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Home My WebLink About1620 ADAMS AVE - Building Permits ii CITY OF COSTA MESA ' t e•rr. ' " ' BUILDING DIVISION • fv ,'!.�T,•,,�A! 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754.5273 • Fax(714)754-4856 • www.Ci.costa-mesa.ca.us / ci. Iwo• FOR INSPECTiOlp )N4) ER: BXO7-00174 r' • ' T TYPE B_MISC • STATUS: ISSUED APN: 13931328 DATE ISSUED: 10/19/2007 Zoning: Cl, ISSUED BY: • CAC JOB ADDRESS: 1620 ADAMS AV CM Suite/Unit: Vicinity: Primary Occ: Const Type :?4 • SO.FT: 0 .,Valuation:- - ,$2 ,000.00 _ SCOPE OF WORK: INTERIOR REMOVAL AND,DEMOLTION OF NON BEARING-WALLS AND ALUMINUM INTERIOR WINDOWS. - OWNER: KLINE SCHOOL LLC -%i, - • •Address::, • 1620 ADAMS AV- - . Unit City/State: COSTA MESA Zip.Code:'' ,-„5-,, -92626 -` Phone: 949.722.7242 •r�" APPLICANT: SUSAN KLINE'' / , Address: . •Unit: City/State: Zip Code: Phone: 949-722-7242 . '•" ---•• • •• - CONTRACTOR: - - ` ",Y,' �' - "' "- :License No. - City/State: Zip Code: Phone . • Cell: ARCHITECT: - License No. , Phone • ' _ ENGINEER: i - - - -- -, - ',License No. - Phone -_ - - _ - - ,. • FEE SUMMARY Building Plan Cheek: $45.01 Building Permit: -. $69.25 Electrical Permit:: $0.00 E SMIP Residential' $0.00 • ' • ' iii' SMIP 00TOT rciai' 14.26 $O.00TOTAC FEES' . . $114.26 -...'`. . • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-26,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit: ODE s INSPECININ TYPE 292E INrm.t$ CODE if INSPECTION TYPE . 90.7E INTUTIM. 1616 Fixed System Final Fire Prevention - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Anal Block/Retaining Wall • 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 1 203 Final Sign - 222• •Final Site • . - . ^ - i 204 Anal Demolition • 250 Final Building/Occupancy � 11 1 WORK§RS'9.OUPENSATION DECLARATION: Owner ID verified by driver's I•, I7Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. /. pirei: '' •/3•I. 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 Verification of Ownership by(type of document,I.e.-pro• tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depthinto which a number are: 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, Cartier. or dismantling thereof,will be more than thirty-six(36) high.feet (This section need mol becompleted the petmeis valued athundreda re hundred dolars(Sred) ksc.) 2,Art 2,Sec.341,Title 8,California AdministraWeCode). (Chap.3.2,Grp Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contractor's signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ❑No Lender's Address: (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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes',the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all slate laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with a contractor(s)license pursuant to the Contractors License Laws.). CERTIFICATEndr OF COMPLIANCE AND AUTHORIZATION thispOF ENTRY: I certify under penalty of perjury that I have read this application and state that VE I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection pu •-ses. I agree not to occupy or allow occupancy of any building authorized •,•,Ps permit until fi•al' sp- tion. �� /0 /4.0 j '. =;ate`!'' /c Dat Stgn2_ 303746 (b/D And/or Aulhonzed AppLbnl Dale E • , . 1. ....., bid Scout COUPCil of Oropoo Couptu • : ..... ...... _._ , ,_:. . • • IVO ADAMS AVENUE • COSTA MESA, CALIFORNIA 92626 • .-. • . • . ,..• .L.-------3 ..• i • . . , .• :i:•••-•;':' -.._,. . . . , -------____•% , s'It's.^.1.. ..,:. • ' . . • -•-•• - .•Occr,„ ; ',,•,.:,.-,st,"; 1 .• r . .. .. . - '• - ••••0 ...7 ..".. ... '''•.;.-r .• . ' CLOGleryLQ 1 ' 1 ii-.11.. ..111--.‘,- .a VED q'• . • P .-"c..:•:.••:. 1.,";:t..• 1:.??,,:;:.....• 4. ...7 • . • . - • • '• - - .4:•-• MESA ,,,,.. , an, . .. ..... . - • OTT OF ±?.... A - : E• D PT. , ......Fi-.4.z.• ‘. 'f. 1-•;.F.:•:.; '1..i • 4 ,..::1 . • .. .ii Ft -.6.- :...p-si I ;1.7 , (Lc,g • , h:,..: . SUBJECT T011i:-;G' DEPT. REG. d'p'../5 y 1,•2/7 4 •-2 l'.!•,:`, :Y:•7.,-:Y•.).“•• • '4•-7.••;:'.;4•'t .;;14. . !',. ., .";:1 4 i-4 '. : ! • 1 144141 . ,'..7..... • 5 c.a. .41-A'Rt.,•••••TE..----•-•••••••••". 4;/ !/.1., ....2.....'i. , . :-.. .. . ,. ..„,. .. , : 1,2.. ..:„...,:;":„....., ,, . '-‘: ":: tr., • 0 •,.•• I.ft.I s „ 9 - DIRECTOR 94..:;:t.. NiPte dI l'. r. V . . o, . J• 'I • ' • . lj • '"' 1141/4 , *"- ' y ;-,.4 :' ry-,--- ...op... t,I,.. F. : .4. 14).-v- - • _44,4. , - .0.1.;:i .• • . s-. • ,1/4•,•7..2.4, i'f. t I. ' X • .411%.... • AY., . L. rats. ' L'.s -.<'-;‘. •• -..'s*J; . c. .1 ' ,L ' - : . , ''' C . -.! 'L ---i,` • ii1.4."‘'•"••"<rS3:11-c•j-7,' '''' e'cnt-itt ......7..--tt, ,.°-..,,,:-...1.- 4, ... '-., ,..' 1/2..... i ,. 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" ..• ' t„ —> 'aV.• t•' .0). .' :tbi ing,4 r.„.1..:Ct /4 I gkr 4114114abt Ikl-C 4:7 ‘ • 6, 5. 5" 5- . 6 -.. .-.. ... • •... •‘%! -. ..,....s....*,?;1/41 m r-..:,• t•i": -' 4..i; •:'::‘,..E.'"?; .“... • .• . :"/.. .... ... . ,„4.• ,&••,,,,-r. . • • i 44t:'4'';',!;11::"3$461/414• ...0van1gron".r-".•.• (rt.- 'If---4:>•••..,;:••'. - '.•.P44:,,,,Irahijiijitf: t'':Yr—.•••••:.i..•••'•:-.4.: : - • :../.....••••,- .,•.• ,9:- . • • or •ip,•:.-t )• 4it : tr ' .t'l• ''' '. - , ' .. ic.....-4,4‘.;.:::.2..c.,:':',....: i ••• ‘•' - '• • '''''954•10‘2,,,ty,it •••• e. p.. c..!(,,,--,e•-i.'”.41--it• 41,E•,..ra-•- •'•6 '- 2-4, '..‘'.-- t . '.- 4 • • - ..,•'-i- " ' ,999•59.6.1/4„ AP '7R0-VVED City of C•.t• ' e•. Building Depf■7 STRUCTURAL APPROVAL ONLY eY.__._. .A �1SEPARATE PERMITS ARE REQUIRED THESE PLANS MUST BE ON JOB AT ALL TMS FOR ELECTRICAL, PLUMBING,, • MAKE NO CHANGES WITHOUT PRIOR APPROVAL HEATING, VENTILATING AND OF DEPT. REFRIGERATION WORK THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED �y 42 // Iy TO BE A PER in' FOR. OR AN APP?DYKE OF, ANY VIOLATIONOF ANY Permit # Vd / SLIMING OTIO GIVE AVIIIIONSTJ TO, It PROVI:IC Pt F'VIOLATE OR CANCELS CODE NO PERMIT THE' THIS NU,°iKR, ;,;JST ACCOP.i9AiIY PROVIJ ONS OF THIS CODE HALL BE VALID, EXCEPT IN SO ALL INSPECTION REQUESTS FAR AS THE WORK OR USE WHICH IF AUTHORIZES IS LAWFUL. -- - -• THE ISSUANCE OF A PERMIT BASED UPON PLANS AND: �� BuiL�IC;i$ �,rIC�lE PERSONS ARE TO +PS:IF:CA.TIONS SHALL NOT ?RLJLN7 THE BUILDING OFFICIAL Fid ILD J tic S.i�;.Si THAT THE EOM THEREAFTER REQUIRING THE :ORRECTIOII OF ERRORS 'TE OF C. LrJ,;i'!IA DIVISION 'OF IN ;''D PLANS.AND S°ECIFICAri: 'S DP. FROM PREVENTING $TR.,! S. FEU I4 CJNS iSION FOR BUGLO NG OPERATION: BEING CAPRIED ON THEREUNDER WHEN 11sT :.L . Ff 11'EMENTS I IN V'UL°TION OF TP'; CODE OR OF ANY OTHER ORDINANCE �__ ____ c, THE CITY 1 \ ---* \! \ • - O " oF: :EI PL..;INV' MAY 2 21978 711800 tllt12t1 t2tst415t6 ' C. • CITY OF COSTA MESA • t�jz�� BUILDING DIVISION Ft•",r,„.„..-A• �. : 'Ii 77 FAIR DRIVE,COSTA MESA,CA 92626.• (714)754-5273 • Fax(714)754-4856 • vnenv.ci.costa-mesa.ca.us t. arra FOR INSPECTIONS CALL:.(714)754.5626 '" . • PERMIT NUMBER:, , $6X07-00196, PERMIT TYPE B_MISC . STATUS:.. ISSUED APN: 13931328 DATE ISSUED: . ', 11/0212007i • Zoning: Cl, . ISSUED BY: RMD JOB ADDRESS: 1620 ADAMS AV CM-%--4:;-:'"'-,,i,":::—," -``F Suite/Unit: Vicinity: SCHOOL ENTERANCE -.'. _Primary Oct ; Const Type :?? SQ. FT: 0 •`-,!; ' ,`,Valuation:,_ 57,000.00,;f SCOPE OF WORK: CONSTRUCT HANDICAP RAMP ADJACENT TO EXISTINGJENTERANCE FOR"KLINE SCHOOL". OWNER: KLINE SCHOOL LLC - Address:: 1620 ADAMS AV , ,.1 Unit . '� City/State: COSTA MESA ZipCode: • t�.•�.�� . 92626- i :7 '",,, , Phone: 949-722-7242 y`,-d -, "` • APPLICANT: HUTCHENSON DEBBIE ` • Address 2973 HARBOR BL " Unrit City/State: . COSTA MESA dA''''':P.;; 'p ,, Zip Code , 92627 li + ` ` S " - . Phone: 714 549 2708 ,Y4 . ' 1, r �-0 . CONTRACTOR: JBF CONSTRUCTION - License No I+692047 ' • Address: 1927A HARBOR BL _, Unit: UNIT 345 City/State: COSTA MESA,CA_'_ ., ; l• ` { Zip"Code: • • 92627; ll` F, ' -i 1 - ..'Phone 7/45906049 Cell: Ids i ..,.. , . -`i' r License No. ARCHITECT: -- � Phone `,I .. �. . . - - •a ENGINEER: License No. r {'i' Phone - •_ � 1/ I • . FEE SUMMARY;':-. . Building Plan Check:-1";-:,‘. i . Building Permit :..:$139.25 - Electrical Permit: ,-,/,''....-if �K a - $0.00 ,� SMIP Residential. ''':el , ,yk 2,i .$0:00 SMIP Commercial $0.00 Se $0.00TOTAL FEES m4''.4..)(:*;-&i:^I. A.-'$229.76'' ' 21 � L - >-• is 411P A NOTICE: The work"authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPEC110N TYPE DATE IN1n1AL5 CODE II INSPECTION TYPE DATE INIIIUL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220' Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • WORKERS'COMPENSATION DECLARATION: • Owner ID verified by driver's e. 0 Yes ❑ No - • I tpreby Barn under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 thisDIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My wo rs' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized if 9 All t 1y/�p� - by this permit,and that no building structure,scaffolding,falsework,or demolition 'Carrier. 77 -FII s9 wCA.7 �- Lam(/ or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This seaionn etl no boa if the permit vale,at pwlars s/t/pol�rless) 2 Art 2,Sec. 341,Title 8,Califomia Administrative Code). r. 1,02n-/s PolicyNumbe /�/1/nY/�C V /N/S v41) ❑ As owner-builder, I will not employ anyone to do work which would er❑ I Ccertify That in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issue• shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to •rkers' compens- ion laws of California, and agree that if I should b: • - s •'ect to the •rkers' compensation provisions of Section 3700 of t' o7W.Qe I sh. .rt •'t amply with these provisions. Applicant's Signature Date !/r�J /7 L` 77 Division of Industrial Safety Permit Number: Applicant'Signat re Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEYS FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my!icons in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No t .r Lic._# / Class# 5 (Section 25533 of the California Health and Safety Code, with some 7 *� -0 exceptions, requires registration with the Costa Mesa Fire Department by r ��, //'' �/� each business which at any one time has on hand a quantity of acutely Conrradpr's grature Date—_ 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of:proving that he or.she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Dale property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.), certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for • inspection purposes. I agree not to occupy or allow occupancy of any building authori •y this permit until final inspection. • Lure of - • - ate Signature Date /1✓ //- z-7 L 3057-46(3107) ♦ nd/or Authorized Applicant - Date— . --. , ' MF CITY OF COSTA MESA • 4 BUILDING DIVISION r F 1, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 p4 PERMIT E01-00537 ee (714)754-5273 • Fax(714)754-4856 • www.cicosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1620 ADAMS AV Status: ISSUED Suite No Applied: 06/27/2001 Vicinity: SIDE PROP BETWEEN 1620& 1640 ADAMS AV Issued: 07/16/2001 Parcel Nunmber: 13931328 Applicant: OLIVAS, TOM ISSUED BY: Address: 1620 ADAMS AV - - - Phone: 714-979-7900 X319 COSTA MESA,CA Zip: 92626 Owner GIRL SCOUT COUNCIL OF Address ORANGE CO COSTA MESA,CA Phone: 1620 ADAMS AVE Zip: 92626 ' D Contractor OWNER-BUILDER F va" j•. Address: DATE - '-' "I / Phone: Zip: License: 0 SCOPE OF PERMIT MISC UNDERGROUND CONDUIT FOR LOW VOLTAGE WIRING BETWEEN 1620&1640 ADAMS AVE FOR TELEPHONE COMMUNICATIONS/COMPUTER-LINES. 1 LOW VOLTAGE WIRING , J , - . FEE SUMMARY ' - Quantity Quantity, ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ' ' Temp service test $0.00 Busway 1100 ft - $0.00 . .0 , Res,a/c package $0.00 :' Standing Section $0.00 New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 ,.0 - New Res(3+units) - ' $0.00 0 Transformers up to 1 kva/kw $0.00 �/ 0 , Pool/Spa ' _ $0.00 0 ' ' - " up to 10 kva/kw . $0.00`% 0- Lighting Fixts / - $0.00, .,r -0. ,' . - - ' / " up to.50 kva%kw� "$0.00/ 0' Recept Outlets ' ',,$0.00:J 0 , > ' ' 'up to 100 kva/kw /.15,,,,$0.00/ 0 Switches , . -A /'/ $0.00/ - 0 0 c _ '"/ oyer 100 kva/kw-j $0 00.2 0 Non Res Appl v ��"� '$0 00N�,-',.'2:,0::,,s1.- Low Voltage Equipment /V$0.00_,',-//-)0 / ' ' Res Appl ,.\-1: . , /$0.00-> ,_ --`0>-,.-,-----..- 1/42 _ Low Volt Wiring:System I CM -$25.00;) 1./7 .j Service to 200a $0.00 i , 0 - Misc.Conduit - - $0 00- 0 Service to 1000ac,,,$0.00. r, 0 Misc.Conductor V�r $0 00 /, 0/ Service over 1000a - $0.00�� /, 0 _ _ Circus(gen or rider, A $0.00,;, 0 Motors to 1hp -$0.00 0 'Circus'(medh ride'orr.lights) .$0.0Q -' 0 Motors to 10hp mar_ 0 ' -. Christmas Tree Stand's �-i, $0.00 0 Motors to 50hp $0.00 ''0-- "- ' '.Fireworks Stand 'v'19'..---$0.00 0 Motors to 100hp $0.00 ' 0 , - Other Electrical,Fee 6---t----- $0.00 Motors over 100hp $0.00 0 - _ - _ Communication drops $0.00 0 l Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 ' Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $48.50 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 2646-46(6100) °DECLARATIONS , WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: 0 I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carder. Policy Number: (This section need not be completed it the penn/f/s valued at one hundred dollars(POO)or less.) ❑ I certify that In the performance of the work for which this permit Ls 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 01 the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE MI00,000,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR COOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lk.I Class I Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: - OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 0(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.). ❑ Ills owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions --'Code:Ttle,contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under se Business and Professions Code for this reason: signatt.—re:� 7W1 cQtC— (nate:-17/ 610/ ` -Owner ID verified by drivers license. Yes 0 No DrfverfeLicenseNo._._ Expires: //02- 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 e.California AdministratNe 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? ❑Ves 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _.._ ._ _ _.._za(dous materials)? Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous ❑yes ❑No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation,certification end 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 compiled with? 0 Yes 0 No _ . _ ___. ...._ ._ _..._ .._._...._ __.... tion_. 5 Does or Southwill the oast Air or present or emen buting o from at any other for the work ntch is the nor of this application a ermit for such construction or modification from the Coast Air Duality Management District or from other air pollution control district or agency? Yes �No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). B 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-Managernehr 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 I 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 abo -d cribed properly on purposes.I agree not to occupy or allow occupancy of any building authorized by this pepnit unseal in;pection. Signature Of Legal Owner(s) r/7/ 6 Dat(% �.. And/Or Authorized Applicant Date MODE I IISPECTION TYPE QAIE 1.011.618 CODEI INSPECTIONTYPE PATE Rl1S 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 Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy i Medical center Adams 1640 Adams Ave. Arthur Murray • 1640 Adams New Girl Scout expansion. 0 Q I 1 1 h ;r tg .! I a � � � 4t �. 202- cn< tla '„z„2 W 2 o Drive way Q I— _s i • �O ` .21 ' C1 LL }g� L f5a c 8 0'U n c7 ,� > 's 38 l,'S i V Proposed 4" voice and data f f a _5 n e I conduit approx. 140 acrosss if a7 a bqdriveway from 1620 to 1640 Fi 5 e E ; r Arlamc ma gi Existing telecommunic ations room 1620 Adams Ave. Girl Scouts // (Not to Scale). Girl Scout Council Of Orange County 4" communications conduit, minimum 24"deep will link 1620 Adams and 1640 Adams buildings - 34054 IAF; 25-72CH5 00 871 ***238.15 'COSTA MESA BUILDING•SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely AEC/ VED B DATE RECEIV • DATE ISSUED BUILDING - I 2021/ ^. ADDRESS / �Q r �/ . if �� • 2� 7 OWNER CS QP l�- e Ili ni A.P. NO. J ��/-ll� ,. '('O n ADDRESS E. ADDRE�'sS.v�1w6'y'-+`�-0�� C..,dp ® /7 �(L'A�r Il U CITY ""�"^•TI7"f '4'14 NO. AC^ T I V LO/T 5 BLOCK Z CONSTRUCTION NEW GADO ALTER REPAIR MOVING OFMOLLCH ON LENDER ,// d co J D BRANCH .Ci�'-"��_ 1 .r'c-O_/w.fi t-� l_Wir LLLQ� J fn °t ate J*St 01 ADDRESS O' 0--0 • VALUE 'M ARCHITECT �T E -1--12S/1" rriTEL. $ ' O' a - - t� iii ,. t_ N• "tar. MIS �I i�� r • FIRE / -/- 7 W w ADDRESS ` .r!/% tom _a »l•,• ZONE TYPE /GROUP / /� W Z s APPROVED a / J Z CONTRACTOR �I V" 4 BY DATE m Z L 4d50.A.4"I J ADDRESS IS' WLR. ,"I�"`: vs... Y ��I (((��/''' W W TEL./ ZONE NO.OF USE OF NEW/ Z F CITY NO. i2o-2511 / PLANS 2_ BUILDING W-O STATE ` CITY YARDS APPROVED YARDS APPROVED to CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING O (FROM C/L STREET) I SIZE INO.OF BLOCS. OF LOT NOW ON LOT FRONT a OFT. USE OF EXISTING BLDG. "—^ _R.SIDE /0 FT. FT.- - - F 312E OFBLDG. ROOMS STORIES ( L.SIDE, .✓ FT. P FT. NO.OF CC Z NEW �jI.I�C�'�SSI �y-�,r p if V COVEERIING RIOR ALIF ICOVVE RING cX'%rlR• REAR Fe/FT. //r FT. . J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& as 'HEW rl4�Lt4rQPI CF MAIN BLOCS. ACCESS.BLDGS. k.. � CUP. A • VAR.# APPROVED I RVWE. ..-c- -c ni DATE - `(3` / � ' ' p HOLD FFOR SPEC AL REQUIREMENTS 4C(2. I hereby acknowledge that I have read this application and state �c Air oy�� ' . that the above Information is correct and agree to comply with 6= CC all laws regulating building construction, and I shall not employ • I— any person in violation of the workman's compensation laws of a- N the State of California. m — I hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR s Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a CC em exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION + as Signature of Xr,Wv PERMIT FEE $ 7S- - D Permittee • q✓7�� p.� PLAN CHECK $�� r �� E Authorized Agee i�' li �� %//L�!E�C TOTAL FEE $ na5 -77, a;° 1 r-77-67.7.700 1120* ****21.00 'COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �/ RECEIV�p V DAT/ ED BUILDING //2, 4 /1/J{7/ DATE Iy�S ',2 ADDRESS sL /,/yJ rl:/ "V--,77 �( / CIZO GOc.t `-0ciAle C, PERMIT NO. NO OWNER of- Me Al Car fl a."./itMAIL A.P.BUILDIN / �J /�I`I /��/ � ///]� � Z ADDRESS z ,122' C6 �V "Wort ADDRESSES /(Q G� O L!a:�C�:L(/{./'t v a,...ei WU TEL CL CITY ^ NO. TRACT LOT BLOCK Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI SH O LENDER am J D BRANCH J U, OWNE 7 [,�L1 • m J ILI ADDRESS /JJ/I q VALUE //�, /� 'm ARCHITECT TEL. USE z.tC ,IG1 $C//YTiS aide. OR ENGINEER NO. FIRE tiler ADDRESS ZONE TYPE GROUP O.W APPROVED W Z CONTRACTOR BY DATE J O 03 J C: ADDRESS W W TEL. ZONE NO.OF USE OF NEW 0 m CITY NO. PLANS BUILDING Z k- CITY STATE CITY YARDS APPROVED YARDS APPROVED to Q LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D O SIZE NO.OF BLDfa5. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R_SIDE FT. FT. t- •.. F SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. VEXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. J USE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& D. 0 MAIN BLOCS. ACCESS. BLDGS. ( VAR.# DATE C.U.P.## APPRPPR OVED I— APPROVED In Rte..Y DATE 0 STATE O U I hereby acknowledge that I have read this application and state p la d 0 0 that the above information Is correct and agree to comply with ct all laws regulating building construction, and I shall not employ H any person In violation of the workmen's compensation laws of TAX ' q the State of California. to I hereby certify that I am properly licensed as a contractor under SO.FT. O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 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 California Business VALUATION //�`//`� ex Professions Code, Division 3,Chapter 9. V {'CEJ m PERMIT FEE $ Signature of co Permittee $ 9.04000 E PLAN CHECK $WA s/ E Authorized Agent TOTAL FEE $Vf//F/°�� ' • 39138 PAID,,,, OCT 23-74tfic, 974r ****12.50 'OSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 5. APPLICATION FOR BUILDING PERMIT For/Applicant to/Fill in Completely/� � RECEIp ATE RECEIVED A E ISS BADIDR E$S/-��//o2O �N� S !N'V L� ♦ - //// ry p�jER _).7..,17p �/ SRMIT NO. OWNER (-Pi elm SCn11T CO U11)GI• kJ A. NO./FY-//2'-441,Qp ` o/S' MAIL BUILDING ✓/�f �7 ADDRESS 11020 RdilmS JL)J ADDRESS ( 4 Ants AZi's_, z 0-U CITY GM m' DSVC S f1 NO.tii 979-79ee TRACT FgIR I f LO'F BLOCK Z Q CONSTRUCTION R NEW ADD ALTFREPAIR I MOVING r1FMOI ISH Z DNLENDER am N, J D BRANCH ' -I CR OWNER 6-Iii._ Sentf m J IL ADDRESS /j ,p,� kin ��//ALVE /COI . M ARCHITECT TEL. USE S7I�-L/U.It/II 5J LAN $ L 0 OR ENGINEER NO �'�/y FIRE ZONE TVP GROUP �� • W m ADDRESS //0_Ly ^s y--� `/ ( /' J O CONTRACTOR ae Oomi/ --ie dr' APPROVED // /DATE/O•-23 �j E0 Z -YY --ie �(� J m ADDRESS W w TEL. ZONE NO.OF �r USE OF NEW O= CITY NO. ' PLANS �/ BUILDING.ci pn,1A) 0 5/�.l Z_H C^ �L,K I� W� STATE CITY YARDS APPROVED YARDS APPROVED co m LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D O SIZE NO.OF BLDGS. (FROM C/L STREET/ (*OFT. A OF LOT NOW ON LOT / FRONT FT. . r (OFT.'[�. XE OF - r / EXISTING BLDG. OFFlCF R.SIDF ---A-4 ]/,T Ir` (OFT. I. ` SIZE"OF - -- - - NO:OF - - - - _. 11l ' r I _ Z NEW BLDG. ROOMS STORIES L.SIDE —FT" - ta.1 EXTERIOR WALL ROOFage �- COVERING COVERING _REAR 7,F A ' FT. -I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& 0- a: MAIN BLDGS. ACCESS.BLOCS. 0 E� VAINB DATE C.U.P.# APPROVED J J`�JJ�•�1 /// - V APPROVFtDy// /1 Y(/- DATE /0 -7y co -9Y 66/-/--'(l Z iz n FOR SPtc IAL RE UIR 0 V I at tbyhe acknowledge information tion I have readtthis applicationto and stawith D that the above information is correct and agree to comply with cc all laws regulating building construction, and I shall not employ F any person In violation of the workmen's compensation laws of f/ co the State of California. ? I hereby certify that I am properly licensed as a contractor under SQ. FT. .- TAX the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VACD'ATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING'N� A PERMIT FEE ONLY: CC am exempt from the provisions of the State of California Business VALUATION �' 7 Ito and Professions •de, Division 3,C •ter 9. � rr CO orQ PERMIT FEE �'_ov j Signature of , I i Permittee IAC %�� -„-ir i $ Co PLAN CHECK $ E� / `o Authorize. •pant \ TOTAL FEE $ /e/ 5o I/ OWNER GIRL SCOUT COUNCIL OF ORANGE CO. DATE 5-22-78 OB ADDRESS 1620 Adams Avenue BUILDING PERMIT NO. 46074 ENERAL CONTRACTOR DESCRIPTION of WORK Non-B:.Lec. rec. — AP No. 3:39_111-22 LOT TRACT FIRE ZONE VALUES 800. INSPECTIONS pa_ Signature . Date TYPE GROUP ZONE C sOIL SUBCONTRACTOR PERMITS ISSUED c.s Date Number Sian eters WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE E7 HOUSE CON. O SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING , TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 9 ROUGH WIRING Heating and Vent. TRENCHES (J FORMS 9 STEEL REINF. 9 FLOOR SYSTEM BOND BEAM 9 STEEL REINFORCE n - ..._ -- ....... ._�� SHEATHING // (I /7"- -.= n IA II II 0 A F FRAME AND FLASHING I, r a n It - LATHING — IN El OUT l^l II tett i n 1: 1 SI n N `I I PLASTER. BROWN COAT 1/ V U V fir% ..cam ' 1 STRUCTURAL. FINAL I EI riI1 HEATING, VENT., REFRIG. AND A.Cr.�, FINAL I PLUMBING, FINAL AND GAS TEST I I G; Ty>J� „I v_•_�G ELECTRIC. FINAL BUILDING. FINAL `- pp vnyV B ADDRESS1620Adams Ave. • BUILDING PERMIT N0.• 39138 G ERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Non Elec. Ground Sign AP No. 139-313-22LOT TRACT FIRE ZONE VALUE $100.00 INSPECTIONS Signature Date TYPE IV GROUP J ZONE Cl SOIL SUBCONTRACTOR PERMITS ISSUED GAS Dote I Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. Li SPRINKLING SYSTEM _ MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING . TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES ❑ FORMS n STEEL REINF. D FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER, BROWN COAT _ STRUCTURAL, FINAL Electric HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC. FINAL y.� BUILDING. FINAL .49 ®..2—iD- 7,4, • Temp. Tag No. 219 2 OWNER SAMAR CONSTRUCTION CO. DATE 4-16-64 JOB ADDRESS 1620 Adams Avenue BUILDING PERMIT NO. 21989 GENERAL CONTRACTOR Carter Sign Company VALUE $ 150.00 QAP No.139-313-05 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK NonElec.Gr. Sig! INSPECTIONS Signature DATE GROUP TYPE ZONE C 1 Boll PERMITS ISSUED Gas - SUBCONTRACTOR DATE NUMBEI Water Rough Corn. Refrig. Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous _ Prop. Swr. Line 0 House Con.0 St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power 0 Rough Wiring Trenches Forms 0 Steel Reinf. 0 RBj%C y_,/–Gy Floor System 11 Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing— In 0 Out 0 Plaster, brown coat Ref rig. 0 Air Con. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test _ Electric Fixtures, Final __ _ _ _, Building, Final et,- G'ab - ' OCCUPANCY Form BU4-5M-3-63—S-B P r)i aRc PRONE ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 055300 OWNER'S NAME: GIRL SCOUT COUNCIL OF ADDRESS: ORANGE CO 'r_ - PERMIT NO: E 055300 PLAN CHECK NO: N GOVT: N SUPP: N 1620 ADAMS AVE ,, COSTA MESA,CA , 92626 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: REP ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPLACE 40 LIGHT FIXTURES SQ FT: PERMITTEE: CLAIM VALUE: CALC-VALUE: GROUP OCC : B-2 / ADDRESS: MAN ELECTRIC ( 714 ) 228-0101 1p42�3a4jpJpAT'TLISCO ROAD COMMENTS: REPLACEMENT NECESSARY DUE TO H2O DAMAGE. LICENSED CONTRALTO DECLARATIbN:—fheerreby affirm that I am licensed under provisions of hap er 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and ell eft CITY LIC.: STATE LIC.: SS: S E T B A C K S 042948 50674 'AO \ Date:7.I—1_7—� / Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby allium that I have a cemficate of nsent to sell-insure or a ceniticate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 38w.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 'POLICY NO.: EXP.DATE: COPA❑ 6PANY0 copy is hereby furnished. ❑ Cendied copy is filed with the city Budding Division. PARKING REQ: PROV: PARCEL: 13931322 Z NE: REF NO: PLANNING NOTES> ate: Applicant: ******************************************************************************* EXEMPTION FROM WORXERS'COMPENSATION DECLARATION: (TILS section need ae .ed i ,he i for one hundred(51(10)or las). DEVELOPMENT S-E• R VICES R E- Q U I R Ell ENTS I certify that in the performance of the work for which this p•rmit is• • I- . • • •toy y p• •n in any manner so as to become subject to the Workers'Compensation Laws of California. - ZONING APPROVED BY DATE: • 2 pe Date: I/- 7-- / Signatu> / i NOTICE:IL alter making this declaration,you should become subjec to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for i which this permit is issued(Section 3097.Civ.C). APPLICATION ISSUED BY: _-,,,Th. DATE: // 2�/ *********************#1F* 4TH *(J�L' ****k******************** *** }*** LENDER: 4: ********************************9f **** ** *********************************** ADDRESS: LEGALIZATION:N F •E•,E, SUMMARY STRUCTURAL' SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 24 , 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SMIP/NON-RES 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(5500). ISSUE FEE 15, 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----> 24 . 00 15 , 00 0 . 00 39 , 00 39 . 00 , 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 ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 39 . 00 OVER/SHORT• . 00 ,, . mrthe purpose ofsale). 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 39 . 00 • • Q and Professions Cade: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts tar such projects with a cantractor(s)license pursuant la the Contractors'State License Law).l am aware ***.*.**,* .*,**.**,*****.***.**,*.*,**,***,***,*,**,*,*,*,***,****.**.*,*,**,*,*,*****,**,.**,**,*,***,**,****,**,**, that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.A P.C. INDIVIDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:• Owner: I do hereby certify that I am aware at and understand the requirements of California Health and Safety Code Sections 25505,25533.and ELE 20 FIXTURES, LIGHTING 1 ST 20 EA, . 75 15 . 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 ELE 20 FIXTURES, LIGHTING ADDITIONAL EA. . 45 9 . 00 permit for construction or ngditication from the Air Quality Management District.Residential construction applications are exempt from END OF FEES (hese provisions. Date: Applicant: 'I I hereby certify that I have read this application and state that the above info- . a s •rrect I ago W comply with all city and county y ordinances and slate laws relating to building construction and hereby au•• •.loves. this y 10 enter upon the dhove-mentioned - - p`.\\ ' • r property for inspection^^purposes.pp V \� •• ,••,: . Date: II— FL/� Signature: Driver's License on Social Security a: 1641.46 Whim—Building:Green—Code Enforcement:Canary—Applicant;Pink,Revenue;Goldenrod—Assessor - CONSTRUCTION AND PLANNING- - PC & APPROVALS Permit# - Date Inspector APPROVALS Permit # Date Inspector ' 1.'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 1,- 53. Steel Reinforcement r] 3.' Electrical Conduit Utility•Undrgrnd. 54. Forms t • ••.4..Electrical Conduit:Undrgrnd. 55. Electrical Bonding 'a,. 'IS. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. - - 57. APPROVAL TO COVER-GUNITE ' 7; Footings v 58. Electrical Conduit•Undrgrnd. _ 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrrid. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK -. 114. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final • 12. Sewer Cap - • 63. Heater& Vent-Final 13.f Roof Drains ., 64. Plumbing System - Final 14.i Rough Plumbing ..• 65. Electrical-Final -1 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 r . 20. Rough Factory Fireplace - - - - APPROVALS: • Permit# - 21.•Ducts, in Structure' - 70. Underground;Hydro ' 22. Ducts, Ventilating •. ' 71. Product Piping OGos O'OiI • - 23.-Gas Pipe-Rough & test - , ' 72. Underground Flush - 24. Roof:Framing . ' - - - -73. Undergrnd:Storage Tank O Gas OOn. 25. Roof Sheathing , "74. Overhead Hydro 26..T-Bat Ceiling (Structural) & Monocoat „ . 75. Dry Chemical , • 27.-Frame and Flashing, : . 76. Dry Standpipe - - i.'28.. Lathing & Siding 77. FIXED SYSTEM FINAL- 29. Insulation • _ ' i 78. FIRE PREV. FINAL 30. Drywall Nailing ' - ,C;r HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat ' it 79.• FINAL INSPECTION'. 32.-Electrical-Power Meier-Finale06/4....----, y// 410F)16 i D CERTIFIc'T.E ISSUED .33. Final Electric ' ' 'G/ 'q / /4 .1- cite!: _ • 34. Final Heating & Air Conditioning • _ . • 35. Final Gas Pipe-Test / - . . . - ' 36. Hood or Canopy• - ' /y - - 37. Final Factory Fireplace - / - ' • 18. Final Plumbing ' r'. ; • 39. Water Service-Final . 40. Gas Service-Final ;• , . 41. Solar Domestic-Final . .- - . 42.-Backf low Preventer 43. Backflow Irrigation- - . . - . ' . '44. Landscape Irrigation System ' , - , • 45. Sound Attenuation - - , • 46. Handicap Regulations • . .47. FINAL STRUCTURE & BUILDING ' //. 48. FINAL PLANNING- �•" - .. 4, . • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co VI • _ 51. CERTIFICATE OF OCCUPANCY -. No. Date .l • 74 PROJECT ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 052732 OWNER'S NAME: GIRL SCOUT COUNCIL OF ADDRESS; ORANGE CO PERMIT NO: B 052732 PLAN CHECK NO: 02407-91 L GOVT: N SUPP: N ', • / 1620 ADAMS AVE COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP • ARCH/ENGINEER: STH STRUCTURAL ENGINEERS REG.NO.: SE7n1 JOB DESCRIPTION : REPAIR 2 FRACTURED BEAMS IN 3 PLACES SQ FT: 5, 000 I ADDRESS: P•O.BOX 10429 ONTT: k N.B. CA 92658 CLAIM VALUE: 5, 000 . 00 CALC-VALUE: 5, 000. 00 GROUP OCC: B-2 / / PERMITTEE MILTON TESAR (714 ) 250-1056 ADDRESS: 14352 BEACH BL 73 COMMENTS: X WESTMINSTER CA 92683 *+E*r************Er*+tEE+P*Tr*yP*RP+r****y ****+t*iE******+E***+P*****EE*+FTr******Tr**********EF+t LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Dale: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT 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.: EXP.DATE: COMPANY: PARKING REQ. PROV: PARCEL: 13931322 ZNE: REF NO: ❑ Cemfied copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING N TES> > Sate: Applicant' ********************************************************************BPMF********* EXEMPTION FROM WORKERS'COMPENSATION OECURATION: (This section need not be completed if me permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E NJ T 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. ZONING APPROVED BY DATE: 'i'• Date: 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 mat there is a construction fending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: '7' l O which this permit is issued(Section 3097.Civ.C). *************************************** ************************ *‘**‘:14*** LENDER: ******************************************************************* ****3F****** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 72 . 00 repair any structure,prior to its issuance.also requires the applicant for such permit to fee a signed statement that he/she is licensedSM I P/NON-RES 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 PLAN 46 . 80 1 . 05 any applicant for a permit subjects the applicant to a civil penalty of not mote than five hundred dollars(S500). ISSUE FEE I. as owner of the property or my employees with wages as their safe compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK • TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 73. 05 0 .00 46. 80 119 • 85 120. 00 - • 15 does not apply to an owner of a properly who builds or improves thereon,and who does such work Nmselt/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 mthin one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 120 . 00 OVER/SHORT: 15 for the purpose of safe). 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 72 . 00 1 . 05 46 . 80 S and Professions Cade: The Contractors'State License Law does not applyto an owner of propertywho builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Gontractori State License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: 7/�V19 owner.Cali i��• SFC 5000 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 5,000 . 00 I do hereby certify that I am aware of and understand the requirements of Cali ornia Health and Sal y Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will nM(circle one)need to comply with said stale codes and the requirements for a AirQ permit lot construction or modification from the Duality Management District.Residential construction applications are exempt from these provisions. 7 Date: App' m: I M1ereoy certify that have read this applicatio and slate That the above information is correct. agree to comply with all city and county N .V// ordinances and state laws relating to build(Signature; nstruction and hereby authorize representatives of this city to enter upon the above mentioned/ �'. property far inspection purposes. /� �L -y/7 (((/ 1 Gate: Vol _ja—L4q,/f`'�/FtA� 0! 00091619-00031622 Y�ol'• '^•3.;ir. I • - 4 ((�x Drivels License or Social Security•: DATE: 07/:0;9+ TINE: 14:Sk -.\ - 1641-46 White—Building;Green—Code Enlorcemeni;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor _III N. CONSTRUCTION AND PLANNING POOL. APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Teernporary Electrical Service or Pole 52. Pool & Equipment Location 2. 'ioirPipe-Undrgrnd. 53. Steel Reinforcement , 3.`'Electrical.Conduit Uiility-Undrgrnd. 54. Forms • -�4.:ElectficarConduit•Undrgrnd. 55. Electrical Bonding . ,j5.•Stee4 Re i'rtrfArcemeet:j 56. Rough Plumbing & Pressure Test ' t"6.`Eeefrical OF ERLGrad. 57. APPROVAL TO COVER-GUNITE Wt Fuingi•C 58. Electrical Conduit-Undrgrnd. - - . 8, Foundation.. - 59. Gas Pipe, O Undrgrnd.,Test - 9_ Water Pine-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - 10. Structural Floor System 61. APPROVAL TO DECK - - 11. PropertyrSewer LineM'& House Connection 62. Backwash & Receptor-Final _ z r 12. Sevier Cap • a. 63. Heater & Vent-Final • 13. Roof Drains t 1a. 64. Plumbing System - Final 14. Rough Plumbipy '- 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric, firing 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electricgt-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT --- ttr A. • SY 20JRotgh Factory FTheplace I 1- & - •Z *AAPPROVALS:r%_Permit #- . ?• __ r N ':' S.7 ' c`I . . r 6.:• t- - 7 • ) . I . - v:�. •-., S >� .�; - :r 21. Ducts,in-Structure. . • .. . ..,.y , , - -y a 70. Underground.,Hydro . 'ti, 22 .Duets, Vtintilatin .y r` N 1: _ r _ Fry * 4;,71. Product,'j ing dries Coil 23.,Gas Pipeffo h & test - - _ 3 ' !+� :., :.72. Undergrdufd Flush, „ 24:-Roof Framing ; '. • v• 1' t _ a • : 73..'>.: 'Undergrnil.Storage5Tgnk 0 Gas C Ot7 25. RoOf Sheathing y , ` _ r •,72- ' 747• 4`,Overhead hydro - _ 26, T-Bar Ceiling (Structural) & Monecoat '+ T.. t 75,7-Dry Chemical -t 27`Frame and Elashing� �u. r 1-, r';. , , 76: Dr t..- ' "3' '' `" _ Y �t'and.ItPe . L .*1 28. Lathin r •• - •• gl Siding -+ '- -.d. � w >. I < ' 77.. FIXED SYSTEM:RINAL� ?"29. Insulatign - ( I t 78, FIRE PREV. FINAL �•r s. r 30. Drywall Nailing Y 4 i4EALTHIOEPTs REQUIREMENT -1. Plaster kIcown Coat; r1.. r '" ' •79t FINAL II�SP-ECTIC N 7, - ' -_32:-Electrical Power Meter:Final/ - -t Ie. * g80..FOQD CERTIFICATE ISSUED . . 33: Pinel E(4ctric r r iI , x ' Notes: _ _ • 34, F441 Heating& Air.Conditioniyg; v. I r y ' t • - tr_ !I' I 35._'Final Gari Pipe-Testi - r _ r• '_ S r ;36. Hogd o------7•1Canopy v 1 , - - ... • 4 . x s _ r' t.. � .rf 'en t n -.r _37CFinal Factory Firer�aaa , 1 .:'. n `. - ?: 1�- t. -a, r to "-38.:E .. ._. • r 38.Final Plumbing .. �' I ,‘ .7 � .. r - G39:ANater Service'FinaF Y, • : 4 v 61 > ,;40:1Gas Service-Ejnal ). to S,•M t• ., 4 -,� r41.'-Solar Domestic-Final°. •• : r_x I 'x . ‘C ` / 0 .: ♦ j. y t' ; t - . .. 4.. 42. Backflow Preventer_ .. th r - . 1 43. Backflow IriJgation z `• ` x o. :-,H ,;44. Landscape irrigation Systema;? a, _ c ,_ z ;o L., _ - al o ;45. Attenuation k:- tr • % r- r • " S : c' i•c4 `46.:Handicap Regulatigps '' • ' •'. O cc 2 , ` " J .f . T CC. �_ 47.sFINAL STRUCTURE & Bt1CLDING 2,41_l' I !� Id S- 48f--FINrflL PI_ANNIN(ti I i.�r 4- pi r 4.. ' rhe-, - -- c•..491.4.:-Elettric Release to-Edison • v t •. i; .. n .. . I ! }+ • n :' i ..50.rGasaRel�ase to Southern Califurrlia Gas Co 2 ! i h: - ;_, -. _'-51. CERTIFICATE OF-OCCUPANCY l No. Date PROJECT ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTAJMESA - BUILDING PERMIT PER NO: B 05218E 7)WNER'S NAME: GIRL SCOUT COUNCIL OF ADDRESS: ORANGE CO PERMIT NO: B 052185 PLAN CHECK NO: 00797-91 L GOVT. N SUPP: N S ''K COSTAAMESA,CAE 92626 ' CONSTRUCTION TYPE: 'PERMIT TYPE: STR PURPOSE: NEW t 979-7900 \ i ARCH/ENGINEER: ROB PATTERSON REc.No.: C7748 JOB DESCRIPTION : 960SF FOOTING (TIE-DOWNS ) FOR MANUFACTUR SQ FT: - 50 ADDRESS: 18002 SKYPARK CIRCLE UNIT: ' IRVINE CA 92714 CLAIM VALUE: 5, 000 . 00 CALC-VALUE: 5, 000 . 00 GROUP OCC: B-2 / P ADDRESS: L NFD (714 ) 979-7900 1620ADAMSAVCOMMENTS: MOBILE OFFICE FOR GIRL SCOUTS • HOLD FOR SPECIAL REQUIREMENTS COSTA MESA CA 92626 ************+6******* aFEF*********TL***prat**>E**x***k6Na6*+Ef ******kE*** ***** -**r** •;'F*+E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMENT S - \ 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S . CITY LIC.: STATE UC.: CUSS: HOLD FOR SPFCIA1 ['Pr!nnrAArartrr Date: signature: MAIN BUILDING ACCESSORY BUILDING • WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: 30 FT IN REAR: 50 FT IN FRNT: FT IN REAR: FT., IN Compensation Insurance.or a cenitied copy thereof(Section 3800.Lab.C). LEFT: 25 FT IN RGHT: 6 FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: -OMPANY: PARKING REQ: 40 PROV: 40 PARCEL: 13931322 ZNE; Cl REF NO: PA'-91-1 Certified copy is hereby furnished. 0 Cenified copy is filed with the city Budding Division. PLANNING NOTES> ADD 960 SO FT. MOBILE TRAILER TO EXISTING GIRL SCOUT • > COUNICIL SITE. .ate: Applicant: ************************lE**************36****sk*******3(***********3E******IE*******\ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is fa one lumdred(5100)or less). D E V E L 0 P M E N T SERVICES REQUIR E M E 'N: T S I certify that in the performance of the work tor which ttis permit is issued.I shall not employ any person in any manner so as to become r subject to the Workers'Compensation Laws of California. ZONING APPROVED BY : C4-- -- DATE: :S`" - - Date' Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y S'f: s DATE:' S Code.you must lonhwith 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 BY. .• „�� ,��, DATE• 2.3�" whim this permit is issued)Section 3097,Civ.C). ********************** ' - - .�.7 - • • • - • • • • • *'*********f�7i��**w* *** LENDER: ***************************** *** ***W**************************************** ADDRESS: LEGALIZATION:N F E S U, . • • M MA R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt Iron the Contractors State License Law for the fotowing reason BLDG PMT PLUMBING ELECTRIC -MECHANIC FIRE SMTP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requkes a permit to construct,alter,improve,demolish,or PERMIT 72 . 00- - repair any structure.prior to its issuance.also requires the applicant for such permit to IJe a signed statement that he/she Is Licensed 4 - 4 4 SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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 46 . 80 • i 1 . 05 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEEI, I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> ' PERMIT ISSUE PLAN-CHECK I TOTAL PAID DUE ❑ structure is not intended or ollered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS --> 73 . 05 0. 0 0 46 : 80 , 119 . 85 119 . 85 . 00 • does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through / his or her own employees,provided that such improvements are not intended or offered for sale.It.however the building or REVENUE DIVISION TOTALS--> COLLECTED: . 73 , 05 OVER/SHORT: 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose el sate). BLD72PMMTT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOTOGRADING PLAN-CHECK I.az owner of the property.am extlusivelyy contrachnq with Ikensed contractors to construct the project(Section 7044.Business , and Professions Code: The Cdnlractofs'Stale Licence Law does not apply 10 an owner al property who builds or improves thereon and who contracts for such projects with acontractor(s)license pursuant to the Contractors State License Law).I am aware *******************************************1************************************ that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ 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 ' UNIT COST TOTAL COST Date: S- %Z.3--9/ Owner: _ ! 1 � SFC 50FOUNDATION BY VALUE.PER $100 100. 00 - 5, 000. 00 I do hereby certify that I am aware of and understand the requirements o' Morita Hea and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant v iNvnu not(circle one .eed to coin i with said state codes and the requirements for a permit for construction or modification from the ITITIllry Manager:n' Sir' I.fl;idijor I construction applications are exempt from / these provisions.� (_///// Date: J'?-3 Applicant: 71 f. ' . 1 hereby cenily that I have read this application and slate( the above intor .tion is correct.I agree to comply with all city and county ordinances and state laws relating to building construction a hereby d'• represent ' of this city to enter upon the above-mentioned property for inspection purposes. • /1 c _ _ ' Date:—4----2.3-1/ Signature: / _ DATE: Ei• "'• rT 1 ' t .. • _ Driver's License or Social Security a: 1641.46 Whae—Building:Green—Code Enforce -nr Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING P(, - & _. A . vAPPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Te$orary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement - 3, 'Electrical Conduit Utility•Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Elecirical UP 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 /! i r 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.• Duct's, Ventilating . '' ` 71. Product Piping 0 Gas OOil 23. Gas Pipe-Rough & Test . 72. Underground Flush, , 24. Roof Framing • . 73. Undergrnd.Storage.Tank O Gas ❑Oil 25. Roof Sheathing 74.-Overhead Hydro_ • 26. T-Bar Ceiling (Structural) & Monocoat " t 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 • f i' - .79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' -• "N , , ote'HOLD FOR SPECIAL REQUIREMENTS 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test ' / .6), "get' // Z c 1 36. Hood or.Canopy I . �� nit e_ ',dint in 3v 37. Final Factory Fireplace . 38. Final Plumbing - 6/5-71/ 39. Water Service-Final - - c • 40. Gas Service-Final . 41. Solar Domestic-Final - I 42. Backflow Preventer i 43. Backflow Irrigation ` 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations C . - 47. FINAL STRUCTURE & BUILDING . 48. f I DM'Kf ,_rec an an-7'5 • 49. Electric Release to Edison - •i - • .t � 1 50. Gas Release to Southern California Gas Co -3 j 51. CERTIFICATE OF OCCUPANCY • No Date PROJECT ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 052238 OWNER'S NAME: GIRL SCOUT COUNCIL OF ADDRESS: ORANGE CO PERMIT NO: E 052238 PLAN CHECK NO: N GOVT: N SUPP: N 1620 ADAMS AVE w COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH 979-7900 ARCH/ENGINEER: ROB PATTERSON mawC7748 JOB DESCRIPTION : TEMP. POWER POLE $Q FT: ADDRESS: 18002 SKYPARK CIRCLE UNIT: IRVINE CA 92714 CLAIM VALUE: CALL—VALUE: GROUP OCC: B-2 / PERMITTEE: MAN ELECTRIC (714 ) 228-0101 ADDRESS: 14234 JALISCO ROAD COMMENTS: REFERENCE BUILDING PERMIT #B52185 LA MIRADA CA 90638 ************ ****+E******EEyE*+t***************+F>EEF*>E*Tr+Fk14*+F*x>EI6************* #***** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under pro*' 'of Cha 'r 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my licensee is in full for•:a d effect SETBACKS cITY m.: 0449.48 STATELIC.:506744 ' ' CO ate:..5 9.1_ Signature:_ _ _ ,— — _ _ • - MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm l .Il ha certified a of c enc to self-insure or a cenilicate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lo..C). LEFT: FT IN RGHT: FT IN LEFT: FT . IN RGHT: FT IN • ROLICY NO.: EXP.DATE: 1MPANY: PARKING REQ: PROV: PARCEL: 13931322 ZNE: REF NO: . Cemfled copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES> > Date:5-.3 Applicant *********************************aE********************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thus section need not be com•meted if 1114 . H M one hundred(5100)or less). D E V E L O P M E N T S E- R V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued I shall not . am rson in any manner so as to become lett In the Ztinkers'C^•mmnsadon Laws of California. ZONING APPROVED BY - ' DATE: Date:_S�Jt _4f you l— BUILDING APPROVED BY : Code.y:If.after making his declaration,you should becomes jet to .e ' dens Compensation provisions of the LaborDATE: Code,you must Ionhrnlh comply with such provisions or this roil shat b deemed revoked. NO CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: �`-� DATE• C--3/-1-7 which this permit is issued(Section 3097.Civ.C). ***************************************** • *******ir********************** ** LENDER: ******************************************** ' ********************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15 . 00 - repair any structure.prior to its issuance.also requires the applicant for such permit to life a signed statement that he/she is licensed 50% SMI P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70(10)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 live hundred dollars(S500). ISSUE FEE 1500 , I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sate(Section7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 15. 00 15. 00 0 , 00 30 , 00 30 , 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED" 30 .00 OVER/SHORT' 00 . improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 . 00 J and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • and who contracts tor such projects with a contractor(s)license pursuant to the Contractors'State License Law).t am aware ***********************************•****if*************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F .E E BREAKDOWN 0 I am exempt under Section: B.&P.C. • for this TYPE QTY DESCRIPTIO N.. . UNIT COST TOTAL COST • Date: Owner: • ELE 1 TEMP SERV PWR POLE W/OUTLETS EA. 15. 00 15 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Satety Code Sections 25505,25533,and ,END OF .FEES 25534 and Thal I or any future building occupant will/wit not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from / these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above i. •malion is cor I. agree comply with all city and county ordinances and state laws relating to building construction and hereby aur Me r "enter 0'his dl/enter upon the above-mentioned • property for inspection purposes. r , ✓.10ale:s~�� Signature: ` I/ 01 0008856.4—00028566 008856-CCC00285 61 ""10.L,, 0.1.. Driver's License or Social Security e: 1641-46 While—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING' PL ' S. r Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# .1 , 1. Temporary Electrical Service or Pole : t; , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Unlirgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd:- 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings 1 1 58. Electrical Conduit-Undrgrnd. ` 8. Foundation s "' 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 • 1 64. Plumbing System - Final / v . 14. Rough Plumbing S) 65. Electrical-Final 15. Rough Electrical-Conduit / ' 66. Solar System-Final t 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 & Test72. Underground Flush 24. Roof Framing , 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing • - . . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding . • - • 77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREV. FINAL . 30. Drywall Nailing - " HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat' ' 79: FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 11{ 1 ' 33. Final Electric Notes: 6,/itiQ( I f Th;5 i s 0. . ricer p;PC os 4- 34. Final Heating & Air Conditioning,, _ !• o� '4he +,gig Rte: Feet 35. Final Gas Pipe-Test, I j. (_ _ -eAyt Fotaf f f Cci1•eR 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing • 39. Water Service-Final • 40. Gas Service-Final •• - _ 41. Solar Domestic-Final - • - 42. Backf low Preventer i . 43. Backflow Irrigation • • 44. Landscape irrigation System- _ " • 45. Sound Attenuation • - - 46. Handicap Regulations - . - 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING '/ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co i • 51. CERTIFICATE OF OCCUPANCY - No Date '1W3ECT ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTA MESA - BUILDING' PERMIT PERM NO: B 0519 I OWNER'S NAME: GIRL SCOUT COUNCIL OF • ADDREss: ORANGE CO PERMIT NO: B 051963 PLAN CHECK NO: N GOVT SUPP °r t.s 1620 ADAMS `AVE ` COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT 979-7900 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/RIGID INSULATION S COMP SQ FT: 57, 000 ADDRESS: UNIT: CLAIM VALUE: 57, 000 . 00 CALL-VALUE: 57,000 . 00 GROUP OCC: B-2 / • PERMITTEE: ROSSCRETE ROOFING INC ( 714 ) 356-1091 ADDRESS: 2173 LOCUST (B)(691 ) **MM**T* T ** *** * * * * D ****** * **RIALTO CA 92376 + + + iP+ ** * ** * * * * ** * ***** ***** 6PS **** t******* tE***** EP*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions o .-ipter 9(commencing with Section Z O N I N G R E Q U I R E M E N T $ 7000)of Oivai pnp(J�g Business and Prole sii t Cnd . d my license is in full fore• a elf. I. SETBACKS CITY LIC.: V °' TATE LIC.:4 J'b a GLASS: C3. ate: 7Signature", _ _ MAIN BUILDING ACCESSORY BUILDING S-/ - VFRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN WORKERS'COMPENSATION DECLARATION: Ihereby a um .tlhave ace•,icateofconsent tosell-insure• aceniliwteofWorkers' FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN Compensation Pc9998d5rt4ed copy thereof(Sect n 3800,Lab.;2/01 /91 POLICY NO.: EXP.DATE: •, DMPANY: REPUBLIC PARKING REQ PROV: PARCEL: 13931322 ZNE; REF NO: Cenilied copy is hereby furnished. 0 Certified copy- , the city Buil... e inion. PLANNING NOTES> > • Date: -�— �/ Applicant ��, i��tt **************************************************1F**************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: ifis section .not be completed if the per' t is for one hundred($100)or less). D EV EL OP MEN T S ER V IC ES R EQUIR E M E N T S I certify that in the performance of the work for which this•-mit is issu•.,I shall not employ any per .n in any manner so as to become ZONING APPROVED BY subject to the Workers'Compensation Laws of Coliform.. DATE: Date: Signature: BUILDING APPROVED BY : DATE: • NOTICE:II.alter making this declaration,you should become subject to the Wolters'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. I ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: Y DATE: S�7 F/ which this permit is issued(Section 3097,Civ.Cl. ******************'**** '******' * ****** ER: ***************************************** ************************************ ADDRESS: LEGALIZATION:N F E E S •U M MAR Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRESMI P/RES , GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 446. 00 _ repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SM I P/NOW-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 11 . 97 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation. will do The work, and the TOTALS----> 457. 97 0. 00 0. 00 457. 97 457. 97 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Cade: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through . his or her own employees,provided that such improvements are not intended or o0ered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 457. 97 OVER/SHORT- 00 improvement is sold within one year of completion,the owner vitt have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/TOT GRADING PLAN-CHECKK or the purpose of sold' 446. 00 11 . 9 7 I,as owner of the property,am exctusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Cade: 711E Contractors' tate License law does not apply to an owner of properly 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 Drool 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 ❑ I am exempt under Section: B.8 P.C. ' for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST • Date: Owner: SFC 57000 REROOF BY VALUE COMMERCIAL NOZONE 1 . 0057, 000. 00 I ' I do hereby certify that I am aware of and understand the requirements of Cabfornia Health and Safety Code Sections 25505,25533,and END OF FEES - 25534 and that I or any future building occupant wit/will not(circle one)need to comply with said state codes and the requirements for a i permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from these provisions. ! Date: AaPlicant: I hereby certify that I have read this application and state that the above information is correct.I aor•: .comply with all city andcounty „11///// ordinances and stale laws relating to building construction and hereby au• -'-:representatives of i•Jo' to enter upon the above.ntemenlioned property for inspection purposes. !i-QE 5 7- 9/ 5gnamm' _ tea, t 01 00086759-00036760 1-07 '' '0- _ ' ‘....__' 1641.46 White—Building:Green—Code Enforcement Canary—Applicant;Pink—Revenue:Goldenrod—Assessor `I• COLI-RUCTION AND PLANNING P0, A / APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector is • 1. Temporary Electrical Ser4ice or 44 Polea 52. Pool & Equipment Location 2.. Soott Pipe-Undrgrnd. ' -'1 53. Steel Reinforcement , 13.:Ele`ctrical Conduit Utility-Undrgrnd.= , , 54. Forms - . 4:'Elec`trical Conduit-Undrgrnd. • 55. Electrical Bonding •- 6-Stell Reinforcement 56. Rough Plumbing & Pressure Test 67 Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE J. „ . ,7. Footings ._rConduit-Undrgrnd.58. Electrical = - - 8. Foundation ' .'J % ^ 59. Gas Pipe, 0 Undrgrnd., Test ,' .1. Water Pipe-UntJrgrnd. /;• / 71 - 60. Backwash Lines,P-Trap, 0 Undrgrnd. / ' 1,0. Structural Floor'System .., ••• `� 61. APPROVAL TO DECK ,, .. 11. Property Sewer Line & House Connection ; 62. Backwash & Receptor-Final 12. Sewer Cap �• T i; ,:i 63. Heater & Vent-Final .. 13. Roof Drains '; / 7' t ' '/, ,- 64. Plumbing System - Final / 14. Rough Plumbing T •V 65. Electrical-Final / 15. Rough Electrical-Conduit i ` 1'. 66. Solar System-Final '', 16. Rough Electric Wiring1. ft, 67. Fencing & Access Approval 21 17. Rough Wiring•Sign 1 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 'i4'' ' = :i D d* . 'APPROVALS' Permit 4 - >' 'T' r. a .T tt;rf, 4 1 -, T r t :� a, 'y O:l-•;• .r 21..Ducts,in Structur1.11 e< .. ,J -. x 1 .-- .' .70. Underground Hydro. r 22."Ducts, Ventilating.) ' a _ s �tw n . -71. Producc.Pip'ng G Oas q Oil t• ~ s^ J is -'r a ;' n I , , el _ 23.,Gas Pipe;Rotlgh &Test fns t „ - , C • ;272. Underground Flush..6 - - 24: Roof Framing , 'it 7 > ^ I , . 7316 Undergrnd.Stocagg Tank 0 Gas 0 Oil " ` 'CO T IA '- CU a :i .3 1- • :-,c- 25. Roof Sheathin g.r. v• pi, a 74�Overhead Hydro) -a 26.T-Bar Ceiling (Structural) &•Monocoat : - -7- r 75?Dry Chemical I ;' • C -C 2T"Frame and Flashing 1 t` 3' `t :1 ' 76. Dry Stand ie ' 28.4 Lathing:& Siding .. --[r,i . + X ••t • ' 77x FIXED SYS_TEMF,INA: �, 'T -4 n'29. Insulation a r - , .* i t, ' 78.: FIRE PR EV. FINAL . > a: } .x'30. Drywall'Nailtng > I j- I. "'> H •HEALT ,DEPT. REQUIREMENT 31. Plaster Brown Coat . r I , .k "+ .79 FINAL INS3ECTION �, ` 2 32TElectrical Power-Meter-Final . 07 I .„ ,.:80y1FOOD CERTIFICATE ISSUED ,, 33Final Electric " r:i `t T • I :�; ' ;)-1' Noes: 3' :S_ v r Ti •:rr x . ?:T ,.34; Final Heating&,Air Conditioning I .Y- . A' ; ♦ •J 35„Final Gas Pipe-Test' i ' ' i 447447/9(/ 036. Hood or.Canopy 1-, _) t r'7 •+ �,. i - r r 37,-Final Factory Fireplac .. e :e` a' 'i I' 3' tc •-38. Final Plumbing ;i • :.: • I ,. » .T �,,Z--`.` r + u _ -39. Water Service=Final m .- '•T1 ! is W p : q. rrr ;.,40. Gas Service-Final T „ J. ,- ;. .. ,; ; Er! :L.. 13 1 '41. Solar Domestic-Final_. •• I 4 .• - o, `4 � 7; 42.SBackf low Preventei ' -' ' ! Er • ? �:., - 43. Backflow Irrigation a;S.`." . 4 a.f-: 4 I: - .,44. Landscape Irrigation r w System, ,. '' J r .,. p - `. y .r' ,i - ;t CI -45:_Sound Attenuation 46^Handicap Regulations - ' ,i <; • _" 47• ::FINA L STRUCTURE & BUILDING + r' • 48`..FINAL PLANNING I I' - 'KS 49. Electric Release to.Edison i I / I. '• `•L: '+ r 50.tGas.Releese to Sou[hern California Gas Ce ;, I i �, r -; inal �!� _ Jam--•__'. � � 51. CERTIFICATE OF,OCCUPANCY • „ ,,, :• - .-_ . No Date , it `7-.a• 7 AODREssa9tRLDwa 1620 ADAMS AV UMT: CITY OF COSTA MESA - BUILDING PERMIT OWNERS NAME IF KNOWN: GIRL SCOUT COUNCIL PERM NO: P 084994 ADDRESS] 1620 ADAMS / P.O. BOX 37391- PERMIT NO: P 084994 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92626 IA, APPL.MIUNO ADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU PURPOSE: OTH ARCHITECT OHENONEER: UC.NO.: JOB DESCRIPTION : REPLACE TUB & SHOWER & VANITY SQ FT: ARCH.OR 010.'5 ADDRESS: UMT: CLAIM VALUE: CALC-VALUE: GROUP OCC : B / CONTRACTar5PUIC THE EARLS PLUMBING ( 714 ) 524-4300 CONTRACTORBMMLRIO 501 N. PLACENTIA COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT ADORES& FULLERTON CA UC.NO_ 217657 it***it*****atit*3t**NSE*it****i ******ft*****+EiEiE******itit**iE***;E*****it;E*itit*;t*;E*at*+H;E;f**iE* 92631 MMT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby Slim under penally of perjury that I no licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 d the Business and Proteseldu Code,and my license is in lull force and effect. CrrYUC.No.: 005938 UC.CLASS: C-36 UCNO.: 217657 EXP: 06/98 MAIN BUILDING ACCESSORY BUILDING /� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Aar I 1-74-,-.. -��- LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN • NER BUILD R DECLARATION:I hereby alum under penally d perjury that I em exempt from the Contractors License Law for the following reason(Swion lents Business and Profession Code:Arry ally or aunty which requires a plunk to manus,alter.buyout, PARKING REQ: PROV: PARCEL: 42534110 ZNE: REF NO: is iii shed or tepee tthe provisionsofto issuance.entraLicealso nse thees [C applicant (commencing such nem*twithMSwmed70 )of�Div'esionh3 or theoPLANNING NOTES> Business end Professions Code]or that he or she S exempt therefrom and the basis for the alleged exemption.My violation d Section > 7031.5 by any applicant for a penrS subjects the applicant to a dei penalty of not more than foe hundred dollars[S500]). ******************************************************************************* 3 I,as owner of the property or my employees with wages in their sole compensation,wig do the work,end Me structun is not intended DEVELOPMENT S E R V I C E S . R E Q U I R E M E N T S or offered for sale(Section 7041,Business and Professions Code:The Contractors License Law does nal apply to an Owner at property who bulds or improves thereon.and who does such work timed or horsed or through his or ler own employers,provided that such . own.oveement'„wmin ham,,,,the burden faradfor f proving lee'npeid rna'bMha'bM�«�mprraanef °"'is w eaie„Ie)hin°ue''nrdoa"'pSbn,"'e ZONING APPROVED BY _.. DATE: o I.as owner of the properly',am exclusively cantrWonW ng with licensed contractors to cuct the project(Section 7044,Business and - Professions Code:The Coarmos License Law don rho(apply to n owner d property who busies or improves thereon and wen BUILDING'APPROVED BY : r DATE: contracts for such Protects with a contractor(s)licensed pursuant to the Contractors License Lae). - . o Iern exempt under Sectfon: B.AP.C.,for this reason: APPLICATION ISSUED BY: ... wY DATE: to .z Date: Owner: *************************i***** * * *************************************** ** LEGALIZATION:N F E E S U M M A' R Y STRUCTURAL SEGMENT:N I do hereby certify that I am aware d and understand the requirements of CaJornia ReaM and Safety Code Sections 25505,25533,and j 25534,and that I or any More building occupant will/will not(de:le one)need to comply well said pate codes and the requirements for a permit for construction o modification from the Ar Ouaky Management District.Residential m ninsmdionappications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 5 . 50 Date: Applicant: • 25% SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under Penally d Pe l%la of the Wang dedarel'one: PLAN I have and wma certificate e consent toseffisme M workers'compensation.as provided for by Section 3700 of the Labor IUILE FEE 22 . 00wilmentalcode. orthepedmamedMworklprthis whichPermkis issued. BUILDING DIV > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE o lhave and w;imaintanwmkra'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the TOTALS----> 5. 50 22 . 00 0 . 00 27. 50 27 . 50 . 00 work lot which this permit is issued.My woken'compensation insurance harder and Poicy number a Carrier: „STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 27. 50 OVER/SHORT: . 00 Policy Number: 1441S01 -97 03/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed y the perm*is for one hundred dollen(Wolof Ass./ 27. 50 • I certify that In the performance al the wok for which this permit is issued,I shall not employ any pence in any manner so as to Same subject to the wadars'oompeneaion laws of Cefdmia,and agree Nat S I nodd become.ubpd to the wwkan' ******************************************************************************* compensation previa'. . ci ..Ins 37a d to Labor CuMele,I el forthwith Oen*with Nae provisos. i �� APPINDIVIDUAL F E E B R E A K D O44 N CO Iam; _`-- r.� L subject employer tocriMrMlpenaltlaand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Warning: up one hundred thousand'compensation coverage la unlawful,allontothe cost of c tan Section ones r9 to Ica died Cahn($rney'a A N.trObn N.sue romperwba damages u Provided for In 3706 of the Labor Cob,Imaru4.nd.ttpmsy'.nes. PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5. 50 5 . 50 CONSTRUCTION LENDING AGENCY: I hereby affirm under penny d perjury that there is a oomnwfon lending agency for the END OF FEES performance of the work for which this penal(is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that Me above information is correct.I agree to comply with at dry and aunty ordnences and state laws relde g to building conhuoion and hereby authorize representatives of This Cry lq enter upon the above-mentioned properly for inspection purpoaes. STEVEN EARL NELLESEN Print Name - 18-82-1997/18:55 Mi/$27.510 Date: 4/ , 9 r 4813176 Signature dawedAg.w•:• -. . redo PERMIT:984994 (5151'45.W P) White-Buildng A SSely Green-AM:Canary-AppFau:Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING _ POOL & . APPROVALS Permit# Date Inspector APPROVALS Permit #. _ Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. - ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -6: Electrical UFER'Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit:Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test - O. Water Pipe-Undrgrnd. - • - 60. Backwash Lines;P-Trap, O Undrgrnd. " 10. Structural Floor System 61. APPROVAL TO:DECK 11. Property Sewer Line& House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent•Final , 13. Roof Drains 64. Plumbing System • Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit . 9 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing-& Access-Approval• 17. Bough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling ' - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT.,SEQUIREMENT ,_ - r • 20. Rough Factory Fireplace . APPROVALS_, Permit# i -- 21_ Ducts,inStrudture' > - 70. Undergrourid Hydro • -r 22. Ducts, Ventila`ing.: 4 , - , . 71. Product'Piping 0-Gas a Oil 23. das Pipe-Rough & Test /O 3 72. Underground Flush - 24. Roof-Framing" r . , : 73. Un ergrnd.Storage Tank. Gas O Oil 25. Roof Sheathing - It '.t . • '`• • r 74, Overhead Hydra _ '' 26. T•Bar_Ceiling (StrgGtural) & Nlonocoato- = 1. •`r `' 75: Dry Chemical ` .• 27. Frame and Flashing . -, r- - , - • 4` 76. Dry Standpipe : - ` 28. Lathing Siding'2 it 5 $1 _• i .. • .. , 77, FIXED SYtTE,M FINAL , 29. Insulation - • a ! 1- 78 FIRE PREV, FINAL " ' 2. ..-• 30. Drywall Nailing • : It ;H4ALTtI DEPT. REQUIREMENT 31. Plaster Blown Coat < I . . 79. FINAL INSPECTION - 32. Electrical-Power later-Final t ' 1 ' " BO. FOOD CERTIFICATE ISSUED 33. Einak;Electric. . .r ' Notes: • • 34. Final Heating& Air Conditioning ' - r , 35..Final Gas Pipe,Test . ' , . . _ r 36. Hood or Canopy ' - --• k - " 37. Final Factory Fireplace _ _ 38. FinalPlumbing -_ : (O6h7 S' • . - r -- 39. Water Service-Final ; . ' 40. Gas Service-Final 1 ' - - - .. - - r 41. Solar Domestic-Final - _ - °; . - 42. Backflow Preventer . - k - - i - • 43. Backflow Irrigation ; , 44. Landscape Irrigation System = - 45. Sound Attenuation- • " " 46. Handicap Regulations - 4 '= " iri 47. FINAL STRUCTURE & BUILDING *- 48. FINAL PLANNING - - - - O a" 11riIn.21 49. Electric Releaie to Edison z1 50. Gas Release to Southern California Gas Co •',='a, _ 51CERTIFICATE OF OCCUPANCY j I �e No. Date A pr \iF PROJECT ADDRESS: 1620 ADAMS AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 05227.- OWNER'S NAME: GIRL SCOUT COUNCIL OF ADDRESS: ORANGE CO PERMIT NO: P 052273 PLAN CHECK NO: N GOVT: N SUPP: N • 1620 ADAMS AVE . • COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH . 979-7900 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION , INSTALL THREE ( 3 ) ROOF DRAINS . SQ FT: ADDRESS: • UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 / PERMITTEE: RESCUE ROOTER- ( 714 ) 835-1602 ADDRESS: 1085 N MAIN STCOMMENT RE: 051963/COMMERCIAL REROOF PERMIT. • ORANGE CA 92667 ******>F .cx************ **** ***>FSE******************IX X.**ate* ***>f*x***Nra*******>F LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SE TB ACK S CITY LIC.: 034408 STATE LIC.:353170 cLAss:: 36 Date: Co ^ 1.1 / Signature:7_ �- �!� 7� MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seg-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.: 1 )WC1748889 EXP.DATE: 01 /01 /92 • • COMPANY: PAC COMP INC. PARKING REQk PROV: PARCEL: 13931322 ZNE: REF NO; ❑ Codified copy is hereby furnished. 03 Certified copy is far r the city Building I ision. PLANNING NGTES> �/ lir • > • )ate: b� —! ! r Applicant: _ s L / / ***#f***********j(******************************.******************** 1f********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit s for one hundred($100)or less). DEVELOPMENT SER VICES REQUIREMENTS r I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE Date: Signature' BUILDING APPROVED BY NOTICE: . . . — de, If,afterstmaking thiscywideclaration.you should become subjectemithe Workers'meensation provisions of the Labor : ��4"--,1-1"6"1" � DATE Code,you must forthwith comply with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: �� _ i// - DATE which this permit is issued(Section 3097.Civ,C). ********************** "!' **************** ** LENDER: **************************************** **** **************3F****************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N •OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT i 6,00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% • SMIP/NON—RES pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 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). ISSUE FEE 3 .00 I. as owner of the propene or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID - DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: -The Contractors'State License Law TOTALS----> 6. 00 ' 3. 00 0 . 00 9 . 00 : 9 . 00 . 00 ' does not apply to an owner of a properly who builds or improves thereon.and who does such work himself/herself or through . - , his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 9 . 00 OVER/SHORT: 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve • Mr 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 - 9 . 00 ❑ 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 ContractorsState License Law). l am aware ****7F*****1r****************************3f*************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B. 8 P.C. • for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: OwnerPLU 3 ' RAINWATER SYSTEM — PER DRAIN 2 . 00 6 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES l 25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a , permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. • Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county • . ordinances and state laws relating to building construction and hero de horrepresentatives of this city to enter upon e above-mentioned property for inspecGtiioon purposes. / ' • Dale: Signature: a/P ��/ ��a Driver's License or Social Security N: 01 C0083S61-00068361 TOT '.tic, •\ 164'46 While—Building:Green—Code Enforcement Canary—Applicant:Pink—Revenue:Goldenrod—Assessor DATE: 06/0 4/91 TIME: iS:Ci CONSTRUCTION AND PLANNING POOL & APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5.,Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation tai CV 59. Gas Pipe, 0 Undrgrnd., Test . 9. Water Pipe-Undrgrnd. f• 60. Backwash Lines, P-Trap, 0 Undrgrnd. -' 10. Structural Floor System /' 61. APPROVAL TO DECK '/ 11. Property Sewer Line & House Connection y; 62. Backwash & Receptor-Final 1! l' . 12. Sewer Cap / •.;'� 63. Heater & Vent-Final _I/1 13. Roof Drains k%� -O ( - 64. Plumbing System - Final j 1111 /, 14. Rough Plumbing .44( -�� 65. Electrical-Final / 15. Rough Electrical-Conduit r-' %i 66. Solar System-Final 16. Rough Electric Wiring 11 ! 67. Fencing & Access Approval e% 17. Rough Wiring Sign ,' ' 68. APPROVED FOR PLASTERING ( ' I, 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure - 70. Underground Hydro, .• 22. Ducts, Ventilating 71. Product Piping 0Gas O Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank It Gas CI Oil 25. Roof Sheathing 74.•Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashin ' 9 - 76. Dry Standpipe 28. Lathing & Siding - - 77. FIXED SYSTEM FINAL 29. Insulation , - 78. FIRE PREV. FINAL 30. Drywall Nailing I '- 01 • HEALTH•DEPT. REQUIREMENT • 31. Plaster Brown Coat -',, ,79. FINAL INSPECTION 32. Electrical Power Meter-Final - j. 80. FOOD CERTIFICATE ISSUED 33. Final Electric �:. t, Notes: - 34. Final Heating & Air Conditioning =:1 1 35. Final Gas Pipe-Test I/ . 36. Hood or Canopy • / - 37. Final Factory Fireplace - ' 'A . f ' ' 38. Final Plumbing t/ (/ 39. Water Service-Final '� - 40. Gas Service-Final j. 41. Solar Domestic-Final - ' 42. Backflow Preventer- i 43. Backflow Irrigation - . 44. Landscape Irrigation System . - 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING ' 48: FINAL PLANNING " 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY . No. Date L 8904 2/06/93 ie Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ' CITY OF COSTA MESA - CONSTRUCTION PERMIT PERMIT pfy.h��/ TRACT NO. LOT NO. UNIT N6. Project Address 1(o 30 A-mei r,S LcSF-.s NARtl� /(/oI 1 -Applicant's Mailing Address 1 - 1 • TYPE OF CONSTRUCTION LJ NEW ❑ ADD H ALTERATION H REPAIR • Owner's Name G t1 S SCc c,- CcgrNC\` Phone c - c -790D ❑ CONVERSION 111 DEMOLISH ❑ OTHER - A.P.# - I Zone • DESCRIPTION OF WORK/USE OF BLDG. Address I to"LO V�QN....Y Cl of - l-'l S Main Building: - Accessory Building: •Arch/Eng. _ License No. - TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LJ STRUCTURAL E Front' . ' O Address � CI TENANT ❑ ELECTRICAL IDPLUMBING ❑ MECHANICAL _ B Rear - • _ N Contractor's Name Srs41Y r\lap"Stu(• Phone 07 r)-3Ll'w ❑OTHER A' - I PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right - N Address(mailing) 153'3 ate.,, LALCOIN K _ G S ' 3% CON ST RUCTION TYPE VALUATION$ S Left R rty License NO. ZONE GRADING CU.YDS ACRES /LICENSED CONTRACTOR DECLARATION ' Pl ng. Ref.# • ` Perking Req./Provided E 0 .1 hereby affirm that I am licensed under provisions of Charter 9(commencing' Remarks: Planning Notes: - - M with section 7000) of Division 3 of the Business and Professions Code, and _ T - ( my license is in full force and effect. • _ ''\\�'I .License Class C-'- 3G n License No.rd'7 w,J - - S Ye_ 'Z-� -� SignaTTie ��j... PLUMBING FEESKERS'COMPENSATION DE LARATION Bar Sink Showers reby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' .) mpensatign I y/s`wance, or a certifietl ectlonw Labs CJ fry � Ibi Backflow Preventer - Service Sink - Automatic Wisher " Transformer 0 15-50 KW blicy No. l/ 6 j Company } Backflow Irrigation Sewer Ca 0 50+KW l P Construction Pole Sub. I 1 Certified copy is hereby furnished. - Certified,copy is.filed with the city B ding ion- Bathtubs Sewer Connection , Cooking Unit : Meter ❑up to 100 amps 47..—atr — —ar Applicant\ N . • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps ' (This section need not be completed if the permit is for one hundred ($100) or . . less). Dishwasher Solar Piping , • Dryers ❑Gas .❑Electric i • 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 Drinking Fountains Solar Tank Fan Motors 00-1•HP ❑1',-6 Workers' Compensation Laws of California. Date Signature -- Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE:If,after making this declaration, you should become subject to the Inc.Solar ❑g-15 HP 016-15+ .. Workers' Compensation provisions of the Labor Code, you must forthwith - Floor Sinks Urinal - Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater - Outlets Lender's Name - Range Lender's Address _ - - Kitchen Sink Water Service OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' - Auto-Wash Garbage Disposal . following reason (Section 7031.5 Business and Professional Code: Any city or 9 P ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays ' Generator 00-5 KW 05-15 KW Trash Com actor any structure, prior to its issuance, also requires the applicant for such permit - InIP . to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains N_1 ✓O , the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 1✓ U� $XOs'�- Division 3 of the Business and Professions Code) or that he/she is exempt • 1 rQn s. therefrom and the basis for the alleged exemption. Any violation of Section La-JOU ' W b C, 7031.5 by any applicant for a permit subjects the- applicant to a civil .„ ' penalty of not more than five hundred dollars($500). I . I, as owner of the property or my employees with wages as their sole Reinspection Fee, ! $15 Issue Fee $ 3 .ompensation, will do the work,and the structure is not intended 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 her own - DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler ' Hood or Type I 0 sale. If, however,the building or Improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date ' pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date • • prove for the purpose of sale). . • 0 I, as owner of the property, am exclusively-contracting with licensed con- Duct-.Structural - Refrigeration System • Application Issued By Dates , tractors to construct the project (Section 7044,Business and Professions Code: - - ' The Contractor's License Law does not applyrto an owner of property who . Duct-Ventilating - . , ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,-and who contracts for such projects with a con- - - - tract or(s} license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration • BUILDING PERMIT $ , SMTP $ • proof of theirWorker's Compensation insurance should be provided to me. O PLAN CHECK $ PERMIT. 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers• PLUMBING $ r11 ISSUANCE $ I Date Owner Heating System& Ducting Registers $ ENERGY P.C. $ PLAN CHECK 25% I hereby certify that, I-have read this application and state that the above- - 00-100,000-BTU 0100,000 BTL - - - $ GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL ' and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $, sentatives of t��iiiiiiis city enter upon t ve-mentionetl property for Inspection pur6o385. S'gnature �•\\// Date --C.—PC, MECHANICAL $' ' TOTAL FEE $ 7 O •rivers' License or SS# • Reinspection Fee $15 Issue Fee $ 3 , PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING •r • POOL & F APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector '1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - • 2. Soil Pipe-Undrgrnd. 53': Steel Reinforcement - 3: Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -6. Electrical UF ER Grnd. I- 57. 'APPROVAL TO COVER-G UNITE -7. Footings 58. Electrical Conduit-Undrgrnd. ..8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test I - 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System - • ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - I 12. Sewer Cap - 63. Heater & Vent:Final • 13. Roof Drains • - 2_7-eL c40 64. Plumbing System - Final • • 14. Rough Plumbing ' 65. Electrical-Final 4. 15. Rough Electrical-Conduit 66. Solar System-Final - _ _ _ 16. 'Rough Electric Wiring 67. Fencing &Access Approval - -- - r 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: Rbugh Factory Fireplace APPROVALS Permit# • • ' 21.-Ducts,in Structure 70. Underground Hydro l 22: Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test - 72. Underground Flush • 24. ,Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing 76. Dry Standpipe ' . 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREV. FINAL • 30. 'Drywall Nailing HEALTH DEPT. REQUIREMENT . - , 31. Plaster Brown Coat • 79. FINAL INSPECTION '32. 'Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED t 33. Final Electric " Notes: - - - 34. Final Heating & Air.Conditioning 35. Final Gas Pipe-Test - • 36. Hood or Canopy- .. - 37. Final Factory Fireplace 38. Final Plumbing 2,-1-84 £i i0 - 39. Water Service-Final 40. Gas Service-Final 41.'Solar Domestic-Final i 42. Backflow Preventer , - • 43: Backflow-Irrigation . • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , • 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co ' ' 51. CERTIFICATE OF OCCUPANCY I No. Date ' `P . _ — CP i , DOUBLE FAD ILWMNATED MONUMENT 40. Xlo=o'" For Inspections P ons C Csfrtenyr r3P.&E. 3- b lDw 5-1721V Call `- n c'I — _ 627) Z2u—� _. 7- T„ LOUT COUNCIL a N • GIRL S 14 3y 48 OF ORANGE COUNTY 5” O1ri; i a3G -T - — - ! rt. TiL G' i -Y.^-r I1'1 '�>.lt•..r w a4 4e4144. ''',i' - '. -'` h`3 •;4- ,`. q_ 'ley; le r1Va_'1N4" �'� 2 y";i.,,i ^�.4>6 �V *,.;rex ..r •i .. I ,%* t i. r. .,,,/� 5,t-r{ r it-.4.;e '..y. ,its; -i �.Ce r ISG v'LN . + kirS S,Cf - it ,.1 • k. ,' - ay WI ; . P .'�y ,,,< •` .,l (�F J(,. .YK!@• •j'r+<�ii % ^. r.. {.• -0 •1. � r -. •}, li D_\r 11 . �� t Si `..4. "" atail .� : +;) .a.-i'�rKvu'ik1;� � a.. ' - \� • � ) � = r_ - .-, '4 .��•.• .y\�.^ ,4`A ':'V��Y�T IS I ..�.I y `e, 4 of Costa Mesa Building Dept. ! t ! ,t z�i'�ec * c,QJ-.5 ,s_.. 1 0 FAcKC�ROUND - tOORY Z14�Av SIP Ccah'CE'/t�� to �na-ccu 8� THESE PLANS MUSE BE ON JOB AT ALL TIMES 1 s-C1ER5 — GREs. -1: .2•1 OS u•'Rt., „�„ _D 86 d I MAKE NO CHANGES WITHOUT PRIOR APPROVAL'i a — --- OF DEPT. (/ O / t� PPR THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL \�n LIN1r - vLGF\ r1EX - . T. APPROVE' a`•.i t Q cr OF PLANS AND SPECIE:CATIONS SHALL ROT BE COR3TRUED GREEKS . 2%O�j 41 • ";:::41 .11.... y'_�I 1' i CITY OF COSTA MESA 10 BEA PERMIT FaR. OR AN APPROIAL OF, ANY VIOLATION I ° LO(z G —' , ;t•:�;;I� PLANNING;KEPT. OF ANY OF THE PROVa1Ot5 OF THG COO:. NO PERMIT PRE ,140 . . •• • {UTUECr TO ING•L'DFP.T. REO. SUMING TO GIVE AUTHORITY TO VIOLATE OR C�.EEL THL ° COtgIf�1ET` — DK (RXt31`) EA3A aL PROVISIONS OF PHIS CODE 514111 BE VAUO, WEPT in t6 `rea ----.DATE_ /84-- FAR AS THE WORK OR USE WHICH H AUTHORIZES IS Wiag., - DIRECTOR OP 1{ANNINO 1HE ISSUGHLE OF A FEIDOF BASED UPC?$PLAN¢ANG SPQ iZAHo S&TAIL AOF FREVcW THE ETSPMO OFfIWL ono Band ra RE07FifV6 INF CO!I>ScmI t woo • , BB SIC3 FLf„A6 CO SeiCieEfAT= 02 TCCO Mentor b LoESTGosS rS.c.4vJS_ (g$4 A mon=annzuntsucuc C.T ' nti Tt1:RJiUI061a WHV . IN 41OCAEIL7$CE 1R3E cal GFS OF Asir Ow.Q'd:dCi3.`L�I. -... . I t=THE QITY. - • t .t S :it`u A, •• r • • CAUTION STRUCTURAL APPROVAL ONLY ELECTRICAL LINE CLEARANCE REQUIREMENTS 'N ACCORDANCE WITH STATE SAFETY REGULATIONS, IF .. . SEPARATE PERMITS ARE REQUIRED ! CONSTRUCTION REQUIRES WORKERS, EQUIPMENT,CRANES FOR ELECTRICAL. PLUMBING. OR HOISTING DEVICES TO BE IN PROX!!..IITY OF OVERHEAD HEATING, VENTILATING ANG I ELECTRICAL LINES, OR UNDER CROUND ELECTRIC REFRIGERATION WORK FACILITIES,CALL SCiU T h!' :iN C::1J NIA Et IUGN COMPANY i IMV:r.,rI I E V (7' &C;0::1. . Permit #r`.6-ZZ 75-8; j THIS NUMBER MUST ACCOMFAN: ALL INSPECTION REQUESTS I FOR BUILDINGS WHERE PERSONS ARE T li No Final Inspection Will Be Made_, " - EM.PLOYM, WE SUGGEST THAT THE WI,Uc CALIFORNIA DAIMON of INDUSTRIAL SAFETY UNTIL COMPLETE SUBCONTRACTORS LIST IS APPROVED. RE ce LI"tS. £o FOR g OITIDNkt BY CITY BUSINESS LICENSE DIVISION. i . . Rf.0O1REMENiS. • -- • .. 1�8 R wcs • 3( - _` IL,L.UMIIVATET, 2�'j�i T �� INET WitH 511�£TMETAt, RASE TENCOATtp WE MoNUME ►JT - J SEPARATE PERMITS ARE REQUIRED r In! FOR ELECTRICAL, PLUMBING, I { T" Atm" w/ 1 4SE I D !� H G, VENTILATING AND �0; Ia FI(MpgI WORK , 1 ' • . SIDE — I 1 I VIEW - Permit # . 1 I I I I �S�C II,z A►�1C.LE Nal11 10I MS !4UMAER MUST ACCOMPANY I i10I SUDADQT GR11ME• 10, Y�."X3S�i LASS g.5'4E11)5 A�,. „TION OEGHES I I (n TYP. 2 ) I I--•-22--i i aI 10�- o 1 PLO /44455, 455 , FOR BJILCiti0.$ WHERE PERSONS ARE 10 FE EMPLOYED. WF SUiiiiES! THAT THE STATE Of i CALIFORNIA OIVISIDN JF INOUSIIIAI. SArn• I o EEK Leaks REQUIREMENTS. TEU FOR AQUIIIUn"i ` 131 AS-b-rano \I a a 3A 0 PLEXICALA$S BACKGROUND ,voRY 22 GA,.Ii41112ErA,NECIS 7 W. 54REEKII LETTERS �. REV I E L • S®taK LPt(QAS \ L" ) als3Tb servo 31 ENAMEL • \, r . —I Wi///////I i' 1 71/77.77.7 7_7777 7 777/7777 77///7 7 7/ 77/7/717- 1210 co& ED _ c I' •►' :•. . _ 1 1 - i ! IYaY I a AN ALE IQDA! BASE. i . •• • , I Ih.I An x 3%i LAGS 1 slabs PtiarTE� 8} ib EE - - - - i R}' C lv Yn ' ' • e COA.C. reo�,J &i q ,' G ,NLCcI S1. ... 1M. _ tem EN'f PAD • - 12"x22" &//2 71r473 . z #4 iroTTzA+ . ... • (488 we -(Rica. X to' M�Nt)titil�►JT. - - - - — -- - _ _ __ - t -- - - - 1 LI157iwG ELwra;os I TSP Uie .j 3 rapLAS s LPs H 4 I 1 ■i Pyr . oTR+UCTURAL APPROVAL ONLY I SEPARATE PERMITS ARE REQUIRED E51t>E 1 - - — -- 7a ELECTRICAL. PLUMBING. vigv � - —" - —� —" — - - - - - 1 EAi1NG. VENTILATING AND t REFRIGERATION WORK I emit #_-________ _ 3 ROWS 10� UO LAMPS HIS NUMBER MUST ACCOMPANY �i ALL INSPECTION REQUESTS i III — ` t k1uAY UstC;Pl�s K'aff;E a f HAIIAST roe u. ( BALLAST �7Av, YFO. K'E SUGSEST THAT S ARE FO OF I RNI4 DIVISION OF INDUSTRIALtME STAEE Of j 3•Sew.l» S'S^""'/•• I RDf SAFETY OR RC01TIONALEMENTS. 410 i Ns I. f �l FASThJG F1&CERLCAL PRIG u fill .51a? i • (,1{ZA4J� ( j meEA•t, C EMT piAt> . Q� i l" { it { JI c • PUC tit/ CONDUCT. t .• T I r �'t. w.[....., !,[cyfn.t rvanlarr il[ -- \ < e _ trSTR CTURAL APPROVAL ONLY ''" 'A ATE P �I h PERMITS ARE REQUIRED �� n_Cu7 � FO ELECTRICAL PLUMBING. 1�1 1 �ti � n. I M HE�TING. VENTILATING ANO /; ,..r. ,t t[ v , NrL r N4.C;•l Son a. C ,I. 'REFRIGERATION WORK Ian r r r_ti y.� y / [ �fl r —�.� . Y.Nr4111 ![4.[,•.. IL'�� IS t4 LIMPER n�� %II e_ ( r �'.l.STACCOMPAN 1.::,. - "VT-1 ; 1, .' 1 INSPECPTON REQUESTS 1�1` run i/ in II 1 .�{�� `, \ / / I':T-1 r ' ��10l 701: O t t W SI O DO FOR 8UROINGS WHEAL PERSONS ARE f0 gf I I W I G+ 1 - - , '' �->-'I �� y .y � ' • E SUGGEQ�IH T• T f STATE a • [w..[Nr owl us[Nu Sitio POOL lit 11 �! �:" iLIEU nrNGUSTA14l SAFETY" uli . NS>l;EU FOA A `^ R �9 a.. COITIONAL f �• — 1 IAMENiS. CI a I I � CC / t� MC[nCN Y[. Dr1— . if J i '•• , ! taNr.[cur..w.a IAN i I WOKEN ; .tan.0 '`�' O p Ire • �- i' c rWr N icC..,.D / I R 23' .‘,„ 2•;:.:, • ,r,\\ . gn in • MOWN LI IJ Ll -_� —Iv 9"z • )UT CENTER \ �4�� PLAN �_ .Y `N, ,1 _I\ ..... . ... 1620 ` 18" high \ a:._ . _ .. DRIVEWAY �-. .R-em OiC /9,5:0'4 fy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. " CITY OF COSTA MESA CONSTRUCTION PERMIT r PERMIT NO. TRACT NO. 1 L�NO. • UNIT NO. B3B7 B/09/85 153.;.; 1'1_ Project Address y O ?��Y/�/ S' 1 if0.✓L a f • ['o�-- TYPE OF CONSTRUCTION U NEW W ADD LJ ALTERATION H REPAIR Applicant's Mailing Address p /L0gc(-04$1.-.- _ _ 0 G' �, JG G. 57 0 �// ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ^ / Owner's Name Phone 'r6 0/10 ,. --TT-,,'' ..,,''�� A.P.AP # )' / 3 �3 d � Zone I DESCRIPTION OF WORK/USE OF BLDG. t 'C 7 -+'--v / -"" Address• -�:3 /S ��%R v/GMK/ `i/�f r�/ - S Main Building: Accessory wilding/ Arch/Eng. t r"1 License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL E Front 7 / P. L. 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 -T ti Address ��— • Rear - L v , v� .'�erf/WJ' Pat Contractor's Name 5 cc-o--a�,''�,1l.5'f �//pphone /7--So O ' U ❑ OTHER ,- • C Right i ' '� N� ddrescense ling) /74/0 g�44/115. vrs 7--A!/ c (7 PROJECT DESCRIPTION' SQ. FT. - OCCUPANCY K 9 `� Cr"- Address. '+•s- 2j #' # 'C G CONSTRUCTION TYPE VALUATION$ rs 20Left y^',.,zCityLicense No. OZ 4 79'-G _ � - Se '�Par •ZONE GRADING CU-YDS. ACRES plug. Ref.# Par IngProvided E LICENSED CONTRACTOR DECLARATION _1,,�y-�'`- Q G- _ - I,,herebyaffirm that I am licensed under provisions of Charter 9 (commencing Remarks: 1 I 8�J Planning Notes: /-/ , 0 CC _ M with section 7000) of Division 3 of the Business and Professions Code, and l� �j - my license is in full force and.effect. / /�. Sf ,/ i��'. S License lass - License No /773 CJ — J • • • Date . Sr - Signatur '-I' _ PLUMBING FEES / / i r i .- 7 • . - �� .LL • WOR ERS'COMPENSATION.•' • RATION Bar Sink Showers / ELECTRICAL r 1 hereby affirm that I have a certificate of consent to self-insure or a certificate _ FEES of Workers' Compensation Insurance, or a certified copy.thereof (Section Backflow Sink 3800, Lab. C.) ft acowPreventerService - Automatic Washer - Transformer 0 15.50 KW , 'Policy No. '' Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW ' 8 Certified copy is hereby furnished. i ' Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps ' (This section need not be completed if the permit is for one hundred($100)or - -,. less). -- / . Dishwasher ' Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in'any manners as to become bject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑i'A-6 Workers,'Lon/onsvion Laws of California . Date X/ d/. 6 Signatur `"C� -/-u-0 Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE:1 after making this declaratti n, ou should become subject to the - - Inc$Olaf ❑9-15 HP ❑16-15+ Workers' Compensation provisions of the- bot Code,-you must forthwith Floor Sinks - Urinal - Fixtures comply with such provisions or this permit shall be deemed revoked. - Microwave. CONSTRUCTION LENDING AGENCY Gas Service Outlets - Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance - - -- __ _ -_ - Pole Light , of the work for which this permit is.issued (Section 3097 Civ. C.) interceptors .. _ Water.Heater= -- Lender's Narne - - ' - - • - - - Outlets : • - Range ' Lender's Address Kitchen Sink • _ Water Service . . Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories, - Auto-Wash ' 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 any structure, prior to its issuance, also requires the applicant for such permit 'Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof'Orains the Contractor's License Law(Chapter 9(commencing with Section 7000)of Division3 of the Business and Professions Code) or that he/she is exempt , • - . therefrom and the basis for the alleged exemption. Any violation of Section _ - - • 7031.5 by any applicant for a permit subjects the applicant to a civil - • penalty of not more than five hundred dollars($500). • - ' I, as owner of the property or my'employees with wages as their sole Reinspection Fee , $15 Issue Fee - I $ 3 i compensation, will do the work,and the structure is not intended or offered - - -- - Reinspection Fee I $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 her own DEVELOPMENT SERVAC-E$R U-I$�J)'IENTS: ; _' employees, piovided that such improvements are not intended or offered for Boiler - . Hood or Type I 0 /7C[ 7�/r Q sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 - Zoning Approved By / '/� Date(' pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By l ..t.,� )4-�'--''"—' Date r,-c1-e-7 prove for the purpose of sale). — /^�,LI ❑ I, as owner of the property,am exclusively contracting with licensed con- ' Duct-Structural . Refrigeration System Application Issued By `f'�L� Dat e' C ' 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 - 00-100,000 BTU El 100,000 BTU SUMMARY 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 thatBUILDING PERMIT $ t 2 .. 5o SMTP $ ..50 proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple ❑ System Repair/Alteration , PLAN CHECK $ '469 .621 PERMIT ❑ I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Bit. ICBO.# Fire Dampers ISSUANCE $ PLUMBING $ - ' Date - Owner', - Heating System& Ducting ' Registers i ENERGY P.C. $ • ' PLAN CHECK 25% $ I hereby certify-that I 'have read this applicationall city state that the above ' 00-100,000 BTU 0100,000 BTI--' GRADING $ ' • information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize re re- MICROFILM $ sentatives of this,city--to enter upon the_above-mentioned rop ty for PLAN CHECK 50% $• _ l^� , ISs noire ur'eZ% it//-y am' Date fr - MECHANICAL $ TOTAL FEE $/�•�,J•�1 Signature Reinspection Fee • $15 . Issue Fee • $ 3 PLAN CHECK 25% $ Drivers' Li cense'or SS /�� I /� a , CMF 0865-46,rev.10/84 hite - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor 714-52......2.-7 /03 4oy CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit -_ Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54., Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement CI 5-1Thor Halt/ g��frS' Cate071 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings Lj/;�� al 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 ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil - • 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe • 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final - 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FI NAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date . Applicant to fill in all spaces except those within heavy border lines and.sign all appropriate declarations. - - CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT TRACT NO. LOT NO. UNIT NO. ._ - - ��a 1 • - Project Address - //> �qqa �� s / • 27f 8/28105 1 I .oci. TL Applicant's Mailing.Address ///F;j /'J2ce.-44 I (12i"7jdfr TYPE OF CONSTRUCTION ' LI NEW LI ADD L.I.LI'ALTERATION REPAIR �r ❑ CONVERSION• ❑ DEMOLISH ❑ OTHER A.P.# , Zone Owner's Name ' _ Phone DESCRIPT ION OF WOR K/USE OF BLDG. - Address - - S Main Building: _ - ' Accessory Building: - Arch/En License No. • TYPE OF PERMIT GRADING ❑ FOUNDATION - E Z ' _ �yy��l UISTRUCTURAL - Rear , • - y _ • Q Addressg ❑ TENANT YJ ELECTRICAL ID PLUMBING ❑ MECHANICAL B Rear N Contractor's Name-7,3P#--4c d 2 I£LFrT ' Phone �-.+3.-/ j El -OTHER - • -Q' Ri ht - - - ' N p �J / PROJECT DESCRIPTION SQ. FT--- OCCUPANCY Rid • lit Addresi(mailing) 9i i• rat- 'r%Z*..v9T (om�.T,t/ -K _ G CON ST RUCTION TYPE VALUATION$ .S Left ; \ .City License No..._ _ _ - _ R ZONE GRADING�CU.YpS. ACRES Ping. Ref.# Parking Req,/Provided E LICENSED CONTRACTOR DECLARATION Q 1 hereby affirm that_I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: • _ M with section 7000) of Division 3 of the Business and Professions Code,and T 1 my license is in full force and effect. p .mss^� •- - � ; (\�,J, Licenseg,,Ciass r- -• Li - se No//B2'l% I $ Date/A/O- - Signature ®r �/.!G'- '7 PLUMBING • FEES WORKERS' COMPENSATION DECLARATION , . I • I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers • ELECTRICAL , FEES of Workers' Compensation Insurance,-or a certified copy thereof (Section. . - Backflow'Pfeveoter -' • Service Sink - - - '- 3800, Lab. C-1y-,±r�) i. _ //�� - Automatic Washer Transformer 40 15-50 KW Polic No- C IA G 30-86 Company•f2'7c' Fiii✓c Backflow Irrigation Sewer Cap , ,Construction Pole Sub. '❑ 50+KW , Certified copy is hereby furnished. - , • . Cer ified'copy vest twith the city wilding Division_ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps • oate4A-'C-20'-F};'S Applicant /��e-t-:L' .t<tC% • - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)br - ,- less). Dishwasher Solar Piping • . fr. Dryers ❑Gas DElectric • Sub Panel ' 1 certify that in the performance of the work for which this permit is issued I • shall not employ any person in'any manner so as to become subject to the • Drinking Fountains Solar Tank . - Fan Motors❑0-1'HP ❑1%,-8 • Workers' Compensation Laws of California. I - - - Date ' ' Signature Floor Drains Swimming Pool w/Spa F.A.U. . Inc.Solar ❑9-15 HP 016-15+ 'NOTICE: If,after making this declaration,you should become subject to the — - , Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - -- - - Urinal - - ' Fixtures - • - - ' - - • - - comply with such provisions or this permit shall be deemed revoked. - Microwave CONSTRUCTION LENDING AGENCY ' ' t Gas Service Outlets Water Closet - Device Boxes Pole Light • B3. g .- I hereby affirm that there is a construction lending agency for the performance - of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater: I r .' Outlets • Range Lender's Name Lender's Address - •• Kitchen Sink- Water Service - , 1_ T Switches Sign - ' OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from-the Contractor's.License.Law for the ' , Lavatories .- ' Auto-Wash - Garbage Disposal ;Standing Sections following reason (Section 7031.5 Business and Professional Code: Anycity or - ' • county which requires a permit to construct,alter,improve,demolish or repair P-,Trap - Laundry Trays Generator❑0.5 KW ❑5-15 KW any structure, prior to its issuance;also requires the applicant for such permit - - Trash Compactor , 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 . • tC - - '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 • $ 3 ' 0 I, as owner of the property or my employees with wages as.their sole Reinspection Fee' ! $15 Issue Fee compensation, will do the work,and the structure is not intended or offered 111 Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's ' ' - MECHANICAL FEES License Law does noLapply to an owner of a property who builds or improves - - - • i thereon, and who does such work himself/herself or through his or her own ' - - ❑ :DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such improvements are'not intended or offered for Boiler Hood or Type- sale. If, however, the building or improvement is sold within one year of com- ' Canopy Type II 0 I Zoning Approved By nate { pletlon, the owner will have the burden of proving he/she did not build or im- Duct-UnderGround, • Building Approved By Date prove for the purpose sale). -- - - - -- 0 I, as owner of the,property,am exclusively contracting with licensed con- Duct-,Structural Refrigeration System ' . Application Issued By iL�/ Dat /(lpl/OS tractors to construct the project (Section 7044,Business and Professions Code: i ) The Contractor's License Law does not apply,to an owner of property who Duct-Ventilating • . ❑o-100,000 BTU, 0100,000 BTU SUMMARY OF FEES - ' builds or improves thereon,and who contracts for such projects with a con= - Itractorfs) license pursuant to the Contractor's License Law). I am aware thatI 1 BUILDING PERMIT $ SMIP $' proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration - 0 I am exempt under Section ' I B.&.P.C.for this reason Firepl/Fact.Blt. ICBG# i Fire Dampers PLAN CHECK $ PERMIT' , PLUMBING $ ISSUANCE $, Date Owner - Heating System& Ducting Registers - I PLAN CHECK 25% $ ' ENERGY P.C: $ I hereby certify'[hat I have read this application and state that the above ❑0.100,000 BTU 0;100,000BTU -- - -- ELECTRICAL $, fir �� • GRADING $ Infarmationiis correct', I agree to comply with all city and county ordinances � ; and state laws relating to building construction,and hereby authorize repre- - PLAN CHECK 50% $' MICROFILM' 5- sentatives of this city to enter upon the above-mentioned property for , , , inspection Pu pee �• /a - ,1 Signature �! Date u'.ZR-s%la� MECHANICAL $' • ' TOTAL FEE ; $I /r�� Drivers' License or 5$# Reinspection Fee $15 Issue Fee - $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &i - - 'APPROVALS Permit Date Inspector APPROVALS Permit# • Date Inspector - -1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . , -...1 53. Steel`Reinforcement 3. Electrical Condult'Utility-Undrgrnd. -' 54. Forms 4. Electrical Conduit;Undrgrnd. r 55. Electrical Bonding - r / 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7..Footings . . . 58. Electrical Conduit-Undrgrnd. 8. Foundation I : 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 - - 1.1. Property Sewer Line & House Connection / r 62. Backwash & Receptor-Final •• • ,12. Sewer-Cap •� 63. Heater& Vent-Final ' ' l • 13. Rdof 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 0Gal 0 Oil 25. Roof Sheathing 74. Overhead Hydro , 26. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe , . 28. Lathing& Siding 77. 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: c-5/ o,/ec 4 774. c Nx(PFer-c? 34.-Final Heating &,Air,Conditioning ' ��"`�(rift ,/��J / q IOL f" &.i 7c'. e- 1- 35. Final Gas:Pipe-Test - - 36. Hood or Canopy - . 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service-Final. - • 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow.Preventer. 43. Backflow Irrigation 44. ,Landscape Irrigation System - - . 45. Sound Attenuation , . 46. Handicap'Regulations - - • 47. FINAL STRUCTURE & BUI LDING - 48. Special Requirements Completed - • • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF•OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . CITY OF COSTA MESA PERMIT.NO. TRACT NO. LOT NO. BLDG.NO. CONSTRUCTION PERMIT • 19/4//040,- 4253 7/ 17/84 5Q01' IL Project Address - - / ,/9-/y %/t'• TYPE OF CONSTRUCTION LI NEW ❑ ADD LJ ALTERATION LI REPAIR "41 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Applicant's Mailing Address�/�G%A[ S�ar?S POdNC/L Or/J,pP4AA�-F, A.P.5W - I Zone Owner's Name s 4 V- Phone/79'7900 DESCRIPTION OF WORK 7(s(I/NASf�f2 ' C479- 11C-oc/T \l• S Main Building: Accessory Building: • Z :1 Address /&,?0 /��am S f'v"-Ve/ £ ,n4 ' °�� • TYPE OF PERMIT ❑ GRADING 11��Uf FOUNDATION U STRUCTURAL E Front . N Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL vim,PLUMBING ❑ MECHANICAL B A Rear N Address • ❑ OTHER C Right • G Contractor's Name H. C. /11oRP1- // Phone gais/744 PROJECT DESCRIPTION SQ. FT. OCCUPANCY C R //57O S2aboot1 C/,Q . STAN Ta AI CONSTRUCTION TYPE VALUATION$ S Left E Addre551mei(mailing) / City License No. r'2PJ 7 g'ZONE - GRADI NG CU.YDS. ACRES Pin Ref.# Park.Fees $ 0 3U LICENSED CONTRACTOR DECLARATION Remarks: /'/CH�i48i4 3 /!/1-n -��Ov-/- Parking Req./Provided I I hereby affirm that I am licensed under provisions of Charter 9(commencing w cc!! ii��/] T//`l�\ R with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: E my license is in full for a and eft ct. License C ss icon - No. --.-'-'''"70PLUMBING FEES Planning Notes: M Date / Signature `a - �I --;_a. E WORK RS'COMPENSATION DECLARATION r Bar Sink Showers N I hereby affirm that I have a certificate of consent to self-Insure or a certificate T - Backflow Preventer Service Sink - - S of Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES licy No. Company - Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer. Transformer ❑ 15.50 KW Certified copy is filed with the city Building Division. 0 50+KW Date . Applicant "- Clarifiers Solar Collectors Construction Pole Sub. _ , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar Pi in (This section need not be completed if the permit is for one hundred($100)or / a- 00 P g Cooking Unit • Meter ❑up to 100 amps less). DrinkingFountains I certify.that in the performance of the work for which this permit is Issued _ Solar Tank Dishwasher Meter Dover 100 amps shall not employ any person in any manner so as to become subject to the workers' omoeps�ati n Laws of -.-q�/ Floor Drains Swimming Pool w/Spa • Dryers ❑Gas ❑Electric Sub Panel , Date 7/&_s / 12 Signature California.)•C-- L - - ' NOTICE:!foal er•making this declaration,you should beco e 5 lect to the - Floor Sinks - Urinal -- . Fan Motors 00.1 HP 011/2-8 - ' Workers' Compensation provisions of the Labor Code, yo must forthwith - • - comply :with such provisions or this permit shall be deemed revoked: Gas Service ' Outlets ' Water Closet . Inc.Inc.Solar 09-15 HP 016-15+ , CONSTRUCTION LENDING AGENCY I hereby affirm that there,is a'construction lending agency for the performance Interceptors Water Heater Fixtures ' :Microwave of the work for which this permit Is issued (Section 3097 Civ. C.) - Lender's Name - Kitchen Sink • Water Service Device Boxes Pole Light Lender's Address Lavatories ' OWNER BUILDER DECLARATION Outlets Range • I hereby affirm that I amexemptfrom the Contractor's License Law for the p-Tra following reason (Section 7031.5 Business and Professional,Code: Any city or P • - : • - Switches Sign • - county which requires a permit'to construct,alter,improve,demolish or repair ' -' _ • .- . .- _ - - 'any structure, prior to its-issuance,also requires thea applicant for such permit ' • , .Roof Drains' - ' P - - •_ Garbage Disposal Standing Sections - to file a-signed statement that'he/she is licensed pursuant to the provisions of - the Contractor's License Law(Chapter 9(commencing with Section.7000)of - • I Generator ❑0.5 KW ❑5-15 KW Trash. Compactor ' Division 3 of the Business and Professions Codec or that he/she-is exempt _ p therefrom and the basis for the alleged exemption. Any violatinn•of Section ' • - I - -7031.5 by''any applicant for a permit subjects the applicant to a- civil , I • laity of not more than five hundred dollars($500). :Reinspection Fee " -$25; Issue Fee ' • ' $ 3 I, as owner of the property or my'employees with wages as their sole l MECHANICAL 'Reinspection Fee $25 Issue Fee I .$ 3 ,,ompensation, will do the work,and.the structure.is not intended or offered ' - FEES for sale (Section 7044, Business and Professional Code:' The Contractor's - • PUBLIC SERVICES REQUIREMENTS: ' License Law does not apply to an owner of a property who builds or Improves Boiler • • 1 Hood or' Type I 0 ' - thereon,'and who'does such work himself/herself or through his or her own - I Zoning Approved By •' • employees, provided that such improvements are not intended or offered for ) Canopy Type II 0 Date sale. It, however,the building or improvement Is sold within one year of com- • Duct-Under,Ground pletion,the owner'will have the burden of proving he/she did not build or im- • Building Approved By ////1/f Date �,/ rove for the purpose of sale). 1 • Duct-Structural Refrigeration System , Application Issued By 1 v `/rt 7 - Date 7-/��j o 1,as owner of the property,am exclusively contiacting'with,licensed con- ❑4100,000 BTU ❑700,000 BTU • tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating _ SUMMARY OF FEES The Contractor's License Law does not apply to an owner of property who builds or improves thereon,+antl who contracts for such projects with a con- - BUILDING PERMIT $ SMIP '$ Exhaust System 0 Multiple❑ System Repair/Alteration tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT - ❑`i am exempt under Section B.& P.C.for this reason , Firepl/Fact.Bit. ICBG# ' PLUMBING $ 1.6'0 ISSUANCE $ Or' Date ' Owner 1 Heating System& Ducting ENERGY P.C. $ • PLAN CHECK 25% $ I hereby certify that I have read this application and state that the above - 1 00.100,000 BTU 0100,000 BTL— GRADING .$ ' Is-----i information Is correct. I agree to comply with all city and county ordinances I ELECTRICAL $ and-state laws relating to building construction;and hereby authorize repro- ' PLAN CHECK 50% •$ MICROFILM '$ inspection sentatives of this city to enter upon the above-mentioned pr arty for • ' inspecur sqr .�,' /D/ MECHANICAL ' $ Signature �Ci '''`��'y Date l✓2 I • 1 - - TOTAL FEE $ � '�d ' Drivers' License or SS#% .'- Reinspection Fee 1 $25, Issue Fee $ 3 PLAN CHECK 25% •$ - CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Plnk-Accounting;Goldenrod-Assessor - - - - - ' -- ' - - -' J \ A - CONSTRUCTION AND PLANNING - - - POOL&1 q - _ . •APPROVALS Permit# Date Inspector APPROVALS Permit-# - ;Date' Inspector' r 1 ' 1. Temporary Electrical Service or Pole 52' Pool 8IEquipme0t Location r - 1 - 21 Soil Pipe-Undrgrnd. 53:: Steel Reinforcement • •- 3. Electrical Conduit Utility-Undrgrnd. ' - 54. Forms - - 4: Electrical Conduit-Undrgrnd. .55: Electrical Bonding - ; , '- 5_ Steel,Reinforcement 56. Rough Plumbing & Pressure Test • - 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE. - - - 7. Footings . : • 58. Electrical Conduit-Undrgrnd. _ . 8. Foundation _ .59. Gas.Pipe, 0.U•ndr•grnd:,Test : - , 9. Water Pipe-Undrgrnd. - "60. Backwash Lines,P-Trap;D Undrgrnd., - 10. Structural Floor System .. _ 61. APPROVAL TO DECK I 4 _I 11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final . ^ _ 12. Sewer Cap ' 63. Heater & Vent-Final- . .. , I. 13. Roof Drains 64. Plumbing System • Final ' ., c. 14. Rough Plumbing 65. Electrical-Final ' • - - 15. Rough Electrical-Conduit - I , l 66., Solar System-FinalT - - - `i - -- _ " _, .- 16. Rough Electric Wiring - - 67. Fencing & Access Approval ,-I 1 __ -,. 1T" - ' 1_- ' 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING I " ' I , I ! r - 18. Rough Electrical-T Bar Ceiling. I 69., POOL/SPA SYSTEMS FINAL 1 .! ' II ' f ' " 19. Rough Heating & Air Conditioning FIRE DEPT.'REQUIREMENT - - _ i • 20. Rough Factory Fireplace APPROVALS Permit# - 1 21. Ducts, in Structure 170., Underground Hydro ,, 1 � -5 ; 22. Ducts, Ventilating 71. Product Piping 0 Gas•' 0011 ' ' ' 23. Gas Pipe-Rough& Test 72. Underground Flush , 24. Roof Framing - - - ' 73. Undergrnd.Storage Tank 0 Gas 0 Oil "- 25. Roof Sheathing 74. Overhead Hydro I . ' . - - - ; 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ; I - - �; . 27. Frame and Flashing I ._ 76.; Dry Standpipe = j n 28. Lathing & Siding 77. FIXED SYSTEM FINAL , I , •-29. Insulation •• ;78. FIRE PREV. FINAL 4 , 30. Drywall Nailing 'HEALTH DEPT. REQUIREMENT' • 31. Plaster Brown Coat • 79.; FINAL INSPECTION . 32. Electrical Power Meter-Final 80., FOOD CERTIFICATE ISSUED , ' - 33. Final Electric Notes:, _ _ _ 34. Final Heating & Air Conditioning _ 35. Final Gas Pipe-Test - } - -• ' - ' 36. Hood or Canopy - ' - - 37. Final Factory Fireplace _ • - 38. Final Plumbing Slickii CO.") i • - 39. Water Service-Final - ' - 40. Gas Service-Final 41. Solar Domestic-Final - - -- i 42. Backflow Preventer, - _.• . - ' 43. Backflow Irrigation I - , - • 44. ,Landscape Irrigation System - , ' _ , 45. Sound Attenuation � • . ... - = 46. Handicap Regulations • • •• 47. FINAL STRUCTURE & BUI LDING, - s- • �' 48. Special Requirements Completed ' ' I - "'I - r0 ., v 49. Electric Release to Edison _._ _. _ - 1 �._ , 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY --• - - - - r I ' , i No. -. Date - -- - --- -- -• - - - - - - - --- - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA, , f PE MIT NO. TRACT NO. LOT NO. BLDG.NO. • - _ - -" CONSTRUCTION PERMIT, -'/ 997 Project Address ^1 -- I G - TYPE'OF CONSTRUCTION U NEW U ADD U ALTERATION IJ.REPAIR - ^r1 C r'"- '-' - Applicant's Mailing..4. S/'- ddress /S33' WL/N cf4/.r� p //V,/ ' , •❑ CONVERSION -❑ DEMOLISH ❑ OTHER - - A.P.# 1 Zone - Owner's Name e&-te/ oivf' Cat / Phone/7i' f00 'DESCRIPTION OF WORK • S Main Building: Accessory Building: - - 2 Address' v >�ntY TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL - E Front .. N ' - •Arch/Eng: License No. • , ❑ TENANT ❑ ELECTRICAL -PLUMBING' ❑.MECHANICAL • B Rear ' . . - - - Address. - -❑ OTHER - - A` - N ��// ��11 C Right ' _ _ Contractor's Name//Ieear/!Y/l iA,d -v-.7b, Phone-97.1 •3770 PROJECT DESCRIPTION SG. FT. - OCCUPANCY K R /a33 A) ie-Ajd-o -/ 'A///J A >//s' CON ST RUCTION TYPE VALUATION $ Left - E Address.)mailing) - T 93 , ZONE : GRADING CU.YDS: ACRES Ping. Ref.# . Park.Fees $ 1 ' O City License No. - - ' LICENSED CONTRACTOR DECLARATION I Remarks: - Parking Req./Provided ' • ' U I hereby affirm that I am licensed under provisions of Charter 9(commencing - R ' with section 7000) of Division 3 of the Business and Professions code, and • I Use of Building: - E my license is In full fyrce and effect. - _ "` -3� '�/ G - - PLUMBING FEES Planning Notes: I - M L•Icens, Class '/ Lice se N Date =•"'��-f7- Signature ' /Y�AL.4 �I•r -�7-T-r1-a/ ' ' - N Bar Sink Shower's WORKERS'COMPENSATION DECLARATION I . I - T I hereby affirm that I have a certificate of consent to self-Insure or a certificate , ' Backflow Prdventer Service Sink t I • S of workers' Compensation Insurance„-or a certified. copy thereof'(Section' . ` - -- - - - _ - - - • '800, Lab. C.) r., I 7 ! I Backflow Irrigation I Sewer Cap % ELECTRICAL FEES ' V alley No. 051r9L0 company 6�ver ?,(/S - 15-50 KW : ertified copy is hereby furnished. I • I ' Bathtubs I Sewer Connection I Automatic Washer,. Transformer Date3 ed copy is filed with the city yqild ing Divisiogg �r `_ 1 - - - - - Date t ` copy i'Y ith theant�l✓yi 6..L i7 C��:1 Clarifiers i Solar Collectors Construction Pole Sub. 50+ KW \ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher $Olay Piping',” - \ (This section need not be completed if the permit is for one hundred ($100) or I I P 9, 1 Cooking Unit ' Meter Oup to.100'amps'- • Iess). I I certify,that'in the performance of the work for which this permit is issued, I Drinking Fountains Solar Tank Dishwasher Meter Cover 100 amps• c- shall not employ any person in any manner so as to become subject to the - '' ' Workers' Compensation Laws of California. , Flo•or Drains I \ Swimming Pool w/Spa Dryers ❑Gas ❑Electric • Sub Panel Date Signature — — ' NOTICE:If,'af ter making this declaration,you should become subject to the Floor Sinks ' Urinal Fan Motors 00-1 HP 01 h-8 Workers'-Compensation provisions of the Labor Code, you must forthwith'3 - '-- -' -- _ •"" - - -� - - " "-' "--"- - comply with such provisions,or. this. permit shall be deemed revoked. Gas Service . .Outlets -Water Closet I •Inc.Solar 09-15 HP 016-15:f • ' CONSTRUCTION'LENDING AGENCY '. .. - " - " - ' I hereby affirm that there is a construction lending agency for the performance ' Interc¢ tors r ' Water Heater d Fi%tures of the work for which this, permit `Is issued .(Section Civ. C.) - P - - I - 'Microwave Lender's Name • - 1 Kitchen Sink ' ' Water Service - - Device Boxes Pole Light ' Lender's Address 1 ' r ' r , - I- - r OWNER BUILDER DECLARATION , - Lavatories - - , Outlets • I . ''Range � , I hereby afflrm•that I am exempt from the C • ontractor's•Llcense Law for the I, , p=Tra , ' • following reason(Section 7031.5 Business and Professional'Code: Any city or ` P. - - Switches Sigri county which requires a permit to construct,alter,Improve,demolish or repair I _ _ ' any structure, prior to its issuance, also requires the applicant for such permit - Roof Drains t - Garbage Disposal • Standing Sections • to file a signed statement.that'he/she Is licensed pursuant to the provisions of _ + - ' , the Contractor's:License Law(Chapter 9(commencing with Section 7000)of 2 1 ( - ' Division 3-of the Business and Professions Code) or that he/she Is exempt . . _ ) _ - - -o - Generator 00-5 KW 05-15 KW Trash Compactor , therefrom and the basis for the alleged exemption. Any violation'of Section _ , ' 70315 by any applicant forte permit subjects.theapplicant'to ,a civil ' ' ' ' f • ' natty of not more than five hundred dollars($500).' _ I - "Reinspection Fee I $25, Issue Fee' $.3 • - cI, 'as.owner of the property or my employees with wages as their Sole _ Reinspection Fee ! $25-,Issue Fee $ 3 ompensation will do the work,and the structure is not intended or offered •- , '.. -MECHANICAL I FEES for sale'(Section 7044, Business and Professional Code: The Contractor's -- - -- - - - - --- - -- Thi ----- -- - - PUBLIC SERVICES REQUIREMENTS: , License Law does not apply to an:owner of a property who builds or improves Boiler . Hood or Type I 0 l I thereon, and:who does such work himself/herself or through his or her own . - , Zoning Approved By • Date employees, provided that such Improvements are not intended or offered,for •- Canopy , Type II 0 ' ' sale. If, however,the building or improvement Isisold within one year of com- ' Duct--Under Ground i ' ' , Application Approved By. Date pletion„the owner will have'the burden of proving he/she did not build or im- - / rrove'for the purpose of sale). , Duct-Structural I • _ Refrigeration System 'r_ Application Issued'By ' 1 ,wJ Date 6.— .�/�� u I, as owner of the property, am exclusively contracting with'licensed con- 00-100,000 BTU ❑100,000 BTU tractors to construct the project (Section 7044,Business and Professions Code: ' Duct-Ventilating ' SUMMARY OF FEES , The Contractor's License Law-does.not apply-to an owner of property,who • - I BUILDING PERMIT $ - SMIP $ builds or improves thereon„antl who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration tractor(s) license pursuant to the Contractor's License Law)- - PLAN CHECK : $ PERMIT ' .4 0 1 am exempt under Section B.& P.C.for this reason , Firepl/Fact.Bit. ICBG# ' PLUMBING $ S. CO ISSUANCE ' $ � � ENERGY P.C. $ Date • Owner I Heating System& Ducting PLAN CHECK . $ ' ' I hereby certify that I have read this application and state that the above ' ' 00.100,000 BTU 010Q000BTL _ _ ELECTRICAL $ • GRADING $ ' information is correct: I agree'to comply with all-city""and county ordinances - and-state laws relating to building construction;and hereby authorize repre- I , PLAN CHECK $ MICROFILM $ I sentatives of this city' to en er u n the above-mentioned property for G Inspection qU uses. // • I , i I . JJp� �,/ MECHANICAL $ ' TOTAL FEE I $ DSirivers' crr S# .- /hif z•�/. Date-3�-'1-a T - - • _ _ _ I __ _ . .__ - _ .- ... _,. .. -. -. _ ,_ _ Drivers' License or SS# Reinspection Fee ,$25, Issue Fee $ 3 • PLAN CHECK . $ ' •• CMF 0865-46 rev. 7/83 - White-Building;Canary-Applicant;Pink--Accounting;'Goldeniod'-Assessor • I _ , . � POOL& ' CONSTRUCTION AND PLANNING • APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &,Equipment Location '2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms '4. Electrical Conduit-Undrgrnd: 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9: Water Pipe-Undrgrnd. 60. Backwash. Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System la 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 .i6. 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 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33: Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test -. 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbingi/1/ec- trap • 39. Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE& BUILDING 48: Special Requirements Completed • 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co , •• 51. CERTIFICATE OF OCCUPANCY No. Date •