HomeMy WebLinkAbout2521 ORANGE AVE - Building Permits' CITY OF COSTA MESA �
BI/ILDING D/VISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPEC710NS CALL: (714) 754-5626
PERMIT TYpE: B COMBO
Sub Type: RES_ALT
PERMIT NUMBER: BC09-00014
STATUS: ISSUED
DATE ISSUED: 01/16/2009
ISSUED BY: KJB
Jo6 ADOReSS: 2521 ORANGE AV CM Suite/Unit:-
APN: 43941114 Zoning: � . '
Vicinity: UNIT A-2 �- m Primary Occ: R-1 �
Const Type: V-B SQ. FT: 0 Valuation: 545,000.00
SCOPE OF WORK: UNIT A-2..FIRE DAMAGE REPAIR TO INCLUDE ROOF FRAMING, ROOF SHEATHING, PARTIAL RE-ROOF TO
MATCH EXISTING, DRYWALL, INSULATION, DOORS, WINDOWS, ETC. SMOKE DAMAGE THROUGH OUT. ELECTRICAL TO
INCLUDE: 6 �IGHTS, 8 SW ITCHES, 25 OUTLETS, PLUMBING TO INCLUDE: GAS TEST FOR 2 OUTLETS, KITCHEN SINK, WASH
BASIN, NEW TOILET, MECH TO INCLUDE: NEW WALL HEATER AND RANGE HOOD. .
OWNER: JENKINS,GEORGETR �.
Phone: 760-934311U .
APPLICANT: VAN MAANEN, MIKE , � '
Phone: 774-826•9860 - - �
coNraaC70R: LELAND PACIFIC INC
Phone: )14ffi6-9860 � '
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: -
Building Fees:
Electrical Fees: - -
Mechanical Fees: -
Plumbing FeCs:
SMIP Residehtial:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
"Refar to fea recelpb �or all ieea pald (or project
Atldress: P 0 BOX 8067
City/State/Zip: MAMMOTH �,4KES, CA
� Atldr¢55: :.1130 E 25TH ST
City/StatehZip: > SIGNAL HILL, CA 90755
Unit:
- .. . . S�d i�
Unit: :
License No. 453414
Address: 1130 E 25TH STUnit:
City/State: SIGNAL HILL, CA
License No.
Litense No.
$0.00
$593.75
$64.SS
$45.75
$65.20
$4.50
$0.00
$2.00
5773.75
ZipCode 90755
PHONE:
PHONE:
NOTCE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia 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 inspeetions and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
40oE�. INSPEC110N7YPE Ij�F INTRIALS CODE/ INSGEC710NTYiE D�G AL
1816 Fixed System Final Fire Prevention 208 Final Mechaniwl
1286 Pool Spa Final 208 Final Plumhing
200 Final Re-Roof 210 Final Elecincal �L
2p1 Fina191otk/Re�aining Wall
202 Final Factory Fire Place
T03 Final $ign
204 Final qemolition
272
220
222
250
Final Fire Prevention
Final Planning Approval
Final Site �
Final Building/OccuOancy '� Z
WORKERS'COMPENSATON DECLARATIO�
I he2by aRrm.un�e�'yeaalry of perjUry one o( the following declarations:
❑ I have and will maintain a certifl�le of consent to self-Insure for workers'
compensation, as pmvided. (or by Section 3700 of the Labor Code, for the
paAormance of ihe work for wliich this permit is issued. �
�0�1 have and will maintain v.orkers' compensatbn insu2nce. as required by
section 3700 of the Labor Code, fa the peRormance of the work tw which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: �v� �
�cartier.- �S %iF�( �
(IDis sedion nee0 irot be mmdete0 d M/e p��'��R 4— �valuetl al Con—e hund—re07 dollars (Sf �) w less )
Policy.Number. ��y`�" �,[( / pC_�•J � /
❑ 1 certify ihat in Ihe pertorman�e of the work for which ihis permif is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation law of Califomia, and agree that if I shoultl
become subject to vrorker ' o pensation provisions of Sec�ion 3700 of
abor de, 1 o pl�with these provisions.
�,.-- /=/G- D 9
( AuWicant_s Slgna e Dale �
\`
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUB.IECT 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 DECLAR�4TION:
I hereby affirtn that I am licensed under provisions ot Chapter 9(commencing
wilh Section 7000) of Division 3 of the Business and PmFessions Code, and
my license is in full force and eRect _, �
�- i
Lic. # � Class.# - J p
�- ' �=�LO�� /
CAmra`_�_lor's.,5ipna} re � ale I
( �
CONSTRUCTION LENDING AGENCY�
❑ I hereby affirm that there is a consWctbn lending agency !w the
pertortnance of the work fv vfiich this permit is issuetl. (Sec. 3097, Civil Code).
Lender'S Name:
Lender's Address:
Signature
OWNER-BUILDER DECLARATIONS:
I hereby aHirm Ihat under penalty of perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
construct, alter, improve, demolish. or repair any strucwre, prior to its
issuance, also requires the applicant for such permit to file a signed slatement
lhat he or she is licensetl pursuant to the provisions o/ the Contrac�ors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 of ihe
Business antl Professions Cotle) or that he or she is ezempt Iherefrom antl
the basis (or Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the app�i�ant to a civil penalty of not more than
five huntlred dollars ($500).):
❑ I, as ovmer of the properly, or my employees with v2ges as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oKered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law dces 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 impro�ements are not intended or offered for
sale. If, however, the building or improvement,is sold within one year of
completion, the ovmer-builtler will ha�e the burden of proving thal he or she
did not build or improve tor purpose of sale.). �
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constNcl the projec[ (Sec. 7044, Business and
Professbns Code: The cont2ctor5 LiGense Law dces not apply to an ovmer of
properly wfio builds or improves thereon, antl who con[racts for such project with
a cmtracta(s) license pursuant to the Contractors License Lav.s.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre Dale
JOS]<6 �3/01)
Owner ID verifietl Oy A�cense. ❑ Yes ❑ N�'
Driver's License No. F�cpires: �
Verifcalion of Ownership by (type of tlocument, i.e. - propeRy tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I he2by cetldy that no excavation frve (5) a more feet in depth into wfiich a
person is requiretl to tlescend, will be made in connectbn wilh work authonzed
by this permit, and thal no building structure, scaffdding, talsev.ork, or demolition
or dismantling thereof, will be more than thiAy-su (36) feet high (Chap. 32, Grp
2. Art 2, Sec. 341, Trtle 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit trom 1he Division ot Industrial Satety, as noted above, unless
such person has a permil to do such vrork Gom lhe tlivision.
Applitanl's SignaWre
Division of IndusMal Safery Pertni[ Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre buildinq occupant need to file and
certify a Business Plan tor emergency response lo release or threatened
release of a hazardous malenal? ❑ Yes � No
(Seclion 25505 0( �he Calilomia Health and Sa(ery Code requires, wilh some
exceptions, that a Business Plan be filed vnth the CosW Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal [o or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas
at standard temperaWre and pressure).
2. Does or will the applicant or present or tulure huilding occupant oeetl to fde
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Health antl SaFety Cotle, with some
exceptions, requires registralion wiN lhe Costa Mesa Fire Department by
each business which at any one time has on han0 a quanti[y o( acutely
hazartlous materials equal to or greater than a weight o/ 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standard
temperaWre and pressure).
3. Does or will the applicant or preseN or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Sa�ety Code provitles that the
Cosla Mesa Fire Department may require Ihe preparation, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with lhe Fire Deparlment.
4. I/ an RMPP is presently requiretl, has Seclion 25534 of the California
Health and Safery Code been fully wmplied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or futwe building occupant require for
the work which is �he 5ubject of this application a permi� for such construc�ion
or modification from the South Coast Air Qualily Managemen[ DisMct or fmm
any other air pollution control tlistrict or agency? ❑ Yes O No
(Section 65850.2 of lhe Califomia Govemment Cotle requires that [he requested
in(ortnatbn be lumislied on applications for rqn-residential building pertnits).
6. Will any part of tha facility to he conslmcted under this permit be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", the faciliry musl mee[ [he requirement of Sections 25534 ana 42303
of the Califomia Health antl Safety Code�.
7. If a permit /rom the South Coast Air �uality Management District or other
air polWtion control disirict or agency is required for the work which is the
subjecl ot this application, have all of the disclosures prescribed by California
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate ot wmpliance from the appropriate air polWtion
cOntrol officer).
CERTIFICATE OF COMPLIANCE: I certify ihat under �penalty of perjury the
infortnation given above is wrrect. I agree to comply with all state laws and
city ortlinances regarding Hazardous Materials antl Emissions.
Signature Date -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RV: I
certify under penalty of perjury that I have read ihis application and slate that
Ihe information given is conecl I agree to comply with all state laws and city
ordinances relating lo building construction, and authonze representatives of
the Ci[y of CoSta Mesa to enter upon Ihe abovedescnbetl property tor
inspection purposes. I agree no[ [o occupy or allow occupancy of any building
authonzetl by Ihis permit until final inspection.
at ega Date
- �sh-�'� / %iv ` D �
MtlIwAUNm¢eE/pP6can� Dale'
�___".'_ ( ��_—!
�
BU�' '�ING AND SAFETY DIVISIr`N
�- Fi..c DAMAGE INSPECTION REPOR�
(Required Prior To Permit Issuance)
Address: _�
Owner: �
Owner's Address
2.,.
different from above):
( 7 �`1wm�
-- 76� — C(�
r v"� �� �
, :� . .
"��°�,�o_{
Unit: _rj � `—�
r�
Street ' ' City State
�- Structural permit required.
'� Repair or replace as necessary.
f-1 oi.,..� .e..���.°a
�iElec[rical permit required.
� Repair or replace as necessary.
Comments:
�c� r d�i
� Plumbing permit required.
� Repair or replace as nece
Comments: �
� Mechanical permit required.
�' Repair or replace as necessary.
Comments:
n
��-� y c�: �� l-�d�`l 7� � 7sy- r�i�
Inspecror Date Phone
1B/2�a6 hi0lrcale'. OriginabOwper, Vellow�ConVaior, Pink�Builamg Drvision
Fice Inciden[ # i� T— a�J
Police Incident # _
( TA MESA FIRE DEPARTMENT
P.v. BOX 1200
COSTA MESA, CA 92628-1200
(714)754-5106
R�LEASE OF PROPERTY AFI'ER EMERGENCY INCIDENT
T7�e Costa Mesa Fire Department, in the interest of the safety and weifare of the community a[ ���� (time) G� II D9(date),
assumed control of the property located at ��O�/ ����%/ /qill• ��_
The necessity for assuming control of the properry was �ecause of / t i.c-�./
Pursuant to the conditions contai�ed herein, as of � 1i�7 (t�me) —%-/f (date), the subject property is released to,
and is to be under [he con[rol and [he responsibility of s.�iq/ � /.� J�n n (name), who
is the owner ( ), owner's representative ( ), tenant (�Q.
YpU ARE HEREBY PLACED ON NOTICE OF THE FOLLOWING CONDITIONS (Check applicable conditions):
( D(,) A rekindle or an additional fire from a hot spot is possibie. The Fire Department recommends that a fire watch, with a
means to extinguish hot spots, should be posted fo� 24 hours.
(�) The following utilities: electricity (AC), gas (�, water ( ), serving the property have been shu[ off. It is advisable to
co�tac[ the appropriate utility company before restoring [he service.
(� ) The slructure may have been weakened by Ihe incident. Until a structural survey can be made, it is advisable to keep all
unnecessary people out of and away from Ihe building.
(p�) Buildings that cannot be locked or secured by normal means must be secured by altemative meana Barricades and/or
fencing are required [o preven[ unauthorized entry. I[ may be necessary to provide a security guard.
�✓ ) Rebuilding and/or repairing the damage will require pemtits (e.g., building, elechical, e[c.) from [he City of Costa Mesa's
Developmen[ Services Department, Building Safety Division. They may be contacted Monday through Friday between
the hours of 8:00 a.m. and 5:00 p.m. by calling (714) 754-5273.
((�C) The Cos[a Mesa Fire Department and the Costa Mesa Police Deparhnent retain [he righ[ to re-enter the property at
reasonable hours, should their inves[igation of this incident require such re-entry.
( ) O[her precautions/conditions (specify)�
The conditions listed above are not all indusive. They are intended as guidelines for the City's Fire Departmen[ in exercising their
discretion in providing emergenty assistance advice.
Informa[ion conceming a copy of [he report for this inciden[ can be ob[ained by calling [he Fire Department Business Office at (714)
754-5106, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m.
You may be entitled ro a reassessmen[ and subsequent reduction of your proper[y tax as a result of [his inciden[. For further
information contact the Orange County Assessor's Office at (714) 834-2727, Monday tluough Friday, between the hours of 8:00 a.m.
and 4:45 p.m.
The OWNER, OWNER'S REPRESENTATIVE, and/or TENANT shall protect, defend, indemnify and hold harmless CITY and its
elected and appointed boards, officers, and employees from any an all claims, liabilities, expenses, or damages of any nature,
including attomey fees, for injury [o or death of any person, and for injury [o any property, including consequential damages of any
nature resulting therefrom, arising out of or in any way connected with the negligen[ performance of this Release by act or omission,
by or on behalf of 01NNER, OWNER'S REPRESENTATIVE, and/or TENANT, or resulting from any violation by OWNER,
OWNER'S REPRESENTATIVE, and/\ TENANT of any s[atute, law, regulation, or other legal requirement.
�'� • " ` � /�•l'� � �
Signed: � • ��. � Date: Time: �-- �
Owner ( � ) Owner's Representative ( ) Tenant�(� )
_ � �.
Costa Mesa Fire
Signed:
Officer in
�923�aa Wn�le-F�reAdmnislration.vellow-Ovmerlp�wner'sRepresenlalrveRenanLPonk-DevelopmentServires�BuileingSafery
�, i/
Assignment: /�� � �� �