HomeMy WebLinkAbout1420 DEAUVILLE PL - Building Permits • ' CITY OF COSTA MESA
4 BUILDING DIVISION
).:l „, *i DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
PERMIT
4 B06-01303
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1420 DEAUVILLE PL Status: ISSUED
Suite: Applied: 08/02/2006
Vicinity: DETACHED GARAGES Issued: 08/03/2006
Primary Occ: U Type of Construction: V-N
Parcel Number: TPN98079 Zoning:
Applicant: VES PEARSON
Address: P 0 BOX 3908 -..�1
Phone: 562-429-7663 ISSUED BY: ��/
SEAL BEACH,CA -- .-- ""Zip-—90740 tt
Owner: FRENCH QUARTERS.HOA- - 3' -, I (`Th Cs-:---c..,
Address 2020 E FIRST'S-1121------5C 1 }) {i , c� '
��� / ` r X 11
SUITE.500 '�1" (�� , 't l - Fhone:' -714-285-2628sX211`�
SAN//T,Ar�ANNA'CA 1�� ,.- l _t Zip`U 92705' // r.���
Contractor:-_0t,M ROOFING COMPANY— yam-.-`-`,� (--,,,,3)\ 1 \�
<\ j Phone: 562-429-7663 `--!‹ 0
�� CNSEAL4BEACH;CA \\ Com/ `/
// / Zip: 907407 License: 472566 V,�C
Li) // iii,f \% v! / _ VC\ .
Arch l� I Eng: •�'
F �)�\, (tom
Address:"----,,,) ✓I Address: i ���
UPhone •• �-.--. o„r, h "� , lPhone: ��\
t u /1"� //_,---- �h �>� al '.x.'•:.•:"
.�,.,.. fl f---‘4.1\`,\ ? �J �\ \
Zip. 7 /0 /‘ I License',„ - �/- , 1 License:/ 4
, l/til t S ci C` i 4 ( \1 ,AV `` ��
/ t_, _' !_ii,�1- r I car U v` y )/ \ �.;,� j l� A
,/ 1 � r ��,�_�- -- SCOPE OF PERMIT- , / v1
!'•TEAR OFF EXITING ROOF.,INSTALL-2 LAYERS OF 15#ASTM FELT,GAF 40 YEAR,LAMINATED COMPOSITION SHINGLESsAND" l f
iet REPAIR/REPLACE SHEATHING AS NEEDED.24 SQUARES FOR DETACHED GARAGES FOR•1420 THRU 1426 DEAUVILLE PL. ,t 4
ri \`-, Jib \ u 1 ,UI'J `IP� � 5
i }! t /- l l� ---__�_�__-FEE'SUMMARY" —=
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
❑ I 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.
C-g6 ---Thole 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 Ls Issued.
My.workers'compensation Insurance carrier and policy number are:
d 'isr:,----fr-C,Thl FUN,19 PoliyNumber:_ 00 II (b2 - too G
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ! -•gi
❑ I 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 Caayyfomia, d agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these prpvis/ons. O
rr aAApkpffbanfSignature: Ar .�X/T --- /.--Date: A f I a I.
1-:-WARNING?FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE is UNLAWFUL AND SHALL SUBJECT AN EMJ{DYER-TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),IN ADDRION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
„I.herebyaffir .that Lam licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pro essions Code,and my license is in full
Lforce and effect Uc.M - : -- 7 S/v�_'Io Class q L-`(1 q
CCo cacti o s Signaature:= V _ (A....-.----- -*—` gr b In,
f -.
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).
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 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 end 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 driver's license. 0 Yes 0 No Drivels 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,faisework,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,Califomia 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 certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia 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? 0 Yes 0 No
(Section 25533 of the Califomia 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.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished on applications for non-residential building permits).
_ _ _ _ _.._ ...._._........_Y. _
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 a catiofhav the South Coos?res Qualityced Management aiHeal or other air pollution ooncontrol district3 or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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:
CERTFICATE 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.
Sign re Of Legal Owner(s) tat
rAuthodzed'Applicantay.t;
4�1 ' • CITY OF COSTA MESA
4 BUILDING DIVISION
A:� �1'8 DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER
4. j j 4 / PERMIT
6' - -00125
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1420 DEAUVILLE PL Status: ISSUED
Suite: Applied: 01/20/2005
Vicinity: Issued: 01/20/2005
Parcel Number 41814605 Zoning: R2 R2 '
•
Applicant: UNKNOWN -- . __ ISSUED BY:
Address: - -- - _
Phone: _
Zip:
Owner: LAKE,/DERRICKM-, `,.�_
— Address/(P„01305(807 - _ _ - �r A V�
,' , . �
i - s - Phone. - - ' , / \ �
MIDWAY CITY,CA Zip: 92655-0807 • V"Vy '
1.
=
Contractor: N -
Address: - �
. . Phone:
. A! vA
, 1
Zip: License: - - -�
Arch- : - ' . - - - , Eng:
Address: ' - - - Address:' - •
. Phone: Phone:
N.
Zip: , License: License: -
- . -
- . —i SCOPE,OF PERMIT - •.- . . •
12'X 15 PATIO.ENCLOSURE AT THE REAR OF THE RESIDENCE.:MINIMUM 10'X 10'PRIVATE OPEN SPACE STILL PROVIDED BETWEEN
THE RESIDENCE AND THE GARAGE.-ICBO 3190 P. - _ , ,
•
`. ' FEE SUMMARY , , :- ,
Plan Check: $99.61 "' Calc Valuation: $7,282.00
Permit: $153.25 /7 Claim Valuation: i $i,282.00
SMIP Res: $0.73
SMIP Coni:, A $0.00 - _ ,,
Other $0.004/' ,'
. 'i
Inspection: -' $0.00 r ' :.r "./'
Total: $253.59 - ,:::4„,..-,;;;-,,-,. ,::/,711/.
PLANNING &ZONING ,,-1.5‘',/,/. ; 4,
SETBACKS`: " . _ : , ; �; /
MAIN STRUCTURE, Front 0-0 - - - , Rear 11;0' - 'Left', 0-0 Right 0..01' ��,
ACCESSORY Front 0-0. Rear 0-0 - - ,Left • 0-0.. • ‘ ' Right ,0-.0 ?!
PARKING Existing: 0 Required: -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
2446-46(6/DO)
DECLARATIONS ('` )
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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.
will maintain workers'compensation Insurance,as required by section 3700 of the Labor. ormance of the work for which this permit is Issued.
y wogerss''�co7pensatlon Insurance carrier andrlicy nu r are: A
Cartier: / ( 1 a r t t•d o n / V a 1/ O nct /httrenand
Pol' Num r: C K �- Q6 2 - 7 7
(This Non need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I 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'
.. . - laws of Calif o a,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
co..' th th:se provis 1.....) f
••.icant Signet - v ♦ a-, — ate )-20 - 6 Z
-. ' 1 URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S1 W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereb - am licenseddunder rovisloonnnss of Chapter 9(commencing with Section 7000)of Division 3 .an rofessions Code,and my license Is in full
for , •.'-^� c.# 4 ti o L.�_ Claae� '�.J
C ifs Signature: Q
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).
Lender's Name: Lenders 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 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. 0 Yes 0 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).
❑ 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 0 No
(Section 25505 of the Califomia 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? 0 Yes 0 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.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a_pPermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 0 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 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 0 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.
KI net re Of Legal Owner(s) Date
A uthorizedA .licant`� C Date
CODE t INSPECTION TYPE PM 1NTITIALS CODES INSPECTION TYP( PATE MALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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 r� I�6
204 Final Demolition 250 Final Building/Occupancy Z !,.J 7�/ i /C_
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4`5711 S 9 CITY OF COSTA MESA
AllW
BUILDING DIVISION
Y %�al_ __ii " I DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
PERMIT B02-01176
4kbftwarso IP
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.I,,a.us ING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1420 DEAUVILLE PL Status: ISSUED
Suite: Applied: 07/29/2002
Vicinity: ROOF Issued: 07/29/2002
Parcel Number: TPN98079 Zoning: ��ff��,,
Applicant: PEARSON, VESS - ISSUED BY: --- 'e3 -
Address: P 0 BOX 3908 , - . _
Phone: 562429-7663
SEAL BEACH,CA, ' - . Zip: 90740
Owner: FRENCH"QUARTERS HOA
Address 2117E 4TH ST. • - _ -
Phone: 714-285-2626_
SANTA ANA,CA . - Zip: 92705
Contractor G M ROOFING
Address: P 0 BOX 3908
Phone: 562-429-7663
SEAL-BEACH, CA
Zip: 90740 License: 472566 .
.Arch : - Eng:
Address: - • Address:
, Phone: Phone:
,
'Zip: , License: -License:
•
/ /
• SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30#ASTM FELT UNDERLAYMENT,'GAF 48 YR COMPOSITION SHINGLES,AND
MODIFIED TORCH DOWN CAPSHEET ROOF SYSTEM(FLAT ONLY).4 UNITS PER BLDG. 3200 S.F. DOES NOT INCLUDE '
DETACHED GARAGES.
_ - FEE SUMMARY;"'., ..- . , - '
Plan Check: $0.00 - Calc Valuation: - S7•;500.00
Permit: $153.25 Claim Valuation: $7,500.00
SMIP Res: $0.75
SMIP Corn: $0.00 ,
• Other: $0.00 ,
inspection: $0.00
• i
Total: $154.00 v '" '
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 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(6/00)
I
r , ' ONS n (Th « • .;
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: - .
0 I 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 thi§permit is issued.
fir 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'compensation Insurance carrier and policy number are: �I _
Carder: li\i\t1t Ft/A.491
n Policy Number: lJ L -- VA) It 00 I Ib41-
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
•
❑ .I 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 3700 of the Labor Code,I shall forthwith
comply with theseovi/sons.
Applicant Signature: V/L` P............--.." Date: '7 jel 4 /0—N---
WARNING:
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 DOLLARE($100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 at3r s 'pns Code,and my license is in full
force and effect.Lic.# Class A (/
Contractor's Signature: V I Date:
1 r
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).
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 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.).
O 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 properly 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. 0 Yes 0 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:
❑ 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).
O 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? 0 Yes 0 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? 0 Yes 0 No
(Section 25533 of the California Health end 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.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a$ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the Califomia 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? 0 Yes 0 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(Duality 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? 0 Yes 0 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.
Signatu0 Of Legal Owner(s) Date
-7 (...1_,
And/Or Authorized Applicant Date
CODE I fNSPECTION TYPE PATE INTfTIALE c00E1 INSPECTION TYPE DEE Its
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final A �j E z6Z j� 208 Final Plumbing
O'"O
200 Final Re-Roof - - I 210 Final Electrical
201 , Final Block/Retaining 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 .
22721 - FEE RECEIVED
•
COSTA MESA BUILDING-SAFETY DEPARTMENT • Lot # AUG 3 1964
P.O.BOX 319 COSTA MESA,CALIFORNIA ' ' Plan //#TTFy\ InnA��NCE--.Q DEPT!
For Applicant to Fill In Completely APPLICR11vN"POR PERINR'E$A
TYPE OR PRINT BUILDING
BUILDING I /f/��^' For Office Use Only
ADDRESS 1 ��� `Y�7LI Ie/G.LC ��-
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA
1 7i
RECE BY DATE ECHI rD DA ISSUED
OWNER Harbor Han of Fame Homes ' Tnc_ - 4�7 PUG 1 3 1961
• BUIL ING
MAIL 2066 ADDRESS
ADDRESS Box '/ /�
FIRE '
TEL. ZONE TYPE t' GROU@7S `j/��
CITY Santa Ana NO. K19-220/ '/�
ARCHITECT TELA APPROVED DATE VVV
OR ENGINEER Ray Levans NQOR3-7010
�y 1,�- 'L ZONING
ADDRESS 3432 Via Oporto, Not Bch 1 1 I NO.OP t, I use or NEV(� 9 1�-%
CONTRACTOR Lifetime Residential Bldg Co^ . fr/ " NE„N BUILDING
LEGAL boy- 7-7433---1/4._
ADDRESS Box 2066 DESCRIPTON r ” II '�
CITY Santa Alla, A.P.NO. 1 Lt i --- O / I ✓ C)
• NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
ST TEN2208Q(rT[6/O TEL. K'C9-2204 30"TO SIDE @ REAR P.L
EAVES
SIZE l6 x 80 I NO.OF ELDGS. 0 ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
- YARDS APPROVED YARDS APPROVED
USE OF - MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. 10 A c
(FROM CA STREET)
SETBACK LINE FROM 251101 FRONT (J FT. , el
LA FT.
• CENTER OF STREET 15t REAR YARD \ ^^
SIDE YARD LEFT 0 '- I RIGHT 0 R.BIDE (J PT.. CJ FT.
DESCRIPTION. OF WORK L.SIDE
I] 0 FT.
�{�) (1) FT.
_
NEW - - DK ALTERATION ADDITION
REAR rf-6' FT.04.4-
l/J -FT.
DISTANCE BET. BET.MAIN @
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING HH
D
NO.OF VA'R• "l ) DATE // r/
SIZE COO ROOMS 7 STORIES 2 C.U.P.* D"-24 APPROVED O b
EXTERIOR WALL,,, ROOF APPROVEG i/• 6 (�
COVERING -O jUOCO COVERING Rock BY 1%. DATE n
USE OF BUILDING AND WORK TO BE PERFORMED
Construction of ItI11 occupancy b1dgs
with 11J1t construction garages'
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U ✓--HQ.FT. / o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- - PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION `�
BUILDING CONSTRUCTION, PERMIT FEE 5 l
SIGNATURE OF -
m
PERMI7TEF e C��/ /n � �I '
/J iPLAN CHECK $ /4511 o AUTHORIZED AGE T TOTALFEE $ 41;9,_5-0