HomeMy WebLinkAbout438 18TH ST - Building PermitsAVV���ant io fill in a11 soaces eaceD< <�ose within heavy boraer lines ane sign all aporooriate tleciantions.
CITY OF COSTA M S QCONS�UCpTI�I P�I�V T PERMIT NO. TRACT NO LOT NO. UN1T NO; �
Project Adtlress �� V �,��-� Up� cri� .B - 26 6 9 � 3
Applicant's Mailing Address ���w ' • ' ' TYPE OF CONSTRUCTION - NEW 'ADD ALTERATION REPAIR
Owner'iName ���`�'" �1^AR Phone � CONVERSION ❑ DEMOLISH ❑ OTHER
Address � ���e ��TIO�qFs ORK Us�oFg��p[qCE iMNEj'
r r
Arch/Eng. �� ��License No. TVPE OF PERMI7 GRaDwG FOUrvDATiOrv STRUCTuaa�
Add!¢55 '� ❑ TENANT ❑ ELEGTRICAL ❑ PLVMBING ❑ MECHANICAI
Contractor's Nam '�'� � Phone ��q U� ���oTHER �
-� �Q�� PROJECT DESCRIPTION ' SR. F7 oCCUaANCY
Addresslmai�ingl—�o51\ C�R..�a"�'G� �
� CONSTRUCTION TYPE � • VALUATION $ = d9oo
Ci[y License No. �+Q �� • ZONE GRADING CU. VDS. ACRES
LICENSED CONTRACTOR DECLARATION
I hereby aHirm tba[ I am licensetl untler provislons of Cbarter 9(commencin9
with section 7000) of Divlsion 3 of the Bu ness antl Professions Cotle, antl
my Iicensa is in tull or gn�t eitect.
Licen CI �v� Z ' ense No.
Datc � ' ' Signature _
WORKERS' COMPENSATION DECLAR �
1 hereby aftirm Ihat I have a cer[ificate ot mn selt-insure or a certificate
• `Norkers' Compen5ation InSurance, or a c¢rtifietl copy, therCot (SectiOn
J, Lab. CJ
iicy No. Company
eCertitietl copy is-�ereby furnisheC.
Certifietl copy is filetl witn the city Bu(Itling Division. . �
Date� APPlicant
EXEMPTION F0.0M WORKERS' COMPE ATI N'OECLARATION
(Thi55eCtiOn nee0 not be completetl if the rml � 5 fo/'O�e huntlretl (E100) or
less). .
I certify that in the oert rmance oi the w � iM• ie-pesmiE-is�issuetl, I
shall nOl employ any p Son in any ne� o a o ecom¢ Subje<t to the
Workers' mq n ati 1 ws of Califo '.
Date � ' Si9nature � -
NOTICE: If, afte� making this tlecla�ation, y u tl become subject to tha
Wo�ker5' Compensation provisioni of the bor Cotle, you must torthwith
comply with SUCh p�ovi5iOn5 Or this pe�mlt shall De tl¢2metl �evoked.
GONSTRVCTION LENDING AGENCV
1 hereby aifirm'[hd[ Ihe�e i5 a const�uciion Ientling agency fo� Ihe Oe�fo�mance
� of the work for which tnis permit is issuetl (Section 309� Civ. CJ
LCntler's Name
�� Lentler's Adtlress 4� .
'�. OWNER BUILOER �ECLARATION
' I hereby alfirm that I am exempt from�the Contractor'z License L.aw for Ihe
followin9 reason (Section 7031.5 Businezs antl Professional Cotle: Any city or
county wnlcn requires a permit to construct, alter, improve, tlemolish or repair
any structure, prlor to its issuance, also requirez the applicant for such permit
to file a Slgnetl slatament that he/she is licensetl pu�suant to llte provisions of
tha Con[racror's License Law (Chapter 9(commencing with Sec[ion 7000) of
Divlsion 3 of •[he Business antl Professions Cotle) or� that he/she is exempt �
'�h¢r¢from antl [he �asi5 tor [hG allegetl ex2Tp[ion. Any violatlon of Sectlon
31.5 Dy any appllcant fOr d permit subjects tha applicant to a civil
ialty o1 not more than'f�ve buntlretl tlollars (E500).
� I, as Owne/ of the p�o0erty or my em0�oyee5 wi[h wage5 as Iheir SolO
compensation, will tlo the work, an0 the sVucture is not in[entled or offeretl
(or sale ($ection 7044, Business antl Professional Cotle: The Contractor'S
LlcenSe Law aoez not apply to an owner of a property who builtls or improves
thereon, antl who tloes sucn work himseit/herzelt or ehrou9h his or her own
employeas, provitletl tnat such improvemenis are not Intentletl or ofieretl for
sdl¢. If, hOwever,�the bulltling o� Imp�ovement i5 Soltl within one year of com-
plltiOn, t�e owner will have tha burtlen OT 0/ovin9 he/she tlitl not builtl or IT-
�rove for the purpose of zale).
�I, a5 Owne� ot tM1e prOperty, am exclusively cantracting witn licensetl con-
Vactors to construcl the project (Section �044, Businesz antl Professions Cotle:
The Contractor'S licen5¢ Law d025 not apD�Y to an owner ot property wbo
builtls or improves thereon, antl who contracts for such projects witn a con-
tractor(sl ncense pursuant co the Contractor's License Law). I am aware that
proof o( Iheit Worke�'s Compansation insu�ance ShOultl be p�ovitletl to me.
❑ I am exempt under 5¢ction B. & P. C. �or Ihis reason
Date Owner
I hereby certity a(}� ave reatl thiz application antl state tnat the above
informatlon is co EL. I a ree to comply witb all city antl county ortlinances
antl state laws r ting _to builaing construction, and hereby authorize repre-
sentatives ter on the above-mentionetl property for(
InsOection purp - _ �J
Signature \ �Date �'Z CSZ
Drlvers' License or 55 �
CMF 0865-46, rev. 30/84 White - Bulltling; Canary
Remarks:
Sink �
kflow Preventer
kflow Irrigation
rinking Fouritains
loor Drains '
lOor Sinks
as $ervice Outle�s
Sink
'—Trap '
Roof Drains
i
PLUMBING
' Service Sink - • '
Sewer Cap � .
� Sewer Connection �
� Solar Collecmrs '
Solar Piping ' .
Solar Tank
. Swimming Pool w/$pa
� Urinal
�:Water Closet
�-f � Water Heacer
Water Service' .
,�. Auto-Wash
� Laundry Troys
!
'Reinspection Fee ` $15 I I laue Fee I $ 3 I
�
� MECHANICAL FEES
Duct- Under Ground
Duct-Structural �
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ai oo,000 sTu � i oo,boo
I I Reinspection Fee
Pink - Accounting; Goltlenrotl - Assessor
$75
Hood or Typel ❑
Canopy Type II ❑
Refrigeretion System' '
❑0.100,000 BTU ❑ 100,000 BTU
System Repair/AI[eration
Fire Dampers
Regis[ers ' �
n
luue Fee � $ 3
A.P. #
S
E
T Front
B Rear
A
C Right
K Lett
S
Ping. Ref. $-`
iT
- �'-/YL6 l�c./+L
� �_ �+�i
7
� �'O�' TO /S1
O i
ConstructionPoleSub. �
Cooking Unit � •
Disfiwasher . .
lectric
Fan
F.A.U. '
Fixtures
Device Boxes
Outle[s
Switches
Garbage Disposal
Generator �0-5 KW
9264 1.2/24/B6
�
Accessory Building:
�
' 1
Parking�Req./Provided
�
ELECTRICAL
, 54o I 2 p •iL
Zo�e ,� ., ..
i
- Transformer,015�50KW
❑ 50+KW
Meter ❑up fo 100 amps �_
Meter ❑over100amps �
i Su6 Panel i = - • '
� Motors DO-1 HP �1'F, - 8
Inc. Sola'r �9�15 HF �16-15+
Z
0
N
I
'N
G
R
• E
Q
M
T
S
FEES �-
�
. Pole-Light '
flange
Sign -
Standing Sections
5 KW • Trash Compactor ,
I Reinspectian Fee I$15 I
DEVELOPMENT SERVICES REQUIR
Zonin9 APPraved By
Buildin9 Approved By
Issua Feo
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ 32•sa SMIP $ O•.Sb
PLAN CHECK $ 2 �� �Z PERMIT
P.LUMBING $ �SSUANCE $ �
PLAN CHECK 25% $ ENERGV P.C. $�
ELECTRICAL $ ' GRADING $ �
PLAN CHECK 50% $.- MICROFILM $ '
MECHANICAL $ TOTAL FEE $ S .IZ
PLAN CHECK 25% $ '
CONSTRUCTION ANDPLANNING , POOL&SPA .
APPROVALS Permit # Date Inspector qPPROVALS Permit # Date Inspector
1.� Temporary Electric8l 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. Electricat Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � '
6. Electrical UFER Grnd. 57. APPROVALTO 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
�. 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Finai '
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. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit #
27. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Venti�ating 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 (Struc[ural) & Monocoat 75. Dry Chemical ��
27. Frame anii'Flashing y 76. Dry Standpipe
28. Lathing & Siding 77. FIXEO 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-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 � Qp
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY � •
No, Date _ �
Costa Mesa, Building Department
11T EAST 20th STREET �
�� �COSTA MESA, CALIFORNIA
FOR �A P�LICANT TO FILL IN
Mesa,,
f
Sixe of Lot (/JL
Use of
ExisSing Bldg. E
Setback Line n
Center of Street
NOW on Lot �
No.Of .oi
Fatnilles I oom�
Rear
_ .."� , .
I' I A�teration � � Addition
II Moving I I Demolish
, ♦,rp No. of /
LI[ %� / Rooms / Stories
I hereby acknowled�
and state that the a'
with all City Ordir
building construcH�o
Signatureof /'�
Pefmittee _ �
Authorized Agt.
/Sop
Valuation �.v
$ /
FONM 204 6-H 2M 5-54
APPLICATION FOR PERMIT
� Bui���.i�� ��;
FOR OFd'ICE.�7SE ONLY
_ . Rreceipt No, Permk h
f`7 �f C-� I Z 8�
Address
Nearesk�
Cross St
A
''-�� l Ci' �
Mesa, California
�:.� I.� c1 S.
CORRECTIONS
� Coverin ApPROVALS.
��� � Foundation Loeation - Inspector
- Forms, Materlals, .
Under-Pinning ' -
Frame: Fire Stops, _
Bracing, Bolta
that I have read this Application Lath. Int. � �'
ve is correct and agree tA comply Lath. Ext.
�s and State Laws regulating _ - .
Plaster, Int.- '
f,,.+ Plaster, Ext.
l
Masonrv Reinforced
� ma i
Fee $ � FI
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' ••'�f�� � ___�`__`l: .'�_T�'_C.fJ�..
riar Pi.aiv ' :-r: _ .. , _ ; : . -
' 8how.^loc�flon,and distances from ,.. n,'i ..<:. � '' ,.••' �,
�;:"::1 f �:t,�i'y �i' �r.....,, . .
properiy �i'ne and tween bulld nge, j� , ,
- . _ . '• . , ,. ��i•.� ..
' ' _ _ . , � :i'v'i��� , f
--- - - --n. -pompensation ';'. . �l, .�,� � : ` ., �� ; ".;. '��,...`
' carrY•Workma s . ;,, „ , . ,� :
, DO:you_ �,�f �,. � 'a No^. � ,,� �; ,�;:`�� : -, '
, ,.._ Yes , �, _ '�. � , �. .
InsuranceY , ' f the'State _ _
o� provision 3700 0, ,,, .
,- em loYeT
,I 8m sware which requires everv' P
I,abor Codo - _ . _ -- - - - - - -�- —
ainst liability,ior ,
red a� .. ,,: :.,:• •',;
� to be 1IIsu , �, r � . .
� orkman' � oomPe ation. ..�;. . . ;.� �, >
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Costa Mesa Bnilding Department ,/ APPLICATION FOR PERMIT
�•'' 111 EAST 20th BTREET . 1,��[,�a5 B U I L D �� N G �
COSTA MESA, CALIFORNIA
�OR OFFICE USE ONLY �
FOR APPLICAN� TO FILY. IN souiPc rvo. . ae�mit rvo.
Addre�� � �%fos% /O � s� `� I i'3 yd�
Rec ed by Date Rec'd. Dah Issued
Costa Mesa, California, � _ �
Nearest �^ .s � � S C .5 'Z�G'
Cross St. / �/.5 %/ Build ng
/'i��!/,S% �/C�/9/}/uC /��•S%— Address � 3 8 �• �d� �.
owner _ CO5te� MOSey G'&lifO1T118�
Ma�l d� / /9S% �O 's� Nearest
Address �— — .
tor Lia � l� �I Plans
• No. Approved
b
City Lfa r'�.
or b6✓ iYC �' No.
Ilon I No. I Block I Tract���
Metes and Bounds) / — 3 —,3�
No. of Bldga
ot �� oZ,S. �� Now on Lot
Bldg.� '/.�h ,� Fam Iles I Rooma
Street m�aT�� ��L Side Va d ^' �'
DESCRIPTION OF WORH
I�' I A�teretton I' I Addiflon I -
II Moving I I Demoliah I
�/�� _ i..:No.of..'
I hereby
and s[ate
with ali
building �
t I hav� e read ttu�
is rnrrect and agree to
�s and Statc I�vs rc�
.
APPROVALS
Foundation Location Inspeeto
� Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
Lath. I nt.
Valu on PermitFee$ a,o-�o �
$ //�/f Plan Check $ — Bond B�
((/ ✓ ' Total /
Fee $ 'C � � FINAL
FORM X04 G-H 2M 5-bb
1 nt.
O
a
�
2
D
r
_ a...,� �..�.�.
Show locat�on and distancea from
property line and between buildfngs.
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