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Home My WebLink About1091 GLEN CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cca.usDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1091 GLEN CI Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 42203148 Applicant: KELLY, DAN Address: 15212 XAVIER CIR WESTMINSTER, CA owner: MONDEGARIAN, ROHINTON J Address 1091 GLEN CIR COSTA MESA, CA Zoning: ISSUED BY: Phone: (714)641-2290 Zip: 92688 . Phone: Zip: 92627 Status: ISSUED Applied: 07/16/2001 Issued: 07/16/2001 Contractor: GREGG THOMAS ROOFING Address: 15212 XAVIER CIR Phone: (714) 641-2290 WESTMINSTER, CA Zip: 92688 _ License: 504871 Arch _ Eng: Address: Address: Phone: ., Phone: Zip: License: License: / / , at.yrryr.rrmnni i REROOF EXISTING 2 -STORY SINGLE FAMILY RESIDENCE &-ATTACHED GARAGE'(20 SO). TEAR OFF EXISTING SHAKE ROOF & RESHEATH WITH 7/16" OSB. INSTALL 30# FELT UNDERLAYMENT & REROOF WITH -40 -YEAR COMPOSITION SHINGLES. _ -- _FEE SUMMARY'/ Plan Check:' ; $0.00 %' Calc Valuation. �;, $3,98aoo Permit: $97.25 Claim Valuation; 53:9800o SMIP-Res $050 SMIP Com: "$0.00 Other: $0.00 Inspection: $6.00, Total: $97.75 PI SETBACKS MAIN STRUCTURE Front -'_0-10 "-f ; Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 -' Required: 0 NOTES: NNING & ZONING _- Left 0-0 r' Right 0�0 i Left �,0-0`:)�-� Right��, -/0-0 Proposed: .�; 0' 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 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm 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. "❑ Lhave and will maintain workers' compensation insurance, as required by sectlon 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' cQm�pen, sati�o Insu ce carrier and policy number are: _ Cartier: �ee not ecm' �[bZ i� .Policy- Numbs,__ -(This section need not fr3 completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certity that inW�Plf, the ork r which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers compensation I n ee rat If I should become subject to the workers' compensation provisions of Sectiolt 3700p1 the Labor Code, I shall fonhwlth comply with-7�A p ant Signatures - Da ` T6 ZC71�� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (S1OD,ODO), 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 provisi sof h ter 9 (commencing with Section 7000) of Division 3 of.the. Business' fessions Code, and my license Is in full force and effect. Lic. N, y Class 1i, Contractors Signature:- Date CONSTRUCTION LENDIN 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 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 Lew 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 Ucense 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, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cenity 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 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 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 matenals? ❑ 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes [_1 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 ....._.........._ .............._......... -e _..................................... ............................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this ,application a ffrmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agenc, L -I 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). ............_...................................................................................................................................................................................................................................... ... ............................... .......................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ 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 omply 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-descn d pr arty fo i s aeon purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign r I Of Legal Owner(s) And/Or Authorized. Applicant—`- lDate_, _s CODE f. INSPECTION TYPE 2AN INTMA CODE t INSPECTION TYPE gAX INfITIAUS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �w 208 Final Plumbing 200 Final Re -Roof _ l 210 Final Electrical 201 Final Block/Relaining 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 Buili ing/Occupancy __Pf OF COSTA MESA REQUEST FOR 0. 'ANCY TRACT NO. D5' R L C FDATtl G{jt CITY OF COSTA MESA LOT NO. pi ey*aye^ �rPT ADDRESS ./Oq/ 6leA!_ /�4�c�i AM AUG 2 21977 PM 718000OW411213AN6 y a 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. j . The undersigned, by executing this agreement, acknowledges -that i (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. .j 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 DATE IJ% h� PURCHASER: ADDRESS '0�1 N� CITY DEL IVERYADDRESS LEGEND: i SPA2 E2UIPbfENT 3 GAS 4 ELECTRIC .D 6 7 8 9 10 VOTES: r .. NESTAR, INC. 18101 Redondo Circle Space P ;0L4,5 L�5 Huntington Beach, CA 92648 EXPF7NSr ✓c 'SOt( (714) 847-5580 6�5®7 t9bA9i 4�,FC Ztc4kra.r4) Crr sP►-'ea¢s' ZIP 'm HOME PHONE: BUSINESS PHONE: I icy 1 -C _3_7_ LOT NO: 'TRACT NO: EST. DEL�!lbR.1`ATE: i I i i .o_ MISCELLANEOUS: r;G,,ra: X'-MlI?:GS ARE TO AN APPROX234ATE TO 1r SCALE. DEPTHS ARE '•I;ASURI:D FROM TOP OF BOND BEAM, ELEVATION SCHEMATIC Harescardai¢.......... ........... ... .......................... NESTA,Z, Ii7C. Checked By 4 CNN........... . . ............. 9105 13-1.717 4'271J3 �.+ COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626. i -P �.•�fi , :.U011a49r- B7.5o P CATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RE I E V TE RECEIVE 19 . %. 74 ATE ISS D�j /_ BUILDING IQ('' � ADDRESS ��1t LI OWNER R & W Development /L / A.P. NO. IS —WV` zq a[a=rr/p R -T.� r.�.i5 MAIL 188 E. 17th St. ADDRESS ADDRIESS No I0 q L°{ CITU Costa Mesa Ca. NEL.642-421 ` �j TRACT Q.7 LOT/3 BLOCK CONSTRUCTION Cal. Fed. Savings & Loan LENDER LE W A A R REPAIR MOVING BRANCH 5670 Wilshire Blvd. •—I OWNER VEl.O LOS Angeles, Ca. 90036 1A1 VALUE 4 / ..�, $ WJ:� ADDRESS ARCHITECT DMA Assoc. TEL731-216USE OR ENGINEER FIRE ZONE PE GROUP ADDRESS -7621 Irvine B1vd,Tustln,Ca. CONTRACTOR J. Ray Construction APPROVED BY DATE Te ADDRESS 188 E. 17th St. TEL Costa Mesa, Ca. O. 642-4210 /+rQ 1.( NO. OF PVNS USE OF NEW BUILDING CITY STATNO. YARDS APPROVED YARDS LIC. 126426 LIC. NTY O. BUILDING ACCESSORY BUILDING SIZE 36 103 NO.OF St. (FROMC/LS BEET) OF LOT X NOW ON LOT O RONT 'FT. FT. USE OF O f EXISTING BLDG. R. SIDE FT, F Separate permits are required for L SIDE FT FT. 'C electric, plumbing and heating work. REAR V FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDDGGSS.. ACCESS BLDGGS. Single Family Dwelling W/ �/ C UR P 4Z4 %(y /w APPRVED (/—/— O w Attached Double Garage APPROVERY U2-2 —?G JOLa FOP. �:�?::1. 1 f391i •:i 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 SO. FT. the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that su icanses ere in full foJcs and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from M __ i bns of the Stat t California Business antl Professions Co a, I n 3, Ch pte VALUATION PERMIT FEE $ e Signature of / /�J PLAN CHECK E TAX E a• ,d �, Permltte �jl $ !/j V TOTAL PAI D E Auth sad Agent a i� -. r.,. 169.00 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Co letely — Use Ink Only COSTA MESA BUILDING -SAFETY DEPARTMENT DATE RECEIVED P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 a i� -. r.,. 169.00 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Co letely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ADDRESS s PERMIT NO. OWNER A.P. NO. BUILDING MAIL ADDRESS /D ADDRESS r TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION W AD A T RREPAIR LENDER BRANCH OWNER ADDRESS V E $ ARCHITECT TEL. OR ENGINEERN 0. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 512E NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R. SIDE FT,FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.* DATE C.U.P.+ APPROVED APPROVED BY DATF 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 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 are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE - $ PLAN CHECK $ Signature of /Permittee $ TAX $ TOTAL PAID $ Authorized Agent OWNER R & W Development DATE 12-7-76 JOB ADDRESS 1091 Glen Circle BUILDING PERMIT NO. 42755 f=`mERAL CONTRACTOR S. Ray Construction DESCRIPTION of WORK Res w/att Gar, 115-661-29 LOT 13 TRACT 9105 FIRE ZONE VALUE$ 43 650.00 LCTIONS Si nature Date 11TYPE v - GROUP I & j ZONE SOIL GAS =' •i3 SUBCONTRACTOR M S Date Number Si nature WATER I D.7r. Plumbin ROUGH PLUMBING PROP. SWR, LINE Q HOUSE CON. ®� SPRINKLING SYSTEM r eeB NSfA 1 q 17 ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER Ej ROUGH WIRING TRENCHES FORMS STEEL REINF, C : 'f �'% eetln O Y. i �' 271220t? A _ FLOOR SYSTEM FRAME AND FLASHING A 07 LATHING IN OUT P' -TER, BROWN COAT (URAL, FINAL HEAPING. VENT., REFRIG. AND A.C., FINAL • O ' PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL ,C. ^'I ed. -7 BU INAI