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Home My WebLink About3016 FILLMORE WAY - Building Permits` • � CITY OF COSTA MESA • � BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0B56 • wwv+.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754•5626 PERMIT TYPE B_ROOF2 APN: 14113415 JOB ADDRESS: 3016 FILLMORE WY CM Vicinity: . Squares: 2800 . PERMIT NUMBER: 609-00051 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 04I1312009 BJK $6,500.00 SCOPE OF WORK: REROOF DETACHED DUPLEX: T/0 EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED (3/8" ORIG). FELT PER MRGR'S SPECS, REROOF WITH 30 YEAR COMP SHINGLES. PITCH 4:12 2800 S� Ff OWNER: ALBERT, LEONARD J MARTIAL TR PHONE: APPLICANT: CEDANO, RICK PHONE: 909-623-7753 CONTRACTOR: CUSTOM ROOF COMPANY Address: 293 E MC KINLEY AVUnit: City/Stale/Zip: POMONA, CA 97767 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund TOTALFEES $0.00 $139.25 $0.00 $1.00 $140.25 Address: 3016 FILLMORE� WY City/State/Zip: COSTA MESA, CA Address: 293 E MC KINLEY AV City/Stale/Zip: POMONA, CA License No. License No. PHONE: License No. 859220 909-623-7753 CELL: PHONE: PHONE: Unit: Unit: . NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) 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 final approval will result in the expiration of this permit. COUE�. INSVECiIONTYPE OpTE IN7RIAL5 O�E� INSPECTIONTYPE D� IN77iIRL5 7816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �� /�� ZOB Final Plumbing 200 Final Re-Roof y a3-o� �w� 210 Final Eleclrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approvai 203 FinalSign 222 FinalSite 204 Final Demolition 250 Final BuiltlinryOccupanty WORKERS' COMPENSATION DECLARA710� I hereby affirm untler penalry of perjury one of the f011owing declarations: ❑ I have and will maintain a certifcate of consent to sel(-Insure (or vrorkers' compensation, as pmvided for by section 3700 of the Labor Code, for the performance of the work tor which this permit is issued. ❑ I have and vrill maintain v�rkers' compensation insurance, as required by section 3700 of the Labor Code. !or the perfortnance of the work for which this pertnit is issued. My workers' compensa[ion Insurance carrier and policy number are: C � , �% CCarrier.- � d �IZ�I� (This section nttb im( be mmde�� the pemrR is vaNed af ine huntlieECdlars (5f 00) w less J Policy Number:. �i�% 3 Z�'� ❑ I certi(y that in Ihe performance o( the work for which this permit is issued, I shall no[ employ any person in any manner so as to become subjecl to the workers' compensation laws of Cali(omia, and agree Ihat if I should become ct to the workers' compensation provisions of Section 3700 of Ihe La r C e, I rthwith comply with these pmvisionsj. � � � �7 � � APO��'s5ignaWre �le- WARNING FAIWRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmfessions Code, and my license is in full force antl eflect. �_Cic. # � Class # � �3 � ��1.(,/ -l3-of Gonlractor's Signalure " � �ate . CONSTRUCTION LENDING AGENCY: � I hereby affirm Iha� there is a cons[ruction lending agency for [he pedormance of the wurk fa which �his pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre Date OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat under penalry of perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Pmfessions Cotle: Any ciry or county which requires a permit to consWct, alter, impmve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such permit to (le a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Professions Code) or Iha[ he or she is exempt therefrom and the basis for the alleged exemption. Any violation o( Section 7031.5 by any applicant for a permit suhjects the applican[ to a civil penalry of not more than (ve hundred dollars ($500�.): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the struc[ure is not intended or offered (or sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ovmer of property who builds or impmves thereon, and who does such vrork himself or hersel( or Ihrough his or her ovm employees, provided ihat such improvements are not intended or offered tor sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builder will have the burden of proving ihat he or she did nol build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to consWct the projec[ (Sec. 7044, Business and Pmfessbns Code: The contraaas License Law does not apply ro an ovmer o! property who builds or impmves thereon, and who contracls for such project wi[h a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ezempt under sec. Business and Professions Code for this reason: SignaWre Dale 305]-46(3/0]) � • Owner ID veri(ied hy tln „ license. ❑ Yes ❑ No Dnver's License No. E:pires: Verification of Ovmership by (type of tlocument, i.e. - pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certRy that no excavation fve (5) or more feet in tlepth into which a person is requiretl lo tlescentl, will be made in wnnection vnth work authorized by Ihis permit, and that no 6uilding sWcture, scaffdtling, falsewnrk, or demolition or dismantling thereof, will be more than [hirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle 8, Califomia Adminis[2tive Code�. ❑ As owner-builtler, I will not employ anyone ro do work which vrould require a permi[ from the Division of Industrial Safety, as noted above, unless such person has a permit to qo such work (rom [he division. Applic3nfs Signalure Division o( Industriat Safety Permit Numbec _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle and certify a Business Plan (or emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Cali(ornia Health and Safety Code requires, with some exceptions, [hat a Business Plan be filed with [he Cos[a Mesa Fire Department by every business which has at any one lime during a reported year a quantity of hazardous materials equal to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre antl pressure). 2. Does or will the applicant or present or future building occupant need to file a registration fortn for acutely hazardous ma[erials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safery Code, wi[h some exceptions, requires registration with Ihe Costa Mesa Fire Department by each business which at any one lime has on hand a quantity of acu[ely hazardous materials equal to or grea[er than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas a[ standard temperefure and pressure). 3. Does or will the applicant or present or (uture buildinq occupant need to prepare an RMPP (Risk Managemen[ and Prevention Program for acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require [he preparation, certifcation and fling with the Fire Department of an RMPP 6y businesses which are requiretl to register acutety hazardous materials with the Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 of lhe Califomia Nealth antl Sa(ely Code been (ully complied with? ❑ Ves ❑ No 5. Does or will ihe applicant or present or future building occupant require for the work which is the subjecl o( this applica[ion a permit (or such construction or modification from the South Coasl Air Quality Management District or from any other air polWtion conlrol distnct or agency? ❑ Ves ❑ No (Sectbn 658502 0( the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building pertnits). 6. Will any part ot [he facility to be constructetl untler this permit be wi[hin 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf'yes", �he facilily must meet the requirement of Sections 25534 antl 42303 of the Califomia Health and Safery Code). 7. If a permit (rom [he South Coast Air Quality Management Disirict or other air polWtion control district or agency is required for the work which is the subject of this application, have all of Ihe disclosures prescribed by Califomia Health and Safery Code Secdon 42303 been made? ❑ Ves ❑ No 8. Qf yes", attach certifcate of compliance from the appropriate air pollution controi oKcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the in(ormation given above is correct I agree to comply with all state laws and ciry ordinances regarding Hazartlous Materials and Emissions. Signawre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury that I have read ihis application and state thal the informatioq-given is correct I agree to comply vnth all state lavrs and city ordinances �elating to building cons�ruction, and authorize representatives of the City o( Costa Mesa lo enter upon the above-described pmperty for inspection purposes. I agree not to occupy or allow occupancy o! any building authorized by this permit until final inspection. igna eofLegalOwner�s) Dale � i� `� —AntllorAuthonzetlAOPlirant Date 1"_ LOT 5 TRACT 42�1 , � . l683C1 �CO�STA MESA BUILDING-SAFETY DEPARTMENT P. O. BO% 917 C06iA M6HA. CALIFORNIA M For Applicanf fo Fill In Complefely TYPE OR PRINT MAIL COSTA MESA CALIFORNIA FNNETH OLL R- Y.- �G�/��4 �7GLh�-0,LT- lFl-_�- VEER i��/nc NO.-------- ��_��_��_��_��_ � y ��n � I NO;.OP,BIDGB. O BHTBACK LINB FROs� 1' / � ceMex ov eT+¢¢i Y�� O�� REAR YARO 2 SIDE YARD I LEF7 � O� I RIGHi U� DESCRIPTION OF WORK SFNO. OF PLAN � �(�j I H8H¢BY ACKNOWLBDOH TH�T 1 XAV6 RBAD TXI6 APPLJGiION NO 6TATH THAT THH A00VH 18 COPPHCT AND �OpHB TO COM• LY WITH ALL CITY ORDINANCH9 AND HIATB LAW9 R80ULATNO u1LDINo GON9TItUG�T10N�. /J // �� /J BIGNATURE OP //"/ M /-�O//�%/ IPRNMIT'I'EP �V /�%L./.v ___.__ _ AUTNORIZED A6ENT � L, .il�� , 'A. ...� �% JAN 1�1 �'�b�� J k=�i'; 3�CE DEPT. en�r OF COST�1 M�sn APPLICATION FOR PERMIT BUILDING For Office Use Only er BUILDING AD�RE68 COSTA MESA. CALIFORNIA APPftOVHD ZONING ZONB /J �� I PLAN9 �, I BUILDINO�/ ��T /) �eow� �o L S %/� y Z oescrtirrioH A. P. NO. YARDS EVEB APPROVED [CLNT[P LINe BT4 � / FRONT R. SIDE " L. SIDE / � REAR �� APPROVHD �!Q BY LR I ,� H � /9/c Z THH AMOUM BXOWN UNOBR VALUATION IB IOP TH6 PURP098 OF H9TABLIBHINO A PBNMIT PEE ONLY. VALUATION PERMIT FEE $ •�S'� S ��/0� � �'7 n � PLAN CHECK $ � /�-�� ¢ TOTAL FEH �' S� u