HomeMy WebLinkAbout115 BROADWAY - Building Permits • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITU OF COSTA MESA CONSTRU TION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO.-
Protect Address /�Sf��20�e?o 4y �/ ,�
Applicant's Mails Address TYPE OF CONSTRUCTION U NEW LJ ADD U g1 E.B•iITION. U REPAIR I I•''CO I I Inn icy: (i
❑ CONVERSION ❑ DEMOLISH ❑ OTHER��6tf5KlC- 'Sn a c• n
Owners N me .' "' �FQ a -O Phone A•P•# 4 a S--- 4 Si --•l( I zone C
.-y �t T DESCRIPTION OF WORK/USE OF BLDG.
e Addre P/U''2M 3/OE na a in/ �I S Main Building: Accessory Building:�J� ,,�,J
T G��GZ� S7`C�(�.Lx/ O
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION 0 STRUCTURAL Front
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear 1'6 /I N
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r n A �,/ ff �XCr•la
n/f�, a/� a ❑ BOTHER /-���+C O'!/✓N/s/iG ,may-•
Contractor's Name�•�� / t JC , ,�,Q.y,`t,. hon�� C Right i N
Address Imai ling/+3-3° "Ti�i. '��AD - YO/✓ eev/G PROJECT DESCRIPTION Sq. FT. ocCUPANC-Yy/` \ - K Left G
'36,-.70 CONSTRUCTION TYPE VALUATION$.? 7 Ot) $
City License No. (/ b ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION IL _ Ping. Ref. # Parking R.eq./Provided
I hereby affirm that I am licensed under provisionssand Charter 9 (commencing Remarks: Pc -4 aLko x-35 Planning Notes: , .fit//J mGNe1`Z/Y7L�/1W � 0M
with section 7000) of Division 3 of - Ines Professions Code,and v xr ^ �7 /-1/y�`✓� �s ,,/
my license is iri 'M fo{ae an• 'Beet. /�7� �t��ii df/> Pa)1 /D' ln,?:/ • S
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License Class C-� v :— License / fit
4
ate MA- Signature /���.- PLUMBING • FEES
/ORKERS'COMPENSATION DEC k-:yp)'ION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate o consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab�,,cj) C Automatic Washer Transformer 0 15-50 KW
Policy Nor r r0a 333 6r 0ompany/ "V eras..-4,73 Backflow Irrigation Sewer Cap - 0 50+KW
9 Construction Pole Sub.
Certified copy is hereby furnished.
ertif ie c py i}tiJed_wAp the city Bu, g r, Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
EXEMPTION FROM WORKERS'COM- NS• ION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amds
(This section need not be completed If the • mit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel -
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 Drinking Fountains Solar Tank Fan Motors 00-1 HP Di%-8
Workers' Compensation Laws of California. _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.'NOTICE: If,after making this declaration, you should become subject to the — - - Inc.Solar 08-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or P
county which requires a permit to construct,alter improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW
any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
• 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
penalty of not more than five hundred dollars ($500).
D I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3 (
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES - -
License Law does not apply to an owner of a property who builds or improves d --
I thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES EQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑
_
//_'�- �7C
sale, If, however, the building or improvement is sold within one year of com- Canopy Type II ElZoning Approved By -'-- Date ii—d-
Diction,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By is----- Date I I-1U-V )
prove for the purpose of sale).
D I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By l--- Date ��� y9 G
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 Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUM ARV OF FEES
builds or license s thereon,t and who contractsc 'sfor such projects). withwa coat •are•
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMI• $
proof of their Worker's Compensation Insurance should be pror this to me. PLAN CHECK $ = P ' ,IT
0 I am exempt under Section B. 8. P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers �� �.UAN .-
PLUMBING $ 1� AA t
i Date Owner Heating System& Ducting Registers PLAN CHECK 25% ttsIV/S�!TL ( i��41- i
I hereby - t at I have r ad th application and state that the above ❑0100,000 BTU 0100,00087E - ELECTfl ICAL $ ��til�a 11= 1, C'
Informati•n Is co ct. I agree to co ply with all city and county Ordinances ��
and state laws r. . Ing to build' construction, and hereby authorize repre- • PLAN CHECK I'. $ . J,11 C O
sentatives of s city to e r he above-mentioned proper f �� CC_
I inspectbn)•,•_•• �y - Date~�� MECHANICAL $ =•�' TOTAL�Eiti $ /
Signature/
Drivers' Lic.- or SS# [ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Ile
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CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor -
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CONSTRUCTION AND PLANNIN. L &SPA
APPROVALS Permit# Date Inspector 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 '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, 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
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 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 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 A _2- 4 NS
48. Special Requirements Completed `f Ott t-I - _
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49. Electric Release to Edison -•
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date _