HomeMy WebLinkAbout2455 ELDEN AVE - Building Permits . sin Mac CITY OF COSTA MESA
4441 ftte - BUILDING DIVISION •
> ,t.
$, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1:fiia �'
dP• PERMIT /
M04-00294
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2455 ELDEN AV Status: ISSUED
Suite No Applied: 06/03/2004
Issued: 06/03/2004
Vicinity:
Parcel Number: 43928130 ISSUED BY:
Applicant: PATTERSON, ANDREW .
Address: 323 EL MODENA AV
Phone: 949-294-9057 CELL
NEWPORT BEACH,CA Zip: 92663
Owner FERGUSON/DAY PROPERTIES LLC .
Address: 2459 ELDEN AV
Phone:
COSTA MESA;CA Zip: 92627
Contractor: PATTERSON CONSTRUCTION CORPORATION
Address: 323 EL MODENA AV
Phone: 949-294-9057 CELL .
NEWPORT BEACH,CA Zip: 92663
License:802367
SCOPE OF PERMIT
CONSTRUCT A NEW 2398 SF TWO-STORY SFD(1076 SF 1ST FLOOR AND 1322 SF 2ND FLOOR)
WITH 711 SF ATTACHED GARAGE AND 28 SF PATIO COVER AT THE ENTRY.REF:
B03-01582. -
MECHANICAL TO INCLUDE: 1 FAU> 100K BTU, 1 FACTORY FIREPLACE,2 VENT FANS.
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 $18.20 1 Ventillation System $0.00 0 '
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/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 $0.00 0 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 $14.50 2 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
•
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
2466.46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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
wo for which this permit is issued.
eve 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 carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($700)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 S ion 37 of the La r 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 CRIMI PENALTIES AND CM FINES UP TO ONE HUNDRED
THOUSAND DCLLARE($100,000),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 corn cin ith Section 7000)of Division 3 of the Businesss�Professions Code,and my license is in full
force and effect.Lk.N a ate 7// Class a /'
Contractor's Signature: // Date: f //
CONSTRUCTION LENDING AGENCY: !!// \l
❑ 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: Lenders 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(commendng with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally 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:
❑ 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,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 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater then 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 en 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 hazard0us materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a2ermit 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part cf 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 end 42303 of the Califomia 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 • •" - •TION 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 a : . e laws : d city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property f• ' spection pu ••ses.I agree no • •• •••• :Slow occupancy of any building authorized by this permit until final inspection.
- •4 Legal • _ Date
And/Or '-0 • z.d Appu:nt — Asa
CODES tf$PECTION TYPE PAIF I7 IAi5 CODE, ttlSPECTION TYPE _--`-
1616 Fixed System Final Fire Prevention 206 Final Mechanical _ L/
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
501 "° CITY OF COSTA MESA
44, 9 - - - - BUILDING DIVISION
44. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT y04-00629
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2455 ELDEN AV Status: ISSUED
Suite No Applied: 06/03/2004
Vicinity: Issued: 06/03/2004
Parcel Nunmber: 43928130
Applicant PATTERSON, ANDREW ISSUED BY: /
Address: 323 EL MODENA AV -
Phone: 949-294-9057 CELL
NEWPORT BEACH,CA Zip: 92663
Owner: FERGUSON/DAY PROPERTIES LLC
Address 2459 ELDEN AV
Phone: '
COSTA MESA,CA Zip: 92627 .
Contractor: PATTERSON CONSTRUCTION CORPORATION
Address: 323 EL MODENA AV
Phone: 949-294-9057 CELL
NEWPORT BEACH,CA ' Zip: 92663
License: 802367
SCOPE OF PERMIT
CONSTRUCT A NEW 2398 SF TWO-STORY SFD(1076 SF 1ST FLOOR AND 1322 SF 2ND FLOOR)WITH
711 SF ATTACHED GARAGE AND 28 SF PATIO COVER AT THE ENTRY.REF:B03-01582.
ELECTRICAL TO INCLUDE:2398 SQ.FT.RESIDENTIAL,GARAGE:4 LIGHT FIXTURES,4
' OUTLETS, 1 SWITCH.
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) $134.29 2398 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 $4.40 4 up to 50 kva/kw $0.00 0
Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0
Switches $1.10 1 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 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0,00 0
Motors to 1hp $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 $0,00 '
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days;
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
■ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
`, •ve and w01 maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance Of the work for which this permit Is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed It the permit Is valued et one hundred dollars($f00)or less.)
❑ I certify that in the performance of the wo • which t '- permit is issued,I shall not employ any person In any manner so as to becomeasubject to the workers'
compensationh laws rofo siofomia,and a. e that if I s•• Id beco to the workers'compensation provisions of t 3700 I//the
,Le e,I shall forthwith
comply with these provisions. ,J^/ V
Applicant Signature: Date:
WARNING:FAILURE TO SECURE W .-, .H TION GE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND WV I ARE(5100,1x10).I w DM• ••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(cam' : -with S• 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.tic.A � i — ' Class 4
Contractor's Signature: Arra Date:
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: Lenders 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 the 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 penally 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 tax bill or deed):
1 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Q 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:
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 al standard temperature and pressure).
. _ t or pr_ tor._utu ._ e__�.r............_..._...__(_.._.._..._.._ r a �............_..._...__._"_
2 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 Thil application ap,ermil for such construction or modification
from the South Coast Air Quality Management District or from any other sir 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 part of the facility to be constructed under this permit be within 1000 feat from the outer boundaries of a school? ❑Yes 0 No
(if"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes',attach certificate of compliance Irom 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 and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property f• ' •action pu .ores.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
a
vial Owner(s) off nt Date
•d/Or iiiiiiApplicant Date
,�•-4. I. :T•!•.MI J PAIS I101E15 COOEIt INSPECTION TIFF gni 111M61.$
1615 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re-Root 210 Final Electrical
WisXi
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
`, ' 'F9 K CITY OF COSTA MESA
4
BUILDING DIVISION
it> •4 ,ftlill - DEVELOPMENT SERVICES DEPARTMENT PERM P NUMBER
I
pr iii i - PERMIT
J .. . . � . B03-01582
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
. BUILDING PERMIT
Job Address: 2455 ELDEN AV Status: ISSUED
Suite: Applied: 09/17/2003
Vicinity: UNIT A/NEW SFD Issued: 05/28/2004
Parcel Number: 43928131 Zoning:
Applicant: DAY, JEFF ISSUED BY:
Address: -
Phone: 949-721-1852 -
Zip:
Owner: FERGUSON/DAY PROPERTIES LLC
Address ,2459 ELDEN AV
• Phone:
' -COSTA MESA,CA-" Zip: 92627 ,
Contractor `PATTERSON CONSTRUCTION CORPORATION
'Address: 323 EL MODENA AV -
Phone: 949-294-9057 CELL ,
/ NEWPORT BEACH,CA " ,
Zip: 92663 'License: 802367 ' -
Arch : STANLEY ANDRADE Eng: LOVELACE ENGINEERING
Address: 24501 DEL PRADO Address: 6496 WEATHERS PLACE
D-1 Phone: 949-248-2684 SUITE 200 Phone: 858-535-9111
DANA POINT SAN DIEGO,CA .
Zip: 92629 License: C018971 92121 License: 39734
•
SCOPE OF PERMIT
CONSTRUCT A NEW 2398 SF TWO-STORY SFD(1076 SF 1ST FLOOR AND-1322SF 2ND FLOOR)WITH 711 SF ATTACHED GARAGE AND 28
SF PATIO COVER AT THE ENTRY. - -
PA-03-11/PM-03.150
- FEE SUMMARY' ' -
Plan Check: $1,155.54 Calc Valuation: $239,303.86
Permit: $1,777.75 Claim Valuation: $0.00
SMIP Res: $23.93 '
SMIP Corn: $0.00
' Other: $0.00 - ,
Inspection: $0.00 -
Total: $2,957.22 - .,
v - PLANNING &ZONING. ' - - N., ,-
SETBACKS
MAIN STRUCTURE Front 0-0 Rear '0-0 Left 0-0 ,, \ ' Right.. . 0-0 7,
ACCESSORY Front 0-0 - - Rear 0-0_ - -Left 0-0 ' / Right - 0-0
PARKING Existing: 0 'Required:. --0 Proposed: 0, - - r
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
2448.48(8/00) ' V, l i J
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 saetion 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 carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I curtly 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,end 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 SMALL SUBJECT AN EMPLOYER TO CRIMINAL 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.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter: a' mencing tit action 7000)of Division 3 of the Business and Professions Code,and my license Ls in full
force and effect.Lk.# �O 2_3 6 --7
Class# it �
Contractors Signature: Date: S /2, f
II
CONSTRUCTION LENDING AGENCY:
❑ t 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: Lenders 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 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. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,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 groator 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
1000 _....__...—...
8 Will any part of the facility to be constructed under this permit be withhinnfeet 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 Califomia 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 prescnbed 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 COMPLIANC• •1 D AUTH•-IZATIO • 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 . all state la,. and '• ordi :noes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described proper o r •action : rpose . agree of to occupy or allow occupancy of any building authorized by this permit until f�i I inspe • n,
S /Lsdx
:gnature Of g-I Orer(s) - Date
C
And/Or Authorized Applicant Date
COOS 9 INSPECTION TYPE 0E 1011aLE CODE INSPECTION TYPE MATE RfTEL9
1618 Fixed System Final Fire Prevention 206 Final Mechanical
1268 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 arCk-
204 Final Demolition 250 Final Building/Occupancy
byte M CITY OF COSTA MESA
40a - BUILDING DIVISION
• ____ ..� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
�: j`is . PERMIT
+r e / PO4-00396
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2455 ELDEN AV Status: ISSUED
Suite No Applied: 06/03/2004
Issued: 06/03/2004
Vicinity:
Parcel Nunmber: 43928130 ISSUED BY:. /-
Applicant:
Applicant: PATTERSON, ANDREW
Address: 323 EL MODENA AV
Phone: 949-294-9057 CELL
NEWPORT BEACH,CA Zip: 92663
Owner: FERGUSON/DAY PROPERTIES LLC
Address 2459 ELDEN AV
Phone:
COSTA MESA,CA Zip: 92627
Contractor: PATTERSON CONSTRUCTION CORPORATION
Address: 323 EL MODENA AV - -
Phone: 949-294-9057 CELL
NEWPORT BEACH,CA Zip: 92663
License: 802367
Arch/ Eng: •
•
-
Address:
Phone:
Zip:
_ _ . _ License: -
SCOPE OF PERMIT
CONSTRUCT A NEW 2398 SF TWO-STORY SFD(1076 SF 1ST FLOOR AND 1322 SF 2ND FLOOR)WITH
711 SF ATTACHED GARAGE AND 28 SF PATIO COVER AT THE ENTRY.REF: B03-01582.
PLUMBING TO INCLUDE:3 BATH TUBS, 1 DISHWASHER, 1 GAS(1-4 OUTLETS), 1 LAUNDRY TUB,
1 SEWER CONNECT,1 SEWER PRIVATE LINE,3 TOILETS, 1 WATER HEATER.4 WASH BASINS,3
SHOWERS, 1 KITCHEN SINK.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 , Trap Primer $0.00 0
Bathtub $29.40 3 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 • 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $39.20 4
Dishwasher $9.80 1 Sewer Cap for Demo 50.00 0 Wash Basin Set $0.00 0
Drain, Floor - $0.00 0 Sewer Connect - $24.65. 1 Waste and Vent System $0.00 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
244646(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 o1 the Labor Code,for the performance of the
Chwoork for which this permit is issued.
( N.'�fTrave end 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.
���•••���QQQ My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit 1 , ed: one hundred dollars($100)or less.)
❑ I certify that in the performance of the •rk for whi this•.• is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,a..agree Iha ' sh•. • .'.. a subject to the workers'compensation provisions of Sectign 37 of the bbbpppr Code,I shall forthwith
complywith
the: provisions/ Q,t(' 7 6
Applicant Signature: i� Date: r//
WARNING:FAILURE TO SECU-ST: wok/PEN-7M COVERAGE IS UNLAWFUL AND S IS .c. CT AN EMPLOYER TO CRIMINAL PENAL S AND CIV L FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($102. •N TO THE••4 F COMPENSATION,DAMAGES AS PROVIDED •R 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(co. • . it. - .• 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 !ir I Z- Class R
Contractor's Signature: Sallr/r Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: _ __ Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered 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. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if en 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? DI Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 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
(II"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 prescnbed 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 • ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for ins•: • •. agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
a , a 0 Date .
Or i zed Applicant Date
41
•. A 1•. ,' • MI lNhltM45 CODE INSPECTION TYPE =� a97.1618 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