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Home My WebLink About2923 PALAU PL - Building Permits(71a) 754-5273 • Fax (714) 754-4856 • W��ci.c0.5ta-me5a.ta.us 77 FAIR DRIVE, COS7A MESA, CA 92626 Job Address: 2923 PALAU PL Suite No Vicinity: WATER HEATER Parcel Nunmber: 13927203 Applicant NOCK, RON Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: BELYEA, ROGER Address 2923 PALAU PL COSTA MESA, CA Contractoc NOCK PLUMBING Address: 11672 KNOTT ST GARDEN GROVE, CA Arch / Eng ; Address: WATER HEATER CHANGEOUT ISSUE FEE BackFlow irrigation BackFlow Preventer BathWb Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over a outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 so.00 50.00 $0.00 $0.00 $0.00 50.00 30.00 $0.00 Qri PLUMBING PERMIT Phone: (714) 895•1246 Zip: 92841 Phone: 2ip: 92626 Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: Zip: License: 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 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, wmmercial � $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 an 0 0 0 0 0 0 0 0 0 0 0 0 a 0 0 0 0 0 Status: ISSUED Applied: 06/Oa1200� Issued: 06/04/2001 ISSUED BY: COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum�Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin � Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping pns[ or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 30.00 $12.30 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 TOTAL CALCULATED FEES: f35.80 Qn 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: Tha work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ortl. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automaticaily expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned tor a period of 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectians end final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration oi lhis pertnit. FOR INSPECTIONS CALL: (714) 7545626 2aaaae le�oo� WORKERS'COMPENSATONtlECLARATON: � —! I hereby alfirm under penalry of perjury one of the following tledarauons: ❑ I have and will maintain e cenificate at consent to sel6insure for workers' compensation, es provided br by section 3700 of the LaDor Code, tor the peAormence ot the lor which this Parmit IS issued. '�� -I have arM will maintain worMers canpensetion Insurance. as requiretl by sectlon 3700 of Ihe lebor Code, for Ihe perfomiance oF the work tw w�iU Vtis pefmit is issuetl. =y workers' compen�5@tlon � rance cartie antl II r ere: q'-,,�.,!/�—� l '/ Cernar� .��/�2.� �� Poli Numne�lLC/�—W /� J� Y Q �Y oNess.1 l,�— -- ❑ I certiy Ihat in the peAortna�e ot t�e work br which this pertnit Is IssueQ I shell not employ eny person in any manner so es to become sub�ect lo the workers' compensation laws of Call��ppmmIIae__Be� ��epree Ihat II I should bacome sub�eG lo the warkers' com ueeti�visions of Sectlon 3700 of theyAY� r pp''otle, I shall fort�with comply wlih these pmNsio� (� --- - � / / / /jf / i" CO O Applicant Slgnature:�- i—Date:_ % � l �� WARNINO:FAILURETOSEWREWO�E 'ODMPENSATIONWVEMGEISUNLAWFULANDSHALLSUflIECTANEMPLOYERTOCRIMINALPENA�TIESFNDCNILFlNESUPTOONEHUNORED THOU3AND DOLLARE (5100,OW). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 3'!OB OF THE LABOR CODE, INfEREST, MID ATTO{iNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb eilirtn thut I am Ilcensetl e.�rp sl�i C cammencin with Saction 7000 0l Divislon 3 0l iha Business entl Profes 'ons Cotle, end my liconse Is in tull force enC eBect: Gc: M� (/ �/ 9 , � Cless a�) G�� Contre�toYs Slpnature: L ��4� �/, / Date:- � / i CONS7RUCT10N LENDING AGENCY: ❑ I hereby aHirm �hat ihere is e construction lentling agenry tw Ne peAormante ol Ihe work for w�lch Ihis pertnil Is issued. (Sec. 3097, Civil Cotle). Lentlefs Name: Lendefs Adtlress: Slgnature: OWNER-BUILDER DECLARA710NS: Date: I heraby aHlrtn Ihet under penelry ot Derjury Ihet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the lallowing reason (Sec. 7031.5, Buslness end Professions Cotle: Any ciry or counry which reqWres e permit lo construd, alter, Improve, demolish, or repair any swcture, prior to its issuance, also requires the ap0��m br such pertnit to tile e signed stetement thet he or she is IlcenseC pursuant ro the proNslons of the Cantrectoro Llcense Lew (Chapter 9(commenGng with Section 7000) ot DMsion 3 0l Ne eusiness entl Proteuions Cotle) or that he or she is exempt therefrom and �he basis for the elleped exemptlon. Any violatian oF Section 7031.5 by eny appliwnt tor e pertnit su6jects the eppllceni to e dWl penalry ot not more than five hundred tlWlars ($500)J: ❑ I, es owner ot ��e property, or my employees with wages as �helr sole compensatlon, WILL DO TME WORK, antl the struciure is not intentled or ottereC for sele (Sec. 704a, Business and Professlons Code: The Contractors License Law does not apply io en owner oi property who builds or improves lhereon, and who does suc� work himselt or hersalt or lhrough his or her own employees, providad ihat such improvemenis are not intended or oMeretl tor sale. If, however, Ihe building or improvement is soltl within one year of completion, ihe owner-builder will have the burtlen of proving that he or she tlid no� build or improve lor purpose ot sale.). ❑ I, as owner of Ihe property, em EXCLUSIVELY LONTRACTING WITH LICENSED CONTRACTORS to constmct the pmject (Sec. 7044, Business end Prolession9 Cotle: 70e coniractors License Lew does not appty to an owner of property who builtls or Improves Ihereon, end who comracts for such projeci with a contractor(s) Ilcensa pursuent to ihe Conlwctors License Wws.). ❑ I am eaempt under sec. Business end Prolessions Cotle lor ihis reeson: Signature: Data: Owner ID verilied by drivers license. � Yes ❑ No Dnvers License No. Expires: Venfcetion ol Ownership �y (tyry�e oi Oaumem, i.e. - property tax bill ar deetl): DIVISION OF INDUSTRIAL SAFEN VERMR CERTIFlCATON: ❑ I �ereby certlty thet no exce�eHw� frve (5) or more feet in tlepih Into which e person b required to descenq wlil be made in connectlon with work euthorizetl Dy this permit, and that no building siructure, scattolding, falsework, or tlemolition or disman�ling thereol, will be more then thirty-six (38) laet hiph. (Chap. 32, Orp 2, Art 2, Sec. 341, Tule B, Cellfomia Atlminisiretive Cotla). ❑ As ownar�builder, I will not employ enyone to Ao work which would require e permll Irom ihe Division of Intlustnal Salety, es noted abova, unless such person has e pertnit lo tlo such work Irom the divis'wn. Signa�ure: Date: Divislon ol Industnel Safety Permi� Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMRY: I cenity under penelry of perjury thal I have reatl this aDPlication and state ihat the information given is correct. I agree lo comply wlth ell s�ate laws entl ciry ortlinances relating to Oulltling consWctlon, end euthodze represeNatives ot �he Ciry of Coste Mesa to enter upon the above�tlescnbetl propeny tor inspt+��ion pusposes. l ag�ee no� b occupy or allow ocwpa�y of any building authorized by Shis permit until linel insDeclbn. FOUE �. INSPECTIONT'PE Of Legel Owner(s) ithonzed ApPlicant — P6IE 1t1�L�L5 1616 Fixed Sy9iem Final Fire 7revention 1266 Pool Spa Final 200 Flnel Ra-Rool 201 FInaI BIaWReWlning Wall 202 Finel Fectory Firo Place 203 Ffnaf Sign 20a Final Demoli�ion cooer iNsvecnoNnre 206 Final Mec�enical 208 Finel Plumbing 210 Finel Electncal 212 Flnel Fire Pravention 220 Final Planning Apprwal 222 Final Si�e 250 Final BulltlingiOccupancy PAg WIIDSLS s��; 6'�j PPOJECT ADOflESS: Z 9 z 3 PALAi7 PL OWNEfl'S NAME: BELYEA ROGER aoonEss: zgz3 P�LAU PL COSTA PSESA,CA AflCN/ENGINEEH: RODflESS: UNIT: 92626 flEG.NO.: UNIT: PEPMITTEE: CONSUMER SERVZCES ( 714 ) 754-1533 aooness: 17950 MT HERMAN B FTN VLY CA 92708 LICENSEO CONtflACTOB OECIABATION: I hereDy a�lirm iha� I am hcensetl u tler provisions o� ChaD�ef 9(Commencing wi�h Sec�ion 70W) ot Divsion 9 0l the Business ana Pmlessions CoOe, and lic nse is tull brce and eilect. cirruc.: 044683 sT^TEuc.:42434 � Oate. � ��'� ��—. Signal WOFKEHS' COMPENSATION DECIAflATION: I hereby a' ha ehilicate ol consenl �o sel4insure or a certilicate of WOBers' Compensation Insurance, or a cenifietl copy lhereo� (Section 38 . ab. C) roucvxo.: 1105091-91 EXP.UATE: lOI �92 camraxr: STATE FUND � Cenifietl copy is hereby �umishe0, � Ceni�ied coDY is - tl w �e ' y ' Uing Oivision. Jale. � 0 ^ � � ^ E � ApplicanC E%EMPTIONFAOMWONNEflS'LOMPENSATIONOECIAflRT10: (TAissec�io e0no1 mpletedillhepermilisioronehundretl(51W)orless). I cehity �hai in lhe performance of Ihe work �or which Ihis Dermit is issuetl, at employ any person in any manner so as to become subleci lo �he Warkers' Compensation Laws o1 Calilomia. �ale: Signaiure: NOTICE: Ii, afier making �his tleclara�ion, you should become su�lect lo the Workers' Compensaiion Dmvisions of �he Labor Coee. you musl brthwiih compty, with such pmvisions or Nis p¢rmit shall be tleemeA revokeU. CONSTNUCTION LENOING AGENCY: I here�y aifirm �hat �here is a canstmc�ion lentling agency lor �he pedormance of lhe work tor w�ic� ihis permii is issuetl (Seclion 3W7. Civ. C�. LENOEX: R�OFESS: OWNEH BWLOEfl DECLANATIDN: I hereby aitirm �hat I am exemp� �mm �he ConUactors' S�ate license Law �ar I�e following reason �Seclion 7031.5 Business and Pmlessional Coae: Any cily ol counly whic� requires a permit Io conslmct. alter, improve, Oemolis�, or repair any simcNre, prior �o its Issuance, also repuiBs Ihe apPlican� for such permll lo flle a signetl sta�emenl thal he/she I5 licensed pursuanl lo ihe pmvisions af �he Contraclors' Sta�e License Law (Ctiapler 9(commencing with Sec�ion 7000) o� Oivision 3 0l Ihe Business and Pmlessions Cotle� or Iha� he/she is exemp� I�erefmm antl I�e basis lor the allege0 exemp�ion. Any viola�ion of Section 703L5 by any applicanl �or a permit suhlecis Ue applicant to a civil penalry oi no� more ��an �ive hundred dollars �$500�. I, as owner of ihe pmpetly or my employees with wages as iheir sole compensalion, will do ihe work, antl ihe � slmcwre is noi intende0 or oilered for sale (Section 70a4, Business and Pmfessional Cotle: The Contracmrs' State License Law does nai apply �o an owner ol a pmpetly who builds or improves �hereon, and who does such work himselOherSell or thmugh his or her own employees, provitled ihat such impmvemenis are not inlended or oifereU for sale. If, however ihe 6uilaing or impmvement is sold within one year oI compleiion. ��e owner will have ��e burtlen ot pmving �e/she tlitl not build or impmve for ihe Ourpose ol sale�. I, as owner ol Ne pmperry, am exclusivelp conVac�ing wi�h Iicen5e0 conVactors to cons�mcl the D�ojecl (Seclion 7�44, Business ❑ antl Professions COEe: T�e ConVadors' S�ate License LawOoes no� apply �o an ownero� pmperty who bui105 or impwves t�ereon ana who convacts �or such pmlec�s with a conirac�or(s) license pursuan� �o ihe Contraciors' State License Law�. I am aware �hat proo� of I�eir Worker's Compensa�ion insurance shoul0 be pmvitled to me. � I am exempt under Section: B. 8 P. C, �or mis reason� Da�e: Owner. 1 do here�y cetldy Na11 am aware o1 and understand the reQuiremenis ol Calitomia Healih ane Safely Coee Sections 25505. 25533. antl 25534 and Itlal I or any fuiure builtling oaupant will/will nal (CifCle One) neetl b tOmply wi�h SaiO Slaie CodeS antl �he requiremen�s for a permit for conslmction or motlilication trom I�e Air Oualily Managemenl �i5iricl. Residen�ial constmction applications are exempl irom IM1QSC pf0V151005 Dale: Apphcani'. _ I here�y cetlity thal I �ave reatl Ihis aD�licalion anA s�a�e �hat the ordinan[es antl slalelawsrelatmgto builtling cons�mciion antl h properly �or in5peciion purposes. Da�e: _.�Q__�� Signatur : odve�'s Gcense o� sociai secunry n: ° is correci. I agree �o comply wiih all city an0 couniy a�Iwes of this cily �a enter upon Ihe above�mentionea 164t-46 While-9uiltling: Green—Cotle Enforcemem: Canary—Applicant; Plnk—Revenue; GOIEenroO—Assessor CITY OF CO3TA MESA — BUILDING PERMIT PERM NO: H 05452 PERMIT NO: H 054527 PLAN CAECK NO: N GOVT: N SUPP: N CONSTRUCTZON TYPE: 5—N PERMIT TYPE; STR PURPOSE: ALT SOH DESCRIPTION : T/O EXIST/RE—ROOF W/"��LE" ICHO#3682 SQ FT: 9,650 CLAIM VALUE: 9,650,00 CALC—VALUE; 9,650.00 GROUP OCC; R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) REf�UIRED IN HOME. �r****�r�*****�r**�r*+��******+rx�*� �***�r*�ru��**x�**�*�****�r�� Z O N I N G R E Q U I R E M E N T SETBA�KS REQUIRED ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT;' FT TN REAR; FT IN FRNT: FT IN REAR; FT IN LEF7': FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARRING REQ• PROV: PARCEL; 1392'12U3 ZNE: REF NO; PLANNING N(fTES> > �**�*��*,��x��**�****�*�*��*�*********��*�**��********�*�+�*�**�r��*******�*�*�x�� D E V E.L O P M E N T S E R V I C E S R E Q U I R E M E N.'T S ZONZNG APPROVED.BY DATE: BUILDING APPROVED BY : DATE; APPLICATION ISSUED BY: .{ r9�r-�—�—ti DATE• :<d lb Y lEikififikifiElfiElfiEifikiElElEiEiEiE1f kif3FiFiFiF 7F iF�F iF iFiFitiF 7F�3F3F3F7Fif�FiFif�fifif3EifiFiElEiE iFiE iFitiEiPififikifikiF�lfiEikiEif#F1fiFiflFiflElfiFifll�iEifiF�lf�fikiFifiFifikiFlfik�Eiflfikikifif iFilifiEiFjElFiflfi4ifif�iFiEiFiEifiE7ElEiFifiiiflFifiEiEiFil� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/RES GRADING PERMZT 117.00 ,9'7 SMIP/NON—RES�' PI.AN r<�' ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHEC3t TOTALS----> 117,97 0.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED; BLDG PMT PLUMHING ELECTRIC MECHANIC LL%.Q� TOTAL PAID '`�. DUE 117.97 117.97 ." .00 117.97 OVER/SAORT; '.00 FIRE SMIP/TO� GRADING PLAN�CHECK �F1F iF�f 1E iE 1F 3E 1F�3E iF iE iF iE if k 3f if iE 1E if if If !E iF 1f if iF if IF if 1E iE iFlF iE iE if 1f if if iF iE iF if iE if jF iF ik 3+ )F !F iF iF if 3tiE iF iE iF �E if ff iE iE 3F if iE )f 3E 3E iE i!� ik iF iF ii� iE I N D Z V I D U A L F E E H R E A K D O W N � TYPE QTY D E S C R I P T I O N UNIT COST TOTAli�COST SFR 9650 REROOF BY VALUE RESIDENTZAL NOZONE 1,00 9,6-50.00 END OF FEES :'•� 1. �' FJ �� . C� QCJS'Y^','.S'LIw�°�: ' ' ' �• var�; io�,��st ri��<< _.: ��; i� � CONSTflUCi'�JN AND PLANNING POOI 'A � APPROVALS Permit# f Date Inspector AppROVAIS Permit# Date Inspector 1. Temporary Electrical Servite or Pole , 52. Pool & Equipment Location �� 2. Soil Pipe-Undrgrnd. . 53. S[eel Reinforcement . 3. Electrical Conduit Utility-Undrgmd: " , 54. Forms 4. Electrical Conduit-Undrgrnd.. �� , 55. Electrical Bonding - 5.- S['eel Reinforcement` - 56. Rough Plumbing & Pressure Test .' 6.� Electrical UPER Gmd. 57. APPROVAL TO COVER�GUNITE ' 7�.-Footings '^� 58. ElectricalConduit-Undrgrnd. � � 8. Foundation � 59. Gas Pipe, O 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� ; J 62. Backwash & Receptor-Final 12. S,ewer Cap 63. Heater & Vent-Final 73. 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 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.-Rough Facto_ry Fireplace �:. .�. Z , q. _ .`y � �APPROVALS • �Permit # - � 21 `Ducts, in Str,�ctu'te � „ ' , ; r70. Undeigr,ound Hydro � ' 22. Dutts, Ventilating . . � � . -7�, Product�Piping OGas QOiI 23.�Gas Pipe�Rough & Test 1� ' y ,l " ; '72, Underground Flush ,. * - ,., 24. Roof Framing � j � � � _ - _� � 73.� Undergrnrl-. Storage Tank O Gas O Oil , 25. Roof Sheathing '. '� -��.�' i - /� �, '74: Overhead Hydro_ _ � D'�/ U.w� 26. T-Bar Ceiling (Structurall &.Monocoat � . . 75..'Dry Chemical � . � 27. Frame and Flashing ; a _� 76. Dry Standpipe �� ' � �'� � 28,`Lathing=& Siding . . . . : . � - � 77, FIXED SYSTEM FINAL �� '29. Insulation �� '�� ' -' ' 78; FIRE PREV. FINAL . . - 30. Drywall,�Nailing'- � �' � . � . ,HEALTH.DEPT..REQUIR�EMENT _37. Plaster Brown Coat� , y �` 79.� FINAL INSPECTI'4N � � 32.- Electrical Power Meter-Final' ;�'. �.SO.,�FOOD CERTIFICATE ISSUED ��, 33. Pinal Electric - . .t.�, } � Nofes: � -' � 'r � 34; Final Heating'& F.iF, Conditioning, - � �� . ?.i ;, ,�. '• � �. � � 35. Final Gas Pipe-Test ' � � "' r •' , - , � _ ' �.... ,.36.'Hood or;CanoPY� � • f , �� :.. ; h . y, . , �;.,; , . . ..r, . 37��Final Factory Pireplace - �� • � %�'j" � � " . -"38. Final Plumbing ' , ' y, � . %� �� "� �, � � _ ; � - ,-.39. Water Service-Finalr ' .. I ' �',� ' . -��, ' . = r �, �: -„40. Gas Service _Einal : S_,•. " , �; r .f ', � � � n .41. Solar pomesticFinal- � �� .�� . ' 'rr . .t.c � � : ` 42.-Backflow Preventer; •- � � � 43. Backflow Irr.igation- �f, :, , t r = � : � _ - -: �. y > . ';�44. landscape Irrigation1System." ` , � , . i� ' ' , - :9 L - ��45.'Sound Atte�uation . �"' •L � � . � ' t �� . i �i �'�46. Handicap Regulatio=,ns t��S , ' �' ' ` ' 47�FINALSTRUCTUAE&.BUI�LDING (,0 � C� � = •� _ 48.';FINALPLANNING+ �' ' � %" ' ' ` ; - �_„ �. .f .�� . . „i � `'... �49.- Ele'ctric�Release to. Edison J . '� f a�l ? - S � _ �� l _ i ' / ,. .� (/ : 50. Gas.Release,to Southem California Gas Cn ' ; �(�f' .� .- . , , ' ` � ��- : ,51. CERTIFICATEOF„ CCUPANCY = r ; No. �'Date AOPlicant to f111 in all spaces exceDt those within neavy bortler Ilnes an0 sign all approvriate aeclarations. PE IT NO. TRACT NO. LOT NO. UNIT NO. CiTYOFCOSTA�M/��SA CO ST UCTI PERMIT 39�,�s � q,P,# Project Address .aL—J . • S Main Building: TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR E Applicant's MailingAddress I/� ❑ CorvvERSION ❑ DEMOLISH ❑ o7HER T Front �\Owner's Name Phone �� DESCRIPTION OF WORK/USE OF BLDG. I A Rear Address AfCh/Eng. LlCense No. TVPE OF PERMIT GRADING OUNDATION STRVCTV RAL � K Right AddrCss _ ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL g Left Contractor's Name ' P one �� OTHER ! Ping. ReL # Address (mailingl �Q PROJECT DESCFIPTION 5�. FT. OCCUaArvCV 9 CONSTRUCTIONTYPE VALUATION3 Plannin Notes: City LicenSe No _�� ZONE GRADING CU. VDS. ACRES LICENSED CONTRACTOR DECLARATION I hereby aftirm ibat I am licensetl untler Orovislons of Charter 9(commencing with section 7000� of Division 3 0l [he Business antl Protessions Cotle, antl my license is in ful �ry/�� antl etfecL ♦ �� LICEf152 C 5 �ja{[/ L 5 �� ate Si9nature . _ WORKE 5' COMPENSATION DECLARATION � hereby affirm that I nave a certiticate of consent to SelGinsure or a certlflcate Workers' Compensation Inzurance, or a certifietl copy thereof (Section 0, Lab. G. ��' �Nol�cert'if etl copy is her¢b fum she0 Company �,T MP 10 FROM'WORKERS�'dCOM ENSATIO�D��RATION (This section neetl not Oe cam0leted it the permit I5 for one huntlretl (5100) or less). I certlty lhat in [he per/o�mance of the wo�k for which this Oe�m�t is is5uetl, 1 shalf not employ any person In any manner so as to become subject to the Workers' Compensation Laws ot Calitornia. Date Si9nature NOTICE: Ii, a(ter makin9 tnis Ceclaration, you shoultl become subject to the Workers' Compensation orovisions o( the Labor Cotle, you must brthwith comply with SucM1 p�ovi5ion5 or this p¢rTit Shdll be tle¢m2tl �evoketl. CONSTRVCTION�IENDING AGENCV 1 hereby aifirm that there is a construction lentlin9 a9ency for the performance ot the work for which thi5 permit is I55uCtl (SeCtion 3097 Glv. C.) I..entler's Name Lentler's Atltlress OWNER BUILDEft DECLARATION I hereby alfirm that I am exemot (rom the Contractor's License Law tor the ioliowing reason (Section 7031.5 BuSiness antl Profe551onal Cotle: Any city or county whicn requires a permic to Conztruct, alter, improve, tlemoli5h or repair any sbucture, pNor to its issuance, also reqWres the applicant for sucn permil lo /ile a signed statement Ihal he/she I5 li<ensetl pursuant to the provisions of the Contractor'S License Law (Cnapler 9,(commencing with Suction 7000) of �ivision 3 oi the Business antl Protesswns Cotle) or tha[ he/5he is exempt ' trom antl th¢ basis for thC allegetl ezempUOn. Any violdtion of $ectlon 5 by any applicant ror a permlt Tubjects tbe appli<dnt lo a Civil �,�ty oi mt more than five nuntlretl tlollars (E500). I, as ownm of [ne property or my employee5 wilh wages as their sole Compensa[ion, wlll tlo the wo�k, antl the structure Is not IntenCetl or offeretl for sale (Section ]044, Business and Professional Cotle: The Contractor's �icen5e Law tloes not apply to an owner of a property who bulltls or improves Ihereon, antl who tloes sucn work himself/h¢r501f ov lnrougtt �is or h¢r own employees, provitletl lhat such imprOvemen[5 are not intentletl Or offeretl for salc. H, howaver, the builtling or improvement i5 Soltl wlthin one year of com- pletion, tne owner will nave the ourtlen oi proving ha/sne tliC not builtl or Im- nrove ior the purpose ot sale). ❑ I, as owner of lhe property, am exUusively con[racting with Ilcensetl <on- lracto�s to construct the Oroject ($ection 7044, BuSin¢55 antl P�ofes5iOn5 Cotle: The Contratlor's License Law does not appry to an owner of proPerty who builtls o� imOroves thereon. antl who Cont�acls for Su[h oroi¢cts wlth a r.on- tractor(s1 Imense pursuam ro cne Conttac[or's Litense Law). i am aware that Oroof o( lheir Worker'S CompensaHon insurance shoultl be ptovitletl [o me. ❑ I am exempt untler Sec[ion B. & P. C. for this reason Date Owner I nereby certity that 1 nave reatl Mis appliWtlon ana state that the above iniormaeion is Wrrect. I agree to comply with ali city ana county ortlinances antl state laws relating to builtlin9 construction, anG hereby au[horize repre- Sentatives of this City to enter u0on tM1e above-mEntiOnetl ptoperly tor Inspattlon pu s Signature Date�-�;�_ Driv¢rs' License Or 55 # 0865-46,rev.5/88 White Remarks: 5 J�b/�i/j�/J/J/ //M� C �(kl(!"L�eVCTi P Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Jrinking Fountains Floor Drains Floor Sinks 3as Service OuUets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Rainspection Fee $75 Boiler Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO �k Heating System & Ducting ❑0.100,000 BTU 0100,000 BTi Rainspectian Fee ' $15 - Applicant; Pink - Accounting: Goltlenrotl - Assessor 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 laue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-t00,000BTU ❑100,OOOBTU System Repair/Alteration Fire Dampers Registers Ifsua Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher � Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes ` Outl¢t5 Switches � Garbage Disposal Generator 00�5 KW C $ 3 FEES $ 3 zone Accessory Building: Parking Req./Provided ELECTRICAL 7ransformer ❑ 75-50KW ❑ 50+KW Meter Dup ro 100 amps Meter ❑over100amps Sub Panel Motors�0-1 HP�iX-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Li9ht Range I I Standing Sections 5-15 KW I Trash Compactor � Reinspection Fea �$15 � , � Issue Fee DEVELOPMENTSERVICESRE�UIREMENTS: Zoning Approved By Buildin8 APProved By �� FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PIAN CHECK $ �/pERMIT PLUMBING $ �— �. W�SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL y GRADING $ PLAN CHECK 50% $ MICROPILM $ MECHANICAL $ TOTAL FEE $ �DD PLAN CHECK 25% $ �i �Lt+'�N�.�.�"��P:_��i ?��+^ ��.-_ �i. _:: "ci ?IGt: ._ ..� O N I N G R E � M T S. . � . _ _ i J . � CONSTRUCYION AND PLANNING POOL °� SPA APPROVALS Permit# Date Inspector pppROVALS Pe....�t# Date Inspector 1. Temporary Electrical Service or Pole "� 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. - 53. Steel Reinforcement �• 3.'Electrical Conduit�Utility-Undrgmd. . 54. Forms 4'. Electrical ConduiY-Undrgrnd. 55. Electrical Bonding �.i .. 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6' Electr,ical UFER Grnd. 5�. APPROVAL TO COVER-GUNITE �: Footings : 58. Electrical Conduit-Undrgrnd. 8.-Foundation � � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line�& HouseConnection • 62. Backwash & Receptor-Final 12. Sewer Cap ' 63. Heater & Vent-Final 73. Roof Dreins 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 ri 17,. Rough Wiring Sign 68. APPROVED FOR PLASTERING �� 1$' Rough Electrical-T Bar 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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framin9 73. Undergrnd.StorageTank OGas ❑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. E�ectrical 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 �0�1 �C' LE� 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer . - !'•• 43. Backflow Irrigation . 44. �and5cape Irriqation System . � 45. Sound Attenuation ' 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison v e�„ 50. Gas Release to Southern California Gas Co f °�� 51. CERTIFICATE OF OCCUPANCY ' No. Date - � G�_ or r LA'1'1': SUBCONTRACTOR ZONE � ' ' � 25961 COSfA MESA BUILDING-Sl�ETY DEPARTMENi P.O. BOX 7200 COSTA MESA.'CALIFORNIA 82820 For AppllcaM M FIII In Compl�tely TYPE OR PRINT ADDREYY � �� L �/ I � I 1 C� COSTA MESA, CALIFORNIA o,�eR�� -Y�� MAIL CI � � � � � ADDX n�� eirv �S rto. ARCHITHCT (�,�, y�� L�A LL T�' �N �.N6�NHHR N�_ 2 i Oi � BBTBACR uN6 � i� U �►�L . u 6;.3 6 a7. pESCRIPTION OF WORK WALL I X6R6DY ACRNOWL[GO[ TMAT.1 HAV[ RGD TNI� AND eTwT6 TNAT TM� AeOVt JB CORpR[CY AND AG GUiL� NO CONBTp�T10M.� � IRAi[�L/1WI � al � AUTNORIZ[DA�[NT � AUC-1-66 00 019n�****36.00 ArPLICATION FOR PERMR BUILDINO For OffTn Ur� Only n�cnrtno. �� YANDB MPROVlD MAIN BUILOIN6 vwn.# no. - � _� � ee �ess rHu+ YARD9 APPROV 6D ACG6880RY BUILDINO � �l" / vr OATfi Tlt AMOUNT �XOWN UMD6R ►YRPOli O! fiT/�GLIBXINO VALUATION / O PEHM a J �O i�� TOTK a 10 FOp TNi �6{ ONLY. : -"` �EE R�CEJVc� � �_�.��; �� 1��0 COSTA MESA BUILDING-SAFETY DEPARTMENT fINANCE DEPT. P.O. BOX 317 COSTA MESA. GALIFORNIA (��'y (�C rncTn ��nn v�� v� vvVln IIIWfI fOR AAP[/CANT TO f/[L /N COMPLETECY APPLICATION FOR PERMIT 7YPE OR PRINT BUILDING ADDRESS 2923 Palau �Pla.ce COSTA MESA. CALIFORNIA ryn OFF/CG USE ONLI OWNER Ken rof D 9 1 C I RECEIPT NO. I PERMIT'NO. �� I� MAIL 1555 Placentia • RECEIVED BY DATE RECEIVED 'DpAT9E 159UEO ADORE55 " Gl� I �— �'� �O � I F€y J 1960 TEL. �_ BUILDING CITY New �rt Beach NO. pDORESS nRCN�Tecr ' ��c. COSTA MESA. CALIFORNIA OR INEER ' NO. ADDRE55 FIRE �/ 1 ZONE TYPE GROUP T" CONTRACTOR K�W� K011 L C NO. 61195 APF'ROVED BY DATE en a ADDRE55 ZONING LEGAL I LOT f) I I ZONE i I NO. OF � I USE OF NEW OESCRIPTION NO. �( BLOCK TRACT PLANS BUILDIN APPROVED�I, A.P. NO. BY .1/ • OATE � O SIZE [�/ [ NO. OF BLDGS. OF LOT J( xl� V irre I rvOw orv �oi Q REQU REO ALLOWED USE OF none (CENTEN LINE ST.) EXISTING BL�G. FRONT O�7, IN. SETBTCK L�NE FFOM C O � �J [ � CENTER OF STREET � REAR YARD LJ R. SIpE S F7', IN. SIDE YARD ILEFT t IRIGHT � L SIDE FT. 'IN. DESCRIPTION OF WORK, REAR �� F'f. IN. NEW I� II AITERATION I II ADDITION I REPAIR I�IIMOVING I IIDEMOLISH I SZIEDING 1HOO S1 ROOMS 6 STORIES 1 EXTERIOR W 1� ROOF COVERING L CC ICOVERING Aock USE OF BUILDING AND WORK TO BE PERFORMED S and Attached Garage a . 1 HEFEBY ACKNO LEDGE THAT I HqVE REA� TNIS APPLICATION THE AMOUNT SHOWN UNDEfl VALUATION 19 FOR THE AND 9TATE TH 1� ABOVE IS COpPECT AND GfiEE TO COM� PLY WITH AL CITY OINqN AND 3TAT UI.ATING PURPOSE OF ESTqBLI3HING A PERMIT FEE ONLY. BUILDING CO STFU T N. VALUATION SIGNATURE F PERMIT FEE $ �� PERMITTEE $ � i/ //�_— 4 lj y PLAN CHECK $ � /'— � AUTHORIZED AGENT TOTAL FEE S ��'�'