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Home My WebLink About3185 Airway Ave - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.cl.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3185 AIRWAY AV Suite No A Vicinity: PETRA GEOTECHNICAL Parcel Number: 42779413 ISSUED BY: Applicant: SCHNIERER, STEVEN Address: 12922 HARBOR SL SUITE 687 Phone: 714-530-7320 GARDEN GROVE, CA Zip: 92840 Owner: CASTLE SOIL Address: 6592 JARDINES DR Phone: HUNTINGTON BEACH, CA Zip: 92647 Contractor: EMPIRE PLUMBING Address: 12922 HARBOR BL SUITE 687 Phone: 714-530-7320 GARDEN GROVE, CA Zip: 92840 License: 794154 SCOPE OF PERMIT REPLACE ROOF TOP FAU. NO INCREASE IN WEIGHT. NOT A NEW LOCATION. FEE SUMMARY Status: ISSUED Applied: 03/08/2004 Issued: 03/08/2004 Quantity Repair / Alt Absorbtion Unit $0.00 Quantity ISSUE -FEE $23.50 0 Inst FAU <100 k BTU $14.80 1 Inst FAU >100 k BTU $0.00 0 Repair / Alt Cooling/Heat $0.00 0 Inst /Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY Status: ISSUED Applied: 03/08/2004 Issued: 03/08/2004 Quantity Repair / Alt Absorbtion Unit $0.00 0 Repair 1 Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems Upto3hp/100kBTU $0.00 0 3 To 15 hp 1 500 k BTU $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Over 50 hp ! Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned for a period of 18D days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448.48 (&W) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers' compensation, as provided for by section 3700 of the labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the labor Code, for the performance of the work for which this permit is issued. My workers' corporis tion Insur ce rder and policy number are: Carder: Policy Number: O! K -�O Z� -Zg%p (This section need not be completed It the permlf Is valued at one hundred dollars ($ f 00) or fess.) ❑ 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 ofPllornla, end�houldbocomebject 10 the workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith comply with the Applicant Signature: Date: 3 — !9 O —_ WARNING: FAILURE T SECURE WO RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Code, and my license is in full force and effect. Lic. 0 Class rt Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Landei s Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for time following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, altar, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to life a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 o1 the Business and Professions Codo) 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 Density 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 safe (Sec. 70x4, 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 safe.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such project with a Conlractnr(s) license pursuant to the Cgntrecto(s License Laws.). ❑ I am exempt under sec. R Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feel in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap, 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic loot of compressed gas at standard temperature and pressure). ---- ................ —........................................_..._....................................................-...................._........_....._.._..._..................................._._.__............._............... — 2 Does ar will the applicant er present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, 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). _._ _....... _ r..........................__._._._.......................-......................................._....................._..................................................... .........__.........�_----------- .... 3 Does or will the applicant ar present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No ((Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Deparlment 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 she California Health and Safety Code been fully compiled with? Ll Yes [I No ............ ............................... _..................----.._........................................................................... _ ............................ — _............. 5 Does or will the applicant far present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency/? Yes a No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). _ _—..............-........................... .....— _----................................. -..................... ..—............._...—........ 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it'yee, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _................_........................._.................. _... —•---.................... ---._... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (11 'yes", attach certificate of compliance from the appropriate air pollution control gtficer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describod property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Data n r u onzed Applicant Date CODE j. INSPECTION TYP pAj$ INTMAig CODE A INSPECnOKTM PBIF 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 BlocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Damo4tion 250 Final BuildinglOccupancy (714) 754-5273 - Fax (714) 754-4856 - www.el.cosia-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3185 AIRWAY AV Status: ISSUED Suite: A Applied: 07/02/2003 Vicinity: BLDG A (PETRA) Issued: 07/02/2003 Parcel Number: 42719492 Zoning: Applicant: EWART, JUSTIN ISSUED BY: Address: 1424 E WILSHIRE AV _ .. Phone: 714-542-1100 SANTA ANA: CA,' -" Zip: 92701'�� - Owner: JLMD LLC .` Address/ATTN JOSETH,F POLIZZOTTO �/, HUNTINGTON BEACH, CA Phone: ,P O BOX 7033 - 'r Zip: 92615-7033 ' Contractor: ALLIED ROOFING COMPANY Address: 1424 E WILSHIRE AV Phone: 714-542-1100 SANTA ANA, CA Zip: 92701 License: 394067 Arch Eng: Address: ` Address: Phone. Phone: Zip: License: License: SCOPE OF PERMIT REROOF BLDG A: TIO EXISTING ROOF DOWN TO SHTG AND INSTALL NEW CLASS A TORCH DOWN ROOF SYSTEM. 6500 SQ FT FEE SUMMARY ' Plan Check:. $0.00 Calc Valuation: $12,500.00 Permit: $223.25 Claim Valuation: $12,500.00 SMIP Res: $0.00 `SMIP Com: $2.63 Other: $0.00 ' Inspection: $0.00 Notal: $22588 J v PLANNING & ZONING SETBACKS" MAIN STRUCTURE .Front , 0-'0 Rear 0-0 Left 0-0 Right 0-.0 ACCESSORY Front ' 0-0 Rear 0- 0 Left 0 0 Right 0- 0 PARKING Existing: 0 Required: 0 Proposed: 0 ' NOTES: c 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 A"G (5=) DECLARATIONS WORKERS* COMPENSATION DECLARATION: hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will malntain 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:hays 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' pompensa on Insurance carrier a d policy number are: Carrier: ? � A e-- 7_ Policy Number: (This sacfion neednof be completed it the permit is valued at one hundred dollars ($100) or less.) i ❑ 1 certify that in the pert ante 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 o Cali mia, and agree that It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, I shall forthwith Comply with theg cion . Applicant Signature; Date: WARNING: FAILURE TO SECU WORKERS' OOAtPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT PJ-0 EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DCLLARE ($100, , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licesed undo provisions o1 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coda, and my license Is In full force and effect. Lic. # Class fr 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed staterllent that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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. 11, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.), - ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type o1 document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Dale: 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? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costs 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 foot of compressed gas at standard temperature and pressure), 2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the Califomla Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has oh hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will theapplicant or resent or future building occupant need to prepare an RMPP Risk Management and Prevention Program for acute hazardous materials)? ❑ Yes ❑ P 9 pa P Pa ( 9 09 hr ) (Section 25534 of the Calilomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presenlfy required, has Section 2$534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a�annit for such construction or modifir-allon from the South Coast Air Ouallry Management District or from any other air pollution control district or agency? Yes t.] No (Section 65850.2 of the Callfomla Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). _............ _..--- -�. .......................__......--........_.._.__. ..............._.........-.............__...................... ..—.—.................. 6 Will any part of the facility.. to be constructed—un_.der......this....permit be within 1000 feet from the outer boundaries o1 a school? ❑ Yes .. ❑ No (if yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). .......1.111.1.......................................................................•---....................----•-.................-.—....._........................................................_............................ _...... __......... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No -- .................................................... .......... ................____-. _.. .................. _ ................__. ..............._..................................................._...WL.......................... _ ...................... B (it yes", attachM_ Ce_._...rt........iflc..a_......to of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I Certify that under penalty of porjury the Information given above is correct. I agree to Comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances rotating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. f agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Slgn to LegalOwner(s) Date rid! orized Applicant Date C00E,L INSPECTIONTYPE fgg INMAL;i CODEC INSPECTION TYPE pAIE IfilMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 PoolSpa Final 208 Final Plumbing Fina 200 Final Re-Rgof 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 Fina( Site 204 Final Demolition 250 Final 8uilding/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3185 AIRWAY AV Status: ISSUED Suite No A Applied: 10/1412002 Issued: 10/14/2002 Vicinity: Parcel Number: 42719412 ISSUED BY: Applicant: COOTER, LYLE Quantity ISSUE FEE Address: 12922 HARBOR BL Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU Phone: 714-530-7320 Repair / Alt Cooling/Heat GARDEN GROVE, CA Zip: 92840 Owner: JLMD LLC Refrig Sys <100 k BTU $14.80 Address: ATTN JOSETH F POLIZZOTTO $0.00 0 Gas Piping HUNTINGTON BEACH, CA Phone: Factory Fireplace $0.00 P O BOX 7033 Zip: 92615-7033 Contractor: EMPIRE PLUMBING $0.00 0 Address: 12922 HARBOR BL 0 Appliance $0.00 0 Phone:, 714-530-7320 Smoke Dampers GARDEN GROVE, CA Zip: 92840 $0.00,\ 0 License: 794154 SCOPE OF PERMIT MECHANICAL TO INCLUDE: CHANGE OUT PACT UNIT (<100 K BTU HVAC) LOCATED ON THE ROOF. "PETRA GEOTECH" UNIT A FEE SUMMARY Quantity Repair 1 Alt Absorbtion Unit $0.00 Quantity ISSUE FEE $23.50 0 Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU $0.00 0 Repair / Alt Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $14.80 1 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood wlMech Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan 1 Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 " 0 Smoke Dampers $0.00. 0 Inst or Relocate Appi Vent, $0.00,\ 0 Air Handlers < 10000cfm $0.00 .. 0 Air Handlers > 10000cfm ISO -00 0 Floor Furnace $0.00 0 Floor or Suspend Heater 50.00. 0 , FEE SUMMARY Quantity Repair 1 Alt Absorbtion Unit $0.00 0 Repair 1 Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors 1 Absorption Systems Up to 3 hp 1100 k BTU $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 15 To 30 hp 11,000 k BTU $0.00 0 30 To 50 hp 1 1,750 k BTU $0.00 0 Over 50 hp 1 Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 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 184 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (SM) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following dederations: ❑ 1 have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by section 3700 of the Labor Cada, for the performance of the Itwork for which this permit Is Issued. he 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' compens Ion Insurance carder and policy number are: er. �/ IiG li Numbers ��J� (rf hlcrlon need n be tompleted it he permit Is valued of one hundred dollars (S 100) or less.) ❑ 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 workers' compensation laws of California, a d agree that If I should become subject to the workers' compensation provisions of Section 3700 1 the Labor Code, I shall forthwith comply with these provislons. l "NW, tcantcanl Slg�natu,,:- rDater-- '/ V --- ---- - WAANlN6'FA1 UL RE TO SE ' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYE TR O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (S7 , IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that i am licensed under provisions of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Professions Coda, and my license Is in full force and effect. Lic. 4 Class 0 Contractor's 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. 3087, Civil Code). Lender's 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 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or hersetl or through his or her own employees, provided that such improvements are not intended or offered for sale. 11, 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.). ❑ f, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (typo of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth Info 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, Seo. 341, Title 8, Calllomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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). — .._........._..........._.............................................ildi..�.......................e...._......._--...........io,"r....._.............a,z".r'd......._..._...—ria1-s'?,._...... .... ..............__._...._..........._....-- 2 Does Or wit] the applicant or present or future building occupant need to file a registration form for acuteky hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safely 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). -.6.11-1 ................................................................................................................................_-........................................................ ,................ ........... .,............ ............................ ............................................. ................................... 3 Does or will the appplicant or present or Futuro building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Socilon 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................_........ ..... ............................................................................................. ................... _._....................................................,,........._................ .......................................... 4 It an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully compliod with? ❑ Yes ❑ No ............................_.._..............................................................................................................................,..__._.........---............................_..............................................................................-._.-.....__..__....................................._..-, 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication armil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? gge Yes fJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). ....................._.........--•---........................................................................................ ................................ _................. ......_........................................................ ........... .... •..... --........................................... 6 WiU any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (11 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................. _.._........ _.._............................ 7 If a permit from the South Coast Air Quality Management District Of 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? ❑ Yes ❑ No 8 (if 'yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and dry ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to anter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Le nor Zio Dat ,Md/Or AMA-Oozed Applicant l ate CODE f• INSPECTIONiYPE 291 NTrMLS CODED 1HSPEC710NTYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1-_I_ 02 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining Wail 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Silo 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3185 AIRWAY AV Suite No A Vicinity: Parcel Nunmber: 42719412 Applicant: COOTER, LYLE Address: 12922 HARBOR BL Phone: 714-530-7320 GARDEN GROVE, CA Zip: 92840 Owner: JLMD LLC Address ATTN JOSETH F POLIZZOTTO HUNTINGTON BEACH, CA Phone: P O BOX 7033 Zip: 92615-7033 Contractor: EMPIRE PLUMBING Address: 12922 HARBOR BL Phone: 714-530-7320 GARDEN GROVE, CA Zip: 92840 License: 794154 ISSUED BY: Status: ISSUED Applied: 10/14/2002 Issued: 10/14/2002 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 1 MOTOR TO 10 HP "PETRA GEOTECH" UNIT A, LOCATED ON THE ROOF. REF.: M02-00453 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) 7545626 244&46 (M) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System 1 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 0 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 kvalkw $0.00 0 Pool 1 Spa $0.00 0 ..............up to 10 kvalkw $0.00 0 Lighting Fixts 50.00 0 .................up to 50 kvalkw $0.00 0 Recept Outlets 50.00 0 .................up to 100 kvalkw $0.00 0 Switches $0.00 0 ..................over 100 kvalkw $0.00 0 Non Res App? $0.00 0 Low Voltage Equipment $0.00 0 Res Appi $0.00 - 0 Low Volt Wiring System I Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a '$0.00 , 0 Misc. Conductor $0.00 0 Service over 100Oa 50.00 "-��, '0 Circus ( gen or ride) $0.00 0 Motors to i hp $0.00 0 Circus (meth ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 01 Fireworks Stand $0.00 0 Motors to 100hp SO.00 0 Other Electrical Fee $0.00 Motors over 100hp SO.00 0 Communication drops $0.00 - - 0 Investigation Fee SO -00 Sub panel to 200a $0.00 0- Plan Check Fee SO.00 Pale Light Pkg $0.00 0- - Reinspection Fee $0.00 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) 7545626 244&46 (M) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. tl� have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of a whl this pA it i issued. My workers' Ca a ati Insuran%� er and policy umber are: :y t/ t� Policy Number: ection need r at a cdmpfe�d it the potmit is valued at Orta hundred dollars ($100) or less.} Certify thatin the performa/nce 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 o1 California, and agree that if hould bocome subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith comply with these provisions. .AppIT nt Slca gnature_P tate: �WAFIRNG�E TO SECURE WOWS ENSATION COVERAGE I5 UNLAWFUL AND SHALL SUBJECT AN EMPLIZ TOC MI ENAZT14AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 O E LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license�,uay�e` prgvl fogs of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and F ofessions Code, and my license is in full fo _,_and gfflBrt Lic.'3f �� Y 7 rr �W la9a.p C 10 _ Contractor e� 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. 3D97, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty O1 perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty o1 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 safe.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, fafsework, or demolition or dismantling thereof, will be more then thirty-six (38) feet ti gh. (Chap. 3.2, Carp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, i will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Dale: 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Alan 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires reglstratlon 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 o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................... .......................................................p-"a.....,........................p'a''e",*............................"'k,"................................rid, ..................io,n......................................................r'd"'o"U'........_.._................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous meterials)7 ❑ Yes ❑ No LSection 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .... ................................................................ ............................................................................................................................... ..................... ..................................,,.....................................,.........................._................................. 4 If an RMPP is presently roquired, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ....................................... _.......................................................... ---........----..................................................... ......................................................................... ....... ......_............ - ...._......................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency/ U Yes LJ No (Section 65850.2 of the California Goverment Code requires that the requested information be famished 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? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement o1 Sections 25534 and 42303 at the California Health and Safety Code). ........................................................................................ ................ .................... --.................................................................................... ...-----._.................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Caliiomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (ff '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: bate: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that l have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection: Signature Of L a1 Owner(s) D to And/ rized Applicant 11 Da Y CODE �• INSPECTION TYPE pAg INTITIAL,4 CODES INSPECTIONTYPE 2&M!(� 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 J Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. P Mi NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MES CO STR CTION PERMIT r r Gl. a t Project Address r�---��/• f� 8� I Dryeri ❑Gas ❑Electric ff&PE OF CONSTRUCTION NEW 1,DD ALTERATION REPAIR / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DE TION OF WORK/USE OF BLDG. / rUT �IVIP�20iU�/UE r E� ! Applicant's Mailin Address 0 - C w 6 Owner's Name Phon [ Address 0 V 1 �' ln� V Arch/Eng. ' T ` Q License No. Address TYPEQp pA MI ❑ ELECTRICAL JG,DG ❑ ITEry ❑ OTHER ON ti RAL PLUMBING MECHANICAL Contractor's Nam hone Address (mailing) • PROJECT'DESCRIPTION SQ. FT. CONSTRUCTIONTYPE— OCCUPAN y VALUATION $ City License No. LICENSED CONTRACTOR DECLARATION ZONE GRADING CU. YDS. �m Remarks: Sign I hereby affirm that I am licensed under, provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Standing Sections Generator 00.5 KW 05-15 KW my license is in fult force and effect. License Class License No. PLUMBING FEES Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell -insure or a certificate Bar Sink Showers gackflotni Preventer Service Sink of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflovv Irrigation Sewer Cap Policy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection pate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors ' (Thissection need not be Completed if the permit Is for one hundred ($100) or Dishwasher Solar Piping I certify that in the performance of the work for which this pe t is Issued I shall not employ any person in any mann t c ubje Work e s' C s tl ws Of Cantor Drinking Fountains , SOlar Tank Floor Drains Swimming Pool w/Spa Date Signature NOTICE: If, a ter ma Ing this declar n, you should become -subject t0 the Floor Sinks Urinal Workers' Compensation provisions ,of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater of the work for which this permit Is Issued (Section 3097 Civ. C.) Lender's Name Kitchen Sink Water Service Lender's Address -- _ _ OWNER BUILDER DECLARATION I hereby affirm that I�am exempt from the Contractor's License Law for the Lavatories Auto -Wash fallowing reason (Section 7031.5 Business and Professional 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 'o file a signed statement that he/she is licensed pursuant to the provisions of e Contractor's License Law (Chapter 9 (commencing with Section 7000) of rision 3 of the Business and Professions Code) *or that he/she Is exempt P_Trap Laundry Trays Roof Drains aretrom and the basis for the alleged exemption. Any violation of Section ,031.5 by any applicant for a permit subjects the applicant to a civil , Reinspection Fee $15 - Issue Fee $ 3 enalty Of not more than five hundred dollars ($500). I, as owner of the -property or my employees with wages as their sole compensation, witl do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I ❑ thereon, and who does such work himself /herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year Of tom- pletion. the owner will have the burden of proving he/she did not build or Inn- prove for the purpose Of sale), Duct - Under Ground Duct - Structural Refrigeration System ❑ I, as owner of the property, am exclusively contracting with licensed con- traCtors t6 construct the project (Section 7044, Business and Professlons Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- ©0-100,000 BTU ❑ 100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration tractor(S) license pursuant to the Contractor's License Law). t am aware that proof of their Worker's Compensation Insurance should be provided to me. 0 1 am exempt under Section B. & P. for this reason Firepl/Fact. Bit. ICBG ck Fire Dampers Date wner I hereby, certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws_ relating to building construction, and hereby authorize repre- sentatives Of th' to enter pbn bove-mentioned property for inspectlOn pu ♦ „I ,.., ��„� Signature Date L-J-`!•i/-�/-F/--� Drivers' License or SS Heating System & Ducting 1:10- 100,000 BTU ❑100,000$ Registers ' Reinspection Fee $15 Issue Fee! $ 3 -.CMF OafiS-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor A.P. 2%"+ %�P S Main Building: E T Front A Rear C Right SI Left Ping. Ref. Planning Notes: 194 1q1A.p� .5407 10/1 7/86 13 _ Zone 14141 Accessory Building: Z O N I N G R Parking Req./Provided E 0 M T S • ELECTRICAL FEES Automatic Washer Construction Pole Sub. Cooking Unit- Transformer ❑ 15.50 KW ❑ 50 + KW ' Meter-Oup to 100 amps ' Dishwasher Meter ❑over 100 amps Dryeri ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP 01'14 - S' F.A.U, Inc. Solar 09-15 HP 016.15+ 16 Fixtures Microwave Device Boxes Pole Light ) + Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor $ Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES 1 EMENTS: Zoning Approved By _ - Data Building Approved By ��. Date f��' �+ 0-S~ BUILDING PERMIT $ s� SMIP $ PLAN CHECK $ /%r �� PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ " PLAN CHECK 50% $ O MICROFILM $ MECHANICAL $ TOTAL FEE $ �� • �� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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, ❑ 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 .?d 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. APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73.' Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 6 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing 1 HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric /747 Notes: i 0� 1`6� 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. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed dr 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co w 51. CERTIFICATE OF OCCUPANCY No. Date y Applicant to fill In all spaces except those within heavy border Imes and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO.LO7,ND. BL _ CONSTRUCTION PERMIT Motors ❑0-1 HP 1K$ I my ticenie'is In full force and effect. I Z License kens t33 Inc,Soiar; 0915 HP ❑ 16-15+ Boiler' I pater___ Signature •- WORKERS' COMPENSATION DECLARATION Applicant's Maiiing Address VfYPE OF CONSTRUCTION U NEw U ADD U ALTERATION REPAIR 4 -1 hereby affirm that 1 hive a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance„ or a certified copy thereof (Section B ❑ CONVERSION ❑ DEMOLISH ❑ Bathtubs I Project Address - Owner's Name -E��TEC�-- --- �hone�✓ri-T-Va� �THER' w U DESCRIPTION OF WORK S 7 Dishwasher Address 5A W Y Arch/Eng,PACt� iL License No.❑.TENANT TYPE OF PERMIT U GRADI G OUNDATION USTRUCTURAL ❑ELECTRICAL PLUMBING ❑MECHANICAL ' Date' Glgnatura -- -- --- ------ -- NOTICE: If, after making this declaration, you should become subjact-to the Workers' Compensation provisions of the Labor Code. You must forthwith comply with' such .provisions or this permit -shall be deemed revoked. -CU4�QNA Address U i � 5 ?PARK C,1R - El 'OTHER • CONSTRUCTION -LENDING AGENCY Contractor's Nam, t�JATr R CA ORYhone$33~2 ZCiC1 PROJECT DESCRIPTION SO. FT. OCCUPANCY Kitchen Sink' ' Address +gw 4)u��CIER j�V� CONSTRUCTION TYPE VALUATION $ Lavatories + ' License No0612." . ZONE GRADING CU. YDS. ACRES ' Remarks: h ' Showers _ LICENSED CONTRACTOR DECLARATION , n I,hereby;afflrm that I am licensed under provision$ Pf Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and Motors ❑0-1 HP 1K$ I my ticenie'is In full force and effect. I Z License kens t33 Inc,Soiar; 0915 HP ❑ 16-15+ Boiler' I pater___ Signature •- WORKERS' COMPENSATION DECLARATION Bei Sink Baekflow Prevent8r ' 4 -1 hereby affirm that 1 hive a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance„ or a certified copy thereof (Section Backflow Irrigation 3800, Lab. C.) PoIEcY fYo.W51161 �� 5766 Company` jar A %Zlr- '.' BCertified copy is hereby furnished. Bathtubs I Certified copy Is filed with the city Building Division. Date Applicant - _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION r (Thissectlon need not be completed if the permit Is forgone hundred ($100) or ; less): 1 I certify that in the performance of the work for which this permit is issued I shall. not employ any person In any manner so as to become subject, to the Workers' Compensation Laws of California. I Clarifiers S Dishwasher Drinkin Fountains g Floor Drains Date' Glgnatura -- -- --- ------ -- NOTICE: If, after making this declaration, you should become subjact-to the Workers' Compensation provisions of the Labor Code. You must forthwith comply with' such .provisions or this permit -shall be deemed revoked. Floor Sinks ' ' I Gas SBrvice Outlets CONSTRUCTION -LENDING AGENCY Interceptors 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued (Section 3047 Civ. C.) Kitchen Sink' ' _ L.onder's' Name Lender's Address OWNER BUILDER DECLARATION Lavatories + ' I hereby•afflrm that I am exempt from the Contractor's License Law for the_ following reason. (Section 7031.5 Business and Profossional'Code: Any city or county which requires a permit to construct, alter improve; demolish or repair °.nY structure, prior to Its Issuance, also requires the applicant for such permit file a Signed statement that he/she Is licensed pufSuant to the provisions of �� ie Contractor's License Law'(Chapter 9 (commenclog'with Section 7000) of i]Ivision.3 of the Business and Professions Code) or, that he//she.is'exempt therefrom and the basis for the alleged exemption Any. vlolation-of�Section P -Trap' , , Roof Drains' - h ' Showers •7031.5 by -any applicant for a permit 'subJ�cts the applicant to a. civil l Umalty oT not more than_ flve hundred datlars ($Soo): Service Sink i, as'owner Of. the property Or'my employees.with wages as their sole , componsatlon wlll.do the work, and the structure is not intended or offered for sale {Secilon 7044, Business and Professional CO de: • The Contractor's , 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 ampl0y eos, provided that such Improvements are'ndt In or offered for solo. I}, howeber, Tho building or improvement Is sold within one year c Com- " platten, the owner will have ha burden of proving he/she did not build or Im- rove for the purpose of Sale). i Motors ❑0-1 HP 1K$ I Dryers []Gas- DElectric Inc,Soiar; 0915 HP ❑ 16-15+ Boiler' I 'Microwave Duct -Under Ground ' Pole Light ; Duct - Structural 1, as owner Of the property, am exclusively contracting with Ilcens. con- tractorsto construct the protect (Section 7044, Business antl PrOfessI.ns.Code: - The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractpr(s} IlcertSe pursuant to the Contractor's LI_n se Law): ' ❑ I•am exempt under -Section ' B. d. P. C. for this reason ' - Duct -,Ventilating Device Boxes Exhaust System ❑ Multiple E Outlets Firepl/Fact. Bit. ICBO Date Owner, - 'I hereby certify that 1 -have . -read this +application and 'state that 'tlle above Information Is correct. I agree to comply with all city and county ordinances r and'slato laws relating to building construction,;and hereby authorize repro- sentatives of '•this lcity.to enter u on the above-mentioned property for s Inspection p as, ' Heating System & Ducting + ❑0-100,000,BTU 0100,0008' Hood Oh_ Type I ❑' i GanO T e II El. a sigriatUre Data Drivers' LlCense Or 55 + I Regl$tBCS , r CMF 0865-46 ray. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Sewer Cap , Sewer Connection Solar Collectors - Solar Piping Solar Tank i Swimming Pool w/Spa Urinal Water Closet' Water Heater Water Service - 1..rATER 1'i+RlrrlEli�0i5T_ LlN6 ,; Reinspection, Fee Issue Fes ; ❑0.100,000 BTU ❑ 100,000 BTU System Repair/Alteration t i ' E t Reinspection Fee A t t I t Issue Fee ; t A. P. 06 PLNG. REF. - TO BUILDING•. PROPER (][ L(N�___ LEFT SIDE YARD PKG. SPACE REGI. STREET WIDTH , SPECIAL CONDITIONS: ZONE -BUILDING S.ET�Cr CJ�S7.- .REAR YARD (TO P/L) ' RIGHT SIDE YARD PROVIDED PARK FEE $ - ELECTR CAL Automatic Washer- Meter. ❑over 100 amps 3 s Construction Pale. , ,Sub Panel t Cooking Unit Sub Pole Dishwasher 'I Motors ❑0-1 HP 1K$ I Dryers []Gas- DElectric Inc,Soiar; 0915 HP ❑ 16-15+ Fan ' + 'Microwave F.A.U. Pole Light ; Fixtures Range > Device Boxes Sign Outlets Standing Sections Switches Trash Compactor Garbage Disposal Generator ❑0.5 KW 05.15 KW Transformer El 15.50 KW 05U+ KW - Reinspection Fee $15 Meter ❑up to100,amps issue `Fee $ 3 Zoning Approved By Application Approved ByDate r l Application issued By Data SUMMARY OF FEES " BUILDING PERMIT $ SMIP l ` $ ' 'PLAN CHECK. $ PERMIT ISSUANCE $ ' PLUMBING $ PLAN CHECK$ 'ELECTRICAL. GRADING i $ , $ [ $' PLAN CHECK, $' MICROFILM $ ' MECHANICAL $; i TOTAL FEE' $ ' ,PLAN CHECK $ + LESS' 1 ADVANCED'PG 1, $ ' > FINAL FEE + } $ '. 0 i I "•CONSTRUCTION AND-PL'ANNING P� . & SPA •APPROVALS .` Permit # '.P70Z�� Date Inspector APPROVALS' Permit # =Date Inspector rr }: Temporary Electrical Service or_Pole ti ' 52:, Pool & Equipment, Location 2:' Soil Pipe-Undrgrnd.- `� r . a53.' Steel Reinforcement .- 3. Electrical Conduit Uiilitv-Undrgrnd. _ = 54 . Forms .•; ' 4'. Electrical Conduit-Undrgrrid: 55.- Electrical Banding 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test - 6: Elecirical.UFER Grnd. - 57.- APPROVAL.TO COVER-GUNITE 7. Footings _ - s _ 58. Electrical'Condbit- Undrornrl. 8. Foundation ' `' •59. Gas Pipe, O -Undrgrnd., Test ' + 9, Water Pipe-Undrgrnd. .60. Backwash Lines-, P -Trap, © Undrgrnd. ' 10. Structural Floor System r - rl` 61. APPROVAL:TO DECK 11. Property Sewer Line& House Connection i :' S2. Backwash & Receptor -Final y 12. Sewer Cap Heater & Vent -Final . 13. Roof Drains `' •. � 64. Plumbing System , Final f 14. Rough, Plumbing $5. Electrical"Final " 15. -Rough Electrical'Conduit I ' a--- �` `" F- 66. j Solar System -Final - - 16. Rough,Elec'tric Wiring- + i ., ' ; =� , _ I , �67.:Fencing &Access Approval _ 17. Rough Wiring Signa. 6$.� APPROVED FOR PLASTERING 18'ou`ghbectriclT'6arCilingi :{ 69.' POOL/SPA SYSTEMS .FINAL , • ' T 19. Rough Heating & Air Conditioning I ` FIRE DEPT. REQUIREMENT APPROVALS Permit # , 20. Rough Factory Fireplace I 1' f J i 21. Ducts, in Structured " ' 1 r i { 70.# Underground Hydro _ r 22, Ducts, Ventilating i 71., Proddct Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72., Underground Flush 24. Roof Framing 73. Uridergrnd. Storage Tank O Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro '. s , 2 T -Bar Ceiling {Structural}, & Monocoat` ; , _ " `` { _ ;, 75. y Dry Chemical , 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding T i 77.F FIXED SYSTEM FINAL F I 29. 'Insulation ; 78.+ FIRE!PREV, FINAL 30. Drywall Nailing ' i ! Notes: 31, Plaster Brown Coat j 3 '32. Electrical Power Meter -Final ' + dr I° + 33. Final Electric 34. Final Heating & Air, Conditioning , 35. Final Gas Pipe-Te"s`t'' 36. Hood or Canopy- 37. Final Factory Fireplace ; 38. Final Plumbing , 39. Water Service -Final' r 'I I 40. Gas Service -Final 41. Solar Domestic-Finatl 42. Backflow Preventers ,- - - - 43. Backflow lrrigatio6 .1 1 1 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 • r i i 51. CERTIFICATE OFOCCUPANCY No Date ! _ Appllcant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTA MESA _ •, " TtNO., • . B - - -� ... � _ -, _ _, - - : -. - I ._•-� -" - -- - --- �- -r— f `, -I PE 7,N0., TRACT NO. ;LO I l CONSTEWCTION PERMtT Applicant's Mailin Address t' 'AJTRIPE "4F CONSTRUCT_ION NEW ADD' ALTERATION REPAIR r �: ' `: gj(�` ��T37ti��jr i '+ /f ❑'CONVERSION ❑ DEMOLISH ❑ OTHER' ''iii',, Project Address- 1 - Owner's Na�}e I hone c i DESCRIPTIQN OF WORK _ .. �C e c I G ULATI S' Address: C - '~ ' TYPE OF PERMIT- •GRADINGt FOUNDATION -STRUCTURAL A. P. 9W - ' ZONE _ Arch/Eng.' - r' i —License No, ; 0 TENANT, ❑;ELECTRICAL' 0IPLUM9ING ❑ MECHANICAL I?LNG. REF. - r -BUILDING Address, I i ' 1 ❑ OTHER 1 ) - j PTO B �IRLDYNGNE -. 'REAR YARD (TO P/L) S Contractor's Nam ..) r _JROJECT DESCRIPTION SQ.- FT. OCCUPANCY t +r CONSTRUCTION TYPE l VALUATION $" ` LEFT SIDE YARD RIGHT SIDE YARD I Address {rrlailingl fm& f ; - �, s { ZONE GRADING CU. YDS. 'ACRE P,KG.SP.ACE REQ. PROVIDED n _ License No: _ i LICENSED CONTRACTOR DECLARATION ! Remarks: t STREET WIDTH I ; y i PARK FEE $ t Thereby,affirm that F -am licensed under provisions of Charterry9 (commencing - # ; with- section 7000) of Division 3 of the Business and Professlons Code, a ' ? l I SPECIAL CONDITIONS: Ty license is in ful once and -effect. r PLUMBING c License lass I Llcen o. ; Date I 549ridture I r I t . WORKERS' COMPENSATION DECLARATIONBar Sink Sewer Cap i ELECTRICAL r- I herebyaffirm that i have a certificate of Gonsent'to self -insure -or a certificate ,- - - t --- - - - -- . -- - _ 'Automatic,Washer '_ y _ _- _•,Meter_LJ over 10q amps _ Pr v Hier Sewer Connection. of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow e e 3800, Lab, C'.),,—r ; ° Backflow Irrigation ` Solar Collectors Construction Pole Sub Panel, Policy No. Combany 4p nA w.� D CookingUnit t 'Sub Pole t HCCertified copy is ereby furnished. , �T Bathtubs Solar Piping j t + 1 Certified copy Is filed with the city.Bu�lying Divisionr}}.,, I I ° Dishwasher 'Motors ❑0-1 HP El 1 %-B ; Date'~ Applicant- (' L U J'f�t��Jl1 Clarifiers Solar Tank _ - EXEMPTION F 40RKER5' COMPExIUSATI N DECLARATION Dryers ❑Gas; ❑Elect�iC Iric.Solar❑9-15 HP'❑1615+ ~' (This section need not be completed If the permit Is for one hundred ($100) or Dishwasher Swimming Pool w/Spa less):" i r f t {+,• Fan' +Microwave 1 j I certify;that In the performance of the work for which this permit Is issued I Drinking Fountains Urinal r +. I shall$ not employ any person in• any manner sofas to become subject. to t}te - ' F.A.U. 1 IPole:Light Workers' Compensation;Laws of Callfornia., ,+ s ; t Floor Drains i Water Closet' Date _ Signature - Fixtures , ;Range 1 NOTICE: If, after -making this declaration, you should become subject to the Floor Sinks - - - Water_ Heater -'.• - -- - - - - Workers' Compensation provislons,of ,the Labor, Code, -you must forthwith, f ,� I _ l Device Boxes Sign Y C comply .with such .provisions•, or .this •- permit . shall be 'deemed' revoked. Gas Service Outlets .Water Service s.. ;' g + CONSTRUCTIONILENDING AGENCY' I hereby affirm that there Is alconstructlon lending agency.for.the performance _ Interceptors ' + ' t I Outlets 1 Standing Sections of the ,work for, which this, permit is I issued .(Section .3097 CIV: C.), f - .a - — Switches ` I Trash Compactor i l Lende'r's Name' _ Kitchem5irtk' `-, Lender's 'Address e " _-• o- s_ _ , Garbage Disposal 1 r OWNER -BUILDER DECLARATION,"� Lavatories_ - , I herebylafflrm that I am exempt from the:Contractor's •License Lavin for tyle Generator ❑0-5 KW '❑5-15 KW fallowing reason (Section' 7031.5 Buslnest an IT Code: Any city or " I P �7rapl }. 'I, I _ ! i j %' ! ' S 'county which' requsres a permit;to construct; alter Improve; demolisWor repair - Transformer ❑ 15-50 KW any structure; prior to its Issuance,jalso requires the applicant for such permit r ROpf Drains to file a signed statement that he/she Is licensed pursuant to the provision$ of _ , ❑5U+ KW1 Rein .the Contractor's.Ucense Law (Chapter 9 (commencing withiSect(on 7000) of r speetion Fee Division 13' of the Business and' Professions Code)' or that, he she_:Is exempt ! Showers 1 - ('r t r Reinspection Fee $7 + therefrom and the! basis for the alleged exemption: Any violation of Section : ' _ Meter ❑up to 100 amps 'Issue Fee`. I ; $ 3" 7031'5 by -:,any applicant for permit; subjects :.the 'applicant to a Civil 1 + k' I r r - — enaity of not more than five hundred dollars ($500). j rt } ; l Service Sink ! ? Issue Fee : $ 3 Zoning Approved By r `Date I, as,owner' of the.property 'or.my 6rnpioyees with wages'as their sole ' _ • # i compensation, wild do the work, and- ths'structure' is not intended or offered C r i r MECHANICAL ! Application Approved By ate for sale ;(Sec{Ion 7044, Business and? Professional Code:': The, Contractor's I j License Law does not apply to'an owner of a property,who builds or improves r + ' 1 Refrigeration System I Boiler �- Application Issued By ! `� Date thereon„and ,who !doesl such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for I ❑0;100,000 BTU ❑ 100,000 BTU Duct' ljnder Ground f sake. If, however, the building suc or improvement is sold Intended one offered year-of for ( i i , S MMARY OF FEES I pletion, the owner?will have the burden of proving he/she did not build or Im- Duct - Structural 1 System Re air%Alteration Me for the purpose of sale). { i - / I i r ; Y P }BUILDING PERMIT $ a SMI? ' 1 1 $ I, as owner of the property, am exclutively contracting,wlth'Ilcensed Con- I t :•tractorsto•construct the project. (Section 7044, Business and Professions. Code. .. Duct —Ventilating_ �., _� � I _ :_ _. PLAN CHECK” , $ PERMIT l The Contractor's License Law does not apply to an owner of property who 1 ' ISSUANCE ' $ , builds or improves thereon, and who Contracts for such projects with a con• j Exhaust System'❑ Multiple ❑k } PLUMBING $, ' ` t tractor($) license pursuant to the Contractor's License Law)' ° [ GRADING $ ; : e I i i 'PLAN CHECK $ ❑ I:am exempt under Section t —I= I - B, & P. C. for this reason f Fi'repl/Fact. Bit. ICBO # t I - 1 i f r $ 1 {ELECTRICAL' $ l l Date l t Owner i = + ! Heatinq'System & Ducting ; j 1 i i + �- r ,PLAN CHECK: $ MICROFILM $ I hereby` certify'that I"have"read'thls abplication-arid state -that tne-above ❑0.100,000'BTU ❑100;000 In Is correct. f agree to comply with all city and'caunty ordinances ) 1 E ! �'� i MECHANICAL I $ fW, ' TOTAL FEE" $ I and state laws relating .to building constr tion land hereby authorize repre- I ! 1 5 ' sentatives of this' cit erste upon a above-mentioned "property Jor d HOOd or Type I ❑+ ? ? $15 c LESS ? i , j P - `PLAN CHECK'' $I i f ADVANCED PC 1 $ f E y' - 1 Reins action Fee c Inspection purposes. 4 Canopy, T e II ❑, s t Signature ^ Date 1 j Drivers' License or)SS l i Registeis t I i Issue Fee $ 3 i I I S o FINAL FEE' $�:5^- ? -- CMF 0865-46 rev, 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - .1 d6hstR-uct]ON'ANDfPL:P�N-NiPi(f.-P °4 9_T7 C .3! -POOL WSPA zi o APPROVALS Pbrm�,,# b;itwo I _ __ �ins;�acr` J, - ': 6., , - _ -APPROVAL �-"Permit + r, I.-ate firiipai6t64 j I _S� tem6odrY-Electrial ServiciPojr?31e -152_P' & 9quipm ' 601 Equipment Location'_ I fip�,-Und grnd 53:, Steei Reinforcement 1,? bectri' Conduit Uti1itv*:Uh.c1rcFrfirl., Forms • EI a -Conduit-Undrgrn`d' < ct.r,ical -El, 'rical� ct BoriclinI5 _ E' 9t 01 R Steel einf6rcemenile. -56 h6ugh'Olu Pressure Test •2 - 0 . S m..!hg& 6.7 'Efeciri"' qa�l UFER Grhd 67:14RPROVACT 'COVER-GUNlft.' Yd 7. Footings'rid '58. Electrical -Co it-Uridrornd.::-? u 44 8 Foundation' j t ::-59. Gas pipe, El-Uridrgrnd., Test _1 9.'Water: ter Pipe-Undrgrrij. 'j �,CO. Backwash. inies, P -Trap, El Undrgrnd. 10. §tr'uct'ura IFfiri " V ' or System - i 61. APPROVAL TO DECK 1, � -0 11. PropertySdwer Line:&,HobseC6nnec{ion -7 -2. BackwashL•& Re epfor-Fin'a'l. 12. Sewer Cap.`, 63. Heater & Ve t-Fi P, rf �aI - 13. Roof'in's Drains 14� - 7 64 Plu -�Final mbing-Sy' Rough Plumbing 14. Ro" 6-5. beictricaCFinal.` 15 -A6-6bWE16dtrii:�il:tb-n�du-it-T- '.' I it - __r - i t_-7- 6611 Solar_Syste7m+i65l`r 7-, r 11 �. b I m A I i I I - I i , : , : t . I I I 61 RoughLlElectric Wiring, rf - 7; j Fencing 8EAEd6ss-A0f6v3I 1 pZA 1.17: uggh fW i ri'ng jSi 6n c-) J, APR�RQVED FOR.PL4S'iTERIN'd P8.� r" 18: ;Rough.Electricai-.TBa'r',C;eiiingI l I 1 c l 1 X69.1 POOL/SPA SYSTEMS -FINAL I 1.6. IR;u6h7lfeating WAir tonditic'nind 1111 1 1 1 1 FIRE bEPT.REQUIREMENT, I , rPROLVALSt PermitA uqh-Fa�tor� Fi rWplace; I r„ mI Zcf0in §tru ure% 21. D Structure'- - Under' d H' Underground I un ydro, Ducts, Ventilating Product odu a I '71A Pr Piping P G:s 0011 ,i�?2. Gas Pi pe- ll o'u h Test A 72.!, UA�er[ ground Flush �jr23. iC24.1 oof Framin g, Uncle g a Ta r, md. ge Stora Tank ❑ Gasr i ! r n _661i L25. jFl6o�f Sheat�iQ`g 74.1,Overl4eacl Hydro &-26. 91`16ar deifing (Strbciurall) [Viono , coa't D: Chemic�l 1 i�5 ry 7. an� Flashing' 1 .76j Dry Standpipe �-2 ;Frame 1, 28. tLath,ing geSiclii`ng 177.1 FIIXED SYSTEWFINAL 29. Insulation 'E FINAL !78.1 FIRE PR EV. NA �0.'Drywall Nailing Noir as:; Plaster Brown Coat lei ------- I I !31. it 32. iElectridal Power Meter-Final- 1 33_Final Electric jj I .T,�,.,l_J( 34. Final Hea'tin �,jAir Condi'tioning, 6-6-21 3 35. Final Gas" 6+=f6sf I 2 1 36. Hood 6r',d Canopy. 37. Final Oac"Ioly F!!'rlepllkke,4 38. Final Plumbing um ing 0; 39. Water Ser,vicb - Ftnall 1i 1 L 40. Gas Service -Final m a 41. Solar Domestic -Final I - ti 4 J11 42. Backflow ��'Preverter.' dit 43. Backflow. Irrigation' 44. Landscape IrrigationjSystem 11 1'; 1 -4 45. Sound (Attenuation I 46. Hanclicap., Regulations t TURE & BUILDING i� 47. F I NAL ST RUC 48. Special Requirements Completed 49. Electric Relaasei'to (Edisonli L -1_.-'_) 50. Gas Release to Southern California Gas Iv 51. CERTIF1CATEj0Fj OCCUPANCY 11 j,, No D ate I Appllcant to fill In all spaces except those within heavy border -lines and sign all appropriate declarations. 882 5/17/03 ' OF COSTA MESA I PE MIT NO, TRACT NO. LOT NO. B j ONStTRUCTMN PERMIT : t � 'Applicant's Mailing Address TYPE OF CONSTRUCTION= NEW ADD ALTERATION LREPAIR o ❑ CONVERSION DEMOLIS,{H ❑ OTHER' Prosect Address .❑ DESCRIPTION OF WORK - Owner's Nama hone LISA ti --ZONINGGU Address d!p�-A l r% ,--- TYPE OF PERMIT GRADING FOUNDATION LJ STRVCTURAL' - ia.P:�W ZONE , ArchlEng: License No, ❑ TENANT ❑' ELECTRICAL ❑ PLUMBING P MECHANICAL PLNG. AHF. M6 BUILDING t Address ❑;OTHER TO BUILDING I REAR YARD (TO P/L) R PE I Contractor's Nam one PROJECT DESCRIPTION SQ. FT. OCCUPANCY t Address (mei lin I �' t� ° ' CON STRUC Ti11 ON TYPE VALUATION S (y2g, �r LEFT SIDE YARD RIGHT'SIOE YARD ; �• ' +� C^� ZQN)= GRADING GU. VO5: ACRES PKG. SPACE REO. PROVIDED ( , a License No: g�� 1 _ __ LICENSED CONTRACTOR DECLARATION _ Remarks: ' _ ' 1 t I STREET WIDTH I PARK FEE $ I'hereby affirm that I'ant licensed under provisions of Charter,9 (commencing 7000) 3 Professions Code, SPECIAL CONDITIONS: - #r with section of Division of the Business and and my Ilcense.Is in f l for a and effect. -Canso ; IJ C/jI/nss�e a. PLUMBING oats rl SIgnaturR ' dGIl Liar I4�` 1 `WORKERS' COMPENSAT ND I caitiff Bar Sink L Sewer Cap' i ELECTRICAL Automatic Washer `� 'Meter Dover 100 amps I hereby af(Irm that ! ha a consen o self Insure or a certificate -' of Workers' Compen ion insur or a c Ifled. copy f<oreof (Section ' , Backflow Preventer «_. __ Sewer Connection ! . _ - _j_ - - 3800, Lab. C.) 1 } ' in I S ! Backflow Irrigation Solar Collectors Construction Pole ;Sub Panel ' PO11cY No. CO nY#qrti V h5, fl., t ® Certified cop furnished. ) 1 I l Bathtubs I Solar Piping y r, Cooking Unit 'Sub Pole, Certified c y ith the city uil ng D tl Z�hppllcan I Clarifiers Solar Tank i ; Dishwasher Motors ❑0-1 HP ❑134$ r Date - EXEMPTION;FROM WORKERS' O EN TION DECLARATION - , - �- - --- - Dryers ❑Gas ❑Electric :Inc. Solar, ❑9-15 HP Ell' 6-15+, Dishwasher { Swimming Pool W/Spa , (This section need not be completed if the permit is for one hundred ($100) or Fan I certify that in the performance of the work for which thls permit Is issued I Drinking Fountains i Urinal ' Microwave # 1 shall. not employ any person in any manner so gas to bec me subject, to the - '' F.A.U. i Pole,Li ht g + Worker Cpmper�atlon• Laws of California t 1 I Floor Drains i ; Water Closet, A Date/ -� �+' Signature NOTICE: If, atter making this declarat yo Mould become subject to•the - Floor Sinks ,- Water Heater - rr� Fixtures - . - Ran e , 9 Workers', Compensation provislons,of he t.a or Code. -you must forthwith i comply ,with such provisions'or thls_permIt shall be deemed revoked:, GasServlce •Outlets' Water.Service - -• �1, Device Boxes ' I .., , Sign; CONSTRUCTION LENDING AGENCY I hereby afflrm that there is a,construction lending agency for thei performance- Interceptors i r Outlets` '��' •, •_ ' -Standing Sections of the work for, which] this. permit is Issued (Section 30@7 Civ: C.)', Lender'si Name ' ' ' Kitchen'Sinki r SWitClies ` J, Trash Com actor p ; Lenj�r's Address ; l { Lavatories ' Garbage Disposal , t OWNER'BUIILDER DECLARATION I hereby affirm that I am exempt from the (Contractor's License Law for the Generator ❑0-5 KW ❑5-15 KW following reason (Section 7031.5 Business and Professional'Code: Any city or, ' -Trap i �' r ; • -- - • 'county which. requires a permit,to construct, alter Improve, demollsh-or repair " , ._ Trinsformer'❑15-50 KW 1 I ,,any structure, prior to Its'lssuance,'also requires the;applGnt for such permit' ' 'o file a signed statement that he/she Is licensed pursuant to the provisions of Roof�Drains - 4 - -= �' . ,• ,S, 05U+ 1 io Contractor's -License Law (Chapter 9 (commencing ,with,SectIon 7000) of'r-,�" 'Business I = Reinspection Fee KW. „•, IRainSpaM_ion Fee $15 ilvision,3, of the and Professions Code)'or that' he/she -Is, exempt therefrom and the' basis for the alleged exemption. Any, violation -of Section Showers i _ Meter ❑up to 100 amps Issue Fee $ 3 7031,5 b any aRPllcant tor_a,perm�t Subjects the applicant to a civil y of not more than five hundred dollars ($$00).: + Service Sink ^„ ' $ 3 ' 1 Issue Fee _„ Zoning Approved By enalty wages their sale r 11 to I,'as owner of; the property or my employees wish as Intended i i ,rt MECHANICAL °' ` i compensation will, do the work, and the siructure.Is not or offered for sale;(Sec�ion 7044', Business and. Profeulonal Code:' The, Contractor's I Application Approved By l + , ' L ate , I License Law does not apply to an owner of a progerty:who builds or improves - Boiler "� ' 'r' I ' Refrigeration System r r Application Issued, By Date .thereon, and who�does-such work himself/herself or through his or her own that such Improvements are not [ntentletl or offered for - I l ❑a100000BTU 0100,000 BTU emplo eas, provided y sate. If, however, the building or improvement is sold within one year Com- Duct =Under, Ground ; i r !'r SUMMARY OF FEES pletlon, the owner•wiil have the burden of proving he/she did not build or Im- fol the purpose Of sale). ; - I : Duct - Structural 1 I S ystem Repair Iter I13� a r "BUILDING PERMIT $ SMIP $ ; Eve 1, as owner of the property, am exclusively contracting:with! IIcensed cbn- tractorsto,construct the protect 1Section.7444,.Buslness and.Prefesslons,Code;� ` -.,_l Duct : Ventilating • _ _ �, _PLAN a , r CHECK ,a' �$ PERMIT i 1 The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- Exhaust System Q6 Multiple ❑; IPLUMBING,- r $ ISSUANCE $ , tractor($) license pursuant to the Contractor's License taw) PIAN CHECK $ s GRADING $ ❑ I am exempt under Section S. & P. C. for this reason ! FirepllFaCt. Sit. (CBO j 1 : . :ELECTRICAL' Heating.System & Ducting ) $$Date ° ( ' 1 ' Owner' t 1 -hereby certify -that -1 have read this appliCation-and state that ttie above ; Do100,000;BTU ❑100,OOOBT , i -._ _�. • •PLAN CHECK. ,, $ MICROFILM + $ information Is correct. I agree to comply with all city andcounty ordlnanCes�!OZ)l �_ TOTAL'FEE� $ and state laws relating to building construction,land hereby authorize repre- sentMlves of t this (city! to enter' upon the above-mentioned property for HOOd Or 'ry'pe I ❑' t E ,•MECHANICAL = Reinspection Fee I;PLAN .r $ '" i �• CHECKYnspectlon'purp LESS1 s. Signature t ` ( ) s Date'ill 3` CanT e 11 ❑' I 1 + r ADVANCED PC $ f ! f , ��tc � Registers I 1 1 Issue Fee G `� + $ , a Drivers'Lice o ,55 �jk ® s FINAL FEE CMF 0865-46 rev. 12/82 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor e'f 3. • 1 - ter' 'CONSTRUCTION;AND�PL'ANNIIVG: `l' =� �''`'-c''' ''"c -'- 3-..POL s, SPA APPROVALS =Permits#= - :Date z' :Inspector - T -' +, A- P,ROVALS - :Perm :1# - Date 'liispector. _7 1, Temporary Electrical Service or -Pole i N �" ' 3 r ; r ' ,'521 Pool &:Equipment" Location' J C3 1 = A r F + }v 2' �SdiI Pipe Undrgrnd _ r , =« I ; �• ` ; i `, D - 53 Steel Reinforcement" r Is 1 I - , �r - Z - - - - 5' Electrical Conduit UtiIity.Undrgrnd a1, 54. Forms' 1; 'L' ' t` ' `= �'1! ILI- _' " 4- Electrical Conduit-LJndrgrnd:' 4 155p Electrical Bonding.', - - 5' Steel Reinforcement' = ` is{' 56. Rough P.luriibing & PressurerTest - - - r 6: 'El' ectricalUFER Grnd.l �'- ' `, s 57r' APPROVAL�T O COVER-GUNITE F _ r 7. Footings ! ~ j "_ n•7 r ' ::58. Electrical: Conduit Undrarnrl�, '= . o ; 8. Foundation i { ` i 59. Gas,Pipe; i�UricErgrnd.; Test r i 9. Water Pipe.Undrg'rnd. ; _ ? ' X60. Backwash Lines,rP-Trap, O'Undrgrnd. - ' ^` r _ 10. Structural Floor System + '� o ^' T. 61. APPROVAC,TO DECK 11. Property. Sewer Line,& House'Connection. : - .62. Backwash Receptor -Final _ 12. Sewer Cap 6; ',' �63. Heater, &-Vent-Final r 13. Roof jDrains .64. Plumbing Syste•rn - Final _ J 14. Rough Plumbing i, Electrical=Final' iT + ir-15�Rough-Electrical=Conduit? i 66.-Soiat.Sysiem Final' - 1+, hs16: !RoughcElectric Wiring. 1; ! .9 j it Apval 67 Fencing & ACoess"pro _ ._17..Rough Wiri`riglSign�� ; i + ' X68.; APPROVED FOR PLASTERING yI + I i 13 = 1$. -Bough =Electrical T;Bar3Ceiiingj i t 1' ,69.i POO 'L/SPASYSTEMS FINAL { - 19., Rough:Heating &'Atr Conditioning ' FIRE DEPT. REQUIREMENT L' i 1 } 20.'R6ughyFactor9 FireplacesAPPROVALS`. Permit # I { 21. bucts,.in Structure 70.1 Underground Hydro r ' h22, Ducts, VentilatingI l i { 171.1 Product Piping 0 Gas L1 Oil ; - 4[23. Gas"Pipe-Rough & Tests I;7 I'-- -�- �- _ 1 f _�. 72! Underground Flush I �' ; Y - t - - --r -* I I ! ! i r 1 !irk 'Roof Foaming i i i i{ti l�n I i i ?' , j .- 73.1 Undergrnd. Storage Tank El Gas -❑ Oil ; I� { i, 25. 1hodf Sheatiiing 1 i ' j ;,r� i i ' { - I i Overhead Hydro 1 , r, 174.1 -26. iT-Bar Ceiling {Structural), & Monocoat ! r ; J5. Dry Chemical- �'�-27. kr me and Flashing: , ! �' '{ ! i i 1 ',76.! Dry Standpipe s ' 28. Lathing &•Sidingl y 1 k l 1 `I i i77.- FIXED SYSTEM FINAL i ! i x'29. Insulation a =' ! P' n I I H' a i I r I 78.` FIRE PREV. FINAL i Y 1 I' I I X30. Drywall Nailing y n _ ! i , ` a �Notes: 31 :Piaster Brown Coat ii 77 - - - - • - - - - - -! - i<c32 lElectrical Power Meter -Final 33. Final Electric t I f `' r34. j j ,! I v Final Heatinfig1 &] Air Conditioning ; 1 � ll •1 ^Inrtl m 1 1- } i 35. Final Gas'Pipe=Testj 36. Hood or Canopy:;}; j - { ! I 10 l = •' _ r .; r . Ir 1 1 n. II , n' 37. Final Factory Fireplaces , I It II 1 i i I I lir 1 { i I I� 38. Final Plumbing 1 1 I 39. Water Service -Final i 0I {; _ 40. Gas Servce.Final i 1 41. Solar Domestic -Final 42. Backflow Preventers r�I i ! k ; { X11 ` rI ,� 43. Backflow ,lrrigation _ I 41 I 44. Landscape lr6gationLSystem 45. Sound lZAttenuation' 46. Handicap Regulations 1 I 47. FINAL. STRUCTURE & BUILDING- ir 48. Special Requirements Completed 49. Electric hele'aseito 'Edison! ii _ I i _ I _ _L' llease it ' I 50. Gas Rato Southern California Gas Co I + l 51. CERTIFiCATEOF- OCCUPANCY o - -��-. _i - ;•- l rl-� .i,._J.__. No, L i l Date- , i ter_, I'•r •---•� ...�• .--��- F COSTA MESA 7RUCTION PERMIT . Applicant to fill In all spaces except those within heavy corder lines and sign all appropriate declarations. — " PERMIT NO. TRACT NO. LOT1NO. BLD . 7775 4/26/B3 I S.Ot, T _ ZONE _BUILDING REAR YARD (TO P/L) RIGHT SIDE YARD PROVIDED l' PARK FEE $ • cr �rTolr•el I hereby affirm that I have a.certificate of consent Ito self -insure or a certificate �pplicant's Mailing Address T• r TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR Sewer Connection' J I iis._ tlfs ❑ CONVERSION ❑ DEMOLISH ❑ OTHE .Meter El over 100 amps ; of Workers' Compensatlon Insurance,, or a certified' copy thereof (Sectlon� 3800, Lab. C. a _ iroject Address , Owner's Name c r hone DESCRIPTION OF WORK BackfWv Irrigation Address TYPE OF PERMIT 11 GRADING 'FOUNDATION El STRUCTURAL A. P. 0 Arch/Eng. �, �V W License No. ❑ TENANT ❑ ELECTRICAL XPLUMBING ❑MECHANICAL PLNG. REF, # - ❑• ' Bathtubs Address Contractor's Nam hone OTHER PROJECT DESCRIPTIION SQ. FT. OCCUPANCY TO BUILDINGAh PROPERTY INE Sub Pole /►� Address ImaiIing)!>.,��— r te ��- ,Pa.Ir—t • CONSTRUCTION TYPE VALUATION $' LEFT SIDE YARD Solar Tank . W License No. • ZON.E GRADING CU.YDS. ACRES PKG. SPACE REQ. EXEMPTION ROM WORKERS' COMPENSATION DECLARA ION r LICENSED CON__TRACTOR DECLARATION Remarks: / STREET WIDTH , I hereby affirm that 4am licensed under provisions of Charter 9 (commencing ' Inc.Solar'❑9-,15 HP ❑16-15+ (This section need -not be completed If the permit Is for,one hundred ($100) oV: less):' 1 ' with section 7000) of Division 3: of the Business and Professions Code, and _ Urinal ? SPECIAL CONDITIONS: y my license Is in full force and effect. • Llranse CI ss • ' License No,�a•L-LQ1riy'P PLUMBING g t Date 4 Signature ' r - , - WORK RS' COMPENSATION DECLARATION Bar Sink Sewer Cap - F.A.U. I ` ZONE _BUILDING REAR YARD (TO P/L) RIGHT SIDE YARD PROVIDED l' PARK FEE $ • cr �rTolr•el I hereby affirm that I have a.certificate of consent Ito self -insure or a certificate Backflowv?reventer Sewer Connection' } Automatic Washer r^ .Meter El over 100 amps ; of Workers' Compensatlon Insurance,, or a certified' copy thereof (Sectlon� 3800, Lab. C. a _ Construction Pole` ' y (' 'Sub Panel + BackfWv Irrigation Solar Collectors No.� �x� ' ��Z iORf Polley Company ❑ Certified copy.is hereby furnished. ,Y Bathtubs Solar Piping Cooking Unit Sub Pole Cartifi cop Is filed with the city SulMiny Dk 31on. ate�� Applicants - _.�1 Clarifiers Solar Tank Dishwasher �,'* Motors DO -i HP C11%-8 EXEMPTION ROM WORKERS' COMPENSATION DECLARA ION r Dishwasher I Swimming Pool w/Spa Dryers, ❑Gas, ❑Electric Inc.Solar'❑9-,15 HP ❑16-15+ (This section need -not be completed If the permit Is for,one hundred ($100) oV: less):' 1 Drinkin Fountains ° _ Urinal ? 1 f } Fan; ir" (Microwave i certify that In„the performance of the work for which this permlt is Issued I/�' shall;not employ -any person In any manner so:as to become subject to the 1{ g t F.A.U. I ` ,Pole Light Workers'- CompensatloniLaws of California. i ' ' ' Floor Drains ; Water Closet 1' Date Signature NOTICE: If; after making this declaration, you should, become subject to the Floor Sinks - , Water Heater - LZ�m Fixtures ,, - - Range i g Workers' Compensation provisions .of the Labor Code, you must forthwith A comply with such provisions or - this, -permit • shall be -deemed revoked. { Gas $erVice. :Water Service % ;`;Z p Device Boxes Sign! r i t CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a.construction lending agency for the performance- I {.Outlets Interceptors - i _ ti � Outlets I :Standing Sections + i F of the work for . which this, perinit is Issued r (Section 3097 Civ. C.), L.ender'sI Name' - _ S ,. Switches ` i Trash Compactor ^ i _ KitcherrSinkt r s: s Lender's Address ` 4 OWNER=BUILOER DECLARATION' Lavatories € s - p p Garbage Disposal + i I hereby affirm that I am'exampt;from the. Contractor's License Law for the following reason 7031,5 Business and Professional Code: Any p—Ira p r r , - !u Generator 110',5 KW 05-15 KW , -(Section city or 'county which requires a permit -to construct, alter Improve, demolish or repair Transformer E115-50KW S any structure, prior to Its Issuance, also requires the applicant for such permit file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains, ❑5U + KW' ” a Contractor's -License Law'(Chapter 9 (commencing with Section 7000) of r ; ' f E Remspm.ion Fee �ivlsion .3 of the Business and' Professions Code)"or that he she is exempt Showers Reinspection Fee ��.$15 therefrom and the' basis for the alleged exemption.- Any, violation' of. Section Meter ❑up to 100,ampi Issue Fee' I $ 3 ,7031:5 by -any applicant for a' permit the applicant to a'civi! � /, ( enalty of not more than }ive' hundred dollars x500: Service Sink ' Issue Fee ., ? 3 ) - - Zoning Approved By Data E, as owner of the property or`my employees with wages'as their sale MECHANICAL compensation wilt do the work, and;the.structure.is not intended or offered + for sale'{Sec{ion 7044, Business andrProfesslonal •Code: The Contractor's Application Approved By ate License Law does not apply to an owner of a property who builds or improves Boiler., t s Refrigeration System ��' z thereon,:and who does'such' work. himself/herself or through his or her own + Application Issued By Date emplo ees, provided that such Improvements are not intendetl or offered,for ❑0100,000 BTU ❑100,0GOBTU .fw. "'---"'-' y j• r; _ _ sale. If, however, the building or Improvement Is sold within one year of Com- Duct -Under Ground 1 SUMMARY OF FEES pletion, the owner•win have the burtlen of proving he/she tlid not build or Im- F roveior the purpose of sale). Duct - Structural 1 System Repair/Alteration ,%; cBUILDING PERMIT $ SMIP $ 1 ds owner of the property, am exclusively contracting.wlth licensed con• i r, 1 tractors to,construct the;project.(Section 7044, Business and Professions Code: Duct -Ventilating _ ;PLAN CHECK( $ ' PERMIT The Contractor's License Law ddoes not apply to an owner of property who ' C ISSUANCE builds or Improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑-' , 'PLUMBING $• 1 C3.� $ tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ 5. GRADING • i $ E)I,am exempt under Section i B. & P. C. for this reason Firepl/Fact. Bit. ICBO # i I Date I Owner • ' Heating'System & Ducting ' ; J { ELECTRICAL $ ` t $ I hereby` certify -that l' have -read this,application•and-state that the above ❑0-100,000BTU ❑100,000BT - !PLAN CHECK $ MICROFILM $ Information is correct. I agree to comply with all city and county ordinances S - f ^ TOTAL FEE, $ ' and state laws relating to building construction, and hereby authorize repre- -MECHANICAL $ } Hood or Type I ❑ + sentatives of "Ph 5 city je} enter upon the above -men propgrty for yp Reinspection Fee ;$15 , LESS ' !/JC f/ (PLAN CHECK $ ADVANCED PC $ ,inspection our e � Ca �T a fl ❑: } Signature Date a +� /- ' r : s r' Drivers' License or -SS 9P$ 3 FINAL FEE $ Registers Issue Fee + t ! � , CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor `'y '. a '1 %}_ - POI. _ dr SPA - �-bkSTFiUCTION.AND' PLA�ING, _� - " t r APPROVALS Permit;#_ �� s bate _ R Inspector 3 t ` ` APPROVALS ' _ * Permit:# Date ` Inspector - t1 1 n' 'l-. Temporary Electrical Service or'Pple 52.• Pool &SEqurpment Location' a ^ 2e !Soi! Pipe-Undrgrnd._ 53 ` Steel Reinforcement F- ,. ,., t - • - •3 Electrical Conduit Utility-Undrgrnri: r> >` 54 ' FormsIZ- " !: 4. Electrical Conduit-Undrgrnd; 55`. Electrical Bonding t r, 5. Steel Reinforcement v, ` = _ !f`� ` _ _ 56. Rough Plumbing & Pressure Test v - - - 6.Electrical UFER ., i : COVER GUNITE G i n� 7. Fo'otin'gs 58' Ele&rrcaf Conduit-Undrarnrl. �_ T 8. Foundation F: 7•59. Gas Pipe,❑-Uncfrgrnd., Test - 9. Water Pipe-Oridrgrnd. I o r c -60. • Backwash: Lihes', P -Trap, 13Undrgrnd. Ip v f "• r e . r, 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection�A • .g2, Backwash &. Receptor-FinaE = 12. Sewer Cap 63. Heater', &`Vent -Final, 13. Roof Drains i '- 1 64. Plumbing -System-.- Final _ Rough Plumbing ' 14. r ' ` - S. Electrical -Final - r' - • r -154 Rough"Electrical--Conduit`- I'«t6.-flough Electric Wiring. E , 7 -67. Fencing &•Access.Approvak-- li I' it 17. +Roujh'Wiring ,68. APPROVED FOR PLASTERING 18. 'dough Electrical-T,Bai Ceiling! '69.i POOL/SPA SYSTEMS FINAL 19. flough,'Heating & Air Conditioning " ! ? j ` FIRE DEPT. REQUIREMENT _ APPROVALS Permit # 20: Rough Factory Fireplace 1 < I <� k I i 21.:66cts,:in Structure 70. Underground Hydro i i 22. `Ducts, Veniilating r `I I l # i7.1. Product Piping Q Gas ❑ Oil 23. `.Gas Pipe -Rough & Test 72.r Underground Flush. i 24. Roof Framing ; „? - ! 73. Uridergrnd. Storage Tank ❑ Gas ❑ Oil 25. 'Roof. Sheat'hin'g I ; ` ' '74. Overhead Hydro ' rf4, -26. T -B& Ceiling (Structural), & Monocoat` ' i ! ! .75. Dry Chemical 4•'27. Frame and Flashing 76.' Dry Standpipe , ,• 28. Cathing &'Siding i j 77. FIXED SYSTEM FINAL 29. �Insuiatiori . " �} 3 f ; '78. FIRE PREV. FINAL T i ''730. Drywall Nailing ! r Notes:- otesr i `31. Plaster Brown Coat "31. j f 'r32.'Electrical Power Meter -Final ; l 133. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Tgst' ` i .2!- 36. Hood or Canopy 37. Final Fadtory Fireplace �, � I' 1 ..r 1 38. Final Plumbing r s, 39. Water Service -Final' , , 1 40. Gas Service -FI inal 41. Solar Domestic -Final 42. Backflok Preventer I 43. Backf lowl Irrigation, 44. Landscape Irrigation System 45. Sound. Attenuation < I I ~ 46. Handicap, Regulations', ;� ; 1 l , i t - 47. FINAL STRUCTURE & BUILDING,, r I l I 48. Special Requirements Completed = i I �w i i s I r 49. Electric Release:to Edison` ' ! 1 _• I i _: ! _ .3_- _ _ k ` r 50. Gas Release to Southern California Gas Co r , 51. CERTIFICATE OF,OCCUPANCY t l I - -- - + Na, I Date i , I I ; 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. BJA ; ' CONVRUCTION PERMIT ! l 7795 4/ _ 'Appliderit's Mailing Addr�es+s I 1 TYPE OF CONSTRUCTION NEW ApD ALTERATION 1 u g ' A Atte CONVERSION "❑ DEMOLISH ❑OTHER Project Address, _�3/ S - _❑ OWrier'S:Neme �-�L Phone I DESCRIPTION OF WORK 1 ' 1 G' E U TIAddress! Y - j I4s rchlErig.* License No. TYPE OF PERMIT GRADING • ❑ ❑ FOUNDATION• STRUCT.A. ❑'MECHANICA:PLNG. P. ZONE Address TENANT ELECTRIC_ L '❑,-OTHERTO PLUMBING' REF„* BUILDINGr-fl Sy "C4, hORe T PROJECT DESCRIPTION' SQ. FT.'- OCCUPANCPROPERTY BUILDING INE =REAR YARD (TO P/L) • j //. .. ` Address (mailing) 2"Y� A' ffAt � ' L� �'�� -- CONSTRUCTION TYPEVALUATION $ LEFT SIDE YAA RIGHT SIDE YARD v r License No, + ' ZONE= • GRADING CU. YDS.- •ACRFS�'' ' PKG. SPACE'REQ. PROVIDED i t• _ _ •LICENSED CONTRACTOR DECLARATION ; 1 Remarks: l W1 STREET WIDTH I PARK FEE'$ I hereby affirm that I am jlcensed under provisions of Charter,9 (commencing f with 'section 7000) of Division 3' of the Business and Professions Code, and ; ' SPECIAL CONDITIONS: ! _ myrlicense -is in full force artd effect. + ��e 3 ! r - ' license CI ss Ll o_ PLUMBING I Date- Signature Ber Sink ^' (' Sewer Cap ELECTRICAL ; WORK RS' MPENSATION DECLARATION , hereby affirm that -I -have a•iertlficate of consent to self -insure or a certificate Backflow Preventer - - Sewer Connection' _ Automatic Washer. :Meter Dover 100 amps, - -- 1. of Workers' CompensatloH Insurance,{or a certified Copy there f (Section ' _.� Construction Pole 'Sub 3800, Lab. i , i G MB /, u[i ,iS�Z ( Backflow Irrigation Solar Collectors y _ Panel 1 Poll o• „ Company/ — Certifietl copy is hereby furnlshed. j ! ; Bathtubs. {.; . 1 Solar Piping - Cooking Unit ,; r lib Pole r 0G? i fled copy is fljetl with the city Bujlding plrision. I ! i Clarifiers Solar Tank :_f Dishwashr3r Motors ❑0-1 HP ❑ 1 h $ Date Applicant EXEMPTION,F ROM WORKERS' COMPENSATION DECLARATION If the 3 - - - - -` _ Dryers ❑Gas ❑Electric �InaSolar ❑9-15 HP ❑16-15+ , t Dishwasher_` ; Swimming PoolYvv/Spa I (Thissectlon need not be completed permit is for one hundred ($100) or r less):, I certify that In the performance of the work for which this permit Is Issued I Drinking Fountains Urinal { , Fan ,Microwave ( { i shalt not employ any person in any manner so las to become subject. to the California.. F.A.U. :Pole Light I _ Workers'+ Compensatlon;Laws of r Gate s' i Signature _ ' NOTICE: If; after making -this declaration, you should. become'subject to the Floor Drains; i Water Closet! ; - ! Fixturesi`_ _ - -- - Range l �l Floor Sinks - Water Heater; -w- - Workers'; Compensation' provisions,of the Labor Code, you must forthwith comply with! such;provisions4or this permit shall be deemed revoked. I � ' GBSServic Outlets` •- 'F Water.Seririce � :p'I .� l�j” Device Boxes i Sign CONSTRUCTION j LENDING AGENCY ; I hereby affirm that there is a construction lending agency.for the erformance p -;is lnterce tors p 1 , - �• '' +, �d Outlets _ i Stendin 5 Ctions i 9 ! this, permit , Issued Section +3097 Civ. C. of the ,work for, which'; P rr :( ) ' Switches Lender's; Name - -- --- -- Kjtchen'Sink - �, i �: ,' ! + Trash Compactor 3n Lender's Address OWNER'BUILDER DECLARATION; I .' i � + Lavatories r : " E�`r i`s Garbage Disposal ( � I hereby affirm that I am'axerript' from the Contractor's License Law for the Business Professional p—Tra = Generator, 00-5 KW 05-15 KW ; } following reason:(Section' 7031:5 and Code: Any city or 'county which requires a permit to construct, alter. Improve, demolish or'repalr, 'also p , �' Transformer 131&50 KW I { ' - ' any Structure. prior to its :ISSUanCe, requires the appllCdnt:for such ppermit. ;' file a signed statement'that he/she Is licensed to the'provisions of Roof Drains � � � - �' � i ,r i - '_ pursuant Contractor's License Law, (Chapter 9 (commencing,wlth Section 7000) of jslon 3, of the ,Buslness' and Professions' Code)' or that; he/she• Is;exempt ` z Showers i �' -j Reinspection'Fea ❑5U+ KW! Reinspection Fee $15' ' erefrom and the' basis for the alleged exemption: Any viola Ion of Section _ '- Meter ❑up to 100 amps ; llssue Fee, 3 ' $ 3 7.031,5 by any applicant for a permit subjects ,the applicant to f a civil nalty of not more than five•hundr d dollars ($500). ' Service Sink s I Issue Fee ,: $ 3 . Zoning Approved'BY I ; Data • 1'' as owner of the .property or my employees with Wdges,as their sole , t ! 1 compensation- will do the work, and the structure is not Intended or offered for sale'(Sec{ion 7044; Business;and•Professional Cade:, The, Contractor's ; . _ MECHANICAL ° , Application Approved By Date I License Law does not apply to'an owner of a property who builds or Improves 1 thereon, land who does such work himself/herself or through his or her own _ Boiler r' i Refrigeration System ; �' I I Application Issued By �� S , t I 'Date I I employees, provided that su Ch'improvements are not Intended or offered for Duct •Under Ground r 00 100 000 BTU 1:1100,006BTU sale. If, however, the building or Improvement is sold within one year.of com• t + r a ° SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- i rove for the purpose of sale). ! I - I a Duct -Structural l System Re ai r/A Iteration p r i BUILDING PERMIT $ + SMIP $ , I, as owner of the proparty, am exclusively cdntracting!wlth.licensed con- on- , tractors tractorsso construct _the project (Sectlon.7044,.Buslness and Protessions.Code: ;- Duct :Ventilating - .'- �, _,. _ - { -' +PLAN CHECK j $ PERMIT The Contractor's License Law does not apply to an owner of property who s builds or improves thereon, and who Contracts for such projects with a con- ! Exhaust System ❑ Multiple ❑ 1 , 3 '•,'PLUMBING $, ISSUANCE x $ , ' J tractors license pursuant to the Contractor's License Law),' + , , ! GRADING t $ ❑ I'am exempt under Section ' ? B. & P: C. for this reason I Firapl/Feet. Bit. 1CB0 # PLAN CHECK. $ } + 'ELECTRICAL I j $ Date owner? k I I c j ' HeSting'System & Ducting 1 I 'BTU ° $ ! i 1 f 31 ( MICROFILM 1 $ r ti !-hereby certify that -i have read thls application' and state that the above E11&10(),000❑100,0006 1 , r- �_. . PLAN CHECK S $, E Information is correct. I agree to comply with all clty;and county ordinances )� and' -state laws relating to Pullding construction,:and hereby authorize repre- t ! + l 1 + MECHANICAL' $ TOTAL+FEE; $ Hood ❑ t , sentatives of =thi Ity! to a er upon a above-mentioned property for j or T e I yp Cano T I I ❑+ Reinspection Fee i ' $15; PLAN CHECK. $ LESS 1 1 Inspection pur i I ' e + ! ADVANCED PC $ i Signature Date ! Drivers' License or SS ( ' Registers ( ; ' Issue Fee I i $ 3' t i ( ! { i FEEy— — j s I I FINAL CMF 0;365.46 rev. 12/82 : Canary - Applicant; Pink - Accounting; Goldenrod - Assessor r . .>.. a • �CONSTRUCTION;AND PLANNING ., r ,s T-•,- �: 7Lh - ,; •1 ';- _ � -�.�' .SPA - ;• =-f, _ .. � _• �; •- ; r • = t ' �, ' APPROVALS Permit # '� • - : iDate \- = ` ^I nspector _ = APPROVALS, Permit # - =Date I nspector- 7 _ 1. Temporary Electrical Service or Pole{ r Pool &.Equipmen# Location' ^d: 2. Soil Pie ndr r c J p U 9 R °' <s r = I '53° Steel Reinforcement': r. o u I �+ _ .,} 3. Electrical Conduit:Uiil tv;Undrgrnr}��'F! ' ` = b; '-� I •`'54 s Forms -. ~ h�; _ - 4. Electrical Con`dU,t �Undig'riid'. c r' = L r A I '55�. Electrical+Bonding. 5. SLeef• Reinforcement' '' ' fj n # _ = �;, r - . i "56.- Rough PtuPressure-Test 6• Electrical UFER Grad- ` '•� rn `' or ; 57" PPROVAL'TO COVER.GUNITE_ 1 -1 r\ r , Rti'r, I�•a]. yc 4 -[I f 7. Fgotings :58.' Electrical Coriduit=iJndrornri. Fou n'.dationI t GaPipe ,O,:Undrgrnd:, Test$. ' K - 9. Water Pipe-Undrgrrid 'r60. Backwash Lines, P Trap,'p Undrgrnd. ` r• 10. St ru�tural Floor System ! - ` i' ' r i 61. APPROVAL TO DECK - 11. Property Sewer Line &.House Connection. _;' ? i • 62. Backwash &-Receptor-Final. - - -: ;r t :- ;; 1 , 12, Sewer Cap s 3 •63. Heaier & Vent -Final 13. Roof'Drains.t •' i f ;� 64. Plumbing System Final` 14. Rough Plumbing V- 65. Electrical -Final-' �= c `15: Rough- Electrical=Conduit -7 `j- - 66.F Solar'Systerri•Fin'I 16. Rough Electric Wiring;n I I i in ccess E1 I r 67: Fi c g& A pprova -- 17, Rough Wiring.Sign=PR 68.±APOVED FOR•PLASTERING .• , 18. 'Rough Electrical,T'Bar`•Ceiiing, +� , : n 69. POOL/SPA SYSTEMS,FtNAL ,r 19. Rough Heating &'Air,Cond.itioning FIRE DEPT. REQUIREMENT • - - APPROYA.LS Permits# .' ?0. Rough Factory Fireplace I i; { I } > p I f ! 1 - 21. Ducts, in Structure ' I l� I i j 70.1 Underground Hydro I' :22. Ducts, Ventilating fr 71. Product Piping D Gas ❑ Oil 23. Gas�Pipe•Rough & Test i I.c'+ i r 72.rUnde'rground Flush :24. floof Framing' I If ` ' t o , 73. Uridergrnd. Storage Tank 0 Gas ❑`Oil , I 25. Roof. Shead irig I .I\, - ' f { _ i ` = I 74.1 Overhead Hydro I 26. T -Bar Ceiling (Structuralj', & Monocoat '' ; I ; j Dry Chemical l27. !75.1 and Flashing,j t {' 76.F Dry Stantlpipe ' + -Frame M 28. lathing &Siding { fI r F=SSE-FINAL r 29. Insulation i I j ! i 78.; FI=RE PREY. FINAL r I + _ + 30. Drywall Nailing r I I I I i ! Notes: i I s , I ; . 31.. Plaster Brown Coat t I II r 1' 32. 'Electrical Power Meter -Final I s l i 433. Final Electric , i 1: 34. Final Heaiing &'Air Conditioning ,r E ;• ' y �'�`�' - 35. Final GasrPi , Te _st` 36. Hood or Canopy= I i , 7, Final Factory Fireplace r' L i ' '• +I i 38. Final Plumbing I , 39. Water Service -Final; 40. Gas Service -Final i 41. Solar Domestic -Final 42. Backflow Preveriter , ' i' 1 ,- } 43. Backflow Irrigation t ;!' j 'n\ 1 t: � 44. Landscape Irr_ig_tion•rSyste+ m . AtterlltlO45. Sound n I 46, Handicap Regulations' 47. FINAL STRUCTURE&B,UILDING,.- 48. Special RequirementsCorripleted 49. Electric Release;to Edison, 50. Gas Release to Southern California Gas Co r 1 1 51. CERTIFICATE OF OCCUPANCY No. I Date • 1 41564) COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 52626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS 3185 A Airway Avenue OWNER MAIL ADDRESS CITY CONSTRUCTION LENDER BRANCH KOII/Irvine-JUEN : 1901 Dove Street TE L. NO. R ADDRESS ARCHITECTTEL. OR ENGINEER Leason PomeroyN4.639-554 ADDRESS 44 Pla CONTRACTOR DON KOLL COMPANY, --IN ADDRESS 1901 Dove Street TR 1 5-7FrF'AU r. 1 00 820* Building #13 APPLICATION FOR STRUCTURAL PERMIT Y DATE RECE V PATE ISSUED USE ogl n PER Tkk f� r FIRE t�2 f. ,A ZONE STATE CITY rDR I LIC. NO. LOO IZE /�` NO. OF F LOT O BLOCK Q YARDS APPROVED YARDS APPROVED MAIN BUILDING a" Separate permits are required for plumbing and heating work. TE L. USE CITY $ FIRE ewpnNO. DISTANCE BET. BET. MAIN & ZONE STATE CITY APPROVE BY LIC. NO, 2.21 71 LIC. NO. LOO IZE ::= NO. OF F LOT NOW ON LOT 1 Q YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING USE OF EE ) HOLD FOR SPEC A! RF UIR EXISTING BLDG. FT In ►r R. -SIDE n!2T,hey a" Separate permits are required for ff Aelectric, plumbing and heating work. VALUE USE • $ FIRE USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & ZONE YPE GROUP APPROVE BY DATE / LOO QC.U.P. ZONO.OF USE OF W PLANS BUILD YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L S EE ) HOLD FOR SPEC A! RF UIR FRONT FT FT. R. -SIDE n!2T,hey FI. L SIDE T. FT. ff Aelectric, plumbing and heating work. REART. F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & Q� MAIN BLDGS. ACCESS. BLDGS. .., VAR. + DATE QC.U.P. — APPROVED % APPROVE HOLD FOR SPEC A! RF UIR 0 1 hereby acknowledge that I have read this application and state h that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of m 400 the State of California. 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. r THE AMOUNT SHOWN UNDER VALUATION 1S FOR the Stateof California Business and Professions Code, Division 3, m Chapter 4, and that such license$ are in full force and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisionshe State of California Business VALUATION PERMIT FEE $ and Professions Code, Divis ter 9. M Iq PLAN CHECK $ ! � Signature of _ e_.r TAX $ Permittee hj $ LL uV` TOTAL PAID $ Authorized Agent COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92825 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS OWNER MAIL ADDRESS TEL. CITY NO. CONSTRUCTION BRANCH ADDS ESS ARCHITECT TEL. ADDRESS CONTRACTORX��f / ADDRESS TE L. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE NO. OF SLOGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUJtLDING AND WORK TO BE PERFORMED . Lil/y/i'/L I hereby acknowledge that I have reed this application and state that the above lnformatlon is correct and agree to comply with all laws regulating building construction, and I shelf not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Oivision 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Parmlttee Authorized Agent APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY 1 DATE REC5IVEDw nATF ISCt1FP A.P. NO. BUILDING AODRESS TRACT I LOT OWNER FIRE ZONE APPROVED DATE ZONE NO. OF USE OF NEW PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM CIL STREET) DISTANCE BET. MAIN BLDGS. BET. MAIN & ACCESS. BLD VAR.+ DATE C.U.P. 4 APPROVED APPROVED n w i m m SQ. FT. a THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE 3 v w m PLAN CHECK $ �+ M 4 tt 5 TAX $ �^ g U TOTALPAID S , INN. , iA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 l APPLICATION FOR STRUCTURAL FERMI. 50 TLI 01 i REI Y � PERMIT N 51037 For Applicant to Fill in Completely — Use Ink Only 1 ADDRESS � /� 7 -UA, OWNEROR BUILDING ADDRESS / ,✓ z L r _g/e5 MAILING r� � ADDRESS ZZl�� L./Jj €j��Y UNIT SPACE NO. .. AI/ ) CITY �istii /� yyNA— NO. 9/� 31 /V TR.NO. LOT BL NEW ADD ALTER REPAtR MOVING DEMOLISH CONSTRUCTION '! 3r LENDER X, BRANCH y� f OWNER /�' /?VpG ' 291WI7 ADDRESSVA UE USE $© ARCHITECT y� TEL.. f7/7 / OR ENGINEER -P' N ADDRESS 4'S� Sr�/Y C- ,sl,¢ . ZONE TYPE GROUP BYPROVED CONTRACTOR Gv� f%�" DATE �7�� -7 S' 5,�44AIAI,01-1 5;TEL! ADDRESS CITY �j�jv% f,L--' NO.,j'4�71 STATE CITY APPROVED SETBACKS LIC. NO. - ZZ(.��Zr LIC. NO. SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT ERONT FT. USE OF EXISTING BLDG. SIDE Separate permits are required for L sl E FT. electric, plumbing and heating work. REAR FT, USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION "/ ` f �/vr ' r /r ,011,A DATE APPROVED APPROVEDY r� DAT AlryTzi b f �S 1 hereby acknowledge that I have read this application and state that the above inforreIetlon Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. 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. em exempt from the Provisions of the State of Callfornia Hess VALUATION PERMIT FEE $ end Professions Code, Division 3, Ch4pilUr 9. t Signature of !�� r 0AN CHECK $ f /� Permittee - S v TAX $ D or 15"D Authorized Agent pate .- TOTAL PAID $ 50 TLI 01 i �: s 4356 .. =-Q 23-77Per°001201,E ** O �;�. 281.,3 COSTA MESA BUILDING -SAFETY DEPARTMENT ' P.O. BOX 12Q0 COSTA MESA, CALIFORNIA 92626 4P*ATPN FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only ' RE 1 EDB GATE RECEIVED DATE ISSUED BUILDING � ADDRESS Ld V d - //JJ d OWNER P MAIL BUILDINGS ADDRES ,u4 '/6Mh ADDRESS P/ VYZ% CITY etTEL. aJr& NO. L BLdGK CONSTRUCTION OW�1 NEW ADD AL LENDER BRANCH OWNER ADDRESS VALUE ARCH]TECT TEL. 5 OR ENGINEER S N l3yg ADDRESS )00% +�• COV ASO-- FIRE ZONE YPE GROUP iG/401160 Z�. APPROVEDIN CONTRACTOR - BY DATE ADDRESS,_90 .sof D �03 TEL Z NO. OF USE OF NE PLANS BUILDI NO CITY PSGE Q F" STATE CITY YARDS APPROV YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING LV SIZE No. OF BLDG& (FROM C/L STREET) ve 4 OF LOT NOW ON LOT RON7 FT. 1 FT, Q �. USE OF 7iWA10T 71'0 EXISTING BLDG. I/ S T Separate permits are required for L. SpD electric, plumbing and heating work. G REAR Fr. [ ~ USE OF BUILDING AND WORK TO BE PERFORM DI N BET.IT BET. MAIN 8i SLi E MAI DGS. ACCESS. BLDGS. .. Qb v /O Ln f -Lo? -S VAR. * C.U.P. DATE APPROVED > APPROVED _ CC W 0 1 hereby acknowledge that I have read this application and state to p[ that the above information is correct and agree to comply withGo GL all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of m the State of California. m I hereby certify that I am properly licensed as a contractor under SO. FT. w the State of Calif Business grid Professions Cade, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR a) Chapter 9, and�that s h licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERWT F NLY: am exempt Ir m the firovislons of the State of California Business VALUATION PERMIT FEE § and Professi ns COde Division , Ch er 9, m PLAN CHECK § or c Signature o Permittee $ TAX $ of Authorized Agent TOTAL PAID W 1 City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 00!834 P, 0. Box 1200 Costa Mesa, California The Building located at 41 f2r� "Ft" A V_Ur a has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group ta.-.7 Occupancy. Use of Building Off i t -=a Legal DescriptionA - A. BA77-1 QA,. -1 7 (See reverse side for Metes and Bounds) Building Permit No E Ae0r-Electrical Permit No.y )Ar, -V7 Plumbing Permit No, Mechanical Permit No. aa7 A A Number of apartments and/or guest rooms ISSUED TO: Building Official WiIIiaTn T. Howarri T1.nia1 Alanrk 3185 "B" Airway Avenue by O^e4-a Q7974 Date January 29, 1987 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File CITY OF COSTA MESA BUILDING DIVISION 4 r 77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us u FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC11-00244 PERMIT TYPE: B_COMBO STATUS: ISSUED ' Sub Type: COM—ALT DATE ISSUED: 0611012011 ISSUED BY: RMD JOB ADDRESS: 3185 A AIRWAY AV CM APN: 42719413 Zoning: Vicinity: BUILDING A Const Type: V -B SQ. FT: 6400 Suite/Unit: A . 1 Primary Occ: Valuation: $246,000.00 SCOPE OF WORK: 6,400 SQ FT TENANT IMPROVEMENT FOR "BRAND I.D.", BUILDING "A". SCOPE OF WORK TO INCLUDE: NEW PARTITIONS AND OFFICE LAYOUT, NEW SHOWROOMS, REMODEL EXISTING RESTROOMS FOR ADA COMPLIANCE, NEW ADA COMPLIANT ENTRANCE. 162 LIGHT FIXTS, 70 OUTLETS, 25 SWITCHES, 1 MOTOR TO 10 HP, 29 COMM DROPS, 2 SUB PANELS, EL EQUIP FOR HVAC, MISC EL FOR WATER HEATER, ALTER DUCTING IN 3 ZONES, 2 FLOOR DRAINS, 2 TRAP PRIMER, 1 URINAL, 3 WASH BASINS, 4 WATER CLOSETS, 1 WATER HEATER. OWNER: CORMAC, COLIN Phone: APPLICANT: SCHRODER. JOHN Phone: 949-376-8871 Address: 3185 AIRWAY City/State/Zip: COSTA MESA, CA Address: CitylState/zZip: CONTRACTOR: JJS INC GENERAL CONTRACTORS License No. 571849 Phone: 949-376-8871 Address: 2549 EASTBLUFF DRIVEUnit: Cell: CitylState: NEWPORT BLVD ARCHITECT: ENGINEER: SHUCRI YAGHI COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: License No. License No.C43205 $294.35 $1,811.35 $400.43 $64.60 $150.90 $0.00 $51.66 $10.00 $2,783.29 Unit: UNIT A Unit: UNIT 383 ZipCode 92657 PHONE: PHONE:714-997-9120 'Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 311812010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays- 9:00 am thru 6:00 pm. Prohibited all hours- Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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 N. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re -Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final pemolition DATE INTITIALS CODE 0 INSPECTION TYPE 206 Final Mechanical 206 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildingfOccupancy DATE INTMALS it C =117" � WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. t have and will maintain workers' compensation insurance, as required by s tan 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance Carrier and policy number are: Carrie �� FOND (This swan need nor be wrnpreted+r me Demura vakred ar one hurA*edd d olars ($100) a• less.) Policy Number: �OO�'0o0 1112291�10{ ❑ 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 wor s compensation laws of California, and agree that if I should beco a work ' Compensation provisions of Section 3700 of the L bor to wi comply with these provisions. !-= Z- Z I a 1 t_ f Apprrom gnature Date 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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. Lic.-#Class -1 CtAtracto Signaiu ;Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such irtmprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature Date 3057.46 (3107) Owner ID verified by driver a license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ 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. Applicant's Signature Dale 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? j] Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any 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? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. if a permit from the South Coast Air Quality Management District or other, air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If 'yes", attach certificate of compliance from the appropriate air pollution ,control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized s permit until final inspection. gna of i Owner ] Date "I- Autmnzed Applicant Date CITY OF COSTA MESA o `hw BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax(714)754-4856 - www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: B10-00236 PERMIT TYPE B ROOF2 STATUS: ISSUED APN: 42719409 _ DATE ISSUED: 0811112010 ISSUED BY: KJB JOB ADDRESS: 3185 B AIRWAY AV CM Suite/Unit: _ B Vicinity: Squares: 4800 Valuation: $14,000.00 SCOPE OF WORK: TEAR OFF EXISTING BUR AND REPLACE WITH TROPICAL WHITE COATING ELASTOMERIC BUR. APPROX 4800 SO FT. ROOF PITCH IS 2:12 OWNER: POLIZZOTTO, JOSEPH Address: P 0 BOX 7033 Unit: PHONE: City/State/Zip: HUNTINGTON BEACH, CA APPLICANT: LEONARD MARTINEZ Address: 1333 GAZANIA CIRCLE Unit: PHONE: 714 493-7859 CitylStatelZip: RIVERSIDE, CA CONTRACTOR: LEONARDS ROOFING License No. 560774 Address: 1333 GAZANIA CIRCLEUnit: PHONE: 714 493-7859 City/State/Zip: RIVERSIDE, CA 92501 CELL: ARCHITECT: License No. PHONE! ENGINEER: License No. PHONE: FEE SUMMARY Reroof Pian Check: $0.00 Reroof Permit Fee: $237.25 Reinspection Fee: $0.00 , Bldg Std Admin Fund $1.00 OTAL FEES $238.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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 p. INSPECTION TYPE DATE INTITIALS cQ�E 0 INSPECDON TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final n�p} 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: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: is section need not be completed Athe permit is valued at one hundred Mlars ($100) or fess.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the r Code, i shall forthwith corn with these provisions. a �d WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE fS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMfNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEC7lON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Contractor' Signa a----,7. 4 �- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a con ruction lending agency for the performance of the work fqr which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Profession$ Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ t, 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 worts himself or herseff 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 burderi of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature 3057-46 (3107) Date Owner ID verified by driver s license. ❑ Yes ❑ No Driver's License No. Expires: f 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 demo)ftion or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applirant's Signature Division'of Industrial Safety Permit Number: Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business P)an for emergency response ;to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials?, ❑ Yes F-1No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No ' (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire, Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No i 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any 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). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7, If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required' for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /J5�gnafure of egal Owners) ��/// • tS81Sr'A� Fiz-AppllC3nt I Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DERIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3185 AIRWAY AV Suite No B Vicinity: ROOFTOP Parcel Number: 42719412 Applicant: POLIZZOTTO, JOSEPH Quantity Address: PO BOX 7033 Quantity Inst FAU <100 k BTU $0.00 Phone: Inst FAU >100 k BTU HUNTINGTON BEACH, CA Zip: 92615-7033 Owner: JLMD LLC • 0 Address: ATTN JOSEPH F POLIZZOTTO 0 Refrig Sys <100 k BTU HUNTINGTON BEACH, CA Phone: Refrig Sys >100 k BTU P O BOX 7033 Zip: 92615-7033 Contractor. OWNER -BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT LEGALIZE 3 A/C CHANGE OUT UNITS ON ROOFTOP. BUILDING "B" SUBJECT TO FIELD INSPECTION. Status: ISSUED Applied: 10/2512002 Issued: 10/2512002 1 wlvoo FEE SUMMARY Quantity ISSUE FEE 323.50 Quantity Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU $0.00 0 Repair / Alt Cooling/Heat $0.00 • 0 Inst 1 Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 ^'o Fire Dampers $0.00 0 Smoke Dampers $0.00 �;'0 . Inst or Relocate Appl Vent $0.001-'o ` Air Handlers < 10000cfm $0.00 , 0 Air Handlers > 10000cfm $0.00' 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 -Other Mechanical Fee Status: ISSUED Applied: 10/2512002 Issued: 10/2512002 1 wlvoo FEE SUMMARY Quantity Repair I Alt Absorbtion Unit $0.00 0 Repair 1 Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors / Absorption Systems Up to 3 hp 1 100k BTU $44.10 3 3 To 15 hp 1500 k BTU $0.00 0 15 To 30 hp 1 1,000 k BTU $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Over 50 hp /•Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3To15hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 -Other Mechanical Fee Investigation Fee $67.60 Pian.Check Fee $0.00 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia (statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all 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 244846 (8740) ' DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier. Policy Number; (This $action need not be completed if the permit is valued at one hundred dollars ($ f 00) or less.) ` )certity that in the part-- ce 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 Callec ia, and agree th should become sub t to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these provis ns AppNana 1 ,g a- t'ure7 t l� Date: WARNING: FAILURE TO SE AEW RS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100, j, TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars (5500).): ❑ 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 Sala.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant)q the Contractors License Laws.). am exempt am a sec. and Professions Code for this reason: f8`M!V �� ( r� • — D ivet s I' rise. Yes No D e s amso.Nn ip by of oleo en , '.e. property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................ildi...............,,...a. *t...............'o.........'r'......'s.1r......................................................... ................................................ ............_......................................................� 2 DDes or will the applicant or present or future building occupant need to fila a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic foot of compressed gas at standard temperature and pressure). .............._-----.—._.—.... _.—_._....................... —.._.................... —_................................................................. -- ..... _... --- --- 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fre 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 Coda been fully complied with? Yes ❑ No _ ..........................._.._- - ........ _ .....__...__ ._....... .._........... _.._.._..... ....................... _...._._............................._.....................—._...__...._...------- 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency[ Yes f No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residentlal building permits). ......................................................... ---._........... _............... ...........--.......................... ............................................... ......... ................................... ............................. ..... ......._.. _ .................. ................ _ . 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑ No (if 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......- ........................... _ -----......._..._............_........ _..... -----.............. •.... -...... ....._...................................... ................................... ....... — _ ....... _....__. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................-...__._.._.._.........._.....---.. ...._..._..........-............. ........................ ................................................_ 8 (It'res', 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 COMPLIANCE AND AUTHOR%TIO F ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is cored. I all o comply with all state laws and ordina cos relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above descri property for i p rposes. re not to coo upy or allow occupancy of any building authorized by this permit until final inspection. (,Z Signature Of ner(s) ~ Date 1� 1 AndlOr Authorized Applicant Date CDaE L INSPECTION TYPE QM Imo$ CODE 0 I#SPAMQN T1`PE a )� 1616 Fixed System Final Fire Prevention 206 Final Mechanical -(q - 03_ Qlp hVf 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 BulldinglOccupancy CITY OF COSTA MESA _ BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT, �• PERMIT (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT Job Address: 3185 AIRWAY AV Suite No B Vicinity: Parcel Nunmber. 42719405 Applicant: JOE POLIZZOTTO Address: PO BOX 7033 Phone: (714)557-3805 HUNINGTON BEACH, CA Zip: 92646 Owner: AIRWAY COSTA MESA Address 3185 AIRWAY AVE SUITE J Phone: COSTA MESA, CA Zip: 92626 Contractor. ' OWNER -BUILDER Address: '. Arch / Eng : Address: Phone: Zip: License: 0 Phone: Zip: License: PERMIT NUMBER I P00-00199 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 0412512000 Issued: 04/25/2000 ISSUED BY: e*n SCOPE OF PERMIT INSTALL WASH BASIN AND WATER CLOSET IN CLOSET AREA AND REMODEL EXISTING BATHROOM TO MEET AOA REROUIREMENTS TO MAKE UNI -SEX BATHROOM. OTY FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto) $0.00 OTY FEE SUMMARY AMT Laundry Tub 1 Washer $0.00 Landscape Irrigation $0.00 P -Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 OTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $9.80 1 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $9.80 1 0 Water Heater / vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $0.00 0 0 Water Softener $0.00 0 0 OTHER $0.00 0 VIOLATION $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS ! SPECIAL CONDITIONS TOTAL CALCULATED FEES: $43.10 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not -commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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' compensatlon Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred Mlars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUaJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($10D,000), IN ADDITON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: r 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. Lic. q Class H Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to fife a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work hirrp4f or herself or through his or her owh employees, provided that such improvements are not intended or pffered for sale. If, however, the building or improvement is d within one year of completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who Contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I arts exempt nd s Business and Professions Code for this reason: Signature: A4 - � —0 0 Owner ID verified by ri s lice ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION- 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? [--)Yes ❑ No (Section 25533 of the California Health and Safety Coda, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I--I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 foot from the outer boundaries of a school? ❑Yes ❑ NA (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (it "Yee, attach certificate of compliance from the appropriate air pollution control officer). f 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. i Signature: Date: l CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree om ly with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-d( ib r e or inspe on p ses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /Y-2 ti_ O d AkAture Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I, INSPECTION TYPE PACE INTMA CODE INSPECTION TYPINTMAL 1616 Fixed Aystam Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 246 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3185 AIRWAY AV Suite No B Vicinity: UNIT B Parcel Nunmber: 42719405 Status: ISSUED Applied: 1110212000 Issued: 11/02/2000 Applicant: POLIZZOTTO, JOE ISSUED BY: Address: 3185 AIRWAY AVE SUITE B Phone: (714) 557-3805 COSTA MESA, CA zip: 92626 Owner: ;/AlRWAYCOSTA MESA Address ' .3185AIRWAY AVE,SUITE J Phone: COSTA MESA; CA- Zip: 92626 Contractor: OWNER -BUILDER Address: Phone: . f - . Zip. License: 0 SCOPE OF PERMIT ELECTRICAL PERMIT TO RELOCATE EXISTING SUB -PANEL FOR "JP INSTRUMENTS" (UNIT B). REF: 800-00555 FEE SUMMARY Quantity - ISSUE FEE $23.50 Temp Dist System i Lighting Temp service'test $0.00 Busway 1100 ft Res. a/c package $0.00 Standing Section . New Res (172 units) , $0.00 0 New Res (3+units) $0.00 0 Pool 1 Spa $0.00 0 Lighting Fixts $0.00 0 Recept Outlets $0.00 0 Switches ,. $0.00 _ 0 Non Res Appl $0.00 0, Res Appl` " $0.00 .,= - 0 Service to 200a . , $0.00 �� "o Service to 1000a . l � $0.00,-, , "0'. Service Service over 1000a $0.00 ", 0 Motors to 1 hp $0.00 0 Motors to 10hp $0.00 - 0 Motors to 50hp $0.00, 0 Motors to 100hp $0.00; 0 Motors over 1 00h $O.00l - - - - 0 Communication drops $0.00 0 , Sub panel to 200a $30.50 1 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 FEE SUMMARY , Quantity ; Temp Dist System i Lighting $0.00 0 , Busway 1100 ft $0.00 0 Standing Section . $0.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 .up to 10 kva/kw $0.00 0 ...............:.up to 50 kva/kw $0.00• '0 .................up to 100 kva/kw $0.00, , 0 ...............:..over 100 kvalkw - $0.00- ' 0 Low Voltage Equipment $0.00 0 Low.Volt Wiring System 1 Ckt .-: $0.00-, 0 Misc. Conduit $DAO 0 Misc. Conductor $0.00 '0 Circus ( gen or ride) x$0.00 ; ' ,D i Circus (meth ride or lights) $0.00 0' Christmas 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 $54.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned, tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratio�th� rmit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performanceof the work for which this permit Is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: I (This section need not be completed if the permit is valued at one hundred dollars ($ f 00) or less.) ❑ 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shelf 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 CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Llc. # Class # Contractor's 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty o1 perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more then live 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 taw does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. if, however, the building or improvement is _ sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I �~ 1, s owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors Licanse Laws.). ❑ I am exempt der Business and Professions Code for this reason: �'Signafure: t. — --p pyvnar ID venfled by s li❑ Yes ❑ No r- Drives-LiCense'N E res' Verification of Ownership by (type of document, Le. - property tax bill or deed). DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live (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 then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release or a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............................d,t'...................gi'str'a---..................f'o, r.......................z'a'............................................................................................................i.................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ Na (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................---------------------................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..............................................................................................................................................................................................................................................:.................... 4 If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code boon fully compliod with? ❑ Yes ❑ No ......................................•--•---------------...............................--------........................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermil for such construction or modification from the South Coast Air Duality Management District or from any 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). ....................................._.__............-..............._.................................................. —_................................. ..............__._....__ M. - __......._..............._ 6 Will any part of the facility to be constructed under this permit be within 1000 test from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ._......................................................................................................................................•---.......................................................-----------------------.----...................-................................................................ .........................._.................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................................................................................._..............................................................................................................._..._.. _.................... 8 (If jos", attach cerTiticate 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 cityordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE F COMPLIANCE ANDA ORIZATION OF ENTRY: I Certify under penalty of perjury that I have read this application and state that the information given is correct. I a9ea o comply with all a laws nd city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-des nb pe for in action purpo as. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspe�yon. �{J nature Of Legal Owner(s) '�� Date And/Or Authorized Applicant Date CODE_P. IN^ 00011 TYPE DAIS fKINIALS fK4.4.g t INSPECTION TYPE DATE INIAL$ 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 (714)754-5273 • Fax(714)754-4856 Job Address: 3185 AIRWAY AV Suite: B Vicinity: BATHROOMS CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT . PERMIT BUILDING PERMIT Parcel Number: 42719405 Zoning: Applicant: JOE POLIZZOTTO Address: PO BOX 7033 Phone: (714)557-3805 4 PERMIT NUMBER vA 00-00555 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/25/2000 Issued: 04/25/2000 ISSUED BY: Lz Total: $39.28 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 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 worts 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 HUNINGTON BEACH, CA Zip: 92646 Owner: AIRWAY COSTA MESA Address 3185 AIRWAY AVE SUITE J Phone: COSTA MESA, CA Zip: 92626 Contractor: ,OWNER -,BUILDER Address: Phone: Zip: License: 0 Arch- � Eng: ` _ Address: Y Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL WASH BASIN AND WATER CLOSET IN CLOSET AREA AND REMODEL EXISTING BATHROOM TO MEET ADA RERQUIREMENTS TO MAKE UNI -SEX BATHROOM, FEE SUMMARY Plan Check: $15.28 Calc Valuation: $500.00 Permit: $23.50 - Claim Valuation: $500.00 SMIP Res: $0.00 SMIP Com: $0.50 Other: $0.00 Inspection: $0.00 Total: $39.28 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if worts is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 NO WORKERS' COMPENSATION DECLARATI[,..: .I hereby affirm under penalty of perjury one oI the following declarations: ❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Coda, for the performance of the work for which this perrttil is issued. My workers' compensation Insurance carrier and policy number are: . Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($f 00) or less.) ❑ 1 certify that In the performance of the work for which this permit is issued, I shall not employ any parson In any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. 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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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. Uc. tf Class ri Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction tending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work imself or herself or through his or her ow6 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a conttactor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exam un Business and Professions Code for this reason: Signature: `7 Owner ID verified is ice ❑ es ❑ No Driver's License No. Expires: verification of Ow hip by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenity that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any arse 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic foot o1 compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an AM PP 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? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aggermit for such Construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes L -I No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If 'yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree ply with all state taws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -d( p r Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final spection. S r Owners) Date And/Or Authorized Applicant Date CODE ONTYPE Qdg =A CODES INSPECTIONTYPE DAM INTMA 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/Retalning Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site f 204 Final Demolition 250 Final Building/Occupancy I f 2446-46 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PC ORA ITN TRA T NO LOT NO UNIT CITf_-CONSTR UCTIOW PERMIT� Projectddress r4u�-aMM, ave CA -ft Y -s I Appant's Mailing Address Owner's Name fin'". ISL Phone9i5�� Addresses Arch/Eng.. UR License No. Ci�'"1"? � 1 Address Contractor's Nam Ee Phone Address (mailing) — City License No, _ LICENSED CONTRACTOR DECLARATION I hereby affirm that I dm licensed under provisions Of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. ste Signature ,ORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance; or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company 8 Certified copy is hereby furnished. - Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if ermit i5 for one hundred ($100) or less). I certify that in the pdrforman of the wor Nchhis perms -issued, I shalja ploy any person i an r so aecomes ject to the sation Laof if ISignatur : If, after making this deClarat o O s I to the Workers' Compensation provisions of the Labor Cotle, you mus for 'ith comply with such provisions or this permit shall be deemed revo� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this s pt is Issued (Section 3097 Civ. C.) Lender's Name -- hl 'f Lender's Address - OWNER BUILDER D$CLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city Or county which requires a permit to construct, alter, improve, demolish or repair ny structure, prior to Its Issuance, also requires the applicant for such permit file a $igned statement that he/she is IlCensed pursuant to the provisions of A Contractor's Licen4e 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 ba4is for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil cnalty of not more than five hundred dollars ($500). 1, as owner of the property or my empioyees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for We. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- pr ve for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed con- ractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursUant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason k Date - Owner I hereby certify that I have read this application end state information ' orrect, 1 agree to co ly with all city and cou and. statws re itdIng construction, and hereby a sentativ s 0f cit o ant n the above-mentioned inspecti Signat Drivers' Licen a or S the above ' ordinances irIZ repre- ope1ty for ` G.T Y J /A4 Showers Service Sink TYPE OF CONSTRUCTION Ll NEW ACID ALTERATION Ll REPAIR Sewer Cap ❑ CONVERSION ❑ DEMOLISH ❑ OTHER P.q�/.�a DESCRIPTION OF WORK/USE OF BLDG. Solar Collectors S Main Building: Dryers ❑Gas ❑Electric Solar Tank Fan TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL EI Device Boxes t, .� ❑ OTHER A Rear Switches , r C Right PROJECT DESCRIPTION Std. F CI CY K DBz JX/ - $2 !� �O S =RY OF FEES' BUILDING'PERMIT+ $ ADO. PLAN CHECK . $a'� 7�{9 v PLUMBING $ PLAN CHECK" 25% $ ELECTRICAL" $ PLAN CHECK r 5096'' $.. MECHANICAL $ ,' z' PLAN CHECK ,25% $, +ti70- -5"emo CONSTRUCTIONTYPE—_ VALUATION g Lett ZONE GRADING CU. Y A RES - - - Ping. Ref. 9V-- Remarks: /Qpm D..; V -'0'7 / - kr Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks . Gas Service Outlets Interceptors ' Kitchen Sink Lavatories P—Trop Roof Drains PLUMBING FEES /A4 Showers Service Sink Automatic Washer I Sewer Cap Construction Pole Sub. Sewer Connection �, Cooking Unit Solar Collectors Dishwasher Solar Piping Dryers ❑Gas ❑Electric Solar Tank Fan Swimming Pool w/Spa F.A.U. Urinal Fixtures _ • q Water Closet ` Device Boxes t, .� i Water Heater Otitlets' Water Service Switches , r Auto -Wash Garbage Disposal„ Laundry Trays Generator 130.5`9W ❑5-15'K f. v DBz JX/ - $2 !� �O S =RY OF FEES' BUILDING'PERMIT+ $ ADO. PLAN CHECK . $a'� 7�{9 v PLUMBING $ PLAN CHECK" 25% $ ELECTRICAL" $ PLAN CHECK r 5096'' $.. MECHANICAL $ ,' z' PLAN CHECK ,25% $, +ti70- -5"emo SMTP $ „�rls:_ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ �2 Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System El Multiple 13Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-109,00OBTU ❑ 100,0006T Reinspection Fee . 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9117 7/09/86 Accessory Building: e.-JIz h-1 � Perking Req./Provided ELECTRICAL T 621.64 L Transformer ❑- 15-50 KW 05, +{KW Meter ❑up to 100 ps Meter Dove( 100a;w. Sub Panel Motors E10-1 HP D111/2- 8 Inc. Solar 119-'l5 HP Q16-15+ Microwave '' Pole Light,' Range' Sign Standing Sections W Trash Compactor FEES Issue Fee $ 3 ' " • '. Reinspection'Fee $15 Issue Fee S 3 1ANICAL FEES Hood or Type I ❑ Canopy Type I I ❑ - DEVELOPMENT SERVICES - Zoning Approved,By Building Ap""proved By. Application Issued By' • REQUIREMENTS: r ' `` 0/ {ap Date Dat Refrigeration System ❑0-100,000 BTU 0100,000 BTU DBz JX/ - $2 !� �O S =RY OF FEES' BUILDING'PERMIT+ $ ADO. PLAN CHECK . $a'� 7�{9 v PLUMBING $ PLAN CHECK" 25% $ ELECTRICAL" $ PLAN CHECK r 5096'' $.. MECHANICAL $ ,' z' PLAN CHECK ,25% $, +ti70- -5"emo SMTP $ „�rls:_ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ �2 SystiunRepair/Alteration Fire Dampers Registers Issue Fee $ 3 _._ '_ c CONSTRUCTION AND PLANNING APPFWVALS Permit # Date Inspector L & SPA APPROVALS Permit # Date Inspector 1. *'Temporary Electrical Service or Pole 52. Pool & Equipment Location J 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. & Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, © 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 - Fina! 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 APPROVALS Permit # 20. Rough Factory Fireplace 21.'Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping © Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (StructuralE & Monocoat 75. Dry Chemical 27. Frame and Flashing PJ(9 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing / Lot- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric G E((� Note,: 07111 N fW 34. Final Heating & Air Conditioning E LfisY' S 1 N p1L� 35. Final Gas Pipe -Test 1 36. Hood or Canopy N 37. Final Factory Fireplace 38. Fina! Plumbing IAPS 46 071 39. Water Service -Final --' 40. Gas Service -Final F 41. Solar Domestic -Final / 42. Backflow Preventer 43., Backflow Irrigation 44.. Landscape Irrigation System 45., Sound Attenuation /O f{ /v6 46: Handicap Regulations 47,�FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50 rGas Release to Southern California Gas Co 51..'CERTIFICATE OF OCCUPANCY No. Date t ' Applicant to fill in all spaces except those witnin heavy border lilies and sign all appropriate declarations. 01TY Ofr COSTA MESA CONSTRUCTION PERMIT PC�RMIT Na` i f TRACT NO. LOT NO. UNIT NO. Project Address - -- -1/ es A), 1h y '6— Applicant's Mailing Address —�` 5� / �L ,Qv� ^K- f.ta Owner's Name �/Q�� . _ Phone Address Arch/Eng. License No. Address Contractor's Name_ -RIC146- 77� Address (mailing) City License No, Zcf % 5 0 I-ICE14SED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 70001 of Division 3 of the Business and professions Code, and eny license Is In full for= d effect, t-iconse Ct s Lice - %ate 2J .4 f! Signature 1ORK RS• COMPENSATION DEcARATIO I hereby affiL rm that t have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company ' Certifietl copy is hereby furnished. Certifietl copy is filed with the city Building Division, Date Applicant 9XEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($1001 or less). 1 certify that In the performance of the work for which this permit Is Issued, I shall not employ y person in any manner so as to be ubject to the Workers' C�o�p�ens on Laws of Callfomia, pale ____!_( Signature NOTICE• I/, aftei making this declaration, you should me subject to the Workers' Componsatlon provisions of the Labor Co e, you must forthwith comply with Such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING, AGENCY I hereby affirm that there Is a construction lending agency for the performance of the Work for which this permit is issued (Section 3097 Civ. C.) LAnder's Name 4encler's Address. - QWNER GUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair -ny structure, prior to its Issuance, also requires the applicant for such permit file a signed statement that he/she Is licensed pursuant to the provisions of .e Contractor's License Law (Chapter 9 (commencing with Section 7000) of ,)WWon 3 of the BuSIneSS and PT010SSiOn5 Code) or that he/she IS exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5L by any applicant for a permit subjects the applicant to a civil �nnal!-i ty,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 (Section 7044, Business and Professional Code: The Contractor's Incense 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 gmployees, provided that such improvements are not intended or offered for sale, If, however, the building or improvement Is sold within one year of com- pletion, -the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). 1, as owner,of the property, am exclusively contracting with licensed con- 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 tluilds Or Improves thereon, and who contracts for such projects with a can• tractors) license pursuant to the Contractor's license Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, 0 1 am exempt under Section B. & P. C. for this reason )ate . Owner I hereby certify that I have read this application and state that the above information IS correct. I agree to comply with ail city and county ordinances and state laws refacing to builtlln onsiructlon, and hereby authorize repre- sontatives of this City to a to Don the above-mentioned pr pertfor Inspection purpos jy Signature Date 7 pi -11 55 9716! ► 7/21196 g i . 75 TL TYPE OF CONSTRUCTION LI NEW L J ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # __ Zone - S Main Building: Accessory Building: TYPE OF PERMITr�7 LJ GRADING FOUNOATiOa? STRUCTURAL ❑ TENANT LJ ELECTRICAL ❑ PLUMBtNG Ir4vVt MECHANICAL OTHER PROJECT DESCRIPTION SR. FT, OCCUPANCY, CONSTRUCTION TYPE VALUATION 5 ZONE GRADINGCU.YOS. ACRES T Front O B A Rear N I C Right G K S Left R Filing, Ref, Parking. Req./Provided E Remarks: Planning Notes: O M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑' 15-50 KW_ 056+ KW Backflow,lrrigatidn Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishvvasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan, Motors ❑0-1 HP 01H.- S , Floor Drains Swimming Pool w/Spa F,A•U. Inc.Snlar 09.15 HP ❑1fi-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light ' Interceptors Water Heater Outlets Range Kitchen Sink 4 Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections PTTrap Laundry Trays Generator ❑0.5 KW 05.15 KW Trash Compactor ,Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee • $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: ; Zoning Approved By, Date_ Building Approved By Date Application Issued By Dat Boiler Hood or 'Type I ❑ Canopy . Type I I ❑ Duct -Under Grourid Duct - Structural Refrigeration System ❑0-100,000 8TU ❑ 100,000 8TU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PIAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF -FEES s $ SMIP $ $_ PERMIT $ ISSUANCE $ $ ENERGY P.C, $ $ GRADING $ $ MICROFILM $ ' $ TOTAL FEE $� $ i Exhaust System C3 Multiple ❑ System Repair/Alteration FirepjlFact. Bit. ICBG # Fire Dampers Z Heating System & Ducting f X0-100,000 BTU ❑100,0008T �` Registers O Reinspection Fee $15 Issue Fee $ 3 avers cense or CMF 6865-46, rev, 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date' r 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 r 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. f 8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ 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 APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ 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 4 9-744 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 & BUILDING ` 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No, Date W ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Automatic Washer'- Construction Pole Sub. CITY OF;*COSTA MESA CONSTRUCTION PERMIT I PE IT NO. TRACT NO. LOT NO. UNIT NO, Dryers ❑Gas ❑Electric Sub Panel Project Address tr A(I�• Motors 00-1•1-11P 01'14-S F.A.U. Inc. Solar 09.15 HP 016-15+ Pixtures Microwave Device Boxes Applicant's Mailing Address TYPE OF CONSTRUCTION El NEW ADD ALTERATION 0 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Range Switches Sign Garbage Disposal 4 Standing Sections A.P. # Trash Compactor Owner's Name Phone- DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: E Arch/Eng. License No. TYPE OF PERMIT El GRADING 1:1FOUNDATION El STRUCTURAL ,T Front c❑ T ❑ ELECTRICAL ❑PLUMBING El MECHANICAL Address ER A Rear Contractor's Nam Pone q OT C Right, PROJECT DESCRIPTION SQ. FT. OCCUPANCY KCONSTRUCTION.TYPE Address (matting) VALUATION $ S Left City License No. 'ZONE GRADING CV.YDS. ACRES - Ping. Ref. # LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: S Planning Notes: with section 7000) of Division 3 of the Business and Professioris Code, and my license is m u or and ect. License las — icen N "late Signature PORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. G.1 [� �D Policy No. (��`t} Company J ❑ Certified copy is hereby furnished. Cer 'fieri cop is f" d with the city Buil g ivisi 7 I Date ArtNe Applicant eXEIWPTION FROM WORKERS' COMPENSATIO DECLARATI N 1 (This section need not be completed if the permit Is for one hued d ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDINGAGENCY 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.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 i file a signed statement that he/she Is licensed pursuant to the provisions of ie Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt - therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to, a civil malty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for thepurpose of sale). — 0.1, is owner of the property, am 0xclusively contracting with llcenied con- , 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under_Section 3. P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construct�p, and hereby authorize repir Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P—T rap Roof Drains Reinspection Fee Outlets I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit, ICBO # Heating System.& Ducting EIC -11 00,000 BTU ❑100,000 BT Reinspection Fee PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays I. I Issue Fee MECHANICAL Hood or , Type I ❑ Canopy Type I I .❑ Refrigeration System ❑a100,000 BTU 0100,000BTU System Repair/AIteration Fire Dampers Registers e - - $15� Issue Fee FEES 1 '9317 7/14/86 27.00 TL Zone Accessory Building: Z O N I N I Parking Req./Provided E Q M T S !EL'ECTRICAL _ Automatic Washer'- Construction Pole Sub. Transformer ❑ 15-50 KW .❑ 50 + KW I _ Cooking Unit Meter ❑up to 100 amps , Dishwasher - Meter ❑ovei 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1•1-11P 01'14-S F.A.U. Inc. Solar 09.15 HP 016-15+ Pixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal 4 Standing Sections Generator 00-5 KW ❑5-15 KW Trash Compactor Reinspection Fee 1 $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By D Building Approved By O Application Issued Bv— E - D FEES $ 3 - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Y'VtCMLT 1<—Z�- � ?{LAW'S '-"' �� / —XSH SUMMARY OF FEES �. BUILDING PERMIT' $ . SMTP _ $ PLAN CHECK $ PERMIT PLUMBING ' $ ISSUANCE $ ' PLAN CHECK , 25% $• ENERGY P;C. $. ELECTRICAL $.-� GRADING $ PLAN CHECK 50% ,$ MICROFILM $ MECHANICAL $ ` TOTALFEE� $ PLAN CHECK 25% ,$ - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Y'VtCMLT 1<—Z�- � ?{LAW'S '-"' �� / —XSH CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector, POOL & SPA APPROVALS Permit # Date ' Inspector ,h 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms c, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 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 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 r [ 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 rs• ��s 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 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. FOO_ D CERTIFICATE ISSUED 33. Final Electric ti �{� f f 14 Notes: (�a 34. Final Heating & Air Conditioning M 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 b ' 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 ;. 43465 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX '1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS OWNER MAIL r ADDRESS (� CITY A-1-1 — CONSTRUCTION LENDER i BRANCH ADDRESS r � r ver TE NO`Mr -�r,--11-77{"-NO 351 *:*1 33.1& Af PYCAITION, FOR STRUCTURAL PERMIT RE ED Y DATE ECE V [j& i% / Q p1 A.P. N O. / DATE I SUED + F + 7 PERMIT NO. ADDRESS;/s 5/ � (� At I I /C J (/ "� -- RAC}T� 5' r 'oW � iL BLOCK W A AL P / APPROVE CONTRACTOR OWNER / /V IS USE OF NE VALUE ► 3 7,Sa ARCHITECTTEL OR ENGINEERLt FIRE ADDRES'51AZONE TYPE GROUP / APPROVE CONTRACTOR BY DATE ADDRESS 1 IS USE OF NE CITY N ON 7! r P PLA BUILDIN YARDS APPROVED YARDS APPROVED STATE CITY LIC. NO. ♦ LIC. NO. MAIN BUILDING A CESSORY BU DING {FROM C/L STREETiOj NO. BLDGS. (� 0. SIZE OF LOT OF NOW ON LOT FRONT FT. IA� d USE OF EXISTING BLDG. R. SIDE FTV�AP v hSeparate permits are re fired for L. SIDE electric, plumbing and heating work. V ' REAR r4T. r F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. AIN Q MAIN BLDGS, ACCESS. BL r VAR.+ DATE C.U.P. APPROVED a APPROVED Ca~ W 0 1 hereby acknowledge that I have read this application and state U) 94 that the above Information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of 4) Uj the State of California. m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. w the State of Califo Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and t t uch licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. " am exempt fro h provisions of)thp State of California Business v r and Profession o e. Dlvisio h r 9. VALUATION PERMIT FEE $ �' yr Z' m PLAN CHECK $ a Signature of f Permittee r ervil L$ TAX S i U Authorized g nt TOTAL PAID S COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA 92626 Building #12 Ln r• r m C0 N D APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely -- Use Ink Only r REM BY I OAT CE;E;j BUILDING ADDRESS '41;85R Airwa)l Avenue LMA7 'Q - aws�ER Ko l Irvine • MAIL BUILDING ' ADDRESS 1901 Dove Street ADDRESS CITY Newport BEACH No�33-3030 47 RACT Q CONSTRUCTION w AL P LENDER BRANCH OWNER ADDRESS VALUE ' $ ARCHITECT TEL OR ENGINE£ N.639-5541 FIRE ADDRESS azaZONE YPE ROUP AP APPROVED CONTRACTOR y1C DATE C ADDRESS 1901 Dove Street Z E 11 OF USE OF NE y� CITY Newport Beach NOL033-3030 PLANS BUILDIN STATE: CITY YARDS APPROVED YARDS APPROVED LIC. NO. 221 764 LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. (FROM C/L ST EET) OF LOT 4800 NOW ON LOT l FRONT FT. FT. USE OF EXISTING BLDG, SIDE 124 J F Separate permits are required for L. slDl= FT, electric, plumbing and heating work. REAR FT FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS, ACCESS. BLDGS. VAR. + DATE; APPROVED A APPROVED -BY AL REQUIREMENTS I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all laws regulating building construction, and I shell not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under 4800 SQ. FT. THE AMOUNT SHOWN UNDER VALUAT40N 4S FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE <)NLY; am exempt from the provisions e State of California Business VALUATION PERMIT FEE and Professions Code, Divislo apter 9- $ Signatureof / PLAN CHECK $ / ! s PermitteItt8e � --'TAX $ $ � O Authorized Agent I TOTAL PAID $ 12 3. d3l Ln r• r m C0 N D COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Far Applicant to FiII in Compl tely —Use Ink Only BUILDING ADDRESS OWNER MAIL ADDRESS TEL. CITY NO. CONSTRUCTION rAR RANCHDRESSCHITECT TEL. ADDRESS CONTRACTOR W ?-B-76fAs'001487 �* * 18U,0 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVEDnerc iccerrr- BUILDING I} ADDRESS TRACT OWNER FIRE ZONE TYP APPROVED TEL. CITY NO. ZONE NO. OF PLANS USE OF NEW BUILDING YARDS APPROVED STATE CITY YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING THE AMOUNT SHOWN UNDER VALUATION IS FOR m SIZE NO. OF BLOGS. (FROM C/LSTREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. 5 FT. FT. Separate permits are required for L. SIDE FT. FT. FT. electric, plumbing and heating work. REAR FT. USE OF BI LDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLOGS. VAR. + DATE a C.U.P. 46 APPROVED APPROVED Es Y DATE I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Cade, Division 3, Chapter 9, and that such licenses are In full force and affect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9, Signature of Permittee Authorized Agent H m i m m SQ. FT. w THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEf 9NLY. " vs VALUATION PERMIT FEE $ M PLAN CHECK $ r� $ LL TAX $ U TOTAL PAID %af-'Arl, City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 000047 P. O. Box 1200 Costa Mesa. California The Building located at 3185 "C" Airway Avenue has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-2 Occupancy. Use of Building intL-x Ax' Alterations -- Wax'elmuse Legal Description 427-194--11 (See reverse side for Metes and Bounds) Building Permit No. R-6239 Electrical Permit No. E-6339 Plumbing Permit No. T)-6264 Mechanical Permit No. M-64 03 !Number of apartments `C—jam and/or guest rooms —B-" // ISSUED TO': 'r ` Building Official r 1 Dale ltaj al.a -.4—) --�--� by .�-fdlilF 318.;-C Avenue, Costa Mesa /_ r T Date ��-fWLt/1fi/ 1,193fj This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner: Canary - Numerical File; Pink • Bldg. Permit File CITY OF COSTA MESA , BUILDING DMSION DEVELOPMENT SERVICES DEPARTMENT P98-00570 r� PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 PLUMBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3185 AIRWAY AV Suite No C Vicinity: Parcel Nunmber: 42719411 Status: ISSUED Applied: 06/26/1998 Issued: 06/26/1996 Applicant: KARJALA, DALE C TR Address: 2007 TAHUNA TER D,.Phone:.. -.' --Zip- CORONA DEL fVIAR,CA� Zip: 92625 ti Owner: KARJALA�DALE,�C TF� Address 2007%TAHUNATER D Phone: ,/CORONA DEL MAR,CA� i Zip: 92625 Contra'6tor: Address </? 3 Phone. Zip: License:i I �r r �- I IIT/!�``% � �� \ T��^;r��:: zC •' _-_ _1 _`r yam.. �l ,_ `� 1 ArchIEng i ,�� `; 1 J;�ti`- 1. ��. , �� - 'r, t 1; ( Address: Phone: ACOPE OF PERMIT f ti 2 ,TOILETS & 2 WASH BASINS.\na �, : - -'r ► .. f f' �� , FEE SUMMARY - - AMT OTYMT OT`( �� 1f �ANiTI ISSUE FEE { x$22.00 { LaundryTub 1 Washer c50.00 _'�0 Sum Pum ��' ' P P i $0.00 Backflow irrigation r ` \$0:00 0 Landscape Irrigation $0.00 0 Swimming Pool - $0.00 Backflow'Preventer� , $0:00, 0 i P -Trap $0.00 0 Trap Primer $0.00 Bathtub ��, r $0.00' , 0 Pressure Regulator' r-;� $0.00 0 Urinal j / x$0.00 Clarifier System'v Connect (Ice,Soda,etc) Dental Units, Dishwasher ��, Drain, Floor \ Drain, Rainwater \ Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto) $0.00'1x'1 0 Process Piping (per,10t) � o �f$0�00,; 0 ' Vacuum"Brkr BkFlow(1-4) ""sib -00 00\\0„ ��0\: Receptors"(".71` . $l).00; ' 0 '�� Vacuum'Brkr Bk1ftow(5+); f -$0"00 `$17.50 $0.00 Septic Tank._, �:�.7 ,$0.00-/';-0 ` ' ` „-Wash"Basin ��I $0.40 0\`l� Sewer Captor -Demote !,r�,$0.00.'.; 0 -.Wash Basin Set $0.00 0 ^,u, i ' " -, i� - i $OHO >- ewer,Connect f, .� "5 �'_ h,•; �.. $0,00. 0 - Waste'and Vent System $0.00 $0.00 /0; ,5ewer.Privafe Line \ . - `�� 50.00 '-"• 0-,= ' Water -Closet (Toilet)/ $17.50 $0,00/' /0 �Shower � `�. „ _.$0:00, µ"_0 - Water t-leaterJ vent $0.00 $000 ` -. 0 /� Sink, bar - __ -^ - = ~$0.00' 0 Water Piping (Inst or Rep.) $0.00 $0.00''_ ` 0 � :Sink, commercial $0.00 0 �tiWater Re p' ipe' $0.00 $0.00 _ :: "0 ; f 1 Sink; Floor a ." $o.00.10. ., Water Service $0.00 $0.00 "'0 -. .. 'Sink, kitchen $0.00 -- 0 -� i Water Softener $0.00 $0.00 0'- .., Sink, service/mop' `\;, ," ..$0.00" 0 -' OTHER $0.00 $0.00 0 , Spa (private) • . $0.00 ,0' �' VIOLATION $0.00 $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 $0.00 0 _ REINSPECTION $0.00 $0.00 0 TOTAL CALCULATED FEES: $57.00. COMMENTS 1 SPECIAL CONDITIONS QTY 0 0 0 0 0 0 2 0 0 2 0 0 0 0 0 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 permll 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 tt4SPECTIONS CALL: (714) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the tabor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will malntWn workers' compensation insurance, as required by section 3700 of the Labor Code, for fhx3 performance of the work for which this permit is issued. My workers' compengation Insurance carrier and policy number are: Carrier: _ Policy Number. (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these pr4vlsions, Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU91ECr AN EMPLOYER TO CRIKNAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5106.050). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR W SECnON 37M OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTOPIS DECLARATION: 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. Lic. 4 Class M Contractor's Signature: _ Date: CONSTRUCTION LENDING AGENCY: ❑ l hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sen. 7031.5, Business and Professions Coda: Any city or county which requires a permlt to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation o1 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 sofa compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors Liconse Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale,). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a oontractor(s) license pursuant to the Contractors License Laws,). ❑ I am exempt under sec, Business and Professions Code for this reason: Signature: Date: Owner 10 verified by drivers flcanse. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type o1 document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION. ❑ 1 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, An 2, Sec. 341, Tale B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do sU o( from the division. Signature: + Date: Division of Industrial Safety permit Nu r. 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................`t'0"...........................................................................................I.................................................-........ 2 Does or wi[I the applicant or present or future building occupant need to fife a registretion form for acutely hazardous materials? ©Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Secflon 25534 of the Califomla Health and Safety Cade been fully complied with? ❑ Yes ❑ No ........................ ..................... ............................................................................. ............... ............ ..... .......................................................................................... 5 Does or will the appllCamt or present or future building occupant require for the work which is the subject of this application a�emrit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yos ❑ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ....................................................................................................................................................................................... 6 WIII any pert of the facility to be constructed under this permit be withln 1000 feet from the outer boundaries of a school? ❑ Yes , ❑ No (if 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..................... ....................................................................................................................... .................................................... I ............ .................. .................. ..--............... ,. 7 If a ppaerrrtit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...................................................................................................................................................................................................................:.................................................I.............. 8 (lf 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: t certify under penalty of perjury that I have read this application and state that the Information given Is correct I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described p9rearty, for inspection purposes, I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .Z G ko I ure Of Legal Owner(s) Date And/Or Authorized Applicant Date 0W_L I? SPE00N TYPCODE INSPECTION TYPE QAIE {MIIDBLS 1616 Fixed System Flhal Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Rnal Plumbingl i 200 Final Re -Root 210 Final Electrical 201 Final Block/Retalning Well 212 Final Fire Prevention 202 Final Factory Firs Place 220 Flnel Planning Approval 203 Final Sign 722 Final Site 204 Final Demolition 250 Final BuildinglOccupancy 2046.46 . CITY OF COSTA MESA _ BUILDING DMSION } DEVELOPMENT SERVICES DEPARTMENT M98-013277 _J�� "• PERMIT PERMIT NUMBER (714) 754-5273 Fax (714) 754-4856 MECHANICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3185 AIRWAY AV Status: ISSUED Suite No C Applied: 06126!1998 Issued: 06126!1998 Vicinity; Parcel Nunmber: 42719411 Applicant: KARJALA, DALE C TR Address: 2007 TAHUNA TER D _f—" ,Phone:-- _ .:,. CORONA DEL MAR ,CA' �. it Zip: 92625 Owner: KARJALA,DAL"E-C TR , Address: 2007 TAHUNATER\ (CORONA DEL MAR,CA _ Zip: 92625 Contractor :•i � � �� • � , Address! r� � �� Zip + ��`\ � � � � � •-, Licenset, A-rch I En Address, Zip: License: i \• ti SCOPE OF -PERMIT. PACKAGED HEATING•UNIT'& 2•VENTEIATION FANS'CONNECTEb TO A SINGLE DUCT. , - i FEE SUMMARY ��- 1� Quantity ISSUE'FEE, , $22.00 �:r_ - _ -- RepairlAltAbsorbtion�Unit $0.00 0 Inst FAU'<100 k BTU ; " ~' -- ` $13.25 'Repair �1 /'Alt Unit , , $O.OD - - 0 Inst FAU?100 k BTU ;5� $0.00 Ventillation System j.' : $0:00 0 • Repair/'Mt CoolinglHeat� , $0.00 0 Evaporalive,Cooler r�:' .'$0.00 i 0 Inst / Rep`Recess Will Htr``� $0.06 0 Commercial• Incinerator$0.00 0, Refrig Sys`<�DO k,BTU V ��; $13.25 1 Domestic Incinerator ��„ j $0.00 10 Refrig Sys k, BTU \ $0.00 0 Compressors ! Absomtion 5ystems \�� . , Gas PipingVA�\ � � �\ $0.00 0 _ C Up.to 3 hp 1 100 k BTU $0,001, : 0 Factory Fireplace , \ $D.00 0 ' ` tr 3,T6 15 hp 1500 k BTU $0.00' 0 Hood wimech EAaust $0.00 0 �o,. , �j , 15 To 30 hp 11,000 k BTU �� $0.00/ 0 VAV Box `1\ �$ , . , } .;, >> 1 c { 3. / $O.a4 0 $0 00�-_0 „ , S �, , 30 To -50 hp;1�1,750 k BTU:'ii Vent Fan l Single�Duct• �,�/� $0:00 0 3 " r �`n �� , Over 50 hp,l;Over_ 1,750 BTU �% ,� I$6.OD 0 Appliance �/, /,$9.50V1�Boilers Fire Dampers $0.00 4 �.�_ � � ` Up to 3 hp. //$0.00 0 Smoke Dampers ` $0.00 .3 To 15 hp,- ; , , - �� j $0.00 0 Inst or Relocate Appl Vent ,\ -$0.00 0 15 to 30 hp "-'� $0.00 0 Air Handlers < 10000cfm ` $0.00, 0� 30 to 50 hp t. r `� 1 $0.00 0 Air Handlers > 10000cfm , ,.,woo 01�, j � � T1� j — � �,. Over 50 hp:1 $0.00 D Floor Furnace $0-ODj 0 —Other Mechanical Fee Floor or Suspend Heater $0.00".- 0 i a� = Investigation Fee "%. % $0.00 - .•... Plan Check•Fee �' $0.00 +' "r-Reinspection,Fee $0.00 TOTAL CALCULATED FEES $58.00 COMMENTS 1 SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced wtthin 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) 7645626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to seff-Insure for workers' compensation, as provided for by section 3700 of the labor Code, for the performance work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This sactlon need not be completed If the permit Is valued at one hundred dollars ($100) or less.) ❑ 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 workers' compensation laws Of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE DOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEMON 3706 OF THE LABOR GODS, INTEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. Lic. II Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued. (Sec, 3D97, CM) Code), Lender's Name: Lenders Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of penury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any Violation o1 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than frvo hundred dollars ($SOD).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL 00 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.).: 'p\ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to th Contractors License Laws.). mpt Unde Business and Professions Code for this reason: 7vadfied ls li nse. ❑ Yes ❑ No ris License N . s: + Verification of Ownership by (type of oCUment, i.e. - property tax bill or deed DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 thtrty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Coda). ❑ 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: t Will the applicant or present or future building occupant need to fila and cartlly a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and ..............................pressure). .................................................................................................................................................................................................................................................... 2 Dees or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. ............................................................................................................................................................................................................................................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ......................................................................................................................... ............... ................................................................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a pllcadon a Lermit for such construction or modification from the South Coast Ali Quality Management District or from any other air pollution control district or agency? Yes [ ] No (Section 65850.2 of the California Government Code requires that the requested information be fumishod on applications for non-residentlal building permits). 8 Wi_lw__________________________________oo? _____❑_Y_e_s___________❑Jo______________________________________________ (if 'fres', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................................................................................................................................................................................ 7 If a crit from the South Coast Air Quality Management District or other air poliui on control district or agency is requlred for the work which is the subject of this application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 bean made? ❑Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: i certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application' and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspects ree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. lure O(Jeg s)ateV� And! 'thodzed Applicant Date ' 006E a. INSPECTION TYPCOD! INSPECTfONTYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 71311le 1268 Pool Spa Final 208 'Final Plumbing ' 200 Final Re-Roof 210 Final Electrical f 201 Final Biock/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 244648 CITY OF COSTA MESA _ BUILDiNG DMSION } DEVELOPMENT SERVICES DEPARTMENT �. F9R_f1f1RRR PERMIT PERMIT NUMBER (714) 754-5273 Fax (714) 7544856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,lob Address: 3185 AIRWAY AV Status: ISSUED Suite No C Applied: 06/26/1998 Vicinity: Issued: 06/26/1998 Parcel Nunmber: 42719411 Applicant: KARJALA, DALE C TR Address: 2007 TAHUNA TER D Phone: CORONA DEL MAR,CA Zip:=. 92625- . Owner: KARJAL ,,,DALE.0 TR Address 2007 T�A,HUNA 7ER`� - � 1 1 ,� i L D CORONA, DEL. r � ." ~Zip: 92625` Contractor; Address Phone �l X� Zip""- .License. uS RY; -FEE SUMMA Qantlty Quantity ISSUE_FEE , $22.00 \ ._ Temp Dist System,/.Lighting J $0.00 0 1 h Teri service e 1 p t st . $0.00 � � Buswa 1100 ft $0.00 0 Res: ale package `• `.', $0 -DO �rr� . 7 = $tandin Se4iion:---_ $0.00 0 - ti �r�-1 - 'F 9, .r New Res, (1-2 units) 1 ' $0.00 - 0 Misc Electricaf.Equipment'= $0.00 0 i 1 New Re`s (3+units). �,' $0.00 0` - -, - Transformers upto 1-kvalkw' $0.00 0 Pool/ Spa, l 1ti, 'i $0.00 0 ........... .up toil0 kvalkw $0.00 0'` Lighting Fixts `\� $27,15 31 ............f7upt50 kvalkw $0.00 Recept Qutlets (� �, $22.60 24 ...........` .::up to'.100 kvalkw $0.00 Switches �� ' $12.00 12 ..................over 100 kvalkw , $0.00 •0' ! v Non Res Apply • - $0.00 0 - Low�Voltage Equipment ' $0.00 i� 0 Res Appl \`� ` \ $OAO 0 �• Cow Volt Wiring System ! Ckt $0.00'' �' 0 Service to 200a�\ `$0:00 0 4)--gypp Misc: Conduitt $D.00f / 0; �} 1�. Service to 1o00a� $0:00 0 `?'Mise: Conductor $0.00 0' Service over 1000a $0.00 0 ' ?, ' `„ ` j L� J, .;'Circus (gen or ride)'. f , -,$0.00 ,. -\ 0 ` Motors to ihp �� i$0.00�� 0� ' �. f��" Circus;(mech'ride.or;lights). = %".$0.00/ '_D /•` r�` Motors to 10h ' �� ?� o Q ,� r� ` -' p %�S11.Op \i�. -:: s. Christmas Tree.Stan&'� $0.00 0 �, Motors to 50hp $0.00'-� �0 A - U �i: �� ?Fireworks Stand, -" - i $0`.00 , , 0 Motors to 1 00h $0.00 l \0 �'�� 1:� _, zOfher Electrical Fee"- -'$0,0 �% Motors over 100hp $0.00) .0__ Communication dro s $0.00 �:J 0C- iI p `. Investigation.Fee $0.00 , Sub panel to 200a $0:00V 10' �' r�-� lr " Plan Check Fee- •s'.� Pale Light Pkg $0:00 0 - Reinspection Fes 11 - $0.00 Sign Circuits $0.00 ` 0, . `,.� i Temp Pwr Pole $0.00 0 _ TOTAL CALCULATED FEES $94.75 Intermed Pole $0.00 0 COMMENTS 1 SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or it work is suspended or abandoned for, a period of 180 days. 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) 7545826 SCOPE OF PERMIT- ERMIT31 31LIGHTS 24:OUTLETS, 12 SWITCHES AND 1 A1C MOTOR. = r uS RY; -FEE SUMMA Qantlty Quantity ISSUE_FEE , $22.00 \ ._ Temp Dist System,/.Lighting J $0.00 0 1 h Teri service e 1 p t st . $0.00 � � Buswa 1100 ft $0.00 0 Res: ale package `• `.', $0 -DO �rr� . 7 = $tandin Se4iion:---_ $0.00 0 - ti �r�-1 - 'F 9, .r New Res, (1-2 units) 1 ' $0.00 - 0 Misc Electricaf.Equipment'= $0.00 0 i 1 New Re`s (3+units). �,' $0.00 0` - -, - Transformers upto 1-kvalkw' $0.00 0 Pool/ Spa, l 1ti, 'i $0.00 0 ........... .up toil0 kvalkw $0.00 0'` Lighting Fixts `\� $27,15 31 ............f7upt50 kvalkw $0.00 Recept Qutlets (� �, $22.60 24 ...........` .::up to'.100 kvalkw $0.00 Switches �� ' $12.00 12 ..................over 100 kvalkw , $0.00 •0' ! v Non Res Apply • - $0.00 0 - Low�Voltage Equipment ' $0.00 i� 0 Res Appl \`� ` \ $OAO 0 �• Cow Volt Wiring System ! Ckt $0.00'' �' 0 Service to 200a�\ `$0:00 0 4)--gypp Misc: Conduitt $D.00f / 0; �} 1�. Service to 1o00a� $0:00 0 `?'Mise: Conductor $0.00 0' Service over 1000a $0.00 0 ' ?, ' `„ ` j L� J, .;'Circus (gen or ride)'. f , -,$0.00 ,. -\ 0 ` Motors to ihp �� i$0.00�� 0� ' �. f��" Circus;(mech'ride.or;lights). = %".$0.00/ '_D /•` r�` Motors to 10h ' �� ?� o Q ,� r� ` -' p %�S11.Op \i�. -:: s. Christmas Tree.Stan&'� $0.00 0 �, Motors to 50hp $0.00'-� �0 A - U �i: �� ?Fireworks Stand, -" - i $0`.00 , , 0 Motors to 1 00h $0.00 l \0 �'�� 1:� _, zOfher Electrical Fee"- -'$0,0 �% Motors over 100hp $0.00) .0__ Communication dro s $0.00 �:J 0C- iI p `. Investigation.Fee $0.00 , Sub panel to 200a $0:00V 10' �' r�-� lr " Plan Check Fee- •s'.� Pale Light Pkg $0:00 0 - Reinspection Fes 11 - $0.00 Sign Circuits $0.00 ` 0, . `,.� i Temp Pwr Pole $0.00 0 _ TOTAL CALCULATED FEES $94.75 Intermed Pole $0.00 0 COMMENTS 1 SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or it work is suspended or abandoned for, a period of 180 days. 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) 7545826 R DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' Compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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 Ihsurance Carrier and policy number are: Carrier: Policy Number. (This section need not be Completed It the permit Is valued at one hundred dollars ($100) or less.) ❑ I Certify that In the performance of the work for which this permit is Issued, I shag not employ any person in any manner so as to beoome subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: _ Date: WARNING: FAILURE TO SECURE WORKERS• COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED n4OUSAND DOLLARE (stoo,OOOL W ADDITION TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF 171E LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # 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, Coil 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 Cr 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 W she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Cr 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 pehalty of not more then five hundred dollars ($500).): ❑ 1, 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 Cr through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of Completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors Ucehse Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such project with a comractor(s) license pursuant to the Contractors License Laws.). pt and Business and Professions Code for this reason: [5r : verifle by driver s cense. Yes ❑ No Driv tens o. pines: Verificatlon of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby Certify that no excavatlon five (5) Cr 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, talsowork, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Adm[hlstrative Code). ❑ As owner-bullder, 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: I Will the applicant or present or future building occupant need to fila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight o1 500 pounds, or a volume of 55 gallons, - or 200 cubic feet of compressed gas at standard temperature and pressure). ...........................................................................I........................................................................................................................................._......... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................................................................................................................................................................................................................................................................I........ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an AM PP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................................................................................................................................................................................................................... 4 It an RMPP is presently required, has Section 25534 o1 the California Health and Safety Code been fully Complied with? ❑ Yes ❑ No ...............................................................................................................................................................'u-b-I.....................'ll'c" ..................II.f'........................................................ 5 Does or wi11 the appllcamt or present or future building occupant require for the work which is the subject of this a p[lr�tion emil for such construction ar modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 5 Yes [No (Section 65850,2 of the California Government Code requires that the requested Information be tumtshed on applications for non-residential building permits). __ ........... _........................................................ ...................................... _................................................................................................... _.............................. ______................ 6 Will any part of the facility to be constructed under this permit be within 1000 foot from the outer boundaries of a school? ❑ Yes ❑ No (if yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................I ....... _.......................................... . _......I.................. _......... _. _. _. _. _. _._......................................................................................................................... 7 If a permit from the South Coast Alr Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 01M., ❑ No _..................................................................................................................................................................................... B (I} yes`, attach CertlfiCate of rbrTlplEance from the appropriate air pollution control officer). ` CERTIFICATE OF COMPLIANCE: I certlthat 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. r Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I Certify under penalty of perjury that I have read this application and state that the information given is Correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pro for' spection oses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. And/Or Au zed Applicant Date CQaE f. INSPECTION TYPE pew IKrMAI,$ CODE! INSPECTION TYPIbmm 4 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 226 Final Planning Approval 243 Final Sign 222 Final Site i 204 Final Demolition 250 Final Building/Occupancy 2446.46 I + CITY OF COSTA MESA _ BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT B98-00983 PERMIT NUMBER (714) 754-5273 - Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3185 AIRWAY AV Status: ISSUED Suite: C Applied: 06/08/1998 Vicinity: Issued: 06/2611998 Parcel Nunmber: 42719411 Zoning: Applicant: Address: Owner: Address Contractor: KARJALA, DALE C TR 2007 TAHUNA TER D Phone: 751-1831 CORONA DEL MAR,CA -"-Zip:- „92625, . _ KARJALA, DALE -C TR 2007 TAHHUNA TERi D�' t Phone: DEL- CORONA -DEAR CA y `Zip: -92625 �_--__ Phone: \�i/i Zip: `\ \ Address: �f � _ i i 9 �.1 '� \'4\ki ' 1 ,� �I•I �� l'Zlp:- �` i t t � t 1 4 w, SCOPE OF PERMIT INTERIOR ALTERATION TO RESTRUCTURE INTERIOR OFFICES FOR EXISTING ELECTRIAL' \ i 1 i "ENGINEERING FIRM + f 1E G V HANDICAP PARKING SPACEITO.BEUP.GRADED T9:SATISFY CURREN7� ' STANDARDS. NO PARKING WILL.BE,LOST '_fir -FEE :SUMMARIC� Ian Check: 463.16 Calc Valuation; $42,500 Calc :,; „t., � 1 Permits $511.75 Claimed Valuation: , $42;500.00 SMIP'Res- `$0.00 f SMIP Com: , �� x$8.93 Other:-' $o:ao It15}]eCt10n: '$0:00 f �/ Total: •$603.84��n. )SPLANNING t.ZONIIVGj SETBACKS MAIN STRUCTURE Front ., z0- 0 f Rear J 0- 0 .. Left _0-0a 1-\ Right 0-,O/r i ACCESSORY Front 0- 0� Rear 0- 61!_:j Left' 0- 0, Right/ i0- 0 PARKING Existing 0 Required: ='0 �''"'"^ `Proposed:, j NOTES: EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and wilt 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 Cade, for the performance of the work for which this perTnh is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number, (This section need not be completed it the permit Is valued at one hundred dollars ($100) or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person In any mannor so as to become subject to the workers' compensation taws of California, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the tabor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARN:NO: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR (ANAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL FIE ($100,00o), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION TMO OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectlon 7000) of Division 3 of the Buslness and Professlons Code, and my license is in full force and effect. UC. # Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: (3 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. {See. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contraclor(s) license pursuant o the Contractors Ucense Laws.). ❑ t arr exempt d sec. Business and Professions Code for this reaso . Signature: Date: Owner ID verified by drivers license. � Yes [I No Driver's License No. Expires: Verification of Ownership by (type of drSccrment, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation fire (5) or more teat in depth Into whim 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 (38) feet high. (Chap. 3.2, Grp 2, Aft 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such parson 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 Ne and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _...............................................................................................................................................................u-.6.......................................................................................................... 2 Does or will the applicant or present or future bulEding occupant need to fila a registration form for acutely hazardous materiats7 . ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic toot of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an AM PIP by businesses which are required to register acutely hazardous materials with the Fire Department. ...................................................................................................................................................................................................................................................................... 4 if an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes C3 No .............................................................................................................................................................................................................................................................................. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a�ermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes L] 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? ❑ Yes ❑ No (Ii yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), i ....................................if a milt from the South Coast Air Qualify Management District or other air pollution control district or agency Is requlred for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 bean made? _ ❑Yes ' ❑ No .............................................................................................................................................................................................................................................I..................... 8 {If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certif� 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 Emiss ons. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of podury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature LegalOwner(s) Date L - Or Authorized Applicant Date Cpgg-/, INSPECTION CODE INSPECTION TYPE DATE ItIIIDALS 1816 Fixed System Final Fire Prevention 206 Rnel Mechanical 1288 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 272 Final Site 204 Final Demolition 250 Flnal BulldinglOccupancy 2446.48 (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT .lob Address: 3185 AIRWAY AV Suite No C Vicinity: BLDG C (GLP KARJALAIKULONIS INC) Parcel Number: 42719411 ISSUED BY: Applicant: KARJALA, DALE Status: ISSUED Applied: 1 111 612 0 0 1 Issued: 03108!2002 Address: 3185AIRWAY C �' Phone: 714-751-1851 COSTA MESA, CA Zip: 92626 `\ Owner.-KARJALA, DALE CTR Address:, " 2007 TAH UNA TER Phone: CORONA DEL MAR, CA Zip: 92625 Contractor: 'OWNER -BUILDER Address: r ." - . u .. Phone: Zip: _ License: 0 SCOPE OF PERMIT REF: B01-01835. TENANT IMPROVEMENT TO CREATE ADDITIONAL OFFICE SPACE AND CONVERT ATTIC INTI FILE STORAGE AREA: APPROX 1283 SQ. FT. MECHANICAL TO INCLUDE INSTALLATION OF ONE PACKAGE UNIT FOR H_ EATING'AND'AIR"CONDITIONING, MISC ALTERATIONS TO EXISITING HVAC. ' -FEE. SUMMARY " Quantity 'Quantity ISSUE FEE $23.50 Repair I Alt Absorbilon Unit $0.00 0' Inst FAU <100 k BTU $14.80 1 Repair 1 Alt RefrigeraUon Unit $0.00 0 Inst FAU >100 k BTU 50.00 0 Ventillatian System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst 1 Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 ;"' Domestic Incinerator $0.00 •0 Refrig Sy's >100 k BTU $0.00 0 Compressors/ Absorption_ Systems,, ,-- Gas Piping, $0.00 0 Up to 3 hp 1 100k BTU $0.00 • '0' Factory Fireplace $0.000 .: ' 3 To 15 hp 1500 k -BTU =-" " - " $0.00 �0 Hood wlMech Exhaust $0.00 0 15 To 30 hp 1 1,000 k BTU. `� so -010/0 VAV Box $0.00 0 30 To 50 hp 1 1,750 k BTU.,- , ,'„�� ,$0.0' 0 Vent Fan 1 Single,Ducl $0.00 0 Over 50 hp / Over 1,750 BTU ," '-/'$0.00 0 Appliance $0.00 -0 Boilers" Fire Dampers $0.00 0 Up to 3 hp /'$0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $27.15 1 Inst or Relocate Appl Vent $0.00 %0 _ 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 = 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm `- "$0.00..' 0 -2 Over 50 hp". = �% $0.00 0 Floor Furnace $0.00 0-- �', , Other Mechanical Fee Floor or Suspend Heater 50.00~-.0 - , Investigation Fee- f . $0.00 _ Plan Check Fees $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $79.15 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) 7545626 2.4A -dA M"I v DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to sett-Insure for workers' compensation, as provided for by section 3700 of the Labor Coda, for the performance of the work for which this permit Is issued. ❑ I have and will rnkintatn workers' compensation insurance, as requlred by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' oompensation Insurance carrier and policy number aro: e Carrier, t . Policy Number: (This section need not be*completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 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 workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. 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 ($100,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNE-rS 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 1s in full force and effect. Lic. 4 Class p Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ❑ 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 w 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.). 121; I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt underk Business and Professions Code for this reason: Signature: e•� Owner ID verified by drivers licen e ❑ No Driver's License No. Expires: 1 • . i - O Verification of Ownership by (type of document, La. - 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 then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Coda 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ......................_._......._ ........................................................ ......._.......... _ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Sectlon 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. ........................................................................................................_................................................................................................................................................... ........................"I'll ............. 4 It.........an RMPP is presently required, has Section 25534 of the CaliforniaCalifomia Health and Safety Code been fully complied with? ❑ Yes ❑ No ....... ............... .................. .................................... ............................... _....................................... ....................................... ........................................................................................ ........................... ......................... .............................. .......... ..... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a pllcation armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ ,gPe, Yes 4.f No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applicatlons for non-residential building permits). ......... ............... ................. ................................ ............._.......................................................................- --........................................................................... ._. .........................:................._...._......................--.... 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries o1 a school? ❑ Yes ❑ No (If 'yes . the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _ t 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _..................-- ........ _....._.---------_..... ..................... ...........-.__._....... _.... _... --- 8 (If 'yes', attach certificato of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply ith all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described prope or inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspoctlon. Signatu " Of1eOwner(s) Date j I And/Or Authorized Applicant Data ' OU_L INSPECTION TYPE 2&M ISL$ CODE INSPEC719H_IYPE 2M ltmm 1616 Fixed System Final Fire Prevention 206 Final Mechanical -a -tea 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 Silo 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.c�.4 LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3185 AIRWAY AV Suite: C Vicinity: WAREHOUSE (G L P KARJALA/KULONIS INC) Status: ISSUED Applied: 11/16/2001 Issued: 03/08/2002 Parcel Number: 42719411 Zoning: Applicant: KARJALA, DALE ISSUED BY: Address: 3185 AIRWAY BUILDING C Phone: 714-751-1851 _ COSTA MESA, CA ` Zip: 92626 Owner: KARJALA, DALE C TR Address 2007/TAHUNA TER Phone: � � � � � � • CORONA DEL MAR; CA Zip: 92625 ` Contractor: Address: Phone:. u Zip: License: ,Argh. ,�� Eng: -Address: " Address -. Phone: _ Phone: Zip: License: License: SCOPE OF PERMIT TENANT IMPROVEMENT TO CREATE OFFICE SPACE. ATTIC AREA -TO BE CONVERTED TO FILE STORAGE - 428 SF ADDED.'APPROX 1283 SO, FT. T.I. NO NEW PLUMBING PROPOSED. 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 , 2448.48 (8100) FEE SUMMARY. �/, . Plan Check: $353.11 - Calc Valuation: $4o,000.00 - Permit: $543.25 Claim Valuation: $40,000.00 SMIP Res: $0.00 SMIP Com: $8.40 Other: $0.00 Inspection:. $0.00 Total: $904.76 PLANNING & ZONING ' SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right '0- V' ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0- 0 PARKING Existing: -0, Required: 0 Proposed: 0, - r NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 , 2448.48 (8100) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following dedarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be Completed It the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: 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 DOLiARE ($100,000), IN ADDITION TO THE COST OF OC*APENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and affect. Llc. a Glass # Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the worts for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (s500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors license Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a oontractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt d r sec. Business and Professions Code for this reason: Signature: Date: 3 • Ji'• Q 'Z— _ Owner ID verified by driver is . ❑ Yes ❑ No Drivneq I lannsn Nn. Expires: _L •t •C 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 loot 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Data: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: i 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa,Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Daes or will the appiicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costs 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 galkms, or 200 cubic loot of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program lot acutely, hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ._............ — —.—_. __............................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aQpermIt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll Yes L] No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................._..._........_............................ .... ....... ....---—.......................--............ --......................................................................... .--.............. _.. 8 Will any part of the facility to be cortstructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes". the facility must meet the requirement of Sections 2SS34 and 42303 of the California Health and Safety Code). I _ _............. _. _..___............................................._.. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes•, attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all stale laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pr rty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ig atur LegalOwner(s) Date And/Or Authorized Applicant Date CODE _!• INSPECTION TYPE ATE INMA46 CODE I INSPECTION TYPE p,� pflMA 1616 Fixed System Final Fire Provention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Ratalning Watl 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 z (714) 754-5273 " Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3185 AIRWAY AV Status: ISSUED Suite No C Applied: 11/16/2001 Vicinity: BLDG C (GLP KARJALAIKULONIS INC) Issued: 03/08/2002 Parcel Nunmber. 42719411 Applicant: KARJALA, DALE ISSUED BY: Address: 3185 AIRWAY ri = C j'' / Phone: 714-751-1851 J` COSTA MESA; CA"-,. Zip: 92626 `. • _ Owner:/ KARJALA, DALE CTR _ �, �, '�,�•�. Address' ; 2007 TAHUNA TER Phone: �' �� ,•;` CORONA DEL MAR, CA Zip: 92625 Contractor: OWNER -BUILDER Address: , i", � ! r� �.' ,' �=✓Phone: � _ , " Zip: - License: 0 SCOPE OF PERMIT i . REF: B01-01835: TENANT IMPROVEMENT.TO CREATE ADDITIONAL OFFICE SPACE AND CONVERT ATTIC INTO FILE STORAGE AREA.`APPROX 1283 SQ. FT. ELECTRICAL TO INCLUDE: 30 LIGHT FIXTURES, 20 OUTLETS, 14 SWITCHES, 1 MOTOR FOR PACKAGE A1C UNIT. "GLP KARJALA ASSOCIATES, INC." 1 FEE SUMMARY.'` Quantity Quantity - ISSUE FEE $23.50 Temp Dist Syst6m•1 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 0, New Res (1-2 units) " $0.00 0 Misc Electrical Equipment $0.00 , 0 New Res (3+units) '1$0.00 0 Transformers up to 1 kvalkw $0.0011' '0 Pool/ Spa, '.$0.00 0 .............up to 10 kvaAw. $0.00 ' ` 0 Lighting Fixts $29.30 30' ..............up to 50 kvalkw '$0.00� 0 Recept Outlets $22.00 20 .................up to 100 kvalkw $0.00 \0 Switches $15,40 14 ..................over 100 kvalkw $0.00 "0 Non Res Appl $0.00 0 Low Voltage Equipment . $0.00 0 / Res Appl $0.00 0 Low Volt Wiring System 1 Ckt $0.00, 0 ' Service to 200a $0.00 - 0 Misc. Conduit $0.00- 0 ' Service to 1000a ` $0.00, 0 _ Misc. Conductor .. $0.00. ; C Service over 1000a $0.00 0 Circus (gen or ride) $0.00-, �0 Motors to 1hp $0.OD. "� -_ 0 :. Circus,(mech ride or lights) $0.00/ 0 Motors to 10hp $12.30._ 1 'Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0-, 'Fireworks Stand - $0.00 0 Motors to 100hp $0.00 -0_ Other Electrical Fee' . $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 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 $102.50 Intermed Pole $0.00 0 COMMENTS 1 SPECIAL CONDITIONS' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (6=) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the foilowing declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. • ❑ 1 have and will main n workers' Compensation insurance, as required by section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. My workers' compa�ation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($ 100) or less.) ❑ 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. 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 ($1 00,OWI IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION- 1 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. Lic, # Class p Contractor's 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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 a1 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. It, 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.). 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ i am exempt undtsre.. Business and Professions Code for this reason: Signature: Owner ID verified by driver's license. ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 thlrty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division o1 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 Pian for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of SOD pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ ............_.............._........._.._.._...................................... � ..........._..o file — ........................... ...._..---- ---.._......................... _�. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? E) Yes ❑ No (Section 25533 of the California Health and Safety Coda, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one lime has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume Of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _...................--.--.._..................-----..._...._.......... ---—._....._.._.......................... .........._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 255534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is prrlsently required, has Section 25534 of the CalifOmia Health and Safety Code been fully compiled with? ❑ Yes ❑ No .............................. _ _. ........................... _ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication afermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency'? Yes L,1 No (Section 65650.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meal the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _.................................--..................................................__.............................. -.................... __......... -- .... ..........•--•--.._...--- 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (If yes ,attach oerfificate of Compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pr f inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. G. �.:0 7- Signature 01 Leg.111 Owner(s) Date r And/Or Authorized Applicant Date f;_4AF !, INSPECTION TYPE QlSII; RMAL gQVE INSPECTION TYPE QAiE INiITA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ccaUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 3185 AIRWAY AV Status: ISSUED Suite: C Applied: 12/1312001 Vicinity: Issued: 1211312001 Parcel Number: 42719411 Zoning: Applicant: PATOCKA, NICOLE -- ISSUED BY: Address: 1653 SUPERIOR AV - — ✓�,,�'� -: -.-._ �� Phone: 949-642-7222 - -. COSTA MESA; CA � � '.i. Zip: 92627 Owner: KARJALA; DALE C `\ Address ,2007,TAHUNATER , - -. - - _ Phone: - = �_ .' � � �. �� ` � � � . _ • � CORONA DEL MAR; CA'Zip: 92625 Contractor. `LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE Phone:'—(949) 642-7222 COSTA,MESA, CA Zip: 92627) License: - 349686 — �`•,� .. Arch.: Eng: - Address: y — �� '� Address; ` l /Phone: ". \ Phone: Zip: ' License: License: SCOPE OF PERMIT; , � , ' ice'• ' r, -,', i. !''� , . � TEAR OFF CAP SHEET, INSTALL (1) 28# BASE SHET`(2) 11# PLY AND CAP SHEET. BUILT,UP ROOF SYSTEM: FEE SUMMARY , Plan Check: $0.00 ' - , ;-� �� --Calc Valuation: Permit: $251.25 Claim Valuation: SMIP Res: $0.00 `_SMIP Com: $3.10 Other: $0.00 Inspection: $0.00 $14,760.00 $14',760.00 -Total: ,,$254.35 PLANNING & ZONING, SETBACKS• �, _ �, C MAIN STRUCTURE Front, ,' 0- 0 - �, -Rear- _ •=0- 0 , Leff 0-0 -Right \'-0- 0 ACCESSORY Front 0_0 ." Rear.. _ 0- 0 Leff 0-0 Right 0- O. ' •: PARKING Existing:., -0. _ _ Required: ', 0 Proposed: 0 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) 7545626 2446.46 (6M) r) DMARATiom WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I ve and will maintain a cartificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the rk for which this permit is Issued. have and will maintain w rs' compensation Insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this permit is issued. My workers corn n alien l sura a mer and policy number are: ardor: _ Policy Number: (This section need not be compi a permit is valued at one hundred dollars ($1 ) or less.) ❑ 1 certify that in the performan o 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 Califom , nd agree that If I should become subject to the workers' compensation provisions of Sectio 3700 of a Labor Code, I shall forthwith comply with these provi ' ns. ApplicantSignature: - Data: WARNING: FAILURE TO SEC RE WORKERS' COMPENSATICOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 4NALTIES AD CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COS16COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that t am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3 o1 the Business and Professions Code, and my license is In full force and effect. Uc, a Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL 00 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an Owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason; Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ i hereby certify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division Of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and carllfy a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...................._....................__......._..._._ _........................... .._........_....._..... .._................................................... ..................................... I ......._............. .. _ _................ 2 Does or wily the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire bepanment Of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _....................................................._._............................................................._........................_..................................................... ................................. —_.............._— 4 We' RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................. ........._......................... ........... ..................................... __._....... ---..... ...._—.................__._................................................................................_..........—..._........--- - 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification-- from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes L -f No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It a permit from the South Coast Air Quality. Management District or other air pollution control district or agency is required for the work which is the subject Of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? []Yes ❑ NO .............................__...__................._..................._................................................................._.....----.....---....----...----••-----...............---............... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I comity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous (Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty Of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, �1bigLiature Of Legal Owners) — r D�Dale / ,And/Or Authorized Applicant ��^ • Date CODE It INSPECTION TYPE ftTrMjS CODE,0 INSPECTION TYPE INTMA(� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 'Z3-aZ- 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 Applicant to fill in all spaces within heavy border lines and sign all appropriate Ceclaratiaua. CITY OF COSTA'MESA PERM T NO. TRACT -NO. LOT NO. lam. NO. i CONSTRUCTION PERMIT' • 1 5072 C Project Address ] TYPE OF CONSTRUgTLON Owner C/ Phone , ❑NEW ❑ ADD ALTERATION Address Q% Ztl,/3. - - LJ REPAIR _❑ CONVER$ION ❑DEMOLISH Archl@ng. zz&r License No. ❑ OTHER 'Address - I 76V - 'C!'i C.l DESCRIPTION OF WORK (L/ . O; s j tGG Contractor - Z7Phone TYPE OF.PERMIT Address ��. ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL LICENSED coNlrRACTORDECLARATION ❑ TENANT ❑ELECTRICAL ❑PLUMBING ❑MECHAN I hereby affirm that I am licensed under provisions of Charter 9 (com- 3 ❑ mencing with section 7000) of Division of the Business and PfWesslons Code,; and my license is In full force and effect. OTHER. PROJECT DESCRIPTION LlCense Class License No. D Date Signature SQ. FT. 'CONSTRUCTION TYPE. WORKERS' COMPENSATION -DECLARATION OCCUPANCY I hereby affirm that I have a certificate of consent to self -Insure ora VALUATION ZONE certificate of Workers' Compensation Insurance, or a certified' Copy . 'hereof (Section 3800, Lab. C.). I'c No Com an GRADING CU. YDS. ACRES - ,- 4006 2/03/t33 ZONING REGULATIONS A.P.- ZONE PLNTTG.. gRUUEF,,bbh SETBACK C ST. PROPEIRTYNNNE ■ ' • �i;iJ�fiil�l� REAR YARD (TO P/L) - - %•/ - . PKG. SPACE REQ. - PROVIDED STREET WIDTH PARK'FEE S - ZONING APPROVED B U� DATE2,3-A3 SPECIAL CONDITIONS: AJ*JM%W X P Y Certified copy Is hereby furnished. ._... 7. REMARKS: . Certified copy is filed with the city Building Division. fJ . O; s j tGG EXEMPTION FROM'WORKERS' COMPENSATION DECLARATION L vJ Csr� (This section need ,not be completed It the permit is for one hundred _ S $,I 00)f or less). Certify that n the performance of the work for which this permit is issued, I shall not4employ any person In any manner'so.as to become -PLUMBING, .. - - PLAN CHECK - ELECTRICAL - - PLAN CHECK - - subject to the Workers' Compensation Laws of.Callfornia. - Date SignatureFT_so-rZI BATHTUBS SHOWERS - -- - - - NOTICE: If after making this declaration, you should become subject • TOILETS URINALS - - -GENERATOR 0-1 KW 1-10 KW - - to the Workers' Compensation provisions of the Labor Code, you must TRANSFORMER - forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS - APPLIANCE - 10-50 KW_50 + KW - revoked. CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS -- MOTORS 01 HP -----;I-10 HP -•- f hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS — r ((NC. SOLAR) 10-50 HP 50,t HP formance of the work for which this permit is issued (Section 3097 -Civ, C.). - 'FLOOR SINKS FLOOR DRAINS' `' FIXTURES" ;'-OUTLETS •SWITCHES. ^: Lender's Name' , - Lender's Address ORINkING F=OUNTAINS GAS TUBE SIGNS• »- - _ _ OWNER BUILDER DECLARATION- ' INTERCEPTORS "" " CLARIFIERS POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for the following reason -(Section 7031,5. Business and professions Code: Any city or county which',requires a permit to construct, .alter, SWIMMING POOL: P TRAP - , .-' POLES METERED SUB - - improve, demolish or repair -any structure, prior to its'issuance, also re- WATER SERVICE--- -ALTERATION - • - PANELS - •- MAIN -- SUB - - - Quires the applicant for such permit to file a signed statement Yhat he IS licensed pursuant to the provisions of the Contractor's -License Law- -GAS SERVICE OUTLETS SERVICE AMP _ Chapter 9 (commencing with Section 7000) of Division 3 of the Vsiness and Professions Code) or that -he is exempt therefrom and the WATER HEATERS BTU OUTPUT sis for the alleged exemption. Any violation of Section 7031.5 by 1 y applicant for a- permit subjects the applicant to -a Civil penalty SEWER CONNECTIONS not more than five hundred dollars ($500). ❑ I, as owner of the property,•or'my employees with wages'as their SOLAR TANK COLLECTORS - - sole compensation, will do the work, and the structure is not Intended or offered for sale. (Section 7044, Business and Profession$ Code: The SOLAR PIPING SYS. -' ISSUE FEE- C4ntractor's License Law does not apply to an owner of a property who bulids or improves thereon, and who does such work himself or ISSUE FEE APPLICATIQN APPROVED HY DATE r through his own employees, provided that such improvements are not intended or offered for sale. If, -however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES is sold within one year of Completion, the owner will have the burden proving he did not build' or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU •' {Gl BUILDING .S �} cs2�5' �`� I, as. owner of _the property, am exclusively contracting with AND DUCTING PERMIT $ S MIP , $[til �Of i'Zensed contractors to construct the project (Section 7044, Business 100,000 + BTLI PLAN CHECK $ PERMIT Professions Code_ The Contractor's LiCense Law tloes noL apply to ISSUANCEowner of property who builds or Improves thereon, and who con- REFRIGERATION 0.10 0,060 BTU PLUMBING $ tracts from -such projects with -a contractor(s) licesned pursuant to SYSTEM — ' GRADING $ the Contractor's License Law). 100,000 +BTU PLAN CHECK- ,S ❑ 1am exempt under Section -B. & A. C. for this BOILERS BTU - ELECTRICAL ' $ $ reason77 PLAN CHECK $ _ _ 'MICROFILM $ , ' Z Date �� Owner SYSTEM REPAIR, ALTERFITION TOTAL+FEE $ I hereby certify that I have read this applJca0on d state that the above EXHAUST SYSTEM MULTIPLE MECi tANICAL $ LESS AD - Information is correct. I agree' to comply with all city and county - PLAN CHECK $ - VANCE PC $ - - Ordinances and tate laws relating to construction, and hereby authorize _ _ representative of this Cit to enter upon the above mentioned for - - j property s do r,$oses, �•�� Signature �. - ,� - i .1 _ -- - _ �y, ,• •; FINAL FEE $2L 7 drivers' License or SS ISSUE FEE CMF 0865.46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # "" Date Inspector " 1. Temporary Electrical Service or Pole 43. Pool & Equipment Locatioh' 2. SoilPipe-Undrgrn 44. Steel Reinforcement ~ 3. Electrical Conduit Utility-Undrgrn+-=•, ' - _... �.. 45. Forms - - - 4: Electrical Conduit-Undrgrn 46: Electrical- Bonding i - bteel Heintorce 47. Rough Plumbin & Pressure Test 6. Electrical UFER Grn 48. APPROVALTO COVER GUNITE �, - '• 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. B ckwash Lines P -Trap.❑ Undr rn 10. Structural Floor System , 52.-" AP-PROVAL TO DECK III. Property Sewer Lind&'House Connection - 53. •Backwash & Receptor -Final 12•`. gkeVt Sewer Connection- = 54. Heater &Vent -Final 13. ' Rough Plumbing - - ' ` 55, Plumbi6a System - Final 14! ' Rough Electric -Conduit ,/. " - ,r,�," -56: Electrical -Final 15. Rough Electric -Wiring _ - 57. Solar System -Final 16. Rough Heating & Air'Conditioning b8. Fencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING, -18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test --Roof Framing - 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing Frame and Flashing �' �,.'7. NOTES: 23. Insulation - 24. Lathing & Siding 3- 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric - 29. Final Heating & Air Conditioning - 30. Final Gas Pipe -Test 31. Final Plumbing - 32. - Water Service -Final 33, Gas Service -Final 34. Solar Domestic -Final 35. Landscape S rinklin -S stem- 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING'' 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. - CERTIFICATE OF OCCUPANCY No _ 06041-7 Date to Applicant's Mailing Address Project Address Owner's Name ��r°GK} PrP hone Address Z95p �irula y �U ten A . COSAn Mixe Arch/Eng, License No. Address' 74I Contractor's Name q� s 110-' -- -- phone Address Imailing) 1&Z".5- • P& -,g - S 12 ze ! . , C14 geo2-_ 1 License No. _ p/ - 394''0 T _ LICENSED CONTRACTOR DECLARATION O 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 1 my license Is In full force and (fact. 3917 License I ss cense No.17o Date Signature RK RS' C MPENSATION DECLARATION ebyaffirm that I have a certificate of consent to self -Insure or a certificate nforkers' Compensation Insurances or a certl d c �r thereo Section 3800, Lab. C. C��1�i3ELG 140 Policy No.7LW€r=Wrt M Company ? Certified copy is hereby furnished. , LJ Certl co is filed with the city Buildl g Division Date APptica_nt W/7 +Al Division/ ,C /Ne . EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION (Thls section need not be completed if the permit is for one hundred ($190) or less). I certify that In the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date _ signature NOTICE: If. after making this declaration, you should become subject to the - Workers' Compensation provisions of the Labor Code, you. must forthwith comply with; such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a'construction lending agency for the performance of the work for which this permit is .Issued (Section 3097 Civ. C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am -exempt from the Contractor's License Law for the' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter improve, demolish Or repair , any structure, prior to Its issuance, also requires the'appllcant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of * v; f'ontractor's'License Law (Chapter g (commencing with Section 7000) of 'r. I"on 3 of the Business and Professions Code) or that he//she is exempt rom•and the basis for the alleged exemption. Any violation•of Section b. 5 by any applicant for a permit subjects the applicant to a civil •� amity 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 sate (Sec{ion 7044, Business and Professional Code: The; Contractor's ' License Law does not apply to an owner of a property who bunds or Improves thereon, and .who does Such work himself/herself or through his or her own '~ ample OaS, provided chit 54Ch Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold w[thln one year of Com- platten, the owner will have the burden of proving he/she did not build or im- TVrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License taw)., ❑ •1 am exempt under sectlon B. a• P. C. for this reason Date Owner I• herebyy certify that I have read this- application and state that the above lnformatlon is correct. I agree to comply with all city and county ordinances and state laws relating to bu Ing construction,'and hereby authorize repre= sentatives of t tcity to er pon the above-mentioned r art for Inspecticn pu se 7-15 Signature Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LXJ ALTERATION LJ REPAIR 1:1 CONVERSION ❑ DEM-O3,ISH ❑ THER DESCRIPTION OF WORK +zit �m�rQ►71117�I3 W�LLi LZQ }7L TYPE OF PERMIT LJ GRADING LJ FOUNDATION JC•STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑,OTHER PROJECT DESCRIPTION SQ. F OCCUPANCY CONSTRUCTION TYPE- VALUATION $ &I�A ZONF_ GRADING CU. YDS. AGR Remarks: jai- `-S . -z , ( _ _ tai- -i / 5? �r , A S Sink Preventer bs Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap: Roof Drains Showers Boiler '. ' Duct - Under Ground Duct - Structural ; Duct.- Ventilating - Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBG + Heating System & Ducting ❑ 0.100,000 BTU 13100,000 BTL Hood or Type I 0 */Registers /\ Drkvers' License or SS � ti CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service 759[] 4/P.1 /8:1 A. P. #-:!M7—Z7T — A -D Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations, _ "CITYbF COGTA MESA CONS'UCTION PERMIT BUILDING PE MIT NO ry REA YARD (TO P/ TRACT NO, 13p7� LOT NO. BLDG. NO. Applicant's Mailing Address Project Address Owner's Name ��r°GK} PrP hone Address Z95p �irula y �U ten A . COSAn Mixe Arch/Eng, License No. Address' 74I Contractor's Name q� s 110-' -- -- phone Address Imailing) 1&Z".5- • P& -,g - S 12 ze ! . , C14 geo2-_ 1 License No. _ p/ - 394''0 T _ LICENSED CONTRACTOR DECLARATION O 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 1 my license Is In full force and (fact. 3917 License I ss cense No.17o Date Signature RK RS' C MPENSATION DECLARATION ebyaffirm that I have a certificate of consent to self -Insure or a certificate nforkers' Compensation Insurances or a certl d c �r thereo Section 3800, Lab. C. C��1�i3ELG 140 Policy No.7LW€r=Wrt M Company ? Certified copy is hereby furnished. , LJ Certl co is filed with the city Buildl g Division Date APptica_nt W/7 +Al Division/ ,C /Ne . EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION (Thls section need not be completed if the permit is for one hundred ($190) or less). I certify that In the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date _ signature NOTICE: If. after making this declaration, you should become subject to the - Workers' Compensation provisions of the Labor Code, you. must forthwith comply with; such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a'construction lending agency for the performance of the work for which this permit is .Issued (Section 3097 Civ. C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am -exempt from the Contractor's License Law for the' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, atter improve, demolish Or repair , any structure, prior to Its issuance, also requires the'appllcant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of * v; f'ontractor's'License Law (Chapter g (commencing with Section 7000) of 'r. I"on 3 of the Business and Professions Code) or that he//she is exempt rom•and the basis for the alleged exemption. Any violation•of Section b. 5 by any applicant for a permit subjects the applicant to a civil •� amity 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 sate (Sec{ion 7044, Business and Professional Code: The; Contractor's ' License Law does not apply to an owner of a property who bunds or Improves thereon, and .who does Such work himself/herself or through his or her own '~ ample OaS, provided chit 54Ch Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold w[thln one year of Com- platten, the owner will have the burden of proving he/she did not build or im- TVrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License taw)., ❑ •1 am exempt under sectlon B. a• P. C. for this reason Date Owner I• herebyy certify that I have read this- application and state that the above lnformatlon is correct. I agree to comply with all city and county ordinances and state laws relating to bu Ing construction,'and hereby authorize repre= sentatives of t tcity to er pon the above-mentioned r art for Inspecticn pu se 7-15 Signature Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LXJ ALTERATION LJ REPAIR 1:1 CONVERSION ❑ DEM-O3,ISH ❑ THER DESCRIPTION OF WORK +zit �m�rQ►71117�I3 W�LLi LZQ }7L TYPE OF PERMIT LJ GRADING LJ FOUNDATION JC•STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑,OTHER PROJECT DESCRIPTION SQ. F OCCUPANCY CONSTRUCTION TYPE- VALUATION $ &I�A ZONF_ GRADING CU. YDS. AGR Remarks: jai- `-S . -z , ( _ _ tai- -i / 5? �r , A S Sink Preventer bs Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap: Roof Drains Showers Boiler '. ' Duct - Under Ground Duct - Structural ; Duct.- Ventilating - Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBG + Heating System & Ducting ❑ 0.100,000 BTU 13100,000 BTL Hood or Type I 0 */Registers /\ Drkvers' License or SS � ti CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service 759[] 4/P.1 /8:1 A. P. #-:!M7—Z7T — A -D ZONE / /J" PLNG. REF, 41 BUILDING TO BUILDING PROPERTYi REA YARD (TO P/ LEFT SIDE YARD GHT SID AR PKG. SPACE REQ. P V)D STREET WIDTH PARK FEE $ SPECIAL CONDITIONS! �L%FL+ C7� /��%/♦ Fixtures Range t Automatic Washer Meter LJover 100 amps - Construction Pole Sub Panel Cooking Unit Sub Pole Dishwasher Motors ❑0-1 HP 01'rG-8 Dryers ❑Gas ❑Electric Inc.Soiar 09-15 HP ❑16-15+ Fan Microwave F.A.U. Pole Light Fixtures Range t Device Boxes Sign Outlets ' Standing Sections awrrcnes Trash Corppactar Garbage Disposal `� y Gen&rator 00.5 KW - 115.15 KW " , Transformer ©15.50 KW r, "1350'+ KW Reinspection Fee $15 Reinspection Fee $15 Meter ❑up to 100amps `f Issue Fee. $ 3- Issue Fee issue $ 3 Zoning Approved By 3 •' Date fANICAL Application Approved 8y r ,l �i• to Refrigeration System Application Wvad'By71 ` T ate ❑0.100,000BTU 0100,0008TU r +, SUM ARY. FEES System Repair/Alteration 1 BUILDING PERMIT $ �' 0 SMIP;i, t' ; $ _ PLAN CHECK $ , ,PERMIT ' s PLUMBING $ • ISSUANCE' 'V M ' $ PLAN CHECK $ GRADING, $ - , v'g'ELECTRICAL $ `. MICROFILM $ $ PLAN CHECK $ MECHANICAL $ " JOTA'L FEE $ I Reinspection Fee •$15' - ',PLAN CHECK $ 5 •LESS, ADVANCED PC r $ I Issue Fee r $ 3 f' 1 i '' $ L] FINAL.FEE. ? C%CONSTRUCTION,AND=PLANNING e _! _ : - POOP 'PA t C.;Date s :;APPROVALS n, Permit,# - Y Inspector _ t - APPROVALS; Per,�ut # Date Inspector „+ +� r + r ^Temporary 1=iectrical Service or�Pole 52.' Pool &Equipment Location _ _ , 'S6iI Pipe- Undrgrnd, j-+ ? , =,- _ 53: Steel Reinforcement i^ �1 - 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4: Electrical Conduit Undrgrnd: `" ; x 55�� Electricai•Bonding i 5' Steel Reinforcement r. `; ; _ r• ,� ° - 56.r Rough Plumbing &Pressure Test ; I ; 6' UFER Grnd., : Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT nt s Mailing Address '1111011kAddreesss lhvner's Namehone 57 Address Y - Arch/Eng.. License No. Address Contractor's Name Phone Address (matting) License No. __ 1 LICENSED CONTRACTOR DECLARATION I'hereby.affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. Date Signature ?RKERS' COMPENSATION DECLARATION treby affirm that I have a certificate of consent to self -Insure or a certificate ;r ; � Workers' compensation Insurance,- or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. I Certified copy is filed with the city Building Division. Date Applicant ' EXEMPTION,FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for. one hundred ($100) or less).. I 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 subjecttotale Workers' Compensatlon,Laws of California., Date Signature ' NOTICE: If, after making this declaration, you-shoufd become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this .permit :shall be deemed, revoked. CONSTRUCTION -LENDING AGENCY I hereby affirm that there is a,construction lending agency for the performance of the work for. which this permit 'Is Issued (Section 3097- Civ. C.), Lender's Name. Lender's Address OWNER'BUILDER DECLARATION I hereby affirm that I am'exerrpt'from the, Contractor's License Law for the following reason (Section 7031:5 Business and Professional Code: Any city or ' county which requires a permit to construct, alter improve, demolish onrepair any structure, prior to Its.issuance, also requires tyle applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of - Contractor's License Law (Chapter 9 (commencing with Section 7000) of {5 `= Ion and the -basis for the alleged exemptionon 13 of the Business and. Professions Code),; Any viotation•or, that he/she,of Section Is exempt .41 y31.5 by any applicant for a permit subjects the ,applicant to a civil malty of not more than five hundred dollars ($500). 1, as owner of the ,property or my employees with wages as their sole ompensation will. do the work, and the structure I5 not intended or offered for sale .(Sec{ion 7044, Business and Professional Code: The Contractor's 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 employees, provided that such, Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Im- rova for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the,proJect(Section 7044, Business and.Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason - Date Owner I hereby Certify that 1 -have read this application and state that the above Informatlon Is correct. t agree to comply with all city and county ordinances and -state laws r ting to building construction, and hereby authorize repre- sentatives of tcity to e r upon th above-mentioned raperty f Inspection Burp s , Signature Date Drivers' LlCense or.SS :P TYPE OF CONSTRUCTION Li NE LiADD ALTERATIONLJ REPAI R ❑ CONVERSION ❑ OEM L�ISHOTMER �� DESCRIPTION OF WORK TYPE OF PERMIT EJ GRADING In FOUNDATION- STRUCTURAL A. P. 06 ❑ ENANT ❑ ELECTRICAL El PLUMBING ElH MECANICAL PLNG. REF. Sjk OTHER TO BUILDING ERTY E PROJECT DESCRIPTION Std. FT. OCCUPANCY �+� LEFT SIDE YARD CONSTRUCTION TYPE VALUATION $ 01477 ZONE GRADING CU. YDS. ACRES PKG. SPACE REQ. Remarks: ' STREET WIDTH SPECIAL CONDITIONS. PLUMBING Bar. Sink Sewer Cap , Backflow Preventer Sewer Connection' Backflow Irrigation Solar Collectors Bathtubs Solar Piping Clarifiers Soiar Tank Dishwasher Swimming Pool w/Spa i Drinking Fountains Urinal Floor Drains 1 Water Closet. Floor Sinks '- - Water Heater Gas Service. ; Outlets Water Service . Interceptors Exhaust System ❑ Multiple ❑' Kitchen Sink _ Lavafories.• - P—Trap Firepl/Fact. Bit. ICBG Roof Drains ? Showers Reinspection Fee : $15 Service ,Sink , m Issue Fee $ 3 MECHANICAL CMF OB65-46 rev. 12/82 White -Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor 7287 4/15183 Ila, ZONE BUILDING, REAR YARD ITO P/L) RIGHT SIDE YARD PROVIDED r - PARK FEE $ Automatic Washer Boiier , Refrigeration System 00-100,000 BTU ❑ 100,000 BTU 1 Cooking Unit Duct - Under Ground Duct - Structural System Repeir/Alteration Dishwasher Motors ❑0-1 HP ❑1'h-8 I Duct %Ventilating )nc.Soler 09-15 HP 1116 -15+ - Fan I Microwave F.A.U. Exhaust System ❑ Multiple ❑' l Range Device Boxes Firepl/Fact. Bit. ICBG Outlets Standing Sections i Switches Heating -System & Ducting ❑0.100,000,BTU 0100,000B Garbage Disposal Generator 00=5 KW El 5-15 KIN - Transformer 1315-50 KW i I Hood or TypeI ❑ Cane Type I I ❑ 050 + KIN Reinspection Fee $15 Issue Fee, $ 3 Registers Date issue Fee $ 3 CMF OB65-46 rev. 12/82 White -Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor 7287 4/15183 Ila, ZONE BUILDING, REAR YARD ITO P/L) RIGHT SIDE YARD PROVIDED r - PARK FEE $ Automatic Washer -Meter LJover 100amps Construction Pole , Sub Panel -' Cooking Unit Sub Pole Dishwasher Motors ❑0-1 HP ❑1'h-8 I Dryers ❑Gas ❑Electric ' )nc.Soler 09-15 HP 1116 -15+ - Fan I Microwave F.A.U. Pole Light +�f Fixtures Range Device Boxes Sign Outlets Standing Sections i Switches Trash Compactor { Garbage Disposal Generator 00=5 KW El 5-15 KIN Transformer 1315-50 KW i I 050 + KIN Reinspection Fee $75 Meter ❑up to 100 ampa Issue Fee, $ 3 Zoning Approved By Date Application Approved Byate ` S S b' Application Issued By Date SUMMARY OF FEES �� 5� BUILDING PERMIT $ M. 0 SMIP $ � �'S� PLAN CHECK $ PERMIT r PLUMBING $ ISSUANCE $ . PLAN CHECK $ GRADING $ + ELECTRICAL $ $ PLAN CHECK' $ MICROFILM $ , MECHANICAL $ TOTAL FEE $ ' PLAN CHECK, $ LESS ADVANCED PC a $ A '. FINAL FEE $ UCTIONzAND;PLANNING' :' t ; -- ;' ` -- - POO! ;PA, - - - `APP ALS `" Permit# r ! - Date n' ;Inspector APPROVALS Permit# Date Inspector f 1t Temporary Electrical Service or Pole • L 52.' Pool &Equipment Location 2. Soil Pipe-Undrgrnd.- i y * ; 53., Steel Reinforcement -� Efectrical Conduit Utility-Undrgrrirl! l 54. Forms', - `3 4. Electrical Conduit-Undrgrnd. 3 '55; ElectricalBonding 5. Steel Reinforcement - ;, C ,. •56.; hough Plumbing & Pressure Test 1 6_ "Electr'i`cal UFER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings �^ 581 Electrics{ Conduit Undrorr,.t, t 8. Foundation ; ' •' : _ 59. Gas Pipet Undrgrnd., Test I 4 a 9• Water, Pipe-Undrgrnd. ! `- _ �� s-60. Backwash Lines,,P-Trap, 0 Undrgrnd. 10. Structural Floor System I. ^'i = 61. APPROVAL.TO DECK 11. Property Sewer Line & House �Connection - 62. Backwash &Receptor-Final 12, ewer Cap - r = . 1 L • 63. Heater, & Vent-Final _ 13. Roof:Drains '64. Plumbing System Final 14. Rough Plumbing r ' `' '= " 65, Electrical, Final 15. Rough Electrical=Conduit-' ;r "" - - - 1 -- - "' , � X66. Solar-System"-Final ~- r,• � _ , ugh ,ugh Electric Wiring, .. i z J16__ , , :+r �: - r- ,Y : 67. Fencing &Access Approval r - - -- _ 1 _ r. t y _ _ _ r I!' 17. Rough Wiring Sign.` 68.1 APPROVED FOR PLASTERING' _ 1$. 'RCeilings 1. #J i f E r 69. POOL/SPA SYSTEMS FINAL ;6b.' ' 19. fiough- . Heating & Air Conditioning FIRE DEPT. REQUIREMENT ` APPROVALS i Permit # 20. „llough Factory Fireplace f ;; t ; 21.Du • s, in Structure. I ' _ �, � , # , ! + 70.' Underground Hydro 0`22_ Ducts, Ventilating r f ' ; I J71. Product Piping PGas 00il i i +r23. Gas-Pipe-Rough & Test !� r ! i 72.1 Underground Flush i 24. Roof Framing. 73.: Undergrnd. Storage Tank 0 Gas El Oil 25.Roof Sheathing ? ' i r+ ' _ ' g , I ' ; 74.' Overhead Hydro - � � , -26. 7-Bar Ceiling (Structurall, & Monocoat t .75.; Dry Chemical v�27. Frame and Flashing' , f i r 76. Dry Standpipe ; 28• Cathing & Siding' i ' '� { =' 177. FIXED SYSTEM-FINAL ' 29. Insulation -3c f l i 78. FIRE PREV. FINAL - 30. Drywall Nailing ' F Notes: �31,'Piaster'Bro+rirn Coat i K 32.'ElectricaI Power Meter-Final 33. Final Electric y 34. Final Heating & Air Conditioning ! ; 35. Final Gas Pipe-Test It J ' f- 36. Hood or Canopy';. ` ' i 36. r - 37. Final Factory Firepla•,'ce f 38. Final Plumbing' 39. Water Se-rvice-Final w ; 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation }. 44, Landscape Irrigation•System, 45. Sound' Attenukion 46. Handicap Regul'atioris 47. FINALSTR�UCTURE & BUILDING:, 48. Special Requirements Completed „ , , F 49. Electric Release to,Edisori 50. Gas Release to Southern California Gas Co 51. CERTIFICATE'OF OCCUPANCY Nom, L _ - i d Date ` Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF,COSTAWSA' - PERMIT NO TRACT NO. , ` �v LOT NO. L a C CONSTRUCTION PERMIT 9iy2D ' ..C,t Applicant's Mailing Address TYPE OF CONSTRUCTION. NEW I ADO ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑' OTHER Project Address Owner's Namehon1&4e L��r+� DESCRIPTION OF WORK ZONING U Addressa7 TYPE OF PERMIT El GRADING FOUNDATION. LJ STRUCTURAL A. P. 06 ZONE [� Arch/Eng. icense No. ❑ TENANT ❑ ELECTRICAL PLUMBING ❑'MECHANICAL PLNG. REF. SW ry BUILDING i 4 Address ❑,'OTHER _ , TO BUILDING, r Contractor's Nam hones°? "9-2-0 PROJECT DESCRIPTION; SQ. FT.' OCCUPANCY E y REAR YARD (TO P/L) , \CONSTRUCTION V Address (mailing) 7 TYPE VALUATION $ y LEFT SIDE YARD { RIGHT SIDE YARD PKG.SPACEREO. ; , License ZON.E GRADING CU. YDS. ACRES PROVIDED VVV No. ' LICENSED CONTRACTOR DECLARATION + '9 Remarks: .� i STREET WIDTH ; f -PARK FEE $ ' ' I hereby;affirm that I am licensed under provisions of Charter(commencing with section 7000) of Division 3 of the Business and Professions Code, and 1..: = j SPECIAL CONDITIONS.- ONDITIONS:my mylicense Is In full f rte n eff t. Ucense CI ssJFeAnIA FA-�-.3 I ' PLUMBING , Date Signature Bar sink t j Sewer Cap' ! ELECTRICAL WORKERS' COMPENSATION DECLARATION l,hereby.affirm,that I have,a certificate of.conse to self insure or_a certificate- �„ „ Automatic Washer !Meter ❑over IObamps,- ' I ; Backflow Preyenter __J_. . Sewer Connection - - -- - of Workers' Corripen5atlon Insurance,'or a certified copy thereof (Section� 3800, Lab. '- I ✓,�/ Construction Pole • -•- - - , r :Sub Panel Backflow Irrigation Solar Collectors i rte., `%/xrZ� Policy No. Company .S cry Certified copy is ruby furnished. , , ' ' ' *Sub Pole Cooking Unit : �. j Bathtubs 1 Solar Piping Certtfi is filed with the city I g isio 1 Clarers solar Tank s Dishwasher f` Motors ❑0-1 HP ❑1%-8 1277& Date � Applicant + EXEIAPTIOTI FROM WOR COMPENSATI DECLARATI y, - Dishwasher i Swimming Pool wlSpa t ' Dryers ©des ❑Electric' Inc.$olar,❑9 15 HP ❑16-15+ 'Th need not be completed if the permit Is for one hundr ($100) or r I I ! " `: I certlfyahat performance of the work for which this permit is Issued Ishall; r ! Drinking Fountains , Urinal { Fan: i ,' +r Microwave 4 ; i ,the ampi y -self person so as to become subject, to the' F,A.U. ? . i e : �POke Light Workers' Comp Laws of CdlifOrnia,er " i } FIOOr Drains Water Closet 1 r l Date Signature '� NOTICE: If, after making this declaration, you stiould-become.subject to -the, . Floor Sinks . ---. - -.Water Heater-- - - 1 . ••. - a I _ _- Fixtures l 1 ;Z i :Range, y, ` Workers' Compensation provisions,of the Labor Code, you must forthwith = Device Boxes 'Sign + Comply 'With, such provisions' or this' permit ,shrill_ b8 deemed' revoked: Gas SBn;ice "Outlets' Water Service ''' ", , - 1 CONSTRUCTION LENDING AGENCY - _ Outlets '• I hereby affirm that there Is a construction lending agency, for.tha'performance 'work '{Section '3097 r Interceptors . y Standing Sections ' of the for which'this permit is. Issued Civ. C.), a ` Switches' Lender's' Name Kitchen'Sink' - J ' Trash Com actor p ; Lender's Address ' OWNER BUILDER DECLARATION '_ + t l I Lavatories.' _ .� Garbe a Disposal gJ r that I am exempt, from ttie,Contractor's,License Law for the , 1 P -Trap' Generator ❑0;5 KW ❑5-15.KW 1 1 fo,creby;afflrm fo lowing reason,(Section' 7031.5 Business and Professional Code! Any city or' county which requires a permit to construct, altar improve, demolish or repair 1 any structure.' prior to Its Issuance, -also requires the applicant for such permit i ,: _ Transformer ❑ 15-50 KW , ? %• „ i _ :'r 20 file a;signed statement that he/she is licensed pursuant to the provisions of Ing r' in r' -059,+ KW' {� Rairispection Fee $15 the Contractor's License Law,(Chapter 9 (commenclwith Section •7000) of Olvision:3 of. the Business and Professions Code)' or, that) he//sheyls exempt Showers ,;, , Reinspection'Fee_ $15. , herefrom and the; basis for the alleged exemption. -Any Aotatlon`of'Section ` Meter ❑up to 100 amps I Issue Fee $'3 .1031.5 by any applicant far' -a . permit;- subjects .the :applicant to a civil ( ) , .r , Penalty of not more than five hundred dollars $500. 'property with 3 Service Sink - ti , a rV + Issue Fee '' $ 3 ;1 : Zoning Approved BY _• _ r Date. - 1, as;owner of'• the or -,my employees wages as their sole compensation wlll.tl0 the work, and the'structure is not ]ntandad or offeretl t for sale (Secfion 7044, Business and' Professlonal. Code:I The. Contractor's r MECHANICAL ,, ( - •r Application Approved Sy -_ ; I 1 �, n ' -_ _ ate ; License Law does not apply tolan.owner of a property'who builds or improves i goner• I t • Refrigeration System u I t ,.• Application Issued By -Y`� - "� r Date--t-�- ; thereon,`and who does. Such Werk himself/horsoff or through his or her own employees, provided that such Improvements are not intended or offered for - - Duct - UnderiGround - ❑0-100,000BTU ❑100,0008TU, i I + -.... °: r ' 'SUMMARY sale. If, however, the building or Improvement Is sold within one year of com- y OF -FEES �, pletlon, the owner.wlll have -the burden of proving he/she did not build or im- !rove for the purpose of sale): Duct -Structural '� + System Repair/Alteration , } , , .!BUILDING PERMIT '$ ,' • , •r SMIP . $ " I, as owner of the property, am exclusively contra cting'.with licensed con- I }"' • �' 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 m Duct Ventilating _ • _ PLAN CHECK_ 1 :"' $ :j PERMIT $ builds or Improves thereon. and Who contracts for such projects with a con- i Exhaust System ❑ Multiple ❑ ' PLUMBWG i f -ISSUANCE s?' r , tractor(s) license pursuant to the Gontractor,'s License taw): 0 1 am exempt under Section B, d. P. C. far this reason Firepl/Fact. Bit. ICBG 4 w"$(� :,PLAN CHECiC� 'GRADING� $ r 1 ELECTRICAL; ;, $ 1 $ MICROFILM $ I Heating System &Ducting ' i , Date ' Owner. t i I hereby certify -that hhave read this application and state that ttie above--- - - ❑0-100,0008TU 0100;0006 _ ! �: •' PLAN CHECK $, ' ,�� - y•• - ' 'POTAL•FEE informatlon Is correct. I agree to'comply wi�11 City. and county ordinances laws MECHANICAL $' $. and'state relating to building constructand"hereby authorize repre- -upon = Hood o� Type I ❑ 1 1 j sentatives of this city to ent thove-mentioned .pr par for r Inspection p p se a�? Cano T e I I ❑ - Reinspection• Fee '$15 PLAN CHECK $ . LESS I ,, 33,,073 ADVANCED PC' $ Signature , / J ' 1 i Registers 1 ; lace Fee $ 9 Y. ;I '{ , % C1a,4.� i Orlvers' License or SS FINAL FEE, $ - CMF 0865-46 rev, 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor �1 CONSTRUCTION AND PLA I = = ' ' = ' POOL o, SPA - r . •i •:APPROVAL•S ,, Permit # - Date - .4nspeefor APPROVALS- Permit 9� ' Date Inspector, tTemporary Electrical Service or Pole , 52. 'Pool &-Equipment Location . J 2. Soil Pipe-Undrgrnd: _ 53: Steel Reinforcement r �, 3. Electkical Conduit Utilitv-Undrgrnd; - _ ', 54, Forms W. 'Elect'rical Conduit-Undrgrnd`. r . "_ 55: Electrical Banding trr + - .i 5'. Steel'Reinfbrcem'ent " . :, r .56. Rough'Plumbing`& Pressure Test . r 6. 'EleetricaLUFER'Grnd: i 57. APPROVALTO COVER-GUNITE r> 7. Footings 58. Electrical Conduit Undrarnrl: 8. Foundation r 59. Gas Pipe', ❑ Undrgrnd., Test 9. P9ter Pipe�Undrgrnd. +_ 60. Backwash'Lines; PTrap, ❑Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK �- i 11. Property Sewer Line &.House Connection 62. Backwash & Receptor -Final ' 12. Sewe Cap, , i •'r 63. Heater & Vent -Final 13. Roof, Drains ! ,1 64. Plumbing.System - Final 14, Rough Plumbing65. Electrical=Final t 15. Rough Electrical -Conduit ` '� - - 66, Sol?,Sysiem-Final•. - T - {-1`6. �,Rough;Electric,Wiring + , _ , - - ;. "67. -Fencing&Access Approval J"17. RoygYirWiring.Signf I • r ! - _ s 68: APPROVED FOR'PLASTERING ! ; 18. Raugti Electrical -T• Bar Ceiling - ' - .69. POOL/SPA SYSTEMS FINAL ' 19..;Rough Heating &Air Conditioning , _ `, ;FIRE DEPT.'REQUIREMENT.' , APPROVALS{ Permit # r f 20. Rough Factor"y Fireplace ' 21. Ducts, in Structure i .. l ' 70. Underground Hydro :~,22A'Ductsr Veniilaiing 71. Product Piping 13 Gas ❑Oil ''.23.'Gas'Pipe Rough & Test _ i i_ i -1 -'*72.' Uhderground Flush; 'c24.. Roof Frainin j; :. 73', Undergrrid. Storage Tank 1] Gas Ll Oil , h 25.'Roof Sheathing i ! 74. Overhead Hydro 2fi.'T;Bar Ceilir4 Structural r& g { } Mondcoat -. " :75. Dry Chemical ; I 27. Frame and Flashing: f , + l 76:, Dry Standpipe 28.',6athing & Siding i ;77. FIXED SYSTEM FINAL. i 29_ylnsulation 178: FIRE PREY. FINAL , 30. sDrywall Nailing Notes: , ' '31.Plaster Brown Coat' ,4 ! _ , J32. Electrical Power Meter-Firial t 33. 'Final Electric , '. • r 34. Final Heating &•Air Conditioning r F r 35. Final Gas Pipe -Test _ ' ' 36. Hood or�Cariopy-,� 37. Final Factory Fireplace- _ ! lee 38. Final Plumbing y, 39. WaterService-Final 40. Gas Service -Final ` + Ale= 4z 777- 41. Solar Domestic -Final 42. Backflow Preventer - f ' 43. Backflow Irrigation ! 44. Landscape Irr-igation System , i 45. Sound Attenuation , 46. HandicapRegulations � I I 3� .0 47. FINAL STRUCTURE & BUILDING ! ' �r- 48. Special Requirements Completedi ' i 49. Electric Release to'Edisor. _ f __AAei i ; 50. Gas Release to Southern California Gas Co 51. CERTIFICATEJOF OCCUPANCY No '' = Date ' Applicant to fill In all spaces except those within �" heavy border lines and sign all appropriate declarations, A CITY OF,COSTA MESA I PE I NO. TRACT NO. S LOT NO. 1 ' -MiSTRUCT14N PERMIT �. - 4752 2/22/83 aS.� T Applicant's Mailing Address ' —SK✓ - TYPE OF CONSTRUCTION : NEW U ADD ALTERATION -REPAIR 3 R _G �'� ❑ CONVERSION ❑DEMOLISH OTHER i Project Address 1 - s�J-12 ! - - Owner's Name n� O XQ d_ ,1 oL Phone � DESCRIPTION OF WOR K i I G,GU I S - Address 4► "' C' /�/`flwA S' - TYPE OF PERMIT GRADING - FOUNDATI N U STRUCTURAL A. 137•4. 'ZONE - Arch/Eng- I License No. ❑ TENANT ❑-ELECTRICAL ❑ PLUMBING. MECHANICAL PLNG. REF. fl4 _ BUILDING Address. - ' ❑,OTHER ' TO BUILDING 'ARD SETBACK C11 ST ' Contractor's Nam hone SS% iI B PROJECT pESCRIPTION. S0. FT. OCCUPANCY ' PROP l E REAR Y(TO P/L1 . Z "S 1 A 5 �,.¢/�7 - Address (mailing) �-._ CONSTRUCTION TYPE VALUATION $ LEFT SIDE YARD Z RfGHT SIDE YARD - _,_�^ 7 - L icanse No. R 4 i fo �. S ZONF_ ' GRADING CU. YDS: ACRES PKG-SPACE REQ. PROVIDED LICENSED CONTRACTOR DECLARATION Remarks: I F STREET WIDTH PARK FEE.$ I hereby afilrin that "I' am licensed under provisions of Charter 9 (commencing r with section 7000) of Division 3 of the Business and Professions Code, and ' SPECIAL CONDITIONS: my license is In full force and•effect. cense Class L'icA!T Ny PLUMBING Date _2'— 2_2-'U Signature ��l!l�r�Q t� Tom' I Sar Sink Sewer Cap ELECTRICAL WORKERS' COMPENSATION DEA CLRATION .I.hereby affirm that.l-have a -certificate of consent to self -Insure or -a. certificate - - _ AutOmatic.Washer _ Meter ❑over 100 amps _ -+ - �- r - - _ _ _. Backflow Preventer Sewer Connection' of Workers' Compensatlon Insurance,- or a certified' copy thereof (Section ` ' Construction Pole Sub Panel 3800, Lab. C.) E Sackflow Irrigation Solar Collectors I Policy No. Company I Certified copy is hereby furnished. H Bathtubs - Solar Piping Cooking Unit Sub Pole i r Certified Copy is filed with the city Building Division. ' , ' ' : Clarifiers f I Solar Tank Dishwasher Motors 00-1 HP 01" Ito, Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION t Dryers ❑Gas ❑Elacln r E36-1-5c Inc.Sotar' 9-15 HP ❑1fi 15+ Dishwasher i Swimming Pool wfSpa (This section need not be completed If the permit is for one hundred ($100) or less). ! I , t I certify that in the performance of the work for which this permit Is Issued I Drinking Fountains Urinal Fan , I Microwave shall. not employ any person In any rim er so as to eco[q�e subject to the F.A,U. Pole Li h; r WorkerCorpp� nsatf+Laws of Callfo !a A } r( Floor Drains: , Water Closef; 9 + pateFixtures _ i ��Slgnature L�'ur NOTICE: If, after maki6g-this declaration; you -should beta e•subject•to the-",- Floor Sinks } +— Water Heater ,( _ _ Range _ A_ _ Workers' Compensation provisions of the Labor Code, you. must forthwith. comply with: such provisions or this 'permit -shall be deemed revoked;, j GasSfsrvite 'Outlets' WatfirService ,= - Device Boxes ' I + Sign CONSTRUCTION LENDING AGENCY i I hereby affirm that there Is a-constructiontending agency for the: performance. 'issued ` Outlets I i Standing Sections ' i Interceptors l _ "", + of the work for which this) permit is -(Section 3097 Clv: C.): Lender's; Name" ' "_ - Kitchen.Sink j Switches , Trash Compactor , Dander's Address 1 j i ` ' 1l Lavatories Garbage Disposal i i OWNER BUILDER DECLARATION , i - I hereby affirm that I am exempt from the Contractor's. License Law for the following Professional Code: Any Z , Generator 00-5 KW ❑5-15 KW i ' P reason (Section-7031-5.Susiness and city or county which' requires a permlt'to construct, alter Improve, demoiish;or repair prior to Its Issuante,talso requires t)Ie applicant for such permit iTrap - Trari5f6rRler ❑ 15.50 KW'anystructure, . , , -►_ Roof'Drain_4, i i wj to file a signed statement"that tie/she Is licensed pursuant to the provisions of ' Contractor's License Law (Chapter 9 (commencing with Section 7000) of , - ;- We lRein ctionFee-the $15Division t + r I i05U+KW, Reinspection,Fee' $15,herefrom-and l3 of the Business and Professions Code) or that he she;is exempt the basis for the alleged exemption: Any viola ion' of, Section Showers ^: �' F Meier ❑up to 100'amps Issue Fee '$ 3 /031:5 by. any applicant fora' permit- subjects the •applicant to a civilenaity 5irik _Issue Fee( of riot more than five hundred dollars $500 ) Service ing Approved By Date I,'asrowner of theproperty or"my Employees with wages,as their sole compensation will•do the work, and the'structuro is not intended or offered - MECHANICAL .rliratipn ' f-Ap Approved By -' I I _'r+atefor sale,(Sec{ion 7044', Business and Professional,Code:rThe Contractor's does to builds improves Refrigeration System License Law not apply an owner of a property who or Boiler 7employees, lication Issued By -' / /-Y Date thereon, and who Coes such work hlmself/herself or through his or her own provided that such -Improvements are riot Intended or offered for the building improvement is within -Z - i • Undei Groun+ ❑0-100,p00BTU ❑100,000 BTU sate. If, however, or sold one'year,of comDuct pletla,, the owneriwin have the burden of proving he/she did not build or Im- ' the purpose of sale), I owner on- 1 Duct - Structural System Repair,jAlteration +BUILDING 'rovefor PERMIT $ SUMMARY QF FEES SMIP t $ ' 1, as of the piaperty, am exclusively contracting with licensed con- tractorsto.construct the -project (Section 7044, Business and.Professions Code: _i tractors j Duct. Ventilating _1_ . - _i . _ _ _ - �L _.- PLAN CHECK, $ 1 PERMIT ' The Contractor's License Law does not apply to an owner of property who ;' builds or improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑, + PLUMBING $ E ISSUANCE $ i ' i tractvr(s) license pursuant to the Contractor's License Law). ❑ I am exempt under Section ` B. & P. C- for this reason ' PLAN CHECK. $ GRADING $ 1 j Firepl/Fact. Bit, ICBO 9W I ' ELECTRICAL, $ $ HeatingiSystem & DudtingoF. Date Owner ' -1 -hereby- certify that 1. have 'read -this -application and State that -the above :- � ' re!'PLAN !_]O.1fl0,000 BTU ❑100.000 CHECK', � $ i MICROFILM $ —�'� Information is correct. 1 agree to comply with all city and county ordinances I t �'' MECHANICAL $ TOTAL FEE', $ and state laws relating to building construction, and hereby authorize repre- sentatives of;this icltyI to ter Pon the above-mentioned property for 'p3 Hood or Type I ❑' Reirtspeetion Fee • $15 , , PLAN CWECK; $' { I � � LESS inspection pu es_• + ` ^�� —6 i Cana T ; e II ❑• r I i ; ADVANCED PC $ ) Signature License or 55 Q , 1 R isters I 1 Issue Fee :$ 3FEE'Drivers' } r r'• I C , FINAL , $ + CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor ��% i? LCONSTRUCTION AND_PLANNING; `. ' ' Date iT :. :., _ 7 r = �.^` POOL.c. sPA- Date Inspector + "APPROVAL,S Permit~# S/Q .Inspector 'APPROVALS Permit �1 Temporary iElectricai Service or Pole . ti 52L Pdol & •Equipment; Location I I <• *. 2? -Soil Pipe-Undrgrnd ; }`� `J '_ n 53_ SteelReinforcement 3i Electrical'Cbnduit Utility Undrgrnd. ,;. 54. Forms o js 4. Electric Conduit-Undrgrnd. .3 ' '- _ 55-- Electrical'Bonding a .- s J , 5 Stgel- Reinforcement ;:1 r �- - ` ', 5 - 56.. Rough Plumbing & Pressure Test ; 6' 'Electrical UFER Gr.nd,' i �" �. 57: APPROVAbTO COVER-GUNITE 'r 7, Fpotings, .• �;; , ; `�'+ ` ',' 58: Electrical'Conduit•Undrarn�. 8. FOU:iiiation ` E 1 59. Gas Pipe; ©.Undrgrnd , Test = ' 9, Water Pipd-Undrgrnd '60. Backwash Lines, P Trap, ©Undrgrnd. , 10. Structural Floor System , t' ,,;.. _ 61. APPROVAL TO'DECK 5 i 11.` Property Sewer Line & ;House Connection "l t 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater &-Vent-Final T 13. Roof,Drains ''' 64. Plumbing System .F,inal- 14. Rough Plumbing E 1 65. Electrical Final 15' hough Electrical -Conduit ; - - ,_-r '�' 66:, Solar System Final - - - - - {' �'�- _1.6. 'Rough `EIeciricWiring- �• i E I I - :fi -. = '' - -677. Fencing & Acdess•Approval `PLASTERING 17: Rough Wiri'ng:Sign' ' I - 1 '6g•' APPROV,ED FOR ' ". 18. 1Rough-Electri'cal,T'.Bar Ceiling: �- '69.' POOL/SP, ASYSTEMS FINAL .19. Rough -,Heating &•Air Conditioning_ , , FIRE DEPT. REQUIREMENT APPROVALS- Permit # 20. tRough-,Factory Fireplace i ' ; 21. !Ducts,:in Structure_; i t i ; I E {70.1 Underground Hydro 22. Ducts, Veniilating . , 71, Product Piping O Gas D Oil t 23, Gas Pipe -hough & Test + ::rr I r - 72. Underground Flush r -24. Roof Framing I r i • . , 73.• Undergrrid. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing174. Overhead Hydro t- el 26. T -Bar Ceiling (Structural),& Monocoat', i ;�- '__ 75.; Dry Chemical E • - _ , _ . ..27. Frame and Flashing s i ' ' + - 1 76. Dry Standpipe . 28. Lathing &Siding - I ` { 77. FIXED SYSTEM FINAL 29. Insulation 78.? FIRE PREV,. FINAL 30. Drywall Nailing> I t I , 1 Notes: 31. Plaster Brown Coat f i + _32.'Electricai'Power MeterrFinal �' ' ' A.J I „ 33. Final Electric I r 1 34. Final Pee'ting &.Air Conditioning 35, Final Gas•Pipe-Test 36. Hood or Canopy;' 37. Final Factory Fireplaces ^1 = l F 38. Final Pldr`nbing { l i 39. Water Service -Final' 40. Gas Sdir vice -Final I } • , 1 41. Solar Domestic-FinalY- 1 42. Backflbw Preventer 43. Backflow Irrigation 44. Landscape Irrigation'System ; ! } s •I I I 45. Sound, Attenuation 46. Handicap; Regulations 47. FINAL STRUCTURE & BUILDIiNG 48. Special Requirements Completed 49. Electric Release'to Edison, 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OROCCUPANCY ri ,_ +_ No Il 1 ! Date - T Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • CITY•QF.COSTA -MESA L i , PERMIT N TRACT NO. LOT NO. t JPONSTRUCTEON PERMIT' _ L - 33 i/Ilii 8'I e��G i J Applicant's Mailing Address 'G TYPE OF CONSTRUCTION NEW ADD ALTERATION'S . REPAIR 1 ❑CONVERSION ❑DEMOLISH ❑OTHER" F Project AddresS��y,lyJ `�'!�r',o�'7�-� Owner's N8M84? A� '- ��` ` phone' DESCRIPTION OF WORK _ - ZONING U IO S' Address _ _ _ - ] TYPE OF PERMIT ,GRADING I FOUNDATION STRUCTURAL ; A. P.+ = r ZONE Arch/Eng: '- a License No. ❑ TENANT, X ELECTRICAL ❑'PLUMBING ❑'MECHANICAL PLNG. REF.'y$_ BUILDING Address' r� -' �/ � k' c- b Contractor's Nam hon ❑.OTHER - PROJECT DESCRIPT(Qf11 SQ. FT. TO BUILDING', PROPERTY I REAR YARD (TO P/L) OCCUPANCY' - s Address,(mailing)! CONSTRUCTION TYPE VALUATION$' �^ 'LEFT SIDE YARD RIGHT SIDE YARD t . j -y3171 T/� t i License No. 7l T ! r ZONA GRADING CU. VDS. ACRES PKG.SPACE REQ. PROVIDED ` ' LICENSED CONTRACTOR DECLARATION I'hereby'affiri•n thit•1'am licensed under Provisions of'Charter,9 (commencing Remarks: _ 3 I i STREET WIDTH I PARK FEE $ With section 7000) of Division 3 of the Business and Professions Code, and SPECIAL CONDITIONS: _ my license'is In full farce and of ec y ! 3�� / 1 lJcensa lass ^' cense No. 1• j PLUMBING - Dat Signature ' WORKERS' COMPHNSATION DE ATI N' �' ! [ 1 '. Bar Sink r i I Sewer Cap' I , I ELECTRICAL I hereby affirm that I have a Cert Cate Of Consent to self -insure or a certificate -. Rackflgw Preyenter - ! _ Sewer Gonnect#pn _ - AULOmatIC Washer_ _ _' ._ _ _ / -Meter. ®Over- 100 amps of Workers' Compensation insurance, o a certifiedi copy thereof (Section , 3800, Lab. ) i I tP ; ��ComPany Backflow Irrigation e I Solar Col)ectprs Construction Pale j Sub Panel. i S Policy No. C i Certified copy Is hereby furnished. ,l t ; Bathtubs' • ' j - ! f Solar Piping I ( 1 ,�. Cooking Unit f i ( Sub Pole y ' I Certified py_i� ed with the city 1 g Isi Date Applicant ' , ' Clarifiers ' Solar Tank 1 t I 1 s i DiShNra her Ir Motors 0 1 HP ❑ 1 %-B k I 1 _ H. ExEMPTIOt+IIRROM WORKERS'•COIN NSATI DECLARATION --- ---- i Dishwasher, i �- -- - _�.. _ Swimming Pool w/Spa # Dryers ❑Gas r'❑ElectriC- '- Inc.Solar;❑9-95 HP -❑15-15+ r (This section need not be campl0tetl If a permit Is for -one hundred ($100) or # ' ' leis)- i ! ' ! ' ' '' I certify !that In the performance of the work for,whlch this permit Is issued I tt shall not employ any person iri any manner so as to become subject to the t Drinkin Fountains 9 Urinal ', , ' i ) I Fan 1 j +Microwave , t t , ' ,Pole I F.A.U. Light - - I + t, Workers' Compensation Laws of Callfornla. r 1 !_ % { ! { Floor Drains, I i Water Closet; l , i ' Date' Signature - • __- -_-_- --NOTICE:-lf; after making this -declaration; you•should" become•subject-to the-- - r Fl6or•Sinks ; -' • • -'�^-� - - Water -Heater -- -,- ' - I Fixtures Y / - j � --- - • # �-- Range.__, ' Workers', Compensation provisions,of the Labor Codo,.,you.must.forthwith comply with' such provisions ,or this 'permit shall be .deemed; revoked„ i 3 ' ' i 1 i. Gas Servrce: _Outlets Water,SerJice = �• i Device Boxes ; i j Sign < ! ; i j Q l g : , CONSTRUCTION LENDING AGENCY ! I hereby affirm that there Is a.construction•lerrding agency for the performance, of the for, which this_, permit Es issued -.(Section Civ C.)- - ' ! a _. Interceptors T l : _ .7 r ! G I ''. t r ! Outlets ! Standing Sections i!work , •3097' y Lander'sl Name_ I ' n r '� kitchen;Sink -' r I :+ ' > _ i � 9 Switches ; l i � l ITrasf} Corr`Ipactor , # I • ' SS { � .. 4 i ; - Lender's Address - _ OWNER BUILDER DECLARATION I + - ., � Garbage Disposal `` Ia'atories 1 herebyaffirmthat I am-exempt'frum the; Can tractor's -License Law for the following Business Profession city I = - P _ _ , r Generator. El 0'5 KW El 6-15 KW { { # I reason (Sectiont7031,5 and al'Cod8: Any or' t county which requires a permit to•construct, alter Improve; demoiishlor'repa[r P any structure, prior t0 its issuarrce,also requires the applicant for such permit . ,Trap' v ' Transformer ❑ 15-50 KW # i ( # t ] t + •E - - i - i i + i Rpof'Drains! 1" j �'-� +,• ' _ 1 ; ,- ! - + ' to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commenting with Section -7000) of 'or i ri ('- s t Reinspection'Fee ❑5U + KW j Reinspection Foe Olvlsion 3 of the ,Business and Professions Code) that' he//she';Is exempt herefrom-and the' pasts for the alleged exemption'. -Any . violation'of;5ection ! ShOw9rS ', t _ + I ;. ` Meter ❑up to 100 amps Issue'Fee. ; $ 3. l031,5 by- any applicant for -,a, permit subjects ,the ' applicant to a' civil penalty of not more than five hundred dollars ($500). , ;r I .. i I -owner the or'•my employees with wages'as their sole I i l Service Sink I = i t Issue Fee # $ 3 _ _ roved B Zoning ApP Y y r # as of propertY compensation will -do the work; and•thestructure is not intended or, offered r for sale!(Sechon 7044; Bus] nessi and 4 Professional Code: The Contractor's _ ;, ' ' '" + - MECHANICAL , ! Application Approved By s 'Date 1 ' License Law does not apply to an owner of a property .who builds or Improves , thereon,;and who tloes,such',work himself/herself or through his or her own that are'not intended for I , Bailer ; r • " • - I �- - Refrigeration System - , I I I ❑6-.1 ❑ r Application Issued By I , ,__ _, W Date employyees, prov]ded such improvements or offered I sale. If, however, the bulldEn improvement Is sold within one'yearinf cpm- Duct - Under'Grqund 00,000 BTU 100,000 BTU , (( i or g I • pletlon, the owner;will have the burden of proving he/she Aid not build or im- for i _ Duct • Structural _ System Repair/Alteiation I _ � SUMMARY OF FEES I i { rove the purpose of, sale}., , ( ! 4 ' � I, as owner of [he property, am exclusively cdntractingiwlthillcensed Can• , !BUILDING PERMIT $ (PLAN tt SMIP 1 $ t , tractarsto.construct the;project,(Sectlon.7044, Business and Professions Code:,..._ I '! Duct., Ventilating _ _ � _ , s w y -. �_ _ I _l i CHECK $ i PERMIT I � + ' j The Contractor's LECensa Law aces not apply to an owner pt property who ! builds Or improves thereon, and who contracts for such projects with aCon- ' trattor(s} license to the Contractor's License Law). Exhaust system ❑ Multiple ❑' 1~ [ ; PLUMBING $ I ISSUANCE $ i ; ! I a pursuant ❑ Lam exempt under Section B. & P. C. for this reason 4 i Firepl/Fact. Bit. ICBO �Y' ! , PLAN CHECK' $ i GRADING $ l I r I I i I j — _ 1 s + �ELECTRICALi $I : a o $# f I�Date `l i Owner+" l hereb '•certify•that I" ve'read thls•app[ication and state that -the -above- above- 'Information Is correct. I ea to comply with all city and county ordinances _ t. t Heating System & Ducting . I {¢100,000iBTU ❑100,ODOBT - + 7 k l ! t , a� `� ' ) PLAN CHECK $l MICROFILM $ I ' ! i 1 TOFAL'FEE. _ $ ! I - _ ._ __ r' I 4 �j # g and',State lArng o u Ing construction,'and herah authorize repre- i y ,MECHA(VICAL + it , t for•u on the above-mentioned propertY for r P inspection i j , Hood or Type I ❑' ' Csno T e II ❑= 4 Reins action' Fee' i p $15 s PLAN CHECK' $ADVANCED'PC lsentatives LESS t$Signature Das1 Orlvers' I Registers i # ' Issue Fee $ 3 ! i ! I + ' LkS y(k 1 i r I y FINAL FEE $ CMF 0865- rev, 12/82 White Building; Canary - Applicant; Pink - +4ccounting; Goldenrod -Assessor CONSTRUCTION AND PLiAN IIVG ., 1 r 71_:: r POOL �. SPA . r =� APPROVALS Permit# Date E; inspector E "' APPROVALS Permit # - Date '- Inspector v j r,- I` 7empor'ary:Electrical Service or^P61b i - '': 152' Pool &Equipment Location r•= ' ri t t ' - m 2: ndr U (Soil Pi a rndc _ - "�.o 6 p 9 d ` 'I _ �- �. - :53. Steel Reinforcement _ E_ 1 r 4 ^� f �- & Electrical Conduit'Uiihty-Undrgrnd �` "! .54. Forms 4: Electrical Conduit Undrgrnd' ' = t a ' �•;' Electrical Bonding.: .' t ,55: e. 5: Steel Reinforcement' r = ra_ e' ! t _`''v �. 56.• Rough Plumbing &Pressure Test - F, �- k t- , r �.`" - ., 6: Electrical LIFER Grnd.' ? r y ^- 57. APPROVAL TO COVER GUNITE ' n 7. Footings q 7 ; - I 5$. Eiectricat'Conduit-Undrarnri__: r _ 8. Foundation ; . o • ' w 59. Gas Pipe, b Undrgrnd:, Test 9. Water Pipe-Undrgrnd. I c 1 60. Backwash Lines,'P-Trap, C1 Undrgrnd. ' Q _ 10. Structural Floor System 4 ." i 1 �' a =` , 61. APPROVAL TO DECK - - - _ I' 11. Property Sewer Line & ,House Connection g2. Backwash &Receptor -Final 12. Sewer Cap' q I '. i _ i E M r `:63. Heater & Vent -Final c - - 13. Roof,Drains I G ''_ 1 j o ,, 1 •64. Plumbing:Sy"stem - Final- 14. Rough Plumbing i + - '65. Electrical -Final 15';'Rough-Electrlea I -Conduit- 66.; Solar,Sysfe h -Final .110. �nough-'Electric Wiring � �� ,,� e`� t -67:'Fe66' & Access'A roval g pps f 1. 1 I kr17. ,,, I 1171, l '- + ' _ 0 _1. ' } 68. APPROVED FOR PLASTERING lRough'Wiring'Sign� ; 1 -' i 1 ; � . I 1$. 'FioughnEiectrical;TgBa_r Geilingl' # `!� I "Ctr f69.� POO VS PASYSTEMS.FINAL 19. sRough'Heating &AiryConditioning J� ^ ( i ` ! i FIRE DEPTc+,3,fiEQUIREMENT: APPROVALS! ; Permit'# " 20.,jRough Factory Fireplace I ! I j i i I i 21. Ducts, in Stheture`", ! 1170.. UndergroundHyQ' + 1 22. -Ducts, Ventilating Product Pip g Etas ❑Oil' r I 123. �Gas'Pipe-Rough & Test k -T ��- , -' 72.` Undeigrourid Flush r r I t 24. 'Roof Frariming, I 1i ' , - ;73. Undefgrnd. Storage Tani' Cffdes Oil l 1 25. Roof Sheathing 74. Overhead Hydro ..r; -26 7 bar Ceiling (Structural), & Monocoat"` 1 I 1 ? 1 ' 75. Dry Chemical { .27. Frame and Flashing; 1i h ; ! ; i ` I 76. Dry Standpipe 2B. Lathing &-Siding, '' �, i 1 li ! i I 77.,, FIXED SYSTEV'FINAL , 29. flnsulation z! R i t 1 �_ + i j 4 78.s FIRE PREV. FINAL 30. 'Drywall Nailing ' fis l ; ,I } I i ; Notes:# ;31 Plaster Brown Coal 32: Electrical Power Meter { .' 1 ' -Final t I' + .{ 1 1 n 33. Final Electric t r 34. Final Heating & Air Conditioning ; i/', (e. .. ;r I 35. Final Gas'Pipe-i`esf 36. Hood or Canopy'- ' - n - IT. 1 37. Final FactortFirep lace z rt 1: l ,_� I, -- i 38. Final Plu1mbi`ng 39. Water Service-Fnall I , 40. Gas Service -Final I I j ' ' 1 r` 1 r I , rl f r ! �• 41. Solar Domestic -Final -----,-- 42. Backfl'ow`Preventer 1 43. Backflow' Irrigations 44. Landscape I irigation System ! !t's r r i ; .; i I `; I •' y I t + 45. Sound Attenuation _ Re s 1 - 46. Handicap°gula'tion`I 47. FINAL STRUCTURE & BUILD� I'NG''I 48. Special Requiremerits Completed': I `•'I ! i ` , 1 r 49. Electric Aelease'to Edison- 50. Gas Release to Souther'n Califorriia Gas Co I• } n 1 • ttl ! i f ! r# i I , 1 I • - '� 1 r 1 k 51. CERTIFICA� E OFJOCCUIPANCY No. - Date --J..-- --.1 �- _•�. ', _ '_.L - - - � Lam.,. -1 - -1JL Z . U.J LU CL U Z Z O N am J J to a IL M J m J Q U � ZQ LU (i a Ly LU Z Jp Eq Z J a LU Lu ay Z_ F Lu 0 N Ir Z)O 43088 ?3-7{Pr.l' Off , LI1,7 ` t:', � 1. •. ^• COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For ApplLDINGicant to Fill in Completely REC VE BY li):yy I p EIS U 1' ADDRESS I ✓ Y W� �' y� �� OWN ER�b PERMIT NO. A.P. NO. MAILC, ADDRESS 3 1 VcR i v BUILDING ADDRESS E '^ CY 3 ITNO. TRACT LOT BLOCK CONSTRUCTION 1NEW D MOVING LENDER �� V 1 OWNERr BRANCH ADDRESSVALUE S • $ ARCHITECT ys f TEL S FIRE ZONE TYPE W GROUP � OR ENGINEER fs 1 ',r � ADDRESS b TOU"Al CPMPd, 4 + Cans APPROVED Z CONTRACTOR` o BY DATE J� ADDRESS ic(J TE,�g5 CITY N ZON � NO. OFe7 PLANS USE OF NEW BUILDING STATECITV ��I YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. C)6t MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF SLOGS. IF ROM C/L STREET} OF LOT NOW ON LOT ONT FT. a I FT. USE OF5 EXISTING BLDG.I cm FT SIZE OF NO. OF NEW BLDG. ROOMS STORIES L SIDE FT. EXTERIOR WALL ROOF COVERING COVERING REAR FT, FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE SET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. VAR. �# DATE C.U.P. # APPROVED �2 APPROVED 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of to W the State of California, I hereby certify that I am properly licensed as a contractor under SQ. FT. o THE AMOUNT SHOWN UNDER VALUATION IS FOR i the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business VALUATION FIt 49 and Professio Code, ivislon 3, Cha9. ;t&, m PERMIT FEE $ &9 Signature of D • m Permittee $ 0DD ' PLAN CHECK $ TOTAL FEE $ LL Authorized Agent COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS 31,85 C AirwayAvenue OWNER Koll Irvine MAIL ADOR ESS TEL. CITY NO. GOf+ISf I CTION LENDER unknown BRANCH ADDRESS ARCHITECT TEL. nccnir_in�cco Leason Pomeroy Nn. 639-5 ADDRESS CONTRACTOR ADO R ESS TEL. CITY Newport Beach NO. 833- STATE 3 -STATE CITY LIC. NO, 2 1 764 LIC. NO, W SIZE NO OF BLOCS. R. OF LOT NOW ON LOT Q USE OF EXISTING BLDG. CA Separate permits are required for G electric, plumbing and heating work. W USE OF BUILDING AND WORK TO BE PERFORMED H Q _0 a a w a 94 a Z W x 3 ,PR 1 F-7CPa"fX0 81t V „.tom 1 M6.`.'2 Building #ll APPLICATION FOR STRUCTURAL PERMIT REC4WBY D$' FEC��i DATE ISSUED tCJQ� 42 O PERMIT NO. A.P. NO. BUILDING ADDRESS B LCLC K OWNER FIRE / '777— ZONE ZONE TYPE GROUP APPROVED BY DATE ZO NO. OF USE OF NEVO PLANS BUILDIN /YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING IF ROM C/L,§/r'rEETj/ ^ REAR FT. DISTANCE BET. BET. MAIN & MAIN BLDGS, ACCESS. BLDGS. VAR. 9)E DATE C.U.P. APPROVED APPROVED m the State of California. I hereby acknowledge that I have read this application end state Ln that the above Information is correct and agree to comply with m` all laws regulating building construction, and I shall not employ } any person in violation of the workman's compensation laws of m the State of California. I hereby certify that I am properly licensed as a contractor under 00 SO. FT. ao a the State of California Business and Profession$ Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of tol State of California Business VALUATION PERMIT FEE $ and Professions Code, Divisio ter 9, m Signature of / w 1 / PLAN CHECK S / e3 a Permittee $ / J(Vy/ TAX $ cn Authorized Agent WWW / " TOTAL PAID $ COSTA MESA BUILDING AFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Onl BUILDING ADDRESS OWNER ' MA I L ADDRESS TEL. CITY NO. CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT TEL. ADDRESS CONTRACTORf / ADDRESS TEL. CITY NO. STATE CITY LIC, NO. LIC. NO. SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 3 1 hereby acknowledge that 1 have read thls application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permlttee Authorized Agent PR 2R -75F,,-001486 =; 219.rC APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED rrX. ...MEF PERMIT NO. A.P. NO. BUILDING ' ADDRESS TRACT LOT OCK !1!l�/�GA/. FIRE ZONE APPROVED DATE ZONE NO. OF PLANS USE OF NEW BUILDING YARDS APPROVED ACCESSORY BUILDING FT. F FT. FT. BET. MAIN & ACCESS. BLOGS. DATE APPROVED YARDS APPROVED MAIN BUILDING (FROM C/L STREET) RONT FT. 13, SIDE 7 L. SIDE FT. REAR FT, DISTANCE BET. MAIN BLDGS. VAR. 46 C.U.P. 46 APPROVED SQ. FT, n THE AMOUNT SHOWN UNDER VALUATION 1S FOR pOp THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ID VALUATION PERMIT FEE $ v m PLAN CHECK s 0 S` TAX S U TOTAL PAID E COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 r For Applicant to Fill in Completely — Use Ink Only BUILDING "11 ADDRBSS J+ r �� `4.0 OWNER V F { 1 � � V-�r(�Z Fa O. 4 rr F�- G w C~ a a a ..i w a O a 1:6o z W x C_ L, . i APPLI ATION FOR STRUCTURAL PERMIT R E C PERMIT 3 9 R I L/_h9/', /:217%3 'AFF {) TL A.P. NO. �7 �' ,I/! �/� ING AODRESS�/gS C A/21.t/fh7 ! t/ MAILING 3t V �+'�a I /& � Jr" ADDRBSrSn`Tr Ur -41 I UK SPACE NO. i ACvi. TEL. (�u CITY 1 �y a/"� NO. + r LOT BLK. T 075 W ql tl� CONSTRUCTION O�j r NEW ADD ALTER EPAIR IMOVINGIDEMOLISH LENDER BRANCH 0U OWNER ADDRESS VALUE USE ,AM-AL� V S 3� ARCHITECT1' n t t EL, IV ff !L/ T OR ENGINEER 0. /�II P Iy( ADDRESS ZONE YPE GROUP wJ '-�.�ia� U� t CONTRACTOR V aYPROVEO DATE iD n�� 721 C_ Ai r_W///4V ADDRESS `KX e- &A 3 -EI -29Y CITY UIJ� F't NOL STATE CITY APPROVED SETBACKS �O� LIC. NO, LIC. NO. �LJT� SIZE NO. OF BLDGS (FROM C/L STREET) OF LO7 WM ON LOT -FRONT FT. USE OF EXISTING BLDG Separate permits are required for L SIDE FT electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION LA L.02 A r ON7 Ck7"�NSrD�I DATE APPROVED rt �IPIO APPROVE KG /<g3 I DATE I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with ail laws regulating building construction, and % shall not employ any per4on in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a r under SO. FT. the State of California Business an ons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that su s are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; am axempt fr a provisions of the State of California Business and P ens Coda, Division 3, Chapter 9 VALUATION PERMIT F EE S �CS. So Signature ofqfjDl�_ O PLAN CHECK $ �L fO� 07' Permittee $ 3� �O TAX $ 2• Y_ or11S 9 f 31 Authoriged Agent Date TOTAL PAID$JSW. D Z o, a m m N m Io T rn M Q ti 2 U n COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1204 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS Sk MSMAIL OWNER 7� A UL ADDRESS J _`� YARDS APPROVED MAIN BUILDING CITY C N0� CONSTRUCTION Ti/" +, LENDER BRANCH ADDRESS ARCHITECT e� 1 TEL _ OR ENGINEER �` TAX $ j ZIP kd S�4• ADORES �� d CONTRACTOR ADDRESS 0 U TEL C, CITY ND. STATECITY r LIC. NO. LIC. NO. f SIZE NO. OF BLDGS. i OF LOT NOW ON LOT r USE OF � ily,,y` x117se- EXISTING BLDG. {J�� W � � Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED a� /"n2 I hereby acknowledge that I have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of Cal rnia Business and Professions ode, Di slon 31 ChapkAA�e(2 Signature of Permittee Authorized Agent APPLICATION FOR STRUCTURAL, PERMIT REVVr BY DATE RF�IV D . � 3 r A.P. NO. GGIJ((+)_jq(� PERMIT NO. .... BUILDING _11845 ADDRESS TeWXY TRACT LOT I BLOCK OWNER VALUE FIREam ZONE TYPE GROUP V APPROVED BY DATE ~2- Z NO. OF USE OF NEW N� PLANS 2 BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM CIL STREET) REAR I DISTANCE BET MAIN SLOGS. VAR. #• C.U.P. + BET. MAIN & ACCESS. BLD DATE APPROVED - .-- I1. FT. Uf r• a7 S Y m a m SQ. FT, THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION. PERMIT FEE m o +� PLAN CHECK $ Gd 1�^/�`� I JQ , S I TAX $ g U TOTAL PAID $ 11914 . _151 CPS COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 VR 16-76PA1L rr�r 00 817,: *xf` 1 23.r3 Building #10 APPLICATION FOR STRUCTURAL. PERMIT For Applicant to Fill in Completely — Use Ink Only RE" BY I A'L'E RECEIVED PATE ISSUED BUILDING ADDRESS 31 a; Q Airway Avin-nije NIN-0. 'PER I OWNERKQxl Irvine MAIL r ADDRESS 1901 Dove Street BUILDING ADDRESS F'22 CITY Newport Beach Nod' 833-30 R1upL BACK CONSTRUCTION W ADDIA MOVING LENDER UnMiown BRANCH OWNER ADDRESS S VALUE $ ARCHITECT TEL OR ENGINEER N39-5541 FIRE ADDRESS 44 Plaza Square, Orange— ZONE YPE ROUP APPROVED CONTRACTO BY DATE ADDRESS 1901 Dove Street TEL. Z NO. OF USE OF NE CITY Ne NO. PLANS BUILD] STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 221 764 LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. IF ROM C/L yrpf ET1 OF LOT 4800 NOW ON LOT FRONT T. FT. EX STING BLDG. Industrial FT Separate permits are required for L SID FT, electric, plumbing and heating work. REAR FT. jbp FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. DATE C.U.P. Y APPROVED "I APPROVED r WrI C F r I_ r D I I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under 4800 SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Olvlsion 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions o State of California Business VALUATION PERMIT FEE $ and Professions Coda. Divisl he ter 9. Signature of LAN CHECK $ a Permittee ��// $ZI9�TAX�"7Authorized Agent TOTAL PAID $ s C7 TEL. COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only E4-LDING ' /:QR ES SIZE NO. OF BLOCS. OF I,OT QNE R USEOF N -'I L EXISTING BLDG. %a:7R ESS Separate permits are required for THE AMOUNT SHOWN UNDER VALUATION IS FOR m TE L. GCY NO. CA'495TRUCTION PERMIT FEE $ v LAI DER ElFkNCH Signature of ALryRESS PLAN CHECK $ 0-- AfHITECT TEL. REENGINEER N AC)RESS V G047RACTOR 00— AD)RESS C7 USE OF BUILDING AND WORK TO BE PERFORMED SRR ?R-76�Alh001485 0*** 184 00 APPLICATION FOR STRUCTURAL PERMIT DATE ISSUED TEL. CITY NO. STATE CITY LIC.NO, L1C. NO. SIZE NO. OF BLOCS. OF I,OT NOW ON LOT USEOF EXISTING BLDG. to SQ. FT, a Separate permits are required for THE AMOUNT SHOWN UNDER VALUATION IS FOR m electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED SRR ?R-76�Alh001485 0*** 184 00 APPLICATION FOR STRUCTURAL PERMIT DATE ISSUED 0 n that the above information is correct and agree to comply with �►137�. GLRmM"."uII.171�1�Owl I m all laws regulating building construction, and I shall not employ FIRE IV ZONE TYPE GROUP APPROVED BY DATE ZONE NO. OF USE OF NEW PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) FRONT FT. FT. REAR FT. DISTANCE BET. MAIN SLOGS. VAR, + C.U.P, 4. APPROVED FT BET. MAIN & ACCESS. BLDGS. DATE APPROVED I hereby acknowledge that I have read this application and state 0 n that the above information is correct and agree to comply with m all laws regulating building construction, and I shall not employ anY Aarson in violation of the workman's compensation laws of the State of California. I her®by certify that I am properly licensed as a contractor under to SQ. FT, a the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FU 9NLY: em e�tempt from the provisions of the State of California Business VALUATION PERMIT FEE $ v and Professions Code, Division 3, Chapter 9. M Signature of ' PLAN CHECK $ 0-- PernArtee $ LLc TAX $ r� 2 V Authprized Agent TOTAL PAID $ `i OSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FgMRl WGI PERMIT 84.65 TL P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �� R PERMIT For Applicant to Fill in Completely — Use Ink Only . ` .BUILDING QS + p 1_ lip �/ yy4,Vj� ADDRESS l rl rV 1 l 1 J'j V A.P. NO. � v OWNER OR `r TENANT y t: ��\! BUILDING `�� ADDRESS MAILING t �v R �� ADDRESS 1 UNIT OR All' SPACE NO. /ni rtrt J� ` 9 CITY 1 iE Vl\ NO T O.f LOT BLK. 4O6Tf: // NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS VALUES ARCHITECT M. �O (� 1n alis -i 55 `i 'T USE 1�'j' i OR ENGINEER 1 V[.V f� of f rl�h� f ADDRESS 99a W N J— 0\,)lJ �Q`� ZONE YP GROUP �pTO CONTRACTOR "�1'y^� ��ri�}�S APPROVED gy DATE .� ADDRESjjS��5 P-� / ► v�� CITY r-T1�N_Fl WC NO. p 1 ►fir STATEQ p CITY I LIC. NO. Sig 1 1 V LC. NO. N e LZ) APPROVED SETBACKS p W SIZE NO. OF BLDGS. (FROM C/Lr6TREET a OF LOT NOW ON LOT FRONT Q USE OF r�r EXISTING BLDG. Separate permits are required for L AT. electric, plumbing and heating work: G R F USE OF BUILDING AND WORK TO BE PERFORMED PLKNNING AC ONDATE' Q D r APPROVED > , p APPROV a x w O1 hereby acknowledge that 1 have read this application and state p, that the above information is correct and agree to comply with IL all laws regulating building construction, and 1 shall not employ Z any person in violation of the workman's compensation laws of m the State Of California. Go I hereby certify that 1 am properly licensed as a contractor under SQ. FT. w the Stateof California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m eyV[ Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from the provisions of the State of California Business'r VALUATION PERMIT FEE $ , and Professions Code ision 3, C ter 9, ,nm I_ Signature at PLAN CHECK O� � + L Permittee J 5 TAX $ L or ' Authorized Agent Date TOTAL PAID $ COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FbVkYR��?�J� PERMI' .27e00 I TLl RECEIVED BY PE MIT f] m_ �a M 0 RE __ **FF For ApplicTtolFdl Completely — Use Ink Only ad 2-N2BUILDING A.P. NO. -ADDRESS/Gw� LDING n / OWNER OR ' ADDRESS I (i/Z 4V4 C TENANT UNIT N l SPACE NO. 4. f� MAILING ADDRESS TR.NO. LOT BILK. TEL, CITY NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER L-"�/L ADDRESS VALUE ARCHITECT TEL. USE f^� $ OR ENGINEER 0. � �- ADDRESS ZONE TYPE GROUP OIL— APPROVED CONTRACTOR BY DATE ADDRESS TEL. CITY NO. STATE CITY APPROVED SETBACKS LIC. NO. LIC. NO. (FROM C/L STREET) SIZE NO. OF BLDGS. OF LOT NOW ON LOT 0NT FT. USE OF EXISTING BLDG. Separate permits are required for L SIDE FT, electric, plumbing and heating work; REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE APPROVED APPROVED Ry QATF I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. 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 am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3, Chapter 9. PERMIT FEE $ 14 PLAN CHECK $ Signature of Permittee $ TAX $ Or Authorized Agent Date TOTAL PAI D $ m_ �a M 0 I 432247] COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 For Applicant to Fili in Completely --- Use Ink Only BUILOING A 3 DDRESS OWNER (J aV J MAI L ADDRESS i TE CITY Q&LOgL L NO ' CONSTRUCTION LENDER BRANCH . ADDRESS ARCHITECTTE OR ENGINEER DATE -ADDRESS CONTRACTOR ADDRESS r 2b TEL CITY NO ) f STATE CITY LIC. NO. LIC. NO. SIZE NO. OF BL OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California, I hereby certify that I am properly licensed as a contractor under the State of California siness and Professions Code, Division 3, licenses are In full force and effect, or I Chapter 9, and that _7s, am exempt from t p visio s of the State f California Business and Professions C Ivlslo 3Chapter 9 Signature of Pormittee Authorized Ag nt .Fr ?7-76rfre.7001 ?58-, ***1 APP/C/T1.0P FOR STRUCTURAL PERMIT ;RE4C1 BY DATERECEIVED D TE IS UEOAnnO. t� 0y BUILDING ADDRESS//�,,,,.,� �+ n IJ TRAa'l / / LOT BLOCK OWNS p VALUE USE Ll$ FIRE ZONE 7XPE GROUP APPROVE I* 100 9Y DATE ZCIN E NO, OF a2e I PLANS YARDS APPROVED MAIN BUILDING (FROM C/L STREET) DISTANCE BET MAIN SLOGS. VAR, 0 C.U.P. * APPROVED I USE OF E BUIL I YARDS APPROVED ACCESSORY sUILDII FT. BET. &IN & ACCESS. SLOGS. DATE APPROVED LO m i m SO. FT. civ THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ v r u, m PLAN CHECK $ r" $ TAX $ ti u TOTAL PAIO $ 4 15%7 �g-74A'100 816- ***12,7-03 Building ui1 g COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill iR Completely — Use Ink Only REC V BY D TE RE CEI DAT>= ISSUED BUILDING ADDRESS PEFO ` OW OWNER Ii011 IiVlne A�. O. MAIL BUILDING ADDRESS 1901 Dove Street ADDRESS} CITY o $p_ach Ko 833-30 RAC r'"L� BL CK CONSTRUCTION 4 ALTER MOVING ngMOLISH LENDER BRANCH OWNER ADDRESS OR ENGINEEF�+eason-?omerO ARCHITECTTEL' 639-55 WALUEZZ& FIRE ADDRESS 44 Plaza Square, Orange ZONE YPE APPROVED CONTRACTOR Don RQ11 Com an Inc. BY DATE ADDRESS 901 Dove Street dq TEL. ZO USE OF CITY New ort Beacivo. 833-3 PL S PLANS BUILD STATE CITY 764 YARDS APPROVED YARDS APPROVED LIC. NO. 221 LC. NO, MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF GL (FROMC/LS EET Q+ OF LOT 4800 NOW ON LOS 1 ERQNj FT. Q USE OF ,�. EXISTING SLOG, FT FSeparate permits are required for L. SIDE T. FT. electric, plumbing and heating work. C REAR r. W F WORK TO BE PERFORMED USE OF BUILDING AND W OtSTANCE BET. BET. MAIN & AMAIN BLDGS, ACCESS. BLOCS, VAR. 0 DATE Q UAL C.U.P. APPROVED , > APPROVED .a Hot n SPEC w FOR AL REQUIREMENT i 1 hereby acknowledge that I have read this application and state C n r- (� that the above Information Is correct and agree to comply with W 17. ail laws regulating building construction, and I shall not employ a any parson In violation of the workman's compensation laws of Z the State of California. �r I hereby certify that I am properly licensed as a contractor under 4 8 0 O S... FT, cmv the State of California Busir+oss and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such license$ are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. am exempt from tho pravis'ons t State of California Business VALUATION PERMIT FEE. $ v and Professions Code, Divisltl ter 9. m / j" PLAN CHECK o Signature ofLL/(/�� r Permittee $ TAX $ V� s Authorized Agent TOTAL PAID $ \ �s COSTA MESA BUILDINI3 FETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDIN ADORESG OWNER MAIL JF ADDRESS TEL. CITY NO. CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT TEL. OR ENGINEER PLAN CHECK $ r,r.r ADDRESS 0 P4 CONTRACTOR ADDRESS TEL, CITY NO, STATE CITY LIC. NO, LIC. NO. SIZE NO. OF BLDGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with all iaws regulating building construction, and I shell not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business end Professions Code, Division 3, Chapter 9. Signature of Parmittee Authorized Agent 1,Pli?8-7fi ,—„00114814 �:r 1$1{.DD APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED DATE ISSUE! rIinrlCrrl�” • ■ �� f�: • MATK � FIRE APPROVED DATE ZONE NO. OF USE Or NEW PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDII (FROM C/L STREETI VALUATION DISTANCE BET. MAIN BI -DGS., BET. MAIN & ACCESS, BLD VAR. qle DATE C.U.P. + APPROVED APPROVED THE PURPOSE OF ESTABLISHING A PERMIT FEE NLY: 0 m SO. FT. co cv THE AMOUNTSHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE NLY: VALUATION PERMIT FEE $ M PLAN CHECK $ r,r.r �j O TAX $ � f U TOTAL PAID $ / Il� (714) 754-5273 a Fax (714) 754-4856 a www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 3185 AIRWAY AV Status: ISSUED Suite No F Applied: 04/11/2003 Vicinity: Issued: 04/11/2003 Parcel Nunmber: 42719408 Applicant: SKINNER, WILLIAM E ISSUED BY: Address: 25681 NELLIE GAIL RANCH,. r Phone: 714-546-3400 LAGUNA HILLS, CA Zip: 92653-6133 Owner:. SKINNER, WILLIAM -E TR - Address 25681 NELLIE GAILRANCH Phone: LAGUNA HILLS, CA Zip: 92653-6133 Contractor: Address: a Zip: ; License: - SCOPE OF PERMIT ' _ BUILDING F: TENANT IMPROVEMENTS FOR PAVING &.ENTRY RENOVATION;FOR HANDICAP.ACCESS. ; WORK TO ALSO INCLUDE NEW ENTRY STRUCTURE (DECORATIVE FACADE) TO ALSO INCLUDE'NEW ENTRY GLAZING. INTERIOR OFFICE TI (NEW NONBEARING PARTITION WALLS, CEILING, PAINTING AND CARPETING. r ELECTRICAL TO INCLUDE:,RELOCATE/ADD 34 LIGHT FIXTURES, 20 OUTLETS, AND 10 SWITCHES. REF.: B03-00417 FEE SUMMARY Quantity _ Quantity ISSUE FEE $23.50 �; �'''� _ Temp Dist System I Lighting $0.00 '0 Temp service test - $0.00 ��..� . Busway 1.100 ft,- $0.00 ",, - 0 Res. a/c package $0.00 Standing Sections- $0.00 0 New Res (172 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 l Spa ' $0.00 0 `. ...up to.10 kvalkw -$0.00 0 Lighting Fixts $32:22 _ 34 ..........:....up to 50 kvalkw $0.00 0 Recept Outlets ., $22.00 ` 20 �:' �_ ......up to 100 kvalkw $0.00 " D Switches $11.00 10 ..over'100 kvalkw $0.00 0 Non Res Appl ' ,$0.00 0 Low Voltage Equipment $0.00 0 - Res Appl $0.00 0 Low Volt Wiring'System 1 Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor:' ° $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 -0.. Circus (meth ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446.46 (stop) DECLARATIONS WORKERS' COMPENSATION DECLARATION: hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to salt-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. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for h this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation iaws of California, and agree should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these prq. ,= Applicant'Signature , 11 Dater �� Q �WARNINGJFAI TO NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI L P[?NAL IES AND CIVIL FINES UP TO ONE HUNDRED THDUSAN R 100,0W), W ADMTiON TOT COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTER€ST,IAND ATTORNEY'S FEES, I LICENSED CONTRACTORS DECLARATION: 1 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. Lic. # Class # Contractor's Signature: _ Date: i CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: _ _ Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500),): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended) or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). it 11, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions �' Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a coniractor(s) license pursuant to the Contra cto cense Laws.). ❑ I am exempt Business and Professions Code for this reason: Signature: � i -Ow Iv d n e 5 lic se. Yes ❑ No Driver's License N Expires: i ication 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, Tette 8, Calitomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 1 Will the applicant or present or future building occupant need to ilia and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesal Fire Department by every business which has at 6ny 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). ............................................................................................................................•----........ile...............................fo.r................................az....----............ t-a--..............................s-................................................................-------- 2 Does or will the applicar''t or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..................................... ................................................................................................................................................................................................................................................................................................................................ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? [I Yes ❑ No ........................----------...................................................................................----__............ ........................... ...................................................................................... .................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution Control district or agency? UYes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................ ..................................................................................................................................................:.................................... 6 Will any part of the iacilityto be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If `fres", 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 duality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califamia Health and Safety Code Section 42303 been made? (:]Yes ❑ No -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--.................................... 8 (If 'fres", 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. Signalure: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all at and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describe o to insp o rposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final i spection. _ O {8 a ure Of Legal Owner(s), L ate ; And/Or Authorized Applicant Date CODE 1r• INSPECTIONTYPF DATE INTRIAL5 CODE INSPECTIONTYP DATE fNTMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical •• IL.� 201 Final Block/Rataining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 260 Final BuildinglOccupancy (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3185 AIRWAY AV Suite No F Vicinity: UNIT F Parcel Number: 42719408 Applicant: SKINNER, WILLIAM"E TR Address: 25681 NELLIE GAIL RANCH LAGUNA"HILLS, CA Owner: SKINNER, WILLIAM E TR- Address: 25681 NELLIE GAIL RANCH LAGUNA HILLS, CA Contractor: OWNER -BUILDER Address: MECHANICAL PERMIT Phone: 714-546-3400 Zip: 92653-6133 Phone: Zip: 92653-6133 Phone: Zip: License: 000000 Status: ISSUED Applied: 05/02/2003 Issued: 05/02/2003 ISSUED BY: ""'7' SCOPE OF PERMIT BUILDING F: TENANT IMPROVEMENTS FOR PAVING & ENTRY RENOVATION FOR HANDICAP ACCESS. WORK TO ALSO 1NCLUDE-NEW ENTRY STRUCTURE (DECORATIVE FACADE) TO ALSO INCLUDE NEW ENTRY GLAZING. INTERIOR OFFICE TI (NEW NONBEARING PARTITION WALLS, CEILING, PAINTING AND CARPETING. 2 REPAIR/ALT COOLINGIHEAT REF: B03-00417 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) 7545626 2446.48 (6=) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair I Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/ All Cooling/Heat $27.40 2 Evaporative Cooler $0.00 0 Inst /Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic lncinerator $0.00 0 Refrig Sys >100 k BTU $0.00. 0 Compressors /Absorption Systems Gas Piping $0.00 0 Up to 3 hp ! 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU .$0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp! 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp 11,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp I Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 110000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446.48 (6=) 0 DECLARATIONS WORKERS' COMPENSATION DECLARATION, I hereby affirm under penalty of perjury one of the following declarations: i ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this; permit is Issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued of one hundred dollars ($ f 00) or less.) b4_2I certify that in the performance of the work for which his permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Caiitorni nd agree t sh Id become subject to the workers' compensation provisions of Sectio 3700 of the Labor Code, I shall forthwith comply with these provisio j Applicant Signature: Date: WARNING; FAILURE S RE ORKERS P NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN RE (SI 00.000), IN ADDITION TO E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: Y I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coda, and my license Is in full force and effect. Lic. ftClass N i Contractor's Signature: - T �^ Date, I CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code), Lender's Name: Lenders Address: Signature: Data: OWNER -BUILDER DECLARATIONS: j 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 taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is `sold within one year of completion, the ownar-builder will have the burden of proving that he or she did not build or improve for purpose of sate.). I - 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts fpr such project with a contractor(s) [;license pursuant to Contractor � ansa Laws.). Signalur I am exam Business and Professions Code for this reason: rIDv s e Se. ❑ Yes ❑No Driver's License No.dficati n of Ownership by (typ 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 parson 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, Sac. 341, Title 6, California Administrative Code). ❑ As ownar-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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). "0"......................._..._.......................................................;.........................................._.....................t-io-r............-•--....--- ---- --- ........... .............................................a.....................--_......................--------- 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....................- ...._ .._.. _ _._. _ -........_.............. ................... ._................................ ..... ----..................... _................ ....... _._.. �_.......... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ' —............................_...--.................. - - _ ................ .................-—........._._..._......._._.............. _..... _.._.__. __ .................... __................ ...._.............. _._..----•---- 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No _ ................ .................. ...................... ................................................................_....................................................... ................ ..................................................... -............... _...................................... ........................................._........ .......... 5 Does or will the applicant or present or luture building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Menagemorit District or from any other air pollution control district or agency? U Yes jf No (Section 65950.2 of the California Government Code requires that the requested information be lumished on applications for non-residential building permits). _. •............. --.-...................................... __... ----...................__....................-...............-----..._..-_........._...-., ..............._...._.__...........................------..--............._. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...................._ _.......... ..... _ -—�._..................--.................. —._.......... ..-...-........... ._......... .........._.................................................- ---......__... _...._.. ..................... _.. 7 !f a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? []Yes ❑ No ..... ilic,, .te of compliance ....................._.._.....air".........__............trol-...........---.............._------ .... ..........................__................ _..--- .... -........... 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. fl Signature: Date: i CERTIFICATE OF COMPLIANCE AND AUTHORIXATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state 1 and city ordinances relating to building construction, and authorize representatives of the City of CostajMesa to enter upon the above -describe or' spa __..I as, 1 agree not to occupy or allow occupancy of any building authorized by this permit i Fina 'nspection. Zz%off I S nature Of Legal Owners /Date And/Or Authorized Applicant Data C00F 41. IHSPECTIOHTTPE (2AIE fNIMAL$ CODE INSPEC111pHTYPE 1616 Fixed System Final Fire Prevention �_ 206 Final Mechanical 1266 Pool Spa Final = 209 Final Plumbing 200 Final Re -Roof �- 210 Final Electrical 201 Final Block/Retaining Wall _. _-____ 212 Final Fire Prevention i 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3185 AIRWAY AV $797.75 SMIP Res: $0.00 Status: ISSUED Suite: F $0.00 inspection: $0.00 Applied: 03/1312003 Vicinity: BLDG F (WILLIAM E SKINNER ARCHITECT) Issued: 041`1112003 Parcel Number: 42719408 Zoning: Applicant: SKINNER, WILLIAM E TR ISSUED BY: Address: 25681 NELLIE GAIL RANCH Phone: 714-546-3400 LAGUNA HILLS, CA." Zip: 92653-6133 Owner: SKINNER, WILLIAM E TR Address 25681 NELLIE GAIL RANCH Phone: LAGUNA HILLS, CA Zip: 92653-6133 Contractor: Address: Phone: Zip: License: Arch : SKINNER, W. E. Eng: KEN OKAMOTO & ASSOCIATES INC Address: 3185 AIRWAY AV Address: 14081 YORBA ST SUITE F Phone: T STE 105 Phone: 714-838-4960 COSTA MESA TUSTIN, CA Zip: 92628 License: C4972 92780 License: 2244 SCOPE OF PERMIT BUILDING F: TENANT IMPROVEMENTS FOR PAVING & ENTRY RENOVATION FOR HANDICAP ACCESS. WORK TO ALSO INCLUDE NEW ENTRY STRUCTURE (DECORATIVE FACADE) TO ALSO -INCLUDE NEW ENTRY GLAZING. INTERIOR OFFICE TI (NEW NONBEARING PARTITION WALLS, CEILING, PAINTING AND CARPETING. FEE SUMMARY 'Plan Check: $51854 Calc Valuation: $71 050.00 Permit: $797.75 SMIP Res: $0.00 SMTP Com: $14.92 ,Other: $0.00 inspection: $0.00 Total: $1,331.21 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 Claim Valuation: $71,050.00 PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Leff 0-0 Right 0-0 Required: 0 Proposed: 0 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 446.46 {6100) dO DECLARATIONS WORKERS'-COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: , ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the tabor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) 1 certify that in the performance of the work for w this permit is issued, I shall not employ any person in any manner so as to become subiect to the workers' lifo L� compensation laws of Caia, nd agree th rf' should become subject to the workers' Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro Applicant 5lg`nature; r'Date• _ WARNING: FAI T CURE WORKERS' OOMP TION COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN EMPLOYER TO CRIM641. PENES AND CML RNES UP TO ONE HUNDRED THOUSAND E ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 0 Class 0 Contracioes Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date; OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason {Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, attar, 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 o1 the Contractors license Law (Chapter 9 (commencing with Sectlon 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 safe.). - 7 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions • ` Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who Contracts for such project with a contraclor(s) license pursuant to the Contractors license Laws.). ❑ I am exam,gloqUIdOr sec. Business and Professions Code for this reason: 5igrtat ire. 1 (Ow duvet rcense. ❑Yes ❑ No �Drive�s LiceJ�eYNo._' �Explres' eri tion a1 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 [his permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or wilt the applicant or present or future building occupant need to file a registration form for acutely hazardous materiels? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _..._................-------.......__....—.._.......... _..^........ ........_............... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 Han RMPP is presently required, has Section 25534 of the Cafifomia Health and Safety Code been fully complied with? ❑Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lLJ Yes 19 No (Section 65850.2 of the California Government Code requires that the requested information be lumished on applications for non-residential building permits). —............... —........................ ..._._.....—.... - ................. --- 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (I1 'yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the ftcfosuras prescribed by Cafilomia Health and Safety Code Section 42303 been made? []Yes ❑ No _ .. .. ... .............. 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cerbty that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply wi�in? laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described r purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ` lgnatu�rdOf _Legal Ownar(s)_=^ / Date And/Or Authorized Applicant Date CODE QE (�E�€ON�PE QM INTIT)A CODE.t INSPE(�, IONj,(�N TYPE 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 Domol$ion 250 Final Building/Occupancy CITY OF COSTA M SA CONS RpU,C'TION PERMIT PrfSjeceAddress F ��/ Applicant's Mailing Address Owner's Name �%/�L1/¢k? �,�l�✓�P ne Address Arch/Eng. _ 51!%M License No. Address ��yr Contractor's Nam Address (mailing) / city License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fC nd effect. •,��/ �� License ass Licens Data Signature KERS' COMPENSATION DECLARATION by affirm that I have a certificate of consent to self -Insure or a certificate irkers' Compensation Insurance, or.Lcertifled copy thereof (Section ? Lab.'�YIO 1ND�wt/T Bey No. ompany - Certified copy is hereb furnished. Certif" copy is filed with the city ddii�tag`lhvI� i� n.l` y�Qpp� Date 72 -?q 99� Applicant a..tl/Yl� l�r�_ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed it the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become Subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the foliowing'rea$on (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair y structure, prior to its Issuance, also requires the applicant for such permit -file asigned statement that he/she Is licensed pursuant to the provisions of `,In traCtor's License Law (Chapter 9 (commencing with Section 7000) of 'n 3 of the Business and Professions Code) or that he/she is exempt 7m and the basis for the alleged exemption. Any violation of Section J by any applicant for a permit subjects the applicant to a civil y of not more than five hundred dollars (5500). 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sate. if, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I. as owner of the property, am exclusively Contracting with licensed con- 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 builds or Improve$ thereon. and who contracts for such oroiects with a con. tra Ctor($) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT N Date Owner I hereby certify that I have reap information is correct. I agree to and statelaws rel ing to buildir sentatives of city to e inspection p s Signature Dr[vers' License or SS �b I this application and state that the above comply with all city and county ordinances g construction, and hereby authorize repre- I upon the above-mentioned ro .arty for Date 493 �r A.P. � D S Main Building: TYPE OF CONSTRUCTION 0 NEW ADD ALTERATION REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTH T Front ESCRIPTION OF WORKIUSE OF BLDG. S A Rear TYPE OF PERMIT EJ GRADING FOUTRU NDATION CTURAL C Right K❑ TENANT 1:1 ELECTRICAL El PLUMBING ❑MECHANICAL $' Left OTHER Ping. Ref. # PROJECT DESCRIPTION SQ. FT. CCUPANCV Planning Notes: CONST RUCTION TYPE rr_� VALUATION $ Y's2T3' 4a ZONE GRAQING CU.YDS. ACRES— Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal . Water Closet Water Heater Water Service Auto -Wash Laundry Trays 1 $ 2— oa Accessory Building: $ PLUMBING $ Jone $ Parking Req./Provided $ PLAN CHECK 50% $ ELECTRICAL -FEES FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Reinspection Fee I $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Duct - Structural Duct • Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =A Heating System & Ducting ❑0.100,000 BTU 0100,0008-P Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000 BTU 0 100,000 8TU System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Transformer ❑ 15.50 KW ❑ 50+KW Meter L l up to 100 amps Meter Dover 100 amps Sub Panel Motors El 0-1 HP C11'r4 S Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor I I Reinspection Fee I $15 1 1 Issue Fee 1 $ 3 j 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By BUILDING PERMIT $ 2— oa PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ EES SMIP PERMIT ISSUANCE ENERGY P.0 GRADING MICROFILM TOTAL FEE 0100012556-00012557 TOT 72.69 DATE. 08/22/88 TIME: 10!10 s 1W 'CONSTRUCTION AND PLANNING,'Date 'APPROVALS Permit # Date Inspector or If SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Polr _ 52. Pool & Equipment Location 2. Soil Pipa,-Undrgrnd. 53. Steel Reinforcement 3. •Electrical Conduit Utility-Undrgrnd. f.- 54. Forms { 4.;Electrical Conduil-Undrgrnd. `� �;' 55. Electrical Bonding 5.,St6el=Reinforcem6t' � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �7. Footing j . i ' j 58. Electrical Conduit-Undrgrnd. 8. Foundation �� I 59, Gas Pipe, 0 Undrgrnd., Test 9, ,W'te Pi, a-Undr nd. + � � P gE' + ^ 60. Backwash Lines, P-crap, ❑ Undrgrnd. 10. Structural Floor System 1 T 61. APPROVAL TO DECK 11. PropeYty Sewer Line,& House Connection 62. Backwash & Receptor-Final 12. 'Sewer Cap I : 63, Heater & Vent-Final 13. Roof _Drains { '' r 64. Plumbing System - Final 14. Rod lumbing 65. Electrical-Final 15, Rougi Electrical-Conduit i 66. Solar System-Final ,16. Rough Electric_ Wiring 67. Fencing & Access Approval 174 Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POO VSPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace'4 21. Ducts, in, Structure 70. Underground Hydro 22. Ducts, Ventilating y Ste% 71. Product Piping ❑Gas OOil 23. Gas Pipe-Rough.& Test 72. Underground Flush 24, Roof Framing i:' s 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Siructural) (&,,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 3j....PlasterlBrown Cqat ( 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 --3 fL 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer s` 43. Backflow Irrigation ✓-, 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7 48- Special Requirements Completed 49. Electric Release to Edison. 7f 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date `� 43138 tFC,-6-7fi" ••Pa,� 00 256* w* * 1 14.39 COSTA E20DEPARTMENT T BUILDING-SAFETY SA, CALIFORNIA 9626 E MIT.0.3O10 TION FOR BUILDING PPAJL4 For Applicant to Fr 1 pletely RE E DATE RECEIVED p UE BUILDING � `'� �(,JV F I e W� V � ADDRESS PERMIT NO. [� �� OWNERjMj �a.i./ '4 C MAIL 3 2) 1V U� BUILDING ADDRESS I,c1 Z/ Z ADDRESS 1 U.1 LU a. V � CITY �1a � TRACT L07 BLOCK \ Z Q CONSTRUCTIO �/�N e M W O LENDER f Y I CL C13 1 J BRANCH 4 J OWN W J ADDRESS VALUE ARCHITECTELQ OR ENGINES q Li ✓339 S 5 C U Cal] Q 3 F Y e FIRE ZONE ItYPE GROUP C tLj CC CL L? ADDRESS . APPROV OATS J O CON7RAC70R By m Z fL ADDRESS 1 '�� \ tJ W ZCITY j �� T �,�_ SeDC Z m,P- NO.OF USE OF PLANS BUILD ` N tlJO 'f STATE a1 l L}+ LECYNO. '8 LIC. NO. lr YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING \ j O I SIZE NO. OF 8LDGS. (FROM C/LSTREET) OF LOT NOW ON LOT FRQNT FT. FT. USE OF 11 EXISTING BLDG. 1 F p F' SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES L SIDE FT. U EXTERIOR WALL ROOF F�1{ COVERING COVERING REAR FT. T. CL USE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN & CL A MAIN BLOCS. ACCESS. BLDGS. Q VAR. * DATE O C.U.P. APPROVED �" i � IZ,WA/Q I 9 0 APPROV vj f�'Y Ai Z 0 VI hereby acknowledge that I have rend this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. m I hereby certify that I am properly licensed as a contractor under SQ. FT. a 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 forcend effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; am exempt from the provisions of the State of California Business VALUATION and Professio ode, Di islon 3, Chap 9, Q m N Signature of PERMIT FEE $ f 3 1501F --,� O Permittee $ j N C ECK $ Authorized Agent _ a 2 TOTAL FEE $ Its, " COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDINGr ADDRESS OWNER MAIL, ADDRESS TEL. CITY NO. CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT TEL. ADDRESS CONTRACTOR ADDRESS USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent APR7rrAll�ao e3 . * ba ,I APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE FIECEIVEDIIII DATE ISSUED A.P. NO. BUILDING ADDRESS J TRACT LOT OWNER TEL. CITY NO. STATE. CITY LIC. NO. LIC. NO. SIZE ZONE NO. OF BLDGS, OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any parson in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent APR7rrAll�ao e3 . * ba ,I APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE FIECEIVEDIIII DATE ISSUED A.P. NO. BUILDING ADDRESS J TRACT LOT OWNER LUE S r S FIRE ZONE TYPE GROUP APPROVED RV DATE ZONE NO. OF USE OF NEW PLANS BUILDING YARDS APPROVED YARDS APPROVED MAIN SUIT NG ACCESSORY BUILDING (FROM C/L STREET) DISTANCE BET, MAIN BLDGS. VAR. + C.U.P. sY APPROVED FT. BET. MAIN & ACCESS. BLOCS. DATE APPROVED THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ Q�a� PLAN CHECK $ TAX $ / TOTAL PAID $ .r —: A15.l:b 16-76sg,`.'00 815Y ***106.R6 r Building #8 'COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RE Iv D sY DATE RECE VE DATE ISSUED BUILDING ADDRESS 3185 F Airway Avenue m _/ L 6PEWT l OWNER — P. N r BUILDING l MAIL - ADDRESS 1941 Dove Street ADDRESS ACT LOT B CK CITY Newport Beach No�33-3030 CONSTRUCTION unknown Ng4l 1ADQ16P LENDER BRANCH OWNER ADDRESS S VALUE $ Qd ARCHITECT Leeson--Pomero TE`639-5541 OR ENGINEER Y FIRE ADDRESS 44 Plaza Square, Oran a ZONE TYPE GROUP '' 1Z CONTRACTOR Don Boll Company, Inc. AP BYPROVE G DATE ADDRESS 1901 Dove Street TEL. Z NO. OF SE OF NE CITY Ne ort Beach "D•833- 030 PLANS BUILDIN , STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 221 764 LIC. NO. MAIN BUILDING ACCESSOSY BUILDING SIZE I NO. OF BLDGS. (FROM C/L RE T OF LOT 4000 NOW ON LOT 1 FRONT, FT. USE OF EXISTING BLDG. FT Separate permits are required for L SIDE T. FT s electric, plumbing and heating work. REAR USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET, MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR. +DATE C.U.P. APPROVED iJl_J APPROVED,/?p'HOLD FOP, SPEC16LL REQUIREMENT' I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construetlon, and I shalt not employ any person in violation of the workman's compensation laws of the State of California. 4 0 d OSQ. FT. I hereby certify that 1 am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the tete of California Business VALUATION PERMIT FEE $ and Professions Code, Division r 9. Signature of 4-4 G� PLAN CHECK $ ! �J Permittee $ , /1 CJ TAX g s Authorized Agent TOTAL PAI D $ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERM T NO. TRACT NO. LOT NO. UNIT NO. 1� a3 -7 1 �L��- � . � F " Project Address 3/ t�-. r aIAW j! RIVE . Applicant's Mailing Address SARE r Owner's Name !�/• �' .i-rILliC11�E—�Z Phor4t �-34too Address ArchlEng r+_0�..—�,s��µ1«��"L License NIP -1549-72 Address � A.Yer�L-1_ Contractor's Nam Phone iWI-s;AS. Address (mailing) ' j City License No. 1' 7 Si LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ^7 C^ License Cl ss _ is nse No. 19-0 f & J Date Signature WORKERS' COMPENSATION DECLARATION Hereby affirm that I have a certificate of consent to Self -insure or a Certificate �WorkerS' Compensation Insurance, or a certified copy thereof (Section -d00, Lab. C.) Policy No. Company �5R �CCC> CJcyd hereby bretyCertecopy is iledwith thc B Ildi iv s' Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This Section need not be completed if the permit Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this peri -rift is Issued, i Shall not employ any person In any manner s999p as to come subject to the Worker�C6frlpensation Laws of California Date ff.�[[ZZ Signature NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby affirm that there Is a construction lending agency for the performance Of the work for w_hicti this permit is Issued (Section 3097 Civ. C.) Lender's Name r Lender's Address T- OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permft 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/She is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of livision 3 of the Business and Professions Code) or that he/she is exempt irefrom and the basis for the alleged exemption. Any violation of Section ,31.5 by any applicant for a permit subjects the applicant to a civil oenalty of not more than five hundred dollars (3500). 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the projectiSection 7044, Business and Professions Code: The Contractor's License Law tines not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date '1 f 7 Owner I hereby certify that 1 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 hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purpos Signature Date �! i Drivers' License or SS :IF 5742 '9/22/87 TYPE OF CONSTRUCTION LI NEW LJ ADD,^ALTERATION LJ REPAIR. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. -0 r g Zone DESCRIPTION OF WORK/USE OF BLDG. AdlI✓ S Main Building: Accessory Building: E TYPE OF PERMIT El GRADING 0 FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL_ B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE Il" A/VALVATION S�pl?(� OO $ K I Lef ZONE GRADING CU.YDS. ACRES Ping, Ref. # ParkinggReci./Provided Remarks: Pl-- 't L -r- V -1 - (4-1 rA", Planning Notes: Z4/r s�-10/P A-tC 7-e72,0 t7 0AJ FC -4 GU- K75' 1 PLUMBING FEES Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P --Trap Roo( Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct -Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10- 100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service ,Auto -Wash Loundry Trays ELECTRICAL Automatic Washer - Construction Pole Sub. Cooking Unit Dishwasher. Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 1:15-15 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter El up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0.1 HP ❑134 - 8 Inc. Solar 09-15 HP 016-15+ Microwave Pale Light Range Sign Standing Sections Trash Compactor 1 1 o50 TL FEES Issue Fee S 3 I I Reinspection Fee $15 Issue Fee S 3 �-J MECHANICAL FEES bEVELOPMENT SERVICES RE I MENTS: C?� Zoning Approved By Date ' Building Approved By Date Application Issued By pat Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 1:10-100,00OBTU 11100,000 BTU SUMMARY OF FEES : v ' SMIP $ Sd BUILDING PERMIT PLAN PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $� PLAN CHECK 25% $ j -S( System Repair/Alteration Fire Dampers Registers Issue Fee S 3 Z O N I N G R E Q M T S 1, CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service'or Pole • 52. Pool & Equipment Location r � 2. Soil Pipe-Undrgrnd.' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 1 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r •' 5. Steel Reinforcement 56. Rough Plumbing & Pressure test � 6• Electrical LIFER Grnd. 57, APPROVAL TO COVER -G UNITE 7. Footings 58. Electrical Conduit- Undrgrnd-.'-8. Foundation 59, Gas Pipe, ❑ Undrgrnd., Test-". 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd, r 10. Structural Floor System 61. APPROVAL TO DECK r 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final ! j 12. Sewer Cap 63. Heater & Vent -Final it . 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 APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro l 22. Ducts, Ventilating 71. Product Piping ❑ 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 i 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. Flood or Canopy 37. Final Factory Fireplace 4 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 • a � 45- Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING r, 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date C1 'Y OF COSTA ML JA 770 F= J Development Services, Division of Building and Safehj ,i CERTIFICATE OF ,OCCUPANCY This certificate is issued pursuant to the requirements'of the 2007 California Building Code, Section 110 adopted by the City of Costa Mesa certifies that at the time of its issuance the building structure herein below described was inspected and approved foroccupancy as foIIows: Building Address 3185 G Airway Ave. Bldg. Permit Number BC1 1 —0001 9 Use Commercial Group B Type of Construction V -B Fire "Zone Use Zone ' r Owner of Building. CCF Holdings LLC Tenant Site Crew Address 3185 G Airway, Ave., Costa Mesa, CA 92626-4601 By BUILDING OFFICIAL -Keith Clarke, C.B.O. Date REQUIRED TO BE POSTED IN A CONSPICUOUS PLACE CITY OF COSTA MESA amp �s4 BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 - Fax (714) 754-4856 www,C1.00St2-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: B11-00062 PERMIT TYPE B_R00F2 APN; 42719407 JOB ADDRESS: 3185 G AIRWAY A_V CM Vicinity: UNIT G ROOF Squares: 4000 STATUS: ISSUED DATE ISSUED: 03/03/2011 ISSUED BY: RMD Suite/Unit: G Valuation: $32,000.00 SCOPE OF WORK: PARTIAL RE ROOF OF UNIT G ONLY. TEAR OFF FXISTING ROOF MATERIALS, INSTALL 1 -PLY THERMOPLASTIC HEAT WELDED ROOFING MATERIALS (CRRC # 0738-0002) (3 YR AGED SOLAR REFLECTANCE .701 THERMAL EMITTANCE .90) ON A COMMERCIAL BUILDING, APPROX 4,000 SF, REPAIR AND REPLACE SHEATHING AS NEEDED, COMPLIANCE FORMS ATTACHED TO PERMIT AND JOB CARD. NOTE: RESIDENTIAL RE -ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide. alarms by the City Inspector. See Attachment wllnspection Card OWNER: CCF HOLDINGS, LLC PHONE: $462.45 APPLICANT: SIE, ERIK PHONE: 714-457-3249 CONTRACTOR: FORTIS 3 CONSTRUCTION Address: 2049 FORD LNUnit: CitylStatelZip: PLACENTIA, CA 92870 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $462.45 Reinspection Fee: $0.00 Bldg Std Admin Fund $2.00 Address: 3185 G AIRWAY Unit: City/State/Zip: COSTA MESA, CA Address: Unit: City/State/Zip: License No. 936140 PHONE: 714-457-3249 CELL: License No. PHONE: License No. PHONE: -OTAL FEES $464.45 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3118/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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 t. INSPE"ON TYPE DATE INTITIALS CODE I INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Poo! Spa Final / 208 Final Plumbing 200 Final Re -Roof t{� /{ ►Y�\/ j✓ 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 DECLARATI I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This section need not be completed d the pennA is valued at one hundred dollars (S 100) or ress.) Policy Number: i certify that in the performance of the work for which this permit is is ued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwit cr* with these provisions. ef App n1' a rer]dle,� 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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. Lic..#— 3l 1 y a i �- 14�Contractor's'Sig � � Dale= CONSTRUCTION LENDING NCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ 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 himselt 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 sate.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws,), ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature 305746 (3107) Date Owner ID verified by (cense. ❑ Yes ❑ No Driver's License No. Expires: Verification of.Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, fatsework, or demolition or dismantling thereof, will be more than thirty -sok (36) feet high, (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: Date 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any 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). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If 'yes attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owners Date -1 ri pr,Auinonz ppl� --� - Da[e_ CITY OF COSTA MESA BUILDING DIVISION y 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC11-00099 o� PERMIT TYPE.. B COMBO STATUS: FINALED Q Sub Type: COM—ALT DATE ISSUED: 03/03/2011 ISSUED BY: RMD JOB ADDRESS: 3185 G AIRWAY AV CM APN: 42719407 Zoning: Vicinity: Const Type: V-8 SO, FT: 3525 Suite/Unit: G Primary Occ: Valuation: $155,000.00 SCOPE OF WORK: 3,525 SQ FT TENANT IMPROVEMENT. BAND F-1 OCCUPANCY. SCOPE OF WORK TO INCLUDE: DEMOLISH ALL EXISTING TENANT IMPROVEMENTS. CONSTRUCT NEW IMPROVEMENTS TO INCLUDE: OFFICES, LUNCH ROOM, NEW STOREFRONT, RECEPTION AREA AND CONFERENCE ROOM. WAREHOUSE AREA ALSO IN THE BACK OF THE UNIT. REMODEL 1=XISTING RESTROOMS. NO NEW RESTROOMS. 3 PKG UNITS FOR HEATING/COOLING, DUCT WORK AND 2 VENT FANS TO SINGLE DUCT, 97 LIGHT F~IXT, 60 OUTLETS 38 SWITCHES, 3 ELEC MOTORS FOR PKG UNITS, 1 KITCHEN SINK, 1 VAC BREAKER, 2 WASH BASINS, 2 TOILETS, 1 WATER HEATER, 1 MOP SINK, 1 SVS SINK, 1 WASHER/DRYER. GAS PIPING FOR PKG UNITS. OWNER: CCF HOLDINGS, LLC Phone: APPLICANT. SIE, E=RIK Phone: 714.457-3249 CONTRACTOR: FORTIS 3 CONSTRUCTION Phone: 714-57-3249 Cell: ARCHITECT: SKINNER, W. E. ENGINEER: COMBINATION PFERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: Address: 3185 G AIRWAY City/State/Zip: COSTA MESA, CA Address: CitylStatelzZip: License No. 936140 Address: 2049 FORD LNUnit: City/State: PLACENTIA, CA License No.C4972 License No. $211.54 $1,301.75 $261.85 $133.15 $154.80 $0.00 $32.55 $7,00 $2,102.64 Unit: Unit: . ZipCode 92870 PHONE:714-546-3400 PHONE: 'Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3118/2010- PER CMMC Sec. 13-279 Monday thru Friday .7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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 C. INSPECTION TYPE 1616 Fixed System Fihal Fire Prevention 1266 Pool Spa Final 200 Final Re -Root 201 Final BlocklRetaining Wall 202 Final Factory Fin_- Place 203 Final Sign 204 Final Demolition DAFT INTITIALS CODE INSPECTIONTYYFPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Fine) 8ui 06VOccuparrey DATE IWn"IIIIALL Ay 57ra-cry � FIs .1L� �s� WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' Compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This section need nor be completed Aire pemuf is valued al one hundred dollars (S100) or less,) Policy Number: ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant's Signature Date 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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. Lic. # Class # Contractor's Signature Date CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature 3057-46 (3107) Dale Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Vogl, hereby certify that no excavation five (5) or more feet in depth into which a rs .i�r to descend, will be made in connection with work authorized this p t and that rt building structure, scaffolding, falsework, or demolition or dism li r�Qf. wit be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ti(Ib $-Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be riled 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any 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). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No B. (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. 1 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 1 have read this application and state that the information given is correct. I agree to comply with all slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owner(s) Andlor Authorized Applicant Date Date I On Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA• CONSTRUCTION PERMIT Project Address,/�31 T - Ail,-o„,Y oyt. Applicant's Mailipg Addre �S b Owner's Name(/'t Phone �� l� Address Arch/Eng. License No. ^Gy Address Contractor's Nam - Z- w Phone`ss�-�� Address (mailing) h City License No y' LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commeneing with section 7000) of Division 3 of the Business and.Professions Gotle, and my license is in f orce and effect. License Class LI - Datee a= `�� ._ Signature C WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 7? PgiicY No. �� ! / Company f g•✓' �tD't / .(��Ulj Certified copy is hereby furnished. +rr Certified cop is filed with the city�Byilfding,Q)vislon +� Dat _ - Applicant' //,„,rf4��. //�� EX MPTION FROM WORKERS' COMPEN5ATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that In the performance Of the work for which -this permit is Issued, I shall not employ any person in any manner so as to become subject -to the Workers' Compensation Laws of California. Date Signature NOTICE: if, after making this declaration, you should become subject t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with - such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that thele is a construction lending agency for the performance of the work for ;which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that i am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 asigned statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section -7031.5 by any applicant for a permit subjects the applicant to a civil Jmalty of not more than five hundred dollars (3500). 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). D I. as owner of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for such projects with a con. tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. S P. C. for this reason Date Owner 1 herebycertify that I have read this application and state that the above information is correct. I agreeto Comply with all City and county ordinances and State laws relating to bull ding construction, and hereby authorize repre- sentatives of this c o ente. r upon the above-mentioned ,pr op- t for Inspectiyo�r}-purposes,, �1�h��-� Signatu DateL4 e Drivers' License or SS :IF P 0,rgR ail 2 TCS �� L07 EVO> UNI7�V0. 4830 'Cl/(]/eQ 149.h5 TYPE OF CONSTRUCTION NEW ADD ALTERATION I I REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. r�S A.P. -0 "T� -' Zone P Main Building: Accessory Building: TYP�E7PERMIT El GRADING FOUNDATION STRUCTURAL L� TENANT F-1ELECTRICALI—]PLUMBING 1:1MECHANICAL ❑ 'OTHER PROJECT DESCRIPTION SQ. F7. _ ZS OCCUPANCY -5' 2 . CONSTRUCTIONTYPE VALUATION$ 630o.eD ZONE GRADING CU:YOS. ACRES 7 Front ' Z O 13 A Rear 1 N C Right N K S i Left G R Ping. fief. # Parking Req./Provided E 'Remarks-C"u Planning Notes: it .5{�V1 VI M PLUMBING FEES Bar Sink Showers ELECTRICAL FEES _ Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to'100 amps �'.Clarifiers Solar Collectors Qishwasher Meter ❑aver 100 amps ! Dishwasher Solar Piping Dryers ❑Gas OElectric Sub Panel Drinking Fountains Solar Tank Fan Motors -1 HP ❑1 h - 8 Floor Drains Swimg Pool wlSpa F.A.U. 1n alar ❑9.15 HP 016.15+ Floor Sinks U ' at Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches 'Sign Lavatories Auto -Wash Garbage O osal Standing Sections P—Trap Laundry Trays Gener or ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Felt $15 Issue Fee $ 3 MECHANICAL FEES SERVICES Approved By Building Approved By Application Issued By R�QU R£ME TS: pv ��1• Date 4 Q Date Date. Boiler Hood or Type I ElDEVELOPMENT Cano Type 11 11Zoning Duct - Under Ground Duct - Structural 4fefrigeration System ❑0.100,000 BTU 01100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES S QQ• 0o SMIP S s $ SQ PERMIT $ ISSUANCE $ S ENERGY P.C. S $ GRADING $ $ MICROFILM S $ TOTAL FEE S $ • 9 Exhaust System ❑ Multip System Repair/Alteration Firepl/Fact. Bit. ICBG Fire Dampers Heating System & -ting ❑0-100,00aBT ❑100,00087 Registers Reinspection Fee i I $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL_ & SPA APPROVALS Permit # Date i Inspector 1. Temporary Electrical Service or role 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings r /�58. Electrical Conduit-Undrgrnd•. B. Foundation f` 59. Gas Pipe, ❑ Undrgrnd., Test - 9. Water Pipe-Undrgrnd. �'� 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System �t 61. APPROVAL TO DECK .11. Property Sewer Line & House Connection h 62. Backwash & Receptor -Final 12. Sewer Cap �' 63. Heater & Vent -Final 13. Roof Drains f�" 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Onderground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical t 27. Frame and Flashing/ / 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL, 29. Insulation 78. 78. FIRE PREV. FINAL = 30. DrywallrNailing f HEALTH DEPT! REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION •. 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 1 ' 33. Final Electric Notes: 1, 17o5cs--- HT1 34, Final Heating & Air Conditioning 35. Final Gas Pipe -Test I,Q 36. Hood or Canopy 37. Final Factory Fireplace �J � s 38. Final Plumbing e 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer t 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 ; � _ t r• � Applicant to fill in all spaces except those within heavy 4order lines and sign all appropriate declarations. z1 OF G4STA Ei 011JSTRUCTIQ R IT PERMIT NO. TRACT NO. LOT NO. UNIT NO. reject Address C[�� 1 "Appl+cant's Mailing Address - rOwner's Name �y+G� Phone Address,,_SA BS�~& a` i 2ki.%+.��5� ArchlEng. License No. Address Contractor's Name_ �� /�,.,P�hone 63 Address (mailing) _� �Z(jQI�, ,,-,.,_.L.[ _fk.-- Nr rn- �!L[111► City License No. pi C LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f I fort nd effect. 40 ucen Clay ns o, a b 1 Date — Signature +�1 WORKERS' COMPENSATION DE 1D4 ATION V lot affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation InSuranCe, or a certified copy thereof (Section 1800, Lab. ) iia. policy No. r �� S� L rL• 1+7Clr� Y 8 Certified copy is hereby furnished. Certi ca y is file with the city ng Dlv Date Applicant EXEMPT ON O RKERS' CO ENSATION DECLARATION (This se ion Hoed not be completed i the permit 35 for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued. I shall -not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. , Date Signature NOTICE: If, after making this declaration, you should become subject to the. - Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions Cade) or that,he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars ($500). J I, as owner of the property or my employees with wages gas their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. if, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of Sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that, proof of their Worker's Compensation insurance Should be provided to me: ❑ lam exe B. &-P. C. for this reason I Cr Date er I hereby certify that I have read f1his application and state that the above information is correct. i agree to comply w h all city and County ordinances and state laws rating builds nstr n, and e ereby a4ithorize repr- sentatives of celhis ci o enc on a tioned prgwwty_.j�or'. inspection purpose . Signature Drivers' License 55 IF 0865-4fi, rev. 10/84 Whi e - u d ng, anary - pp Cant; o s 1 5 $0 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTIONOF.WOR K/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION , SQ. FT. OCCUPANCY G Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. Remarks: Planning Notes: ar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks, Gas Service Outlets Interceptors? Kitchen Sink Lavatories -,i P -Trap Roof Drainsi, Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO =hL Heating System & Ducting C]0.100,000 BTU ❑ 100,000 BTI Reinspection Fee - Accounting; Goldenrod - Assessor $15 5070 9/II/87 2 / Zone Accessory Building: Z O N I N G R Parking Req./Provided E Q M 7 ABING FEES ELECTRICAL FEES Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub,. ❑ 50 + KW Showers Service Sink Sewer Cap Sewer Connection Reinspection Fee Cooking Unit Meter ❑up to 100 amps Solar Collectors AANICAL FEES Dishwasher Meter EJ over 100 amps Solar Piping Date Date Dryers:❑Gas ©Electric Sub Panel Solar Tank I Fan Motors ❑0-1 HP 0134- $ Swimming Pool w/Spa System Repair/Alteration F.A.U. Inc. Solar 09.15 HP ❑16 15+ Urinal Registers Fixtures' ,Device Microwave Water Closet :i Boxes Pole Light Water Heater . Outlets Range Water. Service,p Switches Sign Auto -Wash Laundry Trays ° Garbage Disposal , � Generator 1:10-5 KW ©5.15 KW Standing Sections Trash Compactor Issue Fee $ 3 Reinspection Fee $15 1 1 Issue Fee $ 3 AANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING _ PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ ., $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ System Repair/Alteration Fire Dampers Registers Issde Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA 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, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ 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 c; 15. Rough Electrical-Conduit . Solar System-Final 16. Rough Electric Wiring 67 ng & 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro , 26. T-Bar Ceiling (Structural) & Monocoat .. Dry Chemical 27. Frame and Flashing . Dry'Standpipe L77, 28. Lathing & Siding FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Mailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 9. FINAL INSPECTION ' 32. Electrical Power Meter-Final �. _jgFOOD CERTIFICATE ISSUED 33, Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36.,'Hood or Canopy 37. Final Factory Fireplace L 38. Final Plubing 39. Water Service-Final is ' 40.1 Gas Service-Final r + 41. Solar Domestic-Final 42. Backflow Preventer .43. Backflow Irrigation �r 44. Landscape Irrigation System 45. Sound Attenuation < 46. Handicap Regulations s 47. FINAL STRUCTURE & BUILDING c� 48. Special, equirements Completed 49. ElectriC'.Release to Edison 50. Gas Rel4se to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 4 ' Z� ',•i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA ESQA� CONSTRUCTION PEeR MI lhoiect Address O S A e.Uay Lk_- Applicant's Mailing Address S1 CGSTG{' Owner's NamePhone Sy 4 -19y Address V Arch/Eng, License No. Address Contractor's Nam Phone Address (mailing) �3 3/ n C Ce T City License No. 2 LtCENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and feet. Ucen ee C_larss' —r ` Liken - 2 Dat eJ�R Signature— ` WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate ` Workers' Compensation Insurance or a certified copy there(Section rr,' ao. C Nj,32N239��Qany S-FG..75-/ LC/laf I�Certitied copy is hereby furnished. ((4 , Ce tifie copy -s ed with the city g Date — 'Applicant EXEMPTION FROM WORKERS' COMPENSA ION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency for the performance ofthe work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil Ity of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will d0 the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rOve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professlons Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have rea- information Is correct. I agree to and state laws relating to buildir sentatives of this ci y to en inspection pur os Signature Drivers' License or SS :# I this application and state that the above comply with all city and county ordinances g constructjon, and hereby authorize repre- I up" thJF above-mentioned property for Dated �^^ A.P. � 3�(j©J S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW Ll ADD ALTERATION LJ REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front %E SC IPT O F j(4fORK�SE F B[,p lr Lr r 13 hear TYPE OF PERMIT ,[ GRADING LJ FOUNDATION KSTRUCTURA K Right ❑ TENANT ❑ ELECTRICA ❑ PLUMBING ❑ MECHANICAL S A Left ❑ O'rHER ia4 _ Ping. Ref. # Parking Req./Provided PROJECT DESCRIPTION SQ. FT. OCCUPANCY 00 Planning Notes: CON STRUCTION TYPE '- VALUATION $ !7 ZONE GRADING CU. YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher . Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Boiler ABING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Water Closet Water Heater Water Service 'Auto -Wash Laundry Trays $15 Issue Fee MECHANICAL Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System D Multiple Firepl]Fact. Bit. ICBO Heating System & Ducting ❑0-100,000 BTU 0100,000 Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type I I ❑ Xgeration System 0-100,000 8TU 0 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Zone Z O N I N G R E Q M T S. I I ELECTRICAL I FEES I FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dove 100 amps $15 Issue Fee Dryers ❑Gas ❑Electric Sub Panel $ 3 Fan Motors 00.1 HP 8 Date Date Date F.A.U. Inc.Solar 09-15 HP ❑16-15+ $ 3 Fixtures icrowave BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% Device Boxes Pole Light { Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05-15 KW Trash Compactor Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date 41NIFL., $ 3 FEES BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY Q FE $ —�] SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ 01 00029896-60029807 UATEt OVO4/89 TIME: TOT 00.13 10:35 $ 3 ' '.CONSTRUCTION AND PLANNING APPROVALS Permit # Jae Inspector POOL ' 'A APPROVALS Permit # Date Inspector 16 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. 1 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grrid, 57. APPROVAL TO COVER-GUNITE 7.. Footings r 58. Electrical Conduit-Undrgrnd. 8+',Foundation;. • 59. Gas Pipe, ❑ Undrgrnd., Test s 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . t 62. Backwash & Receptor -Final 12. Sewer. Cap' , 63. Heater &Vent -Final 13. Roof Drai6s 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 APPROVALS Permit # 20'. Rough Facto ry.Fireplace 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 ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 41 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing &rSiding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywa I I •Na i I ing ,,, HEALTH DEPT. REQUIREMENT 31. Piaster�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. FINAL STRUCTURE & BUILDING S ?6 48, Special Requirements Completed �. Electric Release to Edison \Gas Release to Southern California Gas Co CERTIFICATE OF OCCUPANCY Date .1 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING 3185 G Airway Avenue ADDRESS OWNER Koll/Irvine MAIL 1901 Dove Street ADDRESS TEL. CITY Newport Beach NO- 833-3 CONSTRU CTION LENDER BRANCH ADDRESS ARCHITECT Leason-Pomeroy TEL 639-559 OR ENGINEER y N ADDRESS 44 Plaza Square, orange CONTRACTO ADDRESS TEL. CITY Newport Beach NO. — STATE CITY. LIC. NO. 221 764 LIC. NO. SIZE NO. OF SL. C4 OF LOT 4150 NOW ON LOT 55 1 Q USE OF EXISTING BLDG. C+1 Separate permits are required for C1 electric, plumbing and heating work. w USE OF BUILDING ND WORK T B PERFORMED F Q J Q 96 C 1 hereby acknowledge that I have read this application and state ix that the above Information is correct and agree to comply with 17. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of W the State of California. 3 I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or am exempt from the provisions of the State of California Business and Professions Code, Division 3 Jahapter 9. �Z Signature Of Permittee + Authorized Agent PAiE NPR 16-7fcr� 00 814* * •f 110.86 Building #7 APPLICATION FOR STRUCTURAL PERMIT Ri: IV p By 7E RC D DATE ISSUED -/ !D PER f A. . NO. ` .• ! BUILDING ADDRESS ��//.W1L US VALUE Q ' FIRE DISTANCE BET. MAIN SLOGS, ZONE YPE GROUP APPROVE C.U.P. BY DAT HOLD FOR SPEC IAL REUIR USE OF W PLANS BUIL APPROVED YARDS APPROVED BUILDING 4150 SQ. FT. ACCESSORY BUILDI rINO.OF S RE VALUATION PERMIT FEE $ l� /^� FT. R. SIDEF FT Tax $ F FT. Q r REAR T. BET. MAIN & F i I DISTANCE BET. MAIN SLOGS, ACCESS. SLOGS. DATE VAR. q1� C.U.P. APPROVED APPROVED HOLD FOR SPEC IAL REUIR 5 n m m N M 4150 SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: " m v N VALUATION PERMIT FEE $ l� /^� m PLAN CHECK S A$4v36 IL Tax $ u V TOTAL PAID S Q r IT.'?9-77�ys°001;75R'f tK•* 113.12 FOR STRUCTURAL PERMIT DATE RECEIVED DATE��1�S�SUEC ir�r]S� LOT i W I BLOCK BRANCH OWNER COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ADDRESS A L Far Applicant to Fill in Completely —Use ink Only �m S �c+� BUILDING AjAL OR ENGINES !/ ADDRESS OWNER A.P. NO MAIL BUILDIN ADDRESS ADDRE TEL. � CITY NO. CONTRACTOR IT.'?9-77�ys°001;75R'f tK•* 113.12 FOR STRUCTURAL PERMIT DATE RECEIVED DATE��1�S�SUEC ir�r]S� LOT i W I BLOCK BRANCH OWNER ADDRESS VALUE ARCHITECT T a [ADORES �m S �c+� OR ENGINES !/ 1 � { FIRE ZONE PE GROUP ` APPROVE CONTRACTOR BY DATE • ADDRESS JWJ — ZONE[JE NO. OFUSE OF NEW CITYuse 0L PLA BUILDING �- STATE CITY LIC. NO. LIC. NO. YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (� SIZE NO. OF BLDGS (FROM C/L STREET) 1 O. OF LOT NOW ON LOT RONT FT. Q USE OF EXISTING BLDG. FT ;0 4 Separate permits are required for electric, plumbing and heating work. L. SIDE FT. REAR FT, FT. LQ F. AMAIN USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & BLDGS. ACCESS. BLDGS. a (/V VAR. + DATE C.U.P. *� APPROVED APPROVED ^ Ry DATE a 04 w 1 hereby acknowledge that I have read this application and state 0 n p� that the above Information Is correct and agree to comply with all lows regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of the State of California, o 3 property licensed as a contractor under I hereby certiIthatc the State of Cines and Professions Code, Division 3, Chapter 9, ancenses are In full force and effect, or I exempt frslons of th ate of Cal ornia BusinessVALUATION Professionion 3, h 9. SO. FT. N M ui THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT NLYam PERMIT FEE Sand PLAN CHECK $ Z� Signature of Permittee w _ _ r+ $ /'/�JYC]w"� m ^� LL LL U TAX S Authorized A nt TOTALPAiD S' I!, VR ?8-76F T, 001482 U 166.00 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING I ADDRESS t P OWNER A.P. NO. MAIL BUILDING 31 9T ADDRESS ADDRESS TEL. CITY NO. TRACT LOT CK CONSTRUCTION NEW 11 ADD ALTER P LENDER BRANCH OWNER ADDRESS ALUE ARCHITECT TEL. ' USE $ OR ENGINEER N FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZONE NO. OF USE OF NEW TEL. PLANS BUILDING CITY NO. STATE CITY YARDS APPROVED YARDS APPROVED LIG. NO. LIC. NO, MAIN BUILDING ACCESSORY BUILDING SIZE NO, OF 8LDGS. (FROM C/L STRE ET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT. FT. Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & 14 MAIN BLDGS. ACCESS. BLDGS. VAR.+ DATE r ' C.U.P. + APPROVED APPROVED DATE I hereby acknowledge that I have read this application and state that the above Information Is correct and agree to comply with i all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. i 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: am exempt from the provisions of the State of California Business ; and Professions Code, Division 3, Chapter 9, VALUATION PERMIT FEE $ r � PLAN CHECK $ Signature of 7 Permittee $ t .it TAX $ �y � V t Authorized Agent TOTAL. PAID $ � City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. Q O C G 9 9 P. 0. Box 1200 Costa Mesa, California The Building located at '11_Ri ATRWAV 179TT i has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group A-7 Occupancy. Use of Building CIWTC7 Legal Description A92-1Q4—f1g. {See reverse side for Mates and Boundsl Building Permit No G11)486 Electrical Permit No. C, -154a6 Plumbing Permit No. G-15486 Mechanical Permit No. r-1 r,4tar, Number of apartments and/or guest rooms ISSUED TO: Building Official !� JOIN TW -TT) byal _ 3185 ATRWAY ;41. CYRM WFAA. r.A_ %I dS_ Date_ This Certificate of Occupancy SHALL BE posted in a conspicuous place on;he premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (ej U.B.C. CMF 1015.46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in alt spaces except those within heavy border lines and sign all appropriate declarations. -CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mai Owner's Name Address Arch/Eng. License No. Address' Contractor's Na &e22&SC=_Phon Address (mailing)c z? City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7004) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class— Icon N 6 Date /�—� Q mt3 Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation, Insurance, or a certified copy thereof (Section 3800, Lab. C.) )olicy No. Company L� Certified copy Is hereby furnished. ❑ Certified copy Is filed with the city Building Division. Data Applicant EXEMPTION'FROM WORKERS' COMPENSATION'DECLARATION (This section need not be completed If the permit Is for. one hundred ($100) or less). I certify that in the performance of the work for WhSo this permit Is Issu �l shall not employ any person In any mannerso a bec subject t Workers' Co Laws of CaIP is Date ��j!ok Signature NOTICE: 11, after making this declaration, you oe3ultl m coes sect to the Workers' Compensation provisions of the Labor Code, you must forthwith comply -with, such provisions or this .permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY'. I hereby affirm that there 1s a construction lending agency for the performance of the work ,for which this permit is Issued (Section 3097 Civ_. C.). Lender's. Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions Of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of -Division' 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil nnalty of not more than five hundred dollars ($500). ! I, - as owner of the' property or my employees with wages as their sole ampensatlon, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License taw does not apply to an,owner of a property who builds or improves thereon, and ,who � does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- for the purpose of sale). rove 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(iSection 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property -who builds or Improves thereon, and who contracts for such projects with a con- tractor($) license pursuant to the Contractor's License taw): OTam exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have read this appljcatlon and state that the above information Is correct• I agree to comply with all city and.county ordinances and'state laws relating tyy7jbuilding nstructio ,and hereby authorize repre- sentatives of this city/to enter u on the b v -mentioned property for Signature/. _69dC 1 Drivers' License or SS -* PERMIT NO. TRACT NO. LOT NO. BLD TYPE OF CONSTRUCTION U.NEW LJ ADD LJ ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK _ A.P. # Zone. S. Main Building: Accessory Building: Z TYPE OF PERMIT�l GRADING 1:1FOUNDATION STRUCTURAL - ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER / PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ,ZONE GRADING CU.YDS. ACRES E T Front O N A Rear I C Right G S Left E Ping. Ref. # Park.Fees $ Q U Remarks: Parking Req./Provided I 45 9 1-7/ p Z Use of Building: E M E N T S - PLUMBING FEES Planning Notes: B& Sink Showers Backflow Preventer Service Sink' Backfiow irrigation Sewer Cap ELECTRICAL FEES Bathtubs Sewer Connection Automatic Washer Construction POIeSUh. Transformer ❑ 15=50 KW ❑ 50'+ KW ' Clarifiers ', Solar Collectors r Dishwasher Solar Piping - ' " - - Cooking Unit'" Motor ❑up to 100 amps Drinking Fountains r` Solar Tank Dishwasher Meter Clover 100 amps VI16or Drains; Swimming Pool vv/Spa I Dryers ❑Gas ❑ElectricSub Panel I r Floor Sinks Urinal _ Fan' Motors ❑0-1 HP ❑ 11A-8 Gas Service Outlets Water Closet F, A. U. Inc. Solar 09•15 HF 016.15+ Interceptors Water Heater Fixtures Microwave b Kitchen Sink ,r Water Service Device Boxes Pole'Light Lavatories Outlets Range P—Trap r Switches Sign 3LLL- Roof Drains - Garbage Disposal Standing Sections Generator E10-5 KW F-15-15 KW Trash Compactor Reinspection : Fee $25 Issue Fee $ .3 Reinspection Fee $25 Issuo Fee $ 3 MECHANICAL FEES PUBLIC.SERVICES REQUIREMENTS: Zoning Approved By nate Application Approved By Date Application Issued By Date Boiler Hood or Type I - ❑ Canopy Type It ❑ Duct - Under Ground Duct - Structural Refrigeration System 130-100,000BTU 11100,000 BTU Duct - Ventilating BUILDING PERMIT ' $ PLAN CHECK $ PLUMBING $ PLAN CHECK $ ELECTRICAL $ PLAN CHECK $ MECHANICAL $ PLAN CHECK $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ P.C. $ � r 4'D GRADING $ — 9. %0 MICROFILM $ TOTAL FEE $ SA Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO # Heating System & DuctingENERGY ❑0-100,000 BTU 0100,000 BT - - Reinspection Fee $25 Issue Fee , $ 3 L\ CMF 0865-46 rev. 7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & 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. 7i /1 " 55. Electrical Bonding 5. Ste6l 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, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. `' 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 'i 62. Backwash & Receptor-Final 12. Sewer Cap F, 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 W uy }DNS 67. Fencing &Access Approval 68. APPROVED FOR PLASTERING 17, Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling �p 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21, Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing r 73. Undergrnd. Storage Tank ❑ Gas ❑ 00 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 iD {{ 06 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. 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 8621 I'/L'i/'.'_ Zone Accessory Building: tpark.Fees $ , t Z O N I N G R E Q U 1 R E M E N T \3800, I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a•certified copy thereof (Section. • Lab. --» J -T� /) Backflow Preventer t -- ' Applicant.to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PER ET NO. TRACT NO. LOT NO. BLD . Sewer Cap , I J CONSTRUCTION PERMIT / ELECTRICAL FEES - o/. �r��;- policy No. Company -'F jf.S ®Certified copy Is hereby furnished, I Bathtubs Sevver Connection Project Address A TYPE OF CONSTf1UCTION_ NEW ADD ALTERATION 11 REPAIR Transformer (] 15.50 KW i \Certifie opyr) fj�with the city I i Dlvisi Date_ / J->— Applicant ' 1:1 1:1DEMOLISH ❑ OTHER ©50 + KW Clarifiers Solar Collectors Applicant's Mailing Address CONVERSION A_p6 p g -�� Solar Piping Owner's Name d hone DESCRIPTION OF WORK S Main Building: I ceF 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 tke Workers' Compensation Laws of California. Date Signature ' NOTICE: If, after making this declaration, you shquld became subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provision, or this permit • %hall be deemed revoked. P CONSTRUCTION LENDING AGENCY Address ' TYPE OF PERMIT GRADING' FOUNDATION STRUCTURAL T Front — ' ArchlEng. License Na. ❑ TENANT❑ £L£CTRICAL ❑ PLUMBING L;1GIECHANICAL 13R Fan y Address. ❑ OTHER A ear ear Water Heater Fixtures f ' C Right I hereby affirm that there is a construction lending agency for the performance' fthe work for which..this perm[t is issued •(Section 3097 Clv. 'C.)ender's Contractor's Nam Phone PROJECT DESCRIPTION SQ. FT. OCCUPANC KLeft, Boxes, i Device Pole Light f Address {mailing) f(r! U CONSTRUCTION TYPE VALIDATION $ S. - - City. License No. ZONE GRADING Cu, YDS. ACRES Ping. Ref. # I hereby affirm that I am exempt from the Contractor's License Law for the following reason'(Sectlon 7031,5.Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commenting with'Section 7000) of Division 3.of the Business and Professions Code) or that he/she is exempt ,ierefrom and the basis for the alleged exemptioh. Any violation of Section '031.5 by any. applicant for a permit subject% the applicant to a civil pp,e,,nalty of not more than five hundred dollars ($500{. ' LI 1, as owner of the properly ,or my employees with wages as their sole compensation will do the work, and the structure is not Intended or offered for sale (Section ,7044, Business and Professional Code: The. Contractor's 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 employees, provided that such Improvements are hot Intended or offered for y sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or lm- rove for the purpose of sale). as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, ButEness and Professions Code: The Contractor's License Law -does not apply to an owner of properly whoB 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 exempt under Section — B. & P. C. for this reason ' LICENSED CONTRACTOR DECLARATION - Remarks: Parking Req./Provided - _ _ 'Hoof Drains - I hereby affirm that I am licensed under provision%of Charter 9 (commencing - Generator ❑0.5 KW 115.15 KW Trash Compactor Reinspection Fea , with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: Reinspection Fee $25 'issue Fee $' 3 my license is in full forceaT��i effe PUBLIC SERVICES RE4UIREMENTS: ' - Zoning'Approved By pate Application Approved By —_ — _ Date r I Application Issued By Data Boiler ' Li`—'� 1U 1 cense Class rise N PLUMBING FEES Planning Notes: CaterSignatureySignature l WORKERS'COMPENSATION DECLARATION c Bar Sink Showers ` Duct -Structural 8621 I'/L'i/'.'_ Zone Accessory Building: tpark.Fees $ , t Z O N I N G R E Q U 1 R E M E N T \3800, I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a•certified copy thereof (Section. • Lab. --» J -T� /) Backflow Preventer t -- Service Sink 1 '$ Backflow Irrigation Sewer Cap , I ., ' ELECTRICAL FEES - o/. �r��;- policy No. Company -'F jf.S ®Certified copy Is hereby furnished, I Bathtubs Sevver Connection Automatic Washer Transformer (] 15.50 KW i \Certifie opyr) fj�with the city I i Dlvisi Date_ / J->— Applicant Construction Pole Sub. ©50 + KW Clarifiers Solar Collectors - EXEMPTION FROM WORKERS_COMPENSATION ECLARATION (Thissection need not be completed If the permit is for one hundred (a100) or Dishwasher p g -�� Solar Piping - Cooking - - '- - Meter ❑up to 100 amps - ' - ' { 11 I ceF 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 tke Workers' Compensation Laws of California. Date Signature ' NOTICE: If, after making this declaration, you shquld became subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provision, or this permit • %hall be deemed revoked. P CONSTRUCTION LENDING AGENCY Drinking Fountains 9 Solar Tank � � Dishwasher Meter Dover 100 amps , ' floor Drains - Swimming Pool w/Spa Dryers ❑Gas DElectric Sub Panel Floor Sinks Urinal r Fan , Motors DO -11 HP DIX. - B Gas Service ; Outlets Water Closes 1 I F, A. Inc. Solar ❑9-15 HP 01615+ Interceptors - Water Heater Fixtures f ' Microwave ' C y I hereby affirm that there is a construction lending agency for the performance' fthe work for which..this perm[t is issued •(Section 3097 Clv. 'C.)ender's Kitchen Sink Water Service Boxes, i Device Pole Light f I Name, o-ender'sAddress OWNER$UILDER RECLARATION Lavatories 9 = - - ,Outlets - Range ' {,' ' ' r - • •� ' =r 3 I hereby affirm that I am exempt from the Contractor's License Law for the following reason'(Sectlon 7031,5.Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commenting with'Section 7000) of Division 3.of the Business and Professions Code) or that he/she is exempt ,ierefrom and the basis for the alleged exemptioh. Any violation of Section '031.5 by any. applicant for a permit subject% the applicant to a civil pp,e,,nalty of not more than five hundred dollars ($500{. ' LI 1, as owner of the properly ,or my employees with wages as their sole compensation will do the work, and the structure is not Intended or offered for sale (Section ,7044, Business and Professional Code: The. Contractor's 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 employees, provided that such Improvements are hot Intended or offered for y sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/She did not build or lm- rove for the purpose of sale). as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, ButEness and Professions Code: The Contractor's License Law -does not apply to an owner of properly whoB 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 exempt under Section — B. & P. C. for this reason P -Trap i ,' Switches, Sign - _ _ 'Hoof Drains - Garbage Disposal Staliding Sections ' - Generator ❑0.5 KW 115.15 KW Trash Compactor Reinspection Fea $25' Issue Fee $ 3 Reinspection Fee $25 'issue Fee $' 3 MECHANICAL FEES PUBLIC SERVICES RE4UIREMENTS: ' - Zoning'Approved By pate Application Approved By —_ — _ Date r I Application Issued By Data Boiler ' Hood or Type I ❑ canopy Type II ❑ Duct -Under Ground Duct -Structural Ref rrii9_eration System L1d(}1 (]0,000 BTU 131100,000BTU g -� Duct - Ventilating UILDINGPERMIT$ PLAN CHECK P? ,UMWNG PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL �' PLAN CHECK I SUMMARY OF FEES ` SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ %j $ J7, TOTAL FEE $ 0`q 7D " $ Exhaust System El Multiple- El. System Repair/Alteration Firepl/Fact. Blt. IC80 # 9y Date ' Owner: -- _^ I hereby certify that 1 have read t2his and state that the above information is correct. I agree to co pl with all city and county ordinances and state laws relating, bu ping truction;'and hereby authorize repre- sentatives of this city t ter n the oVe-mentioned ' a ty .f inspection purposes. _ Signature ate Drivers' License c ss �1 / pC Hea ng System & Ducting 100,000 BTU ❑l00,000BT a�3 Reinspection Fee $25 Issue Fee .CMF 0865-46,rev. 7/83 white - Building; Canary - Applicant: Pink -'Accounting; Goldenrod - Assessor ' CONSTRUCTIpN AND PLANNING APPROVALS Permit # Date -r Inspector • POOL - SPA 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 LIFER GrndLj� 57. APPROVAL TO COVER-GUNITE - 7. -Footings - %� . L .. 58. Electrical- Conduit-Undrgrnd. 8. Foundation , .°.� .. S 59. Gas Pipe, © Undrgrnd., Test 9. Water Pipe-Undrgrnd.- i - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 4 10. Structural Floor Sys#em ; ' 61. APPROVAL TO DECK 11. Property Sewer Line & House Con` ection 62. Backwash & Receptor -Final 12. Sewer Cap i 63. Heater & Vent -Final 13. Roof Drains , , ti 64. Plumbing System - Final 14. Rough Plumbing `- �' 65. Electrical -Final 15, Rough Electrical -Conduit i ` 66. Soldr 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 1 73.- Undergrnd, Storage Tank ❑ Gas ❑ 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 1 ' 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. 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 f ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -CITY 01= COSTA MESA CONSTRUCTION PERMIT / Project Address + %1�✓ ` Applicant's Mailing Address is % PER IT NO. S T CT NO. - LOT N(O�. UNIT ,e r TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ TENANT ❑ELECTRICAL Owner's Name 54 4P0 R� i�'1/� ^Phone - r�71 0 ❑CONVERSION LJ DEMOLISH ❑OTHER A.P. AA Address 3JbS'H ,4)1ZiJ AX DESCRIPTION OFWORK/USE OFBLDG. M ' B 'Id" Arch/Eng. —Jai mw -o ��- ` License No. Address 2B1/ V%Ll,? 1 ,XB _ /�%6w1�Yli--7 Contractor's Name �A"1G SEE2,�GI Phone -3g+ 7S' Address Imaifingl v � p C City License No. LICENSED CONTRACTOR DECLARATION I' hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In f II force and effect, �1 License Class Licen No,j5aS 8I Date 1 00 .2 -73 4�3 4-- Signature u WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of cgnsent to self -insure or a certificate •f Workers' Compensation Insurance, or a certified copy thereof (Section ,800, Lab. C. $ 'iA�' E F V ND Policy NO. G� 5 a ` %4 Company Certified copy is hereby furnished. _ Certs)' copy is filed with the city Buijq.ing DiviFi Date Applicant __�•s�,�i f� 11L.l EXEMPTIO FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less): I cart ify•that In the performance of the work for which this permit is issued, I shall not employ any person m any manner so as to become subject to the Workers' Comp satlon Laws of Calito �nya , Date _I O - f Signature Rt �_ C\ NOTICE: If, after making this declaration, you ould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed -revoked. CONSTRUCTION LENDING AGENCY - i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, after, improve, demolish or 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 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 •herefrom and the basis for the alleged exemption. Any violation of Section '031,5 by any applicant for a permit subjects the applicant to a civil � natty of not more than five hundred dollars (5500). l._f 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselt/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improverhent is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of )the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractor(s) Ilcense pursuarit'tO the'Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to compfy•With all city and county ordinances and state laws relating to building constr4ction, and hereby authorize repre- sentatives of this city to enter, u on the above-mentioned property for Inspection purposes Signature Date Z' /r>, -d✓1s f+ t S a ul mg. TYPE OF PERMIT GRADINGr ❑ FOUNDATION STRUCTURAL' E T Front _ ❑ TENANT ❑ELECTRICAL PLUMBING ❑MECHANICAL B Automatic Washer - Construction Pale Sub. Transformer ❑ 15-50 KW ❑ 50 + KW A Rear -[:],OTHER Sewer Connection C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K' Clarifiers '�_ CON STRUCTION TYPE ZONE GRADING VALUATION $ ?Li -'tacit CU. YDS. ACRES S Left Ping. Ref. # Remarks: _ I u fly S-S�,_js Planning Notes: r_ 9311 10/02/84 I Zone Accessory Building: Parking Req./Provided ;�5 t'`.j»T Com► 3,08.51 Z O N I N G R E. O M T S. Reinspection Fee $151-A-_ Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firep(/Fact. Bit. ICBO + Heating System & Ducting ®0.100,000 BT ❑ 100,000 BTi Drivers' License or 55 �F I I Reinspection Fee CMF 0865.46, rev. 4/84 White - Building; Canary - Pink - Accounting; Goldenrod - AsSeS5or $15 Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 1100,000 BTU System Repair/Alteration Issue Fee LLI Reinspection Fee $15 FEES DEVELOPMENT SERVICES—E01 Zoning Approved By Building Approved By Application Issued By Issue Fee $ 3 RE ENTS: Date In .L'��_� Date 4^ 2--8 PLUMBING FEES SUMMARY OF FEES $ i-13-C)D $ $ 15-OC�� $ ✓• 00 $ �Q� $ $ $ 3-50 !tO r — LJ4_- f..] CS 4 ELECTRICAL FEES Bar Sink Showers Backflow Preventer Service Sink, Automatic Washer - Construction Pale Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap-, Bathtubs ul Sewer Connection Cooking Unit ''k. ' Meter ❑up to 100 amps Clarifiers '�_ Solar Collectors Dishwasher 7({ Meter ®over 100 amps 2W4p -7 _ Dishwasher +1 Solar Piping' Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors [30-1 HP -❑1%-8 2 Floor Drains Swimming Pool vv/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ Floor Sinks UrinalFixtures _ _ Microwave t� Gas Service Outlets Water Closes Device Boxes Pole Light Zg Interceptors Water Heater Outlets Range Kitchen Sink Water Service CC D3, Switches Sign Lavatories } Garbage Disposal Standing Sections P -Trap Generator 110-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $151-A-_ Issue Fee MECHANICAL Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firep(/Fact. Bit. ICBO + Heating System & Ducting ®0.100,000 BT ❑ 100,000 BTi Drivers' License or 55 �F I I Reinspection Fee CMF 0865.46, rev. 4/84 White - Building; Canary - Pink - Accounting; Goldenrod - AsSeS5or $15 Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 1100,000 BTU System Repair/Alteration Issue Fee LLI Reinspection Fee $15 FEES DEVELOPMENT SERVICES—E01 Zoning Approved By Building Approved By Application Issued By Issue Fee $ 3 RE ENTS: Date In .L'��_� Date 4^ 2--8 BUILDING PERMIT' PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ i-13-C)D $ $ 15-OC�� $ ✓• 00 $ �Q� $ $ $ 3-50 SMIP PERMIT ISSUANCE ENERGY P.C. GRADING - MICROFILM TOTAL FEE $ Z ti� $ $ $ $ ' $ _$3 CONSTRU&ION AND PLANNING -7 APPROVALS Permit # Date Inspector - POOL SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ;l �b��r`�� L� 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, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrrid. 60. Backwash Lines, P-Trap, ❑ 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 /Z 77 �� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air. Conditioning f� Ifs% ! I�AD FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21.' Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73, Undergrnd. Storage Tank ❑ Gas ❑ Oil 25, Roof Sheathing 74. Overhead Hydro 26, T-Bar Ceiling (Structural) & Monoeoat I4 r3%c/ 75. Dry Chemical 27. Frame and Flashing 3/g� �k5Z( �1 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-FinalR 80. FOOD CERTIFICATE ISSUED 33, Final Electric Notes: /,e/j' f'" /yo (per /ry Rf, dj4- cco 34. Final Heating & Air Conditioning 1145- GJ~i'o 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. Backfiow _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 OD 51. CERTIFICATE OF.00CUPANCY ' No. Date COSTA MESA BUILDING -SAFETY DEPARTMENT " P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 4PP 1-7F.AcL, Building #6 MIIIIIIIIIIIII APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink OnJyv7 RECF,yVFp BY DATE RECEI D DATE ISSUED i�/�!/Pl BUILDING ADDRESS 3185 H AirwayAvenue PERM � -� OWNER Koll/Irvine * A. ' N°. - MAIL BUILDING ADDRESS 190 Dove Street ADDRESS ADDRESS %�� TEL. CITY NO. T AG`T LOT OCK CONSTRUCTIO �}nknown W ADD MOVING LENDER BRANCH OWNER ADDRESS ' VALUE B s ARCHITECT TEL �39-554 OR ENGINEER a — N FIRE ADDRESS 44 Plaza Square, Orange ZONE YPE GROUP APPROVE CONTRACTOR BY DAT 46 ADDRESS 1901 Dove Street Z NO. OF USE OF NE TEL. CITY Newport Beach No. 833-303(PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 22 LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE=NOW O. OF BLOCS, (FROM C1L EET) OF LOT ON LOT FRONT FT. USE OF EXISTING BLDG. F Separate permits are required for L SIDE T, FT. electric, plumbing and heating work. REAR F . USE OF BUILDI G ANDWOR TO BE PERFORMED DISTANCE BET. BET. MAIN & If41 oe MAIN BLDGS. ACCESS. SLOGS. VAR.+ DATE C.U.P, * APPROVED : APPROVED RY DAT I hereby acknowledge that I have read this application and state n that the above Information Is correct and agree to comply with all laws regulating building construction, and I shall not employ y any person In violation of the workman's compensation laws of 6400 tho State of California, I hereby certify that I em properly licensed as a contractor under SO. FT, 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: am exempt from the provisions oft a State of California Business v VALUATION PERMIT FEE S and Professions Code, Division 3 r 9. m PLAN CHECK a I 4111^� o Signature of —TAX �+A40 Permittee $ S U Authorized Agent TOTAL PAID S JJWe COSTA MESA BUILDING -SAFETY DEPARTMENT P.Q. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS , OWNER MAIL TE L. CITY _ NO. CONSTRUCTION SPR 28-7hr8N011+81 U* *21 }.00 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY DATE RECEIVED DATE ISSUED P A.P. NO. BUILDING 0 ADDRESS + TRACT I LOT I ACK BRANCH OWNER ADDRESS V LUE ARCHITECTTEL. US $ '0 OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING .F� STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING ttj SIZE NO. OF BLOW. (FROM C/L STREET) Ad OF LOT NOW ON LOT FRQNT FT. FT. Q USE OF EXISTING BLDG. A. SIDEFT t/] HSeparate permits are required for L, SIDE FT. FT. electric, plumbing and heating work. ❑ REAR FT. FT. EW„ USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & Q❑ MAIN BLDGS. ACCESS. BLDGS. VAR. + DATE .a • ' C.U.P. 9!E APPROVED a APPROVED RY DATE J W O 0 1 hereby acknowledge that I have reed this application and state 'n p+„ that the above information is correct and agree to comply with m all laws regulating building construction, and I shall not employ Y Z any person In violation of the workman's compensation laws of the State of California. 3 Y hereby certify that I am properly licensed as a contractor under SQ. FT. Co the State of California Business and Professions Code, Division 3, D THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full farce and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: - am exempt from the provisions of the State of California Business v and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $ m PLAN CHECK $ o Signature of Permittee $ TAX $ LL Authorized AgentO TOTAf_ PAID $ F -. , - 4363.1' ,F, --77FAr':QO 5t+7'1 **tr 179.36 ' COSTA MESA BUILDING -SAFETY DEPARTMENT Ch's P.O. 80X 9200 COSTA MESA, CALIFORNIA 92626 AP Lf ATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only REC 1 D DATE RECEIVED DATE SUED BUILDING ADDRESS r A.P. NO. �O PERMIT NO. OWNER 1 �� MAIL r, BUILDING ADDRESS Y- ADDRESS TEL. �L`07 / CITY �7 NO. FiAGT LOCK CONSTRUCTION W AD ALTERREPAIR LENDER BRANCH J OWNER f ADDRESS _ VALUE t W ARCHITECT TEL. S �J I OR ENGINE R /• N IL0. FIRE ADDRESS /V S ZONE TYPE:g= GROUP APPROVED CONTRACTOR BY DATE ADDRESS T E ZONI I NO. OF USE OF NE CITY NO PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 11j / LIC. NO. MAIN BUILDING ACCESSORY BU W SIZE NO. OF BLDGS (FROM C/L STREET) 0. OF LOT NOW ON LOT ERONT T. F Q W usE OF EXISTING SLOG. F " FT Separate permits are required for L. SIDE FT. F electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. a MAIN & AMAIN BLDGS. ACCESS. SLOGS. n.. VAR.* C.U,P. I DATE APPROVED > APPROVE ",L,Dai, .a W 06 G 1 hereby acknowledge that I have read this application and state r, QC that the above Information Is correct and agree to comply with m 9. all laws regulating building construction, and I shall not employ y Z any parson In violation of the workmen's compensation laws of the State of California. CD 3 I hereby certify that I am operiy licensed as a contractor under SO. FT. `v THE AMOUNTSHOWN UNDER VALUATION IS FOR the Stateof California si ass and Professions Code, Division 3, M Chapter 9, and that su I anses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the ov along Of the S ate of California Business to a and Professions Cod i Sion 3, C ap VALUATION PERMIT FEE $ uti PLAN CHECK S 2O c Signature of i TAX $ Permittee S Y / � TOTAL PAID S , Authorized Apen City of Costa Mesa Building Safety Department P.O. Box 1200 Costa Mesa, California " CEiRTIFIC,ATE OF -OCCUPANCY 1• The Building located at -"ill A has been inspected and found to comply with the -provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 13..E Occupancy. Use of Building Tn-f-"+irnr Al s saraf tri* Legal Description (See reverse side for Metes and Bounds) B -47321-i-4795 Building Permit No. 13-4733 Electrical Permit No.�i; n-4829 Plumbing Permit Na. Number of apartments --f3-- and/or guest rooms _0_ i ISSUED TO: Building Official ' Weft Coast Industrial Relations C. N tfi Bding Division DiXe. tOr Date -�IQ�%� This Certificate of Occupancy SHALL BE posted in 'a conspicuous place on the premises and SHALL NOT BE. removed except by the Building Official of the City of Costa Mesa under Sec. 306.[el U.B.C. n Form RU 34 Rev. 11/70 W (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 3185 AIRWAY AV Suite No J Vicinity: UNIT J. KINGS SEAFOOD Parcel Number: 42719405 Applicant: GARRY, BOBBY Address: 10880 WALKER ST Phone: 714-484-9600 CYPRESS; CA ' C Zip: r,90630 f ISSUE[ Owner: ,UNIVERSITY RESTAURANT GROU_P_INC Address: '3185'AIRWAY AVE1� " - - ' ' STE J Phone: COSTA MESA, -CA, Zip: 92626 r Contractor: TALENVAIR/ /, / �JJLa! Status: ISSUED Applied: 03/12/2007 Issued: 03/12/2007 �(4 Address:', 10880 WALKER ST Phone:' '714-484-9600 CYPRESS, CA ; Zip: %90630-501.1 111 4 _ License: 702568 SCOPE OF PERMIT"o= i .MECHANICAL. PERMIT FOR A 10,'834SF EXTERIOR AND INTERIOR T.I. FOR•",KING'S SF_AFOOD CO", UNIT;J. " - REF#: B06-02161' WORK TO INCLUDE: ISSUE FEE Init FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst I Rep. Recess Wall Htr Ref rig Sys <100 k BTU , Refrig Sys >100 k BTU Gas Piping Factory Fireplace �• �� Hood wlMech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers,,' Inst or Relocate Appl Vent Air Handlers < 10000drn Air Handlers > 10000cfm`. Floor Furnace Floor or Suspend Healer --10.00 0 / � r _ -� � -investigation Fee � / � $0.00 c _ Plan Check Fee j !,J '' $0.00 \ ; Reinspection Fee - ; , G' $0.00 ;'JOTAC CALCULATED FEES $161.30 COMMENTS 1 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) 7545626 2448-48 (BIOOf FEE SUMMARY - � Quantity ti Quantity $23.50 - ,'r = . -Repair/Alt Absorbtion Unit ' �. ' 1$0.00 0, $0.00 0 _ _ _ _ �__ _ Repair/Alt Refrigeration Unit $0.00 0. $0.00 .0 _ r. - Ventillation System _ _ '$0:00 0 $123.30 9 Evapor:ative`Cooler ;' $0,00= 0 $0,00 0 Commercial incinerator �. , $0.00 0 $0.00 0 Domestic�lncinerator $0.00 '0, $0:00 0 Compressors I Absorption Systems ,; r $0.00 $0.00 0 0 Up to 3 hp 1 100 k BTU ;i' .�� „ ',:�. 3 o 15 hp 1500 k BTU r� "$0.001 "$000 0 "o $0.00 0 . ; "�� ' 15 To 30 hp 11,000 k BTU /- ,.� $0.00 - 0, $0.00 0 30 To 50 flip 1.1,750 k BTU/ • ' $0.00 , 0 $14.50. _•_ 2 .• Over 50 hp;! Ovef 1;750'BTU- �;/� $0.00 ; 0 ' $0.00 0 Boiler' $0.00. $D.00 0 0�� Up to 3 hp 3To 15 hp° --%' �� i lj; .$0.00 50.00 0 0 $0.00 �0' ��15to30hpr._' $0.00 0 $0.00 ., 0 � � 30 to 50 hp=- ' • ' � �� . � _ -/$0.00 0 �. $0.00, `0 . � - Over 50 hp __i,/' �;�� $0.00 0 $0.00> -0; - Other Mechanical -Fee �, "� Floor or Suspend Healer --10.00 0 / � r _ -� � -investigation Fee � / � $0.00 c _ Plan Check Fee j !,J '' $0.00 \ ; Reinspection Fee - ; , G' $0.00 ;'JOTAC CALCULATED FEES $161.30 COMMENTS 1 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) 7545626 2448-48 (BIOOf WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fallowing declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 o1 the tabor Code, for the performance of the work for which this permit is issued. rC(,T.h,,ri,_s My wo corn ensatf Insurance carder ang,policy number are: , I./ �} ) r:� CJ. 7Y1 A- �;.� PolicyNumber: �7`-f"`•'f X00 1 section need not be completed Me permit Is valued at one hundred dollars ($100) of less.) ✓ ❑ I ce' that in the rmance o1 the work for whi this it is issued, i shall not employ any person in any manner so as to become subject to the workers' compensation I a Califomia, and agree that If houl come subject to the workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith comply wi ase visions. 17 AppifCan ignafure: Date ` U WARNING: FAILURE TO S&II11RE 0R1ZERS• COr.I NSAT10N ERAGE IS UNLAWFUL AND SHALL SURIECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DDLLARE (5100.000), IN ADDITION TO THE COST OF PENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby.aff inn that I am licensed under prmd on Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and Professions Code, and my license is in full force and effect: Lic. f1 d 7i Gass _ f Contractor's Signature: bete:-- - f � CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a constructipn lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lander's 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 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a cMI penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sola compensation, WILL DO THE WORK, and the structure 1s not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the Owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of properly who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five ($) 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, swifolding, lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec, 341, Title 8, California Administrative Code), ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1 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 EMISSION$ CERTIFICATION: 1 WIII 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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). _........._...._... -..._....._.....-.....11.1.1 ..................... — ................ - ..............................................................................................................................1111 ....................... 2 Does or will the' applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions. requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................ _................................ _ ___...........................,............. -_............. -.._.................. ---................. ............. ...................................... ................................ .._-.._...... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. _ ..................................1111..-......................._ �.._......_..___..-.......................r.._.................---..................._...........................................,............................_..._.............................,........................-1111.. 4 If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ Na 5 Does or will the applicant or proserit or future building occupant require for the work which Is the subject of this a plication a ermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Ll No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................:• ---...--••----••---..-_...............:.:..-11_11..._^._ �..—..._....._.__-.__................._.......................................................................................................................................... .... .................._...-L._...........--.---•---•---- 6 Will any part of the facmllty to bo constructed under this permit be within 1000 feet from the outer boundaries of a ached? ❑ Yes ❑ No (If 'yes", the facility must meet the requirenment of Sections 25534 and 42303 of the California Health and Safety Code). .............. _ .. - ---1111--- ---...�................ .................................. ------•-•- - - - 7 If a permit from the South Coast Air QUali Mana ement 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 disdosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..................••---------•----------_......................-.......___..._..-.�.....---._..........._.......---..................-------•----........................................................-•-•-----•---•--...._..........1111...-•-----•--............._ 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 F ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city o antes relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon tha abov cribed property for inspection purposes. I a not to occupy or allow occupancy of any building authorized by This permit until final inspection. Signature - nen(s) ! ZID t� - rAWOr Authorqd Applicant r f-Dnre 1- CODE i. INSPECTION TYPE P6ff. INTMA CODE# INSPECTIONTYPE PAN 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re -Root N1� 210 Final Electrical 201 Final Block(Rotaining Well 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 .� Applicant to fill In ail spaces within heavy border lines and sign all appropriate declarations. CITYSOF COSTA -MESA TRACT NO, LOT NO. SLOG. NO. .. CUN&TRUCTION PERMIT y M9 Rroject Address I :5 J HIRWIhiTYPE OF CONSTRUCTIO 1� Owner S (20 V2)05Te/44—Phone ❑ NEW ❑ ADD ALTERATION Address 15947` ❑ REPAIR ❑ CONVERSION El DEMOLISH Arch/Eng. License No. ❑ OTHER Address Contractor S 0_ N/J5a,J 6;/Ca - Phone Address LICENSED CONTRACTOR DECLARATION, .1 hereby affirm that I am licensed under provisions of Charter 9 (com- mencing with section 7000) of ;.Division 3—of. the -Business and Professions Cod a d my license Is In full for an effect. 4,4 Llceti Class 0 Lice $ y Date '~ — y Sign _ WORKERS' COMPENSATION D CLARAATION I hereby affirm that i have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a Certified copy ,reof (Se n 3 0 b. C.). Icy NoCompany,r i6EA�2P' T__ Li Certified copy is hereby„furnishecl. O-Cfflfied copy Is filed with the city Building Division. EXEMPTION -'FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less): ' I certify that In the performance of the work for which this permit is Issued, I shall not employ any -person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lendingagency for the per- formance of the work for which this permit is issued (Section 3097 Civ. C.). Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 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 fe- qulres the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions -of -the Contractor's License Law rChapter 9 (commencing with Section 7000) of Division 3 of the •siness and Professions -Code) or that he is exempt therefrom and the ;is for the alleged exemption. Any violation of Section 7031.5 by .y applicant for a permit -subjects the applicant to -a civil penalty of not more than five hundred dollars ($500). 0 1, 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. (Section 7044, Business and Professions_Code: The Contractor's License Law tloes, not apply to an owner of a property who builds or improves thereon, and who does such work himself or through his 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 did not build or improve for the purpose of sale). © I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code. The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who con- tracts. from such projects with a contractor(s) licesned pursuant to the Contractor's license Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner 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 a tl to Iaws relating to construction, and hereby uthonee representat' f this c to tinter upon the abov ent ned property spection u o s. Slgnatur to 4 Drivers' License or SS -r DESCRIPTION OF WORK TYPE OF PERMIT _ ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL - ❑ TENANT ;d ELECTRICAL ❑PLUMBING ❑MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY —'CONSTRUCTION TYPE VALUATION ZONE GRADING CU. YDS. ACRES .REMARKS: _ r ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor A.P. :iF ZONE ' SETBACK C� S IO YARD ~ Clr'1F Y 7712 9/15/82 NING REGULATIONS PLNTTG.. RttE��F.ppzF PRO@@P k1 Y LINE REAR YARD (TO P/L) PKG. SPACE REQ, I STREET WIDTH ZONING APPROVED BY SPECIAL CONDITIONS: PROVIDED PARK FEE $ DATE 17.56 TL SUMMARY OF FEES PLUMBING " ' PLAN CHECK " BATHTUBS — SHOWERS TOILETS y URINALS LAVATORIES DOUBLE CAVS ' KIT; SINKS "' DISHWASHERS SERVICE SINKS SUMPS- FLOORtSINKS ti FLOOR DRAINS DRINKING FOUNTAINS INTERCEPTORS CLARIFIERS SWIMMING POOL' P TRAP - ' WATER SERVICE ALTERATION GAS SERVICE OUTLETS WATER HEATERS BTU OUTPUT SEWER CONNECTIONS SOLAR TANK - COLLECTORS ' SOLAR PIPING SYS. ISSUE F-E'E MECHANICAL PLAN CHECK HEATING SYSTEM AND DUCTING /- 0-100,000 BTU 100,000 + BTU REFRIGERAT16N SYSTEM' 0.100,000 BTU 100,000 +BTU BOILERS BTU SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor A.P. :iF ZONE ' SETBACK C� S IO YARD ~ Clr'1F Y 7712 9/15/82 NING REGULATIONS PLNTTG.. RttE��F.ppzF PRO@@P k1 Y LINE REAR YARD (TO P/L) PKG. SPACE REQ, I STREET WIDTH ZONING APPROVED BY SPECIAL CONDITIONS: PROVIDED PARK FEE $ DATE 17.56 TL FINAL FEE $ /' ' 1—& SUMMARY OF FEES BUILDING ELECTRICAL PLAN CHECK $ SMIP b PLAN CHECK $ PERMIT - GENERATOR'- TRANSFORMER APPLIANCE' '0-1 KW 10-50 KW_50 1.10 KW + KW MOTORS (INC. SOLAR) '0-1 HP _ 'I-10 HP - 10.50 HP 50 + HP " FIXTURESZ OUTL'ETSY XSWITCHES3t> $ j' -'GAS TUBE SI NS JJ �� S [— $ POLE'LIGHTS PLAN CHECK -' POLES METERED SUB PANELS '-" - MAIN SUB - SERVICE AMP ' ISSUE FEE APPLICATION -APPROVED BY C DATE FINAL FEE $ /' ' 1—& SUMMARY OF FEES BUILDING PERMIT $ SMIP b PLAN CHECK $ PERMIT - ISSUANCE S PLUMBING $ GRADING $ PLAN CHECK $ ELECTRICAL JJ �� S [— $ MICROFILM $ PLAN CHECK $ TOTAL, FEE $ MECHANICAL $ PLAN CHECK $ LESS AD- VANCE PC "$ _ FINAL FEE $ /' ' 1—& CONSTRUCTION AND PLANNING APPROVALS Permit ;# Yg�� Date Inspector POOL & SPA APPROVALS Permit.+- Date Inspector' 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. il Pipe-Undrgrn 4 • Steel Reinforcement I Electrical Conduit Utility Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding Steel ein orce 47. Rough Plumbing & Pressure Test 6, Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn B. Foundation 50. , Gas Pipe, p Undr rn Test 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap,❑ Undrqrn 10. Structural Floor System 52. ' APPROVAL TO DECK - 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12.- Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 55, Plumbing System - Final 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring a - 2 {�' 57. Solar System -Final 16, Rough Heating & Air Conditioning b8. Fencing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20. Roof Framing 21. Roof Sheathing NOTES: 22. Frame and Flashin -23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27, Electrical Power Meter -Final 28. Final Electric - - 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing 32. Water Service -Final - 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces Within heavy border lines and sign all appropriate declarations. CITY 10F COSTA MESA PERMIT NO. •TRACT NO. . LOT NO. BLDG. NO. - CONSTRUCTION PERMIT „s7 7578 9/13/62 ' 15.©E3 7L Project Address = 1$" _ w-4 TYPE OF CONSTRUCTIO ; OwnerW6tr CitWsj i6sT & hone ❑ NEW C3 ADD �TERATION Address ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ZONING REGULATIONS ArchlEng. SStit ,License Na. A P DESCRIPTION OF WORK G'� I Address pa Yr — LML.- 0,10../Cam ZONE -PLNG. REF. 5ft ' ContractorS Phone TYPE OF PERMIT To gt�1 I G Pi2oRkl Y LI Address f, Olt-�� f� Q 4 0, ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL SETBACK ST. 1 YARD NE- T LICENSED CONTRACTOR DECLARAON ID TENANT .❑ ELECTRICAL' ❑PLUMBING lld$AECHANICI Y I hereby affirm that I am licensed under provisions of Charter 9 (corn- 0 l RIGHT mencing with section 7000) of Division 3 of the Business and Professions Code, Vd my' license is In full force and effect: OTHER REAR YARD (TO P/L) ` PROJECT DESCRIPTION LlcenSe Class i�lo PKG. SPACE REQ. PROVIDED' I _ -�2 Signature f� Sq. FT, Date WORKERS' COMPENSATION DECLARATI N OCCUPANCY CONSTRUCTION TYPE STREET WIDTH PARK FEE $ + I hereby affirm that 1 have a certificate of consent to self-Insure or VALUATION ZONE ZONING APPROVED BY DATE- ' C, "tate Insurance, or a certified copy . ,_ -i - t ( cco,fj�pWorkers'hl,..aaCom�Gp.j)ensation s GRADING CU. YDS. ACRES SPE=CIAL CONDITIONS: • i Po,,.. y /Ls"Y20r/i✓/T�05�Company i C'e/`J!� r Cl-Certified copy is hereby furnished. REMARKS:_ _ _ i _ r Q"Certified copy is filed with the'city Bulldfng Division, EXEMPTION FROM WORKERS' COMRENSATION,DECLARATION - - This section need not be completed if the permit IS for one hundred •- - _ _ - _ _ -- ($100) or les).s-- - I certify that n the performance of:the- work for which this permit is "- ' issued, I Shall not employ_any person in any manner so as to become PLUMBING .� , - PLAN CHECK - ECFCTRICAL PLAN CHECK .subject to the Workers Compensation Laws of California. Date - Signature BATHTUBS SHOWERS SQFT_ NOTICE, if after making this declaration, you should become subject TOILETS URINALSGENERATOR 0-1 KW 1-10 KW to the Workers' Compensation provisions of the Labor Code, you must TRANSFORMER _ forthWith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS' - APPLIANCE 10-50 KW„___50 + KW _ revoked, CONSTRUCTION LENDING AGENCY KIT, SINKS - DISHWASHERS - MOTORS 0-1 P H_ 2-10 HP I here0Y affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - - - -(INC. SOLAR) -• 10-50 HP" _ 50 + HP �;� •• formance of the work for which this permit is Issued (Section 3097 Civ. C.). Lender's FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Name Lender's Address ~' ' `,^} }' ' .r ` • -DRINKINIG-FOUNTAINS - - 'GAS'TUBE SIGNS r OWNCR BUILDER DECLARATION I her0V affirm that I am,exempt from.the"Contiactor•s License-Law for INTERCEPTORS CLARIFIERS - - POLE'LIGHTS L" -SWIMMING ;.PTRAP POLES METERED SU8 { the folowing•reason,(Sect ton, 7031.5 Business and Pf0fessiohs"Codal, Any city or-County which requliet a permit •to*,construct, alter, WATER`SERVICE ALTERATION - `PANELS MAIW SUB Improve, demolish or repair any structure, prior to its.issuance„also re- quires the applicant for such permit to file a signed statement that he GAS SERVICE OUTLETS SERVICE AMP i r rased pursuant to the provisions of the Contractor's License Law ryer 9 (commencing with Section 7000) of-Division. 3 of the (f'Fss _ WATER HEATERS- - BTU OUTPUT', - . Y and Professions Code) or that he Is exempt therefrom and the . Sectlon 7031,5 by bd'-y -for the alleged exemption. Any violation of any applicant for a permit subjects the applicant to a civil .penalty SEWER CONNECTIONS .? of not more than five hundred dollars ($500), SOLAR TANK COLLECTORS' --L��•i ❑ 1- as owner of the-property, or my employees, with wages-as their sole compensation, will do the work, and the Structure is not intended SOLAR PIPING SYS. - - FE ISSUE FEE or offered for sale. (Section 7044, Susiness.and Professions Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and Who does such work himself or ISSUE FEE APPLICATION APPROVED BY DATE through his own employees, provided that Such improvements are not - MECHANICAL PLAN CHECK SUMMARY OF FEES. ' intendAd or offered for-sale. It, however, the building or improvement the owner will have the burden Is sold within one year of completion, of proving he_ did not build. or .improve for the purpose of sale), - HEATING SYSTEM 0-100,000 BTU BUILDING IT $ - _ SMIP $ ❑ I, as owner of the property. am exclusively contracting with AND DUCTING _ __PERM _ licensed contractors-to construct the project {Section 7044, Business 100,000 +BTU PLAN CHECK $_PERMIT _ and Professions Code: The Contractor's License Law does not apply to ISSUANCE $ an owner ofproperty-who builds or lmproves'thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - GRADING the Contractor's License Law). 100,000 + BTU PLAN CHECK $ ❑ 1 ern. exempt under Section B. & P. C, for this BOILERS BTU ELECTRICAL $ $ reason _ YSTEM REPAI R. ALTERATION - PLAN CHECK $ �a MICROFILM; $ TOTAL FEE $ Date Owner MECHANICAL • 1 hereby certifythat I have read this appilcation and Stale that the above EXHAUST SYSTEM MULTIPLE ,$ LESS AD- - -- Information Is correct. I agree to comply with all city and county PLAN CHECK "$ -' VANCE PC $ - - ordlnaRces and state tav,n relating to construction, and hereby authorize f + representatives of this •t to a upon the above mentioned property "nuwct �__•�,,,� � Signature ate FINAL FEE $ •Q Drivers' License or SS ISSUE FEE B� CMF 0865-46 White-Bullding; Canary-Applicant; Pink-Accounting; Goldenrod-Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &'"SPA • : ' -t' i ,APPROVALS Permit•# �� `' ;•-- Date Inspector 1. Temporary Electrical Service or Pole 43.. Pool & Equipment Location •,� Soit Pipe-Undrorn 44. Steel Reinforcement 3. lectrical Conduit Utility-Undrgrn - - ''� �` - a - 45. Forms4. , 4. Electrical Conduit-Undrgrn .'''� 46. ElecfricalBonding i Steel em orce 47. _ Rou h Plumbino & Pressure Test - F• 6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe ❑ Undr rn, Test,.- est,.9. 9. Water Pipe-Undrgrn 51, Backwash Lines P-Tra ❑ Undrqrn 10, Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53.- -Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final ,• • �- -ti, - 13. Rough Plumbing '55, Plumbing System - Final 14. Rough Electric-Conduit -' 56. Electrical-Final 15. Rough Electric-Wiring 57, Solar System-Final 16, Rough-Heating & Air Conditioning f encing & Access Approval 17. Ducts in Structure .. APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe-Rough & Test 20, Roof Framing 21. Roof Sheathing NOTES: 22. Frame and Flashing 23. Insulation .- 24. Lathing & Siding 25. Drywall Nailing G' 26. ' Plaster Brown Coat -- 27. Electrical Power Meter-Final 2B. Final Electric 29, Final Heating & Air Conditioning 30. Final Gas Pipe-Test _ - 31. 31.: Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 36. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison - ti 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No____ Date Applicant to fill in all spaces.wilhin heavy border lines and sign all appropriate declarations. CITI OF COSTA MESA PE IT NO. r' CONSTRUCTION PERMIT 2r TRACT NO. LOT NO. BLDG. NO. B(P 9/243/62 18000 TL \' 4 TYPE OF CONSTRUCTION ❑ NEW ❑, _A�D ❑ ALTERATION ❑ REPAIR !]!CONVERSION ❑DEMOLISH ZONING REGULATIONS ❑ OTHER DESCRIPTION OF WORK A.P. ZONE PLNG, RiuE1F. V1 Project Address LZ r Owner hone - Address r �, Arch/Eng. • A30?SOOL�s License No. Address Contractor N Phone TYPE OF PERMIT ❑ GRADING ❑ FOUNDATI,O5 ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL LYPLUMBING CIMECHANICAL ❑ OTHER SET ACK LST. PBUILDING ROBPEIRTY GNE Address I YARD SIDE YARD RIGHT LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (com- mencing with section 7000) of Division 3 Of the Business and REAR YARD (TO P/L) Professions Code, and license is In full force n effect, LlCense lass Lie a No, Data — Signature WORKERS' COMPENSATION DEC LAR ON I hereby affirm that I have a certificate of consent to self4nsure or a • 'ficate of Workers' Compensation. Insurance, or a.certified Copy ,PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION ZONE PKG. SPACE REQ. PROVIDED STREET WIDTH PARK FEE $ ZONING APPROVED BY, DATE SPECIAL CONDITIONS: of (Section 3800, Lab: C.).GRADING CU- YDS, ACRES y No. Company - ❑Certified copy is hereby furnished. EICertified copy Is filed with the city Building Division. REMARKS.- EMARKS:EI EXEMPTION FROM WORKERS' COMPENSATION DECLARATION L This section need not be completed if the permit Is for one hundred S$100) or less). -the certify that in performance ofthe work for which this permit is Issued, I shall not'emptoy any person in any manner so as to become Subject toth+�erkWorkers Compensation Of liforn . PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK SHOWERS SQ.FT. SO -FT - 23�k2 -Signature Date F_ -BATHTUBS Inc TOILETS-_ I URINAF_S - D O GENERATOR 0-1 KW 1-10 KW TRANSFORMER _ APPLIANCE 10.50 KW 50 + KW NOTICE: If after making this declaratioggou should become subject to the Workers' Compensation provision of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS 'e) revoked. CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP SERVICE SINKS - SUMPS 1 hereby affirm that there is a construction lending agency for the per- formance of the work for which this permit Is Issued (Section 3097 (INC. SOLAR) 10-50 HP" 50 + HP - - FLOOR�SINFCS� J�� FLOOR DRAINS - DRINKING FOUNTAINS ' FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS ' CW. C.). �_ w�" Lender's Name w V ._.~T--',; t Lender's Address,' _� OWNER BUILDE4jDECL RATION I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS CLARIFIERS - POLE LIGHTS ' SWIMMING POOL P TRAP POLES METERED SUB the following reason (Section 7031:5 Business and Professions, Code: Any city or county which requires a permit to construct, alter, -WATER SERVICE ALTERATION PANELS MAIN SUB. improve, -demolish or repair any structure, prior to its issuance, also re-- quires the applicant for such permit to file a signed statement that he `GAS SERVICE OUTLETS SERVICE AMP Is licensed.pursuant•to the provisions of the -Contractor's License Law If ter 9 (Commencing with Section 7000) of Division 3 Of the -WATER HEATERS BTU OUTPUT E ss and-Prolesslons-Code)-or that- he is exempt therefrom and the b, for'the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS I any applicant• for a- permit subjects the applicant t0 a civil penalty of not more than five hundred dollars ($500). _ SOLAR TANK - COLLECTORS -0. - -• , j ❑ 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 SOLAR PIPING SYS. ISSUE FEE , 4 or offered for sale. (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself or M ISSUE FEE w APPLICATION APPROVED BY DATE through his own employees, provided that -such Improvements are not MECHANICAL PLAN CHECK _ SUMMARY OF FEES BUILDING „ PERMIT $ SMIP $ PLAN CHECK $ PERMIT ISSUANCE .$ PLUMBING S 'GRADING $ PLAN CHECK $ ' j 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 did not build or Improve for the purpose of sale). [II, as .owner of the property, am exclusively contracting with licensed contractors to construct the prosect (Section 7044, Business and Professions Code: The Contractor's -License Law does not apply to an owner of properly who builds or improves thereon, and who con- tracts from such projects with a contractor(s) licesned pursuant to the Contractor's License Law). HEATING SYSTEM 0.100,000 BTU AND DUCTING 100,000 +BTU REFRIGERATION 0.100,000 BTU SYSTEM 100,000 + BTU ❑ 1 am exempt under Section B. & P. C. for this ELECTRICAL $ $ BOILERS BTU reason Date Owner I hereby certify that I have read this application and stale that the above lnformation- is correct. I agree to comply with all city and county ordinances and state laws relating to construction, and hereby authorize MICROFILM $ PLAN CHECK $_ MECHANICAL $ TOTAL -FEE $ - LESS AD- PLAN CHECK $ VANCE PC Vt._ - SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE representatives of this city to enter upon the above mentioned property for inspection r a S. Signature ate �, Drlvi;s� License or SS FINAL PEE s �� ` $ ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Gotdenrod-Assessor CONSTRUCTION AND•PEAN-NTNG APPROVALS Permit # Date Inspector POOL'& SPA.' APPROVALS Permit_# y Date - Inspector 1. Temporary Electrical Service or Pole 43. Pool,& Equipment Location' J-• 2. Soil ipe ndrgrn 44. Steel Reinforcement 1. Electrical Conduit Utility-Undrgrn _ _ _ 1, 45: . Forms ` 4. Electrical Conduit-Undrgrn _4.6_ . %E lectrica1.Bondi ng ` 5. Steel ein arce 47. Rdugh Plumbing & Vretsure'Tc"st' 6. Electrical UFER Grn 48. APPROVAL TO COVER rUNiTE Y 7.-Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, d Undr rn, Test ' 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra •Q U-ndr n 10. Structural Floor System 52•, APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent•Finat 13. Rough Plumbing 55, PlUml2ing System - Fina) 14. Rough Electric-Conduit :56. Electrical-Final 15. Rough Electric-Wiring - 57: Solar-System-Final 16. Rough Heating & Air ConditioningFencing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18.-, Ducts, Ventilating '60. POO.LISPA SYSTEMS FINAL ' •- 19. Gas Pipe-Rough & Test 20. Roof Framing - 21. Roof Sheathing NOTES: 22. Frame and Flashing 23. Insulation - - -,6 82- L 24. ' Lathing & Siding t ^• 25. Drywall Nailing _ 26.: Plaster Brown Coat .27. Electrical Power Meter-Final ` 26. Final Electric , 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing jr . 32.. Water Service-Final . _ 133. Gas Service-Finaf' ' 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation +37_ Handicap Regulations 38. FINAL STRUCTURE &.BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY 'No Date _ „ Applicant to fill In all spaces within heavy border lines and, sign all appropriate declarations, (.ST F COSTA MESA P MIT NO.` TRACT NO. LOT NO. BLDG NO. � 748 I ��7 TL CONS-TRVCTION PERMIT 4-%3 2_>07Z 5 -373.72 - - ,`,''roject Address 5 "Ave I TYPE OF CONSTRUCTION :_ 1 Owner WFSTa r , Phone ❑ NEW ❑ ADD ALTERATION Address i 7 C 0 R 14, REPAIR ❑ CONVERSION I'DEMOLISH Arch/Eng. Rle nb_ License No. ❑OTHER ZONING REGULATIONS DESCRIPT)ON OF WORK A-P-'ZIEPT Address -1 S p o C C, -J41 LL, - 0R—AG ZONE PLNG. REF. ; 4 12 IV. $ { rC .y Phone S 3 1. �) J TYPE OF PERMIT ,' SETBACK p gg��JJI LLol G 4ROPERT Address S� .I t EYE 1 k ❑GRADING ❑-FOUNDATION g[ STRUCTURAL - - ST. -,SIDE YARD LINE' r LICENSED CONTRACTOR DECLARATION ✓' - ❑ TENANT ELECTRICAL- �LUMBING �OIECHANICA - - - ) hereby affirm thdt 1 am licensed under provisions of Charter 9 (com- 7000) Division 3 the 'and ' ❑ I E Y RIGHT mencing with section of of Business Professions Code, and my license is In full force and effect. OTHER iREAR YARD (TO P/L) IContractor r� LlJ5Af No, 21 8 1 �+- PROJECT DESCRIPTIONLicense S<i Class _i1=J- - -f- - - - PKC. SPACE REQ. ROVIDED�t Signature �.d.Z�25Z— . - SQ. FT.L�Ae`Date DEGLARAfioN -self OCCUPANCY ON5TRUCTIONTYPET'"I STREET WIDTH ; • PARK FEE $WORKERS'comPENSATtON hereby affirm that'1 have a certificate of consent to -Insure or a VALUATION 0 ZONE ZONING APPROVED BY �Li DATE Q 18 certificate of Workers' Compensation insurance, or a certified copy _ v ~ eof { C 38 0, ): 'l ' 1i GRADING CU. YDS. ACRES SPECIAL CONDITIONS: ,, .y -N Company LL" Certified copy €5 hereby urn)shed. REMARKS. -_,g,_ 7r Cert ifed copy 0 filed'wlth the city Building Division;- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed If the permit is for one hundred ' ($100j I certify ar that less I; the performance of, the work for which this permit is issued.I shall not employ any person in arty manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subiect to the Worgers Compensation Laws of California. , - Date Signature BATHTUBS SHOWERS NOTICE: if after making this declaration, you should become subject TOILETS URINALS GENERATOR' 0.1 KW _ 1-10 KW to the Workers' Compensation provisions of the tabor Code, you must - TRANSFORMER _ _ - forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - _ _• _ APPLIANCE 10-50 KW 50 + KW € revoked, CONSTRUCTION LENDING AGENCY - KIT. SINKS DISHWASHERS - MOTORS 0-1 HP - 1-10 HP I hereby affirm thdt there is a construction lending agency for the per- SERVICE SINKS SUMPS' (INC. SOLAR) 10-50 HP 50 + HP ' formance of the work for which this permit IS issued (Section 3097 \ Cl V. C.).ppm T --- Lender's Name 'FLOOR SINKS-- ,—'FLLOOR DRAINS - "' FIXTURES � OUTLETS SWITCHES-~-- ,y Lender's Address a .� 1i2V�lU� DRINKING FOUNTRINS "i GAS'TUBE SIGNS---' OWNER BUILDER OFCLARATiON- I hereby affirm that I am exempt from the Contractor's License Law for following. reason {Section 7031.5,•Business:and-Professlons-Code: INTERCEPTORS ' CLARIFIERS POLE LIGHTS'- , SWIMMING POOL PTRAP - �'-" ' POLES ME EREO SUB .the Any city or county which requires a permit ,to construct, alter, WATER SERVICE -ALTERATION PANELS MAIN ,_ SUB improve, demolish or repa€r'any structure, prior to its issuance, also4e- quires the applicant for such permit to file a signed statement that he GAS SERVICE ``,"-'---OUTLETS SERVICE - AMP { Is licensed pursuant tO.the provisions of the Contractor's License 'Law �0^apter 9 (commencing with Section ;7000) of, Division 3. of .the he HEATERS` BTU.OUTPUT ess and Profe$Sions Cade) or that he i6- exempt,therefrom antl theWATER' for the alleged exemption. Any violation of Section 7031.5 by ' -SEWER CONNECTIONS---' a -applicant for a_permit,subjects- the -applicant to.a civil penalty of riot more than five hundred dollars ($500). SOLAR TANK COLLECTORS' ❑ 1, as owner of -the property,•or my -employees with wages as their- sole compensation, will do the work, and the Structure is not intended or offered for sale. (Section•7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License Law does not apply to an owner of a property ISSUE FEE ' APPLICATION APPROVED BY DATE who builds or- Improves thereon, and who does such work himself or through his own ernployees, provided that such improvements are not MECHANICAL PLAN CHECK met SUMMARY OF FEES Intended or offered for sale. If, however, the building -or improvement' Is sold within one year of Completion, the owner will have the burden of- proving he did not build or improve for the purpose of, sale). HEATING SYSTEM 0-100,000 BUILDING I��/ f l.00 2� El 1, as owner of the property, -am exclusively contracting., licensed -contractors to construct the (Section 7044, Business BTU -AND�OUCTING '' -' 100,000 PERMIT �$ + SM1P_ '-$' project and Professions Code: The, Contractor's License Law does not apply to. + BTU PLAN CHECK $ _L2 - PERMIT, I' + ISSUANCE $ ' an Owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ r tracts from such projects with -a, contractor(s)-llcesned pursuant to SYSTEM- GRADING $-+ "the t heContractor's License Law), 100,000 + BTU. --_PLAN CHECK $ * © 1 am exempt under Section B. &•P. C. for this BOILERS BTU -ELECTRICAL $$ reason SYSTEM REPAIR, ALTERATION PLAN CHECK $ MICROF)LJVI $ Date Owner MECHANICAL $ TOTAL -FEE $ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE LESS AD-- - - - information is corfect. I agree to comply with all city and county PLAN CHECK` $ VANCE PC $ ordinances and stat& laws relating to construction, and hereby authorize representatives of this city to enter upon the above mentioned property f inspec 'onurPs. e r * -�73 72. FINA-F$ s EE Signature e Drivers' License -or SS ISSUE FEE -Assessor t CMF 0865-46 white -Building; Canary -Applicant; Pink -Accounting; Goldenrod CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector -'POOL &•SPA f APPROVALS Permit # Date ` Inspector 1. Temporary Electrical Service or Pole 43.' Pool-& Equipment Location 2. SoilPipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4, Electrical Conduit-Undrgrn 46. ' Electria'Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. Electrical LIFER Grn r., 48. APPROVAL TO COVER -GUNITE - 7. Footings - '`' 49: Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe,' ❑ Undr rn, Test. 9. Water pipe-Undrgrn .51 71• -B'ackwash Lines P -Trap.❑ Undrgrn _ 10. Structural -Floor System 52. -APPROVAL TO DECK .1i. , Property Sewer Line'& House Connection 53. Backwash & Rece for -Final , 12. *Street Sewer Connection - 54: Heater & Vent -Final ` 13. Rough Plumbing . ---55, 'Plurnbing System - Final 14. Rough Electric -Conduit ' ' ' S6.: Etecir cal -Final 15. Rough Electric -Wiring _ 577 Solar -System -Final 16. Rough Heating & Air Conditioning - Fencing & Access -Approval 17. Ducts, in Structure 59. .APPROVED FOR PLASTERING 16. Ducts, Ventilating 60.-. POO L/SPA SYSTEMS F 1 NAL 19. Gas Pipe -Rough & Test 20. Roof Framing 21. Roof Sheathing- - NOTES: 22._Frame and Flashing 23. Insulation - --- 10 'p - 24. Lathing.& Siding -. s 25. Drywall Nailing 26. Plaster Brown Coat T Rt?- 0-7-' 27. Electrical Power Meter -Final 28. • Final Electric 0-0- 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing _ 32. Water Service -Final - 33, . Gas Service -Final " 34. Solar Domestic -Final 35..- -Landscape Sprinkling S stem 36. Sound Attenuation _ 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF CCUPANCY _ `. No Date 2 G Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. ..CITY GF COSTA MESA FP MIT NO. t TRACT NO. LOT NO. BLDG}NO. CONSTRUCTION PERMIT 9-4733[_Ao%� .� Project Address /gLJA V TYPE OF CONSTRUCTION 'Owner A S Phone ❑.NEW ❑ ADD ❑ ALTERATION ' Address ❑REPAIR ❑ CONVERSION" XDEMOLISH 1 Arch/Eng. B oinAcr License No. ❑ OTHER Address ! 9W DESCR TION OF WORK Contractor F?ZAAJ14 Phiinen4p.s%r TYPE OF PERMIT - AddressG 4At. ❑GRADING'.-'❑ FOUNDATION ❑ STRUCTURAL LICENSED CONTRACTOR DECLARATION ❑ TENANT ❑'ELECTRICAL ❑PLUMBING ❑NIECHAN I hereby affirm that 1 am licensed under provtsions'of Charter 9 (com- mencing with section 7000) of DIVision 3 of the Business' and ❑ OTHER' ` 7439_ 9/10/62 ZONING REGULATIONS,- A.P. W ^ Qb - . ZONE Pf)p PLNTTG.. ggRttE��F.DDcP7 BUILDING -- SETBACK LST. PROPEIRTYNLI ftp YARO' - _ , - Professions Code; a my license is -in full for an�Cd ffeCt.- . - - PROJECT DESCRIPTION - - REAR YARD (TO P/L) EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Licenrs�e Class cen -N - - PKG. SPACi REQ. ($100) or less). - I certify that n the performance of the work for which this permit Is Issued, 1 shall not employ any person in any manner so as t0 become subject to the Workers' Compensation Lbws of California. Date 3- '3 - a. Signature SO' - BATHTUBS ^' SHOWERS WIDTH Date Signature WORKERS' COMPENSATION DECLARAT OCCUPANCY CONSTRUCTION TYPE TOILETS <i URINALS _ STREET I` I hereby affirm that I have a certificate of Consent to self -insure or a VALUATION ZONE SERVICE SINKS SUMPS ZONING APPROVED BY I hereby affirm that there Is a construction lending agency for the per- formance of the work for which this permit is issued (Section 3097 certificate of Workers' Compensation Insurance, or a certified_ copy $ DRINKING FOUNTAINS ' +`+reof (Se ti Q 3 �t 1 ,A 'y No*! ��! 1T -f *cmpeny 024 • GRADING CU. DS. ACRES OWNER BUILDER DECLARATION I hereby affirm that I am exempt from.the Contractor's License Law for the following reason. (Section 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 re- quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the P ess.anct Professions Code) or that he Is exempt therefrom and the t for the alleged exemption. Any violation of Section 7031.5 by I ppilcant for a permit subjects the-applicant.to a civil penalty. of not more than five hundred dollars ($500). SPECIAL CONDITIONS: - - - - SWIMMING POOL P TRAP- ` - ;ertlfied copy is hereby furnished. 'ETCertified copy Is filed with the city building Division. REMARKS: ` ^ - - - - _ �SMIP EXEMPTION FROM WORKERS' COMPENSATION DECLARATION 1-10 KW SO'+ KW (This section need not be completed If the permit is for one hundred - FIXTURES- ____OUTLETS ($100) or less). - I certify that n the performance of the work for which this permit Is Issued, 1 shall not employ any person in any manner so as t0 become subject to the Workers' Compensation Lbws of California. - - PLUMBING - � •PLAN CHECK - BATHTUBS ^' SHOWERS PLUMBING Date Signature NOTICE: If after making this declaration, you should become subject t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed TOILETS <i URINALS _ LAVATORIES DOUBLE LAVS PLAN CHECK revoked. CONSTRUCTION LENDING AGENCY- KIT. SINKS —DISHWASHERS SERVICE SINKS SUMPS I hereby affirm that there Is a construction lending agency for the per- formance of the work for which this permit is issued (Section 3097 FLOOR SINKS FLOOR DRAINS - $ Civ. C.). _ Lender's Name -- - DRINKING FOUNTAINS ' Lender's -Address y_ PLAN CHECK' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from.the Contractor's License Law for the following reason. (Section 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 re- quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the P ess.anct Professions Code) or that he Is exempt therefrom and the t for the alleged exemption. Any violation of Section 7031.5 by I ppilcant for a permit subjects the-applicant.to a civil penalty. of not more than five hundred dollars ($500). - INTERCEPTORS CLARIFIERS SWIMMING POOL P TRAP- ` WATER SERVICE ALTERATION ' GAS SERVICE OUTLETS -WATER HEATERS" BTU OUTPUT ` SEWER CONNECTIONS SOLAR TANK COLLECTORS ❑ I, as owner of the property, or my employees with wages as their LESS.AO- . sole Compensation, will do the work, and the structure is not Intended Or offered -for sale. (Section 7044, Business and Professions Code: The - SOLAR PIPING SYS. ' VANCE PC $ Contractor's License Law does not apply to an owner of a property who builds- or improves thereon; and who does such -work himself Or _ - - ISSUE -FEE - FINAL FEE $ through his 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 -did not build or -improve for the purpose of sale). ❑ i, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractor.'s License Law does not apply to MECHANICAL PLAN CHECK - HEATING SYSTEM 0-100,000 BTU AND DUCTING - 100,000 + BTU t REFRIGERATION 0-100,000 BTU SYSTEM -• - - 100,000 + BTU an owner of property who builds or improves thereon, and who con- tracts from such projects with a. contractors) Iicesned pursuant to the Contractor's License Law). ❑ I am exempt under Sett ion B. & P. C. for this BO LEAS BTU reason —..._.__•. Date Owner SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE I hereby certify that 1 have read this application and state that the above Information l$ correct. I agree to corMply with all city and County ordinances and state laws relating to construction, and hereby authorize representatives of this city t0, enter . upon - the above mentioned property fr inspec on urpo '9 Signature Date _(J_ -_j -� D Drivers' License or 55 ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor PROVIDED PARK FEE $ DATE , r C.V IVJ.. --will (will - ..- POLES METERED SUB 'PANELS - -' MAIN SUB SERVICE - AMP ISSUE FEE APPLICATION APPROVED BY DATES SUMMARY OF FEES ELECTRICAL" PLAN CHECK So- FT - - _ �SMIP GENERATOR - TRANSFORMER ' 0-1 K4M1f APPLIANCE 10-50 KW_ 1-10 KW SO'+ KW MOTORS • 0.1 HP (INC. SOLAR).--10-50'HP=- 1-10 HP .t 50 + HIP ' FIXTURES- ____OUTLETS SWITCHES GAS TUBE SIGNS - POLE LIGHTS ` PLUMBING C.V IVJ.. --will (will - ..- POLES METERED SUB 'PANELS - -' MAIN SUB SERVICE - AMP ISSUE FEE APPLICATION APPROVED BY DATES SUMMARY OF FEES BUILDING /7, ��jj�� - - _ �SMIP PERMIT $ : $�• - PLAN CHECK $ 4 ISSUANCE' $ PLUMBING $ QRADiNG - $ PLAN CHECK S $ k ELECTRICAL $ MICROFILM S ' PLAN CHECK' $ TOTAi_ FEE $ MECHANICAL.. $ LESS.AO- . PLAN CHECK $ VANCE PC $ _ - FINAL FEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil ipe-Undrgrn • ' 44- Steel Reinforcement 3. Electrical Conduit Utility=Undrgrn 45.• Forms - - - 4. Electrical Conduit-Undrgrn 46. Electrical-Bdnding - - 5. S tee r R ein orce , 47. Rough Plumbing & Pressure Test -- 6. Electrical UFER Grn 48.. APPROVAL -TO COVER-GUNITE 7. ootings 49. Electrical- Conduit•Undr rn . 8. Foundation 50. Gas Pipe; ❑ Undr rn, Test 9. Water pipe-Undrgrn 51. Backwash Lines R-Tra6. ❑ LTndrgM ' " - 10. Structural Floor System 52,', . APPROVAL TO DECK 1i: • Property Sewer' Line & House Connection 53. Backwash'& Receptor -Final 12. Street Sewer Connection ' 54. Heater & Vent -Final 13. Rough Plumbing '"55- Plumbing Systerriz Final 14. Rough Electric -Conduit -56. Electrical -Final 15: Rough Electric -Wiling - 57. Solar System -Final 16. Rough Heating & Air Conditioning 58. Fencing & Access Approval 17. Ducts in Structure SF -. APPROVED FOR PLASTERING 18, Ducts, Ventilating 60. - POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20, Roof Framing - 21. Roof Sheathing - NOTES: _ 22. Frame and Flashing 23.. Insulation = - 24. Lathing & Siding _ 25. Drywall Nailing _ ' 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric - 29. Final Heating & Air Conditioning 30, Final Gas Pipe -Test _ 31. Final Plumbing 32. Water Service -Final ..i33. .-Gas Service -Final 34. Solar Domestic -Final 35. - Landsca e S rinklin S stem.. . 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison ,41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY "No_ ---------- Date � 44400 COSTA MESA BUILDING -SAFETY DEPARTMENT P.Q. SOX 1200 COSTA MESA, CALIFORNIA 92626 JUL 27-77Pai0003030* *** *17.00 CM5A Ln n m V A LI AT N FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RE I D DATE RECip!S UE LL �r / `' BUILDING`j�CIV ADDRESS ✓ IT NO. OWNER cValj,r A.P. NO, BUILDING MAIL ADDRESS Ar tm� ADDRESS TELja' _0.70 CITY�,6L NO. TRACT Z LOT BLOCK CONSTRUCTION W AD REPAIR LENDER r` BRANCH OWNER ADDRESS VALUE USE . $ ARCHITECT TEL. OR ENGINEER N FIRE r% ADDRESS ^—' ZONE T PE GROUP !J APPROVED CONTRACTOR �/�� //GQ BY DATE f ADDRESS //{Ts 14A ZONE NO.OF/j USE OF NEW CITY NO, PLANS(. BUILDING �r STATE CITY YARDS APPROVEDY DS APPROVED LIC. NO. LIC. NO. MAIN BUILDING A SSORY UILDING SIZE No. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT T. USE OF EXISTING BLDG. SIDE FT Separate permits are Iequiled for L. SIDE _!00A'.`FfF1 FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED p15TANCE BET. BET. MAIN & MAIN BLDGS ACCESS. BLDGS. A / A� %/f/T��D�C/Cdr✓j VAR. DATE C.U.P. + APPROVED APPROVE V E I hereby acknowledge that i have read this application and state that the above Information Is correct and agree to comply with ell laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of ' the State of California. I hereby certify that I am properly licensed as a contractor under . FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE QNJ-'f. am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ and Professions Code, Division 3, Chapter 9. � PLAN CHECK 3 • Signature of / TAX $ Parmlttea $ / Authorized Agent ` TOTAL PAI D $ d Q Ln n m V "AY -7-771Pl�aa ill* *:r* 119.16 43908 r CDSTA MESA BUILDING -SAFETY DEPARTMENT • P.U. BOX 1200 COSTA MESA, -CALIFORNIA 92626 P CA ON FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use ink Only BUILDING V Y D E g El DATE ISSUED 3 I ST ts, ADDRESS {, j A.P. NO. — D PERMIT NO. "" OWNER t`'' �S ADDRESS 1`151 I,;�J BUILDINGMAIL ADDRESS •• TEL.�o�AZT CITY f.ltkt G2 NO. J 'I AlliOT BLOCK CONSTRUCTION 0—cu, C ADD ALREPAIR LENDER -"EW BRANCH OWNER ZXA SL ADDRESS VALUE ARCHITECT TEL.E ku�r• S N y l L OR ENGINEER So%A- -11S1 FIRE ,E-2— r� ADDRESS t {� ct+�1Ci5 ZONE YP GROUP CONTRACTOR- F� APPROVED BY Cr DATE ADDRESS L [ S Sty" (V s✓ E--O-J CITY tZ ,t/ _ \ �� NOL SY 3 ZON NO. OF PLANS USE OF NE BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING (� SIZE NO. OF BLDG'S. IFROM C/L ST RE G. OF LOT NOW ON LOT PONT FT. Q USE OF '1 e, EXISTING BLDG. Je FTA 57v. Separate permits are required for L. SID " FT. electric, plumbing and heating work. ❑ REAR FT. FT. kT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET, MAIN & AMAIN BLDGS. ACCESS. SLOGS. �4�1 c`Q� VAR. DATE W C.U.P. 06 APPROVED �>„ L _ In�S� GGR LL APPRORy V , 7 a G 1 hereby acknowledge that I have read this application and state 10, 1:4that the above Information Is correct and agree to comply with 44 all laws regulating building construction, and I shall not employ person In violation of the workman's compensation laws of zany the State of California. r� 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. Co THE AMOUNT SHOWN UNDER VALUATION 1S FOR the State of California Business and Professions Code, Division 3, m Chapter 9, and th h licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ON6Y W am exempt fr the pr vlslons of the St to of California Business `r VALUATION PERMIT FEE and Professi ns Code, D vision 3, Chap a 9. ro Signature PLAN CHECK Permittee $ � TAX $ v•s g U Authorized Ago , TOTAL PAID s ~_``fir-- ��..1.5.t: -s- ' CdSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ADDRESS 3185 J AirwayAvenue OWNER Koll/Irvine MAIL ADDRESS 1901 Dove Street CITY Newport Beach NO. 833-30 CONSTRUCTION LENDER Unknown PAI, Building #5 APPLICATION FOR STRUCTURAL. PERMIT REC,jIygD BY DATE_REG Ep DATE ISSUED /��f� �^3 ) _ 6 rim- _ J._ , . — „1 PER I -f BUILDING j( J ADDRESS �f 1 BRANCH Ie . OWNER ADDRESS ARCHITECTTEL S I nacnir_in�EER Leason-Pomerov No- �39-554 ADDRESS 44 Ylaza 6ccuare, _Orange CONTRACTOR Don Koll Company, Inc. ADDRESS 1901 Dove Street TE L. CITY NO. STATE CITY LIC. NO. .221 764 LIC. NO. 0. OIF ZE LOT 4800 NOW ON LONO. Or 1 Q USE OF rte. EXISTING 13LDG.Industrial C/] HSeparate permits are required for C electric, plumbing and heating work. W USE OF BUILDING AND WORK TO BE PERFORMED H a D a > a x w a. O Qtr a z W 3 FIRE ZONE APPROVED Z NO. OF` PLANS YARDS APPROVED MAIN BUILDING (FROM C/L 9LREETj DISTANCE BET. MAIN Bi -DGS. VAR. * t n C.U.P.r1 USE OF N BUILDI / YARDS APPROVED ACCESSORY BUILDING BET. MAIN & ACCESS. BLD DATE APPROVED I hereby acknowledge that I have read this application and state / ^ that the above Information is correct end agree to comply with m alf laws regulating building construction, and I shall not employ any persoA in violation of the workmen's compensation laws of the State Of California. `4 8 00 SO. FT. 'CO I hereby certify that 4 em properly licensed as a contractor under the State Of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR DI I full force and effect, or I Chapter 9, and that such liceonrfe' THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisloa ate of California Business VALUATION PERMIT FEE $ � end Professions Code, Divislo Signature of r /f /Or PLAN CHECK $ j/ • �0 0 Permittee ffi (/v_ TAX S � /�►oy f U Authorized Agent TOTAL PA! D $ � 7 �/�[ n W-1 PAI:! 28-7h as l ti�3n COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY PATE RECEIVED DATE ISSUED BUILDING 22 ADDRESS � P I OWNER A.P. NO. MAIL BUILDING - I ADDRESS ADDRESSaft TEL CITY NO. TRACT LOT B C K CONSTRUCTION NEW A Q D A P LENDER BRANCH OWNER ADDRESS VALUE ARCHITECT TEL. S $ OR ENGINE R FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING - STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LiC, NO. MAIN BUILDING ACCESSORY BUILDING �y SIZE NO. OF BLDGS. (FROM C/L STREET) Or OF LOT NOW ON LOT FRONT FT, FT. Q USE OF EXISTING BLDG.R. SIDE FT F7 Separate permits are required for L. SIDE FT. FT• electric, plumbing and heating work. A REAR FT. FT. W I--� USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & ' MAIN BLOCS. ACCESS. BLOCS. 0 VAR. 0 DATE i C.U.P. 9y. APPROVED a APPROVED } CIC W 0 I hereby acknowledge that I have read this application and state u� h pr that the above information is correct and agree to Comply with m p+ all laws regulating building construction, and I shall not employ Z Any parson in violation of the workman's compensation laws of m Me State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT, a 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 Ok4LY. em exempt from the provisions of the State of California Business v and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE § Ln Signature of PLAN CHECK , Permittee $ TAX 5 U Authorized Agent TOTAL PAID $ OWNER SENL COP@ CMF 046646 (BU 41 OWNER PEDRp I RANDALL, C DATE 11/20/80 JOR ADDRESS 41 R5 llinaacr wanes_ TTni+ A RUILDING PERMIT NO_ 51047 GENERAL CONTRACTOR Driver -Eddy Const. Co. DESCRIPTION of WORK French Drain AP No, 427-194-13 LOT 13 TRACT 8072 FIRE ZONE VALUE$ 4,000.00 INSPECTIONS Signature Date TYPE GROUP ZONE pp SOIL SUBCONTRACTOR P MI SIS Date Number Si nature GAS WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heatin and Vent. TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM 0 STEEL REINFORCE I _ SHEATHING F^.AME AND FLASHING LATHING - IN n OUT ❑ PLASTER, BROWN COAT STRUCTURAL,FINAL HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL SPECIAL REQUIREMENTS UTILITY NOTIFIED, GAS F1 ELECT. OCCUPANCY CMF 0486-46 (BU 4) 51037 OWNER MAGEMENT SYSTEPIS JOB ADDRESS 31SS�D Airway A�e�,.. auu niur. ocou CMF 040646 (0U 4( ��E4!EEf4l� ®at�� A1�77/�IAtFII:3l'f717aC ■��raC��l!*IJfG�TJ L�� CMF 040646 (0U 4( � OWNER Yeary, Art DATE 5-20-79 JOB ADDRESS 31gr , Ai BUILDING PERMIT NO. 48092 GENERAL CONTRACTO H�rhor Enaineers DESCRIPTION of WORK int, Alt, AP No. 427-194-09 LOT 9 TRACT 8072 FIRE ZONE VALUE $ 30,000. 00 INSPECTIONS Signature I Dot, TYPE v GRO GROUP H ZONE mp SOIL SUBCONTRACTOR PEPMI�S I Date 'J'�IED GAS WATER Plu!bino ROUGH PLUMBING 11-57- -7 7717 PROP. SWR. LINE F] ;�C�USE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND [?' POWER [D CYaj ROUGH WIRING and V"t. TRENCHES J_j FORMS L] STEEL REINF. //-a'- 721 170Y',g FLOOR SYSTEM BOND BEAM [:] STEEL REINFORCE SHEATHING PLASTER. BROWf4 COAT U' -I HEATING. VENT., REFRIG. AND A.C.. FINAL I!z 1090 ELECTRIC, FINAL BUILDING. FINAL AIR 31G. SPECIAL REQUIREMENTS UTILITY NOTIFIED, GAS 0 LECT. OCCUPANCY y"cIVIro48o-4o(BU 4,_______�~__ ,-- ' ' `~^ ~ -48092 ' � N OWNER OWNER DUE SOUTH IMPORTS DATE 6_p9_77 JOB ADDRESS 3185 "G" Airway Avenue BUILDING PERMIT NO. 44228 GENERAL CONTRACTOR K011 Company DESCRIPTION of WORK erinr AltarAtinnc _ AP No. 427-190=02 LOT TRACT FIRE ZONE VALUE $ 13,200.00 INSPECTIONS Signature Data ITYPE V GROUP -2 ZONE mp GAS -. SUBCONTRACTOR Date MNumbes Si nature WATER Plumbin ROUGH PLUMBING /z--;0- -17 PROP, SWR. LINE Q HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING 'TEMPORARY SERVICE OR POLE .UNDERGROUND ❑ POWER ROUGH WIRING Heating and Vent.. . TRENCHES 0 FORMS STEEL REINF. 7 FLOOR SYSTEM BOND BEAM M STEEL REINFORCE SHEATHING FRAME AND FLASHING C LATHING — IN OUT L' PLASTER, BROWN COAT STRUCTURAL, FINAL L HEATING, VENT., REFRIG, AND A.C., FINALonn PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL T SPECIAL REQUIREMENTS UTILITY NOTIFIED, GAS ELECT. OCCUPANCY CMF 0486-46 (BU 4) ` 44228 OWNER AMEREA INTERNATIONAL DATE 3-9-77 JOB ADDRESS 3185 H Airway Avenue BUILDING PERMIT NO. 43631 GENERAL CONTRACTOR Ko11 Company DESCRIPTION of WORK Interior Alterations no 1 AT TDArT FIRF 70NF VALUES 24 _ 7SO INSPECTIONS Si nature Date TYP v GROUP -P-7 ZONE solLPyMl SUBCONTRACTOR Dat. Number I Si nature GAS WATER Plumbin ROUGH PLUMBING ��`v PROP: SWR. LINE [� HOUSE CON.ff SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND I] POWE ROUGH WIRING atl and V.nt. TRENCHES FORMS U STEEL REINF. Lj•L FLOOR SYSTEM A _... -7i BOND BEAM Lj STEEL REINFORCE I I SHEATHING FRAME AND FLASHING LATHING — IN PLASTER, BROWN COAT STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C. FINAL • 'j1 PLUMBING, FINAL AND GAS TEST • Z ELECTRIC, FINAL Y BUILDING, FINAL SPECIAL REQUIREMENTS UTILITY NOT:lZ IED. GAS ELECT. OCCUPANCY i CMF OWNER QUIST & HAYES GAS DATE 5- enueBUILDING I ta— DESCRIPTION of WORK it TRACTTrvi=_W�1E ZONE_ VALUE 1) S I 1 .,. TYPE V GROUP OREM I SUBCONTRACTOR HEATING, V ENT., REF PIG , AND A. CI._, j FINAL PLUMBING, FINAL ANO GAS TEST ELECTRIC, FINAL BUILDING, FINAL SPECIAL BUILDING, UTILITY NOTIFIED, GAS za ELECT. OCCUPANCY *If- CMF 048646 (BU 4) ...... ....