HomeMy WebLinkAbout221 BROADWAY - Building PermitsAoa��cant to till in all spaces except enoze within neavy eoraer Ilnes antl sign all avvroo/�ate aeclaratlons.
CITV OF COSTA E n. ONSTRUCTION PER IT
Project Address � �"���� _
,' Applicant's Mailing AMddress �(��
Owner's Name '"f Phone�J��
Address � � C1�
Arch/Eng. License No.
Address —
Convacror's Nam d h ne ��
Address (mailing)
City �icense No.
LICENSED CONTqACTOR DECLARATION
I M1ereby aHirm that I am litenzetl untl r p�ovisio 5 of C�arte� 9( mmencing
with section 7000) ol Division 3 of e Busin itl rofessim Cotle, antl
my license is in tull orce a ect. ,/�//
Licens 'las i nse u ��
Date � _ Si9na[ure
WORKERS' COMPENSATION DECLARATION
1 he�eby allirm that I have a certilicale of consent to selt-insu�e o� a certitlCate
o/ Workers' Com0en5allon Insurance, or a certlfietl mpy lhereof (Se ion
"900, Lab. C.
licy No. �� �1'� Comp ny
�Certilietl copy is hereby furnishetl.
Ceryi�ieqieo�y�sji}etl wi[h the tlry B i ing �ivi n.
Date Y � �� Applican[
EXEMPTION FROM WORKERS' COM EfJSATION ECLARATION -
(Thissection neetl not be completetl if tne permit iz for one huntlreE (S100J or
I¢55�.
I certity that in the per/ormdnCe of Ihe work fo� whic� thls pe�m�t is issu¢tl I
shall not employ any porson in any manner so as to become su0ject to t�e
Workers' Compensation Laws of Calilornia.
Dat¢ Si9natur¢
NOTICE: H, alte� making this tlecla�atlOn, y0u ShOultl become Subject to the
�Workers' Compensation provisions of the labor Cotle, you must (ortnwilh
comply with suCh' p�ovi5ions o� this Oe�mit shall be tlGEmetl revok¢tl.
CONSTRUCTION LENDING AGENCV
I nereby aflirm thal there Is a construclion lentling agency for Ihe per�ormance
of the work for whi<h this permit is issuetl (Section 3097 Civ. C.)
Lentler•s Name
�ender's Atltlress
OWNER BUILDER DECLARATION
I hereby afiirm lhat I am exempt from the Contractor's Litense Law for the
tollowing reason (Sectlon 7031.5 Business antl Prolessional Cotle: Any city or
county wM1iCh requi�es a pe�mit to const�uct, alter, Improv¢, tl¢moliSM1 o� �e0air
any struclure, prior to i[s issuance, also requires tne apP���ant tor such permlt
lo tile a si9netl slalement Ihat h¢/sh¢ I5 Iicense� pursuant to lhe p�ovi5ion5 Ot
tne ConVactor's Licentt Law (Chapter 9(commencing with Se<tion ]000) of
Division 3 ot tne Business antl Professions Cotle) or that he/she is exempt
the�etrom anA lhe ba5i5 fOr Ihe allegetl exemOtion. Any violdtion ot Sectlon
]031.5 by any appli<ant for a permit subjects [he applicant to a civil
+nal�y o/ not more than five huntlretl tlollars (E500).
� I, as owner oi the property or my emoloyees with wages as their sole
_ompensation, will tl0 Ihe wo�k, antl the S(ruGtu/e I5 nOt in[entletl or off¢�¢tl
IOr Shce (5¢CtiOn 7044, Busine55 antl PrOfessional Cotle: Th¢ COn[lactof'S
License Law tloes not apply [o an owner of a property who builtls or �mOrovez
lh¢reon, antl wno tloCs such work ttimselt/n¢r5ell or IhrOugh nis or ner own
employoes, provitlatl tnat sucn improvements are not intentlea or o/(eretl tor
sale. H, noweveq the builtling or improvement is solC within one year of com-
pletion, the owner will have the burtlen of proving he/she tlitl not buila or Im-
prova for Ihe purposa o1 sale).
❑ I, as own¢r Of lhe property, am exclusivety Con[ractlng wl[h licensetl con-
Vactorsto conztruct tne project (Seccion ]044, Business antl Ro�essions Cotle:
The Contractor's Litense Ldw dOCs not apply to an owne� af property who
builtlz or imoroves tM1mmn. antl wM10 mnVactz br such oroieclz wLLh a r. -
tra<tor(sl bcense pursuane [o me ConVactor�s LlcenSe Law). I am aware tM1at
proot J( lheir Wo�ker'S ComOensatlon in5uranC¢ shoultl be provl0etl to me.
❑ I am exempt untl� Section—� B. & P. C. for thi5 reason
Date Owner
I herGby cer[ I [bat p v¢ rea�
InfOrmation is C rrect :1 ree to
antl state law lalin ld uiltlir
sentatives o/ s Uf to nter
inspettlon pur es.
Si9nature
Drivars' License or 55 � —
0865-46, rev. 5/88
tate that the above
tl county ortlinantes
by authorize repre-
�rnea yg[o�oer vJ��tD[�
oate�_f
� � � `�' I I I r
OFC�NSTRUCTION NEW ADD ALTERATION REPAIR
CONVERSION ❑ DEMOLISH ❑ OTH R �
SCRIPT.ION OF WORK/USE OF BLDI'..,. �1�%^ �' J' T� �•�"--
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. FT. OCCUPAN V{—
CONSTRUCTION TYPE VALUATION $.y�yL�
ZONE GRADINGCU.VDS. AC13E5_
P
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinkin9 Foun[ains
Floor Drains
Floor Sinks
GasService Outlets
Kitchen Sink
Lavatories
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer ConnectiOn
Solar Collecmrs
Solar Piping
Solar Tank
$wimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundrv Tra'vs
A.P. �W
S Main Buildi
E
T Front
-B Rear
A
C Ri9ht
K Left
S
Ping. Ref. #
Planning Notes:
FEES P.uromatic Washer
Construction Pole Sub.
CAoking Unit
Dishwasher
Dryers ❑Gas ❑Elec��
Fan
F.A.U.
Fixtures
Device Boxes
OuUelS
Reinspection Fee I $15 I I Issue Fee I $ 3 I
MECHANICAL FEES
Duct- UnderGround
Duct - Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. iC80 �k
Heating System & �ucting
pai oo,000 sTu O i oo,000
Reinspection Fee � $15
White - Builtling; Canary - Applicant: Pink - ACCOunting; Goltl¢nrotl - ASsesm�
Hood or Typel ❑
Canopy Typell ❑
Fiefrigeration System
❑4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � 5 3
zone
Accessory Bu
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel '
Momrs 00.1 HP 01 :S- B
Inc. Solar 09-15 HP 01G75+
Microwave 1
Pole Light �
Range
Garbage Dispoul
Generetor �65 KW 05-75 KW
S[anding Sections
Tresh Compactor
Fea � S15 � � Ittue Fea
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB APProved By
Building Approved By
Applimtion Issued By
FEES
$ 3
N
I
N
G
R
E
4
M
T
S.
SUM �Ap/ V/ �FEES . �
BUILDING PERMIT $ �=1— SMIP $ �
PLAN CHECK $ PERMIT '
PLUMBING $ ISSUANCE S
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING' $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ �
PLAN CHECK 25% $
0
�' CONSTRUCTION ANDPLANNING
APPROVALS Permit #
7. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit�Undrgrnd.
5. Steel Reinforcement
6. Elec2rical UFER Grnd. '
7. Fdotings . '
8. foundation .
9. Water Pipe�Undrgrnd. ��
70. Structural Floor�System
11. Property Sewer Line & House Cannectian
12. Sewer Cap .
13. Roof Drains ' •
14. Rough Plumbing -
15. Rough Electriczl-Conduit
18. Rough Electric Wiring
17. Rough Wiring Sign
`I8. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power.Meter-Final
33. Final-Electric
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 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
151. CERTIFICATE OF OCCUPANCY
Date
0
�
Date
r�u�o �
Inspector qppROVALS Permit#
� 52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. .Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System � Final
65. Electrical-Final
66. SofaT System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. ProductPipingOGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe �
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. F000 CERTIFICATE ISSUED
Notes: Oa I Z�'°� K-+-O A GCCS �
Date �Inspector
.
0
�`ow�
,� JOE
GEI
� AP
iNs�
� soii
� GAS
ER
W ATER
FOUGH PLUMBING�.y
PROP. SWR. LINE � HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGM HEATING ANO AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNDEftGROUND � POWER �
ROUGH WIRING
TRENCHES � FORMS � STEEL REINF.
FLOOR SYSTEM
BONO BEAM ❑ STEEL REINFOFCE �
SkEATNING
FRAME AND FLASHING
LATMING - IN ❑ OIIT n
PLASTER,BftOWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST �
ELECTRIC, FINAL
B111L01NG. FINAL
DATE
SUBCONTRACTOR
9_30_i
PERMIT
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32297
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
SFP 30-70CM5A00 769 �*****5.00
APPLICATION FOR BUILDING PERMIT
For Applicant ro Fil! in Completely
RECyEIV D DATERECnEIVED DATEISSVED
BUILDING /1� � wA �/ ` �^ /U 9��d^'JU
ADDRESS (;/
7 i'7/J_ /O PERMFTjA{0.,�
OWNER e12CM A.P. NO. � �rf �� /l�i
MAIL eUILDING
ADDRESS ADORESS
/� rfA �� N��' �/ TRACT�% LOT BLOCK/J
CITV wy�
CONSTRUC710N ,_� W ADD A R R P
IENDEF �/ �/
/� /'
BRANCH �
OWNER �,
ADDRESS � VALUE N
ARCHITECT TEL. S $ DO/
OR ENGINEEIi � N . �"
FIRE �
ADDRESS � ZONE TYPE GROUP
APPROVED y / 'j,Q_ � D
CONTRACTOR — BV )/y�DATE �
v—
l '
ADDflESS
TEL. ZO E NO.OF USE OF NEW )
CITV NO. — — P�NS � BUIL ING
STATE CITY �'ARDSAPPROVED VARDSAPPROVED
LIC. NO. ^ LIC. NO. — MAIN BUILDING ACCESSORV BUII.DING
SIZE I 4 , /�q �• NO.OF BLDGS. (FROM C/L STREET)
OF lOT �O'� 'X 3�/ _/ NOW ON LOT '3 FRONT T. FT.
VSE OF a�
EXI5TINGBLDG. ./jN E T. FT.
$IZE OF NO.OF
NEWBLDG. — FOOMS —' STORIES — L.SIDE FT. FT.
EXTEFIOR WALL ROOF
COVERING COVERING — REAR FT. FT.
US OF BVILOING AND WORK TO BE PERFORMED� DISTANCE B BET. MAIN &
CC �'I'hT/ tr MAIN BLDGS. ACCF.�. BLDGS.
VAR.# DATE
�d%//�1DO:a3S C.U.P.# APPROVED
APPROVED O„
I hereby acknowledge that I have read this application antl state
that the above information is corract antl agree to comply with
all laws reg�lating builtling consvuction, antl I shall not employ _
any person in violation ot the workman's compensation laws of
the State ot Calitornia.
I hereby certify that I am properly licensetl as a contractor untler SQ. FT.
the State ot California Business antl Protessions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl that such licenus are in tull force antl effect, or 1 THE PURPOSE OF ESTABIISHING A PERMIT FEE ON�Y:
am eaempt irom the provisions of the State of California Business VALUATION �,.�`
antl Protassions Cotle, Division 3, Chapter 9. pERMIT FEE $
Signatura ot
Permittee $ `'�'00 /'N PLAN CHECK $ —_
c% / �
Authorizetl ABent �—
TOTAL FEE $
i
OWNER KELLY� JEft�
�; GENERAL CONTRAC
• AP No. 117-172
INSPECTIONS
SOIL
J
�
ROUGH HEATING ANO AIR CONDITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
iRENCHES � FORMS � STEEL RE
FLOOR SYSTEM
BOND BEAM � STEEI REINFOftCE �
SHEATHING
FRqME AND FLASHING
LATHING - IN n OUT n
PLASTER, 9ROWN COAT
STRUCTtIRAL, FINA�
HEATING, VENT., REFRIG. AND A.C., FI
PLUMBING, FINAL ANO GAS TEST n
ELECTRIC, FINAL
.,����..�.�� ��.�.. A.._
DATE 7-10-72
BUILDING PERMIT N0.
FYy�lj1[HJ
SUBCONTRACTOR
� .. �„_,.F.:�00 7��:: t:���:�5.01
34943 �'
COSTA MESA BUILDING-SAFETY DEPARTMENT .
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
A L ATION FOR BUILDING PERMIT
For Applicant ro Fill in Completely
BV DATE RECEIVED DATE ISSUED
ADORESS oc.�) /�Q/Q�CI.R '� �^
OWNER ��O M K. E(., {., A.P. NO. I- '�' �� RMIT J^ O
4 7
BUILDING
Z AODRESS �.2 / AO{.✓A .>DDRESS ��R�
a U CITV e0 S TI� /i E SA NOL ��- G� TRACT -/ y LOT/p BLOCK
2 Q CONSTRUCTION � W A P
O N LENDER
am
J � BRANCH � /�
J � OWNE c201Lt c= (� �/-�
m J AODRESS �"' /w� �/ VALUE
J Q ARCHITECT � TEL. �QL%�fAi%�(O/� �% (�C$ O•
N OR ENGINEER N
V Q FIRE ��
W� ADDRESS 20NE TVPE ROVP
a W APPR
W Z CONTRACTOR — BV ATE � d�
�O
mZ
J ¢ ADOFiESS �
Q W TE� _ ZONE • NO.OF USE OF NEW ((U'r("R(C �
Z� CITV .� NO. I P�'� � BUILDING �_ �/��
0 STATE CITY � �'ARDSAPPROVED VARDSAPPROVED
y 2 UC. NO. .�- UC. NO. MAIN BUI�DING ACCE55 V/�UILDING �
7O SIZE p � NO.OFBLOGS. (FFOMC/LSTPEET) ���
OFLOT �� G �r�3�L�� / NOWONLOT RONT T. /'n
USE OF /� /�
EXISTING BLOG. I'i�G� � (L ICE • Fb'. FT
H SIZE OF NO. OF
Q NEWBLDG. ROOMS STORIES L.SIDE FT.
U EXTERIOR WALL FOOF
COVERING COVERING REAR F. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED
a ( I M//II AT E N T�,e�u, ,v.c�s MAIN BLOGS T. Bn T. AI LD�.
a
Q VAR.3W DATE
Q �� / �CNE�, C.U.P.# APPROVED
� APPROVED � �//��Z
N
Z "
O STq
UI �er¢by acknowletlge [het 1 have reatl this application antl state
� thai the above into�mation is cOrrect antl egree to cOmply with '
� all laws regulating builtling consttuction, antl I shell not employ
F any Oermn in violation of Me workman's compensallon lews of
y Me State ot California. �
zI hereby certify ihat I em properly licensetl as a contrettor under �Fr �
ihe State ot California Business antl Professions Cotle, Oivlslcn 3, THE AMOUNT SHOWN UNOER VALUATION IS FOR �
Chaptar 9, antl that such licenses are in full force and eftect, or I TME PVflPOSE OF 6TABLISHING A PERMR FEE ONLY: m
em exempt from the provisions of the Sta[e of Calilornia Business ¢
end Profazsions Cotle, Division r hapter 9. VALUATION ..�c�_ ry
PERMR FEE S �
Sipnatura ot � /� � m
Pe�mittae � $ 1�� PLAN CHECK $ E
r(' � �%� `p
Authorizetl Agant �� LL
. TOTAL FEE $