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Home My WebLink About2165 AMERICAN AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mese.ca.us BUILDING PERMIT --_ � � , _ . 1 JobAddress: 2165 AMERICANAV " Suite: Vicinity: ROOF Parcel Number: 42208112 Applicant: DARRELL CHAMBERS Address: 414 N SHATTUCK PL ORANGE,CA Owner: GOODING, ROGER TR Address 9431 BANNING AVE HUNTINGTON BEACH, CA Contractor. CORNERSTONE ROOFING Address: 414 N SHATTUCK PL ORANGE,CA Zip: 92666 Arch : Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 ` ', `a . � � Status: ISSUED Applied: 05/17/2004 Issued: OS/17/2004 Zonin9� , .._. n ."'. . v � � '---+-�•rJ'., .i J� •^.r�:.r�. .. ISSUED BV: Phone: 714-771-3658 Zip: 92666 Phone: Zip: 92646 Phone: 714-7713658 License: 616586 Eng: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 40 YEAR DIMENSIONAL COMPOSITION SHINGLES, 30# FELT, AND REPLACE/REPAIR SHEATHING AS NEEDED. 26 SQUARES INCLUDES ATTACHED GARAGE. Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.58 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.83 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Lefl 0- 0 LeR 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 ...-� . � � v.. � ss,sis.00 $5,615.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned tor a period of 180 days. � INSPECTIONS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetlona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244fi-46(N00) WORKERS' COMPENSATION DECLARATON: � I hereby aflirm untler penaliy of perjury one of the following declaralions: � ❑ I have antl will maintein a certitiwte of consent to selt-Insure tor workers' compensation, as provitled for by section 3700 of tha Lebor Code, for ihe peAortnance of the work far which this permit is issuetl. ��"�I �ave antl will maintain workers' compensetion insurance, as requiretl by section 3700 oi the Labor Code, for the pedormance of tha work Por w�ich this pertnit is issuetl. My work/ers' ompIe.n,sation ITn�u.rance carrler and policy numbar are: o �'1 �[.� Cerner .l �ZIIT� T /A/�%i Policy,Number: �/l �— �� f L(JV / (This section neetl not be comp/eretl it the permif !s velued et one hundred dollers ($100) ar less.) � ❑ I certity ihat in the peAormance of ihe work for which this pertnit is issued, I shall not employ eny person in any manner so as to becoma su6ject lo Ihe workers' compensation laws of Califomia, end agree that it I should become subject to the workers' compensation pmvisions of Section 3700 of ihe Labor Code, I shell forihwith camply with these pE ' ions. /� ^� L ApPlicantSignetura:� -. �.,. � l � n.i .�� rDete:. S� �/'—� l WARNING:.FAILUREiO'SECURE WORKERS' CAMPENSATION CAVEiiAOE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVERiO CRIMINAL PENALTIES ANO GVIL FINES UP TOONE HUNDRED T}IOUSAND DOLLARE (5100,000), IN ADDITION TO THE C0.ST OF COMPENSATION, DAMAGES /S PROVI�ED FOR IN SECTIIXJ 31O60F TME L480R CODE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihat I em licen ed}+nder �royisions of Chapter 9(commencing wlth Section 7000) of Division 3 ot.the Business end rolessions Code, ar�tl my license Is In full brce 8rM BtfBct. LiC: k � /� �X(O _ �Class #. : C � � �l Ff � L. ConlractoYs Signeturei ,.� d� y� !—Data:— !i—) 7— O� 1 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is e conslruction lentling agency tor Ihe pedormance of iha work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Signature: _ Lender'S Address: Da�e: OWNER-BUILDER DECLARATIONS: I hereby aNirm that untler penalry ot perjury thel I am EXEMP7 FROM THE CONTRACTORS LICENSE �AW tor Iha tollowing reason (Sec. 7037.5, Business and Protessions Cotle: Any ciry or counry which requires e permit to consiruc6 alter, improve, demolish, or repair any strucNre, prior to its issuance, also requires the applicant for such pertnit to file e signed statement that he or she Is licensed pursuant m the provisions of Ihe Caniractors License Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Protassions Code) or that he or she is axempt thereirom and the basis tor the alleged exemption. Any violation of Section 703t5 by eny applicant for e pertnit subjects Ihe epplicenl to e civil penalry ot not more ihan five hundred dollars ($500).): ❑ I, es owner of the property, or my employees with wages es their sole compensation, WILL DO THE WORK, and the structure is not iniended or oHered for sale (Sec. 7044, Business and Professions CoOe: The Coniractors License Law does not apply to an owner of property who builds or improves �hereon, end who does such work himsetl or herself or ihrough his or her own employees, providetl ihet such improvements ere not intentled or oHered for sale. If, however, Ihe building or improvement is soltl within one year of completion, the ownao-builtler will have Ihe burden ot proving that he or she ditl not builtl or improve tor purpose of sale.). ' ❑ I, es owner oF the property, am E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business and Profeuions Code: 7he conirecrore License Law tloas not apply to an owner of proparty who bullds or Improves Ihereon, antl who coniracts for such pmject with a contractor(s) license pursuant to ihe Contrectors License Laws.). ❑ I am eaempt under sec. Business and Protessions Code for this reason: Signature: Date: Ownar ID verifietl by dnver'Slicense. ❑ Yes ❑ No Driver5 LiCense No. Expires: Verification of Owners�ip by (type of tlocument, i.e. - properry tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thet no exceve�ion five (5) o� more feet in depih into which a person is required to descend, will be mada in connection with work authorized by this pertnit, and ihat no building simcWre, sceNolding, falsework, or demolition or dismantling thereof, will be more ihan ihirry-six (36) teet high. (Chap. 32, Gry 2, Atl 2, Sec. 341, Ttle 8, Calitomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit from tha Division of Industrial Safery, as noted ebove, unless such person has a permit to tlo suc� work irom the division. Signature: Date: Division ot lndustrial Safery Pertnil Number: CERTIFICA7E OF COMPLIANCE ANU AUTHORIZATION OF EN7RY: I cehify under penalry of periury that I have reatl this application and state Ihat the information given is correct. I egree to comply with ell state laws and city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa to enter upon Ihe above-descnbed property for inspection purposes. I agree not to occupy or ailow occupancy of any building euthorized by �his permit until final inspection. CO�E1, INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Paal Spe Final 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition DdIE ' IMRIALS 2 �� —�� COOEt INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency Oate Qsjf INTffIRIS . �.;�;�,:a:� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. 60X 917 . C06iA ME6A. CALIFORNIA For Applicanf to Fill In Compleiely TYPE OR PRINT ■ ARCHITECf COSTA MESA. CALIFORNIA PRINCETON, ING. � i� � a ^ �� . ; ', i�.0 � ��' FEB 20i3�S�, FIi�ANCE DEPT. /� � C►TY OF COS1H �:iESA � APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIpT NO. P RMITNO. � �;3:� REC�BV I D� iE�E VEo �I DAT¢ IBBUED -. .//-�� OIS +W$0 TEL. NO. 'I'OVB . FIRE ZONE & Ci01.@ rove II1C.� �+PPROVED BY Baker St. ZONE Mesa Calif. NO. !11 ��117� LEOAL DEBLRIPTIO! ,� X �[O , I NO. OF BLDGB. - ^ , ^ V NOW ON L[]TIIOIIB BETBACK LINB FROM CENTER oP 8T1iEeT S� REAR YARD SI�E YARD I LEFf �� I RIGHT S� DESCRIPTION OF WORK- COSTA MESA. CALIFORNIA ZONING NO.OF 119E OR NEW PLAN9 n BUILDIN¢AT YARDS APPROVED ' (CBNTER LIN6 BTJ 8 S•ft� ROOMS �.O STORIES 1 L WA SLUCC� I COVERING C 1 rock ��ILDING AN� WORK TO BE PERFORMED ;d �ara�e (two_living _ units. ) Gar. Ltlil sq. ft. EVES Plan A I HEPEBY ACKNOWLE�GE THAT 1 HRVE REAO THI9 APPLIGTION THE AMOLINT 9HOWN UNDER VALUATION IB FOR THE AND BTATE THAT TME ABOVE i6 CORRER AND AGRE¢ TO COM- p{�ppOBE OF EBTABLI6HIN6 A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCE9 AND eTATE lAWB RGOULATINO Bu1LDING CONBiRUCTiON VALUATION SIGNATURE OF � _ PERMIT FEE s a� _nn PERMI7TE [ $17,979�do PLAN CHECK $ 18�70 AUTHORIZE� AGENT Dike 8C CiOle OVI�� TI1C• 55.rO TOTAL FEE �