HomeMy WebLinkAbout2018 MEYER PL - Building Permitse
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� CITY OF COSTA MESA
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os`""'FS, B!/ILDING D/V/SION
F�. ., • � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(�14) 754-5273 • Fax (714) 754-4856 • vnvw.ci.wsta-mesa.ca.us
J � a� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: B09-00240
PERMIT TYPE B_ROOF2
APN: 42213510
JOB ADDRESS: 2018 MEYER PL CM
Vicinity: REROOF RESIDENCE ONLY
Squares: 1300
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation
ISSUED
10123I2009
BJK
$4,200.00
SCOPE OF WORK: REROOF RESIDENCE ONLY: T/0 EXISTING ASPHALT SHINGLES, REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER
15# FELT & 1 LAYER 30# FELT. REROOF WITH 30-YEAR ASPHALT SHINGLES. 1300 SQ FT PITCH 4:12
OWNER: BYWARD, LAURENCE JR TR
PHONE:
APPLICANT: HEYWOOD, JANICE
PHONE: 619-893-7096
CONTRACTOR: OW NER-BUILDER
Address: Unit:
City/State2ip:
ARCHITECT:
ENGINEER:
FEE SUMMAFtY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$111.25
$0.00
$1.00
$112.25
Address: 2018 MEYER PL
City/State/Zip: COSTA MESA, CA
Address: 2018 MEYER PL
City/State/Zip: COSTA MESA, CA
License No. 000000
PHONE:
CELL:
License No. PHONE:
License No.
PHONE:
Unit:
Unit: :
NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under Califomia statutes antl related
regulations. (Ord. No. g2-28, § i, 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 wmply with all applicable wdes, and all
required inspections and final approval must be obtained. Failure to obtain inspecNons and flnal approval will resWt in the expiration of this permit.
UEt. INSPECTIONTYPE �AT INTRIALS COUEt INSPECTIONTYPE O�T INif11AL5
1616 Fixetl System Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final ���,/��/�� 208 Final Plum�ing
200 Final Re-Roof /l/// !//J% � 210 Final Electncal
'«vyt""_
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Facrory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demofition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARA710N:
I hereby aKrm under penalty of perjury one of Ihe follovring declarations:
� I have antl will maintain a certificate o( consent to sel(-Insure (or workers'
compensation, as provided for by section 3700 of the Labor Code, (or Ne
peAormance of [he work for which lhis permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 0( the Labor Code, for the pertormance of the wnrk (or which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Cartier:
cvmpleted d IMM pemN u rdNed al ane nuiMreE do9ars (5100) wleu 1
Policy Number:
❑ I certify that in the perfo�mance of t�e work for which Ihis permit is
issuetl, I shall not employ any person in any manner so as to become subjecl
to the workers' compensalion laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 oi
the Labor Cotle, I shall foAhwith comply with ihese provisions.
Applicanl's SignaWre
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER 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 IABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby aKrm that I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) o/ Division 3 of ihe Business and Professions Code, and
my license is in full torce and eflect.
Lic. # Class #
ConVac�or's Signalure Da�e
CONSTRUC710N LENDING AGENCV:
❑ I hereby aKrtn that Ihere is a consWction lending agency for the
per(amance o( Ihe work ta wfiich ihis pertnit is 5sued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's AOdress:
Da�e
OWNER•BUILDER DECLARATIONS:
I hereby affrm that under penalty o( perjury that 1 am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe follovring reason (Sec. 7031.5,
eusiness and Protessions Cotle: Any city or county which requires a permit lo
construct, alter, improve, demolish, or reDair any structure, D�or to its
issuance, also requires the applicant for such pertnit to (le a signed slatement
thal he or she is licensed pursuanl lo lhe provisions of �he Contraclors
License Law (Chapler 9(commencing with Seclion 7000) of Division 3 of lhe
Business and Professions Code) or that he or she is eaempt therefrom antl
Ihe basis for the alleged exemplion. Any violalion of Section 7031.5 by any
applicant for a permil subjects �he applicant to a civil penalty of not more lhan
tive hundretl tlollars ($500).):
I, as owner of the property, or my employees wilh vrages as their sole
�j� ompensation, WILL DO THE WORK, and the structure is not intended or
oflered !or sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law tloes not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oftered for
sale. If, however, the building or improvement is sold within one year ot
completioq the owner-builder will have the burden of proving that he or she
did not build or improve (or purpose of sale.�.
❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and
Pmfessions Code: 7he contractors License Law dces not apply to an ovmer of
property who huilds or improves thereon, antl who contracts for such projecl with
a contracta(s) license pursuant to lhe Contractors License Laws.).
❑ I am exempl under sec.
Business antl Professions Code for this reason:
i�-a3-og
Slgn ure—� -' Date _a...
JOS - 6�Y0]�
Owner ID verifed by Orive� ., ncense. Yes � No
Driver's�icenseNaQ}— Expires:�%�— %—/�
Verification of Ownership by (type of tlocumeni, i.e. - property tax Dill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certi(y that no eacavation frve (5) or more /ee� in depth into which a
person is requiretl to tlescend, will be matle in conneclion with work autMrized
by this permit, and that no buil0ing siructure, scaffdding, lalsework, a tlemolition
or dismantling ihereof, will be more than thitly-six (36) leel high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administ2tive Code).
❑ As owner-builtler, I will not employ anyone to do wvrk which would
require a permi[ irom the Division of Indus[rial Satery, as noted above, unless
such person has a permit ro do such vrork fmm Ihe division.
Apphcanl's Signalure Wle
Division of Industrial Safely Permil Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. will the applicant or presem or future building occupant need to file and
certity a Business Plan for emergency response to release or Ihreatened
release of a hazardous material7 ❑ Yes ❑ No
(Section 25505 of the Calilomia Health and Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has a[ any one lime during a reported
year a quantily of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 9allons, or 200 cubic feel of compressed gas
at standard temperature and pressure).
2. Does or will Ihe applicant or present or fuWre 6uiltling occupant neetl to file
a registration (orm (or acutely hazartlous ma[enals? ❑ Yes ❑ No
(Section 25533 of the Calilomia Health and Sa(ery Code, vnth some
excep�ions, requires registration with the Costa Mesa Fire Depariment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or grea�er Ihan a weight o! 500 pounds, or a
volume of 55 gallons, or 200 cubic feet ot compressed gas at stantlartl
temperaWre and pressure).
3. Does or vrill the applicant or preseM or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of the Calilomia Health and Safety Code provitles [hat the
Costa Mesa Fire Department may require the preparation, certification and
filing with Ihe Fire Depariment of an RMPP by businesses which are required
to reqister acutety hazardous materials with the Pire Department.
4. If an RMPP is presently required, has Section 25534 0( the Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future building occuDant require for
the work which is the suDject of this application a permil for such constmction
or modificalion from Ihe Soulh Coast Air Quality Management DisMct or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Section 658W2 of the Calilomia Govemment Code 2quires that the requested
infortnation be (umishetl on applications for non-resitlential builtling permits).
6. will any part of the faciliry to be constructetl untler this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the (acility must meel the requirement of Sections 25534 and 42303
of the Calitornia Health and Sa(ery Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution conirol disMcl or agency is required for Ihe work which is the
suhject ot this application, have all of the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach cenificate of compliance from the appropriate air pollution
contml officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct. I agree to wmply wilh all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SBnaWre Oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury �hat I have read this application and state that
the information given is correcL I agree to comply wilh all slate laws and ciry
ortlinances relating ro building construction, and authorize representalives o(
the Ciry of Costa Mesa lo enter upon the above-described property for
inspection purposes. I agree not ro occupy or allow occupancy of any building
autho �� e by this per vt until lnal insp ion.
' �,.�/ ��'� 3-U �
gnaturebfL¢ Owner�s) Dale '
/ ,.✓�a� l�- � 3 - Z�
AnOlwAutM1onz ApplKanl "-'-' Dale
//'`""�
_��`�^
Costa 1Vlesa
City of Costa �I�lesa BuiCding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273/Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #�'� �� )`'O
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at „7�/g /7���{�r DICr�'�
We are providing you with an Owner-Builder Acknowledg nt and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DlRECTIONS: Read and inrfra! each statement 6elow to signify you understand or verrfy thrs rnformation.
(�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder' building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious fnancial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
�2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
an the total value of my construction is at least f'rve hundred doilars ($500), inciuding labor and materials, I may
be considered an "employer" under state and federal law.
�6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
, ,.
8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
o any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
(�9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
ab� licensed contractors.
(�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property ownei's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is � d to verify the property ow%� r's signature.
Signature of property owner //�G�� i`�viJ/,Y�vTJU�J' Date: �v �����
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2
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OWNER CRANE� AI,F'p� DATE._9-19-56
JOB ADDRESS 2018 -Meyer :ZgCO BUI�JING PERMIT NO. Ni71S
GENERALCONTRACTOR O�g�l�� VAWE $ iiSO.00
APlls-sw-12 7= t _
�oT 22 BLOCK TRACT Fairview F}ns, Double Garage
GROUP J
INSPECTIONS
Footing Trench
Foundation Forms and Grade to
Rough Framing _
Plumbing, Rough to Slab
Plumbing, Rough Compiete
RougY
Roug
Final
St.
Tank or
9, In
Plumbing, Final, Fixtures
Plumbing, Final GasTest
Wiring, Final
Occupancy
DATE
SUBCONTRACTOR
/
RE DISTRICT 3"jSl}
PERMITSISSUED
DATE I NUMBER
Costa Mesa Building Department
P. O. Box 3! 7
COSTA MESA, CALIFORNIA
FOR APPLICANT TO b'II.L IN
Buflding
Address Z�1
Costa Mesa, Ca orma
Nearest
Cross St. � 1 j_
Owner `�' L�C,�•/� ( /�((11•l A
Mail �
nronicector � �
Engineer � ,
Address v /%
Contrector (�yy,��^
Address pL[� � �J �
Legal Lot
Description No. �
(AtWch Metes and Bouni
No. L 1 5 2>')�
Lic. /��'
No. 'fr
�l�'/Lc�
Clty Lfc.
:J -' J/ 7 -/ o`
No. of Bldga
Now on Lot
No.of I No.ot
Famillee Room�,
Rear Vard
New � z � Alteration � � Additian
Repair I I Moving I I Demolish
Building No. ot
Size �dx5—�� Rooms � Stories
Exterfor Wa Roof
APPLICATION FOR PERbIIT
.`�'��8 BUILDING �
FOR OFF'ICE USE ONLY
Receipt No. Permit No.
37� �
eceive y Date Rec'd. Date Issued
�./' /- � q p
/i/7 rt� /"�/r�
Bulltling /f �� ) v %
Address 0���.� � O
Costa Mesa,
Nearest
Cross St. 0 B .r
Zone S7 No. oi I
/C Plans
SUBJEC� TU
9
Covering ��/%ST6`'�I Covering (�pPR,OV[��'
Use of 9ew � „ne ��
Buildin �J-yC(/ Foundation Location Inspecto
Forms, Materials,
Under-Pinning ..',.,-
_� Frame: Fire Stops,• �� �
' Braeing, Bolts
I hereby acknowledge that I have read this ApplicaUon
and state that the abme is coireM and agree to comply Latb. Int.
with all City Ordinances and State Iaws regulating
building construction. Lath. Ext.
Signatureof /�,)
Permlttee �-L�CI���,/ f%7'� fii1-ti-� : Plaster, InL
Authorized AgL plaster, Ext
Valuafion b G Pe�mit Fee $ '! T Masonry Reinforced
Plan Check $ Nd�!! � gond Beam
$ ��O Total �jj _
Fee �� FINAL
Am zoa io�se o. r. e s.
Date
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PLOT PLAN
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