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Home My WebLink About3101 ROOSEVELT WAY - Building Permits CITY OF COSTA MESA • Aco�"MF'A • BUILDING DIVISION Fy ,l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us `W FOR INSPECTIONS CALL: (714)754-5626 4`OA•uonP ef•' PERMIT NUMBER: B09-00142 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 14169326 DATE ISSUED: 08/03/2009 - ISSUED BY: CAC JOB ADDRESS: 3101 ROOSEVELT WY CM Suite/Unit: Vicinity: Squares: 0 Valuation: $6,500.00 SCOPE OF WORK: T/OFF COMP.SHINGLES INSTALL 115 LB FELT AND 40 YR COMP.SHINGLES OWNER: STIEVE,DAVIS P TR Address: 1731 ORCHARD DR Unit: PHONE: 949.261-3942 City/State/Zip: SANTA ANA,CA APPLICANT: RICK STERNBERG Address: 8662 DOLPHIN DR Unit: : PHONE: 714-968-3233 City/State/Zip: HUNTINGTON BEACH,CA CONTRACTOR: CENTURY ROOFING License No. 674019 Address: 8662 DOLPHIN ORUnit: PHONE: 714-968-3233 City/State/Zip: HUNTINGTON BEACH,CA ., 92646 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $139.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $140.25 _ : 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. CODE A. INSPECTION TYPE DATE INOTIALS CODER INSPECTION TYPE DATE INTITIALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �y{�� 208 Final Plumbing 290 Final Re-Roof a �� 210 Final Electrical 201 Final Block/Retaining WaIl 212 Final Fire Prevention • •a: 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the perfor ance of the work for which this permit is issued. I have and will maintain workers'compensation insurance, as required by sect n 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation flue(5)or more feet in depth into which a nu -are.' person is required to descend,will be made in connection with work authorized \ tom' by this permit,and that no building structure,scaffolding,falsework, demolition airier i� Y i:Y. CO or or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp eln aneed not be completedd the permit is valued at one hundred dollars($100)or less.) 2 Art 2,Sec.341,Title 8,California Administrative Code). P Boy / er: ( � b Zi G O ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of gpplicanrs Signature Dale the . ..• orthwith comply with these p,,,LLL999visions. \li i'i ,6C1 Division of Industrial Safety Permit Number: Applicant's - -ure Cate HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No `;�`�1 `4Q1 CI Cass# 3 - G 21 (Section 25533 of the California Health and Safety Code, with some v exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Comr ors gnawre —oa4\ 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safely Code Section 42303 been made? 0 Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8 (If yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. water(s) Dale Signature Date -�� CC• t--I- V °\ 305846(3/07) And/or A tnzetl i Gate 21346 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 1 7 1964 P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT. yy X61.9 � t For Applicant to Fill In Completely � APrrP�TCA ka k TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS II LA, AK - - RECEIPT NO. .E4 p,y. COSTA MESA, CALIFORNIA - RECEIV DEY DAT�eC-IVED DATE ISSUED -,\ 6 JAN 1 G 1964 OWNER • GQ'4-P. [1W\ e-Sif MAIL r li 11 BUILDING ADDRESS 1� 3a11-01SNO4es ADDRESS /1 -Y FIRETEL. 1 ��/y, ///�/7U/1/l///)_' CITY V`•,• • - NO. / ' ZONE TYPE V/ GROUP t APPROVED 7 OR EARCHIP IN ER TECT \ - NEL'' - S.• CO BY DATE [/y ZONING n, !r ADD. .S 1 1\ ( ► Nen CONTRACTOR is Q • ,t •L • ADDRESS _ 11V C. • • A.P.N•. a ■t. s Mt LICJ� NOTE: NO EAVE OVERHANG SHALL BE LESS THAN .NO( O. l)0111 NQS31-� JI� 5 30'TO SI•E B REAR P.L. ee EAVES SIZE /''7 ) 1 n O I NO.OP NOW ON LOT e ALLOWED (U.B.C.REQUIREMENT/ OFLOT / / A. Iri YARDS APPROVED YARDS APPROVED USE OFMAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) SETBACK LINE FROM ``� CENTER OF STREET J REAR YARD ,J FRONT St.) FT. FT. I HIDE YARD I LEFT .S t I RIGHT J t R.SIDE ,�1/ FT. Ff. DESCRIPTION OF WORK L.SIDE ((I� FT. FT. NEV" X ALTERATION ADDITION REAR ?L�FT. « FT. DISTANCE BET. BET.MAIN Q MAIN BLDGS. ACCESS.BLDGS. ' REPAIR MOVING DEMOLISH BUILDING NO.OF `� VAR.# DATE SIZE �� ROOMS J (S1�TORIIES 1 C.U.P.#��ppp \11 1 APPROVED l� ((/_ EXTERIOR WAL COVERINGVS4\ 11�t BYPR�NA i11,`�J� DATE IJ/ l JCr COVERING L(p Iv'Il --Cf - COVERING OF BUIL• G AND WOR TO BE P RFORMED n' - R! ♦• • . 1 1 •`C A / mos W � r'\, / Cr G1 Cl 2. 1F-130 SQ.FT. , 410 Q' 01 I HEREBY ACKNOWLEDGE THAT I HA : READ THIS APPLICATION THE AMOUNT SHOWN ,HOER VALUATION IS FOR THE AND STATE THAT ,OVE IS -•RR ' AND AGREE TO COM. PURPOSE OF ESTAB ISHING A PERMIT FEE ONLY. PLY WITH ALL ITT ORD AND ST TE LAWS REGULATING BUILDING CON-TRUCTIO� , VALUATION PERMIT FEE $ //�/ 1-19 N SIGNATURE •F ,,,,,s/ 4111 I PERMITTEE .-� $/&/ / /��eI 01174 41: O {/y/ GY 7 AUTHORIZED AGENT - _ A °' TOTAL FEE. P� /