The URL can be used to link to this page

Home My WebLink About1640 ADAMS AVE - Building Permits OWNERBrentwood Savings DATE 9_6-79 JOB ADDRESS 1640 Adams Blvd. BUILDING PERMIT NO.48748 GENERAL CONTRACTOR Heath II Co. DESCRIPTION of WORK Electric Ground Sign AP No. 119-313-16.¢QTp7 TRACT FIRE ZONE VALUE $500.00 INSPECTIONS Signature Date- TYPE GROUP ZONE('1 SOIL GAS WATER SUBCONTRACTOR PEJtMITS ISSUED Date I Number Signature Plumbing ROUGH PLUMBING PROP, SWR, LINED HOUSE CON, 0 SPRINKLING SYSTEM ' ' MISCELLANEOUS I )ROUGH HEATING ANO AIR CONDITIONING ` TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER 0 ROUGH WIRING C _ Heating and Vent.TRENCHES 0 FORMS I I STEEL REINF. FLOOR SYSTEM r C BOND BEAM [l STEEL REINFORCE n FILE SHEATHING DAT .y� ` / . FRAME AND FLASHING^ 6eatty' Lytyf�I\ LATHING — IN ' 3 OUT n PLASTER, BROWN COAT ' STRUCTURAL, FINAL J EI■ tf/ HEATING, VENT., REFRIG. AND A.C.. FINAL -/Q yJp v r ' PLUMBING. FINAL AND GAS TEST fl ELECTRIC. FINAL BUILDING, FINAL _COif_I•I_OCnIIIaCYCYTR OWNER _, BRENTWOOD SAVINGS DATE 12/27/72 M JOB ADDRESS 1640 Adams Blvd. BUILDING PERMIT NO. 35830 ly'GENERAL CONTRACTOR Heath &_Co. DESCRIPTION of WORK Elea. Dir. Grd. Sign AP No. g-.R1�27,1 3- TRACT FIRE ZONE VALUE $ 1,000.00 1 li INSPECTIONS u t Signature Date GROUP .j TYPE JV ZONE C-1 SOIL SUBCONTRACTOR PERMITS ISSUED 4\GAS Date Number I Sianature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING Heating and Vent. TRENCHES FORMS STEEL AEINF. /rib I-3-)Q' FLOOR SYSTEMv' BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN rl OUT rl PLASTER, BROWN COAT STRUCTURAL, FINAL �j EletJrifC' �/HEATING, VENT., REFRIG. AND A.C.,-�FINAL ilea g/ (A . /,�/��f J.rgy �y� PLUMBING, FINAL AND GAS TEST I I / ELECTRIC, FINAL 5/ ?"f(' /S BUILDING, FINAL fit 73 OWNER _, BRKNTWOOD SAVINGS DATE 12/27/72 tAJOB ADDRESS 1640 Adams Blvd. BUILDING PERMIT N0. 35829 GENERAL CONTRACTOR Heath & Co. DESCRIPTION of WORK Elec.Post Ped. Sign P No. 13q_g13_27,1 OT,11 TRACT FIRE ZONE VALUE $ 800.00 INSPECTIONS ' Signature Date GROUP J TYPE TV ZONE C-1 SOIL PERMITS ISSI�ED .t GAS SUBCONTRACTOR Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. fl SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER fl ROUGH WIRING Heating and Vent. TRENCHES FORMS Li STEEL REINF. El /{. �..3.) FLOOR SYSTE BOND BEAM n STEEL REINFORCE rl SHEATHING FRAME AND FLASHING LATHING — IN rl OUT Il PLASTER, BROWN COAT STRUCTURAL, FINAL tris ye HEATING, VENT., REFRIG. AND A.C., FINAL �. /oh/076,8 //q 96 PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL Kt 7S BUILDING, FINAL /•//- 73 OWNER , BRENTWOOD SAVINGS DATE 12/27/72 (JOB ADDRESS 1640_ Adams Blvd. BUILDING PERMIT NO. 35831 GENERAL CONTRACTOR Heath & Co. DESCRIPTION of WORK Elec. Dir Sign "C" AP No. 139-313,27,1LOT 4 TRACT FIRE ZONE VALUES 500.00 INSPECTIONS ' Signature Dote GROUP J TYPE III ZONE C-1 SOIL SUBCONTRACTOR PER T SS D GAS Date Number Signature WATER Plumbing ROUGH PLUMBING J PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 0 POWER ❑ ROUGH WIRING // Heating and Vent. TRENCHESgt FORMS O STEEL REINF. itle FLOOR SYSTEM^ BOND BEAM I ' STEEL REINFORCE ❑ SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL Y 1J.eRNLL/I E/ r y / /oY/'P/,71fiCa PLUMBING, FINAL AND GAS TEST ffl ELECTRIC, FINAL /PA"/, 'I-//7C BUILDING, FINAL ./.2R f-//•73 OWNER ricaN vcnuc, DLJJfiJ. -LAU. DATE L420=01 • JOB ADDRESS ]-6402Adams Blvd. BUILDING PERMIT NO.]14373 GENERAL CONTRACTOR Carter Sign Co. VALUE $1,600.00 AP. No.11j-(Y2_5LOT TRACT FIRE ZONE DESCRIPTION OF WORK Ground Sign INSPECTIONS DATE I GROUP TYPE ZONE Al Underground Soil U.G. Water — SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating 44 G Rough Plumbing_ z Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenchesfyfo1 Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final • Electric Fixtures, Final City of Costa Mesa Building Safety Department CERTIFIICATE OF OCCUPANCY4.f� 2063 , P.O. Box 1200 Costa Mesa,California " 1 The Building located at 18&11. Aft.--,r. n Abrne,n ' r. has been inspected and found to comply witti'the provisions of all City of Costa Mesa Ordinances applicable thereto . for a Group r-9 Occupancy.. Use of Building 4 `.fl.*twrre :;I t:,-,., noriAan: ., J Legal-Description "1:30-?1.?.silk_:`t._27 _ - - - i. 'ri "' ' ' ' 1 '' (See reverse side for Metes and Bounds) k - .` , - - Building Permit No 9R2':iff Electrical Permit No. 3457') Plumbing Permit No. [.1913? 1 Number of apartmenlls • and/or guest rooms" ' ISSUED TO: Building Official C. y. pYry. �•{,. rm�ln�(� +� by . es.J♦ tato)so:t Date January 12. 1375 This Certificate of Occupancy SHALL BE poste()in a conspicuous place on the premises and SHALL NOTBEremoved except by the Building Official of the City of,Costa-Mesa under Sec. 306 lel U.B.C. - Form BU 34 Rev. 11/70 . II - <. IIt. • City of Costa Mesa (� Development Services Department CERTIFICATE OF OCCUPANCY No. OO :,3 ( Building Safety Division P.0.Box 1200 Costa Mesa,California The Building located at 1640 Adams Avenue has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group 82 Occupancy. • Use of Building Office Legal Description 139-315-16 (See reverse side for Metes and Bounds) Building Permit No RPLICACi Electrical Permit No. P. dcRRS Plumbing Permit None dFRs1 Mechanical Permit No. M 45792 Number of apartments - and/or guest rooms N. ISSUED TO: Building Official George Edmiston C. J. Seaerstrom & Sons • 3315 Fairview Road by -' ' AC", ' Costa Mesa, CA 92626 Date March 9, 1990 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the 'Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev.1/83 White-Owner;Canary-Numerical File;Pink-Bldg. Permit File • t3ROJEGT 41NRESS: 1640 ADAMS AV OMIT: CITY OF COSTA •MESAI - SIGN PERMIT _ PERM NO: SHE 045825 OWNEW;NAME: COLDWELL 'DANKER • -• - • ADDRESS: 1640 ADAMS AV - • PERMIT NO: SBE 045825 PLAN CHECK NO: 02422-90 S GOVT: N SUPP : N • • COSTA MESA - • • . • ' .CA92626 . • CONSTRUCTION TYPE: 5 . PERMIT TYPE: ELE STR SIG : PURPOSE: OTH ARCH/ENGINEER: ( 714') 552-2000 REG.NO.: JOB DESCRIPTION INSTALL ELECTRIC GROUND SIGN • , SQ FT: • ADDRESS: ' - UNIT: . • • • CLAIM VALUE: . 2, 000 . 00 CALC-•VALUE: • 2,000 . 00 GROUP OCC: D- 2 /- PERMInEE: -INTEGRATED SIGN ASSO. ( 61 9 ) 579-2229 - - ADDRESS: ' 1160 PIONEER WAY M COMMENTS: ELECTRICAL PERMIT REQUIRED. ' EL CAJON CA 92.020 *+c-+E****9eee9ticrt9E****9titit+r+E+EEEdtet***EE*EEx**** -eeet*et***9E **aE -*EE*******+Eer*it+t*+E*9r*Mic-iE*et*it+e+r LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chaps 9(commencing MTh Section SIGN INFORMATION • 7000)of Division 3 of the Business and Professions Code,and my license is in full foand effect. DISTRICT: 1 YP E: GROUND ' ILLUMINATION: INT CATEGORY: NEW • CITY UC.: 0997411 STATE UC.:44082g cuss: DIMENSIONS: \ 7FT 11IN X 4FT 04IN AREA: 34 . 00SQFT LETTER HT: 9 • , Dae: I-24- 10 Signature: `CJll�ei/ A STREET FRONTAGE---1 : 130 . 00 . STREET 1 : ADAMS AV WORKERS'COMPENSATION DECLARATION: I hereby affirm that have a certificate of consent to self-insure or a certificate of Workers' STREET FRONTAGE 2 : 0 . 00 STREET 2 : - I • . Compensation Insurance,ora certified ropy thereof(section 3800,Lab.C). -PARCEL: 13931316 '.ZONE: Ci LOCATION > FRONT: 'X R EAR: vOUCYNO.: 333-89 UNIT158 EAP.DATE: 10/01 /90 • BUSINESS ' NAME: COLDWELL BANKER > LEFT: RIGHT: , • • ^aMPAxY: STATE FUND , OTHER• TOTALS GROUND SIGN J Certified copy is hereby furnished. 0 Certified copy is filed with the city Bid gDivision. / THIS ACTIVITY : 34 . 00SQFT OVERALL HEIGHT: 6FT OIN . ' • A. THIS SIT£ : 80 . 00SQFT -- GROUND CLEARANCE: OFT OIN - 1-2A-9 Applicant: ITEMS OF INFO' : 1 • PLANTER AREA: 68 '.V00SQFT' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (fit section need not be completed ifthe permit is for one hundred($100dor less). ITEMS FOR ACTIVITY: 7 ^- • BLDG SET BACK: 2OFT • - - I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to bedome COPY VERBIAGE. : COLDWELL BANKER REAL ESTATE WITH LOGO - subject to the Workers'Compensation Laws of California. . • • Date: Signature: .- PLANNING :NOTES: . NOTICE:If,after mating this declaration,you should become subject to the Workers'Compensation provisions of the Labor ************************************ ******************************************* Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. D • E V E L O P M E N T S E R V, I C E S , R E Q U I R . E M E N. T+-S CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ; - which this permit is issued(Section 3097,Div.C). • ZONING APPROVED BY _ % i1 ' DAT P: : %��• LENDER: . • { ADDRESS: BUILDING APPROVED BY : "MAW .:a DATE: ,:f! ,/�2 _ • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License• Law for the following-reason' AP PL I CATION ISSUED BY: ��"/SAVe/ /�� DATE: �/�Y 0. (Section 7031.5 Business and Professional Code: My city of county which requiresa permit to construct:alter,improve.demolish,or *********.*.*:***********• ****- ',s• • •f`,• - • • • •*******.*N.* SFIF'iF3E 3f lF)f** repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed LEGAL I Z AT ION:N - ' F E E S U M Mr R Y STRUCTURAL SEGMENT:Y pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by - any applicant for a permit.subjects the applicant to a civil penalty of not more than five hundred dollars($500). BLDG PMT PLUMBING ELECTRIC MECHANIC CHAR I_C_ SIGN .SMTP/RES GRADING "I,. as owner of the property or`my emDloyees-with vines as�their sole'compensation,'will do'the work,�and the ' PERMIT ' ' ' 45'. 00 ' 1.5 :00 • 34 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law - •5 0$ S M I P/NON-RES •' does not apply to an owner of a properly who builds or Improves thereon,and who does such work himself/herself or through PLAN • 29 . 25 . 50 his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or S improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve ISSUE FEE 15 . 00 for the puposeotsale). BUILDING DIV > PERMIT' ISSUE PLAN CHECK TOTAL ' PAID '. DUE " I.as owner of the property.am exclusive) contracting with licensed contractors to construct the project(Section 7044,Business TOTALS.--'--> 94 . 5 0, 15 . 00 • 29 . 25 ' 138 . 75 138 . 75 . . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon • and who contracts for such projects with a contractorls)license pursuant to the Contractors'State License Law)..I am aware REVENUE DIVISION TOTALS---> COLLECTED : 138 . 75 OVER/SHORT: . 00 ' that proof of their Worker's Compensation insurance should be provided to me. - BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN=CHECK ❑ I am exempt under Section: - B.S P.C. • • ' 4 5,. 0 0 3 0 . 0 0 ' 3 4 . 0 0 ' . 5 0 2 9 . 2 5 for this reason: I - • ' ******************************************************************************* ' Date: Owner- . , INDIVIDUAL F E E BREAKDOWN• ' • I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and • 25534 and that I or,any future building occupant will Mill not(drde one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from TYPE QTY D E- S C R I P T I 0 N UNIT COST - TOTAL COST these provisions. . , ' ELE • 1 ' SIGNS/OUTLINE LIGHT `SYS ON 1 BR CIRC 15 . 00 • ' 15 . 00 Date: Applicant: END OF FEES I hereby certify that I have read this application and state that the above information is corr t.I agree to comply with an city and county , ' ordinances and state laws relating to building construction and hereby authorize representativ Hit dry to en r u the above-mentioned . • ' property for inspection purposes. •' ' • • Cate;. (-24-q.O . Signature: !\''',S WC-) • • ' . 01 00052553-0005.2557 TOT 138.75 • Other's License or Social Security e: • DATE: 01/24/90 TIME: 14:49 - • 1841.40 White-Building:Green-Code Enforcement:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor - . . ' • - - • CONSTRUCTION AND PLANNING • • POOL" & arA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole.•. ' 52. Pool & Equipment Location - _ 2,._Soil-Pipe-Undrgrnd.., ;,, - ';'F+ • 53.-Steel Reinforcement 3.-Electrical ConduirUtility-Undrgrnd--• 54. Forms . ` '4..Elec[rical Conduit=Uhdrgrnd. - - 55. Electrical Bonding 5.<Steel Reinforcement; • 56. Rough Plumbing & Pressure Test „• 7: . - ?,,6.!'Electrical UFER Grnd. _ 57. APPROVAL-TO COVER•GUNITE ;7.;�Footings - . 58. Electrical Conduit-Undrgrnd. .� 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe•Undigmd. 60. Backwash Lines, P-Trap, ❑`Undrgrnd. 10. Structural Floor;System 61. APPROVAL TO DECK 11. Property Sewer Line;& Hduse Connection • 62. Backwash & Receptor-Final 12. Sewer Cap - - - 63. Heater & Vent-Final - i 13. Roof Drains ;i 64. Plumbing System'- Final - 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final -16. Rough ElectricWiring' • 67. Fencing & Access Approval 17. Rough Wiring Sibn 68. APPROVED FOR PLASTERING , 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19;Rough Heating &Air Conditioning _ - _ t. 7J „1. ;,FIRE DEPT.-REQUIREMENT _ 20. Rough Factory Fireplacelr- _ _. . - APPRO• VALS n! P,ernlit# - 21,-Ducts, in Structure*; =",NF1-'J - '__ `- ^: _ .. �` "` C. �JO ,Underground Hydro - 22.r.Ducfs, Ventilatingt u - - }•) = , -.-,c- - 71 Product Piping O;Gas ❑_Oily 23.-Gas;Pipe-Rough & Test 57. . _�- S . = r "' ^72 Under round Flush- 24:`Roof Priming " ') _ '. c -7 :73.Un iergrnd.StorageTank ❑Gas ❑Oil 25. Roof Sh-eathing ' : - - ? RflOJFCTY1KiflESS: 1640 ADAMS AV UNIT: CITY OF COSTA MESA - SIGN PERMIT PERM NO: SBE 045826 - • OWNER'S NAME: COLDWELL BANKER . ' • • ADDRESS: 1640 ADAMS AV PERMIT NO: SBE 04.5826 PLAN CHECK NO: 02423-90 S . GOVT: N SUPP: N COSTA MESA , .. ' • 'CA 92626 • - CONSTRUCTION TYPE: 5 . PERMIT TYPE: ELE, STR SIG PURPOSE: OTH ( 714 ) 552-2400 ; ARCHRINGINEER: REG.ND•: JOB DESCRIPTION ; INSTALL ELECTRIC :WALL - SIGN SQ FT:- ' ADDRESS: UNIT: - ' I ^ CLAIM VALUE: 1 , 000 . 00 CALC-VALUE: 1,,000 ,00 GROUP OCC: B=2 / PERMITTEE[ INTEGRATED SIGN ASSO. ( 619 ) 579-2229 ' . - ADDRESS: 1160 PIONEER WAY , COMMENTS: • EL CAJON CA 92020 **ewer**::iteaer******yl*e6****el**ere6**x-+Eeker**eEe6*N-x-s6x-fr*****ear**alsfbetft*+6*etetere6 -eE*ere6*N-**et*e6+t*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section S' I G N I N F O R M A T I O N - • 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. DISTRICT: 1 TYPE: WALL ILLUMINATION: INT CATEGORY: NEW clnuc.: 049741 sTATELc.:440828 � CLASS: C{�0 �j DIMENSIONS : 15FT 04IN X )FT OOIN ' AREA: 46 ,00SQFT LETTER HT: 12" Date: )"7-4 -9 b Signature: STREET- FRONTAGE 1 : 130 . 00 • STREET 1 : ADAMS AV WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' STREET. FRONTAGE 2 : 0 . 00 STREET. 2 : , Compensation Insurance,or a certified copythereof(Section 3800,Lab.C). PARCEL': 13931316 ZONE: Cl 'LOCATION > FRONT: REAR: PoucYNO.: 333-89 U15 • EXP,DATE: 10/01 /'0 BUSINESS NAME: COLDWELL BANKER > LEFT:. • RIGHT: -X ' ' AMPANY: STATE FUND : OTHER T O T A L .S - GROUND S I G N • J Certified copy is hereby furnished.,® Certified copy is filed with the dtyBuil& I Sion., /• THIS ACTIVITY 46 :00SQFT ' OVERALL HEIGHT: OFT OIN • • THIS SITE - : 80 . 00SQFT _. • GROUND CLEARANCE: OFT _ OIN Date: 1-Z4-1Applicant: 1L J�.va.,... ITEMS OF INFO : 1 -:.-- PLANTER AREA: 0 t:00SQFT' EXEMPROS FROM WORKERS'COMPENSATION DECLARATION: (flus section need not be competed ifthe permit is for one hundred(5100)or less). ITEMS FOR ACTIVITY: 6 '' . BLDG SET BACK: 20FT.. i u' Icertiythat inthe performance ofthe work for which this permit is issued.I shall not employ any person in any manner so as to become COPY VERB IAGE• :' COLDWELL 'BANKER REAL ESTATE WITH A LOGO subject to the Workers'Compensation Laws of California. , 1 -- ' Date: ' - Signature: PLANNING NOTES: .. NOTICE:if,after making this dedaiation,you should become subject to the Workers'Compensation provisions of the Labor ***'*'********'** -*'****'****-*****'* *******k-4**'**'*'*******'******'**4***'N'*'***'i '**'*'*'***'* Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. DEVEL 0- P -M E N T •S P R V I C ES R E Q U I R E M E N ,'TV;•'. ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for'the performance of the work for ( f which this permit is issued(Section 3097,Civ.C). ZONING APPROVED 'BY . _ (jii ,"' r I ,DATE: //�'2-y7�/j LENDER: . , / ADDRESS: - • BUILDING APPROVED BY it �- / , , - DATE: D !a- G OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason ' APPLICATION ISSUED BY : ' af/�ar/i!, ./sem 'DATE: L/ 10 (Section 7031.5 Business and Professional Code:"Any city of county which requires a permit to construct,atter,improve,demolish,or ********M************* .. " ' " . ..***********a *" ** repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed LEGAL I ZAT ION: N F^E, E S M g/ A R Y STRUCTURAL SEGMENT:Y - pursuant to the provisions of the Contractors=State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business . and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of'Section 7031.5 by ' . - - - -. ., . • any applicant for for a permit subjects the appicant to a civil penalty of not more than fivehundred dmars:(5500). BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SM-IP/RES GRADING I, as owner of the property or'irry employees with wages as their sole compensation, will do the work, and the PERMIT. • 2 S . 0 0 1 5 , 0 0 46 . 00 f ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law S 1:1% SM I P/NON-RES does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through PLAN - ' 16 . 25 • ' . 50 - his or her awn employees,provided that such improvements are not intended ar offered for sale.If,however the building or ISSUE FEE • 1 5 . 00 improvement is sold within one,year of completion,the owner will have the burden of proving he/she did not build or improve . forthepurposeofsale). BUILDING-DIV > PERMIT• : ISSUE PLAN-CHECK TOTAL PAID DUE I,as owner of the propelam exclusively contracting with licensed contractors to construct the project(Section 7044,Business TOTALS-'- --> 8 6 . 5 0 '15 .0 0 16 . 2.5. •1 17,7 5 1.17 . 7 5 . 00 ❑ and Professions Cade: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law)..I am aware REVENUE DIVISION TOTALS---> COLLECTED : ' 117:75 OVER/SHORT: • . 00 that proof of their Worker's Compensahon Insurance should be provided to me. . BLDG PMT PLUMBING ELECTRIC MECHANIC ' SIGN SMIP/TOT GRADING PLAN-CHECK t Et am exempt under Section: ' . B.a P.C. 25 . 00 ,30 , 00 46 .00 . 5 0 16 . 25 for this reason: - Date: Owner: I N D I V I', D U A L FEE 'BREAKDOWN • I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a TYPE QTY D E S C- R I P T I O N UNIT COST TOTAL COST permit for construction or modification from the Nr Duality Management District,Residential construction applications are exempt from I these provisions. ELE • 1 -SIGNS/OUTLINE LIGHT SYS ON 1 BR CIRC 15. 00 15 . 00 Date: Applicant: ' END OF FEES • I hereby certify that I have read this application and state that the above information is car d.I a gree to camp• with all city and county . ordinances and state laws relating to building construction and hereby. .'ze representat s of IN-city to este n the above-mentioned properly for inspection purposes. • , Date: I'L4"9f) Signature: ' I - I1 fit, • 01 00052548-00052552 TOT 117,75 Driver's License or Social Security it: DATE: 01/24/90 'TIME: 14:47 , 1641-46 'White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor - - — - - . 1 - - -.. • CONSTRUCTION AND PLANNING- POOL& ...-A APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole- r„ 52. Pool.& Equipment Location ,2._Soil Pipe-Undrgrnd;,: • 53. Steel Reinforcement - •.. 3.<Electrical Conduit-Utility-Undrgrnd'; 54. Forms 4 Electrical Conduit=Undrgrnd. --', • 55. Electrical Bonding • c,5.<Steel'Reinforcement. - 56. Rough Plumbing & Pressure Test -- 6.• Electrical UF ER Grnd. 4' - 57. APPROVAL TO COVER-GUNITE _ C7..-Footings 58. Electrical Conduit-Undrgrnd. _ 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test . 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. • • 10. Structural Floor.System _ . 61. APPROVAL TO DECK 11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap a : o _ 63. Heater & Vent-Final • 13. Roof Drains - _ 64. Plumbing System - Final . 14. Rough Plumbing ' - 65. Electrical-Final • , • 15. Rough Electrical-Conduit - • 66. Solar System-Final 16. Rough ElectricWiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - _ FIRE DEPT. REQUIREMENT 20-Rough Factory Fireplace, `- ` -' - :APPROVALS . Permt#' -i 21:-Ducts, iii•Structurecr.-.7.--..r.'_i = : _C- '- -70.:. Underground erground Hydro.; 22...Ducis, Ventilating, f -' • "`"` _ ` e-::,CT. F' •c. .'. _ 71.-Product Piping OGas ❑Oil 23.-Gas-ripe-Rough& Test tc•_ .. _ _ 72:_Underground Flush 247.Root Framin `` - _ _ - 9 _ . ��- rrri . " 773.-Untlergrnd.Storage Tank.0_Gas 0 Oil 25. Roof Sheathing -.:c•r�-- ''74:'Overheed:Hydro - 26`T-Bar Ceiling (StruFturall''&;Monocoat 75-dry Chemical • - _ ' - �. 27_. Frame and Flashing < 2 -_ 76: Dry Standpipe - 28. Lathing-LS/ Siding ' -= ; - "`o'- - ' 77".FIXED:SYSTEM F,INA L1` , 29. Insulation - .. '^ -• -• i78..�fIRE PREY. FINAL 'i • -30. Drywall-Nailing ' - '"c c-, P" HEALTH-DEPT. REQUIREMENT . i. aoat 31. Plaster Brown C , _ i-- - - - '' d .797EINAI INSPECTION 132r'_,Electrical Power Meter-Final ` ' 7 FOOD CERTIFICATE ISSUED . c;33�Finel Electric r - ' 244c 2% � "'�_' - .-1• - �34i Final Heating-•& Air Conditioning ▪ ' ''- - e35-Final Gas Pipe-Test.; - -:..1 _ r - . : • - _ - 36. Hood or Canopy x -• _ -' r. ^x -• - -37 Final Factory Fireplace_ y,;./....:".. -'- I - r -ai `38.=FinaIPlumbFing • -. - = -, - • •• - r.i U ..'_39.!Water Service-Fina ` • 9..-.: o lS X:_ _ $ -40. Gas-Service- inal s- •--_-?..--.. 5 C - - "' -41:'Solar Domestic-Fin4lr.-' ' i t "• .` `, : ^, 42. Backflow Prevented J .- -• '' - _ , k -• - -• 'c - -Or - 43. Backflow Irrigation' - I, ` - `" ". 7'44. Landscape Irrigation System :J`•• •• •• r '- r• 7; _. r -: . -, �' - c.w - 'F - • Y - `45.-•Sound Atten'uatiors •` rc.` ' i ` - 7 ,- - s _. F_' ..t t .*1 - T ! ... X46:-Handicap Regulations1.'✓ i = o - t 47=FINAL STRUCTURE 8,iBUILDING ��///yam / ho ..x r- r48::FINALPLANNING Y - ' �;i�l�a� x % = • �� ' �" `I r-t '- c 49. Electric Release to"Edison • I%f'; _ " • - -, - '/1 i t 'i1: _ C i. - -. 50_Gas.Release to Southern California Gas Co 'r _ - • '751. CERTIFICATE OF`OCCUPANCY x , r .. -. No. Date ' ' - CITY OF COSTA MESA BUILDING DIVISION 4 g • >:j r,,,•. .•� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4r }1"---7" PERMIT Sbeeominso#41401-00278 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1640 ADAMS AV Status: ISSUED Suite No Applied: 05/08/2001 Issued: 05/15/2001 Vicinity: ARTHUR MURRAY Parcel Nunmber: 13931316 ISSUED BY: Applicant: BRADFORD, DAN Address: Phone: 714-974-4061 Zip: , Owner: C J SEGERSTROM & SONS Address 3315 FAIRVIEW RD Phone: COSTA MESA,CA Zip: 92626 • Contractor: D AND E PLUMBING COMPANY' Address: 1023 W BRIARDALE - - Phone: (714)974-4861 . ORANGE CA Zip: 92665 License: 670903 - • Arch / Eng: '" - /. C� Address: ,...Phone: - - /, _ .-_ __.ZiP . - __ j /._ - License: -� i� ' ' - . SCOPE OF PERMIT . REF:801-00232.TENANT IMPROVEMENT FOR"ARTHUR MURRAY DANCE STUDIO". PLUMBING TO, . f , / .1 INCLUDE:2 FLOOR DRAINS, 1 KITCHEN:SINK,2-.TRAP PRIMERS, 1 URINAL,2 WASH BASINS,3 WATER CLOSETS, 3 WATER HEATERS.,, ,'• `'� -/ .,) 0-=--4- FEE-SUMMARY , m."---.2. '-: .. iii/ -AMT `-QTY v - air AMT :QTY -s-.V �'ij / AMT QTY ISSUE FEE 'iV ($23.50 ) \-‘,"1---:',.. ..� Laund Tub/Washer , $0 00 - 0 - �' \� rY ��iSump Pump,/ // $0.00 0 Backflow irrigation vAv $000 ,'0, ��Landsca elrri ation \ p g � _ $0.00 __0/� Sw'imming Pool �� /� $0.00 0 Backflow Preventer'- $0.00 / '0; - --P_-Trap" _ .: ,.$0.00-_-0:/ _/K Trap••Primer , / $19.60 2 Bathtub v - $0.00',..„--•:, 0/ / ', -- Pressure Regulator - $0.00 - 0 Urinal ' ,, > / $9.80 1 Clarifier System ' $0.00. 0; - Process Piping(per 10 ft) $0.00 ,�0 �\ \�`.Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00,:; 0 Receptors - • • ,� - - $0.00, ',,a, ', '' Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 - -0• �, Septic Tank ... $0.00 0 -' --WashBasin $19.60 2 Dishwasher $0.00 -0 -- Sewer Cap for Demo - i $0:00- • 0 --/'-Wash Basin Set $0.00 0 Drain,Floor $19.60 2 c .Sewer Connect' -- - ' $0.00 -- 0- ,---Waste and Vent System $0.00 0 - Drain, Rainwater $0.00 0 - Sewer Private Line .; i, $0.00''-'10/- Water Closet(Toilet) $29.40 3 Drain, Roof $0.00 0 Shower- -- - : _-_±_-_-_ .$0:00 0 Water Heater/vent $36.90 3 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $150.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $318.20 COMMENTS I SPECIAL OONDITIONO NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 io 244646(&00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I-have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit B Issued. My workers'compensation Insurance carrier and policy number are: Carrier: 5'>,4-re `-Lind Policy Number: -aq—D, AO!Li45f (This section need not be completed if the permit Is valued at one hundred dollars($100)or lass.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I s I become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro�ts�ons. Applicant Signature: / &tom-- lee; Date: S/7`/(0/ WARNING:FAILURE TO SECURE WORKERS'COMPENS ON ERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL/ENACTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDION TOME RT OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 370e OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(corn encing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class N Contractor's Signature: .a Date: S//s'/O/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California AdminlstratNe Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure), 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 —Does Yes r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signa Of Lege .. :r Date VA1,74� sr or . ' orf .plr Date ;ODE IL IySPECTION TYPE PATE IIdl19L5 LADE( INSPECTION TYPE DAM INTRIAL$ 1616 Fixed System Final Fire Prevention 208 Final Mechanical // �1 1266 Pool Spa Final 208 Final Plumbing A['"'DLi -of col l V 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Slte 204 Final Demolition 250 Final Building/Occupancy 9 CITY OF COSTA MESA _ 4 BUILDING DIVISION Y firs.„ ,,,,,,, DEVELOPMENT SERVICES DEPARTMENT PER NUMBER F1.y� . PERMIT '`boRmm`'`� 01-00250 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT i Job Address: 1640 ADAMS AV Status: ISSUED Suite No Applied: 05/09/2001 Issued: 05/092001 Vicinity: - Parcel Number 13931316 - ISSUED BY: Applicant: COOTER, LYLE Address: 143 E MEATS AVE Phone: (714)685-0077 - ORANGE,CA Zip: 92865 • - Owner C J SEGERSTROM &SONS . Address: 3315 FAIRVIEW RD Phone: COSTA MESA,CA Zip: 92626 . Contractor K AND S AIR CONDITIONING INC Address: 143 E MEATS AVE - Phone: (714)685-0077 ORANGE,CA Zip: 92865 License:483431 • SCOPE OF PERMIT MECHANICAL PERMIT,FOR INTERIOR T.I..FOR"ARTHUR MURRAY DANCE STUDIO".RELOCATE 2 EXISTING HVAC PACKAGE UNITS, INSTALL DUCTING FOR 2 VENT FANS,&ALTER 2 HEAT/COOL SYSTEMS. . '' - . -" . . -" - REF:B01-00232 - " . _ . FEE SUMMARY " _ _ Quantity Quantity / ISSUE FEE $23,50 Repair/Att Absorbtion Unit ; / $0.00 '0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Uniti,, / ,$0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00' 0 Repair/Alt Cooling/Heat $27.40 2 ''Evaporative Cooler .'/,;,` ; $0.00' 0 ; Inst/Rep. Recess Wall Htr $0.00 0 _ -%-rl,-• . Commercial Incinerator /- ,/ 10.00 , 0 " Refrig Sys<100 k BTU - $0.00 0 Domestic Incinerator - .;/ $0.00 0 Refrig Sys>100 k BTU , . $0.00 _ 0 7 Com_pressors/Absorption Systems Gas Piping ;v$0.00„0 4:'," - Up to 3 hp/100 k BTU �' $0.00 , 0 Factory Fireplace $0 00, .0 • 3 To 1.5 hp/.500 k BTU / i < _ $0.00' 0 Hood w/Meth Exhaust t.7 �� $000/`0. ` _ - . ,i 5 To 30 h /.1,000 k.BTU/ i a '$0;00 0 VAV Box �.-,V / 7/ $0.06 .0 o '' - i ' . ,30 To hp/1,750 k-BTU ';- ./(' $0.00 0 Vent Fan/Single Duch • �',$14.50. Yom. - �- - - Over 50 hp/-Over-1750 BTU\\--0 i$0.00 0 Appliance . --$000-v0 _ - Boners- Fire Dampers $0.00 :;0` l Up to 3 hp-, m \ K� $29.40 2 Smoke Dampers � $0.00 i' 0 ' / - - 3 To 15 hp- _ 7 t _'- - $0.00 0 Inst or Relocate Appl Vent ' . -$0.00 '0. : ' '15 to 30 hp-',t,, :��, $0.00 0 Air Handlers< 10000chn $21.30:_- .2 �_- 30 to 50hp '' - . <7 $0.00 0 Air Handlers> 10000cfrn $0.00 . 0 - Over 50 hp . - -,%-__ .. $0.00 0 Floor Furnace $0.00 '0 - . Other Mechanical Fee Floor or Suspend Heater $0.00 0 - _ -' Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $116.10 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or it work is suspended or abandoned for a period of 180 days. i i INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.! FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS ( �' WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the _ work for which this permit Is issued. t have and wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. —My workers'compensation Insurance carrier and policy number are: Cather:. - Irl LCJ1 Ni-c>-c>f A. Policy.Number —w C3 D:D 7,/9 /1 L -(This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. /� Ant Signature:- --" /\� Dir - S Ok I WARNING:FAILURE TO SECURE WORKERS'COMPENSATION`_H°ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm Ihal.l am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of.the Busipess and Professions Code,and my license is in full force and effect.Lic. t. ) z-/'&''13/ [class*—1 G zo Contractor's Signature: / (Date: 15 9 1._...01 CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) 9kate C _LUC / And/Or Auth ed Applicant- (Date--.'' CODE I INSPECTION UPS DATE j$TITIALS CODE! INSPECTION TYPEPETE 1616 - 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6-499-C1l a 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy 9 CITY OF COSTA MESA ` BUILDING DIVISION r ," DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4WA • PERMIT .. B01-00232 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1640 ADAMS AV Status: ISSUED Suite: - • Applied: 02/21/2001 Vicinity: Issued: 04/11/2001 Parcel Number 13931316 Zoning: Applicant: CAMBIANICA, JOHN • ISSUED BY: I 4' Address: 1018 S SANTA ANITA UNIT 1 - " Phone: (626)294-0907 ' ARCADIA,CA Zip: 91006 , Owner: C J SEGERSTROM & SONS . Address /3315 FAIRVIEW-RD .- . . Phone: N / COSTA MESA,.CA - Zip: 92626 ' / - Contractor: WALLCO BUILDERS 'Address:- 18262 LEAFWOOD LN STUDIO B ' " \\V\ Phone: 714-838-1364 - �A 7 SANTAANA,CA �'- Zip: : 92705 , 'License: 618670 - ' - •' ‘`7 \ � . _ - v ,- - A v A Arch H JOHN CABIANICA ARCHITECTS Eng: ' Address: 1018 S SANTA ANITA AVE ' Address: SUITE 1 Phone: (626)294-0907 _ ,Phone: ' ARCADIA,CA - 1 ,Zip: 91006 License: License: - - . -- SCOPE OF PERMIT . . , 4500 SO FT INTERIOR T.I. FOR"ARTHUR MURRAY DANCE STUDIO". ' . - , 1 -l FEE SUMMARY ) Plan Check: $71.86 Calc Valuation: g3o, 000 00 • Permit: $442.25 - Claim Valuation: i, . ' " 539,6o6,86/ . '-'SMIP Res: $0.00 ; , - _ ,IJ / SMIP Com:.. ' $6.30 - Other: '$0.00 :77,��/ �I, ';Inspection- x.$0.00 /// , 'Total: "' $520.41 . - - -- - ', /:// \�S PLANNING-8.ZONING ; i.� (i t-. 7 SETBACKS, ;,,,,\ /! 7,�. \ �_`,�, /> \�/ MAIN STRUCTURE Front`/0-0 Rear - 0-0- . Left 0-0 H Right j 0-0% ,,, ��V A� ;i — _• - - \\\ i:, v /�/ ACCESSORY Front-,'0-0 ' , Rear - 0-0 Left 0-0 \ Right\` ,7 0-0 6'7;11/ PARKING Existing:'- Q - - Required: 0 Proposed: 0 '. / ,-j , NOTES: . .., - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(WOO) . WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed ii the permit is valued at one hundred dollars($1 or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Catifomia,and agree that If I should b m bject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p isions. P y Applicant Signature: V✓/J 'v✓`—"`- _ l c Date: "7 WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I am licensed underr rrovisiyns of C,ha-2ter 9(commencing with Section 00)of Division 3 of the Business a ofessions Code,and my license Is in lull force and effect.Lic.# /J 2 fy /7 V ' ipP � Classat8 Contractor's Signaturr � . _ I. _ Date: � CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Catifomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ... .. i.t. other o un. o o 7 If a permit athe South Coast res Quality cri edManagementCaliforniaDistrict Heor Sr airtpollution coon 4l district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by aliforHealth and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agreeeenot to occupy or allow occupancy of any building authorized by this permit until finalfiainspection. tiff ,( iature Of a O ne/(S{� / 1 44 //./ /Ire rl�}-d(�C�[� �"And/O}/�othorized Applicantcaanl//! ✓ /Date CODE L INSPECTION TYPE PATE' INTITIALS CODES INSPECTION TYPE Z€ INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 4 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy / , `p5�AI CITY OF COSTA MESA 4 BUILDING DIVISION 4- 1 DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER b..: -14‘‘..-111I PERMIT E01-00368 se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1640 ADAMS AV Status: ISSUED Suite No Applied: 05/10/2001 Vicinity: Issued: 05/10/2001 Parcel Nunmber: 13931316 Applicant: ADAMS, TRACY ISSUED BY: Address: . -- . Phone: 949-283-4335 Zip: Owner C J SEGERSTROM & SONS Address 3315 FAIRVIEW RD Phone: COSTA MESA,CA Zip: 92626 . • Contractor: KITE ELECTRIC INC ' Address: 28241 FOXWOOD • • Phone: 949-283-4335 - . MISSION VIEJO,CA Zip: 92692 License: 779653 • - SCOPE OF PERMIT. REF: B01-00232.TENANT IMPROVEMENT FOR"ARTHUR MURRAY DANCE STUDIO".ELECTRICAL TO , , INCLUDE:40 LIGHT FIXTURES,20 OUTLETS, 16 SWITCHES. - - - -FEESU MMARY - -/ - !Quantity - -- Quantity/ - ISSUE FEE $23.50 Temp Dist System/Lighting $0.000'J' ' Temp service test $0.00 Busway/100 R-, - $0.00 0" : - Res.a/c Package. $0.00 Standing-Section New Res(1-2 units) . $0.00 0 .: . ) ,Misc Electrical Equipment .$0.00 -'10/ " r New Res(3+units) - $0.00 0 - ,r_.is, Transformers up to 1 kva/kw $0.00 , 0 _ 'r ; Pool/Spa : $0.00 0 '" ; ' `up to 10 kva/kw $0.00-, /0 , Lighting Fixts '"$36.6040 - . .- - up to 50'kva/kw _$0.00'' " 0 - Recept Outlets $22:00,. .I-:---20;v ,; -- up to.100-kva/kw'f -$0.00' 0 -" - Switches $17.60=:.; -16. v - - - - =over 100 kva/kw ,' ".$0.00 ' 0 Non Res Appl ,.A $0.00`��s 0 - ,- - Low Voltage Equipment c 72$0 00-2 -,0 ice, - Res Appl -'7/ $0 00, - 0\; _ Low Volt Wiring System?Ckt- $0.00 `' 0 < /, Service to 200a v _ ' , ,$0.00., -.0-�"-' ` Misc.Conduit c - 7/" �$54;60Th�' 3' % ' Service to 1000a - $0.00 -, - 0 - - Misc:Conductor- "-- y "$54.60/ ,3 r" Service over 1000a - . ,_$0.00, ' / '/0 '-� Circus(gen or ride).... \'v ;-$0:00 -; 0 Motors to l hp , $0.00 A"/,0 -,l / _ Circus(meth-ride or lights) \,'-$0,00 ; ; 0 Motors to 10hp `..$0:00,-.. 0 ,y ;' ` 'Christmas Tree Stand., ,$0.00 0 Motors to 50hp $0.00: "--. _0 ' •+'• Fireworks Stand ••1 - 2$0.00 0 Motors to 100hp $0.00 -7 - 0- A'Other Electridal Fee - 1, '- ,$148.50 Motors over 100hp Communication drops $0.00 0 '"- __ -InvestigationEee-- $0.00 Sub panel to 200a $0.00 0 _. -- - - Plan-Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $357.40 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - O ' I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Cede,for the performance of the rk for which this permit is issued. I have and will maintain wo 'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for w Vis permit is issued. My workers''�omm ensatio Jla sunce carrier and policy number are: Carrier: VY \ q Jp.e . Policy Number: (This section need not be co Ir1f ted it the permit is.valued at one hundred dollars($100)or less.) ❑ I certify that in the pert. ance of the work for which this permit is issued,I shall not employ any person in any manner so as to beco subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 37p90 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: 576:45/ / WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($108000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force andeffect.Lic.# Class# Contractor's Signatu S-7/9/61 /Date: /O/TT ) V/ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code), Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑. I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). • O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (It"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / - -, Sig: Legal Owner(s) s/O/D pate s 1 An Jar Authorized Applicant Date CODE N. INSPECTION TYPE DATE INTIALS CODE II )NSPECTION TYPE pA�F 1NTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical A 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 1,•29 d 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ _ 250 Final Building/Occupancy / CITY OF COSTA MESA ` ��, BUILDING DIVISION , '^;VI , S` F � � DEVELOPMENT SERVICES DEPARTMENTPERMI UMBER t r PERMIT 4%.00,070;# Boo-00612 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1640 ADAMS AV Status: ISSUED Suite: Applied: 05/03/2000 Vicinity: Issued: 05/03/2000 Parcel Number 13931316 Zoning: Si Applicant: JEFF LIMA ISSUED BY: / / / Address: 843 W. 17TH STREET Phone: (949)548-3012 COSTA MESA,CA Zip: 92627 Owner C J SEGERSTROM & SONS Address 3315 FAIRVIEW RD Phone: COSTA MESA,CA Zip: 92626 Contractor: MESA ROOFING Address: 843 W. 17TH STREET Phone: (949)548-3012 COSTA MESA,CA Zip: 92627 License: 564151 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF-PO, REPLACE SHTG AS REQUIRED, INSTALL 2 LAYERS OF 15#FELT AND 30 YEAR COMPOSITION SHINGLES. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,740.00 Permit: $139.25 " . Claim Valuation: $6,740.00 SMIP Res: $0.00 SMIP Corn: $1.42 Other: $0.00 Inspection: $0.00 • Total: $140.67 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21.92) EXPIRATION: This permit shall automatically expire and become void if work is not,commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS r • . WORKERS'COMPENSATION DECLARATION: f hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ®' I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: . Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California t-d agree that if I should be e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr • ion //// Applicant Signature: l/( Date: .6- -co, WARNING:FAILURE TO U-: •RKE`- 'ENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,***),IN ADDI a TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: . I hereby affirm that I am license e o'1sl P1_Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr essions Code,and my license is in full forne andefect.Lia# / /gy�pp' Classat : k C' 7 Contractors Signature: 7 4''V Date: ��'� 3 aO CONSTRUCTION LENDING AGENCY: v O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature end pressure). .... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or wit the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ii Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (if"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 Ifa permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (if yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. lgnatture�O1 Legal ,r(s) 3.-7—05 r01tE�6 d // AnO-IW • ed Applicant Date CODE* INSPECTION TYPE S PM INTIT1AL$ CODE* INSPECTION TYPE PATE INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / ��-1 208 Final Plumbing 200 Final Re-Roof w –L/P-/17) 6J 0# 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 Applicant to fill In all_spaces except those within heavy,border lines and sign all appropriate declarations. • C.IFY'o1C osTA MESA, CQNST..:aaCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. r - /o4C7 SICIIC4 AVC c' • a PDaa566 �AeV/etv x#Q Sy 9953 9/11 /85 Project Address s • 7y� l • Applicant's-Mailing Address is`c...((o,o, /..e.ADr.Ht - . TYPE OF CONSTRUCTION LI NEW ADD ALTERATION U REPAIR 1 , C •S•�i�1G2 r• V� s SONY ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p z Zone �f Owner's Name C ',,�1 Phone ' DESCRIPTION OF WORK/USE OF BLDG. / LJ TB'/ZI t7R A.L7�12/\?IO V I • `�� - 11 — l�/ J �� - I - Address (331 ,/ t'AI'tUhEW Ica l Cal • 1-t A.0 is 9C Hoo C . S Main Building: Accessory Building: .- • Arch/Eng. '•/f'f•4NIG WI I.UNi46 1'T"g CLicense No. ,A • TYPE F PERMIT LI GRADING LJ FOUNDATION USTRUCTURAL E Front ` /�_1z O 14(a&( Dat PA O1 DAMP NWT 64 ' TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL . B !� ��/Jp � �; s(.p� - N Address A Rear /'l..�C/VI ise % 7 . 5 I,✓vz---1 I ❑ -OTHER Contractor's Nam Flaile Z- /i N Address(mailing) '3S 4'O D1a•-m 5 `b O PROJECT DESCRIPTION SQ. FT. '�I rj� OCCUPANCYO C Right�a�� yr Q s//� n•..•N (/� - G z I •^ CONSTRUCTION TYPE VALUATION$ S / 000 s Left '-01' sJl'r`� City License NO. 3rd Zg ZONE GRADING CU.YDS. ACRES {j /+J - R ICENSED CONTRACTOR DECLARATION /�/ Ping. Ref.# PA— C1 S^ /L/ r� ar-�k-�i/ng�R'eq�.,//P�,,�LLrovided I JXX/ E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PC_ S 7(a_S J5 163 I� Planning Notes,`, 0,, 2 /CQ00 Y—/bSz. if 4 4v / M with section 7000) of Division 3 of the Business and Professions Code,and •*2N my license is in full f• - nd effec 3} - ))spy .^t�$/,� - - T Licens Clgqss 4D se r�o. 1 -"�" F / S oate•t -1` Signature _ 1rA- • PLUMBING ' FEES ORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-Insure or a centile a ELECTRICAL FEES of Workers' Compensation Insurance, orra certified copy thereof (Section Backflow Preventer Service Sink / �♦ I _ Automatic Washer . Transfoimer ❑ 15-50 KW ' 'p' ' Lab. C.) _ TMS7n,: No 2�- � Company ST+�T� - Backflow Irrigation Sewer Cap - - -t Construction Pole Sub. • .❑ 50+KW LI -Certified copy is hereby furnishe0� I - u Certifi cop Is f11etl with the cit wmi ivisN Bathtubs • •ewer Co 1. - Cooking Unit a Meter ❑up to 100 amps N• Date x ?' r"'S_Applicant ^ A o,,, EXEMPTION FROM WORKERS'CONATION DECLARATION Clarifiers \ :: .I �. a• Ors ry Dishwasher Meter Cover 10.0 amps '(This section need not be completed if the permit is for one hundred ($100)o p , less). •Dishwasher h r Pipin•li _ - Dryers ❑Gas ❑Electric Sub Panel I certify that in the Performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the 1 Drinking Fountains •lar Tank #7/ Fan -) Motors DO-1 HP 01•1/2-S oZ OC] Workers' Compensation Laws of California. • Date Signature Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE:It,after making this declaration,you should become subject to the Inc.Solar ❑9-15 HP ❑15.15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal e Fixtures - Cocomply with such provisions or this permit shall be deemed revoked. _ - _ - D Microwave / W CONSTRUCTION LENDING. AGENCY - Gas Service Outlets +q -Water Closet / 6 a ' I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light of the work for which this permit Is Issued (Section 3097 Civ. C.) interceptors ' •Water Heater. 3C) Outlets .j . Range 4 — Lender's Name Lender's Address - Kitchen Sink Water Service • y' ,3 Switches Sign 9, OWNER BUILDER DECLARATION I�/ ` eD I hereby affirm that I am exempt from the Contractor's License Law for the $ Lavatories Auto-Wash A Garbage Disposal !Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair ' P-Trap Laundry Trays - Generator ❑0.5 KW ❑5-15 KW Trash Com ctor, any era gre, prior tom itsthat he/, also requiresicensthe tcto applicant for such perof - Pa to • file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of - - , Division 3 of the Business and Professions Code) or that he/she is exempt • . . therefrom and the basis for the alleged exemption. Any violation of Section 4 7031.5 by.any -applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars - ,• ' t .1, as owner of the property or my employeesloyees with wages as their sole - Reinspeetian•Fee $15 Issue Fee $ 3 sale a will do the work,and the structure is not :intendedThe C or offered ' - - 'Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's' - MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or honown i , DEVELOPMENT SER. CE[ EQU(R fuj�fjlTS: - • e le, If, es, provided that such improvements are not tended or offered for Boiler Hood or Type I 0 Zoning Approved By � Date sale. If, however, the building or improvement Is sold within one year o/com- Canopy Type II 0 pietion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By `•+• Date�1-� prove for the purpose of sale). ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ,- DO-100,000 BTU 0100,000 BTU SU RY OF FEES ' _ builds or improves thereon, and who contracts for such projects with a-con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 3 on SMTP $ 2.� `-' proof O their Workers Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bl t. ICBO# • Fire Dampers PLUMBING • $ /5 .0 If ISSUANCE $ • Date - Owner Heating System& Ducting Registers PLAN CHECK 25% $' ENERGY P.C.; $ • I hereby •rtify-that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BT - ELECTRICAL', $- GRADING ' $ informa '•n correct. I agree to •empty with . city and county ordinances and sta - law relating t• ng constru d hereby authorize repro- PLAN CHECK' 50% $ /o.co MICROFILM $ iv • sentati -s of•th' city t• pon to mentioned property for inspetti•s euros. `` MECHANICAL. $ I ��A TOTAL FEE $ 3D7. 4D 5irnatur.i_ a.-___ Date Reinspection Fee $15 Issue Fee $ Drivers' License or 55; • $ 3• �N CHECK 25% _ CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod -Assessor —_ - - -— 1 _ . , .. CONSTRUCTION AND PLANNING J '-" POOL 8 - - I, APPROVALS Permit• ..ate Inspector APPROVALS Permit'# Date Inspector � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �l/P� 4S/) 53. Steel Reinforcement 3. Electrical Conduit-Utility-Undrgrnd. - 54. Forms • / 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement. - 56. Rough Plumbing & Pressure Test .. . Electrical UFER Grnd - ? 57. APPROVAL TO COVER-GUNITE !7. Footings 58. Electrical Conduit-Undrgrnd. -';.k..Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test _ - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 1 62. Backwash & Receptor-Final r 12. Sewer Cap - 63. Heater & Vent-Final ._ 13. Roof Drains 64. Plumbing System - Final _ 14. Rough Plumbing N. 65. Electrical-Final 15. Rough Electrical-Conduit • 66. Solar System-Final . 16. Rough Electric Wiring ?Mr eb 67. Fencing-& Access Approval 17.- Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.- Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - . 72;Underground Flush • /24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil - • 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing nl/-1J -• 3 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing 9/rznic SD-S HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final • 80., FOOD CERTIFICATE ISSUED 33. Final.Electric / Notes: ,q/,3IJJS� l.t/'ASII? 21Uitn1 o Liao GTaJ� �� 34. Final Heating& Air Conditioning + r:35-- •9/ /8Y lin) 77>"1f an oaf a conn VI Ir 35. Final Gas Pipe-Test ¢,(�V1, ;77d - /// y)� 36. Hood or Canopy _/ /-4-/ G:t� f•W 7S tri 37. Final Factory Fireplace 38. Final Plumbing 9/2j/ •' it FL � r ear QO /` ! � b PA-m 114_t1nPna32. 39. Water-Service-Final 'd> PArk v,- D 5 9I3-, 40. Gas Service-Final 41. Solar Domestic-Final , 42. Backflow Preventer . , 43. Backflow Irrigation. , f•) • 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations / . 47. FINAL STRUCTURE & BUILDING 774, pi- p� 48. Special Requirements Completed (%�` Q r 49. Electric Release to Edison- , -50. Gas Release to Southern California Gas Co "- 51. CERTIFICATE OF OCCUPANCY C • No Date • ,` S ' SEP 15-72PpLBOO 527* ***276.50 -3s22O - .�- cfsa COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • A /TION FOR BUILDING PERMIT For Applicant to Fill in Completely REC I V D V DATE RECEIVED DATE ISSUED BUILDING / A ADDRESS /well /! rc EIT NO A.P. NO. /....4 /�% �` LIS z + -OOWNER ✓ a70*k- 2.STJ?O�/ MAIL BUILDING Z ADDRESS • .� ADDRESS r D "on- -" .. Cl U CITY C. X( NOL �4/4YIR^`" / LOT 5y BLOCK ZQ CONSTRUCTION NEW I ADD ALTERI REPAIR I MOVING DEMOLISH O N LENDER X am J D BRANCH /��yy�� pp /\- J DI OWNER erifil OO Salt /Zeal 1 m J ADDRESS ,s tj VALUE �,,�s J Q OARCHITECT R ENGINEER NO. USE St $�"S�� Utn FIRE �� WCC ADDRESS ZONE J/ 1TY/QE ��GROUP '2- cl.Ly APPROVED „/// / _ W 2 CONTRACTOR t,{� MC.AtAuI 1a BY W/l�J DATE ` -72 JO ,J 300(a EN7 r I se-7/CC ADDRESS W w ZONE NO.OF USE OF NEW Z= TEL // PLANS BUILDING Z FIT _ CY DTA -6� NOW/2(iVs l WO STATE CITY YARDS APPROVED YARDS APPROVED co 2 LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING _0 SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG1 (NO.OF R.SIf1F FT. FT. SIZE OF 477y / 'Z NEW BLDG. ROOMS STORIES L.SIDE FT. _ FT. VEXTERIOR WALL ROOF (- COVERING COVERING REAR FT. FT. -I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CLf / MAIN BLDGS. ACCESS. BLOCS. O ISE-10T Vi o co SAV/d!CrS / CURP.# APPROVED F APPROVED (n 2G14 N Stile RY DATE • OI hereby acknowledge that I have read this application and state O that the above information is correct and agree to comply with �V CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of ch the State of California.I hereby certify that I am properly licensed as a contractor under /7/ISO.FT. othe State of California Business and Professions Code, Divlsicn 3, MOUNT SHOWN UNDER VALUATI N IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R am exempt from the provisions of the State of Californla•Business VALUATION z 7 •� and Professions Code, Division 3,Chapter 9 ) m PERMIT FEE $ D Signature of � I (�n/l/�• I' I / to Permittee 1`a✓"'ly[ a WI.J ,0,7640/00 '-' PLAN CHECK $ E Authorized Agent l / 276- `J'O LL TOTAL FEE $ F \ • 35363 SEP -6--/Fuj OO Tei* ****5r•52 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP'LI'ATION FOR BUILDING PERMIT For Applicant to Fill in Completely BUILDING �f A�1 Rr - VE�V i TE RECEIVED ��E ISSUED ADDRESS / 40 4Ds. 0�7 G 7 OWNER sJSI[�VTWgobtp,t)mos A.P. NO. ' J�>3��III-46-.:214r jiy 3 AMAIL DDRESS /565- 4 444& BUILDING j6 A ADDRESS ��(� np,4 W W J A�t 'A TEL fFt-IRucsVLJ It�l Ort Si 0- U CITY CO!%(T /,l A NO. TRACT LOTQ j.I. BLOCK ZZ C CONSTRUCTION N W D ALTER REPAIR MOVING DFMOUSH OI- LENDER • 0- m J D BRANCH WOO",—I N OWNS ReSeCiU/ WOO/, S'7'7 CO—IADDRESS (�s,y /�/ � /(�/t/ VA UE I�{f'�� -CO ARCHITECT (� r� A TEL. i USE(V(/fiI//�7/J int u'/L�A� S • / V" J Q OR ENGINEER /�M•�,FiciI s. Alp., N`0 L. UQ E 1Vs✓WY�I �s L FIRE /J W tr ADDRESS �s ZONE TYPE GROUP �IC•� 2 W �J�,/tuu �A^��A APPROV'C r J Z CONTRACTOR /A 1 / (Nc / � . BY- . .t<_ �DAT� '- mZ J K ADDR ESSIO€ caFreRFIRIed W W ZONE NO.OF USE OF NEW PtUNu>C�ybN^ ZTEL. z/�'At C I PLANS Z BUILDING rbc a K 'zJtNG CITYCOSTA � NO.��,CITY ('�`J,r�� l V IL LIC.NO. 204 213 LIC.NO. ARDS APPROVED YARDS APPROVED p4 I VMAIN BUILDING ACCESSORY BUILDING DO SIZE / / NO.OF BLDGS. (FROM C/L SREET) OF LOT /� k /90 _ I NOW ON LOT f./ FRONT -t S FT. FT. USE OF ^� EXISTING BLDG. R.SLOE YI FT. FT, F" SIZE OF / - t NO.OF - I (/' Z NEW BLDG. %�� _ ROOMS ACID STORIES ( L.SIDE `h'" FT: - FT.'- ROOF ✓0 EXTERIOR WAI,{,�pi 1^, I COVERING ACID REAR J / FT. FT. COVERING tt.„... ..t I{'{/{/ J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& 0- 0- MAIN BLDGS. ACCESS.BLDGS. DATE O &Ath,'ki& Wb to, 1fAAM4c1)CA/5_ C U.P.# 0 7a r7 APPROVED co me/A' / APPROVED ' I\Y5 i ND4r 7 - Qv, �/ �Y L,ALJ DATE //�/7Z Z / 0 O I hereby acknowledge that I have read this application and state g(p.'t�a' that the above information it correct and agree to comply with CCall laws regulating building construction, and I shall not employ D' i— any person in violation of the workman's compensation laws of fA the State of California. ��// m Z I hereby certify that I am properly licensed as a contractor under SO. FT. TM o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: P IC am exempt from the provisions of the State of California Business VALUATION :in and Professions Code, Division 3,Chapter 9. ///]( �/� /� /) 7 aJy PERMIT FEE $ 9 Signature of�lA• 1V1�%� act a /��0Cr✓' /!Sermittre 6) $ PLAN CHECK $ /�7 Authorized ent TOTAL FEE $t AUG 21-72Pp18001503* ***227.25 35220 — tKSk COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APFor Applicant to Fill in Completely LI PA 10D FOR BUILDING PERMIT /LDING , r�At��I./�J {{,,�� REC V. • DATE RECEIVED, D• E ISSUED ADBUIDRESS i�GJ l `� �1*AS tel-1 • / �.�II.. �I • -MIT N O. OWNER G' I)• �l_" • , i _A.P. NO. I� 1 -.3 v. 9- IP MAIL �J [, s• BUILDING j �0s I t ADDRELU LLiSS 43 ��3 1`J ��r �/�e ' p(/zJV� �j` ADDRESS I�(� ,n dU CITY Gl/' \ . ( NO.TELgftQ( (,. .04C1?-ti ,-LD ' � BLOCK Z NEW ADD ALTER REPAIR MOVINGT DFMOI ISH Z a CONSTRUCTION 0- • cn LENDER a. Ccn_i D BRANCH ��^� Ail OWNE !/V �'V /'P a W ADDRESS•COQ r // 'y/ � ayµ/y�� j �I / CU < OR ENGINEER/ARCHITECT WM •1 1' (G`^I� NOILTI I "Z/) USE {�J{SJ(/K VALU• E �f�z�i• FIRE w cc ADDRESS UIai°�t(6 . .CL I.9 •, y �,� DJLI qt_ZONE TYPE 'f�'J GROUP f' 2 J Z CONTRACTOR $ ' Lt�C APPROVED DATE . mZ .--- LCC ADDRESS CSQ6 . cm•/r pope - L. LU Lu ZONE.„."ZONE ii NO.OF USE OF NEW tiA+v� Z= CITY NO. 1 PLANS z BUILDING /311 G _ H LLU STATE CITY YARDS APPROVED YARDS APPROVED V)CC LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING U U SIZE INO.OF BLDG$.--�. -��(FROM C/4S7REETI OF LOT I NOW ON LOT L/ FRONT /(JJ FT. FT. USE OF -- - -.- -EXISTING BLDG. '--"--. /�77_t y__L _ -_ _ _-_- R.SIDE 2-Ci FT. FT. Z SIZE OF 4'170 t' LOOMS STORIES L.SIDE /6 FT. FT. Z NEW BLDG.4:7 (1 "c[1�P U • EXTERIOR WALL ROOF COVERING COVERING REAR J7 FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& 0- 13i ` .7 MAIN BLDGS. ACCESS. BLDGS. QI c VAR.# DATE wl �pios CS C.U.P.# S'7oZ APPROVED 0 [ /1 H ( 1,..._ f ` APPROVED / e) • �E fA �r \I I � ��4--�.� DATE 0 • D F eSCiao . O u�1 G.. v • sr— V I hereby acknowledge that I have read this application and state HOL D that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ 1- any person in violation of the workman's compensation laws of N the State of California. T ,z7,0. • I hereby certify that I am properly licensed as a contractor under FT. O the Stat •f California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapt• 9, . d that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am enmpt f • the provisions f the State of California Business and Pr. essi on-Code, Division ,"Ch ter 9. VALUATION # 00 PERMIT FEE $ Signature o -^ •� e' Permittee Ii (•r • ni $ l not PLAN CHECK $ /3 • Authorized A sent / • l TOTAL FEE • Pfl03Ee Ess: 1640 ADAMS AV UNIT: OWNER'S NAME: C J SEGERSTROM & SONS CITY OF COSTA MESA — BUILDING PERMIT • PERM NO: B 053484 ADDRESS: 3315 FAIRVIEW RD PERMIT NO: B 053484 PLAN CHECK NO: N GOVT; N SUPP; N COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT • ARCH/ENGINEER: ADDRESS: UNIT: SQflEG.NO.: JOB DESCRIPTION : T/OFF RESHT REROOF W/ BUILT UP FT: 3, 500 CLAIM VALUE: 3, 500,00 CALC—VALUE: 3, 500 , 00 GROUP OCC_; B-2 / . PERMITTEE: WOODCRAFT WEST ( 818 ) 368-6519 ADDRESS: 17342 ZOLA ST COMMENTS: T/OFF RESHT REROOF W/ BUILT UP GRENADA HILLS .A 91344 **TLaE* >E *****r.**tE* ******>E*->E*x-%****x3E>EtE****,L*3E*3cx**+E>E+F******>E*3E**>E;y-****x•*arEtt*•yF:t • LICENSED CONTRACTOR DECLARATION: I hereby affirm tha .m lice ea nder provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code. . d my ' , is in lull fore effect. SETBACKS CITY LIC.:, n..q18 STATE LIC.: 448'7 S i CLASS: B / Dale: ' ,;R i Signa re• MAIN BUILDING • ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hers y ailirm th. I have a certified of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3600, Lab.C). - LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: '1250864-91 EXP. 0• • 0 / 1 /92 � COMPANY: STATE PARKING REQ: PROV:' PARCEL: 13931316 ZNE: .REF NO; I I Certified copy is hereby furnished 0 Certified .ry is file, •i the city Division.' PLANNING N TE S> � :> . ,gate: '—Z(—e,( APPli :nt: *******3E3v:****4)1.*1f************IE****/(*3F****lE****393E,a(#iE**yF****#?e.}Ei6* *If**. *3e1E3f 3y**IF* •:••'•11X1PTION FROM WORKERS'COMPENSATION DECLARATION: (T is section need no ompleted if the permit is for one hundred($100)or less), • D E V E..L O P M E N T SERVICES REQUIREMENTS r"fertify that in the performance of the work far which this permit is issued,I shall not employ any person in any manner so as 10 become • subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • DATE: Crate: - Signature: - - 'NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE; Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED �_ �— ' • DATE• ` (v LI °1 I which this permit is issued(Section 3097.Civ.CI. ******************' •�- •s•.-_y��x •ev.k{Eu.*9E*±4*}* cle.***.k9*47 de.** LENDER: 3939*****IE**3946**lE*iE if �1�2'Y-�'+`', ****'.**IE*****3%IE9'?***3f3f*kai.*4****#M***7'949}k**f6*3F ADDRESS: LEGALIZATION:N F E E S U ,M M A R Y STRUCTURAL SE@ ENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECT. IC MECHANIC FIRE SNIP/RES?: GRADING ' (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT . : _ 63. 00 - S(r - ' repair'any structure`prior knits issuance.also requires the applicantior such permit to file a'signed statement that he/she is licensed . - - - — -- - - - - — - pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business • SMI P AON LRES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . •' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 5•., .,6"1-V - any as-owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ' ISSUE PLAN—CHECK TOTAL PAID y-' • DUE ❑ structure is ndt intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law' TOTALS----> 63 . 50 0 . 0 0 . 00 63 . 50 6:34 s.0; . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through - • his or her own employees,provided that such improvements are not intended or offered for sale, If,however the building or - X improvement is sold within one year obcompletion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> • COLLECTED : 63. 50 OVER/SHO.R.a i' .00 for the purpose of sate). BLDG PMT PLUMBING ELECT' IC MECHANIC FIRE SMIP/TUT GRADING'-PLAN—CHECK • I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 .00 , 50 . Y.; and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon - . *. and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware * **.*N..IE**K***N}}***49***19*39**4F***4t394E*** )F ************** *>:*********?iii.***.k'!f`**}:*•N**ick that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN •' r ' o I am exempt under Section: B.8 P.C. fforthisreason: ' TYPE QTY D E S C R I P T I O N UNIT COST 'TOTAL COST • Date: OwnerSFR 3500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 . 3, 500 . 00 ' I do hereby certify that 1 am aware of and understand the requirements of Califomia Health and Safety Code Sections 25505,25533,and _ 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements lar a .;END OF FEES male for construction or modification from the Air Quality Management District.Residential construction applications are exempt from I< these provisions. EXPIRED Date: Applicant: Incomplete Inspections ,.f • . I hereby certify that I have read this application and state Eh a abov i rmati is correct.I agree to comply with all city and county y ordinances and state laws relating to building construction and here) a rite repre es of this city to enter upon the above-mentioned � /� property fpr inspection purposes. Date •,_s - Sig _—_,-----1 ./ Date: 'F—Z(--4/ Sign tun ' /1.. ', 01 fie.T97:2$- :�'�si . Driver's License or Social Security x: +1' :4 ' 1641-46 White—Building,Green—Code Enforcement Canary—ApplicanC Pink—Revenue:Goldenrod—Assessor ft ;�4 I S . CONSTRUCTION AND PLANNING, . POOL & S' APPROVALS Permit# Date Inspector APPROVALS Permit . Date Inspector 1. Temporary.Electrical Service or Pole - -52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54..Forms- _Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough-Plumbing & Pressure Test 6. Electrical UF ER Grnd, - - 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. . 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. " - 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10. Structural Floor System • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • .. 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning - - - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil v os 25. Roof Sheathing 57-23-HI 4tur/j� 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe " 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat • 79. FINAL INSPECTION • 32. Electrical Power Meter-Final - . 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning I 0-, 35. Final Gas Pipe-Test I 36. Hood or Canopy • 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation t: r. - 44. Landscape Irrigation System t.: 45. Sound Attenuation EXPIRED 46. Handicap Regulations I plete Inspections 47. FINAL STRUCTURE & BUILDING Date L sig 71 48. FINAL PLANNING • 49. Electric Release to Edison 1 4 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date NY • 'PROJECT ADDRESS' 1640 ADAMS AV ""R` CITY OF COSTA MESA — BUI• LDING PERMIT PERM NO BP 045653 0Wl R'aNAME:•C J. SEGERSTROM • • ' •ADDRESS: 3315 FAIRVIEW 'RD' , C.M. PERMIT NO:. BP 045653 PLAN CHECK NO: 02132-89, L GOVT: N SUPP : N • CONSTRUCTION TYPE: V—N x PERMIT TYPE: PIU STR PURPOSE: ALT. ARCNWENGINEER: `LILLY ART ARCH REG'"o''C00 JOB DESCRIPTION : 5000 SF OFFICESPACE T. I . SQ FT: 5, 000 ADDRESS: 2052 BUSINESS CTR ' PERMmIE: IRVINE s" CA 92715 CLAIM VALUE: 45, 000 . 00 CALC—VALUE: 49,600 . 00 GROUP OCC: B-2 / • WOODCRAFT WEST ( 818 ) 368-6519 ADDRESS:i 17432 ZOLA ST' COMMENTS : DEMO BATHROOMS / INTEROIR TI / GRANADA HILLS CA 91344 ******rE*4******eraE+r******x•** ren******SE***********sr***+a*er***************;'E***sr*sr ** LICENSED CONTRACTOR 0ECLARATI0N: I hereby affirm Itit I •.T.• 'oder pr• '.ons of Chapter 9(commenting with Section Z ONING R E Q U I R' E M E N T S 7000)of Division 3 of the Business and Professions Code, . - s in full eff.•. SETBACK• S 6"m: 049518 STATE uc.:4 4 8 0 ' H / • Date: j_4—QLD signature- . _ 4_ --- MAIN BUILDING ACCESSORY BUILDING WORMERS'C0MPENSATI0NDECLARATION: I hereby affirm that have a certificate o%sell-insure or a certificate of Workers' FRNT: FT •IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). ' LEFT: FT IN , RGHT: FT IN LEFT: FT IN RGHT; FT IN POLICY No.: B P 19 214 B EAP,DATE: E 7/E 1 /9 0 COMPANY: CALIF INDPARKING REQ: • PROV: PARCEL: 13931316 ZNE: C1 .REF NO: . 'RI Certified copyisherebyfumished. ❑ Certified co. • rued •rth;:city B'•d1,`c�• . PLANNING NOTES> INT ALT TO AN EX COMM BLDG (FORMERLY A BEAUTY COLLEGE) TO A / > REAL ESTATEcOFFICE. • REPL EX LNSCP REMOVED AS PART- OF CONST. ----• Ie: /-4-4A Applicant: *****************,**********************************************************•ie*** aaPTION E9oM W0RNEp5'CDMPENSAn0N DECufmlON: (his--" need cot be B me penin s Iarme hulled istOo)pr less). D E V E L. =0 PM E N -T SERVICES '. .R .E Q U I R E M E N T S I certify that in the performance of the work for which this permits issued.I stag no' ploy any person in any manner so as to become Q .N subject to the workers'Compensation Laws of Catania: ZONING• APPROVED BY :�1 Gp" [ DATE: Qf �0 '17 m Date: • Signature: . • - . NOTICE:If,atter mating this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED ,B Y : - DATE: Code,you must forthwith comply with such provisions or die permit shall be deemed revoked. !. /:4 r CONSTRUCTION LENDING AGENCY: I hereby affirm Ilat.there is a a stmctlon lending agency for Ihe.pertormance of the work for APPLICATION ISSUED •BY—a " DATE: D f which this permit s issued(Section 3097,Civ.C). ,1 ********************** iF iF7F*"IF iFle iF� FiF**********iF`iElF"* LENDER: ********************************** ** ******af********************it********** . ADDRESS: . • LEGALIZATION:N F E E S M' M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: Ihereby afthat am from the Contractors State License Law for the following reason affirm BLDG PMT PLUMBING ELECTRI MECHANIC FIRE SMIP/RES GRADING • (Section 7031.5 Business ant Professional Code: Any thy of county with requires a permit to construct,atter,improve,demolish,or PERMIT 414 . 50 2 . 00 ' • repair any structure,prior to its ssuacoe,also requires the applicant for such permit to fee a signed statement that he/she is licensed 25% SM.I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section MO)of Division 3 of the Business • 1 ' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN 269 . 43 7. 44 • any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). . ISSUE FEE 3 . 00 ' ' I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL • PAID DUE • ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors State License Law TOTALS————> 423 . 94 3 . 00 2.69 . 43 696. 37 696 . 37 .00 does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or through '• • his or her own employees,provided that such improvements are not Intended or offered for sale.If,however the building or _ for the ppuurppossCold�e)Nn me year of competipn,the owner well have the burden of Droving he/she did not build or improve REVENUE BLDG�aPMTON PLUMBING ELECTRICOMECHANIC FIRE6 SMIP0/T0T/S GRADING PLAN—CHECK •I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 414 . 5 0 5 . 0 0 7 • 4 4 . and Professions Code: The Contractors'State License Law does not apply to an owner of property wtio Milds or Improves thereon ' and who contracts for such projectswish acontractor(s)license pursuant to the Contractors'State License Law).l am aware **********************************{4*******M************************************ 1 that proof of their Worker's Compensation Insurance shed be provided to me. INDIVIDUAL F "E .E B R E A K D O W N h ❑ I am exempt under Section: B.8 P.C. • for this reason: • TYPE QTY D E S C R I - P T I O N 'Cr UNIT COST TOTAL COST Date: Owner: - r • .I do hereby ceNry that fam aware of and understand the requirements of California Health and Safety Cade Sections 25505,25533,and SFC 5000 OFF—INT, ALTER A.-N ,, —AVER 9 . 92 49, 600 .00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a PLU 1 DEMOLITION / SEWWERER CCAP r..— —AVER EACH 2 . 00 2 . 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END OF,TEES f ' these provisions. " •J • Date: Applicant: • ' I hereby certify that I have read this application and state the 'ahoy-in Ian is • - t.I agree to comply with all city and county ! ( _ ' ' ordinances and state laws relating to building asnstmNon.•• . :• t, to enter upon the above-mentioned . . property for inspection purposes. • 01 001051403-000.51405 TO T Date: L—q_sib sign.ure: ' DATE: 01/09/90 TIME: 10:24 426.94 Driver's License or Social Security e: ' ' i . • ACCOUNT ?: 81174022002 • 1641-46 White--Buidingj Green—Code Enforcement;Canary—Applicant; nk—Revenue;Goldenrod—Assessor - ' ' .. 01 OO26 003 00051403-00051405 — 1641-46 01/09/90 01 CR TEND 426.94 __ r ! - . Fil _, r _. til CONSTRUCTION AND PLANNING ' POOL & t. . APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector '1: Temporary Electrical Service or Pole:r t "52. Pool & Equipment Location - .1_ .;,Soil Pipe.Undrgnd.. '_ 53. Steel Reinforcement ' "D'3:'-Electricar-GoFiduitlUfility-Undrgrnd- 54. Forms . . .�. -,.,un, ,c .._. .,- .Yr.. ...' .7V 4.rElectrical Corttluit-U+adrgrnd. ., 55. Electrical Bonding - _'StsSteel Reinforcement 56: Rough Plumbing & Pressure Test - *•m~:r, - t:6.EEIectrical:OFER.Gcnd. m 57. APPROVAL TO COVER-GUNITE _ 9,',,Footings:v is:- Vic,_ z-2 f0 ��:(i/.�58. Electrical Conduit•Undrgrnd. &.9Foundation, / / , ." '7_ 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe�Undrgrnd.' .d' 1' 60. Backwash Lines, P-Trap, 0 Undrgrnd. + i 10.r Structural Floor System >�/ ' 61. APPROVAL TO DECK r" � . -. 11.-Property Sevker Line&/F,1 ouse.Corenection. !j 62. Backwash & Receptor-Final -- 1 12. Sewer Cap _ a \v` 'y7 a.t " '• r _ / ' 63. Heater & Vent-Final �- 13. Roof Drains::.,, a ,''• '' / • 64. Plumbing System - Final- , 14. Rough Plumbing - 65. Electrical-Final - 15. Rough EVectrical-Conduit 66. Solar System-Final •16. Rough Electric:Wiring 67. Fencing & Access Approval , 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrics!-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning �� L- a a't. .• FIRE DEPT. REQUIREMENT Cv•-•wr• ... _ =:m a-. z: G c4, 4: '-1^>�C r-+. .• 20�RoSgh F`actor'y Fireplace g -,.q " . 4, -APPROV/A4S ,..,t_Permit# - 21:-Ducts, iri•StrticturSgr. ' •' •• ,-,S ` S `_ �•r" k J70. Ubdergio nd;Hydro �; 22-Duts, Ventilatinglr r x r.' ,v :.,.r 4 <71- Product:Piping O_Gas O,Oi1 237:Gas-Pipe-Rough & Test ^� ?I ' n: =r C `1 h ''72. Underground Flusth3' '- 24=RoofFramin • t ' « •'^ ap 0 r fx ^ Cr; -.r • 9 ;_t. • ,n, > ;; ,-.* rc :73-Undergrna.Storagtiank-O Gas OOil i 25. Rooff Sheathing s Q ui • _ i :_J'. r 7q Overhead Hydro. I 26;4‘T-Bar Ceiling`�tructur &=Mpnocoat 2.'•iC'{vi Jr / . , 75,11;12'1wY Chemical r..•- 4' !- C �=r- 274rameand Ftashing< �.;.- --'Z:z*p -1/ : ` ' 76. Dry Standpipe eft' r 28. Lai-Sing% Stdin ^.t t' ' • •'k • ' TA c _5.., 99�•K �� •-�f.., OF.,;;� t yt R 77F-; FIXED �_ • _ , 29. Insulation .t S ;a: ;.,•ro 78=FIRE PR EV. FIN4I y. .. tr ,,„S_ r30. Drywall-Nailing " f- K' •�.4p- a 4 �oi1 -;HEALTFFD EPT`: REQUIREMENT . .D31. Plaster Brow Cdett. S i !r Mt-* 4..! I e 4 -79.JFINAL INSPECTION t _ r' `.32�Electrical Power Mier-Final, x'`` i.;: 14. - • .t '80`IIC FOOD CERTIFATE ISSUED_ `'_ r33_Final Electric. Ci: t't CG •,, l r '1:4 r NTes: - > Q r �- Ir -� ni34=Final Heating& Aie CAnditionmg :1^t:* ill 'i t'` p c` t -• O � p' - �� - r t: J * , cc: tilt ? I L1 1,141f rj,9.5 07.7 'efe-c./11G� XC., (3 _. varec • :35^FinalGasPipe-Testy •? :;�`•4; ' ,� ' / ,I;, �: - /C ` At' "=36. Hood or Canopy ". D ' - `r�• •* ,I '•� n�n 7-: --.4. ^37.-.tinal Factory FireepIlace- i-•F+ Li--r--,1; - i w jf - ;38cFinal Plumbing/4.V.x240 i?4,/lf,Q�i�� %Y' . - _-7 -39. Water Service,Fina4 S C. t : 1 I _p x _ v. a` "40. Gas-Service-Final * Cl Cr r., S:-ci' ! + r ti - 72. a, a. • k r,t-• m ._.M I X. * F - - 41 a-Solar Domestjc•Fin4l' -.y `•� ,I sr,a; X r-. •- -Z - 42. Backflow Preventerit • a is* * i. r J ,3-• --: ~7C' Y -4 * f ^ r: e-- �• S t7` r * f ....- l - a' .• - 43. Backflow Irngatiorit > '- r_r, 1 f r 1- a -, _ . :l _'J S. :'* rf O C ,` f' ` - "i i, - r. r_ . 44. Landscape ITrigatio'n Systenj'lc" 4-45,:-_,Sound Atterivatio "'r r-�.';� 2' i-in -:x . - n ~ _ .F F l=. Ci . _ _ C46."HandicapRegulations -' Ot*it>x xt :t = - • ._.4 _ x' _47`FINAL STRUCTURE & BUILDING T;;51_40 6w,,'` ri < r-. • • - 48FINAL PLANNING ^`' - • :*. ' C. ' -1 rr r., n • r•r . . �/' X ` _ - 4 ' -1497Electric�Release to TEdison 1�l, " ' - 'j' ' 50SGas1Release to Southern California Gas Co + L., r - -51. CERTIFICATE OPOCCUPANCY - - a ' . r - ' No. Date i PROIECTADDRB ,1640 ADAMS AV ' UNIT: CITY OF COSTA MESA -- BUILDING PERMIT PERM NO: M. 045792- ' OWNEN'sNAARC .J. SEGERSTROM • POORE55: 3315 FAIRVIEW RD ,C.M. • PERMIT )O:,_M 045792 • PLAN CHECK NO: • ', N GOVT: ;N SUPP : N N . CONSTRUCTION TYPE: V N PERMIT TYPE: MEC ; • • • PURPOSE: - ALT , I ARCH/ENGINEER: ZILLY ART ARCH Reo.no.:0000 JOB DESCRIPTION 500.0. SF OFFICESPACE T. I . SQ .F1': , ADDRESS: 2052 BUSINESS CTR UNIT: IRVINE CA 92715 CLAIM VALUE: . CALC-VALUE': GROUP OCC: B-2 . ./ , • . PERMITTEE: FRANKLIN AIR COND . ( 714 ) 828-9147 • ADDRESS: 4891 CAMP STCOMMENTS : RE: BP45653 PRIMARY BLDG. .PERMIT. • • CYPRESS CA 90630 **************XM**tt***etlE**************it*fir***et*M*****Et*********3r**et**it**$**elft**• * LICENSED CONTRACTOR DECLARATION: I hereby affirm that 1 am licensed under• • 'lo...of Cha.er 9(commencing with Section • Z ON ING REQUIREMENTS .. . 7000)of Division 3 of the Business and Professions Code,and my license is in I rc d -Of - SETBACK• S CITY UC.: - STATELUC.:45 G06 Vies •- ' Date: i agfiD Signature' , / ---` MAIN BUILDING - --- ACCESSORY BUILDING'- ---- WORK S'COMPENSATIONDECLARATION: I hereby affirmt .ti .v;.eertifice of•. nt to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN • FRNT: .FT. IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3900. .b.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: ' • . FT . IN - POucrND.: WC8126797 IXP.OATE: 01 /Oa /91 • C0MPAxr:SAFECO INS . PARKING REQ: PROV: PARCEL : 13931316 ZNE: REF NO: 0 Certified opy is nerehy famished. ® Certified copy is tile. 'tit the city mg 0' PLANNING NOTES> , , > . Date: Z rd - APPlicant _ / 'alt**************************************************************•.It*************** • DIEM ON FROM WORSENS'COMPENSATION DECLARA ON: is :Donn 1 not be co ted i. • ''' is for one hundred(5100)or less). D E V E L O' P M E N T :5 E R-'V I C E S R E Q U I R E M E N T S I certify that in the performance of the work for which this permit is issue. I shall not employ an. .. .n In any manner so as to become • • subject to the Workers'Compensation Laws of California. ;ZONING APPROVED BY DATE:' • - • Date: Signature: - - . NOTICE:If,atter making this declaration,you should become subject to the Workers,Compensation provisions of the Labor ,BUILDING APPROVED BY :_ i , DATE: • . , Code,you must forthwith comply with such Provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for •;•AP PL I CAT ION ISSUED. BY: • '" �' DATE: [ /'�2'Z O. , which this permeisissued(Section 3097,Civ.C), - ********************** t F3FiF "0 I' W* ******,*********3E **iFiFF�£ • UNDER: ****************************************** '7 **************it*********.*******It*** ADDRESS: • • • LEGALIZATION:N F E E HS U M M A'R Y .-' - STRUCTURAL SEGMENTIN OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING •EL ECTR IC MECHANIC ' FIRE; SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any dry of county which requires a permit to construct,alter,improve,demolish,or PERMIT - - 78 . 00 , repair any structure,prior to its issuance,also requires the applicant for such permit to file's signed statement that he/she is licensed • • . 2 5$ - •S M I P/NON-R E S pursuant to the provisions of the Contractors State License Law(Chapter 9(commencing with Section 7000),of Division 3 of the Business P L'AN ' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by • - , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).' ' - ISSUE FEE 15 . 00 I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the -BUILDING-DIV-> PERMIT ,I'SSUE ,_ PLAN--CHECK TOTAL PAID : DUE❑ structure is not intended or offered for sale(Section 7044, Business and Professional Code: The Contractors'State License Law TOTALS----> ' 78 ,00 15 , 0 0 0 . 00 93. 00 93 . 00 ' . ' .00 , - does not apply to an owner of a property who builds or improves thereon,and who does such work nimselfPoerself or through - , ' his or her own employees.provided that Such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS-7> •COLLECTED' 93 . 00 OVER/SHORT• 00 ' 'Improvement 6 sold within one year of completion,the owner will have the burden of proving he/she did not build or improve .for the purpose of sale).: BLDG PMT PLUMBING' ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business •• T3 . 0 0 • ' ❑ and Professions Code: The Contractors'Slate License Law does Int apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors',State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. I N D I V I' D U A L ' F E E 'B R E A K D O W N - - o I am exempt under Section: - B.&P.C. • - 1 for this reason: TYPE QTY .. D E S C R I' P T I O .N - ' UNIT. COST TOTAL COST • Date: Owner. MEC 3 INST AIR HANDL UNIT 0-10000 CFM • 6. 50 . 19 . 50 Ido hereby certify that I am aware of and understand the requirements of California Heahh and Safety Cotte Sections 25505,25533,and MEC , ' •1 INST/REL BOIL/COM PR 0 . 0 - 3 . 0 HP . 9 . 00 9 . 00 25534 and that I or any future building occupant will/will not-(circle one)need to comply with said state codes and the requirements for a MEC ' 3 INST/REL BOIL/COMPR 3 . 1 - 15 . 0 HP 16 . 5 0 • 49 . 50 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from , these provisions. • - ' END OF FEES ' • 1 s • i _ • . •1 • Date: Applicant: • I • ' I hereby certify that I have:read this application and state that the above informatio is .rrect .gree •.cooly tit all city and county '. ordinances and SLte laws refiling to building construction and nerehy .*,repre at - this.. the above-mentioned , property for In '.n pia • . '''," Dater _ 'Z r'. Signa] , Driver'- License or 'al Security n: - • ' 01 00052303-00052303 TOT • 93.00 Fi 1641-46 White—Building:Green—Code Enforcement:Canty—Aoplicent Pink—Revenu. eoldenrod—Assessor -, DATE: 01/22/90 TIME: 11:13 y - 1 r • CONSTRUCTION AND PLANNING - POOL & SPA • • . APPROVALS. Permit# - Date Inspector • APPROVALS Permit# Date Inspector -1/Temporary Electrical Service or Pole:.-3 - 52. Pool & Equipment Location „ ,2._Soil Pipe-Undrgrnd. . ' - 53. Steel Reinforcement ^•3.-Electrical Conduit"-Utility-Undrgrnd. 54. Forms '" 4.-Electrical`Conduit Undrgrnd. - 55. Electrical Bonding -.5-Steel Reinforcement - - - 56. Rough Plumbing & Pressure Test , -6.=Electrical'OF ER Grnd. 'I' 57. APPROVAL TO COVER-GUNITE 1_' ; • ," 7�Footings.� - / ' / 58. Electrical Conduit-Undrgrnd. , , M B Foundation, •! . 59..Gas Pipe, 0 Undrgrnd.,'Test 9. ater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. • i 10.,Structural Floor System .3 , ' 61. APPROVAL TO DECK • . 11.-Property Sewer Line&Nouse Connection r 62. Backwash & Receptor-Final , • 12. Sewer Cap -• - " !' c- r / 63. Heater & Vent-Final f 13. Roof Drains- %� . 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -1 16. Rough Electric-Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19..-• Rough Heating & Air Conditioning __ •Jf.S/' c o - 60 • _ FIRE DEPT. REQUIREMENT - - •20-Rough Factory Fireplace 7.7.r' .,c: - y t -APPROVALS L .Peimit# • - - 21:--Duets, in Structure` " " '• - "= -, ^ i.' ' ' X70. Underground H dro 22.-Ducts, Ventilating; r ,- -' - - i .--4 4. :�71. Prod uct@iping C7 Gas ❑:Oil 23.5Gas-Pipe-Rough & Test - r. �, ."' 7:72. Underground Flush 24: Roof Framing , - _. r 73:Undergrnd.Storage-Tank.0 Gas ❑OilJ - 25. Roof Sheathing .. • c, _J _ 7., 74:-Overhead Hydro-'., ^ 26_-.T-Bar Ceiling (Str',uctural) &Monocoat < ~ - 7-•; t 75-Dry Chemical sp a; " - _ 27c Frame and Flashing: _ - t i 76. Dry Standpipe `-•.: .-. - 728. Laihing & Siding. . `_c: 4 •, 77:. FIXED SYSTEM;F,INA� - .;, -•r= 29. Insulaton 5 If ; !r: 78%FIRE PREV. FINAL " - , -, 30. Drywall-Nailing_ �,y ,,., ;_ -_ I `'Y?r '. - INALTH DEPT`. REQUIREMENT C'31. Plaster Brown Coat: _c- C•" I i 'i;;: t' ,79. FINAL INSPECTION l 32;Electrical Power.Meter'-Final ' t `* • -Bo,, y_ # .....,.FOOD CERTIFICATE ISSUED_ _ :33�Final Electric .1-+: �<; -• t. Notes: - - " :434: 'Final Heating& Ai? Conditionings .I ?"27/4:6j •r 7 -- ' ? f' . Li v 35, Final Gas Pipe-Test; •• ': ,_. // .i t ? _ c 136, Hood or Canopt +[ 1 ' c.r', _ -'•4`4-." :� cc . n r.` tr -37.:Final Factory Fire1-7 place>: =i, c �� : ... c :38. Final Plumbing. ' -� I. /, ' _ • "39. Water Service-Final: - * . i :j, , '• - - - •' - 40. Gas Service-Final • ' •r...""" • r", c"_ cr:• - 41. Solar Domestic-Final'= •;j �, .=, It ..- ... r :7' i- 42. Backflow Preventer r' # r C. * •` - 5_ C- i. 43. Backflow Irrigation „ r : + 44. Landscape IPrigation System'V • V - " _ _ x _ - • �45 Sound ,Attenuation G - i T 7246:-.:Handicap. Regulations x x t' _ x 47-1F INAL STRUCTURE & BUILDING1. :. I "' J; i Ci { F. �) 48..FINALPLANNING i .,, .�- ' t" �" a `- 4' It x t 7 ",i S is 49.,Electric Release to.Edison r moi"' "• _, I150.,GarRelease to Southern California Gas Co +, X mcr t-. 51. CERTIFICATE OF OCCUPANCY �� l�4o. Date S �, PROJECT ADDRESS: 1640 ADAMS AV • UNIT: • CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 045885 • OWNER'SMM6(C. J , SEGERSTROM _ • • ADDRESS: 3315 FAIRVIEW RD , C.M . PERMIT NO: E 045885 PLAN CHECK NO: N GOVT: N SUPP: N - CONSTRUCTION TYPE: V N PERMLT TYPE: ELE PURPOSE: ALT • ARCII/ENWNEER: ZILLY• ART ARCH REGMD. C000 JOB DESCRIPTION : 5000 SF OFFICESPACE T. I . SQ FT: • ADDRESS: 2052 BUSINESS CTR UNIT: • IRVINE CA 92715 CLAIM VALUE: CALC-VALUE: GROUP UCC, B-2. / PERMTrTEE: JAMES E . BURNS ( 818 ) 982-6084 .. ADDRESS: 19015 STILLMORE ST • COMMENTS : RE: PRIMARY BLDG. PERMIT BP45653 CANYON COUNTRY CA 91351 ***+e*+E********aE*aEx-aE****3E**+e+E+r*+sarar+EaE*+ESE***4*ar+e>ESE**it***+EitaE+ExaEar�E*aE*3t[rar*itir+r**ae)E*Neer ' LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am hcensed under provisions of Chapter 9(commenting with Section Z ONING REQUIREMENTS, 7000)of Division 3 of the Business and Professions Code.and my license is in rue force and effect. SETH ACK S , CITYtic.:049795 STATE � C.:394928 CUSS: Date: • — ot9. .4.....r--- t. fie Signature: � ` /' ,64'4""-- MAIN BUILDING - ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirmTlrarr ve a certificate of consent to sell-insure or a certificate of Workers' FRN'f: F' IN REAR ; FT IN FRNT: FT IN REAR: - FT IN CompensationInsurance,oracertifiedcopythereof(Secton3800,Lab.C). , LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: • FT IN , • POLICY NO.: • EXP.DATE: COMPANY: PARKING REQ: ' PROV: ' PARCEL : ' 13931316 ZNE:: REF NO: ' ❑ Certified copy is hereby furnished.' ❑ Certified copy is filed with the city Building Division. PLANNINGNOTES> . • )ate: Applicant: 1 a rarararararsrar3r#arararlrararararsrarararararararararararararararaEarararaFararararararararar****araraParararaearararacararatar*arararafararararara(-# EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Tia section nem not be completed if the pemn is for one hundred(51W)or less).. DEVELOPMENT S E.•R V I C E S REQUIREMENT ' S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become •' subject to the Workers'Compensation Laws of California. fir ZON I NG' APPROVED BY ', _ DATE: Date Ail— go sou s re: ciC -P 451K- .•O— O • . • _ -• - - NOTICE:U,offer malting this declaration,you should abject• t to the workers Compensation provisions oftha tabor BUILDING APPROVED BY - 'a a / I DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. • / Del CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: 4 -4e-...— —' ll,�/%�(�__ DATE: �a� which this permit uiissued(Section 3097.CN.C). ��' - - )e******************ae**"- '* - A' WW**ararirsrar*** ** LENDER: • .• *tie***************************tie********r****N*** *tie******tie****tie******tie********* ADDRESS: , , LEGALIZATION:N F E E : SUMWARY • STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC 'MECHANIC ' FIRE SMIP/RES GRADING ' (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT' 105 - 65 • repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed ' pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0 2 v M Z P/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE F E.E 15 . 00 • I owner of the property or my employees with wagestheir sole compensation, will do the worts and the BUILDING-DIV-> •PERMIT ISSUE . PLAN-CIIECK TOTAL PAID DUE ❑ az structure Is not Intended or offered for sale(Sas Section 7044•Business and Professional Code: The Contractors'Slate License Law TOTALS----> 105 :65 15 . 00 0 . 00, 120 . 65 120 , 65 . • . 0.0 does not apply to an owner of a property who builds or Improves thereon,and who does such work himself/herself or through - r .his or her own employees,provided that such improvements are not Intended or offered for sale.If,however the building or REVENUE DIVISION TOTAL S--> COLLECTED • 120. 65 OVER/SHORT• 0 0 'Improvement Is sold within one year of completion,the owner will have the burden of proving he/she did not build or Improve • for the purpose of sale). . - BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ,SMIP/TOT GRADING PLAN—CHECK _I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business , • ' 120 . 65 , ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or Improves thereon ' and who contracts for such projects with acontactor(s)license pursuant to the Contractors'State License Law).l am aware . ******************************************************************************* that proof of their Worker's Compensation Insurance should be provided to me,• INDIVIDUAL . FEE B R E A K •D OWN o I am exempt under Section: ' ' B.A P.C. ' • for this reason: TYPE QTY D E S C R I P T I' O N UNIT COST TOTAL COST • • Date: Owner: ELE 20 FIXTURES, LIGHTING 1 ST 20EA, . 75 15 . 00 Ido hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 45 FIXTURES, LIGHTING ADDITIONAL EA. . 45 20 . 25 25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a ELE 20 REC EPI•/OUTLET 1 ST 20 • EA. . 75 15 :00 permit for construction or modification from the Air Quality Management District'Residential construction applications are exempt from thea provisions. ELE 42 R EC EP T/OUTLET ADDITIONAL EA. . 45 10 - 90 ' ELE . 14 RECEPT/SWITCH 1 ST 20 EA, . 75 10 . 50 Date: Applicant: ELE 5 MOTOR/POWR APPARATUS 0 . 0 - 1 .0 HP • 3 .00 15 .00 I hereby certify that)have read this application and state that Me aboveinformatron iscorrect.I agree to comply with all city and county ELE 1 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 11 .00 ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned END OF FEES ' n property for inspection purposes. ,O • T Dater /--19- o Signatum: is.— ( . !tea?..•. • Driver's License or Social Security e: 01 00052920-00052920 T CE T 120.55 1641-4e White—Building:Green—Code Enforcement:canoe,—Aoplieant:Pink—Revenue:Goldenrod—Assessor DATE: 01/29/90 TIME: 15:27 _ , - . - ii CONSTRUCTION AND PLANNING _ POOL& SrA - / Date Inspector Date Inspector APPROVALS Permit# f APPROVALS Permit# ..-1, Temporary Electrical Service or Pole 52..Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • - 3. Electrical Con_duitUtility-Undrgrnd. 54. Forms • " .4. ,Electrical Conduit-Undrgrnd. - 55. Electrical Bonding % 5.•Steel Reinforcement' 56. Rough Plumbing & Pressure Test : 6 - .=Electrical UFO Grnd. . _ R' Ti: oos57. APPROVAL TO COVEGUNITE Footings-_ _R= 58. Electrical Conduit-Undrgrnd. _ 8._Foundation . 1 59. Gas Pipe, 0 Undrgrnd., Test , 9`Water Pipe_Undrgrnd. 60. Backwash Lines,.P-Trap, 0 Undrgrnd. �' 10..Structural Floor System 61. APPROVAL TO DECK ' 11._Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap .: _ 63. Heater & Vent-Final 13. Roof Drains. 64. Plumbing System - Final ,. 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ' ' 16. Rough Electric,Wiring /-3/j? deed 67. Fencing & Access Approval 17. Rough Wiring Sign APPROVED-FOR PLASTERING 18. Rough Electricii-T Bar Ceiling -1.49'29- 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ . _ • �, - FIRE DEPT. REQUIREMENT 20.-Rough Factory Fireplace -,.. _ '7 . ; -APPROVALS _ :Permit# - r • - - - 21.-Ducts,i Structure = _ r . r ' "70. Underground Hydro ; 22._Ducts, Ventilating 1, ' - - - u . :. s 71. Product-Piping O Gas ❑Oil 23. Gas-Pipe-Rough & Test ' - 72. Underground Flush •• . 24. Roof Framing ;• - - x - - - L. • -.73;-Undergrnd.Storage�Tank:0Gas OOil - 25. Roof Sheathing _ 74, Overhead Hydro_ 26'T-Bar Ceiling (St uctural) &-Moriocoat L75;2 Dry Chemical _ _ , , 27: Frame and Flashing. _. _i- _ - 76. Dry Standpipe _ '.-_28. Lathing-& Siding:;. ' a 7- , •. 77- FIXED SYSTEM FINAL-- 29. -Insulation r - 78`-FIRE PREV. FINAL _ _ 30. Drywall Nailing ., :f � •; 'HEALTH DEPT. REQUIREMENT. - - 31. Plaster Brown Coat- '- * .- : 79. FINAL INSPECTION - ,'32.'Electrical Power Meter-Final i y c x 0."FOOD CERTIFICATE ISSUED- _ .-33.-Final Electric, - - - 07,,,g /' o Nes: - -- • - - - •'34..Final Heating& Air-Conditioning`• ' / i} ` - ! - 1 ; •-.. i v - .. t - - • 35.• Final Gas Pipe-Test ✓1 • • - - : -36. Hood or Canopy • - - -" • /q j ._ - _37. Final Factory Fireplace; - - _, x- - '�I��-' i. :38. Final Plumbing y " -7. '7 .� ° '5 - .. - 39. Water Service-Final ' : - ' •_•!; _ - - 40. Gas Service-Final a .- _ -- 4 • ' • - - -r r, - - .7, t % . i X41. Solar Domestic-Final ' .1, i - - , t 7: _ 42. Backflow Preventer - - - '- . - 1- : • - - .. 43. Backflow Irrigation _ r r, - -i: _ - ' 44. Landscape Irrigation System?" • " - - t4t -45._Sound Attenuation t: L. -1r ` + - 46. Handicap Regulations - x ' •- ' i 47.-FINAL STRUCTURE & BUILDINGr_ �; 48.iFINAL PLANNING - - ' • `r - '- a. 4. 49:-Electric Release to Edison 7, x. e - - _ _ _, . _ ' 50.-Gas;Release to Southern California Gas Co . 61s • - - - _ 1 ' 51. CERTIFICATE OF OCCUPANCY 1. = r,0 No. Date