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Home My WebLink About589 ANTON BLVD - Building Permits,1. � CI Y OF COSTA M:SA Development Services, Division of Building and Safet� CERTIFICATE OF OCCUPANCY ��_ , ;, f``� ''' � � � This certificate is issued pursuant to the requirements of t_he Uniform Buildirig Code, SecHon 308 adopted by the City i�,. ... of Costa Mesa cerHfies that at the time of its �ssuance the bu ilding structu re tierein below described was inspected and � \% "= % ' � \ i �: A, approvedforoccupancyasfollows:-� � /,/._/ �� / �� : % i � \< . ��. Building Address 589 ' y L; � ,i , a � L! �i� � t, <. ,� , Use �4-AOUR FITNESS Bl1ILDING�11 �!'�` - � -- �.�-�,� ��,'j �. `� Group ��B�E3,M Number 899-0984 \ . ; 'i/ � i�. ��' �; Type of Constructiom � dzi�,1N.—+. �n --,Firc_'_`Lone " Use Zone PDC .,..IOKA FARMS � �-��-r ,�/ ��^ 24_HOUR FITNESS Owner of Building '" � TFi;;,nr Address 2377 Crenehaw 0300' Torrance �o �i a, � �� . ` � .' .. ... i \ =t � -• `' , ;'gy '''F > °/C�2 .: �� . . BuiL�iNc oFFicinL-Rick A':.Brow�n; C.B.O. � �� <��v '°' � ° ��/q — I� ' c%DO \\ \l(^ : Datej:: i>, i' , � �z� �,;. " � -�� _ ,,.�:.: ,, _ � REQUIRED TO BE POSTED IN A CONSPICOUS PLACE ...... ... . _.. _....w.. �... . :�.i1..ii.....,I{. .l�^L . : � � C�, ,Y OF COSTA M' ��A c Developnzent Services, Division of Building and Safety CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the requirements of the 2007 California 6uilding Code, SecHon 110 adopted by the City of Costa Mesa cerHfies that at the time of its issuance the building structure herein below described was inspected and approved foroccupancy as follows: 6uildingAddress 589 Antoi'1 BOuleVdld ' 13Idg.PcrmitNumber BCnO-00257 Use Commercial - S Group 1�3 Type of Construction II—A Fire "Lone Use Zone Owner of 13uilding SakioKa Farms Bre South� Coast��nant 29 Hour Fitness Address c/o Edward W. Cook III, 5750 Wilshire Bl�{d., Los Angeles, CA 90 By/�-� (`rc.i"n BUILDINGOFF[CIAL-KlldTill Q. NgUyeri, C.B.�. � Z�ZO/10 Date 1 � Y . REQUIRED TO BE POSTED IN A CONSPICUOUS PLACE � _...- ,` , �: �p o f��o�ta 7Y� E-� a ' DevelopmenT Services, Division of Building and Safery CERTIFICATE OF OCCUPANCY c�osaxx>_ �,�, -�,-� This cerriFicate is issued pursuant t/the�requirements of,-;the Uniform Building Code, Section 308 adopted by the City of Costa Mesa cerrifies.that�at�the rime of-its issuance the building structure herein .�,., below described was inspected and�appro,veil=foi:�occupanc}%as�foIlow� � 589 ANTqN BLVD' �V� 899-0984 Building Address �� ^ � B1dQ. Pernut No. l�'_�� Use 24-HOUR F,fiTNESS,B' ,�, �; ;�� , Group ��B�E3,M Type'4of Consm y � i .�r' Owner of Building SAKIOKA rFARMS � b `�`r ��+:� Address r � Z3�� CRENSHAW E \�p, `i�c ti v Conditiats: 1) C�mvleClon oP' �� ompiccion of Final Grading � from the Engi, 3) Final Deputy � Certification REQUIRED TO VALIH �� ,n., II-1 Fire�Zone ''� �� Use Zone PDC ,,, m._r.�:'.s�.".�0; y.^.=''n'� `24-HOiJR FITNESS =�Tenant v„ay. �-zr�ai�� ,� fi300 _ TORRANCE', - ' CA �, , ' +i i instaSlation By,- u�;�'., ..r ;', '%S-;,. �F : �Work�and -., Date �'� :ificate from�� sof;�Rec`o`x�pj=' � Q`;i . �;� 'Eb=fo`r Pool�>J ._ r`.:. .. � ' � �� .., 20. 2000 PLACE � CI Y OF COSTA 1V� .SA Development Services, Division of Building and Safehj CERTIFICATEfOF.00CUPANCY ,,.i��_;: - - � . ,� �� , , �. � � � ,,, _,�� This certificate is issued pursuant to the requirements of the Uniform'Building Code, Section 308 adopted by the City ofCostaMesacertifiesthatattheHmeof �' approved for occupancy as follows,�/� ,i �� Building Address 589 Anton Blv ,: Use 24-Hour Fitnesa Building Group A3,B,E3,M Owner of Building P�FF/M 535 Anton Blvd,; Address BUILDING OFFICIAL-R1CIC ��` \`rt `, _,l ,Yn � - _- _;:;� � th .te 150 Costa Mes . ..� . ':,�.,;- +' _'Y`i. ° n , n/�\�.».1..�. �".-.�`v REQUIRED TO BE >w descnbed was mspected and Pe�mit Number B99-0984 ,_,y� � s " �\�, ; --� 1,., � , e` „1 one � �'` Use Zone PDC _ �, - nant ��Z4�HQUR FITNESS" n -z:,a-r4' �° %�C°��'9-1-9=2001 � -- :Date ?i'/r,i � ; --�c ;��;�� ! ��, �'.. '� �-' .�. : �%%- � D IN A CONSPICOUS PLACE 0 CITY OF COSTA MESA ' ' " ' ��-'�"'- o pMF BUILDING DIVISION i`' � 77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wewv.ci.costa-mesa.ca.us F �. FOR INSPECTIONS CALL: (714) 754-5626 4ybeimm R PERMIT NUMBER: BC10-00253 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 0910112010 ISSUED BY: CAC Jo6 ADDRESS: 589 ANTON BL CM APN: 41050701 Vicinity: Const Type: II-A Zoning:PDC , , SQ. FT: 51156 Suite/Unit: Primary Occ: Valuation: $200,000.00 � SCOPE OF WORK: 51,156SF INTERIOR TI FOR "24 HOUR FITNESS".1 SPA (STEAM ROOM), 35 LIGHTS, 211 OUTLETS; 20-� � SW ITCHES, 2 MOTORS TO 10 HP , 1 FAU<100K BTU 1 REFRIG. < 100KBTU 1 SMOKE DAMPER 3 MISC. MECH. 1 HOOD, 15_ __ FLOOR DRAINS, 17 SHOWERS, 1 FLOOR SINK, 1 SERVICE MOP, 2 TRAP PRIMERS, 2 URINALS, 12 WASH BASINS, 13 TOILETS, 1 WATER HEATER, 1 LAUNDY SINK, 17 SHOWERS. OWNER: SAKIOKA FARMS�BRE SOUTH COAST LLC Address: EDWARD W COOK III CA Phone: City/State/Zip: 5750 WILSHIRE BLVD APPLICANT: GEET GILL Address: Phone: 714•258•1808 EXT. 13 City/State/zZip: . , i: _ CONTRnC70a: CAL SELECT BUILDERS INC License No. 590765 Phone: Address: 00716 RICHFIELD RDUnit: Cell: Ciry/State: PLACENTIA CA ARCHITECT: TANAKA RILEY ARCHITECTS ENGINEER: COMBINATION PERMIT FEE SUMMARY � Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Sld Admin Fund TOTAL FEES: License No.C17&48 License No. $252.49 $1,553.75 $313.98 $71.20 $660.50 $0.00 $42.00 $8.00 52.901.92 Unit: LOS ANGELES, .;;�u-i?0253 Unit: : ZipCode 92670 PHONE:714-283-1905 � PHONE: . :F1'S.?u � i"•7C'•D. t ; �?{h.�_'>. }:' . _.. _ •r: t;)SAr:GcLFS. ee roc¢Ipts (or all /ees Paitl for prolect �': i:..;t 1'1 f HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/78I2010 - PER CMMC Sec. 13-279 ''�� ' thru Friday-7:00 am thru 7:00 pm. Saturdays• 9:00 am thru B:OOOm. Prohibiled all hours - SUndayS and the following Federal holidays: New Years Dav. Memorial Dav. Indeoendence Dav. La6or Dav. Thanksaivina Dav and Christmas Oav � NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulalions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit. . i .. y �_�� , LOOEt. INSPEC710NTYPE QRTF, INTRIRL � 0 I_NSPEGPONTYPE D�T -, . INililpl5 1818 Fixetl System Final Pire Prevention 1268 Pool Spa Final . 200 Final Re-Roof 201 Final8lock/Retaining Wall 202 Pinal Factory Fire Place 203 Final Sign 204 Final Demolition 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Pianning Approval 222 FinalSite 250 Final BuildinglOccupancy �C. R- I - li rrl Q � � � '�_' ,. ...�,c.... � . � r i�,t<`r �y� � — dL-rL;l� dM �� :w�ya, i ---_'__-1 WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penaly of perjury one ol the following Oeclarations: ❑ I have and will maintain a certificate of cOnsent to sel4lnsure for vrorkers' compensation, as provitled for by section 3700 ot the Labor Cotle, for the peAormance of the work for which this permit is issued. I have and will maintain workers' canperlsation insurance. as 2quiretl by ion 3700 of the Labor Cotle, fa the peAortnarxe of the v.ark fa which this permit is issued. My workers' compensation Insurance wrrier antl policy Carrier BJ�r/� %E ��N � �it� mtbemmde,leLtlatnepertn9is✓dh�etlalonenu�Wrt00o11arsfEt00)wless) P cy Number: ��0��7 0? —�� ❑ I certify Ihat in the performance of N@ work !or which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to Ihe worke ' compensation lavrs of California, and agree thal if I should become subj ct t4 the workers' mpensation pmvisions of Sec ion 3700 0! tha Labor o, 1 shall forthwit c mply wilh lhese provisions. � � Appi nC59grewre �e WARNING: FAILURE TO SECURE ORKERS' COMPE ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 7HE IABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provigions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in (ull torce and effect. /�� S �Class tt oc� q /� Co �wre ate CONSTRUCTION LENDING AGE Y: ❑ I hereby aRum that there is a wnstruction lending agency (or the peAortnance o( the work for which this permit is issued. (Sec. 3097. Civil Cotle). Lender's Name: Lentler's Address: OW NER-BUILDER DECLARA710NS: I hereby aKrm that untler penalty of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to conslruct. alter, improve, tlemolish, or repair any sWCNre, prior to its issuance, also requires Ihe applicant for such permit to file a signed slatement thal he or she is licensed pursuant ro Ihe pmvisions o( the Contractors License Law (Chapter 9(commencing with Spction 7000) of Division 3 of the Business antl Pro(essions Code) or lhat he br she is exempt there(rom antl Ihe basis lor t�e alleged exemption. Any violation ol Section 7037.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five huntlretl tlollars ($500).): ❑ I, as owner of the property, or my employees wilh wages as their sole compensation, WILL DO THE WORK, antl the sWCNre is not intended or ofleretl for sale (Sec. 7044. Business anE Pra(essions Code: The Cont2ctors License Law does not apply to an owner of property vfio builtls or improves thereon, antl who does suc� work himself or �erself or I�rough his or her ovm employees, providetl that such improvementg are not intended or oMered tor sale. I(, however. lhe buildinq or improvement is sold within one year of completion, the ovmer-builtler will have the burden of proving that he or she did not build or improve (or purpo5e o( sale.j. ❑ I, as owner of the property, am El(CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro consWct the projecl (Sec. 7044, 8usiness and Professbns Code: 7he contractors License Law dces not appy to an owner of property who builds Or impmves Nereon, and who contractslor such project vrith a cmtractor(s) license pursuant m the Contractbrs License Laws.). ❑ I am exempt under sec. Business antl Professions Code (or this reason: 305]<6 (3I0]) Ovmer ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownerehip by (type of document, i.e. - propeny tax Dill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: ❑ I hereDy certily Ihat no excavation frve (5) w mae fe¢t ul depth into vfiiCh a person is required to descend, vnll be made in connection vrith v.ork auttarized by this permit, antl that no building sWcture, scaffdding, falsevqrk, a demolition or dismantling thereol, will be more than thirty-siz (36) leet high. (Chap. 32. Grp 2, Art 2, Sec. 311, Ttle 8, Calitomia Administrative Cotle). ❑ As owner-builder, I will not employ anyone to do vrork which would require a permit from the Division of Intlustrial Salety, as noled above, unless such person has a permit lo do such vrork from the division. Appliwnfs SiB��ure Division of Induslrial Sa(ely Pertnit Number: _ HA2ARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fWure building occupant need la file and cenify a Business Plan for emergency response to release or threatened release of a �azardous material? ❑ Yes ❑ No (Seclion 25505 0l the Califomia Health and Safely CoCe requires, vrith some ezceptions, that a Business Plan be filetl with the Cosla Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantiry of hazardous materials equal to or greater than a weight of 500 pounds, or a volume ol 55 gallons, or 200 cubic feet of compressed gas at stantlard temperature antl pressure). 2. Does or will the applicant or present or (uNre building occupant need ro file a registration form for aculely hazardous materials? ❑ Yes ❑ No (Seclion 25533 of the Califomia Health and Safety Code. with some exceplions, requires registration wilh the Costa Mesa Fire Department by each business which at any one time has on hantl a quantiry of acutely hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at stantlard temperature and pressure}. 3. Does or will the appliwnt or present or tuture building occupant neetl ro prepare an RMPP (Risk Management antl Prevention Program (or acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of the California Health antl Sa(ety Code provides Ihat the Costa Mesa Fire Department may require the preparaGon, certification and filing wilh ihe Fire Department o( an RMPP by businesses v+hich are required ro register acutely hazardous materials vrith the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safery Coda been (ully complied with? ❑ Yes ❑ No 5. Does or will the applicaN or present or future building occupant require for lhe work which is the subject ot this application a permit for such construclion or mo0ification frOm the South Coast Air Quality Management District or Irom any olher air pollution conlrol tlistrict or agency? ❑ Yes ❑ No (Sectbn 650502 of Ihe Califomia Govemment Code requires that the requested infortnation be tumished on applications (a non-residential building pertnits). 6. Will any part of Ihe taciliry to be consWcted under this permil be within 1000 leet from Ihe outer boundanes of a school? ❑ Yes ❑ No (It yes', Ihe faciliry musl meet the requirement ot Sections 25534 antl 42303 ol the Califomia Heallh and Salery Cotle). 7. If a pertnit from the Soulh Coast Air �ualiry Management Districl or other air pollution control district or a9ency is required for the work vfiich is the subject of Ihis appliwtion, have all of the disclosures prescribed by Calilomia Heallh and Safety Code Section 42303 been made? ❑ Ves ❑ No 8. (If yes', attach certificate of compliance tmm the appropriate air polWtion conlrol offiter). CERTIFICATE OF COMPLIANCE: I ceAify that under penalty ol perjury the information given above is correcL I agree to comply with all slate laws and city ordinances regarding Hazardous Materials and Emissions. SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certiFy untler penalty o/ perjury that I �ave read this application antl state thal the information given is correcL I agree to comply vrith all state laws and ciry ordinances relating to building construction, and authonze representatives of [he Ciry ol Costa Mesa to enter upon the above-descnbed propeny for inspection purposes. I agree not to occupy or allow occupancy of any builtling authorize by this permit until final inspection. SigruwreolLepal .er ) ale q� � / 0 MCIOr Aul� Appliean� p � ,J CITY OF COSTA MESA P.O. BOX 1200 ' 77 FAIR ORIVE ' CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT T. C.O. Application for Temporary Certificate of Occupancy BUILDING AND SAFETY (PrinffType Onlyj Address: `>S�J �N p,( UD Permit Number: �JC - 60 �3/- Business Name: ZN NDI�12 � I TN�SS Telephone: � I" "2� �� b(L U� Building Owner Name: �l}KIOk/� �{iLMS Address: S�Sb 1N�LSff1� �L� c��Y: �s�� s z�P: qoo3 6 Telephone: ( ) — This Use Would Be Described As: Business OwnerlManager/Contractor Name: C,�1-L ��GT �iu ILt��? S Address: 237 S3 � A- f AiMA" {�✓E. a�y: U�L�p, (ANdI� z�P: q2d$� Teleph no e: {�(`I ) 6� I — 0 Z �� ❑ Newly Constructed Building ❑ Change of Owner ❑ Change of Occupant � Existing Building ❑ Change of Use ❑ Additional Occupant Obtain Electrical, Engineering, Fire, Planning, Building's Approvals or Final Inspections ❑ ENGIN�ERING BY: ❑ PLANNING BY: DATE DATE ❑ FIRE BY: ,Q�T.C.O{'.�— BU^ILDING BY: \:'1�. \)D � UL•tl� DATE Request is hereby made for temporary use and occupancy on the above project for a time period of 60 days only. I am fully aware of Section 110.1 of the 2007 CBC which states that no building or structure shall be used or occupietl untll the Building Official has issued a Certificale of Use and Occupancy for the building, or portion of the building, I also understand that the (ee is for administrative and inspection costs. It is understood and agreed that ihis approval, if granted, will become void aker 60 days, at which time a permanent Certificate of Use and Occupancy will be grented or occupancy terminated if construc6on is not completed within 66 days. Who will take responsibility to handle this matter to conclusion and will call for final inspection7 `�� NameofResponjible � •�IS �/n,�.,r� Telephone � Party (pnnt name : �� 'F"�� number: I�'I � Z� �- 6�S O Reason For �� Signature: _ Print Name: Cash Deposit =_� hrs X$87.50 =$ � I S•UV b.� ❑ Owner �Authorized Agent n�l Date: (L-g-�o Telephane Number. �(�i � 2�' 1� b6 $O Building Division (774) 754-5273 • FAX (714) 754-4856 ' TDD (714) 754-5244 • www.ci.costa-mesa.ca.us 2928<61rev. ]qe) 0 05tN M . � 0 i : J � �O+ro�mm+�'�• f � � ) GTY OF COSTA MESA ' BYILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (7'14) 754-5626 PERMIT NUMBER: SB10-00075 PERMIT TYPE B_SIGN JOB ADDRESS:�S$9iA'NTiONt6l' CM Vicinity: SQ.FT: 0 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 10/18/2010 RMD $50,000.00 SCOPE OF WORK: REINSTALL FIVE ILLUMINATED BUILDING MOUNTED SIGNS FOR "24 HOUR FITNESS" . 5 SIGN CIRCUITS. FOUR SIGNS 84 S�. � ONE SIGN 14 SQ. OWNER: SAKIOKA FARMS BRE SOUTH COAST LLC Address: EDWARD W COOK III Unit:LOS ANGELES, CA PHONE: City/State2ip: 5750 WILSHIRE,BLVD APPLICANT: R4EY, PREET , Address: FANCHER DEVELOPMENT SERVICES Unit:TUSTIN PHONE: - City/State/zZip: 1342 BELL AVE. #3K CONTRACTOR: MEGA H Z ELECTRIC INC Address: 7 72 W ELM CTUnit: � PHONE: 816-566•1850 City/State: BURBANK,�CA ZipCode: 91502 ARCHITECT: ENGINEER: SIGN PERMIT FEE SUMMARY PLAN CHECK FEE: HOURLY PC FEE: PERMIT FEE: ELECTRICAL FEE: SMIP FEE: OTHER: INSPECTION: BLDG STD ADMIN FUND TOTAL FEE: $418.76 $0.00 $644.25 $146.50 $10.50 $0.00 $0.00 $2.00 $1,222.01 License No. Litense No. License No. 898078 CELL: PHONE: PHONE: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenls under Califomia statutes and relaled regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in ihe expiration of this permit. COOE 1. INSPECTION TYPE 161fi Fised System Final Fire Prevention 7266 Pool $pa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final FaUory Fire Place 203 FinalSign 204 Final Demolition OR�F INTITIRLS ♦ � COUEp INSFEC710NTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy OATE INTITIRLS � rr � WORKERS' COIIIPENSA410N DECLARATION� I hereby aNirtn untler penalty of perjury one o( the (ollowing declarations: �' ❑ I have antl will maintain a cenifcate of consenl lo self-Insure (or viorkers' compensalion, as provided for by section 3700 of the Latior Code, for the peAormance o( Ihe work (or which ihis permit is issuetl. • ❑ I have antl will maintain workers' compensation insurance, as required by sec�bn 3700 of the Labor Cotle, lor the pedortnance of the work for which this permit is issuetl. My workers' compensalion Insurance carrier antl policy number are: C'- ,f 6ame . JfN � � ✓l�^ (T/vs sectqn neeHnof Ee wrnp'efatl aVM peim4 a v�lued at one nvnOred EWars (S10D) o� kssJ eoncy:�moer. � I CI � 33 �L�- —0�1 ❑ I certify that in the peAormance ot the work for which this pertnit is issued, I shall not employ any person in any manner so as lo become subject to Ihe workers' compensation lavrs of Califomia, and agree that if I should bewme subject to lhe workers' compensation provisions of Seclion 3700 of the Labor Code all forthwith comply vrith these pmvisions. � lo- I8- lo �Ap 9^aWre Date � WARNING: FAILU SECURE WORKERS' COMPENSATION CAVERAGE IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED fOR IN SECTION 3706 OF hIE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aKrtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) o� Division 3 0l the 8usiness and Professions Cotle. antl my license is in (ull force and effect. ��.� 9 D�1 &iag C f 0 C 4� 5 �O' �fi'�l7 CaqUarJor'- �re ure L5� CONSTRUCTION L NDING AGENCY: ❑ I hereby aKrtn that there is a conslructan lending a9ency fa the pertortnance of Ihe work for vfiich this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Dale OwNER-BUILDER DECLARATIONS: I hereby aKrm that untler penalty ol perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe follovnng reason (Sec. 7037.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improva, tlemolish, or repair any strucWre, pnor to its issuance, also requires the aD7licaN !or such permit lo file a 5igned statement that he or she is licensed pursuant ro the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0( Ihe Business antl Pro(essions Code) or Ihat he or she is exempt therefrom anC the basis for the alleged exemption. Any violation of Seclion 7031.5 by any applicant (or a permit subjects the applican[ to a civil penalry o( not more than five hundred dollars (5500).): ❑ I, as ovmer of the property, or my employees with vrages as their sole compensation, WILL DO THE WORK, and the slrucWre is not intended or offered tor sale (Sec. 7044. Business and Professions Coda: The Contractors License Law dces not apply to an ovmer of property who builds or improves thereon, and who does such vrork himself or herself or lhrough his or her ovm employees, provided that such improvements are not intendetl or offered tor sale. If, however, the building or improvement is sold within one year of completion. the owner-builder will have the burden of proving �hat he or she did not builtl or improve for purpose o( sale.). ❑ I, as ovmer of the property, am El(CLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to consWct Ihe prqecl (Sec. 7044, 8usiness and Professions Code: The contraclors License Law dces not appty to an ovmer ot property who builds or improves thereon, and who conlracts for such projecl with a conlracta(s) license pursuanl lo Ihe Conlractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: siq�aw,e ]059�a6 (YW � 1 Owner ID venfed by driver . ense. ❑ Yes ❑ No Oriver's License No. Expires: Verification ofOwnership by (type o( tlocument, i.e. - property taa bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereDy certi(y that no excavation frve (5) w more (eet in deplh into vfiich a person is required lo descend, will be made in connectbn with work aulhorized by this permil, and that no building slruclure, scaFfdtling, falsework, a demolition or dismantling thereof, will be more than lhirty-sa (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341. Title 8, Califania AdministraWe CoAe). ❑ As owner-huilder, I will not employ anyone to do v.ork which vrould require a permil from [he Division of Industrial Safety, as noted above, unless such person has a permit to tlo such v.ork (rom the division. Applicanl's Sgnalure oale Division of Intlustrial Sa(e[y Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: L Will Ihe applicant or present or fWure building occupaM need to fle antl certify a Business Plan for emergency response to release or threatenetl release ol a hazardous material? ❑ Ves � No - (Section 25505 of the Califomia Healt� and Safety Cotle requires, with some exceptions, that a Business Plan be fled with [he Costa Mesa Fire Department by every business which has at any one time tluring a reported year a quantity of hazardou5 matenals equal lo or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standartl lemperaWre antl pressure). 2. Does or will the appliwnt ar present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 ot the California Health and Safery Code. with some exceptions, requires regisVation wim the Costa Mesa Fire Depanment Dy each business which at any one time has on hand a quantiry of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at slandard temperaWre antl pressure). 3. Does or will Ihe applicant or present or fuWre builtling occupant need to prepare an RMPP (Risk Management and Prevention Program lor acutely hazartlous materials)? ❑ Yes ❑ No � (Section 25534 of the Califomia Health and Safery CoCe provides tha0.lhe Costa Mesa Fire Department may require Ihe preparation, certification�an0 fling vrith the Fire Department o( an RMPP by businesses which are require0 to register acutely hazardous materials with lhe Fi2 Department. 4. 11 an RMPP is presently required, has Seclion 25534 0l tha Califomia Heall� and Salely Code been fully complietl with7 ❑ Yes � No 5. Does or will Ihe applicant or present or fuNre builtling occupant require for Ihe vrork which is the subjecl of ihis application a pefmit lor such construction or modi(calion (fom the South Coast Air �uality Management Districl or Irom any other air pollution control districl or agency7 ❑ Yes ❑ No (Sectbn 658502 0l the Califomia Govemment Code requires that tha requested in/ortnation be lumished on appliCations lor non-resitlential Duildinq permits). 6. Will any part ot the facility lo be wnsWcted untler t�is permit be within 1000 feet from the outer pountlaries of a school? ❑ Yes ❑ No pf yes', the faciliry must meet the requiremenf of Sections 25534 and 42303 o( the Califomia HeaIN and Safery Cotle). 7. I( a pertnil from Ihe South Coast Air Quality Management District or other air pollution coniml districl or agency is requirea for lhe work which is the subject of this application, have all of the tlisclosures prescribed by Cali(omia Health antl Salety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", allach certificate of compliance from the appropriata air polWtion control officer). � CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the infortnation given above is cortecL I agree to comply with all state laws and city ordinances regarding Hazardous Materials antl Emissions; , Wte CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty o! perjury that I have read this applicalion and state that the information given is correcL I agree to wmply with all state laws and ciry ortlinances relating to building construction, and authorize representatives ol the Ciry ot Costa Mesa ro enter upan the above-descnbed pmperty for in5peclion purposes. I agree not to occupy or allow occupancy of any building authorizetl Dy lhis pertnit uniil final inspection. Signawreofl O.meqs� Da�e � o - I�-/0 Ea�"�"� �,` ' „� . �»a> �sa-sz�s • Fa�c (�ia� �sa-aass CITY OF COSTA MESA BUILDING D/VISION � DEVELOPMENT SERVICES DEPARTMENT ' PERMIT BUILDING PERMIT Job Address: SHJ ANTON BL Suite: Vicinity: �Parcel Number: 41050101 Applicant: O'DALY, PAT Address: Owner: SAKIOKA FARMS Address °hCURCI-ENGLAND CO TORRANCE,CA 2377 CRENSHAW BLVD #300 Contrector. CAL SELECT BUILDERS INC Address: 00716 RICHFIELD RD Zoning: PDC PDC Phone: (949)863-1960 Zip: Phone: Zip: 90501 NUMBER I 699-00984 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 6/28/1999 Issued: 1112/1999 ISSUED BY: � J oB S� i � PFIoNE Phone: PLACENTIA CA Zip: 92670 � License: 590765 Arch : STDR ARCHITECTS Eng: Address: 18201 MCDURMOTTVJEST#A Address: Phone: (949)863-1960 �Phone: •�� IRVINE, CA Zip: 92614 License: License: • SCOPE OF PERMIT NEW 51,156 SF 24 HOUR FITNESS BUILDING. 23884 SF FIRST FLOOR, 21542 SF SECOND FLOOR AND 5730 SF THIRD FLOOR. THIS BUILDING CONTAINS THE FOLLOWING GROUP OCCUPANCIES: A3, B, E3, M. APPROVED UNDER PA-99-77 8 DR-99-10 Plan Check: $10,407.96 Permit: $16,012.25 SMIP Res: $0.00 SMIP Com: $1,050.00 Other: $0.00 Inspection: $0.00 Total: $27,470.21 SETBACKS MAIN STRUCTURE Front 460. 0 ACCESSORY Front 0. 0 PARKING Existina: o NOTES: Rear 20. 0 Rear 4 0 Required: 4221 FEESUMMARY Calc Valuation: Ss,000,000.00 Claim Valuation: ss,000,000.00 PLANNING 8 ZONING Left 220. 0 Right Left 0-0 � Right Proposed: 4221 � �, 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable hendicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within /B0 days, or if work is suspended or abandoned for e period of 180 days. , ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, end ell required Inapectlona entl Ilnal epproval must be obtainad. Failure to obtain inspections end final approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS'COMPENSAnON DECLARATON: � I hereby ettirm unaer penalry ol per�ury one of the following tlacleretions: ❑ I heve antl will maintein a ceNficate of consent to selt-Insure tor workers' compensation, as prwitle0 for by section 3700 of Ihe Labor Cotle, for the pertormence ot the %�ork tor which this pertnit is I55uetl. � I have end will maintein workers' compensatlon insurance, as requiretl by sectlon 3700 of Ne Labor Cotla, for the pertortnance of Ihe work for which Nis pertnit is issuetl. My workers' compensetion Insurance wrrier end poliq number are: Carder. PoliCy Number. (This sectlon need no( be ownplered I/ the pemutls valued er one nundred dollers (S I00) or less.) ❑ 1 certify that In the pert nce o Ihe wark far whlU this pertnit is issued, I shell not employ eny person In any menner so es to bewme suDject to the workers' compensation laws elitomia, a tl greH'th� ho eeem sub�ect to the warkers' compenseUon provlslons of Section 3700 of the Lehor Code, I shall lort�with comply with Ihese ovislons. n Applicam Signature: Dete: ��-/l'— Wr1RNIN(3: FAILURE TO WORKERS' OOMPENSATIIXJ COVEMOE IS UNL4WFUL AND SHAl1 SlIB1ELT AN EMPLOYER TO CRIMINAL PENALiIES AND GVIL FINES UP TOONE MUNDRED TMOUSAND DOLLARE (5100.00OA �N ADDRIIXJ TO TNE W5T OF COMPENSATION, OAMAOES AS PROVIDED F-0R IN SECTIqJ 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEVS FEES. LICENSEO CONTRACTORS DECLARATION: I hereby aHirtn that I am force and ettea. LIt. k_ Conlractof5 SignaWre: � oi Chepter 9(commencing with Section 7000) of Divlsion 3 of Ihe Business antl Professions CaCe. antl my Iicense Is In full aess a = Dete: �Ne� �-� CONSTRUCTON LENDING AGENCV: ❑ I �ereby attirtn thet there Is e construction lentling agenty lor the pertortnanca ol the work for which Ihis permit Is Issuetl. (Sec. 3097, Civll Cotle). Lentlels Neme: LBnCelS AtlGress: Signeture: Date: OWNEH•BUILDER DECLARATIONS: I hereby ettirm ihat under panelry ol per�ury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sac. 7031.5, Business and Professions Code: Any ciry or counry which reQuires a permit to canstruc6 alter, improve, Aemolish, or repair any sirucWre, pnor to its issuance, elso requires the appliwnt lor such permit to tile e signed stetement thet he or s�e Is licensed pursuant to ihe provisions of the Contractors License Lew (Cheprer 9(commencing wlih Section 7000) of DiWsion 3 of ihe Business antl Professions Cotle) or Nat he or she is exempt therefrom antl the basis for ihe allegetl exemplion. Any violation of Sectlon 7037.5 by eny applicant for e pertnit sublects the applicant ro e civll penalry of not more than tive huntlretl tlollaro (5500).J: ❑ I, es owner oi the proparty, or my employees with weges as iheir sde compensation, WILL DO THE WORK, end tha structure is not Intentled or oNeretl for sale (Sec. 7044, Business anA Prolessions Cotle: The Contractors License Law tloes not eppty to en owner ol property who builtls or Improves lhereon, and w�o tloes such wark himsetl or herselt or t�rough his or her avn employees, provided that such Imprwements are not intended or oHered tor sale. If, however, Ihe building or imprevement is sold within one year of completion, Ihe owner-Duilder will have the burtlen of proving Ihat he or she ditl not builtl or improve for purpose ol sale.). ❑ I, es owner oi the pmparty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business antl Professions Code: The contractors License Ww does not eppty to an owner ot property who builtls or improves thereon, antl who contrects for such pmjecl with a comracmr(s) license pursuant to the Contraciors License Lews.). ❑ I am exempi untler sec. Business antl Professions Code for this reason: Signeture: Oata: Owner ID veritietl by tlriver's licanse. ❑ Yes ❑ No Drive(s License No. Expires: Veriticetion ol Ownership by (rypa ot dacument, i.e. - praperty tac bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATON: ❑ I herehy cenify thet no e:cavation five (5) or more feet in depth into which e person is requiretl to descend, will be matle in connection wlth work euthorized by Ihis permlt, antl that no bulltling sWCWre, scattolding, lalsework, or tlemolition or tlismantling Ihereol, wlll be more Ihan thiny-six (36) teet hlgh. (Chap. 32, Grp 2, Art 2, Sec. " 341, Title B, Celifomla AtlmlNstretiva Catle). ❑ A5 owner-builtler, I wlll not employ anyone to Co work which would require e pertnit trom Ihe Division of Intlusirlal Sefety, as notetl ebove, unless such person has a permit to tlo such work trom t�e tlivision. Signature: Date: Dlvlsion of Industrial Safery Permlt NumCer: CERTIFICATE OF COMPLIANCE AND AUiHORIZATON OF EMRV: I certity under penalry of perjury that I have reatl this application entl state ihat the information given is cortect. I agree to comply with all state laws antl ciry ortlinances relating to bullaing constmction, antl eu�horize representatives ot Ihe City of Costa Mesa to enter upon the ebove-described pr�rry tor Inspection purposes. I agree not to occuOY or ellow occupancy of any buliding euthorizetl by this permit untll final inspectlon. COOE 1. INSPECTIONTYFE 1616 Fisetl System Final Fire Prevemion 1266 Paal Spa Final 200 Final Re-Rool 201 Final BIocWRetaining Well 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition 2d46d6 Q,�/jE INTffIALS // ��-y� oate 77� Date CODE� INSGECTIONTYPE 206 Finel MeCheniCal 20B Final PIum6ing 270 Final ElecMcal 212 FInelFlre PrevenUon 220 Finel Plenning Approval 222 Final Site 250 Finel Bulltling/Occupancy ft�g, IHf1i1�L5 (714) 754-5273 • Fe�c (714) 754-4858 • www.cl.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 589 ANTON BL Suite: Vicinity: 24-HOUR FITNESS PARKING LOT Parcel Number: 41050101 Zoning: PDC PDC Applicant SUTHERLAND, JAY Address: _ -" � .�, . - _ , , � � .i � Status: ISSUED Applied: 07/26I2001 Issued: 08/02/2001 ISSUED BY: ' .;-��,%- . - Phone: 909-596-7700 - - ��;�/. , � Zlp: / ' . � . .. / � � . i .,, . Owner SAKIOKA FARMS �� Adtlress %CURCI-ENGLAND CO . �- � '- ' � - � �� \ = �TORRANCE,CAV ` Phone: - � � � ' �� , -2377 CREN,SHAW BLVD #300 - Zip: 90501 -' ` - '� � � ' ' � Contiactor. MORROW MEADOWS CORPORATION , Address_ 231 BENTON CT � Phone:--909-598-7700 ' CITY OF INDUSTRY, CA 2ip: 91789 � License: 230813 Arch : Address� Zip: Phone: License: _ Eng: Address: � , . a�.vr� vr r�rc � REIOCATION OF 76lIGHT POCE &�BASES (IWRELATIONS TO CAL-TR/ PROJEC� IN AN EXISTING PARKING LOT FOR "24-HO�UR FITNESS:' - �- ` REF: E01-00652 Phone: License: �u i dS WOFtK FOR AVENUE OF THE ARTS OFF-RAMP � ___ __ _� ._' _FEESUMMARY� : _� Plan Check: $78426 � Calc Valuation: 5�3�,200.00 � Permit: $1,206.55 �� Claim Valuation: Si3�,2o0.00 SMIP Res: $0.00 SMIP Com: $28.81 Other: $0.00 Inspection: $0.00 � , � Total: - $2,019.62 � � � � � . � , �PLANNING & ZONING � � � SETBACKS _ � � � � � MAW STRUCTURE`Front , 0-0, Rear 0-0 �� . � � , ACCESSORY Front' 0. 0 Rear 0- 0 PARKING Existin : 0�' � Reauired: 0 NOTES: Lek 0- 0- , Right 0- 0 Lefl 0- 0 Right 0- 0 � Proposed: 0 . � NOTICE: The work authorized by thls permit shall comply with all applicabla handicap access requirements under Callfomia statutes and related regulations. (Ord. No. 92-28, § 1, 7241-92) EXPIRATION: This permlt shall automatically explre and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a periotl of 180 days. INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all epplicable codes, and all requlred inepeetlona end final epproval must be obtained. FalNre to obtain inspections and final approval will result in the expiretion ol this perml� FOR INSPECTIONS CALL: (714) 754-5626 � 2a6se (erool v WOHKEHS' COMPENSATION DECLAHA710N: I hereby eHlrtn wWer penelry o1 peQury one oi t�e lallowing dedaretlons: ❑ I have enA wlll meintain e ceniflcate of consent to setl-Insure tor workers' compensetlon, es proNded br by seclion 3700 of the Lebor Code, far Ne peAormance of the �-work tor wNch Ihls permit Ls IssueO. ❑_I heve entl will mainiflln workere' compensetbn insurence, az requireA Dy SecUon 3700 of the Lebo� Cade, tor Ne pertortnarqe ol Ihe work for whkh Nis pertnit is Issuetl. Cartiar. antl pollcy number ere: P011i,y'Numlienitivk 8'3�oG �o v velued ef one hundred ddlers (5100) or less.) �--'` ❑ I certity Ihat in t�e peAortnence of Ihe work lor which thls pertnit Is issued, I shell not employ eny person In eny menner ao es to become suD�ect to t�e workers' compensetlon lawa o1 elllomle, end e ree thet ii I ahauld become sub�ect lo t�e warkers' campensetion DroNslons ol Sectlon 3700 of Ihe Lebor Cade, I shell forthwith compty with these p slons. �_ ; r� �_�� AppllcenbSlpnetme:---- �Dele:- D WARNINO:'FAICURE TO E WORKERS' COMPENSATIIXJ CAVEMOE IS UMAWFUL AND SHALL SU6IECT AN EMPIAYER TO CRIMIN�L PENALTIES AND CML FlNES UP TO ONE HUNDRED TFIOUSrW D OOILARE ( ,OOO�.IN ADDfTION TO THE COST OF COMPENSATION, DAMAGES PS PHOVIDED FOR IN SECTION 3'lO60F THE LABOR CODE, IMEAEST, M!0 ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereEy eHirtn thet I em Iicensed under pravisi ns ot Chapter 9(commencing with Section 7000) ot Dlvlsion 3 0l tha.Business antl Protessions Code, entl my Ilcensa is in tull force end exect?uc a'l O b'/ 3 Ciess x+7 G/� Contraaore-Slpnetuie: - -�- � ,u�, ' rDa` te:� �• 3- � U / _ _�- i i CONSTRUCTION LENDING AGENCY: ❑ I �ereDy ettirm Ihet thore is e constructlon lontlinp epency for tha peAormence of the work for which this pertnit Is issued, (Sec. 3097, CMI Code). Lendefs Neme: Lendels Adtlress: Signeture: Date: OWNER-BUILOER OECLARA710NS: I hereby efllrtn that untler penelry o1 per�ury Ihet I em EXEMPT FROM T1E CONTRACTORS LICENSE LAW for t�e lollowing reesan (Sec. 7031.5, Business antl Professlons Cotle: My dry or counry whkh requlres e pertnit lo construct, alter, improve, demdts�, or repeir eny structure, pdor to Its Issuanca, elso requires Ne epDlicant lor such petmlt lo file e signed stetement the� �e or s�e Is IlcenseC pursuant to Ne provLslans ot Ilie Contredors Llcense Lew (Chepier e(commendng with Seclbn 7000) of Dlvisian 3 ai the Buslness enE Professbns Cade) or thet he or sha is axempt theretran end Ihe baais for the ellepetl ezemptlon. Any vldallon of Sectirn 7031.5 by any epplicem for e permll subjects the epplicant lo e civil penely M not more than frve hunGred ddlars (3500).): ❑ 1, as owner af Ihe properry, or my employees with weges es Iheir sole wmpensatbn, WILL DO TME WORK, end Ihe struc[ure b not intentletl or aflered tor sale (Sec. 7044, Business arM Professions Cotle: The Conlwctars License Law does nm eppy to an owner ol property w�o builds ar Impmves thereon, anO who does such woAc hlmseM or herseli or through Ns or her own employees, provided Ihat such imprwements ere not Intentle0 or oMered lor ule. tl, however, the DuilCing or improvement is solC within one yeer o1 completion, ihe owner-builder will have the burden of proving that he ar sha did not 6uilA or Improve lar purpose of ule.). ❑ I, es owner of the properry, em EXCLUSIVELY CONTfiACTNG WIiH IICENSED CONTRACTORS lo consiruct the pro�ecl (Sec. 7044, Buslness and Profassians Cotle: Tha cantrenars tJcense Lew does nat epply to en awner at properry who builtls or Improves ihereon, end who contracb for such prqect wlth a contractoqs) license pursuant to the Contractore License Lews.). ❑ I am exempt under sec. Signeture: Business and Profession9 Code for this reason: Owner ID verllied by dAvefe Ilcen96. ❑ Y69 ❑ No Drivefs Lltense No. Vedflcetlon ol Owners�lp Oy (lype o1 tlaument i.e. - pmperry tex bill or deetl); DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Dala: Euplres: ❑ I hereby ceNty Ihet no excevetlon five (5) or more leet In depth into w�ich a paraon Is requlred to tlescentl, wlll be made in connectlon with work eutharizetl �y this pertnll, entl thet no DUIltlinp atructure, scaHoldlnp, lalsework, or demolitlon or dismentling thereoi, wlll be more then t�lrty-slz (38) teet hiph. (Chflp. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia AdministretNe Code). ❑ As ownerbullOer, I wlll not employ enyone to Oo work which woultl require e permit Irom t�e DlNsion ot Industdal Sefery, es notetl ebwe, unless such pereon �es e pertnil �o do such work Irom the diNslon. Signeture: Date: Divislon of IntlusiAal Sefery Pertnit Number: CERTiFlCATE OF CAMPUANCE AND AVIHORVATON OF ENfRY: I cenify under penalry of per�ury that I heve read thls epplicetlon and state thet the Intormetion given Is canect I epree ro wmply with ell stete lews end ciry ordinances relating to Dullding consWIXion, en0 aut�otlze representatives ol the Ciry of Costa Mese to enter upon Ihe ebove-described propeny br Inspedlon purposes. I egree not to oaupy or ellow occupenry ot eny building euthodzed by this permit unGl tinel inspection. COOE I. INSPECTION TYPE 7616 Fixed SyStem Final Fire Preventlon 7268 200 201 202 203 Pool Spa Finel Finel Re-Roo1 Finel BIocWRetelning Well Flna� Feaory Fire Place Final Sign 204 Final Demolitlon Q� p�/�$ CApE� INSPECTIONTYPE 208 Final Mechenlcal 20B Flnel Plumbing 210 Finel Elettrical 212 Finel Flre Preventlon 220 Finel Planning Approvel 222 Final Site 250 FInalBullding/Occupency Pdg 1l�LS Job nddress: 589 ANTON BL Suite: Viciniry: Parcel Nunmber: 41050101 GRADING PERMIT Zoning: PDC PDC Applicant GATES, LAWRENCE� �' - , Address: � � � ' ��.i%' � . ;�"�� - - ' , % . -" � Owner: �SAKIOKA�FARMS ' Address %CURCI-ENGLAND CO � " , TORR4NCE,CA � , " 2377 CRENSHAN/ BLVD #300 �� , Contractor. HIGH VALLEY CONSTRUCTIO� - Address: � PO BOX 530 / Phone: 714-685-6860� : Zip: �� - Phone: Zip: 90501 Status: PC Applied: 03IO2/2001 Issued: ISSUED BY: ' � , � . Phone: 714-920-5590 STANTON, CA , � � � � - � � - Zip: 90680 � � , License: 664667 Eng : LAWRENCE GATES-,, . ; �Address: �. - Z'P Phone: License: C45715 � ' ' � ' " SCOPE OF PERMIT � � � CUBIC YARDS ON-SITE IMPROVEMENTS AND GRADING ON THE NORTH� WEST SIDE AND THE SOUTH SIDE OF METRO � CENTER FOR FUTURE CALTRANS OFF RAMP. -�, 1000 . FEE SUMMARY Plan Check: $33.00 � Calc Valuation: Eo.00 50.00 Permit: $194.50 Other. $o.00 $0.00 Inspection: $0.00 �� ' �. 50.00 - � . , , � Total: $0 00 � , �. , - i i � � PLANNWG & ZONWG � NOTES: NOTICE: The work authodzed by thls permit shall compty wlih all applicable handicap access requirements under Calitomia statutes and related � regulations. (Ord. No. 92•28, § 1, 12-21-92) El(PIHA710N: This permlt shall eulomaticalry expire and become void if work is not commenced wlthin 180 days, or il work is suspended or abandoned for a periotl of 180 days. INSPECTIONS: In order lor the work authorized under lhis permit to be consideretl legal, such work must camply with all eppliceCla codes, and ell requlred Inapeetlona end Iinal approvel must be obtalned. Failure to obtain inspections and final epproval will result In tha ezpiretion of this pertnit. FOR INSPECTIONS CALL: (714) 754-5628 za+e-ea �aroo� WORKERS' COMPENSAnON DECLAiiArON: I hereby ettirtn under penelry W perjury one of the fWlowing dedaratlons: ❑ I heve entl wlll malnteln a certificete of consent lo sell-Insure for workers' compensatlon, es proWtled for by section 3700 01 the Lebor Code, lor Ihe pertormance of the work lor which this pertnit is Issuea. I �ave enA wlll melntaln wo�kera' campen5e0on insurance, es reqWretl by secllon 3700 of the Lebor Catle, for Ne partormence of Ihe vrork for whlch this pertnit Lq Issued. y workera' compenseilon �nsurence rarrler and policy number ere: Cerrler: Polity Number: (Thls sectlon need nof be canpleted I! the permit Is valued et one hundred tlW/ers ($100) or /essJ ❑ I cenily that In the pedo compensetlon laws of C se provh icant Slgneture: WARNINO: FAILU SECUFE RE (5100.OW), LICENSED CO S I �ere t�at I em Iicem lo end ect. tJc. M ontrect a Slgneiure: _ of tha work r w�ich thls pertnit b Wue4 I shell nol employ eny persan In eny menner so es to bewme subJect to Ihe workers' 1 d agree hat II I should became subJect to t�e workers' compensetlon provlslons af S ctlonj� 700 of Ihe lebor Cada, I s�ell IOMwith te: gl2'/�l RS' COMPENSA EMOE IS UMAWFUL AND SNALL SUBJECT EMPLOYER CFIMINAL PENALTIES iVlD CM� FlNES UP TO ONE HUNDRED IONTOTHECOSTOFCOMPEN5ATI0N,DAAM0E5iVPROVIDEDFOR SECilON37 OFTHEIABOACO�E,INTEREST,PND�TTORNEYSFEES. (commendnp with Sectlan 7000) oi DIvi4lon 3 0l the Dete: CoAe, end my Iicense Is N fup SC�yCTBNLEN0ING AGENCY: �� ❑ I �ereby etlirm that there is e consUuctbn lending egern.y tor the pertortnente oi the work tor which Ihis permit Is Issuetl. (Sec. 3097, CHII Cotla). Lendofs Namo: Lenders AAtlress: Sipnelure: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn Ihat under penalry of perjury that I am EICEMPT FROM THE CONTRAC70RS LICENSE LAW for the follawing reeson (Sec. 7031.5, Buslness anO Pratessione Cotle: Any ciry or wunty which requires a permit ro conswct, elter, improve, demolish, or repair any sirucWre, pnor lo its issuance, elso requlres Ihe eppllcant far such pertnP ro Ole e slgned statemem ihet he or she is licensed pursuent to Ihe proNsbns af the Contrectors Llcense Lew (Chapter e(commencinp wlth Seclion 7000) of Dlvisian 3 of th[ Business end Profassions Code) or that �e or s�e Is exempt therefram antl Ne Eesls br t�e ellegetl exemption. Any NWatlon of Sectlon 7037.5 by eny applicant for e pertM�. sub�ects the appllcant to e dvii penelry of not more Ihan INe hundreO Eollars (5500).): ❑ I, es owner of Ihe properry, or my emplqrees wiU wages es t�eir sole compensetlon, WILL DO TME WORK, entl ihe siructure Is not intentled or otteretl (or sale (Sec. 7044, Business entl Professions Cotle: The Contreaors License Law Coes not appy to en owner ol properry who builEs or Improves thereon, and w�o tloes such work himself or herself or t�rouph his or her own employees, proNtletl Ihat such Improvemenis are not intended or oNered for sale. If, howaver, the OUIltling or imprwement is sold wlthin one year of completion, ihe owner-builtler will have t�e burtlen ol proving Ihat he or sha did not build or improve for Durposa of sele.J. ❑ I, e9 owner ot the properry. am EXCLUSIVELY CONTRACi1NG WfTH LICENSED CONTRACTORS to construct Ihe pro�ecl (Sec. 7044, Business antl Profes5ion5 Catle: The contracrors License Lew does not eppty to an owner oi pmperry who builds or Improves Ihereon, enA w�o contrects for such pro�ect wlth a contractor(s) license pursuant to the ConVactors License Laws.j. ❑ I em ezempt unCer sec. Business and Prafessians Coda tor this reason: SignaWre: Date: Owner ID veAfied by drivefs Iicense. ❑ Yes ❑ No Drivefs License No. Verlllcation of OwnersNp Cy (rype ot tlowment, i.e. - property tex bill or daed): 6cpires: DIVISION OF INDUSTRIAL SAFETY PERMfT CERTFICATION: ❑ I hereby cehify Ihet no excavetion five (5) or more leet in depih Inio which e person is requlretl to tlescentl, wlll be mede In connectlon wlih work euthorized by Ihis permit, end �het no building slructure, scattolding, lalsework, or demolitlon or dismantling thereof, will be more ihan Ihirry-six (38) leet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title B, Celllomla Atlminlstretive Cotle). ❑ Ae awner•builder, I will not employ anyone to tlo work which woultl ropuire e pormit Irom the Division of Intluatrial Selery, es nated ebave, unless such person hes e permit to do such work irom the division. Signeture: Dete: Dlvlsion of IndusMel Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AllT}IORQA710N OF ENTRY: I ceM1ily under penelty oi perjury that 1 have read thls applicetlon end s�ale tha� the into'mation given is correct. I apree to compy with ell stete laws antl ciry ordinences ralating lo bullding constructlon, end aut�orize representatives ol the Giry af Coste Meu to enter upon Ne ebove-tlescrlDetl D�operty for)nsp�tion purpos�s. l egree not to occupy or ellow acupanq oi eny building authorized by this permit until tinel inspectlon. CODE �. ixsveenoHme �- pdg It�E1� 1618 Fixed System Finel Fire Prevention fEI:] 200 201 Pod Spe Finfll Flnel Re-Roof Finel Block/Reteining Weil 202 Flnal FeMory Fire Place 203 Finel Sign 204 Finel Demolillon COOE� INSFECTIONTYVE 206 Finel Mechanicel 20B Final Plumhing 210 Final ElecMcel 212 Flnel Flre Prevenilon 220 Finel Planning Approvel 222 Finel Slte 250 Final Buildinp/Occupency Z �g � (714) 754-5273 • Fax (714) 754•4856 Job Address: 589 ANTON BL Suite: Vicinity: 1 ST FLOOR Parcel Number: 410SDiDi CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT npp�icant: RYAN, MARY Address: 22600 E. LAMBERT ST. LAKE FOREST, CA SUITE 1104 Owner: SAKIOKA FARMS Address °hCURCI-ENGLAND CO - TORRANCE,CA �. � 2377 CRENSFiAW BLVD i1300 Contractor: MISSION POOLS Address: 22600 E. LAMBERT ST. � LAKE FOREST, CA SUITE 1104 Zip: 92630 Arch : Address: BUILDING PERMIT Zoning: PDC PDC Phone: (949)588-0100 Zip: 92630 Phone: 2ip: 90501 Phone: (949) 588-0700 License: 326760 � Eng: Address: PERMIT NUMBER 77 FAIR DRIVE, CASTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 03I14/2000 Issued: 03/142000 � Phona: Phone: . Zip: ' Licensa: License: SCOPE OF PERMIT ' CONSTRUCT NEW 1698 SF POOL 8 137 SF SPA IN NEW FITNESS CENTER FOR "24 HOUR FITNESS". � REF:899-00984 Plan Check: $418.76 Permit: $644.25 SMIP Res: $5.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,068.01 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0-0 PARKING Existina: 0 Rear 0. 0 Rear 0-0 Reauired: 0 FEESUMMARY PLANNING 8 ZONING Left 0- 0 Left 0. 0 ProDosed: 0 Calc Vatuation: Claim Valuation: Right 0. 0 Right 0. 0 sso,000.00 $50,000.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetlone end final approvel mus� be obtained. Feilure to obtain inspections and final approvel will resull in the expiretion o� this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby eHirtn untler penelry of perjury one oi lhe lollowing declarations: � ❑ I heve end wlll mainiain a certlflcete of consent to sell-Insure br workers' compensation, es pravidetl for by sectlon 3700 ot the Labor Cotle, lor Ihe peAormance of the work for which thls pertnil is issued. � �I heve enA wN maintain workers' compensetlon insurance, es requiretl by seclion 3700 0l the Lebor CoOe, tor Ne peAortnance of Ne wark for which Nis Oermit is issued. My worke pensetipn I urance cerder en0 policy number are: Cerrier. �� PolicyNumber. zGyao3��n (ThIs sectlon need rrot be cwnpletetl i! the pertriit /s ve/ued ef one huntlreU dd/ers (5100) or Iess.J ❑ I certify that in Ihe peAortnance ot the work for which this pertnit is Lssued, I shell not employ eny person In eny manner u es to becwne sub�ect to the workers' compensation laws of Celilomla, end agroe thet tl I shoultl Decome sub�ect to Ihe workere' compensetlon provisions of Section 3700 of the LeDor Code, I shell larthwith compry vrith thesa pr o s. 2 2 Applicen�SigneWre: �tJi� �� %�% � Dete: —7 �� S �� WARNINO: FAILURE TO SECURE WORKERS'POMPENSATION � VEPAGE IS UNLAWFUL AND SHFl1 SUBJEGf AN EMPLOYER TO CRIMINAL PENAlT1E5 AND CML FlNES UP TOONE HUNDRED TYIOUSAND DOLLARE (510p,000). IN ADDITION TO iHE COST OF CqMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3'1O80F THE IABOR OODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aRirm t�at I am lorce antl eMact. Llc. a_ "Contreciors Signaiure: ot Chapter 9(commencing with Saction 7000) of Divislon 3 of the Business antl Protessions Cotle, end my license is in tull Cless a G 'S � Date� � 'J �j`'"' d CONSTRUCTON LENDING AGENCV: ❑ I hereby eHirtn Ihat t�ere is a cansWction lending egenCy tor Ihe OedormanCe of fhe work tor which Ihls permlt is i55ued. (Sec. 3097, CINI Code). LenOefs Name: Lentlefs Atltlreu: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby alfirm ihet untler penalry of perjury thet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7037.5, Business end Prolessions Code: Any ciry or counry which requires e permit to consimct, elter, improve, tlemolish, or repair eny simcNre, prior to its issuance, elso requires Ihe epplicant for such permit to tlle a signetl statement that he or she Is Ilcensed pursuent to the provisions of t�e Contractors Llcense Lew (Chapter 9(commencing wlth SecOon 7000) of DlNsion 3 ot the Business antl Professions Code) or Ihet he or she Is exempt t�erefrom and ihe basis for the elloged exemptlon. Any vlolatlon of Secilon 7031.5 by eny applicant for e permit sub�ects Ihe epplicant to e civil penalry ot not more ihen five huntlreA tlollars (5500).): ❑ I, as owner of the properry• or my employees with wages es their sole compensetion, WILL 00 THE WORK, and the structure is noi intentletl or offeretl for sale (Sec. 7044, Business antl Professions Code: The Contractors License Law tloes not eppy to an owner oi property who builtls or improves thereon, entl who tloes such work himself or herself or through his or har own employees, provitled that such improvemen(s are not intended or ottered for sale. If, however, lhe building or improvement is sold within one year ot crompletion, [he owner-builtler will have the burtlen of proving that he or she did not builtl or improve for purpase of sale.). ❑ I, as owner of the pmperry, am EXCLUSIVELY CONTRAGTING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business antl Professions COAe: The contracrors License Law does not epply to en owner of property who builtls or Imprrnes ihereon, and who coniracts Por such pmject with a contractoqs) license pursuant to Ihe Contraciors License Lews.). � ❑ I am azempt under sec. Buslness antl Professions Cotle tor t�is reason: Signeture: Data: Ownar ID veriliad by driver5liten5e. ❑ Ves ❑ No DriverS License No. Verilicatlon of Ownership by (rype of tlocumenl, I.e. � property fax blll or deed�: Expires: DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenlly thal no ezcavetion five (5) or more leat In tlept� into which a person Is requlred to descend, will be made in connection wlih work euthorized by this permit, entl t�et no 6uilding slrucNre, scaNOlCing, felsework, or tlemolition ar dismanlling thereol, wlil be more ihen thirty-si: (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, lltle B, Califomia AdministreNve Code). ❑ As owneaDuilCer, I will not employ anyone to tlo work which would require a permit tmm the Divislon ot Intlustnal Safery, as noteA above, unless such person has a pertnit to do such work from the tlivision. Signeture: Date: Division of Industrial Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORVATION OF ENiAY: I ceriity untler penaliy of perjury that I have read this epplication and state ihat the inlortnation given is correcL I agree ro compty with all state laws and ciry ortlinences relating to builtling caretruction, end eutharize representetives ot the Ciry ot Costa Mesa to emer upon the above-tlescnbed pmpeny lor Inspection purposes. I egree nat to occupy or ellow occupanq ol any Dulitling euthonzad Dy this permit untll final inspecilon. COOE 1• INSPEGTIONTYGE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 20t Final8locWRetaining Wall 202 Finel Feciory Fira Place 203 Finel Sign 204 Final Demolition 26a&48 QA7E INTffIALS • m. a CO�EI INSVELTONTYPE 206 Final Mechanical 20B Final PlumDing 2i0 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupancy Date �•/<^'d � e QLj� INiRIALS (714)754-5273 • Fex(714)754-4856 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: � CITY OF COSTA MESA ' BDILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 589 ANTON BL 1STFLOOR-POOLAREA 41050101 RYAN, MARY 22600 E. LAMBERT ST. LAKE FOREST, CA SUITE 1104 _ " Owner. SAKIOKA FARMS Address ,°hCURCI-ENGLAND CO -, . TORRANCE,CA., � 2377 CRENSHAW BLVD #300 Contractor: MISSION POOLS Address: 22600 E. LAMBERT ST. LAKE FOREST, CA SUITE 1104 i ' ELECTRICAL PERMIT Phone: (949) 588-0100 Zip: 92630 Phone: Zip: 90507 _ Phone: (949) 588-0100 . 2ip: 92630 License: 326760 NUMBER 0213 T7 FAIR DRIVE. COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 03I74I2000 Issued: 03I14/2000 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW SWIMMING POOL & SPA FOR "24 HOUR FITNESS". INSTALL ELECTRICAL FOR NEW POOL & SPA. " � REF: B00.00320 ISSUE FEE Temp service test Res. a/c package New Res (1-2 unils) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 7000a Molors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops $23.50 $0.00 $0.00 $0.00 $0.00 549.50 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �uantity FEE SUMMARY Temp Disl System / Lighting Busway I100 fi Standing Seaion Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up l0 50 kva/kw .................up l0 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low VOIt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electriwl Fee Investigation Fee Quantity 30.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 80.00 0 $0.00 0 $0.00 0 80.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicep access requirements under California statutes end reiated regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is nat commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work aulhorized under this pertnit to be considered lagal, such work must comply with all epplicable codes, and all requlred inepeetlona and tinel approval must be obtained. Failure to obtain inspections and final approval will rasult in the expiration of �his permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATON DECLARAnON: I hereby aNirtn untler penalry o1 per�ury ane oi Iha tdlowing dedaretions: � . ❑ I �ave an0 will maintain a cenificete at consent to selt-Insure for workers' compensetion, as proviAetl for by section 3700 of ihe LaDor CoAe, far t�e pertormance ot the �work for whic� t�is permit is issued. ' I have antl wlll maintaln workers' compen5ation InSUrance, as reQuired by section 3700 ot ihe Labor Code, for lhe peAormence ot the wark lor which Ihis permit is' ed. My wo compensatlon Insurence cartier entl policy number ere: , Cenier. ��l/�'1 POIIcyNumber. e�O�Ia O 3�(�O (Thls secNon need not be comp/etetl/l Ihe pertni( is va/ued et ane hundred dollare ($100) or IessJ ❑ I cenity that In the perlortnence of t�e wark lor which this pertnit is issueq I s�all not emplay any person in any manner so es to 6ecome su��ect to the workers' compensation laws ol Calitomia, and egree thet If I should 6ecome subject to the workers' compensetion provislons af Sec�ian 3700 0l tha Lebar Cade, I shall torthwith comply wl�h Ihese pravi�� .�f i ^ /`' ` C)� Applicant Signeture: y� �i Date: J J WARNINp: FAILURE TO SECURE WORKER$' G MPENSNTIIXJ COVERApE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE$ ANU CIVIL FINES UP TOONE HUNDRED THOUSFND DOLLARE (E10D,000). IN nDD1T10N TO TME COST OF COMPENSFTION, UAM4GES AS PROVIDED F-0R IN SECTIqJ 3]OB OF THE IABOR CADE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aNirtn that I em Iicensed untler provisi< lorce antl aHect. Llc. a ' �� . Contrectofs Signature:—___!� of Chapter 9(cammenGng with Sectlon 7000) of Division 3 oi t�e Business and Pmfesslons Coda, antl my license is In full ��a5s � c_ �-3 1 !G Dato: � • / C � ' � �� CONSTRUCTION LENDING AGENCV: ❑ I hereDy eMirm that there is e consiructlon Ientling agenq tor the pertortnance of t�e work tor which this permit is luued. (Sec. 3097, Civll Cotle). Lenders Name: Lendefs Address: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I �ereby ettirtn ihat untler penalry ol per�ury thal I am EXEMPT FROM THE CONTRAC70R5 LICENSE LAW for �he following reeson (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requiras a pemtit to conswct alter, impmve, demolish, or repalr eny strucNre, pnor to its issuance, elso requires the epplicant tor such pertnit lo file e signed statement that he or she is licensed purouam ro Itie provisions ot Ne CONractors Llcense Lew (Chepter 9(wmmencing wlth Section 7000) of DMsion 3 of Ne Business antl Pmteuions Code) or that �e or she is exempt therefrwn and the basis for the allegetl enemptlon. Any violatlan of Seclian 7031.5 by flny applicant tor e permit subJects the eDP�� o e civll penalry oi not mwe than live hundred dWlars (5500).�: ❑ I, as owner of Ihe proDerty or my employees with weges es their sole compensation, WILL DO THE WORK, end the siructure is not Intentled or oflered tor sale (Sec. 7044, Business entl Professbns Code: The Contradore License Law dces not appty to en owner of propeM who builas or imprwes thereon, entl who does such work himself or herself or through his or her own employees, provided Ihat such imprwements are not intended or ottered for sale. If, howevar, Ihe building or imprwement is sold within one year of complation, Ihe owner-builder wili have ihe burden of proving thet he or she did nol builO or improve for purpose of sale.). ❑ I, as owner oi lhe property, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct t�e pro�ect (Sec. 7044, Business and Professions Cotle: The contrector5 License Lew aoes not aOPly to an owner of property who builtls or improves Ihereon, and wh0 ContreCtS for suCh project with a con[rador(s) license Oursuant to the Contrectors License Lews.). ❑ I em ezempt under sac. Signature: Owner ID veAfietl 6y tlrivers license. ❑ Ves ❑ No Business and Protessions Cotle lar this reeson: Veri(ication oi Ownership by (type of document, i.e. - properry taz bill or deed): Dnver's License No. Date: Ezpires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation INe (5) or more feet In tlepth into which e person Is requlretl to tlescen4 wlll be made in connectlon wiih work authodzed by this pertnit, antl that no builtling structure, scaMOlding, tfllsework, or tlemoli�ion or dismantling �hereot, wlll be more fhen thlrry-six (38) teet hig�. (C�ap. 32, Grp 2, Ah 2, Sec. 341, T�le 8, Califomia Adminislretive Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permil trom 1he Division of Industdel Safery, es noted above, unless such person has e permit to tlo such work Irom �he division. Signemre: Date: Division ot Industrial Sefary Pertnit NumDer: CERTIFlCA7E OF COMPLIANCE AND AUT}IORIZATON OF ENTAV: I certify untler penalty of perjury thel I heve reetl ihis application and state that ihe information given is correcl. I agrae to comply with all stete laws and dry ordinances relating to building consiruction, antl euthorize representetives ot Ihe Ciry ot Costa Mesa to enter upon tha above-descnDetl propeny for inspection purpases. I agree not to occupy or allow occupancy of any bulldinq euthonzetl by this pertnit umil final inspection. CQOE �, INSGECTIONTYPE 7616 Fizetl Sysiem Finel Fire Preventim 1266 Pool Spa Finel 200 Finel Re-Rool � 201 Flnal Blak/Retalning Wall 202 Final FectOry Flra Place 203 Final Sign 204 Final Demolition 2448�48 Date � '/ �• d� Date Q�jE IN 4QQf„( INSPECTIONTYPE � 206 Final Mechanical 208 Flnal Plumbing 210 Final Eleclricel 212 Final Flre Preventlan 220 Flnal Planning Approval 222 Final Site 250 Finel Builtling/Occupancy �g � �� " .mi _ (714) 754-5273 • Fez (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vitinity: Parcel Nunmber: 589 ANTON BL 24-HR FITNESS PARKING LOT 41050101 Applicant: SUTHERLAND, JAY Adtlress: 231 BENTON CT , CITY OF INDUSTRY /CA ' � / . - �� %, � i � Owner/ SAKIOKA FARMS � Address .%CURCI-ENGLANDCO - . �" TORRANCE,CA ', / � " 2377 CRENSHAW BLVD #300 i Phone: 909-598-7700 Zip: 91789 Phone: Zip: 90501 Status: ISSUED Applied: 07I792007 Issued: 08IO2/2001 ISSUED BY: ' �' \ / � i ' �, Contracror: MORROW MEADOWS CORPORATION Address: 231 BENTON CT . ' � ' ' , � . :Fhone: 909-598-7700 CITY OF INDUSTRY, CA ' '_ �- Zip; 91789 ' , License: 230813 , �. ' SCOPE OF PERMIT � ��" RELOCATION OF i6 LIGHT POLES 8 BASES (IN RELATION TO CAC TRANS WORK FOR AVENUE OF . THE ARTS OFF-R4MP PROJECT) IN AN EXISTING PARKING LOT FOR "24-HR FITNESS." ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service ro zooa ' Service to 1000a Service over 1000a Motors to 1hp Molors to 10hp Motors to SOhp Motors ro 100hp Motors over 100hp Communication drops Sub panel l0 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Po�e 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 ' 50.00 � 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 �, 50.00 50.00 5536.00 50.00 so.00 $0.00 Duantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16 0 0 0 _ � FEE SUMMARY ' Temp Disl Syslem / lighting Busway/100k Standing Section � Misc Electrical Equipment .Transformers up to 1 kva/kw ................uP to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw _ ..................over 100 kva/kw Low Vol[age Equipment Low Volt Wiring System I Ckt Misa Conduit _ Misc. Conductor - Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Imestigation Fee - � - Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 80.00 0 - $0.00 0 $0.00 0 $0.00 Oi $0.00 0 $0.00 0 $0.00 0 $0.00� 0 ' $0.00 0 $0.00 ; 0 $0.00 0 50.00 0 - 50.00 0 50.00 0 ' 50.00 - , 0 50.00 � � 0 so.00" $0.00 $0.00 $0.00 E0.00 NO710E: The work authorized by this permit shall comply with all applicabla handicap access requirements under Calitomia statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: Thls permit shall eutomatically azpire and become void if work is not commenced withln 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, end all required Inepectlons antl final approvel must be obtalned. Failure to obtain inspections and final approval will result In the ezpiratlon of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 xaoaea�eroo� WORKERS'COMPENSAnON DECLARArON: I hereby elflrm under penalry ol perjury one of ihe lollawing deGaretlons: ❑ I heve enE will meintflln e certtlicete of con58nl to setl-InSure lor workers' compensellOn, es proNded tor 6y aectlon 3700 01 Ihe Lebor Catle, for the pedortnence of Ihe �'xrork for w�ich tlils pertnit is issuetl. .��1 heve erW will malnt�in workers' canpensetion insurence. es require0 by sectbn 3700 0l Ihe Lebor Cade. tar the peAa�mance of Ure work tor which Ihis pertnit l9 issueE. My workers' cwnpqpsetlon Insurence cartler erW pdky number are: �Carrier." T'.i�% P�7'(/� rPolicV.Number., ��GlE ��! L'"UlilO .(This secflon need nof be oompleted I/!he perrNt Is velued et one hunCred CW/ers (5�00) or less.) ❑ I csnity that In Ihe peAartnaxe of Ihe work tor which Ihis pertnit Is Lssuetl, I shall not employ eny persan in eny menner eo as ro become sub�ect to ihe workers' compensatlon iaws ot eAfomle, end pree that if I should become sub�ect lo the worken' compensation provlslons ot Senlon 3700 of Ihe Lebor Cotle, l s�a0lonhwlth � mpy �n�n Uese vr sio�. Applicant�Slpnature:`-- De et --' � - Z - � � WARNINQ: FAILURE TO URE WORKERS' COMPENSATION COVERAOE IS UNLFWFUL AND S WLLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTES M1D CML FlNES UP TOONE HUNDRED T1qUSANDDOLURE OO,OOO�,INADDRIONTOTHEWSTOFCOMPENS�TION,OAAIFOESASPROVIDEDFORINSECf10N3](IBOFTHEIABORCODE,INTEREST,ANOFTTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby efllrm thet 1 em.licensed untler proNsions of Chapter 9(commenGnp with Sectlon 7000) at Divislon 3 of the.8us�ss entl Professlons Cade, entl my Ilcense Is in tull lorce ena ettect. tJc: x--� 3 0 r Ccless x G/ v ContrecroCs.Signature:- �ic�i� �a:��a�. - GDete;-__ - Z "d � c — CONSTAUCTON LENDING AGENCY: ❑ I �ereby eHirtn t�at ihere is e constructlon Ientling apency lor Ue peAormance at Ne work lor which this permit is luued. (Sec. 3097, Clvil Coda). Lentlefe Nema: Lentlers Address: Signeture: Dale: OWNER-BUILUER OECLARATIONS: I hereby eHlrtn t�et under penelry of pehury I�at I am EXEMP7 FHOM 7HE CON7RACTORS LICENSE LAW for Ihe following reeson (Sec. 7031.5, Business entl Protesslans Code: My clty ar counry which requlres e permit to construct, elter, improve, tlemolis�, or re0eir eny structure, priar ro Ils Issuance, also requires t�e epplicant for such permit to file e signed stetament thet he or she Is Ilcensetl pursuant to Ihe proNsioru o1 Ihe Cantractors IJcense Law (C�apter 9(crommenclnp with Section 7000) of Divislon 3 of Ne Business enG Pmfessions Cotle) or t�at he or she is exempt t�erefmm entl t�e besis tor the elleged exemptlon. Any violetlon of Section 7031.5 by any epplitent for e pertMt sub�ects Ihe epplicant to a civil penalry of not more then Me hundred ddlers ($500).): � I, es owner oi ihe properry, ar my employees with weges es iheir sole compensetlon, WILL DO 7HE WORK, end Iha structure Is not inientleE or oftered lor sale (Sec. 7044, Business and Protesslons Code: The Contrectore License Lew does not eppty to en axner of property who bullds or improves Nereon, and who does such work himself or herself or Nroug� his or her own employees, provi0etl ihat such Imprwements ere nat intenCetl or oNeretl lor sale. If, howevar, Ihe bulltling or Improvement is soltl w0hin one year of completion, t�e owneo-Duilder will have the burtlen ot Oroving ihet he or she did not build or improve for purpose oi ule.). ❑ I, es owner of Ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CON7FiACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The contrectore IJcense Law tloes not eppty to en owner oi property who �ulltls or improves Ihereon, antl who contracis for such projecl with e contracror(s) license pursuant to ihe Contractors License Lews.). ❑ I em exempt undar sec. Business end Proteuions Code br Ihis reason: Signature: Date: Owner ID veAfied by tlrivers license. ❑ Ves ❑ No Drlvels License No. Expires: Vedllcatlon ot Ownership by (rype of documem, I.e. - property taz blll ar deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby certity thet no excavatlon Me (5) or rtwre feet in depth into which e persan is required to OescenO, wlll be maOe in connection wIN work authodzetl by Nls permit, enC t�at iro building stmdure, scaNdCinp, talsework, or demdition or tllsmantling thareol, will be more than ihlrry-slx (38) teet Mgh. (Chap. 32, Grp 2, Atl 2, Sec. 341, l'itle B, Callfomia AdminislretNa Code). ❑ As owner-builder, I wlll nol employ enyone to do work which would require e permil Irom the DiWsion ot Indusiriel Selery, es noted eDove, unless such person hes e permlt to tlo such work tmm the tliWsion. Signature: Oate: Divlslon ol lndusirlal Sefery Permlt Number: CEHTIFlCATE OF COMPLWNCE AND AUTHORQATION OF EMRY: i cerlify under penelry of perjury ihat I have reetl this epplicetion end stete thet the Informetlon given is wrrect. 1 egree to compry with ell stete laws entl Ury wtlinances relatinp to OuilGing wnsiruction, end euthorize representetives ot the Ciry of Coste Meu to enter upon the ebove-descdEed property for Inspectlon purposes. I egree not ro occupy or ellow arupenty ol eny building euthonzed by Ihis permit until fnal inspecUon. CODE I, INSPEGTIONTYPE Qd¢, �{�$ 1618 Fl:ed System Finel Fire Preventlon 1288 200 201 202 203 Pool Spe Finel Finel Re-Roof Flnel Blak/Retaining Well Finel Fectory Fire Place Flnal Sign 204 Final Demolition GO�EI INSPECTONTYPE 208 Flnel MeChenlCel 208 Finel Plumbing 210 Flnel Electdcel 212 Flnal Fire Preventlon 220 Final Plenninp Approval 222 Final Site 250 Finel Builtling/Occupenry � - d� Date '� PLff. Q�LB �'/� � (714)754-5273 • Fan(714)75d-4856 Job Address: Suite No Vicinity: , � CITY OF COSTA MESA � BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 589 ANTON BL 1STFlOOR-POOLAREA Parcel Nunmber: 41050101 Appiicant: RYAN, MARY AddreSS: 22600 E. LAMBERT ST. L4KE FOREST, CA - SUITE 1104 � " � Owner. SAKIOKA FARMS Address %CURCI-ENGLAND CO TORRqNCE,CA Contractor: Address: Arch I Eng : Address: 2377 CRENSHAW BLVD #300 MISSION POOLS 22600 E. LAMBERT ST. LAKE FOREST, CA- ,� . SUITE 7104 PLUMBING PERMIT Phone: (949) 588-0100 Zip: 92630 Phone: . Zip: 90501 Phone: (949) 588-0100 Zip: 92630 License: 326760 Phone: Zip: License: P IT NUMBER P00-00131 77 FAIR DRIVE, COSTA MESA. CA 92626 ISSUED BY: Status: ISSUED Applied: 03/14I2000 Issued: 03/t412000 SCOPE OF PERMIT PLUMBING PERMIT FOR CONSTRUCTION OF NEW SWIMMING POOL 8 SPA FOR "24 HOUR FITNESS'. INSTALL NEW GAS OUTLETS, WA7ER PIPING, 8 OTHER PLUMBING FOR NEW POOL 8 SPA. REF: B00-00320 ISSUE FEE BackFlow irtigation BackFlow Preventer Balhtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank AMT 823.50 50.00 $0.00 $0.00 50.00 50.00 so.00 $0.00 80.00 so.00 50.00 so.00 $0.00 FEE SUMMARY arv nMr Laundry Tub I Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trep $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap tor Demo $0.00 0 � Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 on 0 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping pnst or Rep.) Water Re-pipe AMT $0.00 860.75 $0.00 so.00 80.00 $0.00 $0.00 so.00 $0.00 $0.00 80.00 59.80 $0.00 Qrr 0 1 0 0 0 0 0 0 0 0 0 1 0 NO710E: The work euthorizetl by this permit shell comply with all applicable handicap access requirements under Calitornie statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if 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 codes, and all requlred Inspectlone end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiratlon af �his permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKERS' COMPENSA710N DECLARATON: . I hareby eHirtn untler penalty ol perjury one oi ihe following tleclarations: ❑ I heve end will maintain a cenificata oi consent to self-Insure br workers' compensatlon, es provided tor by sealon 3700 of tha LeDor Cotle, br the peAormance of the work Por which lhi5 permit 19 i55uetl. ' �I have flnd witl maintain vrorkers' compensation insurance, as required by secfion 3700 oi Ihe fabor Code, for the perfartnance of ihe wark for whkh Nis pam�it is iswetl. My workers' compenseYon Insurence wrtier and poliq number ere: /�.� ca��a�: 9��I� POIIcyNumber. z��`�"�SSO� (Thls section need nof be comp/etetl If the permit is ve/ued et one hundred dW/ars ($700) or less.) ❑ I certify Ihat In the pertormence of lhe work for which this pertnit is issued, I shall not employ any person In eny menner so as to became sub�ect to the workers' wmpensation laws ol Celifomia, entl agrae Ihet It I shoulA become sublect ro the workers' compensation provislons ot Sectlon 3700 of the Lebor Cotle, I shall forthwith comply with these pm sl �[/ �J�1/��/� Applicent Signature: � / Y(/ // ' Date: 3 `�S ' �� WARNING: FAILURE TO SECURE WORI(E ' COMPENSATIIXJ COVEqACiE IS UNLAW FUL AND SHALL SUBIECT PN EMPLOVER TO CfiIMIN/ L PENPLTIES AND qVIL FlNES UP TO ONE HUNDRED h10USMlD OOLLARE (5100,000�, IN ADDITION TO THE C06T OF CON.PENSATNXJ, �MUGES 0.5 PROVIDED f-0R IN SECfIIXJ 3'108OF THE LABOR COOE, IMEREST, AND ATfORNEYS FEES. LICENSED CONTRACTORS DECLARATON: I hereDy eNirm thai I am licensetl untler provisions of Chapter 9(wmmenGng with Sectlon 7000) ot Division 3 of ihe Business gQd Professions Cotle, entl my license Is In full force end eflecL Lia x c� � Class q ��53 Contractofs SlgneWre: ' Dete: �i ' � � •/�!) CONSTRUC710N LENOING AGENCY: I❑ I hereby aflirtn that there is e conswction lending egenry for the peAortnance of the work tor which this permit is Issuad. (Sec. 3097, CIWI Cotle). � Lenders Neme: Lentlefs Address: Signawre: Date: OWNER•BUILDER DECLARA710NS: I hereby effirtn that under panalry of parjury ihat I em EXEMPT FROM THE CON7RAC70RS LICENSE LAW for I�e following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires a pertnit to construct, eltar, improve, tlemolish, or repair eny sWciure, pnor to its issuance, also requires the applicant for such permit to file a signatl stetemenl that he ar she is licensed pursuant to ihe provisions oi the Contrectors License Lew (Chepter 9(commancing with Section 7000) of D'Msion 3 of the Business and Professions Code) or that he or sha is exempt theretmm and the basis for t�e allegetl exemptlon. Any dolation of Section 7031.5 by any epplicant for e permil sub�ecls Ihe flppllWni to a clWl penalry ol not more than Ilve hundred dollars (5500).): ❑ I, as owner of the proparty, or my employees wit� weges as their sole compensatlon, WILL DO TME WORK, end Iha sWCWre is not IntenCetl or ofrered for sale (Sec. 7044. Business and Professions Cotle: The Contrectors License Lew does not eppty to an owner of properry w�o builtls or improves thereon, and who does such work him5elf or herself or through his Or her own employees, provided lhat such improvemenis are not intended or ofterad tor sale. tl, however, Ihe building or impmvement i5 soltl within one year of completion, the owner-builder will have Ihe burden ol proving Ihai he or she tlitl not builtl or improve for purpose of sale.). ❑ I, as owner ot the property, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct Ihe praject (Set. 7044, Busineu antl Prolessions Code: The contractors License Law tices not apply to an owner of property who huilds or improves thereon, end who conirects tor such project with a contrador(s) licensa pursuant to the Comractars License Laws.). ❑ I am e:empt under sec. Business end Protessions Code for Ihis reason: Slgneture: Date: Owner ID vanfied by drivefs litense. ❑ Yas ❑ No Dr'rvefs license No. Vedticaiion of Ownership by (type ot tlocumen�, i.e. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: Explres: ❑ I here6y certity thet no ezcevetlon five (5) or more leet in tlepl� into which a person Is requlred to tlescend, wlll Oe matle in connectlon with wark euthonzetl by this pe�mit, and thet no Duiltling structure, ScaHoltling, lelsework, or tlemolitlon or Alsmentling thereoi, will he more ihan thiRy-siz (36) leel high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomla Adminlstrative Code). ❑ As owner-builtler, 1 wlll not employ anyona to do work which woula raqulre a permit trom the Division ot Intlustdel Safery, as noted ebove, unless such person has e permit to do suU work from ihe division. Signature: Date: Division oi InCustrial Safery Permit NumDer: CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity unAer penalty ot perjury that I have read ihis application and siate ihat ihe information given is correct I egree to comply wlth all state laws antl ciry oMinances relating to 6uiltling wnstruction, and emhoriza representelives ol the City ot Costa Mese to enter upon the a6ove-tlescnbed propeny lor inspection purposes. 1 agree no� to occuOY or allow occupancy of any hullding euthodzed �y I�Is permit until tinal inspeciion. �/� - 'gnaNre i Ov�neqs) Oete L" v //I2�-�-- _s' •/. r • ��C� A OrAuNo Applicant Date GOOE �. INSPELTIONTVVE Q/�¢ ��f 1616 Fixed System Final Fira Prevention 1288 200 201 zoz 203 204 26a8de Pool Spa Final Finel Ra-Root Final8locWRefeining Wall Final FeciOry Fire Place Finel Sign Final Demdition CODEi INSGECTIONTYPE 206 Final Mechanlcal 208 Final Plumbing 210 Final Elecidcal 212 Final Fire Prevemion 220 Final Plenning Approval 222 Final Slte 250 Final Bulltling/Occupancy �.i em _ �►m r; CIIY OF COSTA MESA — BI/ILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714)754-5273 • Fgx(714)754-4856 Job Address; Suite No Viciniry: 589 ANTON BL 1STFLOOR-POOLAREA Parcel Numbar: 41050101 Applicant; RYAN, MARY Address: 22600 E. LAMBERT ST. LAKE FOREST, CA SUITE 1104 � . "� Owner: SAKIOKA FARMS . ' Address: � � °hCURCI-ENGLAND CO �. � 'TORRANCE,CA � " . �- 2377 CRENSHAW BLVD #300 Contrector Add2ss: Areh / Eng : AddresS; . MISSION POOLS 22600 E. LAMBERT ST. LAKE FOREST, CA SUITE 1704 � MECHANICAL PERMIT Phone: (949) 588-0100 Zip: 92630 � Phone: Zip: 90501 ��Phone: (949)58&-0100 , � - � 2ip: 92630 ' License: 326760 Phone: Zip: . . .License: � � NUMBER M00-00105 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 03I142000 Issued: 03l14f2000 SCOPE OF PERMIT MECHANICAL PERMIT FOR CONSTRUCTION OF NEW POOL 8 SPA FOR "24 HOUR FITNESS'. INSTALL 3 HEATERS OVER 100K BTU. � " � ' REF: B00-00320 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst I Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >700 kBTU Gas Piping Factory Fireplace Hood w/Mech Exhaust � VAV Box Vent Fan I Single Duct Appliance Fire DampeB Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfrn $23.50 $0.00 $54.60 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 Quantity �� / FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporetive Cooler Commercial I ncinerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp �uantiry 50.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 So.00 0 50.00 0 $0.00 0 80.00 0 $0.00 0 50.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and re�ated regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and hecome void if work is not commenced within 180 days, or if work is suspended or abandoned for a period o1 780 tlays. INSPECTIONS: In order for tha work authorizad under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetiona end tlnal epproval must be obtained. Failure to oblain inspec�ions antl final approval will result in the expiratian of this permit. - FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnONDECLARAnON: I hereby aHirtn untler penelry ot perjury one ol Ihe following detlaretlons: ❑ I have antl wlll maintain e ceNfiwte ot conSeN to selt-Insure tor workers' campensation, es provided lor by section 3700 ot the Labor Code, for Ihe pertortnance of the work far whicti t�is pertnit is issued. � �I have antl will maintain woAcers' compensation insurance, as reQuiretl Dy section 3700 ot lhe Labor Code, tor the peAortnance of the work for which this pertnit is issued. My w compensation Insurence carrier and palicy number ere: ��- Cerrier: C�/l'I /�'%� Po,;�Y N�mbe,: � v yan 3 SSc� ��_ (Thls sectlon need not be comp/eted I! (he permi( Is va/ued et one huntlred dollers ($100) or less.) ' ❑ I cetlity t�at In the peAormance ot the work tor whic� thb permit Is IssueQ I shell not employ eny person in eny manner so as lo Decome subject co Iha warkere' campensetion lews of Califomia, and agree ihat if I should became sub�en to Ihe workers' compensetian provislons of Section 3700 at t�e Labor Cotle, I shall lorthwith complywlththeseprp/yg� o�_ � � )_��//�7 � � Applicam SignaWre: LCC_C.: Lf.<w%(�% / f� Dete: � �� U J WARNINO: fAILURE TO SECURE WORKERS' PENSATI WVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUN�RED TIqUSAND DOLLARE (5100,OW�, IN ADDITION TO TME CQST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECiiON 3]OB OF TME IABOR CODE. VJrEREST. AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirtn that I am Iicensed under proNsions of Chapter 9(commenGng vrith Sectlan 7000) of Division 3 0l the Business entl Prolessions Code, antl my Ilcense is in tull roroe ana enect. uc. a D �f ciass a G�'� � Comrectofs Sipnawre: �i/�— Date: �'% C'� CONS7RUCTION LENDING AGENCY: ❑ I hereby eHirtn thet there is e construction lending egency lor t�e peAormanca ol the work lor w�ich this pertnit is issued. (Sec. 3097, Civil CoCe). . Lentler's Name: Lendefs Address: Signature: Daie: OWNER-BUILDER DECLARATIONS: I hareby affirm that unaor penalry of per�ury that I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to conslmcl, alter, improve, demolish, or repair eny sirucWre, D�or to i15 issuance, elso requires Ihe applicant br such permit b file e signed statemem that he or she is licensed pursuant to t�e provlslons ot �he CoNractors License Lew (Chepter 9(commencing wtlh Section 7000) of D'Msion 3 of ihe Business end Pmtesslons COGe) or that �e or s�e is exempt ihereirom antl tha Dasis for the alleged ezemption. Any Nolaiion of Section 7031.5 by any applicant for e pertnit sub�ects t�e applicant to e civil penalry of not more than live hundred dollars (3500).): ❑ I, es owner of the property. or my employees with wages as their sde compensetion, WILL DO THE WORK, and the siructure is not intentled or ottereA for sale (Sec. 7044, Business antl Professions Cotle: The Contractors License Lew dces not apply to an owner of propeny who �uilds or improves Uiereon, antl who tloes suc� work himself or herself or ihrough his or her own employees, proWdeG ��at such improvements are not intended or oflared for sale. If, however, the bullding or improvement is sold within one year of completian, the owner-builder will have the burden ot proving that he or she ditl not build or improve for purpose ot sale.). ❑ I, fls owner oi the property, am EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTOFS to construd the projact (Sea 7044, Business antl Professions Cotle: The contractors License Lew does not appty lo an owner of property who build5 or improves thereon, and who coNracis for such projeq with a contracror(s) license pursuant to ihe Contractors License Laws.). ❑ I am exempt untler sac. Business antl Professions Cotle tor this reason: SlgnaWre: Date: Owner ID verifietl by tlr'rvers license. ❑ Ves ❑ No Driver's License No. Venfication of Ownership by (rype of documeni, i.e. - DropeM �� bill or tleetl�: DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: Ezpires: ❑ I hereby certlty thet no e:ravatlon Iive (5) ar more teet In depih Into which e person Is required lo tlescend, will be made in connection with woB euthorized by Ihis permit, antl that no builtling sWdure, scettoltling, talsework, or tlemalition or tlismamling thereot, will be more than thirry-six (36) feet Ngh. (C�ap. 3.2, Gry 2, An 2, Sec. 341, Title B, Celilamis Administrative Cotle). ❑ As owner-bulltler, I will not empla/ anyone to tlo work which would require e permit Irom Ihe Division ol Indusirlal Sefety, as notetl ebove, unless such pereon has e permit to tlo suc� work irom the tlivision. Slgnature: Date: Division oi Intlusirial Safery Pertnil Number: CERTFICA7E OF COMPLIANCE AND AI7THORVATION OF EMRY: I cehify under penalry of perjury that I have read this application and state Ihat Ihe informetion given is correcL I agree to camply with all state laws entl ciry ortlinances relatlng to building consWctlon, end eu�horize represen�atives oi ihe City oi Casta Mesa to enter upon the ebove-descnbetl praperty for inspection purpa5es. I aqree not to acupy or allow occupancy of any building euthorizetl by this perml� untll Ilnal inspection. ture Ow r �� . And/Q Authorized p "cant GOOE �. INSPECTONTYFE Qlyjj INiIiI�LS 1616 Fiaed Sysiem Final Fire PrevenHon 1266 200 207 202 203 204 24d&d6 Paol Spe Finel Finel Re-Rooi Final BIaWRetaining Wall Finel Feclary Fire PIeCe Finel Sign Finel Demolitlon Date �•/f•c9c'� Date _ CODE� INSPECTIONTYVE � / [Id� 4/:n / 206 Final Mechanical ! // � / T' 208 Final Plumbing I 270 Final Elecirical 212 Finel Flro Prevenilon 220 Final Planning ApprOval 222 Finel SNe 250 Finel Bulltling/Occupancy (714) 754•52'73 • Fex (714) 754-4856 Job Address: Suite No Vicinity: 589 ANTON BL ROOF CITY OF COSTA MESA - BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT Parcel Number: 41050101 Applicant: GOLLEDGE, TIM Address: 4300 E LA PALMA AV ANAHEIM,CA � Owner SAKIOKA FARMS Address: °hCURCI-ENGLAND�CO - " TORRANCE,CA 2377 CRENSHAW BLVD #300 Contractor: MAGNUM MECHANICAL � Address: ' 4300 E LA PALMA AV ANAHEIM, CA Arch / Eng : " Address: MECHANICAL PERMIT Phone: (714)996-7000 Zip: 92807 Phone: Zip: 90501 '� �Phone: (714)996-1000 - Zip: 92807 License: 354129 Phone: Zip: License: , PERMIT NUMBER M 9p • p0 ��i 77 FAIR DRIVE, COS , 26: ISSUED BY: Status: Applied: Issued: SCOPE OF PERMIT MECHANICAL PERMIT FOR NEW "24 HOUR FITNESS". INSTALL 23 HVAC PACKAGE UNITS, 28 FIRE DAMPERS, 1 AIR HANDLER, AND 13 VENTILATION SYSTEMS. ' REF: 899-00984 ISSUE FEE Inst FAU <700 k BTU Inst FAU �700 k BTU RepairlAlt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Dud Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $340.40 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00' $0.00 $0.00 $0.00 $0.00 $203.00 $0.00 $0.00 $10.65 $0.00 $0.00 50.00 Quantiry 23 0 0 0 0 0 0 0 0 0 0 0 28 0 0 1 0 0 0 FEE SUMMARY Repair! Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation System Evaporative Cooler Commercia l I ncine rator Domestic Incinerator Compressors I Absorolion Svstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp � 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS ISSUED 05IOSI2000 OS/OSI2000 �uantity $0.00 0 50.00 0 $138.45 13 50.00 0 50.00 0 so.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $651.60 24 So.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 ,367.60 NOTICE:� The'work�aNhorized by this permit shall comply with all applicabie handicap access requirements under Califomia statutes end related reguletions. (Ord. No. 92-28, § 1, 12Q7-92) 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 ot 180 days. INSPECTIONS: In orcler for the work authorized under this permit to be considered legal, such work must comply with all applieable codes, and all requlred Inepeetiona end flnal approval must be obtained. Failure to obtain inspections and final approvat will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS'COMPENSAnONDECLARAnON: I �ere6y aXlrm under penalry ot per�ury one of t�e lollowing dedarations: � I heve antl will meintaln e cetliticate ol cronsent to selFlnsure br workers' compensation, es provitletl for by section 3700 of the Labor Code, for the pertortnence at t�a work lor which this pertnit is issuetl. � ❑,� I he've antl will maintain workars' compensatlon insurance, es requiretl by section 3700 of ��e Lebor Code, for ihe pedortnance of the work lor which Nis pertnit is issued. My workers' compensetlo/rrylnsurence carrier and poliry number ere: . Cerrler: �r%� l'PI^�TV2 y .Z'6vS Policy Number. (ii./� �� 3� (Thls sectlon need n�etl i! fhe pe if !s velued et one hundred tlollere ($100) or less.) ❑ I certly that in the pedortnance ot Ih ork tor which this permit is issued, I shall not employ eny pereon in eny manner so es to becrome subject to the workers' campensetion laws ot Celifomle, entl ee t t sho C become subject to the workaro' compensatlon pmvisions of Sectlan 3700 of �he Labor Code, I shall fonhwit� compy with these pmN � /�– �7� ApplicaniSigneture: Dete: J � 7"G WARNINO: FAILURE TO SECURE WONICERS' COMPENSATIQ1 GUVERAGE IS UNUW FUL AND SW1LL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDREO THOUSANO DOUARE (5100.000�. IN ADDRION TO THE COS(OF COMPENSATqJ, ONAAGES AS PROVIDED FOR IN SECfION 3)OB OF TME LABOR CODE, INfERE$T, AND ATTORNEV'S FEES. LICENSED CON7RACTORS DECLARATION: I hareby aHirm that I am licensetl untler Drovisions ot Chapter 9(commencing wit� Sec�ion 7000) ot Division 3 ot ihe Business entl Professions Code, antl my license I5 In full lorce antl ettect. Lic. s 0 Class a C– Z U Contreclofs SlgnaWre: �� — Dete: CONSTRUCTION LENDING AGENCY: � ❑ I hereby aHirm that Ihere Is a conswdion lending agenry for the petlormance ot t�e work tor which this pertnit is issuetl. (Sec. 3097, Civil Cade). Lentler's Name: Lendefs Adtlress: Signeture: Date: OWNER-BUILDER DECLARA710NS: I here6y eHirtn thet untler penelry ot perjury that I flm EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness antl Protessions Cada: My ciry or counry which requires e pertnil to consiruct, elter, Improva, tlemolish, or repeir eny sWcture, prior to its issuence, elso requires the flpplicent for such permit to tile e signetl statement �het �e or she is licensed pursuant to �he proWsions af Ihe Conirectors License Law (Chapter 9(commencing with SecUon 7000) of Division 3 of Ihe Business entl Professions Code) or fhat he or she is exempt therefrom flntl the basis tor the ellegeA exemptlon. Any violation of Section 7037.5 by any flpplicant for e pertnit su6�ecls �he applicant to e civil penalry oi not more than frve hundratl tlWlars ($500).): ❑ I, es owner of Ne D�aPerry, or my employees with wapes as Iheir sWe compensation, WILL DO THE WORK, and the structure is not intended or oHered for sale (Sec. 704d, Business an0 Prolessions Code: The Contractors License Lew tloes not appy to en owner ol property who builtls or improves thereon. and who does such work himself or herself or Ihrough his or her owA employees, OroNtled that such improvements are not intended or offered lor sale. If, however, the building or improvement is sold within one year of completioq Ihe ownerbuilder will hava t�e burtlen of proving Ihat he or she did not �uiltl or improve for puryose of sale.). ❑ I, as owner oi ihe property, am EXCLUSIVELV CONTRACTING WRH LICENSED CONTRACTORS to consiruct ihe pro�ect (Sec. 7044, Business and Professions Cotle: The coniractors LJcense Law tloes not apply to an owner oi propeM who builds or improves thereon, antl who conirecis for such project with a coniractor(s) license pursuant to Ihe Contrectors License Laws.). � ❑ I em exempt under sec. Businass and Professions Cotle tor Ihis reason: SlgneWre: Date: Owner ID veritied by Criver's license. ❑ Yes ❑ No Drivefs License No. Expires: Vedficetlon of Ownership by (rype of document, i.e. - D�operry Wx blll or daed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I here6y cenify that no evcavation Ilve (5) or mora leet in Oept� into which a person Is requirad to tlescend, will �e matle In conneaion with work euthodzetl �y tNs pertni�, an0 �hat no Duilding structure, scattoltling, lalsework, or tlemolition or dismenliing Ihereol, will be more then thlrty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celifomie Atlministrative CoCe). ❑ As owner-Duiltler, I wlll not emplq enyona ro do work whlch woultl reqWre a permit from the Divlsion of Indusirial Sefety, es natetl eCove, unleu such person has a permit to tlo such work from the dMsion. Signature: Oa�e: Division of Intlustnal Sefery Permlt Number: CERTIFlCATE OF COMPLJANCE AND AUTHOHQATION OF ENTRV: I certity under penalty of perJury thal I have read Ihis application antl siate that ihe information given is cartect. I egrae to comply with alt state laws antl dry orAlnances relating to Dullding constructlon, antl euthodze representatives ot the Ciry ot Cosfa Mesa to enter upon the ebove-descdbed prope� for inspealon pwposes. I egrea not to xwpy or ellow accupanry al any bulltling euthonzetl by this pertnit untll flnel Inspectlon. GODE I. INSPECTONTYPE Qeg �� 1816 Fixetl System Flnal Fira Prevantlon 1268 200 201 202 203 Pool Spa Final Finel R�Roof Finel Block/Reteining Well Final Fectory Fire Place Finel Sign 204 Final Demolition ?448d8 Da e S- �-c�� Date�� COQE I INSVECTION TYPE 206 Finel Machanicel 200 Final Plum6ing 210 Flnal Elecincal 212 Flnal Fire Preventlon 220 Final Plenning Approval 222 Final Slte 250 Final Builtling�Occupancy pA7E It�4 II- 9-00 _� .-, (714)754-5273 • Fex(714)754-4856 JobAddress: 589 ANTON BL Suite: Viciniry: Parcel Number: 41050103 Appliwnk TERI WOOD Address: CITY OF COSTA MESA BlIILDING D/VISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Owner: BREISOUTH COAST LLC Address 5750 WILSHIRE BLVD LOS ANGELES, CA Contractor: �.,�N�2/�Ulll.�'� Address: Zip: BUILDING PERMIT Zoning: PDC PDC Phone: 949-768-2538 Zip: Phone: (714) 751-0200 Zip: 90036-3697 Phone: License: ,.., NUMBER !!' �' N B99-01150 77 FAIR DRIVE, COSTA MESA, CA 9 Status: �SSUED Applied: 7/2317999 Issued: 102511999 ISSUED BY: ��-� nrch : . Eng: WILLIAM HARRIS/HUNSAKER & ASSOC Address: • � � • - G • � • � . � Address: THREE HUGHES ' � � " � .- � � • Phone:� � Phone: 949-583-1010 IRVINE ,CA Zip: License: 92618 License: C31737 SCOPE OF PERMIT SITE IMPROVEMENTS INCLUDING GRADING TO 24HR FITNESS CLUB. FEE SUMMARY Plan Check: $982.96 Permit: $1,512.25 SMIP Res: $0.00 SMIP Com: $47.11 Other: $0.00 Inspection: $0.00 Total: $2,542.32 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Ezistina: o NOTES: 0 PLANNING & ZONING Rear 0• 0 LeN 0- 0 Rear 0- 0 Left 0- 0 Reauired: 0 ProDosed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Righl 0- 0 szza,sas.00 S22a,34s.00 . NOTICE: The work authorized by this permit shall comply with all applicable handicap eccess requirements under Califomia stetutes and related regulationa. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with ell applicable codes, end ell required Inepectlone and finel approval must be obtained. Failure to obtain inspactiona and final approvel will result in the axpiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 , WORKERS' COMPENSATION DECLARATION: �� I �ereEy eilirtn under penalry of perjury ma o1 the tollowinq deUarations: ❑ I have antl will maintain a certiliwte ot consent to selt-Insure for workers' compensation, as provitletl for by sectlon 3700 oi ihe Wbor Code, for t�e pertormance of the work tor which Ihis pertnit is Issuetl. ❑ I have antl will malnWin workers' compens2f�on insurence, as reQuired by section 3700 ot the Lebor Code, for �he pertortnance oi Ne work for which Ihis pertnit Is issuad. My workers' compensation Insurence carria� and policy number ere: Cerder. Policy Number. (Thls section need nof be comp/etetl i/ t�e permit Is valued e( one hundred dollers ($f 00) or /ess.) � I ceritly t�at in Ihe peAortnence ol the wOrk tor wNch thLs permit is issued, I shall not employ any person in eny manner so as to become subject to the workers' campensetion laws of Calilomia, antl egreb that ii 1 shoultl become SUDjecl to lhe workers' compensation provisions ot Section 3700 of the LeDor Code, I shall tort�with comply with thesa provisions. Appllcent Signature: Date: WARNIN�: FAILURE TO SECURE WORNERS' COMPEN�T��1 COVERAOE IS UNUW FUL aND S/ULL SUBJECT AN EMPLOVER TO CRIMINAL PENAITIES AND CIVIL FINES UP TO ONE Hl1NOHED THOUSAND DOILARE ($100,000), IN ADDf710N TO THE �T OF COMPENSATION, DAMAGES AS PROVIDED FOP IN SECTION 3]O60F THE LABOR CODE, II�REREST, AND ATiORNEV'S FEES. IICENSEO C�N7RACTORS DECLARATION: I hereby afflrtn tha! I em Iicense0 untler provisiwts of Chepter 9(commenUng with Secilon 7000) ot Divlslon 3 of tha Buslness end Professlons CoOe, end my Iicense is In lull IOrte and BttBtt. LJC. M Cless p Contractors SignaWre: Dete: CONSTqUCTION LENDING AGENCV: ❑ I hereby aHirtn that there Is a construction Idnding agency lor iha pertortnance of ihe work lor which ihis permit is Issued. (Sec. 3097, Civil Cotle). . Lentlers Name: Lentlefs Adtlress: II Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eRirm that untler.penelty of perJury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Busineu and Professions Cotle: Any ciry or counry which requires a permit Io consiruct, elter, improve, demolish, or repair eny strucWre, pnor to its issuance, elso requires the applicanl tor such pertnit to iile e signed statemem that he or s�e is licensed pursuani to ihe pmvisions of the Contractors License Law (Chapter 9(commencing wlih Section 7000) of Division 3 oi the Business antl Professions Code) or Ihat he or slre is e:empt therelrom and the basis for Ihe ellegetl exemption. Any vldation ol Sectlon 7037.5 by any appllcaN for a pertnit sub�ects the epplicant to e civll penalry of not more than Bve huntlretl tlollars ($500J.): ❑ I, as owner of Ihe property, or my employeas wl�h wegas es their sole compen5eiion, WILL DO TME WORK, entl ihe slructure is not intended or olferetl for sale (Sec. 7044, Business end Professions Cotle: Tha Comraclors License Lew dces not apply to en owner of property who builtls ar improves lhereon, antl who Ooes such work himself or herself or ihrough his or her own employees, proWtletl that such Impmvements are not inlentletl or oNered for sele. tl, however, Ihe bullding or imprevement is sold within one year ot complelloq the owner-builtler will heva the burtlen of provinq Ihet he or she did not builtl or impmve for purpose of sale.2. ❑ I, as owner of the property, am EXCLUSI�ELY CONTRACTING WITH LICENSED CONTRACTORS to construct i�e prolect (Sec. 7044, Business flnd Professions Cotle: The contrectors LJcense Lew does no� apply to en owner oi property who builtls or improves ihereon, and who comracis for such proJect with e contractoqs) license pursuant to the Contractors License WwsJ. ❑ I am e t rider c. SignaWre: '� Owner ID venfietl 6y tlrivefs licensa. ❑ Yes ❑ Business �nd Pro�eu�ons Cotle for Ihis Verificetion of Ownership by (type of daument, i e. - properry ta�c bill or dead): DIVISION OF INDUSTRIAL SAFETV PERMR CEATIFICATION: Expire5: ❑ I �ereby cenify that no excavation Nve (5) or more leet in Oepth imo which e person is require0 to tlescentl, wlll be made In conneclion with work aut�odzed by this pertni6 and Ihat no bullding structure, scafl0ltling, falsework, or demolition or Aismantling t�ereol, will be more t�an thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomle Atlministretive Code). ❑ A5 owner-Duiltler. I will not omploy enyone ta do work whlch would require e permll trom the Division ot Intlustrlal Safety, as noted above, unless such person �as a permit to tlo such work tmm the division. Slpneture: _____. _ Date: Division oi Indusirial Salery Pertnit Number: CERTIFICATE OF COMPLIANCE AND AIffHOR17AnON OF ENTTiV: I cenily under penalry ot perjury t�at I have read ihls epplicafion and state that the intormation given is correct. I agree to comply wlih ell state laws and ciry ordinences relating to building construction, entl euthoriza representatives ot the Ciry oi Costa Mesa to enter upon Ihe above�describad property for Inspedion puryoses, � egree not to occupy or allow occupency ol any Duiltling authorized Dy this permit until ilnal inspedion. cooe �. wsvecnoNrrve 1816 Fixod System Finel Fire Preventim 1266 Pool Spa Finel 200 Final Re-Roof 207 FInaI BIocWRetelning Well 202 Finel Feclory Fire Place 203 Finel Sign 204 FinelOemolition J lo�ZC7�i�t ate Q9jE I�AL§ fQ.QF�� INSPECTIONTYVE 208 Final Mechanical 20B Final PlumDing 210 Finel Elec�rical 212 Final Fire Preven�lon 220 Final Plenning Approval 222 Finel Sile 250 Final Builtling/Occupanry 2Ag 1�15 (714)754-5273 • Fax(714)754-4856 JobAddress: 589 ANTON BL Suite No Vicinity: Parcel Nunmber: 41050101 Applicant: WILLIAM TAYLOR Address: CITY OF COSTA MESA Bl/ILDING DIV/SION DEVELOPMENT SERVICES DEPARTMENT PERMIT � Owner: - SAKIOKA FARMS Address�. �%oCURCI-ENGLAND CO ,; � TORRANCE,CA'- - ' � 2377 CRENSHAW�BLVD #300 Contractor. SUNDANCE PLUMBING Address: 8502 E CHAPMAN AV #152 ' ; ORANGE,CA �•. j. .,. . � � 'Arch I Eng : i � - � - �Address:'. � � " . � � i PLUMBING PERMIT Phone: 774-223-1571 . Zip. Phone: Zip: 90501 �. �> . /Ph no e:� 714-567-0458 -� 'Zip: 92869 � � License: 339906 Phone: �+ . .. . Zip: License: �• RMIT NUMBER P99-00689 77 FAIR DRIVE, CASTA MESA, CA 92626 Status: ISSUED Applied: 12/7/1999 Issued: 12/7/1999 � ISSUED BY: � ' ��. SCOPE OF PERMIT ' � . . "24HR FITNESS" NEW BUILDING, RE:B99-00984, INSTALL 26P,CKFLOW PREV, 35FLOOR DR41N, 13R�OF DRAIN, BDRINKING FOUNTAINS, 1EXPANSION TANK, 24GAS OULETS, iWASHER; tSEWER CONN, 29SHOWER, 2COMM�SINKS, 2FLOOR SINK, 1SERVICE SINK, 4URINALS, 14VACUUM BREAKERS, 19WASH BASINS, 23WATER CLOSETS, 1WATER HEATER, 1WATER PIPING,�iWATER SERVICE. � - � - ISSUE FEE� � . Backflow irrigation Backflow Preventer Bathtub Clarifier System � Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Ezpansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 ouNets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $19.60 $0.00 50.00 $0.00 $0.00 $0.00 $343.00 $0.00 $127.40 $78.40 $9.80 $0.00 $6.15 $22.00 $0.00 $0.00 $0.00 $0.00 �y 2 0 0 0 0 0 0 35 0 13 8 1 0 1 20 0 0 0 0 FEE SUMMARY AMT Laundry Tub I Washer $9.80 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator - $0.00 Process Piping (per 10 k) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $24.65 Sewer Private Line 50.00 Shower , $28420 Sink, bar $0.00 Sink, commercial $19.60 Sink, Floor " $19.60 Sink, kitchen $0.00 Sink, service/mop $9.80 Spa (private) $0.00 Spa (public) $0.00 QTY 1 0 0 0 0 0 0 0 i 0 29 0 .2 2 0 1 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum BrkrBkFlow(1�) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service . Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $39.20 $12.30 $20.25 5186.20 $0.00 $0.00 $225.40 $12.30 $9.60 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 so.00 TOTAL CALCULATED FEES: ,5�2.75 QTY 0 0 0 4 1 9 19 0 0 23 1 1 0 1 0 C NOTICE: The work authorized by this permit shall comply with all epplicable 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 i( work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 1 BO days. INSPECTIONS: In order for the work authonzed under ihis permil to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetiona and finel epproval must be obtained. Failure to obtain inspections and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 � ' WORKERS' COMPENSATION UECLARA710N: I herehy eHirtn untler penalry of perjury one ot t�e lollowing tleclarations: � � ❑ I heve and wlll maintain a cartlticata ol consent to setl-Insure for workers' compensation, as provitletl lar by section 3700 of Ihe Labor Code. tor �he perfortnance of the work far which this pertnit is i55ueC. � ❑ I heve antl vnll mainfain workers' compensation insurance, as required by section 3700 af Ne Lebor Cotle, for the pehortnence ot the work for whkh Ihis pertNi is issued. My workers' compensatlon Insurance carrier end policy number are: I/ ca«�a�: CAVF�lia TnIn�N,✓mY POIIcyNumber. ��OI %h/ (7h/5 secfion need wt 6e comp/efed i! fhe permit is velued e( one hundred tlollers (Sf 00J or IessJ ' ❑ I certlty that in the paAormance ot Ihe work tor which this permit Is IssueQ I shall not employ eny porson In eny mennor so as to 6ecome sub�ecl to the workers' compensation lews of all mia agree that ii I shoultl bacame subJect to the workers' compensetion pravisions of Section 3700 0l Ihe Lebor Code, I shall lorihwith comOty with t�ese pro� io . /� � �� ^ � Applicanl Signeture: �I� � Date: 7 � WARNINO: FAILURE TO $ECUPE WORKERS' WMPENSA COVE GE IS UMAWFUL AN SHALL SUBIEGf AN EMPLOYER TO CRIMINA� PEWILTIES AND CML FlNE$ UP TO ONE MUNDRED TFIOUSAND DOLLFRE (5100,000� IN ADIXiION TO THE COST OF dJMPENSATION, DAAUdES 0.S PROVIDED FOR IN SECTIqJ 3]OB OF THE IABOR COOE, IMfERE$T, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm thet I em lorto antl eHeCi. Uc. N_ y Contrectors Signature: ol Chapter 9(commendng wlth Sectlo 000) ot Olvislon 3 of Ihe Business�tl PJ'rofessions Coda, antl my license is in tull Class a CA _ c M � Date: _ % %iFC . CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn thai Nere is a consiruction lendinq egency for the pertormence of the work for which this permlt Is issuetl. (Sec. 3097, CIWI CaEe). Lender'S Nema: Lentlefs Atltlress: Siqnawre: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirm ihai under penalry of perjury thet I em E%EMG7 FROM 7ME CONTRAGTORS LICENSE LAW lor ihe following reason (Sec. 7037.5, Business an0 Professions Code: Any ciry or counry which requires a pertnit to consnuct. alter, improve, tlemolish, or repair any simcture, prbr to its issuence, also requlres Ihe applicant for such permit �o tile e signed statement that �e or she is licensed pursuani to t�e provisions of the Comractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of Ihe Business entl Pmtessions Cotle) or ihat he or s�e is exempt therelrom and lhe basis for Ihe alleged exemption. Any dolatlon oi Section 7031.5 by any epplicant for a pertnit subJects the epplicent to e civil penalry oi not more than tive hundred dollars (5500).): ❑ I, es owner oi ihe property, ar my employees with wages as their sole compensation, WILL DO THE WORK, end ihe structure is not intendetl or oHered lor sale (Sec. 7044, Business and Pwfessions Cotle: The Contractors License Lew does no� epply to en owner of propeny who builtls or improves thereon, and who tloes such work himselF or herself or ihrough his or her awn employees, provided that such improvements ere not intended or oHeretl for sale. Ii, however, the building or improvement is sold wiihin one year oi completion, the owneabuiltler will have ihe burden ot proving Nai he or she Aitl not builtl or improve tor purpwe of saleJ. ❑ I, as owner of Ihe property. em E%CLUSIVELY CONTHALTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business flnd Professions Code: 7Te wmracbrs License Law tloes not apply to an owner ot pm0erry who builds or improves thereon, and who coniracts for such project wi�h a coniracmr(s) license pureuani to the Con[ractors License Laws.). ❑ I am axempt under sec. Business enC Professions Coae for this reeson: Signeture: Date: Ownar ID venlietl by drrver5license. ❑ Ves ❑ No Driver's License No. E:pires: Venlication of Ownership by (rype of tlocument, i.e. - properry tex blll or Oeea�: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavatlon five (5) or more faet in depih inm which e Derson Is requiretl to descenq wlll be mada in connectlon with work aut�orizetl by ihis pertnit, end that no building sWcture, scaXoltling, falsework, or tlemWition or dismflntling thereof, wlll 6e more than thlrty-six (36) leet high. (Chep. 3.2, Grp 2, An 2. Sec. 347, Ttle B, Calilomia Adminisirative Code). ❑ As owner-huiltler, I will not employ anyone to tlo work which woulC require e permil trom the Di�nsion ollnduSMel Satery, as noted above, unleu suc� person has a pertnit to tlo such work Irom Ihe division. Signeture: Date: Division of Industrial Safary Pertnit Number. CER7IFICATE OF COMPLIANLE AND AUTHORVATION OF ENiAY: I cenity under penalry of perjury ihat I have read fhis application and siale thai the information given is correct. I agree to compty wlth all state laws antl city ordinances relating to huiltling construction, end authorize representetives of the City of Costa Mese m emer upon the above-tlescnbed propeNy for inspection purposes. I egree not to occupy or ellow occupancy ol eny huiltling emhonzed by Ihis permit until tinel Inspection. I�� /] // /$ig at e Of Legal �.YYip.FF(/ �^ ,(n '� f�i nd�Ynutt �-i� COOE 1. INSPECTIONTYPE 1618 Flaetl Systam Final Fire Prevonlion 1286 Pool Spa Final 200 Final Re-Roof 207 FInaI BIocWReteining Well 202 Final Fectory Flre Place 203 Finel Sign 204 Final Demolilion 2s+6�ae P� It�l4S � 1)� �'q i Date 40oEr INSVECTIONTYPE 206 Final Mechenical 200 Final PlumDing 210 Final Elec�rltel 212 Finel Flre Prevention 220 Final Plenninp Approval 222 Final Site 250 Final Builtling/OxuOancy Pdffi I�A� ,�-e•oo a� (714) 754-5273 • Fex (714) 754-4856 CITY OF COSTA MESA BDILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 589 ANTON BL Suite: Vicini[y: 24 HOUR FITNESS HEALTH CLUB Parcel Nunmber: 41050101 Applicant: HARRIS, WILLIAM Address: THREE HUGHES IRVINE, CA � owner. SAKIOKA FARMS Address ".. %CURCI-ENGLAND CO � �/ TORRANCE,CA- - / " �� 2377 CRENSHAW BWD #300 Contractor: (y�N�%Z %-�Address:. � ' � . Zip: Eng : „ HUNSAKER & ASSOCIATES Address: THREE HUGHES, - _ . _ , , , ' ,�� ' , IRVINE, CA� Zip: : 92618-2021 � � GRADING PERMIT Zoning: PDC PDC Phone: (949)583-1010 Zip: 92618-2021 Phone: Zip: 90501 Phone: License: Phone: (949)583-1010 License: � � � � � � SCOPE OF PERMIT t CUBIC YARDS PRELIMINARY GRADING FOR FUTURE 24-HOUR FITNESS HEALTH CLUB. L . REF:G99-00005 & � G99-00014. . �� 8550 'Plan Check: ga4.00 '�. $0.00 ` Permit $v6.50 ` Other: $0.00 $0.00 Inspection: �$0.00 $0.00 Total: $320.50 NOTES: FEE SUMMARY PLANNING & ZONING . NUMBER T7 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 0622/1999 Issued: O6/22/1999 ISSUED BY: �� Calc Valuation: 269,400.00 ' ` �, . t NOTICE: The work authorized by this permit shall comply with all epplicable handicap eccess requiremenis under Califomia statules and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIHATION: This permit shall automatically ezpira and become void if work is not commenced within 180 days, or if work is suspendad or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all epplicable codes, end ell requlred Inapectiona end flnal approvel must be obteined. Failure to obtein inspections and finel approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKERS' COMVENSATION DECLARA710N: I hereby eNlrm untler penalry of per�ury one W the following tleclarations: �� ❑ I have entl wlll melntein a cenificate ot mnsent to setl-Insure for workers' compensatlon, es providetl tor Ey sectlan 3700 oi the Labor Cotle, for the pertormance of Ihe work for which this permit is issuetl. ' ❑ I have entl wlll mainteln wwkers' mmpensaUon insurence, as reQuiretl by section 3700 of Ihe Labor Code, for Ihe performence of the work for which this permit is Issuetl. My workers' compensetion Insurance carrier antl policy number ere: Carder: PollCy NumDer: (rnis secaan need nor be comaered i� me pe�mir ts vei�ed er me nu�area adiers �s�oo) o. �ess.) ❑ I certily thet in the pertortnance of che work lar w�ich IhL9 pertnit I5 issued, I shell nol employ eny person In eny menner so es to became sub�ect to Ihe workers' compensatlon laws of Calitomia, antl agree Net it I shoulA become sub�act to the workers' compensetlon provisions of Sectlon 3700 of the Lebor Cade, 1 Wiall forthwith comply wilh Ihese provisions. Applicam SigneWre: Date: WARNINO: fAILURE TO SECURE WORKERS' OOMPENSATION ODVEMOE IS UNLAW Fl1L PND SHALL SUBJECf Ml EMPLOYER TO CRIMINAL PENALTIES PND dVIL FlNES UP TO ONE HUNURED hKK15AND DOLLARE R��•�)• �N FDDRION TO TME WS70F COMPENSATIIXJ, OAMFGE50.5 PROVIDED FOR IN SECfION 3]OB OF THE IABOR C/JDE, INrERE$T, AND ATTORNEYS FEES. LICENSED CONTRACTORS DELLARATION: I hereby eflirm Ihat I em Ilcensetl untler provislons oi Chapter 9(commencing with Section 7000) of Divislon 3 af Ihe Business en0 Professions Code, end my license Is in full lorce and eflect. Llc. q � Closs a Comrectors Signature: Dete: CONSTRUCTION LENDING AGENCY: � ❑ I �era�y eNirm that there is e construction lending egenry lor the peAormence of the work for whlch Ihis parmit Is Issuetl. (Sec. 3097, Civil Code). Lendefs Neme: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn thet untler penalry ot perjury ihat I em El(EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslness end Professions Code: Any Ciry or county which requires a permit to con5truct, elter, improve, demolish, or repair any structure, pdor to IIs issuance, also reqWres Ihe applicanl tor such pertnit to file e signetl atetement that he or she is Ikensed pursuant ro Ihe provisions o1 t�e Contradore lJCenSe Lew (Chepter 9(commencing with Section 7000) of DMsion 3 of the Business antl Prolessions Gode) or that he or she is exemp� t�eretrom end Ihe basis for 1he elleged exem0��an. My Noletlon of SecUon 7037.5 by eny applicanl br a permit sub�ects Ihe appllcant lo e ciWl penalry of not more than five hundred tlollars (5500).): ❑ I, a9 owner Of the proPerty, or my employees with wages as Ihelr sola compensation, WILL DO THE WORK, entl the siructure is not intendetl or oflered tor sele (Sec. 7044, Business entl Professians Code: The Coniractors License Lew does not appty to en awner al properry who builds or Improves thereon, and who tlaes suc� work himself or herself or Ihrough his or her own employeas, provitletl thet such Improvements are not Intended or oRerad for sale. If, hawever, the bullCing or Improvement is sold within one year oi completion, the owner-builCer will have �he burden of proving that he or she tlitl not build or improva tor purpase of sale.). � I, es awner of the property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to cons�ruct Ihe project (Sec. 7044, Business end Professians Gotle: 7he contrectors License Law does not eppy ro en owner oi pr e w o buil s Im rove� reos, entl w. ho conCirG or such prqea with e cromracbr(s) license Dursuant to the Contrectors Llcense Lews.). .�j��" �,� �«9r;� LLC ❑ I am expqipWr�d c. Bysiness end Professions Cotle for this reaso Slqne�ure: ��A �zC e � Date• "— '� Owner ID vedfletl by drivers license. ❑ Yes ❑ No Oriver's License No. �� Expires: Verification ot Ownership by (type of document, i.e. - property tex blll or deea): ' DIVISION OF INDUSTRIAL SAFEfY PERMIT CERTFICATON: ❑ I herehy ceNiy that no exwvation fWe (5) or more teet In tle0�h into which a person is required to descenC, wlll be metle In connecllon with work authoAzetl �y thls permil, entl Ihat no Duiltling sirudure, scattolding, lelsework, or demolition or dismantling thereol, wlll be more Ihan thirty-six (38) feet �Igh. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomla Atlmin151re�Ne Cotle). ❑ As owner�builtler, I will nat empby enyona to tlo work which woultl requlre e pertnit tmm the Division ot Intlustriel Satety, es notetl ebove, unless such pereon �as e permit to tlo such woM from the tlivision. Slgneture: Dete: Dlvlsion of IntluStrial Selery Pertnit Number: CERTIFlCATE OF COMPUANCE AND AUfHORQA710N OF EMAY: I cerUfy under penalry of per�ury that I heve reed this applicetion and state that the Informetion given Is conect I agree to comply with all state laws enC ciry aMinances relatlng to builaing construdion, end authodze representatives of t�e Ciry of Costa Mesa to enter upon Ihe ebove-tlescAbed property lor Inspection puryoses. I agree not to occupy or allow occupancy oi eny builtling euthorizetl by NIs pertnit untll tinal inspectlon. ��nA��_gna O� e IOw er(s) Date�^ q QSl _ . 2.2^�� AntUOr Authorized Applicant Date i•� �' 1818 FI¢etl System Finel Fire Prevention 1268 Pod Spe Finfll 200 Final RaRoof 201 Flnal Black/Reteining Well 202 Finel Fectory Flre Plece 203 Finel Sipn 204 Final DemoliUon zsasee Pdg It�9L9 yODE� INSPEC110NTYPE 208 Finel MOCheniCal 20B Finel Plumbing 210 Finel Electdcal 212 Flnal Fire Preventlon 220 Final Plenning Approvel 222 250 Finel Site Final Bulltling/Occupancy PA1E 4-i9-oi EP � (714)754-5273 • Fax(714)754•4856 JobAddress: 589 ANTON BL Suite No Vicinity: Parcel Nunmber: 41050101 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Appliwnt: SANDERSON, ANDRE MAALIK Address: 2055 S. BAKER AVE. ONTARIO, CA Phone: (909) 923-6733 Zip: 97767 Owner: .SAKIOKIi FARMS - , Address �, °hCURCI-ENGLAND CO - _ ' , TORRANCE,CA � � Phone: �- 2377 CRENSHAIN BLVD #300 Zip: 90501 Contractor: PERFORMANCE POWER SYSTEMS, � Address: 2055 S. BAKER AVE. . Phone: (909) 923-6133 ONTARIO, CA - � .Zip: 91761 - �License: 693087 ZRMIT NUMBER E99-01094 77 FAIR DR�VE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 11/18I7999 Issued: 11/18/1999 � � � � SCOPE OP PERMIT ' TEMPORARY POWER POLE PERMIT FOR T.I. FOR -24 HOUR FITNESS- INSTALL 1-TEMPOR4RY POWER POLE, 4-SUB POLES, & 1= 100 AMP DISCONNECT. REF:899-00984 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixis Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors l0 50hp Motors to 100hp Morors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 523.50 50.00 50.00 30.00 50.00 50.00 50.00 57.70 50.00 50.00 50.00 50.00 $0.00 50.00 so.00 30.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 523.50 84920 Quantity 0 0 0 0 1 0 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 4 FEE SUMMARY Temp Oist System I Lighting Busway/t00ft' Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................uP to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low VOIt Wiring System / Ckt Misc. Conduit Misc. Conduclor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 S0.o0 $0.00 $0.00 TOTAL CALCULATED FEES E97.30 COMMENTS / SPECIAL CONDITIONS NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and re�ated regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expira and become void if vrork is not commenced wi�hin 1 BO days, or it work is suspended or abandoned for a penod of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such wo�k must comply with all applicabla codes, and ell �equlred inepeetlone and tinal epproval must be obtained. Failure lo obtain inspec�lons and final epprovel vnll result in ihe expiration of �his permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATON: I hereby ettirtn under penalry of perjury one of the following detlaretions: ❑ I heve and will maintein e certificate of consent to setl-Insure lor workers' compensetion, es pmvided for by sectlon 3700 at the LeDor Cade, for the pertortnance at Ihe work for whfc� lhis pe�rmit is issuetl. � I heve end will maintaln workers' compensation insurence, as reqWretl by sectlon 3700 0l the Lebor Code, for iho peAortnance of ihe work for which Ws pertnit is issued. My workPrs�' cPmp�enseti Insuren e carrier end policy number are: A � / / /� (��-- erner. �TG:f C_. �� PolltyNumber; '1 �1 4L) —7 �� `—/"'I (This sec(lon need not Ee can /etetl i! the peimit is valued et one hundred dollers (3100) oi /essJ ❑ I carlity Ihe� in the perfortnence of Ihe work for w�ich thls pertnl� Is IssueQ 1 shall noi employ any person in eny menner so a9 �o become SubjeC� �o Ihe workers' compensetlon laws ot Celitomla, end agree ihat If I should becomo SuD�ecl to the workers' compensetion provislons ol Sectlon 3700 oi the Labor Co�e, 1 shall torthwith comply with ihese provisions. _ / ApplicamSignelure: �ic/ �i� DBIe: %�— �g �7 '�i WFRNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINA� PENALTIES AND CML FlNES UP TOONE HUNDRED TFIOUSAND DOLURE (5/00,000). IN ADORION TO iHE W5T OF ODMPENSATION, DMIAGE5l5 PROVIDED FOR IN SECiION 3'!OB Of THE IABOR COOE. IMEHESi. AN� ATTOfiNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I hereby eMirm Ihet I am Ilcerys�Au�� plo� s oi Chapter 9(cammendng with SecOon 7000) ol Dlvislan 3�OB1� Busine�� P{ofesslons Code, flnd my license Is In lull . torce entl BflecL Lic. a U 7 �' �� a " '� Comrectors Signature: �.--� , �--� Date: ��—/ �f —G�=i CONSTRUCTION LENDING AGENLY: ❑ I hereby eMirtn Ihat there Is e construction Ientling egency lor the pertormance ot the work tor which this permit is issued. (Sac. 3097, Clvil Cotle). Lontler's Name: lendots Address: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm t�et untlar penalty of perjury ihat I em EXEMPT FROM 7HE CON7RAC70RS LICENSE LAW for �he following reeson (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires the appliwnt For such pertnit to tile e signetl stetement thet he or she is licensed pursuant to tha proNsions ol Ihe Contractors License Law (Chapter 9(commencing with Section 7000) ot DiNsion 3 of the Business entl Protessions Code) or ihet ha or she is exempt theretrom and the basis for ihe alle9etl eaemption. Any vlolation of Seclion 7031.5 by any applicant for a pertnit sub�ects Ihe epplicant to a civil penalry of not more ihan Trve hunCreA Collars ($500).): ❑ I, as ownar ol Iha property, or my employees with wages as their sole compensation, WILI DO THE WORK, and the structure is not intended or oMered for sala (Sec. 7044, Business antl Protessians Cotle: The ContractoB License Lew Aoes not appy to an avner of propeny who �uiltls or improves thereon, antl who does such work himself or hersetl or through his or her own employaes, provitletl thet suc� improvements are not imended ar oHered lor sale. If, howaver, the building or improvement is sold within one year of completion, ihe owner-builder vrill have the burtlen of proving that he or she ditl not Duild or improve for purpose of ule.). ❑ I, as owner ot tha property, am E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to conSWct Ihe pwject (Sec. 7044, Business antl Professions Code: The contractors License Lew does not eppty to an owner of Oroperty who builds or improves lhereon, enC w�o contracts for such projec[ with a crontractor(s) license pursuant Io tha Contractors License Laws.). ❑ I am exempt untler sec. Business ana Pmiessians Cotle for this reason: Signeture: Date: Ownar ID verilied by dnvers license. ❑ Yes ❑ No Drlvels License No. Venfiwtion ol Ownership by (rype ol documeni, i.e. - Oroperty tau bill ar deed): Expires: DIVISION OF IN�US7RIAL SAFETV PERMIT CERTIFICA710N: ❑ I �ereDy certly thet no excavation tive (5) or more feet In depth Into which a person is requiretl to tlescend, will Oe matle In connection with work authorized by this permit, entl t�et no 6uilding structure, scalfolding, felsework, or tlemolition or dismernling thereot, will be more ihen thlrty-si: (38) leet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Celifomia Atlminisirative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit trom the Division of Intlustnel Safety, as noteA ebova, unless such person has a permit to do such work Irom ihe division. Signeture: Dete: DIvlSion at Industrial Sefery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF EMRV: I certlry untler penalry of perjury ihat I heve reed this application end state that the infortnation givan is correct. I agree to comO�Y'^��h all state laws end ciry ordinances relating to builtling construction, and authonze representatives ol the Ciry of Costa Mesa ro enter upon Ihe above�descrlDed property for inspection purposes. I agree not ta occupy or allow acupancy of eny building authorized by this permlt untll linel InsOection. �/��nature 1 Legal Owner(s) // ` / � Dete�� 1LY And/Or Authorizetl Applicant Date COOE 1, INSPECTIONTYFE Qa¢ INTIf1AL5 1616 Fizotl SySlem FinalFire Prevention 12fi6 200 201 202 203 204 2448A8 Pool Spe Finel Finel Re-Rool Finel BIaWReteiNng wall Finel Fectory Fire Place Finel Sign Finel Demolition CODE 1 INSPECTION TYPE 206 Final Mechenical 20B Finel PIum6ing 210 Finel Elec�rlwl 272 Final Flre Prevention 220 Final Planning ApDrovel 222 Finel Site 250 Finel Building/Ocapancy PdIE IN�15 5-19-0 � �,iQ p51p M6 a � o, > _ ; J �'�a„o„R,"s' (714) 754-5273 • Fax (774) 754-4856 CITY OF COSTA MESA - BUILD/NG D/VISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Job Address: Suite No Viciniry: 589 ANTON BL WHOLE BUILDING Parcel Nunmber: 41050101 ' Applicant: LAWSON, JIM Address: 4308 E. LA PALMA _ ANAHEIM, CA � � - � owner: �SAKIOKA FARMS, � _ Address „"%CURCI-ENGLANDCO'.-;;- � _ / -, ��. ,TORRANCE,CA- � - ' 2377 CRENSHAW BLVD #300 Contracroc CIRCUIT ENTERPRISES INC � Address� 4308 E LA PALMA . ` .Phone: (714)996-9351 Zip: 92807 Phone: Zip: 90501 . �i'. - - Phone: , Q74) 996-9351 " - ANAHEIM, CA � /Zip: 92807 � � �, � ;License: 535583 r: . -i 1. , , . . . . i. NUMBER 11095 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: � � ' � ' � SCOPE OF PERMIT � � . " ELECTRICAL PERMIT FOR NEW BUILDING FOR -24 HOUR FITNESS-. INSTALL 102 LIGHT FIXTURES, 207 RECEPTACLE OUTLETS, 58 SWITCHES, 1 ELECTRICAL SERVICE TO 1000 AMP, 9 MOTORS TO 1 HP, 2 MOTORS TO 10HP, 6 SUB-PANELS TO 200 AMP, 3 SIGN CIRCUITS, 1 ''' TRANSFORMER OVER 100 KVA. ' � � <� . � � � � � � REF: 8999-00984 \ ISSUE FEE . Temp service test � Res. a/c package New Res (1-2 units) .- New Res (3+units) Pool / Spa Lighting Fixts � Recept Outlets � Switches Non Res Appl � Res Appl Service to 200a Service to 1000a � Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole $23.50 $0.00 $0.00 $0.00 „ $0.00 $0.00 $79.86 $156.51 $4774 $0.00 $0.00 $0.00 $0.00 $124.30 $42.75 $24.60 $0.00 $0.00 $0.00 $0.00 $183.00 $0.00 $73.80 $0.00 $0.00 Quantity 0 0 0 102 207 56 0 0 0 0 1 9 2 0 0 : 0 0 6 0 3 0 0 c ,� __ %i, r � . �� .. - � i �_ ` � ,. FEE SUMMARY j � Temp DistSystem / Lighting _ . . Busway /100 k - - � � Standing Section � . Misc Electrical Equipment ... Trancformers up to 1 kva/kw � ................up to 10 kva/kw -. .........._.._.up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw . . low Voltage Equipment Low Volt Wiring System / Ckt � � . Misc Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Chrisfmas Tree Stand - � Fireworks Stand � Other Electrical Fee � Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 17/18/1999 Issued: 11/18/1999 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $74.50 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 $0.00 $0.00 $0.00 TOTA� CALCULATED FEES $830.56 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) El(PIRAT�ON:'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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATION DECLARATON: . I here6y affirm under penalry of per�ury one of the Following tleclarations: ❑ I have antl will maintain a cetlificate of consent to self-Insure lor workers' compensation, es provided for by section 3700 of Ihe Labor Cotle, for the performence ol tho work for w�ich this permit is issuetl. � � I have end will maintain workero' compensation insurance, as repuired by sectlon 3700 of Ihe Lebor Code, for the pedormanca ol the work lor which this permi� is issuetl. My workars' compensation Insuranca carrier antl policy number ere: cerder: G,f.�P,PF�P. /'�i�9P f?%IY� /�/�fUIP. F///J/a Pollcy Number:OYC7' if d.+�1T ri0�"/.?53` (Thls section need nof be complefed i! fhe parmit is valued at one huntlretl dollars (5100) or IessJ ❑ I cenity Ihat in ihe pertormance ot ihe work tor which this pertnit Is issueq I shall not employ eny person in any menner so as to bacome subject to t�e workers' compensation laws oi Califomla, antl agree thet it I shoultl become subject b lhe workers' wmpensetion provisions of Section 3700 of the Labor Code, I shall forthwith comply with ihese provisions. • � / Applicant Siqnature: QrivYY i/.fs�✓Y Date: ��8�%% ti� WARNING:FAILURETOSE EWORKERS'COMPENSATIONCOVERAGEISUNLNWFULANDSHALLSUBJECTANEMPLOVERTOCRIMIN PEN TIESANDCIVILFINESUPTOONEHUNDRED T/qUSPND DOLLARE (51 .000�, IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31W OF iME LABOF CODE.INiEREST. AND ATTORNEY'$ FEES. �ICENSED CONTRACTORS DECLARATION: I hereby aMirm that I am licensetl under provisions oi Chapter 9(commencing with Seciion 7000) of Division 3 of tha Business and Professions Code, antl my license is In full toroe aoa exec,. uo. a 3 aass u Contrector's SignaWre: .�. ././/9�� Date: -//,�/� 9 i CONSTRUC710N LENDING AGENCV: ❑ I hereby aHirtn Ihai Nere I5 a conSWction lentling agency tor the pedortnance oi the work for which this permit is issued. (Sec. 3097, Civll Cotle). Lender's Neme: Lendels Address: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to consiruct, elter, improve, demolish, or repair any structura, Onor to its issuance, elso requires the applicant tor such permit to file e signe0 statemeN that he or she is licensed pursuam ro the provisians ol the Contractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 0l the Business and Professions Coda) or Ihat he or she is exempt �hereirom and ihe besis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant tor a permit sub�ects the applicant to e civil penelry ot not more than five huntlretl tlollars ($500).): ❑ I, as owner of the property, or my employees with wages as lheir sole compensation, WILL DO THE WORK, and Ihe siructure is not intended or oHered for sale (Sec. 7044, Business and Professims Code: 7Te Contractors License Lew tloes not appy to an owner of proPerry who builds or improves thereon, antl who tloes such work himseli or herself or through his or her own amployees, provided thet such improvements are not intended or oflered tor sale. II, however, ihe building or improvement is sold within one year of completlon, ihe owner-6uiltler will heve the burtlen ot proving ihat he or she ditl not build or improve tor purpose of sale.). ❑ I, as owner oi the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to con5lruct the proiect (Sec. 7044, Business antl Prolessions Cotle: The conirectors License lew does not appry to an owner ot property who builtls or improves thereon, antl who contrects tor such project with a contractor(s) license pursuant to the Contrec�ors License Laws.). ❑ I em exempi under sec. Business antl Professions Cotle for i�is reason: Signewre: Date: Owner ID veritied bydrivers license. ❑ Ves ❑ No Otivers License No. Expires: Venfication of Ownership by (rype ol document, i.e. - properry taz Dill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CEFiTIFICATION: ❑ I hereby cenify Ihat no excavation tive (5) or more feet In aept� into which e person is requiretl to tlescend, will be made in connectlon with work authonzetl by this permit, antl ihat no builtling structure, sceHolding, falsework, or tlemolition or tlismantling thereoi, will �e more than thirry-siz (36) leet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Calitornie Admini5trative Code). ❑ As owner-builtler, I will not employ enyone to tlo work which woultl require a pertnit from Ihe Division of Industrial Safety, as noted ebove, unless such pereon has a permi� �o do such wark from the divisian. SigneWre: Date: Division ol InduStrial Safery Pertnit Number: CERTFICA7E OF COMPLIANCE AND AU7}fORIZATION OF ENTRY: I cetlify untler penaly of perjury that I have read this application and state that the intormation given is correct. I agrae to comply with all stata laws and ciry ortlinances relating to 6uilding construction, antl euthonze representatives ot the Ciry of Costa Mesa to enter upon ihe ebove-descnbetl propeny for inspection purposes. I agree not to occupy or ellow occupancy ol any building euthonzed by ihis pertnit until final inspection. Legal COpE L INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roaf 201 Final BIocWReteining Well 202 Final FeIXory Fire Place 203 Final Sign 204 Final �emolition 2448�66 pATE INiIf1AL5 Date ii/� 99 �e COOE I INSVECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Elec�ncal 212 Final Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Final Builtling/Occupancy � INiiTIALS 11-15�0 ��—C. o � > : J .�� NOTES� CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fa�c (714) 754-4856 Job Address: Suite No Vicinity: 589 ANTON BL TEMP WA�L SIGN ON TRAILER Parcel Nunmber: 41050101 Applicant: NANCY K PARKER Address: ,� Owner: IGN INC. sr. ARIO, CA"`� lf � � t:. ^�' � '4'� �� '}�jlf' , t t i �l�? ECECTRICAL I , �',� � i � �J �"24HOUR �� . -FITNESS" ��I��, � �. !�Y'. y-, ,I�,� REF:SB99-001 �1` -� � �� .�s , � , l.. \�i - �� f� , '�,l t'�- til'l' i� �l ISSUE.FEE `iit�r 'lTemp service test Res �a/c package �`, New Res`(1-2 umts) � ��\,� New Res (3+units)-'' �\\�. Pool / Spa�� , � Lighting Fi�Rs�� K� � Recept Outl'eis\ l" Switches `��.:� � Non Res Appl��, �� Res Appl \�-��.A � ! Service to 200a ��-\ ( Service to 1000a �� Service over 1000a � �,, Motore to 1 hp �.� Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole` , Intermed Pole ELECTRICAL PERMIT � ^ Phone:� ` yZiP: � � �; 1_ : �l_aJ #300 Phone: Zip: 9050 � NUMBER E99-00859 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/13/1999 Issued: 09/13/1999 ISSUED BY: r�� 1 � �`�� .` ,`�--�`�� `,,� -�..��x��, �.v� � \ / � � ' �� \Z � � �„ .. Phone:s.�-909460j2530 .. t .. .- , . . - --. . . � -Cicense: 643004 V � �K �----_ ,`=„-- �, �' � f._ �' ± 4 ,�,_� ��. SCOPE OF PERMIT r T PORARY WALL SIGN ATTACHED TO TR4ILER _�,�"� _ � —� \ y'�J r �✓s `t�� r�'��;�1��C�%'�' \ ��t��'. �� ,�- _- _ — _.:__. _ul\_Jl ._.-_— _-"-: ��=._- ( Quantity $23.50 J $0.00 so.00 1 $0.00 �;u '0 � $0.00 ( ` � . 0 ` Temp Dist System / Lighting � - Busway-/100,ft%� , � � � �--^" Standmg Section { � � Misc Electrical Equipment - � �.+ .'�� -Transformers up to 1 kva/kw r:�;f'..je�.,� ._r. .. �$0 00 � 0 �. � ' . up.torl0 kva/kw . �$000 � 0 �'�. �,� r�� -��r upto50kva/kw., �_,;. --� „ �,, p1`,��-..z�Aj� ' %' � >�' =� � up to.100 k " � ��.� '� ��: ,l tl '� � � ` � �... over 100 k �� 0� il,' ,�� n Lov✓ Voltage Equipmei �0��"'�` Y r��". � i�Low�Volt Wmng Syste �` ��0'�a��l �� ` Misc Conduit >_�-'-..%� j r�,' 0�'"` �- �'�Y-'��Misc:.Conductor-="� r �0`- '�- --- "Circus (�gen or ride)- � � r 0 � � � � �� Cirws (meqh'ride�oi li� � r I � ` / , ,r . � { �Christmas,Tree Starid 0 / � :'� 0� '-' 4. 1 I` � �� Fireworks Stand..'='a " _ - + =11... "•J \: (1iFnr CIn�1e:n�1 Cnn .Y $0.00 $0.00 so.00 so.00 $24.60 $0.00 $0.00 0'`"�J�;;_`�--'=�+'-�Investigation:Fee�' � $0.00 0 ` `PladCheckFee $0.00 0 Reinspection Fee $0.00 1 0 TOTAL CALCULATED FEES E48.10 0 ��` I� �`p� `� COMMENTS I SPECIAL CONDITIONS �C.. ��: �.°� ��i/� / � ` i . 0 �t�. ,; j. . � Or�1 fr.�; i�� / �� / Go /r;' ; � � � � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: � � I hereby aHirtn under penalry oi perJury ane of tha following tlacleretlons: ❑ I have antl wlll melntein a certificate ot consent to self-Insure for workers' compensation, as provided for by section 3700 of ihe Labor Code, �or ihe paAormance of the work �or which ihis permit Is Issued. � �I have end will meintain workere' compensation insurence, as requlred by section 3700 ot the La6or Code, for Ihe pedormence of ihe work for which this permit is issued. My workers/' �ompensetlon InSure ce Cerriar and poliCy number ere: � ��'7 / Carrier. l �t�i�. ��U�i''% PolicyNumber:�i��ll��/��/Ja (Thls secNon need not be complered ll the permlt Is velue et one hundred dollers ($f 00) or less.) ❑ I certify that In ihe pertormance of the work for which ihis permlt I5 issued, I shall not employ eny person in any manner so es to become subject to ihe workers' compensation lews ot Californie, and agre at if I sh ultl becroma subject to the workers' compansation provisions of Section 3700 of tha Labor Coda, I shall forthwith comply with these pro 'sions. 1/ ("� ('�/� Applicant Signature: � _ Dete: `�I —I�' —I `�� WARNING FAILURE TO SECURE WORKER ' CAMPE SATION COVERACeE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CPIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDFED THOUSAND OOLLARE (5100,000), IN A�DITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IPREFEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am lorce and ettect. Lic. s_ Conirector5 Signa�ure: Chapter 9(commencing with Section 7000) of Divislon 3 of the Buslnes�nQ PrqtaeaOns Cotle, and my license is in full Class p L�� Date: — � CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm ihat there is e consimction lending egency for the paAormance af tha work for which this permit is issued. (Sec. 3097, Civil Cade). Lender's Name: Lender's Address: Signature: Date: OWNER•BUILDER DECLARATIONS: •`, . I hereby affirm ihat under penalry of perjury ihat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construcL alter, improve, demolish, or repair any simcture, prior to its issuance, also requires ihe epplicant tor such permit to file e signed statement ihat he or she is licensed pursuent lo the provisions ot the Contrectors License Law (Chapter 9(commencing wlth Section 7000) oi Division 3 of the Business end Professions Cotle) or that he or she is exempt therelrom end the basis tor the alleged ezemption. Any violation oi Sectlon 7031.5 by eny applicant for a permit subJects the appliwnt to e civll penalry of not more than five hundred dollers ($500).): ❑ I, as owner ot lhe property, or my employees with wages es iheir sole compensation, WILL DO THE WORK, antl tha structure is not intended or oHered tor sale (Sec. 7044, Business antl Protassions Cotle: The Contractors License Lew does not epply to en owner ol properry who builds or improvas thereon, and who does such work himself or herself or ihrough his or her own employees, provided that such improvemenis are not intentletl or oflered for sale. tl, however, the building or improvement is sold within one year of completlon, Ihe owner-builder will heve Ihe burden of pmving thet he or she did not build or improva tor purpase of sale.). ❑ I, es owner oi ihe property, em EXCLUSIVELY CONTRACTING WITFI LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Prafassions Cotle: The contractors License Law does nol appy ro en owner of properry who builtls or improves t�ereon, and who conirecis tor such project with a contrador(s) license pursuent to the COMrectors License Lews.). ❑ I am exempt untlar sec. Business end Professions Code tor ihis reason: SignaWre: Date: Owner ID veritietl by dnver's licensa. ❑ Ves ❑ No Dnvers Licensa No. Venfication of Ownership by (type ot documeni, i.e. - propehy �az bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby cenify that no excavetion tive (5) or more feet in tlept� into which a person is reQuiretl to descen4 will be made in connection with work authonzed by this pertnit, and that no building strucWre, sceflolding, falsework, or demolition or tlismaniling Ihereol, will De more t�an ihirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, Califomia Administrative Code). ❑ As owner-builtler, I will not amploy anyone to tlo work w�ich woultl require a permii trom ihe Division of Intlusirial Safery, as noted above, unless such person has a permit to tlo suc� work from the tlivision. Signature: Date: Division oF Intlustnal Satery Pertnil Number: CERTIFlCA7E OF COMPLIANCE AND AUTHORIZATION OF EN7AV: I certity under penalry ot per�ury that I have read ihis application antl state that the information given is correcc I agree to comply with all steta laws and city ortlinances relating to building consiruction, end authonze represemetives of the Ciry of Costa Masa to enter upon ihe a6ove-descnbetl property for inspection purposes. I agree not to occupy or ellow occupancy oi any builtling authorizetl by this permit until finel inspection. Signa ur Of �I Owner � (� �� D� /J� � � ..I H A r uth� pplcant Date � COOER, INSpECTIONTVGE 7616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rooi 201 Final Block/Retaining Wall 202 Final Fac�ory Fire Place 203 Final Sign 204 Final Demolition 2066 96 onre ItlImBL$ � COOEY MSPECTIONTYPE 206 Final Mechanicel 20B Final Plumbing 210 Final Elearical 212 Flnel Flre Preventlon 220 Final Plenning Approvel 222 Flnel Sita 250 Final Builtling/Occupency DRTE NTI RIALS \ (714) 754-5273 • FaX (714) 754-4856 • www.Cl.Costa-meSa.Ca.Us 77 FAIR DRIVE, GOSTA MESA, GA 926z6 Job Address: 589 ANTON BL Suite: Vicinity: Parcel Nunmber: 41050101 npp�icant PA�tER, KEVIN Address: _ � � i � � , Owner. ; SAKIOKA FARMS ' Address "%CURCI-ENGLAND CO ; � � �,TORRANCE,CA � � 2377�CRENSHAW-BLVD#300 Contractor, SWAIN�SIGN INC. - Address:" � 1384 E 5TH�ST. � � ONTARIO, CA Arch / Eng : � � �a Address: . " , . SIGN PERMIT Zoning: PDC PDC Phone: 909-460-2530 Zip: Phone: Zip: 90501 Status: ISSUED Applied: 10/OS/2000 Issued: 10/20/2000 ISSUED BY: �; Phone: - (909) 460-2530 . 2ip: ' 92714 , ��: License: 643004 ✓ Phone: Zip: License: � � � � ��, Y _` �; SCOPE OF PEI � - INSTALL 6 ILLUMINATED WALL' SIGNS (1 ON EACH BLDG. � , " � � . SION) FOR 24 HOUR FITNESS. , � - �� FEE SUMMARY : Plan Check: $254.31 Calc Valuation: � � � $0.00 - - - - - , - � I$zs,000.00 Permit: $391.25 SMIP Com: $5.25 � ` Other: . `. . $0.00 �� $0.00 Inspection: � �',��-_$0.00 � � $0;00 • ' V ' $0,�0 .�.� r�.- �,. TotaL�. :�$650:81 �� . .;� '� � - NOTES: � Claimed Valuation: � : $z5,000.00 • ' , .� - %' � _ _ _ �r ..�'. , - ., �. , , . i, r / � / ., . � /: . � a� , " �'.� ` - ;'� � /:; / � , ��- ,%- � / .�/,� PLANNING 8 ZONING � " � � � '� / � � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. . � - INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applirable codes, and all required inapectlons 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 . 24a6-48(6/00) ' • WORKERS' COMPENSA'iTON DECCARATION: I hareby eHirm untler penalty of perlury ona of Ihe following tleclarations: ❑ I have and will maintain e cetlilicate of consent ro selbinsure br workers' compensation, es provided tor by section 3700 of the Lebor Code, tor ihe perfortnance of the work for which this�ermit is issuad. �� I heve end will maintain workers' compensffiion insur nce, as required by section 3700 of tha Labor Code, for the pertortnance of the work for w� h ihis pertnit is issuad. M workers' com ensatl n Ir15urrr�� 16 carrier and lic /qJum��er are: � ��( CartierY P � � .V� PolicyNumber. .(_/"� (This sectian need not be completed i! the permit i 7uetl af one huntlretl tlollars ($100J or less.) ❑ I certify that in [he perfortnance of lhe work r which this permit i5 issued, I shall not employ any person in any manner so es to bewm 5ubject to lhe workere' compensation laws oi Califomle, end agree that if I should become suD�ect ro the workars' compenution provisions of Section3 700 ot Me Labor Code, I shall fotlhwith comply with thesa provisions. /� /�/� Applicent Signature: Date: � WARNING: FAIWRE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNtAWFUL M1D SHPLL SU&IECT AN EMPLOVER TO CRIMINAL ENALTIE AND CIVIL FWES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3]Ofi OF THE LABOR CODE, IMEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTOHS DECLApA710N: I hareby aNirm that I am licensetl under provi ' Chapter 9(co en ing with Section 7000) ot Division 3 oi the Business and P sion ode, torce and eflect. Lic. a� / — � Class x Comra�YSSignelure:� fY� Date: � -�1— r � CONSTRUCTION LENDING AGENCV: ❑ I hereby afFirin Ihat Ihere is a consimction lending agency for ihe peAormance ot the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: � Lender's Address: Signeture: _ OWNER-BUILDER DECLARATONS: Date: is in full I hereby aHirm thai untler penalry ot perjury the� I am E%EMPT FROM THE CONTRACTORS LICENSE �AW tor ihe following reason (Sec. 7031.5, Business and Professions COCe: Any ciry or counry which requires e permit ro construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the applicant for such permit ro file e signetl statement Ihat he or she is IicenseA pureuam ro the provislons ot Ihe Contractors License Lew (C�apter 9(commencing with Section 7000) ot Divislon 3 o1lhe Business antl Professions Code) or thet he or she is exempt thereirom and the basis for the alleged eaemption. Any violation of Section 7031.5 by any applicant for e pertnit subjecis Ihe applicant to a civil penalty oi not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with waqes as iheir sole compensation, WILL DO TME WORK, and the strucNre is not intentled or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot property who builtls or improves thereon, and who does such work himseN or herseN or ihrough his or her own employeas, providetl that such improvements are not Intended or otteretl for sale. If, however, ihe building or improvement is sold within one year of completion, the owner-builder will heve ihe Ourden of proving ihat he or she did not build or improve for purpose of sale.). ❑ I, es owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTFiACTORS to construct ihe project (Sec. 7044, Business and Professions Code: The contractors License Lew does not appty to en owner of property who builtls or improves thereon, and who conirects for such project with a coniractor(s) license pursuan� to ihe Con�rador5 LiCense Lews.). ❑ I am exempt under sec. Business and Protessions Code for Ihis reason: Signawre: Date: Owner ID venfied by tlrivers licanse. ❑ Ves ❑ No Dnvers License No. Expires: Vedfication of Ownership hy (type of daumenL i.e. - pro0erty tax blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavetion five (5) or more feet in depth into whic� a pereon is requireC �o descend, will be made in connection with work authorized by ihls � permit, and ihat no building siructure, scattolding, falsework, or demolition or dismanNing thereof, will be more Ihan thirry-sia (38) feet high. (Chap. 32, Grp 2, Art 2, Sac. 341, lltle B, Califomia Atlmini5tretive Code). -- -� As ownerbuilder, I will not employ enyone to do work which would require e permit trom tha Division of Intlusirial Safery, as notetl ebova, unless such person has e permit to do such work irom Ihe tlivision. Signature: Date: Division of Indusirial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJTHORVATON OF EMRV: I certity under penalty of perjury that I have read ihis epplication and state that ihe infortnation given is correcl I agrae ro compty with ell s�ete laws and ciry ordinances relating to builtling construction, and authonze representatives of Ihe Ciry oi Cosla Mesa to enler upon Ihe ebove-descnbed property for inspection purpases. 1 agree not to occupy or allow occupancy ot any building authonzed by this pertnit until final inspection. CQOE t. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 126fi Pool Spa Final 200 Final Re-Roo� 201 Final Block/Retaining Wall 202 203 Final Factory Fire Place Final Sign 204 Final Demolition DRTE INTRIALS CODE I INSPELTION TYGE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanc PA7E It�LB (714) 754-5273 • F� (714) 754-4856 • www.ci.costa-rt�€a�PRESSION PERMIT n FAIFi DqIVE. GOSTA MESA, GA 92626 JobAddress: 5B9 ANTON BL Suite: Vicinity: Parcel Number: 41050101 AppliwnY. HAVENS, ALLAN Address: Owner. SAKIOKA FARMS Address °hCURCI-ENGLAND CO TORRANCE,CA 2377 CRENSHAW BLVD #300 Zoning: PDC PDC Phone: 1-800-838-2435 Zip: Phone: Zip: 90501 Contractor: PROTECTION SERVICE IND. LP Address: 10535 FOOTHILI BL UNIT 350 Phone: 909.456.8000 RANCHO CUCAMONGA, CA Zip: 91730 License: 701582 ISSUED BY: SCOPE OF PERMIT "24HOUR FITNESS" NEW BUILDING, RE:B99-00984, INSTALL NEW FIRE ALARM SYSTEM. FEE SUMMARY Plan Check: $313.72 Permit: $482.65 Other: $0.00 Total: $796.37 Status: � ISSUED Applied: 04/14/2000 Issued: 11/15/2000 Calc Valuation: Sss,5�6.00 Claimed Valuation: 5as,5�s.00 NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related ragUlations. (Ord. No. 92-28, § 1, 12-21-92) EXFIRATION: This parmit shall automatically expire and become void it work is not comme�cad within 1 BO days, or lt work is suspandad or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codas, and all reqU�red Inspeetlone and final approval must be obtained. Failure to obtain inspections antl final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 � zas-+e (�wo) , WORKERS'COMPENSAnON DECLAHATON: I hereby aflifm under penelry of perjury one ol ihe following declara�ons: ❑ I have and will maintein e certificata of wnsent to sell-Insure far workers' compensetion, as provided for by sectian 3700 oi the Lebor Cotle, tor the peAormance of the wark far which Ihis pertnit is issuetl. ,[� I have and vnll malntein workers' compense6on insurance, es required by section 3�00 of the Labor Code, for Ne peAortnanca oi the wark tor whiM Nis pertnit is LsweC. My workers' wmpensatlon Insurence cerrler antl policy num�er are: Cartier. PoliCy Number: (This sectlon need nat be completed ll (he peimlNs valued et one hundred dW/ars (5100) o� less.) ❑ I cenity that in the performance oi the work for which Ihis partnit is issued, I shall not employ eny person in any manner so as to become subject lo the workers' wmpensation laws of Calllomle, entl epree thet If I should become sub�ect to tha workers' compensatlon provisions ol Sectlon 3700 ot the Labor Cotle, 1 shall forihwith comply with thesa provision '/'`� Applicant Signature: �� Date: �� — � �— D `� WARNING: FAIWRE TO SECURE WORKEfiS' COMPEfJSATION COVERAGE IS UNLAWFUL AND SHnLL SUBJECT AN EMPLOVER TO CRIMINAL PENPLTIES AND CML FlNES UP TOONE HUNDRED TMOUSlWD OOLLARE (5100.000), IN ADDITION TO THE COST OF �pMPEN$ATION, DAAMGES AS PROVIOED FOR IN SECiIIXJ 3%OB OF THE LABpR CppE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I �ereby aMirtn ihat I am licensed under provisions of C�apter 9(commendng with Seciion 7000) at Division 3 oi the Business entl Professlons Code, enA my license Is In full torcB antl eHecL Lic. A CIe55 k Contractor'sSigneNre: C� , ,.o�.ca�- Date: //—/�%(7� I CONSTRUC710N LENDING AGENCV: ❑ I hereby affirtn ihat Ihere Is a construction lentling egency lor the pedormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). LentleYs Name: Lender's Atltlress: Signature: �ate: OWNER-BUILDER DECIARATIONS: 1 hereby affirm that under penalry of per�ury thet I am E%EMPT FROM 7HE CON7RACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requlres e Dermit to construc6 alter, impmve, demolish, or repair any sWcture, prior to ics issuance, also requires Ihe applicant for such pertnil to file a signetl stetement thet �e or she Is Ilcensetl pursuant to the provl5ions of the Contractors License Lew (C�apter 9(tommencing with SeIXion 7000) 01 DMsion 3 of Ne Business antl Protessions Code) or Ihet he or she Is exempt thereiram and the basis for ihe alleged exemption. Any Wolation at Sectian 7031.5 by eny epplicent for a pertnit sublects the applicant to e civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner oi tha properry, or my employees with wages as their sole wmpensetion, WILL DO THE WORK, entl Ihe structura Is not intentletl or otteretl lor sale (Sec. 7044, Business and Prolessions Code: The Coniractors License Lew does not epply to an owner of property who builtls or improves Ihereon, end who tloes such work himselt or hersetl or through his ar her own employees, prod0etl thet such improvemeNs ara nm intended or aflered tor sale. If, however, Ne building or Improvement Is sold within one year ol wmpletion, ��e owner-builtler will heva the burden of praving that ha or sha did not build or improve for purpa5e of sale.). ❑ I, as owner of iha property, am E%CLUSNELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business anA Professions Cotle: The cantractors License Lew tloes not eppty lo an owner ol property who bullds or improves thereon, and who Conirecls lor such pro�ect wit� e wntrector(6) license pursuant to the Comractors Licanse Lews.), ❑ 1 am axempt under sec. Business end Prolessions Code for Ihis reason: Signature: �ete: Owner ID verified by drivefs license. ❑ Ves ❑ No Drivefs License No. Venfication ot Ownership 6y (rype ot daumant, I.e. - property lex bill ar deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTFICATION: Expire5: ❑ I hereby cenify Ihat no axcevation five (5) or more lee� In tlepih into which e person is required to descend, will be matle In wnnection with work euthorizetl by Ihis permit, and ihat no building siructure, scaflolding, lalsework, or demolitlon or tlismantling ihereof, will be more than thlrty-six (38) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ti(Ie 8, Galitomia Aaministrativa Cotle). ❑ As owner-builder, I will not employ enyone to do wurk whic� woultl require a permit from ihe Division ol Indusirinl Sefery, es noted e�ove, unless such person hes e permit to do such work irom ihe division. Signature: Date: Divislon of Indusinal Satery Parmit Number: CERTIFlCA7E OF COMPLIANCE /WD AUTHORIZA710N OF ENTRV: I certlty under penalry of perjury that I have read Ihis epplication and stete Ihet the Information given is correct. I agree ro comply wii� ell state laws enC city ordinances releting to bullding consWction, and authorize representatives ai Ihe Giry of Coste Mesa to enter upon the ebova-descnbed pmperty for inspection purposes. I agree not to wcupy or ellow occupancy of eny building authonzed by t�is permit uniil finel inspectlon. � �� gnature Ot Le '��Q�'�/ //_ /� ' � � And/OrAUlhorized Applicant Date COOE I, insvernoxrrve p� 1616 Fi:ed System Final Fire Prevention 1266 200 201 202 203 Pool Spa Final Final Re-Root Final BIocWPetaininq Well Final Factory Fire Place Finel Si9n 204 Final molitlon J�y$ �( INSPECTIONTYPE 206 Final Mec�anical 208 Final Plumbing 210 Finel Elecirical 212 220 Final Flre Prevenilon Final Planning Approvel 222 Final Site 250 Final Building/Occupancy PAIE Qf�L4 Ilo UU � (714) 754-5273 • F� (714) 754-4856 FIRE SUPRESSION PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 589 ANTON BL Suite: Vicinity: Parce� Number: 41050101 Applicant: DAVE BALA Address: owner: SAKIOKA FARMS Address %CURCI-ENGLAND CO TORR4NCE,CA ' 237� CRENSHAW BLVD #300 Zoning: PDC PDC Phone: (714)842-5630 Zip: Phone: Zip: 90501 Contrector: RETRO FIRE PROTECTION INC. Address: 7351 HEIL AV C Phone: 774-847-7078 H.B, CA . .Zip: 92647 License: 731744 � SCOPE OF PERMIT 602 FIRE SPFtINKLER HEADS FOR NEW 24 HOUR FITNESS BUILDING. REF:B99-00984 Plan Check: $385.94 Permit: $593.75 Other: $0.00 Total: $979.69 FEE SUMMARY Status: ISSUED Applietl: 02/71/2000 Issued: 06/12/2000 ISSUED BY: Calc Valuation: Sas,000.00 Claimed Valuation: 5as,000.00 NOTICE: The work authorized by thls 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 authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlona and final epprovel must be oblained. Failure to obtain inspections and final approval will result in Ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATON DECLARATON: I hereby ettirm untler penalry ai perjury one ot the following dedaratbns: ❑ I have enC will malntain a ceNfiwte of mnsent to sell�lnsure lor workers' compensetion, es provitled lor by section 3700 0l Ihe Labor Code, lor Ihe pertormance ot Ihe work For which ihis pertnit is issuetl. � I have antl will maintain workars' compensatlon insurerxe, es required by section 3700 ot Ne Labor Code, for the peAamance af ihe work ta which Ihis permit is issuetl. My workers' compensation Insurence rartier and policy number flre: � Cartier: Policy Number: (Thts sectlon need nat be campleted 1/ the pertni!!s valuetl et one �undred dollers (Sf 00) or less.) . ❑ I certity thet in the peAortnence ol ihe work tor which Ihis pertnil is issued, I shell not employ eny pereon In eny menner so es to become subJect lo the workers' campensation lews oi Califomia, enE agree h il I shoultl become subject to the workers' compensation mvisions ot Section 3700 0l the LaDor Cotle, I shail forthwith ' seprovisions. p ¢ant Signalure: /%�� oe�a: ��/2J Za �''" YMRNIN6-F�f TO SECUFE WORKERS' COMPENSATIIXJ COVEiiAGE IS UNIAW FUL PND SHALL SUBJECT MI CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TFKKISW D DOLURE (5100,000�.IN ADDITIIXJ TO TME COST OF OOAIPEN5.4TION, DAMAGES AS PflWIDED FOR IN SEC�ION 3108 OF THE UBOR CODE, INfEREST, AND FTTORNEYS FEES. DECLARATON: �ttirm thet I em antl eHect. Lic. a _ ecbr's Signature: Chepter 9 {pommencing wit� Sectian Cless a Code, antl my Ilcense Is In lull CONS7RULTION LENDING AGENCY: ❑ I hereby aflirm that thera is e conslruction Iending egency tor the padormance ol the work lor whic� this permit is Issuetl. (Sec. 3097, Civll Code). Lentlers Name: Lendefs Address: Signeture: OWNER-BUILOER DECLARATONS: Date: I hereby ettirm ihat untler penalry at perjury t�ei l em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business flntl Professions Code: Any ciry or counry which requires a permit to construcl, alter, imprwe, demolish, or repair any structure, prior to its issuanca, also requires the eppliwnt for such pertnit b tile e signed statement that he or she is licensetl Oursuam ro the proNsions ol Ihe Contractors License Law (Chapter 9(commendng with Sectlon 7000J of Dlvislon 3 of the Business entl Protessions Code) or Nat he or she is exempl thereirom and tha 6asi5 for the allegetl exemptlon. Any vidation o1 Seclion 7031.5 by eny epplicant for a pertnit subJects the epplicant to e cMl penalry W not more than Me �untlreC Callars (5500)J: ❑ I, as owner af the properry, or my emplqrees vrith wages es l�eir sde wmpensation, WILL DO THE WORK, antl the structure is not intended or offereC lor sala (Sec. 70a4, Business antl Professions Code: The Contradars License Lew tices not apply to an owner of properry who builds or improves Ihereon, and who tloes such work himself or herselt or [hrough his or her own employees, proviAetl that such improvements are not intended ar aHeretl for sale. N, however, Ihe building or imprwement is sold within one year of completlon, ihe owner-builCer will have the burden of proving that he or she did not build or improve tor purpose ol sele.). ❑ I, as owner of the property. am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to mnstruct the project (Sec. 7044, Business antl Professions Cotle: The cromractors License Law does not appry to an owner o1 property who builds or improves thereon, and who comrects for such project with e wntracror(s) license pursuam to the Con[ractors license Lews.). ❑ I am exempt under sec. Business antl Pmlessions Code for this reason: Signawre: Owner ID verified by tlrivefs licanse. ❑ Ves ❑ No DnvelS Liten58 No. Venfication ot Ownership by (rype of tlaument, i.e. - pmperry taz bill or tleetl): DIVISION OF INDUS7RIAL SAFETV PERMI7 CERTIFICATION: Da�e: Expires: ❑ I here6y certity thet no excavatim tive (5) or more Ieei In tlepth into whlch e person Is required to descend, will ba mede in connection with work eu�hodzetl by this permit, entl that na building slrucNre, sceflolding, telsework, or tlemoll�lon or dlsmantling thereol, wlll be more Ihan thirry-six (38) feet hlgh. (C�ep. 32, Gry 2, Art 2, Sec. 341, Tltle 8, Celifomia Adminisirative Cotle). ❑ As owner-builder, I will not employ anyone to do work w�ich would requlre e permlt Irom the Division of Industrlal Sefety, as noted ebave, unless such person has e permit to do such work fmm ihe division. Signelure: Data: Dlvislon of Intlustnel Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIfTTiORIZATON OF ENTHY: I ceRify under penelty of perjury that I have read this epplication end state that the intortnation given is correct. I agree to wmply with all state laws and ciry ortlinances relating m building conswcUon, and euthoriza representatives of the Ciry of CaSle Mesa lo enter upon �he ebova-tlescdbed Dmperry for inspection purposes. I agrea not m occupy or allow occupency al any building euthonzetl �y this partnit until final inspection. COpE�, INSVELTIONTYPE � 1616 Fizod System Final Fire Prevention 1266 Pool Spe Finel 200 Finel Re-Root 201 Final BIocWReteinin9 Well 202 Final Fectory Fire Place 203 Finel Slgn 204 Final Demoli�ion 20d8d8 COOE/ INSVECTONiYGE ' � 208 Final Mechenical 20B Final Plumbing 210 Finel Electrical 212 Finel Flre Preventi0n 220 Finel Planning Approval 222 Finel Site 250 Final Building/Occupancy 2 Date AL ,•I (714) 754-5273 • Fax (714) 754-4856 dob Address: 5BJ ANTON BL Suite: Vicinity: CITY OF COSTA MESA BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT SIGN PERMIT ERMIT NUMBER S899-00131 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/13/1999 Issued: 09/13/1999 � Parcel Nunmber: 41050101 Zoning: PDC PDC ISSUED BY: !� npplicant: NANCY K. PARKER ' -/ .! ��' �" � � � '� ' ; � � - � Address: ��/l�� ;_ - , � - - - ; , _ , �� !� ��j �C, ,- '�Phone: .. �� / r' i � �\\' �'�, �1 � �i 1 � L ��P ' �' ��i ��. ;� v � � � - i � � Owner� SAKIOKA FARMS \ �G y „_ -,c -c_� � � �� \^�\j\i� ^ `J Address/� %CURCI-ENGLAND CO '�"% ` ��_ . ," �"� � � � ,A� �ji-�ii . �i�i��, �. ; � �.A�\ �TORRANCECA�j%�� Phone: ��'� \� � _i/ /� �\. �� 23iT CRENSHAW.BLVD #300 Zip: 90501 ��, , � , ` ' ��\ ' ' � � \ ��i� �� `y : � / \ ��'� �� Contiactor. SWAIN:SIGN INC. � ��"` vAddressi 1383 E;STH ST. � � � � � �� *�� . � �r , :� - . t -�� ,% j � Phone ' 909 460-2530 _ _ _ �, A � `�', �, i - � ONTARIO, CA . Zip %��92714 .I . F'� � �A- � � �'.. � , �� i/i/, �.� :" �.... �. I , ! v,A . � ' % � .; �. , � %� �rLicense:�-�643004 � , ,, � . �,A� � Arch % Eng '�.. `� � � A /(S ; .. �'' . � .r� � : . _ . Address � � ' , ,� � - / . . ,. , _ _ _ _ - . �_ �, , : _ . � � ` " - � � - ! " _ _ - Phone: � �,. i � - , ' � � . .,�/�. � ne.' - ' _ _- � ��,..y,�, � �� Y ' - Zip' . . . � \{ � \ , � ' ` / `. � j License: �. j r� _� �', � ; / ; , , ,�� )� ' � " �" SCOPE OF PERMIT: � , _ '� L . TEMPORARY 43.5 SQ_FT. C�ONSTRUCTION SIGN."•` `-•: .. .. � . . G � � � �` FEESUMMARY � - _ /, ; :`''�. r`1� " � �.1� - . , � ,� � � Plan Check' �� $35.10 - _ =�- _ _ _ � � :. _ . � _Calc Valuation: 5�,s0o.00 „� � � � � � � $0.00 ' � - . — -- . ,/ ! ' � ��, Perriiit��, $54.00 � � / Claimed Valuation: �: - 5�;500.00 - ' �i ��SMIPCom �� $0.50 i � .�� ;��.; I �, ' �, Other� �� $0.00 � .. — � � ,� �' � � '�,A � '� > V A�`' , .,. .'� " , . , , . � �� , � , , '� �V A ✓ �� , $0.00 vw . �; , � - � � , �' � Inspection' �$0.00 , �.1� �, �$0;00 , •�: r"�� - n i; � , \��1L � " _.�,:.r . � . , _ ��- 1. 0, r, _>„ i " � % � , � � � $0.0 �t-• ,. � / , ;�� . � �� _ -;, � �'. � /. ,� , Total:. . � � , , �� :$8960 �� ' .'�' �,% , A , , ��. . - � � ..;� - � �`� ��>�- '' � � �-� . . NOTES: �-"-�'� "i � � ,. ' �_�. �� i. / i%� _ •� w . v � / I - , . NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inepeetiona and flnal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORI(ERS' COMPENSATION DECLARATION: I hereby ettirm under penelry at perjury one of Ihe tollowing tleclarations: ❑ I end will mainiein a certificale of mnsent to self-Insure lor workers' compensatlon, es proNded for by seciion 3700 ot ihe Labor Cotle, tor lhe pertortnance of �he ork tor which ihis permil is issued. I have entl will maintain workers' compensatlon insurance, as requiretl Dy section 3700 oi I�e Labor Cade, for Ihe perfortnance ot the work for which Ihis permlt is IssueO. My workrar7 s' compyansatlon I///n��surance�� w��rt��_ier and policy number ere: 1^ ��± �•� — Cerrler. l�'\ A.• �� Policy Number. � Jl / Il )� \ 7S 2� %�j (Thls secHon neetl nof be comp/efed 1 fhe perm/f /s ed ef one hundred dollers ($100) or less.) ❑ I cenify thet in the pertormance oi the work for which ihis permit is iuued, I s�all not employ eny person in any manner so es to become subject to t�e workers' compensation laws ol Californie, and e ee [hat'rf I shoultl become sub�ect to the workers' compensation provisions ot Sectlon 3700 of t�e Lebor Code, I shall forthwith camply with ihese isions. 1j�,, � (] 7 /� Applicam SignaWre: �� .�f�-Y� Date: _ -1 � / � —�! � WARNING: FAILURE TO SECURE WORKERS' ODMPENSATION COVERAGE IS UNLAWFUL AND SNML SU&IECT PN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FINES UP TO ONE HUNDflED TMWSAND DqlARE ($t00,OW�, IN ADDIiION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3'l06 OF THE LABOR COOE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby effirm ihat I em force entl eflect. Lic. # _ Comremor's SlgnaWre: Chapter 9(commencing with Section 7000) of Divislon 3 ot the eusiness end Protesslons Code, and my Ilcensa Is In full ��ess « cy — .� . n , oeca: —13 s-f � CONS7RUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is e consiruction lending agency tor t�e pedormance ot t�e work tor which t�ls permit is iuued. (Sec. 3097, Cidl Code). Lenders Name: Lentlefs Atltlress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: � I hereby eHirtn that untler penalty oi perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or county which requires a pertnit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires the appliwnt tor such permit to fila e slgnetl statement tha� he or she is licensetl pursuant to Ihe provislons of ihe Contractors License Law (Chapter 9(commencing with SecNon 7000) ot Divlslon 3 ot Ihe Busineu entl Proteuions Cotle) or ��et �e or she is e:empt iherefrom end the basis for Ihe elleged exemption. My violation oi Sectlon 7031.5 by eny aDP�lcant for e pertnit sub�ects t�e epplicant to e clWl penelry of not more than five huntlretl tlollaro (5500).): ❑ I, as owner of Ihe property or my employees with wages es their sole compensation, WILL DO THE WORK, and the struaura is not intentletl or offered tor sele (Sac. 7044, Business and Professions Code: The Gontractors License Lew tloes not appty �o en owner ot properry who builtls or improves ihereon, end who does such work himself or herself or through his or her own employees, provided Ihat such improvements ere not intended or oHered for sale. If, hawever, the bullding or improvement is sold within one yeer of wmpletion, the owner-builder will have �he burden of proving ihet he or sha Ci0 not huild or improve for puryose of sale.). ❑ I, es owner of the property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct tha prolect (Sec. 7044, Business antl Professions Code: The contrectors Licensa Lew does not apply to an owner of property who builtls or improves ihereon, and who contracis for such project with e coniractor(s) license pursuant to the Conirectors License Laws.). ❑ I am e:empt under SeC. Bu5ine5s end Professions Code for this rea5on: Signature: Date: Owner ID venfietl by drivar's licensa. ❑ Ves ❑ No Driver's License No. Venficetion af Ownership by (type of tlocument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby certity Ihet no excavation tive (5) or more feet in tlep�h Into which e person is required to descend, will be made in connection with work auihonzed by this pertnit, and that no building strucWra, scaHolding, falsework, or demolition or dismantling thereot, will ba more than thirty-six (36) teet hig�. (ChaO� 3.2, Grp 2, An 2, Sec. 347, Title 8, Celifomia Atlministretive Code). ❑ As owner�builder, I will not employ anyone to do work which woultl requlre a permit irom ihe DiNsion of Industrial Safery, as noted above, unless such person �as a permi� to tlo such work from Ihe division. Signeture: Date: Division ol Intlusirial Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUh10R12ATON OF ENTAV: I certify under penelty of perjury that I have read this epplication end state thet the intormation given is correct. I agree to comply with ell state laws and ciry ordinances relating to building construction, antl authorize representatives of the Ciry of Costa Mesa to enter upon the above-descdbed pmperty for inspection puryoses. I agree not to occupy or allow occupancy of eny building euthorized by �his permit untll ilnal Inspection. \^ — � aWre al Owner(s) n, f�Dat� � .` � "� �— AnC/Or Authonzed Applicant - Date COOE I. INSVECTIONTYPE 1816 Fized System Finel Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Flnel FeClory Fire Place 203 Flnal Sign 204 Final Demolitian 2418-48 �� 0 INiiil��j CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 220 222 250 Final Fira Prevention Final Planning Approval Finel Site Final Builtling/Occupancy � wrmais