HomeMy WebLinkAbout3245 MONTANA AVE - Building PermitsApplicant to fill in all spaces eneeot tnose within neavy eortler Iines antl sign all appropriate aeclarations.
CITYOF," STA MESA CONST^RUC^T�ON PERMIT
�.Proj)e;.�ess ��5 M��/�N/'�
, Appiicant's Mailing Address
Owner'snlame �1R.CNAW_E5 l.A HART phoneTN'$—e?07S
Address �A��
Arch/Eng. Licenu No.
Address ���� �p�,�,
Contracror'sNam T��S�!`�=n�u�1��7 Fhone�71-79!/
nddresslmai�ingl �0� �RfJ /hl SAA�TAMJli Ga�a�a
�p��3 --i
Ci[y Lir.ense No. _.tl)_7 �
UCENSED CONTRACTOR DECLARATION
I hereby affirm that I am Ilcen5e0 untle� provi5ion5 of C�ar[er 9(commencing
with seclion 7000) of DIvlSion 3 O/ the Business antl Profe55ions Cotle, an0
my license is in full orc a eilect. [/�855
License Clas �� J� c n}f No. ��
Date ������ �I%n.-+�iCC�J�/Q7�R.6tl'�
WORKERS' COMPENSATION DECLARATIOI`y
� hereby aifirm that 1 have a certificate of consent to self-inzure or a certificate
� Workers' Gompensation InSurance, O/ a certifietl coOY lhe�eof (Settion
100, Lab. C.)
Policy No. Company
8 Certiiied copy is hereby furnisnetl.
Ce�tifletl copy is filetl with Ihe tl[y BWltling DIVISion.
Date APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section ne¢tl no[ be compleletl if [he permit I5 fo� one huntl�etl ($100) ar
less).
I certify that in the peRo�manGe ol (h¢ work fo� wtticlt tnis pe�m�t is i55uetl, I
shall not employ any person in any m er so as lo ec me subject to the
Workers' C pe [ion Laws ol Calif i.
Datc _� p�_Siqnahro
NOTIC I(, atter makin9 this tleclaration, you shou4 become subject to the
Worker5' Compen5ation O�ovislons of the labor Cd e, you must forthwith
comply witM1 such provi5ions or tnis pe�mit sM1all be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 M1ereUy affirm that [here I5 a construction lentling aqency for the performance
of [iie work for whicM1 this permit is issuetl (Sectlon 309] Civ. Q)
L.entler's Name
Lender'S Atltlress
OWNEH BUILDER �ECLARATION
I hereby alflrm that I.am exempt from tbe Contratlor'S License Law for the
following reason (Section 7031.5 Buslness antl Professlonal Cotle: Any city or
county whith requi�es a permit IO cOnst�utt, alteq ImOrove, tlemOlish o� repair
any sV ucture, prior to its issuance, also requires the applicant for such permit
[O file a slpned Statement thal he/sh¢ I5 IicenSetl pur5uant to the provisions ot
-�:�erefrom antl tne basis for the allegetl ezemption. Any violation ot Section
,(+�j31 5 by any applitant for a p¢rmit subject5 tna aOP�icant to a civil
=`'*?nalty ot not mor¢ than five huntlretl tlollar5 (5500).
�� I, as owner of the proper[y or my employees with wa9es as their sole
compensatlon, will tlo the work, antl the structure is not Intentletl or ofteretl
for sale (Sec[ion 7044, Business anA Profezsional Cotle: The Con[ractor's
LicenSe Law tloes not apply �o an owne� ot a prOperty who builtls or im0/ove5
thereon, antl who tloes such work nlmseli/herself or tnrough his or her own
employees, providetl that sucM1 Improvaments are not intonaetl or o(teretl for
sdle. If, however, lhe builtling o� ImprOvement i55oltl withln one year of com-
plGtion, Ihe owner wlll have th¢ bur�en of proving he/she tlitl not builtl or im-
prova fo� the pu�0ose of Sale).
❑ I, as owner ot the property, am excluslvely contractin9 with licensetl con-
tractors lo construct the project (Settion 7044. Business antl Professions Cotle:
The Contractor'S License Law dOes nol apply to an owner of property who
builtlT or imOroves tnereon, anE who conVaclS 1or such projects with a con-
t�acto�(S) I¢ense putsuan[ lo tlte ConVaCtor'S Litense Law). 1 am aware that
proof of Iheir WorkeYs CompenSalion Insu�ance shoultl be Provitletl to me.
� I am exempt unaer Section B. b P. C, tor this reason
Date Owner
I hereby certity that I have raaa this applicatlon antl stata that the above
information is correcL 1 aqree to comply with all city antl coun[y ordinancez
antl state laws relat�'ng lo builtling tonstruction, antl nereby authorize reore-
sentalives oi thiy<�ly [o enjc��uqon abOve-mentiOnetl property for
inspectlon pu�pc
Signature _�
Oiivers' License
the
TVPE OF CONSTRUCTION Ll NEW IJ ADD IJl ALTERATION J2Q REPAIR
❑ CONVERSION ❑ DEMOLISH .❑ OTHER p.p, #
DESCRIPTION OF W RK/USEQ F BLD • A!� QFF 5kA(CF F
�'�Fl� �.�,'�R ��� i1'fdJ� 'i��d�30 V2 �/.ASSA SFill�� E Main Building:
TVPEOFPERMIT GRA�IN FOUND TION STRUCTURA� T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER
PROJECT DESCRIPTION 5a. Pr. oCCUvnrv C Right
K Left
CONSTRUCTION TVPE VALUATION $ $
ZONE GRADING CU. VDS. ACRES P�ng. ReL 5iE
Remarks: Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavamries
P—Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepUFact Blt. ICBO #
Heating System & Ducting
�6100,000 BTU 0100,000
Reinspection Fee I $15
CMF OB65-46, �ev. 30/84 WM1ite - Builtling; Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assesso�
FEES
$hOWers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee $ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
O utlets
Switches
Garbage Dispoul
Generaror 065 KW C
��3aii iii9iea
2one
Perking Req./Provided
ELECTRICAL
Tronsformer � 15-50 KW
❑ SO+KW
5KW
Meter ❑up to 100 amps�
Meier ❑over100amps
Sub Panel
Motors �0-1 HP O1'h - B
Inc.Solar �9-15 HP �i6-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compacror
IANICAL FEES Reinspection Fee I$15 luue Fee
Hootlor Typel ❑ DEVELOPMENTSERVICESRE�UIREMENTS:
Canopy Type II ❑ Zoning Approved By
Buildin9 Approved By
Refrigeration System
❑o-ioo,000sru ❑ioo,000
System Repair/Alteration
F ire Da mpers
Regis�ers
luue Fee � $ 3
28a50 TL
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUM� (R/V/p��FEES
BUILDING PERMIT $ � SMIP $ ��
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTFICAL $ GRADING 5
PLAN CHECK 50% S MICROFILM S�
MECHANICAL 5 TOTALFEE $
PLAN CHECK 25% $
CONSTRUCTION AND.PLANNING � POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector
1.xTemporary 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-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, � Undrgrnd., Tes[
.9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Strucwral Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 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 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. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil •
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil .
25. Roof Sheathing �1I , ��• 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. Final Factory Fireplace � �
38. Final Plumbing . •
39. Water Service-Final "
40. Gas Service-Final �
41. Solar pomestic-Final . ' ' �
" 42. Backflow Preventer :. �
43. Backflow Irrigation � :_ �
44. Landscape Irriqation System ' . .
45. Sound At[enuation � .
46. liandicap Regulations ' '
f
47. FINALSTRUCTURE&BUILDWG '� Gi , .
48. Special Requirements Completed �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co • ,
�:
51. CERTIFICATE OF OCCUPANCY
No. Daie .
�oT �8 - rR 3403
. 1.� �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 C08TA MEBA. CALIFORNIA
Fo� Applieanf fo Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRE6S �Z�FS MONTANA AVENUE
COSTA MESA. CALIFORNIA
ADDREss � PLACENTIA AVENUE
���y NEwPORT BEACH NE�L'
ARCHIT2GT TEL.
.W. KOLL I.ONSTRUCTION CO.�INC,
FEE RECEIVED
f:9 JAN 301�:,1
��'� FINANCE DEPT.
CITY OF COSiA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
nece�ar No. .� GpRWT'woj
BY
�2° I / ^/�-�/ t�
BUILDING FEB � 1369
ADORE55
COSTA MESA. CALIFORNIA
FIRE )�
20NE TYPE (l GROUP �/
APPROVED _1
1 PLACENT IA AVENUE ZONING
NEWPORT BEACH CALIFORNIA � e wo.oF useonrv
7 PlANB BUILDING
6tt95 No: Mi 6- 2z �GAL
oescrs�wnox
�-F7.5OXIOO IRREG INo__oFBID08. O �_ ,� n )
B6TBACK LINE raom C,p i REAR YARD 2� t FRONTR LINe BT.)
CENTER OP BTREET J
SIOE YAR� ILEFT �t IRIGHT "t R SIDE
DESCRIPTION OF WORK ___
BBZEDING 1597•5SF ROOMS " STORIE6 1
EXTERIOR WALL TUCCOIROOF OOD HAKES
COVERING COVERING
U6E�p F BUILDIp G AND WqRK TO BE PERFORMEp
JINGLE—tAMILY ttE51DENCE AND ATTAC
ARAGE PLAN �X� Z-
1 HEREBY ACKNOWLEDGE THAT I HAVE READ TMIB APPLIWTION
AND BTATE THAT THe A90VE I6 CORPECT AND AGREE TO CON-
PLY WIiX ALL CITY ORDINANCE6 AND 6TAT¢ LAW9 R80ULATINO
BUILDIN6 CONBT/Ry jCT/IQ) N. (\�\�. /^/
61GNATURE OF/ L{��//n � . .�K—// .. . �
■ AUTHORIZED AGENT
EVES
�
THE AMOUNT 6HOWN UNOeq VpLl1AT10N �9 FOR TX8
PURP08E OP EBTABLI9HING A PERMIT FEE ONLY.
VALUATION � i __
PERMIT FEE $ 'P a
//], p
S �� � " � PLAN CHECK $ /�"`��
F
y_ �
TOTAL FEE �
LL