HomeMy WebLinkAbout501 19TH ST - Building Permits. �i u�
CITY OF COS'
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. Project Address
�
� Applicant's Mai
Owner's N-a�mel �
Addreu -L.L
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Es � C �ST �� ��N�RR�R IT
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7 Phone —
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iI q /G �i }�i / Licenu No. /�
AVD���ant to fill in all soaees excev� lhose within neavy boreer lines ana si9n all aporopriate eeclarations.
Contractor'sNam - '� � Phone'yS����-�-
Address (mailin� �� � �+'-��G�,�T.,g� �� ���+'7
Ciry License No.
LICENSED CONTRAGTOR DEC�qRATION
I bereby at(irm [bat I am licensetl untle� provi5iOn5 of Charter 9(mmm¢ncing
with section ]000) of Division 3 ot the Business antl Protessions Cotle, antl
my license is in f WI f�Sgantl eitect. /� /
IJcens Clazs �l i nse
Date �""/ �� 59 t (
WORKERS' COMPENSATION'DECLARATION
�ereby a/firm tnat I have a certificate ot consent to selt-insure or a certificate
Workers' Compensation Insurdnce, or a cerHfietl coOY Ihereof (Section
,aoo, � , . 7-s1' ?ra .�.s
Policy N���Company
BCerti(ietl copy is hereby fu�nishytl.
Ce�tyir�e op �5 f' tl wrth tM1e tity BpiltllPg Divis/on.T
Date�f� APPlicant��'2 A P
EXEMPTION FROM WORKERS' COMPENS TION OECLARATION �
(This section neetl not be completetl if the Oermit is for one huntlretl (8100) or
Iezs).
I certify thal in the Oer(o�mantt q} [pe wo�k fOr whic� thi5 perm�t is issuetl, 1
shall no[ employ any per5on in any mann¢r so as to bEtOme subject to lhe
� Workers' COmpensation Ldws o( CalitOmia.
Date Si9nature
'NOTICE: Ii, after makinq this tleclara[ion, you Shoul� become subject to tho
Wo�k¢r5' Comp¢nsation 0/ovi5wn5 ot the Labor Cotle, you must forthwith
compry with sucn provisions or this permit shall be tleemetl revoketl.
��.CONSTRUCTION LENDING A4ENGY '
'i I hereby at(Irm that there is a cons�ruction �lentling agency for the pertormance
of the work for which this permit is issuetl (Section. 309] Civ. C.)
Lentler's Name
�entler's Atltlress
OWNER 6UILDER dECLARATIpN
I hereby aftirm that I am exempt trom the Contrattor's License �aw tor the
tollowing reason (Sec[ion 7031.5 gusiness antl Professional Cotle: Any city or
counry whlch �equires a permit t0 construct, alt¢r, Improve, tlemolish or �epair
any structure, prior [o its issuanc¢, also requires the applicant for such Oermit
to tile a sign<tl stat¢ment tnat he�sne is licensetl pursuant to the p�ovi5ions of
the Con[ractor'S License Law (CM1dpter 9(commentlng with Section ]000) of
p,-_��ision 3 of the Hu5ine55 antl Protes5ion5 COtl¢) o� that tte/she is exempl
;c5�eirom antl the basis tor the dllegetl exemPtlon. Any violation of Section
1.5 by any applican[ for a permit subjecl5 Ihe applicant to a civll
--- ��'Lnalty of not more lhan five hundretl tlollars (5500).
lJ I, as owner of the properry or my employees witn wages as their sola
compen5ation, will Ao the work, antl the Structur¢ i5 not intentletl or otte�etl
for sale (Se<tlon ]044, Bu5lnesS and Professional Cotle: TM1e Contrac[o�'s
License Law tloes not apply to an p�vner ot a property who builCs or improves
ihereon, antl who tloes such work hlmself/herselt or throu9h his orher own
employees, provitled that such improvements are not intentletl or otteretl for
sale. If, however, tne builtlinq or improvement Is soltl within one year of com-
plelion, Ihe owner will have the burtlen Of ptovinq he/she tliC not builtl or iT-
p�ovG fotlhe purpose of sale).
❑ I, as owne� of [he prope�ty, am exclusively contracting with licensetl COn-
Vac[or5 to COnsttucl the Project (,^�ection 7044, Buslne55 antl P�ofessions Cotle:
The Contractor's License Law tloes not apply to an owner ot property who
builtls or Improve5 the�eon, antl wM10 conVaGts for such 0/ojects with a mn-
tractor�s Ocense pursuant to the Cantractor's l.icense Law). I am aware that
proof o� their Worker'S Compensy�ion insurance Shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
I he�eby certify that 1 have rea�
informa(ion is mrrect. I a9ree to
antl state laws relatin9 �o builtlin
sentativez this at to nter
1l1508C��OO rposes. �
Siqnature
Orivers' License or 55 � (�./_}
tion antl s[ate that tne above
all clty antl county ortlinances
n, dntl hereby au[ho�ize �ep�e-
bOve-men[IOnetl property fOr
� Date ��Z �5�
TVPE Of CONSTRUCTION LI NEW LJ ADD L� ALTERATION IJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT� GRA�ING IJ FOUNDATION LI STi2UCTURAL
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
� ❑ OTHER
PpOJECT DESCRIVTION Sq. FT. oCCUvnrvCv—
� CONSTRUCTIONTYPE VALUATION$
ZONE GRADINGCU.VOS. ACRES_
e
Remarks; Ya i � . � L A. ._o YUi I J
Sink
Preventer
Irrigation
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service
Intercepmrs
Kitchen Sink
Lavatories �
P-Trep
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping'
Solar Tank '
Swimming Pool w/Spa
Urinal
Water Closet .
Water Heater
Water Service
Auto-Wash
Reinspection Fee � $15I I Issue
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepUFacL BIL ICBO #
Heating System & Ducting
❑ ai oo,000 eTu � i oo,00a
Reinspection Fee ' I $75
OB65-46, rev. 10/84 White - 8uiltling; Canary - Applicant; Pink - Accounting; Goldenrotl - Asse55or
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,000sTu
SVstem Repair/Alteration
Fire Dampers
Registers
Issue Fae
$ 3
$ 3
A.P. qW
S Main Buildi
E
T Front
B Rear
A
C Right
S � Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets �
Switches
Garbage Disposal
Generator �0.5 KW C
Fee
4971 6/17/85
�
Accessory Building:
Parking Req./Provided
oi3a�3ac�a
� oQQ GA
Zone
ELECTRICAL
Transformer ❑ 15-50 KW
� 50+KW
Z Meter � p to 100 amps
Meter ❑over100amps
Sub Panel
Motors OP7 HP �1'/a � 8
Inc.Solar �9�15 HP 016-15*
Microwave
Pole Light
Range
; Standing Sections
5�15 KW Trash Compactor
DEVELOPMENTSERVICES
2oning Approved By ,
Buildin8 APProved BY —
$15 � � Issue Fee
BUILDING PERMIT,\$
PLAN CHECK (� �
PLUMBING � S�
PLAN CHECK %�S
ELECTRICAL S
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK '25% $
�l�{� $
y�RMIT
ISSUANCE $
ENERGV P.C. $
GRADING S
MICROFILM 5
TOTAL FEE $
n
FEES
$ 3
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{�CONSTRUCTION ANDPLANNING POC SPA
j.4PPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
i. Temporary Electrical Service or Pole ,. 52. Pool & Equipment Location -
_ I
2. Soil Pipe-Undrgmd._ � � ; . 53. Steel Reinforcement �
3. Electri�cal�Conduit�Utility-Undrgrnd. ; � � 54. Forms �
4. Electrical Conduit�Undrgrnd. , 55. Electrical Bonding �
5. Steel Reinforceinent � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � � 57. APPROVAL TO COVER-GUNITE .
i 7. Footings � � � 58. Electrical Conduit-Undrgrnd.
S. Foundation ' _ i �' 59. Gas Pipe, O Undrgrnd., Test
9. WaYer Pipe-Undrgrnd. _ 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � �
i 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrital-Conduit 66. Solar System-Final
i6. 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 �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
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 Faaory Fireplace
38. Final Plumbing
39. Water Service-�inal
40. Gas Service-Final - • ,' .
41. Solar pomestic-Final � �='' �
• i;
42. Backflow Preventer � ' -� �'
43. Backflow Irrigation " � � ' .
44. ,Landscape Irriqation System ., . '
45. Sound Attenu8tion ' . '
46. Handicap Regulations � '
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed �
,.49. Electrie Releas0 to Edison -
50. Gas Release to Southern California Gas Co '
57. CERTIFICATE OF OCCUPANCY
No. Date
. `� . '72�� 1'rl �05.� d
" � • 1 � / AUG —6-SS�n[s^. 284a �+74tcaZ.�Q ^
� .. Q �, ��
COSTA MESA BUILDING DEPARTMENT ��
P. O. BO% 3 i �
COSTA MESA. GALIFORNIA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
Aooa'S5 ,'SO ! 11J� 7M BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
p qECE1pT NO. P£RM1T NO.
OWNER �. OA1' S RtTI `O� � � �
MA�L /� E VFD BY C V O E ISSUEO
ADORE55 C �IQ �J[.�.�. /� � S L �'/3 -1
CIY1' C/q � (� TNO. � � ADD E�55 J O (/`� �� T
ARCHIT�CT LIG 'r
OR E! 'EEF � NO. COSTA MESA. GALIFORNIA
ADDRE55 � 20NE �
J �p CITV LIC. -- ZONE^� PO•NS TYPE ' GN�IjR I
GONIRACTOR nE.` NO. L �= � 'Z—
TEL. APPROVED
ADDRE55 NO. BY DATE
Ltl"` �oT CORRECTIONS I
oeSCruprwru NO. BLOCK TRACT
A.P.NO. 6� Q���
$IZE NO.OF BLOGS.
OF LOT Now on �or
USE OF
EXISTING B�pG. r OFF/ CC
SETBACK LINE FNOM
CENTEN OF BTwfET �'� � REAR YARD �
r_1
SIDE YARD RIGHT F�, LEFT �} .
DESCRIPTION OF WORK
u.
, NEW ALTERATION AODITION
REP/��F MOVING DEMOLISH
BUILDING � � NO.OF
SIZ6 ROOMS STORIES
EXTERIOH WALLp ROOF
COVERING R 8 COVERING '
USE OF NEW 1�A(L /F��iO� "
BUILDING /� '4�KF0 /cc
ST�K TH1T THE �BOVE �5 COFREQ GNO �1GNEE TO COMP�Y WITH 1�L
CITY OROINwNCE3 �ND ST.�TE L�WS REGVLATING�BUILDING CONSTRUG
TION
�_� `��/ / / � VALUATION
P RM�ITTEE � 7 %v� ��
ta
AUTHORIZED AGEN / � `
A
PERMiT FEE 5 � �n�
PLAN GMECK $ �—
TOTAL FEE"8 Zr "°'�`
r`/��'V�1.'O'1�lOD� LU1lLLLas LGF1tL1U111G�a4 �r� 1 allVL�lYZ�.. 1c.E;_—�
h.
`". COSTA MESA? CAL FORNIA /'�'� � B U! L D�t�N G ' /
''� FOR OFFICE IISE ONLY
- E-'" EOR APPLICANT TO FILL IN Receipt No. Permlt No.
euuain9 �, •��r I ��� �
Addresa�-� —�
L'O3�& M888� rifl.�017118 Received by Date Rec'/d. Date Issu�ed—y
Nearest �""�3' �b � � ��v b
Crosa St. � Building
Address
Owner .. < <�� Costa Mesa California
Mnll %
.ntractor
Lot
No.
Size ot Lot
Use of
Existing Bldg.
Setback Llne from
■ Naw
1:F1tl5�
�I hernby
and state
with all
building �
_I e ock �
B G�-
of
�
that I hF
ve is rnn
:s �
.. e
this Applicatlon
agree to rnmply
aws regulating
CORRECTIONS
)
APPROVATC
�n Location ( Inspecto� I
Materials,
Valuatlon PermitFee $%pa�� U� Masonry Relniorced
$�s� 9 g`� � B-� T�a� Check $ J�o. � � gond Beam
Fee �d O� � � FINAL
FORM 204 S-HP 1M 8-SS
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PLOT PT•AN
Show Iocation and diatances irom
� property Iina and hetween buildings
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MES'A S. ���g,
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