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Home My WebLink About417 GLOUCESTER DR - Building Permits�(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT 1ob Address: 477 GLOUCESTER DR Suite No Vicinity: Parcel Nunmber: 42624410 "/✓.' > , Applicant GRODSKI, STEVE''-".�- Address: 2737 S CRODDY��" - . � � SANTA ANA,�CA ' . . Owner:- STAMBAUGH,.ANDREW K TR Address �25380 QUAIL SUMMIT ' Contrector. Address: Arch / Eng : Address: MONTEREY,CA Phone: 714-241-7414 �, Zip: 92704 � , � Phone: Zip: 93940 Status: ISSUED Applied: 12/13/2001 Issued: 12/14/2001 ISSUED BY: � � �,A� ' � . �. \, 'r` � COAST ROOTER PLUMING�HEATING & AIR CONDITIONING� � �`' . . . _ - . � . r . , � , 2737 S CRODDY STE"D � • � �� - � . " . ., � ` - Phone: (714) 241-1414 -- ;, �� . '- : �. -`�,,'- ��.`',.', _ �" SANTA ANA; CA Zip: 92704 � ' - �' � � , � License: 529127 � ' � • . �� - ' I WATER HEATER CHANGE OUT. ISSUE FEE " Backflow irrige�ion Backflow PreJenler Bathtub Clarifer System Connect Qce,Soda,etc) , Dental Units Dishwasher Drain, Floor Drain, 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, $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Phone: Zip: License: SCOPE OF PERMIT : FEE SUMMARY _ � � � QTY AMT � QTY = �� " � -� , AMT _ J: � Laundry Tub / Washer $0.00; :'0�-t `�`; ��" `Sump�Pump � � �, �$0.00 -.0 �� - � Landscape Irrigation $0.00 0 � - � �: �Swirriming Pool � ' � /$0.00 �0��.�.,� P-Trap �� $0.00 0 .,TrzpPrimer - � - � $0.00 0 � _ =. Pressure Regulator' $OAO � 0 �. ��" �Urinal% � !' - '-', i $0.00 0 .��Process Piping (per 10 k) $0.00 0' � � .Vacuum Brkr Bkflow(1-4) $0.00 0 � � Receptors . $0.00 �- 0 " :.� .Vawum Brkr-Bkflow(5+) $0.00 0 �, Septic Tank $0.00 0 =� Wash Basiri � i $0.00 0 ' , , - Sewer Cap for Demo $0.00 �0 • -, � Wash Besin.Sel $0.00 0 � �Sewer Connect . $0.00 -��0 Waste and Vent System $0.00 -0 �" Sewer Private Line $0.00 0 � ' Water Closet (Toilet) So.oO 0- �, . - Shower ' - $0.00 0 ,�� .WaterHeater/vent $12.30 0 - 'Sink, bef $0.00 ��.0-: � "� Wa[er Piping Qnst or Rep.) $0.00 o '� �Sink; commercial -$0.00-" 0�' Water Re-pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 0 " Spa (public) $0.00 0 PLAN CHECK $0.00 0 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 e QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulalions. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: 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 ihis permit to be considered legal, such work mus� comply with all applicable codes, and all required Inspections 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 244G46 (B�W) WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of t�e tollowing tleclarations: � ❑ I heve and will maintain e ceniticate of consent m self-Insure for workers' compensation, as provided for by section 3700 of the Lebor Cotle, tor the pertortnance of �he ork tor which this pertnit is issued. I have antl will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, tor the peAortnance of the work for which ihis pertnit is issued. My workers' compensation Insurance carner entl policy number are: Certier: (This s� one or less.) Policy Number: ❑ I certify Ihat in the performa E o fie work for which ihis Oermit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif m' , 4 gree that if I shoultl become sub�ect to the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply wilh ihese provisio . �/� �� r/ �\ 1 ApplicantSigneture: Date: L `�"'-� WARNING FAILURE TO SECURE WORKER ' O MPENSATION COVERAGE IS UNIAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVI� FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100.OD0�. IN A�DITIqJ TO TME COST OF COMPENSATIIXJ, DAMAGES NS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DE I hereby attirm ihat I am licensed force entl aHecL Llc. a ContrectoYs SignaWre: _ CONSTRUCTION LENDING AGENCY: 9(commencing with Section 7000) of Division 3 oi the Business end Professions Code, and my license is in full Class # Date: — i ❑ I hereby affirm t�at there is a consiruciion lending agency for the pedormance of the work for which this pertnit is issued. (Sea 3097, Civil Code). Lentler's Name: Lender's Adtlress: Signature: Date: OWNER-BUILDER DECLApA710NS: 1 hereby attirtn that under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Profeuions Cotle: Any city or counry which requires e permit lo consWct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to file a signed statement Ihet he or she is licensed pursuant to the provisions of the Contrectore License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business and Profeuions Code) or that he or she is exempt therafrom end Ihe basis Por iha allegetl eaemption. Any violation oi Section 7031.5 by any epplicant for e pertnit sublects the applicani to e civil penalry ot not more ihan five huntlred tlollars ($500).): ❑ I, as owner ot ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe siructure is not intended or oHered for sale (Sec. 7044, 8usiness and Professions Cotle: The Contractors License Law dces not apply to an owner of properry who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provitled Ihat such improvemenis are not intended or ottered for sale. If, however, ihe building or impmvemam is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve tor purpose ot sale.). ❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo Conslruct iha project (Sec. 7044, Business end Protessions Cotle: The cantrectors Llcensa Law tloes nat apply to en owner oi pmperty who builds or Improves thereon, end who contracts tor such pmject wi[h e contrector(5) license pursuant to the Contrectors License LawsJ. ❑ I am exempt under sec. SignaWre: Owner ID veritied by tlrivefs licensa. ❑ Yes ❑ No Business and Professions Code for this reason: Verification ot Ownership by (typa of tlocument, i.e. - property teu bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby ceRify that no excavation five (5) or more feet in depih in�o which a person is required to descand, will be matle in connaction wi�h work authorized by Ihis permiL and Ihai no building siructure, scattolding, falsework, or demolition or tlismantling ihereof, will be more than ihirty-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title B, Califomia Atlministrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a pertnit from the Division of Intlustnal Sefety, as noted a6ove, unless such person hes e pertnit to do such wark from the division. SignaNre: Date: Division ot Industnal Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cenity under penalty of perjury that I have read this application antl state that tha information given is wrrect. I egree to comply wit� all state laws and ciry ortlinances relating to building consiruction, and authonze representatives ol the Ciry of Costa Mesa to enter upon the above-descnbed property for inspection purposes. I agree not to occupy or allow acupancy of any building authonzetl by this permit until finel inspection. COpE 1, INSPEtt10NTYPE Qej� INiRIALS 1616 Pixetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition I2—I�—`t�el Date COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy • L � AOO��ant to fill in all spaces except those witnin heavY Eortler lines antl sign all appropriate tleclara[ions. . CITY OF COSTA n��loucOl�ISr R��IONaPE R 92Tz� Project Address Me 6 Applican�'SMailing,9�jdre�ros - - 9 Owner's Name �ne x a una 1 S Ppony��_ Address 9 ' ��d � . Arch/Eng. License No. Address Contrecror'sName ance SOC 1� �C phone ' — �� Addresslmailing) D!1 Rn_zo__.w�_1Mw_�� '7 � City License No. ��9� LICENSED CONTRACTOR DEGLHRATION I hereby affirm that 1 am licensetl untle� prOvisiOns of Charte� 9(mmmencing with section ]000)'of DiviSion 3 0( tM1e Business antl Profe55ions Cotle, antl my license Is'.In full t cgd ntl effect. License�Clzss � � � �—JJt� � cense No �� Date �=�'"`"�_�7—�Etrpyre WORKERS':CONIPENSATION DECLARATION ' I neretiy'atfirm Ihat I have a certificate ot mnsent to self-insure or a certificate "'�Workers' Compensation Insurance, or a certifietl coOY thereof (Section o, �ac. c.> y�161030253@�, Libert Mutual Insiranc .�iq No: pany y BC¢rtifietl <opy is he�eby fumiSheC. CePlifietl copy is f" e i [he city uiltlin D'vision. oace � �-��-�,r�a�c �ance � �csoc Rfg Inc EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (Thissection neetl nol be comple[etl if the pe�mit is to� One huntl�etl ($100) o� ' Iess). �=' I certiiy that in the performance of the work tor which ihis perm�t is Issuetl, I shall not employ any person in any manner so as to become subject to the !, Workers' Compensation Laws of Califomia. Date Si9natur¢ NOTICE: If,'atter making [his tletla�atiOn, you shoultl become subject to the I Workers' Compensation provisions o( the Labor Cotle, you must forthwith l comply wiM such provisions or tnis permit shall Ge tleemed revoketl. � CONSTRUCTION LENDING AGENCV I nereby atfirm that tnere is a wnstruction lentling agency for the pertormance � of tbe.work ror whith Ihis permit is issuetl (Sectlon 3097 Civ. C.) �Lentler's Name Lender's Atltlress . OWNER BUILDER DECLARATION � Yhereby at(irm lhat I am exempt from tne Contractor's License Law for the following reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or county which reQuires a permit to const�uct, alf¢r, ImO�ove, tlemoli5h or repai� any structure, prior to its issuance, also requires tne applicant tor such permit ' to file a si9netl slatement [hai he/she is IiCensetl pu�suant to the provlsions ot the Contractor's License taw (Chapter 9(commencinq with Section 7000) of Division 3 of the Business antl Professions Cotle) or that he/she is exempt �refrom an0 the basis tor the allegetl exemption. Any violation of Section 1.5 by any applicant �o� a permit subjects the applicant to a civil • ilty of not more tnan five huntlretl tlollars ($500). .—. I, as owner of the prope�ty or my ¢mployees with wa9e5 a5 thei� sole � compensation, will tlo tbe work, antl the structure is not intentled or�offeretl for sale (Section 7044, Business and Protessional Cotle: The Contractor's License Law does not apply to an owner of a property who builtls or improves theqeon, and who tloes sucM1 work himself/herself or through his or her own emVloyees, provitletl that such improvements are not intenaetl or otferetl for - I sale. If, hOweve�, the builtlin9 or improvement i5 Soltl within one yea� ot com- pletion, the owner will have the burtlen Of proving he/sne tlitl not builtl or im- prove for tbe pu�po5e ot Sale). ❑ I,;as owner of the property, am exclusively contracting with licenzetl <on- t�actors to cons[tuct the p�oject ($ectiOn ]044, Business antl Prote55ions Cotle: The Contractor'S LicenSe Law tloes not apply to an owner o( prope�ty who builtls or imoroves thereon. antl who wntracts for sucn oroiects with a r.on- tractor(s) Imense pursuant to me Contractor's License Law). 1 am aware tnat proof of their Worker's Compensation inzurance shoultl be provitletl to me. ❑ I am exemp[ untler Section B. & P. C. for this reason - �ate - Owner _ 1 hereby certify that I nave reatl this intormation is <orrecL I agree to compl antl state laws relating lo builtling mns 5¢ntatives o! thi5 city to �er u0on inspec[ion purpOSp�n n � �Si9nature � � �� QA�BI `Driyers' License or SS�.� f state that the above antl countv ortlinanres Date %—�z—� R�3�I'31q- � � - � TVPE OFCONSTRUCTION � NEW �ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WORK/USE OF BLDG. � TVPEOFPERMIT GRADING FOUNDATION STRUCTURAI ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL O OTHER PROJECT DESCRIPTION Sa. FT. ocCUVAN�y - CONSTRUCTIONTVPE VALUATION$ � ZONE' GRADINGCV.VDS. ACRES Rema�k�: Tear off shakes and reolace with Class B Hardi Shakes Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks GasService , OuUets Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee $15 BOiIQf Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating SVstem & Ducting ❑0.100,000 BTU � 100,000 Reinspection Fae � $15 OB65-46, rev. 5/88 White - Builtling; Canary - Applicanh Pink - Accounting; Goltlenrotl - Assassor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Wundry Trays Issue Fee Hood or Typel ❑� Canopy Typell ❑ Retrigeratlon System ❑a�oo,000sru ❑ioo,000 System Repair/Alteration Fire Dampers . Registers laue Fee FEES $ 3 FEES 5 3 A.P. �k S Main Buildi E T Front 8 Rear A C Right SLeft Ping. Ref. # Planning Notes: Automatic Washer Construction Pole S Cooking�Unit D ishwasher Dryers ❑Gas ❑E Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generetor DO-5 KN lectric Zone Parking Feq./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up ro 100 amps � Meter ❑over 100 amps Sub Panel Mators DO-1� HP O1'h: 6 ' Inc. Soiar �9-15 HP 016-15+ Microwave � Pole Light • r': Range ' I I Standing Sections , 5-15 KW I Trash Compactor I Hainspection Fee !$15 I I luue Fee DEVELOPMENT SERVICES REQUIREMENTS: ZoninB APProved By Buildine APProved By /" 0 FEES $ 3 N 1 N G R E Q M T $. SUMM RV OF FEES � BUILDING PERMIT $ � SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE $ PIAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ � MECHANICAL $ TOTAL FEE $ _�=_ PLAN CHECK 25% $ D1 09037763-D�7037764 T ��'S 63."a� na;=: nlii;tav �Tr�K: �n.a+ .� ,. v� l ` .. �. . �..�. _-_ - � - CONSTRUCTION AND PLANNING POOL �A � APPROVALS Permit# Date Inspector p�ppROVALS Permit# '� "' _ Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -� 3. Elecvical Conduit Utility-Undrgmd. 54. Forms � ;� 4. Electrical Conduit-Undrgrnd. , , 55. Electrical Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test L.�� n 6. Electrical UFER Grnd. �� 57. APPROVALTO COVER-GUNITE 7. Footings ',-j 58. Electrical Conduit-Undrgrnd. :� 8. Foundation �, 59. Gas Pipe, � Undrgrnd., Test �7 r�. � 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P�Trap, O Undrgrnd. � 10, Structural Floor System � , 61. APPROVAL TO DECK 11. Property Sewer Line & House Con�ection 62. Backwash & Receptor-Final 12. Sewer Cap ,.h.1 - 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. Raugh Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL 1�9. 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 � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ 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: ' 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 40. Gas Service-Final 41. Solar pomestic-final 42. Backflow Preventer ,,,� 43. Backflow Irrigation � �� J 44. Landscape Irrigation System , 1, j � 45. Sound Attenuation "'� 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING � � . 48. Special Requirements Completed - 49. Electric Release to Edison _. 50. Gas Release to Southem California Gas Co � ;' �� ,.�, 51. CERTIFICATE OF OCCUPANCY � " No. Date •� � : �i�64 COSTA MESA BUILDINGSAFETY DEPARTMENT � P.O. BO%H17 COHTp M69A� CALIFOiiNiA For Applicanf to F)11 In Completely TYPE OR PRINT A00 E'S$ �� ITLOUCFSTE� .. ��/�/C �� COSTA MESA, CALIFORNIA TeR Brent S. Tok 1320 Carmelita row G'8D2 S'2Y1C�S 221233 Cal Calif. 646-9341 6-9341 Y4698` Beach EXISTINGBLDG. 11�ne � . BET9ACK LINE PNOM �q�,,�..p� ' CENT6R OF BTREE! `�'�' ' D R6AR YAR � .SIOEYARDI LEF7 � �`"� I RIGHT � 1p DESCRIPTION OF WORK S�ZELDIN6 1�C�'Z S/�.f(��MS � STORIE9 1 �I EXTERIOR WALL ROOF COVERING .StuCC� COVERING cedar sh U960FBUILDIfIGAN WO KTO BPHRFOfj HD sinQ�e �amiiv resi�ence � HEREBY �CKNOWLEO�i TNAT I HAVE READ TH19 �PPLICATION ANO 9TATE THAT TXE ABOVH IB CONRECT ANU A6RE6 TO COM. v�x wiTH wLL CITY OROINANC88 ANO 9TATfi LAW6 p80ULATING BIIILDING CONSTPIICT�ON. ' SIGNATURE OF G�I/��- S �%Q(�s � /NC� PERMITTE AIITHORIZHD A6ENT L�SY �� FEE RECEIVED a30i1 2 7 1963 FINANCE DEPT. �nT��Qc�n�fg�A o�EvErsn�rr BUILDINCi For OiHce Use Only , 11ECH1'1'NO. !'�� L R[C[IVg� !Y � OAT 116C6/1VHD O/ Ki� � ^.7 k' —lr, /d eui�o�na ZONING zon no. or- use or � � I ruxs� eua�n �eo�� . . ,., .,. . YARDSAPPROVED MAIN 6UILOING ( FROM C/1�¢TREET ) PRONT �� FT. R. BIDB ^'> FT. L. SIDB '�` � �S p7, REAR `� Fr. DIbTAtiGE BET. MAIN BLDGS. VAR. 3R 6HALL BE LE99 THAN YARDSAPPROVED ACCESSORY B W LDING DATE � � � 1092 so. Fr. m THE AMOUNT BHOWN UNOER VALIIATION IB FOR TN6 E' PURPOSfi OF ESTABLIBHINO /� PERMIT FE6 ONLT. � VALUATION - m �yl�� IOI.00 � PERMITFEE s33.30 � m s - PLAN GHEGK $ o0 0 TOTALFEE �33.30 4