HomeMy WebLinkAbout2630 NEWPORT BLVD - Building PermitsAPplicant to fill in all svaces exeeot those within heavy Doraer lines ane si9n all apvrovriate Eaclarations.
CiTY oF Co�Q MESA CONSTRUCTION PERMIT
Project Address
Applicant's Mailing Address � ' ' '
Owner'sName � i'on��r`E
Address 3i 99' A�3 Q.i�Q��yy �%�,
Arch/Eng. License No.
Address
Convac�or's Name � hone st7 /s��✓
Address (mailingl '
City License No.
LICENSED CONTRACTOR DECLARATION
I ner¢by affi�m Ihdt I am Ilcensetl untler provi51on5 ot Charter 9(mmmencing
witn� section 7000) of Dlvision 3 of tne Business antl Professions Cotle, and
my Ilcense is in full /force antl effect.
License Class y— Ucens No �� 7��
'Dale�/�R� Slgnature .
'vORKERS' COMPENSATION DECIARATION
iereby atfirm that I have a certiticate of consent to self-insure or a cerUflcate
, Workers' Compen5ation Insurance, or a certifietl copy Ihereot (Sectlon'
3800, Lab. C.) � '`�;
Policv rvo. SdCd(B'S—�?.'19605�•O�.mpanv �
rtifietl�copy is hereby /umishetl.
Certifietl cop }i filetl with [he city Building Ivisio
Date �%—�"'�4� APPlicant ��•� �����
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This seCtion neatl not be cOmpletetl it lhe peimit is f0/ one huntlretl ($100) o�
less),
1<ertity [hat in the performance of the work for which this perm�t is issuetl, I
shall not employ any'person in any manner so as to become subject to the
Workers' Compensatlon Laws of CalHomia.
Date Si9nature
`NOTICE: It, after making this tletlaratlon, you shoultl become subject to the
Workers' Compensdlion provisions ot the Labor Cotle, you must��orfhwitn .
comply wilh such O�o�isions or tM1is permlt shall be tleemetl revoketl.
CONSTRUCTION�LENDING AGENCV ' ' '
I hereby af(irm that tM1ere ii a ConStruction Ientling agency fo� the pertormanG¢
ot the work for which this oermlt is issuetl (Section. 309] Civ. CJ
Lenaer's Name �1/e�CF
Lentler'S Atltlress �
OWNER BUIIDEH pECLARATION '
I hereby aitirm that 1 am exumpt from the Contractor's License �aw for the
tollowin9 reason (Sec[ion 7031.5 Buiiness antl Professional Cotle: Any <ity or
coun[y wbich r¢quires a pe�mlt to cOnit�uct, dlt¢r, improve, Cemoli5h or repa��
any structure, prlor to its Bsuance, also requires tne applicant tor such vermit
to file a signetl statement that he/she Is licensetl pursuant to the provisions of
�he Contractor'S License Law (Chapter 9(commencinq with Section ]000) o(
ivision 3 of ihe Business antl Ptoles5ions COtle) o� tha[ he/she i5 exemOt
,e�¢frOm antl [h¢ �asis for th¢ allegetl-�ex¢mption. Any violation of $ection
.031.5 by any applicant for a permit subjects the applicant to a civil
�enalty of not more than flve huntlre0 tlollars (E500).
LJ I, az owner o( the property or my employees with wages as�thelr sole
compensalion, will tlo the wo�k, antl lhe st�ucture i5 not Intentletl or otferetl
for wie (Section Joa4, Businezs antl Profezsinnal Cotle: The Contractor's
t_icense l.aw tloes not apply to an owner of a oroperty who builtls or improves
the�eon, antl wM10 tloes Such wOrk Itlmselt/h¢rs¢If or tnrough hIs or her own
employees, provitletl that such improvements are not intentletl or offeretl for,
sale. It, however, the bulltling or improvement Is soltl within one year o( com-
pletion, the owner wlll have the burtlen of proving he/she tlitl not buIIG or im-
��ov0 tor (he purpose ot sale).
I, as owne� ot the property, am exclu5ively cont�ac[ing with liG¢n5¢tl cOn-
t�actoR to con5lruct th¢ prOject (Sectlon ]044, Busine55 antl P�ofe55lons CoOe:
The Contractor's License Law tloes not appty [o an owner of property who
builtls or improvos thereon, antl who contracts for such projects witn a con-
tractor(s1 llcense pursuant [o tM1e ConVactor'S Litense �aw). I am aware that
proof ol tnelr Worker's Compensatlon insurance shoultl be provitletl to me.
❑ I am exempl untler Sectlon , B. 6 P. C. for this reason
Date Owner
1 hereby certify�that I have reatl thls appli<atlon antl state that the above
iniormation is torrett. I agree to comply wlth all Uty antl county ortllnances
antl state laws relating to builtling constructlon, antl hereby authorize repre-
senta[ives ot thii <ity to enler upon t�e above-mentionetl property tor
inspectlon purposes. /' '
Signature �ttf/ Dafe //— �� R'C
Drivers' License or 55 � � ���
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION Ll REPAIR�.
❑ CONVERSION � DEMOLISH ❑ OTHER Ap y�6
DESCRIPTION OF WORK/USE OF BLDG.
' - S Main Bui
E
TVPE OF PERMIT GRADING ❑ FOVNDATION ❑ STRUCTV RAl . T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL .A Rear
❑ �OTHER ' -C Right
PROJECT DESCRIPTION SQ.F7. � oCCUPANCv
' GONSTRUCTIONTVPE , VALUATION$ �D�O� g Left
ZONE GRAOING CU. VOS. ACRES ping, Ref. #
Remarks: � Planning Not
Bar Sink ,
Backflow Preventer
Backflow Irriqation '
Bathtu6s
Clarifiers � �
Dishwasher
Drinking Pountains
Floor Drains
Floor Sinks .
GasService Outlets :
Interceptors
Kitchen Sink.
Lavatories
P—Trap —
Roof Drains' -
Showers
� � Service Sink , - � �
Sewer Cap' .
Sewer Connection
Solar Collectors
Solar Piping '
Solar Tank i
Swimming Pool w/Spa '
- Urinal
Water Closet . � �
Water Heater.
WaterService' �
ReinSpection.Fee_ � $15
Boiler
Duct- UnderGround•
Duct - Strucmrel
Duct-Ventilating � �
. Exhaust System ❑ Multiple
FirepVFact.8lt.IC80# �
Heating System & Ducting
O ai oo,000 eru 0 i oo,000
Reinspection Fee � $75
CMF 0865-46, rev. ]0/84 White - Builtlin9: Canary - Applicant: Pink - A<counting; Goltlenrotl - qssessor
- Auto-Wash
Wundry.Treys �
� laue Fee"
HANICAL
�Hoodor Typel ❑
Canopy Type I I ❑
FEES
Automatic Washer:
Construction PoleSub.
CoOking Unit �
D ishwasher
Dryers ❑Gas ❑Elec
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW
0
3543 II/04/B5
Zone
Building:
IcoOC. TL
r .
Parking Req,/Provided '
i . �
ELECTRICAI �
+-r____`__-__;n ,�
�
Meter LJup to 100�amps
Meter ❑over100amps
Sub Panel ...
Momrs�0.1 HP�tY�-8 '
Int.Solar �9-15 HP 016�15+
Pole Light �
Range
Sign • '
; Standing Sections
Trash Compactor � I
� $ 3
I Reinspeetion Fee $15 Issue Fea
FEES
. DEVELOPMENTSERVICESREQUIREMENTS: �
� Zoning Approved By
Buildin9 APProved By
Refrigeration Sysiem � '
❑aioo,000eTu ❑ioo,000eru
System Repair/Alteration
Fire Dampers
Registers �
� _ _ r
laue Fee � $ 3
FEES
$
2
O
N
I
N
G
R
E
�
M
T
S
�
' SUMMr7ARI(11F FEES , /�
BUILDING PERMIT $' � I I' � � SMIP ' $ "S V
PLAN CHECK $ � PEFMIT '
PLUMBING $ ISSUANCE $ � �
PLAN CHECK 25% $ ENERGV P.C: $�
ELECTRICAL $ � GRADING � $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE � $�l$.DD
PLAN CHECK 25% $ �
� CONSTRUCTION AND PLANNING . �� ' SP'�`
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
� 1.,'Temporary Electrical Service or Pole 52. Pool & Equipment Location
. 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 . ' 56. Electrical Conduit-Undrgrnd.
8. Foundation . � � 59. Gas Pipe, O Undrgrnd., Test
9. Wa[er Pipe-Undrgrnd: ' 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor.System . � 61. APPROVAL TO DECK
17. 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 Electrical-Conduit , 66. Solar System-Final
16. Rough Electric Wiring • � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. 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 ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framing 73. Undergrnd. Storage Tank 0 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 CERTIFICATE ISSUED
33. Final Electric Notes: -
34. Final Heafing & 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 pomesticFinal � �
42. Backflow Preventer �
43. Backflow Irrigation
44. ,Landscape Irrigation System •
45. Sound Attenuation �
46. Handicap Regulations � � � .
47. FINAL STRUCTURE & BUILDING $ � $� � � �
48. Special Requirements Completed . , �
49. Elearic Release to Edison ' ' , .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date