HomeMy WebLinkAbout1017 PARKHILL DR - Building Permitsr)
CITY OF COSTA MESA J
�y(N "rFq BUILDING DIVISION
i 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4656 • www.ci.costa-mesa.ca.us
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�. FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER: B09-00084
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42431312 DATE ISSUED: 05122/2009
ISSUED BY: KJB
JOB ADDRESS: 1017 PARKHILL DR CM Suite/Unit:
Vicinity: RES AND ATTACHED GARAGE
Squares: 1200 Valuation: $3,000.00
SCOPE OF WORK: TEAR OFF EXISTING SHAKE ROOF. INSTALL NEW SHEATHING AND COVER WITH 40 YEAR COMP SHINGLES.
ROOF PITCH IS 4:12.12 SQUARES. INCLUDES ATTACHED GARAGE. ADD TWO SKYLIGHTS IN LIVING ROOM.
OWNER: GREINER, ROBERT F
PHONE: 949-642-2526
APPLICANT: GREINER, TAMI
PHONE: 949-642-2526
OWNER -BUILDER
Address: Unit:
City/State/Zip:
,
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$83.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
TOTAL FEES $84.25
Address: 1017 PARKHILL DR Unit:
City/State/Zip: COSTA MESA, CA
Address: 1017 PARKHILL DR Unit:
City/State/Zip: COSTA MESA, CA n(i_00 8!
License No. 000000
PHONE:
CELL:
License No. PHONE:
License No. PHONE:
..ES
I?nit:
11i1t: >�i
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE /. INSPECPON�TYPFE DATE NTMAL CODEill INSPECnON TY E DATE :� INTMAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /meq 206 Final Plumbing
76 200 Final Re.Roof {,LL A� 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/Omupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty'of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor 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 Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(T1ps sector need rpt Ee mmpletcN d rM pemN rs vda/N al one dwmpd ddears (5100) w kss )
licy Number:
I certify that in the performance of the work for which this permit is
Is
s ed, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Lab e, I shall (rthwith comply wild these provisi .
1 Applicant's Signature (�_WIe
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. #
Class #
Contractor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
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 hu red dollars ($500).):
I, as owner of the property, or my employees with wages as their sole
c pensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does net 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.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Lkgna ure . ale
305)-a6 (W07)
Owner ID verified by drive. „ License. ❑ Yes ❑ No
Driver's 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) a 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, a demolition
or dismantling thereof, will be more than thirty -sic (36) feet high. (Chap. 3.2, Grp
2, Ari 2, Sec. 341, The 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.
Applic nfs Signature
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions. that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or vAll the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
infomtation 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 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 per it until final inspection.
1 L'�ignature egat Ovmer(s)/ 11 Date,
And/or AuthonZed Applicant
Costa Mesa
City of Costa.Wesa ( - 4fding (Division
77 Fair Drive, Costa Mesa, CA 92626•
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitt n your name listing yourself as the builder of the
property improvements specified at I to Ii �l li 7/ I C,tT, iw
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
der" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
ImtLL. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
19:t4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
I 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
`lZaL6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
__0-7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
V8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable
or any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
CALBO Jan 1, 2009 OB Packet template 1 of 2
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19. I understand I'may obta, ore information regarding my obligations , n "employer' from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the 'California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
1�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the propel y, owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify th property owner's signature.
Signature of property owner Date: S ZZ — C/2
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
CALBO Jan 1, 2009 OB Packet template 2 of 2
CITY OF COSTA D1L'SA REQL ..T FOR OCCUPANCY
TRACT NO, DATE
LOT N0. /
ADDRESS/0/7 �fi2� i� L
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-shc-they) Y (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 conditior
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.
I -
and/or au
%n UWNEH DTEFtIAL SAVINGS S& LOAN
� JOB ADDRESS 1017 Parkhill
GENERAL CONTRACTOR Blackm
N No. LOT1�A�
DATE 12-2-70
drive "'ILDING PE
Constr. DESCRIPTION of WOK Retaini
TRACT 7043 FIRE ZONE VALUE $ 35'
INSPECTIONS Si nature I
Date
GROUP J TYPE III., ZONE R-1
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SUBCONTRACTOR
PERMITS ISSUED
GAB
Date Number Signature
WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING
Heating and Vent.
TRENCHES ❑ FORM> ❑ STEEL REINF. ❑ t`
FLOOR SYSTEM
BOND BEAM ❑ STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
Elect,ic
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
VF 1
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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hereby acknowledge that 1 have read this application and state
that the above Information is correct and spree to comply with
all laws regulating building construction, an tl 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
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THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMITFEE ONLY:
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 Stela t California Business
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I hereby acknowledge that 1 have reatl this application and g
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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
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the State of California.
I hereby certify that I am properly licensed as a contractor under
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THE AMOUNT SHOWN UNDER611ALUATION IS FOR
the State of California Business and Professions Code, Dlvisicn 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
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