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HomeMy WebLinkAbout1646 BEECHWOOD - Building Permits / - . - 4` 4_WW1 CITY OF COSTA MESA - - - o BUILDING DIVISION >: •„a. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4s L / PERMIT itt*Penerel lse /B01-00255 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1646 BEECHWOOD Status: ISSUED Suite: tcrIt:3 Applied: 02/23/2001 Vicinity: PLAN 3 Issued: 03/22/2001 Parcel Number: TPN00061 Zoning: Applicant: PHILIPP, ROLAND -- - ISSUED BY: Address: 1565 W MAC ARTHUR.- <,-,c,,, ._--s— `�_--; r—,-- COSTA MESA,;CA %7C�,—' ---------Phone 714-668-4300\ ` - - . i . 1 , '‘ /� / //% \..' Zip 92626 - f1 // ` A Owner: STANDARD\PACIFIC'HOMES'_--„,_ -."1-:::::-----:::: N Address 1565 W MAC ARTHUR- �-%j - ' '" A V (NN pu S i� � / �> Q C..„` � \7 Cl`N,,,/ ., '-'` COSTA MESA�CA/� �._;.. - Phone: 714-668-4300 ��� � �/ �/ i ` C,yN N ' 05%/c/ „,. ..74,,,,-;:c-c->,.. cii Zip: 92626 `� A'�./ Contractor: OWNER-BUILDER ,W ; Ns /,. ,essr '�j \\',\/ ,-\ itr �� /2/A Phone , \( \ ��I 9 ���7-ZV ��� %1( ••License,'0'N, I ? >c� /,'Arch ' "BASSENIAMLAGONI Address: 2031 ORCHARD DR <f _ ,qY �r - Address:/< 1 \ i \°I STE 100 tr rl``. 'G Phone: 949-553-9100 --` :„_:,2>i \ .-Phone: {, _ .-- --1 S\ 1 ro iA NEWPORT BEACH;CA ,� -- . -01`p -- 1 0 f n \ \Zip:_ 92660 `.%License: �� ��; License:,, (uJ L. 0i / i iirfi( ' 7� 3 ii1'�J I r-`, a I . / POS-/ 7 ,n; -7, .\ .' SCOPE OF'PERMIT'G)'°,”/(�' �� I !yI I 1 N vl l ,. r--, Ii lr ) !i '1t K . �i� , C� I `1 ,� CONSTRUCT NEW SFR,PLAN 3;FOR STANDAR D'PA_CIFICiH OME_S:_'2972S_F LIVING;579SF]GARAGE,20SF COVERED REF: B0O O1 133SF PATV,P 7) j ,�i i1 l it I f 1111 REF: 600=01537-�] r -c (� U 0 o �FEESUMMARY// i % 1--- J " PIanCheck: \\(i$316.19 / Calc Valuation: � �` Per-mit: \$1,945.75 Claim,Valuation: So.00 SMIP Res \ 26.99 • I .! SMTP Com: $0.00 VOfheer: r 1 i $000 Inspection: ,,_$0:00' ,- cr4-c, i �. 1::,,,,, "i r& Totah $2,288.93 - 0004019 �6� 'GPO:© J 0 �CV�1 U/ � FLANNING=B=ZONING>� �U SETBACKS �,`//'1tt � c ___ �� MAIN STRUCTURE Front'\0 ri Left 0�0 � Rig�t 0-.0 1\\ _ PARKING Existing: 0�Requi ed.,—3� !J Proposed;,..-:-. 3_,•2(-- • 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 fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754.5626 / / 244646(6/00) WORKERS'COMPENSATION DECLARATION: • , I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: ' Policy Number: (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 ,,,.f 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.). ,CIS I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ode:The contractors License Law does not apply to an owner of 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 exempt un sec. usiness and Professions Code for this reason: Signature: _-4111 Date: l/2a b' Owner ID verified by driver's license. Yes 0 o Drivers 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 ❑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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the 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? 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes jJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 ❑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 AUTNORIZATION,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. $jgn re Of I O ner(s �z r L�ta�t`ve�1J ,l+`'s",(l/And/Or Authorized App Ica t ;} ate CODE INSPECTION TYPE N,IE' INTRIALS CODE I INSPECTION TYPE 291E INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof _ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 ' Final Building/Occupancy a (11, MCCCOOS410.11 rIW.1.•16 11111 Vtl� I1'T J17-.17C]O IU.; (19C ZOC1 r.w1'W 1 FINAL GRADING CERTIFICATION Project Address: 1 Co 4S P&P 44S Lot Number. l9 Zc -Vrt_1+.1.-115€70B?- Permit Permit Number. Gt eco—000 3 t 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. Adequafeprovisions have been made for drainage of surface water from each building site. The minimums are: • + 2% Fall from structures within 5 feet from exterior walls. 1% Fall for asphalt surfaces and landscaped areas. 0.5% Fall for concrete surfaces to approved disposal areas. The final monuments as shown on the recorded tract map were set. All final grading eleva- dons are within ± 1/10 of the designed elevation • Supervising Civil EngineerA 4"t Reg. No. 39e (Sisnuure) Date IA '4401, tjak Ic -31-01 A'FOFCALV" tt Continuous Inspection &Materiat.c Testi)? • SOUTHST ....... .,............SSS Inspection & Testing, Inc. 10826 South Norwalk Blvd„ Santa Fe Springs,CA 90671 (562)941-2.990• (714)526-844: FAX (562)946-002f Building Official November 13, 2001 • City of Costa Mesa Department of Building and Safety 77 Fair Drive Costa Mesa, California 92626 Re: Final inspection for the Mesa Verde Collection,Costa Mesa CA Tract 15882. Building Permit Number Building Permit Number 17 • 901-00249 24 801.00246 18 B01-00244 25 1301-00241 19 801-10255 44 801-00254 20 801-00248 45 B01-00188 21 801-00253 46 801-00252 22 301-00242 47 801.00247 23 001-00251 48 B01-00197 Dear Building Official: Southwest Hqp action and Testing was retained by the Owner to provide special inspection and materials testing in the arras that swat regi • by section 1701 of the Uniform Building Code,approved project drawings and specifications,this work was witnessed by the following • spacial inspectors. • Concrete placement was observed and compressive strength samples were cast by,Pat Osterman(ICBG 4106152581),Roy Lyndsay(IC1 4503699849), Compressive strength samples were picked up by Southwest and tested in our laboratory.' All work was done in acc ordan with the project plans,specifications and workmanship provisions of the Uniform Building Code. Stressing of 54"post tensioned tendons was observed by Roy Ward(OCEMA 00288).AU work was done in accordance with the project plans,specifications and wolcmannship 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 performa the beat of our knowledge,in accordance with the approved plans,specifications and applicable workmanship provision of the Uniform Building Code. Y-. ,e ic^WBy- �• - President ( (�{ �. ,ti SLG r: :klg ` / Tag ^ g Tuesday, November 20, 2001 2:23 PM Gary&Diana Shouse 702 396-5188 � p.01 /41 [/ STRUCTURAL OBSERVATION GROUP GARY E.RUBIN 2249 AVALON STREET COSTA MESA,CALIFORNIA 92627 Pager: 949 12274668 Billing: 7021396-7758 E-Fax: 118661732-6429 Billing Fax:702/396-5188 County of Orange. Planning& Development Services Department Bulling Inspection Division 22921 Triton Way, Suite 125 Laguna Hills, CA. 92653 Report for: Mesa Verde Mesa Verde & Adams Costa Mesa, CA. Contractor: So Cal Masonry Structural Observation Group was retained by the Owner to provide standard inspection and materials testing in the areas that were required by the approved project drawings and specifications. Observations of Prato II Walls and Middle Walls of Lots 17-25 and Lots 44-48 were done by Gary Rubin (#75823,#78733 ICBO). All work was done in accordance with the project plans, specifications and workmanship provisions of the Uniform Building Code, and in conformance with the Structural Engineers' recommendations, approved drawings and/or revisions,project specifications and applicable workmanship provisions of the Uniform Building Code. 4rC4C4 Gary E. Rubin Structural Observation Group Owner GER/ds . 9 I CITY OF COSTA MESA al 4 BUILDING DIVISION > •it�;; ..� DEVELOPMENT SERVICES DEPARTMENT PERMIT NU BER h r4. 7* t PERMIT 'toaeonings se i 111_00112 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1646 BEECHWOOD Status: ISSUED Suite No Applied: 03/14/2001 Issued: 03/22/2001 Vicinity: PLAN 3 • Parcel Number: TPN00061 - - ISSUED BY: ___±.4t_ �/ Applicant: PHILIPP, ROLA D----1.2(21c- "k' -22:- - ;-1 j 1, - Address: 1565 W MAC-ARTHUR� -` 1 1i 0 )/ I� COSTA MESA;-CA `� Phone L-714-668-4300 / / � � s A ' ='Zip 92626 /\\-`6/\\-`6 ' A Owner:CSTANDARD PACIFIC,"HOMES Address: A1565 W MAC ARTHUR-- /0(1/ RTHUR �� <� / rf/ ' /74//2% w �� � C� 4e///' �/ COST_AM SASCA Phone: 714-668-4300 vv��wv J r/ ��� '•�! Zip: 92626 vX'7`k . Q Co tractor �./OWNER-BUILDER '. 'i•'�._ p �,:: �•- Al Q�Address: 1����i' 0h �i�� - �/ } • _ -%-'/ .Phone 1 f� �i t� n i ���{// i 7, iii •) ,:-,-;;•--7', .1_ - Zip ��_ .' A --A� •;-_:----1, �7 ,1 'f / 41 % 'V� License: 0 / .v a n`l1 ' t Arch/Eng:, 4 °-'17-l ,�.`-. -.V \\� ,. , u i Of /Addressa��;�) . \ li�.l �� (�� lj i ' Phone t ! C7 I U 1 D i L w,./1 11 LC ,d 1 Zip I it t Ll_ __ - I 1)' 1 �_J License: \) (� \\Q.1 !t_/✓_ `C"SC'OPE OF'PERMIT �l.G g�_ = I i C U ONSTRUCT NEW SFR=PIAN'3-,FOR'STANDARD PACIFIC��'HOMES:'2972SFiLIVING,579SF c-----:\ GARAGE,20SF COVERED ENTRY, 133SF.PATIO.`----7-'G' 11I � \, 2 FAU<100K BTU, 1 FACTORY FIREPLACE, 1 HOOD W/MECH.EXHAUST, 1 VENT FAN/SINGLE \/ \� DUCT,2 COMPRESSORS UP TO 3HP/100K BTU.REF:601;00255- l � \� ���V� FEE SUMMARY v 1�/ \� Quantity ., ,"pwe c. ,� c, // �/ ti �J .� �'VA s .0-0 - r, ('>;,,.•.,,- Quantity ISSUEFEE $23.50 �: -�, ) . °r-.�Re air/Alt Absorption Unit 1 ' G -,P - J// *$0.00/900 Inst FAU<100-k BTU V� $29,60,7,1.2,2 O p w� coGwRepair/Alt Refrigeiaticl it '-�J $0.00 J0 n Inst FAU>1d0'k1BTU $0:00 0 -�. fit) d g,tJ'G 0^ VentillatiogS stem . ., o �l r/o U-„ Y r �� � $0:00`0 Repair/Alt Cooling/Heat $0.00�1c0 0 ooc °% Evaporative Cooler %✓(/1/ $0.00 0 Inst/Rep. Recees Wall.Htr $0.000_ o° 0°�22 p°°cc °CommerciarIricinerafor $0.00 0 Refrig Sys<100 k BTII� $0.00 0 o0 " oDomestic.lnciner'ator J�0$0.00 0 Refrig Sys>100 k BTU\ ( C$0.00-0 \\ _" -;� Compressors%Absorption Sl ys'tems Gas Piping ,`� $0.00/ 0 ----- _-Up.to.3'hp/100.k,BTU \\ -J ( $29.40 2 Factory Fireplace ��$10.65�<1,\‘,.. `J/� 3 To_15 hp;/:500'k BTU U /J $0.00 0 Hood w/Mech Exhaust x$10.65 1 V ``' i I'm 1 LTi m ("-15 To,30 hp7,1,000,k BTU <t $0.00 0 VAV Box $0.00.6.,0 c�, i 1 r--151-1-06 Lid To 50.hp/1;750 k BTU,/ $0.00 0 Vent Fan/Single Duct $7:25- 1=- --'I J�(_r"Over so hp/Over -- $0.00 0 Appliance $0.00"0 � ca-;c� a _ Boilers-,- . Fire Dampers $0.00 0 �- -✓C:Up to3hhp $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 $111.05 COMMENTS I CRErVISY NDITIpIr 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 7 2446-46(6/00) V WORKERS'COMPENSATION DECLARATION: - - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,(00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 �j sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). S7 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 exempt under se Business and Professions Code for this reason: Signature: ��,��1Date: 3/-2-3 'd Owner ID verified by driver's license. Yes tic 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, es 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 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? 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? 0 Yes L-I No (Section 65850.2 of the California Government Cale requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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? ❑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. Signal Of Legal Dwnp5(s) Date Lfr61 fin` l�� -p'y/�) .-t (.L') dh And/Or Authodz d Applicant 1- J Date pm# INSPECTION TYPE DAl' iNTITIALS CODEa INSPECTIONTYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical II- b-0 1 OW 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 F ' 1 CITY OF COSTA MESA 4�i @ BUILDING DIVISION 1.e 4 .A DEVELOPMENT SERVICES DEPARTMENT PERMIT N ER FI ":_:.:.f: i PERMIT • %Poaarta`'e 01-00147 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1646 BEECHWOOD Status: ISSUED Suite No Applied: 03/15/2001 Issued: 03/22/2001 Vicinity: PLAN 3 -- - - - - ISSUED BY: -44--- Parcel Nunmber: TPN00061 Applicant: PHILIPP, ROLAND- c V_� 1 ' I I Address: 1565 WMAC'ARTHUR �\ ( ; 7 j, //, f---:::-..„,,,. `\\;�� COSTA'MESA, CA\ /1 \ \J Phone: ‘_714-6684300.,/i / -, -:‘*7'�� �/ / % /.. -Zip 92626 -,.R� C, 1 (N„.`\.tet Owe,00"•STANDARD'PACIFIC HOMES �� ! / }N\ /7//mo7 \-./:/)` Address 1565 W MAC.ARTHUR enc ' / COSTA'MESA, CA Phone: 714-668-4300 > j 7j)/ 7 (it /fr $CaR `/ Addressill i,+, „ 1 r4n ---'� VAl 1S l ) fl ,..---C-1;< ,ii;t; ^(' \ RIlUjl \ CI �\ i; 0i 2 I License .D - I o , t ,, ()I j ; y) _) e : Ii / 1rvvs4 * c_so � C-1Arch / Eg1fy -_ - I � I IlAddress:q , Tf IO ; w, C\,. Phone �01 _ ( ' � SIVn - -� •� IS • � _ t>_:z \� , o / License: _ (� , , ? - \ c-\ (\ ‘��V�� i SCOPE OFDA PERMIT ! f��/-,4 , \\ \ CONSTRUCT NEW SFR-PLAN 3-FOR STANDARD PACIFIC HOMES:2972SF LIVING,579SF �/ GARAGE,20SF COVERED ENTRY, 133SEPATIO'3'BATHRUBS, 1 DISHWASHER;1 EXPANSION TANK, % 1 GAS'•(1'=4 OUTLETS),2 GAS OUTLETSJOVER4), PLAUNDRY TUBMASHER, 1 PRESSURE/ l0 REGULATOR, 1 SEWER CONNECSHOWER, 1:KITCHEN SINK.1 SERVICE/MOP SINKCi WASH 00 sNa ciBASIN,2 WASH BASIN S-EtT�S,;&WATER CLOSETS;1 WTER HEATER?1tWATER-SERVICE. REF:801-0025511,.&-f cv'^?, z U) -\ NQ (/ 60' ,,;,:r .. - -- :a.'�J,�� /il ���0 o° ° � o„ori /�� \ �J° � vn1 � ' cn°FEESUMMARY ° - 10" `� �/ nv U �qMT/ TY �.- sAMT ,O �(rte) "j/ /19/1 AMT QTY ISSUE FEE $23.50 V/ ,Laundry Tub_/Washer.--=$9.80 "1 -Sump`Pumgw $0.00 0 Backflow irrigation $-0:00,-„,.. 0.lI c Landscape Irrigation----$0.00_ 0,„_, �Swirnming'Pool $0.00 0 Backflow Preventer $0:00 \0 4../) P7Trep )(A.�.;1 ( /-'- iao:oo o Trap•Primer" $0.00 0 Bathtub $29.40 3 LP�essure Regulatoi)l 1,.1 1$9:80 �1 Utinal,,% $0.00 0 Clarifier System $0.00 \0� Process Piping(per 1011) \$O.00(--0 Vacuum Brkr Bknow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 7'cReceptors_ $0.00_ 05 ' '"Vacuum Brkr Bkflow(5+) $0.00 0 . Dental Units $0.00 0 Septio Tanker_ $0 007/ 0� Wash Basin $9.80 1 1'J _- . Dishwasher $9.80 1 Sewer Cap for.Dertlo $0.000 Wash Basin Set $19.60 2 Drain,Floor $0.00 0 Sewer Connect $24.65 1 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $9.80 1 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $9.80 1 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $2.20 2 Sink,service/mop $9.80 1 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto 1 $0110 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access rek6lrbRlei4164.. rACHiUbFa8Sta$206.40d related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically exrCPWIMEWSJrS1REGAA1'rGQND1TJQQNSittlin 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) c7 I 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 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 workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 01 the Business and Professions Code,and my license is In full force and effect.Lk.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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.). as owner of the properly.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 exempt u er se Business and Professions Code for this reason: Signature: Date: 31.Z3)01 Owner ID verified by drivers license. ❑Yes No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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. .-r �ig�lat re Of L al w s) �3 Date F And/Or� Authorized Applicant Date ODE 0 INSPECTION TYPE . . DAL' INTIAL$ CODE I INSPECTION TYPE PAlE )NTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing Ii"1(n—O 1 60 200 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 CITY OF COSTA MESA t a BUILDING DIVISION > .j .r1 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER i PERMIT 4. "' E01-00202 aa (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1646 BEECHWOOD Status: ISSUED Suite No Applied: 03/14/2001 Vicinity: PLAN 3 Issued: 03/22/2001 Parcel Nunmber: TPN00061 Applicant PHILIPP, ROLAND _ _ -- ISSUED BY: ��. Address: 1565 W MAC ARTHUR(-� � -.. c - r-----,-------,�-- COSTA MESAc CK�=A�-1 i Phone: ' 714-668-4300' =�-. /I C \ , Zip:- 92626 ,f �..�'7� \ Owner 'STANDARD;_P,ACIFIC,HOMES; - - `�Y�1V�" ' Address: 1565 W MAC <-'-‘ :' .. .- ;'-'' �- i /� n" ( \ /v /ii2,� AN / ' F.r 'COSTA MESA,;CA, Phone: 714-668-4300 �� �///7 //I Zip: 92626 �\:�.\,/ 1�Contractor: OWNER-BUILDER r, , - { / �� Address fl�� �/ ( �, • �� �', 1 k., `� k. i ` 1 r/11 ? C.) :11�/; , ; r. �Ph'��.. ~�t� ' \ , 17 140 4 /1 J l��-�..0y.. Zip. " -----1„,� -��\ y /,v _I}v� \�----n (� J '/ ✓� ' (/ �l �\ VI tr �Q-11---><'-_,--- -_ License: 0 a"• i I i1�--I �1 7:"1'rin7y SCOP_EOF'PERMIT 7 7,)`7(74 '.4 OH L_J l iji I I i i (I iCONSTRUCT NEW SF.R=PLAN.3-FOR STANDARD.P-ACIFIC'HOfdES:_2972SF LIVING,579SF ;01 i �J /')GARAGE,20SF COVERED:ENTRY 133SF PATIO--= - - --- ' if 1' I�U�1 NEW RES(1 UNIT),2 LIFHT FIXTURES 3 OUTLETS 2 SWITCHESy 1 MOTOR TO 1 HP.REF: I O 1 n �� �"B� /yyyy /Jr } \ ',,'0100255 ( ,_^7..i0/1-kat" �� � f _ ��l ic� �'� . FEE SUMMARY" i /--\%\ ���� rQuantity ‘_ -,i �"I Quantity ISSUE FEE \1 $23.50 Temp Dist System'Lighting $0.00 0/ 11- Ili Tempvservice test \'; $0.00 Busway/100 ft $0.00 0777777 Res.a/c packaged \��$0.00 2.7,114 Standing Section $0.00 // 0 New Res.(1-2.units) A$166.43 { 2972 .4""�-Lt IjMisc Efeatnca)Equipment $0.00,--7 /� New Res(3+units) \$000 I 0 . ,, 6, Tfansforomers upto.1 kva/kw • $0.00 Pool/Spa $000'1 - :O7-s�7, _„ r�9 t2L - -up t6-10,kakw v'$000 Lighting Fixts /2$2.20. a2,i, 0 °O 0 up to 50 kva/kw` x$0.00 n Recept Outlets '63.303 o Oo o �' o C r "Gd'r up to 100 kva/kw $0.00 ,,,,---..-.,00� Switches ��$2,202 o$ °� o �� ° - over100 kv_alkw7$0.00 ✓0> Non Res Appl 0 �✓/l$0.00, 0.-- G ° iLciaoltage Equipment%' $0:0_0 �'0 0 Res Appl $0.00 0 ����-CLow Volt Wringsystem/Ckt ($0)00Y 0� Service to 200a ,$6100'�� 0 __�Misc.:Conduit \�\ 80.00/0 Service to 1000a -$0.00 OjI'- _Misc.Conductop( c- \)1$0.00 Ors Service over 1000a $0.000 1 _ '!jr1 1r- Circus('gen or ride) \,_� $0:00��0 Motors to 1hp 6415:-&-- 1 !!!"""/ /_J /I Circus(meth ride oidights) $0..00 0 Motors to l0hp $0.000- �`--J.:\Christmas\TreeStand: $0.00 0 Motors to 50hp $0.00 0-----"c2-,5.22-:---- __, _Fireworks.Stand j!�' $0.00 0 ' Motors to 100hp $0.00 01"� l<=�COther.Elect'ricalFee $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 $202.38 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 / �+ 2440.46(6/00) • • DECLARATIONS (- ) `. `v. 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 i/the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($104000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ode:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under se .. Business and Professions Code for this reason: Signature: Date: �j (7 3/(A Owner ID verified by drivers license. 0 V No Drivers 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 Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes 0 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. Si tu Of Le I wne s) 3I Z3 t And/Or Authorized Applicant to ;ODE I. INSPECTION TYPE DATE' INTRIAL$ CODE II INSPECTION TYPE PAIS INTRIALtt • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ��77� 200 Final Re-Roof 210 Final Electrical /I'��yA06) /cF 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 .