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Home My WebLink About1105 DEBRA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cayJILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1105 DEBRA DR Status: ISSUED Suite: Applied: 01/05/2004 Vicinity: RESIDENCE Issued: 01/05/2004 Parcel Number: 41207106 Zoning: R1 R1 Applicant: VU, TWEE - ISSUED BY: Address: 14672 WESTFALL RD Phone: TUSTING, CA Zip: 92780 - Owner: NGUYEN TR . Address -1105 DEBRA DR Phone: 714-444-0273 ' COSTA MESA, CA Zip: 92626 Contractor: Address: Phone: Zip: License: , Arch Eng: Address: Address: - Phone: Phone: 'Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING WOOD SHAKE ROOF. INSTALL SHEATING, FELT AND COVER WITH 30 YEAR COMP SHINGLES. APPROX 2245 SQ. FT. FEE SUMMARY Plan Check: $0.00 Calc Valuation: 85,000.00 Permit: $111.25 - _ Claim Valuation: 85,000.00' SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 j. ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 4646 (WO) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirn 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' com tel atlonnlnsur n e carrier end is number are: Carrier: \ X Policy Number: his section.need not be completed if the permit isalued atone hundred dollars ($100) Orissa.) I certify that in the performance of the 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 California, and agree that if I should b ome subject to the workers' compensation provisions of Se lion 37 0 of the Labor Code, I shall forthwith comply with these provision� - C U Applicant Signature: 11n3 �<�z- Date: �.% 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL ECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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. Uc. 4 Class q 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). Lender's 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 live 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 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 B, 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 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 aqua to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). _........_...........__.........._...........___.................._...._..._...................................................................... _.... __._.___........................................................... _.......................... _.................................................................................................... 3 Does or will theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes E]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 . ._..........._............__..........._......................................................................................................................................................................................................................................................................................................................................... 5 hoes or will the applicant or present or future building occupant require for the work which is the subject of this .a�ppplication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency.. U Yes L] No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................'!'s ......rmil................hin,............................................................._..................................oc,I...............'e"'s.............................. -.......... ...... .................................. B Will any pan of the facility to be constructed under this permit be within 10001eet 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 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is reGwired for the work which is the subject of this application, have all 01 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No ................................................................"...............................".................................. ........................ .................................................................................................... .................................................................. ................................................ ......... B (If yes", anach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certiry 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 AUTHORLZAT10N 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. 1 agree not to occupy or allow occupancy of any building aulhonzed by this permit until final inspection. SiggetareOtCSgal Owners) /v Date And/Or Authorized Applicant T- Date COOE I. INSPECTION TYPE TYPE gAIE INITTIA15 CODE I INSPECRONTYPE gdTE INITIAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �� 208 Final Plumbing 200 Final Re -Roof[_ 210 Final Electrical 201 Final Block/Retaining Well 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/Occupancy DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # e(N j pna This Permit # Street Address: (IGS 015K312/a- lg- cr r P4��i- tl;A—G//.62G',APNumber: t. I (we), )�' PJWA2 -ej' , declare that I am the Owner of Title of the above referenced real property, and that I (we) hereby authorize: IWcC-- vt.k,- Name: (Ht4c4=4, )`-' r� Telephone Number:%�% � /�1 -00'7> l C/ Ce 7 Z_ _ C,�1�STFi4 LL cR Street Address: ,F(" -s t T2u SG nr �i�^'- -� City: fP+��X 7 �� State: Zip: ? to obtain permits in my behalf, as owner/builder, for 11-k Q - at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. 1 agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. 1 declare under the penalty of perjury that the foregoing is true and correct. Executed this day of 077946 (rev, 1100) 20_,at Print Name: Signature: Date: _�/ D L/ Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. California. s n 60 I / 4 911 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING n,--12nA /1n OWNER MAIL EL. T CITY NM ort Beach CA NO. 675-4914 CONSTRUCTION BRANCH ADDRESS OR ENGINEER Frank Spa�1. filer NOL 67.i-n� ADDRESS 2240 Newport Blvd. Newport Bch CONTRACTOR Owner Gar, ADDRESS CITY TEL. NO. STATE LIC. NO. CITY LIC. NO. SIZEN LOT Approx. 60'x 80' NOW ON LO. 0 OFOF USE OF EXISTING BLDG. ZONE Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Construct single familV 31edroom house Plan # 3 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 1 shall not employ any parson in violation of the workman's compensation lows of the State of California. I hereby certify that I 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 provisions of the State of California Business and Professions Code, Ivizlon 3, Chapter 9. Signature at Permittee -G'• Authorized Agent LLZGG s� WOW to 77Para C -5p00 543* t*x*109.78 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED HTTP i. SIIPn BUILDING ADDRESS D � TRACT 9R66 LOT 9 1 BLOCK T OWNER iTopertles Res. Atd. Gar, VALUE 61,100. FIRE ZONE PE GROUP ( II RYPROVED DATE -fin. / ! .- V ouiwirvm / t LI YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING III (FROM CLLSTREET) a 14f) FVC 7t_ —rne SO. FT. 2295 a THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE E m PLAN CHECK E 105.50 c $ 61,100. TAX j428TOTAL PAID E p 4l