HomeMy WebLinkAbout911 VAN NESS CT - Building Permits� . r. � �
CITY OF COSTA MESA �
` o` M q BUILDING DIV/SION
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax p14) 754-4856 • www.ci.wsta-mesa.ca.us
r
�. FOR INSPECTIONS CALL: (714) 754-5626
��� fi
PERMIT NUMBER: M09-00080
PERMIT TYPE MECH
APN: 41808339
JOB ADDRESS: 911 VAN NESS CT CM
Viciniry:
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 09I09/2009
ISSUED BY: KJB
Suite/Unit:
SCOPE OF WORK: REMOVE AND REPL,4CE FAU 80K BTU AND COIL IN THE GARAGE.
OWNER: ALICIAMENDOZA
PHONE: 310-766-5416
APPLICANT: DANA HAYDEN
PHONE: 714-260-7238
CONTRACTOR: HELP PLUMBING HEATING AND AIR
Address: 8574 CHAPMAN AVUnit: STANTON CA
Ciry/State: UNIT E ZipCode: 90860
e
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $52.00
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $52.00
R'
Address: 911 VAN NESS CT Unit:
City/State/Zip: COSTA MESA, CA
Address: 8574 CHAPMAN AV Unit:STANTON CA
City/State/zZip: UNIT E
License No. 691452 ����-���!��Q
PHONE: 714•260•7236
CELL:
'v !, r.
��ir+,_It1 i���
�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: PERMIT E%PIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
� INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
Yequired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
�CO� INSPECPONttPE U�i INi111RL5 GOOE:1 INSPELIIONTYPE UATE IN7171R15
1816 Fixed System Final Fire Prevention 206 Final Mechanical —�1�-(J�� /f �Sj� 1
J
1266 Pool Spa Final 208 Final Plumbing �
200 Final Re-Roof 210 Final Electncal
201 Final Block/Retaining Wall 212 Final Fire Prevention
' {7A
202 Final Factory Fire Place 220 Final Planning Approval
``=;.r,'}.. � �;; :
�203 Final Sign 222 Final Site ' =.+
204 Final Demolition 250 Fina1 Builtling/Occupancy
a
WORKERS' COMPENSATION OECLARATION:
I hereby aHirm under penalty of perjury one ot the following declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers'
compensation, as provided for by sec�ion 3700 oi Ihe Labor Code, for the
pertormance of Ihe work for which this permit is issued.
❑ I have and will maintain wnrkers' compensation insurance, as required by
section 3700 0( the Labor Code, for the performance of lhe work for which ihis
pertnit is issued. My vro�kers' compensation Insurance carrier and policy
number are:
A�.� -arrier.
(This section neetl rrot be mmpletea rl fhe peimrt rs valued at one buntlred tlollais (St00) or IessJ
"Policy.Number
❑ I certify that in the peAormance o/ Ihe work (or vfiich this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensalion laws of Ca' omia, and agree that if I should
become subjeci to the workers' co ation provisions f Section 3700 of
Ihe�hocC.ode, shall fort ply with these provisi s.
�—
1_
�: Ap ' LSS9^�ur� . a �
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby aKrm ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( lhe Business and Professions Code, and
my license is in full force and effect.
�L�ic-#�'—'} _CI lass.#�
�
�-ontFaclor ,SiWUWreF �Dae
CONSTRUCTION LENDiNG AGENCV:
❑ I hereby aKrtn that there is a construction lending agency for the
per(ormance ot the work for which [his pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atltlress:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby affrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
conslrucC alter, improve, demolish, or repair any struc[ure, prior to its
issuance, also requires Ihe applicant for such permit to (ile a signed s[atement
that he or she is licensed pursuant to the provisions of ihe CoNractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Pmfessions Code) or lhat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant tor a permit subjects the applicant to a civil penalty of not more than
�ve hundred dollars ($500).):
❑ I, as owner o( the property, or my employees vnth v2ges as their sole
compensation, WILL DO THE WORK, and the stmcture is not intended or
oRered for sale (Sec. 7044, Business and Professions Cotle: The Contraclors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himsel( or herself or through his or her own
employees, provided that such improvements are not intended or oKeretl tor
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have the burden oi proving that he or she
did not build or improve for purpose o( sale.).
❑ 1, as owner of [he property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business and
Professions Code: The contrectors License Law dces not apply to an owner of
property who builds or improves Ihereon, antl who coniracts for such project with
a contrector(s) license pursuant to the Contractors license Lavrs.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-a6 (3/0]�
• �
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's license No. Expires:
Veri(icalion o( Ownership by (rype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
❑ I hereby certrfy ihat no excavation Me (5) or more feet in depth into wfiich a
person is required to descend, vrill be made in connectbn vnth work authonzed
by ihis permit, and that no building swcwre, scaFfoltling, falsewvrk, a tlemoli[ion
or dismantling thereof, will be more than lhirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone b do work which would
require a permit from lhe Division of Indus[rial Safe�y, as noletl above, unless
such person has a permit to do such work fmm the division.
ApplicanYs SignaWre Dale
Division o( Industrial Safe�y Permit Number:
HAZAR�OUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to (le and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fted with the Costa Mesa Fire
Department by every business which has at any one lime during a reported
year a quantity of hazardous materials equal to or grea[er than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at siandard temperaWre antl pressure).
2. Does or will the applicant or presen! or fuNre building occupan[ need �o fle
a registration form (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0! the Califomia Heallh and Safety Code, with some
exceptions. requires registration with Ihe Cosfa Mesa Fire Departmeni by
each business which al any one time has on hand a quantiry of acutely
hazardous ma�erials equal to or greater than a weight of 500 pountls, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will �he applicanl or present or (uture building occupant neetl to
prepare an RMPP (Risk Management and Prevenlion Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of ihe Calitornia Healih antl Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certi(icafion and
filing with Ihe Fire Department of an RMPP by businesses which are requiretl
to register acutety hazardous materials vrith the Fire Department.
4. If an RMPP is presently required, has Section 25534 of Ihe Califomia
Health and Sa(ery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is the subject of this application a permit (or such cons[ruction
or modifcation from the South Coast Air Quali[y Management Distric[ or (rom
any other air pollution conlrol district or agency? ❑ Yes ❑ No
(Section fi58502 of the Califomia Govemment Cotle requires that the requested
infortnation be fumished on applications for non-residential building pertnits).
6. Will any part of the faciliry to be constructetl untler this permit be within
7000 feet (rom the outer bountlaries of a school? ❑ Yes ❑ No
Qf "yes", �he (acility must meet [he requirement of Sections 25534 and 42303
O( the Califomia Health and Safety COde).
7. Ii a permit fmm the South Coast Air �uality Managemenl District or other
air pollution control district or agency is required for Ihe work which is Ihe
subject o( Ihis application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the appropriate air pollution
control oHicer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
ci[y ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correcL I agree to compty with all state laws and city
ordinances relating to building construction, and authonze representatives o(
the City o( Costa Mesa to enter upon the above-described pmperty (or
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit un[il fnal inspection.
rzataTa(
gal � a— `
'AiMbrvAW110IiZ¢tlAODIic3n� ) . Oale {
TRACT N0. 10445
LOT N0, 94
DATE March 28, 1980
���� �" �' Y' 1
Development Services Department
Planning Division
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92626
Attention: Pir. Paul Dudley
Dear Pir, Dudley:
Please be aware that the undersigned are aware that a certificate of ::occupancy
on the above referenced lot and unit is being requesCed prior to the entire
tract and its streets and co�cmion areas being completed and accepted by the
City of Costa Mesa.
BY /� (�. �.R.� � J� _
(SIGNATURE OF PURCHA5ER) �
R�CElVED
CI7Y OF COSTA tAESA
DEVELOPP,7ENT SE6VICES D:PARTMENT
l�1.4Y 5
n •+
i° � ,^, � 'i .
7Y
RECEI�IED i•1A'!
1980
r�;
_ _ ` � ,�
1 1980
PR0.IECT RDDHE55: Cj S 1 VAN NESS CT
OWNEfl'SNAMF: KELSEY, VAN R
nooness: 3030 S BUNDY DR
LOS ANGELES,CA
AflCHIENGINEEfl:
aooness:
PEHMITTEE: HILT—WELL ROOFING
noonEss: 3310 VERAOGO
LOS ANGELES
LICENSEO CONTBACTOB OECLABAiION: I here�Y atlirm Ihai I am Iicense0
7000) oi Division 3 0l �he Business antl Pmfessi0n5 Code, an0 my license i5
CITYLIC.:�/ �� /S/�TAT'ELIC.:QjBOO.S ��',
Oale' ! / /__y' SigrmWre'.�
WOBKEflS' COMPENSPTION OECNBATION: I he�eby allirm ��al I have a[e
Campensation Insurance, or a cenilie0 coDY �nereol (Section 9800. Lae. C).
eoucv No.: W 9 3 7 1 0 2 4 8 9 EXP.OATE: �
comenNr: CAL COMP INS.
�] Ceniliea copy is nereby Wmishetl. �. Ceniliea copy is lilea ' i
� / —95G
UNIT:
90066
NEG.NO.:
uxit:
(719) �" �501
CA 9 05 /
nificate ol consent to
7/31/99
9
wit� Section
olworkers'
Oa� ' ApplicanL
E%EMPTION FROM WUflKEflS' COMPENSATION OECUppT�ON: Qhis seclion neetl n01 be tampleletl il l�e p �^rone hmMreE (5100) ar 1e55�.
I cetlify Ihat in Ihe �etlorman[e ol Ihe work lor wbich Ihis permil i5 i5sue4 I s�all noi employ any person in a anner 5o as �0 beCome
sub�e[I to Ihe Workers' ComOensation Laws a� Wli�omia.
Oate: Sip�amre:
NOTILE: II, atier making this Geclaratian. you sAoulA become su�lect to t�e Warkers' Campensation prwisions of the Labor
Code. you musl tonnwitn comply vnih such D�ovisions or Iks oermil shall 0¢ tleemeO revokea.
CONSTflOtTION LENOMG PGENCY: I here�y a��irm that there is a constmction IenOing aAency lor Ihe p¢�o�mance ol ihe work for
whiCh Ihis permn is is5ue0 �SetliOn 3097. Civ. Ll.
LENOEfl:
AOUNESS:
OWNEB BUILOEF �ECLAHFTION: 1 hereby affirm t�at I am exempt irom the Convacmrs' State ticense Law for the following reason
(Seclion 7031.5 Business and Pwiessional COJe: Any ciiy of coun�y w�ich repuires a permi� �o conSVuct, al�er, impmve, demolis�, or
�¢oaii any siNCWre. prior to its issuance. also reauires ine applicant br such Oe�mil to file a signed statement t0at he/she is licensetl
pursuanllo Ihe Dmvisions ol ��e Contracrors Slaie License Law (ChaO�er 9 kommencinp wi�� Section 7000) of Oivisian 3 oi IAe Business
an0 Professions CA�e) or Ihat he/she is ezempl t�erefmm and itle Oasis for Ihe alleAeA exemption. Any violation al Section 7031.5 by
any apPlicanl br a permi� Sublec�5 Ihe apPlicanl l0 a tivil Denalry ol n01 more ��an five �unUfeO Oallars (5500�.
❑ I, as owner af ihe pwperty or my emplayees with wages as Iheir sole compensation, will do ihe work, and ihe
sbumure is not intenUetl or oilered tor sale (Section 70aa, Business and Pmiessional Code: TAe Contractors' State License Law
does nol appry m an owner of a pwperty who UuilAs or im0�oves Ihereon, an0 who does such work nimself/hersell or thmuAh
Ais or Aer own emDloyees. D�ovide0 �hal such impmvemenls are nol in�enGea or otlereE lor sale. I�, �owever Ihe 6uilding or
improvemen� is sold wii�in one year ol compleiian. Ihe owner will �ave IAe �urtlen al pmvinp �e/s�e ditl not huild or impmve
for ihe ourpose al salel.
I, as owner ol Ihe pmpeny, am exclusively canVacting with licensed conUactors to consimct �he pwleci (Section 7044, Business
❑ ana Pmlessi0n5 COde: The Contrac�ors' S�ale License Law Uoes noi aDPly �o an pwner o� properiy w�0 bUiltls or improves �hereon
ana w�o contracis lor such Dmlects wi1M1 a contracroqs) license pursuam to Ihe Caniractors' State License Law�. I am aware
Ihal praoi oi t�eir Worker'S Compen5a�i0n insurante ShONG Ge pmviUeO �0 me.
� I am eeempt under Seciion: B. 6 P. C.
lor IAis reason:
oate: Or+ner.
I ao nereoy cenAy Inat I am aware al antl untlerztane Ihe reQuirtments ol Cdlibrnu Heattn anU Safety CaOe Sectians 25505. 25533, an0
2553a anG IAat I or any IUNre GuilEing occupanl wilVwill not (circle one) neeE to comDN ��� szid sta�e cOGes anG t�e reQuirements for a
permii br con9mciion or moailicalion �mm Ine Air Oualiiy ManaAement Dislnc�. flesiQeniial construclion ap0lications are e�empt imm
�IICS¢ p�Ovi5i005.
Da�e: ADOlicam:
I her¢Ey Ceriityl�al I havereaA this ap0litaiion a�d Sial¢ I�allhe aEOve in�oi
a�dinances ane sta�e laws reWting to builtlmg constfutlion ana here�y aulMnze
pmperiy lor inspetlion purposes. �
o i J �� �� $- nalure'
7�j wiN all tiry an0 c0unry
upon ine aEwe�mentionetl
a e ig
�
Diiver's License or Sociai Security a:
164La6 WM1ne—Bmlaing; Green—Code Enlorcament; Canary—Ap0licam; Pink—Revenue; GalEenrod—Assessor
CZTY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06779:
PERMIT NO: B 067795 PLAN CAECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF E REROOF WITH COMP. 6 BUR IN BACK SQ FT; 1,100
CLAIM VALUE: 1,100,00 CALC—VALUE: 1,100,00 GROUP OCC: R—i /M-1
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM 6 HALLWAY
xit�*�*+r*it*�r*+t+r**�*�r��itx**it�����*+r+�n*+���t+titit�u*#tr�*�*#+t���r*�#�*u�-�r�*#z�it�iEitiF*�*if+�+�*�
Z O N I N G R E Q U I R E M E N T S
s E r B a c x s
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDISVG ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARRING REQ: PROV; pARCEL; 41808339 2NE: REF NO:
PLANNING NOTES•>
>
i! �)f 1E iF iElE 1E it IF it i!'k if it iE 1E 1E 1ElE iE i(� iE iE iE iE if at 1E if �lE 1f 1E k i! i! ih iE 1t tt 1F if 1F 1E fE if if iE if iE il� iE iflk iE iE it # 1: fflF # iE # 1E fF if 1(� if iE ## i! R it iF it iF it iF
� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APFROVED�HY PATE:
BUILDING APPROVED BY : DATE: '
APPLICATION ISSIIED BY; %1 DATE: 4((%��'��
aEi%if'IfiflRififaEiF#iFM'ifififif#iF!('!rlEfFit3FiFfFifiFiF3F3f3fif3F" H h'IF3Fif�if'iFi�iFii'itiFFiiF�'!lXiFifiEi(�lfil'lfifihYti('�F�tT'. �.7F\�i•
iE if 1E 1E fE iF 1p iE if i! ik i4 iF iE 1f ih ie iE iE 1E if iE iF #'� �f it i(� iE iF iE iE aF iF if 1E if iE 1E 1t # iE i! 1f ff f0 ## M iE iF if �f 3E iF iE #° iE iE iE iE 1E ie it if !F if fi Yr it� iF iE i!F ###
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 27.00 50
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 27,50 0.00 0.00
SMIP/NON—RES
TOTAL PAID UUE
27.50 27,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.50 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Z%.�� ,rJO
iE iE iE fE 3E if iE it it iE iE iE iF it iE iE iE iF 1t ik M iE if iE iE iE # iE iE if iE if 9E if iF iE if iE it iF fE iE iE #!E iE iE # fE i.° if iE iE iE iE it 3t iE iE iElF 3E #### aE if iE iE iE i! # iE iE iE if� iE 1f
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1100 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 1,100.00
END OF FEES
0? �0163299—�0163300 T O T 27.50
PATE: 07/Q1/94 TIHE: OE:53
.,�„
CONSTRUCTION AND PLANNING POOL . A
APPROVALS Permit# Date Inspector pppROVALS Permit# Date Inspector
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�Und�grnd. 55. Electrical Bonding
5. Sceel Reinforcement 56. Rough Plum6ing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electricai ConduirUndrgmd.
8. Foundation 59. Gas Pipe, � U�drgrnd., Test
9. Water Pipe�Undrgmd. 60. Backwash Lines, P�Trap, O Undrgmd.
70. Structural Ploor Svstem ' 67. APPROVAL TO �ECK i
17. Properiy Sewer �ine & HouseConnection 62. Backwash & Recepcor-Final
12. Sewer Cap 63. Heater & Vent�Final
73. Roof Drains , 64. Plumbing System � Final
14. Fough Plumbing 65. Electrical�Final �
15. Rough Electrical�Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencin� & Access ApProval
77. Rough Wirin9 Sign 68. APPROVED FOR PIASTERING
78. Rough Electrical•T Bar Ceiling � 69. POOLlSPA SYSTEPAS FINAL
19. Aough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT '
20. Rough FactorY Fireplace � APPROVALS Permit �
27. Ducts, in Strutture 70. Underground Hydro
22. Ducts, Venti�ating 77. Product Piping �Gas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flusfi
24. Roof Framing 73. Undergmd. Stora9e Tank O Gas ❑ Oil
25. floof Sheathtag . � . � �.-$_9U �� 74. Overhead fiydro � � . � I
!
26. T�Bar Ce�ling (Struciural) & Monocoat 75. Orv Chemical
27. Frame and F�ashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINA�
29. Insulation 78. FIRE PREV. FINAL
30. Orywall Nailing HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat �9. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERl"IFICATE ISSUED
33. Finai Electric Notes:
34. Final Heating & Air Conditioning , �
35. Final Gas PiDe�Test ,'f•^
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. 1Nater Service-Final
40. Gas Service-Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING �/�'� ��
48. RNALPLANNWG . '
49. Electric Release to Ediion � �
s
50. Gas Release to Southem California Gas Co
51. CERTIFICATE OF OGCUPANCY �
No. Date
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 911 VAN NESS CT
Suite No
Vicinity:
Parcel Nunmber: 41808339
Applicant: NOCK, RON
Address: 11612 KNOTf ST
GARDEN GROVE, CA
Owner: KELSEY, VAN R III
Address 911 VAN NESS CT
COSTA MESA, CA
Contractor. NOCK PLUMBING
Address: 11612 KNOTT ST
Arch / Eng :
Address:
GARDEN GROVE, CA
s
WATER HEATER CHANGEOUT
ISSUE FEE ..
BackFlow irrigation � .
Backflow Preventer �,
Bathtub � . ,
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo!
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oiq
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00 ,-;
$0.00"
$0.00
$0.00.
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
80.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
Qrv
0
0
0
0'
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PLUMBING PERMIT
Phone: (714) 8951246
Zip: 92841
Phone:
2ip: 92626
Phone: (714) 895-1246
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
� �; ;�PressureRegulator � $0.00
� Process Piping (per 10 ft) � $0.00
� , Receptors � $0.00
, ,SepticTank $0.00
' � Sewer Cap for Demo.. . � $0.00
, Sewer Connect � $0.00
� Sewer Private Line $0.00
snowa� � $o.00
� Sink, bar $0.00
Sink, wmmercial " '$0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
ISSUED BY:
Status: ISSUED
Appl ied: 04/i 6/2007
Issued: 04/16/2001
Qrv . nnnT
0-� � - SumpPump - � �$0.00
0 -Swimining Pool � �$0.00
0 . -. �'frap Prime j�, � - ' ! $0.00
0- .__� % Urinal, �, � - / - � $0.00
0 ` �Vaouum Brkr Bkflow(1-4) $0.00
0 �'��\ Vacuum Brkr Bkflow(5+) $0.00
0 ��, Wash Basin $0.00
0 � Wash Basin Set $0.00
0 - Waste and Vent System $0.00
0 � ,Water Closet (Toilet) $0.00
0 WaterHeater/vent $72.30
0 Water Piping (Inst or Rep.) $0.00
0 Water Re-pipe $0.00
0 Water Service 50.00
0 Wa[er Softener $0.00
0 OTHER $0.00
0 VIOLATION $0.00
0 PLAN CHECK $0.00
REINSPECTION $0.00
COMMENTS I SPECIAL CONDITIONS
TOTAL CALCULATED FEES: $35.80
Qrr
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92•2B, § 1, 12-21-92)
EXPIRATION: This permit shall automatically ezpire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such wo/k must comply with all applicable codes, and all
requlred Inepections end 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
zaasae �aroo�
WORKERS' COMPENSATION OECLARATION: ' �
I hereby eNirm untler penelry of perjury one ot the lollowing declaretlons:
❑ I heve end will meintaln e certilicate ol consent to self-Insure lor workers' compensation, as providetl for Gy sec�ion 3700 ot l�e Lebor Code, for ihe pertormence of the
/'�ark for which t�is pertnit is Issuetl.
PI.�� na ev and will mainlain workere' compensation insurance, as required by section 3700 of Ne Labor Code, for the peAortnance ol the work for which this pertnit is issued.
My wo�r�comp�ensa�io1n Insurence cartler antl pollcy number are: -- y ���� �, !�O �
Cam'ec—' 1L� � � !_P.olic .Number. '�
(This secHon need not be canple(ed Athe permrt is velued at one bundred dW/ars (S /00) or less.) "
❑ I certify that in the part ca ot t�e wOrk lor which Ihis pertnit is issued, I shall not employ eny person in eny manner so as to become subject to the wOrkerS'
compensation laws ol lifo end agree that It I shoulA bacon bject to the workers' compenution provisions of Sectlon 37 o e Labor oda, I shall forthwith
comply with these provis n � �l
ApplicanfSlgnature: � —Date: �
C/
WARNING: FAILURE TO SECVPE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL Ml� SMALL SUBIECT AN EMPLOVER TO CFIMINAL PE T1ES AND GVIL FlN 5 UP TO ONE MONDRED
TFKK15MlD DOIIARE (5100,000), IN ADOITION TO THE WST OF COMPENSATION. DMMGES r1S PROVIDED FOR IN SECIIIXJ 3%OB OF THE LABOR CODE, IMEREST, M1D FTTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn ihat.l.am license prpvi�ns�l L`Ay r 9(commencin9 with Section 7000) of Division 3 otthe Business and Prgiqssielfs C e, and my license is in full
torce and 8ffecL Lic. # � v/�/ . Gass a 0 �-��� �7
Contractor's Signature: • � ' —�ate'
\ `-
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm Ihat ihere is e consiruction lending egency for the peAormance of Ne work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name:
SignaNre: _
OWNER-BUILDER DECLARATIONS:
Lander's Address:
Date:
I hereby atfirm that under penalry of pe�ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Professlons
Cotle: Any ciry or counry whic� requires a Dermit to consWct, alter, Improve, demolish, or repair any strudure, prior lo its issuance, also requires the applicant tar such permit
to file a signed statement thet he or she I5 Ilcensed pursuant to ihe provisions of ihe Contrectors License Law (CheO�er 9(commencing with Section 7000) of Dlvislon 3 oi the
Business end Professions Code) or thet he or sha is exempt therelrom entl the basis br the elleged exemption. Any violation ol Section 7031.5 by eny applicant for a permit
subjects the applicant ta a civil penalty ol not more than live hundred tlallers (5500).):
❑ I, as owner of the properry, ar my employees with weges es their sole compensation, WILL DO T11E WORK, antl the structure is not intended or oHeretl far sale (Sec.
7044, Business and Professions Cotle: Tlie Contraciors License Lew tloes not ap01y to an owner of property who builds or improves Ihereon, and who does such work
himsell or herself or through his or her own employees, provided Ihat such impmvements are nol intended or ofleretl br snle. If, however, Ihe building or improvement is
sold within one year of completion, the owner-buildor will have Ihe burden ot proving that he or she did nol builtl or impmve tor purpose of sale.).
❑ I, as owner of Ihe pmperty, am E%CLUSIVELY CONTRACTNG WITH LICENSED CON7RACTORS to conswct the project (SecJ044, Business and Professions
Code: The conirectors Ucense Lew does not eD�ty �o an owner ol property who builtls or improves thereon, and who contracls lor such project wit� a contrecmr(s)
license pursuant to the Contractors License Laws.).
❑ I am e:empt under sec. Business and Protessions Code lor this reason:
SignaWre: Date: _
Owner ID venfietl by tlrivals license. ❑ Yes ❑ Na Drivers License No. E:pires:
Verification of Ownership Dy (type of Oaument, i.e. - properry taz bill or Ceed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I here6y cenify that no excavation five (5) or more feet in depih Imo which e person is required to tlescend, will be made in connectlon with work euthonzed by ihis
permit, and that no building sWcture, scaffol0ing, falsework, or tlemolition or tlismantling thereof, will 6e more than thirty-six (36) laet high. (Chap. 32, Grp 2, Art 2, Sec.
34 i, Title 8, Calilomia Atlministrative Cotle).
❑ As owner-builtler, I will not employ enyone to tlo work which would require e parmit from the Division of Industrial Sefety, es noted e6ove, unless such person has e
permit to do such work irom the division.
Signature: Date:
Division of Indusirial Safety Permit Number.
CERTIFlCATE OF COMPIJANCE AND AUTHORIIATON.OF EMRV: I cenity under penalry of perjury that I have read this application and stato that the inlormeUon given is
correct. I egree to compty with all state lews end ciry ordlnences relating to builtling consiruction, and authonze representatives of ihe Ciry ot Coste Mesa to enter upon �he
ebove-described propeAy for inspection purposes. I egreo not to occupy or ellow occupency of eny building authorized by ihis permit until tinal inspection.
SignaWre Oi Legal
GOUE �. INSPECTIONTYPE
1676 Fixed System Final Fire Preventlon
1266 Pool Spa Final
200 Finel Re-Roat
201 Finel Block/Re�aining W all
202 Flnal Fadory Fire Place
203 Final Sign
204 Final Demalition
��7.fI�IS1�1GlFj
LOpE I INSPECTION TYPE
206 Final Mechanical
20B
210
212
220
Final Plumbing
Final Electrical
Final Fire Prevention
Final Planning Approval
222 Final Site
250 Final Building/Occupancy
D� `/
U
Date _, ,
PhIE L�4@
1�-l.ri-ol �