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Home My WebLink About13781 OLYMPIC AVE - Building Permits(714) 754-5273 • Fax (714) 7544656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 13781 OLYMPIC AV Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 14153106 Zoning: Applicant: WHITNEY, ROBERT Applied: 09/26/2002 Address: PO 15396 $0.58 SMIP Com: $0.00 Phone: (949) 548-0769 $0.00 NEWPORT BEACH , CA Zip: 92659 Owner: KOELLER, DOROTHY A TR Address 13781 OLYMPIC AVE Phone: COSTA MESA, CA Zip: 92626-3010 Contractor: WHITNEY ROOFING Address: PO 15396 Phone: (949) 548-0769 NEWPORTBEACH,CA Zip: 92659 License: 406022 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 09/26/2002 Issued: 09/26/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF: T/O EXISTING COMP SHINGLES, REPAIR SHTG AS NEEDED, 1 LAYER 15# FELT, APPLY "30 -YEAR COMP SHINGLES." 30 SQUARES Plan Check: $0.00 Permit: $125.25 SMTP Res: $0.58 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.83 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY Calc Valuation: $5,812.00 Claim Valuation: $5,812.00 PLANNING & ZONING 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 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 2m646 (6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: r ❑ 4 have andWII 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 ork for which this permit is issued. I have and will maintain ��yqorkers' co nsation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers', rids fon I ura c carder and policy number Carrier: Policy Number: (This section need not b completed It the permit is value one hundra dollars ($100) or less.) ❑ I certify that in the performance of the work for w is permit' issued, I shall not employ any person in any manner so as o become s ject to the workers' compensation laws of California, antl agree the o bec a subject to the workers' compensation provisions of S n 3700 A th Labor Code, I shall forthwith comply with these provisions. b Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMP NSATION COVERAGE IS UNLAWFUL AND SHlLL1 SUBJECT AN EMPLOYER TO CRIMI PENALTI AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,0x0), IN ADDITION TO E COST OF COMP TION, DAMAGES AS PROVIDED FOR IN SECTION 3]06 OF THE R 00 ,INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ons er 9 mmencing with Se " n 7000) of Division 3 of the Business and Professes Code nd my 'cense is In full force and effect. Lic. # d Class # Contractor's Signature: Date: 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, Civ' Code). Lenders 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 fallowing 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 chril 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 Cade: 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 contractors) 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 certity 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, felsework, or demolition or dismantling thereof, will be more than thirty-six (36) teat high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, 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 [he 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 o1 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? ❑ Yes ❑ No .................._......................................................................................................._._................a'n"i........ui"re"f'........................................................u'bj.............t.h.1........................................................... c-h-..'w"" "s"t...............'o* r............_........_.n. 5 Does or will the ap Coast Air or present or future building occupant require for the work which is she subject c this a plication e8Eertnil for such construction or modiflcellon from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................_...........__............_..............._............... .... _.................................................... ......................................................................... _............................. _....................................................................................................................... 8 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 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 ........._............_......_......... _......... __.............................. ................................................................................................................. ..........._... _......................... .... _.................... .... _................. ................... -.............. ..................................... ......... 6 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under pe Ity 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 A TION OF Y: I certify under penalty of perjury that I have read this application and state hat the Information given is correct. I agree to compty with all at aw nd city ordin Cas relating to building construction, and authorize representatives of the City of osta Mesa to enter upon the above-described property for insp 'On p ogre of to occupy or allow occupancy of any building authorized by this permit until finali peciion. Sig L al ner(s) at �J dlOr Authorized Applicant D to CODE, t, IN$PECf10N TYPE 2M IIfIIIlA6$ CODE 0 INSPECTION TYPE gajE INTMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof �0� 210 Final Electrical 201 Final BlocWRelaining 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 BuildinglOccupancy Property Profile Property Profile ® 2003 DataQuick Information Systems This information is compiled from public documents and is not guaranteed. Property Characteristics Primary Owner: KOELLER,DOROTHY A TR Secondary Owner: Mail Address: 13781 OLYMPIC AVE COSTA MESA, CA 92626 Site Address: 13781 OLYMPIC AVE COSTA MESA, CA 92626 Telephone Number: APN: 141-531-06 Reference APN: Census Tract: 639.082 Housing Tract Number: 3885 Lot Number: 13 Page Grid Old: 27-F3 Page Grid New: 859-D4 Legal Description: N TR 3885 LOT 13 Subdivision: Bedrooms: 3 Year Built: 1962 Square Feet: 1,312 Bathrooms: 2.0 Garage: Lot Size: 8,978 sq ft / 0.21 acres Total Rooms: 6 Fireplace: Number of Units: I Zoning: Pool/View: Use Code: Single Family Residence Heating/Cooling: Sale & Loan Information Transfer Date: 11-04-1986 Seller: Document: 0000529012 Transfer Value: $120,000 Cost/Sq Feet: $91.46 Title Co.: First Loan Amt: $107,900 Lender: In Mortgage Last Trans W/O$: 08-28-2001 Loan Type: Interest Rate Type: Last Trans W/O$ Doc: 0000598051 Assessed & Tax Information Assessed Value: $158,453 Land Value: $92,045 Improvement Value: $66,408 Percent Improvement: 41.91 Tax Amount: $1,858 Tax Status: current Homeowner Exemption: Y Tax Rate Area: 15219 [ Report Menu ] [ Select New Target Property ] Page 1 of 1 http://www.gotitle.com/cgi-binlprofi le.asp?rmt=TOPS&graphic=%2Faccountsn/`2FT07378%2Fcompan... 03/17/2003