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Home My WebLink About268 BAY ST - Building Permitsr AS2' SAY S1�REET, 268 ._ 6153 - �+-25-58 res w/att gar $10,702 66071 - 9-3-'(k P1bg.N.C.(lav.) ; �.. . q, •��' ; :.:.�;� ; � . CITY OF COSTA MESA � BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT . PERMIT .-, .L, _; (714) 754-5273 • Fax (714) 754-4856 Job Address: 268 E BAY ST Suite No Vicinity: Parcel Nunmber: 42621374 Applieant: NOCK, RON Address: 11612 KNOTT ST GARDEN GROVE . CA Owner: PAREJA, CARLOS H Address PAREJA; BRENDA E ' COSTA MESA,CA � 268 E BAY ST ' Contractor: NOCK PLUMBING Address: � 11612 KNOTT ST ArchlEng: Address: GARDEN GROVE , CA PLUMBING PERMIT Phone: 714 895-1246 Zip: 92841 Phone: Zip: 92627 Phone: 714 895,1246 - Zip: 92841 Licerise: 707775 Phone: Zip: License: SCOPE OF PERMIT � REPLACE DISHWASHER - , ISSUE FEE Backflow irtigation BackFlow Preventer Bathtub Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drein, Floor Drain, Rainwater Drain, Roof Dnnking Fountain Ezpansion Tank Gas Earthquake Valve Gas (t-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptore (Grease, Oip Interceptors (Sand Auto ) AMT $22.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qrv 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 Septic Tank $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 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 \ PERMITNUMBER , ht P99-00067 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07J03/1999 Issued: 02/03/1999 Sump Pump 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 (Toilel) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 80.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $30.75 Qn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeeliona and final epproval must be obtained. Failure to obtain inspections and final approval will resul[ in Ihe expiration of lhis permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS' COMPENSATION DECLARATION: I here6y effirm undar penelry of perjury one of Iha tollovnng decla2tions: ❑ 1 heve end will m�intain a certificate ot consent ro self-Insure for workers' compensetion, as provided for by sectlon 3700 of the Lebor Code, tor the pedormance ot the w rk for which this permit is issuetl. I have end will maintain workers' compensation insurance, es required by saction 3700 of tlie Labor Code, for ihe perlortnence of ihe woilc lor which this pertnit is issuetl. My workers' compensailon I�nsu�ren� cartier� �� num er are: Y �, n r _ . , _ � � � � � -` � Cartier. �r"%/ fi�� v7rYf Polic Number. /! J�1,� (j r., (7his section nesd rtof be cro�rp/eted i!! e permit rs velued ef one hundred dollers ($ i00) orless.) 0 I cartity thet in ihe pertormance oi the work for which this permit is issued, I shell not employ any person in eny mennar so as to become subject to the workers' compensatlon lews of Calitomia, end e9ree ihet it I shaNA �ecome subject to the workers' campensetion proNslons ol Section 3700 ot the Lebor Code, I shall tort�with comply with these provlsions. 2 j, f� C � Appllcent Signeture: � � Dete: 7 � WARNINO: FAILURE TO S�CURE WOPKENS' PENSATION COVEMGE IS UNLAWFUL ANO SHALL SU&IECf AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED iMOUSAND Dq1FRE (510p,ppp), IN AODITION TO THE COST OF COMPENSRTION, OPMAGES AS PROVIDED FOR IN SECTION 3108OF THE LABOR COOE.IMFAEST, AND ATTOqNEY'S FEES. LICENSED CON7RACTORS DECLARA710N: I hereby aNirm thet I erri Ilcensetl force entl eflect. Lia x CaNractors Signeture: _ wllh Sectlon 7000) of Divislon 3 of Ihe Business end Protessior/s Cotle, antl my licensa is In full Class p � 'S-(� �— � Dete: `l�` C!-- �5 �_ __ _. .__ _ CONSTRUCTION LENbING AGENCY: ❑ I hereby eRirm that there is e constructian lending agenty for t�e peAortnence of the work for which this parmit is issuetl. (Sec. 3097, Clvil Code). Lendefs Neme: Lendefs Adtlress: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereby ettirm ihet under penalry oi perjury thet I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Buslness enC Professions Code: Any clry or county w�ic� requires a permit 10 construct, alter, improve, demolish, or repair eny awcture, prior to Its Issuance, elso requires ihe applicaM for such pertni� to tile e signed statement that he or she is Iicensed pursuant to the proWsions oi ihe Contrectore License Lew (Chepter 9(commencing with Section 7000) oi Division 3 of the Business entl Protessiqns Code) or thet he or she is exemp� theretrom and Ihe basis for the elleged exemD�ion. Any vlolatlon ot Section 7031.5 Dy any epplicant tor a permit subjects ��e epplicant to e civ�l penalry ot not more Nan five hundrad dollars ($500).): ❑ I, es owner of the properry, or my employees wlth wages es their sole compensation, WILL DO THE WORK, ana ihe structure is nol intentle0 or oHeretl for sale (Sec. 7044, Business end Professions Code: 7he Contranors License lew tloes not epply to an owner of properry who builds or improves thereon, end who does such work hlmself or herself or ihrough his or her own employees, provided that such Improvements ere not intentled or otlered lor sale. If, however, the builtling or Improvement is soltl within one year oi completion, ��e owner-bullder will have the �urden ot proving that he or sha did not bulltl or improve for purpose of sale.�. ❑ I, es awner ot thq properry, am EXCLUSIVELY CONTRACTING WfTH LICENSED CONTBACTORS to consWd the project (Sec. 7044, 8usiness and Protessions Cotle: The coniractors License Ww tloes not epply to an owner of property who builtls or improves Ihereon, entl who contracts for such projeci with a contrador(s) license pursuant to the Contractors License LawsJ, ❑ I am exempt und6r sea Business and Protessions Code tor this reeson: Signalure: Dale: Owner ID verifietl by drivefs license. ❑ Yes ❑ No Dnvers License No. Veriticetlon oi Ownership by (rypa of documenL i.e. - properry lax blll or tlaed�: DIVISION OF INDUS7pIpL SAFETV PERMR CERTIFICATION: Expires: ❑ I hereby cenify that no encavation Ilve (5) or mare teet In depth INo which a person is requiretl ro tlescend, wlll be mede In cannection wit� work euthorizetl by t�is permlt, end thet no builtling structure, sceXoltling, falsework, or Aemolitlon or dismantling thereof, wlll be more then ihirry-siz (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 3C1, Tltle B, Celiiprnla Adminisiretive Cotle). ❑ As owner-builder, 1 will not employ enyone to do work which woultl require e permit irom Ihe Divlslon ot Industrial Sefery, es noted ebove, unless such person hes a pertnit ro do such work from the division. Sipnetura: Date: Division of Industrlel S9fery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF EMRY: I certity under penelty ot perjury thet I heve read this application end state that the infortnetion given is correct. I agree to comply with all stete lews entl ciry ordinences relating to building construction, and euthodze representatives ot the Ciry of Costa Mesa to entar upon ihe above-dascdbeC proparty tor inspection Ourposes. I agree not to occupy or allow occupancy of any building authodzad by ihis pertnit until final InsDedion. Si9na ure Ot Legel Owner(s) Z_ . 48�a C � j 2 Antl/Or AuNorized Applicant Date GOOE � INapECT10NTYPF 1616 Fixatl System Flnal Fire Prevention 1266 200 201 202 203 204 24Y8�4fi Pool Spe Fingl Final Re-Rooi Ffnal BIocWFletaining Wall Finel Fectary Fire Plece Finel Sign Finel Demolitia� QA]E � II�EbS �a INSVELTONTYPE 208 Finel Mechenicel 208 Finel Plumbing 210 Finel Electdcal 212 Finel Fire Prevenfion 220 Finel Planning ApprOvel 222 Final Slte 250 Final Bullding/Occupency �g �� .. , : .. .. .. 6�1�3 COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN 268�Bay Street COSTA MESA. CALIFORNIA OWNER S$IIt$ n{� y�pj� ADDRE55 Iy,l9 E� 17}�r( S c�Tv C a Mesa ARCHITECT Carlson & OR ENGINEER Mj��ohy� ADDRE55 Garden Grov CONTRACTORDynQ and COle 419 E. 17th St ADORE55 LEG4l LOT OESCRIPTION NO. � BLI A.P. NO. OF LOT (J X � USE OF EXISTING BLDG. nOne TEL. NO. LIC. NO. NO.OF BLOGS. NOW ON LOT RORQ SETBACK LINE FNOM 1� [ CErvi[n OG SinEEi a�Vt FEAR VARO 1�� SIDE YARD RIGMT �O� LEFT 91 � DESGRIPTION OF WORK� NEW g q�TERATION ADOITION REPAIR MOVING DEMOLISH BUILDING NO.OF 512E ROOMS r STORIES EXTERIOR WALL ROOF COVERING HtilICCO COVERING COTRA .��:� ;_.C��1lED 11-a9�s�7 Ju. c�rr o�F c ��+ . APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY NECEIPT NO. PENPy'I�f�' \J� RECEIVED BV O�TE RECEIVEO 04TE ISSIIF � � DEC 1 3 BUILOING ADDRE55 COSTA MESA. CALIFORNIA APPROVED " BY DATE CORRECTIONS STATE THAT TME ABOVE IS CORRECT aN0 �GNEE TO COMPLV WITH .�LL CiTY OflDINANGE9 �ND 6T�T LwWS FEGVL/.TI�'G BUILDING CONSTRUC� TION. V LUP.TION SIGNATURE OF PERMiT FEE $ 'z6�� PERMITTEE ` PLAN CHECK $ 13�Q� 5 1��7�2.�� M AUTHORIZED AGENT DIiCE AND COLEGRWF �C• TOTAL FEE $ 39��/ `�� y