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Home My WebLink About1093 GLEN CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. MLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 l ,lob Address: 1093 GLEN CI Status: ISSUED Suite: Applied: 03/31/2003 Vicinity: Issued: 03/31/2003 Parcel Number: 42203149 Zoning: Applicant: GOMEZ, PAUL $0.50 Address: 2626 NEWPORT BL Other: $0.00 Inspection: Phone: (949)548-1645 Total: COSTA MESA, CA Zip: 92627 Owner: VANUS, JEROME W ACCESSORY Address 1093 GLEN CIR Existing: 0 Required: 0 Phone: COSTA MESA, CA Zip: 92627 Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL Phone: (949)548-1645 COSTA MESA, CA Zip: 92627 License:, 460707 Arch _ Eng: Address: Address: Phone: ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING WOOD SHAKE ROOF. INSTALL SHEATHING AND FELT, COVER WITH 30 YEAR COMP SHINGLES. Plan Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 SETBACKS' MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY .- Calc Valuation: $3,200.00. Claim Valuation: $3,200.00 PLANNING & ZONING Left 0-0 Right 0-0 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) C WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 3 ` ❑ 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 we for which This permit is issued. I 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 permit is issued. My workers' compo ation Insurance carrier and p Icy mbar are: n _ Carder: O"rO �7'��us+i�5<- - Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of t`ie 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 Iifomlit d agree that if I should become subject to the workers' compensation provisions of S tion 3700 f the Labor Code, I shall forthwith _ comply with these ISIo � j I �� -Applicant Signature: 1 Date: WARNING: FAILURE TO SE URE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 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 Profes ions Code, and my license is in full force and effect. Lic. M D Class M - :)4 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: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affiml that under penalty of perjury that t am EXEMPT FROM THE CONTRACTORS LICENSE LAW tot 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).): ❑ 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. 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 (Sea 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 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: ❑ 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, 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 $atety, Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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? ❑ Vas ❑ 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). �plicant or or future building Occupant need to file a registration form for .................................................................................................................... .................... .......... ..... 2 Does or will the aPp P 9 P g o acutely hazardous materials? ❑Ves ❑ 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 Ii en RMPP is presently required, has Section 25534 of the California Health and Safely Code been fully complietl with? C] Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis 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). ................................................................................ -......................... ....-.............. ...................................................................... ...................................................... ...................................... I.................................... 6 Will an art of the tacili to be constructed under this permit be within 1000 feet from the outer boundaries of a school? yp ty p ❑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 slate 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 pernit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant r v Date CODE 1, INSPECPON TYPE 2AN INTI.TJALS CODE INSPECTION TYPE gjjj IMTTALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / 208 Final Plumbing 200 Final Re-RDOI ✓ 210 Final Electrical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2D4 Final Demolition 250 Final Building/Occupancy Y OF COSTA MESA REQUEST FOR 0, ;ANCY TRACT NO. ��/ S DATE / - 7- 7 IAT NO. ADDRESS 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) W+ -S 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. to .�z ?�CEIVE.i, c _n i rn COSTA MESP, ^� m - 7 1977 M PM w il213141516 74 w� OWNER R & W Development DATE 12-7-76 JOB ADDRESS 1093 Glen Circle BUILDING PERMIT NO. 42754 115-661-29 LOT 12 TRACT 9105 FIRE ZONE VALUE$ 38.100.00 INSrECTIONS Signature Date TYPE V GROUP I & J ZONE R2 -CP SOIL L'Y3• SUBCONTRACTOR - P MNumT IS AS Date ber $ i nature ;GAT ER /L /j. Plumbin ROUGH PLUMBING f6itQ, Q. �a• YOBO PROP. SWR. LINE ❑ HOUSE CON. L�•) SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING v TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING(: y' -7 Heatin an Vent. TRENCHES FORMS TEEL REINF. / 12,04 FLOOR SYSTEM BOND BEAM HS. M //L -)%Lk 'LO - SHEATHING FRAME AND FLASHING LATHING — IN OUT ER, BROWN COAT .TUBAL. FINAL HEATING, VENT., REFRIG. AND A.C., F NAL Draw PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL �. •7 BUILDING, FINAL 9105 '' 12-/4ffl 442754 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Q0i44E3n- �79.67 For Applicant to FID in Completely —Use Ink Only P CATION FOR STRUCTURAL PERMIT qE E I ED 8 V O TER CEI ' ASE 1j1JE ,I 11V '_ I BUILDING /�� I `7 .ADDRESS OWNER R W DeVelOpment 5-461 - n(i A.P. NO. `�1 PER I` f4- tj J MAIL pp ADDRESS 180 E. 17th St. BUILDING ADDRESS I09 -S GL45--4 C12.. CITY Costa Mesa, Ca. No`642-4210 TRACT (/O LOT BLOCK CONSTRUCTION Cal. Fed. Savings &Loan LENDER AD A P QPMQI ISH BRANCH 5670 Wilshire Blvd. ADDRESS Los Angeles, Ca. 90036 VALV$ . JVu ARCHITECT TEL OR ENGINEER DMA Assoc. 731-2161 ADDRESS17621 Irvine Blvd,Tustin,Ca, FIRE �- ZONE T E GROVP J. Ra Construction CO. CONTRACTOR Y APPROVE BV DATE ADDRESS 188 E. 17th St. TELL 42-/..f toE CITY Costa Mesa, Ca. Np, 64 4G PLAN 2 BUILDING NEW STATE 126426 CITY LIC. NO. LIC. NO. YARDS MAIN BUILDING ACCESSORY BUILDING SIZE OF LOT 38 X 103 NO. OF BLDGS. NOW ON LOT O (FROM C/L STR EET RONi FT. FT. USE OF EXISTING BLDG. O F Separate permits are required for electric, plumbing and heating work. .(I L SIDE FT. FT. REAR � FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN SLOGS. BET. MAIN & ACCESS. BLDGS. Single Family Dwelling W/ VAR - �, APPTROVED// —2 Attached Double Garage APPROVE Dr, ,/ OATS 2_ -Lf _?// HOLD FOR REO IT.r-IV! 1 hereby acknowledge that 1 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 parson In violation of the workman's compensation laws of the State of California. I hereby certify that 1 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/ rovi ons of the St of California Business antl Professions Co , Di a n 3, Ch _ 9. Signature of t Permittee ' THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION ,�,,11 h pVj § 3g 1(/a PERMIT FEE E PLAN CHECK E 4 U TAX y •fa, Aut rl d Agent TOTAL PAID § { For Applicant to Fill in BUILDING ADDRESS , OWNER gfw MAIL ADDRESS CITY ADDRESS ADDRESS CONTRACTOR ADDRESS 'DEPARTMENT I FORNIA 92626 — Use Ink Only Tt L. NO. �F� —?" JI",LMt.'Q� 2r3`3 rn tYfi ar � 51i. t1� APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED I t L. A.P. NO. CITY NO. F LOT 1�7BLOCK W I ADD ;LTTER A PA - DEMOLISH STATE CITY OWNER LIC. NO. LIC. NO. FIRE ZONE TYPE GROUP SIZE NO. OF SLOGS. 4 OF LOT YARDS APPROVED MAIN BUILDING NOW ON LOT Q FT. R. E FT, F r4 USE OF EXISTING BLDG. rA DATE .� x Separate permits are required for �F� —?" JI",LMt.'Q� 2r3`3 rn tYfi ar � 51i. t1� APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED DATE ISSUED A.P. NO. PERMIT NO. BUILDING /0 1,077,17 ADDRESS TRACT LOT 1�7BLOCK W I ADD ;LTTER A PA - DEMOLISH DISTANCE BET. BET. MAIN IL OWNER V UE SE $ FIRE ZONE TYPE GROUP APPROVED BY DATE ZONE NO. OF PLANS USE OF NEW BUILDING YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING %FROM C/L STREET) FRONT FT. FT. R. E FT, F L. SIDE FT. FT. F electric, plumbing and heating work. C REAR FT. w F PERFORMED USE OF BUILDING AND WORK TO BE DISTANCE BET. BET. MAIN IL 0MAIN BLDGS. ACCESS. SLID,VAR. L&YW # C.U.P.# DATE APPROVED Q APPROVED rAV DATE .� x w 0 1 hereby acknowledge that I have read this application and state IY 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 ,mow the State of California. ' 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. THE AMOUNT SHOWN UNDER VALU the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERt 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 /{ TAX $ Permittee $ //J Authorized Agent TOTAL PAID $ FT. n m i e m N ON IS FOR m FEE O LY: — vt e N m m 0 LL f __ U