The URL can be used to link to this page

Home My WebLink About1129 DEBRA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job Address: 1129 DEBRA DR Suite: Vicinity: Parcel Number: 41207112 Zoning: R1 R1 Applicant: WARNER, RICK Calc Valuation: $7,600.00 Address: 22622 LAMBERT ST - Claim Valuation: $7,800.00 SMIP Res: STE 303 Phone: (800) 499-1340 SMIP Com: LAKE FOREST, CA Zip: 92630 Owner: HEFNER, JOE R TR Address 25671 ROLLING HILLS RD - . �. $253.64 Phone: LAGUNA NIGUEL, CA - Zip: 92653 Contractor: BIENEK ROOFING - Address: 22622 LAMBERT ST Right 0-0 ACCESSORY Front 0-0 STE 303 , Phone:- (800) 499-1340 Existing: 0 LAKE FOREST, CA Zip: 92630 License:- 651509 Arch _ Eng: Address: - Address: Phone: 77 FAIR DRIVE, C051A MESA, GA 9215215 ISSUED BY: Status: ISSUED Applied: 03/02/2004 Issued: 03/02/2004 Phone: Zip: License: License: - SCOPE OF PERMIT REROOF; TEAR OFF SHAKE ROOF, INSTALL NEW SHTG, & EAGLELITE TILE ICBO#4660 72k. 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 244646 (6/00) FEE SUMMARY Plan Check: $99.61 Calc Valuation: $7,600.00 Permit: $153.25 _ Claim Valuation: $7,800.00 SMIP Res: $0.78 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $253.64 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 - Right 0-0 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 244646 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and w.11 maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance ol` the work for whih,this permit is issued. � I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. /My workers' compensation Insurance carrier and policy number are: �CarAl r: VE.-1-T lJ.(✓!.0 COQ..? iPoliiy.Number: \NJC_0 ''(/ its section need not be completed if the permit is valued atone hundred dollars ($100) or less.) `❑ 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 th t If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these proon ,Applicant Signature.-- �Dat�e: 'WARNING: FAILURE TO ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUIMECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED fHOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SECTION 37D6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p visions of Chapter 9 (commencing with Section 7000) of Division 3 of.th>Business and Professions Code, and my license is in full for�antl effect. Lit. If 1—a GClass a G] Co 51 I. ntractors Signal Date 3 ^2 v 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). Lenders Name: Lender's 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 five 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: ❑ 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, Art2, 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). _.........__..........._..........................._...................__...._....._................................................a. nt................. fi.....ar...........................................ac.....................................nati........................ ...................[...................... ............ ............ ....... 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ h10 (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 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication a ff"It for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency+ N Yes LJ 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 lacility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (It 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 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. na f legal Date � al Owne3-z -oLi And/Or Authonzed Applicant Date CODE t. INSPECTION TYPE gATE INTMAL3 CODE# INSPECTION TYPE P9If. INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof L 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/Occupancy BIENEK ROOFING 22622 LAMBERT ST., 303 LAKE FOREST, CA 92630 949/951-3798 October 20, 2003 Building Dept. Re: Authorization to pull permits To whom it may concern, This letter is to authorize Rick Warner to pull permits in my absence. if you have any questions please call me at the number above. Sincerely, r Dave Bienek Owner oIraignl Barrel 10. 2 Ost C 'Y OF COSTA MESi_ CALIFORNIA 92626 P.O. BOX 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY Project Address //2q �6"- gl to Project Name Owners Name (�r�a2 •/ �—• .t�%�i✓G� 2Owneowners Address 12- Owners rs Telephone Permit # t56 67M City Use Only (; a � as Owner, (strike out all. except on� do hereby attest that employment of any person, or persons, is.not anticipated at the time of seeking the above -referenced permit. In the event that any person, or persons, are employed under the provisions of this permit, I shall immediately cause a valid Certificate of Workmen Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my own cost, and to indemnify and hold harmless, the City, its officers, agents and/or employees, from and against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly from, or connected with the improvement under this permit. I further state that I have read and fully understand the implication and re- sponsibilities of the above statements, and will comply with all provision of the Contractors State License Law found under the Business and Profession Code, Division 3, Chapter 9, of the State of California. CMF 077766 45932 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING// ADDRESS ` ? kJ OWNER properties West Development Coro. MAli- ADDRESS 508 29111 Street TEL. CITY Ngm=rt Beach CA NO. 675-4910 CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECTE OR ENGINEER Frank SpendT ler NC CONTRACTOR Owner ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. SIZE IND .OF BLDGS. OF LOT Approx. 60'x 80' NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED NOV 10-77CfPA'sca00 566; ***122.64 APPLICATION FOR STRUCTURAL PERMIT RECEIVED B�VJ DATE RECEIVED DATE ISSUED A. . NO. Q4? TINT BUILDING ADDRESS I Z TRACT 9866 LOT 8 BLOCK W AD AREPAIR 2790 v N NN UNDER VALUATION IS FOR m OWNER VALUE PERMIT FEE $ kAPPROVED DATE 1 =LD NO. OF USE OF EW jZrPLANS BUILDINRDS APPROVED YARDS APPROVED AIN BUILDING ACCESSORY BUILDING I hereby acknowledge that I have rda6 this appli4{tion and state !�T that the above Information Is correct and agree to comply with s/1I ,y , !• G all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I em properly licensed as a contractor under S the State of California Business and Professions Code, Division 3, THE AMOI Chapter 9, and that such licenses are In full force and effect, or I THE PURPC am exempt from the provis ns of the State of California Business VALUATION and Professions Code, DI on 3, Chapter 9. Signature of�/�—s./ 73 400. Permittee /F > H.//Gs�i L •�� $ s Authorized Agentn-GFLL�/i— a Fj TOTALPAID $ N ^: 1 DFltl ?Irl r-nlC 1 2790 N NN UNDER VALUATION IS FOR m rABLISHING A PERMIT FEE ONLY: 'e PERMIT FEE $ n PLAN CHECK $ 117.50 e TAX $ 5.14 TOTALPAID $ COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION F0R-1rR0C"A0LPERMIT 5:50 4 P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely —Use Ink Only REC IVED PERMIT 1k t0 50478 1 V .BUILDING //<-/ , �Q^,) 1 %J. ADDRESS /�7 VL"Q�1IY J-1 A.P. NO. Z- O7/— TENANTOWNER OR C SNC, BUILDING �� ,( nI ADDRESS ji, UNIT N SPACE NO. MAILING /2 q ADDRESS / ybk TR.NO. LOT BLK. 'n CITY CDCg�' 14 s NO. NEW ADD LTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH A OWNER 7L �. /_t ADDRESS VALUE USE /r $ ARCHITECT TEL. OR ENGINEER N 0. ZONE TYPE GROUP ADDRESS }}�� r^� ' CONTRACTOR ) /.J /` APPROV BV DATE ADDRESS TEL. CITY NO. STATE CITY LIC. NO. LIC. NO. APPROVED SETBACKS SIZE OF LOT NO. OF BLDGS. NOW ON LOT (FROM C/L STREET) FRONT FT. USE OF EXISTING BLDG. R. SIDE FT. Separate permits are required for electric, plumbing and heating work: L. SIDE FT. HEAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION U frrl 4 .r -r J {, r U/�J t�� DATE APPROVED 4-2 I .� I— APPROVED RY DATE 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 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 grope ly licensed as a contractor under the State of California Business Professi s Code, Division 3, . Cha ter 9, and that such license a in tul force and affect, or I am axe from the pro Iso f t e State of California Business an r e Di $i 3 h pter 9. Si atur Perm SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION C�G $ PERMIT FEE $ PLAN CHECK $ TAX $ a or Authorize ate TOTAL PAID $ lS L] OWNER GARY F. NRJWK DATE 8/11/80 JOB ADDRESS 1129 Debra Drive BUILDING PERMIT N0. 50478 . 412-071-12 LOT TRACT FIRE ZONE VALUE SOIL P M TS SUBCONTRACTOR GAS 1 Date Number Si nature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE F-] HOUSE CON. SPRINKLING SYSTEM AND AIR CONDITIONING UNDERGROUND U POWER ROUGH WIRING 4j BONO BEAM STEEL REINFORCE - 4y1 SHEATHING (j FRAME AND FLASHING -� LATHING - IN OUT PL "TER. BROWN COAT - URAL. FINAL 77 Ul H. .�G. VENT., REF RIG. ANO A.C., FINAL C PLUMBING, FINAL AND GAS TEST 4 ELECTRIC. FINAL P4 BUILDING. FINAL