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Home My WebLink About265 OGLE ST - Building Permits� �� CITY OF COSTA MESA � O pMFS,p BlIILDING DIVISION F�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax �714) 754-4856 • w�wi.ci.costa-mesa.ca.us ° ` FOR INSPECTIONS CALL: (714) 754-5626 �""""`°� PERMIT fVUMBER: P10-00100 PERMIT TYPE PLUM APN: 42522204 JOB ADDRESS: 265 C OGLE ST CM Vicinity: BATHROOM STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: C ISSUED 07/2912010 RMD SCOPE OF WORK: PLUMBING PERMIT TO CHANGE OUT 1 BATH TUB, 2 WASH BASINS AND 2 WATER CLOSETS IN CONJUNCTION WITH A FIRE DAMAGE REPAIR TO UNIT "C". REF#: BX10-00141 OWNER: SHATTUCK, JOHN G III PHONE: 7143373376 APPLICANT: RqGERS, BRETT PHONE: 562-528-B000 Add2ss: 503 N JANSS WAY City/State/Zip: ANAHEIM, CA Addiess: City/State/zZip: CONTRACTOR: HAR-BRO INC License No. 258441 Address: 2750 SIGNAL PARKWAY PHONE: 562•528-8000 City/State: SIGNAL HILL, CA ZipCode: 90755-2207 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: $0.00 $72.50 $72.50 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under CalifOmia slatutes and related regulations. (Ord. No. 92-28. § 7. 12-27-92) 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 compty wilh all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiratlon of this permit. LOOE1. INSPELiIONTYPF ORTE INTITIRLS COUEO INSPEC110NTYPE O�T INif11AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical )�� 1266 PoolSpaFinal 208 FinalPlumbing 10/�S�iQ Q./��-p/,C%' .��v�V 200 Final Re-Roof 210 Final Electrical 201 Final8lwk/R@tainirg Wa71 212 Final Frre PteveNion 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 1l 204 Final Demolition 250 Fina� Building/Occupancy ��J � U�� WORKERS' COMPENSATION DECLARATION: I hereby affirm unaer penalry of perjury one of the following declarations: ❑ 1 have and will maintain a certifcate o( consent to self-Insure (or workers' compensation, as pmvided for by sec�ion 3700 of the Labor Code, tor the peRormance of the work for vfiich this pertni� is issued. ❑ I have and will maintain workers' compensatbn insurance, as requiretl by secCan 3700 ot the Labor Code, for the pertormance ot the v.ork for which this pertnit is issuetl. My workers' compensation Insurance carrier and policy number are:p !7 Carriei, f'1L�\-��i (Tnu seam nee0 irol oa cortipeted athe pe.ma's valued at me nurrtlretl tlnoars (St00� a iess ) POIwy�Nu`mber. L.i� Z�`R��'�� ❑ I certify that in the peAormance of Ihe wnrk (or which this permit is issued, I shall not employ any person in any manner so as to bewme subjecl to the workers' compensation laws of Califomia, and agree lhat if I should become subject to the vrorkers' compensation pmvisions o( Section 3700 of Ihe Labor otle, I sh 1 orlhwith comply � -ese pmvisions. Apqiw � nawre ' ��ab'� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND DOLLARS (8100,000), IN ADDITION TO THE C0.ST OF COMPENSATION, DAM�GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensetl under provisions of Chapter 9(wmmencing with Section 7000) of Division 3 ot the Business and Professions Code, and my license is in full torce and eflect. Lic-#..... �, �4�y� class:t�.`� - '7 I 1fn � 10 "Canlra or's oa ure � � �a aq,�, CONSTRUCTION LENDING AGENCY: ❑ I hereby affrtn that [here is a cons[ruction lending agency for the peAortnance of Ihe �+ork for which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lentler's Address: SignaWre OW NER•BUILDER DECLARATIONS: I hereby affrm that untler penalry of perjury mat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW fof the (ollowing reasOn (Sec. 7031.5, Business and Pmfessions Code: Any ciry or wunry which requires a permit to consVucl, alter, improva, demolish, or repair any slrucWre, pnor to its issuance, also requires lhe applicant for such permit to file a signetl statement thal he or she is licensed pursuant to the provisions o! the Contracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Pro(essions Code) or Ihat he or she is exempl therefrom an0 the basis for t�e alleged exemption. Any violation of Sec�ion 7031.5 by any applicant for a permit subjecls the applicant to a civil penalry ot not more than fve hundred tlollars ($500).): ❑ I, as ovmer ot the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is not intentled or oHered for sale (Sec. 7044, Business and Professions Code: 7he Contractors License Law does not apply to an ovmer of property vfio builtls or improves thereon, antl who does suc� work himself or hersel( or Ihrough his or her own employees, provided that such improvements are not intended or ofleretl for sale. If, however, the building or improvement is sold within one year of wmpletion, lhe owner-builder will have Ihe burden of proving [hat he or she did not build or improve (or purpo5e o( sale.). � I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044. Business and Professions Code: The contrac�as License Law dces not appty to an ovmer ot property who builOs or improves thereon, and wfio contracls (w such project with a cmtractoqs) license pursuant ro the Cont2ctors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code (or this reason: Sigr�aWre ]OS�.a61�]) Owner ID verified by tlrive�nse. ❑ Yes � No Driver's License No. Expires: t� , Verifcation of Ownership by (type o( document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certily that no excavation frve (5) a mo2 (eet in Cepth into vfiich a person is required to descend, will he made in conneclion with wnrk autnorized by this pertnit, antl that no building struclure. scaF(dding, falSe�wAc, a demolilion or dismanUing thereol, will be more than thirty-six (36) (eet high. (Chap. 32, Grp 2, M 2, Sec. 341, T�le 8, Califomia P.eministrative Cotle). ❑ As owner-builder, I will nol employ anyone lo do work which vroultl require a permit from the Division o! Industrial Satety, as notetl above, unless such person has a permit to tlo such vrork (rom the Oivision. Appliom's SignaNre Dale Division of Intluslnal Salety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fulure building occupant need lo file antl certify a Business Plan for emergency response to release or threatenetl release of a hazardous material? ❑ Yes ❑ No (Section 25505 of lhe Califomia Healt� and Safery CoOe requires. with some exceptions, thal a Business Plan be filed with the Cosfa Mesa Fire Department by every Dusiness which has at any one time tlurinq a reponetl year a quantity of hazardous matenals equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ol compressed gas at standard temperaWre antl pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form (or acutely hazardous materials? ❑ Yes ❑ No (Seclion 25533 0( the Califomia Health an0 Safery Code, with some exceptions, requires regislration vnth the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazardous malerials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard temperature and pressure�. 3. Does or will the applicaN or present or future building occupant neea ro prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Satety Cotle provides that the Costa Mesa Fire Depariment may require the preparation, cenification and filing with the Fire Department o( an RMPP by businesses which are requiretl to register acutely hazardous materials wilh the Fire Department. 4. I( 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 presem or luWre building occupant require for lhe work which i5 Ihe subjett of IhiS ap0�icaiiOn a Oefrtli� �of 5uch fAnSWction or modification from the South Coasl Air Quality Management District or from any oiher air pollu�ion control tlislrict or agency? ❑ Ves ❑ No (Sectbn 65850.2 of the Califomia Govemment Cotle requires that lhe requested informafion be (umished on applica�ions far rron-residential builtling permits). 6. will any paA of the facility to be constructetl un0er this permit ba within 1000 feet from lhe outer boundaries ol a school7 ❑ Yes ❑ No (If "yes", the facility must meet the requiremen� o( Sections 25534 an0 42303 o( the Calilornia Health antl Salery Code). 7. If a permil Irom Ihe South Coast Air Ouality Management District or ot�er air pollWion control districl or agency is requiretl (or the work which is the subject ol this application, have all ol the disclosures prescnbed by Califomia Health and Safety Cotle Section 42303 been madel � Yes ❑ No 8. Qf 'yes", attach cetli(cale of wmpliance from the appropriate air polNtion control oKcer). CERTIFICATE OF COMPUANCE: I certify that under penalty of perjury the information given above is wrrect I agree to compty vrith all state laws and cily ordinances regarding Hazardous Materials antl Emissions. oaie CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certify under penalty ot perjury that I have read this apDlication antl state that the information given is correcl I agree to comply with all state laws antl ciry ordinances relating to building construction, and authonze represenWtives of the Ciry of Costa Mesa to enter upon the above-descnbed property tor inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by Ihis pertnit until final inspeclion. ' nawre of L � eqs) Date UyAvi ortzetl,App�anl�. , ��payd � r p p'WF t p o. � ) e r � J .��e � . . � CITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vr.vw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE APN: 42522204 Zoning: , JOB ADDRESS: Vicinity: UNIT C SQ. FT: 0 B_MISC 265 C OGLE ST CM PERMIT NUMBER: BX10-00141 STATUS: ISSUED DATE ISSUED: 07/29/2010 ISSUED BY: RMD Suite/Unit: C Primary Occ: Consl Type :79 Valuation: E15,000.00 SCOPE OF WORK: FIRE DAMAGE REPAIR TO UNIT "C". SCOPE OF WORK TO INCLUDE: RE�NFORCE 8 RAFTERS, REPLACE 3 RAFTER TAILS REPLACE 30 OUTLETS, 8 SWITCHES AND 5 HARD WIRED SMOKE DETECTORS. SEE P10-00100 FOR PLUMBING WORK. OWNER: SHATTUCK, JOHN G III City/State: ANAHEIM, CA Phone: 714337-3376 APPLICANT: ROGERS, BRETT CitylState: Phone: 562-528-8000 CONTRACTOR: Address: CitylState: Zip Code: ARCHITEC7: Phone ENGINEER: Phone HAR-BRO INC 2750 SIGNAL PARKWAY SIGNAL HILL, CA 90755-2207 HC HANSEN 714-573-0073 FEESUMMARY Building Plan Check: Building Permit: EleCtrical Permit: SMIp Residential SMIp Commercial Bldg Std Admin Fund Address:: 503 N JANSS WAY Zip Code: 92805-2530 Address: Zip Code: License No. 258441 Phone 562-528-8000 $163.31 $251.25 $59.70 $1.50 $o.00 $1.00 TO7AL FEES $476.76 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/1 Monday thr� Fritlay - 7:00 am thru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. Proh New Years Dav, Memorial Day, Independence Day, Labor Day, T License No. License No. 3027 Unit UniC Unit Cell: CMMC Sec. 13-279 Sundays and the following Federal Holidays: NOTICE: The vrork authorized by Nis permit shall comply vnth all applicable handicap access requirements under Cali(omia statutes and related regulations. (Ortl. No. 92-28, § 1, 72-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPFCTION. INSPECTIONS: In order fw the wor4 authorized under this permit to be considered legal, such work must comply witA all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CODE /, INSPECTIONTYGE ORTE IN RL COOE/ INSPELIIONttPE ORT INPPRLS 761fi Fi.eO System Final Fire pr¢�ention 206 Final Mechanical 72fi6 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocWReWining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site � 204 FinalDemolition 250 FinalBuiltling/Occupancy ' ��15 ��%� � WORKERS' COMPENSATION DECLARATION: I hereby affrm under penalry of perjury one o( Ihe lollowing tleclarations: ❑ I have and will maintain a �erlifcaie of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance o! the wurk for which this pertnit is issued. ❑ I have an0 will maintain Wp�efS' compensa[ion insu2nce, as required by section 3700 of the Labor CoCy, for the peAwmance of the �+ork (or wfiich this permit is issued. My workers' compensation �nsurence carrier and policy number are: Cartter.- �ICA'R+� (�nrs saum need nor ee mm1p1etpe eme permt m va�uea a� me n�mdmd anears (5�00! a leu ) Policy�Number. � �3"I �i1 � �� v` ❑ I certily that in the peAormance of the work for which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of Califomia, and agree Nat if I should become subject l0 1he warkers' compensation provisions of Seclion 3700 0( the Labo ode, I sh (oAhvrilh c ply with lhese provisions. --.y.. ��o 'AOW ignaWre Dats�. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALl SUBJEC7 AN EMPLOYER TO CPoMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L4BOR CODE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapier 9(commencing vnth Section 7000) of Division 3 ot the Business and Professions Cotle, and my license is in full force and eflecL � Lic.#--�� i (` - tass # � i- � I,� �j,u ' Go aclar's BnaWre �h T� . -�.r: CONSTRUCTION LENDING qGENCY: ❑ I hereby affrtn that Ih@re is a constructbn lentling agency for the pertormance of the �+rork for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER-BUILDER DECLARqTIONS: I hefeby aKfm Ihal UndOr peqalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE �,qW (or Ihe following rea50n (Sec. 7031.5. Business antl Profession5 Cotle: Any tity or counry which requires a permit to consiruct, al�er, improve, tlBmolish, or repair any structure, prior to its issuance, also requires the applicant !or such permit to file a signetl statement thal he or she is licensed pursuant to Ihe provisions of the Contracrors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 0( the Business and Professions Code) or that he or she is exempt therefmm antl the basis for the alleged ezemption. Any violalion of Section 7031.5 by any applicant for a permil subjects the applicant to a civil penalry of not more than fiva huntlred dollars (3500).): ❑ I, as owner of the propeny, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and lhe structure is not intenaetl or oflered tor sale (Sec. 7044, Business antl Protessions Code: 7he Contractors License Law does not apply to an owner of property who builds or improves lhereon, antl who does such wurk himself or hersell or through his or her ovm employees, provided that such improvements are not intentled or oKered for sale. II, however, the building or improvement is sold vrithin one year o! complelion, the ovmer-builtler will have the burtlen of proving that he or she did not build or improve lor purpose ol sale.). ❑ I, as ovmer of t�e prop6rty, am EXCLUSIVELY CON7RACTING WITH LICENSED GONTRACTORS to construct the projxt (Sec. 7044, Business and Professbns Code: The cont2Ctors License Law dces not appy to an owner of property who builtls or improves thereon, and who crntracts for such pmject with a contracta(s) iicense pursuan� ro �he Contractas License laws.). ❑ I am exempt untler sec. Business antl Pmfessions Code for Ihis rea5on: 905>�a6(9/0)7 Ovmer ID verified by drivei s license. � Ves ❑ No � Driver's License No. Expires: �4 Verifcation of Ownership by (rype of document, i.e. - pmperty tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certiry that no excavation frve (5) w mwe feet in tlepth inro which a person is required to descentl, will be made in connection with v.ork autMrized by this permit, and that no building stmcWre, scaHdqing, talseuwrk, a demolitbn or dismanlling ihereof, vrill be more Ihan Ihirty-su (3b) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Tille H, Calilomia Atlministratrve Code). � As ovmer-builder, I will not employ anyone to Oo work which would require a permit (rom the Division of Intluslrial Safety, as noted above, unless such person has a permit to tlo such work Irom the division. Aop�nnl's Signalure Date Division ol Induslrial Safety Permil Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or (uture building occupant nee0 to file and certify a Business Plan lor emergency response to release or threatened release of a hazardous matenal7 ❑ Ves ❑ No (Section 25505 0( the California Health and Safely Code requires. vnth some exceptions, Ihat a Business Plan be filed with the Costa Mesa Fi�e Depariment by every business which has al any one lime tluring a reported year a quanlity o( hazardous matenals 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 preseM or future building occupant neetl ro file a regis[ration form for aculely hazar0ous materialsl ❑ Yes ❑ No (Section 25533 of the Calilornia Health antl Salety Code, with some exceptions, requires registration with the Costa Mesa Fire Depanmem by each business which at any one time has on hand a quantity o! acutely hazardous materials equal to or greater than a vreight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas al standard temperature and pressure). 3. Does or will the applicant or present or future buil0ing occupant need to prepare an RMPP (Risk Management and Prevention Program tor awtely hazardous materials)7 ❑ Yes ❑ No (Section 25534 0( the California Health and Satery Code provides thal the Costa Mesa Pire Department may require lhe preparation, ceAification and filing vdth the Fire Department of an RMPP Dy businesses which are required to register acutely hazartlous materials vrilh �he Fire Depatlmenl. 4. If an RMPP is presently required. has Section 25534 of ihe Cali(omia Health and Safery Code been fully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present or fuNre building ocwpant require tor the work which is �he su6jec� of IhiS applitalion a permit (or Such con5lNGtion or modification Irom Ihe Souih Coas� Air Quality Management Distnct or from any o�her air pollution control tlistricl or agency? ❑ Yes ❑ No (Sectbn 658502 0l the Califomia Govemment CoOe repuires that the requestetl in(wmatbn be fumished on applications fa rron-resitlential building pertnits). 6. Will any part of the lacility to be conslrucletl untler this permit Ce within 1000 feet from the outer boundades ol a school? ❑ Yes ❑ No (If yes". the faciliry must meet Ihe requiremeN of Sections 25534 and 42303 of the Calilornia Health antl Safely Code�. 7. If a permit from �ha South Coasl Air Ouality Management Districl or other air polWtion conlrol diSMc[ Or agency is required lor lhe work which is the subject of this application, have all of Ihe disclosures prescribed by Califomia Health and Safely Code Seclion 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of compliance from the appropriata air polNtion coMrol officer). CER7IFICATE OF COMPLIANCE: I cenify that untler penalty of perjury the information given ahove is correcl. I agree to comply with all state laws and city ortlinances regarding Hazardous Materials and Emissions. Date CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalry o! perjury that I have read this application and state [hat the information given is correcL I agree to comply with all slate laws antl ciry ordinances relating to building constmction, antl authorize representatives of the City of Costa Mesa to enter upon the above-described propeAy for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permil unlillnal in5peclion. Si Wr lLeeal eqs) Daie r � �no�.etl'PPWiwnl�Yi�S^+w:.yi...�.. �. 0°!� i�.- ... CITY OF COSTA MESA 4LOyTaMF$p BI/ILDING DIVISION i�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us ° � FOR INSPECTIONS CALL: (714) 754-5626 RO*wwnm`�•` PERMIT NUMBER: P10-00085 PERMIT TYPE PLUM APN: 42522204 JOB ADDRESS: 265 OGLE ST CM vicinity: STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 06I2212010 CAC SCOPE OF WORK: INSTALL A NEW GAS LINE FOR UNIT B. 1 GAS OUTLET(1-4 OUTLETS) OWNER: SHATTUCK, JOHN G III Address: 503 N JANSS WAY PHONE: City/State/Zip: ANAHEIM, CA APPLICANT: CLIFF JOHNSON Address: PO BOX 6227 : PHONE: 7�4-229•0091 City/State/zZip: BUENA PARK,CA CONTRACTOR: CLIFF JOHNSON PLUMBING AND DRAIN CLEANING SERVICE License No. 633773 Address: PO BOX 6227 PHONE: 714-229-0097 City/State: BUENA PARK,CA ZipCode: 90622-6227 � CELL: ARCHITECT: ' License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: $0.00 $39.45 $39.45 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: In order for the work authonzed under this permit to be considered le9al, such work must comply with all applicable codes, and all required inspections and £nal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COOE11. INSPEG110NTYPE D�T IN1111R15 CODEt INSPECPONTYPE DATE INi111RL5 1616 Fixed System Final Fire Prevenlion 206 Final Mechanical �' � 1266 Pool Spa Final 208 Final Plumbing —� � 200 Final Re-Roof 210 Final Elecincal 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSign 222 Final Site 204 Final Demolition 250 Final Building/Owupancy WORKERS' COMPENSATION DECLARATION: I hereby affrm under penalty of perjury one ot the follovnng declarations: ❑ I have and will maintain a certiticate of consent to self-Insure (or workers' compensation, as pmvided for by section 3700 0( the Labor Code, (or �he performance o( the vrork for which this permit is issued. I have antl will maintain vrorkers' compensation insurance, as required by s' n 3700 of the Labor Code, for Ihe peAortnance of the work for which Ihis pertnit is issued. My workers' compensation Insurance carrier and policy numbe �;M /��`tQ) ,�i..�_ -��- (Thrs seGron neetl no( be mmplete� Alhe peimif is valued af one hundrtd dollars ($f 00J or IessJ Poryy�� l � /a � � /�? � G � �� T ❑ I certify that in the performance ot the work for which lhis permit is issued, I shall noi employ any person in any manner so as �o become subjeci to the workers' compensation laws of California, and agree that i( I should become subjecl b the %6rkers' compensation provisions of Section 3700 ot the Labor Code I hall 6rt ith compy�with these provisions. pp�i s aWre � �al� C WARNING: FAILU 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, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm Ihat I am licensed under provisions of Chap[er 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full f rce antl eHect. � � ss�� 3/�� il 1 re —�pate ! - " ' � CONSTRUCTION ENDING AGENCY: 0 I hereby a rtn that there is a cons[ruction lentling agency for the peAortnance of Ihe v.ork fa which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SlgnaWre Date OWNER-BUILDER DECLARATIONS: I hereby affirm lhat under penally of perjury Mat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5, Business antl Professions Code: Any city or counry which requires a permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant tor such permit to fle a signed statement tha[ he or she is licensed pursuan� to the provisions o( Ihe Contractors License Law (Chapter 9(commencing with Seciion 7000) of Division 3 of the Business and Pro(essions Code) or that he or she is exemp[ therefrom and the basis for Ihe alleged exemption. Any violation of Section 7031.5 by any applicant (or a permit subjects [he applican[ to a civil penally of not more than (ve hundred dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the swcture is not intended or oRered for sale (Sec. 7044. Business and Professions Code: The Contracrors License Law does not apply to an ovmer of property who builds or improves lhereon, and who does such work himself or herself or Ihrough his or her own employees, provided ihat such impmvements are not intended or offered for sale. If, however, Ihe building or improvement is sold within one year of completion, Ihe owner-builder will have the burtlen o( proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to constmct [he pmject (Sec. 7044, Business and Professions Code: The contraclors License Law does not appty to an owner o( property who builds or improves thereon, and who contracts for such project with a cootrac[or(s) license pursuant to �he Cont2c[ors License Laws.). ❑ I am exempt untler sec. Business and Protessions Code /or this reason: Si9nalure 305]-O6 (3/01) Owner ID venfied by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (rype of document, i.e. - property tax bill or deed�: �IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certi(y that no excavation frve (5) or more feet in depth into wfiich a person is required [o descentl, will be made in connection with vrork authonzed by Ihis permil, and that no building structure, scaHolding, falsework, a demolition or dismantling thereof, will be more [han thirty-sis (36) feet high. (Chap. 32, Grp 2, M 2, Sea 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I vnll not employ anyone to tlo work which vrould require a permit from the Division of Industrial Safery, as noted above, unless such person has a permit to do such work from the division. Applirants Signature Division of Industrial Safery Permit Number _ HAZARDOUS MATERIALS ANU 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 �hreatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of [he Calitomia Health and Safery Code requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Department by every business which has at any one time during a reportetl 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 feel of compressed gas at standartl tempereture and pressure). 2. Does or will the applican[ or present oi fuWre building occupan[ neetl to file a registration fortn for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health antl Safety Code, with some exceptions, requires registration with [he Costa Mesa Fire Department by each business which at any one time has on hantl a quanlity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic (ee[ of compressed gas at stantlard temperature and pressure). 3. Does or will the applicant or present or (uture building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides lhat the Costa Mesa Fire Department may require the preparation, cehifcation and filing with the Fire Department of an RMPP by businesses which are required [o regi5ler aCutely hazartlou5 material5 with [he Fire Department. 4. If an RMPP is presenUy required, has Section 25534 of the Califomia Health and Safety Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or future buildin9 occupant require for the work which is lhe subject of [his application a permit for such construction or modifcation from Ihe South Coast Air Qualiry Management District or from any other air polWtion control district or agency7 ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires ihat Ihe requested infortnation be (umished on applications for non-residential builtling pertnits). 6. Will any part of the faciliry ro be constructed under this permit be vnthin 1000 feet from the outer 6oundaries o( a school? ❑ Yes ❑ No Qf "yes", the facility must meet Ihe requirement of Sections 25534 and 42303 ot the Califomia Health and Safery Code). 7. If a permit trom the South Coast Air Qualiry Management District or oiher air pollWion control district or agency is required for the work which is the subject of this application, have all of Ihe disclosures prescribed by California Health and Safety Code Seclion 42303 been made? ❑ Yes ❑ No S. Qf "yes", attach certifcate of compliance from the appmpriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury ihe information given above is correct. I agree to comply with all 5tate laws and city ortlinances regarding Hazardous Malerials and Emissions. Signature Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury [hat I have read this applicalion and state that the information given is correct I agree to comply with all state laws antl city ordinances relating to building consiruction, and authonze 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 au[horized by ihis permit until final inspectio ! SignaW � f gal (s) Da�e Q� � And/or ze lican Dale CITY OF COSTA MESA � BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT r i 698-01105 PERMIT NUMBER (714) 754-5273 • Fax (714) 754d856 gUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite: Vicinity: Parcel Nunmber: Applicant: Address: 265 OGLE ST 42522204 KANE,JEFF Owner: SHA' Address 2650 / ,r, i i � � Contracror:� ��COAST I Address `�!21681 IMP r�!% �� / (/,t�(i r� H.B.bA j �; i v� 1 �/� f /; Arbh / Eng � tr� ,, ��Atldress � 1r1"n'j i! ri :,�_: )' � �— 1, 1! �/ �' _ �; � Plan Check: ' P,ermit .� SMIP Res �SMIP<Com� , `' :t. Other. Status: ISSUED � �� Applied: 06/22/1998 � Issued: O6/22/1998 � Zoning: Phone: 714-968-8754 - � Zip;-�-..-:�, .� _rM�,", ,_� .. ._ _ - iHN:GlII � � � � � � �' - � �t-- . , ' ' - i ' ^ � �-%' ` , � Phone: ._ % t+ � � �� •� � ti� ��.. --Zip ".-92627 _ ��'� / �A -'�.� � � � ' - . ti.� =� i � � �V`; A,�� i �!, ��_ �� ^" Fl <,ti , ` i ��_� , �<\"�.::';:... ..." ; / \`.`-\ c.� ' . � i i" /� � A� \ �, �,;': ti <' '�� ; `v Phone: A�__ A �" � � Zip: 92646 ��`;��,- �� License:?450393 4j� �v' y . . . �� 9�,. 1 '�'�Of12 ,�r�`g. �1� �t � � r,� 4� LICCfISC . .. �'n � .. � ��,: �,�,. . � �� 4 : S � �/ � ; �_r �� SCOPE OF PERMIT %` � � y r~ �, :''T/O'EXIST AND REROOF W/ FIBERGLASS SHINGLES, HOT MOP FLAT C\PORT ONLY. � '`'� ' - - r, ' r ' i'�i-) � -::� �. ._ � ' i "� .,.,. (. � r ti. "„ r � - --' _ - FEE SUMMARY , �. " � ', $0.00 ,r� r. +E Calc Valuation: � � `�. $87.25 � �i; �` r'`�r,��,.- „ � r �� 1 S �Claimed Valuation:, �r t., $0.50 --� _. __ . _ �/ i�$0.00 �.: ,,_$0.00 � �, �� 4, -'i- v:. , ion:�`. '�.'$0.00 __ — ; ; :: -.,�,-�-, , � �� 'L\ �•-' � A��<: 1Total:.-" $87.75 k� �",� _�.:�`�"s�" : � ,,:,. �,;,�:f l ; -''r� ; � $3;995.00 �. $3,sss.00 ' ` � ,:., �.` � ��;� ,,� �RL'4NNINGI&ZONING % , i�V ��i �A�A� .� 1 ��. �� . it�,1r "` , .� /r-�i,� SETBACKS �- . 'i �� t �� ' �tt1 � "i % � �/% i� �i MAINSTRUCTUREFront -0-0�'-.} Rear� OA " '�L'eR� -�00 -Rlght� 0.0,' �i� . .. / f .. ... ` - •. - � . � �i; ACCESSORY Front'`-0-0�� ;';Reac . 0-0� � � -� Ceft� �- 0�0� Right � . 0-0� �"�� . -� rl �-�- i _ _ ` V ',.'/; _ .. _ . 'F. �— . �, PARKING Existin �,0' � Re �uire'd � -�0 � ; � Pioposed.' �0 = `�'- . - � NOTES: - - ,. � i�� - � . . � � - , :n.-� , ,.i �� EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a perlotl of 180 days. INSPEC7�ONS: In ortler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 WORKERS' 60MPENSATION DECLARATION: , . � I hereby aNirm under penelry oi perjury one of the following declaretions:• - � �� ' . ❑ I �eve and will meintain e certificete of consent to self-Insure tor warkers' compensetlon, es pravidetl for by section 3700 at the Lebor Cotle, for the pertormence of ihe work for which this pertnil is Issued. ❑ 1 have antl will melntain orkers' compensetlon insurance, es requlred Dy seIXion 3700 01 ihe Labor Cotle, for the perfortnance of the work for which ihis pertnit is�issued. My warkers' co e n Ins ance ca r en0 poll num6er ere: / /l / Camer. �� L/YI � . , Policy Number. /// �( ��/ — A( O (T)iis section need no comp/eted Ihe pe it is velued et one huntlred Collers ($700) ar less. J �' I certify thet in the pertormai compensation laws ot Celiton ComDly with ihe5e provi5ion5. Applicant Signetura: WARNING: FAILURE TO SECURE WORI I hereby eHirtn ihet I am torca and efFect Lic. u Contrectors Signature: CONSTRUCTION LENDING AGENLV: work for which ihis permit is Issued, I shall not employ eny persan In eny manner so as to become subject to the workers' ree that N I shoultl become sub�ect to the workers' campensetlon provisions at edlon 3700 of ihe Lebor Cotle, I shall forthwith / Da�6: � �� / � ENSATION COVEMOE IS UNLAW FUL ANO $HALL SUBJECT AN EMPLOYER TO CRIMINAL PENA�TIES ANO GVIL FW ES UP TO ONE HUNDRED 1E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]O60FTNE LABOR CODE, INTEREST, MI� ATTORNEV'S FEES. 9(commencing with Sectlon 7000) of Division 3 of the Business antl Professions Cotle, antl my license is in full Cless N Date: ` � _ —% ❑ I hereby effirtn ihet Ihere Is a construction lentling egency for iha peAortnance of tha work tor which Ihis pertnit is issuad. (Sec. 3097, Civil Coda). Lentlefs Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lentlers Address: Date: I hereby attirtn ihat under penelry of pe7ury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to construcL alter, improva, tlemolish, or repelr eny siructure, prior ro its issuance, also requires the applicant tor such permlt to tile e signetl statement that he or she is licensed pursuant to ihe provlslons at Ihe Cantrectors License Lew (Chapter 9(cammencing with Seclion 7000) of Divislon 3 af the Business and Pmfessions Cotle) or t�et he or she is exempt iherefrom antl the besis tor Ihe alleged exemption. Any violation of Section 7031.5 by any applican� for a pertnit subjects ihe applicent to e civil penelty of not more than five �undretl tlollars ($500).): ❑ I, as ownar oi ihe property, or my employees wll� wages es ihelr sole compensatlon, WILL DO THE WORK, and the structure is not Intended or oHeretl for sale (Sec. 7044, Business flntl Professions Code: The Contrectors Llcense Lew does not epply to en owner oi properry who builds or improves thereon, and who does such work himself or harselt or Ihrough hls or her own employees, provltled Ihat such Improvements ere not intentletl or ofreretl for sale. If, hawever, ihe building or improvement is sold within one year of crompletion, Ihe owner-builder will have tha burtlen oi proving that he or she did not build or improve for purpose oi sale.). ❑ I, as owner of Ihe propeRy, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to consiruct ihe prqect (Sec. 7044, Business and Professions Cotla: The conirectors License Lew tloes not epply to an owner of property w�o builtls or Improves ihereon, antl who conirecis for such project wlth a contractor(s) license pursuant ro Ihe CONractors License Lews.). ❑ I am exempt under sec. Business and Professions Cotle for this reason: Signeture: Dete: Owner ID venlietl by tlrivers license. ❑ Yes ❑ No Driver's License No. Expires: Vanlication of Ownership by (rype ot tlocument, I,e. - property te�c bill or tleetl): DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION: ❑ I hereby certify that no e:cavetlon five (5) or more teet in tlepth Into which e person Is requlred to descend, will be matle In connection with work authorized by ihis permit, end that no building siructure, scaflolding, felsework, or demolitian or tlismemling thereot, will be more ihen thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, 71tle B, Califomla Adminlstretive Code). ❑ As owner-builder, I wlll not employ enyone to do work which would require e permit from the Division of Intlustrlal Sefery, es noted above, unless such person hes a permit to tlo such work trom the divlsion. Signature: Date: Division oF Indusirial Satery Permil Number: LODE �. INSPECTIONTYVE 1616 Fixad System Flnal Fire Prevention 1266 z� 201 202 203 Pool Spe Final ' Flnel Ra-Roof Finel BIacWRetaining Wall Finel Fectory Fire Plece ' Final Sign 204 Final Demolition �ff It�� CODE� INSPECTIONTYPE 206 Final Mechanicel 20B Final Plumbing - 210 Final Electricel' 212 Final Fre Prevention 220 Final Plenning�Appraval, 222 Final Site 250 . Final Building/Occupanc 2ddfidfi � . .. . Caller's Ndme� Address �4 � � CITY OF COSTA MESA SERVICE REQUEST & PUBLIC ASSISTANCE FORM Da[e Z � � = �� Time . Nature of equest Qocation type, severity) - �.�.�-��.z w.�-�....�.-� 9 Phone ��'—� 7 7` � ;�.8.�,�,.-, ,�,��'� . �� Referred to �� a Call back � Service Only � � ' Information Only � Person Receiving Call � F 0378•18 . � �� . ��HA : � ��.-� . ,�� ,� ,��- �►.�- �� '� � �� G�� a- ,� a,��'�`"` �/�� . ,� _ �� -� -��-�'�' �� ,� �„ ` � �,, � � i' ' ' y _ _ � G�R� -�� % � /° lG -� . C� . . 935'� COSTA MESA BUILDING DEPARTMENT P.O. BOX 3�] COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN BUILDING �i_ _ _ _. COSTA MESA, CALIFORNIA MAIL ADDRE55 c�T� N ort Heach Cal. '�,o: ARCHITEQ SSII18 LIC. OR ENGINEER NO. ADDRE55 3Hv10 riO2lSti� Ci�• CITY LIC. 1/..y7 oescnivriorv NOT 3 BLOCK TRA�T 2996 A.P, NO. 512E n NO.OF BLOGS. OF LOT O X 14 wow oN �or O USE OF �EXISTING BLDG. SETBFCN LINE FFOM C �f cc�+i[n ov srne[r JH��O�� REAR VAROZS t0 C SIDE YARO RIGHT � LEFT 7�-6n � DESCRIPTION OF WORK NEW ALTERATION AODITION REPAIR MOVING DEMOLISH SIZIEDING 3123 ROOMS ZV STORIES 2 EXTERIOR WALL StIlCCO ROOFo�.�c hot—mop Triplex residence and att. garage � �� AAy Z"1"i9�9 � � ` — � FII�ANCE DEPT. ci?r oF cn�T� C.�FsA APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY T NECEIPT NO. EERMR NO. BUI' ING AD E55 COSTA MESA. CALIFORNIA FIRE v�nrvs BV ( �/rh•L� DATE � CORRECTIONS VAR. � ;;+ ;�� ', - Plan /,—RER � wn under valuation is for the I NEREBY RCNNOWLEOGE TMAT I H4VE FE4D TMI$ APPIIC/�TION AND p�rpose of establishing a permi[ ee on.y. ST4TE TMAT TME /�BOVE �5 CORRECT ANO AGREE TO COMPLY WITN ALL CITY ORDIN<NCES ST�TE L<WS REGVL/�TING BUILOING CONSTRVC� riorv. VALUATION SIGNATUFE OF PERMiT FEE 5 6 OO PERMITTEE 1� nn n 5 26�3�g�W PLAN CHEGK S G3�0� AUTHORIZED AGENT TOTAL FEE $ 69�00 v��