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Home My WebLink About3333 BEAR ST - Building Permits (135)i � CITY OF COSTA MESA � o F BUILDING DIYIS/ON " t� � 77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us �.�o � F�OR+ ECTIONS CALL: (714) 754-5626 * ��-}S�,y� PERMIT NUMBER: BC08-00036 � �,�,a�, �� PERMIT TYPE: B_COMB(�AT£ STATUS: ISSUED .• •,. Sub Type: COM_ALT DATE ISSUED: 03IOSI2008 - ISSUED BY: YH �os aooRess: 3333 3326 BEAR ST CM " Suite/Unit: 3326 APN: 41249208 , � - Zoning: , , � � - � Vicinity: SUITE 332B CALVIN KLEIN � - Primary Occ: S-2 Const Type: I-A SQ. FT: 0 Valuation: $45,000.00 SCOPE OF WORK: 3,788 SF INTERIOR T.I. TO CREATE STOR4GE SPACES FOR "CALVIN KLEIN" WITH 10' HIGH STATIONARY STORAGE RACKS, 1 REPAIR/ALTER COOLING/HEAT, t VAV BOX, 20 LIGHT FIXTS, 9 OUTLETS, 1 SW ITCH, 1 SERVICE TO 100 A AND 1 COMMUNICATION DROP. OWNER: SOUTH COAST PLAZA FEDERATED WESTERN PROP� Address: DIVISION ACCOUNTING DEPT , � Unit CINCINNATI, OH - Phone: � City/State/Zip: 7 W SEVENTH ST t7TH FL - ' ,,, �� fi APPLICANT: BARTH, EDDY �� ' � Address: " � ' Unit: : Phone: 858-967-4325 City/State/zZip: � , . � , • CONTRAC7oR: DICKINSON CAMERON CONSTRUCTION INC License No. 690239 ' � Phone: 858-793-9104 ' - � � Address:- ��140 LOMAS SANTA FE Unit: � SUITE 200 Cell: . - City/State: SOLANA BEACH, CA � ZipCode 92075 ARCHITECT: BARTELUCE ARCHITECTS AND ASSOCIATES PHONE:212-691-7200 � ENGINEER: License No. COMBINTATION PERMIT FEE SUMMARY Building Plan Check: - � � $96:49 Building Fees: $593.75 Eleclrical Fees: � � ' �� $88.00 Mechanical Fees: " , $47.85 Plumbing Fees: $0.00 SMIP Residential: $0.00 SMIP Commercial: $9.45 TOTAL FEES: $835.54 ••Reter to fee receipts tor all fees paid for project License No.C26233 PHONE: r �: �"J , •��•; NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia slatutes 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 fnal approval will result in the expiration of this permit. c�e� ixsrEcnoNTrre t816 Fixed System Final Fire Prevention 1266 Pool Spa Final . 200 Final Re-Roof 201 finalBlocWRetaining Wall 202 Final Facmry Fire Place l 203 Final Sign � 204 Final Demolition DRTE IN7I71AL � COpE1 PELTIONTYPE D 206 Final Mechanical ) /R" ZOB Final Plumbing 210/�FinalElectriwl P/�. 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupancy ' / I • � I � � � ,i i /� � �'�'ORKERS' COMPENSATION DECLARATION: � I hereby affirm under penalty of perjury one ot the tollowing declarations: ❑ 1 have and will maintain a certi�cate of consent to sell-Insure tor workers' campensation, as providetl for by seclion 3700 of the Labor Code, /or the peAormance o( Ihe work for which this permit is issued. � I have and will maintain workers" wmpensation insurance, as required by sectbn 3700 of the Labor Code. fw the performance of the aork for which Ihis pertnit is issued. My vrorkers' compensation Insurance cartier and policy number are:�i'i��11-' . Carcier. a rrc��,��'�^�� 1� ti (TMS Se�m neetl rpl De mnpleletl atM• pemM u reNtNat are �urMretl dMars (5100) a leu) POlicy Number. �'u�.� L � 4%li% ❑ I certify that in the peAortnance of the work for which this permit is is;ued, I shall not employ any person in any manner so as lo become subject lo the workers' compensation laws o� Califomia, and agree that if I shoultl become subject lo lhe rkers' comp ion provisions of Seclion 3700 of the Labor I sh 1 hwith co wit these provisions. Ap li n re �Da� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND A7TORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Seclion 7000) of Division 3 0( the Business and Professions Cotle, and my license is in (ull force anC eHect. � LiC. # Class # 0 . a s ngna ur Da e CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat I�ere is a conslruc[ion lending agency for the pedortnance of the v.ork far wfiich ihis pertnit is issued. (Sec. 3097, Civil Code). L@nder's Name: Lender's Address: OW NER•BUILDER DECLARATIONS: I heraby aKrm tha� under penaly of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. BUsiness antl Prolessions Code: Any city or county wfiich requires a permit to �OnsWct, alter, improve, demolish, or repair any structure. pnor to its issuance, a150 requires ihe applicant for such permit �o file a signetl statemen� [hat he or she is licensetl pursuant to the provisions o( the ConVactors License Law (Chapler 9(wmmencing vrith Section 7000) o( Division 3 0( lhe Business and Professions Cotle) or that he or she is exempt Ihere(rom antl �he basis for lhe allegetl exemption. Any violation of Seclion 7031.5 Dy any applicant for a permit subjects lhe applican[ to a civil penalty o( not more than five hundred tlollars (5500).): q I, as ovmer of the pmperty, or my employees with wages as iheir sole �Ompensation, WILL DO THE WORK, and the simcture is not intended or oNeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ovmer of property who builtls or improves �hereon, and who tloes such vrork himself or hersel� or [hmuyh his or her ovm employees, provided that such improvements are not intended or oRered for sgle. If, however, Ihe building or improvement is sold within one year of cOmpletion, the owner•builder will have lhe burden of proving thal he or she tlid not builtl or improve for purpose of sale.). ❑ I, as owner of the property, am EXCWSIVELY CONiRAC71NG WITH 4CENSED CONTRACTORS lo cons[ruct the project (Sec. 7044, Busines5 and Pmfessions CoOe: The contractas LiCense Law dces not apply to an ovmer ot property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant m the Contractors License Laws.). ❑ I am exempl under sec. Business and Professions Code for this reason: Sipnamre Date 305]<6(YO]) Owner ID verif�river'� � ves ❑ No � Dnver's License No. E.pires: Verification of Ownership by (type of tlocument, i.e. - property Wx bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more leet in deplh into wfiich a person is required to tlescen4 will be made in wnnection with v.vrk auttrorized by this pertnit, antl that no huiltling structure, sc�fdding, falsevrork, pr demolilron or dismantling thereo�, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2. Art 2. Sea 341. Ttle 8. CalRwnia Administ2tive Cotle�. ❑ As owner-builder, I will not employ anyone (o do work which vrould require a permit from the Division of Intlustrial Salety, as notetl above, unless such person has a permit to do such work (rom the division. ApP�i�nl's Signalure Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fulure building occupant need to fle and certify a Business Plan tor emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 0( lhe Cali(omia Health antl Safety Code requires, with some exceplions, Iha[ a Business Plan be filed with the Costa Mesa Fire Depanment by every business which has at any one time dunng a reported year a quantity o! hazardous matenals equal fo or greater than a weight o( 500 pountls, or a volume of 55 gallons, or 200 cuhic teet of wmpressetl gas at standard temperaWre and pressure). 2. Does or will the applicant or present or future building occupant need to file a regisiration lorm (w atulety hazartlous malerials? ❑ Yes ❑ Mo (Section 25533 0( the California Health antl Safety CoCe. wim some exceptions, requires regisUation with the Costa Mesa Fire Deparimenl by each business which at any one time has on hand a quanti[y of acutely hazartlous materials equalto or greater than a weight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feei of compressed gas al stantlartl temperature antl pressure). 3. Does or will the applicant or present or fuWre building ocCupant need [o prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes [] No (Section 25534 of lhe CaG(omia Health antl Safety Code provides Ihat the Costa Mesa Fire Department may require the preparation, certification antl filing wilh Ihe Fire Department of an RMPP by husinesses which are required to register acutely hazartlous materials wi[h the Fire Department. 4. If an RMPP is presently requiretl, has Seclion 25534 of Iha Califomia Health antl Safety Code been fully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present or fuWre building occupant require for Ihe work which is Ihe subject o( t�is applicalion a permit for suth construction or modi�cation from the South Coasf Air Quaiity Management Oisincl or Gom any other air pollution control district or agency? ❑ Yes ❑ No (Sectbn 658502 of lhe Califomia Govemment Cotle requires ihat Ihe requestetl infortnation be fumished on applications for ron-residenlal building pertnit5). 6. Will any part ot the faciliry ro be construc[ed under this permit be vnihin 1000 feet from the ou[er boun0aries of a school? ❑ Yes ❑ No Qf 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cali(omia Heal[h antl Sa(ety Code). 7. If a permit from the South Coast Air Qualiry Menagement Oistnct or olher air pollution contml disirict or agency is required for the vrork which is Ihe subject of this appliwtioq have all of the disclosures prescribed by Califomia Health and Safe[y Code Section 42303 been made? ❑ Yes ❑ No 8. (If 'yes", altach certificate o! compl'rance irom the appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all stale laws and city ordinances regarding Hazardous Materials and Emissions. Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penatty o( pe7ury that I Aave read this application and sWte that the information given is correct I agree to comply with all slate laws and ciry ordinances relaling to builtling consWction, antl authorize representatives o! the City of Costa Mesa to enter pon Ih bove-descnbed property for inspection purposes r iot P ccup r w occupancy of any building authonzed i d 1p on .�D B�a al a� ¢qs) � Da�e (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: 3333 BEAR ST Suite: 322 Vicinity: Parcel Nunmber: 41249207 Zoning: AppliwnC SHEILA LOONEY _ - �" � _ ,- , - - % -�-,; � _ _. , ISSUED BY:� Status: ISSUED Applied: 03/12/2007 Issued: 03/21/2007 Address: 5200 E HUNTER AV i � �%, =- `- — - - - � -_ _ -- - - SUITE B � i%� . � - - � Phone: 7,14-993-2822 ' ANAHEIM. CA"' ��-� ��_ �� Zlp: ' 92807 � . � �' � � ,,,;, i' _ A � � ' � � � `� �� f / �� 'y�\ Owner. SOUTH COAST BLAZA� _ � � � - - ' -- �� :� i / i � A'• � �� Addrese i °hGJ SEGERSTROM & SONS = � �- �- � - � � %`-,�'� - ` � �� " COSTAMESA,CAi� %' "Phone � �;�� i��, ��• i � '.=� � %/�3315 FAIRVIEW RD! � -!� Zip: 92628 � � � � /% � �� ; i/ � � ��\_�i V� , � ' � � . '� �/!'l ��`. i � �\. Contrador: ��ALERT�FIRE,PROTECTION INC � ;`�``\��` � �� , Address: 5200EHUNTERAV � ��-�� :i � � ' ��; SUITE 6= � Phone %� 714 993-2822 \� � � � � � � �. � �� 1 ANAHEIM. CA Zip: '' 928W �A,• V A �\�'- -r �- � . : i,,.;' S License:--316324 � , " - ._: "�• '��,. `� , ' / - _ — . - (� ` � � � � � �-�:-SCOPE OF PERMIT ^ . � \-.--�' ` , � ,':� � ��'.RELOCATE 11 EXISTING OVERHEAD SBRINKLERS FOR "SIMONEP.EARCHE" IN SPACE 322. ,;�'. . . � ' � / . . ... — , , . � �� REF# 807-00082�� -" � . .. ��;�/ �\ �?�� ,� . � �i •�V � _� c�_ � _ � . , c'-' � ��A ` � ' \; Plan Check..�� Permit: Other: $69.25 $0.00 \ ,' `Total:. $114.26 ' FEE SUMMARY \ " ' � - - - - " � . � � r� � � , � �r�� r,y-r7' r-ti- ♦ r nr-s. CB�C �/8�U8tlOf1 ! {' $2000.00 ' �`' � . !�'!�` .;`.�r`_�._.. ,�.:,'. , .�� ClaimedValuation: Sz000.00� . � .�-�> , �'. �?,-�,-s -_� ,_ �� ,'�i ' � - -- , -_, _ �_�; .��c: ,, ' ' " = _ .._ _, �;. : �___� , �� , �,r , ;,, ,� ir�i •/� . . • _ _ . , .j � . I l � ;� � � ' �y� 4 ti �� ' � . L / .� . � . 3 � / r � ' v; 4. �j• � ' % • � t .� //�� / � � / �J . \ " � � o� e . ' c . .�t R' /�// > > � ,'t- _ ' `� . i \ � '� . . � Y : _ •• � �� ,/ / � / . _� . � �A .l iFi ' � �" �( � ' \ �A-\ ��•� i � VAV , ��" n � , � . �� '� .J� � ��':. V ' ' l � o . �j � ��\` � � � . �/�/` = �" . i �/ /,,� � � � ` . � ` ` T�' ` �� .'' i /. ��•� ,�i�� .__ .: _ ,- ` V'�A/.� /, _ _ A,"f% (�i�7 _-1' 1 V-i'' i�'%/ . .�/ _ '" 'i � , � A: i, % �" �-.� � � ' �'( t , -. _ � � . , � _ _, -- � j � j � ,. `� J,- � � � ,,. .�. , �_ i ; � -�%C��/ _ ��' �>, ;.�� - - '" ��: < �' , , —�- --.�.:,�... :,�%.;� / NOTICE: Tha work authorized by this permit shall copryly:with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) ' _ � EXPIRATION: This permit shall automatically expire apd-become void if work is not-commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. �'�"�' : . ,�>` �' INSPEC710NS: In order for the�work authorizeti y this permit to be considered"legal, such work must comply with all applicable codes, and all required Inapeetions and final approval must.be'o��d. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 , zms�as (s�ool . WORKERS' COMPENSATION DECLARA710N: I heraby eHirm under penalty af perjury one ol Iha following decleretions: ❑ I have entl wlll maintain e cenilicate ol wnsBnt to seH-Insure for workers' compensation, as provitled tor by section 3700 0l the Lebor CoUe, far tha pertormance of tha �work tor which ihis permit is Issuetl. � ' I �ave entl will malntai w rkers' compen5eti0n insurance, es requiretl by secllon 3700 ot the Lebor Code, tor the pedortnance of the work tor which Nis pertnit Is issued. My workars' compen C In rence carriq/ �� pol�ic,i�umber ere: y/� p /1/� Cerner. `��^" '-/ Polity Number: �� o r o�� V"� (Th/s sectlon neetl not be wmpleted i( the permit is velued t one hundred dollers ($ f00) ar less.) ❑ I cenity that In the peAormance o1 the work for which this permit is issued, I shell not employ eny person In eny manner so as lo become subject to the workers' compensation laws of Califomla an ep�ee e� tl I ahou become subject to t�e workers' compensetlon pravislons oi Sectlon 3700 ot t�e Lebor Catle, I shall forthwith compty with these provislons. y��,//% / �7 ApplicentSlgnature: �"'�"J-. Date: ��I�v/ WARNINO: FAILURE TO SECUFE WORKERS' CAMPEN$ATION COVERAQE IS U WFUL ANp SHALL SUBJEC� AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED iiqUSM'D DOILARE (5100,000),IN ADURION TO THE Cp$T OF COMPENSATION, OAhNGES AS PROVIDED FOR IN SEGfION 31060F THE UBOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATON: I hereby ettirtn that I am force entl eHBci. LiC. k_ Contraaors SignaWre: wit� Section 7000) oi Division 3 0l Ihe Business ar�Q Pryfe sions Code, and my Iicense is in tull �� ir Cless q G L Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a consimction lending agency for I�e pedormance of the work br w�ich t�is pertnit is issuad. (Sec. 3097, Civll Code). Lenders Name: Lentlefs Atltlress: Signawre: OWNER-BUILDER DECLARATIONS: Date: I hereby e%irtn that under penelry oi pehury t�et I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the tollowin9 reason (Sec. 7031.5, Business antl Pmfesslons Code: Any ciry or counry which requires e pertnit to conswct, elter, improve, tlemdish, or repair any stmcture, O�e� to its issuance, also requires the epplicant for such permit to file e signetl stetement Ihat he or she Is licensetl pursuant to the provisions oi Ihe Contractors License Lew (Chepter 9(commencing with Section 7000) of Dlvision 3 of ihe eusineu and Protessions Cade) or Ihat he or shg I� exempt therefrom end t�e besis tor Ihe elleped exemption. Any violation of Section 7031.5 by eny epplicent far e pertnit subjects the apPlicent to e clvll penalty of not morp than tive hundred dollers ($500).): ❑ I, as owner ot the property, or my employees with weges as their sole compensatlon, WILL DO THE WORK, end the structura Is not Intended or offereA tor sale (Sec. 7044, Business and Protesslons Cotle: The Conirectors License Law does not epply to en awner ot properry who bullds or improves t�ereon, entl who tloes such work himselt or hersetl or through his or her own qmplayees, praWtled thet such improvements are not intendetl or oflere0 for sele. If, however, Ihe building or impmvament is sold within one year oi completion, Iha own0r-builder will heva the burden ot proving t�at he or she did not build or improve for purpose oi ule.). ' ❑ 1, as owner ot the propertg am EJ(CLUSIVFtY CONTRAC7iNG W7TH LICENSED CONTRAC70RS to conswc! the project (Sec. 7p44, Business arM Protesslons Code: The contractors License Lew does not epply to en owner ol property who bullds or Improves thereon, enA w�a wmracts tor such pmject wlih e conirector(s) license pursuant to ihe Contractars License LewsJ. , ❑ I am eaempl untlar sec. eu5ine55 and Professions Cade lar this reason: SignaWre: Date: Owner ID verified by driver9 IICen50. ❑ Ves ❑ No Drivefs LiCenSe No. Expirw: Verification of Ownership by (rype ot document, i.q, - property tex bill or daed): CERTIFlCATE OF COMPLIANCE AND AUTHOR17ATON OF ENTAY: I ceriiy under penalry of perjury thet I have read this applicatlon antl steta thet the informallon given is correcl. I agree lo comply with ell state lews end ciry ordinences relating to building constructlon, entl authodze representatives ol Ihe Clty of Cwta Mese to enter upon 1he ebove-descnbed propeny for inspection puryoses. I agree not to occupy or allow occupency ol any 6uilding authonzed by Ihis permit until linal inspectian. � ��a o� �a � 5 ,3 _�/—d ✓Joa�a And/Or Authodzed Applican Dete CQOE t. INSFECTION TYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 207 Fine181ocWRetaining Well 202 Finel Fectory Ffre Place 203 Final Sign 204 Final Demolition 1jSjF �$ j�j,( INSPECTIONTYPE � - I�I-D� � 206 Finel Mechanlcal 20B Final Plumbing 210 Flnal Electrical 212 Final Fire Prevention 220 FInaIPlenningApprovel 222 250 Final Site Finel Bullding/Occupancy � It�fi .lob nddress: 3333 BEAR ST Suite No 322 Vitinity: Parcel Number: 41249207 App�iwnt: MATT MITCHELL Address: 31716 PACIFIC COASTHWY LAGUNA BEACH, CA � � Owner: Address: Contractor: Address: SOUTH COAST PLAZA %C J SEGERSTROM & SONS COSTA MESA; CA . 3315 FAIRVIEW RD MILLION, GREG MECHANICAL PERMIT Phone: (949)499-9700 .� Zip: 92651-6974 , , Phone: Zip: 92626 Phone: Zip: License: 824235 Status: ISSUED Applied: 11/16/2004 ISSUED BY: \ . �� . �j � � � . '. • SCOPE OF PERMIT . EF B04-01774. ' � 1 VAV BOX AND 1 VENT. FAN 1 ALT DUCT. - � , .. ..� . . .. . . . . FEE SUMMARY � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k.BTU Refrig Sys >100 k BTU � Gas Piping � , � , Faclory Fireplace , � Hood w/Mech Exhaust VAV Box Vent Fan ! Single Duct Appliance � � , Fire Dampeis Smoke Dampers � Inst or Relocate Appl Vent Air Handlers < 10000cfin Air Handlers > 10000cfm � - Floor Fornace � Floor or Suspend Heater Quantity $23.50 , $0.00 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.65 $725 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 0 0_ 1 0 0 0 0 0 � 0 1 , � 0 0 0 � � , Q 0 0 0 �'_ Repair/AltAbso,rbtionUnit 50.00 Repair / All Refrigeration Unit . $0.00 Ventillation System , , $0.00 Evaporative Cooler , $0.00 Commercial Incinerator � $0.00 Domestic Incinerator �� , $0.00 Compre55ors / Absorption SySlems , � - � � ,Up to 3 hp / 100 k BTU ,;,, $0.00 ' �3To15hp/SOOkBTU � $0.00 15 To 30 hp./ 1,000 k BTU - $0.00 -. 30 To 50 hp / 1,750 k BTU �$0.00 � Over 50 hp / Over �1;750�BTU �� $0.00 Boilers � Upto3hp - � � 3 To 15 hp ,� � � � 15to30hp_ � - 30 to 50 hp� - , " - Over 50 hp Other Mechanical Fee � � � - lovestigalion Fee - . � - - , Plan Check Fee � , _ , Reinspection Fee � , . � , . �TOTAL CALCULATED FEES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.10 Quantity 0 0 0 0 0 0 0 0 - 0 0 0 0 0 0 0 0 t, NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) '^ E7CPIRATION: This permit shall eutomaticelly axpire end become void if work Is not commenced within 180 days, or It work is suspended or abandoned tor a periotl of 1B0 days. INSPECTIONS: In order for the work authorized under this permit to be considered legel, such work must comply with all epplicable codes, and all requlred Inapeetlone and finel epprovel must be obtained. Failure to obtain Inspections end final approval will result�in the ezpiration ot this pertnit. FOR INSPECTIONS CALL: (714) 7545626 2aa&48 (8�00) WORKERS' COMPENSATION DECLARATION: � . _ I hereby eMirm under penalry of perjury one ol the tollowing tleclarations: � ❑ I heve entl wlll malnteln e certlticete at consent to sell-Insure lor workers' campensatlon, es provided for by section 3700 of ihe Lebor Code, lar the pertortnance of Ihe work far which this permil Is issued. ', ttf8 e entl wlll melnteln workers' compensatlon Insurance, es reQulred by 5ection 3700 of Ne Lebor Catle, for Ihe peAortnance of the wark for which this peimit is Lssued. '�� My workers' com ..n-s,�at.l.orn �I—nsu.✓renca� c�artler entl pollcy number are: j��^l �� ^� C�r: �I �/ / CS T �N �7 Policy Number. / �- (Thls sectlon need not campletetll! (�e perm/f /s va/ued e( one huntlretl dollers ($100) or /ess.) ❑ I certify ihat In ihe perlormance of t�e work lor which thls permit is Issued, I shall not employ eny pereon In any manner so as to become suhject to the workers' compensatlan lews at Califo la, end qree lhet It I 6hould become su6�eCt to Ihe worker9' compen5atlon provislons ol Section 3 00 ot he Lebor Cotle, I shall forihwlt� comp� ly w��h �nese � lr�c -' AppYcenb6gneNrw�'�' Dai9:_ '-- — � �� 0 WARNINO: FAI�URE TO SECUFE W KERS' COMPEN ON COVEMGE I$ UNIAWFUT AND SHRLL SUBJECT AN EMPLQYEF�TO CRIMINAL P NALTES AND CIVIL FlNES UP TOONE HUNDRED THOUSAND DOLURE (5100,000), IN /�DDITION TO THE OF COMPENSATION, DAhUOES AS PROVIDED FOR IN SEC710N 37080F THE UBOR CODE, IMEREST, AND ATTORNEY'S FEES. LICE�NSED C0� TORS DECLARATION: I herebyeHlrm that I em Ilcansed untlerp roNslon�y 1 Chapter 9(crommencing with Sectlon 7000) ot DlNsiarvS�of�Ihe B�ushresi an¢� rofessions Code, end my license Is In tull larce end enect. Llc. a �a29�Z�j S ��c ass� - 1� . _. CONS7RUCTION LENDING AGENCY: ❑ I hereby eHirtn Ihat Ihere is a construction lentlinq apency for the pertortnance ot t�e work for which ihis permlt is issueG. (Sec. 3097, Clvil Cotle). Lentler's Neme: LentleYs AOdress: Slgneture: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm Ihet untler penelry of per�ury Ihet I em El(EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lallowing reason (Sec. 7031.5, 8usiness and Protessbns Cotle: Any city or county which requlres e permit to construct, elter, Improve, tlemolis�, or reDalr eny structure, prlor to its issuanCe, elso requires t�e appliwnt tor such permit to fila e sipned statement Ihet he or she is Ilcensed pursuent to Ihe provisians af t�e Contractors LJcense Lew (Chapter 9(commencing with Section 7000) of Dlvision 3 af the Business end Prolessions Code) or that he or she is exempt therelrom end the basis lor the elleped ezemption, Any violatlon of Section 7031.5 by eny applicant for e Oermil suDjects t�e epplicent to e civll penelry oi not more Ihan tive �untlretl tlo11eB ($500).): ❑ I, as owner ol the properry, or my employees with wages es their sole compensalion, WILL DO T1E WORK, entl the strucwre Is not intentletl or oHered for sale (Sec. 7044, Business end Professions Cotle: The Conirectors License Law does not apD�Y �a an owner of properry who builds or Improves Ihereon, antl who tloes such work himselt or herself or t�rough his or �er own employees, provitletl that such improvements ere not Intended or oHered for sala. If, however, the 6uilding or improvemem is soltl within one year of comDletion, the owner-builder will heve the burtlen ot proving ihet ha or she did not build or improve lor purpose of sale.). ' ❑ I, es owner o1 the properry, em E%CLUSIVELV CONTRACTNG WRH LICENSED CONTRACTORS to consiruct Ihe O�oject (Sac. 7044, BuSinesS and Professions Code: The contracrors Llcense Lew tloes not eDDh �o an owner ot pmperty who builtls or Improves thereon, anC w�o contracts for such project with a cantractoqs) licanse pursuant b the Contractors License Lews.). ❑ I em exempt untler sec. Business anA Profeuions Cade tor this reason: Signature: Date: Owner ID veAfied by drivers license. ❑ Ves � No Drivers License No. Expires: Verlfication ot Ownership by (rype of tlocument, I.e. - property t� Dill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity that no excavatlon Ilve (5) or more feet in depih Into which a person is required to tlescend, will be metle in connection with work euthorized by this pertnit, end ihet no Dulltling struqure, sceHoldinp, talsework, or demolitian or dismantling I�ereol, will be more t�en thirry-six (36) leet high. (Chep. 32, Grp 2, An 2, Sec. 341, Ttle B, Califamia Atlminisirative Cotle). ❑ As owner-bullder, I will not employ enyone to tlo work which would require e pertnil Irom Ihe Division at Industdal Selery, es notetl eDove, unless such person has a pertnit ro do such work trom t�e tlivision. SlgnaWre: Date: Divislon of Intlustdel Safery Permit Number. CERTIFlCATE OF COMPLIANCE IWD AUTHORIZATON OF EMAY: I certity untler penelty ol perjury that I hava read this epplication entl state t�at the intormailon gNen is correct. I egree to compty wlth all stele laws enC Gry ortlinances relatinp to bulltlinp constructlon, end authodze represenletives of t�e Ciry of Coste Mesa Io enter upon the ebove-descnbetl D�operty for inspection purposes. I egree noI Io occupy or ellow occupancy ol eny building eu�honzed by this Dermit until linel inspection. GO�E /. INSPECTIONTYVE - 1616 Fized System Finel F re Preventlon 7266 Pool Spe Finel 200 Final RaRoot 201 FInaI BIocWRetaining Well 202 Final Fectory Flre Place 203 Finel Sign 204 Flnal Domolltlon QAIE � l f�� a INSVECTIONTYiE 208 Finel Mechenical 208 Flnel Plumbing 210 Flnel Electdwl 212 Flnel Fire Preventlon 220 222 250 Final Plenninp Approvel Final Slte . Final Bullding/Occupency • �7ni nu/1F • r C� (714) 754-5273 • Fax (714) 754-4856 • www.cl.cosla-m�,c�.�cUPRESSION PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3333 BEAR ST Suite: 322 Vicinity: �SPACE 322 (OLIVER PEOPLES� Parcel Number: 41249207 Applicant: LOONEY, SHEILA Address: 5200 E HUNTER AV ANAHEIM, CA Owner: SOUTH COAST PLAZA Address %C J SEGERSTROM & SONS COSTA MESA, CA 3315 FAIRVIEW RD Zoning: Phone: (714) 993-2822 Zip: 92807 Phone: Zip: 92626 Contractor: ALERT FIRE PROTECTION INC Address: 5200 E HUNTER AV ANAHEIM, CA Phone: (714)993-2822 Zip: 92807 License: 376324 Slatus: ISSUED Applied: 12J03/2004 Issued: 12/20/2004 . ISSUED BY: SCOPE OF PERMIT RELOCATION OF 14 EXISTING SPRINKLER HEADS AND THE ADDITION OF 1 IN CONJUNCTION WITH THE 1,022 S.F. INTERIOR TENANT IMPROVEMENT FOR "OLIVER PEOPLES" SPACE 322. REF: 604-01774 FEE SUMMARY Plan Check: $54.11 Calc Valuation: 52,�00.00 Permit: $83.25 Claimed Valuation: 52.�00.00 Other: $0.00 Total: $137.36 C-�s ca7�- ��.� a/r° wrr� vZ.r"—i'�� d..e,�,r�cQ 3l �7 V-'n� F g�FLS . � NO710E: The work authorized by this pertnit shall comply with all applirable handicap access requirements under Califomia statutes and retated regulations. (Ortl. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automaticalty explre and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ol 180 days. INSPECTIONS: In order for the work aulhorized under this permit to ba eonsidered legal, such work must comply with ell applicable codes, end all required Inapeetione and final epproval must be obtained. Failure to obtain Inspections and final approval will result in the ezpiration ot thls permit. FOR INSPECTIONS CALL: (714) 754-5626 2u8d8 (0N0) WORKERS'COMPENSAnONDECLAfiATON: I hereby eHirtn under penalry of perjury one of the following dedarations: ❑ I heve end will malntein a cenificate of consenl to selbinsura tor workers' campensetlon, es pmWtlea for by sadlon 37pp o1 the Lebor Coda, lor the pedormence o1 Ihe �work for which thls permi� is issuetl. I'heve and will maintaln vrorkers' compensation insurance, as required by section 3700 ot t�a Lebor Code, for Ihe poAortnance af the work lor which Ihis permit is IFsued. My workers' compensatlo�/ I�nsuranpce cartier and pdicy num6ar ere: �� /, v Cerder: STf%%�' (�v%nT- PolicyNumber:� � �d�� / (Th/s secrlon need not be cnmp/eted I/ the permitls ve/uetl et one hunCretlOollars (E 100) or less.) ❑ 1 certily that In the perfortnance of Ihe rk for which Nis pertnit is issuetl, I shell not employ eny person In eny menner so es to become sub�act to the workere' compensellon lews of Call}omia, end n�i �hel I' shoultl beco sub�ect to 1he workers' compensatlon provislons o1 Sectlon 3700 01 Ihe Dor Cotle, I shall torNwith comply with these DroNsions. %s� [/ AppllcentSlgnaNre: �"' � Dete: ` � ZQ�Q� WARNINO: FNIURE TO SECURE WORKE0.S' COMPENSATION COVERAGE IS UMA AND SWLL� SU&IECf Ml EMPLOVER TO CRIMINAL PEfULTIES M1D CML FlNES UP TOONE NUNDRED TMd15AND DOIUfiE (5/00.0OO�.IN AODRION TO THE COST OF WAIPENSATION, OAAMGES 0.S PROVIDED FOH IN SECfION 3]OB OF THE LqgpR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I hereCy eMirtn Ihet 1 em lorca entl eHect. lJc. a_ Contrecmrs SlgnaWre: ir 9(commenGng with Sectlon 7000) ol DlNsion 3 0l Ihe Bi � /% (� / Class M 4i ��,/�I%T%�� Date: _ Cotle, end my Iicense L5 in full CONSTRUC7ION LENDING AGENCY: ❑ I �ereby aflirtn Ihat there is a constructian lending egenty tor the peAortnance at tha work for which thls parmit is issuetl. (Sec. 3097, CMI Cotle). Lentlefs Neme: Lentlefs Address: Signeture: Dete: OWNEH-BUILDER DECLARATIONS: I hereby ettirm thet under penelry at perjury Ihet I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW for t�e following reeson (Sec. 7031.5, Buslness entl Professions Code: Any ciry or caunry which requires a permit to construct, alter, improve, Aemdlsh, or repair eny atructure, prior to Its issuance, elso requires the epplicant tor suc� permil lo lile e signetl stelemenl that he or she is Iicensed pursuanl to the provisions ol ihe Contractore License Lew (Chepter 8(ppmmencing with Seclion 7000) ot Dhrision 3 af the Buslness and Professions Code) or Nat �e or she is eaempt therefran antl the basls tor the elleged exemptlon. Any vloletion oi Sectlon 7031.5 by eny epplicant for e permit sub�ects the epplicant to a civil penalry ot not more than Five hunared dollars ($S00).): ❑ I, es owner ot the property, or my employees wlth wages as their sole compansatlon, WILL DO TME WORK, entl the SWCWre Ls not Inlentled or oXered for sele (Sec. 7044, Business antl Professions Code: The Contractors License Law tloes noi apply to en owner of property who builds or Improves t�ereon, entl who does such work hlmseN or herselt or Ihrough his or her own employees, providetl i�at such impravements era not Intended or ottered tor sele. If, however, t�e bullding or improvement is soltl within one yeer of completion, the owner-builder will have t�a burtlen of proving that he or she did not build or improve tor puryose ot sale.). ' ❑ I, as owner of lhe property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Prolessions Code: ThB conlracrors Licensa Lew tloes not apply to an owner oi property who builds or Improves ihereon, end wh0 contracls for such project with a contreclor(s) licensa pursuent to the Contractors License Laws.). ❑ I em exempi under 50c. SlgnaWre: Owner ID venfled by drlveYs Iicense. ❑ Yes ❑ No Business and Protessions Code for this reeson: Vedlication ot Ownership by (rype oi tlocumem, i.e. - property ta: 6111 or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Ddvets License No. Date: Expires: ❑ I hereby certtly that no excavetion tive (5) or more feet in depth into which e person Is requlred to Oescen0, wlll De made in conneciion with work euthorized by this permit, end ihat no building structure, scaNWtling, Falsework, or demolitlon or tlismantlinp �hereof, wlll be moro then Ihir�y-sis (38) teet high, (Chap. 32, Gry 2, Atl 2, Sec. 341, Tltle B, Callfomia Administretive Cade). � ❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Divlslon ol Inauslrlel Sefety, as notetl a6ove, unleas such person hes e permil Io do such work Irom the division. Signature: Date: Divislon ol Intlustdel Safey Permit Number. CER71FlCA7E OF COMPLIANCE AND AUTHORVATON OF EMAV: I certity under penalry ot perjury that I heve read thls epplicailon end stete thet tha Informatlon given is correct. I egree to wmpty wlth ell stete laws enA dry oMinances releting to builtling construcHon, end euthorize representatives of the Ciry ot Costa Mesa to enter upon the ebove-descnCed pmperry lor Inspection Dufposes. I agree noi to occupy or allow occupancy ot eny building euthorized by Ihls Oermit until linel inspection. GOpE �, IN9PECTIONTYPE j1�jE INTRIALS 1618 Fi:ed System Final Fire Preven�lon 1268 200 201 202 203 Pool Spa Finel Finel Re-Rooi Finel BIocWRetelninp Well Final Fectory Fire Place Finel Sign 204 Final Demditlon �o��zQ � (>a�� D e CODE♦ INSPECTIONTYPE 206 Finel Mechanlcal 208 Finel P�umbing 210 Finel Elecirlcal 212 Finel Fire Prevemlon 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupenty OAff It�ELB (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job nddress: 3333 BEAR ST Suite: 322 Vicinity: SPACE 322 (FOR NEW TENANT) Parcel Number: 41249207 Applicant: IMBRIALE, PAT Address: 2oning: � - Pbone: 714-957-8250 Z�p: Owner. SOUTH-COAST PLAZA Address �oC J SEGERSTROM 8 SONS _ ' COSTA MESA, CA - Phone: . , � , 3315 FAIRVIEW RD; � ., Zip: 92626 , � � Contractor: DEVELOPMENT SUPPORT SERVICES INC Address: � 515 W ALTON AV . � � Phone: 714-957-8250 SANTA ANA, CA 2ip: 92704 License: 748446 Arch : PAUL BOZARTH Eng: Address: 18661 VALEAV ' � Address:� . Phone: 714-538-5777 " ISSUED BY: Status: ISSUED Applied: 03126/2004 Issued: 03/31/2004 Phone: SANTA ANA CA Zip: 92705 License: C14800 License: SCOPE OF PERMIT INTERIOR 1022 SF STORE TI FOR NEW SPACE 322 WITH THE DEMOLITION AND CONSTRUCTION OF A NEW METAL STUD DEMISING WALL (NO GYP BD) AND ALTERATION OF EXISTING DECORATIVE MALL COLUMN ENCLOUSRE INTO NEW MALL NEUTRAL PIER. NOTE: WALL IS BEING CREATED IN CONJUNCTION WITH THE ADJACENT SPACE WHICH WILL BE FOR'NIKE WOMEN' IN SPACE 324. Plan Check: Permit SMIP Res: SMIP Com: Other. Inspection: Total: $90.51 $139.25 50.00 $1.47 $0.00 $0.00 $23L23 SETBACKS . MAIN STRUCTURE Front . 0- 0 ACCESSORY Front� - 0. 0 PARKING ExiStinq: o FEE SUMMARY Calc Valuation: Claim Valuation PLANNING & ZONING � Rear 0- 0 , Lek 0- 0 , Right � 0. 0 - � Reai . 0. 0 ' Left 0- 0 � Right 0- 0' Reouired: 0 � ' Proposed: 0 , � � s�,000.00 s�,000.00 i I NOTICE: The work authodzed by ihis permit shall comply with all applicable handicap access requirements under California statNes and related regulatfons. jOrd. No. 92•28, y 1, 12•21-92) EXPIRA710N: This permlt shail automatically expire flnd become void if work is not commenced within 180 days, or if work Is suspentled or abandoned �. foY a period of 780 days. IINSPECTIONS: In order tor the work authorized under [his permit to be considered legal, such work must comply with all appllcable codes, end ali requlred Inspeetlons end final epproval must be oDtained. Failure to obtaln inspections and final approval will result in the expirat(on of th(s pertnit. FOR INSPECTIONS CALL: (714) 7545626 taaa�m (e�oo) WORKERS' COMPENS4TON DECLARATION: � I hereby ettirtn untler penalry ot perjury one oi Na following deGareUons: ❑ 1 have enA will melntein e certificete of con�pnt ta selt-Insure tor workers' campen5etion, es provltletl tor by sectlon 3700 of the Lebor Cotle, tor Ihe pertormance ot the �''ork for w�ich this�petmli is issued. [j' I have and will maintaln workers' compensation insurance, as required by section 3700 of t�e Le6or Catle, tor the perfoimance ot Ihe work for which Nis pertnit is IssueC. My worke� �pmpep5etlon �surence wrder antl polity number ere: {.— Certier. �A�Ndot�/ POIIcyNumber:_�.�/�� r�0e�6��s/ (1'A/s SBGtlM need nol bB L»m e1BU/f the pennl! k VBhled a! OV)B hUndfBOOd/8/5 ($100) orless.) ❑ I certify t�at in lhe perfortnanca ol Iha work tor which MIs pertnit is issuetl, I shall not employ eny peraon In any manner so es to become sub�ad to the workers' compensetlon laws ol Celifomia, enQ egrea 1t� I If11,,shoultl become sub�ect to the workers' compensatlon proNsions oi Sectlon 3700 ot the Lebor CaAe, I shell torthwith comply wlth Ihese proyi5t�ns. / � // � Applicent S(gneture: �� oe�a: �— 3�0 � WARNINO: FAILUFE TO SECURE WORKERS' COMPENSATI COVERA�E IS UNLAWFUL AND SIIA�L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES M1D CML FlNES UP TOONE NUN�RED Tl�qJ$AND DOLLAHE (E100,000), IN ADIXTION TO THE C0.ST OF COMPENSATION, OMUOES AS PROVIDED FOR IN SECTION 3]OB OF THE UBOR CODE, IMEREST, AND AITORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm Ihet I em �QrCe entl eHetL Lic. p_ ContredoYs Sfgneture: ot Chepter 9(commenclnp with Sectlon 7000) ot Divislon 3 of the BUslnes�gend Pmfesslons Code, entl my Ilcense Is In full Cless q �6 �..,�fJr Pi✓rG'1 f pate: _�' 7�^ tl� CONSTRUCTION LENDING AGENCY: ' [] t hereby ettirtn thaf Mere is a wnstrucfion lending agen�y tor the performance of the work br which this permit is issued. (Sec. 3Q97, CiWI Code). LenCels Neme: Lentlels Address: Sipnatura: Dete: OWNER-BUILDER DECLAHATIONS: I hereby eHirtn thet under penelry of per�ury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe lollowing reason (Sec. 7037.5, Business entl Prolessions Code: Any ciry or counry which requires a pertnit to consWct, elter, Improve, demolish, or repeir any sWCWre, pnor to its issuence, also requires Ihe epplicant for suc� pertnit �o tlle a sig�d ststemeM that he w s�e Lv llcertsetl pursuen] to the provislons of the Conlratto�s Llcense Law (Ghapter 9(commenUng wltb Seclkn 7000) of Dlvislon 3 af the 6usiness end Prolessions Cotle) or Nat he or she is ezempt thereirom and the basis for t�e alleged exemption. Any vidation of Seaion 7031.5 by any epplicant tor e permit sub�ects the applicant to e chril penalry at not more than tive hundreG tlollars (5500).): ❑ I, es owner oi the property, or my employees with wages es Neir sole wmpensatlon, WILL DO THE WORK, entl Ihe slructure is not intended or oflereA tor sele (Sec. 7044, Business end Professions Code: The CONractors License Law tloes nol apply to en owner of pmperty who builds or improves thereon, antl who does such work himsel( or �erselt or thmugh his or her own emplqrees, pmvided that such improvements are not Iniended or oHered tor sale. I( however, the building or improvement is sold within one year of completlon, the ownerbuiltler will heve Ne burden ot pmving t�at he or she tlid not build or improve tor puryose oi sale.). � ❑ I, as owner ot the property, am E%CLUSIVELV CONTRACTING WITTf LICENSED CONTRACTORS to constmct tha pmject (Sec. 7044, Busineu entl Professions Cotle: The coniractore Llcense Lew does not eppty m an awner ot properry who bulltls or Improves Ihereon, and who contraas for such pmject wlth e crontractor(s) license pursuant to the ContBctorS lJcense LewS.). q I em exempt untler sec. Signature: Owner ID venlied by tlriver's Ilcense. ❑ Yes ❑ No Businass and Professions Catle for Ihis reason: Vedfcation of Ownership by (rype ot document, i.e. - property ten blll ar deetl): Dnvels Licensa No. Date: E:pires: pIVI510N OF INDUSTRIAL SAFETY PERMI7 CERTIFlGATON: ❑ I hereby certify thet no escevatlon tive (5) or more teet in Eepth Into which a person Is require0 Io descend, wlll be mede In connection wllh work euthodzeC by Ihis pertnit, and that no building siructure, scaHolding, falsework, or tlemolitlon or dismantling thereot, wlll be more �hen Ihiny-six (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Calilomla Adminlsirative Code). ❑ As ownor�builder, I wUl not employ enyone to do work which would repulre e perml� trom the Divisio� ol Industrial Selery, es noted eDove, unleas such person hes e permlt to do such work trom the tlivislon. Signature: Date: Dlvision of Indust�ial Sefery Pertnit Number: CER7IFlCATE OF COMPIJANCE AND AUTNORRA710N OF ENTAY: I certiy under penelry of perjury Ihat 1 have reatl t�is appliwtion and state that Ihe infortnetlon given Is correct. I agree to compy with all stete lews end Gry orClnances relating to Guilding constructlon, and authodze represemativea ol the Ciry ol Costa Mese to enter upon the ebova-descdbed propeny for Inspection purposes. I egree not to occupy or ellow occupency of eny builtling euthorized by Ihis pertnil until linal inspectian. � � Sign�lure Legal Owner(s) ate 3`�i'O AnNOr Auttiorized Applicent Date COpE 1, �y,SPECTIONME Q�¢, �$ 1616 Fi:etl System Flnal Fire Preventlon 1288 Pool Spe Finel 200 Flnel Re-Rooi 201 Finel BIocWReteining Wall 202 Flnel Fectory Firo Plece 203 Final Sign 204 Finel Demoliclon COOE� INSVECiIONTYPF 206 FIOBI Mechenicel 20B Flnel PIum6ing 210 Flnel Elecidcel 212 Final Fira Prevention 220 Final Plenning Approval 222 Flnal Site 250 Finel Bullding/Occupenty