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Home My WebLink About946 CHEYENNE ST - Building PermitsJobAddress: 946 CHEYENNEST Suite: Vicinity: ROOF Parcel Number: 14172309 npplicant PHAM, QUANG Address: 14560 MAGNOLIA ST WESTMINSTER, CA Owner: TRAN,NGUYEN T& DIEP M Address 946 CHEYENNE ST ��COSTA MESA, CA - � Contractor: Address: Zip: Arch : Address: Zoning: R1 R1 Phone: 714-206-2471 Zip: 92683 Phone: Zip: 92626 Phone: License: Eng: Address: Status: ISSUED Applied: O6/16/2004 Issued: O6/16/2004 ISSUED BY: / / Phone: Phone: Zip: License: License: _ SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30# FELT, 30 YEAR COMPOSITION SHINGLES, AND REPAIR/REPLACE SHEATHING AS NEEDED. 1,100 S.F. INCLUDES ATTACHED GARAGE. - � ' Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: FEE SUMMARY $0.00 - - - - $83.25 $0.50 / $0.00 $0.00 $0.00 $83.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o Rear 0-0 Rear 0- 0 Required: 0 PLANNING& ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Sz,zoo.00 Claim Valuation: Sz,zoo.00 Right 0- 0 Right 0- 0 NOTICE: The work authorized by ihis 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 1 BO 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 requfred inspectlons 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) 7545626 !4�16ifi (fi�W) WORKERS' COMPENSATION DECLARA710N: , . / , I hereby ettirtn under penalry oi perjury one of Ihe tollowing declarations: ' ❑ I have end will maintain a cetli�icate of consent to selt-Insure for workers' compensation, es provided lor by section 3700 ot the Labor Code, for Ihe peAormance ot the work for which ihis permit is issued. � ❑ I have antl will maintaln workers' compen5aiion insurance, es requiretl by section 3700 of the Lebor Code, tor �he peAortnance of the work for which this pertnit is issued. My workers' compensatlon Insurance carrler entl pollcy number ere: Cerrier: Policy Number: �(Th�is secfion need nof be crompleted il the permit is velued at one hundred dollars ($100) or less.) B",I�certiy Ihat in the peAortnance of the work tor which Ihis pertnit is issuetl, I shall not employ any person in any manner so as to become subject to �he workers' ��compensa�ion laws ot Californ' end egree that it I should hecome sub�ect to tha workers' compensation provisions o� Section 3700 of the Labor Code, 1 s�all forthwith comply with ihese p�r�ov�isi� �/y� �y2 '— /� APPlirant�Signetnie�` ��/7 !/'" ` Date:.� ��' /� — �Y WMNING; FAILURE E WO PENSATION CAVERAOE IS UNUWFUL AND SHALL SUBJECT AN EMPIOYER TO CRIMINAL PENALTIES ANO CIVIL FWES UP TO ONE HUNDRED THOUSANDDOLU (5100,0OO�,INADDITIONiOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABORfAOE,IMEREST,ANOATiORNEY'SFEES. LICENSED CONTRACTORS DECLAflATION: I hereby ettirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Cotle, anA my license is in tull force Bnd eHBCL LIC. » Class N Contrectofs SlgnaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I herehy aHirm that there is a consWction lending agency for the perfortnance of ihe work for which this permit is is5ued. (Sec. 3097, Civil Cotle). Lendels Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: �I hereby aHirtn ihet under penelry ot perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7037.5, Business end Professions Code: Any ciry or counry which requires e permil to consiruct alter, improve, demolish, or rapair eny sWcture, prior to its issuance, elso requlres the applicant for such pertnit to file e si9netl stetemant ihat he or she Is Iicensed pursuent b the pmvisions of the Contractors License Lew (Cheptar 9(commencing with Sedion 7000) ot Division 3 o� ihe Business end Protesslons Cotle) or ihet he or she is exempt theretrom antl the basis for the alleged exemption. Any violation ot Section 7031.5 by eny epplicant for e parmit subjacts the epplicant to e civil penalty of not more than tive hunCretl tlollars ($500).): ❑ I, as owner of the property, or my employees wi�h weges as Iheir sole compensa�ion, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, 8usiness end Professions Code: The Contractors License Law does not apply to en owner ot properry who builds or improves thereon, and who does such work himseN or herself or �hrough his or har own amployeas, provi0etl ihat such improvements are not intanded or oHered for sale. H, however, ihe building or Improvament is sold within one year of complelion, the owner6uilder wiil heve Ihe burden ol proving that he or she did not build or improve for purposa of sale.�. � ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions Code: The coniractors License Law tloes not epply to an owner of propeny who bulltls or Impmves ihereon, antl who contracis far such project with e comractor(s) licanse pursuant to ihe Coniractors License Laws.). ❑ I am exempt under sec. Signature: Owner ID verified by drivers liCen58. ❑ Ve5 ❑ No Business and Protessions Cotle tor this oeasoa�. Venfication of Ownership by (type of document, i.e. - proparty ta: bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CEqTIFICATION: Drivers License No. Da�e: Expires: ❑ I hereby certify Ihat no excavation five (5) or more taet in depih into which e person is required to descentl, will be made in connec�ion with work authorized by this permit, and ihat no building s�ructure, scaHolding, telsework, or demolition or tlismantling thareof, will be more ihan ihirty-sis (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle e, Calitornia Atlministrative CoCe). ❑ As owner-6uiltler, I will not employ enyone to do work which would require a permit irom ihe Division ot Industria� Safety, as notetl ebove, unless such person has e permit to da such work from the division. Signature: Date: Division of Industrial Satery Pertnit Numher: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATON OF ENTRY: I certify under penalry of perjury that I have read this application end state thet the infortnation given is correct. 1 egrea to comply with all state laws and city ocdinances relati�g to builtling wnstruction, eod authorize representatives ot tha Ciry of Caste Masa lo enter upon the ebove-describe<Jyropedy tor insgp,c�jon purposes. I agree not to occupy or allow occupency of any building authorized by this permit until final inspection. COUE 1. INSPELTIONTYPE 1676 Fixed System Final Fire Prevention 1266 200 201 202 203 Pool Spe Finel Final Re-Root Final BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demolition u.u�ww�:��i ?.Ff'G`1 � D� - � CODE� INSPECTIONTYPE 206 Final MeChanical 208 Final Plumbing 270 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinryOccupancy I•Z\i�lul�P.Ll'. DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Pertnit#�-1_�-�y� \ ll I O� This Permit # StreetAddress: _��/ b (i/��.�/y�l/�� 9� APNumber: I(we), ��I� %��'�"' , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: �Name: �'�G� ��/�� . 7elephoneNumber.� 7�� / �� 2y /� � � Street Address: �l/S �✓✓ ' �`��l�� [ � � �/ i �.,/� City: w��f.�7' �'--�'L State: (r'" Zip: � %�� to obtain permits in my behalf, as ownedbuilder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensatlon Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or wrporation. 4. I agree to indemniTy and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other paRies as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalry of perjury that the foregoing is true and correct. Executed this �� day of � 20 �, at �,f%�1/��1� , California. ov�5-as (rev. f voo) Print Name: �� 1 L N �'+v � N Signature: � . . �� _ Y.. _ _ i Date: Note: This auMwr¢a6on does not grant authorizatlon to perform the work as owner, it solely provides for limited power of attomey to secure this permft in any behalf. � 2398a COSTA MESA BUILDING-SAFEfY DEPARTMENT � P. O. BOl[ 91] COHTA M6HA. CALIFORNIA For � Applicant fo Fill In Completely TYPE OR PRINT - BUILDIN� Cj.�/ Ch'e enne St. ADDRE55 � COSTA MESA, CALIFORNIA ADDRE9S � I�iO TY �,T., Fullerton CtTY Os C"�STA MES�A dzQ MAY 5 1965 APPLICATION FOR P RMIT � � ��Usa ly ` rteceipr No. ��q-(i� L'..'�/�JV nsce� ev ,h /Q°��Gh Ml1YA1817 u� . . ' BUILDIN6 /� / . A A�DRESS "1�� FIRE � 71-2i10 Z�NE APPROYED oR BraEtain Contractors, Inc. 1304 1Y. Commonwealth Ave. Fullerton, Calif. tl 6ETBACK LINE RROM �� i�:3 ��•r, �•r�^r•�;r,� % Sh 1 XEREBY ACKNOWLED08 THAT t XAV6'pEAO TH18 ApF ANO BTATH THAT THE ABOVE IB CORRECT ANO AOI�EE PLY WITH ALL CITY ORDINANC88 ANO 8TAT6 LAWH q8� 9UILDIN� CONeTRYCTIO%. � SIGNATURE OF PERMITTE .� . AUTHORIZED A6ENT . ZONING HO. OF U6E J runa eun fE: NO 6AVE OVERHAN6 8HALL BE LESS THAN ' TO SIOE @ REAR P. L. �ES .OWED �U. B. C. REQUIREMENT) YARDSAPPROVED YARDSAPPROVEO MAINBWLDIN6 ACCESSORYBUILDIN6' VAR..JF OATE (/ �. % 7' U / Q U 7 sa Fr. .C� � Z a�' a THE AMOIINT eHOWN UNDER V�LUATION IB FOR TN8 F PURPOBE OP EBTABL�6HIN6 A P¢RMIT FEE ONLY. � VAWATION - - ` � .G� m PERMIT FEE $ j j m '• C 1 0 $ �� 5 1cP � ,��_� �.