HomeMy WebLinkAbout3136 COOLIDGE AVE - Building Permits'�
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AOPlicant to (ill In all spaces exceot those within neavy boreer lines antl sign a1l aoD/ooriate tleclarations.
Ci7v oF COSTA MESA /[�;ONSTp')UCTION PERMIT
Project Address � � � 4' �O C/� / (fG � /�./� '
Applicant's MailinLg Addrenu`I �'�/�+��) [^ ��/ `
�WnCl�S Ndm¢�/ "��^ "1 /`!i(l� PFnnnJ�J U ✓
Address � �J �`�� O� ��G'�= �
Arch/Eng. License No.
Address
Contractor's Nam ' Phone
Address (mailingl
City License No. �
LICENSED CONT ACTOR DECLARATIO
I her¢by affirm that I am licensetl untl¢r provisions ot Charter 9(commencing
with seclion ]000) ot Division 3 of the Business an0 Professions Cotle, antl
my Iicense is in full force antl effect.
License Class License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION
I nereby affirm that I nave a certificate ot consent to selt-Msure or a certlflcate
of Workers' Compensation Insurance, or a certifietl copy thereof (Settion
3800, Lab. CJ .
'.licy No. Company
�Certifletl mpy iz hereby (urNshetl. �
Certitietl copy is tiletl wiih tne cily Builtling Oivision.
oace Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be mmpletetl if the p¢�mit is fo� one huntlretl (§300) or
less).
I cerlHy that in the pe�fo�mance of tM1e wo�k t wM1ich Ihis p¢rmR is i55u¢ I
shall not employ any pe�son In any man e as to bec rt10 subject t itne
Work C mPens i n LawS of Cpli(Omi �
bate �l� Sigriatu2
NOT C: I, fter' a cii ng'[his tleclaia( , you s Itl bec me subject to the
Workers' Compensafion provi5ion5 of he Labo Cotle, you must forthwith
comply wltM1 such �p�ovisions or this permit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
1 M1ereby affi�m tnat there is a construction lentling agency to� the per(ormance
of the work for whic�h�tpi �,p¢rmlt is issuetl (Section 3097 Civ. C.)
l.antler's Name E1 O V[ '
i
Lentler's Atltlress
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exemp[ troT the ConVactor's LiCanSe Law tor tne
/ollowin9 reason (Section ]031.5 Business antl Professional Cotle: Any tity or
counry wnic� requires a permi[ to construct, alter, improve, Cemolish or repair
any struciure, prior to its issuance, also requires the applicant for such permit
t0 fil¢ a siqnetl statemen[ thdt he/she Is licensetl purSuan[ to tb0 Provl5ion5 of
the Contractor's License Law (Cnapter 9(commen<ing with Sectlon �000) of
Division -3 of-[he Business antl P�otes5ion5 Catle) or Ihat he/she Is exempt
f�om antl the basis fo� the allegetl exemp[ion. Any violatlon of Section
031 5 by any applicant (or a permit subjects the applican[ [o a civil
oenal y of not more than tive huntlretl tlollars (E500). , '
n,-will tlo the wo�k, arltl the s[ructu�e is not Intentled Or otle�e�
or [ion 7044, Businesz antl Professional Cotle: The Contractor•s
License Law tloesnot apply to an owner of a property who builtlsbr Improves
[he�eon, antl who tloes such work M1lmselt/herzelf or through M1B nr ner own
¢mploy¢es, provitletl that such imP/ovements are not in[¢ntletl o� offeretl tOr
sale. If, hOweve�, the builtling o� Improvement is so10 witnin on¢ year ot com-
pletlon, the owner will have the burtlen of proving he/she tlitl not bWltl or im-
proveforthe purpose of zale).
❑'I„as owner oi tne property, am exclusively contracting wi[h Ilcensed con-
tractoR to mnsVuct the project (Sec[ion 7044, Business antl Profession5 Cotle:
The ConVactor'S License Law does nOt apply to an owner o1 P�operty-who
builtls o� improves tM1ereon, antl who conVatts for such project5 wi[h a con-
lractor(s) litenze pursuant to the Contracto�'s LicenSe Law). 1 am aware [hat
O�oot ot thei� Wo�ker's Compensalion insurance shoultl bo provlded to me.
❑ I am exempt vntler Section B. 6 P. C. lor this reason
6ate ^ Owner� '"
I here �y certi y that I have rea is applica antl s te that the above
Information is correct. I aaree to comoN wlt II citv ana countv ortlinances
y � Si9nature—^r�?_'_' --�',�l'
�� Drivers' License o 55 � �''—
`\865-4fi, rev. 30/84 Wnite - guiltling; Canary
,� - Z6 ZS2
TYPE OF CONSTRUCTION
❑ CONVERSION ❑ 1
DESCRIP.TIDN OF WOR
TVPE�OF PEHMIT
❑ TENANT ❑ I
❑ OTHER �
PROJECT DESCRIPTI
CON STRUCTION
ZONE
Remarks:
GRADING
54.
0
J ADD LJ ALTERATION LJ REPAIR
OTyE M A.P. #
%���� 7 � �' /
S Main Buildi
OUNOATION STRUCTURAL T FrOnt �
JMBING ❑ MECHANIGAL B R¢2f
1i � �
�uC� l 3 n
( OCCUPANG C Rlght �
� vALUA7lON 5 3� 9� g left �
GRADING CU.YOS. ACRES ping. Ref. #
Planniny Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bath W bs
Clarifiers .
Dishwasher �
Drinking Fountains. .
Floor Drains
Floor Sinks
GasService 'Outlets
I n tercepmrs
Kitchen Sink .
�avatories
P-Trap
Roof Diains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Sirucwral
Duct - Ventilating '
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑a i oo,000 eTu O i oo,000 sr
Reinspaction Fee
Plnk - Accounting: Goltlenrotl - ASSe55or
515
Showers
Service Sink
Sewer Cap
$ewer Connec[ion
Solar Collectors
Solar Piping
SolarTank �
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
0
Isue Fea
Hood or .Typel ❑
Canopy Typell 0
Refrigerotion System
❑o�ioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
2��5� I I/ I 4/ 86
� S �.�
. � Accessory Building:
�
/
Aummatic Washer
Construction Pole Si
Cooking Unit
Dishwasher -
Dryers ❑Gas ❑E
Fan
F.A,U.
Fixtures
Device Boxes
OuUets
Switches
Garbage Dispoul
Generator OP5 KN
lectriC
ZOf18
ELECTRICAL '
Transformer �� 15�50 KW
❑ SO+KW
Meter �up to 700 amps
Meter ❑over 100 amps
Sub Panel
Motors 00.1. HF � 1'h - 8
Inc.Solar 09�15 HP �16•
Microwave �
Pole Li9ht �
Sign - .
Standing Sections
15 KW Trash Compactor
73.92 TL
FEES
F
2
O
N
I
N
G
R
E
Q
M
T
S
$ 3 �
Reinspection Fae $15 luue Fee .$ 3
FEES
DEVELOPMENTSERV C SRE UIREMENTS:
Zoning Approved By� Date
- Building Approved By ' Data �� �.
Application laued By Datw
� SUfy1MARV�rc�� F, FEES . �•
BUILDING PERMIT $ �"�•' `�' SMIP �$ � S�'
- PLAN CHECK $ 2R• 9L . pERMIT � .
PLUMBING . $ ISSUANCE . $
PLAMCHECK 25% $ ENERGY P.C. S
ELECTRICAL 5 GRADING 5
PLAN CHECK 50% $ MICROFILM S
MECHANICAL $ T_'�TOTALFEE $ 73' �
�$ 3 PLAN CH�CK 25% $ "
�'f/(�(iY� � ! � f
CONSTRUCTION AND PLANNING POOL & SPA �-
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Elecirical 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. APPROVA� TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. 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 .
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Elearic 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 O Gas OOiI
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 S[andpipe
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 pomestic-Final
42. Backflow Preventer ' �
43. Backflow Irrigation •
44. Landscape Irrigation System � � ��
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING j �
48: Special.Requirements Completed � '
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cn .
51. CERTIFICATE OF OCCUPANCY�
No._ Date _ � _
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FRONT
ELEGIRICAt L1NE CLEARANCE
4N ACCORDANCE WITH STATE SAFE'
�ONS�";'�tJl�TION REQUIRES WORKERS,
OR H(;iSi'ING DEVtCES TO BE IN PRO}
ELECTRICAL UNES, OR UNDERC
FACIL( -a, c, SUU i HERN ALIF�RD
IMME IATELY (714) 895-02
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