HomeMy WebLinkAbout2722 BOUGAINVILLEA WAY - Building Permitsr
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2722 BOUGAINVILLEA
Suite: [pT -30
Vicinity: PLAN 3
Parcel Number: TPN00072
Applicant: PHILIPP, ROLAND
Address: 15326 ALTON PARKWAY
IRVINE, CA
Owner: STANDARD PACIFIC HOMES
Address 15326 ALTON PARKWAY
IRVINE, CA
Contractor: OWNER -BUILDER
Address:
Zip:
Arch : BASSENIAN LAGONI
Address: 2031 ORCHARD DR
STE 100
NEWPORT BEACH, CA
Zip: 92660
Zoning:
ISSUED BY:
Phone: 949-789.1600
Zip: 92618
Phone: 949-789-1600
Zip: 92618
Phone:
License: 0
Phone: 949-553-9100
License:
CONSTRUCT NEW SFR - PLAN 3'- FOR STANDARD PACIFIC
ENTRY AND 133SF PATIO.
REF: 600-01537
Plan Check:
$316.19
Applied:
Permit:
$1,945.75
04(13(2001
SMIP Res:
$26.99
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00'
Total:
$2,288.93
SETBACKS;
MAIN STRUCTURE Front .16-0
i.� Rear 21-0
ACCESSORY
Front 0-0'-
- Rear 0-0
PARKING
Existing: 0'Required:
- 3 -
NOTES:
Eng:
Address:
Status:
ISSUED
Applied:
04/04/2001
issued:
04(13(2001
Phone:
License:
72SF LIVING,, 579SF GARAGE, 20SF COVERED
IMMARY
�i Calc Valuation: r�
Claim Valuation:
J
LANNING & LUNING
Left 5-0 Right 5; 0.',
Left 0- 0 Right'/ ��0- 0
Proposed:/ 3�'_
$269,922.26
$0.00
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: This permit shall automatically expire and become void it 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. Fallure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
—1-1
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to sell -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 carder and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued atone hundred dollars ($100) or less.)
❑ I certify that In the performance of the work for which this permit Is Issued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensatlon 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 these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOt1ARE (5100,000), W 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 Professions Code, and my license is in full
force and effect. Lc. N Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby afflirm 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 Adtlress:
Signature: Data:
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 (5500).):
❑ 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, Buslness 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.).
1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professioms
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 contractods)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. ^�rn/Business and Professions Code for this reason: 5/01
Signature: Date:
ars
Owner ID verified by rid license. Yes ❑ NorF - � Drivels License No. t
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 demolitlon 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 WIII 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? ❑ 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 slander temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazartlous materiels? ❑ yes ❑ 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
ane 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).
._............... _..will....—.__...._..__ .._._..._.�_._..............__...................o'n"'I._........r'e"..........................__...._r-a"...__—"..__._—.
3 Does or will the applicont or present or future building ocapanl need to Drepare an RMPP (Risk Management antl Prevention Program for acutelyhazartlous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, Unification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 Ii en RMPP is presently required, hes Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No
5 Does or will the applicant or present or future building occupant a require for the work which is the subject of this ,a�ppplication aEEermit 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 U No
(Section 65850.2 of the California Government Code requires that the requested information be fumishod on applications for non-residential building permits).
..........__........................._............................. _.._—...................................... _............................. ..................... _.............................................................................................................................. ........... _.......................... ............... _.._.......
6 WIII any pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(Ii yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
................ .... ....................... .._...................__.._...._.._...................... ___.._...............___..............._................_...................................................................._...................................... ............ _......_–'".............._............_
7 II a permit from the South Coast Air Oualiry 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 ❑ No
....................... ......................................................... _................. __......................... _._................... _...................... ................ ............................................................................... __._.._.... .......................................... _...................
_
e (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certity 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 comity 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.
� LSl
r VA O "iAnd/Or Authoriz tl Applicant 1/ l Da O
DAte/
CODE 0. INSPECTION TYPE OAIE INTMAL9 CODE r INSPECTION TYPE aeiE jNTITIAL6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Elecirlcal
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �Y
204 Final Demolition 250 Final Building/Occupancy,
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 2722 BOUGAINVILLEA Status: ISSUED
Suite No Applied: 04/13/2001
Issued: 04/132001
Vicinity: PLAN 3
- - - ISSUED BY:
Parcel Nunmber: TPN00072
Applicant: PHILIPP, ROLAND�, 1'
Address: 15326 ALTON.PARKWAY 1� _
Phone: 949-789-1600
IRVINE, CA(� Zip: 92618
Owner: �STANDARDPACIFIC HOMES jAA
Address 1565 W MACARTHUR
COSTA MESA: CA Phone::. -714.668-4300
Zip: - 92626
� � +
Contractor. /OWNER -BUILDER
„- Address, - ` +
.. - Phone:
,A
Zip: ' i1
II ,
` ! - License: 0
I
Arch Eng
Address:l
i
Phone:
zip:, V11
License:
SCOPE OF PERMIT%� AI
\\ \CONSTRUCT NEW SFR -PLAN 3 -FOR STANDARD PACIFIC HOMES: 2972SF
At),
LIVING, 579SF��/�
GARAGE, 20SF COVERED ENTRY, 133SF-PATIO. 3 BATHRUBS, 1 DISHWASHER; 1 EXPANSION TANK;' i 11
1 GAS(1-4 OUTLETS), 2 GAS OUTLETS (OVER4), 1 LAUNDRY TUB/WASHER, 1 PRESSURE/
REGULATOR, 1 SEWER CONNECT, 1 SHOWER 1 KITCHEN SINK 1 SERVICE/MOP SINK,.I WASH
< BASIN 2 WASH BASIN SETS 3 WATER CLOSETS; 1 WiER HEATER 1:WATER SERVICE. > ��
'REF 1301-004411A
A
FEE -SUMMARY ✓ /� / /
AMT ��OTY�\ AMT-�OTY������ �� AMT OTY
�- .c:�: +
ISSUE FEE X523.50 �� /�> ��Laundry Tub! Washer -'$9:80.-'1 Sump Pump, $0.00 0
Backflow irrigation 50:00 0 v �j C Landscape Irrigation $0.00 _ 0' �Swimmine Pool $0.00 0
Backflow Preventer 50.00�-,� 0'- 1/ .0 -trap „- - �_ - ",$0.00 ,��0 Trap Frimer� $0.00 0
Bathtub S29.40 Pressure Pressure Regulator .$9.80 _1�� _Urina� $0.00 0
Clarifier System 50.00 0� Process Piping (pe \10,11) $0.00--0,/, Vacuum Brkr Bkflow(1-4) $0.00 0
Connect (Ice,Soda,etc) SO.00 0 -Receptors $0.00 . 0 i , ,- ,--Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank ;'$0.00/1 '0 i Wash Basin $9.80 1
Dishwasher 59.80 1 Sewer Cap for, Demo_ =_-_$0.00-JO Wash Basin Set $19.60 2
Drain. Floor $0.00 0 Sewer Connect $24.65 1 Waste and Vent System $0.00 0
Drain, Rainwater 50.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $29.40 3
Drain, Roof $0.00 0 Shower $9.80 1 Water Heater / vent $12.30 1
Drinking Fountain SO.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0
Expansion Tank 59.80 1 Sink, commercial $0.00 0 Water Re -pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $9.80 1
Gas (1-4 outlets) 56.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0
Gas (Over 4 outlets) $2.20 2 Sink, service/mop $9.80 1 OTHER $0.00
Gas Repipe 50.00 0 Spa (private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00
Interceptors (Grease, Oil) SO.00 0 REINSPECTION $0.00 0
Interceptors (Sand Au o ) SO.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access related
regulations (nm Nn2g 213 0661.12-21-92)
EXPIRATION: This permit shall automatically ex in 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 expirationof this permit.
FOR INSPECTIONS CALL: (714) 7545626
i
2N6-0 (600) V
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury we 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.
❑ 1 have and will maintain workers' oanpensatiOn 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 and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit fs valued at one hundred dollars ($100) or less,)
❑ 1 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 1 should become subject to the workers' compensatlon provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M 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 Professions Code, and my license Is in lull
force and effect. Uc. a Class a
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirn 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 pemut 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).):
❑ 1, 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
J 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.).
❑ 1 am exempt under sec Bu 'mess an Professions Code for this reason:
Signature: Data:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or dead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 WIII 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? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Caste 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 stantlard temperature and pressure).
..
.............................................._................................................................._ .......__..................................... __.............. ... ............................................................. ..... .................... ......... .
.....................................................
2 Doos or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No
(Section has 25533of
the hand alifornia Health and
acutely
with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
quantity y 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 bung occupant neetl to prepare an ROP (Risk Management antl 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, candication and filing with the Fire
Department of an RMPP by businesses which are required 10 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 ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis Replication eppe,rmit for such construction or mo0lticatlon
from the South Coast Air QualityManagement 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).
.........................................................................I._._..._................................ __............................... ................. .................................................................................................................................................................................................. _........
6 WIII any part of the faality 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 and 42303 of the California Health and Safety Code).
...................................._..............................._......_......._.._............_.._._........................_.................__-..............._....................................................................................................................................................._.................
7 If a permit from the South COest 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 ❑ No
B (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.
ignatuLe al 4n1
And/Or Authorized Appl Date
CODE E. INSPECTION TYPE PATE' RiTITAL CODE I INSPECTION TYPE gam. WITTIA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Well 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 2722 BOUGAINVILLEA
Status:
ISSUED
Suite No
Applied:
04/13/2001
Issued:
04/13/2001
Vicinity: PLAN 3
ti—
Parcel Number: TPN00072 -- ISSUED BY:
Applicant: PHILIPP, ROLAND%
i j .
Address: 15326 ALTON PARKWAY- v
Phone: 949-789-1600 r
IRVINE,CA� i - Zip 92818
- N�V�'.
owner -,J STANDARD PACIFIC—HOMES
i n✓� �' i/ - - i A�
Address: \1565'W MAC ARTHUR
� COSTA MESACA Phone: 714-668-4300 � � `�-
%,. Zip: 92626
Contractor�i OWNER -BUILDER
�\ Address*
'Phone
.� ... - - _
License_0
% = SCOPE OF PERMIT \�
l >`/ ;CONSTRUCT NEW SFR - PLAN 3.- FOR STANDARD PACIFIC HOMES-.2972SF LIVING, 579SF
7i .GARAGE, 20SF COVERED ENTRY, 733SF PATIO.
` Q i2 FAU <100K BTU, 1'FACTORY FIREPLACE, 1 -HOOD W/MECH EXHAUST; 1 VENT FAN/SINGLE'
DUCT, 2 COMPRESSORS UP TO 3HP/100K BTU. REF: 601.00441 ( i
n
FEE SUMMARY
`Ouanhty _. ' �/ �� , - Quantity`)t�
ISSUE,FEE� ��\i ,� $23.50' J Repair/Alt'Absorbtion Unit $0.00 —0
Insl'FAU <100 k BTU ��� $29.60. 2 Repair/ Alt Refrigeration Unit
Inst FAU?700 k BTU 50.00 0 Ventillation System / $0.00--/0
Repair/:Alt CoohnW eat\�� $0.00 0 Evaporative Cooler / x$0.00- 0
Inst / Rept Recess all Htr��� 50.00 0Commercial Incinerator �$0:001 01��
Retng Sys <100A BTU 50.00 0 -�, �� Domestic Incinerator E0.00 0
Retng Sys >100 k BTU , SO 00 0 Compressors / Absorption Systems - r
� � � � "iUp to 3 h h.100.k.BTU : ., O � / �
Gas Piping �� �, A 'SO 00 0 - p $29.40 �"�2
Factory Fir cel '�� \�S70 65 --'*'1 ih ' 6 3 To 15 hp / SOO'k BTU`-''„ $O,OOr)0
Hood w/Medi Exhaust - \
S 10:65 1 - i o,15 To 30 hp /,1 000 k BTU/ �n . $0.00 0
VAV Box 50.00 0, ` ; 30 To 50 h / 1 750 k -BTU A
oG� _ P (/J� $0.`00 0
Vent Fan /Single Duch )//� S725�7� r _ 5 Over 50_hp / Over 1 750 BTU -�/ ,$`0:00 0
Appliance ��/ 50.00 0�� �. > Boilers ----
Fire Dampers "S0:00 0 — UpJo-3 hp'--- % $0.00 0
Smoke Dampers ��S000�0� �, --3 T615 hp �� $0.00 0
InsAirtor Handlers Relocate
10000cimt �� 50:00 �0 ��-'��' 30SO 15 to 30 hp)
'to 50 hp �, j / � $0.00 0
Air Handlers > 10000cfm $0.0o--- 0- 1� _ -�� _ Over
�50 hp ��.% $0.00 0
Floor Furnace $O.Oo�10 Other Nlache icaI Fee ;
Floor or Suspend Heater 50.00 11
0�`-'c:' - Investigation Fee $0.00
Plain he CheckFee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $111.05
-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 it 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 j
246646 (6100) (/
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 carder and policy number are:
Cartier: Policy Number:
(This section need not be completed it the permit is valued at ane 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 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 these provisions.
Applicant Signature: Date:
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 DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION=60F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full
farce and effect. Lic. A Class N
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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
Cade: 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 Loomis 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 oder Business and Professions Code for this reason:
Signature: n Date:
(Tuner ID verified by drivers license. 0 Yes V ,CJ No Drivers License No. Expireg:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 thereol, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B. California Administrative Cade).
❑ 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? ❑ 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 o1 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
..............................................._..................................._.............................fiffe.....__.......i.r......_............................................................................................................_............._................................._....................
2 Does or will the applicant ar present or future builtling occupant neetl to file a regislretlon form for acutely hazardous materials? ❑Ves ❑ 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ f4o
9Section 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
apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
........................................................n`t'*1.........................-.................................................................................................._.'a',f................................................................................................................................
...............
..............................
...........
4 If en RMPP is presently required, has Section 25534 of the Celifomia Health end Satery Cotle been fully complied with? ❑Ves ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis
a plication epp,ermii for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No -
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
................................................ ............................................... ............................................................ ..................._................._.................. ............................. ................................ ..........................................................................................
v facility p
6 Will en part of the lacili to be constructed under this ennll be within 1000 feet from the outer boundaries of a school? [I 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 Celifomia Health and Safety Code Section 42303 been made? []Yes ❑ No
..........._. ................. ................... __.............................................. ........................ _........................ ._._............ _............... _........................................... .....__................................................................. _.... _..................... .... ...............................
B (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: 1 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 bulltling construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. 1 agree/not to occupy or allow occupancy of any building authorized by this permit until final
inspection.
% And/Or Au711 zed Appll i / f D f :7e n
CODE E. INSPECTION TYPE 2AH* ILLS CODES INSPECTION TYPE gdjj INITIAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Well 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 2722 BOUGAINVILLEA Status: ISSUED
Suite No Applied: 04/13/2001
Vicinity: PLAN 3 Issued: 04/13/2001
Parcel Nunmber. TPN00072
Applicant: PHILIPP, ROLAND ISSUED BY:
Address: 15326 ALTON PARKWAY--
/� Phone: 949-7891600
IRVINE CA0 % i
Zip. 92618
Owner: ISTANDARD,PACIFI . ,MOMES
-Address;', X//,1565 W MAC ARTHUR � � V�
COSTA,MESA,-CA; Phone: 714-668-4300
l
Zip: 92628
41
/,,Contractor7 gVONE ER-BUILDER d
i
Address �
-Phone.
Zip:
� License: 0
SCOPE OF PERMIT
'1 rCONSTRUCT NEW SFR_ PLAN.3 - FOR STANDARD .PACIFIC �HOMESa2972SF LIVING, 579SF I
� I
� GARAGE, 20SF COVERED ENTRY, 133SF PATIO.
1 NEW RES (1 UNIT), 2 LIFHT FIXTURES, 3 OUTLETS 2 SWITCHES,A MOTOR TO 1 HP. REF
t,,P01-00098
�Q� U FEE SUMMARY �/
\i
r-Quantity . r `_. -- _ . � puantityi ISSUE FEE
$23.50 Temp Dist System°/'Lighting $0.00 01
Tenip�service test $0.00 y . : Busway /100 ft $0.00 ,i0/
Re`s, a/c,package ��A $0.00 -� g $0.00 0
�,, r.`-'.: Slantlin Section
New Res,(1;3 units) \$166.43 2972 ,HS-' ^ Misc EleCtdcahEguipment $0.00 ��/0 ��
New Res (3+units) r�� A`$0 00 0 v Transformers u to t kva/kw
Pool / Spa P, $0.00 0
P $000 v1--C O,tr"; p _ up to t0.kva/kw- ?,=T. $000 0
Lighting Fizts /` $2.20 � 2 ..........up to 50 kva/kw � $0.00 0
Recept Outlets�� �"$3.30- �3... up to 100 kva/kw /$o.00 �0� y
Switches , $2; 20 2V �� ; �� -............:_.:over 100 kva/kw� $0.00
Non Res Appl < $0.00 �0, CLow.Voltage Equipments $0.00��
Res Appl �� x$0.00 /- 0�:`k'�_��.; .bdwNOlt WiringSystem/Ckt $0.00,/ 0�//
Service to 200a x$0:00 / 0-� _ Misc.�Conduit' $0.00 X0�
Service to 1000a � $0.00 0-v _ Misc. Conductor) C ; �� �• �$l).00 �0
Service over 1000a -Moo, -'0`j ��,�- -. _ Circus (-gen or ride) \ \ � $0.& 0
Motors to 1hp s495� _� 1 _ Circus (mech'rideoi.lights)�"�$0.00 0
Motors to 10hp $0.00�� _0- -� !'Christmas Tree Sand - j��/$0.00 0
Motors to 50hp $0.00 'o- -�, Fireworks Stand $0.00 0
Motors to 100hp $0.00 0�_�_ .OtherElectrica(F.ee--_ $0.00
Motors over 100hp $0.00 0~----
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a so.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 $202.38
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<e(6=1
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 carder and policy number are:
Carrier: Policy Number:
(This sect/on need not be completed It the permit is valued at one hundred dollars ($100) or less.)
❑ 1 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 became 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 these provisions.
Applicant Signature: Data:
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 DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 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 and effect. Lic. N Class 4
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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).):
❑ 1, 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.).
❑ 1 am exempt ur se � Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑� ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - 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? ❑ 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 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 ❑ No
...........................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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 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 and 42303 of the Califomia Health and Safety Code).
.................................................................................................................................................. is-t....................................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control districtagency Is required for the work which Is the sublett of this
application, have all of the disclosures prescribed by California Health and Safety Cade Section 42303 been
made? ❑Yes ❑ No
6 (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 AUTHORIZATON.OF ENTRY: 1 certify under penalty of perjury that I have read this application and state that the information given is
correct. 1 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.
ignetur
Of L.Imal s)q / ^to
n Or Authorized Applicant / ate
CODE A. INSPECTION TYPE QA¢,' IMAL CODE INSPECTION TYPE DATE INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical IZ�
201 Final Block/Retaining Well 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