HomeMy WebLinkAbout2457 ELDEN AVE - Building Permits %� 21513 FEE RECEIVED
re
COSTA MESA BUILDING-SAFETY DEPARTMENT SAN31 1964
P.O.BOX 817 COSTA MESA.CALIFORNIA - ((��IITTFIINA��NCE DEPT.
MESA
For Applicant to Fill In Completely APPLIEPIUDIN�FOROPERAMIT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS . —9 -EL AEA, ej4a r
RECEIPT NO. .. .
RMIT NO
PERMIT
COSTA MESA. CALIFORNIA - •��
RECEIV D sY DATE RECEIVED DATE ISSU-su
owNeR
BUILDING
MAIL ADDRESS
ADDRESS Alpo /4 AtFUfAR rSA Il
R� FIRE
IT
CY C.1j74 A16 t4 ND.LYG•6.ae7 ZONE TYPE GR UP
APPROVED /r/� / [/
ARCHITECT TEL.r---- BY `y� DATE /�(O j,
OP ':INFER NO. v//
ZONING r LA '
ADUHE88 ZONE/A ^ 'NO.OF USE OF NEW /
//�� ,I(\ Y PUNS BUILDING
CONTRACTOR hAwJ iN W000 _ ^ //
//�1 ,�, ••{ // LEGAL Pel
cc//�I /!,, / `
ADDRESS ¢t/Q(J /� N�, /. /(/Q ,
DESCRIPTION
Y Y / Y/r�el—, n • O D
CITY C . psi. A.P.NO. / l ` '- C / 2-- a9
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.NO. x.0 33 22 NO. (A TE TEL. y6 --ack7 90'70 BIDES REAR P.L
EAVES
SIZE ////_ ( / I NO.OF BLOGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT (7(I X 3 / NOW ON LOT
USE OF ee YARDS APPROVED YARDS APPROVED
EXISTING BLDG. Ass (�n Cuo/eAORt MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET) �J/�"-{���
SETBACK LINE PROM r // ( FRONT PT. /.3 FT. ae
CENTER OP STRHHT /3/ REAR YARD _
SIDE YARD I LEFT .9/ r- I RIGHT 3f
R.BIDE FT. 3 f FT•
DESCRIPTION OF WORK L.SIDE FT. /✓ .�/
NF _ n ALTERATION ADDITION REAR FT. /(/ FT•b"'•
DISTANCE BET. BET.MAIN 8 / 3 ica----
REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.SLOGS. / / /
VAR.# DATE
BUISIZE�ING^ ' X7-� ROOMS / //Pt
/ C.U.P. APPROVED / �//
EXTERIOR tlWAL�Ia-,mei
ROOFCOVERING /TPtk• B�' .APPROVED/ LIl I DATE / •- .3 /FIAT
COVERING LL/ (/
USE OF BUILDINGIN �� AND WORK TO.BBEPERFORMED ii�If/
/ Cil .
�Q, H
y/ SO.FT. T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE/AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION q
BUILDING CONHTRURIW 0. 0 1 1 `-� —.--
PERMIT
� N
SIGNATURE OF _ NI ,/, / // PERMIT FEB $ / O
PERM ITTEP /y^-^A ///((( 118/`Mrn�./ /3 V s Z'// (�
ttt!!! $ PLAN CHECK $ 5 0
AUTHORIZED AGENT
• \ TOTAL FEE -$
21514 FEE RECEIVED
, IAN s 1 IBM
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX S17 COSTA MESA.CALIFORNIA FINANCE DEPT.
( iI,OFCOSTA MESA
For Applicant to Fill In Completely APPLIC FORRMIT
TYPE OR PRINT /L 8 BUILDING
f For Office Use Only
ADDRESS r/-515 7 ti0641 AI/F-
RECEIPT NO. FIWIIT NO.
COSTA MESA. CALIFORNIA - I,s-/y
/•�GDD
RECEIV877 g ' 2 �//UE‘r
OWNER infet(a A/�. DA N/Jb R/ E HY DA7
t- BUILDING
MAIL p •, ADDRESS •
ADDRESS 52OP a /•.J /Y.EC f/•n T �( 8 71 /
TAi/l( 3 1 FIRE /I//
�q TEL. ZONE TYPE GROUP
CITY C.as-7l1 /lip rig NO.(oVL-1807
APPROV Dfig _ DATE Z
ARCHITECT TEL. BT '�/I""i _...
laGINEER NO. LAZONING
fa
/
EEB ZON \ I PNO.O01-
I BUUILODFINNGEW
CONTRACTOR ��C / // 5 LOW
/^r/ ��`��`///////�^ / -r-,<,3073
A/ 3 i LEGAL ii) _ 4 '
ADDRESS cV-BIIn /3 A/ ,00gr % i//.t - - Duu,PTION �r��''�"• ((
CITY C-:'144 / A.P.NO. / / / o 22- e,f-
goNG. 6 9 - a J 4 NOTE: NO EAVE OVR P.L. SHALL BE LESS THAN
STATE
33 ',+1-"L -TEL 90"TO SIDE ft REAR P.L. •
LIC.NO. /
SIZE
AL
OWED '
OF LOT ¢ p USE OF /// I
NOW ON LOT EAVES
OF
APPROVED IUYARDS APPROVED REQUIREMENT)
EXISTING BLDG. % LC �' �? MAIN BUILDING ACCESSORY BUILDING
AM
(FROM C/L STREET.]�L..,
SETBACK FINE FROM / / FRQNT' J / FT. (�(/L/
CENTER OF stRarr %/��1IT GARAGE REAR YARD OL a {
SIDE YARD I LEFT C!P I-G R I RIGHT ( D —O 1, R.SIDE �QFT. FT.
DESCRIPTION OF WORK L.SID 7CJFT. too r� FT
•
NE y ALTERATION! ADDITION REAR PT. F-I.
DISTANCE BET. BET.MAIN S
REPAIR M VINO DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDIN T' l /T NO.OF VAR.# DATE
SIZE 71 AA 2- •• 4 ROOMS S7 STORIES A- C.U.P.# APPROVED
EXTERIOR WALL ROOF APP EIS
COVERING r COVERING C.- BT • DATE - -6 •
USE OF BUILDING AN_ )VOORK TO BE PERFORMED /� /J �L-V
UN t T iA�J/ ( Cp,Q 0 e_....24.-.4 re
r / ;X...f4�2�,.
// sur �2d u, ./. u2. N
•/7 7D SQ.Fr. B
r.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. X
0
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION p
BUILDING CONSTRUCTIO n / ���A,,,,�/ �/ I7
SIGNATURE OF` �/D_ (L".^'.- „' / / OO PERMIT FEE $ L5--7— X
PERMITTEE y�•� G
$ / PLAN CHECK $ ,/ • Co o
AUTHORIZED AGENT �[• �O E
a N. TOTAL FEE $ al
CITY OF COSTA MESA•
• @ BUILDING DIVISION
>:l ,.,,,, , 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
u 4,. PERMIT F04-00248
(714)754-5273 • Fax(714)754-4856 • www.cl.costa- finkrgt1PRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2457 ELDEN AV Status: ISSUED
Suite: Applied: 09/02/2004
Vicinity: NEW SFD Issued: 09/21/2004
Parcel Number: 43928130 Zoning:
ISSUED BY:
v
Applicant: READ, MARC
Address:
Phone: 949-337-9679
Zip:
Owner: FERGUSON/DAY PROPERTIES LLC
Address ,2459 ELDEN AV -
Phone:
;COSTA MESA,CA Zip: 92627
i
Contractor: READ FIRE PROTECTION -
Address: P O BOX194
Phone: 949-337.9679
SURFSIDE,CA Zip: 90743 ,
License: 837553
"SCOPE OF PERMIT
INSTALLATION OF 28 OVERHEAD SPRINKLERS IN A NEW SFD. -
B03-01583 "
FEE SUMMARY
Plan Check: , $45.01 ' Y �' Calc Valuation: $2,404.00
Permit: $69.25 - Claimed Valuation: $2,400.00
• Other: $0.00
•
Total: $114.26 • --
•
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
•
24443-45(500)
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 carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,a .; v.r/Iould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
r
comply with these provision ? -----
—O Applicant Signature: Date: a `/y�J
WARNING:FAILURE TO SECURE WORKERS'ee 'ENSAT1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CPENAL'ES RIMINAL PENAES AND CIVIL FINES UP TO ON UNDRED
THOUSAND DOLLARE(s100,000),IN ADDITION Te E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions10 e ith Section 7000)of Division 3 of the Business and Prolas3Lpns Cite end my license is in full
force and effect.Llc,8C\ ?37SS 3 Class a0 <r
Contractor's Sign tire: Date: �/ i �j/ JCC./
v 7 li /
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 Dhvsion 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). -
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No 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(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 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'ryes",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 ❑No
8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Le•- • - - ) • D
_-_,-,--9,1r--.
Y
An.'•r .' of Applicant `Lis
ate } _�
SORE/ INSPECNON TYPE PATE . IIRRIALS SODS. INSPECTION TYPE CAIS =AU
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention • 5-/S-05 ate-
.
202 Final Factory Fire Place ' 220 Final Planning Approval
203 Final Sign 222 Final Site '
204 Final Demolition - ' ' 250 ' Final Building/Occupancy
•
•
CITY OF COSTA MESA
44x9 -- - BUILDING DIVISION
4•,''' '�� __''' -ti DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
f
PERMIT
Irral
M04-00295
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
•
Job Address: 2457 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:
B03-01583. -
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
244646(6'00)
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
SivxI 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
ork 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:
Carrier: / Policy Number:
(This section need not be completed if the permit'- :lued et on: undred dollars($100)or less.)
❑ I certify that in the performance of the •rk for which 's permit 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 that if ould•: • : subject to the workers'compensation provisions of Sectl///nnn 370 of the Labor Code,I shall forthwith
comply with these provisions. 3 01/4.4Applicant Signature: Date:
WARNING FAILURE TO SECUR,• • o• PENSA • COVERAGE IS UNLAWFUL AND S n• •= ECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL FINES UP TO ONE HUNDRED
A
THOUSAND DOURE($100,• I •• • TOTHE••. •F COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION Ms OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed undo .#00'
of Chapter 9(c•• :. Ing wi • 7000)of Division 3 of the Business and Professions Code,and my license is in full
force andenact.g Lie.atu A f/I 6 Classat1 /
Contractor's Signature: /i�/ 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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,litle 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 Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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 epermlt 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 LI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPUANCE AND AUTHOR . ••N 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 is.: :nd city• dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspecti•- •urposes.I .•ree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
I tura Of Le!: Ow : s) W /�,�7// A/ Date
/ • d/Or :• • • -•_Applicant I/ /V��I/I Date 1
llP
QOM* friSPECTON TYPE WI M__$ Com* INSPECRONTYPe a or
1616 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
204 Final Demolition 250 Final Building/Occupancy
5 F CITY OF COSTA MESA
449 ►°" BUILDING DIVISION
)-4 K„'e Mt DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
/104-00397
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2457 ELDEN AV Status: ISSUED
Suite No Applied: 06/03/2004
Issued: 06/03/2004
Vicinity:
Parcel Nunmber: 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
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:B03-01583.
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 AND 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 inigation $0.00 0 Landscape Imgatlon $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 $0.00 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
2446<e(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.
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:
Carrier: Policy Number:
(This section need not be completed if the permit lava•:•et one dyed dollars($100)or less.)
❑ I certify that in the performance of -:work for which this •••' -• I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo :,and agree that Ifs,'- : •ecome subje• to the workers'compensation provisions of Sectlggqnnn 37 of the Labor Code,I shall forthwith
comply with these provisi•• Q QI /
Applicant Signature: � Date: `—Jv(1
WARNING:FAILURE TOS • .,
'ORKERS' •'-EN • • • .SPACE IS UNLAWFUL- • SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CI L FINES UP TO ONE HUNDRED
THOUSAND DOLLARS WM..o,IN A••• •' TO THE••..T OF CO •ENSA11ON,DAMAGES AS PROVID • "• • ECTION 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(comma: g with Sec'-n 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Llc.4 yI . Class 4
Contractor's Signature: .,i " Date: n
CONSTRUCTION LENDING AGENCY: 6
❑ 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,end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Coda for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation.certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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 apermit 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 LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state la.- • • ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspecti•• • .• :' agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
a
Ignature O egal Ow ate
Adeill•
n• x r Authorize: dicant Date
LODE r INSPECTIONTYPE DATE 10116.14 CODEr INSPECTIONTYPE DAIS Ui®EL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical z- C
1266 Pool Spa Final 208 Final Plumbing S`19 -05
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
yt' 6 CITY OF COSTA MESA
•
44, 9. - - BUILDING DIVISION
y° m,r„ t , : DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER
V I ......`'.1 l PERMIT
4 E04-00630
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
•
ELECTRICAL PERMIT
Job Address: 2457 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:B03-01583.
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 1 hp $0.00 • 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
•
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.
I 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.
y workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed 1l the permit is vat o•at one hundred dollars($100)or less.)
❑ I certify that in the performance of the •- for whic Is permit is issued,I shall not employ any person in any manner s0 as to become subject to the workers'
compensation laws of California, : •agree that i shout• •._. e subject to the workers'compensation provisions of Sec n 370 of the Labor Code,I shall forthwith
comply with these provisions
Applicant Signature: SOIL ,Date: Vn 3 0
�T1/
WARMNG:FAILURE TO SE T- • ••,'ENSA',[I COVERAGE IS UNLAWFUL AND HALL SUBJECT AN EMPLOYER TO CRIMINAL ENAL ES AND PVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE(S10O,0001,IN A•. 0 THE*.. OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37090F THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under•rovisions of Chapter 9(co'•"' ng cul• ::ction 7000)of Division 3 of the Business and Professions Code,and my license Ls in full
force and effect.Lic.a _r Z 6 7 / L Class F
Contractor's Signature: ��- 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 end 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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No 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,falsowork,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 Cale,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Cade been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,a,ppplication apermit for such construction or modification
from the South Coast Air Ouality Management District or from any other air pollution control district or agency? U Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be famished 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? d 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
B (II 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 stale laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND A •:IZATION 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 stat: city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for Insert ••-es.I agreenot to allow occupancy of any building authorized by this permit until final inspection.
It Legal Ow Date 1110 Date
'/� 'Or Authorized Via... ant _ Date
CODE I It ' a .ll 1' _•- ILLS SODE( INSPECTION TYPE DATE ILLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wail 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
0a4"19 CITY OF COSTA MESA
o BUILDING DIVISION
> Y ..4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
pj4 PERMIT
ittbom'amo B03-01583
(714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2457 ELDEN AV Status: ISSUED
Suite: Applied: 09/17/2003
Vicinity: UNIT B/NEW SFD Issued: 05/28/2004
Parcel Number: 43928131 Zoning:
Applicant: DAY, JEFF ISSUED BY: _:Kf/f. _
Address:
Phone: 949-721-1852
Zip:
Owner: FERGUSON/DAY PROPERTIES LLC
Address 2459 ELDEN AV ' -
Phone:
COSTAMESA,CA; Zip: 92627
Contractor: vPATTERSON 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
0-1 - _ 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 3 NEW 2398 SF TWO-STORY'S FD(1076SF 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 - ,
- - — --- - "----P EE 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
PLANNING-& ZONING, -
SETBACKS -, N ' ;
MAIN STRUCTURE Front 0-0 , Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-'0 -Left 0-0, _ " Right 0-0
PARKING Existing: 0 Required:;- 0 Proposed: 0; ,'`
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(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 carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of 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 SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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 tin�erprovisions of Chapter 9(co • • • •M Section 7000)of Division 3 of the Business and Proyysions Code,and my license is In full
force and effect.Lac.•a /}•O Z3 - Classat : a Cs/C e
Contradar's Signature: Date: j/Jf/b
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,CMI Cale).
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(commenting 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 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 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? ❑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 25517 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 needle prepare an RMPP(Risk Management and Pre_..._....____vention 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
partment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en
__.......RMPP _..__.......__._ety�
P is presently required.has Section 25534 of the California Health and SafCode 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 agermit 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 65850.2 of the Cahfbmia 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 lest from the outer boundaries of a school? ❑Yes 0 No
(If yes',the facility must meat the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.._..__ _.._._ _..i._..
7 Ifa a permit from the SouththeCoast res Quality cri ed Management al or other airCod pollution ooncontrol district3or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Californiaia 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: .. - . -.•er penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materia : : • Emissions.
Signature: Date:
CERTIFlC OF •MPLIANCE AND A - •TION OF ENTRY:I cervi under penalty of perjury that I have read this application and state that the information given is
correct :gree • • •wl a -r:.. antl city ordinances relating to Wieling construction,and authorize representatives of the City of Costa Mesa to enter upon the
a•• : desc roperty for ins:: on pu ••-• agree not to occupy or all occupancy of arty building authorized by this permit until final inspection.
7�X
Signature• Legal Owner(s) ate 2
And/Or Authorize. ... .nt Date
CODE 0 INSPECTION TYPE D"TE 1[itIDSLi ;ODE# )NSPECTION TYPE MALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy