HomeMy WebLinkAbout178 THE MASTERS CIR - Building Permits ;1 .\ t ,
CITY OF COSTA MESA
ICAll 9 BUILDING DIVISION
>, ,,,,• .fir DEVELOPMENT SERVICES DEPARTMENT PER UMBER
F 1 i� t PERMIT
�, te: B01-00583
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SR,4�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 178 THE MASTERS CI BU
Status: ISSUED
Suite: Applied: 04/30/2001
Vicinity: RESIDENCE 8 ATTACHED GARAGE Issued: 04/30/2001
Parcel Number: 11939120 Zoning:
Applicant: GABRIEL, LOUIS ISSUED BY:
Address: 28241 CROWN VALLEY PKWY
UNIT F293 Phone: 949-3637932
LAGUNA NIGUEL,CA Zip: 92677
Owner: MARTENS, SABINE TR
Address 178 THE MASTERS CIR
Phone:
COSTA MESA,CA Zip: 92627
Contractor: L T G CONSTRUCTION
Address: 28241 CROWN VALLEY PKWY
UNIT F293 Phone: 949-3637932
LACUNA NIGUEL,CA
Zip: 92677 License: 703302
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF 8 INSTALLATION OF 2(2'X 2')VELUX SKYLIGH1RNER-216). .
REROOF PITCHED ROOF(19 SQUARES):T/O EXISTING ROOF,REPAIR SHTG AS NEEDED,FELT PER MFGR SPECS,
APPLY 30-YEAR COMP SHINGLES.
FLAT ROOF(10 SQUARES):T/O,CAP ROOF
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: 55,000.00
Permit: $111.25 Claim Valuation: $5,000.00
SMIP Res: $0.50
SMIP Corn: $0.00 , _
Other: $0.00 .
Inspection: $0.00 •-
Total:, $111.75
- PLANNING & ZONING • /
SETBACKS .
MAIN STRUCTURE Front 0:0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-a - 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
2440-46(0/00)
WORKERS'COMPENSATION DECLARATIO...
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
It
work for which this permit is issued.
IIS/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 o the work for which t s permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomi a agre at if I s uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisio
Applicant Signature: n Dato: '�V- a
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 ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under pr. sioi f Cha•er 9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license Is in full
force and effect.Lic.a Class 4
Contractor's Signature: /�Ar Date: 4V-70 - D /
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 em 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 fore 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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 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? ❑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,ore 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 ❑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 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? ❑Yes ❑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_aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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? ❑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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
•
'.natu; •t Tal Owner(s) Date
And/err • orized Applicant Date
CODE:# INSPECTION TYPE RATE INTmALS LODES INSPECTION TYPE PALE INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final C' L208 Final Plumbing
200 Final Re-Roof / DL 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
31408 PAID
FEF/ 20-7000 600* ***13350
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX .1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECE FtD a DATE RECEIVED DATE ISSUED
BUILDING t� �` •��•- / O
ADDRESS 178 The Masters Circle ea-6,20: 70
OWNER United Savings 8 Loan Assoc. A.P•N , •E• I (
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MAIL BUILDING n ‘7214,A42:2 /�((��/,,����
ADDRESS 9800 S. Sepulveda Blvd. ADDRESS J / l.N ^"u^�
110 CITY NOLU iii . 670-7550 TRACT r $� �J LOT 30 BLOCK
I- Z Los Angeles, Calif. 69
Z 'C CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH
OO. m LENDER Owner
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-1 to OWNEEn' �(LIIIV'. Y/✓
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JQ OR ENGINEER R.J . MaryIck N•CO ARCHITECT O. 839-3840
USE '�� .vl �'f $.2 Ai 3),
5 Lf) FIRE
WCL ADDRESS 1538 N. Century, Santa Ana ZONE TTYPE` GROUP'�T J'
CL ty APPROVED ,.0 -�O' /y'
W Z CONTRACTOR Ryness-Smith Co. BY CCCJ//••• 'DATE / " U
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J¢ ADDRESS 140 E. Industry Ave. ,. �
W wTEL. ZONE NO.OF USE OF NEW
1- CITY La Habra, Calif. NO. 879-31 1 1 r-a d 4 ( PLANS BUILDING . -�v
0 STATE CITY YARDS APPROVED YARDS APPR VED- J•
ttnn CC LIC. NO. 167538 LIC.NO. 1964 MAIN BUILDING ACCESSORY B ILDING
D O (FROM C/L STREET)
SIZE NO.OF BLOCS.
OF LOT 46 x 103 NOW ON LOT O aLRONT FT. IJ FT.
USE OF
EXISTING BLDG. - R.sloe 2 FL FT.
I- SIZE OF NO.OF /J
Z NEW BLDG. 1580 ROOMS 5 STORIES 1 L.SIDE / Fr FT. /-
Q EXTERIOR WALLROOF
C3 COVERING STUCCO COVERING Cedar SM ng le! REAR /V FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED
a DISTANCE BET. BET.MAIN&
0- MAIN BLOCS. ACCESS.BLOCS. _` 9
Q VAR.# 14-1,..--/ DATE / _6
O Single family dwelling d two car C.U.P.# &- In(v APPROVED j �'j( -6y
z attached garage _BY ROVED W V l� DATE r_/f i /70
0 Lot 30 Plan 2-CR WW 1 t'llV
U1 hereby acknowledge that I have reed this application and state �V�YV'
that the above information is correct and agree to comply with
cr all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
to the State of California. / fes/ / lo
.ry m
ZI hereby certify that I am properly licensed as a contractor under J i��(750. FT. o 04 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UN VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State of California Business VALUATION 6 Ci 3`'.
and Professions C••• Division 3,Chapter 9. �j Jz N
PERMIT FEE S is
Signature of - / 6 [ m
Permittee - / 15 p-y PLAN CHECKS 1 w J-D E
Authorized Agent ` - .....
."--2-2,-,clAC C123/.) 231, J33 sem ' s
TOTAL FEE 5 a