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Home My WebLink About345 FISCHER AVE - Building Permits. . . \� ` � CITY OF COSTA MESA � Development �ervices, Division of Building and Safety . ^ , CERTIFICATE�OF .00CUPANCY �,.� _ ,, ,�� , ';' '��'�; �� This certificate is issued pursuant to the requicemenLs of the Uniform Building Code, Section 308 adopted by the City . of Costa Mesa certifies that at the hme obits issuance tFie bu ilding struc[uie he�e�n below described was inspected and approvedforoccupancyasfollows�� -� �� Q � �i��?��' � \�<��\ . BuildingAddress �� Fischer �I�"ve. ,�. , .__ g��{g Perm�tNumberB04-00606 / / ! � �� ' `� / / � � , ' � \ ,Use Church !",�v��/��.? � ��"`.�_ \`_�r�\�\�.�'�`�i e � .... �i;i � _ I ','� i� �� `� �`,. I r ,,ti.'�' Group Type of Constructiony�ror ina: �r,ac Fire'Zone ��' ' Use Zone �,,; � . _ . �" �. � , j , � ,, 7� ,� � �i ;:�i OwneroEBuilding Todd ��1�Sc}i�iffman�T�RU�S�T��'�/�Tenant Rock=Harbor Church �,) ,>\; --`�� ;�� '� Address 9229 W. Sunset�Bl`. Ste 602, Los' Angeles ? 9 069-3406 Actina surt��Nt�gan "�� . ,_ gy --,; ��, y 7 Y �.- , " /1 �ii / ' BUILDINGOFFIC[AL- � Z't'`x1,� C B �., p�te enace, 7, + � ' Combination Inspectmr �.. , \\\�� '- ., .DaEejii � � � 1 ��18 � `��"� c�l--,I.�:�:... . �'-�Js,%' , � REQUIRED TO BE POSTED IN A CONSPICOUS PLACE �� C7ry o/ Costa Mesa Development Services Department Buildin9 Safety Division P. O. Box 1200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No. ��.� �� Tne Building located at 345 7iacher Str,�eC has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B—i Occupancy. Use of Building Of£icn Legal Description � 4�7-081—OG (See reverse s(de for Meres and eounds) Building Permit No R �dl ld Elecirical Permit No!'�d1 ?A, R�S�cp��umbing Permit No. p �nl �F+ Mechanical Permit No. �-� �d974, m 9l.lQl F Number of apartments and/or guest rooms ^irc Prov. Pormlt No. F 24397 ISSUED TO: Ple�cc]bl� P7eta1 's�5 :isc�oc Streot Coata G]osa, CA 92626 Building Official r�i i�;:,m m, u,,,.,,r.� by Date �oaomber 11, 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 oi the City of Costa Mesa under Sea 307 (e) U.B.C. CMF 3015-46 rev. 1/83 Nlhite -Owner; C�ynary - Numerical File; Pink - Bldg. Permit File i . , 4" � .i4�.% :f:fl-7.-�1�N�;��d 104� ��:t��Z6.�� Y COSTA MESA BUILDING-SAFETY DEPARTMENT�. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely REC IV O BV �ATE RE D D E ISSUED BUILDING�y /� � a�� ADORESS J�\ � �-. � P T OWNER '� A.P. NO. � MAIL BUILDING - 2 . ADDRESS � ADDRESS � 1 W W ' TEL TFACT LOT BLOCK d U CITV - NO. ' zZ Q CANSTRUC�ION W A D A P O N LENDEfl 2 (� J � BRANCH J � OWNER � m J ADDRE55 V UE J m ARCHITECT TEL. SE $/ � a ' OR ENGINEER N V a �� FIRE � . �� W� ADDRESS � ZONE TVPE GROUP a W APPflOVED / J O CONTRACTOR \ r' ��\b e�' (-� DATE m Z J � ADDRESS,g � W w ZO NO.OF USE OF N z= CITV '+ . , rypL' 9� PLANS BUILDIN � 1 H w � STATE ' CITY YARDSAPPROVED VAR S PPROVED ? O LIC. NO. �� Q' LIC. NO. MAIN BUILDING ACCESSORV BUILDING SI2E . ' NO, OF BLDGS. (FFiOM GL STREET) , OF LOT NOW ON LOT FFO FT. FT. USE OF ' E%ISTING BLDG. G� - FT. FT. � SIZE OF NO. OF . Z NEWBLDG. ROOMS STOFIES L.S E FT. FT. U EMERIOR WALL ROOF COVERING COVERING REA .FT. FT. J VSE OF BUILDING AND WORK TO BE PERFORMED DI5TAN ET. BET. MAIN & a ' � MAIN BL ACCESS. BLDGS. � ' a Q VAR.# � DATE Q S ` SP r � T^ C.U.P.3k APPROVED � APPROVED N Z � VI hereby acknowletl8a that I have reatl Shis application antl state � that the above informetion is correct antl agree to comply with � all laws �egulatin8 building consttuction, antl I zhall not employ ' � eny person in violation ot the workman's compensation laws of ro y the State ot Califomie. . �y zI hereby certify 2hat I am properly licensed as a contractor untler SQ. FT. o . the State ot Calitornia Businass and Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR � Chapter 9, antl that such licenses are in tull torca and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m am ezampt trom the provisions ot he State of Calitornia Business - ¢ a ter 9. VALUATION / m and Professions Code, Division 3, p PEFiMiT FEE $ � � ' SiBnat�re o / m Parmlttee $�/w � PLAN CHECK $ D• Q E Y .i,',/ , � LL AuthorizedAgent T�TA �)"$ � � '• 1_f63 F COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to "ill in Completely — Use Ink Only BUILDING /�.�� / i1GA /�`'r ADDRESS J J TIN� f•-`�d/ OWNER 1 • �{6(/� MA1L I � � ADDRESS CITV ufW j � / ��{ NOL�.�-IZiE BRANCH ADDRESS ARCNITECT TE _ an�u r ,t�:�,� :�Ec-4-?6�y;:QO SOs� 66.50 TION FOR STRUCTURAL PERMIT 3Y DATE RECEIVED nnrF issucn APPROVED ( ^ CONTRACTOR G� BY v✓ ADDRESS' Q U TEL. I ZON NO.OF� CI7V .�j NO. P�� .��. STATE CITY `�ARDSAPPFOVED LIC. NO. �IC. NO. MAIN BVILDING 0. OF LOT f� X ZID I NO.OF BLOGS. (FROM C/L STqEET) NOW ON LOT RONT FT. 4 USE oF „V'. EXISfING BLDG. � � F � FSeparate permits are required foT � �. sioe Fr. p electric, plumbing and heating work. REAa Fr. HVSE OF BUILDING AND WORK TO BE ERFOFiMED, DISTANCE BET. aMAIN BLDGS. a \ VAR. aY+ Q, � (i b./ ' C.U.P. �W y APPROVED .Y., � W � I hereby acknowladBe ihat I have raetl thls epplication entl state p: that the abova informaiion Ic correet antl apree to comply with a ell laws ragulating buildinp construction, antl 1 sha�l noi employ �any permn in violailon of M¢ workman's compenseNon laws of � Me Stete of Celtforn{e. � I hereby cartify cbat I am prope�ly Ilcanfetl es a contrecior untler SQ. FT. the Staie of CelHornla 8usineu entl Profeplons CoOe, Dlvlsion 3, THE AMOUNT SHO\ ChaPter 9, antl thet s�c� Iicanses are In full forca antl affect, or I THE PURPOSE OF E5 em exempt trom Me p�ovisions o+ the Stete ot Calitorn}a Bustness VALVATION antl Profassion Cotla, ivislon 3, Chaptar 9. Sipnature ot �/ n, ` " / � PermlKee ' ' $ / e!�^' Auihorizetl ABani ��v ��,�• 6(/v 1 f V U V 'v %u u � LOT BLOCK �L' � VALU$ �C �i • GROuv DATE i ��' I • / � USE OF NEW BUILOING VARDS APP ACCESSORV BET. MAIN & ACCESS. BL� DATE APPROVED -A845HING A PERI PERMIT PEE $ PLAN CHECK $ TAX $ TOTAL PAI O S � 7� � m 'm m N IS FOR m ONLY: e J� m m 0 LL f U Z . a tWj 2F O v� am J N CI J J m Q U N Za W � aW W Z J Q m Z J � W W � ZH w� , 7O F Z Q U J a a Q 73 �s G s z �' �rp � a l�� G 40028 �. �;nv z-�t�_�.,,€�0 9�z� ��:��25z5 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 C0.STA MESA, CALI FORNIA 92626 For Applicant to Fill in Completely BUILDING� S �SG ADDRESS OWNEH � E. s.. ADDRE55 Sy�rrq TEL. CITV if7A i�J9F-i.iO NO. BRANCH ADDRESS ARCHITECT OR ENGINEER ADDRESS CONTflACTO,�/R �. ADDRESS �" • v • CITV �� STATE uc. No. /SG SIZE OF LOT USE OF EXISTING BLDG. SIZE OF EXTERIOR WALL COVERING USE OF BUILDING AND i N0�71 yv � CITY ��.No. GG�7 NO.OF BLDGS. NOW ON LOT APPLICATION FOR BUILDING PERMIT RECEIV� BV D TERECEIVED �T�SS=EI �� .7� J � A.P. NO. � � 1 P R EII},'{� �/ BUILDING � , 1 ADORESS TRACT LOT BLOCK OWNER, ' FIRE � 20NE T APPROVED BV ZON NO.OF PLANS VAROS APPROVED MAIN BUILDING (FROM C/LSTREET) DISTANCE BET. MAIN BLDGS. VAR. # I heraby acknowledBa that I have read this application antl stare Mat the above information is correct and agrea to camply with all laws regulaNng buildinp cOnstruction, anE I shali nOt amploy any person in viOlallon of Me workmen's compansaiion laws of Me Smte of Celifornia. I hereby cartify Mai 1 am properly licensetl as a conttactor under S�. FT. Ma State of Celifornia Busineu antl Professions Cotle, Divisicn 3, THE AMOUNT SN� Cheptar 9, antl thai such licenses are in full force entl affect, or I THE PURPOSE OF E em ezempt from the Drovisions of �State of Calitornia Busineu VALUATION antl Protesslons e, Division 3, apter SIB�et�re of � Permlttee G $/O�O• Au Nzatl Ageni VALUE , d I 5 �� GFOUP � DATE � � OF NE DING ARD APPROVED DATE APPROVED .Tj�-r TOTAL FEE �� m 0 ON IS FOF � FEE ONLV: m ¢ /SA � � m q, �s e 5 ' LL i � . � „� �► 39765 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applrcant to Fi!l in Cam (etely AODRESS � � �/t4' �� OWNER �/ . � S . MAIL � � ADDRESS , W W TEL. a U CITV Yl�J NO. OZ CONSTRUCTION �^ � LENDER , I am J � BRANCH J N m J ADDRESS m ARCHITECT TEL. J N OR ENGINEER U Q W � ADOFESS aw J O CONTRACTOR m Z J � ADORESS 1 .Jr w W TEL. � 2 CITV NO.s Z� w � STATE ,t) CI7Y y� LIC. NO, v a IIC. NQ. � � SIZE NO.OF BLDGS. � I OF LOT � NOW ON LOT `�- II �� s, -�s�;,,. on 4�;�-� �:::-� l cs.�� APPLICATION FOR BUILDING PERMIT RECEIV6V,BY/ DATEFECEIVED �,.r��..�� A.P.NO.��I�O� I YI BUILOING /� � ADDRESS �YS TRAC S� LOT'� W A � n OWNER � —�(� ��` „�� . O��/�E vA�u� 7 N . NO.OF�. PLa.fyS� YARDS AGPROVED F SIZE OF � NO. OF _ Z NEW BLDG. ROOMS STOfiIES L SIDE 1 U EXTERIOR WALL r ROOF COVERING COVERING REAR F"�. J VSE OF BUILDING AND WORK TO BE PERFORMED DIS7ANCE BET. a' MAIN B�DGS. a Q i ' VAR.3k O C.U.P. # � , APPROVEDI. ,� w Z O UI �araby eckeowletlBe that 1 heve rfletl Mis appllcation antl sfafe � thet the above informatlon Is carract antl apree ta comply with � all laws ra9ulatinp builtllnp consttucNon, entl � shall not employ F any person in violetion oi Ma workmen's compensation lawz of y the Stete of Californle. ? 4 �ereby cortify that I om properly licenutl asacontractor u�tler SQ. F ihe State of California Business and Professtons Cotla, Divisicn 3, THE AMOUNT Chapter 9, entl that such Iicenses ere in full force antl effect, or I THE PURPOSE C am exempt trom the 0/ovlaions of the Stata of Celifornla Business VALUATION antl Protass nsCode, D��on 3, Cneptar . Sipnatura of � D�b - 3� oc Permittee S / n�inon:ea Aeao< DATE USE OF NEW I BUILDING /p� VAROS APf ACCESSOFV BEf. MAIN & A / ;� ooa 7/-7C^ : � � 0 TION IS FOR � ^ T FE ONI�V: ¢ 7 � n � � E 05'�° ' LL (714) 754-5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT . Job Address: 345 FISCHER AV Suite: Vicinity: CURB AND GUTTER Parcel Number: 42708104 Zoning: App�icant JIM GACKI Address: 1322 BELL AVE � - - - — SUITE 1-F � ,, , -' Phone: �(714j 258-3333 _ TUSTIN, CA � � '"� � Zip: 92780 Owner. SCHIFFMAN; TODD I TR Address 9229 W SUNSET BLVD #602� � � - � - � � �. , .' � �, �-. ;�. - - -Phone: -_ � �, LOS ANGELES, CA� �" Zip: 90069-3406 '_; ��_ � � , i. . . .-. . . , , '_ Convactor. D& H BUILDING.SYSTEMS INC �� ' Address: 1322 BELL AVE -� � . . SUITE7-F, � Phone: (714)25&3333 � " TUSTIN;CA �� Zip: 92780�� License:, 747803 Arch :- � , � , . Eng: ISSUED BY: Status: ISSUED Applied: 10/21/2004 Issued: 10/21/2004 \ \ . � ' � �Phone: ' � . ' : .. Phone: , - `, , Zip: • ' � License: � ,License: � � SCOPE OF PERMIT CONSTRUCT 6' CURB & GUTTER FOR'ROCK HARBOR CHURCH'.. . .�. _ -, - " _ � � ' � . ' - " ' . �� i � � � /r ' � ' FEE SUMMARY Plan Check: $72.31 � Calc Valuation: Sa,soo.00 � Permit: � � $11125 ��" � �� - � ,� � ,, ` _. �� i" "� _—Claim Valuation: �Sa,soo.00- ` SMIP Res: , $0.00 =- - � - — � SMIP Com: $0.95 ' - , � � � Other: , � $0.00 �� , � lnspection:: �. , $0.00 - - � _ ,' ' � � ' � � V . ' �, � ' / �'��Total:� $184.51 �,r,�;," '" ',� / . �� :: �` _. - - .;� / � ' � --� � PLANNING�&ZONING' - " �' � � �� . � i , SETBACKS-. �'/ �' �' � . " � � � , ' -, . MAIN STRUCTURE Front �0-�0 ' ,-- Rear ,. 0- 0 , Left � 0- 0 - -Right � �0 ;0 � � , �� A, �; : �;;;_ . �� -� . .. - - - � . -,� �� , ACCESSORY � Pront �0•0 ,�, Rear- 0-�0�� Left �0-�0� - ' Right - b-0� , , � . `�. .., _ . . _ . . . . , PARKING Existinp:'; 0� �' Reauired: ' 0 PropoSed: 0 NOTES: �V''� �-:- , , . . , ' � • � . , . - —_ " -� -.. <-_ � - - ' _ INOTICE: The work authodzed by this permit shall comply with all applicable handicap access requirements under California statutes and related �, regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire antl become voltl if work is not commenced wlthin 180 days, or if work Is suspended or abandoned for a period of 180 tlays. INSPECTIONS: In order for the work authorized untler this permit to be considered legal, such work must comply with all applicable codes, and�all� required Inepectiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of thi� it!� FOR INSPECTIONS CALL: (714) 7545828 us�ae �aroo� WORKERS' COMPENSATION DECLARATION: . - .. . '� ;;i � � ' I hereby affirtn untler penalry oi perjury one of Ihe foilowing declaretions. `- ' "' "` ��' ._. ' ❑ I have and wlll maintaln a cetliTicate of consent to setl-Insure tor workers' compensation, es provided for by sec�ion 3700 ot ihe Wbor Code, for Ihe pedortnance of the work for which ihis permli is issued. . � �$ I have antl will maintain workers' compensalion Insurance, es requiretl by section 3700 of the Labor Cotle, for t�e pertortnance ot the work br which this permit is issuetl. My workers' compensation Insurence carriar antl policy number era: ' ' Camer: �� L�C/UD PoliryNumber: Gi%/3Oc�y—ZC��- (This section need not be comp/eted il fhe permit is valued et one hundretl tlollars (S100J or less.) . ,_ , „ �, , ❑ I certify that in the performenca of the work for which ihis permit Is issued, I shell not employ any'person in any manner so as to become subject to ihe workers' compensetion laws ol Celifomia, antl egree that H I should become subject to the workars' compensatlon provisions of Seclion 3700 oi ihe Lebor Coda, I shell forthwith complywiththe ions. / / Applicent Signature: '..rrS � � � Dete: /O/"7- � 0 � WARNING FAIIURE T SEWRE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDREO THWSAND DdlARE ($100,000�, IN ADDITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIPE� FOR IN SECTION 37060F THE LABOR CODE, INTEREST, NND FTTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am licensed under rovisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business end Professions Code, end my license is in full torca end e8ect. Lic. # ° i�U� Class N ContracbYsSigneWre��.�Jl' Date: �� Z� DY CONSTRUCTION LENDING AGENCV: or . ❑ I hereby aHirtn that ihere is a consWdion lending egency for the pedormanca of iha work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: . . � � LantleYs Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: a I hereby affirm ihet under penelty of perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW tor �he following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county which requires a permit to construd, alter, improve, demolish, or repair any strucNre, prio� to its issuance, also requires the epplicant for such pertnit to file a signetl statement that he or she I5 licensed pursuent to the provisions ot the Contractors License Law (Chepter 9(commencing with Section 7000) of Divislon 3 of the Business end Professions Code) or that he or sh s exempt therefrom and ihe basis for ihe alleged ezemption. Any violation of Section 7031.5 by eny applicant for a permit subjecis ihe applicent to a clvll penelty of not more han tive huntlretl tlollars ($500).): ❑ I, as owner of the propany, or my employees with weges as Iheir sole compensation, WILL DO THE WORK, and the sirucWre is not intended or ottered tor sela (Sec. 7044, Business and Professions Cotle: Tlie Contractors License Law tloes not apply to en owner ot property who builds or improves ihereon, and who does such work hlmself or herself or through his or her own employaes, provided that such improvements are not intendee or oHerad for sale. If, however, the 6uilding or improvement is sold within one yeer ot completion, ihe owner-builder will heve the burden o� proving that he or she did not build or improve for purpose of sale.). • ❑ 1, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTOFS to construct the project (Sec. 7044, Business antl Professions Code: 7he conirectors License Law Ooes not apply to an owner of property who bullds or improves ihereon, and who comracis for such project wlih a contractor(s) license pursuent to the Comractors License Laws.). ❑ I em evempt under sec. Business and Professions Code tor ihis reason: Signature: Dete: Owner ID verifietl by tlnver's license. ❑ Yes ❑ No Dnver'S License No. VeriBcation of Ownership by (type ot document, i.e. - property tax bill or deetl): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depih into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building stmcture, scaHolding, falsework, or tlemolition or dismantling thereof, will be more than thirry-siz (36) teet high. (C�ap. 3.2, Gry 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e parmit from Ihe Division ol Industrial Sefery, as notetl above, unless such person has e permit to do such work from t�e tlivision. ' Signature: Date: Division of Intlusirial Safery Pertnit Number: CEHt1FlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenity under penalry of perlury that I have read this epplication and state Ihat the iniormatlon given is wrrect. I egree to comply wit� all state lews end city ordinances relating to builtling constmction, and authorize representatives of ihe Gty of Costa Mesa to enter upon ihe above-described property for inspection puryoses. I egree not to occupy or allow occupancy ot any building authonzed by this permit until tinal inspection. COOE t. INSPECTIONTYPE 1616 Fixed System Final Fire Preveniion 1266 Paol Spe Finel 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition P9SE iol� i�ay � ate INTRIRLS COOE1 INSPECTIONTYPE 206 Final Mechanical , 208 Final Plumbing 270 Finel Electrical 212 220 222 .. 250^ Flnel Fire Prevention Final Planning Approval Final Site Final 8uildincyOccupency Iz��r.min�i (714) 754-5273 • Fe�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Vicinity: Parcel Number: 42708104 Applicant: SCOTT, MELISSA Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 . i � � _� , , LOS ANGELES, CA , Coniractor: � PREMIERE'WOODWORKS INC Address: 427 E 17TH ST SUITE 110 � COSTA�MESA, CA Zoning: Phone: (949)631-9911 Zip: Phone: Zip: 900693406 Phone: (949)631-9911 Zip: 92627 ' License: 619755 Arcn : TONY MASSARO Address: 3100AIRWAYAV ' ,� . � - C.M, CA , ' . Phone: 714-556-8299 ' SUITE 114 � - Zip: 92626 . License: C24376 Stalus: ISSUED Applied: 03/25/2004 Issued: 06/16/2004 -.�� ■ = 'i `.II Eng: � Address: Phone: License: � SCOPE OF PERMIT _ ' TENANT IMPROVEMENT FOR "ROCK HARBOR CHURCH". 34,176 SQ.�FY. SCOPE OF WORK TO INCLUDE: NEW SANCTURY, CLASSROOMS AND BATHROOMS AND OFFICE SPACE.�BUILDING IS OF MIXED OCCUPANCY.(A2.1/A3/B/F1/S2) AND MIXED TYPE OF CONSTRUCTION (VIHRANDVN). , . �REF: PA-03-48. � � � , - . Plan Check: $3,336.94 Permit: $5,133.75 SMIP Res: $0.00 SMIP Com: $189.00 Other: $0.00 Inspeotion: $0.00 � � _ Tofal: $8,659.69 SETBACKS MAW STRUCTURE FronC�.. 0-0 � ACCESSORY Front 0- 0 � FEE SUMMARY Calc Valuation: Claim Valuation: ,' . � . _' � ` PLANNING & ZONING �- Rear 0-�0 � �� Ceft �-.0=0 ^ � - Rear 0- 0 �, Left 0- 0 ,, Right . Right 0- 0 . Ssoo,000.00 Ssoo,000.00 i NO710E: 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 code all required inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot ' permit. FOR INSPECTIONS CALL: (714) 7545626 2aasrs (s�ao) WORKERS' COMPENSATION DECLApATION: I hereby afFirm untler penalry ot perjury one of iha following declarations: ❑ I have and will maintain a cetliticate ot consent to selFlnsure for workars' compensation, as provided for by section 3700 of the Labor Code, for Ihe pedormance of the work for which ihis permit is issued. t I have aqd will maintain workers' compensation insurance, as required by sedion 3700 of the Labor Cotle, For Ihe peAormance of ihe work tor which this pertnit is issued. My �anca cerrler antl policy number are: P��` z �O � S.�-�� 3 cy,Number., ._ ❑ I certiry that in ihe ped ia c of th work for which this pertnit is issued, I shall not employ any person in any manner so as to bacome su6ject to Ihe workers' compensation laws of ali , an rea that it I should become subject to the workers' compensation provisions ot Section 3700 of ihe Labor Code, I shall fonhwith comply with these pr isi s. / � �/ Applic__ ent�Sig,n�_re:� �:' Date:', .. l�' ��s ' �i WARNINOM�FAICUREffO � R O CER PENSATIONCOVERAGEISUNL4WFULANDSHALLSU&IECiANEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDRED iFK)USAND OOLLAflE W, , IN ADDITION TO THE COST OFCOMPENSAiION, OAMAGES AS PROVIDED FOF IN SECiION 3]060F iHE LABOR COOE, INiEflES7, MIO ATTOFNEY5 FEES. LICENSED CONTRACTORS DECLARqTION: 1 hereby affirm ihat I am licensed untle�r�vZsrofi's oi Chapter 9(commancing with Section 7000) andProtessions Cotla, anA my license is in full /J CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirm that thare is a constmction lending agency for the performance of the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lendets Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn thet under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires a permit to consimct, alter, Improve, tlemolish, or repair any struaure, prior to its issuance, also requires Ihe applicant for such permit to file a signed statement ihat he or she is licensed p8lsuent �o ihe provisions of the Conirectors License Lew (Chapter 9(commencing with Section 7000) ot Division 3 ot ihe Business end Protessions Code) or Ihat he or she is eaempt ihe�eirom and the basis tor Ihe aileged eaemption. Any violation of Section 7031,5 by any applicant for a Dermit subjects the applicant to e civil penalty ot not more Ihan five hundred dollars ($500).): ❑ I, es owner of ihe property, or my 5mployees with wages as their sole compensation, WILL DO THE WORK, antl ihe siructure is not intentled or offered for sale (Sec. 7040, Business and Professions Code: The.Contractors License Law does not apply to an owner oi property who builds or imDroves thereon, and who does such work himself or herself or through his or her own employees, pmvided ihet such improvements are not intended or oNered tor sale. If, however, the building or impmvement is soltl wiihin one year ot completion, ihe owner-builder wili have ihe burden ot proving that he or she did not buiitl or improve tor purpose of sale.). � ❑ I, as owner of the property, am EXCLUSNELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Protessions Code: Tha coniractors License LaW does not appty ro an owner of property who builds or improves lhereon, and who contracts tor such prolect with a coniractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID veritied 6y drivers licen5e. ❑ Yes ❑ No Driver's License No. Verificetion oi Ownership by (type of document, i.e. - property tax bill or tleatl): Expires: DIVISION OF INDUSTRIAL SAFEN P�pM1T CERTIFICATION: ❑ I hareby cetlify thet no excavation tiva (5) or more feet in depth into which a person is required to descentl, will be made in connection with work authorizetl by this permii, end lhat no buitding simcture, scaffoltling, falsework, or demolition or tlismanlling Ihereol, will be more Ihan Ihitly-six (36j (eet high. (Chap. 32, Gry Z, Art 2, Sec. 341, Title e, Calitornia AdministratiVe Code). ❑ As owner-builder. I will not employ anyone to do work which would require e permit from the Division of Indusirial Sataty, as noted above, unless such person has e permit to tlo such work irom ihe division. Signature: Da�e: Division of Indusinal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND qUTMORIZATION OF EMAY: I cenity under penalty of perjury ihat I have reatl this application and state Ihat tha iniormation given is correct. I agree to comply wlth ell stale laws and city ordinances relating to building consimction, antl authorize representatives of the City of Costa Mesa to enter upon the above-described property tor in�pection purposes. I agree not to occupy or allow occupancy ot eny building authorized by this permit until final inspection. CODEA, INSPECiIONTYPE pATE INTRU 1616 Fized System Final Fire Prevention 1266 200 201 202 203 Pool Spe Final - Final Re-Roof �Flnal BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demo ition COUEX INSPECTIONTVPE 206 Final Mechanical 20B Final Plumbing 210 Pinal EleCtriCal 212 Finel Flre Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy o"re 1NSIIJA6fi (71d) 754-5273 • Faz (714) 754-485fi • www.ci.costa-mesa.ca.us 77 fAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Vicinity: ROOF TOP OF ROCK HARBOR CHURCH Parcei Number: 42708104 Applicant: JIM GACKI Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 Stalus: ISSUED Applied: 04/16I2004 Issued: 04/20/2004 Zoning: � ISSUED BY: � - Phone: 714-258-3333 Zip: Phone: LOS ANGELES, CA Zip: 90069-3406 Contractor: D& H BUILDING SYSTEMS INC Address: 1322 BELL AVE SUITE F TUSTIN, CA Arch : Address: Phone: (714) 258-3333 Zip: 92760 � License: 747803 Phone: Eng: Address: Phone: Zip: License: License: SCOPE OF PERMIT SCOPE OF WORK: 23 PLATFORM ON ROOF FOR FUTURE MECHANICAL EQUIPMENT. NO OTHER WORK AUTHORIZED WITH THIS ACTIVITY. Plan Check: $163.31 Permit: $251.25 SMIP Res: $0.00 SMIP Com: $3.15 Other: $0.00 Inspection: $0.00 Total: $417.71 SETBACKS MAINSTRUCTURE Front 0-0 �ACCESSORY Front 0- 0 PARKING Exislinq: 0 Rear 0-0 Rear 0- 0 Reauired: 0 FEESUMMARY PLANNING & ZONING LeFt 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $15.000.00 $75,000.00 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, 1241-92) EXPIRATION: This permit shall automatically expire and become void ii work is no� commenced within 1B0 days, or if work is suspendetl or abandoned for a period o� 180 days. INSPECTIONS: In order for Ihe work authorized under ihis permit to be consideretl legal, such work must comply with all applicable codes, and all required Inapeetlons and final approval must be obtained. FaiWre to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 75F5626 2a46-46(6/00) (71d) 754-5273 • FaX (�ia� �sa-aess • www.ci.costa-mesa.caB. UILDING PERMIT ,lob Address: 345 FISCHER AV Suite: Vicinity: Parcel Number: 42708104 Applicant: WHITNEY, ROBERT Adtlress: PO �5396 NEWPORTBEACH.CA Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 LOS ANGELES, CA Contractor. WHITNEY ROOFING Address: P015396 Arch : Address: NEWPORTBEACH,CA Zip: 92659 . Phone: Zonin9: Phone: (949)548-0769 Zip: 92659 Pho�e: Zip: 900693406 Phone: (949)548-0769 License: 406022 Eng: Address: 77 FAIR DRIVE, GOSTA MESA, GA 92626 ISSUED BY: Status: ISSUED Applied: 03/22/2004 Issued: 03/22/2004 Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. COVER WITH BUILT-UP ROOFING. Plan Check: $0.00 Permit: $790.75 SMIP Res: $7.06 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $797.81 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Exislinq: 0 NOTES: Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Prooased: 0 Calc Valuation: Claim Valuation: Right 0- 0 Righl 0- 0 570,569.00 570,569.00 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, § 7, 12-21-92) . EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspanded or abandoned for a period ot 780 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 raquired Inspectlona and final approval must be obtainad. Failure to obtain inspections and linal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 1446dfi (NW) (714) 754-5273 • Fa�c (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Vicinity: Parcel Number: 42708104 Applicane GACKI, JAMES Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 LOS ANGELES.CA Zoning: Phone: 774 258-3333 Zip: Contractor: D& H BUILDING SYSTEMS INC Address: 1322 BELL AVE # F TUSTIN, CA Zip: 92780 Phone: Zip: 90069-3406 Phone: (714)258-3333 License: 747803 ISSUED BY: Status: ISSUED Applied: O7/06I2004 Issued: 03/17/2004 Arch : TONY MASSARO En9: Address: 3100 AIRWAY AV Address: C.M, CA Phone: 714-556-8299 Phone: SUITE 174 Zip: 92626 License: C24376 License: SCOPE OF PERMIT INTERIOR TENANT IMPROVEMENT. WORK TO INCLUDE: DEMOLISH EXISTING 5,200 S.F. OF OFFICES AND REBUILD 5,600 S.F. OF NEW OFFICE SPACE. ADD ADDITIONAL OPENINGS IN EXTERIOR WALLS AT WAREHOUSE AREA. NEW SEISMIC RETROFIT OF 34176 SF STRUCTURE. ADD 247 SF BLDG AREA AT,FRONT. NO ADDITIONAL PLUMBING FIXTURES, RELOCATION ONLY. NOTE: THIS T.1. IS FOR FUTURE ROCK HARBOR CHURCH. REF: PA-03-48 Plan Check: PermiL SMIP Res: SMIP Com: Other: Inspection: Total: $718.74 $1,105.75 $0.00 $25.20 $0.00 $0.00 $1,849.69 SETBACKS MAINSTRUCTURE Front 0-0 Rear 0-0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Calc Valuation: Claim Valualion: Right 0- 0 $120,OOO.00 si2o,0o0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitomia staWtes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 7his 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectione and ilnal approval must be obtained. Failure to obtain inspections and linal approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 24t6d816/00) (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Vicinity: Parcel Number: � 42�08104 Appiicant: BRAD HISGEN Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BIVD #602 Zoning: Phone: 714-872-5900 2ip: Phone: LOS ANGELES, CA Zip: 900693406 Contractor. CORNERSTONE CUSTOM PATIO COVERS Address: 20&41 GLENCAIRN LN Arch : Address: Phone: 714-504-8800 HUNTINGTON BEACH, CA Zip: 92646 � License: 709138 Phone: Eng: Address: Stalus: ISSUED Applied: 11/12/2004 Issued: 11/12/2004 �. ISSUED BY: Phone: 2ip: License: LiCense: SCOPE OF PERMIT 72 FEET OF GARDEN WALL 4' IN HEIGHT W/ 4' TRELLIS ON TOP FOR "ROCK HARBOR CHURCH" TO ENCLOSE DOCK AREA. Plan Check: $35.10 Permit: $54.00 SMIP Res: $0.00 SMIP Com: $0.50 Other: $0.00 Inspection: $0.00 Total: $89.60 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Pro ased: 0 Calc Valuation: Claim Valuation: Righl 0- 0 Right 0- 0 si,aao.00 $0.90 NO710E: The work authorized by Ihis permit shall comply with all applicable handicap access requirements under California staWtes and related ., regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: 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 780 days. INSPECTIONS: In order for �he work au�horized under ihis permit to be considered legal, such work mus� comply with all applicable codes, and all requlretl inspections and (inel epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration oi this permit. FOR INSPECTIONS CALL: (714) 75h5626 2MB�a6 (N00) (714) 754-5$73 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob qddress: 345 FISCHER AV Suite: Vicinity: REAR CORNER AT ROCK HARBOR CHURCH Parcel Number: 42708104 Applicane GACKI, JIM Address: 1322 BELL AVE SUITE 1-F TUSTIN, CA Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 LOS ANGELES, CA Zoning: Phone: (714) 258-3333 Zip: 92780 Phone: Zip: 90069-3406 Contractor. D& H BUILDING SYSTEMS INC Adtlress: 1322 BELL AVE SUITE 1-F Phone: (714) 2583333 TUSTIN, CA Zip: 92780 � License: 747803 ArCh : Addr@ss: Phone: Eng: Address: ISSUED BY: Slatos: ISSUED Applied: 10/08/2004 Issued: 10/08J2004 Phone: Zip: License: License: SCOPE OF PERMIT CONSTUCT 162 SF TRASH ENCLOSURE IN THE REAR CORNER OF "ROCK HARBOR CHURCH' ENCLOSURE TO BE CONSTRUCTED PER CITY STANDAftDS. REF: H04-00606 Plan Check: $81.41 ' Permit: $125.25 SMIP Res: $0.00 SMIP Com: $1.09 Other: $0.00 Inspection: $0.00 Total: $207.75 SETBACKS MAINSTRUCTURE Fwnt 0-0 ACCESSORY Front 0- 0 PARKING Existina: o Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY C81C V81UBtiOn: $5,200.00 Claim Valuation: Ss,zoo.00 PLANNING & ZONING Left 0-0 Right Left 0- 0 Right Proposed: 0 0- 0 NOTICE: The work authorized by this permit shall comply with all applicabte handicap access requirements under California statutes and related regulalions. (Ord. No. 92-28, § 1, 12•21-92) EXPIRA710N: This permit shall automatically expire and become voitl il work is nol commenced within 180 days, or il work is suspended or abandoned for a periotl ot 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 requlred ihepaetlons and final approval must be obtained. Failure to obtain i�spectio�s antl final apProval will result In the expiration of this permit. FOR INSPECiIONS CALL: (714) 754-5626 • zaaws le'oo� . ,i . JobAddress: 345 FISCHERAV Suite: Vicinity: ROCK HARBOR CHURCH , Parcel Number: 42708104 Applicane GACKI, JIM Address; Owner. SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 LOS ANGELES, CA Zoning: Phone: 714-2583333 Zip: Phone: Zip: 90069-3406 ISSUED BY: Status: ISSUED Applied: 06107/2004 Issued: O6l08/2004 Contractor: D& H BUILDING SYSTEMS INC Address: 1322 BELL AVE SUITE 1-F Phone: (774) 2583333 TUSTIN, CA Zip: 92780 ' License: 747803 nrch : TONY MASSARO Eng: NELSON CONSULTING ENGINEERS Address: 3100 AIRWAY AV Adtlress: WILLIAM M NELSON C.M, CA Phone: 714-556-8299 IRVINE, CA Phone: 949-752-2070 SUITE 114 17815 SKY PARK CI STE G Zip: 92626 License: C24376 92614 License: SE3417 SCOPE OF PERMIT INSTALLATION OF 15 (48" X 96") BRISTOLITE SKYLIGHTS (MODEL #489&SSL-SF) IN CONJUNCTION WITH THE PREVIOUSLY PERMITTED SEISMIC RETROFIT AND OFFICE IMPROVEMENTS FOR ROCK HARBOR CHURCH. ICBO #ER-2469 REF: 804-00081 Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $99.61 $153.25 $0.00 $1.60 $0.00 $0.00 $254.46 SETBACKS MAIN STRUCTURE Fronl 0- 0 ACCESSORY PARKING Front 0- 0 Exi5tl�9: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0-0 Righl 0- 0 $7,soo.0o S7,sao.0o I NOTICE: The work authorized by Ihis permit shall comply with all applicable hantlicap access requiremenls under Califomia statufes and related �I regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATiON: This permit shall automalicaily expire and become void i( work is not commenced within 1 BO days, or it work is suspended or abandoned I lor a periotl of 180 days. , INSPECTIONS: In order fo� the work aulhoirzed undei ihis permit to be consideretl legal, such work must compry wilh all applicable codes, and all required inspections and final approval musl be obtained. Failure �o obtain inspections antl final approval will result in Ihe ezpiration of this permit. FOA INSPECTIONS CALL: (774) 754-5626 2<e6�A5 (6�00) (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 345 FISCHER AV Suite: Vicinity: Parcel Number: 42708104 Applicant: GACKI, JAMES Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #&02 LOS ANGELES, CA Zoning: Contractor: D& H BUILDING SYSTEMS INC Address: 1322 BELL AVE # F Phone: 774 258-3333 Zip: Phone: Zip: 90069-3406 Phone: (714) 2583333 Status: ISSUED Applied: 01/O6/2004 Issued: 03/17/2004 I UJ I IN, GA Zip: 92780 License: 747803 Arch : TONY MASSARO Eng: Address: 3700 AIRWAY AV Address: C.M, CA � Phone: 714-556-8299 Phone: SUITE 114 Zip: 92626 License: C24376 , License: SCOPE OF PERMIT INTERIOR TENANT IMPROVEMENT. WORK TO INCLUDE: DEMOLISH EXISTING 5,200 S.F. OF OFFICES AND REBUILD 5,600 S.F. OF NEW OFFICE SPACE. ADD ADDITIONAL OPENINGS IN EXTERIOR WALLS AT WAREHOUSE AREA�. NEW SEISMIC RETROFIT OF 34176 SF STRUCTURE. ADD 247 SF BLDG AREA AT.FRONT. NO ADDITIONAL PLUMBING FIXTURES, RELOCATION ONLY. NOTE: THIS T.I. IS FOR FUTURE ROCK HARBOR CHURCH. REF: PA-03-48 Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $718.74 $1,105.75 $0.00 $2520 $0.00 $0.00 $1,849.69 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0- 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Calc Valuation: Claim Valuation: Right 0- 0 s�2o,o00.00 $izo,000.00 INOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Cali(ornia statutes and related I regulations. (Ord. No. 92-28, § 1, 12-21-92) ii EXPIRATION: This permit shall automatically expire and becoma void if work is not commenced within 180 days, or if work is suspended or abandoned � for a period of 780 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 Inspectlone 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 �. 2a1&a6 (B/00) WORKERS'COMPENSqnONDECLARAnON: I hereby attirm untler penalry of perjury one of the tollowing declarations: � + � ❑ I heve and will maintein e ceniticate of consent to setl-Insure tor workers' compensetion, as provided for by sec�ion 3700 ot t�e Labor Cotle, lor Ihe peAormance of b}e �work for which this permit is issuetl. .y-pl I heve end will maintain workere' compensation insurence, as required by section 3700 ot the Labor Code, for ihe peAormance ot I�e work Por which Ihis pertnic is issuetl. J`�My workers' compensation In§urance genier and policy number ere: . Policy Number: �%L� Z�� one hundretl dollars (5100) orless.J � I certity Ihat in the pertortnence ol ihe work for which this pertnit is issued, 1 shall not employ any person in any manner so as to 6ewme subject to the workers' compensatlon laws ol Califomie, and aqrae that II I should become subject m tha workers' compensation provislons of Section 3700 ot the Labor Code, I shall torthwith comply with Ihes sions. �/ � �/� � � �ApplicamSlgneNre/� /��kyA fj+TliG�Y �Daet : � �y WAFNING: FAILUREiO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL PND $HALL SU�ECT AN EMPLOYER TO CRIM�NALTIES AND CIVIL FINES UP TOONE HUNDRED TFIOUSAND DOLIAHE (5100,ppp), IN ADDITION TO THE COST OF �MPENSATION, DAA41GE5 FS PROVIpED FOR IN SEGTIIXJ 31060F THE LABOR �pDE, INTEREST, AND AiiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I her� y eHirm that I am licensed under provisic force antl eRect Lia 7f _� Ooptractors SignaNre: �� . af Chapter 9(commancing with Section 7000) ot Dlvision 3 oi,th�Busines�tl Protessions Code, and my license is in full Cles� � > oaie: 3//7O� CONSTRUCTION LENDMG AGENCV: ❑ I here6y attirm that there is a construction lending agency for the peAortnance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). LendeYs Name: Lendefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirm that undar penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Cotle: Any clry or counry which requires a permit to consimct, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires the applicant lor such permit to file a signed statement ihat he or she Is Ilcensed pursuent to ihe provisions oi the Contradors License Law (Chapter 9(commencing with Sectlon 7000) oi Division 3 ot Ihe Business antl Professions Code) or thet he or sf�e is exempi therefrom and Ihe besls for Ihe allegetl ezemption. Any violetion af Seclion 7031.5 by any epplicent for e pertnit subjects the applicant to e civil penalry oi not m6re than tive hundred dollers ($500).): ❑ I, as owner ot the properry, or my employees with weges as their sola compensatlon, WILL DO THE WORK, and the siructure Is not intentletl or otteretl tor sale (Sec. 7044, Business antl Pmfessions Code: The Contrac�ors License Law dces noi apply to an owner of properry who builds or improves Ihereon, and who does such work himself or herseif or Ihrough his or her own employees, provided that such improvemenis are not intended or oflered for sale. If, howevar, the building or improvement is sold within one year ot completion, the owner-builder wiil have ihe burden of proving that he or she did not build or improve for purpose ot sela.). ' ❑ I, es owner of the pmperty, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslmct Ihe pmject (Sec. 7044, Business and Professions Code: The contractors License Lew tloes not apply to an owner of property who builtls or impmves ihereon, antl who coniracts tor such pro�ect with a contrector(s) license pursuant to the CONractors License Laws.). ❑ I am eaempt untler sec. SignaNre: Owner ID ventied by tlnver's license. ❑ Yes ❑ No Business and Protessions Code for this reason: Venficetion ot Ownarship by (rype of docurtrertt, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIpL SAFETY PERMIT CERTIFICATION: Dnver's Llcense No. Date: Eapires: ❑ I hereby certify Ihat no excavation five (5) or more feet in depth in�o which a person is raquired to descend, will 6e made in connection with work authorized by this permit, end that no builtling siructure, scaHoltling, felsework, or demolition or dismantlinq thereot, will be more than thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Administ�ative Code). � As owner-builtler, I will not employ anyone m tlo work which would require a permit trom the Division of Indusirial Safery, es noted above, unless such person has e permit to do such work from the division. SiqnaWre: Date: �ivision of Industnal Safpry permit Number: CERTIFlCATE OF COMPLIpNCE AND AUTHORVA710N OF EN7RV: I certity under penalry of perjury that I have reatl this application and state that the infortnation given is wrrect I agree �o comply with all state laws end city ortlinances relaling to builtling consWction, end authonze represenSatives ot the Ciry of Costa Mesa to enter upon the ebove-descri6ed property for inspection purposes. I agree not to acupy or ailow occupancy of any building authorized by Ihis permit until final inspection. ,y ignature f Legal �( G � COOE �. INSPECTIONTYPE 1676 1266 200 201 Aulhonzetl Fizetl System Final Fire Prevention Pool Spa Finel Finel Re-Rooi Flnel BIocWReteining Wall 202 Final Factory Fire Place 203 Finel Slgn 204 Finel Demolition QejE Jy7�� Q.Q€( INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site � � � 250 Final Building/Occupancy P9IE 1[i�l�k� (714) 754-5273 • Fau (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suile: Vicinity: REAR CORNER AT ROCK HARBOR CHURCH Parcel Number: 42708104 Zoning: Applicant: GACKI, JIM ISSUED BY: Address: 1322 BELL AVE . _ - - . SUITE 1-F - � - � Phone: "p14) 2583333 � - . Status: ISSUED Applied: 10/08/2004 Issued: 10/OS/2004 TUSTIN, CA - Zip: 92780 �- �- , Owner. SCH�FFMAN; TODD I TR ' � Address 9229N1-SUNSET�BLVDq602� .- . � � , �� , ', ��' _ Phone: _ � . ' ; .. ' ., � ,LOS ANGELES, CA . �- � � - �Zip: 900893406��-- � - . � ' \ / � . . � , , , . � --_: � , , , � ConVa tor.�' �'D & H BUILDING SYSTEMS INC '. � ��'�� Address: �1322 BELLAVE=- = - - � : � ' . - SUITE 1-Fi , Phone: (714) 2583333 � - � ' , TUSTIN; CA - � � , . � ' Zip: , 92780 �.', License: 747803 � � � ' , � Arch : ` " � " � Eng: I . Addre'ss: � � . , � ' Address: �- , - ', , � - �, . � . � : Phone: . .. .. . � � � Phone: Zip: . , ' � � � License: � �� " - License: ,. � � � � SCOPE OF PERMIT � ` � CONSTUCT 162 SF TRASH ENCLOSURE IN THE REAR CORNER OF "ROCK HARBOR CHURCH" ENCLOSURE TO BE CONSTRUCTED PER CITY STANDARDS. "' ,- - �,' � • � . , . � - . , _� ,' ' -, " ' . ' � ' . �, . REF: B04-00606 --� �- • � �- - - � — -> - • ` _ , , FEE SUMMARY .; " Plan Check: $81.41 ' _ �—� _ _ _ _ .'�, ` - ; �Calc Valuation: ; S5,zoo:oo� Permit: , $125.25 . , - � ,_ ' � P -- � � Claim Valuation: � , � Ss,2oo:00 SMIP Res: � $0.00 / � � � SMIP Com: ' �' $1.09 - _ ' `' , � • ;� , � Other.` �' $0.00 ' - � � t'� � � �Inspection: ` _ $0�.00 � - " ` - , . . . ' . r-/ ' ��` �� `�`� .�v�s;��". � �''� � , _ , �.'SotaL• � ',$207�75 ;s � ' • " . •� , � .s.n_ � - i. �� .,_�. '�� ` �� `�� " ` � PLANNING-& ZONING � � , SETBACKS � : � �� ` � � � � MAINSTRUCTURE-F.ront� 0 0 �Rear��0=0� _ � �Left �0-0 - RighC ��0-d', , � � � , , - . " � " `� , . - � _ ACCESSORY Front- �. 0- 0' �� Rear" 0- 0 Left 0- 0, � Right . 0- 0�. � ��..� �" .-.% _. .' .. '- �,. , � � PARKING existinq: - o Required: .0 , Proposed: 0,., �"�.' ' A.__ �,A ' ' . • - ,. ;�- NOTICE: The work authorized by this permit shall comply with a�l applicable handicap access requiremenis under Caiifomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not crommenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetiona and flnal approval must be obtained. Failure to obtain inspeclions and final approval will result in the expiralion of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 � zaaae(s�oo) � . /�"/ WORKERS' COMPENSATION DECLARATION: ' � - - I hereby aHirm under panalty ot perjury one oi tha tollowing declarations: � � ' . ❑ I have entl will malntain a certificate of consent to self-Insure for workers' compensetion, es providetl tor by section 3700 of ihe Labor Code, for the pertormance of ihe work for which thi5 permit is issuetl. • - � I have antl will malniain workers' wmpensation insurance, es required by sectlon 3700 of che Lebor Code, for the pertormance ot Ihe work for which Nis permit is issued. My workers' compensation Insurance carriar antl policy number ere: q�� Z�j,/ � Carfief: �� i' ��.U� Policy Number: �� X/�� / ,(This sectlon need nof be crompleted i/ the permit is velued et one huntlretl dollars ($f 00J or less.) _. . �_ _ ❑ I certify that in the performanCe of the work for which ihis pertnit is issued, I shall not employ any Derson in eny manner so a5 to become subject to the workers' compensation laws of Califomia, and egree that if I should become sublect to Ihe workers' compensation provisions oi Section 3700 ot ihe Labor Cotle, I shall forthwith complywlththes� on6s. '/ � / Applicant Signature: _ Y��iJf�i/ /� iC�� Date: • ��L�/4 y � WARNING FAILURE T ECURE WORKEFS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DO�LARE ($100,000), IN ADOITION TO THE COST OF WMPENSATION, DAMAGES AS PFOVIDEO FOR IN SECTION 3]O6 OF THE LABOR CADE, IPf�EREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am Ilcansed untle.J, provislons ot Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forca and ettect. Lic. a 4%�%¢103 Class A f? Con�ractofs SignaNre: . //•f�Y �� /%fL Date: /D d'O�/ CONSTAUCTON LENDING AGENCV: ❑ I hereby eHirm ihat there is a consiruction lending agency for the pedormance ot the work for which ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Nama: Lenders Address: SignaWre: OWNER-BUILDER DECLARATIONS: Date: I herehy attirm that under penalry ot perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professlons Code: Any ciry or county which raquires a permit to corewct eiter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicent for such pertnit to ille e signed statement Ihat he or she ISllcensed pursuant to the provislons oi the Contrectors License Law (Chepter 9(commencing with Section 7000) of Division 3 oi Ihe Business antl Professions Code) or that fie or sh�is exempt theretrom end the besis for the allegetl enemption. Any violatlon of Sectlon 7031.5 by any epplicant 1or a perm% subjects the applicant to a civil penelty of not more than five huntlred tlollars ($500).): ❑ I, as owner ot ihe property, or my employees with weges es their sole compensation, WILL DO 7HE WORK, and the siructure Is not intended or oflered tor sele (Sec. 7044, Business and Professions Code: The Contradors License Law dces not apply to an owner of property who builtls or improves thereon, and who does such work himself or hersetl or ihrough his or her own�employees, providetl that such improvemenis are not intendad or oflered lor sale. If, however, Ihe building or improvement is sold within one year of completion, iha ow�ier-builder wil� have ihe burden o� proving ihat he or she did noi build or impiove for purpose ot sele.). ' ❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions Cotla: The contractors License Law Ooes not eppty lo an owner oi property who builtls or improves Ihereon, and who contracts tor such project wlth e conirector(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt under sec. Business end Professions Code tor ihis reeson: Signature: Date: Owner ID verifietl by tlnvBYs license. ❑ Yes ❑ No Driver's License No. Verificetion oi Ownership by (type of document, i.e. - pmperty tax bili or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify Ihet no excavation five (5) or more feet in depth into which e person is required to descend, will be made in connection w%h work auihonzed by Ihis pertnit, en0 that no builtling strucwre, swffolding, falsework, or demolition or dismamling ihereot, will be more than thirty-sia (36) teat high. (Chap. 32, Grp 2, Art 2, Sec. 341, TiNe 8, Califomia Adminisirative Cotle). ❑ As owner-builder, 1 will not employ enyone to do work which would require e permit trom tha Division ol Intlusirial Safery, es noted ebove, unless such person hes e pertnit to tlo such work from the division. Signature: Date: Division of Intlusirial Sefery Permit Numbec CERTIFlCATE OF COMPLIANCE AND AIJTHOR17J1TON OF ENTHY: I certify under penalry oi perjury that I have read this application end state that ihe information given is correct I agree to comply with ell state laws end ciry ordinances rela�ing to builtling construction, and authonze representaiives of the Ciry of Casfe Mesa to enter upon ihe above-dascribad property for inspection puryoses. I agree not to acupy or allow occupancy ot eny building authorized by this permit until tinal inspection. COGE I, INSPECTIONTYPE , 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Finel Final Re-Root Finel Black/Reteining Well Final Factory Fire Place Final Sign Final Damoli�ion ' ' CODE� INSPELTIONTYPE , 206 Final Mechanical � 208 210 212 220 /o%'�D Y e � Date . Final Plumbing Final Electrical Finel Fire Prevention Final Planning Approval 222 Final Site . 250 Final Building/Occupancy ��ia� �sa-sz�a • Fax (714) 754-4856 • wv+w.c�.costa-mesa.cBUILDING PERMIT JobAddress: 345 FISCHERAV Suite: Vicinity: Parcel Number: 42708104 npplicant: WHITNEY, ROBERT Address: P015396 NEWPORTBEACH.CA Owner: SCHIFFMAN, TODD I TR Address 9229 W-SUNSET BLVD #602 , LOS ANGELES, CA Contractor: WHITNEY ROOFING Address: PO15396 � Arch : Address: NEWPORTBEACH,CA Zip: 92659 Phone: Zoning: Phone: (949)548-0769 Zip: 92659 Phone: Zip: 90069-3406 Phone: (949)548-0769 License: 406022 - Eng: Address: 77 FAIR DFiIVE, GOSTA MESA, GA 9262fi ISSUED BY: Status: ISSUED Applied: 03/22/2004 Issued: 03/22/2004 Phone: Zip: , License: � License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF, COVER WITH�BUILT-UP ROOFING. , ' FEE SUMMARY Plan Check: PermiL• SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 S790.75 - $7.06 $0.00 $0.00 $0.00 $797.81 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0-0 Re uired: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: S�o,sss.00 Claim Valuation: s�o,ass.00 Right 0- 0 Righl 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is euspended 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 wlth all applicable codes, and ell requlred Inepaetiona end flnel approvel must be obtained. Fallure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 2418�48 (8�W) WORKEflS' COMPENSATION DECLARATION: , I hereby atllrtn untler Denelry of per�ury one of the lollowlnq tleclaretlons: , ❑ I heve end will meintain e certificate ol consent lo seli-Insure br workers' compensetlon, es provided for 6y section 3700 ot the Lebor Cotle, for the performence oF Ihe work for which this permit Is issued. have and will maintain workers' compensation insurance, as required by sectlon 3700 of the Lebor Cotle, for ihe peAortnance ot ihe work for which Ihis pertnit Is issued. My workers' compensatlon Insurence carner and polity number ere: (Thls sectiar need no! be con ❑ I certity Ihet in Ihe peAo compensation lews of C comply with these pm ^: Applicant Signature: _ WARNING: FAILURE TO SECURE TH(%15AND OOLLARE (5100,000), Policy Numher: 00) orless.) � v}pt%tor which Ks Dermit is issued, I shell not employ any person In eny manner sq as to become subject to the workers' vy�ptae ihet If oultl become sub�ect to Ihe workers' compensation provisions�9ction 3700pf� e Lebor Code, I shall fonhwith �/ I2; .; �i Dete: � 6 � COMPENSATION COVEMOE IS UNLAWFU D SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED ITOTHECOSTOFCOMPENSAT10N,0 ESASPROVIOEOFORINSECTION3�O60FTHEUBORCODE,INTEREST,ANDATTORNEYSFEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am licensed under pravisic force and ettect Llc, a / Contrectofs SlgnaNre:� / with Section 7000) of Division 3 of Ihe Business end Prole ions Co e, end my license is in tull Class x � / _ � ! Dete: CONSTRUCTON LENOING AGENCY: � ❑ I hereby affirm that Ihere is e wnstruction lending agency for Ihe peAormance of �he work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lendefs Adtlress: Signelure: Date: OWNER-BUILDER DECLARATIONS: . I hereby aNirm the� untler penalry oi perjury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE �AW tor Ihe following reason (Sec. 7037.5, Business end Professions Code: My Gry or counry which requires e permit to consWcl, alter, improve, demolish, or repair any aWcture, prior to its issuance, also requires Ihe applicant for such pertnil to tile e signetl statement that he or she Is Ilcensed pursuant to the provlslons af t�e Cantrectors License Lew (Chapter 9(commendng with Sectlon 7000) of Dfvision 3 of the eusiness entl Protessions Code) or t�at he or spe Is exempt theretmm end Ihe besis tor the elleged axemption. Any violation of Sectlon 7037.5 by any applicant for e partnit subjects Ihe epplicent to e civil penalry oi nat more then five hundred dollere ($500)J: ❑ I, as owner of the property, or my employees with weges as their sole compensetion, WILL DO 7HE WORK, end the structure is not intended or affered tor sale (Sec. 7044, Business entl Profeuions Code: The Conlractors License Lew Cces not apDh �o an owner of property who builds or improves ihereon, and who does such work himself or herself or Ihrough �is or her own amployaes, pmvided that such impmvemenis ere not Intentletl ar oMered lar sale. If, however, tha building or impmvement Is sold within one year of completion, ihe owner-builder will heve the burden of Droving �hat he or she did not build or improve for puryose of saleJ. ' ❑ I, as owner of lhe D�aOerty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTOFS to construct the project (Sec. 7044, Business and Professions Code: The wntrectors lJcense Lew tloes not epply to an owner oi pmperry who Euilds or improves Ihereon, end w�o contrac�s tor such pmject with a contracror(s) license pursuant to the CONrectors License Lews.). ❑ I am exempt under sec. SignaWre: Owner ID venlied by drlvefs license. ❑ Yes ❑ No Business entl Prolessions Cade lor this reason: Verlticetion ol Ownership by (lype of document, I.e. - propeny tax �III or tleed): Driver's Licen9e No. Dafe: Expire5: DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTFICATION: ❑ I hereby certity thet no a:cavetlon flve (5) or more teel in tlep�h into which e person is required to descend, wlll be metle in connection with work authorizad by this pertnit, end thet no building structure, scaHoltlinp, falsework, or demolition or dismantling Ihereof, will be more than thirry-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Tltle B, Callbmla AOministretive Code). ❑ As awner-builder, I will not employ enyone ta do work whlch woultl require a permit from ihe Division of Indusiriel Safery, as noted ebove, unless such person hes e pertnit to da such work from the tlivision. . Signature: Dala: Division oi Industnal Sefary Permit Number: CERTIFlCAlE OF COMPLIANCE AND AUTTIORPA F ENTRV: I certity under penalry ot perjury thet I have read Ihis application and state Ihat the information given is wrrect. I egrea to comply vnih ell slete lews ' orainances r ting to 6uilding consWctlon, entl authonze reDresentatives of the Ciry of Costa Mesa to enter upon the ebove-descnbed property for inspection I egree qpt t upy or ellow accupanty ot any building authonzed by this permit until final inspection. CODE �. INSPECfIONTYPE ' Qa¢, �,�j 7616 Fixetl System Final Fire Prevention 1288 200 201 202 203 204 Pool Spa Final Finel R8-Roof Finel Block/Reteining Well Finel Factory Fire Plece Final Sign Finel Demolitlon COOEt INSVECiIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electdwl 212 Flnal Fire Prevention 220 Flnal Planning Approval 222 Final Site 250 Final Building/Occupency PAIE 11� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Viciniry: ROOF TOP OF ROCK HARBOR CHURCH Parcel Number: 42708104 Applicant JIM GACKI Address: Owner: Address Contractor: Address: Arch : Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 Zoning: ISSUED BY: SCHIFFMAN, TODD I TR . 9229 W SUNSET BLVD #602 "LOS ANGELES, CA- � - - D & H"BUILDING SYSTEMS INC 1322 BELL AVE� SUITE F , � TUSTIN, CA Phone: 714-258-3333 Zip: Phone: ' Zip: 90069-3406 Phone: (714) 25&3333 Zip: 92780 License: 747803 Phone: Eng: � Address: Slatus: ISSUED Applied: 04/16/2004 Issued: 04/20/2004 Phone: Zip: License: � License: SCOPE OF PERMIT. SCOPE OF WORK: 23 PLATFORM ON ROOF FOR�FUTURE MECHANICAL EQUIPMENT. �'� NO OTHER WORK AUTHORIZED WITH THIS ACTIVITY: �'- -.. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: .. � , Total: $163.31 $251.25 $0.00 $3.15 $0.00 $0.00 $417.71 SETBACKS .� MAIN STRUCTURE �Fmnt� ' 0- 0 ACCESSORY Front , 0- 0 PARKING Existin : 0 FEE SUMMARY _ . _ ___ - - - � Cslc Valuation: Claim Valuation: , :,'_ , ' . PLANNING & ZONING Rear � 0- 0� -� Lek 0- 0 Rear 0- 0 Left 0- 0' � Required: 0 , � Proposed: 0' � Right - 0- 0 " � Right � 0- 0 - sis,000.00 515,000.00 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92Q8, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period ot 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 Inapections end final approvel must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 2646C6 (8/00) WORKERS' COMPENSATION DECLARATION: � I hereby affirtn under penelry oF perjury one ol �ha following declarations: ❑ 1 heve antl wlll maintain a certificate of consent to selbinsure tor workers' compensation, es pmvidetl tor by section 3700 of ihe Labor Code, tor the peAormence of ihe work for which this pertnit is issued. _❑ I heve antl will maintaln workers' compensation insurance, as requirad by section 3700 of the Labor Code, for the pedormance ot ihe work for which this permit is Issued. �� My workers' com nsatlon Insurance carner end policy numbar ere: / �/ c� Cartier.. �7�� `Cl�%Q PolicyNumtier. �"i ''/3da�/ Z�/ I(Th/s secfion need nat be completed ll the permit is valued et ane hundred dollers ($700) or les>.) �- ❑ I certify that in tha pertortnence of ihe work for which thls pertnit is issued, I shall not employ any person in eny manner so as to 6ecome subject to the workers' compensetion laws of Celifomia, and egree tha[ it I should become sub�ect to the workers' compensetion provisions of Sectlon 3700 of the Lebor Cotle, I shall torthwlth complywiththes�e r �}ons. ',/ / �� .Applicant�Slgnature� �>�-`��G� /(� �/"� rDete:! ��0%y IWARNING��FAILURE T URE WOFKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPIOYER TO CRIMINAL PENALTIES AND qVIL FINES UP TOIXJE HUNDRED T}IOUSAND DOLLARE (5100,OW), IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDED f-0R IN SECTION �Ofi OF THE LABOR CODE, IPIrEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hY e,reby.aHirm that I am licensed under provisic foroe and eflecL Llc. # 0? � ... Conirac�or's SignaWre: oi Chapter 9(commencing wiM Section 7000) of Didsion 3 of ihe Businass and Professions Code, arC my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that thare is a construction lending agency tor the pedormance of the work for w�ich this pertnit is issued. (Sec. 3097, Civil Code). Lenders Name: ` Lender's Address: Signature: Date: OWNER-BUILDERDECLARATIONS: �� I hereby aHirm ihet under penalry oi perjury ihat I am EXEMPT FROM THE CONTi7ACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business end Professions Cotle: Any ciry or county w�ic� requires e parmit to Qenstruct, elter, improve, demolish, or repair any stmctura, prior to its issuance, also requires the applicent for such permit to file e signed stetement ihet he or she Is Iicensetl pursuant to the provisions of tha Contractors License Lew (Chepter 9(commencinq with Section 7000) oi Division 3 of the Business end Pmfessions Cotle) or Ihat ha or she is exempt therefrom end the basis for the elleged exemption. Any violetion oi Section 7031.5 by eny epplicant for a pertnit sublecis the applicent to a civil penelty of not more Ihen five hundred tlollars ($500).): ❑ I, as owner of ihe O�operty, or my employees with wages as thelr sole compensation, WILL DO TME WORK, and the structure is not intenaed or oNered tor sale (Sec. 7044, Business and Professions Code: The Contrac�ors License Law does not apply to en owner of property who builds or improves thereon, and who tloes such work himself or herself or through his or her own employees, provided that such improvements ara not Intended or oHered for sele. If, however, ihe building or improvement is sold within one year of complation, the owAer-builder will have iha burden of proving that he or she did not build or improve tor purpose of sale.). � ❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Profasslons Cotle: The contracrore Licanse Lew does not eppty m an owner oi propeny who builds or improves thereon, and who coniracis for such project with e coniracbr(s) license pursuant to ihe Contredors License Laws.). ❑ I am exempt untler sec. Business and Professions Code tor this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Dnver's License No. Expires: Verificetion oi Ownership 6y (type ol dxument, i.e. - properry ta�c blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no ezcavetion five (5) or more feet in depth into which a person is required to descend, wili be mede in connection with work euthonzed by Ihis permit, and that no building sirucNre, scallolding, falsework, or demolition or dismantling ihereot, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Ttle B, Calitornla Atlministrative Cotle). ❑ As owner-bullder, I wlll no� employ anyone to do work which woultl require e permit trom the Division of Indusirlal Satety, as noted above, unless such person has e permit to tlo such work irom the division. SignaNre: Date: Division oi Industrial Satery Permit Numbar: CEPTIFlCATE OF COMPLIANCE AND AUTHORRATiON OF ENTRY: I certity under penalry ot perjury t�at I have read this application and state that ihe infortnation given is correct I egree to comply with all stete lews end cily ordlnences reiating to building consimc�ion, antl euthonze representatives of the City of Costa Mesa to enter upon Ihe ebove-descnbed property tor inspection puryoses. I egree not to cecupy or allow occupancy ot eny building authorized by Ihis permit until finel inspection. COOE �. INSPECTION TYPE 1616 Fixed System Finel Fire Prevention 1286 Pool Spe Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition o"re � I�MiIRLS �� INSGECiIONT'PE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 2/2 Final Fire Prevention 220 Final Planning ApDroval 222 Final Site 250 Final Building/Occupancy 2Ag 1[�ALB (714) 754-5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.�19 P FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 345 FISCHER AV Suite: Vicinily: ROCK HARBOR CHURCH Parcel Number: 42708104 Applicant: GACKI, JIM Address: Owner: SCHIFFMAN, TODD I TR Address 9229 W SUNSET BLVD #602 LOS ANGELES, CA Zoning: Phone: 714-2583333 Zip: Phone: Zip: 90069-3406 Coniractor: , D 8 H BUILDING SYSTEMS INC Address: 1322 BELL AVE SUITE 1-F Phone: (714) 25&3333 TUSTIN, CA Zip: 92780 License: 747803 Arcn : TONY MASSARO Address: 3100 AIRWAY AV C.M, CA SUITE 114 Zip: 92626 Status: ISSUED Applied: O6/07/2004 Issued: 06/08/2004 ISSUED BV: Eng: NELSON CONSULTING ENGINEERS - Address: WILIIAM M NELSON Phone: 714-556-8299 - IRVWE,'CA Phone: 949-752-2070 17815 SKY PARK CI STE G License: C24376 92614 License: SE3417 INSTALLATION OF 15 (48" X 96") BRISTOLITE SKYLIGHTS (MODEL #489f SEISMIC RETROFIT AND OFFICE IMPROVEMENTS FOR ROCK HARBOR REF: 804-00081 Plan Check: Permit SMIP Res: SMIP Com: Other: Inspection: $99.61 $15325 $0.00 31.60 $0.00 $0.00 Total: $254.46 SETBACKS MAIN STRUCTURE Front ACCESSORY Fronl 0- 0 Rear 0- 0 0- 0 Rear 0- 0 PARKING Existinq: 0 Reauired: 0 FEE SUMMARY IN CONJUNCTION WITH THE PREVIOUSLY PERMITTED . ICBO #ER-2469 Calc Valuation: s�,soo.00 Claim Valuation: S�,soo.00 PLANNING & ZONING Left 0- 0 Right Left 0- 0 Right Proposed: 0 0- 0 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetiona 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 2d46d6I�) WORKERS'COMVENSAnON DECLARATON: I hareby aHirm under penalry of perjury one ot the following declaratlons: ❑ I heve end wlll malntain e certiticate of conseN to self-Insure for workers' compensation, es Orovided for �y section 3700 ot the Labor Code, for the pertortnance ol Ihe w for whlch Ihis permit is issued. heve end will maintain workers' compansation insurance, es requlretl by section 3700 of Ihe Lebor Code, for ihe peRortnance o} the work for whlch ihis pertnit is issued. My workers' cyomp nsatlon Insurance carner and policy number ere: Carrier, e5 /�� Guii�%� Pplicy Num6er: �%��y'��Y (Th/s sec0on neetl not�comp/eteO i/ the permit !s velued et one hundred dollars ($100) o! less.), ❑ I cenily thet in the pedormance of the work tor w�ich this pertnit is issued, I shall not employ any person In eny manner so as to become subject to ihe workers' compensatlon laws ot Califomia, end egree Ihet II I should 6ecome sublect to Ihe workers' compensatlon provisions of Sectlor�3700 W Ihe Lebor Catle, I shall forthwit� com 1 with these o - iyJ / �"�'/y�,� /� �I Applicent S Anature: f� �Ii��./� �� ib`fCG�^'� � Dete: l p f WFRNINO: FAI�URE TO RE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHP11 SUBIECT PN EMPLOVER TO CRIMINAL PE TIE�D dVIL NES UP TOONE MUNDRED T/qUSAND OOLLAFE (5100,000). IN FDDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SELTION �OB OF THE LABOR CODE, INiEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS UECLARATON: I hereby aflirm ihat I am force end eHect. Llc. a_ Conlractor'S SigneWre: ot Chapter 9(commencing with Seclion 7000) ot Division 3 oi ihe Business entl Professions Code, anA my license is in full Class a . � _ . CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm �hat there is e construclion lending egency for the pedormance ot Ihe work tor which ihis permi� is issued. (Sec. 3097, Civil Cotle). Lentlefs Neme: Lender's Atltlress: Signature: ' �� OWNER-BUILDER DECLARA710NS: Date: I hereby attirtn that under penalry of perjury that I erp EXEMPT FROM THE CONTRAC70RS LICENSE LAW lor the following reason (Sec. 7037.5, Business end Professions Cotle: Any ciry or counry which repuires a permit to construc6 alter, improve, tlemolish, or repeir eny strucNra, prior to its issuance, elso requires ihe epplicaN for such pertnit to lile e signed slatement thet he or she Is licensetl pursuant ta the proNsions of ihe Coniractors License Lew (Chapter 8(commendng with Section 7000) ol Division 3 ot ihe Business antl Prolessions Cade) or thet he or she is e:empt Iheretrom end the basis for ihe elleged exemption. Any Wolation ot Section 7031.5 by any epplicent for e pertnit sub�ects the applicant to a Uvil penalry of not more than five hundred dollere ($500).): ❑ I, as owner ot ihe properry, or my employees with weges es Iheir sole compensation, WILL DO 7HE WORK, and Ihe structure is not intendetl or otteretl tor sale (Sec. 7044, Business and Professions Code: TIA Contractors License Lew does noi apply to en owner of property who bulltls or improves thereon, end who does such work himself or hersetl or ihrough his ar her own employees, providad Ihat such imprwements ere not intendeA or oNered br sale. If, hov.•ever, Ihe building or improvement is sold wlihin one year oi completion, the owner-builder will have the burden of proving ihat he or she did not build or impmve tor purpose of sale.). ❑ I, es owner ot ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct Ihe project (SecJ044, Business antl Pmfession5 Code: The contradars License Law tloes not apply to en owner ot propeny w�o bulltls or Improves thereon, and who contracts lor such pmject with a conirectoqs) licanse pursuent to the Coniractors License Laws.). ❑ I em ezempt under sec. Business antl Pmfessions Code tor this reason: Slgna�ure: Data: Owner ID veritie0 by tlnver's license. ❑ Yes ❑ No Dnvers License No. Vanfication of Ownership by (type oi document, i.e. - property tax blll or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby cenify that no excavation tive (5) or more Ieel In tlep�h into w�ich a person is requiretl lo tlescend, will be made In connection with wark euthorize0 by this permil, and that no building siructure, scaHoltling, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) fee� high. (C�ap. 32, Grp 2, Atl 2, Sec. 341, Title 8, Celifomia Adminisiretive Cotle). ❑ As ownar-builder, I will not employ anyone to tlo work which woultl require e permit fram the Dlvision of Indusinal Sefety, as notetl aDove, unless such person hes e permit to tlo such work trom Ihe division. Signatura: Date: Division oi Indusinal Selery Permit Num6er: CERTFlCA7E OF COMPLJANCE AND AU7HORVATION OF EMRY: I cenily under penalry ol perjury that I have read this application end stete thet the inlortnation given is correct. I a8ree to comply with all state laws entl ciry ortlinances relafing to building consiruction, entl euthodze representatives of the Ciry ot Cosia Mesa to enter upon the ebova-descnbetl property tor inspection purposes. I agree nol to occupy or allow occupancy of eny building authorized by this permit until finel inspection. COUE I. INSPEGTIONTYPE 1676 Fizetl System Final Fire Prevention 1266 Pool Spa Pinel 200 Final Re-Rool 201 Finel BIocWRetaining Wall 202 Finel Factory Fire Place 203 Final Sign 204 Finel Demolition Qd¢, INiIiIRLS �QQEa INSPECTIONTYPE 206 Finel Mechenicel 208 Final Plumbing 210 Final Elecirical 212 Finel Fire Pravention 220 Final Planning Approval 222 Final Site 250 Final BulldingiOccupancy Q9IF I�LS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT JobAddress: 345 FISCHERAV Suite: . Vicinity: ROCK HARBOR CHURCH Parcel Number: 42708104 Zoning: Stalus: ISSUED Applied: 07/08/2004 Issued: OS/O6/2004 ISSUED BY: Applicant: PARZ, JAYMEE � � � i-� � Address: 10692 STANFORD AV �= � � . . . - , � ' _ _ SUITE B � � . � - Phone: 714-260-0701� � �_ GARDEN GROVE;.CA��, - Zip: � � 92840 : , , . " � " ' Owner.-�CHIFFM9N; TODD I,:TR�: � -- � � � ' � � ` � � � �. . . � _ � � �: - ^ � , \ Address°;' 9229 W SUNSET BLVD #602 � � : - '� �� `�� ' i � � ;A �, _ r . ' -� . , �.� . . Phone: � � , , i � � � LOS ANGECES;.QA� ZIp: 90069-3406 - � � � i ., �. �Contiactor: . ACTION FIRE PROTECTION � � ��Address: 10692 STANFORD AV � � � � � � ` �� SUITE B ' Phone: 714-260-0101 � . - . � , � . , ' � � �. � - _ . GARDEN GROVE, CA �•� �2ip: � - 92840� � � , . . . ' � ` , � ' ; �� . . ��License: 663648�� . . � - , . - �, i �' - ' SCOPE OF PERMIT � • � � � ' �� FIRE-SPRINKLERS FOR TENANT IMPROVEMENT. "ROCK HARBOR CHURCH". i1 � � ' � � � � �- �FEE SUMMARY �" � . - � Plan Check: �. $108.71 � ' - _. _ ; � , _ Calc Valuation: - . Ss,000.00 �Permit: $167.25 �� Claimed Valuation: Ss,000.00 `� � Other: � $0.00 �� ' `� \ - "__ �_ I, . .A. :...y - i, . �' ' , � ��Total:� �5275:96 ,��<' � . i'' , _ �:_, t,. c i . , i!' . �,�t��, t.. ^�' �/ r% '. � �i bz� ��6.Q...a ��/aefov � , � �. ii ° ; :, ��, �� ,�1� �,��t�� ,t^1+..��J1�-�4�r r.ti�tF3 � ij�� i�' � \\\�� (..� � �C �`.nrl� � ��li1C:t^' ��)O�'�� L�• ' ' % �/ � , � , � �\ �_: �� , � � _ ` � : _ - -��,� � , i �;, i '� . �.. -.y �i �j �;' l -. ' � .. - �%, -� , _ _ ., . . � � ,%�:j'-�, � _ ,.;�"-�- - ,z-'�c_ - � - " . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authonzed under Ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions end tinal approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446d6Ifi/00) J j .� WORKERS'COMPENSAnON DECLARAnON: � - I �ereby eXirtn untler penalry of perjury one of the lollowing daGeretions: ❑ 1 heve and will malntein a ceNficete oi consent to setl-Insure for workers' compensation, es provided for by seclion 3700 ot ihe LeUor Code, tor the pertormance of ihe �Work for whlCh IhiS permit is luuetl. I'have antl wlll maintein workers' compensetion insurance, es requlred by sectlon 3700 of Ne Labor Cotle, for Ne pertortnance ot Ihe wark for which Nis pertnit Ls Issued. . My workero' nsatlo Insurflnce certier and policy number ere: //� �/�// Cerrier. ��/1 A� Poliry Numher: �� K-(l0� -{i7S!/`7 (This section need not e cromplefed 1! the permit /s veluetl et are hundred dollers ($f 00) oNess.) ❑ I cently thal in the peAortnence at Ihe work lor whic� ihis pertnit Is issued, I shall not emD�%' any person in any manner so es to become subject to the workers' compensatlon laws of alifomla, A�egr e Ihet If I should becoma sub�ect to the workers' compensation provisions of ctlon 700 ai ihe Lebor CoAe, I shell torthwilh comply with these r sions. �� /� Applicent Signeture: � Date: - �� WARNINO:FAILURETO CU WORKERSCA E@ 9Tl� NppVEMOEISUNLAWFULANDSHALLSUBJECTANEMPLOVERTOCRI INA�P NAL IESANDCNILFlNPSUPTOONEHUNDRED T)qUSANDDOLLAR 100,OW),INADDITIOt THE�OSTOFCOMPENSATION,DAA4IGESASPROVIDEDFOHINSECilON3]O60FTHELABORCOOE,IPREREST,ANDATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm thet I em force end eNact..Lic. a._ Camractors SigneWre: of Chapter 9(commencing wilh Section 7000) of Division 3 ot tha Class e Dete: Code, and my license Is in full CONSTRUCTION LENDING AGENCY: ❑ I here6y aMirm t�at there Is e conslruction lending agency far ihe peAormence of the work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lendels Neme: SlgnaNre: _ Lender's Address: Dare: OWNER•BUILDER DECLARA710NS: ' j� I hereby eflirtn �hel under penelry ot perjury tha�`I em E%EMPT FROM 7HE CONTRACTOHS LICENSE LAW for the tollowing reason (Sec. 7031.5, eusineu end Pratesslons Coda: Any ciry or counry which requlres'a p�it to construct, elter, Improve, demolish, or repair any structure, pnor lo Its issuance, also requires the epplicant tor such permit to flla a signea statement thet he or she is II nsetl pursuent to the proNsions at the Conirectors Llcense Law (Chapier 9(commenUng with Sectlon 7000) 01 DlWsion 3 01 t�e Busineu entl Professions Cotle) or that he or she Is exempt Iherefrom and Ihe basis for Ihe alleged evemption. Any violation of Sedion 7031.5 Dy any eppllcant for e pertnit subjects the epplicent to e civil penalry of nqt more then five hundred dollars ($500).): ❑ I, es ownar ol ihe property, or my employees wli� wages es their sole campensetion, WILL DO 7HE WORK, antl Ihe structure Is no� IniendeG or oflered tor sele (Sec. 7044, Business anA Professians Code: The Contractors License Lew does not appty to an owner of property who builds or improves ihereon, antl w�o tloes such work himself or herselt or thmugh his or her own employees, provided Ihat such improvements ere not intentled or otteretl for sale. If, however, the building or improvement is sold within one yeer ot completion, �he owner-builtler will have Ihe burden of proving thal he or she did not build or improve tor purpose of sele.). ' ❑ I, as owner ot the property, em E%CLUSIVELV CONTRACTNG W17H LICENSED CONTRAGTORS to construct the project (Sec. 7044, Busineu entl Professions Catle: The contreciore License Lew tloes not epply to en owner ot propeny who builds or Improves thereon, entl who conirects for such pmject with e contractor(s) license Oureuent to Ihe Contrectors License Lews.). ❑ I em exempt under sec. Business antl Pmfessians Coda tor Ihis reason: Signature: Oata: Owner ID venfed by tlrivefs license. ❑ Yes ❑ No Drivers Ucensa No. Vedticatlon of Ownership by (type ol tlocumam, i.e. - property tea bill or tleeA): Eupires: DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certify that no excavatlon flve (5) or more feet In tlepth into which e person is required to descend, will be made In connectlon with work authaAzad by thls permiL and Ihat no building structure, scattolding, talsework, or demolition or dismantling �hereof, will be more ihan �hirty-six (36) feet hlgh. (C�ep. 32, Grp 2, Ah 2, Sec. 341, Title 8, Califomle Administrative Cotle). ❑ As owner-huilder, I will not employ enyone to tlo work which would require e permil from the Division ol Industrlal Safety, es notetl ebove, unless such pereon hes e , pertnit to tlo such work Irom the tlivision. SignaNre: Date: Division ol Industrial Salery Permit Number: CEH7IFlCATE OF COMPLIANCE AND AUTHORVATON OF EMAV: I cenity under penalty of perjury ihat I have reatl t�is application and state that the informetlon given is correct I egree to comply with ell state laws end ciry orClnances relating to builtling consiruction, and euthoAze representatives ot Ihe Clty ot Casta Mesa to enter upon the ebovadescribed propeny for inspection puryoses. I egree not to occupy or etlow occupancy ol eny building authonzed 6y this pertnil untii (inel inspection. COOE t. INSiECTIONTYPE 1616 Fixed System Final Fire Preventlon 1266 Pool Spe Final 200 Finel Re-Roo� 201 Flnal BIocWRetaining Well 202 Finel Factory Fire Place 203 Flnal Slgn 204 Final Demolitlon f•7-�i� �� SODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eleddcal 212 Final Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Final BuIltling/Occupancy PdIF II�EL4 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 345 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708104 Applicant: JIM GACKI Address: 1322 BELL AVE � � SUITE�F"; . � - TUSTIN; CA � / . Owner. ' SCHIFFMAN; TODD I TR Address '9229 W SUNSET BLVD #602 � � . .' - , LOS ANGELES, CA PLUMBING PERMIT Phone: (714) 2583333 Zip: 92780 Phone: Zip: 9006&3406 Contractor: D& H BUILDING SYSTEMS INC . Address: 1322 BELL AVE � � � SUITE F � Phone: (714) 258-3333 TUSTIN, CA Zip: 92780 ' � License: 747803 Arch / Eng : - Address: � Phane: ZIP License: �- - Status: ISSUED Applied: 04/29/2004 Issued: 04/29/2004 ISSUED BY: � SCOPE OF PERMIT ` INTERIOR TENANT IMPROVEMENT. WORK TO INCLUDE: DEMOLISH EXISTING 5,200 S.F. OF ._ OFFICES AND REBUILD 5,600 S.F. OF NEW OFF.ICE SPACE. ADD ADDITIONAL OPENINC�S IN EXTERIOR WALLS AT WAREHOUSE AREA.�NEW SEISMIC RETROFIT OF 34176 SF STRUCTURE. ADD � 247 SF BLDG AREA AT FRONT. REF.: 804-00081 , � , , � � NO ADDITIONAL PLUMBWG FIXTURES, RELOCATION ONLY. � - � � PLUMBING TO INCLUDE: 1 FLOOR SINK, 1 URINAL, 4 WASH BASINS, 1 WASTE 8 VENT SYSTEM, 5, WATER CLOSETS, 1 WATER HEATER AND,1 WATER PIPING. . � � '� . - ,. _ _ . , , , - ' ' '. � . , ISSUE FEE Backflow ircigation Backflow Preventer BathNb Clarifier System Connect (Ice,Soda,etc) � AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 Qrv 0 0 ' o '' 0 0 AMT -,QTY Laundry Tub / Washer � � $0.00 0 Landscape Irrigation $0.00 0 P-Trap � . $0.00 0 Pressure Regulator $0.00 0 Procegs Piping (per 10 k) - $0.00 � .0 Receptors $0.00 0 � - �- � / SumpPump Swimming Pool �� Trap Primer � Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) AMT $0.00 $0.00 30.00 $9.80 $0.00 $0.00 QTY 0 0 0 1 0 ' 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) E%PIRA710N: This permit shall automatically expire and become void it work is not commenced within 100 days, or it work is suspended or abandoned for a period of 180 days. ,- INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable code d all required Inspettions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiratloc(,6Lthis permit. FOR INSPECTIONS CALL: (714) 7545626 26a6d8 (N00) WORKERS'COMPENSAnON DECLARAnON: I hereby aHirtn under penelry oi per�ury one of the lollowing declare�ions: . ❑ I have and will maintein e ceniticete of consgnt m seH-Insure tor workers' compensetion, es provided for by sectlon 3700 of the Lebor Cotle, tor the peAormance of the work tor which t�is pertnii is Issued. �-� I have and will mflintain workers' compensatl0n insurflnce, es requlretl by sectlon 3700 oi Ne Lehor Code, for the pedortnance of the work for which this pertnit is Issuetl. LMy workers' compensatlon Insurance certier end policy number ere: POIIcy Number. �%�J ��%—'2�`�'� 7 oNess.J - ' . ❑ I certily that in the peAortnance ol the work 1or whic� this pertnll Is luued, I shall not employ eny person in any manner so as to become sublect to the workers' compensetion lews ot Cellfomia, end egree Ihat it I s�auld Eecome sub�ect to the workers' compensetlon provisions of Sectlon 3700 oi the LeDor GOOe, I shell lorihwith comply�wit�.l�e rovision5. ;�P�� s_ �g�e��re: � '��.�o ,z' .,I-��' ��a �1/2 �-/n s� WARNING: FAILURE CURE WORKERS' CAMPEN$pTIqJ COVERA�E IS UNUWFUL rWD SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PE TIES AND GVIL flNES UP TOONE HUNDqED TqUSAN� DOLURE (5100.000), IN ADDITION TO THE CpST OF COMPENSATION, DAN.4GES AS PHOVIDED FOR IN SECTION 3IOB OF THE LABOR �OE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: ot Chapter 9(commencing with Seciion 7000) of Division 3 af the Business and Professions Code, antl my license Is in tull end eflect. Lic. CONSTRUCTON LENDING AGENCY: ❑ I hereby aftirtn t�al Ihere is a construction lentling agency tor the peAortnance of Ihe woAc for which this permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lentlers Address: Signature: Dete: OWNER-BUILOER DECLARATIONS: I hereby aHirtn that under penelry ot perjury thet I em E%EMVT FROM TME CONTRAC70RS LICENSE LAW for Ihe following raason (Sec. 7031.5, Busineu end Professions Cotle: Any ciry or counry which requVes e permit to conslrucL elter, impmve, demolish, or repair any slrucNre, prior to Its issuance, alsa requires the eppliwnt tor such pertnit to file a Slgnetl statement Ihat he or she is licensetl pursuant to Ihe proNsions ol the Contredore License Lew (Cheptar 9(commencing with Secllon 7000) of DlWsion 3 ot ihe Business end Professions Code) or t�at he ar shp �xempt theretrom end the besis for the elleged exemptlon. Any dWetion of Sectlon 7031.5 by eny applicent for e pertnit subJects the appliwnt to e civil penalry of not morg than five hundred dollers ($500).): ❑ I, as owner of the properry, or my employee5 with wagas es Iheir sole compensation, WILL DO THE WORK, and ihe sWcture is not Intentled or oflered for sale (Sec, 7044, Buslneu end Professions Gode: 7Te Con�rectars License Lew tloes not apply to en owner of property who builtls or improves thereon, and who does such work himself or herself or through his or her own employees, pravidatl that such imD�ovemenis ere not intended or oHered for sale. If, hov.ever, t�e building or Improvement is soltl wit�in one year of wmpletion, the o�iher-builder will heve the burden ol proving that �e or sha did not build ar imprave tor purposa ot sale.). � ❑ I, as owner of lhe property, em E%CWSN��Y CONTflACTNG WITH LICENSED COMRACTORS lo con5trud Ihe projecl (SeC. 7044, Business antl Pmfession5 Code: 7he wntractors License Lew tloes"not apply to en owner of propeny wha builds or Improves Ihereon, end who comracts br such pro�ect wlth e contrector(s) licensa pursuant to the Contractors License Lews.). ❑ I am exempt under sea T Business and Professions Cotle for this reason: Signature: Date: Owner ID verified by dnver's Ilcense. ❑ Ves ❑ No Drivefs License No. E:Dfres: Venlication of Ownership by (rype oi documem, i.o. - property t� bill or daed): DIVISION OF INDUS7RIAL SAFETY PERMIT CEpTFICATION: � ❑ I hereby ceriify that no excevation five (5) or more fee� in depih Into which e persan is requirad to descend, will ba made in cannection with work euthodzed by this permit, and that no building structure, scaflqlding, telsework, or demoli�lon or dismantlinp thereot, will be more Ihen Ihirry-six (36) feet hlgh. (Chap. 3.2, Grp 2, Art 2, Sec. 347, T�le 8, Calltomia Adminisirative Cotle), ❑ As owner-buildar, I will not employ enyone to do work whic� woulU requira e permit from tha Division ol Industrlal Safety, as noted ebove, unless such person has e pertnit to do such work tmm ihe division. Signature: Date: Divislon oi Intlustnal Safety Permit Number. CERTIFlCATE OP COMPLIANCE AND AUTNORIZq710N OF ENTRV: I certify under penalry of per�ury iha� I �ave read this eppliwtion enC state t�at the intortnetion given is correct. I egree to comply with all slete lews entl city ordinences relating to bulltling consWction, end authorize representatives ot tha City oi Coste Mesa ta enter upan the ebove-described property for inspection purposes. I agree not to acupy or ailow occu0ancy of eny building authorized by this permit until finel inspection. 400E t. INSPECTION TYYE 7616 Fixed System Final Fire Preventlon 1266 200 201 202 203 Pool Spa Flnal Final Re-Root Final BIocWRetaining Well Final Factory Fira Place Finel Siqn 204 Final Demolition rd AppllcanL � pAIF. I[R�4,4 CODE� �xsrernoNTvve 206 Final Mechanicel 20B Final Plumbing 210 Finel ElecMcal 212 Finel Fire Praventian 220 Final Planning Approval 222 Final Site 250 Finel Building/Oaupency QdIE I[�LS • Y C. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAlfi DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp 345 FISCHER AV ROCK HARBOR CHURCH 42708104 HANSON,JOEY 3064 E MIRALOMA, AV ANAHEIM,CA SCHIFFMAN, TODD I TR 9229 W SUNSET BLVD q602 LOS ANGELES, CA CORTEAL, RICHARD ELECTRICAL PERMIT Phone: 714-630-8700 Zip: 92806 Phone: Zip: 90069-3406 Phone: Zip: License: 511697 ISSUED BY: Status: ISSUED Applied: O6/17/2004 Issued: O6/17/2004 SCOPE OF PERMIT INTERIOR TENANT IMPROVEMENT. WORK TO INCLUDE: DEMOLISH EXISTING 5,200 S.F. OF OFFICES AND REBUILD 5,600 S.F. OF NEW OFFICE SPACE. ADD ADDITIONAL OPENINGS IN EXTERIOR WALIS AT WAREHOUSE AREA. NEW SEISMIC RETROFIT OF 34176 SF STRUCTURE. 104 LIGHT FIXTURES, 41 OUTLETS, 30 SWITCHES, 2 SUB PANELS TO 200A, 1 TR4NSFORMER UP TO 50 KVA/KW � REF: 804-00081 . - . � , _ . _ �� $23.50 $0.00 50.00 so.00 50.00 $0.00 $83.32 $37.33 $29.30 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 104 41 30 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting . �� Busway/100ft - ' Standing Section MisC Electrical Equipment Transformers up to 1 �kva/kw ................up to 10 kva/kw � .................up to 50 kva/kw .................up to 100 kva/kw ...............:..over 100 kva/kw tow Voltage Equipment Low Volt Winng System / Ckt Misa Conduil Misc. Conductor Circus ( gen or ride) Circus (mech ritle or IighGs) Christmas Tree Stand � Fireworks Stand Other ElecMcal Fee Quantity $0.00 0 $0.00 0 $0.00 0 , so.00 0 $0.00 0 + $0.00 0 $24.60 1 $0.00 0 ' $0.00' 0 $0.00 0 �. $0.00 0 $0.00 0 $0.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 9248, § 7, 1241-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced wlthin 180 days, or ii work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized undar ihis permit to be considered legal, such work must comply with all applicable codes, antl all required Inepectione and fl�al approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 / 2d48�d8I8�00) WORKERS'COMPENSAnON DECLAHATON: I hereby aXirtn under penalry of perjury one of Ihe followinq declaratlons: ❑ 1 �eve entl will maintain a cenificete at consent to selt-Insure tor warkers' compensetian, es pravideA for by sectlon 3700 0l Iha Lebor Cotle, lor 1he pertortnence of the work far whiCh Ihis permi� is issuetl. � I have eritl wlll meintain workers' oompensatlon Inwrance, as require0 Dy secUon 3700 ot the Lebor Cade, tor the peAortnance oi Ne woAc for wh�h Nis peimit ls IssueA. My workers' wmpensation Insurance cerrier and policy number ere: caraec 7..��ch Av�ner�csw; �S. Gcx�nGtw.w POIIcyNumber. le)GZ6%%Z—yOO (Thls section need naf be completed i/ the pe�mit !s velued et one undred Ilers ($100) or /ess.) ❑ I cenity Ihet in Iha pertortnance of Ue work lor which this pertnit is issued, I shell not employ any person In eny manner so es to Decome sub�ect to che workers' compensetion laws of Calilomia, end egree that it I shoultl become sublect to the workers' compensatlon pravislons of Sectlon 3700 of Iha Lebor Catle, I shell fort�with comply with Ihese pr visio%s. ApplicentSigneWre: oln�.�1� Date: �'—�i—O�'} WARNINO: FAIW R TO CURE WORKERS' �MPENSFTION COVER4GE IS UNL4W Rll. AND SHALL SUBIECi AN EMPLOYER TO CRIMINAL PENnLT1ES AND CML FlNES UP TOONE HUNORED TIIOUSANDOOLLA 100,000),INADDfTIONTOTMEC06TOFWMPEN5AT10N,DM14GESASPROVIDEDFORINSECf10N31080FTHElABORCOOE.IMEREST,ANUAiTOHNEY5FEE5. LICENSED CONTRACTORS DECLARATON: I hereby eHirm that I em Ilcensatl under provisions ot Ghepter 9(commendng wlih Secllon 7000) at DlWsion 3 of Ihe Business enC Protessions Code, entl my license is in tull torce end ettec�. uc. a S 11�9 Gass a Gl0 !i �G Contreciofs5igneture� .�.'�o-..- - .s� Date:_ /i—li—�y CONS7RUCTION LENDING AGENCV: ❑ I hereby eflirtn th5t there is e construction Ientlinp egency Por the pedortnance of the work tor which ihis permit Is Issued. (Sec. 3097, CMI CoOe). LenEe/s Neme: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aNlfm t�at untler penalry af pe�ury thai l em E%EMP7 FROM THE CON7RACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business en0 Protessions Code: My ciry or counry which requires a peiinit to construd, alter, imprwe, tlemdish, or repalr any strucWra, pdor to Its issuence, elso reqWres the apDlicant br such petmit to file e signed statement that he or sha is licensetl pursuam to the provisions ol the CoNractors lJcense Lew (Chepter 9(commencing with Sectlon 7000) ot Dlvision 3 oi the Business end Professions Code) or thet he or she is exem0� �erefrom anC the besis for lhe elleped e:emptlon. Any violatlan af Secilon 7031.5 by eny applicant tor e pertnit suh�ects the epplicant to e chdl penalry ot not more than Me huneretl tlalars (ESW).): ❑ I, es owner of ihe properry, or my empbyees with wages as their sde compensetion, WILL DO THE WORK, antl Ihe structure Is not intendetl or aNeretl lor sale (Sec. 7044, Businass and Professions Goda: The Coniractore LJcense Law tloes noI epply to en owner of property who huilds or improves thareon, end who does such work hlmselt or herself or throuqh his or her own employees, prwided that such Impmvemenis ere not Intended or oflered tor sale. If, however, the Wilding or improvement is sold within one year o1 wmpletion, iha owner-builder will have the burden ol proving thet he or she did not build or Improve for DurpaSe ot sale.�. � ❑ I. as owner oi ihe property, am E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the proJect (Sec. 70d4, Business and Pmfessions Code: The contractors License Lew tloes not apply to an ownar ol property who Ouilds or improves t�ereon, end who conlrects ior such pro�ect wilh a contractor(5) license pursuant �o the Contractors License Laws.�. ❑ I em exempt unAer sec. Business entl Professions Catle for this reeson: Signature: �ate: Owner ID venfied by drivefs license. Yes ❑ No Drivels License No. Expires: Verlfice�lon oi Ownership by (rype ol docurtrent, I.e. - D�operty te�c bill or Ceed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: ❑ I hereby cenity ihat no exwvation frve (5) or more feet in depih inlo which e person is required to descend, will be mede In wnnec�lon with work euthorized by Ihis pertnit, end that no buliding siructure, scaHolding, lalsework, or demolition or tlismantling Ihereol, wlll bo more Ihen thirty�sis (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Tltle 8, Celltomia Administrative Goda). ❑ As awnarbuilder, I wlll not employ enyone to do work which would require a pertnit Irom the Divislon of IndusMel Sefety, es noted ebove, unless such person hes e permit ta do such wark tmm the divislon. Slgneture: Dete: Division of Intlustrial Salery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJTHOROA710N OF ENiHY: I ceNfy untler penalry ot perjury that I hava reatl Ihls epplication antl state ihat ihe infortneUon given is correct. I agree to wmpty with all slate laws end dry ordinances relating to building constructlon, entl authorize represenietives at tha Clry of Costa Mese to enter upon ihe above-described properry tor inspeciion purpases. I agree not ro occupy or ellow occupancy ot eny �uiltling euthonzed by this pertnit until linel inspectlon. / �� ignature Of Legal Owner(s) � k And/Or Aul�Orizetl Appllcanl CODE I, INSYECTIONTYVE Qd¢, Q�$ 1618 Fixed System Final Fira Pteven�on 1268 Pool Spe Finel 200 Finel Re-Rooi 201 Flnel BIocWRetelning Well 202 Flnal Factory Fire Place 203 Final Sign 20d Final Demolitlon CO�E I INSPECTION TYVE 206 Flnal Mechenlcal 20B Flnal Plumbing 210 Final Elettdcel 212 Final Flre Prevenlion 220 222 250 Flnal Planning Approval Final Slte Final Building/OCcupancy Date G-i�-o'1 Date �.1 .1111.: . / i �. � � �� (7t4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DFIVE, COSTA MESA, CA 92626 FIRE SUPRESSION PERMIT Job Address: 34S FISCHER AV Suite: Viciniry: Status�. ISSUED Applied: 04/22/2004 Issued: 05/17/2004 Parcel Number: 42708104 Zoning: ISSUED BV: Applicant CRAIG KNOX , • Address: 821 N GLENHAVEN AV � � , _ , ; � Phone: (714) 73&6242 , � � , - FULLERTON, CA � � ', � Zip: 92832 . , � � . . Owner: % SCHIFFMAN, TODD I TR � _ � _- , � ` Address ��,9229 W SUNSET BCVD #602- � � - ^ � , � , � ' � " Phone: � �, �, . _ � , � , . � V " � � ` � . , �LOS ANGELES; CA- � Zip: 900693408 -� = � - -� �. , , . , i. % ° , . ' . Contrector. GALLANT FIRE PROTECTION INC , ��Address: •� 821 N�GCENHAVENAV � ` � � � ; . , � . Phone: (714) 738-6242 .. � � ' , - - FUCLERTON, CA ' -�� Zip: � 92832 � - � �- - � Cicense: 728432 , � .� � � � � . , . . .-, ; . . _ , " SCOPE OF PERMIT RELOCATE 550VERHEAD SPRINKLERS FOR , REF.: B04-00081 , " � , _ _ , _ _ , FEE SUMMARY. � Plan Check: $99.61 ` Calc Valuation: S�,�oo.00 . Permit: $153.25 , Claimed Valuation: S�,�oo.00 Other: � $0.00 ' � � � � ' ---- - --- - � — --- - � - � - +r . . � , Total: $252.86 �` ��,� � ... � - � ` � �- , - � � � � � _ �:� � , _. � �. ; ,, , � �_ �, � � , � � � � _ . „ , : , . , _ . , �� . , ,_ - � �. . i� � , , � �. . ` _ _ A_ . � �' , 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 780 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply wilh all applicable codes, and all required Inspectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of lhis permit. FOR INSPECTIONS CALL: (714) 7545626 !aas-a6l�oo) WORKERS' COMPENSATION DECLAqpTION: � � 1 hereby ettirtn under penelry oi per�ury one oi the lollowing declarelions: ❑ I have end wlll maimein e ceniilcetq of consent ro aelf�lnsure br workers' compensetion, es providetl for by section 3700 of the Labor Code, lor ihe peAartnence of the woAc for which Ihis pertnii IS IuueQ 1 hava arW will maintain workers' coinpensgtlon Insurence, es reqWretl by secUon 3700 0l the L91x , erfortnance of Ihe work tor w�lU Ihis PBrmit Is Issued. orkers' m nsat n Insuranca� r endP� iq number ere: /�/ / Cr / LI _�PY[� I �rrier: �� /—i�v��') PolicyN ber. �`�� 1�� U.17' " ecHon nee not be cromp etlll (he ermit /s veluetl at ane hundred dollers ($100) ar less.) ❑ I certiy thet in t�e pedormence of t�e work tor whic� this permit is issued, I shall not employ eny person in any manner so es to bacame subject ta the workars' wmpensatlon lews ot Ce mla, end egree thet if I should hecoma suE�ect to the workers' wmpensation provislons ol Section 3�00 ot Ihe Lebor Cotle, I shell farthwlth v71�aA� esearo io s. / � _Q,'F plicant SI e: �t�J�� 7�^/� atel �— I� G:FAILURETOSECUREWORKERS'�APENSATIONWVERAOEIS NLAU WFULANDSWLLLSU8IECTAN OYERTOC PENALTIESANDGVILFlNESUPTOONEHUNORED TkIXI5AN000(LAFE(5100,OOd),INAOGTIQVip7ryEC0.570FCOMPEN50.TI0N,DAIMGESASPHON0E0WFIN5E THELABOHWOE,INIERESi,ANOATfOfiNEY5FEE5. LICENSED CONTRACTORS DECLARq710N: Chepter 9(commencing with Sectlon 7000) oi Division ConirectoYs SignaWre: antl my Iicense Is in full CONSTRUCTION LENDING AGENCY: —� � ❑ I hereby eMirtn that Ihera is e construction lentling agency for Ihe peAormance ot ihe work for w�ich this permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Signelure: _ Lentler's Adtlress: Date: OWNER•BUILDER DECLARATIONS: � • I hereby afllrm ihet under penelty of per�ury ihe I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Buslness end Prolessions Cotle: Any ciry or counry whic� reqwres g permit lo construct, elter, improve, tlemolish, or repair any strucWre, pnor lo Its Issuence, elso requlres the applicant for such pertnit to file e signed stetement �het he or ehe Is Ilcensetl pursuent to Ihe provlsions ol the Contrectore License Law (Chepter e(commencfng with Sectlon 7000) ot Didslon 3 of ihe Business and Professions Cotle) or ihet he or she Is exempl therefrom and Ihe besis lor the elleged exemption. Any violation of Section 7031.5 by any eppllcant for e permit sublecls ihe applicent to e civil penelty ot*at more then 8ve hundretl Aollers ($500).): ❑ I, es owner ot the propeny, or my amployees with weges as their sole compensatlon, WILL DO THE WORK, an0 the siructure is nat intentled or oHered for sale (Sec. 7044, Businass end Professions C6Ae: The Coniractors License Lew does not eOPly to an owner of property who builds or improves thereon, and who does such work himself ar herselt or throuph hls oi her own amployees, provided ihat such improvements ere not intentled or oHered tar sala. H, however, ihe building ar improvement Is sold within one year of complet�n, the owner-builder will have ihe burden ol proving that he or she did not 6uild or improve for purpose of Sele.). ' ❑ I, a5 owner oi the property, em EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTOiiS to con5lrutt the pro�ect (Sec. 7044, Businesa entl PrafB55ions Cotle: The conVectors Llcense Lew tloes not epply to en owner ot pmpetly who hulltls or impmves ihereon, end who contrects for such pro�ect with a wnirector(s) licensa pursuent to the Coniractors License Lews.). ❑ I em ezempl under bet. Signeture: Bu5ine53 end Professions Cade for this reason: Owner ID venfietl by tlrivers license. ❑ Ves ❑ No Drivefs License No. Verificetion ol Owners�ip by (type oi dacUment, i.e. - property lex bill or OeetlJ: DIVISION OF INDUSTRIAL SAFE7Y PEqMiT CERTIFICATION: Date: Ecpires: ❑ I hereby certify that no excavetion ryve (5) ar more teet In depih into which e person is reqWretl to descend, will be mede in connection with work authodzed by �his pertnil, entl Ihat no 6ultding slrucNra, sceffoldtng, falsework, or demolifion or dismantling thereof, will be more Ihan Ihirty-six (38) feet high, (Chap. 3.2, Gry 2, Atl 2, Sec. 341, Tltle 8, Celifomia Atlminislretive Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a permit irom the Division al Intlustrial Sefery, as noted above, unless such person has e pertnit ta do such work from Ihe diWsion. � Slgnature: Date: Division oi Industrial Safery Permit Numbqr: CEHi1FlCATE OF COMPLJANCE AND AUT}10RQATION OF EHTRY: I certily under penalry of perjury that I have read this flp0lication and state thet the Inlormetlon given is wrrect. I egree to comply wlih ell s�ete lews end ciry ordinances relaling to bulltling consWction, end euthonze representetives of the Ciry oi Coste Mesa ro enter upon Ihe above-descnbed property for inspection purposes. I egree not to acupy or allow occupancy of eny building authorized by this pertnil until tinal inspection. CppE /, INSFECTqNME \ 7616 Fl:ed System Flnal Fire Prevenllon 1266 Pool Spe Flnel 200 Finel Re-Root 201 Finel BIocWRetelning Wall 202 Final Fectory Fire Place 203 � Final Sign Finel Demolilion CODE� INSPECf10NTYPE 206 Finel MeChanlcal 20B Final Plumbing 270 Finel Eleclrical 212 Finel Fire Preveniion 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupenq (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 345 FISCHER AV Suite No Vicinity: Parcel Number: 42708104 Applicant: JIM GACKI Address: '1322 BELLAVE� �� "_ . � SUITE F , � ' � � ' Phone: (714) 2583333 TUSTIN, CA - 2ip: 92780 : i • � - �� . - . . / ;� i � � Owner SCHIFFMAN; TODD'I TR � Address:- 9229 W SUNSET BLVD #602 �, � - . . . Phone: /i � � . ,' LOS ANGECES, CA Zip: 90069-3406 Contractor: D& H�BUILDING SYSTEMS INC Address: 1322BELLAVE �- _ SUITE F � 1 �Phone: (714) 258-3333 TUSTIN, CA � �� Zlp: 92780 � . . -" " � License:747803 Status: ISSUED Applied: 04/29/2004 Issued: 04/29/2004 ISSUED BV: ��' � ' � � � SCOPE OF PERMIT � - INTERIOR TENANT IMPROVEMENT. WORK TO INCLUDE: DEMOLISH EXISTING 5,200 S.F. OF . � . OFFICES AND REBUILD 5,600 S.F. OF NEW OFFICE SPACE. ADD ADDITIONAL OPENINGS IN ' EXTERIOR WACLS'.AT WAREHOUSE AREA. NEW SEISMIC RETROFIT OF 34176 SF STRUCTURE. ADD 247 SF BLDG AREA AT FRONT. �REF.: 604-00081 . � � NO ADDITIONAL PLUMBING FIXTURES, RELOCATION ON�Y. - � � �MECHANICAI TO INGLUDE:�3 REPAIR/ALT GOOLING/HEAT, 3 VENT FANS,°4 FIRE DAMPERS, �� . AND 3 COMPRESSOR/ABSORPTION SYSTEMS: � � , ii � �- ' � � � � � FEE SUMMARY � . � ISSUE FEE ' V�. � Inst FAU�<100 k BTU �` Inst FAU�>100 k BTU '� . � , Repair/Alt Cooling/Heat Insl / Rep. Recess Wall HU , Refrig Sys <100 k BTU Refnq Sys >100 k BTU ' Gas Piping �� : - � � Factory Fireplace V� = . � Hood w/Mech Exhaust� �-. , VAV Box ' Vent Fan / Single Ducl � � Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfrn Quantiry $23.50 . � �" ". ��'.Repair/AltAbsorbtion Unit � $0.00 ...�,. .�,.' �. $0.00 0 1 �w'-=- �. _ Repaic/ Alt RefrigereGon Unit - � � $0.00 � $0.00 0 . , � � - Ventillation'System _ � ��. $0.00� ,'.$41.10,,._3 - � � Evaporative�Cooler-'. -� , � �$0.00 ��$0.00 ��0"� � ' � � � Commerciallncinerator`"� � � $0.00 �. 0 , � Domestic Incinerator � $0.00 � 0 - � Compressors / Absorption�Systems � / $0.00 �'�-0-;.� �;�.� �� " � -Up to 3 hp / 100-k-8TU� -"$O.OQ�,,O� - ,, , � 3To�95hp/�SOOk-BTU,� � ��, �'$0.00- 0 � ' � � �� 5To30hp/1,OOOkBTU• . � � $0.00 � , 0 - � ' - 30 To 50 hp / 1;750 k BTU .' - � $21.75 3� � ' � � � - - Over 50 hp /.Over 1,750 BTU � - �� $0.00 0 � ," �. Boilers �� . � $29.00 . 4 _ , � , , Up to 3 hp So.00 �- �0 .=. 3 To 15 hp , �� $0.00 0' —. -- � , _. 15to30hp _ - - $0.00 0 � -� - 3010�50-1ip $0.00 $0.00 i � $0.00 , �$0.00 � $0.00 j " $0.00 $0.00 $aa.10 $0.00 $0.00 $0.00 Quantity 0. , 0 0 0 0 0 0 0 0 0 0 3 0 0 i 0 NO710E: The work authorized by ihis 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 1 BO days, or if work is suspended or abandoned for a period ot 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 requlred Inspeetions 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 f'� 2a4666 (6I00) WORKERS'COMPENSAnONDECLARAnON: I hereby aXirm untler penalty ot perjury one of tha tollowing tleclaretions: ❑ I have end will malntain e ceniticate of consent to seHdnsure lor workers' compensetlon, es provided lor by section 3700 ot the Lebor Code, for the pedormance ot the ,.-.�work for which this parmit is IssueO. �7"I have antl will maincain workers' compensellon Insurence, es requlred by sectlon 3700 of the Lebor Cotle, for the pertortnance of Ihe work for which Ihis pertnit Is issuetl. � My workers' campensation Insurence cartier and policy number ere: -.r -r+�Y. ... . 2, POIicyNumber.� G[l/�U�y- .yC'�'C�y or1e55J ' ❑ I cenity that in ihe perlormance ol the work tor which ihis portnit Is issued, I s�ell not employ any person in any manner so as to become sublect lo the workers' compensetlon lews ot Celifomla, end epree that it I s�ould become subf ect to Ihe workers' compensetion provislons ot Section 3700 ot the Labor Cotle, I shall forthwith campl wilh thes� vis—ions. y1 �( �, Applicant'Signatura; � �l�� // /�ril� � CDete::=y/��/n � WApNINO:�FNLURET ECUREWOiiKERS'WMPENSATIqJCOVERAGEISUNUWFULANDSHALLSU&IECTMIEMPLOVEPTOCRIMINALPENALTIESAN�GVILFlNESUPTOONEHUNDRED TFKK15AN0 WLL/ RE (5100,000), IN ADDfTIdJ TO THE WST OF G�DAIPENSATION, DAMAGES AS PROVIDED FOR IN SECfION 31O60F THE LABOR CODE, IMEREST, AND ATTOfW EY'S FEES. LICENSED CONTRACTORS DECLARATION: af Chepter 9(commencinp with Section 7000) of Division 3.of.lhe Business end Pmfessions Cotla, erA my license is in full �iClass N Cl Date: � . �� 27' O CONS7RUCTION LENDING AGENCY: ❑ I hereby attirtn that there is e consiruqlon IenAing agenry tor the peAormance ol Ihe work for w�ich Ihis permit is issueA. (Sec. 3097, Civil Code). Lender's Neme: _ Lentlefs Address: Signature: Date: OWNER-BUILDER DECLARATONS: - I herehy atlirtn thet untler penelry of per�ury Ihet I am�XEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu entl Protesslons Code: Any ciry or counry which requires e pertnit Idcanswct, elter, improve, demolis�, or repair any shucNre, prior to its issuance, also requires the epplicant for such permlt to file e signed statement tha�he ar she is Ilcensed pursuent to the O�ovlsions oi ��e Contrectors License Lew (Chaptar 9(commencing wit� Sectlon 7000) of Division 3 oi the Business entl Protessions Code) or Ihat he or she Is ezempt tharefrom end tha basis br the alleged eaemptlon. Any violation oi Section 7031.5 by any applicflM for a pertnit sublects the epplicant to a civll penalry oi not moie than tive hundred dollars ($500).): ❑ I, as owner of ihe property, or my employaes with weges es Ihelr sole compensetion, WILL DO TT1E WORK, antl the strudure is not intended or ottered tor sale (Sec. 7044, Business end Professions Coda: The Contracbrs License Lew does not apply to en owner of property who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, D�oWtletl that such Improvemants era not intendetl or ottered for sale. If, however, ihe building or Improvement is soltl within one year of wmpletion, the owner-builder will have ihe burden oi proving that he or she did not build or improve tor purpose oi sale.). � ❑ I, as owner ol ihe properry• am EXCLUSIVELY CON7RACTNG WI7H LICENSED CONTRACTORS to conslruct the project (Sec. 7044, Business and Professions Cotle: 7Te contractors LJcense Lew,does nat appy ro en owner of property who bullAs or Improves thereon, antl w�o wntrac�s tor such project with a contractor(s) license pursuenl b the CoNrectors Cicense Lews.). ❑ I em exempt under sec. Signature: Owner ID veritied by tlnvels license. ❑ Ves ❑ No Business entl Professions Coda tor Ihis reason: Veriflce�ion oi Ownership by (rype ot daumeN, I.e. - properry tax bill or deed): Drivels License No. Da�e: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I he�eDy certify thet no excavetion five (5) or more leet In depih inio which e person is required to descend, will be made in connection with work aut�orized by this permit, and Ihet no building sfructure, scettolding, lelsework. or demolition or dismantling thereol, will ha more then ihirry-six (36) leet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle B, Celitomia Adminisiretive Cotle). ❑ As owner-builder, I will not employ enyone to do work w�lch would �equire e pertnit from the Divislan of Intlustriel Sefery, es notetl a6ove, unless such person has e permit to tlo such work irom the division. Siqneture: Date: Division ot Indusirial Satary Permi� Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENTHV: I certity untler penalry oi perjury ihet I have read this application and state that the infortnation given is wrrect. I egree ta comply wl�h flll slate lews entl city ordinences relating Io builtling consiructlon, antl euthorize represantatives of ihe Ciry oi Costa Mesa to enter upon Ihe ebove-descnbed property tor inspection puryoses. I egree not to occupy or ellow occupancy oi eny building authanzed by this permit uniil finel inspection. CQOE�. INSPECTIOXTYPE Q� II�AL$ 1616 Fixad System Final Fire Preventlon 1266 200 201 202 203 Pool Spe Final Final Re-Roof Finel BIocWRetaining Well Final Fectory Fire Place Final Slgn 204 Final Demolition tooe� ixsvecnoxme 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Fina1 BuildinyOccupancy o�re 1I�L5 )o-�H-oY :�N (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 345 FISCHERAV Suite: Viciniry: ParCel Number: ' 42708104 ' - Applirant: BRAD HISGEN Address: Zoning: Phone• 714-812•5900 - Status: ISSUED Applied: 11/12/2004 Issued: 11/12/2004 ISSUED BY: ' , : ' Zip. , . i: � Owner. SCHIFFMAN, TODD I TR � �, _ Address 9229 W SUNSET BWD it602 �. � . '� � � Phone: . � ' � � . � • �� LOS ANGELES; CA� '�� " � - Zip: 90069-3406 ; � �� ; �, .�� -, ` , - � � . Contractor: CORNERSTONE CUSTOM PATIO COVERS Address: 20841�GLENCAIRN LN � � ' '� , ' ' �. ' Phone: 774-504-8800 , � � / , - HUNTINGTON BEACH, CA -' � � .;� . � � Zip: 92646 License:- 709138 � , . . Arch : � - � � Eng: , . Address: , . _ Address: ' - . � :,Phone: Phone: �. 2ip: � - License: � License: . SCOPE OF PERMIT , 72 FEET OF GARDEN WALL 4' IN HEIGHT W/4'SRELLIS ON TOP FOR 7ROCK HARBOR CHURCH' TO ENCLOSE DOCK AREA. . � FEE SUMMARY , Plan Check: $35.10 Calc Valuation: Si.4ao.00 Permit:� � � $54.00 - � - . � � _ " , Glaim Valuation: � So.00 SMIP Res: $0.00 ;- " �- � '�- - - � � � SMIP Com: $0.50 � � „ � Other: � $0.00 , � � Inspection:, ?, $0.00 - . � �_ ; � ' � ��° � . �� .�Total: $89.60 •v.s��:��' ..-�� . . ;,, : � ;i, � �`�' � - ..� � . .. PLANNING &ZONING � r;•'• ,. -�, � , SETBACKS� � �'� � � � � � /,i��..�. . � '� MAIN STRUCTURE Front 0.-�0 �-� � Rear 0. 0� �Left 0. 0 _ Right .0- 0 - `. \ . _ � , . �, , ��_ -. ACCESSORY �.'Pront�O-0 � Rear- -0-0� - �Left 0;"0� " Righl��' 0.0 � " i . `_ � - ., . " � � / �, PARKING Existinq:��o �- �: �Reauired:�� ` 0 , Pr000sed: �o ( � � �� i` ��- _ � „-1 , , , � NOTES: � '� - - - - - , �' � � \' � �\\.. - . - '% ; \ _ - ', �-' NOTICE: The work authorized by this pertnit shall comply with all applicabte handicap access requiremenis under Callfomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) E%PIRATION: This permit shall automaticalty expire erW become void it work is not commenced within 1B0 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work aulhorized under this pertnit to be considered legal, such work must comply with all epplicable codes, end alt required Inapectlons and (inal approval must be obtained. Fallure to obtain InsDeclions and flnal approval will result In the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 , aao-ealauol WORKERS' COMPENSATION DECLARATON: � ' � . � '' , " I hereby aHirtn under penalry ot perjury one ot the Foilovring dedaretions: � � '� • � ' ❑ I �eve entl wlll meinteln e cenificete ot consent to self-Insure far workers' comDensetion, as pravitletl for by section 3700 at t�e Lebor Cotle, lor Ihe pertortnence of Na work for whlch this permil is Iuued. , � ' malntain as one �ired by sectbn 3700 of Ne Lebor Cotle, for Ne pertortnance ot the work for whkh Nis pertnit is l5.wed. a�a: ,�,�R002 K 0�� dicyNumbei: �dred dWlars (5100) or Iess.1 . . ❑ I certity tha� In t�e pertormence ol the work tor which t�is permit I51uueQ I s�all not employ any person in any manner sa as to hecome sub�ect to Ihe workers' compensetlon lews of Calllomle, antl agrpe t at if I should become sub�ect co tha workers' compensatlon provislons of Saciion 3700 at the Lebor Cotle, I shall forthwlth comply wilh �th ' iong. 1 i APPIIten46hne1�71a:.�1'��1C�r, ` �-De�us_" ��. {Z.Q1.� WMMNOrFAlU1RE TO'SECURE WORKERS' CpAPE COVEMGE IS UNLAWFUL AND SWLLL SU&IECf rW ENGCOVEF TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUN�FED hKK15AND OOLURE (5100.000�, IN AOOrt10N TO THE COST OF CdAPEN$AT10N, OAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABON COOE, INrEREST, AND ATTORNEY'S FEES. LICENSEDCONTRACTORS 9(commencing with Section 7000) of Dlvision CONSTRUC710N LENDING AGENCV: ❑ I hereby eHirm that Ihere Is e construction Iending egenty tor the paAortnance of Ihe work tor which this permit is issued. (Sec. 3097, Civll Cotle). Lentlers Neme: �, lentler's Atltlress: Signature: Date: Ilcensa Is in lull OWNER-BUILDER DECLARAT10N5: �> I hereby eNlrm Ihat untler penelry ot perjury Nat'I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7037.5, Busineu entl Proleuions Cotle: Any dry or counry which requires e p�qnit ta conswct, elter, improve, tlemolish, or repair eny swcture, prior to its Issuance, elso requires the applicanl lar suc� permit b tile e signetl statement thet he or sha is licensed pursuant to t�e proNslons oi the Comreaors License Lew (Chepter 9(cammendng with Sectlon 7000) ai Division 3 af Ihe Business end Prolessions Cade) or Ihat he or she is exempt therefmm end t�a 6esis tor the elleged e:emption. Any Nolation of Section 7031.5 by eny epplicent lor a pertnit sub�ects the epplicam to e dvil penalry of no1 more Ihan Trva hundred dollars (5500).): ❑ I, es owner af the propeny, or my emplayees with weges as their sole compensation, WILL DO THE WORK, and Ihe structure is not intended or otfered for sele (Sec. 7044, Business end Protessions CoOe: The Conlractors License Law does nol apply to en owner of proparty who builds or improves Ihereon, and who does such work himseli or hersetl or through his or har own employees, provitletl that such impravements ere not intended or aHered tor sele. II, hawever, Ihe building or Improvement is soltl within one year o1 completion, the owner-builtler will have the burden of proving that he or she did not build or improva tor purpose oi seleJ. ' ❑ I, as awner of tha propeny, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business end Professions Code: The con(ractors License Law does not appty to an owner of properry who bulltls or Improves thereon, end who contrects tor such project with a contrector(5) license pursuent to the Contreclor5 License LawS.). ❑ I em exempi under sec. Business and Protessions Code lor this reason: Signature: Date: Owner ID verilied Ey tlrivers license. ❑ Ves ❑ No Driver's License No. Vedficetion ol Ownership by (type ot Aocument, i.a. - pmperry terz bill or tleatl): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: ❑ I hereby ceNly ihat no excaveilon tive (5) or more feei in tlept� into which e person is reqWretl to tlescenA, will be made in connection with work euthodzed Gy Ihls permit, end Ihat no bullding siructure, sceMolding, falsework, or demditian or dismantling Ihereot, will be more ihan ihifty-six (38j teet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title B, Calilomla Adminisirative Cotle). ❑ As awner-bullder, I will not employ enyone to do work whlG� would require e pertnil Irom iha Dlvision ol Intlusinal Sefery, es notetl ebove, unless such person has e permit to tlo such work trom the tlivision. Signature: Date: Division ol IntlusMel Selery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AUTHOR¢A710N OF EMRY: I ceM1ify under penelty of perjury that I have read Ihis epplication and state that the informetlan given IS correct. I egree to comply wlth ell stete laws end ctiry ortlinances relating to building cronslruction, entl authorize representatives of the Ciry of Coste Mesa lo enter upon Ihe ebove-descnbetl proj7e[�y lor Inspection purposes. I agree not to occupy or ellow occupancy ol eny building euthorized by lhis parmit until final inspection. CODE t. INSiELTIONiYVE 1616 Fi:etl System Final Fire Preventlan 1288 Pool Spa Finel 200 Finel Ra-Roof 201 FIneI Black/Reteining Well 202 Flnel Faciory Flre Place 203 Final Sign 204 Final Demolltlon � PAg It�LS COOEI INSPECTONTYPE 206 Flnal Mec�anical 208 Finel Plumbing 210 Flnel Elecidcal 212 220 222 250 Finel Fira Preventlon � Flnel Planning ApDroval Flnel Site � � Finel Builtling/Occupency '�'f (714) 754-5273 • Fex (714) 754-4858 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: 345 FISCHER AV 42708104 Applicant: ANDREW SANCHEZ Address: 16650'DONNELL WY ORANGE,CA � - ,� Owner: j SCHIFFMAN, TODD I.TR Address - 9229 W SUNSET BLVD #602 ConVactor: Address: LOS"ANGELES,.CA � ELECTRICAL PERMIT Phone: 714-279•9590 Zip: 92867 , Phone: Zip: 900693406 D R ECECTRIC AND CABLING CONTRACTORS, INC �fi�F n•nnNtiFi i wv . ORANGE,CA Phone: 714-279-9590 , , ` � 'Zip: 92867 License: 609145 ISSUED BY: Status: ISSUED Applied: 11I03I2004 Issuetl: 11/03I2004 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 36 LIGHT-FIXTURES FOR "ROCK HARBOR CHURCH" REF.: E04-00939 . . . . _ i ' . � - � - - , . ISSUE FEE Temp service test Ras. a/c package New Res (�-2 units) New Res (3+unils) `.� � Pool / Spa � � Lighting-FIxLs � � Recept OutleLs� = Switches � � � Non Res Appl � Res Appl Service to 200a ,� Service to t000a � `, Service over 7000a -,.�, Motars to 1hp Motors to tOhp � - Motors to SOhp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole li9ht Pkg Sign Circuits ,�� FEE SUMMARY Quantiry- � ' ` _ ' „ Quantiry $23.50 - - - _ "� Temp Dist System / Lighting� $0.00 0 $0.00 � ' � " � Busway /100 ft .. - $0.00 0 , 50.00 Standing Section $0.00 0 $0.00 � 0 Misc Electrical Equipment ,.$0.00 0 50.00 0 Transformers up to 1 kva/kw $0.00 0 �' � 30.00 0 ................up to 10 kva/kw $0.00 0 �� 30.00 0 '-; � '`..: .�:.:........up to 50 kva/kw ' $0.00 ; � �-0 � _._ ;.a .-. • `� � �$0.00 0 � -� � . ..........:...: .up to 100 kva/kw $0.00 , -;' �0 � �$0.00 0 �� .............:....over 100 kva/kw $0.00 - , 0 � \�$0.00 0 .` � �� LowVoltageEquipmenl; � . . $0.00 � 0 , 50.00� �� 0 � � Low VOIt Wiring System / Ckt �.$0.00 0 "� $0.00��; 0 ' � - Misc.,CondWt � $0.00 0 . . ' 50.00 ' , - ��0 �Misc.�Conductor . ; �$0.00��' �0 � 30.00� � 0 �' � � � Circus ( gen or ride) - .- - $0.00 � 0 �. $0.00� ' . �0 � � Circus (mechride or IighLs) . $0.00 , 0 � 50.00 ,` 0_ ChristmasTreeStantl ' ��$0.00� ��0 - `30.00 � 0 FireworksStand. � � "S0.00- 0'� � � $0:00 � ' 0 � � � ,Other ElecNcal Fee � 50.00 "- .-� �50.00-`� � 0.� � �-' ' � . . 30.00�-� =-'-_0 �" '� � � ,� ,-Inve`stigalion'Fee' " �� $0:00 $0.00 �� 0; = - � � ` Plan Check Fee � l 50.00 i, -'' �. $0_00 0� � -' > - �Reinspection Fee - $0.00 30.00 0 �--- �__ �. ..- _� . _. -- NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or if work is suspended or abandoned for� period ot 180 days. � INSPECTIONS: In order for the work authorized under this permlt to be consitleretl legal, such work must comply with ell applicable codes, and� requlred inapectlone end finel epproval must be obtainad. Failure to obtain Inspectlons and tinal approval will result in the axpiratlon of this pe 'It. FOR INSPECTIONS CALL: (714) 754-5626 zeae�ae laoo) WORKERS'COMPENSATON OECLARAnON:�/ . I hereby eMirm under penelry of perjury one of the following declaretions: ' . ❑ I have entl will maintaln a certitiwte ol consent to sel4lnsure for workere' compensatlon, es provided tor by sectlon 3700 of the Lebor CoCe, for Ihe pertormance oi ihe Jwork for which Ihis permit is issueA. '.. � }� Fhave end will meintain workers' compensetion insurance, as requiretl by seclion 3700 0l Ihe Lebor Code, lor the porfortnence ol the wark tor which tNs pertNt Is issuetl. ��My wo�rke-re�' �campensatlon Insurance Wrrier end policy numbar ere: �n I�DI � I � LE�F� ' Cernec. �- 7 � � ��%� (POlicy �Number: 7T�hi�eCflon need naf 6e cromp/eted il fhe permiNs velued ef one hundred dallers ($100) or Iess.J �` � . ❑ I cenity that in tha pertortnence ot Ihe wwk tor which this pertnit is issued, I shall not employ any peraon In eny manner so es Io become suh�ect to the workers' compen5etlon laws of Celifomia, and egree hat II I 5hould become 5ub�eci Io Ihe workers' wmpenselion provislons oi Secllon 3700 ot the Lebor Catle, 1 s�ell torthwith comply with.these provisiqr� , � � �3 �� APP�'� / . ✓�l..n lica�gnewra:--_.� lr�cbi'Yd .CM Date: WARNINO: FAILURE TO SECURE WOFU(E0.S' �MPENSATION �FGE IS UNLAW Fl1L AND SMALL SUBIECT AN EMPLO EFTO CRIAUNAL P TIES M1D CML FlNES UP TO ONE HVNORED TFKKISAND OOLURE (5100.000�.IN ADDfTION TO TNE ODST OF COAIPENSATION, DFMAOES AS PROVIDED F-0R IN SECTION 3'1080F THE LABOR CO�E, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATON: I hereby aNlrm Ihet I em Ilcensed under rovisions oi C�apter 9(commenGng with Section 7000) ol Division 3 of Ihe Busine end Prolessions Code, end my license is in full torce.era�enect. ua N. ' � � �less s^ � � con� r��_-' .ne • rpate�- -Y/�/s c,�/ � %� f v � OC NS7RUCTION LENDING AGENCV: ❑ I hereby eMirtn that there is e consiruction lending agenry lor Ihe peAormance of the woM for which Ihis pertnit i9 issued. (Sec. 3097, Civil Cotle). Lender's Neme: Sipnature: OWNER•BUILDEH DECLARA710NS: LenCefs AtlGress: Date: I hereby eMirtn that under penelry ol perjury Ihat 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Protesslons Code: Any ciry or counry which reQuires a pertnit to consiruct, alter, improve, demolish, or repeir eny structure, prior ta its issuence, also requires the epplicent tor suc� permit Io tile e signed stetement Ihat he or she I5 Ikensed pursuflnt to Ihe provisions of t�e Contradors License Lew (Chapier 9(commencing with Settion 7000) of DMsion 3 oi the Business and Protessians Cade) ar that heDr she is ezempt Neretrom and Ne besis lor the ellepetl evemptlon. Any vloletian of Sectian 7031.5 by any epplicent tor a pertnit suhjects the appliram to a civil penalry oi na more than tive hundred ddlars (SSW).): ❑ I, as owner ot Ihe propef�y, or my employees with wages fls �heir sole compen5elion, WILL DO TME WORK, entl ihe stNcture Is noi Intentled or otteretl for sele (SBC. 70d4, Business and Professions Code: The Contractors License Lew tloes not apply to an owner of property who bullds or improves thereon, end wno eoes such work himself or hersetl or Nrough his or her own employees, provided that such improvements are not intended or oHeretl for sale. If, however, the building or improvement is sold within one year of completton, the ownervbuilder will have the burden ot O�o�inp that he or she ditl not build or improvo ior purpose of saleJ. � ❑ I, as owner oi the pmperty, am EXCLUSIVELV CONTRACTNG WITH LILENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and Professiong Cade: Tha mntractors License Law tloes not epON �o en owner oi propeny who bullds or improvas thereon, and who contracis lor such projea with e conlrector(s) license pursuant to ihe Conirectors License Laws.). ❑ I am exempt under sec. Business ana Protessions Code tor Ihis reeson: SignaWre: Date: Owner ID venfie� 6y tlriver's license. ❑ Yes ❑ No Drivets License No. Venilcatlon oi Ownershlp Dy (type oi tlocument, i.e. - pmperty Ieu 6ill or Aeetl): E:pires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby ceniiy thet no excavation five (5) or more feet in depth into which e person Is requiretl to Cescend, will be mede In connection wlih work authorized Dy t�is permit, entl thet no Duilding structure, swflolding, lalsework, or tlemolition or dismentling thereof, will be more than thirty-siz (36) feet high, (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomle AOminlsiretive Cotle). ❑ Aa ownerbuiltler, I will not employ anyone to tlo work whic� woultl requlre e permit from the Dlvislon ol Intlusirial Sefety, es notetl ebove, unless such pereon has e permit to do such work from the tlivision. Slgnature: Date: Divislon oi Intlusinal Safety Permit Number. CERTIFlCATE OF COMPLIANCE AND AIJfHORQATON OF EMAY: I ceNfy under penalry ot perjury �hat I hava reed this epplication end 5tete thet the informatlon gNen is correct. I egree to wmply with all state Wws anC dry ordinances relating to bullding consWcNon, enA euihodze representatives ot the Ciry ot Coste Mesa to enter upon the ebove-descdbed D�aPertY �or inspecGon puryoses. I egree not to occupy or allow occupenty ot eny building authonzed Dy ihis pertnit until tinel inspectlon. CppE t, IN4PECTIONTYPE QdjE 1616 Fixed System Flnel Fire Prevention 1286 Pool Spe Final 200 Final Re-Roo1 201 Final BIocWRetelning Well 202 Final Fectory Fire Place 203 Flnel Slgn 204 Final Demolition Qjj�Q COpE� INSPECTIONTYPE 206 Final Mechenical 20B Flnal PlumGing 270 Flnal Elociricel 212 220 222 250 Final Fire Prevenilon Final Planning Approvel Flnel Site Final Building/Occupancy 0 (714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-rt��PRESSION PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 345 FISCHERAV Suita: Viciniry: Parcel Number: 42708104 Zoning: �� Applicanr. LUARCA, RODELL, � , Address: 17150 NEWHOPE ST -" " " - STE 109 ' / ' _ - • - Phone: (714) 545-8882 i , FOUNTAIN VALLEY, CA_, Zip: -� 92708 ,' Owner: /SCHIFFMAN, TODD I-TR � Address � - 9229 W SUNSET BLVD #602 ` _ � - � � ' � � i : � ---' � Phone: , ' ; i�- . ,� lOS ANGELES, CA �� Zip: 9006�3406 Conuacroc J M G SECURITY SYSTEMS INC : Address:�� 77150 NEWHOPE ST Status: ISSUED Applied: O6I25Y2004 Issued: 07127/2004 ISSUED BY: � STE 109" Phone: p14) 5458882 � � � , � , FOUNTAIN VALLEY, CA ,; Zip: 92708 � ' � .� . . , � - . . License: 575W0 " ' SCOPE OF PERMIT FIRE ALARM MONITORING FOR "ROCK HARBOR CHURCH. � - � � Plan Check: $81.41 Permit: $125.25 Other: $0.00 Total: $206.66 � FEE SUMMARY ' � � ' Calc Valuation: Ss,000.00 "' ' " -" Claimed Valuation: Ss,000.00 - - ' � �, � � � � - - ,� i - __ _ i-�' , - - . . . - _ . � : -� ' . . _ . _ , �:�i . . , - , - " . - i :' � , „ �% _ � _ ` ` _ ' / i� � . _ _ � � � �.� _ � � �/ /� � �, . ' ' � _ �A , � ; , '. , _. � � - ��, / , j'!/ � � �• � , .. -- . � � /� � _ � J � � �' i� -, � ' ,�- � �� ` � ,� � � '� - ; 'c„ ,��' �- -'-':: , � �' . -- NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § t, 12-27-92) EXPIRATION: This permit shall automaticaily ezpire and become void Ii work is not commenced within 180 days, or ii work is suspended or abandoned for a period ot 1B0 days. INSPECTIONS: In.ortler for the work authorized under this permit to be eonsidered legal, such work must comply with all applieable eodes, end all requlred Inepeetiona end finel approval must be obtained. Failure to obtain Inspactions and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545828 zaaaae �aroo� i WORKERS'COMPENSATONOECLARATON: . I hareby ettirm untler penelry ot perjury ona of ihe tWlowing tleUaratlons: � ❑ I have entl wlll meinteln e csNficate ol consent to selFlnsure for workers' compensatlon, es pmvideA for by sectlon 3700 ot the Lebor Code, lar Ne peAortnence of Ihe rk for which this pertnit Ls issuetl. I �ave antl will melntein workers' compensatlon Insurence, es required by section 3700 ot the Lebor Cade, tor the peAortnence of Ihe work for whiG� ihis pertnit Is Lssued. My workers' compensatlon Insurence cartler entl policy numDer ere: Cartier: Policy NumDer, (fhis sectbn need not be cortrpleted I! fhe perMllS vaNed one hu�Wred dd/ers (5/00) or leu.) ❑ I certify Ihet in Ihe Oertortnance oi Ihe work lor whict t s pertnit is issuetl, I ahall not employ eny peraon in eny menner so es lo become subJett to the warkeB' compensation laws o1 ' oml end e that It I � ultl became subject to the workers' compensation proNsions o1 S�Ction 3700 f th� r CoAe, I shatl lorlhwith Compty with Ihese p i . / O Applicent Signeture: ' Date: � ?t� WARNINO: FAILURE TO SEW ORIfERS' C�OMPENS�TION COVERA�E IS UNLAW FUl Ml� SNALL SUBJECT PN EMPLOYER TO CRIMIWLL PENAL ES M1D CML RNES UP TO WE HUNORED TH(%1SAND DOLL�IRE (5100,OW), IN ADDfTION TO THE COST OF CpAPENSATION, OMNGES 0.S PROVIDED FOfi IN SECTION 3]090F THE LABOR CDDE. INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRAC70RS DECLARATON: I hereby ettirtn ihal I em Ilcen und r provisions ot h pter 9(commencing wlth Section 7000) ol D'Msion 3 0l Ihe Business antl Prolessions Code, end my license is in full torce end ettect. l. M Class N Cantrectors.Signet Dete: � CONSTRUCTON LENDING AGENCV: ❑ I hereby eHirm that Ihere Is e constructlon Iending egancy for Ihe peAormance ol ihe work lor w�ich Nis permil Is issuetl. (Soc. 3097, Clvll Code). Lenders Name: Lender's Address: Signeture: Date: OWNER•BUILDER DECLARATONS: I here6y ettirtn t�et untlei penalry ot per�ury t�et I em EXEMPT FROM THE CONTRACTORS IICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Business end Profassions Cade: Any ciry or counry which requires e pertnit to canstruct, elter, improve, demolis�, or repeir eny structure, pdor to its Issuence, also requires the epplicant tor suc� pertnit to lile e slpnetl statement lhat �e or she is II�e nsed pursuenl to the proWslons oi the Contradors License Lew (Chepter 9(commendng wlth Sectlon 7000) of D'Msion 3 oi Ihe Business end Professions Cotle) ar that he'6r she is exempt theretrom and the basis for the alleged exempiion. Any Nolatlon of Sectlon 7037.5 by eny epplicent for e pertnit sub�ecls the eppllcant to e clNl penalry oi not more than fNe hundred dWlars ($500).): ❑ I, fls owner oi Ihe property, or my employees wlih wages as thelr sole compensation, WILL DO 7ME WOHK, entl the siructure is not Intended or oXered lor sele (Sec. 7044, Business end Proteulons Code: Tlie GonlraIXors Llcense Lew does not apply to en owner of property who builds or improves thereon, anC who tloes such work himsetl or hersetl or t�roug� his or her own employees, provitletl that such improvemems are not Intended or oflered tor sale. tl, however, the builtling or imprwement is sold within one year oi comp�etion, the owner-Duiltler will have Ihe burden of proving Ihat he or she did not build or im0�ove for purposa ot sele.). ' ❑ 1, as owner of the property am EXCLUSIVELV COMRACTING WIiH LICENSED CONTRACTORS to wnstruct the pro�ect (Sec. 70A4, Business and Professions Code: The contrenors Llcense Lew Aoes nat epply to en owner of propeny who builds or imprrnes thereon, antl who contracts lor such pmject wiih a canireqor(s) . license pursuant to t�e Contreciors Ucense Lews.). ❑ I am exempt untlor 6Bc. Signature: Owner ID varified by tlnvefs license. ❑ Ves Venficatlon at Ownership hy (type of dacument, I.e. Business end Prof055ion5 Code lor Ihi9 raason: ❑ No Drivers License No. propeny te�c bill or deed): Dete: Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N: ❑ I hereby certiy t�at no ezceveHon tNe (5) or more leet in depth into which a person Is requireO to descend, wlll be matle In connectlon wlth work authodzed by this pertnit, entl that no building structure, sceHWding, lelsework, or demoliiion or dismantling thereol, will be more then thlrty-six (38) leat high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Atlministretive Code). ❑ As owner-Dullder, I will no� employ enyone to do work which would require a pertnit from the Dlvision of Indusiriel Selery, es notetl ebove, unless auch person has e pertnit ta do such work trom Ihe divislon. Sipnature: Date: Division at Industnel Safety Parmit NumDer: CERTIFICATE OF COMPLIANCE IWD AUTHORIZA710N OF ENiSiY: I certity untler penalty ot per�ury that I have read �his application end stete t�et ihe information given is correct. I egree lo comply wllh ell stete laws end clry ortlinences relating �o building Construction, an0 authodze representatives of the Ciry of Coste Mesa ro enter upon the ebova-descnbed property for insp tion purposes. I epree not to occupy or ellow occupancy of eny building authanzed by this permit until tinel inspecUon. Si ture Ot Legel Ow er(s) � Dete ntl/Or Authodzotl Applicant � � D e GOUE I. INSPECTONTYPE 1878 Fizetl System Final Fire Preventlon 1266 Pool SDa Final 200 Flnal Re-Roof 201 Flnal BIocWRetaining Well 202 Finel Fectory Fire Placa 203 L Finel Sign Final DamdiUon PAIE II�lLS COOE 1 INSPECTION TYPE 206 Finel Mec�aniwl 208 Final Plumbinp 210 Final Elecidcel 1 �i 212 Finel Fire Prevention 1, a 220 Finel Planning Approvel 222 Final Slte 250 Final Bullding/Occupency PAIE It�4S (714) 754-5273 • Fax (714) 7544856 • www.ci.costa•mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: 345 FISCHER AV 42708104 Applicant: ANDREW SANCHEZ Address: 76650'DONNELL WY i" : ORANGE,CA. , - Owner. /SCHIFFMAN, TODD I_TR Address� 9229 W SUNSET BLVD #602 - " �,LOSANGELES,.CA'� �, % ELECTRICAL PERMIT Phone: 714-279-9590 Zip: 92867 � Phone: Zip: 90069-3406 i Contractor: D R.ELECTRIC AND CABLING CONTRACTORS, INC Address:- 16650'DONNELL WY , - . . � . , � . . � Phone: 714-279-9590 ORANGE.CA - . , �: �.. - �. Zip: 92867 � - � . ' � License: 609145 Status: ISSUED Applied: 08I24YL004 Issued: 08124I2004 ISSUED BY: �� SCOPE OF PERMIT ` TENANT IMPROVEMENT. FOR "ROCK HARBOR CHURCH". 34,176 SQ. FT. SCOPE OF WORK TO INCLUDE: NEW SANCTURY,�CLASSROOMS AND�BATHROOMS AND OFFICE�SPACE. BUILDING IS OF MIXED OCCUPANCY'(A2.1/A3/B/F1/S2) AND MIXED TYPE OF CONSTRUCTION (ViHR AND VN). REF.: B04-00606 . . � ELECTRICAL TO INCLUDE: 336 LIGHT. FIXTURES;"147 OUTCETS, 60 SWITCHES, 21 MOTORS TO 50 HP, 30 COMMUNICATION.DROPS, 9 SUB�PANEIS TO 200 AMPS, 2�SIGN CIRCUITS, AND 4 "' TRANSFORMERS UP.TO 50 KVA/KW.- . , � ' i � SUBJECT TO FIELD INSPECTION � ' , ' � � � �,� � \; . .:FEE SUMMARY � � � � � ' � -�� Quantity - � � � ,�- �uantity ISSUE FEE � � �523.50 ' Temp Dist Systerri I Lighting- _,$0.00 ' 0 Temp service test . , $0.00�. ' � �� 'Busway /100 fl � �- . �$0.00 0' Res. a/c packsge �� i�E0.00 :�� - - "Standing Secfion ,- 50.00- � 0 New Res (1-2 units)` " 30.00 �.� �.? 0 ° Misc Electrical EquipmeM `� "$0.00 �' - 0� New Res (3+units) �� ' $0.00� . �� 4:- � „�_ - � _ . Transformers up to 1 kva/kw'� 50.00 � - 0 � Pool/SPa � . �: _:$0.00`. -. '0-,`-,'�_� .: , .:..............upto�Okva/kw� ,�,.� $0.00'/ 0 � . Lighting Fixts \ . A 5252.68 . 336� � _ .................up to 50 kva/kw ` �', $98:40� , � 4- - � Recept OutleLs �, $11471 � � 147-- � � .................up to 100 kva/kw %50.00 � 0'� Swi[ches �V'S51�.20 � � 60 � � � � .:......over 100 kva/kw 30.00 - - 0 Non Res Appl � 30.00�-� 0, � , �Low Vollage Equipment -•$0.00- "� 0 Res Appl 30.00�` _0 �-" �� ' Low VOIt Wiring.System / Ckt"-L�' $0.00 0 \ "' Service to 200a $0.00 �� 0 ,; --- , � � � � Misa Conduit , . - . , .: � � � " $0.00 0 Service to 1000a 50.00 0� ,� � �- - Misa Conductor � � $0.00 0 Service over t000a 30.00 0 � -- -. _ l ,� � Circus:( gen or dtle) $0.00 0 NOTICE: The work authorized by this permfl shall comply wflh all applicable handicap access requiremenis under Califomia stetutes end reiated regulations. (Ord. No. 92-28, § 1, 12-21-92) El(PIRATION: This permit shall automatically expire end become vold if work is not commenced wlthin 1 BO days, or if work Is suspended or abandoned for e period of 180 days. INSPECTIONS: In order for the work euthorized under th�s permit to be considered legal, such work must comply wlih ell appliceble codes, end ell raqulred Inapecliona end tinal approval must be obtalned. Feilure to obtain inspectiona and finel approval will iesult In the expiration o1 this permN. FOR INSPECTIONS CALL: (714) 754-5628 2ao-ae (aroo) WOHKERS'COMPENSAnON DECLARAnON: , � , �' � I hereby aftirm under penalry ot perjury one ot the IWlowing tleGeretlons: ' � - ❑ 1 heve end wlll meinteln e certificete ot consent to self-Insure lar workers' compensatlon, es prodded for by sectlon 3700 0l the Lebor Code, far the perfarmance ot Ihe --�.�� ork for whiCh �his permil Is Issuetl. [��'I heva antl wlll malntain workers' compensellon Insurance, fls requiretl by sectlon 3700 ot the Lebar Catle, lor Ihe peAormence o1 the wark tor whic� this pertnll is issuetl. ��My wor�ke+�rs'. compensation Insurenca caMer antl pdiry number are: G�rrtler. l/ A TE F(.1 Ai17 LPe � bBr C�h ��P ��i �- ZC� (Thfs sectlon need nof be complefed i! fhe perml( fs velued et one huntlretl tlollers (S I00) or less.) , . , ❑ I ceniy thet in Ihe pertortnanca ol the work tor which tNs pertnit is issued, I shell not employ eny person In eny manner so es to become sublec� to tha workers' compensetlon laws of Celif , entl a ree Ihat if I s�oultl hecome suD�ect to the workers' compensetion pmvislons at Section 3700 of t�e Lebor Cotle, 1 s�all torthwith comply with Ihese provisi %� � / � I I� Applic�d�YYStgnetuie� �t_J� ��' � � � r WARNINO'PAICORE TO SECURE WOHKERS�i'.OMPENS�TION COVEMOE IS UNLFWFlIL PND SNALL SOBJECT AN EMPLOVER TO CRIMINQ PENALTIES AND CNIL FlNES UP TO pJE HUNDRED T/IOUSAND DOLLARE (5100,000). IN �DDITION TO THE WST OF COMPENSATION, DAA+AGES AS PROVIDED fOR IN SECTION 3]OB OF THE UBOR ODDE, IMERE5T, AND ATTORNEYS FEES. LICENSED CON7RACTOiiS DECLARATON: I �ereby BHkm'that' frem IICBn5e0 unOer mvi5ion5 ot Chepter 8(commenting wit� Settlon 7000) ol DiWslon 3 of l�e mrce andaieec uc. a (r4z514�„ n c� end mv liCense,ls In full CONSTRUC710N LENDING AGENCV: ❑ � hereby etllrtn thet Ihere is e consWction lending epency for Ihe pedormence ot t�e work lor w�ich ihis permit is issued. (Sec. 3097, Givil Code). Lentler's Neme: Slgnawre: _ OWNER-BUILDER DECLARATIONS: Lentlefs Addreu: Deie: I hereby eflirtn thet under penelry ot perjury Nat I em�EXE(�PT FROM TME CONTRAC70RS UCENSE LAW lor the following reason (Sec. 7031.5, Business entl Professions Code: Any clry or counry which requires e permit to construct, elter, improve, tlemdis�, ar repair eny structure, pnor to Its issuance, alsa requires Ihe applicant for such pertnit to lile e slgneC stetement Ihet he or she is I�ensetl pursuant m the proNsions ol Ihe Cantreciors License Lew (Chapter 9(commenUng with SecUon 7000) of D'Msion 3 of the Business and Pmtessions Cotle) or tl� he or she Is exempt tl�erelrom and the besls for Ihe elleqed ezemptlon. Any violetian ot Section 7031.5 by eny applicant for e permit su6jects Ihe epplicant to e civil penalry of not more then five huntlretl tlollars (5500).�: ❑ I, as owner ol ihe property, or my employees oith wages as their sole compensation, WILL DO THE WOHK, and the strucWra Is not intended or aHared tor sala (Sec. 7044, Busineu and Professions Catle: The Contractors License Lew does not eppty to an owner ot property who builds or improves �hereon, and who does such work himself or herself or Ihrough hls or her ov.•n employees, proviCed that such Improvemams ere not intended or ottered lor sale. If, however, the builtling or improvement is sol� witNn one year ot completion, the owneo-builtler will heve the Curden al proving that �e ar she did not build or Improve tor purpose oF saleJ. ' � I, es owner o1 the property, am EXCLUSIVELV CONTRACTNG WfTH LICENSED CONTRACTORS to construct the pro�eq (Sec. 7044, eusiness and Professions Cade: The coniractors Llcense Lew does rrot apDN �o an owner oi property who OUIIAs or imprwes ihereon, entl who comrects tor such pmject with a cantractor(s) license pursuant to the Contrectors Liaense Lews.). ❑ I am exempt untler sec. Business and Professions Code for this reeson: Signeture: Date: Ownar ID verilied by tlrivels license. ❑ Ves ❑ No Drivefs License Na. Verilicatlan of Ownership by (typa ot documem, i.e. - pmperty tax blll or tleed): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTFICATON: Expire5: � I hareby cartity thaf no excavatlon Ilve (5) or more teet in depth Into which e peroon Is required to descentl, will Ce metle In connection wit� work authoAzeO by Uis permil, antl that no DuIlCing sirudure, scallolUing, telsework, or tlemolition or tlismamling Ihereat, will bo more then thirry-six (36) taet high. (C�ap. 32, Gry 2, Atl 2, Sec. 341, 71Ue 8, Celitomia Adminbtrative Catle). ❑ As owner-bullder, I will not employ enyane to da wark which would reQuire a permit Irom the Division of Inaustnal Selery, es noted ebave, unless such person hes e permil to tlo such work trom the tlivision. Signeiure: Oate: Dlvision of �ndustrial Satery Pertnil NumEer: CER7IFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I cenify untler penelry at perjury ihat I �eve read ihis epplicetion entl state that the Informatlon given is correct. I egree to comply with ell stete lews en0 ciry ortlinences releting to Duiltling consWction, anC authodze representetives ot the Gry ot Costa Mesa to enter upon t�e above-descnbetl properry for inspection puryoses. I agrea not to occupy or allow occupency ot eny builCing euthorized by thls pertnit until linal inspection. CQOE 1. INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 1268 Pool Spe Finel 200 Finel Re-Rool 201 Finel BIocWRetelnlnp Well 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolltlon COOE� INSPECTIONIYPE 206 Finel Mechenical 208 210 212 220 Finnl Plumbing Finel Eloctrical Finol Fire Preventlon Finel Plenning Approval 222 Finel Site � 250 Finel Building/Occupancy � ' pAg 1If�EL9 / i !%3%� �� (714) 754-5273 • Fax (774) 75M1-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 345 FISCHER AV Suite No Vicinity. Parcel Number: 42708104 Applicant: GOMEZ,MIGUEL , Address: 1075 HAMILTON RD. -. DUARTE, CA Owner:- , SCHIFFMAN, TODD-I TR Address:" �9229 W SUNSET BLVD #602 Contrector: Address: LOS ANGELES, CA AT�LANO, ANTONIO MECHANICAL PERMIT Phone: (626) 301-4141 Zip: 91010 Phone: Zip: 900693406 Phone: � 'Zip: - License:349594 � / Status: ISSUED Applied: 09/23/2004 Issued: 09/23/2004 ISSUED BY: . � SCOPE OF PERMIT ` � REF 804-00606. 21 PACKAGED UNITS , 3 VENT FAN /SINGLE DUCTS, 6 FIRE DAMPERS, 6 � ,.. , SMOKE DAMPERS, 1 VENTILATION SYSTEM, � � �- i . ', ,-. ,y . , _ .. v , - ." . - ' ' � ' " FEE SUMMARY '� ' ' , ' � Quantity ISSUE FEE $23.50 �� . Repair7 Alt Absorbtlon Unit Inst FAU <100 k BTU � � $118.40' --�8-"---� - "�� - �'- ��.�� RepairlAlbRefrigeration�Unit Inst FAU >100 k BTU $236.60 13 - - - , � - - � � Ventillation System _ , � � Repair / Alt Cooling/Heat $0.00 0 � � - " ' Evaporalive Cooler - Inst hRep. Recess WaII.Htr $0.00 0 � Commercial Incinerator Refrig Sys <100 k BTU �'. $0.00 0 Domestic Incineretor � Refrig Sys >100 k BTU �' �. $0.00 0 ComDressors / AbsorDtion Systems ' Gas Piping �� . '� , $0.00 0 _.. Up to 3 hp / 100 k BTU ' - - Factory �Fireplace i � �� $0.00 0 `� � � � � �i � � -.��„� � •3To15hp/500kBTU Hood w/Meoh Exhaust $0.00 0 .• ��- �-^ -% � 15 To 30 hp./ 1,000 k BTU VAVBox,� •`��: $0.00 0 �;;,�"� • .. - 30To50hp/.1,750kBTU ;i' - Vent Fan /�Single Duct � ,� $21.75_� -3 � - - � . ` Over 50 hp�% Over 1,750�BTU � � � � Appliance - � , � �$0.00 0 � " Boilers � , � Fire Dampers .'� �� / �� $43i50� 6 � � `� Up l0 3 hp . Smoke Dampers - � • ; $43.50� " 6 � � , - 3 To 15 hp � Inst or Relocate Appl Vent � %� , $0,00 0 �z - � � � �-15 to 30 hp - - - . � Air Handlers < 10000cfin ' � ' S0.00 0 � - - � 30 lo 50 hp , , ' AirHandlers> t0000cfm�� $0.00, 0 - Over50hp � � Floor Fumace ' g0.00 . 0-�, - Other Mechanical Fee ' Floor or Suspend Heater �\ .=$0.00 �. 0 - ' Investigation Fee , , Plan Check Fee , -� - . , . �,� , Reinspection-Fee .- � � - _ .. . . TOTAL CALCULATED FEES NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under regulations. (Ord. No. 92-28, § 1, 12-21-92) � $0.00 $0.00 $10.65 $0.00 $0.00 $0.00 � $O;OQ $0.00 $0.00 $0.00 $0.00 $73.50 $434.40 �� $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ,005.80 Quantity 0 0' t 0 0, 0 , 0 ' p. j 0; 0 Q 5 16 0 0 0 statutes and related EXPIRATION: This permit shall automatically expire and become void if work Is no� commenced within 180 days, or if�work is suspended or abandoned iw a period of 180 days. %/ r INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appliceble codes, and all requlred Inapeetlona and finel approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae�e �avo� WORKEAS'COMPENSAnON DECLARAnON: • I hereby aHirtn under penelty of perjury one of lhe following tleclarations: ❑ I have entl will maintain e certilicate ot consent to setl-Insure for workers'-wmpensetion, es proJided for by sectlon 3700 of the Lebor Code, tor t�e peAormance of Ihe iV7ork for which Ihis pertnit is issuea. - w� flnd will maintain workers' compensation insu2nce, es raqul�ed by seciion 3700 of Ihe Lebor Cotle; forl rtortnance of Ihe woB lor whic� this pertnit Is issueC. My wo� ers' compensatlan Insurance c.a�rrner antl policy number ere: �i/ Carrie � 2(/��il� �%"�F/�/�� //1JG • Gc% - POIItyNumber l�G Z% �b l��'�— O� �s sectlwr need nof be comple ed il (he peimit is valuetl e( one hundred do/lars ($100) or /ess.) ❑ I certity Ihet in Ne peAormance of ihe work tor which Ihis pertnit Is issue4 I shall not employ any person in any manner so as to bewme subject lo the workers' com e tion laws oi Celifomia, antl egrea t�at should 6ecome subject lo Ihe workers' compensatlon provisions o1 Sectlon 3700 of the LaDor Cotle, I shall forthwlth mply wit e provisions. _ rj �—O � Applicant SlqnaW . \ � Dat�� — � WAR IWRE TO SEC ORKERS' COMPENSATION COVERAGE IS UN�L FUL AND SHALL SUBIECT AN EMP[OYER�GCAMAINAL PENALTIES AND CIVIL FlNES UP TOIXJE HUNDRED T USAfD�00LLARE(51 ,OOO�.INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3')080FTHEUBORCODE,IMEREST,ANDATTOIiNEV'SFEES. LICENSED CONTRACTORS DECLARATION: ot Chepter 9(commencing wilh Section 7000) ol Div' on t Ihe Business and Professions Catle, entl my license Is In full -- Z O _.. y � 3-0 CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm that ihere is e constmction lentling agency tor the pertormance ol ihe work lor which ihis permit Is Issued. (Sec. 3097, Civil Code). Lender's Neme: Lentler's Atldress: Slgnature: Q-' Date: OWNER-BUILDERDECLARATIONS: r�� I hereby affirm Ihet under penelty of perjury that I em EXEMPT PROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Business entl Professlons Code: Any ciry or couniy which reQuires e permit�to const[uct, elter, improve, demolish, or repeir eny stmcture, prior to its issuence, also requires tha epplicant tor suc� permit to file a signed stetement that he or she is Ilcensed pur�ant to the provisions ot Ihe Contracbrs License Lew (Chapter 9(commencing with Sectlon 7000) ol Division 3 oi the Business end Protessions Code) or ihat �e or she Is exem0� iherelrom end ihe besis lor ihe elleged e:emption. Any violetion ol5ectlon 7031.5 by eny epplicant far e permit subjects the applicant to e civll penalry ot not more than ilve hundretl tloliars ($500).): ❑ I, as owner of Ihe properry, or my employees with wages as Iheir sole compensailon, WILL DO THE WORK, and ihe structure Is not intended or oHered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law tloes not appty to en ownor of Droperty who �uilds or improves ihereon, end who does such work himself or herselt or thmugh hls or her own employees, provided Ihat such improvements ere not intentled or oHeretl far sele. It, howaver, the bulltling or impmvement is sold within one year oi completion, the owner-builder wiil heve the burden of proving that he or she did not build or improve for puryoso of sele.). ' ❑ I, as owner ot the properry, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professlons Cada: Tha coniractors Llcense Law does not apply to en owner ol proparty wha bWltls or Improves Ihereon, and who contracts tor such pro�ect with e contrector(s) license pursuant to tha Contractors License Lews.). ❑ I am exempt under sec. Business antl Professlons Code for ihis reason: Signature: Date: Owner ID venfied by tlnver's license. ❑ Ves ❑ No Driver's License No. Expires: Venlication of Ownership by (rype ol document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATON: ❑ I hereDy certlfy ihat no excavatlon tive (5) or more feet In depth into whic� a person is requiretl to descenq will 6e mede in connection with work aut�orize0 by Ihls permit, antl that no builtling structure, sceNoltling, talsework, or tlemolition or dismantling thereof, will be more then thirry-six (36) teat high. (Chap. 32, Grp 2, An 2, Sec. 341, 7tle B, Calitomla Atlminisirative Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e pertnit from Ihe Divisian ol Indusirlel Safery, es notetl ebove, unless suc� pereon has a pertnit ta do such work from Ihe division. Signatura: Dete: Division oi Intlusinal Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORRA710N OF ENTRY: I certity under penalry of perjury that I heve read this epplication end siate that the intortnatlon given is correct. I egrea to comply with ell state lews end ciry ordinances relating to bullGing constructian, end euthorize representatives ot Iha Ciry of Casta Mesa to enter upon the ebove-descnbed property lor inspection puryoses. I agree not to acupy or ellow occupancy of eny building authonzad by this permit un�il finel inspection. Date /-j� 2 � �y COUE r. � INSPEClIONiYPE b'fT011i5J �9ufIJ alrismem?� zzeoar. r.��i EWsoilqG��R:�svernoxTrre�.Z �iRnnq 2i�11 �d besi�anfuf.��w 4r1T :��ii __,...�. ....� ........�.. ..._ c . �......_..r_� 1616 Fi:edSystemFlnalFlrePrevenllon 208 FinelMechaniwl (S&fS-Sf,fa �a��17:-��{),z�i 1266 Bool Spe FInO�q ,� -...'-'��"--"-' yi qtOW lt 20B! pRFinaLPlum6in9� i. --._ �_.. .,.:�.ob�.,..., ,, auz z� Hi^'r� li 10 ? C"'". _ . . . .�C� � sDBGmolus IISA_ ` -.--- � '10"• """'7 200 Final Re-Root 210 Finel Electricel .zvsb O8� to boi��p G iot 201 bnFt Finel BIacWReteiNng Well�iw �Iqmoa '^� ��^ �•^,•, ^^^9 '�^�� n^•�.hi2noo ed �212;mo5inal FIre;Prevention��tus �I�ow 9dt r,' •^�•^ ^' .�qp'T'�ao�u� 202 ��mFin"afFactory Fire Plac"e9r11 ni 11u2at Iiiw �6voiqQu �snd bn6 2noibsqcni nie1tlJ220'+lufrFinefPlenningfApproval�6vo�qqe IBnit bns snoiM:fqenl bei(up�1 203 Final Sign 222 Final Site BSBi-DdC (At�) ' 1 �4:1 ?.Li[11T730�M1 FOq (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 345 FISCHER AV Suite No Vicinity: Parcel Nunmber: 42708104 Applicant: GRAHAM, ALAN Address: 404 WEST BLUERIDGE AVENUE ORANGE, CA Owner: SCHIFFMAN, TODD I TR Address . 9229 W SUNSET BCVD tk602 LOS ANGECES, CA Contractor: AMERICAN CONTRACTORS Address: 404 WEST BLUERIDGE AVENUE - Arch / Eng : � Address: ISSUE FEE Backflow irtigation BackFlow Preventer Balhtub Clarifier System Connect pce,Soda,etc) Dental Units ORANGE,CA Phone: 714-282-5700 Zip: 92865-4204 Phone: Zip: 90069-3406 ISSUED BY�, Status: ISSUED Applied: O6/18/2004 Issued: 06/18/2004 - Phone: 714-282-5700 � Zip: 92865-4204 � License: 309863 Phone: , Zip: _ _ . . _ - _ License: � . SCOPE OF PERMIT REF: 604-00606-TENANT IMPROVEMENT FOR "ROCK HARBOR CHURCH". 34,176 5�. FT. SCOPE OF WORK TO INCLUDE: NEW SANCTURY, CLASSROOMS AND BATHROOMS AND OFFICE SPACE. BUILDING IS OF MIXED OCCUPANCY (A2.1/A3/B/F1/S2) AND MIXED TYPE OF CONSTRUCTION (V1HR�AND VN). ' PLUMBING PERMIT WILL INCLUDE: 1 FLOOR SINK, 1 SINK KITCHEN, t SERVICE SINK, 1 DISHWASHER, 4 DRINKING FOUNTAINS, 2 TRAP PRIMER, 4 URINALS, 11 N/ASH BAS , 13 ' TOILETS, 3 WATER HEATERS, 1 WfR PIPING. .}-CQl �� j�Y��S :� ' AMT $23.50 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer . $0.00 0 Landsrape Irrigation $0.00 0 P-Trap � $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 SepticTank -. � $0.00 QTY 0 0 0 0 0 0 " 0 SumpPump, Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(t-4) Vacuum BrkrBkFlow(5+) Wash Basin AMT $0.00 $0.00 $19.60 $39.20 $0.00 $0.00 $107.80 QTY 0 0 2 4 0 0 11 � '�� 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) EXPIRA710N: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and final approval must be obtained. Failure to obtain inspeciions and final approval will result in the ezpiration of this pertnit. FOR INSPECTIONS CALL: (774) 7545626 2446d61d�) WORKERS'COMPENSAnON DECLARATON: � I hereby aHirtn under penalry of perjury one of the lollowing tleclarations: ❑ I heve end will malntain a cenificete of consent to self�lnsure for workers' compensetion, es D��tled for by section 3700 of ihe Lebor Cotle, for the pertortnance ot the work for which Ihls permit is luued. 0/I have en� Intai� ' canpens�tion i�es requiretl by sectian 3700 0l the Lebor CaAe, for the perfortnance af Ihe work for which this pertnit is issued. jMy mp tlon Insu te ted�ar end Ilcy numDer ere: ,L Cerrier: �w � Pdicy Number: DI � I.�% `13 '�3 (Thls sec on need nat be comp/e il the p it /s valuetl at one huntlretl0ollers (Sf 00) or less.) ❑ I cartiy that in the p o ance of Ihe rk for which thls pertnit Is issued, I shell not employ eny person in any manner so es to become subleci �o the workere' compensatlon law ot Ca'r mla, en agree that II 1 should become sub�ect to the workers' compensatlon pmWsions at Saction 3700 of the Labor Cotle, I shall torthwith ��omplywiththesa rovisi s. ' / �j �[ App4cent Signature: �Date•— b� � 0� � 7 WARNING: FAILURE TO SECURE WORI(ERS' 15ATION COVERAGE IS UNLAW FUL PND SMALL SU&IECf AN EMPLOVER TO Ci11MINAL PENALilES AND CML FlNES UP TOONE HUNDRED TFKKISPND DOLIARE (5100,000), IN ADOfTIIXJ TO THE COST OF COMPENSATION, DnMAGESlS PROVIUED WR IN SECTION 3'1080F THE IABOR COOE, IMEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I herehy.aRirtn that I am licens u�nde�r qroNsio brce anC'ettecc Uc. s ��`'7 � Contr ca tofs SigneNre: Chepter 9(commencing wlih Section 7000) af Divislon 3 at the Code, anA my licensa Is in full CONSTRUCTION LENDING AGENCV: ❑ I hereby aNirm ihet ihere is a wnsiruclion lending egency br ihe pedormanca of iha work br which t�is permit is issued. (Sec. 3097, Civil Code). Lenaer's Name: Lender's Adtlress: SigneWre: Da�e: OWNER-BUILDERDECLARATIONS: � � I hereby aNirm thet untler penalry ot per�ury thet I em E%EMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professlons Code: Any city or county which requires e permit lo constmct, elter, improve, damolish, or repair eny siructure, prior lo its issuance, also requires the epplicant tor suc� permil to tile a signed stalemen� that he or she is Ilcensetl�prsuent to the provislons ot the Contrectors License Law (Chapter 9(commencing with Seclion 7000) ot Dlvision 3 at Ihe Business and Proteulons Code) or that he or she is exempt ihe�elrom end Ihe besls foi Ihe elleged exemptian. Any violatlon of Section 7031.5 Dy any epPlicent far e parmit subjeds �he epplicent ta e civll penalry of not more than flve huntlretl tlollars ($500).): ❑ I, as owner of the property, oi my employees with wages as iheir sole compensetlon, WILL DO TliE WORK, antl t�e simcture Is nat intentletl or otterad for sale (Sac. 704d, Business entl Professions Code: The Contractoro License Law tloes not epply to en owner ot properry who builds or improves Ihereon, and who does such work himself or herself or through his or her own employees, provided ihet such Improvemenis are not intendetl or oNered lor sele. If, however, ihe building ar improvement is sold within one year ot completion, the own6F-builder will heva the burden ol proving that he or she did not builtl or improve tor purpose of sale.). � ❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the praject (Sec. 7044, Business end Protessions Code: The conirectors License Lew tloes not epply Io an owner of property who bullds or Improves t�ereon, entl who contracis tor such prolect with e contractor(s) licen5e pur5uent to the Conttacbrs License Laws.). ❑ I am exemp� under sec. SignaWre: Owner ID venfietl by arlvers license. ❑ Ves ❑ No Business enA Protessions Cotle br this raeson: Venfication ot Ownership by (type oi tlaumem, i.e. - pmpeny tax blll or deed): Dnvef9 Lltensa No. Dete: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby ceNfy that no excavetion five (5) or more feei in tlep�h Into which a person Is required to descend, will be matle in connection with work authorized by this permil, and Ihat no huilding struclure, sceflolding, talsework, or demolition or dismantling ihereoi, wlll be more ihan ihirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 3C1, Tltle 8, Celifomia AdmlNSireilve Code). ❑ As owner-builder, I will not employ enyone to do work which would reQulre e permit Irom the Divislon af Intlustrlel Sefety, es noted ebave, unless such person has e pertnit to do such work from Ihe tlivision. Signature: Date: Division of Industrial Safery Pertnit Num6er: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF EMRY: I cenify under penelry ot perjury that I heve read this application and state Ihet the intortnation given is cortect I agree to compty with all state laws end ciry ordinances relating to builtling constructlon, entl authorize representatives ol t�e Ciry ol Costa Mesa to enter uDon ihe above-descnbed properry for inspectian purposes. I agree not lo occupy or allow occupency ot eny 6uilding authorized by this pertnit until final inspeciion. COUE I, INSPEC710NTYPE 1616 Fixetl System Final Fire Prevenllon 7268 Pool Spe Finel 200 Finel Re�Rooi 201 Finel Block/Retaining Well 202 Finel Factory Fire Place 203 Final Sign 20a Final Demoli�lon Owner(s) Date (a.i 8-,0� ADoican � Date Q�, �$ �QQ€( INSVECTIONTYPE 206 Finel Mechanical 208 Final Plumbing 270 Final Electrical 212 Finel Fire Prevention 220 FinalPlanning Approval 222 Finel Site 250 Finel Building/Occupency Pe� li� ' 7'O � )�a � ;, � � �I Pfl0.1ECT ROOHE55: 3 4 S F I SCHER AV owxen s xnmE: SCHI FFMAN iODD I aooecss:9046 SUNS�.T BLVD #202 LOS ANGELES,CA 90069 RNCMIENGINEEN: ADOHE$$: UNIT: NFG.NO.: UNIT: PEBMITTEE: SOOTH COAST FIRE ( 714 ) 259—] 770 aooxess:15042 PKWY LOOP A TUSTIN CA 92680 LICENSED CONTpACTOB OECIABAiION: I her¢Gy allirm t�a� I am Iicen5e0 un0er D�ovisions ol C�aD�er 9(commenting wii� Seciion 7000) of Divisian 3 0l �he Business antl Prolessinns Cotle, antl my licensa is in lull lorte an0 ellecl. ciTruc.:053011 sTATEuc.:533669C— cuss:l6 Date: �^� ( — � � Sign'a� WOPNEPS' COMVENSATION OECLABATION: I �ereby al�irm Iha� I have a cetlilicale oi consent lo sell�insure or a certilicate of WorNers' Compen5alionJnnurOnce'1rA Geriilie��`oDY ihereol (Section 3800. Lab.CA � O i� 9 4 eoucr No.:STATE�FUND EXP. UATE: V� � COMPqNY: ,i, ❑ Cerli�ieU copy is Aereby lumished. l'J CertilieJ caDY is filei wilh Ihe ci�y Building �ivision. 1 oaie. 3-61—c13 nnn � �— E%EMPfION FflOM WOPNENS'COMPENSATI�N OELLl�BAiION: (Thissection ne¢4 nol0ecomDl¢IeOillhe p¢rmilisfoione�unEreE�511p)orlMs�. I ceNfy Ihat in Ihe pedormance of ihe work br which ihis permit is issued. I shall nol employ any person in any manner so as lo b¢come su0lect lo t�e WorkeR' Comp¢nsa�ion Laws ol Califomia. Oale: ' SiAnature: NOTICE: II, alter making Inis eeclaration, you shoulA become subie�� a �he WOBers' Compensation provisions of Ihe La�or Cotle. you mu5� IOtlhwiih com0ly wil� SUch Orovisions or Ihis permi� SAall Ue deem¢U revOkeO. CONSTNUCTION LENOING PGENCY: I �ere6y allirm Ihal Ihere is a conslmc�ion lentling agenry lor the pedormance ol �he wotk lor which I�is permit is issued �Sec�ion 3097, Civ. C�. LENOEX: aooeess: OWNEfl BWIDEB OECIANATION: I �ereby ailirm �hal I am eeemD� ��om Ihe Conlraclors' Sta�e license Law for t�e I011owinB �eason (Seciion 7031.5 Business ana Pmlessional Code: Any city ol coun�y which requires a permit Io conSimcL aller, impmve, tlemolish, or �eoair any s�mctwe. prior to its issuance. also repuires ihe aDPlicant lor such permi� to file a siBnetl slalement ihat �Gshe is licensetl pursuam Io ihe pmvisions ol Ihe Coniraclars' State License Law �C�apter 9(commencing with Section 7000) ol �ivision 3 of Ihe Business antl Pmlessions Cotle) or ihal he/she is exempt iherelrom anA Ihe basis br Ihe allegetl exemption. Any viola�ion ol Sec�ion 7031.5 by any applicanl loi a permil su0jecis I�e applicant lo a civil penalty ol no� more l�an live AunAreA Aollars (5500�. I, as owne� of ine pwoeny or my employees wilh wapes as iheir sole com0ensation, will do Ihe work, anU ihe ❑ slmclwe is noi inlenaed or ollere0lor sale (Sedion 70a4, eusness anE Pwlessional CaAe�. The Convactori Staie License Law tloes nol aOPly lo an owner of a D�oDetly who builOs or improves thereon, antl who does such work himsell/hersell or t�rough �is or her own emDloyees. D�a��4eU t�al suc� impmvemenis are nol intentle0 0� ollereU lor sale. If, �awever tAe UuilAing or , impmvemenl is soltl wiihin ane year o� complelion. �he owner will have Ihe �urden of proving he/she did not 6uild or improve lor ihe purpose ol sale�. I, as owner of Ihe pmpetly, am exclusiuelp conlrac�inB wi�� licensetl conlraclars to consimct Ihe pwjecl (Section 7044, Business ❑ antl Pmfessions CoAe: T�e Canlrac�ors State License Law tloes not aDDly Io an owner oi OmOetl9 w�o builEs or impmve5lherean antl wno comracis for such pmiec�s wilh a comracmqs�license pursuam io the Coniractors' State licensa Law�.l am aware Ihai pmol ol Iheir Worker'S Compensalion insurance shoultl be pmvided lo me. � I am exempi un0er Snminn: B. 8 P. C. , lor Ihis reason: Daie'. Owner I eo herehy ceniry tna� I am aware al and untlersianU the requiremen�s of Cablamia Healib ana Salely Code Sections 25505, 25533, and 2559a an0 ihat I or any �Nure building occupant will/will nol (circle one) need lo com0ly wi�h saitl state cotles and the requiremen�s lor a permit loi conslmclion or moUification Irom I�e Air Ouably Management Oi5lricL Re5i0ential conslruction apDlications are exempt Irom IhCSC pf0Vi5i0n5. �ale: Applicanl: I bereDV �¢riily Ihai I Aave read�Ais apP�ication antl state Ihallhe aDoveiniormation is correcL I agree to comply with all ciry anE counly or0inances antl slalelawsrelalinglo building consimclion and here6y aWharize re0resen�alives ol�his ciiylo enleru0onl�e a�ove�men�ioned property loi inspeciion purposes. � Dale: �� ( ^��3 5�'�YC /�1 DriveYs Llcense or Social Securny 16aL46 White—Builtling�, Green—Co�e Enlorcemenl: Canery—AOPlicanf, Pink—Revenue: Goltlenmtl—Assessar CITY OF COSTA MESA — BUILDING PERMIT rnxiiv�; r voi�� PERMIT NO; F 061333 FLAN CHECR NO: 00739-93 L u vi; rv �rr: �v CONSTRUCTION TYPE: PERMIT T'YPE; FIR PURPOSE; OTH JOB DESCRIPTION ; BACKFLOW RETROFIT SQ FT; CLAIM VALUE: 8,200.00 CALC—VALUE: GROUP OCC; B-2 / COMMENTS: BACKFLOW RETROFIT f'OR "FMH" �+��r�x-�*�c*x**��*�x�x•�+�x��-x��+�x�+�**x�x*��xx��*x-x*x*x�*�xx�xz��cx��xxx��x*x-�*x*�..x.�;..�*x Z O N I N G R E Q U Z R E M E N T S s�TBAcxs ------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT? FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT;� FT IN RGHT; FT IN LEFT; F7' IN RGHT: FT TN PARKING RE • PROV; PARCEL: 42708104 2NE; kEF NO; PLANNING N TES> i 3E 1Fit k iF if if iE if 1f 1F k if ik it iF if if !f 1E it it iE iE k!h iFlf iE iF it it if 1t it ih 1!!f iF �%� k iElP it if N�if if if iE iFlE fF iF i6 it if !E %� k it il� it ft-1E iE iE iE it!(� if N� fE #�EiF 3E 3f iF D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED HY ; DATE: APPLICATION ISSUED BY: �- �rr DATE: �� .%..N�ik�f3flE�%ik�14�1fif�lkifikihifitM'ihlfiE�M�TFiF�FifiFiF�F;F�iriiF � �iFSF if�iFiF7FSfdiiFR'dF3E'SF7F7fiFiEiE1Elk3Plf�lElf3f. r . .'3tiFik !E iE N 1E N� k af ik iE iE iE 7! iE iE 34 it iE if 3f iF iF if iF�lf� 1E iE IE iE iF iE iP iE if if )t iE iP 3F if dE IP iE 3F 3k fE iF iE iF ih N� iE iF ik iE if jF1f i(� i(� iF jF 3E �3F # iF if fE 1F i(� X� if iE iF K-3Flk 3k i6 iF LEGALIZATION:N F E E S L1 M M A R Y STRUCI'URAL SEGMENT;N HLDG PMT PLUMBING E:LECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 108,00 653 5MIF/NON—RES PLAN 70.7.0 ISSUE FEE BUILDING—DIV—> PERMIT IS5UE PLAN—CHECK TOT'AL PAIP DUE iTOTALS----> 108,00 0,00 70,20 178,20 178,20 .00 REVENUE DIVISION TOTALS--> COLLECTED; 108.00 OVER/SHOftT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING FLAN—CHECK 1�8,�� *�xxxzx*****�t�t*xx�c�t�+t�K . x��x�tx�t+r�x�c�x��r*x+��rxx x�c..x�..... x� xxxx*��*�r*x�x��c�x�*xxxxx�c I N U I V I��U�I, F' E E H R E A K D U W N TYPE QTY D E S C R I P T I O N UNIT COS'P TQTAL COST FIR 108 FIRE E�UZP FEE (FROM BLDG VAL 'PAH1�E) 1,00 SO8.00 END OF F'6'ES t 'J � _., . . �, . . . i'�T�.'; . - _ CONSTRUCTION AND PLANNING PG b SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector t, Temporary Electrical Service or POIe 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Condurt-Undrgrnd. 55. Electrical 9ondinq 5. Steel Reinforcemen[ 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Foocings 58. Eleetrical Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P�Trap, O Undrgind. 10. Structural Floor System 61. APPROVALTO DECK i i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & VenbPinal 13. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing 65. Electrical�Final 15. Rough Electrical•Conduit 66. Solar SYstem-Final 16. Rou9h Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPftOVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPq SYSTEMS FINAL 19. Rough Heating & Air Conditibning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. DuMs, Ventllating ' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe�Rough & Test - 72. Underground Flush �(-'7$53 �1(� 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74, Overhead Hydro i 26. T•Bar Ceiling (Structuraq & Monocoat 75. Ory Chemicai 27. Freme and Flashing 76. Dry Standpipe 28. �athing & Siding . � � 77. FIXED SYSTE(vl FINAL 29. Insulation I ( I 78. FIRE PREV. FINAL y( 1$•Ct3 � 30. Drywall Nailing ' I HEALTH DEP7. REQUIREMENT i 37. P�aster Brown Coat � � 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Eleciric � � i I Notes: 34. Final Heating & Air Conditioning � � � � 35. Final Gas Pipe�Test I � i � 36. Hood or Canopy ' i i 37. Final Factory Fireplace � '{ I 38. Fina� Plumbing 1� I 39. YVater Service�Final � � � 40. Gas Service-Final � i 41. Solar pomesticFinal ' � 42. Backflow Preventer I 43. Backflow �rrigation 44. Landswpe Irriqation System 45. Sound Attenuation 46. Handicap Reguiations i 47. FINAL STRUCTURE & BUILDING i 48. fINAL PLANNING . 49. Electric Release to Edison � �_ 50. Gas Release to Southem California Gas Co I 51. CERTIFICATE OF OCCUPANCY No. Date Pfl0.1ECT RDONESB: � 3 4 S F I SCAfiR ' AV OWNEP'SNRME: FLEX METAL HOSE • 4DONESS: $j�E . 751-1000 RNCHIENGIXEEB: ' ' ' . FOORESS: � UNIT: , , .: . , HEG.NO.: � UNR: . PEHMITTEE: ISAACS PLUMBING . ' ' � ( 714 )�641-1499 �ooaess: Z033 SO. MAIN ST. --- �SANTA ANA CA 92707 llLENSEO CONiMC70R UELUMTION: I �ereby atlirm that I am IiceriSeE unEer provisions ol Chapter 9(rnmmencinp waA Section 70W) al Oivision 3 0l t�e Business anE Profeulons CaUe. anA my Ikens in lull /orce antl enect. cmuc.: 30556 �p��•�429549 �S 36 Date: SiO�ature: WONKENS'COMPENSATIONOEClAMT10 : IAereUyatlirmUatl veaceNfmalea/consenitoseli-inmre c ifcateofWorkers' Compensation �s4rw g, or ac�rtQie� yapy �eteaj ISe�tion . Lab. yI. , PotICYNO.: ��, 1/b� UU4 �(p,DQE: V8P25/90 . toMP�Nx: NATIONWIDE � Cerlifietl coDY is here0y fumis�e0. � ertilie0 wpY is fileE R he ciry Bu' inp �ivision. ' - , - Date: Appllcanl: � IXEMPf10N FAOM WOflKEflS' COMPENSIITION DECIAMTION: .(Ilus 'on nee0 not De completM if Ihe pemnt is for one h I100� or less . I Certi/y �ha� in tl10 peAofmance o� ��0 w01k lal whiCh IIIiS p¢rmli issueG. I Shall noi employ any perwn in any man r o a5 to hecoma WGiEtI �0 lI1C WOlkER' Campensaiion law5 0� Calitomia. , Oate: S�qnature: - � - - N�TICE: tl, atler makinp t�is Geclaratlon, you s�oWA become su�lect to the WaMers' CamOensation Orovisions of Ihe Labor Cotle, you must forttiwlth cumDly vntA such pmdsians ar ihis Dermit shall Ce tleeme0 revoke0. � CONSTPUCTION LENOINO �GENCY: I hereGy affirm that Nere is a construction IenOing aAency for IAe petlormance ol t�e woB for w�ich �his permit i5 i55ueA (Section 3W7, Clv. C). � " , LENDEfl: i , ' ' ' �OOflESS: ' - ' � � � OWNEfl BUIIDEN DEClAIL1TI0N: I �ereEy allirm tlwt I am exempt Iram tAe Cantactors' SWta License Law tor IAe followin0 reason (Section 7031.5 Business antl Professional Catle: My city of counry which requires a permit m construct,�alter, impmve, Oemolish, or repair any stmcWre, prior'to its Issuance, also repWms the appliwnt lar wc� permit to tile'a sipnetl statement that �e/s�e is'llcenu0 pursuant to Ne Drovisions of t�a Cantradors' State License Law (CAapter 9(commencin0 �� tion 7000) at Division 3 0l the Business anC Professions Code) ar that hdshe is exemDt iherelrom anU the hazis for ihe alle0etl exemption. My violaGon ol SecGon 7031:5 Oy any aODliunt for a Dermi� suDl��s the apDlicant to a ciWl penalry of nat more ihan 1Ne �untlre0 Uollars (5500).' I, az owner ol iM properry or my employees xit� wapes az ttrelr sale comDenution, vnll Uo ihe,wak, and IM ❑ slmcNra is nat intenOeO or ottereE lor sale (Sectmn 7044. Business an0 Pmlessional Code: T�e Cantactars' State License Law Oces not aOVN �o an awner ol a properry wM OuildS or Improves IAereon. anE wla Eaes such xrork himsell/herself or tAroup� ��k or �er own emDloyees, provi0etl [Aat sucA impmvemenls are not intenaeE or ottereE for sale. If, tpwever'tAe EWIEInq or impmvement is sold within one year ot campletion, t�e owner vnil �ave t�e Gurden'of provinA he/s�e EiE not build or imprwe , lor Ne Durpose ot sale). ' - _ � � �I, az owner a/ Itre D�acehY. am e�clusively contracGnO �� Gcensetl contractars ro consWp t�e pmject (SecGon 7044, Business ❑. an0 Prolessions CoOe: The Cantnctors' Siate Liunse Law Ooes not apDN m an owner oi D�rry �w OWEs or improves Nereon and who coniracts for suc� Drol��s with a contractor�s)license pursuant m the Contractors' State License Law).1 am aware tlut 0�� oi t�eir Worker's CamDensatlon insurance stroul0 Oe D�aed ro me: ' ' � 1 am exemD� untler Sectian: � B. 8 P. C. � . CITY OF COSTA MESA - BUILDING PERMIT PERM NO;�P• 046943 PERMIT NO: P 046943 PLAN CHECK NO: � N GOVT; N SOPP: N CONSTRUCTION TYPE: " PERMIT TYPE: PLU PUAPOSE; OTA JOH DESCAIPTION ; EARTHQUAKE FLEXIBLE GAS VALVE SQ�FT; ' CLAIM VALUE: . �CALC-VALUE: GROUP OCC: . / COMFIENTS : ***�r��r*x��r�e��**xx*x��r*�r**x�r�r*r***+t�r**+txx*+rx�xw�e*�e�***�r��r�e�r**�***�r**�*�r�r***�r�e* Z O N Z 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 --------- FANT; FT IN REAA; FT IN FRNT: FT IN REAR: FT� 'IN, LEET: � FT IN,RGHT: FT IN LEFT; FT IN RGHT; FT IN PARKING REQ: PROV; PARCEL: 92708104 ZNE: 'REF NO: PLANNING NOTES> • > • . _. . M iF iflflk if it ik if if if if 1k 1f f! 1k 1k ik ik if if it dF iF iF 1F 1F iFlk ik if 1flflk ik iF if iklk i! 1klf k 1t ik 1F 1! k M iF if 1f iF if 1f 1f k Ik M if if iE iF'1F if M iFlF 1F 1f k iF iflF ik 1f iflF �t D E V E L O P M E N T S E R V I.0 E 5:-: R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPAOVED BY e _ DATE: ,� DATE: APPLICATION ISSUED BY: "' - DATE; r-- — v MiFihikkiFifitlfMffikififfflflkfk�flfltfF 1kM1ElkltitikifiEiE ifit ik k if ik it k it k M M If M N�Mlklk if !f if �Fjf M iFlF iF it 1! if iflF if if if iE iF 1f 1f if �t k!f �f 1f !F k!F iF k k iF it M ik M 1E �t M �E it iE it if if ik iE if if if if ik fk 1f iF iF �ElF iF iE iF LEGALIZATION:N F E E S U M'M A A Y STAUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT ' 2,00"�' 252 - SMIP/NON-RES PLAN . +. , ISSUE FEE -3.00, BUILDING-DIV-> PERMIT,� ISSUE PLAN-CHECK TOTAL ' PAID . DUE TOTALS----> 2,00• '3.00 ' 0.00 5.00_ 5.00 ,00 : �_ .. 'REVENUE DIVISION TOTALS=-> COLLECTED: S.00�;�OVER/SAORT: ,00 • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK . . rJ.�� ,. , - . i , - � iFitifiFiFiFMMifMMMKiFiFiFlfiFiFififiFK�f�f�F�fiklfikif3tif1Ei4MiFifMMMMiFiFiFifMaFiFiFiFifiFMik%it�FlfiFM�FiFiFNKKMiFiMiFifiFiFifififiFiF I N D I V I'D U A L F E E. B R E A K D O W N tor tnis reasan: � � . ' TYP E QTY Date: P�mer: PLU� 1 I Jo �ereDy ceniry ttwt 1 am aware ol an0 unEerstan0 ine reauiremenis al Calilornia Healtn ana Sa(ery CoOe Secuons 25505, 25533, and ' 25534 anG Wt I or any tNua DuilEinp occupant vnlUwill not (drele one) nee0 to camply wit� sai0 staie codes aM Ue requiremen6lar a . _ permit for wnstruttwn or maUilication imm ��a Nr Uualiry Manapement District. ResiOential consimnion apDliwtions ara eaemD� �mm these D�avisions. . Date: � ApDlicant: � • I �ereby cerliry iha� I have rea0 tAis aDD�icatian anU state that tAe above inio ' n is correcL I aqree ta comDN �� atl ciry anE counry ' , orEinafrce5 anG state Wx3 2Wtln0 �o EuilEinp conSlrutUon antl her¢Oy aut�� ' B r eSenGC a1�Gi � r upon Ihe ve-menlioneE � . . propeM � �insD ian Dur sw. Oate: � I Sipnature: � , « oriver's �icenu or Socia� Securiry � ' t6a�-4fi- White—Builtlino; Green-Cotla EnlorcemenC Cenen—AOollcent D E S C A I P T Z O N GAS SERVICE END OF FEES , ' UNIT COST .TOTAL CO$T 2.OU 2,OU ' O1 QQ05857`-�d0`3`75 TCoT' `.00 DATE: Q;/16/90 TI17E: 11:11 ` ��. ,CONSTRUCTION AND PLANNING �- P� � SPA � i �4PPROVALS Permit# � Date Inspector Date Inspector %' APPROVALS Permit # 1. Temporary Electrical Serv�e or�Po�e,� ;� - , 52. Pool & Equipment Location , '� � � �2.LSoil P�e�Undrgrnd�� ' �'�' nr 53. Steel Reinforcement � - '-�V3��.ElectricalCondGit=Gtility-Undrgrnd?S �^ '� � 54. Forms � � � . .n ��3. Electi�al Condi�it�llndrgmd. �b . � 55. Electrical Bonding ' ' +-+i�i. Steel3ieintorcemenF, r�� x �' 56..Rough Plumbing & Pressure Test . O ,.�,« .. ��5. Electrical UFE�3.LGrnd. y o 57. APPROVAL TO COVER�GUNITE v �r7. Footings y�=: � c 58. Electrical Conduit-Undrgrnd. o j�8. Foundation �'r� � , . � , 59. Gas Pipe, O �Undrgrnd., Test � � 9. Water Pipe-Undrgind. ' }; 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Structural Floor System' .•'' � �� 61. APPROVAL TO DECK � 11. Property Sewer Lin�& House Coni1"ection '. ,� 62. Backwash & Receptor�Final � - �� 12. Sewer Cap d re c+ 63. Heater & Vent-Final , .� 13. Roof Dreins �'o �„ .'� 64. Plumbing System - Final 14. RoughPlumbirg :. . 65. Electrical-Final� �' '• � 15. Rough ElectriC�l-Conduit �.,' ,' �'' 66. Solar System-Final ;., �� 16. Rough Electrii�Viring �� /�p ��- 67. Fencing & Access Approval i7. Rough Wiring 4igh � 68. APPROVED FOR PLASTERING 18. Rough Electricaj-T Bar Ceiling 69. POOUSPA SYSTEMS EINAL 19. RougFi Heating & Air Conditioni� � � FIFjE QEPT.�EQUIREMENT e-� , � C� nv� i`• .-rn � cn m s: x cr' �..�-+ c,;. .s F tr � ! i l ti y 1 C'.. Cry �^ X V � Q' i; Y, n "� C" �!� (�, * �+ '7 20MRoogh Eactp�y F�i place .,, -APPROV L�S f.,�..,Pe��y�it #� S i s. ��¢ � s r, ci: �. -. 9... 214Du'c�ts, in Str�TictJ�pY � �" "' '-"Y * ` n n* � �70. �Undergio�n`� H�ro » 22.-Du�s, �ent�'ti `"� ' `''S * S ��" �' : "'� � � C�OiI t�a r?9,�c � CJ t t7 �y C� -,x � 77. Produ4t7,F'C'ping �, s 23.�fia^Pipe,Rongh &,Test i [�75 *(+7 tJ' rn O� * 72, Undergr�ntl Fh,�S� � E' 24�"Roof Ftaming * � �"F" "'�`",.� % � � � H* * „73yUndergrna. StorB,y�Tank�LJGas ❑ Oil 25. Rot�f SlSathing :k d v �� O> cux i: �74.;Overhead Hydro'�� * ..� ... nK �; <rn � 26`iT-Bar Ceiling (Stru�tural) B�=M��'pcoat * o O ``�'� * 7 cDr Che �cal y *�' � � 5 ..a� � O 7+ U'x x 5E Y �E .F� � 'Q 27tiFrameaqd Flashing� p�r� x^ �+ ��ic k 76. Dry S[an�'pipe �� *' �V �+ � Y � Y� n n �28. LathingT$i Siding * �� C�� * � •.� ..� } 77�.7y FIXED SY�^1'E[��}1±�1A� H n ,��,' r29. Insulatiw'o� * S •• �� I ( �* 7 J FIRE PREV. FIN74L �= ''x H T30. Drywall�`(Vailing � � � # � I � � * Sa,` � o'�F�IEALTF[�DEPI�. �Fi'EQOIREMENT � i m �. i ��,... . . • r� � �31. Plaster Browm Coat!: S i c�'C�' * I ( �x �-79. FINAL IW32ECTIDN �• . 32 �ElectriG'� Power Mkter-Final� " N �� Y 80�FOOD CERTIFtC'A"'TE I�S�LED Q � � W 1 �K � # ^] � f'! 'V,^ p' ?t 1 x I V B: Fi '# . .. ' � L �33SFirra,l Elactrie, �: �s: � Q �: I I �k i. Notes: ; '7c*1 'A"'] G C7 � ...� n r < ��34nFir�l Heatin;97& Air'Coriditionin� �% = � � �!' � � S� Cl� * S C7 x � c7 J F i*� ;, K'� Fs x �y 1 F cC y. � 35�Final Ga� Pipe�Test� ps .: �(si D�,qpi; � �� x� �jF., � r• '�36. `Ho'od oP=CanopY �' D � tT� �7 a r C1 K M .e. ;1 O * T R' � 5 C t. �i I�'. C�! u s: . I �' it•, ' %C o fi[*] C i H V r � �K :-� 1 ' V .f s � � . �y37...Fina7 FaFtory Fireqlacex i;-•F o + I I t � M {u �38. Final P13mbing *�� C C� (j�Qv �KK * f H � � 4 - �"39. Wat�r Service�Fina,�'� � i � `i � ,� � � * � y"' * `�' t*;40. Gas Service-Final r� m Qt�cT� s w tT; I ��.* x O�v �;� * M rr � F. F, m K I * E' • ��.. A tL �41. Solar pomestic•Fin�ls n " � • * �`� '" ;-, ;•� x: j I * ,� .o c - a �42.�Backflow Preventerk � ro � v � � �ti � x 7E- '! C' f- Y ftl !1 N H M( H �( X if [�'i C * F 43. Backflow �rr� atio* aSS '� �` � ''`� x`'' �' N � r .cz �* � � n T44^Landsc�e IYtipatiAn Syster��1CJ M * i�l � G v* * N ,N '^r � (U o O� �S i45`.�Sound �Attehuatior� `"�`�" R' * � `� " n* �` � � " ^'" y. 'k r LT, m x M .T 'Q • F 3 r c� . ' p46.••HandicapRegulations f- C * *: ��C S �o S * �:� � � t n; r �c o,47sFIf�.L STRUCTUp E& BUItDING � x 7 N S a #' r E. I � x � tf X 48^FIPIAL PLANNING' � i-�F x N � I s� *-, [� C � `-� � s: � I•..� M x . CJ N S �K � a49Q;Electric Release to#Edison � * I � . � * , ,� .n w a50SGaCRelease to Souihem Califwn're Gas Co � ; � ��' '� po �C�i i � o -.�51. CERTIFICATE OFkOCCUPANCY � � r� s c� mc „ . No. Date � Applicant-to fill in all sDaees except those�within heavy borEer lines antl sign a�l ao��opriate �FOMIT IV(l .. TR�(`T N(1 I(1T Nll CiTY oF COSrA AME'StAt CONSTRUCTION PERMIT ''""' "'"� � Proje:�ddress y�7 �/ s � � ✓ � Applicant'sMailingAddress �V�00 g �wvl.urr�� s�rfw4.•,� Owner'sName �Lie.�L�-��-6 '�.iae6 Phone�.i_�zyszi Address Arch/Eng. License No. Address � � • Contractor'sNameg.�a�l-�.i T� W ,ho . 7=15-OLi10 Addresslmailing) �..{.�9m .S V Mrl.�✓ SAy;# Ah� City License No. � G 5� 2 9 LICENSED CONTRACY�R DECLARATION ' � 1 hereby aHirm ttlat 1 a�n licensetl untle� prOviSiOni of Charte� 9(COmmencing with SeClion 7000) ol p��sion 3 01 the Bu5ine55 antl P�ofe55IOn5 Cotle, antl my license is in full (orce antl etfect. �' .(� / License Class ��_��¢nse No. j 9 Z-7.Z.G Date_�_��ylgnature �� '� y�JORKERS'COMPENSATION DECIARATION E; hereby aHirm tnat I hava a certifica[e ot consent to selt-insure or a certifi<ate 'ot Workers' Compensal{on Insurance, Or d C¢rtlfietl cOPY th¢r¢ot (5¢ction 3800, Ldb. .C�.`1_ + �., � � Po11cy No. JpL�/�4%ZCompany�/�� ST�'� [ifletl toOY is �eraby (umishea. Certifietl <opy is flle�tl �w�th the city Builtling DlviSion. ...�'� 1 Date�=Li_YT.APPlicant C��+M��%��.y EXEMPTION FROM WORKERS' GOMPENSATION DEGLARATION (Tnis section neetl not be �ompletea if Ihe permit Is tor one huntlretl (5300) or iess). I certlfy lhat in Ihe pe�fo�mance of thC wo�k fo� which this pe�m�t is iszuetl, I shall not employ any pJrson in any manner so� as [o become subject to the Worke�s' ComDenSation LdwS of California. Date 99nature �NOTICE: II, after making this tleUaration, you shoultl becoma SUDject to the WorkCrS' COmpenSdtion PtoviSionz O1 the LdbOI Cotl¢, y0u must fofttlwith � comply with such pro��sions or this permlt shall �e tleemetl revoketl. CONSTRUCTION LENP�NG AGENCV � 1 M1ereby atflrm tha[ ther8 is a cons[�uctlon lentlinq agency for the performance o! the wa�k fo� whlLh thi5 pe�mlt is issuetl (Sect�an 3097 Civ. C.) ltnder•s Name LenEer'z Adaress OWNER BUIIOER �EGLARATION I M1ereGy aHirm that I aR� exempt irom the Conlractor's License Law for the foliowing reason (Sectio� ��31.5 Bu5ine5s antl Professlonal Cotle: Any city or munty whlCh r¢quir¢s a PGrmit t0 ConS[ruGt, al[¢r, improve, tlemolisfi or r¢pair any structuro, prior to I�s issuance, also requires the applicant for zuch permi[ to (ile a slgneC siatemed� that he/she is licensetl pursuant to tne provisions of '�e Contraclor'S License �w (Chapter 9(commencing with Settion ]000) ot iviSiOn 3 Of Ih¢ Bu5itl855 dntl ProfezsiOns COE¢) OI tbat h¢/She i5 exem0� ie�elrom antl the ba5I5 �O� the allegeG exemOtion. Any violatiOn of SectiOn 1031.5 by any applicanl fo� a p¢�mit SubjeCtS the aoo��ant to a civll �enalty of not more Ihan ��ve hundretl tlollars ($500). I, a5 owner o( the prOp¢rty o� my employees wi[n wag¢5 a5 th¢ir sol¢ compensation, will tlo lPe work, antl the sVuctura is not intentletl or offeretl for sale (Section 7044, Busine55 antl Professional Code: The Contractor'S License Law tloes not apP�Y to an owner of a property who builtls or improves thereon, an0 wM10 tloos such wark�M1imselt/hers¢If or through his or her own emplayaes, orovlaea tnat such improvements are not intentletl or offeretl for sale. If, howBv¢r, fhe bu��tling or improvement is soltl within one year of com- oletion, [ho owner will nave the burtlen oi proving he/s�e Oltl not builtl or im- prOvO tol tha purpOSe Of ShceJ. , ❑ I, as own¢� of the prOPerty, am eXCIuSlvely cont�aGting wlth licensetl cOn- tractors to <onstruct tne �ro�eci (Section 7044, Business antl Pwiessions Cotle: The Conlractor's LicenSo L2w tloes not apply to an oW�Cr ot property who builtls or Improves therCon, antl who conVaCtS for such Projects wltM1 a Con- traclor(5 llcense pursua�< <o the Cont�acto�'s LiGanse Law). I am awa�e tnat p/Oat o� th¢ir Worker'S Compen5ation insurance should be provitletl to� me. ❑ I am exemo� under 56�tlon B. & P. 0. Ior thls reason Date Owner ' � I h¢r¢by certi/y tnat I have rea0 tttls applicatiOn dntl State [ha[ the above In(ormatlon it correct. I a9ree to comply with ail city and counry ordinances antl state laws relating to builtling construction, antl hereby authorize reore- sentatives O/ this cl�y to ente� upOn the abOve-mentionetl p�operty tOr Inspection pu pq ses. . }��-87 Signature i�� /� Date Drivers' License or 55 # TYPE OFCONSTRUCTION NEW T ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ��-LL��K M DESCRIPTIONOFWORK/USEOFBLDG. �O�Y'ZO AAT�b FO� a "'.. _ .! � •.�..�� e i � TVPEOFPERMIT � IJ GRADING LJ FOVNOATION L_NSTRUCTU'. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � OTHER PROJECT DESCRIPTION SQ. FT. - Z OG pCCUaANCY � CONSTRUCTION-TYPE1��lU1�LL�A VALUATION$� ZONE- � GRADINGCU.VOS. ACR 5_ Remarks: _ � -� n . In � - '. Bar Sink Backflow Drinking Fountains Floor Drains � Floor Sinks Gas Service � Outlets InterCeptOrs Kitchen Sink . Reinspection-.Fee ' ' � $15 eoiier Duct- UnderGround D�ct-Structural ' Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/fact. Blt. ICBO'# Heating System & Ductin ❑aioo,000eruDi ,aoo Reinspection Fee � $15 Showers ' Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Ta Swi ing Pool w/Spa nnal WdLE! C�052i � Water Heater Water Service Auto�Wash ' Laundry Trays � laue Fee - IANICAL Hoodor Typel ❑ Canopy Type I I ❑ 7P700;000 BTU 0100,000 �ystem Repair/Alteration Fire Dampers ' Registers � IAUB B8 FEES A.P. qY+ L-�'� S Main Buildi E T FronL 8 Rear'�' � A C Right K g Left Ping. Ref. # � Planning Notes: iA326 3%20/67 � �� Accessory Building: Parking Req./Providec �az(,o /�ni/�� Automatic Washer Cons[ruction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. � ' \ 44022. TL c: 2one h/. f/ Z O N I N G R � E _ � N T S ELECTRICAL ' _ Transformer ❑ 15-50 KW ❑ 50+KW I I Meter ❑up to 100 amps Meter ❑over 100 amps � Fixtures. Device Boxes f Outletsi i Svuitche5� - Garbage Disposal l.. ��' Generator �0.5 ❑5-15 KW $ 3 `� � / Reinspection Fee $15 FEES ��.DEVELOPMENTSERVICESREQUIR 2onine'APP�qved By ,Building Approvetl 8� $ 3 FEES Jub;Yanel : '- Motors OO-1 H 1 X�- 8 - ' Inc.Solar -,15 HP �16-15+ Micr ave • ole Light Range Si9n ' Standing Sections Trash Compactor Issue Fee ' $ 3 �� /. . /2i. 7 _ 1r ^ r�� SUM^MA� V� GGF FEES '� �� -' - BUILDINGPERMIT $ �� SMIP $ � . PLAN CHECK $ (� •a� PERMIT � PLUMBING $ �SSUANCE $ ' PLAN CHECK 25% $ ENERGV P.C. 3� ELECTR�CAL 5 � GRADING $ 'PLAN CHECK 50% $ MICROFILM ' $ ,l r7 . MECHANICAL $ TOTAL FEE � $ . � e �/x - PLAN.CH�ECK 25% $ � PO� < SPA CONSTRUCTION AND PLANNING ' � APPROVAL� Permit# Date Inspector AppROVALS Permit# Date Inspector 7:�.Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � �, ,� 53. Steel Reinforcement � 3.�ElectiicalConduitUtility-Undrgrndi" ' �� 54. Forms � 4.'Electrical Conduit-Urtd'rgrnd. " 55. Electrical Bonding 5. Steel I4einfarcement ° - . 56. Rough Plumbing & Pressure Test � 6. _Electrical UFER Gmd. • 57. APPROVAL TO COVER-GUNITE 7. Fopti�ngs - -�� 58. Electrical Conduit-Undrgrnd. 8. Foundation � '� 59. Gas Pipe, � Undrgrnd., Test 9. Water,Pipe-Undrgrnd` i; 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor,System ',� . � 67. APPROVAL TO DECK 11. Property Sewer Cine & House ConAection . . 62. Backwash & Receptor-Final 12. SewerCap .. .. 63. Heater & Vent-Final 13. Roof Drains ��` 4 ' � 64. Plumbing System - Final ^ ',14. Ropgh,Plumbing ; - " " 65. Electrical-Final � Y15. Rough Electriral-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 � 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. DuC[5, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Tesf- • 72. Underground Flush 24. Roof Framing -. 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing `�� , 74. Overhead Hydro 26. T-Bar Ceiting (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathirig & Siding 77. �FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywafl Nailing , HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Elecfrical Power Meter,-Final 80. FOOD CERTIFICATE ISSUED 33. Final�Electric Notes: FJ � �� 34. Final Heating & Air Conditioning , ` � � 35. Final Gas Pipe-Test � 36. Hood or Canopy • �--�- �r�- 37. Final Factory Fireplace . - - - � 38. Final Plumtiing � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � _ 44. Landscape Irrigation System � 45. Sound A[tenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 2� ' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , � 51. CERTIFICATE OF OCCUPANCY � . No. Date ` I . Applicant to till ln all spaces except thoso wltnin �ea�y bortler Iines antl sign aIl aDProo��ate tleciarations. � CITY OF, COSTA M A C NSTRUCTION�PERMIT P IT NO. �/ TRACT NO. LOT,yp. UNIT N6, � '- , Project Address � ��,�a-�'�- S,�iq �_ �� " /" v �� J A.pliCant'SMailingAddrey5 —�/ Sf1A% l/1/4�f2- ��'ZEL TYPEOFCONSTflUCTION NEW ADD ALTERATION ftEPAIR ---� ❑ CONVERSION ❑ DEMOLISH ❑ OTHE� __ N � Ap � Owner's Name �� <<�^- ' �phone ' - Address - 7 u�Sr7� �� `�✓��'�%k� Z� Arch/Eng. � License No. Address '}cr�_@�� Contrecmr's Name ' Phone � ��YdJ nddress (mailingl 5q/} ' S Z10 �I.�J. �Z(.�� City License No. '. J_� S �(' _ I LICENSED CONTRACTOR DECLARATION 1 h¢r¢by dffirm Ihdt 1 dm Ilcensetl untler provi5ion5 of Chdrter 9(commencing � with �section 7000) bf Dlvislon 3 of the Business antl Protessions Cotle, antl my Iicense is in fu6 f e anC effecL � Llcens� _Cla 5__ icei se No.�� `e_ �-�� Si9ndture . _ RKERS' COMPENSATION DECL RATION � �iereby affirm that I have a certificata of consent to self-Insure or a certificate �� ot Workers' Compensation Insurance, or�e�certitied copY thereot (Sectlon • 3800, Lab. C.) • . Policy No. Company � �Cerfitietl coOY Is hereby tumishetl.. � Certitietl copY is filetl with the city Bulitling Division. . , Oate Applicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION � IThis zection neetl not be completetl if the permit is for one hundreG ($300) or less). i ttr[ity that in thC perfO�mdnc¢ Of the wOrk tor which th`s pe�m�t Is IssUetl I ;hall not employ any person in any m nef so as be orJ*e subjecl to the Nork Co Oe sat o �,aws of Califo n a, `. �ate �� U.Si9nature V ` NOTl�fter mdking t�is tleclarati you shoultl become subject to the Worke�s' Compensation provision5 ot the Labo� Cotle, you mtlst fo�t�wilh comply with such provi5ions or .Ihis permit shall be' tleemetl revoketl. CONSTRUCTION�LENDING.AGENCV ' � 1 hereby aHirm that there is a constructlon lenaing a9ency tor the performance Ot She work for whicn this �permit is issuetl (SectiOn 309] Civ. C.) LenGer'S Nama �enEer's AGaress - � OWNER BUIIOEH DEGLAR TION � I hereby atfirm that 1 am exempt from the Contractor's LfcenSe'Law for the following reason (Section 7031.5 Business antl Professional Code: Any tity or � . counry whi<h requires a permit to Eonstruct, alter, improve, Demolish or repair •hy structure, prior lo Its issuance, also requlres the applicant tor such permit flle a slgnetl S(dtem¢nt ttla[ he/she is licensetl pursuant to th¢ provisions of Contractor's License Law (Chapter�9 (commencinq with Sectlon 7000),of �.vlsion 3 of ihe Bu5Ine55 alltl Prote55iOn5 Cotle) or that he/SM1¢ is exempt therefrom'and the basis for the allegetl ezemption. Any vlolation of Sectlon � �7031.5 by any applicant tor a permit subjects the applicant to a civil , enalty oi not more lhan five huntlretl tlollars ($500). ' � I, as owner of the property or my�employees with waqes as their sole . compensatlon, will tlo the work,'antl tha structure is not Intentletl or oiteretl for sale (Sec[ion 7044, BuSiness antl Profezsional Cotle: The Contractor's'. Litense Law tloes not apply to an owner�of a property who builtls or improves Ihereon, antl wM10 tloes such work himself/herself orthrough his or her own " employees, provltletl tFiat sucb Improvements are not mientletl or offeretl tor t sale. It, nowever, the builtling or improvement is soltl within one year ot <om- pletion, the owner wlll' nave the burtlen ot proving.he/she tlitl not buiitl oY Im- . prove tor the purpo5e of sale). - ❑ I; as owner of the properry, am exclusively contracting with Ilcensetl Con- SIdC�OR LO COOSSNCi ib8 pIO�CCf ($CCIIOO %�44� BUSI0055 d04 PIO{Q5510lIS COdB: . The Contractor'S License Law doe5 not apply to an owner oT.property who builas or Improves thereon, antl-who contracts tor such projects with a con-, tractor(sf Iicense Oursuant�to the Contractor's License Law). I am aware tbat' orooi o( [heir Worker'S Compensation Insurance shoUltl be provitletl to me. ❑ I am�exempt untler 5ectlon B. & P. C. for ttiis reason Date � Owner I herebv certi/v that I have reatl this aoolication antl statn enwi �nn annvn TYPE OF PERMIT LJ GRADING ❑ TENANT ❑ ELECTRICAL ❑ OTHER PROJECT DESCRIPTION S�.FT: CONSTRUCTIONTVPE � VP.LUATI6N$ GRADINGCU.YDS. � AC 1 FOVNDATION Ly STRUCTURAL PLVMBI,NG '❑ MECHANICAL Remarks: �/G, +` ;1�8 � ; Bar Sink � Backflow Preventer Backflow Irriqation ' Clarifieri . Dishvrasher ' Drinking Fountains Floor Drains Floor Sinks " � Gas Service Interceptors Kitchen Sink . P-Trap Roof D Reinspection'Fee Outlets $15 1 _ � � Under Ground Duct - Ventilating ' - Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ; ❑ Q7 00,000 BTU O 100,000 BT X�, Signature U\1 `7 \` /�� iate W'll UY orivers' �icense or 55 � � Rainspection Fee $15 `/ _ CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Actountin9: Goltlenrotl - Assessor . Showers Service Sink •, •- Sewer Cep � Sewer Connection Solar Collector5 Solar Piping � Solar Tank ' Swimming Po01 w/Spe Urinal Water Closet Watec Heater �'. �Weter Service �� Auto-Wesh , � � . Laundrv Travs . . L' ', � Issue Fea Hootl or Type I ❑' � Canopy � Type I I ❑ ' Refrigeration System ❑aioo,000aTu ❑�oo,000s' System Repair/Alteration Fire Dampers ! Registe�s Issue Fee 0 0 $,_3 S Main Bu E i F.ront B Rear A � Fiight K Left S Plnq. Ref. # Automatic Washer • Construction Pole $ Cooking Unit �IShWd5h2f Dryers �Gas. ❑E Fan F.A.U. Fixture5 Device Boxes . ' Garbage Disposal Generator �0�5 KW � i f _ -� Reinspection Pee � DEVELOPMENTSER� . ' Zoning Approved By - Building Approved By � r. Applintion.lssued By_ 7221 ,6/1'I%86 "" _ ' , �.. _- _ .. - Zone Accessory Building:. P king Req'/Provided, - , � .- . ELECTRICAL Transformer LJ 15-50 KW � ❑ 50+KW Meter ❑up to 100 amps Meter �over t00amps - , Sub Panel ' - Motors OO-1 HP O1 %- 8 InaSolar �9.16HP �16d5+ Microwave . Pole Light ' 347.90 TL �� FEES Sign ' ; Standing Sections i-15 KW Trash Compactor • • � ' I $15 Issue Fee � ' � ' $ 3 Z O N 1 N G R E Q M T $' - � ` SUMMARV OF FEES /� L e� �, � -BUILDINGPEfiM1T g 3`f3.en SMIP $ � PLAN CHECK $ PERMIT PLUMBING ' $ ISSUANCE $ � ' PlANCHECK 25% $ ENERGV�P.C., $ -ELECTRICAL $ GRADING �$ ' PLAN CHECK 50% $ ' MICROFILM $ . �� MECHANICAL � $ TOTALFEE ' $ 7� d $ 3 ` � � ' PLAN CHECK 25% $ ' , . �- CONSTRUCTION AND PLANNINQ P .& SPA Date Inspector Date Inspector AVPROVALS Permit# APPROVALS Permit# 1'. Tempora �y Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical C'onduit Utility-Undr9rnd. . 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � l 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 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar System-Final 16. Rough Eleciric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. POOL(SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test , 72. Underground Flush 24. Roof Framing , 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat a�j, (�j 75. Dry Chemical 2� lFrame and Flashing L 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing (� � (�� HEALTH DEPT. REQUIREMENT 31. Plaster 8rown Coat� � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: G � � �/f,��y/k B/�{CC F.�% [�Or(�(T�/(r L 34. Final Heating & Air Conditioning „/ U �� //1/�4L O�%Gl�cO - L'011.ltit>%b 5 G 35. Final Gas Pipe-Test � � � „vyyL `y�£,p yd S✓25 C.-�S�` �i 36. Hood or Canopy � l� -� � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final 41. Solar pomestic-Final � . 42. Backflow Preventer •- � 43. fiackflow Irrigation � � 44. Landscape Irrigation System 45. Sound Attenuation . - � 46. Handicap Regulations 47. FzINALSTRUCTURE&BUILDING �/t�'.�g , 48. Special Requirements Completed , 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . v 51. CERTIFICATE OF OCCUPANCY � � ' . . No. G Date � � { ' i II __,.�, .. . . . - Applicant lo fill in all spatts excepTlhase within heavy �ortler lines antl sign all aporavriate tleclarations. aTv oF•cOSTn mESA- CONSTRUCTION-PERMIT PE �j �/.�j / TRACT NO. LOT NO. UNIT NO. ' f 3 e •� o �o . . Project Address � r. ) n " ' _ � ' . ', Applican✓sMaili a,,�eQ � I:IA.A,�.v7 'c" �wN� /lPlt IY�� - TYPEOPCONSTRUCTION � : NEW ADD ALTERATION REPAIR - QWne�'sName �/s�{Q�L '"I�AL NV:�_phone. ' �� CONVERS�ON ❑ DEMOLISH ❑ OTH R ' q,p.# . ��S f, ? , DESCRIPTION OF�WORK/USE OF BLDG. �FN � r � Z/r/�- V_r)JMFA) Address 15Hf - Arch/Eng. � � License No. i � Address � /�,, /' ' - Contractor's Name—.� f �•��r�� "+' V{MF4 � Phone� n¢�� • t� Addiesslmailingl ��7 C�� Cu!'�r�il� �IIY�✓. City License No. � �i;x.�a� � � LICENSED CONTRACTOR DECLARATION � ' I hereby at(irm that I am licensetl untler provisions of Char[er 9(commencing with section �000) of �ivision 3 ot the Business antl Profe55ion5 Cotle, ana my license is in full to/r�ce antl /e�tfecL : ' License CIa55 �'. `�' ~ � r � ry Li ns^�'No. � �4 - �, � Jate �` %.7'� �F+ 'Signature �/�'�� (r+- 3�% JJORKERS' COMPENSATION OECLARATION ' I nereby affirm that I have a certiticate�of consent to self-insure or a certiflcate -ot Worke�s' Compensation Insu�ance, o� a cevtitletl mpy Thereof (Sectioo 3800, Lab. C.)'� � � PolitY No ax sioz96� ComPanY �Qi�FKm . �i��/. , 1��yI ser[ifi¢tl Copy is hereby fumishetl. � � '� '; I�YCert}�tietl copy' fletl with the city BW�1ing [17visior✓J �� !� ,'/ ^,� Datesf� APPlicant //.7./Gf•1:(/�P.f� G(�Y�.Civ �EXEMGTION FROM�WORKERS' COM ENSATION DECCARATION ' ' (Thissection neetlfiot be <ompletetl if the permiP,is for one hu�tlred ($300) or � less). � ' , • - I certity that in _the peilormance ot th¢ work for whith thi5 pe�m�t is i55uetl,;l ' �shail not employany person in any manner so as [o become 5ubjeCt [o�the Workers' Compensation Laws of Califomla. Date � +•'r Slgnature - `NOTICE: If, aiter making Ihis tleclaration, you shoultl becbme subject to �the � Wo�ke�s' Comp¢nsation provi5ion5 of the Ldtior Cotle, you must lorthwi[h romply with such provisions, or �this permit- shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � ' - ' 1 hereGy affirm that there is a const�uctlon lentling agency fo� the perto�mance of the work for which this permit is issuetl. (Seciion 3097 Civ. C.) L¢ntler's Name �entler's Atltlress � ' OWNER eUIL�EH �ECLARATIOIV ;- � � i � ' I hereby atfl�m that 1 dm exempt trom th¢ Cont�acto�'s License Law fOr the followinq reason (Section 7031.5 Business and Protessional Cotle: Any city or . county which requires a permit to construct, alter, improve, tlemolish or repair i;,-"?rpy structure, prior to its issuance, also requires the aoP�icant for such permit � ::.� � Lle a slqnetl statement that he/She is Ilcensetl pur5uan[ to the PrOvisions ot ,t�,f:Me Contractor's Ltcense Law (Chapter 9(commencin9 witn Sectton ]000) of Division 3 of the Business antl Professions Cotle) or tM1at be/she is exempt � theretrom antl the ba5is fo� the allegetl exemption. Any violation o( Section �]031'.5 by any applicant for a permiP subjects Ihe applicant to a civil �enalty bf not more than five huntlretl tlollars ($500). •- ' I; as owne� ot the properry o� my empioyees with wages as th¢ir sole aompensation, will tla the work, antl the sVucture�is not lntentled or oiferetl tor sale (5¢t[ion 7044, Business an❑ Professianal Cotle: The Contractor's License Ldw tloes not apply to an owner oi a property wM10 builtls or improves , [bereon, antl who does sucn work himself/herself or Ulrouqh his or M1er own employees, provitletl that such improvements are not, intendetl or offeretl for , sale. If,�however, the bulltlin9 or improvement i55oltl within one yeav of com- pletion, tM1e owne� will have the burtlen Of proving he/she tlitl not builtl or Im- � prove tor [he purpose of 5ale). � , ❑ I,ias ownet of the property, am exclusively cont�acting wiN Iicense0 con- iractors to construct the projecf (Section ]044, Business antl Profession5 Cotle: The Contractor's License law tloes nol apply to an owner of property who builtls or improves thereon, antl who conVacts for such projects with a con- tractor(sl lit¢nse pu�suant to the�Contractor's License Law). I am aware that proof ol their Worker'S Compensation insurance shoultl be provitleG to me. ❑ I am exempl untler Sectlon � g. & P. C. tor this reason Date � ' Owner I hereby certify that I have reatl this ap0�ication antl state that the above � intormation is correct. I agree to'comply with all city antl county ortlinances , • antl"state laws relatin9.�o builtlin9 construction; antl hereby authorize repre- � sentatives o( this' citX. to enter upon thG above-mentionetl orooerlv for . S Mam Bwldin TVPEOFPERMIT ❑GRADING�,-� /pOUNDATION STRUCTURAL '� T Ftont ❑ TENANT ❑ ELECTRICAL IfAPLUMBING ❑ MECHANICAL � �� B Reaf - � � O �OTHER ' � ' ' ' %� PROJECT DESCRIPSION SQ. FT. OCCUPANCV - C Right K CONSTRUCTIONTVPE � VALVATION$ S Left - 20NE GRADING CU.YDS. - AC0.E5 . P�ng. R¢f. # Remarks: � :� y � � ) J [L � , , � Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation � Bathtubs � Clarifiers.. �_ . _ . _ Drinking Fountains Floor Drains � FloorSinks ;� � GasService ��OuHets Interceproro Kitchen Sink - � Roof Reinspection� Fee �� $15 Boiler ' Duct - Under Ground - DUCt - $LluCtufdl � Duct-Ventilating . - Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating SyStem & Ducting � ❑ ai oo,000 sTu O i oo,000 Signature U ' Date 6"� 6� • ' � Drivers' License or 55 � ' Reinspection Fee $15 '�0865-46, rev. 30/84 White - Builtling; Canary - Applicanh Pink - Accoun[inq; Goltlenrotl - Assessor � Showers Sewer Cap Sewer Connection Solar Collectors t Solar Piping Solar Tank ' Swimmin9 Pool w/Spa� Urinal Water Closet Water Heater ' � Water Service Auto-Wash . �LaundryTrays. . ' I Issue Fee ' „ ; )394 • 6% 12Y96' . Zone ' Accessory Building: ' Parking Req./Provided . M Automatic Washer � Construcjion PoleSub. � Cooking Unit �� Dishwasher- � - Diyers ❑Gas ❑Electric Fan ' F.A.U. _ Fixtures Hood or Typel ❑ , Canopy Type l l ❑ ' Refrigeration System , � � ❑0-t00,000BTU ❑100,0008 System Repair/Alteration Pire Dampers t Registers ; Issue Fee $ 3 es , � sposal ❑0.5 KW 05�15 j 9 t �� • � � : . Reinspection Fee �. DEVELOPMENTSERVICES Zoning Approved By ,Building Approved By � Application Issued Bv_ ELECTRIC/1L Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps -Meter pover 100 amps," Sub'Panel . Motors OO-1 HP O1'h - 8 Inc.Solar 09-15 HP �i6-15+ i ' Microwave ' � Pole Light . ' 9.00 TL 2 O N I N G R E Q M T 5 FEES � Sign ' �; Standing Sections . - .W Trash Compactor 5 'Issue Fee � $ 3 lU1REMENTS: , , %: � ' �SUMMARY OF FEES '!� BUILqWG�PERMIT . $ � SMIP $ � : • PLAN CHECK � $ PERMIT PLUMBING ; $ �� ISSUANCE $ � �� ENERGV�P.C. $ � ' PLAN CHECK 25% $ i'! ELECTRICAI � $ - GRADING � $ • �,� PLANCHECK 50%, $ ' ' MICROFILM � $ � � MECHANICAL � $ � TOTAL FEE $ � ' PLAN CHECK 25% $ �� . , ' .. . .. ., ,. , . . . . _. . � .. :. .:::. ... . ... ... . . . .- CONSTRUCTION AND PLANNING •� . L& SPA . Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# . -, � }. Ter�porary Electrical Service or Pole� 52. Pool & Equipment Location 2. Soil Pipe=Undrgrnd. �G � � 53. Steel ReinforcemenT 3. Electrical Conduit,Uiility-Undrgrnd. � 54. Forms � 4.' tectrical Conduif-Undrgrnd. �� 55. Electrical Bonding 5. �eel Reinforcement � 56. Raugh Plumbing & Pressure Test ' 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE - 7. Footings �• � .- 58. Electrical Conduit-Undrgrnd. 8; Noundation , 59. Gas Pipe, O Undrgrnd., Test � ': 9.'VVater Pipe-Undrgrnd. . , 60. Backwash Lines, P-Trap, O Undrgrnd. i m� 10. Structural Floor System • 61. APPROVAL TO DECK 11�Property Sewer Line & House Connection t_u,�� ,� 62. Backwash & Receptor-Final , 12. Sewer Cap � 63. Heater & Vent-Final . . 13. Roof Drains ' 64. Plumbing System - Final � 14. Rough Plumbing ,, (��Y¢-d'(, GIbI 65. Electrical-Final � � 15. Rough Electriral Conduit 66. Solar Sy�tem-Final - 76. Rough Electric Wiring � 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Condiiioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure � � 70. Underground Hydro 22. Ducts, Ventilating -' 77. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test .� . r 72:�Underground Flush - •24. Roof Framing' .73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe i 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' ' 78. FIRE PREV. FINAL 30. Drywall�Nailing HEALTHDEPT.,REQUIREMENT 31. Plaster Brown Coat � � � 79. FINAL INSPECTION 32. Electriral Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: _� � yL �� 34. Final Heating & Air Conditioning � �� f. �o •'2G- hRloor-i 9 M4. 35. Final Gas Pipe-Test , 6'��dl(r CTi� 1AK76 O�C.(�G�7 36. Hood or Canopy �//�iY �Lo-�t' e� �- T 37. Final Factory Fireplace _ � 38. Final Plumbing � {�"�� 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � Y w 4�4. Landscape Irrigation System � 45. Sound Attenuation ro 6. Handicap Regulations � :n �. FINAL STRUCTURE & BUILDING ro 48. Special Requirements Completed � � 49. Electric Release to Edison - - - • 50. Gas Release to Southern California Gas Co 5� CERTIFICATEOFOCCUPANCY . , � No:' Date . � � � �_ � � Applicanl to fill in al1 spaees exceo� thosa witnin neavy Oortler Ilnes ana si9n all apvrooriate Oeclaiatians. cirYOFCOS7aM S rCO TRUCTION.PERMIT . 'Project Address ��J ��5� �� 2 •_Applicant'sMailing�Address��8�� Mq'�RS�� Owne1's Name Phone Address Arch/Eng. � License No. �Address � � /"' Contracwr's Name �� P j{7�� Pyh�on�" �S v� Address (mr i��gl l��'i�� S%�QE/Yl I I;� �V/Ri�-`��IK.�Cj //�• City License No_ � �� -`o7C LICENSED CONTRACTOR DECIARATION �.1 hereby afflrm tM1at�l am Ilcensetl under provi5ions of Chartet 9(commencinq with sectlon 7000) of DIvlSion 3 of [he Buslness antl Pr0(e55ions Cotle, antl my Ilcense is in tull fDrcey�tl�fect. � License lass G� L nse rvo. • � �� Date�� 51g t � ' C JJORKERS'COMPENSATIO A0.ATION � I hereby attirm that I nave a cerlificate of consent to selt-insure or a certlficate '� o! Workers' Componsatlon' Insurance, or a certified copy thereoi (Sectlon�. I 3800, Lab./r�py� / % c . \ Policy No.�.Q.��l�`��+ COmpany � _ �� Certi/ictl coOY is hereby furni5hetl. er "�tl p` I f etl wlth the c ' tling io • Dale _ APPIi nt EXEMPTION FROM WORKE ' C NSATION DEC RATION (This section neetl, not be com if the permit is tor one huntlretl ($300) or less). I certify [hal in Ihe performdn<0 Ot th¢ work fOr which thi5 p¢rm�t is i5sue0 I zhall not employ any person in any manner so as to become subject to t�e Workers' Compensatlon Laws o( California. . Date Si9nature ' 'NOTICE: It, after making this tletlaration, you shoultl become subject to the -Workers' Compensatian provi5iOn5 Ot [h¢ Labor COtle, you m�sc mrcnwitn- comply with such provlsions or this permit shall be deemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby 5ifirm that there Is a constructton lentling agency for the per(ormante ot lbe work fOr whicn th15 p¢rmit i5 issuetl (Section 309] Civ. CJ LPntler's Name Lentler's AdEress OWNER BUILOEH OELLARATION 1 hereby afflrm that I am exempt irom the ConVactor's License Law for the following reason (Sectlon 7031.5 Business anE Professlonal Cotle: Any city or counry which requires a.permit to construcq alter, improve, demolish or repair any struGturo, prlor IO Its issuance, al5o rCquires ttie ap0��ant tor Su<h permit "o file a siqnetl Sta[ement that he/She is Ilcensetl pur5uant to [h¢ Provl5ion5 0( .he Contractor's License Law (Chapter 9(commencing with Section �000) of Division 3 ot [he Busines5 antl. Profevions Cotle) or tnat he/she is exempt Ih¢refrom antl [ne ba5i5.fOr tne allegetl ex¢mptlon. Any violatiOn of $ection� 7031.5 by any applicant for a permit subjects the applicant to a•civil � enalty o/ not more than five huntlretl tlollars (§500). �- � I, a5 owner Oi tM1e p�OpBrty o� my emplOy¢es with wages a5 th¢i� sole compensation, will tlo tho work, antl� the structure is not intentletl or offeretl for sale (Section 7044, Business antl.Professional Cotle: The Con[tactor's License Law tlOes not dpply to an owne� O( a p�ope�ty who builtls o� Improve5 [hcroon, antl who tloos such work hlmself/herself. or through M1is or h¢r own em0�oy¢es, p�ovltletl Ihat such Imp�ovement5 are'not intenEatl o� offeretl (o� Sale. H, how¢ve�, Ine bulltlln9' or Improvement I5 soltl within one yea� of com- ple[Ion, the owner wlll have the bu�den ot proving h¢/She Citl not builtl or im- prove lorthe purpose olsale). ' � ' ❑ I, as owner of the proper[y, am exclusively contracting with licensetl con- tractorsto constructtha project (Sectlon ]044, Business antl Pro/esslons Cotle: The Convactor's Li<ense Law does not apply-to an owner of property who 'builds or ImOrovas roereon, antl who confracts for such p�o�eCts witn a con- t�ac[o�(5 I1cen5a pursuan[ to the Con[ractor's License Law�. I dm aware that proof o� thei� Wo�ker'S Compen5ation insurante Shoultl be pwvltletl to me. ❑ I am exempt untler Seclion B. 6 P. C. for this reason Date Owner I hereby certlly,that I have rea �informatlon Is eorreel. I aqreP e� tate that the above tl counry oroinances !by au[ho�Iie repr¢- ionetl property for Date S�� TYPE OF CONSTRUCTION LJ NEW LJ ADD IJ ALTERATION LJ REPAIR ' ❑ CONVERSION ❑ DEMOLISN ❑ OTHER � 'A p.# DESCRIPTION OF WORK/USE OF BLDG. � ' S Main Bu E - TVPE OF PERMIT GRADING FOUNDATION STRUGTURAL T Front .❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL � B Reaf � � �OTHER - %� PROJECT DESCHIPTION Sq. F7. OCCUPANCv C Right ' CONSTRUCTION�TYPE ' - VAIUATION$ S Left ZONE GRAOING CV. VDS. ACRES p�ng. Ref. # Remarks. , �' �� Planning No Bar Sink Backflow P�eventer Backflow Irrigation Bathtu6s ' Clarifiers ' Dishwa5her ' � Drinkin9 Fountains Floor Drains ' Floor Sinks Gas Service OuNets Interceptors Kitchen Sink.. � Lavatories P—Trep , Roof Drains � Reinspection Fee. � $15 Duct - Under Ground Duct - S[ructural Duct = Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIt. ICBO # ; Heating Sysrem & Ducting U700,000 BTU 0100,000 Reinspection Fee I $15 rev. ]0/B4 White - Bulltlin9: Canary - APPlicant; Pink - Ac<ountin9: Goltlenrotl - AsSessor Showers ServiceSink - � Sewer Csp Sewer Connection � Solar Collecrors Solar Piping Solar Tank Swimming Pool w/$pa Urinal Water Claset ^ � Water Heater Water Service Auro-Wash laue Fee 1ANICAL Hoodor Typel ❑ Cenopy Type I I ❑ Refrigeratian System ❑0.100,OOOBTU ❑1i System� R epair/Alterati Fire Dampers Registers Issue Fee FEES �_ ` � . . � .... � ' .. ? '� �1L . . _.. . _ ". '. 2onB . . . ilding: - � Accessory Building: . Z . O • • N 1 N G R �n Re ./P ' ed E es: M T � � . . _ . � � . . . .. � S. ELECTRICAL Automatic Washer ConstructionPoleSub. ` Cooking Unit ' Dishwasher Dryers �Gas �Electric Fan F.A.U. Fixtures ' ' Device Boxes Outlets Switches Garbage Dispoul ; Generator �QS KW OS-15 KW ❑ 15�50 KW' " ❑ 50+KW Meter L•Jup to 100 amps Meter ❑over100amps Sub Panel Morors 041' HP � 1 K� 8 � Inc.Solar �9-15 HP 016�15+ -Microwave Pole Light Range ; Standing Sections Trash Compacmr FEES $ 3 Reinspeaion Fee $15 Issue Fee $ 3 FEES . DEVELOPMENTSEHVICESREUUIREMENTS: � . . � � - Zoning Approved By �ate � Building Approved 8y � Oate�--��^j ' Applirrtian Isuad By Date�d.V � �L ,I $3 BUILDING PERMIT $ PLAN CHECK $ � PLUMBING $, PLAN CHECK 25% $ � ELECTRICAL $. PLAN CHECK 50% $� MECHANICAL $ � PLANCHECK' 25% $ SUMMARY OF FEES � SMIP $ PEfiM1T ISSUANCE $ . ENERGV P.C. $ � GRADING � $ � p- p� .MICROFILM, $ +�� j� -��— TOTAL FEE $ � � CONSTRUCTION AND PLANNING � APPROVALS � Permit # .� � 1: Temporary Electrical Service or Po�e 2. Snil Pipe-Undrgrnd. d � � 3..Electrical Conduit Cltilitv-Undrqrnd� � 5"S�BeI Reinforcemen��+A p 6!Electrical UFER:�G nd��' ngs 11. Property Sewer Line�& House Conngctic �� Y �� 12. Sewer Cap ✓t� �U�/ , 13. Ro"of Drains ��i'&q � 14. Ro gh Plumbing��d � . . 15. Rough Electrical'Conduit. � 76. Rough Electric Wiring 47. Rough Wiring Sign 18. Fough Electrical-T Bar Ceiling 19.. Rough Heating & Air Conditioning 20: Rough Factory Fireplace � 21. Ducts,in'Structure � -22. Ducts, Ventilating . 23. Gas Pipe-Rough & Test - 24. Roof Framing� � - 25. Roof Sheathing " 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding, 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat � 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 38. Final Plumbing � � 39. Water Service-Final• � <.- 40. Gas Service-Final ' 41. Solar pomestic-Final !��: 42. Backflow Preventer � 43. Backflow'Irrigation ' �.. 44. �L"andscape Irrigation System 45. Sound Attenuation " , r� 46. Handicap Regulations . . 47. FINAL STRUCTURE & 9UILDING rt 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas C 1. CERTIFICATE OF OCCUPANCY , C Date - � �a .r . .. . � / �_ . i L &�SPA Inspector p�ppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding' 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines,P-Trap, 0 Undrgrnd. 61. APPROVAL TO DECK � 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final � 66. Solar System-Final _ _ 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING , 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # L iti� 0 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd.Storege Tank 0 Gas ❑ Oil 74. Overhead Hydro . 75. Dry_Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL �H�EALTH DEPT. REQUIREMENT 79: �FINAL INSPECTION - 80. FOOD CERTIFICATE ISSUED Notes: ' � � - - � ' . .'_' . . Date i - _� Inspector /�y � �� \ � C�TY OF COSTA MESA < , Project Address Applicant's Mailingj�ddresi � IT , APVlican� to fill in all ! Address 7Y'� � i �� „='�-- '� Arch/Eng. License No. Address y��j�� ' Contractor's Nam � Phon �I ,Address (mailing) ' i� � � � � f Ciey LicenseNo. .� q L� 9Qe%Q LICENSEO CONTRACTOR DECLARATION � I he�e�y a�/7�m that I am Ilcensetl untler provision5 of Cha�[e� 9(comm<n<ing with SCCtion 7000) of DiviSion 3 Of the Business antl ProlCsSions Cotla, antl my Ilcense is in tull forc ntlp/t ct. Q pr.Q License lass � �� Lic nse No 4_.].�.�—_ Date�'��"'� $i9 ature ' ' WORKERS'COMPENSA ION OEG A I hereby affirm that I M1av a certific of consent to self-insure or a certl(Icate � of Worker5' Comp¢nsdti0 ce, or,.a certifietl cOPY [horeof (SeCtiOn � 3800, Lab.�C��_ _ . � PolicY N�d��;�� ComPanY p V N Certifietl copy is �ereby furnisned. er letl cop s fllea with the cit Bu" tlin ivislon Date�_ AOP � t EXEMPTION FRO WORK 5' COM A ION DECLARATION (Thissection neetl nol be co pletetl' e permit is tor one huntlretl (E300) or iess). I certiry t�at in the perPormance of tne work for which this perm�t is issuetl, 1 shall nol employ any person in any manner so as to become suD�ect to the workers' Compensation �aws of California. . Date Signature 'NOTICE: If, a(ten making tM1ls tleclaration, you shoultl become subject to the Workero' Compensation p�ovisions of tlte Labo� Cotle, you mus[ fOrthwith comply wilh such provisions or this permit shall be tleemetl revoked. CONSTRUCTION LENDING AGENCV I ne�eby afflrm tha[ Ih¢r¢ i5 a Construction lentlin9 agency for tha perlormance ot Ih¢ work for which this permii is issuetl (SectlOn 3097 Civ. C.) Lender's Name Lenae�'s Atltltess OWNER BUILDER OECLARATIOIJ I hereby affirm that I am exempt from tM1e Con[ractor•s License Law for tne (ollowing reason (Section 7031.5 8usiness antl ProTe55ional Cotlo: Any.city'or county whiU r¢quires a permit to construct, alter, improve, tlemolish or repair � any structure, prlor to its issuance, also requires the applicant for such permit [o fiie a signetl sta[ement tM1at he/she Is licensetl pursuan[ to the provisions ot 'M1e Contractor's License Law (Chapter 9(commencing with Sactlon �000) of Jivision 3 of the Business and Professions Cotle) or that he/she I5 exempt therofrom antl the basis for lhe alle9etl exemption. Any vlolatlon of Sec[ion ]031.5 by any appliGan[ fo� a pe�mlt Subjects the appliCant to a clvil �endlty o1 not mor¢ than tiva hundretl tlollars ($500). - ' I, as owner of tM1e p�ope�ty or my ¢mployees with wage5 a5 their 501¢ compenSatiOn, will tlo the wOrk, antl [he stfucture i5 nOt Int¢ntletl'Or oftefetl tor 5alc (Section ]044, Business antl Professional'Cotle: The Contrattor's' Licensa Law tl0ls not apply t0 an Owne� of a property wlto buI105 0� Imp�oves thereon, antl who tloez zucn work himself/herzelf or [hrough �Is or har own ¢mplOyees, provldetl that such Improvemenfs are not Intentletl or oflareG for ule. I1, however, tne bulltlin9 or improvement is soltl within ona year of com- pletion, lhe owner will have the burtlen of provin9 �e/she tlltl not builtl or im- �rove tor the purpose ot sale). I, as owner of [he property, am exclusively contractin9 wlth Iicensetl ton- Vactors to <Onsttuct the prOject ($ection ]044, Business antl P�Ofesslon5 COtle: . The Contractor'S License Law tloes not apply'to an owner of property who bWltls or Impwves v tractor�sl Ilcense purs proot o� [heir Worke ❑ I am axempt untler Date I hereby certiry that IIIfOIRIdiIOO �5 mrrecl. 0 i5 upon � LDrivei�l�or 55 � �' �� F OB65-46, rev. 10/B4 White - 8ulldinq; Canary '�uch pro�ects with a mn- �e Law). I am aware that oultl bn provitletl to me. B. & P. C, for Ihis reason tate that the above •Oy authorize reore- lon¢tl property for Data,��J exce0� tM1oze within heavy borOer lines antl si9n all aOProp�iate tleclar9tion5. , TRACT NO. LOT NO. . uNiT r�n TYPE OFCONSTRUCTION LINEW LI"ADD �ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH O OTHER � � A p # . DESCRIPTION OF WORK/USE OF BLDG. • S Main Buildi TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �CHANICAL � I' B Rear ❑ �OTNER ' %� - C Pight PRQIECT DESCRIPTION 5a. FT. oCCUaANCv � CONSTRUCTION TVPE VALUATION $ g LCf[ � ZONE GRADING CU.YDS. ACRES . p��y, R¢L �f Remarks: . _ 6.- aL'((�Y ' PlanningNOtes: oar amK i Backflow Preventer Backflow Irrigation � Bathtubs . Clarifiers � Dishwasher Drinking FOuntains Floor Drains Floor�Sinks - Gas Service Outlets InterceptOrs Kitchen Sink Lavatories .- P—Trap Roof Drains . Reinzpaction Fae $15 Boiler Duct- Under Ground • Duct-Structurel � Duct - Ventilating , � Exhaust System ❑ Multiple � FirepVFact Blt. ICBO dh �H,5eating System & Ducting 7cY0.100,000 BTU � 100,000 BT Reinspection Fae � , $15 Pink - Ac<ounting; Goltlenrotl - Assessor $hOW2fS Service Sink ' Sewer Cap� ' Sewer Connection Solar Collecmrs Solar Pipin9 ' Solar Tank Swimming Pool w/Spa Water Clout Water Heater Water Service Auro-Wash laue Fee � $ 3 IANICAL . � FEE Hood or Typel ❑ - Canopy Typell ❑ • � flefrigeration Sys[em ❑aioo,000eTu ❑�oo,000 System Repair/Alterotion FireDampers � Registers a Issue Fee $ 3 Automatic Wasfier Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator O65 KW C -=io54 - eioeie6 � ,":' ' ' - 2on8 Accessory Building: � -, Parking ELECTRICAL ' . � Transformer ❑ 15-50 KW 0 50+ KW Meter ❑up to 100 amps Meter ❑over100ampi Sub Panel Motors � 0.1 HP � 1 X- 8 Inc:Solar 09-15 HP �16-15+ Microwave - ' , Pole Light � Range . I I; Standing Sections 5�KW � Trash Compacmr � 42.50� � Z O N � � .. N G R ' E � M T S �,FEES I Reinspection.Fee �$75 I . I Issue Fee I $ 3 I DEVELOPMENTSERVICESRE�UIREMENTS: , � � 2oning Approved By ' �ate Building Approved By � Date' Appliption laued By' ' �ate . . • SUMMARV OF FEES ' . ' BUILDING PERMIT $. � � SMIP $' ' PLAN CHECK $ - PERMIT � , PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ � ENERGV P.C. $ . ELECTRICAL $. � �GRADING $ � � 'MICROFILM $. PUIN CHECK 50% $ • � ' MECHANICAL' $, � TOTAL F.EE i$� Z' � O PLANCHECK 25% $ �`5 1� ' , ' �� . . . / 'JNSTRUCTION AND PLANNING i , � PPROj/ALS Permit # �I: Temporary Electrical Service or Pole � 2. Soif Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings i 8. Foundation ' 9. Water Pipe-Undrgrnd. ' 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap �13. Roof Drains , 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Elec[ric Wiring 17. Rough Wiring Sign . 18.. ;Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20: Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating .23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 2�. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 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 38. Final Plumbing , � 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final I 42. Backflow Preventer 43. Backflow Irrigation - � 44. ,l.andscape Irrigation System � 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ;o. Date I P & SPA Date Inspector AppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement ' 54. Forms 55. Electrical Bonding . 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final � - 65. Electrical-Final . 66. Solar System-Final . 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT . APPROVALS Permit # 70. Underground Hydro 71. Product Piping �Gas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro ' 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL � HEALTH DEPT. REQUIREMENT .79. FINAL INSPECTION � � 80. FOOD CERTIFICATE ISSUED Notes: r/-I L-YG � L.� c7 u a ,\ Date Inspector �\ n Cn Applicant to lill in all spaeez exeept [�ose within heavy Eortler Ilnes anE si9n all appropriale Geclantians. CirY OF COSrn nnE�SA�� CONSTRUCTION PERMIT •'Project Address _...�? � �/ � �=ii�P 1`% ✓Lc . A licant'sNl�ilin Address �i�CHL�iifi�d.m.�. PP 9 � �— Owne�'s Name f«.�-�.��-/'n�'�� !�� —Phone �L� Address 3�5�/SG'H�� ✓l� !'f� Arch/Eng. License No. Address Contracroi'sNam �Sr�FiN�7 i�+-C:��.CieF/C.Phone�s� Addresslmailing) 'S�,'��'x�Z� � eA✓� Q�� Ciry license No. �'�. t� S ' LICENSED CONTRACTOft DECLARATION 1 hereby alfirm t�at I am licensetl untler D/ovi5ion5 of Chart 9 Commencing wit� section �000) of Olvision 3 of the Bu 'r ezs antl ,,! � n5 Cotle, antl my Iicense is In tull force antl effect. s License ss � � — .a Date � — Signature '� NORKERS' COMPENSATION D RATION I �ereby affirm that I have a cert" cate of consent to salhi re or a certiflwte of Workers' Compansa[ion Insurance, or a certil�etl copy thereof (Soction 3800, Lab. C.) ' Policy No. Company eCertifietl cooY Is hereby fumishetl. � Certifietl copy Is (iletl with the <ity Builtling Div�sion. Datn ' Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATIO (Tnis section naetl not �e completetl if the permit Is �Or On< huntl E100) or less). I certity tnat In tne oerformance of the work fo ich t' t is Bsu I sM1all not employ any pe�son in any man e� s to ubjeG o t�e Worker5' ompensati ws of Califor '. Oate ;Ij�� ''�Si9nature NOTICE: 1f, after kmg this tleclarafi , you�shtl ecome s bje to the- Wo�kero' Compensatlon provisions the Labor o a, you St f fhwith comply wlth such p�ovlsions or, his pe�mit snall be tlee etl evoketl. CONSTRUCTION LENDING AGENCV 1 hereby ai(Irm that there is a construction lentling 8gency tor the pertormance O/ [he wOrk tOr which this permit is issuetl (SeCtion 30B] Civ. C.) Lentler's Name LCOtl¢I'S ADA!¢55 OWNER BUILOEN OECLARATION I hereby atflrm that I am exempt from the Contracror'S Llcense Law fOr the tollowing'reason (Section ]031.5 Business antl Prdfe551onal Cotle: Any tlty or caunty which requires a permit to construct, alter, �mprove, tlemolish or repalr any structure, prlor to its issuance, also requires tpe a0��iwnt for such permlt o(ile a 5igneC Statem¢nt Ihat he/she is licensetl puriudnt t0 th¢ prOviSiOns of ne Contractor'S Llcense Law (Chapter 9(rommen[ing wlth Section 7000) o( OlviSion 3 Ot the BuSiness antl-Profes5ion5 CotlE) of Itlat he/511e I5 exempf � th¢ra(rom dntl Ihe ba5is (or the all¢getl exemptioP� Ahy vlolation of 58<tion 7031.5 by any applicant tor a permit subject5 the applicant lo a civil �enalty of not more Ihan five huntlre0 Gollars (5500). I, as owne� of th0 prope�ty o� my employeis with wages as l�elr Sole compenSatiOn, will tlo tne work, antl the st�uctur9 I5 not int¢ntletl Or ot�¢r¢tl IOr sal¢ (Section 7044, Buziness antl Profe55iOnal Cotle: The Contrattor'S Licenie Law tloes not apply co an owner ot a property who buJtls or improves tne.eon, ana wno aoes such work himselt/harzalf or tnrou9n niz or ner own employees, provitletl that zuch Improvemen[5 are PO[ intentletl ot offer¢tl f0/ salG. If, how¢ver, the Duiltling or improvement i5 Soltl wlthin one y¢dr of com- pl¢IIOn, the owne� wlll have the bur0en ot proving hC/S�e tlitl nOt builtl or im- prove tor tne purpose of sale). � ❑ I, as owner of Ihe.property, am exdusively mntracting with IiGenSatl con- tractorsto construct [he project (Section ]046, Bu5ine55 antl Professlons Cotle: The Contractor's License Law dOes not apply to an owner ot prOPerty who builtls or Imoroves tnereon, antl who contracts fnr such projects with a con- trattor(sl ucense pursuant-to the Contractor's �Icense Law�. I am aware [hat proof of Iheir Work¢r'S Compensation insurance Shoultl be provitletl t0 m¢. ❑ I am exempt untler Secilon B. & P. C, for this reason Date Owner I hereby �certity that I have rez� information is correct. I agree to antl state laws relatlng t"/builtlin sentatives ot lhis y tb ente Inspection urpose . Si9nature Drivers' Licen 55 � this IF 0865-46, rev. 10/84 White - Builtlin9; i � _ TV,PpE�OF CONSTRUCTION LJ NEW LJ ADD Ll ALTERATION LJ REPAIR J'3CONVERSION ❑DEMOLISH ❑OTHER '� p�p.�f! DESCRIPTIONOFWORK/USEOFBLDG. MAnlJfweT�d�Mb S Main Building: E TVPE OF PERMIT � GR.ao�NG FOUNDATION S7RUCTV aA� T Front ❑ TENANT �ELECTRIGAL ❑ Pl_UMBING ❑ MECHANICAL 6 Real ❑ OTHER ' C qight PROJECT DESCRIPTION 5c1. PT. OCCUvnNCV K ' CONSTRUCTION�TYPEN/tlCF/. j.Jtd�tlP VALUATION$ g Left , ZONE GRADING GU. VDS. � ACRES p�ng. Ref. � � Remarks: �a �� : ,��`� %1Y , � Planning Nores: Bar Sink . Backflow Preventer Backflow Irriga[ion Bathtubs Clarifiers Dishwasher Drinkin9 Fountains Floor Drains ' � Floor Sinks � Gas Service ' ( Interceptors � Kitchen Sink�� - .- P—Trap Roof Drains Reinspectian Fee' � $15 Duct- Under Ground � Duct-Structural ' ' Duct - Ventilating . Exhaust Syitem ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑o�i oo,000 aTu O � oo,000 Reinspection Fee � $15 AppllCant Pink - ACCOunting; Goltlenrotl - ASSessor Shower5 Service Sink SewerCap Sewer Connection Solar Collecmrs Solar Piping Solar Tank • Swimming Pool w/$pa Urinal Water Clout � Water Heater Water Service Auto�Wesh Laundry Trays Isue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em - �0.100,OOOBTU ❑100,OOOBTU System RepairlAlteration Fire Dampers Registers � Issue Fee g3 �, FEES $ 3 I� 2975 __9/.I I/96 � Accessory Building: 3�5.c�� Zon Parkin9 ReqJProvided � ELECTRICAI _ Au[omatic Washer Transfoimer ❑ 15-50 KW ConstructionPoleSub. �50+KW ., Cooking Uni[ Meter ❑up to t00amps Dishwasher .� Meter �over 100 amps . Dryers �Gas ❑Electric Sub Panel Fan •� Motors �0.1 HP 01 K- 8 F.A.U. . InaSolar �9-15.,HP �16-15+ Fixtures . Device Boxes Outlets Switches � -' Garbage Disposal Genereror �0-5 KW 05-15 KW Pole Light Range ' gi9� - � Standing Sections Trash Compactor � -� � i e ....-.� .. �$ifr � b IaUe F@e DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By � Appliotion luued By A FEES u $ 3 SUMMARV OF FEES • � BUILDING PERMIT $ SMIP . . �$ PLAN CHECK $ PERMIT . PLUMBING " $ ISSUANCE � $ PLAN CHECK 25% $ � ENERGV P.C. $ ELECTRICAL $ --� GRADING '.$ � PLANCHECK 50% $ -MICROFILM '$ MECHANICAL $ TOTALFEE $ �•� PIAN CHECK 25% $ Z O N 1 N G R E Q M T S CONSTRUCTION ANDPLANNING POOL&SPA - APPROVALS Permit # � Date Inspector . AppROVALS Permit # Date Inspector �'v 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. ' ,i 8. Foundation �� --�� 59. Gas Pipe, O Undrgrnd., Test . , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. . � 10. Structural Floor System ' 67. APPROVAL TO DECK � 11. Property Sewer Line & House Connection �' � 62. Backwasfi & 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-Cqnduit . 66. Solar SVstem-Final 16. Rough Electric Wiring . , 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro � . 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & 7est 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing � 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78, FIRE PREV. FINAL ' 30. Drywall Nailing' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �� Notes: - � 34. Final Heating & Air Conditioning . � 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Faaory Fireplace � � 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final ' � 41. Solar pomesticFinal . '42. BackflowPreventer 43. Backflow Irrigation 44. Landscape Irrigation System � 45. Sound Attenuation • 46. Handicap Regulations � � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co _. ' ' 51. CERTIFICATE OF OCCUPANCY No. Date , �_ Applicant lo fi11 in ali,SpdtGi�ezcept t�Ose w@Nn �eavy 60rd¢� lin2s antl figtl ali dppropriata deciareNOnT. _ CITY OF CdSTA MESA CONSTRUCTION PERMIT �� ' �� - � � � - � � Pioiett AddreSs �) y� ✓ � APPlica�t's Maili_y �.�� __�� "��'�§L�yl+ yj` �tiyl.�i-L/,L pw'ner's Nam1e'�� r L.�F��G��• � prt6A � Z Addrest �.,_�� .�-L__�� ArchtEng. .license No•'�7�_f�.� _., Address �9 �� r�^ �y� �/�t � Convactor's Nam � y}� -4 ,�` <=-� u/ �Phonq;�,Ccl.sc.zf Addreutmailingl �L�c.i��EK�`/ZpY.� I��iE City LicenseNn. ��3• ' UCEf�5E0 CONTRACTOR pECIARATION I boreby atf7Ym t�a[ 1 Em li<en5etl untler pYoviSions o� C�arier 9(commencin9 � with sEction 7000} of �ioisinn 3 of tno eusiness ana r os5ion5 Cptle, antl (ny pCer150 i5 !p (UII fa�tR dOtl etfeGt. �7t� ��j Llcen3e �C�Ia�5�5 �., ��/,�V�Lfr . ' � �a[e_(�_�_6'� c�gnature WORKERS'COMPENSATION OEL RATION. 1 OerG�Y atHrT tilat 1 hdvE a�<ertifl<at0 ot [Onsent to 501t-insure of d G¢rtificAie of Wurk¢rs' �Compensation Inw�ance, O� a certifittl topy tbereOt (50ction , 3800, lib. C.) Pollcy Ntl. � Company ❑ Certiti¢d eopy is hereby fumi:hetl. � ' ❑ Certi(ietl copy ix riieq with tne tlry Buildin9 oivision. Dat6 � APpli<0nt HXEMPTION FRpM WORKERS' COMPEN5A710N OECIARATION ' (Thi4seGtion n&ed noC be complet¢tl if tbe Oermit 15 for one hunOred (5100) or Iess). / / 1[e�UfY thdt itl ttie pertO�TanCe O� the wO�k f0� wOiSfl t��5 pCrY�pi fs iSSUeQ 1 NOTGE: If, afte� makin9 thiz declaralfOn, you sti6uitl becon�i�bjeLt ta tne Wplke(5' Compensation p�ovl4iD�5-D� t�e Ldbor Cotl�, you must fprthwith • Con�ply Wilh StICh p�pvi5�on5 tl� this p2�T�t zhd�l Pe tl¢eMltl revoked. CONSTRUCT�ON.4ENDING AGENCY " ' I hereny:2lfNrii [hdt therg I5 a construCtion lentlin9 �9ei�cy for th@ performanc5 ot .the'w0�k tor which thiS ptrmR is issuetl (5ecUon 3097 C�v. CJ �enderti Name I.Cntler•z Adaress - OWNER BVILpER �EGLARATICIN ' I herGby atitrm tn9t I am exempt irom tne Contractor's 4�tense law for the . �herefrom and itte basi5 10�� tne a��egetl axemption. Any viplatlon of Section 7031:5 �by any appiicant tor a permit subject5 t0a dDP��cant to a dvi� �enaity or not more than five nundred tlo�iars (g50P).� 1, az owne� of tbe propertY P� my emp�oyees wiib wages as their Sole mmnensa<Inn_ wt�i tlo the work. antl khe itrUcture is not InlCnqeC or Offered . ijc¢nse �2W tlo¢s �lot apply io an O'M�@� Ot a ploO¢rty Wbo bWItlS Of 1tl1ptOYES there0n, and who tices 3ucn wOrk himselfJhCrself or t0�oU9� hf5 or hE� own emploYees, R�oviaetl tnat sucb improvements are not lntendetl or otteretl tor SaIC. It, hDwOveq tBe bulld�ng or imProvemen[ is soltl wit�in ona yea+ ot Com� ple4ion, tne owner wiil �ave tha burtlen of Drov(ng h&/she Oitl rtot builtl nr im- �rove for t�e RurRose o1 sale�. 1, as owner of tne pfoperty, am exUusively contricting with �icen5etl con- Vactaritd consVucl ihe prtliect (5ection 7044, eusinesz antl Pro}es3ions CoOe: The Contrecter'S Licenza t,aw does not appiy to an ownar of pmperty whtl� �ullds or improves tneraon, ana.wno co�tracts tor sucn projeci witn a Gon�' vactor�g� Iicense Oursusnt�l0 tueTConiractor's i.lcense Law) I m�wa�e.4�at proot o their Worke�'s CompCnSdtion Insurance shou�tl tl to me. ❑ I am 0xempt under SeGtion r tB75 reason Da4e Owner 7YPEOFCONS7RUCTION LJ NEW LI ARO� L.� ALTERATION LI REPAIR � CONVERSiON ❑ QEMQUSH C� OTHER DESCRIPTIONOF WORKNSE OF BLDG. TVPEO�PERMIT GRA�wG FOUNDATION STRUCTURAL r� ❑ TENAN7 � EIECTR�CA4 ❑ PWMBING ❑ MECMANICAL ' ❑ �07HER • � t'RQIECTDESCRIPTION SQ.�T. �� __pCCUPANCY � CONS7RVC7I�N 7YPE Cd____. VAIUATION S �ZONE� _� GRADING CV. VOS. qCRES loor prains loor Sinks, as Service Sink ROof Dr�ins '. ,i ReinapacUon-Fee Boiter Duct � Unaer Ground Duat-Strucwrel Exhaust Systsm 4J Mul Pirep1lPact.6lt. tC80 s{E Neacing System & puctin Shpwers Service Sink Sewar Gap , Sewer Connection $olar Colleciors � Solar Piping SOiar 7ank . ' 5wimmi�g Pool w(Spa' , Urinal � 4V8t2Y CIPx2t � W er HeSter eter Servirn . 'Auto-WasO ' . � Laundry Trays $15 � � � issue 6ee HOqd or Typei � , CanoRY TYPg I I ❑ . Reirigeratipn System ' ❑dt00,0006TU Ot00,000E zle ❑ Sysiem PepairfAlteration � Fire Dampers Register5 . i ncretlY �e�City mat 1 hava rea i�s appliwtion antl state tnat me adove �0.7W,OOOBTU Q100,0008' fnformation is coneGt. gree t mp1y w�th a11 clty antl GountY o�dinances , dntl Siate IawS �eldti O Gu � COnSt�uGtio�, antl Iler¢6y dUt�OtiZE �e0�e- sentativa: Of'this' to' up t�e above-menUanetl gro er�y for inSPactian Ru / �j �/ S�gnature PateO— � E� Orivers' �ucense or� SS qF Reinspeetion Pee $15 CMF 0866-46, rev. IOj64 WhitG - Builtlin9; Canary - APRUaant; Plnk � ACGountin9: Goltlenrod -/Us6isor � IAUB Fee A.P. �k 5 Main Bu E T Front A ftear ��___� C Ri9hi K left S pl�g, Ret. # - --�-_- .-. --- �,"'''!� t . 748D 6/12Y86 1++4.Otl �rL zo� . ES Z Auwmacic Washer Conrtruction Pole Sub, Cooki� Unii . . .n:....._.�..._ ' o�vers uca: ue� Fan F.A.U, Fixtures ' Device Boxes Outiets Switches Garbage Oisposal . Generator OO-5 KW KW Parking Req.lProvidtti Z O N I, N G R E Q M T S� ICA4 F I��sfoKr.Ymp b 75-50 KW � ❑ 50+KW Meter ❑up Lo t00amps . MetOr ❑overt00amps � Sub Panel Motors L� 0�7 HP � t h� 8 Inc.Solar �9-75 HP []t6 Microwave . Poi6 Light � Range ; Standing Sec[i0na Tresh Compacter $.3 ` Rei�spection Fea 515 iss�e Fes F�ES —� pEYEt�OPMENTS6RViCESREQUIREMENT5: Zoning Approred By 8uilding APProred By' $ 3 $ 3 SUMMARY OF fEES • � BUtIDiNG pEflM17 S SM�P ' $ PLAN CHECK $ ' PERMIT ' � FLUM6ING . $ ' ��SSUANCE , S PIAN CHECK 25% $ EN&RGY P,C. S - � ELECTRICAL $ -=-� GRADING $ J � P�ANCHECK SQ36 $ MICROFILM $ ! MECHANICAL 5 TOTAIFE�� PI,AN CHECK 25% $� ____. i r�y CONST�UCTION AND PLANNING POOL & 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 1 � 3. Electrical Conduit'Utility-Undrgmd!� 54. Forms J 4.� Electrical Conduit-Undrgrnd. + 55. Electrical Bonding '� , 5. �Steel Reinforcement 56. Rough Plumbing & Pressure Test , r. . 6• Electrical UFER Grnd. ,. 57. APPROVAL TO COVER-GUNITE ;� "� 7. Footings • ' - �i,• 58. Electrical Conduit-Undrgrnd. �� t 8. FouAdation ' ' � � 59.� Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd'.� . 60. Backwash Lines,�P-Trap, O Undrgmd. �� 10. Structural Floor System ' 67. APPROVAL TO DECK 11 �Property 5ewer Li�e & House Connection � �� 62. Backwash & Receptor-Finai ��` 12. Sewer Cap � . '`� 63. Heater & Vent-Final 13. Roof Drains- - ' � 64. Plumbing System - Final 14. Rough Plumbing s 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring AL-LS 6 �S C/ 67. Fencing & Access Approval 17.� Rough Wiiing Sign 6S. APPROVED FOR PLASTERING 18.'Rough Electrical-T Bar Ceiling (0 3i� CC' 69. POOL/SPASYSTEMS FINAL 19. Rough Heating &�Air Conditioning � . FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace�.: � APPROVALS Permit # 21. Ducts, in 5tructure 70. Underground Hydro 22. Ducts, Ventilating . � � 71. Product Piping O Gas .00iI • 23. Gas Pipe-Rough & Test. , - 72. Underground Flush � 24. Roof Framing � - 73. Undergrnd.StorageTank OGas ❑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 IS U D 33. Final Electric ��.y-� �(� Notes: r i 34. Final Heating & Air Conditioning 35. Final Gas P�Pe-Test 36. Hood or Canopy - . � 37. Final Faaory Fireplace . 38. Final Plumbing 39. Water Service-Final � � 40. Gas Service-Final 41. Solar pomestic-Final � , 42. Backflow preventer ' 4� -� : '�' � . � 43�Backflow Irrigation �. � � N+i � , � 44�Landscape Irrigation System K -�� . - 45ySound Attenuation +`n= � � 46.��Handicap Regulations . 47 �FINAL STRUCTURE & BUILOING � ' 48. Special Requirements Compteted ' 49. Electric Release to Edison - - - - '' t 1 50.�Gas Release to Southern California Gas Co � 57..CERTIFICATE OF OCCUPANCY ' . No. Date � Applicant to fill in all spaces except t�ose within hcavy OorEcr lines anG sign all appropriata Geclarations. CITYOFCOSTA.MESA GO��N.S.nI�R�UCTIONPtFiMld . • ' Project Address �y5 ��7--�/� �� Applitan�'sMaili�ng.�A�dd�ress !-�. 80k 3(�R �,Ih__�� 9�L,4 Of,ner's Name �_�• yL� �- �%�.P�� Phone Address 3ys � A.G�C.�I�n- � • � Arch/Eng. �"�0.- ��n'�^ I°'= c.rK. License No. ,�n/�G� Address �� iX 3��"f+//�� g�( �y Contractor's Name �1� Sr�n •.a lxl v r0.w phone �%S6-SOND Address Imailingl � p � L�er ' �/C, City License No. �Q� / LICENSED CONTRACTOR DECLARATION 1 h¢reby a/fivm [ha[ I am li<ans¢tl untler provi51on5 of Chart¢r 9(commencing with 5ection ]000� of Division 3 0l lhe Business antl Pwtesslons Cotle, antl my license is in iWl torce ana eftect. License Class� C-/ � cense Nq ��S�K - Date �"/f - 8� Si9 t �� I. l,�Jlyl� WORKERS' COMPENSATION OECLARATION I nereby affirm that I have a cerUficate of consent lo selt9nsure or a certificate ot Workers' Compensation Insurance, or a certifiea copy thereof (Section 3800, Lab. C.) ��C1 � -t !1 Policy No. wP�� 6$v •= Company ��n'�'�0� T�tiry �Cer[ifiCtl Copy is h¢reby /urnl5he0. Certlfietl� cop�' �is filetl wilh [he Uty B� iltlin9 DI sion. Date� -J! -$�_ Applican[ EXEMPTION FROM WORKERS' COMPENSATION DECLA TION � (This section neea nat be completetl It the p¢rmlt is tor one hu tlretl ($300) or less). �I certity that in tM1e Oe�fotmance o1 lhe wo�k fot which Inls pe�Tit is issuetl, I snall not employ any person ln any manner so as to becoma 5ubject to the Workers' Compensation Laws ol Calitornia. Date � Sl9nalure � ' �NOTICE: If, atter making thls tlOClaration, you sM1Ould be[ome subjec[ to Ihe \Workers' Compensa[ion provislons of the Labor Code, you must (orthwlth � comply with such provlsion5 or thi5 permlt Shall be tleemetl revoketl. I,� CONSTRUCTION LENDING AGENCV _ .. .. u O1 bereby aftirm that ttiere is a tonstruction lentling agency tor tho pertormance of Ihe work for which• this parmih is Issuetl (Sectlon 3097 Civ. �C.) ' LRntler's Name Lentler's Adtlress � ' OWNER BUIIDEH �ECLARATION - I nereby affirm that I am oxempt from the Contractor's Llcense��aw for the tollowing reason (Section 7031.5 Buslness antl Professlonal Cotle: Any dty or County which requires a pe�mlt to ConS[ruct, al[er, improve, tlemolish o� repal� any struc[ure, prior to Ils Issuance, also requires the applicant for such permit to filo a si9netl statement that he/she is licensetl pursuant to the provisions of . �[he Contractor's License Law (Chapter 9',(commencing wllh SetUon ]000) ot Division 3 of the Business antl Protessions Cotle) or that he/she is exempt therefrom antl fh¢ ba56 for Ihe dll¢9etl ezemption. Any viOla[ion ot Section 7031.5 by any applicant for a permlt subjects tho applicant to a tivll pendlty ot not moie than tiv¢ huntlretl tlollars ($500). '' ❑ 1, as owner of the proparty or my-employees with wa9e5 as tneir sole compensation, wili tlo the work, antl the structuro Is not Intentletl or o(teretl for sale (Section�7044, Business antl Protessional Code: ThB Contracior'S Licenie l.dw tloe5 not apply t0 an owner-Ot a prOPerty who bulltls or imprOves the�eon, antl wno tloes such work himseli/herself or Mrougn hls or her own ` ¢mpl0Yee5, provitletl [nat SUGh Improvemenls a�e not InlentlBtl or OffereO fo� sale. It,�howeve�, the bUiltling or imp�ovam¢n[ IS soltl witnin onC Year ot com- pletion, the owner will have the burtlen of proving he/she tlitl not bulltl or Im- �rove �or the purpose o/ sale). I, as owner of the property, am exclusively contracting with Iicensetl con- Vacto6 [O constNct [he projett ($ectiOn 7044, Busine55 antl Profe55ions Cotle: The Contrac[or'S LicenSe Law tloes not apply to an owne� of 0/operty wh0 builtls or Imoroves thereon, antl wno contracts tor such projects with a con- tractor(s Ilcense pursuant [o tM1e Contractor's License �aw). I am aware that prooi o� their Worker's Compensatlon insurance shoultl be provltletl to me. ❑ 1 am exempt untler Se[tlon B. A P. C. fOr IM1is reason Date Owner I hereby certify that I have reatl thit apP��a[iOn antl state thaC the above intormatmn is correcL I agree to compty with ail city antl tounty ortlinances antl state laws relating to building mnsiruction, antl hereby authorize revre- 5¢nlatives of fhiz city t0 ¢nter upon th¢ abOv¢-mentiOnatl property fo� insoe«�on pur oses. Signature j?atC �ia 10-4� Driver5' LicenSe or 55 � TVPE OF CONSTRlSCTION, LJ NEW IZU ADO LI ALTERATION. LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT�R DESCRIPTIONOFWORK/I�SF.OFBLDG. � "'�a.n��y��w.mam TYPE OP`PEFMIT LJ GRADING. LJ FOIINDATIO{�N LJ STRVCTVRAL ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING yx MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sq. FT. oCCUaarv4V— CONSTRUCTIONTYPE � ' VALUATION$ �i ZONE GRADINC� CU. VDS. ACRES_ Sink <flow Preven[er <flow Irrigation ' itubs ifiers _ iwasher iking Fountains � x Dreins �rSinlis' � Service Outlets, ' Interceptors � Kitchen Sink � Lavatories � P-Trap � ' Roof Drains ' . Reinspection'Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating - Exhaust System ❑ Multiple ❑ F i repVFact. BI L I CBO # Heating System & Ducting ❑ 0.100,000 BTU 0 7 00,000 BT Reinspection Fee ' � $15 CMF 0865-46, rev. ]0/04 WhitC - Builtling; Canary - Appllcant; Plnk - ACcountinq; GOItl¢nrotl - Asse55or ES Service Sink Sewer Cap Sewer Connection Solar Collectors . $olar Pipin9 Solar Tank Swimming Pool w/Spa Water Closet • � Water Heate'r ' Water Service . • Auto-Wash . � r Laundry Trays . - 1 Issue Fee . $ 3 IANICAL FEE Hood or Typel. ❑ � Canopy Typell � Refrigeration System , ❑0.100,OOOBTU ❑100,OOOBTU � System Repair/Alteration � Fire Dampers Regi'sters - r Issue Fee ,_ � ;, I $ 3 A.P. # p(• S Main Buildi E T Frant B Rear A C Right K Left $ Ping. Ref. # Planning Notes: Automatic Washer � Construction Pole Sub. Cooking Unit Dishwasher � �- �i 8693 6%30%96 ,� r„ 44.5qhA�j4 Zone Accessory Building: ELECTRICAL Trans(ormer ❑ 15-50 KW ❑ 50+KW Fan F.A,U. Fixtures , � Device Bozes , � , Outlets Switches , Garbage Disposal : , ' Generatoi O0.5 KW OS-15 KW Meter LJup to 100 amps Meter ❑over100amps� Sub Panel � � MomrsOalHPOt9.-s � Inc.�Solar �9-75 HP �76-15+ Microwave Pole Light Fange Standing Sections Trash Compacmr e FEES 2 O N I N G R E Q M T S I Reinspection Fee I$75 I I Issue Fee I $ 3 I DEVELOPMENT SERVICES REQUIREMENTS: � Zanine APP�oved By Date Building Approved By Date Appliwtion Issued By Data SU V EES � BUILDING PERMIT $ � SMIP $ PLAN CHECK $ PERMIT P�UMBING g �SSUANCE 5 PLAN CHECK 25% $ ' ENERGY P.C. S ELECTRICAL S GRADING 5 PLANCHECK 50% § - MICROFILM S �,� MECHANICAL $ , TOTAL FEE $ -p��'/v PLAN CHECK 25% $ . � , :!'. :.,.� ' - � . .. � . " .. • 1 . � r . � ". . . : r. , r :CONST,�RUCTION AND PLANNING ,. POOL & SPA Date Inspector Date' Inspector +APPROVALS Permit # APPROVALS Permit # 1. Tei�porary Electrical Service or Pole. � 52. Pool & Equipment Location 2. Soil Pipe-llndrgrnd. � - 53. Steel Reinforcement �'. 3. Electrical CondOit-U[ility-Undrgrnd. �� 54. Forms �� I' 4( Electrical Conduit:Undrgrnd. � , 55. Electrical Bonding •,� 5..:�teel Reinforcement :� � . 56. Rough Plumbing & Pressure Test � 6. Electcical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE 7. Footings,; .- , ' 58. Electrical Conduit-Undrgmd. 8. Foundation' � ' � 59. Gas Pipe, O Undrgrnd., Test 9.'Water,Pipe-Und�grntl. - � 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor,System • . 61. APPROVAL TO DECK 17. Pro`perty Sewer Line & House Conriection ' 62. Backwash & Receptor-Final 12. Sewer Cap �-�� - � �� 63. Heater & Vent-Final � � � 73. Roof Drains. ` , , 64. Plumbing System - Final � 14. Rough Plumbing - � 65. Elecirical-Final . 15. Rou'9h Electrical-Conduit 66. Solar System-Final 1�6�. Rough Electric Wiring . 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in�Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Ftough & Test � 72. Underground Flush � 24. Roof Frariming 73. Undergrnd.StorageTank OGas ❑Oil . 25. Roof Sheathing 74. Overhead Hydro :�- a� 26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe ' 28. Lathing & Siding . 77. FIXED SYSTEM FINAL 7'3`a� 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 EI'ectric , Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace � � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer c: 43. Backflow Irrigation r � j 44. Landscape Irrigation System �. 45. Sound Attenuation � = � 46. Handicap Regulations . � � 47. FINAL STRUCTURE & BUILDING ^"48. Special Requirements Completed 49. Electric Release to Edison - '' S0. Gas Release to Southern California GasCo ' r i 51. CERTIFICATE OF OCCUPANCY ' c� No. Date �_. � r''+7a_ . < I