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Home My WebLink About3106 YELLOWSTONE DR - Building Permits CITY OF COSTA MESA t 4 BUILDING DIVISION > :j r,„,.- ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I /; • PERMIT ♦ 441 B00153 653 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 3106 YELLOWSTONE DR Status: ISSUED Suite: Applied: 09/23/2004 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 09/23/2004 Parcel Number: 14107223 Zoning: R1 R1 Applicant: FERGUSON, LEW ISSUED BY: Address: 4091 E LA PALMA /Or dr SUITED Phone: (714)630-5543 ANAHEIM,CA Zip: 92807 Owner CARLES, DONALD M TR Address 3106 YELLOWSTONE DR Phone: COSTA MESA,CA Zip: 92626 Contractor: MC CORMACK ROOFING Address: 4091 E LA PALMA . SUITED Phone: (714)630-5543 ANAHEIM,CA _ Zip: 92807 License: 643700 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE:T/0 EXISTING COMP ROOF,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER 30#FELT, APPLY"OWENS CORNING 30-YEAR COMP ROOF.”2200 SO FT ' FEE SUMMARY Plan Check: $0.00Calc Valuation: $3,700.00 Permit: $97.25 Claim Valuation: $3,700.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 -Total: $97.75 - , PLANNING & ZONING ' SETBACKS . MAIN STRUCTURE Front 0-0 Rear 0-0 Left, 0-0 Right 0-0. ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 • .Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) . DECLARATIONS - } - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers compensation,as provided for by section 3700 of the Labor Code,for the performance of the /fork for which this permit is Issued. 2." I lave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is i<aled. My workms'compensation Insurance card andLpp1 Iic�y�number are: Carrier: `) Kir/Aoc4I72NCE O '!' "etch C 2 bG Policy Number: wco?O/0 r,10$ocoo/ (This section need not be 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 Ca ia,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 pr v' s. Applicant Signature. Date: 19/2.910 0 T WARNING:FAILURE T SECURE WORKERS'COMPENSATI ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOUARE(S100A100),IN ADDITION TO THE 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 I am licensed under provisions 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.Lk.4 `) q370-0 Class q (/ '3 9 B' Contractors Signature: �s.:e 7 �.....o--� Date: '/ 09/23/0 y CONSTRUCTION LENDING AGENCY: �7 ❑ 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: 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 properly,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.). ' ❑ 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. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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(38)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 Califomia 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 reponed 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). .� _.. _ ac _...— .... .. .__ 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 materiels)? ❑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? 0 Yes ❑No esu_..._uildii____._occupant ___ _ _ _ ._..._ _orilding occuorwillorQualityManagementanythedistrictis from the South Coast Air Dlsirki or from other air pollution control or agency? �Yes LJ No (Section 65850.2 of the California Govemment 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_..._ .__p._ quire..._..— _— 7 If a permit tram the South Coast s Quality Management CaliforniaHeat or nd epo eion control district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Callloia 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. atu - Of Legal Owner(s) ate f �. _ 0 9/a—V; An.:ar Auth• _.Applicant Dat CODEC INSPECTION TYPE RATE INIIDAL$ ROOF( INSPECTIONTYPE Qd7E IMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final I 208 Final Plumbing 200 Final Re-Roof U"30 0M ►i ft t 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 RECEIVED • JAN 1 01961 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN COMPLETELY APPLICATIONC1T FOR�PETRMITSA TYPE OR PRINT BUILDING BUILDING 3106 YELLOWSTONE DRIVE ADDRESS /COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY f RECEIPT NO. �5 g�Q� OWNER KWK CONSTRUCTION CO., INC. I I �]I 0J MAIL RECEI ED BY DATE RECEIVED/ 1 DATE ISSUED ADDRESS 1555 PLA CENT IA AVENUE / .r�.�6/1 JHN j j 1961 I /I CITY NEWPORT BEACH CALIF 7G,10-32272BUILDING2� ADDRESS I ARCHITECT LIC. COSTA MESA, CALIFORNIA OR ENGINEER NO. /�-- FIRE ///1 T� ( ADDRESS ZONE TYPE 1/ GROUP ry / `/iJll 1 CONTRACTOR K. W. KOLL LSTATE APPROVED BY NO.61195 BY DATE 1555 PLA CENT IA NEWPORT BEACH ZONING ADDRESS II 1, ( •--''�F raw. LEGAL LOT 4041 ZONE NO.OF USE OF NEW5IUIS' him. DESCRIPTION NO. 20 BLOCF( I TRACT R-1 I PLANS 2 I BUILDINGW/ 814 gar. A.P.NO. nnne BY PROVED W.L.D. G DATE 1_6-Y6Y1 SIZE 60x100 NO.OF SLOGS.O REQUIRED O/2EEVES VESWED OF LOT NOW ON LOT USE OF (CENTER LINE ST.) //�� EXISTING BLDG. FRONT ii,L, FT. DR) 33 SETBACK LINE FROM I I ii,L, CENTER OF STREET I+5 REAR YARD 3o R.SIDE `J FT. IN. SIDE YARD (LEFT S i i(RIGHT 5 L.SIDE .0 FT. IN. DESCRIPTION OP WORK �-(F 1) REAR 1 FT. IN. NEW X ALTERATION II ADDITION • REPAIR I II MOVING I II DEMOLISH I SIZBUIEDING t3z0SF ROOMS NO.OF 6 STORIES 1 ¢ I EXTERIOR WALL.., ROOF ASPHALT '/O COVERING J TUCCCOICOV�gRINGSH -dINGLFS /— USE OF BUILDING AND WORK TO BE PERFORMED SINGLE FAMILY RESIDENCE AND ATTACHED GARAGE PLAN No . 1—B I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE COM- PLY WITH ALL CITY ORD/NA ES AND STATE WS Rae R ATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY, BUILDING ALLCONSTRUC'ON. / i • VALUATION SIGNATURE OF PERMIT FEE $ g�--- PERMITTEE �� - - .1- .../ / 7��, JJJJ / / 7 PLAN CHECK $ / E $ / AUTHORIZED AGENT TOTAL FEE s, Q�2 N $ Q