HomeMy WebLinkAbout990 19TH ST - Building PermitsApplieant to flll in all Spaces except thosa wll�in �lavY Oo�Oer Iines anC sign all apprapriate Eeclarations.
CiTY oF COSTA MESA CONSTRUCTION PER IT
Project Address �— �d 7% o � 9 e�
I
Applicant's Mailing Address
Owner's Name ���j�� � � � ��"�^^^ ' �
-Addreu "" r �n �"�M$�P�
ArchlEn9. , Licenu No. '
Address
� Convactor's Name hon/e �'��9c
Address (m�'�'n�l � � � � ' M— '
City License No. ��- l� l _ • .
LICENSED CONTRACTOR OECLARATION �
I hereby affirm thaf I am Itcensetl untler provisions of Charter 9(commencing
with section 7000) of Divislon 3 of the Business antl Proteszlonz Gotle, an0
my Ilcense is in tull forc ntl efi t. ,
License Class � � License No d 9
Date' ^ — Signature
WORKERS'CO PENSATION DEC RATION
' hereby afti�m thdl I have a ce�U(iGate of ronsent o self-insu�e o� a ce�tiflcate
Wo�kers' Compen5ation Insurance, or a ce�tifietl cOpy thereof ($ectlon
d00, Lab. C.)
PolicY No. ComPanY .
Certifietl copy is hereby furnished.
Certifietl coPy I5 filetl with [hC dty B f�ng Oi is�o .
ate ' Appliwnt
EXEM TION FR M WORKERS' COM NSA O ECLARATION .
(Thiz section neetl not be mmpletetl if the vermit iz tor one huntlretl ( 0) or
less).
I certify lhat In Ihe perlormance of tbe work for whlch thi5 p¢r ii IssueO, I
zhall nOt employ any pe�son in any mann�o as [O Ileco ject to the
Workers' Compen ation wz of Calitomi
Date _f���ature
'NOTICE:4f, aiter aki 9 is tleclaratio , you shoultl wme subject m t
Workers' Gompensalion provisions of lhe Labor Cotle, you must fortnwith
comply with such provisions or this permit snall be tleemetl revoketl.
CONSTRVCTION�LENDING AGENCV '
I nereGy aiflrm that there is a constructlon lentling agency for the performance
of [he work ior whiCh Ihis permil is i55u¢tl (Section 3097 Civ. G.)
Lentler's Name -
L¢naer's AtlG/e55 _ - �
OWNE0. BUILOEN �ECLARATION ' -
I hereby afFlrm that I am exempt trom the Contractor's License Law-for the
following reason (Sectlon ]031.5 Business antl Protesslonal Cotle: Any city or.
mrv wnich reouires a ce�mlt to construct, alter, improve, tlemoli5h or �epal�
any sfructure, prior to Its issuance, also requtres tne appl�cant tor sucn permii
to tile a si9netl statement that he/she is licensetl pursuant to the provlsions of
(he Contractor'S License Law (Chapter 9(commencing with SeGtlOn 7000) o(
'pivision 3 of [be Business antl Professions Cotle) or that he/she Is�ezempt
�,,ierefrom antl the basls for lhe allegetl exemption. AnY violation of�5ottion
'%!.�D31 5 by any apPlicant for a permit subjects [he applicant to a civil
.�';rendlty of not more than tive huntlretl tlollar5 (5500).
LJ I, as ownar of the property or my employees'with wa9es as tholi sole
compensation, will Go the work, antlrthe structure is not Intentletl or offeretl
for sale (Sectlon �044, Buslness antl Professlonal Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or improves
tnereon, antl wno tloes such work himself/herself or through his or her own
¢mployeez, provitletl [hat SUGb Improv¢ments are not int¢ntletl o� oHeretl fOr
sale. H, nowever, lhe builtling or improvement is soltl witnin one year of com-
pletion, the own¢r will have [he bwtlen Ot proving he/she tlitl not bulltl or im-
�rove fo/ the purpo5a 01 sale).
I, as owner of the property, am exclusively contracting with Iicensetl con-
t�act0/s to const�u<[ lhe project ($ection ]044, BuSiness antl Profe55ion5 COtle:
The Contractor's Li<ense Law does not apply to an owner of property who
builOs or imOroves [nereon, antl who conVacts for such Orojects with a con-
Itactor(51 license pursuant�to th< COnt�acto�'S License Law). I am dware Ihat
proof ol their Wo�ke�'s Compensation in5urance Shoultl be prOvitletl t0 Te.
❑ I am exempt untler Sectlon , , �B. & P. C. for this reason
Date Owner ' '
1 hereby certiry tnal P have reatl this applicatior
Intormation is correct. I agree to com0ly with all
antl 5[at¢ laws rel g[o bulltling CO 5[ruction, a
sentatives of thi c)' y[o enter n the bov
inspec[ion purp es/ (^
$l9ndtute
Drivers' Licen or 55 �
_..... . _— _ _
Pa� 3s-a -
TVPEOFCONSTRUCTION NEW ADD ALTERATION � REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER� - �
DESCRIPTION OF WORK/USE OF B�DG.
TVPE OF PERMIT GRADINCa���---yyy FOUNDATION STRUCTURAL
❑ TENANT- ❑ ELECTRICAL lA 7LUMBING ❑ MECHANICAL ,
❑ �OTHER . � -
PROJECT DESCRIPTION 5a. FT. OCCUaANC4 �
CONSTRUCTION TVPE ' VALUATION $ '
20NE GRADINGCU.VDS. ACRES�
Remarks:
Bar Sink
Backflow Preventer
Backflow Irri9ation
Bathtubs ' �
Claritiers
Dishwasher
Drinkin9 FOuntains
Floor Drains
Floor Sinks
Gas Service "
Kitchen Sink
Lavamries - .
P—Trap .
Root Dreins' -' -
Reinspeetion Fee�� ,
$15
Boiler '
Duct- Under Ground
Duct-Structural '
Duct- Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blc ICBO #
Heating System & Ducting
❑4100,000 BTU 0100,OOOBT'
Date � ff—Y___r /9 S_1i_
, � ^ Reinspection Fee $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap�,
Solar Collectors
Solar Piping
Solar Tank' .
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service � '
Auto-Wash
�
FEES
A.P. #
S Main Building:
E
T Front
A Rear
C Right
K Left �
S
Ping. Ref. #
Planning Notes:
Auromatic Washer�
Construction Pole Sub.
Cookin9 Unit '
� Dishwasher
� Oryers OGas ❑Elec�
Fan
F.A,U. �
' Fixtures
� r Device Boxes
' OuUets� .
��
Issue Fee
Hood ar Type I ❑
Canopy Typell ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
$ g,� , ;�
FEES ;
i
f
!i
�r
•� %
$ 3
, 8845 B/19/85
. Accessory Building:
Parking Req./Provided
� ' . .
COPs
2one ,
ELECTRICAL - .
Trensformer ❑ 15-50 KW
❑ 50+KW
Garbage Disposal
Generator �0.5 KW 05�15 KW
Meter Llup to 100 amps
Meter ❑over 100 amps
Sub Panel
Mocors�alHPO1Y,-a �
IncSolar �9-15 HP �1645+
Pole Light
Range
Sign ; ;
', Standing Sections
Tresh Comoactor �
0
% � Reinspection Fee' �$15 � .I luue
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning APProved By
Building Approwd By �
ApplimtiOn IAUBd By- �
0
FEES
$ 3
Z
O
N
Ii
N
G
R
E
Q
M
T
S
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP . $
PLAN CHECK i $ � PERMIT �
PLUMBING $ � ' ��UANCE � $ .
PLAN CHECK 25% $ oZ � ENERGV P.C: $�
ELECTRICAL' $ ' , GRADING $' �
PLANCHECK 50% $ � MICROFILM $�
MECHANICAL $� � �TOTALFEE $� '�
PLANCHECK 25% $�, . ' � •
' CONSTRUCTION AND PLANNING � POO >PA � '
APPROVALS Permit# Date j Inspector qPPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location '
i
.2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgmd. � � 55. Electrical Bonding -
5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test
6• Elecirical 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 Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
' 11. Prope�ty Sewer Line & House Connection ' 62. Backwash & Receptor-Final � �
• I
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 . .
1� Rough Elec[ric Wiring 67. Fencing & Access Approval ,
� 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ,
18. Rough Electriral-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 rJ 0il _
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing � 73. Undergmd. Storage Tank O Gas O 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � Q_�
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test � � . . . . , � , �
36. Hoodor_Canopy � ' ,
37. Final Factory Fireplace, � ' �
38. Final Plumbing ' � . i' �
39. Water Service-Final , �
40. Gas Service-Final � � ,
41. SoVar 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 Complsted . . j�
49. Elec[rie Release to Edison , . -_ _ . ' -
50. Gas Release to Southern California Gas Co '
� h,
'51. CERTIFICATE OF OCCUPANCY � � � � ; ' ' '"
No. Date