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Home My WebLink About1911 ORANGE AVE - Building Permits • • CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 7 PERMIT �• 04-00146 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.Bua UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1911 ORANGE AV Status: ISSUED Suite: Applied: 01/12/2004 Vicinity: • Issued: 01/12/2004 Parcel Number: 42603113 Zoning: Applicant: DAVID HURWITZ ISSUED BY: Ce Address: 179 E 17TH ST#110 Phone: 949-642-7321 COSTA MESA,CA Zip: 92627 Owner: RICHARD & DAVID HURWITZ •'(1 Address 179E 17TH ST#110 •♦ Phone: 949-642-7321 • COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: • Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXIST.COMP.SHINGLES AND INSTALL 1 15LB FELT.AND 15 YEAR COMP. SHINGLES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,000.00 Permit: $97.25 Claim Valuation: $4,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $97.75 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: 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 2448-48(WOO) DECLARATIONS t WORKERS'.COMPEI SATION DECLARATION: '�'• I hereby affifm under penalty of perjury one of the following declarations: • , ❑ I have and will maintain a certificate of consent to sell-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 carrier and policy number are: Carrier: 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 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(5100,000),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: 1 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.Lie.M Class a Contractor'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 unde.1/ 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)orthat: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.m 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 sale(Sec, 7044,Business and Professi• s 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 is 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. •..,lotion,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• e prop. /:m EXCLUSIVELY •• - • - -NG WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: 1 :contractor S se La ••= . apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) lice se pursuant to t ay•.• - ors License Laws.). el exe .pt -;/•':. Business and Professions Code for this reason: _ ea efl fialm weer IDS. ¶by'�YJp�; !icense. ,Cres 0 No • _ xpir: :��.'�� Ve '•n of Owner-y b• (type of document i. . 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,laisework,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? 0 Yes 0 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 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? 0 Yes 0 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 Califomia Health and Safety Code been fully complied with? 0 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 pe constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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? 0 Yes 0 No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify t :t 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.E• ' . Signature: al Date: CERTIFICATE OF COMPUANCE AND A ' ORIZATION 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 sta• ':ws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe•property for ins. r• - • :e not to occupy or allow occupancy of any building authorized by is rmit until final inspection. / % •/ //: •f Legal Ow., ) ate /A,srOr Authorized Applicant Date C_ INSPECTION TYPE V PSS INTBIALS CODE INSPECTION TYPE QM HOLM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 1. P- - r.• 210 Final Electrical 201 Final Block/Retaining Wail 1 / 1 z.G/'!,I'r /9 I 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 - �'✓_ -e4 neat I i e a " sereS L/Wean :,• , 1tr OWNER-BUILDER ` ea/ VERIFICATION A city or county, which is required 10 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 return of. an owner-builder verification. Attention Property Owner: An 'owner-builder building permit has been applied for in your name and hearing 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 he issued until this verification is received. 1. I personally plan to provide the major Labor and materials for construction of the proposed property improvement. g Yes ❑ No 2. I (have/have not) N..t;-y: _ ' #•igned an application for a building permit for the proposed work. � , 3. I have contracted with the following person (finn) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work. hut I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lie. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work I 1n4'.46 IREV 919AI r I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety G ''and have completed the above information to the best of my personal knowledge, in compliance with tate law. • 7011r H Signed: i. 1j Date: \ ( c Name; - "/ 1 _ Vic_ (Printed or Typcd) C.D.L. # For more information call City of Costa Mesa Building Division at(714)754-5273. 104216 REV.9/98)