HomeMy WebLinkAbout1072 TOWNHOUSE DR - Building Permits �Yiw -' CITY OF COSTA MESA
4,i . BUILDING DIVISION
° ►
F • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT P05-00439
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1072 TOWNHOUSE DR Status: ISSUED
Suite No Applied: 06/29/2005
Issued: 06/29/2005
•
Vicinity:
Parcel Nunmber: 93584002 ISSUED BY:
Applicant: SCOTT LITTLEFIELD
Address: 24707 SAN FERNANDO-RDS '
Phone: (661)259-7131 -
SANTA CLARITA,CA Zip: 91321
Owner: HOPPE, JAMES E
Address 1072 TOWNHOUSE DR
Phone:.;:
COSTA/MESA,CA Zip: _92627-3916
Contractor: AFFORDABLE WATER HEATERS & PLUMBING
Address: 24707 SAN FERNANDO RD •
Phone: (661)259-7131 -
SANTA CLARITA,•CA Zip: 91321
License: 627368
•
SCOPE OF PERMIT
CHANGE OUT OF WATER HEATER.40 K BTU.
•
FEE SUMMARY
AMT QTY AMT QTY AMT . QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump , $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation - $0.00 -0 Swimming Pool,', $0.00 0
Backflow Preventer ' • $0.00 0 P-Trap $0.00 0 Trap Primer- • $0.00 0
Bathtub $0.00 0 • •
Pressure Regulator ''• $0.00 0 Urinal • $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors • $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 - Septic Tank $0.00 0 • Wash Basin $0.00 0
Dishwasher $0.00 0 , Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 . Waste and Vent System $0.00 0
Drain, Rainwater, .$0.00 0 . Sewer Private Line $0.00 0 - - Water Closet(Toilet) $0.00 0
- Drain, Roof $0.00 -/ 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 1 0: 'Sink,bar • $0.00. 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank '"$0.00 1 0/ Sink, commercial - $0.00 0 v Water Re-pipe • $0.00 0
Gas Earthquake Valve '-$0.00- 0 " Sink, Floor $0.00 0 • Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00. 0 . Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe . $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 . 0 , X. PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
wyrk for which this permit is Issued.
nd will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
wo rs'compensation/(I�r-p'�surence caner and policy number are: r,,
Carrier: Te Yv1rk� Polity' er: (PCS?SC
• c lon need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perform ce of the work for which this permit is issued,I shall not employ any person in ner so as to become subject to the workers'
c••••---- •n laws of Calif la,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
`• • with t ese provisio
•••Iicant Si..- •re: e497 Dat=• -
WARNING:FAILURE TO SECUR KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E - • R TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100, ,IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3IDa OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby a • r(-yi am licensed under provisions of Chapter 9(commencing with Section 7000)of Division Busin,ss3 nd Professions Code,and my license Is in full
force an• b a 4 l'' �}A' _
Contractor. e:. Da (L -d - n-
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or sho did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from'the division.
Signature: Date:
Division of Industrial Safely Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.___....If....._...._.___._ .__ io_._ _—....—__._ .._
4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Ves ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application ajPormit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 11%X1 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and slate that the Information given Is
correct. I agree to comply with at state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Le•:I Ow':r s cc — (/- I •-te
Affi
And/0 Authorized,Icant D.to
CODE,I, INSPECTION TYPE RAIL I1TITIALS CODE( IHSPECRON TYPE PAIL 01M18LS
1616 Fixed System Final Fire Prevention 206 Final Mechanical {�
1266 Pool Spa Final 208 Final Plumbing 7/Sia S
200 Final Re-Roof 210 Final Electrical P 1(F
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy