HomeMy WebLinkAbout543 19TH ST - Building Permitsqpplirant to fill in all spaces within heavy DorCer lines anC.sign all appropriate Eeclantions.
GTY OF COSTA M�SA � PERMIT'NO. TRACT NO. '" LOT'NO.`, �BLOG. NO. " ' ' '' ' '
�1``' / J � �,� .
CONSTRUCTION PERMIT (��p- ,j /� 3' ' ' I�,�-==�--� '' -� -'�'� ; � �' ' " '
Phone
Addrea
License�No.
Addreu
�Contfactor
TVPE OF CONSTRUCTION
❑�NEW� 'OADD ❑'ALTERATION
❑ REPAIR ❑ CONVERSION'�DEMOLISH.
O OTHER �
DESCRIPTION'OFWORK� T�GI+�O GOH
. . - � n� ..� ' '
AddfESS � 01��3i �G � _� GRADING ❑ FOUNDATION � �'STRUGTURAL �
LICENSED CONTRACTOR� DECLARATION_ . � � ��TENANT ❑ ELECTRICAL �PWMBING ❑MECHAN
I hereby affi�m that_I am Iicensetl un0er provi5lon5 of Charter 9(cOm- ,. �
men<in9 with section 7000) oi Division 3 of the Business antl �❑ OSHER �� '
Protessions Cotle, antl my license iz In fuu forca antl eftecL _PROJECTDESCRIPTION,
LJcense Ciass G—J 1 ' Li No�i/nTI7.� ' . . , .
Date�A��;'�� " ' Signature_ ' ' � f . � - -. 54. FT. '. .
WORKERS' COMPENSA710N DECLARATION '� OCCUPANCV CONS RUCTION TVPE
1 hereby affirm that I heve a teriifiwte ot consent to ulNnsure or a O C
certiTicate of Workers' Cvmpensa[lon Iniurantt, or a certifietl'copy VALVATION' �' � ZONE
thereoi (Sect�'on 3800, l.nb. C.). . GRADING CU�YDS.��' � AGRES
� �"Y No. �30�9/S ' ' ' ComPanY �T. Fi�ND " .
MHOM <opy is bereby fmNsheA. - � REMARKSl. . . . . .
L �ertlfletl copy I5 tlletl Wjth the Uty Builtling Dlvislon,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' ' "' ' "
(This secUon neetl nol Dp completed if the permit is fOr one huntlreC _ _ , � .
(E300) or les). : • �
I.certlfy.that inlne perfOrmance,ot [he work for which [his permit is
iiSueQ I s�all not emPloy any permn in any 'manner so as to become PLUMBING �• " . PLAN CHECK'
sub�actto.lheWorkerz.Cpmpen5alionLawsot..Cali(ornia. " gATHTUBS - SHOWERS ��
Date Signature
NOTICE: If aiter making this tleclaration, you zhoul0 becoma subiett TOIlETS URINALS ' -
to [he Workers' Compensat{on provlsions of the Labor Cotle, you must
to�lhwith comply with s4th provisions or this permit shall De Ceemetl �VATORIES` DOUBLE LAVS '
�¢vOketl. :. . _ . ..
CONSTRUCTION LEND�qG AGENCV KIT.SINKS -' � DISHWASHERS"
1 hereby a(tirm that Iher@ is a con5truction lentlin9 a9ency for the perv SERVICE SINKS �� SUMPS �' ''
formance of the work fqr which this permit is issuetl (Sectlon 309]
Ci'v. C.j. ' " - " ' ' ' ' ' ' " " ' -FLOOR SINKS � � � � FIOOR DRAINS '
LenCer's Wme
Lentler's Adtlras DRINKING FOUNTAINS�- � - " ' � �
OwNAR BUILDER DECtqRAT�ON A^ r^^ '^ ^^^,^ � �^ INTERCEP70R5 CLARIFIERS .
a
a
tor t�e alle9etl exer�p[ion. Any vic
ppliwnt tor a'permit zubjects the
F more tltan (iV2 h4ntl�¢tl tlOIIdfS (�
as owner ot.the property, oi my e
omcensation, will tlo the work. antl
of Division�3�of [he G%i55ERVICE OUTLETS �
npt ther¢trom anU t�e WqTER HEATERS' ' BTU OUTPVT -
�( Section ]031.5 by
fnt to a civll penalty SEWER CONNECTIONS QW
:5 with wages as their SOLAR TANK ' COLLECTOR
ucture is not Intentle0
or otteretl ror uie. (Secuon 7044, Business antl Protessions Cotle: The SOLAR PIPING SVS. �
Contractor'S LicenSe,Law tlo¢s not apply. to.an owner ot a property
wno builtls or improves thereon, antl wno tloes such work himself or ISSUE FEE �
throu9h his own employees, provitletl thal 5uch improvement5 are not
intentletl or offeretl for s;�e. If, howeveq the builtling or improvement MECHANICAL PLAN CHECK
is soltl within one year.ot completion, Ihe owner wili have the burAen
tit proving hG tlitl nOt Guiltl or improv¢ for th¢ purp05¢ Of sale). HEATING SYSTEM 0-100,000 BTU _
� 1, as owner �oh lhe �property,•am exclusively contracting� with - qND DUCTING ' '"
Iicensetl contractors to crynstruct the project (Section 7044, Business 100,000�+BTU_
antl Rofesiions Cotle: The Contractor's License�l.aw�tloes not apPty4o
an owner of property w�o Ouiltls or improvez thereon, antl who con- REFRIGERATION 0-100,000 BTU_
tracts'�from such �projectb �with a contra<tor(s) Iicesnetl pursuant4o� �SVSTEM — �- -' �
tne Goniractor'S License Lyw), 300,000 + BTU _
❑ I 5m eieinpt untlei SeStion � B. & P: C.-tor t�is � BOILERS BTU
I¢dTOO " —
Date OW�¢� SVSTEMREPAIR,ALTERATION
1 hereby certifytha[ I have reatl this application an0 state [hat the above EXHAUST SVSTEM MULTIPLE
information is correct. I agree to comply with all tity and 2ounty
orEinances antl State IawS Yelating to con5truction, an0 n¢reby authoriie
representatives of this City to enter upon -the above mentionetl
p�ope�ty (o/� i Spectl u�0o5es.
Si9nature y�����. Date/6-/,3-hd
Orivers' License or SS � '' ISSUE FEE
CMF 0865-4fi White-Builtling; Canary-Applicanl; Pink-Accoun[ing; Goltlenrotl-Assessor
i
OCT 15 1982 � � ;: ' � .
20NE �'� � P�-NTGp. gRUEF. �
SETBACK G/L ST. PROPE�RTV LGNE •'."� ' �
cinc.vnon .. . .. ..
�REAR VARD (TO P/L) - � -
VKG.SPACEREQ. � � PROVIDED' ' �
STREET WIDTH � PARK FEE E'
ZONING APPROVED BV �. DATE V
SPECIAL CONDITIONS: - �
PLANCHECK ' _ , - .,
GENERATOR 0-1KW_1-lOKW '
TRANSFORMER - � ��
"APPUANCE 10-50 KW_50 +�KW � �
'MOTORS � 0-1 HP_3-10 HP -
�QNG. SOLAR) 30-50 HP 50 � HG � "
FIXTURES' ' OUTLETS SWITCHES ' ' ' �
GAS TUBE SIONS ' �
'POIELIGHTS ' •
" cuw . P I :-I �
-PAN@LS ' MAIN
"" ISSVE FEE " '
.SPPLICATION APPROVED BY DATE�J 'L
� S,UnMMSIRV OF FEES -� M
PERMIT G S� SMIP E D•'v
PLAN CHECK S PERMIT
PLUMBING § ' �SSUANCE E � �
PLANCHECK E - GRADING E
ELECTRICAL § S �
�PLAN CHECK E ' MICROFILM E' � ���/�
MECHANICAL § ' TOTAL FEE S.�
PLAN CHECK ' S � LE55 AD-.
VANCEPC S /
t9 �
� . FINALFEEIE/O,
�' ��. 8�.�0
�' ,_---= v1-5 �UILDING DEPARTMENT
' O. B O % 31 ]
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING /
ADDRE55 �7 �J kJ E 5T I•� I N S l
COSTA MESA. CALIFORNIA
MAIL .1
AODRE55 2S S� 1 IS�.4�JD
cirv NEWpo2T___BEecN
ARCHITECT WF.STE(Lrl D2AF7�1.1
OR En�;��fJEER (LEAG e 1.� �TEb6Ul'
Aooa`��5 494 /.)o. 1.1EvpoR,Y
� F1.Qp. I .CLAVToyY �'o`:
s a o asy s�o E ue, rE�
�ece� ILOT fc�c �.-.� I
oescnrrnoN NO. 4 BLOCK
A.P. NO. �I� _� � v �li
NO.OF BLDGS.
I _i i. ��I ......�...�....
��--� v �� �I�i�� � ��'�� �
iy s S� 4=
EflCJA' �Dl�T.
�l�i Q� ��Q �:�
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO, pEAMIT NO
S46
�e Sd � I BYPFOVE
USE OF
EXISTING BLOG.
SET0ICK LINE FROM p
CENIER OF STnEET � /� REAR YAqD
SIDEYARD RIGHT O� I�� LEFT �O�
DESCRIPTION OF WORK
NEW ALTERATION I qDDITION
�— —
REPAIN MOVING DEMOLISH
BUILDING C X (20� NO.OF '
SIZE � ROOMS STORIES
E%TERIOR WALL STJ GG O qOOF CbN'PO -
COVERING M4 R COVERING �, 1[.,
B�ELDFNGEW �E'PAtL. ST�R.�L .
�
� e♦ ORE ISSUED
� d-�/-3
Y . ��f
COSTA MESA. CALIFORNIA
NO.OF TVPE GROVP '
PL<NS ��� �`
� v
� `—
G%� IL DATE p�II j —1
L
cOftftECTIONS �„�
%� '��` 4' �a °.� � � �
CITY 0:= � ..'f , ' l:. ; �
P., i•�;t:.G �:,rt. �
nc
3Y DAT h'"
LHI . .
O�( Y� t.�
0
STATE TM�T THE 10OVE I$ CORRECT �NO AGREE TD COMPLY WITN >LL
CITY ORpIN�NCES 4N0 ST�TE L�W6 NEGULATING BUILUING CONSTHUG
T�oN. � VALUATION
SIGNATURE OF PERMiT FEE $ �� �
PERMITTEE
$ n O� � y6\ PLAN CHECK S � �
L /� y!�
AUTHORIZEo AGENT TOTAL FEE S `�`
Vµ�
.: %�J�98
COSTA MESA BUILDINCrSAFETY DEPARTMENT
• P.O. BOX 7200 COSTA MESA� CALIFORNIA 82828
For AppUmM ro FIII In Complotoly
TYPE OR PRINT _
�RCMITEGT
MESA, CALIFORNIA
1
DESCRIPiION OR WORK
WALL
1 HHii[pY 11CKNOWL�C�
/�ND 9TAT6 TNAT iH�
PLY WITX ALL'CITY OR
ew�o�qa eoxerxu
H16NATURG O►
PHRMITT6
AUTHORIZ[D A6[NL
XAV6 RGD lHl� APOUGTON
COqR6G1' ANO AOp68 M COY.
AryD �T/f�[ LAIM� P[YYIATINO
OCT 28-66 Q01233 ��'*���3.00
I,rPLICATION FOR PERMR
BUILDIN�3
for Offlc� Uss Only
� �
L_Z
LROAL
N0T8: N08AV8
90• TO 81D6 R F
EAVEB
ALIOWHD
YARDD MPF
MAIN BUILI
vnn.#
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2rG //.�wTe /d/Z`6(�c6 �
� ZONING oPS �
usa or Miw �
� lYILDIN�
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� Q'�.J � �_ � J_— ` `
:RpHA�,N,a BHALL �! Ll88 TNAN
/ <U.B.C.NeGOIREMBNT] ��
:O YARDB APPROVHD
i ACC6880RYBUILDINO
DAT6
TMi AMOYM �XOWN UND6R VIILUATION 19 POR T118
�YRPoBi O! �iTAlLIOXINO A PlRMIT Pii ONLY.
VALUATION � ,
PBRMIT FEH
� � � � TOTAl. PEE �/
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