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Home My WebLink About2086 MARIAN WAY - Building Permitsytp M 4� p 0, � > _ f J •��ayo�ca `h� (714) 754-5273 • Fax (714) 754-4856 Job Address: 20BB MARIAN WY Suite No Vicinity: Parcel Nunmber: 42620222 Applicant: DORISH, GARY Address: 2086 MARIAN WAY COSTA MESA, CA Owner: DORISH, GARY Address 2086 MARIAN WAY COSTA MESA, CA Contrector: Address; • Arch/Eng: Address: CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT Phone: 949-548-7154 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: License: PERMIT NUMBER P99-00568 77 FAIR DRNE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10I6/1999 Issued: 10/6/1999 ISSUED BY: � .• � Is � I' L� i !� �� SCOPE OF PERMIT REF 899-01472, 4 LIGHTS, 8 OUTLETS, 7 SWITCHES, 2 MOTORS, " VENTELATION FAN AND INDOOR TUBISPA". 1 KITCHEN HOOD, 1 BATHROOM VENT. 1 GAS OUTLET, 1 LAUNDRY TUB/ WASHER, 7 KITCHEN SINK, 1 TOILET. ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifer System Connect Qce,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 ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $9.80 Landscape Irrigation $0.00 P-Trep $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receplors $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 $9.80� Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum 8rkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION � PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $59.05 on 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 C NOTICE: The work authonzed by ihis permit shall comply with all applicable handirap 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 penod 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 inspeetiona end final approval must be obtained. Failure to obtain inspections and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS'COMPENSAnON DECLARAnON: I hereby attirm under penalry of perjury one of ihe tollowing tleclarations: ❑ I heve end will maintain a certiticate of consent to self-Insure for workere' compensation, as provided for Dy section 3700 of the La6or Cotle, tor the peAormance of the work tor whiCh ihis permit is issued. ❑ I have and will maintain workers' compensation insurance, as raquired by sedion 3700 of ihe Labor Code, for Ihe peAortnance oi ihe work for which this pertnit is issued. My workers' compansation Insurance carrier an0 policy number are: Carrier: Policy Number. (This section neetl not be completed il the permit is valued at one hundred dollers ($100) or less.) ❑ I certify that in ihe perfortnance of the work for which this permit is issued, I shall not employ any person in any manner so as to �ecome subject to the workers' compensation laws of California, antl egree that if I should become subject to the workers' compensation provisions ot Section 3700 of ihe Lebor Code, I shall forihwith comply with these provisions. , Applicant Signature: Dete: WARNING FAILURE TO SECURE WORKERS' COMPENSATION CAVEfiAGE IS UNLAWFUL AND SHALL SU9IECT AN EMPLOVER TO CRIMINFL PENALTIES AND CIVIL FINES UP TO ONE MUNDRED THOUSAND DOLLARE ($100,OW), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3106 OF THE LABOR CADE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm iha! I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, antl my license is in tull lorce and eHect. Lic. # Class» Conirectors Signature: Date: � CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that ihere is a consiruction lentling agency tor ihe pedormance of ihe work for which this permit is issued. (Sec. 309�, Civil Code). Lender's Name: Lender's Address: Siqnature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm ihat under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7031.5, Business and Protessions Code: Any city or county which requires a permit to constmct, alter, improve, tlemolish, or repair any stmcwre, prior to its issuance, also requires the applicant tor such permit to file e signetl statement that he or she is licensed pursuant to ihe provisions of the Contractors License Law (Chapter 9(commencing with Sectian 7000) ot Division 3 of ihe Business antl Professions Cotle) or that he or she is exempt iherefrom antl the basis for ihe alleged exemption. Any violation of Section 7031.5 by eny epplicam for a permit sublecis ihe applicant to a civil penalry of not more than five hundred dollars ($500J.): ❑ I, as owner of the property, or my empioyees with wages as their sole compensation, WILL DO THE WORK, entl the simcture is not intended or ottered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who 6uiltls or improves thereon, and who does such work himself or herself or through his or her own employees, providatl that such improvemenis are not intended or ottered for sale. If, however, ihe Duiltling or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.). ❑ I, as ownecof�the,property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmcl the project (Sec. 7044, Businass antl Protessions Code: The'contr��acst rs C Law does not p01y to an owner of property who builds or improves thereon, and who contracts for such project with a coniractor(s) i license oursuan1.16W � ontrac License �.). 9wr� ID venfied by dnW Verification of Ownership Business and Professions Cotle for this reason: s ❑ No ve 's License i.e. - property taz bili or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N: ❑ I hereby cetlity ihat no ezcavation tive (5) or more feet in dep�h iNo whlch a person is required to tlescend, will be made in connection with work authorized by this permit, and ihat no building siructure, scattolding, falsework, or demolition or dismantling thereof, will be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, California Adminis�rative Code). ❑ As owner-builder, I will not employ enyone to do work which would require a permit from the Division of Intlusinal Safery, as notetl above, unless such person has a pertnit to tlo such work trom the division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFICATE OF COMPLI D AU7HORRA�ENTRY: I certify under penalty of perjury that I have read ihis application and state that Ihe iMormation given is correct I agree to c� ly ith all s e laws and ciQ ordinances relatinq to building constmction, and authorize representatives oi ihe City of Costa Mesa to enter upon the abova-describad o y 1 � s eclio puryoses. I grae not to occupy or allow occupancy ot any bnilding aNhorized by inis pertnit untif tin insp ction. � Si ture Ot Le ner(s) te And/Or Authorized Applicant ate COPE N, INSPECTIONTYGE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Finel Ra-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 204 244fi 46 Final Sign Final Demolition A(�TF INTRIALS �� COOEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final EleCtrical 212 Final Fire Prevention 220 FinalPlenning Approval 222 Final Site 250 Final Builtling/Occupancy j1AT� INTRIALS ■�YI%5i%�i)'�[��:L�I I CITY OF COSTA MESA BU/LDING DIVISION ` DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (774) 754-4856 ,lob Address: 2086 MARIAN WY Suite No Vicinity: Parcel Number: 42620222 Applicant: DORISH, GARY Address: 2086 MARIAN WAY COSTA MESA, CA owner: DORISH, GARY Address: 2086 MARIAN WAY , COSTA MESA, CA Contractor: Address: �, ArchlEng: � Address: :� MECHANICAL PERMIT Phone: 949-548-7154 Zip: 92627 Phone: Zip: 92627 Phone: 2ip: License: Phone: Zip: License: SCOPE OF PERMIT REF B99-01472, 4". 1 KITCHEN HOOD, 7 BATHROOM VENT. ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heal Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Re�rig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm' Air Handiers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $10.65 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY PERMIT NUMBER M99-00465 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10/6/1999 Issued: 10/6/1999 ISSUED BY: Repair I Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation System Evaporative Cooler Com me rcial I nci nerato r Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 541.40 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 requlred Inepeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of �his permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSATION DECLARATION: I hereby attirm under panalry of perjury one of the following declarations: ❑ I have antl will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 ot the Labor Cotle, for ihe pertormance of the work for which ihis permit is issued. ❑ I have and will maintain workere' compansation insurance, as required by section 3700 of ihe labor Cotle, for ihe peAormance of Ihe work tor which this parmit is issued. My workers' compensation Insurance carrier antl policy numbar are: Carrier: Policy Number: (This section need not be completed il the permit is valued at one hundred dollars ($100) or less.) ❑ I certiy that in the pedormance oF the work for which this permit is issued, I shall not employ any parson in eny manner so as to become subject to ihe workers' compensation laws of California, and agree ihat if I shoultl become subject to ihe workers' compensation provisions of Section 3700 of ihe Labor Cotle, I shall forthwith comDly with these provisions. Applicant Signature: Date: WARNING FAILURE TO SECURE WORKERS' WMPENSATION CAVERAGE IS UNLAWFOL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDRION TO TME CAST OF CqMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOF CqDE, IMEREST, AND A7TORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm tha! I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, antl my license is in full force antl eNAct. Lic. N Class # Conirector's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm ihat there is a constmction lending agency for Ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendar's Name: Lender's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: � I hereby aNirm ihat under penaAy of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires ihe applicant tor such permit to file a signad statement that he or she is Ilcensed pursuant to the provisions of the Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code) or that he or she is exempt iheretrom and the basis for ihe aileged 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 dollers ($500).): � ❑ 1, as owner of tha property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, end ihe simcture is not intendetl or ottered for sale (Sec. 7044, 8usiness�end�Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, and who does such work himselt or herself or Ihiough,his or her own employees, provided that such improvements are not intended or ottered for sale. If, however, ihe building or improvament is sold within one year oi completion,�the owner-builder will have the burtlen ot proving ihat he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of the propetly, am�EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70R5 to wnstmct the prqect (Sec. 7044, Business and Protessions Cotle: The contractors License Law Aoes�not apply to an owner ot property who builds or impmves thereon, and who contrac�s for such project wi�h a coniractor(s) Ilcense pursua�j o th iredors Lice se Laws.). @'� I am exempl(�er s� -°�� Business and Protessions Code for this reason: _ Ow�eriflec7by dri r s I ense. a'es - � No Veritication of Ownership by (type of tlocumeN, i.e. - propeny tax bill � DIVISION OF INDUSTRIAL SAPETV PERMIT CERTIFICATION: ❑ I hereby cenity ihat no excavation five (5) or more feet in tlepth into which a person is requiretl to descend, will be matle in connection with work authorized by this permit, antl ihat no �uiltling strucNre, scaHoltling, talsework, or demolition or dismantling thereof, will be more than ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which woultl raquire a permit from ihe Division ot Intlusirial Safety, as noted above, unless such person has a permit to da such work from ihe division. - SignaWre: Oate: Division of Industrial Safery Permit Number: 1 Will the applicant or present or future building occupant need to file and cenity a Business Plan tor emergency rasponse to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 oi the Califomia Health antl Safery Code requires, with some exceptions, ihat a Business Plan be filed with the Costa Mesa Fire Depatlment by every business which has at any one time during a reported year a quantiry of hazardous materials equal to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperature and pressure). .......... ._....... __...___ ......... _____....... ..... _.......... ................. .... ..__._ ._........... ....._ .._... ............... 2 Does or will the applicant or present or tuNre building occupant need to tile a registration torm for acutely hazartlous materials? ❑ Ves ❑ No (Section 25533 of ihe California Health and Satety Gode, with some exceptions, requires registration with ihe Costa Mesa Fira Depahment by each business which at any one time has on hand e quantiry of acutety hazardous materials epual to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic 'eet of compressed gas at standard temperaWre antl pressure). _.__... ........ .... ____ ...... ....... _........ ..... ................. ._.._._.._.. ........ ..........._.. _...... ............. 3 Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management antl Prevention Program for acutely hazartlous materials)? ❑ Ves ❑ No (Section 25534 of the California Health antl Safety Code provitles ihat ihe Costa Mesa Fire Depatlment may require the preparation, certification and filing with ihe Fire Departmant of an RMPP by businesses which are requiretl to register acutely hazardous matena�s wi�h the Fire Department. .............. ................ ............."" ............. .......... ........_ """.......... ........ ..._'___.. ........... .......... ....... .......... 4 It 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 raquire for ihe work which is ihe subject of Ihis a plication a germit for such constmction or modification from the South Coast Air Qualiry Management Disirict or from any other air pollution control tlistrict or agency? � Yes u No (Section 658502 ot the Calitornia Govemmen� Code requires �ha� �he requestetl information ba turnished on applications for non-resitlential building permits). _'_.... .'_........ ........... .............. ........""...... ....... . """'... .................. ....... .. ._ � __ _.... .. ...""......... ..............__.. 6 Will any part of �he facility b be cons�mcted under this permit ba within 1000 feet from ihe outer boundaries of a school? ❑ Yes ❑ No (If'yes", �he faciliry must meet ihe requirement of Sections 25534 and 42303 ot ihe California Health and Safery Cotle). .. _____.. __......___ ........ ....__ ............... .._ _ _.._....._ .__ ... 7 If a permit from ihe South Coas� Air Qualiry Management Disinct or other av pollu�ion control disirict or agency is required for Ihe work which is the subject of �his application, have all of the disclosures prescribetl by Calitorma Health antl Safery Cotle Section 42303 been made� ❑ Yes ❑ No Qf'yes", attach certificate of compliance irom the appropriate air polWtion control officer). CERTIFICATE OF COMPIIANCE: 1 cehity ihat under penalty of perjury ihe information given above is correcL I agree to comply with all state iaws and city ordinances regarding Hazartlous Matarials and Emissions. Signawre: Date: CER7IFICATE OF COMPLIANCE AND AUhIORIZATION OF ENTRV: I certify under penalty of perjury that I have read ihis application and state ihat the information given is correcL I agree omply '!ft'3th�tate laws a d city ordinances relating to building consimction, and authoriza represen[atives of the City of Cosla Mesa to enter upon tha above-des rib party b ins ecii n puryo I a ree aot to occupy or allow occupancy of any building authorized by this permit until tinal inspecfp n. �� /D/�Q � S ature Of 40v er(s) te And/O � d Applicant Date �E k. INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Finaf Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition zgas<s OATE INTITIALS CODEX INSVECTIONTYYE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Appro�al 222 Final Si�e 250 FinalBuilding/Occupency DRTE INTITIAL Il-ti-oq hy B,J� (714) 754-5273 • Fa�c (714) 754-4856 Job Address: Suite No Viciniry: Parcel Nunmber: 2086 MARIAN WY 42620222 Applicant: DORISH, GARY Address: 2086 MARIAN WAY COSTA MESA, CA Owner: DORISH, GARY Address 2086 MARIAN WAY Contracroc Address: INDOOR TUB/SPA". ISSUE FEE Temp service test Res. a/c package New Res (i-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA, CA CITY OF COSTA MESA BU/LDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT : � ELECTRICAL PERMIT Phone: 949-548-7154 Zip: 92627 Phone: Zip: 92627 Phone: 2ip: � � License: PERMIT NUMBER E99-00923 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: I SSU E D Applied: 10/6/1999 Issued: 10/6/7999 ISSUED BY: V 1� - SCOPE OF PERMIT REF 699-01472, 4 LIGHTS, 8 OUTLETS, 7 SWITCHES, 2 MOTORS, " VENTELATION FAN AND $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $4.40 $8.80 $7.70 $0.00 $0.00 $0.00 $0.00 $0.00 $9.50 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Trensformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 $53.90 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for �he work authorized under �his permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalry of p��ury one of the following declarations: � ❑ I have and will maintain a ceniticate of consent ro self-Insure tor workers' compensation, as provided for by section 3700 of ihe Labor Code, for the padormance of the work for which �his permit is issued. ❑ I have and will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, tor the peAormance of the work for which this permit is issuetl. My workers' compensation Insurence carrier antl policy number ere: Carrier. Policy Num6er: (This section need not be completed i/ the permit is valued et one hundretl dollars ($f 00J or less J ❑ I certify that in the peAormance 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 CalifO�nia, and agree ihat if I shoultl become subject to the workers' compensation provisions oi Sectlon 3700 of the Labor Cotle, I shall forthwith comply with ihese provisions. AppliCant Signature: Dete: WARNING: FAILURE TO SECLIRE WORRERS' COMPENSATION CAVEMGE IS UNLAWFUL AND SHALL SU9IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND OOLLARE ($100,000), IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3]O6 OF THE L480R CADE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aflirm iha! I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and ef/ect Lia # Class k Contrecmr's SignaWre: Date: CONS7RUC710N LENDING AGENCY: ❑ I hereby aHirtn Ihat ihere is a conswction lending agency for ihe pertormance of iha work for which this permi� is issued. (Sec. 3097, Civil Code). Lender's Name: Lendefs Address: SignaWre: Oate: OWNER-BUILDER DECLARATIONS: I hereby attirm ihat under penalty oF perjury ihat I am EXEMP7 FROM THE CON7RACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a pertnit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires ihe applicant for sucB permit to tile a signetl statement that he or she is licansetl pursuant to ihe provisions of Ihe Contractors License Law (Chap�er 9(commencing with Seciion 7000) oi Division 3 ot Ihe Business antl Frofessions Code) or ihat he or she is e:empt iherefrom antl ihe basis for the allegetl e:emption. Any vlolation of Section 7031.5 by any applicant for a permit subjects the applioeni to a civil penalry of not more than five hundred dollars ($500).): ❑ I, es owner ofihe-property;-ormy employees with wagas as their sole compensation, WILL DO THE WORK, end the structure is not intended or otteretl for sala (Sec. 7044, Business and-Profession4 Code: The Contractors License Law does not appiy to an owner of propeny who builds or improves Ihereon, and who does such work himsetl or herself or througF�his or fier own employees, provitletl that such improvements are not intended or oHeretl ior sale. If, however, the building or imprcvement is soltl within one year of completion,.ihe owner-builder will have the burden of proving Ihat he or she tlid not build or improve tor purpose of sale.). ❑ I, as owner of the pmperty„am.EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consimct the prolect (Sec. 7044, Business antl Professions Cotle: The con cmrs e Law doe not apply to an owner of property who builds or improves thereon, and who contrecis for such project with a contrecmr(s) � license purs�o th ontfa ors Licer�e Laws.). SwnafiD venfied by Venfication of Ownei Business and Professions Code tor ihis reason: IicenSe. �Tes ❑ No � (type of document, i.e. - propehy �ax bill or deed): DIVISION OF INDUSTRIAL SAFHTY PERMIT CERTIFICATION: ❑ I hereby certify Ihat no exca�ation five (5) or more feet in depth into which a person is required to tlescend, will be made in connection with work authorizatl by ihis permit, antl that no building Slmcture, scaHolding, talsework, or tlemolition or dismantling t�ereof, will be mora than thirry-sia (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Adminisirative Cotle). ❑ As owner-builtler, I will not employ anyone to do work which woultl require a permit from the Division of Indusirial Safety, as noted above, unless such person has a permit to tlo such work from the division. SignaWre: Date: Division ot Industrial Satery Permit Number. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RV: I certify under penalry oF perjury ihat I have read this application and sta�e iha� ihe information given is correct. I agree to c y u"4tr2t�ate laws a ciry ordinances relating to building consiruction, antl amhorize representa�ives ot �he Ciry of Costa Mesa to emer upon the ebove-described o fo insp c n puryos I agree not to occupy or alfow occupancy of any building authorizad by this p rmit til iinal inspedion. lv�� Sig ture Of Legal O D te Antl/Or Authorized Appiicant Oate CODE N. INSPECTIONTYGE OATE INTRIALS 1616 Fixetl System Finai Fire Preven[ion 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final Block/Retaining Wall Final Factory Fire Place Finat Sign 204 Final Demolition 24a8-46 COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Pravention 220 Final Planning Approval 222 Finai Site 250 Final Builtling/Occupancy �F � �� NT IALS (714) 754-5273 • Fax (714) 754-4856 � CIfiY OF COSTA MESA BUILDING DIVIS/ON � DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 2086 MARIAN WY Suite: Vicinity: Parcel Number: 42620222 Applicant: DORISH, GARY Address: 2086 MARIAN WAY COSTA MESA,CA Owner: DORISH, GARY Address 2086 MARIAN WAY COSTA MESA, CA Contractor: Address: Zip: Arch : � � Address: � � • Zip: BUILDING PERMIT Zoning: Phone: 949-5483622 Zip: 92627 Phone: Zip: 92627 Phone: License: Eng: Address: • • 'Phone: '• ' " License: SCOPE OF PERMIT ADD 499SF TO THE KITCHEN AREA , MASTER BEDROOM AND BATHROOM. ADD 36SF PORCH AND 19.6 SF ROOM TO HOUSE THE FAU AND THE WATER HEATER. FEE SUMMARY Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $372.81 $573.55 $426 $0.00 $0.00 $0.00 $950.62 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: 2 NOTES: Rear 28-0 Rear 0- 0 Required: 2 PLANNING & ZONING Left 15- 0 Left 0- 0 Proposed: 2 � , PERMIT NUMBER t I B99-01472 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 9/14/1999 Issued: 10/6/1999 ISSUED BY: �� Phone: License: Calc Valuation: Claim Valuation: Right 4- 0 Right 0- 0 $42,579.00 $o.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutas 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 780 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 lagal, such work must comply with all applicable codes, and all required inspectlons 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 r �� WORKEAS'COMPENSAnON DECLARAnON: I hereby aHirm under penalty of perjury one oi the following tleclarations: ❑ I heve end will maintain a certificate of consent to seli-Insure for workars' compensation, as providetl tor by section 3700 of ihe Labor Code, for tha peAormance of the work for which this permit is issued. ❑ I have and will main�ain workers' compensaiion in5urance, as required by sec�ion 3700 of Ihe Labor Code, for �he performance of �he work for which �his permit is issuetl. My workers' compensation Insurance carrier antl policy number ere: Carrier: Policy Number. (This section need not 6e completed il the permlt is veluetl af one hundred dollers ($100) or Iess.J ❑ I certify that in t�e pertormance of ihe work for which this permit is issuetl, I shall not employ any person in any manner so es to become subject to ihe workers' compensation laws of Californie, antl egree that if I should become sublect to ihe workers' compensation provisions of Section 3700 ot the Labor Code, I shall fotlhwith comply with Ihese provisions. � Applicant SignaWre: Date: WARNING FAILURE TO SECURE WORKERS' COMPENSATION WVERAGE IS UNLAWFUL AND SHAII SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNpRED THOUSAND OOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMhGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm tha! I am licensed under pmvisions ot Chapter 9(commencing with Section 7000) of Division 3 oF Ihe Business antl Professions Cotle, and my license is in full force a�d eHecL Lia N Class x Contractofs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there Is a consimction lending agency for �he performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLAFiATIONS: `�`rt .� � � A I �ereby atfirm ihat untler penalry�of per7ury,ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires�a�peimitto oonstmct, alter, improve, demolish, or repair any stmcwre, prior to its issuance, also requires Ihe applicant for such permit to file a signed statement ihat he or she is�licensetl pursuant to the provisions oi the Contractors License Law (Chaptar 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or ihet he oi�slieds�eaempt thereirom and Ihe basis tor the alleged exemption. Any violation of Section 7031.5 by eny applicant for e permit subjects the applicant to e civil panalty of not mo�e Ihan 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 oHered for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of property who builtls or improves lheraon, and who does such work himself or hersetl or through his or her own empioyees, provided ihat such improvements are not intended or oNeretl tor sale. If, however, the building or imprcvement is sold within one year oi completion, Ihe owner-builder wiil have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of ihe property, am EXCIUSIVELV CONTRACTING WI7H LICENSED CONTRAC70RS to consiruct ihe projec� (Sec. 7044, Business and Professions Code: The coniracbrs License Lew does not apply to en owner ot proparty who builds or improves ihereon, and who comraqs for such project with a contractor(s) � license purs�t to�aC`niractors Lic�e Laws.). Owner ID ven Veritication of Business and Professions Cotle tor this reason: license. es ❑ No (type ot documen�, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: ❑ I hereby cehify �hat no excave�ion tive (5) or more feet in depih into which a person is required to descend, will be mede in connection with work authorized by ihis permit, and ihat no building StmcNre, scattoltling, falsework, or demolition or dismantling ihereot, will he more ihan thirty-siz (3fi) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Administretive Cotle). ❑ As owner-builder, I will not employ anyona to do work which would require a permit irom the Division of Intlustrial Safety, as notetl above, unless such person has a permit to do such work from �he tlivision. Signature: Date: Division of Industrial Safe�y Pertnit Number: CER7IFICA7E OFJ,'OMPLIANCE AND AUTHORIZA710N OF ENTRV: I certify under penalry of perjury that I have read ihis application and state that the information given is correct. I agree�16 rompl wi I state laws and ty ordinances relating to building construction, antl authorize representatives oi the City of Costa Mesa to enter upon the above-describA opert or in ction puryoses. agree not to occupy or allow occupancy of any building authorized by ihis per t until final inspection. /D�� %� iqnaWre Ot Legal Ow (s � Dat And/Or Authonzetl Applicant Date CQDE �, INSPECTIONTYPE 1616 1266 Fixetl System Final Fire Prevention Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place p03 Final Sign 204 Final Demalition 244fi-06 p� INTff1ALS COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtlin<yOccupancy pATE INTITIAlS , CITY OF COSTA MESA - • � " � ` BI/ILDING DIYISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • ewiw.ci.cosla-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5826. - PERMIT NUMBER: BC08-O(1482 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 10/02/2008 ISSUED BY: (� � . � dos aooRess: 2086 MARIAN WY CM Suite/Unit: U ' APN: 42620222 - � Zoning: , . - Vicinity: " ' . � � ' Primary Occ: '. R3 ConstType: V-B ' SQ.�FT: 0 � -�,Valuation: $0.00 ' � ' SCOPE OF WORK: RE-INSTATEMENT OF EXPIRED PERMITS: B99-01472, E99-00923, M99-00465 & F99-00568 FOR ADDITION OF 499 SF KITCHEN AREA;.MSTR�BEDROOM 8 BATH, 36 SF PORCH, 19.6 SF AREA FOR�NEW FAU &WTR. HTR, ELECT - 4� LIGHTS, 8 OUTLETS, 7 SW ITCWES, 2 MOTORS, ELECT. FOR TUB SPA. - - - . MECH. - VENT FAN, & KITCHEN HOOD', &(NOT ORIG. PERMITTED RELOCATION OF FAU). -. PLUMB. - GAS OUTLETS, LAUNDRY TUB/N/ASHER, KITCHEN�SINK, TOILET &{NOT�ORIG. PERMITTED RELOCATION OF WTR. HEATER). : ` - - - . -: . - . - , ' . , . OWNER: FHC,INC.; � ,.. Address: 6306W.COASTHWY � , � ' Unit: - ��"��{�'�� Phone: . - City/State/2ip: NEWPORT BEACH, CA .- , APPLICANT: FHC, INC. AGENT/BUSH, MATHEW Address: 6306 W. COAST HWY . Phone: 949 566-9155 City/State/zZip: ,NEWPORT BEACH, CA -- CONTRACTOR: LiCenSe NO. Phone: - - � � -� Address: Unit: � - Cell: � � - . City/State: , ARCHITECT: . � " License No. . � � � ENGINEER: : � � License No.. � , - , � . COMBINATION PERMIT FEE SUMMARY Building Plan Check: " . $0.00 Building Fees: $0.00 Electrical Fees: -, $0.00 Mechanical Fees: $38.50 Plumbing Fees: $33:30 SMIP Residential: $0.00 SMIP Commercial: $0.00 TOTAL FEES: $269.80 ••Refer to fee receipts for all fees paitl tor project Unit: : ZipCode � � � � � PHONE: PHONE: -i�': '7�J '��": C. � � b'/ I�ti. ;, -,.j , NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements underCalifomia statules 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 inspecHons and finel approval must be obtained. Fail�re lo obtain inspections and final approval will result in�the expiration of this permit. CODEN. INSVECIIONTYFE � INP7IRL CODEt INSPEC710NTYPE jl�� IN717UL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical . . -.�..� 12fi6 Pool Spa Final 208 Final Plum6ing 200 Final Re-Roof 210 Final Eledrical ' 201 Final Block/Retaining Wall 212 Firial Fire Prevention .. ,, 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site - � . �, /� 204 FinalDemolition 250 FinalBuiltlinglOccupancy ' 0-� � B�(��,oJ�� WORKERS' COMPENSATION DECLARATION. - I hereby aKrm untler penalty o( perjury one of [he following declarations: ❑ I have and will main[ain a certi(ca[e of Gonsent to self-Insure for vrorkers' compensation, as provided !or by section 3700 of the Labor Code, for the peAormance of the work for which thls permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, (or the peAortnance of Ihe work for which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (ihis sectiwi neetl rpt be romde�ed dtM1e permd is va��ed af one h✓naretl tldlars (5100) w less ) Policy Number: ❑ I cerlify that in Ihe peAormance of [he vrork for which this permit is issued, I shall nol employ any person in any manner so as to become subject to Ihe vrorkers' compensation laws of Califomia, and agree iha[ i( I should become subject to the vrorkers' compensation provisions of Section 3700 ot the labor Cotle, I shall forthwi[h comply with [hese provisions. AOPliranfs Signawre oa�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF GOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L.P�BOR 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 ihe Business and Professions Code, antl my license is in full force and eftect. Lic. # Cless # Conuatlor's Signalure Date CONSTRUCTIQN LENDING AGENCY: ❑ I hereby aKrm ihat there is a consttiction lentling agency fw lhe perfortnance of [he work fa which this pertnit is �ssued. (Sec. 3097, Civil Code). Lender'S Name: Lender's Address: SignaWre OWNER-BUILDER DECLARATIONS: I hereby atfrm that under penalty of perjury that I am EXEMPT�FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pro�essions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any slructure, prior to its issuance, also requires the applicant (or such permit to file a signed statement that he or she is licensed pursuant to the pmvisions of the Contrecbrs License Law (Chapter 9(commencing wi[h Szction 7000) of Division 3 of the Business antl Professions Code) or that he o� she is eaempt therefrom and ihe basis for the alleged exemption. Any violation of Section 703t5 by any applicant for a permi[ subjects lhe applicant to a civil penalty of not more than fve hundred dollars ($500).�: ��/ as owner of ihe pmpetly, or my employees wil� wages as Iheir sole compensation, WILL DO THE WORK, and �he stmcture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propeAy who builds or improves thereon, antl who tloes such work himself or nerself or through his or her own employees, provided that such improvements are not intended or offered for sale. I(, however, the building or improvement is sold within one year of completion, the owner-builtler vrill have the burtlen of proving that he or she did not build or improve for purpose of sale.). . ❑ I, as owner o( the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The contractors License Law tices not apply [o an owner of pmperty who builds or improves thereon, and who cont2cis for such project vnth a caniractw(s) license pursuaN to the Contractors License Laws.). Owner ID verified by dn�, ..cense. �{SYes ❑ No , i• �� Dnver s License No. Expires: Venfication o! Ownership by (rype of document, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certify that no excavalion frve (5) or more feet in tlepth into vfiich a person is required to descend, will be made in connection wilh work auttrorized by Ihis pertnit, and [hat no building structure, scaffdding, falsev+ork, or tlemolition or dismanUing thereof, will be more than thirty-s�c (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Code). ❑ As owner-builder, I will not employ anyone ro do work which would require a permiCfmm Ihe Division of Indus[rial Safety, as noted above, unless such person has a permit to do such work from the division. ,. Applicanfs Signa�ure Dafe Division of Indus[rial Safely Permil Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applican� or present or fWure building occupanl need b(le and certi(y a Business Plan for emerqency response to release or [hrea[enetl release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the California Health antl Safety Code requires, with some exceptions, that a Business Plan be filed with the Cos[a Mesa Fire Department by every business which has a[ any one time tluring a reported year a quantity ot hazardous malerials equal to or greater than a weight of 500 pountls. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will ihe applicant or present or (uture building occupant need ro file a registration (orm (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Cotle, with some excep[ions, requires registretion wi[h [he Costa Mesa Fire Department by each business which a[ any one time has on hand a quantity of acutely hazartlous ma[erials equal lo or greater [han a weighl of 500 pounds, or a volume o( 55 gallons, or 200 cubic (ee[ of compressetl gas a[ slantlard temperature and pressure). 3. Does or will the applicant or present or fu[ure building occupant neetl to prepare an RMPP (Risk Management and Preven[ion Program for acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the Calitomia Health and Safery Cotle provides that the Costa Mesa Fire Department may require the preparalion, certifcation and filing wilh the Fire Department of an RMPP by businesses which are requiretl to register acutety hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of ihe Califomia Health antl Safely Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require (or the vrork which is the subject of Ihis application a permit for such construc��on or modification from the Sou[h Coast Air Quality Management Distric[ or trom any other air pollution conlrol tlistrict or agency? ❑ Yes ❑ No (Section 65850.2 of Ihe Califomia Govemment Code requires that Ihe requestetl in(ortna[ion be fumished on applica[ions for non-residenlial building permits). 6. Will any part of the facility to be consVucted under this permit be wi[hin 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility musl meet the requirement o( Sections 25534 and 42303 of Ihe Califomia Heal[h and Safery Code). 7. If a permit fmm Ihe South Coast Air Quality Management Dis[rict or other air polWtion control disMcl or agency is required for [he wnrk which is the subject of ihis application, have all ot 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�polWtion conUol officer). - � � � CERTIFICATE OP�COMPLIANCE:"I certify Iha[ under penalty of perjury:[he information given above is correcL I.agree to comply vnth all state laws and city ortlinances regarding Hazardous Materials and Emissions. � '� SgnaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I . certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. [he information given is correcl. I agree to comply with all state laws and ci[y � ordinances relating to building constmction; and authorize representatives of Business and Professions Code for ihis reaso��: 1he City of Costa Mesa lo enter upon the above-tlescnbed property for - . , inspection purposes. I agree not to occupy or allow occupancy of any building � authorized by this permit until final inspection. �. f��j��g � �S�ign/y, of al er�s) Da�e SiqnaWre l./� Date �--///O�� '/Q/.. /O� " JOS]<6 �3I0]� , ��U//AL�%%1 L/ Nor.ANnonzeEApplicant �Date � FHC, INC. October 2, 2008 City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Reference: 2086 Marian Way Costa Mesa, CA 92627 PERMISSION TO OBTAIN PERMITS This letter provides notice to the City of Costa Mesa, California that, FHC, INC, A California Corporation, is the property owner of the above-described property. Owner hereby grants authorization far Owner's Agent, Matthew Bush to obtain the permits for any construction on this site related to this project. If you should�e any�efues�ys!please feel free to contact me at � HOWSER, (0�0(o cJ. CoAsi FI��(. 99��#�car�a�y Newport Beach, CA 92663 (949) 566-9155 � Fax (949) 566-9144 RECURDING REQUESTED BY ' ' Lawy?rs Titl� Company - WHEN R�CORDED MAIL THIS DOCUMENT AND TAX STATEMENTS TO: Fritz Howser too$ 5rv�rr S'�,nEs PL. N�w Pt:�r aEf�c-N -Gi qaW 3 APN: 426-202-22 Escrow No: 05210983-502-LL2 This Document was electronically recorded by Lawyc Title Company,B Recorded in O�cial Records, Orange County Tom Daly, Clerk-Recorder II�I�IIIDllllllllnlllll�l�lll�lllll�lllllliillllllllll�l �Z.00 2008000419801 08:OOam 09/05/08 717 73 G02 3 379.00 319.00 0.00 0.00 6.00 0.00 0.00 0.00 Space GRANT DEED THE UNbERSIGNED GRANTOR(5)DECLARE(5) DOCUMENTARY TRANSFER TAX IS S 638.00, CITY TAX S 0.00 computed on full value of property conveyed„ AND line for Recorder's use FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Marian Way Partnership #2086, by Talbert Capital LLC as it's Managing General Pa�-tner hereby GRANT(S)to ggC, Inc., a California Corporation the following described real property in the City of Costa Mesa, County of Orange, State of California: See Exhibit B attached hereto and made a part hereof. Commonly known as: 2086 Marian Way, Costa Mesa, CA 92627 Dated: quoust 29, 2008 Marian Way Partnership #2086, by Talbert Capital LLC as i' ging General Par er � ��0��',}/j; Den��i's Gimian, Managing Member STATE OF CALIFORNIA }55: COUNTY OF C72-Pr�=�C On �-�-O � before me, �. 1 N O Ft l.i4S-re�C.�G� , a Notary Public, personally (here insert name and title of the officer) appeared P�N1J' (��rnr who proved to me on the basis of satisfactory evidence to be the person(s) whose nam e subscribed [o the within instrument and knowledged to me thal�elbhe/they executed the same i his er/their authorized capacity(ies), and that by is er/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the �aws of [he State of California that the fore oin aragraph is true anq correct. A LA8TEUC WITNESS y hand and official seal. � ComNitbnl1eQ10B9 � Nowf � � � � c Oan� CouatY II 12 Signature (This area for notarV stamp) MAILTAX STATEMENTS AS DIRECTED ABOVE � PREL•INSINARY CHANGE OF OWNERSHIP REPORT To Ca cnmpletetl by transferea (buyer) pnor ro Vansler ol suDjed pmperty in accordance vnth Section a80.OJ o! tha Revenue and TaxaUon CoOe. A Preliminary C�ange of Ownenhip Repotl Musl Oe filetl vnth each conveyance in Ne Counry RecorCers oKce for Me counry wnere Ne properry is IocateQ Ihis partiwlar form may be use0 in all 58 wuntiee of Calilomia. A PUBLIC SELLERlfRANSFEROR: Marian Way PaRnership #2086, by Talbert Capital LLC as IYs Managing General Partner, BUYERRRANSFEREE: FHC, Inc. a Califomfa Corporotion, ASSESSOR'S PARCEL NUMBER(S): 426-202-22 PR�PERNAOORESSoRIOCATI0N:2086 Mari:.n Way, Coeta Mesa, CA 92627 MAIL TAX INFORMATION T0: Name FHC Inc. a California Coruoredon Address: (G+O`� ;krN' �i►+�^6$ PL� NE�..�firf [3��trGp, R3ir(� NO710E: A lien for property laces applies to your property on Ja�uary 1 of each year kr Ue taxes owing in Ne following fisral year, Juy 7 through June 30. One-�alt ot Nese laxes ie Oue NovemDer 1, and one�alf is tlue Fe�ruary 7. The Ant installment becomes Eelinquent an December 70, and Ne second installment becomea Oelinquent on Apnl 70. One tax b��l is mailed belore November 1 to Ne owner ot recortl. If Nis tranater occun akar January 1 and on or balora OecemOer J1, you may be responsiDle far tha aeconA InsGllmant of hses Oua Fehruary 1. FOR RECORDER'S USE ONLY OOCUMENTNUMBER RECORDING UATE The property which you acquired may be subject to a sup0�emental assessment in an amounl to be determinetl Dy the Orange Counry Assessor. For lurtner information on your supplemental roll oUligation, please wll Ne Oronge Counry Assessor. PART I: TRANSFER INFORMATION (please answera/l questionsJ YES N9- ❑ R1 A. Is this trans(er solely hetween husband and wi(e {addiUon of a spnuse, death ot a spouse, divorce sattlement, etc.)? ❑ L'i 8. Is this transaction only a corredion of the name(s) of the person(s) holding tille to the property (For example, a name change upon marriage)? Please explain ❑ � C. Is this document recorded to create, terminate, or reconvey a lenders interest in the property7 ❑ � D. Is this trensaction recorded only as a requirement foi financing purposes or to create, tertninate, or reconvey a security interest (e.g. cosignerJ7 Please explain ❑ � E. Is this doament recorded to substitute a trustee of a trust mortgage, or other similar document9 ❑ E( F. Did this transter result in fhe creafion of a joint tenancy in which the eeller (fransferor) remains as one of the joint tenants? ❑ C3� G. Does this trensfer return property to the person who created the joint tenancy (original transferor)? ❑ 0' H. Is this transfer of property: ❑ L� 1. to a revocable trust that may be revoked by the transferor and is for t�e benefit of Ihe O transferor p trans(erors spouse7 O R� 2. lo a trust that may be revoked by lhe CreatorlGrentor who is also a joint tenanL and which names Ihe other joint tenant(s) as benefidaries when the CreatodGrentor dies? ❑ O� 3. to an irrevocable trust for the benefit of Ihe O Creator/Grantor and/or O Grantor's spouse9 ❑ C� 4. to an irrevowble trust from which the propeAy reverts to the Crea[orlGrantor within 12 years7 ❑ C� I. If this property is subject to a lease, is the remaining lease term 35 years or more including writtan options? ❑ �'J. Is this a transfer belween [] parent(s) to child(ren)? O or fram grandparent(s) to grandchild(ren)7 ❑ �" 'K. Is this transaction to replace a principal residence 6y a person 55 years ot age or older7 Within the same counry7 ❑ Yes O No ❑ C� 'L. Is this transaction ta replace a principai residence by a person who is severeiy dlsabled as defined Ey Revenue and Taxation Code / Sedion 69.5? Within the same county? ❑ Yes O No O f3 M. Is this trensfer solely belween domestic partnere currently registered with the California Secretary ot State? 9t you checked yes to J, K, or L, you may quafify tor a property tax reassessment exclusi0n, which may result in lower faxes on your propedy. If you do not file a claim, your property will be reassessed. Please provide any other in(ormation that would help the Assessors to understand the nature of Ihe transfer. If the conveying document constitutes an exclusion from a change in ownership as deiined in section 62 of the Revenue and Taxation Code for any reason other than those listed above, set forth the specific ezclusions claimed: Please answer all questions in each sectlan. If a question does not apply, Indicate with "NIA". Sign and date at bottom o( second page. PART II: OTHER TRANSFER INFORMATION . B. C. Date of trensfer IF other than recording tlate �E r Kt i�2io � n)[, pq�: T pe of lransfer (Please check appiopnale box.J Purchase ❑ Foreclosure ❑ Gift ❑ Trede or ExChange ❑ Merger, Stock, or PaRnership Acquisition Cantract of Sale - �ate of Coatract ❑ Inheritance - Date of Death ❑ Other: Please explain: ❑ Crea!ion oF Lease ❑ Assignment oF a Lease ❑ TerminaUon of a Lease ❑ Sale/leaseback ❑ Date lease began ❑ Original term in years (including written options) ❑ Remainirtg tertn in years (including written options) Monthly Payment emaining Term Was ony a partial interest in the propedy transferred? O Yes c If yes, indiwte the percentage transferred % BOE-502-A (BACK) REV. 8(70-OS) ASSRdO (Rev. O5/O6� Page 1 ot 5 CITY OF COSTA MESA CALIFORNIA 9282&1200 P.O. BO% 1200 DEVELOPMENT SERVIGES DEPARTMENT 77 FAIR DRIVE, 2ND FLOOR MINOR MODIFICATION Reference No.: Status: Applied Date: Approved Date: Denied Date: MINOR MODIFICATION NO.: MM-99-13 Project Address: 2086 MARIAN WY Suite: Parcel Number: 42620222 ProjectApplicant: DORISH,GARY �Q�l -b ( 4'? Z APPROVED 09/15/1999 09/15/1999 PROPOSED MINOR MODIFICATION: MINOR MOD TO ALLOW AN ADDITION TO AN SFD THAT ALLOWS A 4 FT SIDE YARD SETBACK. ADDITION IS AN INFILL PROJECT CONNECTING TWO EXISTING BUILDINGS THAT ALREADY ENCROACH 1 FT. INTO THE SIDE YARD SETBACK. REQUIRED FINDINGS:Y The improvement will not be materially detrimental to the health, safety and general welfare of persons residing or working within the immediate vicinity of the project or to property and improvements within the neighborhood. Y The improvement is compatible and enhances the architecture and design of the existing and anticipated development in the vicinity. This includes the site planning, land coverage, landscaping, appearance, scale of structures, open space and any other applicable features re�ative to a compatible and attractive development. PRWECTPLANNER: CAMPB TJ NOTES: Building Division (714) 754-5273 • Planning Division (714) 754-5205 • FAX (�14) 754-4856 • TDD (714) 754-52A4 � Aoo��ant to fill in all spaces ezceD< thoze witnin heavy eortler Iines ana sign all aoG�oD��ate Oeclarations. CI7voFCi�`S'r''AIvIESa Cp,O�NSTRUCTIONlPfERMIT Project Address �� `�A' � ��/�� 1/� Applicant'SMailin1o1Adrlress,�t ��`i7^ O�,/-t �� \�(��'n' qI Owner'sName I��S� I`�C`'„��'�n� Phone.�(1S2t� Address �.lp- Arch/Eng. LicenseNo. �T"'fo$�� Address ,/c,,, C Comracmr'sName�'v�� 1 U�� Phone S—�� Addresslmailin9) ' �� Ciry License No. 3 r� LICENSED CONTRACTOR DECLARATION I h¢reby affi�m that I am licensetl untle� provlsions ot CM1arte� 9(commencing with section 7000) of Division 3 of the Business antl Professions Cotle, antl my license is in full orc tl effect. ---�� License Qass �� .. li e e Dzte��' c;,,��r��. ^�� WORKERS'COMPENSATION �ECLARATION ,1 hereby atfirm tM1at 1 ave a certificate of cf�nsent to self-insure or a certificate �:: �4 W rkers' mpen [ion 1 urance, o/(/j� certifietl copy t�eof (Section �doo� No. ' � � COtn0a11Y ��G �� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This section neetl not be completetl it Ihe permit is fo� one huntlretl ($300) or less). , I certify that in the perfo�mance of the wo�k for wM1ich this perm�t i5 i55ueG, I- shall not employ any Oe�son in any ner zo as t bec�,�{*��e 54b�e/�pt to Ihe , Workers� Co�eS�satjgn.6.aws ot Calif� tlJ'1 ..`FE' Date �^ `� � Signature i" t'W�=FE� 'NOTICE: If, aiter making this tleclaration, you shoultl become subject� Workers'. Compensation provisions of the Labor Cotle, you must forthwith compty with such p�ovisions or this permit Shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV I hereby affirm that tKere is a cons[ruction lentlin9 agency tor the performance Of the work for which this petmii is issuetl (Section 3097 Civ. CJ Lentler's Name Lentler's Atldress � � OWNER BUIL�EH dECLARATION ' ' 1 hereby affirm that I am�exempt from the Contractor'S License Law (or the fo�lowinq reason (Section 7031.5 Business antl Professional Cotle: Any clty or counry which requires a perinit to construct, alter, improve, demolisM1 or r¢pair any structure, prior to its issuance, also requires the applicant tor such permit to file a signetl Statement that he/She is Iicense0 pursuant to the Provisions ot the Cmtractor's License Law (Chapter 9(commencing with Section 7000) of DiviSion 3 of [he Business antl P�ofessions Cotle) o� that he/sne is exempt `erefrom antl the Dasis (or the allegetl ezemption. Any violation of Secfion 31.5 by any applicant fo� a permit subjects the aOP��cant to a civil �nalty of not more than five huntlretl tlollars ($500). ❑ I, as owner of the property or my�employee5 with waqei as their sole compensation, will tlo the work, antl the structure Is not intentletl or offeretl for sale (Section 7044, Business antl Professional Cotle: The Contractor's License ;Law tloes nol apply to an owner of a property who' builtls or improves thereon, antl wno does sucn work himselt/ne�seli or through his or her own employees, provitletl that su[h improvements are not intentled or ofteretl fo� ��Sale. If, howeve�, tne builtling or improvement is Soltl within one yea� of com- pletion, the owner will have ihe burtlon of proving he/she tlitl not builtl ot im- prove for [he purpose of sale�. ❑ I, as�owner of the property, am ezclusively contracting with licensetl con- tractorsto ronstruct the Oroject (Section ]044, Businessantl Professions Cotle: The Contractor's Li<ense Law does no[ apply to an owner of property who builtls or imoroves thereon, antl who conVacts tor such projects with a con- trattor(5) license pursuan[�[o Ihe�Contrattor's License Law). I am aware that 0/oot ot [heir Worker'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. to� lnis �eason Date t sentauves oi [pis cit insoection pur se Signature � Drivers' License or 55 CMF 0865-46, rev. 30/84 _ Owner -have reatl this application agree to campty with all [ to building mnstruttion, ai to enter�uoon the abovi above ances �ep�e- v for _....... .._ lG � Z- _. .._. __. .._. ..,.,, ,.�. TYPE OF CONSTRUCTION NEW ADD. ALTERATION REPAIR — ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P'# DESCRIPTION OF WORK/USE OF BLDG. n 0� E Main Building: TVPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL . T Front ❑ TENANT ❑ ELECTRICAI_ ❑ PWMBING ❑ MECHANICAL B Rear ❑ OTHER %� PROJECT DESCRIPTIO Q.FT. =�n�' OCCuaANCY C Right CONSTRUCTIONTVPE �VALUATION$��XSC g Left 20NE ' , GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: , , Planning Notes: Bar Sink Backflow Preventer Backflow IrrigatiOn Bathtubs ' ' Clarifiers Drinking Fountains Floor Drains�� Floor Sinks � � . Gas Service Outlets 1 nterceptors Kitchen Sink Lavatories , � P—Trap Roof Drains Reinspection Fee � PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors �' Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Water Service � Auto-Wash Laundry Trays $15 Issue Fee . Boiler . Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFact. BIt. ICBO # Heating System & Duc[ing . ❑ o-i oo,000 eTu O i oa,000 eT� Reinspection Fee � $15 White - Builtling; Canary - Applicant; Pink - Accountinq; GoltlenrOtl - As5e55or Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alt2ration Fire �ampers Registers Issue Fee FEES 5547 6/26/85 � Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer - - � Transformer Construction Pole Sub. ' Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan P.A.U. Fixtures Device Boxes OuHets Switches Garbage Disposal ' Generetor �0�5 KW �5�15 KW LJ 15-50 KW ❑ 50+ KW Meter ❑up to 100amps � Meter ❑over 100 amps Sub Panel Motors �0-1 HP O1 %� 8 Inc.Solar �9-15 HP �76-15+ ' Microwave � Pole Light Sign ', Standing�Sections Tresh Compacror 3G.5a 7L FEES $ 3 I �— Reinspection Fee $15 luue Fee $ 3 FEES DEVELOPMENTSERVICESREQUIREMENTS: � � ' Zoning Approved By Date Building Approved By ' � Date Application luued By DatN �l Ua ' SU_ MARV OF FEES ' BUILDING PERMIT $ �v•OC) SMIP $ � . S� PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ . ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICFOFILM $ ' MECHANICAL $ TOTAL FEE $ 3O •S� $ 3 PLAN CHECK 25% $ � � , Z O N I N G R E Q M T S i� CONSTRUCTION AND PLANNING ' • POOL PA � APPROVALS Permit# � Date Inspector AppROVALS Permit# Date Inspector `1. Temporary Electrical Service or Pole . • 52. Pool & Equipment Location .�2. Soil Pipe-Undrgrnd. � � ' i � 53. Steel Reinforcement -' � '�' 3. Electrical Conduit Ut?lity-Undrgmd. '' 54. Forms 4. Electrical Conduit-Undrgrnd. � � , ' 55. Electrical Bonding � 5. Steel Reinforcement ! -- _ 56. Rough Plumbing & Pressure Test � i� 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings � � - ' • � 58. Electrical Conduit-Undrgrnd. , 8. Foundation i i ; � 59. Gas Pipe, O Undrgrnd., Test • � 9..Water Pipe�Undrgrnd� ;. i , ., 60. Backwash Lines, P�Trap, 0 Undrgrnd. 70. Strucwrel Floor SYstem _' �� , 61. APPROVAL TO DECK 11. Property Sewer Line &�House Connection 62. Backwash & Receptor-Final i 12. Sewer!Cap ' . � �,, - 63. Heater & Vent-Final � i � 13. Roof Drains ,� , 64. Plumbing SYstem � Final � i i 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 Eleciriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21 . Ducts, in Structure � 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing - 76. DryStandpipe 28. Lathing & Siding -, 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINA� 30. Drywall Nailing � � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � , 79. FINAL INSPECTION 32. Electrical Power Meter-Final � ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ` � 36. Hood or Canopy � � : 37. Final Factory Fireplace 38. Final Plumbing � � 39. Water Service-Final � . 40. Gas Service-Final . 41. Solar pomestic-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. Electrie Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ��` AOPlicant to flll in all svaces excev� thoze within heavY bartler Ilnes ana sl9n all aooroDriata tleclarations. CITY.OF COSTA MESA CONSTRUCTION PERMIT PERMIT . —. TRACT NO. LOT NO. 11NiT Nn ��jer AUdress A��1 ki0 �I�Ji./G� •Applican�'s Mailing' ddress �(j� �.�� ,y� —�'/ Owner's Name��J �uh/�'� ��Le,�.�k ��,�,�i�,y( phone S�Y.t1LdLr 'Addreu !�� G�� P'7 / 'Arch/Eng. License No. Address Gontractor's Nam hone Addreu (mailing) , (L �� City License No. LICENSED CONTRACTOR DECLARATION I hereby a�11rT [hat 1 am licensetl unUer provisions of Charter 9(commencing with section 7000) of Dlvision 3 of the Business antl Protessions Cotle, antl my license is in lull force ana effect. License Class License No. Date' Signature WORKERS' COMPENSATION DECLARATION ' '`ereby af8rm tnat I nave a certiticate ot consent to self-insure or �a certificate Norkers' Compensation Insurance, or a certi(letl copy tnereof (Section �0. Lab. CJ . 1 Policy No. ' Company eCe�Hfletl copy IS h¢rOby (umishetl. Certifietl copy is illetl with the clty Builtling Dlvision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completetl If Ihe permit Is for one huntlre0 (5100) or less). I cetUfy thal in th¢ �p¢rl0rmance o1 the wo�k fo� whic� tM1is Oe�m�t Is Issuetl, I shall not employ any person in any maj�ner�so as to become �ect to the Work¢rs' C p�' n Laws of Cali/pc� [/yJ_ n/ Date .�1 %�'�Si9nature JJL% �NOTIC Ii, af1 � making lhi5 tlGtlardtion, y0u shbWd become svDje to [he Workers' COmp¢n5ation prOviSions of the LaEo� Cotle, you must fortnwitn comply witlf such p�ovlsions o� th15 pe�mlt shall be tleemetl revok¢tl. CONSTRUCTION LENpING AGENCV , 1 hereby atOrm tbat tM1e�e is a con5truction'lentling agency for the pertormdnC¢ o( the work for which this permit iz- issuetl (Section 3097 Civ. CJ Lentler's Ndme 4enaer's F\tlaress OWNER BUILDER DECLARATION I hereby afflrm Ihat I am exempt trOm the Contrdctor'z License Ldw tor the following reason (SecHon ]031.5 Business antl Protessional Cotle: Any ciry or county wblch requires a petmlt to ConStruc[, al[e�, improve, tlemolish or repal� any structure, prior [o Its issuance, also requires lhe applicant for such permit to file a signetl ztatement that he/sne Is licensetl pursuant to the proviLons of Me Contractor's License Law (Chapter 9(commencing with Section ]000) of ^�vision 3 bf the Busines5 anU Profe55ions Cotle) or that he/she is exempt 'etrOm antl the ba5is lor the all¢9¢tl exemption. Any violatiOn of SecHon 1.5 by any applicant Por a permlt subjects Ihe applicant to a civil .aalty of no[ more than five huntlretl aoilars (E500�. � . �.1,' as'owner ot the property ^• ^+^ ^""^'^"^^� �"sOt6 cgmpvrlatiDR"Onll tlo the work, antl the structure is noi intenaetl or offeretl �� for sale (Sectlon 7044, Businezs antl Professional Cotle: The Contractor's I LicenSe Law tlo¢s not apply to an owner of a properTy wtto builtls or improve5 '� thereon, and wno tloes such work nimselt/herseH or tnrough his or her own Iemployees, provitletl lhat such improvements are not intentletl o� otfere0 for sale. If, nowever, tne bulltling or imp�ovement is soltl within one year Of com- plefion, tho owner wlll have tbe hwtl¢n of proving he/she tlitl not builtl o� Im- �ove tor tM1e purpose of sale). LI I, as owner of tM1e Oroperty, am exclusively contractin9 �+�th Ilcensetl con- t�actorsto COnitructthe p�ojeCt ($ectlon ]044, Business antl P�oteSzionS Cotle: The Contractor's Li<ensa Law tloes noc avPly to an owner oi property who builtls or Improves thereon, antl wno contracts for such projects witn a con- tractor(s) ucenze pursuant to tbe Contracror's License Law). I am aware�that proaf of their Worker'S Compen5ation insuranGe shoultl be provltletl to me. ❑ I am exempt untler SecNon . B. & P. C. tor this reason Date d�L� Owner � E�,f�KHp�'L � �/ � �'v I hereby�certi/� tbat 1 hav! �eatl th15 applica[IOn dntl state Iha[ the abOve Information iz correct. I agree to comply wifh all tfty antl county ortlinances antl stat¢ laws �elating t0 builtling const�uction, antl he�eby autho�iie repra- . sentatives o1 this city_ to enter uonn md ibove-mentionea orooertv for Inspectlan Si9nature Drivers' Li or55� TYPE OFCONSTRUCTION LINEW U ADD LJ ALTERATION LIREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER AP � - _ DESCRIPTION OF WORK/USE OF BLDG. - � ' S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELEGTRICAI. ❑ PLUMBING ❑ MECHANICAL 6 Rear � ❑ OTHER . - .. %� PRQIECT UESCRIPTION $Q. FT. OCCUPANCV C Righf CONSTRUCTION TVPE VALUATION $ ' S Left ZONE GRADING CU. VOS. ACRES Ping. Ref. # Remarks: - ' . , Planning Notes: � Bar Sink Backflow Preventer Backflow Irrigation. Bathtubs Jrinkin9 FOuntains =1oor �rains Floor Sinks 3as Service �11t12L5 . I nterceprors Kitchen Sink - Lavatories � P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exheust $ystem ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑6100,000 8TU 0100,000 RainspeRion Fee � S75 CMf 0865-46, rev. 30/B4 White - Builtling; Canary - Applicant; Pink - Accounting; GOltlenro0 - Assezsor PLUMBING Showers Service Sink ' Sewer Cap' ' Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank 'Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auro-Wash Laundry Trays Issue Fea Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑aiaooaoeru ❑iao,000 System (iepair/Alteration Fire Dampers Registers laue Fee FEES $ 3 FEES $ 3 , � � ' �� seea 10/29/96 i ' Accessory Building: Parkin9 Req./Provided ELECTRICAL ' Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher - Meter ❑overi00amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors D0�1 HP 01 h- 8 F.A.U. Inc.Solar �9-15 HP �16�15+ Fixtures Microwave . Device Boxes Pole Light ' Outlets Range ' � Switches Garbage Dispoul Generator �0-5 KW �5-15 KW i ". " 5.OD Tl 2one ,. _ FEES Fee � $15 Standing Sections Trash Compactor Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zaning APProved BY . 8uilding Approved By � Aoolication laued Bv SUMMARV OF FEES BUILDING PERMIT $ SMIP • PLAN CHECK $ ��}� PERMIT PLUMBING $ �tL ��UANCE PLAN CHECK 25% $ ENERGY P.C. E�EC7RICAL - $ GRADING PLANCHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ $ 3 $ Z O N I N G R E Q M T S. � CONSTRUCTION AND PLANNING POOL & SPA ,_ APPROVALS Permit # Date Inspector . AppROVALS Permit # Date Inspector i. 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-Undrgrnii. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structurel Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � � 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe 28. l.athing & 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. Electriral 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 pomestic-Final 42. Backflow Preventer - 43, Backflow Irrigation F/�� , 44. Landscape Irrigation System � 45. Sound Attenuation . - � 46. Handicap Regulations 47. FINAL STRUCTUFE & BUILDING �' 48. Special Requirements Completed � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY � � No. Date % Applicant to fill in all spaces CITY OF cOSTa MESa CONSTRUCTION PERMIT . Project Address ��.�'.+ �`�,O'.ii� t EN� ��/�✓'' ��v; ('� Applicant's Mailin/y� Address � pQ� �'' �'ccLvTp Owner's Name '�/'�NNY MC�h h 0% Phone 5]�2 �t Address �e 0.S d �b, a � y Arch/Eng. License No. Address p Contractor's Nam r!� Q /S �N pryo�e ��S Address(mailing) •0' �� i'(�3�b% s e�` 9.Z�+:� E City License No. � A�a I LICENSED CONTRACTOR OECLARATION I hereby affl�m that I am lic¢n5etl untlar provislons ot Charter 9(commencing witn section 7000) of Division 3 of [ne Buslness antl Professions Cotle, antl my Iicense is in tul orc an etiect. �.�� /�y � 1 Licenze CI 55 � License N. � � j�) Date Signature � � YWORKERS' COMPENSATION DECLARATION I hereby affirm [ha[ I have a certlticate ol consen[ [o se f-insure or a certificate �f Workers' Compensation Insurance, or a certi ietl copY thereof (Sectlon \' J800, lab. C. Policy No. r-`�'�k�l 3(oSOqCompany \ r[ifietl coOY is noreby furnlshetl. Certi£e copy i letl with the city Bui ng Divi 'on � n_ _. � Date Applicant (� EXEMPT ON OM W0f3KER5' COMPENSATION DECLARATION (This section neetl not be completetl it the permit is for one huntlretl ($100) or less). I certify that in the p¢rtormante of tho wo�k for whiCh thi5 perm�t is i55uetl, 1 shall not employ any person In any mann¢r So a5 t0 bCcome subject [o the Workers' Compensatlon Laws ot Califomia. ' Date Signature 'NOTICE: If, af[e� making Ihis tleclaraHon, you sM1oultl become subject to the Workers' CompensdliOn provisions of tne Labor Cotle, you must forthwith tompry wilh zuch provisions or thi5 permil Shall be tleemCtl revoketl. CONSTRUCTION LENDING AGENCV ' I hereby afflrm tM1at thera is a construttion lentling agency lor the performance of lne work for which this permit is ,issuetl, (Sectlon 3097 Civ. C.) Lentler's Name lenaer's Atlaress OWNER BUILOEN UECLARATION � I hereby aftinn that I am exompt trom the Contractor's License Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or counly whicb requir¢s a pe�mlt lo Cons[ruct, alte�, improve, tl¢mOlish o� repair any sVuclure, prior to Its issuan<e, also requkes the applicant for such permit [O flIE d S19OCd SSdI2lOEl1L Ihdl h2/SM1C IS IICClISCd PUfSIIdOI t0 lhC pIOVI510I15 Of the Contractor'S Licensf law (Chapter 9(commancin9 with SeGtlon 7000) of " Division 3 0l the BUSiness antl Profe55iOn5 Cotle) or thal h¢/She is exempt �heretrom antl th2 basis fo� lhe all¢9¢tl exem0��on. Any violatlon ot Section il31.5 by any applicant fOr a Oermit SubjGClS [he applicant to a civil endlty ot not more lhan five huntlretl tlollar5 (E500). . ❑ I, as owne� of the prope�ty or my employ¢e5 with waqes as their Sole compensation, will tlo the work, anC the structure is not intentletl or otfere0 for ule (Section 7044, Business antl Pm(essional Cotle: 7he Contractor's License Ldw tloes nol apply IO an owner Ot a p�operty who builtls O� imp�oves thereon, antl who tloes such work hlmself/nerseli or throu9h his or her own employees, provitletl that such improvaments arn not intentlea or oHeretl for sale. If, however, the builtlin9 or Improvement Is soltl wiNin one year ot com- pletioq the owner will M1avc tbo bur0on of proving he/sha tlitl not builtl or im- p�ov0 for the purpo58 01 sale). ❑ I, as owner oi the property, am exclusively contracting with licensea con- tractors to construct the projec[ ($ection ]044, Business antl Profession5 Cotle: The Contractor's License Law does not apply [o an owner of property wno builtls or ImDrovez tnereon, antl who conVacts for sucn pro]ects with a<on- tractor(s) llcense pursuant�to-the Con[ractor's Lirense Law). I am aware tnat oroof ot their Worker's Compan5ation insurance shoultl be proviaetl to me. ❑ I am exempt untler Sectlon B. & P. C. for tnis reason Date Owner I hereby certify tnat I have rea� iMo�ma[ion I5 cortect. 1 agree [O antl-state laws relatlng to builtlir SCfIShcIVCS Of I 5 Clly (O CIl[CI in5pection pur ses. Signature Drivers' License or 55 � i this applicatlon antl ztate lnat the above comply wltM1 all city antl counfy o�tlinances g construction, antl nereby authorize repre-' u n[ne above-men[lonetl pro rty for Y^*�� Date�� _ n t�ose wilhin heavy Oortler Iines anE sign all appropriale Geclarationz. TRACT NO. LOT NO. UNIT N6. TVPE OF CONSTRUCTION LI NEW LJ ADD LI ALTERATION I��REPAIR — ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � - q,p.# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING yOVNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PRQIECT DESCRIVTION 5�. Fr. ' ocCUPaNCv C Right K Left CONSTRUCTIONTVPE VALVATIONS S ZONE GRAOING CV.YDS. ACRES ping. Ref. # Remarks:� r � � �. � � � � K Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Clarifiers ' Dishwasher Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets Kitchen Sink Lavatories � ?—Trap ' Roof Drains Reinspection Fee� $15 Duct - Under Ground Duct-Strucmral ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ o-i oo,000 eru o i oo,aoo Reinspec[ion Fee � � $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor PLUMBING _ $IIOWCfS Service Sink ' Sewer Cap Sewer Connection Solar Collecrors ' Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet ' Water Heater � Water Service � Auto-Wash Laundry Trays I�sue Fee. Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-t00,0006TU ❑100, System Repair/Alterotion F ire Dampers Registers , Issue Fee FEES ' I $ 3 9320 8/29/55 � Atcessory Building: ' Parking Feq./Provided ELECTRICAL Auromatic Washer - Transformer Construction Pole Sub. Cooking Unit - D ishwasher Dryers ❑Gas ❑Elecvic Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW �5�15 KW °Jol�l. � Zone - ' ' LJ 15-50 KW ' - ❑ 50+KW Meter LJup to 100amps Mecer ❑over100amps Sub Panel Momrs OO-1 HP Oi X- 8 Inc.Solar �9-15 HP 016-15+ Microwave Pole Li9ht Range Sign ; Standing Sections Trash Compactor fee �$15 � '� luue Fee �EVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By BuildinB APP�oved By � Aoolieatian Issued Bv � �� Z O N I• N _ G H E � M T $ FEES $ 3 � SUMMARV OF FEES BUILDING PERMIT $ � SMIP $ PLAN CHECK $ � PERMIT ' � PLUMBING $ �7• Cl�/ ISSUANCE $ _ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL' � $ GRADING � $ PLAN CHECK 50% $ .MICROFILM $ MECHANICAL $ � TOTAL FEE � $ � PIAN CHECK 25% $ , � . CONSTRUCTION ANDPLANNING POOI PA APPROVALS Permit # Dat� Inspector p�ppROVALS Permit # Date Inspector 1. Temporary ElectricBl Service or Pole � 52. Pool & Equipment Location ,i 2. Soil Pipe�Undrgrnd. �- �.� 53. Steel Reinforcement .. � 3, tElectrical Cond �it�Utility-Undrgmd � �_� 54. Forms � 4t ElectFical ConduitUndrgrnd. d� . 55. Electrical Bonding '� 5.��Steel Reinforcemeni% 56. Rough Plumbing & Pressure Test ��% . 6. EleciricaLUFER��Gmd. 57. APPROVAL TO COVER-GUNITE _� � � 7.:Footings �;�,� ri � 58. Electrical Conduit-Undrgrnd. j 7 8i�Foundation .`� i �. 59. Gas Pipe, O Undrgrnd., Test t�. ,i 9 fWate? Pipe-Undrg`rnd. . ' ^ 60. Backwash Lines, P-Trap, O Undrgrnd. � 10, Structural Floor Sysfem -- 61. APPROVAL TO DECK , it ,Pro�perty Sewer Line�& House Conn�ction � 62. Backwash & Receptor-Final 12.,Sewer'Cap �! i✓' "' ` r', 63. Heater & Vent-Final a. �f .. 13' Roof�Drains l�j (" w � 64. Plumbing System - Final � I 14. Rough Plumbing'r,r l' _ 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 c 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Condifioning FIRE DEPT. REQUIREMENT 20. �Rough Factory Fireplace � ' APPROVALS Permit # 21. Duc[s, in Structure • 70. Underground Hydro , �, 22. Ducts, Ventilating �. . 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test -.. �' 72. Underground Flush 24. Roof Frami�g` • 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing '*., i 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Moriocoat 75. Dry Chemical 27. Frame and Flashing �-,• 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-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 9 �� - �p 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-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. Elearic Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY No. Date OWNEH DUMORD COx'p. DATE 7-31-63 JOB ADDRESS 2� t''�8riB31 W�Y � BUILDING PERMIT NO. 2�1 `� FIRE ZONE DESCRIPTION OF DATE GROUP I&aT TYPE V SUBCONTRACTOR mm �l� /. t •- COSTA MESA BUILDING•SAFETY DEPARTMENT P. O. BOX 817 C08TA MEBA. CALIFORNIA For Applieant fo Fill In Complefely TY^PE OR PRINT BUILDING ! 1 1 _1 ` - `� ADDRESS �P M W CPSTA MESA CALIFORNIA ' n �� ucTrio. Z-1 � J No: � bi� 61ZE �/'j ^ � NO. OF 1 OF LOT / //DI/ HOW on � U6E OF .—Q � EXIBTING BLDG 86TBACK LINB PPtlN /I {'� � �/� LEFT � RIGHT DE5CRIPTION OF WORK BUILOWG /( Jj NO. OF 812E �"��O ROOMS STORI EXTERIOR WA L ROOF COVERING GLU COVERING � USE OF BUILDING AND WORK TO 9E PERFORMED �EF c� {tr�� -�1 APPLICATION-F R PERMIT JUL 3 10R tDING FINNNCE DEPT. CI�o�JOEfi� lls�.Only RECEIPT NO. Ppf L FEC8IVED�BY I pA . E�F1=Eq`�I p�' iTI J G Z BUILDING ADDRES6 �-c COSTA MESA. CALIFORNIA ZONIMG ' ' ZONfi �I NO. OF U6E.OF N ,� I PLAN9 ILD�! l/ �/A� DEBCRIPTIONWO � � � Y� L � EVES � ' (CCNTCR LINE 8Tq �-�-v . 1 HlHET' ACKNOW�OOH THAT 1 XA ftGD TH18 APPLIGTION ANO BTATE TNAT TME ABOVC 18 GOPRECi AND AGREE TO COM- PLY WITH I�LL GITY CHOINANCEB AND eTATE UWB REGUUTING OUIIDINO CON9iRUGT10N. BIGNANRE OF PERMITTEa_� ? AUTHORIZED AGENT I� -/2, G TXE AMOUNT BNOWN UNGEH VALUATION 18 POR THE PURPOBE OF EBT/�BLISHING A PEHMIT FEE ONLY. VALUATION // �; � PERMIT FEE $ �7'• $/�1 � � 3/�i PLAN CHECK $ a �" ! <r . � I, 6C itlTAL' FEE $ J �. V 111YL' 11 ,� GENliRAL CO AP No. 11� 1P" 'CTIONS � So_ � Gas Final LH1G �ax Pat3o lE ZONE VALUE $ 1 GROUP I TYPE V SUBCONTftACTOR I r 1Y V � ��' r rnm %-� �� 2'%�28J JuL 14-67cras;.��7G26"' :....': 1'.5C COSTA MESA BUILDING-SAFETY DEPARTMEM P.O. BOX 12J0 COSTA MESA, GALIPORNIA Y3620 -�OWNER MON50N Robert N. v JOB ADDRESS 20S M� _, GENERAL CONTRACTOR OWTIET '' nP No. ii8-io3-4o �oT �r�• ECTION$ i. s, . '� GAS WATER ROUGH PLOMBING PROP. SWR. LINE � HOUSE CON. � SPRINKLING SYSTEM MISCELLANEOUS ROUGN HEATING AND AIR CONDITIONING TEMPORARV SERVICE UNOERGROUND � ROUGH WIRING TRENCHES � FORM1 FLOOR SVSTEM BONO BEAM n S1 SHEATHING FRAME AN� FLASHING LATHING — IN n ( PLASTER, BROWN COAT STRi"'TURAL, FINAL HE. , VENT., REFRI PLUMOING, FINAL ANO ELECTRIC, FINAL aiui niur. ciuei R STEEL REINF. DATE 10�17/72 BUILDING PERMIT N0. 355 FIRE ZONE SUBCONTRACTOR ` �� 35574 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely ADOF�SS � OWNEp MAIL � ADDR�SS CITV �OST CONSTNUGTION LENDFq BRANCH ADDFE55 ARCHITECT OR ENGINEER ADDFiE55 CONTRACTOR ADDRESS CITV STAT� uc. No. U� SIZE OF LOT �Q USE OF EXI5TING BLDG. SIZE OF NEW BLDG. I S EXTER�OR WALL COVEpING $/ USE OF BUILOI TE L. NO. 7EL. dTV UC. NO. NO. OF BLDGS. OW ON LOT `� NO.OF / ROOMS STOF ROOF o COVERING O AND WORK TO 8E PERFORMED PAIL� Oi,T 17-72cnv�� 76f;�` TION FOA BUILDING PERMIT DATE RECEIVED DATE I SU °' " Z' -I — �/n�_ PERM �iC BUILOING ^D {`` / ADDRESS p( (J i� TRACT S� W ADD A R x OWNER �OU�r% use R G � FIRE ZONE T APPROVED BV / ZONE_ � NO.OF�� u PLAI�tS� VARDSAPPROVED MAIN BUILDING (FROM C/L STREET) VAR. #E I hereby acknowletlge that I have reatl this epplication antl state tha[ the above intormation is correct antl agrae to comply with all laws regulating builtling construction, antl 1 shall not employ eny psrson in violation of the workman'S compensation lews Ot tha Stb[e ot Califomia. � I hereby certify Nat I am properly licensetl os e conttactor under SQ. F [he S[ate af California Business and Profassions Cotle, Dlvlzicn 3, THE AMOUNT Chapter 9, antl that such 'canc s are in full force and afiact, or I THE PURPOSE ( am ez@mpt from th ovisions f Ihe Steie of California Business VALUATION antl Prbfessions e, Division�apter 9. /J SipnaiUreof / - /�� Permittee S � Authorizetl Agant LOT � BLOCK P �%ohSOvl VALUE �� $ yPE GROUP � DATE/��// USE OF NEW 1 — BUILDING �'�� YAqDSAPPROVED DATE APPROVED & m 0 iM1T FEE ONLY: � ¢ ! �_ . N � � m s Q 2�" � LL