HomeMy WebLinkAbout1112 DANIELLE 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: 1112 DANIELLE DR
Suite:
Vicinity: ROOF
Parcel Number: 41207429 Zoning: R1 R1
Applicant: SELL, RON
Address: 18032 LEMON
Phone: (714)528-1758
YORBA LINDA, CA Zip: 92686
Owner:
COLE, ROGER C
Address
1112 DANIELLE DR
SMIP Res:
Phone:
SMIP Com:
COSTA MESA, CA Zip: 92626-1602
Contractor:
SELL ROOFING COMPANY
Address:
18032 LEMON
Phone: (714)528-1758
YORBA LINDA, CA
Zip: 92686 License: 323842
Arch :
Address:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 07/22/2003
Issued: 07/22/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
LEGALIZE ROOF INSTALLED, EAGLELITE, ICBO #4660, SHEATHING REPLACED. 25 SQUARES INCLUDES ATTACHED GARAGE.
Plan Check:
$0.00
Permit:
$167.25
SMIP Res:
$0.89
SMIP Com:
$0.00
Other:
$167.25
Inspection:
$0.00
Total: $335.39
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: $8,900.00
Claim Valuation: $8,900.00
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
Wa 6 (ruoo)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: r
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ ?1 have and will maintain workers' compensatio insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' ns n Ins rrce card nd policy number are: /
CartCier: x Policy Number: o�
(This section need not be completed if the permt7f is valued atone 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 prep that it I s Id be me subject to the workers' compensation provisions of Section 370 1 the Labor ode, I shall forthwith
comply with these provisions. {/meq/p G
Applicant Signature: 1 Date: ' J
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN LTIES AND 0141L FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (8100,000j, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
-Lhereby affirm that I am licensed under provisigpvs gf.,�.ha tprz9 (commencing with Section 7000) of Division 3 of the Business and Prptessionnss Code, and my license is in full
force and effect. Lic. P i }l L Class It t�
Contractors Signature: 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 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 fora 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ 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:
❑ 1 hereby certify that no excavation live (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 ❑ 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? ❑ 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.
............................................................................................................................................................................................................................................................................................................................................................................................
4 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................. I ..............................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this aQplication aemit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LL. -l1 Yes La 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? [:1 Yes ❑ 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? [:1 Yes [:1 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.
Signet Of gal Owner Z t@i 3
And/Or AuthorizAppicant Dated
CODE I. INSPECTION TYPE INTRIALS CODE♦ INSPECTION TYPE DATE INTIT19L5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 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
'kPPLICATION FOR A BUILDING PI AIT
Tract 47 8 6
Block
Lot
BUILDING PERMIT NO.
�--0 .-S O
v( -\ J[
Electrical
Permit No.
BuildAddr ng .
Atltlress
Plumbing
Permit No.
5. n. ;'u►Y. d' Cross
Area — Street Off EbEF %SIR
Mechanical
Permit No.
Owner C LO
I s
Type of Project:
❑ New ❑ Alter ❑ Addition
Address /�/ta ) % CL�LI Cz F�
V I.r AJ
❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt.
Zip Phone 1
City CasT ET
A.P.
Sup. Dista
nsp. Area
Architect/L, PMDS.! n ,
Designer It ) (.License No.
Zone
Spl. Pmt. No.
Address / T .� N E S T
Setbacks
P/L Front
C/L St.
Street Width
City Zip/�J666 Phone 3S �O
D N
Yards
Lett
Igh
ear
ave of.
a
l9
Engineer License No.
rk ng Spaces
Required
rev a
overs
Address
Siruct
No. of
No. of
City Zip Phone
Height
Stories
Family
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
Park Fees Yes
Required No
C.T.
Fee
Receipt
Zoning Approved BY:
Date
(commencing with Section 7000 of Division 3 of the Business and
Professions Coda an i liceme is in full force and3eff
Licari, ClassLicense Number
Date _ contracte NAT14 f X is REFI L&MnSVillf
isc.
Atldress
Proposed Use
of 5tructwo
City and ZI Phon4533
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097,
Civ. C.).
Lender's Name _LV V I]I_ry
Dec
Class
Type
Const.
Code
Year
USE/OCCUPANCY
SIZE SO. FT.
Lender's Address
1.
OWNER -BUILDER DECLARATION
I affirm that I am exempt from the Contractor's License Law
2.
forr the
tha f following reason:
❑ 1, as owner of the property, or my employees with wages as their
sole compensation, will do the work, and the structure is not
intended of offered for sale.
❑ I, as owner of the property, am exclusively contracting with
3
4.
Ikensed contractors to construct the project.
❑ I am exempt under Sec. , B&PC for this reason
Total Valuation
Data Owner
WORKERS' COMPENSATION DECLARATION
Encroachment Permit Required ❑ Yes ❑ No
1 hereby affirm that 1 have a certificate of consent to self -insure,
or a certificate o Workers' Compensation Insurance, or a certified
copy thereof.sj os- S?.bTE F61 Al
olicy No. Company rL
Grading Pmt.
Required ❑
Yes ❑ No
Grading
Pmt. No.
Certifiatl copy is hereby furnished.
Cpr ijtl yis with County,/�A.--�-�
U
Rough Grading
Approved by:
Date
Det App
Applican �(���
CERTIFICATE OF EXEMPTION
FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed if permit is for $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.
PERMIT FEES
Data Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Structural $
Plan Check $
Exemption, you should become subject to the Workers' Compensation
ElectricalSpecial
Invest. $
Invest.
provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
Mechanical $
RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH-
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE NTIONED PROPERTY FOR I PELT ON PUR-
Inspection $
ms pectio
✓/p—naturreof
Sl
—nature uLra of Applicant or Ag n[ / Date o
GL " �1I M�
Re . No. $
Rec. No.
Permit $
Issue
Print Applicant's/Agent's NarNar lie
All spaces within this box must be completed to process
Plan
Check BY:
Issuance
Approved:
CMF 0335-46 (BU -28) rev. 6/80
m
3
Z
c
3
tT
to
101
tI
0 r
. TY OF COSTA MESA REQUEST FOR u_.:UPANCY
DATE r,� — '� - `S 0
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he she)they)
( as)or were) L J Ccf advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
RECEIVED
CITY nF f l:T� `ncSM1.
MAY 0 9 1980
APA PM
718191IU11111ZII[?13141516
representative
B
en er
R
r
�459I
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 121X1 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS
OWNER Properties West Development Corp-
MAIL
o .MAIL
ADDRESS 508 29th Street
Newport Beach, CA NOL
CITY Wlp-675-4910
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT Frank Spangler TEL'673-0952
OR ENGINEER
'!OV 10-77Nsa00 583* ***122.64
APPLICATION FDIC STRUCTURAL PERMIT
RECEIVED [""SUED
�B/yY 7DA�T%E%RECEIVED
IPJ
.P. NO. —i
BUILDING
-
ADDRESS
'
TRACT
LOT BLOCK
W ADD
ALTER
REPAIR
MOVING DEMOLISH
v
DATE J
ADDRESS
OWNER Pro erties West Development C
Res. Atd. Gare VALDE 73,400.
4
ADDRESS 2240 Newport Blvd. Newort BchTYPE
GROUP
Owner
20
CONTRACTOR
DATE J
ADDRESS
UMAINBUILDING
TEL.OF
USE OF
CITY NO.
NS .8 LOIN
STATE CITY
VED YARDS APPROVED
LIC. NO. LIC. NO.
ACCESSORY BUILDING
SIZE
NO.OF BLOGS.
(FROM C
EET)
OF LOT '
NOW ON LOT
ROM
FT. FT.
USE OF
EXISTING BLDG.
R. SIDE
FT, 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 BLDGS.
ACCESS- SLOGS.
constru bedroomC
URP.
DATE ED l [ T-7
house Plan # 4
Of
APP RfWJR,
BY
1 hereby acknowledge that I heyad this appl tion and state
FOR
SPEC AL REQUIREME
$�
that the above Information is co rent and agree to comply with
m
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
�
o
the State of California.
I hereby certify that I am properly licensed ea a contractor under
50. FT. 2790
m
�
THE AMOUNT SHOWN UNDER VALUATION IS FOR
m
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 PURPOSE
OF ESTABLISHING A PERMIT FEE ONLY:
n
am exempt from the pr felons of the State of California Business
VALUATION
PERMIT FEE E
y
antl Professions Coda, Iv,I ion 3, Chapter9.
m
PLAN CHECK E
117.50
c,
Signature g T">—✓ y D!IL
73, 400.
Permittee `y y�(//I ��11��^^C�i
$
TAX E 5,14
I
Authorized Agent
TOTAL PAID E
,So -a
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS
OWNER
TEL.
CITY NO.
BRANCH
ARCHITECT TEL.
OR ENGINEER Mo.
ADDRESS
CONTRACTOR
"EC -9-77c 1000 527 d***235.00
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I DATE RECEIVED nATp ISSUFn
M
'
ADDRESS /��/� �{J�j%[,�� [u/ •'
OWNER
OVED
OFI USE OF NEW
NS BUILDING
FT.
SET. MAIN &
ACCESS. BLDGS.
DATE
T L
n
_ —
ADUHFss
m
m'
FT,
TEL.
ZONE
m
CITY NO.
STATE CITY
YARDS API
LIC. NO. LIC. NO.
MAIN BUI
W
S12E
NO. OF SLOGS.
1FROM C/L ST
0.
OF LOT
NOW ON LOT
ROM
Q
USE OF
.�.,
EXISTING BLDG.
TOTAL PAID E.
CAI
FSeparate
permits are required for
L. SIDE
electric, plumbing and heating work.
O
REAR
tw.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
QMAIN
SLDGS.
VAR. #
a
C.U.P.40
7
APPROVED
r
a
w
0
1 hereby acknowledge that I have read this application and state
fX
that the above Information Is correct and agree to comply with
0•
all laws regulating building construction, and I shell not employ
Z
any person in violation of the workmen's compensation laws of
w
the State of California.
3
I hereby certify that I am properly licensed as a contractor under
SI
THE AMOU
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 PURPOE
am exempt from the provisions of the State of California Business
VALUATION
and Professions Code, rvision 3, Chapter 9.
Signature of
Permittee Oo/y%�o"L��
g
Authorized Agent GUG/i s.4lf =•
OFI USE OF NEW
NS BUILDING
FT.
SET. MAIN &
ACCESS. BLDGS.
DATE
T L
n
_ —
m
m'
FT,
a
rSHOWN UNDER VALUATION IS FOR
m
OF ESTABLISHING A PERMIT FEE ONLY.
PERMIT FEE E
<
PLAN CHECK E
TAX S
u.
U
TOTAL PAID E.
0.'
COSTA MESA BUILDING -SAFETY DEPARTMENT APPLKATION FCF 0RUZiVJiWPERMIT 5150 TU
P n ROX 22nn CaRTA MESA CALIFORNIA 92R2fi - •
For Applicant to Fill in Completely — UseInkIInkk Only
REC D PERMIT _S—C) 360
BUILDING
N) E�,.'C z
ADDRES///a UAl
A P NO /2 -07-6
ADDRESS I Z r
TENANT „ rY tl K` -
OWNER OR J p �J
UNIT OR
SPACE NO.
MAILING i�A N'��L� f•1�r
ADDRESS /� I✓J�
LOT
T R.NO. er
y
BLK.
p�
CITY GO NEILOi7°f-69iR
NEW ADD LTER
REPAIR
MOVING
DEMOLISH
CONSTRUCTION
LENDER JIVi-
BRANCH
OWNER rf(�/�
� -
ADDRESS
VALUE 2Z
USE $ 4
ARCHITECT ND z' TEL. 6jj '
OR ENGINEER Ct1fT C'L•U 960
ZONE H
TYPE GROUP
Tit rt 2 IJ ,_ I;
ADDRESS O
CONTRACTOR , IN�tTi�%�c
APPROVED
BV DATE
ADDRESS fit r Ory L
TEL.
CITY o NO. 3� ez,
4-R
R
STATE 7 CITY IO) 5'
LIC. NO. LIC. NO.
APPROVED SETBACKS
SIZE
OF LOT
NO. OF BLDGS.
NOW ON LOT /
(FROM C/L STR ET)
PONT
, 1
EXISTING BLDG. S1 ^ry G
Ap If
1 CJ FT. 6 r,
Separate permits are required for
electric, plumbing and heating work.
6' I
L. SIDE ",w/'l�./ FT. D
REAR '!`T.
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
1 D ^ _
(�
DATE
APPROVED
APPROVEDDaJE
I hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
all laws 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
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division Chapter 9.
Signature of
Permittee
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
$ ZZ
PERMIT FEE $
LAN CHECK $
P�r
TAX $ DsS^
or
Authorized Agent Date
TOTAL PAID $