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HomeMy WebLinkAbout3158 YELLOWSTONE DR - Building Permits fie CITY OF COSTA MESA • don it% BUILDING DIVISION r IAI� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.0 7". 1111,4 . FOR INSPECTIONS CALL: (714)754-5626 fos PERMIT NUMBER E07-00949 PERMIT TYPE ELEC STATUS: ISSUED APN: 14153112 DATE ISSUED: 12/19/2007 ISSUED BY: RMD JOB ADDRESS: 3158 YELLOWSTONE DR CM Suite/Unit: Vicinity: GARAGE SCOPE OF WORK: 2 ELECTRICAL OUTLETS IN GARAGE. C07-02245 OWNER: REVELY, MARGARET L Address: 34 HARDING DR Unit: PHONE: 914-255-7888 City/State/Zip: RYE, NY APPLICANT: GONZALEZ,ANTONIO Address: Unit: PHONE: 949-903-4516 City/State/zZip: . CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State: ZipCode: CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $25.70 Reinspection Fee $0.00 TOTAL FEES $25.70 • 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE S. INSPECTION TYPE DATE INTI11ALS CODES INSPECTION TYPE DATE INnnIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /� 200 Final Re-Roof 210 Final Electrical d/4/c F �'/U 201 Final Block/Retaining Wall 212 Final Fire Prevention P 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy aWORKERS'COMPENSATION DECLARATION. Owner ID verified by drip. Dict. _ es ❑Nd • I hereby affirm under penalty of perjury one of the following declarations: Driver's License No.' / , Expires: El have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure.scaffolding,fafsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed Sthe permit a valued al one hundred dollars($100)or less.) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless jissu d,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I p hwith comply with these provisions. 12-/i I V 7 Division of Industrial Safety Permit Number: Applicant's signature, Date \.._._._---- > HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to rife and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No Lic.7t Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ElYes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). : --(,-as-owner of the property, or my employees with wages as their sole 7, If a permit from the South Coast Air Quality Management District or other Vcom—pensatiori, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date properly who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contactors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that 1 have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 J authorized by this permit until final inspection. I 7-)14//07 r "r1 of Legal Ovmer(s) !Date SL9�ature - s Date`-_ , /Z// /707 305146(3/07) And/or Authorized Applicant L—Date-- 12/12/2007 21: 36 9143054961 BRAND PAGE 01 • • . j DECLARATION OF AUTHORITY Bldg,Permit a ' • FOR AGENTS OF PROPERTY OWNER This PermttV TO APPLY FOR PERMITS • trout Address: _31 TS yatl.>#4 S4wL Or„rt_ AP Numoer: _ -- 1. (we), CnA ���\ $rry.rd ____, declare that I am me Owner of Title of the Move tfarented real pi operty.and that I (we)hereby authortte: lame: A-4.,o (•esn a®\r'7_ _ Telephone Number. C' '\) (83 t Iso 0 ,T itreetAddresa: _ 35-= E. ter, Oh tnl 11y: C a r\ 'fl, ____ Stets: Ca 21p: C 2628 a obtain permits n my bona.as owner/builder,for r _ it the above riga enced property. 2. ihould any pen m become an employee engaged in the improvement of the property, I (we)shall immediately provide Workers )onlpensabon In:uranco coverage and caute a certificate of that coverage to be filed with the Building Division of the City of Costa Ana,as require.I by State of California laws. 3, >s owner/builde in fact, I understand and accept that my reeponsibilaiee do not transfer to any other person. company or ;orporeaon. 4. agree to Indemi iffy and hold the City of Costa Mese and its employees or officers harmleaa from any claim resulting in damage or mrsonal injury s: myself or any other parties as a resue of worm authorized by the permits from the City of Costs Mesa. 5. declare under tie penalty or penury that trio foregoing Is true and correct. Executed this—, day of Qt.L. _ 20 O-7 ,al (yes V a (yrs c- _,California, came: �1(DX `se: ;o-c � ,-c.-e-o� mar \ C-77) G I 01 Note: This authorlzseon does not grant su*onzeton to perform the roam as wmer it solely provides for limited power of attorney to inane this perms m any behalf. ON-46(IN r+KKIf Barr 89LfzaetTL ty:t L0:41 Loaz:sr/tT CITY OF COSTA MESA o .F BUILDING DIVISION FY , �( = 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • FOR INSPECTIONS CALL: (714)754-5626 ckiviimsu PERMIT NUMBER. P07-00619 • PERMIT TYPE PLUM STATUS: ISSUED APN: 14153112 DATE ISSUED: 12/1912007 ISSUED BY: RMD JOB ADDRESS: 3158 YELLOWSTONE DR CM Suite/Unit: Vicinity: GARAGE . SCOPE OF WORK: 1 GAS FOR DRYER IN GARAGE. REF#: C07-2245 OWNER: REVELY,MARGARET L Address: 34 HARDING DR PHONE: 914-255-7888 City/State/Zip: RYE,NY APPLICANT: GONZALEZ,ANTONIO Address: PHONE: 949-903-4516 City/State/zZip: CONTRACTOR: OWNER-BUILDER License No. 000000 Address: PHONE: City/State: ZipCode: CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $29.65 TOTAL FEES: $29.65 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE r/ INSPECTION TYPE DATE INIITIALS CODE I INSPECTION TYPE DATE INPTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �.�.,n /^/ ry 1266 Pool Spa Final 208 Final Plumbing:/'..Y „V p2/ ./o 200 Final Re-Roof 210 Final Electrical www"`��� xKKK !! 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive .ca..__. Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's.License No. £' Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' r t�- Verifiwtion of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Cartier: or dismantling thereof,will be more than thirty-sic(36)feet high.(Chap.3.2,Grp (This section need not 0e mnpleted s'the perm4 is valued at one hundred dollars(5100)or less) 2.Art 2,Sec 341.Title 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑—('certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless 'ISSued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. 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 Cod hall forthwith comply with these provisio75. Applicant's Signature Date Z/ /y/.3. Division of Industrial Safety Permit Number: Applicant's Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fcc non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). /aL. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compe ation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and IDI, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and slate that am exempt under sec. the information given is correct. I agree to comply with all state laws and city Iordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. _ ? ��'1/� '�-7 Own ( 1 Date Signature_ , L.� Dalelll , _ _ // Z c/ 3057-4613/07) / 'And/or Authorized Applicant , Dale r 'Lot 2 Tr. 3500 FEE RECEIVED 14461 ' MAI 1719e COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT 1' ' BUILDING BUILDING ADDRESS 3158 Yellowstone Drive COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. I lPPJIMITbOl K OWNER K W Construction Co. . Inc. 1t �-']]1I�'CC jj��pp(('' MAIL RECVED BY DATETERECEIVED DATE IS/SUED ADDRESS 1555 Plaacenti a_AOo I `) '//-L'� I -/!f-,&/ TEL. BUILDING CITY Newport Beach NO. M1 6-322-)ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. /� ADDRE`S ZONEFIREV ' he 9- TYPE " GROUP�L.\ -`//;/Q CONTRACTOR K.W. Koll YPROVED BY DATE ADDRESS 1555 Plat-en-tin ZONING sing. Yam. ZONE NO.OF USE OF NEW/ CITY Ne ..-port Beach R-1 PLANS 2 BUILDING w att gar. STATE TEL. LEGAL LIC.NO, 61195 NO. 71 6 DESCRIPTION // V ` �y 3_.a7 Lot 2, Tract 3500 OF LOT �4. /4 / //'5i 8 d/I NOW Ox LOTS A.P.NO. none USE OF YARDS EVES EXISTING BLDG. None APPROVED ALLOWED SETBACK LING PROM ?^J/ (CENTER LINE BTA /l CENTER OF STREET t4549REAR YARD ✓J FRONT `TFT. IN. SIDE YARD I LEFT .. I RIGHT R.SIDE FT. IN. DESCRIPTION OF WORK • X I L.SIDE •J2 FT. IN. NEW I X II ALTERATION I I ADDITION I REAR 33 FT. IN. , REPAIR I II MOVING I II DEMOLISH I APPROVED BYW. L. D. DATE 5-16-61 BUILDING,''11^^q NO. OF rlb SIZE N7' sQ.ft. ROOMS 6 STORIES 1 EXTERIOR WALLIjtUCCO I ROOF Wood shingle A / COVERING COVERING �^ y 505 l)a / TO USE OF BUILDING AND WORK TO BE PERFORMED C _ I;NGLE FAMILY RESIDENCE /� ATTATCHED GARAGE / Plan No. 2-CR --- - 2 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE OF � ,s___,' JJ all PERMIT FEE $ •3 N PERMITTE a - - a $ f(0 , )( PLAN CHECK $ �� AUTHORIZED AGENT / F 0 LW— / �C' TOTAL FEE $ / I.