HomeMy WebLinkAbout2533 BACK BAY LOOP - Building Permitssr
Applicant to fill in all spaces except those within heavy border lines andsign all appropriate declarations. 0870 -4/09/85 - "
CITY OF COSTA MESA CONSTRUCTION PERMIT - PE MIT NO. TRACT NO. • LOT NO. UNIT • . - -EoOG TL'
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. Project Address II
q z� TYPE OF CONSTRUCTION NEW IJ ADD U ALTERATION U REPAIR • __
Applicant's Mailing Address^ �'V Q C. ' OO / / -❑ CONVERSION -1 DEMOLISH ❑ OTHER• - - A.P.# - Zone
Owner's Name •-•� 'I'' O- (-tl0`-.41 Q�,�j pp r hat ' DESCRIPTION OF WORK/USE OF BLDG.
Address O / Z S. 'fes .r(}.7( tea 2.- t • ' - 5I - S Main Building: Accessory Building: , , -
Arch/Eng. License No.. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATIO ❑ STRUCTURAL - E Front - - _ I - 0
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Address - - ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear i• ,
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Contractor's Name _f. ...I� i I -'/ -Phone IL 3(I-Z7` Cl.BOTHER' - - ''" `.'s'�1 _ SI 5 _ A _ - N
i - - PROJECT DESCRIPTION SQ. FT. J - OCCUPANCY C Right • -
Address(mailing) /1 3A /�+ - • : e v-C-. K Left G
8 'CON STRUCTION-TYPE VALUATION SR
City License No. C I3 _ ' - ' ; ZONE GRADING CU.YDS. - •ACRES - - E
LICENSED CONTRACTOR DECLARATION _ _ Ping, Ref.# Parking Req./Provided -
I hereby affirm that I am.licensed under provisions of Charter 9 (commencing Remarks: • - ' • I Planning.Notes: . _ , M
with section 7000) of Division 3 of the Business an• Professions Code, and I _ •- - T
my license is in jyll fo/rxe and effect. 34,5-2 S . •• - _ _ . •
License lass C..r'Ctl r =1��i�. / • - S
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Date Signature - -: ..������.! • PLUMBING _• FEES
WORKERS'COMPENSATION DECLARATION , Bar Sink I Showers • 1 ELECTRICAL - FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate ' -
' Workers' Compensation Insurance,'or a certified copy,there f (Section Backflow Prevent¢f-- - - - Service Sink '- - t - - -
0.0, Lab. G)(t ,// / - Automatic Washer Transformer 0 15-50 KW
policy No. r `� ] I./t' Company ' Backflow Irrigation Sewer Ca , • 0 50+ KW
Cap ' Construction Pole Sub. • I
_Certified copy is hereby furnished.
ertifietl c4�Iy a with the city Builr'u{.'g sM/ �� Bathtubs Sewer Connection I Cooking Unit 'Meter pup to 100'amps I I
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Date 3' .s'Q Applicant /�'� '/�/-T��' I -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers •
Solar Collectors Dishwasher • Meter Dover 100 amps
(This section need not be completed if the permit is for,one-hundred ($100)or - - - -' -
less). Dishwasher Solar Piping' Dryers ❑Gas' DElectric 'Sub Panel '
I certify that in the performance of the work for which this permit is issued, I • -
shall not employ any person in any manner so as to become subject to the ' Drinking Fountains Solar Tank ' Fan Motors❑0-1 HP 01%-•8
Workers'Compensation,Laws of California., '
. Date Signature Floor Drains: •
Swimming Pool vii/Spa j F.A.U. 'Inc.Solan�9-15 HP 016-15+
NOTICE:If,after making this declaration, you Should become subject to the -
Workers' Compensation provisions of the Labor Code, you must forthwith - ' Floor Sinks _ . - . . -Urinal , - - . -- .. Fixture- - - - -- -:• - - 'Microwave ", -'
comply ' ,with such provisions or this permit shall be deemed revoked. ' '
CONSTRUCTION LENDING AGENCY - - Gas Service" Outlets WaterCloset I - '
I hereby affirm that there Is a construction.lending agency for the'performance . Y ' - Device Boxes Pole'Light
of the work for which this permit is issued (Section 3097 Civ. C.) r-
Lender's', Name• - - ° '
• Interceptors Water Heater, Outlets Range
Lender's Address - • Kitchen Sink - Water Service S• witches Sign
OWNER BUILDER DECLARATION -
I hereby.affirm that I am exempt from the'Contractor's License Law for the ' Lavatories . Auto-Wash . Garbage Disposal 'Standing Sections '
following reason (Section 7031.5,Business and Professional Code: Any city or • - '
county which requires a permit to construct,alter,Improve,demolish or repair ' - P-Trap' • LaundryTrays? •any structure, prior to its Issuance, also requires the applicant for such permit - y•
Generator 00-5 KW ❑5-15 KW Trash Compactor i •
.to file a signed statement that-he/she Is licensed pursuant to the provisions of 'Roof Drains �- • -
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of - '
Division 3 of the Business and Professions Code) or that he/she-is exempt : r , •
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therefrom and the basis for the alleged exemption.-Any-violation-of Section . , - . , , '
'031.5 by any applicant for a- permit subjects the applicant!.to a civil ` ' . .
penalty of not more than five hundred dollars($500). - - ' '
'❑ I; as owner of the property or'my employees with wages as their sole - ,Reinspection Fee ` '$15, I Issue Fee • $ 3 • I -
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee - $15 Issue Fee, , $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL 4 I FEES
License Law does not apply to-an owner of a property,who builds or improves _ - - ' .
thereon, and who does such work himself/herself or through his or,her own . DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler • Hood or' Type I , 0 I . _ , I
sale. If, however, the building or Improvement is sold within one year of com- Canopy ' Type II' ❑ - - Zoning Approved By Date • .
pletion, the owner will'have the burden of proving he/she did not build or im- Duct-Und¢r,Ground .- • ' Building Approved By Date_
shrove'for the purpose of sale). -
U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Det
tractors to construct the project (Section 7044,Business and Professions Code: . . .
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BT. SUMMARY OF FEES '
, builds or improves thereon, and who-contracts for such projects with a con-- • _ - -• - .. - - —.
tractor(s) license pursuant to the Contractor's License Law). I am aware that - Exhaust System 0 Multiple D System Repair/Alteration BUILDING PERMIT $ - SMIP $
'proof o their Worker's Compensation insurance should be provided to me. PLAN CHECK I $ • PERMIT
❑ lam exempt under Section ' . B.& P.C.for this reason ' Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ ISSUANCE $
Date • Owner - _Hfating System& Ducting Registers ' PLAN CHECK 25% $ ENERGY •P.C. $ '
I hereby certify that J have read this-application.and state thatthe above s ' &100,000 BTU 0100,000BTL -- - - OU GRADING ! $
information is correct. I agree to comply with all city and county ordinances I ELECTRICAL i$ s
and state laws relating to building construction,and hereby authorize repre- _ // h PLAN CHECK 50% $ MICROFILM $ •
sentatives of -this',city to a ter'upon the above-mentioned property for '
inspection pu�oses:•�d d Il _ �7�Z Ar 'T��'^ t MECHANICAL $ '00 TOTAL FEE $ - �`�°
Signature (S J .X�lYY'�"ll(��...aaa" Date J "O ,
Drivers' License or SS# '• - - Reinspection Fee $15 , , Issue Fee $ 3 PLAN CHECK 25% $• ( `&Q
_ _ a _ _ _ _ . _ ....r....-. _ 4. _
, CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor 2S,G
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CONSTRUCTION AND PLANNING • 1 . • POOL _SPA .
APPROVALS Permit# Date Inspector APPROVALS Permit# - - , Date' Inspector ,
1. Temporary Electrical Service or Pole• 52. Pool & Equipment Location
2.'Soil Pipe-Undrgrnd. 0 .. !- • 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms ,•
4. Electrical Conduit-Undrgrnd. ' - . _ 55. Electrical Bonding -
tri•5. Steel Reinforcement'' E -- ' _ ' 56. Rough Plumbing & Pressure Test: - 4;
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE .
,.-7;Footings - 58. ElectricalConduit-Undrgrnd. .
8. Foundation • 59._Gas Pipe, 0 Undrgrnd., Test
,9. Water Pipe-Undrgrnd. /b , r • 60. Backwash Lines, P-Trap, O Undrgrnd. .
40.'Structural Floor Sysiem i}��'.' - 61. APPROVAL TO DECK
11-.Property,Sewer Line & House Connection ?, / , _ 62. Backwash& Receptor-Final •
12..SeweS Cap ' ; - - 1 63. Heater & Vent-Final
13. Roof Drains �` - 64.'Plumbing System'- Final " •
14. Rough Plumbing• . ,.r 65. Electrical-Final
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-15. Rough Electrical-Conduit - i .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# ' '
21. Ducts, in Structure 70. Underground Hydro
- 22. nets, Ventilating 71. Product Piping 0 Gas- 0 Oil •
23.,Gas Pipe-Rough & Test` 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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
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33. :Final Electric Notes: -
34. Final Heating & Air Conditioning /q4/ - (JO
35' Final Gas Pipe-Test -
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36'Hood or.Canopy • . - '
i. i37'Final Factory Fireplace
38. Final Plumbing . ' ' '
39. Water Service-Final, -
40. Gas Service-Final '
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41. Solar Domestic-Final . -
42. Backflow,Preventer ,
43. Backflow Irrigation
44. .Landscape Irrigation System ' -
45. Sound Attenuation -
46. Handicap Regulations ' -
47. FINAL STRUCTURE & BUILDING '
48. Special Requirements Completed. - , • - -
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49. Electric Release to Edison - - -. - .
50. Gas Release to Southern California Gas Co
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I51. CERTIFICATE OF OCCUPANCY . . '
No. Date