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Home My WebLink About2702 ASHWOOD - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 2702 ASHWOOD Suite: ��T�%� Vicinity: PLAN 3 Parcel Number: TPN00082 Applicant: PHILIPP, ROLAND Address: 15326 ALTON PARKWAY, � IRVWE, CA Owner: STANDARD PACIFIC HOMES Address 15326 ALTON PARKWAY " � IRVINE, CA Contractor OWNER-BUILDER Address: Zip: Zoning: �Phone: 949-789-1600 �� Zip: 92618 , . Phone: 949-789-1600 � Zip: 92618 Phone: License: ` 0 ^ � nrcn : BASSENIAN LAGONI - . Address: 2031 ORCHARD DR ' � � ' � - ' STE 100 � � Phone: 949-553-9100 NEWPORT BEACH, CA Zip: 92660 License: ....-� -•� � _ ., CONSTRUCT NEW SFR - PLAN'3 = FOR STAP iRY AND 133SF PATIO,REF: B00-01537 \ Plan Check.' Permit: SMIP Res: SMIP Com: Other: Inspection: � Total: � '., .$316.19 $1, 945.75 , $26.99 $0.00 $0.00 $0.00 , � . � �� ISSUED BY: En9: Addressr" . . Status: ISSUED Applied: 06/13/2001 Issued: 07/O6/2001 Phone: License: � � ` SCOPE OF PERMIT;-' "'.� ' " IDARD-PAGFIC�HOMES: 2972SF LIVING�579SF GARAGE, 20SFCOVERED � . _ .. _ �-_ . - - - ---` - .. i.� �-r7 . 1 � � .. ' ,._ r', ii�� - . � ,_. �_ �FEE�SUMMARY%�• �_ _. r;,, � `_ , � --- - - , - __ _ - � � — �� z � -�Calc Valuation: �r' •' ; gzss,ezz.ie� _ ' ,� � � i Claim Valuation: � �� ' � $o'.00 • . 5 ` ,'',,! r L . ,,yr : _' ✓l� � � - _ __ �.'/,� , ,�� ,.- - !��, / , /, �: `� , %�� ,�f-', . ' t �� ., r .� �- �� ;p; % ' a .�_'` - -� i � ' - r„�, ,. � �' ,. i : � ,> .'1�T'.j%� � � :. <� ,. , , �C-� _ ' . J� � -;�� < . . %/�� l',n .. /,� '�% � �'� � �_, A`� ��"� \�� r � \ `,.+��° �PI SETBACKS � �� ` �� '- �� '��- . MAINSTRUCTURE F,ronh�6=-0�� /��Rear, 21-0 V . � A ! �j • ACCESSORY Fronl �0 0 � r ��,Rear� �0-0 .. ��_ �:.' . i , PARKING Existinq: o � �`, Required: �s � NOTES: NNING'&ZONING�� -�� ' l, ; ��. _e � ,�' , _ ; --_-, ..� 1�'��/ �� _Lek --�5-0�� _� RighP,,:!5-0 � - -�1, c `�1`� ,`.Left i" 0 0�-�`� �-� 1 Right , � 0'0. � t ., —�' � �,�/ � i � �� • � Pr000sed: 3 .-- ji� ��- � ,/j„- _ _'=�'_ n � _ - OTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related igulations. (Ord. No. 92-28, § 1, 12-21-92) XPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned r a period ot 180 days. ISPECTIONS: In order for the work authorized under this permit �o be considered legal, such work must comply with all applicable codes, and all qulred inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. )R INSPECTIONS CALL: (714) 7545626 � lfi-4fi(6/00) WORKERS' COMPENSATION DECLARATION: � � I hereby aflirtn undar penalry ot perjury one oi ihe following declaretions: � , • ❑� I heve end will maintain e certificate ot consent to self-Insure for workers' compensation, es provided for by section 3700 of the Labor Cotle, for ihe pertormance of the work foi whic� this permit Is issued. ❑ I have an0 will maimain workers' compensetion Insurance, as required by sectlon 3700 of the Lahor Code, for Ihe peRortnance of the work for whic� Ihis pertnit is issued. My workers' compensation Insurenca carrier antl policy number ere: Cerrier: Policy iJumber: (This section need not be comp/eted il the permit is velued ef one huntlretl dollars ($100) or less.) ❑ I certify ihat in Ihe pertormance of the work for which ihis pertnit is issued, I shall not employ eny person in any manner so es to become subject to ihe workers' compensalion laws of Celifomia, entl egree thet if I shoultl Decome subjad to the workars' compensation provisions of Section 3700 ot the Labor Code, I shall forihwith comply with these provisions. Applicant Signature: Date: WARNING FNLURE TO SECURE WORKERS' CAMPENSATION CAVEMGE IS UNIAWFUL AND SHAII SUBJECT AN EMPLOYER TO CRIMNAL PENALTIES FND CIVIL FINES UP TOONE HUNDRED TFqUSMlD DOLLARE (5100,000), IN ADDIT1qJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3/O60F THE LABOR CADE, It�f�EREST, AND ATTOqNEV'S FEES. LICENSED CONTflACTORS DECLARATION: I hereby eflirm Ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) ot Division 3 oi the Business and Pmfessions Code, and my license is in full forCe antl eHeCt Lic. # Class W Conirector's SigneNre: Date: CONSTRUCTON LENDING AGENCY: ❑ I hereby aHirm Ihat ihere is a cons�ruction lentling agency for the peAormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lendels Address: Signature: Date: OWNER-BUILDEH DECLARATIONS: I hereby aHirtn thet undar penelty of perjury that I em E%EMPT FROM TXE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Professions Cotle: Any city or counry which requires a pertnit to consiruct, elter, improve, demolish, or repair eny siructure, prior to its issuance, also requiras the applicant tor such permit to flle e signetl statement Ihat he or she is licensed pursuent to the provisions of the Contractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or thet he or she is exempt iherefrom and the basis tor t�e alleged e:emption. Any violation oi Section �031.5 by eny applicant tor e permit subjects the epplicant to a civil penalty of not more ihan five hundred dollars ($500).): ❑ I, es owner oi ihe property, or my employees with wages es their sole compensation, WILL DO THE WORK, antl the siructure is not intentle0 or ottered for sale (Sec. 7044, Business an0 Professions Cotle: The Contractors License Law does not apply lo an owner of property who builtls or improves thereon, and who does such work himself or herseN or ihrough his or her own employees, provitled that such improvemenis ere not intantletl or offered lor sale. If, howaver, the building oi improvement is sold within one year of completion, tha owner-builder will have the burden of proving that ha or she did not build or improve tor purpose oi sale.). �I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS to consimct the project (Sec. 7044, Business and Professions Cotle: The coniractors Llcense Law does not epply to an owner of pmperty who builds or improves Ihereon, and who contracts tor such prolea with a contracior(s) license pursuant to the Contractors License Laws.). ❑ I am exempt ar se Signeture: Owner ID veritied by driver s iicense. Ves and Professions Code for this reason: Date: Drivers License No. Expires: Verlficetion of Ownership hy (type of document, i.e. - properry tez bill ar deed): OIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehity ihat no excavation five (5) or more feet in depth into which e person Is required to descend, will be matle in connection with work authorizad by Ihis permiL and that no building simcNre, scattolding, talsewolk, or demolition or dismantling t�ereot, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2. Art 2, Sec. 341, Title 8, California Adminisirative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit from iha Division of Industnal Safety, as noted above, unless such person has e permit to do such work from the division. Signature: Data: Division ot Industrial Safery Permit Number: 1 W ill ihe applicant or presant or future building occupant need to file and cetlity e Business Plan tor emerqency response to release or thraatened release of a hazardous matenel? ❑ Yes ❑ No (Section 25505 of ihe Calitornia Health ana Safery Cotle requires, wi�h soma ezceptions, ihat a Business Pian be tiled with the Cosia Mesa Fire Depanment by every business which has at any one time dunng a reponed year a quantity of hazartlous matenals equal to or greater �han a weight of 500 pounds, or a volume oi 55 gallons, or 200 cubic Feet ot compressed gas at standard temperaWre and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the epplicent or present or fuWre buildinq acupant need to file a registration torm for acutely hazardous matenals7 ❑ Ves ❑ No (Section 25533 of the Califomia Health and Safery Code, with some exceptions, repuires regishation with ihe Costa Mesa Fire Depariment by each business which at any one time hes on hand a quaniiry of acutaly hazardous meterials equal to or greeter then e welght of 500 pounds, or a volume ot 55 geilons, or 200 cubic teet of compressetl ges at stendard tempereture and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or fuNre building wcupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 ot ihe California Healih and Safety Code provides that the Costa Mesa Fire DepartmeN may require the preparation, certification antl filing with the Fire Department of en RMPP by businesses which are required b register ecutely hazartlous materials with the Fire Department. an � �� or wlll ihe applicent or present or future building occupant require for the work which is the subjeCi Of this a pliCa�ion a permi� for such cons�ruction Or �he South Coas� Air Oualiry Managemenl Dlstnct or irom any other air pollution coNrol tlistrict or aganc}!+ � Ves u No �.ion 658502 of Ihe Californie Government Code requires that the repuested information be furnished on applications fo� nomresitlentiai buiiding permits). any part of the taciliry to 6e constmcted under this permit be within 10001ae� fmm ihe outer bounderies of a school �es', the tacility must meet the requirement of Sec�ions 25534 and 42303 of ihe Califomia Health antl Safery Code). ......... ....................................................................................... permil from the South Coest Air Oualiry Menagement District or other air polWtion control district or egency is ication. have all of the tlisclosures orescribetl bv Calitomia Healih and SafeN Code Section 42303 been matle? C CERTIFICA7E OF COMP�IANCE: I certify Ihat under penalty of perjury Ihe information given above is wrrect. I agree to comply with all state laws and ciry ordinances reqartling Hazardous Materials and Emiss�ons. Slgnature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORII.ATON OF ENTRY: I certify under penalty of perjury that I have read ihis application antl sta�e ihat �he information given i: correct I agrea to comply with ell state laws and ciry ortlinances relating to building consiruction, and authonze representatives of the Ciry ot Costa Mesa to enter upon ihe above-described pmperry for inspection purposes. I egree not to occupy or a�low occupancy of any building authorized by this permit until final inspection. CO�E Y. INSPECTION TYPE 1616 Fixetl System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 203 204 Final Factory Fire Place Final Sign Final Demoli�ian irnma�s Date �� ate COpE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Pinal ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy Q� INTITIALS souTxw��T Inspectlon & TestSng, [nc. Jaauazy 28, 2002 Building Official City of Costa Mesa Department of Building and Safcty 77 Fair Drive Costa Mesa, Califomia 92625 Continunux Irt.spection & Mureri�ds Tc.crin,q 0.��.�,s��s�J�i�.�.�,�.�.�.� 10R26 South N��rwafk Bi� d., Sanra Fe Springs, CA 90670 (562) 941-2990 • (714) 526-8�i�Fl FAX (562) 9�16-�0"'6 Re; Fiaal inapecHon fbr the Mesa Vcrde Collecaon, Costa Meaa CA Tcact 15882. Building 60 61 62 32 33 � Deei Buildi[Ig Od-1Cial: Petmit Number B01-00E47 Bp1-0Ol88 BO1-OOS92 BO1-00899 B01-00E89 B01-00898 Build'mg Parmit Number 35 B01-00893 36 B01-00896 37 BO1-00887 38 BO1-00895 39 B01-0t)R91 40 H01-00894 41 801-00890 Sarthwest Inspecdon and Tmting wes xetained by ihe Owner to provide special u�spection imd materials tating in the aieas that were requ�d by sectian l701 ofthe LJnifo�m Birild'wg Code, approved project drawmgs and spxiticadions, this work was witnessed by che fbllowing special iaspocton- Conaete pl�eme+u was obsaved md compressive ureagth semples were esst by, FFarry WaDca (OCEMA #0468), Erick Shauch (OCEMA MU548) snd Kenay Chupp (OCEMA # 1158?. Compressive strsagth samples wete pitked W bY Southwest end tested in our labo�atory. � All waic wa9 done m accordnnce w@h the ProJa� Plans, sP�ifications and �anship Drovisions of the Uniform Building Code. Sdesa'u�g of'h" post tensioned tendams wes oburved by Pac Osiemian (ICHO #]061525-81). All wotic was done m accordmue with thc P�'o1� P�, �� worlmoanship provisions of the Umform Building Code. Bmed upun speciel inspeaion and materisls tatiag written repofts of this wodc, it ie au judgement t6at the inspecrtd work was performa to fia beat of aur irnawledge, in acw�dance with ihe epproved plans, spuificatioos end applicable wmim�anship provision of the Uni form Biriiding Code. � � No. C0412� Ian R Waddell P.E. "FpFCN1�° R4nei�l Eng�neer For ir�ection and testing only, no design responsibility 19a�pw�t�peo6m u mMad r� rrd�4 emmg I�' hY�e �G CEf �lm ANpks. CC4L.11�0. D4A QIY d5a Di.6aCLL '[eri�lYArdSleCpudeMd M�v..lPo�v E;Z a6ed `WdOE�E Z�-BZ-�ef `9Z00 946 Z95 �18I 1S3MH1IlOS ��9 }uag � FINAL GRA�?ING CERTIFICATION lb-c� $o L-b L ' Pcoject Address: 1 Co 4 A�DAw�S -- ,, LolNumber. �t"Tt'•►'(.��kH 41 "�ia..�4[_'(t5�z Permil Num6er. � � — �� 3'i- By Civil F.ngineer: I ceRify to the sacisfaaory campietion of gmding in accotdance a�ith the approved ptens, spesifications. local aad s►ate codes: All d�ainage. devices required by ttu gnding permit. gradit�g plaa and grading ordinana,havrbecn installe�: /�dequa�c.provisions have banmade for drainage ot wrfaa water from eacfr building Si�e.. '' The rrrinimums are: . + Z96 Fal! from cwctuns wi�hin 5 feet from extevior walis. 1% Fall for asphalc surFaces and Undscaped aceas. 0.59� Fall for concrcu surFaces w approved dispcual anas. The final monuments as showa on the recorde�d tract map w�ere sa. All finai grading ele+m- rions are within ± 1/10 uf the designed elevatio � Supervising Ciyil•Engineer �g. No.. 394"�8 - - 1SiPeqturc) � , . • ' ; �arc 2 I l S �.oz. ,�: :�, "" i : - , ,:,t� - . , . � ..��'� '_n w�r. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: � �SUE FEE � �,mp service test is. a/c package es (1-2 units) es (3+units) ipa � Fixts Outlets� _�� s � Appl q 0 200a 0 1000a ver t000a ihp tOhp SOhp 100hp ar 700hp ation drops ;0 200a 'kg s 'ole le 2702 ASHWOOD PLAN 3 TPN00082 PHILIPP, ROLAND 15326 ALTON PARKWAY IRVINE, CA STANDARD PACIFIC HOMES 1565 W MAC ARTHUR COSTA MESA, CA OWNER-6UILDER Phone: 949-789-1600 Zip: 92618 Phone: 174 668-4300 Zip: 92626 Phone: Zip: License: 0 ISSUED BY: Status: ISSUED Applied: 06/28/2001 Issued: 06/28/2001 SCOPE OF PERMIT,�' , ` ' CONSTRUCT NEW SFR � PIAN 3- FOR�STANDARD PAGFIC HOMES: 2972SF LIVING, 579SF GARAGE, 20SF COVERED ENTRY, 133SF PATIO. - " 1 NEW RES (1 UNIT), 2 LIFHT FIXTURES, 3 OUTLETS, 2 SWITCHES; i MOTOR TO 1 HP. REF: 801-00098 � .. , � FEE SUMMARY�' � 1 i� 'Quantity . � = � Quanti `� ' :� 1' �Y,, � $23.50 TempDistSystem`/Lighting $0.00 .,0%-� � $0.00 .- Busway /100 ft $0.00 <'.Oi� - � $0.00 -„+� ��. � Standing Section $0.00 '!;��0 � . 5166.43 2972 - � ^' _ � Misc Ele`ctrlcaLEquipment $0.00 � � i" 0 � � $0.00 0 �- .� Transformers up to.1 kva/kw_ $0.00 �� 0�� . . ; . , . . _., , . $0.00. .Ir "r 0:, . _, - " ...:up to 10 kva/kw--::'=' ;$0:00' 0 '... / � $220�'�` 2"� � - .upto50kva/kw "$0-00, �0 � , ;/ $330 �A��3 `- � �.' . `upto700kva/kw-�%�$000�% -.0 ;�> ; . = $220_ � 2 � =� . '.... �.over 100�kva/kw � '� $0 00_ �"0 : ; ' � $0�00�,�, 0 =�.� _ . Lov�iVoltage�Equlpment":� ��$0.00��0,/,- �� $0�00 , � 0 ' �- �- ' Low Volt Wlring:System / Ckt:.�, ' $0.00 � � 0 �" � ,$0:00' ' � . � 0- �_ Mlsc Conduit 1 - � -$0.00 -'," 0 �� $0.00 " .. �. 0 ,� � , Misc. Conductor � � � � "$0.00 �, , 0 ��.$0.00;,. � � 0 . , �Circus ( gedor ride)�, � ; �$0.00, ' 0 $475 . � - 1 � . Circus,(mech ride'or lights).; �j $0.00 0 $0.00�_ . 0 - �- ' - ' � Christmas Tree�Stand .". , � $0.00 0 $0.00 � 0 '-._ _ FireworksStand.; �'' - $0.00� 0 $0.00 0 � � � � Other Electrical Fee � $0.00 $0.00 0 - $0.00 0 Investigation Fee $0.00 $0.00 0 Plan Check Fee $0.00 $0.00 0 Reinspection Fee $0.00 $0.00 0 $0.00 0 TOTAL CALCULATED FEES 5202.38 $0 00 0 COMMENTS I SPECIAL CONDITIONS � work authorized by tnis permit shall comply with all applicable handicap access requiremenis under California statutes and related 'd. No. 92-28, § 1, 12-21-92) This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abantloned BO days. In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all tions antl final approval must be obtained. Failure to o6�ain inspections and final approval will result in the expiration of this permit. �NS CALL: (714) 75A-5626 - _ _ - - �� WORKERS' COMPENSA710N DECLARATION: I hereby aRirtn untlar penalry oi perlury one of the following tleclaretions: ❑ I heve end will main�ein a certificate ot consent to self-Insure tor workers' compensation, as provided for by section 3700 of the Labor Cotle, for the pedormance of the work for which ihis permit is issued. ❑ I hava antl will maintain workers' compensetion insurance, as requiretl by section 3700 of the Labor Cotle, For the pertortnance ol the work tor which this permit is issuetl. My workers' compensation Insurance cerner and policy number a�e: Carner: Policy iJumber: ' (This section neetl not be comp/eted il the Oermif is velued af one hundred dollars ($100) or less.) ❑ I certily ihet in Ihe performance of Ihe work for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the workers' compensation laws oi Califomla, antl agree ihat ii I shoultl bacome subjacl to the workars' compensation provisions of Sactlon 3700 of the Labor Code, I shall fort�with comply with these provisions. AppliCant SlgneNre: Date: WAfiNING: FAIWRE iOSECURE WORKEFS' COMPENSATION CAVERAGE I$ UNLAWFUL PND SMALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDqED TFIOUSANO DOLURE (E100.000�, IN ADDITIqJ T0 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 31060f iHE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirtn that I am licansed untler provisions of Chapter 9(commencing with Saction 7000) of Division 3 ot the Business antl Professions Code, antl my license is in full torce end eflecL Lic. # Class x Contracrofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aftirm ihat Ihere is a consiruction IenOing agency for the pedormance of the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby effirtn that undar panalry ot perjury ihat I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protesslons Cotle: Any ciry or counry which requires e permit to consiruct, alter, improve, tlemolish, or repair any sWcture, prior to its issuance, also requires the appliwnt for such permit to file a signed statement ihat he or she is licensetl pursuant to the provisions oi ihe Contractors license Law (Chepter 9(commencing with Section 7000) of Divislon 3 of ihe Business end Professions Code) or ihet he or she is eaempt therefrom and tha basis tor ihe ellegetl exemption. Any violetion of Section 7037.5 by eny applicanl for e permil subjects the epplicant to a civil penalty of not more ihan five huntlretl tlollars ($500).): ❑ I, as owner of the pmperty, or my employees with wages es iheir sole compensation, WILL DO THE WORK, antl the structure is not intended or oflered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not aOPly to an owner of property who builds or improves Ihereon, and who tloes such work himself or hersetl or ihrough his or her own emplayees, provided that such impravements are not imendetl or oNeretl for sale. N, however, the building or improvement i: �sold within one year of completion, ihe owner-buildar will have ihe burden of proving ihat he or she did not builtl or improve tor puryose oi sale.). I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions Code: The contractors License Law does not apply to an owner of propeny w�o builds or improves thareon, and who coniracis for such project with a conVactor(s) license pursuant to ihe Contrectors License Laws.). ❑ I am exempt und sec. Business and Professions Cotle for ihis reason: Signawre: �� _ nA Date: Owner ID verified by tlrivar's license. ❑ Ves No Drivefs License No. zpire : Venficetion of Ownership by (type of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby cenity that no excavation five (5) or more feet in depih into which a person Is required to descenq will be made in connection wi�h work authorized by this permit, and ihat no building 5tructure, scaflolding, falsework, or demolition or dismantling ihereof, will be more Ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, 341, Title B, Califomia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permil from Ihe Oivision ot IndusMal Setery, es notetl above, unless such person I permit to do such work from ihe division. Signature: Date: Division of Indusinal Safety Permit Number: 7 B Ai1DOUS MATERIALS AND EMISSIONS CERTIFICATION: Will the applicant or presenl or fuWre builtling occupant neetl to tile and certify a Business Plan for emergency response to release or threatened release of a ha� meterial? ❑ Yes ❑ No (Section 25505 ot ihe CaliFornia Health and Safety Code requires, with some exceptions, that a Business Plan 6e tiletl with lhe Costa Mesa Fire Depanment t business which has et any one time during a reported year a quantiiy of hazardous materials equal to or greater than a weight of 500 pountls, or a volume ot 55 or 200 cubic feet ot compressed gas at standard tempera�ure and pressure). ............................................................................................................................................................................................................................................................................................................................................................ Does or will ihe epplicant or present or tuWre builtling occupant need to file e ragisiration form tor ecmely hazardous matenals7 ❑ Ves ❑ No (Section 25533 oi ihe Calitomle Health and Sefery Code, wlth some eaceptions, requires ragistration with ihe Costa Mesa Fire Department by each businass whii one time hes on hand a quantity of acutely hazardous meteriels equal to or qreeter ihan e weiqht oi 500 pounds, or e volume oi 55 gallons, or 200 cubi compressed gas at stendard tempereture and pressure). ......................................................................................................................................................................................................................................................................................................................................................... Does or will the epplicaM or present or fu�ure builtling occupant neetl to prepare an RMPP (Risk Management and Prevention Program lor acutery hazartlous me 25534 0 en� of an en that has Section 25534 0l ihe Calitornia Health and Fire Depariment may require ihe preparation, cenification and filing wil � matenals with ihe Fire Depatlment. .......................................................................................................................................................... Code been fully comDlietl with7 ❑ Yes ❑ No uoes or wui me eppucaN or present or NWre bwming occUpani reqwre tor Ine work wnitn i5 Itle SubJeCi of tnis a plica9on a Permrt tor such constmclion or n fmm tha South Coast Air Duality Management District or from eny other eir polWtion conirol tlisMct or egency9 � Yes �J No (Section 658502 ot ihe Califomia GovemmeN Coda requires ihat ihe requested inbrmation be furnished on applications tor non-residen�ial building permits). ..................................................................................................................................................................................................................................................................................................................................................... Will any part oi the tacility to be constmctetl untler this permit be within 10001ea1 from Ihe outer bountlanes of a school7 ❑ Ves ❑ No Qf'yes", the faciliry must meet the requirement of Sections 25534 and 42303 ot the California Health and Safety Code). .................................................................................................................................................................................................................................................................................................................................................... If e permit from Ihe Sou�h Coast Air Qualiiy Menegemen( District or olher eir polWlion con�rol tlis�ric� or egency is requiretl tor �he work which is ihe su application, have all ot the tlisclosures prescribed by California Health antl Satery Cotle Section 42303 baen matle? ❑ Ves ❑ Na ................................................................................................................................................................................................................................................................................................................................................... (tl'j�es", attach certificata ot compliance irom the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cenity that under penalry of perjury the intormation given ebove is correct. I egree to comply with all state laws and cit regattling Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I cetlify under penalty of perjury that I have read this application and state that the infom correct I agree to comply with all state laws entl city ordinances relating to building constmction, antl authonze representatives of the City of Costa Mese to r above-descnbed propeny for inspection puryases. I agree not to occupy or allow occupancy oi any builtling au�horizetl by this permit un�il final inspection. CODE �. INSPECTIONTYPE 1616 Fized SyStem Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rooi 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finai Demolition � / � �, Date Date IVij[ I TT L � INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Pravention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �2\13 �—� (714) 754-5273 • Fax (716) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 2702 ASHWOOD Suite No Vicinity: PLAN 3 Parcel Number: TPN00082 npp�icant PHILIPP, ROLAND Address: 15326 ALTON PARKWAY IRVINE, CA Owner: S7ANDARD PACIFIC HOMES Address: 1565 W MAC ARTHUR COSTA MESA, CA Contractor: OWN ER-BUI LDER Address: Phone: 949-789-1600 - Zip: 92618 � Phone: 174 668-4300 Zip: 92626 =Phone: ZiP License: 0 StatuS: ISSUED Applied: 07/09/2001 Issued: 07/09/2001 ISSUED BY: SCOFE OF_PERMIT , CONSTRUCT NEW SFR,- PLAN 3- FOR STANDARD PAGFIC HOMES: 2972SFLIVING, 579SF ' � GARAGE, 20SF COVERED ENTRY, 133SFPATIO. - � � fj ,.'. ' '� � ' r ' � - . ` 2 FAU <100K BTU, 1��FACTORY`�FIREPLACE,-T HOOD W/MECH�EXHAUST,�1 VENT FAN/SINGLE „, � ,;� DUCT, 2 COMPRESSORS UP TO 3HP/100K BTU. REF: B01-00894-�� . ' � � � RI' � - - _ _ '._ FEE SUMMARY__-_ � . "' " � �' � � ; �, - _ . - ��- Quantity ' --- .- , _ , /,' "'-".: _ . , � .. � . �� Quantlfy �.FEE � $23.50 Repaii%AltAbsorbtionUnit i-..'�$O.OQ_'0 %�` � �U <100 k BTU' �- $29.60 2 Repair=/-Alt Refrigeration Unit '� , � $0.00 �0 � � �U >100 k BTU $0.00 0 Ventillation System j- �.$0.00 0. � r- , � / Alt Cooling/Heat '�� $0.00 0 Evaporative Cooler � `, �i . �$0.00 � Oti � �� - tep. Recess Wall Htr �. $0.00 0 �:-a�.; �" � "�:Commercial Incinerator � �� $0:00� ,0; - Sys�<100 k BTU ``• $0.00 0 wr�_�;� � Domestic Incinerator .,��,� �$0.00 . 0% iys>700 k BTU ; � $0.00 0 � - Compiessois /Absorption Systems/ � .' �ing ; �� , � ,� $0.00 0 � ' 1- Up to 3 hp 6100,k BTU .�„c,� - //.� ' $29 40� 2 Fireplace ' �$10.65 1 �,1'�' � � •� 3 To-15 hp % 500�kBTU° ' ��%' � $0 00 % 0 �Mech Exhaust � � � $10.65� 1 � - i ' �, ,45 To 30 h / 1,000 k BTU�� $0.00 � 0 x `. '_ � <,� j� /� $0:00'�0 �� 30 To 50 hp /�1;�750-k�BTU�i �/� �$0,00 0 v / Single Duct� �� i / $7,_25�VV'�� Ovar 50 hp / Oyer 1 750 BTU < �� $0.00 0 e , �✓ /�$0:00 0�'�``� ; `� :. ' Boilere, !" %'� i �� %/ ipers � �A. `.�$0 00 � , p� � � � . - - Up�to 3 h � 1.`L , r �� / �„ . i P--� � - /,',J� $0.00 0 ampers �$0�00 0 � - 3 To 15 hp� ; � � `� (/ . $0.00 0 � �locate Appl Vent � �� $0.00�� 0. �! � - ' � � 15 to 30 hp:.� `� + �l '-' � �;, r / $0.00 0 :rs < 10000cfm � � $0.00 � �0 L., . ' - -. ' 30 to 50 hp�'��,, �_',i %�' � / $0.00 0 ars> 10000cfm �$0.00_-, 0 L, -.Over50'hp= !=,l-i; '� $0.00 0 ace $0.00��„ 0 - . � � ' � Other Mechanical Fee��-'`� ispendHeater $0.00 -0 _- � , `-� . Inyestigetion"Fee-' $0.00 '- � _ _. : �:�-��.P.lan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 5111.05 COMMENTS / SPECIAL CONDITIONS work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related d. No. 92-28, § 1, 12-21-92) This permit shall automatically expire and become void if work is not commenced within 180 days, or iF work is suspended or abandoned i0 days. In order for the work authorized untler ihis permit to be considered legal, such work must comply with all applicable codes, and all ;fons and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit. NS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I �ereDy affirm under penalry of perjury one o1 the tollowing tleclarations: ❑ I heve end will maintain e certiticete of wnsent to self-Insure for workers' compensation, as provided for by section 3700 of ihe Labor Code, tor ihe partormance of the work for which Ihis permit is issued. ❑ I heve and will maintain workers' compensetion insurence, as required by section 3700 of the Labor Code, for the peAortnance of ihe work lor which Ihis pertnit Is issuetl. My workers' compensatlon Insurence carner and policy number ara: Cerrier: Policy ivumber: (This sectlon need not be completed i! the permit is velued et one hundred dollars ($100) or less.) ❑ I certify Ihat in the pertortnance of Ihe work for which ihis pertnit is issuetl, I shall not employ any person in eny manner so as to become subject to the workers' compensation lews of Califomia, end agree that if I should becrome sub�ect to Ihe workers' compensation provisions of Sadion 3700 of ihe Labor Code, I shall fotlhwith comply with �hese D�ovisions. Applicant Signature: Date: WFRNING: FAILURE TO SEWFE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDHED TFKKISAND OOILAfiE (E100,000), IN ADOITION TO THE COST OF CAMPENSATION, DAMAGES AS GROVIDED FOR IN SECTIdJ 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby aHirm ihat I am licensetl under provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot the Businass and Profeuions Code, and my license Is in full force antl eNect. Lic. k Class x Coniractors Signeture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn thal there is e cons�ruction lending agency for ihe pertortnance of �he work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lentler's Adtlress: Signature: Date: OWNER-BUILDER UECLARATIONS: I hereby eHlrtn ��at under penalry ot perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (SecJ031.5, Business antl Professions Code: Any ciry or counry which requires a permit to construct, eltar, improve, demolish, or repair any structure, pnor to its issuance, elso requires Iha applicant for such permit to flle a signetl statement that he or she Is licensed pursuant to ihe provisions of Ihe Contrecrors License Lew (Ghapler 9(commancing with Section 7000) of Division 3 of the Business an0 Protessions Code) or that he or she is exempt iheralrom end the basis for the alleged exemption. Any violation of Section 7031.5 by any epplicant for e pertnl subjects the applicant to a civil penalty of not more Ihan tive hundred dollers ($500).): ❑ I, as owner of the propeny, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the siructure is noi intendatl or oHered tor sale (Sec. 7044, Business and Protessions Code: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work himself or hersel� or ihrough his or �er own employees, provided that such improvements are not intended or oHered for sale. If, however, ihe building or improvement i /j� sold within one year of completion, ihe owner-builtler will have lhe burden of proving that he or she did not build or improve for purpose of sale.). 'j(�, I, as avner of Ihe properry, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct iha project (Sec. 7044, Business and Professions \ Code: The contradors License Law does not apply to an owner of propeny who bullds or improves Ihareon, and who coNrects for such project with a coniractor(s) license pursuant b the Comractors License Laws.). ❑ I am exempt unde ec. eusiness antl Professions Code for Ihis reason: SignaNre: �/) Date: • Owner ID verified by dnver's license. ❑ Yes ❑ No Drivers License No. Ex ires: Vedfiwtion oi Ownership by (rype ol document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CER7IFICATION: ❑ I herehy certify that no axcavation five (5) or more teet in depth into which e person is required to descenq will be matle in connection with work euthorized by Ihis permit, and lhat no building siructure, scaHolding, falsework, or tlemolition or dismantling ihereot, will be more ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, 341, Title 8, Celitomia Administrative Code). ❑ As ownerbuilder, I will not employ enyone to tlo work which woultl require e permit irom the Division of Intlusirial Safety, as noted above, unless such person' permit to do such work irom Ihe division. Signature: Division ot Industnal Safety Permit Number. Date: ARDOUS MATERIALS AND EMISSIONS CER7IFICATION: W ill the applicant or present or tuture building occupant neetl to file end certity a 8usiness Plan tor emergency response to release or threatened release of e ha; materiel? ❑ Yes ❑ No (Section 25505 of the Calitomia Healih and Safety Code requires, with some ezceptions, ihat a Business Plan be liled with ihe Costa Mesa Fire Departmeni t business which has et any one time during a reported year a quantiry of hazartlous matenals equal to or greater ihan a weight of 500 pountls, or a vo�ume of 55 or 200 cubic feet of compressetl gas at standard temperature and pressura). ........................................................................................................................................................................................................................................................................................................................................................... Does or will the applicant or present or future building occupant need to file a regisiration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of ihe Califomia Healih end Sefery Code, with some exceptions, requlres registration wiN the Costa Mese Fire Depanment by each business whi one time has on hend a quantity oi ecutely �azar0ous materials equal to or greater then e weiqht of 500 pounds, or a volume of 55 gellons, or 200 cub wmpressetl gas at stantlartl tempereture end pressure). ........................................................................................................................................................................................................................................................................................................................................................ Does or will the applicant or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous m; (Section 25534 of �he Califomia Healih and Safety Code provides Ihat the Costa Mesa Fire Department may require the preparation, certification antl tiling wi� Depatlment of an RMPP by 6usinesses which are required to register ecutety hazardous matenals with the Fire Department. ...................................................................................................................................................................................................................................................................................................................................................... If an RMPP is presently reQuired, has Section 25534 ot the California Healih and Safery Code been fully complied with? ❑ Ves ❑ No ..................................................................................................................................................................................................................................................................................................................................................... Does or will the applicant or present or tuture building occupant require for the work which is the subjea of this a plication a Permit tor such consimction or n from �he Sou�h Coest Air Quelity Menagament Ois�nc� or irom eny o�her air pollution control dis�ric� or agency? � Yes �J No (Section 658502 oi the Califomia Govemmem Cotle requires that the requested inrormation be furnished on applications for non-resitlential builtling permits). ................................................................................................................................................................................................................................................................................................................................................... Will eny patl of the faciliry to be constmcted under fhis permit be within 1000 teet from tha ou�er bountlanes ot a school7 ❑ Yes ❑ No (H'yes", the facility must meel Ihe requirement of Sections 25534 and 42303 of the Califomia Healih antl Safety Code). .................................................................................................................................................................................................................................................................................................................................................. If a permit irom Ihe South Coest Air Qualiry Managemant District or other air pollution contml disirict or egency is required for ihe wotk which is the s� epplicatlon, have ell ot Ihe disclosures prescribed by California Healih and Safery Cotle Section 42303 been matle? ❑ Yes ❑ No CERTIFICATE OF COMPLIANCE: I cetlify that under penalty of perjury ihe information given above is correcC I agree to comply with all state laws and ci� regartling Hazardous Materials and Emissions. Signaiure: Date: CERTIFlCATE OF COMPLIANCE AN� AUTHORIZATON OF ENTRV: I certify under penalry of perjury that I have read this application and state �hat the inforr correct I agree to comply with ell state laws and city ordinances rela�ing to building cons�ruction, and authonze representatives of the City ot Costa Mesa to � ebove-described property for inspeclion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit umil finel inspection. yODE�, INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool SDa Final 2p0 Final Re-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition �' ' /J �� pATE �� 1 INSPECTIONTYPE fZi� 206 FinalMechanical a.�q.�� 208 210 212 220 222 250 Final Plumhing Final Electrical Final Fire Prevention Final Planning Approval Final Site Final Building/Occ (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address�. Suite No Vicinity: PLUMBING PERMIT 2702 ASHWOOD PLAN 3 Parcel Nunmber: TPN00082 Applicant: PHILIPP, ROLAND Address: 15326 ALTON PARKWAY IRVINE, CA Owner: STANDARD PACIFIC HOMES Address 1565 W MAC AR7HUR COSTA MESA, CA Contractor: OWNER-BUI LDER Address: Arch / Eng : Address: ISSUED BY: Phone: 949-789-1600 Zip: 92618 Phone: 174 668-4300 Zip: 92626 Phone: Zip: License: 0 Phone: Zip: License: Status�. 1SSUED Applied: 07/09/2001 Issued: 07/09/2001 SCOPE OF PERMIT � CONSTRUCT NEW SFR - PLAN 3- FOR STANDARD PACIFIC HOMES: 2972SF LIVING, 579SF- . � GARAGE, 20SF COVERED ENTRY, 133SF PATIO. 3 BATHRUBS, i DISHWASHER, 1 EXPANSION TANK, , ," . 1 GAS (1-4 OUTLETS), 2 GAS OUTLETS (OVER4), 1 IAUNDRY TU8/WASHER, 1 PRESSURE � � REGULATOR, 1 SEWER CONNECT, 7 SHOWER, 1 KITCHEN SINK, 1 SERVICE/MOP SINK,"1 WASH � BASIN, 2 WASH BASIN_SETS, 3 N/ATER CLOSETS, 1 WTER HEATER; 1;WATER SERVICE. � � ' REF: 801-00894 , ' ' � . � ' " , JE FEE ;Bow irrigation flow Preventer 'ub ier System ect (Ice,Soda,etc) tl Units �asher Floor Rainwater Roof ig Fountain ;ion Tank adhquake Valve �4 outlets) ver 4 outlets) pipe rvice rtors (Grease, Oiq tors (Sand Auto ) AMT $23.50 $0.00 $0.00 $29.40 50.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 56.75 $220 $0.00 $0.00 $0.00 $0.00 Q7Y' 0 0 3 0 0 0 1 0 0 0 0 i 0 1 2 0 0 0 0 FEE-SUMMARY � �� AMT Laundry Tub / Washer $9.80 Landscape Irrigation $0.00 P-Trap , $0.00 � Pressure Regulator $9.80 Process�Piping (per 70 ft) , $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $24.65 Sewer Private Line $0.00 Shower $9.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $9.80 Spa (private) $0.00 Spa (public) $0.00 QTY � 1 0 0 � 0 0 . 0 0 1 0 1 0 0 0 1 1 0 0 i. . . `� Sump Pump . Swimming Pool � TrapYrimer �Urinal . "'� Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkflOW(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION The work authorized by this permit shall comply with all applicable handicap access raquirements AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $19.60 $0.00 $29.40 $12.30 $0.00 $0.00 $9.80 $0.00 $D.00 $0.00 $0.00 so.00 QTY 0 0 0 0 0 0 1 2 0 3 1 0 0 1 0 0 and related - '- - - -- --' " ' - - -' COMMENTS I SPECIAL CONDITIONS ION: This permit shall automatically expire and become voi i wor is no commence wi in 180 days, or if work is suspended or abandoned d of 1 BO days. ONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all nspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. ECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: � I herehy aflirtn under penaly ot perjury one of Ihe following declerations: ❑ I have and will malntein e certiilca[e ot consent to self-Insure for workers' crompensation, as providetl for 6y section 3700 of Ihe Labor Code, tor the pedormance ot the work tor which t�is permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 ot the Labor Cotle, tor ihe peAortnance ot the work for which this pertnit Is issued. My workers' compensetion Insurance wMer entl policy number are: Carrier: PolicyiJumber: � (This section need nof be completed il the permit is veluea et one hundred dollers ($f 00) or IessJ ❑ I cehity that in ihe peAortnance oi ihe work for which this pertnit is issuetl, I shall not employ eny person in any manner so es to become subjed to the workers' compensation lews of Californie, and agree ihat if I should become subject to the workers' compensatlon provislons of Section 3700 of Ihe Lebor Coae, I shall fonhwith comply with Ihese provislons. AppliCen� Signeture: Date: WMNINO: FAILURE TO SECURE WORKERS' CO�dPENSATION COVERAGE IS UNUWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (E100,000�, IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SEGTION 3]Ofi OF THE LABOq COOE, IFf�EREST, AND ATiORNEY'S FEES. LICENSED CONTHACTORS DECLARATION: I hereby ettirm ihat I am licensed under pmvisions of Chapter 9(commancing with Saction 7000) of Division 3 ot the Business and Pmfessions Cotle, and my license is in tull Porce end efFect Lic. R Class N ContrectoYs Signeture: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby attirm that there is a construction landing agency tor ihe performance of the work for which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lentler's Neme: Lender's Atldress: Signatura: Dale: OWNER-BUILDER DECLARATIONS: I hereby atfirtn ihat under penalty of perjury �hai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions Code: Any city or counry whic� reQuires a permit to construct, alter, improve, tlemolish, or repair any siructure, prior to its issuance, also requires ihe applicant for such permit to file a signed statement Ihet he or she is licensetl pursuant to the proNsions of ihe Contrectors License Law (Chapter 9(commencing with Sedlon 7000) of Division 3 of the Business and Profeuions Cotle) or Ihat he or she is exempt thereirom and Ihe 6asis for the allegetl exemption. Any violetion ot Section 7031.5 by any applicant foi a pertnit subjecis the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of the properry, or my employees with weges as Iheir soie compensatlon, WILL DO THE WORK, antl the s�ruc�ure Is not intendatl or oNered tor sale (Sec. 7044, Buslness antl Professions Code: The Contractors License Law tloes not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or Ihrough hls or her own employees, provided that such improvemenis are no� in�entletl or offered for sale. If, however, tha building or improvement is �sold within one year ot completion, the owner-builder will have ��e burden of proving Ihat he or she did not build or improve for Durpose of sale.). I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the D�oject (Sec. 7044, Business and Professions Code: The contraciors License Lew does not apply to an owner of propetly who builds or Improves Ihereon, and who contrac�s tor such projact with a contractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt.l�o'der sec Signature: �I`l� O Owner ID veniietl by�riveYs license. � Yes ❑ and Protessions Code for this reason: Ventication oi Ownership by (rype of tlocument, i.e. - propeny tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY VERMIT CER7IFICA710N: Drivers LiCense No. Date: Ex ires: ❑ I hereby renify ihat no excevetion tive (5) or more tee� in depth into which e person is required lo descend, will be made in connection with work authonze0 by this permit, and that no building strucNre, scaHoltling, falsework, or demolition or dismantling thereof. will be more lhan thirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Se 341, Title 8, Celifomia Adminisirative Code). ❑ As owneabuilder, I will not employ anyone to do work which woultl require e permit from the Division ot Industriel Safery, es noted above, unless such person hae permit to do such work from Ihe division. Signature: Division ot IndusMal Safety Pertnit Number. Date: 1 W ill ihe epplicant or present or future building occupant need to file and cenity e Business Plan for emergency response to relaase or ihreatened releese of a hazerd matenal? ❑ Yes ❑ No (Section 25505 ot the Calitomia Health and Safety Cotle requires, with some exceptions, that a Business Plan be tiletl with ihe Costa Mesa Fire Depanment by e busineu which has ai any one time dunng a reported year e quantity ol hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gall or 200 cubic feet of compressed gas at standard temperature and pressure). .............................................................................................................................................................................................................................................................................................................................................................................. 2 Does or will ihe epplicant or present or future 6uildinq acupant need to file a registretion fortn for ecutely hazartlous materials? ❑ Ves ❑ No (Section 25533 of Ihe Calitomla Healih and Safery Code, with some exceptions, requlres regisiretlon with ihe Costa Mesa Fire Department by each business which a one time has on hend a quantiry of acutely hazardous materials equal to or greater Ihan e welght of 500 pounds, or e volume ol 55 gellons, or 200 cubic fe compressed gas at stantlartl tempereWre antl pressure). ............................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the appiicant or Dresent or fuNre builtling occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous maten. ❑ Ves ❑ No (Section 25534 of ihe California Health and Satery Code provides ihat ihe Cos�a Mesa Fire Deperiment may require ihe preparetion, certification and Filing with th� Depertment ot en RMPP by businesses which are required to register acutely hazardous materials with iha Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................... 4 If en RMPP is presently requireq has Section 25534 of ihe Calitornie Health and Safety Code been fully complied witM ❑ Ves ❑ No .......................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the epplicant or presem or tmure building occupant require for ihe work which is ihe subject of this a plication a permii tor such constmction or modif'� irom Ihe Sout� Coast Air Ouality Management District or from eny other air polWtion control district or agency? � Ves u No (SBCtion 658502 ot Ihe Celifornia Government Code require5 ihat ihe feques�ed informetion be tumishetl on applications tor non-residential builtling permi�s). any part ot ihe facility to be cc res", ihe faciliry must meet the have all of the tlisclosures ier this permit ba within 1000 feet from the outer 6oundaries of a school7 ot Sections 25534 antl a2303 of the California Heal�h and SafeN Cotle). ismct or omer eu po�wnon commi aisina or egency is reqwreo ror tne r Health and Safetv Cotle Section 42303 been made? ❑ Yes ❑ No GER7IFICATE OF COMPLIANCE: I cehify that under penalry of perjury the iniormation given above is correcl I agree to comply with all state laws and ciry ord regardinq Hazertlous Matenals antl Emissions. Signature: Date: CER7IFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cehity under penalty oi perjury ihat I have read Ihis application and state that the information correct I agree to comply with all stata laws and ciry ordinances relating to builtling construc�ion, and euthorize representatives of the Ciry of Costa Mesa to enter ebove-descnbed property for inspection purposes. I egree not to occupy or allow occupancy ot any building authorized by this permit until final inspection. CODE t. INSPECTIONTYPE �� INTRIFLS 1616 Fixed System Final Fire Prevention 1266 200 Pool Spa Final Final Re-Rooi 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Date �% l� ll1 �-�U �� COpE I INSPELTION TYPF 206 Final Mechanical 208 Final Plumhing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupancy ILua '��'