HomeMy WebLinkAbout1700 PALAU PL - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
y "I\ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
'r "tet•-.• i
fl. FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: M08-00159
PERMIT TYPE MECH STATUS: ISSUED
APN: 13927107 DATE ISSUED: 12/17/2008
ISSUED BY: RMD •
JOB ADDRESS: 1700 PALAU PL CM Suite/Unit:
Vicinity:
SQ. FT: 0
SCOPE OF WORK: MECHANICAL PERMIT TO REPALCE AN (E) FAU < 100 K BTU.
•
OWNER: ESLER,JAMES R Address: 1700 PALAU PL Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: HUAPAYA,YOLANDA . Address: - Unit:
PHONE: 714-393-6251 City/State/zZip: •
CONTRACTOR: ADD ARE INC. License No, 906705
Address: 1531 COLLINS AVUnit: PHONE: 714-997-2969
City/State: ORANGE,CA ZipCode: 92687 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
R
•
TOTAL FEES: $38.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE+. iN$PECVON?YP DATE txtmat$ cOOEI 11r$PECPON TYPE pAgt1xmutE
1616 Fixed System Final Fire Prevention 206 Final Mechanical ) 'al-09 l (3w
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive..„cense. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
Cartier: •
( AI: I , i L , • by this permit,and that no building structure,scaffolding,falsework,or demolition
(Tn¢secncmm eemrnNet nm mna� vamee at one hundred dollars(S100)ortessor dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
-%i'<' ( - 2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number: �J ` ' L
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of Applicants Signature Date
t e bor Cr•4I shall forthwith comply with these provic s
A L l T r,
.4 11 2) Division of Industrial Safety Permit Number:
Apdiran1 Si. stare j j a HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
• G: FAILURE TO .CU WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS LAWFUL AND SHAL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
mylicen • ' tt ful force effect. a registration form for acutely hazardous materials? ❑Yes 0 No
•iV,1 1 Class# — (Section 25533 of the Califomia Health and Safety Code, with some
���,�J. ,`_L a exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
•_tract Sig .iure ' tae 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
CO - RUCTION LENDING •GE Y: temperature and pressure).
❑ I hereby affirm that th' : is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
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 8. (If"yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of•proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and'Emissions.
❑ I. as owner of the
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this p-rmit until final inspection.
a ► 1 A
�r\ G,'R er(s)
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Signature Date d pp ,(/a -I■ �,
a06]a6tJ/e]I ���i'� pp-
'17�
&or Authenxe< 'p0 rant •.<
4011 v 9 CITY OF COSTA MESA
4 BUILDING DIVISION
Y •0-, ill "' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�t /f � PERMIT
44*Par:arst IP 1PO4-00359
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1700 PALAU PL Status: ISSUED
Suite No Applied: 05/25/2004
7ssu � 05/25/2004
Vicinity:
ISSUED BY:
Parcel Nunmber: 13927107
Applicant: SZABO, KEVIN
Address: 2737 S CRODDY, ,
STE D Phone: (714)241-1414 -
SANTA ANA,CA Zip: 92704 '
Owner: FISLER, JAMES R
Address 1700 PALAU PL
Phone:
•
COSTA MESA,CA Zip: 92626
Contractor: COAST ROOTER PLUMBING HTG & NC
Address: 2737 S CRODDY
STE D Phone: (714)241-1414 '
SANTA ANA,CA Zip: 92704 '
License: 529127
•
Arch / Eng :
Address: •
• Phone:
Zip: ,
_ -License:
SCOPE OF PERMIT
CHANGE OUT WATER HEATER
. FEE SUMMARY ,
AMT QTY AMT QTY _ - AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 :. -. - Sump Pump $0.00 0
Backflow irrigation $0.00 '0 Landscape Irrigation $0.00 0 ' Swimming Pool . $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer - $0.00 0
Bathtub $0.00 0 Pressure Regulator - $0.00 0 Urinal $0.00 0
Clarifier System $0.00 ' 0 Process Piping(per 10 ft) , $0.00 . 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) , $0.00 0 Receptors $0:00 • 0 - Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 ' 0 Septic Tank $0.00 0 ''Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 , 'Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 - 0 . Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial -$0.00 0 Water Re-pipe $0.00 0 1
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
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: 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 this permit to be considered legal, such work must 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)754-5626
244646(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have 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
work for which lfils 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: �r +t?
Carrier: s 'Fu hi A Policy Number: Ji-�f-Eiv 17688 S'7cc'3
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
71. I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so es to become subject to the workers'
compensation laws of California,and agree t If I s uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi n ' JI
Applicant Signature: Date: J 2-4c-0
WARNING:FAILURE TO SECURE WORK RS' PE COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(510 .000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force andteffect.sLic. 52_x] Z� / Dlassate: # L 3 -
Contradors Signature: . ti -, Date: S-Z$-o
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,Civil Code).
Lenders 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 Division 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 civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,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 of 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 Drivers 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,California 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? ❑Yes 0 No
(Section 25505 of the California 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire 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 Califomia 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()ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes iJ No
(Section 65850.2 of the Califomia 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 c_onstructed under this permit be within 1000 feet from the outer boundaries of a school?? 0 Yes 0 Na
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit 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 California Health and Safety Cade Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from 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 to occupy or allow occupancy of any building authorized by this permit until final inspection.
- • zt)Jr=Of Le I Owner(s) Date
s"yam o�
An't`, "uthorized Applicant Date
CODE I INSPECTIONTYP6 2Mg iMmAL$ CODE. INSPECTIONTYP( LLA¢ IN'lmALU
1616 Fixed System Final Fire Prevention 206 Final Mechanical T
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
1L.32v ...
EE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 2 1 MO
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
` FOR APPLICANT TO FILL IN COMPLETELY '' APPLICATION 4L a PERMIT
. TYPE OR PRINT BUILDING
ADDRE
BUILDING 1700 Palau Place
SS
• COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
• RECEIPT NO. I / f ft,T�
OWNER Kenkol Development o„Inc. 1
MAIL 1555 Placentia .. RECEIVED BY I DATE RECEIVEDI1I DATE ISSUED
MI• ADDRESS A-i— i—Cy./'-4 AN 9 i +r
.mss
CITY Newport Beach TEL.6'3'2`27 ADDRESSI
ARCHITECT LIC. COSTA MESA, CALIFORNIA
OAR ITECEER NO.
61195 FIRE
,1 (�
ADDRESS V FIE
RE TYPE GROUA� �V/Jy
CONTRACTOR K.W. Koll L C NTO. APPROVEDBY DATE
1555 Placentia
ADDRESS Newport Beach q ZONING
LEGAL LOT R 3529 ZONE / I NO.OF USE OF NEW JC.,-..B-
. DESCRIPTION I NO. 3” BLOCK I TRACT ANS ..BUILDINGft ` 4✓✓.„,
APPROVED (/� ✓ I VA.P.NO. BYde DATE /----;2/—
OFLOT71.50x100 irreg NLDTS0 YARDS E NOW
.: REQUIRED ALLOWED
USE OF NoneJ
(CENTER LINE ST.) //
EXISTING BLDG. FRONT n FT. IN.
• SETBACK LINE FROM SFT.OF STREET 50' REAR YARD 211 R.SIDE J FT. IN.
SIDE YARD I LEFT 8 1 I RIGHT 5' 11, L.SIDE ( IN.
• DESCRIPTION OF WORK
,.. REAR /FT. IN.
NEW I K II ALTERATION I II ADDITION I
. REPAIR I I MOVING qII DEMOLISH
SREDING 1840 sf ROOMS !,T STORIES 1 '
EXTERIOR WALL 11ROOF Wood Shingle S
COVERING st UC4COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Single-Family Residence
and Attached Garage
•
I HEREBY ACKNN DG= THAT I HAVE READ THIS APPLICATION
• AND STATE THA THE A=•VE IS •RRECT AN• AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL ITY ORD ANCES AIYO STATE AWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CON RUCT • ..�.. ` VALUATION
PERMITTEE O .���lini •A-��Aa.Ats� p/ PERMIT FEE $ .3 le-
,
• ,�_ $ /l Y/ - -- PLAN CHECK $ /9"
AUTHORIZED AGENT TOTAL FEE $ ,5r-7—