HomeMy WebLinkAboutS2016-0179 - Permit Application(11111Rf
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION CITY OF NEWPORT BEACH
BUILDING DIVISION & LSV V� DILA -0 Oliq
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LOT BLOCK
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION�(x%6rn
SWIMMING POOL ❑ SPA ❑ POOL FENCING ❑ DRAINAGE ❑
Check ADDroariate box for Applicant
3. OWNER'S NAME
LAST
FIRST
lr p e
ADDRESS
OWNER'S E-MAIL ADDRESS
9
be
t` f- V
0 b� . com
CITY
STATE
ZIP I
PHONE NO.
e.'%et l3eq&
c. a
9 43 0
-• 3 1 o3
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
P s¢ �C :n
eeck
, {� p
L (Q(I .f0�
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1 1� • iJ0 V Cl v
5-t
l -Eo ho
e a en ok . co
CITY
STATE
ZIP
PHONE NO.
6fo e
c
90\8
1y- 3- 3 5 05
5. CON RACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
90 -Tone
-Fo
Poc51s � S
a 9
No. 7�?37r7 Class 53
ADDRESS
CONTRACTOR'S E-MAIL
ADDRESS
as4�(;;b m sr
b' OCA
Lam r cr)m
CITY
STATE
ZIP
PHONE NO
ens; de
Cs�}
�So3
n5 - 1 -Q a (23
CE USE ONLY
PERMIT N0. �-Z j'o u . oil
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
Worksheet for Electrical/Mechanical/ Plumbing Application
City of ort Beach
D i
New SZOI10 " pt'iq ;
Building Division �
oar.P
1. Project Address (Not mailing address) Building Permit No.
f X 69 sa(itQ T,06e N ts' ?9`1 161ffC6 Q9-000 Floor F— Suite
r 2.Owner's Name Last SmSh_ First%�'lodlfl�
Owner's Street Address
3 G Q� City I j�CV (�l &ACVt v State I CA-, Zip 1d E1V7�
Telephone 103 Owner's E-mail Address
[—: 3. Applicant's Name Last �11e� _. _ First
A lica[nt's Street Address ,a 'D
t�J 4s _.lj ri�.SOtI 5 City R1 lie State ZiP [9t SO3
TelephoneC�Jif I-31a� Applicant's E-mail Address b1 ro\$iW CO(Y\
[ 4. Contractor's Name Last "" J First ,y State Lic # L
Con^^tractpor/'s' Street Address d`d_re_ss "'" � � ` ' �'p ^�� J�
d'J LJ. l9' 7.^� .5�� — ',`City �,r�t�Cflsl_State � Zip 71 iYJg3
Telephone Q CI 3 v� Contractor's E-mail Address _ U, I Pc)d� lJ I �� ' C- m Business Lic # �W
Mechanical
Furnace Quantity
up to 100,000 btu:F—
over 100,000 btu:F—
wall/Floor heaters:F--
Heat Pumps/Package Units
up to 100,000 btu:@'
up to 1,000,000 btu::�',
up to 1, 750,000 btu:F—
> 1, 750,000 btu: �.
Boilers/Compressors
up to 3HP::
3 HP -15 HP:F_,,.
15 HP -30 HPF_
30 HP -50 HP:F -
>50 HP:F_
Air Handling Units
up to 10,000 CFMF_
> 10,000 CFM::'
VAV Box:-
Repair/Alter/Add HVAC
Number of Zones:'.
Ventilation
Bathroom Fan F_
ExhaustFan:r—
Attic Exhaust:F—
Residential Hoocl f
Commercial Hood l u
Metal Fireplace:F—',
Gas Line I—
Fire, Dampers:._ �.
Electrical
New Construction Quantity
I & 2 Family S.F:F_
Multi Family S.F:F—
Receptacle, Switch Lighting Outlets
Total Outlets:
Lighting Fixtures
Total Fixtures:F_
Total Low Voltagef—'
Separate Circuit:
Motors/Transformers
0-1 HP or KVA::
1-10 HP or KVA:F--':
10-50 HP or KVA:F
50-100 HP or KVA:F�
Over 100 HP or KVA:F—I,
Signs
One branch circuit:�l'
Add'I branch circuit—'.
Service
0-600V not over 200AF —'
0-600V& over 2004
over 600V,.1_
Temp PP/Piggy Back;-'..
Sub Panel:[—
Other. F_
Bathroom QuantityPlumbing
Quantity
Water closet(toilet):F
Backflow device up to 2'S_L.
Bidet:F_
Backflow device over 2'Sr_
Urinal:
Regulators•.
Bath Tub:
Lawn Sprinkler System:F_
Shower stall:F—
Roof drains:F—
Lavatory(basin$—
Hose bibb:F-
Hydro-massage tub:F—
Drinking fountain. -F --
Kitchen
Kitchen sink:F--
Garbage Disposal::—
Bar sink:[--
Vegetable
ink:[Vegetable sink:F—
Dishwasher[—
Laundry/washing trap:F_
Ice makerj—
Floor sink:
Miscellaneous
Floor drain:-.
Water piping:�p
Water softened —
Water heater.F—
Lavatory(basin):
Gas sys up to 4 outlets:`
Gas sys# of outlets over 4i —
Grease trap:F—
Grease interceptor.F—
P-trap:F—
Sewer
New sewer:(
Sewer alter/repair.F--
Sewer abandonmenbr—"A