HomeMy WebLinkAbout1567 AMBERLEAF - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us n I -AIN Unrve, UUa i A Mian, �A U40ZD
PLUMBING PERMIT
Job Address: 1567 AMBERLEAF Status: ISSUED
Suite No Applied: 02/01/2001
Issued: 02/07/2001
Vicinity: PLAN 2
ISSUED BY: ZY
Parcel Nunmber: TPN00056
Applicant:
PHILIPP, ROLAND
ISSUE FEE
$23.50
Address:
1565 W MAC ARTHUR
Backflow Preventer
$0.00
Bathtub
COSTA MESA, CA
Phone:
714-666-4300
Connect (Ice,.6oda,etc)
$0.00
Zip:
92626
Owner:
STANDARD PACIFIC HOMES
Drain, Floor
$0.00
Address
1565 W MAC ARTHUR
Drain, Roof
$0.00
Drinking Fountain
COSTA MESA, CA
Phone:
714-666-4300
Gas Earthquake Valve
$0.00
Zip:
92626
Contractor: OWNER -BUILDER
Address:
Arch / Eng :
Address:
Phone:
Zip:
License: 0
Phone:
Zip:
License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 2 FOR STANDARD PACIFIC HOMES: 2816SF SFD, 606SF GARAGE, 94SF
PATIO. 2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK, 1 GAS (1-4 OUTLETS), 3 GAS (OVER
4 OUTLETS, 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 HEATER/VENT, 1 WATER SERVICE.
REF: B01-00103
QTY
FEE SUMMARY
AMT
ISSUE FEE
$23.50
Backflow irrigation
$0.00
Backflow Preventer
$0.00
Bathtub
$19.60
Clarifier System
$0.00
Connect (Ice,.6oda,etc)
$0.00
Dental Units
$0.00
Dishwasher
$9.80
Drain, Floor
$0.00
Drain, Rainwater
$0.00
Drain, Roof
$0.00
Drinking Fountain
$0.00
Expansion Tank
$9.80
Gas Earthquake Valve
$0.00
Gas (1-4 outlets)
$6.15
Gas (Over 4 outlets)
$3.30
Gas Repipe
$0.00
Gas Service
$0.00
Interceptors (Grease, Oil)
$0.00
Interceptors (Sand Auto )
$0.00
QTY
FEE SUMMARY
AMT
QTY
- -��
AMT
QTY
Laundry Tub / Washer
$9.80
1
Sump Pump
$0.00
: 0
Landscape Irrigation
$0.00
0
Swimming Pool
$0.00
0
P -Trap
$0.00
0
Trap Primer
$0.00
0
Pressure Regulator
.$9.80
1
Urinal
$0.00
0
Process Piping (per 10 ft)
$0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Septic Tank
$0.00
0
Wash Basin
$29.40
3
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$9.80
1
Sewer Connect
$24.65
1
Waste and Vent System
$0.00
0
Sewer Private Line
$0.00
0
Water Closet (Toilet)
$29.40
3
Shower
$9.80
1
Water Heater/vent
$12.30
1
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Sink, Floor
$0.00
0
Water Service
$9.80
1
Sink, kitchen
$9.80
1
Water Softener
$0.00
0
Sink, service/mop
$9.80
1
OTHER
$0.00
Spa (private)
$0.00
0
VIOLATION
$0.00
Spa (public)
$0.00
0
PLAN CHECK
$0.00
REINSPECTION
$0.00
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access reTOiremenls i:ni!'WE{7oF�aF!WtatV2rts6'§Rd related
OM NoTTS / dVwCIAL CONDI! n.
EXPIRATION:' This permit shall automatically expo a cttto�r m 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
244646 (6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to salt -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance Carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN $ECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. # Class #
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction ;ending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
f 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt u sec Business and Professions Code for this reason:
-OwneSignature: Date: L 07 -
Owner
r ID verified by driver's license. Yes EVNJ Drivers License No. xpires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Masa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.............................................................................................................................................................................................................................................................................................................................................................I..............................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............................................................................................................................................................................................................................................................................................................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................................................................................................................................................................................................................................................................................................................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...................................................................................................................................................................................................................................................................................................................................................................................
7 F.W.If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
....................................................................................................................................................................................................................................... ..........................................................
8 (It "yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION. OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
.--� SjanatuTB Of er(s) Date
O I
i�J(And/�OrrrAuut onzed Appllc Date
CODE 0. INSPECTION TYPE gljT[' INLJ96@ LOPE# INSPECTION TYPINTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical p
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
2G4 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us /r rAni Unlvt, L Us i A M=DA, UA azozo
Job Address: 1587 AMBERLEAF
Suite No
Vicinity: PLAN 2
Parcel Number: TPN00056
Applicant: PHILIPP, POLAND
Address: 1565 W MAC ARTHUR
COSTA MESA, CA
Owner:
Address:
Contractor:
Address:
Arch / Eng :
Address:
MECHANICAL PERMIT
STANDARD PACIFIC HOMES
1565 W MAC ARTHUR
COSTA MESA, CA
OWNER -BUILDER
Phone: 714-668-4300
Zip: 92626
Phone: 714-6684300
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zip:
License:
ISSUED BY:
SCOPE OF PERMIT
CONSTRUCT NEW SFR - PLAN 2 - FOR STANDARD PACIFIC HOMES: 2816 SF SFD, 606 SF
GARAGE, 94 SF PATIO. 2 FAU<100K BTU, 1 FACTORY FIREPLACE, 1 HOOD W/MECH
EXHAUST, 2 VENT FANS/SINGLE DUCT, 2 COMPRESSORS UP TO 3 HP/100K BTU.
REF: 801-00103.
TOTAL CALCULATED FEES
Status: ISSUED
Applied: 01/25/2001
Issued: 02/07/2001
Quantity
$0.00
FEE SUMMARY
10
Quantity
0
ISSUE FEE
$23.50
$0.00
Repair / Alt Absorbtion Unit
Inst FAU <100 k BTU
$29.60.
; 2
Repair / Alt Refrigeration Unit
Inst FAU >100 k BTU -
$0.00
0
Ventillation System
Repair/ Alt Cooling/Heat
$0.00
0
Evaporative Cooler '
Inst / Rep. Recess Wall Htr
$0.00
0
Commercial Incinerator
Refrig Sys <100 k BTU
$0.00
0
Domestic Incinerator
Refrig Sys >100 k BTU
$0.00
0
Compressors / Absorption Systems
Gas Piping
$0.00
0
Up to 3 hp 1100 k BTU
Factory Fireplace
$10.65
1
3 To 15 hp/500k BTU
Hood w/Mech Exhaust
$10.65
1
15 To 30 hp / 1,000 k BTU -
VAV Box
$0.00
0
30 To 50 hp 11,750 k BTU
Vent Fan / Single Duct
$14.50
2
Over 50 hp / Over 1,750 BTU
Appliance
$0.00
0
Boilers
Fire Dampers
$0.00
0
Up to 3 hp
Smoke Dampers
$0.00
0
3 To 15 hp
Inst or Relocate Appl Vent
$0.00
0
15 to 30 hp
Air Handlers < 10000cfm
$0.00
0
30 to 50 hp
Air Handlers > 10000cfm
$0.00
0
Over 50 hp
Floor Furnace
$0.00
0
Other Mechanical Fee
Floor or Suspend Heater
$0.00
0
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
Status: ISSUED
Applied: 01/25/2001
Issued: 02/07/2001
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$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. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2446.46 (6W)
Quantity
$0.00
0
10
$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
$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. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2446.46 (6W)
DECLARATIONS r_")
WORKERS' COMPENSATION DECLARATION;
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrit r and policy number are:
Carrier: r Policy Number:
(This section need not be completedif the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lia Al Class #
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of safe J.
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exem er Business and Professions Code for this reason:
Signatod
ure: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
...........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
........................ ............................................................... .... ............................... ... ............... ................................... ......................................................................... -........................................................................................ ................. .........................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
................................ ................................... ..........._...................................................................................................................................................................._..................._.._...................... .........................._...........
4 If an RMPP is resent) required, has Section 25534 of the California Health and Safe Code been full complied with?
presently q N Y P ❑Ves ❑ No
5 Does or will the applicant present or future building occupant require for the work which is the subject of this plication apermit for such construction or modification
from the South CoassAir t Air Quality Management Distract or from any other air pollution control district or agency? Ll Yes O No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for . non-residential building permits).
.........
............................................................................................................................................................................................................................................................................... ..........................................................................................
6 Will any part of the facility to 6e constructed under this permit be within 1000 feet from the outer boundaries of a school? Dyes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
if ..... ..............................;..................................................... ......... .............................................................................................:.........................
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.......................................................ific.............................................nt-t.............................................11ut.........................................................................................................................................................................................................................
attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZAT1ON.OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sig ure eg ner(�, 2 '46L� oto
And/Or Authorized Applicant /Date
CODE If INSPECTION TYPE DALEINTMAL CODE Y INSPECTION TYPE 2AM
1616 Fixed System Final Fire Prevention 206 Final Mechanical 0' ' 0 N
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 1567 AMBERLEAF
Suite No
Vicinity: PLAN 2
Parcel Nunmber: TPN00056
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
COSTA MESA, CA
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA
Contractor:. OWNER -BUILDER
Address:
ISSUED BY:
Phone: 714-668-4300
Zip: 92626
Phone: 714-668-4300
Zip: 92626
Phone:
Zip:
License: 0
Status: ISSUED
Applied: 01/25/2001
Issued: 02/07/2001
SCOPE OF PERMIT
CONSTRUCT NEW SFR - PLAN 2 - FOR STANDARD PACIFIC HOMES: 2816SF SFO, 606SF GARAGE,
94SF PATIO. 1 NEW RES (1 UNIT), 2 LIGHT FIXTURES, 3 OUTLETS, 2 SWITCHES, 1 MOTOR TO
1 HP.
REF: B01-00103
FEE SUMMARY
Quantity
Temp Dist System / Lighting
$0.00
Quantity
ISSUE FEE
$23.50
0
Temp service test
$0.00
0
Res. a/c package-
$0.00
0
New Res (1-2 units)
$157.70
2816
New Res (3+units)
$0.00
0
Pool / Spa
$0.00
0
Lighting Fixts
$2.20
2
Recept Outlets .
$3.30
3
Switches
$2.20
2 ,
Non Res Appl
$0.00.
�0
Res Appl
$0.00
0
Service to 200a
$0.00
0
Service to 1000a
$0.00
0
Service over 1000a
. $0.00
0
Motors to 1 hp
$4.75
1
Motors to 10hp
$0.00
0
Motors to 50hp
$0.00
0
Motors to 100hp
$0.00
0
Motors over 100hp
$0.00
0
Communication drops
$0.00
0
Sub panel to 200a
$0.00
0
Pole Light Pkg
$0.00
0
Sign Circuits
$0.00
0
Temp Pwr Pole
$0.00
.0
Intermed Pole
$0.00
0
FEE SUMMARY
Quantity
Temp Dist System / Lighting
$0.00
0
Busway /100 8
$0.00
0
Standing Section
$0.00
0
Misc Electrical Equipment
$0.00
0
Transformers up to 1 kva/kw
$0.00
0
................up to 10 kva/kw
$0.00
0
.................up to 50 kva/kw
$0.00
0
.................up to 100 kva/kw
$0.00
0
..................over 100 kva/kw
$0.00'
i0
Low Voltage Equipment
$0.00
0
Low Volt Wiring System / Ckt
$0.00 -
0
Misc. Conduit
$0.00
0
Misc. Conductor
$0.00
0
Circus ( gen or ride)
$0.00
0
Circus (mech ride or lights)
$0.00
0
Christmas Tree Stand
$0.00
0
Fireworks Stand
$0.00
0
Other Electrical Fee
$0.00
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES $193.65
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE ($100,I)DO), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. u Class If
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby offimt that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code),
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cade: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt undo BUMS and Professions Code for this reason:
Signature: kr. 11/ / Date:
Owner ID verified by driver's license. ❑ Yes0 No V ' Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Cade).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............................................................................................................................................................................................................................................................................................................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............. .............. ................................ ........ ................. ....... ........ ............................................................................................................. ........................... ...................................................... ............. ................................................. I .................
..........
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
..........................................................................................
.........................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION,OF ENTRY: I codify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sig a O al r(s Z� D eO
And/Or Authonz pplicant I Date
CODE t. INSPECTION TYPE 2&U INTRIALS CODE INSPECTION TYPE RAI& INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1567 AMBERLEAF
Suite: LU'r 14
Vicinity: PLAN 2
Parcel Number: TPN00056 Zoning:
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
COSTA MESA, CA Phone: 714-668-4300
Zip: 92626
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA Phone: 714-6684300
Zip: 92626
Contractor: OWNER -BUILDER
Address:
Phone:
Zip:. License: 0
ISSUED BY:
Status: ISSUED
Applied: 01/25/2001
Issued: 02/07/2001
Arch :
BASSENIAN LAGONI
Eng:
Address:
2031 ORCHARD DR
Address:
STE 100 Phone:
949-553-9100 Phone:
$1,867.35
NEWPORT BEACH, CA
Claim Valuation: $0.00
Zip:
92660 License:
License:
SMIP Com:
$0.00
SCOPE OF PERMIT
CONSTRUCT NEW SFR - PLAN 2 - FOR STANDARD
PACIFIC HOMES: 2816 SF SFD, 606 SF GARAGE, 94 SF PATIO.
NOTES
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2446-06 (6/00)
FEE SUMMARY
Plan Check:
$303.45
Calc Valuation: $255,918.28
Permit:
$1,867.35
Claim Valuation: $0.00
SMIP Res:
$25.59
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$2,196.39
PLANNING & ZONING
SETBACKS
-
MAIN STRUCTURE Front 13- 0
Rear 23-0 Left 5-0
-�
Right 5-0
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Right 0-0
PARKING
Existing: 0
Required: 3 Proposed: 3
NOTES
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2446-06 (6/00)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE (3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lia 4 Class if
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempter s Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes CYNo Driver's License No. lExpires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
........6-...............................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
................................................... ........................................ ....................................... ............................................................................ .......................................................................... ................................ ........................................... -.......................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [I No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a -permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................................................................................................................................................................................................................................................................................................................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(It 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................................................................................................................................................................... ...........................................
7
if
a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.........................................................................................................................................11ut..........................................................................................................................................................................
6 (It'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
=Te,w (s) 2 Data
And/Or Authorized Applicant Date
CODE t. INSPECTIONTYPE PATEINTMALS CODEC INSPECTION TYPE PATE INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site Z
204 Final Demolition 250 Final Building/Occupancy
=, FINAL GRAt)ING CERTIFICATION
Project Address: 161
Lot Number- It T ttytet) 12 ce H Ce -Vv-4S&-7 15aS z
Permit Number: G CX2 — o00 31—
By Civil Engineer:
I certify to the satisfactory completion of grading in accordance With the approved plans,
specifications, local and state codes. All.drainagc devices required by the grading permit,
grading plan and grading ordinance have been installed. Mequate provisions have.been made
for drainage of surface water from each building site.
The minimums are:
2% Fall from structures within 5 feet from exterior walls.
1% Fall for asphalt surfaces and landscaped areas.
0.5% Fall for concrete surfaces to approved disposal areas.
The final monuments as shown on the recorded tract map were set. All final grading.eleva-
tions are within ± 1/10 of the designed elevation
Supervising Civil Engineer Reg. No.
(Signature)
:.s Date-10lr-_121
i`
rlraun J�A CTMI
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR UHI V t, V VJ 1 A MLJA, VA V20Z0
BUILDING PERMIT
Job Address: 1567 AMBERLEAF
Suite:
Vicinity: 3RD CAR GARAGE INTO 5TH BEDROOM
Parcel Number: TPN00056 Zoning:
Applicant: PHILIPP, ROLAND
Address: 15326 ALTON PARKWAY
Phone: 949-789-1600
IRVINE, CA Zip: 92618
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA Phone: 714-6684300
Zip: 92626
Contractor: OWNER -BUILDER
Address:
Arch
Address:
Phone:
Zip: License: 0
Phone:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 08/24/2001
Issued: 08/24/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REPLACE 179 SF PORTION OF THE THIRD -CAR GARAGE WITH AN 179 SF FIFTH BEDROOM OPTION - PLAN 2 - FOR
NEW SFR FOR "STANDARD PACIFIC HOMES."
REF: B00-01536
NOTES
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
i
2aa64e(6MO) 7
FEESUMMARY
Plan Check:
$34.00
Calc Valuation: $11,277.00
Permit:
$209.25
Claim Valuation: $11,277.00
SMIP Res:
$1.13
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$244.38
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE
Front 0-0
Rear 0-0 Left 0-0
Right 0-0
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Right 0-0
PARKING
Existing: 0
Required: 0 Proposed: 0
NOTES
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
i
2aa64e(6MO) 7
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed /f the permit Is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full
force and effect. Lic. a Class 8
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pem+'
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sate.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cade: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: `T%� r Date:
Owner ID verified y nvers license. ❑ Yes Nc Driver's License No. Ex fires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, fatsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
Permit to do such work from the division.
Signature: Date:
Division of Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
n r building occupant need to file a registration form for acute) hazardous materials? Yes N
..................................................PP..................P... .... g ...... .. ....
2 Does or will thea applicant or present or tutu a bu oc p g y ❑ ❑ o
(Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................ ...................... ........................................................................................... ... .......... ............... .............. -........................................... ......................................................... ......................................................... ............... ... ....................
3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
......................................................................................................................................................................................................................................................................................................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ONO
.............................-........... .............. ............................................................. ....................... ....................... ........................ .................................................................... ......................... ..... ..................................................... ..........................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LLII Yes L] No
(Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits).
.............. .................... ......................................................... ...................... ................................. ............................... .................................. ...................................... ........................... ....................................... ..................... ___ ......................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(Ii "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................................................................................................................................................................................................................................................................................................................................................................
7
Vii
permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
8 (It yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si nature ego t er( Date
And/Or Authorized Applicant Date
CODE r. INSPECTION TYPE DATE INTITALS CODE INSPECTION TYPE PAIS I TSI L
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy ��