HomeMy WebLinkAbout427 GLOUCESTER DR - Building PermitsADo���ant to fill in aIl spaces except lhose within heavy Eoreer Iines antl sign all aporopriate tleclarations.
CITY OF COSTA M n CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P#
�Project Address 4�� Gloucester, Costa Mesa, Ca 92627
Applicant's Mailing Q�dre,�s�ro$ O — — J
Owner's Name �Cle f'f1U p on
Address P• •�x Laguna Hi s, �'a �2654-
Arch/Eng. License No. �
Address
Contractor's Name ance SOC lfl(j IlC Phopp�� Z�
Addresslmailingl P•�• �X �AStd MESa� Cd yLbG/
City License No. ���'� �
IICENSED CONTRACTOR DECLARATION
I hereDy affirm [hat I am licensetl untler provisions of Charter 9(commencing
wiin section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in full t r ntl eftect.
License Clazs ��� nse No. ���
Dale 7—�ue
WORKERS'COMPENSATION DECIARATION
I hereby affirm that I have a certificate ot mnsent to self-insure or a certi(icate
Workers' Compensation Insurance, or a certifietl copy thereof (Section
�Y No. " WC2161030253�'�„Pa�y liberty Mttual Insur
u Cer[ifietl copy is hereby furnishetl.
❑ Cer[ifietl copy is le wi,t� the city Builtlinq Ivision.
oa�e �/-�2-�fP���a�c vanrP � Accnr fd�of� Tnr
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION
(Thissection neetl not be completeE if the permit is for one huntl�etl ($300) or
less).
1 cer[ify tha[ in the performance of the wo�k for which this perm�t i5 i55uEtl, 1
shall not employ any person in any manner so as to become subject to the
Workers' Compen5ation Laws of Cali(ornia.
Date Si9nature
NOTICE: H, after making this tleclaration, you shoultl become subject to the
workers' Compensation provisions of the Labor Cotle, you must fortnwith
compry with wch provisions or tnis permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby afFlrm that tnere iz a construction lendin9 a9ency tor the pertormance
of the work for which t�is permit is issuetl ($ection 3097 Civ. C.)
lRntler's Name ,
�entler's Atltlress
OWNER BUILDER DECLARATION
I hereby affi�m Lhat I am exempt f�om the Gont�actor'S LicCnse Law for the '
following reason (Section ]031.5 Business antl Professional Cotle: Any city or
county whith requires a p¢rmit to construct, alter, improve, tlemolish or repai�
any structure, prior to its issuance, also reqWres the applicant fbr such permit
to file a signetl statement tnat he/she is licensetl pursuant to the provisions of
the ConVactor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Bu5ine55 antl Profe55ion5 Cotl¢) or that ne/she is exempt
iF"^from antl the basis for lhe allegetl exemption. Any violation of Section
�- 5 by any applicant for a permit Subjects the applicdnt to a civil
1 y of not more than (ive huntlretl tlollars (y500). _'
L, as owner ot the p�operry or my employees with wages as Iheir sole
mmpensation, will tlo tM1e work, antl the structure is noc intentletl or offeretl
for sale (Se<tion 7044, Business antl vrotessional Cotle: The Contractor's
License �aw tloes no[ apD�Y [o an own¢r of a property who builtls o� improv¢5
thereon, antl who tloes su<h work himself/herself or throu9h his or her own
employees, provitletl thal such improvements are not intendetl or ofleretl for
sdle. Ii, however, the builtling or improvement is soltl within one year ot com-
pletion�the owner will M1ave tne burtlen of proving he/she tlitl not builtl or im-
prove tor [he purpose of sale). ,
❑ I,'as owner ot fhe property, am ex[lusivery mntracting with lic¢nsetl con-
Vactors to mnstruct the project (Section 7044, Business antl Prolessions Cotle:
The ConVactor's License Law tloes not apply to an owner ot property who
builtls br imoroves tnereon, antl who contracts for such oroiectz with a r.on-
tractor(sl Lcense pu�suant m[ne Cantracto�'S Cicense Law). I aT aware that
prooi o1 tneir Worker'S Compen5ation in5urance shoultl be provltletl [o me.
❑ 1 am exempt untler Section B. & P. C, tor this reason
Date ' Owner '
I hereby certify that I have reatl tnis application ana st
information is mrrecL I a9ree to wmply with all city antl
anG state laws relating to builtling conStruCtiOn, antl here
sentatives of this cily [q er�e,r upon the above-mentii
Signdture ��� \
Drivefs' License or 55 � �
oate 7_1'J-A9
TYPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION %JjJ REPAIR
❑ CONVERSION ❑ DEMOLISH �� OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL .
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S4.FT. � oCcuaANCV
CONSTRUCTIONTVPE VALUATION$ 3703.00
ZONE GRADINGCU.VDS. ACRES
Remarks:
Bar Sink
Preventer
Irrigation
Jrinking Fountains -
Floor Drains
Floor Sinks
GasService Outiets
Interceptors
Kitchen Sink '
Lavatories
P—Trap
Roof Drains
Reinspection Fea � $15
Boiler
Duct- Under Ground
Duct-Structural -
Duct - Ventilating '
Exhaust System ❑ Multiple ❑
Firepl/Fact.8lt. �CBO �k
Heating System & Ducting
❑ ai oo,000 eTu � i oo,000 eT
Reinspection Fee � $15
0865-4fi, rev. 5/88 Wnite - Builtlin9; Canary - Applicanq Pink - Accountin9; Goltlenrotl - Aszessor
$f10W2fi
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash .
Issue Fee
Hood or TYPeI ❑
Canopy Typell ❑
Hefrigeration System
❑o-ioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fae
S Main Building:
E
T Front
A Rear
C Ri9ht
K . Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fiztures
Device Boxes
Outlets
Switche5
Garbage Disposal
Generator �0�5 KW C
Fee
Accessory Buildin9:
Parking Req./Provided
EIECTRICAL
Transformer ❑ 75-50 KW
❑ 50+KW
Meter ❑up ro 100 amps
Meter ❑over100amps �
Sub Panel ' ' '
Motors �0.7 HP �1�% - 8
Inc.Solar �9-15 HP �16-15+ .
Microwave
Pole Light
Range
Si9n
Standing Sections
Trash Compacmr
Issue Fee
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
FEES Building Approved By —�
��' Application luued By
$ 3
N
1
N
G
R
E
Q
M
T
S.
FEES
$ 3
SUMM RV OF FEES I
BUILDINGPERMIT $ ��.._r SMIP � $ ��
PLAN CHECK $ � PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENEFGV P.C. $
ELECTRICAL $ GFADING $ I
PLANCHECK 50°k $ MICROFILM $
�
MECHANICAL $ TOTALFEE $
PLAN CHECK 25% $
o; ooa,7i�3-COD3773� �c�� s;�5,
4P.TE: U7/I3i89 TIi7E: ]�:2f
.. _ .. . � f -�. -- � . .-
CONSTRUCTION AND PLANNING POOL R- CPA
APPROVALS Permit # Date Inspector AppROVALS Pe, _# 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 /Z
4. Electrical Conduit-Undrgrnd. . . 55. Electrical Bonding - .:��
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test /�l
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � U1
� --
7�. Footings i'j 58. Electrical Conduit-Undrgrnd. �,,�
8. Foundation 59. Gas Pipe, O Undrgrnd., Test ����
.L
9. Water Pipe-Undrgrnd. `�� 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System � � -61. APPROVAL TO DECK
11. Property Sewer Line & House Co n�tion 62. Backwash & Receptor-Final
12. Sewer Cap � r � 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
1�7. Rough Wiring Sign . 68. APPROVED FOR PLASTERING
16. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19'. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
i
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping OGas OOiI
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 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation 7S. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • . 79. FINAL INSPECTION
32. Electrical PoweriMeter-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
i't
43: Backflow Irrigation u
i
44. Landscape Irriqation System ' �� �
45. Sound Attenuation � �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING 7 _
48. Special Requirements Completed �
49. Electric Release to Edison �..
.•• 50. Gas Release to Southern California Gas Co �;� � � ''
51. CERTIFICATE OF OCCUPANCY � � ..,�
No. Date ' t% `� �
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