HomeMy WebLinkAbout2282 FOUNTAIN WAY - Building PermitsAVC�icant to fill in all s0aces except thosa wil�in heavY Oortler Iinez anU si9n all aOCropriate tleclaralions.
CITY OF COSTA MESA CONSTR UCTION PERMIT I PERMIT NO. ��, � TRACT N0. LOT NO. UNIT NO.
Project Address s ' 1$ u G' L w f
Applicant's Mailing Address � :�
Owner's Name � ���� Phone�Sn-��'.�o
Address
Arch/Eng. License No.
Address ` _ `,.,-�, - y��� �-��� �
Contractor's Nama k���.pJs.a��'�.�n44��Ph�o(�ne� c.t1.Y�'Jil�S
Address (mailing) �B�c�+�cyp� , ���� l� t,� �J e�j
City License No. -uL,»�� p
LICENSED CONTRACTOR DECLARATION ' �
I hereby a�firm that I am licensetl untle� provisiOns o( Cha�ter 9(commencing
witn section ]000) oi Division 3 of [he Bu5ine55 dntl Professions Cotle, antl
my license is in !W (orce a efiect.
Licen Cla - 'c
Date U ' "" Si9nature
WORKERS' COMPENSATION OECLARATION
�ereby aifirm that I have a certificate ot consent to self-insure or a certificate
Workers'. Compensation Insurance, or a certifi¢tl coOY thereof (Section
�00, Lab. CJ ,^
Policy No. �y ��� � Company ���� n� •
Certitietl copy is hereby fvrnisnetl. � -
e� i ietl co`p is fletl with th¢ tity 1 in9 Divisiqq � ne
Date— �- APPlicant _ 11 /L/ L� �� � .�1 �
EXEMVTION FROM WORKERS' COM NSATION DECLARATION��
(Tbis section neetl not be compleletl it the permit i5 for one huntlred (5100) or
less).
I certiry Ihat in the Oerformance of [ne work fot which thi5 perm�t is Issuetl, I
Shall n0[ employ any person in any manner So a5 to betOme SubjeGt to the
Workers' Compensation Laws of Califomia.'
Date Signature
NOTICE: If, a/ter making this tleclaration, you snoula become subject to the
Workers' Compensation provisions of tne Labor CoOe, y0u must (orthwith
comply with Suc� P�ovisions or thi5 pe�mit Shall be tleemetl �evoketl.
CONSTRUCTION�LENDING AGENCV
I hereby aitirm that Nere Is a cons(ruciion lentling agenty for the performance
of th0 wo�k fa� which this pe�mit is i55uetl ($eGtlOn 3097 Civ. C.)
len0er'S Name �
Lentler'S Atltlress
OWNER BUILDER OECLARATION
I hereby a�(irm tnat I am exempt irom thu Contractor's License Law for the
following reason (Sectlon ]031.5 Business antl Professional Cotle: Any city or
cOunty which reqUires a p¢rmit to con5(rutt, alt2�, ITProve, Aemoli5h or rlPai�
any structure, prior lo its issuance, also requires the applitant (or such pe�mit
to Iile a sign9tl Slalemenl that he/She is IlcCnsetl pU�suant to th¢ provlsions ot
the Contra<tor's Ucense Law (Cnapter 9(commencin9 with Sectlon 7000) of
^'vision 3 of t�e BuSineSS an0 Protessions COGe) or Ihal he/She Ii exempt
wfrom antl the basis for t�e allegetl exemption. Any violation ol Section
.�.5 by any ap011cant fo� a pe�miL SubjeG[s [ne appllcant to a civil
�Ity of not more lhan five huntlratl tlollars (5500).
❑ I, as owner of [he property or my em0loyee5 with wages as their Sole
compensation, will tlo the work, antl the SVucture Is�not intentletl or ofleretl
for sale (Soction ]044, Buslness antl Professlonal Cotle: The Contractor's
License t2w Coes nol apply to an owner ot a properry wno ovilds or imp.oves
thereon, antl who does such work nimsel(/nerself or through nls or her own
employ¢es, prOvitled [ha� such imOrov¢m¢n[5 are not Inte�tled or ofteretl fo�
Sale. If, howeve�, the builtling cr imptovement is soltl withln one yea� oi com-
pletlon, tne owner will have the burtlen of proving he/she tlia not builtl or im-
prova lor the purpose of sale). .
❑ I, a5 owner of [he OroDerty, am exclusively ContraGting with IlcenSetl mn-
traCtorz to cons[ruct the project ($eclion ]044, Business antl PrOfessions Cotle:
The ConVactor's License Law tloes not apply to an owner ot property who
builtls or Improves thereon, antl who wntracts for suc� projects wifh a con-
tractor(sl Ocense pursuant�to the�Contractor's Llcense Law). I am aware tM1at
proof of thei� WO/ke�'S Compensalion insurance zhOultl be O�ovidetl t0 me.
❑ I am exempt untler Section . 8. & P. C. tor this reason
Date Owner
I hereby certify that 1 have reatl this application antl state tnat the a�ove
information is mrrect. I agree to compty with all city antl caunty ortlinances
antl state laws relating to builtling construction, antl hereby authorize repre-
sentatives ot t is city to en[er on t e above-mentionetl Oroperry t
inspeCtlon p e5.
Siqnature Oat
Orivers' License or 55 � —
TVPE OF CONSTRUCTION LJ NEW LJ ADD LJ A�TERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WOFiK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa.F7. OCGUaarvCv
C ON STRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES
Remarks:
3ar Sink
3ackflow Preventer �
3ackflow Irrigation
3athtu6s
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks .
GasService Outlets
Intercep[ors
Kitchen Sink �
Lavatories
P-Trap
Roof Orains -
Reinspection Fee
Showers �
- Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater
/ Water Service
$75
8oiler
Duct - Under Ground '
Duct � Strucmral
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ a i oo,oao aTu � i oo,000
Reinspectio� Fee � $15
CMF 0865-46, rev. 4/84 White - Builtling; Canary - Applitant; Pink - Atcounting; Goltlenrotl - ASsessor
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Isue Fee
FEES
$ 3
FEES
$ 3
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
$
Ping. Ref. 4p
Planning Notes:
Automatic Washer .�
Construction Pole Sub.
Caoking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
SwiLcheS
Garbage Disposal
Generator �0-5 KW �
Fee
9133 10/01/B4
Zone
Accessory Building:
Parking Req./Provided
TELECTRICAL
� Transformer ❑ 15-50 KW
❑ 50+KW
Merer LJup ro 100amps
Meter ❑over100amps
Sub Panel
Motors �0.1 HP 01'h - 8
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range '
Standing Sections
5-15 KW Trash Compacmr
§75 Issue Fee
6.00 TL
FEES
S 3
Z
O
N
I
N
G
R.
E
Q
M
T
S.
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By Date
Building Approvad By Date
Appliwtion Issuad By � Date ��
SUMMARV OF FEES
BUI�DING PERMIT $ SMIP $
PLAN CHECK S PERMIT
PLUMBING $ S•L`O �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. S
EIECTRICAL § GRADING � S
PLAN CHECK 50% S MICROFI�M S
MECHANICAL S TOTALFEE S S•On
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POO '�pA
APPROVALS Permit # Date Inspector p�ppROVALS Pe/mit # � Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
3. Electrical Conduit Utiliry-Undrgmd. _ 54. Forms
4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. . 57. APPROVALTO COVER-GUNITE
7. FoOtings � 58. Electrical Conduit-Undrgrnd.
S. 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
i3. Roof Drains 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final
i 6. .Rough Eleciric 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 Heaiing & 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.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-6ar Ceiling (Structuraq & 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 �d7L� (�0 �
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. Handirap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison r
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
1
-. �: �--� � 1€�.��.�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BO% 31] COSTA MESA. CALIFORNIA
e����
FOR APPI/CANT TO F/[L /N COMP[ETf,L,/Y,,
TYPE OR PRINT �UJ^
� BUILDING / �
ADDRESS $
COSTA MESA. CALIFORNIA
AR�:HITECT LIG.
OR -'�INEER W_ Jordan NO.
� LEGNL
NO.OF oLOGB.
� USE OF
EXiSTING BLDG.
SETBRCK LINE FflOM
DESCRIPTION OF WORK
I X IIALTERATIONI IIA�DITL
BUILDING NO.OF
SIZE 32 X SS ROOMS �
E%TERIOR WA�L ROOF
COVERING JCllCCO COVERING
USE OF BUILDING AND WORK TO BE F
I HEREBY ACKNOWLEDGE THAT 1 HAVE NE�D TNIB APPIICATION
•ND STAT6 THAT THE A90VE IS CONRECT AND AGHEE TO COM�
PLV WITH �LL CITY OROINANCE9 AND ST TE L.�W9 REGULATING
BUILDING CONSTRUCTION.
SIGNATURE OF Q ^�A
PERMITfEE —
� AUTHORIZED
.. . ".l,(1—\ �' —��\
-�-.�,i:i��+r [iFn�. \
. ii��'u, L �� �
„!' � ' ' _ ... �..
APPLICATION FOR PERMIT
�� BUILDING
�
' foR officE usE oNcy
I ftECEIPI' NO. ,j� �QE;ET{y1�0.
�� V �
flECEIVED BT � D�TH RELEIVED „� DATE IBSUED
COSTA MESA. CALIFORNIA
APPROVED
ZON$� -1 1I I P ANS � I BUELOINGEW
lA �{
APPROVED l4 L 11
BV I // DATE I
�.� d FT. IN.
i -O U Fr. ir�.
� a a FT. IN.
�
THE AMOUNT BHOWN UNOER VALUATION 18 FON TNE
PUFPOSE OF E9TABL�BHING A PERMIT FEE ONLY.
VALUATION '�w
/J// � PERMIT FEE S yi� �`
$+�' ' % /�/ PLAN CHECK $ �y ^
TOTAL FEE 5 �� �
. .' _ ��� S�'i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 319 GOSTA MESA. CALIFORNIA �
FOR APPL/CANT TO f/CL /N COM�PLETECy
TYPE OR PRINT . '
COSTA MESA, CALIFORNIA
MAIL
ADDRE55
CARCH�TECT LIC.
'LEGAL I LOT
DESCRIPTION NO. S
�srze 65 X 135 .1�V I�o. ov e�o�s.
OF LOT NOW ON LOT
SETBqCK LINE FROM �O•��
CENTEF OF 6TREET REAR VARD
SIDE VARD ILEFT IRIGHT
DESGRIPTION OF WORK
NE' IX IIALTERATION I II�+DDITION
REPAIR I IIMOVING I II�EMOLISH
RIOR WALL ROOF
:RING WOOd COVERING built L
OF BUILDING AND WORK TO BE PERFORME�
I HEREBY ACKNOWLEOGE TMAT I MAVE FEAD TM13 APPLICATION
RNO STATE TNAT THE A90VE IS COR CT AN� AGREE TO COM-
PLY WITH ALL QTY OF�INANCES AND TATE LqWS REGUTATING
BIIIL�ING CONSTPUCTION. �� I
SIGNATURE OF
f%
PERMITTEE� _ , �A
AUTHORIZED
_�
�i� b��Ol�di�@a1;��
�o— 1 f.—Sr(
FINANCE DEPT. � ��
r.�Tv (1F f,�STA �9ESA
APPLICATION FOR PERMIT
BUILDING
FOR Off/CE USE ONLY
I RECEIPT NO. I
1'�J�
PECEryE Y I OATE�OC `V'�I . ./D�I
G ��
FIRE
ZONE
COSTA MESA. CALIFORNIA
ZONING
NO. OF I� I,USE OF NEW
PLANS L BUILDING �
vnRos
REpUIRED
(CENTER LINE ST.)
R.SIDE
L.SIDE
�
IG�
THE /MOUNT SNOWN UNOER VqLUAT10N IS FOR THE
PIIRPOSE OF ESTABlISHING A PERMIT FEE ON�Y.
VALUATION
PERMIT FEE $ / Q .—
$"� �`=� � PLAN CHECK $ S��
/
TOTAL FEE $ �`r'