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Home My WebLink About163 ALBERT PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT .lob Address: 163 ALBERT PL Status: ISSUED Suite No Applied: 09/05/2001 Issued: 09/05/2001 Vicinity: ISSUED BY: Parcel Nunmber: 42606304 Applicant: NOCK, RON Address: Phone: 714-895-1246 Zip: Owner: MARSTELLER, DEBRA L Address 3374 CALIFORNIA ST Phone: COSTA MESA, CA Zip: 92626 Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Phone: (714)895-1246 GARDEN GROVE, CA Zip: 92841 License: 707775 Arch / Eng Address: QINI Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. 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 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS / SPECIAL CONDITIONS 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) 7545626 2446416 (6=) 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 rkfor which this permit is issued. 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' compers n lasurance canner and policy number are: Carrier: 45;!V J PolicyNumber. (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) ❑ 1 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 workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisiogf p _/0 -0/ O j Applicant Signature: I/' \ Dete: J / WARNING: FAILURE TO SECURE W ERS' ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), INADDITION! 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 rovisions of Chart 9 (�r [i encing with Section 7000) of Division 3 of the Business and Pro>sioy§Co�a, and my license is In full force and effect. Lia q Class N Contractors Signature: Date:_ CONSTRUCTION LENDING AGENCY: ❑ I hereby affin that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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 perms! 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 contractors) 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 drivers license. ❑ Yes ❑ 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 cenity 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,ihatno 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 S. Califomla AdministrativeCode). J ^r _r ❑ 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. r 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 ❑ No (Section 25505 of the California Health and Safety Cade 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). r will the applicant or resent or future building occupant need to file a registration forth for acute) hazardous materials? Ves No ...................... .. ..... 2 Does o PP P 9 P 9 Y ❑ ❑ (Section 25533 of the California 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 California 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..............................................................................................................................................................................................-................................................. -..................... ...................................................... .. plica.................... ant 5 Does or will the applicant or present on future building occupant require for the work which is the subject ofthis a plication aggermit for such construction or modification from the South Coast Air QualityManagement District or from any other air pollution control district or agency? Vas u No (Section 65850.2 of the California Government 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 ❑ No (it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California 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 Code Section 42303 been made? ❑ Ves ❑ 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. ignature Of Legal Owner s Date AnSOTA01frionzed Applicant 41 Date CODE t. INSPECTION TYPE gATF INpj7TALm $ CODEE INSPECTION TYPE PATE RiiITIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 7V 200 Final Re-Roof 210 Final Electrical 201 Final Slock/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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 163 ALBERT PL Suite No Vicinity: Parcel Nunmber: 42606304 Applicant: NAVASURDYAN, HOVIK Address: 600 KENWOOD AV GLENDALE, CA Owner. MARSTELLER, DEBRA L Address 3374 CALIFORNIA ST COSTA MESA, CA Contractor: NUMBER 1 STATE PLUMBING Address: 600 KENWOOO AV Arch / Eng : Address: GLENDALE, CA Phone: 877-272-7282 Zip: 91335 Phone: Zip: 92626 Phone: 877-272-7282 Zip: 91335 License: 695125 Phone: Zip: License: SCOPE OF PERMIT WATER REPIPE TO AN EXISTING SFD. NO OTHER WORK TO BE DONE WITH THIS PERMIT. Interceptors (Grease, Oil) $0.00 0 Interceptors (Sand Auto ) $0.00 0 Status: ISSUED Applied: 12/13/2001 Issued: 12/13/2001 ISSUED BY: 4_�& QTY _ AMT FEE SUMMARY 0 AMT QTY 0 AMT ISSUE FEE $23.50 0 Laundry Tub / Washer $0.00 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 Backflow Preventer $0.00 0 P -Trap $0.00 Bathtub $0.00 0 Pressure Regulator $0.00 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 Dental Units $0.00 0 Septic Tank $0.00 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 Drain, Floor $0.00 0 Sewer Connect $0.00 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 Drain, Roof $0.00 0 Shower $0.00 Drinking Fountain $0.00 0 Sink, bar $0.00 Expansion Tank $0.00 0 Sink, commercial $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 Gas Service $0.00 0 Spa (public) $0.00 Interceptors (Grease, Oil) $0.00 0 Interceptors (Sand Auto ) $0.00 0 Status: ISSUED Applied: 12/13/2001 Issued: 12/13/2001 ISSUED BY: 4_�& QTY _ AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkfiow(t-4) $0.00 0 0 Vacuum Brkr Bkfiow(5+) $0.00 0 0 Wash Basin $0.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater / vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $9.80 1 0 Water Service $0.00 0 0 Water Softener $0.00 0 0 OTHER $0.00 0 VIOLATION $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 TOTAL CALCULATED FEES: $33.30 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: 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 2446.46(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 this permit is issued. have and will maintain workers' compensation Insurance, as required by section 37 of the Labor Code, for the performance of the work for which this permit is issued. My work m e ation urn errler and p li%y u r are: r er: (�(l / (Policy Number. section need not he completed if the permit is valued atone hundred dollars ($100) or less.) ❑ 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 workers' compensation laws of Califomia, agre that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am titan dCde I ns apter 9 (commencing with Section 7000) of Division 3 of the Busine end ofe Bions/C; �9d my license is in full force and effect. Lic. N �✓ Class 8 � ,� 6 /7 �(i Contractors Signature: Date:—/,/--/ I CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affiml 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: Lenders 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 per: 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. It, 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 drivers license. ❑ Yes ❑ 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, Califomia Administrative Cade). ❑ 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 ❑ 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? ❑ Yes ❑ No (Section 25533 of the California 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 California 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? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication ayPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes Ll No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................................................................................................................................................................................................................................................... -............................... ............. 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? El Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................ ....................................................................... .................... .... ......... ........ ............................. .............................. ...................... .......... .......................... -..................................................................... .... ......I............................. 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 Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................ 8 (It'yes", amach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the intonation 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 map ectPas. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) 12— _ 1 'S ^ Da'80 / And/Of Authorized Applicant Date CODE f. INSPECTIONTYPIt per TE INTRIALS CODE INSPECTION TYPE 2&M INTIMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 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 ADDRESS OF BUILDING: 163 ALET$ki"r gf UNIT: VMNEWSNAMEIFIODWN: MARS T ELLER , DEBRA L ADDRESS: 3374 CALIFORNIA ST COSTA MESA,CA 92626 4 APDL. MAILING ADDRESS: ARONDECT OR ENGINEER- UC. NO, ARCH. OR ENG: S ADDRESS: UMT: CONTRACTOR'S NAME: CONTRACTOWS MARRO ADDRESS: UC. Ni UW-. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm under many of perjury that I am licensed uldm provlemm of Cheshire 9 (commedp with Section )000) of Division 3 d the Business and Professions Code, and my license is in full force And effect. CITY LIC. NO, UC. CLASS: LIC. NO.: EXP: Dela: Conrad. WNER BUILDER DECLARATION: I hereby ahem under mnaky of mrNry Ihal I cors mempl from IM Contractors Uperoe Law for the ,roving reeaon (Section 7031.5 Buri ass erst Profemsions Coda: Any city or county which reauirea a permit to coea nrd. after, i oma e, ' offish, a rapes any structure, prior to he arnumew. Also requires IM wdirem for such wori t to fib a sgnad statement that M a she �$g""'immed msmet to the soviscm of the Commoners Lioenae Lew (Chaser 9 (commendrq wfth Section TOW) of Division 3 of the !$uderea and Prdaa.m Code) or that he or she. nems Iherehwn anal the bels for ft alleged exemption. Awry videlim of Section 7031.5 by any applicant for a norma subjects the soldiered to a dvil penalty of not mon than We hudred ddlea ISSOOB. 1, as Duma, of the property ar my, employees with wmgas As firer sots can ,ensmon, will do the work, and the structure's m1 imedd or offered ler ads (Sedion 7OW t. Bwor se end Prolsoons Cade: The Contractors Lomas Lew does not appt, to an owner of prop" who builds or knwoves thereon, and aho does such mak Nmself or heneP or %rwuph No or her own employes, pra'ided fine such m,mmirmsts are not inledd es offered for eels. 1. however, the building or msovemem in; sok! within ons, yen of compbian, the owmr-0uiker wail have the Whalen of provip M or she did mc, bulk or improv fpr IM Wrpose d We). ❑ I, as owner of the oweM. em exclusively connecting wflh licensed contractors to westrucl IM projed (Sadist 1040, Gammas ad Professions Coda: The Contrmon Lcense Lew aloes M appy to an owner of property wM Wiks or imsovss thereon ed e o contracts fpr such propos with a comredor(s) licensed musam to the Contractors Duma Law). ❑ I am � .Aaxa//m�s der Section: B. S P.C., for Nie Date: I j r, &4 Owners, I an hereby artily that I am awsre of east uderslod the nquireenma of Callomu Health and Slay Code Sedioro 25505, 25533, And 25530, ad that I or any future Wikip opwpml wi11I if mI load. aro) need to comply with mil state codes ad the requkemanta W a permit for consthmiion wmdifoation from the Air atyTI.anegamenl District.R®demid construction applications Are exams from these provisions. Data: Apdicam: WORKER'S COMPENSATION DECLARATION: I hereby affiml udn penally of perjury ons of the following declarations: ❑ I have and miff maintain a cenBicete of consent to solinsun for woMers' canpenaelbn, as provided for by Section 314 of the Lobar Cada, for IM pedonma os of tiro mark for wldch this permit is mued. ❑ 1 hen Aad mil maimsm workers' mmparnat.n irourope, n n and by Section 314 dine Lebo Code, wine pedarmanca dim wale far which this mmt ie .sued. My workers' axnperoAlion insurenu oats, ad policy numher are: Carrier: Polity Number: (Th. seduca head nor he camWded IF the cern la for aro hudred dellen Ill or Int.) ❑ 1 urliY that m the petamame of the work as witch this pamH . named. I shell M employ, airy pe eon . any manner s a to became subject to the worinra co nWnaetion .s of Ca111om., end Ors Nat H I shook become subject to the eorlms' comWneation provisions 0 Section 37M d the Lebo Code, I shell fonhvAh comply wfth dome masiom. Date: Applicant: Waming: Faffun to secure wodims' mnasmadon doe age Is unMwArl, and shall subject en emeloys, In slasher penelda end civet haw W to one hundred thousand! dollen (310ggggd In notation W the cost of rompsssfbn densities as provided for In Section 37M of it,. Labor COAT, Interest, end momey's Mss. CONSTRUCTION LENDING AGENCY: I hereby affirm oder pests d perjury thin e, i time construction pIM ruction .ent, for performance of the wait far which the Imes a issued (Section 347, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I candy That I have reed this application od date that the above Information. coned. I nes to candy with ell city and welly warmers And state sora deW ^g to Wilding construction and hereby m ll arice repreBernlAtiva of Int, sty to enter upon the abwe-m aracrrod properly for impaction Wrposes. DEBRA MARSTELLER e Date: Signature dOwnmlAganV ppXunVConire a (5151 .WP) WMe-0uildiV A Soley; Grsn-.; Cony-Appiunt; Pink -Remus: Oddemd-Asaenor _ CITY OF COSTA MESA - e ii ^vib(3 rTMIti 1 PERM NO: E 080848 PERMIT NO: E 080848 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ELECTRIC SERVICE CHANGE -OUT SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42606304 ZNE: REF NO: PLANNING NOTES> > ############################################################################### E) E V E L 0 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 ZONING APPROVED BY DATE: BUILDING APPROVED BY : c,, DATE: APPLICATION ISSUED BY: 2 DATE: \Ilii CtC, LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 27,25 503 SMIP/NON-RES PLAN ISSUE FEE 22,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 27.25 22.00 0.00 49.25 49.25 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 49,25 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 49.25 ############################################################################### I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 27.25 27.25 END OF FEES 01 00220870-00220870 TOT 49.25 DATE: 12/12/95 TIME: 11:10 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector PO SPA APPROVALS Permit # Date Inspe ctor 1. Temporary Electrical Service or Pole i 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. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 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 APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping El Gas 00il 23. Gas Pipe -Rough & Test 72, Underground Flush r 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monoccat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29, Insul!ion 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final I�, 17 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date