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Home My WebLink About1067 CONCORD ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1067 CONCORD ST Suite No Vicinity: Parcel Nunmber: 14165210 Applicant: SANCHEZ, JENNIFER Address: 24707 SAN FERNANDO RD Phone: (661)259-7131 NEWHALL, CA Zip: 91321 Owner: LOUDERMILK, GEORGE H Address 1067 CONCORD ST Phone: COSTA MESA, CA Zip: 92626 Contractor: AFFORDABLE WATER HEATERS & PLUMBING Address: 24707 SAN FERNANDO RD Phone: (661)259-7131 NEWHALL, CA Zip: 91321 License: 627368 Arch / Eng Address: Phone: Zip: License: SCOPE OF PERMIT CHANGE -OUT OF AN EXISTING WATER HEATER IN A SFD. Status: ISSUED Applied: 11/06/2001 Issued: 11/0612001 ISSUED BY: FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 1 Drain, Roof $0.00 1 Drinking Fountain $0.00 1 Expansion Tank $0.00 1 Gas Earthquake Valve $0.00 1 Gas (1-4 outlets) $0.00 1 Gas (Over 4 outlets) $0.00 1 Gas Repipe $0.00 1 Gas Service $0.00 1 Interceptors (Grease, Oil) $0.00 1 Interceptors (Sand Auto ) $0.00 1 Status: ISSUED Applied: 11/06/2001 Issued: 11/0612001 ISSUED BY: FEE SUMMARY ,TY AMT QTY_ AMT QTY Laundry Tub / Washer $0.00 0, Sump Pump $0.00 0 1 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 1 P -Trap $0.00 0 Trap Primer $0.00 0 I Pressure Regulator $0.00 0 - Urinal $0.00 0 I Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1 A) $0.00 0 I Receptors $0.00 0 Vacuum.Brkr Bkflow(5+) $0.00 0 I Septic Tank $0.00 0 Wash Basin $0.00 0 I Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 I Sewer Connect $0.00 0 Waste and Vent System $0.00 0 I Sewer Private Line $0.00 0 - Water Closet (Toilet) $0.00 0 I Shower $0.00 0 Water Heater / vent $12.30 1 I Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 I Sink, commercial - $0.00 0 Water Re -pipe $0.00 0 I Sink, Floor $0.00 0 Water Service $0.00 0 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 1 Sink, service/mop $0.00 0 OTHER $0.00 1 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 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. I have and will maintain workers' compensation insurance, as require y section 3700 of the Labor Code, for the performance of the work for which this permit is issued. wo rs' umber are My�o^mpensetion Insu nce cardfler nd policy number rci Caer: �lLlAl�_A (�('I��nL Policy Number: _ 0 (This section need not be completed if the permit Is valued atone hundred dollars ($100) or less.) . ❑ I certify that in the p mance of the t c for which this permit is issl d, I shall not employ any person in any manner so s to become subject to the workers' compensation laws 1 alifornla, and r e that If Id become s fact to a workers' compensation provisions of Se tion 370 of the Labor Code, I shall forthwith comply with these isions. Applicant Si ature. O Date: WARNING: AILURE TO S URE WORKERS' PENSATION COVERAGE IS UNLAWFUL A SHALL SUBJECT AN EMPLOYER TO CRIMINA PENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND LARE($1 ),INADDITIONT THE COST OFCOMPENSATION,DAMAGE PROVIDED FOR IN SECTION 3708 OF THE ROO , INTEREST, AND ATTORNEY'S FEES. LICENSED CON RS DECLARATION: I hereby affirm that I am lice s der vi f C ter 9 (commencing with Section 7000) of Division 3 of the Busipe�ss rofessions Code, and my license is in full force and effect. Lic. k Class# �. Contractors Signal Date: CONSTRUCTI N LENDING AGENCY: ❑ the a m that th a is a construction inq agency for the pedorman the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affinn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: 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 perr+. subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 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 dead): 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 6, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully compiled 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Il Yes LJ 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 pernit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if 'yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). ............................................................................................................................................................................................................................................................................................................................................................................................ 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 (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 I ogre 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 ri property for ins action purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Labcve-descrect. ignature Legal Owner(s) D An Au ri tl App ant Date N INTRIAL$ CODE? INSPECTION TYPE aeiE fry Fixed Sy t Final Fire Prevention 206 Final Mechanical V161 266 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 tK UAIt AP No. 141-652-10 LOT TRACT FIRE ZONE VALUE 5 7,600.00 INSPECTIONS SOIL Signature \ •� Date I. '7 TYPE V SUBCONTRACTOR GROUP j ZONE R-1 PERMITS ISS E Date Number Signature GAS 'WATER Plumbin ROUGH PLUMBING I—po&A,2]—O PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING -0 V TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING l C--//� -]!j Naatin and Vent. TRENCHES FORMS STEEL REINF. �•(� FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING f FRAME AND FLASHING 4j 1/1-14L. / LATHING — IN LA OUT PLASTER. BROWN COAT STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL V PLUMBING, FINAL AND GAS TEST�— ELECTRIC, FINAL BUILDING, FINAL 4080 i COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 F r Applicant to Fill in Completely — Use Ink Only DINGRESSEfl M -4 RESS Z --1 TEL. CITY G a NO CONSTRUCTION LENDER BRANCH TECT iINEEF TEL. NO, CITY /li/ R NO.0 113 - STATE CITY LIC. NO,13 LIC. NO. SIZE ROUP NO.OF BLDGS. OF LOT r1DI IE NOW ON LOT USE OF TAM EXISTING BLDG. IT41111i sA USE OF NE Separate permits are required for electric, plumbing and heating work. USY_ OF,BUI\DING AND WORK TO BE PEWRMED I hereby acknowledge that 1 have read this application and state that the above Information is correct and agree to comply with all laws fegulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter Signature o Permittee w /�R% Authorized Agent ZZ PAib A fPVCA/TION FOR STRUCTURAL PERMIT 1 DWNFR4 Lo. Lt%U1_. lz m I—IL DATE RECEIVED DA E S (aP ERMI��n { G Z �� `� ROUP ROVED ` r1DI IE DAT 7 I 1L. NO. OF USE OF NE LOT YARDS APPROVED MAIN BUILDING P OM C/L STREET) 1 DWNFR4 Lo. Lt%U1_. lz m I—IL i FT. BET. MAIN & ACCESS. BLD n V E /- m i S (aP E { G Z E PE ROUP ROVED ` m DAT 7 ✓I 1L. NO. OF USE OF NE PLANS BUILDING ARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING OM C/L STREET) NT SIFT. FT. I F FT r /r DE FT. FT. i FT. BET. MAIN & ACCESS. BLD n TOTALPAID E m i 2 Lu ✓SO. FT. cm THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m VALUATION PERMIT FEE E n PLAN CHECK E o TAX E xV� $ LL U TOTALPAID E 19903 -COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOK 217 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA Y ARCHITECT E-IF•1= ■ SETBACK LINK FROM BUILDING 1 HEREBY I AND STATE PLY WITH I BUILDING C TEL, TEL.T NO 4 NO. OF NOW OI DESCRIPTION OF WORK _0J LTERATION .ORION V MOVING DEMOLISH ROOMS / STORIEI JAL +• I ROOF �. 1 COVERING - LD NG AND WO KTO NE PERFORMED P . r T - N AUTHORIZED AGENT M.YM•Ii1N!M!MMr'•+YNy1J'rvL.NAJ. FEE dURECQVED APPLICATION FOR PERMIT CIFY� U 'fi� cgnty v1 V/,dC RZCINo. P n )nIPT {iq RECEIV DEY pA RKCEIV— 'DATE .UED ..till ^ , 1963 BUILDING ` ADDRESS FIRE ZONE TYPE GROU APPROVED BY DATE ZONING ZONE NO. OP DS! OP NEW R-1 PLAN! 2 EUILDINGWy aI LEGAL1' C 10t Tract46 DESCRIPTION 37, aCt A. P. NO. none NOTE: NO EAVE OVERHANG SHALL BE LESS THAN SO' TO SIDE 8 REAR P. L. EAVES ALLOWED (U. S. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) FROM Fi. -1- 0 FT. EJ /D ' ' 1 0 R. SIDE V FT. FT. L. SIDE.PT. FT. ^ , 9� REAR 1 O FT. �./ PT. DISTANCE SET. BET. MAIN Q MAIN SLOGS. ACCESS. BLDGS. VAR.# DATE C.U.P. # APPROVED APPROVED / BY DATE -O ,, 3a �a. 60. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE 'OF ESTABLISHING A PERMIT FEE ONLY. VALUATIOM .� PERMITFE $ 9 s � > J PLANHEC �j S - -' v1 V/,dC