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Home My WebLink About2584 WESTMINSTER AVE - Building Permits CITY OF COSTA MESA BUILDING DIVISION qri. DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER PERMIT �,s B03-00565 warm (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2584 WESTMINSTER AV Status: ISSUED Suite: Applied: 04/07/2003 Vicinity: ROOF Issued: 04/07/2003 Parcel Number: 43919219 Zoning: Applicant: CHAMBERS, DARRELL ISSUED BY: Address: 414 N SHATTUCK PL Phone: 714-771-3658 ORANGE,CA Zip: 92666 Owner: ST SURE, KENNETH F TR Address 1818 COMMODORE RD Phone: • NEWPORT BEACH,CA Zip: 92660 Contractor CORNERSTONE ROOFING Address: 414 N SHATTUCK PL Phone: 714-771-3658 ORANGE,CA Zip: 92666 License: 616586 Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL CLASS A,30 YEAR,HIGH DEFINITION SHINGLES, 30#ASTM FELT. 19 SQUARES INCLUDES ATTACHED GARAGE. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,485.00 Permit: $97.25 Claim Valuation: $3,485.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 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 2446-46(6/)0) 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. 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'co pensatjon Insu tar carrier and policy number are: Carrier: ,r It' 1/1/72) Policy Number: 0002$5-bay Y70- 2e&3 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 s. n ,i L1—7 -63 6 3 Applicant Signature: -‘44 / Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RIVES UP TO ONE HUNDRED THOUSANDD(1 I ARE($100,000),IN ADDITION TOT/4E 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 1 am licensed under proyisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.a do 1(a $r1O Class a G-.Z 1' h`/C.- Contractors C-Contractors Signature: . ..... Date:_ A. Date: sem- 1-7/— 7 --0.-- 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). Lenders 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.). • O 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,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ l am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 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: O 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O 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 materiel? 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 lima 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? 0 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 end 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 en 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap.Permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes u No (Section 65850.2 of the California 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? ❑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? 0 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 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 end 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 ature Of agar Owner(s) Date An Or Authorized Applicant t.iate SODS A INSPECTION TYPE Rail INTOAL$ RODE INSPECTION TYPE TATE INTrttAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 1�I ...'t ,7� 208 Final Plumbing 200 Final Re-Roof ti-30 W k(� 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 1.4 Limn,tUA � 11On DATE 7-S-t-Of JOB ADDRESS 2584 Westminster Avenue BUILDING PERMIT NO. 27127 ENERAL CONTRACTOR Owner-B1dr. DESCRIPTION OF WORK Int.Alter.for bath P To.119-152-19 LOT TRACT FIRE ZONE VALUE § 100.00 11. ECTIONS Sig Date GROUP I TYPE V ZONE R-1 Soil '� �Y` e C7 SUBCONTRACTOR I PERMITS ISSUED Gas /�Bv q__ Date j Number I Signature Water I ilk_ umbingJ y Rough Plumbing ,6-c;-6'3 ,X [, [/, / 6-67-67 d p.0r0. Prop. Swr. Line 0 House Con.0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wiring /f'i? G-N.Cry _ __Heating and Vent. Trenches 0 Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing --- Frame and Flashing Lathing — In 0 Out 0 P'- 4er, Brown Coat E :ural, Final Electric Heating, Vent., Rettig. and A.0 Final � � s'�r��-- �.�G� .‘1.1–t/ 9727f Plumbing, Final and Gas Test ;f /C. % —Sym{�k 0 _ 7 Electric, Final /: - Building, Final �� i 2,./. � 127 PAID ��Y 31-67— ' "� sti001508 zit****,::2.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA 92620 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PR e/ BUILDING BUILDIN iji£.4 w.T For Office Use Only ADOREH I1� RECEIPT NO. A✓ I. I' COSTA MESA, CALIFORNIAN / �G/ PATE ISSUED OWNER 4 E�3 ;; 15-C-9/1-67 1,'9/"67 /'7' BUILDING ADDRESS/�jQ y42.41.-D4,..-- 7/Lyv} ADDRESS �(ia e— �j f TEL/� //,r FIRE V CITY LF�'G� G�l NO. O ��7�// FIRE B GROUP ARCHITECT TEL BYPROVE14;#`/ DATE % --.2/—.6 7 / OR ENGINEER NO. ��// ZONING ADDRESS XON,{1(. P 7 / -NO.OP I USE OrN LANE CYILDI O • CONTRACTOR _ Ara_ LEGAL — ADDRESS Y.i. - - DESCRIPTION CITY A.P.NO. /19 — /5 2 /p 1 NOTE: NO CAVE OVERHANG SHALL BE LESS THAN STATE TEL Sr TO SIDE a REAR P.L LIC.NO. NQ, VES SIZE T-�r i NO.OFSLOS& ALLOWED (U.B.C.REQUIREMENT). OF LOT , /-J X / 1� NOWON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) SETBACK LINE PROP CENTER OP STREET REAR YARD FRONT FT. i/)Pr. SIDE YARD I LEFT I RIGHT R.SIDE 114. l' Pr. Q �� qr / DESCRIPTION OF WORK L.SID, Fr. ✓ Pr. NEW _ ALTERATION ADDITION , REAR PT. PT. DISTANCE BR. BET.MAIN ft MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING _ .DEMOLISH VAR.* DATE BUILDING NO.OF SIZE ROOMS STORIES C.U.P.# APPROVED EXTERIOR WALLROOF APPROVIW/) n ""`-� / ^7 COVERING I COVERING BY liL/,� L.I�{�‘.AATE 6/3/ 1� / a USE OF BU ILDINS AND WORK TO BE PERFORMED N I SQ.PT. ',>s I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND ST AND STATE THAT THE ABOVE IS CORRECTAHDAGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. R1 PLY WITH ALL CITY ORDINANCES AND RATS LAWS REGULATING BUILDING CONSTRUCTION. VALUATION CO //�J ) PERMIT FEE 5 SIGNATURE PERM ITTEF O �/- ''l/ - /��/ / �� GI $(/ (f �/ PLAN CHECK S AUTHORIZED AGENT /` �J ,� ._....,..; ,,.. .. _ . TOTAL FEE $ QR