HomeMy WebLinkAbout196 THE MASTERS CIR - Building PermitsCITY OF COSTA MESA
O`1AMFSy BUILDING DIVISION
4
> 0 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.aov::, :. •�,;;;:,.,y:
FOR INSPECTIONS CALL (714) 754-5626 ------ - --------
PERMIT NUMBER: BX12-00056
PERMIT TYPE B_MISC STATUS: APPLIED
APN: 11939124 DATE ISSUED:
Zoning: ISSUED BY: MDM
JOB ADDRESS: 196 THE MASTERS Cl CM Suite/Unit:
Vicinity: Primary Occ: Const Type :??
SQ. FT: 0 Valuation: $0.00
SCOPE OF WORK:
INSTALLATION OF A 6.240 KW ROOF MOUNTED PHOTOVOLTAIC SYSTEM WITH 26 PANELS; 1 INVERTER, DISCONNECTS,
MISC EL EQUIP FOR A SFD.(PER CHARLES- REFERENCE FEES & PLANCHECK UNDER BX11-00390)
OWNER:
AMIRSOLAIMANY OMID
Address::
196 THE MASTERS CIR
Unit-
City/State:
COSTA MESA, CA
Zip Code: 92627
Phone:
`
'
APPLICANT:
AMIRSOLAIMANY OMID
Address:
196 THE MASTERS CIR
Unit ^
City/State:
COSTA MESA, CA
Zip Code: 92627
Phone:
818-239-6180
CONTRACTOR: OWNER -BUILDER
License No. 000000
Address:
Unit:
City/State:
Zip Code:
Phone Cell:
'ARCHITECT:
License No.
Phone
'ENGINEER:
License No.
Phone
FEE SUMMARY
"
Building Plan Check:
$0.00
Building Permit:
$0.00
Usti
Electrical Permit:
$0.00
„-
SMIP Residential
$0.00
;
SMIP Commercial
$0.00
�,.
Bldg Std Admin Fund
$0.00
TOTAL FEES $0.00
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
?.Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Day, Memorial Day Independence Day Labor Day Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE r. INSPECTION TYPE DATE INTITIALS CODE IN5PECTI0N TYPE PAN INTMAL
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 Site
1204 Final Demolition 250 Final Building/Oaupancy
ft
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, bs provided for by section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
❑ 1 have and vnll 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:
(This sector head nx ae completed a the parrot a valued at we puna ed Coban, (S 100) or less.)
Policy Number:
❑ 1 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.
Applicants 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 DOLLARS
($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. #
contractor, Signature
Class #
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:
f\ 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).):
❑ 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
�d,,idd t build or improve for purpose of sale.).
( Jd�,.as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSE 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 contracta(s) license pursuant to the Contractors License taws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057.46(3/07)
Owner ID verified by driverse. []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, a 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).
❑ 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.
Applicant's Signature
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 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 feel 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 feel 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 vAth? ❑ Yes ❑ No
5. Does or volt the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 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 Wthin
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 ❑ 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.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and stale that
the information given is correct. 1 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 purposet. I agrk not to occupy or allow occupancy of an building
authorized by " rmit uI f inspection. 1 Z
Signature of Legal er(d) Date r
And/or Authorized Appl¢ant Date
x
40
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.
❑ 1 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:
(This section need Trot be mandated if the permit is valued alone hundred dollars (Slee) or IessJ
Policy Number:
❑ 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.
Appbwnl'a Signeture
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 DOLLARS
($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. #
Class #
Contractor's 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).
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 pennit 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).):
❑ 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/0p t build or improve for purpose of sale.).
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 appy 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 Data
M
Owner ID verified by driver's license.
Driver's License No.
❑ Yes ❑ No
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, vrill be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, a 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).
❑ 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.
Appla ant's 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 ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled 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 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 Safely 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 permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested
information be furnished on applications fa non-residential building perils). .
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
(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 ❑ 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 1 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 purposet. I agrnot to occupy or allow occupancy of an building
authorized by rmil u�i jl ftgpl inspection. _ �_ / 1-7
Signature of Legal O ens)
rN
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Post -it® Fax Note 7671
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CITY OF COSTA MESA 40
4�5�p MFSq BUILDING DIVISION
4
> 6' 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.00v
�. � 6� FOR INSPECTIONS CALL: (714) 754-5626
+•mmco
PERMIT NUMBER: BX11-00390
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 11939124 DATE ISSUED: 01/06/2012
Zoning: ISSUED BY: RMD
,1
JOB ADDRESS: 196 THE MASTERS CI CM Suite/Unit:
Vicinity: ROOF \ Primary Occ: Const Type
SO. FT: 0 �� Valuation: $9,800.00
SCOPE OF WORK: \
INSTALLATION OF A 6.240 KW ROOF MOUNTED PHOTOVOLTAIC SYSTEM WITH 26 LS; 1 INVERTER, DISCONNECTS,
MISC EL EQUIP FOR A SFD.
OWNER: AMIRSOLAIMANY, SAID
City/State: COSTA MESA, CA
Phone:
APPLICANT: SIMMONS, MARK
City/State:
Phone: 740-217-4716
CONTRACTOR: THIRD GENERAT
Address: 8320 SVL BOX
City/State: VICTORVILLE,i
Zip Code: 92395 1
ARCHITECT:
Phone
ENGINEER:
Phone
Monday thru
SAID
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit:
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address" % f S)(ERAS C k Unit
�\ Zi�d1IC dg:QQ 9 2
7 V
Unit:
Zip Code:
License No. 922640
1 \ Phone 740-217-4716 Cell:
\\' License No.
\ License No. C037835
$45:31
$18125
$62.10
$1.00
Unit:
IRS FOR CONSTRUCTION ACTIVITY: EFFECTIVEj3/18/2010 - PER CMMC Sec. 13-279
7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE r, INSPECTION TYPE PAZ INMIAL CODE INSPECTION TYPE DATE INTRIALS
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 Blmk/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
a
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:
Cartier:
(This sWon need nor pe cumdeted Jthe parmd u valued atone hundred doCars (s 100) w fess.)
Policy Number:
R 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 subjectto the wo ' compensation provisions of Section 3700 of
the ^Labor Codfl, I shall fod wi cpmply with these provisions.
�V✓ X� . I / te azo 1
Applicant's 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 DOLLARS
($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.
Class # C— o
ConVador's Signature Dale
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 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).):
❑ 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 taws.).
❑ lam exempt under sec.
Business and Professions Code for this reason:
Date
3057-46(3107)
0
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 degd):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation We (5) a more feet o1 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, a 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).
❑ 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.
Appiicanrs 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 ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled 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 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 Califomia
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 permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 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
(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 ❑ 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.
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.
lure of gal
ignaOwner )
F
Andlw Aul nzed Applicant
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Data
MFS CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
J
PERMIT
(714) 754-5273 • Fax (714) 754-4856
BUILDING PERMIT
Job Address: 196 THE MASTERS CI
Suite:
Vicinity:
Parcel Nunmber: 11939124 Zoning:
Applicant: MIRANDA, FRANK
Address:
Phone:
Zip:
Owner:
TATE, WILLIAM S
Address
196 MASTERS CIR
Phone:
SCOPE OF PERMIT
COSTA MESA,CA Zip: 92627
Contractor:
ISLAND PACIFIC ROOFING
Address:
17762 CAMERON ST
PERMIT NUMBER /
B98-02022
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED RV
Applied: 11/05/1998
Issued: 11/05/1998
-,
Arch / Eng :
Address:
H.B. CA
Phone: 714-557-6516
Zip: 92647
License: 631472
Phone:
Zip:
License:
SCOPE OF PERMIT
T/O EXISTING AND REROOF THE HOUSE AND GARAGE WITH COMP. SHINGLE, ROOF CERT ATTACHED.
FEE SUMMARY
Plan Check:
$0.00
Calc Valuation: $5,000.00
Permit:
$99.75
Claim Valuation: $5,000.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$100.25
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: o
Required: 0 Proposed: 0
NOTES
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 penat(r of p"ury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to sell -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 th0vonnit is issued.
My workers' compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the pormit is valued at one hundred dollars IS 160) or less.)
❑ 1 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 elifomla, and ago that if I should become subject to the workers' compensation provisions o Section 3700 of the Labor Code, I shall forthwith
comply with these pr. to
"My'144 �,�----�
Applicant Signature: Date:
WARNING: FAILURE TO SECUR WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUSIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100.000).$N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION $706 OF THE IABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provi„Ions 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. Uc. # Class #
J
Contractor's Signature: Date:.
I T
CONSTRUCTION LENDING AGENCY: ,
❑ 1 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: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
1 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, poor 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.).
❑ 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 Lew 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, 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 6, 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 ❑ 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 Does or will the eDDlicanl or present or future building- lwp t need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 01 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 en RMPP is presently required, has Section 25534 of the Califomia 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 apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government 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 regqwired 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? ❑Vas ❑ No
....................................................................................................................................................................................................................................................................................
8 (If'yes", attach certificate of compllence 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 Emigslons.
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 ppurp/o�ses. I agree not to occupy or allow occupancy of any building authorized by thispermit until final inspection.
8 01 Le
-� Data
/rfh"" all
An Or uthodie ADDlicant Data
Applicant
CODE E. INSPECTION TYPE DATE WImALS CODE INSPECTION TYPE DATE DITTIA64
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/Retatning 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
2446-46
OWNER
JOB AC
GENER
° No.
t
5
SS 196 The Masters Circle
TRACT
DATE
VALUE
iPEC TIONS
S7 natures Date
GROUP J TYPE
III ZONE -
solL
SUBCONTRACTOR
PERMITS ISSUED
Date Numbcr Signature
GAS
WATER
Plumbin
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON.
SPRWKL4*-SYSTEMsif'/✓)/.N
J'JZ
S v /IS
L
ROUGH HEATING AND AIR CONDITIONING
_
TEMPORARY SERVICE OR POLE
UN OERGRO UND POWER
-Zj•7 7/
ROUGH WIRING
-73%
Heating and Vent.
TRENCHES El FORMS ❑ STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REI FORCE
-/S •7y
MIN
-13- L,
FRAME AND FLASHING
LATHING — IN 0 OUT
PLASTER, BROWN COAT
:TURAL, FINAL
FJ td
1. ING, VENT., REFRIG. AND A.C., FINAL"r�
PLUMBING, FINAL AND GAS TESTELECTRIC,
FINALRUU
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r 34103
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
"r°nrg
-li'7 00 200* ****
PAI 34.50
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIV C3� 8�
/
DATE,RECF,iVED�
O'I U/
I E SJ$I/EY
[ UE
BUILDING /�
ADDRESS ( / _
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OWNER
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MAIL
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BUILDING C t
ADDRESS -I?
ADDRESS P
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/ TEL.
CITY 057i� �P NO.,SS'j_ P7
TRACT 56ZT
LOT,? 6 BLOCK
CONSTRUCTION
MEW
LENDER AS
✓
BRANCH
OWNER . - If7 n/ '
ADDRESS
q VALUE
S /=�wrrn. Do $ Z %iT77] '
ARCHITECT TEL
OR ENGINEER YJ'�' /, N
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ADDRESS 162OY' - ✓�✓i( r(/1- L'r Ei✓Ciw
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APPROVED yy
CONTRACTOR ` ,, i✓ dd
BY t DATE, .
ADDRESS a, .�I/G z
TEL.
ZO
NO. NSF
PLA
USE OF NEW
BUILDING
CITY A' NO
z_'
STATE CITY
YARDS APPROVED
YARDS AP ROVED
LIC. No.��3�J O LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDGS.
(FROM C/L STREET)
OF LOT NOW ON LOTFRONT
FT.
USE OF �J
EXISTING BLDG. iR.
SIDE FT,/
FT
SIZE OF // NO. OF
NEW BLDG. ROOMS STORIES
L. SIDE FT.
FT.
EXTERIOR WALL
ROOF
/
COVERING
COVERING
REAR FT.
d FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. BLOCS.
��JJ
DATE
I '/'qo
APPROVED
D
r
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
rVAR
the State of California.
I hereby certify that I am properly licensed as a contractor underSO.
FT.
SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Dlvisicn 3,AMOUNT
Chapter 9, antl that such licenses are In full force antl effect, or IURPOSE
OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California BusinessIONantl Profession Code, Division 3, Chapter 9.
PERMIT FEE $Signature
ofCµ�Permittee
PLAN CHECK $L/Authorized
Agent �
"TOTAL
c�.
�,�—
FEE $ J
a
31404
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
FEB 20 7o�pPAID5f00 596* *** 163.50
r�
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVE B
DATE RECEIVED
DdSUED
BUILDING 196 The Masters Circle
ADDRESSOWNER
United Savin s 8 Loan Assoc.
A.P.N
MAILBUILDING
%'y,DDRESS
/+�/✓uW/[/CITY
9800 S. Se ulveda BIYd.
ADDRESS
LOS Angeles, Calif. No`'670-7550
(�
TRACT
LOT(�CONSTRUCTION
PLENDER
OwnerBRANCH
OWNEADDRESSARCHITECT
�ALUSrORENGINEER
TEL.
R.J. Maryick 839-3840
//
N
FIRE
ADDRESS 1538 N. Centur Santa Ana, Cali
ZONE TYPE GROUP
APPROVE D D
/ G
CONTRACTOR R ness—Smith Co,
DATE
ADDRESS 140 E. Industry Ave.
T.
TEL.
ZONE
C d�
NO. OF
p0 O
a
VSE OF NEW
BUILDING
CITY La Habra Calif. NO. 879-3111
STATE CITY
YARDS APPROVED
YARDS APPROIVED
LIC. NO. 167538 LIC. NO. 1964
MAIN BUILDING
ACCESSORY qUILDING
SIZE NO. OF BLOGS.
(FROM C/L STREET)
OF LOT 40 X 180 NOW ON LOT —FRONT
r FT./
FT.
USE OF
O
EXISTING BLDG. —
FT.
FT.
SIZE OF NO. OF
NEWBLOG. 2165 ROOMS 7 STORIES 2
L. SIDE FT.
FT.
EXTERIOR WALL
COVERING StucC
ROOF
COVERING Wood Shakes
��11
REAR c('�FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS, BL
Single family dwelling and 2 car
VA.
6
DATE
CURP P. y= /
APPROVED
attached garage.
APPROVE��/jBY
DATE Q IlaD
Lot 26 Plan 4 -AR
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
r�
/0 G, (�
the State of California.
I hereby certify that I am properly licensed as a contractor under
!l� SO. FT. J
THE AMOUNT SHOWN UN&LIA VALUATION IS FOR
the State of California Business and Professions Code, Divisicn 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
and Professions Code, Division 3, Chapter 9.
n
PERMIT FEE $ ^� v
Signature of
Permittee `"�
n) j G
S - / ✓�
y
PLAN CHECK $ v "'So
Authorized Agent 4L s
TOTAL FEE $
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