HomeMy WebLinkAbout421 GLOUCESTER DR - Building PermitsApplicant to fill in all spaees exceot tnose within heavy EorOer lines anE sign ali aDorovriate tleclarations.
CITY OF COSTA �jS CO�ST�U�T�N P�RMI�� °F"""'r nin � Tancr Nn. � �oT Nn. . �����T nin
� Project Address "-' �1WCPS 1"� S Sd� �z
Applicant's Mailing Address -
Owner's Name . �lP �YC1S �0 Phone ��4-�-��
Address P Q Rnx F�)f,4 laguna Hills Ca 92654
Arch/Eng. � License No.
' Address
Contracmr'sName-Vanr�qR 4cs� Rm_.� fr,m�_Tnr�phone 71d�efi�F+-421
Address (mailing) ��n �+ 1MF� !` c+a Ivhca a '�'L�
F
Ciry License No. -�N1F���
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untle� provisions of Charter 9(mmmencing
witn section ]000) of Divislon 3 of the Business antl 7rofessions Cotle, antl
my Iicense is in tull iprcp�ntl efiect. �c��
License Class �' J7 on l.i e se No. ��09
Date �-�9wnure
WORKERS'COMPENSATION DECLARATION
'^ereby af/irm that I have a certificate of consent to self-insure or a certiticate
'JJorkers' Compensation Insurance, or a certi�ietl copy thereof (Sectlon
i0, Lab. CJ �61603025341�„ Libert Nlttual Insurance
voncy No. pany y
BCertifietl copy Is nereby tumishetl.
Certifietl copy is 4ieriy+� tne city Buii�a��'e"'����'lSsoc Rfq Inc
Date � �� plicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if the permit is for one huntlretl ($100) o�
iess).
1 certity that in the performance of tM1e wo�k Por which this Oe�m�t is i55uetl, I
snail not employ any person in any manner so as to become subje<i to the
WO�k¢�5' COfnp¢n5atio� 12W5 Oi Cd�l}OIOId.
Date Si9nature
NOTICE: H, aiter making [his tleclaiation, you Shoultl becoma SubjeGt t0 th2
Workers' Compensation provisions ot the Labor Code, you muzt forthwith
. comply with such orovisions or tnis permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
II hereby affirm that there is a mnstruction lentlinq agency for the performance
of the work for which thi5 permit i5 i55uetl (SecHon 3097 Civ. CJ
Lentler's Name
� Lentler2 Atltlress —
OWNER BUILDEft DECLAHATION
^ �I hereby affirm Lhat I am exempt from the Contracror's License Law for the
`' following reason (5ection ]03L5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repalr
any structure, prior to its issuance, also requires the applicant tor such permit
to (ile a signetl statement that he/she is licensed pursuant to the provlsions ot
the Contractor's License Law (Chapter 9(commencing witn Section 7000) of
^'vision 3 of the Business antl Professions Cotle) or that ne/she is ezempt
'efrom antl the basis tor the allegeC exemption. Any violation of Section
1.5 by any applicant for a pe�mit Subjects the appliCant [o a civil
ealty of not more tnan five huntlretl tlollars ($500).
' � 1, as owner ot the property or my employees with wa9es as their sole
cpmpensalion, will tlo tM1e work, antl the structure i5 not intentletl o��offeretl
f.h,r sale (Section 7044, Business and Professional Cotle: The Contractor's
t�rense Law tloes not app1Y to an owner of a propertY who builtls or improves
t�ereon, antl who tloes such work himself/nerself or through his or her own
. emp�oyees, provitletl that such improvements are not intendetl or offeretl Por
sale. If, however, the builtling or improvement is soltl wiihin one year oi tom-
plelion, the owner will have the burtlen ot provin9 he/she tlld not builtl or im-
prove torthe purpose ofsale).
❑ I, as owner of the proPerty, am exclusively contracting with Ilcensetl con-
tractorsto construct the project (Section 7044, Business antl Professions Cotle:
The ContractorY License Law does not appty to an owner ot property who
buiitls or improves thereon. antl who'contracts Tor such oroiects with a con-
tractor(s1 license pursuan[ to me Contractors License Law). I am aware that
proof of their Wo�ker's Compensation insurance shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for ihis reason
Date Owner
I hereby certify that I have rea�
information is mrrect. I agree to
antl state laws relating to builtiv
upon
+Slgnature L�Y.
Orivers' License or 55 � _
��
B 3�131 c� i I I
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
, DESCRIPTION OF.WORK/USE OF BLDG.
TVPEOFPEflM1T GRADING FOUNDATION STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 54. FT. oCCUVANCv,_R-�—
CON STRUCTION TVPE VALUATION $ �' �a'3_�_
ZONE GRAOINGCU.VDS. ACRES
Remarks:
Sink
I rrigation
Drinking Fountains
Floor Drains
Floor Sinks
GasService Ouilets
Interceptors _�
Kitchen Sink
lavatories
P—Trap
Roof Drains
Reinspection Fee
PLUMBING
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Coliectors ,
SOlar Piping
Solar Tank
Water rvice �
ut e
Laundry T ys
$15 Issue Fee
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL �CBO �k
Heating System & Ducting
❑ a� oo,000 eTu 0 i oo,000
Reinspection Fee � $15
OBfiS-46, rev. 5/BB White - BuilCin9; Canary - Applicant: Pink - Accountin9: Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,000BTU ❑t00,00DBT
System Repair/Alteretion
Fire Damperz .
Registers
Issue Fee
FEES
$ 3
FEES
$ 3
A.P. # ,
S Main Buildi
E
T Front
6 Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
ic Washer
tion Pole Sub.
Unit
lectric
F.A.U.' . ' . .
Fixtures
Device Boxes
Outlecs
Switches
Garbage Disposal
Generetor �0.5 KW �5-15 K
a
Parking Req.lProvided
ELECTRICAL
Transformer ❑ 15-50 KW •
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors OO-1 NP O1'f, - 8
- Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign '""
Standing Sectibhs �
W Trash Compactor
`Y'�
� Reinspection Fee ' $15 '�.
DEVELOPMENT SERVICES REQUI
2aning Approved By
Building APP�oved By
Appliwtion Issued Bv
SUMMAR �OF
BUIL�ING PERMIT $ %��
PLAN CHECK $ "
PLUMBING $ ' "' �
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50°,6 $
MECHANICAL $
P�AN CHECK 25% $
O
N
1
N
G
R
E
O
M
T
S.
FEES
f
$ 3
ES : �
SMIP r$ �__
PER�MIT
ISSUANCE,::,,•$
ENERGY P.C. $
GRADING $
MICROFILM $ �/
TOTAL FEE $ _lp.�=_
���/ G/I O1 Od03771�7-G0031768 T"�3'
' �k?E: �?!?3/S9 7IISE: ?0�32
b3.50
. . .. , ...� . .. .0 �`J ' \" � __ . . , . .._
CONSTRUCTION AND PLANNING POO' iPA ;ti
APPROVALS Permit# Date Inspector p�ppROVALS 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 r�
4. Electrical Conduit-Undrgrnd. . . 55. Electrical Bonding ' ��
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ���
- 1
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings �% 58. Electrical Conduit-Undrgrnd. �1
8. Foundation �"� 59. Gas Pipe, � Undrgrnd., Test [,,r
??-
9. Water Pipe-Undrgrnd. !!1 60. Backwash Lines, P-Trap, O Undrgrnd. �
u
10. Structural Floor System � � ' 61. APPROVAL TO DECK
17. Property Sewer Line & House Con�ection 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. 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
J9. Rough Heating & Air Conditioning "FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace , APPROVALS Permit #
21. DuCts, in Structure � 70. �Undergrourid Hydio�
22. Ducts, Ventilating 7.1��•Product Piping OGas O�OiI
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 (Structural) & Monocoat � 75r-Dry Chemical
27. Frame and Flashing ' �" 76. Dry Standpipe-
28. Lathing & Siding ,!j 77���FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat • ' �� 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED
J
33. Final Electric Notes:
34. Final Heating & Air Conditioning �',
%�
35. Final Gas Pipe-Test _ .
36. Hood or Canopy �
�
37. Final Factory Fireplace � �-^`
- . a
38. Final Plumbing �
_/_
39. Water Service-Final �.�
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer %'
43. Backflow Irrigation ��� j �+
44. .Landscape Irrigation System �
tIOf1S
45. Sound Attenuation
'46'�Handicap Regulations t�0t8
/ 4�7. FINAL STRUCTURE & BUILDING
i
46,- Special Requirements Completed � / .
� •49. Electric Release to Edison �;
50. Gas Release to Southern California Gas Co �+! '�1 `t�
51. CERTIFICATE OF OCCUPANCY � :� b'
No. Date � �_.
�. 2 i os� FEE RECEIVED ;
WOV 2 7 1963 �
COSTA MESA BUILDING-SAPEfY DEPARTMENT � FINANCE DEPT. �
P. O. BOX 817 COBTA ME6A. CALIFORNIA
CITY OF COSTA MESA '�
• For Appl►cont to Fill In Complefaly APPLICATION FOR PERMR c�
� TYP.E OR PRINT � � �� BUILDING �
aui�oina D For Oiilce Use Only
ADDRESS �� � GLOUGF��/�j �!n �vE
, , RCC61'T NO. �P���.
COSTp MESA, CALIFORNIA . ' " �
. P[C61�a. o�r �a��.� . ar�a�
owNER Ca e Series Inc.
MAIL , BUILDIN6 ' .
ADDRSS9 5�4 N�. NeW OYI BIVd. ADDR6SS
RIRB
cirr N2 Tt BeaCh Ca1.No �646-934 ZONB TYPH GROUP �
APPROVED
AORCHI �N ER Bxent S.� � Tobe� �_ NoY-IY46985 BY DATE
ZONINC; �
A, :g 1320 Carmelita . La una Beach �o �o op,7 Ue op� ��
- _ runs eu ' _� A1 e:p.y�
CONTRACT Ca e Series Inc. . �^' -�
p q '�°"'- Lot d2 Tr t 5212 ��L�"
AODRESS 504 No. New �rt llIVLL. ' oEecRl'TION
CITY New ort Beach, Calif. A• P• NO. Vy
ZGIZJJ 646-9341 NOTE: NOEAVEOVERHANGSHALIBELE88THAN ��
� STATE TEL 90" TO SIDE @ REAR , L.
LIC. NO. NO. � �
p p pp(�9 EAVES
OFLOTJ9.03X�4.J3XJ7.�J I NowoNwT� ALLOWED (U.B.C:REQUIREMENT) �
USEOF - � . YARDBAPPROVED YARD8APPROVED
EXISi1NGBLDG. nOne MAINBUILDIN6 ACCESSORYBUILDING 'r'- ,
. O � (FROMC/��l'REET) �
BETBACK LINE PROM ��y PRONT CJ Fr. F-r. 0.
CENTER Op BTRCET 6. 'dR$pR Y/�RU �j. U . ^'�'
�y L 'J � CiAt
61b6 YARD I LEFT %� �l •S I RIQHT ��- � R. SIDB I(�FT. FT. �
%
DESCRIPTION OF WORK �. sioa,S� Fr. Fr. �
u»
N�.�„ X ALTERATION ADDITION REAR FT. �FT. �
REP�R MOVINO DEMOLISH MAINABLDOS.T ACCE55!BLD6A �+
'S�ZELDIN6 lOOO S f[NO.OF 4 � i Vp'R.SC " DATE � '
ROOMS ' BTORIHB 1 0. U.P. APPROVED
EXTERIOR WALLtuCC� I COV�ERIN6 cedar shak BYPR� / ' �"�'�' DATE /I �+ � V
�COVERING 5
USHOFBUILONGANDY� RKTOBQP RFORMED � . ' �
sin e famiYy resicfence
1080 sa: �. � m
I HEREBY ACKNOWLqO08 THAT I HAVE READ TH�9 APPL�CATION TXe AMOUNT BXOWN UN�ER VFLII�TION 18 FOR THH �
ANO 6TATE THAT THp ABOVB 18 CONRlCi AND AOREE�TO COM- PURPOSE �OR 88TABLI6NING A PERMIT FBE ONLY. �
e�x wiTw w�L CITY Op�INANCBB AND 9TAT8 LAWB R80ULATINO ypLUAT10N � m
eUl101rvO cOnsTROCT�oN. ' /� �-�. �j999O. OO ' PERMIT FEE a 32. 97 �
SIGNATUItEOF �'f��.7� SL' ss�Fc.S IB��' . � m
PERMITTE
L� D /n/. S . L ECK p
AUTMORIZfiD A6EryT�/'�LliW�^� TOTAL FEE $ 32. 97