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HomeMy WebLinkAbout1112 SAN JOSE AVE - Building Permits CITY OF COSTA MESA 4 � BUILDING DIVISION >% ,.,.. � , DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER t. argil PERG7IT - B03-01867 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cotnLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1112 SAN JOSE AV Status: ISSUED Suite: Applied: 10/27/2003 Vicinity: Issued: 10/27/2003 Parcel Number: 41204326 Zoning: R1 R1 Applicant: SELL, RON ISSUED BY: Address: 18032 LEMON Phone: (714)528-1758 YORBA LINDA,CA Zip: 92686 Owner MILLER, ROBERT F Address 1112 SAN JOSE AVE Phone: 949-963-8855 COSTA MESA,CA Zip: 92626 Contractor: SELL ROOFING COMPANY Address: 18032 LEMON Phone: (714)528-1758 YORBA LINDA,CA Zip: 92686 License: 323842 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF SHAKE ROOF, INSTALL SHEATHING, FELT AND EAGLELITE TILE,ICBG 4660. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,900.00 Permit: $167.25 Claim Valuation: $8,900.00 SMIP Res: $0.89 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.14 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 WOO) 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 w or which this permit Is issued. have and will maintain wo ars'compensation Insur ,as requiredby section-6700 of the Labor Code,for the performance of the work forwhichthis permit Is ued. My workers'com ranee er and p y number are: /(>,,` ,r 5-3— Carrier: ( Policy Number: (This section need nor be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which thi ermit is sued,I shall not employ any person in any manner so asr to become subject to the workers' compensation laws of California,an e that III sho bec subject to the workers'compensation provisions of Sectin 3700 of th LLLaaabbb000r Code,I shall forthwith comply with these provisions. m� O 93-'I Applicant Signature: r/ ✓l Date: I EI U 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 DOLIARE($10Q000),IN ADDITION TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed und.r.tvin,, hapter 9(commencing with Section 7000)of Division 3 of the Business and Profe ion Code,and my license is in full force and effect.LIc.4 Class N Contractor's Signature: ��WA" Date: fIIaaIAtt 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 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. ❑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,Gm 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,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 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling 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 end 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 ermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 Safely 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 /ttt�ordinances��drelating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i ion purpo s.I�I a not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ate;L.ef I 0 0 1I) �'Q'7Bte�) And/Or Authorized Applicant / Uate CODE# IN.2E04f1.IYPE DAIS II:AU CODE I INSPECTIONTYPE DAIS MEW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof /F 12127 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 6069 1 /21 /8I 306.51 TL' COSTA MESA BUILDING-SA' -IV DEPARTMENT APPLICATION. ..STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVE BV PERMIT - l�lB 41751 For Applicant to Fill in Completely - Use Ink Only iii N BUILDING ADDRESS 1112 San Jose Ave . A.P.NO. I is 0'90,....-675-- BUILDING SBUILDING OWNER OR Wimbledon Assoc. ADDRESS 1112 San Jose Ave. TENANT UNIT OR MAILING 1470 Jamboree Rd SPACE NO.41 ADDRESS TR.NO. LOT BLK. CITY Newport Beach No 40-6800 10275 41 NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION o_Cr UPON Imperial Savings & LoanLENDX BRANCH Pasadena Wimbledon Assoc. ^ �f OWNER j� ',7 ADDRESS 61 S. Lake Ave USE PRD VALUIE &.r � S ARCHITECT TEL. ORENGINEERCOrhlll/Yarnafllji No549-712A " //�� ��/��/ R. ADDRESS 17992 Mitrhel l co ,Irt>inP ZONEr/�P,(��-��- TYPb)J- l\ � GROUP —3 APPROVED CONTRACTORMCLain IlPV fn_ BY DATE //20/0 I ADDRESS 1470 Jamboree Rd — TEL. F CITY Newport Beach No640-6800 APPROVED SETBACKS STATE CITY LIC. NO. 273875 . LIC. NO. 18873 SIZE I NO.OF BLOCS C.17%-67Rbbb1P4 _ 0. OF LOT NOW ON LOT 0 FRONT r O FT. et USE OF Cn EXISTING BLDG. _R.SIDE kr. FT. CI) FSeparate permits are required for L.SIDE .)u5� FT. electric,plumbing and heating work. REARp6/ FT. La USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q • al DATE n PRD - New Construction 7 79—alAPPROVEDczr-.P7 75 } Single-family dwelling a P 11I D S DATE i f 2c tat z HOB FOR SPECIAL REQUIREMENT Lu 0 I hereby acknowledge that I have read this application and state ei pv that the above Information Is correct and agree to comply with C r 0• all laws regulating building construction, and I shall not employ ` a N Z any person in violation of the workman's compensation laws of a �I T the State of California. tt //�7� , m lb �7 / SD. FT. /�O 7. A ry • I hereby certify that I am properly licensed as a contractor under O the State of California Business and Professions Code, Division 3, THE AMOUNT SH N UNDER VALUATION IS FOR M Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OFESTABLISHING A PERMIT FEE ONLY: ur am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ Y9 Y and Professions Code, Division 3,Chapter 9.r I s m \ Signature ofalt r'7//�Q,/'/// / 2 PLAN CHECK $ mo Permitteeo /�/��% '(.•" . ' $ el " '2 TAX $10 0I.51 U Authorized Agent Date - TOTAL PAID $ 6 ,s- N.