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Home My WebLink About256 CAMELLIA LN - Building Permits(714) 754-5273 • Fa�c (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 256 CAMELLIA LN Suite No Vicinity: WATER HEATER Parcel Nunmber: 42615320 Applicant NOCK, RON Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: WILLIAMS, JOYCE TR Address 256 CAMELLIA LN COSTA MESA, CA Contractor: NOCK PLUMBWG Address: 11612 KNOTT ST GARDEN GROVE, CA Arch / Eng : � �� Address: PLUMBING PERMIT Phone: (714)895-7246 " Zip: 92841 Phone: Zip: 92627 Phone: (714)895-1246 - Zip: 92841 License: 707775 _ / . . . ' Phone:� . .. -- -".ZiP;-� -- - - �- � License: � - ` Status: ISSUED Applied: 06I04/2001 Issued: O6/04/2001 ISSUED BY: SCOPE OP PERMIT . .- , r - - WATER HEATER CHANGEOUT � ' � ' � ' � FEE�SUMMARY•� �- •, � � � AMT QTY - �. � AMT � QTY �� _: ,. - %' - - � AMT QTY ISSUE FEE ' $23.50 ��_ � � �_ -� Laundry Tub / Washer_ �� $0.00 � �� 0 . �� Suinp Pump . ' $0.00 0 Backflow irrigalion�-, . $0.00 0 ,�� Landscape Irrigztion , , $0.00. � 0 , Swirriming-Pool � ; � i $0.00 0 Backflow Preventer, A � $0.00'�> 0 � � � ��.�� P-Trap -� ' ' . $0.00 �� 0. � if -=� Trap Primer � .; , $0.00 0 Bathtub � $0.00!l._ Q � � Pressure Regulator- $0.00 .0, i �,Urinal' `, �i� /.� i $0.00 0 Clarifier System � � $0.00' � �0 � ,--Process Piping (per 10 ft)� $0.00 =:0�� " �.VacuurriBrkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) . $0.00 . -. 0 � � Receptors $0.00 �0 `�� Vacuum Brkr Bkflow(5+) g0.00 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�� ` Wasli�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 Privafe Line , $0.00 � 0 �<-Water Closet (Toileq SO.00 0 Drain,Roof $0.00 0 �� Shower � $0.00 0 , . -- WatefHealef/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 50.00 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: 535.80 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO 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 requlred Inspections and flnal approval must be ob�ained. Failure to obtain inspections and final approval will resufl in the expira�ion of this permit. i FOR INSPECTIONS CALL: (714) 7545626 2446-46 (fi/00) WORKERS'COMPENSAnON DECLARAnON: - ! I hereby aHirtn untler penalty of perjury one of ihe following declarations: ❑ I hav ntl will maintain a certificate of wnsent to self-Insure tor workers' compensation, as provided for by section 3700 of Ihe LeDor Code, for the pertormance of the lor which Ihis permit is issued. - y I�heve end wlll maintain workers' compensailon insurence, fls required by saction 3700 of ihe Labor Code, tor ihe perfortnance of ihe work for which this permit is issuetl — My workere' compens�ion Insura e carrier nd Ilcy number are: �--�--- �7�' `� J 1 Carrier. � �,��/)L�� POIIcL^ y�Numb�%�(�C��% (� T ( il (Riis.sec�ion need nof 6e comD�eted il fbe permit Is velued et one hundred dollers ($100) or less.) ❑ I cenify that in tha pertortnance of ihe work for which this pertnit is issuaq I shell not employ eny person in en manner so as to become sub'e to Ihe orkers' compensation lews of Califomia anA egree Ihat If I should become sub�ect to ihe workers' compensetion Drovisions ot Sectlon 3700 of e or Cotl I shall forthwlth I comply wlth ihese Drovisions.�\�� \ /l App11C0niSigneture: � \ I l � �Date"—�- � !/� � / WARNINO['FAILURE TO SECURE WORNER PENSATI ERAGE IS UNLAWFUL D SW1LL SUBJEGT AN Fraai - CRIMINAL PENALTIES AN CIVIL ES UP T ONE HUNDRED T110USAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIOED FOR IN SECTION 3]O6 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereby affirtn ihat�l'am'llcensad uyQa�g�y�sbnsph8�a�19y9�(Comm torce entl eNect�uc. a • ' �-� —/!� / / / � CONSTRUCTION LENDING AGENCY: with Section 7000) of Division 3 att�e.Business and Professjpn, Coye, and my license is in full ❑ I hereDy alfirm that ihere is a consiruction lending egency for ihe performance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lentler's Adtlress: Signe�ure: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirtn that untler penalry oi Derjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions Code: Any ciry or county which requires e permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permil to file e signetl statemant thet he ar she Is Ilcensatl pursuant to the proNsions of Ihe Gontractors License Law (Chapter 9(commencing with Section 7000) oi Division 3 oi ihe Business and Professions Coda) or that he or she is exempt thereirom and the basis for ihe alleged ezemption. Any violation of Section 7031.5 by any applicant for e parmit subjects ihe epplicant to e clvil penalty of not more than five hundred tloilars ($500).): ❑ I, as owner ot �he properry, or my employees wi�h wages es iheir sole compensation, WILL DO THE WORK, and the structure is not intended or oHered for sele (Sec. 7044, Business and Professions Code: The Coniractors License Law does no� apply to an owner of property who builds or improves thereon, and who does such work himsalt or herself or through his or �er own employees, providetl �hat such improvements are not intendetl or oflered for sele. It, however, the building or imp�ovement is sold within one year of completion, the owner-builtler will have ihe burden of proving that ha or she did not build or improve for purpose ot sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, 8usiness and Professions Cotle: The coNractors License Law tloes not apply to an owner of propehy who bullds or improves thereon, and who coniracts for such projea with a comractor(s) license pursuant to the Comrectors License Laws.). ❑ I am exempt under sec. Business and Professions Cotle for Ihis reason: Signature: Date: Owner ID verified by tlriver's license. ❑ Ves ❑ No Driver's License No. Verification of Ownership by (rype of document, i.e. - properry tex bill ar deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: Expires: ❑ I hereby certily that no excavation five (5) or mora feet in depth into which a person is requirad to descend, will be made In connec�ion with work authorized by this pertnit, and ihet no building structure, sceffolding, falsework, or demolition or dismantling Ihereof, will be more �han Ihirty-six (36) fee� hig�. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celifornla Administretive Code). ❑ As owner-6uiltler, I will not employ anyona to do work w�ich would require e permit irom the Division of Indusirial Salery, as noted ebove, unless such person has a pertnit to da such work from the division. SignaWre: Date: Divislon of Indusirial Safery Permit Number: CERTFlCATE OF COMPLIANCE AND AU7TfORVA710N OF ENTRY: I canity under penalry of perjury that I have read this epplication and stata that the infortnation given is correct. I agree to comply with ell state laws antl city ordinances relating to building construction, and authorize representatives of ihe Ciry of Costa Mesa to enter upon Ihe above-descnbad property for inspection puryoses. I agree no� �o occupy or allow occupancy ot any buil�g authorized by this permit until tina�spection. CODE �, INSPECTIONTYPE �[ INTRIALS 7618 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Roof 201 Final BIaWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition QOUEA INSPECTIONTYPE 20fi Final Mechanical 208 Final Plumbing 210 Final Eletlntal 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency I�RTE INTITIALS OWNER �'n�LINE HOMES�, INC. DATE 2'19-� JOB ADDRESS 5 C2IRiula L3ne BUILDING PERMIT NOl� GENERAL CONTRACTOR er-B dr. VALUE $ 6,-746.-00 AP�-150j4 LOT TRACT RIR� ZONE D�SCRIPTION OR WORKReS.w att �r. INSPECTIONS I Signature I DATF, GROUI' I& J TYPE V 7.ONE Rl coat 0 ❑ SUBCONTRACTOR 16441 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEBA. CALIRORNIA For Applieant fo Fill In Complefely TYPE OR PRINT BUILDING � / . AODRESS Q � l L-(�v� COSTA.MESA. CALIFORNIA OWNER TYLELINE HOMES INC. AD�RE6S TS� b � � S � � ■ ARCHI7EC1' APPROVED FE REC��V�� fEB 1 9'1962 FINpNCE D��: C�TY Of C05�A M�S� APPLICATION FOR PERMIT euauiN� For Offiee Use Only REGE�PT NO. PERqIl�Np.w °= I °"�".°ir�-��Ea i se �yba COSTA MESA. ZONING ' ZONEn NO. OP UBE OP NEW O' �..� �, /t �' I PLANB �'- BUILDIN6 �..P TEL. LEOAL P/L " �� I /_� �� ' ,/ NO. DEBCRIPTION �J • ' I NOW ON LOTB � A. P. NO. /Id � , ja � � / USE OF EXISTING BLDG. 6ETBACK LINE PROM ILEFT CJ '�j '• I RIGH7 ,� /[D " DESCRIPTION OF WORK BUILDING I � NO. OF� � SIZE b ROOMS STORIES E%TERIOR WAL�[j� ROOF COVERING -+/✓�� COVERING S�/�� eS USE OF BUILDING ANO WORK TO BE PERFORMED� cceemx urve sr.i DE � DE ✓� t yZ tOVED �� HOLD FOR SPE � � 6 IN. 7 �N. DATE L/� 9/� Z_ REQUIR�MENTS 1 HEREBY ACKNOWIJ!OpE THAT i H�VE RBAD TX18 APPLIGTION THH AMOUNT BXOWN UNDER VALUATION 16 POR TH6 AND BTATE TXAT THE ABOV¢ 18 GORRECT AND A6RE¢ TO COM- PUIiP09E OF, E9TABL�BH�NO A PERMIT P6E ONLY. PLY WITX ALL CITY ORDINANLE9 AND BTATE LAW6 R66ULATIN6 eu�tDlNo CONeTRU ION. VALUATION �j /� SIGNATURE OF PERMIT FEE $..J V•-- PERMITTE // yi//� f� $ . � / T�� PLAN CHECK $ ��/ � AUTHORRED AGENT iC' TOTqL FEE �J -�