HomeMy WebLinkAbout717 CENTER ST - Building Permits�-__ Cbs� Mesa:°Building Department �� APPLICATION FOR PERMIT
,�, °•.�'s � , 1,1,7".�AST 20th STREET ;.:: _ B U I L D �t N G '
, COSTA MESA� CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
_ I Receipt No. Permit No.
Bullding ����Y yi'ye�,a� � !%
Address
Costa Mesa, BIIIiOPill& Received by Date Redd. Da Issued
Nearest � -� �� �� '7— 7 � S�
c�osg sc. Po��tea S$�eeC
Owner ���tld�ayRss:�e�i�?�mesofOs+�xa�<
Mail 3�i6 E39€ d7f•2� 5�0 �
Address
c�ey �;ers�t R!��a No�; &3��5�
E^gi eer °�i�i9fi �817e�F.EO8�4T No.
Address 1 a� CJ' Z SF.1l1Q@$ ��VfTe ��..fl9 �1.11,}�4 '4.ZC
,c�oto� Ho1x�:efl+3 & 5aao NoY Lic. ^+L�B
Address ��t�1 �e ���$ .�7'�.°Q�sOE:'(.� �@E8
Legal Lot r/
Descriotion I No. I 1 Block I Tract ��
rvo. ot nmgs, b
Size of Lot 6Q X ta� Now on Lot
Useof oo�com I No.of � I Na.of
Existing Bldg. Familiea � Room�
SetbackLinefrom � RearYard 3
CenterofStree2 �5 SideVard ��
New I �
�tr � � Moving I I oemo��sh I
ding 5 +� x No. of
�6�4'� z 1!>'4'� Rooms 5 Stories �
rior Wall �a'ZYCl Roaf ����
:ring �k�.� I Covering
ot New 8•.fc��n.v devt3313use
iinn
I hereby acknowledge that I have read Uvs Application
and state that the above is rnrrect and agree to rnmply
with all City Ordinances and State Laws regulating
building construction.
Signature of
Permittee _ _ __
Valuation
$ ��S�C'�
FORM 204 G•H 2M 5-56
Q
�
Address
California
u
APPROVALS
Foundation Lxation I Inspector
Forms, Materlals,
FINAL
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J
CITY OF COSTA MESA
Project Address %/�% !
Appiicant's Mailing Addres
Owner's Name �
Address 7/? �
ADolicant to fill in all spatts exceot those witnin neavy bortler Iines antl si9n ali aoDropriate
PERMIT • PERMIT N�^� N, �RACT �O LOT' O. UNIT N6.
✓� ri .
Address �� /
Contractor's Nam �� �ts hon
Add�esslmailingi �� C�s. /�� Ct ��
City License No. � � _
LICENSED CONTRACTOR DECLARliTION
I hereby aftirm that I am Ilcensetl untler provisions of Charter 9(commencing
with section 7000) of Division 3 of the Buslness antl Professions Cotle, antl
my license is in yf 11 —forGe dntl ef!¢ct.
License Class �/�.3 ' � �icense rvo�Y' �7%
WORKERS' COMPENSATION DECl/�RATf10N ' I r •�Y
�^ereby atfirm thaK I have a certifica[e ot consent [o selt-insure o� a certific e
Vorkers' Comp t on Insura e or a cerH(ietl copy thereof (SeCtion
,\ �. �b. c.� �7'0p=�}'3867�"��
�� Policy No. Compan�..;��• �•0�✓Y
\�Gertifietl copy is hereby furnlshe0. ' IM'� (/�
Cer�V ietl ropy is f'I tl�with the city Buil ing Divi "on. '� � p
� Oate �p^ 2� r'� Applicant r
\EXEMPTION FROM WORKERS' COMPE SA ON DECL RATION
(This section neetl not be completed if tne rm is for one huntlretl (5300) or
\less).
I certify that In the per(ormance oi tM1e work (or whlch [his pCrmH is IsSuetl, 1
shall not employ any pe�son.in any manne� so as to become subject to the
Workers' Compensa[ion Laws ot California. '
Date Signature
NOSICE: 1f, atter making. this tleclaration, you shoultl bewme subject to the
Workers' CompenSatlon provisions ot the Labor Cotle, you must forthwith
comply with such provi5iOn5 or this pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING FGENCV ' �
I hereby affi�m that there is a consiru[tion lentling agenCy tor the per(ormance
ot tne work for whicn tliis permit is issuetl (Sec[ion 309] Civ. C.)
Lentler's Name
.Lentler's AGtlre55 �
OWNER BUILDEH �ECLARATION �
I hereby atfirm that I am exempt from the Contractor's license Law for the
� tollowing reazon (Section 7031.5 Business antl Professional Cotle: Any city or
' county which requires a.permit to construct; alter, improve, tlemolish or repair
any structure, O�Io� to i[s is5uance, also requires the applicant for SUCh pe�mit
to tile a signetl Statement that he/sM1e is licensetl pur5udnt to [h¢ Provisions of
i the Contractor,'s License Law (Chapter 9(mmmencing with Section 7000) ot
�DiviSion 3 OT the Business and Prote55ions�Cotle) o� [hat he/zhe is exempt
�irom antl the �asis�for the alle9etl exemption. Any vlolation ot Section
.5 by any ap0��cant fo� a permit Subjects the applicant to� a civil
ity of not�more than frve huntl�etl tlollars ($500). -
I�J I, a5 owner of�the p�op¢rty or my employees with wages as thei� Sole
compensation, will tlo the work, antl the structure is not intendetl or,ofteretl
� for sale (5¢ction ]044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owner ot a property who builtls or improves
thereon, antl who tloes such�work hims¢If/hersEl( or through his or he� own
employees, provitletl that such improvements are not intentletl or ofteretl tor
sale. If, howeveq the bulltling or improvement is soltl within one year oi com-
pletion, the owner will have the burtlen of provin9 he/sne ditl not builtl or im-
prove fortM1e purpose otsale).
❑ I, as owner of the prbperty, am exclusively contracting with Iicensetl con-
tractoR to construct the project (Section �044, Business antl Professions Cotle:
The Contractor'S License 12w tloes not apply to an owner of-prop¢rty who
builtls o�'im0�oves tttereon, antl who wntracts for such projects with a con-
tractor�s) Ilcense pursudnt [o th¢ Conttacto�'S License Law�. I am aware thaf,
proof o(,their Worker's Compensation insurance sboultl be providetl to me.
❑ I am exempt untler Section B. &�P. C. for this reason
. Date Owner
certify tha[ I have reatl this a0�lication antl state that tM1e above
m is correct. I agree to comply with all�city antl county ordinances
laws relating to builtli�n constructlon, antl hereby authorize repre-
ot thia citvrke+errC@r�on the above-mentionetl orooertv tor
I; Drivers' License oi 55 �� �
i �
cMF 0865-46, rev. 10/84 White
TVPE OF CONSTRUCTION PSI NEW LJ ADD LJ ALTERATION LJ REPAI R
� O CONVERSION ❑ DEMOLISH ❑ OTHER
D�i✓IHt-JiNC K/iL1.'� I DG. . _ . _ .
TYPEOFPERMIT GRAOING�q FOUNDATION r�TRUCTURAL
❑ TENANT � ELECTRICAL CSYLUMBING ❑ MECHANICAL
• O'OTHER_ '
PROJECT DESCRIPTION 5G1.�.FT. oCCUCA y�,g
CONSTRUCTION TVPE VALUATION $ «!J�/(J �
ZONE GRADING CU. V�S. ACRES
Remarks: '� �' , '� Ca J.� T� •� S' 6/�!� � Fl�
eackflow �reveriter
eackflow Irrigation -
Bathtubs ' � ' .
Clarifiers ' '
Dishwasher ' _
Drinking Fountains
Floor Drains �
Floor Sinks '
Gas Service utlets
Interceptors �
KitchenSink, -
Lavamries
P—Trap
Roof Orains �
Reinspe�ction Fee, � $15
Boiler �
Duct-UnderGround
Duct-Structural � '
Duct � Ventilating
Exhaust Sys[em ❑ Multiple ❑
FirepVFacL Blt. ICBO #
Heating System & Ducting •
❑ 0-7 00,000 HTU � 100,000 BT
, . �-�o-P(.,
ate
,��
Canary - Applicant; Plnk - Accountinq; Goltlenrotl - Assessor
$15
$IIOWClS
Service Sink
Sewer Cap
Sewer Connection - •
Solar Collectors. %
Solar Piping � '
Solar Tank �
Swimming PooMyv/6pr
Urinal
1Nater Closet .
Water Heater �
Water Service � ��
Auto-Wash �
� Issue Fee
i
$ 3
FEES
Hood or Typel LJ -
Canopy Type I I ❑ '
Refrigeration System '
❑0-100,000 BTU ❑100,OOD BTU . �
System Repair/Alteration I • '
Fire Dampers � • ' � �
Registers. - �
Issue Fee - � � $ 3
A.P. � �,
S Main Buildi
E
T Front
8 Rear
A
C Right
K �eft
S
Ping. Ref. #
Planning Notes:
� 8259� 6/25/B6'
�. Q . Zane �
. Accessory Building: � �
ii�
// ' -!u� C�. 8[OG / Z •
2(0 , S � ��
. S� �.
. ' Parking Req./Provided
Automatic Washer'
Consiruction Pole Sub.,
Cobking Unit , ' ,
Dishwasher ., � � •
Dryers ❑Gas ❑Elect
Fan
F.A.U.
Fixtures .
Device eoxes
Ou!lets � /
Garbage Di o
Gener ❑0- .K
.�
51 �
�) .
\
Reinspecti Fee
DEVELOPMENT
Zoning Approved By _
Building ApproV¢d 8y
e
179.41 Tl
ELECTRICA Q� g FEES
. Trensformer ❑ 15-50 P. �
, ' � ❑ 50+KW;
� � Meter ❑up to 100 amps .
Meter ❑over100amps -_ � �
- . Sub n
' rs�0. HPO1�-6
_R nc. r - " HP�O16-75+
' Nfcrowa`be •
oja`Lignt �
4y� Range � ' '
Si n '
� ��ections '
15 KW/ r..�..,.��.A. , � �
REQUIR
Issue Fee
Z
O
N
I
N
G
R
E
Q
M
T
S
� � - , SU MA V F FEES "� ' �
BUILDING PERMIT $ � SMIP , • ' $ �
PLAN CHECK $ '� ' . PERMIT � ' � � - .
P�UMBING $: DC% - ISSUANCE ' $
PLAN CHECK � 25% $ � ENERGV P.C: $
ELECTRICAL $� ' GRADING $ � "
PLAN CHECK 50% $ � _ MICROFILM $
f' ���
MECHANICAL $ TOTALFEE � $ f�-F_—�
PLAN CHECK 25% $ � ' �
/ � /i
`
,
'CQNSTRUCTION AND PLANNING POOL & SPA L
% ' Date Inspector Date Insp�ctor
'APPROVALS Permit# • APPROVALS Permit# �
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 �
N
7. Footings . � 58. Electricat Conduit-Undrgmd. V
8. Foundation .� ' � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
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 .
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. POOUSPA SYSTEMS FINAL
79. 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 OGas ❑Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24, fioof Framing 73. Undergrnd.StorageTank OGas ❑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 �
37. Plaster Brown Coat �� 79. FINAL INSPECTION ,' i '
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 � �' � � � i � •
46. Handicap Regulations � • i � � ;' � .
t.
47. FINAL STRUCTURE & BUILDING r I� ��, ��
�.. :
'- 48. Special Requirements Completed ��i ' . .
49. Elearic Release to Edison - �`'
50. Gas Release to Southern California Gas Co � �
51. CERTIFICATE OF OCCUPANCY
No. - Date