HomeMy WebLinkAbout2276 FOUNTAIN WAY - Building PermitsMV/
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Aop�icant to fill in all spaces except thosa within heavy bortler Ilnes antl sign all aoPropriate Oeclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address 2� � �OU� T� �il \�� E.' r
9 i fiGn1 �
ApplicanYs Mailin9 ddress - ^! � . '//
Owner's Name ��l^ -S Phone t- �d
Address
Arch/Eng. License No.
Address
Contractor's Nam LG �� e -% � hone q�%6—_,�7��F
Address (mailingl / U�/� ��AC � ) i /�%i .
City License No. �%�% $ 3�+�
LICENSEO CONTRACTOR DECLARATION
I bereby aflirm Ihat I am licensetl untler provi5ion5 Of Cbarter 9(<ommencing
wiin section 7000) of Divislon 3 of the Business antl Professions Cotlu, antl
my license is In t W I Arc �n� eftect. G3/�. S/�
License Class [T �
Date�' ��' �j'�'� 99nature _ r � �
WORKERS' COMPENSATION DECLAHATION
hereby affirm that I have a<ertiticate of mnsent to self-insure or a certlflcate
.f Workers' Compensation Insurance, or a-certifietl copY thereof (Sectlon
3800, Lab. ac) � 11 /�
PolicY No. I� �'�� ComPanY ��'�"�'l (1 (J�g« o-1 L'�"�I
eCe/ti/ietl copy is he�eby furnishetl. I
Certl i tl c9 yp �5 filetl witM1 the city B Itlinq� Divi 'on.
Date�{_b�Applicant �O`P�e.4=�_l-�q��
EXEMPTION kRC�M WORKERS' COMPENSHTION OECLARATION
(This seclion neetl not be <ompletetl if the permit is tor one huntlretl (8100) or
less)
I ce�tily that In the perfOrmdnce of the work for�which Nis pe�m�t is i55uetl, I
snall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Califomia.
Date Si9na[ure
NOTICE: H, after making t�is tleclaratlon, you shoultl become subject to the
Workers' Compensatlon Orovisions of the Labor Cotle, you must forthwith
comply with sucn PrOvl5ion5 0� thi5 permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I nereby affirm ihal there is a conStruCtiOn lentling agency-fOr tM1e performanGe
of tho work for wnich this permit is issuetl (Sec[ion 3097 Clv. C,)
L.enEer's Name
Lentler's Atltlres5 ,
OWNER BUILDER DECLARATION�
I hereby affirm that I am exempt from the ContractoCs �icense Law for tna
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
county wnlch r¢qulres a permlt to wnstruct, alter, improve, Gemolish or repair
any structura, prior to its issuance, also requires the aoP�icant for such permit
t0 file a SiqnCd slatement that he/sM1e is litensetl pursuan[ [o the provisiOns of
the Con[ractor's License Lnw (Chapter 9_(commencing witM1 Section 7000) ot
Division 3 of the Busine55 antl ProfeSsionS CoGe) or tha[ he/she i5 axempt
hereftom antl th¢ basi5 for the allegetl exemption. Any vlolation of $ectiOn
/031.5 by any applicant for a Permlt Subje[ts tne 'appliGanl ro d civil
'�endlty ot not mo[e than five huntlretl tlollars ($500j.
LJ I, a5 Owner of Ihe prOp¢rty or my employee5 with wage5 as thelr sol0
comDensatlon, will ao the work, antl the structure is not Intentletl or otieretl
i0! Sd�C ($CCllOfl %�44. BUSIpf55 dlld PIOiE5510Od1 Cotle: The COlfIldCIOf�S
License Law tloes not apply to an owner of a property who builtls or improves
Ihereon, antl who tloes such work hlmself/herself or through his or her own
i emplOy¢es, provitletl tnal such_ improvemen[s are not in[entletl or otte�etl for
� Shce. If, hOwOve�, lhe bulltling Gr improvement is SOItl withln ona year of com-
� pletion, the owner will nave the burtlen ot provin9 he/she tlid nbt bulltl or im-
�rove for the purpose ot sale).
I, as owner of the property, am exclusively contracting with licensetl con-
[ractors to construcl Ihe projec[ (Section 7044, Business antl Professions Cotle:
The ContractorY �Icense Law does not apply io an owner ai proper[y who
builds or Imoroves tnereon, antl who conVacts for such pmjects with a mn-
tractor(5) Ilcense pursuanl�to the GontractOr's Litense Law). I am aware that
proof of Ih¢i� Worker'S Compensation insurance shoultl be p/ovitletl lo me.
❑ I am exem0� untler 5¢ction B. b P. C. lor thls reason
Date Owner
I hereby cerlify Ihal I nave rea�
information is correct. I agree [O
antl 5tate laws relatin9 �o builtlir
sen[atives of lhi5 clty to en[e
Ip50eC[IOO �POSCS�� / ��
5' t �I.�n.�l: v� i -2.
tate Ina[ tne above
tl COUOty OltlIOdOCCS
•by authorize repre-
lonetl pto0erty fOr
G /�� ��
Date -��
_ {'t�F�3�1 I _ I I -_ ._.
TYPE OFCONSTRUCTION NEW %1DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF B�DG.
TVPE OF PERMIT LJ GRADING LJ FOVNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTftICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANCV—
CONSTRUCTION TVPE VAWATION 5
ZONE � GRADINGCV.VDS. ACRES—
qema�ks:
Bar Sink
Backflow Preventer
Backflow Irrigation
' Bathtuhs
Clarifiers
Dishvrasher �.
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
SOlar Piping
Solar Tank
Swimming Pool w/Spa
Urinel
Water Closet
Water Heater
Water Service
Reinspectian Fee � $15 I � Issue Fea I $ 3
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
igna ur¢ -
D' L' S 55 � � I I Aeinspection Fee I $15
CMF 0865-46, rev.4/04 White - Builtlinq; Canary - Applicant; Pink - Accountinq; Goltlenrotl -Assessor
Hoodor Typel ❑
Canopy Typell ❑
Refrigeration System
OO-t00,0008TU ❑100,000
System Repair/Alteration
luue Fee � $ 3
A.P. �f`-
S Main 8uilding:
E
T Front
B Rear
A
C Right
K �eft
S
Ping. Ref. #
Planning Notes:
Auromatic Washe�
Construction Pole Sub.
Cooking Unit
Dishwasher
DryerS OGas ❑Electr
Fam
F.A.U.
Fixtures -
Device Boxes
OuUets
Switches
Garbage Disposal
Generamr �0-5 KW ❑
6571 8/17/84
Zone
Accessory Building:
Parking.Req./Provided
ELECTHICAL
Transformer ❑ 15-50KW
❑ 50+KW
5�15 KW
Meter LJup to 100 amps
Meter ❑overt00amps
Sub Panel
MotOrs OO-1 HP O7 h- 8
Inc. Solar �9-75 HP 016-15+
Microwave �
Pole �i9ht
Range
Sign
Standing Sections
Trash Compactor
500� TL
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S.
Reinspeaion Fee I S75 luue Fee $ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
8uilding Approved By Date
Application laued By �1 '� Date___���
SUMMAfiV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING 5 �'r1 �OO ISSUANCE $
PLAN CHECK 25% $� ENERGV P.C. $
ELECTRICAL $ GRA�ING $
PLAN CHECK 50% $ MICROFI�M $
MECHANICAL $ TOTALFEE $ � ��O
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POO� _�SPA
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. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbin9 & Pressure Test
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe. � 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 - Final
14. Rough Plumbing 65. Electrical-Final
15. Fough Electrical�Conduii 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. -Fough 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.StorageTank OGas ❑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. Insula[ion 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: � µf�•�,� 2;[��ASa'. l2� , L(�O
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �� �y ��
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 Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date