HomeMy WebLinkAbout347 21ST ST - Building PermitsAOv���ant to fill in all spaces except thosa within neavy EorCer Ilnas anO sign a11 aporopriate oeclarations.
�i7Y OF COSTa MESA CONSTR�TION PERMIT
Project Address �~� ��- '3 � C N�
Applicant's Mailing Address
Owner's Name ��'� n1 d� G' ��'uf' Phone6yd� ��+�L
Addreu 1 S'% sisi N� A �S N �-t L
Arch/Eng. License No.
Addiess
Con[racror's Nam F`h 1� 1� L� � N l� rN G- Phone � y 6 4 V 4 Y
Address Imaiiingl ! g { ' h - � '• � �7 S 7 • L /�� .
City License No. �� 9 e��
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untlGr provi5ion5 of Charter 9(commencing
wi[h section 7000) 01 Division 3 of the Business antl Professions Cotle, antl
my license is in tull forte an0 effect.
License Class �� 6 Li nse No. � �
Date �'� � �' F`1 Signature � � '^
WORKERS' COMPENSATION DECLARATION
1 hereby affi�m [hat I have a certificale of cons¢nt to selt-insu or a certilica[e
� Worker5' CompensS[ion Insurance, or a certifietl copy thereof (Section
100, �ab. C.)
Policy No w�G ��'� � 9 9' F S COmpany ��\� . C C �
8 Certifietl copy is hereby furnishetl. � ..
Certi(ietl copy is tiletl with the city Builtlin9 Division.
Date AOP�icant
EXEMPTION FROM WOFKERS' COMPENSATION DECLARATION
(ThiS section n¢etl nol be complefetl if the pe�mit i5 for one huntlretl ($300) or
lezs).
I certi}y that in the pa�formance of Ihe work foi which thi5 pe�mit is issuetl I
snall not employ any porson in any manner so a to becomo subject to t�e
Workers' Compensation Laws of C li a. � � '
Date Si9natui '
NOTICE: Ii, after makin9 this tleclara ion, you shoula bec e subjec to the
Wo�ke�s' CompensatiOn D�ovisions of th¢ Ldbo� Cotle, u mu5t forthwith
comply with such O�ovisions or lhis permlt sltall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby aifirm that there is a mnstructlon lentling agency for the pertormance
of th¢ work tot whiGh this Oermil i5 issuetl (Section 3097 Civ. C.)
l.entler's Name
Lentler's ACtlreSs
OWNER BUILDEF DECLFRATION
I hereby affirm Ihat I am exempt trom the Contracto�'S Llcense Law tor thC
following reason (Section 7031.5 Business antl Protessional Cotlo: Any city or
county wM1ich requires a Oe�mit to Construct, alte�, improv¢, tlemolish or repair
any sl�ucture, prio� to Its issuance, also �eqWres Ihe applicant tor such pe�mit
to file a ziqn¢tl statemenl Ihai he/She I5 IicenS¢tl pu�suant lo lh¢ Provisions of
th¢ Gontractor'S Litense Law (Gnapter 9(Commencing with SecHon ]000) of
DiviSion 3 of tne Businezs antl Professions Coae) or lhat he/zhe is ezemPt
��'h¢retrOm antl the ba5i5 for the allegetl exemplion. Any viOlation of SecHon
�131.5 by any applicant fo� a permit subjects the applicant to a civll
n.^�nalry of not more lhan five huntlretl tlollars (5500).
�� I, as owner of the Droperty or my employees with wages as their solo
compensalion, will tlo th¢ work, antl the 5[ructure is not Intentletl o� offe�etl
fOf Shc2 ($CCII00 �044. B1151l1255 dpd PfOf¢SSiOndl Gotle: The COOifdC�OI'S
License Law tloes not aoo�Y to an owner o( a property who bulltlz or improves
thereon, antl wM10 tloes such work bimself/herself or throu9h his or ner own
employ¢es, provi0etl lltat suth improvemEn[5 a�e not intentled Or otfe�etl tor
Sale. Ii, nowever, thC bulltling cr improvement is Soltl within one year oi com-
pletion, the owner wlll nave the burtlen of provin9 he/she tlitl not build or im-
��ove for the pu�pose o1 sale).
1, a5 owner of the p�operty, am exclusivery confratting with Ilcensetl con-
tractorsro consVuct the oroject (Section 7044, Business antl Professions Cotle:
The Contractor's Licanse Law tloes nol appty to an owner of property wbo
builtls or ImO�oveS lhereon, antl who coni�acls tor such projeGts wittt a con-
Iractor(s) license pu�suant�to the�ContractoYs Lirense Law�. I am aware tha[
proof of Iheir Work¢r's Compen5ation insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. ior this reason
Date Oww -
I he�e�y certity [bat I have rea0 [hi5 appl�cation and Sta hat the above
information is correcL I agree to comply wi[h all city antl c unty ortlinances
antl state laws relatln9 to builtling construcNon, antl nereby authorize repre-
senta[ives ot tl'� dly to e r upon the ab ve-mentlonetl Property for
inspectlan p
Signature �/%� Date/� � ^� �7
Orivers' License or 55 � �
PE OF CONSTRUCTION L� NEW LJ ADD LJ ALTERATION OJ REPAI R
❑ CONVERSION ❑ OEMOLISH. � OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT LIGRA�ING IJ FOUNDATION LJSTRVCTURAL
❑ TENANT ❑ ELECTRICAL L� PLUMBING ❑ MECHANICAL
❑ OTHEi2
PROJECT DESCRIPTION Sq.FT. oCCUaaNCv_
CONSTRUCTION TYPE VALUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service Ouclets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspection Fea � $15
Duct-UnderGround
Duct - Snuctural
Duct - Ventilating
Exhaust System � Multiple ❑
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
O ai oo,000 eru O i oo,000 sr
Reinspac[ian Fea I $�5
CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accoun[ing: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar CollectOrS
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Refri9eration Sys[em
❑o�ioo,000aTu ❑ioo,000
SVstem Repair/AI[eration
laue Fae
A.P. ;I�
S Main Building:
E
T Front
ARear
C Ri9ht
K Left
S
Pln9, Ref. #
Planning Notes:
Automatic Washer
Constructior Pole Sub.
Cookin9 Unit
Dishvrasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
OuUets
Switches
Garbage Disposal
Generator �0.5 KW �
4373 12/20/84
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transfarmer ❑ 15-50 KW�
O SO+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Mators 00�1 HP O1 %� 8 •
Inc. Solar �9-15 HP 016�15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compactor
5.00 TL
FEES
$ 3 '
� Rainspection Fee $15 luue Fee $ 3
FEES
DEVELOPMEN7 SEFVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved ey Date
Appliwtion Issued By Dat L Z
SUMMARV OF FEES
. BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ S.pO ISSUANCE $
PLAN CHECK 25% $ ��O ENERGV P.C. S
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM 9
MECHANICAL $ TOTAL FEE $ S� SC�
$ 3 PLAN CHECK 25% $
Z
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CONSTRUCTION AND�PLANNING POOL 2A
APPROVALS 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 Utillty�Undrgrnd�. � 54. Forms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding �
- 5. Steel Re`inforcement ' 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 " �
7 7. 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. Fough Electrical-Conduit . 66. Solar System-Final - �
16. Rough Electric Wiring . _- 67' Fencing & Access Approval � ,
17. Rough Wiring Sign " �� 68. APPROVED FOR PLASTER�NG '
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 Hydra
22. Ducts, Ventilating , µ ; 71. Product Piping O Gas ❑ Oil
a:rA �
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing - � 73. Undergmd.5toregeTank 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. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. �laster Brown Coat 79. FINAL INSPEGTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air�Conditioning .
35. Final Gas Pipe-Test �/�/, fy' �f�'�r"
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. Electric Release to Edison �
� 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY '
No, Date