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Home My WebLink About385 22ND ST - Building Permits' CITY OF COSTA MESA ' ' ' BIIILD/NG DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE: B COMBO Sub Type: RES_RRIP PERMIT NUMBER: BC08-00506 STATUS: ISSUED DATE ISSUED: 12112I2008 _ ISSUED BY: YH JOB ADDRESS: 385 22ND ST CM " SUlte/Unit: APN: 42617112 .. � Zoning: , -; . _. � Vicinity: REAR QF HOUSE � � Primary-Occ: R-3 . Const Type: V-B SQ..FT: � 251 • .. �� . Valuation: $40,000.00 SCOPE OF WORK: 251 SF ADDITION TO A"SINGLE STORY SFD. WORK TO INCLUDE THE ADDITION�OF A SITTING ROOM WITH 1 ALTER/R�PAIR HEATWG/COOLING, 7 LIGHT FIXTS, 6 OUTLETS AND 2 SWITCHES. � � - <�,' � . � . . .. . . .. OWNER: ROLLINS, CNARLES JOSEPH �� - Address: � 385 E'22ND ST ' , . . Unit: Phone: 949-463-511t' �� City/Slate/Zip: COSTA MESA, CA � ' � APPLICANT: GAY�OS, JAMES �- Address: " � - Unit: :,- ��t.�`��7j Phone: 916-691-9339 �. „ _.. . City/State/zZip: . , � � � CONTRACTOR: � ' . � � . Phone: � - Address: Unit Cell: �, _ City/State: , ARCHITECT: �- � � License No. � � ENGINEER: QIANG XIAO � - License No.C66510 COMBINATION PERMIT FEE=SUMMARY Building Plan Check: - � - . $353.11� � � 8uilding Fees: $54325 Electrical Fees: $40.00 Mechanical Fees: � $37.20 � � Plumbing Fees: $0.00 . ' SMIP Residential: $4.00 SMIP Commercial: , $0.00 TOTAL FEES; $977:56, "Refer lo fee receipts fer all fees paid for project �� License No. ZipCode PHONE: PHONE:949-261-7740 4=` L��Yy � `�.K � tF r:,. ' �s- r _-f. �� ` •^ i NOTICE: The work authorized by lhis permil shall comply with all applicable handicap access requirements under California statules 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. INSPEC710N5: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable wdes, and all required inspeetio�s and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. cooet. iNsvEcnox.rve � ixnnn� � ixsvecnoxrme o�h wmui 1616 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool SOa Final 208 Final Plumbing 200 Final Re-Roof 270 Final Electrical 207 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Fadory Fire Place 220 Final Planning Approval 203 FinalSign 222 FinalSite __�� 204 Final Demolition 250 Final BuildinglOccupancy 71 � WORKERS' C�OMPENSATON DECLARATIO� I hereby aHirtn under penalry of perjury one o( the following tleclarations: ❑ I have and will maintain a certifwte of consent to self-Insure for workers' compensation, as provided (or by section 3700 of the Labor Code, for the performance of the work for which this pertnit is issuetl. ❑ I have and will maintain wurkers' compensation insurance, as required by section 3700 of the Labor Cotle, for the peAortnance of the work for which this pertnit is issued. My warkers' compensation Insurance carrier antl policy number are: Cartier. (Tha secm needml6e mmpefed /t�re pemq s vaNeO af are �untlred Edlars f5100J wMss7 Policy Number: ❑ I ceAity Nat in the peAormance o/ ihe 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 Califomia, and agree that i! I should become subject to lhe workers' compensation provisions of Section 3700 of lhe Labor Code, I shall forthwith comply with [hese provisions. Appfiom'S SignaWre 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 DOLIARS ($700,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 0! the Business and Pro(essions Code, and my license is in full force and effect. Lic. # Class # Gomro<tor's Sgnawre �a�e CONSTRUCTION LENDING AGENCY: ❑ I hereby a(firtn thal lhere is a consiruction lending agency for the perfortnance of the work fa which this pertnit is issued. (Sec. 3097, Civil Code�. Lender's Name: Lender's Address: SiB�aWre �ale OWNER-BUILDER DECLARATIONS: I hereby aKrtn that under penalty o( perjury �hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7037.5, Business and Professions Code: Any ciry or counry which requires a permit to wnstruct, alter, impmve, tlemolish, or repair any slrucWre, pnor ro its issuance, also requires the applicaN for such permit to Ole a signed sta[ement that he or she is licensed pursuanl lo the provisions of the Conlractors License Law (Chapter 9(wmmencing with Section 7000) o( Division 3 of the Business and Professions Code) or that he or she is exempt therefrom antl the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant tor a permit subjects lhe applicant ro a civil penalry of not more than five hundfetl dollars ($500).�: ❑ I, as ovmer of the property, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the slructure is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply to an ovmer ot property who builds or improves thereon, and who dces such work himsel( or hersel( or lhrough his or her ovm employees, provideA that such improvements are no� intended or offered (or sale. If, however, the builCinq or improvement is sold within one year of wmpletion, the ovmer-builtler vrill have the buiden of proving that he or she did n build or improve for purpose of sale.). I; as ovmer of �the property; am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to cons[rucl the project (Sec. 7044, Business and Professions Code: The cont2ctas License Law Cces not apply to an owner of property who builds or improves thereon, and who contracts fa such project with a contractor(s) license pursuant tOlhe Conlractors License Lavrs.). ❑ I am ezempt under sec. Business and Professions Code for lhis reason: �Z �Z Z�� Signewrc j Date JOS]-a6 (3/O))— � Ovmer ID verified by Ari�cense. ��Yes ❑ No �' ; �Dnver s License No. � , Expires: � 0�3 �o -/ � Verification of Owners�ip by (rype of tlocument, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: .- ❑ I hereby certRy Ihat no excavation frve (5) or more feet in deplh into which a person is required to descend, vrill be made in connection with wvrk auttrorized by ihis pertnit, and Ihat no building sWcture, sc�fdding, false�wrk, or tlemolition or dismantling thereof, will be more Ihan ihirty-siz (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sea 341, Title B, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do vrork which vrould require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such vrork from lhe division. AOPliwnfs SignaNre Division of IndusMal Safety Pertnit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or luWre building occupant need lo file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Sec[ion 25505 of the Califomia Health and Safety Code requires, v+ith some exceptions, that a Business Plan be filetl with the Costa Mesa Fire Departmenl by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater Ihan a weighl o( 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 2. Does or will Ihe applicant or present or (uture 6uilding occupant need ro file a registralion form for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions. requires registration wilh the Cosla Mesa Fire Department by each business which at any one time has on hand a quantity o! acutely hazardous ma[enals equal to or greater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al standard temperature and pressure). 3. Does or will [he applicant or present or fulure building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutey hazartlous matenals)? ❑ Yes ❑ No (Seclion 25534 of [he Calitornia Health and Sa(ety Code provides thal Ihe Costa Mesa Fire Department may require Ihe preparalion, certifca�ion and filing with the Fire Department of an RMPP by businesses which are requiretl to register acutety hazardous materials wilh [he Fire Department. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and SaFety Code been fully complietl with'7 ❑ Ves ❑ No 5. Does or will �he applicant or present or future building cecupant require for the work which is the subject of lhis applicalion a permil for such wnslruction or modification (rom the South Coast Air Qualiry ManagemeM District or from any other air pollution conlrol tlistnct or agency? ❑ Yes ❑ No (Section 658502 0( ihe Califomia Govemmen� Code requires ihat ihe requested informa�ion be fumished on applications fa noo-residential builtling permits). 6. Will any part o( the facility to be constructed under this permit be within 1000 fee� from [he outer boundaries of a school? ❑ Ves ❑ No Qf yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cali(omia Health and Safety Code�. 7. If a pertnit (rom the South Coast Air Qualiry Management Disirict or other air pollution wn[rol disMct or agency is requiretl for [he work which is the subject of this application, have all of [he disclosures prescribetl by Calitomia Health and Sa(ety Code Section 42303 been ma0e? ❑ Yes ❑ No 8. pf'j�es", allach certifiwte of compliance from the appmpriate airpollution control oKcer�. ' - �" CERTIFICATE OF COMPLIANCE: I�certify that urider penzlty of perjury the infortnation given above is wrtect. I agree to compty with all stale laws antl ciry ordinances regarding Hazardous Malenals and Emissions. � SignaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury tha[ I have read this application and sta[e Ihat Ihe information given is coaecL I agree to comply wilh all slate laws antl city ordinances relatlng to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-0escribed property for inspection purposes. I agree not ro occupy or allow occupancy of @@ny building authory[gtl by is peimit unlil final inspection. '� ,,2 1 � 2� Zw p L�� ignaWreofLegalOwner�s)' ' Dale Nndbr Aul�onz¢0 Ap0licanl