HomeMy WebLinkAbout2706 HIBISCUS PL - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 27�G HIBISCUS
Suite:
Vicinity: 3RD CAR GARAGE WTO DEN
Parcel Number TPN00116
npp�icant: PHILIPP, ROLAND
Address: 15326 ALTON PARKVJAY
IRVINE, CA - "
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA
Contractor: OWN ER-BUI LDER
Address: r �
Zip:
Arch :
Address:
Phone:
Zoning:
Phone: 949-789-7600
Zip: 92678
Phone: 714-668-4300
Zip: 91616
Phone:
License: � 0
Eng:
Address:
Status: ISSUED
Applied: OB/24I2001
Issued: 08/24I2001
ISSUED BY: '
Phone:
Zip: License: License:
SCOPE OF PERMIT
REPLACE 138 SF PORTION OF THE THIRD-CAR GARAGE WITH AN �138 SF DEN OPTION - PLAN 1- FOR NEW SFR FOR
"STANDARD PACIFIC HOMES." - �
REF: B00-01535
Plan Check: $27.18
Permit: $167.25
SMIP Res: $0.87
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $195.30
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Ezistinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lett 0- 0
Left 0- 0
PrOpOSCd: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$e,ssa.00
$8,694.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Cali(ornia 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
requlred Inspeetions 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) 7545626
zansas(aroo) //
WORKERS'COMPENSAnON DECLARAnON: �
I hereby affirm under penalry of perjury one of the following tleclarations:
❑ I have entl will maintain e certificate of consent to self-Insure for workers' compensetion, as providetl for by section 3700 of the Labor Coda, for the pertortnance of the
work far w�ich Ihis pertnit is issuetl.
❑ I have and will melntain woAcers' compensatlon insurance, as requiretl by section 3700 of Ne Labor Code, for ihe peAortnanca of ihe work for which this pertnit is issuetl.
My workers' compensatlon Insurence carrier and policy number ere:
Carrier: Policy Number:
(This section need nat be comp/efed i/ the permit is valued et one hundred dollers ($700) or less.)
❑ I certity Ihat in thB perfortnance of the work tot which thi5 Dertnit is issuatl, I shell not employ any person in any manner so e5 to become subject to ihe workers'
compensation lews oi Celifomla, and agree that if I shoultl Cecome sub�ect lo Ihe workers' compensation provisions o1 Section 3700 of Ihe Labor Code, I shall forthwith
camply with these provisions.
Applicant Signeture: Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000), IN A�DITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTIIXJ 31060F TME LABOR CqDE, INTEREST, AND FTTORNEV'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby eHirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code, and my license is in full
torca antl effect. Lic. p Class N
Contrectofs Signature: Date:
CONSTRUCTION LENDING AGENCV: '
❑ I hereby aHirtn that there is a construction lending agency tor the peAortnance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lendefs Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirm ihet under penalry of perjury that 1 am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Cotle: Any ciry or county whic� requires a permit to constmct, alter, improve, demolish, or repair any simcture, prior to its issuance, elso requires the applicant for such pertnit
to file a signed stetemant thet he or she is licensetl pursuant to Ihe provislons ot ihe Coniracbrs License Law (Chapter 9(commencing with Section 7000) of �Ivision 3 of the
Business end Prolessions Gode) ar thet he or she is exempt therefrom and the 6esis for ihe alleged ezemption. Any violation oi Section 7031.5 Dy flny applicant for a pema'
subjects the applicant to e civil penalry of not more than five hundred dollers ($500).):
❑ I, es owner of the property, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, antl �he simcture Is not intendetl or oNered tor sale (Sec.
7044, Business and Professions Code: The Coniractors License law does not apply to an owner of property who 6uiltls or improves thereon, and who does such work
himselt or herseN or through his or her own employees, provitled ihei such improvements are not intended or oHered for sale. If, however, the building or improvement Is
sold within one year of completion, lhe owner-builder will heve the burden of proving that he or she did not build or improve for purpose of sale.).
� I, as owner oi the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the proJect (Sec. 7044, Business antl Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves ihereon, antl who comracts tor such project wlth a contractor(s)
license pursuani to ihe Contractors License Laws.).
❑ 1 em exempt un e�.
Signature:
Owner ID venlied by dnvers license. ❑ Ves
Business antl Professions Code for this reason:
Oate:
Dnver's License No. Expires:
Verificetian oi Ownership by (type ot dwument, i.e. - property tex bill ar tlaed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFILATION:
❑ I hereby cartity ihat no excavation five (5) or more feet in depth into which a person is required to descentl, will be made in cannection with work authonzed by this
permit, and ihat no building simcWre, scattolding, felsework, or demolition or dismantling thereot, will be more than thirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, Calitornla Administretive Code).
❑ As owner-builder, I will not employ anyone to do work which would require e permit from the Division of Indusiriel Safery, es noted a�ove, unless such person hes e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Parmit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTAV: I cenity under penalty oi perjury that I have read ihis ep0�ication and state that the information given is
wrrect I egiee to comply with all state laws and city ordinances relating to building consWction, and authorize representatives oi ihe Ciry ot Costa Mesa to enter upon the
ebove-describetl property for inspection puryoses. I egree not to occupy or ellow occupancy ot any building authorized by this permit until tinal inspaction.
CO�EI, INSPECTIONTYPE
1616 Fixad Sysiem Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
��I:
ORTE INTRIALS LOOE1 INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final ElecMcal
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
UATE II�A6i
/B�/%—D/ �
To:
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CER7IFICATE OF COMPUANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 ANO AB 181
�►�''
3945
r
( City of Costa Mesa District Receipt No%�/
( ) City of NewpoR Beach (j,
( ) County of Orange Plan Check No!/Qf' 0 l�J �
Applicant:
Address:
Telephone Number: 1 � �-f' r lIJ �o b'-' ��i�t P
Tract/Parcel and Lot Number(s):
Location of Project:
Number of Square Feet ot:
Residential Space
Commercial and
Industrial Space
CommerciaUlndustrial Projed is: (Check One)
Warehouse
R8D
Movie Theater
Mini-storage
Heavy Industrial
Regional Shops
Light Industrial
'i � f� X a�.aa
x E .30
_ Motel
_ Bank
_ Neighborhood Shops
_ RacqueVHealth
_ Hotel
_ MedicalOffice
_ O(fice Park
Total �s3. -) �
Total
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
Fast Food
This project is exempt because
This certifies that the above-named beveloper/Applicant has paid school faafity fees in comptiance with Government Code sections
53080 and 65995. The Building Pemiils for this square footage in this proposed development may now be issued by your jurisdictlon.
Checks are to be made payable to Newport-Mesa Unified School
Repre.eMaWe
The above representation as to square footage is Vue. AppNcant agrees that if R is later determined that such representations are not
true, then this certificate shall autortlatically terminate and the appropriate City/County shall be n8�i�. �881/9:33 RN/f 2484.88
RCDTN:01-8883680
. . .. . n /1 116331
Date: 8 L
App6cent
(714) 754-5273 • Fax (71A) 754-4856 • www.ci.coste-mese.Ca.Us 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
JobAddress: 2706 HIBISCUS
Suite: GOl— ( 7
Vicinity: PU'.N 1
Parcel Number: TPN00116
Applicant:
Address:
Owner:
Address
PHILIPP, ROLAND
1565 W MAC ARTHUR
COSTA MESA, CA
STANDARD PACIFIC HOMES
1565 W MAC ARTHUR
COSTA MESA, CA
Contractor: OWNER-BUILDER
Address:
Zoning:
Phone: 714-668-4300
Zip: 91616
Phone: 714-668-4300
Zip: 91616
Phone:
ISSUED BY:
Status: ISSUED
Applied: 12/29/2000
Issued: 01 /17I2001
Zip: License: 0
Arch : BASSENIAN LAGONI Eng:
Address: 2037 ORCHARD DR Address:
STE tOtl Phone: 949-553-9700 Phone:
NEWPORT BEACH, CA
2ip: 92660 License: License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 1 FOR STANDARD PACIFIC HOMES: 2558SF LIVING, 612SF GARAGE, 29SF PATIO.
REF: B00-�t535
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$282.52
$1,738.55
$23.30
$0.00
$0.00
$0.00
$2,044.37
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
I�I:i:U:[�3
NOTES:
xistin : 0
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$232,946.46
so.00
NOTICE: The work authOrized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
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 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 �
26dBd8 (fl�00)
WORKERS' COMVENSATION DECLARATION: � �
I hereby attirm under penalty ot porjury one of the tollowing declaretions:
❑ I heve end wiil maimein e certilicete of consent to selFlnsure for workers' compensation, es p�ovitled for by section 3700 0l ihe Lebor Cotle, for the pertormence ot tha
work tor which this p8rmii is issuetl.
❑ I have antl wlll melntain workers' compensation Insurance, es requiretl by section 3700 ot t�e Lebor Cotle, for the pertormence oi the work for whic� this permit Is issued.
My workers' compensatlon Insurance carrier and policy num6er are:
Carner: Policy Number:
(This soctlon need nof be completetl U fbe permit is veluetl et one huntlretl dollaro ($100) or less.)
❑ I certify that in Ihe pedormence ot Ihe work for which this permit is issued, I shall not employ any person in any menner so as to bewme subiect to the warkers'
compensation laws oi Celifomia, antl egree that if I shoultl become subject to Ihe workers' compensatlon prodsions ol Sectlon 3700 ot the Labor Code, I shall toRhwllh
wmply with these provlsions.
Applicant Signeture: Date:
WARNINO: FNLURE TO SEWFE WORKERS' COMPENSATION COVEMGE IS UNLAWFVL AND SHAIl SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AN� CML FlNES UP TOONE HUNDRED
TMOUSPNO DOLLARE (5100,Opp), IN ADDRION TO THE COST OF COMPENSAT1pN, DAMAGES AS PROVIDED FOF IN $ECTION 3%O60F THE IABOq CODE, INiEREST, AND ATTOfiNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aMirm that I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, antl my license is in full
lorce entl eHect. Lic. x Class a
Cancrecrors SignaWre: Date:
LONSTRUC710N LENDING AGENCY:
❑ I hereby ettirtn that there is e construction lentling agenty lor the peRortnance of ihe work lor w�ich ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lenders Addrass:
SignaWre: Dete:
OWNER-BUILDER DECLARATIONS: ,
I hereby aNlrm thet under penelty of perjury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Buslness end Professlons
Cotle: Any dry or county which raquires e permit to constmct, alter, improve, demolish, or repeir eny structure, pnor to its issuance, also requires tha epplicant tor such pertnit
to file a signed stetement thet he or she Is Ilcensetl pureuan� to [he pmvisions ot t�e Contrectors Llcense Lew (Chapter 9(commencing with Sectlon 7000) of Divislon 3 0l the
Business and Professions Cotle) or thel he or she is exempt t�erefrom end the basis far the elleped e:emption. Any vloletion ol Sectian 7031.5 hy any epplicant for a pertnit
subjects the eppliwnt to e civil penelty of not more than five hundretl tlollars (5500).):
❑ I, as owner of the property, or my employees with waqes as their sole wmpensation, WILL DO THE WORK, and Ihe structure Is noi intended or oHeretl tor sele (Sec.
7044, Business and Professlons Code: The Contrac�ors License Law does not apply to an owner ol propeny who builds or improves thereon, and who does such work
himselt ar hersetl or ihrough his or her own employees, provided thet such improvements ere not intended or oHeretl lor sele. If, however, the building or improvement Is
sold within one year ol completion, iha owner-6uilder will have ihe burden of proving the� ha or she did not 6uild or improve for purpose of sale.).
�I, as owner oi the property, em E%CLUSIVEIV CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e pro�ect (Sec. 7044, Business ana Pmfessions
Cotle: The wntreci0rs License Law tloes not apply to en owner oi pro0erry who hulld5 or Improves thereon, and who conirects tor such pmject with e conireclor(s)
license pursuant b the Contracbrs License LawsJ.
❑ I am exem t un r c.
SigneWre: �i — —�
Owner ID verilied by drivefs license. ❑
No
Business and Professions Catle lor ihls reason:
Date:
Dnvers License No. Expires:
Vedlication ol Ownership by (rype of daument, i.e. - pmperry tac bill or deed):
DIVISION OF INDUS7RIAL SAFETY VERMIT CERTFICA710N:
❑ I hereby certity ihat no axcevation five (5) or more feet in depth into which a person Is required to descend, will Ce made in connection with work authodzed by this
permit, antl tha� no building siructure, scaHolding, talsework, or demolition or dismantling t�ereol, will be more than thirty-slx (36) feet high. (Chep. 3.2, Grp 2, Ar12, Sec.
341, Title B, Californla Atlminislretive Cade).
❑ As owner-builder, I will not employ anyone to do work which would raquire a permit from Ihe Division of Intlustnal Sefery, es noted above, unleu such person hes e
pertnit to do such work imm the division.
Signawre: Date:
Division of Intlusinal Safety Permit Numher:
CERTFlCA7E OF COMPLIANCE AND AUTHORVATION OF ENTRY: I cerlify untler penalry of perjury thal I have read ihis epplication and state that the infortnetlon given is
correct. I egree lo wmpty with ell state laws and ciry ortlinances relating to building consiruclion, end euthonze representatives oi the Ciry of Costa Mesa to enter upon ihe
ebove-described property tor inspection purposes. I agree not to occupy or ellow occupency of eny Duilding authonzed by this permit until final inspection.
i ur Owner(s � � z O�Date
/� J �
AnNOr Authorized App � Date
COpE1, INSPECTIONTYVE ILA¢, �
1676 Fixetl System Final Fire Prevention
1266
200
201
202
203
Pool Spa Finel
Finel Re-Rool
Final BIocWReteining Well
Final Factory Fire Place
Final Sign
204 Final Demolition
COOE I INSPECTION iYGE
206 Final Mechanical
20B Final Plumhing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSita
250 FinalBuilding/Occupancy
QdIE lI�L9
3��v
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: ( X) City of Costa Mesa District Receipt No.
( ) Ciry of Newport Beach
( ) County of Orange Plan Check No. 800-02063
Applicant:
STANDARD PACIFIC
Address: 15326 ALTON PARKWAY, IRVINE, CA 92615
Telephone Number: 949-789-1600
TracUParcel and Lot Number(s):
Location of Project:
Number of Square Feet of:
Residential Space
Commercial and
IndustrialSpace
2706 HIBISCUS, COSTA MESA, CA
Commercial/Industrial Projed is: (Check One)
Warehouse
R&D
Movie Theater
Mini-storage
Heavy Industrial
Regional Shops
Light Industrial
__ This project is exempt because
2558 SF x $1.84
x $ .30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueVHeafth
_ Hotel
Medical Office
Office Park
Total
Total
$4706.72
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
Fast Food
ihis certifies that the above-named Developer/Applicant has paid school hacility fees in compliance with Government Code sections
53080 and 65995. The Building Pemiils for this square footage in this proposed development may now be issued by your jurisdicBon.
Checks are to be made payable to NewpoR-Mesa Unified School District.
By: BONNIE KUBOTA
ANlaraed RepreaeMative
The above representation as to square footage is We. Appticant agrees that if it is later determined that such representations are not
true, then this certificate shall automaticaly terminate and the appropriate City/County shall be notified.
JRN 23 28�1/11:29 N19/f 62475.30
n kCPTN:01-0�71725
114012
Date: I Z3 � 17 �An
noou�m
INSULATION CERTIFICATE IC-1
2706 HIBISCUS COSTA MESA
City
ORANGE 15882 67
County Trac[ No LOT
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) Termal Resistance (R-Value)
2 CEILING
BattorBlankefType BATT BrandName OWENS CORNING
Thickness (inches) 6 1/4" Thermal Resistance (R-Value) R-19
Loose Fill Type Brand '
Contractor's min installed weight square ft Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation
Material BA77
Thickness(inches) 31/2"
8. EMerior Foam Sheathing
Material
Thickness (inches)
4 FLOOR OVER GARAGE AREA
Material BATT
Thickness (inches) 6 1/4"
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Brand Name OWENS CORNING
Thermal Resistance (R-Value) R-13
Brand Name
Thermal Resistance (R-Value)
Brand Name OWENS CORNING
Thermal Resistance ( R-Value) R-19
Brand Name
Thermal Resistance (R-Value)
Brand Name
Thermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Elficiency Standerds for residential buildings (TiUe 24, part 6, Califronia Code of Regulations) as indicated on the
Certifcate of Compliance, where applicable.
^ � d 7/27I01 PARAGON INSULATION
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s
Item #s
Signature, Date
Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
�
EtLINGSON, BEN
From: SANTORO, SUSAN
Sent: Thursday, August 23, 2001 7:� 9 AM
To: ELLINGSON, BEN; OOSTERHOF, SYLVIA
Cc: GUEVARA, MICHAEL; MUNOZ, ERNESTO
Subject: C of O Standard Pacific
Ben/Sylvia: Engineering approves fnal C of O for Standard Pacific Homes, Tract No. 15882, Phase 1, Lots 6-13 8 66-69
only. Further approval will be required for any remaining lots.
Susan
P�TROS, EDWARD
From: LEE, MEL
Sent: Wednesday, September 12, 2001 2:00 PM
To: PETROS, EDWARD
Cc: BOUWENS-KILLEEN, WILLA
Subject: Standard Pacific Phase 1
On 9/12/01 I signed off the remaining Phase 1 units for Standard Pacific, as well as the pool and rec area:
2704 Hibiscus
2706 Hibiscus
2708 Hibiscus
2710 Hibiscus
Mel
yo_cwi w.�a rrcu.�.�u�i aaaa�a.ci� �i-T ��� .a�oo IU:fl'iC7�Clo Y.�l��i.:
• � 7�.0 !O-OSO Z-Oz . .
FIIVAL GRA�ING CERTIFICATION
Projat Address: � � 4' �DAw�S
Lol Number• 66 Tt'.''�.�i 9k H 6 9 �rt�4[_'115aP� Z
Permil Number. � � — �� 3 Z-
8y Civil.Engincer:
I cenify to the satisfaaory completion of grading in accordance a�ith the appraved plans,
specifica[ions, local and s�te codes. All.drainage devices required by the grading permit,
grading plan and gtading ardinana have 6een instailed. t,ti�ua�e; provisions have ban made
for drainage of surface water fmm each building si�e.. `
The minimums are:
+ 2�i Fall from aWctures within 5 feet from acterior walls.
1% Fail for asphal� surfaces and landscaped areas. �
0.59� Fail for concrcte surFaces to approved disposal areas_ .
The final monuments as showa on the tecordcd tract map w�ere set. All final grading elna- �
tions are within ± I/10 of the designed elevation �
Supervising Civil Engineer Reg. No. 394"�a
(Si�,uwro) ' r,. .
. ` Da�e 9—► i-o l
;a .
z �.; , .
i
�
No. 39a79
E�.12�31-0i
c+ra�,m �,.a crna
n�
���,{,
Contirtu�us L�spectirni & SIalerials Testiny
S�V�11 Vr 1J�� ������5��������
Inspection S Testing, Inc
City of Costa Mesa
Depanment of Building and Safety
77 Fair Dr.
Costa �lesa. CA 92626
IOS26 South Nonvalk Blvd., Santa Fe Sprinos. Cr\ 90670
(562) 9d1-2990 • (71d) 526-3441
FAk (�62) 9�t6-0026
Au�ust 22, 2001
Re: Pinal inspection for the (�Iesa Verde Collection) n Harbor & Adams, Costa Mesa, CA. Standard Pacific Homes.
Lot # Permit # -
6 B00-02029
7 B00-020�1
3 B00-020»-
Pool Bidg. B00-02039
Lo[ #
�
Pertnit #
B00-02056
B00-020�7
B00-020�8
Lot � Permit #
12 B00-020�9
13 B00-02061
66 B00-02062
Lot # Permit #
67 B00-02063
68 B00-02064
69 B00-02069
Dear S'u
Southwes[ Inspec[ion and i esdns �vas retained by the Owner to provide special inspection and materials testine in the areas thaz were required
by section 1701 of the Uniform Building Code, approved projzct drawinss and specifications, this work was witnessed by the followin�
inspectors.
Reinforced concrete inspection was done bv the follo�rinE:
Nlr. Eric Strauch (OCEb(A 0�98)
�1cScott Bald QCBO �0» 178)
\tr. Bam� Ben Ron (ICBO �036396-49)
�tr. Ron Scog�ins pCBO 08�1689 i-89)
Stressin¢ of %:" Post Tensioned Tendons was done bv the foliowing:
Mr. Pat Brennan (OCE:b1A 0317)
Mr. Jay Dresner (IC80 OS»301-89)
Mc Ken Rodeers (ICBO O8J6897-89)
All work was done in conformance with the Structural Engineers' recommenda[ions, approved drawings and/or revisions, project specifications
and applicable workmanship provisions of the Uniform Building Code. Ifyou should have any further questions, please do not hesitate to call
us.
Sincerelv,
even . God
President
SLG/fRW:kl�
Reviewed By:
lan R. WaddelT�o�
Principal En�ineer
FOR INSPECTION AND TESTING ONLY, NO DESIGN
RESPONSIBILITY EXPRESSED OR IVIPLIED.
(7ta) 754-527s • Fax (71a) 75a-4ess • www.ci.costa-mesa.ca.us n rnih urtrve, GUJ I A Mt.�A, GA BYtiZti
MECHANICAL PERMIT
Job Address: ZiOB H�BISC�J$
Suite No
Vicinity: PLAN 1
Parcel Numbec TPN00176
Applicant:
Address:
Owner:
Address:
Contractor:
Address:
Arch / Eng :
Address:
PHILIPP. ROLAND
1565 W MAC ARTHUR
COSTA MESA, CA
STANDARD PACIFIC HOMES
1565 W MAC ARTHUR
COSTA MESA, CA
OWNER-BUILDER
Phone: 714-668-4300
Zip: 91616
Phone: 714-668-4300
Zip: 91616
Phone:
Zip:
License: 0
Phone:
Zip:
License:
ISSUED BY:
Status: ISSUED
Applied: 12/29/2000
Issued: Ot/12/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN t FOR STANDARD PACIFIC HOMES: 2558SF LIVING, 612SF
GARAGE, 29SF PATIO.
1 FAU <100K BTU, t FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 3 VENT FANS/SINGLE
DUCT, 1 COMPRESSOR UP TO 3 HP.
REF: B00-02063
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > t0000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$14.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$10.65
$10.65
$0.00
$21.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporetive Cooler
Commercial I n cinerator
Domestic Incineralor
Compressors / Absorotion Svstems
Upto3hp/100kBTU
3 To 15 hp / SOO k BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To15hp
1510 30 hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee �
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED PEES
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$14.70 1
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$96.05
NO710E: The work authorized by this permit s a compy wi a appica e n i p equirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmit.
FOR INSPECTIONS CALL: (714) 7545626 , ,
244fi18IG/00)
WORKERS' COMPENSA710N DECLARA710N:
I hereby aflirm under penalry of perjury one oi the following tleclarations:
❑ I have and will mainlain e certificate of consent to self�lnsure for workers' compensation, as provided br by section 3700 oi tha Lebor Code, tor the pertormenca of the
work for which ihis permit is issued.
❑ I have an0 will maintain workers' compansatlon insurance, as requiretl by section 3700 of tha lebor Cotle, tor Iha pertortnance of Ihe work for which this pertnit Is issuetl.
My workers' compensation Insurence carrier antl pollcy number are:
Garrier: Policy Number:
(fhis section need nof be complefed il the pemrit is velued af one hundred dollars ($f00) ar less.)
❑ I certify that in Ihe pertortnence of �he work for which this permit is issued, I shell not employ eny person in any mennar so as to become sublact to the workers'
compensation laws oi Celifomia, end agrea ihet if I should 6ecome subject to the workers' compensatlon provislons of Sectlon 3700 of the Lebor CoCe, I ahall forthwlth
comply with these prOvisions.
Applicant Signature: Dete:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TOONE MUNDRED
THOUSAND DOLLARE ($100,OW), IN ADDITIIXJ TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]Ofi OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions oi Chapter 9(commencing with Section 7000) ot Division 3 of the Buslness entl Professions Cotla, entl my license Is In full
force antl effect. Lic. p Cless N
Coniractor's Signature: Dete:
CONSTRUC710N LENDING AGENCY:
❑ I hereby aflirm ihet there is a consiruction lending agency for the pedormance of tha work for which ihis permit is issued. (Sac. 3097, Civll Code).
Lender's Name: Lender's Address:
, SignaWre: Date:
OWNER-BUILDER DECLARA710NS:
I here6y affirm thet under penelry ot perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professlons
Code: Any ciry or counry which requires a permit to constmct, elter, improva, tlemolish, or repair any structure, prior to its issuance, elso requiws the applicant }or such pertnit
to file a signed statemem ihat he or she Is Ilcensed pursuent to t�e provislons ot ihe Contrectors License Lew (C�epter 9(commencing with Sectlon 7000) oi Divlslon 3 of Ihe
Business end Professions Code) or tha� he or she is exempt thereirom and ihe besls for the allegeG axemption. Any violation ot Section 7031.5 by eny applicant for a permlt
subjects the applicant to a civil penelry oi not more ihan five huntlred tlollaro ($500).):
❑ I, as owner of the property, or my employaes with wages as Ihelr sole compensation, WILL DO THE WORK, end the slrucNra Is not ImantleE or offered for sele (Sec.
7044, Business and Protessions Code: The Contractors License Lew does not apply to an owner oi property who builtls or improves thereon, and who does such work
himself or herself or through his or her awn employeas, Orovided ihat such improvements ere not intended ar oHered for sale. If, however, the bullding or improvement Is
�sold within ona year oi comple�ion, ihe owner-buildar will have Ue burden of proving thet he or she did not build or improve for puryose ot sale.).
I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business end Professiona
Code: The conirectors License Lew tloes no� apply �o an owner of propeny w�o bulltls or Improves thereon, entl who conirects lor such pro�ect wlih e contractor(s)
license pursuant to Ihe Comractors License Laws.).
❑ I am exe un sec I�
SignaWre:
Owner ID venfied by dnvers licensa. ❑ Ves
No
Business entl Professions Code br this reeson:
Date: O
OnveYs License No. Expires:
Verification of Ownership by (type oi document, i.a. - property ta: bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity �hat no exwvation five (5) or more teet in depth into which e person Is required to descand, will be metle In connection with work eu�horizetl by ihis
permit, and that no builtling sWdure, swflolding, falsework, or demolition or dismantling thereot, will be more ihen Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sac.
341, Ttle B, Calitomla Administretiva Code).
❑ As owner-builder, I will not employ anyone to tlo work which would require e permit from the Division ot Intlustnel Setery, es noted ebove, unless such person hes e
pertnit to do such work trom Ihe division.
Signamre: Date:
Division of Indusirial Safety Permit Number:
CERTIFlCATE OF COMPIJANCE AND AUfHORIZATION OF E1lfRY: I certity under penalry of perjury that I have reatl this appliwtion end state that the information given is
correct. I agree to comply with all stata laws end ciry ordinances relating to building consWction, entl euthodze representatives oi ihe Ciry oi Costa Mese to enter upon ihe
above-described properry for inspection purposes. I egree not to wcupy or allow occupency ot any building authonzed by Ihis pertnit uniil finel inspeclion.
Sigr�qWr tLe�a�Qwrpr(s) ^ II�; �1Date
._SL l/ lJ �)� I
And/OrAuthor ed Applicent -� Date
CODE �, INSVECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roof
201 Final BIxWRetalning Wall
202 Final Factory Fire Plece
203
204
Final Sign
Final Demolition
QBIE 1[QII19L5
COUEI INSVECTION7VPE QS¢, �]�'�$
20fi Finel Mechanical ` � ' l ylpL
20B
210
212
220
Finel PlumCing
Finel Eledrical
Finel Fire Prevention
Finel Planning Approval
222 Final Site
250 FinalBuiltling/Occupancy
(714) 754-5273 � F2% (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVt, GUS I A MhSA, GA 9'Ltl16
PLUMBING PERMIT
Job Address:
Suite No
Vicinity:
2706 HIBISCUS
PLAN 1
Parcel Nunmper: TPN00116
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
COSTA MESA, CA
Owner: STANDARD PACIFIC HOMES
AddYess 1565 W MAC ARTHUR
COSTA MESA, CA
Contractor: OWN ER-BU I LDER
Address:
Arch / Eng :
Address:
ISSUED BY:
Phone: 714-668-4300
Zip: 91616
Phone: 714-668-4300
Zip: 91616
Phone:
Zip:
License: 0
Phone:
Zip:
License:
Status: ISSUED
Applied: 12/29I2000
Issued: Oi/12/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 1 FOR STANDARD PACIFIC HOMES: 2558SF LIVING, 612SF GAR4GE,
29SF PATIO. 3 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK, 1 GAS OUTLET (1-4), 2 GAS
OUTLETS (OVER 4), 1 LAUNDRY TUBM/ASHER, 1 PRESSURE REGULATOR, 1 SEWER CONNECT, 1
SHOWER, 1 KITCHEN SINK, 1 SERVICE/MOP SINK, 1 WASH BASIN, 2 WASH BASIN SETS, 3 WATER
CLOSETS, 1 WA7ER HEATERNENT, 1 WATER SERVICE.
REF:800-02063
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountai�
Expansion Tank
Gas Earthquake Valve
Gas (74 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceotors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$29.40
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$6.15
$220
$O.aO
$0.00
$0.00
$0.00
QTY
0
0
3
0
0
0
1
0
0
0
0
1
0
1
2
0
0
0
0
FEE SUMMARY
AMT
Laundry Tub / Washer $9.80
Landscape Irrigation $0.00
P-Trep $0.00
Pressure Regulator $9.80
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
SewerCapforDemo $0.00
Sewer Connect $24.65
Sewer Private Line $0.00
Shower •$9.80
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $9.80
Sink, service/mop $9.80
Spa (private) $0.00
Spa (public) $0.00
QTY
1
0
0
i
0
0
0
0
1
0
1
0
0
0
7
1
0
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(i-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.8�
$79.60
$0.00
$29.40
$12.30
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
1
2
0
3
1
0
0
1
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requ�iremenfS un�er C�rtorr�i�SStann��'�Rd related
regdlaNens {61rc1 Na A2-�@ § 1 1227 92)
EXPIRATION: This permit shall automatically ex COMMENTS I SPECIA�CC�I,�I���in 180 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order tor the work authorized under this permii to be considered legal, such work must comply with all applicable cotles, and all
requlred inapecllons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALI: (774) 7545626
zaae-as �s�oo� /i
WORKERS'COMVENSAnON DECLARAnON:
I hereby ettirm under penalry of perjury one of the following tleclarations:
❑ I have entl will melntein e certificete of wnsent to self-Insure tor warkers' compensetion, as provided for by saction 3700 0l the Lebor Cotle, tor the pertormence of the
work tor which Ihis pertnit is issued.
❑ I have entl will melntain workers' compensation insurence, es requiretl by sectlon 3�00 of Ihe Lebor Code, for the peAortnence of the work for wh1U this pertnit Is IssueA.
My workers' wmpensation Insurence cartier and pollcy number are:
Certier: Policy Number:
(This secGon neetl nat be comp/eted i/ the permit is velueC et one hundred dollers (5100) or less.)
❑ I ceNty that in Ihe peAortnance ol ihe work for which t�is permit is luued, I shall nm employ eny person in any menner so es ro become subjecl to Ihe workers'
compensetlon lews of Calilomie, entl egree that tl I should become suD�ect ro the workers' compensatlon proNsions ol Sadlon 3700 ai the Labor Code, I shell tort�wflh
comply with these provisions.
Applicant Signatura: Oate:
WARNINO: FAILURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNUWFUL AtJD SHALL SUBIEGT AN EMPLOYER TO CHIMINAL PENALTIES M1D pVIL FlNES UP TOONE HUNDRED
T/qU$+1ND OOIlARE (5100,000), IN MDRION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED PoR IN SECTION 3�OB OF THE LABOR CODE, INfEREST, AND ATiORNE1"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I em Ilcensed under provisions ot Chapter 9(commencing with Sectlon 7000) of Division 3 of Ihe Buslness entl Protesslons Cotle, antl my Ilcense is in tull
lorce and eflect. Lic. q Cless x
Contractors Signawre: �ate:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eMirtn that there is a construction lentling egency tor the paAormance of the work tor which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lendar's Name: Lendefs AAdress:
Signature: Date:
OWNER-BUILDER DECLARA710NS:
I herehy effirtn Ihat under penalry of perjury ihet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness end Professlons
Cotle: Any city or county which requires e permit �o constmct, eller, impmve, tlemolish, or repair any structure, D�ior to Ils issuance, elso requires the applicant for such permit
to tlle e signed statement that he or sha Is licensed pursuent to Ihe provlsions ol the Conirectors License Lew (Chepter 8(wmmencing with Section 7000) of Divlslon 3 at the
Business end Professlons Code) or thet ha or sha is esempt Iherefrom and the besis for the alleged exemption. Any violetlon of Section 7031.5 by eny applicant for e permit
subjects the epplicent to e civil penalry of not more than five huntlretl dollers ($500).):
❑ I, es owner of the properry, or my employees with wages es thelr sole compensation, WILL DO TME WORK, end Ihe siruc�ure Is not Intended or oHered tor sele (Sec.
704a, Business and Protessions Code: The Conirectors License Law does not epply to an owner of property who bulltls or Improves thareon, antl who does such work
himself or herself or through �is or her own employees, providetl that such Improvements ere noi Intended or aflered tor sale. If, however, t�e buildinp or Improvement is
sold within one yeer ot comple�ion, Ihe owner-builder will heve the 6urden ol proving ihat he or she tlitl not build or improve for purpose of sale.).
� I, es owner of t�e propeny, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct ihe pm�act (Sec. 70a4, Business antl Professlons
Coae: 7Te conirecbrs License Lew tloes not apply to en owner of pmpeny who builtls ar Improves iheraon, antl who conirecls lor such pmject with e contrector(s)
licensa pursuant m the ContraUors License Laws.).
❑ I em eae_m,�ot untl . se Business antl Prolessions Code for this reason:
Signawre: _�. _� /� Date:
Owner ID venlietl by drivers license. ❑ Yes No Orivers License No. Ezpires:
Vedfice�ion oi Ownership by (type of document, i.e. - property lax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION:
❑ I hereby certi y Ihat no excavatlon five (5) or more tee� in depih into which e person is required to dascend, wlll be made In connectlon with work authodzad by this
pertnit, entl ihat no builtling swcmre, sca8oltling, talsework, or demolition or dismantling thereoC will be more Ihen thirry-six (38) feel high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Title 8, Califomie Administrative Code).
❑ As ownerbui�der, I wiil not employ enyone to do work which would require e permit from tha Division af Industrinl Sefety, es noted ebove, unless such Oerson hes e
permit to tlo such work from ihe division.
Sipnature: Date:
Division of Industrial Sefery Permit Number:
CER71flCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certity under penalry of perjury Ihat I have read this epplicetion and state that ihe information given Is
correct. I egree to comply with ell state laws and ciry ordinences relating to builtling conswction, end euthodze representetives of the Ciry ol Gosta Mesa to enter upon the
ebove-describetl property tor inspection purposes. I agree not to occupy or ellow wcupancy ot eny buildinq authonzed Dy this permit until final inspection.
COOE 1. INSPECTIONTYPE
1616 Fixed SyStem Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Raol
201 Finel BIocWRetaining Wall
202 Final FettOry Fire Place
203 Final Sign
204 Finel Damolitlon
Qdg �$
�j INSPELTIONTYVE
20fi Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Flnal Fire Preventlon
220 Finel Planning Approval
222 Final Site
250 FinalBuilding/Occupency
�g �
� r 1
(714) 754-5273 • Fax (714) 75A-4B56 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
ELECTRICAL PERMIT
2706 HIBISCUS
PLAN 1
TPN00116
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
COSTA MESA, CA
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA
Contractor: OWN ER-BU I LDE R
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (7-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 7000a
Service over t000a
Motors to thp
Motors to lOhp
Mo[ors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
ISSUED BY:
Phone: 774-668-4300
Zip: 91616
Phone: 714£68-4300
Zip: 91616
Phone:
2ip:
License: 0
Status: ISSUED
Applied: 12/29/2000
Issued: Ot/12/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 1 FOR STANDARD PACIFIC HOMES: 2558SF LIVING, 612SF GARAGE,
29SF pATlO. 1 NEW RES (1 UNIn, 2 LIGHT FIXTURES, 3 OUTLETS, 2 SWITCHES, 1 MOTOR TO
1 HP.
REF:B00-02063
$23.50
$0.00
$0.00
$143.25
$0.00
$0.00
52.20
$3.30
$220
$0.00
$0.00
$0.00
$0.00
$0.00
$4.75
$�.�0
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
�uantity
2558
0
0
2
3
2
0
0
0
0
0
i
0
0
0
0
0
0
0
0
0
0
FEESUMMARY
Temp Dist System / Lighting
Busway/100ft
Standing Sedion
Misc Eleclrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ritle)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electriwl Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
so.00
$0.00
$0.00
TOTAL CALCULATED FEES 5179.20
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced vnthin 180 days, or if work is suspendetl or abandoned
tor a period ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wi�h all applicable codes, and all
requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2asas �broo�
WORKERS' COMPENSATION DECIAtiATION:
I hereby aflirm under penelty of perjury one of t�e following declarations:
❑ I have antl wlll malntain e cenificate of consent to self-Insure Por workers' compensation, es provided tor by section 3700 ot tha Lebor Code, tor the pertortnence of ihe
work tor which this Dermit is Issuetl.
❑ I have entl wlll maintain workers' compensetion insurance, es requiretl by sectlon 3700 of the Lebor Cotle, tor the performance ot the work for which this Dertnit is issued.
My workers' compensetion Insurance cerrier and policy number are:
Carner: Policy Number:
(This secfion need no! be comp/efed 1! the permit is velued af one hundred dollers ($ f00) or less.)
❑ I certity ihet in the pertortnence of Ihe work for which this permit is issueq I ahell not employ eny person in any menner so as to become subject ro t�e workere'
compensatlon laws oi Calitornia, end agree that Ii I should become suD�ect lo Ihe workers' compensation provislons of Section 3700 of the Lebor Cotle, I shall torthwith
comply wllh these provisions.
Applicant Signature: Date:
WARNING: FNLURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLNWFUL AND SHALL SUBIECr Ml EMROYER i0 CRIMINAL PENPLTIES AND CML FlNES UP TOONE HUNDRED
TMOUSAND OOLLARE (5100,000), IN ADIXiIIXJ TO THE WST OF COMPENSATIIXJ, U0.NAGES AS PROVIDED FOR IN SECiION 3]O60F TME LABOR COUE, IMEREST, AND ATTOFiNEYS FEES.
LICENSED CONTRACTOFS DECLARATION:
I hereby aXirtn that I em Ilcensed under provisions of Chapter 9(commencing with Section 7000) ol Division 3 ot Ihe Business antl Protessions Code, end my license is in full
farce end effect.lJc. p Class N
Contrectors Signature: Date:
CONSTRUC710N LENDING AGENCY:
❑ I herehy ettirm Ihat ihere is e construction lending agency for the peAormance ol ihe work for w�ich ihis permit is issued. (Sec. 3097, Civll Code).
Lenders Nema: Lender's Atltlress:
Signature: Date:
OWNER-BUILDER OECLARA710NS:
I hereby aHirtn t�et under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness end Protesslons
Code: Any city or county w�ic� requires e permit to constmct, eller, improve, tlemolish, or repair any structure, pnor to its issuance, elso requlres the epplicant for such pertnit
to lile e signed stetemem t�et he or she Is Ilcensed pureuam to t�e pmvisions of tha Contrectors License Law (Chapter 9(commencing with Section 7000) 01 DlWsion 3 of the
Business an0 Professlons Cotle) or thet ha or she is exempt thereirom end ihe besis for tha ellepetl e:emption. Any vloletlon of Sectlan 7031.5 by any epplicant for e parmit
sublects the epplicanl lo e civil penelry of not more than five hundred dollars ($500).):
❑ I, as owner oi Ihe property, or my employees with weges as iheir sole compensaiion, WILL DO THE WORK, antl ihe structure Is not IntendeC or oHered for sele (Sec.
7044, Business an0 Professions Code: The Contraciors License Law does not apply to an owner of properry who builds or improves ihereon, end who does such work
himselt or herself or ihrough his or her own employees, D�ovided thel such improvements ere not intendad or ottered for sele. If, however, Iha building ar improvement is
�soltl wi�hin one year of completion, Ihe owner-builder will have the burden of proving ihat �e or she did not build or improve for purpose of sale.).
I, as owner oi the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe projact (Sec. 7044, BuSiness end Professions
Code: The wntrectors License Lew does not apply to en owner o1 property who builds or Improves Ihereon, end w�a contracts for such projact wlth e conirector(s)
license pursuant to the Coniractors License Wws.).
❑ I em exem 1 der c. Business antl Professions Coda for this reason:
SignaWre: � �,��- Date:
Owner ID verified by tlrivers license. Yes ❑ No Driver's License No. Expires:
Veriilcntlon of Ownership by (type ol document, i.e. - property tex bill ar deed):
DIVISION OF INDUS7RIAL SAFE7V VERMIT CERTIFICA710N:
❑ I hareby certify �hat no excavatlon fiva (5) or more faet in depth into whlch e person is required to tlescend, wiil be made in wnnecilon wlt� work euthodzetl by this
permit, end Ihet no builtling structure, scatfolding, falsework, or demoll�lon or tlismantling thareol, will be more ihan thirty-six (38) teet high. (Chflp. 32, Grp 2, Art 2, Sec.
341, Title B, California AtlminisireUve Code).
❑ As owner-bulltler, I will not employ enyona to do work which woultl reQulre e permit from ihe Division of Intlusinel Sefety, es nated e6ove, unless such person hes a
pertnit to do such work from Ihe division.
Signature: Date:
Division of Industdal Satery Pertnit Number.
CER7IFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I certity undar penalry ot perlury �hai I have read ihis epplicatlon end state that the information given is
correct. I agree to comply with all stete laws and ciry ordlnances relating to builtling construction, end euthonza representetives ot Ihe Clry ol Costa Mesa to enter upon Ihe
ebove-descnbed property for insDection purposes. I egree not to acupy or allow occupancy ot eny building au�horized by this Dermit until tinel Inspection.
a���, ��a w��5,_ �.n , Z> o, oe,a
Antl/Or Autho zed ADPlicant Dete
COpE Y. INSFECTONTYPE Qe¢, IIiIIDEL$
7616 Fixetl System Final Fire Prevention
1266
200
zoi
Pool Spe Final
Finel Re-Roat
Finel BIocWRetaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Finel Demolition
COOE� INSFECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electricel
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAg. It�dl�