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Home My WebLink About995 17TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mese.ca.us 77 FAIR DRIVE, GOSiA MESA, GA e'Lti1ti BUILDING PERMIT Job nddress: 995 W 17TH ST Suite: Vicinity: Parcel Number: 42438102 Applicant: IWAO KOGA Address: owner: KOGA, JEFFREY K Address %KOGA COLORSCAPE COSTA MESA, CA - - - 2037 WESTMINSTER AVE Contractor. Address: Zip: Arch : AddresS: Phone: Zoning: Phone: 714345-2835 Zip: Phone: Zip: 92627-2137 Phone: License: Eng: Address: Sfatus: ISSUED Applied: Ot/20/2004 Issued: 01/20/2004 ISSUED BY: S �� Phone: Zip; License: License: . SCOPE OF PERMIT T/OFF, FtEPAIR SHEATHING IF NEEDED,.AND REROOF 3000SF RESIDENCE W/COMP SHINGLES. Plan Check: $0.00 Permit: $8325 SMIp Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 FEE SUMMARY , � PLANNING & ZONING SETBACKS MAINSTRUCTURE Fronl 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existinq: . 0 Required: 0 NOTES: Calc Valuation: g3,000.00 Claim Valuation: S3,000.00 Left 0- 0 Right 0- 0 Left 0- 0 Right 0- 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes end related regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION; This permlt shall automatically explre and become vold if work Is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. . INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end all requlred Inspeetiona end finel approval must be obtained, Fallure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 2MBd8 (8/00) �� WORKERS'COMPENSAnON DECLARAnON: . • I �ereby affirm under penalty of perjury one of the following tlecleretions: - ❑ I have entl will melnlain e certificate of consenl to self-Insure tor workers' mmpensation, es pmvided tor by section 3700 of iha Lebor Cotle, tor ihe peAortnance ot the work 1ar w�ic� this permit is issuetl. ❑ I �ave and wlll maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pertortnance of �he work tor w�ic� Nis partnit is Issued. My workers' compensa[ion Insurence wrner end policy number are: Cerner. �� PoliCy Number: (This secfion need not be wmpleted il fhe peimif is valued al one hundretl dollers ($f 00) or less.) ❑� I cenify that in the performance ol ihe work for which this pertnit is Issued, I shall not employ eny person in any manner so as to become subject to the workers' wmpensation laws ot Califomla, end apree that if I shoul0 become subJect to Ihe workers' compensation proNsions of Section 3700 of ihe Labor Cotle, I shell lorihwith comply with Ihese pravisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAW FUL AND SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND QVIL FlNES UP TO ONE HUNDRED TFKKISAND DOLLARE (5100,OW), IN ADDITIqJ TO THE COST OF CAMPENSATION, OAMAGES AS PfiOVIDED FOR IN SELTION 3]OB OF THE IABOR CODE, IPIrEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I here6y aNirm Iha� I am licensed under provisions of Chapter 9(wmmencing with Section 7000) ot Division 3 of the Business and Protessions Code, and my license is in full torce and ettect. Lic. N Class a Comraaor's SigneWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirm that there is e construction lending egency tor the paAormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirtn thet under Denalty ot perjury that I am EXEMPT FROM TME CONTfiACTORS LICENSE lAW for ihe tollowing reason (Sec. 7031.5, Business antl Professlons Code: Any ciry or county whic� requires e permit to construct, elter, improve, demolish, or repair any structure, prior to its issuance, elso requires the applicant tor such pertnit to flle a signed statemem t�at he or she Is Iicensed pursuent to Ihe pmvislons of Ihe Contractors License Lew (Cheptar 9(commendng wlth Secllon 7000) of Division 3 of the Business antl Protessions Cotle) or Ihat he or she is exempt iherelrom and the basis ior the alleged exemption. Any violation ot Section 7031.5 by any epplicent for a Dertnit sub�ects the eppllcent ta e clvil penelty ol nm more than Ilve huntlred tlollars ($500).): ❑ I, es owner of ihe property, or my employees wlth wages as iheir sole compensation, WILL DO TME WORK, entl the slmcNre Is not Intended or oHered for sale (Sec. 7044, Business an0 Professions Code: The Conirectors license Law does not apply to an owner of property who builtls or improves Iheraon, end who does such work himsalt or herself or ihrough his or her own employees, provided that such improvemenis are not Intended or ottered far sale. If, however, ihe building or improvement is sold within one year of wmpletion, ihe ov+ner-builtler will have the burden of proving that he or she did not build or improve for purpase of ule.). ' ❑ I, as owner ot Ihe properry, am E%CIUSIVELV CONTRACTNG WITH LICENSED CON7RAC70RS to consiruct the project (Sec. 7044, Business entl Professions Cotla: Tha contrac�ors License Lew tloes not eppty to en owner ot pmpany who builtls or Impmves thereon, antl who contracts tor such Drqect with e comractor(s) licensa pursuent to the Comractors License Lews.). ❑ I am e: nder sec. Signature: � Business and Pmlessions Coda tor this Owner ID vanfietl Dy dnvers Iicense.0 ❑ Yes ❑ No Drivers ucense No. � Expires: Verificatian of Ownarship by (rype of document, i.e. - praperty ten bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certlty that no exwvatlon flve (5) or more leet In depih Into whlch e person is required to descend, will be mede in connedion with work authonzed by this permit, antl Ihat no builtling structure, scatfolding, talsework, or demolition or dismantling thereof, will ba more Ihen thirry-six (38) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 347, Title 8, Celifomia Administrative Code). ❑ As owner-huilder, I will not employ enyone to do work which would require e permit from the Division oi IntlusMel Satery, es notetl ebova, unless such person hes e permit to ch work from ihe di 'sion. /! �)// Signature: �� ( _ Date: l �� / i� �- Division of Intlusirial Safery Permit Numbec � CEHTIFlCATE OF COMPLIANCE AND AUfHOROATION OF EMRY: I cenity under penelry of perjury that I have read this appliwtion and state that ihe inlormation given is wrrect I egree to comply wlth ell state laws end clly ordlnences relating to Duilding conslmction, antl euthorize rapresentatives of Ihe Clly of Coste Mese to enter upon the ebova-descnbed property for inspection puryoses. I agree not to occupy or ellow acupancy ot eny building au�horized by this permit until final inspectian. cooe r. iNsvecnoNTrve 1616 Fized System Final Fire Prevention 7266 Pool Spa Finel 200 Finel Re-Raol 201 Finel BIocWRetaining well 202 Final Fectory Fire Place � 203 Finel Sign 20C Final Demolition P6ff. 1tRIDAL$ Z-/9-aY � �Date /-�v-D i Date COOE� INSPECTIONTYPE 206 Finel Mechanical 200 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 Final Bulltling/Occupancy QAIF 1t�Lfl