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Home My WebLink About3176 COUNTRY CLUB DR - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3176 COUNTRY CLUB DR Suite: Vicinity: ROOF Parcel Number: 13912304 npp�icant: FERGUSON, LEWIS Address: Owner: LAKE, BRIAN W Address 3176 COUNTRY CLUB DR - " COSTA MESA, CA Contractor: MC CORMACK ROOFING Address: 4091 E LA PALMA SUITE D ANAHEIM,CA Zip: 92807 Arch : Address: Zip: Phone: license: Zaning: R1 R1 Phone: Zip: Phone: Zip: 92626-2344 Phone: (714)630-5543 �icense:_ 643700 - � Eng: . � Address: e Status: ISSUED Applied: 04/04/2003 Issued: 04/04/2003 Phone: License: SCOPE OF PERMIT REMOVE EXISTING ROOF. INSTALL 40 YEAR, GAF, COMPOSITION SHINGCES,ON PITCHED'ROOF (34 SQUARES) AND BUILT UP ROOF ON FLAT (1/2 SQUARE). • - - - � . - -� - i Plan Check: $0.00 Permit: $11125 SMIP Res: $0.50 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $111.75. SETBACKS MAIN STRUCTURE Front �0- 0 ACCESSORY Front ' 0- 0 PARKING Exlstina: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY Calc Valuation: Claim Valuation: PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Right 0- 0 Right �- 0- 0 ss,000.00 $5,000.00 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 780 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 requlred 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 2446�46 (N00) WORKERS' COMPENSATION DECLARATION: '� " • I here6y ettirm unaer penelry oi perjury one ot the following tleclarations: �� ❑ I heve end will meintain e certificate of consent to seif-Insure for workers' compensetlon, es provided lor by section 3700 ot the Labor Code, for the peAormance ot iha rk tor whiCh Ihis pertnii i5 i55ued. "_I heve antl will maintain wo�kers' compensatlon insurence, as required by sectlon 3700 ot Ihe Labor Code, for the performance of the work for which Ihis permit is issued. �)Mv workers' comoensatlon Insur�ce carner antl Dolicv numbar ere: fhe permil is Policy, Nu�� 7 � �-�!� �S % d 7 orlessJ �""'`• ❑ I certify ihat in t�e peAormenca of the work for which this permit is issueQ I shall not employ any person in any manner so as lo become subject to ihe workers' compensation laws of Cel' ma, antl egrae that if I shoultl become sub�ect to the workers' compensetion provisions of Sectlon 3700 oi the Lebor Code, I shall forthwith complywlttll�eseprovi . �J / i Applicant SlqnatuFe'�� Dat� � 7/ d�/ � 3 WARPoNG."FAILURE T SECURE WOFKERS' COMPENSATI ERAGE IS UNLAWFUL AN� SHALL SUBJECT AN EMPLOVER70 CHIMINAL PENALTIES ANO CIVIL FINES UP TOIXJE HUNDRED THOUSAND OOLLARE (5100,000). IN A�DITION TO THE COST OF COIAPENSATION, DPMAGES AS PROVIOED FOR IN SECTION 3]O6 OF THE LABOR CO�E, IMEREST, AN� AiTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: of Chapter 9(commencing with Section 7000) of Division Code, antl my license Is in full CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirm Ihat there is a construction lending agency tor the pertortnance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lentler's Address: SignaWre. OWNER-BUILDER DECLARA7�ONS: Date: I hereby efllrm �het under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Protessions Code: Any ciry or counry which Yequires e permit lo construct alter, improva, demolish, or repair any stmaure, pnor to its issuance, also requires the applicant for such pertnit ta file a signetl statement thet hB or she Is licensed pursuant b the provislons oi ihe Contrectors License Ww (Chapter 9(commencing wilh Section 7�00) of Divisian 3 01 the Business end Professions Cotle) a< <�at he or she is eaempt there�rom and ihe basis tor the alleged exemption. Any violation o� Section 7031.5 by any appliwnt for a permit subjects the epplicam to a clvil penalry oi not more than five huntlred tlollars ($500).): ❑ I, as owner of the properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the stmcture is not intentled or oHeretl for sele (Sec. 7044, Business end Professions Code: The Contractore License Law does not apply to an owner of properry who builds or improves ihereon, and who tices such work himself or herselt or Ihmugh his or her own employees, providad Ihat such improvemenis are not intendetl or ottared lor sale. If, however, ihe huilding or improvemenl is sold within one year oi comPletion, the owner-buildar will heve ihe burden ot proving that he or she did not build or improve tor purpose of sala.). � ❑ I, as owner oF ihe property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business antl Professions Code: Tha contrectors LlcBnse Lew tloes not apply to an owner of propeny who builds or improves ihereon, antl who coniracts for such project wit� a contrector(s) license pursuant to the Con�ractors License Lews.). ❑ I am exempt unaer sec. Business antl Professions Code for this reason: SignaWre: Date: Owner ID verifietl 6y driver's lice�se. ❑ Ves ❑ No Drivers License No. Verification of Ownership by (type of document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereCy ceriify �hat no exca�ation five (5) or more feet in depth into which a person is required to descentl, wlll be made in connection with work authorizetl by Ihis permit, end that no building structure, scattdtling, falsework, or demolition or dismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Adminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industrifll Setery, as noted above, unless such pereon hes e permit to do such work irom the division. Signature: Date: Division ot IndusMal Safery Permit Number: CERTIflCATE OF COMPLIANCE AND AUTHORIZA7ION OF ENTRY: I certity untlei penalty of perjury ihat I have read this application antl state that ihe infortnation given is correct. I egrea to comply with all state laws end ciry ordinances relating to builtling consWction, antl authorize representatives of the Ciry of Coste Mese to enter upon the e6ove-descnbed property for inspection puryoses. I ag�ee not to occupy or allow occupancy of any building authorized by this permit unlil final inspection. [�] ]31�1iF'77S3i.P.i�l� Legal Owner(s) a ed �pncam"�'i PdIF INTRIpLS 1616 Fixetl System Final Fire Prevention 7266 Pool Spe Final 200 Finel Re-Raof 207 Finel Block/Retaining Wall 202 Final Fectory Fire Plece 203 204 Final Sign Final Demolition � � CODE1 INSPECTIONTYGE � 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Builtling/Occupency PeIE 1�LS �OWNER �JOB AC G.F�";tcR � 4 � � �I�i �§cC SOIL GAS W ATER LINE U HOUSE CON. SVSTEM ANO AIR CON�ITIONING POWER ROUGH WIRING TRENCHES �} FORMS FLOOR SVSTEM 60N0 BEAM � STE SHEATHING FRAME AN� FLASHING� LATHING — IN n �OUT � P' '4R, BROWN COAT 5 'URAL, FINAL HEA'�ING, VENT., REFRIG. ANO A PLUMBING, FINAL AND GAS TEST ELECTFIL FINAL DATE BUILDING PERMIT N0. ;onsLructiion �=��R�� u�v o� n�rcn F RACT 6 FIRE ZONE VALUE iignafure Dare GROUP I TYPE --�I +�o�,vi� � nna.ivn , / � 30735 ;� COSTA MESA BUILDING-SAFETY DEPAF P.O. BOX 1200 COSTA MESA, CALIFORNIP For Applicant to Fill in Complete/y BUILDING � � ADDRESS OWNER MAIL ti . . _ _ � ./ _ �r%I Z . W W a U FZ Z a O v~i am J 7 J '^ t C J Q U N Za W � aw W Z J Q m z J � W W 0 Z H w� 70 CITV BRANCH ADDRESS ARCHITECT °a1Q 61.50 SFA —5-69cnsa00 129� t*�* APPLICATION FOR :ENED�Bv DAT�R A.P. NO. I � BUILDING ADDFESS ` TPACT bR S'OR/ � L T+�� OWNE •r• / ninL.7��'!(�� SEF� ADORESS ` '�V /� Q/�L B� < CONTRACTOR ') A�ORESS �y �Po`/Q,Qj� �1�� Y TEL. ��T�� r�- M�s� • NoSrlL-r STATE CITV IIC. NO. Q� LI0. NO. SIZE • O ) / � NO.OFBLDGS. OF LOT �� y NOW ON LOT USE OF EXISTING BIDG. / F z NEWBLDG.1��KA V� ROOMS � U EXTERIOft WAL1,� ROOF COVERING .J'r�«� COVEFING USE OF BUILDING ANO WORK TO eE PERF 4 � �"' N Z O F- U � � �"' N z I hereby acknowletlge that I have reatl this applicaiion antl state that the above intormation is correct end agree to comply with all laws regulatin8 building consttuction, and I shall not employ any person in violation of the workman's compensation laws of the State ot Calitomia. I hereby certify xhat I am properly licensetl as a contrector untler the State of Calitornia Business antl Professions Code, Divisicn 3, Chapter 9, and thet such licenses ara in tull force antl affeci, or I am axempt from the provisions ot the Stata of Calitornia Business antl Professions Cotle, Division 3, Chapteyr �9. Signature o � ��j�',�`r �y,..�.�a Permittee �''��/ �I J� ' i%— AuthoriEed ABent FIR�� ZONE T APPROVED BV � ZON NO.OF PLAN$ VARDS APPROVED MAIN BUILDING (FROMGLS7RE� —E}77�)_ FRONT�� 5-W � R. SIOE •� % PT N f �y L SIDE � FT./'e/L FEAR .�( � FT. DISTANCE BET. MAIN BLDGS. VAR. # C.U.P. # q( APPROVED /, �,y/� U LDING PERMIT ' VED Dfy7 IS�D` s� � r % PERMIT —o .3�" , /I i LOT VALUE BLOCK USE OF NEW_�-�ji��n BUILDING �/�_M7� i'-- VARDS APPROVED BET. MAIN & ` m b V SQ. FT. o THE AMOUNTSHOWN VNDEF VAIUATION IS FOR � THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m ¢ VALUATION � $ 9/y/, /% � PERMIT FEE $ / � � O i ( ' PLAN CHECK $ O� ✓ E � lo /SD ' LL TOTAL FEE $ . :i '� ��Y9� � ��; COSTA MESA BUILDING DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA FOR APPLICAN7 TO FILL IN Aooa°E�ss 3176 Country Club Drive COSTA MESA. CALIFORNIA OWNER Newport Homes, xnc. � MAII 1555 Placentia. Af]fJRF55 TEL. CITY i n+��Ae�no� NO� ARCH�TECT LIC. OR � VEER NO. LEGAL DESCRIPTION A.P. NO. SIZE OF LOT K011 COIISt• COi ITY NIO. 101 112 ,- „�. . ._�.�..- - �. pUG 4 1959 �'ii��'^�nr' n�7i . .. .1.'L �. APPLICATION FOR PERMIT BUILDING FOR OFF'ICE USE ONLY BUII DING AD�RE55 FIRE ZONE 'z ZONE /•n� // \ APPROVE[ BV rRncr 3363 rvo.oF a�ocs. O NOW ON LOT SETBACK LINE FROM C ^I CENTEn OF slae[r JOO REAR VARO lJ SIDE YARD RIGHT `r LEFT � � DESCRIPTION OF WORK NEN X ALTERATION IAOOITION REPAIR MOVING DEMOLISH SIZIEDING ��025 ROOMS EO STORIES EXTERIOR WALL 9t.i1CC ROOF 470 $. COSTA MESA. CALIFORNIA DATE CORRECTtONS � � I HEREBY PCI(NOWLE�GE THFT I HAVff REqD iH15 f�PFLIC4TION AND STwTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLV WITH nlL CiTY OROINANCES AND STFTE L/.WS RE�ULATING BVILOING CONSTRV6 TiON. V A W ATION SIGNAT pt PERMIT FEE $ 3 �/ �- PERMIT EE �` Q�7 � /y l 7 /� PLAN CHEGK $ / j � L � AUTHORI D GENT , � TOTAL FEE $ �.� �V� vOMI