HomeMy WebLinkAbout441 GLOUCESTER DR - Building PermitsAVPlicant to fill in all soaces eacept those within heavY Oortler lines antl sign all aoP�eoriate aeclarations.
CITY OF COSTA �s�oucO�ISTF�UCT�sa,PGa 9Z627 �
Project Address Std
Applicant's Mailing Address 7�� ��� �
Owner'sName 1he Prrbros�Co Phone—�-L�.a.�LJ�
Address P 0 Box 8064 Laguna Hills Ca 92654
Arch/Eng. License No.
Address
Contracmr's Name VdIICP �r Ac50(' Rfg Tnr Phone 714-�-4911
Address (mailingl P_(]_ Rnx 104�,f, fntta M�ca, fa 9�7
City License No. �q1�
LICENSED CONTRqCTOR DECLARATION
I hereby affirm [hat 1 am licensed untler provisions of Charter 9(commencing
with section ]000) o( Divislon 3 Of the Business antl Professions Cotle, antl
my license is in full force antl effect.
License Class nse No.
Date� 15j9p�'.ure
WORKERS' COMP N51rr5�iN DECLARATION
1 nereby attirm that 1 have a certificate ot consent to selt-insure or a certificate
'Workers' Compensation Insurance, or a certifietl copy thereof (Section
°, Lab `� WC21610302530�1� Libert NUtual Insuranc
�olicy No. mpany y
8 Certified copy is hereby furnishetl. �
Certifietl copy isiila0.vygf{� the city Buj�qj�geDv/isjpns� �fl Inc
Daie ��� VPpplicant Vtilll, h!'J f1C]
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thisseclion neetl not be completetl it the permit is for one huntlretl ($300) or
less).
I certify that in the performance of the work fo� which titis pe�m�t is issuetl, 1
shall not employ any person in any manner so as to become subject to the
Warkers' Compensation laws of Califomia. �
Date Signature
NOTICE: If, atter makinq this tleclaration, you shoultl become subject to the
Worke�s' Compensation provisions of the Labo� Cotle, you must forthwith
comply witn sucn provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION IENDING AGENCV � .
I hereby afflrm that there is a construction lentling agency tor the perfarmance
of the work for which tnis permit is ISsuetl (SectiOn 3097 Civ. C.)
lentler's Name
Lentler'S Atltlre55 .
OWNER BUILDER DECLFRATION
I hereby aftirm ihat I am exempt from the Cantractor4 License Law tor the
followin9 reason (Section �031.5 Business and Pwtessional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any strutlure, p�iot to its issuance, al5o requi�es Ihe applicant f0� such permit
. to file a signetl statement thaC he/she is licensetl pur5uant to Ihe provi5ions of
the Contractor's License Law (Chapter 9(commencing with Section ]000) of
�ivision 3 of the Business antl Professions Cotle) o� tha[ he/SM1e is exemp[
t' �trom and the basis (or the alle9etl exemption. Any violation of Section
' S by any applicant tor a pe�mit Subjects [he applicant to a civil
'� y ot not more than fiv¢ huntlteC tlollars ($500).
�� I, as owner ot the pro0erty or my employees with wages as their sole
I compensation, will tlo the work, antl the structu�e i5 not intentletl o� otferetl
� for sale (Section 7046, Business antl Professional Cotle: The Contractor'S
I License Law does not apPy to an owner of a property who builtls or improves
lhereon, antl who tloes such work himself/herself or through his or her Own
employees, provitletl that suCh improvemen[5 are nOt intentletl or affetetl tor
sale. If, howeveq the builtling oi improvement is sold witM1in one yedr of mm-
pletioq tM1e owner will nave tha burtlen of proving he/she aitl not builtl or im-
prove for Ihe purpose of sale).
1, az owner oi the pro0erty, am exclusively cont�acting with IicenSetl con-
ractors to construct the project (Section 7044, Business antl Professions Cotle:
The Contractor'S License I�w does not apply to an owner of property who
builtls o� improves the�eon. antl who contracts Po� SUCY1 OYOIQCIS WIIh a mn-
Vactor(s) license pursuan[ to me Contractor's License Law). I am aware that
erobf of Iheir Worker'S Compensation insurance shoultl be providetl to me.
u I am exempt untler Section B. & P. C. for this reason
Date owner
I h2reby certify that I M1ave reatl this applicatiOn antl state that the above
Information is wnecL I agree to comply with all cityana county ortlinances
antl state laws �elafing to builtling ConSlruCtion, antl hereby autho�iie repre-
sentatives ot Ihis city [o ent upon the above-mentiOnetl O�operty fo�
inspection purpases,/ �- �
Signature __{..�(j/ � Date 7-12-89
Drivers' License or ss ����
r!� soi./
TVPE OF CONSTRUCTION . NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRAOING FOUNDATION STRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ �OTHER ' � �
PROJECTDESCRIPTION Sci.F7. oCCUPANCV��_
, CONSTRUCTIONTYPE VALUATION$ ���
ZONE � GRADING CU. VDS. ACRES
Rema.k:: tear off shakes and reolace with Class B hardi Shakes
Backflow Preventer
Backfiow Irrigation
Bathtubs
Clarifiers �
Dishwasher
��inking Fountains
Floor Drains
Floor Sinks �
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspection Fee
Bailer
Duct - Under Ground
Duct - Structural
$15
Exhaust System LJ Multiple
Firepl/Fact. Blt ICBO #
Heating System & Ducting
❑ 0.100,000 BTU 0100,000
peinspection Fee � $15
0865-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor
Showers
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
Laundry Tra'ys �
A.P. #
S � Main Buildi
E
T Front
B Rear
A
C Right
K . Left
S _
Ping. Ref. #
Planning Notes:
FEES /automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F.A,U.
Fixtures
Device Boxes
Ou[lets
Switch¢5
Garbage Disposal
Generator �0-5 KW �5-
Zone
ry Building: �
. Z
O
. N
I
• N
G
R
Req./Provided - � E
�
M
T
$.
ELECTRICAL
c
� Transformer ❑ 15-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100amps ,
$ub Panel ' �.
Motors �0-7 HP 01 %- 8
Inc.Solar �9-75 HP �16-15+
Microwave �- �
Pole Light •
Range
c��., ..
Standing Sections .
5 KW Trash Compactor •
- Reinspection Fee $15 luue Fee
. $ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Issue Fee Zoning Approvad ey
� FEES Building Appraved By
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
Sysiem Repair/Alteration
Fire Dampers
Registers
Issue Fae
$ 3
FEES
$ 3
SUMMARV OF FEES . /��iJ
BUILDINGPERMIT $ �� SMIP � $ _S,C—._
PLAN CHECK $ PERMIT '
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $�
ELECTRICAL $ GRADING $
PLANCHECK 50°� $ MICROFILM $ —��v
1
MECHANICAL $ TOTAL FEE $ �
PLAN CHECK 25% $
�. ... _. , � _ .
,. _
<ti �, ,. � -
CONSTRUCTION AND PLANNING POOL p� SPA ... ,
Date Inspector . -Date Inspector
APPROVALS Permit # . APPROVALS Pa. _c #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms ' �' '- 1
, ..�,
4. Electrical Conduit-Undrgrnd. ,' " 55. Electrical Bonding . �-�"
5. Steel Reinforcement 56. Raugh Plumbing & Pressure Test �,^,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �?
7. Footin s � `�
. g Ji . 58. Electrical Conduit-Undrgrnd. /*
�8. Foundation � �� 59. Gas Pipe, � Undrgrnd., Test :�j
9. Water Pipe-Undrgrnd. ,- n 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System �i 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 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
T6. 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
7`9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑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 (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 Coat . 79. FINAL INSPECTION
32. Electrical Power Nl'eter-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
�'1
43. Backflow Irrigation �,
44. Landscape Irrigation System ' ,7/ �
45. Sound Attenuation �
46. Handirap Regulations
47. FINAL STRUCTURE & BUILDING pf��� SMo�LL� p � l.
48. Special Requirements Completed
49. Electric Release to Edison �f
50. Gas Release to Southern California Gas Co , �� �
51. CERTIFICATE OF OCCUPANCY r � � ���
No. Date -- . -
.�
2 � 07� FEE RECEIVED �
� �oy 2 � ,9s3 �.
- COSTA MESA BUILDING-SAFETY DEPARTMEM' FINANCE DEPT.
P. O. BOX 917 C09TA ME9A, CALIFORNIA
CITY OF COSTA MESA �
For Applicant fo Fill In Complefely APPUCATION FOR PERMR
TYPE OR PRINT � BUILDING � �
BUILDING yy� /� FO/ �ffIC@ {�5@ �I1�Y
ADDRESS (J-LOUGES%E �/�IV�
R¢c61PT NO. �'I��fiO. .
COSTA MESA, ,CALIFORNIA � � J
RGCl1 [DpY D T HEC V! DATE159UEO
OWNER Ca e Series Inc. � - � � ' � �� �a' • ' �
BUILDIN6
nooRsas 504 No. Ne o2'C B1Vd. aooaess
FIRE
��n. Newport Beach, Callf. No!646-9341 zoNe �rrne GROUP
APPROVBD
ORENGIN eR Brent S. Tobey To •HY4698 Y DATE
AooREeg 1320 Carmelita La una Beach ZONINCi
. ZOX6 NO. OF%'� I UBE OF NCYr , �
PLANB i�- em�o� �
CONTRACTOR Ca e Serles j11C. . '� � �
504 No. New OTC B1VLL. L80�L Lot 22 Tract'S212
ADDREDII oeecn RiOn ^
CITY NL' OYC BeaCI7- Callf. � A• P• NO. "
NOTE: NOEAVEOVERH/.NOSHALLBE,LESSTHAN
STATE 221233 . TE`. 646-9341 a0" TO SIDfi @ REAR P. L. . .
LIC. NO. NO.
plQ EAVES
OF LOT Jl. �`� X S�. 08x28. 3�„o;;�;„ �or� �+LLOWED fO. B. C. REQUIREMEI
YARD8APPROVEO VARDSAPPROVED
USEOF none MAINBUILOIN6 ACCE950RY.BUILDII
EXISTING BL�O.
( PROM GL STREET
eETBACK LIN6 FRO � �"Z FRONT 1 FT. ��� � 'FT.
cErvTEx oF BTrsGci��AR��EAR YARD � .
SIDB YARD L6FT � v RIOHT � � R� 81DE FT. ' F7'.
DESCRIPTION OF. WORK �. sioe' Fr. Fr.
N6W X ALTERATION AODITION REAR ���`�FT. FT.
� DISTANCG BET. BET. MAIfJ d
REPAIR MOVIN6 DfiMOLIBH MAIN BLDGB. ACCESS.BLDG3.
BUILDINO C NO.OF C VAR•# DATE
SIZE ���`� "SQ• �t• ROOMS `� BTORIE � C. U. P. # APPROVED
EXTERIORWAI�uCCO I ROOR Ced•dT S•hake APPROV6 ,�n�,A /�.�6-G�
COVERING COVERINO BY I DATE
US6 OF BJJILC}IM63AND {NARK TO BE P, 6RFORMfiD �
1425 84. FT. �
1 HEREBY ACKNOWLEOOB THAT 1 HAVB PEAO TXIB APPLICATION TMB AMOUNT 9HOWN UNDEq VALURTION IS FOp TH8 F
•NO BTRTE THAT TX8 ABOVB 18 CORR6CT AND AOR68 TO COM� � PUNP086 Or [BTA6L�6HING 6 PERMIT FEE ONLY. Q
PLY WITX /�LL CITY OROINANClH ANO 6TAT6 LAWe H[OULATING ' ypLUAT1OP1 0
BUIL�INO CONBTRUCTION. ) A A ry
91GNATURE OP � G� $1`3� 181. 'L5 PERMIT FEE $'Y2. SY � �
PERMITTE OO � �
' $ LAN CH GI O
AUTHORIZHD AOEN a
TOTALFEE s42.54
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