HomeMy WebLinkAbout1106 RIDGECREST CIR - Building Permits CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 89/S DATE sC --
LOT NO, S
ADDRESS //O6 ea Fee-err c'gccE
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) 77t%Y (was or were) 44...:QC 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.
P
WC /
•urchaser
Developer a d/or authorized
RECEIVED represent/�
BY ���✓��
CITY OF COSTA MESA "ais' '
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` CITY OF COSTA MESA
BUILDING DIVISION
F .,�I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t nj • PERMIT
41t• os# / B01-01137
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1106 RIDGECREST CI Status: ISSUED
Suite: Applied: 07/23/2001
Vicinity: RESIDENCE&ATTACHED GARAGE Issued: 07/23/2001
Parcel Number: 42203124 Zoning:
Applicant: BOULGER, SHAWN ISSUED BY: '
Address: 845 W GROVE AV . . -
UNIT B6: " - Phone: 714-974-5059 -
ORANGE, CA- /i - Zip: 92865
�. �..
•
,
Owner FLOWERS;SHARON L
Address 1106 RIDGECREST CIR - • - _
i - Phone: _ N
-COSTA MESA,CA - -- - Zip: 92627
Contractor: •LINNERT ROOFING INC. -
Address: 845 W GROVE AV
UNIT B Phone: 714-974-5059 v v ORANGE;CA -
Zip: 92865 • License:; 664319 - '
Arch : Eng: -
Address: Address:
Phone: • Phone: "
Zip: License: -License:
•
' . SCOPE OF PERMIT
.' REROOF:T/O EXISTING SHAKE ROOF,7/16"OSB:SHTG,1'LAYER 30#ASTM-FELT,-APPLY CERTAINTEED'S 40-YEAR
"PRESIDENTAL"ASPHALT SHINGLES.ALL NEW METAL AROUND PIPES&CHIMNEY. 1700 SO FT - ,
FEE SUMMARY
Plan Check: $0.00 - - . - - - - Calc Valuation: 2 -. $5,150.00
Permit: $125.25 Claim Valuation: .. $5,150.00
SMIP Res: $0.52
SMIP Com: $0.00
Other: $0.00
Inspection: .$0.00 ;:_ - .
• 7/
Total: $125.77
•
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
244646(6/00)
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.
Ft 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 wo �j compensation Insurance carrier and policy number are: '' II All 9 �1 _
Cartier: V(/cr-hOVa. Policy Number: VC W287,
(This section 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'
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 these pro ns.
Applicant Signature: l Date: 7 . 3 O r
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 15 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RIVES UP TO ONE HUNDRED
THOUSAND DOU ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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 and Professions Code,and my license Is In full
force and effect.Lia# Class It
Contractors Signature: Date: 7•a 2 O1
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 fore Dem+:
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 driver's license. ❑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,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,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? 0 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? 0 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 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 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 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? 0 Yes 0 No
(If Nes.,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? 0 Yes ❑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.
L.SjgRe)ture f Legal Owner(s) 7 ,-13 ()Date
AnJJdd//Or Authorized Applicant Date
CODE t INSPECTION TYPE PATE 1MITIALS CODE I INSPECTION TYPE PAM INTR1AL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 7 208 Final Plumbing
200 Final Re-Roof 7"1C'-0f 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
-. I,, 747718 FAIe
'PR 16-76r„—;.00 866* ***x=78.16
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
s APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely - Use Ink Only
EIV • BY DATE RECEIVED DATE ISSUED
BUILDING i/ / /r 0-
ADDRESS O /q/'I,/ _. '.... . > .///..��I///��� _
OWNER /Cb!'Y1/�.�.�.�/4&c4r2r i A.P.NOI'5TQQ,-2'23� PER `' .. . r
MAIL JJ J� /-7 741 ', BUILDING ,/� //��
ADDRESS/e 77 /// `Cr ADDRESS I.luso RI GR` r &
CITY �-! * 4 NO Z �f(j','- TRACT 1I ' I . LOT S BLOCK
CONSTRUCTION-( ••-��-III NEW ADD ALTER REPAIR MOVING DEMOIISH
LENDER
BRANCH �([1I_ • r/
OWNErRt / a /� J
ADDRESS �/ p Se?
JJJJ �����//// /V LUE 1Q ev
OR ENGINEER ARCHITECT /�/ NO-rel-�. if USE I •�/ • $ �4'Ya
Tr/ FIRE ``yI
ADDRESS // ZONE TVP GROUPXr !
✓Rty4cPssr.•fir /c n APPROVED
CONTRACTOR BY DATE
ADDRESS`/�3 E /7 f5r • E , NO.OF USE OF NEW
TEL
CITY On'' %�s4 NO -4112/0 k . PLANS— BUILDI + •• / I e�CT
F STATE CITY 777 YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. I. MAIN BUILDING ACCESSORY BUILDING
SI2E INO.OF BLDGS. (FROM C/L ST RL,EyTIA •
0. OF LOT NOW ON LOT •'' FRONT /--�/an. ([/�_ FT.
y
•
USE OF .
EXISTING BLDG. - B.SIDE 4 FT. FT.
[-••
Separate permits are required for L.SIDE 7 FT. FT.
electric,plumbing and heating work.
C - REAR tail FT. FT.
[W., USE OF BUILDING AND WORK TO BE PERFORMED ;} DISTANCE BET. BET.MAIN&
Q� 7`� ,,../ II h MAIN BLOCS. ACCESS. BLDG% �.y
BATE
Q l2ea c //•/C/7ACe b 2 CAr.e.. ' C URP. P.76--7,5-'''71 APPROVEDe.5—7r
7 `t APPROVED I�/.I/f y -
>. ��AI1b DATE / /•�
W Er • • • t ' a -
L I hereby acknowledge that I have read this application and state
O n
C that the above information Is correct.and agree to comply with
m
0. all laws regulating building construction, and I shall not employ
i
z any person in violation of the workman's compensation laws of '
the State of California.z
/'// /�
fi(i//y yn
I hereby certify that I am properly licensed as a contractor under SO. FT. R ! 'Jp? co
the State of California Business and Professions Code, Division 3, • THE MOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
la
am exempt from the provisions of the State of California usiness �. VALUATION a
PERMIT FEE $ n
and Professions Code, Division 3,Chapter 9 yl� " •'
rn
c PLAN CHECK $ S
0
Signature of ��'',��JJ - V.
Permittee nen.' CV _ $ /](/(/r a•v(/ TAX $
• VU/ /Vf U .
Authorized Agent TOTAL PAID /•
I.
Ilir
A _ .
II
407FTh 1411. 2e-74,PAID
cR "00:3283 d*** 151.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
' PP IC TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RE -E VE BY DATE RECEIVED DATE ISSUED
ADDRESS
BUILDING Ie'(o Rita EGltEsr Gia
PERMIT NO.
OWNER A.P. NO.
MAILBUILDING
I er/ ki;Dgwasi 6 p....MADRESS ADDRESS Il UV
TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION NEW I ADD ALTER I REPAIR I MOVING DEMO!ISH
LENDER I\j/`
BRANCH •
OWNER
ADDRESS t-�� W VALUE
ARCHITECT TEL. USS t_Z /i(�J ♦� $
OR ENGINEER NO, '
FIR
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY (DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLANS BUILDING
CITY NO.
STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET/ —
W SIZE INO.OFBLDGS.
0. OF LOT NOW ON LOT _FRONT FT. FT. _
a USE OF
Ca EXISTING BLDG. R SIDE FT. _ FT.
V]
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. REAR FT. _ FT.
GLI
I.—. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
Q MAIN BLOCS. ACCESS.BLOCS.
VAR.# DATE
C.U.P.# APPROVED
7 APPROVED
> BY DATE
.-I
E4 .
0 I hereby acknowledge that I have read this application and state
N
N.
EL that the above Information is correct and agree to comply with
m
AU all laws regulating building construction, and I shall not employ
Z any person In•violation of the workman's compensation laws of e
LLl the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business VALUATION C �� v
and Professions Code, Division 3,Chapter 9. PERMIT FEE $ J' �� N
m
PLAN CHECK $
Signature of ../(l(//lj7// 0
Permittee $ TAX $
_ U
Authorized Agent ` TOTAL PAID $ 1 5I �-_..1