HomeMy WebLinkAbout586 FAYETTE CIR - Building PermitsCITY OF COSTA MESA
�STaMFS,p BUILDING DIVISION
F�� 77 FAIR QRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754•5626
�`°"40^°"�' PERMIT NUMBER: P11-00055
PERMITTYPE P�UM
APN: 41804122
JOB ADDRESS: C586:FAY,ET_TE CI�CM�^,
Vicinity:
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
03/1612011
CAC
SCOPE OF WORK: INS7ALL 1" COPER WATER MAIN FROM METER TO HOUSE
OWNER: ROBINSON, SHIRLEY ELYSE Address: 586 FAYETTE CIRCLE
PHONE: 714-5463506 City/Slate/Zip: COSTA MESA, CA
APPLICANT: KEVIN SZA60 Address: 17392 MT CIIFFW00D CI
PHONE: 714-247-141y City/State/zZip: FOUNTAIN VALLEY, CA
CONTRACTOR: COAST HEATING AND AIR License No. 771970
Address: 17392 M7 CLIFFWOOD CI PHONE: 714-241-1414
City/SWte: FOUNTqIN VALLEY, CA ZipCode: 92708 CELL: 714-241-1103
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
50.00
$33.30
$33.30
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 fnal approval will result in fhe expiration of this permit.
GOOER. INSPEC110xTYPE DATE INIITIRLS COOE/ INSPECTIONflPE DA1 INi111RL5
1618 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing X.3 ��'� '� njp byC�9--
200 Final Re-Roo( 210 Final Electnwl
207 Final BIocWReWining Wgll 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
.203 Final Sign 222 Final Site '
204 Final Demolition 250 Final BuildinglOccupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the following tleclaretions:
❑ I have and will maintain a certi(cate o( consent to selbinsure'for workers'
compensation, as proviDetl for by seclion 3700 0! the Labor Coae, for the
per(ormance o( Ihe work (or which this pe�mit is issued.
I have and will maintain wurkers' compensation insurance, as required by
s tbn 3700 of the Labor Code, for the perfortnance of the wnrk (or which this
pe it is issuetl. My vrorkers' compensalion Insurance cartier and policy
arrier: Eii.1 1JS U(jJa..i C� C V M p'
eetl rp! be mmyeted d t�e perm4 is r�lued a! me �untlred 49ars (5100) a leu )
olicy Nu r: W�G O� ��7 (� � 3
❑ I certify Ihat in ihe pertormance o( the vuork for which this permi� is
issueQ I shall not employ any person in any manner so as to become subject
to ihe workers' compensation laws of California, and agree that if I shoultl
become subje f lo the workers' compensalion provisions of Section 3700 of
ihe ab Co e, I shall forthwith comply with these provision .
✓ �J
aPliwnfs ' ure te
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions ot Chapter 9(commencing
with ction 7000) of Division 3 of the Business antl Professions Code, and
is in full (orce and effecl.
�i 1 7� �a C�36 (2�
�-Ilo-(l
nalure �
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that Ihere is a conslructbn lending agency (or lhe
peAortnance o( the v.ork for v.hich this pertnit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lentler's Address:
SignaWre Date
OW NER-BUILDER OECLARATIONS:
I hereby aKrm that under penalty of perjury Ihat I am El(EMPT FROM THE
CONTRACTORS LICENSE LAW (or lhe (ollowing reason (SeC. 7031.5,
Business antl Professions Code: Any city or counry which requires a permit to
consiruct, alter, improve, demolish, or repair any structure, pnor ro its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to Ihe provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) o� Division 3 of the
Business and Pmfessions Cotle) or that he or she is exempt lherefrom and
�he basis for Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
frve hundred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the structure is not intendetl or
offered for sale (Sec. 7044, Business and Pro(essions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such wrork himself or herself or through his or her own
employees, provided that such impmvements are not intended or oftered for
sale. If, however, the building or improvement is sold vnthin one year of
completion, the ovmer-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 prqed (Sec. 7044, Business and
Professions Code: The contractas License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project vnth
a contracta(s) license pursuaN ro the Contractas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signalure
305]�a6�310]�
Owner ID verifed by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ovmership by (rype o! document, i.e. - property tax bill or Geetl):
DIVISION OF INDUSTRIAL SAFEN PERMI7 CERTIFICATION:
❑ I hereby certdy Ihat no excavation frve (5) or more feet in depth into wfiich a
person is requiretl [o descenQ will be made in connectbn with work authorized
by this pertnit, and that no building siructure, scaftdding, talseewrk, or tlemolition
or dismantling thereof, will 6e more than Ihirty-su (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Cali(wnia Atlminist2We Code).
❑ As ownerbuilder, I will not employ anyone ro do vrork which would
requiie a permit from ihe Division of Industrial Safery, as noted above, unless
such person has a permit to do such work (rom the division.
Appliranl's Signalore oa�e
Division of Industrial Safery Permit Number _
HAZNRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applican[ or present or (uNre building occupant need b file and
certify a Business Plan tor emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ery Code requires, with some
exceptions, tha[ a Business Plan �e fletl with the Cosla Mesa Fire
Department by every 6usiness which has at any one time tluring a reported
year a quantiry of hazartlous 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 vdll the applicant or present or tuture building occupant need to file
a regislration lortn (or acutely hazardous materials? ❑ Yes � No
(Section 25533 ot the Califomia Health and Safery Code, with some
exceplions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quanti[y of acutely
hazardous materials equal to or greater than a vreight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas al stantlard
temperawre and pressure).
3. Does or will the applicant or present or Wture building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program !or acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Code provitles that the
Costa Mesa Fire Department may require the preparetion, certification and
filing with [he Fire Depahment of an RMPP by businesses which are requiretl
�o register acutely hazardous materials with the Fire Department.
4. It an RMPP is presently required, has Seclion 25534 of the Cali(omia
Health antl Satety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the aOP�icant or presenl or future building occupant require for
the vrork which is the subject of this application a permit for such construction
or motlifcalion from Ihe SOWh CoaSl Air �uali[y ManagemeN District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requires that the requestetl
inlormation be fumished on applications (or noo-residential building pertnits).
6. Wiil any part of the facility to be constructed under [his permit be within
1000 leel from Ihe outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", the facility musl meet [he requirement of Sections 25534 and 42303
of the Califomia Health antl Safety Code�.
7. If a pertnit from the South Coasl Air �uality Management District or other
air pollution control tlistrict or agency is required for the vrork vfiich is the
subject of this appliwtion, 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 appropnate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify tha[ under penalty o( perjury the
in(ormation given above is corcecl. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
SignaWre oaie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that 1 have read this application antl state [hat
the in�ortnation given is wrrecl I agree to comply with all state laws antl ciry
ordinances relating to building construction, and authorize representatives ol
the City of Costa Mesa to enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspeclion.
Sign WreofLegalOwner(5) Date
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(714) 754-5273 • Fax (714) 754-4856
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
JobAddress: 586 FAYETTE CI
Suite:
Vicinity: HOUSE & ATTACHED GARAGE
Parcel Number: 41804122
Applicant: NGUYEN, CUONG
Address: 14351 EUCLID ST #E
GARDEN GROVE, CA
Owner: ROBINSON, SHIRLEY ELYSE
Address 586 FAYETTE CIRCLE
77 FAIR DRIVE, COSTA MESA, CA 92626
Zoning: R1 R1
ISSUED BY:
Phone: (714)545-6994
Zip: 92843
Phone:
COSTA MESA, CA Zip: 92626
Contractor: VILLA ROOFING PROFESSIONALS INC
Address: 14351 EUCLID 5T #E
Arch :
Address:
Phone: (714) 545-6994
GARDEN GROVE, CA
Zip: 92843 License: 758361
Phone:
Eng:
Address:
Status: ISSUED
Applied: 07/12/20D0
Issued: 07/72/2000
Phone:
Zip: License: . License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY DWELLING 8 ATTACHED GARAGE (23 SQ). TEAR OFF EXISTING COMPOSITION
SHINGLES, INSTALL 1 LAYER OF 15# FELT UNDERLAYMENT, 8 REROOF WITH 25 YEAR COMPOSITION SHINGLES.
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
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pro osed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$z,soo.00
sz,soo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 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 suspanded or abandoned
for a period of 1 BO 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
requlred inspectlone and (inal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATON DECLARATION:
I hereby affirm under penalry ol Derjury one oi the following tledarations:
❑ I have antl will meintain a cehifcate of cronsent to self-Insura for workers' compensation, as provided tor by section 3700 at the Labor Cotle, lor the performance ol the
work lor which ihi5 permit is issued.
��I.hav'e antl will maintain workers' compensation insurance, es required by section 3700 of the Labor Code, lor the peAortnance ot t�e work for which this permit is issued.
My workars' compensa�io Insur%a� e�carrie�jend policy number ere:
Cartier.
S`�7 � /�UC�/J �otlCyNumEer.'�—��.� ��O
�(Ihls section need not be wmplefed it the permit is valued a( one hund�ed tlollers ($100J or less.) �
❑ I certify that in Ihe pedortnance oi the work lor which this permit is issued, I shall not employ any person in any manner so as to bacome subject ro the workers'
compensation laws oi Californie, and egree Ihat if houltl become subject to the workers' compensation provisions oi Section 3700 of ihe Lebor Coae, I shall forthwith
comply with these provislons ��/� /�O
Appl ci an(Signaturer-� pa�a;
W.4HNING�FNLTIRE TO SECURE WOP SATIO ERAGE IS UNIAWFUL AND SHALL SU6IECT AN EMPLOYER TO CPIMINAL P NPLTIES GVIL FINES UP TO IXJE HUNDRED
THWSANDDOLLARE(5100.000),INA OTHECOSTOFCOMPENSATION,DAMAGESASPqOVIDEDf-0RINSECTION3]O60FTHElABORCODE,INTEREST,ANOAiTORNEY'SFEES.
LICENSED CONTRACTORS DECLAHATION:
I hereby a(firm thatd�am'�Icepsetl � tler�r�io�of
torce and ettect. L c..#—J / J �
CONSTRUCTION I.ENDING
(commencing with Section 7000) of Divlsiom3�afMe�Business an wf io Cade, and my license is in tull
(_c�ss»� � ��
rDate:'-� 2 l�� ��
❑ I hereby aHirm that there is a constmction lentling egency for the pertormanca of the work for which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lenders Name: Lendefs Adtlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I here6y aHirm ihat untler penal�y of perjury ihat I am EXEMP7 FROM THE CONTRAC70RS LICENSE LAW for �he tollowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or county which requires a permil b consimct, alter, improve, demolish, or repair any simcture, prior to its issuance, also requires the epplicant for such permit
to tile e signetl statement Ihat he or she is licensed pursuem to Ihe provisions of �he Conirectors License Lew (Chapter 9(commencing wlih Section 7000) of Division 3 of the
Business antl Professions Code) or Ihet he or she I5 exempt theretrom end the besis for tha allegetl exemptlon. Any violetion of Section 7031.5 by eny applicant for a permit
subjects the applicant to e civil penelry ot not more Ihen ilve hundred dollars ($500).�:
❑ I, as owner ot the property, or my employees wi�h wages as their sole compensetion, WILL DO TME WORK, end Ihe stmcWre Is not intended or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The Contrectors License Lew does not epply to en owner of property who builtls or improves thareon, antl who tloes such work
himselt or herself or through his or her own employees, pmvitletl that such improvements are not Intended or oflered for sale. Ii, however, ihe building or improvement is
sold within one year of completion, the owner-builder will have ihe buraen of proving ihat he or she ditl not builtl or improve tor purpose of sale.).
❑ I, as owner ot ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pro�ect (Sec. 7044, Buslness and Professions
Code: The contrectors Licensa Law does not epply �o en owner of propeny who �uilds or improves thereon, antl who coniracis for such project with a conhactor(s)
license pursuant to ihe Contractors License Lews.).
❑ I am axempt untler sec. Business entl Professions Code for this reeson:
Signature: Date:
Owner ID venfied by driver's license. ❑ Ves ❑ No Dnver's License No. Explres:
Verification of Ownership by (type of document, i.e. - property tax Gill or deed):
DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICA710N:
❑ I here6y cehity �hat no e:cavation five (5) or more feet In depth into which e person is requlretl to descend, will be matle in connectlon wi�h work authorized by this
permit, and that no building simcture, scaflolding, telsework, or demolition or tlismantling thereof, will ba more ihan thirty-siv (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
347, Title e, Califomia Atlministretive Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which would requlre a pertnit trom the Division of Industrlal Safery, as noted ebova, unless such person has a
permit to do such work fmm the division.
SiqnaNre: Date:
Division of Indusirial Satery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVATON OF ENfRY: 1 cenify under penalty of perjury that I heve read this applicetion and state that Ihe infortnation given is
correct. I agree �o comply with all stete laws and ciry ordinances relating to 6uilding wnstruction, end authorize representatives ol the Ciry of Costa Mesa to enter upon tha
aDove-tlescribed pro � for inspecC n purposes. I egree not to occupy or allow occupancy ot any building authonzed by this permit until final inspection.
�
igna u � Legel Owner(s) ate
r ' ". _ _____ %/.2 :�%.�--. _
AntUOr Authonze Applicenl— ---- -- - ' �T^-7�Date
COOE X, INSPECTIONTVPE
1fi18 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Finel BIxWReteining Wall
202 Finel Fectory Fire Place
203 Finel Sign
204 Finel Demolition
2d48-a6
P.SIE It�1SLS
'�,,/ ���
eooe� u+svecnoxTrae
206 FinelMeChaniWl
208 Final Plumbing
270 Final Electncal
212 Finel Fire Prevention
220 Final Plenning Approval
222 Final Site
250 FinalBuilding/Occupancy
PAIE
.wt
27944
COSTA MESA BUILDINCrSAFEfY DEPARTMEM
P.O. BOX 1P00 COSTA MESA, CAIIFORNIA 9M26
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