HomeMy WebLinkAbout2544 FAIRWAY DR - Building Permits; . ,
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� CITY OF COSTA MESA '
��pMFq ' ' BUILDING DIVIS/ON • �
F4�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BC10-00202
PERMIT TYPE: B COMBO
Sub Type: R�S_RRIP
�os aooREss: 2544 FAIRWAY DR CM
APN: 43918210 Zoning: , ,
Vicinity: REAR YARD
Const Type:
SQ. FT: 964
STATUS: ISSUED
DATE ISSUED: OS/11/2010
ISSUED BY:
Suite/Unit:
Primary Occ:
Valuation: $30,000.00
SCOPE OF WORK: CONSTRUCTION OF A 900 SF IN-GROUND GUNITE POOL WITH A 64 SF IN-GROUND SPA (STANDARD
PLAN #SW-07-0348) WITH A 4' HIGH WATER FEATURE. POOL EQUIPMENT: 1 FAU < 100 K BTU, ELECTRICAL FOR POOL/SPA,
1 SUB PANEL TO 200A, 2 ADDITIONAL MOTORS TO 1 HP FOR WATER FEATURE, GAS OUTLETS (1-4), PLUMBlNG FOR
PRIVATE
POO/SPA, EL CONDUI7 TO UNDER GROUND ELECTRICAL.
OWNER: FULLER G�ENN H JR AND LAURIE Address: 2544 FAIRWAY DR
Phone: 949-650-6119 City/Stale/Zip: COSTA MESA, CA
APPLICANT: FULLER GI,ENN Address: 2544 FAIRWAY DR
Phone: 949-650-61yg CitylState/zZip: COSTAMESA,CA
CONTRACTOR:
Phone:
Cell:
ARCHITECT:
ENGINEER:
OWNER-BUILDER
POOL ENGINEERING INC
COMBINATION PERMI7 FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: Unit:
City/State:
License No.
License No.64525
$287.46
$44225
5113.00
$38.50
$120.65
$3.00
$0.00
32.00
$1,006.86
License No. 000000
Unit:
Unit: .
ZipCode
PHONE:
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3I18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. ThankSaivina Dav and Christmas Dav
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: In order for the work aathonzed under this permit to be considered legal, such work must comp7y 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.
CODE�. INSPECTONTYPE DATE INTITIALS LOOE1 INSPECTIONTYPE OATE INTITIALS
ifit6 Fixed System Final Fire Prevention ' ,, p 2�6 Final Mechanical
1266 Poot Spa Final -I - �I 6� 208 Final Plumbing
200 Final Re-Roo( 210 Final Elecirical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning qpproval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
,,
� , 4
WORKERS' COMPENSA710N OECLARATION:
I hereby aKrm untler pgnalty of perjury one oF Ihe following declarations:
❑ I have and will maintain a CertifiCa[e of consent to Self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for lhe
peAormance of the work for which Ihis permil is issued. -
❑ I have and will maintain wvrkers' compensation insurdnce, as required by
section 3700 of Ihe Laboi Code, for the peAormance of the wvrk for which Ihis
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This sedion nee0 irof be mmple(ed tl the permR is valued af one M1undretl dollars (5100J w less J
Policy Number:
-I certify that in Ihe peAormance of the work for which Ihis permit is
ssu8d, I shall not employ any person in any manner so as to become subjecl
to the workers' compensation laws of California, and agree thal if I should
become subject to the workers' compensa[ion provisions of Section 3700 ot
the La od hall torthwith comply with these provisions.
-� //-/�
NppNeanfs'SignaWre '�Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SUBJECT AN EMPIOYER 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 aKrm [hat I am licensed under provisions of Chapter 9(commencing
wi[h Section 7000) o( Division 3 of the Business and Pro(essions Code, and
my license is in full force and effect.
Lic. # . . _ _ _ . . . . _ _ _ _ Class #
Gontrac�or's SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that lhere is a construction lentling agency (or the
peAormance o( ihe wark for which [his pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Dale
OWNER•BUILDER DECLARATIONS:
I hereby aKrm [hal under penalty o! perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, al[er, improve, demolish, or repair any stmcwre, prior ro its
issuance, also requires the applicant (or such permil to fle a signed statement
that he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or that he or she is exempt therefrom and
[he basis for the alleged exemption. Any violation of Section 7031.5 by any
applicaN (or a permit subjects the applicant to a civil penalty of not more than
five hundretl aollars ($500).):
C I, as owner of lhe property, or my employees with vrdges as Iheir sole
ompensation, WILL DO THE WORK, and ihe structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Conlraclors
License Law does not apply to an owner of property who builds or improves
lhereon, and who does such work himsel( or herself or [hrough his or her own
employees, provided lhat such improvements are no[ intended or oRered for
sale. I(, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of pmving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner ot Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conSWct the project (Sec. 7044, Business and
Professbns Code: The wntractas License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such projec[ with
a contractor(s) license pursuant to the Contrectors License Laws.�.
❑ I am exempt under sec.
Business and Pro(essions Cotle for lhis reason:
S"- //- /D
GSignaWre' (i�z1e
L��
Owner ID verifetl by drive� � license. � Yes ❑ No
'----'
Driver;s.License No.<� Expires: �- —/ y
y,_ .
Verificalion of Ownership by (rype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation five (5) or more (eet in tlep[h into which a
person is required to descen0, will be made in conneclan with work authonzed
by [his permit, and thai no building sWcture, scaffdding, falsework, a demolition
or dismantling thereof, will 6e more than lhirty-six (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Title 8, Cali(omia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a pe�mit from Ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work trom the division.
Ap01iwn1's SignaWre
Division o/ Intlus[rial Safely Permit Numbe[ _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle and
certify a Business Plan (or emergency response to release or threalened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, that a Business Plan be filetl with the Costa Mesa Fire
Department hy every business which has at any one time during a reported
year a quantity o( 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 stantlard temperature and pressure).
2. Does or will the applicant or present or tuture building occupant neetl to fle
a registretion form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Heal[h and Safety Cotle, with some
exceptions, requires registration with the Costa Mesa Fire DeparimeM by
each business which at any one time has on hand a quantiry of acutely
hazardous ma[erials equal to or grea�er Ihan a weigh[ of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet ot compressed gas at standard
temperature and pressure).
3. Does or will the applican[ or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Progrem for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Sa(ely Code provides that Ihe
Costa Mesa Fire Department may require [he preparation, certification and
filing with the Fire Department o( an RMPP by businesses which are required
to register acutely hazaidous materials with the Fire Department.
4. 1( an RMPP is presently required, has Section 25534 of the California
Heallh and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupan[ require for
the vrork which is the subject of this appliwtion a permit /or such Construction
or modification trom the Soulh Coas� Air �uality Management District or from
any o[her air polWtion contml distric[ or agency? ❑ Yes ❑ No
(Section 658502 of the Calitomia Govemment Code requires that ihe requested
in(orma�ion be fumished on applications fa nornresidential building pertnits).
6. Will any part of lhe facility [o be constructetl under this permit be wilhin
1000 feet (rom the ou[er boundaries of a school? ❑ Yes ❑ No
(If'yes", the (acility must meet the requirement of Sections 25534 and 42303
of the Califomia Health antl Satery Code).
7. If a permit from the South Coast Air Qualiry Management District or other
air pollution control tlistrict or agency is required for the work which is the
subject of this application, have all of the disclosures prescnbetl by California
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the appropriate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
in(ormation given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
9gnawre 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
ortlinances relating to huilding construction, and authorize represenlatives of
the City of Costa Mesa to enter upon lhe above-descnbed property for
in5pection pur agree not to occupy or allow occupancy of any building
authorilp���u ' fnalinspection.
S �/ -/C7
Sig�uWreo�Legal'Owner(s) �Data=--�-
305]-<6 (3I0])
Antl/o� AOPonaetl Appl¢ant
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Costa Mesa
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City of Costa �I�lesa Bui�ding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # l/i-�(�'�� W `�
Disclosures 8� Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted 'q �y�qurp ame list��inp yqu�rself as the builder of the
property improvements specified at i-�j`'1�'1 Yw�(�u"A Vf .
We are providing you with an Owner-Builder Acknowledgment an Informati Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECT/ONS: Read and rnitia! each statement below lo signrfy you understand or venly this rnformatron.
�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies thai the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
2. I understand building permiis are not required to be signed by property owners unless ihey are
esponsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3 ! understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential Financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
(� 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
� I understand if I employ or otherwise engage any persons, other than Califomia licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
�6: I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
`-7. I understand under California Contractors' State License Law, an Owner-Builder who builds sing�e-famity
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
�
^8. I understand as an Owner-Builder if I sell the property for which this permit is issued, 1 may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
�understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
ab�o,ut /licensed contractors.
C.l� 10. I am aware of anii consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
� -.1;1:,1 agree that, as the party legally and financially responsible for this proposed wnstruction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
(�a`�:12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued er�ficthe property owner's siqnature.
� l\
�Signature of property owner CDate: ��� -� v
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent o( the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personaliy filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presenfed when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan t, 2009 OB Packet template 2 Of 2
COUN'I'Y OF ORANGE
BUTJ.DING DEPT.
636 No. Broadway
Santa Ana� Califoruia
Phone: KI 2-6211
Application Eor Builciiny Permit
AND FOR A
CertiFicate of Use and �ccupancy
1. OWNER'S NAME ............._..Aa.lse..&. �olegr_aX�-----.
MAILING ADDRESS...--._...._.15.th.--.&..Irvine..�.ts....__..
Name ....- ................
nddre.5
Cicy .
State
Lic. No.---------��---..
PROPOSED USE:
(Archi[ect or Engineer)
Permit No.-� /-d-/----'�---�----'...
,
Dacc------August..71,_..1952----------------------..
PHONE:Bea,,..7225-- ---
CITY--N.�wPort..B�a�h......- � - ....
Namc _..J?3kg. &..ColegrOVe--------.__.------...—"---:--------'
(Contractor) �
- �aar�55 _ 15.th._ &..T.r.vine. Sts. - -- . _ ..... - - ........
__ - -._......._-- -..... Cicy - Newuort_Beachv -Calif - -- --- -- - --- - --
State
Phone -- - --.... -_ .._ Lic. No...12�202. - ._..._.. Phone -Bg&...722�`.........._.
-----A86.�.dfl17C.0
�
Jos LocnT�orr ... - -- 251�. ...--k'air.way Arive - --- - --- ---- Costa_Mesa -...--... -- .... ... -
(House No.) (Name of Strcet) (Town or School Dis[ritt) ,
LEGAL DESCRIPTION: Lot__._..-----��-----....------------`---Block ---.._--...--------------------.--- Tracc.----12'j4----------------..._.
(Me[es and Bounds Destription—Use reverse side of (orm)
CORNER LOT ( ) INTERIOR LOT (��3��j1R UGH LOT ( ) SLOPE OF LOT ( )
SIZE OF BLDG.:. �rz-R -2� AREA: ,7.0.� ..-----� ..SIZE OF LOT: ._.60_X._1�5........AREA: ----8200--- --
6. HEIGHT OF BLDG.:
CEILING HEIGHT:..........._..5�...........__NO. OF STORIES .............1.......
7. NO. FAMILIES----__-_------_1--._-_.-----.---Size of Smallest Bedroom:--_.._7.Q..X..�.--.-----_.---- Size of Kitchen._..�.0_.)C--�g--------------
S. EXTERIOR WALL CONSTRUCTION:......_St�cco______________...._INTERIOR WALL COVERING......__.Plaster ,
..
(Frame, Stucco, E[c.) (Plaster-Drywall, Etc.)
9. SETBACI:S: Front Yard From Center Line of Street......_'---_--.-'-__�5�.--.-'-_--------_--.-_---------------- ..--_-.-_--...----...._--_'
Nearest Side Yard........_5.�.........Rear Yard_.........�2Q�....__Distance in Feet Between Bldgs. on Same Lot.__.._NOnE___________._._
]0. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTCJRES AND USE OF EACH.
11. For (a) Footing: Width----------Ll�'.n-----....---_......Depth in Ground-.----.1�.��-----'-----Width of Wall----X---------------....
Accessory , '
Bldgs. and '
Similar �b) Size of Studs:......�..i�../a........_Spacing....-__.._...�.�T.-_--:'CC Marerial of Floor.___....WOOd----_----_--._-----------
Scruaures:
(c) Size of Floor Joists:._-_2--X--£�-----..-_-.--.---....Spacing-.--..---_-.------.
1�". - - � CC
(d) Size of Rafters:..._......_._z..X_6..._ .................Spacing
"CC
] 2. VALUATION OF PROPOSED W`O�K: Including all labor, plumbing, electrical wiring, hcating, fire eprinklers, painting and
sewage disposal 5....._...�1.;��'r%........"_....... •
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORAN3E AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Plans Filed:._...�.�� � ��.
--------'-----'--...--�----....---' --------
FOR DEPARTMENTAL USE ONLY
FEES:
cm GROUP..T�•-....'�...._----
Bldg. Permit - $.-_.�d..�_. �_ "-
o�....---
Plan Check - $... --'� -- - TYPE ....:� -- - --- -
Total . , , � � S ���... - - - DIST.
- �.....G......�.y..:.........
Receipt No. - _rn��Q3,�.�..---....... �
Paid to • � �!"j. �- �� SHEET NO..:..�........ � -
,. . fr��4 � ��.
DATE - � � S � c5 �
.........................
: M-8-51
ZONING.. _ _.----------------
PLANS AND
SPEC'S - -�-- - -
CORRECTIONS
V ERIFIED.--.-_-..._.....------
r:3�
H EA LTH. ----------. _ _..... _.....
FIRE
MARSHAL- -- .......... � ..
STATE....._..
ENGINEER
P �}pqgg�y�y� COUNTY El.' LD'NF;
1�. � WIY�/(7l1 �/
i I�:EiP_�TOR
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---- - ....................... •
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