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Home My WebLink About3221 WASHINGTON AVE - Building Permits(714) 754-5273 • Fex (714) 754-4856 CITY OF COSTA MESA BlIILDIN6 DIYISION J DEVELOPMENT SERVICES DEPARTMENT PERMIT JobAdd�ess: 3221 WASHINGTONAV Suite: Viciniry: Parcel Nunmber: 13909603 Applicant: LATIMER,JEFF Address: 03218 OREGON AV COSTA MESA CA owner: BUSH, SCOTT D Address 3227 WASHINGTON AVE COSTA MESA, CA Contracmr. J R CONSTRUCTION � Address: 03218 OREGON AV COSTA MESA CA Zip: 92626 Arch : Address: BUILDING PERMIT Zoning: Phone: 714-641-7448 Zip: 92626 Phone: Zip: 92626 Phone: 714-641-7448 License: 485367 Eng: Address: Phone: . NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 06/08/1999 Issued: O6I08/1999 Phone: Zip License: Zip: License: SCOPE OF PERMIT TEAR OFF 2 LAYERS OF ROCK INSTALL 2 LAYERS OF 30LBS FELT AND 30 YEAR COMP. FEE SUMMARY Plan Check: 50.00 Calc Valuation: Permit: $87.25 Claim Valuation: SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: �0.00 Total: $87.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0. 0 Rear 0-0 Required: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Right 0- 0 Right 0. 0 $3,500.00 $3,500.00 NOTICE: The work authorized by this permit shell 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 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under �his permit to be considered legal, such work must comply with all applicabla codes, and all requlred inapectlone end final approval must be obtained. Failure to obtain inspections end tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: � I hereby eflirm untler penalry oi per�ury one oi the tdlowing tleclaretions: ❑ I have antl will melntain e certtticate of consent to self-Insure for workere' crompensation, as provitletl for by section 3700 oi t�e Lebor Code, for the pertormance of the wark far which this permit is issuetl. �I hava entl will mainiein workers' compensation insurance, as requiretl by section 3700 0l the Lebor Code, tor the peAortnanca ot the work for whid� this pertnit Is issuetl. My workers' compensetlon Insurence Cerrler and policy number ara: Cerder. Policy Number: (Thls sectlon need not De com0�eted if Me pertrilf !s valued et one huntlre0 dWlars ($100) or less.) ❑ I certity thet in the peAormence ol the work tor ¢ is permit is issued, I shell not employ any person in eny manner so es to become subject to Ihe workers' compensation lews ai�lifosnia�end egree that I��bacame subject to the workers' compensetlon provislons of Section 3700 0l Ihe Lebar COCe, I shall lonhwith LICENSED CONTpACTOR9 I hewby efl�ir t�.hat-7�emiicen ��a a,�eneci. uc. a _ � Conirector's SI n . _ CONSTRUGTION LENDING ✓��;,1 C/L�it. Dete:—� (/� — U — '�f 7 X)MPENSATION COVERAGE IS UMAWFUL M!D SMALL SUBIECT PN EMPLOY IMINAI P TIES AND qVl� FlNES UP TOONE HVNORED TO THE OOST OF COMPENSATION, DFMNCaES 0.5 PROVIDED FOR IN SECTION �W OF THE LABOR CODE. IMEREST, AND ATTORNEY'S FEES. wlth Section 7000) ot .W�the Busin�y entl% rofessions Cotle, entl my Ilcense is In full Cla ss #� / S — / oate: /_ — d`�9 �' ❑ I hereby aNirm t�et there is e wnstructlon lentlinp apency tor Ihe partortnence at the work for which Ihis permit Is issuetl. (Sec. 3097, Civll Cade). Lenders Name: Lendefs Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby atlirtn thet under penalry of perjury thet I em E%EMPT FROM TME CON7RAC70RS LICENSE LAW tor ihe lollowing reason (Sec. 7031.5, Business entl Professions Code: Any city or county which requires a pertnit to construct, elter, improve, demolish, or repair any strucWre, pnor to its issuence, also requires the applicant br such pertnit to flle e signed stetement ihat he or she Is Ilcensed pursuent to Ihe proWsions of the Contrac�ors License Lew (Chepter 9(commencing with Sectlon 7000) ol Divislon 3 of Ihe Business end Prolessions Code) or thet he or she is exempl lherefrom entl the basis tor the ellegetl exemptlon. Any violatlon of Sectlon 7031.5 by eny epplicent far a permlt su6�ects Iha epplicant to e civll penelry of not more than five �undred tlollars (5500).): ❑ I, es owner ot t�e praparty, or my employaes with wages as their sola compensation, WILL DO THE WORK, entl the siructure is not Intended ar oftereE far sele (Sec. 7044, Business and Prolessions Code: The Contractors Liconse Lew does not apply to an owner ot propeny who Duiltls or improves Ihereon, antl who tloes such work himself or hersell or throug� his or �er own employees, provided that such improvements are not intended or oHered lor sale. If, however, the bullding or improvement is sold within one year of completion, the owner-builder will have Ihe burtlen of proving that he or she did not build or Improve lor purpose ot sale.). ❑ I, as owner oi the proparry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct t�e proJect (Sec. 7044, Business and Pmtessions Catle: Tha wntractors License Lew does not appty to an owner of properry who 6uiltls or improves thereon, entl who contrects lor such proleci 'N��h e contrector(s) liCenSe pursuant to the Contrectors LicenSe LewS.). ❑ I am exempt un0er sec. eusiness an0 Pmfessions Code tor Ihis reason: Signeture: Da�6: Owner ID verified by tlriver's IlcensB. ❑ Ves ❑ No Drivefs LicenSe No. Expires: Veriticetion of Ownership by (rype ot documenL I.e. - properry lax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity thet na excevetim live (5) or more teet In depth Into which e persan is requlred ta descend, will ba made in connecHon wlth work euihodzetl by this pertnit, entl that no builtling structure, scaHdding, IaLsework, or demWitlon or dismanWng iheraof, will be more then Ihirry-six (36) teet hig�. (Chep. 3.2, Grp 2, Atl 2, Sec. 341, Titla 8, Celltomia Adminlstwtiva Cade). ❑ As owner•builder, I will noi employ enyone Io do work whith would reQuire 8 permit Irom t�e Divi5lon of IntluStnel SafOry, a5 notetl above, unless such pereon �as e pertnit ro do 5uch work tran Ihe d'Msion. Slgneture: Dete: Division ollntlustAel Satety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAY: I certify under penalry of perjury ihat I have read this eppllcation and state that the intortnation given Is correct. I egree ro camply with ell s te I s end dry orCinances relating to building consWctlon, antl amhorize representetives of ihe Ciry ot Coste Mese Io enter upon the ebove-descdbed property lor Ins�o�urposes. I egree not �o occuDY or ellow accupanry of any building authorizetl Dy this permll until Ilnel Inspection. COUE I, INSPECTIONTYPE 1616 FiaeO System Flnal Fire Preventlon 1266 Pool Spe Finel 200 Final RaRoof 207 Finel BIocWReteining Well 202 Flnal Fectory Fire Place 203 Finel Sign 204 Final Demolition xuaae BAiE 1t�ELS 15 ' � �� CODE� INSPECTIONTYVE 206 Finel Mechenical 20B Finel Plumbing 210 Finel Elecirical 212 Finel Fire Preventlon 220 Final Planning Appravel 222 Final Site 250 Finel Builtling/Occupancy � � �' �M��s COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 COBTA MEBA. CALIFORNIA For Applicani fo Fill In Completely TYPE OR PRINT AD RE89 3221 klashington Avenue COSTA MESA. CALIFORNIA OWNER Amherst Develo ment Co. MAIL �� AOORE65 1533 Baker Street TEL. K1911�i1 BUILDING ,,,T,. Costa Mesa ,,,, � BTATE Baker Street KI 9-1151 I NO. OP BID� use oF None EXISTING BL�G 6HTBACK LIN6 FROM �iOi 281 cervr¢x on srn¢e�r REAR YARD SIDE YARO I LEFT i� I RIGHT J� DESCRIPTION OF WORK _._... I� II .. -----�--. I II ---�- -- � APPROVED FEf� RECEIVED `�SEP L 61960 iKa�cE o�T. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RBCHIPT NO. w P.GRNK MOs� BY DATE 189U8D �61' � ti ias0 COSTA MESA. CALIFORNIA ZONING ZON6 I NO. OP I U9C OF N R�1 PLANB '2 B1111DINO �a.� . _ IC6NT¢R YNe BT.1 EVES 81=EDING].�b5 SC1.Fti.ROOMS V STORIES 1 EXTERIOR WA4L ROOF COVERING SLl1CCO COVERING Rock USE OP BUILDING AND WORK TO BE PERFORMED /1 i / 0 Single £amily residence with ,� � attached garage. Plan 11AR I H6REBY ACNNOWLPD06 THAT I HAVB PCAD THIB AtPLIGTION 7H6 AMOUNT BHOWN UNDHR VALUAT�ON IB POP THE AND 9TATE THAT TH8 A90V8 IB G00.REGT AND pRHE TO GOM- pUi1POB8 OP 88TPBL18HIN0 A PEPMIT FEE ONLY. PLY WITH ALL CIN OPDINANCEB Ap{D BTATE B IiHOULATINp BU�LOINO CONeTRu VALUATION [ SIGNATURE OF � ' � PERMIT FEE $ 37�00 PERMI7TE r 17 . SO $ ZJ,139�� PLAN CHECK $ AUTHORIZED AGENT D11C0 & olegmve, Znc. _ 2. 0 i 0 d \ ;