HomeMy WebLinkAbout2314 HALF MOON LN - Building Permits�
Job Address: 2314 HALF MOON LN Status: ISSUED
Suite: Applied: 02/712005
Vicinity: TEMPORARY SALES TRAILER FOR SHEA HOMES Issued: 08/09l2005
Primary Occ: B Eat<50/ OKce/ Bar<50 Type o( Construction: V-N
Parcel Number: TPN00521 Zoning:
Applicant: WILLIAMS, GARY
Address: 1450 N. TUSTIN AVE
SUITE 105 Phone: 714-245-9760 X24 ISSUED BY:
SANTA ANA, CA Zip: 92705
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ACUMEN ENGINEEI
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12808 SOUTH 600 I
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SALES TRAILER FOR "SHEA HOMES".
LOCATED ON THE FUTURE TOT LOT PROPERTY,(\
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NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-27-92)
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 780 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codas, and all
required Inspectlons and final approval must be obtained. Failure to obtain inspections and (inal approval will result in the expiration of this permi�
FOR INSPECTIONS CALL: (714) 7545626
244618 (6N0)
WORKEflS'COMPENSArON DECLARAnON:
I hereby eKrtn under penalty of perjury one ai the following deGarations:
❑ 1 heve end will maintain e ceNficate o} wnsent to seN-Insure for workers' crompensatlon, es provitled lor by section 3700 of Ihe Lebor Cotle, for ihe pertortnence of Ihe
work for which t�is pertnit is issuetl.
❑ I have arW w��� melnWn workers' compensaGon insurence, az required by sectlon 3700 of Ne Lebor Code, for Ne pertartnance oF ihe work for which MIs pertnit is issuetl.
My workeB' �o�npansatfon Insurence wnler and poliry numbar are�.
Carrier. Policy Number.
(Thls secNar nead no� be complete0 il fhe Oermif is velued et one hundied dollars ($100) or less.)
D7 / I certity ih9t In t�e OeAortnanca ot Ne work for which Ihis pertnit is issuad, I shall nat employ eny person in any manner so as to become subJecl to the workers'
P� compensa�ion lews of Ilfomie, end hat if I shoultl Decome sub�ect to the workers' compensatlon provisions of Sedlon 3700 of Ihe Lebor Code, I shall forihwith
compywlth.th ions. %�
ApPnce tn signatu� �11�� Cete _: �/%IOS�
W�NO: FAILUFE E WO KERS' COMPE TIO OVERAOE IS UNLAWFUL PND SHAIL SUBIEGT AN EMPLOVER TO CRIMINAL PENALTES AND dVIL FINES UP TOONE HUNDRED
T/IOUSAND OOLLARE (5100.000). IN ADDRION TO THE OF OOMPENSATION, OAMAGES AS PROVIDEU F-0R IN SECTION 3]W OF THE UBOR CODE, INTEREST, AND FTTORNEI^5 FEES.
LICENSED CON�ACTORS DECLARATION:
I hereby eMirtn tnat I em licensed under provisions oi ChaD�er 9(commencing wit� Sectlon 7000) of Division 3 oi ihe Business and Professions Cotle, end my Ilcense Is In tull
force end eHect. �c. M Class #
Contrectors Signature: Date:
CONS7RUCTION LENDING AGENCV: �
❑ I hereby eHirtn that there is e wnsiructlon lending egancy for the pedortnance of the work tor which ihls pertnit is issued. (Sec. 3097, CiNI Code).
Lentlers Nflme: Lenders AtlGress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I �ereby eHlrtn Ina� under penelry ot perjury Nat I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for the fallowing reesan (Sec. 7031.5, Business and Professions
Cotle: My ciry o� �unry which requires e pertnit to construc�, alter, improve, demolish, or repair any structure, pnor to its issuance, elso reQuires ihe epplicant for such pertnit
ro flle e signetl s�etemem thet he or she is Iicensed pursuarn ro the proNsions af ihe Contrectors License Lew (Chepter 9(commencing with Section 7000) ot DlNslon 3 of t�e
Business end Plotessions Code) or tha� ha or she is eaempt thereirom anA the basis tor the alleged exemption. Any violetlon of Section 7031.5 by any epplicant tor e pertnit
subjects tha app�icant ta e civil penalry of nd more Ihen five hundred dollers ($500).):
❑ I, es owne� oi the property, or my employees with wages as their sole compensation, WILL DO TME WOHK, and the siructura Is not Intended or oHered tor sele (Sec.
7044, Business and Protesslons Cotle: �e Coniractors License Law does not apply to an owner of property who builds or improves Iheraon, entl who does such work
himself or hersetl or through his or her own employees, providetl inat such improvements ere not Intentletl or oHered for sale. N, however, ihe building or Improvement is
sold within �e year of comple�ion, Ihe owner-builder will have the burden of proving that �e or she did not build or improve for purpose oi sale.). '
� I, es owne� of the properry, em EXCLUSIVELY CONTRACTING WI7H LICENSED CON7RACTORS to construct the project (Sec. 7044, Buslness end Pmtessions
Code: The �nirectors License Lew does not appry to en owner of properry who builds or Improves ihereon, end who contrads tor such project with a cnntrector(s)
license pureuant to the Contractoyq L�cense Lews.).
Vadflcation
Business and Professions Code tor ihis reeson:
ls licen5e.��Yes ❑ No
by (rype of document, I.e. - properry tac bill or deed):
DIVISION OF INDUSTRIAL SAFETY PENMI7 CERTIFICA710N:
❑ I hereby ce�1y Ihat na excevation tive (5) or more feet In depth into which e person is requiretl to descend, will be made In connection with work euthonzed by this
permit, end ihat no building structure, scaHolding, falsework, or demolition or tlismantling ihereof, will ba more ihen thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341. Tltle B. CelHomia Adminisiretive Code).
❑ As owner-builder, I will not employ anyone to tlo work which would requlre a permit iram the Division of Industnel Safery, es natetl ehove, unless such persan hes e
permit to do such work from ihe diNsion.
Signature: Date:
Division of Industnal Safery Pertnit Num6er:
CERTFlCATE OF COMPWINCE AND AUfHORQATION OF EMRY: I Certity under penalty of perjury ihat I have read this application antl state Ihet ihe iMormation given is
wrrect I egree ta compty with ell state lews end ciry ordinances releting to building consiruction, end authonze represantatives of the Ciry of Coste Mesa to en[er upon Ihe
ebove-descnbed p�operty for inspection purposes. I egree not to occupy or allow occupancy of eny building euthorized by Ihis permit until finel inspection.
P6IF Urrmn�s
7676 Fixed Sys�em Final Fire Prevention
1266 Paol Spe Finel
200 Final RB-Roof
201 Final Blo�k�Reteining Wall
202 Flnal Fe�iory Fira Place
203 Final Sign
204 Final Demolltion
CODE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elecirical
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Finel Buil
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FP,OM :CITY OF CDSTF MESFl
FRX NIJ. :714 754 4BSb er. 09 2005 04:57PM P1
�c�y o� �asta '�Keaa b"u�Fducg Dus�a�o.c
OWNER-BUILDER
VERIFICATION
A tity of County. WhiCh is myuircd In givc nolicc purnuanl to $CCIiOn 19R30. shall atG�ch to such norice, and.
as a condition precedent io issuing n building Fxrmi4 �quiro the completion nnA rcyuire thc return nf, an
uwncr-huilclrr venfication.
Attcntinn Property Ownec
nn 'uwncr-buiidtr' huilding prrnut has been applied for in your name and bearing ynur signalurc.
Please rnmplete anA retum this inforinuion in the envelope p�ovided al your earlies� np�rtunity �u avoiJ
unne.cns:vy delny in prceessing and issuing your building prrmit. No buildinkj+ermit will t+e issued until �hic
vcriticafion i� rocr.ived.
1. i�x�ram:dly pl:m �o provide fht� majnr I:�Mtt and m:iterials for a�nstn�ctinn of the pro�ud
. �xuExny imprnvcmcnL � ,Ycs ❑ No
'_', I�fi:�vc :rve not) .i�ned :m applica�ion for a building permi� far
Ihc p�O�x�crd wurk. .
:i. I have cunlrac�ed with Ihe (ulluwing pcetiun I linn) lu provi�lta Il�e prupcur.d cnnslNelion:
M1amc
Address.—'-'--._._....,.....-------`----... . . . ..,. ..__ (:ily---
Phone ( ) Contractur's Lic. No. ^_.____,
4. I plan io prnvide poniunc n1'the wnrk, hut I h:�ve hired ihe fc�lluwing persnn to c��rdinare.
supervisc anA pravidc Ihc majur work:
N�uncI,�� 'T•: �
�iEVE� fAS7LEJ��TOf' f-W���tlN.-�:-r-[LNEj �lJRTL`�
�� '.' � "'...
nAdn•ss Gt'I3. S(�A�lM u'c .J�I,�. City ...
Phonc (�I�� ) 74 2- 2.��1 Contractor's Lic. No. __,,.,___J_,
5. I will prnvidc some oT Ihc work bu� I Illv� �OI1V0l'[fl� (I111Y.ti) Ii1C fulluwing �rsnn. 1u
prnvidr. �hc work indicmr.J:
Nxmc � Address Phnnr '1'y� �( W'nrk
�M]. (II
�o : G� �- �X 7/So 7S`F— ��5�
I�j�nh��2�
^ ._ ._ `^ 1 i 1 _ I I 1 I 1 A 1 i 1 i i i i � � i � i � � � � � . � . . . . � . . _. .. - .
Street Address:
AP Number:
1. I(we), .Sl'�C-� iipMlES �—� �• , declare that I am the Owner of Title of lhe above
referenced real property, and that I(we) hereby autborize:
Name: � L �1rfC_G ��� i,�— '—Li–.�-� S Telephone Number. 7�U �C�� .��L �1
�% C£3lC�Z. r9t:d'���N�✓ "�t� Y 6�J��i.r�d5
Street Address: lu'�� A: • �C,`�7l'1 �'L^C� � ��� �G�S
Ciry: �Z�' �l L'4�(�i � State: CA� 2ip: � �
to obtain pertnits in my behali, as ownedbuilder, for Yl'��� �� � TKG �— � 4 � U�
at the above referenced property.
2, Should any peraon become an employee engaged in the improvement of the property, 1(we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certiticate of that coverage to be filed with the Building Division of the City of Cosla
Mesa, as required by Stale of Calitornia laws.
3. As owner/builder in tacl, I understand and accept that my responsibililies do not transfer to any other person, company or
corporation.
4. I agree to indemni(y and hold the Ciry of Costa Mesa and its employees or oHicers harmless (rom any claim resulting in damage or
personal injury to myselt or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty oi perjury that the foregoing is true and correct.
Executed this � day of �i7� 20 OI— , at �RC"'�" , Califomia.
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Prinl Name:
Siqnature: ;�`i DhNVE�/
Date: �'� ���
Note: This auVrorization does not grant auttwrization to perform ihe work as owner,
it soley provides tor timded power ot attomey to secure tfiis permit in any behatt.
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