HomeMy WebLinkAbout1632 BEECHWOOD - Building Permits f - . , • ,
CITY OF COSTA MESA
4BUILDING DIVISION
y°
:l__ __ . DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
F 1 Citi I PERMIT
J• e 601-00439-'ooaarafi
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1632 BEECHWOOD Status: ISSUED
Suite: tor Z.( Applied: 04/0412001
Vicinity: PLAN 3 Issued: 04/13/2001
Parcel Number: TPN00068 Zoning:
ar
. /
Applicant: PHILIPP, ROLAND - - ISSUED BY:
am
Address: PART, -/„"':= -” - - - - -
/'" ,- Phone: 949-789-1600 _
IRVINE CA .G 1 Zip: 92618 / /
\
Owner: STANDARD PACIFIC\HOMES - - �, �/
,/,,,--„,
Address 15326 ALTON PARKWAY - - _ -,. Cv '�`�
/ s> \t, \\. /� Phone 949-7891600\\ ' \ �/ \ \
IRVINE 1' _7,2"-,- -::',--- Zip: 92618
Contractor: OWNER-BUILDER t
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`V/Address/ �/ ,A�-, / \/ /l
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/ License ''0 -
' jiArch':-?BASSENIANLAGONI Eng: Av� =' - \�'
, Address: 2031.ORCHARD DR / . / ,j - �• -.Address:_ ,- , '
/ -�1 STE 100 _--Ij .Phone 949-553-9100 - - 'r Phone;' _ - , lc\\
t; Zip: 9 660 ORT BEACH;QA :license: License 1 11
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C / iiii'i --,-;;;-r 7, yi,-A SCOPE OFPERMIT:1, ",-7\-7: ‘rs Ic'(1�1l, ! 1L 1II N1 CONSTRUCT NEW SFR-PLAN 3=FOR,STANDARD PACIFIC HOMES:2972SF LIVIN ;579SF GARAGE,20SF ICOVERED_.J \J
ENTRY AND 133SF PATIOA\ ---r 'if)'i 1 0
REF: 1300 01537--" i�l I r ' u- O
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'. .A`. t) \W�0 . :7—
_ FEE SUMMARY/., -..: "-/ r R /4'
(PlamClieck `1$316.19 % %� Calc Valuation: L _$269,922:26
'Permit: '$1,945.75 } / Claim Valuation: goon
SMIP Res�' \$26.99 �� /
SMIP Com» ��'$0.00 i ��
\' ,Other, $000 ticA;' - r
Inspection: ,(( $0.00 v If;y /'
o `riff �<
TO�I: $2,288.91 .,:a 1 0 - 2i�A ' '0 77'; ii ," � nO
\\\& Cf� 1/) �A�V�cc° u`.% < o :o rj "9, u ° '•o °� /7��/7l MGI
\IN vy/ �`, ,N1/4` -ZONING,�� �� " �U
SETBACKS V l — / \VA—� ��
MAIN STRUCTURE Front- 16-0 AY./1'Ream-21-0 — Left 5-0- }C i Righ15-751 -2
\��\ vcy.�'i/r-,, r-;�,r �i�riL 1vv-5 i%1)
ACCESSORY Front 0-0 cmRear/ 0-'0_ , Left ` 0-0 `- - --Right / -0-0
Li
PARKING existing: 0 Required:, ;,3_ -- _ Poposed:>�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) \/
w -
DECLARATIONS C ) (-)
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 DOLLARS($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.Lie.# 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.).
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 a sy . Business and Professions Code for this reason:
Signature: Date: 14((1 Q'
Owner ID verified by driver's license. 0 Yes No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 al 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 tor 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? U Yes U 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? 0 Yes 0 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: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 stale 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.
ign rey�f}�gav �l D
!ner(s) (7/oats/
And/Or A thonzed Appl n ate
CODE A, INSPECTION TYPE ME' INTRIALS DODEn INSPECTIONTYPE PAIS INTRIAL£
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planhing Approval .
203 Final Sign 222 Final Site
204 Final Demolition • - _ 250 Final Building/Occupancy
Sent By: SOUTHWEST IBT; 582 946 0026; Dec-7-^1 4:09PM; Page 1/1
Continuous Inspection&Materials Testing
SOUTHWEST saaaaaaaa aaaaaa
Inspection & Testing, Inc. 10826 South Norwalk Blvd.,Santa Fe Springs,CA 90670
December 7, 2001 (562)941-2990• (714) 526-R441
FAX (562) 946-0026
Building Official
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
26 B01-00439 57 801-00437
27 R01-00436 58 801-00440
28 801-00435 59 801-00433
29 H0l-0043S
30 801-00441
31 801.00434
Dear Building Official.
Southwest Inspection and Testing was retained by the Owner to provide special inspection and materials testing in the areas that were required
by section 1701 of the Uniform Building Code,approved projcxt drawings and specifications,this work was witnessed by the following
special inspector.
Conroe placement was observed and compressive strength samples were cast by,Craig Frampton(ICBO#501281449),Roy Lyndsay
(ICB0#503699849)and Clyde Lacher(OCI?MA#0131). Compressive strength samples were picked up by Sombwest and tested in our
lab ratory.l All work was done in accords a with the project plans,specifications and workmanship provisions tithe Uniform Building
Code.
Stressing of%i post tensioned tendo ns was observed by Clyde Lacher(OCEMA#0131). All work was done in accordance with the project
plans,specifications and wodananship provisions of the Uniform Building Code.
Bawd upon spxial inspection and materials tasting written reports of this work,it is oar judgement that the inapx:terl work was performal to
the best of our knowledge,in accordance with the approved plans,specifications and applicable workmanship provision of the Uniform
Building Code.
t/L. C;.n- "�jZ//'�
- ie.iI di No.COItl/p .�
ST,G/1 W:klg imp.3^3f-171 .
ie
For inspection and testing only, no design responsibility
•
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FINAL GRAI)ING CERTIFICATION
' Project Address: 1 (2 4S ASO -tS
Lot Number. Tkliet!A 24-c►uket..--115 z.
Permit Number. G.00—Coco St.
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. ua 9 provisions have been.made
for drainage of surface water from each building site.
The minimums are:
•
4 2% Fall from structures within 5 feet from exterior walls.
1% Fall for asphalt surfaces and landscaped areas.
0.5% Fall kr concrete surfaces to approved disposal areas.
The final monuments as shown on the recorded tract map were set. All final grading elm-
dons are within ± 1/10 of the designed elevatio '
Supervising Civil Engineer Reg. No. 319-'18/s (Signature)
• Date
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•
6ST'WO CITY OF COSTA MESA
�� 9BUILDING DIVISION
> ;,,,' �,..•/i, DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER
4 ��,., PERMIT
Sb+„a„sose 01-00216
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1632 BEECHWOOD Status: ISSUED
Suite No • Applied: 04/13/2001
Issued: 04/13/2001
Vicinity: PLAN 3 •
- - • __#,.._„4._,
Parcel Nunmber: TPN00068 - - - • ISSUED BY:
Applicant: PHILIPP, ROLAND
Address: 15326 ALTON PARKWAY , '
Phone: 949-789-1600 ' - _
IRVINE,CA_ Zip: 92618
' Owner: STANDARD PACIFIC HOMES
Address 1565 W MAC ARTHUR
COSTA MESA, CA Phone: 714-668-4300
Zip: 92626
' Contractor: OWNER-BUILDER
Address: • .-
Phone: -
Zip:
License: 0 _ •
.
Arch / Eng : ..-' - .! ✓ . - '�/
Address: ' - - _ .. _ -.
` _Phone: ,
License: .
SCOPE OF PERMIT. '_'---
CONSTRUCT NEW SFR-PLAN 3-FOR STANDARD PACIFIC HOMES:2972SF LIVING,579SF'/ 11,'/
GARAGE,20SF COVERED ENTRY, 133SF, PATIO`.`3 BATHRUBS, 1 DISHWASHER, 1 EXPANSION-TANK; ' / '
- 1 GAS(1A OUTLETS),2 GAS OUTLETS(OVER4), 1-LAUNDRY TUB/WASHER, 1 PRESSURE
-REGULATOR, 1 SEWER CONNECT;1-SHOWER, 1 KITCHEN SINK, 1 SERVICE/MOP,SINK/'1 WASH
BASIN,2 WASH BASIN SETS 3 WATER. CLOSETSLWTERtHEATER•1 WATER SERVICE.
REF: B01-00439 ' - 6,g ti s /k� . -i/ ,.-Z; '> • >,3P,-iU'
V/ i \ f
/') .,.A\r. ',_ . ' 'lei 7, (,./7,‘' 7 ,
N'*'> '/ -\� � , FEESUMINARY -��, �um l % /'/ ,
AMY% QTY-.---,-.,--- .--\- ,
--H.-7' �^ /_ -AMT_'�QTY� /..�H2/ 77 / AMT QTY
ISSUE FEE v,`-$23.50`-:' ' . Laundry Tub/Washer $9:80 - 1 c �.,Sunip'Pump! ,, $0.00 0
Backflow irrigation $0.00 0` i// Landscape Irrigation ` $0.00 . 0; \\Swimming Pool $0.00 0
Backflow Preventer �$0.00c,_.�0 -/�; . - P-Trap'' $0.00, _,`0, N. '�Trap-Primer $0.00 0
Bathtub $29.40 -':3-:- Pressure Regulator '' $9.80.; ' 1 ''/ �-Urinal.-/ $0.00 0
Clarifier System $0.00 ` -0 - - Process Piping(per-10 ft).-. --$0.00. -0 -- %Vac`uum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 ._Receptors ' '' ' $0.00 , 0-1,-11, .",-i I-- -Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 -Septic tank'; =;$0.00-:fl-0 ., Wash Basin $9.80 1
Dishwasher $9.80 1 Sewer Cap for,Demo! $0.00. '0 Wash Basin Set $19.60 2
Drain,Floor 50.00 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) $0.00 . 0 •
101 AL t.ALLULA1 EU FEES: $235.40
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related L,
regulations.(Ord.No.92-28,g 1712-21-92) COMMENTS/SPECIAL CONDITIONS
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
6,
2446-46(6/00)
DECLARATIONS fl (tel
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 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 RNES UP TO ONE HUNDRED
THOUSAND DOLLABE($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 then 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 exempt under sec. Business and Professions Code for this reason:
Signature: Date: if
r 1 -7O
Owner ID verified by driver's license. 0 Yes ❑ o Driver's License No. et,
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).
0 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 ❑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 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 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? ❑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.
Sign e ego((ner( ^n , �D/ette
tfr
And/Or Authorized Applicant I' ' bate `
CODE 0 INSPECTION TYPE PATE INTITIALS CODE I INSPECTION TYPE MSIE INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical p (�Un
1266 Pool Spa Final 208 Final Plumbing Id`fil•01 r V
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
;Ole
�D CITY OF COSTA MESA
4 BUILDING DIVISION •
f•',. �I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4 PERMIT
4itbsonvi.atso ft
M01-00194
(714)754-5273 • Fax(714)754-4856 • www.cicosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1632 BEECHWOOD Status: ISSUED
Suite No Applied: 04/13/2001
Issued: 04/13/2001
Vicinity: PLAN 3 .
Parcel Number: TPN00068 - -- ISSUED BY: ,ii),' ,A____
Applicant PHILIPP, ROLAND<%"- ' - - ,
Address: 15326 ALTON PARKWAY. `
- rj /, , ' Phone. 940-789.1690 / :•-,.',:t '\
IRVINE'CA( _ Zip- 92618 ' --
As//)\ - -
O ner % STANDARD PACIFIC HOMES / \�
Address:A1565'W MAC ARTHUR" - /\\k,\A
/ /
COSTA MESA,.../QA Phone: 714-668-4300
/ / ;� /� //./.77/.. Zip: 92626o'."/ �\`
‘: \
/ Contractor i OWNER-BUILDER i • \ '
/ / ,
/ Address / 0,, -- 'i .,\�v
r Jl�'' / '.Phone. 1 AA `, \ _. .\
t
` i„ Zip: - ' .� / ,. 1 �-'v 1 I
License:0 \V -----27---:, '.
' .A i .r / V A\ 1, '
: ) !lir` SCOPE OF PERMIT. I l4 , L 1�
,) CONSTRUCT NBW SFR:PLAN 3,FOR"STANDARD PACIFIC HOMES 2972SF LIVING, 579SF I il;; f'
10I �� I GARAGE, 20SF COVERED ENTRY,-133SF PATIO ,'-: , ` v v! I: - UI� r-, `
�i I �•i,[2 FAU <100K BTU, 1'FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST,-1 VENT FAN/SINGLET ,/" L----/ 1
, , DUCT, 2 COMPRESSORS UP TO 3HP/100K BTU. REF: B01-00439 .c 1 r '�,/ i -"(i I
( � <�_ �tb _ '_�`i) •� `'' l ,In !
I I. (� \,v ;FEE SUMMARY �I/1
1/ ��
�t J ' . ' - uantitY�
ISSUE FEE` ) , , ' $2350 Repalr%All Absorbtion Unit $0.00 0
InstEAU<'100'k BTU \\A $29.60; 2 Repair./Alt Refrigeration Unit I $0.60'�0
Inst FAUN>100 k BTU `,‘,\',,,, $0.00 0 Ventillation System $0.00-/0
Repair/•Alt Cooling/Heats , $0.00 0 Evaporative Cooler ' '$0.00 o/
Inst/Rep\Recess Wall Htr\':,., $0.00 0 $-:Commercial Incinerator 4/ C$0.00/ 0
Refrig Sys.<100 k BTU \‘‘,•7`„',,., $0.00 0 c,74:7;,'`'," : . Domestic Incinerator /7 $0.00 /o'
Refrig Sys\100 k BTU,� - $0.00 0Compressors/Absorption Systems/% /�l/
Gas Piping\fit < N „lap() 0 , ,,ei.,'.• . ?Up:to.3 hp/,100 k BTU i,,, � C` .$29.40 2
Factory FireplaceV -rte $1065'-*-1 ' )) >'v rr,.3To 15 hp/500`kBTU - !r ' '-J so,ob Jo
Hood w/Mech'Exhaust " $10 85 1 0 - (-15 To 30 hp/1 000 k BTU j�1 $0170 0
VAV Box ��� `/n/� $6.66 � o � 0 30 To50 hp'/1 750 kBTU�/��'(/>� $0 00 0
Vent Fan/Single Duct` V 57.25\1,- ,_%:7;s7 7„), Over 50,hp/Overt 750�BTU <�v%$0:00 0
Appliance �� / $000 , OVAL\ _ `• r Boilers —'� "��A%�/1
Fire Dampers \-,,,,,,,. l,$0.00'N. 0,- _'Up to 3 hp' /. (i o $0.00 0
Smoke Dampers �� N'$0.60//o' r. --3•To 15 hp ,--- (2 $0.00 0
Inst or Relocate Appl Vent �.C,�'�$0 00-' O-- J/ (---,T\/, i 15�1o•30'hp-'\1, " ' f7 $0.00 0
Air Handlers< 10000cfm \ >.$0 00�0 -,1 i/ J ' if r"30 to 501hp--\ .7 /"J• $0.00 0
Air Handlers> 10000cfm • $0:00-�0- \,_1_ , \2 j rOvert50 hpi- _0-2/2' $0.00 0
Floor Furnace $0.00,:0 9_ _ ' ' ' Other MechanicalFee'
Floor or Suspend Heater $0.00 0_. 'c%,=- - Investigation Fee-- - $0.00
"_--"C"PIan:CheckFee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $111.05
•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
2446-46(6/00) v /�'
• C )
WORKERS'COMPENSATION DECLARATION: • '
•
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for Workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 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 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 37C6 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.# 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.).
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 unde se Business and Professions Code for this reason:
Signature: Date: y' (7 (ZI
Owner ID verified by driver's license. ❑Yes o 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 ❑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? ❑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 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 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 ❑No
(If ryes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I 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.
ig reg a Own�e ) Date//O
And/Or Authorized Ap idyr/(Sant �Da)§
CODE t INSPECTIONTYPE 2TE' INTITIAL$ CODE( INSPECTION TYPE pta (j�yIII���L�
1616 Fixed System Final Fire Prevention 206 Final Mechanical 1A- 18-cg tiJrY
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
` s�Ws CITY OF COSTA MESA
t BUILDING DIVISION •
> . .fir! • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. I w.._.±sa r
• PERMIT
�. ' E01-00291
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT .
Job Address: 1632 BEECHWOOD Status: ISSUED
Suite No Applied: 04/13/2001
Vicinity: PLAN 3 Issued: 04/13/2001
-
Parcel Nunmber: TPN00068
Applicant: PHILIPP, ROLAND - ISSUED BY: _iiii,4).../._
Address: 15326 ALTON PARKWAY L - , y -
:�-e/ Phone: 949-789-1600'
IRVINE,CACI/2�r ' i1 ! Zip:- 92618 / '-j
% c' \ r
Fi'��( 1 vC � ., ` It V�`�
Owner. lSTANDARD,PACIFIGHOMES
/,(1'7/ i i _ �� .\
Address/71565 W MAC ARTHUR -;i- // A��
„,,,,,-/-
/0/ V l //'-,,;j' 2`\`‘ / \
/c/ COSTA.MESA,I-CA; Phone: 714-668-4300 \, t
/,,i;/
-,/
2 jic"% Zip: 92626 . \ / 1
"//�/ VA
f/✓,` /( � �%/ ' ,��`\\ /moo\
/ 'Contractor �i OWNER-BUILDER 1 �A•
� ��
1 r� ``�-+ t•7/', 7 A ,/ , CPhone ��q , � (�
'' (\ f � � 1'ji/'<� i� _M ib - Zip. - - _� %/V / � i\V\ �5 ,A1
, 7 rJ) ' i�vv License: 0 % ' � c _ itv -_y A(Q�
�: i 1\ ' ' " ' - V 'I Q
\ \ 1rli
! ' . / -rin`r • - - -- • - - \ i ' � . Uta 1
r ',(11 a /'-1 I�
r i' '\, I
' i �f'- i l �/ SCOPE OFPERMIT ; i7 v;v I Oil C 7 { li
'i)• I O`CONSTRUCT NEW SFR' PLAN.3-FOR STANDARD PACIFIC HOMES �2972SF LIVING, 579SF 1 I) : I J I
f r GARAGE,20SF COVERED ENTRY- 133SF PATIO. - - -
•
i I, Iwo ' \Q 1 NEW RES(1 UNIT) 2 LIFHT FIXTURES,3 OUTLETS,2 SWITCHES;•1 MOTOR TO 1 HP. REF: 1/Y:I' L U 1 1\t
1 l V it ..-1 ��v 0,601-00439 t) / i,,,/,,/,11 , �1�J j
o/i
,' \\ ` - \ - FEE SUMMARY J� ' (--•-••• /
\�VN \- \ V Quantity Quantdy% �J
ISSUE FEE C\ \\\A\ $23.50 Temp Dist System'/-Lighting $0.00 g0�
Temp.service test \ v $0.00 _ :.r Busway/100 ft $0.00 /i0i
Res are package t`.$0 00 ,0t` 1 Standing Section $0 00 ,<>/o '`�f
New Res.(1'2iunits) \$166 43 i 2972 /.'�% ' ' ,Misc Electrical Equipment $0.00.t /'0 I
New Res(3+uh ts) c1 \$0.00 0 r - -Transformers up to 1 kva/kw• $0 o0� 0 \
Pool/Spa \-. 2- $0.00:, t;,-; 0151 2 \ t -� ' up fo'10 kva/kw 't"S S $0 00 0
Lighting Fixts -� $2‘.20: 2 a7, t / H, up to 50 kva/kw c$0.00 0
Recept Outlets $3.30A �s3 006' 0 0v - o - �0ii up to 100 kva/kw J $0.00�e/C /,
Switches Ni„ "�j $2.20 �2� ", q'o.'L ` r' - over.100 k\a/kwW$0:00) `/ 0/ V
Non Res Appl 1 §6.00,i 0� �' ; „A�L2ow,Voltage Equipme'nt� $0:00 �0
Res Appl �� 50.00 1�, 0�"-��_ Y`` Low:Volt Wiring-System/Ckt- ($0:00 0,0�
Service to 200a ��-�,s0:00 c'/j/A-\ - '-_ -Misc..Conduit- $0.00 %/0
Service to 1000a \\-$0.00 2--„,,,,,/, ,/ 0-:,)//-,.`- - Misc. Conductonc r 1$0.00 two
Service over 1000a '$6:60,„ 0�'l `-j 7/.2) Ti Circus Ogen"or ride)�� $0.000
Motors to 1hp $475�� 1 . ' i '! ',,Circus(mech ride or-lights) �- $0.00 0
-
Motors to 10hp $0.00 - 0; 2-- ' ::.\ Christmas-Tree`Stand / �j$0.00 0
�
Motors to 50hp $0.00 -.0r--'•- - ,-- Fireworks Stand1,:--,i7:1'.-i $0.00 0 '
Motors to 100hp $0.00 0 -- Other.ElectricaLFee'"� $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 ig
244636(NW) //
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.sectlon need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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.).
05Z. 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 sec. Business and Professions Code for this reason: f
Signature: Date: I 7
Owner ID verified by driver's license. ❑Yes 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).
El 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 ❑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 a plication epermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes D 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? ❑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.
Signbure
Okgal sy� / ate
g�_ � t7 / i
And/Or Authorized Applicant ate
CODE S. INSPECTION TYPE Wim' INTRIALS CODE INSPECTION TYPE PAU INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing V.�,�/
200 Final Re-Roof 210 Final Electrical 12-10
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