HomeMy WebLinkAbout543 VICTORIA ST - Building Permits (2)-- AOG���ant to (ill in all ipaces ezcepl those within heavy OorOer Iines anE sign all aDVropriate aeclara[ions. �"" �' �� �' F u C'�- �
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CITV OF COSTA ME� $A CONSTRUCTION.PERMI�T PERMIT NO. TRACT N0. LOT NO. UNIT NO. /H � �
ProjectAdtlress 5`�3 {Y�GiIIf'-tr✓� :�r�A(7 i�. .('�32o�aCp 3`{S Q0�(� ! I 6 H�J�✓�f�/ �� `; ., l J
20�0 ��JS�M.-SS G� 2.OQ. SFI(�O f�� TYPE OF CONSTflUCTION NEW ADD ALTERATION REPAI R
AppliCeM's MBiling Addre55 �" ' ; � CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # y� �Z �� ��,� - p� -� ✓� � Zone RZ
i
Owner's Name ��'� �=� ���a2tSC-S, i^i/.'phone�jfJD _DESCRIPTION OF WORK/USE OF BLDG.
Address �%°��� � ..'. S Main Building: Accessory'Building:
Arch/Eng. ��Stt1N �'A ��`�L� �AK. License No:' TVP,E OF PERMIT GRA�ING FOUNDATION STRUCTV RAL T Front ' I� �p '(f!, p
Address �'�' IoI ��� �' �-�-K c>2d(N4C RZ�I � "� TENANT ❑'ELECTRICAL ❑ PLVMBING ❑ MECHANICHL B Rear � 5� N
'O OTHER �
Coniractor'sNamP �3 �'� �'J., `�CE�NS2_ Phone ��-�0'�5 _ C Right �Q � N
PROJECT DESCRIPTION Sq..FT. � ocCucarvCv �
AAdresslmailingl C�A�M� ' � � K �
' . _ ,,,�CONSTRUCTIONTVPE VAWATION$ �!•Z4Q�1'- $ Leh SZ
City License No. 4� Z{.} � ,, � j�ZONE GRADING CU. VDS. ACRES R
LICENSED CONTRACTOP OECLARATION � �. .. �- ' Ping. R2f. #�]�L-��{ ��� Pafking Req./ProvidCd �j N Q Q
I hereby aftlrm that I am licensetl untle� provisions o( Charter 9(commenCing Rem^arks: � 2(p _ g7 � Ptanning Notes: 3- p-��+ M
with section ]000) of Division 3 of the Business antl Professions CoEe; antl �
my Ilcense is in full force antl e(IecL i� . Y ' T
Licansc Class Li ns No. 5(�' �Z� -��# �" r S
Date 2-�-�`i— Si9naWre �'�' -_f� PLUMBING FEES --. � � IAL (�U�IU:lY1GlYiJ
WORKERS' COMPENSATION DECLARATION r^� � B3� $ink $hOWE�S
1 nereby affirm that I have a certificate oi consem to seli-lnsure or a certificate� ELECTRICAL FEES
o/ Workers' Compenzation Insurance, or a certlfietl cooY.:�nereof (Section' i gackflow Preventer Service Sink
3800, Lao. c.) , Automotic Washer Trensformer ❑ 75-50 KW
(� volic No. company 5��`�- ���- �; �Backflowlrriation SewerCo� ❑50+KW
Y . 9 { Construction Pale Sub.
Y �CcrtifieC copy is hereby furnishetl. "•:1
U Certl/letl cop is filetl with the city B Itlin Djvisi �,�. ��. Bathtubs Sewer Connection Cooking Unit Meter �up ro 100 amps
I Date '�-�- , APPlican��r/� � �p�= e�
EXEMPTION FROM WORKERS' CO�u1PEN5�N ECLARQriOrv- ,� �r �- Clarifiers Solar Collecmrs Dishwasher Merer �over 100 amps
_ (Thisse<tion neetl not be complete0 If tM1e permit is far one�huntlretl (5300) or �
1 less). 1 ,fi Dishuvasher Solar Piping Dryers ❑Gas ❑Electric Suh Panel
1 certlly tnat in tne pe�fo�mance of the work for whichLthis permiYi5155uetl,�1
zhall not employ any person in any manner so as to.become.subject io'the Drinking Fountains Solar Tank Fan Motors �0.1 HP �1 %- 8
^ Workers' Compensa[ion LawS of CallfOmia. •`.,_, �.
Date Si nature �
� 9 �� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar �9-15 HP �i6-15+
�NOTICE: H, at[Cr making this tletlaration, you shoultl:becOme zublect to [h¢
Workcrs' Compensation provisions oi the Labor Cotle; you must torthwith FloorSinks Urinal Pixtures Microwave
comply wl�h such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV Ga552rvice Outlet5 .��' Walef,CloSet DeviceBOxeS POIeLi ht
I M1ereby affirm that tliere is a construction lentling agency for the pertormante 9
oi the work for which ihis permi[ is issuetl (Section 3097 Civ. C.1 Intercepiors 'i, j � Water�Heater Outlets Ran e�
Lentler'z Name 9 Y
Lantler's Atleress' • Kitthen Sink ! °'�' Water $ervice Switches - Sign '
OWNER BUILDEH OECLARATION - � �_ .
I hereby affirm lhat'I am exemP[ imm the Coniractor's Lirense Law fot the LavdtOrieS ;;./ `' AUtO-WdSh
tollowing reason'(Section �031.5 Business antl Professional Cotle: Any city or ^' --'�� �• - Garbage Disposal Standing,5ections
county wnich requires a`permit m construct, alter, improve, aemolisn or reoair p-Trap �' - - Laundr Tra s
any sVucture, prior.to Its izsuance, also requires me applicant for such permit Y � Generator �0-5 KW �5-15 KW _ TraSh Compacmr
lo filo a Si9n¢tl�siatement Ihal he/sbe is licensetl pursuant to llle provision5 0/ ROOf Dfd105 ''�
tbe Contractor's License Law (Cnapter 9(commencin9 �+itb Section ]000) ot �
Dlvision 3 0/ lhe Busine55 antl Professions Cotle) or Ibal be/she is exempl
the/e7rom antl lhe basi5 for [he allegetl exemption. Any violation of Section
7031.5 by any applicant tor a permit subjectz tM1e applicanl to a civil
�e0dlty of noE more lhan five huntlred tlollars ($500). 3 �
I, as owner of the properry or my employeez with wages as their sole ReinspeMion Fee $15 Issue Fee � ,
wmpensalion, will tlo the work, antl the structure is not intentletl or oHeretl Reinspection Fee $15 ��; Issue Fee $ 3
tor sale (Sectfon ]044, eusiness ana Professional Cotle: The Contracmr's MECHANICAL FEES
LicenSe Law tloes nol apply lo an owne� of a proPerty who builtls o� imp�ove5
cnereon, antl wno tloes such work himself/herself or mrou9n nis or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provitletl that such improvements are not intendetl or offeretl for Boiler Hood or Type I ❑
sale. II, howeveq the b W Itling or improvement is soltl within one year o/ <om- CanOpy TypC II ❑ ZaninB APP�oved 8y �_Data ,
plOtlOn, lne owner will have the bu�tlen of provinq he/she tlitl not builtl or im- Duct � Under Ground Building Approved By Det¢
prov0 lor tbe purpose Of sale). �
❑ I, as owner o( tne property, am exclusively contracting wlth licensetl con- Dun -Structural Refrigera[ion System Application Issued By Dat
vactors to construct the proiect (Section ]044, Business antl Professions Gotle:
The Convactor's License L.aw tloez mt appry to an owner of oroperty who Duct - Ventilating ❑0�100,000 BTU ❑700,000 BTU SUMMARV OP FEES 1$
builtlz or improves lhereon, and wno contracts for sucb projecls wltn a con- pp
iractor�sl ucense pursuant to the Contractor's Liwnse Law). I am aware that � BUILDING PERMIT $_�_L1_8- SMIP $ u-i �
proof o( Ihe�r Worker's Compensation insurance shoultl be provitletl ta me. Exhausi System ❑ Multiple System Repair/Altera[ion
!-1 ' PLAN CHECK $ '� �, �g PERMIT
�❑ I am exempt untler Section B. & P. C. for this reason Firepi/Fact.6lt. ICBO # Fire Dampers ' PLUMBING $ ISSUANCE $
�Date Owner Heating System & Ducting Registers pLAN CHECK 25% $ ENERGY P.C. $
;�I �ereby certify thai I�have read this appiication and statc that the above ❑O�100,0000TU �100,OOOBT ELECTRICAL S GRADING $
iMormation is correcL 1 agree to comply with ali city antl county ortlinances
antl state laws re�ting to uil n9 construction antl hereby authorize repre- MICROFILM $
sentatives ol t cit t e t upon tM1e a ve-menlionetl property �ot PLAN CHECK 50% $
inspectlnn pur ej � 7�i �p MECHANICAL 5 70TAL FEE $ I�iZS �'
Signature Dqale— �
Drlvers' Lice e or 55 � � � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
��'� � �" POOL & SPA
CONSTRUCTIOp{,.ANDPLANNING
r• ' '_t Date Inspecmr ! , Date Inspector '
APPROVALS �:�Permib# APPROVALS Permit# .
�.'�'Temporary Elcctrical. ervice or Pole � 52. Pool & Equipment Location � ��
2. Soil Pipe-Undrgrnd. , 53. Stzel Reinforcement . j
3. ElecVical Conduit Utility-Urtdrgmd. 54. Fornrs �
4. Electrical Condui[-Undrgrnd. 55. Electrical Bonding � �
5. Steel Reinforcement �" . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gr d ' y (9 ` 57. APPROVAL TO COVER-GUNITE
7. Footings ;" �'� `"' 58. Electrical ConduiDUndrgrnd.
%:i
8. Foundatior��' �L� �' �`- .I 59. Gas Pipe, O Undrgmd.. Test .
.
9. Water Pipe-Undrgrncl. ��-- • -60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK .
i t. PrqpertY Sewer Line & House Connection 62. Backwash & ReceptorFinal
12. Sewer Cap 63. Heater & Vent-Final � �
13. Roof Drains 64. Plumbing SVstem - Final'
�14. Rough Plumbing 65. Elec[rical-Final
15. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rou h Wirin Si n i:�
9 9 9 6$. APPROVED FOR PLASTERING
78. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �'
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •�.
20. Rough Factory Fireplace APPROVqLS Pe.mit # �-
21. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil '
25. Roof Sheathing S 3� p� 74. Overhead Hydro
26. T-E3ar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing l�1 � 76. Dry StandpiPe
. �•
28. Lathing & Siding 77. FIXED SYSTEM FINAL ' '
29. In;ulation � 78. FIRE PREV. FINAL � �
30. Drywall Nailing ' 7 �- HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ('� 79. FINAL INSPECTION ., '
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Final Elecvic rvoces: HOLD FOR SPECIAL RGQUIREMEHTS
34. Final Heating & Air Condrtioning 8� ` �. � �. � � ����
35. Final Gas Pipe-Test �-- � �
36. Hood or Canopy y jS�$� �/L.t 8 l,%q:,,� s�.,N.
i
37. Final Factory Fireplace (o `� �
C� �= Pa . w ��1P �9'
3�. Final Plumbing 7�& Dl< ,1� ..�-NS���}� ��/�
� 39. Wcter Service-Final �
� 40. Gas Service-Final � /� �
41. Solar pomestic-Final � • � ' '
42. Backflow Preventer �
43. Backflow Irrigation .
� 44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations �
47. EINAL STRUCTURE & BUILDING � � � � � �
48. Special Requiremenis Compleied 3Q_ � ' .
49. Electric Release-to Edison - � �
50. Gas Release to Southern California Gas Co . �
51. CFRTIFICATE OF OCCUPANCY � � �-• �
, '
No. - Date
City of Costa Mesa
Development Services Department
Building Safety Division
P. O. eox 1200
Costa Mesa, Califomia
�
CERTIFICATE OF OCCUPANCY No. �:il.�L��+
The Building located at `'_' ''' " StCe2:, Units G: H, J, K, ; I�i
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Occupancy.
Use of Building � »� =•��a:i=�
Legal Description y�%'"���:1—��
(See reverse side for Metes and Bounds)
Building Permit No ��ZOEh Electrical Permit No. E 32339
Mechanical Permit No. �� �-''1= 59, �? 39�08 Number of apartments E
._, Fc�v. P�cmit ,dc. :�835
ISSU E D T0: Building Official
. ',�- ;t� - -_ :2:., Ine.
i� :;� :'�:si;:�•ss C�n�er Dr�. $160 by
✓ : r;
lumbing Permit No���=t'�U, P��-' L�I
and/or guest rooms
Wi.lt iam 7�. Hodac�
Date �Janua�yl0, 19&9
'ihis Certificate of Occupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Corta Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 Whi[e - Owner; Canary - Numerical File; Pink - Bldg. Permit File
J
CITY OF COSTA MESA
4�,�5tpMFy'q BU/LDING DIVISION
i�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax pi4) 754-4856 • www.ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754-5626
�°"°°�°"` PERMIT NUMBER: BC11-00472
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 09/14/2011
ISSUED BY: MDM
Joe aooRess: 543 L VICTORIA ST CM
APN: 93411027 Zoning: , ,
Vicinity:
Const Type:
SQ. FT: 0
Suite/Unit: L
Primary Occ:
Valuation: $6,925.00
SCOPE OF WORK: HOUSING RE-HAB PROJECT, REMOVE/REPLACE DISHWASHER, DEMOLISH EXISTING TUB AND
SURROUND INSTALL NEW TUB/SHOWER VALVE SET, INSTALL NEW BATHTUB, DRAIN HARDWARE AND P-TRAP, REPLACE
EXISTING OUTLET WITH GFI, MISC FRAMING DRYWALL REPAIR,
OWNER: CHANG. NORMA TR
Phone:
APPLICANT: RON BEWLEY
Phone: 714-539•7010
CONTRAC70R: R AND R CONSTRUCTION
Phone: 714-534-7010
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
^Re/er to fee roteints (or all fees oalA fer mninrt
Address: 543 VICTORIA ST #L
City/Stale2ip: COSTA MESA, CA
Address:
City/State/zZip:
License No. 609338
Address: 11832 MAC STUnit:
City/Slate: GARDEN GROVE, CA
License No.
License No.
$0.00
$139.25
$24.60 /'
$0.00
$39.20
$0.69
$0.00
$1.00
$204.74
HOURS FOR CONSTRUCTION ACTIVITY: EFFE(
Monday lhru FriAay - 7:00 am ihru 7:00 pm. Saturdays- 9:00 am ihru 8:00 pm.
New Years Dav. Memorial Dav. Indeoendenee �av_ Lah
Unit:
Unit :
1 4 -•
:i�:'t_n ,Yf1
ZipCode 92626
PHONE:
PHONE:
� /�i;ri
.'•i". ; i.F[:�I_l14.::
�
3/18/20'10 - PER CMMC Sec. '13-279 '�'
oited all hours - Sundays and the following Fed'e"rel'holidaysi ;'
ThanksaiJina Dav and Christmas Dav
q;::"y�.
NOTICE: The work authorized by this permit shall comply vrith all applicable handicap access requirements under Calitomia 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.
INSPECTIONS: In order tor the work authonzed under this permit to be considered legal, such work must comply wiih all applicable wdes, 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.
��. ,' t
CODEt. INSPECTIONTYPE ORTE IN1111RL5 GOOEt INSPELPONTYPE UAiE' "jINiRL1L5
1616
1266
200
201
202
203
204
Fixed System Final Fire Prevention
Pool SOa Final
Final Re-Roof
Final Blak/Retaining Wall
Final Factory Fire Place
Final Sign
final Demolition
�
ZO6 Final Mechanical
208 Final Plumbing
210 Final Electncal
272 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 FinalBuiltling/Occupancy
q.z4.�� �
' '_�__—___'_"�
: GA•., r,vi:� �}�..• . �. i
�� ��--r�
WORKERS' COMPENSA710N DECLARATION:
I hereby aKrm under penalry o! perjury one of the follovring declarations:
❑ I have and will maintain a certifcate of consent to selbinsure for vrorkers'
compensation, as provitled for by section 3700 of the Labor Code, fo� the
peAormance of the vrork for Which �his permit is issuetl.
�I have and vnll maintain v,nrkers' compensation insurance, as required 6y
section 3700 of the Labor Code, for the perfortnance of the work for which this
permit is issu . My vrorkers' compensation Insurance carrier and policy
number are:
carr�er. D C�� I b
(This sedon need ral Ue wmdaf llM1e permrt is valued at rne �unO�M dollars (51Ctl) oi less )
Policy Number:
❑ I certi(y 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 ihe workers' compensation laws ol California, and agree lhat if I shoultl
become subject to lhe workers' compensation provisions o( Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Ap01¢anfs Slgnalure Oate
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHA�L SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION J706 OF THE LABOR CODE. IMEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencinq
with Section 7000) of Divisiqn 3 of the Business and Professions Code, antl
my licens(e�is in full torce a/n�d effecl. //��
L' `�� �O Class # i ✓ I
cj - /N ao/i
acmr's Signai�re Date
CONSTRUCTION LENDING qGENCY:
❑ I hereby aHirtn lhat there is a construction lending agency for the
peAormance of the work ta which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name:
Lentler's Address:
Signalure Da�e
OW NER-BUILDER DECLARATIONS:
I hereby aHirm that under.penalty of perjury that I am EXEMPT FROM THE
CONTRAC70R5 LICENSE �AW (or the (ollovnng reason (Sec. 7031.5,
Business and Professions Cbde: Any ciry or counry which requires a permit to
construct, alter, improve, tlemolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to file a signed sla[ement
Ihat he or she is licensed pursuant b the provisions of the Coniractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 0! the
eusiness and Pmfessions Code) or Ihat he or she is exempt iherefrom antl
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permit subjecls lhe applicant to a civil penalry of not more �han
fve hundretl tlollars (5500�.):
❑ I, as owner of lhe property, or my employees vnth vrages as their sole
compensa[ion, WILL DO THE WORK, and the sWCNre is not intended or
oHered for sale (Sec. 7044, 6usiness and Prolessions 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 imended or of(ered for
sale. If, however, the builtling or improvement is soltl within one year o(
completion, the ovmer-build@r vrill 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 fo construcl lhe projec� (Sec. 7044, Business and
Professions Cotle: The contractors License Law tices not apply ro an ovmer of
property wfio builds or improves thereon, and who conl2cts for such pmject with
a contractor(s) license pursuant to the Contractors License Lavrs.�.
❑ I am exempt under sec,
Business and Pro(essions Cpde for ihis reason:
Owner ID verified by driver s license. ❑ Ves ❑ No
Driver's License No. Expires:
Verifca�ion of Ownership Dy (type of document, i.e. - pmperty tax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy lhat no excavation frve (5) or more feet in tlepth inio which a
person is required to descentl, will be made in connection with work authonzed
by this pertnit, and that no builtling structure, scaffdding, falsework, a demolition
ordismant7rng thereo(, will be more Ihan thirty-six (36) (eet high. (Chap. 3.2, Grp
2, Ari 2, Sec. 341, Title 8, Califomia Adminisfrative Code).
❑ As owner-builtler, I vrill not employ anyone to do work which would
require a permit from �he Division of Intlus�rial Safety, as noted above, unless
such person has a permit to do such vrork from �he division.
Appl¢dnts Siqnalure Date
Division of Industrial Sa(ety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will ihe applicant or presen[ or future building occupant need to fle and
certify a Business Plan tor emergency response to release or threatened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of ihe Cali(omia Health and Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantiry o/ hazardous materials equal to or greater than a weighl of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlartl temperawre antl pressure).
2. Does or will the applicant or present or fuNre builtling occupant need Io fle
a regislration (orm !or acu�ely hazardous materials? ❑ Yes ❑ No
(Section 25533 0! the Califomia Health and Sa(ety Code, with some
excep�ions, requires registration wi�h the Costa Mesa Fire DepaAment by
each business which at any one lime has on hand a quantiry of acutely
hazardous ma�erials equal to or greater than a weigh� of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet o! compressed gas at standard
temperature antl pressure).
3. Does or will Ihe applicant or present or tuture building occupant need to
prepare an RMPP (Risk ManagemeM and Prevention Program for acutely
hazardous materials�? ❑ Ves ❑ No
(Section 25534 of the Cali(ornia Health and Safety Code pmvitles that the
Costa Mesa Fire Depanment may require ihe preparetion, certifcation and
filipg with the Pire Deparlmen� of an RMPP by businesses which are required
to register awtely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant or preseN or future builtling occupant require for
the work which is the subject of this application a permit for such construction
or motlifcation from the SouN Coas� Air Qualiry Management Dislrict or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Sec�an 658502 of the Califomia Govemment Code requires that Ihe requested
information be fumishetl on applications !or nornresidential builtling pertnits�.
6. Will any part of the facility to be constructed untler this permit be within
1000 feet from lhe outer bountlaries of a school? ❑ Yes ❑ No
(It "yes", lhe faciliry must meet the requirement of Sections 25534 and 42303
of the Cali(omia Health antl Safety Code).
7. If a permil from fhe Soulh Coast Air Quality Management District or olher
air pollution control district or agency is required for the work which is the
subject of [his appliwtion, have all of the disclosures prescribed by Califomia
Health and Safety Cotle Section 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certi(cate of compliance from the appropnate air polWtion
contml oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct. I agree to comply with all slate laws and
city ordinances regarding Hazardous Materials and Emissions.
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 compty with all state laws and ciry
ordinances relating to Duilding construction, and aWhonze representatives of
the City of Costa Mesa ro enter upon me above-described property (or
inspection purposes. I agree not to occupy or allow acupancy of any building
aWhorized by this permi� until final inspection.
SlgnaWre alOwneqs) Date
' Signawre, Daie 9�
309-a6 {3I01) �E� �NhorrzeJ Apo��wntv� Da� � //