HomeMy WebLinkAbout423 GLOUCESTER DR - Building PermitsApplicant to /ill in a11 soaces except tnose within �eavY bortler lines ane sign all appropriate tleclarations.
cI7Y OF COSTA MEsa CONSTRUCTION PERMIT
Project Address 423 Glouce�+pr �0�'a Mesa .a � _
Applicant's Mailing Address -
owner's Name ��X °S � Laguna Hi S� Pl.d�� 71��—
Address
Arch/Eng. License No.
Address
Contractor'sName �C2 X SOC �00 ing Isa a�`JL�%--,
Address (mailingl '
Ciry License No. ��59�3
LICENSED CONTRACTOR DECLARATION '
I hereby affirm that I am licensetl untler provision5 of Charte� 9(commendnq
with section �000) of Division 3 of tne Business antl Professions Cotle, antl
my licenze is in (ull fn`'r u2ntl effect. GO!1
License Class "��'2J1�� c nse No. �W,�
Date —�%— gy.py.�re
�ORKERS'COMPENSATION DECLARATION
�e�eby affirm that I have a certiticate of con5ent t0 self-Insur¢ or a ce�tificate
Workers' Compensation Insurance, o� a certifietl copy thereof (SeGtion
�aoo. �ab. �.� �����253QI�,Pa�Y liberty M�tual insurance
Policy No.
BCertifietl copy is nereby fumishetl.
Certifietl copy i5tll ep,y� i,(p the tity Bui inq Divisip n.
' oate /—'IL—g}lpiicant ��nrP R Ac$p(' RMfin�1 Tnr
EXEMPTION FROM WORKERS'-COMPENSATION DECLARATION
(This section neetl nol be wmpletetl it the permit is for one huntlretl ($100) or
less�.
I cer[ify fhat in the pe�to�mance of Ihe work for which this perm�t is issuetl, I
shail no[ employ any pe�son in any mdnn¢r 50 a5 to become subject to the
Workers' Compensation Laws ot Calitomia.
Date Si9nature
NOTICE: If, aiter makin9 thiz tleclaration, you shoultl become subject to the
. Workers' Compensation provision5 of the l2bor Cotle, you must forthwith
comply with such provision5 or tnis pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV' �
� 1 hereby at8rm that there is a construction lentling a9ency for the performance
Of the work for which this permit i5 issuetl (Section 309� Civ. C.)
� Lentler's Name
( Lentler's Atltlress
OWNER BUILDER DECLARATION
� I hereby affirm Ihat I am exempt from the Contractor's License Law for the
foilowinq reason (Section 7031.5 Business antl ProTessional Cotle: Any city or
wunTy wnich requires a permit to construct, alter, improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signetl statement that he/she is licensetl pursuant to the p�ovislOns of
� the Contractor's License Law (Chapter 9(commencinq with Section ]000) of
Division 3 of the BuSinesS antl Profe55ion5 Cotle) or Ihat he/she i5 ¢xempt
thetefrom antl the basis for the alle9etl exemption. Any violation ot Section
7031.5 by any applican[ tor a permit subjects the applicant to a civil
�enalty of not more than tive huntlretl tlollars ($500).
I, as owner of the prope�ty or my employee5 with wage5 a5 thei� sole
mmpensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale ($ection ]044, Business antl Professional Cotle: The Contractor's
License Law tloes not appty to an owner ot a property who builtls or improves
the on, antl who tloes Such work himself/her5¢It or [hrougM1 his or her own
em�loyees, providetl that such improvements are not intentletl or ofteretl Por
sale..11, however, the bulltling or Improvement iz soltl within one year of com-
pletion, tne owner will have the burtlen oi proving he/she tlitl not builtl or im-
prova tor the purpose ot sale).
❑ I,yas owner of the orooerty, am exclusively contracting with licensetl con-
tractors to wnstruct the project (Section 7044, Business antl Protessions Cotle:
The Contractor's License Law tloes not apply to an owner of property who
builtls or impraves thereon. and who conVacts to� Such oroiects with a mn-
tra<tor(sl hcense pursuanc to me ConVactor's License L.aw). I am aware that
proo/ of their Worker's Compensa[ion insurance ShoWtl be provitletl to me.
❑ I am eaempt untler Section B. & P. C. for this reason
I
Date Owner —
I hereby certify Ihat 1 have reatl this
Info�mation i5 w�rect. I ag�ee to Compl
antl 5[ate iaws relating to builtling <on5
sentatives of this city to en upon
Inspection purposes.
Si9nature
Drivers' License or 55 �f —^��
:norae repre-
propzerty for
� I �
TVPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION Q� REPAI R
' ❑ CONVERSION ❑ DEMOLISH � ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. FT. OCCUPANCV
CONSTRUCTIONTVPE ' VALUATION$ 3 .00
ZONE � GRA�INGCV.VDS. ACRES
Remarks: Tear �ff
Bar Sink
Backflow Preventer
eackflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof DrainS
Reinspaction Fee . � � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.6lt. iCBO dk
Heating System & Ducting
❑0-100,000 BTU 0100,0006T
Reinspection Fee � $15
0865-46, rev. 5/88 WM1ite - Builtling; Canary - Applicant; Pink - Accounting; Goltlen�Otl - AssesSor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
Water Heater „
Water Service
Auto-Wash
Laundry Tra'ys
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
A.P. ;1�
S Main Buildi
E
T Front '
B Rear
A
C Right
K . Left
S
Ping. Ref. #
Planning Notes:
FEES P�utomatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
� Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
DEVICC BO%CS
O utlets
SwiLcheS
Garhage Disposal
Generator DO-5 KW �5-'
$ 3
FEES
$ 3
2one
Accessory Building:
Parking Req./Provided
ELECTRICAL � � �
Transtormer ❑ 75-50 KW
❑ 50+KW
Meter ❑up ro 100 amps
Meter ❑over100am'ps
Sub Panel �
� Motors�0-7 HP�1'/:-8
� Inc.Solar �9-75�HP �i6-15+
Microwave �
Pole light
Range
Sign � -
Standing Sections '
5 KW Trash Compactor � -
IReinspection Fee '$15 I I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APP�oved By
Building Approved By
QPO�ICdil011 �$$110d BV
�
FEES
$ 3
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SUMMAR2V NOF FEES � r�7�
BUILDINGPERMIT $ �`� SMIP : $ ��L�
PLAN CHECK $ PERMIT .
PLUMBING $' �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ ��
PLAN CHECK z5% $
o� ooQs��sv-ooea�77o 7'��� ,u.=,_r,
'JASE: 0�/�3/29 TII1E: 1Q:33
:�1' -\ \'
CONSTRUCTION AND PLANNING . POO� & SPA
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. Electrlcal 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 ��
�
7. �Footings �� , 58. Electrical Conduit-Undrgrnd. ��
8. Foundation � 59. Gas Pipe, O 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 Con�ection 62. Backwash & Receptor-Final
!t, r
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 6S. 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 Struciure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & 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 �',
n
43. Backflow Irrigation ''•%
44. �Landscape Irrigation System ' �� �
45. Sound Attenuation �
I 46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ��7 s r-�o�.E c7
48. Special Requirements Completed
49. Electric Release to Edison � ' � �"
�'�
50. Gas Release to Southern California Gas Co -'1 �� ' r
51. CERTIFICATE OF OCCUPANCY ' _ , .
No. Date � .�_ �
� 2106��
COSTA MESA BUILDING-SAPETY DEPARTMENT
P. O. BOX 91] COBTA ME9A, Cp�,�ppRNIA
For Applicant to Fill ►n Complefely
. � TYPE OR PRIN7 � �
ILOIN6 yz3 GLo���.T�� �,�!✓�
JRE55
' COSTA MESA, CALIFORNIA �
NER Cape Series II�IC.
�� 504 No. Newport Blvd.
JRE88
., Newnort Beach: Cal. ?.��b46-934]
ENGINEERBrent�S. Tobey- �. �NoHY46985
]RE53 1320 Carmelita, I,aguna Beach
�TRA�TOR Cape Series Inc.
]RESS 504 No.. Newport Blvd.
,. Newport Beach, Calif.
,*E 221233 TE�646-9341
NO. NO.
E,._43.83x44.33 � ��:�Pa�o�ap
�
��i
EFT � �'-y' I RI6IiT
DESCRIPTION OF WORK
FEE RE��IVED
FdOV 2'7 1._J
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMR
' BUIlDIN6
For Office Use ,Only
I ,PlCEIF1'NO. I �I
rtece�v{o sr
�
BUILDIIiO
ADDRfiSS
FIRE
OATE
. . ZONIN(i c, '
� / PLhNB� � I' BUILDINy q._L�
i�.,• o—
"�,�.,,,, Lot 13 � Tract 5212
EAVES
ALLOWED
YARDSAPPROVED
MAIN BUILDIN6'
BUILDINOl'Z'76 S ft.NO OF . 5 � YAR.#
SIZE q• ROOMS . BTORIEB "C. U. P.
GOVERINGWAL�tuCC� I �°o°ER�Nocedar shake BYPRO'
U6E OF BUILDIN6,AN WO K TO. 8 PERFOR ED '
sin�ie �amiiv resi�ence
I HEREBY FCKNOWL¢OOE TXAT I X�VE R6AD THIe APPLICATION
AND BTATE THAT TXE A60VE 19 COFRECT ANO AOREE TO COM.
PLY WITH ALL CITY ORUINANCE9 ANO 6TATg y�WB R60ULATINO
BUIL�IN6 CON6TRYCTION.
SIGNATUREOF�' Psi�. SL'�-(�� �/LJ.r...
PERMITTE ,
AUTHORIZED AGENT
e
SHALL BE LESB THAN
YARDSAAAROVED
AGCESSORY BUILDIt�16
DATE
TH8 AMO�INT BHOWN UNOER
PIIRPOSB OR 89TA8LIBXINO
VALUATION
$11, 803.00 PERM
$
IB FOp THE
FE6 ONLY.
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