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Home My WebLink About217 FLOWER ST - Building Permits� . ' (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.c�s �LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 217 FLOWER ST Suite: Vicinity: ROOF Parcel Number: 42540318 Applicant ROBERT SCHMITZ Address: 20082 SPRUCE AV NEWPORTBEACH;CA� � Owner: HOFFMAN, HOWARD T Address 217 FLOWER�ST Contractor: � Address: Zip: Arch : Address: COSTA MESA, CA Phone: Zoning: Phone: 949-852-9586 Zip: 92660 Phone: Zip: 92627 Phone: License: Eng: � Address: Status: ISSUED Applied: 07/31/2003 Issued: 07/31/2003 ISSUED BY: �� Phone: Zip: . . License: License: SCOPE OF PERMIT TEAR OFF 5 SQUARES OF RESIDENCE'S EXISTING ROOF. INSTALL 25 YEAR, COMPOSITION SHINGLES, 3 TAB OVER 1 EXISTING ROOF. 4 SQUARES FOR DETACHED GARAGE AND 24 SQUARES FOR RESIDENCE. WORK WILL BE DONE CONCURRENTLY. Plan Check: Permit SMIP Res: SMIP Com: Other: Inspection: Total $0.00 -- - - $111.25 $0.50 $0.00 $0.00 $0.00 $111.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY Calc Valuation: ga,soo.00 Claim Valuation: ga,soo.00 PLANNING & ZONING Left 0- 0 Right 0- 0 Left 0- 0 Right 0- 0 Proposed: 0 NOTICE: The work authorized by Ihis permi� shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 72-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO 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 requlred Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2b6E06IN00) WORKERS'COMPENSAnON DECLARATON: � ' , I hereby affirm untler penalry of perjury one oi ihe following declarations: � ❑ I have end will maintain e Certificate of consent l0 5elf-In5ur0 for workers' Compensation, as provided for by seclion 3700 oi ihe Labor Code, for the pertormenCe of tha work for whith IhiS permit 15 iuuetl. ' ❑ I have and will mainiain workers' compensation insurance, as required by section 3700 of the Lebor Code, br the pedortnance oi the work br which this pertnit is issued. My workers' wmpensatlon Insurance carrler and policy numher are: Carner: - Policy Num�er. (�T�his section neetl not be completetl il the permif is velued ef one hundred dollars ($100) or less.) L,1 i cenify thet in ihe peAormanca of ihe work for which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workers' � compensetlon laws ot Califomia, antl agree that if I s uld become suDject to t�e workers' compensatlon pmNsions of Section 3700 of t�a Labor Cade, I shell fort�with wmply wiih ihese visions. c� � Applicam Signature: �i � o— Date: 1"�� 3 WARNING FAILURE TO SEWRE WORKERS' COMPENSATION COVE GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED T}IOUSAND DOLLARE (5100,000), IN AODITION TO THE COST OF COMPENSATION, DAAMGES AS PFOVIDED FOR IN SECTION 3]O60F THE LABOR CADE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrtn that 1 am licensed untler provisions ol Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ettecl. Lic. x Class # Coniractofs Slgnature: Date: CONSTRUCTION LENOING AGENCY: ❑ 1 hereby ettirm ihat ihere is a consiruction lentling agency for the perfortnance ot t�e work for which ihis pertnil is issued. (Sec. 3097, Civil Cotle). Lenders Neme: LentleYs AAtlress: ' Signature: Date: OWNER-BUILOER DECLARATIONS: 1 hereby eXirtn that under penalry ot perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Code: Any ciry or wunry which requires a pertnit to conswct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requlres the applicant lor such permit to file a signetl stetement thet he or she is licensetl pursuant to Ihe provisions o1 the Contradors License Lew (Chapter 9(commencing wich Section 7000) oi DlNsion 3 of Ihe Business end Prolessions Code) or Ihet he or she is exempt therefrom and the basis ior the alleged examption. Any violation oi Section 7031.5 by eny applicent tor a permlt subjects the epplicent to e civil penalry of not more than tive huntlred dollars ($500).): � I, as owner oi the properry, or my employees with wages es �heir sole compensa�ion, WILL DO THE WORK, and the structura is not intended or otfered for sale (Sec. 7044, Business and Prolessions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves thereon, end who does such work himsell or herselt or ihrough his or her own employees, provided �hat such imprwemenis are not intended or otteratl tor sale. If, however, the building or improvemant is sold within one year of completioq Ihe owneo-builder will have ihe burden of pmving that he or she did not build or improve for purpose oi sale.). � �I, as owner oi the property, em E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business antl Professions Cotle: The contractors License Lew does not apply to an owner of propetly who builds or improves Ihereon, entl who coniracts tor such projecl with e contrector(s) license pursuant to ihe Conlreciors License Lews.). ❑ I am exempt under 5 c. I Business and Professions Code �Signature: � �':L.v�.--^ a�-- Q�LB'`--.5� c Owner ID venfied by drivers license. ❑ Ves ❑ No Drivets License � Verification of Ownership by pype oi document, i.e. - property ta: bill or deed): reason: Date: � `l � �3 � ^ o � �. Eapires: Z.Oo'�' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet in depth into which a person is requiretl to descend, will be made in connection with work auihorizetl by ihis pertnit, antl that no building structure, scaHolding, falsework, or demolition or dismantling theraot, will be more than thirty-six (36) faet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Ttle B, California Adminisirative Cotle). ❑ As owner-builder, I will no� employ anyone to tlo work which woultl require e permit irom the Division ot Indusirial Setety, as noted above, unless such person hes e pertni� to da such work from �he division. Signature: Date: Division oi Intlustnal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AllT}IORIZATION OF EHTRY: I certify under penalry of perjury that I have read this application entl state that ihe information given is correct. I agree to comply with all state laws entl ciry ordinances relating to building construction, and authorize represeniatives of the Ciry ot Costa Mesa to enter upon ihe above-descriDetl property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by Ihis permit unlil finel inspection. P Signat e egalOwneqs) Date � -i - 3, -03 And/OrA ri tl Aoolicant Date COpE �. INSYECTONTYPE � � 'P1�L " �MIfIRLS 1616 Fi:etl System Final Fire Prevention � ' 1266 Pod Spa Final � � 200 ' Finel Re-Roof ��+ �'� 201 FIneI8lock/Retaining Well 202 Final Factory Fire Place 203 Final Sign 20a Final Dem � '4QpE( INSPECPONTYYE '• ' 206 Final Mechanioal � � 20B Finel Plumbing 210 ' Final Electncal 212 Final Fire Prevention '220 Final Planning Approval 222 Final Site � 250 Final Building/Occupancy �g � �$ � DECLARATION OF AUTHORITY FOR AGEN7S OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Permit # �— O I This Permit # c�a(�a 7 Street Address: � � � / �(� l.¢� �%T ��• Waa �x,{ AP Number: 1. I(we), �� ,� �� , declare that I am the Owner of Title of the above referenced real property, and tnat I(we) hereby authorize: Name: � � �' � (i/I/{�LL�. Telephone Number: `�l �-1�1 �SS2-.-�IS�S �o Street Address: d�LJ� gZ SP�" -�= �� ^ Ciry: ��Qi . State: C� Zip: C1 Z� C�0 to obtain permits in my behalf, 2s owner/builder, for at the above reterenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or wrporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I dec�are under the penalty of perjury that the foregoing is true and correct. Executed this �'� day of 20 � 3, at �� /�t�sC� , CalifOrnia. 0779�46 (rev.t 1I00) Signat Date: � ��/ � / � � ��i L � i I Note: This authorization does not grant authorization to perfortn the work as owner, it soley provides ior fimded power oi attomey to secure this permit In any behatl. / I / • / ' I / • / ' � I OWNER-BU[LDER VERIFICATION A city or counry, which is reyuired to give notice pursuant to Section 19A30, shall attach to such notice, and,''' as a condition precedent to issuing a bui�ding permit, require the completion and require the re[um'of, an owner-builder verification. Attention Property Owncr: An `owneo-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelopc provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildine permit will be issued un[il [his I. I personally plan to provicle the major labor and materials for construction of the proposed property improvemenL �Yes ❑ No 2. (have/have not) �,�i signed an application for a building permit for _ he proposed work. 3. I ave conVacted with the following person (firm) to provide the proposed conswction: ame -K T. ��;�f2i Address City Phone ( q� `��7 (� 'R� �{�� Contractor's Lic. No. �(O � 0 3�o a. 4. I plan [o provide portiuns of the work, but I have hired the following person ro coordinate, supervise and pronvide [he major work: Name /`— • Y' � .5��/�� 8'� Address `�70SZ S��YLc� City Y�-31� Phone F-1�P1) �S Z-q S ES�+ Contractor's Lic. No. - 5. I will provide some of the work but I iiave con[racted (hired) the following persoos lo provide the work indicatcd: Name Address Phone Type of Work t0a2as �aEv.9/99) ER II,STON. LYLA S. DATE 5-26-78 7 AOUGH PlUM6�NG PROP. SWR. LINE �___� SPRINKLING S�StEM MISC£ ROUGH TING nND nIR CONOITIONING UNOERGROUNO LJ ROUGH WIRING TRENCHE� FLOOR SYSTEM BONO BEnM ST SHEATHING FRAME ANO FLNSHING LATMING — IN { � P' -TER. 6ROWN COA ❑RAL. FINRL POWER �G. VENT., REFRIG. AN PLUMBING. FINA� AND GR$ T EI.ECTRIC. FIN4L BUILDING, FiN<L ORCE FINA� 6UILDING PERMII NO. SUBCONTRACTOR �i . ' . _.�; - 4594� COSTA MESA BUILDING-SAFETY DEPARTMENT . ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill ia Completely — Use Ink Only BVILDING AooREss r J= �.�,r,os7: C��sn��, fOWNER J S D MAIL ADDRESS � �/' C L£. �2 20d �� q _u {' NOL /GS� �S. CITV �l�i✓%�//✓(uv%D /> CONSTRUCTION LENDER BRANCH ADDRESS ARCHITECT ..... _. � . T/.i. �TEL. � ��; ADDRESS �I� CONTiiACTOfl ADDRESS REC A.P. NO. BUILDING /+� ADDPESS �{ ( TRACT J ED , GI J�L�.I%^ 750�2 TL FOR STRUCfURAL PERMIT ��EN D E IS$UEp N . ZG �-� 7 �J PERMIT NO. l � ��!! . LOT�� BLOCKG TEL. ZONE ( NO.OF CITV NO. :�F p PLAPLS '� STATE CITV . :'��'ARDSAPPqOVED �. LIC. NO. LIC: NO. MAIN BUILDING �' SI2E NO.OPBLOGS. (FROMCL REET) � OF LOT 0.� ��'� NOW ON LOT ONT � FT. � a USE OF J � EXISTING BLDG. (rC d � FT � / FSeFarate permits are required for L. SIDE � FT. � elec[ric, plumbing and hea[ing work. REA —'J' � USE OF BUILDING AND WORK TO BE PERFORMED F , DISTANCE BET. QMAIN BLDGS. a Dt'�! !� � E.% C VRP. � � APPROVEp1��/ � � V{N' a a w 0 I hereby acknowledge thet I have �ead this applicaiion antl steie � Mat ihe above intormetlon is correct antl aprae to comply wlth d all laws regulatln8 building construction, antl I shall not employ z eny person In violation of Ma wOrkman's compensation laws of � ihe State of Celifomia. 3 I hereby certify that I em properlY licensed as a cancractor unaer � SQ. FT. iha State of Callfornie B�siness antl Professions�Cotla, Division 3, THE MOUNTSHOWN UNDER VALU C�apter 9, antl that such licenses sre In full force antl effact, or I THE URPOSE OF ESTABLISHING A PERI am exempi fram ihe provlsions of the Stata of Celifornia Business VALUATION ' PERMIT FEE antl Professians Cotle, Division 3, Chapter 9. s Signetureof �j�� /%�{ 1 $/�i DO� P�NCHECK E Pefmltte¢ �� ti / � �� j�p/ rnx a AuthorizedABenT� � T TALPAID f t/ VALUE �/ ��l �Y g fp v GROUP DATE J ! USE OF NEW n BUILDING �dD �� BET. MAIN & �� O O N � n m` :V m \h m \ N _ . , `� TION IS FOR m T FEE ONLV: � � N Z m i SD o LL Z�� I D ' F � W a a y H '� F ��9�/ COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 1664 5%26/78 c in�.vo 145.00- ioa� �rc.+rru 1'G5.OQCK�� APPLICATION FO��'R +l��dJ�y$htlT"" �.p " '"' For Applicant to Fill in Completely — Use Ink Only !�/ RECEI DATE RECEIVED npTE ��_ ADDRESS �`�(/(/L�G� � • PERMIT NO. j OWNER GS�� A.P. NO. • . MAIL BUILDING .ADDRESS - ADDRESS ' TEL. TRACT LOT BLOCK CITY NO. CONSTflUCTION ,. W ADD P LENDER BRANCH OWNER ADDRESS ' ' VAWE ARCHITECT . . TEL. $ OR ENGINEER N . FIRE ' ADDflESS ZONE TVPE GROUP - , � • � APPROVED CONTRACTOR � Y DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITV ' NO. P�� BUILDING STATE CITV . ,VP.RDSAPPqOVED VAROSAPPROVED LIC. NO. LIC. NO. MAIN BUIIDING ACCESSORV BUILDING 512E . - NO.OFBLOGS. (FFOMGLSTREET) OF lOT NOW ON LOT ONi FT. FT. VSE OF. EXISTING BLOG. S FT. Separate permi[s are required for � �. s�oE FT. FT. electric, plumbing and heating work. � REAR FT. FT. USE OF BUILDING AND WOFK TO BE PERFORMED DSTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BIDGS. �D O ES. � VAR.# DATE C.U.P.#6 APPROVED APPROVED I hareby acknowletlge that I have reatl this application antl stata ° � ihai Me above informailon is carract entl agree to comply wlih a all laws regulating builtline �onstruction, antl 1 shall not amploy any person in vlolation of Me workmen's compensation lews of ; the State ot Celifornla. I hereby cartify ffiat I em properly licensetl as a contrector under SQ. FT. o t�e State of Calitornia Businesa and Protessions Code; Division 3, THE AMOUNT SHOWN UNDEH VALUATION IS FOF o Chapter 9, antl that such Iicenses are In full force and atfeci, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLV: � em ezempt trom the provisions of t�e Staie of Celifornla Business VALUATION PERMIT FEE § � end Professions Cotla, Dlvision 3, Chaptar 9. � 0� � Signeture of PLAN CHECK E ^ �� t Permittee $ TAX E �'� � � AuThofized Agent TOTAL PAID E! � O(>