HomeMy WebLinkAbout1112 RIDGECREST CIR - Building Permits r Si
CITY OF COSTA MESA i I
rias BUILDING DIVISION
F ( ,,,,•� � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
0 PERMIT
B04- 716
(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 RIDGECREST CI . Status: ISSUED
Suite: Applied: 10/05/2004
Vicinity: Issued: 10/05/2004
Parcel Number: 42203127 Zoning:
Applicant: RICHARD BURNER ISSUED BY: \
Address:
- Phone: 949-642-0414-,
-i: Zip: - - ..
'
Owner: BURNER, MELANIE C
Address P 0 BOX 11227 _ •- _ - %
/ - Phone: _ 1 ��
-.'COSTA MESA,CA, ` _ -
Contractor: ' CHURCHILL CONTRUCTION .
Address: 4425 FOREST GLEN RD ! ��
- - Phone: (714)974-0456 vmayyy�.-
` / " , ANAHEIM,CA �" A- � \
' Zip: , 92807 - License: 660990 - ,
Arch : - , H , - -� � Eng:
Address: _ __ —A Address:
-Phone: • ._ Phone: ', -
Zip: License: License: •• - •
i
SCOPE OF PERMIT
T/OFF,SHEATH AND REROOF 2150SF RESIDENCE W/COMP SHINGLES. .. - . `
-FEE SUMMARY - ---- - '
Plan Check: $0.00 Caic Valuation: • $5,630:00
Permit: —$125.25 - - - - ''' Claim Valuation: ., _ •$5,630.001=
SMIP Res: $0.56 _ - ,
•SMIPDim: $0.00 ,
Other: $0.00 -•
7'
Inspection: $0.00 _ - i;%/ ; ' l
/ c
Total:" $125:81 . / '
!,// i
PLANNING &ZONING +' 'rm.:- • /
�_
SETBACKS ,/i - _ ,
MAIN STRUCTURE Front 0-0 - Rear 0-0 ,Left - 0-0 .Right 0-0 /' / '.- •/
\-
ACCESSORY Front' 0-0 ' - _Rear - 0=0 --Left
PARKING Ezistinq:` 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 end 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)
WORKE 'COMPENSATION DECLARATION: - -.
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
li
jr, 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'-- G compensation� Insurance carrier and policy number are:
Carder: S/ !"I / fui/P Policy Number: /3 Sint 7
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
"Dfl 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'
77'x' 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 provisio Applicant Signature: / Date: V --DY
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLARE($100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
ullfoI hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7 0)of Division 3 of the Businessend Professions Code,and my license is in fully"—
force
rce and effect.Lic.Il (/e o 9 q o Class# D—c-fl
9" Contractor's Signature: 1 ,.. I Date: / a —4'—o Yt /
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).):
O 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 en 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 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).
❑ 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 end 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,ore 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 et 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 permit 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"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? 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. •
ature Of a al Owners) Date
And/Or Authorized Applicant ! Date
coos f 91SPECTIONTYPE . PATE PiITiA45 POPE INSPECTIONTYPE PATE IIM611
1616 Fixed System Final Fire Prevention 206 Final Mechanical •
1266 Pool Spa Final �jy 208 Final Plumbing
200 Final Re-Roof l8-/2-pt( u"'GL� 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 -
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 89/S DATE k�//
/
///�2/J 7
LOT NO. 2
ADDRESS ///2 eh sceesr C/,ecte
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) Q� (was or were) 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. /-
/ R,
c_____;)
i
BY z _,//„_C_
RECEIVED Purchaser
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BY 7. /).Ey k l/1.� _.
MAR 2 2 'r/ . . beveloper and/or authorized
AM I7 i. PM repress a i
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COSTA MESA BUILDING-SAFETY DEPARTMENT •
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant+ to Fill
�rin Completely
r—�Use Ink Only _ ,.I V E :V DATE RECEIVEDDATEDATE ISSUED
•
ADIDRESS Frs� i I I ec-" 1\i1/bEc r _ i'.. /:. • -a �"' 0. I_ 2..0e
OWNER PtVDC.:va_ c/
opz, LJ 7- f A.P. NO ,f, a J. . . rMAIL
BUILDING
ADDRESS /8s E I7rac ADDRESS I,i/•2 D6E es7 eR
TEL
CITVasrA 1,,,,e._,4 NO6yz-47{C TRACT P' qr sl LOT ol..., BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH X )f
OWNER '
ADDRESS 1
y V•LUE di3 '•
ARCHITECT �J A TEI� ,y c USE . z Ar. 44i ' $
OR ENGINEER a� A N0.7 -q 2`.
FIRE Tr
ADDRESS �• ZONE TVP/ROUP / J
CONTRACTOR) SI t OS'r( P, /arc
APPROVED
IL-GROUP/1r"
DATE ✓
ADDRESS/88 Et /7T�Sj
TEL. Zj NO.OF USE OF NEW iyi '
CITY �� _ 4_, z N•
,Z • a a• - - 'PLANS BUILD! , - ^� / I /fir
F STATE - CITY ` YARDS APPROVED YARDS APPROVED Of
LIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDIN
I
(FROM C/ SfET ,
W SIZE NO.OF BLOCS.
0s OF LOT NOW ON LOT FRONT T. FT.
Q USE OF //
:-1 FT.
EXISTING BLDG. R.SIDE �71.fT. FT.
v, �
F Separate permits are required for L.SIDE ✓ FT. • FT.
•
welectric,plumbing and heating work. REAR l9FT. FT.
F. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
�Q MAIN BLLOCSS..-�/,../� ACCESS.BLOCS. ry
DATE
.....:1 /{(J�/l r��� YE Z ^Z.Q CA rI . .0 URP#'T '/�j -//sem APPROVE/Cy�' .�/S� 75
�7' ' . BPPROV ED//Y �wF�,p Pt/ DATE /�O�rJ'• /6 CP
`' TOLD FOR SPECIAL REQUIREMFiyj
oI hereby acknowledge that I have read this application and state in
that the above information is correct and agree to comply with
• au all laws regulating building construction, and I shall not employ w
Z any person in violation of the workman's compensation laws of
V
tha State of California. /7/-7
�! y `� , (� N_
I hereby certify that I am properly licensed as a contractor under
/ / SQ. FT. L7! 0,
the State of California Business and Professions Code, Division 3, THE AMOUNT 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: _
am exempt from the provisions of the State of California uslness - 'o
VALUATION PERMIT FEE $ V
and Professions Code, Division 3,Chap r 9. i „ m
Signature of a/�i� T $ ' /3 -6��TAXN CHECK $ n3r 0 LL
Permittee l��r rrr/.'/•aU•J- ,G//�/ / f{
Authorized Agent ` J TOTAL PAID .r/ •///; ,/„//
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k. X0724 Iiii. 28-76 - 0.13289 4***169.00
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
t�A TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely
]— /Use Ink Only RE EBY DATE RECEIVED A DATE ISSUED
BUILDINGADDRESS Mg. )?ioc E T VI Q 1
PERMIT NO.
OWNER A.P. NO. `
MAIL
BUILDING I'' 1 /1p&G�es-rCI�
ADDRESS ADDRESS ?j I,C` [�
TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION \ NEW
✓ DD ALTER REPAIR MOVING DFMOLISH
LENDER
BRANCH
OWNER
ADDRESS /'1
Gm.2_ VALUE$ pyo �.
ARCHITECT TEL. USE /C�
OR ENGINEER N .
FIRE .tom �{
ADDRESS ZONE TYPES_ GROUP T. Y'
APPROVED .IIIIII
CONTRACTOR . BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITY NO.
PLANS BUILDING
E^ STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
w SIZE INO.OF BLDGS. (FROM C/L STREET)
4 OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
EXISTING BLDG. R.SIDE FT. FT.
E Separate permits are required for L.SIDE FT. FT.
C electric,plumbing and heating work. REAR FT. FT.
W USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN
Q� MAINAIN BLDGS. ACCESS.-BLDGS.
VAR.# DATE
QC.U.P.# _APPROVED
APPROVED
j —BY _DATE
a
w
QI hereby acknowledge that I have read this application and state n
X that the above information is correct and agree to comply with
•O. all laws regulating building construction, and I shall not employ m
Z any person in violation of the workman's compensation laws of m
Sthe State of California. . ^;
I hereby certify that I am properly licensed as a contractor under
SQ. FT, cl
m
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: :
am exempt from the provisions of the State of California Business 'o
VALUATION PERMIT FEE $ i (A and Professions Code,Division 3,Chapter 9.
`t
n
PLAN CHECK $ o
Signature of _ L
Permittee $ TAX $ F
vie(
U
Authorized Agent TOTAL PAID $