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Home My WebLink About2172 MAPLE ST - Building Permits BL .—DING AND SAFETY DIVISruN FIRE DAMAGE INSPECTION REPORT • (Required Prior To Permit Issuance) �7Z rg/e Ltcr /rf e 2/ / Address: Unit: R E4'v 2 t 7� Owner r ✓aZ -5-4C-kit E — gel9• 67 / 2709 Owner's Address (if different from above): Street City State R7 Structural permit required. 0 Repair or replace as necessary. ❑ Plans required. 4 / !— / / / Comments: /1-1 ,17 Q G dtr-«cz ySG 1 liv e, i G��f /`S!` /14f'6 4 /k4 ops' t v, �u /r— a� f�Os.-, t—, 4dU ' me,nt to IF -lv"/ C°o`- - ❑ Electrical permit required. ❑ Repair or replace as necessary. Comments: )W/a. ❑ Plumbing permit required. ❑ Repair or replace as necessary. Comments: // • ❑ Mechanical permit required. ❑ Repair or+replace as necessary; Comments: iv/4H e4 /✓ itc0 c- /2-C7 7/1/— 75 V— CO 7 Inspector Date Phone 1 .46 Triplicate:Original-Owner;Vellow-Contrator; Pink-Building Division •witt CITY OF COSTA MESA qC BUILDING DIVISION >:f ,,;;,-!l a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • 1 ••••••;1101 PERMIT �• t 1E103-00817 4kboaniso(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. �LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2172 MAPLE ST CU Status: ISSUED Suite: Applied: 05/15/2003 Vicinity: Issued: 05/15/2003 Parcel Number: 42220205 Zoning: Applicant: CRUZ, YOLANDA ISSUED BY: Address: 2172 MAPLE ST Phone: 949-631-2709 COSTA MESA,CA Zip: 92627-2515 Owner: CRUZ, OSCAR R Address 2172 MAPLE ST Phone: COSTA MESA,CA Zip: 92627-2515 • Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: . Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPAIR MINOR DAMAGE TO FRAMING,STUCCO AND INTERIOR DRYWALL AT FRONT WINDOW NEXT TO ENTRY DOOR DUE TO VEHICLE DAMAGE. • FEE.SUMMARY Plan Check: $0.00 Calc Valuation: $1,200.00 Permit: $44.85 Claim Valuation: $1,200.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • • Total: $45.35 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'com(,ensation,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: Carrier: Policy Number: (This section need not be completed it 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 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 these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ml EMPLOYER TO CRIMINAL PENALTIES AND OWL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000).N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lk.it Class 0 Contractors 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). 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 ubjec a 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.). ❑ 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License taws.). ❑ I am exempt under sec. Business and Professions Code for this reason: ,lK� Signature: Date: /V Owner ID verified by drivers license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of d nt,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: I 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 California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has et 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? ❑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 lime 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 and 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 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 0 No 5 Does or will the applicant or present or future building oaupant require for the work which is the subject of this application a_oermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 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 pert 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 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 and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ei34/3 ignature Of Legal Owner(s) Date And/Or Authorized Applicant Date BODE I INSPECTION TYPE PAIL MOM NDOE I! INSPECTION TYPE BATE MALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 Slte }z 204 Final Demolition 250 Final Building/Occupancy a" -03 BUi_JING AND SAFETY DIVISIL.N • , FIRE DAMAGE INSPECTION REPORT Ve� rG • -7 (Required Prior To Permit Issuance) / -7 L� Y 0 -4 Address: 2/ / /e Unit: Reor Of 2 ( 70 Owner: C r ti Z , l a c kr e- — 671 2 7 0 9 Owner's Address (if different from above): ete— Street 2A }Vr • . City., \ State Et Structural permit required. ' I. - f' 4 _+ Repair or replace as necessary. I" 0 NC ❑ Plans required. / / / Comments: ell a L d€ t- -4 kO 47e2 L r !=-S�' /0( .5-4 /14Ikefrapr.—�J ta)ry r.�,u7( cr� f` i td 14e 10 h'f'!/- Or-CV"' I ❑ Electrical permit required. ❑ Repair or replace as necessary. e I Comments: A/7/1- 0 Plumbing permit required. ❑ Repair or replace as necessary. Comments: W/14 ❑ Mechanical permit required. ❑ Repair or replace as necessary. Comments: IV/4 Inspector Date Phone 1872-48 triplicate:Original-Owner;Yellow.Contrator; Pink-Building Division !LIAZ- ; 9 OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, 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 be issued until this verification is received. I. I personally plan to pro ide ajor labor and materials for construction of the proposed property improvem:'rr5 Yes ❑ No 2. I (have/have not) signed an application for a building permit for the proposed 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 104246 (REV.9198) • I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the'above information to the best of my personal knowledge, in compliance with this State law. Signed: .2 �ni/3_, Date: 57/5-11.3 Name: ✓D 4297 . .. an.' 2 / (Printed or Typed) C.D.L. #OR S.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. • 104246 (REV.998)