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HomeMy WebLinkAbout2536 BACK BAY LOOP - Building Permits ftts X01 '�4 CITY OF COSTA MESA BUILDING DIVISION > •- ,�I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t ti:nsia I � � PERMIT l'01-00742 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2536 BACK BAY LOOP Status: ISSUED Suite No Applied: 12/13/2001 Issued: 12/14/2001 Vicinity: _ Parcel Nunmber: 93765066 _. _-- -- - - _ ISSUED BY: iii%= - Applicant: GRODSKI,STEVE" . • - :" Address: 2737 S CRODDY! DECLARATIONS . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ Ie 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 ork for which this permit is issued. I have and 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. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance offor which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California : • :.gee t t If I s u become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. /� Applicant Signature: 1/ M 1 Date: 19,. -I �'v 1 WARNING:FAILURE TO SECURE WORKERS'COp6 SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN ADDITION Told THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA I•N: I hereby affirm that I am licensed und- pr. 'si•is of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# i� / Class k Contractor's , Signature: i - ri(7/7 Date: 12. -g 4. - n I 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,CMI Code). Lender's Name: Lender's 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 DMsion 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 cNil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and 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 she did not build or improve for purpose cf 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 driver's license. 0 Yes 0 No Driver's 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 8,Califomla 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 Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 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 Califomla 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 Flre 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 Califomla 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No (Section 65850.2 of the Califomla Govemment 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 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If apermit 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 Califomla Health and Safely Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance front 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 state that the information given Is correct.I agree to comply with all 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 t//too///occccupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of L .r(s) ^ 4 _„tte And/Or Auth• zed If nt Date CODE 6 INSPECTION TYPE PATE PMIEBAll MU INSPECTION TYPE PATE U®!LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -. I– IO –Obi 1JI■ • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Finial Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. - P RMIT NO. TRACT NO. LOT NO. UNIT NO. 0873 4/09/85' _ CITY OF COSTA MES C,QNSjR�TIO PERMIT . , `�y,o, ) -6-- Project /,, ',• • _ - Be00 IL Project Address �� Z (/7p/--�e',. --- l% J/ `� 1 :46,--> y O �1 - /� TYPE OF CONSTRUCTION- ,5� NEW -LI ADD LI ALTERATION U REPAIR • Applicant's Mailing Address . �J,30 fi -(-0 ✓`V II . )// ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.4 ' Zone • Owner's Name '1'hone �>aG DESCRIPTION OF WORK/USE OF BLDG. Address ICO Z C -- , '4-to- 5. e- S Main Building: . • Accessory Building: Arch/Eng. License No. TYPE OF PERMIT 1E1 GRADING U FOUNDATION U STRUCTURAL T Front 0 Address ' / p / ❑ TENANT ❑ ELECTRICAL ❑ PPLUMBINGG ('MECHANICAL B Rear N Address Contractor's Nam' ! ♦ . "-'i 'hone 3V"z7G` ❑ OTHER ?{5 613 A I 0 PROJECT DESCRIPTION SQ. FT. ✓ - 'OCCUPANCY_.. C Right G Address(mailing/ f -O p• 0-e •-Cr.49-1 1 K City License No. d Ia I35 CONSTRUCTION TYPE __ VALUATIONS $ Left �1� --�fs ZONE GRADING CU. ACRES- Ping, Ref.# t � Parking Req./Provided E LICENSED CONTRACTOR DECLARATION 5445 2-8 - Q I hereby affirm that I am licensed under provisions of Charter 9(commencing Romar(s: Planning Notes: - M with section 7000) of Division 3 of the B si ess and Professions Code,and - - - T my license is in full fort¢,antl effect. _/ {�/ I license Class 'S- b Licen �a O 0 S Date '•s Signature /'� '- " •10 PLUMBING - FEES WORKERS' COMPENSATION DECLARATION , Bar Sink Showers ELECTRICAL , FEES i lereby affirm that I have a certificate of consent to self-Insure or a certificate - Workers' Compensation Insurance, or a certified copy tpere f (Section Backflow Preventer - - Service Sink • - - ^ -_ ,00, Lab. C.) • Automatic Washer ,Transformer 0 15-50 KW - Policy No. PJ`l6lG Company �D Backflow Irrigation Sewer Ca 0 50+KW • ' lf" P Construction Pole Sub. Certified copy is hereby furnished. Certified c p i filetl with the city Builtlin n.[ ynnn��J,/�/,f �� Bathtubs I Sewer Connection - - Cooking Unit Meter Duo to 100'amps ' ate ?-7 b-# Applicant • r+"ea`�'/crL/"'^' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers . Solar Collectors Dishwasher _ _ Meter Dover 100 amps I • ' + (This section-need not be completed if the permit is for one hundred($100)or - ' less): 1 Dishwasher Solar Piping I Dryers OGas ❑Electric Sub Panel • I certify:that in the performance of the work for which this permit is issued, I . - shall not employ any person In any manner so;as to become subject to the Drinking Fountains Solar Tank - Fan Motors 00.1 HP 011/2-8 Workers' Compensation Laws of California. - • . Date. • Signature - Floor Drains Swimming Pool w/Spa r F,A.U. Ina Solari09.15 HP 016-15+ 'NOTICE:If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith , Floor Sinks • -. Urinal , - - Fixtures ' - MicroWavC - comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCYs • • Gas Service Outlets' Water,Closet -• 9 Device Boxes Pole Light • I Hereby affirm that there Is a construction lending agency for the performance - _ of the work fors which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater - Outlets - Range Lender's Name - _ - _ , Lender's Address - • - Kitchen Sink. Water Service Switches Sign OWNER BUILDER DECLARATION , I hereby affirm that I am exempt from the Contractor's-License Law for the Lavatories, r _- . Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or ) Garbage Disposal Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P-Trap' , - r Laundry Tray( Generator ❑0-5 KW❑5.15 KW Trash Compactor ' any structure, prior to its Issuance, also requires the applicant for such permit - -to file a signed statement that ho/she is licensed pursuant to the provisions of Roof Drains - • . ' the Contractor's License Law(Chapter 9 (commencing with Section 7000)of Division.3-of the'Business and Professions Code) or that he/she is exempt - - - lerefrom and the basis for-the alleged exemption. Any violation of Section _ ' - - 031.5 by any-applicant for a permit subjects the applicant.to a civil • • �seenalty of not more than five hundred dollars($500). U 1,as owner of the property or.my employees with wages as their sole Reinspection Fee I x$15• - Issue Fee; • $ 3 compensation, will do the work,and the structureisnot Intended or offered - Reinspection Fee l $15 Issue Fee $ 3 ' for sale (Section 7044, Business and, Professional Code: The Contractor's - - MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself nr through his or her own DEVELOPMENT SERVICES REQUIREMENTS:. employees, provided that such improvements are not intended or offered for Boiler Hood or Type I , ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By - • Date ' pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved By Date s�rov�for the purpose of Salo). I U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • r Refrigeration System . Application Issued By ' LL1r�C.fJ Date Iel - tractors to construct the project (Section 7044,Business and Professions Code: - 11 ' The Contractor's License Law does not apply to an owner of property who - Duct-Ventilating 0o-100,000 BTU 0100 000 BTU SUMMARY OF FEES builds or improves thereon,and who Contracts for such projects with a) era -con- • - - - tractor(s) license pursuant to the Contractor's License Law). I am aware that - Exhaust System 0 Multiple 0. System Repair/Alttion I -• BUILDING PERMIT $ SMIP $ proof oftheir Worker's Compensation insurance should be provided to me.• PLAN CHECK $ PERMIT 0 I am exempt under Section B. A P.C.for this reason Firepl/Fact.Bit. ICBO 4 Fire Dampers' ' ' PLUMBING' $ ISSUANCE $ - - , Date Owner ' • Heating:System& Ducting Registers PLAN CHECK 25% . $ ENERGY P.C. $ • I hereby: certify that I have read this application and state that-the above • I e.0-100,000 BTU-0100,000BTL . . - - -q Co ELECTRICAL $ GRADING $ Information is correct. I agree to comply with an city and county ordinances t sentat ate laws relating to building construction, and hereby authorize repro- • �7f I/ !/ I PLAN CHECK 50% '$ © MICROFILM $ sentatives of this city.to en, / upon a above-mentionedhepropert for 17-/nn �� V/^0-(2- Inspection purpo(��Qs, i,i,%, /t / -� /y JdM MECHANICAL $ 6 Signature V L -1 I - CJ ° Date 3 A-M'a'r l' TOTAL FEE $ �•�� Drivers' License or SS# Reinspection Fee ( $15 i Issue Fee , $ 3 PLAN CHECK ?5% $ I •00 - I - CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING % POO. .SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3i Electrical Conduit Utility-Undrgrnd. • 54. Forms ;g.�Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.-Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Elecvical UFER'Grnd. t 57. APPROVAL TO COVER-GUNITE • 7. Footings - 58. Electrical Conduit-Undrgrnd. •• • 8.-SFoundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap,❑ Undrgrnd. 10,-Structural Floor System 61. APPROVAL TO DECK• 11.,Property Sewer Line& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . ,� ,s •'• 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final - 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.-Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.:Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0 Gas C Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry_Chemical 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL -. 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: _r 34. Final Heating& Air Conditioning 3/4I,rc ci 35.' Final Gas Pipe-Test !"I (I' 36., Hood or Canopy 37.:Final Factory Fireplace , 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final . 42. Backflow Preventer 43. Backflow Irrigation - ' . • 44. .Landscape Irrigation System 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY _ _ . _ No. Date