HomeMy WebLinkAbout2712 ALBATROSS DR - Building Permits" Lot 84 `� �L
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 91] C09TA M6BA� CALIFORNIA
For Applicanf to Fill In Comple►ely
TYPE OR PRINT
■ MAIL
COSTA MESA. CALIFORNIA
' [.'��i�
TEL.
HLTBACK LINC PflOM
CENTER OF HTREEI' 55 � REAR
SID6 YAR�I LEFT H� " I R16FIT
DESCRIPTION OF WORK
�
�
5 Z'E D1N6 2 419 ROOMS 7 $TpRIEB �
EXTERIOR WA �� ROOF 4 Ce
COVERING ��}UCCO COVERIN6 S 1111QIQ
US6 OF BUILDIIiG AND WORK TO BG PERFORMED
1 HEREBY ACKNOWLEDGE THAT t X�Ve RBAD TMIB APPLIGTION
ANO 6TATE TNAT THE ABOVE 18 CORNECT �NO AOREE TO COM.
PLY W�TH ALL CITY ORDINANCHY ANO BTAT[ �AWB REOULATINO
BUILOINO CONSTRUCiION.
SIGNATURE OF
PERMITTE
AUTHORIZED A6E
rtt KECEIVED
MAN s l tb64
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
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ZONING
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DEBCRIRION Lot 84, Tract 5289
A. P. NO. IIORP.
NOTE: NOEAVEOVERHAN68HALLBELESSTHAN
YAROHAPPROVED
MAIN BUIL�ING
VAR. #
YARDSAPPROVED
AGCESSORYBUILDING
DATE
�/ / 7�� �
4. �. m
THE AMOUNT BXOWN IINOEP VALUATION IB FOP TXe F
PUHP09E OF 88TABLISHINO A pERMIT FEE ONLY. �
VALUATION � O � m
PERMIT FE8 $ �
r// �J �
s/�� /G�Q — urv c � D o
�a 4
TOTAL FEE $ '
�nonEssaeundra: L71L ALti711XV55 iltt °NTi
OWNENSNAMEIiIRlOWN: b�KV�N, t(F1LYH Ji 1it tLVVL; AE—Qb
'�0�u� L lIL ALt7A11tU5S llt(
CUSYA M�.SA,c:A 7LbLb
MPl.1WIWG/iWPESk
RPCHRECT OP FNtlNFEN:
CONiPACTdYSNAME ��q ROOFING bY' GENE
CONfPACTORSMNIJNG 1 G d 9 b i,£u77i iN
uc. ra.:
UNf:
i 909 ) "lFsS-5751
• moaEss RIVEkSILE CA uc.w.: 5721b�
9L7V3 UNf:
UCENSED COHrN1CTOP5 OECLRHATION: I MroEy ellim uMs panely d perjury ihet I em IicemeE uMer povivom W Cheqer 9
( ndrq wnh Seclion )000) d Orv'sbn 3 d Ne Businma eM Pmieesime Cade. erd mY �� u in tull lorro eM eXetl.
mu No.:G5I�52 Muccuss: L jg ua 5-7z�• pvAr EiiP: GViuG
<: �" 3 � T 1 convea«: �A M, 11�1tNb
�Q BUILUEH �ECIANATION: I Mreby elfiim uMer peneYy d per'Plhet I em eicemq Iram iM Con�mpon Licenae lew la Hro
folbwin9 redon (Seqian )031.5 &»maa vd Prdeviom Code: R�ry ciy n munry xfiich �pwm e pemin b owo-un. ellr. improva.
damolbh, a rapai eiry sVUGure, priw to na'neuerce, ebo requirae iM eppliraN lar wch peimN to file e egned etetemenl lhet M a eM
ia licenseE W�a^� �o �M pansiona d Me Conlreawa License law jChepx 9(oommendnp wNh Setlion ]OW) d Diveion 3 d ihe
8uainea vM Prdwione Cada� rn thel M a Ma ia azampt Ihxehom end �M beeis Iw Iha dleped eaemption. My violetion ol5epun
�asi s M�r wd�� mr e�am�n wqeas me eap�m io e am �eneM a �a m«. men �we nw,erea mu.o Issaall.
� I. es ow�w d iha peopenY a mY a^DMMa �h wepea m theF eob mmpenution. wJl do Ne wa'k. erd iM nruelure c �at mlenEeE
or oMared la eele (�ion ]aa. Buwiwa eM Prdeesiona Gotle: The Comredars Limma Law Eoea iwl epplyloen owrwr d papmry
who W Wa a inproves IMrem. ak who doee euM work NmwM or Mner w thraqh he or Mr own empbywe, proviJed tMl wcl�
improvemente ere mt imaMed a dlered lor aeb. X. however, tM EuiNi�q a inpovemam u wid wnhin ona Yav af oomplelon. IM
owmr-buitler will Mve the burden d povi'p M« sM did mi build w imparo /w iha purpoea d eele�.
� I. m owner d tlre propeM. � eaduervey mntredrp with IimnseA wnlrecton to conshud tM qajx! (`�� ]�. �ina�s enE
Vrolemiom Cade: TM CaNretla+ L'cenn law Eoea M xVNY b en owm N P�W�Y w1w Wiks n im0�'m Ihaean end who
convene lor euM D�I�%��h e mMredoKe) Icensad pu�auem to the Comreaae liwme lew�.
� I am exempt uMer Sec�ion: B. 8 P.C., br Ilue remon:
Dete: ��:
I Eo henby canity Il�et I em eware d enE u�Me�steM tln rayuimnmua W Celfwnia HeW� eM Sdety Cada Sadiwn 25505, T5533, W
2553p, eM ihet I a eny luluro WiWi�q vpaM will / wpl nM (dreb one) neeE lo mmpN wA� �� �e cotles eM iM reyuiremend M
eCermulormnhuctionamoEifxslionham�heA'i�y enepenianiGmiia.Raddenivlmim�wionePP�bmanecemphomlMea
qwisqne.
o�e: AvviM�n:
W ONKEP'S COYPplSATION DECLRNATON: I hereEy elfi�m under penely d pe�jury ma d Ne blbxi�p Eedualiom:
, ❑ in..��ew���ma:,.�nnwea�o�mm.w.�w�n.,�d:�w�.m�.ea���Ms.ammaoam.�no.
' COAe, la iM pMmronca d Ne wak ta which thia pamil u iasued.
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wpk /a xfi'rA Mu pertnil'n mued. MY wa�rs' �^Ve�b^ ineurvice w�ier eM poW.y number me:
c�.: S1AiE c��ya7 G1SY17(t5
va�yN�mw: in�—�ii�iuui�TTti Ulivliy8
(ihis seainn rreeJ �W canWMed f fhe prtnt's b one hunLred ddlars /Sl WI a hss.)
� I carlM � in tM pMormanca d the woM la whc� Ihis pa'mA'fl uetl. 1 ahell iwl pby enY Ve�n in enY memwr ao m to
b«ome subjecv ro �M woAen' mncen+mion lewe a CeNwn' earea thm ehauk becana mbjsr+ to tM whe�e•
companamim pewiaione�° �SeA'an 3]00 ot �M Lebor Coda, I eM1 t h DN � �a�
de � G ��-0 �"! � nowi�am: . .
Wer /n0� F�llun ro sxvro woAxi rompsnaetlon eowreps l� unleNful, end �hsll subNef en smploysr ro erlM�xl penaltlu mL
flnu ay ro ais ��nWM tMuuM Aollen (S1IX{QP01, b�Ifbn b M� roat ol m�awlbR d+�pu u PlovltlW br In
Sscf/on 9]06 0/ tlrs Le6or Cotls, Intwsa( antl ettornsy i frw
CONSTflUCTION LENOINO P�ENCY: I hereEy e/firtn unEer penelry o/ perlwy Ihet �Mm w e oomt�uGion bMiip pqity M Oe
paAwmaMe d �M xak M whiM iha i�Y m ewed ISeaun 3081. Civ. CI.
LENDEN'S NMIE:
LENUEH'S AODRE55:
I cenM thel Il�eve read ihis epplicetbn vd etme Ihet Ne ebove iMametion b mrtetl. I epne io canpy wnh all1ay erd oouMy oMmenus
anE ntma lexa relmip W Wikvq mnmrutlion erd hereby eu�horae repreeentmivee W this dlyto enter upon iM ebova-men�ionad propery
lorinspedion purposes.
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10-38-1997/81:24 PM/5125.37
kCPTq:81-8014748
PERI`l I T : 085525
.._
� �OL & SPA
CONSTRUCTION AND PLANNIP r�. �
APPROVALS Permit #`' Date lospector qppROVALS Permit # -' " Date Inepector
t, Temporary Electrical Service or Pole 52. Pool & Equipment Location
2, Soil Pipe•Undrgrnd. �. 53. Steel Reinforcement
_3.� Electrical Condwt Utility�Undrgrnd. 54. Forms
4. Electrical Cond�it�Undrqmd. 55. Electrical Bonding
5. Steel Reinforcement ' S6. Rough Plumbing & Pressure Test
6. ElectriGal UPER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings � 58. Electrical Conduit,Undrgrnd.
8�. Foundation - 59. Gas Pipe, O Undrgrnd., Test ,
9. Water PiPe�UndYgrnd. � 6Q. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO D�ECK
11. PropertY Sewer Line & House Connection 62. Backwash & Receptor•Pina1
12. Sewer Cap - -� 63. Heater & Vent�Final '
13. Roof D�ains � � 64. Piumbing System � Final � �
14. RaughPlumbing� � �� �65. Electrical-Finai
75. Rough Electrical•Conduit 66. Solar SYstem-Final
16. Rough Electric Wiri�g . � � 67. Fencing & Access-Approval
17. Rough Wiring Sign � . . 68. APPROVED FOR PLASTERING .
18. Rough Electrical-T Bar Ceiting � ' 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Condi[ioning FIRE DEPT. REQUIREMENT
20. Rough Facmry Fireplace � . ,- _ ' ' APPR�OVACS PeFmit # ' � �
21. Ducts, in Struccure� � � • ' � ' ' 70. �Underground Nydro '
22. Ducts, Ventilating�� � � . � 77. Product Piping I7Gas ❑Oil
23. Gas Pipe-Rough & Test e, ;�� 72, Undeiground FIUsh '� �
24. Roof Framing " �- , ; 73. Undergrnd.S[orayeYank OGas ❑Oil
25. Roof Sheathing �•� � 74. Overhead HYdro
26. T-Bar Ceiting iStructural) & Eflonotoat '_ � �, 75. Dry Chemicai ` '.
27. Prame and Flashing : - . � _ -- •�., 76. Dry StandWipe � .
� 28. Lathing & Sidin9 . ' • - - � r y ' "•i 77. FIXED SYSTEPIt-FINAL -
29. Insulation �. � . � � .. , ! 78. FIRE PREV. FINAL '
30. Drywail Nailing �� �_ � ' -HEALTN DEPT. REQUIREMENT
� -
31. Piaster Brown Coat �- . , . 79 FINAL INSPECTION • ;�
32. Electricai Power MArer�Final � 80 FOOD CERTIFI'CA7 E ISSUED '
33. Final Electric � ,� ' . � . Notes: �. � � - .
34. Fi�al Heating & Air Conditioning � � '
35. F.inal Gas Pipe•Test ' � ,. ' " . - � : .
- 36. Hood or Canopy � . J � " � ' . �
37. Finai Factory Fireplace ; ' �. �� � i
� ---�{
38. Final Piumbing . � � � , • �
39. Water SerJice�Final . . � .
i
40. Gas Service-Final . . . � • , -
41. Solar pomestic-Final , .
42. Backtlow Preventer . � � �. � •
-43. Backflow Irrigation � . ' - . �
44, Landscape Irrigation System • . � � � •
45. Sound Attenuation' � - ', ;
46. Handic3p Regulations � � ' �
47. PINAL STRUCTURE & BUIL•DING /C l.��
t�
48. FINALPLANNING, -
49. Electric Release to Edison
. �
50. Gas Release to Souttiern California Gas Co � „ � �� - ' .
51. CERTIFICATE OF OCCUPANCY •
No. Date
(714) 754-5273 • Fa% (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
2712 ALBATROSS DR
13947613
App�icant: NOCK, RON
Address: 11612 KNOTT ST
SUITE 17
GARDEN GROVE, CA
Owner: BERGAN, RALPH B Tft
Address 2712 ALBATROSS DR
COSTA MESA, CA
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
Arch / Eng :
Address:
GARDEN GROVE, CA
WATER HEATER CHANGE OUT.
ISSUE FEE
Backflow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,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
Qn
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PLUMBING PERMIT
Phone: 714-895-1246
Zip: 92841
Phone:
Zip: 92626
Phone: (714) 895-7246
Zip: 92841
License: 707775
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
SepticTank $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, commercial $0.00
Sink, Floor � $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: 01/03/2002
I ssued: Oi /03/2002
ISSUED BY: v
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 (Inst or Rep.)
Water Re-pipe
Water Service
Water SoHener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$12.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: a35.80
QTY
0
0
0
0
D
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 Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This p6rmit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a penod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
C{LC�J�C�iF1:)]
WORKERS'COMPENSAnONDECLARATON: '� � -
I hereby aNirm under penelty of perjury one ot ihe following declarations: -
❑' I heve antl will maintain a certificate of consent to self-Insure for workers' compensation, as providetl br 6y section 3700 ot Ihe Labor Code, for Iha performance of the
work for which [his permit is issuetl. .
1 have and will maintain workers' compensation ipsurence, as required by section 3700 of tha Labor Code, for the perfortnance of the work for which ihis pertniy�s issued.
My workers' compen ati� on Insurance cardar an�l policy number are: �� 7�� �( �
Carrier. �� ��� n 1 Policy Number: > ���
(This section need nof be completed i/ the permit is velued af one hundred dollars ($100J or less.)
❑ I certify ihat in the peAormance of the work for which ihis pertnit is issued, I shall not employ any parson in any manner so as to become subject to the workers'
compensation lews of Califomia, egr ihet if I ecome sub�ect to ihe workers' compensation provisions oi 5ection 3700 of the Lebor Cotle, I s�all forthwith
comply with ihese provisions.
Applicant SigneWre: Dete: / � � � � �
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDFED
THOUSAND DOLLARE (5100,000), IN ADDfTION TO THE COST OF COMPENSATION, �AMAGES AS PPOVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INiEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn that I am licensed untler provisic
torce antl ettect Lic. s —7 G
Contractors Signature: �
with Section 7000) of Division 3 ot the Business antl Professions Code, and y license is in full
Clau# � ��
Date: / ^ � O Z_.
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat there is a consiruction lending agency for ihe performance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lender's Address:
Signature: � Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn thet under penalty ot perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protessions
Code: Any city or counry which requires a permit to consimct, alter, improve, demolish, or repair any structure, pnor m its issuance, also requires ihe epplicant for such pertnit
to file a signed statement that he or she is licensed pursuent to the provisions of the Comrecrors License Lew (Chepter 9(commencinq with Sedion 7000) ot Division 3 ot ihe
Business and Professions Code) or thet he or she is exempt therefrom and Ihe basis tor Ihe alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
subjecis ihe epplicant to a civil penalty of not more than tive hundred dollars ($500).):
❑ I, es ownar of ihe property, or my employeas with weges as �heir sole compansation, WILL DO THE WORK, end the stmcWre is not intentletl or oHered for sale (Sac.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot property who builds or improves ihereon, antl who tloes such work
himseN or herself or ihrough his or her own employees, provitled that such improvements are not intended or oNered for sale. If, however, the building or improvement is
sold within one year of completion, ihe owner-builder will have ihe burdan of proving Ihat he or she did not build or imp�ove for purpose ot sale.).
❑ I, as owner of the property, am EXCLUSIVELV CONTqACTING WITH LICENSED CONTRACTORS to constma the project (Sec. 7044, Business and Professions
Cotle: The contrecmrs License Lew does not epply to an owner of pmperty who builds or Improves ihereon, and who contracis for such project with a contractor(s)
license pursuant to the Contrectors License Laws.).
❑ I am ezempt under sec. 8usiness and Professions Code for this reason:
SignaNre:
Ownar ID venfied by drivets license. ❑ Yes ❑ No Driver's License No.
Verification of Ownership by (type ot document, i.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Date:
Expires:
❑ I hereby certi(y that no excavation Five (5) or more feat in tlepth into which a person is required to tlescentl, will be matle In connection with work authorized by this
permit, antl Iha� no buiiding siructure, scaHolding, felsework, or demolition or dismantling thereot, will be more ihan ihirty-six (3fi) feet high. (Chap. 32, Gry 2, Ah 2, Sec.
341, Ttle 8, Calitomia Adminislretive Cotle).
❑ As owner-builder, I will nol employ anyone to do work which would require a permit irom the Division of Intlustrial Setery, as notetl above, unless such person hes e
permit to do such work trom ihe division.
Signature: Dale:
Division oi Intlustrial Safety Permit Number:
CERTIFICATE OF COMPLIANCE /WD AUiliORIZA710N OF ENTAY: I certify under penalty of perjury that I have read this epplication and sta�e that ihe inFortnation given is
correct I agree to comply with all state laws ena ciry ordinances relating to building consWction, and authonze represenlatives of ihe City of Costa Mesa to enier upon the
above-descnbed property for inspection puryoses. I agree not to acupy or allow occupancy of eny building euthorized by ihis permit until finel inspection.
Signa gal Owner(s) / � �6 �
AnNOr Authorizad Applicant � Oate
LOOE 1. INSPECTON TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition . .
�f, INTRIALS
COUE� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval �
222 Final Site
250 . Final Building/Occupancy
D�ff U�ELfl
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