HomeMy WebLinkAbout250 FISCHER AVE - Building Permits •
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• City of Costa Mesa .• 2409
Building Safety Department CERTIFICATE OF OCCUPANCY NO
P. 0. Box 317
Costa Mem, California
The Building located at 250 F.l3eiwr AT'uti'.0
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Bal B"Q Occupancy.
Use of Building Industrial. Buil/lint,
Legal Description Trept 39 c, tnt +♦►
(See reverse side for Metes and Bounds)
Building Permit No.' 2)579 Electrical Permit No. 2::291 Plumbing Permit No. ?Min
Floor Load Signs have been installed as Room Capacity Signs have been instaled'as
required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C.
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator'has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8.
Number of apartments_ and/or guest rooms
ISSUED TO: Building Official
LA M) gn:: C ��by l� , // e1
Date Ci 3bor 31, 3966
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. 306 (e) U.B.C. Form a1334—IM_11-e3._3-13 p
26407 Nov 25-66 001179 I*****9.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
• P.O. BOX 1200 COSTA MESA, CALIFORNIA 02020 .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BYILDINo // ^ , ' -� ///� p For Office Use Only
ADDRESS 2-O fi SO - Vt,u-z_
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA
.`FM RECEIVED SY DATE RECEIVED DATE ISSUED
14,5
OWNER Atka-ED M. 4eP)bO 1-) /1-Zr-a.., /1-2,r-66�� ,(
AMAIL DDRESS �v Z ADDRESS ZSO //'S4BI� V""-
TEL �p����I1 FIRE N
3
CITYr% sm MFsSA' NO.qyn-L{JIOV� ZONE TYP '"GROUP
APPROVED ~ /P .y r -66
ARCHITECT P014 7 a NEL BY /11��\ DATE GJ
4NGINEER
Ammo, ya1- GAgrigN C2a'/t BL&, ZONING L
mI1S I NO.OP /q� I USE OF NEW�l .1.4)4 I
P t PLANS V BUILDING
CONTRACTOR / 1 17/
/
ADDRESS I�'F 3 rLAC'n'n �-�6-7, onGAe Imon LO 7 Y '- r —o��j''js
``4A ,, --••..__,,.. AA .6 Ci ne--3
CITY � T 7� _
STATE TELa Id NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
LIC.NO. NO. �' SO'TO SIDE Q REAR P.L
EAVES
SIZE I NO.OF BLDGS. / ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BU I LDI NO ACCESSORY BUILDING
EXISTING BLDG. �-I j)nUI DElvtzlL 11.1et
(FROM C/L STREET)
SETBACK LINE FROM FRONT FT. PT.
CENTER OP STREET REAR YARD -
SID;YARD I LOFT I RIGHT R.SIDE FT. • If PT.
J
DESCRIPTION OF WORK L SIDE FT;X I .4 ' ( PT.
ALTERATION _ ADDITION REAR PT. PT.
DISTANCE BET. BET.MAIN D
REPAIR _MOVING DEMOLISH MAIN SLOGS. ACCESS.BLDGB.
BUILDING NO.OF VAR•# DATE
SIZE ROOMS STORIES C.U.P.* APPROVED
EXTERIOR WALL I ROOF APPROVED/a,
COVERING COVERING IT DATE
USE OF BY ILDINS AND WORK TO BE PERFORMED 0,
MS:* 4gffW g94 KS PA11.I1' 'iR4y
goat if r 2- SQ.Fr.
I HEREBY ACKNOWLEDGE TNAT.I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE Cti
AND STATE THAT THE ABOVE.18 CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF � J� / PERMIT FEE $ .
PERMITTEE .�-'
i/�
S / PLAN CHECK S g.
AUTHORIZED AG /��f
TOTAL FEE $ /`�
dit-
28596
, COSTA MESA BUILDING-SAFETY DEPARTMENT Mtn,6C00 936 dt***12 00
P.0, BOX 1200 COSTA MESA, CALIFORNIA 92620 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDINo _ For Office Use Only
AD�RE-' 2.5' f7Scss/eR ST
RECEIPT N0. rJRrKO,..,4
COSTA MESA, ALIFOBNIA 1 �l ��
�K, �,4y-r,,� BROS / DA IVE Dfl�IIG°7UEDD fY/
OWNER � 1 f� .�/bd J-//'(�I+
MAIL y� / c�j BUILDIN 1
:DREW t�' O A/7�.55Gf/G /\�/J�7',7 ADORES-FIRE //j� �+//
emag,QW6L� �A ii ti' jgy/#L -ZONE 'J TYPE r GROUP
ARCHITECT TEL APPROVED
DATE
OR ENGINEER NO. BY'
ZONING
ADDRESS e - ZONE NO.of us[or NEW rte../C/Crf
CONTRAGTOR vory ^west �A�/�t Mop, /VI^I I LPU.,c z' I DUILD"ING /
ADDRESS 4z0$ dr° er/4/67'7 N fl�/ LEGAL
RRIPTION ^d! V ii\ •-?9 3 -5--
ADDRESS
4il/6E46.S an/A'. A.P.NO. /il a 7 ` 03 Z — 07
Q //�y ^ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
1621;10g14-190173 It.
O. (393/a f./ SO•TO SIDE S REAR P.L.
`rf / ft EAVES
SIZE I NO.OFBLDOB. "_ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON IAT
_ YARDS APPROVED YARDS APPROVED
USE OF - MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROM FRONT PT. FT.
CENTER OP STREET REAR YARD _
SIDE TARP[ LEFT RIGHT R.SIDE FT, / , c__ FT.
DESCRIPTION OP WORK L.HIDEFT.i-, FT•
i
NEW ALTERATION ADDITION REAR V." PT. FT.
DISTANCE BET. BET.MAIN O
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
y /SOT / TIUq/ VAR.# DATE
BUILDING WO 1/A-79;OMS
SIZE �'I WO T /I ROOMS STORIES C.V.P.# APPROVED J� 8
EXTERIOR WALL I ROOF COVERING APPROVED ✓A4 DATE 5�/C`�
COVERING ` (O/
USE OF BUILDING AND WORK TO BE PERFORMED D.
WOO pfan?K//)'C- 174 4::76-. w
M/-57:14.4 39 F/R6 5.°43W4' 4. �[/v /m
TSI%/Jr sy�rein, /. LO_I/ SQ.FT. . 1
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O
AND STATS THAT THE ABOVE.IS CORRECT A EE TO COM• PURPOSE OF ESTASLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDI ES AND STA LA RE OYMTINO VALUATION
BUILDING GONSTRY �A g ' m
PERMIT FEB LrSCr N
SIGNATURE OF
PERMITTEE !�T $ 7 /f fl PLAN CHECK SF 2.
AUTHORIZED AGENT TOTAL FEE $ / 5$
A -`,' 28273 As��,..ai.- *a•1o$;S
o COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
QUILDING a co F'/S H E2 ST For Off ice Up Only
AGGRESS RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA
71 LA
7R/( //A�Oj
6�
OWNER 2o3e21 Dv H'4`Cw�2D " .
BUILDING
MAS /673 fLACEN774-
ADDRESS
FIRE y
CITY r0,JnI / , Ne42/2/7 ZONE TYPE GROUP I
ARCHITECT APPROVED f.7-7SRONI yet.
9" 7" BY.
Y e DATE D _zs
g
OR ENGINEER
ZONING ONING
ADDRESS 900/2. (a42DEA/GA2OOFg[42ZO NO.OF 2 I USE OF NEW.rnd4 rf
e/
PLANS BUILDING /wA /
CONTRACTORT , S.- LEGAL La/
yrn . i3
•-57-
ADDRESS �6 741/0/..4e-e-Are a• DESCRIPTION
CITY (ASTMer� A.P.NO. '7— O 3 Z -- Or"
�� I2 2.. NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
STATE TELSO'TO SIDE a REAR P.L
LIC.NO. 2 NO.
SIZE OF LOT .2 03
3/ / I No.OF NOW ON LOT'Loot / EAVES
ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF /6�r /11/C- - MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. _
(FROM CO-STREET) 1
SETBACK UNE FROM /` FRONT e/(rj/X41
CENTER STREETOF 7 O REAR YARO /D //I T. !I /'T•
SIDE YARD I LEFT /O / I RIGHT JU / R.SIDE 10 PT. PT.
DESCRIPTION OF WORK �/ L SIDE/p/SFT, FT.
NEW _ ALTERATION _ ADDITION /t REAR / PT. •
FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDOB. ACCESS.BLDG'S.
BUILDING // NO.OF VAR.* DATE
SIZE [OD X?O ROOMS / STORIES / , C.V.P•# APPROVED /p
ALE. /440
EXTERIOR WROOF APPROVED y-L—Ql p
COVERING c ti CO I COVERING ST 9604 DATE
USESQOF B ILDING AND WORKTO BE PERFORMED HOLD FOR SPECIAL REQUIREMENTS a
/,�//„/77A./C+/fr Al I,E.c/es< Tre//I arty a. y/ /Fr /„ 'face, 0.1
(4(�_,gmd,ic..r cfrrc lefire dcic.I `1')-Z/-G8 1
_ •/. .y 4rc%q/PIrNa/ C4rc/f./i„.!
097r) it
I HERESY ACKNOWLEDGE THAT" NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 2
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT PSR ONLY.
PLY WITH ALL CITY ORDINANCES AHD STATE LAWS REGULATING VALUATION
BUILDING CONSTRU�{ON. 74
_/ J /�1 / PERMIT FEE E
SIGNATURE O • /f/ L�/(¢'4'cVE9C-ie . Lj/n�/�J TO
D / " 11/ j/N CHECK S ✓'6/----4,
AUTHORIZED AGENT J \ /� // r
TOTAL FEE S/11 '.'
-, E • �d�rR{r
264055 NOV 25-66 001130 _ 18.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
• P.O. BOX 1290 COSTA MESA, CALIFORNIA 9262! -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
Dunning ZSp F/SCWS,C ace., For Office Use Only
ADDRESSRECEIPT NO. P[ IT N . .
COSTA MESA, CALIFORNIA .2o"gpOLr
/� / Rsc ED■ DATE RECEIVED DATE-ISSUED
OWNER r/A"Y WQR'D FG Tt.e (, p (� ! -,._. �L� A- - k
OU ILDI NO C
MAIL EE;./6 73 -eo f Y ADDRESS S-U et .1L h� "v✓�
AODR
FIR!
J�T 7 e TEL ZONE TYPE /GROUP
CITY / •`"'�' NO. _
APPROVQD�(1/�/y Atte, d / 1
ARCHITECT TEL B7' it
% fir DATE //;.2St4
ENGINEER NQ. `/"
ZONING
ImORBSS ZO (1(I NO.OF USE OF NEW . ♦ -
C '7 /!/! 1 PLANS
I [YILDINO �/- /f A�
CONTRACTOR flan,Wes r fie-F /'eorGGTev6 �.�T_C/�pJ�/�(I�}rUf ,
// �/ LEGAL / l J/ • ✓ f/3✓
ADDRESS 7 Z ffs /TU/VT/N6TN D.P, -sa DESCRIPTION f[f"`"'���
%...CITY X 0-5. , %/c-e€eS 3L 0-.41/ A.P.NO.
NOTE: NO EAVE OVERHANG SHALL B8 LESS THAN
LIC.TNO./(�/®l //q.3 NMOL«s/O7¢- 30 TO SIDE @ REAR p.L.
EAVES
SIZE NO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED ROB APPROVED
USE OF MAIN BUILDING C •RV BUILDING
EXISTING BLDG.
(FROM C/L ETRE'•
SETBACK LINE FROM FRONT • PT
CENTER OF STREET REAR YARD i -
SIDE YARD LEFT RIGHT sR.SID •A .
DESCRIPTION OF WORK 7 PT.
Fro.-/
ALTERATION ADDITION
MAIN @
REPAIR MOVING DEMOLISH - MAIN /ACCESS.SLOGS.
BUILDING NO.OF DATE
SIZE ROOMS STORIES APPROVED
EXTERIOR WALL ROOF APPROVED a
COVERING I COVERING Y DATE - - -
USE OFBUILDINSAND WORK/7[ B8 P8p�)pRMED�- y- "�}0.(
L7 J SQ.IT.
I HERESY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTIONS VALUATION 10 O
SIGNATURE OF %/��'s' _ �.50��� PERMIT FEE /O E
PERMITTEE /J+`�`��
$ PLAN CHECK S w°
AUTHORIZED AGENT �( D 0
TOTAL PEE $ /I/
3703. 1 lU120-7• *****5.50
• • - C
• COSTA MESA BUILDING-SAFETY DEPARTMENT
- P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
RECEIV BY DATE RECEIVED DA E1170.73
BUILDING / �JIFJ/3
ADDRESS 1�C ` �� �/ /�
,/ se !I'4 1 �j :MIT N•,
OWNER 4 �// A.P. NO. 1 ALJ J��O o
/�{J I'/� BUILDING �,y. �/ /�,,
MAIL A'S C- 10,r // a/(� •• ADDRESSSO Ec�oY•Icjc Ai it
ADDRESS r
CL CITY o /�%�Cr<I. r w LII NOLQ�<E� TRACTJ(JJ LOT BLOCK
CONSTRUCTION CJs/ /� 'N/•� NEW ADD ALTFR REPAIR MOVING fFMOI ISH
O N LENDER ���LK� [7q�/� j /1
J CL 03
D BRANCH /y t I�l,"0 . . r O/L.�Q
!rI' OWNER lT
< J ADDRESS /t/ (2 tet-s0 n t /�y/��� 744721.11
•m ARCHITECT / TA TEL. USE /'�`�[` n</�
''< OR ENGINEER /�r Q '1/l p NO.
U Vt L
Q FIRE
W CL ADDRESS A L k A ZONE TYPE GROUP
d Ly + APPROVED /j/ `
J O CONTRACTORAkaqi6 le,)1 p y ' BY /[./ DAT E7�! f"--
CO /
JK ADDRESS n (/(-p1
W w TEL ZONEAA NO.OF USE OF NEW
z1- CITY /b h O NO. `� /VI ' PLANS '� BUILDING
LLl-� STATE �' ^" • CITY YARDS APPROVED YARDS APPROVE�1./�
V)CC 'LIC. NO. •rte LIC.NO. •�- MAIN BUILDING ACCESSORY LIMN
r 0 (FROM C/L STREET)
SIZE .r.-----...., NO.OF BLDGS.
OF LOTNOW ON LOT FROM FT. _
USE OF
EXISTING BLDG. id
S.g,$
SIZE OF NO.OF ///I I�Q���J'' /n/
Z NEW BLDG. ROOMS STORIES L.SIDE F�'. J[ �C/ .FiL
ta.1 EXTERIOR WALL • ROOF (//,(_/ VVV
COVERING COVERING REAR FT. 0/FT.
.J U$E�OF BUILDING ANO WORK TO BE PERFORMED S DISTANCE BET. BET.MAIN&
�J f`j/ .ryt j/J\ //� �1 [% MAIN BLDGS. ACCESS. BLDGS.
Q A i°•Q l / 3 Q oit /1-y 12_ y E V AR..W APPR
0ATE
/ C.U.P.qt+ APPROVED
zAPPROVED _ DATE 77,9/n
O r
U▪ I hereby acknowledge that I have read this application and state % STA)'F
that the above information is correct end agree to comply with r/1
CC all laws regulating building construction, and I shall not employ C/
F any person In violation of the workman's compensation laws of I
y the State of California. m
ZI hereby certify that I am properly licensed as a contractor under SQ.FT. Neo
the State of California Business and Professions Code, Di ' n 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses ar full force and or I 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
cc
am exempt from the provisions of : • ate of Califo siness VALUATION dU
and Professions Co . Div" '. ter 9. m B
PERMIT FEE $
D
Signature of / / f //'') m
i
Permittee S . ��.1•.�� $ c5t,�0 PLAN CHECK $ "�� E
G v
u.
Authorized •gent TOTAL FEE $ �`
. • 37020 PAID *****5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
•
AP' I, • ION FOR BUILDING PERMIT
For Applicant to Fill in Completely I
^ RECEI r DATE RECEIVED DATE�JI SUEDBU `
ADIDDESS I NG 4 5O F--/pP✓ / f lie• / 7—/O' 3 /—''r _7J
I � / '( ''') F/ERMIT NO.
OW : - \ / n sem/ o r/ 715�/d . A,P.NO. `I � / -03-1.--0-(
MAIL ��• YYY BUILDING /� • . - I it
Z„Jul ADDRESS
5 Q pA/S�jr� ,,,,TE ADDRESS /G
a U CITY Ohs / 05 C • NO.JXb^Z��V TRACY, �5 LOT • BLOCK
OZ Z CONSTRUCTION // / NEW DD.ALTER REPAIR MOVING DFMOLISH
N LENDER `n' �f/I lam` •
a m h r
J D BRANCH !X (fl
J N 1 A -��OWB 01...D
`
,/ OW Sl�ir1{N)
At LO ADDRESS a `� �'I �/} s,Y
mJ ARCHITECT �f �'^ TEL., USE I ra 1 V'I pore TITII/M$
J N OR ENGINEER 1Y. (]7/I P ' NO. O y( V
U FIRE T '(''
CW ADDRESS /?/ b 21/P r ZONE TYPE V . GROUP T
( APPROVED ( •
J O CONTRACTOR �1 p r/` BY `_ DATEi— 13_7 3
mZ
Jy�
CC ADDRESS 2 6- R r• /LU LuE, NO /'yr..��y�_
ZOF USE OF N0
HCITY NOL ZO 7 I `' PLANS a W BUILDING E •r yT Ogal
w0 STATE CITY YARDS APPROVED YARDS APPROVED
(ry m LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY : -1LDING
•
DO SIZE NO.OF BLDGS. (FROMC/L STREET)
OF LOT l NOW ON LOT FRONT FT.
USE OF / }
EXISTING BLDG. R,SIDE (17.1 / /
Z SIZE OF NO.OF / T
NEW BLDG. ROOMS STORIES L.SIDE - T.
C.) EXTERIOR WALL ROOF
_ COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND ADAK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d n Ig- j-I 1,.. .14 A trr IiD IJ!A. .L A -MAIN BLDGS. ACCESS. BLDGS.
DATE
0 Atli,N Ot-h.-VI1,4-7s�,/1° Act I a' CORP# APPROVED
Z a///_ /n//� j �® r APPROVED ,r'/� '^7//
5 O h f UT 1-V (/ 4aTLr V !j�/�✓� DATE /( 111-2•3
er
V I hereby acknowledge that I have read this application and state J_
D that the above information is correct and agree to comply with 7
CC all laws regulating building construction, and I shall not employ
F, any person in violation of the workman's compensation laws of
(A the State of California. m
2 1p
I hereby certify that I am properly licensed as a contractor under •FT. 0
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 full force effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of he State of • is Business 2
and Professions Code,Division 3 h.pter 9. VALUATION N
n \ V ,�./] PERMIT FEE $
Signature of n ' e O •' m
Permittee /17�+1 • $ {,/ o— )� PLAN CHECK $ E
LL
Authorized Agent TOTAL FEE $
36854
PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT JUN 25-73zI,54002901* *****5.50
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626 ,
P' IC TION F BUILDING PERMIT
For Applicantli� to Fill in Completely
L
250 } S HE2 /14EE R C I •i E •ECE� D pATF�I$SUED�
BUILDING Tfr/J^�
ADDRESS
1r�c.L I H . ()cane PERMIT N•
OWNER A.P.A.P.N.N•. _ -40 � �� .J ih•r .1
MAIL BUILDING
ADDRESS2-Lu LU � p FI ► A�!E ADDRESS �_j F� '�/�
1-0
d U CITY CESTA t-'IDSA NO.TE .�6,0 , TRACTS-955 LOT �-�F BLOCK
ZZ 'Nf�" /
cE CONSTRUCTION . NEW ADO A, LTEF REPAIR MOVING DFMOI ISH
O N LENDER ,\/X\/
0- m
JJ CO BRANCH OWNER ALFsE'nH GP z,�1
4 W ADDRESS � \.... Re.r.„,...•••
M•CO ARCHITECT c/y ,' {�s��/ TEL. �jQ�' .yL USE �N I arm - \VALU$ ' �///
N OR ENGINEER Wl."t t ZA 1 NO. \ - 1� ��/ �LjTU
V 7 T FIRE �J
WCC ADDRESS 4(,Q \\I . �y1- 1 Sr ZONE T PE� GROOPP �/,
11 Ly J O CONTRACTOR Ox.�.4 E„1_ Y 2171' APPROVED DATE
6 Ll���
J f O\V . k-1 -S T. Si Liz Z4
�1I
J¢ ADDRESS _
ZI- CITY�IC T I C) � NO.TEL 34 /{/N/�y1 PLANS BUILDING NEWE NO.OF USE OF
w O STATE CITY ,/YARDS APPROVED��' YARDS APPROVED
th O
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING /�
SIZE q't}. I NO.OF BLDGS. (FROM C/L STREET) p/4
OF LOTy(�,x`7 �L 33O I NOW ON LOT (
FRONT FT.
T. ��6
USE OF £ M� Q + //�-N
EXISTING BLDG I-4-PG R.SIDE Szyb../ 1„./...t0111/
1- SIZE OF NO.OF 2 NEW BLOG. ROOMS STORIES L.SIDE .
U EXTERIOR WALL ROOF
011
/��
COVERING COVERING REAR FT. 14/ FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
Cl. MAIN SLOGS. ACCESS. BLOCS.
0
Q ^I �z��-z �-t�y VAR.# DATE '�
O �f"51� TO X11 1 1NVS C.U.P. / /jL //�)/
APPROVED NyQ�
/•••
�IlY ROVE9/�e+" `YJY DATE6 -.° - Z s 1=,
0 I hereby acknowledge that I have read this application and state
CCthat the above information is correct and agree to comply with q
all laws regulating building construction, and I shall not employ D'
Hany person in violation of the workman's compensation laws of
y he State of California. to
e
2 I hereby certify that I am properly licensed as a contra or under SQ. FT. o
the State of California Business and Prof cions Cod• • isicn 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR s
Chapter 9. and that such linen : are ' f 'll force • fact,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
CC
am exempt from the p ovii•ns o -e ate of C • is Business O
VALUATION
and Professions Cn`o,,!i ' on •/�/ =.ter 9. ,• ✓_ PERMIT FEE $ N
Signature •// ' / • - / (J`/ E
Permittee s it/"�� $ PLAN CHECK $ ) (,/( E
Authorized Agent i (�(/V/ u
TOTAL FEE $ `.✓
3678.7 .
COSTA MESA BUILDING-SAFETY DEPARTMENT )UN 2O-73IA �OO1819* ****39.50
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
/ �//// RECEIVED BY DATER CEIVED DATE ISSUED
BUADILDING DRESS G' O/756,d-fete ,4',r / -
/`l f di /., ,/f//_/� P r T •,
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SIZE NO.OF BLOCS. (FROM C/L STREET)
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\O � �
0 state
acknowledge that I have read this application and ath - I �''`.
that the above information is correct and agree to comply with k
all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of 1P
Cf, the State of California. - coto
Z I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Code, Diviiicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: •
cc
am exempt from the provisions of the State of California Business
and Professions Code,Divisio .3,Chapter 9. VALUATION Jam//r/ (9= m
PERMIT FEE $ c tw
Signature of p� m
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Permittee , $ r7 Oa � PLAN CHECK $ /3 E
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Authorized Agent is
TOTAL FEE $
39727 PALL
'BAR 19-75600 66(1* ****40.10
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
if
APP I TION FOR BUILDING PERMIT
For Applicant to F,iillll in Completely
RI V DATE RECEIVED DATE ISSUED
ADDRESSSAix) \ l//L��N�J//L�`/�, 4yr I l/'//,z/J S _//�(� ( -i'PER-if-75�_
OWNER/`QE") M. AV �P/ OC�A+� ate,' /
A.P.NO.
MAIL
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ADDRESS 2.10 193 0/4_:,e /Jz/U '�¢¢ ADDRESS 7J Q f S'I-} _ {/C
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en
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JN OWNER AL.FR.&0 M , GorLoo&)
CO J ADDRESS / (�t� VALUE /J Q� en'
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UI hereby acknowledge that I have read this application and state J,�
D that the above information is correct and agree to comply with
CCall laws regulating building construction. and I shall not employ TAX
F any person In violation of the workman's compensation laws of
h the State of California. of
? I hereby certify that I am properly licensed as a contractor under I SO. FT. o
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 full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
cr
am exempt from th provisions of the Stat of California Business
VALUATION n
and Professions , Division 3,C•-p.- PERMIT FEE $ r `I m
w
Signature of ��� 7 $ .2- VV Cr/-3
PLAN CHECK $ s E
Permittee
Authorized Agent :
TOTAL FEE $�� —
DEC 10-73PFf,/»00 298* h***4;6.50
37670
VTAMESABUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP C ION FOR BUILDING PERMIT
For Applicant
/toFill iinCompletely RE IV B DATE RECE71VxJED DATEISSVED
ADIDRESS 5Q id G.0 1 /2-to - " 1 _Io_23
�9cpz&,a .0 4/ 7 D/�_O PERMIT NO.
OWNER 4 G '•Y/ A.P. NO.
MAIL BUILDING '/
Z ADDRESS p r ��p/� ADDRESS � O /��✓ E� ygt�6,
- 0 CITY (�'zurA / 2634 NOL SI�d:d D TRACT 7S LOT BLOCK
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Zr F- CITY NO. /21 / PLANS BUILDING60 4 _T/Il7r 7�:
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F APPROVEt )J.3 Po / _
N _HY DATE
O SZ PTE
UI hereby acknowledge that I have read this application and state gv
D that the above information ii correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of SAX
(A the State of California. co(9Z I hereby certify that I am properly licensed as a contractor under SO. FT, o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State . California Business VALUATION '�q.�
and Professi n r ie, Division 3.Chapter 9. `� m
PERMIT FEE $ 5 J _ re
Signature4IP / COP 02
\ Permittee ,cG� $ L-. J PLAN CHECK $ ^�' E
Authorized Agent u.
TOTAL FEE
•
. COSTA MESA BUILDING-SAFETYODEPARTMENT NAP —2�73�s/°,O0 01 0* ***195.78
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P C ION FOR BUILDING PERMIT
For Applicant to Fill in Completely
For
_ �y� RE IV D V DATE�tRECEIVED DATE ISSV E7D
ADBUIDRESS LDING '�5D /5 CA/a_ 4VC `�� 3 —
FAST) /� `�� Imo°
OWNER L FFGf J �' O/c.U�/y A.P.DIN
MAIL BUILDING //30 rs . ,Ave_ mC�
Z
ADDRESS ADDRESS /,"'_� / ! V
WU NEL.
a
CITY TO, TRACT LOT BLOCK
CONSTRUCTION NEW I ADD ALTER I REPAIR MOVING DFMOLISH
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JN L. _BRANCH - 4LFRED/ ,' • coeOE/�/
OWNER
m J ADDRESS ``// VALUE q
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W O STATE CITY YARDS APPROVED YARDS APPROVED
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J O ( (FROM C/L STREET)
SIZE I NO.OF BLDGS.
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0
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0
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co —Ety
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i— s z...../
H I hereby acknowledge that I have read this application and state /
Dthat the above Information is correct and agree to comply with
cc all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
h the State of California. m
? I hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
am exempt from the provisions of the State of California Business —j} iL
and Professions Code.Division 3,Chapter 9. VALUATION
PERMIT FEE $ /1.
Signature of 5—.0 m
Permittee $ PLAN CHECK $ E
f-----------19Z2
� o
Authorized Agent LL
a TOTAL FEE $
PAID
• • ;Tr. 25-73E-,: -.-00 945-' *****5.50
•
36123
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• 'P C• ION FOR BUILDING PERMIT
For Applicant to Fill in Comple ly
/, n - RE -,0f a 2•DATE
9ISSUED
.
BUILDING SG ?� r?fc%' /� VE - V_'�w ~//
ADDRESS 1 / � / n • �J L-1.277-o3.1-01
OWNER /L�jeeO ,4 .6esC.Q i4 0 /4i� A.P.NO. �5]'JPERMyNf�d.23
ff ADORBUILDING V V /5SCH .C"1
MAIL ,(�ngrLi uf -il
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I-Z
Z Q CONSTRUCTION Wada
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_I V) OWNER A�,rVeg/0 PIA C 61Tt1OA
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LC/Z. t BY DAT
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CO Z
J K ADDRESS
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ZFCITY NO. M I (PLANS . BUILDING Y3 0�T(„1
w STATE CITY YARDS APPROVED YARDS APPROVED
In CC LIC.NO. LIC.NO. AIN BUILDING AC EBSORY BUILDING
D 512E NO.OF BLOCS. (FRO . Cl
OF LOT NOW ON LOT FRONT FT.
USE OF i1/J A�,/ AG die-f,z✓/�s R.SIDE ,, . T.
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y Q ,/s 2 l ABAPPROVED - 6 DATE ~^1 � • /3
a
0 .
U I hereby acknowledge that I have read this application and state // l
D that the above information is correct and agree to comply with l."/1 V
cc all laws regulating building construction, and I shall not employ r
F, any person in violation of the workman's compensation laws of
pg the State of California. co
ZI hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses aro In full force and effect,or I THE PURPOSE OF ESTABLISH 1 .HERMIT FEE ONLY; Q
am exempt from the provisions of the State of California Business S d
and Professions Code,Division 3,Chapter 9. VALUATION _, J m
�� ��A jT�/ PERMIT FEE $ N
Signature o m
Permittee `J 0 $ � ' PLAN CHECK $ E
fir C7 L
IL
Authorized Agent
TOTALFEE
1
' 3580 PAIOo� 7331 ****95.65 (
sr TEC 19-7,Ot;t
•
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
R CE
A P (CATION FOR BUILDING PERMIT
For Applicant to Fill in Completely/LA.446-NPUVE BV D�9)TE RECEIDATE
BUILDING r
FISC.4ela tr 'Y-1 - VVED
ADDRESS
�p�� �,s / _ �( �7
OWNER r/4_FRE✓ sV�f�.�..�jWQOENJ A.P.NO. 4J^ O32ts_--O . 5.'�EJRNO(
MAIL '150 FtSGN•-IER. AA a ADDRESS BUILDING 2 0 1 1 scJ- 2 IA v�
Z ADDRESS 'I. C^ �[
0-U CITY COSTA Mk SSA TEL
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am
J D BRANCH •
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.:cc ADDRESS A A a lil'Y' l rep
W W ZONE NO.OF � USE OF NEW
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IUB STATE CITY YARDS APPROVED YARDS APPROVED
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D0 SIZE INO.OF BLOCS (FROM C/L STREET)
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EL MAIN BLDGS. ACCESS. BLDGS.
pOFF%CE , SiteAGE £ Li EIkW C.U.P.# a APPROVED
N WtA J0CACTU i NG AD i) l TI o .L) APPROVED i / 1, In 6 .j -a-'7� .
I A.AZ
DATE ,..7
Q = - . 4 lbO i -
c. . fI 1
�•s� %' /
U I hereby acknowledge that I have read this application and state �1
that the above information is correct and agree to comply with �•
DC all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL -
F- any person in violation of the workman's compensation laws of
y the State of California. �/� co
Z 41-I hereby certify that I am properly licensed as a contractor under r �/SO. FT. O
T
the State of California Business and Professions Code. Division 3, HE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the p •v' 'ons • th. - ate of California Business VALUATION
and Professions Code, •i r • ry
�� �p PERMIT FEE $ 3
Signature of •/� ��1������I///777 •� r/� r �S m
Permittee LA $ '/® /91YP] PLAN CHECK $ 90 E
!11 >(�J(1{lJ o
.
Authorized Agent n
TOTAL FEE $
25S JUL -5-66 00 074 As***158.25
•
A MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING //JI c /- �(j•y,� For Office Use Only
ADDRESS 2 V o /�- A. / / • -� RECEIPT NO, PERMIT NO.
COSTA MESA. CALIFORNIA ply
/f `CEIVED BECIEIVILD
/{. sr DA - 12.44, D I'/ Y 6b
OWNER ,4 /44“4 F/L7F� C CoO
BUILDING
ADDRESS it;73 A.1-4-ce. i rm. /.vx. ADDRESS Z
FTEL ZONE TYP ROUP �
CITY COST+ /✓/ri c.'} N Lova/el/o7. �j
ARCHITECT p THL��'`in.,—
OR APPROVED /j�/�� DATE / -/�-A,
ENGINEER ICDA/ YrEO NO. 0'0 /
ZONING • J
ADDRESS 4 .• 4I . .. . B(a/, •,.moi 10 ND.OF uBE OF NEw,rj,i y,T'fj
/�// ,' PLANS Z BUILDING ,/d',
CONTRACTOR OWNH'2 a;EL0'FA " t I/ TiIC' 9P�. s ,�
LEGA
ADDRESS DESCRIPTION D
A.P.NO.
CITY
NOTE: NO RAVE OVERHANG SHALL SE LESS THAN
STATE TEL sr TO SIDE a REAR P.I...
LIC.NO. NO,
SIZE /4.7..L., 317 I NO.OF 51.004. HAVES
ALLOWED I U.B.C.REQUIREMENT) _ .
OF LOT 7/1 �31Tl/ NOWQN IAT
YARDS APPROVED YARDS APPROVED
USE OFA� MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. MFT6 _
(FROM C//L STREET) /L�
SETBACK LINE FROM 6- / FRONT 8-s FT. /C'�S�`/lrr�(' " ' ��
CENTER OF STRUT O REAR YARD /S O _
BIDE YARD LEFT ,241_ I RIGHT /D / _R.SIDE /D- /Fr. Pr.
DESCRIPTION OP WORK L910Q/aOFTY FT.
J r
�-ALTERATIONI ADDITI•N
REAR /-�/ pr. PT.
NEW I(
DISTANCE BET. BET.MAIN Q
MAIN BLDG$, ACCESS.BLDOS.
REPAIR MOYINO DEMOLISH
UILDING/ NO.OF VAR• F DATE
SIZE 6200 ROOMS STORIES / C.U.P.# APPROVEED /
COVERING EXTERIOR WALLS?IKC.J I CROV BRING avec Lift APPROVED iH.��f,�,{: DATE 74—6'-/
USE OF BUILDING AND WORK TO BE PERFORMED (�"�� r'Y.r a
E-// I/S5 /d/BLOmV6 0cO'S/0M4L HOLDpR//SPFCIA RFQIRRFMENTS 9
A•SSsM/,{Ly- S70K9� -oFr/Ceti V��yydr/t/na
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. LA
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING //��r
BUILDING CONSTRUCTIo/BJ�L�J - _ / VALUATION PERMIT FEE $ /KJ/✓ �q
SIGNATURE OP(PERM ITTEFOfKA / IL' O
i,�LS/ 9$?5 PLAN CHECK S ✓r;2"..7S w
-.AUTHORIZED AGENT TOTAL FEE 5/ O,/sir
t a CITY OF COSTA MESA -
. a-.
et � .. BUILDING DIVISION
F i . .� 1 DEVELOPMENT SERVICES DEPARTMENT PERIT NUMBER
a. ni, ;# - PERMIT
F99-00142
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
FIRE SUPRESSION PERMIT
Job Address: 250 FISCHER AV Status: ISSUED
Suite: Applied: 06/10/1999
• Vicinity: NEW OFFICE AREA @ WEST SIDE OF BLDG. ..Issued: 08/04/1999
Parcel Nunmber: 42703204 Zoning: ISSUED BY: .04..--
Applicant: KILIAN, STEPHEN,r,,�/ �. - - -
Address: 300 S WALNUT STjr - ' ,- i ''
CA : -/- - �/� :: Phone: 714-871-8283 % \
LA ABRA -- -' V I_ Zip: 90631 7 / _
Owner/PIERCE, RONALD D SR `. / ��
Addressfi 33751 BLESSINGTON LN% "_ ...:;,..:<.,-,:,', ;c1>� - `` � / A���
-1 �v Phone: vA . �mti �,,
.r/ \SAN,JUAN CA TRANO, Zip: 92675
ibontraptor: KILIAN-FIRE SPRINKLER t:' v 7
i 'T/Address:' 300'S WALNUT ST
/vy ) CAO, Phone,• (714)871-8283
,LA'HABRA Zip: 90631 " I �
. 1 T h A'/ 0•-2, ,.-License: 240665 , ):
/ ( 1 (, • /, . i' ,A 122 .,-1-,-t .- - a , y
ICf. ‘-- -- '/' -- ' -! ' i , - SCOPE OF PERMIT /', ' . , N
If
I % ADD 18SPRRt
INKLEHEADS. ` \, r'-; ,A
i : �_ PPLF':C_ lq -bo9 f° 'v �v
Iv /� . . : ' FEE SUMMARY �
' Plan Check:':. $31.53 / .', ri,. • ,',;,c, ;,, : v _ Calc Valuation:. ' $1,450.00 v
;' . Permit:, $48.50 - .. Claimed Valuation:' $1,450.00
i ' ._Other:,,,, .$0.00 N -
'
VC ..-- \\''',. 5, ri
r .\\' \ i-t - i
y:\ \v
\v ��� %1:
,
% .
r
•
.
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
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 workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
�/ work for which this permit is Issued.
11C 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 canter and policy number are: �—/_
Carrier: •SrAtf= FONPolicy Number: (D 5 — 9 F5 U N L T It
(This section need not be completed?!the permit s valued at one hundred dollars($100)or less.)
❑ I certify that in = performs of the work for w Ic this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation la - of Califorand agree t if s uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with th= • •rq isiols.� I ynM p
Applicant Signature: vain/4M•�" _ Date: y -9'9
WARNING:FAILURE TO SECURE W•- ERS'COMPENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN •DITION 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 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 0 5 r Class a(+�Ua
Contractor's Signatu ' �1 ' :{�+--. Date: 0•4-a�
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 Cade).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally of perjury that I art 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 emglo�yyees 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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 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,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? 0 Yes 0 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 lime 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? 0 Yes ❑No
(Section 25533 of the Califomia 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 en 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? 0 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 agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? i 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? 0 Yes 0 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(Duality 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 0 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 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 bythispermitmiuntilunfinal inspection.
41111 1. . Sigr T'"r@•`/ ega�=er(s) CJ - `'f' - f I Date
An, Or Authorized Applicant Date
CODE r INSPECTION TYPE DAT.ET� ' =AA CODE INSPECTION TYPE' aim !NTIML$
1616 Fixed System Final Fire Prevention 11'I to -1 L P, 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 1I-I lo
202 Final Factory Fire Place _ 220 Final Planning Approval _
203 Final Sign 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
2446-46
�yt ,- \
4 �? CITY OF COSTA MESA -
S ft ca. 2 . BUILDING DIVISION
F. ..„" ' DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
PERMIT
99-00774
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 250 FISCHER AV Status: ISSUED
Suite No Applied: 08/17/1999
Vicinity: Issued: 08/17/1999
Parcel Nunmber: 42703204
Applicant: KEVIN HOOPS ISSUED BY: n
Address: _,- //--tH -
://_'= Phone: 714-328-3733
/ -
7://9, 2- V , is /; - --CA�
Owner: PIERCE;RONALD-D,SRt. _ , _ _ �� -
Address�i/33751 BLESSINGTON LN,- % - - - ti `-_ ' -Nv ��/ �v7,\
//-/-2-%:---11-2,--;----- Phone: �` - ` i `J
/,12%' SAN JUAN CAPISTRANO, Zip: 92675 - ;; '-2,-,N,,, < / 'yC v\
/.i /2 4-2/ / � � :A ice,��
Contractor/ HOOPS-ELECTRIC '
Address P.O.BOX 6336 r ,\ �,A
•
l ' i j'i i ,Phone: 714-328-3733 - \
l / / �--\ /ANAHEIM,CA f •L;;;„„.....--Zip:. 92816, ' ' \ •
�' ! - ,- ,� .- License: 730190 ' i
t nf 4.1 /17 ;\ /- SCOPE OF PERMIT \\,_ . " 1
' ;\' "\ ,CAN AM CONSTRUCTION"OFFICE TI, INSTALL 33FIXTURES,25OUTLETS, 10SWITCHES, 1-101-IP
' V. / 'Y"<MOTOR, 15COMM DROPS, RE:B99-00913: - , , ;
I/ r7, '- - -.. \
is
' ''s \ FEE SUMMARY
Quantity �r.-, fie` Quantity•/ .- v ,
j ISSUE FEE ,, $23.50 ,_ _. s Temp Dist System/Lighting , $0.00 0
/Temp service test , : $0.00 - . - - -- - _ _C--Busway/100,ft f $0.00 0 _ �
,Res.a/c packages',,,. $0.00 Standing Section $0.00 0 i ,
NeviFRes(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 0i-' ,,
Poet/Spa �, ��, .' \ $0.00 0 - - • up to 10 kva/kw ' $0.00 :0' /� 'III
Lighting'Fixts V N. ` , $29.49 33 - up to 50 kva/kw , $0.00 ;
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 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: Policy Number:
(This section need not be completed/f the 99 rmit is v-ued at one hundred dollars($1 )or less.) '
a I certify that in the performan • the wo •r 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 Califon 5. and agr-- at if •uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provi;• /
` Applicant Signature: i' . I r/>LA / Date: e/j 1 ) `C,
9
7' WARNING:FAILURE TO SECURE'•/kr ERS'�I PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE($10o,o00)/pAODrnu'I TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORSDECLARATION:
I hereby affirm that I am licensed under provisions of Ch •ter 9( •mmendng with Sectlon7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.# ('10 —T30\S0 ' // Class#J'IO
Contractors Signature: / . ' '7 ,, Date: Pit l Mel /
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: f 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 rages 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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 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? 0 Yes 0 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,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
_e ___.---_.. _ .__n_._. _r...—i.____o_._....___ ..._._ _ azar.._____-_ __0 _ _ arra
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 Califomia 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? in Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? pi Yes LJ No
(Section 65850.2 of the Califomia Govemment 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 0 No
(If"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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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 COMPLIANC D A •RIZATJON 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 wi II s • la s and oWWdWWgtttytytyyyy ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property f mspe• ion% pas—.I agree not to occupy or allow occupancy of any building authorized by this ermll ntll final Inspection.
T1. /A— E 7�cf q
._,_9 / Signa>#' Legal Owner(s) / Date .
/ . d/Or Authorized Applicant Date
Pope I INSPECTION TYPE PAIL INTIf1AL$ ;ODEI INSPFCTION TYPE PAIS INTffIAM
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 2081Final 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
2446-46
'-'In
CITY OF COSTA MESA •'
F y ,)/ BUILDING DIVISION PERMIT NUMBER
i DEVELOPMENT SERVICES DEPARTMENT /
PERMIT \/
se M99-00373
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
•
Job Address: 250 FISCHER AV Status: ISSUED
Suite No Applied: 08/05/1999
Issued: 08/05/1999
Vicinity: ROOF
Parcel Number. 42703204
ISSUED BY:
•
Applicant COOTER, LYLE .- -
Address: 1418 S.CENTRAL PARK - - _
CA , "i ' Phone: (714)772-9699 / -
ANAHEIM-,.!=",„ ‘ Zip: 92802 - ,
/
Owner. FIERCER RONALD"D SR • _
Address://33751 BLESSINGTON IN ,
� �,' � Phone: �-
///2, NSAN JUAN CAPISTRANO, Zip: 92675 ( ;�
N/
Contractor ANAHEIM HTG. & COOLING .
/ Address; 1418 S;-CENTRAL PARK •t
j �
- - CA',/./2/ Phone: (714)772-9699v �
�..; - �
ANAHEIM - Zip: '.92802. '. -
ii - „4 • _ License: 594843
Arch/Eng: _ r V � . - ,
,-Address 'J - �/
•I 1i.: II - Phone: - j` , �V �\
,_,, - Zip: _\ - ,
A'. \`_ r ,/ License: -
2 - //r" ' _
/ t 'SCOPE OF PERMIT 7 ‘
'3 INSTALL 1-PACKAGE-HVAC UNIT FOR T.I.FOR"CAN-AM CONSTRUCTION". • 1
I
REF:
, 4_ B99-009131 ; •/
' �, • - - _ _
'\�� �, . FEE SUMMARY/ ,
�� �--" ,�, Quantity - ,'. ' Quantity
ISSUEI?EE - , $22.00 _ Repair/Alt Absorbtion Unit $0.00. 0.
Inst FAU'<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit ,' $0.00 0
-
Inst FAU?100 kk-BTU' $0.00 0 ' • Ventillation System 0
Repair/Alt\Cooling/Heat $0.00 0 - Evaporative Cooler $0.00 0
Inst/Rep.-Recess Wall Htr '- $0.00 0 1 ' - • Commercial Incinerator - •• $0.00 0
Refrig Sys<100 k BTU f. $0.00 0 Domestic Incinerator - $0.00 0
Refrig Sys>.100 k BTU' - ' $0.00 0'.,• ' Compressors/Absorption Systems
Gas Piping \\--, • '10.00 0-' / , - - Up to 3 hp/100 k BTU - ,$0.00 0
Factory Fireplace c <i $0.00 ' 0. ' , 3 To 15 hp/500 k BTU• ' '- /$0.00 0
Hood w/Mech Exhaust' - $0.00 0- - - - 15 To 30 hp/1,000 k BTU " $0.00 0
VAV Box '\<,� • $0.00 0 - - • , 30 To 50 hp/1,750 k BTU
Vent Fan/Single DuctA 7. A $0.00-'0Over 50 hp/Over 1,750 BTU $0.00 0
Appliance ' $0.00 0 _ Boilers
Fire Dampers $0.00 0 , Up to 3 hp $13.15 1
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air 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 $35.15
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
DECLARATIONS •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: .
•
0 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
47 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: G I Ai V Policy Number: A/6 U S S V/VI?
(This section need not be completed if the permit 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 If 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date: 3
WARNING:FAILURE TO SE URE WORKERS' COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER TO IMINAL PENALTIESA D CNIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE(5100,000),IN ADDmON 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 protilonso hapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
5"
force and effect.Lic.# r QP Class# l ,P
Contractor's Signature: Date: 5 I 1
CONSTRUCTION LENDING AGENCY:T�
❑ 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,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 fore permit
subjects the applicant to a civil penalty of not more tffan 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.
704(I,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 doesvnot 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 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-properly 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 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 certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Cale 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? 0 Yes 0 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? 0 Yes 0 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? 0 Yes 0 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.
Signature Of Legal Owner(s) Date
�
And/Or Authorized Applicant C 011e 72(
CODE/ INSPEC'IONTYPE DEE MAW ;OW( INSPECTION TYPF _ 94
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
204 Final Demolition 250 Final Building/Occupancy
2446-46
u CITY OF COSTA MESA /
rat
its'___ BUILDING DIVISION PERMIT NUMBER V
( •''IQ ' DEVELOPMENT
. PERMITSERVICES DEPARTMENT
P99-00608 •
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 250 FISCHER AV Status: ISSUED
Suite No Applied: 10/25/1999
Issued: 10/25/1999
Vicinity: •-
//��
Parcel Nunmber: 42703204 ISSUED BY: A_
Applicant: BRIAN DALY
Address:
. Phone: 714-774-1489
Zip:
Owner: PIERCE, RONALD D SR
Address 33751 BLESSINGTON LN
Phone:
SAN JUAN CAPISTRANO, Zip: 92675
Contractor: HARP PLUMBING INC
Address: P.O. BOX 3639
Phone:
ANAHEIM,CA Zip: 92803
License: 520769
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
RELOCATE 1WATER CLOSET AND 1 LAVATORY IN OFFICE TI, RE:B99-00913.
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,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 $9.80 1
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) $9.80 1
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 $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 • Sink,service/mop $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: $43.10
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
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 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 an will me lain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the wodc.lo hi1chfthhis 1 r>P I wed.
My er ' Vp Insure carder an 'cy number are: Policy1 F"//�(,��`7]V
Carder: Number. OS
(This section need not be completed it the permit Is valued at one hundred dollars(SItH!)or less.)
❑ I certify that in the performance of the w... for which this permit Is issued, I shall not employ any person in any manner so as to become subject to tho workers'
compensation I: .of California,and ago= if I sh'.Id become subject to the workers'compensation provislgns of Section 3700 of the Labor shall forthwith
comply with the • b...ns. O/ ' 4E5
�, Applicant Signature: "�t t _ .A a A - Date: L -e--"
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS NLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T ONE HUNDRE'6"
THOUSAND DOLLARE(S100,000).IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am lice . -•e •ro! .,ns•f W,ter 9(commencing with Section/ 7000)of Division 3 of the BusincandrEryfe;sions Code,and my license is in full
force and effect.Lic.# • < Class* �S'�b h
Contractors Signature: nar�iMI - Date: 1 -3b� cS C0( /
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:
A.
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 Division 3 of the
Business and Professions Code)or that he or she is xempt therefrom end 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 sate.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. 0 Yes 0 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,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? 0 Yes 0 No
(Section 25505 of the California Health and Safety Cale 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 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? 0 Yes 0 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 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 Cale been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agarmlt for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? U 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 W III any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (It 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 end 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 lot to occupy or allow occupancy of any building authorized by this permit until final inspection. ///jjj
NB Signature �: ner( s ^ aDate Cf
I
y ' ... And/Or Au. zed Apr";nt Date
CODE I INSPECTION TYPE LAM INTRIAL$ CODE! INSPECTION TYPE DATE REE1A15
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pod Spa Final 208 Final Plumbing 1:1-'7-99 E N
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
2448.46
t ''
' . CITY OF COSTA MESA
4,y-Aa�� BUILDING DIVISION
F I ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
e.. �; PERMIT V
1/400,• w B99-00913
•
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 250 FISCHER AV Status: ISSUED
Suite: Applied: 06/16/1999
Vicinity: OFFICES ON WEST SIDE OF BLDG. Issued: 08/03/1999
Parcel Nunmber: 42703204 Zoning: nn
Applicant: LAMASTUS, LES ISSUED BY: t`�1
Address: 29026 CANYON RIM DR. - = i r - ,. _,
CA / " -, ,Phone: (949)766-1300— c- ->y
TRABUCOCANYON " Zip: 92679 �= ‘ _ ' _ ��
Owner: PIERCE•RONALD-D SR _ . / '
Address 337$1 BLESSINGTON LN - -
//CAS A, `, '" ; Phone: (7141966-8500, - - -
n�SAN JUAN CAPISTRANO Zip: 92675 V / � A�
it//�\ ice-
Contractor: NL D•LAMAST.US COMPANY /
`
/Address: 29026 CANYON RIM DR
://,,',Y/ A•::� �, \‘ -i''/,,',w �/ CA ,��C� Phone:. (949)766-1300
, _ . -''
if
' � �
// TRABUCO CANYON
I N% ' Zip 2 92679' License 612068 1 - ,`,
U/ ;.��
l YArch.: /1l2--.. f1 - . 1 Eng:
',,Address; '2, - V / . • Address: , ,
-
A'•
t " Phone: . - - -
\ Zip �� / License: Zip: - License:
,i A
k / '" SCOPE OF PERMIT , . -
L; /1344 SF TENANT IMPROVEMENT FOR CREATION OF OFFICESWITAIN EXISTING BUILDING. "CAN AM CONSTRUCTION'. `
FEE SUMMARY
Plan Check: „$625.46 , '/-• Calc Valuation: $115,000.00
,\, - Permit: ,, $962.25 - ' y Claim Valuation: $115,000.00
\i SMIP Res: : $0.00 - -- • • / % '
' SMTP Corn: ' " $24.15 _ % �'
�' Other `.`\ $0.00
'inspection,:‘, --„$0.00 •- - .
•
/\Total:' $1,611.86
�• v.; _ _
\�� [
PLANNING &ZONING w
\y''\
SETBACKS . • • • - /.
MAIN STRUCTURE.'Front -0-0 • Rear'- „GI 0” . ' Left '0-0 - Right ' 0-o', "�"
. -/
ACCESSORY Front', '.0-0- •- Rear 0-0 Left 0-0 Right. . 0-0 7
PARKING Existing:- -0- ' Required: / 0 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
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 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'co pensation�Insurance carrier and policy number are: II ^yam
175
Carrier: ) n Policy Number: - � &l /1
(This section need not be completed it the permit is valued et 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 if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these ions. ,, • ��
Applicant Signaturg• a�7 /` • //yyJ
Date: L
WARNING:FAILUR CURE WORKE PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license under p ovi ion of Chapter 9(commencing with Section 7000)of Division 3 of the Business aarofessions Code,and my license Is In full
force and effect.Lic.# LCI Class#
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,CMI 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 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.).
O 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 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? 0 Yes 0 No
(Section 25505 of the California Health end 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
.. .--._-__._. _ ._
2 Does or will the applicant or present or future building occupant need to file a registrationonform for acutely hazardous materials? ❑Ves 0 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? 0 Yes 0 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 epermit 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 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer bountlartes of a school? 0 Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.. oageny Is required for If a permit from
av the South iscAir Quality Management is or other air pollution controln district agency Is r Yesed for the work which is the subject of this
application,have all of the disclosures prescribed by Celifomia Health and Safety Code Section 42303 been made? ❑Yes 0 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.
-^ signature Of LegalOwner(s) Date
/Li '1/2�[ g 3-41
And/Or Authorized Applicant Date
CODE r. 1112=t1121 QAff. INI189L5 COW s INSPECTION TYPE • ge¢, j LS
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 Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign222 Final Be
204 Final Demolition 250 Final Building/Occupancy /y �a -•
2446.46
ADDRESS a 9LRLCOM: 250 FISCHER AV IMT: CITY OF COSTA MESA — BUILDING PERMIT
IASNES NAME IF MC"' GORDON, COLWELL & RAY PERM NO: 'B 078458
ADDRESS: $RAYLARRYL
•- 763172 POPPY LN PERMIT NO: B 078458 PLAN CHECK NO: 02703-96 L GOVT: N SUPP : N
PALM DESERT, CA 92260
'AM.MAILING ADORES& CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: 0TH
ARCNTECT OR ENVIER: sac NO: JOB DESCRIPTION : 14 ' X 20 6" THICK CONC . SLAB FOR SUMP PUM SQ FT: 15, 000
ARCH.OR Ea'S ADDRESS: UIT:
CLAIM VALUE: 15, 000 . 00 CALC—VALUE: 15, 000 . 00 GROUP OCC: S-2 /
0a4TRACTONS NAME RICHARD WILLIAMS ( 714 ) 998-4597
COMPACTORS IMMO 432 W. CRYSTAL VIEW COMMENTS : CONST. CONCRETE SLAB FOR SUMP PUMP
ADDRESS: OR. CA ratio.: 466279 *+E******4r******sE*** ***sE*AExsE+ rit+rSE+E+E*ir*+t+Err+r*it*+tAr+r*+t*MESE+t*irrtitiE*rt***LE*iF****Rt***rt*
92665 Ina Z ONING REQUIR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby dram under penally of perjury that I am licensed under provisions of Chapter 9 •
S E TB ACK S
(commencing with Section 7000)of Divoion 3 d the Busilrovaid Professions Code,end my kerma is in full
force end street.
CITY Lie.
� 7
/ �/YG a �� �
.: LIG.CLASS: C_q/�UC.No.: 66279EXP: MAIN BUILDING ACCESSORY BUILDING
/ —/t/1 / b FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
R BUILDER DECLARATION:I hereby drum under penally of perjury that I am exempt from Ihe Contractors License law for the
hallowing reason(Sedion 7031.5 Busness and Professions Coda:Any ray or county eta requires a perm@ to construct.after.improve, PARKING REQ: PROV: PARCEL: 42703204 ZNE: MP REF NO:
oen'sdantruani any provision prior of lee Convectors La(C appficent 9(cornmsuch e Iwithe�armm)d slalomed 3 she PLANNING NOTES> INSTALL CLARIFYING WASH SYSTEM BEHIND EXISTING BUILDING.
,siren and Professions Coda)or thathea she o exempt therefrom end the base for theanegS examptun.Mryvklation ofSedcn > WASHING OF EQUIPMENT FOR THIS BUSINESS ONLY WILL OCCUR.
7031.5 by any applicant for a perm@ subjects the applicant e civil penalty dor nmore than fws hundred dollars($500)). **************************** ***************************************:*****ill*****
❑ triowner dthe pnope"yorroe emdayeasw4hwages isthee side co pensation.willdomew°&andtheewrn"enotthlended
DEVELOPMENT V E L O P M E N T S E R V I C E S R E U I R E M E N .T S
or dtered for sale(Section 7044,Business and Profns essioCode:The C«iradadoesen s Liense Law rapply to en owner d properly Q
who bride or ailerons thereon,and who does such work tinned d a Ilene/a through his a her own emploes, ovided tathsuch ter
improvements axe "seed not intended ed I« rverwanent
sale. ,hower,the building a EnpS sold yeardcom
withiyepr
n onspledn,the ZONING APPROVED BY V1 DATE: i!•'
owmerbditdhave th
er will he leaden of proving he or she did not build or improve la d the purpose sale).
❑ Preowner o Coda:The Contractors r=e se awddoes"not appp M an`°"contractors err of pconstruct operly who bedprotect Section 10ththereon and Business no BUILDING APPROVED BY : DATE: 1''.
contracts for oven projects with a contrador(s)licensed pursuant to the Contractors License Law). ,..-
El ,..-
ElIamexam!under Section: B.SP.0ufor the reason: APPLICATION ISSUED BY: DATE:
**********-IE***IE************************* ********If*************** ^ **
Date: Owner - LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I aero 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 I wit not(mole one)need to comply with said Nate codes and the requirement@ for ( ,
a permit for construction a modification bangle Ar Quaky Management District RaddereidmMrWion eppkatiau N exempt hornless BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE' SMIP/REST GRADING
provisions. PERMIT 224 . 75 ' •
Dale: Applicant • .SMIP'/NON`—RES
WORKER'S COMPENSATION DECLARATION:I hereby alum under penallyd oneof Ut
perjurye following declarations: PLAN 146 . 09 0 '_ 3 . 15., ;;
❑ Ihave and wdmaintandXi
acardiceteconsenttosenwWio
eforworkers'oompenn.asprovidedforbySection3700oftheLabor ISSUE FEE . ' i
Code,for theperfonnanceoflheworkforwichmepenneeesued. BUILDING DIV > PERMIT ISSUE PLAN—CHECK TOTAL �� < ? -PAIDgDUE
Eln
Ihave and w;lmaintaworker: N
camp«wkinsurance,ar
nequuiof
redbySection3700m
E
him e le
eLabor Code,for the performance ofthe TOTALS----> 227 . 90 0 . 00 146 . 09 373 . 99 ''' 373: 99 ' . 00
work for wthe permit issued.My workers' .ker'compensation inflame WOand WSW number we: h
Caner: REVENUE DIVISION TOTALS--> COLLECTED : •
373. 99 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT4. GRADING 'PLAN—CHECK
, -seedonneedo emnpeted/the permkethe one hundred dolan(i1WJcrlest) 224 . 75 3 . 15,.,, - . "a •, c. 146 . 09
A I cerdy that in the performance of the work kr which thetro
pe@ is issued,I shell not n "Mane, n nemploy any perm= any mer soto ti.
,I y
performanceperformanceperformance
cabled to the wakes'co weation laws o Cakl«nia,and agree Net ll Shoddbemme SOEjedlo the wears' *****************************************************************'**************
..Ion provisions d Sedicn 3700 of the Labor Code,I Null r con want Pnoesiom. J
t G .j : /" • IND I V IDUAL F E E B R E A K D ,0�.W n N .�
late: APpliwa: 4•e'' (/.e,r�«+yd' - ..
ng:Feu to secure workers'comonedon corona leutfml
w •and she subject an employer to criminal penam«and TYPE QTY DESCR IP T ION UNIT COST %., TOTAL COST
civil niers w lo one hundred thousand dollars($104000).In adddon to dere cost of coniert@aSrt donnas as provided for In
Section 3705 of the Lisbon coda Interest, tro
end eneyS teed. SFC 15000 ALTER BY VALUE COMMERCIAL NOZONE d-. 00 ` I , 15, 000 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a conengion lending agency for the END OF FEES
performance of the work kwhich r whthis par*a issued(Section 3097,Civ.C). ,
LENDER'S NAME: I•
•
LENDER'S ADDRESS:
I certify hail have read this application and dthe that above interaction is oncorrectt l easel°comply withal city and county ordinances
and state laws relating to building Conwudion and hereby adhabe representatives of this city to enter upon the above-mentioned property '.2 ' f
for inspection pmpmea. RICHARD N WILLIAMS •" rt '1 , �( ,'%'� .
(5151Je.WP) White-Building 5 Safety;GrmrFFle:Canary-AppFan;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING : POO' SP$' _
APPROVALS Permit# - I Date Inspector - APPROVALS Perniltt# ) 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 Conduil•Undrgrnd. 55. Electrical Bonding ,I_
-
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 Sl4v ��� 7•-/�_R'H cal/ 59. Gas Pipe, 0 Undrgrnd.,Test
1„."
9. Water Pipe-Undrgrnd. I 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 1
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains i • 64. Plumbing System - Final ' - ' •
i
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final -•
16. Rough Electric Wiring 67. Fencing & Access Approval '
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning • FIRE-DEPT. REQUIREMENT
20. Rough Factory Fireplace - - - APPROVALS. Permit #
21. Ducts,in Structure - , - 70. Underground Hydro -
22. Ducts, Ventilating . = 71. Product Piping O Gas 0Oi0
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 - 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: rn_ --
34. Final Heating& Air Conditioning . : •
35. FinafGas.Pipe?est - •
_
36. Hood'or Canopy -- • -� 1 -. -
• 37. Final Factory Fireplace - ' : - -1 '_
38. Final Plumbing - - - - -
39. Water Service-Final - .
40. Gas Service-Final ,
41. Solar Domestic-Final _ -
42. Backflow Preventer - - -• - -•
A1
43. Backflow Irrigation 7 `/_g6,__ i4/c,ep's Q /u,,„/6
44. Landscape Irrigatioq System - •k-7
/ /}m ou- nia yki _ /__�_
45. Sound Attenuation 6 • 5(4 6 ml/�nd r 6j`�/
46. Handicap Regulations - .• - ..,---___,__._.
47. FINAL STRUCTURE & BUILDING ?-/8i6 c<i� /�`i- h c/Pis/ A l�
48. FINAL PLANNING
t v G CC [+' /�'
49. Electric Release to Edison .
50. Gas Release to Southern California Gas G .
51. CERTIFICATE OF OCCUPANCY' . J
No. Date
ADDRESS OFBMWDq: 250 FISCHER AV UMo CITY OF COSTA MESA — BUILDING PERMIT
p,ERSNAMEIFIWOWN: GORDON, COLWELL & RAY PERM NO: E 078459
ADmm %RAY LARRYL
763172 POPPY LN PERMIT NO: E 078459 PLAN CHECK NO: N GOVT: N SUPP : N
PALM DESERT,CA 92260
Ant.SWUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: , ELE PURPOSE: OTH
ARCHITECT OREtaIEER: UC.NO.: JOB DESCRIPTION 14 ' X 20 6" THICK CONC. SLAB FOR SUMP PUM SQ FT:
Anal OR END'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : S-2 /
CONmACTORSNAME RICHARD WILLIAMS ( 714 ) 998-4597
CeNTRACTOITS MAILING 432 W. CRYSTAL VIEW COMMENTS : INSTALL WATER PURIFIER REF: B-78458
ADmw, OR. CA uciio.: 466279 *****************************SE*************************************************
92665 inn ZONING REQUIR EMENTS
UCENSED CONTRACTORS DECLARATION:I hereby asem u penaly of perjury that I ant licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Business Professions Code.and my license is in full face and effect.
C . • NO.: UC.CLASS: -.4 *C.NO.: •A6279 EX MAIN BUILDING ACCESSORY BUILDING
p - a'{�f (24� A FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
ConLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law la the - •
• • •reason(Section7031.5 Business and Professions Code:Anycy o county whirr requires a permitto construct alter.improve, PARKING REQ: PROV: PARCEL: 42703204 ZNE: REF NO:
dish.or repel any structure,pia to its issuance.also requires the applicant for such permft to file a signed slmement that he or she PLANNING NOTES>
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Sead n 7000)of Division 3 the
.sines and Professions Coder or that he or she is exempt therefrom and the basis for the alleged exemption.Arty violation of Sedan > .
7031.5 by any applicant lore permit subjects the sDlicenl toe civil penalty dna more then lNa hundred dollen l55o011. ******************************************************************************* •
O 1.I'Sownet d theprosny or myemployees with wages as the sole sompe,smbn,sill dove work,and the structure is not intended D E V E L O P M E N T SERVICES R V I C E S R E U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does nit appy Canter to en orof properly Q
who beide or improves thereon,and who does such wok himself a herself or through he or her own emplyMs,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 ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner of the property,am exduseely contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a cMnadorjs)licensed pursuant to the Contractors License Law). f� a�
❑ I am exempt under Section: _ B.AP.C.,for this reason: APPLICATION ISSUED BY: hl DATE: J
Dale: Owner.
*********************************�E****** ** ******************** **
LEGALIZATION:N F E E SU MARY R Y STRUCTURAL EG ENT: N
I do hereby certify that I am aware of and understand the requirements of Cdeomia Health and Safely Code Sections 25505,25533,and
25534agree lwm trud omod wonhamiheAiQalyMaagewd rcle 0need d.. IRasddeent®l with iuddd a eppe mnom..e°e�pf°fments kr
rom BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 4 . 25
Date: Applicant: 5 101/c SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm usher penalty of perpuy one of the following dedarations: PLAN
ISSUE FEE • 22 , 00
❑ !have and MI maintain a certificate cf consent lo self-insure for workers'compensation.as provided for by Section 3700 of the Latxt BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the peromengedthe work for which this permit isissued. TOTALS----> 4 . 25 22 . 00 0 . 00 26 . 25 26 . 25 . 00
❑ !have and will mainten workers'compensation insurance,as required by Section 3700 of the Labor Code,tor the performance of the
work for which this permit is issued.My workers'compensation insurance carrier end policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : /' 26 . 25 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
iris section need not be completed y the snot is for one hooted dollars MOO]or less.) 26 . 25
•SI I cMiy that in the performance of the work for which this permit is issued,I ehll not employ any person in any manner ea as to
became subject to the workers'campensalbn lawn o California.ash agree that B 1 should become subject to the workers' *******************************************************************************
pewit•n• • sane d Section 3700 of the Labor Code,I 4h vl 4h wtnpfv wish t
Q� Applicant: /�ci `/(// INDIVIDUAL F E E BREAKDOWN
Warning:Failure b secure workers'compensation coverage is unlawful,and shell subJect an employer to criminal permltlsand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollen(slOy000A In eddltlon to the cost of compensation,damages as provided As,In
Section 3706 of the labor Cods,Interest endatbmsy's lase ELE 1 NON—RES APPLIANCE NOT OVER 1 .0 HP 4 . 25 4 , 25
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of penury that there is a construction laming agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: -4
I certify that I have read this application end date that the above information a
correct.I agree to comply with at city and county ordinances ‘11,
and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purposes. '
RICHARD WILLIAMS �• Gl: ;_. :
,___xii: Y jaciert
v Date: //4/F6
Signatureof Ownedpgent/Appltcan B'ontractor/
(5t51'46.WP) White-Building A Soley;Green-Fle;Canary-Applicant Pink-Revenue;Goldenrod-Assessor
.CONSTRUCTION AND PLANNING -`'y POOL PA
/ APPROVALS Permit# / Date Inspector APPROVALS Permit#� Date Inspector
. 1. Temporary Electrical Service or Pale 52. Pool & Equipment Location ; ' -
2. Soil Pipe-Undrgrnd. •' I 53. Steel Reinforcement ' '
3. Electrical Conduit L4,tility-Undrgrn1. 54. Forms 1
- 4. Electrical Conduit-Undrgrnd. 7/7/9 55. Electrical Bonding r
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. • c.f. ' 60. Backwash Lines,P-Trap, 0 Undrgrnd. .'
TO. Structural Floor System . '. 61. APPROVAL TO DECK
•11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 1 63. Heater & Vent-Final
13. Roof Drains64. 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 I
18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20, Rough Factory Fireplace • . . - APPROVALS: Permit # '
21. Ducts, in Structure . _ - _ , - 70.-Underground Hydro
22. Ducts, Ventilating . ' • - 71. ProductPiping 0 Gas 0 Oil
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. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27.-Frame and Flashing, - - - -- 76. Dry Standpipe -
28. Lathing&Siding;. 77. FIXEDSYSTEM_FINAL
29. Insulation - -- •"' -z 7$. FIRE PREV. FINAL '
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - - 79. FINAL INSPECTION , -
•
32. Electrical•Poveer Meter-Final . - 80: FOOD CERTIFICATE ISSUED -
33. -Final Electric - Notes:
34. Final Heating& Air-Conditioning . . ,. ' �'�• "
35. Final Gas Pipe-Test' I • - -- -
36. Hood or Canopy - %") _ - -
' i .
37. Final Factory Firentate - - . 1_7
•
38. Final Plumbingi - -_
39. Water Service-Final
40. Gas Service-Final - -
41. Solar Domestic-Final ••
42. Backflow Preventer ` -
43. Backflow Irrigation- - _.-- -
•
44. Landscape IrrlgatioA System , •
'45. Sound Attenuation - f L. •• - -
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING 'L„
48. FINAL PLANNING'
49. Electric Release to Edison T -
50. Gas Release to Southern California Gas CvL� ,
51. CERTIFICATE OF OCCUPANCY %
No. Date
ADDRESS OF9UL0910: 250 FISCHER AV UMT: CITY OF COSTA MESA - BUILDING PERMIT
mursoAMEIFQllplb GORDON, COLWELL & RAY PERM NO: P 078460
ADORES& %RAY LARRYL
7631`2 POPPY LN PERMIT NO: P 078460 PLAN CHECK NO: N GOVT: N SUPP : N
PALM DESERT,CA 92260 tit
ML
A .IWLIIO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
t
ARCHITECT OR ENGINEER: IDG NO.: JOB DESCRIPTION : 14 ' X 20 6" THICK CONC . SLAB FOR SUMP PUM SQ FT:
ARCH.OR ENG.'S ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: S-2 /
CONmACTWSNAa RICHARD WILLIAMS ( 714 ) 998-4597
CanRACTDIn MAnaa 432 W. CRYSTAL VIEW COMMENTS; INSTALL WATER PURIFIER REF & SUMP PUMP REF;B-78458
ADDRESS: OR. CA ticx0: 466279 **************)r**+t**x****xit+ ************+F+rit*)rx*******x+F**+r+E)r** +E********x******
92665 UM Z ON ING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby dlim under penely of perjury that I am loosed under promos of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business Pmlpaions Code.end my Bonen u in fiat trace and aged.
Cr UC. 0.: UC.CLASS: C-4I LIC.NO.: 6279 EXP; MAIN BUILDING ACCESSORY BUILDING
.e Contractor -� �,�f FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
ntal
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
OW. R BUILDER r ECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contrition license Law for the
.reason(Section 7031.5 Runless end Professions Cods:Any city«county which requires a pannit to contact.alter.improve. PARKING REQ• PROV: PARCEL: 42703204 ZNE: REF NO:
demolish,or repair any°tractors:prior bas issuance,,abo requires the applicant for such permit to a signed statement that he or she
teamed pursuant to the prams of the Contractors License Law(Chapter 9(commencing with Sedan 7000)of Division 3 d the PLANNING NOTES>
nnen and Professions Coder or the he or she is exempt therefrom and the basis for the alleged exemption.My vitiation of Section > .•.
ya1.5 lel any applicant for apermit subjects the applicant toecivil pmM dmf mare then furs hundred dollars 135000. *******************************************************************************
❑ I.es owner of the propeny or my employees with wages as their oole compensation,will do the v.ock,and the structure is not imended
DEVELOPMENT V E L O P M E N T S E R V ICES,-E 5- R E Q(� U I R E M E N T, S
Of offered for sale(Section 7044,Business and Professions Code:The Contractorsd License Law does not apply loan owner property M
who bolds or improves thereon,end who does such work kneel'or herself or through his or her own employees,provided that such
improvements we not intended ordlered for sale.11.however,the building or inproelnem is sold within one year dmmpldnn,the ZONING APPROVED BY . Kit DATE:
ownrbuilder will have the burden d proving he or she did rot bulk or improve for the purpose d sale).
•
❑ I,as owner of the property,am exclusively ootrad g with licensed contractors to consbup the projed(Seton 7044,Buskins and
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projeds with a gmtrad«(s)licensed pursuant to the Contractors License Law).
o I am exempt under Section: B.&P.C.,for this reason: APPLICATION ISSUED BY: �''/ DATE: OLS
********************** *** *iF********************** a **
Date Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
I do hereby certify that I am aware of end understand the requirements of California Health and Safely Code Sections 25505.25533.end -
25534,and thel I or any Mure building oaupenl will/will not(dole one)need to comply with said slate codes and the requirements for
a perch for construction o modifcation9w the krtr fyMmagemenl Dieing.Residential oonetngnnepplcatiis are exempt from Owe BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING •
provisions. PERMIT 17 , 50
Dale: Applicant: 25% jig SMIP/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby affirm under penally el piton,one of the following dedatrns: PLAN 00 ,
o Ihave and wsmainn
aacenilksleofconsentloselikmprtlic
nsurewaken' nen.asprovidedforbySection3700oftheLabo ISSUE FEE 22 ,
Code.for the ped«manceoftw
ekforwtichthisprmhbisued. BUILDING DIV > PERMIT ISSUE PLANCHECK TOTAL PAID DUE
❑ I have and 00 maintain m
workers' mpemeton insurance.as required by Sedum d 3700 the Labor Code.tor the performancedthe a TOTALS > 17 , 50 22 , 00 l 0 . 00 39 . 50 39 . 50 . 00
work for which this permit a issued.My workers'mmprsetion insurance wren and policy number are: •
Caner: REVENUE DIVISION TOTALS--> COLLECTED: 7— 39 . 50 OVER/SHORT: . 00
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
t
section not be completed 1 the permit is for one hundred loran Maga less.) 39 . 50
„ • ,
certify that in the performanced the work kr which this permit b issued,I shell not employ any person n any manner so as to
eacon°ubjed to the watare ompnstion Imus d CeMIXnia,and row Nat El should beacon enhjed to the woM°' *******************************************************************************
//'I�e'n�/prod-�reions d Section 3703 d the tabun Coda l /'ply motor« is. I N D I V I D U A L ,;.', F E E B R E A K D O W N
///+/ ],{ Appfram n.K w-V�G�'4L/�-c 1. �.
hep:Failureto scan workers'compensation covenpe Is unlawful,and shall subject an rnplayseropdMrolpruMs and TYPE QTY DESCR IP T I O N ' UNIT COST TOTAL COST
civil fines rpt to one hundred thousand dollars(6100,000A In sIlllion to the cost of compensation,damages as provided ler In
Section 3105o/tls Luton Cob,Intres4 and adomq's tau PLU 1FIXTURE SET/TRAP W%PIPING & BACKFLOW 8 . 75 8 . 75
• CONSTRUCTION LENDING AGENCY:I hereby elfim under paneby of peiAay that there is c construction Swing agency for Ns PLU 1 WATER RE-PIPE l• 8 . 75 8 . 75
prMmancad the work forwnid,this pemib isued(Sedon 3097.Civ.C). END/OF FEES
LENDER'S NAME: .
LENDER'S ADDRESS:
r
I certify that)haveread this application end date that the above Wormatocarted.n is ed.I agree to comply with al my endcounty day odvarcw t, T
end state laws relating to b ildng coMumo end hereby authorize representatives of this dry to enter upon the aboe-mentioned property .4 U 3
kr wpeds.ion purposes. -
- . -
RICHARD WILLIAMS
Name
��':�1J_�' Dale: 4./QAalbU
Signature el Ormer/AgrdApplcen t .
n �I
(5151-IS.WP) White-Buildingom
&Safety:Green-Fle: ary-Applrant;Pink-Revenue:Goldenrod-Assessor . ` ' 4
1
GI . Et
1 CONSTRUCTION AND PLANNING` ! POOL PA
r DateI nspector ��` �• Date inspector
APPROVALS Permit# r APPROVALS Permit #
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 Reinforcement56. 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 ' -j
9. Water Pipe-Undrgrnd. -. .C., 60. Backwash Lines, P-Trap, 0 Undrgrnd. `�
10. Structural Floor System I 61. APPROVAL TO DECK 1
i ..
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-Coriduit y� 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factoiy Fireplace - APPROVALS Permit #
21. Ducts, in Structure • . . - _. 70. Underground Hydro
22. Ducts, Ventilating . ' •- 71. Product Piping 0 Gas 0 Oil
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 - - 78, FIRE PREY. FINAL -
30. Drywall Nailing - • HEALTI4 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
t_i1- Z( 1-'-'4AGP
35. Final Gas Pipe-Test -
. 36. Hood or Canopy / : _. ..
37. Final Factory Fireplace - ' - _i ' .
38. Final Plumbing - 7 i211i {7P -- (
39. Water Service-Final 7 - ^
40. Gas Service-Final - .
41. Solar Domestic-Final -
.
42. -Backf low 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
. -r. .
low
PROJECT ADDRESS: • 250 FISCHER .AV UNIT: CITY OF COSTA MESA••1..' BUILDING PERMIT • PERM NO: M 046559
,OWNER'S NAME: LARRY RAY ' - '• ._ '
ADDRESS: 77-312 POPPY EN - •
PERMIT NO: M 046559 PLAN .CHECK� NO: • N GOVT; N SUPP: N
PALM DESERT, 92260 •
' CONSTRUCTION TYPE: ' V-N PERMIT TYPE: •MEC PURPOSE: ALT
<619 -345-7725 . •
-ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : A/C 5 TON UNIT CHANGE-OUT SQ FT: •
ADDRESS: UNIT:
� CLAIM VALUE:- , ' CALC—VALUE: GROUP OCC: B-2 /
PERMITTEE: NATIONAL AIR SYSTEMS.. INC ( 213 ).245-6611
ADDRESS: 1842 FLOWER t COMMENTS : ' • • r '
GLENDALE CA 91201-2095 ********************************* ****************M*BHN************ ******.*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section .Z 0 N I N G R E
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. '5 E T BQAUC I KRS E M E N T S ;
Dale: 0�}007 [$J7ATEuc.: 02133 Cuss: 7.0 FRNT: FT'
MAIN BUILDING
BUILDING FT IN E'RNT: •
ACCESSORYFT IN RBUILDING FT IN •
Date: c 7 /�'- 1 Signature: /� �jq'i�+ - / --- - ---"
WORKERS'COMPENSATION DECLARATION:: I hereby affirm that I have a certificate of c to self-insure or a certificate of Workers'
CompensationInsurance,ora,crtiie p ereof(Section 3800.Lab. ). LEFT: FT IN RGHT: FT IN LEFT: FT ' . IN RGHT: FT . ' IN .
POUCy NO.: TC 1 2112 b EKP.DATE: 01 /01 /91
COMPANY: MARYLAND CASUAT PARKING REQ: ' PROV: PARCEL: 41810206 ZNE: REF NO:
0 Certified copy is hereby furnished.. ® Cert ed copy is filed wi tit city Bur ing Division. PLANNING NOTES> ; '
C+' /� ic **************************.*********** *******9P*****************,********** ***>E*
.ate: -•J� (' %[� •
Applicant: P• �.4.19--4-,----- t
E%EMPRON FROM WORKERS'COMPENSATION DECtARATION: (chis section need not be cant ted if permit is for one hundred 151WI or less). • I): E V E L 0. P M E N T' .S E R V•L:.C E S R E Q U I R E M E N T S
I certify that in the perforntance of the work for which this permit is issued,I shall not em to y person in any manner so as to become ' < • '
subject to the Workers'Compensation Laws of California. _ . . i , ZONING APPROVED BY He.-:'- 'DATE.:
Date: ' ' Signature:- . . - •
•NOTICE:If,after making this declaration,you should become'subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: 3 (�
Code,U you must forDING G compI ith such provisions r[his ermit shah be ending deemed revoked.cy :.' .,�' t FA *- �"* i '
CONSTRUCTION LENDING AGENCY: I hereby C). that there is a construction lending agenty for the performance of the work for APPLICATION ISSUED B Y : DATE
which this permit is issued(Section 3097,Civ.C). **********************3e*******iF'WWW-ae****** ********** * **
LENDER: •
,• ***********'**************************************************************iE*****
ADDRESS: -- LEGALIZATION:N F E E" ' S, U M M -A R -Y , STRUCTURAL SEGMENT:N -
OWNER BUILDER DECLARATION: I'hereby affirm that l am exempt from the Contractors'Stale License Law for the following.reason • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES ' GRADING i
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or • PERMIT ' ' .. 20 . 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she islicensed , . 2 t.5% • SM I P/NON-RES '
pursuant to the provisional 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.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a,civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I, as owner of the property or my employees with wages as.meir sole compensation, will do me work, and the . '.BUILDING-DSV-> PERMIT. ISSUE PLAN-CHECK TOTAL • PAID DUE
'Li tmRure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> • 20 .'50' 15 . 0 0 0 . 00 35 . 50 35 . 50 . 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 . REVENUE DIVISION TOTALS--> :• COLLECTED : 35 . 50 OVER/SHORT: . 00
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). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN'-CHECK
•
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sectiod.7044.Business • 35 . 50 v •
❑ 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'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided tome. I N D I ' V I' D U A L F E E BR E AKD OW N - .
❑ I am exempt under Section: • 8 P.C. . f
forthisreason: ' : . , TYPE QTY DESCRIPTIO 'N UNIT COST' ' TOTAL COST
i r
•
Date: Owner: ,
MEC 1 ' INST 'FORC-AIR/GRAV FURN > 100 K BTU 11 . 00 • 11 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and S 1 - 4 OUTLETS 3 . 00 3 . 0 0
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 MEC 1 GAS PIPING SYS
I4EC • 1 INST/REL AIR' HANDL UNIT 0-10000 CFM 6 . 50 6 . 50 '
permit for construction ions, or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. END OF 'FEES '
Date: Applicant: . , '
_
I hereby certify that I have read this application and state that the.,we information is correct.I agree to comply with all city and county • - •
ordinances and state laws relating to buildi(signature:
nstruction and hee bonze,presentatives of this city to enter upon the above-mentioned • _. - •
property for nspeccttioonnn pu
Date: f"r 760 d;_ ..4 / ' ' ,
Driver's License or social security x: 8148224001 00056337-00056337 T CE T : 35.50
1641-46 White-Buibinq:Green-Code Enforcement:Canary-AopllcanC Pink-Revenue:Goldenrod-Assessor DATE% 03I19I90 TIME: 10:19 , •-
•
. ; CONSTRUCTION AND PLANNING - POOL 'A
APPROVALS Permit#• Date Inspector APPROVALS Permit# _ Date - Inspector
' 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
.2. Soil Pipe-Undrgrnd. ^,• 53. Steel Reinforcement -
•*3. Electrical Conduit Utility-Undrgrnd:`54. Forms . .
'4:.Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
- 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test
_, 6.: Electrical UF ER Grnd. ' 57. APPROVAL-TO COVER-GUNITE -
•
ir -. 7. Footings `- 58. Electrical Conduit-Undrgrnd. _• ...
B.-Foundation - 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. - . 60. Backwash Lines,P-Trap, CIUndrgrnd.
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
1Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20:1Rough Factory Fireplace . .•' `.' . - z-, • . ' APPROVALS _ -.Permit #
21�Ducts, in'Structure. _ - - - 70. Underground Hydro
22,Ducts, Ventilating • . - - - .: , ,71. Product Piping ❑Gas 0 Oil
23:Gas-Pipe-Rough & Test -
r - _ -72. Undergrou'nd Flush
24. Roof Ftamirig - - - -- 73:-Undergrnd.Storage.Tank 0 Gas 0 Oil
25. Roof Sheathing - 74: Overhead Hydro-
26,T-Bar Ceiling (Structural) & Monocoat 1 75:_Dry Chemical -_
27. Frame and Flashing 76. Dry Standpipe - - •
-
28. Lathing & Siding _ , ' 77. FIXED SYSTEMIF,INAL ,., - „
29. Insulation - -. , : 78`-FIRE PREY. FINAL - --
30. Drywall-Nailing - . HEALTH;DEPT. REQUIREMENT
-
31. Plaster Brown Coat _ - - 79. FINAL INSPECTION ..
`
32. Electrical Power Meter-Final •• 80:. FOOD CERTIFICATE ISSUED 'T
-
:33. Final Electric z r - _< : Notes: -- -? _
34. Final Heating& Air Conditioning nitro tat ; -- - _
l5•. Final Gas Pipe-Test _ . 44 (,,Ef: :- - -
3._;:36._ Hood or-Canopy - _ • • •
37. -Final Factory Fireplace =- - • . -
38. Final Plumbing i- - - - ' r• - . '
39. Water Service-Final' - - - -
•'40. Gas Service-Final _. I • ?
A. - '• '-
.,41. Solar Domestic-Final - • .
7.
42. Backflow Preventer ' : '
43. Backflow Irrigation - -
-'44. Landscape Irrigation System' t • . -4
45:Sound -Attenuation - -- - . . ", -
46. -Handicap Regulations - = .
•
- 47: FINAL STRUCTURE & BUILDING I ,
48:-FINAL PLANNING '`R .' -
49.,Electric Release to Edison - ,
50. Gas Release to Southern California Gas Co ' r ' '
51. CERTIFICATE OF OCCUPANCY " - - - -
No. Date
PROJECT ADDRESS: 250 FISCHER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 060369
OWNER'S NAME: OLWELL & RAY
ADDRESS: $RAY GORDON,LARRYL PERMIT NO: F 060369 PLAN CHECK NO: 04697-92 L GOVT: N SUPP: N
763171 POPPY LN
PALM DESERT,CA 92260 CONSTRUCTION TYPE: PERMIT TYPE: FIR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : BACKFLOW RETROFIT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 7, 600 . 00 CALL—VALUE: GROUP OCC: B-2 /
PERMITTEE: FIRE CONTROL TECHNOLOGY ( 213) 861-6666
ADDRESS: 9102 FIRESTONE BL R COMMENTS: THE "SIMCO MEDICAL" WAREHOUSE
DOWNEY CA 90241 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 at the Business and Professions Code.and my license is in fun force and effect. SETBACKS
clTYuc.: 054833 srATEuc.:619461 cuss: C— 6
Coate: eg,e' • 17 .1v signature:_ .� MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT I N REAR: FT IN FRNT: FT I N REAR: FT I N
CompensationA�q5siyq1u�fyg 5icgnlu�redcopythereat(Section3800,Lab.f� LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: W L /1 9 1 EXP.DATE: s/7/0 1 1 9 3
COMPANY: CALIFORNIA PARKING REQ• PROV: PARCEL: 42703204 ZNE: REF NO:
❑ Certified copy is hereby furnished. L19 Certified copy is filed with the city Building Dr ion. PLANNING NOTES>
le,ter: I7• eft- Applicant. n *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature: /
NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY . 1 a, DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ---7 , '/'7•
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: - DATE-
which Ia
this permit is issued(Section 3097.Civ.Cl. ************************ *********"'mai **********************
LENDER: *************************************** "1'1 ************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 99,00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 65% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN - 64 . 3 5
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). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 99 .00 0. 00 64 . 35 163. 35 163 . 35 . 00
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.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 99 . 00 OVER/SHORT; 00
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). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 99.00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: FIR 99 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1 . 00 99 . 00
I do hereby certify that I am aware of 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/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ouality 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.1 agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city •enter tiro,the e•-•rationed
property for inspection purposes. .401 /�/ }.
-Thr"- Date: iC-- l7- 9 Signature: �Or .....1 4
Driver's License or Social Security v: i'.:':_
1641.46 mire—Building:Green—Code Enforcement:Canary—Aoolicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNIN, G
t POOL .. .'A
'_APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
•
1. Temporary Electrical Service or Pole
r 7 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
• k. .
. 3.'-Electrical Conduit'Utility-Undrgrnd: " 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5: Steel.Reinforcement • 56. Rough Plumbing & Pressure Test .
:-. 6. :Electrical OF ER 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. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65, Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT, REQUIREMENT
20. Rough Factory Fireplace ' -- r t _ ' ��r F APPROVALS' '=Permit# - ''_
21T-butts, in Structure t-. ,- K -, t.-'. •• i 70. Underground,Hydro •• r
22. Ducts, Ventilating u : '-.ti.:-.;, _ , ill ,t• f 71. Product.Piping 0 Gas 0OiI
23..04Pipe-Rou &•
gh Test i • ; ;; .-c •-. 1. a -472. Underground Flush; >
-r/-93 0324:=Roof Framing I ' • y -.7. , u- ,, Z 73;-Undergrnd.Storage Tank O Gas ❑Oil
25. Roof Sheathing - ,. `- :�- - -- ...-. , = '7q:Overhead Hydro
26.T-Bar Ceiling (Structural) & Monocoat -ti = 751 Dry Chemical -
27. Frame and Flashing 76. Dry '
T. r x Li r ...1{ Standpipe ,
L 28. Lathing& Siding • • - •. -- ' ••i r„ 7 • 7717FIXED SYSTEMS FINALI
-'29. Insulation • • , - ' r" I :t 78;FIRE PREV. FINAL (./�R_ 1414-
'30. Drywall Nailing • - •� ! II
it * • 'HEALTH-DEPT:REQUIREMENT
`-31. Plaster Brown Coat _ t .4 -.; ' I• . 79'. FINAL INSP.ECTIbN .. ' •7.
32t,Electrical Power Meter-Final . ,1 7 ; :-,80. FOOD CERTIFICATE ISSUED.
33: Final Electric �i Notes: K
••34,. Final Heating& AiConditioning t- dr. , , _ - _.y
35.Final Gas Pipe-Test ,. I fr"' ' '4 44 '- - - - - -
36. Hood or CanoPY ', .• . r - -
37. Final Factory Fireplace ,
-38.-Final Plumbing - -
-39.'Water Service-Final- -
,40.-GasService-Final - - - 1 I _ ; - _
•41. Solar Domestic-Final. -
.
42. Backflow Preventer,• - :.
43. Backf low Irrigation ' r
.:44. Landscape Irrigation System. - : - •
: 45..Sound Attenuation - - - •- - j
46..Handicap Regulations -
47.=FINAL STRUCTURE & BUILDING - I - -
48. FINAL PLANNING " . a c. l
49, Electric Release to Edison I 2'
50. Gas to Southern California Gas Co A I fes, - _ - _ •
51. CERTIFICATE OF OCCUPANCY J i .
No. Date
ADDRESS OF BUILDING: 250 FISCHER AV WIT: CITY OF COSTA MESA — BUILDING PERMIT
• a.NERaNAMENID1OR'N: GORDON, COLWELL 6 RAY PERM NO: B 075060
AD" BRAY LARRYL
76312 POPPY LN PERMIT NO: B 075060 PLAN CHECK NO: 04260-95 A GOVT: N SUPP : N
PALM DESERT, CA 92260
APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: V—N SPR PERMIT TYPE: STR PURPOSE: ALT
I
ABcxREc7 aR E1 JEER: JAMES WHALEY
3198 AIRPORT LLOOP DR sic.No.: C5300
UNIT: D JOB DESCRIPTION : 5320SF OFFICE T. I . SQ FT: 75, 000
MicxORENO.'sADDREss:
C.M. CA 92626 CLAIM VALUE: 75, 000 . 00 CALC—VALUE: 75, 000 . 00 GROUP OCC : B-2 /B-4
cCNTBACTGBSNANE SHEPPARD CONSTRUCTION ( 714 ) 259-1470
canucTORSMNc 15042 PARKWAY LOOP COMMENTS : "THE PIERCE BUILDING" OFFICE TI
muss: COSTA MESA CA ue.No. 631416 *****+A*+tx****aEit************ **at*****K-*iciE**** -ftiE**ft** -iE*at*******itatx*et*atitit*******
92626 u,c A Z ONING REQUIREMENTS
uCENSED CONTRACTORS DECLARATION:I hereby Slim under windy of perjury that I an Ice sed under provisions of Chapter 9 S E TB ACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code and my Ecense is in lug force and effect.
CITY UC.NO.: 05 670 uc.cuss: B uc.N 631416 EXP- 00/00 MAIN BUILDING ACCESSORY BUILDING
�J FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: f�'(p Q� contractor F((4LQ/� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty d perjury thin 1em mot from IM Cont license law for mefollowi g reason(Sadiron 7031.5 Business and Professions Code:Any city r county rrr mch requires a permit to Iran,after,improve, PARKING REQ: PROV: PARCEL: 42703204 Z NE: MP REF NO:
demolish.or repair any etmcture,per to its issuance,also requires the applicant for such perm to fib a signed statement that he or she
licensed pursuant to the provisionso r Ben
t e Contractors Law'Chapter9(commencing with Se d Division 7000) n 3 el the PLANNING NOTES> INTERIOR AND. EXTERIOR ALTERATIONS FOR AN EXISTING
lusiness and Professions Code]or that he or she is exempt therefrom ed the basis tor the see ped exemption.Anyviolation el Section > INDUSTRIAL (BUILDINGS. •
/031.5byanyappicant fa a Deme Wbjers the applaattoacvi penally o not mote than fee hundred dates[S5001 ********************************************************************9b**********
❑ I,asowner dp
the r
ymyemcployeeswithwagesestheirsole mWenaaticn,SIIdothework,andthestructureisnotintended D E V E L O P, M"E N T - SERVICES R E Q U I R E M E N"y,T. S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan owner of popery Q
who buids or improves thereon,and wee does such work himself or horse,or through his or her own empbyees,provided that such _
improvements ore not intended or offered for sal,I.however.the building or inpaamwsold is within one yewce completion.the ZONING APPROVED BY DATE:
owner-0udir will have the burden of proving he Or she did not build Of improve for the purpose of sale). j.,y/ 7� r
❑ I,as owner of the properly.am exclusively contracting with licensed contractors to construct the projectproject(Section 7044,Business and y� (oDATE: I v2 '9J
Professions Code:The Contractors License Law dossed appeor to an ownerof property who buildsimproves thereon and who BUILDING APPROVED BY- : Kik: //
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law), � _
❑ IamexemptundrSection: B.A'PD.,mrthisreason: APPLICATION ISSUED BY: �� DATE: (/�_ 90
Dale: Owner: *********************************************** i(-17•************ *,If eE********
LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I em aware of end understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534,and that I or any enure building occupant will/will not(circle one)need to comply with said pate codes end the requirements for
awmt for constructionr modificationhrn the Ai uhty anagement District.Residential mrWvibpp
applications am exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 527. 00
Date: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under pey of perjury one of the following dedeolions: PLAN 85 . 64 m 15 . 75
nab
❑ compensation.aspraided for by Section 3703 of the Labor ISSUE FEE
Code,drdhe performancemacothe wdcowhich
seginsuro le Sued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
for the of the work for which this game is Issued.
y Ihaveand will maintain workers*compensalbninsurance,as required bySection 3700dtheLabor Code,lerthe pedrm
oance othe TOTALS----> 542 . 75 0 . 00 , 85 . 64 628 . 39 628 . 39 . 00
A work for which this permit is issued.My workers'compensation insurance Tamar and policy number are:
Carrier: CNA INSURANCE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 628 . 39 OVER/SHORT: . 00
Policy Number: 101447RF,77 09/26/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
his section need nor be completed i the berme is for o e hundred dollars(5100)or las.) 527 . 00 15 . 7 5 85 . 64
O I certify that in the performance of the work for whish this pert is issued,I shall not employ any person in any macer so as to i•
become subject to the wodrri compensation Mws ofCSJrnie,andWee Nor t I ehoukd become abject to the workees *******************************************************************************
7 ami
11 n t' of Section 3700 of the Labor (�/{'L//
Code.I shall I hwah comply con Mose. , IND I V I D U A L. •F E E BR E AK DOWN
G
Dat.: I1 4J Ateacan: ' i /
Warning:Fours re worts'compreadon coverage Is unlawful,end she lest an'mph trifling!penaidea and TYPE QTY D E S C R I P T I O, N^' ' UNIT COST TOTAL COST
civil fines W to one Audrsd thousand dollars(51040 001 In addltbn to the I compensation, . . as podded for In '
Section 3705 of the Labor cod),lnrreaL and attorneys aces. SFC 75000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 75, 000 . 00
CONSTRUCTION LENDING AGENCY:I hereby elfin.under Portant of perjury that there is a choshoc r,larding agency for the END OF FEES
performance of the work ler with this peri is issued(Section 3097,CN.C).
LENDER'S NAME: w
A
Le red this
application
/
I certify top I have reed buapplcatbn and para that theels above information lsconal.)Wroeto complypon aft dry and musty ad'mum® •
and stale taws urpose to buiMrg construction and hereby authorize ropaaentaives of this may to Inter tape the above-mentioned Properly . ',
for inspection purpose.
RANDY MOODY /
ci 32
./,LL • 9Lilfl/./, ore: n froi •A 01 001G ;; ^..J17?81 5 e; 3 2.,,
signatu• ofOwnr/AgenttA••• :6 . radar -, 7 DATE: i;, L':.4:7; TS(4E; 1:„4a
(5151'6.WP) Whle-Buddig A Safety;Green-Fid:Cuury-Appicant;Pink-Revenue;Golderod-Aasasrr
CONSTRUCTION AND PLANNING - POOL. A
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. 'Temporary Electrical Service or Pole 52. Pool & Equipment Location_'-
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement -. - -?
i ,
3. Electrical Conduit Utiity-Undrgrnd. 54. Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement:- 56. Rough Plumbing & Pressure Test
6. EledtricarUFER_Grnd. 57. APPROVAL TO COVER-GUNITE - ..E.,
7:'Footings• - ,T ��J/�j 58. Electrical CondGit-Undrgrnd. %._
B. Foundation �s/5C 59. Gas Pipe, 0 Undrgrnd.,Test
t
„.9. Water Pipe-Undrgrnd. 60. Backwash Lines-,P-Trap, 0 Undrgrnd. 1
10. Structural Floor System _ 61. APPROVAL TO DECK
11. Property Sewer Line& HouseConnPcion 62. Backwash & Receptor-Final-L.-
12. Sewer Cap - - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System- Final
14. Rough Plumbing 65. Electrical-Final '
1 -t15. Rough Electrical-Conduit Y V . • 66. Solar System-Final
16. Rough Electric Wiring, '. - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR-PLASTERING .l
18. Rough Electrical? Bar Ceiling- 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT..REQUIREMENT
20, Rough Fagtorg-Fireplace - - APPROVALS_,:.Permit#
21. butts, in Structure= • . • - 70. 'Underground Hydro
22. Ducts, Ventilating z • r:: 71. Product.Piping O Gas P Oil
23. Gas Pipe-Rough & Test . _ + 72. Underground Flusfi-' '
24. Roof Framing - , , ' 73., Undergrnd.Storage TanktOGas 0 Oil
25. Roof Sheathing _• _ 74: Overhead Hydro _
26. T-Bar Ceiling (Structural) & Mono oat " ' . i;2';', 751- Dry Chemical -
27. Frame and Flashing t - 76 Dry Standpipe "'
•
28 &thing iding , ' r .'_/If .% ,�D�` 777 FIXED SYSTEM-FINAL r- r, •
.
29. Insulation, .-� ' • --,r • 78: FIRE PREY. FINAL "
30. Drywall Meiling /a/ r r HEALTH DEPT. REOT/IR'EMENT
- 31. Plaster Brown Coat, / N, -•79:FINAL ISSPECTION
32. Electrical-mower Meter-Final '80:•FOOD CERTIFICATE ISSUED,
33. Final,Elecuic-- - . tyl
• • .y 'til ' . Notes: (--1-Lam-`_ p t- -/ :R1✓R",4�2areQ.
34. Final Heating& Air Conditionirig •r - T
35. Final-Gas Pipe jest. . - r - // ‘41.4r--
'
...-- . , . . ..
36.
41. r-
36. Hood or Canopy - r - "''
. 37. Final.F actory Fireplace-• t_ - !r'' •r r
38. Final Plumbing -! + I '" '-' r. `� r
39. Water Service•Final -'' tr '
.
- 40. Gas Service-Final - '/.'ii
„ r
r41. Solar DomestictFinal' .. ' ' '
42. Backflow Preventer 1 " ' -
Ii,
43. Backflow Irrigation • - '' F.. . T. -
44. Landscape IrrigatiorvSystem J - - -
45. Sound Attenuation • -
r' r• L --, •1 .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -i/:02 `�S P
48. FINAL PLANNING - - - a ,1
49. Electric Release to Edison • ,i ' -r -
50. Gas Release to Southern California;Gas Co _ _ - .
51. CERTIFICATE OF OCCUPANCY -
No Date
•
ADDP#SS a RACING: 250 FISCHER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT
o^NExyf"MElvwow": GORDON, COLWEL' RAY PERM NO: P 075063
•' ADDRESS: SRAM LARRYL `-
763112 POPPY LN "PERMIT NO: P 075063 PLAN CHECK NO: N GOVT: N SUPP: N
PALM DESERT,CA 92260
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: V-N SPR PERMIT TYPE: PLU PURPOSE: ALT
ARCHITECT ORENtNEER: JAMES WHALEY UC.NO.: C5300 JOB DESCRIPTION : 5320SF OFFICE T. I . / PLUMBING SQ FT:
ARCH.OR M.'S ADDRESS: 3198 AIRPORT LLOOP DR UNIT: D
CONTRACTOR'S NAME
CHEPPARD CONSTRUCTION CA 926264) 259 1470 CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /B-4
CONTRACTOR'SMMUNG 15042 PARKWAY LOOP COMMENTS: "THE PIERCE BUILDING" OFFICE TI / REF B-75060
ADDRESS: COSTA MESA CA uchlo.: 631416 '>E'***9I'#ififikififif3El ***x-fEitrtjEiFiEiflEiFiEiEit3fiEitiElEiEfEiElElE****iEfE1E#1E1E1E1EiEifiElEiE3Eit3EiEifiEx-1EiElEiE+t9E3EiE9EiEjElE***
92626 UMT: A Z O N I N G R E Q U I R E M E N T S
UCENS ED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I em licensed under provisions of Chapter 9 S E T B A C K S
(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license bin fug force end effect.
CITY LIC.NO.: 059 70 UC.CLASS: B LIC.N 631416 E P: 00/00 MAIN BUILDING- ACCESSORY BUILDING
// nI FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: II to 9b Contractor: ��L�{ LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under Randy of perjury that I em mot from the Contraa nse law for the
followag reason(Section 7031.5 Business end Professions Code:Any city or county requires a permit to ,after,improve, PARKING REQ: PROV: PARCEL: 42703204 Z N E: REF NO:
demolish.or repair any sllucture,prior to its issuance,abo 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 Sedwn-7000)of Dibion 3 of the PLANNING NOTES>
Business end Professions Code]or that he or she is exempt therefrom and the basis fo the alleged exemgion.My violation of Section > 17 4
7031,5 by any applicant for a permitsubpcte the applicant to a civilpenaty of not more than the hundred dollaa]S500]). *******************************************************************************
❑ I,asow er01thepropelryormyemployeeswithwagesasthirWorth solecompensation,willdotheWorandtlwdructureisnotimended D E V E L O P M E N T S E R V I C E S f," R E`Q U 'I R E M E N T 5
or offered lor sale(Section 7044,Business and Professions Code:The Contractors Ucense Law does and eppfy to an Owner of property
who bolds or improves thereon,end who does such work Nmsei or hersel or through his or her awn'emdoyees,provided that such 1'f
improvements
prwill havenot theintendedor
of sale.
e«'ads however,
notthe build for improve for the purpose of side). year d completion.the ZONING APPROVED BY eV-
L ‘ •C. f4\ DATE:
I r ' L( i
❑ Las owner of the propeem exclusively contractile with licensed conirector to construct the Project(Section 71114,Business and
Professions Code:The Contractors License Law does not apply to an owner d prtper y who builds or improves thereon and who BUILDING APPROVED BY : !` :. -7 , DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Liss). •gyp +a a
❑ I ens exempt under Section: B.&P.c.,for this reason: tliz/ ' 1 � APPLICATION ISSUED BY: .^ DATE: ��—�- /J
Date: owner: *******************************************************************************
LEGALIZATION:N F E E S U_ M M A R Y STRUCTURAL SEGMENT: N
I do hereby certify that I em aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,end Vit ..- .
a25534.penn and n,etlaany future building occupant will/w+lrrot(amla one)need to comply witn.eie state codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECH'AN IC t., t,^ (FIRE f SMIP/RES GRADING
e pem.a for construction a modification from the Av-Ou teTiFnot(dreione)()Writ Residential construction tppf�iare me exempt from these
provisions. - ✓ - + I -n /L
PERMIT 127 .00
Deo; Applicant: 252 = . . f.- • ✓' )- V SMIP,/NON-RES
PLAN r. .11„ 1 t- n, - /
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dedvatona: ISSUE FEE 20 .00 - "_
ElIhave and wilmaintanaceriicateof consent tosel-insure for workers'compenwon,as provided for bySection 3700of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK .. 'TOTAli" ^ �' iPAID DUE
Code,for the performance of the work for which this permit is issued. . ' 'fl •+ ,.-4
TOTALS----> 127 . 00 20 . 00 n Q.00 ,•, 147 . 00 14.7 .00 . 00
I haveand wit maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the t .
work for which this permit is issued.My workers'compensation insurance cornier and policy number are: '
Carrier: CNA INSURANCE EXPIRES REVENUE DIVISION TOTALS > COLLECTED ': LT fr 147 . 00 OVER/SHORT-:' 00
Policy Number: 109449Ah77 09 /26/96 BLDG PMT PLUMBING ELECTRIC MECHANIC TG :FIRE .— SMIP-/TOT `GRADING PLAN—CHECK
(This section need nor be completed if the penny is for one hundred dollars/$100)or less.) 1 4 7 . 0 0 i + . `- • i ` f q - V .I� 1j-
❑ I unify that in the p&amance of the work for which this permit is issued,I shall not employ anY Person in anY m: nor eo as to ,(T ,' ( I
IA
become subject to the workers'compensation laws o Celdorna, agree that H I shouts become subject • the workers' ***********************************.**************.7E-**7(,******1E*******************
oompensatio p •ons of sectio,37C0 of the Labor Code,I shall Ia
h corn with p'sions. ) I N D I V I D U A .� FIE E 2B R E F1 K` D O W N r
Date: I I l� 95 ApApplicant: / y / L.) " n/1 1 r (' ✓'
warnmv:hallo fos rewaters'compwuatlon coverage Is unlsw*unlawful,end awlstf)pctan srrLvloyerroe �j /pxurou and TYPE QTY D E S C R I P T I O,'N• • -^ - UNIT' COST \ TOTAL COST
civil fins tq to one hundred thousand dollars(5100,000),In addition to the cost o repensatb%da a provided for In d ,i '' •, ' A t, ( I
section 3706 of me Labor Code,Interest.and attorney's fees. " n -
PLU 1 DISHWASHER �] 1 X7:•00 ( 7 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the PLU 1 SHOWER {., .^ - •n 7 .;00 7 . 0 0
pedormenu dthe work fa wnidl cob pemlitbbetred(sedia13as7,cN.c),
PLU 1 SINK, KITCHEN i', --' %' (,7 , P. ,'•7,. 00 -..,,);1' 7 . 00
LENDER'S NAME: '' '•,<"� r` q
LENDER'S ADDRESS: x�d+13 WA',j' B " :T " ' 7 13• 7.00 35 00
PL WATER CLOSET ( TOILET) 3 If -fes IX7. 00r 28 . 00
I certify that I have read this application and mate that the above information is cones.I agree to comply with all dry end county ordinances PLU 2 WATER HEATER AND/OR VENT L- ;" I' '�
a• • i7 002- 14 . 00
and stalecion Satin building constructor and hereby authorize representatives of this my to enter upon the above-mentioned prooeM PLU 1 GAS RE-PIPE '/ '� / -, -47. 0 0 7 . 00
for inspection Purposes.
RANDY MOODY PLU 1. SEWER, CONNECTIONrTO' BUILDING EAGH. t . 15100 15 . 00
Print Name PLU 1 URINALS,-' WALL l<21 • ‘;) . , : 7,.-00 7 . 00
4 1 Date: I I/GP5 'END OFA FEES• y - , �r t],--,
Signature a.A�YAgenUAppkcanUContrect« . "r -14
,'� 01 0 �r `
} 0li- )-7,r,;))1935.1.7 _r 11" 1+7�
.f,, , .BATE:-x1?L';:cl III)77 )-: N IA
(5151da.WP) Whhe-Building. Safety:Green-Fre:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
ISTRUCTION AND PLANNING POOL& SPA
• e APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location-`
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
3. Electrical Conduit UTilitY.Undrgrnd. 54. Forms •
4. Electrical Condvitzendrgrnd. 55. Electrical Bonding -- > -
5..Steel Reinforcement. 56, Rough Plumbing & Pressure Test .-
6: 'Electrical LIF ER.Grnd. 57. APPROVAL TO COVER-GUNITE ,
7�' Footings' - . 58. Electrical Conduit_Undrgrnd.
•
'8. Foundation` • 59. Gas Pipe, 0 Undrgrnd.,Test
•
.9. Water Pipe-Undrgrnd. I 60. Backwash Lines;P-Trap, 0 Undrgrnd. -
10. Structural'Floor System61. APPROVAL TO DECK . r '
11. Property Sewer Line & House Connection G 62, Backwash & Redeptor-Final •
12 Sewer Cap - 63. Heater & Vent-Final ._
13. Roof Drains - [I'M -tie-a�/�. 64. Plumbing System - Final C
• 14, Rough Plumbing-. 6l -` 7'/, 65. Electrical-Final
_
15. Rough Electrical-Conduit 66. Solar System-Final , r
16. Rough Electric Wiring 67. Fencing & AccessApproval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical:7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19.,Rough Heating & Air Conditioning . . FIRE DEPT.•REOUIREMENT ,
20. Rough Factory Ficedlace- _ _ APPROVALS H _: Permit # y . - , '
21. Ducts, in Structure + . . •" - - ' 70.)Underground Hydro
22. Ducts, Ventilating , . - , 71. Product-Piping D-Gas QOil
23. Gas Pipe-_Rough &Test _ • . y 72. Underground Flush
24. Roof Framing" ‘ - ' t ' c ...., , . 73, Undergrhd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing • t --t _- ' - 74: Overhead Hydro•_ '`
26. T,Ba? Ceiling (StructLral) & Moriocoat ' r 75 Dry Chemical H.-. : - ._or; _ -
27. Frame and Flashing . _ a Y o-- a 76. Dry StaniApipe T - a ~•
28. Lathing& Siding -. ' :- _ :k 7 - •':t 77. FIXED,Sf$TEM FINAL _ r, - ,
29. Insulation' - _ 78,. FIREPREV. FINIAL r" .' --,.'1-..,-
30. Drywall Nailing ', I x ',., :, HEALTfi DEPT.'REOUIREMENT.1 -
31. Plaster Brown Coal.r n iv c. 79. FINAL INSPECTION -
- 32. .Electrical Power Meter'•Final ". ' - ' 80: FOOD CERTIFICATE ISSUED ,
33. Final.Electric . 1- • - Notes: ..d.•,-' G
- 1(_16`x . scwyti_PAG-� '-
34. Final'Heating&Air Conditioning:- ,
mz.
t •/17119.5-4 61‘.. , e ? n i -1
35. Final Gas Pipe:. est. s " - I 2-4,.-1 9 r:7-±-151?- 0:127-
• _6032-R_� 17 -±
- 36. Hood or Canopy '- -
. -' -'T , a • 6 ' /z=2^5���cr - atm
37. Final.Factory Fireplace 7: , t-r. -• ,!- .• '
- 38. Final Plumbing • 2-4,--14-4:) ':. c• t (6 LLJCrree OO _ vg g0�� I�/
r.. _ S �(sC1-IDYL •" -
39. Water Service-Final . , -'I . • 1 2r lit
•nLera0-,17_12- - ri• _s
40. Gas Service-Final - • n • - r :4,
41. Solar Domestic-Final i -
/21-2-1----,C t-c car-i__Pory I
42. Backflow Preventer .
iliCP tt.4.) 91
43. Backflow Irri ation
44. Landscairrigation System y
a , ' + •
•
pe ' 2;1/2- 26 `L ►,
45: Sound Attenuation . - `,i
_ '-ZS Its `Ptisu i-L
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING • • s .
48. FINAL PLANNING �' �,
49. Electric Release to Edison .. _
xl
50. Gas Release to Southern California-Gas Co - -; - '
51. CERTIFICATE OF OCCUPANCY • - -
No. Date
AD°B OF W111.003: 250 FISCHER AV °NTt CITY OF COSTA MESA — BUILDING PERMIT
aY"E"s alka.sow"' GORDON, COLWELL 'a RAY ERM NO: M 075062
Aromas: PRAYLARRYL
/ 763171 POPPY LN • _ r ,PERMIT NO: M 075062 PLAN CHECK NO: N GOVT: N SUPP : N
PALM DESERT,CA 92260
APPL.YAWNS ADORERS: CONSTRUCTION TYPE: V—N SPR PERMIT TYPE: MEC PURPOSE: ALT
Agc""ECTOf"effla: JAMES WHALEY UC'"a: C5300 JOB DESCRIPTION : 5320SF OFFICE T. I . / MECHANICAL SQ FT:
ARCH.OREtici ADDRESS: 3198 AIRPORT LLOOP DR aim D •
• C.M. CA 92626 CLAIM VALUE: CALC—VALUE: s" GROUP OCC: B-2 /8-4
CONTRACTORSNAME: SHEPPARD CONSTRUCTION ( 714 ) 2'59-1470
c0"RIACTOWSMWI0 15042 PARKWAY LOOP COMMENTS : "THE PIERCE BUILDING" OFFICE TI / REF B-75060
ADDRESS COSTA MESA CA lic"o.: 631416 "s*sE**sEss+A+E***sESE*sE+L** **+t**+t '*As**ss*****x'******x******* *****rtes*****x*****s(ss******
92626 mm A Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby shim under penalty of perjury that I am licensed under prwisiora of Chaplin 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is in lid tome and effect.
CITY LID NO.: 059670 UC.CLASS, B UC.NO.: 631416 EXP: 00/00 MAIN BUILDING ACCESSORY BUILDING
Dae: i I
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
95 toreador: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DE LARATION:I hereby affirm under penalty of perjury then am
Paulin.
the Contract Law la the
foww'greason(Se" '"' "
i°n70315B " endProfeae"nsCode:Anyrayorcounty apermit t° akar,improve, PARKING REQ: PROV: PARCEL: 42703204 ZNE: REF NO:
demolish,or repair wry structure,°dor to is issuance.also requires the epplrenl for such penin to file a signed statement gal he or she
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(oanmerrin9 with Section 7000)d Division 3 d the _.PLANNING NOTES>
Business end Professions Code)or that he or she is exempt therefrom and the basis fa the reneged eeanptian.My violation of Sedion 1 >
7031.5 by any applicant for eperm'subjects the applicant toaern!penally ci rid man than five hundred dollen 1350011. 1*******************************************************************************
❑ I,as owner of the property or my employees with wages as then sole compensation,will do the work,and the structure le not intended D E V E L O P M E N TS E R. V I C E S R E Q U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner d property Q
who Wide or improves thereon.and who does such work himself or herself or through his or her own employees,provided that such •
impwema "'" "4"'""oflaed fasale.t,however.the building ornpr
ivement h sold wihin oneyserdoompatlon,de .''ZONING APPROVED BY �� DATE:
ownerburider will have the laden of proving he or she did not bald purposed
d or improve for the purpose sale). (
❑ I.as owner d the property.am exclusively caranmig with&meed contractors to on=the project(Sedan 7044,Business and
PMestiw coda:The Contactors L ,se Law doss nd appy to an owner d property win corns orimproves thereon and war BUILDING APPROVED BY : .."vr DATE: �)//(J ,/-('/�(a\/�
corn exefa such
ndprojade: amdrador(e)liB.AP.ed Wnramtinathe nomndora License law). / � � p=#� if 1F* 1!ie iF
❑ lameempund«Sectlon: B.aP.c.. am.a..o : -*****CATION ISSUED BY: DATE: *
Dale: Owner ********************************************** *************** * ***
LEGALIZATION:N F E E S U M M A' R Y STRUCTURAL SEGMENT:N
I do hereby certify that I am aware d and understand the requirements d California Health and Safety Code Sections 25505,25533.and / !- — r jn ( ,
25531.and that I or any future building oo pat will/will not(circle one)need to comply with said stats codes and the requirements for
a permit for constructvuaneddretion heaths Ai wyt wgm ®
eere District-Residential cvmnd
linnappiceare eezempfmm thaw BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ' SMIP/RES GRADING
provision.. PERMIT :. _ 102 . 00
Date: Applicant: _ I- 1/ L ' 2'5%r hr " , .vSMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby elfin n under penalty a perjury one a the following declarations: PLAN {.n j' 'fir. '
ISSUE FEE ni 15 . 00
❑ I deI�ce bpedornancceofthe work�hthtthiJ�ap workers'mmpamab ,naoWdedfabySedan3700d1MLabor
BUILDING—DIV—> PERMIT ISSUE PLANCCHE( K ' ' "� 'TOTAL- PAID DUE
O IhaveadMImaida:nWOWS.wmpensaioninsuance.esrequaedbySw�3700dthe Labond
Code. TOTALS 102 s 00 15 . 00 c- A 0 . 001 1,17 0 117 . 00 00
work for whin this permit is issued.My waken'compensation insurance miler and policy number are:
Carder: CNA INSURANCE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 117,. 00 OVER/SHORT: 00
Policy Number: 1fl1447REy77 09/26/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP;/TOT )- GRADING PLAN—CHECK
(This suction need not be completed I the porta is lot one hundred dollars 1$1001 or less.) 117 . 00 _ : — rti (r l• ',
❑ 1 eerily that in the oedemas/me d the wok for which this permit Is issued,h shall rd employ any person in any manner 03 m to L' 4, SC A
become subject to the workers'compensation lawn d California, and agree that A I shook'become subject to the worker,' *********************************** **************IE*'dE******IE*******************
coin ion d Section 3700 d the Labor Code.l shall I h mm with " -.
� 95 k .. I N I V I D UALi1-' F ;E E. - B—R -E 'A KtD�'ONN
Dore: Applicant: l l / , 'n.
Warning:Faun secure workers'compensation coverage Is unlawful,and shall lectin employer to . nal penalties and TYPE QTY D E S C R I P T I O", Nr / UNIT COST TOTAL COST
civil fines M to one hundred thousand dollars(0104O00A In eddlt/on tomer4
e cost npaatlo • •ore as provided for In -v �, n v Y I
Settlors 3706 of the labor COW,Interest,and atromey'e hes. MEC 4 INST FORC—AIR/GRAV F9RN' .<_ 100 K BTU( 49'400 36 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency tor the MEC 4 REFRIGERATION SYSTEM —<=:1.. 10.0 -K BTU/H , '--9 , 00 36 . 00
pedamamcedtha oak for which this permit is haired(Section 30g7.Civ.c). MEC 4 GAS PIPING SYS 1 — 'A.'OUTLETS U �' - 43, 00 12 .00
LENDER'S NAME: 'l 1
MEC' 4 VENTILATION FAN CONN TO SIEES : DUCT 14 , 50 18 . 00
LENDER'S ADDRESS: y
END OF�FEES 4 h' t .2.
Iceruy this I have real this application and stele Mel the above information h correct I agree to comply with all city and countyadirarw® / 4. /j . r. �'n . 1
and state laws relating to building construction and hereby authorize representatives d this city to enter upon the abwa•mentmed property ( Gj-•{ / {
for inspection purposes.
a RANDY MOODY ! �'
e1.11.ZA (1141141, Date: b� 01 u93e. iriv,ga3 TOT :17.k'
SMnalurer OanenAgentrAppmn EF nada 1 De r4;'1y',ch./9:f. 1:':4E
(5151'4SWP) White-B'Adng&Safely;Green-File;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor 1 I
L
•
CONSTRUCTION AND PLANNING POOL & SPA
.._,APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
„1. Temporary Electric& Service or Pole Pool & Equipment Locatio_n.
2. Soil Pipe•Undrgrnd. 53. Steel
3.-Electrical.Conduit iiitility-Undrgrrid.
46. Electrical Conduit}Fhidrgrnd. 55. Electrical Bonding
-5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . i.
-
6. Electrical4JFER Gina. 57. APPROVAL • COVE
7.. Footings 71.„ • . . • .
11
• 8. Foundation c.-L Gas = UnZW-groci.,Test •
-
9. Water Pipe-Undrgrntt.
• 10. Structural Floor-System _ . 61. APPROVAL TG •
11. Property Sewer Line & House`Connection .,
12., Sewer Cap _- ° 63. Heater & Vent-Final
13. Roof Drains i -
1' . Rough Plumbing
15. Rough Electrical-Conduit - -.-•-•-.i•'
16. Rough Electric Virint - o 67. Fencing & Access.Approva
17. Rough Wiring Sign •• • • • ;
18. Rough Electrical• Bar Ceiling 69. POOL/SPA SYSTEMS iFINAL __
19. Rough Heating & Air Conditioning i� FIRE DEPT. UEOUIREMENT
20. Rough Factory Fireplace _ x _ . '1APPFiDVALS^_; Perjnit# '
21. butts;in.Structure-, - •• - _ - ..,. ' 70. 'Underground Hydro r
22. Ducts;Ventilating ' 71. Product Pip ng Deas 0Oil
23. Gas Pipe-Rough & Test _ + 72. UndergroUnd Flush '
24. Roof-Framing `•. "; l i. 73.: Undergrnd.Stori4Tank",DGas ❑bii"
25. Roof Sheathing - ‘.1 - c. - 74. Overhead Hydro-
T
26. T'-Bar Ceiling (Structural) & Mondcoat ).' 75:.Dry Chemical .
27. Frame and Flashing - - 76. Dry Standpipe --
28. Lathing &_Siding ,..,.,ii, -r t, = 77.1 FIXED StSTEM;FINAL ,. , • , -
"29. Insulation i-1 • •• 78.: FIRE PREY. FINAL 'r r a'
30. Drywall Nailing ti:.- , .HEALTH DEPT,. REQUIREMENT
31. Plaster Brown Coat=: = '79. FINAL INSPECTION - i :
.
32. Electrical Power Meter-Final '80:1FOOD CERTIFICATE ISSUED r,-
•
-- 33. Final,Electric -• • Notes.
e. z-6 -GS. onfic- T -
34. FinarHeating& Alf Conditioning'' 2:75*-_?‘ t r •:"7
_ 9+ , '
35. Final Gas'Pip2':Test ' y
rZ=`7=5 f a n_�u�o� t=:_
' 36. Hood or Canopy - ' ' I (` n/7 r
r rt _ a ? - i4171C.4?tc!lt
-37. F.inaiiFactory Fireplace - _ _ .g 7.
38. Fina(Plumbing . - ;
39. Water Service-Final' ' '
z c e S -kC -VIA-E.-0
4140. Gas Service-Final , <:t-it _- ' ` Arr 1-
`41. Solarpomestic•Final -' - -'21
"
. , 4. -'2`7-1 c" Jolt-rut Ott? 4.3,
42. Backflow Preventer • i i -
r- cc. ytp _
43. Backflow Irrigation %' ~, e : :' _5-_'2g•, ri-__
44. Landscape.Irrigation System •- i" ' -• '; ' • r- t, ' : 1. i - -
45. Sound Attenuation • ` • • - °'
46. Handicap Regulations i r
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING - - '
.
49. Electiic Release to Edison :n -
50. Gas Release to Southern California Gas Co '-' -
51. CERTIFICATE OF OCCUPANCY - -
No. Date
ADDRESS UP BOUM: 250 FISCHER AV WMT: CITY OF COSTA MESA - BUILDING PERMIT •
OWNERSNAMEIF101" GORDON, COLWELL & RAY ifePERM NO: E 075061
ADDRF CRAY LARRYL
P 76312 POPPY LN PERMIT NO: E 075061 PLAN CHECK NO: N GOVT: N SUPP: N
( PALM DESERT,CA 92260
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: V-N SPR PERMIT TYPE: ELE PURPOSE: OTH
i
ABCHDEcronEta+EFT: JAMES WHALEY uCi : C5300 JOB DESCRIPTION : 5320SF OFFICE T, I . / ELECTRICAL SQ FT:
ARCH.ORENG'S ADDRESS: 3198 AIRPORT LLOOP DR WMT: D
C .M. CA 92626 CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 /B-4
ccifimawsmI¢ SHEPPARD CONSTRUCTION ( 714 ) 259-1470
CalmonORSMADRIG 15042 PARKWAY LOOP COMMENTS: "THE PIERCE BUILDING" OFFICE TI / REF B-75060 •
ADDRESS: COSTA MESA CA uc.NO.: 631416 *****************************1E1E1E1f1ElE** *1EiE1EiEiElEiEltlErtiElFdt7ElEiEiEiFiffEiE+t1E1E*iEiEiFifdEif#jEfEiElEiE***
92626 WIT: A ZONING REQUIREMENTS
LCENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury ****I em licensed under prwlelons of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 a the Guineas and Profession Code,and my license u in lull force end effect. ,
CRY LIG.NO.:JJ5g670 UC.CLASS: B LlC.NO.: 631416 EX ; 00/00 MAIN BUILDING ACCESSORY BUILDING
f ri/i I(1 JC n�nyA FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: a cgrmma: "'�l LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
\, OWNER GUILDER ECLARATIDN:1 hereby affirm under penely of perjury)hal I am e/rJnpi from the Contract Law 1«the
following reason(Section 7051.5 Business end PmfessonsCork:Awry dry or county wwhMM�requires a panne to .altar,bepae, PARKING REQ: PROV: PARCEL: 42703204 ZNE: REF NO:
dirndls'',or repair any shucture,prior to its issuance.also requires the applicant fa such permit to file a signed statement that he or she
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(omunendrg with Section 7000)of DNalon 3 d tie PLANNING NOTES> ,
Business and Professions Code]or that he or she is exempt therefrom end the basis lot the alleged exemption.My violation of Section >
7031.5 by any applicant fa a permit subjects the applicant toe owl penalty of not more than fire hundred dollen[55001).'. ***********************.******.**.*.**t.***{t.d(.{l*******************{E.***********.*te****{(..)y.
❑ I,as owner of the propeny or my empkwees wih wages as thei sae compensation.vill do the work.end the stnicture is nOl intended DEVELOPMENT S E6.R V ICES R E /� U I R E M E N T S
Gammons offered for sale(Section 7044.Business and Professions Code:The Cmons License Law does not apply loan ismer of propend yd
who builds or improves thereon.and who does such work himself or henell or through his or her own employees.provided that such
improvements are not intended or offered for sale.If.however.the building or Wnprovemerd is wit within one yearol completion the ZONING APPROVED BYDATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose dew).
o IPmfaseadonamw d Ctade:lrwellY
Tae Cos.
eon eaudvey
Licenseconatna
w doigweirm rsed
ppy tow;tracts
ower a k propermnwywhohe bsada Smnnpro ion es04th4ere.Bnd coteand
BUILDING APPROVED BY : DATE:
contracts for such Protects with a mmrmor(s)licensed pursuant to the Contractors License law). y `
❑ m
Isinca pi under B.8P.c..frthis reason: APPLICATION ISSUED BY: �� DATE: (O-g�
********************** -::.: **********i�4***** 7a **
Data: Owner LEGALIZATION:N F E .E SUMMARY STRUCTURAL SEGMENT:N
I do hereby certify that I am aware of end understand the requirements of Callan Health and Safety Code Sections 25505,25533,and
25534,and ihatLorasymodialdipom theAQualityMa. (dnkaDineednidenpy weheaoonappkaband eesemrempt m thse BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
for
2pacednd that l or an l orei e builiin °meantr Ouewil onagemeotei)nee toc mpiy cenmrmonte codes n t ehe requirements
e uiremethese
provisions. PERMIT 179 . 30
Date: Applicant: 50% SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby alarm moor penally of perjury a one the following dedargom: ISSN
und
ISSUE LD FEE 15 . 00
o I haveCode.and the erirminceortthe sof rkorwt m eeubemi for waken'oonnp.rn.etkn.ropro idea ler by s.dan 37oodthe lab« BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
c�de.famepedamw eamew«k1«wNhmkpama . ,Ness. TOTALS----> 179 . 30 15 . 00 0 . 00 194 . 30 194 . 30 .00
fl hen heend wit maintainwaken'compensation insurance,es required by Sod n 3700 the Labor Code,ford the performance the
7C"
work lot which this permit a issued.My woken'compensation insurance caner and policy number are:
Center: CNA INSURANCE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 194 . 30 OVER/SHORT: . 00
Policy Number: 101447R672 09/26/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed if the permit is for one hundred dollars 151001 or lest.) 194 . 30
o I may that in the pedomence d the work fa which this permit is issued,I shall not employ any person in any manner so as to
became subject o rhe wooers'compemetion laws d Caliromia. and agree that n I should becamworkers' {E
e sit to the ************************************************ ******************************
compenatinINDIVIDUAL F E E BREAKDOWNsman Section 3700 d the Labor Code,I shall hh�vrith mwnay weir pay ,.
/ Date: 1I to 95 Applicant: I�V�INN
Warning:Failure onemecum wodos'mrryo01040004 I leunkwn to hes i,of compensation,
damages minipenaltiestor
TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil on 3 w to hundred a Interest,
dollars nomey''s l In addition the I rompawrbM1 as Provided roe In
Section 37as of the Leber Cove,mtNeet am etromey's yeas. ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. . 75 15 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the ELE 81 FIXTURES, LIGHTING ADDITIONAL EA. . 45 36 . 45
/... v2.peaomawaamewmdlorwnihinpemalelseaod(Sedlon3097.c .D). ELE 20 RECEPT/OUTLET 1 ST 20 EA. . 75 15 . 00
LENDER'S NAME: ELE 59 RECEPT/OUTLET ADDITIONAL EA. . 45 26 . 55
LENDER'S ADDRESS: ELE 20 RECEPT/SWITCH 1 ST 20 EA. . 75 15 .00
7 l ceaiy that l have read this application end stale that the above information is comm.I agree to comply with all city and county ordinances ELE 34 RECEPT/SWITCH ADDITIONAL EA. . 45 15 . 30
end mate laws relating obuilding candrmand authorize hereby euerepreaentaivee of this dry to enter upon the above mentoned properly
for inspection purpossa. ELE 4 MOTOR/POWR APPARATUS 0 . 0 - 1 .0 HP 3 . 00 12 . 00
RANDY MOODY ELE 4 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 44 . 00
Print ,; , END OF FEES
Da
I / e: 9 O1 1019' 2 . l : - v, -
g9wre. OrmetlAgenUQcenWContrma LITE. ;1.r! .;,l 7:4C' 701-1 14.3::
(5151<&WP) While-Building 8 Safely:Green-Fite:Canery-Appicanl:Pink-Revenue:Goldenrod-Assessor
t
', --"liIlliIlliqll
POOL& SPA
CONSTRUCTION AND PLANNING -
APPROVALS Permit-# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement _' ' -
3. Eiectrical'Conduit UtilityUndrgrnd. 54. Forms
-,'=4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding _
• 5. Steel Reinforcement- 56. Rough Plumbing & Pressure Test
. 6. Eleetrical`UFER Grnd. 57. APPROVAL TO COVER-GUNITE
',.7_,Footings " ' _ ;, 58. Electrical Conduit-Undrgrnd.
8. Foundation -• 59. Gas Pipe, 0 Undrgrnd.,Test
-1
9. Water Pipe-Undrgrnd. 60. Backwash Lines;P.Trap, O-Undrgrnd.
Y0. 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‘i -. ! 2k/ // I_67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough ElectricatT Bar Ceiling- 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factor% Fireplace T ' t"APPROVALS-_ .Permit# • - -
21. Ducts, in Structure • - `-170. Underground Hydro `
-
-
22. Ducts, Ventileiting' - _ , 71. Product.Piping OGas OOil
23. Gas Pipe-Rough& Test .- c 72. Underground Flush '
24. Roof Framing z ' - -4 ; '. 73. Undergrrld.StorageTanktGas 0 Oil' `
25. Roof Sheathing - • 74. Overhead Hydro ,.
26. I:Bar'Ceiling (Structarall & Mopocoat r- r1 75.-Dry Chemical _ _
27- Frame and Flashing ,- 76. Dry Standpipe
28. Lathing&,Siding 77... FIXED SYSTENI'FINAL • ie ... .. --
29. Insufatiois� . _ - 78.- FIRE PREV- FIN9L
30. Drywall Nailing _ HEALTR'DIPT. REQUIREMENT
-.31. Plaster Brown,Coat, - -- } -� 79. FINAL INSPECTION
32. Electrical'Pow-elr Meter-FinpI i r SC FOOD CERTIFICATE ISSUED -
33. Final Electric-. r �� Notes: .-_ .t 4r! -I i ...
34. Final Heating'& Aif•Conditioning ' + r •I' -• t
35. Final Gas Pipe,Test , , - 1 • ,� ' -- 2. '
',36. Hood•or Canopy r -I' - ' - F . - -
- I
37. Final Factory Fireplace - -_
__38. Final:Plumbing 1 1,----: _ -
39. Water Service-Final r r - - -
- ' l
40. Gas Service-Final ' ' - ' ' - -,•
-
41. Solar Domestic-Final' - . - , • -
42. Backflow Preventer - ' _ -
43. Backflow Irrigation - •
44. Landscape Irrigation System -. - ,I _
45. Sound Attenuation .. -
-
46. Handicap Regulations -. • '
47. FINAL STRUCTURE& BUILDING 1 '
48. FINAL PLANNING • - • / '' - ' '
49. Electric Releases to Edison - _- - -
50. Gas Release to Southern California Gas Co _Jim: - - 7. T.
-
51. CERTIFICATE OF OCCUPANCY - ' -
No Date
ADDRESS OF BUILDND: WIT:
1YNERS NAME IF IDIONgt 250 FISCHER AV CITY OF COSTA MESA — BUILDING PERMIT
0
GORDON, COLWELL & RAY PERM NO: F 075537
ADaEss
BRAY LARRYL •
76312 POPPY LN PERMIT NO: F 075537 PLAN CHECK NO: 04763-95 L GOVT: N SUPP : N
PALM DESERT,CA 92260
APP11" p'OADDRESS:
CONSTRUCTION TYPE: V—N SPR PERMIT TYPE: FIR PURPOSE: ALT
AnCNAECi OR ENGNEER: JAMES WHALEY UC.N0.: C5300 JOB DESCRIPTION : 5320SF OFFICE T. I . SQ FT:
ARCH.OR ERGS ADDRESS: 3198 AIRPORT LLOOP DR UNIT: D
C.M. CA 92626 CLAIM VALUE: 5, 000 .00 CALC—VALUE: GROUP OCC: B-2 /B-4
cONTRACTOBSNAka: LUTTER FIRE ( 714 )789-9360
CONTRACTOR'S WANG 6374 INDUSTRIAL COMMENTS : "THE PIERCE BUILDING" OFFICE TI REF B-75060 FIRE SPRINKLER ALT
ADDRESS: RIVERSIDE CA MOND.: 444220 **********************x****RE*******+t**+t**4 **+E*****iF*REk•+E**x******* •iFRt*+ERt*******
92504 un ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Dvision 3 of the Business and Professions Code,and my license is in full force end effect.
C C.NO.: 036150 LJC.CLASS: C16 L/C.NO.: 444220 DQEXP: 00/00 MAIN BUILDING ACCESSORY BUILDING
/a/i�/y,— ConU6do 7c '4 c �Tjf v(LCw FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
°' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NER BUILDER DECLARATION:I hereby affirm under penalty of perjury than am exempt from the Contractors Burse Law for the
following reason(Section 7031.5 Business and Professions code:Any clyacounty which inquires sperms to mmbuc6 alter. PARKING RE PROV: PARCEL: 42703204 ZNE: REF NO:
demolish,or repair any structure,pia to its issuance,also requires the applicant for such permit to file a signed statement that he or she
is Scented pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES>
Business end Professions Coded or that he or she is exempt therefrom end the basis for the alleged eaemplion.My violation of Section >
7031.5 by any applicant for eWW1 subjects the applicant loacivil penaffyd not more than five hundred dollars 1f500p. *******************************************************************************
❑ I.as mow el the dolierlY Or mY emPloyees with wages as their sole compensation,will do the work and the tincture is not intended DEVELOPMENT SERVICES R E Q/•s U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner d ownAmnesty
fSaxonswig bus or Saxons thereon.and who does such work himself or herself or through his or her own employees.Provided that such
impmrements ere nal intended catered for salt ff.however'the building et inpmnt ts sold
wmewithin oneyear d completion,the ZONING APPROVED BY DATE:
owner-builder will have the burden d proving he or she did not rat budd or improve for the purpose sale).
❑ 1,as owner of the properly.
saLadootl *ed werrey°wblddthronan° oProfessions CodaThe Contractors License wdes not apt* an contractors ofpopertwbuilds oimprovSection es and whBUILDING APPROVED BY : DATE:
contracts for such projects with a maada(s)!Sensed pursuant to the Contractors License Law). P
❑ Iamexempt under Secion: B.8P.C..fathis reason: APPLICATION ISSUED BY: L' DATE: 2 /l 1�
Date: Owner: *****************************Ca `** * 1 4iiF4*******************. ., . .i.**
I do herebycandy that I am aware of and understand the requirements d Californiah onua Health end Safety Code Sections 25505.pcc'T,and LEGALIZATION:N F E E SUMMARY STRUCTURAL S ' GME T; N
pg534,and that I or any future building moment will/wit not(circle one)need to comply with said sate codes end the requirements for
permitResidentialfrom BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 72 .00
Dae: Applicant: 658 SMIP/NON—RES
WORKERS COMPENSATION DECLARATION:I hereby affirm under penally of penury one of the following declarations: PLAN 46. 80
o I have and MI maintaina cermmecconsent toselfinsura fon workers m
canpean,n pro
ioided for by Section 37C0 of 37the Labor ISSUE FEE
Code,for the performance of ework for which wlea
penaiesued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
0 Ihave and wamaintanworkers'compen ®ad
compensation e
the Laker d
lex TOTALS----> 72 .00 0 .00 46 .80 118 . 80 118 . 80 . 00
work for which this permit is issued.My workers'compensation insurance canter and policy number we:
Carder: STATF. FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 72 . 00 OVER/SHORT: . 00
Poky Number. 1270905-9S 02/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need net be completed it the permit is to one hundred dolem/3000)a less.) 72 .00
-
❑ 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•onkns'compenaaion laws d Cafdmda,end agree that ff cuk I shsubject to til walans *******************************************************************************
ion pmvaicn of Section 3700 d the Labor Code,�I'shat forthwith own*witye
/,Q/i./c4 Applicant: -71gtel. te,,,, m( _, INDIVIDUAL F E E BREAKDOWN
� mig:Fiuretosecureworkers'conpauadoncoveragelaunlawful,andshallsubjectansmploywroctlMnlpenaltiesend TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
MI fines up to one hundred thousand dollen(3/04000),In esfron to the cost of compensation,dameps as provided for In
don 3706 or the Labor Cods,Interest,and atromayi fees FIR 72 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1 . 00 72 .00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a oordrucion lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Civ.C).
LENDER'S NAME: r e jt •,
LENDER'S ADDRESS: !2.�•�•
r
I candy that I have read this application and date that the above Information is correct.I agree to comply with all dry end county ordinances
end state laws',Islip to building nstrucion and hereby authorize representatives d this city to enter upon the above-mentiproperty '--- '71
for inspection purposes. cy
MIKE L TTER
s
�,ys� o P' N�ayos.,{'tt �� / .' 01 0030c:'—Lt9195301 TOT %2.,..
/// GG[A -----7 /[ J Dae: /.24- /q J -4. —= _
Signature d Owner/Agent/Appican s DATE: 12:11:y TINE:, h_ ;y
L �,-
(5151-46.WP) While-Building 8 Safety:Green-Flo:Canary-Appkant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING- - POOL & SPA 1 .
APPROVALS Permit# Date Inspector APPROVALS Permit# ' Date '•'Inspector
1. Temporary Electrical Service or Pole 52. Pool& Equipment Location
2. Soil Pipe-Undrgrnd. J ,' 53. Steel Reinforcement
c3c-k3nctrical Epngiiiil�c+lity-UnrhgrnW. 54. Forms 1-
.i0.<---.! z -u.---
o q?E Ftrical•rdtK4Sri,dd t�'-Urg
r rnd. 55. Electrical Bonding .: .
rr"St-feel Rein rce erat!iL'., 56. Rough Plumbing & Pressure Test - r
tine fh'*trical �lER ,¢rr"-n'dt 57. APPROVAL TO COVER-GUNITE ` '
71::..;'og{ings rS r-1C� 58. Electrical Conduit�Wndrgrnd.
.."B. I$tfidation -i 1• 59. Gas Pipe, 0 Unercrnd.,Tes(
^„9. Water Pipe-Wndrgrr d. 0 60. Backwash Linesr j"rap, O tindrgrnd.
. Structural PCdor System ^ 61. APPROVAL TCp6ECK
i'1. Prdjjerty Se}�reF,LineA House FQUnnection 62. Backwash & Receptor-Final
12. Sever Cap ✓ 63. Heater & Vent-Final I
13. Roof Drains I^ ^ �,; 64. Plumbing System - Final
14. Rough Plumbing, m 65. Electrical-Final
15. Rough Eleetrice-Cor4uit 7-.2 66. Solar System-F inaL, V
n r'.'
16. Rough ElAttric VP1'ri4 o 67. Fencing & Access.Approval
_ _
17. Rough Wiring Sign 68. APPROVED FCrgPLASTERING •
18. Rough Electrical Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning_ r,FIRE IEPT.REOUIREMEr'T _
r9 f", J. r, r.. I ^ K' , * -t C1 4'A: H �. *.
I r.t-: < *• • tr? '?APPF IV�. •COPe tit# x =" r
20. OugFaoryFirce St" IX .• # H u'* �, H.ti s•
21. ..icts in Strutturtrrl t •• •• H K rJ r'-r -70. Dndergidn❑� H ro
22. 1)2ctRWei4ilatingn* rJC x L7 cA t.;* •71. Produc jfp ng 6tyas O.Oil
23. Gas Pipe- a ugfj& Teet I ill., I m .2 Ot •a 72. Undergrotr:u F 9fir 1* H
h,,, hr, -.e t^ CY HV w >. L-
24. Roof:Fra�Ptying " is ' •`E" •• . 4. C 1 H ••73�Undergrrta.Stor TankQGas ❑Oil _/
25, Roof;xShep{hing s ti k'lltll ' 74 Overhead F yr}r •f C R (� ZI�e 1Gj� .
26. ' Bar''Ceiling (Strut't&ral) & A8ipiloat C rx 75 Dry Chereical E,b ,` -1 '7 Er,
_JJJ
u.;w .->.j.
s - �£
27. game and FIgfJ inglt . -, > m* 76"". Dry Stan-G • !FT * • r
-'28. Lath�g 8c�'Sid`•g '' rn sal g "' z. 77c FIXED 3T ~'FINALm
m* r7 tCF C e -3 c§ t� i n C* ���� -
11111111111.11 78€FIRE PREV. FN'}N'L F > x i--' 4e 4b eY
r
'"30. Drywall t ili 9 C! ,„ r { j t iAEALTItf1DEP' .REO`UIRtEMENT
'D31. Plaster Brown•6oal17 * S I IT ! 79.�FINAL ItrSPECTION *4. � tr
�T32. ETectricalCPowe? M�tEar!FfnNal n; MI 8012;FOOD CERTIFJaCCNt"fE IS14ED,--, ,::
m
.
z33. gnal;Ele[is ;C.; m i Notes: ^:t C 0,m
r
:-j34, EinalZ leating&Air GonditioninF' t f a = r'M * 61.. ^'7
d S H 0 m* r. ^7 * % 'J H E-.< ' '�_
1 4.1 35. fgipal`�Gas Pi e:Tes y: I t • w4 ' ' rr
P I-+ r 4 .-; �r: • mro OH Y 5• r•••
x36. Hoodl+or Canopy '* 0r-3 < •t r - I i{ir • t C1c7 C'
t n rt..2 tA * I -t VO * 7' >.7,
r
' ?• - r. -. C.
y37. Frnal`xactory Firetrpere-i x i i.-tri...,-tri..., v o *•Kt11 . Jh: 2 * '-(al
Z38. Fnal`Plumbing * re ' v * I I -� F-1,1 �' W H
',39. Nd�ter`�Service-Final', * a'" i * " ,x'.1
Iy '� f..1f..1 0 * 7
c
I vim. * Kr r.
x;40. Gas Service-Final O* m < 0, S * to I ; Cm CN r --
tr ni it K .'9-' -• T t I i H • C.2: * L,"'
•,41. Sellar Domestic•Firna'Jr •-' M y Cn # tr, a ,0 r y, .71 t7
r42. Backflow Preventer"'• N * I 4 •'c • :E- * p -
,l .-fk n) ^HH * -r' - h".;'urn m0 'I H
43. Backf low Irrig tiopj .r s `""' ter' . -
44. Landscape-'IrrtaatidAGystem r,irj 'X * rr, C C O•t R CC. -• ^7 ^3
r'- k rl<tri C. <r - '- C y ti
45. Sound Atynt}atioT,' i- E,* �- 0 is• ' ` t
4. Handicap Regulations a r; tx s CC-
I
m o
4J. F4NRL STRU@'TUBE.& BUILBING
,.. .t .4'. :(i I r f F
,.p c r
48. FINAL PLANNING:.r , HE- * rt.! - '_ tr./ C, F r+
49.. Elbctnc Releasyt to:Eel:son * '1 _ -• ' x e L.• '
5D. Gas Release to-Southern California Gas Co ' ' -1 ,r - tt • o?' x- G •
. c c 1: * •• 5 DO r > :J 0
51: CERTIFICATE OF OCCUPANCY r +" = :°r" • ..
No Date
ADORESS OP BNlGNO: 250 FISCHER AV WIT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERSNAMEIRIOKrVN: COLWELL & RAY - PERM NO: E 076319
ADDRESS %RAY GORDON,ARRYL
76312 POPPY LN • PERMIT (O. E 076319' PLAN CHECK NO: . N GOVT: N SUPP : N
PALM DESERT,CA 92260 • •
APDL.MAILING ADORE54: CONS TAUC' ^ v•E• T SPRPERMIT TYPE: ELE . . Y2
PURPOSE: ALT
•ARCHITECT ORENGNEET: - uc.No.: JOB DESCRIPTION : ELCTRIACL COMPLIANCE CORRECTIONS SQ FT:
MCN.OR END.'5 ADDRESS: UNT: i t
' CLAIM VALUE: - CALC—VALUE: GROUP OCC: 'F-2 /
AME
CONTRACTORSNSHEP ARD CONSTRUCTION -( 714 ) 259—1470. '
CONTRACTORSMMUNG 15042 PARKWAY LOOP COMMENTS : "THE PIERCE BUILDING" WAREHOUSE • '
ADDRESS: COSTA MESA r CA ucNO.: 631416 *******#+r********stn***** *********#***********************.**** ESN***************
92626 um A ZONING R 'E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby Aim under penally of perjury that I am licensed under provisions of Chaplet 9 S E T B A C K S
(..,.....ndng with Section 7000)d Division 3 of the Business end Professions Code,and my license is in lull force and effect.
• u• NO.: p 9 ,70 uc.cuss: B uc.N n6t3,1416 EXP• 10/96 MAIN BUILDING ACCESSORY BUILDING •
If k!1//i/I )' 071 FRNT: . FT IN REAR: - FT IN FRNT: FT IN REAR: FT IN
Pate: i Contractor: //'''Tn�� LEFT: FT IN RGHT: FT IN LEFT: FT . IN RGHT: FT IN
•
OW :' BUILD - DECLARATION:I hereby affirm under penaly d pr)ny that I em Impt horn the Cons ors license taw for the - r '
resNn(Sedion7031.5 Business and Professions Code:My city or county requires a permits uud,alter,improve. PARKING REQ: PROV: • PARCEL: 42703204 ZNE: REF NO:
nolah,or repair any structure.prior to he issuance,also requires the applicanl for such permit to file a sig s ement that he or she PLANNING NOTES> - •'
,licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Seabn 7000)of Division 3 of the
Business and Professions Code!or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant fora permit subjects the applicant to a civil penalty oet nmore than fvehOndredddten[S5001). *******************************************************************************
ElI,as owner of the property ormyemployees with wages ea their sole compensation,will dothe work.end the stwctureInot lntended ' 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 -
or offered for sale(Section 7044,Business and ProfessionsCode:The Contreaet on License Law does nappy to an Owner of propend r
who builds or improves thereon,end who does such work unset or herself or through his or her own employees,provided that such
improvements are rt intended adlered forsele.It,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE':
owner-builder will have the burden d proving he or she did not bold or Improve for the purpose of sale). •
o I.as owner of the properly.amexclusively contradigwith lcensedCOMO1000Nburfthe project(Section7044,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does net apply to an owner of property who builds or improves thereon end who
i convac"for such projects with a contractor(s)licensed pursuant to the Contrwrs License Law).
o iamexempt under Section: Et.&P.C..for this reason: • APPLICATION ISSUED BY: '� DATE:
• ************************************ ***************************** ** * **
Date: Owns LEGALIZATION:N•
F E E SUMMARY STRUCTURAL EGM NT: N
Ido hereby certify that I am aware of and understand the requirements d Cat&omla Health and Safety Code Sections 25505,25533,and I '
25530,end that I or any futureficatingoaupenf t-CM;Titnot Irnagebnt Dieded to comply with said state codes and the requirements for BLDG PMT ! PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
•perm&for aonatwcion futureficillionhocupant u3Tyyl�ageme one) ned toentWcanmmcionte codelaueree requirements
provisions. PERMIT . 312 . 50
•Dor Applicant: •
503 SMIP/NON—RES
PLAN ,
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of penury one of the following dederetbm: ISSUE FEE 15 .00
❑ I have endwil maintain acenTcate of consent to SI-insure for waken' presided for bysedicn 3700 d the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
cMa,lathe p.nantama.dthe wahl«wNah this pemit i.issued. TOTALS----> 312 . 50 ' 15 .00 0 .00 327. 50 327. 50 ? . 00
Q. haveha I awill maintain workers compensation insurance,as required by Soak..3700 d the Labor Code,for the performance d the
_
7� work for which this permit is issued.My workers'compensation Insurance comer and policy number are: 1,.
CNA INSURANCE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 327. 50 'OVER/SHORT: 00
• ' Carrier
10''144'1867/ . 09/26/96 • - BLDG PMT. PLUMBING . ELECTRIC MECHANIC FIRE, SMIP/TOT GRADING PLAN—CHECK
(This eetion need not be completed if the perm&is for one hundred dollars MOO)or less.) , ', 3 2 7. 5 0 .
o I certify that In the pedonmance of the work for which this permit Is Issued,I shall net employ any person In any memo(so as to
become subject to the woken'compensation laws of California, and agree that N 1 should become sub)ed to the workers' *******************************************************************************
,
ompen ion Signs of Seabhaftn 3700 of the Labor Code.I shall haft with Ilcse net.
��M �
De: INDIVIDUAL F E E BREAKDOWN
Applicant: 'C /
•
Warning:Falunworkers.'compensation coverage Is unlawful,and shah t an 7employr to unpin,'penalties and TYPE QTY DES C RIPT ION UNIT COST TOTAL COST
c/dl fines up to one hundred thousand dollars f6104000A In addition to the cost r cotrosnsation damaga►eaprodded for In
Section 3706 of the Labor Cods,Interest,and attorney's lees. ELE 10 FIXTURES LIGHTING 1 ST 20 ',EA. . 75 _ 7 . 50
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there S a construction lending agency for the - ELE • 10 RECEPT/OUTLET 1 ST 20 : EA. .75 7 . 50
performance of the work for which thipenn*Is Issued(Reaion 3097,cal.C). ELE 10 RECEPT/SWITCH • 1 ST 20 EA. . 75 - 7. 50
LENDER'S NAME: ELE 5 'NON—RES: APPLIANCE NOT OVER 1 .0 HP 3. 00 15:00
LENDER'S ADDRESS: '+ . • ELE 5 ' MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 55 . 00
Iminify thatl have read this application and rate that the above information le cond.lagree to*amply with all city andcoumy ordinances ELE ' 10 MISC CONDUCTOR NOT LISTED RE PERMIT 11 .00 110 . 00
end state laws relating to buildspconstrudnn en hereby authorize representatives o this my to enter upon the abovementbned propend ELE 10 MISC CONDUIT NOT LISTED RE PERMIT 11 . 00 110 . 00
for inspection purposes. RANDY MOODY ' END OF FEE
n,`�,� P t NameJ
�IA/�[((/^//
....".-----77 Doe:__�� / D1 002DDD4� D0200045 TOT 327. .(1
'lynature of / the jAPPlito ont 5_ C
C t 'DATE: 02/07/95 TIME: 09:15
IIIL (5151.46.WP) White-Building&Safely:Green-Rio Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
(i 1