HomeMy WebLinkAbout354 BUCKNELL RD - Building PermitsAVG�icant to fill in all soaees except those witnin heavy bortler Iines anE sign all aooropriate Oeclarations.
CITY OF COSTA MESA CONS7R UCTION PERMIT PERMIT NO. • TRACT NO. LOT NO. UNIT NO.
Project Address Mkt G 1,l
Applicant's Mail�ng Add es /1C� � � nJ - �-7��
�
Owner's Name �Af E Phone
Address �—'�
Arch/Eng. _ License No.
Address
Contracmr's Nam Phone �S�i- �S
Address�mailing) �3 �A�
City Licenu No. � ����P
LICENSED CONTRACTOR DECLARqTION
1 her¢by aftirm [hat I am litensetl untle� O�ovisions of Charter 9(commencing
with seclion 7000) of Division 3 of the Business antl Professions Cotle, antl
my Ilcense is in lull tp rre ntl eftect. /,
LicensG %lass `';� ��rens„�+o. 7�����
Date /I �vs -�V 5'9 t C�
WORKERS' COMPENSATION DECLAftATION
I hereby attirm lha[ I have a certititate Ot consent to salt-insure or a certificate
�t Workers' Compen5ation Insuranca, Or a certlf tl cop IhereOf (Settion
�o. �c. c.,��5�21c!lol
��cy No. Company _ r
��w}}..�Cartifletl copy I5 hereby furnishetl. � �A /I
'l�E Cer[ifieqc y' ile0 with Ihe city q��� Division� //
6ate_ �� � Applicant L% S! �
r v�- —
EXEMPTION FRO WORKERS' COMpENSATION DECLARATION
(Thii section nee0 not be completetl if the permil is for one nuntlretl (5300) or
less).
I certify that In tM1e pe�tormance of the y,rork for whiCh IM1is pevmi{ I5,i55uetl, I
Shall mt employ any per5on in any manner so as to bagpme yr�jet[ to the
Workers)f� orQpgns ti n Laws ot Cal
Date _J.�—_LH�Signature
NOTICE: If, aitCr making tnis tleUarat�on, you sttoultl become subject to the
Workers' Compensation provisions of tne Labor Code, you must forthwith
comply wlth such provisions o� ,thi5 permit Shall be tleemetl revoketl.
CONSTRUCTION LENOING AGENGV
I h¢reby atfi�m thal th¢re is a constructlon lentllnq agency !o� the perto�mance
of [he work fOr which this permit is 'ssuetl (SeGtion 3097 Civ. C.)
Lentler's Name
Lender's Atltlress
OWNER BUILDER DECLAR ION
I hereby affirm tha[ I am exempt from the ConVactor's License Law tor the
followin9 reason (Section 7031.5 Business antl Profezsional Cotle: Any city or
county whiCh r¢quires a pe�mit to cOnStrucl, alt¢r, improve, tlemolisb or repai�
any structure, prior to its issuance, also requires the applicant tor su<h permit
to til¢ a 5igne0 Statemenl lhat he/she is licensetl pursuant [o the prOvisions ot
the Cont�acto�'S License Law (ChaPte� 9(�ommencing with Settion �000) of
Division 3 of the Business antl ProfeEsions Coae) or lhat ne/she is exempt
th¢ref�om antl th¢ basis fOr the allegetl ex¢Tption. Any viOlation of Section
'031.5 by any applicant fo�. a permit subject5 tho applicant to a civil
e0dl[y of not mo�e Ihan five huntlr¢tl dollars (§500).
❑ I, as owner of the prooe�b or my employees with wa9es as their sole
compensa[ion, will tlo the work, antl the structure is not In[entletl or offeretl
tor sale (Settion 7044, Business antl Professional Cotle: The ConVactor'S
LicenSe Law tloes no[ apply to en owner ot a property wno builtls or Improves
fharaon, anG who tloes such work M1irhsclf/herseH or IM1rou9h his or M1er own
employees, pwvitletl that such improv¢ments are not In[entled or offered for
Sal0. It, howev¢r, the bulltling cr imprry�ement IS Soltl wlthln one year of com-
pletlon, the owner will have the burtlen ot provin9 he/she tlitl not bulltl or im-
�rova for [he OurpoSe of sale).
I, as owne� oi [he property, am exclusivery Cant�acting with Iicenzetl con-
[racto�s to mnstruct the Drolett (Sectiqn 7044, Business antl Profe55ion5 Cotle:
The ConVactor's Licenze Law tloes not apply to an owner o( property who
builtls or Improves lnereon, antl wno contrac[s for such projects with a con-
tractot(51 license pursuant [o the Con(ractOr's LlcenSe Law�. I am aware that
orooi o( Ihei� Worker's Compensatioh insuran e zhoultl be provitlltl [o me.
❑ I am exempt untler Section B. d P. C. for tnis reason
Date Owner
I nereby certity that I have reai
intormatlon is correct. I a9ree to
antl state laws rela[ing [o builtlin
SQp[d[IV25 Oi t�115 CIfY IO CO CI
inspection purposes.
Siqnature
in antl Stale that lhe above
city antl county ortlinan<es
and heteDy autho�IEe repre-
ve-menlionetl %�r�op�erjt,ypf�o�r
Oate�Q.rl��
TVPE OF CONSTRUCTION LJ NEW I.J ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
TVPE OF PERMIT LJ GRADING
❑ TENANT ❑ EIECTRICAL
❑ OTHER
ALTERATION LJ REPAIR
FOUNDATION LJ STRVCTURAL
WMBING ❑ MECHANICAL
PROJECT DESCRIPTION 5(l; FT. oCGUPANCv
CONSTRUCTION TVPE VALUATION $ _
ZONE GRADI�NG GU. VDS. ACRES_
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Dishwa5her
Drinking Fountains
Floor Drains
Floor Sinks
GasService Ou
Kitchen Sink
Lavatories �
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct-UnderGround '
Duct � Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
P(repl/Fact. Blt. ICBO #
Heating System & Ducting
❑P100,000 BTU 0100,OOOBT
I I Reinspection Fae
Drivers' LicenSc or 55 � —
CMF 0865-46, rev.4/84 WM1ite - Builqjnq; Canary -Applicant; Pink -Accounting; Goltlenroa - Assessor
$15
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wacer Hea[e
Water Service
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
laue Fea
FEES
e
A.P. �
S Main Buildi
E
T Front
B Rear
A
C Right
K �eft'
S
Ping. Ref. #
Planninq Notes:
352� I2/O�/84 jo�
Zone
Accessory Building:
Z
- O
N
1
N
G
R
Parking Req./Provided E
Q
M
, T
S.
ELECTRICAL
Auromatic Washer Transformer ❑ 15-50 KW
Constructior Pole.Sub. � 50+ KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elecvic
Fan _
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW �5-15 KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motars 00�7 HP 01 %- B
Inc.Solar �9-15 HP �16-15+
Microwave �
Pole Light
Sign
Standing Sections
Trash Compactor
$ 3
Reinspection Fee � $15 luue Fea
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
2oning Approvad By
Building Approved By
_ .. . . . _ A
$ 3
F
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK 5 PERMIT
PLUMBING § �@O ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFI�M S �^�,�
MECHANICAL $ � TOTAL FEE $ �2L—
P�AN CHECK 25% $
CONSTRUCTION ANDPLANNING � •� POOL, .:A
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
7. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. � i � 53. Steel Reinforcement -
3. Electrical�ConduitUtility-Undrgr'nd. � 54. Forms
. 4. Electrical'Co duit-Uniirgrnd. � • 55. Electrical Bonding '
5. Steel Reinforcement :� � � 56. Rough Plumbing & Pressure Test
� 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER�GUNITE .�
7rFootings " '. ,' �.. 58. Electrical Conduit-Undrgrnd.
-8.�'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
11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final
12. Sewer Cap . '" � � 63. Heater & Vent-Final
i
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
79. 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 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. F,IXED 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 Notes: ,
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace
38. Final Plumbing . /���/ LE�
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
i
43. Backflow.lrrigation . .
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