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HomeMy WebLinkAbout1118 SAN JOSE AVE - Building Permits • y CITY OF COSTA MESA 4 BUILDING DIVISION h ••„� DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER PERMIT ”' ) 05-02218 4tbR (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaBUILDING PERMIT `V i AIR DRIVE,COSTA MESA,CA 92626 Job Address: 1118 SAN JOSE AV Status: ISSUED Suite: Applied: 12/05/2005 Vicinity: 2 FLOOR IP Issued: 12/28/2005 Primary Occ: R3 Type •KwagrA-ction: Parcel Number: 41204329 747-ng: R1 Applicant: KATHY ANN RODEFFER / Address: 1118 SAN JOSE AV �`� Phone: 714-662-6992 ISSUED BY: COSTA MESA,CA Zip: 92626 Owner RODEFFER, JOHN 0 Address 1118 SAN JOSE AVE Phone: COSTA MESA,CA Zip: -92626 Contractor: OWNER-BUILDER Address: Phone: • Zip: License: 000000 Arch : Eng: Address: Address: Phone: - Phone: Zip: License: License: SCOPE OF PERMIT ADD 450SF OF FLOOR AREA TO CREATE A 2ND FLOOR FOR LOFT AREA. FEE SUMMARY Plan Check: $117.81 - Calc Valuation: sio,000.00 Permit: $181.25 Claim Valuation: sio,000.00 SMIP Res: $1.00 SMIP Com: $0.00 Other: $0.00 - Inspection: $0.00 • Total: $300.06 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 ):xistinq: 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 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. Jit 'have and. 'II maintain worker mpensation insu.. n. Ce,as required by sectio 700 of the Labor Code,for the performance of the work for which ' permit is issued. My wo�rke mpensation In carrier and umber are: rC•ye �.- -olicy Numb.r: (T mse ..- eed n. •e cramp ed it the pe s valued at on: .undre. -.Ilars($100)o :5s.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ccjrnpensation laws of California,and agree th t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith _--comply with these (prr i Io ( an>rSignature% - !� 6'(3'//! /"` ©!1/ 77Gr '/� / rDate:""� &/0.� `WARNING.."FAILURE'TO'SECUREWORKER$' PENSATION COVERA iS LAWFUL AND SHALL SUBJECT AN EMPLOYER TOCRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. v. 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 Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the wort(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 sale.If,however,the building or improvement is �e/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.). � ni owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions I_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 :. ey t n.e.sec. �, Business and Professions Code for this reason: Slgnat rue <O ' _.. '!l/i tatea,' ( ' Expires: /r2/d/�� 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 feel 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: I 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 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 ❑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 ❑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 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 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 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- e r bed property for inspec en purpos I agree t o rpy or allow occupancy of any building authorized by this permi until final inspection. "Frovi ibignnture-OL Legal Owners) - �; i : ate y And/Or Authorized Applicant Date CODE I. INSPECTIONTYP8 DATE MURALS COPE INSPECTIONTYPE all INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Signm 222 Final Site ( 204 Final Demolition 250 Final Building/Occupancy _- • o a�-1.L! � CITY OF COSTA MESA . BUILDING DIVISION )• 0-,,,,,, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER i 1114•1 i j PERMIT J I"+ , E06-00142 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1118 SAN JOSE AV Status: ISSUED Suite No Applied: 02/21/2006 Vicinity: Issued: 02/21/2006 Parcel Nunmber: 41204329 Applicant: ERIC PENNINGTON Address: ISSUED BY: Phone: 714-726-1467 Zip • Owner: RODEFFER, JOHN 0 Address 1118 SAN JOSE AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: ERIC PENNINGTON CONSTRUCTION Address: 8611 ROLAND Phone: 714-726-1467 BUENA PARK,CA Zip: 90621 License:784685 SCOPE OF PERMIT INSTALL 20FIXTRUES,2000TLETS,8SWITCHES FOR RESID ADDITION,RE:B05-02218 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $22.00 . 20 up to 50 kva/kw $0.00 0 Recept Outlets $22.00 20 up to 100 kva/kw $0.00 0 Switches $8.80 8 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 10003 $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 • 0 - Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 -0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $76.30 Intermed Pole . $0.00 0 COMMENTS/SPECIAL CONDITIONS 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) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the follow,,,9 declarations: 0 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. jJ 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 w ars ompensati )I isurance carrier and policy number are: J Carrier: , rY mip�4o7'L� / Policy Number: t7 '/ -S S' —02 (This section need not be completed i the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the perform nce of the work for . ich this permit i issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of omia,and agreeif I -.uld b- •zr:subject to thworkers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr sl s. Applicant Signature: / Date: - WARNING:FAILURE TO SE WORKERS'COMPENSATION t1 E-'GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 ,IN ADDmON TOTHE 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 tic' sed under provisions of Chapter 9(commencing with Section 0)of Division 3 of the Busines . d "rofessions Code,and license is in full force and effect. ' Lic.# �'g y (p QHS I Class# i • r p,S Contractor's Signature:// •_a _ re _= Date: '- — S / 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 Marne: 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 end 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,Dusiness and Professions Code:The Contractors License Law does not apply to an owner of properly 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 properly 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 ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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(38)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 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 ❑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? ❑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 epermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes L7 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? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 end 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? 0 Yes ❑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 10 occupy or allow occupancy of any building authorized by this permit until final inspection. Si Of Legal Owner(s) / Date Z_ Olo d/Or Authorize 'Applicant Date • .r INSPECTION TYPE PATE IIff1D815 CODE 0 INSPECTION TYPE IAIF INrlTALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 1 200 Final Re-Roof • 210 Final Electrical ''l'CL CD.1-- 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 --"L! CITY OF COSTA MESA • 4 @ BUILDING DIVISION >• �,,'� $ DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER F r ""-.ieg I PERMIT M06-00078 itbepoRrits� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1118 SAN JOSE AV Status: ISSUED Suite No Applied: 02/21/2006 Issued: 02/21/2006 Vicinity: Parcel Number: 41204329 ISSUED BY: CS fa- Applicant: ERIC PENNINGTON Address: Phone: 714-726-1467 Zip: Owner RODEFFER, JOHN 0 Address: 1118 SAN JOSE AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: ERIC PENNINGTON CONSTRUCTION Address: 8611 ROLAND Phone: 714-726-1467 BUENA PARK,CA Zip: 90621 License:784685 SCOPE OF PERMIT INSTALL 1FACTORY FIRE PLACE,1 GAS PIPING FOR RESID ADDITION,RE:B05-02218 CONTRACTOR DOING ALL THE WORK FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Ins(/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 • Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $40.30 COMMENTS/SPECIAL CONDITIONS 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 2446-48 lerool 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 a, work for which this permit is issued. yy 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 w�orke�-rs'compenn atlon Insurance Carder and policy number are: / J Carrier: r (a YL�ViL St-1/13 Number: /i7 (This section need not be completed if the permit is valued at one hundred dollars($1 )or less.) ❑ I certify mat in the performance of the work for which th ermit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws f California,and a that If I u bcome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith / comply with the ovlsio s. Applicant Signature: 2—( Date: _z 1 _OG, / WARNING:FAILURE TO S RE WORKERS'COMPENSATION COVERAGE LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS( ,OWN,IN ADDIRON 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 lic,n ed under rovisi ns of Chapter 9(commencing with Sectior)r7000)of Division 3 of the Busi ss and f Profe ions�Code and m ense is in fulll force and effect.Lic.# I, ,lea I _ Class# 841 (O V Q Contractor's Signature! , -- _ ' iI / J. Date: �— Zt. - ' (0 // CONSTRUCTION LE DING 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 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 Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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). o 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 ❑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 ❑No (Section 25533 of the Califomia Health and Safely 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 end Safety Code been fully complied with? 0 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 13 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? ❑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 tho 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:1 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 end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.s./I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re q,�'Owner(s) / Date C-,-- _ And/or Authorized Applicant Date DE Q, INSEESJ148leE BATF INTRIAL5 coDF[ INSPECTION TYPE Fixed System Final Fire Prevention 206 Final Mechanical y (810n- 1616 1265 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 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 7� ' ..' CITY OF COSTA MESA 4 i BUILDING DIVISION .f ..4 VELOPMENT SERVICES DEPARTMENT PE IT NUMBER � PIT2 806-01948 illtooriacto(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cB.IULDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1118 SAN JOSE AV Status: ISSUED Suite: Applied: 11/20/2006 Vicinity: ROOF Issued: 11/20/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 41204329 Zoning: R1 Applicant: LINTON, NEIL Address: DBA GUARDIAN ROOFS SANTA ANA,CA Phone: 714-770-7968 ISSUED BY: 1651 E 4TH ST Zip: 92701 SUITE 239 Owner RODEFFER, JOHN 0 Address 1118 SAN JOSE AVE • - Phone: COSTA MESA,CA Zip: 92626 Contractor SUDDUTH CONSTRUCTION INC Address: DBA GUARDIAN ROOFS SANTA ANA,CA Phone: 714-770-7968 1651E 4TH ST Zip: 92701 License: 847279 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 2 LAYERS OF G40 MODIFIED FIBERGLASS,MONIER DURAL/TE TILE,ICBG#2656,5.96 LBS/S.F.AND REPAIR/REPLACE SHEATHING AS NEEDED.2,800 S.F.INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $16,000.00 Permit: $265.25 Claim Valuation: $16,000.00 SMIP Res: $1.60 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $266.85 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 2446.46(6/00) DECLARATIONS .12 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. .12-71Trave 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. L Myworkers'compensation Insurance Carrier and policy number are: - Carrier.:-CT-e7-E ecr.NO /06/icyNumber:�7n '3 23 —tea�G (Thi Fon need not be completed If the permit Is valued at one hundred dollars($100)or less.) O 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. AppRca Slln gnature: rzDate:/T/�/0L uTHFit4AFtN` c.. OUSAG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVERTO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARS($1003:00),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 Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force;an'd effect.Lie.a F? J7 9 Class a G 3ly ConoctaSlgnature__7`<'`c' Date:-f1-F�O/�' qt,. • 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 end 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 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 drivers 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: O 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 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 end 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 end 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 end 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 end Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Flre 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 er future building occupant require for the work which is the subject of this Application aaermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes Ll 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 (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? 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 end 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. I ature 2gal Owner(s) pate/ And/Or Authorised Applicant-�-----y.�_,. (rate CODE P INSPECTION TYPE gdI& INTITIA14 CODE( INSPECTION TYPE DATE INITiAL4 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ./2 So 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 COSTA MESA BUILDING-SAFE DEPARTMENT APPLICATION FO :RUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVE BY PgnlLiX. 1.../W tll _ 8J DI. For Applicant to Fill in Completely — Use Ink Only q 1 V `4 7 7�J BUILDING 1118 San Jose Ave. A.P.NO. di 7A— Odic —$r ADDRESS BUILDING OWNER OR Wimbledon Assoc. ADDRESS 1118 San Jose Ave. TENANT UNIT OR MAILING 1470 Jamboree Rd SPACE NO. 44 ADDRESS TR.NO. LOT IBLK. CITY Newport Beach No1640-6800 10275 44 NEW ADD ALTER 'REPAIR IMOVINGIDEMOLISH CONSTRUCTION LENDER Imperial Savings & Loan I II X BRANCH Pasadena Wimbledon Assoc /, 93 � OWNER VALUE /%] 60 ADDRESS Al S T.akp Atrp USE PRD S , GI a Corbin/Yamafuji r701549-7124 ADDRESS 17992 Mitchell So. ,Irvine ZONE PLC.LO I(i7VPE /" GROUP /r_3 McLain DE v. CO. APPROVED V DATE l/20/f3/ CONTRACTOR (((..XPP�N���--- ADDRESS 1470 Jamboree Rd - CITY Newport Beach NOL640-6800 E+ STATE Rt22tR 273875 CITY 18873 APPROVED SETBACKS LIC.NO. LIC.NO. W 512E NO.OF BLDGS (FROM CIL 3TFIECT)V°i 0. OF LOT NOW ON LOT 0 FRONT r90 FT. Q USE OF V) EXISTING BLDG. R SIDE FT. X I-4 Separate permits are required for L.SIDE lO,a/FT. electric,plumbing and heating work. REAR d bFT. I.., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION -C X:1 PRD — New Construction ZE— ?8_39 DATE —�APPROVED c97 78 Single—family dwelling _ RY Qj$i DATE w tlQ ! FOR SPECIAL REQUIREMENT 0 I hereby acknowledge that I have read this application and state 0 X that the above information Is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ s Z any person in violation of the workman's compensation laws of 2 W the State of California. (,�J��(J r C D (' I hereby certify that I am properly licensed as a contractor under —" SQ. FT. ,J Q ...7 rm`+ the State of California Business and Professions Code. Division 3, THE AMOUNT SH UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF E OI A PERMIT FEE ONLY: —to si am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ l gr Y NTS and Professions Code, Division 3,Chap or 9. ,.S PLAN CHECK E ^ ro Signature of w J'' o ' Per oo'ttue ` Sq III 3 TAX E ✓ 7/ U tl Authorized Agent Date — �`� / TOTAL PAID $ AP e o, OWENS-CORNING • Fiberglas 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: Seth . IO5 9 4U( -XtVV /17Z-ar Street Lot Number Tract Number Exterior Walls Owens-Corning Fiberglas Blanket Insulation _ �' // Thickness R-Value Ceilings Owens-Corning Fiberglas Blanket Insulation (c // Thickness R-Value Floors Owens-Corning Fiberglas Blanket Insulation Thickness R-Value Jndation Walls Manufacturer Type Thickness R-Value General Contractor License No. By • Title - Date � (SignaWre)/, / ,,� Insular ontr ctor Gf - �J /I-�2/�At 1Li cense No. � �1 � By— Title X7,2 Date 6',4a/f/ pgnaturet • • OWENS/CORNING FIBERGLAS Homeowner Copy (White) State Copy (Yellow) Builder Copy,(Pink) OWENS-CORNING FIBERGLAS CORP. Insulation Operating Division Pub.No.I6-BL-6995-A Litho in U.S.A..July 1977 Fiberglas Tower.Toledo,Ohio 43659