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Home My WebLink About772 18TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �77p Job Address: 7•72'W 18TH ST Suite No Vicinity: Parcel Nunmber: 42417212 Applicant: GONZALES,DENIS Address: 6250 PARAMOUNT BL LONG BEACH CA Owner: CAMBEROS, OSCAR Address 772 W 78TH ST COSTA MESA, CA PLUMBING PERMIT Phone: (562)984-5511 Zip: 90805 Phone: Zip: 92627-4279 Contractor: C�. Address: / �S-1\ ��one: (O v ,� /� Zip: L .5��1s G�4-. � f-�--- / License: Arch / Eng : Address: ISSUE FEE Backflow irrigation BackFlow Preventer Bathtub Clanfier System Connect pce,Soda,etc) Dental Units Dishwasher " Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Phane: Zip: License: Status: ISSUED Applied: 10I30I2002 Issued: 10I30I2002 ISSUED BY: L 4G�� /'D�d ,r 704414 S Gz 9'�'S�- SS/l � oL•-° � ,BG D/J 77� SCOPE OF PERMIT CHANGE OUT OF WATER HEATER. AMT orv $23.50 $0.00 0 so.00 0 $0.00 0 • $0.00 0 � 50.00 0 � $0.00 0 $0.00 0 . 50.00 0 50.00 0 . so.00 . o so.00 0 $0.00 0 $0.00 0 FEESUMMARY ' AMT Laundry Tub / Washer � $0.00 Landscape Irrigation $0.00 P-Trap � $0.00 �Pressure Regulator $0.00 Process Piping�(per 10 fl) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect ' $0.00 Sewer Private Line $0.00 Shower : , „ $0.00 Sink, bar .$0.00 Sink, commercial , � $0.00 Sink, Floor � � $0.00 �N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkfiow(1-4) Vacuum Brkr Bkfiow(5+) Wash Basin -Wash Basin Sel Waste and Vent System Water Closet (Toilet) Water HealeU vent Water Piping (Inst or Rep_) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically expire and become void if work is not commenced within 7B0 days, or It 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 ell required inapeetlone and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2MBd8 (8�00) WORKERS'COMPENSAnON DECLARATON: — � I hereby efflrm under penelry ol perjury one of Ihe �allowing declaretlons: ❑ I huve end wlll melntein a certilicate of consent to self-Insure for workers' campensation, es provitled lor by sectlon 3700 of the Lebor Code, for the pertortnence of the work for w�iCh Ihis pertnll is issued. � I have end will meintain workers' cwnpensatlon Insurence, es required by sectlon 3700 of the Labor Code, for the pertortnance of the work br whkh this permit is Iswetl, �Ady w �s' �ampensa�n^ In�sutra'nnce carrier andC Iity n�r�are: � /� j wn secnon neea or be co ierea u m� e �N � o icy eec V! �j; --�77 0007 �( �/,' ( p permi( �s vefued et one hundred tlWfers ($100) or /ess.) ❑ I certlfy that In the peAormance of the work lar whi ihU pertnit Ls Issueq I shall not employ any parson in any menner so as to becwne sub�ect to the workers' compensation lav�e alifomia, an84grea th it s�oul0 be e sub�ect to ihe workers' compensatlon provlslons oi SecQpII 37 6ot the Lebor Cotle, � shall fonhwlth � � hese pro i' n. �� 3D ApPIi gn e: te: I : URE T E WORKERS' OOMPENSATION C' EM��rI ! WFUL AND SHALL SU81ECf rW EMPLOVE TO CRIMItUL PEN T1E5 AND VIL FlNES UP TO ONE MUNORED D DOLURE (5100,000), IN ADDIiION TO THE WST OF PE�J�ATI DAMAGES AS PROI��ED WR IN SECTION 31O80F THE IABOR E, IMEREST, M!D ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: Chepter B(commencing wlih Sectlon 7000) ot end eflecL �. M CoAe, end my license L5 In tull CONSTRUCTON LENDING AGENCY: � ❑ I hereby eftirm that there Is a wnstruction lending egency lor the peAormence of Ihe work for which this permit is Issued. (Sec. 3097, Civil Cotle). Lentler's Name: Signature: _ LenOers Address: Date: OWNER•BUILDER DECLARATIONS: I hereCy eMirtn that untler penelry of per�ury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: My ciry or counry which requires a pertnit to construM, alter, improve, Oemdish, or repair eny sWqure, O�or to its issuance, also requires the epplicant far such pertnit ta tile e slgneC slatement Ihat he or she is Iicensed putsuaN to Ne provisions oi the Gonirectors License Lew (Chepter 9(commendng with SecGon 7000) ol Dlvisbn 3 of Ne Business entl Professions Code) or ihat he ar she is exempt Iherelrom end t�a basis tor the alleged exemptlon. Any Ndatlon of Sactlon 7031.5 by eny applkent for a pertnit sub�ects the epplicant to e civil penalry ot not morB then fiva hunAreA Collara ($500).): ❑ I, as owner of �he propeny, or my employees wlth weges es their sole compensatlon, WILL DO THE WORK, entl Ihe structure is nat intended or otteretl tor sele (Sec. 7044, Business and Protessions Cotle: 7he Contractors License Law tloes not apply to an owner of propeny wha 6uilds or improves thereon, antl who does such work himselt or herselt or thwugh his or her own amployees, provided thet such improvements are not Intended or ottereA tor sale. II, however, ihe building or Improvement Is sold within ona year ot completion, the own6�-builtler will have Ihe 6urden ol proving that he or she diA not bulid or impmve for purpose of sale.). ❑ I, as owner ol lhe property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct Ihe praject (Sec. 7044, Business end Professions Catle: The contrectors Llcense Lew does no� appty to en owner of propeny who builtls or improves ihereon, and who contrecis tor suc� project with e wntractoqs) license pursuant to the Coniractors Licensa �ews.). ❑ I em exempt under sec. Business antl Professions Code for this reeson: Signelure: Date: Owner ID veNietl by Erivers license. ❑ Yes ❑ No Drivefs License No. Verllication oi Ownership by (rype oi tlocumeni,l.9. - property tex blll or tleetl): DIVISION OF INDUS7RIAL SAFE7Y PEHMR C&RTIFICATON: Expires: ❑ I �ereby certlty t�at no exwvation tNe (5) or more leel in depth into which a person is required to tlescentl, will be made in wnnecUon wIN work euthoAzetl by Ihis permit, anA that no Gullding siructure, scetto�ding, falsework, or demolitlon or dismentling thereol, will be more t�en t�irtysi: (36) teet hiph. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle 8, Califomia Administretive Cotle). ❑ Ae owner-Oulltler, I will not empioy anyone to tlo work which would require e permit trom the Didslon ol Industdel Sefery, es noted ebove, unless such person hes e permlt to do such work Irom the division. Signature: Date: Divlslon ot Industrlel Safety Permit Number. CERTIFlCATE OF COMPW�NCE AND AUfHORIYA7�ON OF ENfAV: I certify untler penalry ot perjury thet I have reaG this eppliwtion antl stata ihat t�e information gNen is carrecL I egree to comply wit� all stete lews end nry ordinences relatinp Io builtling cons[ructlon, en0 euthodze reD�esentatives of the Ciry ot COste Mesa to enter upon Ihe ebove-descnbed properry tor inspection purposes. I egree not to ocwpy or ellow occupency ot eny builtli�g euthorized by this pertnit until linal inspectlon. cooe �, ixsvecnoNnre 1816 FIxeA System Finel Fire Prevention 1288 Pool Spa Final 200 Finel Re-Roof 201 202 203 Flnal BIocWReteining well Final Faclory Fire Place Finel Sipn 2W Flnel DemollUon Pdlf. It�lEL6 CO�E 1 INSPECTION TYPE 208 Flnel MeChenlcel 208 Flnal Plumbinp 270 Final ElecMcal 272 Finel Flre Prevenqon 220 Final Plenning Approval 222 Final Site 250 Flnel Bullding/Occupenq Pd1E II�ALE '� 'O � �0�:5� �� "�;�] V� . � COSTA MESA BUILDING-SAFETY DEPARTMENT F��A��E pEpT, P.O. BOX 317 COSTA MESA. GALIFORNIA ��v o� �ns?4 M�SR fOR APPL/CANT TO F/Ll /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDRESS a - 7 7 - . - -i i �` � r� 1� COSTA MESA, CALIFORNIA ryR OFFICE USE ONC! OWNER I HEC81P1' NO. I PEORMS �.0 MAIL �( � RECEIVEO BY OATE N/ECE VCD DAT5 �BIIUED ADDRE55 Y l/ . _[ I � �/ .� / 0 ��' } � TEL. BUILDI G CITY NO. AODRE55 ARCHITHCT LIC. OR E' IEE Ho. COSTA MESA. CALIFORNIA AODRE55 ' FIRE ZONE TYPE GROUP � STATE APPROVED � II t/ � CONTRACTOR LIC.NO. BY DATE ADDRE55 ' V � � ZONING ,q'_. LEG�L I LOT � I I„� / tONE � I M�.OF �I U8E OF NEW OEBCPIPTION NO. BLOCK 7Fip�.T � iP��AN6 BUILDIN � A.P. NO. � � �' BYPR , � ATE O -I — SIZE J� , /� I NO.OF BlDG9. � yqRDS � EVES ' OF LOT '� - Cl nOw orv Loi REQUIRED ALLOWED USE OF . (CENTER LINE 6T.� E%ISTING BLDG. FRONT, i IN. a� ` \J SETB.�CH LINE FROM (� c[rvien oF eTnEET i�� REAR YARD ��f � R. SIDE FT. ♦\, ! v� SIOE YARD I LEFT I RIGHT /� L. SIOE �Ff. IN. DESCR4P{TION OF WORK � R6AR, / FT'. / iN. � NEN' I II ALTERATION I II'1DDITION I `�� (/, �O� IS =.i� REPAIR II M VING II DEMOLISH I � BUILDIN NO.OF SIZE ROOMS STORIES � EXTERIOR WA ' I ROOF �p � _�v COVERING COVERIfiOT= � � 115E OF BUILDING AND WORK TO BE PERFORM D � w �- „f -- .�.�t, - • � o, 1 HEflEBV ACNNOWLEDGE THAT I HAVE FEAD THIS APPLIC/�TION THE.M1MOUNT BHOWN U R VALUATION IB POR THE ANO 6TATE TH�T THE ABOVE I6 CONNECT /�ND AGREE TO COM� pUFPOSE OF ESTABL�BHING • PERMIT FEE ONLY. PLY WITH ALL CITY OHDINANCEB ANO STATE LAW9 REGULATING aULLOINa c uCTiON. VALUATION /� SIGNATU OBi ^^�y �l PERMIT FEE $ �7•� o-O PERM ITTE L�Y �� $ /Q [� i % PLAN CHECK S ��. ( /� � .J / �4/ AUTHORIZED AGEN TOTAL FEE $"� SO , •J ' "