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Home My WebLink About3223 MICHIGAN AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicanf: Address: Owner: 3223 MICHIGAN AV 13907313 GOMEZ,JUAN 7050 LAMPSON AV GARDEN GROVE, CA MC INTOSH, ALLISTER Address 3223 MICHIGAN AVE COSTA MESA, CA Contracror EMPIRE PLUMBING Address: 7050 LAMPSON AV GARDEN GROVE, CA REPLACE SEWER LINE ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect pce,Soda,etc) - Dental Units Dishwasher Drein, Floor , Drein; Rainwater Drain; Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe � Gas Service � , Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY . PLUMBING PERMIT Phone: 714-530-7320 Zip: 92841 Phone: Zip: 92626-2236 Phone: 714-530-7320 Zip: 92841 License: 794154 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 (or Demo $0.00 Sewer Connect - $24.65 Sewer Private Line $0.00 Shower � $0.00 Sink, bar- $0.00 Sink, commercial $0.00 'Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 01/19/2006 Issued: 01/19/2006 ISSUED BV: Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Sel Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service W ater SoNener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $48.15 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicabla 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 780 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 tnspeetlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (774) 7545826 <e�� _+a�ru:m WORKERS'COMPENSATON DECLARAnON: 1 hereby aHirtn under penalry ot perjury one ot the folbwin9 tleclarations'. ❑ I have end will maintain a CetlifiCete of consent to sell-Insure lor workers' compensatlon, es prohdetl tor by section 3700 of ihe Lebor Code, tor the pertortnance of the work tar which Ihis pertnit is issuetl. �"pe and will maintain workero' compansation Insurance, es requiretl Oy saction 3700 of the Lebor Cotle, for Ihe performance of tha work for which Ihis permit Is issued. +My� orkers' compensetion Insurence carner end policy number are: GaMe� �`�0 I � � V'1� � P_olicv tJumber:. .� A�� 1 �j ^ � �� - Is�sectlon need not be comple! il fhe pertnif is velued a! one huntlred dWlers (5700) or IessJ ❑ I certity that in the peAormance ol the work for which this permit is isSueQ I shall not employ eny person in eny manner so as to become subject to tha workers' compensation laws ol Celifornia, end a,g�ee thet II I Shoultl become suD�act to iha workers' compensation provisions of Saclion 3700 ot Ihe Le�or Cotle, I shall torthwith y ,T�Si'� { Dat/�tr e:iFy��,n�- � i �4 KERS PENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOYEi7T0 CFIIAINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PPOVIDED FOR W SECiION 3]O60F THE IABOR CADE, IIJrEREST, AND ATTORNEY'S FEES. LICENSED CONTHAC70RS DECLARATION: provisions of Chapter 9(commencing with Sectlon 7000) ot Cotle, and my licanse is in tull CONSTRUC710N LENDING AGENCY: ❑ I �ereby attirtn that there is a construciion lentling agancy tor ihe perlormance of �he work for which ihis permit is issuetl. (Sec. 3097, Civil Code). L@nders Name: Lentler's Addrass: Signelure: OWNER-BUILDER DECLARATIONS: Dete: I nareby atfirtn that under penelry of perjury Ihat I am E%EMPT FROM TME CONTHACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Protessions Code: Arty ciry oo counry which raquires e pertnit to construct, elter, improve, tlemofish, or repair any structure, prior to its issuanCe, also raquires the applicant tor such permit to lila e signed statement the� he or she is licensed pursuant to ihe provisions ot the Contrectors License Law (Chepter 9(commencing with Seciion 7000) ol DlWsion 3 of Ihe B�siness and Professions Code) or Ihat he or she is exempt therelrom and Ihe basis for lhe allegad e:emption. Any violatlon of Saction 7031.5 by eny epplicant tor a permit subjects the applicant to a civil penalty of noI more ihan five huntlretl dollers ($500).): ❑ I, es owner of ihe propetly, or my empioyees with wages es thelr sole compensation, WILL DO THE WORK, antl ihe structure is not intendetl or otteretl tor sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apO�Y �o en owner ot property who builtls or improves Iheraon, end who does such woM himself or herseli or through his or her own employees, pmvided that such improvements are not intentled or oflered for sale. If, however, the building or improvemeN is soltl within one year of completion, the owner-builder will have Ihe burden of proving tha� ha or s�e did not Duiltl or improve for puryosa of sale.). � ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to constNct Ihe pmject (Sec. 7044, Business and Professions Cotle: 7he coniradors License Law tloes not apply to an owner of property who builds or Impmves ihereon, end who coniracts for such prolact wiih a coniractor(s) license pursuant to Ihe Comrectors License Laws.). ❑ I am exempt untler sec. Business antl Protessions Code tor this reason: Signalure: Daie: Owner ID verified by dnver's license. ❑ Ves ❑ No Drivefs License No. Explres: Ve�ification oi Ownerehip by (type of tlocument, i.e. - property taa bill or deetl): DI�ISION OF INOUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby certify that no excavetion five (5) or more leet in de0�h into which a person is repuired to Aescend, will be made in connection with work authonzeU by Ihis permi6 antl thai no building strucWre, scafloltling, fal5ework, or tlemolition or tlismantling Ihereot, will be more �han ihirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Calitomia Atlminisirative Code). ❑ As owneabuilder, I will no� employ anyone ro tlo work which would require a permit tmm the DiNsian ol Industrial Sefety, as noted above, unless such person has e permit to do such work Irom the tlivision. Signature: Date: Division of Indusinal Safery Permit Number. ICEPnFICATE OF COMPLIANCE AND AUT/iORVATION OF EMRY: I certify under penelty of perjury thai I have read this epplication and state t�al Ihe information given is I correct. I agree to comply with ell state lews and city ordinences relating m builtling constmction, and authonze represemetives of ihe Ciry of Goste Mesa ro enter upon ihe abo�e�described propeAy for in5pection Durposes. I egree not to occupy or allow occupancy ot any building authorized by this permit until final inspection. Signature 4QQf,y INSPECiIONTYPE i.�� 1616 Fixed Sys�em Final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Finel Re-Roof Final BIocWRetaining Well Final Factory Fire Place Final Sign Final Demolition � 400E� 'INSPECTIONTYYE 206 Final Mechanical 208 Final Plumbing 210 Finel Elecirical 212 Final Pire Prevention 220 F�nal Planning Approval 222 Final Site 25� Final Buildingl0cc�pancy Applieant to titl in all soaces exceot those within heavy Oortler Ilnes antl sign a11 apDroo��ata tleclarations. CI7Y OF COS7a MESA CO SSRUjC� TION PERM/�IT,�^ Proie�� P.ddress �� ' 1 l��" I' . AppUcant's Mailing Addr �ss �� _^7-�u Owner's �-Lam-�e� � Phone =-L.1�--Z� T Ada�ss 'l.�� — ArchlEn9. License No. Address Contrec[or'sNam r � PC�� a ' Address Imailing) ' Ciry License No. � �q� LiCENSED CONTRACTOR DECLA ATION � 1 hereby affirm thal I am licensetl untler p�Ovislons of Charte� 9(commenGing with zection ]000) of DiviSion 3 ot tne Business antl Professlons GoCe, antl my license is in (ull fo e na tect. Licenzen Class se �o, � Oate ✓� �+�— Signa[ure WORKERS' COMPENSATION DECLARATION 'ereby afiirm that I have a certificate ot consent t seli-insure or a certiticata Workers' Compensation Insurance, or a certitiea co/py thvereo/f� (�S.e}4tion ,JO. Lab.n 1C..I__�.}(�.)-fi V,1�✓ ' I�^-�1`� � Polity No.µk��.� Company � ;�Certitietl mpy is hereby tumishetl. - Certifietl opY }i �filetl with ihe city BuiltlinJ oi nsy� �(�v .Date ��L"-�O APPlicant %_:��/�V �C - EXEMPTION FROM WORKE0.5' COMPE ATIO DE LARA ON (T�issection neetl mt be wmpleted i( (he permit is for one huntlretl ($300) or Iess). I certify [M1al in [he pe�(ormdnce ot tne work for wnich [tti5 pe�m�t is issuetl, I snall not employ any person in any manner so as to become subject to the Worken' Compensation� Laws of Califbrnia. � Date Si9nature NOTICE: If, after making this tlecla�ation, y0u shoultl becom¢ Subjec[ to tha Workers' ComOenzation provisions of Ihe Labor Cotle, you must forthwith comply with sucn provisions or tryiz permii shall be tleemetl revoketl. CONSTRUCTlON LEN�ING AGENCV I hereby atflrm thal there is a consVuctlon lentlln9 agency tor the pertormance of lhe work Por whic� tbis perrt�it iz issuetl (Section 3097 Civ. Q) Lentler's Name Lentler'z Atltlress OWNER BUILDER DECLARATION I hereby a/iirm inat I am ezempl from the Contractor's Lltense Law for tne /ollowin9 reason (Section ]031.5 Business antl Profassional Cotle: Any city or county whiGh �equires a permit lo CoqStruct, alt¢�, imprOve, Oemolisn Ot repdir any struclure, prbr to ils issuance, also requires the applicant lor such parmi[ to file a 5igneG Statement [hat h¢/She Is liG¢n5¢tl pulSudnt lo th8 prOv75ion5 Of the ConlractoYs License law (CM1apter 9(commencin9 wi[n Se<tlon ]000) of ;$>.ivision 3 of che Business ana Profgssions Coae) or that he/the is exempt :.�rebom-antl the basis for the allegetl exemptlon. Any violatlon of Section �?��.31.5 by any appliGant for n peYmit 5ubject5 Ihe applitant to a clvil '}fenalty ot not more than five hunEreq tlollars (E500). ❑ I, as owner ol Me 0/oper[y or yny omplOyaes with wd9e5 a5 Ihei� sole com0ensatioh, will tl0 Ihe wOrk, antl (he sl�uttu�e Is mt in[¢ntletl O/ offe�¢tl for Sale (SeCtion ]044, Business antl Professional COtle: The Contractor'S License Law tloes not apply to an own¢r ot a property who builtls or improves thereon, antl who CoeS zuch wo�k himSeH/hCrzclt ot lhrough his o� h¢r Own employees, prOvitletl lhat such Improyement5 a�e nol int¢ntle� or offeretl tor �� sdle. If, howeve�, lhe bulltling o� improvement is Soltl withln one year of com- pletlon, the owner will have tne buraen of proving ne/sne tlitl not bulitl or im- p�ove to� Ihe pu�po5a of Sale�. ❑ I, as owner of the property, am ezclusivety contracting with Iicensetl con- bactors lo construct lhe pro�ect (Secqon �044, Business antl Professions Cotle: The Contractor's License Law aoes not apo�Y �o an owner of property who builtls or improves thereon. antl whq �pntrac[s br such oroiect5 with a con- t�actor(s I¢enze purouan[ ro me CoqVaGtOr's LicenS¢ Law). I a�n awa�e that prooi o� their Worker's Compensaiipn insurance shoultl be provitletl to me. ❑ I am exempt untler Settion B. & P. C. Por [his reason Date Owner 4 I hereby certify that 1 have reatl this information is correct. I agree to comp antl state lawi rela ing to �u� ing eOn Sentatives of lh'c ity to t r pp� Inspection purp se3� $igndture Drivers' Licerise or 55 � 1 state that Lh¢ a0ove antl county ortlinances ereby authorize repre- ntionetl properry for TVPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION fqj'REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ O�;j E�R DESCRIPTION OF WORK/USE OF BLDG. {�'F'� �� iYPE OF PERMIT LI GRADING LI FOUNDATION �STRVCTURAL ❑ TENANT ❑ E/l_ECTRICA ❑ PLUMBING ❑ MECHANICAL ��j"(' OTHER 1 'P/ �� / —fJ-.�— PROJECT DESCRIPTION 5�. FT. �� T OCCUaArv4.y _�,�--, �-��_ CONSTRUCTIONTVPE � � VALUATION$_(�` 20NE GRAOINGCU.VDS. ACRES Remarks: � �/ � /� / 1. L-o.7 I.t Q i• /` . A. � S. ., _/ 2-i o Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks' GasService Outlets Interceptors Kitchen Sink Lavamries P-Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar 7%nk Sw'Yhming Pool w/Spa rinal Waier Closet Water Heater Water Service Auto-Wash Laundry Trays $15 Issue Fee Duct-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact.8lt. iCBO �k Heating System & Ducting ❑ai oo,000 eTu � i oo,000 Reinspection Fee $75 0865-46, rev. 5/88 White - Builtlinq; Canary - Appliwnt; Pink - Accountin9; Goltlenrotl - Assessor Typ¢I ❑ Type I I ❑ �fefrigcraiion System 00.100,000 BTU ❑700,000 BT System Repair/Alteretion Fire Dampers Registers Issue Fee A.P. # S Main Building: E T Front A Rear C Right K Left S Ping. Ref. dk Planniny Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Zona Accessory Building: Req./Provided ELECTHICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan F.A.U. Fixtur¢5 Device eoxes Outlets Switch¢5 i Garbage Disposal Generator �0.5 KW �5-15 KW Fee $ 3 DEVEIOPMENTSER 2oning APProved BY_ FEES Building Approved By Appliwtion luued Bv_ $ 3 Meter LJi Meter ❑i Sub Panel Motors ❑ Inc. Sola/ to 100 amps r 100 amps HP O'1'fe - 8 -15 HP 016-75+ �lle Light " Range Sign Standing Sec[ions Trash Compacror $15 � � luue Fee CES REQUIREMENTS: SUMMARV OF BUILDING PERMIT $ •UD PIAN CHECK $ PIUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ N I N G R E � M T S. FEES 5 3 SMIP $ � `Sb PERMIT ISSUANCE $ ENEFiGV P.C. $ GFADING $ MICROFILM $ � TOTALFEE $ � ��,i�''71• C�.��^ :.7�' ' .. .". ' CONSTyR�UCTION ANDPLANNING POO SPA AP?ROVRLS Permit # Date Inspector AppROVALS 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-Undrgrnd. 55. Electrical Bonding . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. -Structural Floor System 61. APPROVA� TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing SYstein - Final � 14. Rough Plumbing 65. Electrical-Final 15. Rough Elec(rical-Conduit 66. Solar System-Final �16. Rough Electrc Wiring 67. Fencing & Access Approval � 1�7�.. Rough W�g Sign „_ 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceili�g �� 69. POOL/SPA SYSTEMS FINAL . � 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace!' i" APPROVALS Permit # 21. DuCts, in Structure "'� 70. Underground Hydro 22. Ducts, Ventilating ,.• � 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test ' 72' Underground Flush � 24. Roof Framing " . �� 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing - • 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical 27. Frameand 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 Elecvic � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . 36. �Hood or Canopy , 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final f i 40. Gas Service-Final -8- ' ,r � "r 41. Solar pomestic-Final / /�� /. PJ'� 42. Backflow Preventer ' i� 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 . • C'} 51. CERTIFICATE OF OCCUPANCY ,. A: No. Date , - ' 1�) Lor6- � � rxcj COSTA ME5A BUILDING-SAFETY DEPARTMENT P. O. BOX S17 C06TA MgBA. GLIFORNIA For Applicanf fo Fill In Compleiely TYPE_OR PRINT 3ZLj � AVENUE COSTA MESA. CALIFORNIA rJK INVESTMENT CO., INC. CH� CALIF jj�I 6- TEL. 60x � QD ( NO: OP lLDOB. 9HTBACK IJN[ FR�M Q% ^ z � nv��su �n n�nv S GFAO VeO S i I LEYT 5� I RIGHT 5 t DE5CRIPTION OF WORK )INGi621sF NO. OF ROOM6 � 6T0 iIOR WALL ROOF 00 RING STUCCO COVERING )F BUILDING AND WORK TO BE PERFORMED SiNr.iF FaMILY RESIDENCE AND ATTACHED GARAGE 1 N8q¢BY ACKNOM�LHGCE TNAT 1 HAVE RGD TH18 MPLIGTION AND 6T�T8 THAT TH2 ABOVE IB CORHECT ANO AORGB TO COM- PLY WITM ALL G11Y OPDIHANCE9 �HD 8TAT8 LAWB IieOULATNO BUILDINO CONBTRU ION. SIGNATURE OF OL�� ,��,�� PERMITTE AUTHORIZED AGENT FEE RECEIVED �;�a� z a r�tl FlNANCE DEPT. Ctr( OF COS1A MESA APPLICATION FOR PERMIT BUILDING For Offlce Use Only RBCEIPT NO. ggNY�T N� � ev I oere xecryyeu , � oere �eaueo COSTA MESA. CALIFORNIA PIRE ZONE TYPE GROUP� APPROVED ZONING ZONH I NO. OP I U88 OF N R�1 PLANB 2 BIIILDINO L80AL . � _ . _ LIN6 9TJ APPROVED f THE �NOUNT BHOWN UNDER VALUATION IO PON TXH PURPOBE OP EBTABLIBHIN6 A P6RMIT FEZ ONLY. VALUATION PERMIT FEE $ �� N S /� d'} yA O t!J/ " � PL,AN CHECK $ / O ! l 0 TOTAL F6E y