HomeMy WebLinkAbout292 BROADWAY - Building PermitsApplicant to fill in all spaces excnpt thos! within heavY �o�Eer Ilnez anC tlgn all approprlala tleclarations.
Ci�Y OF COSTq MESA CONSTRUCTI N PERMIT
Projec� Address � � �1��'� `r� , _
Applicant's Maili�g qdd1res\s � 0�/ 1 .�
Owner's Name �� w' �� �--�-A � � Phone � D� "L0•
Address � � b� � arn h`�R-�O^ `-�- '
Areh/Eng. License No.
Address
Coniractor's Nam hone
Address (mailing)
Ciry License No.
UCENSED CONTRACTOR DECLARFTION
I bereby al�irm lhal I am licensetl una¢r provi5lons o1 Charter 9(commencin9
with soctlnn ]000) ol Dlvizion 3 oi tha Buslnoss antl Profeislons Cotlo, antl
my Ilcense is In iWl torco antl eflect.
License Cldss Lic¢n5¢ No.
Date Si9ndture
WORKERS' COMPENSATION OECLARATION
I nereby aHirm [hat I have a certifica[e of consent lo selt-insure or a certlfiwte
i Workeri' COmpensation Iniurance, or d Certltietl capy tnar00f (SeCtian
.800, �ab. GJ
Pollcy No. Company
BCcrlifietl copy is heroby turnishe�.
CerHfiea copy is tiletl witn the city Builtlin9 Division.
Date APPlicant .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis saction neetl nat bo complatetl ii the perml[ is (or one huntlrotl (5100) or
Iess)
I cerlily that in the petlormdnte of the wo�k for whlch t�is pe�m�f IS ISSuetl I
inall nOl �mploy any pOrion In any Ta So 5 t0 U�DQ19 Sub�Ott lo [he
Workor ompe satlon ws ot Calif Va. J
Date%�� � - `��.59nature-
NOTICE: If, atter makm9 this tleclaration, you shoul! become 5 ject co the
Worker5' Compensation provisions of the Labor COUe, you mu t forthwith
compy with sVch provi5ion5 or tnis De�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I nareby a/tirm thal lhere is a construc[ton lentling agency for the pnrtorman<e
or tne work �o� wnicn enis permit is tssuee �secuon 3ov7 civ. c.)
LenOer's Name
Lentler's Aatlress
OWNER BUIL�ER DECLAHATION
I hereby atfirm ihat I am exampt irom lhc ConVactor's Litenze Law tor the
lollowing reaso� (5oction ]031.5 Busine55 antl Professional Cotlo: Any clty or
COun�y whicll r@quifes a P<rmil l0 con5truct, altCr ImOrove, Cemollzh o! repal!
anY structure, prlor to its issuance, also requires t�e applicant for such permit
to tile a signetl atatemeN lhal he/sh¢ iz IiCen5o0 purzuanl to th¢ P�ovi5iOn5 ot
tne Contractor's License Law �Chapter 9(<ommencing with Sectlon 7000J ot
OiviSion 3 of [he Bu51ne55 dn0 Pro(e551on5 Cotle) o/ tllat he/She IS <xempt
herelrom ana ihe basis tor tne alleqed ezemption. Any violatlon of Section
031.5 by any applicant for a permit sub�ects lne applicanf [o a civil
�ey Ity oi not more tnan live huntlretl tlollars (y500�.
SG 1, as owner o/ tne O�aPerty or rn}�ertiplvyces�with wagos as thalr sole
CompanSdtion, WIII tlo tha wOrk, antl thU StruCtUlo IS nOt In[entleA Or olfefotl
lot Sal¢ (52C[iQn �044, Bu5ine55 dntl PrOlesslondl Cotle: The COntlattOr'S
License Law tloes nol appry ro an owner ot a property wtia builtls or impmves
tbereon, arttl who tloes such wo�k himsel�/hersell or througb his or bor own
employees, proyitletl Ihat such improvements are not intendetl or offemtl for
salo. If, bowever, Ihe �ulltling or improvement is soltl withln one year of com-
oletlon, the owper will nave the burtlan of o�ovin9 he/she tlia not bulltl or Im-
prova torthe p4rposo otsalo).
❑ I, as owner oi lhe property, am excluslvaly contracting wlth Ilconsea con-
tlact06 t0 Constfucl Ihe prOject ($ection 7046, Busin¢ss antl Pro1a55ions Cotla:
Tho Conlractors Licenu Law tloes not app1Y lo an owner of property who
builtl5 0� �morp�¢s tnereon. antl who cOntrattz for Such oroiec�s wIN a mn-
VdGto�(Sl I�cens¢ pyrsuan[ ro me ConHactor'S llcense l.aw). I am awa�e lhat
p�oof o� thei� Wprker'S Compensation insu�anco shoultl be p�oviGed to me.
❑ 1 am exempt untler Section �L� P. C. (ov this reason
Dato
I hereby certify that I
Inbrmatlon is correct. I
antl State lawz relatin9 I
sentatHes of th' ty
Inspectlon pu�rp i ��
Signalure �—�-\-y+
' Drivars' License or SS �
AOwner L
hav0 /eatl th
, �.,�.�. � �.... ......,. ..,,. _... .._. ..�.� � ,.... A.P. #
B 39-995
S Main Buildi
TYPE OFCONSTRUCTION NEW�-y AD� ALTERATION REPAIR E
❑ CONVERSION ❑ DEMOLISH
L� OTHER T Ffont
DESCRIPTION OF WORK/USE OF BLDG. RE rZ O O A Rear
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL I C Right
K Left
❑ T ANT ❑ ELECTRICAL ❑ PLVMBING ❑ MEGHANICAL S'
-OTHER Pln9. Ref. $
PRQIECT DESCRIPTION 50. FT. oCCUPA ��O� Planning Nocet:
CONSTRUCTION TYPE VALUATION $
ZONE GRADINGGU.VDS. ACRES
Remarks;
Bar $ink
Backflow Preventer
8ackflow Irrigation
Bathtubs
Drinking Fountains
Fioor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavetories
P-Trap
Root Orains
Rainspection Fee � S15
Bofler
Duct - Under Ground
Duct - Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVFact Bh. �CBO dk
Heating System & Ducting
❑0.700.000 BTU �100,000
Reinspoction Fea � 515
0865-46, rev. 5/88 White - Bulltling; Canary - ApPliwn[; Pink - Accountinq; GOIGenrotl - Assesior
Shawers
Service Sink
Sewer (;ap
Sewer Connection
Solar CollectOri
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Clout
Water Heater
Water Service
Auto-Wash
lsundry Trays
laue Fea
Hoodor Typef ❑
Canopy Type II ❑
Refrigeration SVstem
❑aioo,000eru ❑ioo,000eTu
Sys2em Repair/Alteration
Fire Dampers
Regiseers
Iswe Fee
$ 3
FEES
S 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Device Boxes
OuUe[5
Switches
Garbage Oispoul
Generator 00.5 KW �5-75
2one
Accessory Building:
Parking Req./Provided
EIECTRICAL
Transformer � 15�50KW
❑ 50+KW
Meter Uup to 100 amps
Meter �over 100amps
Sub Panel
Motors 00.1 HP �1 h� 8
Inc.Solar �9�15 HP �16-15+
Mivowave
Pole Light
Sign "
Standing Sections
Trash Compac[or
� � Rainspec[ion Fee '$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB APOroved By
Building AOProvad By
Aooliotion Issued Bv
SUMMARV OF FEES
BUI�DING PERMIT $ ZCi• GS SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
P�AN CHECK 50% $ MICROFI�M
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $ •
N
1
N
G
R
E
�
M
T
S.
FEES
� $ 3 �
—
te
[e�[e Z �
g •50
$
$
$
$
$ 27. / S
oi aaoi•as92-onoizs9a �oT 27.is
DATE� 08/22/88 TI17E: 1?:22
� CONSTRUCTION ANDPLANNING POG .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' 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-Un�irgrnd.
8.'Foun�iation • 59. Gas Pipe, O Undrgrnd'., Tes[
_ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Struciural 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 ElecVical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
L7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
98. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heacing & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure , 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �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. Lattiing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Cqat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � � n
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
3S. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ,
43. Backflow Irrigation �
44. Landscape Irripation System �
45. Sound Attenuation
46. Handicap Regulations y y/ � �
47. FINALSTRUCTURE&BUILDING .� �- �� ��
d8. Soecial Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co . �
51. CERTIFICATE OF OCCUPANCY • �
No.� Date '
OWNER PAYNE JOh71 W. DATE 1Z-i0-S%
]OB ADDRESS 292 BroadHay BUILDING PERMIT NO. 6Z�.B �
xs zorre
Z& J �rrnE V zo� 1
VALUE $ 7,536.00
Re
INSPECTIONS I DA7E I SUBCONTRACTOR I___ PERMITSISSUED
O
e
r
v '
- ' 62�L8
COSTA MESA BUILDIN6 DEPARTMENT
P. O. BO% 31� '
COSTA MESA. CA�IFORNIA
FOR APPLICANT 70 FILL IN
COSTA MESA. CqLIFORNIA
OWNER
MAIL e']
ADDRE55 G
GITY y0 y
ARC'HITECT
OR ENGINEER
ADORE55
�eca� LOT��_
oescAiPrioh No
A.P.NO. // ��
SIZE . — ., i A/
SIDE VARD
�EE RECEIUED
t a- - � � - s'7 -- �! l�
FINANCE DEPT.
APPL�1'CA�TI�O°N� F'0��2 PERMIT
BUILDING ,.
FOR OFFICE USE ONLY
RECEIPT NO. PEPMIT NO.
la2/�
RECEIVlO BV L�ATE FECEIVEo O
� � .,S' / �
TNo LI 8���7s1 qDORE55 �` ` ✓201Q �i W li
uG COSTA MESA. CALIFORNIA
NO.
FIRE
ZONE
TV LIC. � �ONE pLaNS TYPE ' /
NO. /` v
_ rri — _ _ _ _ _ _ APPRO�L / � .b L
CT
vo.or e�ocs.
OW ON LOT
RIGHT �/ LEPT �J /
DESCRIPTION OF WORK
NEW � ALTERATION ADDITION
REPAIR MDVING I DEMO�ISH
5 ZE OING n Y N�'�MS C STORIES
G✓ li �J
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW _ _ ,
•�•
CORR'ECTIONS
C1TY OF
—�c`['
�J�T TO
V .w PJ
A A1ESA
3C-�T'—
DEPT. REG.
_�F
I XEREBY ACKNOWLEOGE THAT I MAVE FEA� TMIS TPPLICLTION PNp // �Y �/
STl�TE THRT TNE ABOVE IS CORRECT nN0 qGREE TO COMPLY WITM ALL V
CITY OROINANCES� D 5 �J,IA�.q�ll�qTING BVILUING CONSTRUC�
norv. VALUATION �J
SIGNATURE PERMITFEE S pLO �
PERMITTEE
� r 3 /�. PLAN CHECK � �Q �
g � J ✓ fo
AUTHORIZED AGENi TOTAL FEE $ '3p� �Brs
GENERAL
DATE
BUI�
DESCRPPTION OF WOHK �
FIRE ZONE VALG
GROUP J TYPE
- SUBCONTRACTOR
25899 � ,
COSTA MESA BUILDING-SAFEIY DEPARTMENT
P.O. 80% 7200 � COSTA MESA� CALIFORNIA 926Y6
For Appl7cant fo F711 ►n Completoly
TYPE OR PRINT
IIDIN� .
DRE58 w �
COSTA MESA, CALIFORNIA
■ ARCHITECT
,. .O � V C..J ��
LI0. NO. et � l 1 O N O� S 1
6IZE No. oI �LCo�. �
OFLOT Now N
USE OF .�
EXIHTIN6 BLOO.
BETC�CH L�X[ IROY � Q �
cenisrt o� oi�[R RiAR Y D
[ �j 1
HIDB YA D L[PT � RIOHT ) a
DESCRIPTION OF WORK
� EXTERIOR
._ \
AND WORK TO
I HlREBY ACKNOWLtDOC TXAT 1 NAVQ R6�O T11�9 APPLICATION
ANO BTATB THAT TH6 ApOV6 It CORRBR�AND I10R6[ TO COM.
PLY WITH ALL CITY OROIIUNCY AND YTAT[ IAWt RtOULATIXO
�UILOIN6CON8iROCTION. / /�
�` J
SIGNATUREOr � Q �
PERMITTi� �l �� J
C lJ�'�— -
AUTHORIZiD AGQNT �.Q,
:JUL iL VV �� .�v.��
JUL 12-66 QO 50303*'���'�5.00
APPLICATION FOR PERMR
BUILDING
fOI �fIC9 {�SO �/l�
R�ct�rtxo. I fP�
ZONING
z I °°`
em�
�.co�t
YARDH APPROVHD
MAIN BUILDINO
VM. �F
' �� J ` //
6 SHALL BE LE88 TMAN
f U. B. C. RECUIREMENT'.
YARDSAPPROVHD
ACGEiSORY BUILDIN6
� ���
�% . /
��' F
BHT. MAIN Q
ACCESH. BL[
DAT6
erPllov� AT! % �' G�
a
W
�
�O BQ. Rr. �
TH8 AMOUNT BHOWN YNOBR VALUATION 19 POR TXB j
�Y0.P086 OP UT/.BLIBXINO l� PEPMIT FfiH ONLY. 3
VALUATION � �
PERMITFEE p
/� c
s 7' Z O ��� W
( �TOTALFEE $ ��