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Home My WebLink About1789 ORIOLE DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cBVJILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1789 ORIOLE DR Suite: Vicinity: ROOF Primary Occ: R3 Type of Construction: V -N Parcel Number: 13962304 Zoning: R1 Status: ISSUED Applied: 11/01/2005 Issued: 11/01/2005 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(6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑),havg:end will maintain a certificate of consent to self-Insure for workers' com_ ; ansation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 - i ❑ t hive and will maintain workers' compenrrfer insurance, a required by section 3700 of the Labor Code, for the performance of the work for whi is permit is Issued. �fdy wo4dler ' corn ns ion Insurence/carderand poll number ere: �� Carder: - \ ll�l _ { olicy�: !ti (This sect/ I(need not be completed I/ me permit is ve/u at one hundred dollars ($100) or less.) J❑:�;"l certify that in the performance of the work for which Ibi pe It is issued, I shall not employ any person in any manner so as to become subject to the workers' � / compensation laws of ifomia, a d agree that If I s fo d b ome subject to the workers' compensation provisions of Section 3700 of t e Labor Code, I shat �gflWltfl comply with these vis! s. Ap Ican[T1j5_W_�. 4 Data WARNING: FAILURE T SECU WORKERS' COMPENSATION C/JVERAGE IS UNIA UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL TI D L RNES UP TO ONE HUNDRED THOUSAND DOLLAR 100 I, IN ADDITION TO THE COST OF COMPENSATION, GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IME ST, 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. Uc. # Class # Contractors Signature: 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). Lenders 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 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 properly 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 driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - 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 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 Nu C- HAZARDOUS MATERIALS AND EMISSI CER ATIO4,lqwl'th 1 Will the applicant or present or future builtling antnd certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No i n 2 OS of the California Health and Safet Code som Vons that a Business PI n b fit w'Sect o 55I t e ed Ith the Costa Mesa Fire of me o( Y1 � Department by every business which has at any one time at during a rd temp year a quantity of h canals 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 registra ion torte for acutely hazardous materials? p�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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? [3 Yes ❑ No SSection 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire apartment 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes . LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .......................................................................................................................................... ni't...........it-h-......................................the"........'e"'r.......................................................................................................................................... - ....... ......... 6 Will any part of the facilily [o be constmctetl under this permit be within 1000 feet from the outer bountlanes of a school? C] 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 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. J. S' nature L gal nar ) q e Or. Applicant ate CODE 0 INSPECTIONTYA PATE INITIALS CODE# INSPECTION TYPE DTE INTITALt 1616 Fixed Syste F I Fire Prevention 206 Final Mechanical 1266 Pool Spa Final- 208 Final Plumbing 200 Final Re-Root 7 210 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 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. p 7.-5-& DATE LOT NO. pp6Z ADDRESS�7pl� The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. yh The undersigned, by executing this agreement, acknowledges that (he-she-6y(was or< were) advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BY /Purchaser BY ( jf/ XA* ` v - L/ Developer and/or a&horized representative Z . aU Z ZQ O v~i am J to co J J ca Q U-1 Za W K I1 W W Z JO m Z J fi W yi 0 Z l - LU O �O 36V0 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 SEP 1 t . ��rs'00 361=r* -."*19011 (10 rr APPLICATION FOR BUILDING PERMIT 67— For Applicant to Fill in Completely REC�IV D BY gDAT�EjRECEIVED /—O" / DATE ISSUED SEP 14 1911 BUILDING/ ADDRESS / PERM T O pp p OWNER /s-/, r A.P. NO. �— ADDRESS O MAIL NG ADI DRIESS/�GL..V/(,/'- TEL.Z/3 TRACT LOT(p BLOCK CITY NO. W CONSTRUCTION el LENDER BRANCH L/ OWNER — ,0 ADDRESS VALUE ` $ may' �C.v�r S/SL ' NEL O OR ENGINEEFl FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZO PNL OF !1 PLANS USE OF W BUILDING TEL. _ CITY NO.j p- 3j i (/ 51 // ,,// L C NO. ��b i LIC. No. 2Of3 AARDS PPROVED BUILDING ACCESS RY BUOI DING (FROM C/LS EET) SIZE // /• NO. OF SLOGS. OF LOT C� _ ��Q NOW ON LOT FRONT FT. FT. USE OF y/ EXISTING BLDG. ✓ FT FT SIZE OF Lig NO. OF CJ 2%/ NEW BLDG. O� / O flOO MS STORIES L. SIDE / FT. FT. EXTERIOR WALL ROOF � COVERING S U CC O COVERING N/ W E REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. VAR.* DATE C.U.P.+ APPROVED / APPROVED - / l I l I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with TREWNTC� 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 SQ. FT. ' THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses din full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt fro he provisions t the State olCalrnia Business VALUATION and Professio Co eDiv' ion 3 Chapter 9. PERMIT FEE $ Signature oPermittee - f //� $/`� PLAN CHECK $ Authorized enc �"'' M �1 OA r+ TOTAL FEE 9 C:1 rr