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Home My WebLink About1789 HAWAII CIR - Building PermitsPROJECT ADDRESS: 1789 HAWAII CI - UNIT: OWNER'S NAME: THOMAS KAMPH AOORESS: SAME ARCHIENGINEER: REG.NO.: DRESS: UNIT: RTES: ALUMINUM ROOFING SPEC ('71 4)-558'-0678 DRESS: 1529 MCFADDEN S.A. CA 92705 LICENSED CONTRACTOR DECLARA71ON: I hereby affirm thatI 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. CITY LIC.: 0 3 37 2 3 STATE LIC.:0 CLASS: - -----77,�, Date: SAO Signature:'-• /�'�� '�//�"-i3-s'r� WORKERS' COMPENSATION DECLARATION: I bereby affirm th I have a certificate of consent toself-Insure or a certificate of Workers' Compensation lospraace, g p, Certified gin, thereof (Section 3800, Lab. 04 / 0 1 / 9 0 POLICY NO.: VS TA LTE tl `Y EXP. DATE: ll t 1MPAIll Certified copy is hereby furnished. Candied copy is filed with the city Building "I sisi�on.�� Date: ` 90 Applicant:��- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: R� n need not be completed if the permit is for one hundred ($700) or less). I candy 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. Date: Signature: - NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 (commencing with Section 7000)'ot Division 3 of the Business and Professions Code) or that he/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 96 a civil penalty of not more 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 F] structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himseff/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 willhave the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the propery, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. A P. C. for this reason' _ Date: Owner: I do hereby candy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any future building occupant will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certily that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. Date: �_S--,GNU Signature:—i2kiTi Driver's License or Social Security w: I 164146 White—Building: Green—Code Enforcement: Canary—ApPlicanC Pink—Revenue; Goldenrod—Assessor CITY'OF COSTA MESA — BUILDING PERMIT PERM NO: B 045943 PERMIT. NO: B 045943 PLAN CHECK NO: N GOVT: N SUPP:.N CONSTRUCTION TYPE: PERMIT TYPE: STR, PURPOSE: OTEI JOB DESCRIPTION, REROOF W/ALUM ROOF ICBG#3149.FOR1.1600SF SQ FT: 4,200 CLAIM VALUE: 4,200.'00 CALC-'VALUE':: 4200. , 00 P OCC: R-9 L COMMENTS: REMAINDER OF ROOF W/FIBERGLASS BASE SHEE SAKE DETEP' ZK1I�� O N I N G R E Q U I R E M E N T S uIC u S E T B A C K S --------'---- MAIN BUILDING ----------- ACCESSORY -•----- - ACCESSORY BUILDING-------- FRNT: FT IN REAR: FT IN FRNT: FT IN RI'AR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT:; FT IN' PARKING REQ: PROV: PARCEL: 1390217 ZNE: REF NO: PLANNING NOTES> D E V E L O, P M E N T S E R VI C E S R E Q U I R E M E N 'T S ZONING APPROVED BY BUILDING APPROVED BY DATE: DATE: APPLICATION ESSUED'BY:,DATE: ###S — 10, # LEGALLZATION:N F E E S U M -M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT '72,00 PLAN ISSUE FEF: BUILDING -DIV-> PERMIT• ISSUE "PLAN -CHECK TOTALS ---- > 72.50 0.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 72.00 FIRE SMIP/RES GRADING .50 SMIP/NON-RES 'TOTAL PAID DUE '72.50 72.50 .00 72.50 OVER/SHORT: 1.00 FIRE SMTP/TOT .GRADING PLAN-CIIECK .50 ' I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I- P T I O N UNIT COST 'TOTAL COST SFR 4200 REROOF BY VALUE RESIDENIAL NOZONE 1.00 4,200,00 END OF FEES D 01 00053268-00053269 T O T DATE: 02/05/90 TIME: 08:40 72.50 _ CONSTRUCTI -Rl AND PLANNING • '11 APPROVAL yQeermit # Date .Inspector Pl & SPA APPROVALS Permit # Date Inspector 1 Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3: -Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. _ - 55. Electrical Bonding _ 5. Steel Reinforcement - - - 56. Rough Plumbing & Pressure Test ` '6. Electrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , - - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, Cl Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap _ - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final _ 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68!APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS.Permit # 20. Rough Factory Fireplace 21-. Ducts, in Structure - - 70. Underground Hydro 22..Ducts, Ventilating I, 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test .= _ 72. Underground Flush -' 24: Roof Framing _ 73.. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26:'T -Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27.., Frame and Flashing -' 76. Dry Standpipe - 28. Lathing & Siding "' _ 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric -- - Notes: - 34. Final Heating &:Air Conditioning 35. Final Gas Pipe -Test - •= 36. Hood or. Ca nopy 37. Final Factory Fireplace- = 38. Final Plumbing 39. Water Service -Final ' 40. Gas Service -Final -- 41. Solar Domestic -Final' 42. Backflow Preventer - 43. Backflow Irrigation - - 44.. Landscape Irrigation System 45'. Sound Attenuation -• _ . 46. Handicap Regulations'. 47. FINAL STRUCTURE & BUILDING L � �- 48. FINAL -PLANNING 49. Electric Release to Edison' 50. Gas Release to Southern California Gas Co > 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MES/ NS � `1Q,N �RVIT Project Address rr!! Applicant's Mailing AAdddrre�ss� y Owner's Name ��'t/�—s.(^ti—-Phone Address S' Y Arch/Eng. License No. AddressLd.SO,r/) Contractor's NA,S I �nn✓2 ✓3S 11.U-- Phnne`;q - q 7 Address (mailing) tf 11 S LA-'pc0�f J r 14-- 4-�- City License No. 6 0 C U -h LICENSED CONTRACTOR DECLARATION Ihereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force andpS t. Ll c�•,pse f."1 Ss j (cense Date — Signature '"'OR KERS' COMPENSATION DEC LAT N :reby affirm that I have a certificate of c sent elf -Insure or a certificate Workers' Compensation Insurance, or a cer etl copy thereof (Section 3800, Lab. C.) I{ y&Pq Company loLA I?L11 LCI Lt L ert ified copy is hereby furnished. �Erf it etl copy fi ed with the ci�uilding Division. Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Th is section need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair anystructure, prior to its issuance, also requires the applicant for Such permit .�.. , �...., n Ifs—Ant than hpahe is licensed oursuant to the provisions of ,'aision 3 of the Business and Protessions cope) or mat ne/sne a opt '^Irefrpm and the basis for the alleged exemption. Any violation of Section : V31.5 by any applicant for a permit subjects the applicant to a civil malty 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 -o flared for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 com- pletion, the owner will have the burden of proving he/she aid not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiects with a con- tractor(s) license pursuant to me Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance shoultl be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason LJ te ereby certify t ormation is curl and state laws reli tatives of this pection purpose nature ivers' License or 0865-46, rev. 5/88 — Owner I have rea 1 agree to to bonder to enter this application and state that the above ,imply with all city and county ordinances construction, and hereby authorize repre- po t above -mentis. a properly for Date � P35-9 -7 S 1 TYPE OF CONSTRUCTION NE ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK/USE OF U ADD L7 ALTERATION IK REPAIR OTHER -G. I C— TYPE OF PERMIT GRADING ppIILJ FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES Remarks: I 1 le -'L _ - — f ). rye— %)A/A. A 1 Bar Sink Showers PERMIT Backflow Preventer Service Sink $ Backflow Irrigation Sewer Cap GRADING Bathtubs Sewer Connection $ Clarifiers Solar Collectors Dish washer Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors d Water Heater Kitchen Sink Water Service Lavatories Auto -Wash Roof Drains Reinspection Fee I $15 I 1 Issue Fee 1 $ 3 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # / Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 Reinspection Fee 1 $15 Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Typell ❑ Refrigeration System E10-100,000BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 A.P. # S Main Building: E T Front A Rear C Right K Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Accessory ./Provided Zone ELECTRICAL Transformer El El KW ❑ 50+ KW Dryers'❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes; - Outlets Switches Garbage Disposal Generator ❑0.5 KW ❑5-15 KW Meter LJup to 100 amps Meter El over 100 amps Sub Panel Motors 1:10-1 HP ❑1'h-8 Inc. Solar 09-15 HP 1:116-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee $15 Issue Fast DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By :.� SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ ,o5z 00 PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ T N G R E Q M T S. FEES $ 3 SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ S—, t� 0100013329-OLOIS329 T13T s.00 DATE: 11/01/38 TIME: 09:24 CONSTRUCTION AND PLANNINGPO i APPROVALS Permit # - ,Date Inspector ➢ SPA APPROVALS Permit # Date r Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 'r 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -4; Electrical Conduit-Undrgrnd. 55. Electrical Bonding W;Steel Reinforcement r •- 5.6. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd:, ! 57. APPROVAL TO COVER-GUNITE _ -�.1Footings 58. Electrical Conduit-Undrgrnd. 8r Foundation i •-' i 59. Gas Pipe, 0 Undrgrnd., Test .9 :,Water Pipe-Undrgrnd. i 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 's - 61. APPROVAL TO DECK '1.17 Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap tri i , - 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System - �FiAal 14. Rough Plumbing 65. Electrical-Finale 15. Rough Electrical-Conduit 66. Solar System-Final 16' Rough Electric Wiring 67. Fencing & Access Approval 117. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough. Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL Rough Heating & Air Conditioning r_ FIRE DEPT. REQUIREMENT APPROVALS Permit # F*20. Rough Victory Fireplace ( A, 21. Ducts, iri Structure Iri70. Underground Hydro 22. Ductsj,Ventilating„ "'- 71. Product Piping OGas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing & Siding `� 77. FIXED SYSTEM FINAL 29. Insfrlation / 78. FIRE PREY. FINAL 30. DrAall Nailing - HEALTH DEPT. REQUIREMENT 31.. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80, FOOD CERTIFICATE ISSUED 33. FinCl Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 4 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final - % 40. Gas Service-Final % 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation - • i 44. Landscape Irrigation System ' 45. Sound Attenuation +�• 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Soemal Requirements Completed 49. Electric Release to Edison r' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date a CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NOo_/�_____ DATE Z—Z-67— %O LOT. NO Z ADrFESS 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. The undersigned, by executing this agreement, acknowledges that (he -she -they) (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 chas Developer represent BY Fender CITY OF COSTA MESA o ° �Fsq BUILDING DIVISION i 6r 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 PERMIT NUMBER: B09-00173 PERMIT TYPE B_R0OF2 APN: 13957217 JOB ADDRESS: 1789 HAWAII CI CM Vicinity: DETACHED HOUSE AND GARAGE ROOF Squares: 2500 STATUS: ISSUED DATE ISSUED: 08/27/2009 ISSUED BY: RMD Suite/Unit: Valuation: $4,000.00 SCOPE OF WORK: TEAR OFF (E) ROOF,MATERIALS, INSTALL 1 LAYER OF 30# FELT ON A 4:12 PITACHED ROOF AND REROOF WITH 30 YEAR COMP SHINGELS ON A DETACHED HOUSE AND GARAGE, APPROX 2500 SF. REPAIR AND REPLACE SHEATHING AS NEEDED. - OWNER: SMITH DEREK D; DELOSSANTOS RACHEL L Address: 1789 HAWAII CIR PHONE: 949-285-6355 City/State/Zip: COSTA MESA, CA APPLICANT: SMITH, DEREK PHONE: 949-285-6355 CONTRACTOR: OWNER -BUILDER Address: Unit: City/State/Zip: ARCHITECT: ENGINEER: ' FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $97.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTALFEES $98.25 Address: 1789 HAWAII CIR City/State/Zip: COSTA MESA, CA License No. License No. PHONE: License No. 000000 CELL: PHONE: PHONE: Unit: Unit: : 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: 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE N. INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE DATE INTITIA!, 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final q,,, 208 Final Plumbing 200 Final Re -Roof _q _q -C4 by /L�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 0 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Cotle, for the performance of the work for which this permit is issued. ❑ 1 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 pennit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This section needrpt oecompleted Attieperr u vatuetlatane hunt daaars(5100)aless.) ZNumber: _,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 I should become subject to the workers' compensation provisions of Section 3700 of th ode, I shall forthwiti with these prroqovisio s. 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 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 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. Lic. # Contractor's Signature Class # 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 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 fuer ndred dollars ($500).): UI, 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 property 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: IFEMAlrar / - Owner ID verified by driv r• se.Yes ❑ No - Dri4er a License No. ERp e „Il 0 Verification of Ownership by (type of document, i.e. - 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, An 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. Applicant's Signature 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed 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? ❑ 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 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 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 present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ 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 be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 8. (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. 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 authg);izad-Yy-(his perp tLpntil finq_H531;Iection. _ / 7 SigdalNpe(Legal.DvAlr(i1 Andlw Authorized Applicant Dale �qB qty of Costa %esa uffing Dn ivisio 77 Fair Drive, Costa Mesa, CA 92626 7®Sta Sa 714-754-5273 /Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # 6� ,aO Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been suid�in ypur name listi}9 yourself as the builder of the property improvements specified at f c I J 6 Iruml,( 1 We are providing you with an Owner -Builder Ackriowll5dgrneht and Informati n Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each sta ement below to signify you understand or veAfyIhis information. 1.. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- BuHUV9 building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Buildcr and am aware of the limits of my insurance coverage for injuries to workers on my property. ZL_2=h'understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. "&3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that Itmay-Rrotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4,�_I,understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. .. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, an`d-the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6-1 understand if I am considered an "employer" under stale and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. NMZ _1=understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �05_8_ h- pderstand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 1 of 2 9,J._understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb,ca.gov for more information about licensed contractors. am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party Iegolly and financially responsible for�p�r{opos�eyd construction activity at the follo:ving zd�dre`ss7 1-7 9 ( l4fawetii Cir i'19 -R i1/l^�J . �c62 Z 1K�1.1.._I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. U�— 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the informa tot n I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as O,.vnar-Budder and vrish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. t Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Sigoa.Mre.of-property_cwrieL ` 4Date: a Nota: T"e fcl,ovrirg Authorizat;on Form is required io u`e con p(eted uy the properly uwrei only lvlran designating an agent of the property owner to apply for a construction permit for the Owner -Builder. PERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Nola: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 2 of 2 OWNER APOLLO DEVELOPMENT DATE 1-22-70 JOB ADDRESS 1789 Hawaii Circle BUILDING PERMIT N0. 31300 GENERAL CONTRACTOR Same DESCRIPTION of WORK Residence W/Attached rare AP No. LOT 34 TRACT 6694 FIRE ZONE VALUE $ 21.850_nn INSPECTIONS Si n ture Dote GROUP T A I TYPE ZONE SOIL )—?u SUBCONTRACTOR PERMITS ISSUED GAS / Date Number Signature WATER O r PI bi ROUGH PLUMBING PROP. SWR. LINE HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING 3-2c-> TEMPORARY SERVICE OR POLE UNDERGROUND POWER ,,& -16 ROUGH WIRING 'Heating an Vent., TRENCHES FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM El STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT STRUCTURAL, FINAL _ t' HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST c� ELECTRIC, FINAL ,! ,♦ BUILDING, FINAL 6 Y 3.1300 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING ADDRESS OWNER Apollo Development CorpDevelo�ent Corp. ADDRESS 1104 E. 17th Street CITY TEL. No. 547-967= U. S. National Bank BRANCH Main Office ADDRESS 190 S. Broadway, San ARCHITECT Kermit Dor TEL OR ENGINEER ADDRESS 3111 2nd Ave., Corona Del Mar CONTRACTOR Apollo Development Corp. ADDRESS 1104 E. 17th Street CITY Santa Ana No.547-9673 STAT No. 252549 �iC. No. 1690 SIZE OF LOT SO X LOOINO.OF 8LOG5. -- NOW ON LOT USE OF EXIS TING BLDG.SIZE OF --- NEW BLDG. 1440 S.F. ROOMS 7 STORIES 1 EXTERIOR WALL a ROOF COVERING P1anS COVERING Shingle USE OF BUILDING AND WORK TO BE PERFORMED Construct new dwelling with attached garage. 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with 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 the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, isi//oqq//n 3. Chap r A9.- Signature of Y / �/ / Permittee ;V, A/ �/A11( / ci-�-14 _ /31�y, P/j0A770�AS 06/74,# ***120.00 APPLICATION FOR BUILDING PERMIT D =E R�¢E 4 /Y 0 DATE ISSUED USE OF NE `f/% i- �a-7o PLANS y'BUILDING PERMI YARDS APPROVED .: 1 U �J6694 ACCESSORY BUILDING (FROM CIL S�E ET) EADDRESS/7,dg LOT 34 BLOCK SIDE FT, FT. L. SIDE FT. FT. V.Ts REAR FT.� DISTANCE BET. ollo Develo ment Cor . lling VALUS 13,300 FIRE T q•r ZONE TYPE ' GROUP. APPROVED BY DATE 20N NO. OF USE OF NE `f/% THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ar PLANS y'BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM CIL S�E ET) ROM FT. FT. D SIDE FT, FT. L. SIDE FT. FT. V.Ts REAR FT.� DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLDG$. VAR .# // C.U.P. DATE 5 APPROVED /-CJ- APPROVED (rel An t.. i , , Il o HOLD FOR m �J o SO. FT. 3 ti THE AMOUNTS OWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ar VALUATION m D � _ PERMIT FEE S N /y/[' $ O 50 PLAN CHECK $ �0 — E- 0 0 Authorized Agent TOTAL FEE S /- —