HomeMy WebLinkAbout562 PIERPONT DR - Building PermitsO�p MFS
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CITY OF COSTA MESA �
BIIILDING DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
�oe aoDRess: 562 PIERPONT DR CM
APN: 41802325
Vicinity: MASTER BEDROOM AND ENTRY
Const Type: V-6 SQ. FT:
Zoning:R1, ,
105
<. `.
PERMIT NUMSER: BC10-00086
STATUS: ISSUED
DATE ISSUED: 03/30/2010
ISSUED BY: RMD
Suite/Unit:
Primary Occ:
Valuation: $25,000.00
SCOPE OF WORK: ADD 105 SQ FT TO AN EXISTING RESIDENCE. 83 SQ Ff ADDED TO ENLARGE MASTER BEDROOM AND
BATH. REIOCATE BATHROOM FIXTURES FOR M4STER BATH. 22 SQ FT ADDED TO INCREASE ENTRY AREA AND RELOCATE
FRONT DOOR. MECHANICAL TO INCLUDE: 1 VENT FAN /SINGLE DUCT. ELECTRICAL TO INCLUDE: 11 LIGHT FUCTURES, 5
OUTLETS
AND 8 SWITCHES. PLUMBING TO INCLUDE: 1 SHOWER, 1 FLOOR DRAIN, 1 WASH BASIN AND 1 TOILET.
NO ADDITIONAL RESTROOMS. ADDITION IS ONE STORY.
OWNER: WHITACRE,ROBERTL
Phone: 7�4-540-2305
APPLICANT: WHITACRE, ROBERT L
Phone: 714-540-2305
cON7Rnc7oR: OWNER-BUILDER
Phone:
Cell:
ARCHITECT:
ENGINEER: WILLIAM CORREIA
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 562 PIERPONT DR
City/State/Zip: COSTA MESA, CA
Address:
Ciry/State/zZip:
Address: Unit:
City/State:
License No.
License No.2132
$254.31
$391.25
$49.90
$30.75
$62.70
$2.50
$0.00
$�.00
$792.41
Monday thru Fritlay.7:00 am thru 7:00 pm. Sa[urtlays- 9:00 am thru 6:00 pm.
License No. 000000
Unit:
Unit :
ZipCode
PHONE:
PHONE:774-840-5582
:R GMMC Sec. 13-279
Sundays and the following Federel hotidays:
NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 fnal approval will result in the expiration of this permit.
COOE t. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Piace
203
204
final Sign
Final Demolition
ORTE INTTIRLS CODEp INSPEC110NTVPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
272 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
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WOR�RS' COMPENSATION DECLARATIO�
I hereby aKrm under penally of perjury one of Ihe following declaretions:
❑ I have and will maintain a certifwte of consent to selbinsure for vrorkers'
compensation, as providetl for by section 3700 of Ihe Labor Code, for Ihe
pedormance o! lhe work for which this permi[ is issued.
❑ I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Code, for the peAortnance of the wnrk fw which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier.
(TNs serlm nee0 rrol be mmdeled JMe perm4 is valueE at me huntlrtd N9ars (S] W) w less )
Policy Number:
r 1�ertify thal in the perfortnance of [he work for which this permit is
issued, I shall not employ any person in any manner so as to hecome subject
to the vrorkers' compensation laws of California, and agree that if I shoultl
become sub�e� t o the,yrorkers' compensation provisions of Section 3700 of
the L �C �h If � i comply wilh lhese provisi
`A3Dh�0.t5Si naiure
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Protessions Code. and
my license is in full force and effect.
Lic. #
Class ii
Cont2ctor's Signawre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a constructbn lentling agency tor the
peAwmance of Ihe work (a which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signalure
OWNER-BUILDER DECLARATIONS:
I hereby aKrm iha[ under penalty of perjury lhal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe (ollovring reason (SeC. 7031.5,
Business and Pro(essions Code: Any city or county which requires a permit ro
consWct, alter, impmve, demolish, or repair any structure, prior lo its
issuance, also requires the appliwnt (or such permil to fle a signetl statement
that he or she is licensed pursuant lo lhe provisions of the Contraclors
License Law (Chapter 9(wmmencinq with Section 7000) of Division 3 of Ihe
Business antl Professions Code) or t�at he or she is exempt therefrom and
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permil suDjects Ihe applicant to a civil penalty of not more than
five hundred dollars ($500).):
�wner of the property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the stmcture is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Conhactors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided that such improvements are not intentleC or offered for
sale. If, however, the huilding or improvement is soltl within one year of
completion, ihe ovmer-builtler will have the burden of proving that he or she
did not build or impmve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construc[ the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply to an owner of
pmperty wfio 6uilds or improves [hereon, and who contracis for such projecl with
a cont2cbr(s) license pursuant to [he Conl2ctas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
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Owner ID �d b drn, .�cense. es ❑ No �� /���//�'� //�
Oriv I.�sec'���r.nSE'N��� ��_ eFipir��s:/�¢!� [.y/'�
Venfwtion o! Ownership hy pype of document, i.e. - property t x bill�:
DIVISION OF INOUS7RIAL SAFEN PERMIT CER7IFICATION:
❑ I hereby cetldy that no eacavation frve (5) or more feet in depth into wfiich a
person is required lo descen4 will be made in wnnection with wnrk authonzed
by this permit, antl that no building structure, scaf(dding, falsev.ork, a demolition
or tlismantling thereo(, will be more than thirty-su (36� leet high. (Chap. 32, Grp
2, Art 2. Sec. 347, Tdle 8, Califomia AdministraMe Code).
❑ As owner-builtler, I will no� employ anyone to do work which would
require a permit from the Division of Industrial Safety, as notetl above, unless
such person has a permit to do such vrork from the division.
Appiwm's Signature Date
Division o! Indusirial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future Duiltlinq occupant need to fle and
certify a Business Plan tor emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Salery Code requires, with some
exceptions, that a Business Plan be filed with tha Cosla Mesa Fire
Department by every business whic� has at any one time tluring a reportetl
year a quantity of hazartlous malenals equal to or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cu6ic feet o! compressed gas
at standartl temperawre and pressure).
2. Does or will the applicant or present or fWure building occupanl need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0! lhe Califomia Health and Salety Cotle, with some
exceplions, requires registration with the Costa Mesa Fire Department by
each business vfiich at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas al standard
temperature and pressure).
3. Does or will Ihe applicant or present or luture buil0ing occupant need to
prepare an RMPP (Risk Management and Prevention Proqram for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of ihe Califomia Health and Satery Code provides that Ihe
Costa Mesa Fire Department may require the preparation, cenification and
filing with ihe Fire Depariment of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Section 25534 0! Ihe California
Health antl Safe[y Cotle been (ully complied with? ❑ Yes ❑ No
5. Does or will Ihe appliwnt or present or future building wcupant require for
Ihe vrork which is the subject ot this application a permit for such construction
or motlification from the South Coast Air Quality Management Distric� or Irom
any other air pollution conirol disMct or agency? ❑ Ves ❑ No
(Section 658502 0( the Califomia Govemment Code requires that the requested
information be fumished on applications fa non-residential building pertnits).
6. Will any part o( the facility to be constructed under this pertnit be within
1000 (eet from the outer pountlaries of a school7 ❑ Ves ❑ No
(If'yes", the faciliry must meet Ihe requirement of Seclions 25534 antl 42303
of the Califomia Health antl Safery Cotle�.
7. I( a permit from Ihe South Coast Air Qualiry Management District or other
air pollution control district or agency is required for Ihe work which is ihe
subject of this application, have all of lhe tlisclosures prescribed by Cali(omia
Health antl Safety Code Section 42303 been made7 ❑ Yes ❑ No
8. Qf yes", attach certificate of compliance from the appmpriate air polWtion
GONroI oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL 1 a9ree lo comply wit� all state laws and
ciry ordinances regarding Hazartlous Materials antl Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury thal I have read this application and state thal
Ihe information given is correcL I agree ro comply with all slate lavrs and ciry
ordinances relating to builtling construction, and authonze representatives of
the Ciry of Costa Mesa to enter upon the above-0escribetl property for
inspection . agree 1 to ccupy or allow occupanc of a building
authqrt � �6u � nspection. �,
Sig mred.Le��Qwners) /D�
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NnG/orAulM1onze0A00��can1 Dale
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Costa 1VV�esa
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City of Costa �l�lesa BuiCding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # � �"
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been�S.u,br�itted in yo r name listing ourself as the builder of the
property improvements specified at ���f i� p�L�� s�,� f,���-+y ��{�.,�
We are providing you with an Owner-Builder cknowl gment and nformation Verification orm to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signi�y you understand or verify this information.
��1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
�2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
I3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. i understand that
may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�4. I understand Contractors are required by law to be licensed and bonded in California and to list their
licens� numbers on permits and contracts.
��5. I understand if I employ or otherwlse engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, 1 may
be considered an "employer" under state and federal law.
(�%6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contrihute to unemployment compensation for each "employee." 1 also undersiand my failure to abide by these
laws may subject me to serious financial risk.
�7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
� /
�. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
� I understand I may obtain more information regarding my obligations as an "employer" from the Internal
evenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
�10. i am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�ja,Z11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is ued to veri y t property owner's signature.
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Signature of property owne�%�� ��. Date�
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2
uwrvttt MESA BERGER uA�t 1-17-68
JOB ADDRESS 562 Pieroont Drive - BUILDING PERMIT N0. 2$107
GENERAL CONTRACTOR (1_ M. HM �+oin DESCRIPTION of WORK Residence W/Att. Gare2e
SUBCONTRACTOR
ftOUGH PII/MBING
PROP. SWR. LINE
MISCELLANEOUS
ROUGH HEATING
TEMPORARY SERVICE OR POLE
UNOEPGf30UND � POWER �
ROUGH WIftING
TRENCHES � FORMS � STEEL REINF.
FLOOR SYSTEM
BONO BEAM � STEEL FEfNFORGE �
SHEATHING
FRAME ANO FLASHING
LATHING - IN I� OUT rI
Hr �G, VENT., REFRIG. AND p.C., F
P� ,ING, FINAL ANO GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
28��%
COSTA MESA BUILDING-SAFEiY DEPARTMEM
P.O. 60X 7200 � COSTA MESA� CALIFORNIA 92826
For ApplJcanf fo FIII In Complefaly
TYPE OR PRINT �
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AODRES8
COSTA MESA, CALIFORNIA
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DESCRIPTION OF WORK
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SIZE
EXTERIOR WALIL
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EUILO�NO GONi
AUTHORIZiD
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APPLICATION FOR PERMIT
BUILDING
For Offlce Use Only
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NOTH: NO RAVE OV [RHAN6 SHALL BE LE88 THAN
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MAIN BUILDINO
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APPROVHD
YARDS APPROVED
ACCE880RY BIIILDINO
DATE
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TXe AMOUNT 8 N UNDBR VALUATION 18 FOP TH8 j
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VALIJATION � /O — �
PERMITFEB �'
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TOTAL FEE $ �`� �