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HomeMy WebLinkAbout3066 TRINITY DR - Building Permits CITY OF COSTA MESA CY.,� BUILDING DIVISION Yt%1 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER Fr _^i .� PERMIT 06-01934 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.®tJLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3066 TRINITY DR Status: ISSUED Suite: - Applied: 11/17/2006 Vicinity: Issued: 11/17/2006 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: v-n Parcel Number: 14107114 Zoning: R1 Applicant: JOSE GORINA Address: Phone: 800-807-9889 ISSUED BY: Owner: STANLEY, GAETANAJUNE TR Address 3066 TRINITY DR%- _ I • - - ��� i Phone: ' ' CosTA.MESA,CA'. - _ - Zip: 92626 Contractor:- SEARS HOME IMPROVEMENT PRODUCTS INC . Address 10395 SLUSHER'DR-;-:" %�_ , i,,/ /�;jj. Phone: 800-807-9889 `SANTA FE SPRINGS,CA ,''! Zip: 90670 /- License: 721379 -Arch : '' ,'/" Eng: Address: - Address: - Phone: Phone: l License: ` r ' - - - SCOPE OF PERMIT INSTALL VINYL SIDING OVER'EXISITNG STUCCO,ICBO#er1478 i , - FEE SUMMARY , Plan Check:. _ $0.00 ,• i, -•' 7 -, ' ' • Calc Valuation: $16,500.00 Permit:' $279.25 ,�,-` - _-'- <./- - -•� •--- • -` ' - Claim Valuation: $16,500.00 SMTP Res: •. $1.65 SMIP Com: • $0.00 • - --Other:, $0.00 %' ' • A: , I'nspection:� . $0.00 -Total: $280.90 " PLANNING &ZONING SETBACKS - \\ a ';, MAIN STRUCTURE Front-... 0,-0 Rear. C0-0-_ Left • 0:0. Right 0-0 j' ACCESSORY / Front 0 o-- '-->—"-=Rear , 0-'0 ' Left 0-0 - Right 0-0 / , ',`=-N'' /� PARKING , Existing - 0� ` Required 0 ProposeQ: �i L � • �J ia3 1 " ra % ` C n .. . . ' 2 :::.,,,,, ,,i.., )r --- ., -. - C r i. _ \� -.;,t _ • 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 244648(6/00) . DECLARATIONS r 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: \ f7 c�?// 7J Carrier: At C /fin 1424 C t —J PPolicy Number:WLg 4 ea-0 geo--0 (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 California, :-- :gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro• 0 Ca Applicant Signature: Al. •ns. _dela Date: 1-7- WAW4INO:FAILURE TO SE' R:WORI(ERS'ra dirt( 44' ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI..000)IN ADOmON ,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 underprovisions of Chapter 9(commencing with Section 7QOp)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.tt 7 Z 13' l Class# ` Y, Contractor's Signature: Date: I I ' I al • (o .77 CONSTRUCTION LEN G 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 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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(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. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 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? 0 Yes 0 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 end Safety Code been fully complied with? 0 yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be fumished 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? 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 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? 0 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 peltury 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. �.r:ture Of Legal Owner(s) Date cK� 1 lI - IOC .1 Or Authorized Applicant Date CODE II 1NSPE NTYPE PATE INTRIAL$ • CODE! INSPECTION TYPE PATE INTRIAL$ 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 7���j1 204 Final Demolition '' 250 Final Building/Occupancy ' G /' 7 /J 16849 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT r APR 2 1962 P. O. BOX 817 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT - - BUILDING BUILDING ADDRESS 3066 Trinity Drive COSTA MESA. CALIFORNIA i For Office Use Only ._ ..... RECEIPT NO. £68{9 OWNER Leroy Williamson 4 MMDADRESS 3066 Trinity Drive RECEI BY I DA EC EDiciv DATE SUED CITY Costa Mesa, Calif. TN%-..101 5-504 ABUILDING - KI. DDRESS o' •ITECT TEL. GINEER NO. COSTA MESA. CALIFORNIA ADDRESS FIRE // ZONE" TYPE / ,GROUP fr"-- CONTRACTOR Owner builder APPROVED BY ZONING DATE ADDRESS - ZONING ffita • • ZONE / NO.OF USE OF NEW -//y_,, CITY �� / PLANE /�I BUILDING (/f/iV YI STATE TEL. LEGAL ((( ( ( �T 4S, `J Y. ./ LIC.NO. NO. ----Pi //o /V" ')4 �l DESCRIPTION SIZE OF LOT / L� i` / (� / I NO. OP BLDOB. (p NOW ON LOT 1 A.P.NO. USE OFYARDS - EVES EXISTING BLDG. residence APPROVED ALLOWED SETBACK LINE FROM I (CENTER LINE T STAyy--�� CENTER OF STREET REAR YARD FRONT N-2;�.FT.Z5/��a IN. SIDE YARD I LEFT I RIGHT R.SIDE 37FT. IN. DESCRIPTION OF WORK L.SIDE .5----h N. NE' I X I ALTERATION I II ADDITION I X REAR O —FT IN.N-� / REPAIR II MOVING ( DEMOLISH I APPROVED u.,Y of DATE 0-3O-67------- BUILDING -3 67-- BUILDING �/ NO. OF lam( 691f�l SIZE �/� � ROOMS STORIES EXTERIOR WALL ROOF COVERING stucco I COVERING wood sYn.ng1: USE OF BUILDING AND WORK TO BE PERFORMED • •- . • • • - • - • • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE AEOV IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY GROW EB AND STATE LAWS REGULATING BUILDING CONSTRUCTION VALUATION /J/ SIGNATURE `/''�i 7 PERMIT FEE $ QC -- PERMITTEE OF /A / Il JI ®_ PERMITTEE �^� (�U a $ X PLAN CHECK $ `� hY AUTHORIZED AGENT a 7 I . - - m ..m r ,e .. TOTAL FEE $ o+- I. OWNER WILLIAMSON, Leroy SEP 1 1 1962 SIcriDATE 4-2-62 • JOB ADDRESS 3066 Trinity Dr. BUILDING PERMIT NO. 16849 GENERAL CONTRACTOR Owner-Builder VALUE 4400.00 AP No. LOT 66 TRACT 4041 FIRE ZONE DESCRIPTION OF WORK Add Pat.Cov.to INSPECTIONS Signature DATE GROUP j TYPE V ZONE R-1 Res. Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring 'trenches Li forms U Steel Reint. U ii, ryf` age. Floor System Bond Beam 0 Steel Reinforce ❑ Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, brown coat Ref rig. 0 Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final am e- q-1t _ OCCUPANCY FORM BU4-5M — 7.61 16849 13624 .SAMPLE • COSTA MESA BUILDING-SAFETY DEPARTMENT JOI. 019�� P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA FOR APPLICANT/TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BDDRESSUILDING 3066 T ;R IN I TY.DR I A COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY. . i RECEIPT NO. PERMIT N . OWNER *Ilk CONSTRUCT ION CO., INC. 1 /3 G.� T MAIL 1555 PLACENT I A AVENUE RECEIrr 1 DATE RECEIVED DATE ISSUED ADDRESS / ' C(,^ Un e/ 1 1 1961 I CITY NEWPORT BEACH CALIF.' TEL o- ADDRESS 1�-3227 ADDRESS P 1TCT GGENEER I. No. gIXNV COSTA MESA, CALIFORNIA ADDRESS FIRE / j ZONE TYPE 1�.G� GROUP le(fr K.W. KOLL CONSTRUCTION COSTATEAPPROVED CONTRACTOR( LIC.NO. 61195 BY DATE 10E PLACENTIA AVE., NEWPORT BEACH ZONING AD ESS ) 'I 11C p LEGAL LOT / / 140141 ZONE NO.OF USE OF NEWSIUS1 y WR. DESCRIPTION NO. © o BLOCK TRACT R-1 PLANS 2 I BUILDING w/ att par, AP A.P.NO. nond BYPROVED W L.D. O� DATE 1-6-61SIZE f'. OF LOT 65x 100 I NOW ON LOTS (-) YARDS VES REQUIRED ALLOWED USE OF - (CENTER LINE ST.) ',{�//, cr EXISTING BLDG. a' FRONT 1 FT. 0 33 4IN. SETBACK LINE FROM 1151 REAR i�RIdD71 fff /� 6) 11141,0-4.14.10 � A ' n ,I I- CENTER OF STREET 11 I R.SIDE I�J FT. (I' 11141 Q4i`.1i. SIDE YARD (LEFT 5'1 (RIGHT 10' L.SIDE FT. IN. DESCRIPTION OF WORK REAR 3-. FT. i V IN. NE. X I ALTERATION II ADDITION I ' REPAIR I . II MOVING I II DEMOLISH I BUILDING 14075E NO.OF SIZE ROOMS STORIES 1 EXTERIOR WALL ROOF COMPOSITION / COVERING QTUCCO COVERING SH I NGLFS / n �/Cr USE OF BUILDING AND WORK TO BE PERFORMED C/ SINGLE FAMILY RESIDENCE AND • ATTACHED GARAGE PLAN No. 2=DR I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM _ THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL. CITY ORDINANCES AND STAT LAWS RE EATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONONSTRUCTIllpppN." 1 ,��,e VALUATION '/ SIGNATURE OF � } / $ / PERMIT FEE $ /7 ` PERMITTEE ��,�� 1 r- / 7G PLAN CHECK $ --- AUTHORIZED AGENT N..• TOTAL FEE $ (S 444/1111: CITY OF COSTA MESA y- 4, BUILDING DIVISION F r .:-.'""-I-:::" ' DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER 4PERMIT '`b+.a,,,O++0 M99-00371 (714)754-5273 • Fax(714)754-4856 / 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT • • Job Address: 3066 TRINITY DR Status: ISSUED Suite No Applied: 08/05/1999 Issued: 08/05/1999 Vicinity: Parcel Number: 14107114Y ? ISSUED BY: /'J'/ Applicant: SOCO AIR CONDITIONING , Address: 6892 CARNELIAN - Phone: (909)944-1340 - ALTA LOMA'CA Zip: 91701 �1' Owner .STANLEY;,GAETANAJUNETR - Address: '3066 TRINITY DR - - ' ��N '// / N i. - Phone: - , /' \ ,- /., • COSTA MESA;CA= Zip: 92626 A `_�-.. / �' / i ', Contractor: SOCO,AIR- CONDITIONING / 'yN , ,Address:; 6892 CARNELIAN -' / - ` Phone: (909)944-1340 •ALTA LOMA CA . . Zip: 91701 • - - ; 1 License: 333239 Ar`ch'lEng:. '_ :. . , _ , V • Address: ' '�, Phone: - ?: . \': ' 1 �� ° I p Zip: {. _. . . , \ , ' ' License: : , , / F, 'SCOPE OF PERMIT REPLACE EXISTING FAU WITH NEW 75K BTU UNIT IN SAME LOCATION. ' - FEE SUMMARY , '. ' . Quantity - Quantity ISSUE FEE ',. $22.00 Repair/Alt1Absorbtion Unit $0.00 0 ?-' InstFAU<100,k-BTU':'' $13.25 _ 1 Repair/Alt Refrigeration Unit >„ _ $0.00 0 ., • Inst FAU>100 k BTU . $0.00 0 Ventillation System $0.00 '0 Repaii/Alt Cooling/Heat $0.00 0 Evaporative Cooler 40.00 0 ' ` Inst/Rep. Recess Wall Htr,' $0.00 0 Commercial Incinerator ,' $0.00 0-' Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator " $0.00 0 Refrig Sys'>100 k-BTU $0.00 0 Compressors/Absorption Systems- ' Gas Piping, $0.00 0 Up to 3 hp/100 k BTU . ' $0.00 0 Factory Fireplace 4, - $0.00 0 3 To 15 hp/500 k BTU , $0.00 0 Hood w/Mech Exhaust' $0.00` ,0 • 15 TO 30 hp/1,000,k BTU ' $0.00 ' 0 VAV Box '' "�-, / i ' $0.00 O. 30,To 50 hp/1,750 k BTU ,WOO 0 Vent Fan/Single1Oct ' $0.00' ' 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 ' Boilers ,• Fire Dampers :v $0.00 0 Up to 3 hp ' ' - - $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp . $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0- , Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $35.25 COMMENTS/SPECIAL CONDITIONS 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 \ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally 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: c Carder: ,S 7, 'FK dip Policy Number: (y 7a.. Q Cr 5- p ' ' 7 (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 California,and agree that if 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. � C4� Applicant Signature: om7a !7 / Date: ''— .5` 9 / 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(S100,07D),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.# 3 3'3 d- 3 �( Class# C (9. G Contractor's Signature: eX Date: S" t 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.). O I, as owner of the properly, 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. 0 Yes 0 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: O 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 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 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 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? 0 Yes 0 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? 0 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 ermit 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 U 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? 0 Yes 0 No • (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomia Health and Safety Code Section 42303 been made? 0 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. yIl�agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �- nr Signature OfJ,e ali./� ar(s) c, Date t7/- An97/1Or Authorized Applicant Date CODE.. INSPECTION TYPE PAM Wm#1.4 CODE t INSPECTION TYPE11 ATE • 1616 Fixed System Final Fire Prevention 206. Final Mechanical 8-1 6-99 AT 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 204 Final Demolition 250 Final Building/Occupancy 2446-46 PROJECT ADDRESS: UNIT: ' • OWNER'S NAME: 3066 TRINITY DR CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 057709 ADDRESS: STANLEY GAETANA J 3066 TRINITY DR PERMIT NO: B 057709 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92626 • CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER; REG.NO.: 1. , ADDRESS: UNIT: JOB DESCRIPTION : REROOF SFD W/FIBERGLASS COMP SHINGLES SQ FT: 3, 635 PERMITTEE: CLAIM VALUE: 3, 635. 00 CALL—VALUE: 3, 635.00 GROUP OCC; R-3 /M-1 - 1 ADDRESS: OLSEN ROOFING CO. , INC. ( 213)634-8470 6951 NEWTON AV ( � pp/7�1pp((��r COMMENTS• SMOKE DETECTOR(S) REQUIRED IN HOME• LICENSED CONTRACT 7j���(�����/(.� IBM:"n2rdoY S4v oas4ftQ ****************************** ****************3************3e*******3f*********** DRTIECGflAT allirm that I am licensed uncle isi r 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and m ense is in lull force and effect. ZONING REQUIREMENTS CITY LIC.; STATE LIC.: C SETBACKS 033906 25414yC 4 Date: Signature: 111,1'1/u Y, (, "G � MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION; I hereby affirm that I have a certificate a onsent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT . IN LEFT: , FT IN RGHT: FT IN POLICY ND.: EXP.DATE: 07/21 /92 COMPANY: E,TPfi F(�i�Dr, PARKING REQ: PROV: PARCEL: 14107114 ZNE: REF NO: ❑ Certified deify is re y tarot e . `X Certified copy Is d d with the city Building Di islon. C5 l / l / ^ /7 -��/N( PLANNING N TESD r� Date'. r/7'�J�—/ Applicant: �i(, c / / �C..� 3E3k3E3P3F****#iF3E3f#if3F3E3F3fil3E3f3k3f3k3l3Fikk3f•iE3FiF#3kiF3P3fiP****3f#3E3f3f3f3k313k3f3f3f3Eff3F3F3k3EiEaFif3kifiF3fr3F3E1F3k#3F3E3f*** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIR E M E N 'T S I certify that in the performance of the work far 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. Date: Signature: ZONING APPROVED BY DATE: ,--41 NOTICE;If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY '/�A DATE: Code.you must forthwith comply with such provisions or this permit shall be lending revoked. 3�� •; 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(Section 3097,cm.Cl. APPLICATION ISSUED **BY• • DATE• 31 d 2 LENDER: *************************** * ** * *** ****************** 3�* ***** ADDRESS: REROOF SFD & ATTACHED *********************************************** ****************************** GARAGE. LEGALIZATION:N F E E SUMMARY STRUCTURAL1SEGMENT:Y OWNER BUILDER.5Business sinesndIPro hereby d :rm that yin exempt whic tre uiresa ri Stoe nstnse Law for fpr folve,dem reason BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE SMIP/RES' GRAD ING repairon y stru5 rep and Pissuance, Code:r Any cityh f county which requires a permitfieto construct,alter, s,tlEmol6n,or repair any structure.prior to its issuance,also requires the applicant for such permit to Tile a signed statement that he/she is licensed PERMIT 63. 00 . 50r pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—R ES and Professions Code)or that he/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(S500). PLAN iti,— ' ISSUE FEE 1 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT • ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a properly who builds or improves thereon,and who does such work himselt/hersell or through TOTALS----> 63. 50 0. 00 0.00 63. 50 63 . 50 • 00 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 63. 50 OVER/SHORT: . . 0 0 for purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING —CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code. The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon 0 �i and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware t that proof of their Worker's Compensation insurance should be provided to me. ************************************************************************,******* o I am exempt under Section: B.a P.C. . INDIVIDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCRIPTION UNIT COST 'TOTAL COST Dale: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 3635 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 3, 635 . 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from i these provisions. Date: Applicant: I hereby certify that I have read this application and state that thbove information is c rrect.I agree to comply with all city and county ordinances and state laws relating to building construction and hppykkEggqqqq���yyy authorize representapppyyyve of thi (y to enter u'id the above'mentioned property tar inspection SCS. y / , Date: 6-- (/f] G Signature. f/( �f� C/// . e / G1 00'117Dh1-GG1.1?Gb2 'Fc ,,57r I� DATE: 06/10/92 TInE: 13:02 Driver's License or Social Security#: Applicant;Pink—Revenue;Goldenrod—Assessor / CONSTRI,'TiON`NAND PLANNING - POOL .PA Date Inspector Date Inspector ' - APPROVALS Permit# - APPROVALS Permit # . 1. Temporary Electrical Service or Pole,,+: 52. Pool &'Equipment Location - • 2. Soil Pipe-Undrgrnd. _ C- 'c 53. Steel Reinforcement ,r �. . c3,c6fe�tricaI Condut IJt irty-Undrgrnd. :7 • ,r5,,„4.. Forms - r ,V• 'r4,.Elettrical Conduiti-Undrgrnd. u;_ D55. Electrical Bonding . ',15'St5 Reinforcer` il' r c56. Rough Plumbing & Pressure Test J , 1. `S+:' EleEtrical UFERTGmd'. X57. APPROVAL TO COVER-GUNITE .)7;`-Foiktings .~ _ °58. Electrical Conduit-Undrgrnd. , c. 8>Eoundation r - y - •i59. Gas Pipe, 0 Undrgrnd.,Test Ir •i _ 9,. Water Pipe-Undrgtnd. a;60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System - •1-161 'APPROVAL TO DECK 11. Property Sewer Llne:& House Connection 62. Backwash & Receptor-Final 12. Sealer Cap o, , • -. 63• . Heater& Vent-Final 13. Roof Drains - 64. Plumbing System - Final _ ' 14. Rough Plumbing i, 65. Electrical-Final 15. Rough Electrical:Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sidn _ 68. APP:ROVED.FOR PLASTERING 18. Rough Electrica(C Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. RougFaBtory.Fireriace I n1 `, - :.' PROVALS:':°Reraia# x . tr 21. Ducts.,in Structure-. I •• • -�. - _ - ' :. : 70. UndergrourmHydro -...• � 22. Ducts]Veh'tilaling�::' i :'-� ^ _� c ."•„ ¢* '; 7_1. Product PJPjng Elba's" DOiI 23. Gas Pipe-R,ougtl & 'Sex`st i tr'IS •-% ,� < _- 7.2. UndergrouiQl FlusEr -o yit t-+ -c 24. Roof_Framing' ,"+x ' .--4-• -- ; J L ,_4' Ei 73. ,f ndergrnd-Storage. a j OGas 0Oi1 ' • 25. Roof heathing (, f ` i 1 if--i. &' C' 13 ' c yS t . 74. Overhead Hydro :4"--!: 26. ,tBarrCeiling (Structural) & Monocoat x Lc r t*1•i '' 75. Dry'Chemiccal 8 ' -K . . -- .,c c-c- •1 �. '!x .,,rJ rn 27. Esme an ,Flashin ' ' `J= ' _ c rn „z ,S •r. s Igi ,�.cm -,.. _ >- t-c : 76. DryStandpype, ;4z -44 r 28. Lathing &;Siding 14.4"r" - tisr~: t + `r: •• 77. CFIXED SYSTEM;F1$JAL " J .- t.: hl I y, :: 29. Insulatio} '. 'c� .a S f 78. •FIRE PREY. FINALri It r i 30. Drywall Nailing y I 1- HEALTH DEPT. REQUIREMENT 5i, Plaster Brown,Coat:* S inn y 1 :` '` 79. FINAL INFEC`TION a -' _r i3_2. Electrical-Power Meierr'binal 1` .Y. a Cu ' .- 80. FOOD CERTIFICATE ISSeiED .r r ' s. 33. Fanal_EIectnic•� rr r I K w, C1 ' p 'Kota! -',m > C `Jill 4. Fjna Heting.& Ail Conditioning; ,ri t i� .i l-- s per. 35, P_inahGas Pipe'Tes15` I14 : 1; L ni i`j • r - 36, Nood.or Genopy '',..7•4. j --1r r :j_ ..`I. s• z :, o ¢ r 37, Final Factory Firedlice -�, -� C, r I -• P z 2 :r .•7 is I ,r K _ 38. FinatfPlurriibing * ��cu I •--f .. r' k S t•1 x Iq 0I. , 39, Water+'Ser-4ice-Final : I a. x K .,r. - tr• i ' %40. Gas Servcy-Final ;. , iS t1. p '-nt y, . tr. I.' 41. Solar Domestit=Final .a n ,. : cc:u 4Ba 2. ckflowPreventer r • I 43, Backflow Irrigation .. •- 'ra S a• n - `F:- o .c C _ °-' 2 IF.'I: T t. - t,i 44. LandscaptIrrigationSystem ;r„y;: ,a; .. .. '- r- r.17.4. - b• +t ;i ;�:•-, ti j 45. Sound AttenCation .._rt,r• , :£ - r*: -; - - �f'- t;.K n r r . r • ri: .. 46. Handitap,Reg4lation " i• -• ••- .-it a: •s _ s M 47, 51NAL STRUCTURE & BUILDING �]11_ ' 61i�Cµ < -:i ,-:,7,-.-..•:-.-- 48. FINAL PLANNING ; ' _r y`' �+ E til r i 4-<?-4C7- .c. 49. Electric R'eiease to Edison i I: I - r - r%: T . r . -f' .:, - 50. Gas Releae to Southern California.Gas Co i ; •4 ::::.' c - `'= • 2 • 51; CERTIFICATE OF OCCUPANCY ' .. . >, - ~i; x . .) No. Date