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HomeMy WebLinkAbout1568 AMBERLEAF - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1568 AMBERLEAF Suite: ( i:T Ly Vicinity: PLAN 3 Parcel Number: TPN00084 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: Zip: Arch : BASSENIAN LAGO Address: 2031 ORCHARD DR STE 100 NEWPORT BEACH, CA Zoning: Phone: 714-668-4300 Zip: 92626 Phone: 714-6684300 Zip: 92626 Phone: License: 0 Eng: Address: Phone: 949-553-9100 ISSUED BY: Status: ISSUED Applied: 01/25/2001 Issued: 02/13/2001 Phone: Zip: 92660 License: License: SCOPE OF PERMIT CONSTRUCT NEW SFR PLAN 3 FOR STANDARD PACIFIC HOMES: 2972SF LIVING, 579SF GARAGE, 20SF COVERED ENTRY AND 133SF PATIO. REF: B00-01537 Plan Check: $316.19 Permit: $1,945.75 SMIP Res: $26.99 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $2,288.93 SETBACKS MAIN STRUCTURE Front 16-0 ACCESSORY Front 0-0 PARKING Existing: C NOTES: FEE SUMMARY Calc Valuation: $269,922.26 Claim Valuation: $0.00 PLANNING & ZONING Rear 21-0 Left 5-0 Right 5-0 Rear 0-0 Left 0-0 Right 0-0 Required: 3 Proposed: 3 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 2446-46 (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. ❑ 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 peril 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 et 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 WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100=), 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. Lic. x Class If Contractors 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). Lenders Name: Lenders 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 ode: 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 wridoyisec.Business and Professions Code for this reason: Signature: YN&I �I 1\ Date: L Owner ID verified by drivers license. ❑ Yes No Driver's License No. Ex ires: 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, 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). D r will th a licant or resent or future builtlin occu ant need to file are istration for for acute) hazartlous materials? Yes N'0 2 oes o e pp p g p g y ❑ ❑ (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). ........................................................................................................................... I................................ ..................... ............. ............................................................... ................... -........................... .......... 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 aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Yes a 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 an fy .............................................. y part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................I............................................................... ......._................................................................... .Qualit 7 If a permit from the South Coast Air Quality Management District or other air pollution control districtagency is required for the work which is the subject of this application, have e11 of the disclosures prescribed by California Health and Safety Code Section 42303 beenn made? El 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 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. 1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature 1 Le Ow r Date ` ntl/Or Autho a rizeZrAi1plicant I Date IFU ll CODE t. INSPECTION TYPE 9&U IiRBIAL$ CODE INSPECTION TYPE p9IE INTMAk9 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 IU: f1VG17tY1u FINAL GRADING CERTIFICATION Project Address: ; 1 &-- 4S 1>pAwtS Lot Number. - �C�'t r7 r � � H g ' �' -'l 150,5 z - Permit Number. 6f dxP-CIC'03L- By Civil Engineer: I c"tify to the satisfactory completion of.grading in accordance with the approved plans, specifications, local and state codes. All.drainage.devices required by the grading permit, grading plan and grading ordinance, have been, installed. ua:'e.provisions have been made for drainage of surface water from each building site. ' The minimums arc: r 2% Fall from structures within 5 feet from exterior walls. .I% Fall for asphalt surfaces,and landscaped meas. 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. Date !oi zO.l is (714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.ca.us 11 t -Ain UHIVt, wain MtaA, UA atom PLUMBING PERMIT Job Address: 1568 AMBERLEAF Status: ISSUED Suite No Applied: 01/26/2001 Issued: 02/07/2001 Vicinity: PLAN 3 Parcel Nunmber: TPN00084 ISSUED BY: Applicant: PHILIPP, ROLAND ' Address: 1565 W MAC ARTHUR FEE SUMMARY COSTA MESA, CA Phone: 714-6683300 AMT - Zip: 92626 Owner: STANDARD PACIFIC HOMES - - AMT Address 1565 W MAC ARTHUR $23.50 Laundry Tub / Washer COSTA MESA,CA Phone: 714-6683300 $0.00 0 Zip: 92626 ' Contractor: OWNER -BUILDER $0.00 0 Address: $0.00 0 Backflow Preventer $0.00 0 Phone: $0.00 0 - Trap Primer Zip'. 0 Bathtub $29.40 License: 0 Arch / Eng : Address: Phone: Zip: License: NOTICE: The work authorized by this permit shall comply with all applicable handicap access related EXPIRATION: This permit shall automatically exppmm J=Iei6FQQUQAM§ I in 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 246646 (fil00) SCOPE OF PERMIT CONSTRUCT NEW SFR PLAN 3 FOR STANDARD PACIFIC HOMES: 2972SF LIVING, 579SF GARAGE, 20SF COVERED ENTRY, 133SF PATIO. 3 BATHRUBS, 1 DISHWASHER, 1 EXPANSION TANK, 1 GAS (11 -4 OUTLETS), 2 GAS OUTLETS (OVER4), 1 LAUNDRY TUBNVASHER, 1 PRESSURE REGULATOR, 1 SEWER CONNECT, 1 SHOWER, 1 KITCHEN SINK, 1 SERVICE/MOP SINK, 1 WASH BASIN, 2 WASH BASIN SETS, 3 WATER CLOSETS, 1 INTER HEATER, 1 WATER SERVICE. REF: B01-00097 ' FEE SUMMARY AMT - QTY AMT CITY - - AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $9.80 1 Sump Pump - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 - Trap Primer $0.00 0 Bathtub $29.40 3 Pressure Regulator $9.80 1 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 - Wash Basin $9.80 1 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $19.60 2 Drain, Floor $0.00 0 Sewer Connect $24.65 1 Waste and vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $29.40 3 Drain, Roof $0.00 0 Shower $9.80 1 Water Heater/ vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $9.80 1 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor .$0.00 0 Water Service $9.80 1 Gas (13 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas (Over 4 outlets) $2.20 2 Sink, service/mop $9.80 1 OTHER $0.00 Gas Repipe .$0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access related EXPIRATION: This permit shall automatically exppmm J=Iei6FQQUQAM§ I in 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 246646 (fil00) 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 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 carver and policy number are: Carder: l i 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 ($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. Lic. It Class q 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: Lenders 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 ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am e t u er s Business and Professions Code for this reason: Sig nature:$� Date: ZL 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, talsework, 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 Cade 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 en 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? Yes 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 If a permit from the South Coast Air Quality Management District or other air pollution control 303 boon 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......................................................................................................................................................................................................................... 8 (If'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. Sig ret¢gal r(s /'h Z, Z its i ( J L Lof And/Or Authorized Applicant f I Date CODE 1. INSPECTION TYPE DATE INTRIALS CODE INSPECTION TYPE DATE NTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 0.19-Ol 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 // FAIH UHIVt, VUJ IA MLJA, l A VZOZO MECHANICAL PERMIT Job Address: 1568 AMBERLEAF Suite No Vicinity: PLAN 3 Parcel Number: TPN00084 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: Arch / Eng : Address: ISSUED BY: Phone: 714-668-4300 Zip: 92626 Phone: 714-668-4300 Zip: 92626 Phone: Zip: License: 0 Phone: Zip: License: Status: ISSUED Applied: 01/26/2001 Issued: 02/0712001 SCOPE OF PERMIT CONSTRUCT NEW SFR PLAN 3 FOR STANDARD PACIFIC HOMES: 2972SF LIVING, 579SF GARAGE, 20SF COVERED ENTRY, 133SF PATIO. 2 FAU <100K BTU, 1 FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 1 VENT FAN/SINGLE DUCT, 2 COMPRESSORS UP TO 3HP/100K BTU. REF: BOt-00097 FEE SUMMARY Quantity Repair/ Alt Absorblion Unit $0.00 Quantity ISSUE FEE $23.50 .0 Inst FAU <100 k BTU $29.60- 2 Inst FAU >100 k BTU $0.00 0 Repair / Alt Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $10.65 1 Hood w/Meth Exhaust $10.65 1 VAV Box $0.00 0 Vent Fan / Single Duct $7.25 1 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers > 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 FEE SUMMARY Quantity Repair/ Alt Absorblion Unit $0.00 0 Repair/ Alt RefrigerationUnit$0.00 .0 Ventillation System $0.00 ; 0 Evaporative Cooler $0.00" 0 Commercial Incinerator '. $0.00 0 Domestic Incinerator - $0.00 0 Compressors I Absorption Systems , Up to 3 hp 1100 k BTU $29.40 2 3 To 15 hp / 500 k BTU $0.00 0 15 To 30 hp / 1,000 k BTU - $0.00 0 30 To 50 hp / 1,750 k BTU _ $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $111.05 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. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjuryone 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) [:jI 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. Lic. # Class # Contractors 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). Lenders Name: Lenders 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 Cade) 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 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.). ❑ 1 am exam der Sea, Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes No Driver's License No. Y Expires: Verification of Ownership by (type of document, Le. - 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 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? ❑ 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 RM PP 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 a8armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). .....................................................cility"t......................................................................................ithi................................................................................................................................................................... 6 Will any partof the facility to be wnstructed 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 byCalifornia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...............................'aff........................................................................................................................l l ut.......-c'o............................................................................................................................................................................................................ e (It "yes", attach certificate of compliance from the appropriate air pollution conlroi 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: 1 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. ' natu fglow'"' a Ow ) Dale -2-h Z Q/ And/Or Auth rized pplicant Dat CODE t. INSPECTIONTYPE INTITIAL CODE r INSPECTION TYPE JIM INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical Io' IS -0( 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: 1568 AMBERLEAF Suite No Vicinity: PLAN 3 Parcel Nunmber: TPN00084 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: 01125/2001 Issued: 02/07/2001 SCOPE OF PERMIT CONSTRUCT NEW SFR PLAN 3 FOR STANDARD PACIFIC HOMES: 2972SF LIVING, 579SF GARAGE, 20SF COVERED ENTRY, 133SF PATIO. 1 NEW RES (1 UNIT), 2 LIFHT FIXTURES, 3 OUTLETS, 2 SWITCHES, 1 MOTOR TO 1 HP. REF: B01-00097 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 244646 (6100) FEE SUMMARY Quantity Quantity , ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $166.43 2972 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 .. 0.. ................ up to 10 kva/kw-. -$0.00 0 Lighting Fixts $2.20 2 ..... ._........ up to 50 kva/kw $0.00 0 Recept Outlets $3.30 3 .................up to 100 kva/kw $0.00 0 -� Switches $2.20 2 ..................over 100 kva/kw- " $0.00 --0/ Non Res Appl $0.00 0 Low Voltage Equipment - $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckl $0.00 0" Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0" Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $4.75 1 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 1001 $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $202.38 Intermed Pole $0.00 0 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 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 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued of one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, 1 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' CWPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL -ARE ($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. Lic. # 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). Lenders 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 J 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.). 77) 5� 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 axe oder c. Business and Professions Code for this reason: Signature: ` Date: Z -t Owner ID verified by drivers 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 Dces 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). ................................................................................................................................................................................................................................................................................................................................................................................. I .......... 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 It 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? Yes U No (Section 65850.2 of the California Goverment 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 (11 '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 .................................................................................................................................................I.....................................................................-.................. ............................................... . e (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. 1 agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATIOPL 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 rg 1 ner(s)/Z1 to And/Or Authorized Appli n ate CODE E. INSPECTION TYPE DAM INTITIAL$ CODE! INSPECTION TYPE 2AH INTRIAL 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,