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Home My WebLink About2811 LORENZO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.r9 ,141LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2811 LORENZO AV Suite: Vicinity: ROOF Status: ISSUED Applied: 10/31/2002 Issued: 10/31/2002 Parcel Number: 14162429 Zoning: Applicant: SKIRZYNSKI, JOHN ISSUED BY: Address: 10782 S MEADS AV Phone: (714)771-0118 ORANGE, CA Zip: 92869 Owner: BERGUM, GARY E Address 2950 MC CLINTOCK WAY Phone: COSTA MESA, CA Zip: 92626-4009 Contractor: SHARP ROOFING Address: 10782 S MEADS AV Phone: (714)771-0118 ORANGE, CA Zip: 92869 License: 571575 Arch : Eng: ., Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 7/16" OSB OVER SPACED SHEATHING. INSTALL ELK, 40 YEAR, COMPOSITION SHINGLES PER SPECS OVER 15# FELT. 3,200 S.F. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,400.00 Permit: $153.25 Claim Valuation: $7,400.00 SMIP Res: $0.74 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $153.99 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<6 (6100) DECLARATIONS WORKERS' GOMPENSATION DECLARATION: I hereby a(firn 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 end will maintain workers' compensation insursnCo, es required by section 3700 of the Labor Coda, for the perlortnance of the work for which this permit Is Issued. >, �A1y work pen�°n Insur ce carrier and policy number ere: q -Carriar�l'� f J ✓1 (� PaidyiNuinber:._�,Z(1S OOO Z� -OZ .(This section need not be completed 11 the permit is valuetl t one huntlred dollars (5/00) or less.) ❑ I certify that In the pertornance o e w 1 Coni this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' Compersetlon laws of Cel' mi d a I become subject to the workers' compensation provisions of Section 3700o the Labor Code, I shelf forthwith comPly.withlhemprovisl n . IAP !ice ignaWre:-� �Da1e: 1 10/3� 0 2 WARNING: FAILURE TO SECURE ERS' COMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTTES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DO"RE ($100,00c, IN ADDITION TO THE OOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Was OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: _I.hereby-affirm that I am licensed under provisions of Ch ter 9 (commencing with Section 7000) of Division 3 of the Business en Profes Ions Code, and my license is in full lorcnland effeot. Lrc�p 7 / ��Class a �'.� _Conbactoes.Slgnature: 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: 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, eller, 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).): ❑ 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 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 live (5) or more feet in depth Into which a person is required to descend, will be made In ConnectIm with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2. Sec. 341, Title B, 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 hes 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 lila 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 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 Doles ar will the applicant or present or future building occupant need to lila a registration form for acutely hazertlous materiels? ❑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, cerlificatlon 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 5 Does or will the applicant or present or future building o require for the work wnlch Is the subject this a plication aPPertnit for such Construction or modification from the South Coast Air Quality Management a Management District or from any other air Pollution Control district or agency? y? Yes U No (Section 66650.2 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 ❑ No (It 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 Celltomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................___..._........................................._......_.._...................___..................................................................................................................._.................__.....................__.........._.._............_ B (If yes', attach certificate of compliance from the appropriate air pollution Contra 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 property for inspection p77's sas. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. S' tore 1 6�1 Owner(s) /o�3i Date c�2<- And/Or Authonzed Applicam—� L Date f CODE I INSPFMON TYPE DA¢ Qi'I1BA4S CODE I INSPECTION TYPE 2M INTRA 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 Slock/Retaining Well 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 2.0221 SO' TO SIDE S REAR P. L. COSTA MESA BUILDING -SAFETY DEPARTMENT R r� E I V C D P.O. BOX 917 COSTA MESA, CALIFORNIA FEE I L22L L {_ �f L U USEOF ��Iqq` 1 5 P,8 ON For Applicant to Fill In Completely VUL F.�pQJ1Rg PERMIT FINANiUILDIN6• TYPE OR PRINT (FROM C/L REET) CI I' fab[OkIRPUPOEgolY G F FIT. S 28 RECe1Pi No. COSTA MESA. CALIFORNIA I] I L/J R.SIDE S PT. .G IJCL 1 SIDS YARDI LEFT I RECIUrY D i CBM¢ _ OAT 6 ISSUED 1//L�( JUL 2 A 19 L. SIDE FT. FT. MAIL 3800 E. Coast Highway SUILDING ADDRESS ADDRESS TEL. Oriole FIRE aYA CITY CoronaDel CalifNO. ZONE TYPE GROUP ARCHITECT TEL 101e APPROVED BY .ATH OR" (NEER 2"IaCN Realty CO - ZONING ADDRESS Same as above ZONE NO. OF UB[OP NEW i C DISTANCE BET. PUNS 2 BUILDING W/ att HE STATE TE SO' TO SIDE S REAR P. L. LIC. NO. NO. EAVES SIZE p I I NO. OF SLOG, I ALLOWED (U. S. C. REQUIREMENT) OF LOT U X NOW ON LOT Non YARDS APPROVED YARDS APPROVED USEOF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. None (FROM C/L REET) SETBACK LINE FROM .ENTER OF STREET I REAR YARD 1 FRONT FT. FIT. I L/J R.SIDE S PT. FT. SIDS YARDI LEFT I RIGHT I DESCRIPTION OF WORK L. SIDE FT. FT. NE' ALTERATION ADDITION REAR FT. FT. —I DISTANCE BET. BET. MAIN B REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS. BLDGS. VAR.* DATE BUILDIN NO. OF SIZE II I II ROOMS STORIES C. U. P. # APPROVED EXTERIOR WALL OCI BPOVDw L. D. 7-22-63R COVEINGOVEaie CRING Y ATE USE OF BUILDING ORKTO BE PERFOR Dwelling 1896 S F garage. Plan 400-A Garage 483 S.F. N 60. FT. ? I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE i AND STATE THAT THE ABOVE 16 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G PLY WITHALL CITY ORDINANCES AND STAT[ LAWS REGULATING VALUATION c0 BUILDING CONSTRUUTION. (06 PERMIT FEE $ SIGNATU RE OF TR `, L, PERMITTER+"14 n E By: � s 20,288.00 G3 g AUTHORIZED A Q TOTAL FEE