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Home My WebLink About1925 LANAI DR - Building Permits - ,. , r /600 MFS 4 ?: CITY OF COSTA MESA F iJ -I A BUILDING DIVISION PE NUMBER`+ z� DEVELOPMENT SERVICES DEPARTMENT PERMIT • 00-00828 4`4;;; rf0't (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1925 LANAI DR Status: ISSUED Suite: Applied: 06/07/2000 Vicinity: HOUSE&ATTACHED GARAGE Issued: 06/07/2000 Parcel Number: 13951404 Zoning: R1 R1 Applicant: GROSEK, GEORGE ISSUED BY: r2/ Address: 1925 LANAI DR I Phone: (714)735-1187 COSTA MESA,CA Zip: 92626 Owner: GROSEK, FRANTISEK Address 31200 LANDOW BLVD CATHEDRAL CITY, CA Phone: UNIT 2806 Zip: 92234 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : , Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 2-STORY SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(29 SQ).TEAR OFF EXISTING WOOD SHAKES& INSTALL 1/2"OSB SHEATHING. INSTALL 1 LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH 40 YEAR "PRESIDENTIAL"FIBERGLASS COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,000.00 Permit: $139.25 Claim Valuation: $7,000.00 SMIP Res: $0.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.95 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 NOTES: 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 . . 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: Carrier: • Policy Number: (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 Califomia,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 AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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.Lic.a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O 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 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).): O 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 _ o If self 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 old 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 ap•ly 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 a ::- -'-. 1 Business and Professions Code for this reason: _ / Signa •� (Expires: 7:754..0/ / Verification of Ownership by(type of document,i.e.-properly tax bill or deed): r 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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 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 wfeet of compressed gas at standard temperature and pressure). ._.--.- ...l...- _—_ — -_ 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 Califomia 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). ..-- ......_ .. .cant 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program materials)? 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? ❑Yes 0 No occupa._t.requreor..t... wor the subject 5 Does or will the applicant or present a future building occupant at other for the work which isi the r this L estion a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). yt.... permit be within ___ _..__._.... 6 Will any part of the facility to be constructed under this permit be wi1000 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 11 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? ❑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 0:---'•-Y:I certify under penalty of perjury that I have read this application and slate that the information given is correct.I agree to comply with all staleJaws and city ordi - relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d: ... . •. .•• spection pu osesT gree no • cupy or allow occupancy of any building authorized by this permit until final inspection. . "9 - Co Signature Of Legal Owner(s) ____}V— Date —�_ 3- /9-r-o/ And/Or Authorized Applicant Date CODE Y. INSPECTION TYPE DATE INTRIALS CODES INSPECTION TYPE DRTE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /'� 208 Final Plumbing 200 Final Re-Roof !(/-06- !4 co � 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 2446-46 Lot 12 - Tract 6384 P1 3-B 11 : -� 2l 1 88 MY 25-67PAID, 0014011* ***1147.00 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.0. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDRESS J925 Lanai Drive C.H. • COSTA MESA. CALIFORNIA For Office Use Only I RECEIPT NO. PERMIT NO. owNERClub House Road Joint Venturi T? � I„lnpC MAIL Re I - Y °`�-,2,2 tECEIVED ✓D/7E I2 2- 7 ADDRESS 2850. Mesa Verde Drive y n � CITY Cost a Mesa No549-039 BUILDING ADDRESS OR ENGINEER E.G.Kaltenbach M7547-804,0 COSTA MESA. CALIFORNIA' -{/ J]% ADDRESS1823 E. 17th St , Santa Ana ZONE { TYPE /ALGROUP V CONTRACTOR Republic Homes Corp. APPROVED BY DATE ADDRESS 2850 Mesa Verde Drive ZONING ,,A CLj-n,- ZONE ys _ I NO.OF USE OF NEW I"'( CL•41: CITY Costa Mesa, California .1J l�f'P�LANS .),......--1 IBUIL°IN° 6. .5 STATE 197838 No; 549-0395 — DESCRIPTION Imo/' i �-, '7-- p [.1Q ✓I� T' LIC.NO. ll// �'SIZEl OF LOT 60 x 100 I I NO. OF BLOTS. • NOW ON LOT A.P NO. USE OF _ YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM I , (CENTER LINE SET.) (�y,y CENTER OF STREET 46 REAR YARD 2" FRONT L/- trliffe FT. IN. SIDE YARD I LEFT 5 I I RIGHT 5 I R.SIDE 11 `� FT. IN. DESCRIPTION OF WORK L.SIDE ST. IN. • NEW I XII ALTERATION I II ADDITION I REAR ' FT. IN. REPAIR I LOVING I II DEMOLISH I APPROVEDhi. ` (, BY I•{f•, ., S . ATE C -II-4 NO. OFBBIZE G2478 sq . ft ROOMS 9 STORIES 2 �r/� EXTERIOR WAI,L,WoOd& I ROOF COVERING Ll tuC Co COVERING Wood USE OF BUILDING AND WORK TO BE PERFORMED & ;/ .j yy/ 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 TO COM- PURPOSE OF, ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CI ORDINANCES AND STATE WS REGUNO BUILDING CONS r 0 . / / VALUATION C SIGNATURE 0- , I • i PERMIT FEE $ 5.2"- PERMITTEE E� 'f/ o ,y\/J,(/'A //q / / $ 3.a / (/!1� PLAN CHECK $ /7- `K AUTHORIZED AGENT(^"" / / TOTAL FEE $/V f-� � 1,9 / 4' 28489 . PAID 23-6CfOO1295 d*****5.00 et. COSTA MESA BUILDING-SAFETY DEPARTMENT CRSA P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262E - For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING /9„, ch AR AUg J ADDRESS � - - RECEIPT NO. PERMLT.NO COSTA MESA, CALIFORNIA OqL f 5/ / / �// ,,1 ( R!C[I Oil DA�T� B,C�Vjp/ O/ DA ISSUED Ij OWNER N N T. V 96d)bc) / rcam[,✓✓<< (PJ 2 - ... MAIL /� Bu ILDING ADDRESS/n}I q��/y 039/ ADDRESS /, J/�j,/ FIRE CITY C..�.`'�J79 •�/tsa TEL ZONE TYPE JP' GROUP // ARCHITECT TEL APPROVED // DATE OR ENGINEER NO. BY ZONING ADDRESS -- Z N! I NO.OI US[OP NEW , ®�AD Qy FLANS 1�ISUILDINO CONTRACTOR \ D ADDRESS DESCRIPTION Low T�/,0-- I -(/ A.P.NO. CITY _ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL 30•TO SIDE a REAR p.L LIC.NO. NQ. EAVES SIZE I NO.OF BLDGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT USE OR YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) -- OUTBACK LINE PROM FRONT PT. PT. CENTER OP STREET REAR TARP SIDE YARN I LEFT RIGHT R.SIDE PT. DESCRIPTION OF WORK L.SIDE rr. 0 rr. ^xALTERATION ADDITION— ` REAR PT. FT. NEW DISTANCE BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING NO.OP VAR•# DATE / SIZE ROOMS STORIES C.U.P•# • o��///J APPROVED >3,4-7 ) �'Q EXTERIOR WALL I ROOF COVERING APPROVED Li"�)/✓' �{ DAT Y 7 (J 0 COVERING �L me/OF U.�I,L//DI{�//G Atjq pR 8Rq IS `IL 9 me/ p/ (i/.) /(�5'A//`AI/ �1d`OD--`//i%/d' _ 3 L�'j/ ,/ SQ.PT. 2 I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. I PLY WITH ALL • • - . AND STATE LAWS 'GULATING A BUILDING C• • UCTION.- �� VALUATION 01 SIGNATUR- • — q"1• *l^ PERMIT FEE PERMITTED ` 1 L S • ! PLAN CHECK S 9Oi AUTHORIZED AGENT ��, <; . ; x. •>-s,.= z.,e, TOTAL FEE s