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Home My WebLink About259 SIERKS ST - Building Permits a CITY OF COSTA MESA - + ` r BUILDING DIVISION f �.•�' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us iqFOR INSPECTIONS CALL: (714)754-5626 d • PERMIT NUMBER: BX08-00340 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42621105 DATE ISSUED: 12/03/2008 Zoning: , ISSUED BY: RMD • JOB ADDRESS: 259 SIERKS ST CMSuite/Unit: Vicinity: GAME ROOM _ ' 'Primary Occ: - . Const Type :?? SQ. FT: 0 • -'"Valuation: - $500.00; SCOPE OF WORK: LEGALIZE THE CHANGE OUT 1 SLIDINGGLASS DOOR FOR A SFD. NO CHANGE:IN HEADER , WNER: BELNA, DAVID S:TR Address:: 259 SIERKS ST Unit City/State: COSTA MESA; CA, - Zip Code: 92627-2150 Phone: APPLICANT: BELNA, DAVID S TR'. " - Address 259 SIERKS ST Unit: Cit /State: COSTA MESA, CA ._ Y - - 'Zip Code.' . .926222150 .. Phone: 949-422-9394 CONTRACTOR OWNER BUILDER _ _. - _ License No.. .000000 '�i Address: � ; - - . - -_ Unit: City/State: Zip Code: t� -- ` _ Phone . - Cell: ARCHITECT: License No: Phone ENGINEER: License No.. Phone FEE SUMMARY Building Plan Check $0:00 , • Building Permit: $23.50 Electrical Permit:' SMIP Residential $0:50, SMIP Commercial TOTAL FEES $24.00 ' • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and'all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE I. INSPECTION TYPE DATE INTITIAL$ CODE INSPECTION TYPE DATE INTnULS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 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 (Z''ef-Pa Q wit ! . . WORKERS'COMPENSATION DECLARATION: Owner ID verified by Expires: or)--,-)V 12 ❑ I have and will maintain a certificate of consent to self-Insuie for workers' Verification of Ownership compensation, as provided for by section 3700 of the Labor Code, for the b y(type of document,i.e.-property tax bill or deed): performance of the viork 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,a demolition Cartier, or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed if permit the peis valued at one hundred collars(3100)or less) 2,Art 2,Sec.341,Ttle 8,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ittrI 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 sued, 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 Applicant's Signature Date t L bor Cod/e2.\I shall forthwith comply with these provisions. / ��`! /al 7 _3 Division of Industrial Safety Permit Number: /h/ , t Applicant's Signature d' Date 8 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 ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the Califomia 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? 0 Yes 0 No Lic.# Class# (Section 25533 of the Califomia 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 Contractor's signature Date 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 fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 10Yes IDNo (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 Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑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? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished 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? ❑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 ompensation, 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 Safety Code Section 42303 been made? 0 Yes 0 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 ownerbuilder will have the burden of proving that'he or she CERTIFICATE OP 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 city ordinances regarding Hazardous Materials and Emissions. 0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH . LICENSED CONTRACTORS to construct the project(Sec.7044. Business and Professions Code:The contractus License Law does not apply to an owner of Signature • : Date'. property who builds or improves thereon,and who contracts for such project with a contractor(s)license pursuant to the Contractors License Laws.). . CERTIFICATE OF COMPLIANCE AND AUTHORIZATION SOF ENTRY: I certify under penalty of perjury that I have read this application and state.that 0 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 insp n purposes. I agree not to occupy or allow occupancy of any building auth riz d fby is perm until final inspection. 8 Prii �-- l�3 4 fi r la �3—� O Signature of Legal Owner(s) Dale signature Date 305746(3/07) L r And/or Authonzed Applicant Dale