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Home My WebLink About619 SHASTA LN - Building Permits o P CITY OF COSTA MESA BUILDING DIVISION SM v. ' " " � ' DEVELOPMENT SERVICES DEPARTMENT �• • PERMIT PERMIT NUMBER P98-00840 iv (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 619 SHASTA LN Status: ISSUED Suite No Applied: 11/10/1998 Issued: 11/10/1998 Vicinity: Parcel Nunmber: 93405180 Applicant: RON Address: WI NOCK PLUMBING Phone: 714-895-1246 Zip: Owner: HIPPERT, RALPH A Address HIPPERT,LAURIE A COSTA MESA,CA Phone: 619 SHASTA LN Zip: 92626 Contractor NOCK PLUMBING Address: 11612 KNOTT ST • Phone: 714 895-1246 GARDEN GROVE,CA Zip: 92841 License: 707775 Arch l Eng: Address: • Phone: Zip: License: • S COPE OF PERMIT • DISHWASHER CHANGE-OUT FEE SUMMARY AMT QTY AMT --QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer 50.00 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 $0.00 0 Dishwasher $8.75 1 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 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 $0.00 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: $30.75 COMMENTS/SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora 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 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. [Y I have end 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�I_ns_u_r_en`ce centerraandd policy nu er are: ' 1 1 Carrier: C—!/Liv C./'C' � - Policy Number:/V WC 79 3 r /7/ (This section neat-he completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this 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 agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: 9- \ Date: /(—/ L— 97 • WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chaptteer,9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.k .1 0 7 7 7 / Class a C 3.6 Contractor's Signature: Date: // • i- 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 Code). Lender's 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 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.). C 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 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? 0 Yes 0 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 0 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 an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? ❑Yes ❑No (Section 65850.2 of the Califomia 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 permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 0 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 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. Si•nature Of Legal Owner(s) Date //-/2--' And/Or Au orized Applicant Date CODE L INSPFCTInNTYPF DATE D11mAL5 CODEC INSPECTION TYPE DATE IMMALSj 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ( -10-11 1VI 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 2446-46 PROJECT ADDRESS: 619 SHASTA LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 063762 OWNER'S NAME: PASCO MANAGEMENT CO ADDRESS: POST OFFICE BOX 2968 PERMIT NO: B 063762 PLAN CHECK NO: N GOVT; N SUPP; N COSTA MESA CA 92628 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: REP ARCH/ENGINEER: 641-0593 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPLACE SIDING NER#224 UNITS 619 SQ FT: 3, 200 PERMITTEE: CLAIM VALUE: 3, 200 . 00 CALC—VALUE: 3, 200. 00 GROUP OCC: R-1 / ADDRESS: ORION CONSTRUCTION ( 714 ) 363-0727 28 OAKCLIFF DR COMMENTS: REMOVE SIDING REPLACE W/STUCCO UNIT 621 LAGUNA NIGUEL CA 92677 *******+Est+ESE*************************+E****x*****el****yE*** **+E****+ ********+r***** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITYLIC.: NSA.,-040100 STATE LIC.: 485459... CLASS: B �_e; IMY P 4 Signature; // - MAIN BUILDING ACCESSORY BUILDING WORN TIONDECLARATION: Ihereby affirm ave a certificate oftseftreoraceflificateofWorkers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Sectio I.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: 046-93UNIT03554 EP.DATE: 01/01 /94 COMPANY: STATE FUND PARKING RE • PROV: PARCEL: 93405180 ZNE; REF NO; ❑ Certified copyhereby furnished. C� Certified copy is rile with the city Buil,Division. PLANNING N TES> -Elate: / 3 Applicant: .0L/"_ .i ********************************************************************!t'1F1k******** EXEMPTION OM, DRKERS'COMPENSATIONDECLARATIO ' i5 section need not completed it a ermitisMronehundred(SI®)orless). DEVELOPMENT SERVICES R E Q U I R E M E NI T'S I certify that in the performance of the work for which this permit is issued,I shall not employ a erson in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: �"� Date: Signature; .. NOTICE:If.after malting this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ( DATE; x' d' • Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. AA U 4:11-'D- . CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency lar the perlormance of the work lot APPLICATION ISSUED BY• DATE, `.-.f �'( which this permit is issued(Section 3097.Civ.C) *************************,* ,**�,******* UNDER: ******************************************************************ik****ik******ik ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL) SEGMENT:Y J OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/R'ES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63 . 00 5 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she B licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLANSM I P/NON—RES and Professions Code)or that he/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(5500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 63. 50 0. 00 0 . 00 63. 50 63 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 63. 50 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63. 00 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'Slate License Law).l am aware ****. ***.**,***,*********.**..***.* .* .**.**..**.**.*******.***.)(.*****.*.**,*,y,*,*,*****,***********,* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.d P.C. lorthis reason TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 3200 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 200 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant I hereby certify that I have read this application and stale That the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. eike 'Bale: 7{ 45'1Signature. Atoll alligatall 01 00146239-00146240 TOT 63.50 Driver's License or Social Security a: • DATE: 09/02/93 TIME: 09:22 164x'46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor --- CONSTRUCTION AND PLANNING- POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3::Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement t 56. Rough Plumbing & Pressure Test 617 tEtettrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE '7., Footings • 58r . Electrical Conduit•Undrgrnd. 9•, foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrd. 60. Backwash Lines, P•Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains64. Plumbing System - Final 14. Rough Plumbing' - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT I. 20. Rough Factory Fireplace i ' . .1 •,'. . APPROVALS - !Permit# • ; , a r, ,a„7. - n 21.;Duds; in Structure;' '- ,• '-.'• ;.i �� .- "70. Underground-Hydro ' `+ - t 22. Ducts, Ventilating - ; r . F, : ' 21, Product Piping OGa09iI 23.'Gas srP� e•Rou &Test "' r , h P 9, _ r.� �;. 12, Underground,Flµsh,; ,, t , ' 24.'RoofFraming• r a a ' l 1.1 : 1. 73.;4Dndergrnd.:Storage'TankDGas ❑Oil 25. Roof Sheathing ' ' ' ' '•' _ , • ` '74,,bverhead Hydro ' 26. T,-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - i 27.'Frame and Flashintj _ , , y, , ' t 76. Dry Standpipe !28.' LathIing&Siding>�• , ••I • { ••I• r 77,t'FIXED SYSTEM FINAL . 29. InsulatiodI I f 78., FIRE PREV. FINAL 1 • 30. Drywall Nailing -.) . 1HEALTH DEPT.,RaQUIREMENT 31. Plaster Brown Coat,' 79.'FINAL INSPECTION • • :32. Electrical Power Meter-Final r I • 80, FOOD CERTIFICATE ISSUED 33. Fin31 Electric' ' t - ''Notes: `' 21 34.,F,inaf Heating& Aig:Conditioning. t� " • ,t • t, . - , 35. Final-Gas Pipe Test ' 36. Hood or Canopy , ••4 • 137.'Final Factory Fireplace ! r ' . 38. Final Plumbing .,. - - 39. Water Service-Final • - 1 . 40. Gas Service-Final . • t , 41. Solar Domestic-Final -• '> • 42. Backflow Preventer •' I 43. Backflow Irrigation , ' 44. Landscape Irrigation System , r -. 45. Sound Attenuation - •- . . tj' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING C alk .. 48. FINAL PLANNING - - - l _ �/ - .49. Electric Release to Edison , - 50. Gas Release to Southern California Gas Co - ' 51. CERTIFICATE OF OCCUPANCY , , ; No. Date City of Costa Mesa Planning Department Post Office Box 1200 77 Fair Drive p DO (�j{1( Costa Mesa, California 92626 1 DO I C Ib & (714) 556-5245 • PFr 1' y� REQUEST FOR OCCUPANDY- C ' b E u • (Single Family Residential orpi �Lay F,-. 'T_� MESA Condominium Units) , AM SEP 1 6 1977 71819,10111114112131415/6 Tract No. ) — Date 9 4-7 6 - 77 Lot No. / '(r) Address f 9 •e The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreeme , acknowledges that (hee, he, they) l va were)-21.2-) vised that this tract has . not been given final inspection nor has it been accepted by the City of Costa Mesa • as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions I necessary for approval other than those conditions protected by surety bond. he undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or person, i •ury to the undersigned by / reason of the aforementioned uncompleted co o . / . • — 0, A urch By ass3c / , By � h� /jI/ ' evelOper . .F/Au hon x,.• Represe •ati - if . v .. SES „ i1:.',�l_+.L .4../Pi— %Ur. _ • 71 1 IRVINE BOULEVARD, SUITE 210 - -CMF 0569-26 TUSiffi, CALIFORNIA 92680