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Home My WebLink About1176 PRINCESS CT - Building Permits • CITY OF COSTA MESA ' BUILDING DIVISION • • i B 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us t I rw�:•i WORKERS'COMPENSATION DECLARAT10• . Ovmer ID verified by drirv. ..cense. ❑Yes 0 No , r; I hereby affirm under p'ena)ty of perjury one of the following declarations: .Drivers License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the • performance of the work for which this permit is issued. O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: T �,^ ' person is required to descend,will be made in connection with work authorized S77)-7-IS R)rV p by this permit,and that no building structure,scaffdding,falsework,er demolition artier:. • or dismantling thereof,will be more than thirty-sic(36)feet high.(Chap.3.2,Grp (T his sector,need notwbebcompleted✓the permit is valued at one hundred chars($1110)West) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy:Number:_ !1 J DOC [ A 81-9 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. 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 Labor Code, I shall forthwith comply with these provisions, n Applicants Signature Dale ----- t-----..„. - q_yq--Q Division of Industrial Safety Permit Number: L_Applranrs Signature C``77-1e _- HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be fled with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. 2 a registration form for acutely hazardous materials? 0 Yes El No Lic.#— 507� av CWss# lr.- £ 5 (Section 25533 of the California Health and Safety Code, with some .--- .Z_ Q %/^C^O O� exceptions, requires registration with the Costa Mesa Fire Department by [ O each business which at any one time has on hand a quantity of acutely Contractor's Signature Tits__ 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does,or will gie,'applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). . ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed b9 California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution, employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer), • completion, the owner-builder will have the burden of proving that.he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to,comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinanges regarding Hazardous Mate els and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date' property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under SeC. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owner(s) to 9 Signature Date ----1.—____. z2r U 305746(3/07) C-- And/or Authonzed Applicant -- m Cpate--11 • 02/29/2008 08:54 714562e-9 PERMIT SERVICE 1^1+N PAGE 05/10 • 09/_9/2008 08:12 818-84, ,058 MODERN ROOFING PAGE 02 09-26-'28 i0:52 FROM-7 H D at Rime Svcs 5629811451 T-248 7801/003 F-5377 Thri let:10'1(1)4%e • September II,20D8 APNNt3&)101a1X,KAZARIAN • 1176 PRINCESS COURT COSTA MESA,CA 92626 • RS WIMBLEDON VILLAGE ASSOCIATION RRQTIEST FOP.ARCWTBCTURAL MANGE APPItWWAL As Maaagtonent Aged for the Wimbledon village Assoafadon I have beet requested by the :Quhlteortrai committee to coat= you in reepoaee to your aegtS for mehitoetural obsuge Approval ea A¢e result of the inview wad die dem of Tho¢ab,si Sion,it was the deelatoe of the orehimetrat committee to wove your request to Stall anew root For your mast please fwd slotted a copy of year Request for Arabibdarei C haege'Appmyal Form. Should you bare toy questions mgmdiugthe above referenced iafarmetioy please db not heSte to contact Maaogemart et(714)0)8-2629, • Sincerely, For the Used epDi+eat rs • % ambledon Village Aasoaianot • Bcro(i— e—r6M—tt, I � rwiry Menage Gold C Me, Cc: SOD • • • 200 H Satattn•Orange,CA 92867*(71'0 2834620*(714):88-2631 FaX www tub .aa s T19/29/2008 08:54 714552p "-s PERMIT SERVICE •T^4N PAGE 06/10 ' 09/a^^9/2008 08:42 818-84r505H MODERN ROOFING PAGE 03 09-26 '00 10;52 FROM-T H tt at Noma Svcs 5623311461 T-Z46 ?082/e4l3 P 53? WIMBLEDON VILLAGE ASSOCIATION 1lerpert For Architectural Change For nrrar_SMENTROOF The suggested roofing styles and colors are strewn below, A natural wood shake roof identical ,' to the aloe one ea he approved. Manuteturer I Serlea/Style 1 - u,nirer-Name,Color AmericanHeinoopp7 LU?8705-Coastal ond,Brown/Fan limber Range UW 5706-Caaoado BIend.Drove/Gray Range 13agte>ite 901--Oakwood,Brown/Bmwa Streaks • • Double Eagle 903-Charcoal,GGreyR3lack Streaks ., ossa 904-New Cedar,Ta frown Streaks Eagle Roofing Products 9g7-Double Eagle Bleu ,Brown/Gray Range 301-Oakwood,BrowA/Brewn Streaks Eag1CN#e 3Q2-Areadia.Brown/Black Streaks ,- Ponderosa 303Charcoal,oray/B1a*Straka 311-Ffiattidgc,Natural OraY/Bleck Sneaks 387--sent Mend,.aroww'Gray Range Eagtelite 134-Kings Canyon Blend,TantDadr Green Red- (laldeu$agle Blank Blw.al(Added 4/26/95) 2aiel 3774-Muirwocd • ( Cedariitc 2e!o13783-Stanwood .• 2olel 57800-Silverwood 2etcl 5872-Ashwoud i I 2slccb 1130-afar«.: MenterL[ftite 5 453- * , at Ihualin Shake 2skt b 3934-Saddle 2akcb 5932-Silvers-make 2secb 3333-Barnwood • Durslite Split Shake 2seeb 3953-SmokeY 2secb 3963-Camouflage Under no cipauntstances may a toot be replaced without prior application approval. 1 , ey,nude ekrfti...4-.4,,,m,,so.insv..waue..4 A CCAtNew AM usknolronnmt&aaeeeiwrlorybn i stn .,yp3 i COSTA MESA BUILDING-SAFETY DEPARTMENT l3781 2/21 /79 342.31 TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 61378.1 2/21 /79 342.31CKTD APPLICATION•FOympugDjgtmtp iuggsHT" I A For Applicant to Fill in Completely- Use Ink Only _ -R EI D TER C - DATE ISSUED BUILDING - ADDRESS Tract 10277. Lot 51 �/ ^-D7/_O, / PERMIT NO. OWNER McLain Development Co. A.P. No. f `/ MAIL BUILDING _MADRESS 1470 Jamboree Road ADDRESS // �W �(,C, j CITY Newport Beach TEL.. 640-6800 TRACT 10277 I LOT 51 BLOCK CONSTRUCTION NEW f ADD ALTER REPAIR MOVING DFMOLISH LENDER BRANCH �� /�� OWNER t/ ADDRESS .`1-J�///[dJ/, VALUE//ry �r Q ARCHITECT TEL. USE AS / E U OR ENGINEER Corbin/Yamafuii No, 752-5567 7 FIRE ./_J ADDRESS 3661 Spruce St. , Newport Beach ZONE TYPE GROUP 7 APPROVED CONTRACTOR McLain Development Co. BY DATE ADDRESS 1470 Jamboree Road TEL. ZONE 1NO.OF USE OF NEW CITY Newport Beach NO. 640-6800 POR-nlo PLANS BUILDING RES i-i STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. 273875 LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE NO.OF BLDGS. (FROM C/L STREET) O. OF LOT 45 X 95 I NOW ON LOT FRONT JO FT. O FT. hUSE OF EXISTING BLDG. R.SIDE J FT. 0 FT, tI q Separate permits.are required for , L.SIDE Jr FT. V FT. electric,plumbing and heating work. _ - , - REAR /9 FT.0 FT. IQ USE OF BUILDING AND WORK TO BE PERFORMED (- DISTANCE BET. BET.MAIN AMAIN BLOCS. ACCESS. BLDGS. it: Single family residence, VA U. DATE P# 2E -7S-3y APPROVED ,a902748" New House APPROVED^ i�] Q >+ —ELYl'/�tL/ DATE / X71S a HOLD FOR SPFCIAL REQUIREMENT:. — Q I hereby acknowledge that I have read this application and state n N ya that the above Information is correct and agree to comply with m a• all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of House 2190 m = the State of California. Garage 585 m 3 I hereby certify that I am properly licensed as a contractor under SO. FT. g r the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business 6 < and Professions Code.Division 3,Chapter 9. VALUATION PERMIT FEE $ 7�1S B ,a PLAN CHECK $ �L Sa m Signature of (^ /,.(/ - / e'D /� �, c Permlttoe /� AA-r �I (-) fm"- $60, 200 _ TAX $ / U b. Authorized A nt TOTAL PAID 9// 3/