The URL can be used to link to this page

Home My WebLink About113 ASPEN LN - Building Permitss n a C. L 40 - COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant te-M11in Cgjmpletely — Use [nk Only BUILDING /I/ irN _ OWNER MAIL ADDRESS CITY CONSTRUCTION LENDER BRANCH ADDRESS TEL. NO. ITECT TEL. SINEER NO, 7929 10/30/78 233.00 TL 7929 10/30/78 -'233.000KTO, 7929 "00004469 62 IA' 4LI5ATIION FOR STRUCTURAL PERMIT FIRE ZONE TYPE GROUP APPROVED CONTRACTOR DATE RECEIVED ATE ISS ED PERMIT NO. ERESS L T BLOCK USE OF NEW CITY NO.PLANS TER P OVINGVALUE STATE CITY ROVED YARDS APPROVED LIC. NO. LIC. NO.LDING ACCESSORV BUILDING SIZE NO.OF SLOGS.REET) US OF LOT NOW ON LOTFT. FIRE ZONE TYPE GROUP APPROVED CONTRACTOR DATE ADDRESS n m TEL. N.OF USE OF NEW CITY NO.PLANS THE AMOUNT SHOWN UNDER VALUATION IS FOR m BUILDING STATE CITY ROVED YARDS APPROVED LIC. NO. LIC. NO.LDING ACCESSORV BUILDING SIZE NO.OF SLOGS.REET) US OF LOT NOW ON LOTFT. FT. USE OF EXISTING BLDG. T FT. Separate permits are required for FT. FT. electric, plumbing and heating work.FT. FT. USE OF BUILDING AND WORK TO BE PERFOR D DISTANCE BET. BET. MAIN & MAIN SLOGS. ACCESS. SLOGS. �(✓l�.- VAR.46 DATE / -27- C.U.P.# APPROVED/12 r� 7 !i Irr APPROVED / __/o '22. 75; I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee Authorized Agent TOTALPAID $ N n m i m SO. FT. �+ THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ ut m PLAN CHECK $ 0 0 u. TAX $ 2 $ U TOTALPAID $ 7 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 113 ASPEN LN Status: ISSUED Suite No Applied: 11/03/2000 Issued: 11/03/2000 Vicinity: GARAGE Parcel Nunmber: 43917211 ISSUED BY: Applicant: GLOVER, LORIE Address: 2737 S CRODDY Phone: (714)241-1414 SANTA ANA, CA Zip: 92704 Owner: BURROWS, DAVID Address 113 ASPEN LN Phone. COSTA MESA, CA Zip: 92627 Contractor: COAST ROOTER PLUMING HEATING & AIR CONDITIONING Address: 2737 S CRODDY Phone: (714) 241-1414 SANTA ANA, CA Zip: 92704 License: 529127 Arch / Eng Address: �A Phone: Zip. License: SCOPE OF PERMIT 1 WATER HEATER CHANGE -OUT QTY FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY FEE SUMMARY AMT QTY AMT QTY Laundry Tub /Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater / vent $12.30 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 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: This permit shall automatically expire and become void if work is not commenced within 180 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 required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (a=) DECLARATIONS u,JF1:.7G1 'IV 'T WORKERS'COMPENSATION DECLARATION: F I elf.) C,n � I 1 f-; ( ,r 1' _Lhereb .affirtnunder. anal ofone of the following declaiatlons: 1.e �. ki Y P tY perjury 9 o `L7 4 <'1. uu.r t! .�'y': c.il,�Fi�_,.�f� '.�1 _�✓,� . i»r5 ❑q 1-have and wllbmelntain a certificate of consent to self-Insure,for workers',compensation,.es provided for bysection 3700 of the Labor Code, for performance of the IiiH'Y m Y,]/IVI'1 P'T3""" IL'I:iM �V G7J1 V JG I V_l bMU work 1oi which this ermil is issued IU i I have and will maintainlwokers' compensation insurance, as required by sectlori 9700 of the Labor Code, for the performance of the work for whichlthis permit is issued My worker ' cortlpensatlon surance c mer and policy number are: I ,( Cartier: f Policy Number: ./\)O� O (\ rI>'6'�-1=+oz' (This section nW not be cromplot ed i/ the permit Is val oat one hundred dollars ($100) or less.) '�_ _ _ II tiie 2Scomgeri'sallon laws of Calit0 iaoand agree that if should become subjecttothe workers' co`mpe sation provielons ot'Secllo`n 3700 t the Lab6i Code,, Iahalrl Gl iwith comply with these provision Applicant Signature ��Date: f �� WARNING: FAILUREECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($10D,ODO), 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 affirm that I am licensedu er provisions of Chapter 9 (coral encing with Section 7000) of Division 3 of the Business an rofessions Code, and my license Is In full force and effect. Lic. It s'r� 9 a-� Class 1t 3 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the wok for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: ' I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031,5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the ContractorsLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of 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 Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such wok himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the Property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owneri of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetlily that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made mconnection with wok authorized by this permit, and that no building structure, scaffolding, falsewok, or'demolitlon or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TitleB; Celifomia_'A"dmihisirati`v`e Code). L:SII'\ n�l ❑ As owner-builder, I will not employanyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person hes e permit to do`such wok from the division. IA� Signature: Date: I Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requirl s, with some exceptions, that a Business Plan be filed 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 to or greater than a weight of 500 pounds, or a volume of 55 gallons, 200 cubic feet of compressed gas at standard temperature and pressure)................ ,or ................................................................................................................................................................. ... ............................................. ............ ....................................................I..................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptlons, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, w 200 cubic teal of compressed gas at standard temperature and pressure). ................................ ........................................ ................... . ........................ .............. ................................................................................... ........................................................... ............... ..... ......................................................... .............. ............ ....I 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................................................................................................................................................................................................................................................................................... ............................................................................................. 4 If an RMPP is presently required, hes 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 wok which Is the subject of this a plication a ermit for such construction or modification � other No , from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes (Section 65650.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school?_.:_O Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................................................................................................................................:.................................................................................................................................................................................................................................... 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is reawik red for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No ........................................................................................................................................................................................................................................................................................................................................................................................... 8 (if 'Yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI ature Of Legal Owner(s) J fjale / �� OQ ndfOr Authorized Applicant Date CODE N, INSPECTION TYPE INTII16L5 CODE.k INSPECTION TYPE - Ilm iNTmAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 7� 4 _ oq 1266 Pool Spa Final 208 Final Plumbing - •a1 JI 1u 200 - Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 2D4 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 Job Address: 113 ASPEN LN Suite: Vicinity: Parcel Number: 43917211 Applicant: Address: CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: Phohe, - ' - - w. "MIT NUMBER B99-01403 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: APPLIED Applied: 09/02/1999 Issued: Arch : /� �; _ Zip: v ,' , - Address:. �• Address: •'. owner: BURROWS, DAVID Phone: �� Address 113 ASPEN LN License: Phone: COSTA MESA CAS - - Zip: 92627 SCOPE OF PERMIT'' , Contrador:j ORANGE COUNTY FENCE HIGH BLOCK WALL- REPLACESEXISTINGWOOD FENCE. ,� / Addru A1i i RA r ess: 412-5' CENTRAL PARK AVE #A Phone: i (714)991.7773 y ANAHEIMICA Plan Check% $15.28 Zip 92802% License. 606245 Permit $23.50 Claim Valuation: Arch : /� �; _ --- :. - .. Eng. v ,' , - Address:. �• Address: •'. ;Phone' - -_' , _ Phone: �� 1'. Zip: License: SCOPE OF PERMIT'' , CONSTRUCT 24 LF OF 5'6" HIGH BLOCK WALL- REPLACESEXISTINGWOOD FENCE. ,� i / FEE SUMMARY Plan Check% $15.28 Calc Valuation: $480.00 Permit $23.50 Claim Valuation: $000 �I SMIPRes,;v $0.50 titSMIP Comf $0.00 ,Other'.. •_ $0.00 Inspection: $0.00 _- - �.,Total `$39.28 �. PLANNING & ZONING- SETBACKS MAIN STRUCTURE Front '0-0 - Rear 0-0 Left" 0-0 _ Right 0-0 ACCESSORY "F)ont 0-0 Rear 0-0 Left 0-0 Right 6-b PARKING Existin i 0 Required: 0 Proposed: 0. - NOTES: 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: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. r INSPECTIONS: 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 final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Xae!rhave and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: I Policy Number: (This section need not be completed If the permit Is valued et one hundred dollars ($100) or less.) ❑ 1 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 to the workers' compensation laws Califomia, pnd aggg[[[@@@a tat if I should become subject to the workers' compensation provisions ofSection 3700 of the Labor Code, I shall forthwith comply with these ro ' I Z� ^ Applicant Signature:OWL .i Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($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 CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the BusirLWs and Professions C de a my license is in full force and effect. Lim K 1 Class n F Contractor's Signature: 41 Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the progeny, 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 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 offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owni r of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: I Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). I ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed 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 to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety 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 acutely 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 at standard temperature and pressure). I 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, hes Section 25534 of the California Health and Safety Code been fully complied with? El Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or-modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (11 "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been made? ❑ Yes ❑ No 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I'Icenify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. fur O ego( VI/l�9ye And/Or Authorized f cant I Date CODE 9. INSPECTIONTYPE - gAiE INTMA CODE INSPECTION TYPE 2AH Igo 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof Q 210 Final Electrical 201 Final Block/Retaining Wall L "/ 212 Final Fire Prevention .202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 1 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2496-46 V)4L _ TY FB-A �PME9P ` r. t� , VZ`IIs� G�� Y v st ON ala b�,5 ala ON�p�ol ,�n1� • lroa`�`a AM ,,,asp°"'" nes,` , ,acfibo'' 1aat�cVaO"' h��ulYi�p a. �' a�Jll'd� ��%ic�,uL ,��a5al�.��Wil�Masa i��hr,�'• of �psd yod any �'�31 ,osJ�'�.of V...addbec�viPMrl6 ,slym0�1cm1 p o yh _p"�an6 — }�'C` �LCI�. MNNINO DIY. S "'J'a" BY TIONS, DELETIONS, OR CORRECTIONS SHALE E � DIVISION i � r •P _ r• s�a� .. r .O I 1 ,I 1 /� f`f !l iF • ..rL I � iii ✓.P:'; r. -ifs ti."� " �?��t•b:: a.�. �J'Mli :; -tirn''�r:?J Tr•. ' '��d,o. '1i5b ., _ r ..n t_ ` o: (714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 113 ASPEN LN Suite: Vicinity: UNITS 111 & 113 Parcel Number: 43917211 Applicant: COOTER, LYLE Address: 23015 DEL LAGO LAGUNA HILLS CA Owner: LAUREL POINTE HOA Address 113 ASPEN LN Zoning: Phone: (714) 583-1858 Zip: 92653 Phone: COSTA MESA, CA Zip: 92627 Contractor: PRO -TECH WEATHERPROOFING Address: 23015 DEL LAGO Arch : Address: Phone: (714)583-1858 LAGUNA HILLS CA Zip: 92653 License: 620476 Phone: Eng: Address: ISSUED BY: Status: ISSUED Applied: 06121/2000 Issued: 06/21/2000 Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING 2 UNIT CONDOMINIUM (24 SQ). TEAR OFF EXISTING SHAKES, INSTALL 1 LAYER OF 15# FELT UNDERLAYMENT, & REROOF WITH 30 YEAR "GAF' COMP. 2 UNIT CONDO INCLUDES 111 & 113 ASPEN LN. NOTES: 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: This permit shall automatically expire and become void if work is hot'commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. r INSPECTIONS: 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 final approval will result in the expiration of this peimit. FOR INSPECTIONS CALL: (714) 754-5626 ' FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,400.00 Permit: $97.25 Claim Valuation: $3,400.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00. Total: $97.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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: This permit shall automatically expire and become void if work is hot'commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. r INSPECTIONS: 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 final approval will result in the expiration of this peimit. FOR INSPECTIONS CALL: (714) 754-5626 ' DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compens,a�t�ion,�'Insurance carder and policy number are: -Carder. 1/11 1 6 u4a1 / Policy Number: L'Ll G )-7 4fI= -7 1-F1-3 (This section nee not be completed if the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 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 to the workers' compensation laws of California, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. / Applicant Signature: Date: `O LI O z> WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLgRE ($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 CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect{ Lic. # j� L Class If Contractor's Signature: �- Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby allirn that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of 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 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 awn employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: I Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA71ON: ❑ 1 hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or i demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which woild require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Pernit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: - 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No I (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed 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 to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety 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 acutely hazardous materias equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of i compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? [:3❑ Yes No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required 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 work which is the subject of this a plication aRermit for such construction or modification from the South Coast Air Quality Management District or from any Other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). --- _......_..._.__..__.____-.__—_.....__.--.___..__....___.____._......_--_.........____.__. .._..........__. ..__.._.._ __.._...._..._. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if -yes-, the facility must meet the requirement of Sections 25534;and 42303 of the California Health and Safety Code). 7 a a permit from the South Coast Air Quality Management is Heal or other air pollution control district b or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No _. __ — -_ 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature Of Leg Owner )/ / Date v/1 �• l J" O And/Or Auth pplicant c' Date CODE t, INSPECTIONTYPE 12M INTTIAL CODE INSPECTIONTYP DATE INTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 7-dl-wNOW 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place li 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 24A6a6