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Home My WebLink About443 BROADWAY - Building PermitsAVP��ant to till in all svaees except those wlthin neavy bortler lines antl sign all avvrovriate eeclaiations. cirV oF COSTA MESA CONSTRUCTION PERMIT Project Address �� $n��A—�� ApplicanYSMailingAddress ��(J �� — Vwne�'sl�ame W�LL�A'M �"�o��'" Phone�8' � Address ��'� B�'Qp��7 Arch/Eng. License No. Address CA Convactor's Name D(��e%�s ��' phon;��`F�S�• Addresslmailing) �g� S• )� City License No. � y lU a- LICENSEO CONTRHCTOR DECLARATION � I he�eDy atfi�m that I am licensetl untle� p�ovisions of Cha�te� 9(commencing with section ]000) of Division 3 of the Business antl Professions Cotle, antl my license is in full pr� antl eftecL 3�� License lass ��f� License No. Date ��Z " 5"g t � WORKERS' OMPENSATION DEC ARATION 1 M1ereby affirm tltat I have a certificate ot consent to self-insure or a certiticate of Wo�kers' Compensation Insu�ance, o� a certifietl coOY the�eof (Section 3800, l.ab. C tr� �{ > C_�_��D Policy No. - L,T��/` Company J rti/ietl wpy is hereby (umishetl. Cert'f@y p"s f'letl with the city${�ilcyp' ivision. Date � Applicant ��Y/L EXEMP ON F OM WORKERS' COMirENSATION DECLARATION (This section neetl not Ee com0�etetl if the permit is for one huntlretl (5300) or less). I certify that in the Oerto�m ncy� ot the wo�k tor which thls Oe�mit is issuetl, I shall noi employ any pers�tl �manner so as to become subjeGt to Ihe Workers' Compenwtion LaJrs�6f a mia. . Date Signature 'NOTICE: If, after making this tleclaration, you snoultl become suDject to the Workers' Gompensation Otovisions of the Labo� Cotle, you must torthwith compry with 5uc0 p�ovisions or thiz permit shall be tleemetl �evoketl. CONSTRVCTION LENDING FGENCV � 1 bereby atfi�m that there i5 a mnstruction lentling agency tor the Oe�to�mance ot ine'work tor which thi,E, p�r t �s issuetl (Section 309] Civ. C.) Lentler's Name T� 7�'� Lentle�'s Atltl�ess OWNER BUILDER pECLARATION I hereby atfirm lhat I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or munly which requires a permit to construct, alter, improve, tlemolish or repair any structure, prior to its issuance, also requires the applicant tor such permit to file a siqnetl statement that M1e/she is licensetl pu�suant to fhe provisions o( the Contractor's License'Law (Chapter 9(commencmg with Sectlon �000) ot Division 3 ot [he Business antl Professions Cotle) or tha[ he/sM1e is exemp[ the�efrom antl the-basis tor the all ge/� exempfion. Any vlolation of Section 7031.5 by any applicLnt to a e//�it� subjects tM1e applicant to a civil penalty of not more than five rebr�xlars (5500). ❑ I, as owner ot the �pro rty or'm4 employees with wages as their sole compensation, will tlo the work, antl lhe st�ucture is no[ int¢ntletl o� otferetl for sale (Section J044, Business antl Protessional Cotle: The Contracto�'S License Law tloes not apply to an owner of a property who builtls or improves thereon, antl who tloes such wo�k himself/hers¢I! or tnrouqh his or her own employees, provitletl that such improvemenis are not intentletl or offe�etl for sale. If, howeveq lM1e builtling or improvement is soltl within one year of com- pletion, the owne� will have the burtlen of proving he/she tlitl not builtl or im- p�ove torthe purpose of sale). ❑ I, as owne� of the property, am exclusively contracting wi[h Ilcensetl con- tractors to construct tM1e project (Section 7044, Business antl Protes5ion5 Cotle: The ConVactorR License Law tloes not apply to an owner oi property who builtls or improves thereon, antl who <ontracts for such projects wi[h a con- Vactor(s) license pursuant�[o the Contractor's License Law). I am aware that proof oi tneir Worker's eompensation insurance shoultl be provitletl to me. ❑ I am ezempt untler Section B. & P. C. fo� this reason Date Owner I hereby certity that I have reatl this application ana state that the above intormation is correct. I ag�ee to comply witn all city antl county ortlinance5 antl state laws relating to builtling [on ction, antl he�eby authorize �ep�e- sentatives of this ciry to enter upo t e above-mentionetl pr pert for inspection pur e w � � J Signature Date `Z' Drivers' License or 55 � �,��—'� �� — �'11 E I��-k I I I I-�-' TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � D SCRIPTIONOFWORK/U$EOFBLDG. �� L � � aJ �/d,�1 D fFt'12 C'_s��0� �n- CV N ,PGS i I�G..JG TYPE OF PERMIT GRADING FOUNDATI N STRUCTV RAL ❑ TENANT O�ELECTRICAL ❑ PWMBING �MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.F7. ocCUPANCv CON STRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACf3E5 Remarks: Sink Preventer Irrigation Clarifiers Dishwasher • Drinking Fountains Floor Drains Floor Sinks GasService �l1tICL5 Interceptors Kitchen Sink Lavatories Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BI[. ICBO # /Heating System & Ducting Ig�100,000 BTU O 100,000 Reinspection Fee � $�5 _. —_ .._ ... __ _._ .._.— _—___—__... _ CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Ac<ounting; Goltlenrotl - A55es5or 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 Trays Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers S Issue Fee $ 3 FEES $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: �960 4/29/db Zone Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer � Transformer ❑ 15-50 KW Construc[ion Pole Sub. � 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. L�/9jz.ef� Fixture:�8� 0�, Deviceeoxes � �� . Outlets Switches Gar6age Dispoul Generetor �0-5 KW �5-15 KW Meter LJup ro 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP I Inc. Solar �9-15 Microwave /��, Pole Light v/', Range • �� Sign � S[anding Sections Tresh Compactor Fee �$15 � � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: ZoninB APProved 6Y . Building Appraved By Aooliption luued Bv �� 8 6-15+ �z.nu 'i� FEES $ 3 Z O N 1 N G R E Q M T $ SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ S•SC� GRADING $ PLAN CHECK 50% $ �—f MICROFILM $ MECHANICAL $ l �G� TOTALFEE $ —12.`�� PLAN CHECK 25% $ CON�TRUCTION AND PLANNING �� POOL tv SPA APPROVALS � Permit# Date Inspector AppROVALS Permit# Date InspPr.ror r 1. Terriporary Electric:al 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 . � 5S. Electrical Conduif-Undrgrnd. _ � v S- Foundation 59. Gas Pipe, O Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural.Floor System . 61. APPROVAL TO DECK i t. 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 O Gas ❑ Oil 23. Gas Pipe-Rough & 7est 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 Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric S�/ �i- . r Notes: � �_ _ 34. Final Heating & Air Conditioning i��%r �' 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. �inal Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer � � 43. Backflow Irrigation 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 _ � 51. CERTIFICATE OF OCCUPANCY _ No. Date OWNLR or Pole FIRE ZONE VALUE Date I GROUP J TYPE SUBCONTRACTOR NO. . �- ?_394�4 %COSTA MESA BUILDING-SAFETY DEPARTMErIT P. O. BOX 917 COSTA MBBA. CALIFORNIA � For Applicant to Fill In Complefely TYPE OR PRINT BUILDIN6 � �U /"F U ADDRESS COSTA MESA, CALIFORNIA � USE OF M Dw��v�2 �u�C -=--�' „01 I - �4 s� � ��' x ��.��I w°w��a�oa. DESCRIPTION OF WORK CITY OF C�1STA MESA APR 29 1965 APPI�Q f� ��RMIT I �Dif�FA For Ofiice Usa Only I fl6CE1PTN0. PEflI BYPROVED�/�/}/ ¢�DATJH�/�J� Ti( /�� ZONING � ZON6 NO.OF tlBfiOpNEW L / PL�Ne� BUILOIN�np� S'VF / '/ �-�ti�� t.¢ow� �QT T 9' �i�� c.5 oescrt�rnon A. P. NO. �� 7._ �!� I— O� NOTE: NO EAVE OYERHAN6 9HAl.L BE LE55 THAN YAR03APPROVED MAIN BUILDINO � (FROMGLBTREET) � FRONT� SS� Ff. � R. SIOE �O , Ff. �_aioe� c�r. BUILDIN6 NO.OR / ( SIZE � 2 �� ROOMS ( BTORIES , EXTERIOR WALL%!�. �_ I ROOF � PI.. __ _ 7w o CA �? �� _ �i i� � � - 1 HEREBY ACKNOWLEOOE TX/�T � NAVH READ TXIB APPLICATION AND BTATE THAT THE ABOVE IB COqpECT ANO'AOqEE TO <OM� PLY WITH ALL CITY ORDINANC88 AND 8TAT8 LAWe RH6UUTINO BUIL�INO WNBiRUCT10N.^ SIGNATUREOR ��4 e �'� el i PERMITTEF a li�f}ip AUTNORI2ED A6ENT VAR. SC r_+� YARDSAPPROYED ACGESSORY BUILDING DATE THE AMOUNT 6HOWN OND� VA PUFP09E OP ESTABLIBHI O A VALUATION � PERMIT f�� g�I LA i TOTALF IS FOR FEE O F 6