HomeMy WebLinkAbout330 22ND ST - Building PermitsApplicant to lill in all spaces exeept tnose within neavy bortler Ilnes ana sign all aDo�oo��ate tleclarationz.
�ITY OF COSTA MESAn CONSTRUCTI N PERMIT � - PERMIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address � 3/ � � � � �� � �
Applicant's Mailing Address n
Owner's Name TI?omG � Phone
Address
Arch/Eng. License No.
Address _
Contractor'sNam � —Phone�'i.C�.2Q,s
Addreu Ima�i���� n,-, C����
Ciry License No. L'73L7'�)
LICENSED CONTRACTOR DECLARATION
I h¢reby'aflirm Ihat I am licensetl untle� provisions of Charte� 9(commencing -
wilh section ]000) o/ Division 3 of the Business antl Professions Cotle, antl
my license is in f W ( ntl etfect. /�,I
License C sz Lice Se No.�ll�(��
Date - � Si9nature'
WORKERS' COMPENSATION DECLARATION
� nereDy aitirm lhat I have a certiticate of consent to selbinsure or a certificate
� Workers' Compen5dtion Iniurdnc¢, Or d certltietl cOpy [hereot (Se[tlon
800, Lab. C.) �- �' /!'7 I G/1 Comoa�Y --
Polity No. fSl�7 (OrX /\� i
�efLitietl co�PY is heeQwithrlhehUtlY-/g�//� Itli�%�}}}/''']]] %I /`I5I� n/l / ��� �� �
E%EMP I�O� KERS aCOINPENSAT Of N DECLARATION
(This section neetl nol be completetl If the p¢rmit i5 (Or on¢ huntlretl (5300) or
Iess).
I certify that in the performance oi the work for which this perm�t is issuetl, I
shall not employ any p¢�son in dny mann¢r 50 as f0 become SubjeGt [o [he
Workers' Compensatlon' Laws of Calitornla.
Date Signatura
NOTICE: If, after making this tleclaration, you snoultl become subject to the
Workers' Comp¢nSatlOn provislons of the �Labor Cotle, you muSP forthwith
comply 'with such provl5ions o� thi5 p¢rmit shall b¢ tle¢metl revoketl.
CONSTRUCTION LENDING,AGENGV �
1 hereby affl�m that there i5 a con5tructlon 1¢ntling agency f0/ tM1e performance
of tne work far which this permit ,Is Issuetl (Section 3097 Civ. CJ
Ltntler's Name
Lender's AtJaress �
OWNER BUILDER DECLARATION
I hereby afflrm that 1 am exempt lrom tne Contractor's License �aw for the
fotlowing reason (Seclibn �031.5 Buziness antl Professional Cotle: Any tl[y or
county whlcn requires a permlt to construcl, alter, improve, tlemolish or repalr
any structure, prior to its issuance, also reqWres the apolicant for such oermit
to file a signetl statement that he/she is licensetl pursuant to the provisions ot
the Contractor's License Law (Cnap[er 9(mmmencinq witb Section ]000) ot
Division 3 of the Business antl Protession5 Cotle) or tnat he/sne is exempt
•refrom� anG th¢ ba5iz fo� [ho allegetl Cxfmption. Any violafion o1 Section
1.5 by any ap0��cant Por a permlt subjects the applicant to a civil
�alty of not more Nan tive huntlretl tlollars (5500). '
U 1, a5 owne� ot the prop¢rty o� my employe¢s with wage5 a5 their sole
compensatlon, will tlo the work, antl the structure is not intentletl or oHeretl
for sale (SeGiion�7044, Busine55 antl Professional Cotle: The ContraCtor'S
Llcense Law Goes not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himselt/hersal/ or through his or her own '
employees, provitletl that sucb Improvements are no[ Intentletl o! offeretl fo!
Sale. I1, however, the bullding cr improvement is soltl within one year of com-
plltion,_the Owne� wlll have the burtlen Of proving h¢/She tlitl n0[ builtl o� im-
�rove fo� the purpo5e ot Sale).
I, as ownet ot fhe prOp¢rty, am exClusively Cont�acting with lic¢n5etl con-
tractorsto constructthe oroject (Setfion 7044, Business antl Professions Cotle:
The ContraGtOr'S License Ldw tloes nol dpPly to an ownet ol pwperty who
builtls o� improve5 Ihereon, antl who ConVactz fo� such proj¢Ct5 wi[h a mn-
tractor(sl license pursuant�to tlte ConVattor's License lawJ. I am aware tnat
proof ol th¢ir Worker'S Compensatlon Insurante zhoultl Ee 0/ovitletl [o me.
❑ I am exempt untler 5ection B. & P. C. tor Ihis reason
Date Owner
1 herebvi certifv thal I have reaa this applitation antl s[ate that tne above
0 owwm9 �ons[ruciwn, ana nereoy autnonze repre-
to e��e� upon [Ij0 abOv¢-mentiOned p�operty for/
Signature VI A/ lL'
Drivers' License or SS'�
CMF 0865-46, rev.4/84 White
TYPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION YJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p #
. DESCRIPTION OF WORK/USE OF BLDG.
' ' S Main Buildi
TVPE OF PERMIT GaADiNG FOUNDATION $TRVCTURAL T F�ont
❑ TENANT ❑ ELECTRICAL �XPLVMBING ❑ MECHANICAL ' B Rear
❑ OTHER %�
C Right
PROJECT DESCRIPTION 5�. FT. oCCUaArvcv K
CONSTRUCTIONTYPE VALUATIONS S Left
ZONE � GRAOING CU. VDS. � ACRES Ping. Ref. $-`
Remarks: - Planning Notes:
Sink
Preventer
Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks ' '
Gas Service Outlets
Interceprors
Kitchen Sink ,
Lavatories
P—Trap
Roof Drains � '
Reinspection Fee � $15
Boiler
Duct - Under Ground
DUct - $tructufel
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVFacL Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU � 100,000
�� T"— I I Heinspeaian Fee I $15
Cana�y - AOP�iGdnt; Pink - Accounlin9: Goltlen�od - Assesso�
$howers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors �
Solar Piping
Solar Tank �
Swimming Pool w/Spa�
Urinal
l�`/3LCf C1052i �
Water Heater --
Water Service
Issue Fae
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0�100,OOOBTU ❑100,000
System Repair/Alteration
Isue Fea
$ 3
$ 3
Automatic Washer
Construc�ion Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fan
F,A.U.
Fiztures
Device Boxes
Outlets
Switches
Garbage Oisposal
Generator �0.5 KW OS-1
1991 I�/V�I/85
Zone
Acceuory Buildin9:
Parking Req./Provided �
ELECTRICAI
Transformer ❑ 15-50 KW -
❑ 50+KW
Meter ❑up m 100 amps
Meter ❑over100amps
Sub Panel
Motors �0-i HP � i%� 8
Inc.Solar �9-15 HP �i6-15+
Microwave - '
Pole Light
Range •
Standing Seccions
KW Trash Compactor
- 5,�:, TL
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S.
:I Reinspection Fee I S75 I ' luue Fae I $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Builtling Approved By Date
Appliotion Issued By DatO—
i% SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
� .PLAN CHECK $ PERMIT
,� � PLUMBING � S � � ISSUANCE $
�,v PLAN CHECK 25% S ENERGV P.C. $
. • �ELECTRICAL $ ' GRADING S
PLAN CHECK 50% $ ' MICROFILM $ �/�/�
MECHANICAL $ TOTALFEE $ '�� � �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING
< POOI PA
tAPPROVALS Permit#- � Date Inspector AppROVALS Permit# Date Inspector
/1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � - 53. Steel Reinforcement
3:�Electrical Conduit Utility-Undrgrnd. - 54. Forms
4.� Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.� 57. APPROVALTO COVER-GUNITE -
7: FOotings - 58. Electrical Conduit-Undrgrnd.
8.'Foundation , , 59. Gas Pipe, O Undrgrnd., Test �
g��Water Pipe-Undrgrnd. � 60. Backwash Lines, P�7rap, 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-Conduit 66. Solar System-Final
i 6! 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 Ftush
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
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � r.
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. ��andscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. �lectrie Release to Edison � .
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No ' Date