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HomeMy WebLinkAbout300 FISCHER AVE - Building PermitsCite of Costa 210esa Development Services, Division of Building and Safety .MWOOOO�. %tv�f CERTIFICATE OF OCCUPANCY This certificate is issued pixrsuant tithe` -r Qtiiremen!t ofstheF�niform Building Code, Section 308 adopted by the City of CostwMesa cernfies�thatIat_the tune ofits.issuance the building structure herein below described was inspected and�approvedfoa occupancyas follows:, Building Address 300 FISCHEW4V Use sc--- Group E-1 /A-2.1 Type of'Construct. 5 f Owner of Building SYMBOL_TECHNOL ISCHER Address 340, AV BUILDING OFFICIAL -cony I / REQUIRED TO BE Permit No. B70342 -Y--N Fire,Zone" k; ^-! Use Zone MP S INCA M02 ^, 5N' .it RI2 HR' S' CHURCH�� =,Tenant .� . By, te���MARCH 10 1995 iNSPICOUS PLACE Citp of to5ta Mesa Development Services, Division of Building and Safety CERTIFICATE OF OCCUPANCY _ This certificate is issued pursuant to the requirements of the Uniform Building Code, Secti 308 /.-�, ,�� adopted by the City of Costa Mesa certtftes3hat'at the time of,its_issuance the building structure herein below described was inspected and!appro.ved:�foroccu`pangy,asfollows: t Building Address 300 Fiach'erAvenue z,\ Bldg. Permit No. 8-83621 BUILDING OFFICIAL-tBZ['TX Acting Building Odfical d .'.and Office-: 3.81' Fire•Zone\ ' �' Use Zone Tenant By —Date Morgam" -' REQUIRED TO BE POSTED -IN A CONSPICOUS PLACE Use TPnanh TmnrovemPnr/--]2nd J > , 1� 7 Group B Type of_Con Owner of Building Marine -_hr ; Address 30d Pr AvPnnP BUILDING OFFICIAL-tBZ['TX Acting Building Odfical d .'.and Office-: 3.81' Fire•Zone\ ' �' Use Zone Tenant By —Date Morgam" -' REQUIRED TO BE POSTED -IN A CONSPICOUS PLACE t r k A City of Costa Mesa Building Safsty,DepartmentIi r 'CERTIFICATE 'OF OCCUPANCY - 11- P.O. Box. 1200 _ - V Costa Mesa, California - - The Building, located at 300 FisCher' AJ Costa Neaa. 'Calif. - - has been inspected and found to comply with the }provisions of all City of Costa Mesa Ordinances applicable thereto - r .;•w i +.for a Group _ -. -- Occupancy. IE`! Use of Build mgSheet Neta Fabricatfo�In Legal Description Ti&Ct 6956 'Got 17 (See reverse side. for Metes and Bounds) i1T. Built in County jurisdiction Building Permit No -Electrical Permit No. Plumbing Permit No. \" Number of apartmentsand/or guest rooms .. ISSUED TO: Building Official Omni Industrieo by II • Date ' 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 CityofCosta Mesa under Sec. 306'ie) U.B.C. \ Form SU 34 Rev. 11/70 City of Costa Mese Building Safety Department CERTIFICATE OF OCCUPANCY'-- (y (� P.O. Box 1200 N12 13000 Costa Mesa, California The Building located at 9100 Fischar qtr(-nt I has been inspected and found to comply with the provisions of all City�of Costa Mesa Ordinances applicable thereto for a Group P-7 Occupancy. Use of Building rrtmmnrrrnl Y2rrilAinn Legal DescriptionA n A77-nr?-m (See reverse side for Metes and Bounds) Building Permit NoS0052.50063 Electrical Permit No. Plumbing Permit No. 50064, -- --Number-of,apartments and/or -guest rooms - �- - - - ISSUED TO: BuildingOfficial---,,� fby- M- S. T. PfATA MWOVATTrri Victor C. Nvuton - Diroctor lLdl li,-,! S:'- DateMnv 20_ 1980 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 BU 34 Rev. 11/70 6443 5/06/80 25.00 TL COSTA MESA BUILDINu-SAFETY DEPARTMENT APPLICAI,—A FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA_ CALIFORNIA 92626 u REC IVE BV PER N° - 50052 For Applicant to Fill in C(o'mpletely1s�— Use Ink Only ,BUILDING 30� A.P. NO. ^ ADDRESS T �S' C,l Nva Tg TOWNER ENANT M �'T J i BUILDING ADDRESS O MAILING 3 L 1^ s ADDRESS I O d IS <' UNIT OR SPACE NO. LOT BLK. (�TR.NO. CITY Cos��, I j S NOL �rpOOo NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS V�, LUE ARCHITECTTEL. USE $ OR ENGINEER ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR 'LEL BY DATE V4 V1, ADDRESS TEL. CITY NO. STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXISTING BLDG. R. SIDE FT - Separate permits are required for L. SIDE FT. electric, plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVED RY DATE I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. the State of California Business and Professions Cod-, Division 3, THE AMOUNT SHOWN UNDERVALUATION IS FOR Chapter 9, and that c licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from i p visio sof the State of Ifornia Business VALUATIONi F $ and Professions e, ivisi 3, Chap r 9._,PERMIT P LAN CHECK $ Signature of Perminee S TAX $ ��— or / D Authoriz ent Date (a TOTAL PA u 6442 5/U6/80 5.00 • • COSTA MESA BUILDINu-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 RE EI EDPERMIT W 0063 For Applicant to Fill in Completely — Use Ink Only 1 BUILDING O C A.P. NO. ADDRESS OWNER OR MST `l TENANT BVILDI SS /� 4 s^ ADDRESS44 MAILING ADDRESS 3 �� �1 UNIT OR SPACE NO. TR.NO. LOT ELK. TEL. CITY NO. NEW ADD ALTER IREPAIR IMOVINGIOEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS VALUE ARCHITECTTEL. USE fp • E OR ENGINEER N 0. ADDRESS ZONE TYPE GROUP z� APPROVEDBV DATE CONTRACTOR I/-"�, r � %•• ADDRESS TEL. CITY NO. STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. SIZE NO. OF BLDGS (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. USE OF EXISTING BLDG. Separate permits are required for L SIDE FT. electric, plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVED DATE 1 hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. the State of Caiifo is Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and t at ch licenses ere in full fore antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: em exempt fro th provis ns of the state of Wornia Business antl Profession Co a, Divi n 3, Che• erg. / VALUATION PERMIT FEE $ Qi V / PLAN CHECK S Signature of Perm lilac TAX $ �O •/�`// Autho ized Agent Date TOTAL PAID $ S•QO 6441 5/06/80 I5o00 COSTA MESA BUILDIN.,-oAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 RECEIVED BY PERMIT 6 N- 50064 For Applicant to Fill in Completely — Use Ink Only BUILDING//��r� /1k, A.P. NO. a - -© ADDRESS / C N OWNER R OR / !_ A ^ TENJ -N /7 BUILDING ADDRESS MAILING ADDRESSS� 3 Q /'�J � UNIT OR SPACE NO. / C TR.NO. LOT BLK. CITY L9 a f NOL_ � NEW I ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS VALUE ARCHITECT TEL. USE E OR ENGINEER N ADDRESS ZONE TYPE GROUP yy I rJ APPROVEDBV DATE CONTRACTOR C - y ADDRESS TEL. CITY NO. STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT Ni FT. USE OF EXISTING BLDG. Separate permits are required for L. SIDE FT. electric, plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED .. APPROVED DATE I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under SO. FT. the State of Celiforn a Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, andth such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: em exempt from halprov ions of the Sta of California Business VALUATION PERMIT PERMIT FEE $1,4"00 and Professions o , DI slon 3, Cpepter PLAN CHECK $ Signature of (�G�{ Permittee $ TAX b � �� or Q Auth Agent Date TOTAL PAID S/,45'.00 8380 7101 78 53.30 TL 4 `3 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only RECE)W I DATE RECEIVED E SU D BUILDING ADDRESS' 7G. PER MIT NO. I OWNER <J � A.P. NO. —C/ MAIL BUILDING ADDRESS .4 f/e!a- ADDRESS TEL . �� Seo 71 CITU Cn �� NO. �� TRACT LOT/ BLOCK CONSTRUCT70 NEW [ADD A .TP FPATH MO NQ DE LENDER QIW� BRANCH /� �� , OWNER W ADDRESS VALUE us♦ ARCHITECT TEL. OR EN INE R FIRE ADDRESS ZONE TVP GROUP APPROVED CONTRACTOR BY DATE ADDRESS _____rO.OF 'TEL. ZONE USE OF N CITY NO. LANS BU LOIN STATE CITY 'YARDS APPROVED YARDSAPPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS (FROM C/L STREET) OF LOT NOW ON LOT MT FT. FT. USE OF 0��C� L4B3 , EXISTING BLDG. EXISTING FT- Separate permits are required for L. SIDE FT. electric, plumbing and heating work. REA FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLOCS. VAR. 46 C.U.P. * DATE APPROVED APPROVE I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in Lull force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT IEE ONLY: am exempt fromth rovisions of the State of California Business VALUATION PERMIT FEE E 50,00 and Professions C, a Division 3, C pter 9. PLAN CHECK ED ` Signature of©DO Perm lttae $ TAX E 1 J `0 Authorized Agent / TOTAL PAID $ O - *uc 3 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 _; 9124 7%1 2/78 --- . I _ AP LI ATI N FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RE I D DATE RECEIVED D BUILDING ADDRESS F' her osta Mesa P R OWNER MSI Data Corporation A.P. NO. 7:7- "00 MAIL BUILDING ADDRESS ADDRESS 9BLOCK TEL. CITY NO. TRACT LOT CONSTRUCTION WP -AIR MOVING QFMOi ISH LENDER BRANCH OWNER ADDRESS VALUE E ARCHITECT TEL. OR ENGINE le- - R FIRE ADDRESS 1000 S. Magnolia Ave. ZONE T PE GROUP APPROVED CONTRACTOR Tele -Fire of California Inc. Y DATE ADDRESS 1000 S. Magnolia Ave. TEL. ZONE =F USE OF NEW CITY Monrovia, CA NO. 357-7081 PN PLANS BUILDING STATE CTYS LIC. NO. 129291 LIC. NO.1,1-4/3 APPROVED YARD MAIIN BUILDING YARDS APPROVED ACCESSORY BUILDING SIZE NO. OF SLOGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS SLOGS. /� /-A /�//♦ VAR.46 DATE C.U.P.# APPROVED / APPROVED DATE by acknowledge that I have read this application and state I hLemem he above Information is correct and agree to comply with s regulating building construction, and I shall not employ arson In violation of Me workman's compensation laws of tate of California. by certify that I em properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR tate of California Business and Professions Code, Division 3, ter 9, and that such licenses are in full Lorca and effect, Or i THE PURPOSE OF ESTABLISHING A PERMIT F E ONLY: r iii am pt from Me provisions of the Stem of California BuaineisVALUATION PERMIT FEE E rofessions Code, v n 3, Chapter 9. PLAN CHECK E / t""af Tel - ire_of Calif nc.o /�ittee TAX E . $ ,j�� TOTAL PAID E 71 orized Agen ��^ ,– __ ---.—� Q PAIU SEP 111-73t,ft.�0 503 ****�f�.6° ' COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 PP I ATION FOR BUILDING PERMIT - For Applicant to Fill in Completely RE E BY DATE flECEIVED D E ISS ED BUILDING 3n� Y s$trt�� -73 ADDRESS VV C" OA4 ` OWNER �OSQ ,l 1-�U'2.LT ADNf A.P. NO. 0 N MAIL .p ADDRESS BUILDING ADDRESS Z UJ W U p CITY G O aT A M `2.S A NOL SO4 TRACT LOT//IBLOCK ZQ CONSTRUCTION NEW 14DD I ALTER Oy LENDER oto J D BRANCH -J (n OWNER iii m J ADDRESS VALUE m JQ ARCHITECT EL. — C..ONGtP S $ U N OR ENGINEER�JIL,Ov r-� FIRE 1//,./ W Er ADDRESS 1'"1'151 SKY fA2 K- C k �CC_Q 20NE TV PE GROUP aW W Z CONTRACTOR 2(�U 00 (Z N I Pr (L APPROVED BY DATE J ADDRESS 1'agaoYZ k. LAmge2TMZ 1121 �€2E-` W W �= , , t� �t /� c TEL �y W1KL�leiZ ii 10 �J �ZI'-I4�0 ZONE NO. OF USE OF NE ,Q/O PLANS BUILDIN Z_ F CITY -�1 NO. Q USTATE ,�tt //�1 CITY YARDS APPROVED YARDS APPROVED NM LIC. NO. 21 8"'t 2`7 LIC. NO. MAIN BUILDING ACCESSORY BUILDING 7 SIZE NO. OF SLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT SIZE OF ;^1 t,, 'f NO. OF '- / O to Z NEW BLDG, f ^ —1t ODMS STORIES L. SIDE FT. EXTERIOR WALL ROOF _ COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WOR TO BE PERFORMED DIST CE BET. BET. MAIN & d 0 r' 1e/O (.. /V -S MAIN BLOCS. ACCESS. BLDGS. Q VAR. *+ DATE O \'(✓A—TL Cs C.U.P.gA APPROVED /'Y*019 APPROVED y �f'V tom' Jr Z 0 6 VI I_Ia7K5 vair 7yI06 O STAT O t~.1 I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with cc all laws regulating building construction, and I shall not employ /TAX F-, any person in violation of the workman's compensation laws of N the State of California. b z I hereby certify that I am properly licensed as a contractor under SO. FT. o THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business and Profession Cry DNIS on 3, Chapter 9. It m VALUATION ��� PERMIT FEE $ N Signatureo • Permittee $ 1704-% p m E PLAN CHECK $ Z 0--a— V a Authorized Age t TOTAL FEE $ 9 7 n 2 J . COSTA MESA BUILDING -SAFETY DEPARTMENT < P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 0.16 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — UI REC V BY DATE,RE•CEIV `� LDATEjISSUED I BUILDING • ADDRESS ��} FISCHEP, ..Iff .�1 �` t� .y<� OWNER Ms J:I. QA_rA A.P. NO. ^O PERMIT NO. MAIL �+�BUILDING ADDRESS 34.4 1=1SCi4ER S 1ADDRESS CITY COSTA /tiESA TE TRACT6 S6 LOTl/ - BLOCKCONSTRUCTION IADDIALTELENDERBRANCH%OWNER ,1 •/ T fiI- ADDRESSARCHITECT /((I ALU$ S3 OO© J MES S+ Bi1RN5'0. FIRE ZONE TYPE GROUP ADDRESS 199 S. t4U0f0SADENA CONTRACTOR 0-K. ( �1�I. CO APPROVED BY DATE ADDRESS + TEL. ZONE NO. OF USE OF NEW 4 p/��• �`, p CITY PASAC)Nn�r NO. 'I� OI - PLANS BUILDING I� Oro STATEARDS ,t 4)+i 4- APPROVED YARDS APPROVED YMAIIN LIC. NO. - I LIC. NO. BUILDING ACCESSORY BUILDING t ISI ��V SQ+FT+ OF BLDGS. ' (FROONM C/L STREET) OF LOT NNO. OW ON LOT PreA 09, USE OF EXISTING BLDG.. VACAI4T . M � r ppyy�� r� pX i r4s niied for WT A, R L SIDE FT. XPR_electdc lum 'ng and heating work w eikeI REAR FT. USE OF BUILDING AND NNORK TO BE RM IWED DISTANCE BET. BET. MAIN & CG STR CT FLITURE IX�R MAIN BLOGS. ACCESS. BLOW. (0,38r, Std. FT VV I T1i i O 4/• I STI,IG A DATE C URP, ys APPROVED S -Y SSa Sk. FT Bi/1L.';>iN(5. REit4f;0 ;C APPROVE RC0f:-"T0—WAi.L CONNrACc c7NS 1 1.07- /6 A.✓y 17 /✓oT 721Br - O- P hereby acknowledge that I have raetl this eppllceilon antl state¢7"e 7a' /iaTit BcI D /e7'a /�/ivgG that the above Information Is correct antl agree to comply withr: P'ie +`+ — all laws regulating building construction, and I shall not employGa�96Aany person in violation of the workman's compensation laws of FOR SPECIAL the State of California. hereby certify that I am properly licensed as a contractor underSO. .REQUIRE,1l1I FT. SHOWN UNDER VALUATION IS FOR rATI the State of California Business and Professions Code, Division 3,AMOUNT Chapter 9, antl that such licenses are In full force antl effect, or 1PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California BusinessTION PERMIT FEE $ and Professions Co ivision 3, Chapt'r 9. PLAN CHECK $ature/,jr']!j�.'C+'{lD� TAX f �' �\ TOTAL PAID $ •t 0.16 r=' .35 COSTA MESA BUILDING -SAFETY DEPARTMENT I CITY 0� COSTA Mice P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 i - M O APPLICAT N FOR STRUCTURAL PERMI For Applicant to Fill in Completely —Use Ink Only RECE PN DATE RECEIVED pq T'E IS UE l _ DING (n� ADDRESS ADOR ESS u DD PERMIT N OWNER S� �� A.P. NO. MAIL BUILDING ADDRESS ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEW ADD ALTER REP IR VINQ LENDER BRANCH OWNER ADDRESS VALUE S S ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR By DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. IF ROM C/L STR EET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT, F Separate permits are required For L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLOGS. n VAR. -0 DATE C.U.P. yW APPROVED APPROVED Ry I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all Jews regulating building construction, and I shall not employ any parson in violation of the workman's compensation laws of the state of California. I hereby certify that 1 am properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am axompt from the provisions of the State of California Business and Professions Coda, Division 3, Chapter 9. VALUATIONPERMIT FEE E PLAN CHECK E Signature of S Permittee STAX Z Authorized Agent TOTAL PAID E 2S Q i 7 L\ F. ,,79 COSTA MESA BUILOING•SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 6461 2/27/78 559.90 P TION FOR STRUCTURAL PERMIT licant to Fill in Completely — Use Ink Only R V BY D TE CE DATE ISSUED Sao FISCHER ST, F M,� 5 DCCp�Z • S' I. ✓/\TA �aA�PO1vlTIQN 08Z — p/PERMIT A.P.N0.7,(� NO. r 340 r" ISCHER �- BUILDING ADDRESS �' CAM CITY COSTA MESA NOL549406 /8 TRACT®!s6 LOT /% BLOCK CONSTRUCTIONA ALTER REPAIR MOVING OFMrMH ISH LENDER BRANCH OWNER .1, QATA ,f ADDRESS '� LCE V 4'5O coo ARCHITECT TEL. oR _�:_��:==-.LAMES 5. BU R1yS X96-610 I ADDRESS 199 SO, HU DVON PASADENA FIRE , ZONE TYPE GROUP CONTRACT(p O��RO. K. EARL• COOL. . APPROVED DATE ADDRESS (7 J SO• MG13 OGFrCrJ' TEL. ZO NO. OF Z USE O NEW Ip/( NO. -19(p-4101 CITY P,ASAp&4A,( PLANS BUILDING//V 11 AIRq/ T/ON ,(� STATE B'� YARDS APPROVED YARDS LIC. NO. !T�(Y LIC. NO. MAIIN BUILDING ACCESSORY BUILDING SIZE ISI 586 NO. OF BLOCS. I INOWON (FROM C/L STREET) OF LOT FRONT F7 FT. USE OFV EXISTING BLDG. VACANT R. SIDE FT -1 Separate permits are required for L SIDE T` FT. electric, plumbing and heating work. REAR � FT, FT, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & CA U CE MAIN BLOCS. ACCESS. BLOCS. -000 T. A E U HIN EX Wr iG VAR# C.U.P. ys GATE APPROVED u L N6• o G L� APPROVED Q ed 3—jo -7LP DATE I hereby acknowledge that I have read this applleetlon and stere that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of Cell/ornia. I hereby cartHy that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Mexempt from Me provisions of the State of California Business VALUATION PERMIT FEE f entl Professions Co Division 3, Chapter 9. Signature o ` TA Permittee H' 7 4 /, S o TOTA PAID f Authorized Z., CbSTA MESA BUILDING -SAFETY DEPARTMENT' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Pi 12001 APPLICATION FOR STRUCPURAL PERMIT Fill in Completely —Use Ink Only RECE DATE RECEIVED TE ISSUED n ZPERMIT FADDRESSO NO. A.P. NO. BUILDING ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION AREPAIR LISH LENDER BRANCH OWNER ADDRESS VALUE 3 ARCHITECT TEL. OR NGINEER FIRE ADDRESS - ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITU NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. p Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. Gfs VAR# DATE //il7`E2�02 C.V.P.# APPROVED APPROVED 1 hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person In violation of the workmen's compensation laws of the State of California. I hereby cattily that I am properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and affect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE 3 �ya •W and Professions Code, Division 3, Chapter 9. P�. LAN CHECK 3 Signature of TAX $ permittee S Authorized Agent TOTAL PAID $ / rOt7 9 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 90-16 4/11/78 236,75 TL .. APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSU D BUILDING ADDRESS O P OWNER /DT O P. A.P. NO. BUILDING r MAIL > ADDRESS CNEn_ ADDRESS ' TRACT LOT BLOCK TEL. CITY CO T.(1 ��E.S/a NO. CONSTRUCTION W ADD ALTERREPAIR LENDER BRANCH OWNER s s s ADDRESS / V UE S S ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP A CONTRACTOR pV/JUCE TECT\OK APPROVED BY DATE ADDRESS eT TEL. ('I JZ0 ZON NO.OF USE OF NEW CITY e,/a C NO. S 'ZZ I PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. -I Zgyq 3(4 LIC. NO. I MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLOCS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. y/J CAICT R. SIDE FT, FT. Separate permits are required for L. SIDE FT. FT. . electric,plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLDCS. ` VAR. + DATE \_ /J,1' \ 0117U C.U.P. of APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Coda, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Profession da, Division 3, Chapter 9. VALUATION PERMIT FEE E PLAN CHECK $ ClIz r`�' `; Signature of \ .rL^ ) TAX S Permittee A?.lJf1/ \11.ii]!i�/ 5 3�,000. -�` 4 S TOTAL PAID E Authori,.d Agent COMBINATION PERMIT FEE SUMMARY Building Plan Check: CITY OF COSTA MESA Building Fees: -. BUILDING DIVISION to 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7544856 www.ci.costa-mesa.ca.us Mechanical Fees: FOR INSPECTIONS CALL: (714) 754-5626 Plumbing Fees: PERMIT NUMBER: BC09-00231 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 07/07/2009 Bldg Std Admin Fund ISSUED BY: BJK JOB ADDRESS: 300 FISCHER AV CM Suite/Unit: _ APN: 42708212 - Zoning: Vicinity: CHAPEL AT MARINERS CHRISTIAN SCHOOL ' Primary Occ: E - Const Type: V-A SQ; FT:. 0 . Valuation: $8,000.00 SCOPE OF WORK: INTERIOR TI TO "MARINERS CHRISTIAN SCHOOL". WORK TO INCLUDE THE ADDITION OF AN INTERIOR NON -LOAD BEARING WALL'AT,AN EXISTING CHAPEL ROOMIN ORDER TO CREATE A NEW MEETING ROOM. OWNER: MARINERS CHRISTIAN SCHOOL Address: 300 FISCHER AVE Unit: Phone: City/State/Zip:COSTA MESA, CA - APPLICANT: LETTERMAN, CHRIS, Address -,. Unit: Phone: 714-623.3072 - - _ City/State/zZip: CONTRACTOR: UNLIMITED GENERAL CONTRACTORS INC License No. 867798 Phone: 714-572-10 67 - - Address: 3305 E MIRALOMA AVUnit: SUITE 175 Cell: - City/State: ANAHEIM, CA ' - - ZipCode 92806 ARCHITECT: MARS HILL STUDIO License No.C24376 PH6NE:714-556-8299 ENGINEER: NELSON; WILLIAM M License No.3417 „ - PHONE:949-752-2070 COMBINATION PERMIT FEE SUMMARY Building Plan Check: $99.61 Building Fees: -. $153.25- - - Electrical Fees: $0.00 Mechanical Fees: '. $0:00- - Plumbing Fees: $0.00 SMIP Residential: $0.00 - SMIP Commercial: - $1.68 - Bldg Std Admin Fund - $1.00 - TOTAL FEES: $255:54 "Refer to fee receipts for all fees paid for project - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE 1. INSPECTION TYPE DATE INMALS CODE# INSPECTION TYPE DATE INMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. G� I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier, S1 ­11i COMe I f S W-0 .�-(This sedion need not oa mmpleted J the permit is valued at one hundred polars ($I (K)) w less.) Policy Number: S5-7 516�7 ❑ 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 provisions. �� 1 09 Applicant s Signature I - Datea WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Ltic g67 �R Cla_ss#r % V -O Contractor's Signature ate" CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: er- Signature ' Date OWNER -BUILDER DECLARATIONS: tl!`` " 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 permifto file a signed statement that he or she is licensed pursuant to the proAsions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature 305746 (3/07) Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Venfication 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 penton is required to descend, will be made in connection with work authorized by this permit. and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", allach 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. 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 Ao6hcant � me�� CITY OF COSTA MESA �,O'^p MFsp BUILDING DIVISION o r � ! 77 FAIR DRIVE, COSTA MESA, CA 92626 (714) 754-5273 •Fax (714) 754-4856 www.ci.costa-mesa.ca.us r 8 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX11-00220 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42708212 DATE ISSUED: 07/27/2011 Zoning: I ISSUED BY: RMD JOB ADDRESS: 300 FISCHER AV CM Suite/Unit: Vicinity: PLAYING FIELD Primary Occ: Const Type :?? SQ. FT: 0 Valuation: $7,000.00 SCOPE OF WORK: INSTALLATION OF AN 11 FT HIGH SCOREBOARD WITH MISC ELECTRICAL CONDUIT TO PULL ELECTRICAL FROM F EXISTING LIGHT POLE FOR "MARINERS CHRISTIAN SCHOOL". OWNER: MARINERS CHRISTIAN SCHOOL Address:: 300 FISCHER AVE Unit City/State: COSTA MESA, CA Zip Code: 92626 Phone: APPLICANT: VERHEYEN, TERA City/State: Phone: 949-274-0198 CONTRACTOR: OWNER -BUILDER Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: JAMES HU Phone 949-690-7788 FEE SUMMARY Building Plan Check: Building Permit: Electrical Permit: SMIP Residential SMIP Commercial Bldg Std Admin Fund Address: Phone $90.51 i $139.25 $41.70 $0.00 $1.47 $1.00 Zip Code: License No. 000000 License No. License No. 68736 Cell: Unit: TOTAL FEES $273.93 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE #. INSPECPON TYPE OATS INTInALS CODE INSPECTION TYPE DATE INTIMAL$ 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 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjuryane 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: (furs sector need rncu 0e mrndered d rhe germd is valued al ane hundred Wllars (S100) w less.) Policy Number: W 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 Ate workers' compensation provisions of Section 3700 of the Labor Code, I a orthwith comply with these provisions. ( 7 a7- lI AppILrM's SigreWre it, may' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPjO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. tK 1 LICENSED CONTRACTORSIDECLARATION: I hereby affirm that I am IiceASed 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. # I Class # Contractor's Signature Date i CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). bT I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). .. Owner 10 verified by driver n License. ❑ Yes ❑ No ,Driver'sJ-icense 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, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that ❑ 1 am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. 1Signatureo egal 0f,,vner(s) Date igneture.`\ ate �- "I D t n rnYM M -L— - - ]05]-46 (310'!) V � - u onzetl Applirdny�� Date _a-1 _ i CITY OF COSTA MESA f 1 BUILDING DIVISION ± 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 - wvnv.ci.costa-mesa.ca.us r FOR INSPECTIONS CALL: (714) 754-5626 ' PERMIT NUMBER: BC08-00283 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 08/11/2008 ISSUED BY: RMD JOB ADDRESS: 300 FISCHER AV CM Suite/Unit:. APN: 42708212 Zoning:. - Vicinity:,�� - Primary Occ Const Type: V-A SQ',FT:- = ' 0 - , Valuation: $30,000.00 SCOPE OF WORK: INSTALLATION OF.11 NEW SKYLIGHTS, RELOCATE A FOLDING PARTITION WALL AND IN AL EXTERIOR EXIT FOR "MARINERS CHRISTIAN SCHOOL". OWNER: . MARINERS CHRISTIAN SCHOOL - Address: .300 FISCHER AVE Unit: Phone: City/State/Zip: COSTA MESA, CA APPLICANT: LETTERMAN, CHRIS ' .'" i - Address: "� Unit: Phone: 714.623.3072 I\ .• - - City/State/zZip: ' CONTRACTOR: UNLIMITED GENERAL CONTRACTORS INC License No. 867798 Phone: 714-572-1067 Address: 3305 E MIRALOMA AVUirit: ITE 175 Cell: - City/State: ANAHEIM, CA Zi ode 92806 ARCHITECT: MARS HILL STUDIO License No.C24376.PHONE:714-556-8299 ENGINEER: NELSON,WILLIAM M License No.3417 'PHONE.'949-752-2070 COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $287.46' Building Fees: $442.25 Electrical Fees: $0.00 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $0.00 SMIP Commercial: $6.30 TOTAL FEES: -$736.01 "Refer to tee receipts for all fees paid for project A NEW OK PER t� 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, 9 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE 1, INsvecnON lrrE DATE INSs3 CODE 1 IesaeCnoe TYPE DATE INTMAL5 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 BuildingtOccupancy -! WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fo owing 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: �ry� Kamer. 7 t Tr F IFU t -J O _ (The saU)on neednct fa oveyiM/ eethe, rp�armf a valued of one hued dinars (f100) oaleu it Policy Number: �QP6157-729-7OoD_] ❑ 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 shalllffportthhWth comply with theseprovisto s. s It o Appllranl's Signature "—Da e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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 licensed under provisions of Chapter 9 (commencing with Section 7000) of Division.3 Of the Business and Professions Code, and my license ois`in full force and effect. " _ p Lic. # 01���j����8 Class # D opa-- G-...7-' 94 I V O $` Gontranoes Signature Dan j e, CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Stgrawre F OWNER43UILDER DECLARATIONS: i, I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW fm the following reason (Sec. 7031.5, "B slhess.a d'Professions Code: Any city or rounty which requires a permit to ItmCL !ler, improve, demolish, or repair any structure, prioe, to its Llssuancg)Ao requires the applicant fm such permit to file a signed statement that he or she is licensed pursuant to the provisions of the �roiibactors 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 civi( penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ lam exempt under sec. Business and Professions Code for this reason: Signature W5746 (Y07) Owner ID verified by drive Jr, J Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or mora feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding. falsework, a demolition or dismantling thereof, will be more than thirty -s& (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. Apolcantb Signature Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to rile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ 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 an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. 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 Ovmens)to g II O' And/or Authorized Axiirant .Date (714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.cBa-UILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHERAV Status: ISSUED Suite: Applied: 07126/2005 Vicinity: MAIN BLDG Issued: 07/26/2005 Primary Occ: Type of Construction: Parcel Number: 42708212 Zoning: Applicant: RICHARD GASTELUM ISSUED BY: Address: 3065 VERDUGO RD Phone: (323) 257-9329 LOS ANGELES, CA Zip: 90042. Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE .. .. ...Phone:. COSTA MESA, CA ° :`Zip. 92626 Contractor. REY CREST ROOFING/WATERPROOFING Address: 3065 VERDUGO RD • �. Phone: (323) 257-9329 LOS ANGELES, CA Zip: 90042 - 'License: 334758 - r Arch - - .. Eng: Address: - - - Address: 'Phone: - -- _ Phone: Zip: License: License: - SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL NEW 4 PLY JOHN MANILLE CAPSHEET, BUILT UP ROOF SYSTEM, SPECIFICATIONS #4GNC. 38,700 S.F. FOR "MARINERS CHRISTIAN SCHOOL' .. .. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $94,420.00 Permit: $958.75 _ Claim Valuation: $94,420.00 SMIP Res: $0.00 SMIP Com: $19.83 Other: $0.00 Inspection: $0.00 Total: " $978.58 PLANNING& ZONING SETBACKS ". MAIN STRUCTURE Front" 0-0 .Rear 6-6 Left=0 0 'Right' 0-0,, - ACCESSORY Front 0-,0 'Rear 0-0--,Left, Right %0=0 i0�0"r PARKING Existing: 0 ._a Required: 0, ' - .-.,Pioposed: 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7645626 �1 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. ave and Will maintain workers' compensation Insurance, as requlred by section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. My-workers' mpensatlon Insurance carrier and Icy number are: artier: II _ CQ I'bl_ n%frfy=-'rsli� w� � �Qf� H.nnM ( PdkY• Number: (77r/Ssecdon need not be -completed® it j permit is valued a me hundred dollars (Sr or ass.) ��• ❑ 1 certify that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, a9dAres that if I shoe, d bgCOMO subject to the workers' compensatlon provisions o1 Section 3700 of the Labor Code, I shall forthwith com ty�vfth.thesaprwlSicns" cant SlgneN Date: ! �J AAM : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPL E�NAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business Uri P%1essions Cade, and my license Is In lug Iorcear d OffiFL LTc.�— —�- Class N C_ OcnlrectoTS gesture:_ - Date: =; CONSTRUCTION LENDING AGENCY: L 'r'."n"erm,,,n,e,n,me'.L.ew.emwtiv..M1m.f'ny vgmtiylwlFra weormance 0r me wom Tor which this permitIs'Issued. (Sec. W97; CMI I 13). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of potful that I em 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 IiIg a signed statement that he or she is licensed pursuant t0 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 therefrorn and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjectsehePapplicant to 8 civil penalty Of not more than five hundred dollars ($500).): ❑r' I, as ownor%f the property, or my employees with wages as their sole watpensatlon, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7G44:,BusIrlIgss 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 himseff or hgrself 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 y�ar 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 Lew does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolitlon or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and codify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................. ..................................... _.__.............................._............................. ............................. ....................................... .................................................... .................................... ................ ._....................._.._ 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................orwi.......-..........._.—...__._.____...�._......_...._._..............._...._......................._................................................................_..............._..cutely........___._—.? 3 Does or will the ePppllcenl 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 Cully complied with? [:1 Yes ❑ No 5 Does or will the applicant orpresent or future building occupant require for the work which is the subject This a plication egermit for such construction or modification from the South Coast Air Quality Management District Or from any other air pollution control district or agency? y! Yes ❑ No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................._......................_..........__._...................—......................._......................_................................................................................._.............................._........____......_......_. 6 W III any pert of me facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...........__....................__...............___..._—____.__....._..___..._..___.................. ........_..__.............._.._—_—___.—. 7 If a permit from the South Coast Air Quality Management District Or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 6 (If yes". attach certificate o1 compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certiry, 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. ftagaFOwner(s) r� Ar�d10r, uU0o UUIKI APWcant� _�- l Date . CODE I. INSPECTION TYPE glin ILLS CODE INSPECTIONTYPE PATE INTIIIALS 1616 Fixed System Final Fire Prevention JJJ 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roel 210 Final Electrical 201 Final Block/Retaining W811 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 1203 Final Sign 222 Final Site 2G4 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa9E&TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708212 Applicant: CRAWFORD, MICHAEL Address: 1001 ROSARIO LN Phone: 760-941-9408 VISTA, CA Zip 92084 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE COSTA MESA, CA Phone: 714-437-1700 Zip: 92626 Contractor: M.R. CRAWFORD COMPANY Address: 1001 ROSARIO LN Phone: 760-941-9408 VISTA, CA . Zip: 92084 License: 539453 Status: ISSUED Applied: 05/25/2006 Issued: 06/12/2006 ISSUED BY: S�n- SCOPE OF PERMIT ELECTRICAL PERMIT FOR 8• WIDE X 4' TALL FREESTANDING MONUMENT SIGN (INCLUDES 1 -FOOT TALL BASE) FOR MARINERS CHRISTIAN SCHOOL; ADDRESS NUMERALS ••300 FISCHER AVENUE" NEED TO BE MINIMUM 8" TALL. APPROX. 24 SOFT. OF SIGNAGE REF#: SB06-00049 - y WORK TO INCLUDE: 1 SIGN CIRCUIT '.FEESUMMARY ,Quantity-� ISSUE FEE $23.50 Quantity Temp service test $0.00 0 Res. a/c package $0.00 0 New Res (1-2 units) $0.00 0 New Res'(3+units) $0.00 0 Pool / Spa - $0.00 0 Lighting Fixts $0.00 0 Recept Outlets $0.00 0 Switches $0.00 0 Non Res Appl$0.00-1. $0.00 0"'<. Res Appl - . $0.00A 0 " Serviceto200a �, $0.00 o - Service to 1000a $0.00. . ' 0, Service over 1000a $0.00 0 '. Motors to the $0.00 - - 0 Motors to 10hp =, . $0.00, 0 Motors to 50hp $0.00 0 ' Motors to 1 00h $0.00 - 0 Motors over 100hp $0.00 0 - Communication drops $0.00 0 - Sub panel to 200a $0.00 0 Pole Light Pkg $0.00 0 Sign Circuits $24.60 1 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 '.FEESUMMARY - - - - - - Quantity - - - Temp Dist System / Lighting $0.00 0 Busway /100 ft $0.00 0 Standing Section $0.00 0, Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0- „.................... ............up to 10 kva/kw up $0.00 0 ' - .................up to 50 kva/kw $0.00 0 . ................:up to 100 kva/kw $0.00 0 ..................over 100 kva/kw $0.00 0 " Low Voltage Equipment $0.00 0 Low Volt Wiring System I Ckt ,$0.00 0 Misc. Conduit $0.00 0 Misc. Conductor - $0.00 - ". "0 - Circus ( gen or ride) $0.00 0 Circus (mach ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 Fireworks Stand $0.00 0 - Other Electrical Fee $0.00 - Investigation Fee $0.00 Plan Check Fee $0.00 - Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.10 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 wi(hin 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)7S4-5626 F�.L•� +IU&I a DECLARATIONS WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penaltyof 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 Cade, 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 Cade, for the performance of the work for which this permit Is Issued. My wars' wmpenso on Insure vier andel polity number are: Carrier: ,t 1 / Policy Number: O TZ (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) T— ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that if Ish Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these vi s Applicant Signature: Date: Z ag WARNING: FAILURE TO SECURE ORKERS' MPENSATIO IS UNLAWFUL AND SHALL SUDJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,0001. ADDITIGJT THE COST MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEE S. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am Ilc�psed under provisions of Chapter 9 (commencing with Sectio ) of Division 3 of the Business and Professions Code, and my license Is In full `J farce and effect. LIC. N Class N Contractors Signature: Data: Z_ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construe riding agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: =•,, xv 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 heor 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 employeeslith 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 o1 sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No 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 feel in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa 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). .......................................................................................................................................................aa................................................................................................................torl........................................................................................................ 2 Does or will Ih�plicant or present or future building occupant need to file a registration form for acutely hazartlous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet 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 Coda provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject this a construction a ermlt for such nstruction or modification � from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...................................................................................................................................................................................................................................................................................................._................._I...................... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (ll yes', the facility must meal the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........._._......................._..........................._................._................................................_........................._.._........................_...... ..................__......................................................................... _.._................_..............._...............__.._.. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................. _........................... _........................... _......................................................................... _........... __................. _.............. __..... ........._.......................... _........................................ _..................... ............................................... 6 (II 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. 1 agree to comply with all slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZ4T10N 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 f Le I ner(s)/ ate 22�L And/oftAncy9pyMoftea A plicant Dat CODES. Qajf, INTRIALS CODEN INSPECTION TYPE DATE ISL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1206 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 M (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 SIGN PERMIT Job Address: 300 FISCHERAV Suite: Vicinity: Parcel Nunmber: 42708212 Applicant: CRWAFORD, MICHAEL Address: 1001 ROSARIO LN VISTA, CA Zoning: Phone: 760-941-9408 Zip: 92084 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE Phone: 714437-1700 COSTA MESA, CA Zip: 92626 Status: ISSUED Applied: 05/25/2006 Issued: 06/12/2006 ISSUED BY: Contractor: M.R. CRAWFORD COMPANY Address:. 1001 ROSARIO LN Phone: 760-941-9408 VISTA, CA Zip: 92084 License: 539453 Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT 8' WIDE X 4' TALL FREESTANDING MONUMENT SIGN (INCLUDES 1 -FOOT TALL BASE) FOR MARINERS CHRISTIAN SCHOOL; ADDRESS NUMERALS "300 FISCHER AVENUE" NEED TO BE MINIMUM 8" TALL. APPROX. 24 SQ.FT. OF SIGNAGE Total: $137.99 PLANNING & ZONING 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 �W.o-.o Mawr FEE SUMMARY Plan Check: $54.11 Calc Valuation: $3,000.00 $0.00 Permit: $83.25 Claimed Valuation: $3,000.00 SMIP Com: $0.63 Other: $0.00 $0.00 Inspection: $0.00 $0.00 $0.00 Total: $137.99 PLANNING & ZONING 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 �W.o-.o Mawr 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 work s' compensatl Insurance carrier and policy number are: Carrier: —1 D, �D ) �k ( 1 / Policy Number: 17 _05 (This section need not be completed i/ the permit is valued of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' 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 shell forthwith comply with these provisions. Applicant Signature: Data: I jo ., WARNING: FAILURE TO SECURE ORKERS' 4MPENSATlOjIf19bVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AG CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE($100,000), IN ADDITION TRTHE TGVCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION3706 OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Susines nd Professions Code, end my license is in full force and effect. Lic. If Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 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 Prafessions 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: T1te 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 awn 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 ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certity that no excavation live (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner-builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a pernit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........._...................._.............. _....................................-........................................................................-................... .................................... _........................................................ .... ................... ......................._...... ........_........... ......................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ NO (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................... .................................................................................................. ...... ............... ................................ ..... .............................................. ...................................................... _........................ _............... ........................... 3 Does or will 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 II en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit tot such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ 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). ..............................-p-a-..........................l ity........................................................................................................................................................................................................................................................................................................................ 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..................................it.......o.....................................hin....o. I..o.in..........................................................................................................................................................................................................-................................................................... B (II yes', attach comificate of compliance tram 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 taws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe tion pure ses. I agree not to Occupy or allow occupancy of any building authorized by t is permit un t final inspection. ignature 6fialinal Ownererr(s) / LUatol- C/ AndlDr Authorized Applicant Date CODE 0 INSPECTION TYPE HATE IMIAL$ CODE INSPECTION TYPE PAR INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708212 Applicant: JIM HANENBERG Address: 7870 WOODSBORO ST ANAHEIM, CA " Phone: (800)995-1947 Zip: 92807 owner: -MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE' Phone: COSTA MESA, CA Contractor: PRO -TECH ELECTRIC INC Address: 7870 WOODSBORO ST ANAHEIM, CA Zip: 92626 Phone: (800)995-1947 Zip: 92807 License: 469893 Status: ISSUED Applied: 07/31/2000 Issued: 07/31/2000 ISSUED BY: fr_9 SCOPE OF PERMIT 250 LIGHTS, 110 OUTLETS, 35 SWITCHES, 7 A/C MOTORS UPTO 10 HP, 2 200 AMP SUB -PANELS, 2 400 AMP SUB-PANLES, 1 100 KVA TRANSFORMER AND 1 INVERTOR LIGHTING FOR MARINERS CHRISTIAN SCHOOL... _, - - . .. !. _ - 11_ REF:1300-00534 FEE SUMMARY ' Quantity ISSUE FEE - $23.50 0 Temp service test $0.00 Woo Res: a/c package $0.00 New Res (1-2 units) $0.00 _ 0 New Res (3+units) $0.00 0 - Pool / Spa "$0.00 0 .. -. Lighting Fixts $187.90 ;;250 �_,' Recept Outlets - -$85.70 110 Switches $30.95 35 -- Non Res Appl � $0.00- $0.00 ResAppl $0.00, 0� -'- Service to 200a '-$0.00 0 Service to 1000a- $0.00 �� 0 Service over 1000a $0.00 0 " Motors to lhp ",$0.00 0 Motors to 10hp $86.10 7 Motors to 50hp _ $0.00' 0 Motors to 100hp $0.00 0 Motors over 1 00h $0.00 0 - Communication drops $0.00 0 - Sub panel to 200a $122.00 4 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp I Pole $0.00 0 Intermed Pole $0.00 0 Temp Dist System/ Lighting Busway /100 it - "Standing Section Misc Electrical Equipment Transformers up,to 1 kva/kw ................up to 10.kva/kw .....:...........up to 50 kva/kwd .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment ' .. Low Volt Wiring System / Ckt Misc. Conduit - Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand ' 'Fireworks Stand Other Electrical Fee . Investigation Fee Plan Check Fee Reinspection Fee Quantity' $0.00 0 $0.00 0 Woo 0 - " $18.209 $0.00 0 $0.00 """ 0 $0.00. 0 "$0.00 , "o , ,-,1- $0.00 01 - $0.00- �' �'0 --$0.00 -� ,0, =.0,/ $0.00' 0, $0.00 0 ,$0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $628.85 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the for which this permit is Issued. 1 have anti 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' compensatlon Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I cenihy that in the performance of the work for which this pemlit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation law 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 th ovisions. l Applicant Signature. Date: �7�3 / / [ri CCi WARNING: FAILURE TOS CUREWORKERTOOMPENSATIONCOVERAGE UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE I 00,000), IN ADDITION TO THE COST OF COMPENS TION, DAMAGES AS PROVIDED FOR IN SECTION S/0a OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. M z4L492 S Class a Contractor's Signature: Date: Tie (�7e CONSTRUCTION LENDING AG CY: ❑ 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). Lendefs 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 constiuct, 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 (commenclng with Section 7000) o1 Division 3 of the Business and Professions Code) or that he or she isggxempt 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 A* 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License 6aws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by ddver'S license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this pernit, 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, Califomia 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 Remit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to lila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). ........................ ....................................................................... ............. ....................... .................................. ...................... ........................................................................................................ ..................................................... ....................... I.._....... 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some 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 materiels equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 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 Rection 25534 of the Celifomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire partment of an RMPP by businesses which are required to registei acutely hazardous materials with the Fire Department. ...........__...............................__-............................................................................_..__............... .......___..........................__.......................____..................................................... ....._........._............................._..._................. 4 If an RMPP is Dresently requireed,d.has Section 25534 of the Celifomia H..... and Safety Code been fully complied with? ❑Ves ❑ No o . . . 5 Does or will the applicant or present or future building occupant require for the work which is the subject Ofthis a plication a ppermit for such construction or moditicallon from the South Coast Air Quality Management District or from any other air pollution control district or agency.? Y"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 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................... _................................................ _........................................... __............................ _.............................. ............................. _._................................................................................................... _................. _................. _- 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ............................... .............. ............................................................................. _............................................................................................... ._..................................................................................................................._..................... _........... B (II 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. Sig re Of Legal O ner(s) Date /,3r r And/Or Authorized Applicant 7— Dale WOE # INSR&TION TIP RiIITdLS CODE MSPECTONTIPE 2ATI DITTIA 5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical I^\ Wy 201 Final Block/Retaining Well 212 Final Fire Prevention �T 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 300 FISCHERAV Suite: Vicinity: Parcel Number: 42708212 Zoning: Applicant: CAFOUREK, JESS Address: - - ;�/ii;Phone: 949-929-8230 Zip:, / ISSUED BY: Status: ISSUED Applied: 08/20/2001 Issued: 08/20/2001 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHERAVE', Phone: _ - COSTA MESA, CAS - - Zip: 92626 Contractor: "SHADE CONCEPTS Address: 18001 SKY PARK CIR - SUITE F , Phone: (949) 250-9525 - IRVINE, CA ' Zip: 92614 License: -. 746488 Arch - Eng: - Address: Address:, Phone: Phone: 'Zip: ,,-License: - � � License: SCOPE OF PERMIT ' CONSTRUCT TWO ALUMINUM AWNINGS. EACH ONEIIS 6110" DEEP'BY,BW' LONG. ONE AT REARY NEAR GYMNASIUM. ONE AT SIDE OF BUILDING ADJACENT TO THE LOCKER ROOMS - Plan Check: $54.11 Permit: $83.25 SMTP Res: $0.00 SMIP Com: $0.50 Other: $0.00 Inspection: $0.00 Total: $137.86. _ SETBACKS-' MAIN STRUCTURE Front 0-0 - Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: .0 NOTES FEE SUMMARY, c Calc Valuation: $2,080.00; j Claim Valuation: $aoo PLANNING & ZONING Leff 0-0 - Right 0-0 Left 0-0 Right 0-0 , Proposed: 0' - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446.49 (9roo) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars ($100) or less) ❑ 1 certify that in the pertormanc f th rk 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 Calilo nTe, afire hat if I should become subject to the workers' compensation provisions of Section700 of the Labor Code, I shall forthwith comply with these s. /� ^ ure: p'Ovis A ' Applicant SignatDate: y WARNING: FAILURE TOS UORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND 00, ), INADDRICN 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 and provisl 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. If Class N Contractor's Signature: Date: czy CONSTRUCTION DING GENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affiml 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 perms' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year Of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type o1 document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cenity 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 Permil Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reposed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materiels? ❑Ves ❑ No (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 apials)? plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous mater ❑ Yes 11No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 I1 en RMPP is presently required, hes Section 25534 of the California Health and Salary Code been fusty complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject age c itis .application a19 No for such construction or modification from the South Coast Air Quality Management District or from any Omer air pollution control tllsirtcl Or agency? LJ Yes LI 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 ba constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (if *yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). .............................................................................._..._......................................__............................_.........................._....................._._._.............................._._..............................._..............._......._...................__......................__.......... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ NO .................................................... __........................... _.......... __.._._...__................................ _......................... _....................... ....................................................................................... _._....... .......................................................... _........... 8 (If yes , attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all stale laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cartity under penalty of perjury that I have read this application and state that the Intonation 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. ZSitura O gal O s D1te n uthodzed Applicant Date CODE INSPE E INiMA CODE INSPECTION TYPE 2&3 INTITA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcoi 210 Final Electrical 201 Final Bloc /Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �� q 204 Final Demolition 250 Final Building/Oocupancy (714) 754.5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 300 FISCHER AV Suite: Vicinity: NEW SHADE STRUCTURE Parcel Number: 42708212 Zoning: $593.75 Applicant: CAFOUREK, JESS 'SMIP Com: $0.00 Address: 18001 SKYPARK CIR Inspection: $0.00 SUITE E Phone: (949) 250-9551 / ;,-�' �• IRVINE, CAS ��, - Zip: 92614 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE \ " ' - - Phone: (714)437-1700 i- " COSTA MESA, CAS Zip: 92626 Contractor: 'SHADE CONCEPTS .Address: 18001 SKY PARK CIR SUITE F', Phone: '(949) 250-9525 IRVINE, CA Zip: 92614 License: 746488 Arch Eng: Address: - - Address: Status: ISSUED Applied: 08/09/2001 Issued: 10/31/2001 ISSUED BY: - - Phone: Phone: Zip: License: License: SCOPE OF PERMIT _ CONSTRUCT 2230 SO FT SHADE STRUCTURE FOR"MARINERS CHRISTIAN SCHOOL". Plan Check: $385.94 Permit: $593.75 SMIP Res: $0.00 'SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $979.69 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front .0-0 PARKING Existing: 0 NOTES: FEE SUMMARY PLANNING & ZONING Rear 0-0 Left 0-0 Rear 3-0 Left 42-0 Required: 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 , Right - 0-0 " $44,600.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work Is not commenced withln 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: V14)754-5626 244A 46 (6100( 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 carder and policy number are: Carrier: 4 Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or fess.) ❑ I certify that in the perfornan of th"ork 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 Celi ia, 9 ogre h t if I should become subject to the workers' compensation provisions of section 700 of the Labor Code, I shall forthwith comply with these provi ns. /` / 3 1 /0 1 Applicant Signature: Date: / // WARNING: FAILURE S UR RKERS' C MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL PINES UP TO ME HUNDRED THOUSAND 0p, , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affiml that I am licensed un provisi s 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. a Class q Contractors Signature: Date: ZZ CONSTRUCTION MIND AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, 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 perr+: subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, 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 parson has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). t� re building n n to file registration form for acutel���hazardous�m riall ................................................................................................... .......... .. ........................ I...................... ..... 2 Does or will the applicant or present or tutu ng ocoupa t sect to a registration y materials? 57 ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................................................................................................................................................................................I............................................................................................................................... 3 Does or will END or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? [I Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................................ 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [I No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lYes IPJ No (Section 65950.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................. ..............................................................................................................-........................................................................................ ............... .......................................................................................... ..... any p ... .. 6 will an art of the facility to be constructed under this ermit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 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 pemnit until final inspection. natu al Owner(s) ate /'0 it 01 -And/Or Authorized Applicant -TTS CODE rr �INSPECTIONTYPE gATE INTRALS CODES INSPECTION TYPE pAT[ IIS$ 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/Retadmg 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 _Z �Q (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Number: 42708212 Applicant: WILLIAMS, CHAD Address: Owner: MECHANICAL PERMIT ISSUED BY: Phone: 714-572-6880 Zip: MARINERS CHRISTIAN SCHOOL Address: 300 FISCHER AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: AIR CONTROL SYSTEMS INC Address: 1901 NANCITA CIR Arch / Eng : Address: Phone: (714)572-6880 PLACENTIA, CA Zip: 92870 License: 639003 Phone: Zip: License: Status: ISSUED Applied: 01/03/2001 Issued: 01/03/2001 SCOPE OF PERMIT REF: 80001983 8 B00-00534. KITCHEN ADDITION TO EXISITNG CHRISITAN SCHOOL. HOOD W/EXHAUST AND ALTERATION TO COOLING/HEATING SYSTEM; RELOCATE 3 DUCTS AND ADD 1 NEW DUCT. FEE SUMMARY Quantity Repair / Alt Absorbtion Unit $0.00 Quantity ISSUE FEE $23.50 0 Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU $0.00 0 Repair/ Alt Cooling/Heat $13.70 1 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $10.65 1 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY Quantity Repair / Alt Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventilation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems Up to 3 hp / 100k BTU $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $49.50 Reinspection Fee $0.00 TOTAL CALCULATED FEES $97.35 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 244646 (fiW) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation ins ani$ es required by section 3700 of the Labor Code, for the performance of the work for wh ch this permit is Issued. My workers' compensation Insufarrcq carrier end �dicy er are: Carder: (�•-�`/� Policy Number: (This section need not be completed i/ PM permit is valud f one hundred dollars ($100) or less.) ❑ 1 certify that in the performance o1 the work for w it his permit is issued, I shall not employ any person in any manner so as to become subjI to the workers' compensation laws of Celifo a afire that It II me subject to the workers' compensation provisions of Sectl n 370 of the Labor Code, I shall forthwith comply with these provlslo {� Applicant Signature, / -'1 Data �I /�� jy WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 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. If Class 4 ,Contractors -Signature:— Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Data: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I arWEXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employee's 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, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a pernit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division, Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..........._._............._.__..................__......_..............._._.._....____................................__...___......_........_....____._........._...__._...._........_...______....... .......__........... ...._............___._... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................._...... ...,................................................................... ............................................................. ................................ ............................... ............... ........... __.................................................................................. _....... _................ _ 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No 9Section 25534 of the California Health and Safety Code provides that the COst4 Mesa Fire Department may require the preparation, certification and tiling with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................_...... .......................................................... _......................................................... -.................................... _....................................... ......... __._.............................................................. _....................... "'— .......... _.. 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Ves ❑ No ..................._................._.........................._......... ................._.._................................................. _..__.................................._.................................__..........................._......_...................... _...................... _........................ __............ _.. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plicatlon a emit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? jJ Yea LJ No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any pan of the Iaciliry to be constructetl untler this pertnit be within 10001eet from the outer boundanes of a school? ❑ Yes ❑ 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 agencyis required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ................................aff........................................................................................................................llut................trol................................................................................................................................................................................................... 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. 3 / O Pate CADyOT:AuBwdied,-AppQMn!--, I Data CODE -1. INSPECTION TYPE fid¢. INTITIALS CODE INSPECTION TYPE `. g)!¢, SLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHER AV Suite No Vicinity: KITCHEN AREA Parcel Nunmber: 42708212 Applicant: HANENBERG, JIM Address: 7870 WOODSBORO ST ANAHEIM, CA ELECTRICAL PERMIT Phone: (800) 995-1947 Zip: 92807 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE COSTA MESA, CA Phone: Zip: 92626 Contractor: PRO -TECH ELECTRIC INC Address: 7870 WOODSBORO ST Phone: (800) 995-1947 ANAHEIM, CA Zip: 92807 License: 469893 ISSUED BY: Status: ISSUED Applied: 12/12/2000 Issued: 12/12/2000 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW KITCHEN ADDITION FOR "MARINER'S CHRISTIAN SCHOOL". INSTALL 8 LIGHT FIXTURES, 10 OUTLETS, 1 SWITCH, 1-75 KVA TRANSFORMER, & 1-200 AMP SUB -PANEL. REF: B00-01983 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 perrriil__� FOR INSPECTIONS CALL: (714) 7545626 24 6(6100) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kvalkw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kvalkw $0.00 0 Lighting Fixts $8.80 8 .................up to 50 kva/kw $0.00 0 Recept Outlets $11.00 10 .................up to 100 kva/kw $49.50 1 Switches $1.10 1 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $30.50 1 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 h $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 1 00h $0.00 0 Other Electrical Fee $0.00 Motors over 1 00h $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $124.40 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and -all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this perrriil__� FOR INSPECTIONS CALL: (714) 7545626 24 6(6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 at the Labor Code, for the performance of the for which this permit is issued. —f ha ev and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carder and policy number are: [ . -Came,. /rI"SAI;J 6-S..L1%",4_ Poilry Number:—/IiS.LJ R.T.7 t-1)% '- �(This section be completed H the Permit is valued at one hundred dollars (5100) or less.) ❑ I certify that In the performance of the work for which this pernit 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 compty.with these provisi s. . - ApplicanYSignature: �Q�w4n.._.Crt�-� �. Date: �.L. �Y. Co'.) WARNING: FAILURE TO SECURE WERS' COMPENSATION C0VEFl IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), Ilft'ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affmin that.l.am.licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and Professions Cade, and my license Is in full force and effect. Lic. p 47 Class M__1" Contractor's Signature7.— Date:` -� On CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: ;. 1 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 pernit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type at document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a pernit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, .or 200 cubic feet of compressed gas at standard temperature and pressure). ..._ ................. __....................._..__................................................................___.............................. _... _.......................... _.................................................................... _............... _........................ _.......................... _.. 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Masa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......__.................... ................... —_.................................................................... ___................................ _.._._........................ __.................................................. _.... __............ .... _................... __................. ___......... 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? - ❑ Yes ElNo (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. .............................................................................._....................................................................................................................................................................................................... ............................................................................I............... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ED Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of ruts a plication appertnil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................. ............................................ ........-............................................................................. ....................................... ................................................................................. I........................................................................................ 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (II 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 disdosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................................... ................... -.............................. ....................................... ........ ...................................................................................................................................................................... ..,................ ....................... ............................ ........... 8 (II 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 cenify 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 gal Owner( Date ,1kJ/.1 And/Or Authorized Applicant--- - - (yDete 400E I INSPECTIONTA RiImELS CODE.I INSPECTION TYPE 2&11 Immut 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pod Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754.5273 • Fax (714) 754-0656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708212 Applicant: JOHNSON, DARROL Address: Owner: PLUMBING PERMIT Phone: 714-630-7700 Zip: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE COSTA MESA, CA Contractor: Address: Arch / Eng : Address: Phone: Zip: 92626 WALLACE P. JOHNSON PLMB & HTG, INC. P.O. BOX 550 ATWOOD, CA Phone: (714)630-7700 Zip: 92811-0550 License: 262469 Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 12/21/2000 Issued: 12/21/2000 SCOPE OF PERMIT INSTALL 2 DISHWASHERS, 1 GAS SYSTEM, 2 SINKS, 1 CONNECTION TO EXISITING WATER n SERVICE. CGF,'E�W _ LI) ICIO 3 QTY FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $19.60 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $6.15 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater / vent $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1 Sink, kitchen $19.60 2 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $78.65 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244946 (9/00) DECLARATIONS Adak WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑I certify that in the performer�c of the work for w h thispermit Is Issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of laffoml a gm. sl Id become subject to the workers' compensation provisions of Section 3700 Of���hhha or Cotle, I shall forthwith co mply.with.these, visions. / / Applicant Signature: vvv(((/// Date: WARNING: FAILURE TO S URE WORKERS' COMP ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), IN ADDITION TO COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice d U der visions o1 h er 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lia q. Class p 6pntractofs Signature: Date: r r CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affiml that under penalty of perjury that ram 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).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID venfied by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). n r future buildin����O pnt ned to file a registration torte for acutely hazardous materials? Yes No ..................................................PP..................P. ......................... 2 Does or will thea applicant or present o building scup g y ❑ ❑ (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). . ........................ ....... -............................................................... ........... ................................. ........................................ ... ................. ......................... .................. ............................... ....................... -...... .......................... ... ........................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? - ❑ Yes ❑ NO (Section 25534 of the California Health and Safety Code provides that the Caste Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................................................................................................................. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................ithi......................................................................................................................................................................................................................... 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................................................................................................................................................................................................................................................................................................................................................... ................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ e (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is 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 authodze representatives of the City of Costa Mesa to enter upon the above-described pro for inspection purposes. I gree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. i et e e Owners) 23/37 7 /00 77And100IJthOTTZ8c1 Applicant-,--.,Date CODE I. INSPECTION TYPE INTRIALS CODE INSPECTION TYPE PATE INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing S—o 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 300 FISCHER AV Status: ISSUED Suite No Applied: 09/11/2000 - Issued: 09/11/2000 Vicinity'. MARINERS CHRISTIAN SCHOOL Parcel Nunmber: 42708212 - ISSUED BY: Applicant: JOHNSON, DARROL Address: P.O. BOX 550 - - Phone: (714)630-7700 - - ATWOOD, CA - Zip: 92811-0550 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE - " Phone: COSTA MESA, CA Zip:" 92626 Contractor: WALLACE P. JOHNSON PCMB_& HTG, INC. ' Address: P.O. BOX 550 - ,, Phone: (714)630-7700 - ATWOOD, CA. Zip: 92811-0550 - License: 262469 - Arch / Eng:' Address: _ " Phone: - - Zip. ' .. , .. Licenser- SCOPE OF PERMIT- . ` TI FOR "MARINERS CHRISTIAN SCHOOL." , 15 GAS OUTLETS, i.SUMP PUMP. - - REF: BOO -00534 & POO -00352 FEE SUMMARY �- ' /'AMT QTY - - - - AMT - OTY ,ij �� AMT QTY ISSUE FEE -$7.25' Laundry Tub / Washer ' $0.00 0 - -' j Sump Pump,� $9.80 1 Backflow, irrigation $0.00-0.:_ Landscape Irrigation $0.00 0 - Swimming Pool, $0.00 0 Backflow Preventer $0.001 0 P -Trap .$0.00 0 • , Trap Primer �. - , $0.00 0 Bathtub $0.00 0 " - Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00'-. 0 Process Piping (per 10 ft), $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00, '0- - Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 ,Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo' $0.00 0 - -Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 -. 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line - $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower -$0.00 0 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $16.50 15 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: $33.55 NOTICE: The work authorized by this permit SQ0MMEN" /aSR ,'idAls 6�dd6iL�ITdE?�kS requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-08 (6100) (j 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. �rf I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance olthe work for whl,h this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o a liforn And agree thaP I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these ovis'in� _ Applicant Signature: /� Date: WARNING: FAILURE TRKERS' COMP a ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RE ($100,IxlD), IN ADDITION TO TOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license r pro 'sions of Chap 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 i _ Class N Contractors Signature: r Date: 77— z 0 � b CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: 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).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................................................................................................................................................................_......................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................._.................................................................................................................................................................................................................... .......... ............. .......................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety.Code been fully complied with? ❑ Yes ❑ No .............. ............................................................................................................................................................................................................................................................................................................................................................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a8plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes O No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ...............- ................................. ..................... ......................... ........... ................................................................................ ......................... .................................................................................. .............................................................................. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................................................................................................................................................... t r ol............................................................................................................................................................... 7 a a permit from the' South Coast Air Oescri Management District or other elr pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify, that under penalty Of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described arty for inspection purposes. I ee not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Le O ner(s) Date AncI/Crr­AZri4e9KAppIicant Date CODE #. INSPECTION TYPE PATE INTITA CODE# INSPECTION TYPE 21M INTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final PlumbingL 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2134 Final Demolition 250 Final BuildinglOccupancy (714) 754.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.usING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHERAV Suite: Vicinity: KITCHEN FOR MARINER'S CHRISITAN SCHOOL Parcel Number: 42708212 Zoning: Applicant: (FULLMER) Febe-4Zt Address: 1725 S GROVE AVE ONTARIO, CA Phone: (909)947-9467 Zip: 91761 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE COSTA MESA, CA Contractor: FULLMER CONSTRUCTION Address: 1725 S GROVE AVE ONTARIO, CA Zip: 91761 Arch : Address: Phone: Zip: 92626 Phone: (909) 947-9467 License: 301814 Eng Address Phone: ISSUED BY: Status: ISSUED Applied: 12/08/2000 Issued: 12/11/2000 Phone: Zip: License: License: SCOPE OF PERMIT KITCHEN ADDTION PORTION OF PREVIOUSLY APPROVED PLANS 8 ISSUED PERMIT FOR "MARINER'S CHRISTIAN SCHOOL." REF: B00-00534 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6=) FEE SUMMARY Plan Check: $163.31 Calc Valuation: $15,000.00 Permit: $251.25 Claim Valuation: $15,000.00 SMIP Res: $0.00 SMIP Com: $3.15 Other: $0.00 Inspection: $0.00 Total: $417.71 PLANNING &•ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: KUBOT_BJ 12/08/2000 NO FEES PER MARTHA FORD & RICK BROWN. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6=) 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 i1 the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C fomla gree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with�thes Applicant Slgnatur -� /� Date: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31rO6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 11 Class It Contractols Signature: Date: 12— \ 1*C0 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lender's Name: Lender's Address: Signature: - Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed' pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivels License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a re orted year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................................................................................................................................................................................................................................................................................................................................................................................ 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................... .. ......................................................................................................................................................................................................................................................................... ...........will....................................prese t 5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Vas O No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .......................................................................................................................................................___..._....................................................................................................................... ....I................... .............................. 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 IF a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .......................................................ific................................................................................................11ut................trol.................................. ............................................................................... .................... ......................... ........................ ............. B (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. 1 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 properly for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature Of Legal Owner(s) Date \- \2-- Ll - OO And/Or Authorized Applicant Date CODE 0. INSPECTION TYPE PAIS ItiTIT9LS CODE# INSPECTION TYPE 1NTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4�,0 E CITY OF COSTA MESA ° BUILDING DIVISION F DEVELOPMENT SERVICES DEPARTMENT v 7 •,� �; PERMIT (714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT Job Address: 300 FISCHER AV Suite: Vicinity: GYMNASIUM/MULTI PURPOSE ROOM Parcel Number: 42708212 Applicant: SPENCER, JIM Address: 1725 SOUTH GROVE AVE ONTARIO, CA NUMBER B00-00534 77 FAIR DRIVE, COSTA MESA, CA 92626 Zoning: ISSUED BY: Phone: (909) 947-9467 Zip: 91761 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: FULLMER CONSTRUCTION Address: 1725 S GROVE AVE Phone: (909)947-9467 Status: ISSUED Applied: 04/21/2000 Issued: 06/30/2000 ONTARIO, CA Zip: 91761 License: 301814 Arch : NUTTALL UCHIZONO ASSOCIATES Eng: KRAMER LAWSON INC Address: 3199 AIRPORT LOOP DR #C Address: 3002 DOW AVE #136 Phone: (714)545-3760 Phone: (714)838-6222 COSTA MESA, CA TUSTIN, CA .Zip: 92626 License: 92780 License: SCOPE OF PERMIT _ MARINER'S CHRISTION SCHOOL TI INCLUDING ADDING 5,588 SF SECOND FLOOR (ALREADY INCLUDED IN BUILDING ENVELOPE). FEE SUMMARY Plan Check: $962.62 Permit: $1,480.95 SMIP Res: $0.00 SMIP Com: $39.24 Other: $0.00 Inspection: $0.00 Total: $2,482.81 Calc Valuation: $186,855.88 Claim Valuation: $0.00 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: o 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 C WORKERS' COMPENSATION DECLARATION: II he�ffirm under penalty of perjury one of the following declarations: ❑ eve and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the ork for which this permit is issued. 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 or is' c p/e/n patio I ura e c er and policy number are: /,/ /�[ /% ;Carrier: M 17,jj�' /)i Poilcy Number: /N��jO////i�17 �D (This section need not 5e complotearif the permit is valued atone hundred dollars ($100) or less.) ❑ I certify that in the performance of the work which s- permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws o alifomia, and agre Nf I Id become sub'ect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these Iaions. Applicant Slgn '� Date: T� WARNING/FAILURE T ECURE WORKERS' COMP5K6TI0NI COVERAGE IS UNLAWFUL AND SHALL SUMECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU D (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice r ovist s of C ter commencing wi Section 7000) of Division 3 of the Busirj s and Professions Code, and my license is in full force and effect. Lic. k Class /f ,U Contractors Signature: Data:. i CONSTRUCTION LENDIN ENCY: ❑ 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: Lender's Address: Signature: '• Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjutythat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or, ty which requires ayermit 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 d(her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bili 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: I WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication eppermlt for such construction or modification from the South Coast Alt Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ retrad ❑ 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. Sign eg ner(s) AndrOrA odze Applcant b / Date ,1500E Ot INSPECTIONTYPE 2ANiNt InALS CODE. INSPECTION TYPE 26ff. INTIMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 24x636 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Number: 42708212 ISSUED BY: Applicant: RISINGER, TOM Address: 1901 NANCITA CIR Phone: (714) 572-6880 PLACENTIA, CA - Zip: 92870 owner:, MARINERS CHRISTIAN SCHOOL Address: 300 FISCHER AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: AIR CONTROL SYSTEMS INC Address: 1901 NANCITACIR 'Phone: "(714)572-6880 PLACENTIA, CA --Zip: 92870 License: 639003 Arch / Eng Address: Phone: Zip: License:- ..._ Status: ISSUED Applied: 08/14/2000 Issued: 08/14/2000 SCOPE OF PERMIT REMOVE AND REPLACE 14 ROOF MOUNTED PACKAGE UNITS. THREE UNITS TO BE USED AND PUT BACK UP. NEW UNITS TO BE SAME SIZE OR LESS IN WEIGHT AND HEIGHT THAN EXISTING UNITS. REF; B00-00534 FEE SUMMARY Quantity ISSUE FEE $23.50 Quantity Inst FAU <100 k BTU .$207.20 14 Inst FAU >106 k BTU $0.00 0 Repair/Alt Cooling/Heat $0.00'-'-0" 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 10 " Refrig Sys >100 k BTU - $0.00 - 0 , Gas Piping .' - $0.00 0 ' Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box . $0.00 0 Vent Fan / Single Duct $0.00. 0 Appliance $0.00-'- 0 Fire Dampers $58.00 8 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers> 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY - Quantity Repair / Alt Absorbtion Unit - $0.00 0 - Repair/ Alt Refrigeration Unit $0.00 0 Ventilation System - - ;� . $0.00 0 Evaporative Cooley' ' $0.00 0 Commercial Incinerator - $0.00- 0 -- Domestic Incinerator . - "�j - ,' $0.00 0 - Compressors / Absorption Systems, - Up to 3 hp / 100k BTU $0.00 0 3 To 15 hp / 500 k BTU - $0.00 0 ' 15 To 30 hp / 1,000 k BTU $0.00 0 - 30 To 50 hip / 1,750 k BTU $0.00 0 Over 50, hp /Over 1,750 BTU -, �" $0.00 0 Boilers - Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $288.70 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No: 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 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 01 the Labor Code, for the performance of the %irk for which this permit is Issued. 0- I have antl will maintain workerscompensation insurance, w required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: ,t Lanier: OWTE0D AC1799C Policy Number. N%Vd- / C� �� 02— (I his section need not be complatetl it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the gfor which this permit is issued. I shall not employ any person In any manner so as to become subject to the workers' compensation laws o1 Califomi ,e �6a that If I should become subject to the workers' compensation provisions o1 S coon 3700 of the Labor Code, I shall forthwith comply with , r e: 'aLe ��� Applicant Signature: �1�^��� r Date: WARNING: FAILURE TO SECURE 'ORKERS' COMPEN ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), NADDITION TO THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provlsio o Chapter 9 (commencing with Section 7000) of Division 3 of the Business aAPrWAssions Code, and my license is In full force and effect. Uc. k Class a L, Contractors Signatur —�`Date: oy CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: J� 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 Divislon 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 ndt more Ilan five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does nottapply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at slander d temperature and pressure). _ .................................................... ............................................................................................................................................................ .......................................__........_................ __....-...... ................_....._.................__...............__.......... 2 DDes or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety 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 requiretl, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ._._ ......................._................ _..... _................................................................. _.___............................ __..................... _................................ _........ ............ ............................. ........................ ...... _.._.......................... ................................. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this plication apemill for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Byes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? L] Yes-__ ❑ No (It -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................_...._........................................__..........................__......................___................................................................._....__...........................__................._................_. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disdosures prescribed by Califomia Health and Safety Code Section 42303 been made? []Yes ❑ No ..................................................................... .................. .......................... ................. ........................................................................................................................................................... ... _..__......................... ___................... _................ _... 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all state laws and cry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspect' purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / ig me Of Le at Owner(s) )Date And/Of 4 Oobtod'gpplicant/Date CODE f. INSPECTION TYPE PATE INITIALS CODE1 INSPECTION TYPE E 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re-Rcoi 210 Final Electrical 201 Final BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval '203 Final Sign 222 Final Site 20\4 Final Demolition 250 Final Building/Occupancy \ ,e� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-rrWeSa.€ 9b PRESS ION PERMIT 77 FAIR DRIVE, COSTA MESA, GA 92626 Job Address: 300 FISCHERAV Suite: Vicinity: SECOND FLOOR TI Parcel Number: 42706212 Zoning: Applicant: MIKE MEEHAN Address: 1101 S. GRAND AVE. Phone: (714) 547-7474 SANTA ANA, CA Zip: 92705 Owner: "MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE ' Phone: COSTA MESA, CA Zip: 92626 Contractor: AMERICAN ALARM SYSTEMS Address: 1101 S. GRAND AVE. Phone: (714) 547-7474 Status: ISSUED Applied: 07/24/2000 Issued: 08/16/2000 ISSUED BY: '( SANTA ANA, CA Zip: 92705 License: 299406 SCOPE OF PERMIT INSTALL FIRE ALARM FOR MARINERS CHRISTIAN SCHOOL TI. - REF:B00-00534 FEE SUMMARY Plan Check: $117.81 Permit: $181.25 Other: $0.00 Total: $299.06 Calc Valuation: $10,000.00 Claimed Valuation: $to,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 / 2446-46 (6100) I DECLARATIFONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. I have and will me talo workers' compensation insurance, as quired by section 43710ol r Code, for the performance of the work for which this permit fs i uad. My wprke o satlooinsurancecarrier a Iicy nu r are:Carrier: l f(Qi0. <-UiCrr-w� Policy Number:(This section need not he completed if the rmit Is valued et one hundred dollars ($.) ow -J-a� ❑ I certify that in the performance of the work or which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Celifomla,and agr a If I becort�e subject to the work���[[[aww'compensation provisions of Sedlon 3700 of the Labor Code, I shall forthwith comply wit ase pr )Ons. / n- / _ /A J Applicant Signature: I .R/v/c ` IvJL/`� Date: iJ' �� it �� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LIBOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under4olY4lonrS's of Chapter 9 (commencing with SectioyY�oo) of Division 3 of the Business and Professions Code, and my license is in full. force and effect. Lic. k o'Z X4b / Class p (,.-/0 Contractors Signature: 7 r .CL/ Date: A - a7,? CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: • OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a. pal it 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 Ilce sed 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 UConse Lew does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to Construct the project (Sec. 7044, Business and Professions Cade: The Contractors Ucense Lew does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection With work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................_...............................................................................................___....................................__............................_........................._................................................................................................._...................._.__................._. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety 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 materiels equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compassed gas at standard temperature and pressure). ...................._........................ _.................... .__........................................... _............................. ................................... .......................... _..................................................................... ........................................... _........................ __............... 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 Coste Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to ragistei acutely hazardous materials with the Fire Department. 4 If an RMPP H presently required. has Section 25534 of the California Health and Safety Cafe been fully Compiled with? [1Y" ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject ofthis a plication 819 No for such Construction or modification Cowl from the South Cot Air Quality Management District or from any other air pollution Control district or agency? Yes Lf No (Section 65650.2 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 conslrucietl under this permit be within 1000 feet from the outer Dounderies of a school? ❑Yes ❑ No (If -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .....__._.............._................._._......................._............:............. _.........�.._..................___...........__—_.__................__�_.........._.�.__........ _........... _.._........ __......... _._. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No B (If yes', attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is Correct. I agree to Comply with all stele laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that 1 have read this application and state that the Informa]up�on Is correct. I agree to comply with all state laws and city ordinances relating to building constructlon, and authorize representatives of the City of Costa Mesa to en 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 Date CODE E. INSPEOnom TYPE JIM INITIALS CODE j INSPEcnON TYPE UX ItDIM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing _. 200 Final Re-Root 210 Final Elmtr cal 201 Final Block/Retaining Wall 212 Final Fire Prevention -fA� 1•-`4 - 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/OCoupancy 0 Job Address: 300 FISCHER AV Suite No Vicinity: i Parcel Number: 42708212 Applicant: RISINGER, TOM Address: 1901 NANCITA CIR PLACENTIA, CA MECHANICAL PERMIT Phone: (714)572-6880 Zip: 92870 Owner: MARINERS CHRISTIAN SCHOOL Address: 300 FISCHER AVE COSTA MESA, CA Contractor: AIR CONTROL SYSTEMS INC Address: 1901 NANCITA CIR Arch / Eng : Address: PLACENTIA, CA Phone: Zip: 92626 Phone: (714) 572-6880 - Zip: 92870 License: 639003 Phone: Zip: License: - - ISSUED BY: Status: ISSUED Applied: 08/04/2000 Issued: 08/04/2000 SCOPE OF PERMIT ' MECHANICAL PERMIT FOR T.I. FOR "MARINERS CHRISTIAN SCHOOL". INSTALL 3 HVAC PACKAGE UNITS, 4-20 TON SPLIT SYSTEMS, 4 SUSPENDED HEATERS, 7 VAV BOXES, 7 VENT FANS, & 8 FIRE DAMPERS.-- - - - - REF: 800.00534 FEE SUMMARY Quantity ISSUE FEE $23.50 Quantity Inst FAU <100 k BTU $74.00 5 Inst FAU >100 k BTU $109.20 6 Repair/Alt Cooling/Heat $0.00 - 0 -- Inst / Rep. Recess Wall Htr $0.00. 0 Refrig Sys <100k BTU $0.00 0 Refrig Sys >100 k BTU , - , - $0.00 -- 0 Gas Piping $0.00. , 0 - Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 - VAV Box $74.55 7 Vent Fan / Single Duct - $50.75 -7 Appliance -$0.00 0 Fire Dampers $58.00 8 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers> 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY - - Quantity Repair./ Alt Absorbtion Unit - $0.00 0 - Repair/Alt Refrigeration Unit $0.00 0 Ventillation System,: -:.-.. $0.00 0 Evaporative Cooler - '- `- $0.00 , 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors/ Absorption Systems ' Up to 3 hp'/ 100 k BTU $0.00 0 3 To 15 hp/500k BTU $0.00 0 15 To 30 hp 11,000 k BTU S0.00 0 30 To 50 hp) 1,750 k BTU $0.00 0 Over 50 hp / Over 1,750 BTU/,' - $0.00 0 Boilers Up to 3 hp - $0.00 0 3 To 15 hp $81.45 3 15 to 30 hp $149.00 4 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $620.45 COMMENTS if SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 X 2"&46 IBM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirn under penalty of perjury one of the following declarations: ❑ 1 have nd 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 or which this permit Is issued. I _ -1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance, of the work for which this permit Is Issued. ' My workers' compensation Insurance carder and policy number are: ,'Carrier: 0:N-IMD `PPA -C4 Fk- (Policy Number._N —(This section need not be completed it the permit Is valued atone hundred dollars ($100) or less.) ❑ 1 certify that In the performance of thew c 1 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 Calif e; antl at if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these all , L 'ApplicanYSlgnature: - M A Date: �7 /ez, -WARNING: FAILURE TO'SECUR ORKERS'COMPENS COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIM&ALPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOULAAE ($100.0001/1 ADDITION TO THE OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION S706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: Ihereby affirm that,l.aarliconsed under provi I Chapter 9 (commencing with Section 7000) of Division 3 of.Ne.Busine/s�s�end esslons Code, and my license is In full forca and effect. LIC. It Laaas N. _ (J' Contractor's Signee __ _ - Date: _ CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: r 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 constmct, 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 licenseQ 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 4 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 o Vner-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 Ucense 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 taws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certity that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Hire 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 ton for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..._......................_...................... -................................-......................................................................................................... _....................... _......... ................................. ............. .............................................................................. I .................. . 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Year ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No 5 Does or will the applicant Ai rt or present or future building occupant require for the work which Is the subject c this a plication a..ppertnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................... ................................ ............................................................................................................................................................ .............................................................................. ...... _................................. _.................... _.................... 8 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes*, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................................................................................................................................................................... 7 If apermit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes [INo ................................. _.......................................................... ..................................................................................... ........................ __........................................................ __._._._................ _._...................... __..................... _................. _.... 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 Mese to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. na a Of Lagal Owner(s) D e afid2tg Ahtl/Or Autho' Appl _M�^___ _ 0 -D e — CODE If INSPECTION TYPE 61gdTE ISL$ CODE r INSPECTIONTYPE � IK � QDt➢!LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical Ely 1266 Pool Spa Final 208 Final Plumbing -. 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT Job Address: 300 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708212 Applicant: ANDY PEARSON Address: P.O. BOX 550 Phone: (714)630-7700 ATWOOD. CA Zip: 92811-0550 Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE COSTA MESA, CA Phone: Zip: 92626 Contractor: WALLACE P. JOHNSON PLMB & HTG, INC. Address: P.O. BOX 550 Arch / Eng : Address: ATWOOD, CA Phone: (714)630-7700 Zip: 92811-0550 License: 262469 Phone: Zip: License: NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 06/30/2000 Issued: 06/30/2000 SCOPE OF PERMIT 5 FLOOR DRAINS, 1 DRINKING FOUNTAIN, 4 GAS OUTLETS, 1 LAUNDRY TUB, 2 RECEPTORS, 5 COMMERCIAL SINKS, 2 SERVICE SINKS, 5 TRAP PRIMERS, 6 URINALS, 13 WASH BASINS, 1 WATE AND VENT, 13 WATER CLOSETS, 1 WATER HTR AND 1 WATER PIPING FOR MARINERS CHRISTIAN SCHOOL. RERB00-00534 NOTICE: The work authorized by this permit st0 " flgfElijfAll@ M"S requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub /Washer $9.80 1 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 $49.00 5 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $58.80 6 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(14) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $19.60 2 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $127.40 13 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $49.00 5 Sewer Connect $0.00 0 Waste and Vent System $9.80 1 Drain, Rainwater $0.00 0 Sewer Private Line $0.00" 0 Water Closet (Toilet) $127.40 13 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/ vent $12.30 1 Drinking Fountain $9.80 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink, commercial $49.00 5 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (14 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $19.60 2 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: $580.95 - NOTICE: The work authorized by this permit st0 " flgfElijfAll@ M"S requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fallowing declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by Section 3700 of the tabor Code, for the performance of the work for which this permit is Issued. I have and will maintain workers' compensatlon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. My workers' Compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Calif mia, an agree".f I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with these provislo Applicant Signature:_Lam'' — Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOU ARE (Slw,ocu), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LADOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Iicen etl nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine and Profess i s ape, and my license Is In full force end effect. L N T Class e (p Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of$erjury 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 pumMnt 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 two hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. 11, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. J Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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, An 2, Sec. 341, Title 8, California Administrative Cade). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 5S gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires reglstration 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 ocxupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, codification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully Complied With? ❑ Yes ❑ NO 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication epereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L) Yes LJ No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes", attach certificate of compliance from the appropriate air pollution Control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materiels 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. Signur Of Legal Owner(s) 7- ,[, O Date TndQr AuthorzWd Applicant Date CODE r. INSPECTION TYPE 2S1E Ifs CODE r INSPECTIONTYPE 2AH IBI" 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 9 200 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 244946 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-m1W.'Si)PRESSI0N PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 300 FISCHERAV Suite: Vicinity: 2ND FLOOR, Parcel Number: 42708212 Zoning: Applicant: COLLINS, MIKE Address: 1612 MORNING SUN Phone: (909) 595-5165 . WALNUT, CA Zip: 91789 . Owner: MARINERS CHRISTIAN SCHOOL Address 300 FISCHER AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: ABLE FIRE PROTECTION Address: 1612 MORNING SUN Phone: (909) 595-5165 Status: ISSUED Applied: 07/26/2000 Issued: 08/08/2000 ISSUED BY: WALNUT, CA Zip: 91789 " License: 398869 SCOPE OF PERMIT "MARINERS CHRISTIAN SCHOOL" 2ND FL ALT, RE:1300-00534, REWORK EXISTING FIRE SPRINKLERS. -FEE SUMMARY Plan Check: $117.81 Calc Valuation: $9,600.00 Permit: $181.25 Claimed Valuation: $9,600.00 Other: $0.00 Total: $299.06 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit FOR INSPECTIONS CALL: (714) 7545626 2"rr46(6/00) V 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' com nation Insurance, as required b section 371X1 of the Labor Code, for the Performance of the work for which this r Pe ad, Y Pe permit is issued. My workerr//yy��tcoompensation Insurance. c�ajm'a7r�an—d policyywnber are: Carrier:,-C2lill�%12�� a�-I"5.� Policy Number: Id OU '(Flits section need not be completed if the permit is valued atone hundred dollars ($100) or ess.) ❑ 1 certify that in the perfo price of th work fo hlch this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C ornia, a ogre 11=8 ou become sublect to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith comply with these pr ons c— _ -Applicant Signature:- Gate:—E/ tJ 0 WARNING: FAILURE S6ldRK0RK­ER`V`COMPENSATIONI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL FIENALTIE4AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am li r 'so f Chapter 9 (commencing with Section 7000) of Division 3 of the, Business and P fessions Code, and my license is in full force and effect. Li C. p Class,q-� L — Conlracto[s.Signature:— - �Dela� CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: - 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 01 the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not morAlhan 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 cwn'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 EXCLUSWELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors Uconse Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feel 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: I Will the applicant or present or future building occupant need to file and certlty a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to registei acutely hazardous materials with the Fire Department. ............................................................................................................................................................................................................................................................................................................................................................................................ 4 Ii en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a $ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution Control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..... ....................................................................................................................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...........................................................................................................................................................................................................................................................................................................................................-.........................I..................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .............................................. ....................................................................... .......................................... ....................................................................... _.-............................... ....................... -._..................... ....................... _............. _.... B (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty 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 gal n at �O P ntl/Or a plic Iii - CODE 0. INSPEC'TIONTYPE QA¢, lili 1� CODE INSPECTION TYPE gn Ifs 1616 Fixed System Final Fire Prevention q � OU + 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Rcot 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 2134 Final Demolition 250 Final Building/Occupancy PROA.CT(DDRESS: 300 FISCHER AV UNIT: OWNfliNAME: SYMBOL .TECHNOLOGIES INC ADDRESs:340 FISC14ER AVE COSTA MESA.CA 92627 ARCH/ENGINEER:NU'TTALL UCHIZONO ASSOC REG.NO.:C-9 �3 ADDRESS: 3199 AIRPORT LOOP DR G I'C C.M. CA 92626 PERMITTEE:FULLMER CONSTRUCTION (909)947-9467 ADDRESS: 1725 S GROVE ONTARIO CA 91761 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. cITrL06�2 B2 ATELID301814 G SSBI /rvX�P- 10/95 ate J/`7� 7 Signature: _ ! ,�jYl' ORKERS' COMPENSATION DECLARATION: I hereby affirm that have a cenilicate of consent to selFinsure or a certificate of Workers' Compensation Insurance, or a penned copy thereol (Section 3800. Lab. Q. POLICY NO.:3901972 EXP. DATE: 01/01/95 COMPANY:ROYAL INS ( Certified copy is hereby furnished. 117 Certified copy is MvJAh the qty Building QDision. / EXEMPTION FROM 11DRKENS' COMPENSATION DECLARATI611: (Trisection need nolbeeomDletedif the dernil is forced hundred(SIOl less). I certify trial in the oedormance of the work for watch this permit is issued. I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that mere is a construction lending agency lot the performance of the work for which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESs:ADD SEPARATION WALL, ONE NEW STAIR OWNER BUILDER DECLARATION: I hereby affirm that I am exempt tram the Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that rte/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 two hundred dollars ($500). I. as owner of the progeny or my em loyeres with wages as their sale compensation, will do the work, and the ❑ structure is not intended or offered lot sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the grocery. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does trot apply to an owner of property who builds or improves thereon and who contracts tot such projects with a contradicts) license pursuant to the Contractors' Slate License Lawl.I am aware that proof of their Worker's Compensation insurance should de provided to me. ❑ 1 am exempt under Section: B. 5 P. C. Ion this reason: Date: Owner I do hereby codify that I am aware of and understand the requirements of California Health and Salely Code Sections 25505, 25533 , antl 25534 and that I or any future building occupant wilUwill not (circle me) need to Comply with said state codes and the requirements for a permit for Construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby cenily 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 state laws relating to building Construction and hereby���WWWjjj�aa0❑ie r resenta(l of this city teener upon the above menti fined pmpedY for in5p tion poses. �'/I— / Tt If Signature_ r CCt Driver s License or ocial security 164446 While—Building; Green—Code Enforcement; Conary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 070342 CONSTRUCTION TYPE: V—N PLAN CHECK NO: 03446-94 A PERMIT TYPE: STR PERM NO; B 0%0342 GOVT: N SUPP: N PURPOSE: ALT JOB DESCRIPTION : INTERIOR 59580 T.I. SQ FT: 194,659 CLAIM VALUE: 470,000.00 CALC—VALUE: 498,360,40 GROUP OCC: E-1 /A-2.1 COMMENTS: T.I. " 21466SF TO GYM AREA S 35499 TO CLASS ROOM " iE Bf HE Rf Hf.)E �E iE*#*9E*iE 1E BF***iE*#*##*#iE 9E iE#**iE jf*iE 1f#;f iE iE if.�iE iE of iE jf iE DE*iE dE*iEiE iE iE BE BE*iE**iE �E iE*iE iE iE iE* *x iE iE iE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- BRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT - IN RG T IN PARKING REQ: PROV: PARCEL: 4.2708201 ZNE: MP • PA -94-38 PLANNING NOTES> INTERIOR ALTERATION TO CONVERT AN INDUSTRIAL > SCHOOL FOR MARINER'S CHURCH. 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 ,TnS ' ZONING APPROVED BY_/,A/DATE: �G•=�' BUILDING APPROVED BY __. DATE: _411 _f/���]��"j/�/ � PPLICATIONiE ISSUED BY: Ycif *-IE IE DAT E*if 7F3E�F'£iFif l 3E iF * * Bf Bf * iE * if BE # BE BE iE jE BE * 1E BE BE * BE jE * iE iE BE if iE iE 1E iE BE iE iE * BE DE * )f iE BE iE iE iE iE iE lE iE iE 1E -lE jE iE BE # iE if * iE BE BE * * * * DE iE * BE if if •M BE.� iE Bf if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2,036.00 4.00 SMIP/NON-R S PLAN 330.85 r 96.26 ISSUE FETE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK `TOTAL PAID DUE TOTALS ---- > 2136.26 0.00 330.85 2467.11 2467.21 -.10 REVENUE DIVISION TOTALS--> COLLECTED: 2136.36 OVER/SHORT: .10 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 2036.00 100:26 BE iE BE if iE 9: iE 9E 1E iE iE iE Bf * iE M * iE HE if iE if iE iE BE iE BE.� 9f 9f dE iE * if * iE * 9E # iE;E iE if iE iE iE BE iE iE if BE iE iE iFiE iE BEy* * iE iE iE * * -lE •lE NE * jE BE * iF if BE BE iE iE 1f HE I N D I V I D U A L F E E B R,E A K D 0 W N TYPE QTY D E S C R I P T I O N UNIT -COST TOTAL COST SFC 35499 SCH—INT. ALTER TYPE V -N —AVER 11.20 397,588.80 SFC 59580 EQU—ALT COMM. SPRINKLER SYS —AVER .33 19,661.40 SFC 59580 EQU—ALT COMM. AIR COND —AVER .69 41,110.20 SFR 40000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 40,000.00 / END.OF FEES \V// 01 0037330E-00173308 TEA T 3136.?6 . DATE: -12/11/44 Ttf,E: :4.;10 _ CONSTRUCTION AND PLANNING �•� APPROVALS Permit # Date Inspector PO( SPA APPROVALS Permit # Date Inspector 1 1.1 Temporary Electrical Service or Pole 52. Pool & Equipment Location Z Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical -Conduit Utility-Undrgrnd. -54. Forms '4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding 5; Sieel Reinforcement - 56. Rough Plumbing & Pressure Test 6, Electrical. OF ERGrnd. 57. APPROVAL TO COVER-GUNITE - >, Footings -58. Electrical Condmt•Undrgrnd. 8. Foundation - 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor•Finat 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT , .APPROVALS'- Perr9it # 20. Rough Factojy Fireplace ,y - 21. Ducts, in Structure -• '- _ 70. Underground Hytjro 22. Ducts, Ventilating, • 71. Product Piping O Gas aDII 23. -Gas Pipe -Rough & Test - 72. Underground Flush 24. -Roof Framing' 73. Uodergrnd'Storage Tank Gas ❑Oil 25. Roof Sheathing 74, Overhead Hydro_ 26. T•Bar Ceiling (Structural) & M6nccoat .. 75. Dry Chemicaf ' 27. Frame and Flashing 76.' Dry Standpipe 28. Lathing & Siding _ 77. -FIXED SYSTEM,FINAL 29. Insulation 78: FIRE PREV. FINAL ' 30. Drywall Nailing HEALTF4'OEPTv'RE00IRI=9ENT- 31. Plaster Brown Coat - - / �q_- 79. FINAL INSPECTION _ 32.' Electrical Power Meter -Final "80. FOOD CERTIFICATE ISSUED 33. Final. Electric - r Notes: 34..Finaf Heating-& Air Conditioning- 35. Final Gas Pipe, -Test", , 36. Hood or Canopy - - - %' -� 1 2 .461��.��/yam - rJ✓v /-.iir�/ _ - _ -iJ%yZN/fs/R/!o0{L 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service -Final 40. Gas Service -Final -- - + Y 41. Solar Domestic -Final �42. Backflow Preventer. 43. Backflow Irrigation' n - 44. Landscape Irrigation System - 45. Sound Attenuation - n 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 6 9� 48. FINAL PLANNING tT I r 49. Electric Release to Edison _ 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date AOOREWOlF SWLOR(0 300 FISCHER AV YNT: mVNE"SxSMEIFIOfowlf: MARINERS CHRISTIAN SCHOOL FLOOD: ADDRE§s: 300 FISCHER AVE COSTA MESA,CA 92626 VPL. MMI➢l0 AODRFSS: AR RTVOROWEEA: NUTTALL 6 UCHIZONO UCND< C9123 ARCH. OR EM'S ADORESS: 3199 AIRPORT LOOP DR M.. C C.M. CA 92626 caNmAcpalrS ' FULLMER CONSTRUCTION (909)947-9467 COKMACTOR9 NADIRS 1725 S GROVE iiDDREx ONTARIO CA mm, 301814 91761 M. LICENSED CONTRACTORS DECLARATION: I hweby aKim anttlr penalty of prjry Man I em fcaued «tdv pwalate a cheer P (conun.ncing with Secdon ]000) of Dimlon 3 of the Old. end Prdm lom Cods. end my Emroe b in M lorca antd exact. uc."o.:Of 26; uc.cLwss: B u.No.: 301814 EXP: OS/ d Done Z R cpmada: ER BUIL R DEC RATION: I lterebY alfim ada palely d Inc, I ut e lit the Cmrecta Dema far the fdbw:N reaem (Semon ]0315 Bmewes end Rclseiom COM: Arry W « oovly velli um a permit to a attw, r, inpave, %' apmdeh, a repoi vy ewmvs, prior b u eamrca, ebo raOtum the alp&am la eW prmi to Me a dprd enea M a end ` ,. 11rolnad laftnnnt to IM lown rhe d the Cairtlae Licenee Lew (Cheer 9 (mnnMrvN wvh Sadion d 3 a IM Buaboes entd Prdeaions COM] a that M a end is easmPt thadr«n and the b® la tlo doped mvription. ARE d Section 7031.5 by any apoiard 1« a pane erbjvb IM applicant to a dW penalty d not mere then On, hundred doDm ]SSDDD. ❑ I.uownerdlM prapMy«my empbnea wYltwpes ntMkoab mmpensafion, witldetM work Wthe etrudataetnl "vlandnd or ollened for sale(Section ]0 1.B....endPrdaedoni Cods: TM (lmractm License Lew does not eppy to an om ofpopedy who bads or enprwea thereon. and who does tc M work heneatl o Med a thraph hb a M own ampbyeee, podded the each 'unprwementa era tw vaadrl a axand la aW. tl, however, the buOMtp a enpowtwl's eatl wehM are yw a oanPlerion, der owrrer-0uildar witl hw the brutes d predrq M a dte did Iw dad «inprow la Oo pvrpms d soMl. ❑ I. m owner d IM P port, am mduirely mrereCitO with fiwneed camadon to comnuct the W*d (Section ]Om. Bueirse and Pmlaedom Cade: The Cmrectm Licence Lew does not nv* b an oener of popony who buBM or i npwm thereon and who cauntrecte la ouch Pajeda wait a mlmaa(p liarwa . ptueuMnt to the Ctwreme flume. Lew). ❑ 1 em esempt under Seclian: B. & P.C., W the nmvc Done: Owner. I do hereby candy Met I am aware of and ixderetacl the reeuitaneeN of Celiomle Iledh and Safety Code Sections 25505, 25533, and 25531, and that 1 o ave Mm buildim oo."M will I w0 not (dmle are) need to conO, with teid Mels codes end the reRukemann for a totmit l« mmtructionamodRtulion tram the shy—antepmwa Di tAd+Refida[elmMtWion eppimtioman afomp Iran Mesa Pombns. Done: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby dfnn ii dr penalty of pwr xy err d the bticwlrtp Mdanatiom: ❑ I hem end veil meimen a cenxreM d uot®e to vmlf r ere for worken'tompemvion. u prvided for by Salim 0]00 of IM Lebo cads, to the partamena of the wok for wfirA the permit u blued. ❑ w hew and veal menden wMae' mmpauetin Wuranca, m reOWad by 6wim 3]OO a the lobar CDM. br 1M padamerae d IM wak la wfiidt that v«nd u blued. My waken• eOmtperreananlun :weaae mn+en endpofe.Y rvmbr en: Canter: TDrr)TIPT Tr ThIn EXPIRES Pdim•Number: TnCSOn7 01/01/98 (ma seabn need not bi, aon,Ww l Me pant u levans lmm dellen Rlwj or NmJ ❑ I eenh tlw n Or pNotnMrce a w wmrkW whin Otv Delnnt b Wtod, I dtd lta entplof anry prvt n ave merew ee m to aubinct to the worker,• wmpsMalon Mwe of colds a endp epee than it I ehald nmpa to the worlwY / ped. pw"vum a ^sectionn voo d the lobar COM. I Wpb{ptd\nit amply wen Mw WJ—/IW:Flynn b,sun workri rorrpruetlon coeeeYe/i WVdh4 ens ehdleW/cf oyerb MMrtel u awl Mee `4P b ate hl 1Mueerrd "len, fir 104004, b eaYten b thea pest of bA rferrtepes m rbe0 b In Seed. 3]05 of ft Leber Cock IW t and f.1,W. leu. CONSTRUCTION LENDING AGENCY: I hereby Mom tinder pataby of pr iry the Owe is e ooetnict. W.*, aparKT for dw Md.. of the work for ~ Ohm pane u Bawd (Seam 3 . Cb. C). LENDER'S NAME LENDER'S ADDRESS: I candy tht I town pond this appfcetvt and Mesa Ihet the above itlarltwion is con W. I qpu to comply with a ody rd rwMy «dWn w and aide Iowa relonbp tp Wld'np mtufnwim end haabyaahaba rapmaaebNe ath'e ray to enter upon the ebo eiltert1011ad papery la inspection Ixmpcx m. DAVE-LCnENZ / Done: Z (5151a9.Wpl White-SuiMito B Safety: Green -File: Genn oolrent:Pink-Rermue: Odchnnn -Afameo CITY OF COSTA MESA - BUILDING PERMIT PERM NO: ➢ 083621 PERMIT NO: B 083621 PLAN CHECK NO: 01910-97 A GOVT: N SUPP: N CONSTRUCTION TYPE: V -N -SP PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : 17385SF 2ND FLR CLASS RM & OFFICES TI SQ FT: 250,000 CLAIM VALUE: -250,000.00 CALC-VALUE: 250,000.00 GROUP OCC: B /E-1 COMMENTS: "MARINERS CHRISTIAN SCHOOL" Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708212 ZNE: MP REF NO: PLANNING NOTES>TENANT IMPROVEMENT TO CONVERT OFFICE SPACE TO SCHOOL ROOMS > P-ND.OFFICES•-AT MARINERS CHRISTIAN SCHOOL x-**>E****Fir**dr��*-(,�a��*>E*�*�pRk36Y*�k*�df*�*�E�r***��*�*aE**>F**>E�**tE�#��#n��>E•r.�F�#*tea*�dr� D E V E t0 P_ M E N `+T S E R V I C E S` ,. R E Q U I R E M E N T S ZONING APPROVED EY'�jyf DATE., _ r� (� BUILDING APPROVED ­,BY ��� DATE:-d'e�—�1, I APPLICATION ISSUED BY: �' DATE: il•R6 dk if d(•df if'lE iE iF iF iE iE iF d(-ih iF 34 ih iF iF iE Y x -K -k RFitii'�i=iF�+�iE iEiE if lE if if jE-)E Bt iF�'>��iE IF LEGALIZATION:N F E E S -U M M A Y. STRUCTURAL SEGMENT:Y -' , , ✓. mss. .. BLDG PMT PLUMBING ELECTWrC M$CHANist. FIRE SMIP/RES GRADING PERMIT 1,637.25 SMIP/NON-RES PLAN 266.05 52.50 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE .PLAN -CHECK rIGiAL PAID DUE TOTALS ---- > 1689.75 0.00 266'.08 (1455!80 1955.80 .00 REVENUE DIVISION TOTALS--> COLLECTED: 1689%.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC 'FIRE SMIP/TOT GRADING PLAN -CHECK 1637.25 r 52.50 Fir?'rie�t**x��r>E�t��F***Fir*�rxirrt�Rt*x•reit*�EiFx�t*k.******�t�r**�E�***•���t****�F�t*�E*�F�t*ar.+E#*rt**=*t�Rl;� IND I V I D U A I I; "F E E B/.R •£ A K D O W N TYPE QTY D E S C R I P T I O N z UNIT COST TOTAL COST SFC 250000 ALTER BY VALUE COMMERCIALS NOZOlfE " 1.00 250,000.00 ENDi OF FEES' l ricer Y;G:; a t –• r .+ � a'brl,f,; y s i,�tgttrhV•o�r) i2a3odaby this permit . thaf• fr, f is,4fahandiStatute ja � /t .r � '' q1 -47J% and iC^f aatcdregulatCITY COST ions., "+vela CONSTRUCTION AND PLANNING ' APPROVALS Permit# Date Inspector POt SPA APPROVALS Permit# Date Inspector, 1. Temporary Electrical Service or Pole 52. Pool & Equipment Locatio6 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit -Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undtgrnd. 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 I :68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 26. T -Bar Ceiling 'Stru • fall & Monocoat 27. Frame and Flashing Y 74. Overhead Hydro 75. Dry Chemical " 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL - 30. Drywall Nailing _0=a101 -In HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 33. Final Electric 34. Final Heating &Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace _ 80. FOOD CERTIFICATE ISSUED Notes:? 7 7/11:1 4 % ��� �✓ ,,,,lll �_ �N.7 // /��`-�L,`/`'�/ �^S- �bA 1/7087 /� f Tlc d3we 0.4d, �cJa )Go COO • 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final --t 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations -� 4T. FINAL STRUCTURE & BUILDING 6`p 0 1 �`✓/� - 48. FINAL PLANNING 49'. Electric Release to Edison ` 56. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF BUILDING: 300 FISCHER AV UNIT: OWNERS NAME IF IVIDWN MARINERS CHRISTIAN SCHOOL FLOOD: ADOREss: 300 FISCHER AVE k " COSTA MESA,CA 92626 APPL. "IIND AOORF55: ARCHITECT OR ENGINEER: NUTTALL & UCHIZONO MONO: 09123 ARCH. OR ENG.'S ADDRESS: 3199 AIRPORT LOOP DR UNIT, C C,M, CA 92626 cONDIACTpTSNmm* FULLMER CONSTRUCTION (909)947-9467 CONTRACTORS MNUNG 1725 S GROVE ADDRESS: ONTARIO CA uallo, 301814 91761 uNr LICENSEDCONTRACTORS DECLARATION: I hereby alum under penaky, of perjury Mat I am licensed under provisions of Chapter 9 ( ' with Section 70W) of Damon 3 of the Business and Professions Code. ad my liceree is in Nil lace end effect. Cm LIC. I o.: (6 3 2 8 LIC. CUSS: B LIC. NO.: 3 018 14 EXP: 0 0 0 Dae: Cohador: OWNE UIL ER DECLARATION: I hereby eNrm ands peoly, d parjrry 1Mt Iem q em mm the CaN4.1=h. Lew to Ma p reason (Section 7031.5 Buenas end Professions Code: Any city a awnty x Ruima a pewR lermprov, demolish. or repair any swohms. Prior to Is lsauance, also mousses the applicant for such permk 1p fib a eipnM a she is licensed I muaN to the Wovisions d the Conuect«a License Lew (Chapter 9 (memmeraa9 with Sectionn 3 of the Businses and Prdeaiaa Coda] or that he a ahs, IS aaemp th«alms sect the buu 1« the ellped "sorption. MY violation of Setlon 7031.5 by my app Dunt for a perms sldpcta the applicant 1p a dwl penally of not in. than Twa hundred dollen [S500D. ❑ 1, w owner ofthe propend or my employees with wepes w their mole mmpenadan, will do the work. and IM slouches b not intended or onemd for tale (Section 70th, Susinea and Professions Code: The Commctom License Lew does not applyto an ownerd property who bolds or improves thereon, and mho does such wok hu sen or Mnel or thraph his or her own employees, provided that each impanemema ars not intended a dlemd for vale n, however, IM Wftol; or improvement is sok vdlhin one year of rxnplelion, par ownsr-0uilder will beers IM Wrdan of famarp the or aha dk not Wik or rmpron for the Purposes of sale). ❑ 1. as owner of the properly, an asdusrvdy, awlmol with licensed onb«dors to construct the project (Section 7044. Bwirwe and interest, Coda: The Contreaon Licence Lew dose not appy to an owner d property who alike or improve, thereon and who awtretti tar much projects wind a ormatoms) Icansed mrstant to the Contrasors License Lew). ❑ I an exempt oder Sermon: B. d P.C., ler this mason: Data: Owner: I do hereby ceriy post I am ease of and understand the m0utre mxb of CaRoma Health and Safety Cab Sedans 25505, 25533. ad 2553x, and that I or my Noun, W ikirro 000tm nt will tons cat (cimie one) orad to comply with aid sae codes end the recaimments ler e permklacantnation«mod'drmionkanlMAi ue yanepemenl Destrid. Residedial ooralntlion appnretions ere of fins, theme Provisions. WORKER'S COMPENSATION DECLARATION: I hereby, alfilm under penally d parlay ane d the follosenniI soone ions: ❑ I haws, end will menden acenifraledamaenl to seninsure ler woken'canperwaion,m Provided lor by Section 3700dme Labor coda 1« the performance of the work la which this Persil is issued. ❑ I have real ail maintain warkan' mmpenalion insurance. as reRuin l by Sermon 37M of the Labor Coda, ler IM perlormanm of that j� wok for which this permit is Neued. My workers' compensation immence order and pdiq number as,: Carrier. PVPTTAT.Tr TUT) EXPIRES Policy Number. 4Q& 5 � 0 � 01/01/98 (this section need nal be aneplered l the permit is ler one hundred dollen (Stool or lees.) ❑dy i Iha in IM pedom sere d IM wmk for ehpermit ich this pit is issued, I shall cat employ any pamoo In ary m r eo eam to —w-, Ins Ihe ora .1011.1011awes d Cekfssma. and .. Mat w e I awed beomx e biem t as; i Dile Ing: Fegun lo exon wol9era' compaNstlon rovengaNalRfwbl, end Nell t an employer cdmlNl p l f/N she vll Rhea W b one hurdrM fhouNnd tlo/bn (S7ag00D1, In edtlltlon b in coat f interstate 4 mega u v/ded for In 5 son 3706 of Ms (ebur Cods, IntereaL end egomsyl Taxa CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d perjury that them is e o onion bndirq apenoy for the pedormalro of the work for ehiM the permit is e,uad (Section 3097, Civ, C), LENDER'S NAME: LENDERS ADDRESS: I teddy Ihet I have read this appfcalion and state that the shone information is carred. I apse to campy wUh all dry end mwnly, adinarcea and sure ties repai g to W iMinp conaumon and hereby au0arae npnaentativea of this city to anter upon IM above-memiwW properly for inspection wrpmies. DAVE LORENZ 7 (5151-460P) WMs.-Suiknp& Sdery; Date: Pink-Rmeno; Gddanrad-M. CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 083221 PERMIT NO: B 083223 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N -SP PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION : DEMOLISH NONBEARING WALLS ON 2ND FLOOR SQ FT: 12,000 CLAIM VALUE: 12,000,00 CALL -VALUE: 12,000,00 GROUP OCC: B /E-1 COMMENTS:,"MAR'INERS CHRISTIAN SCHOOL" PC#1910-97A ##*####### Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING --------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROM PARCELS 42708212 ZNE: REF NO: PLANNING NOTES> > 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 ZUNING APPROVLD BY BUILDING APPROVED BY ; APPLICATION ISSUED BY: iFa eF £iF>f LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 187-25 PLAN ISSUE FEE BUILDING -DSV-> PERMIT ISSUE PLAN -CHECK TOTALS ---- > 189,77 0,00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 187,25 DATE: DATE: DATE:, STRUCTURAL SE MENT:Y SMIP/RES GRADING SMIP/NON-RES 2.52 TOTAL PAID DUE 189,77 189,77 ,00 189,77 OVER/SHORT: 00 FIRE SMIP/TOT GRADING PLAN -CHECK 2.52 'Ir####tri#ir####]F9('#'irl('####X'tr####A'#')r#1r####')r#'lF##-ir ir'#######')('##'x')('#y(•'##fF###'K'##ir##)F aF##]F iF #'Ir## I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 12000 DEMOLISH BY VALUE COMMERCIAL NOZONE 1,00 12,000,00 END OF FEES 06-03-1997/01:48 Pii/i189.77 RCPTJ:51-Z'074_(7 PERMIT, -083223 CONSTRUCTION AND PLANNING - APPROVALS Permit # Date 1. temporary Electrical Service or Pole Inspector POC . SPA - APPROVALS Permit # 52. Pool & Equipment Location • Date Inspector 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test i 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 t 14. Rough Plumbing 65, Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating.& Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 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 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32, Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final t 41. Solar Domestic-Final 42. Backflow Preventer it 43. Backflow Irrigation 44. Landscape Irrigation System 45, Sound Attenuation 46. Handicap Regulations / 47, FINAL STRUCTURE & BUILDING 6Cp� GGG 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF rUILGNG: MARINERS CHRISTIAN SCHOOL FLOCuxh; ONw� r --Nom: 300 FISCHER AVE *lREss: COSTA MESA,CA 92626 IV�,. NPL. WUUNG ADDRESR NUTTALL 6 UCHIZONO 09123 ARCNRECTORENDINEER: 3199 AIRPORT LOOP DR uc. eco.: C ARCH. OR M'S ADDRESS: C. M. CA 92626 uMT: FULLMER CONSTRUCTION (909)947-9467 ax MTOBSNAME 1725 S GROVE c,NmAcmlrslwLRfG ONTARIO CA 301814 AODRESs 91761 UC. NO: UNIT: SED COMRACTORS.DECLARAnON: I hereby,affrm under pemtly d perjoti I nm, licenesd under provviorn d Chesser 9 ( er. , mesh Sectmn.700() iof DiMnon 9 of the sue. end Professions CaEe!and'mY lioines e n hUl lace end a facL, 0 LIC. NO, UC. CILASS: UC. NO.: Dore —7— 4 — % l co trona: ER BUILDER DECLARATION: I hereby elfiet under pensky mrlury that I est stem Irons t ro Camdm limes w la N. win, w, reawn (Section 7001.5 Storms and PMe®orn Code: Any cry or county mhich n e ,scot to com+eucl ser. bop demolish, or raper airy,runure,prow M its Iseumco, also roquiros IM apptk'Ara for such permh to We a stated ales Net M a a licensed Wraanl to Ihe prwei«d of Ne C tnbatas lmeree law (Chapter 9 (commencer, whh Sedion 700)) of on the 7MI.5b end app6o ort Cade(a Nd M « end a l m t lherehom end d bete to Ne r h m ptbn. Airy )D bodion 7001.5 by env appkcant 1«. permh ,Npda Ihe aWlnaM to a civil narmM1Y d ml mss Than fine hadne 7bDva �5500�. ❑ I.mown«dtMacWnv«myampb/ee Prota9mmC eTe Cm nwioL Wldo Nemork,e applytomby nol'vrW" «offered la sob (Sechm 7044, Budnsss end Prdesuons Godo: TMCanrodas li0ense law dot M appytom szrd propery who MEC. s mpr not ended! end who dose send mark , th «bend a Nra,h hIs a her own empyw, provMed mio ,the impro+ameme ra M emended «dhnd la esb. tl, however, the Wpdirp a knprovemeM b add wiNn one year d o0mpblbn, the ownwbuiMer mill have IM WNz d ,covet, M w end d'd red MiM a improve la the pumoee tl mss). , ❑ I, as ownsr a the property, are as iusively conVmk, vmh Uoensed contrztas to construct the project (Session 7044, Sntr,es and pndessmuns Cads: The (;ontractm license Law does not appy 10 an owrm of pfapedy mso buide w, improves thereon end mho cantrocb for such pro ol. "h a mnsa l r(e) Icemad Wnuam to IM Cadradors limine law). ❑ I an esempl under Section: B. & PC.. for this roams: , I Date: Ownsr: 1 do hereby cw* Net 1 am aware of end wdemtrd the reauinrnems of California Ila.hh And Safety Cada Seth«, 25505, 25593, end 255D1, end ted I or any future Wibing omge d wi11I will not (outdo m.) need to eanply ekh said some codes and IM neuirameme tor epzrd l«mnsmrmon«modifimtionhomlMAi�GaTt anep,nam Di,rid. Residential wnmudion appiretiom en eumpt from these probmns. Dine: Apdipam: WORKER'S COMPENSATION DECLARATION: I hereby atNm under pansky of perpvy one of the fofkvoinp declensions: ❑ 1 have and mil mermen a oandrs e of convent to selfiruun for ewkre' compenaelion, m provided for by Section 3700 of the LAbor Y Cade, for the pedomarcs of this w Iw whish One pannh m issued. ❑ I hone and coil merman •«kere' oampe cation rose". m nquirad,b, Sect" P700 of the Labor Cade. for the perbrmathoss work for which Nis strath is issued. MY waken' mmpenatlionn,inrm c rdsi-aid p sic, mmher era: ren Y 1>1 G S carrier: 3065202 01/01/98 policy Number: smuinn needn t e cornplred ] the prml is Mr aro Auedrod it is h ryecl. I «Anse) ❑ I oenly thin in the W. d IM wwk la whish this mrmh is issued. I shell red ploy rry per in erry manner we ro to mbjap to IM of Ti' commnesthe bws G Cd'dan' and apse UW tl elwud bac atbMd to the markets' p.m./r n prwoi.on9 a�pfd'-'sT7oD d the L.b« cod..1 nwhn raspy wish No.. pre .. 1 - Dale: L i / m / Afrotioam: A/VtI-:C Wrnlp: Fe0ur, Mazur, wants' coape Suri covre9, IsydmlFl, and elWi Hot lays, to odrdrW I1191hIn dull fines W M ons Modred tMuseref do/bn ($10900% As aMtlldon M the cost 0 dprl deros9es m vidSecdon 97M of the Labor Cods, ,menet, Bond edomey'e fees. CONST111=0N LENDING AGENCY: I hereby affirm under mneRy d prry this there is e aorWrodi0n rep spa pedorraze of the w for Which this mink is Issued (Section 9097, Civ. C). LENDER'S NAME LENDER'S ADDRESS: 1 certify that I hem reed this epplicetion end mule that the above information is torted. I Wires to comply Mh At city And and state bine relatk, to buigN nonst, inn ahlh—by author¢. ropremetativee of the ary to enter upon the abovei for inspd ebrym n pues. _ V Date: Z _ '" _9 Whft - uildiw A Sefaty; GrenrFI.I every-Ap omk Pink -Revenue; Oodlcwu d-Aosemor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P83669 PLAN CHECK NO: N 1777 .. CONSTRUCTION TYPE: V—N—SP PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION ; 17385SF 2ND FLR CLASS RM 6 OFFICES TI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B /E-1 COMMENTS: "MARINERS CHRISTIAN SCHOOL" REF:B-83621 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- ^.NT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ: PROV: PARCEL: 42708212 ZNE: REF NO: PLANNING NOTES> PLU 11 WASH BASIN 8.75 96.25 > 2 WATER CLOSET (TOILET)/, ' 8.75 17.50 PLU 2 DRINKING FOUNTAINS, ., 8.75 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 PLU 1 REPAIR/ALTER DRAINAGE/VENT PIPING 8.75 t ZONING APPROVED BY BUILDING APPROVED BY : APPLICATION ISSUED BY: LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC,' MEC; PERMIT 175.00 ? •� 258 j r PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CITECK TOTALS ---- > 175.00 22.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC M'EZ: 7AvIC 197.00 ,1 IC FIRE TOTAL 197.00 DATE: DATE: STRUCTURAL SEGMENT:N SMIP/RES GRADING SMIP/NON—RES PAID DUE 19'7.00 .00 197.00 OVER/SHORT: ,00 FIRE SMIP/TOT GRADING PLAN—CHECK 87-89-1997/83•' I N D I V I D U A U-` `,.F 'E E B R E A K D ®' W N r Gs' �• — f TYPE QTY D E S C R I P T I O_xl UNIT COST TOTAL COST PLU 1 DISHWASHER�F 8,75 8,75 PLU 1 SHOWER ,i 8.75 8.75 PLU 11 WASH BASIN 8.75 96.25 PLU 2 WATER CLOSET (TOILET)/, ' 8.75 17.50 PLU 2 DRINKING FOUNTAINS, ., 8.75 17.50 PLU 2 FLOOR DRAINS c 8.75 17,50 PLU 1 REPAIR/ALTER DRAINAGE/VENT PIPING 8.75 8.75 END,�OF FEES 87-89-1997/83•' PERMIT .i'f�.•ii H r Gs' �• --iCONSTRUCTION AND PLANNING APFlr:OVALS Permit#1 -- Date Inspector POG. SPA - ' "i APPROVALS Permit'#-- Date- % Inspdctor - 1 emporary Electrical Service or, Pole , 52. Pool & Equipment Location , 2. Soil Pipe•Undrgrnd. ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Farms 4. Electrical Conduit -Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE ,.. 7. Footings 58. Electrical Conduit- Undrgrnd. I - 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P.Trap, E 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 -Fin al ' 13. Roof Drains 64. Plumbing System -Final 14. Rough Plumbing, ;65. Ele6trical-Final 15. Rough Electrical -Conduit l .66. Solar System -Final ._ 16. Rough Electric Wiring - '67. Fencing -& Access Approval ' i 17. Rough Wiring Sign - '' , - - 68. APPROVED FOR PLASTERING " 18. Rough Electrical -T Bar Ceiling 1 - 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating '& Air Conditioning - -- FIRE DEPT. REQUIREMENT APPROVALS Permit ' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas 0 -Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 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 33. Final Electric 34. Final Heating & Air Conditioning Notes: D �L,,P._o 4fSt/ L�Z_ct�t y�Lt-is =Ilrff- DG kt.rrck'rcz-rSi+•rot+;c 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40, Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer - 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation , Cr 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison ,50t Gas Release to Southern California Gas Co 151. CERTIFICATE OF OCCUPANCY No. Date9�8 �6tj 9; �'78.641d' MORESSO'NIMLIIWG MARINERS CHRISTIAN SCHOOL FLOCuffiT; o�lRERSNsmyiF OwrI: 300 FISCHER AVE b ,;ODREm: COSTA MESA,CA 92626 APDL. "ll NG MDRE55: NUTTALL E UCHIZONO C9123 ARCNINECTOREN(ONHR: 3199 AIRPORT LOOP DR uG No: C UM OR M's ODIUM: C.M. CA 92626 um FULLMER CONSTRUCTION (909)947-9467 CONMUORsf - 1725 S GROVE CCNmMmirsia If➢NG ONTARIO CA 301814 MORIMt 91761 vac No.: mAf: LICENSED C0MflACTORS DECLARATION: I hereby dtkrll aster perety of pajr .." I wn Pawned oMar p.d ChWer S (mmnsumu, wfth:Sect d the *'ol Ones. 3 re Band ars! Prdmeoes Code?andTY 5m. is in hog jgrce wed .1i a. / 9 8 WN BUILDE DECIARATION: I hereby affirm ulster peneL jd perµy thel I Weer the Contest Law a IM reason leer ]031.5 Buskrem est Pedesa«u Cada: Arty cry «manly nqu'vva a pmnit to Mer. prove. doh, «repel any atudure, Prior a ns ewanee, abo requires the epgimd la inch permlt to fib a wgned that a she s licensed purNwnt to the provisions d the Conlredon linea law IChegw 9 Immmarweq wilt seaon 1000 d D"' 3 d the Bucirrem est Prdessoos Cadet a that he «aha a ezemq Iherdrem est the brae I« tlne a0eged exemgipn. Airy d Beton ]031.5 by wry epi iCent 1« a permit .4eea Ute applimm to a cid penaby of no, mea than We hundred dollars rM)D. ❑ I,asawosr of the property or my, em Pit. wet, wages n thei ads mmpenseton." do Use week aM the amalure'w not moeMed «Haredfa sale(Boston ]OW,Bimosmend Pmleasbna Cattle: The CO mLininslawd mapplytombvnwdpm ay who hide «mpossys Thereon, next who doss su h wk fimntl or hessa «Uraph his or hos own employes. prwded lines welt improvernwda we not bderstetl or dived for sale. D, bev eser, the building a knpraanent is add "No one yew of mmpeton, Ue o.-Wilcier will have the burden of prosin he or she did not buitl «improve for 0re purpuae of sale). ❑ I, as owner d the properly. em esdumvely nmrmkq eilh licaesed cantrxtwe b mrretruC IM project (Section 1 , Elmnam and Professore Code: The Contractee L'owas Law does not so* to an ower, of property who Wilds or improvva Thereon end who contracts for suh ptgects with a owdrele ls) beenseA esmoaw to IM C sclera Litems law). ❑ 1 ern emmpt under Be to : B. 8 P.C., Re this revon: Date: Owren. PERMIT NO: M CONSTRUCTION CITY 08 3688 TYPE: V—N—SP OF COSTA MESA — BUILDING PERMIT PLAN CHECK NO: I N PERMIT TYPE: MEC JOB DESCRIPTION : 17385SF 2ND FLR CLASS RM S OFFICES TI CLAIM VALUE: CALC—VALUE: PURPOSE: ALT SQ FT: GROUP OCC: B /E-1 COMMENTS: "MARINERS CHRISTIAN SCHOOL" REF:B-83621 iE dE df df dE***��***�i di dP�******+t**+f•�*******�t*�t-�*****�*xr���c ac �P****�*�t***�yt*+�*�k**:>E �r��**�*->F Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ----------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT- FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708212 ZNE: REF NO: PLANNING NOTES> > . dE dF df iE 3E dE'6 dE iE iE iE dE df if ie dE iE ie df iE dE dE ibiE lE if ?E iE dF ik?E if df lo- i(-* d! iF?(• dE dE if dE * dE dE dE * * * * * iE )E )h 1(-dE iE dE 3E dE #c iE dE iF df if * * 36 �i dE df if dE � * ie ie D E V E L O P M E N T S E XV I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE- -APPLICATION ISSUED BY:DATE: -if dE dk*dE dE iE dE ih *iE iE iE if dh dE*dF*dE j6 if „ ] .. ***iE*iF*iE iE i6�F"Fd iE� 3E if .LEGALIZATION:N F E E •�S U M M A R Y STRUCTURAL SEGMENT:N I re hereby certify that l am awwe d ane nmdaabrd the regdramwm of caBornia Health ane Bafdy coda Bwion 25Nn. u ,end BLDG PMT PLUMBING ELECTRIC . -MECHANIC FIRE SMIP/RES GRADING 25534, cost thet I or any Mum Wilding omupare will / coil Iwl (dmle ane) need to comply with said ewe mdva text the em tremwva for .pwmlt lamreWdian«maeifimtlmhantMA: racy vregemtm Dshiid. Rtaidwnid owhst tion appintiam ere asemgrran these PERMIT �• 1; 65.00 gaysion3. 25% SMI,P/NON-RES Doe: Applicant: PLAN.. ISSUE FEE G 22.00 WORKER'S COMPENSATION DMURATION: I hereby atUm uMw penalty d perry, one of the followbp dwWetbm: BUILDING—DIV—> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE ❑ IhevaeMwOmatntanecertacatedmreenitoaefiynmrehvweekere'c«npenmton,mpraystedlabySedion3]00dtMlalgr TOTALS ---- > 65.00 22.00 0.00 87.00 87.00 .00 �. COde. 1« the self e d the week 1« which this pernld s acted. ❑ Ihevs wsteel mainlen w«kerued. Mynsnorers' water insurame. i6hIntad.bySegderl6d die, labor COM. brlro Parlmmwlacd�M work r« whoh Ula Perms is ecued. MY waken'�canpiineation inedrwaa cardei4ind pdiry number carrier: 3065102 01/01/98 Policy Number: (This melon need rel be eOmpletad y Ue perm, a ler Ono hundred dollen /5100] «len.) ply that in the Warmance of the wok ler which this parent is issum. I atoll rlol empty wry in wry "renew w we to subjeQ to the canpeeuation laws d Co' agree that d I abaust subZ to the workare' Psnmtim ArostsianyLof W igCS)W or he Lebo Code, l 1 r wnPh wiU Dose P�u. tivll neva op Its one nwnrea nraumrq dome fe700.0oU/, m eaw0on ro me westo/rorrpyn++Von ++rrWu a+ vessel Ses,don 5106 of Me Lebo, Code, Interval, and attomay's lass. /V/ CONSTRUCTION LENDING AGENCY: I hereby wfine urster penalty of perjury that there is a benowction irg We or Ua pedeser. of the work ler which the panni is issued (Swfon 305)7. Ci,. c). LENDER'S NAME: LENDER'S ADORESS: I certify that I heve mad this eoplcatim and dab Ihw The above information is carred. l Vnesto campy with all dry est mumy odinwnns and state laws relating IP Wildkng egnseud'an and hereby authorize rePremntwives of this dtyto enter upon the above-mentbnetl property for inspection urpams. L—. L I1l1""V Date: (515146.WP) aih'no-Buildkg b B§bTy: GrewrRi:Cen,r PPicent: Pink-Rerenos: Gddenmd-Aememr REVENUE DIVISION TOTALS--> COLLECTED: 87.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 8 7.. (47.0 dE iE dE dE dE dE dE dt dE iE iE if di if iE dE de dh iE iE dE dE iE iE iE dE if if iF � iE tlh dF if dE dP iE dF'.iF iFil• iE iE iE iE lit iE 3f iE dF?P � iE dE * 3f dE dE iE tlE * iE f df iE dE * iE iE iF iF-1E iE * it iE iE * iE IND I V I D U A L `;F lE E B R E A K D. p W N TYPE QTY D E S C R I P T I O N/ i' UNIT COST TOTAL COST MEC 2 INST FORC—AIR/GRAV,,FURN > 100 K BTU 16.25 32.50 MEC 2 REFRIGERATION SYSTEM `> 100 K BTU/H 16.25 32.50 ENDI OF FEES 1�71r/ 87-09-1997/83:17 P8/487.88 MYTI:91-8888894 i1 PERMIT:983688 V 41 , . � QNSTRUCTION AND PLANNING- _ �.,PPROVALS Permit # Date Inspector POO. SPA APPROVALS Permit # Date Inspector ,1�, Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe'Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms' 4. Electrical Conduit -Undrgrnd. - 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9, Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap,, 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 - y 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 - 20. Rough Factory Fireplace Zt. FIRE DEPT. REQUIREMENT APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd, Storage Tank O Gas ❑ 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 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36, Hood or Canopy Ly •t Notes: 37. Final Factory Fireplace 38. Final Plumbing . 39. Water Service -Final 40, Gas Service -Final 41, Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45,. Sound Attenuation rt 46. Handicap Regulations �,• X S ,47. FINAL STRUCTURE &BUILDING r� 4&, FINAL PLANNING A4 . Electric Release to Edison7,µ, 50'. Gas Release to Southern California Gas Go 51!, CERTIFICATE OF OCCUPANCY No. Date ^_ ADDRESS Op BUILDING: 300 FISI_HER AV UNIT: 0MITS1,AMEW1010011: MARINERS CHRISTIAN SCHOOL FLOOD: AODEss: 300 FISCHER AVE COSTA MESA,CA 92626 VPL. MMLmO ADDRESS: ARCNITECT OR ENGINEER: Uhl No, ARCH. OR ENO: S ADDRESS: UNIT: coNmAc7ows NAME: AMERICAN ALARM SYSTEMS (714)547-7474 CONRIACTORSM RING 1101 S GRAND AV ADDRESS: SANTA ANA CA mw.: 299406 92705 UNIT: G UCMS50 CONTRACTORS DECLARATION: I Mreby affirm under penalty of pejo" tlr I m how ned under provivions of Chapter D (commeoarp w h Section AtD()) o1 Deeion 3 of the Bustr m and Prareiam Coda. ane my Samara is e 1M bon and Med. 3uc.No, 0666691 LIC. CLASS: C 10 LIC. No, 2994// LA06Q Exp. 01 /98 NER BUILDER DECRATION: I hereby affirm uMmnalt penalty of penury Ihat I am _Marr l harmthe Com trrfon Lame Lear I« IM Idlawig reason (Section 7031.5 BmhMr and Prdmer Cade: AM My or county which Moves a permit Io aomwa. Mer, improv, M IkM9ed W19Uant to the gm'm.Ma a pM 1 Fao*«a LNtlNe Lew JUtWW 9 (mmmrmq weh SedGn 7000) d Uhm Bwirr aro Ramer Code] d that a pr dM a exempt Ihadmnn end IM bone for the eloped rerl ion. MY violeti 7031.5 by ary applimnt for a panne subleds the epplicenl Io a awl penaDy of W mare than five hwdrad dollars 1550D7). ❑ I, eaownar dlM proyenym my w0arer MhwepeantMieok mmpanrWim. Waldo the wok. and lheandune «OwedMWe(Sadiron7o ,Busiparand Profraaor Code:TMCmtWm LimreLewdoesnaIapplytoaown wM Meda «hnomros therm. end who dor sud Bark InnaeB a MnM pr Mandl he «herr parr emokneas. pnovk ian « snN aro not warder d dleral for,eele. I. however, the baldity w knpwwnea ie sold Whkr oyear of aomplalion, the.. buadw welt have IM bola of pmvinv M or Mar did not bald or bngove td UM puryme of sale). ❑ I. as ownar of the property, are esd w* mdradiq rnhh I ended coracbne W cmarud ye voted (Sadiron Tota, a.. and Prof. Code: TM C«areapra limens I.A. dm rot appy M m www d papa" who builder v irnrnrr tMraOn and who conlrecM for eurh protects wM a oatlmdor(s) literal punuW to the C«Nradds Limos Law1. ❑ 1 am e er p1 oder Ser3en: B. 8 P.C., for She seem: Data awrw: I do h.M, caniy that I em aware of end ardenw nd the rseuiemads d Callorria N and Salary C Senior 35505. Y5533, end 25531, and IMI I «eery Mur WildiN oocpaun will / wR not (circle err) need W amply whh rid nate codes and the raquiromab Wes apamh for mnauuaionwmodAaation hon IM As 01 y Waaftsensot0ianot. Rrkential candludion appbrlens are ermq ham these pownone. Dae: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby sham ander penalty d pwry, one of ys fdbwieq dwWaior: ❑ I her old Wal mains n cenif"o d (Oram So sMimn M waken'rompenmtion, r provided far by SWion 3700 d the Labw code.Iw the padmwsn d the wok M wMh the PsnM a Wua. Q 1 hew end alp mss ,arrwaken' m. My earicn irurarv, di naunssd ro Section 3 rel d ys labor Code, tar the paddmenae d the a • work I« xhkh Mie permh b Mued. My woken' romperuakM inmate artier end policy number er: Cartier: ZENITH INS EXPIRES Policy Numbsr: L U 4 L b 1 6 b V 1 11101197 (This section need nal be oaropaeasd it UM Perak e M or honored ddlan )9100/ or Ier.) ❑ I m Dal in 1 pedormence a the work la whirl the aklor a aocl I sup nnol employ err parser M arty mannan r lu to _bbb a aubled to IM worker' wmparation Wr d Ceeprnia end epos Uiat p I dark baron rbjarl to the woMen' /a romp Wim pweaa d Sed'Mn� d the Labor Code. Map fahwh wmpy}iN yrs v00�«F� y �(/� v: W he rr aacura Iral l ft cloywtlon04=1 a lWilcr Ad, aM a l of mesa a error, de ro,,me as rvWrAmparrawea //In ir Ilona W ro Meer Labor tMueard ddbn 1.,0we A M addltlon ro tl1a ml of rorrlpsrsdeq darrarw es pmrldad roes In 9actlm 3705 0l tlla Labor Code. /dart arM atlemsyi /roe CONSTRUCTION LENDING AGENCY: I hereby Mim under perwhy of parry" IM there e a dvrrWen Lan W aOao.Y for the parterre. of IM woek for whirl the pMal a mated (Salim 3097. Ci. C). LENDER'S NAME: LENDER'S ADDRESS: I ceray that 1 Ova reMl this eppl'vsten end Yee I W the above'edormaion a coned. I firs W comply Wh M ay end count' ordination end stale ler relating to Mildip conaeuaion and hereby authorize representeli"r of She ahy 10 star upon theabove monli«Mep rty far inapecrion purpme MARK PIKE (5151 .WP) Data n LlI Pink -Ramus: Gddanrod-Asserd CITY OF COSTA MESA - BUILDING PERMIT PERM NO: F 08368_' PERMIT NO: F 083683 PLAN CHECK NO: 02397-97 L GOVT: N SUPP: N CONSTRUCTION TYPE: V -N -SP PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION : ADD TO EXIST. FIRE ALARM SYSTEM SQ FT: CLAIM VALUE: 12,475.00 CALL -VALUE: GROUP OCC: B /E-1 COMMENTS: "MARINERS CHRISTIAN SCHOOL" Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708212 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: sl �� DATE: 4SE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL MENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 200.00 65% SMIP/NON-RES PLAN 130.00 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 200.00 0.00 130.00 330.00 330.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 200.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 200.00 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 200 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 200.00 END OF FEES Y I' 81-89-1997/11:31 AN/$M.@8 PERMIT�:.TeB3 3 CONSTRUCTION AND PLANNING' -APPROVALS Permit #- i Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1-, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57• APPROVAL TO COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 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•Fiml 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign - -' - 68. APPROVED FOR PLASTERI(QG 18. Rough Electrical -T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas 0011 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. FINALJ){�- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 60. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test _ 36. Hood or Canopy 37. Final Factory Fireplace -'-- 38. Final Plumbing 39. Water Service -Final r 40. Gas Service -Final r� 41. Solar Domestic -Final 42. Backflow Preventer . 43. Backflow Irrigation 44. Landscape Irrigation System R 45. Sound Attenuation W R 4d. Handicap Regulations _rr v *{ 47. FINAL STRUCTURE & BUILDING 46. FINAL PLANNING _ _ _ -`� 49. Electric Release to Edison __ 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date ADDRM OF AYLOWO: JVV Y15CH1ri( AV UW. BWNEIPS NAME IF KNDNN MARINERS CHRISTIAN SCHOOL FLOOD: ,ADDREsa 300 FISCHER AVE COSTA MESA,CA 92626 APPL.IWUSIG ADDRESS: ARCHITECT OR ENfd1EER: uG NO: ARCK OR END'S ADDREIt& UIaT: m,,ACTdIs NY¢: ABLE FIRE PROTECTION (909)595-5165 CONTNACIORS MARINO 1612 MORNING SUN AV App�px WALNUT uD 81789 CA No_ 398869 uw-. uDENSED COMRACTOR4 DECLARATION: frenaby eflim oder pamly d peryvy Ortl I em fcrsed lndlaypr prwmpo d Chapter 9 (mrmsodry rdlh Section TOW) d Didsur S d do Nam" And PNmei«s� end my 6orvr's N hA/` • • /% A eay.uC.NO.; uc.cues: C-16 uc.No.: 3988,,@9 E OW R BUILDER DECLARATION: I hereby e15rtn odr prury of priry Od I am eeemyl horn Ne Canvacton Limine Lew for On lesson (Section 7M1.5 Brskren aM Pmleuiom Coda: A" cry «Doody vett r req irm a pame to pdnaNm, albr, inpove, 'demolish, «repair airy sOuclos. prior to h ism um. abo nabm the apphoortl for suds Femur to Ge a synod eltlenrrenr 0m M a she Is Deco d pnrora to IM povbiom of dr Coolo ct Umse Lew rhaplr a (mmn ocing w9h Section TOW) d DrvblOn 3 of tM Ruane» aM Prolmiorm Coda( or thtl M or sM is e oropl tfweban W tM Mab b dr aft& ed memption. Am violation of Section 7M1.5 by any a Iioonl for a perm! w*ft tM aPP!i a to s da PrmRy of Tal moos tMn Me huMretl ddb" M5001). ❑ I. m Derr dtM papdy or my wnpl r with wepee m tfwi sde mnpemtlbn. will do the wak.eod 0m slrmmn is ndintended or ollered M"o(SMion T .Btoti n MPlofmsbm Code: TM Coamdm Uoerse LAwdose M applyto an ovne dpopery Mm Weds or mprmwe therm, and w o done aunt work Iterntoll «MneE or dram his or Mr oven wgly, s. provided that such impno anenU rs ml idrdad or dared for r . A. howavwr, tM bdY'up or knp eot I. said wdhin pre year of aompbtion, Qct pwnenWH wire Mve IM Wdan of pmkq M or sire did m laild or bnprova 1« IM Dor,oea of sob). ❑ I. m ower of IM popery. am ud w.* cadrMky wdh kmnmd caneacmn to mmbW ft project (Section TOu, &rimae and Profambm Codne e: TM Contractors Liroe ImotAw dada rapply to m owner d property or who Wilds it w IMnm mod w o commets for euah propos with a mmracta(s) I'v:ansed paroa to tM Canrrtae Limens Lew). ❑ I em msmpl under Section: B. A P.C., for Nb reason: Date: Owen I do Mreby candy IMI I am ewers of rd u to,d tM rpdimmenm of CelEmva tleeeh end SaWy Code Sreions n505, 2SSM. end 25.531, and Nal I or Try M«s boedkp poouoo l will I wG m (droll ore) need m mrnply wrh ed "a codes and the rpdnemrm b a pamrlla commation«moddNdion hanlM Airyll—mspm Ditn.RasidWwlmM bnappimttpuaneaemplMmnrse povlaon.. Date: Appboard: WORKER'S COYPENSANON DECLARATION: I MrAby affoo odr poroey of porjvy oro of On Idbwep dectrtivm: ❑ Ihevs end wmaa.TemndiWed mnwto mtliamelw werken'mrsanWion.n pnwkadla by Section 3TMdlM leba cad., r« tM penMmm. a die wok f« wltn Nb mine b b,aee. hew rod wU mekdan wmnkrs' oorn ion beeps. m required by Section 3TM of the Labor COM, mr tIm pMamume of 1M wank for wnia rob and b MaM. My waken•cgrRaD ltwT=v pricy rvmrber ra: EXPIRES Crile Paas Number. — 11/16/97 (Thi. sMioo neM n« M coo,W I Ns Fermi u M oro hnAed dol. ISIMI or hour) I��xrt1N OW b dw panpmuw d IM wont b wh'rA INe prm'd b . I slree red ayipo/ o"Y inmy nonnm m m to lbec7lpw subject to IM warkrs' omnrntlian laws a1 Cefdada, a(fns aoo /I Nwa914aEOtm APbjep to tM waken• m wcnre rwkri m CONSTRUCTION LENDING AGENCY: I hr WY affirm ur dpeaky of prjry t ti r b e mu ruction landinga0ray br Dr port. dM Iwork for wbicti Nb pemr b bald (S ion 3091. Civ. C). LENDER'S NAYS: LENDER'S ADDRESS: 1canny IhtlIhen toad Nb amTrJlion Yrdtlbthe rine ebova Wcnrmtknbmnect.Ia Iocomplywehmcityrdoutlayorduunml end elate bww rWlkq bbuidrrp mnmurlim YN Mraby adA«be repeeMYbsed Ova otym Tion Won the Bbds meai(m properly for mspatb lrm MIKE COLINS (515146WP) WMe-fluedN A Safety: NnkJisvaraw: Oddsnrod . CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 084161 PERMIT NO: F 084164 PLAN CHECK NO: 02904-97 L GOVT: N SUPP: N CONSTRUCTION TYPE: V—N—SP PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION ALTER EXIST, SPRINKLER HEADS SQ FT: CLAIM VALUE: 11,000,00 CALL—VALUE: GROUP OCC: B /E-1 COMMENTS: "MARINERS CHRISTIAN SCHOOL" REF:B-83621 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708212 ZNE: REF NO: PLANNING NOTES> >>f***lE dF dF ih k dh kdhk***ret*iEN•*irkif*dE*dt if*if iF*dF it**irk dE iE iE iF dF****iF dh ie*iE**ffN•dF jF ih*dF*dE *fE �E 9E dE if iE*�F dE db iF iF**irk dE D E V E L O P M E N T S E R V I C E S R'E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY ISSUED BY LEGALIZATION:N F E E IS D'M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT PLAN ISSUE FEE DATE: DATE: DATE: 1F 1E****dE*1E h STRUCTURA GMEN :N FIRE SMIP/RES GRADING 175.00 65% SMIP/NON—RES 113.75 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 175.00 0,00 113.75 288.75 288.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 175,00 OVER/SHORT: .00 BLDG PMT,PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 175.00 ih iE ih d!*lir irk irk iE it kiE dF iF dt*ih irk it iF ib it irk*irk iF df iE***dF lid*did dt irk irk ih iF db dh iE 4irk lid if*lidirklidN•dE*ilk ib lb iE irk Hh dt dh iE irk irk df df dF lid iE ih ih dE fE jf irk*jE 3h I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 175 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 175,00 END OF FEES i Ir, L. 08-12-1997/01:21 PM3175.00 RCPT0:01-6010622 i PERMIT:084164 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL. 6 SPA - APPROVALS Permit # / Date Inspector 1'. Temporary Electrical Service or 4bte .52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement V . 3. Electrical Conduit Utility-Undre'rnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57: APPROVAL TO COVER•GUNITE 1 7. Footings 58. Electrical Conduit-Undrgrnd. ' 8. Foundation 59. Gas Pipe, O Undrgrnd., Test �) 9. Water Pipe-Undigrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK" 11. Property Sewer Line & House Connection 62, Backwash &Receptor-Final; 12. Sewer Cap Z-, 63, Heater & Vent-Final ' 13. Roof Drains - 64. Plumbing System • Final. 14. Rough Plumbing 65. Electrical-Final r• 15. Rough Electrical-Conduit. '� 66. Solar System-Final -• -- 16. Rough Electric Wiring .( 67. Fencing & Access Approval ,. 17. Rough Wiring Sign t 68. APPROVED FOR PLASTERING - 18. Rough Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT APPROVAL'S Permit # 20. Rough Factory Fireplace - - 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating _ 71. Product_Piping El Gas OOil 23. Gas Pipe-Rough & Tes[ 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead::� roLt_ h 818[97 26. T•Bar Ceiling (Structural) &'Monocoat t 75. Dry Chemical - 27. Frame and F14shing' r .' 76. Dry StaoSipipe.- 28. Lathing & Siding.: •_ 77,, FIXED SYSTEM FINAL '�Wvq.7 29. Insulation '. ` t 78. FIRE PREY. FINALN-q7ALI 30. Drywall Nailing ' - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' "` 79. FINAL INSPECTION 32. Electrical Power Meter-Final _. 60: FOOD CERTIFICATE ISSUED 33. Final Electric Notes: • . 34. Final- Heating & Air Conditioning 35. Final Gas Pipe-Test, 36. Hood or Canopy .. •i r 37. Final Factory Fireplace., 1 __•_... - , 38. Final Plumbing - 39. Water Service-Final - r 40. Gas Service-Final- - 41. Solar Domestic-Final ' 42. Backflow Preventer, .43. Backflow Irrigation - - 44. Landscape Irrigation System - 45. Sound Attenuation' ; . 46. Handicap Regulations - 47'. FINAL STRUCTURE & BUILDING _ •. 48l. FINAL PLANNING; 49: Electric Release to Edison 50. Gas Release to Southern California Gas Go 51. CERTIFICATE OF OCCUPANCY No Date ADOREaaO BNLGNO; Pru V D 1 D L R LR M y UNF OWADDA AIEIEIWONG: MARINERS CHRISTIAN SCHOOL FLOGu: 300 FISCHER AVE AD..S& COSTA MESA, CA 92626 P OPL. MUND AODRM- NUTTALL 6 UCHIZONO C9123 ARCHITECT OR EIMEER: 3199 AIRPORT LOOP DR LIC xo: C ARcx. aR DasAooREsa: C.M, CA 92626 um: FULLMER CONSTRUCTION (909)947-9467 CCNTRACTOnNAt«: 1725 S GROVE COMIACTM MA1LTN0 ONTARIO CA 301814 ADDRM 91761 11C N0. iATION: I Iwehy�f alum roan 3d the Bmvso aM . UC. cuss: IINT: licanaed Near ptov®Olu a Glupt« a m. u M uO.brcb And aHea: / 7 if r your: /OWNER B � ER DEQ RATION:1 hereby shoo oder p«Wy d parAvy the I em am trOln a Camectm loo leve t the IdbwM on (sedan 70313 Buaims arId Pmleenom Cods: Any ory a OotmtY whit permb Io eon . Mm. " �demqq�� a rapei enY rmlclua, Prior b d seueroe, urea mpdru tM epp&ed for •WI Ne a sgrsd sus Rw M eM �sAL61eM pmued to the ProvidotA d its Cmmfm Nowa law jChePr« B (omuib ' 0 wah Section 7o00j d Oi.%Aian d tM BueMeo ad Rdmiorn Code) a that M a Ns o auwnp Ih«ahom end tM base la Rs ebped wempin. M Sectors` ]031.5 by enY ePplud la a pend eubjeds 1M eppired to a eiN penatly d oat mae Run Tw. htptdM tlapan , \0 I. As owner of Ne prcpeny a my wrob" with w m that eoaampwwain, with dO Os wank end tho sbx.9ue b rot ioWded I or offered for tele lSactlan70u, Budroa end Pmleaaiam Gude: TM Ca«adas Uotwom law does nd apply to en owner of paperl, wM dude a Ynpwaa Ihmeon, aml Mho doss tt a wak h'vneeh or M a through he a her own ernpt>/sea. pavjbd that suds tmprdmnede are m,t wonaw a dense to, Seo. 1. howww. the, buBtlinp or inpovemad is add W" Ors Year of mmplouon. lM - owtwb Witu Mh have the be d povbN Mor its db not babe a'unpww la IM pepme of tab). - I. A, owner d the popetty. Am asduady OmumaiN with limnsad mmree on, to lvdbnd the project (Section 700, BwMess and Pnlaolans Cob: TM Coamom Lkww law done not Apply b an owner of Property Mo buBds or impoves thereon apt wdo aontrada far audt projects wbh a mod tt"'M haeuM p n ua to the Cont redas Lmrua taw). 0 1 em memp uMer Seadon: B. 8 P.C., br this reason: .. Dow: owns: I do hereby malty that I am Aware of AM uMentaM tM mauitemana of CAIYmo Neebh aM 6oatY Cob Sedinm P3505. PSSST. And' p3 . apt that I or soy Mum WKW 000"M MO / will M (dub Ors) mad to mnpy with said oats mdse onto tits r quimam h' lo,a pem,, la rewtrudm w mMSrsm NS tm hM�enppnwA D'mda. Rwaereiatpmdrudon Applications An exempt fmI Bloss pmiebns. Dae: AppTr+d: WORKER'S COMPENSATION DECLARATION: I Mreby steam uldw palatly of pshury as of the fa0owinP dmbwom: I Mw ertl MN maMleM s mnyiub d roruere to aetlLuura b wak«a' Compmsaron, ea pep lar by $action 3700 d Rs Lebo L, CMB, lm the pmfamenaa of the w for w h the pwmb is muM. 'p woe It,nd Iohro ptuout M1wa'mnmrsaton'4F. l r.es..adeed by Sedor!3]OOtltM Lebon Cade MR a pwbr:wcedtbe work la whiN tha permit a usmd. My waken'ianpiirinio'n inlslttixl poky ntnrtber »: LAY 11<LS car*: 3065202 01/01/98 Poly Number. (]his sadbn need not al oornplded l Rs pt ml a was hupwA dallam (31071 or AmJ I eeRN IhM M Us palwmace d IM work lar wfiiall Rus perlrN' I NAR M wnploy arp' Mary mauve n n to becarrs eubjasa ))0 1M waYen' mmpenemon Iaws of , apt Rpt a 1 dwM MMSr�fPs� alhied to 1M waelm«' .-.�vmeensnion eebvew .F a ion 3700 d Rhe Lobar Cob. I ffaNwVh w with Ilv pwb6s. / Wfiffla Feab b 8WUrjFM,ftm' faiwu ItM I== tlbeMN9 Yo 1pa b PrIwtloueetl ddn (III,rM uMOd PAnelOr Alp Ifp roof rl danepw I(a povpW/yll, In 5.110tt 3705 of 0. Labor Ce b. lomat apt edonreY'e Ma CONSTRUCTION LENDING AGENCY: I hw.W dhm uper prosy of Parj v IMt then o e aawructbn ltmkt-.Odkry for tM wohoonaa of the wank m Medi the panni o eauee (Salton =t7. CM. C). LENDWS NANE LENDER'S ADDRESS: I coaly that I hew sed Ida appttrenon aM dm Iha ate ebava Homwion is correct. l etPee to oanpy with a ay AM courtly or*w apt one ewe mmib todddryrplaudim m01wfeby aAlw¢erepomanivw of this city b wm exon Ow �i Property (5151de.W ) CITY OF COSTA MESA - BUILDING PERMIT Ythp J`JV: L U0-100 / ERMIT NO: E 083687 PLAN CHECK NO: N %awv d : IN JUe v, IN DNSTRUCTION TYPE: V -N -SP PERMIT TYPE: ELE PURPOSE: ALT GB DESCRIPTION : 17385SF 2ND FLR CLASS RM 6 OFFICES TI SQ FT: LAIM VALUE: CALC-VALUE: GROUP OCC: B /E-1 DMMENTS: "MARINERS CHRISTIAN SCHOOL" REF:B-83621 #################################*############SSSS###*SSSS###E############### Z O N I N G S E' T B A C K S R E Q U I R E M E N T S ----------- MAIN BUILDING----------- RNT: FT IN REAR: FT IN EFT: FT IN RGHT: FT IN --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR, FT IN LEFT: FT IN RGHT: FT IN ARKING REQ: PROV: PARCEL: 42708212 ZNE: REF NO: LANNING NOTES> > c D E V E L O P M E N T V-5 $ C: R V I C E S R E Q U I R E M E N T S vv ONING APPROVED BY DATE: UILDING APPROVED BY DATE: PPLICATION ISSUED BY: DATE: L #ED##DDD#US##SUED#### r iF7- if is## EGALIZATION:N F E E'4 S U M A R Y STRUCTURAL 3EGMENT:N i, , BLDG PMT PLUMBING ELECTRIC ,-MECHANIC FIRE SMIP/RES GRADING ERMIT 211.50-; ^- 50,$,�; SMIP/NON-RES LANt? SSUE FEE -22.40 . UILDING-DIV-> PERMIT ISSUE PLAN-CH-ECKf- TOTAL PAID DUE OTALS ---- > 211,50 22.00 •10.00. 233.50 233.50 .00 EVENUE DIVISION TOTALS--> COEI'ECTED-: ti 233.50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN -CHECK 233.50 r I N D I V I D U A L: F ,EJE. B R E A K D 0 N IN YPE QTY D E S C R I P T I.0 v UNIT COST TOTAL COST LE 20 FIXTURES, LIGHTING^ 'ly S •ZA EA, 1,00 20,00 LE 40 FIXTURES, LIGHTING ADDzzIOT1AL EA. .65 26,00 LE 20 RECEPT/OUTLET is T 210 EA. 1.00 20.00 LE 100 RECEPT/OUTLET ^DDI-TIO14AL EA. .65 65,00 LE 20 RECEPT/SWITCH 1•_�20 EA. 1,00 20.00 LE 1 •.>.T' SUB -PANEL , 16.25 16,25 LE 1 MOTOR/POWR APPARATUS..•50,1 -100.0 HP 44.25 44.25 END OPS FEES i -• 97-89-1997/83:17 DB/f233.58 RCPT9:@1-%N 893 PERNIT:B83687 CONSTRUCTION AND PLANNING "APPROVALS Permit # i Date Inspector POG. . SPA . APPROVALS Permit # Date Inspector t. Temporary. Electrical Service or Pole r' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms " 4. Electrical Conduit-Undrgrn 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test " 6. Electrical UF£R 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 Elect(ical-Conduit - 56. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling POOL/SPA SYSTEMS FINAL - 19. Rough Heating &Air ConditioningFIRE DEPT. REQUIREMENT APPROVALS Permit # i 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Geis 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydrq 26- T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29, Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 33, Final Electric 34. Final Heating & Air Conditioning 0. FOOD CERTIFICATE ISSUED Notes: ' .. 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final 40, Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation Otn 46'. Handicap Regulations 47. FINAL STRUCTURE & BUILDING yi .481 FINAL PLANNING J" ^' rr 49- Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 300 F I SCHER AV OWNER'S NAME: SYMBOL TECHNOLOGIES ADDRESS: COSTA40 IMESARCAVE INC 92627 UNIT: ARCHIENGINEER: NUTTALL UCHIZONO ASSOC REG.NO.: C — 9 12 3 ADDRESS: 3199 AIRPORT LOOP DR UNIT: C C.M. CA 92626 PERMITTEE. AIR UNLIMITEAS DSINCORPORATE (714)632SAS -5310 ADDRESS: 1230 ANAHEIM CA 92806 LICENSED CONTRACTOR DECLARATION: I hereby altirm that 1 am licensed under provisions at Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code. and my license is in full force and effect. CITY LIc.:0^11060 STATE LIC.: 32293 cu CC 20 EXP: 06/95 le I�7-95 Signature: _-\\; { WKERS'COMPENSATION DECLARATION: I hereby affirm that I have a cerlilicate of consent to sell -insure or a certificate of Workers' CompensationOWCnce. 24 4rlpq 7,2y deleol (Section 3800, Lab .& /01/95 POLICY NO.: STATE FUND EXP. DATE: COMPANY: ,,}}((,, ❑ Certified copy is hereby furnished. C7 Certified to '' with the city BlJlding sion. oat I - 9- q O Applicant: nb/ EXEMPTION FROM WORAEflS' COMPENSATION DECLARATION: (This section need act be completed if the permit is tar one hundred ($100) or less). I cerlity that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws at California. Date: Signature: NOTICE: It, after making this declaration. you Should become subject to the Workers Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions at the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the properly or my empployees with wages as their Sale compensation, will do the work, and the El structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himsell/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year Of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I. as owner of the property am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ID and Professions Code: The Contractors State License Law does not apply to an owner of promwho builds or improves thereon and who contracts for such projects with a conilicense pursuant to the Contractors' State License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 5 P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of Cahforma Healon and Safety 25534 and that I or any future building occupant will/will not (circle one) need to comply with said stat permit for construction or modification from the Air Ouahly Management District. Residential constru these provisions, Cade Sections 25505, 25533, and e codes and the requirements for a :lion applications are exempt from Date: Applicant: I hereby certily that I have read this application and state that the above information is correct. I agree 10 comply with all city and county ordinances and stale laws relating to building construction and her authorize repose fives of this city to enter upon the above-mentioned property for inspection purposes. AA ,J{��f to eO e?,r s License or Social Security 1641-46 White—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO; M 070638 PLAN CHECK NO: N CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC JOB DESCRIPTION : INTERIOR 59580 T,I, CLAIM VALUE: CALC—VALUE: PERM NO: M = GOVT: N SUPP: N PURPOSE: ALT SQ FT: GROUP OCC: E-1 /A-2.1 COMMENTS: REF: B-70342 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708201 ZNE: AEF NO: PLANNING NOTES> *MM*MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM*MMM*****MMMMM*MMM D E V E L O P M E N T S E R;V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY DATE: DATE: APPLICATION ISSUED BY: '//iZE DATE: 0140147 M MMMMMMMMMMMMMMMMMMMMM♦fTMMMMMMMMMMM �tl?{t�iFit M�i�MMMMS M1fM MiFMMMMMMMMMMMMM MMM M M M MMM MM M MM MMM M M M M MM MMM MM MMM MMM M M MM Mitts M M M M M MM M M M M M M M MMM MM M M MM M M M MM MM M MMM M M M M MMM M LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRICI MECHANIC FIRE SMIP/RES GRADING PERMIT P 522,.00 LF 25% SMIP/NON—AES PLAN i ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 522,00 15,00 0,00 537,00 537,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED;: 537,00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK '537,00 M MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM M�ItMMMMMMMMMMMMMMMMMMMMMMMMMitM MMMMM Mitts MilMMMMMM I N D I V I D U A L F E E B,,,R E A K D O W N TYPE QTY D E S C R I P T IO N UNIT COST TOTAL COST MEC 4 INST FORC—AIR/GRAV FURN '<= 100 K BTU 9.00 36.00 MEC 17 REPAIR/ALT COOLING UNIT%SYS .W/.CNTLS 9,00 153,00 MEC 17 REPAIR/ALT HEATINGT,>UNITVSYS W/CNTLS 9,00 153,00 MEC 4 REFRIGERATION SYSTEM" <=1100 K BTU/H 9,00 36,00 MEC 32 FIRE DAMPERS4.50 144,00 END OF FEES f; 01 00174606-00174606 Tll T 537.00 LATE: 01/09/95 TIRE: 10:23 CONSTRUCTION AND PLANK NG POU.. & SPA - APPROVALS Permi[# ate Inspector APPROVALS Permit # Date Inspector . 1. Temporary Electrical Serv-ice.•?,r Pole. 52. Pool & Equipment Location .. 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement y,,E�ectrical i ond'ujt�tility�Jrt�igrnd pt 54. Forms _4.'Electric9l:Conduit•Undrgrnd. -'- 55. Electrical Bonding �c,''�,&feel RdA$orc?rpeht 56. Rough Plumbing & Pressure Test 71 d,: Electrical't1FER Grnd. - 57. APPROVAL TO COVER-GUNITE :I:7. Fboting3'2: 58. Electrical Conduit-Undrgrnd. •-grtFoundaijon ••±' 59. Gas Pipe, O Undrgrnrl., Test ,9. Water Pipe -Un J . 60. Backwash Lines, P Trap, 0 Undrgrnd. - 10. Structural.Floor System 61. APPROVAL TO DECK '',•. ?7. Property Sewer Line & Houp-Con4ection rid 62. Backwash &Receptor -Final �r 12. S wer Cap 63. Heater & Vent -Final 73. Roof Drains,64. Plumbing System - Final 14. Rough Plumbtr�g 65. Electrical -Final 15. Rough Electrical -Conduit. 66. Solar System -Final 16. Rough ElectricWiring - 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 'APPROV)wsS 9Pe[init# .a,. 20'tRough Factory Freplace r, r. ' �,? ^-t - y 21 tiD=s, in StrrtcttNe ... x _ •a t . 70. 'Underg,'odrtcl 1 1fro 22.Vent?sting' -_ `: `• '' 71. Produ' Flpjng t2as d Oil .,Duets, _ q 23Aas,P,pedRough & Fest r.; T. , 'n J . ♦ ------------ • 72. Underground Flush -_ 24,-Ro5f Framing ' - •' =' Or i 73:.'. Undergrnd. Stora Tank Gas ❑ Oil'7. �� .0 25. Royf Sfteathing .. N •' '- _ I; t 0 74:) Overhead Hydra• 26. -T -Bar Ceiling (Sttucturap 8iiM.9ngcoat 75;'. Dry ChemiG9l 27,';Frame apd Flashing ,• :• r •r, t 76 Dry Standpipe -.ro V i -•a' Y C:;,.i •28. Lathin & Siding' - : 1: h 9'� + - ,.I + } 77;; FIXED SYSTE,d1-FINAf, _ t t p 29. Insulation 7 FIRE PREV. FINAL 30. Drywall'Nailing ' HEALTH'DEPT.REQOIREMENT'; _ 31. Plaster Proven Coal ..•••79''FINAL I�S_PECTION - - 32.'Electri PbWer Meter -Final = = t n r180zI1FO0D CERTIF1i4ATE ISSUED .' ^33:-FinAl Electri� r ' Notes: -7�m 1 P +'34.- Final Heating& Ai, ConditionYog: i:�r * 1357'Final Gas Piae-Test ? I :/y na. •• ' .' .; Z(a_- ( r36. HlID_ or Canopy o- :.37.; Final Factory Fi,ejlaceL 0 - 38. Final Plumbing ` I �* •,'• r.� y-,;;-'� - ' _ .v 39. WatAr Service -Finan - I i �: • "^ -'' "� �• ='-" y. ,�. ;40. Gas Service -Final ":41. Solar Domestic-Finsal -' ' s� - d 42. Backflow Preventers I + = r•E• vC 43. Backflow Irrigation j44. Landscape Irrigation Systems ,r - r; :7 ,t 1 1:- • 45.:3ound Attenuatioq '''' '' r ;_"' i. r.- i_. w 46.. Handicap Regulations 47.7I4AL STRUCTURE & BUILDING lI* i r• 48. -FINAL PLANNING . a • �s ,t r 49.. Electric Release to Edison % Gas Release to Southern California Gas Co % -• • - .. - _ i, 51. CERTIFICATE OF OCCUPANCY l', •. �' -•' No, Date PRCIECT ADDRESS: 30.0 F I SCHER AV UNIT: OWNER'S NAME: SYMBOL TECHNOLOGIES INC ADDRESS: 340 FISCHER AVE COSTA MESA,CA 92627 ARCHIENGINEER: NUTTALL UCHIZONO ASSOC REG.ND.:C—%1f 3 ADDRESS: 3199 AIRPORT LOOP DR C C.M. CA 92626 PERMITTEE: VAL ELECTRIC (909)923-0070 ADDRESS: 1261 E. FRANCIS ONTARIO 91761 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am he u r ovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my nse is ul orce and effect. .: STATE LIC.:576817 D —10 EXP; Date' Signature: _ RKERS' COMPENSATION DECLARATION: I hereby affirm that I have certificate of consent to self -insure or a certificate of Werkers' Compensation113n5yryncg pr p yprB,liep copy thereof (Section 3600. Lab. C). POLICY NO.: (C... ..77 `y6 ll 1 J L b EXP. DATE: 0 1/ 0 1/ 9 5 COMPANY: REPUBLIC IBS ❑❑fa d copy is hereby furnished. Certified copy is fit i the Building Division. e: �G z3 % Applicant: MPTION FROM WORKERSCOMPENSATION DECLARATION: (This S need not he completed if the punct is let one hundred (5100) ot less): I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature'. NOTICE: If, after making this declaration, you should became subject to the Workers' Compensation provisions of the Labor . Code. you must fort comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for, which this permit is issued (Section 3097. Civ. C). LENDER: I ADDRESS: '1 ONE NEW STAIR OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Cade: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars (MI. I. as owner of the property or my employees with wages as their Sale compensation, will do the work, and the ❑ structure is not intended or offered lot sate (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or agered for sate. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sate). 1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of prope(ty who builds or improves thereon and who contracts lot Such projects with a cantractogs) license pursuant to the Contractors' $tate License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 2550.5, 25533, and 25534 and that I or any future building occupant wilVwill not (circle one) need to comply with said slate codes and the requirements for a permit lot construction or modification from the Air Quality Management District. Residentul construction applications are exempt from these provisions. Date: Applicant:ffl I hereby certify that I have read this application and state that the abov formation t r t. 1 agree to comply with all city and county ordinances and state lawsrelating to building Construction and hereb a tire fepresen' of this city to enter upon the above mentioned for inspection purposes. '2Z ^mai Signature. or Driver's License or Social Security 164Y46 While—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 070517 PERMIT NO: E 070517 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ALT JOB DESCRIPTION INTERIOR 59580 T.I. SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: E-1 /A-2,1 COMMENTS: REF: B-70342 *MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMrw*****arr***rr*�H«rr�rr*r**r**r**r****�E**** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708201 ZNE; REF NO: PLANNING NOTES> MMMMM MMMM M M MM MMM M MM M M M M MMM M MM M MM M M M M MM MMMM M M M M MMMMMMMMM M M MM M MMM MM M M M M M MMM M MMM M M D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: M MMM M MM MM MM M M MMM MMM M M M M MM M M MM M M M M M M M M MM MM MMM M MMMM MM MMM MMMM M M MMMM MMM MMil MM MM M MMMM MM MMM M M M MM M M Mil MMMMMMMM M M MM M MM MM MM LEGALIZATION:N F E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTR•IC''MECHANIC FIRE SMIP/RES GRADING PERMIT 277, 65'•'' 504;', SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 277,65 15,00 0,00 292,65 292,65 .00 REVENUE DIVISION TOTALS--> COLLECTED: 292,65 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 292,65 MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S� C R I P T I O N UNIT COST TOTAL COST ELE 20 FIXTURES, LIGHTING 1 5T 20 EA. ,75 15,00 ELE 180 FIXTURES LIGHTING- ADD,ITIONAL EA, 81,00 ELE 20 RECEPT/ObTLET 1•ST 20 ,45 EA, ,75 15,00 ELE 115 RECEPT/OUTLET ADDITIONAL EA. ,45 51,75 ELE 20 RECEPT/SWITCH j 1 ST 20 EA, ,75 15,00 ELE 22 RECEPT/SWITCH ADDITIONAL EA, ,45 9,90 ELE 12 MOTOR/POWR APPARATUS 1,1 — 10,0 HP 7,50 90,00 .END OF FEES 01 00174014-00174014 Till 292.6` DATE: 12/23/94 TIME: 0:40 CONSTRUCTION AND PLANNJNG PO4.. &SPA - 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 aiC'o)7dgitl ility-Uridrgrnt,•y ��;�6ctric.r£tectrica�:9ond0it•C3hdrgrnd:'" _ S.. Forms 55. Electrical Bonding ' � r5.,.feel Reir;#QrcAi}se its 7i •� 516. Rough Plumbing & Pressure Test - r - :•t!�.I'&kctrical t;FERiGrnd. 57. APPROVAL TO COVER-GUNITE Electrical Conduit-Undrgrnd. G .;'¢oundat'IDrti r, 59. Gas Pipe, Q Undrgrnd., Test 4 H i 9'. Water Pige�Jndrgrnd. 60. Backwash Lines, P -Trap, Q Undrgrnd. 10. Structural'Ploor System - " 61. APPROVAL TO DECK 1:1; Property Sewer Line•& HdO, se Conn'er'ction 62. Backwash & Receptor -Final ' ,I o c 12.yver Capa, c, 63. Heater & Vent -Final 70 13. Roof Drains '; ' 64. Plumbing System - Final a rt, , 14. Rough Plurnein-g• ':. 65. Electrical -Final 15. Rough E!lectrlcal-Conduit 3. 66. Solar System -Final 16. Rough Elciric't?✓iring f 67. Fencing & Access Approval 17. Rough Wiring Sign F, PPROVED FOR PLASTERING 18. Rough Electric3f-T Bar Ceiling n4 POOL/SPA SYSTENIS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ^> -] _ 1 y T - 3. R Pl 1 PPRLiVA`S ?!�Peri7 it #T_ M M r: M rrt ��ZI JIM 20. rRo h Fact F e lace r'� -4 11 _ -1 i, i 21.•.Dur,tc, inI •• •• �, ! '_'+ i a :,70._Str"=tuIM+ 0. Undergr-dG q!l I Zifro ` 22.,,Puc V nti tinqS Product P ii C° a Q J J s1j1. 23. as Ipe.Ropyh & Test ni- . 11 a < O 1 72. UndergrourNd Flush) J 24.-Aoo•SFreming �? + F•�-• ''� s n =' '' -r•73 rn ank Gas ❑011"� 9 q p •�<�-'+ + V. Nt, ,Under .Stora' t 25. Rodf,Shiathing i d; * V r .- CO £ �74COverhead HydroC. •_ + 26. T -Bad Ceiling (Structural) &:MghcfEll coat - 75.,Ary Chemica4 ' �� t 27.'.'.F.•rameago Flashiip� �o;ir; ! C• alt r 7 r � - a ! ;.:•�+_ 6. Dry Standpipe a T �'(--' ^_; ^t'. tt. _ Lat9!ng.& Siding+a %+ h �!? y "+ 77 "FIXED SY!FTEf� eeNAL; � ��:� 0 .-I�,trs'r '"29. Insulation _ •• u • i 78xFIRE PREV. FINA1 ` _• y 7130. Drywall*Nailing J n Y i L• M&A LTHI7EPVREQUIRE• f�� " i r..t, ,� V ` 1 Cpl. Plaster BLowr,Coat, s I t,•-.• 1 . " * , .:79. FINAL I �. .'ter•.,., 6CT1• e 3'a: 0N •o• t42.!Eli ini -, ectrcapPoW'er MeePFal ' m ' „ �t n• -_fOOD CERTIFICYYE'IS�UED tlr` =t 33.$inlEle>rtris. , r i '• j ' 1, . to., 'I q /TJQi� -7{pU /L t �-' - 0�4.;6inffi[Heating$Air;Conditioni'n4:. 135.r'inil'Gas Pil;F.-Test 01•"+ I �Q�S:,.,_ =t''' r •'' ,36.•Hoad or Canopy 1 P>':el a a I 4 . {'� 9 , '-' + •-�"b' - r' rn 1-, 37. )1 ina(,Fattory Fireplace , 11 + -38. Final;Plumbing ;u i s r• 5 k w^ v 4,1 s : •. m ct . `39. WatEkService-Final } I .y ♦ I } 1 W't' < t� �. <<, L ❑: £ � � > �, t m nm!nmm r40. Gas Service -Final r. n � h • � •S -d1. Solar Domestic -Fina ` • k ;CD 42. Backflow Preventer. Cu 1 '• ..F� _+ - .., 43. Backflow Irr "'tion; :,; �•-• ; ', "' - .� o. -o .� "44. Landscape Irii9atioo SystemujmO :r • ''; '7 t7 a ' r „ ` - i '.,vr mj-r^10 c - -'45.:Sound %tertdation' "'a:f" '"' F F -• T^• 7 i-, •'-+ 7 46. Handicap,Regulatioas 0 r 1 ,+t 'C Z. .. S r m ^ FINAL STRUCTURE & BUILDING I I� � y n' ; ,17. ••, F, 46. 31N L PLA.NNINGl i E+f- �; 1 ` • t 'st at •4 t .-• , 49. electric Release to Edison I -90. 'Qas tlelease to Southern Califpvnia'Gas Co � I_ � � � � - " r� - oat �_, . ' ' • • ' 51. CERTIFICATE OF OCCUPANCY > No. Date 300 FISCHER AV ,?AQIECT ADDRESS: SYMBOL •TECHNOLOGIES INC UNIT: OWNER'SNAME: 340 FISCHER AVE ADDRESS: COSTA MESA,CA 92627 ARCHIENGINEER: NUTTALL UCHIZONO ASSOC REG NO.: ADDRESS: 3199 AIRPORT LOOP DR UNIT: C C.M. CA 92626 HONEYWELL INC (213)726-6166 PERMITTEE: HONEYWELL PLZA MN12-4184 ADDRESS: MINNEAPOLIS MN 55408 LICENSED CONTRACTOR DECLARATION: I her affirm Ina( I am li nsed a der provisions of Chapter 9 commencing with Section 70D01 of Di'ie22 5 gelusiness and Prof Afslerw,(2r10e. and my ense is i fW force d t"9 0 9 5 clT uC.: / 9 �j1ATE sac: C 1 1 Y 7S ate: I- / Signature:— ERS' CO P ry�ATI QN DECLARATION: I hereby affirm that I haw a cenilicate of consent to self4marre or a certificate of Workers' Compensation alc(.tiEfirPied apNSe)eof (Section 3800. Lab.I12 / 31 / 9 9 POLICY NO.: ALEXANDER EXP. DATE: COMPANY: X ❑ Certified copy is hereby famished. ❑ Certified copy filed with he city -- Date: I'/(—� J� Applicant: PTION FROM WORKERS' COMPENSATION DECLARATION: '((crus senor need ort be ciernmeted if the penal is for one hundred (SIOD) or less). I certify that in the performance of the work for which this perrind is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. alter making this declaration, you should became subject to the Workers' Compensation provisions of the labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. Cts LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from ttce Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct. alter, improve. demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to lite a signed statement that he/she is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 70801 of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ort more than live hundred dollars (SSW). I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided that Such improvements are not intended or offered for sale. If, however the building or improvement is old within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the pmpeny, am exclusive] y contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not appy to an owner of proper who builds or improves thereon and who contracts for such projects with a contnielorls) license pursuant to the Contractors' rty Slate License Law). I am aware that proal of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. & P. C. for this reason: Date: Owner I do hereby cenny that I am aware of and understand the requirements of CaliforniaHealth and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wilNxifl not (circle one) need to epmpy with Said state Codes and the requirements for a permit for Construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date, Applicant: I hereby certify that I have read this application and state that the oci information is correct. I agree to comply with all city and county ordinancesannsectonpurpose to mining construction and he yaul/ ryes all y Dente eabove-mentioned Int inspection la purposes. ate: BreCo ti_ er's License or Social Security s: 164146 White—Building: Green—Godo Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: F 070675 PLAN CHECK NO: 05118-94 L CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: ALT JOB DESCRIPTION INTERIOR 59580 T.I. (ALARM SYSTEM) SQ FT: CLAIM VALUE: 4,000,00 CALL—VALUE: GROUP OCC: E-1 /A-2.1 COMMENTS: REF: B-670342, FIRE ALARM SYSTEM T.I. **kkMMMkMkkkkMMMkMkkkMMkMMMkMkMMkMk�;'Er********�6aF�rr**r****+r**+r�Err*r**rr***�E�Es*rat. Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ: PROV: PARCEL; 42708201 ZNE: REF NO: PLANNING NOTES> D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY; N,41 i_� DATE: MkMM*kkkkkk*MMMk MMk Mk*ir-Fi M el iT Er �r FiFi��H �r"ii*rrlEr�Ewir Irrr ryr *** MM Mk k ed MM M k k M k M M kkM M Mk M k M k k k kk k M M M M M k Mk M M MM M k kk M k M k MMMM M M M MM M M M M MM ked M M k MMMM M ked LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING PERMIT 63 00 PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS ---- > 63,00 0,00 40,95 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 652 SMIP/NON—RES 40.95 TOTAL PAID DUE 103,95 103,95 ,00 63,00 OVER/SHORT: ,00 FIRE SMIP/TOT GRADING PLAN—CHECK 63.00 kkkM Mkilk M MMk MkkkM k MM Milts M M M M M Mk kMMk kMMMMkkM MMk kkkMitkMMM k M MMMk MMk kMkkMM M MM M M M #-all it+f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 63 FIRE EQUIP FEE (FROM BLDG VAL TABLE) 1.00 63,00 END OF FEES 01 00174726-00174726 TOT 63,00 DATE: 01/11/95 TIME: 08:56 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date _ Inspector 1, Temporary Electrical Seryice or Pole- 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement flectriipf:Gohduit7btility-Undrgrnd:? 54. Forms --�4t Blectricaicot,duit*Undrgrnd. • 1 55. Electrical Bonding • 54.teel lieiiIoIEfMFit t 56. Rough Plumbing & Pressure Test ,6. flectribal'UFERGrnd, 57. APPROVAL TO COVER-GUNITE '•7,. Eootir&* _ ^ 58. Electrical Conduit-Undrgrnd. , 8j Found@tion , 59. Gas Pipe, O Undrgrnd., Test 9. Water PipO-Und+prnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. StructuratFloor. System _. 61. APPROVAL TO DECK t 1. Property SCwer.Line & House Connection r 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains - _ 64. Plumbing System - Final ' 14. Rough Plum'pirw 65. Electrical -Final 15. Rough, Electrical -Conduit. 66. Solar System -Final 16. Rough _Flectr�c Wiring ' - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electr�al-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVQLS,C• PtYmit# " 20 Rough--Factpry E?feplace 21: Ducts, in Structu `e j .• i -, t 70. -UndeegrBltnd Hydro 22, Dgbts,'Venfilatin¢ t �''? i � � �' 71, Product iliing Gas 00il 23. Gas Pipe -Rough &Test 72. Underground Flush 24. R iof Framing 73; Undergmd. StnSa�e Tanl� 0 Gas OOil 25. Rbbf Sheathing•• '�, L _ r - > 74' Overhead Hydro 26: T -Bar Ceiling (Structural) SiMEmocoa[ 7 '. Dry Chemical , • _] '• 27' Frame and Flasti' Jq9 ]S >f 4 . '. 76. Dry Startdpipef ii 28. Lathing & Sidinq �: 7y; FIXED'SIST MfINAL_, ' ra .. .. 29. Insulation ° " 5 :. > n• , • T • . 78: FIRE PREY. FINAL j�j rr 30. DrywatrNailin��IEALTN DEPT! -REQUIREMENT 11 31. Plaster,Brown Cdai 7 FINAL INSPECTION •+] 32. Electrical POWerJvletcr-Final ' it = 8(1_.] FOOD CERTIFICATE ISSUED ' 33. Final Electric , 34.E Final Heating &'Air Conditioning _ , :? '• n1 .'� !1 ` i' 3V, Final Gas Pfpe-fAft - - 36. Hood cr Canopy:- - I r r• - .•a s ii .0 ; r . 37,• Fio'pl Factory F~r-eylace• `'t' r' t- - 387 Final Plumbing I ! =' 39.' Water Service -Fina; - I > i le ro '�''•U , r• 40: Gas Service -Final • n -- -,• (< . _ : �] - 41: Solar Domestic-Finai- ° '- �- • ' `''t' .Y - ' 42.Backflow Preventer tr: • t�t-• `- 43. Backflow Irrigatioh r 144. Landscape Irrigation System.' - •45. Sound AttanuatioP ,•; ;' ; 46.. Handicap Regulations -• - •i. ' 47. FINAL STRUCTURE & BUILDING 48;, FINAL PLANNING _• -• - .. _ , _ _, 49:' Electric Release to Edison r 50r Gas:Release.to Southern California Gas Co 51. CERTIFICATE OF OCCUPA14CY No. Date -. PROJECT -ADDRESS: 300 F I SCHER AV UNIT: OWNER'S NAME: SYMBOL ��T+EEqCCHNOOA�LOGIES INC ADDRESS. �62TA ARRRCHVE 92627 ARCH/ENGINEER: NUTTALL UCHIZONO ASSOC - REc.xO.:C ADDRESS: 3199 AIRPORT LOOP DR C C,M, CA 92626 PERMITTEE:CARDEN, J M SPRINKLER CO (213)258-8300 ADDRESS: 2909 FLETCHER DR LOS ANGELES A 90065 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I in lice se u r provisions of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code. and m 'c se i all force and effect. C le.: 0 536 uSTATE LIC.: 166282 16 XP• 0/95 al �y (- Signature: ORXERs' COMPENSATION DECLARATION: I hereby all m t a ve a ceNfi a of consent to self -insure or a certificate o1 Workers' Compensation Insyranyy yr cer Ifie opy thereof (Section 3900. . C) POLICY NO.: W`!4 /1�8��� P. E: 7 01/95 COMPANY: CALIFORNIA COMP ❑ Certified copy is hereby furnished. X Certified copy is filed the c Wild Divi Date: G/I • Applicant: c PTION FROM WONXERS'COMPENSATION DECLARATION: (This section need not be co that it the permit is for one hundred ($1DD) or less), I certify Ihal in the performance of the work for which this permit is issued, I shall nal a loy any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If. alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction leading agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: ADD SEPARATION WALL, ONE NEW STAIR OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that helshe 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). Structure owner of the property or my emvlevees with wages as their sole compensation, with do the work, and the ❑ structure is not intended or offered for sale(Section 7044, Business and Professional Code: The Contractors' Stale License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmself/hersell or through his or her own employees, provided that such improvements are not intended or offered for sale. IL however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors State License Law does not apply to an owner of property who builds or Improves thereon and who contracts lar such projects with a contraCtor(S) license pursuant to the Contractors SState License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. & P. C. for this reason: Dale: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements tar a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and stale that the ve i ormal Is orr . I agree to comply with all city Ind county ordinances and state laws relating to building construction and hereby a one re es III five of this to a Don the above cottoned properly lagqr insp�e'cl]ian�p1urpo es ((}gtqL ate' ' VI `J " 7 Signature: Driver s License or Social Security 164146 Witte—Duiloing: Green—Code Enforcement Canary—Applicant. Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: F 070471 PLAN CHECK NO; 03735-94 L CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PERM Ni F070471 GOVT; N SUPP; N PURPOSE: ALT JOB DESCRIPTION ; INTERIOR 59580 T.I. SQ FT: CLAIM VALUE: 15,000,00 CALL—VALUE: GROUP OCC: E-1 /A-2,1 COMMENTS: TI "21466SF TO GYM AREA & 35499 TO CLASS ROOM", INST FIRE SPRINKL xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx;rxxxx;Exxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REPp• PROV; PARCEL; 42708201 ZNE: REF NO; PLANNING NiSTES> xxxxxxxxxxxxxxxxxxxxxxxxxxBHiF 1F 1E BEx iH iH if xlE iF xiH ie if iF ih iExxxxxxxxxxx+fxxxxxxxxxxxxxxxxxxxxxx D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY DATE: DATE: APPLICATION ISSUED BY; V DATE: x xxxxxxxxxxxxxxxxxxxxx xxxxxxxxxx �� x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx kxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xx xx LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 162,00 652 SMIP/NON—RES PLAN 105.30 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 162,00 0,00 105,30 267,30 267,30 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 162,00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 162,00 1L'�EBl7E iF 1E AE 1E 7F 1Fx iE x iPx 1E 1f 7E iE itx ilMxi4 xBfxxxxle xlfxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx I N D I V I D U A L F E E B R E A K D,.O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 162 FIRE EQUIP FEE (FROM BLDG VAL TABLE) END OF FEES a r �s- 1.00 162,00 01 00173905-00173905 Till 152.00 DATE; 12/21/94 TIKE: 13:17 1- CONSTRUCTION AND PLANNING POOL a SPA _. ` APPROVALS Permit #_- Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Serve or Po1c,.) "_ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, rJ' LH Steel Reinforcement �5�. igclricai,tilftcl 'h ility )ndrgrncb -) = r Forms C;ArEOFtric<06ndgi2-Lsi drgrnd. t+"'•S SUS. Electrical Bonding -, c •:rH - _�Oei Rehr fErcerr{ef} nJ `',ti �6�. Rough Plumbing & Pressure Test rt rt . iFaectricsTVFER:Goid. .m O APPROVAL TO COVER-GUNITE o, - t r r ;. Electrical Conduit-Undrgrnd. 2 rrotingi'��; ,��� ­4$t=Foundatlorr, ^� •59. Gas Pipe, 0 Undrgrnd., Test Water Pi3tJndfgFi,d. - ` 0. Backwash Lines, PRTrap, 0 Undrgrnd. 10. Structural'Eloor,System al. APPROVAL TO DECK I= P,Operty Sewer LinPj& Haase ConriWtion _ 62. Backwash & Receptor -Final 12. S§�ver Cap 63. Heater &Vent -Final 13. Roof Drains'n 0 ul ? 64. Plumbing System - Final 14. Rough Plum NJ'� ' 9 rR9 _ � 65. Electrical -Final 15. Rough Electrical -Conduit �' - 66. Solar System -Final 16. Rough Etctric'UViring m 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electric{ -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT :APPRPV 'JD�Iegiiit # :4 -R -7"V_ 20.,Ao�h Fktd?�Ij F3ei,11ace I a:til `t "1 O =l C-' # S H C* a 'j r H ' C7 H i + ;70. p dergttiGI, H ro 22. Due?;, Vp'v,til tini,�"•# I C.) * S 'L� 4'71. Produc i�gL`1As evil 23. aai pe��lou_h & Tyest I m5 * t1 C %4 O* * W2. Undergro TJ FI"n c.. 24. mRod7 Framing H» INF '• ^ O =�3.c'Iy.Jndergrn Stor yaank t3Gas C1 60 H» 25. Roti,�Sha thing �t ,C v Y 0 7 N* i 74iJOverhead Hydro(D * �• I /�� (H1� . 26.:T-eni Ceiling (STt6G}urdl) &3Toj dcoat fit to d Gi t 75 r C h emLlr ai F� 27.JFrargeago sht�g; jb,t,r * t' '1l+» 76. Dry Stan _ ipe Fta mm J 28. Latl ing.& Siding + c: "1<= b; Ex * 77 "'FIXED S4STE yNA t 1 t •••• -"19. Insulation` '� O' O wN 4- 78<FIRE PREV. FINAL »> a: n4r^S0. t Drywall'Naili'itg "hLTI ?%EPT,*+REQUIRWENT D1. Plaster Bgowp)Coat*t `•- i n'n• * * » ,79 INAL 1 P_ECT10.N t-82.tElectrical,Po%er WterrDFinal I * N » E%O.g00D CE R T I F I I TE IS�U D H t^ . I z33.'.'InElggtric, 'i;k if;in3t Heating-`$ Air Coorotion ' 6 * �• * rA C; S flx 35.,EFinakl'Gas Pip'@ -Tet �N H # y t t 10 aH { Off' t36. Hogd or Canopy * J I to -1 a• * n } e. "_ ; 7. r1?inaT Factory Fired ac� p tri » x r, I HH * 1N .38.,Binaf+Plumbing ^]+ ej i' H tib' .i f f09. Water Service-Fin331' 1 t * Cl oPtO a • [40. �as Service•Finaltr*f mn qw I" S tr1 r OIC Oco + • F O -41. -Solar Domestic-F� lyl S h " * Chto + -+ -• Sw r t42. Backflow Preventev» iu * �# # rJ•-n F Cl H 43. Backflow Irr'*tipb» r,«; y * oa,0 tr-;-. + �. x * a: i n 44. Landscape Irtipatuan SysterntL,-10 c. ? p1 t7 O t7. f u; pJ N w 1 ..0 a Ell 45. §0 and en`ilatibM t" F: F F Ff t C. H H '' c•� FCJ r1 Im f F V c^ QIP tP. 'GandicaP• Re9 ;g' ula +9 .qids H O * # + t: a, 7a =i P 47. FINAL STRUCTUR'E & BUILDING # * `1 `u •' rr n- 46. SINAL PLANNI G' I 1s n :q 4 t 09. -Eletiltic Release ttl'Edison I • R.. s .Ti �. •n r.J w 10. Gas.Qelease to. Sout;ern Califocnia,Gas Co #* - F • cJ ohi C/ _r< :51. CERTIFICATE OF OCCUPANCY No. Date fi■ PROJECT ADDRESS: 300 F I SCHER AV' OWNER'S NAME: SYMBOL TECHNOLOGIES INC ADDRESS: 116 WILBUR PL BOHEMIA,NY 11716 UNIT: ARCHIENGINEER; KNAP P E ASSOC REG.NO.: 0 3 0 57 7 ADDRESS: 2105 N ARROWHEAD AV UNIT: SAN BERNARDINO CA 92405 PERMITTEE: F172MES CONSTRUCTION (909)947-9467 ADDRESS: GROVE ONTARIO CA 91761 LICENSED CONTRACTOR DECLARATION: hereby ii an that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 the mess and Professions Code, and my lic as is in full force ane effe t. clrr uc.:��6 �J Ta7E uc.: 3 0 18 14 c s. B /% %P : 10/95 Date: l Signature: �1��� WORNEflS' COMPENSATION ECLARATION: I hereby afttlhat l have a CertificatI have a cr�enificate of consent to self insure or a cenificate of Workers' Compensation I�"et aj a)ce ufied copy thereof (Section 3800. Lab. V.1 /01/95 POLICY No.: ROYAL INS EXP. DATE: COMPANY: ��{{ El Certified opy ereby furnished. (J Certified copy is filed wi cit wilding Division Date' ' / Applicant:' EREMPTI NFROMWORAERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred (SIOO)or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency low the performance of the work for which this permit is issued (Section 3097. Civ. Cu LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing rain Section 7000) of Division 3 at the Business and Professions Code) Or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a card penalty of not more than live hundred dollars ($500). h as owner of the property or my emoloyees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sate(Sechon 7044, Business and Professional Cade: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I,as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business ❑ antl 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). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: 0. d P. C. for this reason: Date: Owner: I do hereby cenlfy that I am aware of and understand the requirements of California Health a 25534 and that I or any future building occuwpant illwill not (circle one) need to comply with permit for construction or modification from the Air Duality Management District. Residential these provisions. an Safety Code Sections 25505, 25533, and said state codes and the requirements for a construction applications are exempt from Date: Applicant: I hereby certify that I have re d this application and state that the above in motion is correct a eta comply with all city and county ordinances and state1,S rel ing to building construction ago hereby out represent ares of i city to nter upon the abovementioned property for ips ec pu s Date: � / Signature: Driver's License or Social Sec ity a: 164146 White—Bu llding: Green—Code Enforcement; Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM O: B Ob9ritl_ PERMIT NO: B 069889 PLAN CHECK NO: 04507-94 L c CONSTRUCTION TYPE: PERMIT TYPE: STP, PURPOSE: OTH JOB DESCRIPTION 1009LF 6FT HIGH(MAX) BLOCK WALL SQ FT: 1,009 CLAIM VALUE: 21,000,00 CALC—VALUE: 20,180,00 GROUP OCC: B-2 / COMMENTS: WALL INSIDE OWNER'S PROPERTY LINES Z O.N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- ------ ACCESSORY BUILDING------`=- FRNT: FT IN REAR: FT IN FRNT: 80 FT IN REAR: FT 1 IN LEFT: FT IN RGHT: FT IN LEFT: FT 1 IN RGHT: FT 1 IN PARKING RES: PROV: PARCEL: 42708201 ZNE: MP REF NO: PLANNING NdOTES> 1,009 L,F. OF 6' HIGH BLOCK 14ALL AROUND PERIMETER OF MARINER > CHRISTIAN SCHOOL, 12 MATURE EUC. TREES TO BE REPLACED:- PLNG i•*%i+%ie%%if i+*%iEiEfe 4E +Fi<*4%i4%?¢%ie%if %4EM* iE%ie%iF%%%%af %%%iE%!F*%%MY%%?F%{eM iPiw9r-%%k%%;YOFiF9e it ie%%fE9f 9eih D E V E L O P M E N T S E R V I C E S P, E Q U I R E M E'N'T S ZONING APPROVED BY DATE:tO BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: W (b(ci . 1Ei+if%%�,''%iE%iR iF**iF%%%%%Yif%+f♦fif-%%%%%%{R {e%%1e 9F i+iE%%%%%%%% ie%%%%ia%%%iL%%%%%%%9E%%%%%%%%%%ih% LEGALIZATION:N F E E S U M M A P, Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 216,00 1 2,02 SMIP/NON-RES PLAN 140,40 ISSUE FEE +� BUILDING -DIV-> PERMIT ISSUE PIAN -CHECK TOTAL PAID DUE TOTALS ---- > 218,02 0,00 ' 140,40 358,42 358,42 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 358.42 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 216,00 2,02 140.40 I N D I V I D U A rL -F E E, B R E A K D O W N TYPE QTY D E S C R I P T I;0 N UNIT COST TOTAL COST SFR 1009 RES -CONCRETE BLOCK -WALL / FT. 20.00 20,180,00 rE.ND OF FEES' L t� YI 01 00171515-00171517 T13 T 358.42 DATE: 11/10/P4 TIME: 13:57 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 7. Footings�Z/d/!J9 �J /d/ 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17- Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit ---------- 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 000 25. Roof Sheathing 74. Overhead Hydro 26, T-(jar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B.' 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 33. Final Electric 34. Firial Heating & Air Conditioning Nates: HOLD FOR SPECIAL LBEQl1lREMEM.T-S� 35- Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace o Z-01-4- 0A,�Z_- �(� �:�. QLO .✓�arna% 38. Final Plumbing 3 �'-/ef, �K oO e e4 39. Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING W 48. FINAL PLANNING _ - - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Go 51. CERTIFICATE OF OCCUPANCY No. Date PROAOT'ADDRESS: 300 F I SCHER AV UNIT: OW11ER'S NAME: SYMBOL TECHNOLOGIES INC ADDRESS: 340 FISCHER AVE COSTA MESA,CA 92627 ARCRIENGINEER: NUTTALL UCHIZONO ASSOC REG.NO.: C-9123 ADDRESS: 3199 AIRPORT LOOP DR UNIT: C C,M, CA 92626 PERMITTEE: FULLMER CONSTRUCTION (909)947-9467 ADDRESS: 1725 S. GROVE AV ONTARIO CA 91761 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions UI Chapter 9 (commencing with Section 7000) of Division 3 0l the B mess and Professions Code, and my license is in full force and effect CITY CIL.: TATE LIC.: 3 O C SS _ _ � Signature: VW pensa MPEN ATION DECLARATION: hereby a do that l have a cenlhcate of consent to selhinsure or a certificate of Workers' Compensation Igslyyr 1§a fetlNied copy thereof (section 31i00. Lao. 8'1/01/95 L1 / 01 / 9 5 POLICY NO.: ROYAL INS EXP. GATE: U COMPANY: ,..y enified cop is here furnished. d Certified copy is lilt th ily Build' msmn. I Applicant ... E MP710 ROM OnXERS' COMPENSATION DECLARATI : (This savemn need trot be completed if the permit is for one hundred (Slog) or less). cedily Thal in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: It. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency tar the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Prolessienal Code: Any City 01 county which requires a permit to construct, alter, improve. demolish, or repair any structure. mior to its issuance, also requires the applicant lot such permit to file a signed statement that he/she is licensed pursuant a the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section TODD) of Division 3 0l the Business and Professions Codel or that heisne is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I. as owner of the property or my emyyloyees with wages as their sale compensation, will do the work, and the ❑ structure is not intended or offered for sale (Seetlon 7044, Busmess and Professional Code: The Contractors' Slate License Law does not apply to an Owner of a property he builds or improves thereon, and who does such work himselUhemell or through his or her own employeesprovided that such Improvements are not intended or offered for sale. If, however the building or improvement is sold within One year of completion. the owner will have the burden of proving he/she did net build or improve for the purpose Of sale). I, as owner of the propeny, am exclusive contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Cocke: The Contractors' State linerse Law does not apply to an comet of pmpelly wtlp builds or improves thereon and who contracts for such projects with a coniractor(s) license pursuant to the Contractors' State License Lai I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby certify mat I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 255N and that I or any future building occupant wilOvAl not (circle one) need to comply with said state codes and the requirements for a permit lot 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. I agree to comply with all city and county ordinances and sta laws Nting In ouiMing construction andhereby bounce repiesenta' sol this tyro enter upon the above mentioned properly for ins C. r os s. JOat : Signatu 54 er's L ense Social Security C: 164146 White—Buildmg: Green—Code Enforcement: Canary—Applicant Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B069701 PERMIT NO: B 069701 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT JOB DESCRIPTION : INTERIOR DEMO TO WALLS rr GYM 6 CLASS RM SQ FT: 20,000 CLAIM VALUE: 20,000,00 CALC—VALUE; 20,000.00 GROUP OCC: E-1 /A-2.1 COMMENTS: DEMO WALLS & PARTITION WALLS IN THE GYM & CLASSRM REF PCk3446-94 ****aer*4r 4e*r4t44ar4ei4*err*4f 4flEiEr4EM4E4f1tif**yE*iFi¢ielt4fifkifiEiflEMifif4E*�iyMM*******k*4f Br 4f 44********ie 4E Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- PERMIT --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING RES: PROV; PARCEL: 42708201 ZNE: REF NO: PLANNING NOTES> FIRE SMIP/TOT GRADING PLAN—CHECK 207.00 > 4,20 it%ie if4Mif 4e**if klF 4e*k%iE if iE 4iek4if**%1f iE aE ie iE ie �F je iEMie iE**aF ff lE iE iek iE*iE 1F**IE ie if***4lE ie iE*if iE**4*iE iE if *iEk4f* D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE,- ATE;APPLICATION APPLICATIONISSUED BY: L DATE: iflf ie Mie fF iL*ie Mih MiE itMMif iF*ie ik itMM MBf ifMMlf Mif Mif iE 4eMMif Mif ie l¢ie It if 4e*1E*ie ifMMieff ie 4¢e4*%it M14 iE*ie lF iE ie ie iE ie *if ie iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING PERMIT 207,00 PLAN ISSUE FEE SMIP/NON—RES 4,20 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 211,20 0,00 0,00 211,20 211,20 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 211,20 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 207.00 4,20 *ice#M4e MiE ie*1e 1f 4e1e ie it4Mie iF ie*iEki: it iEwk*MiE*aEk iE 4t ie ieM**it ie**1f M1t**it*if 4FMM*ieie ie iE ik iEM44*r4ie ice***�f 14 iEMK1E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFC 20000 DEMOLISH BY VALUE COMMERCIAL NOZONE 1,00 20,000.00 END OF FEES TOCT S11994 ". CITY OF COSTA MESA CONSTRUCTION AND PLANNING '1'. APPROVALS Permit # --Date Inspector POOH 6 SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .6.' Electrical 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 I& Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace - .. 21. Ducts, in Structure ,- - 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe:Rough &Test ,; - - 72. Underground Flush 24. Roof Framing - 73.' Undergrnd. Storage Tank OGas 00il 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 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat .79. FINAL INSPECTION 32. Electrical Power Meter -Final 80.,FOOD CERTIFICATE ISSUED 33. Final Electric Notes: I 34. Final Heating & Air Conditioning- r 35. Final Gas Pipe -Test ' 36. Hood or Canopy 37, Final Factory Fireplace 38. Final. Plumbing -� 39. Water Service -Final - 40. Gas Service -Final ; _- 41. Solar Domestic -Final` - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING S 48. FINAL PLANNING 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 300 F I SCHER AV OWNER'S NAME: MSI DATA CORP ADDRESS: 335BAKER ST, C.M. UNIT: ' CITY OF COSTA MESA — BUILDING PERMIT a 850-9299 ARCH/ENGINEER: EQ E REG.IjC43751 eADDRESS: 3150 BRISTOL ST UNrt: 350 C.M. CA 92626 PERMITTEE: SAUNDERS CONSTRUCTION (714)646-0034 ADDRESS: 1760 MONROVIA AV A-1 CM CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 com a g with Section 7000) at Division 3 of the Business and Professions Code, and my license is in full force and elle CITY A1C.: 2 1 4 STATE UC.: 3 8 2 7 4 /' Date: Signature: '—RKERS' COMPENSATION DECLARATION: I hereby affirm that havInbriide .a to of nsation Insurance, or a certified copy thereof (Section 3800, Lab. C). No.: 1159615 Exp. DATE: 12/01/90 wPANY: STATE ��, Q;erttied copy s hereby furnished. ® Cunified co rile with ity Bu OivlRi i . Date: Applicant: EKEMPIION FROM WORKERS' COMPENSATION DECLARATION: (Reis section need not be N the mane hundred (5100) a less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: -- "Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: - OWNER BUILDER DECLARATION: I hereby affirm that I am exempt tram the Contractors' State License Law for the following reason (Section 7031.5 Business and Processional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to is issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing win Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my empployees with wages as their sole compensation, will do the work, and the ❑ stmcture is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/hersell or through his or her awn employees, provided that such improvements are not intended or offered for sale. 11, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ ' and Professions Cade: The Contractors' State Licenee Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects cith a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ am exempt under Section: B. S P. C. for this reason: Date: ovena, I do hereby certify that I am aware of and understand the reduirement�of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Dated Applicant: I hereby certify that I have read this application and state that 94 above information is correct. I agree to com I with all city no county ordinances sap sight lam relating to building construction and he to representatives of t ant 'pon the aboviimentioned prope nn ectlon ityposes. Date: Signature:411 Driver's License or Social Security x: 164146 White—Building; Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor PERM NO: B 047749 PERMIT NO: B 047749 PLAN CHECK NO: 03749-90 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: ALT SOB DESCRIPTION : 62000 SF ROOF SEISMIC STRENGTHENING SQ FT: 22,000 CLAIM VALUE: 22,000.00 CALC—VALUE: 22,000.00 GROUP OCC: B-2 / COMMENTS: Z 0 N I N GS ERTEBQA CIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT 'IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE& PROV: PARCEL: 42708203 ZNE: REF NO: PLANNING N TES> > D E V E L O P M EE N � T S E R V I C E S R E Q U I R E M E N T.S ZONING APPROVED BY ; CgGp Pi �� DATE: 06,- BUILDING APPROVED BY DATE APPLICATION ISSUED B - DATE:' -- LEGALIZATION:N F E E S U M A R Y. STRUCTURAL,,SEGMENT:Y BLDG PMT PLUMBING ELECTRIC ECHANIC '1 FIRE SMIP/RES,' GRADING PERMIT 225.00 — SMIP/NON—RES PLAN 146.25 _ 3.30 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 228.30 0.00 146.25 3.74.55 .374,55 ,00 . t REVENUE DIVISION TOTALS--> COLLECTED: 228;30,!OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE _SMI'P/TOT GRADING PLAN—CHECK 225,00 3.30 #################################################deft•##je######################### I N D I V I D U A L F' E E B R E A K D O W N TYPE QTY D E S C R I P T I O -N UNIT COST TOTAL COST SFC 22000 ALTER BY VALUE COMMERCIAL NOZONt END OF FEES 1.00 22,000.00 01 00063522-00063184 Tf_ET 228.30 DATE: 06/14/90 TIME: 11:.23 CONSTRUCTION AND PLANNI APPROVALS Permit #- .Date Inspector POPA _ . APPROVALS - Permit • Date Inspector -i.:Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . ' , ' 53. Steel Reinforcement - - 3. Electrical Conduit Utility-Undrgr.nd., 54.. Forms .3 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding - 5..Steel Reinforcement - - 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. - - 57. APPROVAL TO COVER-GUNITE - 7. Footings _ . ' 58. Electrical Conduit-Undrgrnd. 8. Foundation' - 59.'Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ElUndrgrnd. 10. Structural Floor System -1 -� '- 61.__APPROVAL TO.DECK - 11. Property Sewer Line & House,Connectio,n 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 - I 16. Rough Electric Wiring. F _ 67. Fencing & Access`Approval 17, Rough Wiring Sign - -' - 68.•APPROVED FOR PLASTERING y 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS,F I NAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure' - 70. Underground Hydro 22. Ducts, Ventilating. 71. Product Piping C3 Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground. Flush ' 24. Roof Framing - - 73: Undergrnd. Storage, Tank ❑Gas El 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. Insulationi , j J; 78. FIRE PREV, FINAL 30. Drywall Nailing j �' �.'. _ HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ( 79. FINAL INSPECTION 32. Electrical Power Meter -Final, 80..FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning SL k-35. Final Gas Pipe -Test- i r� l "` F, 36. Hood or Canopy 37. Final.Factory Fireplace 38. Final'Plumbing - - 39. Water Service -Final 3• '+t5 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irriqation 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 Appllcant to fill In all spaces except those CITY OF COSTA MESA CONSTRUCTION PERMIT T Applicant's Meiling Address l Project Address 0 L Owner's NameC 9�1% r --- - Phone E' ? G Address J Arch/Eng. License No. Address _ , li� Contractor's Nam /I hone Address lmailingll �� �.�%/Si�N License Nn _�_�1- LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am Ilcensea under provlslons of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license Is In full f rc pqd effe�( a/ ��J,%�� U en./e �. %CJ Signature�`7� No. iRKKER/S' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a.cart ficate of Workers' Compensation. Insurance, or a ce tified copy thereof (Faction D 3800, Lab. CJ - policy Nied co— Is homPany����� \ Certified Copy Is hereby furnished. • r fl c D Is filetl with the city BQI�tlIng slo Date h 1,r. cit / A' EKEM PTIO_�M WOgKE RS' CO ENSATION DECLARATION ' (This section need not be completed if the Permit Is for one hundred ($100) or less). •s I certify .that In the performance of the work for which this permit Is Issued 1 shall:. not employ any person In an yy manner so as to become subject, to the Workers' Compensation Laws of Californla. Date I ISignature NOTICE: If, after making this declaration, you Should become subject to the Workers', Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit , shall be (leemed revoked. CONSTRUCTION: LENDING AGENCY I I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is .Issued -(Section 3097 Civ. C.) Under's Name - Under's Address; OWNER'BUILDER DECLARATION -- I hereby affirm that I am exempt from the Contractor's License Law for the 5w r ; f7r o rW antl the basis for the alleged axe m ption- Any viola{lon of 5ecll on 7031.5 byany applicant for a permit subjects the applicant to a civil I enalty of not more than five hundred dollars ($500). I; as owner of the property or my employees -with wages as their sole compensation will -do the work, and the structure Is not Intended or, offered for Sale (Section 7044; Business and. Professional Code: The. Contractor's Tor The purpose as Owner of the ❑ I.am exempt untler Section— ' Date Owner FI hereby certify that I'have real 1 Information Is correct. I aaree to all appropriate declarations. TYPE OF CONSTRUCTION LJ NEW LJ ADD L ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER r DESCRIPTION OF WORK UUDa+` Groul✓n - Dk`f'Pr /o~J01/1 TYPE OF PERMIT U GRADING L1 FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION SG. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONA GRADINGCU.YDS. ACRFS Remarks: Sink kflow, Preventer kflow Irrigation Drinking Fountains Floor Drains Floor Sinks - - Gas Service. Outlets ; Interceptors Kitchen Sink Lavatories P Trap Roof,Drains ' Showers Service Sink owner of a property who builds or Improves k himself/herself or through his or her own provements are not Intentl ed or offered for mprovement Is sold within one year of Som- urden of proving he/she did not build or Im- : r Boiler Sub Panel Duct - Under Ground Sub Pole ' Duct - Structural n exclusively contracting with, licensed con. action 7044, Business antl. Professions Code: _ ; Duct : Ventilating ,as not apply to an owner of property who aho contracts for such projects with a con- :ontractor's License Law). 'Microwave Exhaust System ❑ Multi .Pole Light j Firepl/Fact. Bit. ICBO # B. & P. C. for this reason Device Boxes an Heating System & Ducting 06100,000 BTU 0100,( I this application and state that the above comply with all city and county ordinances yyyyyy co ristructicln, and hereby authorize repre- 'llppn the Dov -mentioned proper t for yy5,Z - iL--JDateJ[/✓ �I MECHANICAL $1 TOTALIFEE: $ Hood or Type I 11; Hoo yp T eI1 ❑' $15 Drivers' License or SS 919 , i Registers MF 0865.46 rev. 12/82 Wh -Applicant; Pink - Accounting; Goldenrod - Assessor Sewer Cap Sewer Connection_ Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water. Heater,- - Water Service , Reinspection Fee Issue Fee ; MECHANICAL Refrigeration System 06100000BTU 0100,ODO BTU Reinspection; Fee i Iswe, Fee ' i REF. 06, LEFT SIDE YARD PKG. SPACE RED. STREET WIDTH 155 7/ql/A3 REAR YARD (TO P/L) RIGHT SIDE YARD PROVIDED PARK FEE $ I3.OU TL Automatic Washer -Mater UOver 100 amps Construction Pole Sub Panel Cooking Unit Sub Pole ' Dishwasher Motors 061 HP 01'G-8 - Dryers ❑Gas ❑Electric lnc.Solar 09-15 HP ❑16-15+ Fan 'Microwave F.A.U. 1 .Pole Light j Fixtures_ 'Range 1 Device Boxes an 1 Switches , - 'Trash Compactor SUMMARY OF FEES : I , BUILDING PERMIT $ I SMIP $ ' PLAN CHECK. $ I PERMIT ' PLUMBING $ 1 ISSUANCE $ ' PLAN CHECK $ GRADING $. Garbage Disposal ' Generator 00-5 KW 05-15 KW Transformer 015.50 KW 050+KW Reinspecti $15 Meter 0up to 100 ampi Issue Fee $ 3 Zoning Approved By Date Application Approved By Date Application Issued By �A' nate ' SUMMARY OF FEES : I , BUILDING PERMIT $ I SMIP $ ' PLAN CHECK. $ I PERMIT ' PLUMBING $ 1 ISSUANCE $ ' PLAN CHECK $ GRADING $. ELECTRICAL $ /2"� $ PLAN CHECK $ MICROFILM $ MECHANICAL $1 TOTALIFEE: $ $15 1 LESS PLAN CHECK $ ADVANCED;PC $ $ 3 _ FINAL FEE; $ ? 't CONSTRUCTION AND PLAN 1Nd ;Sr ' SPA - I v' >- APPROVAL'S Permit #_ " s 2Date :Inspector ; 2APPROVALSy Permit # ` -'Date Inspector ," "d' r1, ITemporaryl ElQctrical Service o�,3Pore s a? • '•; ,; . a o � ;-� ': -}52± Pool &JEguipment Location - .. • `n T J I -. V C'�'• pI v •2! fSoilrPl a-Undrrnd= p �... E,53^.Steel;Reinforcement II'S CC - r t'i. I H w ,9 rnd. - 's"-�- g •3. Electrical Conduit Utilitv-Undgr ;, _ r54. ;Forms Condn1'. 5°. Electrical.Bondin 9: I - IEecrical �-,Iuit-Undr `. .;� ,I 5. Steel Reinforcemerit•' i56 RoughiOlumbmg &'�Piess'ure Test ! �- , I .� 16.{ElectricalLIFERiGrnd.;' Fg •I "n 'lR:. ' 57 APO, ROVALTOCOVER-GUNITE - .. . 7.:Footings ( ; +' ? T I .: F.. ° o `S rP _- , .<58. Electrical Conduit-Undrornd. _ 8. 'Foundation r59. Gas Pipe;'O Oridrgrnd., Test' " I t Pipe=Urdrgrnd. I , wash Lines, PTrap, O Undrgrnd. -9.. 60. ackWate} 10. Structural Floor System .I „`.' o ; �;; .` .61. �APPROVALTO DECK - ` _• 11. Property Sewer Line & HousegConnection" - ' % ��' 'E .62Backwash &Rece tor -Final' 12. Sewer Cap • i" i 1 ' j _ 63. Heater & Vent -Final ' • _ co _ 13. Wo'ofjDrains' �• .``, ` j ` ' ` ' -� ! 64. Plumbing System,• Fina! •rl 0 14. jRough Plumbingi i f165. Electrical=Final- - `- - - -=15F'Rough-Ele'ct Tical=Conduit - - - - T:I !i T -T T',�-1'- I -166_! Sola?System-Final' �. 1- 1 I I u h- 16.IIIRi+ I ( - 7=.Fencing &Access Aproval9 1 - -- ---- - 1•�a• Io,• m• t I 1`1 V . •. I, Rough4iring�Sidnti +t { "' i� U_ 1i ` o I t' `. c I 168.• APPROVED EOR PLASTERING - "" ,�17. Ceilingi69.I POO L/SPA SYSTEMS FINAL - 6118.jRough-EleTical;T`Ba 't' 19. u?Heating &�Air',Conditioning �i I I 1 S I I �' i FIRE DEPT. (REQUIREMENT I APPROVALS: t permit # ! _! 20.R6ugh_.Factory Fireplace { 1 .I II 1 i _ ( •' I t• Jn n I n[ .i '31 21. �Ducfs,0in Siructurew 1I�X70 1 Underground Hydro 6222. bucts, Vensilaaing ;' r: i •j I� {i } I ( "70 Product Piping ❑ Gas O Oil Test it°' i T T rTr! I72.Undeound Flush23.IGas:Pipe-Rouge& , ; , i•=24. (Roof Frarrnng� 1 t i ` l j ij c `� - I 173.E Undergrnd. Storage Tank O Gas OiOil j II! 25,Roo4 Shea Thing Overhead Hydro ,74. 26. T Ba'r Ceilio`g (Structural! & Monocoatr' a �, A 1 s 1 " c I ! J5. Dry Chemical - - - <: 1,_27. ;Frame a401ashingl I� ; } ` i i i X76. Dry Standpipe 28. ,;&th'ing &-Siding, I i II I + , IR { 177,', FIXED SYSTEM FINAL 29,;flnsulation = ' ('+' ` a I I r t III( (( 1 { ' 78: FIRE PREV. FINAL - I r -'r T, I 1 I r,30.IDrywall Nailing n r I I !� �I I I I { (Notes: '- I ; 31. IPlaster Brown Coat ( �I'I I 1 I ! I; 32. Electrical lPower Meter -Final LL�Lj ' 33.t Final Electria 34. Final Heating &Air Conditioning 1 I' -II :¢, IIF. t 35. Final Gas" Pipe=Testi - 36. Hood or Ca n4iV'�n � �'I( ff n ( { �, ! I t I u e I - �l "' �' i j-{� 37. Final Factory Fireplaces 38. Final Plumbing- � 39. Water SeEvice'-Fifnal� •j I I I '� I i ! �. I' `- -. , : ': - . 40. Gas Service -Final ! I! 1 I' l l i�{ i •{ i i i l i 1 'til 41. Solar Danestic-Final i - ' I 4- I -I��� 42. Backflow Pre'veriten, ,_ { 1 °,,,! �," •.I 1 ! I i„'I. 43. Backflow Irrig anon 1 ..;' 151 `!�s �c I vl - I- � , 44. Landscape Irrigation;System 45. Sound;,Atte4aii, r I m' 1'<1 - n 46. HandicapRegulations I~ ° I r. I ; I� 47. FINAL"STRUCTURE & BUILDING r I t I t t " I 48. Special Requirements Completed ; 49. Electric Release'to Edison I H k-t!_� I i 50. Gas Release >!o Southern California Gas i 51. CERTIFICATE OFIOCCUPANCY � � No ;( I I ! "I I f• f ! Applicant to fill In all spaces except those within heavy border lines and sign all appropriate CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 300 t/S L.ry [_7L /�//C' _elg jpn Applicant's Mailing Address : 116C1 h171i'LTEUS AW, 'f. rt • F. Owner's Name �S"/. 10ArA f.CAP-hone '.C`V9130DD Andress Son. '�isc++E•rt 4o' . - Arch/Eng. License No. Address P Contractor's Name !Z=V$T L`_O"4V/ ' Phone .2ML 7%13 Address,(mai ling) &M- %71AfCrE'A1. /Z %L/• Cit.. T.v. City License No. LICENSED CONTRACTOR DECLARATION Ihereby' affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class ice e No.33/� 7Zi 'Date u'y D—.C,4 Signature ')RKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to.self-Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) I Ppncr No. bb1c.ls ] l966 73 Company RJ(�tOc?+LI /^-LC ✓J2AaJr.a� Certified copy, is fledbwithrthe city B))J Ilding DNw n. / Data L/-10- 4e Applicant Li/sr - o L EXEMPTION FROM WORKERS' COMPENSATION DECL RATION (This section need not be completed 1f the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If,iafler making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be ,deemed revoked. CONSTRUCTION. LENDING AGENCY - I hereby affirm that there is a construction lending agency for the Performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Under's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or - county which requires a permit to construct, alter, improve, demolish or repair anv structure. Pllor t0 Its Issuance. also requires the aDpllcant for such permit and a permit Subjects the applicant to a as owner of the property or License law aces not apply to an owner or a property wno oullas or Improves thereon, and who does' Such work himself/herself or through his or her own employyees, provided that such Improvements are not Intended or offered for safe. If, however, the buliding or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she old not build Or Im- rove for the purpose of sale). I. as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044,, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner I'hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to nter pun the above-mentioned property for inspection bu/r/pp /sps. /SL.� [/ 51 nature �I A.[�r i Date TYPE OF CONSTRUCTION NEW LJ ADD LK ALTERATIONLJ REPAIR - ❑ CONVERSION ❑ DEMOLISH LJ THER. OESCRIPTION OF WORK ?2 J90tV,!q 2e) �- 22 14:2H TYPE OF PERMIT LJ GRADING lJ FOUNDATION Llk.STRUCTURAL - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL , !0 OTHER, PROJECT DESCRIPTION SO. FT. OCCUPAN Y CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRE Remarks: - Sink Preventer Irrigation Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $25 Service Sink Sewer Cap 1;_�; Sewer Connection Solar Collectors' Solar Piping Solar Tank Swimming Pool W/Spa Urinal Water Closet Water Heater Water Service Issue Fee $ 3 g /- �',;ers' License or 55 � '��� ��Reinspection Fee�$25Fee�$25 ^6 rev. 12/83 White- Building; Canary - Applicant;Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 ons Automatic Washer Construction Pole Cooking Unit ELECTRICAL Transformer 0' 5-50 KW ❑ 0 + KW Meter ❑up to 100 amps Meter ❑over 100 amps Dryers LJGas LJElectric Sub Panel Fan - Motors ❑6-1 HP ❑1X-8 F.A.U. Inc. Solar 139-15 HP Ell 6-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Generator ❑0.5 KW 135-15 KW Reinspeption Fee PUBLIC SERVICES REOUI Zoning Approved By_ Building Approved By _ Application Issued Bv ing Sections Compactor 73.97 TL Z O N I N G R E Q U 1 R E M E N T S FEES $ 3 8366 4/10/34 A.P. # y / QVC Q Zone, S Main Building: Accessory Building: , E T Front - ARear $ 2- PERMIT C Right S Left $ Ping. Ref. # Park. Fees $ - Parking Req./Provided - ENERGY P.C. Use of Building: - Planning Notes: _ Automatic Washer Construction Pole Cooking Unit ELECTRICAL Transformer 0' 5-50 KW ❑ 0 + KW Meter ❑up to 100 amps Meter ❑over 100 amps Dryers LJGas LJElectric Sub Panel Fan - Motors ❑6-1 HP ❑1X-8 F.A.U. Inc. Solar 139-15 HP Ell 6-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Generator ❑0.5 KW 135-15 KW Reinspeption Fee PUBLIC SERVICES REOUI Zoning Approved By_ Building Approved By _ Application Issued Bv ing Sections Compactor 73.97 TL Z O N I N G R E Q U 1 R E M E N T S FEES $ 3 S MM RY OF FEES BUILDING PERMIT $ SMIP $ �•�1 �+ PLAN CHECK $ 2- PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM '$ MECHANICAL $ TOTAL FEE $� PLAN CHECK 25% $ . CONSTRUCTION AND PLANNING APPROVALS ; Permit# _ - Date Inspector POO SPA APPROVALS Perm it Date 1 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 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 i - 65. Electrical -Final -- 15. Rough Electrical -Conduit - ' -. - _ 66.• Solar System -Final - - - - jp" Rough Electric Wiring - 67. Fencing &Access Approval -- -- 17. Rough Wiring Sign' '' 68. APPROVED FOR PLASTERING 18: Rough Electrical -T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19... Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20.'Rough Factory Fireplace 21? Ducts, iri Structure 70. Underground Hydro 22. Ducts, Ventilating r I 1.1 71. Product Piping El 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 l 1 j 76. Dry Standpipe 28. Lathipb&,Siding r X77. FIXED SYSTEM FINAL 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 33. Final Electric Notes: 34. Final Heating &-Air Conditioning 35. Final Gas Pipe -Test' r " 36. Hood or Canopy - 37. Final Faciory Fireplace I - 38. Final Plumbing - 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer r , 43. Backflow Irrigation r - 44. Landscape Irrigation System - 45. Sound Attenuation., - 46. Handicap Regulations l - 47. FINAL STRUCTURE & BUILDING, to .2,54 48. Special Requirements Completed, 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Cn '• j - 51. CERTIFICATE OF OCCUPANCY No. - .� 'Date - r - '-- -- - - • -'! Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA' PERMIT NO. TRACT NO. LOT NO. BL CONSTRUCTION PERMIT Applicant's Mailing Address—1 OF S TYPE OF CONSTRUCTION NEW ADOA4 ALTERATION_ - REPAIR 3 ..� ❑❑ 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 Project Address �� rS P.. - Owner's Name '3"3 M CONVERSION. DE.rO'LIISH�'❑ P1 OTHER - DESC RIRT ON OF WORK•t`sl.eq eN `f'%1'1�r �yp C=vw1P •a 6 '/I �C_'v I _ _` - - Showers - Reinspection Fee $15 Address 5— /3 a!4 TYPE OF PERMIT��II GRADING FOUNDATION STRUCTURAL - -r - Service Sink - ! Issue Fee - t $ 3 Arch/Eng. '—License No. 1:1T, S TENANT; ELECTRICAL ❑ PLUMBING ❑ MECHANICAL MECHANICAL - , Address;❑I - OTHER - ' Contractor's Na ' • Phone>--Y�%3 YS m Fixlores _ PROJECT DESCRIPTION SG. FT. / G 00 OCCUPANCY_a "s thereon, antl who 'tloes such work himself/herself or through his orherown '• Address (mailing) CONSTRUCTION TYPE VALUATION $ I StanamgSections 1 191 / ZONE - _ GRADING CU. YDS: !ACRES - 1 i 1 License No. / //LJL %- Com/ n I 1 I ' LICENSED CONTRACTOR DECLARATION ! 1 hereby,affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Remarks! ' 1 pletion, the owner .111 have the burden of proving he/she did not build or Im- Irafor thepurpose of, sale). .+ LJ I, as owner of the property, am exclusively contracting•wlth,licensed con- ! { - Duct -Structural System Repair/Alteration my license is In full force and effect. ( PLUMBING - ( UcenC ss ! Licen o. G•� �� { Date Yi Signet r �.c,'+�'j'(7�� '1RKERS' OMPENSATION CLARATION V '7 Bar Sink Sewer Cap` O— areby affirm.that I have.a cartificate of consent to self4nsure or a certificate Workers' Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer' - Sower Connection - Backflow Irrigation ,Soler Collectors Collectors \3BOc Lab. C n 00, No. (O Com Pant °r'„'/ �[/xr Bathtubs ' i Solar Piping ryjpe�s- -ertlfiedcopy Ii hereby furnls etl. ! 1 U Car If ed c I Tlletl with the cit Bu11 Ivi on ) Date Applicant' "rr - , _ Clarifiers Solar Tank , • EXEMM ION�RKERS''CO PENSATION ITECILARATION I (Thissectlon need not be completed If the permit Is for.one hundred ($100) or 'less). I cerlHy.that In the performance of the work for which this permit Is Issued I shall not employ any Person in any manner so•as t0 become subject. to the - Workers' Compensatlow laws of California.' I DishwasherSwimmin9 Pool w/Spa , Orinking Fountains Urinal , -- , Floor Drains Water Closet - - 110-160006 BTU ❑100,0008T� Date Signature ' ”' )- Floor Sinks- - Water Heater NOTICE: If, after making -this declaration, you should become subject to the—'- Workers', Compensation provisions of the Labor Code, you must forthwith 1 comply with, such provisions -or . this 'permlt shall be .deemed revoked. ! CONSTRUCTION, LENDING AGENCY I f _ Gas Service. .Outlets' Water Service r Interceptors !. - -- $15 I hereby affirm that there is a. construction -lending agency for the performance of the work for which: this permit Is -Issued •_(Section 3097 Civ. CJ _ Kitchen:Si_nk Cann T e 11 ❑' '1 Lender's` Name Lentler's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason -(Section •7031.5 Business and Professlonal,Code: Any city or I Lavatories. r- " p—Tre p' = 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 Roof Drains - t0 file a sl goed statement that he/she Is Ilcensetl pursuant to the prpvl510e3 Of _ _` - - Showers - Reinspection Fee $15 r n 9 Cont ractor's License La9 (commencing with Section 7000) of - flslon 3 of the Business antl. professions Catle) or ihet� he/she is exempt 3refrom and the' basis for the a' 'aged axe m ption. Any -violation oi, Section I -r - Service Sink - ! Issue Fee - t $ 3 ,531-5 by: any applicant for. -a permit subjects the applicant to a -civil �nalty of not more than five hund retl o.1 tars ($500). , - I LI I, as !owner of thp'Oro pO rty or my e'm Picy oes with wages as then solo com pensatlon wlll: do the work, antl the structure Is not Intended or offered MECHANICAL - forsale (Sec�lon 7044; Bull nets antl Professional Code: The Contractor's F.A.U. ' Boiler' r Refrigeration System Fixlores _ Ucense Law tloes not apply to'an owner of a pro Pe rty who builds or improves thereon, antl who 'tloes such work himself/herself or through his orherown '• Sign; ''• .' I StanamgSections 1 191 / ; employyees, provided that such improvements 1., of Intended or offered for sale. 1}, however, the bus Idlun or Improvement Iz so Id within oneyear of com- - Duct - Under Ground ❑0-100,000BTU ❑106,006BTU $� pletion, the owner .111 have the burden of proving he/she did not build or Im- Irafor thepurpose of, sale). .+ LJ I, as owner of the property, am exclusively contracting•wlth,licensed con- $ - Duct -Structural System Repair/Alteration $ _ '_ Duct - Ventilating - PLAN CHECK tractors to construct the project/Section 7044, Business and Professions Code:. The Contractor's License Law does not apply to an owner of property who $.':7sXV Exhaust System ❑ Multiple ❑ builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). Firepl/Fact: Bit. ICBO �/' I , ❑ I annexempt under Section- B. & P. C. for this reason 1 Date' Owner -' ' `" i Heating System & Ducting .: 1 1 hereby cart ify-that-1, have read^thls application' and state that -the-- above ' 1 110-160006 BTU ❑100,0008T� Information is co ct. I agree to.comply with all city, and county ordinances t - and. state law elat g to bulldin ns tion, antl hereby authorize repre- ,' sentatives o this • ty o an t e above-mentioned pr party or Hood or I - Type I ❑ l ` Reinspection Fee $15 .Inspection urp Z. f �3 Cann T e 11 ❑' '1 Signature , Drivers' LI sa or SS � - - I s , Registers Issue Fee 1 , $ 3 CMF 0865-46 rev. 12/82 White -Building; Canary - ApPllcant; Pink -Accounting; Goldenrod -Assessor A. P. 46 - PLNG. REF.'* - 1 TO BUILDING PROPERTY LINE LEFT SIDE YARD PKG.SPACE REO. STREET WIDTH ,SPECIAL CONDITIONS: `0331 6/14/; f OG REGULATIONS - REAR YARD (TO P/L) - - RIGHTISIDE YARD PROVIDED ' ,PARK FEE $ , u _. Automatic Washer .-. ; _ _ 'Meter LJover100amps' Construction Pole Sub Panel / Cooking Unit 'Sub Pale Dishwasher I Motors 00-1 HP W1X-8 Dryers ❑Gas• ❑Electric 'Inc. Solar 09-15 HP 1116-15+ Fan. ;Microwave ! F.A.U. ' �Pole'Light Fixlores _ Range. Device Boxes !' - Sign; !O outlets I StanamgSections 1 191 / -.lbwncnes - I I Trash Compactor I I�QI IGarhabe Disposal ! Generator UO -5 KW U5-15 KW SUMMARY OF FEES Transformer V115-50 KW -- 05U+KW' 'Reinspection Fee 575 Meter ❑up to 100 amps .Issue Fee' $ 3 Zoning Approved By Date Application Approved By 1 Date •/�^ $ SUMMARY OF FEES BUILDINGPERMIT $ i SMTP $ ,PLAN CHECK. $ PERMIT 'PLUMBING $ ISSUANCE $ ,PLAN CHECK GRADING ' $ ELECTRICAL' ��'$ yg -: $ ,PLAN CHECK: $� MICROFILM $ MECHANICAL $ TOTAL FEE PLAN CHECK $ .! I LESS ADVANCED PC $.':7sXV FINAL FEE -GONSTRUCTIONAND.PLANNING 1=-f4'':- - '� ;=' '-- ° rPOO SPA ' '--tMate- ? APPROVALS ': Permit# - - Inspector --' --,APPROVALS--.:-Parmit# .Date Inspector Temporary Electrical Service or'Pole ' �' 'h: - 5 i525 Pool &'Equipment Location n : 1„2; Pipe-Undrgrnd;. s '�.- .: ; 53.- Steel ReinforcementV@ iSoil _._ 3: Electrical Conduit Utility-Ungrgrhd! Forms ^-^ �•, " « - 1 � � 9 +1 _ , ,54.• c' _ 4'. Electrical Conduit-Undrgrnd. _ < < ' `_ y - '" •' �.) `f- � �'55 � ElectricahBoriding. - • v 5: SteefReinforcemerit _ ' '•I �, r W.� ' - - 4;: o'. _ ' 56.. Rough Plumbing &-Pressure Test 6: '�Electiiral LIFER Grnd; '_ •, j .-= Sr n = ' 1,57:.: APP,ROVALrTO COVER-GUNITE - - r. 7. Footings I � 4,J �'� e; ' y' _ ;-`, ! ,'58^ Electrical Conduit-Undrgrnd,;. z I 8. Foundation I � e; F`r og 59. Gas Pipe 5FUn.digrnd:;Test 9. Water, Pipe-Undrgrnd. i P ! - z ; x;60. Backwash' Lines, P-Trap, clUndrgrnd.' 10. Structural Floor System I ° ?'.; =9 .61. APRROVA'L' TO DECK - 11. Property Sewelr Line &�HouseConnection 62. Backwash &'Receptor-Final. -- - <'r I 12. Sewer Cap I I ,I _ �- n3 ^` =63. Heater &-Vent-Final -' - - 13. Roof,Drains I I'.' I y r ! ,- ;:64. Plumbing. Systein;`F,inal"'-- - I . 14. RoughPlumbing I + I - 65. ElectricaFrinal 15. Rough Electrical-Conduit T�r `� � ,- ,T 7- (I- � _I- T-- 1 66. So-Fin-al "- "-- -. ---- 16.Rough-Electric Wiring, H (I. '- - I_-' T, - 67:i Fencing&;Acce`ss ApprovaI,--- �'l7. 'Rough Wiririg'Signp 68. APPROVED FOR PLASTERING- 18. 'Rough Ele`c[rical T'Bar Ceiiingl !i I �' I + 169.1 POOL/SPA SYSTEMS FINAL I i 1 . 19. R_ou hHeatin• & Air'YConditi1 nin9 9 ' DEPT. REQUIREMENT-, ' 9`. IFIRE 1 1 I I APPRO,VALSI ' Permit'# P - I " 20. +Rough Factory Fireplace) I iI 1 a I I I i I 21. Ducts,'-:in St-ructurew -7Uriderground Hydro ' r 4.22. Ducts,,Ventilating �• t jl I, i j 1 71•'ProductPiping OGas 00il i ,23. Gas Pipe-Rough &Test I h !, I T I I 72.1 Undiground Flush I j !^ 24. Roof Framing' '• ( ,� ,� ; , v - �, I - 1 73.. Undergrnd. Storage Tank O:Gas._,O Oil - ! 25. Roof Sheathing i A ' 74 Overhead Hydro ! '-26. T-Bar Ceiling (Structura0, & Mono'coat' I o.. - ' `_ 1 75.1 Dry Chemical - - - I,"i 27. Frame and Flashing, , I;I 1 ' I', j j j76.i DGy Standpipe . I 28. Lathing & Siding I I ; I' !I 11 i I 11 1 77•! FIXED SYSTEMrFINAL i s 29. `Insulation T '' - p !I I I ` I 178.1 FIRE PREY. FINAL i 1 I 1 1 s - 30. Drywall-Nailing ' i 'T !Noies:I r' I 1 31. Plaster Brown Coat 32. •Electrical Power Meter-Final ' 1 j j l I1 i I •• " - 33. 'Final Electric i 34. Final Heating &!Air, Conditioning 35. Final Gas Pipe-Test. ' I ' , f Ii i ' t = i � i -• � ' <_� 11" I �� � I ' � � - 36.Hood orCanopYt- :i .i �I a 1' - 1- 1'��'�: I= 'tG -• - _ _ 37. Final Factory Fireplace' 38. Final Plumbing I $' I " I _ i ! 1 I '' ! r.. =• I'' 39. Water Service-Final I 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer + _ -� -4 43. Backflow Irrigation) ' I �'+� ` ! I ` - t i I j�' 1 - • ' _� 44. LandscapelrcigationSysteml 45. Sound i Attenuation- ', I c I �� • ; y I I ' ! ! I I ;1 . i 1 ,`� I - �; 46. Handicap'Regulations ! r a! 4 Ti I 'I ! 1 • � r. .1 It i I i 47. FINAL STRUCTURE & BUILDING'! f ! 48. Special Requirements Conipletedl ' 49. Electric Release o Edison I ! 1 50. Gas Release to Southern California Gas 51. CERTIFICATE OF=CUPANCY- _ No Date CITY OF COSTA MESA CONSTRUCTION PERMIT Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. pc RaalT NO I TRACT Nn I 1 nT NO I Rt MR.Nn -UCTr Applicant's Mailing Address 'TYPEOF&`DP74 ION NEW AD ALTERATI DON REPAIR Project Address - - E:1 CONVERSION ❑ DEMQ41$F{ ��QTrH goner Owner's Name 14 S'I DATA COP.PORATI NPhone 545-6135 DESCRIPTION RIPTION OF WOR K [�jQ 1 Address '2110 F1S(-har AVpnip Costa Mesa TYPE OF PERMIT U GRADING FOUNDATION -STRUCTURAL Arch/Erg. License No. ❑ TENANT 11 ELECTRICAL 1:1 PLUMBING AJ MECHANICAL NOTICE: If, aftermakl Workers'. Compenwtlol comply with such Dt CONSTRUCTION' LEI I hereby affirm that the of the work for wt, Under'S Name Uender's 'Address OWNER BUILDER DE I hereby affirm that I following reason fSectl county which requires ,any structure, prior to o file a signed stateme to Contractor's Ucens Jivlslon 3 of the'Busl therefrom and the has .7031.5 by any apDlir �analty of not more the U I, as -owner of the signature its declaration; you should-become'subject to the Floor'Sinks '- avisions of the Labor Code, you must forthwith ons or this permit Ishall be -deemed revoked. Gas Service ' .Outlets IG AGENCY a construction lending agency fpr the performance Interceptors this permit Is ;Issued (Section 3097 Civ. C.) ' Kitchen Sink the a i perrnit SubjectS the ap ndred dollars ($500). r or my employees with s and the structure Is not li ss and. Professional Code: n owner of a orooertv.who Address. El OTHER Contractor'sName* RIANE ArIS�,��Ce oho a 66330--66441122 Address (mailing)1175 N. OpsreY Circle �eLI3,7LOUr city or PROJECT DESCRIPTION SO. FT.— T._Address(mailing) CONSTRUCTION TYPE r repair f License No._ )3= 076096 ZONJ= GRADIN( CONTRACTOR LICENSED DECLARATION Remarks: I Firepl/Fact. Bit. ICBG + ' )0) of I hereby affirm that I am licensed under provisions of Charter 9 (commencing exempt Showers ^. with section 7000) of Division 3 of the Business and Professions Code, and $ 3 uyl`canw is in ful f a and effect. , e p 396-109 .. Service Sink Pwe net, Signature IORKERS' COMPENSATION DECLARATION; Bar Sink Backflow Preventer 'k -1 hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance„ or a certified copy thereof (Section 3800, Lab. C Policy No. �i01062 I Company�'� INSURAN A Certified copy is hereby furnished. _ Backflow Irrigation Bathtubs 1 (,�I\ W Car If cpplL is filed with the city ul ding OlvWon. Date^>Jr13 Applicant 7- 1 EXEMPTION FROM WORKERS' NSATIO DELLA f the permit Is for one hundredndred (S100) or (This section need not be completedd If less). I Cart Hy Ghat In the performance of the work for to this permit Is t to t 1 In to become to file _Clarifiers Dishwasher Drinking Fountains - Floor Drains shall rs' employ any person as subject anyy manner so as ' Workers', Compensation, Laws of Californla. NOTICE: If, aftermakl Workers'. Compenwtlol comply with such Dt CONSTRUCTION' LEI I hereby affirm that the of the work for wt, Under'S Name Uender's 'Address OWNER BUILDER DE I hereby affirm that I following reason fSectl county which requires ,any structure, prior to o file a signed stateme to Contractor's Ucens Jivlslon 3 of the'Busl therefrom and the has .7031.5 by any apDlir �analty of not more the U I, as -owner of the signature its declaration; you should-become'subject to the Floor'Sinks '- avisions of the Labor Code, you must forthwith ons or this permit Ishall be -deemed revoked. Gas Service ' .Outlets IG AGENCY a construction lending agency fpr the performance Interceptors this permit Is ;Issued (Section 3097 Civ. C.) ' Kitchen Sink the a i perrnit SubjectS the ap ndred dollars ($500). r or my employees with s and the structure Is not li ss and. Professional Code: n owner of a orooertv.who .-'--- t such. -poppy loop -. , em ploty, hoes. ever. ad that such Immprov e e are. not wihinoor offered for . sale. If, the own the 11 hav ng or Improvement Is sold within one year wild r Im- pletion, the owner will nave the isof proving he/she did not build or Im- rove for the purpose of sale). y - I, as owner of the property, am exclusively contracting'with'llcenied con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con. • Lavatories for the 1 city or p_Tra p' I r repair f % permit Roof Drains. Ions of Firepl/Fact. Bit. ICBG + ' )0) of s - exempt Showers ^. iectl on $ 3 a civil - .. Service Sink .-'--- t such. -poppy loop -. , em ploty, hoes. ever. ad that such Immprov e e are. not wihinoor offered for . sale. If, the own the 11 hav ng or Improvement Is sold within one year wild r Im- pletion, the owner will nave the isof proving he/she did not build or Im- rove for the purpose of sale). y - I, as owner of the property, am exclusively contracting'with'llcenied con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con. Duct - Under,Ground - $ ; Duct • Structural - - t Duct - Ventilating % Exhaust System ❑ Multiple ❑ ' tractor(s) license pursuant to the Contractor's License Law). ❑ 1 am exempt under Section - B. & P. C. for this reason Firepl/Fact. Bit. ICBG + ' Date Owner - I hereby cartily that 1 have read this application and slate that the above Information Is correct. 1 agree to comply with all city and county ordinances and,state laws relating to building const ruction,' and hereby authorize repro- zantatives o/ t city' to Doter, u on [he above-mentioned pro ersy for _• Intpeclldn pu s S. 6%1�+/II3 Signature ai/�!i/.0 :N..:� Date Drivers' lJcense or SS - - s - Heating System & Ducting 00100,000 BTU 0100,000 BTi r $15 Hood or Type I ❑ VP ' Can T e II ❑' $ 3 Registers CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor v ' OCCUPANCY VALUATION $ YDS. ACRES_ Sewer Cap Sewer Connection - Solar Collectors Solar Piping Solar Tank Water Closet Water Heater Water Service ' Reinspection Fee Issue Fee Refrigeration System 110.100,000BTU 0100,000 System Repair/Alteration Reinspection Fad; Iswe Fee j LEFT SIDE YARD PKG. SPACE REO. STREET WIDTH 1 I GRjMLftONS ZONE r17F rnSTA BUILDMU e - CTeAPy 11. eT REAR YARD (TO P/L) RIGHT SIDE YARD PROVIDED PARK FEE $ , DNS: ELECTRICAL ' !r. • -I Meter , ❑over 100 amps' Cooking Unit Dishwasher Dryers ❑Gas,❑Electric F.A.U. Fixtures Device Boxes Outlets Generator 00-5 KW ❑5-15 KW Transformer ❑15.50KW ' ❑50+KW. $15 Meter ❑up to 100 amps $ 3 Zoning Approved By Application Approved By Com, Application Issued By p Sub Panel Sub Pole Inc.Soler'09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections I Trash Compactor ME ME M■ ®E ME ME ME _®E WM- OF FEES :al/MMAI BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ 'PLAN CHECK $ ELECTRICAL $ ' 'PLAN CHECK $ MECHANICAL $ PLAN CHECK $ $ ; PERMIT ' ISSUANCE • % 50 $) MICROFILM s - TO TAUFEE r $15 LESS ' $ 3 ADVANCED PC $ ME ME M■ ®E ME ME ME _®E WM- OF FEES SMIP $ ; PERMIT ' ISSUANCE • $ GRADING $) MICROFILM s - TO TAUFEE $ 10.50 LESS ' ADVANCED PC $ FINALIFEE $ ; _CONSTRUCTION AND PLANNING ._ `T _ c -.POS. _&SPA": ' .:APPROVALS r Permit# Datector - - ;APPROVALS:" Permit# Date Inspector r •• 1~ Temporary Electrical Service or Pole - 52. Pool & Equipment Location .. - ." 21 Soil Pipe-Undrgrnd. - ". - 53.,°-, Steel Reinforcement - 3: Electrical Conduit Utilitv-Undrgrnd. 54. Forms' 4: Electrical Conduit-Undrgrnd: c - '? 55. Electrical Bonding - - - S. Steel Reinforcement `; _ ."�' �, ` %• 56. Rough Pluinbing & Pressure Test _ _ 6:, Electrical LIFER Grnd. ` r 57. APPROVAL, TO COVE R-GUNITE 7. Footings - -r� -:.s� -.'58.' Electrical. Conduit-Undrarna.- 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 Drain 64. Plumbing'System • Final - 14. ough Plumbing = 65. Electrical -Final- - •- - - 15. Rough Electrical -Conduit ('� -�-� -66. •SolarSystem-Final- -- - - - ' Rough Electric Wiring• - - I. �`,-_ -'l' 67.,Fencing &Access Approval 17.' Rough Wiring Sign '68., APPROVED FOR PLASTERING ' 1B�,Rough:Electrir IJBar•Ceiling 69. POOL/SPASYSTEMS FINAL _ - 19,'Rough Heating &'Air Conditioning I _ f FIRE DEPT. REQUIREMENT APPROVALS' Permit # i 20t�ou9h Factory Fireplace' I 21. Ducts, in Structure i i 70.' Urideiground Hydro 22. Ducts, Ventilating . i 71.. Product Piping PGas 00il 23. Gas Pipe -Rough &Test 1 72. Underground Flush " 24. Roof Framing- 'I + 73.; Undergrnd. Storage Tank O'Gas 00il I 25. Roof Sheathing + + 74.E Overhead Hydro • 26. T -Bar Ceiling (Structural), & Monocoaf ! I 75.; Dry Chemical - 27. Frame and Flashing I+ - ; 76.' Dry Standpipe , ' 28. Lathing & Sigi_ng + •' , - 77.' FIXED SYSTEM FINAL - - i 29. •Insulation 78.1 FIRE PREY. FINAL 30r Drywall Nailing Notes:. 31. Plaster Brown Coat -32. Electrical Power Meter -Final I I t 33. Final Electric 34. Final Heating &,Air Conditioning Z ( I- 35. Fina! Gas Pipe -Test 36. Hood or Canopy -i I - 37. Final Factory Fireplace' 1 38. Final Plumbing , 39. Water Service-Finali ' 40. Gas Service -Final - i 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations' 47. FINAL STRUCTURE & BUILDING , r 48. Special Requirements Completed i 49. ElectricReleaseitoEdison, 50: Gas.Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY -i-_-_ No Date ! i , PROJECT ADDRESS: UNIT: OWNER'S NAME: 300 F'ISCHER AV AOOREss: SYMBOL TECHNOLOGIES INC 340 FISCHER AVE COSTA MESA,CA 92627 ARCMIENGINEER: REG.NO.: ADDRESS: UNIT: PEO : RooDflessRESS: FIRE CONTROL TECHNOLOGY (213)861-6666 9jj1�hjjN0NE� �p2'yy FIRESTONE BL ((`Jy� Gq((�Y���� R LICENSED CONTRACTDA�ECI:A"I'l: 1 hereby affirm that I am licensed und07 ,bvhf2rt9?r Cha�ter 9 (commencing with Section 7000) at Division 3 of the Business and Professions Code, and my license is in lull force and effect. clTv LIc.:O 3 3 STATE uc.:619 4 6� C-16 Date�� �. Signature: x Compensation COMPENSATION DECLARATIop: I hereby affirm That have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance. ora certified copy thereat (Section 3000. Lab. C). POLICY NO.:W2710241 EXP. DATE: 07/01/93 COMPANY CAL FO(AN I� Certified copy h5 ereby urmsne Certified copy /ism/filed with theyity Building Division. Date: reb -& gD Applicant: " ' h EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it pie pant is for one hundred (3100) or less). I equity that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If, alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions at the Contractors' State License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Cope) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1, as owner of the property or my em layers with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided trial Such improvements are not intended or offered for sale. II, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the properly am exclusive N contracting with licensed contractors to construct the project (Section 7044, Business El and Professions Code: The Contractors' State License Law does not apply to an owner of property, who builds or improves thereon and who contracts for such projects with a cantraclogs) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. & P. C. for this reason: Dale: _ _ _ Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505, 25533, and 25534 and mal l or any future building occupant will/will not (circle one) need to comply with said stale codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county Ordinances and slate laws relating to budding construction and hereby authorize repr¢senWlim of th6 city to enter upon the above-mentioned property for inspection purposes. ,X Dale: 4 /. i//—, go Signature:'/ a i Driver's License or Social Security a: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; F 061011 PERMIT NO; F 061011 PLAN CHECK NO; 00396-93 S GOVT; N SUPP; N CONSTRUCTION TYPE; PERMIT TYPE; FIR PURPOSE; OTH JOB DESCRIPTION ; RETROFIT DETECTOR CHECK SQ FT; CLAIM VALUE; 7,400.00 CALC—VALUE; GROUP OCC; B-2 / COMMENTS; BACK FLOW RETROFIT kkkkkk%k kkkkkkkkkkkkkkkkkkkkkkkkkkkio-k%ick%-k kkkiEk9F k.%iekkkkkkkkkkkk%kkkkkkkkkkkk-1Ekk Z O N I N GS E R T E B Q A U C I K R S E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REO: PROV; PARCEL; 42708203 ZNE; REF NO; PLANNING NOTES> > kkkkkkkkkkkiEkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkklFkkkkkkkkkkkkkkkkkkkk D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY ; DATE; 2 --Cf fill APPLICATION ISBHED BY; it DATE; � kkkkkkkkkkkkkkkkkkkkick kkkkkkkkkk ick k kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkki kkkkkkkkkkkkkkkkkkkkkkkkkkkkkk LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 99.00 65% SMIP/NON—RES k kkkkkkkif kkkkkkkkkkkkkkkkkkklEkkkMi4 kick%kkkkkkkkkkk%kkN-kiE lE kifiFkkkkk%k if kiF iFkkkkkkiFk% I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 99 FIRE EQUIP FEE (FROM BLDG VAT TABLE) 1.00 99.00 END OF FEES 64.35 ISPLAN SUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 99,00 0,00 64,35 163,35 163,35 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 99.00 OVER/SHORT;00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 99.00 k kkkkkkkif kkkkkkkkkkkkkkkkkkklEkkkMi4 kick%kkkkkkkkkkk%kkN-kiE lE kifiFkkkkk%k if kiF iFkkkkkkiFk% I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST FIR 99 FIRE EQUIP FEE (FROM BLDG VAT TABLE) 1.00 99.00 END OF FEES CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POG_ -. SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3. Electrical Conduit Utility Undrgrnd. 54, Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electricaf-Conduit 66. Solar System-Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 3-Ib-43 4.:IJ. 24. Roof Framing 73. Undergrnd:Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM F4NAL 29. Insulation - .� I 78. FIRE PREY. FINAL �3 30. Drywall NailingI' .� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: • 34. Final Heating & Air Conditioningil 35. Final Gas Pipe-Test I 36. Hood or Canopy { I. 37. Final Factory Fireplace 38. Final Plumbing I, 39. Water Service-Final i 1 40. Gas Service-Final i - 41. Solar Domestic-Final - 42. Backflow Preventer I I 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations i 47. FINAL STRUCTURE & BUILDING 48.'F.INALPLANNING 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 300 F I SCHER AV OWNER'S NAME: SYMBOL TECHNOLOGIES INC ADDRESS: 116 WILBUR PL BOHEMIA,NY 11716 ARCHIENGINEER: ADDRESS: RFG.NO.: UNIT: UNIT: PERMITTEE' FULLMER CONSTRUCTION (909)947-9467 ADDRESS: 1725 S GROVE ONTARIO CA 91761 LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my lice is in lull force and elle Llc.' Oft 3 YSTATE LIC,' 3 0181L^ XP 10/95 Date Al Signature: _ HERS' COMPENSATION DECLARATION: (hereby of mthatl haveacenificateol consent to self -insure ora certificate of Workers' ompemotion Insurance, or a Certified copy Mel (Section 3800. Lab. Q. POLICY NO.:SA25019509029 ESP. DATE: 01/01/96 COMPANY: ROYAL INS fealilied copy is h4by furnished. R Canfield Copy is lith the City Building Divistoo ( EKE ION FROM WORKERS' COMPENSATION OEClAFLATM: (This section need battle compelW it the perm) is for we hundred (5100) or less). I lily that in the pedrimumce of the work for which this perms is issued. I shall not employ any person in any manner so as to become Sable h to the WorkersCompensation Laws of California. Date: Signature: NOTICE: It, after making INS declaration. you should become subject to the Workers' Compensation provisions at the Labor Code, you must forthwith comply with such Provisions or INS permt Shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a Construction lending agency for the performance of the work for Which this permit is issued (Section 3097, Cil C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that mishe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars (5500). I. as owner of the properly or my empployees wain wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Sedkln 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a properly who builds or improves thereon, and no does such work himselflhersell or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of Saler 1. as owner of the property, am exclusive y Contracting with licensed contractors to Construct the project (Section 7044, Business El am Professions Code: The Coal Slam License Law does Out appy to an owner of property who builds or improves thereon and who Contracts for such projects with a ConlritClor(s) license pursuant to the Contramors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: S. 8 P. C. for this reason: Date: Owner I do hereby penny that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any luture building occupant wiNwiO not (Circle one) need to Comply with Said state codes and the requirements for a permit for construction or mConication from the Air Oul Management District. Residential construction applications are exempt from these provisions. Date: Applkant: I hereby certify that I have read this application and sl a that the above information is Correct. I agree to Comply with all city and county propertyefori sl to lawssl lawsr nsiruc �nd here Yaullw' reWesenta' of this Ylo enter upon the above mentioned property for i mi �rpo � / Oat Signature: Of''s License or Social Security »: 1641-46 While—Building; Green—Code EnlorcemenC Canary—Applicant; Punk—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 070787 PERMIT NO: B 070787 PLAN CHECK NO: 00206-95 L GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION : CONSTRUCT TRASH ENCLOSURE 6 GATE SO FT: 600 CLAIM VALUE: 2,500,00 CALL—VALUE: 2,500,00 GROUP OCC: A-1 /A-2,1 COMMENTS: CONST, TRASH ENCLOSURE PER CITY OF C.M. STD, 6 NON SLIDING GATE Z O N I N GS ERT EBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRil FT IN REAR: FT IN FRNT: 60 FT IN REAR: FT IN LEFT: FT IN RIGHT., FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708201 ZNE: MP REF NO: PLANNING NOTES> CONSTRUCT A CITY STANDARD TRASH ENCLOSURE AT THE MARINERS > CHRISTIAN SCHOOL SITE, D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY �i� L DATE: BUILDING APPROVED BY DATE: . APPLICATION ISSUED BY: DATE: LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 54,00 ,50 SMIP/NON—RES PLAN 35.10 ,50 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 55.00 0.00 35,10 90,10 90,10 .00 REVENUE DIVISION TOTALS—> COLLECTED: 90,10 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54,00 1,00 35,10 I N D I V I D U A L -F E E B R E'A K D O W N TYPE QTY D E S C R I P T I O N. UNIT COST TOTAL COST SFR 100 RES—TRASH ENCLOSURE / FT, SFC 500 ALTER BY VALUE COMMERCIAL NOZONE END OF FEES '20,00 2,000,00 1,00 500,00 Oi 00175'216-00175218 TOT 90.10 DATE: 01/19/95 TINE: DE:56 D CONSTRUCTION AND PLANNING APPROVALS Permit ,$ Date Inspector POG SPA APPROVALS Permit # Date Impactot 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. 1 55. Electrical Bonding "5..Steel Reinforceritent 56. Rough Plumbing & Pressure Test 6. Electrical UFERGtnd. 7r Footings �4� 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit -Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9r Water Pipe-Undr§rnd, _ 60. Backwash Lines, P -Trap, ❑ Undrgrnd. ' 10, Structural Floor System 61. APPROVAL TO DECK 11.. Property Sewer Line & HousexConnection 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 Electrica T -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Hough Heating & Air Conditioning FIRE DEPT. REQUIREMENT d . APPR4VAL•S; "Permit _r 20. Rough Factory Fireplace =, 21. Ducts, irr-SiructuFe• a - •• 70. Underground Hyd7o 22. Ducts, Ventilating' 71. ProductpGping ❑'Gls 001 23. Gas Pjpe,-'$ought &Test - r r ' 72. Underground Flush^ 24. Roof Framing s 73. `Undergrnd, Storage Tank C Gas 00h 25. Roof Sheathing74..Overhead Hydro . 26. T -Bar Ceiling (Structural) & Monocoat 75.sbcy Chemical 27. Frame and Flashing > :-• 76. Dry Standpipe 28. Lathing & Siding c 77. �FIXED SYSTEM FINAL. . 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing _ ' ti HEALTH DEPT. REOUIREMCNT 31. Plaster Brown Coat i I' .79. FINAL INSPECTION - 32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED `Notes: 33. Final Electric., - 34. Finan Heating & Air Conditioning 35. Final Gas PiWTes( 3 A`l/ -��, 9' 36. Hood.or Canopy .. 37. Final Factory Fireplace 38. Final Plumbing • - 39. Water Service -Final' 40. Gas Service -Final I - 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation -• 44. Landscape Irrigation System : - - 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 6 -' 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co -- 51. CERTIFICATE OF OCCUPANCY No. Date �Rf3ECT ADDRESS: 300 F I SCHER AV UNIT: OWNSR'S NAME: SYMBOL TECHNOLOGIES INC ADDRESs:340 FISCHER AVE COSTA MESA,CA 92627 ARCHIENGINEER: NUTT A L L UCHIZONO ASSOC REG.NO.: C-9123 ADDRESS: 3199 AIRPORT LOOP DR UNIT:C C.M. CA 92626 PERMITTEE:OWEN BROS THERS PLUMBING (818)443-0078 ADDRESS: 4265 N. BALDWIN AV EL MONTE CA 91731 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am ficeri under provisions of Chapter 9 fcommencing with Section 7000) of Dimon 3 of the Business and Professions Code, and my license is in fun force and effect. Ic.:011965 STATE LIc.:231741 cLAss:C-36 EXP: 00/00 le. Signature: _ellhtv!� 'ERS' COMPENSATION DECLARATION: Iherebyaffirmrmate unmet to sellinsure oracerhficate of Workers' Compensation lnff2 gr,a,ceryfad,goay theme: (Section 8/01/95 POLICY NO Y. FORGE EAP. DATE: ,COMPANY: eruhed Copy is hereby furnished. ❑ Certified copy is filed with the City Bufldi Division. ate: I Z �I7 — �y Applicant: �— PTION FROM WORAERS'COMPENSATION DECLARATION: (ThSS .on need cot mphled if the perms is for one hundred (5100) or less). I Certify that in the performance of the work for which this permit is issued. I shall . of employ any person in any manner so as to became subject to the WorkersCompensation Lam of California. Dater Signature: NOTICE: It. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or INS permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby alfiren that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Gy. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant lar such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolessions Code) or that he/she is exempt therelrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars (SSOO). I. as owner of the property or my em diners with wages as their sole compensation, will do the work, and the 11 structure is not intended or offered for sale (5Clion 7044. Business and Professional Code: The Contractors' State License Law does not appy to an Comer at a property who builds or improves mention, 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. II, "yet the building or improvement is sold within one year of completion, the me, will have Ile burden of proving he/she did nor build or improve for the purpose of sale). '.as owner of the property. am exclusively conlracbng with licensed contractors to construct the project (Section 7044, Business ❑ and Pmlessions Cade: The Co practors' State LicenseLaw does rot appy ton miner of property who builds or Improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. d P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of Califomia Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wilOwill not (arae one) need to campy with said state Codes and the requirements for a permit lot construction or modification from the Air Guilty Management District. Residential construction applications are exempt from these provisions. Date: Applicant I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state lam relating to building construction and hereby authorize representatives at Has ay to enter upon the above-mentioned puppetry for inspection purposes. _ ate' I Z /Y- / r Signature: —1 r vers License or Social Security <: 164146 White—Budcung; Green—Code Enlorcemem; Canary—ApppcanC Pink—Revenue; Goldenroo—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 070363 PLAN CHECK NO: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION SUPPLEMENTAL TO P-70362 SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: E-1 /A-2.1 COMMENTS: REF: B-670342 *1E**9E*iE****RE REM*iEiE*�E**RE*BE BE**#iEiEX**XRERfiE*1EiEiE*iE9ERE REiE.��ERERE9LRE9t9ERE*�E�ERERE�E**�EBE*�EiEX*XiEBEBE9f9E*M Z 0 N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42708201 ZNE: REF NO: PLANNING NOTES> > if**iE**if iE*if 1f BE**9f****BEiE BE iE*BE BE 1EiE iEiE iE iF iE iE iE iE iE iE RE'x if if RE iE***1E*iE**XiEiE iEiEiEiE iE iE*#*jE *RE iE iE 9f iE*iE iEX iEiE** D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY :_ DATE: _ APPLICATION ISSUED BY: DATE: BE if if iE iE if if iE iE iE iE 9EiE >FiEiE iEiEiERE �E iE3FiF'�F'iE�3FiF3FiFiFiFiFi �F£iFiFiE�EiE IEiEiE (ERE iE �E --- �RE� iE9EiERE*iEBE#iEBEiEiEiE#iEiE9F�FiFiF*iEBEif**iE9E*.)EiEREREBE9f1E ERf*iE*xREBE*BE1EBEifiE*if BE*BE1Eit*BE if 9E**9E if if*REiE 9EBE>FiFRE if* LEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGMENT:N BLDG PMT PLUMBING ELECTRIC ,MECHANIC FIRE SMIP/RES GRADING PERMIT 15.00 25% SMIP/NON—RES PLAN ISSUE FEE 10.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 15.00 10.00 0.00 25.00 25.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 25.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 25.00 �EiE 9f.)(. iE 9E if RE iE iE iE iE iE*iE BE**iE iF iE iE**iEXiE jE**9E 9EiE iE;EXiEiE IEXiE*iE iE#iE�*RE 9E iE RE iE.)E**if RE if*iE***iE iE iE**iE BE*iE 9E iE iE*iE if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 SEWER. CONNECTION TO BUILDING EACH 15.00 15.00 END OF FEES, J 01 00173419-00173419 TOT 23.00 DATE: 12/14/9$ TIIE: 1-2:06 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PG. & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Ser lice or Pole . 52. Pool & Equipment Location Z, Soil Pipe-Undrgrnd., 7 53, Steel Reinforcement 3. Electrical Conduic UtilityUndrgrnd. 54. Forms • �4.:Electrica( Conduit-Undrgrnd. 55. Electrical Bonding ' ., 5: Steel Reinforcement 56, Rough Plumbing & Pressure Test •6: Electrical,UFIf{Prnd. 57. APPROVAL TO COVER-GUNITE ' !.,Footings .. 58. Electrical Conduit-Undrgrnd. 81 Founda'tibn 59. Gas Pipe, ❑ Uncirgrna.. Test `9. Water Pipe�UgdrBrnd. 60. Backwash Lines, P -Trap, ❑ Unirgrnd. 10. Structural FloSr•System r 61. APPROVAL TO DECK 171. 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 ElectricyWiring 67. Fencing & Access Approval 17. Rough Wiring'Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating &Air Conditioning r^ FIRE DEPT. REQUIREMENT �APPROVAt,S-. -'Permit # :_ 20-Rovbh Factory Fireplace _ '� - 21,=Duels, in Structure - 70. Underao-6hd H2dro 22 .Ducts. Yentifati P4 7.71. Produce Piping I�.Ges fOd 23: Gas Pipe' -Rough & Test _ 9 72, Underground Fluslt 24: Roof Framing 73. Undergrnd.StorateTank 0G;s 0 5 25. Roof Sheathing -• 74. Overhead Hydro 26: •T -Bar Ceiling (Structural) & Monocoat 7 Dry Chemical ` 27' Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding-- ra -• 77.E FIXED SyST�M 0WA4 • . '-29. Insulation 78. FIRE PREY. FINAL • 30. Drywaf Nailing .HEALTH DEPT. REQUIREMENT 31. Plaster grown Coe; 7. 79. FINAL INSRECTiON 32: Electrical Power Meter -Final 33. Final Electric • ' x. 80. FOOD CERTIFICATE ISSUED_ Notes: 34. Final Heating & Air Conditioning' 35 •Final as Pipe -Test 2 �L_- Hood or Canopy - 37.: Final Factory Fireplace 38. Final Plumbing _ -39. Water Service -Final - .--- •• • - 2--Z -40. Gas Service -Final 21?2 -'2531- „ 41. Solar Domestic -Final= m - r X42. Backflow Preventei 43. Backflow Irrigation r- 44. Landscape Irrigation System - 45..Sound Attenuation - " •_ _ .. i- •46 ... Handicap Regulations • . - , 47.. FINAL STRUCTURE & BUILDING 46: -FINAL PLANNING J X49. Electric Release to•Edison 50.. Gas Release to Southern Califo{pia Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date PROl,Cr ADDRESS: 300 FISCHER AV 'Z6K UNIT: oViNER'SNAME: SYMBOL TECHNOLOGIES INC ADDRESS:340 FISCHER AVE COSTA MESA,CA 92627 ARCHIENGINEER:NUTTALL UCHIZONO ASSOC NEG.NO.:C-9123 ADDRESS: 3199 AIRPORT LOOP DR UNIT:C C.M. CA 92626 PERMITTEE:OWEN BROS'THERS PLUMBING (818)443-0078 ADDRESS: 4265 N. BALDWIN AV EL MONTE CA 91731 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.:011965 STATE LIc.231741 CLASS. C-3 EXP: 00/00 WON Z �( �sy Signature:. �— WON ERS' COMPENSATION DECLARATION: I hereby alfirm that I have aate of osem to self -insure or a candidate of Workers' Co ensabor�ur 2 ohlly [yWl6do&y thereof (Section 3800. Lab Il / O 1 / 9 5 LIMY NO.: IVY IA A, LEY FORGE EXP. DATE: COMPANY: aNertified copy is hereby furnished. ElCertified copy is filed with the city Buildin :vision. C te: 2`_ by — • Applicant: — PTION FROM WORKERS' COMPENSATION DECLARATION: (This sectiona co I ad if the hermit is tar one hundred(S100) or less). I certify that in the performance of the work for which this permit is issuene Shall not en ad any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: If, after malting this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby alfirm that I am exempt from the Contractors Slate License Law for the following reason (Section 70315 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant lot such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars (3500). as owner of the property or my emylevees with wages as their sole compensation, will do the work, and the ElI, structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve lar the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044. Business El and Professions Cade: The Contractors' Stare License Law does not apply to an owner of property who builds or improves thereon and who contracts tot such projects with a contractors) license pursuant to the Contractors State License Law).1 am aware that proof of their Worker's Compensation insurance should be provitled to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533. and 25534 and that I 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 ualily Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building cons r ohon and hereby authorize represent Of this City to enter upon the above-mentioned property for inspection purposes. te: Z�/ Signature'. 5s License pr Social Security 1641.46 White—Boli Green—Code Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 070362 PLAN CHECK NO: N GO CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: ALT JOB DESCRIPTION INTERIOR 59580 T.I. SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: E-1 /A-2.1 COMMENTS: REF: B-670342 Z 0 N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42708201 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY It DATE: BUILDING APPROVED BY :_ _�/}'� DATE: APPLICATION ISSUED BY: DATE: v iF 3F ########:E##xiE7E#�L#iE###IE;FiF'iF3FIF3F3F3£iE3FIFiFiF'iFiFfF3f�iF£#iEiE###iE#iEiE�F -1F id�E� #ifaEiflE##if###iElf##if#iElEif#iE##iElf##iE###aEifiE#iE1f######'lEifif###if####if##'>F####1f##iE##Iflfif if###iaF(�E LEGALIZATION:N F E E S U M MA R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 84.00 PLAN ISSUE FEE BUILDING—DIV—> TOTALS ---- > 25% 20.00 PERMIT ISSUE 84.00 20,00 SMIP/NON—RES PLAN—CHECK TOTAL PAID DUE 0.00 104.00 104,00 .00 REVENUE DIVISION TOTALS —> COLLECTED: 1,104.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 104.00 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I OAN IUNIT COST TOTAL COST V PLU 3 SINK, BAR PLU 2 WASH BASIN PLU 3 WATER CLOSET (TOILET) PLU 4 DRINKING FOUNTAINS END OF FEES 7.00 7.00 7.00 7.00 01 00173412-00173418 T CET DATE: 12/14/94 TIRE: 12:06 21.00 14.00 21.00 28.00 104.03 ' CONSTRUCTION AND PLANNING', r ' APPROVALS Permit # .D+ite Inspector POOL & SPA APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole- ,' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd, .- ,� 53. Steel Reinforcement - 3.- Electrical Conduit Utility-Undrgrnd. 54. Forms ` '4. Electrical Conduit-Undrgrnd. _ 55. Electrical Bonding 5.- Steel Reinforcement - 56. Rough Plumbing & Pressure Test - 6?ElectricalOFERGrnd. 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 ' r' - 1.1. Property SeWerLine & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap - 63. Heater &Vent -Final 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrica kFinal 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 •APPR'OVALS •-,Pernit # _ 20"Rough Factory Fireplace _ - ` t 21. Ducts, in Structure, j 70. 'Underground Hydro 22. Ducts, Ventilatiig' ,' 71. Produdt Piping C.Gas CJOil f 23:..Gas Pipe;Rodgh & Test 72. Underground Flush 24.- Roof Framing 1 _ 7L Undergrrii.Storag&Tank;OGas 0Oil' 25. Roof Sheathing _ .1-:4, 74_ Overhead Hydro' - i 26. -T -Bar Ceiling (Structural) & Monocoat 75-. Dry Chemical 27. Frame and Flashing ,ti ,; ,� - - 76. Dry Standpipe - r 28. Lathing &Siding 77,' FIXED SYcSTE�11Jt •FINAL a 29. Insulation s •• ` 78., FIRE PREV. FINAL 30. Drywall Nailing H> ALTfltDEPT. REQUIREMt NT 31. Plaster Brown Coat •ti- 79. FINAL INSPECTIQN - 32: Electrical Power Meter -Final "• r 80: FOOD CERTIFICATE ISSUE 33. Final Electric_ ,c - 34. Final Heating & Air Conditioning 35. -Final Gas Pipe -Test - �~ Notes: Z_ 46 ' ---C'GiLQ�%D:-L✓J-�f7� - - - ' ��;✓vL.LG �_'l�.L�g i Xl'R.1/ /208F' 36. Hood or Canopy 37. Final Factory Firepla`de - f N-_�S•✓t�f`�'b/n'� 38. Final Plumbing _ c� S t „ /_.fir �Y� �` S • . s� • '� 39. Water Service -Final •_ :�f�:`715.,��•- '___('/�.-/��, 7�..._Kn L�cC4����-'-�-' '- 40. Gas Service -Final '41. Solar Domestic -Final 42. Backflow Prevente < �'^ �`i •' ' �c ��J'Yc: YrciSTz �✓ice _ _1`�r - a c -Z2 - 43. Backflow Irrigation 44. Landscape Irrigation System,; 45. Sound Attenuation 46. Handicap Regulations - :,._-,• 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING •. �j; �. ,.- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co .. 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all CITY CF COSTA MESA p�RIgIT CONSTRUCTION PERMIT Address License No. within heavy border lines and sign all appropriate declarations. TRACT NO. - LOT NO. BLDG. NO. Address Contractor [, Phone Address 14 M t= , s I �, D6 s..., ni.sn I hereby affirm that I am licensed under provisions of Charter 9 (com- mencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force a d e I. License Cla ce N Ddte Signature WOR ER ' C MPENSATION DECLARATION I herebyaffirm that 1 have a certificate of consent to self -insure or a -ertificale of Workers' Compensation Insurance, or a certified copy •reof (Sec on 38 0 ). Ilcy No.CompanyJ�'TIG[nmQ KCertified copy Is hereby furnished. �— Certified copy Is filed with the city Building Division. E EMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($1001 or less). I cortl'fy that in the performance of the work for which this permit Is ,r issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. `. Date Signature (� NOTICE: If after makingthis declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed O revoked. 12 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lendingagency for the per. formance of the work for which this permit Is Issued (Section 3097 Civ. C.). WLender's Name Lender's Address VOWNER BUILDER DECLARATION I herebyy affirm that I am exempt from the Contractor's License Law for lh0 following reason (Section 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 re- quires the applicant for such permit to file a signed statement that he Isiness and P,olessions Code) Or that he is exempt therefrom and the sis for the alleged exempt Ion. Any violation of Section 7031.5 by .ny applicant for a per mil subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work,.and the structure is not Intended or offered for sale. (Section 7044, Business and Professions Code: The Contractor's License Law. does not apply to an owner of a property who builds or improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner will have the burden of proving he did not build or Improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who con- tracts from Such projects with a contractor(s) licesned pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county ordinances and state laws relating to construction, and hereby authorize representatives of this city_ to enten upon the above mentioned TYPE OF CONSTRUCTION ❑ NEW XADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTION OF WORK TYPE O"ERMIT ❑ GRADING ❑ FOUNDATION ❑ STR ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CO NSTR UCT ION TYPE . VALUATION ZONE GRADING CU. YDS. ACRES _ REMARKS: 6333 8/19/82 83.00 ZONING REGULATIONS A.P. # ZONE PLNG. REF. # REAR YARD (TO P/L) PKG. SPACE REO. PROV STREET WIDTH PARK ZONING APPROVED BY SPECIAL CONDITIONS: PLUMBING - PLAN CHECK -� ELECTRICAL PLAN CHECK BATHTUBS SHOWERSSQFT PLUMBING So_ FT_ PLANCHECK TOILETS LAVATORIES URINALS DOUBLELAVS - - GENERATOR TRANSFORMER APPLIANCE 0-1 KW_ 10-50 KW_50+KW 1-10 KW KIT. SINKS SERVICE SINKS DISHWASHERS SUMPS MOTORS I -S (INC. SOLAR) 0-1 HP—%. -1-10 10-50 HP HP pp 50 HP `O'er FLOOR SINKS FLOOR DRAINS FIXTURES' 'OUTLETS SWITCHES DRINKING FOUNTAINS - - GAS TUBE SIGNS INTERCEPTORS CLARIFIERS . POLE LIGHTS SWIMMING POOL PTRAP POLES METERED SUB WATER SERVICE ALTERATION PANELS MAIN SUB ' GAS SERVICE OUTLETS SERVICE AMP SEWER CONNECTIONS SOLAR TANK COLLECTORS SOLAR PIPING SYS. ISSUE FEE MECHANICAL PLAN CHECK HEATING SYSTEM 0-100,000 BTU AND DUCTING - W i 100,000 + BTU REFRIGERATION Q1-100,000 BTU SYSTEM 100,000 + BTU '9A 1 BOILERS BTU I I I SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE Signaturecense or LOEDate ISSUE FEE Drivers' LiSS $ CMF 0065-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor APPLICATION APPROVED BY SUMMARY OF FEES BUILDING PERMIT E PLAN CHECK $ PLUMBING $ PLANCHECK $ 0 ELECTRICAL S PLAN CHECK E� MECHANICAL E PLAN CHECK S SMIP PERMIT ISSUANCE GRADING S MICROFILM E TOTAL FEE E LESS AD- VANCEPC S_ FINAL FEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # /2 f. 453 Date Inspector POOL & SPA - APPROVALS Permit # 4 �_ , •',a . _ Date Inspector • ' - 1. Temporary Electrical Service or Pole 43. Pool Aquipment Location«) 41_14l� 14=t'i 2. SoilPipe-Undrgrn 44. Steel Reinforcement rt /`^''r•�� •��"'' 3. Electrical Conduit Utility-Undrgrn r-- _314 131 A 45. Forms 4. Electrical Conduit-Undrgrn 46:,.EleytriQLBonHing 5. 5teel Heinforce 47. Rough Knibing & P U re Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITEI�J','�J` 7. 1;' 7. Pootinqs 49. Electrical Conduit-Undr rn 8. Foundation _ 50. Gas Pipe, ❑ Undr rn, Test.. 9. Water Pi a-Undr rn P 9 51. Backwash Lines P-Tra�-`�' nd 'r ��'"•' 1.- � ., 10. Structural Floor System 52. APPROVALTO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final .'� a a - 13. Rough Plumbing 14. Rough Electric-Conduit 56. •Electrical-Final "/ 15. Rough Electric-Wiring - 57. Solar System-Final 16. Rough Heating & Air Conditioning �1' Fencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18. 19. 20. Ducts, Ventilating Gas Pipe-Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL `_21. n Roof Sheathing' 22. "Frame and Flashing NOTES: 23. Insulation - 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric - 17- Z29. 29. Final Heating & Air Conditioning D-I 30. Final -Gas Pipe-Test 31.. ,Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE&.BUILDING `', t; 39. Special RequirementsCompleted\ 40. Electric Release to Edison - �. 41. Gas Release to Southern Calif rnia Gas Co. 42; CERTIFICATE OF OCCUPANCY kNo Date i '"t t:':i Aoolicant to fill In all soaces within heavy border lines and sign all appropriate declarations. CIT-Y'OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. - BLDG: NO. - CONSTRUCTION PERMIT TYPE OF CONSTRUCTION ❑ NEW ❑ ADD IN ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ` 6576 8/23/82, So.OD - , - T ZONING REGULATIONS - Project Address 300 Fischer Avenue- Owner - Phone - Address - - - - - - Arch/Eng. License No. DESCRIPTION OF WORK _ • - A.P. 41 - ,ZONE PLNG. REF. # Address' - Contractor " I • ' Phone _ TYPE OF PERMIT - - ' - - T�rpp BgP1tP� 1�pING -. PR(JPE RTV LINE' Address ee Ve'nUei out 011ie . .❑ GRADING ❑ FOUNDATION '❑ STRUCTURAL •❑ TENANT- ❑ ELECTRICAL IMPLUMBING ❑MECHANICA SETBACK C T. YARD - SIDE Y - - ( - -- - - - - LICENSED CONTRACTOR DECLARATION - '- 9 ,I hereby affirm th:.t 1 am licensed under provisions of Charter (com- men ting with section 7000) of `Division• 3 of the Business and -' -❑ OTHER RIGHT - Prof eS5lons Code, a license Is In full fort ffect. PROJECT DESCRIPTION REAR YARD (TO P/Lj - C-g.�6 720�9� Liconso Class • Llcenso No. _ .i ♦ la t s` SQ. FT. OCCUPANCY_CONSTRUCTION TYPE PKG. SPACE REQ. . . ,STREET WIDTH.:: •a l' ZONING APPROVED BY _ PROVIDED PARK FEE.$ DATE QQ/ :Data 19/19182 Signature WORKERS' COMPENSATION,DECLARAT ION - ' hereby affirm that 1 have a Certificate Of consent l0 self -Insure or a VALUATION - - ZONE 11ficate of Workers' Compensation Insurance, or a certified copy - ;SPECIAL CONDITIONS: erect (Sa I n 80 b. C.). t GRADING CU.,VDS. ACRES �q) icy No.�CompanY '��'P Farm {`S Certified copy is hereby -furnished. REMARKS: •'• ❑ Certified copy is filed with the city Building Division. - 716 EXEMPTION FROM WORKERS"COMPENSATION"DECLARATION- (This section need not -be completed if. the -permit Is for one hundred - - - -_ - - '• '' - ($100) or less). I certify that n the performance of the work for which this Permit is Issued, I shall not employ any person in any manner so as to became PLUMBING - PLAN CHECK - - -- ELECTRICAL '- '"' PLAN CHECK ' subject t0 the Workers. Compensation Laws of California. '_ - _ _ _ BATHTUBS SHOWERS-�Q -,T,OI LETS • , 1 URINALS- - - - FT- -- sG EN ERATOR -- 0-1-KW_1-]0 "'— KW' - - - .4 Date Signature INOTICE: If after making this declaration, you should become subject to the Workers' Compensatlon provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS- ;TRANSFORMER 'APPLIANCE - 30-50KW_50* KW - -- - ---- r ••' .. .-._ revoked. _' _ ... __ -. ... - ---' CONSTRUCTION LENDING AGENCY KIT: SINKS- ;' DISHWASHERS"` T' -' - MOTORS- -�-"'0-1 HP 1-10 HP -- -- ; r- Iherebyaffirmthat there,is a construction lending agency for the per. SERVICESINKS -SUMPS- -� - .(INC.SOLAR)_.-10-50HP 50+HP formance'of fretwork for which this pelmlt IstSsued (Section 3097 FLOOR SINKS - FLOOR DRAINS',FIXTURES -OUTLETS SWITCHES " Civ- C'.). - - - - Lender's Name _ _ _ _ 'Lender's Address DRINKING FOUNTAINS h - - 1 %GAS TUBE SIGNS- - - - - ;INTERCEPTORS - CLARIFIERS POLE LIGHTS'1 OWNER BUILDER DECLARATION hereby.affirm that 1 am exempt from the Contractor's License Law forthe SWIMMING POOL-'PTRAP - •POLES METERED SUImprove, following reason (Section 7031.5 Buslness-and Professions Code: •Any city,'or\county�which.requires•a permlt^to construct, alter,, WATER SERVICE _ALTERATION"',PANELS- - ' "MAIN' SUB' -quires demolish Or repair any structure, prior, to Its issuance, also re. the ap411Wnt,for such permlt to file;a signed statement that'he, 1 OUTLETS'SERVICE - - -• - AMP•-- -:hapter licensed pursuant t0 the provisions of the-Contraclor's License Law--GASSERVICE 9 (commencing with Section 7000) of Division 3 of the.uslness-and WATEWHEATERS BTUOUTPUT-oasis.for•the'alleged`exemptionTAny'vlolatlon`of - •- •2: ' Professions' Code) or that he9s exempt therefrom antl the Section' 7031.5• by SEWER CONNECTIONS'^"t 'anypplicant for a permit"subjects the applicant to'acivil penalty more than five honored dollars.($500).'�I,asowne SOLAR TANK '"' COLLECTORS'sole,compensallon,,.will.tlo of the propertyor my employees with wages as their the work, antl the structure is not Intended_ R or offered for sale. (Section 7044, Business and Professions Code: The -SOLAR PIPING SYS.- - ISSUE'FEECOntraclor's Ucense-Law does not. apply to an owner Of a property ISSUE FEE APPLICATION APPROVED BV - - -DATE-who builds or improves thereon, antl who does such work himself or through his Own employees, provided.-tflat such improvements are notIntended PLAN CHECK SUMMARY OF FEESis or offered for sale. If, however, the building or improvementMECHANICAL sold within one year of completion,the owner will have the burden - of proving he did not buildor Improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTUBUILDING PERMIT $ SMTP,=rEAND as owner of the property, am -exclusively -contracting -with DUCTING'- Ilcensed construct the proice (Section Business100,000 +RTUPLAN K CHECK E •PERMITand not apply to essioncontractorse: License Law tl es not Professions Cotle: Tho - — ISSVANCEtr builds or i , a owner of property who builds or Improves thereon, antl who con- 'contractor(i) REFRIGERATION 0-106000 BTUPLUMBING $-VSL.V� tracts from such projects with -a Ilcesned pursuanE to SYSTEM -• '$+ `,the Contractor's Ucense Law). 100,000 +BTUPLAN $GRADING CHECK , ❑ t am exempt untler Section "- -- B: S P. C. for this BOILERS BTU ELECTRICAL -5' $ t reason - - - - - SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK $ _ ' MECHANICACI I ' i _MICROFILM $•' TOTAL FEE $ - LE55 •AD- Data Owner I Hereby cert i fy that I this application and state that the above t. I -agree Information is correct. I agree to 'comply with all city and county PLAN CHECK -$ _ 'VANCE PC $-'- - ordinances and stale laws relating tconstruction, and hereby authorise representatives of this City to o enter upon the above mentioned i•' • property for i peclion purposes. _ _ ry p FINAL Signature Date ISSUE FEE - -- - FEE $�V.-._0 _Y _ Drivers' cense or SS P CMF 0865.46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TL CONSTRUCTION AND PLANNIN - APPROVALS Permit # .5 `�J Date Inspector POOL & SPA APPROVALS Permit # .• - Date Inspector 1. Temporary Electrical Service or Pole_ 43. Pool & Equipment Location - 2. Soil ipe•Un rgrn L 44. Steel Reinforcement - - 3. Electrical Conduit Utility-Undrgrn _ 45. Forms - 4. ..Electrical Conduit•Undrgrn 46. Electrical Bonding - 5. tee ein orce 47. Rough Plumbing & Pressure Test 6. Electrical UFER urn _ 48. APPROVAL TO COVER-GUNITE - - _ 7. Footings. _ 49. Electrical Conduit-Undr rn . 8.. Foundation . ' 50. .Gas Pipe, ❑ Undr rn, Test .. 9. Water Pipe r �N 4JN�'1-f'_ 27Y.0- ' 51. Backwash Lines P -Trap, 1:1nd r - 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer. Line &House Cdnnectiori--53. Backwash & Receptor -Final ' .12. Street Sewer -Connection _ '_ - - 54. Heater & Vent -Final 13. Rough Plumbing-qgT//�L - - - 14. Rough Electric -Con u i t_ - - - --56.• Electrical -Final - - - - 15. Rough Electric -Wiring - 57. Solar System -Final - - - 16. Rough Heating & Air Conditioning - encing & Access Approval 17: Ducts in Structure APPROVED FOR PLASTERING ` 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof'Framing B0. POOL/SPA SYSTEMS FINAL 21. 22: Roof Sheathing-" Frame and Flashin NOTES L PlPe D Es(/T 23. Insulation - 24. Lathing &Siding 25. Drywall Nailing' - 26. Plaster Brown Coat 27: Electrical Power Meter -Final - `L 28. Final Electric - - - 29. Final'Heating & Air Conditioning - - - - - 2,9- 30. Final Gas Pipe -Test 31. Final Plumbing. 32: Water Service -Final - - - -33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation _ 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING -- 39. Special Requirements Completed 40. Electric Release to Edison - • 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY _ No Date 801;;. 2_l 5// Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CMF PEgMI fyQ� F '/ TRACT NO. LOT NO. BLDG. NO. - CONSTRUCTION PERMIT 7386 9108182 123.55 - Project Addresses F/5e:y�rt V5' TYPE OF CONSTRUCTION ❑ ❑ .. ' Owner t Phone r �� NEW ADD ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ER ❑ ZONING REGULATIONS Address S.Q /.yam ,�f ` ,���, Arch/Eng. License No. C7 P DESCRIPTION OF WORK ' 00 EV A.D. qj ZONE —Q PLNG. REF. 591 Address Contractor Phone TYPE OF PERMIT ❑ GRADIING ❑ FOUNDATION ❑ STRUCTURAL ❑TENANT ➢ELECTRICAL ❑PLUMBING ❑MECHANICA SETBACROPE $IDE YARD LS5EDpF pp ggULiILLppI G PPLGI NE - . Address /'Z 3• C7aRji&-)Glbvr. LICENSED CONTRACTOR DECLARATION - 1 hereby affirm that I am licensed under provisions of Charter 9 (com- Division r/ RL S N t e RIIGHT men ting with section 7000) of 3 of the Business and Professions Code, and my license IS In full force and effect, OTHER REAR YARD (TO P/L) C / ;�'s 4 PROJECT DESCRIPTION Llcengcla,(,£ U No. PKG. SPACE REO. PROVIDED ` �� 50. FT. Data Signature _ STREET WIDTH PARK FEE S WORKERS' COMPENSATION DECLARATION OCCUPANCY_ CONSTRUCTION TYPE I hereby affirm that I have a certificate of consent to self -Insure or a VALUATION 900o ZONE ZONING APPROVED BY DATE -artifiwte CQompe�nsaattiioonn Insurance, or a certified copyIreof - ({otffLqW�or�keerrss' aL�s'VL p7,!r �aVS••�' - GRADING CU. UDS. ACRES SPECIAL CONDITIONS: - Icy No. •��Coin ny LJ Certified copy is hereby furnished. .. REMARKS: NrCertified copy IS filed with the city Building Division. - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -- - (This section need not be completed if the permit is for one hundred - -� - - - or less)). " S§0) . ce30rtify that In the performance of the work for which this permit is Issued, 1 shall not employ any person In ahy manner so as to become -PLUMBING 'PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers Compensation Laws oLCalifornia. - BATHTUBS SHOWERS -- - Date Signature NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR' 0-1 KW_ 1-10 KW. - to the Workers' Compensation provisions Of the Labor Code, you must - TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS - - APPLIANCE 10-50 KW_50 + KW - revoked. CONSTRUCTION LENDING AGENCY KIT. SINKS- - DISHWASHERS '" - MOTORS 0-1 HP __1`10 HP I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS - SUMPS (INC. SOLAR) 10-50 HP SP+ HIP - formance of the work for which this permit Is Issued (Section 3097 FLOOR SINKS, _, FLOOR DRAINS FIXTURES OUTLETS - SWITCHES Civ. C.)• Lender's•Name \ Lender's Address •II ,- - DRINKINGFOUNTAINS - - DRINKING -FOUNTAINS GAS TUBE SIGNS - - - INTERPEPTOFiS CLARIFIERS - POLE LIGHTS -- - - ' OWNEaL DECLAMFATION -NN. 1 1 -, i ";- RLLDER hereby affirm that I am exempt from the Contractor's Llcense,Law for POOL - PTRAP - ihe following reason (Section 7031.5 Business and Profsisions Code:''SWIMMING Any city or county which requires a permit to construct, alter, POLES METERED SUB . WATER SERVICE ALTERATION - PANELS MAIN SUB Improve, demolish or repair any structure, prior to Its Issuance, also re- quires the applicant for such permit to file a Signed statement that he -' - \GASSERV.ICE f�AUT,LETS - SERVICE - - - AMP Is licensed pursuant to th0 provislon5 of the Contractor's License Law l '^hapter 9 (commencing with Section 7000) of' Division 3 of the WATER HEATERS ' " BTU OUTPUT - - ¢Iness and Professions Code) or that he is exempt therefrom and the $is for tho alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - - .ny applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (§500). SOLAR TANK' - 'COLLECTORS - - ❑ I, as owner of the property, of my employees with wages as their Sole compensation, will do the work, and the structure is not Intended or offered for sale. (Section 7044, Business and Professions Code: The _ SOLAR PIPING SYS. _ ISSUE FEE - Contractor's License Law does not apply to an Owner of a property _.. ISSUE FEE - APPLICATION APPROVED BY DATE who builds or improves thereon, and who tloes such work himself or through his own employees, provided that such Improvements are not MECHANICAL PLAN CHECK - . - SUMMARY OF"FEES intended or offered for sale. If, however, the building or improvement Is sold within one year Of completion, the owner will have the burden of proving he tlitl not impr0e for the purpose Of sale HEATING SYSTEM 0-100,000 BTU. ,' tPERMIT BUILDING 7 - \ e pro rt ❑ I-, as owner of the property, am exclusively contracting with ' P x § '�\ s , SMTP $� licensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000 + BTUPLAN CHECK - Z PERMIT and Professions Code: The Contractor's License Law does not apply to - $ . ISSUANCE S an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING S tracts from such projects with a contractor(s) licesned pursuant to SYSTEM- GRADING S the Contractor's License Law). 100,000 + BTU PLAN CHECK $ ❑ 1 am exempt under Section B. & P. C. for this BOILERS BTU ELECTRICAL $ § reason SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK SMICROFILM MECHANICAL S $ TOTAL FEE $ LESS AD- Dale Owner 1 hereby cerlifythat I have read this application and state that the above is correct. I agree to comply with all city and county - PLAN CHECK S VANCE PC § _ - ordma ce s a sof laws relating to construction, and hereby authorize rep eS rlt t i y to e�n�syy f upon the above m¢MiOn¢tl pro e r Ofd ' es of property o n rbvses/f FA e 3� z / y / Signature _ FINAL FEE $ ISSUE FEE ' CMF 0865-46 White -Building; Canary-Abplicant;Pink-Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA " APPROVALS Permit # _Date Inspector 1. Temporary Electrical Service or Pole - 41' Pool & Equipment Location 2. SoilPipe-Undrgrn 44. Steel Reinforcement - - 3. Electrical Conduit Utility-Undrgrn k __ _ - -:45. ,Forms - 4. Electrical Condit-Undrgrn .'46.s: Electrical Bonding Steel ein orce 47. Rough Plumbing & Piessuie Test ' 6. Electrical UFER Grn _ 48. APPROVAL TO COVER-GUNITE - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9.. Water Pipe-Undrgrn 51. Backwash Lines P -Trap.❑ Und6rn110. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53: Backwash & Receptor -Final 12.. Street Sewer Connection" 54. Heater & Vent -Final 13. Rough Plumbing 14. Rough Electric -Conduit - 56. Electrical -Final 15. Rough Electric -Wiring 57. Solar System -Final ' 16. Rough Heating & Air Conditioning - - encing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING 18. Ducts, Ventilating_ 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20. Roof Framing. - 21. Roof Sheathing- NOTES: 22. Frame and Flashing 23. Insulation b" S✓T 61J .Ei 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final - 28. Final Electric 29. Final Heating & Air Conditioning - - 30. Final Gas Pipe -Test - - 31. Final Plumbing 32:, Water Service -final - 33. Gas Service -Final 34. Sola stic-Final ' 35.' rinklin System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. ,CERTIFICATE OFOCCUPANCY �t No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PE�1=N0. TRACT LOT NO. BLDG.NO. --CONSTRUCTION PERMIT I/!/9G�t/Y 7 .1672 7/E8/82 - 1392.65 TL, Protect Address iS TYPE OF CONSTRUCT19N Owne1' S Chi - Phone 1�j/ ❑ NEW El ADD - ALTERATION Address ❑ REPAIR ❑. CONY ER510 N' ❑DEMO LISH _ Arth/Eng. - - License NoQ. GIOZ ❑ OTHER '' ZONING REGULATIONS Address-jpp N SG DESCRIPTION OF WORK q•P' Z , q;tt /7 ZONE PLNG. REF. 9F. •' Contractor •fir- f.Q Phone � 51 TYPE OF PERMIT - - - - - "' ' e N TO gI�ILLpDING ,Address /�e/F�' />C .- q I GRADING - ❑ FOUNDATION 0STRUCTURAL- :SETBACK T. PROPS RTV LINE' -51 YARD LICENSED -CONTRACTOR DECLARATION __ .'-'_ I licensed 9,(co ❑ TENANT ❑ ELECTRICAL ❑PLUMBING-❑MECHANICA L9IpENA - - - - - 1 hereby affirm that am under provisions of Charter m-, mencing with section 7000) of Division of the Business. and .. ❑ OTHER RIGHT -.3 Professions, Code, land my license is In full force and ffect. _ .1 __ REAR YARD (TO P/L) -4• PROJECT D SCRI ION'' _ _ - _ - pe o:39 License Class 38 ,�--'- "" - - -- _ _ __ _ _ _ _ -: PKG. SPACE RED. PROVIDED -----`- Date' �• 7i ' 519 t - SQ- FT: PANG 7i' _ -_ .. _ .. _ STREET WIDTH PARK FEE.$- r , WORKERS' COMPENSATION DECLARATION _'OCCU hereby that I have t self -insure ora CONSTRUCTION TYPE ZONING'APPROV ED ByDATE ; I affirm a certificate of consent •rtNicate of Workers'- Compensation Insurance, or. a. certified c pY ireof (Secti 3 0 C.). , � _VALUATIO GRADING; CU. YDS. "�l ACRE$ ISPECIAL:CO NDITIONS: ., - llcy No �+ Company-Q-4AfV - - - - -- - ' HOLD FOR SPECIAL REQUIREMENTS L Certlfled copyis,hereby_ furnisheb.._,+ _ _ __ .-s REMARKS:,', Certified copy is filed with the city Building Division. ��•., ��s W `''/N r EXEMPTION -'FROM WORKERS' COMPENSATION DECLARATION This section need not be completed if the permit is for one hundred _ -1 - _. __.. _ - _ _s --- - -" '- -- - '- - - -��: _ Qom. _ _'•. '^ •.. s' i ___-, - - _ - - _ ($1001 or lessl. I certty that m the. performance of the work for which this permit is ; _ Issued, I shall -not"em Ploy any person-in'any manner'so'as-to'become -PLUMBING .PLAN'CH SCK-"-- -" — - PLAN CHECK ' subject to the Workers Compensation Laws of Callfornia. • •• - 'ELECTRICAL _ DateSignature 1 _ BATHTUBS SHOWERS'-"- - 1 �" - "- " NOTICE: If after making this declaration, you should become subject TOILETS -URINALS '- - - - - -GENERATOR 0-1 KW_ 1-30 KW to the Workers' Compensation provisions of the Labor Code, you must' TRANSFORMER _ I forthwith comply with such provisions or this permit shall be deemed J LAVATORIES DOUBLE-L'AVS - -t^ - -APPLIANCE -'- '10-50 KW_50+ KW- - - revoked. , ___ _ _ _ _____ _ CONSTRUCTION LENDING AGENCY -KIT: SINKS - - -- DISHWASHERS - 'MOTORS --•-• O-I•HP ^ "1'=10'HP - "!, "j 1 hereby affirm that there Is a construction lending agency for the per-- ,SERVICE SINKS .,SUMPS- -" '--- - •` (INC -. SOLAR)_.. :10-50 HP--�-50 + HP- formante`of the.work for which this mitlir;issuetl, (Sec[lon 3097-•--- I - -• - � _per - - ♦ �" ; = - �' �- _ _ -�\ • -FLOOR`SINK9'. - �- FLOOR DRAINS" - -' FIXTURES` `OUTL-ETS' SWITCHES Lender's LeptleY'S N_a me 0��' -- _ _ _ Lentlers-Atldress � � - {"'-' l 'r -'-' DRINKING FOUNTAINS'`'"-" -' "- - r. -- _ .•t.:_ __ _ _ _ 'GAS TUBE' SIGNS' - - - _ OWNER BUILDER DECLA R ATIO N-- from :-INTERCEPTORS -' CLA`R IFIERS ,., - - -' POLE'LIGHT$'-- I herebyy affirm that Lam exempt the Contractor's License q Law,fo theyfollowing reasoner(Section'7031-.5"Business and-Professl-Ons Cotle:. 'SWIMMING � - i' - -�-- - -'• Any%city or,'county which requires a permit' -to construct, -alter, Improve,�demolish-or arty prior twits Issuance,^also POOL PTRAP - t• ^ 1 - - -- -- POLES METERED -SUB --a 'PANELS- repair structure,- re-, the ap: licanl for such permit to file a signed%tatement that he'' �pIATEWSERVIC ;- ALTERATION- --- - •• - -- - - -MAIN,'- :SUBquires f Is-hapte.?9 (commencing_with 'Section`7000)„ oKCgivision 3, of the. -Iicensetl-pursuant-to-the provisions of the Contractor's License Law GAS'SERVl E, "� - 'OUTLETS "- - - - V - SERVICE ^• -- - - _ - -AMP - - - siness�and-Professions Code)'or. that,he is'exempt therefrom'and then -- --' -' 'WATER HEATERS' i {'BTl'1�OUTPUT ' � -' ------ � •^' - --- - - - - - -- - *IS Qor the alleged exemption.' Any. violalionpof*Section 7031.5.by -subjects-the 'a ppllca nY'for. hermit applicant tdcivil -Penalty -SEWER'CONNECTIONS _' r - - -I -' — -' '• - _ - --- - -- _ - �• of not mope than five hundred-dollars'($500): ,- _ _ El I, as Owner of•the property7or' my t employees with wages -as their SOLAR TANK-' .Os e -'COLLECTORS sole compensation, will do the work, and the structure is not intended ) or offered for sale: (Section 7044, Business and Professions Code: The SOLAR.PIPING SVS. - - - ISSUE FEE Contractor's License Law does not'apply_to an owner of a,properly who builds,or improves thereon, and who does such work himself or - - , - ,, _ _ _ _ ISSOE'FEE -• - "• -'gppL•ICATION APPROVED 'BY DATE - K• S. own employees, provided that.su Ch improvements are not Il intentletl. of offered for, sa le.'If, however, the building or improvement' intended 'within _ _ _ _ MECHANICAL PLAN CHECK f __ __ _ _ _ _ f SUMMARY OF FEES - I is soldone year of .completion; the owner, will have the burden -he -not _ -- - '- - -fBUILDING - - s �^•s r i of proving did buud-or Improve for the purpose of sale).- ❑.I,_as' the 'p,cperty, exclusively contracting with NG SYSTEM 0-100,000 BTU j- !PERMIT $ �SMIP, owner•:of- am, licensed contractors to construct' the project (Section 7044,-Business.100,0001+ _ Ham- _ _ _ _ BTU I _,}, PLAN CHECK $ rPERMIT, . 1antl-Professions. - Cotle:' The Contractorts-Llcense.Law tloes not apply to.`' owner•of, property who builds or improves thereon, antl who con-GERATION _ 0-100,000 BTU -_ _ _ _ ._ ___-ISSUANCEan 'PLUMBING $ -.tracts from suchprojects_with a contractor(s) Ilcesned -Pursuant tc.M: License Law), '- n - �, i - - - -- - - -100,000:+BTU - GRADINGtheContractor's PLAN CHECK E 4 ,., I am exempt untler Section - • -Br6'PrC. for thrsR$` k_.�ANDOUCTING 1p,• `ELECTRICAL S$reason BTU - __'MICROFILM $ _ Date owner M REPAIR, ALTERATION ,PLANCHECK'$` 'TOTACFEE�SI �M hereby cerlif that I have read this a lication antl state that the aboveUST Y PP SYSTEM MULTIPLE I ECHANICAL ;$ A' b, r•.f f.'r.! %LESS AD-..:,", - .I, " 1 Information"is Correct.-I-agree'to co ly with all'city-and-county „ PLAN,CHECK S-^---'VANCE PC $-" - - 'j ordinances and state laws relating t c s�ruction, antl hereby authorize .J ,^ ,r 'r e - - represenlatives 'of -Ibis city- too -upon the above mentioned 1 _.- property 'e purp �f� Signature- r I FINAL FEE $ Date Drivers' License oTSS # '/ - - - - ISSUE FEE- CMF 0865-46 White-Building;Canary-Applicant; Pnk-Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # 6-ti�c�l Date Inspector POOL & SPA -_�• ._ ;rC' _ ; ,; APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - 43. Pool & Equipment Location' - Soil ipe-Uq rgrn '^ _ _ 44. Steel Reinforcement' - - - - 3. Electrical Conduit Utility-Undrgrn. _ 45. Forms - 4.. Electrical Conduit-Undrgrn _ - - 46.. Electrical Bonding - - - - _ _Steel R.einfo-r.ce _ 47. Rough Plumbing & Pressure Test - - - -- '- - - - - - 6. _Electrical UFER Grn _ - 48. APPROVAL TO COVER-GUNITE 7. Footings_ _•-_ _ _ �-Foundation 49. Electrical Conduit-Undr rh - - _8. . _ 5 50.. Gas Pipe, ❑ Undr rn; Test J,- .9. .Water-Pipe-Undrgrn._. _. 51. Backwash Lines P-Trap,Undr rn' "-- - -`- - 10. - Structural Floor System 52. APPROVAL TO DECK - - ' Property Sewer_Line'& House Connection 53.- Backwash & Receptor -Final .12.__Street Sewer_Connection _ _ _ _`_" _ - - -54:- Heater &Vent -Fina L•. -13. Rough_ Plumbinj;i�V_'t .R_.3l .: tarl • 14. • Rough Electric -Conduit 56r - Electrical -Final 15. -Rough Electric -Wiring _ - - - 57. Solar System -Final•„ --- 16. -Rough-Heating & Air Conditioning- encing &-Access.Approval• • , '' 17. Ducts, in Structure_ C59.. APPROVED FOR PLASTERING ' 18.� Ducts, -Ventilating 60. _.POOL/SPA'SYSTEMSFINAL' 19. Gas Pipe-Rough'&Test - - _ _ _ 20. Roof Framing 21. Roof Sheathing- '-- -- ---- - - '- -.'•�• - .� r. NOTES: y 22. Frame and Flashin 23. Insulation 24. Lathing & Siding = • 25. Drywall Nailing_ 5,g, _10_$;0. - - 26. Plaster Brown Coat' 27. Electrical Power Meter -Final - - • 28. Final Electric- -- _ SL - 29. - Final Heating & Air- Conditioning - - ---" - 30: Final Gas Pipe -Test - d 31. Final Plumbing - 32. -Water Service-Final- 33:- Gas Service -Final ^� 34. Solar Domestic -Final ='•t' '• ' ' 35. ` Landscape Sprinkling System - ' ' 36. Sound Attenuation^ ��• 37. Handicap, Regulations - 38. FINAL STRUCTURE & BUILDING -• p-7-gp_ ,fj' _ 39. Special Requirements Completed r 40. .Electric Release to Edison - ' 41. Gas Releaseao Southern California Gas Co. i • ' . 42. CERTIFICATE OF OCCUPANCY - -No - Date "V Applicant to till In all spaces within heavy border lines and sign all appropriate declarations. CITY- OF COSTA MESA - - ' PERMIT NO. -- TRACT NO. LOT NO. BLDG. NO. CONSTRUCTION PERMIT E- S"31 6250 8/1.8/82 1 18.29 Project Address r7t7 .f EiP - .,9v6. TYPE OF OONSTRUCTION ❑'NEW ADD ❑ALTERATION _❑ REPAIR,❑.CONVERSION• ❑DEMOLISH - EI t _ ZONING REGULATIONS -` ' Owner f Q� Phone IAddre55 -a Ca "Bat -A..E'--- - - '-Arch/Eng. - _ License NO. - -OTHER , - _ - DESCRIPTION OF:WO RK - - TA.P. •Address - - .. __ _ - _ _ ZONE- - - P,LNTGp. - ' Convactq p-- �;� ,rrjq G' ,-Phdne ,r / I TYPE OF PERMIT-'' "- -' -� - • 1' gR1E1FL. p� " - PROPEIRT VNU NE - SETBACK C/L T. ' '❑ GRADING' ❑ FOUNDATION - ❑ STRUCTURAL ❑ TENANT) ELECTR ICAO ❑PLUMBING. -- IEpF VARO-- -- -- - - - - ❑MECHANIC .LICENSED CONTRACTOR_DECLARATION_. ' - '' I hereby affirm that I am licensed under provisions of Charter 9 (com- - I 1 5'p Y=_ RIGHT - mencing with -section- 7000) -of Division _3. of the- Business and. '_ ❑ OTHER ,. . Professions Code, I d m license is in full force and effect.. i, (REAR YARD (TO P/q"- - - !J - ' PROJECT DESCRIPTION i_ _ �I I Llcen se Cl ss License' a - -`' PKG: SPACE REQ. - -- 'PROVIDED - bate -`L' " Slgnat ure ,0 /- SQ. FT: qq�� - _ - _ _ _-,-`_ ._ -_. - STREETWIDTH -PARK FEE $ WORKERS' COMPENSATION DECLARATION OCCUPAN CY' -CONSTRUCTION TYPE It hereby affirm that I have a -certificate of consent to self -Insure or d - I ZONE - ZONING'q PPROV ED BY- - - '-- DATE - -- _ �_+-•- 'rtificate of -Workers' Compensation Insurance, -or -a certified. copy. _VALUATION - aeof (Section 3800, Lab. C.). GRAOING'CU. YDS. ACRES - rSPEC1AC CONDITIONS:' Ocy-No: '•. - -ComPanY`-- '❑ Certifled.copy is Ihereby _furnished., -_ _ - I "a " .- _ _. -'. :❑ Certified copy is:filed with the city Building Division. ,REMARKS:' _ _ _ _ _ - IEXEMection WORKERS'edCOMPENSATION-DECLARATIONif - -- 75 1z n section neetl not be completed it the permit is for one hundred need tamit isf �'.- '!- - /` E �-'• "$10 (.torless). that In the performance of the work for which perm -PLUMBING-.-�'- y,�- PLAN CHECK ' - - ' ELECTRICAL' - PLAN CHECK -- mIg Issued I in any Issued! I shall not employ as t to become e pensat ion California.-nnar'as subjett to the Workers' Compensation Laws of Cia_ _ BATHTUBS- - 'SHOWERS ---' - -'-'-' - - - Date Signature NOTICE: If after making this declaration, you should becometsubject -TOILETS. ,�r r, - URINALS- -- - -- •GENERATOR - '0-1'KW=1-30 KW - ' 'TRANSFORMER to the Workers' Compensation provisions of the Labor Code,, you must) forthwith with - LAVATORIES DOUBLE LAVS - ` - r 1-� - -- 10-50.KW-,&50+ comply such provisions or this permit shall be deemed revoked. ' _ y. _ _ _ _ (CONSTRUCTION LENDING AGENCY - -. APPLIANCE' KW - KIT. SINKS'-" '-' DISHWASHERS' -;- ,MOTORS 0-1'HP-- -1-10 HP - - -, I hereby affirm that there Is a construction lending agency for the per- formance of the work for which this permit is issued (Section 3097 SERVICE SINKS. SUMPS ____ __ - _ _ `^- INC. SOLAR) Z50"+ - it -]0-50 HP _ . 2 . ,Ci V. C:)�------ -- �---,-.'- -- 'Lender's Name + -FLOOR SINKS- - „•FL'OOR' DRAINS .. - +FIXTURES, ZOUTLE ,,,SWITCHES - - O . --- --- - -- _ Lender's Atltlress DRINKINr FOUNTAINS'- '- - l` -,-'- - - 'GAS TUBE -SIGNS- ' --'- - -'--^ - - - OWNER-BUILDERDECLARATION-.--"INTERCEP,-TORS' I hereby affirm that I'am exempt from the Contractor's License Law for - - CLARIFIERS--'- '- - POLE L-IGMTS'---- ---- - •----- - --- the -following reason (Section -7031.5-Business and Professions. Code:_ SWIMMING- POOL`-PTRAP-- - - - -- - -SUB Any city or county which requires a permit to construct, alter, POLES METERED -WATER-SERVICE - -ALTERATION-- —' "-- iPANELS'- -- MAIN 'SUB - improve, demolish -or repair any structure, -prior -lo its -issuance, also re- quires the apl,lifant for such permit to file a signed statement that he is -licensed pursuant -lathe provisions of the Contractor's License Law -GASSERVICE-- -- !SERVICE -- -------- - AM.- 'hapter 9 (commencing with Section 7000) of Division 3 of the OUTCETS--- siness-and-Professions Code) or that he -is exempt therefrom and the- . WATER HEATERS-- -BTU OUTPUT- - - - - - - - - - - for the dexemption. Any violation of Section -7031.5 by ,y - SEWER CONNECTIONS—' -"- `-- - - for a any applicant for - permit- subjects the applicant to a Civil -penalty of not -more than live hundred dollars ($500). ;:01,-as-owner-of'the-property ',-or my employees -with -wages as -their -SOLAR TANK - ---'COLLECTORS - -- --------- - - - - -_ sole compensation, will do the work, and the structure is not Intended or offered for -sale.-(Section 7044,'Business and Professions Code: The SOLAR PIPING SYS:- -- '- - - - - - - ISSUE FEE-- - -- - - - -,� - 'Contractor's License Law does not apply to an owner of a property - ISSUE FEE' -" -fir- `"' - - -r--- - 'APPLICATION APPROVED BY who builds or improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not ' Intendetl or offered for sale. If, however, the building or improvement is the burden _ _ MECHANICAL PLAN CHECK H t - - - SUMMARY OF FEES sold within one year of completion, the owner will have -proving -build -or"Improve -sale). - -- off he did not for the purpose of - - - - ----' -- - HEATING SYSTEM 0-100_000 BTU f BUILDING - - --- - •-' --- - - ____ _. _ ❑•I,_as_owner_of.[he propert am .excl usivel y,_ y -.contracting_ with - AND DUCTING- '- - -- -l- -- PERMIT __ - - _ _ _ $ ._ _ -, r. SMIPt�. licensed contractors to construct the project (Section 7044, Business 100,000'* BTU " ' PLAN CHECK $ PERMIT �,i, �• and -Professions Code: The -Contractor's License Law does not. apply to f ISSUANCE. $ ' an owner of property who builds Or Improves thereon, and who con- tracts.from such.prolects with a contractor(s) licesned pursuant to REFRIGERATION 0.100,000 BTU �_.._ PLUMBING S �F the Contractor's License Law). _SYSTEM- - ._ 100,000 i+ BTU__ GRADING: $-7rH 'PLAN CHECK $ ❑'I am exempt under Section - - -- --' B. &'P: C:for this - - - - - - - -' -- -- - BOILERS BTU __� - - — ELECTRICAL-$ I��- reason SYSTEM REPAI R, ALTERATION _r - MICROFILM; S- ' PL'AN CHECK-$ -- Date Owner - MECHANICAL'$-'- - TOTAL FEE $ I hereby certify that 1 have read this a application and state that the above EXHAUST SYSTEM MULTIPLE I - LESS AD- LESSVANAOC information'is correct. '1 agree to -comply with all' city and county ,PLAN CHECK-•$ - - ordinances and State laws relating to construction, and hereby authorize ,1 _ '�• representatives of this city -to- enter - upon the above mentioned - - - - - ! r ,FINAL Property for inspect`on pujp)y�s,.., _ _ �,r-/�� 114 G�I'��h ice.' Dale J�Lr,�� Signature - - CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TL i- CONSTRUCTION AND PLANNING APPROVALS Permit # - Date POOL & SPA - - - Inspector _APPROVALS, Permit # Date Inspector' 1. Temporary Electrical Service or Pole _ _ 43. Pool & Equipment Location --- - - - 2.._ _Soil Pipe-Undrgrn' - 44. Steel Reinforcement •3. Electrical Conduit Utility-Undrgrn A - .45. Forms - - - - - - 4. g- _Electrical. Conduit-Undr rn -. _-- ._ 46. _ - Electrical -Bonding- - - ---- -- -- - - -- - 5,._!5teel, Reinforce - - 47. Rough Plumbin" &Pressure Test - - - - -- - - - .6. Electrical UFER Grn_- _ _ 48. APPROVAL TO COVER-GUNITE - - - - - _ 7. --Footings,_- 49. Electrical.Conduit-Undr rn ^'' •- _8. - .Foundation_., 50. • Gas.Pipe,Q Undr rn, Test ' .9. Water Pipe:Undrgrn 51. Backwash Lines P-Tra .0 Urodimn ' 10._. Structural Floor System - •.52: APPROVAL TODECK- ---- - L..11._ Property Sewer Line &House. Connection _ _ --�••� --53. Backwash&+Rece tor-Firial.� _ -12. -St reet.Sewer-Connection.__-- - ---- - - - • �` - - 54-- -Heater & Vent -Final r ' .13._ Rough Plumbing _-- - --'Fin-al- - -- �- - - -- ... .. , 14. Rough Electric -Conduit - -P- -to' '56. Electrical -Final---'• 15. Rough Electric -Wiring y- - ' • 57'.Solar System -Final- . .. 16- - Rougb Heating & AirConditioning - _ -- -- - -- - - - - -W. Fencing & Access Approval ,- 17r -Ducts, in Structure..: - - -- APPROVED -FOR PLASTERING`. '--18. _ 19. -20. Duct S, Ventilating --- -- - -- - Gas Pipe -Rough &Test -Roof Framing -- - -- - - _ -. -- "• -_ _ _.,60.__ POOL/SPA SYSTEMS FINAL 21: 22. Roof Sheathing Frame and Flashing .,� NOTES:` 23. Insulation' -----..- _- ------ - - - - - $'l0•- L- G.O- . • - 24. Lathing & Siding --- -- - - - - - -- - - -- -- -- _ __ _ - 25. Drywall Nailing -- ----- - - - - - - - 26. PlasterBrown Coat - - - - - - - �- 27. Electrical Power Meter -Final- - - - • • "� •-28r Final'Electric ---- - ---- - -- - -' '- '" - 29'.-k Final Heating& Air Conditioning--- - - - - - - -- -- - - - - 30. -Final Gas Pipe -Test - -- ---- - - - -- - - --- - - - ' 31. Final',Plumbing 32..- Water Service -Final - - - - - - --33. Gas Service -Final - - 34. Solar Domestic -Final••"= ' 35. Landscape Sprinkling System •' - I 36. Sound Attenuation 37. Handicap Regulations --- 38. FINAL STRUCTURE & BUILDING 39.- Special, Requirements Completed _ - 40. Electric Release ,to Edison - - - 41. Gas Release to Southern California Gas Cd. - - 42. CERTIFICATE OF OCCUPANCY No_ Date --' -' - - ?f Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. .CITY OF COSTA MESA PER (jTRACT �Isl NO. N LO'BLDG. NO. Cj jr) 45.80 CONSTRUCTION PERMIT b G95co /T TYPE OF CONSTRUCTION '-❑ NEW ❑ ADD 1% ALTERATION 11 REPAIR ❑ CONVERSION El DEMOLISH 11 OTHER" - - ZONING REGULATIONS ' Project Address 30 a n Owner m 5 ) _ Phone j Address - - DESCRIPTION OFWORK � - Ot I� d A.P. # ' - ZONEPLNG. REF. 9F Arch/Eng. nse N3 Addres _ C Contractor _Gb -pr, �_ Phone$.5 TYPE OF PERMIT - - ❑ GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT�ELECTRICAL ❑PLUMBING ❑MECHANICA B SET ACK LST. SIDE YARD SIEL& VA TTop ggUL1I LppINC PROPERTY LINE Address LICENSED CONTRACTOR DECLARATION I hereby that I licensed under Charter 9 affirm am provisions of (tom- mencing with section 7000) of Division 3- of the Business and ❑'OTHER - - - RIGHT Professions Cotl antl my license is In full force an tl efffe t. PROJECT DESCRIPTION REAR YARD (TO P/L) License Class icer o. B a L'l /7 t'I_��- PKC. SPACE REQ. PROVIDED Date r7 — ( 3 -2 ( Signature SQ. FT. - - W ORKE RSf CO MPEN SATION DECLARATION' OCCUPANCY CONSTRUCTION TYPE STREET WIDTH PARK FEE $ I hereby affirm that I have a certificate of consent to salt -ins ora VALUATION ZONE .ZONING APPROVED BV DATE '-+r of Workers' Compensation Insurance, or a certified copy 'SPECIAL reef (e reof (Section 3800, lab. C.)- GRADING CU.�V DS. ACRES CONDITIONS: ' .Icy No. Company LJ Certified copy is hereby furnished.- - - •. REMARKS: -• - - - .-. - _ {yam+ Certified copy is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the .permit is for one hundred - - - S$100) or less). •.. _ ' certify that in the performance of the work for which this permit is issuetl, Ish II no employ any person In any manner so as to become' PLUMBING. PLAN CHECK L PLAN CHECKsubjeoW�� rs' BATHTVBS SHOWERS - _Date-' NOTICft r makiTOILETS URINALS R 0-1 KW_ 1-30 KW tothe WorMERforthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS nELECTRICAL '- 10-50 KW_50 + KWrevoked. --- - _ KIT. SINKS _CONSTRUCTION DISHWASHERS 0-1-HP._1-10 HP LENDING AGENCY I hereby affirm that there is a construction lending agency for the per- SERV ICE SINKS SUMPS ) 30 -SO HP50+HPformance of thework forwhich this permit is Issued (Section 3097 _..:�• FLOOR SINKS FLOOR DRAINS - OUTLETS SW ITCH ESL Civ. C.). . Lender's Name Lender's Address DRINKING FOUNTAINS - GAS TU BE SIGNS ' INTERCEPTORS CLARIFIERS -POLE LIGHTS' ' OWNER BUILDER DECLARATION" I hereby affirm that I am exempt from.the Contractor's License Law for POOL P TRAP - '- POLES METERED - - SUB the following reason (Section 7031.5 Business' and Professions Cotle:SWIMMING Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also re- WATER SERVICE ALTERATION PANELS - MAIN SUB' ' quires the applicant for such permit to file a signed statement that h¢ GASSERV ICE OUTLETS 1 1 ti- SERVICE - AMP - is licensed pursuant to the provisions of the Contractor's License Law --hapter 9 (commencing with Section 7000) of Division 3 of the " WATER HEATERS BTU OUTPUT- - - - 'iness and Professions Code) or that he Is exempt therefrom and the ,Is for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - -- - ' _ ry applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). SOLAR TANK COLLECTORS - ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not intended " or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SVS. ISSUE FEE J Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself or ISSUE FEE - APPLICATION 'APPROVED BY DATE? �J 8 through his own -employees, provided.that such improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES ' intended or offered for sale. If, however, the building or Improvement is sold within one year of completion,.the owner will have the burden of proving he tlitl not improve for the purpose of sale). BUILDING ❑ HEATING SYSTEM 0-100_,000 BTU PERMIT $_6_lT._,6 SMTP $' h pro rt exclusively contracting with a5 owner of the property, AND DUCTING - - licensed contractors to construct the project (Section Business n p 100,000 + BTU PLAN CHECK $��� PERMIT ' License Law does not apply to and Professions Code: The es not dor - ISSUANCE $ build i owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(.) Iicesned pursuant to tracts SYSTEM - - - GRADING . $ the Contractor's License Law). 100,000+BTU :.��: fz �'� PLAN CHECK $� ❑ I am exempt under Section B. & P. C. for this BOILERS _ BTU ELECTRICAL $ `� • '-" $ reason- SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK $ . ' MECHANICAL $ MICROFILM $ TOTAL FEE $ LESS Date Owner - - 1 hereby.certify that 1 have read this application and state that the above information Is correct. I agree to comply with all cit and count 9 pY Y Y PLAN CHECK $ E P VANCE PC $_ ordinances and State laws relating to construction, and. hereby authorize representatives of this city to enter upon a above mentioned property for 1 a pur os �QO -�• Signature Date 2f� _ FINAL FEE $ Drivers' License or SS YC ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor 'TL CONSTRUCTION.AND PLANNING APPROVALS Permit # Date Inspector �`�' \ ;�_ POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole _ 43: Pool & Equipment Location 2. SoilPipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn.. 45. Forms - 4. ..Electrical Conduit-Undrgrn "`� t ., 46. Electrical Bonding - - 5. Steel ein orce _ 47. Rough Plumbing & Pressure Test 6. Electrical _UFEP Grn i• 48. APPROVAL TO COVER-GUNITE " 7. Footings"" 49. Electrical Conduit-Undr rn B. Foundation - - 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra •❑ Undrqrn 10. Structural Floor System 52. APPROVALTO DECK ';11-: -Property Sewe? Line.&-1­1606e Connection 53: Backwash•& Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55, Plumbing' 14. Rough Electric-Conduit - - '56. Electrical-Final 15. Rough Electric-Wiring - ,jC Ce -; 57. Solar-System-Final ' 16. Rough Heating & Air Conditioning bb. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. - POOL/SPA SYSTEMS FINAL 19. Gas Pipe-Rough &Test _ 20. Roof Framing 21. Roof Sheathing NOTES: 22. Frame a f. j 3 gyp/ 23: 'Insulation tK No C'-:2 24. Lathing & Siding " 25. Drywall Nailing 1 26. Plaster Brown Coat - 27. Electrical Power Meter-Final 28. Final Electric •-- $'� 12.gf C- " 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test - 31. Final plumbing, - 32. 'Water Service-Final 33. Gas Service-Final . 34. -Solar Domestic-Final - 35. Landscape Sprinkling System ' 36. Sound Attenuation- . 37. Handicap Regulations 38. FINAL STRUCTURE &BUILDING „re_ 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA P MIT NO. TRACT NO LOT NO. BLDG. NO. CONSTRUCTION PERMIT S-6 6726 11/25/81 41075 Proy,r•Address'0 /SCWE012 . TYPE OF CONSTRUCTION Cl NEW []ADD O ALTERATION O REPAIR O CONVERSION ❑DEMOLISH ❑OTHER 4 , ZONING REGULATIONS Owner A) - . Phone Address Aao Fise 14,u. U Arch/Eng. License No. D� IPTI OF WORK yl _ P' ZON PLNTGp. Address �a Contractor'` 1 crtrz d e ,;,a Phone ir13,S&f TYPE OF PERMIT O GRADING O FOUNDATION O STRUCTURAL O TENANT O ELECTRICAL OPLVMBING ❑MECHANIC SETBAC C ST. SID YARD LS IEDE Y gRtE�FL. p$�f.1 PROPEII7TY LINE Address L kbk_0 . LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (com- 7000) O RIGHT men cing with section of Division 3 of the Business and Professions Cotl and my license Is In full force and effect. OTHER REAR YARD (TO P/L) y C t� �� PROJECT DESCRIPTION. Ucen$e Cl ss o..+�+�f�, SQ. FT. _ - PKG. SPACE REQ. PROVIDED �p �Ucan$ �� O.ALQ '—�^t�— Date Signature STREET WIDTH PARK FEE $ WORKERS' DELLA RATIO - OCCUPANCY--CONSTRUCTIONr)NETYPE of m that I have a I hereby affirm that I have a certificate o/ consent to self -Insure ora VALUATION ._ZDNE ZONING APPROVED BV DAT - of Workers'b.C.). Compensation Insurance, or a certified copy �certact SPECIAL ereof (Section 3800, Lab. CJ- (S GRADING CV. UDS. ACRES CONDITION licy NO. Company - C<rtifled copy is hereby furnished. REMARKS: O Certifle0 copy is filed with the City Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section need not be completed if the permit Is for one hundred ($100? Or lessl. I Cart fy that to the performance of the work for which this permit is _ Issued, I shall not employ any person In any manner sg.,Osto become PLUMBING '. PLAN CHECK ELECTRICAL PLAN CHECK subject t0 he orkers COmpensa p of Ca o old. BATHTUBS SHOWERS -- _ Date A Signature NOTICE: If after making this declaration, you s ould become subject to the Workers' Compensation provisions of the Labor Cotle, you must TOILETS URINALS GENERATOR TRANSFORMER 0-1 KW_ 1-1 O.KW forthwith comply with such provisions or this permlt shall be deemed LAVATORIES DOUBLE LAYS ,APPLIANCE 10-50 KW_ 50 t KW -- revoked. KIT. SINKS - DISHWASHERS MOTORS 0:1 HP_1-10 HP CONSTRUCTION LENDING AGENCY I hereby,affirm that there is a construction lending agency for the per. SERVICE SINKS SUMPS (INC. SOLAR) 10-50 HP 50 t HP 'formance•of the-work.for whichthispermib.lsAssued,(Sedtlon 3097 FLOOR SINKS FLOOR DRAINS 'FIXTURES OUTLETS SWITCHES Clv. C.). MbV t Lender's Name Lender's Address V OV L DRINKING FOUNTAINS GAS TUBE SIGNS " INTERCEPTORS CLARIFIERS POLE LIGHTS ' OWNER BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for POOL PTRAP POLES METERED SUB the following reason (Section 7031.5 Business and Professions Cotle:SWIMMING Any city or county which requires a permit to Construct. alter, improve, demolish or repair any structure, prior to its Issuance, also re- the applicant for such to file a signed statement that he WATER SERVICE ALTERATION PANELS MAIN SUB quires permit Is Ilcensetl pursuant to the provisions of the Contractor's License law GAS SERVICE OUTLETS SERVICE AMP 'Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT 'isiness and Professions Code) Or that he Is exempt therefrom and the ,sis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS -ny appllcant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). SOLAR TANK COLLECTORS O I, as owner of the properly, or my employees with wages as their sale compensation, will do the work, and the Structure is not Intended Or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE - Contractor's License Law tloe5 not apply to an Owner of a property ISSUE FEE APPLICATION APPROVED BY DATE�/ fr who builds or Improves thereon, and who tloe5 Such work himself or through his Own employees, provided that Such improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES intended or offered for sale. If, however, the building or Improvement Is sold within of completion, the owner will have the burden one year of proving he did not build or Improve for the purpose of Sale). HEATING SYSTEM 0-100,000 BTU BUILDING PERMIT $ SMIP $ SD O I, as owner of the property, am exclusively contracting with AND DUCTING licensed Contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK SJam• �>_� PERMIT and Professions Code: The Contractor's License Law does not apply to ISSUANCE $ an owner of property who builtl$ or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING S tracts from such projects with a contractor(s) Ilcesned pursuant to SYSTEM GRADING $ the Contractor's Utensil, Law). 100,000 ♦ BTU PLAN CHECK $ O 1 am exempt under Section B. & P. C. for this BOILERS BTU ELECTRICAL S $ reasonMICROFILM SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK $ MECHANICALnforrn$ $ TOTAL FEE $ LESS AD. Date Owner I hereby. certify that I have read this application and state that the above Is correct. agree to comply with all and county PLAN CHECK $ VANCEPC S_ ordinances and state laws relating to construction, her and hereby authorize t r¢pr¢senta[i ves of this city to entgL upon the above mentiOn<tl representatives ned mentioned property fo�r try pection ptt[()ose5. � Signature -Cl• L'"` Date - -ISSUE FEE 7H FINAL FEE $ w - - Drivers' License or SS—�� '• CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TO CONSTRUCTION AND PLANNING \^ �� I : g Date A "- APPROVALS Permit # J 1 S� POOL & SPA., Inspector APPROVALS Permit # Date Idspector .t 1. Temporary Electrical Service or Pole '- 43. Pool & Equipment Location 2. Soil Pipe -Un rgrn 44. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrn . 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE ' 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test _ 9. Water Pipe-Undrgrn 51. _ Backwash Lines P -Trap.❑ Undrcirn 10. Structural Floor System 52- APPROVAL TO DECK 11. Property Sewer Line & House Connection .53.:Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 55, Plumbino System - Final -I 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring 57. Solar System -Final 16. Rough Heating & Air Conditioning Fencing & Access Approval 1.7. Ducts in Structure 59. APPROVED FOR PLASTERING 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing _ 60. POOL/SPA SYSTEMS FINAL 'e 21. 22. Roof Sheathing Frame and Flashing NOTES: i1/(�oAi /!/ t!Q /✓O ✓Gv�li>7i%o. 23. Insulation ' 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test ' 31. Final Plumbing 32. Water Service -Final 33. Gas Service -Final 34.. Solar Domestic -Final 35' Landscape Sprinkling System,' "} 36. Sound Attenuation �''�• y\ 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. �:A . ' CERTIFICATE OF OCCUPANCY .% - No Date E• r