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Home My WebLink About436 CABRILLO ST - Building Permits. CITY OF COSTA MESA � �`" F,Q BUILDING DIVISION r � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p74) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us : °. � FOR INSPECTIONS CALL: (714) 754-5626 4ro�mm p• PERMIT NUMBER; BC09-00300 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 08/10/2009 ISSUED BY: RMD JOB ADDRESS: APN: 11732208 Vicinity: Const Type: V-B 436 CABRILLO ST CM SQ. FT: Zoning: , , 1656 Suite/Unit: Primary Occ: R-3 Valuation: $60,000.00 SCOPE OF WORK: INTERIOR REMODEL OF AN EXISTING 1-STORY SFD. WORK INCLUDES PROVIDING A GARAGE ENTRY INTO THE DWELLING, UPGRADE ELEC SVS, WINDOW CHANGE-OUT FOR ENTIRE SFD & MAKING BEDROOMS EGRESS REQUIREMENTS, CHANGE-OUT KITCHEN DOOR TO SLIDER, RE�OCATE THE LAUDRY ROOM, CREATING NEW CLOSETS (DUE TO REMODEL); NEW INSULATION THROUGHOUT. ELEC: 10 LIGHT FIXTURE, 10 SWITCH, 20 OUTLETS, 1 RES APPL, 1 SVS TO 200A; MECH: 1 ATTIC FAU < 10000K BTU, 1 VENT FAN SINGLE DUCT; PLUMBING: 1 BATHTUB, 1 DISHWASHER, 1 GAS OUTLET (1-4), 4 P-TRAPS, 1 SHOWER, 1 KITCHEN SINK, 2 WASH BASINS, 2 WATER CLOSETS, 1 WATER HEATER OWNER: STARR,ALBERTTR Phone: APPLICANT: HOLMES, DOUG Phone: 714-943-5291 cON7Rac7oR: HOLMES CONSTRUCTION Phone: 714-943-5291 Cell: ARCHITECT: ENGINEER: . Address: 436 CABRILLO ST Ciry/State/Zip: COSTA MESA, CA Address: City/State/zZip: License No. 620928 Address: 21932 SUMMERWIND LANEUnit: � City/State: HUNTINGTON BEACH, CA License No. Litense No. COMBINATION PERMIT FEE SUMMARY Building Plan Check: $463.94 Building Fees: $713.75 Electrical Fees: $102.75 Mechanical Fees: $45.75 Plumbing Fees: $157.05 SMIP Residential: $6.00 SMIP Commercial: $0.00 Bldg Std Admin Fund $3.00 TOTAL FEES: $1,492.24 •'Refer to fee recaipts for all fees paid for project Unit: Unit: : ZipCode 92646 PHONE: PHONE: NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECiION. 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. COOE �. INSPECPONTYPE OpTE INTIiInLS CODE� INSPEL710NTYPE OATE I L 1616 Fized System Final Fire Prevent{on 206 Final Mechanical 2 3 O 1286 Pool 5pa Final 208 Final Plumbing ( d 200 Final Re-Roof 210 Final Electncal ��0 201 202 203 204 Final Block/Retaining Wall Final Factory Fire Place Final Sign Final Demolition 212 220 Final Fire Prevention Final Pianning Approval 222 FinalSite 250 Finaleuilding/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby atfirm under penalty of periury one of the (ollowing declarations: ❑ I have and will maintain a certifcate of consent ro sel(-Insure for workers' compensation, as provided !or by section 3700 of Ihe Labor Code, !or the pertormance of the vrork for which lhis permit is issued. ❑ I have and will maintain v.nrkers' compensation insurance, as required by section 3700 of the Labor Cotle, lor the peAormance o( the v.ork lor which this permit is issuetl. My vrorkers' compensation Insurance carrier and policy number are: ��,,,, ,anion need rat oe mmdetetl n the peimrt is relued al one huntlied tlollars (Stoo) a �ess J ��I certify that in ihe per(ormance of the vrork (or which this permit is issued, I shall not employ any person in any manner so as to become subjecl to Ihe workers' compensation laws o! Cali(ornia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of thQ-6abor-6a e, I shall foAlhvilh ly with these provisions. � I l_�^ B�%•Oq[ oW�Siananue-'.. .•.- LDa�e�„-,f 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 DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 0! the Business and Prolessions Code, and my license is in full force and effect. �, 7- ' ZQ/ L��Class�#-* g � ✓ �'j�/o o� �Co,n( � cbYs SgnaWre L05b�- CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn Ihat there is a constructbn lending agency tor the pertortnance of the work fa v.hich this pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lentler's Address: SignaWre Date OW NER-BUILDER DECLARATIONS: I hereby affrtn that un0er penalty of perjury thal 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to conSWCI, aller, improve. demolish, or repair any slructure, prior to it5 issuance, also requires the applicant (or such permit to file a signed slatement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0( the Business antl Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemplion. Any violation o( Section 7031.5 by any appliwnt (or a permit subjects the applicaM to a civil penalty of not more than five hundretl dollars (5500�.�: ❑ I, as ovmer of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe structure is not intended or oflered 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 oKered 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 ovmer o! the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construcl lhe project (Sec. 7044, Business antl Professbns Code: The contractas License Law does not appty to an ovmer of property who builtls or improves lhereon, and who contracts !or such prqect with a contractw(s) license pursuant ro the CoNractors License Laws.). ❑ I am exempt under sec. Business and Pmfessions Code !or this reason: SlgnaWre 305]-O6(3I0)) Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Venfication of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certify that no excavafion five (5) or more teet in tlep[h into which a person is required to descend, will be made in connection with v.ork authorized by this permit, and that no building strucWre, scaffdding, falsework, a demolition or dismantling thereof, vnll be more than thirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8, Califomia Administ2tive Code). ❑ As owner-builder, I will not employ anyone �o do work which would require a permit from the Division o( Industrial Satery, as noted above. unless such person has a permit to do such work from [he division. ApWitanl's Sign3lure Da�e Division o( IndusVial Safely Permii Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or (uWre building occupant need to file and certify a Business Plan for emergency response to release or threatened release o( a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Calitomia Health and Safety Cotle requires, with some exceptions, that a Business Plan be fled with the Cosla Mesa Fire Department by every business v+hich has at any one time during a reported year a quaNity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at standard temperaWre and pressure�. 2. Does or will the applicant or present or future building occupaM need to file a registration form for awtely hazar0ous materials? ❑ Yes ❑ No (Section 25533 of ihe California Healih and Safety Code, with some exceptions. requires registration with the Costa Mesa Fire Department by each 6usiness which at any one time has on hand a quantiry o( awtely hazardous malenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at stantlard remperature and pressure). 3. Does or will Ihe applicant or present or (uNre building occupant neetl ro prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Sa(ety Code provides that the Costa Mesa Fire Department may require the preparation, certifwtion and filing with the Fire Depariment of an RMPP by businesses which are require0 to register acutely hazardous materials with the Fire Departmen[. 4. I! an RMPP is preseMly required, has Section 25534 of Ihe California Health and Safety Code heen fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or luture builtling occupant require for Ihe vrork which is lhe subject of this application a permit for such construction or modification from Ihe Soulh Coast Air �ualily Management District or from any other air polWtion wntrol district or agency? ❑ Yes � No (Section 658502 of ine Califomia Govemmem Code requires that the requested information be tumished on applications for non-residential builtling permits). 6. Will any part of the facility ro be consWcted untler this permit be within 1000 feet from Ihe outer boundaries of a school? ❑ Yes ❑ No Qf yes", the lacility musl meet Ihe requirement of Sections 25534 and 42303 of the California Health antl Safety Code). 7. I( a permi� from ihe South Coast Air �uality Management District or o�her air pollution comrol disMct or agency is required for the wnrk which is the subject of this application, have all of the disclosures prescribed by California Heallh and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appmpnate air pollution conhol oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty ot perjury the infortnation given above is correct I agree to comply with all siate laws and city ortlinances regardinq Hazardous Materials and Emissions. SignaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application an0 state that Ihe inlormation given is correcL I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives o( the Ciry of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until final inspeclion. - naWre Le (s) Dale � �, �6 0� 'Antlbr'PUtM1O�YteC'AOPllmnl� �" r DaleJ , .. Job Address '�/,3,� �%�/� Inspectors Name _� �y,:,.ti�.. F-� Residence Address Number & SVeet City c:ITY OF COSTA MESA, BUILOING DIVISIOrv SPECIAL INSPECTOR REGISTRATION ' State � Permit # ��%� '� �%�� Phone # Zip Laboratory ✓N/..�r�/r' d�lf' i%% � SB/CfU.e Address 31t1 / S' 1��Pi f�iL C�L .s�dT /�2 �L2✓Y"i4 A,rv// l,� _�� 7!a S� SVeet � �'� City � Zip All licenses listed below must be currently valid and legible copy(s)�and must be attached to this registration. DISCIPLtNE L.A. COUNTY L.A. CITY ORANGE COUNTY OTHER Concrete Ductile Moment�Resisting Frame - Reinforcing Steel, Prestressing"Steel • � �' Welding �S6 %�C C'.WIDy - High SUength 8olting ', • � � StmcNral Masonry Reinfarced Gypsum Concrete Insulaling Concrete Fill - � :` Sprayed on fire proofing �� Pilings, Drilled piers, Caissons , Special Grading, Excava�ion or Filling . Special Cases Unusual Hazards , ~ � �� I hereby ceRify that I am qualified by training and experience to perform the inspections for which I hold the above listed Special Inspectors lic;enses, and will provide all certifcations required by the City of Costa Mesa. . `�� I will inspect and certify the following procedures and locations: [�,ZSF%%Vi l� •.1�Y1/ �l� //lJ �/i.��is I will certify not only to the job conditions but that they are in conformance with the approved plans. If at any time, progress occurs on the above mentioned job relating to my area(s) of responsibility, without my knowledge or approval, I will stop the jobs process immediately with notification in writing to the job superintendent and notity ihe Building Division of the situation. A record of my tests and/or inspections as agreed to above will be available upon request by the Building Divisibn. Upon request I will submit a complete package of testing and inspection results. A letter certifying.satisfactory completion?viljbe ppovided•by me upon completion: � ��— Date This registration is accepted and approved by: (Plan Check Engineer) ' (Building Official) 1068-46(rev.6109�y�i�e-Bmltling0ivisioqCanary-S�allnspector,Pink-Oev�per , � ; : � CITY OF COSTA MESA � ' � t�o " F, BIIILDING DIVISION i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us F�, .` °. FOR INSPECTIONS CALL: (714) 754-5626 . ' �"°"°"� PERMIT NUMBER: B09-00184 PERMIT TYPE B_ROOF2 APN: 11732208 JOB ADDRESS: 436 CABRILLO ST CM Vicinity: Squares: 3100 STATUS: DATEISSUED: ISSUED BY: Suite/Unit: Valuation: ISSUED 09/02/2009 KJB $10,983.00 SCOPE OF WORK: TEAR OFF EXISTING SHAKE ROOF. COVER WITH 40 YR COMP SHINGLES PER CODE. ROOF PITCH IS 5:12. 31 SQUARES. OWNER: STARR, ALBERT TR PHONE: APPLICANT: LINDA DIAZ - PHONE: 949-642-7222 , . CONTRACTOR: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVEUnit: � City/Slate/Zip: COSTA MESA, CA 92627 ARCHITECT: - ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund TOTALFEES $o.00 $195.25 $0.00 $1.00 $196.25 Address: 436 CABRILLO ST City/State/Zip: COSTA MESA, CA Address: City/State/Zip: Litense No. License No. PHONE: Unit Unit: : ;�iP'+, fy"T'15]/ -:s; a::�F License No. 349686 949-642-7222 CELL: PHONE: PHONE: ._ ...; 7��;> 31 �tnl:: Vn�c NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 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 wiih 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. COOE 1. INSPECTIONTYPE OATE INii11RL5 LOOEp INSPECTIONTYPE OATE,� �. - .INTITIRLS 1616 Fixetl System Final Fire Prevention 206 Final Mechaniral 1266 Pool Spa Final � 208 Final Plumbing ' ' 3.I P. q 200 Final Re-Roof 2 210 Final Electriwl 201 Final Block/Retaining Wall 212 Final Fire Preventian 202 Final Factory Fire Place 220 Final Planning Approval " 203 Final Sign 222 Final Site �'� n Y• `� 204 Final Demoli�ion 250 Final Building/Occupancy 1 '- �� WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalry ot perjury one o( Ihe following tleclarations: ❑ I have and will maintain a certificate of consent to sel6lnsure for workers' compensation, as provitletl (or by section 3700 of the Labor Code, for the pe ance of �he work for which Ihis permit is issued. I have and will maintain workers' compensation insurance, as required by (s t n 3700 of Ihe Labor Code, (or Ihe perfortnance of Ihe work for which Ihis pertnit is issued. My workers' c mpensation Insurance carrier and policy nuC�,_`',�� ) 1U� �� arrier-_ l (IDissectionneed'iro`t0erc`wf\npetednpthepe'm�rnnisvra`lu atwe�untlredda9ars(5100)aless.) _ic-�Number:� U�vV22'(l� �`�'v� ❑ I certity that in the performance of [he work tor which this permit is issued, I shall not employ any person in any manner so as to become subject [o �he vrorkers' compensation laws of California, and agree lhal i( I shoultl become subject to the vrorkers' co pensation provisions of Section 3700 of Ihe Labor Code hall (orthwith co with these provis ons. rtanf"Si etvre �� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL 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, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm lhat I am licensed under provisions of Chapter 9(commencing wi�h Section 7000) of Division 3 of Ihe Business and Protessions Code. and my license is in full force a(nd_ eflect. LI� �Y la�.#� �q ��pnt , ' ien re -Da�e CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that the�e is a construcfron lending agency for Ihe pedortnance of the wofk for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: lender's Address: oa�e OWNER-BUILDER DECLARATIONS: I hereby aKrm �hat under penalty of perjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe follovnng reason (Sec. 7031.5. Bu5ine5s and Pro(es5ion5 COtle: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires Ihe applicant for such permit to fle a signetl statement that he or she is licensed pursuant to the provisions of the CoMracrors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt there(rom and the basis for the alleged exemplion. Any violation of Section 7031.5 Dy any applicant (or a permit subjecls the applicant to a civil penalry of not more than five hundred dollars (5500).): ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the strucWre is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appty to an owner of property who builds or improves thereon, and who does such work himsel( or herself or through his or her ovm 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-builtler will have the burden of provinq that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of ihe property, am EXCLUSIVELY CON7RACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Pmfessbns Code: The contractas License Law dces nol apply to an owner of property who builds or improves thereon, antl who contracts tor such project with a con[ractor(s) license pursuam to the Cont2ctors Ucense Laws.). ❑ I am exempt under sec. Business antl Pro�essions Code for this reason: 309>6(3N�) SignaWre Da�e Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (rype of document, i.e. - property tax bill or deed�: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: � I hereby certify that no excavation five (5) or more feet in tleplh into which a person is required to descentl, will be made in connection with work authorized by this permit, antl thal no building stmcNre, sca!/dding, falsev.�rk, a demolition or dismantling thereo(, will be more than thiAy-six (36) (eet high. (Chap. 32, Gry 2, M 2, Sec. 341, Ttle 8. Califomia Atlminist2tive Code). ❑ As owner-builder, I will not employ anyone lo do work which vrould require a permit fmm the Division of Indusinal Safety, as noted above, unless such person has a permit to tlo such vrork from the division. AO�liwnfs Signawre Date Division of Industrial Safety Permi[ Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or WNre builtling occupanl need to file and certify a Business Plan for emergency response to release or threatene0 release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safery 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 lime tluring a reported year a quantity of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressed gas at standard temperature antl pressure). 2. Does or will the applicant or present or fuWre building occupant need ro file a registration form (or acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 of the Califomia Healm antl Salety Cotle, with some exceplions, requires regislration with the Costa Mesa Fire Department by each business which at any one time has on hanC a quanti[y of acutely hazartlous materials equal to or greater than a vreight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compresseA gas al stantlard temperature and pressure). 3. Does or will the applicant or presem or fWure building occupant neetl ro prepare an RMPP (Risk Management and Prevention Program lor acutely hazartlous materials)7 ❑ Yes ❑ No (Seclion 25534 of the Califomia Health antl Safety Code provides that lhe Costa Mesa Fire Department may require the preparation, certification and lling with the Fire Department of an RMPP by businesses which are requiretl to register awtely hazardous materials with the Fire Department . 4. If an RMPP is presently require4 has Section 25534 0( the Cali(omia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or luture building occupant require for Ihe work which is the subject of this application a permit for such construction or motlifcalion from the South Coast Air �ualily Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 658502 ot the Califomia Govemment Code requires Ihat the requestetl in(ormalion be fumishetl on applications fa nomresidential Duilding permits). 6. Will any part of the facility to be constructetl under this permit be within 7000 leet from the outer bountlanes of a school7 ❑ Yes ❑ No (If "yes", the (aciliry must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safety Code). 7. If a permit from the South Coast Air Qualiry Management District or other air polWtion control disMct or agency is required for the work which is the subject o( this application, have all of the disclosures prescnbea by Calilornia Health and Satety Code Section 42303 been made? ❑ Yes ❑ No 8. pf'yes", anach ceni(cate of compliance fmm the appropna[e air pollution control oKcer). 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 reqartling Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RY: I certily under penalty of perjury that I have read this application and state that the intormation given is correct. I agree to comply with all state laws and ciry ordinances relating ro builtling consWclion, and authonze representatives of the Ciry of Costa Mesa to enter upon the above-descnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspeclion. SiB��ure c egal Owneqs) D�le � �ns r�a no.aeana ��q ( o �e� (714) 754-5273 • Fau (714) 754-4856 • www.a.cosca-mesa.BUILDING PERMIT Job Address: 4SB CABRILLO ST Suite: Vicinity: Parcel Number: 11732208 Applicant: BRINAGH, GLEN Address: owner: STARR, ALBERT TR Address 436 CABRILLO ST COSTA MESA, CA Contractor: ADAMS ROOFING Address: 1572 MARSHALL LN CORONA,CA Zip: 97719 Arch : Address: Zoning: Phone: 714f32-5325 Zip: Phone: Zip: 92627 Phone: (714)632-5325 License: 652470 Eng: Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 07/16/2001 Issued: 07/16/2001 Phone: . Phone: Zip: License: , License: ' SCOPE OF PERMIT - TEAR OFF WOOD SHAKE, INSTALL HEAVY WOOD SHAKE. -' ��- - Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $16725 $0.88 $0.00 $0.00 $0.00 $168.13 FEE SUMMA?tY � " i o�� _. , , � SETBACKS � i, : MAINSTRUCTURE Front 0-0 � � � Rear `\-0-0 ACCESSORY Front . 0-0 � Rear �. 0-0 PARKING Existinq: 0_ Required: 0 NOTES: �; Calc Valuation: sa,aoo.00 Claim Valuation: , Sa,eoo.00 PLANNING & ZONING , �F \� Le8 0-0 - � � RigFit "- 0-�0, , � Left 0- 0. , Right. � 0- 0 � , Proposed: 0 ' , . 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 it 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 requlred inapections and Tinal approval must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of ihis permit. FOR INSPECTIONS CALL: (774) 7545626 taasafi I�oo� WORKERS' COMPENSATION DECLARA710N: � I hereby affirtn untler penalry oi perjury ona of the tollowing tleclarations: ❑ I heve end will maintain a certificate of consent to seN-Insure tor workers' compensetion, as provided for by section 3700 of ihe Labor Cotle, for ihe pertormance of ihe wark tor which lhis permit i5 i55ued. ❑ I have end wiil maintain workers' compensation insurance, as required by section 3700 oi the Labor Code, for the pertormance of the work for which this pertnit Is issued. My workere' compensation Insurance carrier and policy number ere: . Cerrier: � Policy iJumber: (This sectlon need not be canpleted i! the permit Is valued et one hund 3d dolla �f$100) ar less.) ❑ I cartiy ihat in t�e pertormance f�pe work for which this p� rm1't is issued, I shell not employ any pereon in eny manner so as to become subject to the workers' compensation laws of Celifomi Stl egree t t If I shou dbe 6me sub�ec� ihe workers' compensatlon provisions oi Section 3700 oi ihe Labor Code, I shall forthwith comply wi�� Ihese provisions. � //� { � / Applicant SignaNre: ' � Date: T � WARNINp: FAILURE TO SEC O ERS' COMPENSATON CO RAGE IS UNLA UL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AN CIVIL FINES UP TOONE HUNDflED THOUSAND DOLLARE �8100,OW), IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED f-0F IN SECTION 3�O60f THE LABOR CODE, If�TEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70R5 �ECLARATION: I hereby ettirm that I em licensed under pr isions of Chapter 9 force entl eNect. Lic. # Contractor's Slgnature: with ctlon 7000) of Division 3 of ihe Business and Professions Code, end my license is in tull cless a Date: (� CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm that there is a consiruction lentling agency for Ihe Oerformance of ihe work for which ihis permil is issuetl. (Sec. 3097, Civil Code). Lenders Neme: SigneWre: _ OWNER-BUILDER DECLARATIONS: Lentler's Adtlress: Date: I hereby ettirm ihat untler penelty ot perjury Ihet 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Profeuions Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant for such pertnit to tile e signed stetement lhet he or she Is Ilcensed pursuant to ihe provlsions of ihe Contractors License Lew (Chapter 9(commencing wilh Seclion 7000) of Division 3 of ihe Business and Professions Gotle) or that he or she is exempt therefrom antl Ihe besis for tha alleged examption. Any violation of Section 7031.5 by any applicant for a permit subjecis ihe applicam ro a civil penalry of not more than five hundred dollers ($500).): ❑ I, es owner ot the propary, or my employees with wages as iheir sole compensation, WILL DO TME WORK, and ihe structure is not intentled or oNeretl tor sale (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves iheraon, antl who does such work himself or herself or thmugh his or her own employees, provi0etl thal such improvements are not intendetl or oflered for sale. If, howaver, the building or impmvement is soltl within one year of completion, ihe owner-builtler will have Ihe burtlen of proving ihat he or she ditl not build or improve for purpose of sale.). ❑ I, es owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The conirectors License Law tloas not apply to an owner of propetly who huilds or improves Ihereon, end who coniracts for such project with a contrector(s) license pursuant to ihe Contractors License Wws.). ❑ I am ezempt under sec. Business and Pmfessions Code for this reason: Signature: Date: Owner ID veniietl by tlnver's licensa. ❑ Ves ❑ No Driver'S License No. Expires: Ventication at Ownership by (rype of tlaument, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby certify ihat no axcavation five (5) or more teet in depih into which a pereon is requiretl to descend, will be matle in connection wilh work euthonzed by �his pertnit, and that no building structure, scaHolding, falsework, or demolition or dismamling ihereot, will be more than thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Galifomia Administretive Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit from the Division of Indusinal Safery, as noted ebove, unless such pereon has a permit ta do such work from ihe division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIffHORIZATION OF ENTRY: I cortify under penalry of perjury thai I have read this application and state that the infortnation given is correct. I agree to comply with all state laws end ciry ordinances relating to builtling constmction, and authorize represeniatives of the Ciry of Costa Mesa to enter upon the ebove-described propedy for inspection purposes. I agree not to occupy or ellow occupancy ot any buiiding amhorized by this permit until final inspection. 40DE �. INSPECTIONTYPE 7616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 203 204 Final Factory Fire Place Finel Sign Final Demolition DATE INTRIALS ZJ 1 �� /�/„�Date � v Date OU X INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy D�TE IHtIilALS � 5 'e'��c►„sta Mes� Building Department � � ' , - 117 EAST 20th STREET COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN Building Address �„3C CRBA/<Gr STyF_, Coata Mesa, California Nearest Crou St. �[/ s T/N � v F Owner � � /{ Cor7�? Mail Address $� /� VV /9T�.s% or ■ Contractor T� �S' % ( ' I Blxk i Metes ahtl BounEs) �ot E'4� "/3�� g Bldg. k Line from / of Street SO ■ New �Size----y / C �f � Exterior Wall Covering J T /� � Use of New City Lic. No. /6'// (>STA /YlGIA ITrac��9 of Bldgs. v on Lot � M I No. oi niliea Rooma :arYaM �r de YaM f ' woRx IAddition I Rooms � Stories I Roof I hereby acknowledge that I have read this Application and state that the above is rnrreM and agree to comply with all City Oidinances and State Laws regulating building construCtlon. Si natureof '-�/� i Permittee �il.�"+-r/'w�-G� �/ " ��c.�n , � e��ti,,.t�.d e..� �..L.�_'_ '� �r :-� 1/_ / Valwation $ ��, r�a rnwu vnn r-w �,w S.5a P. ,heck $ .i 7ota1 z +� Fee $ ✓ / APPL ATION FOR PERMI� �.048 BUILD�ING FOR OFFICE USE ONLY . ReceiptNo. PermitN /° 35[ Received by � Date Rec'd. � Date Issu� Costa Mesa, California Nearest Cross St. Zone O, / � No. of � TYPe ,/ � APPROVALS Foundation Location Inspector Forms, Materials, Under-Pinning Frame: Fire Stops, Brecing, Bolts FINAL 0 z � 2 D r Y�� . � � . �' . . .. _ �tti �'f��i � O �SiD{ESAA IO�a i�:rfrx�37.(�Q � Sbow IoCatlon and distances lrom' � . - . '- ' � �� property line and between buildings. , ' ' .. . . � r . . . � _ � o' � . . �. . . ! . i