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Home My WebLink About989 OAK ST - Building Permits(714) 754-5273 • Fa�c (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 989 OAK ST Suite No Vicinity: Parcel Nunmber: 42247101 Applicant: GLOVER, LORIE Address: 2737 S CRODDY STE D SANTA ANA, CA Owner: VAN DOORN. HENNIE PLUMBING PERMIT Phone: (714)241-1414 Zip: 92704 . Address 954 GOVERNOR ST Phone: COSTA MESA, CA Zip: 92627 Contractor: COAST ROOTER PLUMING HEATING & AIR CONDITIONING Address: 2737 S CRODDY STE D SANTA ANA, CA Arch / Eng : � - Address: - . Phone: (714)247-1414 Zip: 92704 . License: 529727 -�, . �-. - � • - .-- . _ .✓_ � _ f. _.. .. _ . � . Phone: � . - ` ' _-.ZiP, . - � _ . Lioense: .� Status: ISSUED Applied: OS/08/2001 Issued: 05/08/2007 ISSUED BY: • ' M� � ��`�. • SCOPE OF PERMIT� '! .. � � ' WATER HEATER CHANGEOUT ��;�� - ' ' ` �,..: , �- . . - - .i;� � � r. -. ., . : �,. . f � � � � "` FEE'SUMMARY� ��% � � ,� � �� r � � � � AMT . � QTY -. . � � - ' �= AMT "�TY i ,�,� . � , ' - AMT ISSUE FEE $23.50 - �s�`. Laundry Tub / Washer �� $0.00 � -0 � � � �'''.Suinp Pump ' � $0.00 Backflowirrigation.� �$0.00 �0�� '_Landscapelrngahon' =�� $0.00 �0 " �=Swu4immg-Pool �%.'i$0.00 Backflow Preventer_ A (,� $0 OOi� 0 V� �P Trap -i '" " : $0.00 � 0 � � � �iTrap Primer ' �i j $0.00 Bathtub `� �.>� $0.00�� ; 0� �;Pressure Regulator� �-. p $0.00 � 0�� Unnal ; � �i� �/ `% $0.00 Clarifier System � � � �'- $0.00' i �0� �� ^ Process Piping.(per 10 ft) .; $0.00 ;-;0�%� ! Vacuum'Brkr Bkflow(1-4) $0.00 Connect (Ice,Soda,etc) � ' $0.00 �.' 0 � � . Receptors. $0:00 0 \�`. Vacuum�8rkr Bkflow(5+) $0.00 Dental Units $0.00, � 0 - ' . �Septic Tank - $0.00 ;0';�� '� `� Wash Bzsin � $0.00 Dishwasher $0.00, _ � , 0 � � �( � Sewer Cap for Demo, : - � $0.00; _ ", 0' ` �' Wash-Basin Set $0.00 Drain, Floor $0.00� . 0 -� � ' Sewer Connect � � � $0.00 . �. 0 '/ -Waste and Vent System $0.00 Drain, Rainwater $0.00 - 0 : - Sewer Private Line � $0.00- -- 0 � %<�N/ater Closet (Toilep $0.00 Drain, Roof $0.00 0 � , ?Shower -� � � $0.00 ,- 0 -; "-'.-`-�'WaterHeater/vent $12.30 Drinking Fountain $0.00 0 � �Sink, bar . � - �- $0.00 � `"0 � Water Piping Qnst or RepJ $0.00 Expansion Tank $0.00 0 Sink, commercial� -,�-. J$0:00� ' 0 Water Re-pipe $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor 50.00 0 Water Service $0.00 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Sokener $0.00 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: E35.80 COMMENTS I SPECIAL CONDITIONS QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 C 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, 12-27�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 au[horized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetiona 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) 7545626 2446�46 (&00) WORKERS'COMPENSAnON DECLARATON: I hereby ettirm unCer penalry ot perjury one of the following tleclaratlons: - ❑ I heve and will maimain a certifcete of consem to setl-Insure for workars' compensetion, es provided tor by section 3700 of the Lebar Coae, tor the pertormance of Ihe work tor w�ith this pertnit is Issuetl. �[�I have erW will maintain workers' compensatlon insurance, as required by secUon 3700 of the Labor Code, br Ne peAortnanca ol the work for which ihis permit is issueG. �My,worker ' wm ensatl Insurenc carner and policy number ere: _ r- Certie��'��(.�-In � Policy.Numtier�� lL.�iO a �^�'�� (TM1is section need not be comp/eted il t e permit is ve/ued et one hunOred dollars ($700) or less.) ❑ I certily that in the pertortnance of Ne work for which this pertnit is issued, I shall not employ eny person in any manner so as to heComa suDjett to Iha wOrkers' compensetion laws of Califomia, entl egree that If I s�oultl become subjact to the workers' compensation provisions o1 Sactlon 3700 ot ihe Labor Code, I shell forthwlih wmply with these provisions. O ApPlicant Signature� ��' CDate:— �S' /1 �0 I �--- WAFiMNOr FAILUR � ECURE WOHKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHP1L SUBJECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TVKK1SrW 0 OOLLARE (5100.0OO�.IN ADORIIXJ TO THE CQST OF COMPENSATION, DMMGESlS PROVIDED FOR IN SECTION 3)W OF THE LA60R CODE, ItJrEPEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby aXirm Ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business antl Professions Code, end my license is in full rorce enC eNect' �c..k, -� ,� anj /d "� �_ �lass a� —�� CONS7RUC710N LENDING AGENCV: � ❑ I hereby aRirtn that t�ere is a consiruction lentling agency tor the pertormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lentlefs Name: Lendefs Address: Signe�ure: Da�e: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet under penalry of perjury Ihet I am El(EMPT FROM THE CONTRACTOHS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business entl Professlons Code: Any city or county which requires a Dermit to consiruct, alter, impmve, tlemolish, or repair any structure, pnor to its issuance, also requires Ihe epplicant for such permit to file e signed statement thet he or she is Ilcensed pursuant to the provisions of t�e Coniractors License Lew (Chapter 9(commencing wiN Section 7000) oi Division 3 of Ihe 8usine55 antl Professions�.Code) or ihat he or she is exempt thereimm and the basis for the alleqed e:emption. Any violetion af Sectlon 7031.5 6y eny applicant for a pertnit suhjacts the applicanYto e iivifpenalry of not more Ihen five hundred dollars ($500).): �:tiu �rr �r._�_ ❑ I, es owner ol the property, or my,employees with wages es their sole compensation, WILL DO THE WORK, and the strucwre is not intentlea or oflaretl for sele (Sec. 7044, Business and Professions�Code: The Contractors License Ww does not appry to an owner ot property who builds or improves ihereon, and who does such work himself or hereelt or Ihrough his or he�ovin'employees, provided ihat such improvamen�s are not intended or oHered for sale. If, however, the building or improvement is sold within ona year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for Ourpose of sale.). ❑ I, es owner of the properry, em E%CLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS to construct the project (SecJ04a, Business antl Protessions Code: The wniractors License Law tloes not appry to an ownar oi propeny who bullds or Improves thereon, antl who contracis for such project with e contractor(s) license pursuant to Ma Contractors License Laws.). ❑ I em exempl under sec. Signature: Owner ID verifietl by drivef5licen5e. ❑ Ves ❑ No Business and Professions Coda tor ihis reason: Verification ot Ownership by (rype of tlocument, i.e. - D��Perry ta�c bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMR CERTIFICATION: Orivers Licanse No. Date: Expires: ❑ I hereby certity that no excavatian five (5) ar more feet in depth into which e person Is required ta descend, will be made in connection wiih work authonzetl by this pertnit, and that no building sifucture, scallolGing, talsework, or tlemolition or dismantling Ihereoi, will ba more �han thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative CoCe). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industrial Safety, as noted above, unleu such person hes e permit to do such work from Ihe division. SignaWre: Oate: Division ot Industrial Safery Pertnit Number: CERTIFICATE OF COMPLIANCE AND AIJTHORVATION OF ENTAY: I certity under penalry of perjury Ihat I �ave read this application and state Ihat tha information given is cortect. I egree to comply with ell state laws end ciry ordinances relating to bullCing constmction, end authorize representatives of the City of Costa Mesa to enter upon �he ahave-descri6ed property tor inspecUon Qurpases. I egree not to occupy or allow occupancy of any building authoRzed 6y this Dermit until tinal inspection. CODE �. INSPECTIONTYPE 1618 Fi:etl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re�Root 201 Final BIocWRetaining Wail 202 203 Final Faciory Fire Place Final Sign 204 Final Demolition j1� I IRL fi00E 1 INSPECTION TYPE 206 Final Mechenical 20B Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �5' 8=o j Dele�_� QeSE ItlIID�li L � . � � ' , _� r : r � CITY OF COSTA MESA F BlIILDING DIVISION Ft � 77 FAIR DRNE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.0 � �.�,�fe � FOR INSPECTIONS CALL: (7'14) 754-5626 fi PERMIT NUMBER BC07-00293 PERMIT TYPE: B COMB02 STATUS: ISSUED Sub Type: RES_RRIP DATE ISSUED: 12/OS/2007 � - ISSUED BY: JOB ADDRESS: 989 OAK ST CM ` Suite/Unit: naN: azza�i0i Zoning: . Vicinity: ' Rrimary Occ:' 7 Const Type: V-N , "�� SQ �FT - 519 � � -�Valuation: $56,963.00 i. t -.,v i.�"r - SCOPE OF WORK:'CONVERT�EXISTING 256SF GARAGE TO A LIVING/DINING ROOM WITH THE ADDITION OF 109SF TO THIS ROOM. CONSTRUCT A NEW�410SF ATTACHED GARAGE WITH LAUNDRY FACILITIES: ELEC: 14 LIGHT FIXTURES, 16 OUTLETS, 8 SWITCHES, 1:RES'APpL;,MECH: 1 REPAIR/ALT COOUHEAT; PLUMBING: T BACKFLOW PREVENTER, 1 GAS OUTLET UP TO , ` �' , „' � : , -. ..'. 4, 1 LAUNDRY TUB/WASNER;-1 SVSSINK,�1 TANKLESS,WATER HEATER, RELOCATE WATER SVS. � . .. . r 'f ... . . . . . . - . . .- , .. OWNER: R4PP, EDDIE ;_" J .. - - Address: 989 OAK ST � - .. _ . �� Unit: , . . , Phone: 714•915-2808 � . --City/State/Zip: COSTA MESA, CA - , - , -. � APPLICANT: RAPP, EDDIE � "Address: 989 OAK ST . , . - � , � 't �-Unit : Phone: 714-915-2608 �. -' ' � - � �City/State/zZipi�'� COSTA MESA, CA .- - � �� , CONTRAC70R: OWNER-BUILDER � -- - - � � � ��License,No.- 000000'� - ' Phone: , -� Address:'�" Unit: � . ,. ' � Cell: ;:i City/State: � � _ � , , ,'}ZipCode ARCHITECT: - .i��;��;. - ��..., License.No.��-�- - .�� ' ��`PHONE: ENGINEER: JAMES HU '� - ,-��'� License No.68736 -.�, . PHONE:NONE PROVIDED COMBINTATION PERMIT FEE SUMMARY :- � _. Building Plan Check: ,, $45029', ' , Building Fees: $692 75 = � Electrical Fees: � �- $65 30 ` " -' = � Mechanical Fees ;, $37 20 �� J Plumbing Fees: ' $78.65 SMIP Residential: $570 ;', � SMIP Commercial: $0.00 " - �� TOTAL FEES: $1,329.89 "Refer to fee receip[s tor all fees paid for project . "� Hi5 � 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 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. COUE N. INSPECTION TYPE 7616 Fiaed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 204 Final Sign Final Demolition DATE INTITIALS � COOEp INSPECiIONttPE 206 Final Mechanical 208 210 212 Final Plumbing Final Electrical Final Fire Prevention 220 Final Planning Approvai 222 Final Site 250 Final Building/Occupancy �%/!1 rl UATE INTITIRLS iiY.> 1 � � WORKERS' COMPENSA710N DECLARATION: � I hereby aKrm under penalty of perjury one of the (ollowing declarations: � I have and will mainlain a certifcate o( consent to self-Insure for workers' compensalion, as provitletl for 6y section 3700 of lhe Labor Code, for the peAormance of the vrork for which lhis permit is issued. ❑ I have antl will maintain v.orkers' compensation insurance, as required by section 3700 of [he Labor Code, for the peAortnance of the vrork for which this permit is issued. My workers' compensalion Insurance carrier and policy number are: Carner. (�his stt]un nee0 rot De mmpefe0 ett�epenM a vawetl at me nuntlred cta'lars (E1 W) mless ) Policy Number: I certity that in the perfortnance o( the work for which lhis pertnil is issued. I shall not employ any person in any manner so as to become subject lo lhe vrorkers' compensation laws of California, and agree that if I shoultl become subject to the workers' compensation provisions of Section 3700 of ihe Labor Code, I shall forthwith comply with [hese provisions. ' � / /��SfiU% Appican�SSigna� e Dale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, 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 affirm that I am licensed under provisions of Chapter 9(commencing with Seclion 7000) of Division 3 ot lhe Business and Professions Code, antl my license is in full force and effect. Lic. # Class # Conlraclor's Signa W re CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affum lhat there is a constmction lending agency (or the peAortnance of the wurk for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress: "� � , Signamre ' <. Date .. • 4.,. OWNER-BUILDER DECLARATIONS,, •�.; ,� „ I hereby atfirm that under penalty of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE:LAW,for Ne following reason (Sec. 703L5, Business and Pmfessions Cotle: Any ciry or counry which requires a permit to construct, alter, impmve<,de�olish, or repair any structure, prior to its issuance, also requires the applicant tor such permit to file a signed statement Ihal he on 5he is licensetl pursuant to Ihe provisions of Ihe Contractors License��Law (Chap[er 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��foi the alleged exempuon. Any violation of Section 7037.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than fl,ve/ hundred Gollars ($500).): ly I, as owner of the property, or my employees with wages as their sole pfT6pensation, WILL DO THE WORK, antl ihe strucNre is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves [hereon, and who does such work himsel( or herself or through his or her ovm employees, provided that such improvements are not intended or offered for sale. If, however, [he building or improvement is sold within one year of completion, the owner-builder will have lhe 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 UCENSED CONTRACTORS lo conswct the project (Sec. 7044, Business and Professbns Code: The contractors License Law dces not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contracta�s) license pursuaN to the Contraclors License Laws.�. ❑ I am exempt untler sec. Business and Professions Code for this reason: s ,,� /2 S O% jy aw ate 305]-46 (3IOl � � .,, . Owner ID verified by drive Ves ❑ No Driver's License No. ��/�� Expires: �� 7 JFj Verifcation of Ownership by (rype of documen�, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavatbn Me (5) or more (eet in tlepth into xTiich a person is required to descend, will be made in conneclion vrith Hork aullrorizetl by this pertnit, antl that no building sWcture, scaHdding, falsev.ork, a tlemolition or dismantling lhereof, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 311, Ttle 8. Calitwnia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which vrould require a permil from the Division of Industrial Sa(ety, as noted above, unless such person has a permit to do such work from Ihe division. ApPliwnfs Siqnalure Division of IndusMal Safety Pertnit NumDer: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will [he applican[ or present or fuNre building occupant neetl to file and certify a Business Plan for emergency response to release or lhreatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of ihe Cali(ornia Healih and Sa(ety Code requires, vnth some exceptions, that a Business Plan be fled wilh the Cosla Mesa Fire Depariment by every bu5ine55 which has at any one time dunng a reported year a quantity of hazartlous materials equal lo or greater Ihan a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant neetl ro file a regis[ration form for acutely hazardous materials? ❑ Yes ❑ No (Sec�ion 25533 of Ihe California Health and Satety Cotle, with some exceptions, requires registration wi[h lhe Costa Mesa Fire Department by each business which at any one time has on hantl a quantily of acutery hazardous matenals equal ro or greater Ihan a weight o( 500 pountls, or a volume of 55 gallons, or 200 cubic fee[ of compressetl gas at standard temperature antl pressure). 3. Does or will the applicant or present or fuWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides ihat the Cos[a Mesa Fire Department may require lhe preparation, certification antl filing with the Fire Department of an RMPP by businesses which are required to register awtety hazartlous materials with [he Fire Departmen[. 4. If an RMPP is presently required, has Section 25534 of the Cali(omia Health and Satety Code been fully complied vrith? ❑ Ves ❑ No 5. Does or vrill the applicant or present or future building cecupant require for the work which is the subjec� of this application a permit for such construction or modifcalion fmm the South Coast Air Quality Management District or (rom any other air pollution control tlistricl or agency7 ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires that Ihe requested information be fumished on applications (a rron-resiaential building pertnits). 6. Will any part of the faciliry to be consWcted under Ihis pertnit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No �(If'yes", Ihe facili[y musl meet lhe requirement of Sections 25534 antl 42303 of the Califomia Heal[h and Safety Code). 7. I( a permi[ (rom the South Coast Air �uality Management Dis[ricl or other air pollution control dislrict or agency is required for lhe work which is the subject of this application, have all of the disclosures prescnbed by California Health antl Safety Cotle Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance trom Ihe appropriate air pollution control oKcer). CERTIFICA7E OF COMPLIANCE: I certify that untler penalry of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Matenals antl Emissions. oa�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify untler penalty of perjury that I have read this application antl state that the informa[ion given is correct. I agree lo comply vnth all state laws and city ordinances relating to building consWction, and authorize representatives of the City of Costa Mesa to en[er upon ihe above-tlescribed property for inspection purposes. I a ree not to occupy or allow occupancy of any building authorizetl by qi i un i fnal inspection. � S 6� ' Signawre of gal er�s) Da�e An0/or Authonzed Appli W n� Da�e ` • . � I ' / / I / �I / • // � ' ♦ / OWNER-BUILDER VERIFIC�►1"lON Address: � / d�� c�� I�iT%% ///�S/� �� % Permit #: �W�`��,� �� A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and; as a condition precedent to issuing a building permit, require the comple[ion and require the return o£, an owner- builder verification. Attention PropeRy Owner: An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for cons[ruction of the proposed property improvement. �' Yes ❑ No 2. I(have/have not) �i?/Gy� signed an application for a building permit for the proposed work. 3. I have contracted with the following person (Fian) to provide the proposed construction: Name Address City _ Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name �Jiv�ilL KEfl��t.� Address (�%i'.L� �% City �� Phone ( ) Contractor's Lfc. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name !'�� Address Phone Type of Work /�19�-D%�L f4{fcY9L�S d9,�� S� S>�/�I2UI.S/c� 1042-46 (Rev.11104) � CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT New State Law: Swimming Pool Safety Act of 2006 (Assembly Bill 2977) Effective January 1, 2007 California Health and Safery Code Section ll5928 "(d) Whenever a buildin� permit is issued for the remodel or modification of a sinQle family home with an existin� swimming pool, toddler pool, or spa, the permit shall require that the suction ouUet of the existing swimming pool, toddler pool, or spa be upgraded so as to be equipped with an anti-entrapment cover meeting the current standards of the American Society for Testing and Materials (ASTM) or the American Society of Mechanical Engineers (ASME)." �Qii 0��,�" c5'L. %'ZG�Z �7 Adclress/Permit Number Permit Applicant or Contractor's Affidavit (Please check appropriate box): ❑ There is an existing swimming pool, spa, or toddler pool on this property. I will install an anti-entrapment device that conforms to this law, and I understand that the installation of Ihis device is required prior ro final building inspection approval. �There is no swimming pooP, spa, or toddler pool on this property. �P�� ' ��P� �'ame (please pri Sighature/Date Buildin9 Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245 FAX pt4) 754-4856 • TDD (714) 754-5244 • w.mv.ci.costa-mesa.ca.us (714) 754-5273 • Fax (714) 754-4856 Job Address: 989 OAK ST Suite: Vicinily: HOUSE & GARAGE Parcel Nunmber: 42247701 npplicant: FUNKE, KEN Address: CITY OF COSTA MESA BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Owner: VAN DOORN, HENNIE Address 954 GOVERNOR ST COSTA MESA, CA Contractor: FUNKES ROOFING Address: 19622 RUMSEY LN Arch : Address: HUNINGTON BEACH, CA Zip: 92646 Phone: BUILDING PERMIT Zoning: Phone: Zip: Phone: Zip: 92627 Phone: (714)645-0193 License: 348877 Eng: Address: PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 03/26/1999 Issued: 03/26/1999 ISSUED BY: � D / I �� Phone: Zip License: Zip: License: SCOPE OF PERMIT REROOF - T/O, NEW 25 YR COMPOSITION SHINGLE ROOF (i800SF). 1 LAYER 30# FELT, USING EXISTING SHEATING. Plan Check: Permit: SMIP Res: SMIP Com: Other: I nspection: Total $0.00 $87.25 $0.50 $0.00 $0.00 $0.00 $87.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $3,900.00 $3,900.00 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: This pertnit 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 Inapeetione end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 WORKERS' COMPENSATION DECLARATION: I hereby eftirm untler penalry of perjury one of �he tollov.•ing tleclaratians: � � � ❑ I �eve and will maintein e cenificate ot consent ta selt-Insure far workers' compensation, as Drovitled for by sectlon 3700 of ihe Labor Cotle, for ihe pertortnance of ihe work for which Ihis permit Is Issued. ❑ I have an0 will maintain wwkers' compensatlon inwrance, as required by section 3700 of the Labor Code, tor the pertortnance of Ne work tor which this permlt is issued. My workers' compensatian Insurence certier end policy number ere: Carner. Sr�'T �U lJ� Palicy Number: (Thfs sectlon need nat be completed il fhe permit Is valued af one huntlretl Collars ($100J or less.) ❑ I certity Ihat in the pertormence of the work for which Ihis pertnit is issued, I shall not employ eny pereon in any manner so as to become subject b tlie workers' comDensetion laws of Californie, end agree ihat if I should become sublec� to the workers' compensation provisions of Section 3700 of t�e Lebor Code, I shell forthwith complywilhihese � visions. C Applicant Signeture: r � � Date: � — � — 4 � WARNINO: FNLURE TO 5 CURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SIiALI SUBJECf AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THWSAND DOLLARE (5100.000). IN A�DITION TO THE WST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 3]O6 OF TNE LABOR ODDE, INfEREST, AND ATTORNEYS FEES. LICENSED CON7RACTORS DECLARATION: I hereby aNirm Ihat I em licensetl under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Businass entl Prj �fesslons Code, end my license is in full force and eHecL Lic. x 4- 7 qass # G— 3—I Contractofs Signawre:' w Date: .3 — Z — CONSTRUC710N LENDING AGENCV: ❑ 1 hereby affirtn Ihat Ihere Is a construction lending egency for the pertortnance of Ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lentlefs Address: Signature: Date: OWNER•BUILDER DECLARA710NS: I hereby eflirtn that under penalry ot perjury ihat I em EXEMPT FROM TME CONTRACTOHS LICENSE LAW for the following reason (Sec. 7031.5, Busineu antl Protessions Code: My ciry or county which requires a permii to construct, alter, improve, demolish, or repair eny sWcture, prior to its issuance, also requires the applicent for such permit to file e signetl stetement ihat he or she is licensetl pursuam to the pmvisions of the Contractors License Lew (Chapter 9(commenGng wlth Section 7000) ot DlNslon 3 of t�e Busineu ana Protessions Cotle) or Ihat he or she is ezempt iherefrom and the basis tor ihe alleged exemption. Any violetion of Section 7031.5 by any appllcent for e pertnit sublects ihe epplicant to e civil penalry of not more than five hundretl dollars ($500) J: ❑ I, es owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the stnuture is not intentletl or oflered lor sele (Sec. 7044, Business antl Professions Code: The Contrectors License Lew does not apply to an owner of properry who builds or improves thereon, end who does such work himself or herself or through his or har own employees, provided that such improvemenis ere not intentletl or ottered tor sale. If, however, the building or improvement is sold wit�in one year of wmplation, Ihe owneabuiltler will have the burden ot proving Ihet he ar she did not build ar Improve for purpose of sale.). ❑ I, es owner of lhe property, am EXCLUSIVELV GONTRACTING WfT}1 LICENSED CONTRACTORS to consiruct iha pro�ect (Sec. 7044, Business end Protessians Cotle: The conirectors License Law tloes not apply to en owner of property who builtls or improves thereon, and who contrects for such project with a contractor(s) license pursuaN to t�e Contractors License Laws.). ❑ I am ezempt under sec. Business entl Professions Cotle for this reason: SignaNre: Date: Owner ID verified by dnver's license. ❑ Yes ❑ No Dnvers License No. Expires: Veritication of Ownership by (type oi tlocumen�, i.e. - pmperty tax bill or Ceed): DIVISION OF INDUSTRIAI SAFETV PERMIT CER7IFICATION: ❑ I hereby certlfy that no excavation five (5) or more feet in depth Into which a person is requiretl to tlescend, will be made in connedion wlth work authorizetl by this pertnit, and that no Duiltling structure, scaHoltling, talsework, or demolition or dismantling thareof, will be more than ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Califomia AOministre�ive Cade). ❑ As owner-builtler, I will not emDloy anyone to tlo work which woultl require a permit From �he Dlvlsion of Industnal Safery, as notetl above, unless such person has a pertnit to do such work irom the division. Signature: Dete: Division of Indusinal Safery Pertnit Number: CEH'TIFICATE OF COMPLIANCE AND AllT}IORRATON OF ENTRV: I ceM1ify untler penalry of perjury that I have reatl Ihis epplication and state that the iniormation given is wrtact. I egree to wmply with all state laws end ciry orUlnances relating to building construction, end authorize representetives oi Ihe Ciry of Costa Mesa to enter upon the above-tlescribed praperry tor inspectian purposes. I egree not to occuDY or ellow occupancy of eny builtling euthonzetl by t�is permit untll final inspection. ignet L er(s) Date U--.. 3-z6-4 4 AnNOr uthonzed Applicant Date CODE �. INSPEC710NTYPE 1616 Fixed System Final Fira Prevention 1266 Pool Spa Final 200 Finel Re-Rooi 201 Final BIocWRetaining Wall 202 Finel Fectory Fire Place. 203 Finel Sign 204 Final Demolition 244E48 �11: '�!� ♦ COUE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 � Flnal Site 250 Finel Building/Occupency QAg 0 uw_ � 0 0 ANGE�COUNTY BUILDING DEPA(tTMENT ' . 636 North Broadwcy ' - . SANTA ANA, CALIFORNIA FOR APPLICANT TO FILL IN . ADD E'S5 � �989 Oak 9t. scHoo� oisr. COetB �988 OR TOWN NEAREST =Ross 5T. gtate Ave. OWNER SNAVNHE Fbwe�, [ne. } MAIL 9363 W►�sH�eE e��o. { ADDRE55 ��Ty BEVERLY i�111,9 �o��CR. 5436t' ENG N'EERTCAIN S� MCKERRACMER NOL SY O�S7� 1 Z��O E, WALNUT ST.� PASADENA ) ADDRE55 CONTRACTORNEMPOHT VISTA C��NO. CR♦ `� O ADDRE� W113NIRE BLVO�� BEV�H�LLSi DESCRIPTION I LOT NO. J� BLOCK ��G (ATTACH METES & BOUNDS) TRACT SIZE OF LOT 00 X 1 IO � NOW ON LOTS Q USE OF I NO. OF I NO. OF EXISTING BLDG. FnMi�i[s ROOMS DESCRIPTIQN OF WORK NEW I x I ALTERA710N I I ADDITION I 6UILOING NO. OF C SIZE �O3 $Q• FTQpMS J STORIES WALL ROOF COMPI COVERING STUCCO COVERING e�� USE OF NEW eu��o�N� RESIDENCE Att_l".str2�a APPLICATION FOR PERMIT � . ----��..V. �.� .�_�e_��..� j _FOR OFFICE USE ONLY, _ _ _ ' `RECEIPT NO: PERMIT NO. ' l� %i�� -,;�..� l�'a��0 RECENEO BV DATE OF APPL. DATE ISSLED ,� t�ET , lo -�3 J.3 /�r/y—�/j; OUILDING �/' �/% I^1�.�� -- ADDRE55 � % (L� SCHOOL DIST.� ///}}} Jn/�/_� q �� OR TOWN � 'r'/i'L��'/� -� '� I �. _...._ . �....��._ I �'�'J pCK LINE FROM ENTER OF ST, j[ � �YARD � 2rj��-� 'SIDE YARD �U��Q � oveo , ��'�p�r DATE / 1 � CORR�CTIONS i ; �� , � 1 � `r � � � i ..� _ ��.."'_'""_ __.��._ . � . , . . - --- - -- - - �---- .._ _ �.o. A � 2 D r 1 HEREBY ACKNOWIE'JGE THAT I HAVE REA� THIS FORMS APPLICATION ANO STATE TMAT THE ABOVE IS CORRECT UNDER AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIR AND STATE LAWS REGULATIryG 6UILDING CONSTRUCTION. BRACI� LATH.�INT. SIGNATURE OF LATH, E%T. PERM ITTE E�E�NPp� /� AUTHORIZEO AGT.S�K� • �A/�� PLASTER. I� PLASTER.E: $ 483o�W P C S�� MASONRV i FEE � `F' ' BOND BEAM S VALUATION �� FINAL w ��.a� FEE APPROVALS : LOCATION I �gC' MATERIALS, /� �