HomeMy WebLinkAbout2186 AMERICAN AVE - Building Permits�
Applicant ta fill in all spaces exce0� those wit�in heavy borAe� Iines antl sign all app�opriate tleclarations.
�ci7YOPCOSTAM A CO RUCTIONPERMJ�
. PrqectAddress ��g� ��0/Y Fi07n G
`Qpplicant's Mailing Adqress
Ou�her's Name r�%��/J414-• ' PhoneS �U'3G[;.0
Addr�s �/�
Arch/Eng. icens o. b` i
Address
� ,
Contractor's Name Phone ry'i-�.J3 3
Address (m�'1'n�l 37 .� 3i. S-F.
Ciry License No. Y%�� �>! .
LICENSED CONTRACTOR DECLARATION
1 hereby atfirm tM1at I am licensed untle� provisions oi Charter 9(commencing
with section ]000) of oivision 3 ot the Business antl Proiessions Cotle, antl'
my license is in full torce antl effect. ,
License Class License No.
Da[e Signature
WORKERS' COMPENSATION DECLARATION
'`ereby affirm that I M1ave a ce�titicate of consent to self-insure or a CertifiCate
Norkers' Compensation Insurance, or a certifietl coOY thereof (Section
0, Lzb. CJ
Polity No. ' Company
8 ceriifietl copy is hereby furnishetl.
Certifietl copy is filetl with the city Builtling Division.
Da[e APPlitant .
E%EMPTION FROM WORKERS' COMPENSATION DECLAR TION
(ThissectiOn neetl not be completetl it the permit is or one h tlred ($300) or
less).
I certity that in the pe�formance of the wo�k ' h th' pe�mit is issued, I
shall m[ employ any pe�son in any manner a o wmE Subjec[ fo [he
Workers' Comqe n ai,'on Laws Of Cali(omia.
Dale /j' ��+%S�`� Signa[ure
'NOTICE: If, after makin9 this tleclaration, ho Itl become subject to tne
Workers' Compensation provisions of tM1e Labor Cotle, you must forthwith
comply with such provisions or thi5 ermit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENG �
I hereby affl�m that there i5 a tonstruction lentlinq a9ency for the per(o�mance
of the work for which this etmit is issuetl (Section 3097 Civ. CJ
Lentler's Name �/V��
�entler's Atltlress
OWNER BUILDEN bECLARATION �
I hereby altirm that I am eaempt from the Contractor's License Law for the
following reason (Section �031.5 Business antl Professional Cotle: Any city or
county wbich requires a permlt to con5truct, alter, imp�ove, tlemolish o� repair
any st�ucture, p�lo� to its is5uance, also �equires the applicant fo� such permit
to tile a si9netl slatement that he/she is li[ensetl pu�suant to the provisions ot
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
^bision 3 of the Business antl Prolesvons Cotle) or that he/she is exempl
ef�om antl the basis for the allegetl exemptiOn. Any violation of Section
l.5 by any applicant (o� a permit subjects the aOP��cant to a civil
alty of not more than five huntlretl tlollars ($500).
Ll I, as owne� ot the p�ope�ty o� my employees with wages as their sole
mmpensation, will tlo the work, antl the s(ructure is not intendetl or of(e�etl
for sale (Sec[ion 7044, Business antl Protessional Cotle: The Contractor'S
License L.aw tloes mt appty to an owner of a property who builtls or improves
thereOn, antl wM10 tloes such work himself/he�selt or through his or he� own
employee5, prOvitletl that SUGh improvements a�e not intentletl or offeretl Por
Shce. It„howeveq the builtling or improvament is soltl within one year ot com-
pleE�on, tM1e owner will have the burden of proving he/she tlitl not builtl or Im-
prove tor the pu�po5e of sale).
❑ I, as owner of the proper[y, am exclusively contracting with licensed con-
tractorst8 construct the project (Section 7044, Business antl Professions Cotle:
' The Contractor's Litense Ldw does not apply to an owner of property who
. builds or improves thereon, antl who contracts for such projects with a con-
tractor(5) license pur5uant to the Contractor's License Law). I am aware tnat
proof of Iheir Wo�ke�'s Compensatlon insurant¢ shoultl be provi0etl to me.
❑ I am exempt untler Sectlon�— B. & P. C. for tnis reason
//
Date
I hereby certity tha
intormation is corre
dptl SIdi2 IdWS (Eld 1
sentatives oi thi ci
Inspection purp es
Signature
Drivers' Lic nse r Sd
CMF 0865-46, rev. 30/84
itl this application antl state that the above
� compty wlth dll city antl counry ortlinances
n9 construction, antl hereby authorize repre-
r upon the abOve-mentionetl p�op erty fo�
. /_n_�
�/S3
TVPE OF CPNSTRUCTION LI NEW LJ ADD L.J ALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTR L❑ P MBING ❑ MECHANICAL
❑ �OTHER ����7'
PROJECT DESCRIPTION SQ. FT._,yC��C.% ocCUa.arvCY
n�_�_m
CONSTRUCTIONTVPE � VALUATION$
ZONE GRA�INGCU.VOS. A<
Remarks: � � 1„ � , � �J��i
Bar Sink
Backflow Preventer
Backflow Irrigation
Ba[htubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspec[ion Fee � $15
Boiler
Duct - Under Ground
Duct - S[ructural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVFact.81L IC80 #
Heating System & Duccing�
❑aioa,000 aru Oioo,oao
Reinspection Fee
White - 9uiltling; Canary - Applicant; Plnk - Accountin9; Goltlenrotl - A55¢ssor
$15
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
laue Fee
Hood or TYPeI ❑
CanopY Typell ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Iwue Fee
FEES
$ 3
$ 3
A.P. #
S Main Building:
E
T Front
A Rear
C Right
K Left
$
Ping. Ref. #
Planninq Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
O utlets
Switches
Garbage Dispoul
Generator �0-5 KW
Zone
Accessory euild
Parking Feq./Provided
ELECTRICAL
' Transformer ❑ 15-50 KW
❑ 50+KW
� Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors �0-1 HP O1 %- B
Inc.Solar �9-15 HP 01fi-15+
Microwave
Pole Light
Sign
; Standing Sections
5-15 KW Trash Compacmr
FEES
Z
O
N
1
N
G
F
E
Q
M
T
S
� Reinspection Fee �$15 � � Issue Fee ' $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Dato
Appliwtion laued By Dat � 2 �
SU MARV OF FEES ��^�
BUILDING PERMIT $ �� SMIP $' ��/
PLAN CHECK $ PERMIT '
PLUMBING $ ' ISSUANCE $
� PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $' GRADING $
PLAN CHECK � 50% $ � � MICROFILM $ T
MECHANICAL $ TOTAL FEE $ �' Sv
PIAN CHECK 25% $ � .
' CQ,�ISTRUCTION AND PLANNING POO' 'PA �
Date Inspector Date Inspector
APPRQVALS Permit # APPROVALS 1 .: #
" 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
.2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3.�.Electrical 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 Undrgmd., Test
9. Water Pipe-Undrg�nd. 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System 67. 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
16. 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#
21. Ducts, in Structure 70. Underground Hydro -
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush
24. Roof Framin �
9 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. �nsulation - 7S. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electriral 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 pomesticFinal -
42. Backflow-Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �� 88
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release io Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date �
r
�---
. ����o
COSTA MESA BUILDINGSAFETY DEPARTMENT
P. O. BOX 317 COBTA MEBA. CALIFORNIA
Fo� Applieanf fo Fill In Complefely
TYPE OR PRINT
COSTA MESA. CALIFORNIA
Baker St.
�ARCHITECf Caz'1son.MiddlebrookTe�.
Dike & Colegrove, Inc.
1$33 Baker St.
OF LOT W$ 1�9 I NO. OP BLDG9
NOW ON LOT h�ne
U6E OF
EXI6TING BLDG.
68TBACK LIN6 PROM [
Cermx oP STHeeT �> � REAR YARD 9�,
SIDE YARD I LEFT S� I RIGHT S� �
DESCRIPTIOM OF WORK
NEW I 6 II ALTFRATION I II Gf]I]ITI[fN I
NO. OF
� attached earaee (txo livir� units.
� �E RECEIV ED
n � FEe aot�°c
; A/j F�IVANCE DEPT.
F/ APPLICATION Fc�ItjYrERMITOSTA MESA
BUILDING
For Offiee Use Only
R¢GHIPT NO. PERHIT NO.
RECF�VEO 0Y
u�
COSTA MESA.
APPROVED
ZONING
zoxe xo. oF I use oF n
R�4 PUNB 2 BUILDING
LEOAL
ccexren uH¢ er.�
Gar. ltL�l sq. ft.
atiti gir •
1 HEHEBY RCKNOWLED6E TXAT i XAVE READ THiB APPUGTION THE AMOUNT 6HOWN UNDER VALUATION 18 FOR THE
NND eTATB THMT iHE ABOVE IB CORPECT AND A6REE TO COM- pURPOBE OP EBTABLIeHINp q PEqMIT FEE ONLY.
PLY WITX ALL CIT' ORDINANCE9 AND BTATE LAW9 R86ULATINO
Bu1tDINo CONeTRUCT10 VALUATION
BIGNATURE OF ///� PERMIT FEE � 37��
PERMITTE �� 18.50
s 17,979.90 pLAN CHECK $
AUTHORIZED AGENT Dike & Ci e�rove. T1iC.♦ •