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HomeMy WebLinkAbout2459 ELDEN AVE - Building Permits �i LT CITY OF COSTA MESA • BUILDING DIVISION - j DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT B04-00479 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite: Applied: 03/03/2004 Vicinity: PERIMETER BLOCK WALL Issued: 03/03/2004 Parcel Number: 43928131 Zoning: / Applicant: PATTERSON, ANDREW ISSUED BY: S//� Address: 331 COSTA MESA ST - // Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 Owner: FERGUSON/DAY PROPERTIES LLC Address 2459 ELDEN AV Phone: COSTA MESA,CA Zip: 92627 Contractor: PATTERSON CONSTRUCTION CORPORATION Address: 331 COSTA MESA ST Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 License: 802367 Arch : Eng: LOVELACE ENGINEERING Address: Address: 6496 WEATHERS PLACE Phone: SUITE 200 Phone: 858-535-9111 SAN DIEGO,CA Zip: License: 92121 License: 39734 SCOPE OF PERMIT CONSTRUCT 3 FT HIGH 120 LF RETAINING WALL WITH A 6 FT HIGH 600 LF BLOCK WALL NOTE:BLOCK WALL HEIGHT NOT TO EXCEED 6 FT FROM HIGHEST GRADE PER PLNG. __ . FEE SUMMARY Plan Check: $172.41 Calc Valuation: $15,600.00 Permit: $265.25 Claim Valuation: so.00 SMIP Res: $1.56 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 .J • Total: $439.2i PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front -0-0 Rear 0-0 Left 0-0 Right 0-0 • PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 160 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(&root 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: is s cfion need not be completed if the pe r.Usanl ed at one hundred dollars($100)or less.) certify that in the pertorman , • the work f• permit is issued,I shall not employ any person in any manner so as to become subject to the workers' co tion laws of Cal • I:.and ag - .t If I shou•become subject to the workers'compensation provisions o f Section 3700 the Laggaar Code,I shall forthwith rs_Estiply wit e,p . ;.ons • _ : ApplbDl� ate: 3 2 enfSlgnature: J '3/n WARNING:FAILURE • • 'IR • •-KERS COMPENSATI COVERAGE • :• .••SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND•• 1.•.•••),IN ADDITI• 0 THE COST F 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 derRrovisions of ap•r 9 ••m•-:ncing with Section 7000)of Division 3 of the Buttes nd Professions Code,and my license Is in full force and effect.L c�J C-36? Class � iCo0tracto^, s.Slgnnature:. CONSTRUCTION LENDING AGE •-• . ❑ 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 Sectbn 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,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,ore 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 lime 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 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 Alr Quality Management District or from any other air pollution control district or agency? 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 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for 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 penally 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 :•• • • • -nces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectio• .' •oses.I ogre: of to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Le• • ner(s) _ 71, •r Au • •• CODE t gag INTRUL$ LODE! INSPECTION TYPE 2AIE• lr? 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 2001 Final Re-Roof p/meg /���— � � • 210 Final Fire Prcal evention Final Block/Retaining Wall 0/`•I� AU'?W� 212 Final Fire Prevention 202 Final Factory Fire Place P 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy 4 ' CITY OF COSTA MESA. A1 . BUILDING DIVISION >•to ,,,,,,l4t , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 'Lir� y MI 1 o OPKIlli . PERMIT F04-00249 4%so_/ fr (714)754-5273 • Fax(714)754-4856 • w.ci.costa-r P4fet@e JJPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2459 ELDEN AV Status: ISSUED I Suite: Applied: 09/02/2004 Vicinity: NEW SFD Issued: 09/21/2004 Parcel Number: 43928130 Zoning: ' ISSUED BY: _/ A Applicant: READ, MARC - - — / Address: - - _ 2•" • - Phone:. 949-337-9679 •- .•,_ Zip: - - Owner FERGUSON/DAY PROPERTIES LLC Address '2459 ELDEN AV - - " _ ' ' - Phone: ,COSTA MESA,CA Zip: 92627 Contractor: \IIREAD FIRE PROTECTION ' . ` % 'Address:' P O BOX/-194 - �' . - Phone: 949-337-9679 SURFSIDE,CA Zip: 90743 License: 837553 . ' SCOPE OF PERMIT - INSTALLATION OF 28/OVERHEAD SPRINKLERS IN A NEW SFD. - 803-01584 FEE SUMMARY Plan Check: $45.01 •r ' •/ ,7-' - ' , Calc Valuation: $2,000.00 ' Permit: $69.25 //. _' Claimed Valuation: $2,000.00 • Other: $0.00 -n • Total: $114.26 !,i via , - < - ' -2/:' _ . \c..\ ,/,? '` - . _ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 /. ' 244638(8/00) • /'-7L• 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.) Peer-lily that in the performance of the work for which this permit is Issued,I shall not employ any poison in any manner so as to become subject to the workers' compensation laws of California,and a•,,t t •'t If I should•'come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provislo s l JJ Applicant Signature: -f 4��� Data: 9'2/—� Y WARNING:FAILURE TO SECURE-'ORk 5'r.'•' PENSATION COVERAGE Is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($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 proRr d ter encing with Section 7000)of Division 3 of the.Business and Profess Cade and my license is In full force and effect.Lia A Ft 7 3 7.S-S3 Class# ft—/(00 Contractor's Signature:_ -Date: a v/ --a.,' 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-BUILDIER 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 fore permit subjects the applicant to a civil penalty of not more then 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,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 greeter 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 (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? C]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 Duality Management District or from any other air pollution control district or agency? D Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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: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 for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SignatureajoBr(s) _ / j Z —a/Y A Ian Date T CODE• INSPECTION TYPE PATE MEW./ CODE E INSPECTION TYPE PAIL IKIMALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Sba Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall . 212 Final Fire Prevention, 5-18'0S CGrr 202 Final Factory Fire Place • •• 220 ' Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 'Final Building/Occupancy • ,&:50'!4' CITY OF COSTA MESA ` i �� BUILDING Di1Y1S1ON :j-,:17,....„. ; DEVELOPMENT SERVICES DEPARTMENT PERM UMBER :t. �s I PERMIT 444•PoRnnot E05-00614 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite No E Applied: 06/20/2005 Vicinity: UNIT E Issued: 06/20/2005 Parcel Nunmber: 43928130 Applicant: ANDREW PATTERSON ISSUED BY: Address: 421 31ST ST ; ,' - - - - Phone: 949-294-9057 CELL . NEWPORT BEACH,CA_, -- Zip '92663 " r I i, j - - - Owner:, , FERGUSON/DAY.PROPERTIES LLC Address "2459 ELDEN AV, '- i ,- Phone: ' , ' COSTA MESA;CA Zip: 92627 r 1„, ,„ A ; .� 2„ Contractor: " PATTERSON CONSTRUCTION CORPORATION,, - . . - , Address: 421 31ST ST _ Phone: 949-294-9057 CELL NEWPORT BEACHI:CA Zip: 92663 'N, , • , ` License:802367 -,, N SCOPE OF PERMIT, ;l. r SERVICE PANEL UPGRADE TO 100AA - - WORK TO INCLUDE:SERVICE TO 200A. . - FEESUMMARY ' Quantity - Quantity 'ISSUE.FEE $23.50 , Temp Dill System/Lighting $0.00 0 '' Temp service test $0.00 Busway/100 ft ,, ' $0.00 0' ' . Res.a/c'package, $0.00 Standing Section - $0.00 :0 ' - New Res(1-2 units) , $0.00 0SMisc Electrical Equipment $0.00 /0, New Res(3+units) ' , .$0.00 ' 0 .i:"' Transformers up to 1 kva/kw $0.00 1',0 - Pool/Spa'' , ' $0.00 0 '' - - ' • up to 10 kva/kw . $0.00 r /0 Lighting Fixts-- H $0.00 _ 0 ' ' up to 50 kve/kw $0.00' 0 Recept Outlets.- / $0.00..' - '= 0" up to 100 kva/kw -$0.00 0 Switches . over 100 kva/kw ,$0.00 0 Non Res Appl $0.00 0 , Low Voltage Equipment, x$0.00. - .0' ' Res Appl . ,A ., $0.00' 0 Low Volt Wiring System I Ckt-' $0.00 H-U Service to 200a A ` ,,$30.50 1 o Min':Conduit - %, $0.00', 0, ' Service to 1000a $0:00�� 1` 0 _- '.11--- Misd:Conductor - y\'..\\,,$0:06,'- 0 Service over 1000a �� $0.00 ' ,/,'./; 0 Circus Motors to 1h \$0,00 '- 1 ,o.' -- -- (9ec orride)--o '$0 00-- 0.' P _ v Circus(meth ride or lights) $0.00-- ,- 0 Motors to 10hp '-$0.00,:- ` 0. ; � Christmas Tree Stand• .-$0.00 - 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 0 Motors to 100hp $0.00 - 0'- - \. Other Electrical Fee $0.00 Motors over 100hp $0.00 ' 0 - - ' - 7 , Communication drops $0.00 0 • Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 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(WOO) 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. f4ve and will maintain workers'compensation insurance,as pe required by settlor 3700 of the Labor Code,for the performance of the work for which this permit is issued. %� others'compensation Insurance canter and policy number are: `P.-olicy N4.m ' GQj(aTsx bTr'need not be completed if the permit Is valued at one hundred dollars($100)or less.) 6. co that in the performance of the work for which this permit Is issued,I shell not employ any person In any manner so as to become subject to the workers' pensation laws of California an• :.roe that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith mply with these provis•••. Applert at •� Date:_ ----4/7.--,)/11 �Tmw 9q v W FNLUR- W- WORKERS'.., th0N COVERAGE IS •• AND SHALL SUBJECT AN EMPLOYEH�r?O'&CRIMINAL P AN FINES ONE HUNDRED THOUSAND.. - (S10e000),1• .,•. .• 0 THE.•LT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr fesslons Code,and my license is in full force mdef1%M �O'�1 '2 class,acc / cora c t 's ✓" /C )„........--\\__ — D tS 2 o/ C 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). 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 DMslon 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 fora 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 then 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 ❑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 materialsr 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 es will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 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 a2Permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? j1 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). 8 Will arty part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If-yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). • 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for 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 - • s.s and city ord'r=. '5 relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props -••• •• •. -•ree not to..• py or allow occupancy of any building authorized by this permit until final inspection. ure••♦ s es er(s) 4dilr-- CODF S, INSPECTION TYPE PAIL EMU CODE( INSPECTION TYPE gag =AA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ` j��' �jy�/ f 200 Final Re-Roof 210 Final Electrical /p7 gln.J� L�Z r V 201 Final Block/Retalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Slte 204 Final Demolition 250 Final Bullding/Occupancy 0 SS CITY OF COSTA MESA . • BUILDING DIVISION >__J el Irlitt 7- DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER PERMIT • J*`b+. m.* G03-00012 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 GRADING PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite: Applied: 09/17/2003 Vicinity: Issued: 03/31/2004 Parcel Nunmber. 43928131 Zoning: ISSUED BY: Applicant: PATTERSON, ANDREW Address: Phone: 949-294-9057 Zip: Owner: FERGUSON/DAY PROPERTIES LLC Address 2459 ELDEN AV Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Eng: VALLEY CONSULTANTS INC Address: P O BOX 10516 Phone: 949-650-5430 NEWPORT BEACH,CA Zip: 92658 License: 29329 SCOPE OF PERMIT CUBIC YARDS GRADING IN CONJUNCTION WITH CONSTRUCTION OF 3 NEW 2398 SF TWO-STORY SFD WITH 711 SF ATTACHED GARAGE NOTE: OVER EX IS 2300 YDS WITH 200 YDS CUT AND FILL WORK TO INCLUDE: PAVING, CURB, GUTTER, CON,,STRUCT DRAIN INLET& LINE. 200 0-Y" -C Qr-c_` . „Al C44 ifCLOM oP^• 3/4/a>7 FEE SUMMARY Aft" Plan Check: $33.00 Calc Valuation: $50,000.00 $0.00 Permit: $54.50 Other: $0.00 $0.00 • Inspection: $0.00 $0.00 Total: ' $87.50 PLANNING &ZONING - NOTES: 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(WOO) • .--4 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. - • ❑ t have and will maintain workers'compensation insu nce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'corn at/ig/p Innsurance carrier a Ilq number are: Carrier: /Y Policy Number: (This section need not be completed f the permit - •:u:•at one hundred dollars(5100)or less.) I certify that in the performance of t ork for Ich 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 - d agree ih- if I shout. •:come subject to the workers'compensation provisions of Sec n 3700 1 the Labor Code,I shall forthwith comply with these provisions , �� �� Applicant tore: Date: WARNING:FAILURE TO SECURE( • :: •• pENSATHt ERAGE IS UNLAWFUL AND LSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND cam NES UP TO ONE HUNDRED THOUSAND DOLLARS(Sf00.00e).I• TO THE COST•-•• - TION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ns 0 hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.Lis.0 L 7.('7 Class If bontractors Signature: / Date: / CONSTRUCTION LENDING AGE Y: O 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.). O I,as owner of the property, - CLUS ' LY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors ' ense Law does of apply to en owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to •:Contractors Lice. e Laws.). ❑ I am exempt un.:r sec. a Business and Professions Coda for this reason: ' t Signature: • Date: l/Q OWner ID ed• •nv: s'icons: 0 ell 0 No Drivers License No. Expir 5: Verification o Owners •by . .e 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 Cale). ❑ 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 end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health-and Safety Code requires,with some exceptions,that a Business,Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _.. _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic:feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. • 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No - _ ant..osent or building ;quire _ _ .._..._ __ _ 5 Does hr wo the ep st Air u present ar emen bustling o from at yothr for the work ontr l districtis the or age c this a estion appermit torr such con5tmction or modification - Irom the South Coast Air Quality Management District or from any other air pollution control or agency? �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? El 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 •:: •UTHORRA •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 : state laws and • .inances relati.• to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property fo ' spection purpos'.. agre not to caw y or':How occupgnay of any building authorizedb thisrrtllt until fi al Inspection. / Signatur=• Legal•` ner(s) 1 U/oJ��7yIN'J'JJ 3 L// ljl� ate 1 •nd/Or Authon :• •pplicant Date ;ODE 1 INSPECTIONTYPE ;AD: MALS ME it It&ECRON TYPE OM IIMALS` 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 204 Final Demolition 250 Final Building/Occupancy 8 9 LS • •4 • I . 51 CITY OF COSTA MESA BUILDING DIVISION Ff.„ DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER PERMIT 03-01587 .44 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.GluSLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2459 ELDEN AV GUI Status: ISSUED Suite: Applied: 09/17/2003 Vicinity: Issued: 09/17/2003 Parcel Number: 43928131 Zoning: Applicant: PATTERSON, ANDREW ISSUED BY: Address: 331 COSTA MESA ST Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 Owner: FERGUSON/DAY PROPERTIES LLC Address 2459 ELDEN AV Phone: • COSTA MESA,CA Zip: 92627 Contractor PATTERSON CONSTRUCTION CORPORATION Address: 331 COSTA MESA ST " Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 License: 802367 Arch : - Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLITION OF 4 UNITS(2 DUPLEX UNITS)ON A LOT IN CONJUNCTION WITH CONSTRUCTION OF 3 NEW DETACHED 2-STORY SFD. • TITLE REPORT SHOWS 2723 SF EXISTING UNITS(2 DUPLEX UNITS). PROPERTY OWNER NOTIFIED THAT NOTIFICATION REQUIRED TO BE GIVEN TO AQMD. FEE SUMMARY • Plan Check: $0.00 Calc Valuation: ' 54,000.00 Permit: $97.25 Claim Valuation: $4,000.00 SMIP Res: $0.00 SMIP Com: " $0.00 . Other $0.00 - Inspection: $0.00 Total: $97.25 PLANNING &ZONING SETBACKS - MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 / ACCESSORY Front 0-0 Rear 0-,0 Left 0-0 - Right - 0-0 PARKING Existing: 0 Required: 0 Proposed: - 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21.92) EXPIRATION; Thls 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 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: S Hon need not be completed if the•.. .is valued et one hundred dollars(S100)or less.) I certify that in the performance•••• • for which this pa • '• ssu•• I shall not employ any person In any manner so as to become subject to the workers' pensation laws of Callfo ., • • ..ree that if I shouts •:come sub', t to the workers'compensation provisions of Section 3700 oft Labor C ,I shall forthwith comply with these provisi• -. Applicant Signature: Date: /9 / 7 3 WARNING:FAILURE TO SEs - '" ERS'COMPENSA'• •• RAGE IS UNLAWFUL AND SABJECT AN EMPLOYER TO CRIMINAL PE TIES AND L FINES UP TOONE HUNDRED THOUSAND DOLLARE(510,000).IN-r OfiION TO THE COST• 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• • •nco ChgPIwith Se )of Division 3 of the Business and Proles s C de,an my license is In full force end effect.Lic.N4 ea 4 b Classitt Contractors Signature: � Date: • 7 /7 D i CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction len• g 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(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,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(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? 0 Yes 0 No (Section 25505 of the Califomla 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 then 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 Mese 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). .._ _ need ___.. ...._.._ r_...- 3 Does sr will the applicant or present or future building occupant neto prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomla 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 ey businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 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 plicationU a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the factlity to be constructed under this-pe-rmit be within 1000feet 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). —...._.t._.. _._ __ ist _ __ .._...___ ._u __._.i_ 7 a a permit from the South Coast s Qualityced by CaliforniaDistrict or other air pollution control district3 or agency is required for the work which u the subject of this application,have all of the disclosures prescribed by CalifoHealth 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 AUTHO'. •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 I: and ci r ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectio• •urposes agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. "nit e Of :.al Owner(s) Date /7/// 03 • utho'••- •,••scant ' D e V PALE tflilALS CODEC INSPECTION TYPE MI gER/LS 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site at 204 Final Demolition olition 250 Final Building/Occupancy • CITY OF COSTA MESA �� ►)",. BUILDING DIVISION - >:� DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER • PERMIT IPPICal ,y. P03-00603 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite No Applied: 09/17/2003 Issued: 09/17/2003 Vicinity: 4111, Parcel Nunmber: 43928131 ISSUED BY: Applicant: PATTERSON,ANDREW Address: 331 COSTA MESA ST Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 • - .- Owner: FERGUSON/DAY PROPERTIES LLC Address 2459 ELDEN AV, Phone: COSTA MESA,CA Zip: 92627 Contractor: PATTERSON CONSTRUCTION.CORPORATION Address: ' 331 COSTA MESA ST - Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 License: 802367 'Arch / Eng: , - • Address: Phone: • Zip: License: - SCOPE OF PERMIT SEWER CAP IN CONJUNCTION WITH THE DEMOLITION OF 2 DUPLEX UNITS. REF:B03-01587 • FEE SUMMARY • AMT QTY • • AMT QTY ° - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer - $0.00 0 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 $0.00 0 . 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 Vacuurim Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 - 0 Sewer Cap for Demo $9.80 1 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 . , 0 - Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar - $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $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 2448-48(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: Cl 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. O 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 riled. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (Thlsection need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance o work for w ' h this permit is issued,I shell not employ any person in any manner so as to become subject to he workers' mpensation laws of Gallic ,and a•ree tha I sin, • •ecome subject to the workers'compensation provisions of Section 3700 of a Labor e,I shall forthwith comply with these provisi � Applicant Signature: Date: - V WARNING:FAILURE T EN •• COVERAGE I •••'" L AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL P ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR ,000),1 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 p • : psoChapter 9(commencing with Section 7000)of Division 3 of the Business and Pr Ions Code•an my license Is in full •force and effect.L lc.p N a J Class Contractor's Signature: SW Date: `t o CONSTRUCTION LENDING AGENCe O 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 end 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 dMsion. 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 ❑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 compiled 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 a—Permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes P No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 —Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 sir 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 A 1-•-IZATP 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 stat: .ws end ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe• •n purposes. :gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ature Of L:•: • /late r • .ho'•••Ilcant %ate CODE. . '.er:' ,1- RAIL DEW CODE INSPECTION TYPE DAIL g4MAL$ 1618 Fixed System Final Fire Prevention _ 206 Final Mechanical 1288 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 9 ' Mac CITY OF COSTA MESA 4 BUILDING DIVISION - Y•:j :-4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER Ii ` PERMIT 03-00841 J (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite No Applied: 09/17/2003 Vicinity: SITE FOR 3 NEW DETACHED SFD • Issued: 09/17/2003 Parcel Nunmber: 43928131 Applicant: PATTERSON, ANDREW ISSUED BY: Address: 331 COSTA MESA ST " - 41W-- Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 - A Owner FERGUSON/DAY PROPERTIES LLC- Address "2459 ELDEN AV " , - - Phone: COSTA MESA,CA Zip: 92627 , Contractor PATTERSON CONSTRUCTION CORPORATION Address: 331 COSTA MESA ST Phone: 949-294-9057 CELL COSTA MESA,CA Zip: 92627 License: 802367 SCOPE OF PERMIT TEMPORARY POWER POLE IN CONJUNCTION WITH CONSTRUCTION OF 3 NEW DETACHED 2-STORY SFD. • FEE SUMMARY Quantity - - - Quantity ISSUE FEE $23.50 • Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 " New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 -0 Pool/Spa - $0.00 0 - up to 10 kva/kw $0.00 -0 , Lighting Fixts $0.00 0 'up to 50 kva/kw $0.00., 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 -" , 0 - - Switches • $0.00 0 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' Motors over 100hp $0.00 0 , - - - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 - Plan Check Fee ' - $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 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 244&48(MO) 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 Ls Issued. My workers'compensation Insurance carder and policy number are: Canter. Policy Number: (fhiysection need not be completed ll the It Is lued at one hundred dollars($100)or less.) I certify that in the performance the work r which this permit is Issued I shall not employ any person in any manner so as to become subject to the workers' pensation laws of Califo ,and agr that If I should become subject to the workers'compensation provisions of Section 3700 of a Labor e,I shall forthwith comply with these provisi Applicant Signature: ADate: 7 v 3 WARAN: DOLLARS ET( 1C CU COMH ST O COMPENSATION,UNDA PAL MD SPALLIDED SUBJECT I AN E EMPLOYER TO CRIMINALTHE P DIES MD CML RDFS TO TO ONE HUNDRED THOUSAND DOLLARE(5100 ,IN ON TO THE COST OF DAMAGES AS FRONDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under pwl3l nsit•{yhapJer menclng with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lk.# �(� C– b Class a) Fc,Ci z>36 7 Contractors Signature: Date: 1 7 03 CONSTRUCTION LENDIN NC • ❑ 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 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 she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,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.It,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: 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). _ ...._..__.. __ _.—_._..___ _____ s._._. ......... _. _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Vas 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 Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑yes ❑No 5 Does orwill the applicant or present or future building occupant require for the work which is the subject of this a plication appermit 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 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 7666 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end 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 AUTH TON 0. •Y: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 I and city or• ances relating to bui• •- •nstruction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectto s.I agr•: not to occup • : ow••••pancy of any building authorized by this permit until final inspection. /7/3 4izedAppllca.i ate , gQDF 1, INSPECTION TYPE PATE IMALS BODE( INSPECTION TYPE RA3 SLS 1616 Fixed System Final Fire Prevention _ 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 6 O ,8E4.2Kf' 201 Final Block/Retaining Wall 212 Final Fire Prevention �fffjlll� 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy pSTA MF CITY OF COSTA MESA 44,aa - BUILDING DIVISION -f a __ DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER I. __ i l iii . PERMIT M04-00296 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2459 ELDEN AV Status: ISSUED • Suite No Applied: 06/03/2004 Issued: 06/03/2004 Vicinity: Parcel Number: 43928131 ISSUED BY' .--1499._/_ 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: B03-01584. 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 Ref rig 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< 10000dm $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 2446-40(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 kwork 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 touted. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number (This section need not be completed if the permit is vat :.. • one hundred dollars($100)or less.) ❑ I certify that in the performance of the . . for which is 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 • ,gree that it . : •:••me subject to the workers'compensation provisions of Sect 37gg9000 of the Labor Code,I shall forthwith comply with these provisions. (.-9 3 —+ Applicant Signature: Date: WARNING:FAILURE TO SECUR ••'• .-S'••- -ENSA •2i,•• ERAGE IS UNLAWFU •• D SHALL SUBJECT AN EMPLOYER TO CRIMINAL.P NAL ES AND C VIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,.••, •AD• •. 0 THE COST•' COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. .....-- LICENSED LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(co • encin! id',Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.a _ase — Class ff ConlractoYs Signature: IfrAllW Dale: f CONSTRUCTION LENDING AGENCY: O 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(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 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: I Will the applicant or present or future building occupant need to file end 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 end Safely 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 forth 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 ❑No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application appermm it for such construction ormodification 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). 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 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 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 AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have road this application and state that the information given is correct.I agree to comply with all state laws afinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection pu ••j:• Y:t•:a not to occupy or allow occupancy of any building authorized by this permit until final inspection. i Sign: .Of Lege • a Date p:'- ..dzed •�•,yant Date toner. • ' qt.. L' QM Mal CODE If INSPECTION TYPE �2&1561' 11 . . 1616 Fixed System Fina ire Prevention 206 Final Mechanical �� [%L/�� A /L. 1266 Pool Spa Final 2013 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 �5E"M CITY OF COSTA MESA \ 44 I II ►9 BUILDING DIVISION Y:� PERMIT NUMBER �m �I DEVELOPMENT SERVICES DEPARTMENT t IPA i PERMIT VP04-00398�' ami (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite No Applied: 06/03/2004 Issued: 06/03/2004 Vicinity: Parcel Nunmber: 43928131 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:B03-01584. 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 Bkfow(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 2446-46(600) 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 carrier and policy number are: Cartier. Policy Number: (This section need not be completed it the palm/Us valu:.• - one hundred dollars(S 100)or less.) ❑ I certify that in the performance of the w•• or whi a Is permit issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,an. •ree that I should•. • = subject to the workers'compensation provisions of Sectio 3700 the Labor Code,I shall forthwith comply with these provisions. 2 Applicant Signature: Date: Ce 27 WARNING:FAILURE TO SECU:, •'- • SATI•�••• RAGE IS UNLAWFUL AND SUBJECT Ni EMPLOYER TO CRIMINAL TIES AND FINES UP TO ONE HUNDRED THOUSAND DOUARE(51011000),IN AD• • TO THE• . COMPENSATION.DAMAGES AS PROMO D FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under• °visions of Chapter 9( • .. . g with ion 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a :" 2. _ 7 ' Class a• Contractor's Signature: Aiar Date: CONSTRUCTION LENDING AGENCY: afr ❑ 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Ls 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(5500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense 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 Ucense 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 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 feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Cale 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, ._._ ..._ __._ __...t.._._.._._._ .� 4 If an RMPP is presently required,has Section 25534 of Ne California Health and Safely Cotle been fully complied with? 0 Yes ❑No .t._ _.._.._ t work or modification 5 Does he So the oast Air or present a future bustling occupant at requirehfor the work which the subject c this a lies apermli for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �vas ❑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 O No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a ermit 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? ❑Yes 0 No 8 (II yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally 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 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 lawordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspectio •• •• :. agree not to allow occupancy of any building authorized by this permit until final inspection. �e:nature Of =gal Ow4 /(/ O ate • Authorize•• licant Date ;ODE t • . w. lEi all !tom ;ODE( INSPECTION TYPE PATE ?MAU 1616 Fixed System Final Fire Prevention 206 Final Mechanical z' G ,Q 1266 Pool Spa Final 208 Final Plumbing 'I ('�S 9-)IY 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 D9 Mac ytCITY OF COSTA MESA 4� 9 - BUILDING DIVISION >y ..t, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 1. PERMIT E04-00631 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite No Applied: 06/03/2004 Vicinity: Issued: 06/03/2004 Parcel Nunmber: 43928131 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:B03-01584. 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 10kva/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 244646(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 work for which this permit is issued. ave 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: Cartier: Policy Number: (This section need not be completed If the permit Is valued- a u ,red dollars($100)or less.) ❑ I certify that in the performance of the work for • ich this per it Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agre: at If I shout. •. • e.ubject to the workers'compensation provisionsof Sect n 3700of the Labor Code,I shall forthwith comply with these provisions. r/ / Applicant Signature: — Date: \ WARNING:FAILURE TO SECURE WOR -• v PEN I• )L: ERAGE IS UN. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND VIL RHES UP TO ONE HUNDRED THOUSAND DOLLARE($10p000).IN)P' • TO • COST• I. PENSATION,DAMAGES AS--• IDED FOR IN SECTION 37080F THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 0(commend... -action 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.a _�• _ ./ Class x Contractor's Signature: /�—� Date: / CONSTRUCTION LENDING AGENCY: o 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,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 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 then thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). o As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e 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 feel 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 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 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 motlification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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? 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 A ••- •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 all s = aws and 'y ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i -.ec ion purpose-. agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1 • • ee' Owner(s) Date •r Auth'rized A.•licent \._ Date CODE 6 I .orRAIL QfmIAI5 CODE( INSPECTION TYPE RAIL 1HImSLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 5"- fr 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 CITY OF COSTA MESA 4BUILDING DIVISION ,) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT ithbosisro B03-01584 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2459 ELDEN AV Status: ISSUED Suite: Applied: 09/17/2003 Vicinity: UNIT C/NEW SFO Issued: 05/28/2004 Parcel Number: 43928131 Zoning: Applicant: PATTERSON,ANDREW ISSUED BY: Address: ' Phone: 949-294-9057 Zip: Owner FERGUSON/DAY PROPERTIES LLC Address 2459ELDEN AV • Phone: COSTA MESA,CAI 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 3 NEW 2398 SF TWO-STORY SFD(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 FEE SUM_MARY 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 Irispection: $0.00 Total: $2,957.22 PLANNING&ZONING_ :. , ' SETBACKS \ MAIN STRUCTURE Front 0-0 Rear 0-0 Left . 0-0 , • Right 0-0 j ACCESSORY Front 0-0 Rear 0-0. -Left 0-0 ' Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 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. O 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 valued at one hundred dollars($100)or less.) ❑ I certify that in the performance o e work for ich this pe ..Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo '-,and agree t if I shoul. .=come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi•••. Applicant Signature: Date: WARNING:FAILURE TO S.# R. •- PENSA•r• ERAGE IS UNU" - • -. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARE ' r•,00D), •••TION TO THE•• 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 underc^ provisions of Chapter 9( •• en g with Sec .1 7000)of Division 3 of the Business end Professions Code,and my license Is In full force and effect.Lic.N 8 n D 3 C. 7 Class k /L Contractors Signature: Ser_ Date: ,TL.Vc, 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). 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 DiWsion 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).): O 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 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ... _ _...._ _ _....__materials)? 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 maaterials)?)? ❑Yes ❑No (Section 25534 of the California Health and Safety Cale provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aIermit 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 Califomia 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? ❑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 ❑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 CO. - INCE AND • 1 •14 ' r, , • -NTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t• amply with all stat: :ws :•• city ordlna• es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri•.. property • ' pe •n •ses.I agree •t to occupy or allow occupancy of any building authorized b thls permit un final inspection. S .Z>< Signal a Of =gal Owner(s) Date And/Or Authorized Applicant Date CODE f INSPECTION TYPE gdIE ltaMhL2 E9DF( INSPECTION TYPE PATE RIIITAAUU 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 Applicant to fill in all spaces within heavy border lines andsign all appropriate declarations, CITY OF COSTA MESA PE IT NO. TRACT NO. LOT NO. BLDG.NO.s 5_676_ .5/1082 55.00 ' TL CONSTRUCTION PERMIT 3997 Project Address�'(/ I I� �/ ^���?iJ ��/!i�- a TYPE OF CONSTRUCTION , Ownein�/.v;q#r y/"j�j S",L/A `v-s Phone9.,r7-07e/ ❑ NEW 0 ADD 0 ALTERATION AL- Address„ 4LYMI,. )F « Lt ente !/r t sr 4 0 REPAIR 0 CONVERSION ❑DEMOLISH Arch/Eng. License No. 0 OTHER ZONING REGULATIONS ..D�ESCRIPTION OF WORK /, A.P.# " \ Address mil �1-7.0-1/-5-'Ai�'7 /,5,71-ee- /7e, re' / ZONE PLNG. REF.TA eic Contractd�p �,, Yiiin-r/wit.. Phone l um, TYPE OF PERMIT BUILDINGSETCK L ST. XRdiP IlFFILINE I Address/S33 bl 4/,.0 P/,✓ 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL OPLUMBING ❑MECHANICAL siDE YARD 1 I hereby affirm that I am licensed under provisions of Charter 9 (com- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER ID Professions Code, and my license Is in full force nd effect. 'REAR YARD(TO P/L) \ License Class e PROJECT DESCRIPTION PKG.SPACE REQ. PROVIDED Date y./6-tZ' Signature _ - - License No / / S-4.AdsJ e.x , _ SQ. FT. WORKERS'COMPENSATION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE 5 I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers' Compensation Insurance, or a certified copy SPECIAL CONDITIONS: thereof (Section 3800 Lab.C.). GRADING CU. YDS. ACRES Policy No. O4-rJ-D CompanyA94Ve r 1-!<, r Lertifled copy is hereby furnished. - REMARKS: ertlfied copy is filed with the city Building Division. L..CMPTION FROM WORKERS' COMPENSATION DECLARATION (This seocti en need not be completed if the permit is for one hundred 10I 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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subjectto the Workers Compensation Laws of California. uwtLLlrvb IaH XHOt Date Signature BATHTUBS SHOWERS SO FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0.1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW 50 + KW revoked. CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR). 10-50 HP 50+ HP formance of the work for which this permit Is issued (Section 3097 Clv. C.). FLOOR SINKS FLOOR DRAINS - FIXTURES . OUTLETS SWITCHES Lender's Name Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS - OWNER BUILDER DECLARATION CLARIFIERS - POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP - CUNSI XUL IIUN - Any city or county which requires a permit to construct, alter, POLES METERED SUB Improve,demolish or repair any structure, prior to Its issuance,also re- WATER SERVICE ALTERATION PANELS' MAIN SUB ' quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS • SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT ' - ,2 D O . basis for the alleged exemption. Any violation of Section 7031.5 by any,z&pllcant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS - - of,,`.t ;more than five hundred dollars ($500). ❑:,u1,, owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS . \ ' sold umpensation, will do the work,and the structure Is not intended _ or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. ISSUE FEE • Contractor's License Law does not apply to an owner of a property S 436) APPLICATION APPROVED BY DATE who builds or Improves thereon, and who does such work himself or ISSUE FEE through his own employees, provided that such improvements aro not Intended or offered for sale. If, however,the building or Improvement MECHANICAL PLAN CHECK _SUMMARY OF FEES is sold within ono year of completion,the owner will have the burden of proving he did not build or improve for the purpose of sale). BUILDING HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with AND DUCTING ' �, licensed contractors to construct the project (Section 7044, Business 100,000 + BTU _ PLAN CHECK $— PERMIT and Professions Code: The Contractor's License Law does not apply to , v� ISSUANCE $ - ' tan racts owner suchp projectsowithlds or contractoores(s)theresned pursuant and who oto REFRIGERATION 0-100,000 BTU PLUMBING E the Contractor's License Law). SYSTEM 100,000+BTU PLAN CHECK $ GRADING $ ❑ I am exempt under Section • B.& P.C.for thisBOILERS BTU ELECTRICAL $ $_ reason - - PLAN CHECK $ MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE$ -7• e--eS I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ Information is correct. I agree to comply with all city and county PLAN CHECK $ VANCE PC $_ ' ordinances and state laws relating to construction,and hereby authorize representatives of this city to enter upon the above mentioned ' property fof jp spection Dur ses.Q1 L, C Signature �//n4>-L 5- rn-- ISSUE FEE CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor ne%wX -749r :/f/Se e e ftOM✓ • CONSTRUCTION AND PLANNI.�p}J� POOL&SPA • APPROVALS Permit # �9 Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation - 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines,P-Trap, ❑Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55. Plumbing System - Final • 14. Rough Electric-Conduit .56. Electrical-Final 15. Rough Electric-Wring 57. Solar System-Final 16. Rough Heating & Air Conditioning b8. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test - 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation . 24. Lathing & Siding 25. Drywall Nailing 26. • Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating &Air Conditioning 30. Final Gas Pipe-Test _ 31. Final Plumbing i17'/fZ_ ar 32. Water Service-Final 33. Gas Service-Final 34. Solar DomesticFinal 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE& BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY • No Date 14186 •• FEE RECEIVED - COSTA MESA BUILDING-SAFETY DEPARTMENT __ 271501' eoN P. O. BOX 917 COSTA MESA. CALIFORNIA �J Applicant to Fill In Completely !%, FINANCE DEPT. For P Y cg APPLICAMPN Si71C0IrA AMESA TYPES OR PRINT -/• // BUILDING i BUILDADDRESS z / y l<C/e-(� - .�1 COSTA MESA. CALIFORNIA For Office Use Only '. RECEIPT NO. I P �1� OWNER l�u MAIL / REC81V BY DATE RECEIVED Owie a eD ADDRESS..„.760 J //J/,,'J /' .' 0 • BUILDING ,e) ji / ;*-- 7^4//�V TC Lam. /IFC-C;a NECY;9(P I ADDRESS (J / 764://6„. CITY — CITY /j V 6l ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER /,/(,(LI NO: ADDRESS FIRE �I / t Ai.14- - ZONE TYPE AGROUT/pCONTRACTOR/,(/! -CL{G�'/ BYPRO/VE 2/ - DATE // ADDRESS J ZONING' - ZONeg^[ 1/ NO.OP USE OR N8 CITY \ lJ I PLAN/e/ //I BUILDING STATEIC.NO. TEL. LEGAL ` /' /. �n eH� LIC. NO. LEGAL PTIo / (((GGG �^� vl NO. or OF LOT SIZE �Q (,{� ) /Q �/ I.NNOWW ON LOTS © A.P.NO. //y - v 2-4-�7- USE OF YARDS EVES EXISTING BLDG. CA!.)- 7 ,- APPROVED ALLOWED yq CENTER OP STREETSETBACK LINE ,7f / ,9P�REAR YARD FRONT OMR unE ST.) 4 FT. 4 -2-- - . IN. SIDE YARD I LEFT q I RIGHT 5 , R.SIDE - 5-FT. IN. DESCRIPTION OF WORK3 �/ L.SIDE (� FT. IN. NEW I x II ALTERATION I II ADDITION I REAR 6 FT. / ' l IN. REPAIR I II MOVING I DEMOLISH I B,,PROVED/ I �I DATE `) -O �6I BUILDINCCn�� ' / NO. OF l/�-� O` r -y(/ SIZE �O ,( 7 z ROOMS STORIES V_ EXTERIOR WALLROOF , COVERING I COVERING4 "(f Jr USE OF BUILDING AND WORK TO BE P RF MED '- n- �ofT Dei Vi • 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 PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTIO VALUATION SIGNATURE OF 0a PERMIT FEE $ 7- N PERMITTEE '��_— j $ / �vv PLAN CHECK 1/2 $ / 4 AUTHORIZED AGEN U// /c7 Q TOTAL FEE d " 14187 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENTI BEAR 21 ISI 0 uJ P. O. BOX 917 COSTA MESA. CALIFORNIA • FINANCE DEPS`, For Applicant to Fill In Completely APPLQXT&CI 4ti MOAT STYr!..7. �R INT BUILDING BUILDINGADDREss /e/nS< COSTA MESA. CALIFORNIA For Office Use Only �/ RECEIPT NO. PPH/RMIT)iO... OWNER Ail/ /7 IS / MAIL �T RECB�H�yD BY DA RECEIVED ) /DATE IHHUUAD ADDRESSYIQ ea /It• - Y / yy °� / iL " I S^-?7-6, / -�.. -4/ CITY (e's-74,- n7 TEL. 1 ��. BUILDING 72-S.v� NO / ADDRESS ARCHITECTTEL. COSTA MESA. CALIFORNIA OR ENGINEER "17414-- NO. FIRE ' ADDRESS C . ..�./„C ZONE TYPE V// GRO/UV 4 CONTRACTOR ((//IP('D j \BYPROVED (97)i1�/ DATE' /`- / ADDRESS ZONING • Clry ZONE �1 V I NO.OP IUSEOFNE UDH OP NH / P\1 PLANE BUILDING , / STATE TEL. LEGALR f /'11 1< , LIC. LEGA I C/,p•( -• • SIZE /� / // NO. OF BLOCS. �1 OF LOT ge, /I 30 J I NOW ON LOT Q A.P.NO. I1 0 2.....>-.10" USE OF �� YARDS l EVES EXISTING BLDG.C //.GP////� _ APPROVED ALLOWED SETBACK LINE FROM / / (CENTER LINE ST.) CENTER OF STREET OG REAR YARD/a-� FRONT CL FT, I IN. 4. SIDE YAAD I LEFT p / I RIGHT t/ / R.SIDE .5-FT. IN. DESCRIPTION OF WORK L.SIDE 2 FT, IN. NEW I .. II ALTERATION I II ADDITION I REAR / 7FT./.,!`\ IN. REPAIR I II MOVING I II DEMOLISH I BvPROVED)/) / I 0C-- 7/ �ATE 3 -,..--7 7-Ln' SSIZE.DING 9/y A .//ROOMS \NO. OF 5 STORIES� / / EXTERIOR WA /I I ROOF _/- Ped COVERING arc COVERING /��f At A J° USE OF BUILDING r 77AND WORTS TO BE PERFORMED /`j e�� � ..„-' 150 0 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 OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION ' SIGNATURE OF /1 pe..--/-2„.• 96" >/ PERMIT FEE 5 0 PERMITTEj /1 ^,/ e_ "" �I S i ' 1 PLAN CHECK $ /�� R' AUTHORIZED AGENT L L/�- 0 TOTAL FEE $ 7 y • • L 4.4188 FEE RECEIVED • COSTA MESA BUILDING-SAFETY DEPARTMENT UR 24 1961 e W P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLGSXTP! PMP Oggir Ng-a:21407 OR PRINT BUILDING AD RESS O6 r'T�3.Tfl� J EID N „sr • ' COSTA MESA, CALIFORNIA For Office Use Only /� OP/72 RECEIPT NO. I 72.11;77,1 OWNER 6!/�` ff ISSE MAIL • RBCHIV • BY I DATE -ECEIIVBO DATE ISSUED ADDRESS • . - - /^'- TEL. • BUILDING CITY/I S a /122e.c A✓ N• •'><V f/ ADDRESS ' ARCHITECT ,,,nTEL. COSTA MESA. CALIFORNIA OR ENGINEER {y t�I'J a,' NO. FIRE ! ADDRESS y l.Y/A//P // n ZONE TYPE I/ GROUP�� //(/ CONTRACTOR/J �' {,Z'[ 2jII.CIGILL APPROVED DATE //�/ !/ L ADDRESS C[/ ONING '/��.��.�{��y��� 'y''�/ ZONE NO.OP I U88 OF NHW I� V - CITY PLANE r2. BUILDING STATE TEL. LEGAL c // r /� LIC.NO. /. NO. DESCRIPTION /' b / '\ -0 NO. OF OF LOT ei, / ?O 3 ' I NOW ONLOTO A.P.NO. I / -! _ 0 .2'3-- 0-9 USE OF YARDS - EVES EXISTING BLDG.Cat'fib /<'LS APPROVED ALLOWED SETBACK LINE FROM // / / • (CENTER LINE ST.) CENTER OF STREET SO REAR YARRD/2 FRONT LJ t FT. IN. SIDE YARD I LEFT �0 / I RIGHT .5 / R.SIDE CET. IN, DESCRIPTION OF WORK �J L.SIDE �Q FT. IN. NEW I II ALTERATION I II ADDITION I REAR /`4 FT. ��k� - REPAIR I�II MOVING I II DEMOLISH I BYPROVED/,. I / / 2,fATE 3 ) -7'-‘/ BUILDING ply NO. OF BY (�f (((YYY // SIZE �. .A./ /T$tOOMS .? STORIES EXTERIOR WALL. • I ROOF 10 / COVERING 5/(GC-' COVERIN pQ / "/ (.i USE OF BUILDI G AND WORK T2 eE ERF MED /ggirini �� r.0171:4- 0 I i 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 OP ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION VALUATION Jt SIGNATURE OR // PERMIT FEE $ ,?u r PERMITTEE 7- -s2- Glre ,/.' / Na I� S /I 9� PLAN CHECK $ IS 4" AUTHORIZED AGENT G TOTAL FEE S /�— a 7FE RECEIVED 17127 MAY 17 1y62 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS AySf f/./en . COSTA MESA. CALIFORNIA For Office Use Only RECEIPT No. I 1-1127 OWNEv, y O Z�LP SS ff MAIL t+ / R¢cyfye• BY DATE RECEIVED/ DATE ISSUED ADDRESS J��7 G. . . I `� //�tl Z I .J'����Z TEL CIN Same NOM/G 3 ra ABDDLRDEISG y L , -q eL41/, rt,. ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. —.-.------ ADDRESS FIRE ZONE TYPE VV YGROUP 7-1 AYPROVEDCONTR � , BY �C5 • / GATE r ADDRESS 3 r r E if ix WNING Pacolormili I /�.. ZON PLANS USE OP NEW�'' . D� CITY r.e 5 P ///C Se 4(-� I PLANS 2 I BUILDING 1A=I�^!tit NO.,/ LEGAL III--- t .. 0 d _ ao G LIC.• ND. /Q'y-z H 9 NO./ / /6 YS 7/ DESCRIPTION tic V I/ O ' ` ^ t 1-7.~-I NOW ONBLOTB A.P.NO. 2I / -O -2 - �7 OF LOT B V C USE OF YARDSEVES T EXISTING BLDG. nt/pIpi�_. APPROVED ALLOW SETBACK LINE FROM / (CENTER LINE ST. rj•,_- (�y�/�� �y� CENTER oP Et EEr J 0 REAR YARDc�/ Z r'� FRONT i- FT. (� ��v�v}�IN. SIDE YARD I LEFT 7-ire I RIGHT .6 / R.SIDE IJ J?AL-A 41 IN. DESCRIPTION OF WORK 9--C)4107-FT. IN. NEW I ,II II L.SIDE (/'I ALTERATION I II ADDITION I REAR Cr- FT.� (J�' IN. , REPAIR I (MOVING I II DEMOLISH I BYPROVE�ne DATE D -f > -6 2-- BUILDING NO. OF (,� Y v SIZEUIROOMS STORIES EXTERIOR WALL I ROOF T n. -� _�/ COVERING COVERING '�/-` L� ('/Jl/ USE OF BUILDING AND WORK TO BE PERFORMED /1 au 7 Sr TA. . 4/ '[u a # .n.r. To f'es a -Loa//e 6'Y AI, e 2 . 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 OP ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. �✓/ �7,. /� VALUATION - C-0 SIGNATURE OF ///_ JJt1 PERMIT FEE $ �7 PERM ITTEP !/7lrNC•¢'/J1/ o S `� PLAN CHECK 5 4 AUTHORIZED AGENT E TOTAL PEE $ o