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Home My WebLink About1108 DANA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1108 DANA DR Suite: Vicinity: Parcel Number: 41207416 Zoning: R1 R1 Applicant: COFFEY, BRIAN Address: Phone: 949-722-8846 Zip: Owner: WILLS, BRADFORD J Address 1108 DANA DR Phone: COSTA MESA, CA Zip: 92626 Contractor: THE ROOFING SPECIALISTS Address: 2428 NEWPORT BLVD #5 Phone: (949)722-8846 COSTA MESA,CA Zip: 92672 License: 734068 Arch : - Eng: Address: Address: Phone: Status: ISSUED Applied: 07/18/2002 Issued: 07/18/2002 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING WOOD SHAKE, ONSTALL SHEATHING OVER SPACED SHEATHING, APPLY MONIER LIGHT WEIGHT TILE. 5.7 LB PER SO Plan Check: $0.00 Permit: $209.25 SMIP Res: $1.20 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $210.45 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY Calc Valuation: $12,000.00 Claim Valuation: $12,000.00 PLANNING & ZONING Left 0-0 Right 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 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - - ❑ I have al 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 which this permit is issued. ( p. I ve and will maintain workers' compensation insurance, as required by'section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. y work` ' Comp`naation it sur nc` tamer and policy number are: 2_,85--62- = V �_ Carder: n4 -n �QTJ Policy Number: ((his section need not be Completed if a 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 if I should become subject to the workers' compensation provisions of Section 370 of the labor Code, I shall forthwith comply with these prey' ns. " '/ Applicant Signature: C /Vit// Date: CJX U WARNING: FAILURE TO SECURE WORKERS' COI ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDDOLLARE($100,000),INADDRIONTO E COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WOO OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisi of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof ssions Code, and my license is in full force and effect. Lic. a q 06s Class q C Contractors Signature:Ce%Date: CONSTRUCTION LENDING AGENCY: ❑ I 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: I hereby affirm that under penalty of perjury.ihal:l,am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires e'perrnialo 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`Iicensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Sectlon 7000) of Division 3 of the Business and Professions Code) or that he or sfie 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 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 owner 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 drivers 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 CERTIFICATION: ❑ 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 demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ 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 cartify 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). ..............................................................nt o..e..............................................istr.............................................................. ............ ...................[.................................................... 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). ............................................................................................................................................................................................................................................................................................................................................................................................ 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 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. ...................... ............................................................................ ........................... .................................... ................................. ................................ ................................ .......................I................................................................ ... 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u 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 (It 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 Code Section 42303 been made? ❑ Yes ❑ No ..... ......................................................................................................................................................................................................................................................................................................I.................... 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. alure Of Legal Owners) - /\, Date / LJ —,— And/ ? _And/O Authorized Applicant Date CODE I. INSPECTION TYPE DATE INTRIAL CODE .0 INSPECTION TYPE DAM ItMAUS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final a/ 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final BlockuRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 final Building/Occupancy 45�J04 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 [CONSTRUCTION or Applicant to Fill in Completely —Use Ink Only DING116�0) t. 1 RESS i Properties es eve opmen ER OPp RESS 5MAIL 08 29th Street New ort Beach Ca. NOLb -4 10 DERNCH MHVn""' OR ENGINEER Frank Spangler '°`6 -0 2 ADDRESS 2240 Newport Blvd., CONTRACTOR Owner '!0V 1O'7�PA'°00 536* *==103.36 cnsn APPLICATION FOR STRUCTURAL PERMIT RECEIVED BV I DATE RECEIVEDDATE ISSUED .. D. Z - BUILDING ADDRESS vrJ N TRACT 9866 LOT 20 1 BLOCK roper Yes West Deve'iment OWNER O VALUE usE Rpq-(nr. $ r 0 FIRE ZONE PE GROUP APPROVED�^ By DATE ' IJ—_7 NO. OF USE PLANS BUIL 'ROVED v BET. MAIN & ED n ADDRESS )FC AL RE?t RP.41ENT o TEL. Z NE )WN UNDER VALUATION IS FOR m_ CITY NO. m PERMIT FEE 3 S ► STATE CITY YARDS AP i LIC. NO. LIC. NO. MAIN SU W SIZE NO.OF SLOGS (FROM I�l 0. OF LOT NOW ON LOT ONT G USE OF .N. EXISTING BLOC. R. SIDE y FSeparate permits are required for L SID electric, plumbing and heating work. REAR L [W.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. G MAIN SLOGS. Construct single familybed- VAR. * C.U.P. as yroe house, P an #2 APPRo .1 a m 0 1 hereby acknowledge that I have read Vis applicatl n and state C, that the above Information Ic correct and agree to comply with 4 all laws regulating building construction, and I shall not employ Z any person In violation of the workmen's compensation laws of ill rN Cir" = the State of California. -- 3 1 hereby certify that I am properly licensed as a contractor under S THE AMOL the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPO em exempt from the provisions of the State of California Business VALUATION antl Professions Code, Div sion 3, Chapter 9. Signature Permittee $ 55,100 Authorized NO. OF USE PLANS BUIL 'ROVED v BET. MAIN & ED n TOTALPAIDTOTALPAID $1o3 )FC AL RE?t RP.41ENT o 2,057 N )WN UNDER VALUATION IS FOR m_ TABLLSHING A PERMrr FEE ONLY: m PERMIT FEE 3 S PLAN CHECK s 99.50 0 TAX $ 86 LL V f u TOTALPAIDTOTALPAID $1o3 _C—9-77�V 5`00 483 o*:r* 199.00 COSTA MESA BUILDING -SAF TY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Com letely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ADDRESS PERMIT NO. OWNER A.P. NO. BUILDING MAIL ADDRESS ADDRESS TEL. CITY NO. TRACT LOT BLOCK CONSTRUCTION NEW I ADD A R REPAIR LENDER =z4#. BRANCH OWNER 21� ADDRESS LUE ARCHITECT TEL. • • $ OR ENGINEER FIRE ADDRESS 4 ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO. OF USE OF NEW CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT Separate permits are required for L. SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& MAIN SLOGS. AOCESS. BLDGS. VAR. 906 DATE C.U.P.+ APPROVED APPROVED By DATE I hereby acknowledge that I have read this application and state �a that the above Information is correct and spree to comply with n m all lows 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 SO. FT. N THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, m Chapter 9, and that such licenses are in full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: em exempt from Me provJsions of the State of California Business a and Professions Cotle, D' islon 3, Chapter 9. VALUATION PERMIT FEE S m � Signature of. /�� // o AN CHECK $ �// rr /!� �/ Permittee ��✓�' $ a. f U TAX $ TOTAL PAID $ `�/// Authorized Agent jji✓ LG�