HomeMy WebLinkAbout2216 PACIFIC AVE - Building PermitsCITY OF COSTA MESA '. ,
CONSTRUCTION PERMIT ' '
Project Address - �/ �� -
APPlitant's Mailinqly�resf .S� ������'!� � /� N�
Owner's Name ��G �'h'� U�%% PhOn¢ V�
Addreu ��y �� �� f%� �5 -
Arch/Eng. �6� ��"ei`� LicenseNo. 2��
Addreu�' � � � ��%
� �Vif�3 ��c vnone �ui/3
Contractor's Namo
Addreu (mailing) '� �%�'� �G�
City License No.
LICENSED CONTRACTOR DECLARATION
1 hereby. aftirm that 1 am Iicensetl untler provislons o( Charter 9(commencing
with seclion ]000) of Divislon 3 of the Buslnass antl Professions Cotle, antl
my license�is in fuli force antl effect.
�Icense cipss ryo. �Gn�
--te ' /2� r'�r 5'g t
i
RKERS'COMPENSATION DEC ION
ereby affirm that I have a certifica[e Ot conunt to selt-insure or a certlfiwte�
of Workers' Compensation Insurance, or a certlfied mpy thereof (Sectlon
3800, l.db. C.��&yZ38�B ��j'y/�Wr '
POlicy No. Company
❑ Certifietl copy is her¢by fUrnisnetl '
� Certitied c3o�yi; tlle,{� with the cl�A�iilfh�
Date G4� � APPlican� S
EXEMPTION FROM WORKERS' COMf�E ATION DECLHRATION
(This section neetl not be completetl if the permit Is for one huntlretl (E300) or
I¢ss).
I certi(y that.in the performance of the work for whlcn tnis perm�t Is Issuetl I
snall not employ any person in any manner so as to become sub7eci to t�e
Workers' Compensation Laws of California. '
Date Si9nature
NOTICE: If,iattermakin9 this tleclaration, you shoultl�become subject to the
Workers' Compensation provisions of the Labor Cotle, you must (orthwith
comply witn such provisions or this permil shali be tleemed revoked:.
CONSTRUCTION LENDING AGENCV -
I hereby affirm tnat there Is a construction lentling agency for the pertormance
of the work for which t7iCp��15 i55uetl (Section 3097 Civ[ C.)
Lentler'S Name r�� �
Lentler'S Atltlre� �uG �%e' �—
OWNER BUILOER DECLARATION ' � - " ' • ^ �
I hereby, atfirm that I am'exemp[ from the Contractor's License L.aw for the
following rea5on (Section 7031.5 Busine55 antl Profe55ional Cotle: Any city or '
� county which requires a p¢rmit'f0 cOnstruct, alte�, improve, tlemolish.o� repal� �
�any st�uctu�e, p�io� to Its I55uanca, also requlres the ap0���ant to� Such permi4
;...,file a Sign¢tl Stalement thdt h¢/She IS Ilcen50tl pufSUant t0 the prOviSions of�
.„-"Cdntractor4 Licensa Law (Chapter 9(commenang with Sectlon 7000) of
�-y�slon 3 of the Business anG Professions Cotle) or that he/she I5 exempt
�•Brefrom antl the basis for the alle9etl exemptlon. Any violation ot Sectlon
� 7031�.5 by any applican[ for �a permit subjects the applicant lo a civil �
� enalty of not more than tive M1undretl tlollars (E500). �
'� I, as owner of the p�ope�ty o� my emplOyees with wages a5 thei� sole �
comPanzation' will.tlo the work, antl tho s[ructure iz not intentletl o�offered
Tor sale�(Secfion ]044, Business an❑ Protessional Cotle:'The Contrac[or's �
Llcense law tloes not apply [o'an owner of a property who builtls or improves .
thereon, antl who tloes such work himsel(/herself or lhrou9h his or her own
employees, provitletl lhat such improvements are not In[entletl or offeretl for
Sal¢. If, hOwever, the builtling or improvement IS Soltl wit�in one year'of com- '
pletlon, the owner'wlll have the burtlen ot provin9 he/she tlltl not bulltl or im-
�rova for the purpose o( sale). �
I, as owner ot tha prOperty, dT excluslvely contraCling with IiG¢nietl COn-
tractorstb <onstruct the,Project,lSection 7044,.Business.antlProfesslons Cotle:
-The Contractor's LICanSe Law does not apply to an owner of property who
builtls or improves thereon, antl who contracts tor such projects wlth a con-
tractor(5) Iicense pursuant to the Contractor's Licenu Law). .
❑ I"am exempt untler Sectlon ! B. & P. C. for this reason �
Appllcant to flll in all spaces axcept those within heavy Cortler Ilnas anE slgn all aOG�oDrlate Eeclarations.
. PERMIT NO. � TRACT NO. LOT NO.a . BLD . .
Date Owner �
I hereby certlfy that I have rea0 this applicatlon antl state that tha above ,
InformatlOn is mrrect. I a9ree t0 compl�with all Uty antl counb ortlinance5
antl%state laws rei �, b Itl' �i{Tuttion, antl hereby authorize repre-
cnntirNoc or rn�lcltv�� n tha ahn�w.mwnflnnan nrnoerN for �
�'� ' �
TYPE OFCONSTHUCTION LJ NEW LJ ADD.LJ ALTERATION. U-REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT I_I GRADING LI FOUNDATION I_I �STRUCTURAL
❑m�—TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
�oTHER OC�J
PROJECT DESCRIPTION 5q. FT. oCCVPANCV___„
CONSTRUCTIONTYPE ' VALUATION$//,/SD[
ZONE GRADING CU. VDS. ACRES_
Remarks:
�
Preventer
Irrigation
iking Fountains
�r Drains
�r Sinks
Service ' Outlets
Sink
�
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors �
Solar Piping
Solar Tank .
Swimming Pool w/Spa
Urinal � '
Warer Closet .
Water Heate�� �
WaterService
Q
' Roof,Drains " � ' " '
. i
�Reinspeaion Fee � $25 . ' • Issue Fee � $ 3
. , MECHANICAL , FEES
eoiler � �
Duct-Under�Ground�� ,
Duct-Struc[ural �
Duct - Ventileting �
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO �k
Heating System & Ducting
❑0.100,000 BTU �100,000
Signature � �ate ' - ' - ' . �
, Drivers' Li <c ae ' Reinspection Fee �$25
rev. 12/83 White - Builtling; Canary - APpliwnt; Pink - Accounting; Goltlenrotl - Assessor
Hood or, Typel ❑ ' � •
Canopy , Type I I ❑ , •
Refrigerafion SYstem
❑0.100,OOOBTU Ot00,000BTU
System Repair/Alteration ' �
�� laue Fee � $ 3
A.P. qW
S. Main Building:
E
T Front
B Pear
A
C Right
g Lett
Ping. Ref. #
Parking Peq./Provided
Use of Building:
Planning Notes:
Automatic Washer
Cooking Unit
Dishwasher
Dryers �Gas C
Fan
F.A.U.
Fixtures
Device Boxes
Outlets '
$WitChes ,
Garbage Disposal
Generator �65
Electric
� Roinspection Fae
PUBLIC SERVICES REQUIR
ZoninB APProved BY .
• BuildinBiAPPraved By —
APDlicatiOn IUUBd BV
0
7525
3/acr/S/c�
Zone
Accessory Bui
Park.Fees $
ELECTRICAC
Transformer ❑ 15-50 KW
❑ so + Kw
Meter �up to 100 amps
Meter ❑over 100 amps`
Sub Panel
Momrs�ai HP��i%-8
Inc.Solar �9�75 HP OtE15+
� Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compactor
$25 luue Fee
MENTS:
' ' SUMMARV O�FEES � �
. BUILDING PERMIT $ � SMIP
� PLAN CHECK $ �� PERMIT
� PLUMBING $ ISSUANCE
� PLAN CHECK 25% ,$ ' ENEflGV P.C.
' ELECTRICAL �$ GRADING
PLANCHECK 50% �$ MICROFILM
MECHANICAL ' $ TOTALFEE
�� PLAN CHECK 25% $ � .. .. , �
29.37 Tl.
0
�
FEES
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CONSTRUCTION AND PLANNING . � " - PO- SPA - . _ �-.
:��
- Date - Inspector ' � ' ' l' � � - � .. .'Date Inspector �
� APPROVALS Permit# _ . 'APPROVALS 'Permit.#' _ . -
' i. Temporary Electrical Service or Pole , 52.. Pool & Equipment Location � � -� _ �
. 7i Soil Pipe-Undrgmd. - . 53.' Steel Reinforcement - , _ �-, � . -" - � '
3: Electrical Conduit Utility-Undrgrnd. ' � 54. Forms � ' ' . -,
��� 4. Electrical Conduit-Undrgrnd. � ' � 55. Electrical;8onding - - �� _ -
5. Steel Reinforcement 56. Rough Flumbing:& Pressure Test � � •'.i �
6. Electrical UFER Gr,nd. - 57. APPROVAL TO COVER-GUNITE, : , �- „;
7. Footings - 58. Electrical'ConduitUndrgmd. -
. 8. Foundation � �. 59. Gas Pipe, O Undrgrnd., Test' '
9. Water Pipe-Undrgmd. , 60. Backwash, Lines, P-Trap, O Undrgrnd. -. . �
r
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 .
t
13. Roof Drains � 64. Piumbing System -,Final . � , � , �
14. Rough Plumbing ' � 65. Electrical-Final •- � - - '
- 15. Rough E�ectrical-Conduit � � ", � - 66., Solar SYstem-Final ' -; , '
16. Rough Electric Wiring . --i 67. ��Fencing�& Access Approval � - � � � .
17: Rough Wiring Sign , ' 68. APPROVED F.OR PLASTERING ' • -
' r.
78.-Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS�FINAL -- �• }
19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT. - ' `� �'
20. Rough�FactoryFireplace ' ; APPROVALS Permit# - f
21. Ducts, in Structure � , 70. Underground Hydro, -• i� � �
�22„ Ducts, Ventilating 71. Product Piping O Gas ❑ Oil .'
23.' Gas Pipe-Rough & Test 72.� Undergroun8 Flush � � ' ; �
'2 :. 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. FI',RE PREV. FINAL � '-
30. Drywall Nailing . � H�ALTH DEPT. REQUIREMENT '
31. Plaster Brown Coat � . 79. FINAL INSPECTION ' '
, 32. Electrical Power Meter�Final � 80. FOOD CERTIF�ICATE ISSUED � ; �
33. Final Electric � Notes: � !
34. Final Heating & AirConditioning � . � .
35. Final Gas Pipe-Test � - ' - . � - ,
. . . . 1 ' � I _. i ' ' . 7 . '. �'
36. Hood or Canopy , � � , . �� 1
37. Final Factory Fireplace , , � ' . , •
38. Final Plumbirig � ' , • � , . � � , � . -
39. Water Service-Final . ' � . ' . , , �
40. Gas Service-Final , ' ��
41. Solarpomestic-Final � � ' -, --, - .- � - _ �
42. Backflow Preventer� , _ , . __ . � : ,. _- •�
43. 8ackflow Irrigation � :. _ � � ' •
44. Landscape Irrigation System � . � . �
r , .
.45. Sound Attenuation� � ' . _
��46. Handicap Regulations � , � � ' i � � - �
, 47. FINAL STRUCTURE & BUILDWG g� ' , � � . ; �� '
� 48. Special Requirements Completed i , i � � ' ' � ` '
49. Electric Release to Edison � - �� , �
j �
50. Gas Release to Southern Ca�lifornia Gas Co ' � � � � , �� , . � . �
51. CERTIFICATE OFOCCUPANCY - ; ; - ,- � - � � ; � - • � � ' , �
No. - �Date� � - - ._. i _ -. . . - .. -
owNER �ack Thompson
JOBADDRE55 2247 Pacific Ave
GENERAL CONTRACTOR E. & G.
AP �o. LOT T
I, :CTIONS
so��
Gn5
WnTEA
ROUGM PWMBING
PROP. SWR. LINE Q MOUSE CON.
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGM HEATING >NO 41R CON�ITIONING
TEMPORRRV SER`1�CE OR POLE
UN�ERGROUN� [�I POWEF �
pOUGM WIRING
TRENCHES FORMS STEEI REINF.
FLOOR SYSTEM '
BONo BE�M STEEL REINFORCE
SHEPTMING
FRAME AND FL45HING
LNTNING — �N OUT
PLASiER, 9ROWN COAT
5' '�TURAI, FIN4L
1 NG. VENT., AEFRIG. r1ND A.C., FIN�L
PWMBING. FINRL 4N0 G�5 TEST
ELECTRIC, FINLL
BWLOING. FINAL
DATE �
BUILDING PE
SUBCONTRACTOR
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COSTA MESA BUILDINGSAPETY DEPARTMENT APPL[CATION FOKSTRU�TIIR'A"L PERMIT 5.50 TL'
Y.U.6UA ICVV I�VJINIYICJN�l�N41fVn1VIMDcvcv
RECE BY PERM�T
For Applicant to Fill in Completely — Use Ink Only
BUILDING 2 �/��/) A.P. NO. �a� �O� �
ADDRESS �� V
BUILDING
OWNER OR ADDRE55
TENANT
UNIT OR
MAILING � SPACENO.
ADORE55 TjE.NS4� LOiO BLK.
TEL (p
CITV N
NEW ADD ALTER REPAIR MOVING DEMOLISH
CANSTRUCTION
LEN�ER
BRANCH
ow SD
ADDRESS VALUE �
ARCHITECT TEL. USE l 5
OR ENGINEEfl
J.,'
ADDRESS ' 20NE TVPE "GROUP
APPROVED �
CONTRACTOR BV DATE 7
ADDRESS � I�i�J�O
TEL.
CITY N -
L C NO.� Z�� I� C Z LICYNO. QPPROVED SETBACKS
SIZE NO.OF BLOGS (FROM C/L STREET)
OF LOT NOW ON LOT ONT FT.
USE OF
EXISfING BLDG.
Separate perrtilts are required for L SIDE FT.
electric, plumbing and heating work: REAR Fr.
USE OF BUIIDING AND WOFK TO BE PERFORMED PLANNING ACTION
DATE
APPROVED
. nmaoveo R % .7
I hereby acknowlatlpe that I heve reatl this appllcation antl ztate °i
�
that the above informetion is correet and epree to comply with
all laws repuleting builtlinp construction, and I shall not amploy �
any person in violaiion of Me workman's compensation laws o1 d
Me State of Californie.
m
1 hareby ce�tify that I am praperly licensatl es e eonttecior under SQ. FT. N
the State of Californla Business end Protessions Cotla, Dlvlsion 3, THE AMOUNT SHOWN UNDEF VALUATION IS FOR m
Chapter 9, antl thei suc� licenses are In full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt from tha Orovisions of the Stete of Callfornia Buslness VAIVATION PERMIT FEE S ^ q
antl Professions Cotle, Division 3, Chapter 9. Q O in
SiB�ature of � E�e.i. PLAN CHECK $ `^
p�/(�LA� �
Permittee ��e ��� $�/%/ � TAX E f
o� � ``2�J�—� Cyr l / V
Authorizetl Agent Date v TOTA� PAID E �