HomeMy WebLinkAbout362 GRENOBLE LN - Building Permits� CITY OF COSTA MESA �
�o pMFSq � BUILDING DIVISION .
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-0856 � w�wi.ci.costa-mesa.ca.us .
� `� FOR INSPECTIONS CALL: (714) 754-5626
�`a+ro�on� `�
PERMIT NUMBER: BX09-00099
PERMIT TYPE B MISC STATUS: ISSUED
APN: 43914126 DATE ISSUED: OS/04/2009
Zoning: , ISSUED BY: RMD
JOB ADDRESS: 362 GRENOBLE LN CM Suite/Unit:
Vicinity: SECOND STORV MASTER BED Primary Occ: Const Type :??
SQ. FT: 0 Valuation: 55,000.00
SCOPE OF WORK:
PERMIT FOR FIRE DAMAGE REPAIR TO 2ND STORY MASTER BEDROOM. NON-STRUCTURAL REPAIRS TO FRAMING,
DRYWALL
AND REPALCEMENT OF 1 OUTLET.
OWNER: MANNEY, ROBERT S AND RITA CLAUDINE Address:: 362 GRENOBLE LN Unit
CitylState: COSTA MESA, CA Zip Code: 92627-1452
Phone: 949-642-1278
APPLICANT: MANNEY, ROBERT
City/State: COSTA MESA, CA
Phone: 949-642-1278
CONTRACTOR:
Address:
City/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER:
Phone
OWNER-BUILDER
FEESUMMARY
Building Plan Check:
9uilding Permil:
�lectrical Permit:
SMIP Residential
$MIP Commercial
91dg Std Admin Fund
70TAL FEES
Address: 362 GRENOBLE LN
Zip Code: 92627-1452
License No. 000000
Phone
License No.
License No.
$0.00
$111.25
$24.50
$0.50
$0.00
si.00
$137.25
Cell:
UniC
UniC
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statules and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
El(PIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In ortler 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 musl be oblained. Failure to obtain inspections and final approval will result in the expiration oi this permit.
OOE� INSPECPONTYPE �AiF� INifI1AL5 C 0 � INSGEL110NTYPE 0� INTRIr1L
1616 Fixed System Finbl Pire Prevention 206 Final Mechanical
7266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electncal
201 Final BIocWRetaining Wall 272 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Sile �
204 Final Demolition 250 Final BuilOing/Occupancy ��
WORKERS' COMPENSATION OECLARATION:
I hereby affirm under penalty o( perjury one o( the following declarations:
� I have'and will maintain a certificale of consent to self-Insure for vrorkers'
compensation, as provided for by section 3700 0( the Labor Cotle, for the
peAormance ol the work for which this permit is issued.
❑ I have and will maintain wprkers' compensation insurance, as required by
sectbn 3700 0l the Labor CodC, (or the peAortnance o( the v.ork for which this
pertnit is issuetl. My vrorkers' compensation Insurance carrier antl policy
number are:
Carrier:
(i�u ectqnneetlno(Oemmp'e(GydNepertri4isvaluedalme�urdiM0o0ars(E100)orless)
Poli Num6er:
�"t� ertily that in the peAormance o( the work (or vfiich this permit is
issued, I shall not employ any person in any manner so as to become subject
lo the workers' compensation laws of Califomia, and agree that if I shoultl
become subject to Ihe worker5' compensation provisions of Section 3700 of
Ihe bor ode, I shall f hvrith mpy vnth these provision
�`���,�.� 5 �e q
� - 'sS9naNre'-� par y�-
��-'-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLP.RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
AiTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihal I am licensed un0er provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Code, and
my license is in full lorce and ef(ect.
Lic. # Class #
Conl2clor's SignaWre Date
CONSTRUCTION IENDING qGENCY:
❑ I hereby aHtrm that thgre is a constructbn lending agency for the
performance o( Ihe work (a wfiith lhis pertnil is issuetl. (Sec. 3097, Civil Code�.
Lendeis Name:
Lender's Atltlress:
Date
OWNER-BUILDER DECLARq710NS:
I hereby aKrm lhal under peqalry ol perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE �qW for the following reason (Sec. 7031.5,
Business and Profession5 Coqe: Any ci[y or wunty whith requires a permit lo
consWc�, alter, improve, damolish, or repair any sWcture, prior to its
issuance, also requires �he applicant lor such pertnit lo fle a signed statemenl
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Coc1e) or that he or she is exempl therefrom antl
the basis (or the alleged ezehiption. Any violation of Seclion 7031.5 by any
applicant for a permit subjects the applicant ro a civil penalry o( not more than
fve huntlred dollars (5500�.):
-.r4;as owner of the pmperty, or my employees with wages as their sole
�ompensation, WILL DO 7HE WORK, and the sWCNre is not intended or
oKered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not apply lo an owner of property vfio builds or improves
thereon, and who does such work himsell or hersell or through his or her ovm
employees, providetl that such improvements are not intentletl or oflered for
sale. If, however, the building or impmvement is sold within one year of
completion, the ovmer-builder will have the burden of proving thal he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the propeny, am EXCLUSIVELY CON7RACTING WI7H
LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and
Pmfessbns Code: The contractas License Law dces not apply to an owner of
property who builds or improves t�ereon, antl who cont2cts fw such project with
a contractor(s) license pursuant to the Contractors License Laws.�.
❑ I am exempt under sec.
Business and Pmfessions Cotle !or this reason:
� ,�.•�� s y a 9�
� l�'- Date
3051d6 (3/0])
Ovmer ID verified by drio... ., iicense. L�I Yes ❑ No //
ori4e`s;Liceiise!No��.s �� ! Ezpres��' � / � Z 8 / `f
Verifcation of Ownership by (type of documenl, i.e. - property taz bill or deetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more teet m depth into wfiich a
person is required to descend, will be made in cOnnection with worlc auihorized
by [his pertnit, and that n0 building sWCNre. scaffdding, (alscxwrk, a demolition
or aismanUing thereof, will Ge more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Tille 8, Califpnia Administslive Code).
❑ As ovmerbuiltler, I will not employ anyone lo Co work which wou10
require a permit from Ihe Division of Industnal Safety, as noted above, unless
such person has a permit to tlo such wOrk trom Ihe division.
Ap0liconl'S Signalure
Division of Induslnal Salety Permil Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling occupaM need to file antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous malerial't ❑ Yes ❑ No
(Section 25505 of lhe California Health and Satety Code requires, with some
exceptions. that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantiry of hazartlous matenals equal to or greater than a weight of
500 pountls, or a volume ot 55 gallons, or 200 cubic leel of compressed gas
at standard IemperaWre and pressure�.
2. Does or will the applicant or present or fuWre building occupant need to (le
a registralion (orm tor acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 ot the Cali(ornia Health and Safely Code. with some
exceplions, requires registration vrith Ihe Costa Mesa Fire Departmenl Dy
each business which at any one lime has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic teet of compressed gas at standard
temperature antl pressure).
3. Does or will the applicant or present or (uNre Duiltling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Code pmvides that the
Costa Mesa Fire Department may require the preparation, certifiwtion and
filing with the Fire Department o/ an RMPP by Ousinesses which are required
ro register acutely hazardous materials vdth the Fire Department.
4. I( an RMPP is presently required. has Section 25534 of the Califomia
Health and Satety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or (uture building otcupanl require for
the work which is Ihe subject of this application a permit for such construction
or modification fmm the Soulh Coasl Air Quality Management District or Irom
any ot�er air pollution control district or agency7 ❑ Ves ❑ No
(Sec�bn 65850.2 0l the Califomia Govemmenl Code requires that Itre requeste0
inlormatbn be fumished on applications for ronfesidential building permits).
6. Will any part ot the lacility to be construcled under this pertnit be within
1000 feet from the outer boundanes of a school7 ❑ Ves ❑ No
Qf'yes", lhe /acility must meet the requirement ot Sections 25534 and 42303
Of lhe Cali(omia Health an0 SafBly Code�.
1. II a permit from the South Coast Air Quality Management District or other
air polWtion control dislrict or agency is required (or the wnrk which is the
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Salety Code Section 42303 been made? ❑ Ves ❑ No
B, pf "yes". attach certificate of compliance trom the appropnate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of peryury the
inlormation given above is correct. I agree lo comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Dale
CER7IFICA7E OF COMPLIANCE AND AUTHORIZAiION OF EN7RY: I
certify under penalty of perjury that I have read this application and state that
the information given is correcL I agree to comply with all state laws and ciry
ordinances relating to building construction, and authonze representatives ot
the City of Costa Mesa to enter upon the above-descrihed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorize Ihi permtun' fi al' speclion. �/�/Da
� �
'Sl�eofLlgaFOvme�� iD3te
MElor Aut�mxM Appl�cani Daie
1� � �—� �. y of Costa �I�lesa �13uiC zg 1�ivisioii
-.�__.___ �
, 77 Fair Drive, Costa Mesa, CA 92626
�S'�a 19��eCJ' � . 714-754-5273 / Fax 714-754-4856
C�YVRIER �l1lLD�R V��IFI��i�O�!
�- i.l�i �i �i
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has be u itted ��}'�'''���YYYour �}a�,me lisF ing yourself as Ihe builder of the
property improvements specified at �n��.l"! ��14 J
VVe are providing you �vith an O�vner-Builder A'�owledg t 2nd Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permil issued in your name as fhe
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 of(icial address i�dicated. An agent of the
owner c2nnot exeate 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 belo�v to signi(y you undersfand or verjfy�his in(onnation.
^/�/� �`1.-1�nderstand a irequent practice of unlicensed persons is to have the property owner oblain an "Owmer-
�p � i i Builder" building permit that erroneously implies that lhe properly owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject fo serious financial risk for any
injuries suslained by an unlicensed person and his or her employees while working on my property. A4�
horneowner's insur,nce may not provide coverage tor those injuries. I am wilifully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for irjuries to vrorkers on my preperty.
�1'� �2:"'�understand building permits are not required to be signed by property o�a�ners unless they are
�X �� responsible for the tonstruction and are not hiring a licensed Contractor to assume this responsibilily.
�� �
�� ,.�_ -l�understand as an "Owner-Builder" I am fhe responsible party of record on the permiL I understand thaf
may p otect mysel( from potential (inancial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my o�vn.
�
�
�
�
�/ J�
t
�. I understand ConUactors are required by law to be licensed and bonded in California and to list their
license numbers on permiis and coniracts.
�5.—�1-c�nderstand if I employ or otherwise engage any persons, other than Califomia lic=nse� Contractors,
and lhe total value of my construction is at least five hundred dollars (5500), including labor and materials, I may
be considered an "employer" under state and federal law.
�.�._6 :17understand if I am considered an "employer" under state and federal law, I must register �vith the sfzte
and federal government, v+ilhhold payroll taxes, provide workers' compensation disability insurance, znd
contribute to unemployment compensation for each 'employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
C7.-1_understand under California Centracters' Stale License La�v, an Owner-Builder who builds sing(e-family
residentiai structures cannot Iegally buiid them with the intent to offer them for sale, unless all �aork is performed
by licensed subconVactors 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 Contraclor.
o�8:JI understand as an Ovmer-Builder if I sell the property (or which this permit is issued, I may be held liabl=
ny financial or personal injuries sustained by any subsequent owner(s) that result from any lateni
construcfion defects in the workmanship or materials.
1 of 2
�9� understand I may obtain more information regarding my obligalions as an "employer' irom the Inlernal
Revenue Service, Ihe United Sta(es Small Business Administration, lhe California Department of Bene(it
Payments, and the California Oivision of Induslrial Accidents. I also undersland I may conlact Ihe Califomia
Contraclors' State License Board (CSLB) at 1-800-321-CSLB (2752) or ww�v.cslb.ca.gov for more information
about licensed conlractors.
����1'0�1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
thal I am the parly legally and fin2nci211y rosponsible for proposed con=!ruc!ion zctivity zt the folle�ving zddress:
(�"=1:1.-1yagree thal, as the party legally and financially responsibte for this proposed construdion adiviry, I wiii
abide by all applicahle laws and requiremenls that govern Owner-Builders as �vell as employers.
�1�. I agree to notify the issuer of this form immediately of any additions, delefions, or changes to any of tha
m ormation I have provided on Ihis form. Licensed contractors are regulaled by laws designed lo protect the
public. IF you contract wilh someone who does not have a license, lhe Contraclors' State license Board may be
unable lo assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
uri{icensed Contraclors may be in civi{ court. 4t is also important tor you to understand that it an unlicensed
Contractor or employee of that individual or firm is injured while �vorking on your property, you may be held
li�b!e for damages. If you cb;an a permit as Or.•rer-Builder and v:i;h to hira Ccn,ractcrs, ycu will ba respor�sible
for verifying whelher or not those Contractors are properly licensed and lhe status of their workers'
compensalion insurance coverage. i
BeFore a building permit can be issued, this
and returned to the agency responsible for
driver's license, (orm notarization, or othe
presented when the permit is issued fo veri(}
Jgnat �re•of-�roperl�
'
form must be completed and signed by ihe property owner
issuing the permit. Note: A copy of the properfy owner's
� verification accepta6le to fhe agency is required to be
� the prope�Yy owner's signafure. /
�//"l.G�i"",-�.y ,.�,P✓� 5 /`�( v !
^�O�E: TiiE �viiOY✓ifi� n"fii/iG�fZoli0I1 FGii71 IS IBQUIiBtI iJ u`B cvmp�eteJ by il�a propaiiy owiieroriiy ivh�n
desrgnating an agent of the property owner to apply (or a construction permit (or the Ov✓ner-Euilder.
AUTHORIZATION OF AGEN7 TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibilify, I
h0reby aulhorize the following person(s) lo act as my agent(s) to apply for, sign, and file the documents
necessary lo oblain an Owner-Builder Permit for my project.
Scope of Consiruction Project (or Descriptio� of Workj:
Projecl Location or Address:
Name of Authorized Agent:
Address of Authorized Ageni:
Tel No
I declare under penalty of perjury that I am the property owner for lhe address listed above and I personally fitied
out lhe above information and certi(y its accuracy. 1Jo(e: A copy c/tha owner's driver's license, form
notarization, or other veri�cation acceptable fo the agency is required to be presented �vhen the permit is issued
to verily the property o�vner's signature.
Property Owner's Signalure:
Dale:
20f2
(714) 754-5273 • F2x (714) 754•4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626
Job Address: 362 GRENOBLE LN
Suite No
Vicinity:
Parcel Nunmber: 43914126
Applicant: ANTHONY, PAT �
Address: 1556 S ANAHEIM BLVD ,
ANAHEIM,CA
Owner: MANNEY, CLAUDINE ."
Address 362 GRENOBIE LN
COSTq MESA, CA
PLUMBING PERMIT
Phone: (714) 758-7725
Zip: 92805
Phone:
Zip: 92627-1452
Contracror. PACIFIC COAST COPPER REPIPE
Address: 1556 S ANAHEIM BLVD
Arch / Eng :
Address:
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roo(
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
ANAHEIM.CA
Phone: (714) 75&7725
Zip: 92805
License: 661428
Phone:
Zip:
License:
SCOPE OF PERMIT
COPPER RE-PIPE FOR EXISTING RESIDENCE.
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 �t Landscape Irrigation $0.00
0 ° P-Trap $0.00
0 Pressure Regulator $0.00
0 ' Process Piping (per 10 ft) $0.00
0 . Receptors $0.00
0 Septic Tank $0.00
0 . SewerCapforDemo $0.00
0 - Sewer Connecl $0.00
0 Sewer Private Line $0.00
0 Shower $0.00
0 Sink, bar $0.00
0 ; Sink, commercial $0.00
0 Sink, Floor $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: 07/22/2003
Issued: 07/22I2003
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkOow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Waler Piping (Insi or Rep.}
Water Re-pipe
Water Service
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$9.80
$0.00
�TY
0
0
0
0
0
0
0
0
0
0
0
1
1
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626
2446-06 (NW)
WORKERS' COMPENSATION DECIARATION:
I hereby aHirtn under penalty of perjury one of the followinq declerations:
❑ I �eve entl will meintain a cenificete of consent to self-Insure lor workers' compensation, es provitletl for by section 3700 of ihe Lebor Code, tor ihe pertormence of the
work tor whiCh this pertnit is issued.
ave antl will maintein workers' compenseti insurance, es required by section 3700 of the Lebor Cotle, for the pedormance of the work for which this Dermit is i5sue0.
My workers' p on Ins cern entl pollcy number ere: j �7 z 2�
Cerriar: �� � Policy Number. L, 3/� J l
(This section n�d not be comp/etetl i Me peimit is veluetl a( one hundred dol rs(5700) or less.) '
❑ I cartity thet in the peAormance ol tha wo for w Ich th permit i is etl, I all not employ any person in any manner so es to become sublect to the workers'
compensation laws ot Calitomia, end re the I I s ultl Ceco ubje o the workers' compensetion provisions oi Se tlon 3700 t�e Lebor Code, I shall lonhwith
compty.withlhese provisions. � �nn %��
Applicant Signeture: Date: �����,
WARNING FAILURE TO SECUFiE WORKE 5' CAMPENSATION COVERApE IS L AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND QVI� FINES UP TO IXJE HUNORED
TFKKISANDDOLURE�5100.000),INADDfiIIXJTOTHECOSTOFC(M/PENSAT ,DAMAGESASPROVIDEDFORINSECTIIXJ3)OfiOFTHEL400RCODE,IMEREST,ANDATTORNEI^SFEES.
LICENSED CONTRACTORS OECLARATION:
I hereby aNirtn t�at 1 em licensed
torce end eflact..Lic. N -
Contrector's Signature: _
CONSTRUCTON LENDING AGENCY:
Section 7000) of Divislon 3 of the Business antl Prolessions Cotle, end my license is in full
_ Cless x
_ oa�a: n � n—z
� 1 �ereby eNirm t�at ihere is a construciion lending egency lor the peAormance oi the work tor which this pertnit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lendefs Atlaress:
Signature:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby effirtn that untler penalry of perjury Ihet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Protessions
Code: Any ciry or county which requires a permit b consiruct, elter, improve, demolish, or repair eny stmcture, prior lo i�s issuance, also requires ihe applicaN tor such pertnit
to tile a signed slatement thet he ar she is Ilcensed pursuent to ihe provislons oi the Contrac�ors Ucense Lew (Chapter 9(commencing with Sectlon 7000) ol Division 3 at the
Business end Prolessions Code) ar thet he or she is exempt iherelrom and the besis for the elleqed ezemption. Any violation of Section 7031.5 by eny epplicant tor e permit
sublects the aOG�icant to a civil penalty of not more than five hundretl dollers ($500).):
❑ I, as owner of �he propeny, or my employees with wages es t�eir sole compensation, WILL DO TME WORK, antl Ihe sirucWre is not intentlea or oflered tor sale (Sec.
7044, Business and Professions Code: The Contrectors License Law tloes not apply to en owner of propeny who builds or improves thereon, entl who does such work
himselt or herself or through his or her own employees, provitletl that such improvements are not iniendetl or oNered for sale. If, however, the builtlinq or Improvement is
soltl within one year oi completion, the owner-builder will heva Ihe burden of provinq iha� he or she did not build or improve lor purpose of sale.). �
❑ I, as owner of �he pmperty, am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct the pmject (Sec. 70aa, Business antl Professions
Code: The contractors License Law does not epply Io an rnvner ol property who builds or Improves t�ereon, antl who contracts for such project wlth a contrecbr(5)
license Dursuant to i�e Contractors License Lews.).
❑ I am e:empt under sec. Business antl Professions Code tor this reason:
SignaWre: Date:
Owner ID ventied by dnvef5license. ❑ Yes ❑ No Oriver's License No. Expires:
Verification at Ownership by (rype ot document, i.e. - propeny tex bill or tleetl):
DIVISION OF INDUS7q1AL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity Ihat no exwvation tive (5) or more feet in depih into which a person is require0 to descend, will be made in connection with work euthonzea by t�is
permit, antl thet no building strucWre, sceHoltling, lalsework, or tlemoli�ion or dismantling ihereo�, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle 8, Celitomia Adminisirative Code).
❑ As ownervbuilder, I will not employ anyone to tlo work which would require a permit trom the Division ot Industrial Safery. as notad ebove, unless such person hes a
pertnit to tlo such wark tram the division.
Signature: Date:
DiviSion ot InduS�riel Sefe�y Permit Number:
CEHTIFlCATE OF COMPIJANCE AND AUTTfORIIATION OF EMRV: I certity under penalry of perjury ihat I have read ihis application antl state t�at the information given is
wrrecl I egree lo comply with ell state laws end ci dinanc releling to building construc�ion, antl euthodze representatives ot Ihe Ciry of Coste Mesa to enter upon ihe
above-descnbetl property for in�ection ➢u . I egrea �occuDY or allow occupancy of eny building authorized by this pertnit until linel inspection.
CODE t. INSPELTIONTYPE
7616 Fixetl Sys�em Final Pire Prevention
1268 Pool Spa Final
200 Final Re-Roof
207 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
���
COOEI INSYECTONTYPE
206 Finel Mechanical
208 Finel Plumbing
210 Final Eleciriwl
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
QajE INRMLS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 362 GRENOBLE LN
Suite:
Vicinity: FLAT AREA OF 362,364,&366 GRENOBLE LN
Parcel Number: 43914126
npplicant: HANSEN, DUKE
Address: 260 E. ALTON AVE
SANTA ANA, CA
Owner: BACK BAY GARDENS H.O.A.
Address 960 CALIE AMANECER
SAN CLEMENTE, CA
Contractor: ROSS 8 BARROWS INC.
Address: 260 E. ALTON AVE
SANTA ANA, CA
Zip: ' 92707
Arch :
Address:
Zoning:
Phone: (714)557-7440
Zip: 92707
Phone: (949)498-1129
Zip: 92673
Phone: (714)557-7440
License: 327802
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 04/17/2001
Issued: 04/77/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF UPPER FLAT PORTION OF EXISTING 3-UNIT CONDOMINIUM BUILDING (24 SQ). TEAR OFF EXISTING , �
ROOFING 8 INSTALL NEW 4-PLY BUILT-UP ROOF SYSTEM FOR "BACK BAY GARDENS H.O.A.". �
' REROOF INCLUDES 362, 364, & 366 GRENOBLE LN. �
Plan Check: $0.00
Permit: $15325
SMIP Res: 30.71
SMIP Com: S0.00
Other: S0.00
Inspection: $0.00
Total: , $153.96
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0 �
PARKING Existinq: o
NOTES:
, Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lefl 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
$�,ioo.00
$7,100.00
� ,�
�
i
i' � � �"�,
��
Right 0-0
Right 0-0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regula[ions. (Ord. No. 92-28, § 1, 72-21-92)
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 ro be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetione and f(nal approval must be obtained. Failure to obtain inspectlons and final approval will result in the ezpiration.of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2d4&48Ifl�00)
WORKERS'COMPENSAnON DECLARAnON: �
I hereCy efllrm under penalry ot perjury one of ihe lollowing declarations:
❑ I heve end will maintein e ceniticate of consent to sel4lnsure for workers' compensation, as provided for by section 3700 of the Labor Code, for the pedormance oi the
work for which ih�s permit Is issueU.
r'=
��I'have en0 will meintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for Ihe pedortnenca of the work lor which ihis permit is Issued.
My workers' corrip nsat on Insuranca carriar antl policy number are:
i
'cerriar: --r5�^/ti f v-✓� %Policy Numbec ��/ /J -' O/ OOJ bf O�L
(This section neetl nof be completed if the permit is veluetl af one huntlred dWlers (3100) or less J
❑ I certity thet in tbe pertormance of the work for which this permit is issueq I shell not employ eny person in any manner so as to become subiect to the workers'
compensatlon laws alifomie, antl agrea that if I should become subject to the workers' compensation provislons ot Section 3700 ot Ihe LaDor Code, I shall lorthwith
camplywit�theSe oh ions.
r---
-APPlicant SlgneWre: � "'"'T�— LDeta: � / % " �(
,WARNINO: FARUilE TO SECURE WORKEfiS' COMPENSATION COVERAGE IS UM.AW FUL AND SHALL SUBIECT PN :MPLOYER TO CPIM�WII PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
hIOUSAND DOILARE (5100.000�, IN ADDITION TO THE COST OF COMPENSATION, DAMNGES AS PROVIDED FOR IN SELTON �OB OF THE IABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm lhat.l.am Il�ensed under provisions of ChaO�ar 9(commancing with Section 7000) ol Division 3 of the Business and Professions Code, antl my license is in full
tarce antl ettect..Uc: k� d� D"%� �Class k) G—� �/
Cont e� ctors.Signeture: � �- _ -�„ _ !_Date: �_/ 7 -- c /
CONSTRUC710N LENDING AGENCY:
❑ I hereby attirm idat ihere is a consWction lending egency br ihe pedormance of the work for which ihis permit is Issued. (Sec. 3097, Civil Code).
Lentlers Name:
Signeture: _
OWNER-BUILDER DECLARATIONS:
Lentlers Address:
Data:
I hereby effirtn that under penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor �he lollowing reason (Sec. 7037.5, Business an0 Protessions
Code: My ciry or counry which requires a pertnii to consWct, alter, improve, tlemolish, or repair any strucmre, prior to its issuance, also requires the applicant tor such permit
to file e signad statemant that he or s�e is licensed pursuent to �he D�a��sions oi �he Comracrors License Lew (Chapter 9(cammencing with Sectlon 7000) ol Division 3 oi Ihe
Business end Professions Code) or thet he or she is exempt therefrom end the basis for the alleged axemption. Any violation ot Section 7031.5 6y any epplicent lor e permit
subjects the epplicent lo e civil penalry of not more than live hundred dollars ($500).):
❑ I, as owner ol th0 p�operty, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl t�e stmcture is not intentled or ofleretl for sale (Sec.
7044, 8usiness and Professions Code: The Contractors License Law does noi ap01y to an owner of property who builds or improves ihereon, and who tloes such work
himsell or herseU or ihmugh his or her own employaes, provided ihat such improvemenis are not intended or oNered for sale. If, however, �he building or Improvement is
sold within one yaer of comple�ion, ihe owner-builder will have ihe burden oi proving ihat he or she did no� builtl or improve for purposa of sale.).
❑ I, as owner ol ih� p�operry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to Construcl the pwject (Sec. 7044, Business end Professions
Cotle: The contractors Llcense Lew does not apply to en owner ol property who builtls or impmves Ihereon, antl who contracls lor such project with a contrector(s)
license pursuant �o Ne Coniractors License Lews.).
❑ I am exempt untler sec. Business antl Protessions Code br �his reeson:
Signature: Date:
Owner ID venfietl by tl��efs license. ❑ Ves ❑ No Driver's License No.
Vedtication oi Ownersqip by (type of document, i.e. - properry tax blll or deed): _
DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICATION:
Expires:
❑ I hereby cetlily tbat no escava�ion five (5) or more feet in depth into which e person is required to descen4 will be mede in connection with work euthonzed by Ihis
pertnit, end the� no builtling siructure, scallolding, lalsework, or demolition or dismantling Ihereof, will 6e more lhen thirty-six (36) leet high. (Chap. 32, G�p 2, Art 2, Sec.
34i, Ttle B, California Atlminisirative Cotle).
❑ As owner-buildeY, I will noI employ anyone to do work w�ich would require a pertnit from the Division of Industrial Salery, as noted abova, unless such person hes e
permit to do sucl+ wark from ihe division.
Signature: Date:
Division of Indusirial Sa�ety Permit Number:
CERTIFlCATE OF COMPtJANCE AND AUTHORIZATtON.OF ENfRY: I certify under penalry of perjury that 1 heve read this epplication antl state that the inlormation given is
correct. I egree to compry with all state laws end city ordlnences relating to building consiruction, end authorize representatives of ihe Ciry of Costa Mesa to enter upon ihe
above-described pmpehy 1or inspection puryoses. I agree not to occupy of allow ocwDa�y ot any bnildi�g authorized by this permit until tinal inspection.
CODE �. INSVECTONTYPfi PAIE'
1676 Fiaea System Final Fire Prevention
1266
200
201
Pool Spa Fina�
Finel Re-Roof
Finel Blak/Rp�aining Wall
202 Final Factory Fre Place
203 Finel Sign
204 Finel Demoliti0n � �
IIfiITI�LS
�
Date
Y-/ �-O_(
Date__ _ ,
CO�E I INSPECTION TYPE
206 Finel Mechaniwl
20B Final Plum6ing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupancy
PA7E INTRIALS
,F'-,-�l-c�l ' �
owxEx m� & SHIELDS Development Co.,Inc. DATE 6-3-63
JOB ADDRESS reno E BUILDING PERMIT NO.
AP No. ' LOT 26 TRACT 34�� r•IRE 'LONE DESCRIPTION OF WORK REB. W/2.tt.
1 ECTIONS I Sign�l7 (�_I GROUP �,J TYPE V ZONE R-
Sou � 3 SUI3CONT1tACTOR p��TS ISSUED
r.a� c �i.�n.�.� ..,,T� 1 NtiIUBCB
�`�"—�
���
IiRFMcnrmc
� l9515
COSTA MESA BUILDING-SAFEf'f DEPARTMENT
P.O. BOX 91] C06TA ME6A, CALIFOPNIA
For Applicant }o Fill In Completely
TYPE OR PRINT
i
BUILDING 2/�� ,X'1�Ma
AODRE59 JV
COSTA MESA, CALIFORNIA
h C� e.31¢Y �!
F �� ��o
OPC~'i NEER j�I �1 C �4✓� NOJ%I^ ��
noorsess �� � � �LJt �ol�.manweo-�'�'
CONTRACTOR 0. Vr` ��'
ADDR6S8 v % �ti�P
CITY S�f/h �:.
LIC.Na.J,r/-�,ra'C�-1 NO� �c! ��Q
OFLOT 33 �c s3, s—o I�o.o�aLDae.
NOW ON LOT ��
USE OF
E%ISTING BLOO.
BETB/�CK LINH FROM -T � �
CENTEP OF 6TNCET �• V V REAR VARD
SIOEYAROI LEFT � I RI�MT
DESCRIPTION OF WORK
I
ING33 �
IOR WA{.L
9NG J7
� BUILDIa
I
FIRE
LEOAL
FE RECEIVED
�� y s 1963
FINANCE DEPT.
APPLICATION �,�� �JDSTA MESA
BUILDINf3
for Office Use Only
RHC6IPT NO. 1 �l�1� �
f �U
Y DATERfiC81VED ��No�*E��1963
.�t —�9_ L .'3
ZONING �-.� �
� us� aocxv�
2% �ro.�" 3�/33
'�
EAVE OVERHAN6 SHALL BE LESS THAN
YARDS APPiEOV ED
MAIN BUILDIN6
I DISTANC6 BET
MAIN BLDOS.
VAR. SR
y ��,P�
1 XEqEBY ACKNOWLEDOB THAT 1 HAVe pHAD THIB APPLIC�TION
ANO 6TATE THAi TH6 ABOVB 18 COqqECT AND AGflER TO COM.
PLv WITH �LL CITY OqDINANCiB ANO GTAT[ LAW➢ H[OUTATING
BUILDINO CON9TRYCT�ON. �I
SIGNATUREOF � � �u, W C ,
PERMITTE '
AUTHORIZfiDAGE T �� /lIM.� �
�3 3 s,
THE �MOUNT
PURPO58 OI
S�9,sy��
YARDSAPPROVED
ACCES60RV BUILDIN6
BET. MAIN R
ACCE55. BLI
DATE
5 �2,4' —�
/lQ V I N
, �
VALIIATION I8 FOH TXH t',
A PERMIT FEE ONLY, p
� p
ITFEE $�� j
m
CHECK S �/� `y� 0
� . _ _. 4