HomeMy WebLinkAbout971 DENVER 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 nddress: 971 DENVER DR
Suite:
Vicinity: PITCHED ROOF OF RES AND GARAGE ONLY
Paroel Number: 41808129 Zoning:
Applicant: RASOA, ODILLE
Address: 939 SERRA WAY . � �
� � � Phone: (714) 434-2525
� "' _
COSTA MESA, CA .� �, � Zip: 92626
Owner: WASILEWSKI, MARIAN
Address ,971 DENVER DR -
Phone:
COSTA MESA, CA - Zip: 92626
Convactor: #1 BEST ROOFING CONSTRUCTION
Address: 939 SERRA WAY -
. " Phone:. (714)434-2525
, COSTA MESA, CA
Zip: 92626'� � License: 722805
Arch : �" , Eng:
Address: " . -- � Address:
Phone:
Zip: . � License:
Status: ISSUED
Applied: 04/23/2002
Issued: 04/23/2002
ISSUED BY:
Phone:
License:
� _ : . -,. , , SCOPE OF PERMIT ., �
� � REROOF SHAKE ROOF AREA AND GARAGE ONLY (NOT FLAT AREA): T%O EXISTING SNAKE, 7/16" OSB, 1�LAYER 30#
FELT, APPLY "30-YEAR" OWENS CORNING COMPOSITION SHINGLES. 1200�SF -
Plan Check: $0.00 —
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other. $0.00
Inspection: $0.00 _
Total: $83.75 �; _ _. ;,
SETBACKS. � � � �
MAIN STRUCTURE Front 0- 0 Rear 0- 0
ACCESSORY Front 0. 0 � Rear 0- 0
PARKING Ezistin : 0 Required: 0
NOTES:
PLANNING & ZONING
Left 0- 0
Left 0- 0
, Pr000sed: 0
- ' Calc Valuation:
Claim Valuation:
Right 0- 0 � �
Right 0-0 �� !
�
s2,�26.00
S2,�zs.00
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 ot 180 days. �
� INSPECTIONS: In order for the work authorizad under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspections and final approval must be obtained. Failure to obtain inspec�ions and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS'COMPENSATON DECLARA�ON: .
I hereby ettirm under penelty of perjury one of iha following declaretions: -
❑ I have and will maintain e certificate oi consent to self-Insure for workers' compensation, as provitled for by section 3700 of the Lebor Cotle, for the pertormance ot the
�,/ work for which this permit is issuetl.
pd� I have and will maintain workers' compensation insurence, as requiretl by section 3700 of ihe Labor Code, for the peAormance of ihe work for which this permit is issued.
My w =rS1'�.comp �sat�ion/ �Insurance �9`rr��er and1 policy number are: %('y�, /7
Carner. �IML �11TNA/ � A..A. YlM�ri_ - � PalicyNumber ! J�'T �4 /"!-D�
(This section need not be comp ted il fhe permil is valued at one huntlred dollers ($100) or /ess.J
❑ I certity Ihat in the pertormance of t�e work for which ihis pertnit is issuetl, I shall not employ any person in any manner so as to become subject to tha workers'
compensation laws ot Califomia, end egree ihat if I should become subject to [he workers' compensation provisions of Section 3700 of Ihe LaDor Code, I shall torthwith
camply with these p i �s�.,/� �{ /�
ApplicnnlSignature: bl.Cl�_.. Date: �i"�2��IJ�
WARNING: FAILURE TO SECURE WORKERS' WM1�PENSATION COVERAGE IS UNLAWFOL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDREO
THOUSAN� OOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAM4GE5 AS PROVIDED WR IN SECTIIXJ 3]O6 OF THE LABOR CQDE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn that I am
force and eHect Lic. k
Con�ractors Signature:
of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and P fessions Cotle, and my license is in tull
ClessN C-�
Date: !.� _ Z 2 _ n�✓
CONSTRUC710N LENDING AGENCV:
❑ 1 hereby attirm ihat ihere is a consiruc�ion lending agency for the peAormance ot the work Por which t�is permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lender's Address:
SignaNre: � Date:
OWNER-BUILDER DECLARATIONS:
I here6y aftirtn tha� under penalty of perjury that I am E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, eusiness and Protessions
Coda: Any city or counry which requires a pertnit to construct, alter, impmve, tlemolish, or repair any stmdure, prior to its issuance, also requires the applicant for such permit
to file e signed stetement ihat he or she is licensetl pursuant to the provisions of the Contractors License Lew (Chapter 9(commencing with Sedlon 7000) of Division 3 oi the
Business and Professions Code) or that he or she is exempt therafrom and Ihe basis tor the alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
subjects Ihe applicant to a civil penalry of no� more ihan five hundred tlollars ($500)J:
❑ 1, as owner ot the properiy, or my amp�oyees with wages as Iheir sole compensation, W1LL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, 8usiness and Professions Code: The Contractors License Lew does not apply to an owner of properry who builds or improves thereon, and who does such work
himsetl or herself or Ih�ough his or hef own employees, pmvided thet such improvements are not in�ended or oHered tor sale. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have ihe burden of proving ihat he or she ditl not build or improve for purpose ot sale.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct lhe projact (Sec. 7044, Business and Professions
Code: The contrectors License Lew does not apply to an owner oi propeny who builtls or improves ihereon, and who coniracts for such projact with a contractor(s)
license pursuant to the Contrectors LiGense Lews.).
❑ I am ezempt untlar sec. Business and Professions Cotle for ihis reeson:
Signature: Date:
Owner ID veniied by tlnveYs licanse. [] Yes ❑ No Driver's License No.
Veniication of Ownership by (rype oi documem, i.e. - properry ta�c bill or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETV PERMI7 CER7IFICA710N:
❑ I hereby cetlity Ihat no excavetion live (5) or more feet in depth into which e person is required to descend, will be made in connection with work authonzetl 6y ihis
permi�, antl ihat no building simcture, scaHolding, falsework, or tlemolition or dismantling thereof, will be more ihan thirty-siz (36) feet high. (Chap. 32. Gry 2, Art 2, Sec.
341, Title 8, California Atlministrative Code).
❑ As ownar-builtlar, I will not employ anyone to do work which woultl require a permit irom ihe Division of Indusirial Safery, es noted ebove, unless such person has e
pertnit to do such work from the divisio�.
Signature: Date:
Division of Industnal Safery Pertnit Number:
CERTiFICATE OF COMPLIANCE AND AIJfHORIZATON OF EN7FiV: I certity under penalry of perjury ihat I have reatl this application and state ihat the infortnation given is
correct. I agree to comply with all stete law5 end city ordinances releting to building consiruction, and euthorize representatives of the City of Costa Mesa to enter upon the
ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupancy oF any building authorized by ihis permit until final inspection.
' ature Of L69a1 Owner(s) Date
_ 4-�a-oz
And/Or Amhoriaed Applicant Date
cooe�. iNsvecnoxmae
1616 Fi:ed System Final Fire Prevention
1266
200
201
202
203
Pool Spa Final
Final Re-Roof
Final BIocWRetaining Well
Final Factory Fire Place
Final Sign
204 Final Demolition
QlIE IMRI�LS
COQEt INSPECTIONTYPE
206 Finel Mechanical
20B Finel Plumbing
210 Finel Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PeIE It�IAL$
�\
cn
ApP�icant to till in all spaces except those within heavy borEer lines antl sign all approp�iate tleclarations.
ciTv qF COSTA(�jE$7//� C STRUCTION PEOR M,IT^/
Project Address � / / / ���� �� . ,•�L� V
� Applicant's Maili g Address � � �//
Owner's Name �� � � a Phon�t�i':� ��
Address
Arch/Eng. License No.
Address
Convactor's Nam -�+��- �-��m� I/I�G Phone /�� �
Address (mailing) ' � � ��
City License No. ���
LICENSED CONTRACTOR DECLARATION
1 hereby atfirm that I am licensetl untler provisions of Charte� 9(commencing
with section 7000) of Division 3 of the Business antl Professions Cotle. antl
my license is in (uIl /p/{',ce tl efiect. �I /_ C(
LJC¢!I5 ;� ` C]�{/�{�E /ryyO. C]� I I�i%V /
Date 5'g t ���(�/��
WORK RS' OMPENSATION DECLARATION
` hereby aftirm that I have a certificate oi mnsent to self-insure or a certificate
Wo�kers' CompenSa[iOn Insur�ce, o� a c etl/ ,cOpy thereot (Section
,00, Lab. C.),ryj(UG / 'Company�^�1�"
Policy No. � N�1 ���
IIYCertifietl c�oPY is heetlbwitbrthehcrtY By17 i 9 Di is'o r�7 /%
Date � APPiicant %''� � ��t Yl"%%f�Y11 1
EXEM ION FROM WORKERS' COMPENSATiION DECLARATION
(Thissection neetl not be completed if the permij is far one huntl�etl ($100) or
less).
I certify lhat in [M1e performance o7 the wo�k to� which this pe�mit is issuetl, I
snall not employ any person in any manner so as to become subject [o the
Workers' Compensation Laws ot Calitomla.
Date $ignature
NOTICE:tt, afte� making this tlecla�ation, you Shoultl become subject to the
Worke�s' Compensation provisions ot the Labor Cotle, you must forthwith
comply with such provisions or this permit shall be tleeme� �evoketl.
CONSTRUCTION LENDING AGENCV �
I hereGy afiirm that there is a mnstructlon lentling agency for the p2rformance
of the work for whith this permit is issuetl (Section 309]' Civ. C.)
Lentler'S Name
Lentler's Adtlress
OWNER BUILDER OECLARATION
I he�eby aftirm that I am exempt trom [he Gont�actor's License Law fo/ the
following reason (Section ]031.5 Business antl ProfeSsional Code:'AnY citY or
county wnicM1 �equires a permit to const�uct, alter, improve, tlemoliih or repair
any structure, prior to its issuance, also requires the applicant for 5uch permit
to file a signetl statement that he/she is licensetl pu/suant to the provisions of
the Contractor's License I,aw (Chapter 9(commencin9 with Sectioa 7000) of
Division 3 of the Business antl Protessions Cotle) or that he/she is exempt
eref�om anC [he basis to� the alleged exemption. Any vi0lation of Section
31.5 by any ap0licant for a permit subjects the applicant to a civil
malty of not more than five nuntlretl tlollars (E500).
❑ 1, as owner of the property or my employees with waqes as their sole
com0ensation, will tlo the work, antl the structure is not intentled or offered
(or saie (Section 7044, Business antl Profezsional Cotle: The Contractor's
License l.aw tloes nOt apply to an own¢r of a pwperty who builtl5 or improve5
thereon, antl who tloes Such work himself/herself or through his or her own
¢mploy ees, O�o��tletl that such imptovements are not intentletl or offeretl for
sale. If, howev¢r, the building or imD�ovement is soltl within one year of mm-
pletion, tM1e owner will have the burtlen of proving he/sM1e tlitl not builtl or im-
prove tor the Ourpose of sale).
❑ I, as owner of the property, am exclusively contracting wlth licensetl con-
Iractors to construct the O�oject (Section 7044, Business anE Protessions Cotle:
The Cwtractor's License Law tloes not appty to an owner of property who
builtls or improves thereon, antl who mniracts for such proiects with a con-
t�actor(5) bcenze pursuanf to the Cont�actoYs License Law). I am aware that
proof ot their Worker's Compen5ation insu�ance shoultl be provitletl [o me.
❑ I am exempl untler Section B. & P. C. fo� this reason
rCni �`�� n.Yi.i rvv. �v� �. , Vrvll NV.
TYPE OF CONS /UCTION NEW ADD ALTERATION REPAI R
❑ CONVERSION ❑ OEMOLISH ❑ OTHER A p #
DESCRIPTION OF WORK/USE OF BLDG.
� S Main Building:
TVPEOFPERMIT ❑GRADING FOUNOATION STRUCTVRAL T front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION Sc�. FT. ocCUParvCv C Fiight
K Left
CON.STRUCTION TVPE VALUATION 5 $
zONE GRADING CU. VDS. ACRES Ping. Ref. #
RemarksS" Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
rinking Fountains
loor Orains
loor Sinks
as Service Outlets
Kitchen Sink
Lavarories
P—Trap
Roof Drains
ReinspeMion Fee
$15
Boiler
Duct - Under Ground
Duct - Structurel
Duc[ - Ventilating
Exhaust Sys[em ❑ Multiple
FirepVFact. Blt. ICBO #
Date Owner Heating System & Ducting
I he�eby certiry that 1 bave reatl this application antl state that [he above ❑4700,OOQBTU �lOQ�00
Intormation Is correcL I a9ree to comply with all city antl'munty ortlinances
antl state laws relating to builtlin9 construction, antl hereby authorize repre-
sentatives of his city to ente upon the above-mentionetl�ropert for
inspection pur c{j
Signature � 1/✓%tS _ Date--��(��
Drivers' License or 5 — Reinspection Fea
IF 0865-46, rev. 10/84 White - Builtlin9: Canary - Applicant; Pink - Actounting; Goltlenrotl - Asse55or
$15
ShOw¢rs
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater
Water Service
Auto-Wash
LaundryTrays ,
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-t000006TU ❑100,000
Sysrem Repair/Alteretion
Fire Oampers
Registers
luue Fee
FEES
Automatic Washer
Construction PoleSub.
Cooking Unit
Zone
Accessory Building:
Z
O
N
I
' N
G
R
Parking Req./Provided E
Q
�� M
T
�
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
DrYers LJGas LJElectric
Fan
F.A.U.
Fixtures
Device Boxes
O utlets
Switches
Garbage Disposal
Generator �0-5 KW OS-15 KW
Meter ❑up ro 100amps
Meter ❑over 100 amps
Suh Panel
Momrs �0-1 HP �1'fe - 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Sign
Standing Sections
Trash Compactor
$ 3 I
�— Reinspection Fee $15 Issue Fee
FEES
�DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Buildin9 Approved By �_
APP�ication Issued By �� /� /
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ r PERMIT �
PLUMBING $ il � ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
10/1�4/88 TTPIf:
$
FEES
$
�
CONSTRUCTION AND PLANNING POOL & SPA
�APPROVALS Perrtiit # Date Inspector � qppROVALS Permit # Date Inspector
7. Temporary Electrical•Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Sieel Reinforcement ��,
r, ,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .�,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
e,v
7. Footings � 58. Electrical Conduit-Undrgrnd�.
8. Foundation �. 59. Gas Pipe, O Undrgrnd., Tesj
9. Water Pipe-Undrgrnd: 60. Backwash Lines, P-Trap, ��Undrgrnd.
70. Structural Floor System 67. APPROVAL TO DECK =-
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing �',� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashin9 76. Ory Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ;����
31. Plaster 8rown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED „�
33. Final Electric Notes: ` �'
/Z•zI- BS L�'r-C4,a�. �.�A
34. Final Heating & Air Conditioning ._�� `
35. Final Gas Pipe-Test
36. Hood or Canopy , ,
37. Final Factory Fireplace
38. Final Plumbing '-Q-��{ L�D • � � �
39. Water Service-Final . • ' �
40. Gas Service-Final � '�
41. Solar pomestic-Final - �
42. Backflow Preventer - � � -
%
43: Backflow Irrigation � �
_�
,44. Landscape Irrigation System � , . ��-
45. Sound Attenuation • , �'
46. Handicap Regulations '' '
47. FINAL STRUCTURE & BUILDING . ' '� �
48. Special Requirements Completed .
49. Electric Release to Edison , '
50. Gas Release to Southern California Gas Co � .
51. CERTIFICATE OF OCCUPANCY ,
No. Date � ,
, � � ..
23483
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] ' COBTA MHSA. CALIFORNIA
For Applicant fo Fill In Completely
� TYPE OR PRINT �
ILOIN6 /i.-� i . .. �
COSTA MESA. CALIFORNIA
� MAIL
) J /7 �
FLOT�! 3s!X /�/
U6E OF
EXISTING BLDO. '
SfiTBACK L�N[ RROM �--�
.-curnw ow n.weaT �
NO. OI CLO06.
EF9' .if � C� „ I RIOHT
DESCRIPTION OF WORK
FEE RECEIVED
JAN 2 7 1965
fINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMfT
BUILDING
For Offica Use Only
q[CCIPT NO. � P[I�1ll�f/I�
ZONIN(3 ,
ON NO. OI UiH OF N
i PLANO CYILOINO
LeOAL �/ -
DHBCII�IT�ON �
A. P. NO. I / I — I/"/ � / '
NOTE: NO EAVE OVERHANG SHALI BE LES9 THAN
YARD9 MPROVED YARDSAPPROVED
MAIN BUILDIN ACGESSORY BUILDIN6
( FROM C/ E
L/ / FRONT Ff. FT.
U
d R. SIDE S�. �•
// L�
L.91OE FT. • Ff.
��
Rewre Fr. �. �
DISfANGfi BHT. BET. MAIN Q
MAIN BLO ACGfi55. BLDOH.
p� VAR. Jj DATE
Ig O`� C. U. P. APPROVEO
� APPROV� A ...re I � / �� �l
s' o,� - '� �v c� � i N�
W �' p �'�F ! ,l/ ��> >
1 HER6BY ACKNOWL8008 THAT I XAVe pBAD THI6 �PPLICATION
ANU BT�TB TN�T TH8 �BOV[ IB CORH[R AND AORHt TO COM.
PLY WITH ALL CITY OFUINAHC88 ANO 6TATL LAWB p[pULATINO
BUILO�NO CONBTpURION.
SIGNATUREOP��. � 9���
PERMITffiF
AUTNORIZHD AGHNT
l o ti�� 80. �.1 � y ���� �
TH8 AMOUNT 9NOWN UNDHP VALl1FTION 19 FOq TX8 =
PURP08H OI HDTABLIBMINO A PEHMIT F8H ONLY. �
VALUATION �� m
PERMITFEE �� �
0
m
sa, � � 39— o
i h_ o
TOTALFEE �