HomeMy WebLinkAbout221 FLOWER ST - Building PermitsJobAddress: 221 FLOWERST
Suite:
Vicinity: ROOF
PrimaryOcc: R3�Dwellings/CongRes<10
Parcel Number: 42540317 �
npp�icant: DALE MILLER
Address: 13781 NEWHOPE ST
Type of Construction: V-N
Zoning:
Status: ISSUED
Applied: 11/14/2005
Issued: 11/142005
_ � -_ Phone: ���714=534-6398 ISSUED�BY:
GARDEN GROVE, CA - �' .� - . . -- -� Zip:- � ;92703:::��:, _: _,� .- .
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Owner: DRUITT, MARY I TR OOF''� `� � � I'�� ?�� -_
Address SURVIVORS TRUST � !"`� ' ' ''' - ' j"� �, � ` `�+
SANTA'ANA, CA . � -�"'+ '� �. `` -. � Phone � � i � . . �- � y
529.W SANTA CLARA AVE'� _ � . - Zip � 92706`�- ` � � �� �. \ �.
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Contracror �t DALES ROOFING% �-�`� �\,�� , �.
Address.- ?'13781 N�WHOPE_ST:.'�� =�`.` • � ' .� �.���',
i` ` �,�-y�°J Phone: 714-534-6398 -y.�`-���';_� ''� .��
' ; � •� GARDEN.GROVE,CA . � '.�;,�?;���� � �
Zip:'; 92703 �;,,'i ,,-License: 503508 �� �. ��, �
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Address:= ;,�i ;'_ �, -. - _ __ � Atldress: � �. �'?, - - � ..
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SCOPE OF PERMIT_ , ';' �
�' TEAR OFF EXISTING ROOF: INSTALL'�1/2"-CDX, 1 LAYER OF 30# FELT, AND 30 YEAR GAF SHINGCES. 12 SQUARES�FOR S.F.D. ON�Y. ;� �
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� , ;-„- �' � ; ��.,FEE'SUMMARY � - „- •.. � � .. ', �
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Plan Check:. ., . $O:OD ' � = ��-l� � - Calc Valuation: ' � • Ss,soo.00
Permit: $97.25 � ' Claim Valuation: . ` g3,soo.00 ,
SMIP Res','� � $0.50' � •'^ i � ,�
: SMIP Com �' � '� $0.00 � ^� ' r „ _ �
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' Other.:� , $0.00 --- --_ : = , - ' , ' '
�'.,Inspection: $0.00 "� ` � . � '
- � �� �.«'�. — - �.• � - � ;t,,�
Totalr $97.75 - _ --- �
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' � � � .-� PCANN�NG & ZONING �%"' z �'
SETBACKS ,_, � �-. - � , '
MAINSTRUCTURE-.Front 0 0,. Rear �`0-0� �Left 0 0 �`^� .Right ! 0 0:� ' i/:�
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ACCESSORYt�. Fronf `0 0 .� � Rear - 0- 0" - �' � - � Left ,� 0 0 �� , � �Right !�0- 0 � � �,�'�.
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� NOTICE: The work:authorized�bythis permihshall comply with�all applicable handicap:access,requirements,under Califomia statutes and related I
regulations.�(Ord..No. 92-28,-§�1, 12-27-92) � �
�EXPIRATION: �This�,permit shalPautomatically�expire and,become void-if work is�not�.commenced within�i80.days,�or if work is�,suspended.or abandoned
�� �for a period of'180 days.
;�INSFECTIONS: In,orderfor the+workrauthorized.underthis.permit�to:be�wnsidered legal,-such.work•musfcomply with al6applicabte�.codes, and all I
��-requl�ed Inapeetlona andiinalrapprovePmusCbe�obtained. Failure io�obtain�inspecilon5 artd.tinal:approval will resutt in the:expiration�ot ihis permit.
1 :FOR INSBECTIONS�CALL: (714J754-5628 � .
zaae-ae (doo�
WORKERS'COMPENSAnON DECLARAnON: � ' � , ��
I hereby effirm untler penalry ot perjury one of iha following declaretions: •- � `` ' �
❑ I have and will maintain a cenificate of consent to self-Insure for workers' compensation, es provitletl for by section 3700 0( lhe Lebor Cotle, for the pertormance of the
work for which'this permit is issued. � � � '
fl--1•have antl will maintain workers' compensation insurance, as required by section 3700 oi tha Lebor Code, tor the perfortnance of the work for which this pertnit is issued.
�My workers' com nsation Insurance er antl policy number are: . _ . y ��� �� i.
/�-�-"_�;, /
�rrrer:�5`���'f� fI/^� ; ' �' -'�.'P�olicv.�DWmber.- � i�
hj5.aection neetl nof be cnmp/eted i! (he permi( is velued et one hundred tlollars ($100) or less� rki�.i� �Y" �s � �
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❑ I cetlify that in the peAormance of the work tor whic 'this parmit is issued, I shalfnot employ eny person m any manner so as to 6ecome suDjecl to ihe workers'
compensatlon laws o1 Calitomia, agree Ihat' ould become subject to ihe workere' compansation provisions of Saction 3700 ot ihe Lflbor Code, I shalllorthwith
comply with Ihesa pr sio s. [�
A�plicant�Signeture�'�^- i �"'Date:���"� �7 �-s
WAfiNI � AILURE OT BECURE WORKERS' COfdPENSATION COVEMGE IS UMAWFUL AND SHALL SUBJECT AN EMPCOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE MUNDRED
� � $ANDOOLLARE(5100,000),INADDITIONTOTHEWSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTIqJ3706pFTHEUBORCO�E,INfEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
9(commencing with Section 7000) ot Division 3 of the Business anG Profpqsions Code, end my license Is in full
CONSTRUCTION LENDING AGENCV: � .
� I hereby aHirm that Ihere is a consWction lentling agency for Ihe peAormance of the work for which Ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lenders Address:
Signature:
Date:
OWNER-BUILDER DECLAFiA710NS:
I hereby afllrm ihet under penalry ol perjury that I flm EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe tollawing reeson (Sec. 7031.5, Business and Protessions
Code: Any ciry or counry which requires e permit to consWCl, alter; improve, demolis�, or repair any struaure, prior to its issuance, elso requires the applicant tor such permit
to file e signed statement ihat he or she is licensed Oursuant to the provisions oi the Contractors License Law (Chaptar 9(commencing with Sectlon 7000) of Dlvision 3 of the
Business and Pmfessions Code) or thet he or she is exempt therefrom and the basis for the alleged exemption. Any violatian of Section 7031.5 by any applicant for e pertnit
sublecls Ihe applicant to a civil penalry of not more than tive hundred dollars ($500).):
❑ I, es ownar of the propery, or my employees wlih weges es �heir sole compensetion, WILL DO TME WORK, and the structure is not intended or oRerad iar sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner ot properry who builds or improves Ihareon, end who aoes such work
himsalt or �erseN or ihwugh his or her own employees, pmvided ihat such impwvemenis ere not Intended or otteretl for sale. If, however, Ihe building or improvement is
soltl within one year of completion, the owner-builder will have the burtlen of proving that he or she did not build or improve for purpose of sale.). �
❑ I, as owner of ihe property, em EXCLUSIVELY CONTRAGTNG WITH LICENSED CONTRACTOPS to con5lruct the project (Sec. 7044, Busine55 end Professions
Code: The conirectors License Lew tloes not appty to en owner ot propehy who builds or impmves thereon, antl who contracts for such pmlect with e contracmr(s)
license pursuant to ihe Conirectors License Laws.).
❑ I am exempt under sec. Business and Professions Cotle tor ihis reason:
SignaNre: Date:
Owner ID venfietl by tlriveYs licensa. ❑ Yes ❑ No Dnvefs License No.
Verification of Ownership by (rype of tlocumem, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
E:pires:
❑ I hereby certiy ihat no excavation five (5) or more feet in tlep�h inio which a pereon is requiretl to descend, wiil be matle in connection with work euthonzed by Ihls .
pertnit, and that no building structure, scattolding, falsework, or demolition or disman�ling Ihereof, will 6e more Ihan ihirry-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Ttle 8, Calilomia Atlministrative Code).
❑ As awner-bulltler, I will not employ anyone to do wark which would require a pertnit from Ihe Division of Intlustnel Sefery, es noted abova, unless such pereon hes e
pertnit m da such wark irom the division.
Signature: Date:
Division oi Intlusirial Satery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUiHORIZATION OF EMAV: 1 certify under penalty of perjury that I hava reatl this application and state that the informa�ion given is
correct I agree to comply with ell state laws and ciry ortlinances relating to building consiruction, and authorize representatives of the Ciry of Coste Mesa to enter upon iha
ebove-describetl pmperty tor inspection purposes. I agree not to occupy or ellow occupancy of any building authonzed by this permit until finel inspeciion.
COUE I' INSPECTIONTYYE' "' '�" ` PdIF "" ` LH
1616 Fiaed System Final Fire Prevention' � _
7266 Pool Spe Final
200 � Final Re-Raot' � '
201 Final BIocWRetaining Wall
202 , ,'Final Factory Fire Place� �
203 Finel Sign
204 Final Demolition
/I//11 �.•..
. , ' " LOOE� INSPECiIONTYPE . � �• . QdjE 7y��
' 206 Final Mechanical.. , �
20B Final Plumbing
� � 210 ` Final Electrical � � '
212 Final Fire Prevention �
' 220� Final Planning Approval � ' �
222 Finel Site �
250 Final Builtling/Occupency � �
_ . .H.tiCAJ� i
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING' ��"L� ��� S� •
ADDRESS �f�'����'
COSTA MESA. CALIFORNIA
. -.� "TYT- Y'i �-� .7/ . T. - �
■ 6TATE
� _ TEL.
NO.
TEL.
NO.
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I/w�..r� y' �
� _ 4 , .�
pUG 1 i 1960 .
� F1i�`'',1"�C�STA PIIESA
cirv aF co
APPLICATION FOR PERMI7
BUILDING
For Office Use Only
HECEIPT NO. PEiiMIT pNO.I
� � �O ! r
rseceyveo er I DO `/ 7�% � I �Y f�'l u b L
�C/
BUI6DING
ADDRE68
COSTA MESA. CALIFORNIA
�0 � 9 LEOAL
'� ' � oescx
NO. OP BlAGB. %
9ETBACK LINE FROM, � '���� ' I
cernea or s'raeer REAR YARD
SIDE YARD I LEFT ,�r- � I�RIGHT cy_ ,'
DESCRIPTION OF WORK -
.�.� x.�o ROOMS
WALL (°a/!Li�� I ROOF
�ZONING ''"'\.� �
NO. OP �. USE OF NEryi��-y�
PLANB� L I BUILDING/it� �, ctd
tcexTea uNe sr4
e
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�2 �i D — I �iAR. PtO.�� �1PPP,OVE� : "���.�•
1 HEHEBY AGKNOWLEDGB AT 1 XAVE R6�D THIB APPLIGTION THE AMOUM BXOWN UNO¢P VAI.UATION IB FOR TXE
AND BTATE THAT TH6 ABOYE I6 CORRECT'AND AGREE TO COM- pUPP09E OF, E9TABLI6HIN0 A PERMIT PEE ONLY.
PLV WITN ALL CIIY ORDINANCES AND BTATE LAWB P80ULATING
BUILDIN6 CON9TRUR1 . VALUATION - �f
SIGNATURE OF � ��iii7'Y' �I �JO^ � PERMIT FEE $ �> �`
PERMI7TE � S� y �i �,.
$ JI PLAN CHECK $ � �
AUTHORIZED AGENT � �� � � �
TOTAL FEE