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Home My WebLink About111 BROADWAY - Building PermitsApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT/ PERMIT NO. TR C NO. LOT NO. UNIT NO. 6649 7/15/8h 2.86 Project Address 11i l i �:3 1 �r�Ct[t II.�.V TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. FI1CA `l _4 Qj T REPAIR Applicant's Mailing �yA.,ddre55 Owner's Name fq 1n�'�% �) �er bP CA� Phone n n Address I Z.RZ f -!I tm -�Id� OC. TIJ S'i"I h ISI [ A.P.AP# �j — — �l0 Zone �n S Main Building: Accessory Building: c1 Arch/Eng. J` y License No. Address `L��-: e`L's'i f I b t LJ TYPE OF PERMIT GRADING FOU NDATIOry STRUCTURAL ❑ TENANT ❑ELECTRICAL ❑PLUMBING ❑ MECHA�r�11�C q(1J,� ❑'OTHER -1�/I �/- I PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES E T Front Z O B peat Q N ) Contractor's Name_ ` Phone 16 Address (mailing) .�y`,,'!�{j:.�S ''(CM/j� — ( City License No. . Of -3 7 � LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full rce and effect � censo N, -?,0A4;74-7 LJce la1109 Date Signature A C Right L,( l I N K S Left G R Ping. Ref. 8 _ 1.'` Parking Req./Provided Cd E 2 Remarks: •pC 1020 /� Planning Notes: M - FOR SHICIA REQUIREMENTS S ss PLUMBING FEES 1 • WORKERSI COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent o self4nsure or a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Preventer Service Sink - - Automatic Washer Transformer ❑ 15-50,KW Backflow Irrigation Sewer Ca P v 1 Policy No. Company k2k Na Certified copy is hereby fu fished. 8 Certif1 co y is filed with the city Build 1pp99��Division. Date -T9 Applicant_�{�S.atnn EXEMPTION FROM WORKERS' COMPENSATI ECLARATION Construction Pole Sub. ❑ 50+KW Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors- Dishwasher Meter Clever 100 amps (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel ' I Drinking Fountains Solar Tank Fan Motors 110-1 HP ❑1''A,- 8 Floor Drains Swimming Pool w/SpaF.A.U. log -$Olaf ❑9-15 HP ❑16.15* Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Liht 9 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction landing agency for the performance of the work for which this permit I5 Issued (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater Outlets ets Range Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ;Standing Sections P -Trap Laundry Trays y y Generator ❑0-5 KW ❑5-15 KW Trash Compactor county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation Of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builtls or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- Prove for the purpose Of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner Of property who builds or improves thereon, and who contracts for such projects with a con- lractor(s) license pursuarit'to the Contractor's License Law). I am aware that proof off their Worker's Compensation Insurance should be provided to me. Cl I am exempt under Section B. & P. C. for this reason ROOF Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES flEQUIR ENTS: _ Zoning Approved By C Date Building Approved By Date Applica Issued ey Dat Boiler Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK PERMIT PLUMBING ISSUANCE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO-0 Fire Dampers Date Owner road this application and state that the above 1 hereby certify that I agree information Is correct. I agree to comply with all city and county ordinances and state laws relalln tc building construction, and hereby authorize repre- sentatives of tM1is to eqI r upon the above-mentioned property for inspection purpose s. / Signature Drivers' License or S � Heating System & Ducting ❑0.100,000 BTU ❑100,00087 Registers PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ ENERGY P $ R I Q/ T z•{�y� Y Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector . 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, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ 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 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 APPROVALS Permit# 20. Rough Factory Fireplace 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 ❑Gas Ii Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Mon000at 75. Dry Che6iical - 27. Frame and Flashing 9 76. Dry Standpipe 28. Lathing & Siding O 77. FIXED SYSTEM FINAL. 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat A 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 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed r ' 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTA M A ?n�ISTR UCTIOsN/ P/E��IIT PERMIT NO. TRACT NO. LOT NO. UNIT Nt5. Project Address /�� 4KCWD✓✓�/ i S411y,ErA Applicant's Mailing Address s630 ��"/ �U Owner's Name ZIQK,GAIZI E111 --1e9 I nnee / Address 5,;2 /127Z, /.AV Arch/Eng. License No. Address Contractor's Nam �'/2 Lvv Pho 99i� Address (mailing) 6 1)4 rB/VO �i0-vf� Q/i2 City License No. - 3, LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in 1 f tce and effect. License lass _ License N Dale Signature WORKERS' COMPENSATION DE ARA ION I hereby affirm that I have a cerlific [e of 0osent to self -in ore or a certificate of Workers' Compensation InsuranC , r a certified copy thereof (Section 3800, Lab.Ebro Policy No. s -Com ��r Certified copy is hereby furnished. Cet[iJletl opy l filed with the City Bu' ng DI ision. DateLLLI"'"Sf� -f Applicant EXEMPTION FROM WORKERS' COM ENSAT ON DELL RA N (This section need not be completed if t e per t is for one red ($100) Or less). certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of livision 3 of the Business and Professions Code) or that he/she is exempt ierefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil ralty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com. pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date I he info, and Signature Drivers' L CMF 0865146, Owner 4t 1 M1 ad this application and state that the above e t. I agree t comply with all city and county ordinances ng top ing construction, and hereby authorize repre- ity' t enter upon the above-mentioned propertyy JI rrr Date — YY—J " 55 # TYPE OF CONSTRUCTI ON LJ NEW LJ ADD ALTERATION ALJ REPAIR 1111n1 ' l 1111' 11 CONVERSION F-1DEMOLISHElOTHE ��C "^'��"' A.P. # zqo/' S— S�—/ Zone,, one /f C— DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT GRADING ❑FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL El PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION 5q. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATIONS / b S Left ZONE GRADING [CSU. YDS. ACRES Ping. Ref.+ Parking Req./Provided Remarks: ��' , /, —�� Planning Notes: L/1l1 , kiln Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO+ Heating System & Ducting C-10-1 00,000 BTU 11100,000 BT Reinspection Fee 1 $15 10184 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uto-W ash Issue Fee I $ 3 Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer Construction Pale Sub, Cooking Unit Dishwasher Dryers ❑Gas ❑Electric ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors ❑0-1 HP C1 % - B Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 110.5 KW 1:15-15 KW FEES Z O N I N G R E O M T S I I Reinspection Fee I $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENTSER Zoning Approved By - Building Approved By BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHE ELECTRIC L PLAN CHECK 5 MECHANICAL $ PLAN CHECK 25% $ Yp,F FEES L_I'— SMI, S fly ` $ E P.C. $ 1 NG $ CROFILM $ ITAL FEE $ CONSTRUCTION AND PLANNING (APPROVALS Permit# DateInspector POS s SPA APPROVALS Permit# Date Inspector /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, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ 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 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 1�9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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. Undo rgrnd. 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 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 Domestic -Final ` 42. Backflow Preventer ' 43. Backflow Irrigation ._ .. 44. ,Landscape Irrigation System - 45. Sound Attenuation - 46. Handicap Regulations , ' 47. FINAL STRUCTURE & BUILDING ( g� 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Go ' 51. CERTIFICATE OF OCCUPANCY No. Date , ER F155 -01-1-01d JOB ADDRESS 111 Broadway - . BUILDING PERMIT NO. 1070 GENERAL CONTRACTOR J. I AP# 117-103-14 BLOCK GROUP F2 TYPE const. TRACT III ZONE C-2 VALUE x16.900.00 Stores FIRE DISTRICT 992 INSPECTIONS D� gTE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench Foundation Forms and Grade -to Garages Rough Framing Plumbing, Rough to Slab G�- J r• /q /'/L •3- 2 C��1'i / J Jn'_� Plumbing, Rough Complete -.7D iewrperar7Pele U tJ t 8 -� u . C'eA. Wiring, Rough _ •,,g,-�� _ 89p Heating, Rough / ^^ sting, Final t ewer, House Sewer, St. ) ��_<... y yy.n' iS�dS Septic Tank or Cesspool La'"ing, In( Out '- F ;ring , . G401 / Plumbing, Final, Fixtures Complete Plumbing, Final Gas Test Sa-e- ' r e Wiring, Final < 7Z 2-,ao_ 0A .:w i✓ Occupancy v 66 .Form 210 G -H 15001-55 1-zrn' ,.n� � Lei 83 i4( G it 1 a � eh ib /6 ok r 6 Costa Mesa Building Department 111 EAST 20th STREET r COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN ress , =_V_, - _o Costa Mesa, rest cs St. E�� G ress ,✓!) — li) _ (� Contract.24a, L53-a. s (� Addres� C' & Legal Lot / Description I No.//t/.ZI BI 9 No.� Lic. / No_ e City No. (Attach Metes and Bounds) 7 �,/7��D3 _ i r�L S. Size of Lot �,��it �1J-. J If Now nLot oB Use of .s No. of No. of Existing Bldg. J to-rti S Families Rooms Setback Line from Rear Yard Ao iv, New X IAXPLICATION FOR PERMIT B U 91. D I N_G... _ FOR OFFICE USE ONLY cei pt Permit.No. ? /d'TO i Received by„ Date R c'd. Date Issued ildina Address Costa Mesa, California Nearest Cross St. Zone No. of I Type ,y1J� y I Group 'r - Plans 'T !' Approved I I Moving_ Demolish v _Repair Building qqqq No. of / �'/OX .S Rooms Stories -Si- I for Vypll�t' Root C. _ringCO/YC T, rt ,Covering APPROVALS Us? ldind, 9 New 6ui,,/ Foundation Location Inspector Date S7` -d -,S+ -s Forms, Materials, • Under -Pinning Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application Lath.lnt. and state that the above is correct and agree to comply Lath. Ext. with all City Ordinances and Slate Laws regulating building constr 10 Signature of G (/�I�,., Plaster, Int. Permittee i — 0 Autho iz A t. �: Plaster, Masonry Rei Reinforced Valuation ' Permit Fee $ V .. Plan Check $ 1 Bond Beam $1Z Lj 0 40— Total / Fee $ '7f� FINAL n nim 204 f, -H IM 12-63 •r�y PLOT PLAN Show location and distances from property line and between buildings. C p J � J Ci d a a �I Street PLOT PLAN Show location and distances from property line and between buildings.