HomeMy WebLinkAbout2208 AMERICAN AVE - Building Permits�:
�,�,
*:-., .
T:
7�!
�' STn Mp
. �
e
>
r
J
;oqPo�O�.,+'
� �
CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�wv costamesaca.qov
FOR INSPECTIONS CALL: (7'14) 754-5626
<.r
.; ,
PERMITTYPE B ROOF2
P;PN: 42207217
Fr
PERMIT NUMBER: B12-00112
STATUS: ISSUED
DATE ISSUED: 05129I2012
ISSUED BY: SAK
JOB.ADDRESS: 2209 AMERICAN AV CM Suite/Unit: ,
Vicinity:
Sguares: 2100 Valuation: $2,500.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF. RE-SHEATH AS NECESSARY COVER WITH 30 YEAR COMP SHINGLES. INCLUDES
ATTACHED GARAGE. APPROX 2100 SQ FT. ROOF PITCH IS 3:12.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
'verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/lnspection Card
OWNER: SKYTTE, BIRTHE B
PHONE:
APPLICANT: MICHAEL SKYTTE
P,HONE: 7141317-0478
:F.<
GONTRACTOR:
A5ldress: Unit
City/State/Zip:
��
ARCHITECT:
f`S� .
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldq Std Admin Fund
$0.00
$83.25
$0.00
$1.00
Address: 10780 SAN �EON AVE
CitylState/Zip: FOUNTAIN VALLEY, CA
Address: 10473 LA SOMBRA AVE.
City/State/Zip: FOUNTAIN VALLEY
License No.
License No.
PHONE:
License No.
CELL:
PHONE:
PHONE:
Unit
Unit: :CA
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18I2010 - PER CMMC Sec. 13-279
Monday thru Fritlay - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays
3iOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
�i€'gulations. (Ord. No. 92-28, § 1, 12-21-92)
�XPIRATION: 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
'�cequired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
S1
' 0/. INSPEClIONTYPE UAi� INTITIRLS C DEp INSPEG110NTYPE OATE INPTIFLS
�i,@16 Fixed System Final Fire Prevention 206 Final Mechanical
F4266' Pool Spa Final � 208 Final Plumbing
i� I,
�200 Final Re-Roof � ___Cl.� 210 Final Electrical
:201 Final Block/Retaining Wall 212 Final Fire Prevention
F4f12 Final Facmry Fire Place 220 Final Planning Approval
�203 Final Sign 222 Final Site
C204 Final Demolition 250 Final Building/Occupanty
i`i
�
WORKERS' COMPENSq710N DECLARATION:
I hereby affrm under penalty of perjury one of the tollowing declarations:
❑ I have and will maintain a certificate o( consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
pertormance of the work for which ihis permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAortnance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This section rieetl not be �mdete7 Atne permrt is valuetl at one hu�mtl tlollars (Ef00) orlass /
Policy Number:
❑ I certify [hat in the periormance of ihe work /or which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to the workers' compensation laws of Cali(omia, and agree Ihat if I shoultl �
become subject to lhe workers' compensalion provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Applicanfs SiqnaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAVJFUL AND SHALL SUBJECT 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 CONTRAC70RS DECLARATION:
I hereby affrm Ihat I arq licensed untler provisions o( Chapter 9(commencing
with Section 7000) of qivision 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class tl
Controcrofs Signawre Date
CONSTRUCTION LENbING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
pedortnance of lhe work for which this pertnit is issued. (Sec. 309�, Civil Code).
Lenders Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm �hat untler penalty of perjury ihat I am EXEMPT FROM THE
GON7RACTORS LICENSE LAW tor the following reason (Sec. 7031.5,
Business and Professiuns Code: Any city or county which requires a permit to
conslmct, aller, improve, demolish, or repair any structure, D�or to its
issuance, also requires ihe applicant for such permit to fle a signed statement
that he or she is licensed pursuant to the provisions of ihe Contrac[ors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of the
Business antl Protessions Code) or ihat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 703L5 by any
applicant for a permit subjecis the applicant to a civil penalty of not more than
five dred dollars ($500).):
I, as owner ot ihQ property, or my employees wilh wages as iheir sole
compensation, WILL qO THE WORK, and ihe siructure is not intended or
oftered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have ihe burden of proving ihat he or she
did not build or improve (or purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to wnstruct the project (Sec, 7044, Business and
Professions Code: The contractors License Law does not apply to an ovmer of
pmperty who builds or improves lhereon, and who contracts for such project with
a contractor(s) license pursuant lo ihe Conl2ctors License Laws.).
❑ I am exempt under sec.
Business and Professi0ns Code for lhis reason:
�//�—,t�-= s- a9 iZ
SlgnaWre Date
3051<6 (3/0])
Owner ID verifed by dnv r's icense. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype o( document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereGy certify ihal no excavalion five (5) or more feet in depth into which a
person is required to descend, witl be made in connection with work authonzed
by this permit, and that no buiiding sWcture, scaHolding, (alsework, or demolition
or dismantling thereof, will be more than ihirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, Calitornia Administrative Code).
❑ As owner-builder, I will not employ anyone �o do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit �o do such work from the division.
Applicanfs SiBnaWra
Division of IndusMal Safery Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICAiION:
1. Will the applicant or present or future building occupant need to fle and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of lhe California Health antl Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature antl pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Cafi(omia Health and Sa(ery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of aculely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed 9as at standard
temperature and pressure).
3. Does or will the applicant or present or fuWre builtling occupant need to
prepare an RMPP (Risk Managemen[ and Prevention Program for acutety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of lhe Cali(ornia Health and Safery Code provides that the
Cosla Mesa Fire Department may require ihe preparation, ceAifcation and
filing with the Fire Department of an RMPP by businesses which are required
to register awtely 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 complietl with? ❑ Ves ❑ No
5. Does or will ihe applicant or present or Future huilding occupant require for
the work which is lhe subjecl of lhis application a pertnit for such consiruction
or modifcation from the South Coast Air �uality Management District or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemmenl Code requires Ihat Ihe requested
infortnation be fumished on applications for non-residential builtling permits).
6. Will any part of �he faciliry to be constructed under [his permit be within
7000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes", ihe (aciliry must meet ihe requirement of Sections 25534 and 42303
of Ihe Calitomia Healih and Safery Cotle).
7. If a permit fmm the South Coast Air Qualiry Management Distnct or other
air pollution control district or agency is required for the work which is ihe
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Sa(ery Code Section 42303 been made? ❑ Yes ❑ No
8. p( "yes", attach certificate of compliance from the appropriate air pollution
conirol oKceQ.
CERTIFICATE OF COMPLIANCE I certify that under penafly of perjury lhe
information given above is correct. I agree to compy with all slate laws antl
city ordinances regarding Hazardous Materials and Emissions.
Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of peryury ihal I have read this application and slate that
the informalion given is correcL I agree to compty with all state laws and city
ordinances relating to building consiruction, and aulhorize representatives o(
the City of Cosla Mesa to enter upon Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
SiB�aWre of Legal Owner�s)
AnNot AutM1orizetl Applicant Date
.7
=�
---�—_i--�..^
Costa Mesa
City of Costa �Lesa BuiCding lnivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #
Disciosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANTI NOTICE TO PROPERTY OWNER
Dear Property Owner:
M application for a building permit h s beer�,sub itted ir� your name lis6n urself as the builder of the
property improvements specified at ��' o�f EX/CAiY i�1/� O�'T/f f�� 9� (o� 7
We are providing you wifh an Owner-Builder Adcnowledgmerrt and Infortnation Verification Form to make you
8ware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We wlll not issue a building permtt untll you have read, InRialed your undersWnding of
each provislon, signed, and retumed this form W us at our officlal address Indicated. M agent of the
owner cannot execute this notice unless you, the property owner, obtain tlie prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF (NFORMATION
DIRECTIONS: Read and in8ial each statement below to signify you understand or verily this information.
�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
6uilder° building permit fhat 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 coverege for those injuries. I am willfully acting as an Owner-Builder
and am aware of the IimRs of my insurance coverege for injuries to workers on my property.
(�2. I understand building pertnits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Con6actw to assume fhis responsibility.
/�3. I understand as an "Owner-Builder I am the responsible party of record on the permit. 1 understand that
�a�l may protect myself from potential finandal risk by hiring a licensed Contractor and having the pertnit filed in his
or her name instead of my own.
/�.�4. I understand Contractors are required by law to be licensed and bonded in Califomia and to list their
� z{�I�se numbers on pertnits and contracts.
5. I understand ff I employ ar othervvise engage any persons, other than Califomia licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), inGuding labor and materials, I may
be considered 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 govemmerrt, withhold payroll taxes, provide workers' compensation disability insurance, and
conVibute to unemployment compensadon for each "employee.° I also understand my failure to abide by these
laws may subject me to serious financial risk.
I understand under Califwnia Contractors' State License Law, an Owner-Builder wtio builds single-family
sidential structures cannot legally build fhem with the iMeM to offer them for sale, unless all work is perfortned
by licensed subconVactors and the number of strudures does not exceed four within any calendar year, or all of
the work is pertormed under contract with a licensed general building Contractor.
314&30 CALBO Jan 1, 2009 OB Padcet 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 resuk from any latent
cronstruction defects in the workmanship or materials.
�. t understand I may obtain more information regarding my obligations as an "employer' from the Intemal
Revenue Service, the United States Small Business Adminlstration, the Califomia DepartmeM of Beneffi
Payments, and the Califomia Division of Industrial Accidents. I also understand I may coMact the Califomia
Contractore' State License Board (CSIB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more informadon
about licensed contradors.
/� n 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
'vfnat I am the party legalty and financially responsible for proposed construction activity at the following address:
(/{��"�� � 11. I agree that, as the paily legally and financially responsible for this proposed consWction activity, 1 will
v g6ide by all applicable laws and requiremerrts that govem Owner-Builders as weli as employers.
(!0`�_ 12. I agree to notliy the issuer of this fortn immediately of any add'Rions, deletions, or changes to any of the
rinformation I have provided on this form. Licensed contradors are regulated by laws designed to prMect the
public. If you contrad with someone who does not have a license, the ConUactors' 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 importaM for you to understand that 'rf an unlicensed
Contractor or employee of that individual or flrtn is injured while wwking on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contrectors, you will be responsible
for verifying whether or not those Contractors are property licensed and the status of their workers'
compensation insurance coverage.
Before a building permlt can be issued, this fortn must be completed and signed by the property owner
and retumed to the agency responsible for Issuing the pertntt Note: A copy of the property owner's
driveps license, form rwtarization, or other verfficafion acceptable to the agency is requlred to be
presehted when the permk !s lssued to verfly the p� pe owner's slgnature.
Signature of property owner ���c=���� Date: �i �� ��
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 conshuction permit for the Owner-Buiider.
F�cGuding the Notice to Property Owner, the execution of which I understand is my personal responsibiliry, 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. / i.
Scope of ConsUuction Projed (or Des�xiption of Work): d� !�P�2./il /
Project Location or Address:
Name of Authorized Agerrt:
AddreBs of Authorized P�qent:
!1 i
I deGare under penafty of peryury that I am fhe propeRy owner for the address listed above and i personally filled
out the above information and certify its accuracy. Note: A copy of the owners drivers license, form
notarization, or other verification acceptable to the agency is 2quired to be presented when the permit is issued
to verily the propeRy owner's signature. �
Property Owner's Signature: Date:^/�9"' ���@
314&3D CALBO Jan t, 2009 OB Padcet template 2 0} 2
C%�" � n o� /6 � 7 ` 7
Y t COMPLAINT INVESTIGATJ �'
C��itE� �/
Receivect Uy— �� O 9 � � ate �` �� —
(/�/�,'.p GYo � '�
Made by: Address� ��'�'�" -` • Ph. No��.��__
Against: — � 9cldre�s —
�� /,n. �. //. _ n
Complefe: Yes��+�-
No—
lOM-7-'54
�
Complaintant s " /„� 3. ^ � By:
Interviewed: ✓v"
No_ D Date:
- Z
• � Ii—� �� 1 ^, i � pt
' � ♦d � `� �g , �! V i., w_
° � " 12 `.��'7 1 d�� °` 1 � }960 /�����
COSTA MESA BUILDiNG-SAFETY DEPARTMENT � ��L pEpT,
P. O. BOX 917 COBTA MEBA. CALIFORNIA `��',A��� jA MESA
��jy OF COS
Fo� Applieanf +o Fill in CompletelY APPLICATION FOR PERMIT
`� �TYPE OR PRINT gUILDING
BUILDING ��. �e: ican Avenue �
ADDRESS
COSTA MESA. CALIFORNIA For Offite Use Only
OWPIER Colwnb7.a i"jOII18S� IT1C• AEc[iei No. I rersMir Ho.
MAIL Baker Street REccrv av onre eec rv n �o1.'fr7, 9vco
ADDRESS 7-533 I ��d �-�6•�p-�- s
Costa b�esa Calif. TE`�K191151 BUILDING
CITY 7 NO. ADDRESS �ti,. A a�.�SJ;
necH,reci C�1S011 & YE�T�,�,�,��ry COSTA MESA. CALIFORNIA
FIRE
TOR �i� & (�i e�rove IT1C• APPROVED
BY
1533 Baker Street
Cos�a biesa� Cz7.ifornza ��
167293 No: KI91151 �E� �
DEBCRIPTIO!
SL X�•]O I NO. OP BLDOB .^ ^
� < „�w o�, ��, none
■ usE
. BHiHACK LINB PROM � q �
ZON��I(N'G
NO. OF _ � �+BE OF N
vLANB v IBUILDING
Lot 16, Tr. 3717
� , ICENTEP LINE 8T.1
SIDE YARD ILEF7 � IRIGHT S�
DESCRIPTION OF WORK
NEW I X II ALTERATION I (I ADDITION I
REPAIR I IIMOVING I IIDEMOLISH I
BUILDING 175a sq.{� oF ],0 1
SIZE 72(SEMS STORIES
COVERINGwALLStUCCO I COV�ERING COII1J.rock
USE OF BUILDING AND WORK TO BE PERFORMED
8 �tWO 17.V1II? 11T11't
Plan C
I H¢R6BY ACNNOWLEG�e THAT 1 HAV6 RBAD THIB APPLIWTION
AND BTATE TXAT THE ABOVE Ie CORPECT AND AGREE TO COM-
PLY WRX ALL CIiY OR�INANCEB AND BTATE LAWB RE6ULATINp
BUILDINO CON9TRUCTION /1
SIGNATURE OF �( / A /d�
'AUTXORIZED AGENT gike z Col�'rove� Inc.
.1
Gar. L;20 sg. ft.
THE AMOUM eHOWN UNDEP V�LIIATION 16 POR THE
PURPOBE OF EBTAHLiBMING A PERMiT FEE ONLY.
VAWATION
PERMIT FEE $ 37�00
s 17,926�� p�pN CHECK $ �'g�Jo
r.,r.. «< ¢ 55•50