HomeMy WebLinkAbout3097 KLONDIKE AVE - 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: 3097 KLONDIKE AV
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 41806303
Applicant: NGUYEN, CUONG
Address: 14351 EUCLID ST #E
GARDEN GROVE, CA
Owner: REGALA, FLORENIO P
Address 3097 KLONDIKE AVE
COSTA MESA, CA
Zoning: R1 R1
Phone: (714)545-6994
Zip: 92843
Phone:
Zip: 92626
Contractor: VILLA ROOFING PROFESSIONALS INC
Address: 14351 EUCLID ST #E
Arch :
Address:
Phone: (714) 545-6994
GARDEN GROVE, CA
Zip: 92843 License: 758361
Phone:
Eng:
Address:
ISSUED BY:
Status:
ISSUED
Applied:
09/16/2002
Issued:
09/16/2002
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: T/O EXISTING WOOD SHAKE, 7/16" OSB 2 LAYERS 30# FELT APPLY "DURALITE VILLA TILES" AT
5.8
PSF. ICBG#2656
21SQUARES
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) 7545626
244646 (600)
FEESUMMARY
Plan Check:
$0.00
Calc Valuation: 86,900.00
Permit:
$139.25
Claim Valuation: 86,900.00
SMIP Res:
$0.69
SMTP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$139.94
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
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) 7545626
244646 (600)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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' ccoompponscat�ion In%prance riser and policy number are: /' —7 �7
Carrier: ST/f—/�— T�Ci(� Policy Number: Z(�7 2 / iG fCJ Q�
. (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. Date
Applicant Signature: - : 9 �/ �(G 1�9A
WARNING: FAILURE TO SECURE WORKE P NSXTION-CO ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTtESAND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), INA FQWTO E CAST OF MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby alfimn that I am licensed under pr visions 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. It Class #
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affimn 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 Ucense 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 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.).
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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, falsawork, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code).
❑ As owner-bulkier, 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: Data:
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? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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 tomo for acutely hazardous materials? ❑ Yes ❑ 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).
........................................................ .... ............ _._._................................................ ................................. ..._... _............. ..._..................... _............... ................. ............. _.................................... _.......
3 Does or will the appplicant 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 II en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................................._................................ .................._............... __.................... _.._.................. _.......................................................................... ............._._........ ........................................................ .... _......... .... _................ I......... _..................
5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication aZprmit for such construction or modification
from the South Coast Air Qualify Management District or from any other air pollution Control district or agency? UYes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..._..............._........_............._...................._..........................................._......................................................................................................................................_..._................. ....._..............._...................._........................................_...
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.
............__............. __........ _..............._..........._.._.......
.................._.........................................._..............___..................._..........................................__............................................................................................_......................._....
7 If a permi....t 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? ❑ Yes ❑ No
...6......(Ii yes'. attachconificate of Compliance from the appropriate air pollution Control officer)............................... I ..................................... . ...................................... . ............................ . ............ ........... - ............. . . .......
fficer)..............................................-........................................._............................_........................................._.......
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: 1 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 pro�pe or Inspection puyoses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
�alyOwner(s)i _Date
An Or Aulhodzed Applicant Date
CODE f. INSPECTION TYPE gSTE INTITIA4 CODE INSPECTION TYPE 2&U 1NTITIA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � +p—�r� 208 Final Plumbing
200 Final Re-Roof -fr lfC�'[[L� 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 1222 Final Site
204 Final Demolition 250 Final Building/Occupancy
:I* OF STA MESA
CALIFORNIA 92626 P.O. Box 1200
FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY
Project Address 30V K001111t AV15
Project Nacre ? �-T((D W VEIL
Owners Name FLDR-r j (o P. (fes r AL A
Owners Address 3 047 7 I <W N D Icc-
Owners Telephone 1 tf - 33 1 1
Permit
Type
City Use Only
I rtog&(O P, g-<e*1 L A -Owner (strike out all
except one) do hereby attest that nt of any person, or persons, is not
anticipated at the time of seeking the above -referenced permit. In the event that
any person, or persons, are employed under the provisions of this permit, I shall
immediately cause a valid Certificate of Workmen Compensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my own cost, and to indemnify and hold harmless, the City,
its officers, agents and/or employees, from and against, any and all liability,
damage, costs, losses, claims and expenses, howsoever caused, resulting directly
or indirectly from, or connected with the improvement under this permit.
I further state that I have read and fully understand the implications and re-
sponsibilities of the above statements, and will comply with all provisions of the
Contractors State License Law found under the Business and Professions Code,
Division 3, Chapter 9, of the State of California.
Ltoko P.
Print Name
V
f - k4
Signature
CMF 0777.46
15
Date
a
WILLIAMS INSULATION COMPANY
OF CALIFORNIA
1201 E. Hunter Ave., Santa Ana, California 92705
(714) 547-5148
THERMAL INSULATION;CERTIFICATION
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITI
CURRENT ENERGY REGULATIONS, CALIFORNIA 'ADMINISTRATIVE CODE, TITLE 24 STATI
OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Tract Name:
Lot No.
/� Tract No. Block No
Street "S �� / ( City
- r •
EXTERIOR WALLS:
Other
Mfg.
General Contractor
Thickness/Type
California Contractors License No.
Signature
Williams Insulation Co. of California
California Contractors License No. 2675221
Y
R—
Value
Date
Date
Signature Title --
s
JOB COPY -WHITE I p- BUILDING DEPARTMENT -PINK -
GENERAL CONTRACTOR -YELLOW , FILE COPY -GOLD
r �
R—
Mfg. C::mnr,, Corning
Thickness/Type 6°
Value gg
.. Ceilings:
n
' Batts:
R_
Mfg Q!En C,C,rn$na
Thickness/Type - 3`r-
Value -�•
Blown In:
R— '
Mfg.
Thickness/Type
Value-
R—
Sq. Ft. Covered
No. of Bags Used
Value
Floors:
R—
Mfg.
Thickness/Type
Value
Other
Mfg.
General Contractor
Thickness/Type
California Contractors License No.
Signature
Williams Insulation Co. of California
California Contractors License No. 2675221
Y
R—
Value
Date
Date
Signature Title --
s
JOB COPY -WHITE I p- BUILDING DEPARTMENT -PINK -
GENERAL CONTRACTOR -YELLOW , FILE COPY -GOLD
CITY OF COSTA
TRACT NO. 10513
LOT NO. 1
ADDS 3097 Klondike Ade., Costa Mesa, Calif.
MATE: 3-2-8o
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been ompleted and its streets
accepted by the City of Costa Mesa.
By executing this agreement, the undersigned acknowledges that he/she/they
was/were advised that this tract has not been given final inspection nor has
it been accepted by the City of Costa Mesa as having conplied with the conditions
of approval which were inprsed.by the City at the time the Final Tract Map was
approved.
The City assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned unocapleted oondition(s).
BY—
(Signature
Y(Signatre Of Purchaser)
BY a2
(Signature of Developer and/or
authorized representative
RECEIVED
COSTA MESA
DEVELOPMIENTOSERVVICES DEPARTMENT
MAR 5 1980
AM
718iq,; Prl
.-.J,4'516
D
Home Savings and Loan
BY
(Signature of Lender)
s
c
6754 5/13/80 18,50 TL
COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O. 80X,1200 COSTA MESA, CALIFORNIA 92626
RECFTDIW PERMIT ' T�
1�
For Applicant to Fill in Completely — Use Ink Only
30q-7 D KT
A.P. NO.
/�7��/- 0 6 3 —
ADILDINGDRESS i
�7TKt�1.0N jf5vt/�
TO NAROR'Fi—V1�'P • 0,G1.L��H
y-7
ADDRESBUILDINS JcIi7 / KI -01 ,0
UNIT OR
_
MAILING /� 1/
ADDRESS 1, i
SPACE NO.
SPACE
����((I�QLt/N t� ry ('t ] -7
yy3o
CITY l.1/J to IrIGJ/) NOL
LOT
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A
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NEW ADD LTER REPAIR MOVI
CONSTRUCTION
LENDER
BRANCH
OWNER FL,OLLRE')N/D/QE
ADDRESS
aA& �tJ - yALU
ARCHITECT TEL.
USE �(j� LL.•
OR ENGINEER N 0.
))T ,
V
ZONE IR GROUP V
ADDRESS
41TYPE
APPROVED S �a
CONTRACTOR
ByDATE 8(�
ADDRESS
TEL.
CITY NO.
STATE CITY
APPROVED SETBACKS
LIC. NO. LIC. NO.
SIZE NO. OF BLDCS.
(FROM C/L STR ET)
OF LOT NOW ON LOT
FRONT
USE OF
EXISTING BLDG.
0 FT. 0
Separate permits are required for
L. SIDE 16 T. i
047,2.20 3333 2%13/79 )1I7 a TL
COSTA MESA BUILDING -SAFETY DEPARTMENT 33332/ 13/.79_ _I
P.O.BOX1260 COSTA MESA, CALIFORNIA 92626 3333 `0000447420 I;A
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING J \
\�n
ADDRESS /V V
PERMIT NO.
- Z
OWNER FoleyConstruction Co. Inc.
A.P. NO.
MAIL
ADDRESS 2101 E. Fourth St. 100
BUILDING
ADORES
TEL.
CITY Santa Arta NO. 543-947
TRACT 10513
LOT 11 BLOCK
CONSTRUCTION
W
ADD
ALT fl
P I M V
X
LENDER
BRANCH
OWNER Foley Construction C.O.r InC.
ADDRESS
�q
W c i ALU$
(�
TEL.
ARCHITECT
OR ENGINEER Hales -Tan stun N 547-086
FIRE
ADDRESS 777 S. Main .St. r #lOSr Oran a
ZONE TYPE GROUP
CONTRACTOR Owner/Developer
APPROVED
BY DATE
ADDRESS Same
TEL.
c...LIc
ZONE pQ
^ (
NO. OF --,
PLANS
USE OF NEW F
BUILDING
�..� NO.
CITY �
vi—
WWII
STATE CITY
Sante
YARDS APPROVED
'YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO.OFBLDGS. O
(FROMC/LSTR)pL
II
K1a I Ve
t\
OF LOT NOW ON LOT
FRONT
FTUSE
OFP
N/A
//tt / /}
I
� la
EXISTING BLDG.
I V V
FT
Separate permits are required for
L. SIDE S FT. O
FT.
461 D
electric, plumbing and heating work.
FEAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS SLOGS.
Development of 41 single-family
VA.+
DATE
C URP.. 46
APPROVED
detached residence units.
APPROV
RY
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
P �
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
^
oC 3 y b!
the State of California.
I hereby certify that I am properly licensed as a contractor under
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION
PERMIT FEE $
and Professions Code, Divislon 3, Cha ar 9.
abo'/
PLAN CHECK $ l
Signature �p�
TAX $
Permittee t�'�r/
,��n
$ 's't'T�
Authorized Agent
TOTAL PAID $ / -•a_7
'� 5735 3!27/79 6'Od
TTuu'
«,.6736 3127/79,_ "22226..uuQ0C_K
IH'6735 0000447420 "' 'IQ
COSTA MESA BUILDING-SAFETYDEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For ABUILDI pplicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
�`1I I,
ADDRESS /A\Ai k� V
PERMIT NO.
OWNER 601
A.P. NO.
MAIL
'1I
BUILDING /� ON
ADDRESS AV
ADDRESS
l/ / (
TEL.
CITU NO.
TRACT LOT BLOCK
CONSTRUCTION
NEW ADD ALTER P M Vndr, DEMOLISH
LENDER
BRANCH
OWNER
ADDRESS
VALUE
ARCHITECT TEL.
$
OR ENGINEER No.
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR
BV DATE
ADDRESS
TEL.
ZONE OF USE OF NEW
CITY NO.
PLANS BUILDING
STATE CITY
YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SIZE NO. OF BLOCS.
OF LOT NOW ON LOT
FRONT FT. FT.
USE OF
EXISTING BLDG.
FT.
FT.
Separate permits are required for
L SIDE FT.
FT.
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
'
MAIN BLDGS.
ACCESS. BLDGS.
VAR. 46
DATE
C.U.P.#
APPROVED
APPROVED
DATE
I hereby acknowledge that I have read this application and state
�n
n
that the aboveinformation is correct and agree to comply with
m
all laws regulating building construction, and I shell not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly. licensed as a contractor under
SQ. FT.
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
m
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
<
antl Professions Code, Division 3, Chapter
VALUATION
PERMIT FEE §
n
PLAN CHECK §
Signature of
o
TAX §
Permittee
§
u.
F
U
TOTAL PAID §
Authorized Agent