HomeMy WebLinkAbout3024 COOLIDGE AVE - Building Permits. .,�� _. _. ,'� � -- - ._ . .. AGplicant to fill in all s0aces exttpt t�ose within �eavy borCer lines,antl si9� all aDP�oDriale Eeclarations.
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� CITY-0F�COSTAMESA �NS •RUCTION P�R�MIT ' PERMYLNO. _. . TRACTNO. , LOT�NO. UNITNh. ' i
Project Addresi ��a� � V � � �'74.� �
; . 33 ,, � �iiAh-
Applicant;s Mailing Address ' ,_
1 �
�p '' Owner's Name � A Phon�� .�� �
`b � Address , %✓� p ,
� Arch/Eng.� , LicenseNo.
iAddress ' `
\ Contracmr'sNam Phone�7a-.3�7D
� ' AddresslmailingllS.33 IAI �/A�NiJ�i/ �n�tie�i�», 9�,�ai
1
Ci ty License N o. .S�/3 k '
LICENSED CONTRACTOR OECLARATION �
1 hereby affirm�that I am'licensetl untler,provisions of Charter 9(commencing
/\ with section 7000) �oi Division 3 ot the Business antl Profes5ions Cotle, antl
'� my license is in full torce a tl effec .
,� • i�ense Class _ - � 'cenjp N���� � �
I ie // /� O 5'9 t r /1
O..ORKERS' COMPENSATION DECLARATION �
I hereby atiirm that I have a certificate of consent to self-insure or a certiticate
ot Workers' Comp�e/n/sation Insurance, or a certifietl mpy the�reot^ (Section
3800, Lab. C.)Oid ��i ��f/VG/i� -f�(/Jl
Poliry .No. ' Company
yn !,,�er[ilietl copy is nereby fumishetl. �
G ce� itietl C py 1 file0 with the city tling Di Isi n.
oate }/—/'�'F� .aooiican�/��/N���1
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is (o� one huntlretl (E100) o�
Icss). � .
I certify that in the performance of the work ior which thls perm�t is issuetl, I
shall no[ employ any person in any manner so az to become subject to the
Workers' Compensation LawS of Calitomia.
Date Signature -
NOTICE:It,aftermaking�[his tleclaration, you shoultl become subject to�the
Workers' Compenxation provisions of the Lzbor Cotle; you must torthwith
comply with such provlsions or thi5 permit shall be deemetl revoketl.
CONSTRVCTION LENDING AGENCV �
1 M1e�eby afti�m that [here is a mnstruction lentling aqency (or the perPormance
of the work for which this permit is issuetl (Sectlon 3097� Civ. CJ
LPntler's Name
Lentler's AEtlress - - - -
OWNER BUIL�EH DECIARATION -
I nereby af(irm that I am exempt from the ConVactor's Licenze'Law (or the
followinq reason ($ection ]031.5 Business and Profe55ional Cotle: Any city o�
county wnich requirez a permit to construct, alter, improve, tlemolish or repair
�.ny structure, prio� to Its issuance,'also requi�es the applicant tor Zuch permit
o file a signetl statemenf that he/she is Ilcensetl pursuan[ to th¢ prOvisions of
the ContractoYs �icense Law (Chapter 9(commencing with Section �000) ot
-Division 3 of�the Business an0 Profe55ions Cotle)'o� tnat Ite/she is exempt
therefrom�antl �the basis tor the alle9etl ezemOtion. Any violation of Section
70315•by any applicant tor a permit subjecis the applicant to a civil
: enalty'of not more than five huntlretl tlollars ($500). '
� I,.as owner ot the+property or my employees with wages as their sole
compensation, will do the work, antl the structure is not intentletl or otferetl
fot( sale� (Section']044, Business anC Profe55ional Cotle: The ContraGtor's
� License Law tloes not apO�Y to an owner of a property who builtls or improves
'thereon, antl who tloes.such work himself/herseli or through his or her own
employees, provitletl [hat SUCh improvements are not intentletl oc of/eretl tor
Shce. It, however, Ihe builtling or improvemen[ is soltl wlthin�one y¢ar of com-
-�pletion, the owner will have the buraen of proving he/she tlitl not builtl or im-
. prova for the'purpose Ot Sale). � ' �
❑ I� a5 owp¢I of.Ih¢ pIOPEIty, dT ¢%ClUsiv¢ly COOtldCilflg WI[h IiC¢nSCtl'CaO-
t�actorsto construcYthe'project (Section �044, Business antl Professions Cotle:
� The Contractor'S'License Law tloes not apply to an owner ot.property who
builtlz or impwves [hereon, antlj,wM10 contract5 for such profects with a mn-
t�acto�(5) licenie pursuant to the Contractor'S License Law). I am aware tnat
' proot, ot their Worker'S Compensation insurance shoultl be provitletl [o me:
' L7 I'am exempt untler Section � B. & P. C. for this reason -
Pate ' Ownei � � �
I hereby.certify that�i have reaa this application antl state that the above .
information is correct. I agree to compty with all city antl,county ortlinances -
�antl State laws relating to builtling constructlon, antl�hereby authoriie /epre-
sentatives of t �city to enter� pon above-mentionetl property for
� r ac � i u a� _ -� ' -� _ --
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH � OTHER _ _ _ _ _
DESCRIPTION OF WORK/USE OF BLDG. ' �
TY,PE OF PERMIT GRADING' � OUNDATION STRUCTURAL �
�❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER . _ _ �
PROJECT DESCRIPTION Sa.FT. oCCUPANcv
.CONSTRUCTION TVPE VALUATION $
ZONE - �GRADINGCU.VDS. ACRES
Remarks: ' � � ,
Bar Sink . . ` .
eackflow Preventer �
Backflowirrigation
Bathtubs '
Clarifiers � - - �
Dishovdsher' ' -
Drinkin9 Fountains
Floor Orains �
Floor Sinks
Gas Service Outlets
Kitchen Sink — -
Lavatories
P-Trap
Roof Dreins -
Reinspection Fee • 9
Boiler •
�uc[ - Under Ground
Duct - Structural
Duci - Ventilating
Exhaust System �' Multiple 0�
Firepl/Fact. BIt. ICBO #
Heating System & Ducting �' �
❑0.100,000 BTU � 100,000 BTl
' Inspe<tion pyi'p'ofQ,� � �� 1 Date �'�'/�"o �
p SignaWre /� ��� � . � ' '
�rivers' Li Reinspec[ion Fee $15
CMF OB65-46, rev. 10/84 Wnite - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor '
�Showers ,
Service Sink '
Sewer Cap
Sewer Connection
Solar Collectors �
Solar Piping
�Solar Tank
Swimming Pool wlSpa
Urinal
.Water Closet �
�Water Heater
Wacer Seryice
Auto-Wash .
LaundrY Trays ,
laue Fee
Hood'or Typel ❑
Canopy 'Type I I ❑ '
Refrigeration Sys[em
❑o-ioo,000sru ❑ioo,000eT
SVstem Repair/Alteration�
Fire Dampers � �
Registers . . ^ -
Issue Fee - � $ 3
A.P. #
S Main I
E
T Front
B Rear
A.
C Right
K Left
S
Ping. Ref.
Planning P
ing:
�_ " _ "_ , _ '__ ___ _
� � �9385 12/29/86 �
, _ ... , , ,
; .
��
- .. 1 __ _ . �__ L. ' .ZOne ..
' ' �Accessory�Building: ' ;
� t / �
Parking
' � I „ � = ELECTRICAL� �, .' � . �
Auromatic Washer . � Transformer .� �15�50 KW, :
Gonstruction�PoleSub. � � _ , �, � _� 50+�KW ',
� Cooking.Unit ' Meter��Lpto.100amps j
Dishwasher ' � � - Meter ❑over,100amps �
� Dryers ❑Gas ❑Electric � Sub Panel ' -
Fan Motors �0-1 HP � 1 X'� 8�
F.A.U. �- � Inc Solar 09-15 HP 016-15+
Fixtures • Microwave
' Oevice Boxes ' Pole Light �
Outlets . � Ran9e � t
' $WIICfICS . _ . . . _ . $19n y ' _. .. � -_
Garbage Disposal Standing Sections �
'• Generator �0.5 KW �5�15 KW Tresh �Compacmr °
t
• ._ _. . . .._.__ . i. _ .._ _.. . .._
I
� Reinspection fee $15' Issue Fee ' � .
DEVELOPMENTSERVICESREQUIREMENTS: . '- �
2oning Approved By � � �ate _
Building Approved By � � Date_
i
Appliration luued By ' Date � Z
5.00 ,TL
�
� U
� N
"' I
1 N
G
R
E
Q
M
� T
S
FEES
�
'; � . ' . SUMMARV OF FEES r . • - _ �
, BUILDING PERMIT $ . -SMIP � $
� PLAN CHECK $ �' PERMIT � � _ � �
. PLUMBING � $ -� / P"� ISSUANCE' �-� $ �
PLAN CHECK • 25°k $ ` � ; ENERGV P.C. $ - �
E�ECTRICAL � $ ' .GRADING . $ '
- PLAN,CHECK 50h� $. ' ' ' , �MICROFILM . $ ��� �
,. MECHANICAL $ ` : ' ,TOTAL F,EE $ 5 ' �
. PLAN CHECK 25% $ -� � , .
CONSTRUCTION ANDPLANNING � POOL&SPA � � � �
APPROVALS Permit # - Date Inspector AppROVALS Permit # ;: Date Inspector
�: 3
1. Temporary Electric0l Service or Pole 52. Pool & Equipment Location ! ' �
� 2. Soil Pipe-Undrgrnd�. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgmd. � � 54. Porms � � ��
a. �
r .: . -
4. Electrical Conduit-Undrgmd. � � � 55. Electrical Bonding ' , �
5. Steel Reinforcement -- 56. Rough Plumbing & Pressure Test l! � � �
6. Electrical UFER Gmd.� 57. APPROVAL TO COVER-GUNITE ���
i
7. Footings , • ;. . � 58. Electrical Conduit=Undrgrnd. � ' � i
8. Foundation � � . , ' 59. Gas Pipe, � Undrgmd., Test `�t� � � .
�.�
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 � '
72. Sewer Cap �' � . 63. Heater & Vent-Final
1,3. 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 PLASTERItUG•
� 18. Rough Electrical-T Bar Ceiling� ` -. " 69. POOUSPA SYSTEMS FINAL
19; Ro'ugh Heating & Air Conditioning � . FIRE DEPT. REQUIREMENT �
�20. Roughi Facto'ry Fireplace � � � APPROVALS - Permit # �
21. Ducts, in Structure 70. Underground Hydro' `
22. Ducts, Ventilating_ . � . . � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush ,
24. Roof Framing - � 73. Undergrnd. Storage Tank � 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 CERTIF_ICATiE 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 .� Z.o-?j7 LE� -
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 Southem California Gas Co � '
51. CERTIFICATE OF OCCUPANCY . � � . .
No.� � � Date � � �
� �OT 2 TRACT 428�
. . '�6�6�
�STA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA M88A. GALIRORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING G
ADDRESS
COSTA ME&A CALIFORNIA
.. _ ..KFNNETH W. KO,tL . i
IaooaFsc 1�iF�i Pi arFNTIA
:ft IVUrvc rvo. -------
_'________'_"____'____'_'____
A
STATE . TEL.
LIC. NO. NO.
SIZE NO. OP Btoce.
OF LOT �(%(� � X � Qn � I NOW ON LOT �%
USE OF
EXI6TING BLDG.
6ETBACK LINB FROM �/ It 1 �
CENTeR OP 9TxeeT O REAR YARD 1
61DE YAR� I LEFT �� O� I RIGHT � O�
DESCRIPTION OF WORK
+ SFNO. OF
� SF ROOMS:- �P STOF
ROOF ROCK
JCCO ICOVERING
AND WORK TO BE PERFORMED
FEE ��E���VED .
°' FINA�CE OEPT.
eiTr oF c��a �+Esa
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
RHCEIPT NO. PERMI � �.
BY I DAT�/ fEG�4"ED //I ,yT`/ ! �
i �..
Iv'
COSTA MESA. CALIFORNIA
ZONING
ZONH I NO.OF I UeE OF NLry/ %/�
� � PIAN9 Z— BUILDINp��_y-�_
L�;
�aA�e,e,,,,N !at L 9 T.z y z�d�
LINB BT.) /
`.�'� -3 FT. �
Id FT. -_
3 a F�.
/r � Fr. ���'Y
:O,
�����a DATE /
A�
/ �L �d� .
I`
�'T-NEREBY ACKNOWLBDOE THAT 1 HAVE RGD TH19 APPLIGTION THE AMOUNT BHOWN UNOER VALUATION IB FON THE
AND BTATE THAT THE ABOVE I6 CORRELT ANO AGRBE TO COM-
PURP08E OF EBTABLIBHINO A PERMIT FEE ONLY.
PLY WRH ALL CITY ORDINANLEB ANO BlATE LqWg {�GUTATING
Bu1LOINo cONBTRurnON. VALUATION -
SIGNATURE OF . PERMIT FEE $�� r
PERMI7TE $ �, q�-/ r� � 7 >
l� PLAN CHECK S�/. S�
AUTHORIZED AGENT � G� , t�
TOTAL FEE // �