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Home My WebLink About1116 SAN JOSE AVE - Building Permits • On MF 9 CITY OF COSTA MESA 4 • BUILDING DIVISION }• S i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. IP '2_ 1, PERMIT imow, i "B02-01139 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1116 SAN JOSE AV Status: ISSUED Suite: Applied: 07/24/2002 Vicinity: Issued: 07/24/2002 Parcel Number 41204328 Zoning: R1 R1 . Applicant: JONES, CHARLIE — ISSUED BY: }-tom / cc2 � Address: 1222 MAGNOLIA AV -,/'��.-------.�.._—, �/C' t ----'n Phone: 909-739-7663 �'C-� t3 CORONA,CAnO C- 92881 ` �\ Owner: GROTY JJO/HN \.:ip:I '1"� ��1 \1� • Address 1116 SAN JOSE AVE(�//`�'"� ",- "-=-- �,, j J �r"�iPhone�"cue>T��= 0C COSTA A MESi �/�� Zip: 92626 �j 1 ffv�`"'� Contractor: THE ROOF-STORE fir` S Address/:,� 1222MAGNOLIA AVE#105-219 \V `/ �/ U iii, / Phone: (909)739-7663 k\ ./ ,< t COR/ON/CA ro �"� ��,\ �.-� ,1 Zip:�92881 9Llcense: 760394 Q Q '--` -�� \�1AA� / /fr CN or`",. -------r-,..--_,,,,--„:—._Address ‘7 j { 1 \,'\ \T, �.' - ,oag.Phone: _'�� \ Phone: �1 \` ( 1 a � �i. ickI \ Zip_ {JI �'' �Cicense: "`� License: �� IN I J ,'� 1i �nl'�l � . � 1 I � ✓ 1',7`-/ ✓� /T'7T `rT SCOPE OF PERMIT;h , ` `r'.'i I ( _ i { , (\: TEAR OFF EXISTING ROOF.RE;ROOFiWITH DECRA'SHAKE.�ICBO# 11fh„'. ,. �' 7II I -' I ' 1 I I1 I1,Vry ?_ = s _= -- ,I( _, �(I i i)lll)L j FEE SUMMARY ^y .1v1/r c I n� r Plan-Check;�;)� $0.00 icJ✓'��vr j��k lJ� A(I , Calc Valuation 1 $1a 000.00l ' O Permit: !r $237.25 - j--, .....::=7.2_,.------L_-_,:.,11:-._c--;:b _Claim Valuation �Al -� 1 - �H� $1a,000.00r \�'SMIP Res:A\ih•$1.40 i ----. I /// (C" ;,l . SMIP"Com: VA 1$0.00 ,S c- _ --.T /� Al If' \c);\ Other ' 1 v , �, $0.00 _ '_ ,,i%I' 4� �.' f'•%/ . Inspection`. `""$0.00 i, �. , /// 7"---, - :\ - �\t�: -v ° ------,7,-,.„A... I ,�//�/ V �/I \: -.$23&\65, r 'C ti �'` ' �� (1 SETBACKS (7 �� \ ,\< 2- PLANNING'&`ZONING �1 % Gid AV / MAIN STRUCTURE Front 07-- Rear 0 0.,-, ` Left 0 0 -Fj� -Right ,`0.01/ r',„,,2 �v y�, ;r , )i y2 ACCESSORY Front 0 0" ( / ,Rear 0,0 Left -0-0 ,, \ Right,L-0-07'./..,,,-/ `- i,' / �/ i i_ - r 20(� ,` / / PARKING Existinq'�0 ,��Required l0, I i+ i Proposed:I r�0�A� j. (/�/� NOTES: \'..< `c _.�__________-•,i__ � • • -, . ' ' 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 isnot 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 2446-48(6'00) DECLARATIONS •(_ . ._ ... (fl . 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 rk for which this permit is issued. � arrier�r:h�ave 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. — workers'comp isation Insurance carrier and policy number are: . . arner: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo la,an agree tha 'f I should become subject to the workers'compensation provisions of SectJ471-f n 3700 of t�e Labor Code,I shall forthwith comply with these pro o . Applicant Signature: --------- Date: '1. VWARING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SBJET AN EMPLOYER TO CRIMINAL PIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($l00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 Profess'ons Code,end my license is In full force and effect Lic.N ' 9 Class a 7 Zak D--L / Contractors Signature: AL2,1� Date: lJ 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: n nU.I- _ I hereby affirm that undenpenalty,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 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 lls 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 sheiisij xempt 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 civileenalty of not more than`fle hundred dollars($500).): ❑ I,as owner of the property,or my employees,wlthLwages 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 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 Drivers 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 I 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? ❑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 Califomia 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 aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI 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 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 ❑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 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 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. /t•z nature Of Legal Owner(s) 1114 ln ate And/Or oozed Applicant \ ate CODE P. INSPECTIONTYPE Oa INTmALS CODES INSPFCTION TYPE Oa KEW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root t2-15--a3 5 (f 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 • os'("'"' , CITY OF COSTA MESA �` 6G, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 -F► DEVELOPMENT SERVICES DEPARTMENT �: BUILDING DIVISION NOTICE OF PERMIT EXPIRATION October 31, 2003 John Groty 1116 San Jose Ave. Costa Mesa, CA 92626-1660 PERMIT NUMBER (S): B02-01139 FOR: Re-roof PROJECT ADDRESS: 1116 San Jose Ave., Costa Mesa Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees may be required to finalize expired permits. According to our records, the permit(s) listed above have not had an inspection for a • period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. A time extension may be granted if you intend to commence work and complete the project. Requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you need to request an inspection please call our Inspection Request Line at 714.754.5626. If you do not contact this office within 10 days, your permits will expire on November 18, 2003. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, / " '. / � / /, . Mar- Jane Weidenkeller Office Specialist II Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • w.wr.ci.costa-mesa.ca.us 6112 a:-I+/21/81 24400 : Tl • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - - RECEIVED V PERMIT TO 4'7 7 5 3 • For Applicant to Fill in Completely — Use Ink Only • LA tA X l BUILDING 1116 San Jose 'Ave. A"P-NO. ilia 6q? S z ADDRESS BUILDING ' OWNER OR ADDRESS TENANT Wimbledon ASSOC. 1116 San Jose Ave. MAILING - SPACE NO.' 43 ADDRESS 1470 Jamboree_ Rd E TR.NO" LOT BLK. CITY Newport Beach No640-6800 10275 43 , CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER Imperial Savings & Loan X BRANCH Pasadena 61 S. Lake Ave.OWNER Wimbledon .Assoc. OrrrJ ADDRESS VALUEARCHITECTGINEER Corbin/Yamafuji- No- 549-712USE PRD OR ENn /p� y� `I ` 1 n ADDRESS 17992 Mitchell So. , Irvine ZONEPOR-I--17 TYPE-- GROUP /C- "3 APPROVED CONTRACTOR McLain Dev. Co. BY DATE I '2. O o�p f ADDRESS 1470 Jamboree Rd - CITY Newport Beach No`640-6800 E• - APPROVED SETBACKS ii-i STATE LIC. NO. 273875 , CITYNO. 18873 SIZE NO.OF SLOGS. (FROM CIL3TRECT) 1. ' Lti 0. OF LOT NOW ON LOT FRONTC9O FT. - Q USE OF '(.2 EXISTING BLDG. fin C5.— FT. rA F Separate permits are required for • L.810E1578 FT. electric,plumbing and heating work: REAR/43/ FT. 1W. USE OF BUILDING AND WORK TO BE PERFORMED - PLANNING ACTION xe 11In PRD — New Constructon n- 3z/ APPROVE Da DATE ^I�7_ /_/�7 9 2a-Ig- Single-family dwg 1744M_ �� DATEt/ $P3( w tIOLD FOR SPECIAL REQUIREMENT' O I hereby acknowledge that I have read this application and state a4 that the above information is correct and agree to comply with S all laws regulating building construction, and I shall not employ - S 4 any person in violation of the workman's compensation laws of `�J e ' • thereby of California.. !iCl8r SO. FT. J Q ss w Vj I hereby certify that I am properly licensed as a contractor under + the State of California Business and Professions Code, Division 3, THE AMOUNT SH N UNDER VALUATION IS FOR D oc Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ABLISHING A PERMIT FEE ONLY: to \ am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ a34, _ Y and Professions Code, Division 3,Ch.••ter 0. - - w Signature of // PLAN CHECK $ o Permittee .4' /,,��r/� �/� $ �//I I` or • ' RO 15/ TAX $ - i.�jt U�Y Authorized Agent ' Date TOTAL PAID $ c 9ts36 OWENSCr^NING • Fibs. jlas Blanket Insulation • The contractor named below certifies that the Owens-Corning Fiberglas Blanket Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Blanket Insulation is in- stalled in conformance with current energy conservation regulations, California Administrative Code,Title 25, State of California, in the building located at: ll /J eSer Street • Lot Number Tract Number Exterior Walls �r Owens-Corning Fiberglas Blanket Insulation . 92)- /// Thickness R-Value Ceilings l Owens-Corning Fiberglas Blanket Insulation /.J� Thickness 'A-Value Floors Owens-Corning Fiberglas Blanket Insulation Thickness R-Value Foundation Walls Manufacturer Type Thickness R-Value General Contractor • License No. By Title Date 1519 tureln �J 4/� d Insula� ont for �/f/,r1.fi�v/IO–jf77ll��`�/�✓�,/(jiT'L•icense No. JLn A�� V r Date 6//l1/�'/ By _ — �$yna �"� Title 1 �9nalure) OWENS/CORNING • FIBERGLAS Homeowner Copy (White) - State Copy (Yellow) Builder Copy (Pink) OWENS-CORNING FIBERGLAS CORP. Insulation Operating Division Pub No.16-BL6995-A Limo rn u.S.A.,July 1977 • Fiberglas Tower,Toledo, Ohio 43659