HomeMy WebLinkAbout328 ALVA LN - Building PermitsCITY OF CtiSTA MESA
LO�pMFS,P BlIILDING DIVISION
F�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • anrm.v.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�°�.��^` PERMIT NUMBER: B11-00337
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 42629512 DATE ISSUED: 10/05/2011
ISSUED BY: RMD
JOB ADDRESS: �328 ALVA LN_CM--�
Vicinity: HOUSE AND-6ARAGE ROOF
Squares: a700
Suite/Unit:
Valuation: $5,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 2 LAYERS OF 15# FELT ON A LESS THAN 2:12 PITCHED
ROOF AND REROOF WITH ASPHALT SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 4700 SF. REPAIR
AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATiACHED TO JOB CARD AND CITY PERMIT.
NOTE:RESIDENT�AL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
veriTication of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/lnspection Card
OWNER: GRISCOM, DAVID L
PHONE: 949-230-4980
APPLICANT: GRISCOM, DAVID L
PHONE: 949-230-4980
CONTRACTOR: OWNER-BUILDER
Address: UniC
City/StatelZip:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $111.25
Reinspection Fee: 50.00
Bldg Std Admin Fund $1.00
Address: P O BOX 1506
City/State/Zip: NEWPORT BEACH, CA
Address: P O BOX 1506
City/State/Zip: NEWPORT BEACH, CA
License No.
License No.
PHONE:
License No. 000000
CELL:
PHONE:
PHONE:
Unit:
Unit: :
TOTAL FEES $772.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N8/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. SaWrdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federel
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: 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 the expiretion of this permil.
COOE k. INSPELTION tYPE
1676 fixed System Final Fire Prevention
126s Poal Spa Final
200 FinalRe-Roof
201 Final8lock/Retaining Wail
202 Final Factory Fire Place
203 Final Sign .
204 Final Demolition
�ATE IN7ITIRLS
LOOEi INSPEG710N7YPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
272 Final Fire Prevention
220 FinalPlanningApproval
222 Final Si�e
250 FinalBuilding/Occupancy
OATE INTilALS
WORKERS' COMPENSATION DECLARATION:
I hereby a(frm under penalty of perjury one ot Ihe follovnng declara�ions:
❑ I have and will maintain a certifcate of cOnsent to 5e161n5Ure (or workers'
compensation, as provided for by section 3700 of the Labor Code, for the
pedormance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as requiretl by
sectbn 3700 of the Labor Code, (or Ihe peAortnance of the work for vfiich this
permit is issued. My workers' compensation Insurence carrier and policy
number are:
Carrier:
(Thu sectm neetl ipt De wmpeletl Alne pertnrt is valuetl at one nundied tlollars (St00) w less )
Policy Number:
c❑ I certify that in the performance of the work for which this permit is
issued. I shall not employ any person in any manner so as to become subject
[o lhe workers' compensation laws o( California, and agree Ihat if I shoultl
become subjecl to the workers' compensalion provisions of Section 3700 of
the labor �o�de, I shall o iwith comply with Ihese provisions
.J �� / � % �
� Applicanl's�ignaWre G t
WARNING. FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(8100,000�. 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 ihat I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of �he Business and Professions Code, antl
my license is in full force and effect.
Lic. # Class #
ConVacmr's Si9nalure Oate
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn that [here is a consWction lending agency for the
peAortnance of ihe �wrk fa which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm lhat untler penal�y o( perjury lhat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 703L5,
Business and Professions Code: Any city or county which requires a permit to
constmcC alter, improve, demolish, or repair any sWCNre, prior lo its
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant lo [he provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Protessions Code) or tha[ he or she is ezemp[ Ihere(rom and
ihe basis for the alleged exemptioa Any violation of Section 703L5 by any
applicant for a permit subjects the applicanf to a civil penalry of not more than
fve hundred tlollars ($500).):
��,I. as owner ot the property, or my employees with wages as their sole
�compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an owner o( property who builds or improves
thereon, and who does such work himsel( or herself or through his or her own
employees, provided that such improvements are not intended or oflered for
sale. If, however, the building or improvement is sold within one year of
completion. the ovmervbuilder will have the burden of pmving that he or she
did nol build or improve (or purpose of sale.).
❑ I, as owner of the property. am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the pmject (Sec. 7044, Business and
Pmfessions Code: The cont2ctors License Law dces not apply ro an owner of
property who builds or improves thereon, and who contracts for such project with
a conirector(s) license pursuant rothe Conhactps License Lavrs.).
❑ I am exempt untler sec.
Business and Protessions Code tor this reason:
[ � S �J
� ���Q9a�-�' � o �e
JOS]-O6(�IO])
�Owner {� verifed by drive� � iicense/
Expires: � � b —/
Verifcation of Ownership by (type of documen[, i.e. - property taa bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation (ve (5) or more feet in tlepth inlo wfiich a
person is required to descend, will be made in connection with work authonzed
by �his permi�, antl that no building structure, scafidding, falsework, a demolition
or dismantling lhereof, will be more than thirty-sia (36) (eet high. (Chap. 32, Grp
2, Art 2, Sea 341, Ltle 8, Califomia Administrative Cotle�.
❑ As owner-builder, I will not employ anyone �o do work which would
require a permit fmm the Division of Industrial Safery, as noted above, unless
such person has a permit �o do such vrork (rom the division.
Applicanfs Signalure
Division of Industrial Sa(ely Permit Numhe[ _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or preseN or fuNre building occupant need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Cali(ornia Health and Sa(ety Code requires, with some
exceplions, tha� a Business Plan be filed with the Costa Mesa Fire
Department by every business which has al any one lime during a reportetl
year a quantiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
al s�andard temperature and pressure).
2. Does or will the applicant or present or fuNre building occupant neetl �o (le
a regis�ration (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of ihe Califomia Health and Safery Code, with some
exceptions, requires regisVation with Ihe Costa Mesa Fire Department hy
each business which at any one time has on hantl a quan[iry of acutely
hazardous materials equal to or grea[er Ihan a vreight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas a[ standard
temperature antl pressure).
3. Does or will Ihe applicaM or present or fu�ure building occupant need to
prepare an RMPP (Risk Managemen[ and Prevention Progrem for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 0/ the Califomia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparalion, certificalion and
fling with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is lhe subject of this application a permil (or such conslruction
or motlifcation fmm the South Coast Air Ouality Management Dislrict or from
any other air polWtion wntrol disMct or agency? ❑ Ves ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applica�ions for non-residential building permits).
6. Will any part of the faciliry ro be constructed untler ihis permit be within
1000 feet from the outer bountlaries ot a school? ❑ Yes ❑ No
(If "yes", the faciliry must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. It a permit from the South Coast Air Qualiry Management District or other
air pollution conlrol disirict or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certifcate of compliance from the appropriate air polWtion
coNrol oKcer).
CERTIFlCATE OF COMPLIANCE: I certily that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury Iha[ I have read this application and state that
the information given is correcL I agree to comply with all state laws and city
ortlinances relating to builtling construction, and aWhorize represeNatives of
the City of Costa Mesa to enter upon the above-descnbed property for
inspecti � purposes. I a ee not [o occupy or allow occupanc of a y builtling
au hori e b this e mi until final inspectioa //' �/ /
V �/
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AnGbrAu��orizetlApPliranl oate
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Costa Mesa
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City of Costa �I�lesa �uiCding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # �� ! � ����
Disclosures 8 Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in yo yr name listing yourSel( as the builder of the
property improvements specifed at �vfi � �Il%i �5��
We are providing you with an Owner-Builder Acknowledg t and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our officiai address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder' building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
�2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I�may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her n me instead of my own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their
licen numbers on permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be consi ered an "employer" under state and federal law.
6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�.i` 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
4esidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
_8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for�any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
const�uction defects in the workmanship or materials.
�/ —.,. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
aboutl' nsed contractors.
10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that l am the party legally and financially responsible for proposed construction activity at the following address:
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
a�all applicable laws and requirements that govern Owner-Builders as well as employers.
' y� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify the p operty owner's signature.
Signature of property owner �i�J �' _Date: �� J ��
�
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
el No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
314830 CALBO Jan 1, 2009 OB Packet template 2 Of 2
�OWNER C jjf�y jjqC, DATE Lt�2LG—S8
JOB ADDRESS 328 Alva 1,3IIE BUILDING PERMIT NO. 6666
GENERAL CONTRACTOR Dike & Coleerove VALUE $ 13�(790.00
AP. No. LOT 33 TRACTI.E>3I{ F[RE ZONE DFSCRIPTION OF WORK Reaidenra w�at.t,��r, �
GR011P I& J TYPE V ZONE RL PLAN NO.
ECTIONS � DATE I SUBCONTRACTOR
NUMBER
7
lc�. ?iay� :�vy�er
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Cas�► Mets� Cali!'bauia
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t tberf ie ass f�ls ia t,�o s ot M8� Hqildin�
ot Costs itesa, s aotiae a? au o! tLe City
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CB �t0ltY' g17R1al6.
T!y e1�cEric�1 �+irtn6 end rixtures abe�v�r t,he t�rp�nt
eeliis+i 1a tbe kLtcLen en� diaiag ttsaa lurs .�► ilePia� lit� hat�tsd �nd Eo nat
mseet LLe rrr�i,�eeeata at the lCltc� Cads at' �e `y at Caeta !lease Tbin
wirSog !s alto ia Molaticm of �i�o. $Ol o! t.�a 8o17Air� Cade as
�3c�t�1 by t�e �i.ty pf CesLs IY� 3a t it ves inatalLea ttithatt bemPit c�
ps+oper �sraLts or inepectiao�. aaah r! aos et+� sab,jseG to a Yiae o! aaL
aort t�len iYve firi8xtid i�JO•00) �,Y' la�rifa�als ia Lhe Oa�Ly .1�11
fcrt s pssiod ot aaE aqre ' �c (6i aastLa.
W]+esa e�td �rlrio� a swiasLsl],�d ia A�at'� mlu�nor'y yniez 3'+��'�s
�eaa sa�e�tiea. o;�tainea ri+a rsYtaen ty.5) �'► ar tma eata, ths. n.ttrr
3ti11 Z� re3't=a+ed 't� tM Cft'iCr� C+! t� CStY ��Y !b� 11n�r leptl 1lctiai.
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COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING g2g Alva Lane
ADDRE55
COSTA MESA. CALIFORNIA
OWNER C-RAY, INC.
MAIL �9 E. 17th Street
ADDRE55
�,7., Costa Mesa ��o:Li-8-115
nRCNirecl ar,] 's1onL 1� �ic.
ORENGINEERM].dt11BUI�OOh NO.
ADDRE55 Garden Grove
1 2 o egrove, nC• GTV LIC. rrnnn
LEG/L L07 �
OESCflIPT10N NO.
A.P. NO.
5'ZE 75 x 80
OF LOT
USE OF
E%ISTING BL�G.
$ETBACN �INE FROM
CENTEF OF STFEET
INEw
R
�ING
3treet `No. Li-8-l1L1'
BLOCK TRACT PI�+N
no.or e�ocs.
riow om �01 nOn
REAR YARD y�J�
RIGHT g� LEFT 7:5��
DESCRIPTION OF WORK
X AITERATION ApDITiON
MOVING OEMOLISH
�nl Sn. Ft._ Roo�r.is 4(a0i sroRies
w�i.i1C CO
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i_-, s� li � t_ �1J «u �,i .�.�
u,aa_.s-� ���
FI�!A�!CE DEPT.
G��Y �� ��ST�i �,iFS�
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECE�PT NO. P�yf��
l I\ J
p`�`� s�= a 3' :1 APR ?SaEio�
COSTA MESA. CALIFORNIA
FIRE
ZONE
mrvE ^� ��v. �� -w
/� PLRNS � / / '
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/ � 23
APPROVE G
BV QYh/ DATE
CORRECTIONS
STPTE TMAT TXE RBOVE IS COPFECT iND 4GPEE TO COMPLV W!TM ALL
CITY ORDINPNCES ANO ST/ E LAWS REGULATING BIIILOING CONSTRUC�
TION. VALUATION
SIGNATURE OF �� � O
PERMITTEE /�+�
J / /
� 13,690.00
AUTHORIZED AGENT Dike 3c Colegrove, TIlC•
PERMIT FEE $ �G,�OO
PLAN CHECK � 1{��OO
TOTAL FEE S 4g•�0
"OMf