HomeMy WebLinkAbout1010 NANCY LN - Building PermitsCITY OF COSTA MESA am
BUILDING DIVISION
iA 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa .us
� FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER. P07-00552
PERMIT TYPE PLUM STATUS: ISSUED
DATE ISSUED: 10/22/2007
ISSUED BY: BJK
JOB ADDRESS: 1010 NANCY LN.CM Suite/Unit:
Vicinity: FIRE PIT - -
SCOPE OF WORK: GAS OUTLET FOR AFIRE PIT AT THE REAR OF AN EXISTING SFD. GAS OUT (1-4)
OWNER:
SADO, MUNETAKA AND DEBORAH .
Address:
1010 NANCY LN
PHONE:
714496-1433. -
- _ City/Stale/Zip:
COSTA MESA, CA '
APPLICANT:
SADO, MUNETAKA AND DEBORAH - -
- Address:
1010 NANCY LN -
PHONE:
714-496-1433 ` ;
City/Stale/zZip:
COSTA MESA, CA
CONTRACTOR: OWNER -BUILDER -
...
License No. 000000
Address:
-
PHONE:
City/State:
ZipCode:
- CELL: -
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $29.65
TOTAL FEES: $29.65
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: 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.
CODE/. INSPECTION TYPE DATE INTmALS CODES INSPECTION TYPE DATE IN S
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing P/R
200 Final Re -Root 210 Final Electrical
201 Final Block/Retaining 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 Building/Occupancy
WORKERS'COMPENSATI DECLARATION:10
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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 work for which this permit is issued.
❑ 1 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' compensation Insurance carder and policy
number are:
Carrier:
(This seCpn need rpf De mmpleletl /Ne cerrnd is vahnaO of ate huMked Wrars ($100) orless.)
Policy Number:
AAI certify that in the performance of the work for which this permit is
S d, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become sub'ect to the wo(kers' compensation provisions of Section 3700 of
the or Code, hsfl�l fortpwit omply vnth these provisions.
p' nl's tgnaWre Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
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, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. #
Class #
Con ractor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ I 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),
Lender's 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 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
ENSED 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 License Laws.).
❑ lam exempt under sec.
Business and Professions Code for this reason:
une Date
305746 (3107)
I 1
Owner ID verified by driv e. ❑ Yes ❑ No
qqq
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - 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, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, 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.
Apptlrari Signature Dale
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 the applicant or present or future building occupant need to file
a registration forth 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, cerlifcation and
fling 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
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such cOnsWcti0n
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part 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
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 lam and
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION 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 build g -construction, and authorize representatives of
the City of Costa Mesa to en r upon the above-described property for
=purposes. t a ee no 0 occupy or allow occupancy of any building
authonz\ by i this emit. nti! nal in ection. /0 Z ?
1 errs Date
Andlor Authorized Applicant
�� a� C?a�ta %?ZeQa �u�P Dcucdia�
OWNER -BUILDER
VERIFICATION
Address: � G N' 1 f V 1 J (ANL Permit #: Aq ;=�
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 completion and require the retum of, an owner -
builder verification.
Attention Property 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 building permit will be issued until this
verification is received.
I. I personally plan to provide the m,a_j..Jo labor and materials for construction of the proposed
property improvement. ❑ Yes IXI No
2. ave ave not) ��CC\ signed an application for a building permit for
ave
work.
DI have contracted with the following person (firm) to provide the proposed construction:
Name AAA jE22y �A2NC -5
Address PG )RC City
Phone(74) 10-5 0-79-2-1 Contractor's Lic. No. 4y 4SS ���LC J�o
4. 1 plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. 1 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
1042-06 (Rev. 11104)
.. s
Job Address: 1010 NANCY LN
Suite:
Vicinity:
Primary Occ: R1 Type of Construction: V -N
Parcel Number: 93530006 Zoning:
Applicant:
TODD ALDAMA
Applied:
02/052007
Address:
4502 RANCHGROVE DR
SMIP Com:
$0.00
Other:
$0.00
Phone:
714-280-3528
IRVINE,CA
Zip:
92604
Owner:
MUNETAKA, SADO AND DEBORAH
Address
1010 NANCY LN
Phone:
714-496-1433
COSTA MESA, CA
Zip:
926274862
Contractor:
BLACKJACK BUILDERS
Address:
4502 RANCHGROVE DR
Phone:
714-280-3528
IRVINE,CA"
Zip:
92604 -
License:
849709
Arch
Eng:
Address:
Address:
Phone:
Zip:
License:
Status:
ISSUED
Applied:
02/052007
Issued:
02/05/2007
ISSUED BY:
U IF
SCOPE OF PERMIT
REPLACE WINDOWS IN THE UPSTAIRS BEDROOMS AND 1 BATHROOM. SAME SIZE AND LOCATION
WINDOWS IN THE BEDROOMS SHALL COMPLY WITH UBC SEC 310.4 FOR MEANS OF EGRESS
Plan Check:
$0.00
Permit:
$111.25
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $111.75
FEE SUMMARY
Phone:
License:
Calc Valuation: $4,500.00
Claim Valuation: $4,500.00
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Fronts 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 Ezi tg: - 0 _ Required: 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
2446-46 (6=)
AIM
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and willmaintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Cade, for the performance of the
work for Which this permit is issued.
❑ 1 have and will maintain Workers' compensatlon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier. Policy Number:
5AILiURE
not be completed 11 Iia permit is valued et one hundred dollars ($100) or less.)
n the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
n of Calit mia, and agree that if I should become subject to the workers' compensation r 'ons of Section 3700 of the Labor Code, I shall forthwith
s row s/
(�/ Date'
TO SE RE WORKERS' COMPENSATION COVERAGE IS UNLAWFULAND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE I$100,D00), IN ADOTf1ONTOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affir I am licensed untr gr viqof Chapter 9 (commencing with Section 7000) of Divisi o e Busines d Professions Code, and my license is in full
force . Ic. L" 4 ns ri
ontractors lure: I t, -
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).
Lender's Name: Lenders 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 70001 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 (S500).):
❑ 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
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 License Laws.).
❑ 1 Are exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's 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 certify that no excavation live (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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 6, 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).
'ill the appllicant�o r present
r future building occupant need to file a registration form for ac
................................. ............... _.......... ................................... .... .................... ......... ....
2 Does or well pp o p ase t o g pa g o o acutely hazardous materials? ❑ Ves ❑ 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 en RMPP is presently required, 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 this a plication a ermit for such construction or Modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................................................... ............. ......................
.........................................................................
6 Will any part 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 11 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 (1f yes". attach certificate of compliance from the appropriate all 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 AUTHORIZATION 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 purpos . I agree not to Occupy or allow occupancy of any building authorized by this per• -
mit un I nspection.
2
rt to Orin Owners to
2' 07
And/ ihollzetl Date
CODE 1, jgSPECTIQN12 INTITIALS CODE r IN5PECPON TYPE gAN INLTITIA65
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining 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 /�_29 _ QZ
t c0 �7
1000 W. La Palma Avenue
Anaheim, G4 97601-3650
Mr. & Mrs. M. Sado NL11
1010 Nancy Lane
Costa Mesa, CA 92627
Re: Installation of vinyl windows — Canyon Bluffs HOA
Dear Homeowner:
January 24, 2007
As managing agents for the Board of Directors of Canyon Bluffs HOA, we have been inshucted fo
advise you that your request to install white vinyl windows at your unit 1010 Nancy Lane, Costa
Mesa, has been approved with the following stipulations:
• Installation to be done by a qualified licensed and insured contractor.
• Permits — if required by the City of Costa Mesa, a copy of the sign -off permit to be
submitted to the Association upon completion.
• Construction debris to be cleaned up each day from the common areas prior to 5:00 P.M.
• The unit owner will be responsible for the curb area of installation. Any problems
associated with the windows including but not limited to leakage, structure damage, and
any collateral damage to other units as a result of any problem associated with the
windows or its installation is the unit owner's re;ponsibility. If the installation is required
to be removed, the unit owner will be responsible for all damages and restoration costs
of said installation area.
• The approved specification is to be the same design as the existing installations of vinyl
windows with a 2 inch sash, white vinyl only. Any modification to such specification must
be approved prior to installation.
• This installation and maintenance to be disclosed in all pending and future escrows of
this unit.
The Board of Directors appreciates that you have followed the necessary procedures in order to
have a homeowner modification approved.
Enjoy!
Sincerely yours,
FOR THE BOARD OF DIRECTORS
CANYON BLUFFS HOA
Kcwe,YvA. LDANU.P. *
Karen A. Daniels
Perkcam Management Company, Inc.
BOD: pmc
Fax: (949) 642-4672
ic' -SquONc' 715-;56-1011 FtiC.' 714 -95O -3772G
0710 41.11
To: Development Services
From: Dusty Bent, Treasury Management
Date: February 15, 2007
Re: RETURNED CHECK
The following check did not clear the bank:
Black Jack Builders - $161.75 - Amount now due $186.75
p'D1
RECEIVED
CITY Of COSTA MESA
FEB 16 2007
Please discontinue services for 1010 Nancy Lane until payment has been received by this office.
Should you have any questions, please contact me at X5072.
Date: 02-05-2007
C.L fY OF COSTA MESS-,
P.O. BOX 1200 • 77 FAIR DRIVE - CALIFORNIA 92628-1200
DEVELOPMENT SERVICES DEPARTMENT
Transaction Receipt
ACTIVITY NUMBER: B07-00131 TYPE:
SITE ADDRESS: 1010 NANCY LN
Unit / Suite
APPLICANT: TODD ALDAMA CONTR:
BLACKJACK BUILDERS
4502 RANCHGROVE DR
4502 RANCHGROVE OR
IRVINE,CA
IRVINE,CA
92604
92604
714.280-3528
714-280-3528
OWNER: MUNETAKA, SADO AND DEBORAH STATE LICENSE
849709
1010 NANCY LN
CITY LICENSE
COSTA MESA, CA
92627.4862
714-496-1433
TOTAL FEES: $111.75
TRANSACT, AMOUNT: $111.75
BALANCE: (PERMIT FEES) $0.00
PAYMENT METHOD: Cash
NOTATION:
TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY:
CAC
2000 Building Permit Fee 0300 $111.25
2100 Building SMIP Fee 0340 $0.50
13000016177
Building Division (714) 754-5273 - Code Enla¢emenl (714) 754-5623 - Planning Division (714) 754-5245
FAX (714) 754-4856 • TDO (714) 7545244 • w c.wsl2-nlesa,G .us
Memorandum
To: Development Services.
From: Dusty Bent, Treasury Management
Date: March 26,October 30, 2006
Re: RETURNED CHECK
Payment has been received for the following check:
Black .lack Builders
You may now continue inspections for 1010 Nancy Ln.
Should you have any questions, please contact me at X5072.
Job Address: 1010 NANCYLN
Suite:
Vicinity: ROOF
Primary Oct:
Parcel Number: 93530006
Applicant: FRANKIE FISHER
Address: 5732 ALFRED AVE
WESTMINSTER, CA
Type of Construction: V -N
Zoning:
Phone: 714-381-5055
Zip: 92683
Owner: MUNETAKA, SADO AND DEBORAH
Address 1010 NANCY LN
Phone: 714-496-1433
COSTA MESA, CA Zip: 92627-4862
Contractor: SKYLIGHTS`PLUS
Address- 5732 ALFRED AVE
Arch :
Address:
Phone: 714-381-5055
WESTMINSTER, CA
Zip: 92683 License: 740408
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 06/19/2006
Issued: 06/19/2006
Phone:
Zip: License: License:
SCOPE OF PERMIT
INSTALL 2 SKYLIGHTS, 2'X2' AND 4'X4', ICBO # WER216
FEE SUMMARY
Plan Check:
$54.11
Permit:
$83.25
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
SO.00
Inspection:
$0.00
Total: $137.86
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0
ACCESSORY Front 0-0 Rear 0-0
PARKING Existing: 0 Required: 0
Calc Valuation: $2,800.00
Claim Valuation: $2,800.00
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 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 compy 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
'. tawr
DECLARATIOMS
WORKERS' COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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
work for which this permit is issued.
1 have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code, for the pertormance of the work for which this permit is Issued.
My workers' compensation Insurance carder and policy number are:
Cartier: 5- I FU}.�Q Policy Number: 1-15105--2oo6
(This section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
❑ I certity that in the performance of the work for which this permit is issued, I shall not employ any personin any manner so as to become subject to the workers'
compensation laws of California, and agree that II I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro 'Sions.
Applicant Signature: _/ /ills'✓" ` Date: (y-0 6
WARNING: FAILURE TO SEC RE WORKERS' COMPE SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed and r provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. a �'au4UClass a
Gontractor's Signature: j(,dl l Date: J`O')9�y
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).
Lender's 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 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
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 License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Data:
Owner ID verified by drivers license. ❑ Yes ❑ Nc Drivels License No. Expires:
Verification of Ownership by (type of document, i.e. - 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, 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:
I 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 reponed 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).
...........................__.....................__......................................_....................................................._._.........file................._......................f"o"t'............__......_...................""'a"I's"............ ..........._......._..............................................._.....
2 Does or will the applicant or present or future builtling occupant need to file a registration form for ecutefy hareMous matenals7 ❑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 appplicant 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 Mess Fire Department may require the preparation, certification and tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 II en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ NO
........................................................................................................................_..................................................._................................_...._..-_.._.................................................................__..................................__......._........................_..........
5 Does ar will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes 0 No
(Section 65850.2 o/ the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..................................................... ............................................. _.................................................................... ................................................................................................................. ....... I ............. .....................................................................
6 WIII any pert of the facility to be constructed under 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 California Health and Safety Code).
.
...........................................................................................................................................................................................................................................................................................................................................................................................
7 Ii 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
...........................................................................................................................................................................................................................................................................................................................................................................................
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 AUTHORIZATION 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-descdbed property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection.
Signature/0l,LegaII 7r(s) Date
AndtOr Authorzbd Applicant Date
CODE P. INSPECTION TYPE PAM I[jTRIALj CODE# INSPECTION TYPE INVRIA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Bloc lAotalning 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
C TY OF: COS-rA' MESA - SKYLIGW RSWIREMEMS
OW UP OCCWAIICr
aWARAlj$M MAR I ,
ISION OF 1ILDiNG SAFE MAFi� � �® WO •
Nr -1 CITY OF C TA MESA
L1 A PRO ' F DR
gate VCE Y6L/6 /�Gs+N ��z2
This set of plans anc sceafKarons "Jj i be ke0t on tnrs wa at : mas . c a is unlawful t
make any charges of aaerations or same wArgtit wra!en permfssar. ft alsionof RR
and Safety. Cay of Costa Mesa
The stamping of Inas plan ane sDecitications ShAi'_ NOT be het:c, ce^nB or!o be an approval
of the violation of any provisions of any City of Costa Mesa Ordnance andror State law.
These plans anc permit shall expire by limitation and become null and void it the buildN W
Will i8 not corranenced and maintained active per UBC §303 (dl within 180 days of iss e'
4501IRM I WOF FLAL FOR 61CYL1fiR6
OtE11107JUM 16$ atT rIFl7p CGDE 1810=31 UM — 1294ER TO ILWX%4=Xi !lP2CtF AT&`J tl
FLISME NOM VOW LOCATION a 9116TA M FgWn CMW1 IAa1LT l9WtAT10N - 01 ABOW VWRA T-
WA2 low 4pim VEW TEi3BHmm —.6101 V*W 6"L VW&WA TE "0RM 6 THW W-ap .6`ri
OR Ar LLA61 dt'-d A901WO ANT' OPERAI= BOOR 0000 OF"00 AN 61MAM OR VIEW 6LLaiI
1F 1m 1ew F10Ol6tIL 1'IATHALAL 0e01 ED6 i Lfi i OEAO LOAD H19/�s OBLION FOR THE
ROOF611IF111rp1W:E IS 05CIBRID
17E3QA SAW CHi qUCt-(IqZ-467,2
1010 hl Wk f LA -1,
Co�:,TA MESA CA. �cict- U46 -(Y33
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DIVISION`
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This set of pia cau
make any cnandes S dq2'3l',O"•5
and Satel} -In m Costa mesa.
The slampInc a; mts ptan and s
of the violation of any proviv
These Plans am Penna shalt
work is r., commas and n
i7E&rA SA -00
) 010 NANCY (-N
COSTA M ES k CA
r-
SUiLDING SAFETY
COSTO, MESA
Rc1N EI)
L. _Cate
v, �t ee keot or, ina ioh at an u' ��� " rvision of Bud6t'9
wAMUi wrlllen :c -
aIOY�
ions SHALL NCI be ne�c �c permA or :c o an r
of any City of Costa Mesa Ordinance ands r St to law•
oll and void it t e b ldd�9 01
re y limitation and become d withintB0 of
y ad active pet UBC 43031 )
�2
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Jun 19 06 04:08p Deborah $ Mooky Sado
ft
9do 642 4672 p.2
1000 W. La Palma Avenue
Anaheim, C4 91501-3050
June 8, 2006
Mr. & Mrs. M. Sado NL11
1010 Nancy Lane
Costa Mesa, CA 92627
Re: Installation of skylight — Canyon Bluffs HOA
Dear Mr. & Mrs. Sado:
As managing agents for the Board of Directors of Canyon Bluffs HOA, we have been
instructed to advise you that your request to install one skylight in the stairwell area of
the unit has been approved with the following stipulations:
• Installation to be done by a qualified licensed and insured contractor.
• Permits — if required by the City of Costa Mesa a copy of the sign -off permit to
be submitted to the Association upon completion.
• Construction debris to be cleaned up each day from the common areas prior to
5:00 P.M.
• The unit owner will be responsible for the curb area of installation. Any problems
associated with the skylight including but not limited to roof leakage, structure
damage, and any collateral damage to other units as a result of any problem
associated with the skylight or their installation is the unit owner's responsibility.
If the installation is required to be removed, the unit owner will be responsible
for all damages and restoration costs of the roof in said installation area.
• The approved specification is to be the same design as submitted. Any
modification to such specification must be approved prior to installation.
• This installation and maintenance to be disclosed in all pending and future
escrows of this unit.
The Board of Directors appreciates that you have followed the necessary procedures in
order to have a homeowner modification approved.
Enjoy!
Sincerely yours,
FOR THE BOARD OF DIRECTORS
CANYON BLUFFS HOA
l(are vA. lDa 1.t.P.lia'
Karen A. Daniels
Perkcam Management Company, Inc.
BOD: pmc
1EEPHONE- 714-95_6-ZC12 F. -1X:714 -95_6-572C
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address:
1010 NANCY LN
Status:
ISSUED
Suite No
$0.00
Applied:
06/06/2006
Bathtub
$0.00
Issued:
06/06/2006
Vicinity:
$0.00
Dental Units
$0.00
Parcel Nunmber:
93530006
Drain, Floor
$0.00
Drain, Rainwater
$0.00
ISSUED BY:
$0.00
Applicant:
MARTIN HOPPING
Expansion Tank
$0.00
Address:
137 SIERRA ST
Gas (1-4 outlets)
$0.00
Gas (Over 4 outlets)
Phone: 310-322-3015
Gas Repipe
$0.00
Gas Service
EL SEGUNDO, CA Zip: 90245
Interceptors (Grease, Oil)
$0.00
Owner: MUNETAKA, SADO AND DEBORAH
Address 1010 NANCY LN
COSTA MESA, CA
Contractor: LIQUID PLUMBING INC
Address: 137 SIERRA ST
EL SEGUNDO, CA
INSTALL WATER SOFTENER
2
Phone: 714496-1433
Zip: 92627-4862
Phone: 310-322-3015
Zip: 90245
License: 322064
SCOPE OF PERMIT
FEE SUMMARY
AMT
ISSUE FEE
$23.50
Backflow irrigation
$0.00
Backflow Preventer
$0.00
Bathtub
$0.00
Clarifier System
$0.00
Connect (Ice,Soda,elc)
$0.00
Dental Units
$0.00
Dishwasher
$0.00
Drain, Floor
$0.00
Drain, Rainwater
$0.00
Drain, Roof
$0.00
Drinking Fountain
$0.00
Expansion Tank
$0.00
Gas Earthquake Valve
$0.00
Gas (1-4 outlets)
$0.00
Gas (Over 4 outlets)
$0.00
Gas Repipe
$0.00
Gas Service
$0.00
Interceptors (Grease, Oil)
$0.00
Interceptors (Sand Auto )
$0.00
2
Phone: 714496-1433
Zip: 92627-4862
Phone: 310-322-3015
Zip: 90245
License: 322064
SCOPE OF PERMIT
FEE SUMMARY
AMT
QTY
AMT
QTY
Laundry Tub / Washer
$0.00
0
Sump Pump
$0.00
0
Landscape Irrigation
$0.00
0
Swimming Pool
$0.00
0
P -Trap
$0.00
0
Trap Primer
$0.00
0
Pressure Regulator
$0.00
0
Urinal
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr BkOow(1-0)
$0.00
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Septic Tank
$0.00
0
Wash Basin
$0.00
0
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Sewer Connect
$0.00
0
Waste and Vent System
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$0.00
0
Shower
$0.00
0
Water Heater/ vent
$0.00
0
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Sink, kitchen
$0.00
0
Water Softener
$9.80
1
Sink, service/mop
$0.00
0
OTHER
$0.00
Spa (private)
$0.00
0
VIOLATION
$0.00
Spa (public)
$0.00
0
PLAN CHECK
$0.00
REINSPECTION
$0.00
0
COMMENTS I SPECIAL CONDITIONS
TOTAL CALCULATED FEES: $33.30
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
i
C
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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
work for which this permit is issued.
❑ 1 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' compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be complated if the permit is valued at one hundred dollars ($100) or less.)
V-1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
p,- corrpensatlon laws of Coma, and agree tl t if I should'become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro si as. /
,Applicant Signature: Date: `66-64-6 S^
WARNING:FAILURE TO SEG E WCR RS' COMPE TI COVERAGE UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSANDD0LLARE($100. OI.INA IT)ONTOTM CO OFCOMPEt ATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby,affirm thal.tarn license u er provisi ns of Chapter 9 (commencing with Section 7000) of Division 3.of.the.Business and Professions Code, nd my license is in full
'force and effect. Lic. q _ ' �Class,a.�/—..JAS C' Z 4
'ContfaE%W5'signature: 1 Date: GKx
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).
Lender's 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 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
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 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 drivOr's license. ❑ Yes ❑ No Driver's 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 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Californla 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 tiled with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity o1 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 loot 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 II an RMPP is presently required, 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 this a plication a$$ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................... .................................. ................. .... ................. ................ .......................................... ..................................... ........ .... ......................................................................
.....................................................................................................
6 Will any part 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
................................ ...................... ............................................. -.................................. ........................................ ... ..................................................................... ... ........................................................................................... ......................................
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 AUTHORIZATION 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.
ign re Of Legal Owner(s) Date
�Ifknd/ orizad App at r—Data—
CODE If INSFkfiON TYP INTITIALS CODE. INSPECTION TYPE DATE INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining 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 BuitdiagtOocupancy
CITY OF COSTA MESA
v F4 BUILDING DIVISION
o DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER
B98-01396
(714) 754-5273 • Fax(714)754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1010 NANCY LN Status: ISSUED
Suite: Applied: 08/06/1998
Vicinity: Issued: 08/06/1998
Parcel Nunmber: 93530006 Zoning:
Applicant: MIRANDA, FRANK
Address:
Phone: 714-557-6516
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 roust be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
Zip: -
Plan Check:
$0.00
Owner:
LOEFFLER; TIERRY
! _
Address
2103YACHT MISCHIEF-.
Claim Valuation: $1,400.00
`SMtP Res:
i.
1010 '. '. -
Phone: - --��
NEWPORT BEACH,CA �'- - -
--
Zip: 92660
ROOFING
Other:,
Contractor:
Address:
,ISLAND'PACIFIC
17762 CAMERON ST
Inspection:
$0.00
Phone
-.
H.B. CA,,,
Zip: 92647
1
PLANNING & ZONING
License: 631472
Arch / Eng
Address:
SETBACKS
`Phone:. - -
MAIN STRUCTURE Front 0,0 -
Rear 0- 0 - •Left ' '0_0
Zip.
ACCESSORY
I
License:
Right 0-0
PARKING
SCOPE OF PERMIT
" . APPLY #30 FELT OVER EXIST AND D INST 25 YR COMP SHINGLE. ,
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 roust be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
FEE SUMMARY ;1
Plan Check:
$0.00
Calc Valuation: S1,400.00
Permit:
$45.75
- -- - y
Claim Valuation: $1,400.00
`SMtP Res:
$0.50
SMIP Com:
Other:,
$0.00
— - -
Inspection:
$0.00
Total:
$4615
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE 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 roust be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: I
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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
ork for which this permit is issued.
❑ I 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' mppeensation Insu nce carrier and policy number are:
Cartier: workers'
nn� Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
❑ I certify that in the performance of Itme work 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 of lifomla, an agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
�Ih th Ions �j �;/
Icent re: Date: � f LUX
WARNING: FAILURE TO S C RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE 1$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,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens un or p ov sof Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. q l Class N
rector's tura. Date: —
CONSTRUCTION LENDING AGENCY:
❑ I 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).
Lender's 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 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
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 License 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 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 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 8, 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 Industnal 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 the applicant or present or future building occupant need to file a registration Corm 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).
............................................... I........................................................................................ I ..................................... ........ ...............................................................................................
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 El No
..............................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....................................................................................................................................................................................................................................................................................
6 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
....................................................................................................................................................................................................................................................................................
B (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 AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information gi]the
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 up
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
t to Le al Owner(s)
nd/Or AuthorizeSIkipplicant Date
CODEA INSPECTION TYEE�'E gA7F INiID1AL5 COLE.! INSPECTION TYPE DATE II1TRIa6i
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining 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 Building/Occupancy
241646 Nd s64 aJlity AQr- _1Jf4/p7`Z/1Gi
OWNER BALALIS & PIGNERI DATE 4-26-77
JOB ADDRESS 1OM-1rYA-1mn'- Tl,vw,,F Tm,,P BUILDING PERMIT N0. 4357-4
AP No.115-02'T-ll LOT TRACT OFYQI FIRE ZONE VALUES IPn_Pon _nn
INSPECTIONS et I
Si nature
Date 11TYPE
v
GROUP
ZONE
SOIL
. SUBCONTRACTOR
GAS
Data
Number Si nature
WATER 4 .Lr. -7 7Plum
I
ROUGH PLUMBING
g L
171
PAOP. SWR. LINE 0 HOUSE CON.
�
> �'tG•
-�
.�
SPRINKLING SYSTEM
T1ISC EL LAME OUS
ROUGH HEATING AND AIR CONDITIONING
OFL
TEMPORARY SERVICE OR POLE
c-
UNDERGROUND L] POWER
ROUGH WIRING
NOatln and
V nt.
TRENCHES FORMS STEEL REINF.
.6t
_47_
`]-
If
FLOOR SYSTEM
ym-77
BOND BEAM 'STEEL REINFORCE
SHEATHING
FRAME ANO FLASKING
LATHING — IN OUT O_( -
e
PLASTER, BROWN COAT
STRUCTURAL,FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
a 2•
__' _
Y,tt --
W
PLUMBING. FINAL AND GAS TEST r
ELECTRIC. FINAL
BUILDING. FINAL
/k .7
SPECIAL REQUIREMENTS
JAI
�_/7
e
tai" f-'� 43573
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely -Use Ink Only
ADDRESS'10,f 1I # C LOVE
OWNER A4141-15 4 O/AlArO /
CITY /( &I
CONSTRUCTION
LENDER
BRANCH
ADDRESS
TEL
NO.
APPLICATION FOR STRUCTURAL PERMIT
CEIVED BY
DATE RECEIVED
D/yTE�S$UF�:
PE I
I)/18 /9
. NO./LDING
DR ES 006 DOD
rA
oTRACT
LOT
BLOCK
W/
A
L
P
e
a
APPROVED
OWNER ALLYL 08 IS
VALUATION
SE VN/dALU$
DATE
USE OF
BUILDIN
YAR
FT
BET. MAIN &
ACCESS. SLOGS.
DATE /
i
n
m
ARCHITECT J TEL.
*A"- -� Z
L V
SQ. FT. el
w
THE AMOUNT SHOWN UNDER VALUATION IS FOR m
OR ENGINEER G A/I 7
Chapter 9, and that such licenses are In full force and effect, or 1
FIRE
ADDRESS L ICKLLY 4. 6. �
ZONE
e
a
APPROVED
antl Professions Cod Ivislon 3, Cha r 9.
VALUATION
CONTRACTORIVA)
BY
PLAN CHECK III
ADDRESS
Signature of
TEL.
E
NO. OF
Permittee
nn
$/A10,?v
CITY NO.
-
PLANS
r
STATE CITY
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
w
SIZE
NO. OF BLDGS.
(FROM C/L T EE )
Q
OF LOT
NOW ON LOT
FROM FT
a
USE OF
R
EXISTING BLDG.
5 /v F
_h
Separate permits are required for
L. SIDE FT. kf
electric, plumbing and heating work.
A
REAR FT
SE OF BUILDING AND WOR T BE P RFORM D
DISTANCE BET.
A/
O
MAIN BLDGS.
VAR. vlE /
�'
...i
C.U.P. [
a
7
APPROV
a
w
CI
hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
OLD F oi`
Oa.
all laws regulating building construction, and I shall not employ
Z
any person In violation of the workman's compensation laws of
the State of California.
DATE
USE OF
BUILDIN
YAR
FT
BET. MAIN &
ACCESS. SLOGS.
DATE /
i
n
m
1 hereby certify that I em properly licensed as a contractor under
L V
SQ. FT. el
w
THE AMOUNT SHOWN UNDER VALUATION IS FOR m
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or 1
THE PURPOSE OF ESTABLISHING A PERMrr FEE ONLY:
em exempt from the rovisions of the State of California Business
e
a
antl Professions Cod Ivislon 3, Cha r 9.
VALUATION
PERMIT FEE $ m
PLAN CHECK III
Signature of
0
Permittee
nn
$/A10,?v
TAX $ / f
_
U
U
TOTAL PAID f _/�s
/ C_
Authorize Agent _ _
0