HomeMy WebLinkAbout3103 ROANOKE LN - Building PermitsCITY OF COSTA MESA
o�pMFs BUILDING DIVISION
iA 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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� FOR INSPECTIONS CALL: (714) 754-5626
9�'"°"°"°� PERMIT NUMBER: E09-00190
PERMIT TYPE ELEC STATUS: ISSUED
APN: 14151218 DATE ISSUED: 07/15/2009
ISSUED BY: BJK
JOB ADDRESS: 3103 ROANOKE LN CM Suite/Unit:
Vicinity: ELEC SVS AT REAR SFD _
SCOPE OF WORK: CHANGE -OUT OF AN ELECTRICAL SERVICE AT THE REAR OF AN EXISTING SFD. 1 SVS TO 200 A
OWNER: FRAZIER, JOHN A
PHONE:
APPLICANT: SAENZ, DON
PHONE: 714-244-8980
CONTRACTOR: SAENZ ELECTRIC
Address: 5722 BELGRAVE AVEUnit:
City/State: GARDEN GROVE, CA ZipCode: 92845
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee:
$0.00
Electrical Permit Fee:
$54.00
Reinspection Fee
$0.00
TOTAL FEES
$54.00
Address: 3103 ROANOKE LN Unit:
City/State/Zip: COSTA MESA, CA
Address: 5722 BELGRAVE AVE Unit:
City/State/zZip: GARDEN GROVE,CA
License No. 374652
PHONE: 714.244-8980
CELL:
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION,
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.
CODES. INSPECTION TYPE DATE INTMALS CODE# INSPECTION TYPE DATE INTnIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical Z oei
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
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.
❑ 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:
Carrier:
(This sectgn need not be completed Athe permit is valued at one hundred bobars (SIX) or less)
Policy Number:
1 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 rthwith comply with these provisions.
!J
Applicant's .tune I Date 7
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 DOLLARS
($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.
ticClass# ,CSO
%//`
Contractor a �i .lure 1 .Dates
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 Data
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 contmctor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057-46(3/07)
Owner ID verified by driver's 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:
❑ 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.
Appliranrs Signature
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 fled 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
fling 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 ❑ 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 ❑ 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
(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 ❑ 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.
Signature qal Owners)
�/ u
And/or AuthorWed Applicant`
Date
-2�}�O%
9z e- a'
(714) 754-5273 • Fax (714) 754-4656 • www.cl.costa-mesa.ca.us 77 I -AIH UHIVt, UUJ I A MtbA, UA VZbZU
BUILDING PERMIT
Job Address: 3103 ROANOKE LN Status: ISSUED
Suite: Applied: 01/09/2004
Vicinity: ROOF Issued: 01/09/2004
Parcel Number: 14151218 Zoning: R1 R1
Applicant: FERGUSON, LEWIS ISSUED BY:
Address: 4091 E LA PALMA
SUITE D Phone: (714) 630-5543
ANAHEIM, CA Zip: 92807
Owner: FRAZIER, JOHN A
Address 3103 ROANOKE LN
Phone:
COSTA MESA, CA Zip: 92626
Contractor:
MC CORMACK ROOFING
Address:
4091 E LA PALMA
SUITE D Phone: (714)630-5543
ANAHEIM, CA
Zip:
92807 License: 643700
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER 30# FELT, G.A.F., 50 YEAR COMPOSITION SHINGLES. ICBO #5546.2,200 S.F. INCLUDES
ATTACHED GARAGE.
FEESUMMARY
Plan Check: $0.00 Calc Valuation: $4,500.00
Permit: $111.25 Claim Valuation: $4,500.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
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: o
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
2440.46(6/00)
DECLARATIOMS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perju 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 thApe:dormaice of the
,,Work for which this permit is issued.
1 have and will maintain workers' corn nation insurance, as required b section 3700 of the Labor Code, for the performance of the work for which this
Pa q Y pe penult Is Issued.
My wo ars' compensation Insurance Farrier and =policy are:
�ws"�' L Gly -07410 Policy Number:. W'I
(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 Califomi nd agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith
comply with these provisions
Applicam-Slghatilin ..mak+-� /L On-u"C 4+-+"�— (Date:_.. f'� �/,!p 9/� 7
WARMIN3'FAILORE TO SECURE ORKERS' COMPENSATION W RA E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/09 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereb sitiM.tha6Lam.licensetl nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Business and�o3 �,pnn� e, and my license Is in full
ort e_aad.effect cWc-#—} 7 �� Lclass.al i
Contractors IgnaturerDate:` / / 0 q O
z
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 Cotle).
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 Cade: 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 awn 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 contractors)
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 driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property lax 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 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
Pamir 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 Cade 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).
.............................................................................................................................................i-n-,..,,,....,.....,,,,...,,.,,,,,,,,,,,,....,........,,,,,,,,,,,,,.........,..ac,...,,,,-'h'......,..,.,,,,,.,...,.,...,...,.,.,,,,,.........,.........,.,...............,...,,,,,,,,,,,...-.....................................
2 Does or will the applicant or present or future buiitling occupant need to fila a registration form for acutely hazardous meterials7 ❑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 ❑ fJ0
(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 en RMPP is presently required, has Section 25534 of the California Health antl Safety Code been fully complied with? ❑ Yes ❑ No
..................................................................................._.................................................................................................................................................................................................................................................................................I.....................
5 Does or will the appiicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 W III any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
(If yes the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Coda Section 42303 been made? ❑ Yes ❑ No
............................................................... ......................... -............................................................. _.......................... _._............................. _............................................................................................................ ...._.............. ...................... _.............
B (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the information given above is correct. I agree 10 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.
Signatur _��l Owner(s) — / / D ate
9 /O
An Or,Authodzed-Ap cat r Uata---_�_,
CODE x. INSPECTION TYPE gATE INTIT)AL3 CODE# INSPECTION TYPE PAIE INTIMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root/ Z 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
JOB ADDRESS 3103 Roanoke Lane
GENERAL CONTRACTOR Bonser Constl
AD Wn T,nT 141 TR A f`.T
I:Y�l1Jrl�Atld
DATE JUL 5 1963
J
DATE GROUPZONE
j gc
BUILDING PERMIT NO, pO0p1E
"��-� SUBCONTRACTOR
VALUE $ i5�16,332.()o16,332.()oIf�So
V
DESCRIPTION OF WORng.Fam.Dwl/gt.
TYPE
Rough Com. Refrig. ❑ Air Cond. ❑
INSPECTIONS Signature
DATE GROUPZONE
j gc
Soil
"��-� SUBCONTRACTOR
PERMITS ISSUED _
DATE NUMBE..
Gas
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating !
-3/- ,,
UL 2 6 2120
Rough Plumbing 2
k• ��
JUL 1 2 is ; k
Miscellaneous
Prop. Swr. Line p House Con, M'St. Swr. ElQ
�-,- L
a loci -<
Sprinkling System /
0-Z
1 6 19c
Construction Pole
Underground 0 Power :p
Rough Wiring
,,
UGC
Trenches &- Forms 18- Steel Reinf.
'
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashing
Lathing — In Out
Plaster, brown coat d
i
Refrig. ❑ Air Con. C]Final
Heating, Final
_
Plumbing Fixtures, Final
_
Final Gas Test --
U
Electric Fixtures, Final
_
Building, Final
i
OCCUPANCY
'
20004
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA, CALIFORNIA
F
or Applicant to Fill In Completely
TYPE OR PRINT 48514-33
G D ANO e -
COSTA ME5A, CALIFORNIA
'MAIL
ADDRESS 13341 Golden West i
Box 11,p Anaheim
-OR Bonser Construe
13341 Golden West
Westminster, Cal.
77 e^Ln TEL.
FEE RECEIVED
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f I N�(� J, aha N PERMIT
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RECEIPT NO. I CI
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