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1086 GLEN CIR - Building Permits
0 (714) 754-5273 • Fax (714) 754-4856 Job Address: 1086 GLEN Cl Suite: Vicinity: Parcel Nunmber: 42203159 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning:, 'k a B98-00906 PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 05/26/1998 �7Y Lb Issued: 05/26/1998 Applicant: COLLIER, DAVID Address: Phone: Zip: - Owner: THOMPSON, CHARLES Address 1086 GLEN CIR Phone: COSTA MESA,CA - Zip: 92627 - Contractor: 'DUNLAPROOFING-- Address: 9424 VIA ZAPADOR Phone: 619 449-9803 SANTEE, CA' Zip: 92071 License: 290883 Arch / Eng Address: Phone:, _ .. Zip* .� .. Licenser SCOPE OF PERMIT T/O EXISTING & REROOF THE HOUSE AND GARAGE WITH COMP. SHINGLE. FEE SUMMARY Plan Check: "►� $0; 00: '; — ' , Calc Valuation:, $5,250.00 Permit: $112.25 j Claimed Valuation: $5,250.00, Other: x$0.00 �' Inspection: "$0.00 Total: $112.78 PLANNING &ZONING SETBACKS ^ MAIN STRUCTURE Front 0-0 Rear 0_'0 Left-, , 0-0 = . Right . 0-0 , ACCESSORY Front 0-0 Rear 0-01 Left _0_0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES 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. IINSPECTIONS: 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 DECLARATIONS WORKERS'�POMPENXATION DECLARATION: I hereby affiml under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Caller: Policy Number. (This section need not be completed ff the pemlit /s valued at one hundred dollars ($100) or less.) ❑ 1 cer ity that in the performiange of the worrlIyyfor 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 Calitor l ,and agrss hat I hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio� �/y�(!//f/tea//'� Applicant Signature w�; .�il�/'//�r/-/ r /�l Date:/., WARNING: FAILURE TO(SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER O CR? IMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 9060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affiml that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. L.C. P /l Class H Contractor's Signature: IhI.A.i /,Yiv Date, 9 .i�;_ 2 �o y 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). Lender's 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 o1 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).): ❑ 1, 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. It, 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 contractor(s) 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 drivers liconse. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity 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, scaffoli ing, 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 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. Signature: Date: 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 Cade 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 ocwpant need to file a registration forth for acutely hazardous matariels7 ❑ Ves ❑ IJo (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costs 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? [I Yes [I 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 appernit 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 pen of the facility to be constructed under this permit be within 7000 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 tram the appropriate air pollution control officor). 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 corect. 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. / op/ /i J Si fur L r //Z te v/AndlDr Authorized Applicant �� Date CODE t, INSPECTION TYPE gm INTMAIS CODE r INSPECTION TYPE ATF ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root $ �` W 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 2saa-46 CITY OP COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. ` O� LOT N0. ADDRESS DATE vy -,77 The developer of the above entitled tract desires to sell the above set 4 ' forth lot prior to the time that the tract has been completed and its streets r accepted by the City of Costa Mesa. The undereigned, by executing this agreement, acknowledges that (he -she -they) (fit_. (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. urchuser BY Developer and/or -a thoriz representativ LA*IBY der �o-Z7- 71� e i 1 ! OF COSTA MESA REQUEST FOR OL ANCY TRACT NO. ��, D S �� SAO DATE — i- LOT N0. 0G2/ / ADDRESS /UO.Io lPA! The developer of the above entitled tract desi es 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)/rd!.f o 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 Gond 00 OWNER R & W DEVELOPMENT DATE 17-7-76 JOB ADDRESS 1 ORF, ('lpn C;,la BUILDING PERMIT NO. I ei�aiTltam CTIONS Signature Date ITYPE GROUP I & J ZONE R2—CP S, r11 2 SUBCONTRACTOR M ISS ens Dote Number Si nature WATER tY I Pl umbin ROUGH PLUMBING 2 , C. PROP. SWR. LIN@ Q HOUSE CON. J/ SPRINKLING SYSTEM MISCELLANEOUS 1 ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND D POWER ❑ ROUGH WIRING G N4'7 Heating d nt, TRENCHES U FORMS STEEL REINF. FLOOR SdASTEM O - •� BOND BEAM STEEL REINFORCE SHEATHING .21--Z7 " FRAME AN=FINAL G m 1i•% LATHING OUT S- _PLASTER,AT'TURHG, FRIG. AND A.C., F HAL DAgPLUMBINGD GAS TESTELECTRICBUILDING, 9105 - 2-tZ.Sa 4274 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 5i For Applicant to Fill in Completely — Use Ink Only BUILDING 1 wO7/ t .— OWNER R & W Deve MAIL ADDRESS188 E. 17th St. CITY Costa Mesa, Ca. TNoL.642-421( CONSTRUCTION LENDER Cal. Fed. Savings & Loan NCH 5670 Wilshire Blvd. ADDRESS LOS Angeles, Ca. 90036 ARCHITECT DMA Assoc. TEL 731-M OR ENGINEER NO. ADDRESS17621 Irvine B1vd,Tustin,Ca, CONTRACTOR J" .''Ray Construction Co: - ADDRESS188 E. 17th St. CITY Costa Mesa, Ca. TEL STACTY LIC. NO. 126426 LIC. NO. SIZE NO OF OF LOT 36 X i l l . 27 NOW ON LOS O USE OF EXISTING BLDG. O Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Single Family Dwelling w/ Attached Double Garage I 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, andVts enses ere in full force antl effect, or I am exempt frLin he tat ialifornia Business and ProfessiononsaCSignature of AtP41CATION FOR STRUCTURAI,PERMIT RECMY 575 qy I 'ff 6D D IIS5 A.P. NO.IIS "''2. PERMIT A Y BUILDING �I I �\ ADDRESS tOR(n �JL�G I/��L TRAC l OS LOT 2 1 BLOCK W ADD ALTER R PMOVING QFMQLKH YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING OWNER Vr L..O /� S WATT A (� VALUE �� _ FIRE 575 qy ZONE ATYWE GROUP APPROVEDWIWI PERMIT FEE $ BY l -2-'//J% DATE bb E NO.OF% PLANS C..^. USE OF NEW C5, BUILDING YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING REAR 2 - FT. FT. DISTANCE BET. BET. MAIN & MAIN BLDD�GSS.G76 . / ACCESS. BLDGS.VA* `'') DATE C URP.*ze -J APPROVED aq- /(o AJJPPROVE /'{ .1 DAT� .IOL© FOP E., E °, I {7 ?/`'^1 I•.. tAi` e. \ .] �-.u♦'lu 2 JrUso. FT. 575 qy THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ PLAN CHECK $ S �� ,yL, $ '3� 6V v TAX $ a TOTAL PAID $ 7/0 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Cot pletely — Use Ink Only BUILDING J0 A'/ �_/ ADDRESS , OWNER MAIL ADDRESS TEL. CITY NO. CONSTRUCTION BRANCH ADDRESS CONTRACTOR lA ADDRESS V V TEL CITY NO. t STATE CITY LIC. NO. LIC. I, {al SIZE NO. OF BLOGS. 0. OF LOT NOW ON LOT Q USE OF EXISTING BLDG. FSeparate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Q a i' �IX i W 0 1 hereby acknowledge that I have read this application and state 09 that the above information is correct and agree to comply with 0• all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of the State of California. 3 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, Division 3, Chapter 9. Signature of Permittee Authorized Agent ,.Fp _7'7��r a5nQQ 285 tom +. -9.00 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED nnTo iccnor PERMIT NO. BUILDING ADDRESS OWNE FIRE APPROVED FIP°NS BUILDINGSE OF EWVED AIN BUILDING ACCESSORY BUARDS APPROVED YARDS OILDING I DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. BLD VAR.# DATE C.U.P.* APPROVED THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ / PLAN CHECK $ $� TAX E TOTAL PAID $ s