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Home My WebLink About3480 WIMBLEDON WAY - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3480 WIMBLEDON WY Suite: Vicinity: ROOF Parcel Number: 41204311 .4pplicant: RON SELL Address: 78032 LEMON YORBA LINDA , CA Owner: HUU, NGUYEN Address 1220 W HEMLOCK WAY SANTA ANA, CA Contracror. SELL ROOFING COMPANY Address: 18032 LEMON YORBA LINDA , CA 2ip: 92686 Arch : Address: Zoning: R1 R1 Phone: (714)528-1758 Zip: 92686 Phone: Zip: 92707 Phone: (714)528-1758 License: 323842 Eng: Address: Phone: Status: ISSUED Applied: O6/15/2004 Issued: O6/15/2004 _ /� ' .: �� Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1/2" OSB, DURALITE, ICBO #2656, 5.8 LBS. 29 SQUARES FOR 2 STORY S.F.D. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $16725 $o.a9 $0.00 $0.00 $0.00 $168.14 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Lefl 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 s8,9o0.00 sa,soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap.access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned for a period of 780 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabie codes, and ail required inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 �aas-as �evoo) WORKERS' COMPENSATION DECLAPA710N: ( '� I hareby aHirm under penalty of perjury one of Ihe following declarations: ❑ I have antl will maintain a certificete of consent to self-Insure for workers' compensation, es provided for by section 3700 of the Le6or Code, for the peAormance of ihe work for which this permit is issuetl. l. ❑ I have antl will maintain workers' compensation insurence, as required by section 3700 of ihe Lebor Code, for ihe padormance of Ihe work for w�ich Ihis pertnit is Issued. M workere' co tlo nsuranc arde� en Iic number are: � / ['-- Car er:�� (G .�� Y POIicyNumber� / N� S J �� (.This�sectlon neetl not be complefed ll fhe permit is alued et one hundred dollars ($f 00J or less.) .. � ❑ I certify [hat in the performance of the work for which ihis permit is issuetl, I shell not employ any person in eny mennar so es lo become sublect to ihe workers' compensation lews of Calitornia, antl ee at if I shoulQ� ecome sub�ect to iha workers' compensatlon provislons of Section 3700 of the Labor Cotle, I shell forthwlth comply with these provisions. G� i/ _// rDele � �/� 6, S�_ jApplicant SigneNre: �Xi{A . �WARNING.^FAICURE TO SECURE WORKERS' COMPENSATION COVERAGE 5 UNLAWFIIL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND QVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PFOVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IPfrEREST, AND ATTORNEV'S FEES. IICENSED CONTRACTORS DECLARATION: I hereby,attirm.that.l.am licensed under provisic torce�end eflact. Llc. # � �/ Z 'i 1.'[::;> ` � Contrectors SignaW e � I. ., CONSTRUCTION LENDING AGENCY: 9(commencing with Section 7000) oi Divislon 3 af iha Business end Professlons C�e, anA my license Is In full ❑ I hereby affirm that there is a construction lending egency for the pertormance of Ihe work for which Ihis permit Is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn thet under penelty ot perlury thet I em EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Prafesslons Cotle: Any ciry or county which requires a permit lo consiruct, elter, improve, demolish, or repair eny stmcture, prior to its issuance, elso requires the epplicant for such permit to file e signetl statement that he or she is licensed pursuant to ihe provisions ot the Contractors License Lew (Chepter 9(commencing with Section 7000) ot Division 3 ot the Business and Protessions Code) or thet he or she is exempt therefrom and the besis for ihe elleged ezemption. Any violatlon of Sedion 7031.5 by any ep0�icant for a pertnit sublects the applicent t0 e civil penalty ot not more ihan five hundred dollers ($500).): ❑ I, as owner of Ihe property, or my employees wi�h weges es their sole compensation, WILL DO THE WORK, an0 the structure Is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Lew does not apply to an owner of property who builds or improves thereon, end who tloes such work himself or herself or Ihrough his or her own employees, provided ihat such improvemenis are not Intended or oflered for sale. tl, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving ihat he or she did not builtl or improve for purpose oF sale.). ' ❑ I, as owner of the property, am E%CLUSIVELY CON7RACTING WI7H LICENSED CONTRAC70RS to constmct the project (Sec. 7044, Business and Pmfessions Code: The contrectors License Law does not epply to an owner ol property who bullds or Improvas ihereon, antl who contracts for such project with a contractor(s) license pursuant to �he Con�rectors License Laws.). ❑ I am exempt under saa Business and Professions Code tor this reason: Signature: Date: Owner ID ventied by drivefs licen5e. ❑ V85 ❑ No Drive/s License No. Venfication of Ownership by (type of document, i.e. - properry tax bill or deed): E:pires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ 1 hereby certify Ihat no excavation five (5) or more Feet in depih into which e person is requireC to descend, will be made in connection with work euthonzed by this pertnit, and ihat no building slrucWre, scaflolding, falsework, or demolition or tlismantling ihereot, will ba more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla 8, Califomia Adminisirative Coda). ❑ As ownerbuilder, I will not employ enyone to do work which would require e permit from the Division ol Industnal Sefery, as noted ebove, unless such pereon has a permit to do such work from the division. Signature: Oete: Division ot Indusinal Satary Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I cenity under penelty ot perjury ihat I have read ihis epplication end state thel the information given is correct. I agree to comply wilh ell state laws antl ciry ordinances ralating to building construction, end euthotlze representatives of the Ciry ot Costa Mesa to enter upon ihe above-tlescnbed propetly for inspection puryoses. I agree not to occupy or allow acupancy oi eny builtling authonzetl by this permit until final inspection. COOEI, INSPECTIOXTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition GLiE 1[iIQJBL$ �Lii ��ra'�� CO�E I INSGECTION TYPE 206 Finel Mechanical 20B Final Plumbing 210 Final Elecirical 212 Flnal Flre Prevention 220 Final Plenning Approval 222 Final Site 250 Final Buildinq/Occupancy � I•]YI�I:Ihlrlbi F � a Q � � S F O fr] f' Q > �- � z w a O � a � W � 3 INGSAFETY DEPARTMENT A MESA. CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADORESS 3480 Wimbledon Way T�ENANT�R Wimbledon liSSOC. ADORE 5 1470 Jamboree RCl CITY Newport Beach Np`'640-68 � oER�T�o" Imperial Savings & Loan BRANCH Pasadena ADORESS (1 5. Lake Ave. ARCNITECT ADDRESS CONTiiACTOR in/Yamafu-ji No`'549-712 2 Mitchell So.,Irvine APPLICATION F�� RECEIVE �V PER A.P. NO. y,�.�— [ BUILDING ADDRE55 ';4g� W7 VNIT OR SPAGE NO. TR.NO. LOT 10275 NEW ADD ALTER X N° 47765 eY'-�s OWNER wimbledon ASSOC /� VALUE use PR� s APPqOVED ADDRESS 14%0 Jamboree FiCl ' c�Tv Newport Beach r`�o`.640-6800 LIC.NO. Z%3H7S LICVNO. �.HH%3 APPROVEDSETBACKS (FROM2M.-9�R6ST; K S12E NO.OF BLDGS. ^h OF lOT NOW ON LOT � RONT eY`+ FT. USE OF � EXISTING BLDG. Separate perrttits are required for L. SIDE ��i�� cr. electric, plumbing and heating work. PEAR FT. VSE OF BUIIDING AND WORK TO BE PERFORMED PLANNING ACTION PRD - New Construction Single-family dwelling I hereby acknowletlge that I heva reatl this apO��cetion and state that the above information is correct and agrea to comply wlth ell lawz regulatln8 build��8 �onrtruction, antl I shell not employ any Oerson in violailon of the workman's compensation laws of iha State ot California. I hereby certify that I em proparly licansetl as a contrecior untler the State of California 9usiness antl Professions Cotle, Division 3, Chaptar 9, and that sucl� licenses are in full force and effect, or I em exempi from the prO��sions ot th Staie of Celltornia Business entl Protessions Cotle, i Ision 3, C te �9. Signetura of Permittee or Authortzed AAan[ Data HOLD FOR SPECIAL OEMO � I�� S�. FT. /i �/ C� / i� THE AMOUNTSH WN UNDER VALUATION THE PVflPOSE OF ESTABLISHING A PERMIT FEE VALUATION PERMIT FEE E �� I1 � � PLAN CHECK E 5 �O /�p1� THX S / TOTALPAID b� (y OWENS•CORNING �iberglas �lanket Insulation The contractor named below certifies that the Owens-Corning Fiberglas Blanket Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Blanket Insulation is in- stalled in conformance with current energy conservation regulations, California Administrative Code, Title 25, State of California, in the building located at: / �y,P/S l,!/�mhl�rlD� L(% �' SS� /D�is r Street � Lot Number Tract Number t..�erior Walls Owens-Corning Fiberglas Blanket Insulation Ceilings Owens-Corning Fiberglas Blanket Insulation �-� / � Thickness ' R-Value ,; Thickness � R-Value Floors Owens-Corning Fiberglas Blanket Insulation . Thickness R-Value Foundation Walls Manufacturer Type Thickness R-Value General License No. By Title Date � �SiqnaWre� • �nsu�atio ntractor ��/�/I/�j�� /{D�1Tl7��License No.��,� . By_ _'s ame'r _ . _ . —Title �� Date�� / 'HomeownerCopy(Whlte)- , � � State Copy (Yellow) BUiIdBf COpy (Pink) OWENS-CORNING FIBERGLAS CORP. Insulation Operating Division Pub. No. 16-BL699Sh umo �� u sn., �wy isn � Fiberglas Tower, Toletlo, Ohio 43659