HomeMy WebLinkAbout366 19TH ST - Building Permits1
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� ADO���ant to fill in a11 ipaees eicepl those wit�In heavy Eortler Iines anG sign aii aoCropriata Oeclantions.
CITY OF COSTA MESA CONSTRUCTION PERMIT PE�Rj�d1T NO. TRACT NO. LOT NO. UNIT NO.
,����
Project Address �' �
ApplicanYsMaili�ngAqddress � p �V�����'U�Q,�} ��2
Owner'sNnme N"'✓ ��'/T��TC�' Phone7S3—eP.ZT
Addreu ��e�a ��� l7%
Arch/Eng. License No.
Address
Contracmr's Nam hone��
Address Imailing) � J
City License Np. ��� 3'�
LICENSEO CONTRACTOR DECLARATION '
I hereby aflirm tnat I am Itcansetl under provislons oi Charter 9(commencln9
�+�th seCtion 7000) oi DVvisian 3 ot the Busine55 antl Pro(<5 ns COtle, antl
my Iicenze is in (ull torca an�a �e/t�fecL /% /
L.�CBf15C CId55'- CC_[1`�.� _ ^' P I �
Date $i9nalure 7��j �
M�bRKERS'COMPENSATION DECIARATION
' hereby aHirm that I have a certHicate oi wnsent to seH-insure or a certlficate
1 Workerz' Compensation InSurance,�Or a certi�ietl copy theteot (Sectiort
.800, l.ab. j ��r�
PolicY No.�' ��� �,O Company W •
Certifietl topy is h reby tumisnetl.
Cert i¢ Op ietl with the city ' i
Ddte--���� APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(ThisseCtion n¢etl not bo completetl if the permit ii (or one nuntl�etl (S300J or
less). �
1 Certify tha[ in tlte Oer/ormance of th0 wo�k for wbith thiz pe�m�t ii issuetl, I
Shall not employ any PeROn In any mannGr so ds lo UecoTe subjecl t0 l�e
WOrkers' Compensation Ldws of California,
Ddte 99�ature
NbTICE: Ii, a}I¢r makin9 lhis tleCla�ation, you Shoultl becortl¢ subjeCt to the
-WOrkers' Comp¢nsation provisions ot tho LabOr Cotla, y0u musl forthwi[h
comply wllh such provislons or this permit shall be tleemetl revoketl.
LONSTRVCTION LENDING AGENCY ' '
1 hereby aifirm Nat [h<re is a COnslruttion IenOing agenty fOr the performante
. of the work for whlch thls permit I5 izsuetl (Sectlan 309� Civ. C.)
L6ntlels Name
LOntl¢r's Ail0�e55
OWNER BUILDER DECLARATIOIV� � '
I hereby afflrm that I am oxaTPl frOm th¢ Conlrattor's LltCnse Law tOr tn0
l�un..��na reaznn 6ection ]031.5 Businesi antl Professlonal Cotle: Any city or
IhB
[O }II¢ d SignOtl Std[¢lt1011[ tlldl O¢/SpC IS IICCnS¢a pUlsuan{ lo ine prVv�arvm m
the Contractor's Licenso I,aw (Cnapter 9(commencing witn Section 7000) of
:I�IviSion 3 of the 6usines5 antl Profes5ion5 CotlC) o� thal he/she Is axem0�
i%F'��erefrom antl the basis for the alle9etl exemption. Any violation ot SecUon
5p;.031.5 by any applicanl for a permlt subjects tho aDP��cant to,a civil
' endlty ol not more Ihan five huntlretl tlolldrs (5500).
� 1, az owner ot tM1e pro0a/�Y o� my emO�oy¢Gs wlth wages as tholr solo
Cbmp¢nsatiOn, will tlo lhp wOlk, antl th0 stfut[ure IS nOt IntenOetl Of o7f¢retl
Ip� zale (SeCtiOn 7044, Bu5ine55 antl PrOtCssional Cotla: The COnlractor'S
license law Oaes no[ apply [o nn owner ot a properry w1�o builtls or impmves
�hereOn, antl who tloe5 such wo�k himselt/herself or Ihrough his or hor own
employBas, provitletl [hat such improvamonts are not Intentletl or offaretl for
sbl¢. It, nowover, the builtling cr Improvement i5501tl wlthin one yoar OI com-
pletion, No owner will have tbe burtlen o1 Proving �e/zDe tlitl not builC or im-
�ove for tlte purpose of 5ale).
I, as owner ot ine property, am ezclusivelY contracting with li<onso0 con-
tractorito tonslruct (he project (Sec(ion 7044, Business ane Professlons Catle:
ihe ContraclOr'S License L. w doe5 nol d0�b to an own¢r ot property who
builtlz or Improves lhereon, antl who conlracts for such proJects with a con-
trac[or(s ❑cense pursuant'to the Contractor's License Law�. I am aware that
proof o� tneir Worker's CompenwUon insurance zhoultl oe proWtlea to me.
� I am exempt untler SetUon B. & P. C. for this reason
Date
cerHfy t
ion is con
: laws rel;
Owner
Vr�vers' u[ense or »� � �
CMF 0865-46, rev. 4/84 White - Builtltng: Canary
�^E-� OF CONSTRUCTION LI NEW IJ AD� � ALTERATION LJ REVAIR
LJ CONVERSION ❑ DEMOLISH ❑ OTH
DESCRIPTION OF WORK/USE OF BLDG. � �����'� --
TVPE OF PERMIT LJ GRA�ING LI FOUNDHTION U STRVCTURAI
❑ TENANT �ELHCTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER �
PROJECT DESCRIPTION Sq.FT. oCCVaANCv_
CONSTRUCTION TYPE VALUATION 5
ZONE GRADING GU. VOS. ACRES_
$Ink
Preventer
Irrigation
ing Fountains
Drains
Gas Service
Interceprors
Kitchen Sink
Lavarories
P-Trap
Foof Drains
�Reinspection Fee
-0uclets
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventileling
Exhaust System ❑ MWtiple ❑
FirepVFacL Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 eTu � i oo,000 ar�
Reinspection Fee
Pink - Accounting; GOldenrOtl - A55e55or
$15
$hOwEfS
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors '
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Uiinal
Wa[er Closet
Water Heater
Water Service
I�sue Fee. � $ 3
iANICAL FEE
Hoodor Typel ❑
Canopy Typell ❑ -
Refrigeration Sys[em
❑aioo,000sTu ❑ioo,000aTu
System Repair/Alteration
Isue Fee � $ 3
A.P. �
5 Main Buildi
E
T front
B Rear
A
C Right
K
S Left
Ping. Ref. #
Planning Notes:
Automa[ic Washer —�
Constructior Pole Sub.
Cooking Unit
Oishwasher '
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures -
Device Boxes
Outlets
Switches
Garbage Disposal
Generaror �0�5 KW ❑
3752 7/10/84
2one
Parking'Req./Provided
ELECTRICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
I Meter up ro 100 amps
� Merer ❑over 100 amps
Sub Panel
MotorsO0.7 HP O1Y,-6
InaSoiar �9-75 HP �16�15+
Pole Light
Range
Si9n
� ' Standing Sections
5�15 KW Trash Compactor
S15 laua Fee
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB APProvad By
Building Approved By �
BeO� TL
S 3
' SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ , PERMIT
PLUMBING $ ISSUANCE $
PLAN CNECK 25% $ �ENERGY P.C. $
ELECTRICAL $ . O CJ GRADING 5
PLANCHECK 50% § MICROFILM $ p�
MECHANICAL $ TOTAL FEE $ o- o�)
PLAN�CHECK � 25% $
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5.
.,-CONSTRUCTION AND PLANNING • • POOL �PA
. ��APPROVALS Permit# Date � Inspector p�ppROVALS 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. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
6. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwa'sh Lines, P-Trap, O Undrgrnd.
10. Structural F�oor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent•Final
13. Roof Drains � 64. Plumbing System - Final
r
14. Rough'Plumbing' 65. Electrical-Final '
15. Rough Electrical-Conduit 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. POOUSPA SYSTEMS FINAL .
19. Rough Heating & Air Conditioning FIRE OEPT. REQUIREMENT .
20. Rough Factory Fireplace � - . . .. _ . ' � APPROVALS� Permit # -
21. Ducts, in Structure 70. Underground Hydro �
2>. Ducts, Ventilating ,� ,^ �„ A_ _ 71, product Piping � Gas ❑ Oil
23.,Gas Pipe-Rough & Test � 72. Underground Flush -
� 24. Aoof Framing - � 73. Undergrnd. Storage Tank � Gas ❑ Oil �
25. Roof Sheathing ; ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &JMonocoat 75. Dry Ghemical
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 7�� 80. FOOD CERTIFICATE ISSUED
33. Final Electric ��� L Notes: ',
34. Final Heating & Aic 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,lrrigation . .
44. ,Landscape Irrigation System / !
45. Sound Attenuation �
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING '
48. Special Requirements Completed � �
49. Electrie Felease to Edison ', � � � �„
50. Gas Release to Southern California Gas Co : ,
51. CERTIFICATE OF OCCUPANCY . .
No. Date �