency for the performance' Interceptors. t Water Heater 1 of the -work ,for which thls permit -,is issuedp(Sectionr�3097T. Civ: 'C.) Lender's' .Name' I - _ ' Kitchen Sink - Water Service _ Lender's Address OWNER BUILDER DECLARATION t Lavatories I hereby affirm that I am exempt from the.Contractor.'s License Law for the p—Tre r'- following reason (Section 7031.5 Business and Professional Code:.Any city or p' .ounty which requires a permit to construct, alter. Improve', demolismor repair my structure, prior to Its Issuance, also requires the applicant for such permit Roof Drains) '* .to file a.signed statement -t h at he/she is licensed pursuant to the provisions of ' - _ I ,.no r•..n�r�,-r,.. I ��e.,eo r'.,.. ,rn �.,,e. o n.........e.,a..,• ,.,nn, ee��i...; �nnm ..<- 1 - I 11 . rom and, the 1 5 by•any.apl y of not more as, owner of roe ;Il sl r ON License Law does not apply to an.owner of a property who OullOs or Improves thereon,. and who;does such work himself/herself or through his or her own employees, provided that sgchiimprovements are not intended or offered for sale. If, however, the building.or Improvement is sold within one year of com- pletion, the owner' will have the burden of proving he/she did not build or Im. prove for the purpose of salt), ❑ I, as owner of the prOPArty, am exclusively contracting, witti licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who_'. builds or improves thereon, and who contracts for such projects with a con- tractor(s)license pursuant tb'the Contractor's License Law). I i ❑ ram exempt under Section B. & P. C. for this reason t i Date ' Owner ' I hereby certify that 1 have read this apolicatlon and state that the above Signature IL ZLZZ-11� -Drivers' License or - ,_ CMF 0865-46 rev. 7/83- White Exhaust System LJ MultipleLJ; I Systeerr t � !,Reinspection Fee,, ';$25 Issue Fee _ _ 1 .5 'MECHANICAL c t - c FEES _ Boil e_c i t . ` _ Hood or TYPe I -'d Duct - Under Ground Canopy Type I1 0 -` Duct - StructuralRefrigeration System ' Duct - Ventilating ❑0-100,000;BTU ❑100,000 BTU Exhaust System LJ MultipleLJ; I Systeerr F irepl/Fact. Bit. ICBO,# I ,` Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT r T � / I I Reinspection Feel $25 I Canary - Applicant;Pink - Accounting; Goldenrod - Assessor-. - --- .-- - 7 $ 3 4:P.'# `C S Main Building: E - Meter -❑up to 100 amps T Front' A Rear Fan Motors 00-1 HP 01'/:-8 C Right Ping. Ref. # Use of Building: Planning Notes: Accessory Building: - r Park.Fees $ - i ' ELECTRICAL t Automatic Washer Construction Pole_ Sub. Transformer El 15.50 KW El 50 + KW Cooking'Unit I- '— - Meter -❑up to 100 amps Dishwasher' ' Meter ❑over 100amps Dryers ❑Gas, ❑Electric Sub Panel, Fan Motors 00-1 HP 01'/:-8 F.A:U. 'inc.SolarE19-15 HP 1116 - Fixtures j ,Microwave Device Boxes ' IPole'Light ' Outlets i Range I' 1 Switches Sign I ' Garbage Disposal j •Standing Sections Generator ❑05 KW ❑5.15 KW :Trash Compactor t I t Reinspection Fee $25 'Issue Fee ' $ ' -?sem _' PERMIT O N I N 131' R E O U I R E M E PUBLIC SERVICES REQUIREMENTS: I Zoning Approved By - Date ! Application Approved By T i I Date " Application Issued By Dat , c SUMMARV.l1F FEES - BUILDING PERMIT $ -��'6 .7z SMIP $ ' PLAN CHECK $ ' -?sem _' PERMIT ' ' PLUMBING $ -ISSUANCE $ PLAN CHECK $ ENERGY P.C. , $ 1 ELECTRICAL $ GRADING $ PLAN CHECK - $ I MICROFILM $ p2� MECHANICAL - $ TOTALFEE $ 93_ PLAN CHECK "$ ' 'CONSTRUCTION'AND PLANNING APPROVALS, Pe, rmit# Date - Inspector . JOL &SPA - Date ;Inspector APPROVALS Permit# �7. Temporary Electrical Service or Pole K. Pool & Equipment Location 2: Soil Pipe-Undrgrnd.: 53. Steel Reinforcement .3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,4: Electrical Conduit-Undrgrnd. -", 55. Electrical Bonding , 5. Steel Reinforcement - - 56. Rough Plumbing & Pressure Test ' 6:- Electrical LIFER Grnd." 57, APPROVAL TO COVER-GUNITE 7.` Footings "• r- •� - 58. Electrical Conduit-Undrgrnd.- onduit-Undrgrnd:8. 8.Foundation - 59. Gas Pipe, O Undrgrnd., Test 9: Water Pipe-Undrgrnd. - _ .60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10: Structural Floor System 61. APPROVAL TO DECK ' 11: Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap -63. Heater&-Vent-Final ' 13. Roof Drains 64. Plumbing System -.Final 14. Rough Plumbing - - 65. Electrical-Final 15. Rough 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure -' 70. Underground Hydro , 22. Ducts, Ventilating. , 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough& Test i 72. Underground Flush ' • 24. Roof.Framing . Undergrnd.StorageTank OGas ❑Oil 25. Roof. Sheathing74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 27. Frame and Flashing 76. Dry Standpipe 28. Lathing &Siding 7. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL �1 i�%7"�-a4-$H •� 30. Drywall Nailing - 31. Plaster Brown Coar- 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric '� Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final, - 42. Backflow Preventer - 43. Backflow Irrigation - 44. ,Landscape..irrigation System 45. Sound Attenuation - 46. Handicap Regulations , 47. FINAL-STRUCTURE&.BUILDING 48. Special Requirements Completed , 49. Electric Release to Edison , -- - - " 50. Gas Release to Southern.California Gas Co 51. CERTIFICATE.OF OCCUPANCY , No, Date , COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING eD �� VE ADDRESS OWNER � CA�, MAIL ADDRESS TE L. CITY NO. BRANCH ADDRESS ARCHITECT TEL. BUILDING ADDRESS_ TRACT ROVED Pt.lu I IEC 77 74�;—„CO ass 4AA*961.5C TION FOR BUILDING PERMIT VALUE CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLDG, tFROMC/LSTREETI OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT SIZE OF NO. OF NEW BLDG. ROOMS STORIES L. SIDE FT FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDG. ACCESS. SLOG. VAR. 4e DATE C.U.P. 1W APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent SO. FT. O THE AMOUNT SHOWN UNDER VALUATION IS FOR = THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION sO m PERMIT FEE S m PLAN CHECK $ E o I L u TOTAL FEE $ (C Z W U Z Z_ < O to am J LO J N mLU J m J Q z N Z4 wa aw JD 03 J a WW z Z r Wp 0O 7 - ry-1-71-INI 00 o41 * - tt 539.20 COSTA MESA BUILDING -SAFETY DEPARTMENT P:O. BOX 1200 COSTA MESA, CALIFORNIA 92626 S/ W 0 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely REC BY DA E RECEIV D BUILDING /,,'L / Ove ADDRESS ,Li<w4V IU C OWNER A.P. NOMAIL�•BUILDINGMAIL ESS `iKl y Cw „ ADDRqjWFTEL.Q N0.CONSTRUCTIONLENDER JISSUE TRACT LOT ,CITY BRANCHOWNER ADDRESS VALU / ARCHITECT 41gge14N TE OR ENGINEEFeeg FIRE ADDRESS 461 ZONE YPE GROUP APPROVE CONTRACTOR BY DATE ADDRESS �Q,,,Q S"Crl, TE ZONE NO. OF USE OF N _Z CITYF"Off NO64 PLANS BUILDING ) / STATE 5I-2lII LIC.fNO. 'Ig LIC. NO. L �O ARDS APPROVED Y MAIIN BUILDIING YARDS APPROVED ACCESSORY BUILDIN SIZEa NO. OF BLDGS. (FROM C/L S1%R E ET) OF LOT NOW ON LOTFT. FT _ USE OF -tee EXISTING BLDG. A SIDElG OFT. FT SIZE OF co NO. OF &GFT. NEW BLDG. ROOMS STORIES L SIDE FT. EXTERIOR WALL ROOF rr f /1 COVERING COV ER I N G r� REARr FT. FT. USE OF BUILDING AND WORK TO BE PE F R M ED DISTANCE BET. BET. MAIN& la MAIN SLOGS. ACCESS. SLOGS. VAR .*DATE C.U.P. APPROVED APPROVED nATP RE-QUIREMEMS I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VAL IS FOR the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION T and Professions Co s t 3, Chapter 9. PERMIT FEE $ Paemlttnet eof LK/ C.�_V(/� A` PLAN CHECK$ (J ${��yJ.yl� �/ I n(/(/ quthorlxed Agent TOTAL FEE $ S/ W 0 Z . aZ Z Z 2Q Ov~ am J � J to Q W Co J -IM Q U N Za W D: o. yl W Jp M J c W W 0 zI.- W � N � 4( 78 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PA:�0OIouFY ; , P �� 75t,.! AP I ATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE I E By I DATE RECEIVED D BUILDING 3U3U lkwA/ ISL ADDRESS zl P ROWNER A.P. NO. MAIL BUILDING •�-r/JADDRESS 3000 AgWAY V6TEL. ADDRESS CITY NO. TRACT LOT JE CONSTRUCTION ALENOER XBRANCH OWNER ADORES$ARCHITECT F/R(, Sej(//A'Z6K5 VALU$ TEL. OR EN INEER FIRE ADDRESS ZONE TYPE GROUP [� CONTRACTOR (,4'GI�'C GC/Y ��x P' APPROVED By -DATE ADDRESS ��So GU'TRVN.ITON TEL. Ok)AW6c= ZONE NO. OF PLANS USE OF NEW BUILDING CITY N0.63`9-7 CTY Z 7 APPROVED LICNo.C16- 7 3Z LIC. NO. NS BUILDING ACCESSORY BUILDING SIZENO. OF BLOCS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT, FT SIZE OF NO. OF NEW BLDG, ROOMS STORIES L SIDE FT. FT. EXTERIOR WALL ROOF - COVERING COVERING REAR FT. FT, USE OF BUILDING ND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & %NSTA�L Pn '1Q.S /A) MAIN SLOGS. ACCESS. SLOGS. ./ /^ VAR.* C.U.P.+/E DATE APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Coda, Division J, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Professions Cpppddd��e DI Islon 9. / _ I ✓ PERMIT FEE $ �haaapttajrr Signature of (v/f./ f'Q(2 �• ^�'`• Permittee 1/.�� --- - $ /V""if"), / PLAN CHECK Authorized Agent TOTAL FEE S Z aLu U Z Z_Q am M O J W J N Q W m J M J Q UQ Zcr aW W Z JO Co Z J W W Z z� WO =)O COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 '11 29-75L z.5P1"002759x ****33.78 ' 0 u APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEI - D TER EI ED DATE ISSUED -7 : _ i� BUILDING /j•�,,.sjO ��•"p •, ADDRESS PERMITNO. e'7•[ OWNER • A.P. NO. MAIL /• �j �t_ I I� BUILDING ^JO,3O yJ ' ADDRESS J/ /T ADDRESS �i �i iL_• TE TE � �9S CITU K� TRACT LOT/, BLOCK CONSTRUCTION LENDER BRANCH / OWNER � <,q ADDRESS VALUE DeD ARCHITECTr. A• TEL. $ OR ENGINEER /► c ADDRESSI �T� Sv(T FIRE ZONE VPE GROUP APPROVE CONTRACTOR BV DATE / // ADDRESS I 7TWIE166 ZONE P NO.OF PLANS L USE OF NEW 1t` BUILDING NOARDS CITYSTATE /Y I LIC. NO L: 7 LIC. NO. !18 APPROVED VMAIIN BUILDING YARDS ACCESSORY BUILDDING 512E 2 NO.OF BLDG(FROM �•FRONT C/L STREET) OF LOT NOW ON LOT FT. FT. USE OF .t, ZQ / 1/ she EXISTING BLDG. . /T SIZE OF NO. OF NEW BLDG. ROOMS STORIES6 L SIDE 11K F EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE WET. BET. MAIN & MAIN BLDGS. ACCESS. BLOGS. VAR. 46 DATE T C.U.P.91" APPROVED APPROVED R DATE I hereby acknowledge that I have read this application and state STATE that the above Information is correct and agree to comply with D all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. TAX THE AMOUNT SHOWN UNDER VALU TION IS FOR the Stets of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: em exempt from tha visions of the of California Business VALUATION antl Professio Ivislon 3, C '70 PERMIT FEE $ 41) PLAN CHECKS Signature o r ns Permhtae 7Li�+ $ �%O �� Authorized A nt ' TOTAL FEE S 0 u . - 39 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 W: ?Q-75r� •00 859' Wit, * 196.3C J l APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RE I D By DATE C ED / DATEI UED BUILDING14q ADDRESS D �� OWNER E � A.P. NO. -D P MAIL BUILDING 3 �Q ADDRESS Q ADDRESS Q �J TEL. CITY /�/�S NO. TRACT LOT BLOCK CONSTRUCTION _ LENDER BRANCH OWNER ADDRESS VAL S S 4 F40N ARCHITECT TEL. OR ENGINEER FIRE y ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY GATE ADDRESS,/,. a TEL. ZONE NO. OF OF USE OF N CITU NO. PL BUILDIN STATE CITV YARDS APPROVED VAR APPROVED LIC. NO LIC. NO. _ MAIN BUILDING ACCESS RV BUILDING SIZE NO.OF SLOGS. %FROM C/L STREET) OF LOT NOW ON LOTFRONT FT. FT. USE OF EXISTING BLDG. FT SIZE OF NO. OF NEW BLDG. ROOMS STORIES . SIDE FT. EXTERIOR WALL ROOF COVERING C OVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLDGS. VAR. 4L DATE C.U.P.,W APPROVED APPROVED By DATE I hereby acknowledge that I have road this application and state $TATE that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VAL WT40KIISFOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business end Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $ , Q 0 Signature of /�y� p�r p �s Permittee✓ ��.6yKBt/ N•/�/� �. ' / $(�D ate, ,S 7 PLAN CHECK $ CP ir�D // Authorized Agent i7Qf� TOTAL FEE J l = T 4� 17 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only [ADDRESS UILDING © / DDRESS WNER C Q •[, Ptt t AIL ��ss``// Jr,�b / 4'CU//' AVII TEL._TY .z lioY mI NO.42'<—t 1 i1F fPAIL k **x' S. QQ�384� �3�64 FOR STRUCTURAL PERMIT DATE RECEIVED WITAMT9 Issl Wrl A.P. NO. __U_>_U BUILDIN to ADDRESS APPROVED FSeparate permits are required for L. SIDE TRACT OWNER &/C `- _I`6 SO' BRANCH S to that the above information Is correct and agree to comply with APPROVED FSeparate permits are required for L. SIDE any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a c rector under OWNER &/C `- _I`6 SO' THE AMOUN' REAR ADDRESS USE.QE ILDING AND WO&j E PERF RMEG, ` DISTANCE BET. Q� - - � � m � I (7 S S VALU$ 76-m ,J Signature of V/M ARCHITECT TEL,74Z, OR ENGINEE C.U.P. sls Q 7 APPROV RY ADDRESS iao tyV 1 .- FIRE ZONE TV E GR UP �f CLON't P— CONTRA CTOR 12 /� yj f� (yµ Lk� APPROVED BY DATE/2-M-7 PLAN CHECK $ ADDRESS -5li`/)0,'Att / 0 LL F U TAX $ C TOTAL PAID $ 3 3%� CITY �7 (,r ' 4 NOF OI. 9r� - C/a� ZO OF PLANS BUNO. ILDING EW F STATE LIC. NO. 3y[ ^3 CITY LIC. NO. YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY B ILDING W SIZE NO. OF BLDC>S IF ROM C/L STRE ET) L OF LOT NOW ON LOT FRONT F T. Q y USE OF n a ., I) EXISTING BLDG.R. ' S to that the above information Is correct and agree to comply with APPROVED FSeparate permits are required for L. SIDE any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a c rector under electric, plumbing and heating work. SO' THE AMOUN' REAR Uj F USE.QE ILDING AND WO&j E PERF RMEG, ` DISTANCE BET. Q� - - � � m � I (7 S MAIN BLDGS. N \ Signature of V/M VAR. W C.U.P. sls Q 7 APPROV RY fz7 D. VN UNDER VALUATION IS FOR mt.1 1 hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with APPROVED 0. all laws regulating building construction, and I shall not employ IZ 3 any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a c rector under SO' THE AMOUN' the State of California Business and Professions od Division 3, Chapter 9, and that such licenses are In full f ce a effect, or I THE PURPOSE am exam Pt fro he pro si ns ofthe Staten Calif rnia Business antl Profession o e, D' Is n 3, Chapter 9. VALUATION N \ Signature of V/M $57 � �yft ��s..JJJJ// oft Authorize\ L=nt DATE APPROVED N \ m VN UNDER VALUATION IS FOR mt.1 'ABLISHING A PERMIT FEE ONLY: PERMIT FEE $ am— Q v N , PLAN CHECK $ M ^I 0 LL F U TAX $ C TOTAL PAID $ 3 3%� I COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING s ADDRESS OWNER K {'1 ((�� Ils • 0,, %z V1//i=, Au1C R:'IIAI�001?1E?a FOR STRUCTURAL PERMIT 0 CITY (V nS, IA �//oQ A NO 7SI-93 //1 tM C BRANCH ARCHITEi OR ENGINE ADDRESS 'FIRE ZONE TYPE/` GROUP APPROVED Au 111111111 USE OF I, BUILDING V BET. MAIN & ACCESS BLD DATE G A PERI, PERMIT -FEE E PLAN CHECK $ TAX E TOTAL PAID E ADDRESS ZONE NO. OF TEL. CITY NO. PLANS Fy STATE CITY YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING W (FROM C/L STREET) SIZENO. OF BLOGS G. OF LOT NOW ON LOTFRONT FT. a USE OF XM EXISTING BLDG. R. SIDE y FSeparate permits are required for L. SIDE FT electric, plumbing and heating work. REAR FT. [�. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. QMAIN BLOCS. VAR. # QL D.U.P. # > APPROVED Y C [s1 0 1 hereby acknowledge that I have read this application and nate C that the above information Is correct and agree to comply with 96 all laws regulating building construction, and I shell not employ Z any person In violation of the workman's compensation laws of the State of California. 3 I hereby certify that I am properly licensee as a contractor under SO. FT. THE AMOUNT SHO the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ES emd e•e t-fr the prov ielona of �t1S to of California Business 3, C VALUATION P apter enfessions tl ,. Isi Sipn urs of Parml ^ l� �G �_� SP—.(rp'/r�J1� Au 111111111 USE OF I, BUILDING V BET. MAIN & ACCESS BLD DATE G A PERI, PERMIT -FEE E PLAN CHECK $ TAX E TOTAL PAID E COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 .FR -2-77� j EB(J _?' ljcE100* flij1*10*1 MIA APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only FIECEJVER BV DATE RECEIV /� D 1 ED Off/ BUILDING 30 ADDRESS �aJ�Jii �I Q�V/S. ISVE 1/� OWNER Q.iK O��.iilLTi%Z/�If�E"1. A. P... NO. ^ Q P MAIL ADDRESSS050 Airzyb wff • BUILDING r ADDRESS TEL. CITY (:M'rJ /AE` &A �.6j F. NO. TRACT LOT LOCK CONSTRUCTION A AL LENDER BRANCH OWNER ADDRESS • f VA E S $ .�- ARCHITECT TEL. OR ENGINEER FIRE Q� ADDRESS ZONE TV PE GROUP ✓ .APPROVED CONTRACTOR SlEe" FIQE �J BY DATE /( ADDRESS3r,65 gWq1 L4. 20Nfjy) NO.OF USE OF N /�' � Cw' CITY M /n� CQ, NOL.,.i{rp• 4� �/i PLAN UILDIN /L•E• STATELIC. NO. • (,�QZ,$5 - G�s(p LICCIT. NO. YMAIIN BUILARDS RDING ACCESSORY BUILDING SIZE NO.OF BLDG4.. (FROM C/L STREET) OF LOT NOW ON LOT IFRONT j FT. FT. USE OF � EXISTINGBLDG. /A��rjjCn• R. SIDE F FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE B BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. ,,mss♦ 1Nsmu_ IME S ,4IzLI3f�+b 1b VAR. 46 C U $'+ DATE APPROVED AJ L IL0� s♦ D_ E±By APPROVED DATE 1 horeby acknowledge that I have read thisapplication and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the $tete of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisio of the State f Califo tla Business Code iv IsIo VALUATION PERMIT FEE S ` w I� and Professio , Cha er 9. Signature of I / / PLAN CHECK $ Q Perm ittae $ ,,/ O •'J �— K W TAX $ 1 O TOTAL PAID S • D Authorize Ag nt MIA COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING�y O ADDRESS f,/ OWNER MAIL y/ ADDRESS �,r / ��//f CITY �O S�/ri //��GJ/f NOL. BRANCH ADDRESS ARCHITECT TEL. CONTRACTOR ADDRESS/¢/,S ,�/ TEL. 7 CITYSTATE LIC. NO.t:5-/6',7— 7,9 i97 LICVNO. SIZE NO, OF BLDG OF LOT NOW ON LOT O USE F USEOEXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED �I 9683 11 /29/78 APPLICATION FOR STRUCTURAL PERMIT RECEIVEDBY I DATE RECEIVED III❑ATF Issue❑ NO. R FIRE VALUE Kit> I'PLA ^ I BSE OF NU UILDING . YARDS APPROVED !I YARDS APPROVED VAR. 46 BET 1 hereby acknowledge that 1 have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State Of California. I hereby certify that 1 am properly licensed as a contractor under the State of California Business and Professions Code, Division 3,[VALUATION Chapter 9, and that such lice ses era in full force and effect, or I am exempt from the Prov sl a.oYF�ie State of California Businessantl Professions Code, f51 le n Ch .ter 9. Signature ofPerml"ee r Authorized Agent BET. 61AIN & ABLISHING A PERMIT FEE ONL PERMIT FEE $/0,1191 PLAN CHECK $ _ TAX S TOTALPAIO E /Or S� 10.50 TL 047Q ? C o- iA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS /0r�Ci,* OWNER CITY , BRANCH ADDRESS ARCHITECT TEL. OR ENGINEER CONTRACTOR CITY C STATE LIC. NO. SIZE OF LOT FIRE ZONE APPROV 9246 11/20/76 4206 11!20/78 VALUE DATE // ', NEOL'C CIT CIT YARDS APPROVED YARDS APPROVED LIC. N[� MAIN BUILDING ACCESSORY BUILDI NO. OF BLDGS. (FROM C/L STREET) NOW ON LOT .� FRONT 1 64 : EXISTING BLDG. An/(A- / FT Separate permits are required for L. SIDE F , FT. electric, plumbing and heating work. �r REAR FT. // FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. IN & MAIN SLOGS. ACC . BLDG9. VAR. 9W DATE I hereby acknowledge that (hove read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person In violation of the workman's compensation laws of the State of California. L I hereby cartify that 1 am properly licensed as a contractor under J the State of California Business and Professions Code, Dlvlalon 3, THE AM Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. Signature Hyl Pae Perms Authorized Agent VN UNDER VALUATION IS 'ASLISHING A PERMIT FEE O PERMIT FEE E PLAN CHECK E TAX S TOTAL PAID7T$ 33.304 CK IQ ._ .__ Cj COSTA MESA BUILDING -a. FETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 1539 5/15/79 42.50 TLS APPLICATION FOR STRUCTURAL PERMIT / For Applicant to Fill in Completely — Use Ink Only RECEIVED BY PERMIT I,4 a�E ,J / BUILDING D ADDRESS A.P. NO. OWNER OR T/r�AdEl eLECT't1/Gs nt/TFR TENANT BUILDING ADDRESS UNITOR SPACE NO. MAILING ADDRESS 3a3� A1,V604 TR.N LOT BLK. �1 �A q CITY C(J.sT/'t /!�/��s/7 NOL S 7 NEW ADD LTE REPAIR MOVING DEMOLISH CONSTRUCTION LENDER /i� y� BRANCH 1 r ��— `�0 w /'� OWNER Z/ ' ADDRESS VALUE USE E ARCHITECT / TEL. OR ENGINEER N®�F ZONE T PE GROUP ADDRESS fr CONTRACTOR Il APPROVED BV DATE, ADDRESS TEL. CITY I t NO. ' STATE CITY LIC. NO. 1 C LIC. NO. APPROVED SETBACKS S1ZE �ay� OF LOT 3Qil K 9OC� NO.OF BLOGS NOWCO�Nr LOT / (FROM C/L STREET) FRONT USE OF EXISTING BLDG. OFFICES I NI [ � �7� SIDE /F Separate permits are required for electric, plumbing and heating work: L. SIDE F REAR FT. USE OF BUILDING AND WORK TO BE PERFOR MSO PLANNING ACTION ...� �� DATE APPROVED APPROV DATE I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shell not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business antl Profession. C e, Division h ter 9. Slgnatur o n Permlttea �j y SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $ ��f PERMIT FEE E PLAN CHECK $ ��- TAX E or G Autho edA nt Date TOTAL PAID $ COSTA MESA BUILDIN = ETY DEPARTMENT *377 * 773 9/26/79 26.90 TL APPLICATIOrii FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA N._ _A, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only RECEIVED By PERMIT No 4 8671901 BUILDING © O ADDRESS Jr A.P. NO. O�p2 A �/ TOENANT WNER R GT/L��l �S BUILDING n ADDRESS /L UNIT OR SPACE NO. MAILING3D3o / NI .! �r ADDRESS 'C /T' /�j[ LOT BLK. - /J- TEL. CITY S N/ NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS VALUE ARCHITECT TEL. OR ENGINEER NO USE $ ADDRESS ZONE TVP GROUP CONTRAC APPROVED BY DATESP;=--79 ADDRESS TEL.. CITY N0.& p(h E STATE CITY LIC.NO. 2--7©1?9 LIC. NO. APPROVED SETBACKS SIZE BLDGS. (FROM C/L STREET) O. OF LOT IND NOW ON LOT FRONT FT. Q USE OF EXISTING BLDG. R. SIDE FT. VI FSeparate permits are required for electric, plumbing and heating work: L. SIDE FT. REAR FT. W USE OF BUILDING AND WORK TO BE P9B,FORMED PLANNING ACTION DATE APPROVED Q 7 APPROVED rPLY DATE a CC 1 hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with 06 all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of SQ. FT. 5 3 the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divislon 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the or( vis' sof tet California Business and Professions Cod e, isi VALUATION PERMIT FEE $ B� L11- P t TAX CHECK Signature of $ J Permittee $ or Authorized Agent Date / TOTAL PAID $' D COSTA MESA BUILDING: TY DEPARTMENT 11 / P.O. BOX 1200 COSTA MEN—, CALIFORNIA 92626 APP ATTON x JR STRUCTURAL PERMIT e02 TL RECI VPERMIT- For Applicant to Fill in Completely — Use Ink Only BUILDING A,p, NO. ADDRESS OWNER OR BUILDING ADDRESS TENANT MAILING UNIT N N SPACE NO. _ ADDRESS TEL. T LOT BLK. lryll- CITY O. CONSTRUCTION Ci77O NEW ADD ALTER EPAIR MOVING DEMOLISH LENDER BRANCH LL OWNER ADDRESS USE VALUES �jMO ARCHITECT �/Sa s+TE Lr►7.'�0., D �C%F(/ W V OR ENGINES r� /7 -E-11 —L/ AAV�AITYPE V ADDRESS ZONE GROUP Aid, l2birr BYPROV EO CONTRACTOR DATE ADDRESSS'.?/ZCALAaA.YYf� �L��jr CITY l_�l�l r� /v►CrNOV;-077a STATE CITY APPROVED TBA LIC. NO. LIC. NO. SIZE NO. OF BLOGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT 0 FT USE OF EXISTING BLDG. Separate permits are required for L SIDE FT electric, plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APP V qs P C C71 I hereby acknowledge that I have read this application and Rate that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in fy4 tort: and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provis'o's of }'dt of California Business VALUATION PERMIT FEE E and Professions Code, Div i n 3 h er s o PLAN CHECK E 2 $'• 2 Signature of Permittee q OV0 TAX E O or ITS_ Authorized Agent Date TOTAL PAID E e02 TL Job Address: 3030 AIRWAY AV Status: ISSUED Suite: Applied: 06/01/2005 Vicinity: RIPCURL Issued: 06/23/2005 Parcel Number: 42708302 Zoning: ISSUED BY: Applicant: VINCENT LUU Address: 17992 COWAN Phone: 949-474-0555 XT1154 IRVINE, CA; Zip: 92614 - Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address, %INSIGNIA COMMERCIAL GROUP is "IRVINE, CA, '.;:. Phone: , ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 Contractor: THE GREATER ALARM CO INC Address: ' 17992 COWAN , - Phone: _- 949-474-0555 - - IRVINE, CA ^--Zip: _ . 92614 -= - License: 469046-,, SCOPE OF PERMIT FIRE SPRINKLER MONITORING SYSTEM FOR "RIPCURL" REF # B05-00336 FEE SUMMARY Plan Check: $63.21 Calc Valuation: $4,000.00 Permit: $97.25 Claimed Valuation: $4,000.00 Other: $0.00 Total: $160.46 i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244848 (SU) ` DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declaration: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the % work for which this permit Is Issued. insurance.have and will maintain workers' compensation insurance. as required by section 3700 of the Labor Code, for the performance of The work for which this permit is Issued. M coo compensation Insurance carrier an polly number ere: �r:: Y A�r4urnm9e �� t r.1��s� *i�S .Pad,. 530000000 P-04/ (T)iis'secr/on need not be completed If thapermf is valued at one hundred dollars (S100) or lass.) ❑ I certlty that In the performance of the work for which this permit is Issued, I shall not employ any person In any manner eo as to become subject to the workers' compensation laws of Celifomla, a gree that II 1 should become subject to the workers' compensallon provisions of Section 3700 of the Labor Code, I shall forthwith comply With Nese provi ons ukut WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PTE LTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100.000), IN ADDITION TO THE 00ST OF OONIPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Che ter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in lull force and enact. Llc4 '7 . 4 D= �iCoW=e. Signet re;__415Y17CLA nr' 1L CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any dry or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, poor to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a Parrott subjects the applicant to a civil penalty of not more than two hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. Ii, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner o1 the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, faisework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 9, Celllornla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and ceNty a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at atantla temperature and pressure). _..__—— ......... .... ..._ 2 Does or will the applicant or present or future building occupant need to lila a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the aeppplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ClNo (Seolw 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, hes Section 25534 of the California Health and Safety Cade been fully complied with? ❑Ves ❑ No 5 froea cur will applicant or present or future building occupant require for the work which is the subject of this a plication appemit tori such construction or motliflcaUon from the South Coast Air QualityManagement Distract or from any other air pollution control district or agency? UYes LJ No (Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). B W III any pert of the iia;ity to be constructed under NIS permit be within 1000 feat tram the outer boundaries of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Celitomia Health and Safety Code). ..................___..............—............_____.__�.___.... __._....................... ........._..._...__..__.___......_....._ 7 If a permit from the South Coast Air Quality Management District or other air Pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes (I No ......................................... ........... ............................................................................ __._.......................... _........... .................................................................... ............. ....................................... __—__............ _._........... ___....... _._ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and dry ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Legal Owner(s) Dat v " s ndR, uthbrzed'Appkanty_` CODE r, INSPECTION i1RE JIM INTITIA65 CODEj INSPECTION TYPE 2&U DrrrnALg 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bulding/Occupancy Job Address: 3030 AIRWAY AV Status: ISSUED Suite: Applied: 03/16/2005 Vicinity: RIPCURL Issued: 04/01/2005 N Parcel Number: 42708302 Zoning: ISSUED BY: Applicant: MORENO, ANNA ,IV Address: 30060 SILVER SADDLECT '- r ._ Phone:. (951)244-9836 f CANYON LAKE, CA ( -. Zip: 92570 - - Owner: CONNECTICUT, GENERAL LIFE INSURANCE_COMPANY, Address%INSIGNIA COMMERCIAL GROUP IRVINE,CA, _ - Phone: - - ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 contractor: ALL PROFIREPROTECTION Address: 30060 SILVER SADDLE CT ' Phone: (951) 244-9836 ' CANYON LAKE, CA o I, Zip: 92570,_,,,,, - - -i License:. 1629993 SCOPE OF PERMIT FIRE SPRINKLER PERMIT FOR INTERIOR T.I. FOR "RIPCURL". RELOCATE 65 FIRE SPRINKLER HEADS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 1/ 244646 (6/00) DECLARATIONS 1, 1 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the I work for which this permit is issued. 1 have and will n ntaain w rkers' comp sation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' cot (sail nsuran'ce(l9lnarrier er(t/, p/olicy number are: / �✓I�""� aofiayjNu ber r s section needmot be completed if the V rmit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the perfo nce 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 omia, end agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro CIA~ IA A � /~ ,r . - n A.pplk:entlSigpature: y Ly/ L(��/(i(1 Y fl J W ,ftNING FAl URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed ndgr 5�1 Chapter 9 (commencing with Section 7000) of Division 3 of the Business Fe Prj$sgions Code, and my license is in full force and effect. L (� ../ Glass Ci (�/ CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................................- ............................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................................................................................................................................................................................................................. ....................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................ ..................... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this implication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ........................... ........................ ..................................................._.................................................................. ......................._.....................__..............................-.................................................................. .............. .............. .....__........................ . 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............... ....................I...........................................................................................................................................................................................................................................................,...... 7 a a application, from the South Coast Air press Management District or other air pollution control district n agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, 4 it natur Of u uthonzedlAAWicant Date CODE C INSPECTION TYPE DATE INTITIALS GgPEI INSPECTION TYPE gAIE INTITLALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Block/Retaining Root 210 Final Electrical i 201 Final BIocWRetaining Well 212 Final Fire Prevention 202 Final Factory Fire Piece 220 Final Planning Approval 203 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 3030 AIRWAY AV Status: ISSUED Suite No Applied: 04/01/2005 Issued: 04/01/2005 Vicinity: RIPCURL Parcel Nunmber: 42708302 ISSUED BY: Applicant: WIGGAM, CHRIS Address: 404 WEST BLUERIDGE AVENUE - - Phone: 714-282-5700 ORANGE; CA - Zip: 928654204 Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address .%INSIGNIA COMMERCIAL GROUP IRVINE, CA Phone: ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 Contractor: AMERICAN CONTRACTORS Address: 404 WEST BLUERIDGE AVENUE Phone: 714-282-5700 ORANGE, CA Zip: 92865-4204 License: 309863 SCOPE OF PERMIT 75,816 SF INTERIOR T.I. FOR "RIPCURL" IN THE OFFICE, BREAKROOM AND RESTROOMS. 2 SHOWERS, 1 BAR SINK, 1 KITCHEN SINK, 2 WASH BASINS, 2 WATER CLOSETS, 3 WATER HEATERS (21NSTA-HOTS), 1 MISC (14 REMOVE/REPLACE LAV FAUCETS). REF: B05-00336 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446.46(9/00) FEE SUMMARY AMT QTY AMT OTY - AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer 50.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation - $0.00 0 Swimming. Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal. $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 - Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 ' - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash,Basin Set $0.00' 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $19.60 2 Drain, Roof $0.00 0 Shower $19.60 2 Water Heater I vent $36.90 3 Drinking Fountain $0.00 0 . Sink, bar $9.80 1 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $9.80 Gas Repipe $0.00 0 Spa (private) $0.00 - 0 - VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446.46(9/00) DECLARATIONS 'I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ave and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. y workers' compensation Insurance carder and policy number are: 1 apiece., Cri-'ce-iL. C—]a}--�ol� {hSUVCnNIy�JVIC' I fir: pYL_1574"i—O4 X15 loo need not be completed it the permit is valued el one hundrad dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Celllomla, and agree that If I should become subject to the Workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith Comply with these pro 'Joos. (cant pe ra: ) t G: WARNINFAILURE TO SECURE WORk RS' COMPE TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C MIRI�NAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND GOLLARE (S100.000), IN ADDICTION! TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION VOS OF THE LABOR CODE. IMEREST. AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effecl.I 6 las a G .,Cgptractw:c.SialAgWre: rBa1e� CONSTRUCTION LENDING AGENCY: l^-� ❑ 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued, (Sec. 3097, CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm the$ under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or County which requires a permit to construct, alter, Improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty o1 not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner Of property who builds or Improves thereon, and who Contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivels license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type o1 document. i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certily that no excavation five (5) or more teat in depth into which a person is required to descend, will be made in Connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art 2. Sec. 341, Title B. California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above. unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and cortity, a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Caste Mesa Fire Department by every business which has at any one time during a repome I year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 Cubic feet of compassed! gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration torn for acutely hazardous metenals7 ❑Yes ❑ No (Section 25533 Of the California Health and Safety Code, with Some excetions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equarto or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compassed gas a1 standard temperature and pressure). ............................................................_... _.............................................. ............................ _................................................................................................................................................................................... _......... __..... __.......... __ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 2553A of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..........._._........................_.._.___._..__.._._...__._._—......._._.._.........._...............__........................_.............................. _...........___........ ............__......__.�...__ 4 If an RMPP is presently required, has Section 25534 of the Celifomia Health and Safety Code been fully complied with? ❑ Yes ❑'No ..................................._.._....._..........................._..................__...__.__...............___...............__..........................................................................._......................................................._............._._...______.__.__........... 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication a ermit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agenCy7 Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..........__............. ............. _,--........... _......... _._............-._.._._................. __......... __....... .—................ __........................................ _................. .................... _..___._......... __........ 6 Will any pan of the facility to be Constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the Celifomia Health and Safety Code). ..................................... ............................. .............. _........ __............... _...... __.._.......................... ....... ....................................... ............. ..................... ....................................... .... ... ... ._... ..._......................... ........... __............ ___............ 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by Colllornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ....................................__.._...................._._._________......_...____..............__......ffic....._.............................................................__............................_..... _._..........................._.....___....____........ 8 (II "yes-, amach Certificate of compliance From the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury, the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that the information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. A4946= n re Ot Legal Owner(s) �/ PCO RAA Applicant /r CODE„}, INSPECTION_ITEF DdIE INITIAL $ CODES INSPECTION TYPE DAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing IF I 200 Final Ro-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Job Address: 3030 AIRWAY AV Suite No Vicinity: RIPCURL Parcel Number: 42708302 Applicant: HOLLIS GENTRY Address: 9750 DISTRIBUTION AV SAN DIEGO, CA MECHANICAL PERMIT Phone: 858-564-1100 Zip: 92121-2310 Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address: %INSIGNIA COMMERCIAL GROUP IRVINE, CA Phone: ONE TECHNOLOGY DR BLDG G Zip: , 92618-2339 Contractor: COMFORT SYSTEMS USA Address: 9750 DISTRIBUTION AV SAN DIEGO, CA Phone: 858-564-1100 Zip: 92121-2310 License: 445836 Status: ISSUED Applied: 04/04/2005 Issued: 04/06/2005 ISSUED BY: SCOPE OF PERMIT 75,816 SF INTERIOR T.I. FOR "RIPCURL" IN THE OFFICE, BREAKROOM AND RESTROOMS. 8 REPAIR/ALT COOLING/HEAT, 2 VENT FANS SINGLE/DUCT REF: B05-00336 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall HV Refdg Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Meth Exhaust Quantity $23.50 $0.00 � $0.00 0 $0.00 0 $109.60 8 $0.00 0 $0.00 0 $0.00 0 $0.010 0. - '$0.00 0 $0.00 0 VAV Box $0.00 � , 0 , Vent Fan / Single Duch , ;%$14.50 2` Appliance - $0.00'--- 0 Fire Dampers "1'$0.00 0 Smoke Dampers $0.00" 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm - $0.00. 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 - - 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY Quantity Repair / All Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventillalion System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems Up to 3hip /100k BTU - $0.00 0 3 To 15 hp/500k BTU $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp /-1,750 k BTU - $0.00 0 Over 50 hp / Over 1,750 BTU - " , $0.00 0 Boilers Up to 3 hp ' $0.00 0 3 To 15 hp - $0.00 0 15 to 30 hp' - $0.00 0 30 to 50 hp - $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, -and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon o;tliis,permit. FOR INSPECTIONS CALL: (714) 7545626 NO WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensatlon, as provided for by section 3700 o1 the Labor Code, for the performance of the r which this permit Is Issued. eve and Will maintain werkers' compensation insurance, as required by section 3700 of the Labor Code. for the performance of the work for which this Perit is issued. M workers' compensation Insurance carrier and policy number are: a' c_-IIIA=RLCp,.,I LUR.\cit�rJsuR,ANC.G COMppIJy P0110Numbec,W629183o8Oi rs sed/on need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this penult Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and ag ee that if I should become subject to the workers' compensatlon provisions of Section 3700 of the Labor Code, I shall forthwith comply �with these p r .Mo A IgneS tore: Data: APwL (0, zoo,& W4aNeIOr A10DREf SECURE RKERS' C GE IS UNLAWFUL AND SHALL SUBJECT AN EM VER TO CRIMINAL PENALTIES AND CML RHES UP TO ONE HUNDRED THOUSAND DOLLARE ).1 ADOITION TO THE COST OFCOWIPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: herebyof i thafl-ant licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of a Business and Processions Code, and my license is in full ohne effecl:Lic,g c _C20 C-4.CLO. C�8 Ctb.�-3to 3,cSt �ltgiact�ois Signaturef- Oete: /tiPP-1L to Jg75 3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a constmclion lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury (hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cede: Any dry or county which requires a permit to construct, eller, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he Or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) Or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensatlon, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an "nor of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a comractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (typo of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art 2. Sec. 341, Title B. California Administrative Code). ❑ As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above. unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........__......................—_...__..................,......................................................................__...................__.........._..__......................_................................._.......................................___....................._................_. .............. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazartlous materials? ❑ yes El No (Section 25533 of the California Health and Safety Code, with some exception, requires registration with the Costa Mesa Fire Department by each business which at any one rime has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................_.......... ....... _._........... ................................. ............ ........................ .... ..................... __............... _.............................................................. ........................................................................ .... _.............................. .... ............. 3 Does or will theaappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutety hazardous materials with the Fire Department. ......................_v__.____.................____......__.___.__._—_..__.._...................._.._._...............__..__... ......_........_........__.............._......... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Ves ❑ No .........._.._--_— ............... __... .__._..._...... .............__..__............._—__._—__......_.........................._.............._....__....._..__......__—.........._................_.......... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication efermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? a Yes Ll No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .........................................................................,............................................................................._...................._...................._................................................................................. ...................... 6 Will an ly p .................................................... ............... y Dart of the lacill to be constructed untler this ermlt be within t0001eet from the outer bounderles of a school? ❑Ves ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .........._........_._....................__—_.._.._................................................................................sI6'.............._..................._....................................................................'is'......................f'o.r.................................................................................... 7 a a permit from the South Coast Air Oescri Management District or other etc pollution control district n agency is required for the work which is the subject of this epPlicadon, have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? []Yes ❑ No .......................__.._............._..._.—_............................................_........ _......._.__...................._..____trol...___.............._.._............................_..................................__.._........._.............._...._.___.................................................. B (If yes', attach certificate of compliance from the appropriate err pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply With all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury (hal I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date r Authgbizaa.Apphcanl. - , _Date CODE I. INSPECTION TYPE QA3 INTITIALS CODE r INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Silo 204 Final Demolition 250 Final Building/Occupancy ON (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3030 AIRWAY AV Suite: Vicinity: OFFICE, BREAKROOM, & RESTROOMS Primary Occ: BIS -1 Type of Construction: V -N Parcel Number: 42708302 Zoning: Applicant: ROBERT ASKINS Address: Phone: 949-337-2180 CELL Zip: Status: ISSUED Applied: 03/02/2005 Issued: 03/29/2005 Owner: AIRWAY,LP $366.24 Permit: Address 3030 AIRWAY AVE SMIP Res: $0.00 SMIP Com: - Phone: Other: _ COSTA MESA, CA ; - - Zip: 92626 - - Total: $2,688.24 Contractor: 'ROEl- CONSTRUCTION Address: 3366 KURTZ ST - Phone: 619-297-4156 , SAN �DIEGO, CA - Zip:. 92110 ; -.License: 184531 '. Arch > WARE MALCOMB Eng: Address: 18111 VON KARMAN AVE Address: IRVINE, CA Phone: 949-660-9128 - Phone: SUITE 600 Zip: 92612 License: License: SCOPE OF PERMIT _ 75,816 SF INTERIOR T.I. FOR -RIPCURL-. - -:, " ' , , - PLANNING: WAREHOUSING = 49,834 SQ.FT. ' OFFICE ASSOCIATED WITH WAREHOUSING =25,982 SQ.FT Plan Check: $366.24 Permit: $2,253.75 SMIP Res: $0.00 SMIP Com: $68.25 Other: $0.00 Inspection: $0.00 Total: $2,688.24 SETBACKS MAIN STRUCTURE Front , 0-0- ACCESSORY -0.ACCESSORY Front 0-0 FEE SUMMARY Calc Valuation: $325,000.00 Claim Valuation: $325,000.00 Rear 0-0 left 0-0 = , Right 0--0 Rear 0-0 `-Left 0-0 -,_Right �" 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 woown(WW) FA _G932MEOSGO -1 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury we of the following declarations: ❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the irk for which this permit is issued. _U_<have and will maintain workers' cornpensedon Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permll is issued. My workers' compensation surence carrier and policy number are: e -Aa B.LkiYy AfCNC j'n�er• ons sect/on need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this penult Is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o1 Celifo la, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these.p Ise Zplpfe ��I alai _3�ZS -0, BNING. FAILURE T SECUPE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMP L RTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I artLliSensed undergvi/sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine antl Professions Code, and my license is in lull forS'/ J 3 f Class a - CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this peril is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for such peril to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing With Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a peril subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements ate not Intended or offered for sale. if, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type o1 document. i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation two (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure. scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a peril from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..............................._..........................__.._.—__......_.._..._..__._..._._... Occupant tofile......regist.................._..............................................................._................... .......................+.................. _....... ..._..._... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazertlous materiels? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....._ ...................... ........ _..........................................._._._.....__...—_.._.........._.._................_._.................... ..................................................... ........... ............................... _.-... _._.................... __._.____....... __ 3 Does or will the applicanl or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ t�0 (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..............._..__............................ntly__...._.._._............ecti_._.._._.._..._..........._.............alth................._._........................._..................................._................ ................................_........... ._..... _.__.......... .__...... 4 If an RMPP is presently required, has Section 25534 o.. the CaliforniaelifoHealth and Safety Code been fully complietl with? ❑Yes ❑ No ..................��...._.................................—__........._._._...._.._....._............_.__._..........._................_........................_.................................................................................................................._................_............._........ 5 Dass or will the applicant or present or future building Occupant require for the work which Is the subject of thisimplication a ferit for such conswct Or, w nwdification from the South Coast Alf Quality Management District or from any other air pollution control district or agency? Byes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). rt ...6 Will an ......... ._..___._._______ y paof the laciliry to be constructed under this permit be within 1000 feel Irom the outer boundaries of a school? ❑Ves ❑ No (If yes , the facility must meet the requitement of Sections 25534 and 42303 of the California Health and Safety Code). .......................... _._........................................_....._..._......_._.__........................_._.... _..............__..._............._............................_......_...................__.._................___.......................... ___...._.......__._........_.. 7 if a peril from the South Coast Air Quality Management District or other epollution control district agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by Californiaea la Health and Safety Code Section 42303 been metle? ❑Ves ❑ No yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. �I nature OI Lggal Owners) And/Or 691porized AppIxant__. 2io��y CODE -I, INSPECTION TYPE \r PATE IN atw CODE INSPECTION TYPE QATE INTML5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRelalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2D4 Final Demolition 250 Final Building/OOcupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3030 AIRWAY AV Suite No Vicinity: Parcel Nunmber: 42708302 Applicant: STEVE SANFORD Address: Phone: 949-724-1569 Zip Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address %INSIGNIA COMMERCIAL GROUP IRVINE, CA - - Phone: ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 Contractor: SASCO ELECTRIC Address: 5000 BIRCH ST STE 1400 NEWPORT BEACH, CA - Phone: (949)724-1569 Zip: 92660 License: 125897 Status: ISSUED Applied: 04/05/2005 Issued: 04/05/2005 ISSUED BY: SCOPE OF PERMIT ONSTALL 108FIXTURES, 61 OUTLETS. 16SWITCHES AND 52COMM DROPS FOR "RIP CURL' TI, RE:1305-00336. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for a pedod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zasaes (ryes) FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 it $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 $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa - $0.00 0 . ................up to 10 kva/kw $0.00 0 Lighting Fixts $86.24 108 ...............:.up to 50 kva/kw $0.00 - 0 Recept Outlets $51.93 61 .................up to 100 kva/kw $0.00 0 Switches $17.60 16. - ..................over 100 kva/kw - $0.00 0 - Non Res Appl $0.00. 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 - 0 Service to 1000a $0.00 •. _ 0 - Misc. Conductor $0.00 0 - Service over 1000a $0.00' 0 _ Circus ( gen or ride) $0.00 0 " Motors to 1hp ��A $0.00 - -0- _ Circus (mech ride or lights) -$0.00" • 101" 0 -� Motors to 10hp " so.00 ", -r 0 - Christmas Tree Stand' - $0.00 - i 0' Motors to 50hp - $0.00 ' , 0 Fireworks Stand $0.00 " ' 0 Motors to 100hp $0.00 0, - Other Electrical Fee -$0.00' Motors over 100hp $0.00, --0 Communication drops $43.36 ., 52._ Investigation Fee " . $0.00 Sub panel to 200a $0.00 - -0 Plan Check Fee' �. $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 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, 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 pedod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zasaes (ryes) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby all mr, under penalty of perjury one of the following declarations: d.P ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensatlor ritletl for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 37(X1 of _ .Jbor Code, for the performance of the work for which this permit is issued. My workers' compensation Insure/n Ve �carder and polity number are:'i Carrier. %1l/1/C1-I /-/ICl2/P,an) 1_� Policy Number: %7S5) -COI (This section need not be completed if the permit is valued at one hundred dollars ($100) of ssJ ❑ 1 cedity 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, and agree that If I should become subject to the workers' compensation provisions o1 S tion 3 00 o1 the Labor Code, I shall forthwith comply with these ,p�rowsi/ons Applicant Signature: j/.cc, ' /- Dale: WARNING: FAILURE TOfRE "WORKERSV06aPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 6ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby allIml that I am licensed under vi Ions of Chapter 9 (commencing with Section 7 0) of Division 3 o1 the Business and Professions Code, and my license Is in full force and effect. Lic. 0 '�7 Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any dry or county which requires a permit to construct. altar. Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of DlviSion 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sate (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself Or herself or through 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivels License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, fatsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above. unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Masa Fire Department by every business which has at any one time during a to tied year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...........__.._......................._.__.._.................................................._..._._..............................................._..................................................................... ............................................ ...................... _................ __........ _.__.._._.__.. 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code. with some exceptlons, requires registration with the Costs Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .... ��__......_. ._..._._..__......................_._............... __.___. 3 Does or will theaeppplicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required, has Section 25534 01 the California Health and Safety Cade been Cully Complied with? ❑Yes ❑ No .......___................__._....___.—______._.___._..�.........._._—.........__......._._...............__....................................................................._.........._..__.__...__.—_._—._- 5 Does or will the applicant or present or future building Occupant require for the work which Is the subject of this a plication aRemit for such construction or modification from the South Coast Air Quality Management District or Irani any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..........___......_..............................__.___.._........_......._...................................................._.__._....................................._..................................................................................... ..I..............................................._............._....................... 'T_WW any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management a Heal or other air pollution control district or add? is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No ............................................................................ontriplI............._.............._............................___.luti........._................._......................._......................................................................................._.._...................__._.....__................._.. 8 (If yes', mach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and dry ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cartity under penalty of perjury that I have read this application and state that the information given is Correct. I agree to comply with all state laws and city Ordinances relating to building construction, and authorize representatives of the City of Costa Masa to enter upon the above-described property for inspection purposes. 1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. y Ignal)! a Leel Own/ y Date �i�� 5/� 5ers) f d f And/Of Authorized Applicant / Data CODE E. INSPECTION TYPE RATE QRIDELS CODE • INSPECTION TYPE PATE IIBIDSL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 200 Final Plumbing 200 Final Re-Roel 210 Final Electrical 201 Final Slock/Retaming Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy r M (714) 754-5273 • Fax(714)754-4856 • www.ci.cos1a-mesW1UPRESSION PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3030 AIRWAYAV Status: ISSUED Suite: Applied: 06/02/2005 Vicinity: RIP CURL Issued: 07/01/2005 Parcel Number: 42708302 Zoning: ISSUED BY: Applicant: MORENO, ANNA Address: 30060 SILVER SADDLE CT- Phone: (951)244-9836 CANYON LAKE, CA, - Zip: 92570 , owner: - _CONNECTICUT GENE RALLIFE INSURANCE COMPANY - - Address' , %INSIGNIA COMMERCIAL GROUP " , IRVINE,.CA ',j', -i Phone: . ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 , Contractor: ; ALL /P,RO"FIRE PROTECTION ,Address: 30060SILVER SADDLE CT o'. Phone: ° (951) 244-9836 CANYON LAKE, CA iZip1. ..92570 " -.License: 629993 SCOPE OF PERMIT CATWALK STORAGE RACKS FOR "RIPCURL". REF: B05-00714 Plan Check: Permit: Other: $154.21 $237.25 - $0.00 Total: \$391.46 Y FEE SUMMARY ' Calc Valuation: . $14,000.00 Claimed Valuation: $14,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 160 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"&46 IBM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the ,Dwrk for which this permit is issued. /I have a will maintain work rs cwnpensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. yw s' co nsation uranc mer end policy number ere: / -7/1 Mar: rINV ,� umber, y//C NZ (This secs n need not be corn ted II The permit is valued of one hundred tlollars ($100) or Iess.J ❑ I certify that in the performance of the work for which This permit is issued, I shell not employ any person in any manner so as to become subject to the workers' cnmpensatlon laws of Calif ia, and agree that If should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith �pomply—with these provi�si �7� q/� ,r�� / ,4 � 11011,45— H /®, ` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLIARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pff,A�ovlsions of Chapter 9 (commencing with Section 7000) of Division 3-of.the Busines and Professions Code, and my license Is in full force rid eff L Lia N /O Z .��% F� Class - y Cion Tact tura, D, ete�'' �7 0 O S CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires 8 permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Zction 25534 of the California Health and Safety Code provides that the Costa Mase Fire Department may require the preparation, certification and filing with the Fire Dartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 It en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes [I No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building . permits). ................................................ ..........................................................................................-........................................-..........................._....................................................._................................................ ........ .......................-.........--................._...........___..... e Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (it 'yes". the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). ..................................................................................................-........................................................................................................................................................................................................................................................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................... e (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is cored. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signe" ign -22_ I,'g)31j�yp9q(s) 1710110 i D/ O�e `And!Or Authorized Appli nt , (� Date CODE 1. INSPECTION TYPE PATE INTMALS CODE INSPECTION TYPE gAT& INITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention UJ�� 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Job Address: 3030 AIRWAYAV Suite: Address:. Vicinity: WAREHOUSE Primary Occ: S Parcel Number: 42708302 Applicant: RIAD, IHAB Address: PO BOX 67 CHINO HILLS, CA Type of Construction: Zoning: Phone: 909-630-6557 Zip: 91709 Owner: CONNECTICUT GENERAL LIFE INSURANCE COMPANY Address %INSIGNIA COMMERCIAL GROUP IRVINE, CA Phone: ONE TECHNOLOGY OR BLDG G Zip: 92618.2339 Contractor: RAYMOND HANDLING SOLUTIONS INC Address: - 10261MATERN PL- Phone: 562-944-8067 SANTA`FE SPRINGS, CA Zip: 90670 - License: 842707 Status: ISSUED Applied: 07212005 Issued: 08/082005 ISSUED BY: �+ Arch : , Eng: RACK DESIGN & ENGINEERING CO Address:. Address: 412 W BROADWAY - - - - Phone: Total: STE 204 .Phone: 818-240-3810 GLENDALE, CA Zip: , .License: - _ 91208' License: C053524 SCOPE OF PERMIT INSTALL 15', 16' AND 20' HIGH STORAGE RACKS FOR "RIPCURL". REF.: B05-00714 g ALL INTERIOR WORK. NO INCREASE IN FLOOR AREA. . FEE SUMMARY Plan Check: $208.81 Calc Valuation:, $20,000.00 Permit: $321.25 Claim Valuation: $20,000.00 SMIP Res: $0.00 SMIP Com: $4.20 Other: $0.00 Inspection: $0.00 Total: $534.26 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front. 0-0 -Rear 0.0 - Left 0-0 - Right 0-0 ACCESSORY '_Front 0.0 _Rear 0-0 Left, 0-0 -.Right 0-0 PARKING E9LM:_ 0 'Required' 0 "o NOTICE: - - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 264646 (8/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a cenificate of consent to self -Insure for workers compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ t have end will maintain workers' compensatico insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance caller and policy number are: t4 ,- Carder. �._ ,l zLo �"�e-, t.� j—..mss. xN s . Ce- Policy Number: _To 7 (This section need not be completed If the permit Is valued atone hundred dollars ($100) or fess.) ❑ 1 certity that In the performance of the work for which this permit is Issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensatlon laws of California, and agree that It I ouldecome subject to the workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith comply with these provisions �7 Applicant Signature: "' / Date:�;/1 WARNING: FAILURE TO SECUREWORNERS' COMPENSATION COVERAGE IS UNLAWFUL AN SHALL SUWECT AN EMPLOYER TO CRIMINAL PkNALT16 AND CML FINES UP TOONE HUNDRED THOUSAND DOl1ARE ($100,0DO), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under roviqns of Chapter 9 (commencing with Sect] jj100I of Division 3 of the Business and Profamlons Code. and;! liana Is In full force and effect. LIC. a / Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslnma; and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) 01 Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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 -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thlrtf six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Solely Code requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). .._.... _.. __..............._—.__ ._ 2 Daes or will Iho applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Callfomle Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of SDO pounds, or a volume of 55 gallons, or 20D cubic feet of compressed gas at standard temperature and pressure). 3 0 B9r will ih❑e eppliwnt or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? C Doe (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been Cully complied with? []Yes ❑ No __........_._..which i............._.bjec.........................._cation_...........................__ 5 Does or will the applicant or present or future building occupant require for the work which is the subject c ? a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes � NO (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................._....................____.._............._.....—_.............._.....__..................._.................................................................................................... ................................._................ _........ —_....... _._ 6 WIII any par of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................_.._.._..............._____.____.. _._..__.—.......... _........... ......... _......................... _................................................... _..__............. __._..._._...__..- 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? []Yes ❑ No ... ....................................................... ......................................... _........ ........_-................. 8 (II'yes", amach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and dry ordinances relating to building construction, and authorize representatives of the Clry of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Sign re Of Lepal Owner(s) Date AncuoroAuffrod Roftant Date CODE E. INSPECTION TYPE gA¢, INTRIAL Sggf.1 INSPECnONTYPE gejE gNTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocWRetaining Well 212 Final Fire Preventlon 202 Final Factory Fire Placa 220 Final Planning Approval 2D3 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.j4d LDING PERMIT . 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3030 AIRWAY AV Status: ISSUED Suite: Applied: 05/04/2005 Vicinity: RIP CURL Issued: 06/30/2005 Primary Occ: F-1 Mod Haz Factory Type of Construction: Parcel Number: 42708302 Zoning: ' Applicant: WHITELEY, RICHARD-- Address: - - - - - - ISSUED BY: ` Phone: 562-208-7761" _ .Zip: Owner: CONNECTICUT�GENERAL;LIEE INSURANCE COMPANY Address %,INSIGNIA:COMMERCIAL GROUP , i IRVINE; CA Phone - _ - .ONE TECHNOLOGY DR BLDG G Zip: 92618-2339 � Contractor: RICHARD,WHITELEY Address:' P O BOX.1959� •Phone: 562-208-7761 i LOS AI:AMITOS, CA ' Zip: 90720/ ='ee -License: 829656 'Arch; -/'i I �, `.�>j:' Eng: RONALD WHARTON, �- Address: �!" i� ,� �-'j - -- ;Address:; -601 S MILLKENAV ' Phone:' _ SUITE "H Phone: 909-605-6865 -- ONTARIO CA Zip: \,-,,,'License: 921761 License: C32320 G .. SCOPE OF PERMIT - INSTALLATION OF A CATWALK AND RAIL SYSTEM_ FOR GARMENT STORAGE AND DISTRIBUTION. UNIT WILL BE 9 FT HIGH INSIDE THE WAREHOUSE AREA FOR "RIP CURL." - - - - - PLNG. APPROVAL BASED ON: - THE VERTICAL, RACK SYSTEM IS NOT SUBJECT TO FAR STANDARDS BASED ON THE FACT THE SYSTEM IS (1) INDEPENDENT OF THE BUILDING, (2) THE "FLOORING" IS MESH, (3) THE PLATFORM ISAN INTEGRALPART OF THE SHELVING SYSTEM"AND IS NOT DESIGNED TO BE USED INDEPENDENT OF / ` THE OVERALL SYSTEM, (4) THE USE OF THE SYSTEM IS FOR STORAGE PRIOR TO SHIPPING. - CONDITION OF APPROVAL: THE STORAGE'SYSTEM SHALL BE REMOVED IF1WHENfRIP CURL OR A°SUCCESSIVE COMPANY IS REPLACED BY A NON -SIMILAR USE. -FEE�SUMMARY Plan Check: $234.29Calc Valuation $180,000.00 Permit:�� $1;441.75 Claim Valuation '- $1ao,000.00 SMTP Res '' $0.00/,�� SMIP Com: 1.80 Other:` $0.00,. Inspection: $0.00 I' Total: $1,713.84 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2-44648 IBM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: - I hereby affi under penalty of perjury one of the following declarations: ❑ 1 e and will maintain a certificate of consent to sell-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the ork for which this permit Is Issued. I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My works y��m�nsellon Insurance carder end poll/umber-----�� + �/ /, n/J T �T hl`Y /�/1Ne/% �il S. '�G-/i /!(� PQ-/Nuntber:� fCl�� L(/� (/ PQ- -finis need not be completed if the permit /s valued atone hundred dollars ($100) or less.) ❑ 1 conity that in the performance of the work for hick this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif In e t if I should becomesublect to the workers' compensation provisions o1 Section 3700 of the labor Code, I shall forthwith comply with these pro Applicanl.Signatura�:- �D / _�D _(57 WARNING: FAILURE TO SECURE WORKERS' TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100.000). IN ADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice ad under proNsiona of Chapter 9 (commencing with Section 7000) of Division 3of � Rusin gss_apd r9fa� ons Code, and my license Is in full force and effect. Ur - Cie N &&a '/);Z/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) 01 Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, Be owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Uconse Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivels license.Yes ❑ No Drivers License No. Expires: Vellication of (Ownership by (type o1 document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Indusidal Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standar temperature and pressure). ...........____..................... __...................._.—__._........._.............................___.................._._._............._____................_......_............................... ____._...._..................._._...._........... _........ ._. 2 Does or will the applicant or present or future building occupant need to file a registration toren for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..............................................................................................................................................................................................................................................................................................................................................................I............................. 3 Does or will the aappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ................................................................................................................................................................................................................................................................................................................................._.................................................. 0 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No . ................................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication app'r�il Icr such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Es Yes L.1 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ....._._..._......................___................................___._...........-............................._._..........................._......................___...........................___......._............................... ......................................_......_........_.............__............ 8 Will any pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..................._....___._............................_._...........................___.............................__..................__..............luti...—_........................__..........................................or.....__...........w......_............_..........a...._........I.I." 7 If a permit from the South Coast Air Oescri Management District or other elr pollution control district or agency Is reGuked for the work which Is the 5ub�ect of this application, have all of the dlsdasures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No _..........__._.__.._... 8' yes' (If _............__. __......_ _ ___—__....._._.—...___.._......__.. , attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that 1 have read this application and state that the information given Is cored. I agree to comply With all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re Of Legal Owner(s) 9-t- ndlor.lwgadzed-Appgdani'r CODE I. INSPECTION TYPRiITTALS CODE If INSPECTION TYPE 20 IHTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final RB-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupancy 5!n M