HomeMy WebLinkAbout982 TRABUCO CIR - Building Permits�
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(714) 754-5273 • Fau (714) 754-4e56 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 982 TRABUCO CI
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42205207 Zoning:
Applicant: BLANKS, JERRY
Address: 17501 NORWOOD PARK P-L- � �'�_ "
. - - Phane: (7'14) 573-0155
TUSTIN, CA � . . , � Zip: 92780
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Owner: HENDRICKSON, STEVEN J
Address 982 TRABUCO,CIR , -' - -
/ . ;i, . . . - - � . � -Phone:
- �COSTA MESA, CA ' - ' . " Zlp: 92627
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Convactor: � PREMIER.ROOFING AND BUILDING CO INC
'Address:. 17501 NORVJOOD PARK PL
" j, ��/ Phone: (714) 573-0155
� _ ` _ TUSTIN;-CA
' , Zip:-�� 9278�
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Arch. : . , „ ir
Address:
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Zip:
1800 SQ FT
�� License:', 634404
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-' License:
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' REROOF: T/O EXISTING SHAKE ROOF, 7/16" OSB S
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Othe�:
inspection:
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$0.00 _
$97.25
$0.50
$0.00
$0.00
$0:00
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597.75 � ;, i=-�., ,
Eng:
Address:
Sta(us: ISSUED
Applied: OS/07/2002
Issued: 05/07/2002
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LAYER 30# FELT, P.PPLYjI "30;YEAR COMP SHINGLES:'
� FEE SUMMARY
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SETBACKS ; � �� „ ; ,: � .
MAIN STRUCTURE Front 0- 0��, � - Rear �-
ACCESSORY Front �= 0= 0 � - Rear �
PARKING Existin � 0,�- Re uired:
NOTES: '
- Calc Valuation: ,' ,
Claim Valuation: ;, � �
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� PLANNING & ZONING
0- 0�- `''CeR , 0- 0 Right
0- 0 . , Left 0- 0 Righl
0 , � �� Proposed: 0
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_ �$3,600.00
� �3,600.00
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
required Inspections and itnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
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WORKERS'COMPENSAnON DECLARAnON: �
I heraby aHirtn under penalry of perjury,one of the tollowing tleclarations: � �. -�
❑ I heve and wlll maintain a certiticate of consent to seN-Insure tor workers' compensation, as pmvided for by section 3700 of Ihe Labor Code, for tha pedormanca of Ihe
`, work for whiCh IhiS Dermit is issued. �, -
�I have antl will mai�tain woAcers' compensation insurance, as requiretl by section 3700 oi the Lahor Code, for the peRortnance of the woAc for which this permit is issued.
My worke com ensation Insu/ra�n'ce carrler anE policy numDer are: !� )
Carner. '�A�E /-li-W!) � PolicyNumber. I "[ �a�S/ - d �
(This sectlon need not be camp/eted i/ the permit is velued et one huntlretl dollers ($100) ar less.)
❑ I cenity that in the PeAortna e of the work for which Ihi ermit is issued, I shall noi employ any person in any manner so as to become subject to ihe workers'
compensation laws of Calif la, and egreelhaUY�ish become subject to the workers' compensation provisions oi Saclion 3700 of Ihe Labor Code I shall forthwilh
comply with these
WARNING-FAILURE TO
iHOUSAND DOLLARE C
�� .�/ �/� �
�a,a:
dJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOVER TO CPIMI PENALT S AND GVIL FINES UP TO ONE HUNDRED
OF COfAPENSATION, DAM4GES AS PROVIDEO WR IN SECTION 3]O60F THE IABOR COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACYORS DECLARATION:
I hereby aflirm that I am licensed un er ovi io s of Ch pter 9(commencing with Section 7000) of Division 3 of the Business and Profps� ions Code, and my license is in full
torce and effec���c.� � �Class � L�- -3 7
C\ractoYs'Slgnatu� Date3 . �
CONSTRUCTON LENO�N AGENCY:
❑ I hereby aHirtn that there is a conswc�ion lending agency for the pertormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
LentleYs Name: �enders Address:
SignaWre: � Date:
OWNER-BUILDER DEGLARA710NS:
I hereby attirtn thet unae� penalry of perjury ihat I am EXEMP7 FROM TME CONTRAC70RS LICENSE LAW tor ihe tollowinq reason (Sec. 7031.5, Busineu end Professlons
Code: Any ciry or counry which requires a permit to construct, elter, improve, demolish, or repair any structure, pnor to its issuance, elso requires Ihe applicant for such permit
to file a signed statemen< <hat he or she is licensed pursuant m the pmvisions ot the Contradors License Law (Chapter 9(commencing with Section 7000) of Division 3 01 the
Business antl Protessio�s Cotle) or that he or she is exempt therefrom antl ihe be5i5 for the allegad e:emption. Any violalion of Sectlon 7031.5 6y any applicent for e pertnit
subjects ihe epplicant to e civil penalry ot not more ihan tive hundred dollers ($500).):
❑ I, as owner of Ihe p�operry, or my employees with wages es iheir sole compensation, WILL DO T1E WORK, and the siructure is not intentletl or oNerea for sala (Sec.
7044, Business and Professions Code: The Contractors License Ww dces not apply to an owner ot property who builds or improves Ihereon, and who tloes Such work
himseN or herself 0� ihmugh his or her own employeas, provided ihat such improvemeNs are not imentletl or otterad tor sale. If, howevar, the building or improvement Is
sold within one year oi completion, the owner-builder will have the burden ot proving ihat he or she did not huild or improve tor purposa ot saleJ.
❑ I, as owner ot the property, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct the proiect (Sec. 7044, Business antl Professions
CoEe: The contractors License Law does not epply ro an owner of pmperty who bullds or Improves Ihereon, and who contracts tor such pro�ect wit� a coniractor(s)
license pursuem to the Contraaors License Laws.).
❑ I em exempt unde! sec. Business end Professions Code for this reason:
Signawre: Date:
Owner ID verifietl by dnVefs licen58. ❑ Ves ❑ No Driver's License No. Expires:
Veritiwuon oi Owners�ip by irype of documenl, l.e. - propeny leu blll or deed):
DIVISION OF INDUSTflIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify iha� no escavation tive (5) or more teet in depth inm which e person is required to tlescend, will be made in connection wlth work authodzed by this
permit, end that ntl building siructure, scaHoltling, talsework, or demolition or tlismantling thereo�, will be more Ihan thirty-six (38) feet high. (Chap. 3.2, Grp 2, An 2, Sec.
341, Title 8, Califom�a Admini5irative Code).
❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Industnal Satery, as noted ebove, unless suc� person hes e
pertnit to do such Wark trom tha division. �
Signature:
DiviSion of InduSlnal Safe�y Permit Number:
Date:
ARDOUS MATERIALS AND EMISSIONS CER7IFICATON:
Will the applicant of P�esent or future builtling occupant nead b tile and cenity a Business Plen for emergency response b release or threatened releese of a hezertlous
matenal7 ❑ Yes ❑ No
(Sedion 25505 of the Calitomia Healt� and Safery Gode requires, wit� some exceptions, that a Business Plan be Filetl with Ihe Costa Mesa Fire Depariment Gy every
business which has at any one time during a reponed year a quantity of hazartlous matenals equal to or greater ihan e weight of 500 pounds, or e volume o155 gallons,
or 200 cubic feet of compressed gas at standartl temperature and pressure).
........................_..............._..................................................................................................................................................................................................................................................................................................................................
Does or will the app���nt or present or future builtling occupent neetl to file a registration form for acutely hazartlous meteria�s? ❑ Ves ❑ No
(Section 25533 of tne Califomia Health and Safery Cotle, with some eaceptions, requires registratlon with the Costa Mesa Fire Depertment by each business which at any
one time has on hend a quantity ot acutely hazartlous metenels equel to or greatar then e weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas e� stentlard temperaNre flnd pressure).
..........................................................................................................................................................................................................................................................................,.................................................................................................
Does or will the applicant or present or future building acupant need to prepare an RMPP (Risk Managemen� and Prevention Piogrem tor acutely hazardous materials)1
❑ Ves ❑ No
(Section 25534 of tde Califomia Health and Satety Code provides ihat ihe Casta Mesa Fire Departmen� may require the preparetion, certification and filing with ihe Fire
bepertment of an RMPP by busineues which are requiretl to register acutely hezardous materials with the Fire Department.
.........................._..............................................................................................................................................................................................................................................,.................................................................................................
If an RMPP is presontly requiretl, has Section 25534 of the Califomia Healih antl Safery Code been tully complied with9 ❑ Ves ❑ No
........................................... .................................................................................................................................................................................................................................................................................................................................
Does or will tha applicant or present or tuwre building occupent require for ihe work which is the subject ot this a plication a permit lor such consiruction or modificatlon
irom the South Coest Air Queliry Management Disirict or irom any other air pallutian conirol district or aqenc/7 � Ves �J No
(Section 658502 01 the Califomia Government Code requires ihat ihe requested iniormation be fumishetl on applications for nomresidential builtling permits).
W ill any part of the facility to be constructed under Ihis permit be within t000 feet irom the outer bountlatles ot a school7 � Yes ❑ No �
Qf yes", the tacility must meet Ihe requirement of Sections 25534 antl 42303 of the Celifomia Health antl Safery Cotle).
................................ ...... ...................................................................................................................................................................................................................................................................................................
It e permit from Ih0 South Coast Air Ouelily Menegement DisMct or other eir polWlion control distnct or egency is requiretl for the work which Is Ihe sublect of Ihis
epplicatlon, have ell of the disclasures prescribad by Celitomia Health antl Safery Cotle Section <2303 been made7 ❑ Yes ❑ No
.........................................................................................................................................................................................................................................................................................................................................................
(If yes", atlech certificate of compliance from ihe appropnate air polWtion conlrol oFticer).
CERTIFICATE OF COMPLIANCE: I certity ihat unde� penalty ol perjury the intortnation given above is correct. I agree to compty with all state laws antl city ortlinances
reaardina Hazardous Ma�erials entl Emi55ions.
Signature: Date:
CERTIFlCATE OF COMPU4NCE AND AUTHORIZATON OF ENTAY: I certify under penalry of perjury that I have reatl �his application and state thet ihe intormaiion given is
correct. I agree tq comply with all siate laws a d city ortlinances relating to building conswqion, anC authonze representatives ot the Ciry ot Coste Mesa to enter upon ihe
ebove-describe �property for inspection purp �S s, I agree not to ocwpy or allow occupency ot any buildinq authorized by Ihis permit until finel inspection.
e e , wner(st— �/%/O�
AnNOr Authorized Applicant rDate �
COpE �. � QL�SE IN�LALS ,CcQpE� INSPELTIONTYPE Q� J(�$
1616 Fl:etl System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �/' -�sn�-��- 208 Final Plumbing ,.
200 Final Re-Roof ��'�' �`� `� ' ` 210 Final Eladrical
201
202
203
204
Finel elocWRetaining Wall
Final Fectory Fire Place
Finel Sign
Final Demolitio�
212
220
Final Fire Prevention
Final Planning Approvel
222 Final Site
250 Final Building/Occupancy
. . � '' .. _ ^XJV.£t�
� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For Applicant [o Fill in Completely — Use Ink Only
BUILDING / %%
ADOFESS L��"
OWNER � �l • VJr (v"��w�
ADDRESS I � 1 ���-F, �L�„�
CITV G6/� �'�/'�' TEL.
NO.
CANSTRUCT{ON
BRANCH
AODRESS I'' `
ORENGINEEF �/'-' �` 1'- �-�S NOLW�"�'I
ADDRESS � YI I M�/ -�� ���
CONTRACTOfl `�� i�?� 62�0'"y CU���
ADDRESS (q��j 1 �v_�� ������
CITV L�S7� � 1y+q' N�L.
STATE CITV
LIC. NO. LIQ NO.
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXI5TING BLDG.
Separa[e permi[s are required for
electric, plumbing and heating work.
USE OF BUI�DING AND WORK TO BE PERFORMED
�
I hereby acknowletl8e that I he�e reetl this application and state
that the above informetion is Gorract end egree to comply with
all laws regulatin8 building consvuction, end I shall not employ
any person in violation of the workman's compensation laws of
the State of Californie.
I he�eby certify that I am properly Iicensetl as a conttacior untler
ihe State of California Business and P�ofessions Cotle, Division 3,
Chapter 9, and that such licenses are In full force entl etfect, or I
empt from the provisions of tha Stata of CalitOrnla Business
antl Profassions Code, Dlvislon 3, Chapter 9.
Signature of r;��rll..�/'.J�1Y�
Permittee �T���
Authorizetl ABent ✓ �
RE EO
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A.P. NO. I
BUILDING �
ADDFESS
TRA(
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OWNER �
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FIRE
ZONE
APPROVED
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�e�: �s--i�""�"-00 Q�:srJ �,::� :>i659
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FORSTRUCTURALPERMIT
DATE RECEIV D DATE ISSUEO
I�-�� ��
�'ARDS APPROVED
MAIN BUILDING
US
VALUE
/
REAR FT. FT
DI5TANCE BET. BET. MAIN &
MAIN BLD(35. ACCE$$. BLD('S.
vAR ATE
C.U. i. PROVEf� ��
�APPROVED / '!. �K ....'� � �
1 '�� !'_SQ. FT. V ' �'�/ I
1
THEAMOUNTSHOWNUNDEqVALU
THE PURPOSE OF ESTABLISHING A PERI
VALUATION PERMIT FEE $
��j PLAIV CHECK $
^ i ��c�
iC / - TAX $
e� �
TOT LPAID $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For Applicant to Fill in Completely — Use ]nk Only
BUILOING ��J��A Q� ��.M CI F�.
ADDRESS 'G1 /R�f"��IVLLJ
OWNER �,.' Y � V���'�,Y
MA1L
ADDRESS
TEL.
CITV NO.
CONSTRUCTION
BRANCH
ARCH
ADDRESS
A�DRESS
CITV
STATE
LIC. NO.
SI2E
OF LOT
USE OF
TEL.
NO.
CITY
IIC. NO.
NO.OF BLDCS.
NOW ON LOT
Separate permits are required for
electriq plumbing and heating work.
USE OF BUIIDING AND WORK TO BE PERFOR�
1 hereby acknowledge that I have �eatl this application and state
that the abova informacion is correct antl agree to comply with
all laws ragulating buildin8 �a^nruction, antl I shall not employ
any person in violation ot the workman's compensation laws ot
the State of California. '
I he�eby certify thai I am properly licensed as e conttactor untler.
the Stata ot Califarnia Business and Professions Cotle, Division 3,
Chapter 9, and that such Iicanses are in full fo�ce entl aftect, or I
am exempt trom the provesions ot the State ot Calltornia Business
antl Professions Code, Division 3, Chapte� 9.
Sipnature of
Permittee
Auffiorized AOent
R
BUILDING
F
ROVED
=:Rr -a-� �''��`'oa so2 � �^-��� i l,8,��D
� �,
TION FOR STRUCTURAL PERMIT
V DATE FECEIVED nnTc I.SRUFn
ZONE NO.OF
PLAN$
VARDS APPPOVED
VAR. #
C.U.P. #
THE AMOU
THE PURP0.'
VALUATION
-�
VALUE
USE OF NEW
BUILDING
VARDS APPROVED
ACCESSORY BUILDING
BEf. MAIN &
AOCESS. BLD
DATE
APPflOVED
VN UNDER VAIUATION IS FOR
"ABLISHING A PERMR FEE ONLV:
PERMIT FEE $ ��
PLAN CHECK §
TAX $
TOTALPAID § �
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