HomeMy WebLinkAbout3333 BEAR ST - Building Permits (121)(714) 754-5273 • Fez (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3333 BEAR ST
Suite: 315
Vicinity: SPACE 315
Parcel Number: 41249207
Zoning:
Applicant: SNEDEN, KENT
Address: 1087 ST REGIS PL _, �, .. -
� . � _ Phone: p14) 838-4722 - .
SANTA ANA„CA, . � . � � Zip: 92705 ' ,
i / ',
Owner SOUTH�COAST PLAZA � �
Address %C J,SEGERSTROM & SONS ' -
�COSTA MESA, CA � " Phone: ' � �
- � 3315 FAIRVIEW RD " ; Zip: 92626 - - -
ContraUor. SNEDEN & BOWERS GENERAL BUILDWG CONTRACTORS
Address: 1081 ST REGIS PL
SANTA ANA, CA
2ip: 92705
Arth :
Address:
Phone:
Phone: -(714) 838-0112
License: 776885
� Eng:
Address:
Status: ISSUED
Applied: 10/22/2001
Issued: 17I14I2001
ISSUED BY: '
Phone:
%�
2ip: , �� License: � " License:
SCOPE OF PERMIT
' � TENANT IMPROVEMENT FOIR'TRAFFIC". APPROX. 2800 SQ. FT_ �; ' -
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
,Sotal:
$206.99
$1, 273.75
$0.00
$31.50
$0.00
$0.00
$1,512.24
,
,
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existina: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: � 0
FEE SUMMARY
PLANNING & ZONING
LeN 0- 0
Left 0- 0
Proposetl: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
a�so,000.00
$150,000.00�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilornia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with ell applicaDle cotles, end all
required Inspectiona end finel approval must be obtained. Failure to obtain Inspections and final approval will result in ihe ezpiration of lhis permit.
FOR INSPECTIONS CALL: (714) 7545826
zau�s �dao�
WOFKERS' COMPENSAT1bN DECLARATION:
I heraby eKrtn untler penelry of per�ury one W Ue Idlowlnp tleUaretlons:
❑ I heve aiW will maintelq e cenificete of consent ta selt-Insure tor warkers' compensetlon, es provltletl br Dy sectlan 3700 oi Ihe Lebor Cotle, br Ihe peAortnance of Ihe
WOlk �Of Wi11C11 ih�9 PBfm�i �S ISSU04.
wlll maintai� woAcora' compensetlan insurence, as required by sectlon 3700 ot the Lebor Codo, tor Iho peAomiarwe of ttie work fw whlch thLv pertnit La IssueE.
; compensation I� nce carrie� antl polcy number ere: �� ��� ��
��'� / I i�1 � CPollcy Num e.
vd nof be cromDlefed ll th� permif /s velued el one hUntlred dollers ($100) or less.)
❑ I ceNiy tha[ in tha paA /}nan ot Ihe work tor Is pe�nit is luuetl, I shell not employ eny pereon in eny manner so as to come u6�ect to Ihe workere'
compensaf7on laws o� gIi m7e, end e re � sh Id become subject to Ne workers' compensatlon proNstons o� Sectlon 700 0} t Lebor Code, I shall farthwlN
comP�Yvriththe58 (Si� _ __.
�m SlgneNre: DLate: 5 (r � � O �
WARNIN�: FAILURE TO SECURE W RS' COMPENSATION ODVEMOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIE M1D CNIL FlNES UP TO ONE MUNDRED
T/qUSANDDOLURE(5100,OOOJ,IN ITIONTOTHEWSTOFCOMPENSATON,OAMAGESISPROVIDEDFORINSECTION3)O60FTMEUBORC�ODE,IMEREST,ANDATTORNEY5FEE5.
LICENSED CONTRACTORS DECLARA710N:
I hereby aKrm
force en0 ettec
CONSTAUCTON LENOING
9(commencing wich Section 7000) ol OMslon 3 ot the B
`Class.p
ena my Ilcense Is in full
❑ I hereby aHifm that there is e construction lentling agenq for the pertormance oi the work tor which ihis pertnit is issued. (Sec. 3097, Clvll Cotle).
Lentlera Name: Lenders Address:
Signeture: Oate:
OWNER-BUILDER DECLAqpTIONS:
I hereby eHlrm thet untler penelry oi per�ury that I em E%EMP7 FROM TME CON7RAC70RS LICENSE LAW tor the tollawing reesan (Sec. 7031.5, Business end Professiona
Code: Any ciry or cnunry which requlros e permil to consiruct, elter, Improve, tlemolish, or repair eny sWcture, pdor to Its issuence, elso roqulres tha eODlicant lor suth pertnit
to tile e slpneG statement thg� he or she Is Iicensed pursuent to Ihe provlslons of ihe Contrectore License Lew (Chapter 9(wmmenGnp wlth Section 7000) ai DlvLalon 3 ot ihe
Businuss entl Prolessions Cp�fe) or Ihat �e or she Is exempt thorelrom entl tha basis for Ihe elleged exemptlon. Any Noletion ol Section 7031.5 by eny epplicent lor e pem+'
sublecta tha applicant to e civil penelty of not more than tive huntlred dallars ($500).):
❑ I, es owner ot the properry, or my empbyees vrith weges es thelr sole compensatlon, WILL DO THE WORK, and the structure is not IntenOed or ottered for sa�e (Sac.
7064, Business and Protessions Code: The Gontractors Llcense Law does no� appty to an owner ol property who builds or imprwes thereon, antl who tloas such work
himsetl or hersetl or throug� his or her own emplqrees, provided that such improvements ere not Iniended or oflerad for sale. If, howaver, the building or improvement is
sald within one year ot com0�etion, the avner-builder will heve the Durden a! proting that he ar she did rrot budd or improve !or purpose ot ulg.).
❑ I, es owner of the propgrty, em EXCLUSIVELY CONTRACTING WITN LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business entl Professions
GoAe: TTe comwctore L7cense Lew tloes not appy to en ownar oi property who builds or improves t�ereon, entl who wniracts lor suc� pro�ect with e wntreqor(s)
license pursuant ro ih4 Contrectora Llcense Laws.).
❑ I em exempt under seC. Business entl Professions Catle lor Ihis reeson:
SipneWro: Date:
Ownor ID vedlletl Dy tldveYs licenso. ❑ Yes ❑ No Drivers Ucense No.
Verlflcetion of Owners�ip by (lype of tlocument, i.e. • property tex blll or Ooetl):
Ezpires:
OIVISION OF INOUSTRIAL SAFETY PERMR CERTiFlCATON:
❑ I hereby canify that no excavetlon tNe (5) or more teet in depi� Into which e person is required to descenQ will be made In connectlon wit� work euthodzed by thls
pertnit, entl Uat no bullding structure, sceXdding, falsework, Or Aemditlon w dismanlling ihereof, will ba more Ihan Uurty-su (38) laet hlph. (Chep. 32, Gry 2, Art 2, Sec.
341, TiUa 8, Califomia qtlministrative Code).
❑ As owner-Duiltler, I wi11 not emplay anyone to Eo work which would require e permit from ihe Division of Industrial Satery, es noted ebove, unless such person hes a
pertnit to do such work from ihe tlivislon.
SigneWra: Date:
Divislon oi Induslrial Sefary Permil Number:
CEHTIFlCATE Of CAMPLIANCE ANO AUfHOR¢ATON OF EHTRY: I cenity under penalry ol perjury that I heve read tNs epplicetion end siate Ihet the intortnation gNen Is
wrtect. 1 egree tp comply with ell stete laws end dry ortlinances releting to hullding constn�ctlon, end authoAze representatives of the Ciry of Goste Mese to enter upon Ihe
above-tlescribeypropertyJW inspectlon pu�poses'6pgree not to occupy or ellaw occupency ot any Duiltling authorized hy Nis pertnit until tinel inspection.
4QQ�/� INSPECTONPYiE
1876 Fixetl System Final Fire Preventlon
1288 Pod Spa Finel
200 Finel Re-Roo1
201 Finel BIocWRetaining Well
202 Flnel Fectory Fire Flace
20.3 Finel Sign
204 Final Demolitlon
�. i uw. . ,n' �i6P.ii19�
208 Final Machenical
20B Flnel Plumbing
270 Finel Elec�dcal
212 Finel Fire Preventlon
220 Finel Planning ApOroval
222 Final Slie
250 Finel Building/Occupanq
QAff lt{I�L9
� ,.
(714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 3333 BEAR ST
Suite No 315
Vicinity: SPACE 315
Parcel Nunmber: 41249207
". i_-�.,.-.,_, . , .
Applicant: GRIMM, DAVID -,!'� � � �
� i: �',-�- ;
Address: 387 SMOKERIDGESERRACE ,
, ,� � . Phone: (714)283-1586�,
ANAHEIM, CA ` - � . Zip: 92807 ' �
/ '. � ` _
Owner:.
Address
/
SOUTH COAST PLAZA
%C J SEGERSTROM & SONS
COSTA MESA, CA
3315 FAIRVIEW RD
Contractor. J'E D S PLUMBING
Address: � �387 SMOKERIDGE TERRACE
Arch / Eng :
Address:
ANAHEIM,CA,
i ' �
Phone:
Zip:�� 92626
Phone: (774) 283-1586
Zip: 92807
License: 547467
. ; � ,
Status: ISSUED
Applied: 11/29/2001
Issued: 11/29/2001
ISSUED BY: '
:� .
� �
� � Phone: '� �
Zip . ,
License: . � ,
,
SCOPE OF PERMIT
PLUMBING PERMIT FOR INTERIOR STORE T.I. FOR "TR4FFIC" (SPACE 315). INSTALL 1 WATER
CLOSET, 1 WASH BASIN, 1 BAR SINK, 1 FLOOR DR41N, 8 2 WATER HEATERS. ,
REF:.801-01687 _. �� �- . . .. ,
.
ISSUE FEE � �
Backflow irrigation �
Backflow Preventer .
Bathtub �
Clarifier System
Connect(Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drein, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaAhquake Valve
Gas (i-a outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
' ' FEE SUMMARY
AMT QTY , ' AMT
$23.50 - � . - Laundry Tub / Washer - $0.00
$0.00 � 0 Landscape Irrigation $0.00
�$0.00 �" 0 P-Trap $0.00
$0.00 �' 0 - Pressure Regulator $0.00
�$0:00 . 0 Process Pipinq (per 10 k) $0.00
50.00 0 , � Receptors � $0.00
$0.00 �- � 0 � Septic Tank , $0.00
$0.00 -'0, - Sewer Cap for Demo. , , $0.00
59.80 1 � -- Sewer Connect $0.00
$0.00 0 - Sewer Private Line $0.00
$0.00 0 Shower � $0.00
$0.00 0 Sink, bar $9.80
$0.00 0 Sink, wmmercial $0.00
$0.00 0 Sink, Floor $0.00
$0.00 0 Sink, kitchen $0.00
$0.00 0 Sink, service/mop $0.00
$0.00 0 Spa (private) $0.00
$0.00 0 Spa (public) $0.00
$0.00 0
$0.00 0
QTY
0
0
0
0
0
0
�0
0
0 ,
0 -
0
1
0
0
0
0
0
0
-Sump Pump , .
Swimming Pool ,
Trep Primer
' � Urinal , -
� � Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
30.00
$0.00
$0.00
50.00
50.00
59.80
50.00
50.00
$9.80
524.60
50.00
$0.00
$0.00
50.00
50.00
50.00
50.00
50.00
TOTAL CALCULATED FEES: 587.30
QTY
0
0
0
0
0
0
1
0
0
1
2
0
0
0
0
0
NOTICE: The work authorized by this permit s(�ppy��N�/3$p�e��p�� requiremants untler California statutes and related
regulations. (Ord. No. 92•28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced wlthin 180 days, or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work euthorized under ihis permit to be considered legal, such wo�k must comply with all applicable codes, and all
required Inspectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
2468-6818�00)
WOFiKERS' COMPENSATION DECLARATION: -
I hereby aHirm under penalry of perjury ane of the following declarations:
❑ I heve entl will maintain e certificate of consent to self-Insure for workere' compensation, es provided tor hy section 3700 0l Iha Lebor Coda, lor the pertormence of the
work for which this pertnit is issuetl.
� I have end will maintain workers' compensatlon Insurance, es requiretl by SeIXlon 3700 oi Ihe Lebor Cotle, for the perfortnance oi the work tor which this permit is issued.
My worke�J com�pensation Insurance cartier and poliq number ere:
Carttei: S7�M�- Fvs-ici IP.oI ylc Number:,�.'�9.-c) / Op/oOy.�
(!h!s sectlon need nat Oe crompleted tl the permit is va/ued et one hundred dollers ($700) ar less.)
❑ I certify that In the pertartnance of Ihe work for which Ihis permit is Issuetl, I shall not employ eny peraon in any manner so es to became subJect to the woAcers'
compensetlon lews of Calllomle, and egree thet If I shoultl becoma sublect to the workers' compensatlon provislons ot Sectlon 3700 oi the Lebor Code, I shell farthwith
comply with thesa prov' ions. t
Applicant Signewre: �ete:- � Uo
r
WMNINO: FAILURE TO SECU CERS' WMPENSATION GOVEMOE IS UNUWFUT AND SHALL SIIBJECT Ml EMPIOYER TO CRIMINAL PENALTIE ANO CNIL FlNES UP TOONE HUNDRED
TMOLSAND OOLIARE (51 , 0), IN ADDRION TO THE CQST OF COMPENSATION, DAMAOES AS PROVIDED FOR IN SECTION 3'IOeOF TME LABOF CODE.IMEREST, M1D ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm Net I,em Iicensetl under provislons of Chepter 9(commendng with Sectlon 7000) ot Division 3 ot Ihe Business entl Professions Code, and my Iicense Is in lull
farca end enect. Lla M�L��/ ��f�o -7 Cless M l C�� L
..__'__"'_" ..'_"...__. _ d-. _ � / �n_.- _ �/i � _4 �� i
CONSTRUCTION L61Q61NG AGENCV:
❑ I hereby ettirtn Ihat ihere is e consiruction Iending egency for the pertortnance oi t�e work tor which ihis permlt is issued. (Sec. 3097, Civil Catle).
Lende(s Neme: Lentlers Address:
Signature:
Date:
OWNER•BUILDER DECLMATIONS:
I hereby eHirtn thet untlef penelty of perjury that I flm E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the lollowing reasan (Sec. 7031.5, Bu5in855 en0 Protessions
Coda: Any ciry or counry which requires e pertnit to consWcL elter, imprrne, demolish, or repalr eny strucWre, pnor to its issuance, also requires the applicant tor such pertnit
to file e sipned statement ihat he or she Is Ilcensetl pursuant to Ihe proNsions o1 ihe Contrectors License Lew (Chepter 9(commencing with SecUon 7000) ot DMsian 3 of Ne
Business end Professions Cotle) or that �e or she is exempt therefrom end the besis for Ihe alleBetl exemptlon. Any violetlon of Section 7031.5 by eny epplicent for a pertr+'
subjects ihe aDD�icant to a civll penelry of not more ihan five hundretl tlollars ($500).):
❑ I, es owner oi Ihe properry, or my employees with weges es thelr sola compensatlon, WILL DO 7XE WORK, end the stmcWre Is not IntentleC or otteretl for sele (Sec.
7044, Business and Professions Gode: The Contractors Licensa Lew does not apply to en owner of property who builds ar improves thareon. antl who Ooes such work
himself ar herself or through his or her own employees, provided that such Improvemenis ara not Intended or ottered for sale. II, however, Ihe builtling or imprwement is
sold within one year of completion, the owner-builder will have the burden oi proving that he or she tlitl not builtl or improve for purpose of sale.).
❑ I, as owner of the pro0erry, am EXCLUSIVELY CON7RACTING WRM UCENSED CONTRACTOFS to wnsWct the Droject (Sec. 7044, Business end Professions
COEe: TTe contrectors License Lew does not appy to an owner ot pmperty who builds or Improves thereon, antl w�o coniracts for such project with e conirector(5)
license pur5uanl tO the Contractors License LawS.).
❑ I am exempt undar sec.
Siqneture:
Ownar ID verified by drivers Ilcense. ❑ Ves
Vedficatian oi Ownership hy (type of document, I.e.
Business end Professions Code tor this reason:
❑ No Driver's Licensa No.
propeM �%`� blll or tleetl):
DIVISION OP INDUSTRIAL SAFETY VEflMR CERTIFICATION:
Date:
Expires:
❑ I hereby certtly ihat no excavetion tive (5) ar more feet in depth Into which e person Is requiretl �o tlescend, wlll be made In connectlon with work euthorized by t�is
permi�, and �hat no huilding structure, scaXolding, falsework, or demolition or dismantling thereof, will be more ihen thirty-six (36) leet high. (C�ep. 32, Grp 2, Art 2, Sec.
341, 71tla B, Califamla Adminisiretive Cada).
❑ As owner6ulltler, I will not employ enyone ta do work which would requlre a permit trom Ihe Division of Intlustrial Selery, as notetl ebove, unleu such person hes e
pertnil lo tlo such work Irom Ihe division.
SignaNre: Deta:
Division of Indusirial Selery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUiHORVATION OF ENTRV: I cenify under penalry of perjury that I have read Ihis flpplication antl stata t�at ihe Information given is
correct. I egree to wmpty with ell state laws end dry ordinances relating to builtling wnstructlon, entl eut�orize representetives oi the Ciry ot Coste Mesa to enter upon the
ebove-descdbed property lor inspection puryases. I agree not to occupy or ellow occupency of any builtlinq authorized by this permit until finel inspectlon.
, Signalure OI Legal Owner(s)
�y iNsvernoxrrre
1676 Fized System Final Fire Preventlon
1266 Pool Spe Finel
200 Flnel Re-Roof
201 FInaI Block/Retaining Wall
202 Final Fectory Fire Plece
203 Finel Sign
204 Finel Demolition
QLIE I[�9L5
COOE 1 INSPECTION TYPE
206 Finel Mechanical
200 Finel Plumhing
210 Flnel Electdcal
212 Final Flre Preventlon
220 Flnal Plenning Approval
222 Final Site
250 Finel BulltlingiOccupency
PAg 1N7III�LS
,, . _, ..�-��. � - , a „ . ., . _ . .--- ......._..----
Job Address: 3333 BEAR ST
Suite No 315
Viciniry: SPACE 315 (TRAFFIC)
Parcel Number: 41249207
Appliwnt: GARRY, BOB -
Address: 14726 GOLDENWEST ST
UNITJ'., "-; � ` _ _
WESTMINSTER, CA
Owner SOUTH COAST PLAZA
Address: �%C J SEGERSTROM 8 SONS
" - COSTA MESA, CA
3315 FAIRVIEW RD
Contractor: � TALENT AIR
Address: 1d726�GOLDENWEST ST
UNIT J
WESTMINSTER, CA � �
MECHANICAL PERMIT
Phone: 714-899-9100 �
Zip: 92683-5206 �
Phone:
Zip: 92626
Phone: 774-899-9100
Zip: 92683-5206
License: 702568 .
Status: ISSUED
Applied: 12/04I2001
Issued: 12I042001
ISSUED BY: '
� � .
�
, .
SCOPE OF PERMIT
MECH PERMIT FOR INTERIOR STORE TI FOR'TRAFFIC" IN SPACE 315. 1 REPAIR/ALT
COOLING/HEAT, 1 VAV BOX, 1 VENT FANISINGLE DUCT, 2 fIRE DAMPERS.,REF: 601-01687
ISSUE FEE
Inst FAU <700 k BTU
Inst FAU >700 k BTU
Repair I Alt Cooling/Heat
Inst / Rep. Recess Wall Hlr
Refrig Sys <700 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace.
Hood wlMech Exhaust
VAV Box
Vent Fan I Single Dud �
Appliance �
Fire Dampers , �
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers � 10000dm�
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
823.50
$0.00
$0.00
$13.70
50.00
$0.00
$0.00
50.00
$0.00
50.00
$10.65
$7.25
50.00
; 574.50
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
Quantity
0
0
1
0
0
0
0
0
0
1
1
0
2
0
0
0
0
0 .
0
FEE SUMMARY
Repsir / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillatlon System
Evapoiative Cooler
Commerci a l I ncina rator
Domestic Incineraror
Comoressors / Absorption Svstems
Upto3hp/100k8TU
3 To'15 hp / 500 k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp I Over�1,750 BTU "
Boilers
Upto3hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee .
Plan Check Fee
Reinspection Fee � �
TOTAL CALCULATED FEES
COMMENTS I SPECIAL CONDITIONS
Quantity
50.00 ' 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0,
$0.00 0
so.00 0
so.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
$0.00 0
50.00
50.00
50.00
569.60
NOTICE: The work authorized by this permit shall comply with all applicable handicap accass requirements under Calitomia statUtes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permii shall allomaticalty expire and become.vofd if work is not commenced wlthfn 180 days, or if work is suspended or abandoned
tor a pedod of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must compty with ail applicable codes, and ell
requlred inepectlona end flnal epproval must be obtained. Failure to obtain (nspections and final approval will result in tha expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zaae�ae Ierool
WORKERS'COMPENSAnON DECLARAnON:
I hereby elfirtn unOer penelry ot perjury ona ol the fWlowing dedaratlons: -
❑ 1 have and will mainWin e certitirate of co�ssent lo selt-Insure for workers' cwnpenSeUon, es proWded for by section 3700 0l the Lebor Code, for Ihe peAormance of the
work lor whlch NIs permit Is Issued.
� I heve aM wlll meintein workers' canpensatlon Inwrence, as requiretl by secUon 3700 of Ne Lebor Cade, tor Ne pertortnenca oi the wwk ta wNcli NLs partnit La IssueC.
My wo rs\ c�ompensation I surance wrtier end policy{�umber ere: q
Cartier: � T��.�"C �n �p-�v> P�J G n T 1 w �1. i� Policy Number. ��i �i — �� � I��
(Tnls secrrorr neea not ne comp�eted U Nie ' Y!s va��ed er one nu�rea aalers �s �oo) or �ess.)
❑ I cenify thet in ingye rtnanca o1 tha work for which t�Ls pertnit is IssueQ I ahall not employ any person In eny manner so es ro Eecome sub�ecY to the workers'
compen�at�w o elifomia, entl egrea Ihet it I sh0uld Dewrne sub�ect to the workers' compensatlon provislons ot SecUon 3700 of the Lebor CoOe, I ahell toMwlN
comply wLLh Ihese oNsions. �� I a �
Applicent Sipnature: Date: � Z
WARNINO: FAILURE TO SECURE WOHKER$' COMP � TION COVEMGE IS UNLAWFUL AND SHALL SU9IECT Ml EMPLOYER TO CRIMINAL PENALTIE AND GVII FlNES UP TOONE HUNORED
TKKl$M1D DOLLARE (f100,000), IN ADDfiION TO OF COI.iPENSATION, DNMGES.�S PROVIDED FOR IN SEGfION 31080F THE LABOR CODE, IMEREST, AND ATTOqNEVS FEES.
LICENSED CONTRACTORS DECLARA710N:
I �ere�y eHirm thet I em Ilce etl untler proNslons at Chapter 9(commencing with Sectlon 7000) ot Division 3 of Ihe euslnes end Profesaions Cade, entl my Ilcense Is In full
lorce antl eMect. Lic u/� 6 Z SC� 4i __ c�ess a �� ZO
i
Cornrector's Slgneture� n _�--�+ i � Date: � 7 U( 6 l
CONSTRUC710N LENDING AGENCY:
❑ I hereby etlirtn t�el Ihere is a construction Iending egency for the peAormance oi t�e work for whic� this permit Is issuetl. (Sec. 3097, Civil Cotle).
Lender's Namo: Lender's Address:
Signeture:
Dete:
OWNER-BUILDER DECLAFiATIONS:
I hereby eHlrtn Ihet under penalry ot per�ury Ihat I am EXEMPT FFiOM THE CONTRAC70RS LICENSE LAW lor the following reason (Sec. 7031.5, Buslness anA Professions
CoGe: Any ciry or counry which requires a pertnit to consWct, elter, improve, Aemdish, or repalr eny strucWre, pdor m its iuuance, elso requires t�a epplicant lor such pertnit
to flle e signeA stetement ihet he or sha is Ikensed pursuant to Ihe proNsions ol ihe Contrectors Ucense Lew (Chapter 9(commenanp with Secllon 7000) of DWLUon 3 of the
Business and Profe55ions Cotle) or Ihat he or she is exempt Iherefrom anC I�e Dasis tor the ellepetl ezemptlon. Any Wolatlon of SecUon 7031.5 by eny epplicant for e pemY,
subJects the applicant to e ciNl penalry of rwt more ihen frve huntlred dollars ($500).):
❑ I, es owner oi ihe properry. or my employees with wages es their wle compensatlon, WILL DO THE WORK, and the slructure is nat Inientletl or offered 1or sele (Sec.
7064, Business and Professions Code: Tha Contractors License Lew tloes not aDPN �o en owner ot properry who builds or improves ihereon, anO who does such work
himsetl or hersetl or ihmugh his or her own emplayees, pmvidetl Ihat such improvements are not Intendetl or oHeretl tor sale. tl, �owever, the building or improvement is
soltl within one year o1 completion, the owner-builder witl heve the burden ol proving t�at he or she did not 6uild or improve for Durpose of sale.).
❑ I, es owner of the properry, am EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS to constmct me projea (Sec. 70a4, eusiness end Prolessions
Code: T1ie contractors LJcense Lew Ooes not appty ro an owner of pmperry w�o builtls or impmves t�ereon, antl who contracts for such project wit� a contrac[or(s)
license pursuant to tha Contractors License Laws.j.
❑ I em exempl under sec. Business and Professions Code for this reason:
Signeture: Date:
Owner ID veriiletl hy tlrivefs license. ❑ Yes ❑ No Drivers Llcense No. Expires:
Vetlficetlan of Ownership �y (type o1 daument, i.e. - pmperry tax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT GERTFICATION:
❑ I hereby certHy ihat no excavetion five (5) ar more leet In tlepih into which e person Is requlrad to descend, wlll be metle in connectlon with work euthorizeA by UL5
permil, and Ihat no building structure, scafloltling, lalsework, or demolition or dlsmantling thereoi, will be more than thlrry-six (36) feet hlph. (Chep. 32, Grp 2, Art 2, Sec.
341, 71t1e e, Celifamia AdminlsiretNe Catle).
❑ As ownerbulltler, I will nat employ enyone to do work which would require e permic Irom Ihe Divislon of IndusMel Setey, es noteA eDove, unloss suc� person has a
permll to do such work from the division.
Signeture: Date:
Division ot Industrlal Sefery Permit Number:
CERi1FlCATE OF COMPIIANCE AND AUTNORQATION OF EMRY: I cenify under penalry ot perjury that I have read this epplication antl staie Ihet t�e informatlon given is
conect. I agree to compry wlth ell stete laws end ciry ordinances relating to bullding construction, and aut�orize representatives ol the Ciry ot Costa Mese to enter upon the
above-descnbed property lar inspection puryoses. I agree not lo occupy or ellow occupanry ot eny Duiltling au�horized by this pertnil until final InspecUon.
COOE �. IN4PECTIONTYPE
1618 Fixetl System Finel Fire Prevention
1288 Pool SDe Finel
200 Flnel Re-Roof
201 Flnal Block/Retaining well
202 Flnal Fectary Fire Pleco
203 Finel Sign
204 Final Demolitlon
Pd7E ItIIIDALfl
Pate
i � ��o a,
GOUE 1 INSPECTION TYPE
208 Finel Mochenlcel
20B Finel Plumbing
210 Final ElectAcal
212 Pinel Fire Preventlon
220 Finel Planning Approval
222 Finel Site
250 Final Bullding/Oaupenq
1-ati oa �M
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
JobAddress: $$$$ BEARST Stams: ISSUED
Suite No 315 Applied: 17/16I2001
Vicinily: SPACE315 Issued: ii/16I2001
Parcel Nunmber:
41249207
Applicant: ORUNA, ROLAND
Address: 15166 VIA MAR4VILLA . � , " � � � � - � � � ' -
i.
�'�i '! `� _ �Phone: (909) 597-6780
CHINOHILCS�CA-'.-'�_ � � Zip: 91709
� ,
i �/. ".- ..� -
., '�, � �. , ' _ . _ � .
Owner �OUTH COAST PLAZA �- ' �
Address ��%C�JSEGERSTROM�SSONS' �
- ' COSTA MESA; CA-� ; " Phone:
. . 3315 FAIRVIEVV,RD Zip: 92626
Contractor: -�ROCAND ELECTRIC
ISSUED BY: �
\
i
//
� ��
� �, .,
• ; � `.
i.
. `i .
.. ��`� .' ' .
Address. 15166 VIA MAR4VILLA , . , ,
� � ' � ��..Phone: (909) 597-5760
CHINO HILLS; CA- _ `�" ` Zip: 91709 -.
� "_t �- ` � License: 600011
.� i� �
ISSUE FEE
Temp service test
Res. a/c package'
New Res,(1-2 units)
New Res (3+units) .
Pool / Spa • � � �
Lighting Fizts , �
Recept Outlets� � -
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR INTERIOR STORE T.L FOR'TRAFFIC". (SPACE 315). INSTALL 59
LIGHT FIXTURES, 25 RECEPTACLE OUTLETS,�72'SWITCHES�, 4 ELECTRICAL SERVICE TO 200 AMP
,1 MOTOR TO 50 HP, 6 COMMUNICATION DROPS, 1 SUB PANEL, &.i SIGN CIRCUIT. �
REF:B01-01687 . � ��-' . �- , , ,
. '---�--- ---- - - _/.._ .
Quantity
$23.50
$0.00
�,�-� $0.00
.�;,$0.00 0
$0.00 0
� $0;00 �, l �� -,,p: � �,
% � $SOA7�,; , 59
$25.65 � �-. `� c25 - .
��� $1�320 � �12��-.
�, $0.00 � �0 - _
„� $0.00 ; ,� � 0
. -$30.50 . .�, 7� .
� $0.00 ' � 0 � - -�
$0.00 ` 0
$0.00 0
$0.00 �,. .. �0 .,
$24.60 A
$0.00 0
$0.00 0
$6.60 6
$30.50 1
$0.00 0
$24.60 1
$0.00 0
$0.00 0
Switches � '
Non Res Appl �� �
Res Appl
Service to 200a �
Service to 1000a
Service over t000a
Motors to ihp
Motors to tOhp
Motors to SOhp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a •
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
� Quantity
Temp Dist System / Lighting $0.00 0.
' . Busway /100 ft $0.00 ' 0: �
� •` Stantling Section $0.00 � r 0 �
� - , MiscEledrical.Equipment $0.00 � "� 0
Transformers up to�1 kva/kw_ 50.00 �' 0 ,
� " � ' ........:.......up to tOkvalkw"-.... - "$0.00� 0 � .
. :..........._...up to 50 kva/kw � $0.00 , � 0
. , .................up to 100 kya/kw -. : " $0.00 � „0
� � . ........._.......over 100 kva/kw � � $0.00 � �0 '
� . - Low Voltage Equlpment � , � $0.00 0 ,
' Low Volt Wiring System / Ckt $0.00 � 0 '
Misa Conduit � ; �$0.00 - 0� �
. Misc Conductor $0.00�;- . 0
Circus ( gen or ride) :$0.00 ,� 0
Circus (mech ride or lights) �$0.00 0
- � � Chdstmas Tree Stand ; . - �$0.00 0
Fireworks Stand $0.00 0
- � . �Other Electrical Fee � $0.00
Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES E229.62
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under �his permit to be considered legal, such work must comply with all applicable codes, and alI
requlred Inapeetlona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permi�
FOR INSPECTIONS CALL: (714) 7545626
zaasre �eroo�
WORKERS' COMPENSATION DECLARATION: - • �
I heraby aflirtn under penalry of perjury one of the tollowing declarations: �" �
❑ I have antl will maintein e certificate ot consent to self-Insure tor workers' compensation, es provitletl for by section 3700 of the Labor Cotle, for the pertormence of the
�—�work for which this pertnit is issuetl.
❑ I have antl will maintain workers' compensation insurence, as required by section 3700 of the Labor Code, fo� ihe peRortnance oi the work for which this pertnit is issuetl.
My w/or+kers' compensation Insurance carrier end pol�'cy� nu�mber _er_e�:
Carrler:_ 1,41 \�bQYJ 1.4�.91�.xnw� 1"�� LPolicy.Number-'� �91�'� ��yr
(Tlils sectlon need not be comp/eted il ihe permit Is valued aT7�lre hundred dollars ($f 00J o� Iess.J , ,
❑ I certity ihat in the p e work 1 hich this pertnit is issued, I shall not employ any person in any manner so as to become subject to tha workers'
compansation la of Celifomie, en e e tha ii I shoWtl become subject to lhe workere' compensetion provisions of Seclion 37 0 ot Ihe Labor Cotle, I shell totlhwith
cnmply with ihase proNsio .
Applicent Signeture: � Det -� ��l %16 D(
WARNING FAILURE TO SECU WORKERS' COMPENSFTION CAVERAOE IS UNL4WFUL AND SHALL SUBIECT AN EMPLOYER TO CPIMINAL PENALTIES AND CIVIL FWES UP TO IXJE HUNDRED
THOUSAND OOLLARE (S10D,000�. IN ADDIiION TO THE WST OF COMPENSAiION, DAMAGES PS PROVIDED FOR IN SECTION 3]O60F THE UBOR CODE, IMEPEST, AND ATiORNE1"S FEES.
LICENSED CONTAACTORS DECLARATION:
1 hereDy attirtn thal I am Ilcensed under provislons of Chapter 9(commencing wlth Sectlon 7000) of Divislon 3 oFihe Business and Protessions Code, end my license is in full
force end eXecL Lic. N�1 /1��� � Cless a- 0 �— �C�
r,..,..e,a�re�ci��e%� . � nArw� '�s \ 1 % I .( T!"1 /'
CONSTRUCTON IENDING AGENCY:
❑ 1 hereDy aNirtn ihat there is a construction lentling agency for the peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lentler's Address:
Signamre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby eNirtn that under penalty o1 perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires e permit to construct, alter, improva, demolish, or repair any structure, prior to its issuance, also requires the epDlicant 1or such pertnit
to file e signetl statement ihat he or she Is licensetl pursuant to the provislons oi Ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) oi DlNsion 3 of the
Business end Professions Code) or that he or she is exempt tharefrom and the basis for the elleged exemption. Any violation of Section 7031.5 by any applicent for e DerrN'
subjects Ihe epplicant to a civil penalry of not more than five hundred dollars ($500).):
❑ I, as owner ot the property, or my employees with weges es thelr sole compensa�ion, WILL DO THE WORK, and the SiruIXure is not Intended or oHerad for sale (Sec.
7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of properry who builds or improves Ihereon, and who does such work
himself or hersetl or Ihrough his or her own emD�oyees, provitlad that such improvements ere not intended or oHered tor sale. H, however, the building or Improvement is
sold within one year ot completion, ihe ownerbuilder will heve ihe burden of proving ihet he or she did not build or improve for purpose of sele.).
❑ I, es owner of the property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions
Cotle: The contractors Licanse Law does not apply to en owner of property who builds or Improves thereon, end who comracis tor such project with a contracmqs)
licen5e putsuant to ihe Contrector5 License Laws.).
❑ I am Bzempt under 58t.
Signature:
Owner ID ventied by dnvefs liCense. ❑ Ves
Veriflcetion oi Ownership by (type oi tlacument, i.e.
Business and Professlons Coda for this reeson:
❑ No Orivefs License No.
propertytax billordeed):
Date:
Expire5:
DIVISION OF INDUSTRIAI. SAFETY PERMR CERTIFICATION:
❑ I hereby certity that no excavation five (5) or more feet in depth into which e person is required to descend, wlll be mede in connection with work euthonzetl by Ihis
permit, antl ihat no building siructure, sceffoltling, talsework, or demolition or dismantling ihereof, wiil be more ihan ihirty-sla (36) teet high. (Chap. 32, Grp 2, Ah 2, Sec.
341, Title 8, Celifomla Atlministrative Code).
❑ As owner-builCer, I will not employ anyone to tlo work which would require e pertnit trom Ihe Division ol Industnal Sefety, as noted ebove, unless such person hes a
permit ta tlo such work from ihe divisian.
Signeture: Date:
Division of Industnal Safety Permit Number:
CERTIFICA7E OF COMPLIANCE /WD AIJTHORIZATON OF EMRY: I cehity under penalry of perjury that I have read this epplication end state that the infortnation given is
correct. I egrae to comply with all state laws end ciry ordinances relating to building consiruction, and authodze representatives of ihe Ciry of Costa Mesa lo enier upon ihe
ebove-descnbed property for inspec�ion purposes. I egree not to occupy or allow acupancy of eny building authorized by this permit until finel inspection.
nature Ot Legal Owner(s) Date
� AnNOJraAuthodzetl�Applicant-- �— (r—Date--�.__ _.
[�IIT�I�ATT311I•liYPI»
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIxWRetaining Wall
202 Final Fectory Fire Place
203 Flnal Sign
204 Final Demolitian �
�jE INTITIpLg
CODE� INSPECTIONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Final Electncal
212 Final Flra Preventlon
220 Final Planning Approval
222 Final Sita
250 Finel BuiltlincyOccupency
PAI€
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uu .
(714) 754-5273 • Fax (714) 754-4856 • www.cf.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3333 BEAR ST
Suite: 315
Vicinity: SPACE 315
Parcel Number: 41249207
Applicant: SNEDEN, KENT
Address: 1087 ST. P.EGIS P:.
SANTA ANA, CA
Owner: SOUTH COAST PLAZA
Address � %C J SEGERSTROM & SONS
COSTA MESA, CA
3315 FAIRVIEW RD
Zoning:
Phone: (774)350-2475
Zip: 92705
Phone:
Zip: 92626
Contractor: SNEDEN & BOWERS GEN BLDG CONTRACTORS
Address: 1081 ST. REGIS PL.
SANTA ANA, CA
Zip: 92705
Arch : BOZARTH, PAUL
Address: 18667 VALE AVE
Phone: (714)350-2415
License: 635444
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 01/10/2001
Issued: 01/10/2001
Phone:
SANTA ANA, CA
Zip: 92705 License: License:
SCOPE OF PERMIT
INTERIOR NON-BEARING DEMOLITION OF EXISTING SPACE & INSTALLATION OF NEW DEMISING WALL TO CREATE 2
NEW SPACES FOR "SOUTH COAST PLAZA".
Plan Check: $99.61
Permit: $153.25
SMIP Res: $0.00
SMIP Com: $1.57
Other: $0.00
Inspection: $0.00
Total: $254.43
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0�
PARKING existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
Calc Valuation: S�,aoo.00
Claim Valuation: g�,soo.00
PLANNING & ZONING
Left 0- 0 Right
Left 0-0 Right
Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspendad or abandonetl
�,. for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considerad legal, such work must comply with all applicable codes, and all
requlred Inspeetlons and finel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244WBI6/00)
WORKERS' COMPENSATION DECLARATION: � ' �
I hereby aflirm untler penelry oi perjury one of the following declaretions:
❑ I have antl will maintain a cehifiwte of consent to self-Insure for workers' compensation, es provided br by section 3700 of Ihe Labor Code, br the pertortnence of the
�_work tor which this permit is issued.
� I.have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the pertortnance oi the work tor which this pertnit is issued.
�My worker ' pensatlon/��nsu- rence carder end policy number are: �----- y q[�
Cerrier:` �� V�+�i' '� Pl-�- olicy�Number.—r=� ���Y(� � I 7
(This secfion need not be completed i/ the permit is velued ef one hunOred dollars ($100) or less.)
❑ I certity ihat in ihe pert anc f Ihe wo for ich thjs pertnit is issuad, I shell not employ any person in any manner so as lo become subject to the workers'
compensetion lews of at i I should bacome subject to the workers' compensatlon provislons oi Sectio 3700 oi e Lsbor Code, I shell forthwith
complywiththese ns. �----
Applicent Signature: � D�- ete:------�� 0 02 a
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION �OVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL P NALTIE AND GVIL FlNES UP TOONE HUNDRED
THOUSANDDOLLARE($100,000),IN ITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]OBOFTHELABORCADE, MEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aftirtn ihaLl.am lic nsetl nder rovis Chepter 9(commencing with Section 7000) of Division�3 of the Buslness rofeuions Code, and my license Is in full
torce entl eflecL Lic. e, -� irCless�tt�
GontractoYs SignaNre: -' Date: / TJ
I ��
CONS7RUCTION LENDING GENCY:
❑ I hareby attirm that there is a consWdion lentling agency tor the periormance of iha work for which ihis permit is issued. (Sec. 3097, Civil Code�.
LentleYs Nama:
Signature: _
OWNER•BUILDER DECLARATIONS:
Lender's Adtlress:
Date:
I hereby aHirtn that under penalry of perjury thet I am EAEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry which requires a permit to constmct, alter, improve, demolish, or repalr eny stmcWre, prior to its Issuance, also requires the aOP�icant for such permit
to file a signetl statement ihat he or she is licensed pursuant to the pmdsions ot the Contrectors License Law (Chapter 9(commencing wit� Sectlon 7000) of DlWsion 3 ot the
Business end Protessions Code) or Ihat he or she is exempt iheretrom and ihe besis for the elleged exemptlon. Any violetion of Section 7031.5 by eny epplicent tor e permit
subjects the epplicant lo a civil penalry ot not more than live hundred dollars ($500).):
❑ I, as owner ot the property, or my amployees with weges as Ihelr sole compensation, WILL DO 7HE WORK, and the stmcWre is not intentlatl or otteretl tor sale (Sac.
7044, 8usiness and Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves ihereon, and who does such work
himself or herseN or Ihrough his or her own employees, providad that such Improvemen�s ere not in�ended or ottered for sale. It, however, ihe bullding or improvement is
sold within one year oi completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purpose oi sale.).
❑ I, as owner of the properry, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTHACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contradors licensa Law does not epply to en owner of property who builds or Improves thereon, antl who contracis tor such projact with a contracror(s)
license pursuant to Ihe Conirectors License Laws.).
❑ I em exempt under sec. Business and Professions Code for ihis reeson:
SignaWre: Da1e:
Owner ID verifietl by tlnver's license. ❑ Ves ❑ No Dnvefs License No.
Verificetion of Ownership by (type of document, Le. - propeny tas bill or tleetl):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no exwvation five (5) or more feet in depih into which e person Is required to descend, will be matle in wnnection with work authonzed by �his
permit, and that no building strucWre, scaHolding, talsework, or demolition or tlismantling thereo( will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Ah 2, Sec.
341, Title 8, Celifomia Atlminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which wauld require e permit from Ihe Division of Industriel Setery. es notea ebove, unless such person hes a
pertnit to do such work from the division.
Signature: Date:
Division of Indusinal Safery Pertnit Number:
CEFTIFICATE OF COMPLIANCE AND AUfHORVJITON OF ENTRY: I certity under penalty oi perjury ihat I heve read ihis epplication end state Ihat the iniormation given is
correct. I egree to comply wit II state end ciry ortlinances relating lo building cons�ruction, and authonze representatives of the City of Costa Mesa to enter upon Ihe
above-tlescnbed,property f nspectior� s�s. I egree not to occupy or ellow occupency oi eny builtling authorized by ihis permit until finel inspactian.
CO�E t. INSYEC�
161fi Fixed System Final Fire Prevention
1266
200
201
202
203
Pool Spe Final
Final Re-Roof
Final BIocWRetalning Well
Final Pectory Fire Plece
Finel Sign
204 Final Demolitian
BA�F INTRIRLS
��—C1) -O(
COpEt INSPECTIONTYPE
206 Finel Mechanical
208
270
212
220
Finel Plumbing
Finel Electncal
finel Fire Preventlon
Finel Planning Approval
222 FinalSite
250 Finel Building/Occupancy
PA7E IIIII�LH