HomeMy WebLinkAbout3213 WASHINGTON AVE - Building PermitsADolleant to fill in all soaces except tnosa witnin heavy eortler Iines and sign all approo��ata tlrtclarations.
ciTv oF COSTA p�ESn CO�N�S)TR�JJCTION PE�R/MIT
ProjectAddress --���3 wa3/'//NG�� /1�1�G
Applicant's Mailing Address �I '"`� /
Owner'sName +�0✓�3�"�a /"�• �/�LI� Phon Z8 �
Address 3�/3�NA1Ln ��
Arch/Eng. �+�n—� Lice�ns/ej �N�o.
Address �� liW1�� -[ %�L//
Contractor's Nam� �"*� Phone
Address (mailing) 'N'�"� �/��'���/
City License No.
IICENSED CONTRACTOR DECLARATION
I �ereby attirm that I am Ilcensetl untler provision5 of Charter 9(commencing
witn section 1000) of Dlvision 3 of the Business antl Professions Cotle, anA
my license is in tull torce anE ellect.
Li<ense Clazs License No.
Oate 519nature
WORKERS'COMPENSATION DECLARATION '
1 hereby atiirm ihat 1 have a<ertlticate oi mnsent lo setl-insure or a cert7licate
;;i Workers' Compensatlon Insurance, or a certif�etl tooY �hareoi (Saction
ti"300. Lab. C.)
�-��6olicy No. Company
BCertifi¢tl Capy I5 h¢reby lurnish¢tl. '
Cer[ifietl copy I5111etl with the city BuilAing Division.
Date APOlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl na[ bo Camplc[etl if the pe�mit i4 �or one huntlretl ($100) o
less).
I certify tnat in the perfOrmanGe of the w k for Whic this p r' is suo , I
shalt nol employ any porson in any r so s bet sub" c ha
Workers' !O�e�j3❑yn LawS ol Calif ni .
Date _'����LL.../�"( 519nature
'NOTIe :(, af4�r r„sking this tletlar , you shoultl b oma s �ect to tho
Workers' Compenu�ion provisions the Labor Cotle, you m t forthwith .
tomply with such p�ovislons or is Oermlt Shall be tle otl revoketl.
CONSTRUCTION LENDING�A ENCY
1 hereby afllrm tnat iheru is a conztructlon lentling agency tor tha performance
ot lhe work for wNch [hi5 permil i5 issued (Section 3097 Civ. C.)
Lentlar'S Name
Lenticr's AdOresS
OWNER BUII�ER OECLARATION
1 hereby a�tirm thal I am oxempt hom the Contra[[OrY Ucense Law lor the
foilowing reason (Soctlon 7031.5 Businesz and Pr0lessional CaEe: Any tlty or
County wbich rcqui�os a permit [O Construct, alle�. �mprOVB, tlCmolisb o� �epair
any structum, prlor lo ils izsuanca, also requires the applicant for such parmit
f0 fl10 d SlgnOtl SIdIOTplIt [hdt 118/Sh8 IS Ilt¢n52tl OUlSUdOt l0 lI1B plOvl5i0lIS O/
th¢ COntractor'S Licenw Law (ChaptGr 9(commen���9 �+��h SeCUOn 7000) oi
Divislon 3 0l t�e Business antl Proteszions Code1 or that �o/sho Is oxompt
'hCrGl�Om antl th0 ba5is tOr th0 allegetl exemplion. Any viOldt(on ol $ectlon
731.5 by any appliWnl lor a pe�mit Subjo<t5 Iho applicanl to a Civil
e alry ol not more tnan tive buntlretl tlollarz (f500).
1, as ownOr Oi tho property
will Uo lhe work, anE Ne Stru<lure iz nol Intontlotl or olferotl
for sale (Settion 7044, 8uslness antl Fro(essional Cotla: The Contractor's
Licenie l.dw tlocs not apply to an owner oi a property who bulltls or Improves
thereon, antl wno Eoes such work himsel(/herself or through his on c�r own
employ¢e5, prOvitl¢tl that such ImprOvemenls ate nat intentlCtl O/ oHerotl lor
sale. It, hOwaver, Ihe builtling or Improvement I5 SOItl within ono y0ar O/ Com-
plctlOn, ttte owner will hav0 Ihe burtlen OI Provin9 ne/Sh¢ tlitl not builtl or im-
prove for the purposo ot sala).
❑ I, as owner ol ihe Droperty, am exclusively contracting with Ilcentetl con-
tfactors to conStruGl IM1a project (SCtliOn 7044, BULness and ProfeSSiOnz COtla:
The Contractor's �License Law Ooes not applY la an owner ol property who
builtls or Improves IM1ereon, antl who coni�acl5 tOr such prOjMts with a con-
lractor(51 IicBnSB pur5udnt�t0 lh¢ ConVactOr'S LiGe se Ldwj. I am awaro [bat
proof o( tbolr Worker's Compensatlon Inmrance oultl be provitletl me.
❑ I am ezempl untler SeGtlon� �b��fy� ln' �eason
Date � Owner,
I nereby certif tbat I have reac
informat on is carrect. I aaree to
in5pection purp�
Signature
DriJerS' License
CMF 0865�46, �ev.`
TVPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPNIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
OESCRIPTION OF WORKIUSE OF BLDG.
TVPEOFPERMIT GRAOING FOUNDATION STRVCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ 9THER
PROJECT DESCRIPTION 5�. FT. oCCUPANCv
CON STRUGTION TYPE VALUATION $
ZONE GRADING CU. VpS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
DishNrasher
Drinking Fountains
Floor Dreins
Floor Sinks -
Gas Service Outlets
Interceptors - �
Kitchen Sink
Lavatorie5
P—Trap
Roof Drains
Reinspection Fee • � $15
Duct � UnAer Ground
Duct - S[ructural
Duct- Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blc ICBO #
Heacing System & Ducting
❑ ai oo,000 aTu O i oo,000
Feinspection Fee
White - Builtling; Canary • APP���anh pink - ACCOuntin9; GOIGen�otl - ASse52or
$15
Showers
Service Sink
SewCt Cap
Sewer Connection
Solar Callecmrs
Solar Pipin9
Solar Tank
$wimming Pool w/$pa
Urinal
Water Closet .
Water Heater e
Water Service
AUw-WeSh
Issue Fae
HoOd or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aiao,oaosru ❑ioo,oaoeT
System Repair/Alteretion
Fire Dampers
Registers
laue Fea
FEES
A.P. dp
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Plne� Ref. #
Planning Notes:
Aummatic Washer
Construction Pole Si
Cookinq Unit .
Dishwasher
Dryers �Gas ❑E
Fan ' '
F.A.U.
Fixtures
Device Boxes
Outle[s
$Wi[CI1C5
Garbage Disposal
Genera[or �0-5 KN
lectric
J�7:1 ii�''i�:J •.
Zane
Accessory Building:
Z
O
N
I
N
G
R
Pa�king Req./Provided E
�
M
T
5
ELECTRICAL
Transformer ❑ 75-SOKW '
❑ 50+KW
Meter Dup ro 700 amps
Meter �over 100amps
Sub Panel
Morors D O-1 H P � 1 h- 8
Inc. Solar �9-15 HP �16-15+
Microwave
Pole Light
$i9(1
' Standing Set[ions
5-15 KW Trash Compactor
$ 3
Reinspection Fee $15 Issue Fee
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
� 2oning APProved By
Building Approved By
Appliwtion Issued By
$ 3
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
7LAN CHECK $ PERMIT
PLUMBING g '� ISSUANCE 5
PLAN CHECK 25%� $ ENEFGY P.C. 5
E�ECTRICAL § GRADING 5
PLAN CHECK 50% S MICROFILM S
MECHANICAL S � TOTALFEE g ��OD
PLAN CHECK 25% $
.�
'CONSTRUCTION AND PLANNING POOL 'A
'�rqppROVALS Permit# Date Inspector APPAOVALS Permit# Date Inspector
l� Temporary Electrical Service or Pole � 52. Pool & Equipment Locatio�
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforce'ment 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduic 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 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. 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
37. Plaster Brown Coat 79. FINAL INSPECTION
' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. FinalElectric Notes:y.zq_�'ia L�i�TG�lZD• LFn /d.lL
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing s /-�{6 („i�
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. Electric Release to Edison
. 50. Gas Release to Sou[hern California Gas Co
'�51. CERTIFICATE OF OCCUPANCY
No. Daite
' � �z�3�L : ,
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 COBTA M68A. CALIFORNIA
For Applican+ fo Fill In Comple+ely
TYPE OR PRINT
ADDRESS 321j Washington Ave.
COSTA MESA. CALIFORNIA
OWNER �erst Development Co.
FEE RECEIVED-
� NAI��C���
CItY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
fl8C81P1 NO. PCRbIT NO.
MAIL 1533 Baker $b2'20t. aece c er oe necellveo/,, o�r
ADDRESS ��j ^ !R� �(.P
��.�. Costa Me9a No: K191151 BUILDING
ADDRE88
ARCHITBGT Carlson 8C TEL.
.,e �..,... «e .,r_ ��� _ti__ _i. .�,. COSTA MESA. CALIFORNIA
CONTRACTOR Dike SC COZ
ADDRESS 1 B31S0S �
Icin Costa t4esa
'�;�T„o. 167293
s'ZE 6o x l00
11F 1 f1T
Inc.
KI 9-]
I NO. OF
S6T0ACK LINH FROM -C3�,
ceNTen OP eTReET TJ' SO � REAR YARD"�L
� 5' � 5'
SIDE YARD LEFT RIGHT
DESCRIPTION OF WORK
NEW I X II ALTERATION I II A�OITION
APPROVED
ZONING
ZON¢ I NO. OF I USE OF NEW /
R-1 Puna '2 euuo�na W g-tj-,
LEOAL _ . . _ _,�_�
YARDS EVES
APPROVED ALLO
(CHHT6P LJN6 9T.1 --y) -
_'_'._ �. (/ _
BUILDINC�„6,r' $ . f`t�ROOMS o ST041E6 �- ({�� � /
SIZE "d" 7
EXTERIOR WA{.L ROOF
COVERING U CC I COVERING WOOd Sl'LlR ZB
USE OF BUILDING AND WORK TO BE PERFORMED �
,: v
Sir�le £amily residence with y
attached garage. Plan 111B
I HEREBY ACKNOWLLDG6 TH�T 1 HAVfi RBAD TMIB MPLIGTION {N8 AMOUNT 6HOWN UNDeR VALUATION IB POq TM6
AND BTAT¢ THAT TH8 ABOV6 I6 COPRCCT AND AGREE TO CON- p{�pp088 OP EBT�BLI9HING A PERMIT FEE ONLY.
PLY WITM �LL CITY ORDIN/�NCEB AND BTATC e RH6ULATINO
eu11LINa CONBTRU 1 N. VALUATION
SIGNATURE OF � PERMIT FEE $ 36•
PERMITTE � ,I' ' 18.
$ �.6�Ouy�6O pLAN CHECK $
AUTHORIZED AGENT Dike & olegrove, TIIC• 54•
TOTAL FEE
OWNER NONDQUIST� HERBERT DATE 10-5-77
JOB ADDRE55 �213 Washinaton Avenue BUILDING PERMIT
GAS
PNOP. SWR. IINE U HOOSE COM.
NEr1TING ANU �IR CONOITIONING
UNOERGROlINO �J POWER
ROUGM WIRING
HEINF.
FLOOR SVSTEM
BON� BEAM �
SHEATMING
FNAME ANO FLqSHING
LATHING - IN [J
PL 'R, BROWN CO�
ST URAL, FINAL
MEATING, VENT., REF
SUBCONTRACTOR
Y 44768
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Flll in Completely — Use Ink Only
BUI�DING / � i-� � /
ADDRESS ��v
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OWNER N S
MAI� �jJ�_ `
ADDRESS /��/!t
CITV �' � �{S/L NO.�(/• �
CANSTRUCTION
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ARCHITECT TEL.
ADDPESS
aooaessif'Y� (��pDrw/ �U�E �IUD.
TEl
CITY�s�IUS (2. NO.�.-L�
LIC.NO.z7��f7� LICVNO. �Qp��
SIZE iNO.OFBLDGS. /
OF LOT NOW ON LOT
USE OF
EXISTING BLDG. Sf-�
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOFK TO BE PERFORMED
Cuu�2 ,o.�C ,C:,,. /�.-
I heraby acknowlatlpe that I have reatl this appllcation antl stata
ihet the ebove informetion is corract an� aBree to comply with
all lews requlating bulltlinB connruciion, end I shell not employ
any person in violetlan of the workman'S compenseiion laws of
the Staie of Celifornie. �
I hareby certify thet I am p�ope�ly Iicensed as a contracSor untler
ihe State of Californle Businesa and Profeuions Cotle, Dlvizion 3,
Chapter 9, antl thet sueh Iicenees are in full force entl effect, or I
am exempt from the provislona of the State of Californle Business
end Professlons Cotla, Dlvision 3, Chapter 9.
SIB�ature of ///f
Parmittee �'/• ��✓t
Auihorizatl ABani
PAIO
`OC7 -5-77���SpOO 196'� *�*�36.50
FORSTRUCfURALPERMIT
DATE RECEIVED n��rc ieci mn
A.P. Na. O;SY- o<!,� a,5
BUILDING
ADDRESS 3ZI� �a'�
. TRACSi67S �OT
OWNEF
FIRE
ZONE
APPROVED
�NO.OFi
PIAN$
ARDS APPROVED
i �
/
REAR
DISTANCE BET.
MAIN BLDGS.
VAq. #
C.U.P.qW _
THEAMOVNTSF
THE PURPOSE OF
VALUATION
$ /�00 �
�v�� �
PEflMIT NO.
BLOCK
i �ON.AsjVl$f
' _ VALUE s4. .
. ��
USE OF NE
BUILOING ��B
VAFDS APPROVED
ACCESSORV BUILDI
BET. MAIN &
PE0.MIt FEE $
PLAN CHECK E
TAX S
TOTALPAID $
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