HomeMy WebLinkAbout3076 MADISON AVE - Building Permits Til-' CITY OF COSTA MESA
4 BUILDING`DIVISION
F •
f„,, ,5,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER
n • PERMIT
t '5-01782
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesasS ULDING P 77 IR DR ,COSTA MESA,CA 92626
Job Address: 3076 MADISON AV Status: ISSUED
Suite: Applied: 10/05/2005
Vicinity: ROOF Issued: 10/05/2005
Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N
Parcel Number: 14159319 Zoning: R1
Applicant: DAVIES, MARK THOMAS
Address: 3076 MADISON AVE
.Phone: 714-850-1646 ISSUED BY:
COSTA MESA,CA Zip: 92626
Owner: DAVIES, MARK THOMAS
Address 3076 MADISON AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License:' License:
SCOPE OF PERMIT
TEAR OFF EXISTING. INSTALL 1 LAYER OF 30#FELT,50 YEAR COMPOSITION SHINGLES,DIMENSIONAL,AND REPAIR/REPLACE SHEATHING
' AS NEEDED.2,900 S.F.INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,000.00
Permit: $125.25 Claim Valuation: $6,000.00
SMIP Res: $0.60
SMIP Com: $0.00
Other: $0.00
Inspection:. $0.00 . - . . - -.
Total: $125.85
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 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'compensation Insurance carrier and policy number are: '
Cartier. Policy Number:
is section need not be completed/f the permit is valued at one hundred dollars($100)or less.)
1 Iderti Sat 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'
-inpensation 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
com ly wjth,these provisions. L
plicanFSlgnaturer � �/y �-- Mite: 1tS �Q 7
W G:FAILURE TO SECUf1E� ER5'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN 0 GW AUNAL PENALTIES AND CNR.FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Lic.A Class#
Contractor's Signature: Date:
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).
Lender's Name: Lender's 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 end 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
ubjects the applicant to a civil penalty of not more than five hundred dollars($500).):
it hies ewnr of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure is not intended or offered for sale(Sec.
044,-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,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
a ` l erti'exe r.t un er sec. Business and Professions Code for this reason: _
, nature.4-4 _ad' �
Sxpres:_,�/I/l>t n_i
Verification of Ownership by(type of doe, nL 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 than 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 WIII 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 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 time 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).
the
applicant
.r pros....
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 materials)?
❑Yes ❑No
(Section 25534 of the Califomia 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,hos Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes I�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 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia Health and Safety Code Section 42303 been made? 0 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•roperty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/ �� ` ---- t (rte 4-s-.r 0 Li
[Warders 9 LegaLOwnar(s)---- 1 Date
And/Or Authorized Applicant Date
000E/ INSPECTIONTYPE BR INITIALS CODEf INSPECTION TYPE OATS INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ,1� 208 Final Plumbing
200 Final Re-Roof4.— A,I-y 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 —
a 4 e taw 4 taddc4 Da acan
OWNER-BUILDER
wt
VERIFICATION
A city or county, which is required to give notice pursuant to Section 19X30, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the return of, an
owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will he issued until this
verification is received.
•
I. I personally plan to provi e the major labor and materials for construction of the proposed
property improvement. Yes ❑ No
2. 0100 ave not) signed an application for a building permit for
t roposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone ( ) Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
J
1047.46 (REV 99X(
17064 E� �� .tri '
COSTA MESA BUILDING-SAFETY DEPARTMENT MAY i 719691
P. O. BOX 917 COSTA MESA. CALIFORNIA I FI��11}NCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING
BUILDING3� .4,404_,<+. "/.. .ADDESS
COSTA MESA, CALIFORNIA For Office Use Only
R7D
T
} RECEIPT HO. I e4
OWNER Occidental Loan Company II U
AIL RECEIVPD BY DATE RECEIVED ° E 1$ UHD
'
ADDRESS 2.01 Benedict Can on Drive .: �_•7 I M� 3 .1' =762
TEL. r
CITY Beverly Hills NO. CR.-o- ADDRESS 3076 Madison Avenue
y
ARCHITECT TEL. "l "' COSTA MESA. CALIFORNIA
OR ENGINEER NO. t
ADDRESS Z `/ V
ZOO FIRE NE TYPE Y GROUP
CONTRACTOR AJ free A EdP1 Rnhn BYPROVED DATE
ADDRESS 2901 Benedict Canyon Drive . ZONING 2,^,-Mel
CITY Beverly Hills California °" _f IPLA OF
. IBUILDING USE OF E Cy/Q ff4
STATE TEL (�}� �1 1111^^ LEGAL �/
LIC.NO. 1 13c5 No. \,!'I-6-F49 1 DESCRIPTION • 3[ -4 Te_11•
SIZELOT 627C1vas10NO. OF LDGS.
OF O I B
NOW ON LOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. -- APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.) _
CENTER OP STREET 5n t REAR YARD 3] I FRONT S--°
_
FT. IN.
SIDE YARD I LEFT 51 I RIGHT 5' ' R.SIDE 'CT. IN.
DESCRIPTION OF WORK s -
X L.SIDE FT. IN.
NEW I II ALTERATION I II ADDITION I REAR 3 ' FT. 3 / IN.
REPAIR I II MOVING I DEMOLISH I APPROVED - /�"AfR DATE '7//a( C N.
SIZE •
BUI52)04-9
NO. OF 52x14-9 ROOMS 7 STORIES 1 ��/7
EXTERIOR IW?AL At ROOF
COVERING O COVERING I' •• s
USE OF BUILDING AND WORK TO BE PERFORMED
a
/930 47 ,a a at 3.3d a.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UR VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLI ING A PERMIT FEE ONLY.
PLY WITH ALL CHI ORDINANCES AND STATE WS REGULATIN•
BUILDING CONNSSS LICTION. / VALUATION
SIGNATURE IOC / � 411
PERMIT FEE $
PERMITTEF(Yj„GF / � Clid -
/ • 21,024.00 PLAN CHECK $ •21:10
I
AUTHORIZED GENT �l/ IS
TOTAL FEE . !I LL