HomeMy WebLinkAbout2290 FOUNTAIN WAY - Building Permits.T
��UILD3Nf; SAFETY DEPARTMENT ' TO �� O� C
P.-Qr. Boa No. 317 N•
Costa Mesa, California
Date�i.4tir /.? �1y�n " .
__ —T ' f
CTl'Y OF COSTA MESA � �
CERTIFICATE OF OCCUPANCY �
Buildin Permit No d `��
g � Electrical Permit No PWmbing Permit No.
use oe suilainq— �'"� – r � ,i; i �i ,? i'�` i; r, , L ; , ,..� /
..,_ „ .. �_ e.. oiW � .r_ . . � _ � i .,z
Th�e building located at �'� r�� ��D N �, .-7 y� f:0
Legal Descdption
(See reverse side for Metes and Bounds)
has been inspected and found to comply w./�ith the provisions of all City of Costa Mesa Ordin-
s applicable thereto for a Group rL—Occupancy.
�.,oUED TO:
� City Building Official
�atli F �� Ls �:`.'S � Al � Ie /�
, � (Owner af Building) By 'f .�...a..t_t_r, %1!(9 �.r+-c.f" ..
CC: ❑ Original—Owner ❑ lst copy—Gas Co. ❑ 2nd copy—Edison�Co. ❑ 3rd copy�ile
Form 208 SB P IM 1-� � /
\
r'TY OF COSTA ME�
CALIFORNIA �2626 P.O. BOX 1200
FROM THE OFFICE OF THE DIRECTOR OF BUILDIN6 SAFETY
Project Address 2290 Fou r�tain Wav tJest
Project Name
Oanexs Name
Qaners Address
CHC Manaaement Company
E
O+mers Telephone 774-646-2846
Pernut # 78753
Zjrpe Plbg.
City Use Chly
I rra,v�� v. �,.n V e'���. as 6waer, �,on�r �—Agerrt (strike out all
except one) do hereby attest that ertq�laynent of any person, or persons, is not
anticipated at the time of seeking the above-referenced pecmit. In the event that
any person, or persons, are e�loyed under the provisions of this permit, I shall
imnediately cause a valid Certificate of Worlanens Coatq�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my awn oost, ard to indemnify and hold harmless, the City,
its officers, agents and/or e�loyees, frcm and against, any and all liability,
damage, costs, losses, claims and expenses, haascever caused, resulting directly
or indirectly fran, or connected with the improveJnent under this permit.
I further state that I have read and fully imdezstand the implications and re-
sponsibilities of the above state�rents, and will canply with all provisions of the
Contractors State License Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
��'aV�� v. �UE�rr' P
Print Name
� � � �
_ . - -� - - --
CM F 0777-46
� i
♦�
CiTY oF coSra, MESA CONSTRUCTION PERMIT �
Project Addre55 2 O. Z�L Z� 7 Z ... �C•U/.�iAM YVh �S
i i ,� ���j
Applicant's MaiTling Addr�,{s � �Qi�p► ��� � �._�
Owner's Name .11r ���Q� � Phone
Address
Arch/Eng. License No.
Address �� �� q� p��� ��/�
Contractor's Namel.^_E_1��S ne -0T�p.t.las
AAdress (mailingll�'1�� —
City License No. �� ��+��.
LICENSED CONTRACTOR DECIA ATION
I h¢reEy alfirm [hat 1 am licensetl untler provi5iOn50t Char[e� 9(commenCing
with 5ection 7000) of DivlSion 3 of the Busine55 antl Prof¢sslOns Coae, antl
my license is in tul orc tl effect.
Licen Cla s � ic se ,
Date� � � Signature
WORKERS' COMPENSATION ECLARATION
I hereby atfirm that I nave a certilicate oi consent to self-insure or a certiticate
�f Workers' Compensation Insurance, or a certitietl copy thereof (Sectioo
800, Lab. C.) 1 /y�� (��,..
Policy No. �.1��� CompanyS��Fi'�U�'�
� C rti(ietl coPjY� }15'f�I¢tlowithrthehc[��y'�yyy i�ltlin�9 Divi on[� -/ ��.�.
Date�1L`� APPlicant�'�,[�.LL � ^�.S�L"'�L`�—/��
EXEMPTION FROM WORKERS' COI�PENSATION OECLARATION
(This section neetl not be completetl if tne permii is for one huntlretl (E100) or
less).
I certHy that in [he perto�man<e Of [h¢ wo�k fo� which tnis perm�t i5 is5uetl, I
snall not employ any person in any manner so az to become subject to the
Workers' Compensalion l2ws o( California. •
Date Si9nature
NOTICE: 11, after making this tleclaration, you shoultl become subject to lha
Wo�kers' Comp¢n5ation provisions of the Ldbo� Cotle, you must forthwith
mmply with suc� provisions or this permit snall be tleemetl revokea,
CONSTRUCTION LENDING AGENCV
I hereby aifirm that tnere is a construction Ientling agency tor the per(ormance
of the work tor whith [his Oermit i5•i51u¢tl (Section 3097 Civ. CJ
Lentler's Name
Lender's Atltlress
OWNER BUILDER DECIARATION
I h¢reby affirm [hat I am ¢xemp[ from the Cont�actor'S LIC¢nse Law to� [he
following reason (Section 7031.5 6usiness antl Professlonal Cotle: Any c7[y or
munty whlcn �equirCs a pe�mlt to ConSt�ucl, dlt¢r, Impfove, tlemolish or �¢Oair
any structure, prbr to its issuance, also requires Ihe apo�icani for such oermit
to fi�e a signetl ttatement that ho/sbe I5 licensetl pursuanl to the Provi5lons of
the Contractor'S LicenSe Law (Cbapter 9(commenung wltn Section �000) of
Division 3 of the Business antl Professioni Coae) or tha[ he/zha is exempt
therefrom antl the basis for the allegetl exemp[lon. Any violation o1 Sectlon
'031.5 by any applicant for a permit SubleCtS [na apPlicant to a civll -
�enalty of not more tnan five huneretl tlollars (5500).
❑ I, as owner of the pmperty or my employees witn wa9es as thelr sole
compensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Se<[ion 7044, Buslne55 and Professional Cotle: The Contractor'S
License Law tloez not a0�ty to an own¢r of a property wM10 builtl5 or Improves
thereon, antl who tloes sucn work himsclt/herseli or tnrougn hiz or her own
emploYoes, proWaeG that such improvements are no[ Intentletl or oiferetl tor
sale. If, howeveq the builGing cr impwvement i5 Soltl within One yea� of com-
pletion, tne owner wiil have the burtlen ot proving he/sne ala not bulltl or im-
�rove for the purpose oi sale).
I. as ownm of'Ihe pro0erfy, am exclusively coM�acting with Ilcen58tl Con-
traclorsto cons[ruc[the project (SectiOn 7044, 6u5ine55 antl PrOte55iOn5 GOtle:
The Contractor's License Law tloes not apply to an owner o( property who
builtls or improves Nereon, antl wM10 conVacts for such projects with a con-
tractor(s1 littnse pursuant�to tne Contractor'z License Law). 1 am aware tnat
proot of lheir WOrker'S COmpensation in5urance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. Por this reason
Date Owner
1 hereby certi/y ihat 1 have reatl tnis application antl state that the above
information is correcL I agree to comply with all city ana county ortlinancez
antl s[ate laws relating to builtling construction, antl hereby au[borize repre-
senta[ives of tM1is city to enter UpOn [Ite dbov¢�mentlOneG Oroperty fo�
inspectian purposes.
Signature Date
Drivers' License or 55 �
plicant to fill in all spaces except those within heavy GorGer lines ana sign all avoroo��ate tleclarations.
PEqMIT �n� S TRACT NO. LOT NO. UNIT NO.
�J 7
1 TVPE OFCONSTRUCTION NEW AD� ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER A p.�
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAI ❑ VLUMBING ❑ MECHANICAL A Reaf
❑ OTHER C Rlght
PROJECT DESCRIPTION Sa. FT. oCCUaANCv K
CONSTRUCTIONTVPE VALUATIONS 5 Left
20�vE GRADING CV. VDS. ACRES Ping. Ref. # �
Remafks: PIdOOIfI(] NOt¢5:
Bar Sink
Backflow Preventer
6ackflow Irrigation
eathtubs �
Clarifiers
Dishwasher
=1oor Orains
=1oor Sinks
.ias Service �I1LIC15
Interceptors
Kitchen Sink
Lavarories
P—Trep
Roof OrainS
i
Reinspection� Foe $15
eoiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blc ICBO #
Heating Sysrem & Ducting
❑ ai oo,000 sTu � i oo,000
Reinspection Fee I $15
CMF 0865-46, rev. 4/84 White - Builtlinq; Canary - Appliwnt: Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
$ewer Cap
Sewer Connectian
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa.
Urinal
Water Closet
Water Heater
Water Service Qe,t
Issue Fee
Hoodor Typel ❑
Canopy Typa I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
laue Fee
$ 3
$ 3
Automatic Washer
Constructior Pole Sub._�
Cooking Unit .
Dishwasher .
Dryers ❑Gas ❑Eleccric
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
Switche5
Garbage Disposal
Generaror �0-5 KW
1222 10/31/B4
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL '
Transformer ❑ 15-50 KW '
❑ 50+KW
Meter ❑up ro 100 amp5
Meter ❑over 100 amps
Sub Panel
MotorsO0.1 HP �iX-8
Inc.Solar �9-15 HP �76-15+
Microwave
Pole Light
Range
Standing Sections
5-15 KW Trash Compactor
5.00 TL
FEES
I Reinspection Fee I$15 ' ' Issue Fee I S 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By //{� � � Date
Application Issued By ��`� Dat �� —.3�—
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PEfiM1T
PLUMBING , $ �SOV ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. 3
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ .Sod
PLAN CHECK 25% $
Z
O
N
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G
R
E
Q
M
T
S.
CONSTRUCTION AND PLANNING POOL � . �A
APPROVALS Permit #' Date _ Inspector qppROVALS Permit # Date Inspector
7. 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 Plumbing & Pressure Test
;'
6. Electrical UFER Grnd.�' •� 57. APPROVAL TO COVER-GUNITE
r -
7. Footings � � �, '_ 58. Electrical Conduit�Undrgrnd.
8. Foundation � � - 59. Gas Pipe, � Undrgrnd., Test
„ .
� 9. Water Pipe-Undrgrnd,. . � 60. Backwash Lines, P-7rap, � Undrgrnd.
10. Structural Floor System . ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � � 62. Backwash & Receptor-Final
• 12. Sewer Cap .i i. -= 63. Heater & Vent-Final
13. 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 $tructure 70. Underground Hydro
22. Ducts, Vehtilating 71 . Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical
27. Frame ancl 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 Fac�ory Fireplace ' �
38. Final Plumbing ' /��y(dY L�p
39. Water Service-Final � ��Ib��r..� Lq,7 .
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
57. CERTIFICATE OF OCCUPANCY
No. Date
ya .-
.. ; c �f.- l���s`�:i7
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 31] COSTA MESA.CALIFORNIA
��
fOR APPI/CANT TO f/C[ /N COMPLETF[Y
TYPE OR PRIN � C!� /�,y�
BUILDING� � /
ADORESS �
COSTA MESA. CALIFORNIA
�MAIL
ARCHITECT LIC.
OR F^�GINEER W_ .7ordan NO�:-
ADDRE55 771 W 19th S
LEW� I LOT � I
OESCliIPT10N NO. � f
A.P. NO.
NO. OF BLDGS.
SETBACK LiNE FFOM
CENTER OF StflEET S.O REAR YA(
SIDE YARD ILEFf S.O IRIGHT
DESCRIPTION OF WORK
BUILDING NO.OF
srze 32 x 55 eooms
EXTERIOR W�LL IROOF
GOVERING tnt��n COVERING
I HEREBY r1CKNOWLEDGE THAT 1 HAVE READ THIS APPLICRTION
RNU STATE THAT THE ABOVE IS COFRECT ANO AGFEE TO COM-
PLY WITH RLL QTY OPOINqNCES ANO STATE LqWS REGULqTING
�BWLOING CONSTFUCTION. ^ .
1
SIGNATURE OF
PERMITTEE
AUTHORIZED AGENT_
,, io i��-5`r
���,�',i:CE DE? . \� �.�
; <<�.
. `I n(l:.0 '1�•CC.
APPLICATION FOR PERMIT
� � ,A� BUILDING
y V�{.Li'_
FOR Off/Cf USf ONLY
I RECEIPT NO. �n R'MI�T1Nb.
I� l!' ll
RECEIVEO BY OA E REC IVEO DATE ISSUED
A� �O��0-59 i�-iG-s
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
FIRE
ZONE TYPE GROUP
BYPROVED t ATE/D�'�'�
ZONING
20N / NO.OF �15E OF NEW /// �pI
�_ // PLANS � I BUILOING �* f�AAI
�r /r
BPPROVED j,./ L II DATE �s����
W f�7{
VARDS RL'�'/ EVES '
REqU1REO ALLOWED
(CENTER LINE ST.rJ^
FRONT y/j.(J O FT. IN.
R. SIOE �.S��Q � FT. IN.
L SIDE .S � U U �. � iN.
�
3a�
THE NMOUNT 9HOWN UNOER VALUNTION IS FOH TXE
PUFPOSE OF ESTABLISHING q PERMIT FEE ONLY.
VALUATION ��—_
PERMIT FEE $
S��/A I�� PLAN CHECK S b� %' •}
/
TOTAL FEE 5 ���
�_ t
: ~ 10538
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPC/CANT TO f/LC /N COMP[ETELY
TYPE OR PRINT
BUILDING � � / ' �
ADDRESS
COSTA MESA, CALIFORNIA
nia.
� LEGRL � LOT
SIZE
OF LOT 65 X
USE OF
EXISTING BLDG.
SETBACK LINE FFOM
N'°. r.-
NO. OF aLOG6.
DESCRIPTION OF WORK
I X II ALTERATION I II ADOITION
SU�I�LDING ZZ X 4O
EXTERIOR WALL
COVERING WQ�
USE OF BUILDING AND
NO. OF
ROOMS STOR
ROOF
COVERING }�llLIL
2K TO BE PERFORMED
_j
,�. ��►���e'1��'
. jO ���� � S�t v��
FINAP;CE DEPT.
n��e nr �p�rn �6�nf
APPLICATION � FOR -PERMIT
BUILDING
fOR OFF/CE USE ONLY
BUILDING
ADDRE55
COSTA MESA. CALIFORNIA
APPROVED �
BY
ZO INO.OF
� PLANS
BPPROVE /� J
?
YARDS
REQUIRED
(CENTER LINE ST.1
FRONT ��f^-
I65UED
IING
U9E OF NEW �
BVILDING /'^ \� (,1
L �1.1
DATE 1_!,S ",
ALLOWED
FT. IN.
�. C. ��.
L.SIDE � FT.
�
REAR K��f FT.
IIC11
1 HEPEBY ACKNOWLEUGE TNAT 1 MFVE FENO THIS RPPLIC�TION 7HE AMOUNT SHOWN IINDEF VALURTION 18 FOq THE
AND STRTE THAT THE ABOVE IS CORNECT pG AGREE TO COM� pUFPOBE OF ESTRBLISHING A PEFMIT FEE ONLY.
PLY WITH ALL CITY ONOINRHCES ANO LRWS REGULATING
e�i�oinc corvsinuciiorv. VALUATION
SIGNATURE OF PERMIT FEE $ /O^
PERMITTEE S ��UG�� `
p� PLAN CHECK $ 'J '��
AUTHORIZEOAG TOTAL FEE 5 �`�
'- ' • .j� nFC ?6-72r.risct�0 565:` :,�.': �zZ3.�a
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 120Q COSTA MESA, CALIFORNIA 92626 /
PP I ATION FOR BUILDING PERMIT .
For Applicant to Fill in Completely qE i e ev ATE fl CEIVED OATE ISSUFD
BUILDING / u �n
ADOPESS Z (p � � �
OWNEP J� S /. A.P.NO.//��� � P NO.
ADORESS �Z ADiDRfE 5 F�j�/II �.��
Z . � • r� �—y�
W W TEL. � TRACT �J�JJ(/ LOT BIOCK
a U CITV �(iy,�j„' �� NO.
2
Z Q CONSTRUCTION W
O N LENDER
am
J � BRANCH �
J � OWNER S � S
� w ADDiiESS / VALUE
ARCHITECT TEL. 5 PSI�i(�YJCe. $ 4�
- OR ENGINEER N
U Q FIRE
w Q AODRESS ZONE YPE GROUP
a W ' APPROVE !J _^/
W Z CONTRACTOR �jL/jJ/s' C f BV DATE (i ZG /
J Q
m Z
J � ADDRESS 3�� ^Lf/_ � ' �//t-tT fi�4
W W ZONE��% NO.OF USE OF NEW Y
Z�LO/1 �f,4c NOL ^��O 5.��. PLqfS BUILDING e /�
= CITV
w � STATE CITY �'ARDS APPROVEO �'ARDS APPROVED
jO �IC.NO. � ��c.No. 6s'6 MAINBUILDING ACCESSOFVBUILDING
SIZE NO.OF BLOGS. (FROM C/L STPEET)
OF lOT NOW ON LOT RONT FT. FT.
USE OF
EXI5TING BLDG. S F ,
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT.
U EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
J USE OF BUIIDING ANO WORK TO BE PERFORMED OLSTANCE BET. BET. MAIN &
�' MAIN eLDGS. ACCE�, BLOGS.
` , VAR.# . DATE
O � C.U.P.qp .qPPROVED
r APPROV
N f
Z
O
V1 hereby acknawleqga that I have reatl thiz application antl state
� that the above informetian is cOrrect antl agree to comply with s
� afl laws re8ulatinB buildin8 construccion, and I shall not employ
F„ any permn in violation of the workman's compensetion laws of
N
the Stete ot Calitornia, m
Z �
I hereby tertify that I am prOperly IlcenseA as a tontractor under SQ. FT. o
the S[ate of Californie Businass antl Professions COGe, DIvlslon 3, TNE AMOUN7 SHOWN UNDER V ATION�IS FOR �
Chapter 9, and ffiat suc� licenses are in full force antl effect, or 1 THE PURPpSE OF ESTABLISHING A PER FEE ONLV: Q
exempt from tne provisions ot the $tate of CelifOrnla Bus(n0i5 „�
VALUATION m
entl Profassions Code, Divisi 3, Chapter 9. PERMR FEE 5 ��
Sipnatura ot j� , �� � y m
Permlttee �Tr ��� $/LS UO PL4N CHECK $ E
`a
Authorizatl Aqent /� LL
TOTAL FEE 5 r'�