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Home My WebLink About1125 DEBRA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 1125 DEBRA DR Suite: Vicinity: Parcel Number: 41207111 Zoning: R1 R1 Applicant: WARNER, RICK ISSUED BY: Address: 22622 LAMBERT ST- — STE 303 Phone (800) 499-1340 - Status: ISSUED Applied: 09/15/2004 Issued: 09/15/2004 Arch Eng: Address: / - Address: -' Phone: - - _ Phone: ,Zip: _ License: License: LAKE FOREST, CA - 'ice- - Zip: 92630 ' SCOPE OF PERMIT MAIN STRUCTURE Front Owner: GARCASIE RGIO L & SUSAN G \ , Address 1105 DEBRA DRQ ;. `_' ,Left" - Phone: 714 875-7958,-, . �.-COSTA'MESA, _ CA Zip: 92626 `;; '=�, �.� �•.�`� Right, . •.Plan Check' ,� $117.81 „1 Calc Valuation: $10,600.00 Contractor: BIENEK-ROOFING Address: 22622 LAMBERT ST SMIP Res: $1.00 STE 303; ? Phone: (800) 499-1340 " - LAKE FOREST, CA $0.00 Zip: - 92630 License:- 651509 Arch Eng: Address: / - Address: -' Phone: - - _ Phone: ,Zip: _ License: License: - SCOPE OF PERMIT MAIN STRUCTURE Front REROOF: T/OF'SHAKE ROOF, INSTALL_1/2"OSB, 30# FELT -AND -30 SOR'S.OF EAGLELITE, TILE -ICBG 4660 (7.2#) Right 0-'0 oma. �� ;. `_' ,Left" ' ACCESSORY Front FEE SUMMARY _ Right, . •.Plan Check' ,� $117.81 „1 Calc Valuation: $10,600.00 Permit:'. $181.25 -Claim Valuation: _ $10,000.00 SMIP Res: $1.00 - e SMIP Com: $0.00 Other: `.A:`4$0.00 1 � �A" ..�i " $300.06 h to IC �'\X',Total: i / 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: 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) 7545826 2446.46 (6M) SETBACKS. MAIN STRUCTURE Front 0 0 Rear 0.0 �- 0-0 Right 0-'0 oma. �� ;. `_' ,Left" ' ACCESSORY Front D- 0 - Rear 0 0 — Left _ 0 0 >" Right, 0 0/ PARKING Existin '� - ..0 �- � Re wired:, `' 0 -_ -- Proposed: 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) 7545826 2446.46 (6M) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have end will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Cada, for the performance of the work for which this permit is issued. 1eHave antl 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. y workers' compensation Insurance carrier and policy number are: ff p, �,�--t mer: S�– �V N� Number: IG \ 1621"Z OV/ 7 (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 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith triply with the pr cant Signature:' /c--�-- �✓ ��/'S —O Of ARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOUARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WOS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I In byJhirm 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 for nd effect. Lia N CI e 3 ntractors Signature: tee CONSTRUCTION LENDING AGENCY: ❑ 1 hereby all 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: r Signature: �i-,r,, �,. Date: OWNER-BUILDER DECLARATIONS: I hereby affirn 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 Cade: 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.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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: ❑ 1 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 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................... S Does or will the applicant or present or future building occupant require for the work which is the subject of this 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 fumished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................................................................................... 6 WIII 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 [3 No ..........................................................._........ _....................... _................. _............................... -............................ ....._............................. ............................... _...................... _.......................... -.......... _..... -............................... I.............................. 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 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 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 permit until final inspection. Ignature Of Legal Owner($) cj Date And/Or Authorized Applicant Date CODE t. INSPECTION TYPE IAN INTITA .CODE!. INSPECTION TYPE glSff. INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �J 208 Final Plumbing 200 Final Re-Rcof ! 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 450.2 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING rADDREsS perzles wesT Levelopmen C C MAIL JCS 29th Street TEL. ,25-91 ewport Beach, Ca. NO. 6 PAIU 109.78 4D4 1 Q 77tr su00 544 u••x APPLICATION FOR STRUCTURAL PERMIT . RECEIVED BY I DATE RECEIVED DAT, IASUFn LENDER -�'Y ' / ►•1 ✓ el. CITY i - a - .�1 r^n enr'r . - - —"- BRANCH F •STATE CITY roper OWNEfi les We$ eve ADDRESS W SIZE s Res. Atd. Gar. VALUE $ ARCHITECT' TE OR ENGINEER Frani{ Spangler o -0 2 ADDRESS 224.0 Newport Blvd. FIRE ZONE VPE GRC CONTRACTOR Owner APPROVE BV _ n // DATE TE TEL. -�'Y ' / ►•1 FaiNs el. CITY i - a - .�1 r^n enr'r . - - —"- Al r—^r i[n :�aaCpl'T 11 F •STATE CITY YARDS APPROVED SQ. FT. 29 2 LIC. NO. LIC. NO. MAIN BUILDING l W SIZE NO.OF BLDGS. (FROM C/ S REET) TOTAL PAID $ 0. OF LOT A pr h0 I XF10 I NOW ON LOT 0 ROM 4 USE OF EXISTING BLDG. .�. F Separate permits are required for L SIDE � FT electric, plumbing and heating work. 25T. G REAR w USE OF BUILDING AND WORK TO BE PERFORMED H DISTANCE BET. BI GMAIN BLDGS. � A� a Construct single family 3 bedroom culla# DA > housePlan #3• APPRO As -It aBY c4 w QI hereby acknowledge fhat I haveree is ap plicati and state n 0., that the above Information is con,end agree to comply with A+ all laws regulating building construction, and I shell not employ z any person in California. of M8 workmen's compensation laws of Wx the State of Cetifornte. i - a - .�1 r^n enr'r . - - —"- Al r—^r i[n :�aaCpl'T 11 3 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, D vision 3, Chapter 9. Signature of P/� / /T7yL� Permittee SQ. FT. 29 2 a1 w m a n 0 ic U THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $61 , 100 PERMIT FEE $ PIAN CHECK $ 10 50 TAX E O , 2V TOTAL PAID $ Authoriged Agent '/L��s'� '"R._w-nom. n.a.__._— ��R_A1d._'��'•---=[ry„� I a'Va[l.otiss:i yOLut —.✓- - .w II I? f f_ •.ugI,LoFn,2lonz Co9a' Di!gajuu 3' CuattoL a• ; sw :nu Wea AVrnV 11ON zwta ALo,[Vo bLan,goI,1 of L 2rorc o1 CollloLuls nab+c . I C}'noto, y auq fpll Ln LV I!cnutaz sw N inti lmro nuq cjlcc nL I i j 1HE bnHb( t"n 2moc xxi C'•Iautuls ontluvca auq bLotoar�oua CogW Oirlal1HE V WO 1 V,.,u GA re LyltM1 xp,n I nw btob.,L1A poouxoq va v 00611.1iLLa: nugaL �}--•- ny [ra 2c:•La 07 Lat!Lo,upn• " roA bouou lu etoWRou N IV* n'o:puxou,a cowbounpou luw.a of ty, i vll 1cmz LSYnfo+lub nNigiu9 cnuannc8ou' nuq I Lpail uo[ u.bl"A [p +L LVc opana p,LOLworlou 12 coLLacx uuq valo., ro cowblA rn�,•y y1 I jlmvpA f1L$U2.�1LgT6 {p,. I pmo i.m "jL1C 4b SN,Cv((Ay swo ai•,m r7 �.^!: ,�.:auty... _ \�. 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