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Home My WebLink About1467 DEAUVILLE PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1467 DEAUVILLE PL Suite No SCOPE OF PERMIT Vicinity: Parcel Nunmber: 41814621 Applicant: BLIAYA, MOUATOU Address: 10682 TRASK AV FIXTURES, 2 OUTLETS, 2 GARDEN GROVE, CA Owner: NASH, STEVEN P Address 1467 DEAUVILLE PL - COSTA MESA, CA Contractor: GT CONSTRUCTION Address: 10682 TRASK AV GARDEN GROVE, CA Arch / Eng FEE SUMMARY . Address: -- - " PLUMBING PERMIT Phone: 714-539-0682 Zip: 92843 Phone: Zip: 92626-2627 Phone: 714-539-0682 Zip: 92843 License: 763425 Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 06/15/2004 Issued: 06/15/2004 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 2"6-46 (6100) SCOPE OF PERMIT HOUSING REHAB JOB. SCOPE OF WORK TO INCLUDE: 5 LIGHT FIXTURES, 2 OUTLETS, 2 SWITCHES, 1 GAS (1-4 OUTLETS), 2 WASH BASINS. FEE SUMMARY . AMT QTY .- AMT QTY. AMT QTY ISSUE FEE $23.50 - "Laundry Tub / Washer $0.00 0 SumpPump $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 $19.60 2 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 $0.00 0 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 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 2"6-46 (6100) 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 ork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' Compensation Insurance Cartier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for whit s 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 agr that if ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply with these p w s !, Applicant Signature: Date: lSl �l � U—( WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,(100), IN ADDITION 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 provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full farce and effect. LIC. a Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lenders Name: Lender's 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 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 permit 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 Cade: 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 Cade 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 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, 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 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 compressetl gas at standard temperature and pressure). ............................ ........... -._........................._................._...............___.._........_........................................................................................................................................ ................................. ..............._........................................................... 2 Does or will the applicant or present or future building occupant need to File a registration Corm 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 theappplicant 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. ................................................... . qu-jr.................................................................................................rid.......................................................................................................................[I.....,.......... ............ ............................ ........... .. 4.......If an RMPP is resentl re uired, hes Section 25534 of the Califomia Health end Safe Coda been full Com lied with? P Y q N Y P ❑Ves ❑ 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 emit 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 U No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................................................................................................................................................ 6 WIII any pan of the facility to be constructed under this permit 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 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? ❑ 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 AUTHORIZAT10N 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. 1 g as not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnature O ego wneds) /' _ ^ Date And/Or Authorized Applicant v—(,f Data COVE I. INSPECTIONTYPE DATE INT L`2 CODE I INSPECTION TYPE DAT J[ITTLALj 1616 Fixed System Final Fire Prevention 206 Final Mechanical / 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 (714) 754-5273 • Fax (714) 7544656 www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1467 DEAUVILLE PL Suite No Vicinity: Parcel Nunmber: 41814621 Applicant: BLIAYA, MOUATOU Temp service test $0.00 Address: 10682 TRASK AV New Res (1-2 units) $0.00 New Res (3+units) $0.00 Phone: 714-539-0682 Lighting Fixts GARDEN GROVE, CA Zip: 92843 Owner: ' NASH, STEVEN P Non Res Appl $0.00 Address 1467 DEAUVILLE PL Service to 200a $0.00 Service to 1000a �' $0.00 Phone: $0.00 Motors to 1 h COSTA MESA, CA Zip: 92626-2627 Contractor: GT CONSTRUCTION Motors t0 100hp $0.00 Address: 10682 TRASK AV Communication drops $0.00 Sub panel to 200a $0.00 Phone: 714-539-0682 - Circus ( gen or ride) GARDEN GROVE, CA Zip: 92843 $0.00 " "0 License: 763425 ISSUED BY: SCOPE OF PERMIT HOUSING REHAB JOB. SCOPE OF WORK TO INCLUDE: 5 LIGHT FIXTURES, 2 OUTLETS, 2 SWITCHES, 1 GAS (1,4 OUTLETS), 2 WASH BASINS.. Quantity ISSUE FEE $23.50 Temp service test $0.00 Res. a/c package $0.00 New Res (1-2 units) $0.00 New Res (3+units) $0.00 Pool / Spa $0.00 Lighting Fixts $5.50 Recept Outlets $2.20 Switches $2.20 Non Res Appl $0.00 Res Appl , , $0.00 Service to 200a $0.00 Service to 1000a �' $0.00 service over 1000a $0.00 Motors to 1 h $0.00 Motors to 10hp $0.00 Motors to 50hp $0.00 Motors t0 100hp $0.00 Motors over 1 00h $0.00 Communication drops $0.00 Sub panel to 200a $0.00 Status: ISSUED Applied: 06/15/2004 Issued: 06/15/2004 FEE SUMMARY -- Quantity Temp Dist System / Lighting $0.00 0 Busway /100 ft $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 ..:......:.....up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 .................up 10 100 kva/kw $0.00, 0 ..................over 100 kva/kw ' - $0.00 0 Low Voltage Equipment $0.00 0 " Low Volt Wiring System / Ckt " $0.00 0 Misc. Conduit $0.00 0 Misc. Conductor. - $0.00" 0 - Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 " "0 Christmas Tree Stand $0.00 '0 Fireworks Stand $0.00 0 Other Electrical Fee. $0.00 Investigation. Fee. -- - $0.00 r..Plan Check fee "_ $0.00 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 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to salt -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 required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for whit thjs permit Is issued, I shell not employ any person in any manner so as to become subject to the workers' compensation laws o alitomia, ano agree oat if s ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code I shall forthwith comply with these pr visi s Applicant Signature: Date: coy WARNING: FAILURE TO SEC E WO RS' OOMPENS TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP G ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION 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 provisions of Chapter commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. 4 C r 1 4 // Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm 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 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 permit 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 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: ❑ 1 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). - ...._.......__.......................... _..................... _....................... _......................................................................................................................................................................... _............................... _......................... ............................ _............ I........... 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 tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..........................._..............................ly--req,........d.','.........._.....................5,3-.................................................................... p-11..........._............... ........_..................._............................ ......... ......................... 4 If an RMPP is presently requiretl, 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 Ditrct occupant require for the work which is the t or subject c This a plication a ffP No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � 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). ........................... .............. ............... ............................................... ............... ............................................ ................................................................................................................... ............................................................................................. I......... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Vas ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....... . ........................................_............_....... .............................................................. .....................__._.____............... .................................._.._............................................................... .................... -................................................. ............ 7 It 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 .............................................................................................................................................................11ut................trol............................... ............................................................................................................................ .............. .......................... B (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. Signatur L I Owners) / _ / > " d to ( i And/Or Autho6z d Applicant Date CODE I. INSPECTION TYPE 20 INTITIALS CODER INSPECTION TYPE QA19 ItiTITI►ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �L 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 elerf 4 Geta we" 69" y V&a(li m PERMIT PROCESSING CENTER SUBMITTAL APPLICATION EL -)-f - �n(,--7 V 2546-46 (rev. 10/02) Activity Number: Received By: Project Address: �L�k] peAU Vl LLQ ACE Suite/Unit: EXISTING CHAIN LINK FENCE ❑[-I((`�� YES NO / ��ff O� 6 ` "'f C�S OFFICE USE ONLY SUBMITTAL TYPE: ❑ Building ❑ Engineering ❑ Sanitary District ❑ Fire ❑ Planning ❑ Grading ❑ Sign ❑ Electrical ❑ Plumbing ❑ Mechanical Other Description of work to be performed: (please be specific) lT MOQ6l.�g%tf L �t"omO l PAWT ItrfeCLl �R Sq. Footage: Type of Const: Valuation: Occupancy Type: Occupant Load: Grading: Cut/Fill cubic yds. Owner/Tenant: Phone No.: Address: Suite/Unit: City: State: Zip: 1 Applicant/Agent: MN9Uy2;&4A-(A Phone No.: Address: Suite/Unit: CDL #: City: State: Zip: Architect/Eng.: Reg. No.: Phone No.: Address: Suite/Unit: City: State: Zip: Contractor: (7- C&NS�C/� W 1 Phone No.: \� kq) f I7I - O ' tZ Address: koai —1�K- A* Suite/Unit: City: State: CA Zip: ckU'Lli3 State License No.: �1� �i%� Expiration: r71 �cto0S 1 `Class Workman's Comp. Policy No.: ,bti�l 1�7 ^O`i Expiration: m uI 5 Insurance Company: /trtn N4 (SEE BACK FOR ITEMIZED ELECTRICAL, MECHANICAL AND PLUMBING) (254]-46) 2546-46 (rev. 10/02) 254646 (rev. 1=2) ELECTRICAL PERMIT City. Description Oty. Description City. Description ISSUE FEE Motors to 50 hp Transformers up to 100 kva/kw Temp service test Motors to 100 h p Transformers over 100 kva/kw Res. a/c acka a Motors over 100 hp Low Voltage Equipment New Res 1-2 units Communication drops Low Volt Wiring S stem/Ckt New Res 3+ units Sub panel to 200a Misc. Conduit Pool/Spa Pole Light Pkg Misc. Conductor Lighting Fixts Sign Circuits Circus en or ride Z Rece t Outlets J Temp Pwr Pole Circus mech ride or lights) Switches Intermed Pole Christmas Tree Stand Non Res Appl Temp Dist System/Lighting Fireworks Stand Res Appl Busway/1 00 it Other Electrical Fee Service to 200a Standing Section Investigation Fee Service to 1000a Misc Electrical Equipment Plan Check Fee Service over 1000a Transformers up 1 kva/kw Reinspection Fee Motors to 1 hp Transformers up to 10 kva/kw Motors to 10 hp Transformers up to 50 kva/kw MECHANICAL PERMIT Oty. Descri ion City. Description Oty. Description ISSUE FEE Smoke Dampers Com ressors/Absor tion Systems Inst FAU < 100 k BTU Inst or Relocate Appl Vent Up to 3 hp/1 00 k BTU Inst FAU > 100 k BTU Air Handlers < 10000 cfm 3 to 15 h /500 k BTU Repair/Alt Cooling/Heat Air Handlers > 10000 cfm 15 to 30 hp/1 000 k BTU Inst/Rep. Recess Wall Htr Floor Furnace 30 to 50 h /1,750 k BTU Refriq Sys < 100 k BTU Floor or Suspend Heater Over 50 hp/Over 1,750 BTU Refrig Sys > 100 k BTU Repair/Alt Absorbtion Unit Boilers Gas Piping Repair/Alt Refrigeration Unit Up to.3 h Factory Fireplace Ventilation System 3 to 15 h Hood w/Mech Exhaust Evaporative Cooler 15 to 30 h VAV Box Commercial Incinerator 30 to 50 h Vent Fan/Single Duct Domestic Incinerator Over 50 h Appliance Other Mechanical Fee Fire Dampers Investigation Fee Plan Check Fee Reinspection Fee PLUMBING PERMIT Qty. Description Oty. Description Oty. Description ISSUE FEE Laundry Tub/Washer Sump Pum Backflow Irrigation . Landscape Irrigation Swimming Pool Backflow Preventer P-TrapTrap Primer Bathtub Pressure Regulator Urinal Clarifier System Process Piping (per 10 ft Vacuum Brkr Bkflow 1-4 Connect Ice, Soda, etc. Receptors Vacuum Brkr Bkflow 5+ Dental Units Septic Tank Wash Basin Dishwasher Sewer Cap for Demo Wash Basin Set Drain, Floor Sewer Connect Waste and Vent System Drain, Rainwater Sewer Private Line Water Closet Toilet Drain, Roof Shower Water HeaterNent Drinking Fountain Sink, Bar Water Piping Inst or Rep.) Expansion Tank Sink, Commercial Water Re -pipe Gas Earthquake Valve Sink, Floor Water Service Gas 1-4 outlets Sink, Kitchen Water Softener Gas Over 4 outlets Sink, ervice/Mop OTHER Gas Re i e Spa Private VIOLATION Gas Service Spa Public PLAN CHECK Interceptors Grease, Oil REINSPECTION Interceptors Sand, Auto 254646 (rev. 1=2) 2272ti F E RECEIVED COSTA MESA BUILDING -SAFETY DEPARTMENT Lot # AUG 3 1964 Plan # P.O. BOX 317 COSTA MESA. CALIFORNIA "ANCE DEPT. �ITY OF COSTA MESA F�, or Applicant to Fill In Completely APPLIC TION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only NG / _ %I , //r L SS (�FIRS RHCHIPt NO. PEflMITCOSTA MESA, CALIFORNIARECEIV Y DATE ECEI D DATE ISSU ED rbo o eUG 1 8 1964 BOA 2066 BUILD NG ADDRESSSSaIlta Alla NO. KI 22O ZONE TYPE, �Y GROUPECT Bay Levanas TEL. OR3-701 BYPROVEDDATE INEER NO. ZONING HS3432 Via 0 orto N t Bch iGNE' NO. OP USEOFNLifetime Residential Bldg Co ACTOR �[LEGwL 1 -- L Z LSS BOX 2066 •�A. P. NO. G 7 /' .� 1D anta Ana NOTE: NO EAV E OVERHANG SHALL BE LESS THAN LIC. NO, 208676 NO ' K19-2204 SO" TO SIDE 8 REAR P. L. EAVES SIZE 16 X HO NO. OF SLOOT. O ALLOWED (U. B. C. REQUIREMENT) OF LOT NOW ON LOT YARDSAPPROVED YARDS APPROVED USE OF ` MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. none OF (FROM C/L STREET) CENTER HEREON '11(FRONT CENTER OF STREET t � REAR YARD250PT. SIDE YARD I LEFT O I RIGHT O R. SIDE G FT FT. _ C' DESCRIPTION OF WORK . L. SIDE n FT. Fr. NEW Iwu) IIM ALTERATION —III ADDITION REAR FT.1%4- FT. e [AUTHORIZED IR DEMO ISH DISTANCE BHT. I BET. MAIN C M VI G MAIN BLDGS.NCEBK ACCESS. BLD S. INq� NO. OF 2, VAR..JC DATE ///�� Ui O8O ROOMS - STORIES C. U. P. .}t APPROVED IOR WALL I ROOF APPROVED RING COVERING Rock BY DATE U U F BUILDING AND WORK TO BE PERFORMED' W do of IIIII EP EX m. bld n IIJII construction garage D SQ: FT: .3 7r� o EBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLICATION THE AMOUNT' SHOWIIUNDER VALUATION IS FOR THE E TATE THAT THE ABOVE IT CORRECT AND AGREE TO COM.. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O O ITH ALL CITYbRDINANCEE AND STATE LAWS REGULATING VALUATION - m ING CONSTRUCTION. � ATURE OF PERMIT FEE $ j PERMITTEE - `/'j //� $ /j / PLAN ORIZED AGEN L r n TOTAL FEE 5 �� J