HomeMy WebLinkAbout428 EMERSON ST - Building Permitsi
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Applicant to fill in all spaces except lhose within heavy borGer lines antl sign all aoaroDriate aeclarations.
CI7Y oF COSTP,MESA CONSTRUCTION PERMIT
Project Ac'��ess- 4?S Errprcnn ('ntta I�hsa Ca 9%27 _,
Applicant's Mailing Address
Owner's Name �12 �ro5 CO � � Phone ���4-�i�-��
Address P.O. Box 8064 Lag�ma Nills. Ca 92654
Arch/Eng. License No:
Address
Contractor'srvame Vance & Associates Roofina k�,�e 714-646-32��
Addresslmailingl P � ��y 7(l��i(� nci'd Crl �ri Qi�ii�
Ciry License No. �JQ�3 '
LICENSED CONTRACTOR DECLARAT�ON
I hereby aftirm that 1 am licensetl untle� provi5iOn5 of Charte� 9(commen<ing
with seclion ]000) ot Divislon 3 of the Business antl Prote551on5 Cotle, antl
my license is in full force antl effec[.
License Class — i ense No. g9�_
Date — ure
WORKERS' GOMPENSATION DECLARATION
� hereoy atiirm ihat I have a certiticate oi consent to self-insure or a<ertiticate
'Norkers' Compensation Inwrance, or a certifietl copy thereoi (Section '
ro�.°Y No `�' WC21610302530�78 Pa�Y liberty NUtual Insura
8 Certifietl copy is hereby fumishetl.
Certifietl copy is f�le.�+�the city BuiI���L]ivi&lo�sociates Roofing I
Date plicant �'C
EXEMPTION FROM WORKERS' COMPENSATION DECLA0.ATION
(Thissection neetl not be completed it the permit is tor one huntlretl ($100) or
less�.
1 certi(y that in the performance of the work tor which this perm�t is issuetl, I
shall not em0�oy any person in any manner so as to become subject to the
Workers' Compensation Laws ot CalifOmia.
Date Si9nature
NOTICE: 1I, after making this tlecla�ation, you ShOWtl become subject to tne
Workers' Compensation provisions of. the Labor Cotle, you must torthwith
comply with such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 nereby affirm that there is a construction lentling a9ency for the performance
of the work for which this Oermit i5 i55uetl ($ection 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress �
I OWNER BUILDER DECLARATION
� I hereby affirm ihat I am exempt from the ConVactor'S LlCense Law to� th¢
foilowing reason (Section �031.5 Business antl Protessional Cotle: Any city�or
counry which requires a permlt to construct, alter, imprave, tlemolish or repair
any sVucture, prior to its issuance, also requires the applicant for such permit
.to file a signetl statement tM1at he/she is licensetl pursuant to the provisions ot
the Gontractor's License Law (Chapter 9(commencing with Section �000) of
nivision 3 of the Business antl Professions Cotle) or that Ite/she is exempt
retrom antl the basis for lhe all¢getl ezemption. Any violation ot Se[tion
'1.5 by any applicant for a permit subjects the applicant to a civll
.ialty of not more tnan five huntlretl tlollars ($500).
L� I, as owner ot tne property or my emoloyees witn wages as thelr sole
mmpensation, will tlo tne work, antl tM1e strucfure is not intentletl or offeretl
for zale (Section 7044, Business anG Professional Cotle: The Contractor's
License Law tloes not apply to an owner ot a property who builtls or improves
thereon, antl who tloes such work himseif/herself or through his or her own
em0loyee5, provitletl that such improvement5 are not intentletl or otferetl fo�
sa1e. 1/, however, the builtlin9 or Improvement is soltl within one year of com-
pletion; the owne� will have the burtlen of proving h¢/she tlitl not builtl or im-
prove for the purpo5e of sale).
❑ I, as owner ot the p�operty, am ezUusively contractlng with licensetl con-
IractorslqconSVuct Ihe praject (Sectian 7044, Bu5ine55 antl Profe55ion5 Cotle:
The Conirattor'S License Law tloes.not apply to an owner of properry who
builtls or imoroves thereon. antl who conVacts for such oroiects wlth a con-
[ractor(s) license pursuan[ to me Contractor•5 License Law). I. am aware thac
proof oi fTeir Worker's Compensation insurance shoultl be provitletl to me.
❑ I am emlmot untler Section 8. & P. C. tor this reason
oate owner
I hereCy certify that I have reatl tnis application antl state tnat the above
information is correct. I agree to compty with all city antl county ortlinances
antl state laws relating to builtling const�uction, antl hereby autho�ize re0�e-
senta[ives Ot this cit to eptQr upon th¢ above-mentionetl property fOr,
Inspection purposes 1 I t�n
Signature .`Q v � oate �—�2-0,
Drivers' Licenze or 55 qF QF_ ._
8,,.,,, ,..,. ......,. .._. -- -- .,,., ,..,.
� . ' . A.P. # .
S Main Building:
TYPEOFCONSTRUCTION- NEW� ADD ALTERATION EPAIR E
❑ CONVERSION ❑ DEMO�ISH ❑ OTHER - � T F�ont
DESCRIPTION OF WORK/USE OF BLDG. � A Rear �
TYPE OP PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL I C Rlght
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - ', $ � Left
❑ OTHER ' , Ping. Ref. # -
PROJECT DESCRIPTION 54. FT. oCCVvarvCY a-1 �' Planning Notes:
CONSTRUCTIONTVPE VALUATION$ Q��.��_
ZONE GRADINGCU.YDS. ACRES
Remarks: T""'rr '�'i"" "� ""i"_ ..n�.� ni_" n �_._�: rv'�""
Bar Sink
Backflow Preventer
8ackflow Irrigation
Bathtubs
�rinking Fountains
Floor Drains
Floor Sinks
�as Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspection Fee . � $15
BOiler
Dutt-UnderGround
DUCt - $tfuCtUfdl
Duct - Ventilating
ExhaustSystem ❑ MWtiple
Firepl/Fact. Blt. iC80 dk
Heating System & Ducting �
❑ 0.100,000 BTU O 7 00,000
Reinspection Fee � $15
0865-46, rev. 5/88 Wnite - Builtlinq; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
ABING
$f10WEf5
ServiceSink � .
Sewer Cap
Sewer Connection
Solar Collecrors �
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater •
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hoodar Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioa,000eru ❑�oo,000eru
System Repair/Alteration '
Fire Dampers
Fiegisters
Issue Fee
FEES
$ 3
FEES
$ 3
Accessory eui
Parkin9 Req./Provitled
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F:A.U.
Fiztures
Device Boxes
�UtIEtS
Switches
Garbage Disposal
Generator �0.5 KW 05-15 KW
Meter ❑up to 700 amps
Meter ❑over100amps
Sub Panel
Motars 00.1 HP �1'/:-8
InaSolar �9-15 HP-016-15+
Microwave
Pole Light
Range
$tanding Sections
=.
Trash Compactor '
y
� Reinspection Fee �$15 I � Issue Fee�� ;y "
DEVELOPMENTSERVICESREQUIREMENTS: � ;�
2oning APProved BY :r [
Building Approvetl By ' [
Application Issued Bv � 4
SUMMARV OF FEES � `� ��f
BUILDING PERMIT $ �.��-. n SMIP ;,
PLAN CHECK $ PEFMIT �
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
N
1
N
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M
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FEES
$ 3
�l ��G� oi ooQa��iz-000a��.i2 �s�.,�s
DATE� 07/13/E9 TIME� i0�E5
E3.�Q
� - � � .. {'' � - `' ` Y �• . .
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CONSTRUCTION AND PLANNING • � POOL ' �A
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
1.-?emporary Electrical Service or Pole 52. Pool & Equipment Location ,
2. �Soil Pipe-Undrgrnd. 53r Steel Reinforcement �
3. Electrical CondUit Utility-Undrgrnd. 54. Forms ��)
�
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding �-'�
5. Steel Reinforcement 56. Rough Plumbing & Preswre Test "-j �
6. Electrical UFER Grnd. n 57. APPROVAL TO COVER-GUNITE ``
7. Footings � 58. Electrical Conduit-Undrgrnd. ,�
8. Foundation ,c 59. Gas Pipe, O Undrgmd., Test �'�+�
9. Warer Pipe-Undrgmd. ��� 60. Backwash Lines, P-Trap, � Undrgrnd. 1
��
10. Structural Floor System i1 ' 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. Sewer Cap �+� Y 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final �
14. Rough Plumbing' � 65. Electrical-Final
15. Rough Electric�l-Conduit 66. Solar Sysiem-Final
1'6� Rough Electric Wiring 67. Fencing & Access Approval
1,7� Rough Wiring Sign 68. APPROVED FOR PLASTERING
18� Rough Electric2l-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 Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ 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 HEAITH DEPT. REQUIREMENT
31. Plaster Brown (;oat � 79. FINAL INSPECTION
32. Electrical Power Mete'r-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
a
43. Backflow Irrigation •;+
44. -Landscape Irrigation'System t �` '
45. Sound Attenuation E;'. i� l�t c ���
46. Handicap Regulations ncomp u
47. FINALSTRUCTURE&BUILDING Uate � - � �
. 48. Special Requirements Completed
49. Eleciric Release to Edison - .
50. Gas Release to Southern California Gas Co , ' �-'� ��
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51. CERTIFICATE OF OCCUPANCY "
i;
No. Date --
., � ! 0�2
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX it7 C08TA MHHA. CALIFORNIA
Fo► Applicant fo Fill In Complefe►y
� TYPE OR PRINT
ORES$ yz8 EME,�'n�v . ST�c� j
�COSTA MESA, CALIFORNIA
0 MAIL
Newport Blvd.
ich, Calif. No'646-9341
. Tobey ryo �HY4698`
1320 Carmelita, Laguna Beach
�oR Cape Series Inc.
504 No. Newport Blvd:
Newport Beach, .Calif.
FEE RECEIVED
NOY 2 7 1963
" FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMR
BUILDING
� For Offiee Use Only
APPROVEO
LEOAL
LIC.TNO. �LlL�� ' ryp' v�V-7��1 90'TOSIDEBREARF
S'ZE 2g, 33 x 51.08x31.3� NO.OFBLGO� ��o�„fio
oF Lor rvow on wr
YARD9 APPROVED
USEOF 11One MAINBUILDING
EXISTING BLO6.
, � ( FROM C/L�S1T�REfiT)
BETBACK LI118 FROM_ _ _ ���� ' �'�J�y FRONT I//FT.
a
[� U56 OF BU
LfiFT O I RI6HT O
DESCRIPTION OF WORK
I II I II
.ft. NO.OP 5.
R(]AMfl
1 HEqEBY ACKNOWLBDOE TNAT 1 XAVe RE�O TH�B APPLIGTION
•NO BTATE THAT TH8 �BOV6 IH CORRECT AND AORE[ TO COM�
PLY WITH ALL CITY OqDINANC69 AND BTAT6 LAWY P[OULATINY
BUILOINO CON8TRUC1'ION.
31GNATUREOR�'�Z. S' �� S' G�G
PERMITTEF �)�, n
AUTHORIZ6DA6fiNT ii�% �'"/��i�l„�i/
ZONING
BHALL BE LESS THAN
YARDSAPPROVED
ACCESSORY BUIL�IN6
owre
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425 ec. �. �
TXE �MOUNT eHOWN UNDEH VALUATION IB FOq THE F
PUFPOSE O!� E6TABLISXINO A pERM�T FE6 ONLY. Q
VALUATIOpN m
�j3� jp1.2S PERMITFEE $ j
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