HomeMy WebLinkAbout1639 BRIAR ROSE - Building Permits c -
CITY OF COSTA MESA
fr 9 BUILDING DIVISION
if•4- ____ra#,. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
l;t
1c..1141k
11 �k . - PERMIT
*sty. B01-01319
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1639 BRIAR ROSE Status: ISSUED
Suite: Applied: 08/24/2001
Vicinity: 3RD CAR GARAGE INTO 5TH BEDROOM Issued: 08/24/2001
Parcel Number: TPN00097 Zoning:
Applicant: PHILIPP, ROLAND ISSUED BY: --NS
Address: 15326 ALTON PARKWAY
Phone: 949-789-1600
IRVINE,CA Zip: 92618
Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA,CA Phone: 7147-668-4300
Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPLACE 179 SF PORTION OF THE THIRD-CAR GARAGE WITH AN 179 SF FIFTH BEDROOM OPTION-PLAN 2-FOR
NEW SFR FOR"STANDARD PACIFIC HOMES."
REF: B00-01536
FEE SUMMARY
Plan Check: $34.00 Calc Valuation: $11,277.00
Permit: $209.25 Claim Valuation: $11,277.00
SMIP Res: $1.13
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $244.38
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 �
i�
2446-46(6/00)
r.
,
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 at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is Issued,I shell not employ any person in any manner so es 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(5106,000),IN ADDITION TOTHE(MT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Uc.4 Class if
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exam• n.:r se• . a a Business and Professions Code for this reason: 56--71/0/
Signature: ' ' vis �� Date:
Owner ID verified.y driver's license. 0 Yes 0 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? 0 Yes 0 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? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 Flre
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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application azermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j,�Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 Duality 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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 COMPUANCE 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.
Signature e I ner(s) ate
�{I7�-t 7� �1
x And/Or Autrlonz d Applicant Oat
CODE t INSPEC1IONTYPg PAIS IN11ALS CODE! INSPECTION TYPE WI gQIIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 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 10-12-01 /!E
•
• • e• r 1 S
' - MF CITY OF COSTA MESA
fr9 BUILDING DIVISION
1 .• • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
V• t
PERMIT
/01-00106
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1639 BRIAR ROSE Status: ISSUED
Suite: LeTS.0 Applied: 01/25/2001
Vicinity: PLAN 2 Issued: 02/08/2001
Parcel Number: TPN00097 Zoning:
Applicant: PHILIPP, ROLAND ISSUED BY:
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: 7147-668-4300
Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : BASSENIAN LAGONI Eng:
Address: 2031 ORCHARD DR Address:
STE 100 Phone: 949-553-9100 Phone:
NEWPORT BEACH,CA
Zip: 92660 License: License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR-PLAN 2-FOR STANDARD PACIFIC HOMES:2816 SF SFD,606 SF GARAGE,94 SF PATIO.
REF: B00-01536
•
FEE SUMMARY
Plan Check: $303.45 Calc Valuation: $255,918.28
Permit: $1,867.35 Claim Valuation: $o.00
SMIP Res: $25.59
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $2,196.39
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 13-0 Rear 23-0 Left 5-0 Right 5-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 3 Proposed: 3
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§1, 12.21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714)754-5626 •
2446-46(6/00)
DECLA'RAI IONS
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 at one hundred dollars(S100)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(5100,000),IN ADDrnON 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.Lie.0_ Class a
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,CMI Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ 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.).
tylik 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exem n se Business and Professions Code for this reason:
Signature: Date: -z...-1..../el
Owner ID verified y driver's license. ❑Yes No Drivers License No. E pires:
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 end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 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,ora 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? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Cade.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 greeter 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 Califomia Health end 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I No
(Section 65850.2 of the Califomia 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? 0 Yes ❑No
(If"yes",the facility trust meet the requirement of Sections 25534 and 42303 of the Califomia 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? 0 Yes 0 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,end 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.
iDate
I And/Or Authorized Appr t ` /" ate
CODE I INSPECTION TYPE PAIS' INTtfAL$ CODE# INSPECTIONTYPE DA€ IAL$
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 BIock/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 DAY
•
Continuous Inspection d:Materials Testing
SOUTHWEST "s s'`" `ss'`. s`.,....
Inspection & Testing, Inc. 10826 South Norwalk Blvd.,Santa Fe Springs,CA 90670
P �
(562)941-2990•(714)526-8441
FAX(562) 946-0026
Bnikiing Official October 10, 2001
City of Costa Mesa
Department ofBmlding and Safety
77 Fair Drive
Costa Mesa, G lifonr a 92626
Re. Final inspection for die Mesa Verde Collection,Costa Mesa CA Tract 15882.
Building Permit Number Building Permit Number
14 B01-00103 55 901-00106
15 ' 301-00098 56 B01-00100
16 "1301-00109 43 301-00104 •
52 801-00102 42 801-00097
53 • 301-00105 51 B01-00105
54 801-00101 50 801-00107
49 1301-00099
Dear Building Oficial:
Southwest Inspection and Testing was retained Sy Me Owner to provide special inspection and materials testing in the areas that were required
by section 1701 of the Uniform Building Code,approved project drawings and specifications,this work was witnessed by the following
special inspectors.
•
Caret:placement was observed and compressive strength samples were cast by,Ran Scoggin9(ICBG 81064228-8I). Compressive
strength samples were picked up by Southwest and tested in our laboratory.'All work was done in accordance with the projec plans,
specifications and workmanship provisions of the Uniform Building Code.
Straining of W post tensioned tendons was observed by Ken Rodgers(ICBO#08468997-89).All wad(was done in accordance with the
project plans,speriflrtnin t and workmanship provisions of the Uniform Building Code.
Based upon special inspection and materials testing written reports of this work,it is our judgement that the inspected work was performed to
the best of our knowledge,in accordance with the approved pleas,specifications and applicable wotktnsnship provision of the Uniform
Building Coda.
•
S' • , Reviewed By: Q�
�ssfoy4 •
• • W No.c04t to gn
t• WYfg tG aap.'t -03
z} i7
tt4f
Ian R.'Wadden P.E. e of CA>r1f
Principal
Far inspection and testing only,no design responsibility
rsae-a hrpema P mtib<d u ss.aa a Cahlanta 'by a.:tanner oar.nn mega OOU-Iranna.\c4 ars Nana
Ts.44tA ad lbs Depua.et at Ws ad Taw
FINAL GRACING CERTIFICATION
•
Project Address: 1 (2 "VS- PAO tAA.S
Lot Number. 2- "TANK-o_t9ee H 5& Vt4a [-'i 15 etS z
Permit Number: Gt 0-000 5 Z
By Civil Engineer: •
I certify 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. fdequa.9.provisions have been made
for drainage of surface water from each-building site.
The minimums are: •
t 2% Fall from structures within 5 feet from exterior walls.
1% Fall for asphalt surfaces and landscaped areas. •
0.5% Fan 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 v' � Reg. No. 39415
(Signature) ,. ,.
Date .ka \ 1S `b I
•
00
•
4 'EOFCAItFOP�P
C+raulo mewl cult
,51111 F 9 CITY OF COSTA MESA
4
BUILDING DIVISION
>•"n..4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4. � . PERMIT 1E01-00070
se
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1639 BRIAR ROSE Status: ISSUED
Suite No Applied: 01/25/2001
Vicinity: PLAN 2 Issued: 02/08/2001
Parcel Nunmber: TPN00097
Applicant: PHILIPP, ROLAND ISSUED BY:
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: 7147-668-4300
Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
SCOPE OF PERMIT
CONSTRUCT NEW SFR-PLAN 2-FOR STANDARD PACIFIC HOMES:2816SF SFD,606SF GARAGE,
94SF PATIO. 1 NEW RES(1 UNIT),2 LIGHT FIXTURES,3 OUTLETS,2 SWITCHES, 1 MOTOR TO
1 HP.
REF: 1301-00106.
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) $157.70 2816 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 kvalkw $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/Ckt $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 100hp $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 $193.65
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
/1 I.
2448-46(WOO) i
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 rile permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,end agree that II 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 SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE t51CO,CCO),IN ADDITION TOTtIE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.4 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,CMI 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.).
12(I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exem'pLsz 1erflc. �{�--rq Business and Professions Code for this reason:
Signature: K)'G C\v(X�T'1/ ) Date: Z L a
Owner ID verified by drivers license. ❑Y.
z .2 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:
❑ 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 tho division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 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 cur present or future building occupant need to file a registration form for acutely hazardous materials? 0 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).
__._.._ .._.... ._ed.__..___ _._ _ _ _ _
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 matenals)1
❑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? 0 Yes 0 No
__._ tio..__._..e_ c.i.
5 Does h wo the tcAir or present ar emen building occupant at other
for the work which the subject age of this Oep estion a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Gevemment 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? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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? 0 Yes 0 No
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&missions.
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 end 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.
i n : Of • Dal-mew A
�J
And/Or Aut orized Applicant i z D e
CODE I INSPECTION TYPE OAff" INRMLS CODEC lJ$PECTION TYPE E IE 'MALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1288 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical /eO�Z7
rstia
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
CITY OF COSTA MESA
:41111,11 BUILDING DIVISION
I. f•r,,,r, I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 i4 .
PERMIT
SboPormrs et b /01-00073
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1639 BRIAR ROSE Status: ISSUED
Suite No Applied: 02/01/2001
Issued: 02/08/2001
Vicinity: PLAN 2
•
Parcel Nunmber: TPN00097 ISSUED BY: N____
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: 7147-668-4300
Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
Arch / Eng:
Address: -
Phone:
Zip:
License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR PLAN 2 FOR STANDARD PACIFIC HOMES: 2816SF SFD,606SF GARAGE,94SF
PATIO.2 BATHTUBS, 1 DISHWASHER, 1 EXPANSION TANK, 1 GAS(1-4 OUTLETS), 3 GAS(OVER
4 OUTLETS, 1 LAUNDRY TUB/WASHER, 1 PRESSURE REGULATOR, 1 SEWER CONNECT, 1 SHOWER, 1
KITCHEN SINK, 1 SERVICE/MOP SINK,3 WASH BASINS, 1 WASH BASIN SET, 3 WATER CLOSETS,
1 WATER HEATERNENT, 1 WATER SERVICE.
REF: B01-00106
FEE SUMMARY
AMT QTY AMT QTY 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 $19.60 2 Pressure Regulator $9.80 1 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum 13th 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 $29.40 3
Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $9.80 1
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(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0
Gas(Over 4 outlets) $3.30 3 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
Interceptors(Sand Auto) $0.00 0 7
NOTICE: The work authorized by this permit shall comply with all applicable handicap access regtQr etStglcaaig%iat •t3`Rd related
regulatinne (Orrf Nn 92-2R § 1 12-21-921
EXPIRATION: This permit shall automatically aka- -!-I-LL.=!t •_ ..,P - • !? - -• •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 / C7
2446.46(6/00) Z
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 rlaintaln 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: ` j Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less,)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workors'
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 OVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($110,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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 end effect.Lic.a Class a
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,CMI 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(5500).):
❑ 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 properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am axe - nde 'c. a • . Business and Professions Code for this reason: /
Signature: ` _ ��� V Date: Z/1.'Z—/ U
Owner ID verified by driver's license. ❑Yes No Drivers License No. E pires:
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 B,California AdminlsfralNe 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:
I 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? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with somo 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? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
....
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this/Application appe.rmit 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).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
l_
6 (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.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
;g _of r(s)0 �2 L D /
And/Or Au orizedI Appli t III D o
CODE A INSPEOTIONTYPE BEE' INTITIAL$ CODE( INSPECTION TYPE pill PIMPLE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 10•1 4 o t /�� ki
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
4 CITY OF COSTA MESA
t BUILDING DIVISION
f• ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
V• -RnaNpRo
M01-00039
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
•
MECHANICAL PERMIT
Job Address: 1639 BRIAR ROSE Status: ISSUED
Suite No Applied: 01/25/2001
Issued: 02/08/2001
Vicinity: PLAN 2 /
Parcel Number: TPN00097 ISSUED BY: 24
Applicant: PHILIPP, ROLAND
Address: 1565 W MAC ARTHUR
• COSTA MESA,CA Phone: 714-6684300
Zip: 92626
Owner: STANDARD PACIFIC HOMES
Address: 1565 W MAC ARTHUR
COSTA MESA,CA Phone: 7147-668-4300
Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
CONSTRUCT NEW SFR-PLAN 2-FOR STANDARD PACIFIC HOMES:2816 SF SFD,606 SF
GARAGE,94 SF PATIO.2 FAU<100K BTU, 1 FACTORY FIREPLACE, 1 HOOD W/MECH
EXHAUST,2 VENT FANS/SINGLE DUCT,2 COMPRESSORS UP TO 3 HP/100K BTU.
REF: B01-00106.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $29.60 2 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 / 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler .$0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator j' $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $29.40 2
Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $14.50 2 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $118.30
COMMENTS /SPFCIAI CnNf11TInms
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) /l
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: - i Policy Number:
(This section need not be'bompleted if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE DOST 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.Ii 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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exemp(��od�(er�se\CJ� B Iness and Professions Code for this reason: /� d
Signature: t H .L./� n Date: u(
Owner ID verified by driver's license. 0 Yes 0 No 8/fess
Drivers License No. xpires:
Verification of Ownership by(type of document,i.e.•property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,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? 0 Yes 0 No
(Section 25505 of the Califomia 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? 0 Yes 0 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 end 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this Application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes P 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? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 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.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
• °f ^,� Date
0
And/Or Auth rued Applican ,/ Dat
CODE S INSPECTION TYPE Pr,TE' INITIALS CODES INSPECTION TYPE PATE
1616 Fixed System Final Fire Prevention 206 Final Mechanical )13-1(01-01
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