HomeMy WebLinkAbout352 16TH PL - Building Permits_�
CITY OF COSTA MESA
�,OStpMFs,p BYILDING DIVISION
4
� .�,„.. � 77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us
°, " A& FOR INSPECTIONS CALL: (714) 754-5626
'�°�a�^fi PERMIT NUMBER: BC11-00255
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
JOB ADDRESS: �352 1'6TH$PL'�GM`""""
APN: 42519201 �.----°" Zoning: , ,
Vicinity:
ConstType: V-B
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 05/09/2011
ISSUED BY: KJB
Suite/Unit:
Primary Occ:
Veluation: 57,000.00
SCOPE OF WORK: INSTALL HARDIE PLANK SIDING ON ENTIRE DWELLING. REF: ICC-ES LEGACY REPORT NER-405.
CHANGE OUT 14 WINDOWS LIKE-FOR-LIKE WITH NEW FLASHING.
OWNER: MC CONNELL, NANCY
Phone: 949-650-8336
APPLICANT: ELLIS, DAVID
Phone: 949378-8997
CONTRACTOR:
Phone:
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 352 16TH PL
City/State/Zip: COSTA MESA, CA
Address:
City/State/zZip:
Address: Unit:
City/State:
License No.
License No.
$0.00
$139.25
$0.00
$0.00
$0.00
$0.70
$0.00
$1.00
$140.95
License No.
Unit:
Unit: :
ZipCode
PHONE:
PHONE:
HOURS FOR CONSTRUGTION ACTIVITY: EFFECTIVE 3118/2010 - PER CMMC Sec. 13-279
Monday thru Friday-7:00 am ihru 7:00 pm. Saturtlays-e:oo am thru s:oo pm. Prohibitetl ali hours - Sundays and the following Federai holidays:
NfW Y2af5 DaV. Memo�lal DaV. Indeoendenee �av_ Lahtx Uav_ Thanksnivinn nav and Chriclmae flev
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work mUst comply with all applicable codes, and all
required inspections and final approvai must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
GODEp. INSPEC110NTYPE OpTE INi111AL5 CODEy INSPEC110NTYPE DATE INPTIRLS
7616 Fixed System Final Fire Prevention 206 Final MechaniCal
1266 Pool SDa Final . 208 Final Plumbing
200 Final Re-RooF 210 Final Elecirical
201 Final Block/Relaining Wall 212 Final Fire Prevenlion
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 FinalBuilding/Occupancy � � �
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of �he following tleclarations:
❑ I have and will mainlain a certificale of consent �o sel6lnsure for vrorkers'
compensation, as providetl /or by section 3700 of ihe Labor Code, for �he
peRormance of ihe vrork for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as requiretl by
section 3700 0( �he Labor Code, for Ihe pedormance of Ihe vrork for which �his
permit is issued. My workers' compensation Insurance ca rier and policy
number are: �
Carrier C
(ThrsSecirnneed�wl�ecnmpleletlAtliepermRrsvaluedafone�u retlddlars(Si00)orlessJ
P cy Number:
I cehify ihat in the peAormance o/ �he work br which ihis permit is
is ue ,"shall not employ any person in any manner so as ro become subiect
to the workers' compensation laws o/ Califomia, and agree ihat if I should
become subject to the workers' compensation provisions o Sec�ion 3700 of
Ihe Labo�all with comply with these prov �o .
Appl¢aol s SenaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5700,000), 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 here6y aKrm that I am licensed untler provisions of Chap�er 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, antl
my license is in full (orce antl e((ect.
Lic, # Class #
Contracmr's SignaWre Daie
CONSTRULTION IENDING AGENCY:
❑ I hereby affrm that there is a constmction lentling agency for the
peAormance o( the xork !a which lhis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affrm Ihat under penalry of perjury that I am E%EMPT FROM.7HE
CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5,
Business antl Pro(essions Code: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any stmcture. pnor to its
issuance, also requires Ihe applicam for such permit to file a signed statemenl
[hat he or she is licensed pursuant to ihe provisions o/ the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or ihat he or she is exempt iherefrom and
�he basis for Ihe allegetl exemption. Any violation of Section 7037.5 by any
applicam (or a permit subjecls lhe applicant to a civil penalry o/ not more �han
five huntlred dollars (5500).):
I, as ovmer ot the property, or my employees with vrages as their sole
co ensation, WILL DO THE WORK, and the structure is not intendetl or
offered for sale.(Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply to an owner of property who builtls or improves
Ihereon, and who does such vrork himsell or herself or through his or her ovm
employees, provided that such improvements are not intended or oHered (or
sale. If, however, �he building or improvement is sold wilhin one year of
completion, Ihe owner-builder vrill 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 EXCWSIVELY CONTRACTING WITH
LICENSED CONTRACTORS ro construct the pmject (Sec. 7044, Business and
Professbns Cotle: The contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contrects for such proiecl with
a contractoqs� license pursuant to the CoNractors license Laws.�.
❑ I am exempt under sec.
Business antl Professions Code for Ihis reason:
� .�
SignaWre 0.iie
305]-4fi (JIO])
Owner ID verified by tlrivei , iicense. � Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type ol tlocumenl, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify that no excavation frve (5) or more feet in depth into which a
person is requiretl to descend, will 6e made in connection with work au�horized
by �his permit, and that no buiiding sWCWre, scaffolding, falsework, or demoli�ion
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, TiUe 8, California A4ministralive Code).
❑ As owner-builtler, I will not employ anyone to do work which would
require a permit fmm the Division o( Industrial Safety, as noted above, unless
such person has a permit to do such work (mm the tlivision.
AGOlicant's Signalure Date
Division of Industrial Safe�y Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican� or presenl or fuNre building occupant need to !le antl
cehify a Business Plan for emergency response to release or ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 oi the California Health and Safery Code requires, wi�h some
exceptions, ihat a Business Plan be fled vnih the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity o( hazardous materials equal to or greater than a weight ol
500 pounds, or a volume ot 55 gallons, or 200 cubic (eet of compressed gas
at s�andard temperature and pressure).
2. Does or will the applicant or present or fuWre building occupant need to file
a registration form (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health antl Safety Code, with some
exceptions, requires registretion wiN the Costa Mesa Fire Departmenl by
eaCh bUsine55 whiCh at any one time ha5 On hand a quantity of aCuley
hazar0ous materials equal to or greater than a weight ol 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at slantlard
temperaNre an0 pressure).
3. Does or will the applicant or preseM or fuWre building occu0ant neetl ro
prepare an RMPP (Risk Managemenl and Prevention Program for awtely
hazardous materials�? ❑ Yes � No
(Section 25534 oi Ihe Califomia Health and Sa(ery Code provitles that the
Costa Mesa Fire Depariment may require the preparalion, certifica�ion and
filing with the Fire �epartment o! an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of Ihe California
Health an0 Sa(ery Code been fully complied with? ❑ Ves ❑ No
5. Dces or will the appliwnt or present or future building occupant require for
the work which is Ihe 5ubject of this application a permit for such consWction
or motlification from the Swth Coast Air Quality Management DisMct or from
any ofher air pollulion control distnct or agency? ❑ Yes ❑ No
(Sectbn 658502 of Ihe Califomia Govemment Code requires that the requestetl
information be (umi5hed on appliwtions for nomresidential building pertnits).
6. Will any part of the lacility lo be consWcted under this permit be within
1000 feet fmm Ihe outer bountlaries of a school? ❑ Yes ❑ No
(If'yes", Ihe lacilily must meet the requirement of Sections 25534 antl 42303
of �he Califomia Heallh antl Sa(ety Code).
7. If a permit !mm ihe Swth Coasl Air Quality Management District or olher
air pollution contml disMcl or agency is required for the work which is the
subject o( this application, have all of the disclosures prescribed by Calitornia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach cenificate o! compliance Irom the appmpnale air polWtion
control offcer�.
CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the
information given above is corred. I agree to comply wilh all state laws antl
city ordinances regarding Hazardous Matenals and Emissions.
Signalure Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
cenify under penalry of perjury lhat I have read this application and state that
the informalion given is correct. I agree to comply with all state laws and ciry
orainances relating to building construction, and authonze representatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by �his permit until final inspeclion.
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Antl/or Amborize0 ApPI¢anl Datc
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COSTA MESA BUILDING DEPARTMENT
' P.O. BOX 31J
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
COSTA MESA. CALIFORNIA
OWNER WiLGROWE CONSTRUCTION CA., INC.
M^�� 11933 Stanton Blvd.,
ADORE55
ARCHITECT
OR EN^'NEER
California No;TW 3-3135
LIC.
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APPLICATIONYFOR�PERMIT '
BUILDING
FOR OFFICE USE ONLY
COSTA MESA, CALIFORNIA
QTY LIC. �ONE pOqNs TVPE
CONTRACTOR T. P. GTC NO.
11933 Stanton Blvd., rE�.TW 3-3135 APPROVE
ADDRE55 NO. BY ' DATE
�E�A� �or 14 33�:5 CORRECTIONS
o[scaivnorv NO. BLOCK TRACT
A.P. NO.
size 52.85 x 135.07
OF LOT
"� �F a�°°� None
NOW ON LOT
SETOFCK LINE FFOM SOt SHT
CErv1EA OF STwEEr REAR YARD
/
DESCRIPTION OF WORK
NEW p ALTERATION AODITION
REPAIn MOVING DEMOLISH
BIZELDING 28 X 57 ROOMS � STORIES
E%TERIOR WALL uCCO qpOF
rnvcaiNr. 51:�1I1�. COVERING Ci0IRj1.
Duplex
I HEREBV nCKNOWLE�GE TMST I N
STATE TM4T TME T90VE IS CORqECT
CITY OROINnNCES RND ST4T L�W
TION.
SIGNATURE OF
PERMITTEE
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COMPLT WITH aLL
ILOING CONSTRUC�
VALUATION �'{
/ PERMiT FEE $ `./� �
� g / �/ ^�� �_ PLAN CHECK g �p �`
/ / �
TOTAL FEE 5
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COSTA MESA BUILDING-SAFETY DEPARTMENT
p.0. BOX 1200 COSTA MESA, CALIFORN�A 92626
For Applicant to Fill in Completely — Use Ink Only
IILPING y.^� /�Thf �%f _ . .
OWNER
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FORSTRUCTURALPERMIT
DATE RECEIVED DA^TE ISSUEC
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OR ENGINEER N .
FIRE
ADDRESS ZONE T
APPROVED
CONTRACTOR BV
ADDflESS � � Q�I Z NO.OF •
TE L. P�
CITY NO.
� STATE CITV �'ARDSAPPROVED
LIC. NO. IIC. NO. MAIN BUILOING
/ (FROM C/L STREET)
4 OF LOT!/7G x yv NOW ON LO � ROM FT.
a USE OF
^ exisriNc e�oc. • clJL=� � N SI E FT.
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FSeparate permits are required for L. SIDE Fr.
0 electric, plumbing and heating work. REAR Fr.
y USE OF BUILOING AN� WORK TO BE PERFOFMED
�ISTANCE BET.
qMAIN BLDGS.
VAR. �
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� I herebV acknowlatlga that I heve reatl this application antl smte
y� thnt tMe above Intormat(on b correei antl apree to comply with
�+ ell laws regulaNng buildin8 construction, antl 1 shall nOS ¢mploy
r�L any person in vlolation of iho workman's compensatian lews of
= the Stete of Celitomie. �
3 I herebVi cenify that I am p�oparly Iicensetl as a contrae<or untlar SQ. FT.
the State of Californie B�sineas entl Profeuions Catle, Olvision 3, TH A OUNT SHOI
Chapter 9, antl that such Iic6nses are in tu�l farce and etfect, or 1 THE PURPOSE OF ES
om exempt from tha provisions of the State of Californie Busineas VALUATION
antl PrO+essions Cotla, Divislon 3, Chapter 9.
SIBnaTUre of , � y�,y�
Permittee $ i (/ D
Auffior�zatl Apen CC/�
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BET. MAIN & I �-
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'ABLISHING A PERMIT E ONLV: —
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PERMIT FEE $ �— d
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PIAN CHECK $ r � o
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TAX $ �
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TOTALPAID $
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For Applican[ to Fill in Completely — Use Ic c Only
ADIDRESS JS L I� Y� /�/e< ��-(� '. y( f
OWNER y' %�JS � '�C
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ADDRESS
ARCH ITECT TE L.
CONTRACTOR ��j`LCil� `
ADORESS �'�� �
TEL.
CITY NO.
STATE CITV
LIC. NO. LIC. NO.
512E I NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
elec[ric, plumbing apd heating work.
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FORSTRUCTURALPERMIT
DATE FECEIVEO n Tc icc�iFn
BUILDING �L
ADDRESS
TRACT/
W ADD AlT
OWNEF
SE ' 1
FIRE
ZONE
APPROVED
8Y
ZONE NO.OF
Z P��
VARDS APPROV EI
MAIN BUIIDING
DISTANCE BET.
MAIN BLDGS.
VAR. qib
G.U.P.�
APPROVED �I
1�
�(y ��AT.E� %Q
� USE OF NEW
BUILOING
VARDS APP
ACCESSORY
DATE
&
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I hereby acknowledge thet I have reatl this appliceiion and stete '^
n
that the above information is corract antl egree to comply with m
all laws regulatin8 building connruction, antl I shall not amploy �
any person in violation of the workman's compensation laws of m
ihe State of Celifornia.
m
I hereby ce�tify that I am properly licensetl as a contractor untler SQ. FT. rv
Me State of Califo�nia Business and Professlons Cotla, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and thet such Ilcenses are in full force antl efiect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FE ONLV: �
am exempt from (he p�ovisions of the $tate/�f Calif{y Busin VALUATION PERMIT FEE $ �
and Professions Cotle, Division 3, Chapter 9lM������(� �
� ft/ �/ //J 6 � �-� � PIAN CHECK $ LL
Slenaiuraof � ".S/��/// /�
Permittee �'L(� �- $ (J V V TAX $ �
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AuthorizetlAgent TOTALPAI� $ v, �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
APP I N FOR STRUCI'URAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
REC OATE RECEIVED D TE ISSUED
ADDRESS � ,� t' �I � �C
ry � 1D PERMIT NO.
OWNER S.I V IGLL n A.P.NO.
/ `' ADDRE 5 �%Z `��
ADDRESS ^� �(p�� �=-��•
CITV �! � NE � yS4/� TRACT LOT BLOCK
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CL�ENOER�ION �^/� W A A P
BRANCH
OWNER � !'" �P�
ADDFESS VALUE ����
ARCHITECT TEL. 5
OR ENGINEER N .
FIRE
ADORE55 ZONE T PE � GROUP
� / C�2 APPROVED
CONTRACTOR L BV C DATE ��Z� �
ADDRESS � C
TEL. ZaNE NO.OF�/f USEOFNEW`1
CITV NO. P��h BUILDING �
F STATE CITV YARDSAPPROVED VARDSAPPROVED
� �IC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
W 512E NO.OFBLDGS. (FROM� /LSTRE
a OF LOT NOW ON LOT ONT' FT.
a USE OF /J � �
,.�. EXISTING BLDG. � T FT
�
FSeparate permits are required for L. SIDE FT.O FT.
� electric, plumbing and heating work. REAq Z��i ��,• FT.
� USE OF BUILDING ANO WORK TO BE PERFORME�
DISTANCE BET. BET. MAIN &
�G MAIN BLOGS. ACC6S. BLDGS.
VAR.qW DATE
, C.U.P.M• APGPOVED
Q
} APPROVED � /L �
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0 I heraby acknowlatlBa that I hava reotl thls applieaHon entl smte �
q� thet No ebova InfarmeNon is correct antl agrea to comply with m
d ell lewa repuleNnp bulltlinp conttrucUon, entl I zhell not employ
Z any person In vloleNon of Ne workman's compenaation lewe of
0
� the State oi Celifornle. m
3 I hereby certity that I em proporly Iicenced es a tontteeior unCer Sp. FT. �v
tha Steta ot California Businass entl Profealons Cotle, Dlvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapier 9, antl thet sueh Iicanses ere In full force antl aifect, or I THE PURPOSE OF 6TABLISHING A PEflMR F ONLV: �
am exempt from the provisions ot the Stata of Californla Businau VALV ATION PERMIT PEE �
and P�ofesslons C e, Oivislon 3, Chepter 9. S m
SIB�atura of �/� PLAN CHECK y "�
K o�^--� �
Permlttea TAX E LL
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Au�horiza ABont /((/ TOTALPAID E �--
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