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Home My WebLink About220 ROSE LN - Building Permits 4�__ M 4q . CITY OF COSTA MESA ` 1. i a•l 4 BUILDING DIVISION PERMIT NUMBER 1;' : ' DEVELOPMENT SERVICES DEPARTMENT °• PERMIT B00-00110 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 220 ROSE LN Status: ISSUED Suite: Applied: 01/26/2000 Vicinity: HOUSE&GARAGE Issued: 01/26/2000 Parcel Number: 42614316 Zoning: Applicant: JACK GOODGAME ISSUED BY: ;4)9 Address: 16631 KETTLER LN Phone: 714-847-1773 HUNINGTON BEACH,CA Zip: 92647 Owner: LESTER, NORMAN S Address 220 ROSE LN Phone: COSTA MESA,CA Zip: 92627 Contractor: SIERRA ROOFING Address: 16631 KETTLER LN Phone: 714-847-1773 HUNINGTON BEACH,CA Zip: 92647 License: 511172 Arch : Eng: Address: • Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF-T/O,USING EXISTING SHEATING,INSTALL 1 LAYER OF 30#FELT,AND 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,900.00 Permit: $83.25 Claim Valuation: $2,900.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 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: 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 DECLARATIONS . t 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 o1 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'corn nsation Insurance carrier and policy number are: 7‘..-5 Carrier: SPITE PoNO Policy Number: /d 9ef (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 Califomia,and agre that If hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the rovision ) Applicant Signature:� d"L_ Date: / ` -26- 0 0 WARNING:FAILURE ECURE WORKERS'COMPENSATIO COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR ($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 Cha ter 9(commencing with Section 7000)of Division 3 of the Busine s and Professions Code,and my license is in lull force and effect.Lic. ///_Kj, // Class p .4 39 _ Contractor's Signature: ��/,a—nt--(- Date: /— 226- 0 0 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 sate.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 property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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)feel 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 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). .......... ... future ........c.. -. o...p. _-..mat rats)? . 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 Safely 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 application appermit for such construction or modification U from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 (II"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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (II'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 O`/ al Owner(s) Dat Ste et i i' r� »u 'a- And/Or Au rized Applicant Date CODE N INSPECTION TYPE QAL INTRULS CODE k INSPECTION TYPE ELATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final t ! 208 Final Plumbing 200 Final Re-Roof I-31- &0O Q'#' 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 2446-46 OWNER DIKE & 00LE'TROVE / DATE 12-15-55 JOB ADDRESS 220 Rose Lane BUILDING PERMIT NO. 2176 GENERAL CONTRACTOR Dike & Colegrove VALUE $ 8,500.00 L 31- BLOCK TRACT 2562 Residence & Garage GROUP I & J TYPE V ZONE Rh FIRE DISTRICT 2199 PERMITS ISSUED INSPECTIONS I)�� DATE SUBCONTRACTOR DATE NUMBER Footing Trench )k/Y / Foundation Forms and Grade to Garage,�c Rough Framing Y5a - ' Plumbing,Rough to Slab j L .dA Plumbing,Rough Complete 1 __ I 7 ..„4„...--t-r".., . a _ c-S" q de 6 Temporary Pole , . /(/ ��/-2,..14- . / /-_ Wiring, Rough , JJ__�,.- I0- $6 /1ti,-(A ��'i,�..J j 24 Co / 907 ✓ Heating,Rough / 1 Heatin Fi �,�c (/, t 1/W. i -a,"- 3or'64 (hewer,g' f 44{, Sewer,St. G�7R -±12-A f . .2---S-6 ,/., / 9 Sentic Tank r Cesspool t tg, In Out g��rr—4- .' a ^ Plastering C �i lit'!ti Plumbing,Final,Fixtures Complete /I ,/ y y, ✓L �� Plumbing,Final Gas Test tot ,�J G/ /` 3!_ , Wiring,Final Av '9-/(.l - - r Occupancy 40,ei Ii„jj.A--- Costa Mesa Building Department ZILIPPLICATION FOR PERMIT • • 111 COSTAEMESA, CALIFORNIAAST 20th STREET 199 BUILDING " . FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN I Receipt No. I Permit No. Building ^ / .7 6, Address 220 Rose Lane o� Costa Mesa, California Received by Date Recd. II Date Issued Nearest ��-/y I/- riS --CC Cross St 21st St. & Orange Ave. Building Address owner Dike and Colegrove Costa Mesa, California Mail Address 419 E. 17th Street Nearest Tel Cross St. City Costa Mesa No.L±. 8-1159 Zone /J,/ I No.of •I Type `/ G r rc Architect or Lic. /� 7- Plans Engineer Carlson & Middlehrooko. Approved by Date Address Garden Grove CORRECTIONS City Lic. Contractor Dike & Colegrove No. 2707 Address 419 E. 17th St., Costa Mesa -_ Legal I Lot I 1 i. ‘1!_4 A\ I l 11� Description No. 31 I Block I Tract2562 P ,._ �--,---` i ) f- (Attach Metes and Bounds) ' - ' - No.of Bldgs. Size of Lot 82.51 x 74.111 Now on Lot none UEC 15 ici7; o Use ofNo.of No.of 1 71 Existing Bldg. none I Families 11 Rooms bg /1 L Setback Line from Rear Yard 311 _ ' PIT/ 1w nnnr n n __ Z Center of Street 501 q Side yard ,] 1 �S/ " ° 1J1 VG'•' In Gill`_JA D DESCRIPTION OF WORK r New I X I Alteration I I Addition I • Repair I I Moving I I Demolish I Building , No.of Size 151 sq. ftRooms 67 Stories 1 Exterior Wall I Roof Covering Fr. Stucco 1 Covering Conn. APPROVALS Use of New Building Single Family Residence & Garage FoundationForms,MateriLocaals,tion Inspector Date Under-Pinning Plan ?7A Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath.Int with all City Ordinances and_ State Laws regulating building construction. Lath.Ext. Signature of Dike and Colegrove Permittee Plaster, Int. / Authorized Agt. e V/� ��'��', Plaster, Ext. Valuation Permit Fee $ .7 o?. O-O Masonry Reinforced enerwm Plan Check$ Al• o-0 Bond Beam $ 8500.00 Total Fee $ Si, 0-0 FINAL FORM 204 S-BP 2M 6-55 - - • e y . - . o u a ' a PPcosrr,,, c� • • Street • PLOT PLAN . Show location and distances from Property line and between buildings. • • _L.