HomeMy WebLinkAbout2914 PEPPERTREE LN - Building Permits(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2914 PEPPERTREE LN
Suite:
Vicinity: ROOF -
Parcel Number: 13929606
npp�icant: MIKE PLAYER
Address: 11321 MAGNOLIA AV „� �
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GARDEN GRO E�.j�
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Owner: JACQUES, DONALD F
Address /2913'PEPPERSREELN�
� P:ddress: 11321�MAGNOLIA AV
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GARDEN GROVE
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Zip: 92841
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OFF EXISTING ROOF. FLAT{ROOF, BTANDARC
3LES. 2,600�S.F. INCLUDES ATfACHED:GARAG
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� Check: � � $0.00 �='�
.Permit:' U°$111.25
IIP•Res:\ �� $0:50
ACCESSORY
PARKING
Zoning: R3 R3
Status: ISSUED
Applied: 06/25/2003
Issued: O6/25/2003
ISSUED BY: �
Phone_—�---7'14-534-5696 ���
2ip: 92841 0
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'ITCH'ROOF TWO 15# FEL'•T�,120 YEAR, ASPHALT
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� Calc Valuation: � r��"`$a;zoo.00
Cleim Valuation: � / �$a,zoo 00
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NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ortl. 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
tor a period of 180 days. ' � �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must complywith all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2as-as (s�oo�
WORKERS' COMPEySA71QN DECLARA710N: - -
I hereby attirm under penelry of perjury one of the tollowing declarations: .
❑ I have entl will maintain a certificate of consent to selFlnsure for workers' compensetion, as provided for by section 3700 of the Labor Cotle, for ihe pertormance of the
— /work for which this permit Is i55uetl.
� y I have end will maintain workers' compensation insurance, as required by section 3700 ot the Lebor Code, for ihe pedormance of the work for which ihis pertnit is issuetl.
--�' My workers' compensation Insurenc cerrier antl policy number ara: G,
Carner:. -�-t-A�'� ��T�..,,� Policy Number._ OCif) Z O 1 I�-9"I - O�
(This secfion need not be completed i/ the permit is valued af one hundred dollars ($100) or /ess.J
❑ I cetlity ihat in Ihe pedormence of ihe ior which ihis permit is issued, I shall not employ any person in eny manner so as to become subject to the workers'
compensetion laws of Califomi egree that If I should become sub�ect ro the workars' compensatlon pmvisions of Section 3700 of ihe Lebor Code, I shall forthwith �
camply with these provisions p�
Applicant Signatura: �.Date: W —2' �' � 3
WARNING FAILURE TO SECURE W�FKEFS' CAMPEN$ATION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
T}IOUSAND DOLLARE (5100,000), IN ADDITIIXJ TO iHE Qp$T OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 3'lO60F THE LABOF CADE, IMEREST, AND ATTOFNEV'S FEES.
LICENSED CONTRACTORS DECLARATION: -
I hereby aflirm Ihat I am licensed under provisiong of Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business and Professions Code, and my license is in full
force and effect. Lic. a � �Class n C-3�
ContracbYs Signature: V-� ' - �oate: (v—Z i —03
CONSTRUCTION LENDING AGENCY: �
❑ I hereby aHirm ihat there is a constmction lending agency for Ihe performance oi the work for which ihis permi� is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lentler's Atltlress:
SignaNre: Date:
OWNER-BUILDER DECLAFiATIONS:
I hereby ettirm that under Denalry of peryury Ihat 1 am EXEMPT FROM 7HE CON7FiACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, eusiness and Professions
Code: Any ciry or counry which requires a permit b constmct, elter, improve, demolish, or repair any sWCNre, prior to its issuance, also requires the applicant for such pertnit
to file a signetl statement that ha or she is Ilcensed pursuent to ihe provisions of ihe Contractors License Lew (Chaptar 9(commencing with Section 7000) of Division 3 ot ihe
Businass and Professions Code) or that ha or she is exempt Iherefrom antl tha 6asis for t�e alleged exemption. Any violetion ot Section 7031.5 by any appliwnt for a permit
subjects the applicant to a civil penalry of not more than tive hundretl dollars ($500).):
❑ I, as owner of the properry, or my employees with weges as Neir sola compensation, WILL DO TNE WORK, and Iha strucWre Is not intended or oNered for sale (Sec.
7044, Business and Protessions Cotle: The Contrectors License Law does not apply to an owner of property who builds or improves �hereon, and who tloes such work
himself or herseH or ihrough his or her own employees, provided that such improvements are not intended or oftered for sale. If, however, �he builaing or improvement is
sold within one year of completion, the owner-builder wiil heve.the burden of proving that he or she did not build or improve br purpose of sale.). �
❑ I, as owner oi the properry, am E%CLUSN�LV CON7RACTING WITH LICENSED CONTRACTORS to constmct tha project (SecJ044, Business and Professions
Cotle: The conirectors Llcense Lew does not epply �o an owner oi property who bulltls or improves thereon, end who contracts br such pmject with a contractoqs)
license pureuam to ihe Contrectors License Laws.).
❑ I am exempt untler sec. Business and Professions Cotle for this reason:
Signature: Date:
Owner ID veniietl by tlriveYs license. ❑ Ves ❑ No Dnver's License No. Expires:
Verification oi Ownership 6y (type oi dwument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICA710N:
❑ I hereby certity the� no excavelion five (5) or more feet in depth into which a person is raquired to descend, will be made in connec�ion with work authorized by Ihis
permit, and Iha� no Duilding sWcture, scaHpiding, talsework, or demolition or dismantling thereoi, will be more ihan Ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sac.
341, Title B, Calitornia Administrative Gode).
❑ As owner-builder, I will not employ enyone to do work which would require a permit fmm the Division of Industrial Safery, es noted above, unless such person has e
permit to do such work irom the division.
Signatura: Date:
Division of Indusirial Sa(ery Permit Number:
ARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
Will ihe applicant or present or fuNre building acupant need to tile and certily e Business Plan tor emergency response to release or I�reatened release oi e hezartlous
materlal? ❑ Ves ❑ No
(Section 25505 of Ihe Callfomia Healih end Sate�y Code requires, with some excep�ions, I�at a Business Plan be filed with I�e Costa Mesa Fire Department by every
business which has et any one time during g repotled year a Quantiry of hazartlous materials equal to or greater �han a weight of 500 pounds, or a volume oi 55 gallons,
or 200 cubic teet of compressed gas at stanryard �emperatura and pressure).
........................................................................................................................................................................................................................................................................................... ..............................................................................
Does or will the applicant or present or lutur� buildinq occupant need to tile a regisiretion torm for acutely hazartlous materials7 ❑ Yes ❑ No
(Section 25533 oi the Calitomia Health and 5atety Gotla, with soma ezceptions, requires registration with ihe Costa Mesa Fire Departmant by each business which at any
one time has on hantl a quentiry of ecutely hazerdous meterlals equal to or grealer ihen e weight of 500 pounds, or a volume oi 55 gallons, or 200 cubic faet of
compressetl gas e� siantlartl IemperaNre and pressure).
....................._......_..............................................................................................................................................................................._...............................................
. ...................... . .........
Does or will the applicant or present or futur� building occupent need to prepare an RMPP (Risk Management antl Prevention Program for acutely harardous metenals)7
❑ Yes ❑ No
(Section 25534 of the California Healih antl Safery Code provides iha� the Cos�a Mesa Fire Depariment may require the preparation, certification and filing with Ihe Fire
Depertment of en RMPP by businesses which are required �o register acutely hezartlous materials with the Fire Department.
4 It an HMYY is presently requlrea, nas Jectlon 25534 of ine Gallfornl9 Heelin antl Sarery GOOe Deen tu0y complle
...........................................................................................................................................................................................................................................................
5 Does or willYhe applicent or present ar future building occu0ant require lor Ihe work which Is the subjec� of this
frOm ihe Sou�h Coast Air Queliry Manegamen� Dlsirict or trom any other elr polWtion conirol tlisirict or agency?
(Section 658502 of �he Celifomia Govemmant Code requires Ihet the requestetl infortnation be fumished on ap�
...........................................................................................................................................................................................................................................................
6 W ill eny pan ol ihe taciliry to be constructad under this permit be within 10001eet hom the outer 6ountlaries of a
Qt yes", the tacility must mee� ihe requirement of Seclions 25534 and 42303 of ihe California Healih entl Safety
�n conlrol tllsinct or agenCy
Section 42303 Ceen made7
�
[y
tor non-rasidential
work which is the subjecl af Ihis
B (tl'yes", attach ceftiticate ot compllance trom ihe appropriate air polWtion con�rol onlcer).
CERTIFICATE OF COMPLIANCE: I certity lhat untler penalry of perjury the information given above is correct. I agree to comply with all state lews and ciry ortlinances
regarding Hazardo�s Materials and Emissions.
Signature: � Dete:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZp7ION OF EMRV: I cenify under penalry ot perjury Ihat I have read this application and state that the intormation given is
correct I agree to comply with all state lews ancf ciry ortlinances retating to building construction, end authorize representetives ot the City of Costa Mesa to enter upon the
above-described property br inspectlon purposeg, I egree not to occupy or allow occupancy oi any building euthorized by Ihis permit until final inspection.
CODEN. INSPECTIONTYPE '
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Rooi
201 Final BIocWRetaining Well
202 . Final Factory Fire Place .
203 FinalSign
204 Final Demolition .
Q�jf, IMRIALS
'(�i -�:1-0�
- Date
CODE1 MSPECTIONTVVE
206 Final Mechanical
200 Final Plumbing
210 Finel Elecirical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
P�IE L�LS
. . . -: � ,. � ���� � . �rEE i�tC�.IUED
COSTA MESA BUILDINGSAFETY DEPARTMENT cj -
. P.O. BOX 317 GOSTA MESA. CALIFORNIA ' � ' � �� "����j �
FlNn"�CE DEPT.
fOR APPL/CANT. TO.F/LL /N COMPLETELY �LIGATION,�FOR;�BERMIT .
TYPE.OR PRINT, . . / •�'f�' ": �'��.r. :.._..n ..
BUILDING'
e���o�Nc 2c� pepper Tree Lane
'nooRess . . � . ��/�
� . COSTA MESA, CALIFORNIA �. ryle OFFI{.L USG ONLJ
A• �eJ nC�- RECEIPT NO. ��ISM� J
OWNER P `�
MAIL RECEIVEDBY� DA,UE�p4VI^D OCTTE133U+^rQ
ADDRESS � E• 1 fi�l Sti• � �� �— I 2 �y.� �
�,T•, _ Costa Niesa TNo:LI8-1159 AooRess `
AF :GT. - CST'ZSOLl $c � ��c.� - - GOSTA�MESA, CALIFORNIA �
OR �WEER NO. � ,
ADDRE55 n� n �,i'd, en Grbve ZONE ' TVPE �'�GROUP '
GOND7.iC OR VOle�ro�72� �Ir1C�LIC.NO. 1672`� BYPROVED� � - DATE -
ADDRESS �� E• l.7fi�'1 S{�i� � CiOStiB t$esa . 20NING
LEGAL LOT <�G Z�NE� � ,NO.OF USE Oi NEW) . �
�ESCRIPTION INO. � � IBLOCK ITRACT �'� ,1/IP�-ANS .��IBUILUING��/��`������i�� �
A.P. NO. • APPROVED y, / ,/'� . _. P,�+�/� ; �!J I .
[ BV D(/ N-.l� �� ../ DATE I✓ !ti/� /
SIZE Vl� X 99 ' �o.oF a�o�s. non . ' `y-"� ' - _
OF LOT I�ow Orv �or Y/�RDS EVES .
REQUIRED ALLOWED
USE OF . ' ftENTER IINE ST.1 . '
EXISTING BLDG. FRONT ,� LFT. IN.
SEteqCK 4NE FROM + ^� �
CENTER OF STREET �G� ' REAR YARD �� R. SIDE �FT. IN.
i ' C� �y
SiDE YARD LEFI' '�*- RIGHT J L.SIDE / FT. IN. . ,
DESCRIPTION OF WORK � • �J � A
REAR ' �/ FT.' G/ ��/�.!'//�IN! . .
N� I X II ALTERATION I II �+DDITION I , "/ /
REPAIR I IIMOVING- I II�EMOLISH I � '
SUZIEDING 3516 RO MS STORIES � �
EXTERIOR WALL a ROOF '
COVERING $td]CC�ICOVERING rock �
USE OF BUILDING ANO�WORK TO BE PERFORMEO , , �
'Multiole famil dwelli with •
attached garage,— 730 sq, ft. '
. .
r
1 HEfiEBY ACKNOWLEDGE THqT 1 H�VE READ THIS APPLICATION ' �
AND STRTE THAT THE A60VE IS COFNECT AND AGREE TO COM- THE AMOUNT SHOWN UN�ER VALUATION 18 FOR THE
PLY WITH ALL CITV OPUINANCES ANO STATE LAWS REGULATING �'URP08E OF ESTABLISHING A PERMIT FEE ONLY.
euamNc coHsiAucnoH VALUATION � M
SIGNATURE OF- ' ,� ' PERMIT FEE $ 5O� W
PERMITTEE n nn
� '1- � $ 3os979�.�'O PLANCHEGK $-GS��1V
AUTHORIZED AGENT D1nQ & Cble i�8 Iri0. TOTAL FEE $� 7S�w ' "