HomeMy WebLinkAbout433 GLOUCESTER DR - Building PermitsApplicant to fill in all s0aces except those within neavy bortler lines antl sign all appropriate Ceclarations.
MIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PER
Project Address 433 Gloucester: Costa N�sa. Ca 9262i �_,
Applicant's Mailing Address
Owner's Name ��m, fn Phone 714-5R�-1�
Address P 0_BOX- I•a�a Hillt �'�3 92fi54
Arch/Eng. l.icense No.
Address
Contractor's Name�VdllC2 R�p(' RMfip(� Til(' Phone 714-fi46-321
Addresslmailin9) P�O� E�nx 10456_Cnsta._N�sa, �a 9�h�7
Ciry License No. �q14
LICENSED CONTRACTOR DECLARATION �
I M1ereby.aHirm [hat I am licensetl untler provi5iOn5 of Charte� 9(commenCing
with section ]000) of Division 3 of the Business antl Professlons Cotle, antl �
my license is in full torce antl effecL �
License Class nse No.
Date—�- �}�p{� re
WORKERS' COMVENS�IiYF! DECLARATION
"ereby.affirm tnat 1 have a certifiwte of mnsent to self-insure or a certificate
Workerz' Compensation Insurance, or a certifietl copy thereof (Section
J0, Lab. C.) .
Policy No. _���.�e���mpany I ilwrl�v Mrt al Tne ran�E
8 Certified copy is hereby furnishetl.
Certi(ied copy is filetl with the city Builtling oivisnio,.n,..,.,, n,,,,r,„,, in
EXEMPTION FR0�0.�RSaCOM�ION DEC ARAL T•ION ��
(This section need not be coTpletetl if the p¢rmit is for ane huntlretl ($300) or �
less).
I certity thal in lne perfo�mance ot the work for wM1ich this pe�m�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
WOrkets' Compensation Laws o! Califomia. �
Date Signature
NOTICE: If, after making this tleclaration, you shoultl become subject to the
Workers' Compensation provi5ion5 of the tabor Code, you. must torthwith
tompry wi[h such �provisions or lttis pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV ' '
I hereby atfirm that there iz a consiruction lentling agency for tne pertormance
o� tM1e work for which this permit i5 issuetl (Section 309� Civ. C.)
LenEer'S Name -
Lentler's Atltlress
OWNER BUILDER DECLARATION
I hereby affirm lhat 1 am exempt from [he Contractor's License Law tor the
following reason (Section 7031.5 Business antl Professlonal Cotle: Hny city or
munty which requires a oermit to construct, alter, improve, tlemolisn or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signetl statement that he/sne is li<en5etl pu�suani to the provi5ion5 Of
the Contractor's License Law (Chapter 9(commencing with Section ]000) of
'�•ision 3 ot the Business antl Professions Cotle) or Ihat he/she is exempt
efrom antl the basi5 for the allegetl exemption. Any violation o( Section
1.5 by any applicant for a permit subjects the appliCant lo a<ivil
nalty of no[ more than five huntlretl tlollars ($500�.
� I, a5 owne� o( the property or my employee5 with wages as their sole
wmpensa[ion, will tlo Ihe work, antl tM1e structure i5 n0t intentled Or offeretl
tor sale (Section ]044, Business antl Protessional Cotle: ThE Cont�actoYS
License Law tloes not apply to an owner ot a property wlto builtls or imprOves
thereon, antl who tloes sucM1 work hirtiselt/her5elt or thrOuqh his o� hEr own
employees, ptovitletl that such imOrovements are not intentletl or offe�ed to�
sale. It, ttowever, the builtling or improvement is soltl within one year o/ com-
pletion, the owner will have the burtlen of provin9 he/she tlid not builtl or im-
p�ov¢ fo�the purpose of Sale). .
❑ I, as ownev ot the property, am exclusively Co�tracting with licensetl con-
1 tractors to construct tne project (Section 7044, Business antl Professions Cotle:
The COnVattorY �icense Law does mt apply to an owner of property who
builtls or imOroves tM1ereon. antl who contracts Tor such oroiect5 with a mn-
tractor(sl Lcense pursuani ro tne Contractor's License Law). I am aware tha[
proof o( Ih¢ir Worker's Compensation insurance sboultl be provitletl fo me.
'� 1 am exempt untler 5ection B. & P. C. for this reason
Date Owner —
I hereby certity Ihat I have reatl this
Information is correct. I agree to compl
antl state laws relatin9 �o building conf
5¢Ofdtiv25 Oi flli5 Ci[y t0 ¢O UpOfl
InSpection pu�poses. ^� �
Signature
Drivers' License or 55 �f �-,-�_
'tate that the abova
tl countY ortlinances
eby authoriEe repr¢-
ionetl Property for ,
Date �-�2-�
O Z � � . A.P. #
S Main euilding:
TVPE OFCONSTRUCTION � NEW AOD ALTERATION REPAIR �E
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ��T Front
� DESCRIPTIONOFWORK/USEOF.BIDG. A Rear
� C Right
TVPEOPPEFMIT GRADING ❑�FOVNDATION STRUCTURAL �K
❑ TENANT ❑ ELECTRICAL .❑ PLVMBING ❑ MECHANICAL - S Left
' ❑ �oTHER �- � Ping. Ref. #
PROJECT�DESCRIPTION 5c�. FT. oCCUCANCv - � Planning Notes:
CONSTRUCTION TYPE �VALUATION ^y �7Oi_(�(�
ZONE GRA�INGCU.YDS. ' ACRES
Remarks: CaY� s a es a rep ace wi a$$ a 1 a es
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishvrasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service � Outlets
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspection Fee
PLUMBING
Showers
. . Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
� WaterSerJice
A uto-W ash
LaundrY Trays
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.6lt �CBO #
Heating System & Ducting
❑0-100,000 BTU 0100;0008T
peinspection Fee I $15
0865-46, rev. 5/88 White - Builtling; Canary - Appiicant; Pink - Accountinq; Goltlenrotl - Assessor
Issue Fee
Hood or Typel ❑
Canopy TYPe I I ❑
Refrigeration Sys[em
❑aioo;000aru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES /lutomatic Washer
Construction Pole Sub. �
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Zone
Accessory Bui
Parking Req./Provided
ELECTRICAL
Transformer ❑ 75-50 KW
❑ 50+KW
Fan
F.A.U. '
Fixtures
Device Boxes
OUIIetS
Switches
Garbage Disposal
Generator �0.5 KW 05-15 KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel �
Momrs O41 HP O1.'/:.= 8
IncSolar �9-15 HP 016-75+
Microwave � " �
Pole Light ,
Range
Standing Sections
Tresh Compactor
FEES
N
i
N
G
R
E
�
M
T
$.
Reinspection Fee $15 Issue Fee $ 3
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved'8y Date
FEES Building Approved By Date�—�—
Application Issued ey Dat �'� S
' SUM RV OF FEES
BUILDING PERMIT $ � SMIP $ d�
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ /
MECHANICAL $ TOTALFEE $ _ ln3N
P�AN CHECK ZS% $
$ 3
Oi 00�37739-tla03?740 'd"l'�T b.a.5D
�ATE: OJ; 13/39 TII'IE: 1a�7'�
. . , . . y.. .�.
���' - i - ��' .. .
CONSTRUCTION AND PLANNING POO SPA • --..
Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit #
1. Temporary Electrical Servics or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Uhdrgrnd. � 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 Undrgmd., Test .���!
' ,S
�--•
9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System t� � 61. APPROVAL TO DECK
11 . Property Sewer Line & House Con'ne �ion 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-FinaV
16T 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 #
i
21. Ducts, in Structure 70. Undergraund Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑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-Bar Ceiling (Structural) �& 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 Coa� • 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. Ftnal Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer . s�
43. Backflow Irrigation . . �'�
F
44. Landscape Irrigation System ��� '
45. Sound Attenuation � �
46. Handicap Regulations - � '
47. FINALSTRUCTURE&BUILDING �� �-�� '
48. Special Requirements Completed � _
49. Electric Release to Edison -•
50. Gas Release to Southern California Gas Co ^+ `l, ��
51. CERTIFICATEOFOCCUPANCY �
�i` ; � �.
No. Date _
. FEE RECEIVED
� � A Q72 .. PdOY 2 7 1863 �
COSTA MESA BUILDINGSAFETY'DEPARTMEM' �1 �
P.O.BOX91] . C06TAM69A,CALIFONNIA FIIYANCE DEPT� �
CITY OF COSTA MESA
For Applican! ro Fill In Complefely APPLICATION FOR PERMIT �
� � TYPE OR PRINT � - � � BUILDINf3
BUILDINO �[Z /� r D -n For�.Office Use Only �
ADDRESS / J� � (]�LOUCFS%E1 v ��u�
, , � . q[QIR NO. I'� �9I{�1}f�t1p
� COSTp�,MESA, CALIFORNIA . � L v �G
p6CQ1V� �/!Y . OA 'RGC6NfD- DATH 189OE
OWNER � ' + � ia-a-�
. BUILDIfiO � �
MAIL AOOft6SG �
aooRess 4 Yt $IVCl' '
FIRE
crrr Ne Ozt BeaCh Calif. Na' 6469341 ZONB TYPE GROUP
APPROVED
pp' 'TECT TE - BY ' ' DATE �
O INEER� NO.
ZONINCi - v�
AooRE5�320 Carmelita La una Beach H
., ZO NO. OP� UBE OF NBW�+L�'�J'� ({ z
' . I - PLANe BUII.O O�� ..l �iG�Yi./Y'4✓� �
InVY
CONTRACTOR Ca e Series Inc. �
aooaess 504 N. N2wpOrT $1Vd. ea�a�wr�or+ • LOT 18 Tr 5212 �;
A. P. NO. �
�,T„ Ne ort Beach, Calif. �— d
221233 �46'C�'341 NOTB: NOEAVEOVERHANG6HALLBELE55THAN �
STATE TEL 90" TO SIDE 8 REAR P. L
LIC. NO. NO. `�
38.83x44.33 I 0 ��ES
� SRE xo.oFeLDoe. ALLOWED - (U.B.C.RECUIREMENTI ''•
OF LOT NOW ON LOT ( j '
USEOF YARDSAPPROVED YARDSAPPROVED
EXISTING BLDa: 11011e � MAIN BUILDIN6 �ACCESSORY BUILDINa �L�
( FROM G/L STREET ) �^, �
SETBACK LINE FROIA..On�n'��' a �'�" U FRONT C FT. � S �/ F'�', �
CENTEH OF BTFEET t' REAR YAR �� .
�
HIDEYARD � LEFT� 2'y I RIGHT � R.SIDB � Ff. FT. ' �'�'
..i
' DE5CRIPTION OF WORK �. s�oe a' F-r. Fr. • 0.
/-y �
NI X ALTERATION AD�ITION REAR ' V Ff. FT.
REPAIR —_ MOVIN6 DEMOLISH DISTANCE BET. BET. MAIN B
MAIN BLDG9. ACCESS. BLD69.
1 VAR. # DATE �
6=ELDIN6�•jO92' SCl• �CROOMS � 8T RIHB 1 G. U. P.� APPROVHD /
EXTERIOR WAL�nuCCO I R�3Ea���cedar shake BYPR�V ,. ��� DATE �/�" ��J
COVERING t
. . - � . 1�92 SQ. iR. ' c
1 HEREBY ACKNOWLEDOE TXAT 1 XAVH RBAD TNIB APPI.ICATION TH2 AMOUNT BHOWN UNDER VALUATION I8 POH THE F
RNO 6TNTE THAT T1�g pBOVB IB COqqECT ANO A6qE6 TO COM. PURPOBE OP EBTABLIBXINB A PERMIT FEE ONLY. Q
PLY WITH ALL CITY pqOINANCHB AND BTATH UWB R60ULATINO ypLUAT1ON ' m
BUILDINOCON9TRUGryyON. ,. . 1 ^�. ^O �
SfGNATUREOF/��p �� ^�+s, ���� �iQp �OI.00 PERMITFEE 3 3 m
PERMITfE %� E OO Q
, $ i
AUTHORIZEO AGEN ` , � 33. 30 �`
T TAL FEE