HomeMy WebLinkAbout2710 HIBISCUS PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
BUILDING PERMIT
Jab Address: 2710 HIBISCUS
Suite:
Vicinity:
Parcel Number: TPN00111
App�icant: EZZAT SALAH
Address:
Owner: EZZAT SALAH
Address
Contractor:
Address:
Zip:
Arch :
Address:
Zoning:
, Phone: 714-444-1878
Zip:
Phone:
Zip:
Phone:
License:
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 07/19/2002
Issued: 07/19/2002
Phone:
Zip: - License: License:
SCOPE OF RERMIT
BUILD AN EXTERIOR MASONRY FIREPLACE. - � "
Plan Check: $35.10
Permit: $54.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $89.60
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Exlstinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Praposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
st,soo.00
$1,500.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related
regulations. (Ord. No. 92-28, § 7, 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
fo� a period of 180 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
required inspections and flnal approval must ba obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626 .
:aao-ao �aw�
�
WORKERS' COMPENSATION DECLARATIDN: '
I heraby eHirtn under penalry of perjury one ot t�e tollowing declarations: �
❑ I heve antl will maintain e certifiwte of consent to self-Insure for workers' compensation, as providetl for hy section 3�00 of the Labor Code, tor the pertormance of ihe
work for which Wis permit is issuetl. .
❑ I have and will maintain workers' com(rensation insurance, as required by section 3700 0� ihe Labor Cotle, for the Oerfortnance ot the work for whiU this pertnit is Issued.
My workere' compensatlon Insurance carner antl policy number are:
Carrior. ' Policy Numbec
(This section need nof be cromplefed i/ the permit is valued et one hundred dollers ($100) ar less.)
❑ I certify ihat in ihe peAormance oi the work for which this permit is issuetl, I shall not employ any Derson in any manner so as to become subject to the workers'
compensation laws of Celifomia, end agree that it I shoultl become subject to the workers' compensation provisions oi Section 3700 oi the Labor Code, I shall forthwlth
comply with ihese pravisians.
Applican� Signeture: Da�e:
WARNINO: FAILURE TO SECURE WORKEPS' COMPENSATIqJ CAVERAGE IS IINLAWFUL ANO SHALL SUBIEC� AN EMP�OVER TO CRIMINAL PENALTIES NND CIVIL FINES UP TOIXJE HUNDRED
T}IOUSAND OOLLAFE (5100,000), IN ADDITION TO T'{E CQST OF COMPENSATION, DANAGES AS PROVIOED FOR IN SECTION 3]Ofi OF THE LABOR CODE, If�TEREST, AND AiTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Pmfesslons Code, end my license is in tull
force antl ettecc Llc. k Class a
Cantractors Signeture: Date:
CONSTRUCTION IENDING AGENCY: �
❑ I hereby aNirm ihat there is a consiruction lending agency for Ihe pertormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lentler's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hareby affirtn thet untler penalty of perjury that I em EXEMP7 FROM THE CONTHACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permit to construct, alter, impmve, demolish, or repair any siructure, prior to its issuance, also requires the aDP���nt tor such pertnit
to file a slqnetl statement that he or she is licensetl pureuant to the provisions of the Contrectors License Law (Chapter 9(commencing wlth Sectlon 7000) ot Division 3 of the
Businoss and Pmfessions Gotle) or ihat he or she is eaempt iherefrom and ihe basis for the alleged azemption. Any violation oi Section 7031.5 by eny applicant for e pertnit
subiects the applicant to a civil penalry of not more Ihan tive hundred dollars ($500).):
❑ I, as owner of ihe properry, or my emplqyees with wagas as iheir sole compensation, WILL DO THE WORK, end the struaure is not intended or otterad 1or sale (Sec.
7044, Business and Protessions Code: The Coniractors License Law does not apply to an owner ot property who builds or improves Ihereon, an0 who does such work
himself or herseN or Ihmugh his or her own employees, providetl that such improvements ere not intended or oNered for sale. If, however, the 6uiitling or impmvement is
sold within one year oi completion, ihe Owner-builder will heve the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner ol the properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: 7Te contrectors License Law tlogs not apply to an owner oi property who hullds or improves ihereon, and who contracis for such project with a conirector(s)
license pursuam to ihe Contracmrs Licanse Laws.).
❑ I am exempt under sec. �i ��, � Business antl Protessions Code for Ihis rea� _
Signeture:
Ownar ID venfied by nvers I ense. ❑ V s ❑ No Drivefs LicenSe No.
Ventication of Ownership by (�ype o ocument, i.e. - property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby ceniy ihat no axcavation five (6) or more feet in depth into which e person is required to descend, will be matle in connection with work authonzed by this
permit, and that no building siructure, scaftolding, falsework, or demolition or tlismantling thereof, will be more ihan ihirty-six (36) teet high. (Chep. 32, Gry 2, Art 2, Sec.
341, Title B, California Adminisirative Cotle).
❑ As owner-builtler, I will not employ enyone to do work which would require a pertnil Irom lhe Division of Industrial Safery, as noted above, unless such person has e
permit to do such work from the division.
Signature: Date:
Division ot Indusinal Safety Permit Number:
CERTFlCATE OF COMPLIANCE AND AUTNORIZA710N OF ENTAY: I certiy under penalty ot perjury iha� 1 have read this application antl state ihat the informe�lon given is
correct. I agree to comply with all state laws end ciry ordinances relating to building constmction, and authorize representatives of the Ciry of Costa Mesa to enter upon ihe
above-descnbed property for inspec �� ur oses I agree not to acupy or allow occupanc .ot a'ny builtling authonzed by this Dermit until final inspection.
� �}-\�-o� /
Slgn ture Of Legal Owner(s) � Date
AnNOr AuthonZed Applicant Date
COpE t, INSFECTIONTYPE Qa1E INTRIRLS
1616 Fixed System Pinal Fire Prevention
1266 Pool Spe Finel
200 Final Re-Roof
201 Final Block/Retaining Well
202 Final Fectory Fire Plece
203 Final Sign
204 Final Demolition
U N INSPECTIONTYPE Q��
206 Final Mechanical
20B
210
212
220
Final Plumbing
Final Electrical
Final Fire Prevention
Final Planninq Approval
222 Final Site
250 Final Building/Occupancy
.w:
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2710 HIBISCUS
Suite No
Vicinity:
Parcei Nunmber: TPN00111
Applicant: EZZAT SALAF-1
Address: . � �
Owner: EZZAT SALAH
Address
Contractor:
Address:
Arch / Eng :
Address:
GASLINE FOR BBQ.
ISSUE FEE
Backflow irngatlon
Backflow Preventer
Bathtub
Clanfer System
Connect(Ice,Soda,etc)
Denlal Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$6.15
$0.00
$0.00
$0.00
$0.00
$0.00
�TY
PLUMBING PERMIT
Phone: 714-444-1878
Zip:
Phone:
Zip:
Phone:
2ip:
License:
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 07/19I2002
Issued: 07/19/2002
ISSUED BY:
SumpPump
Swimming Poal
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toileq
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
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: E29.65
�TY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis 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 780 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 vnth all applicable codes, and all
required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
244fid818�00)
�
WORKERS' COMPENSATION OECLARATIbN:
I here6y affirtn under penalry of perjury one of the following tleclarations:
❑ I heve entl will maimein a certificate of cqnsent to setl-Insure tor workers' compensation, as provided for hy section 3700 of the Labor Code, for the pe�ormanca of Ihe
work for which Ihis partnit is issuetl. .
❑ I hava end will maintain workers' compensation insurance, as raquired by section 3700 oi Ne Lebor Cotle, tor Ihe pedortnance of tha work for which this permit is issued.
My workere' compensation Insurance carrler antl policy number ere:
Carnor: ' Policy Number:
(This section need nof be complefeC il the permit is velued ef one hunOred dollars ($700) or less.)
❑ I canity Ihat in the paAortnanca of the work for which this pertnit is issued, I shall not employ eny person in any manner so as to become subject to ihe workere'
compensation laws of Calitomia, and agree t�at ii I should bacome subject to the workere' compensatlon proNsions ot Section 3700 ot the Lebor Cotle, I shall fotlhwith
comply with ihese provisions.
Applican� Slgneture: Date:
WARNING: FAILURE TO SECURE WORKERS' COMCENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
T}IOUSAND DOLLAFE (3/ W,OW), IN ADDRION TO T}�E COST OF COMPENSATION, DAMAGES AS PROVIDED FOIi IN SECTION 3108 OF THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my licanse is in full
force and eHecL Lic. N Class q
ConVnctors Signamre: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby aMirtn that Ihere is a constructi6n lending aqency For the Derformance of Ihe work tor which Ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lentlefs Name: � Lentler's Atltlress:
Signature: _
OWNER-BUILDER DECLAFiA710NS:
Date:
I hereby aXirm Ihat untler penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the toliowing reeson (Sec. 7031.5, Buslness and Professions
Code: Any ciry or counry which requires e permit to consiruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant tor such pertnit
to file a signetl statement that he or she Is Ilcgnsed pursuant to the provislons of the Comrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Dlvislon 3 ot the
Businass end Professions Code) or that �e or she is exempt therefrom and the basis for the alleged e:emption. Any violetion of Section 7031.5 by eny applicant for a pertn%
suDjects the epPliwnt to a civil penalry of not more then five hundred dollere ($500).):
❑ I, as owner of the property, or my employees with wages as iheir sole compensetion, WILL DO THE WORK, end tha structure Is not intended or oNeretl tor sale (Sec.
7044, Business end Professions Code: 7he Coniractors License Law tloes not epply to an owner of property who builds or improves ihereon, and who tloes such work
himseN or herself or ihrough his or her own employees, pmvided Ihet such improvements ere not intendetl or oNeretl tor sale. If, however, ihe building or improvement is
sold within one year of completion, ihe owner-builder will have ihe burden of proving that he or she did not builtl or improve for purpose ot sele.).
❑ I, as owner of ihe property, am E%CLU$IVELY CONTRACTING WITH LICENSED CONTRACTOFS to construd the project (Sec. 7044, Business and Professions
Cotle: The contrectors License Law does not appy to an owner oi pmperty who bulltls or improves Ihereon, antl who croniracts lor such proiect with a contrector(s)
license pursuant to the Contraaors Licensa Laws.).
❑ I am eaempt untler sec. � Business and Protessions Code for this reason,
Signature: — Date: -F — \"\ —�=
Owner ID venfiatl y" '— s icens ❑ es ❑ No Orivers License No.' �Ezpires:
Venfcation ot Ownership by (type of document, i.e. - pmperry tex 6ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERM17 CERTIFICATION:
❑ I hereby certify ihat no excava�ion tive (5) or more feet in depth in�o which a person is required lo descend, will be mede in connection with work authonzed by this
permit, and that no building sWcture. sCattolding, faisework, or demolition or dismantling ihereot, will be more than ihirty-sia (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Tule B, Calitornia Atlministrative COde).
❑ As ownervbuilder, I will not employ anyone to do work which would require a permit irom t�e Division oi Industriel Sefety, es noted above, unless such person hes e
permit to do such work irom Ihe division.
Signature: Date:
Division of Intlustrial Satery Permit Number:
CERTIFlCAT� OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I cenity under penalry of perjury ihat I have read this apPlication and state ihat the information given is
correct. I egree to comply wlih all state laws antl ci ordinances releting to builtling consWc�ion, end authorize representatives of the Ciry ot Costa Mesa to enter upon ihe
ebove-described property tor inspefrlien pur Oses. I gree not to occupy or altow occupancy� 'any buiiding authorized by Ihis permi� until final inspection.
_ / �-��--e1 �
ig ura Ot gal owher(s) � Date
And/Or Authori;ed Applicant Data
LppE�, INSPECTIONTYPE p0¢, ItIIII19k,4
1616 Fi:ed Syslem Final Fira Prevention
1266
200
Pool Spa Finel
Finel Re-Rooi
201 Finel BIocWRetaining Wall
202 Final Factory Fire Placa
203 Finel Sign
204 Final Demolition
C 0 INSVECTIONTYVE
206 Flnal Mechanical
208 Flnal Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
OATE f�
��13-R3 �
(714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2710 HIBISCUS
Suite:
Vicinily:
Parcel Number: TPN00111
Applicant: EZZAT SALAH
Address:
Owner: EZZAT SALAH
Address
ConVactor:
Address:
Zip:
Arch :
Address:
Zoning:
Phone: 714-444-1878
Zip:
Phone:
Zip:
Phone:
License:
Eng:
Address:
ISSUED B�'�
Status: ISSUED
Applied: 07/19/2002
Issued: 07/19/2002
� Phone: Phane:
Zip: License: License:
SCOPE OF PERMIT
80 SQ. Ff. DETACHED OPEN TRELLIS IN REAR YARD ' �
Plan Check: $39.07
Permit: $60.10
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $99.67
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 5- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 3- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Ri9ht 10- 0
��
S�,s�s.as
so.00
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned
for a period of 180 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 tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (714) 7545626 ,
�yas-a� lyoo�
��
�
WORKERS' COMPENSATION DECLARA710N: •
I hereby aifirm under penalry of perjury one ot ihe following declarations:
❑ I heve entl will mainiein a cehificate oi consent b self-Insure for workers' compensation, as Orovided for by section 3700 of the Lebor CoOe, for the pedormence of the
work tor which this pertni� is issued. .
❑ I have antl will maintain workers' compensation insurance, as requirea 6y section 3700 of Ihe Lebor Code, for the partortnance of the work for which this permit is issued.
My workers' compeQSation Insurence carner and poticy num6er are:
Carner: Policy Number:
(This secfion need nof be completed i! the permit is velued af one hundred dollars ($100) or less.)
❑ I certify that in iha paAormanca of Ihe work for which this pertnit Is issuetl, I shall not employ any person in any manner so as to becoma subject to the workars'
compensation laws of Californla, and agree that If I shoultl become sub�ecl to ihe workers' compensation provisions of Sectlon 3700 of the Lebor Code, I shell forthwith
comply with ihese provisions,
Applicant Signature: Data: �
WARNING: FAILUFE TO SECURE WOqKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUflIECT AN EMPLOYER TO CRIMINq� pENALTIES AND CIVIL FlNES UP TOONE HUNDREO
TFIOUSMIO OOLLARE (5100,000), IN AqORION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOEO WR IN SECTION 31O60F THE IABOR W�E, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby etfirtn that I am Ilcensed under provisions oi Chapter 9(commencing with Section 7000) of �ivision 3 ot the Business and Professions Code, and my license is in full
force antl eflect. Lia N Class #
Contrecrors SignaWre: Date:
CONSTRUCTION LENDING AGHNCV: �
❑ I hereby aHirm ihat there is a construction lending agency for the Derfortnance of the work for which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Name: Lendefs Address:
Sigrtafure: Date:
OWNER-BUILDER DECLARATIQNS:
I hereby aflirm thet undar penelry ot perjury ihat I am EXEMPT FHOM THE CONTRAC70RS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Profsssions
Code: Any ciry or counry which requires e permit to constmct, alter, imDrove, demolish, or repair any structure, pnor to its issuance, also requires the applicant tor such permit
to file a signed statement ihet he or she Is Ilcensed pursuent to Ihe provisions of the Comracrors License Lew (Chepter 9(commencing with Sectlon 7000) of DlNslon 3 of the
eusinass end Professions Cotle) or that ha or she is eaempt ihereirom end the basis for the alleged exemption. Any violetion of Section 7031.5 by any applicant for e pertnit
sublects the epplicant to a civil penalry ol not more ihan five hundred dollars ($500).):
❑ I, as owner of the property, 6r my employees wit� wages as their sole compensation, WILL DO THE WORK, end Ihe structure Is not intended or offered for sale (Sec.
7044, Businass and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, entl who does such work
himself or harsetf or through his or her own employees, provitled �hat such improvements are not intended or oRered For sale. If, however, Ihe building or improvement is
sold within one year of completion, the owner-builder will have Ihe burden of proving ihat ha or she did not build or improve for purpose oi saie.).
❑ I, as owner ot the proparty, ym EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Professions
Code: The coniractors License Law does not epply to an owner ol pmperty who bullds or Improves thareon, antl who contrects for such project with a contractor(s)
license pursuant to ihe Coniractors License Laws.).
❑ I em exampt under sec.
Signature: �--
Owner ID verified by dnver's � enae� Ves ❑ No
eusiness and Professions Code for this reason:
Venfication ot Ownership by (rype oi tlocumem, i.e. - pmperty tan bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY pERM17 CER7IFICATION:
Drivers License No.
Date:
Expires:
❑ I hereby certify ihat no excayation five (5) or more faet in depth into which a person is required to descend, will be made in connection with work authorizetl by this
pertnit, and that no building sWcture, scaflolding, talsework, or damolition or tlisman0ing Ihereol, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle B, California Adminisira�ive Code).
❑ As owner-builtler, I will not employ anyone to do work which would require e peimil from the Division of Indusirial Safety, as noted above, unless such person hes e
permit to do such work from ihe tlivision.
Signamre: Date:
Division ot Industrial Sefery Permit Number:
CERi1FlCATE O� COMPLIANCE AND AU7HORVA710N OF EMRY: I cenify under penalty of perjury ihat I have read ihis application antl state that ihe information given is
correct. I egree ro comply with al1 state lews and ciry ordinances relating to building construction, entl authonze representatives of the Ciry of Costa Mesa [o enter uDon the
ebove-descnbed propetly for Inspe ierryu ose I egree not to occupy or ellow occupen 'any builtling authorized by ihis permit until9nal inspedion.
�--_ '� _ \�l - o �.�
S" aNre Of Leg�wner(s) � Date
AndiOr Authorizad Applicant Date
COpE �. INSVECTIONTYPE Q�¢, irnrtu�s
7676 Fixed System Final Fire prevention
1266
200
Pool Spe Finel
Finel Fie-Roof
201 Finel Block/Reteining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
COOE I INSPECTION TYYE
206 Final MeChaniCel
208 Final Plumbing
210 Final EleciriCal
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 FinalBuilding/Occupancy
QiL IMRIALS
2-S-cx3 �_
.
� : .
(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us n FniR oNive, cos i n mrsn, cn szeze
BUILDING PERMIT
JobAddress: 2710 HIBISCUS
Suite:
Vicinity: 3RD CAR GARAGE INTO 5TH BEDROOM
Parcel Number: TPN00111
Applicant: PHILIPP, ROLAND
Address: 15326 ALTON PARKWAY
IRVINE, CA
Owner: STARDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA CA
Contractor. O WN ER-BU I LDE R
Address: ^
Zip:
Arch :
Address:
Phone:
Status: ISSUED
Applied: OB/24/2001
Issued: 08/24/2001
Zoning:
ISSUED BY: '
-Phone: 949-789-1600
Zip: 92618
Phone: 714-668-4300
Zip: 92626
Phone:
License: 0
Eng:
Address:
Phone:
Zip: � License: License:
SCOPE OF PERMIT
REPLACE 179 SF PORTION OF THE THIRD-CAR GARAGE WITH AN 179 SF FIFfH BEDROOM OPTION - PLAN 2- FOR
NEW SFR FOR "STANDARD PACIFIC HOMES."
REF: B00-01536
Plan Check: $34.00
Permit: $20925
SMIP Res: $1.13
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $244.38
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Ezistinq: o
NOTES:
Rear 0-0
Rear 0- 0
FEE SUMMARY
Calc Valuation: si �,zn.00
Claim Valuation: Si �,zn.00
PLANNING & ZONING
Left 0- 0 Right
Lek 0-0 Right
Reauired: 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, § i, 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. ,
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepectlons end 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
zaaa+e (arool �/
WORKERS' COMPENSATION OECLARATON: �
I hereby ettirtn under penalry ol perjury one ot the following declaratlons:
❑ I have entl wlll maintain e certificate ol consent to seN-Insure lor workere' compensetion, es provided for by section 3700 0l ihe Lebor Coda, for Ihe performence ot the
work far which t�i5 permit i5 issuetl.
❑ I have and wlll meintain workers' compensation insurance, as required by saction 3700 0l Ihe Labor Code, fo� ihe pertortnance of Ihe work tor which this pertnit is Issuetl.
My workers' compensatlon Insurence wrder end policy number ara:
Cartior. PWicy Number:
(Th/s sectlon need not be cnmp/eted il fhe peimit is ve/ued et one hundred dollars ($700) or /essJ
❑ I certiy t�et In t�e Deriormence of the work for which ihis pertnit is issueq I shell not employ any person in any manner so es to became subject to the workers'
compensatlon laws ol Callfomia, end egree Ihat If I should become sub�ect to the workers' cwnpensation pmWsions oi SecNon 3700 of tha LaCor Code, I shall forthwith
complY with these pmvisions.
Applicant Signature: Date:
WARNIN(3: FAILURE TO SECURE WORKERS' ODMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPIOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRE�
THOUSNND DOl1ARE (S10U,000�, IN AODITION TO TME C0.5T OF CAMPENSATIIXJ, �AAMGES AS PROVIOED FOR IN SEGTION 31O60F iHE LABOF CODE, IMEREST, M!D ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: j
I hereby effirtn that I em licensed under provisions of Chapter 9(wmmencing wlih Section 7000) of Divislon 3 ot the Business and Professions Code, end my licensa is in full
torce end eHect. Llc. a Class x
Comrectofs Signetu.e: �ate:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that there Is a construction lending egency for the peAormence ot the work for whic� this parmit is issuetl. (Sec. 3097, Civil Cotle).
Lentler's Neme: Lendor's Atldress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm that under penelty of perjury Ihet I flm EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Buslness end Professlons
Code: Any ciy or counry which requires e permit to consiruct, alter, improve, demolish, or repair eny structura, prior to its issuance, also requires �he epplicant tor suc� pertnit
to file a signed stetement ihet he or she is Ilcensed pursuant to Ihe D��slons ot Ihe Contradors License Ww (Chepter 9(commencing wlth Sectian 7000) of Division 3 oi the
Businoss entl Prolessions CoAe) or ihat he or she is e:empt therefrom antl Ne besis lor the elleged ezemption. Any violetion af Section 7031.5 by eny epplicent lor a pem+'
sublects the applicant to e civll penalry af not more Ihan five huntlred dollars (5500).):
❑ I, es owner of the property, or my employees with wages as their sWe compensation, WILL DO THE WOFK, antl the structure is not intentled or offered tor sale (Sec.
7044, Business and Professions Code: The Contrectors Licanse Law does not appty Io an owner of property who builtls or improves ihereon, end who does such work
himsell or herself or Ihrough his or her own employees, provideC t�at such Improvements ere not imentletl or oNered lor sale. It, however, Ihe building or improvement is
sold within one year oi completioq t�e owner-builtler wiil �ave ihe burden of proving ��at he or she did not build or improve for purpose of saleJ.
�I, as awner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTAACTORS to construct the pro�ect (Sec. 7044, Business end Protessions
Code: The conirectors License Law tloes not appty to an owner of property who Gulltls or Improves ihereon, and who contrac�s for such project wit� e contrector(s)
lican5e pursueM to ihe Camractors License Laws.).
❑ I am exe� t �un_�yqr s�ec(�']��\
Signature: —R`�
Owner ID veritied by drivers license.
❑ Ye�s ❑ No
Business and Professions Code for this reason:
Vedficntion of Ownership by (type of document, i.e. - property ta: bill or deed):
DIVISION OF INDUS7RIAL SAFE7Y PERMIT CERTIFICATION:
DnvefsLicense No.
Date:
Expi es:
❑ I hereby certify the� no excevation live (5) or more feet in dep�h Into whlch e person Is required to descen4 will be matle In connection with work euthonzed by this
pertnit, end ihet no builtling siructura, scaRolding, falsework, or demolition or dismanNing thereof, will 6e more ihan ihirty-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Title B, Celifomle Administrative Cotle).
❑ As owner-builtler, I will not employ anyone to do work whic� woultl reQuire e permit irom ihe Division of Industnal Sefery, es notetl above, unless such person hes a
permit to do such work irom ihe division.
Signature: Date:
Division ol Industrial Sefery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMRY: I certity un0er penalty of perjury that I have reatl this epplication enC state t�et the iniormation given is
correct I egree to comply with all state laws and ciry ordinances releting to building constmction, and authonze representatives of the Ciry of Coste Mesa to enter upon the
ebove-described property for inspection purposes. I agree not to occupy or ellow occupancy of eny building auihorized 6y Ihis permit until tinel inspectian.
iqnaWre Lege er( � n, J��Dp��e �
�i / /
And/OrAuthonze Applicent ate
COpE �. INSPELTIONTYPE QOIE
1616 Fi:ed System Final Fire PrevenUon
1266 Pool Spe Final
200 Final Re-Root
207 Final BIaWRetaining Well
202 Final Fectory Fire Placa
203 Finel Sign
204 Final Demolition
�@ �( INSPELTIONTYVE
206 Final Mec�enical
208 Final Plumbing
210 Final Eleciricel
212 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupancy
Pa7E I[�ALS
/O-/i-O/ �
To
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTiFICATE OF COMPLIANCE OF DEVELOPMENT fEES
PURSUANT TO AB 1600 AND AB 181
i .
N° 3947
( City of Costa Mesa District Receipt No,f /l� 33/
( ) City of Newport Beach
( ) Counry of Orange Plan Check No.��" O ��JI �
Applicant:
Address:
Tetephone Number. � �� �fl `� rJ J���
TracUParcel and Lot Number(s):
Location of Project:
Number of Square Feet of:
Residentlal Space
Commercial and
Industrial Space
CommerciaUlndustrial Projed is: (Check One)
Warehouse
R8D
Movie Theater
Mini-storage
Heavylndustrial
Regional Shops
Light Industrial
This project is exempt because
�_x 51.84
x S .30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueVHealth
_ Hotel
_ Medica101fice
_ Office Park
To�� 3a� . 3C�
Total
Preschool
Auto Repair
Hospital
Large Office
Otfice Bldg.
Restaurant
Fast Food
This certifies that the above-named Developer/Applicant has paid school faciNty fees in comptiance with Government Code sections
53080 and 65995. The Building Permils for this square footage in this proposed development may now be issued by your jurisdic9on.
Checks are to be made payable to Newport-Mesa Unified School
RapreseMativa
The above representation as to square footage is We. AppNcant agrees that If it is later determined that such represe�ta6ons are not
true, then this certificate shail automatically temtinate a�d the appropriate CitylCounty shall be n�Ai�.z881/9:33 AM/f 2484.88
kCPik:Al-B8B3808
g 116331
Date: Z
Apptle�M
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 2710 HIBISCUS
Suite:
Viciniry: PLAN 2
Parcel Number: TPN��I l l
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
COSTA MESA CA
Owner: STARDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA CA
Contrector: OWN ER-BU I LDER
Address:
Zoning:
Phone: 714-668-4300
Zip: 92626
Phone: 714-668-4300
Zip: 92626
Phone:
ISSUED BY:
Status: ISSUED
Applied: 12/29/2000
Issued: 01/17/2001
Zip: License: 0
nrch : BASSENIAN LAGONI Eng:
Address: 2031 ORCHARD DR Address:
STE 100 Phone: 949-553-9100 Phone:
NEWPORT BEACH, CA
Zip: 92660 License: License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR PIAN 2 FOR STANDARD PACIFIC HOMES: 2816SF LIVING, 606SF GARAGE, 94SF PATIO.
REF: B00-01536
Plan Check: $303.45
Permit: $1,867.35
SMIP Res: $25.59
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $2,196.39
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
LeR 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$255,91828
so.00
NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Calitomia statutes and relatad
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned
for a period of 780 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
required Inapeetlone and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
24C&4fi (6/00) / /
v
WORKERS' COMPENSATION DECLARATION: _
I hareby a%irm under penalry of perjury one oi tha following tleclarations:
❑ I have end will maintain a cenificele of consent to self-Insure br workers' compensetion, as provided tor by sectlon 3700 of the Labor Code, for Ihe peAortnence of the
work tor whlch ihis permit Is issued.
❑ I have antl wlll maintain workers' compensation insurence, as requiretl by section 3700 of ihe LaDor Cotle, for the Dertormanca oi the work for which Ihls pertnii is issued.
My workers' compensation Insurance carner entl pollcy num�er are:
Cerner. Policy Number:
(This sec(ion need nof be completed i! fhe permi( is velued ef ane huntlretl dollars ($100) or /ess.)
❑ I cenity t�ei In the pertortnance of the work for which t�is permit is iuue0, I shall not employ any person in any manner so as to become sublact to the workers'
compensatlon laws oi Calitomia, end egree thet II I should become sub�ect to the workers' compensation provisions oi Section 3700 0l Ihe Lebor Code, I shall forihwith
comply wit� t�ese provisions.
Applicant Signeture: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVEMGE IS UNLAWRIL AND SHALL SUBIECT AN EM%.OVEF TO CRIIWNAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED
THOUSAND DOLURE (5100,000), IN ADDRION TO THE COST OF COMPENSAiION, DAA41GE5 AS PROVIDED fOR IN SECTION 3�O60F THE LABOR CODE, IMEREST, AND ATTOHNEY'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I here6y aNirm ihet I em licensetl under provlslons of Chapter 9(commencing with Sectlon 7000) of Divlslon 3 oi the Business and Professlons Code, entl my license is in full
force antl eNect. Lic. N Class q
Comractor's Signatura: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that Ihere is a conslruction lending aBency for ihe perfortnance of the work for which this permi� is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lendefs Address:
Siqnatura: Date:
OWNER-BUILDER DELLARATONS:
I �erehy eRirm Ihet under penalry oi perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for tha tollowinq reason (Sec. 7031.5, Business entl Professions
Coda: Any ciry or counry which requi�es a permit to consimct, alter, improve, demolish, or repair eny slmcture, prior lo its issuance, also requlres the epplicaN for such pertnit
to lile e signetl stetement ihat he ar she is Ilcensad purauent to ihe provislons of Ihe Contrectors Licensa Lew (Chapter 9(commencing with Sectlon 7000) ai Division 3 oi the
Business and Professions Cotle) or thet he or she is ezempl iherefrom and the basis for the elleged exemp�ion. Any violation oi Sectlon 7031.5 by any ap0�icant for a permlt
sublects tha appllcant to a clvil penalry oi not more than five hundred dallars ($500).):
❑ I, es owner ot Ihe property, or my employees with waBes as iheir sole compensation, WILL DO THE WORK, antl the structure is not Intendetl or offeretl tor sale (Sec.
7044, Business end Professions Code: The Gontrectors License Law tloes not apply to en owner of propeny who huilds or improves Ihereon, end who does such work
hlmseN or herself or through his or her own employees, provitletl Ihat such improvemenis ere not Intended or oHerea for sale. II, however, ihe building or improvement Is
�soltl within one year of completion, ihe owner-builder will �eve the burden of proving that he or she did not build or improve tor purpose of saleJ.
I, es owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the Drolect (Sec. 7044, Business end Proteuions
Code: Tha cantractors License Lew does not epply to en awner ot pmperty who builds or Improves thereon, and who contrects lor such project with e contrector(s)
license pursuan� to �he Contractors License Laws.).
❑ I am exempt u er —�-�--�—, �� Business antl Professions Code lar this reason:
SignaNre: � 11 � y�—��,1,� 1 Date:
Owner ID veritietl by tlriveYs license. LJ Ne5 ❑ No Dnvefs Licensa No. Expires:
Vedfication of Ownership by (rype of documem, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certity that no excavation five (5) or more �eet in depih into which a Derson is requlred to descenq will be made in connectlon wlih work euthodzed by Ihis
pormit, and thet no building swcWre, scaHoltling, lalsework, or demolition or tlismantling thereol, will be more �han ihirry-six (38) taet hlgh. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, Calitomia Adminisiretive Code).
❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Intlustrial Safery, as noted ebove, unless such person hes e
pormit to do such work irom the diNsion.
Signature: Date:
Division of Intlusirial Safery Pertnit Number:
CERTFICATE OF COMPLIANCE AND AUTHORVATION OF ENTRY: I cenify untler penalry ol perjury that I have reatl this application entl state that the iniortnation given Is
correct. I agree to compty with all state laws end ciry ordinances relating to building consiruction, antl authorize representatives ot Ne Ciry o� Costa Mesa to enter upon the
ebove-descnbed property for inspection purposes. 1 egree not to acupy or allow occupancy of any huilding authorized by this pertni� until linel inspection.
Sign re ege r 5�n n I,� O Date
�� I i
AnNOr Authorize Applicent Y � (Date
CODE �. INSPECTIONTYPE
1616 Fi:ed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Roo�
201 Final BIocWReiaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
pdjf, �NTRIALS
COOE I INSFECTION TYPE
206 Final Mec�anical
208 Final Plumbing
210 Final Eleciricel
212 Final Fire Preveniion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
PAIE It{�LS
1 =�
NEWPORT-MESA UNIFIED SCHOOL OISTRICT
CERTiFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 ANO AB 181
To: (X ) City of Costa Mesa
( ) Ciry of Newport 9each
( ) County of Orange
Applicant:
Address:
STANDARD PACIFIC
15326 ALTON PARKWAY, IRVINE, CA 92618
Telephone Number: 949-789-1600
TracUParcel and Lot Number(s):
Location of Project 2710 HIBISCUS, COSTA MESA, CA
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
CommerciaUlndustrial Projed is: (Check One)
Warehouse
R8D
Movie Theater
Mini-storage
Heavy Industrial
Regional Shops
Light Industrial
This project is exempt because
2816 SF x $1.84
x $ .30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueVHealth
_ Hotel
_ MedicalOffice
_ OiGce Park
Total
Total
3719
District Receipt No.
Plan Check No. 800-02069
$5181.44
Preschool
Auto Repair
Hospital
Large Office
Office Bldg.
Restaurant
Fast Food
i his certifies that the above-named Developer/Applicant has paid school fadtiry fees in comptiance with Government Code sections
53080 and 65995. The Building Permi� 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 Disfid.
BONNIE KUBOTA
By:
AWaraed ReprcseMative
The above representation as to square footage is true. Applicant agrees that i( it is later determined that such representations are not
true, then this certificate shali automaticalN terminate and the appropriate CitylCounty shall be notifled.
JAN 23 2801/11:29 Atl/E 62475.36
I 2� O � � ��^^� RCPTp;01-Ba71725
p 114Q12
ate.
APP4eaM
INSULATION CERTIFICATE IC-1
2710 HIBISCUS
COSTA MESA
CiTy
ORANGE 15882 69
County TrectNo LOT
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) Termal Resistance (R-Value)
2 CEILING
BattorBlanketType BATT BrandName OWENS CORNING
Thickness (inches) 6 1/4" 7hermal 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 BATT
7hickness (inches) 3 1/T'
B. Ezterior 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 tha[ [he above insulation was installed in the building and the above location in conformance with the current
Energy Efliciency Stenderds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Compliance, where applicable.
�+( (�F 7/27/01 PARAGON INSULATION
Item #s ignature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
ltem #s
Signature, Dafe
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
ELLINGSON, BEN
From: SANTORO,SUSAN
Sent: Thurstlay, August 23, 2001 7:19 AM
To: ELLINGSON, BEN; OOSTERHOF, SYLVIA
Cc: GUEVARA, MICHAEL; MUNOZ, ERNESTO
Subject: C of O Standard Pacific
Ben/Sylvia: Engineering approves final C of O for Standard Pacific Homes, Tract No. 15882, Phase 1, Lots 6-13 & 66-69
only. Further approval will be required for any remaining lots.
Susan
PETROS, 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
� .. �.._ � . ....... _ ' ' . . . ' �. �.,. �.��.....� ., r.nM1�HB1.
i ' � 7".V !O -b$O L-oZ - . �
FINAL GRA�ING CERTIFIC�4TION
Project Address: � � 4 A�DAu-�S
Lol Number. 66 Tt�+K.oi � �c H� 9 �yta+.L'1 t52�v z
Permil Number: � � — �� 3 Z—
By Civil Engineer:
I ceaify to the satisfactory completion of grading iq accordance with the approved plens,
specificarions, locai and state codes. All d�ainage devices required by the grading permit,
grading plan and grading ordinana have been installed. /,kdequa� provisions have ban made
for drainage of surfaa water fmm each buAding siu.
The minimums are:
+ 2% Fall from atruccures within 5 fat from exterior walls.
l% Fail for asphal� surfaces and landscaped areas. '
U.59� Fall for concrete surfaces W approved disposal areas..
The final monuments as shown on the morded tract map w�ere set. Ali final grading elna• �
[ions are within ± 1/10 of the designed elevaqon �
Supervising Civil Enginecr Reg. No. 394"�8
(SiY,umm) �. ,.
. Date _9-1�-0/
s:
_ � ;;;
�.
crn•ao a.,.a crna
1 '
,.; I,,J���.1� ♦ ♦ �AJ JL
Inspection S Testing, inc.
Ciry of Costa Mesa
Depanment of Buildin� and Safery
77 Fair Dr.
Costa �lesa. CA 92626
Corttiiiunus lnspeclion & iYlnterinls Tea'ti�ty
�i ftb. � - -t. .P C�• .a-. �c,
IOS26 South �Ior�valk Bh�d., Santa Fe Springs. CA 90670
(�62)9d1-2990•(714)526-3441
FAX (562) 946-0026
Au_ust 2?. 2001
Re: Final inspection for the (Mesa Verde Collection) r�i Harbor & Adams, Costa Mesa, CA. Standard Pacific Homes.
Lot n Permit =
6 B00-02029
7 B00-020�1
3 B00-020»
Pool Bldg. B00-02039
Lot = Permit =
9 B00-02056
l0 B00-020�7
ll B00-02058
Lot � Permit rt Lot � Permit #
12 B00-020�9 67 B00-02063
I3 B00-02061 63 B00-02064
66 B00-02062 69 B00-02069
Dear Sir
South«�est Inspection and Testing was retained by the Owner to provide special inspection and materials restin� in the areas that were required
by section 1701 of the Uniform Buildino Code, approved project drawines and specifications, this work was wimessed b}' the followin��
inspectors.
Reinforced conerete inspection ���as done bv the followine:
\1c Eric Strauch (OCEJ�IA 0598)
�1cScott Bald QCBO 50�5178)
J1r. Bam� Ben Ron pCBO �036896-J9)
\Ir. Ron Scoe�ins (ICBO 0846897-89)
Stressine of %." Post Tensioned Tendons w�as done bv the followino:
\1r. Nat Brennan (OCEA�1.4 031 i)
�Ir. Jay Dresner QCBO 08i�301-89)
�Ir. Ken Rodeers (ICBO 08�16897-89)
All work was done in conformance with the Shvctural Enoineers recommendations, approved drawings and/or revisions, project specifica[ions
and applicable workmanship provisions of the Unifortn Buildin, Code. If you should have any further questions, please do no[ hesitate to call
�
Reviewed Bv:
lan R. Waddeii��
Principal Engineer
FOR INSPECTION AND TESTING ONLY, NO DESIGN
RESPONSIBILITY EXPRESSED OR IMPLIED.
p�a) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIFi OHIVt, 1:U51A MtJA, GA 8YbZ0
Job Address:
Suite No
Vicinity:
Parcel Number:
Applicznt:
Address:
Owner:
Addr85s:
ContracCor
Address:
Arch / Eng :
Address:
MECHANICAL PERMIT
2710 HIBISCUS
PLAN 2
TPN00111
PHILIPP, ROLAND
1565 W MAC ARTHUR
COSTA MESA CA
STARDARD PACIFIC HOMES
1565 W MAC ARTHUR
COSTA MESA CA
OWNER-BUILDER
Phone: 714-668-4300
Zip: 92626
Phone: 714-668-4300
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zip: ,
License:
ISSUED BY:
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 2 FOR STANDARD PACIFIC HOMES: 2816SF LIVING, 606SF
GARAGE, 94SF PATIO. 2 FAU <t00K BTU, 1 FACTORY FIREPLACE. 1 HOOD W/MECH
EXHAUST, 2 VENT FANS, SINGLE DUCT, 2 COMPRESSORS UP TO 3 HP/100K BTU.
REF:B00-02069
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair / A!t CoolinglHeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Re(rig 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 < 70000cfm
AirHandlers> 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$29.60
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$10.65
$10.65
$0.00
$14.50
$0.00
$0.0�
$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
Evaporative Cooler
Comme rcial I n cinerator
Domestic Incinerator
Compressors / Absorption Svslems
Up l0 3 hp ! 100 k BTU
3To15hp/500k8TU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 12/29/2000
Issued: 01/12/2001
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$29.40 2
$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
$0.00
TOTAL CALCULATED FEES S'118.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 1241-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTION5: �n order for ihe work authorized under ihis permit to be considered legal, such work must comply wilh all appticable codes, and atl
required Inspectlons and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this parmit.
FOR INSPECTIONS CALL: (714) 7545626
2aas.ae (sroo)
WORKERS'COMPENSAnON DECLARAnON:
I hereby affirm under penalry of perjury one of the following declaratlons:
❑ I heve end will maintain e certilicete of wnsent to self-Insure for workers' compensation, as pwvided for by section 3700 0l the Lebor Code, for ihe peAortnence of the
work for which this pertnit is issued.
❑ I heve end will maintain woAcers' compensation insurance, es required by section 3700 oi the Lebor Code, for the pedormance of Ihe work for which Ihis pertnit is issued.
My workers' compensation Insurance carrier and policy number are:
Cerrier: PoliCy Number:
(This sectian need not be com0�eted i/ the permif is valuetl at ane hundred dollars ($f00) or less.)
❑ I certity ihat in the pedormance oi the work for which this permit is issueq I shall not employ any parson in any manner so as to bacome subject to iha workers'
compensation laws of Californie, antl egrae ihat If I should become subject to the workers' compensation provisions of Sectlon 3700 of ihe Labor Code, I shell forthwith
comply with ihese pmvisions.
Applicant Siqneture: Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIELT FN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED F-0R IN SECiIIXJ 3/Ofi OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION: '��
I hereby eNirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 oi the Business end Professions Code, end my Iicense is in full
force end ettect. Lic. N Class a
Contrectofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby attirm that there is e consiruction lending agency for the peAormance of ihe work for which this permi� is issued. (Sec. 3097, Civil Cotle).
Lentler's Name: Lender's Address:
Signeture: Da�e:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm Ihat under penelty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions
Code: Any ciry or county which requires a permit to consimct, alter, Improve, demolish, or repair any strucwre, pnor to its issuance, also requires the epplicant tor such pertnit
to file a signed statement ihat ha or she is Ilcensed pursuent to the provisions of the Coniraciors Licensa Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Pmfessions Code) or that he or sha is exempt therefrom antl the basis tor the elleged exemption. Any violetion of Section 7031.5 by eny epplicant for e partnit
subjecis the applicant to a civil penalry af not more ihan tive hundred dollars ($500).):
❑ I, as owner of tha property, or my employees with wages es Neir sole compensatlon, WILL DO TME WORK, and iha structure is not in�entletl or oNere0lor sele (Sec.
7044, Business and Professions Code: The Contractors License Law does no� apply �o an owner of property who builds or impmves ihereon, and who does such work
himself or herseN or through his or her own employees, provided that such improvements are not Intended or oHered for sele. It, however, the building o� Improvement is
soltl within one year oi completion, the owner-builder will have ihe burtlen of proving ihat he or sha did not build or improve tor purpose of sale.).
� I, as owner ot ihe property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to consimct the pmject (Sec. 7044, Business end Prote55ions
Code: The contracbrs License Lew does not apply to en owner of propeny who builtls or Improves thereon, antl who contracts tor such prolect wlih a contractor(s)
license pursuant �o �he Conirec�or5 LiCenSe LawS.).
❑ I am exe t und sec
Signatura: ��
Owner ID ventied hy drivefs
❑ Yes ' '� No
Business and Professions Code tor Ihis reason:
Date: CJ
Orivels License Na. Exoires:
Verilicetion oi Ownership by (typa ot tlocument, i.e. - property taa biil or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavetion five (5) or more feet in depth into which a person Is requiretl to tlescend, will be mede In connecNon with work euthodzed by this
pnrmit, and ihat no building s�mcture, scallolding, falsework, or demolition or dismamling thereof, will be more �han thirty-six (36) fee� high. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Ttle 8, Calitomia Atlministretiva Code).
❑ As owner-builder, I will not employ anyone to tlo work which would require a permit irom ihe �ivision of Indusiriel Sefety, as noted above, unless such pereon hes e
pormit to do such work irom �he tlivision.
Signature: Date:
Divisian ot Industnal Safery Permi� Number.
CERTFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I certiy under penalty of perjury that I have read this epplication antl s�ate tha� the intortnation given is
correct. I egrea to comply with all state laws and ciry ordinences relating to building construction, end au�horize representa�ives of ihe Ciry of Costa Mese to enter upon iha
ebove-described propeAy tor inspection puryoses. I egree not to occupy or allow occupancy of eny building authorized by this permit until final inspection.
CODE t. INSPECTIONTYPE QLff. Ui�JELS
1616 FixeC Syslem Final Fire Prevention
1266 Pool Spa Final
200 Finel Re-Roof
201 Finel Block/Re�aining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
�`E
CODE� INSGECiIONTYPE
206 Final MecOanical
200 Final Plumbing
210 Final Elec�rical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Psu p�4) �5a-aess • www.ci.costa-mesa.ca.us n Fnia oHive, cos i A mrsn, cA azozo
PLUMBING PERMIT
Job Address: 2710 HIBISCUS
Suite No
Vicinity: PLAN 2
Parcel Nunmber: TPN00111
Applicant
Address:
Owner:
PHILIPP, ROLAND
1565 W MAC ARTHUR
COSTA MESA CA
STARDARD PACIFIC HOMES
Address 7565 W MAC ARTHUR
COSTA MESA CA
Contractor: OWNER-BUILDER
Address:
Arch / Eng :
Address:
ISSUED BY:
Phone: 714-668-4300
Zip: 92626
Phone: 714-668-4300
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zlp:
License:
Status: ISSUED
Applied: 12/29/2000
Issued: 01/12/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 2 FOR STANDARD PACIFIC HOMES: 2816SF LIVING, 606SF GARAGE,
94SF PATIO. 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK, 1 GAS OUTLET (t-4), 3 GAS
OUTLETS (OVER 4), 1 LAUNDRY TUBNVASHER, 1 PRESSURE REGULATOR, 1 SEWER CONNECT, 1
SHOWER, 1 KITCHEN SINK, 1 SERVICE/MOP SINK, 3 WASH BASINS, 1 WASH BASIN SET, 3 WATER
CLOSETS, 1 WATER HEATERNENT, 1 WATER SERVICE,
REF: 800.02069
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bathtub
Clarifer System
Connect pce,Sotla,slc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drein, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (7-0 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
AMT
$23.50
$0.00
50.00
$19.60
$0.00
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$9.80
$0.00
$6.15
$3.30
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer .$9.80
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $9.80
Process Piping (per 10 ft) $0.00
Receptors $0.00
Seplic Tank $0.00
Sewer Cap for Demo $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
nrr
1
0
0
1
0
0
0
�
7
0
1
0
0
0
1
1
0
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(1-4)
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
50.00
$0.00
$0.00
$0.00
$0.00
$29.40
$9.80
$0.00
$29.40
$12.30
$0.00
$0.00
$9.8D
$0.00
$0.00
$0.00
50.00
$0.00
Qn
0
0
0
0
0
0
3
1
0
3
1
0
0
1
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access red����ig'oS',N�h�,Rd����;at�6s��`�Ad related
EXPIRATION: This permit shall automatically ex � P in 180 days, or if work is suspended or abandoned
for a period of 180 daYs.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlona end (inal approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of ihls permit.
FOR INSPECTIONS CALL: (714) 7545626
2d46�a6�N00)
WORKEPS'COMPENSAnON DECLARAnON: �
I herehy aHirtn untler penelty ot per�ury one ol tha tollowing declaratlons:
❑ I heve entl will malntein a ceM1lNcete of consent to sell-Insure for workers' compensation, es prodded far Cy sec0on 3700 of ihe Lebor Coae, for the pertormence ot tha
work tor which t�is permil Is IssueO.
❑ I have and wlll meintein workers' compensation insurence, as requiretl by seclion 3700 of the Lebor Cotla, Por the peAortnence of the work tor which this pertni[ I5 issued.
My workers' compensatlon Insurance carrier end policy number are:
Cartier. Policy Number:
(This section need nol be�completed i! the permit is velued et one huntlred dWlars ($100) or IessJ
❑ I certity t�at in the pertortnence ot the work tor which this permit is issueq I shall not employ eny person in any menner so as to bewme subjeM to Ihe workers'
compensatlon laws of Cellfomia, antl agree thet II I shoultl Decome subject �o t�e workers' compensation proNslons ol Sectlon 3700 of Ihe Lebor Cotle, 1 shell torthwith
comply wit� thesa provisions.
Applicant Signatura: Date:
WARNING: FNLURE TO SEWRE WORKERS' COMPENSATIqJ CWEMGE IS UNLAWFUL AND SHaLL SUBIEGT AN EMPIOVER TO CRIMIWIL PENALTIES PN� qVIL FlNES UP TOONE MUNDRED
TH(%15rW D DOIURE (2100.000), IN ADOrt10N TO TME COST OF WMPENSATION, DAMNGES AS PROVIDED FOR IN SECTION 3]080F THE LABOR CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I em Ilcensed under provisions of Chapter 9(commencing with Sectlon 7000) ol Division 3 0l tha Business end Professions Cotle, and my license is in full
f0lCB 8nd BflBCL LIC. M CI355 N
Contrectols Signawre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirm ihat ihere is e constmction lending egency for the pertormance of ihe work for which this permlt is issued. (Sec. 3097, Civil Coda).
Lender's Name: Lender's Atldress:
SignaNre: Date:
OWNER•BUILDER DECLARA710NS:
1 hereby aHirm Ihat under penalty ol perjury t�el I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business and Professlons
Code: Any city or county which requires e permit to constmct, eller, improve, demolish, or reDair any structure, pdor to Its Issuance, elso requires Ihe apD�icant far such permit
to file e signad stetement thet he or she is IlcenseA pursuent to ihe provisions oi Ihe Cantrectors License Lew (Chepter 9(commencing with Saction 7000) of DlNslon 3 af the
Business end Professions Code) or that he or she is exempt iheretrom and tha besis tor the alleged exemption. Any violatlon of Sectlon 7031.5 by any applicant for e pertnit
sub�ects the epplicent to e civil penalry of not more than Ilve huntlretl dollars (5500).):
❑ I, es owner ot the properry, or my employees wit� wages es t�eir sole compensatlon, WILL DO 7HE WORK, end Ihe siructure Is not IntenOetl or ofleretl for sale (Sec.
70a4, Business and Professlons Code: The Coniractors License Law does not appty to an owner of property w�o bulltls or improves thereon, antl who does such work
himseN or herselt or Ihrough his or her own employees, provided that such improvements ere not Intende0 or oHered lor sale. If, however, Iha building or improvement is
sold wit�in one yeer oi completion, the owner-builder will have the 6urtlen of proving Ihat he or she did noI builG or Improve tor purpose oi sale.).
� I, es ownar of the pmpetly, am E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Protessions
Code: The comrecrors Llcense lew tloes not apply to an owner of propeny who builtls or Impmves Ihereon, end who coniracis lor such project with a coniraIXor(s)
license pursuant to the Contrectors License Laws.).
❑ I am exempt under Business end Professions Code far this ree5on:
Signature: � i.{1 Date:
Owner ID venlied by river's licensa. ' � Ye� 0 No Drivers License No. E�ireS:
Vedficetion of Owners�ip by (type ot tlocument, i.e. - propeny taa bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CEFi71FiCA710N:
❑ I hereby certily t�at no exwvetion five (5) or more faet in depih into which e pereon is requiretl to tlescend, will be mede in conneciion with work authorized by this
pertnit, and thet no builtling siructure, swflolding, falsework, or demolition or dismantling thereol, will De more ihen thirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle B, Celitornle Administretive Cade).
❑ As awner-bulltler, I will not employ enyone to do wurk which would requlre e permit from the Division of Intlustrlal Safery, es noted ebove, unless such parsan hes e
pertnit to do such wark from ihe division.
Signature: � Oate:
Division of Industnel Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVJITON OF EMRY: I cenity under penalry of perjury thet I have read Mis epplication enG stale that ihe iniormetion given Is
corcect I agree to comply wlth ell stete lews end city ortlinances relating to builtling consWctlon, entl euthorize representetives ot Ihe Ciry of Costa Mesa to enter upon �he
ebove-descnbed property for inspection purposes. I egree not to occupy or ellow occupancy of eny building euthonzed by this pertnit until finel inspection.
COUE 1, INSPECTIONTYPE Q�g INf111ALS
1616 Fixed Sysiem Final Fire PrevenUon
1266 Pool Spa Finel
200 Final Ra-Raol
201 Final BIocWRetalning Well
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
Date
I z3 v 1
Date
CO�EI INSPECTIONTYFE p� QQ�$
206 Final Mechanical
20B Finel Plumbing . � � ��
I
210 Flnel Electdcal
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
(714) 754-5273 • Fa�t (714) 75a-4856 • www.Ci.Costa-mesa.Ca.us 77 FAIF DRIVE, GOSTA MESA, GA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
2710 HIBISCUS
PLAN 2
TPN00111
PHILIPP, ROLAND
1565 W MAC ARTHUR
COSTA MESA CA
STARDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA CA
Contrector.
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 t000a
Service over 1000a
Motors to 1 hp
Motors to tOhp
Molors to SOhp
Motors to 100hp
Motors over 700hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
OWNER-BUILDER
Phone: 714-668-4300
Zip: 92626
Phone: 714-668-4300
Zip: 92626
Phone:
Zlp:
License: 0
ISSUED BY:
Status: ISSUED
Applied: 12/29/2000
Issued: 01/12/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 2 FOR STANDARD PACIFIC HOMES: 2816SF LIVING, 606SF GARAGE,
94SF GATIO. 1 NEW RES (7 UNIT), 2 LIGHT FIXTURES, 3 OUTLETS, 2 SWITCHES, 1 MOTOR TO
1 HP. •
REF: B00-02069
$23.50
$0.00
$0.00
$157.70
$0.00
$0.00
$2.20
$3.30
$220
$0.00
$0.00
$0.00
$0.00
$0.00
$4.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$o.00
$0.00
Quantity
2816
0
0
2
3
2
0
0
0
0
0
1
�
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical 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
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantiry
$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 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
$0.00
TOTAL CALCULATED FEES E193.65
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
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: (774) 7545626 � ,
zaas�ae Idoo) �\
WORKERS' COMPENSA710N DECLAfiATION: �
I herehy affirm undar penalty ol perjury one of Ihe tollowinq tleclaretions:
❑ I heve entl will maimain e certilicate ol consent to selt-Insure tor workers' compensetion, es pmvitletl tor by section 3700 of the Lebor Cotle, tor the pedormence of Ihe
work tor which this permil Is issued.
❑ I heve and will malntaln workers' campensation insuranca, as required by section 3700 0l the lebor Cotle, for [he petlortnance of Ihe work for which Ihis pgrtrilt Ls Issuetl.
My workars' compensatlon Insurance wrtier and policy number are:
Cerrier: � Policy Number:
(This sectlon need nof be comp/efed il the permi( is valued et one hundied dollars ($100) or /ess J
❑ I ceRity that in the pertortnance ol the work for which Ihis pertnit is iuuetl, I shall not employ eny person in any manner so as to become suD�ect to tha workers'
compensetlon laws of Calilamle, entl eqree that it I shoulU Decome subject to the workers' wmpensation pmvislons ot Section 3700 of Ihe Lebor CoGe, I shall torthwith
comply with these provislons.
Applicant Signature: Data:
WARNINO: FAILURE TO SEWRE WORKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHPLL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED
TKKISAND DOIURE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAN.4GE5 AS PROVIDEO FOR IN SECfION 31080F THE 1A80R ODOE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CON7RACTORS DECLARATION:
I heraby eXirm thal I am Ilcensed under provisions of Chapter 9(commencing wit� Sectlon 7000) of Division 3 of Ihe Business and Professions Coda, entl my Ilcense Is in full
force antl eHecL Lic. x Class a
ConirectoYs Signature: Da�e:
LONS7RUC710N LENDING AGENCY:
❑ I hereby ettirm thet ihere is e construction lending egency for iha pertormance ol Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lendefs Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATONS:
I hereby aHirm Ihet under penalry of perjury that I am E%EMPT FHOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any Ury or counry which requires a permit to construct, alter, improve, demolish, or repair eny siructure, prior to its issuance, also requires the epplicant tor suc� pertnit
to lile e signetl stetement that he or she is Iicensed pursuani to the provisians ot t�e Contractors License Law (Chapter 9(cammendnq with SecHon 7000) of DlNsion 3 of Ihe
Business and Pratessions Cotle) or t�at ha or she is exempt therefrom and the basis lor Ihe ellegad exemption. Any violation of Section 7031.5 by eny applicant for e permlt
suhjeds ihe applicant to a cMl penalry ol not more than tive hundretl tlollars (9500).):
❑ I, es owner ot Ihe properry, or my employees with wages es t�elr sole compensation, WILL DO THE WORK, antl the sWClure Is not intentletl or oHered lor sele (Sec.
7044, Business antl Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, entl who does such work
himself or herself or ihrough his or her own employees, provided Ihat such improvements ere not intentled or oflered tor sele. If, however, ihe builtlinp or Improvement is
�soltl wi�hin one year ol completion, the owner-builder will have the burden of proving thel ha or she ditl not build o� imprave tor purpose ol sale.).
I, as owner ot Ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business entl Protessions
Cotle: The comracbrs License Lew does not apply to en owner of pmpeny who bulltls or Improves ihereon, antl who contracts for such pmject with e contrector(s)
license pursuant to the Contractors License laws.).
❑ I em exem untl 5 Business entl Professions Code tor this raason:
SignaWre: Date:
Owner ID veritied by dnver's license. ❑ Yes ❑ No Dnver's License No. Eapires:
Vedficatlon ol Owners�ip by pype oi documem, i.e. - pmpeny tax �ill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby certify thet no eacavetion five (5) or more teet in tlepth into which e person is requlretl to tlescend, will be made in connection with work euthodzed by this
permit, end that no building structure, scaHolding, talsework, or demolition or dismantling ihereof, will be more than thirry-six (3fi) feet high. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Tltle 8, Calitornle Administretive Code). �
❑ As owner-builder, I will not employ anyone �o do work which would require e permit irom Ne Division of Industnal Sefery, as noted above, unless such person hes e
permit to do such work irom the divisian.
Signature: Date:
Division ot Industnal Safery Parmit Number:
GER7IFICATE OF COMPLIANCE AND AUTHOROATON OF ENTAY: I cenify unCer penalry ol perjury that I have reatl this epplice�ion en0 siate that Ihe Information given is
correct. I egree to comply with ell stete laws and ciry ordinances relating ro building consiruclion, end euthonze representetives ot Ihe Ciry ot Coste Mesa to enter upon Ihe
ebove-described propeRy tor inspeclion puryoses. I egree not to occupy or ellow occupency of eny building authorized by this permit unlil finel inspection.
�ySign re gal e s) ,^ ��, a�
�AnNOrAuthorized pplicant � / J �—�te�
COOE t. INSPECTIONTYVE
161fi Fl:etl System Final Fire Prevention
1266 Pool Spe Finel
200 Final Re-Roof
201 Flnal BIacWReiaining Well
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
P�IE
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�y$ �QQE� INSPELTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning ApD�oval
222 Final Site
250 Final Building/Occupenty
PAIE
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