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Home My WebLink About3117 ROOSEVELT WAY - Building Permits • STS @ CITY OF COSTA MESA w l 44.S.66 ` ` ` BUILDING DIVISION }; i rew '.toaqsarms r,g DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER "r".1.1 ig PERMIT J. B01-00767 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 3117 ROOSEVELT WY Status: ISSUED Suite: Applied: 05/29/2001 Vicinity: Issued: 05/29/2001 Parcel Number: 14169322 Zoning: R1 R1 Applicant: NGUYEN, CUONG ISSUED BY: Address: Phone: 714-545-6994 Zip: Owner: PHAM, NGUYET THI Address 3117 ROOSEVELT WAY Phone: COSTA MESA,CA Zip: 92626 Contractor: VILLA ROOFING PROFESSIONALS INC Address: 14351 EUCLID ST#E Phone: (714)545-6994 GARDEN GROVE,CA Zip: 92843 License: 758361 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF WOODSHAKE.APPLY SHEATHING,APPLY 25 YEAR COMP SHINGLES, INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,300.00 Permit: $111.25 Claim Valuation: $4,300.00 SMIP Res: $0.50 SMIP Corn: $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: 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 2446-46(6/00) . DECLARATIONS 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 d policy number are: / '7 7-?7 / Carrier: 5 i// /!.r 47 Polity Number: /(/,a/� / _?7,4 (This section need not be completed i/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 s0 as to become subject to the workers' compensation laws of California,and:tree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. / �-c �/ Applicant Signature: . Date: -�9/0 WARNING:FAILURE TO SECURE WE!NSATI• .• ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000), MON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed uncjat provisions of C qapter 9(commencing with Section 7000)of Division 3 of the Business d P les;Ions Code,and my license is in full force end effect.Lice 7. €S' co Class e y Contractor's Signature: ......----./.....:, ass.. Date: 57.2 9/'0/ c r 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: 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 00 THE WORK,and the structure is not intended or offered tor 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. 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 and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia 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 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). 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 agpermit for such construction or modification 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 Wilt any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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(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 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 slate 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. Signatu f Legal Owner(s) Dile -A Mori 0d Applicant Date .-- CODE# CODE• INSPECTION TYPE PAIL INTTAL$ CODE• INSPECTIONTYPE MI lama 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / 208 Final Plumbing G 200 Final Re-Roof C( 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 2, 1350 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 1 7 1964 II P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT.o� CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMR TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS • Cs.:a- COSTA RECEIPT NO. 2tSbfl COSTA MESA. CALIFORNIA I JOU "two— - 11 -c• RECEIYEO BY DATE[—Me .DA'(H11BBUHID,L�,• OWNER IAcV-\\ 1Q l� I V\.` YYY!✓ (/!L� 757 Jl1Y MAIL 1 BUILDING ADDRESS 141 31 LQ s �10 r Q. S ADDRESS Ft) 1 TEL./� I /� FIRE CITY t)a V\ C. \1n 0 a11� NO. >�I'Lir ZONE TYPE ARCHITECT C 1 TEL / APPROVED DATE OR ENGINEER - 4;"ay-- ND.Kc_Sa1o2 11�� ZONING ADC ` T 1 I11G L P , rem No.oF. U6[of N¢w oL- ./ I PLN81/ I BUILDING41 a CONTRACTOR VIS L Y C -0 V.1 -L ' ��C I l"l _/- `1 LEGAL ADDRESS` 1'�l�(1 �A_,S ♦r 1 Q I/ e•S DESCRIPTION /� /u• /9.-ZS CITY I •l.'(1�n .(\r_1 V Q 'tQ- A.P.NO. //�� { q NOTE: NO EAVE OVERHANG SHALL BE LESS THAN 4TN0 LI . A I .1 'l:/� 41 NG. 4-31-kel 15, SO"TO SIDE A REAR P.L. 1/_ 0 �/ b EAVES OF LOT 1(J /- � I Now ON LOGE x ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C//L/STREET) SETBACK L INE FR OM Sf FRONT FT, FT. CENTER OF STREET ..�0 REAR YARD C[{�] J SIDE YARD I LEFT S I RIGHT `, R.SIDE FT. FT. DESCRIPTION OF WORK L.SIDE 3 FT.T. Fr. NEW 4 ALTERATION _ ADDITION REAR;:)14�9 lig.- FT. FT. DISTANCE BET. BET.MAIN Q REP! MOVING DEMOLISH MAIN BLOCS. ACCESS.SLOGS. V//��, �( Q VAR.# DATE BUILDING (V,(i� ROOMS Q STORIES SIZE 1 C.U.P.*a APPROVED •EXTERIOR WA�I Iq{ ROOF APPRO rI-i ! lam/ COVERING J-:•) CCT I COVERING ,e1.:‘ (e_ BY ,�� .\�• I DATE ` '" i/ / USE OF BUILDING AND WORK TO BE PERFORMED �`A, J / II/ cc o {�a Q J .7/41 9a.FT. -y, 1:2 1 ERESY ACKJOWLEDGE THAT I . = READ THIS APPLICATION THE AMOUNT SHOWN OER VALUATION IS FOR THE F• AND STATE THAT -' . E CORRE AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITHI TY OROIN AND ST 8 LAWS REGULATING VALUATION �.! q BUILDING TRUCTIO4e, ./ • N PERMIT FEE $ /�• j SIGNATURE":F G PERMITTE �V `_ ./t.l. /� n N ,,� / t S "/ / / PLAN CHECK $ (O o 4 AUTHORIZED AGENT TOTAL FEE $ //3 I "ti