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Home My WebLink About317 22ND ST - Building Permitsr (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.Ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 Job Address: 317 22ND ST Suite No Vicinity: Parcel Nunmber: 42616�20 Applicant: HOLMES, NICHOLAS Address: P O BOX 10483 COSTA MESA, CA Owner: HOLMES, ULLA Address P O BOX 10483 COSTA MESA, CA Contracror. OWN ER-BUILDER Adtlress: Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Dnnking Founfain PLUMBING PERMIT Phone: 949-631-0054 Zip: 92627-0171 Phone: Zip: 92627-0171 Phane: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT REPLACE EXISTING PVC WATER LINE WITH COPPER. PLUMBING TO INCLUDE: WATER RE-PIPE. AMT $23.50 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 FEE SUMMARY QTY AMT Laundry Tub / Washer 50.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) 50.00 0 Receptors 50.00 0 Septic Tank $0.00 0 Sewer Cap for Demo 50.00 0 Sewer Connec[ $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 Qn 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 07/28/2003 Issued: 07/28/2003 �� : �l, " SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum BrkrBkFlow(5+) Wash Basin Wash Basin Sel Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep J AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeclions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas�as Ie�oo� WORKERS' COMPENSATION DECLARA710N: � � I hereby aHirm under penalty oi perjury one of the following declarations: ' ❑ I have antl will maintain a cenificete of consent to self-Insure for workers' compensation, as providetl for by section 3700 ot ihe Labor Cotle, for ihe performence of tha work for which this permit is issuetl. ❑ I have and wiil main�ain workers' compensation insurance, es required by section 3700 of the Lebor Code, Por Ihe pertortnanca of ihe work lor which this Dermit is issued. My workers' compensation Insurance carner and policy number are: Carner: Policy Number. (This secfion need nol He compleled il fhe permif is valued ef one hundred dollars ($f 00) or Iess.J �`I cenify that in Ihe pertormance of the work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to tha workers' compensatlon laws of Califomia, end agree tF�at Ii I should become sub�ect to the workers' compensation proNsions of Saction 3700 ot the Labor Code, I shell Forthwith comply with these p�j�ions� n �� /�� ; � � j�� ApplicantSignature: ��IA/i{/l.U'�TNJ � �_ Date: �__ WARNING: FAIWRE TO SE RE WOOU RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHPLL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND DOLLARE �5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOP IN SECTION 3]O60F THE LABOR CODE. IMEREST, AND ATTOfiNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Code, and my license is in fuil force antl eHact Lic. A qass % CantractoYs Signe[ure: Date: CONSTRUCTION'LENDING AGENCV: ❑ I hereby aflirm ihat there is a cons�mc�ion lentling agency for the pertormance of �he work tor which �his permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender'S Address: Signature: Date: OWNER-BU�LDER DECLARATIONS: I heraby aflirm that untler penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires a permit to constmct, aiter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit to tile a signed statement ihat he or she is licensed pursuent to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) ot Dlvision 3 ot the Business antl Pmfessions Cotle) or ihat he or she is eaempt theretrom and the basis tor the elleged exemption. Any violation of Saction 7031.5 Dy any applicent for a permit _subJL'ects the applicent to a civil penalty of not more ihan tiva huntlred tlollars ($500).): CX 1, as owner of Ihe property, or my employees with wages as iheir sole compensation, WILL DO 1TiE WORK, and the strucWre is not In�ended or ottered for sale (Sec. t� 7044, Business antl Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, antl who tloes such work himseN or herselt or ihrough his or her own employaes, provitled that such improvements ere not intended or oflered for sale. tl, however, the building or Improvemant is sold within one year of completion, the owner-buiider will heve�the bwden of proving ihat he or she did not build or improve for puryose oi sale.). � ❑ I, as ownar of ihe propetly, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo consimct ihe project (Sec. 7044, Business entl Protessions Code: The contrectors License Lew does not epply to an owner of propeny who builds or Improves thareon, and who contrects lor such project with e contractor(s) license pursuant to ihe Contractors License Laws.). r� Owner ID venfi§tl by dnvers license. Verificetion of Ownership by (type of antl s ❑ No � i.e. - properiy �az bill ot deed): DIVISION OF INDUSTRIAL SAFETY P�RMIT CERTIFICATION: Code lor this reason: License No. E:pires: ❑ I hereby certify that no excavation tive (5) or more feet in depih in�o which e person is required to descend, will be made in connedion with work authorized by Ihis permi�, and ihat no building sWcture, scaHolding, falsework, or demolition or dismantling ihereof, will be more then Ihirry-six (36) fae� �igR (Chap. 3.2, Gry 2, Ah 2, Sec. 341, Title e, California Adminisiretive Cotle). � As owner-builder, I will not emplay enyone m tlo work which would require a permit irom the Division of Industriel Safety, as noted ebove, unless such person hes a permit to do such work from the division. SignaNre: Date: Division of Industnal Safety Permit Number: ICEHTFICA7E OF COMPLIANCE AND AUfHORIZATON OF ENTAV: I certih/ untler penalty of perjury tha� I have reed Ihis applica�ion antl state that ihe informa�ion given is I correct. I agree to compty with ell state laws and city ortlinances relating to building construction, entl authonze representatives of ihe Ciry oi Costa Mesa to enter upon ihe above-described property for inspection purposes. I agree not to acupy or allow wcupancy of any building authorized by �his permit until tinal inspection. �� A� Si nat e O�f egal Owner(s) � �/� B� i�-�/�./�iti.��-, _� T' An� Authorized A cant D a CO�E �. INSPECTIONTYVE 1616 Fixetl System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Q�f, INTRIALS COOE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildincyOccupency U�¢, INTITIRLS -�a o,: n�