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Home My WebLink About1012 NANCY LN - Building PermitsIr CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 1012 NANCY LN Suite: Vicinity: TRIPLEX: 1012 NANCY LN. Parcel Nunmber: Applicant: MIRANDO, FRANK Address: Owner: BURNER, MELANIE Address1012 NANCY LN, - COSTA MESA, CA`. . Contractor /,ISLAND PACIFIC.ROOFING Address: '/ 17782 CAMERON ST BUILDING PERMIT Zoning: r /98-01098 PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Phone: Zip: Phone: - Zip: 92626 - �-'/ �•� �!�-_ Phone: , H.B.CA/,,/ / Zip: 92647 �. License:,. 631472 Arch FEng Address: , r 'Phone: -. .. - Zip: .. _License: SCOPE OF PERMIT REROOF THE TRIPLEX WITH ONE LAYER OF COMP. 2ND LAYER OF ROOFING, CERT. ATTACHED TO PERMIT FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,400.00 Permit: $45.75 _' Claimed Valuation: $1,400.00 Status: ISSUED �/ ,tom �./ Applied: 06/22/1998 Issued: 0612 5/1 99 8 SMIP Res: $0.50 SMIP Com:,. $0.00 Other: $0.00 Inspection: $0.00 'Total: $46.25. SETBACKS:'_ MAIN STRUCTURE Front 0-0 Rear 0- 0 ACCESSORY Front 0-0 Rear, 0- 0 PARKING Existing: A Required: o NOTES PLANNING & ZONING Left 0-0 Left 0-0 Proposed: 0 Right 0-0 Right 0-0 , 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 Inepeetlons 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 WORKERS' COMPENSATION DECLARATION: VW 1 I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to seff-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. ❑ 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' compensation Insurance carter and policy number are: Carder: Policy Number, (This section need not be completed if the permit Is valued at one hundred dollars ($100) or less.) ❑ I 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' compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With these provisions. Applicant Signature: Date: 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 DOLLARE ($100,0D0), 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 effirm 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. LJc. P Class N Contractor's Signe :' Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affimt 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 (5500).): ❑ 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 sets (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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby 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: 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 epplicent or present or future bulltling occupant neetl to file a registratlon 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 Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................................................................................................................................................................................... ................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 DOGS Or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or ageOC- 8 Yee a 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 paR 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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant r Date 02LL INSPECTION TYPE DATE INTMALS CODE INSPECTION TYPE 210 gTMAL$ 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 Well 212 Final Fire Preventlon 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244616 NG PE FIRE ZONE VALUES 120,200.00 INSPECTIONS et al 5i naturtFZ77' TYPE GROUP ZONE - SOIL GAsSUBCONTRACTORData Number Si nature WATER � (� e.., PlumbfROUGH PLUMBING^PROP: SWR. LINELJ HOUSE CON. L ( DSPRINKLING SYSTEMIMISCELLANEOUS ROUGH HEATING ANO AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND C:] POWER ROUGH WIRING •i Nea in an Vert. TRENCHES te FORMS STEEL REINF. FLOOR SYSTEM .j.7 BOND BEAM Lj 'STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING - IN Ll OUT PLASTER. BROWN COAT . ;,;7 STRUCTURAL. FINAL _ HEATING, VENT., REFRIG. AND A.C., FINAL r- 27 7, PLUMBING, FINAL AND GAS TEST 2 ELECTRIC, FINAL 4• BUILDING, FINAL .1;3p_ /O/!c jtcy obi. - /9/,7e 43574 1 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA'MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only s i� 05 t C BUILDING ,s ADDRESS OWNER MAIL _ ADDRESS u�5 CITY s1/Ci, t✓/w7 BRANCH AD ADDRESS `If, CONTRACTOR CITY STATE LIC. NO. SIZE OF LOT I %i L -✓0• TEL. NO. 67j - TE NOL 961' H, b. TEL. NO. CITY LIC. NO. NO. OF SLOGS. NOW ON LOT TP i5-77YFfJ00, s2s w -x,15.41 APPLICATION FOR STRUCTURAL PERMIT FIRE DATE % 'A(D — ' E_y/ (PLAN I BUILDING NO.USE OF ,ice ' YARDS APPROVED YARDS APPROVED CT MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. DATE RECEIVED D TE ISSUED nn�� Z3— B ERMI lois collo Nanc LADDREQ0/al LOT BLOCK ALT R P FT. JE(OF BUILDING AND WORK TOB ER ORMEDNCE G BET. BLDGS.ACCESS. BET. MAIN & SLOGS. if 2t _/7z n ,A /J CIC •VALUE L JR 4 FIRE DATE % 'A(D — ' E_y/ (PLAN I BUILDING NO.USE OF ,ice ' YARDS APPROVED YARDS APPROVED CT MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. R. FT FT. Separate permits are required for electric, plumbing and heating work. E am exempt from th provisions of the State of California Business FT. TREARatF FT. JE(OF BUILDING AND WORK TOB ER ORMEDNCE G BET. BLDGS.ACCESS. BET. MAIN & SLOGS. if 2t _/7z n ,A DATE I I hereby acknowledge that I have read this application and state OLD that the above information is correct and agree to comply with OLD FOR 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. 11 m I hereby certify that I am properly licensed as a contractor underFVALUATION . FT. ry the State of California Business and Professions Code, Division 3,T SHOWN UNDER VALUATION IS FOR D Chapter 9, and that such licenses are In full force and effect, or I OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from th provisions of the State of California Business v and Professions Co , Division 3, Ch tar 9. PERMIT FEE $ m PLAN CHECK $ b n Signature of �Permittee s u. TAX $ i U Authorized Agent TOTAL PAID $ 'p4 2 77PA—LCQ147; v'''^`'1Q.5t t" fir• COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED GATE ISSUED I Z-�D/✓��0� LAuEPERMIT Q/LDING [ADDRESSUG DATE APPROVED NO. WNER ALALIS I6A.7 CIL) A.P. NO.AI L BUILDING/DDRESS ADDRESS '1, .. /t�-1O/(� 4Aj CIi TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEW ADD ALTER P TAX $ Authorized Agent TOTAL PAID s3/ Q LENOER BRANCH n OWNER 4-44JS ADDRESS VALUFE_—^ , USE �� $ v ARCHITECT TEL. OR ENGINEER N 0. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW PLANS BUILDING CITY NO. STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO.OF BLOCS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. SIDE FT. FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLOCS. BET. MAIN & ACCESS. BLDGS. VAR.# C.U.P.+ DATE APPROVED APPROVED By DATE 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 the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I em exempt from the provisions of the State of California Business end Professions Code, Division 3, Chapter 9. Signature of Permittee SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $ PERMIT FEE $ /q, SQ PLAN CHECK s TAX $ Authorized Agent TOTAL PAID s3/ Q