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Home My WebLink About3069 JOHNSON AVE - Building PermitsN � � Appllcant to till in all spaces ezcept Ihose wil�in �eavy �orCer Ilrles antl sign at1 aoo�opriate tleclaratlons. CITY oF COSTa, MEsn CON��1TRUCTION PERMIT Project Address � h�s'- --G,�� .10�7 TnJ 5�0� S T� a: �Q� � � 1 � nlfa 'Applicant'sMail'n Address � �. -ST• . Owner's Name /��•D ( A) i � � f Phone �`�G -�n� Address �ii [O % )a�.JSo.�i Sy� Cal�'N /�'iE1 � '. Arch/Eng. Licenu No. Address - ' ' '�/ ' Contractor's Nam µnT �� u''� phork'� ��-�n /� Address (mailingl�� -�-•'��"'��+ Gt/ �. %��7ZL Ciry license No. 341 r� � LICENSED CONTRACTOR DECLAftATION I hereby affirm that 1 am license� untle� 0/ovisions ot Char[¢r 9(mmmencing witn sectiOn ]000) of DiviSion 3 Of the Busineiz antl Protesslons Cotle, dntl my license.is in full toKe antl eftecL �/// �� r� ' LiCenSe CId55 �� Lic se �o.7v Q • Date 7- �%�± ' Signature �H""' WORKERS'COMPENSFTION DECLARATION ' � 1 Oereby affirm that I have a cer[ilicate of consent lo s¢If-inzure or a certiticate �f Workers' Compensation Insurance, or a certlfietl copy .thereof (Section �.eoo, �ao.& I � - - Poy�Y No. ^' f6��'� ComPany�OS[ I e T r. Ce� ' Q Certitietl copy is �ereby furnishe0. ❑t�Ce�tsfiel� p�] iletl wAPPI cantY Bu�4M yr sion�.�� J i7 U EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be Complet¢0 if the pGrmit i5 tor one hundre0 (E300) o� less). � I certity that in lhe per(ormance Of the wo(k for whiCh [his perm�t is isSueQ I shall mt employ any person In any manner so as to become subject to the Workers' Compensation Laws oi California. . Date Si9nature - 'NOTICE: If, after makin9 this tleclaratlon, you snoultl become subject to the Worker5' Compensalion provisions ot the Labor Cotle, y0u must forthwlth comply with such p�ovisions or thiz permit shall be tleemetl �evok¢tl. CONSTRUCTION LENDING AGENCV 1 hereby affirm that tnere is a mnstru[tion lentlin9 agency fo� the performdnce of tne work for which fhis permit is issuetl (Section 3097 Civ. CJ Lentler's Name Lentler's Atltlress _ OWNER BUILOER DECLARATION I hereby afflrm that I am exempt lrom the COnt�ac[or's LI[ense Law ior [he following reazon (Seclion 7031.5 Bu5lness antl Profezsional CoOe: Any city or wun[y whlch �equires a pe�mit t0 Const�uct, alter, improve, tlemOlish o� �epair any sVucture, prlOr to i[5 issuance, also requires [he aOP��<ant tOr such permil t0 iile a signetl stalement Ihd� he/sn¢ IS licensetl pu�5udnt to lhe p�ovi5ions of the Conbaclor'S LicenSe Ldw (Chapter 9(commenUng wi[h $ectlon 7000) ot Division 3 of Me Business antl Profesvons Cotle) or [hat he/she is exempt therefwm antl lne ba5iz fo� the allegetl exemptlon. AnY vlolatlon o1 $ection '031.5 by any applicant tor a permil zubjects the applicant [o a civll :nalty oi not more than five huntlretl tlollars ($500). .� I, as ownar ot the property or my employe¢z with wages as Ihelr sole comoensatlon, will Eo the work, ana the structure is not IntenGetl or ofieretl f01 Sd12 ($CC[I00 i�44. BUSI0055 dfld PfOfQ551011d1 Cotle: The COO[IdCIOY'S License Law tloes noc apply to an owner of a property who builtls or improvez Ihereon, antl wbo tloaz sucM1 wo�k him5¢I//he�selt or throuqn ttis or h¢r Own employecs, p�ovitletl thal such Improv¢men[s are not intentletl or otfe�ed fo� sale. If. however, tbe builtling or improvement is soltl wllhin one year of com- Oletlon, the owner will' have the burtlen Ot Proving he/she tli� not builtl or Im- p�ova tot Ine purpose of sale). ❑ I, as owner of the property, am exclusively contracting with Ilcensetl corv tractors to construct the project (Section ]04a, Businezs antl Professions Cotle: The ContractoYs Llcense Law tloes not appty to an owner ot property who builtls or im0�o�es thereon, and wno mntracts for such proiects with a con- tractor(s1 ➢cense pursuant to tne Coniractor's License Law). 1 am aware thai proof o1 their Worker's Compensation insurance shOultl be provltletl to me. ❑ I am ezempl untler Secilon B. & P. C. fo� thls reason Date Ownen. I h¢reby certity that I have reatl into�mation is conecL I agree to c antl state laws relaling to builtlin9 5¢pldtiv¢5 Of 5 C y IO fl[2 inspection pu�pos � Siqna[ure 'L Drivers' License or 55 �t �� - �i'� �I b 2- I , TVPE OP CONS7RUCTION� ' NE� � ❑ CONVERSION ❑ DEMOLISH DESCRIPTI N OF WORK/USE OF B y'c.tl - �P CaJ2ti.° W 'f"�. TVPE OF PERMIT cRaDING- ❑ TENANT ❑ ELECTRICAL C ❑ OTHER PROJEC7 DESCRIPTION� CONSTRUCTION TVPE VALVATION $ GRADINGCU.VDS. � �A( ADD L1 ALTERAT.ION LI REPAIR 1FOUNbATION LJSTRVCTURAL PLUMBING ❑ MECHANICAL Remarks: Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains ' Flaor Sinks Gas Service Outlets� Interceptors Kitchen Sink Lavarories � P-Trap Roof Drains� Reinspec[ion Fea � PLUMBING � Showers Service Sink . Sewer Cap Sewer Connection Solar Collecrors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash $15 Duct - Under Ground Duct-Sttuctural � Duct-Ventilating � Exhaust System ❑ Multiple Firepl/FacL Blt. ICBO # Heatin9 System & Ducting ❑6�100,000.BTU �100,000 Reinspection Fea � $75 CMF 0865-46, rev. 10/84 White - Bulitling; Canary - Applicant; Plnk - Accounting: Goltlenrotl - Asse55or Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-t00,0008TU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES 0 A.P. # S Main Building: E T Front ARear C Rigfit K Left S Ping. Ref. # Planning NoteS: Automatic Washer- Construction Pole: Cooking Unit Dishwasher � Dryers ❑Gas� �E Fan P.A.U. Fixtures Device Boxes Outlets 7141, 2/OS/�;:� Accessory Building: � Parking Req./Provid . , , �. , Zane , Z O � N I N G R ELECTRICAL � Transformer� � 15-50 KW � ❑50+KW i .Meter ❑up to 700 amps Meter ❑over100amps Sub Panel Momrs O0.1 HP O1'h -�8 Inc.Solar �9�75 HP �16�15+ Microwave � Pole Li9ht Garbage Disposal � I I; Standing Sections Generetor �0.5 KW �5�15 KW � Trash Compactor $ 3 Reinspection Fee $15 laue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: � 2oning Approved By Building Appioved By �_ Appliwtion Issuad By � M T S =EES � — $ 3 SUMMARV OF FEES � BUILDING PERMIT $ � LO .00 SMIP $ • �� PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL � $ GRADING $ PLAN CHECK 50% $ � MICROFILM $ ' �..�\ MECHANICA� $ TOTAL FEE $ ��'v PLAN CHECK 25% $ � - � CONSTRUCTION AND PLANNING � • � � � POOL ?A � � APPROVALS Permit# - Date � Inspector AppROVALS. Permit# Date Inspector - 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement 3. �lectrical Conduit UtilitY-Undrgmd.� � 54. Forms , 4.'�Electrical Conduit-Undrgmd.- - 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. . 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-7rap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK �i i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , �12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 14. RoughPlumbing' 65. Electrical�Final � 75. 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 Eleceriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA� � 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 0 Gas ❑ Oil � � ' � 23:�Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTankOGas ❑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. Flnal Factory Fireplace ' 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final ' . � 42. Backflow Preventer � � 43. Backflow Irrigatlon - 44. .Landscape Irrigation System � � - 45. Sound Attenuation . �� 46. ,Handicap Regulations , 47. FINALSTRUCTURE&BUILDING �� 48. Special Requirements COmpleted � � � � � 49. Electric Felease to Edison � - . ,, - 50. Gas Release to Southern California Gas Co i � 51. CERTIFICATEOFOCCUPANCY , _ , No. Date . 17074 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX St7 COBTA MEBA. GALIFORNIA For Applieant fo Fill In Completely TYPE OR PRINT ADDRE6S �6 / �hhs'en �K• COSTA MESA CALIFORNIA Beverl.y 3111s "` �n.— NO. Unl� � � ISTATE _ �._—__ TEL. OP BLDGB. USE OF EXISTING BLDG. OBTBACK LIN¢ FROM ceHi¢w ov aiweei �O � REAR YARD �� SIDE YARD I LEFf r� I RIGHi � DESCItIPTIOPi OF WORK EXTERIOR WALL IROOP COVERING Sj'I1RQO COVERI� USE OF BUILDING AND WORK TO BE l _ Sinm Anq ur/ntt I H¢ftEBY AGKNOWLEPOe THAT I NAVB RHA� TX19 �PPLIGTION ANO eTATE THAT THE ABOV¢ IB COPRCGT AND GRE! TO COM- PLY W�TH ALL CITY RDINANC¢8 ANO HTAT W9 R80U4TINQ BU�LDINO CONBTR ION/. � HIGNATURE OF /s N//�//// ��l i/� '`_'_' �r;F��.9�i'^� ��hs �ie.elJtT� v �. % MAv 17 1961 �FIiV�',i,GE D��'T. CI�iY OF COSTA 1.4ESA APPLICATION FOR PERMIT BUILDING For Office Use Only p[CEIPT NO. PZRMIL N4._ FECBIVED Y I DATE REC8IVED �•.1�' Y � r� M� ADDRESS 3069 Johnson iiV COSTA MESA. CALIFORNIA FIRE ZONE TVPE GROUPI� APPROVEO BY DATE ZONING ZONE NO.OF �j UBE OF NEW r* �_/ I PUNB L OUILDINO w/d cecn�rTior+ j�i%t #� TA��I. �� A. P. NO. YARDS EVES APPROVED ALLOWED ¢ervrew uNe er.� __ � REAR 2' �"�— A�PPROVED 4�� r )/✓� � I�' i TH6 AMOUNT BHOW� S! DEf � PUPP09¢ OP E9TA "�BHINC VALUATION PERM $ y1,g55.00 PLAN "L TF '�' JC �-/!s < , VALUAT�ON IB PON TH8 ♦ PERMIT PEE ONLY. 'FEE $ ��i�