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HomeMy WebLinkAbout1006 NANCY LN - Building Permits4 CITY OF COSTA MESA BUILDIMG DIVISION t u DEVELOPMENT SERVICES DEPARTMENT 4 � PERMIT PERMIT NUMBER / B98-01394 ✓ (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1006 NANCY LN Suite: Vicinity: Parcel Nunmber: 93530004 Applicant: MIRANDA, FRANK Address: Owner: BURNER; MELANIE Address ,. P O BOX'11-227, Permit: $45.75 _ _ % Claim Valuation: $1,400.00 'SMTP Res: COSTAMESA,CA, - SMTP Com: $0.00 Other:'. $0.00 - Contractor: ISLAND'PACIFIC ROOFING Address: 17762 CAMERON ST . , BUILDING PERMIT Zoning: Phone: 714-557-6516 Zip: Phone: Zip: 92627 Status: ISSUED Applied: 08/06/1998 Issued: 08/06/1998 Phone: .� i - H.B. CA"G Zip: 92647 • '•� License: 631472 Arch / Eng Address: .'Phone:__ .. .. Zip: - ; License: , SCOPE OF PERMIT / • APPLY #30 FELT OVER EXIST LAYER OF COMP AND INST 25 YR COMP. SHINGLE. , SETBACKS MAIN STRUCTURP Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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) 7545626 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,400.00 Permit: $45.75 _ _ % Claim Valuation: $1,400.00 'SMTP Res: $0.50 SMTP Com: $0.00 Other:'. $0.00 - Inspection: $0.00 Total: $46.25 - -PLANNING & ZONING ' SETBACKS MAIN STRUCTURP Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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) 7545626 FA DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will 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 ark'Orwhich this permit is Issued. have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' comgeg6atl9n Insuxencgpamer and policy number are: Policy /<i� - -Z8 �/ Cartier. </G/L/C � 1� /J Poli Number.G ((/) i7 (711fs section need not be completed if the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 certify that In the parlor mance of ork 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 o1 Califo la, an agree that If 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith with these visi .� A �� licant Sign lure: /, Date: 7 r WARNI 'LURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED USAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. E NSED CONTRACTORS DECLARATION: eby affirm that I am licensed under pro o�s 1 h i (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full Uc. p Class 1rract`a ignature: Data: 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, Civil Code), Lendefs 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 following 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 civil 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 Professlons Code: The Contractors License Law does not appy 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-bullder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's Ucanse No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Cellfomia 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 WIII 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 the 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 of 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 requlretl, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication aQeuniI for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 5 Yes (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .......................................................................................'I'h'1.......................................................... u.t'9r.6'0...............................17...........................-............... ............... ...- 6 WIII any part of the facility to be constmctetl untler this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 reGwired 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? ❑Ves ❑ No .................................................................................................................................................................................................................................................................................... 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty 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 AUTHORIZAT10N OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI Ln ) — O " 9 Andpr Authorized Ap icant Date CODE I. INSPECTION LENSPErnox WPE DATE INTMA CODE 4 IYSLEcnoN TYPE Tp EON TYPE DAM IKMIA$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2448.46 A10 VT& b440 �jiL SrSNAf 7-1'* ., City of Costa Mesa Plar Department Post Office Box 1200 77 Fair Drive Costa Mesa, California 92626 (714) 556-5245 REQUEST FOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. Date & — ,a Lot No. /� The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he, she, they) _(was or were) J -kA,-) advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted By ad 86L £ Z 933 By 6141ty id ypyy i2 10 A110 Q3A1303b CMF 0569-26 By hot t V I A4P eC Lender BUILDING PERMIT NO. AP No.115-023-11 LOT TRACT 9691 FIRE ZONE VALUES 120.200.00 INSPECTIONS et al \`SPRINKLING V Si nature Date TYPE V GROUP ki k J ZONE SOIL SUBCONTRACTOR GAS Date NumEar Si nature WATER C v. -Z 7 Plum i ROUGH PLUMBING PROP. SWR. LINE HOUSE CON. i Q. SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE G' UNDERGROUND ❑ POWER ROUGH WIRING Naatin and V nt. TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM D 'STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT 1e-( e PLASTER, BROWN COAT V '- � - j' STRUCTURAL, FINAL Electric_ HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST r LO ELECTRIC, FINAL BUILDING, FINAL co Pries RrnuiPPU PUTc >rl 7-/27 r 4357.3 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Pk[- F3',-77r„�,001,3?_1)� i U APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED By DATE RECEIVED n,TE�S$UF� �7/j �C (� BUILDING ADDRESS /OG6 - 00 - /l0 !i L C I1- Oei3— 11/ 1 �� l9f PE ,�(f y/ OWNER [ GIS 7 Yl AIL M IL ADDRESS ZOQ L / I/O. BUILDING o0/ DOn D C. n ADDR ES 6 iJ TEL. CITY �X% -/ NO. L -ZG TRACT LOT BLOCK CONSTRUCTION W JADDI, REPAIR LENDER �OPWNN�ER BRANCH I &LA� ADDRESS /� s.� BL U,A/fdALUE US /� $ ARCHITECT J ,y TEL. p,p _Z OR ENGINEER C Nl Y �l ilL N fZno FIRE ADDRESS q /eKLtr ex. I-�,G. ZONE hl VPE GROUP APPROVED CONTRACTOR BV DATE r ADDRESS TEL. E NO. OF USE OF N /,' PLANS BUILDING CU CITY NO. _ STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLDGS. (FROM C/L T EE ) OF LOT NOW ON LOT FRONT FT FT. USE OF % EXISTING BLDG. / FT. FT Separate permits are required for L. SIDE 131�31`T.kea FT. electric, plumbing and heating work. REAR FT. FT. SE OF BUILDING AND WORK,10 BEP RFORM D DISTANCE BET. BET. MAIN & ! O MAIN BLOGS. ACCE�. BLOCS.VAR // C U.P pC�� APPROVED/—// APPROV I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building constructlon, and I shall not employ OW OR 5PT-"t� any person In violation of the workman's compensation laws of J L _ P r p 771) SO. FT. J ALZR the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the Stateof California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the rovislons of the State of California Business VALUATION PERMIT FEE $ and Professions Cotl 1visi on 3, Cha r 9. PLAN CHECK E Signature of TAX S Permittee n /S $�O��©O TOTAL PAID $ Authorize Agent i U Pa 25-71[a -0914x7 'df-. 31,9.`10 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 A L1 AT N FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R 1 ED V DATE RECEIVED DATE ISSUED ��nn c ,f J / W D&—O ^1O TNCt f.�N DRESS AI / PERMIT NO. ^ A OWNER HL 4e �S A1t� A.P. NO. MAIL BUILDING ADDRESS/00& ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEWADDALTER LENDER BRANCH y OWNER A1,AUS 41"�1261W7Zf ADDRESS VALUS S ARCHITECT TEL. OR ENGINEER FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR By DATE ADDRESS TEL. CITY NO. ZONE NO. OF I PLANS USE OF NEW BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAINBUILDING ACCESSORY BUILDING SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT. FT. Separate permits are required for L. SIDE FT. FT. REAR FT. FT. electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. VAR.906 DATE C.U.P.* APPROVED APPROVED I hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: om exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $ aj r PLAN CHECK $ Signature of - TAX $ Permittee S Authorized Agent TOTAL PAID E r