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Home My WebLink About625 WHITNEY WAY - Building Permits(714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 625 WHITNEY WY Suite No Vicinity: Parcel Nunmber: 93405'140 Applicant: NOCK, TIM Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: DOVE, THOMAS L Address 625 WHITNEY WAY COSTA MESA, CA Contracror. NOCK PLUMBING Adtlress: 11612 KNOTT ST GARDEN GROVE, CA Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer BathWb Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve m WATER HEATER CHANGE OUT. AMT $23.50 $0.00 30.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 PLUMBING PERMIT Phone: (714)895-1246 Zip: 92841 Phone: 714-549-1356 Zip: 92626 Phone: (714)895-7246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo 50.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 QTY 0 0 0 0 0 D 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 02/27l2003 Issued: 02/28/2003 ISSUED BY: Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum BrkrBkOow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Wa[er Hea[er / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $O.Oo $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $72.30 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 7 0 0 0 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 1 BO 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 compty 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: (774) 7545626 244&d6 (fi/00) WORKERS'COMPENSAnON DECLARATION: � I hereby ettirm untler penalry of perjury one of the follawing daclaretions: ❑ I �eve end will maintain a cerliticate ol consen� to self-Insure for workers' compensatlon, es pmvitletl tor 6y section 3700 ot ihe Labor Code, tor ihe paAormence of the work lor which t�is permit Is issuetl. � � I have en0 vnll maintain workere' compensation Insurence, es requiretl by seqion 3700 ot �he Lebor Cotle, tor �he pedortnanca of [he work for which I�is pertnit Is Issuetl. My workers' wmpens�tion Insurance carner en�tl1poli numbe ere:/` —p�-� �S -�,,� Carriar. T 5 C rAi Q D'� N�W ��F�l^( Policy Number. �� /OVOD /HA�O (This sectlon need not be completed i the permit !s veluetl ef one hundred dallars ($100) or less.) ❑ I ceitity thet in the peAormence of ihe work for which ihis permit Is issued, I shall not employ any person In eny manner so as to become sublact to the workere' wmpensatlon laws of Califomia, C egree t If I ould 6ecome sub�ect lo Ihe workers' compensation provlslons ot Seclion 3700 ot Ihe LdbOr Code, I 5hell totlhwl�h comply with Ihese praVisions. 2 Applicent SlgneNre: ��%/t� � Dete: )� S�' � 3 WARNINO: FAILURE TO SECUqE WORKERS' GENSATION CO fiAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE MUNDRED THOUSAND DOLLARE ($100,000), IN A�DITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTIqJ 3]OB OF THE LABOF CADE, INTERESi, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm Ihet 1 am force entl eflect. Lic. x_ Comreciofs Signature: C�apter 9(commencing with Section 7000) ot DiNsion 3 0l ihe Business and% rofessions Cotle, end my license Is in lull ClesSk �v �� oare �— f - a GONSTRUCTON LENOING AGENCY: ❑ I hereby aHirtn Ihat Ihere is a construction Ientling egency tor t�e pertortnance ol the work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lentlefs Neme: Signe�ure: _ OWNER-BUILOER DECLARATIONS: Lendef5 Adtlress: Date: I hereby eHirm thet untler p�nelty ot perjury Ihet I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons Code: Any ciry or counry which requires e pertnit to consiruct, al�er, improve, demolish, or repair any sWcture, prior to its issuance, also requires tha eppliwnt for such permit lo ille e signed stetament ihat he or she is licensed pursuant to the provisions of ihe Contrectors Llcense Lew (Chapter 9(commencing wlth Section 7000) ol Dlvlsion 3 oi lhe Business entl Professions Code) or ihet he or she Is exempt therefrom antl the basis for ihe alleged e:emptlon. Any vlolatlon oi Section 7031.5 by eny eDD�icant for e permit subjects the epplicant to e civil penalry of not more then live hunEred dollare ($500).): ❑ I, es ownar ol the propeny, or my employees with weges as iheir sole compensation, WILL DO 7HE WORK, entl the structure is not intantletl or offeretl for sele (Sec. 70d4, Business antl Professions Code: 7Te Contrectors Llcense Lew does not apply to an owner of propeM who builds or improves thereon, arM who tloes such work himsell or �erselt or Ihrough his or her own employees, provldetl lhat sucl� improvements ere nol intendetl or oHered Ior sale. I}, however, t�e builtling or ImD�ovement is sold wit�in one year oi completion, Ihe owner-builder will heve the burtlen ot proving that he or she ditl not 6uiltl or improve for purpose of sale.). ' ❑ I, as owner of the pmpetly, am E%CLUSIVELV LONTRACTING WITH LICENSED CONTRACTORS to construct the project (SecJ044, BuSiness antl Professions Code: ThB tOntractors LicenSe Lew does no� epply to an owner ol property who builtls or improves I�ereon, end who contracts for such project wllh e contractor(s) licen5e pureuent �o Ih� Coniractors License Lews.). ❑ I am exempt under sec. Business and Professions Code tor Ihis reason: Signature: Date: Ownar ID veniietl by tlrivafg liCense. ❑ Ves ❑ No Dnvefs License No. E:pire5: Vedflcation of Ownership by (rype ot tlocumem, i.e. - properry taa bill or tleea): DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICA710N: ❑ I hereby cenify ihat no excavation five (5) or more feet in depih into whlch a person is required to descend, will be made in connection wi�h work euthorizetl by (hls permit, and �ha� no builtling structure, scafloltling, lalsework, or demolition or dismantling ihereoi, will be more then thirty-six (36) feet high. (Chep. 32. Grp 2, An 2, Sec. 341, Title 8, Celifornia Atlminisirative Code). . ❑ As owneabuilder, I wiil not employ enyone to tlo work which woultl require e permit tmm the Dlvlsion of IntlusMal Safery, es noted above, unless such person hes e permi� ta do such work from Ihe division. SignaWre: Date: Division ot Industnal Sefery permit Number: CER7IFICATE OF COMPLIANCE AND AIfTMORIZATON OF ENTAY: I cenity under penalry of perjury ihe� I have read ihis epplication and state Nat ihe inlormation given is correct. I egree to comply With all state laws end city ordinences relating �o builtling construction, and euthodze represemetives of the Ciry ol Costa Mesa to enter upon ihe ebove-descnbed propeAy for inspection purposes. I egree no� to occuOY a� allow occupancy of any building authorized by ihis permil until final inspection. / �gnature Of Legal Owner(s) �� Date �� AnNOr Authonzed Appliwnt Date CODE I. IHSVECTION TYPE 1618 Fixed Sysiem Fin81 Fire Preven�ion 1288 Pool Spa Final 200 Final Re-Raof 201 FIneI BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition - �j( ��j GODE� INSPECiIONTYPE 206 Finel Mechanical 208 Final Plumbing 210 Final Elec�rical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site �250 Finel Bullaing/Occupancy PAg 1ti�4S • G r ►