The URL can be used to link to this page

Home My WebLink About3151 HARBOR BLVD - Building PermitsC*Y OF COSTA N*A Development Services, Division of Building and Safehj CERTIFICATE OF OCCUPANCY This certificate is issued pursuant to the requirements of the 2007 California Building Code, Section 110 adopted by the City of Costa Mesa certifies that at the time of its issuance the building structure herein below described was inspected and approved foroccupancy as follows: Building Address 3151 Harbor Blvd. Bldg. Permit Numbe rl10 ?81 Use ''ienartt, m Group M Type of Construction ii Fire Zone Use Zone OwneroPBuilding Commercial Realty Tenant. Fresh N Easy Address 149 Palos Verdes Blvd., Redondo Beach,.Cali A n BUILDING OFFICIAL -Keith Clarke, C.B.O. Date March 30, 2012 REQUIRED TO BE POSTED IN A CONSPICUOUS PLACE City of Costa Mega Building Safety Department CERTIFICATE OF O C C U P A N C Y NO 2541 C P. O. Box 317 Costo Mesa, California _ The Building located at !11¢ safter �QB has been inspected and found to'comply-with the'provisions of'all City,of Costa Mesa Ordinances applicable thereto for a Group F" Occupancy. Use of Building 50 =it EXftl CC11.. Legal Description A. P, .M (Lot Ili of ftwt T75)' (See reverse side for Metes and Bounds) Building Permit No. 28ro7 Electrical Permit No. 28787 Plumbing Permit No. ;+u Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as. required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article S. Number of apartments— and/or guest rooms so ISSUED TO: Building Official V®asbOua F+3tgr LtetAiEs 7Ctic. by Pe, 11JT J Date 1FQ9i1IIP1@T 20, ),A This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. soon su34—ara-11-e3__s_s r COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262! For Applicant to Fill In Completely / TYPE OR PRINT MAIL 110W-eoR oxy"O COSTA MESA. CALIFORNIA 9v/ M .tl Btun .tar' 'RENIGINEER/"r'VA'h=(IdQy11A-s—Nt314-r2161 InnwPMCe5"DO !0/YF-Sy f,VZIA ADDRESS L517f%,L Fly �- RECEIPT NO. CITY C3; RECEIVEDST LIG. g"Y'3 NL'�84-399 T/ NO. ZOS ADDR /' 3 X a 0 ZONE TYPE A OROU APPROVED` SIZE OF LOT 97x /3 y ING e NO. OP ELDBS. b I Now ON tar EXIs-rmc; BLDa.Pa" F_ �x' `e Si o.r•g6 C SETBACK LIN[ FROM DESCRIPTION OF WORK No. OF ROOMS .2 I i ALL"� A/ ROOF //E9✓O Pool F_QvipMEAv/- X LSTOR AjPC /: 1 N!RlBY ACKNOWLEDGE THAT 1 MAV[ READ THIS APPLICATION AND STATE THAT TNR ABOVE 18 CORRECT AND AGREE TO COM- PLY WITH ALL CITY OORpyNANCRB AND ATE LAWS R[OYLATINO BUILDING CONETRU ONdd AUTHORIZEDGGRNT / AIR 26 68«a002252LQd*****5.00 APPLICATION FOR PERMIT BUILDING / For Office Use Only / II I RECEIPT NO. amamly NO RECEIVEDST DI,T[ [C D (i ` IIBB Z V 1pf BUILD I / ADDR FIRE ZONE TYPE A OROU APPROVED` BY ATE ING e ZONE GrLANS NO. OPYSEOFNIW `�/ SUILDINQ LGAL IPO l o" J17 R - -DESCR NOTE: NO RAVE OVERHANG SHALL B LEAS THAN SO' TO SIDE IS REAR P. L. EAVES ALLOW (U. B. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STRfR��-q�t/rf1' FRONT t Pyr :/ O i•T-.1 R. SID[ f5FT. L. 91019 FT. / p/Fr. �Ii RT. rJrX n REAR 10 ' DISTANCE 0 BET. MAIN e MAIN BLD SR. ACCESS. SLOGS. VAR.# DATE C. U. P. 6 APPROVED APPR ED �' BY DATE /f-+ BQ. FT. TMR AMOUNT BROWN UNDER VALUATION IS FOR THE PURPOSE OF ESTANUBMING A PERMIT FRE ONLY. VALUATION VL PERMITFEE PLAN CHECK 5 I1 Qi w TOTALFEE II I r1 28783 COSTA MESA BUILDING WETY DEPARTMENT P.O. 00X 1200 COSTA MESA. CALIFORNIA 02020 For Applicant to Fill In Completely _TYPE OR PRINT COSTA MESA. CALIFORNIA I I f1 AIR ENIG eNHER C. Adams NO, Firestone Blvd Gates California 9 1.5- SP -32210 BLDG[. FROM81()11 1()1 tt J RGR YAR 79 81 1418" LSRi RIGHT DESCRIPTION OF WORK X0 vj.LwA I NEREST ACKNOWLIK"R THAT.1 HAVE READ THIS APPLICATON ANDSTAT[ 11MAT V[.IS CORRECT AND AORER TO COM- PLY WIT, ALL'C ORDINANCES AND STATS•LAWS.NEOYLATINO BUILDING CO wYRION. / 1 II JUL —1-68Nsg00 020* **` APPLICATION FOR PERMIT BUILDING For Office Use Only J w[C[Irt NO, wNIT w[CE BUILDING 517 IL(1/L4(I/L �.f..(/(1♦� ADDR RIR[ l ZONE GROUP APPROVED BY' DATB !o ZONING ZONK No. or US[ Or NSW gWLMMt4[ET GI PLANS Z,SV'Orm 00� LRDAL O S4'TO D[[cwlmoN A. P. NO. I O Z NOTE: NO SAVE OVERHANG SHALL BE LESS THAN 30• TO SIDE a REAR P. L HAVES ALLOWED (U. S. C. REOUIREMHNT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) 'r NT RT. R.' ID PT. ± L. 619)K FT. FT. REM Fr. Fr. DISTANCE BUT. BHT. MAIN e 421 MAIN BLDG$. ACCESS. BLDGe. VAR.* DATE C. APPROVED AFFROVED L ` — / q Illy DATE t 10 �1 HOLD FOR SPECIA RE UIRE � elf 2 SO. Fr. TM[ AMOUNT SHOWN UNDER VALUATION IB FOR T,E FURPOB[ OF ESTADLIBNIND A PERMIT FEE ONLY. VALUATION PERMITFEE / 4,00.00 y� 8 PLAN CHECK S TOTAL FEE 9/ J , COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For ' Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA OWNER I//iCc9fJl /,0 N/0/41Z /'/olItI415 "irC MAIL -Su/TQ ADDRESS •Y77G. �EL C,R,72W )3(vD . 9o5- CITY 03CITY S�'�/F_ �o O rTio aiG 3�5d `RCH A ENGINEGIBE ERWO.'-e lI/OCQS Y/%$5pG p!p J/GS'%/G / 'G'/i114R/1� �-1D TaIe .h`d1SLS ,Lut /7 E OS '1 NNx FROM, . NO. w I ."s. NOW ON LOT DESCRIPTION OF WORK USE OF BUILDING AND WORK' C0 2/S T.P L`C r/ CAI G sv /10 7E Sr/.4KF AND STATE THAT THE AEOVE 15 CORRECT AND AGREE TO CON. PLY WITH ALL CITY CV ANp RATE LAWS R[GULAI.N. BUILDING CONSTA. ON. /� . it i /) SIGNATURE OF PERMITTE AUTHORIZED G[NT _Jim 26-6PP�GQ22531* ***453.90 APPLICATION FOR PERMIT BUILDING For Office Use Only WO . R[C{/V[p BYGm_i� {88 1. BUIL (� ADDR a FIRE ZONE TYPE UP APPROVED BY DATE ONING �µ ZONE NO. OP 'l Y[[OP HEW • C- PLAN[ _ OYILDINO NWU Y oc°[cnlmoNToR LLLA6 NOTE: NO HAVE OVERHANG SHALLBE ESSTHAN 90' TO SIDE B REAR P. L EAVES ALLOWED I U. IS. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING .(FROM C/L STREET) q -Fr. FT. -FRONT R. SIDE 'FT. • FT. L sla - SPT. FT. ' REM,; -FT. DISTANCE DET. BET. MAIN e MAIN BLD S. ACCESS. SLOSS. VARDATE C. U. APPROVED / APPR VdD 61 �'�� BY DAT! HOLD FOR SPECIP L REQUIREMENTS SEE REVERSE `'IDE n "A3,45 / SQ. FT. • /�' - TME AMOD NT SHOWN UNORR VALUATION IS FOR THE PURPOSE OF [STASUSHINO A PERMIT FEE ONLY. VALUATION PERMIT FEE ) TOTAL FEE 7l'.t'ilttr ; r�ccn(��(++e��avz 8S SPECIAL REQUTIII�IENTS: 1. Installation of concrete sidewalks and driveway approaches from the curb to property line, at applicant and/or owner's expense, under the direction of the City Engineer. 2. A grading plan shall be submitted to the Engineering Department prior to issuance of a Building Permit. (this has been done), 3. Applicant and/or owner to post a $1000.00 bond or deposit cash toward the cost of installing a street light in the median island on Harbor Blvd. cost differential to be refunded should the expense be less than $1000.00. 1 - 4. Tree planting in the parkway, under the direction of the Street Superintendent. 5. Must meet all the requirements of Title 19; must meet all require- ments of Uniform Fire Code. 6.-.10ne hydrant (1000 gallon Class A) to be located just.north of the, driveway approach on Harbor,Blvd. 7: 'Minimum height, clearance for front drive entrance canopy shall be 8'. 8,c,Fire Extinguishers)as required by the Fire Department. 9. A' recorded Parcel Map.,forithe division of land shall be filed with the'City,prior'to issuance of building permit. 10. Extensive landscaping will be required subject to the approval of, the Director of Planning. 11. Installation of a 6' high decorative opaque fence on the south property line for 205 feet, by owner, at his expense, subject to the approval of the Director, of Planning. 12. One free standing Identification.sign with small changeable copy panel will be permitted.:. -Building Permit to be secured prior to erection of said sign-. 13. No kitchens will be permitted in the units except for the resident manager's �,unit.' 14. All utilities shall be placed underground. 15. Final occupancy and utility releases shall be issued based upon .compliance with conditions as listed above. _- I . , 46 % CITY OF COSTA MESA BUILDING DIVISION r - 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 PERMIT NUMBER: BC11-00281 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM—NEW DATE ISSUED: 09/08/2011 ISSUED BY: RMD JOB ADDRESS: 3151 HARBOR BL CM Suite/Unit: APN: 13950110 Zoning:CL, , Vicinity: Primary Occ: Const Type: V -B SO. FT: 14408 Valuation: 1,663,197.00 SCOPE OF WORK: CONSTRUTION OF A NEW 14,408 SO FT COMMERCIAL BLDG FOR "FRESH N EASY". MECHANICAL TO INCLUDE: 1 FAU > 100K BTU, 1 REFRIG SYS > 100K BTU, 1 AIR HANDLER 0-10K CFM, 2 MINI SPLIT SYSTEMS. ELECTRICAL TO INCLUDE: 135 LIGHT FIXTURES, 63 OUTLETS, 8 SWITCHES 11 NON RES APPLICANCES < 1 HP, 1 SERVICE OVER, 60OV/1000 AMPS, 19 COMM DROPS, 4 SUB PANELS TO 200 AMPS, 10 POLE LIGHT PKGS, 2 LOW VOLTAGE EQUIP. REF: PA -10-26, PM -10-05, G11.00005. NEW RETAIL FOOD STORE ON GROUND LEASE PAD FACADE AND ALL EXTERIOR FINISHES BY FRESH AND EASY. OWNER: COMMERCIAL REALTY Phone: 310-373-2797 APPLICANT: CANNING, RYAN Phone: 858-997-3098 Address: 149 PALOS VERDES SL City/State/Zip: REDONDO BEACH, CA Address: City/State/zZip: CONTRACTOR: STEVE JULUIS CONSTRUCTION INC. License No. 553607 Phone: 949-369-7820 Address: 230 CALLE PINTORESCO Unit: Cell: City/State: SAN CLEMENTE, CA ARCHITECT: PERKOWITZ AND RUTH 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: License No.C13363 License No. $1,305.26 $8,032.35 $1,034.24 $77.80 $431.80 $0.00 $349.27 $67.00 $11,297.72 Unit: Unit: : ZipCode 92673 PHONE:949-721-8904 PHONE: -Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday -7:00 am thru 7:00 pm. Saturdays -9:00 am thio 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays: New Years Day, Memorial Day, independence Day, Labor Day, Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODEC INSPECTION TYPE DATE INTmALS CODE/ INSPECTION TYPE DATE /�INTMAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical I - S t -t Z -2M R 1266 Pool Spa Final 208 Final Plumbing (-2i-'L 2 _pr; %^ A 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 Z - 2 (- Q Q,�t 11_ WORKERS' COMPENSATION DECLARATIOOwner ID verified by drivere. []Yes❑ No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self -Insure for workers' Verification of Ownership by (type of document, i.e. - property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,i/ permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five (5) or more feet in depth into which a number are: r` person is required to descend, will be made in connection with work authorized LN�' r /�.,/�) N/� / '_ {� y this permit, and that no building structure, scaffolding, false work, a demolition Cartier: V l (_1,A11JQ NV 0 - r dismantling (hereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp finis Sectiontneed11mrx mmyeteddrne ocmtae raxreo raven nee ravers /srao)orkss.l"" 2 Art 2. Sec. 341, Title B, California Administrative Code). Policy Number: UJ� ��-! ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the w rkers' compensation laws of California, and agree that if I should become fiubject to Ihq_ww�ers' coon ensation provisions of Section 3700 of the a r ode, I elf I forKwith c tply 'th these provisions Q�(,- % Apphcanth S gnature i, Date WARING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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 infullforce and effect. Lic. J Class # — Contractor's Signature Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that them 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 (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7144, Business and Professions Code: The contractors License Law does not appy 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 3057-4613107) ❑ 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. ApMrcant'a Signature Division of Industrial Safely Permit Number: _ Date 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? ❑ 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 feel 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? ❑ 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 pountls, 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ; ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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 ❑ 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. Si9nalure Anaior�Authorized Applicant I Date j TOTAL FEES: $1,505.83 "Refer to foe receipts for all fees paid for project 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE 1, INSVEc710N TYPE PAR L Inr s CODE 11 INSPECTION TYPE DATE INTMA 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 Black/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign f 222 Final Site 204 Final Demolition PIA- / /I" lw/llx� 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION t 77 FAIR DRIVE, COSTA MESA, CA 92626 " (714) 754-5273 " Fax (714) 754-4856 - www.ci.costa-mesa.ca.us t�pr' FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER BC08-00216 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: DEMO -ALL DATE ISSUED: 05/14/2008 ISSUED BY: JOB ADDRESS: 3151 HARBOR BL CM - Suite/Unit: APN: 13950110 „ ZOning:CL,.- Vicinity: PrimaryOCG[ R-1 Const Type: V-A SO: FT: 0 Valuation: $84,000.00 SCOPE OF WORK: DEMOLITION OF 50 -UNIT MOTEL "INN AT COSTA MESA" - (17,192 SQ. FT AS NOTED ON ORIG. CONST. PERMIT 28767). DEMO INCLUDES SWIMMING POOL BLDG. SEWER CAP. T— OWNER: ELTINGE, PATRICIA Address: 344 MESA RD Unit: Phone: l City/State/Zip:- SANTA MONICA, CA APPLICANT: LEGER, TODD.` Address: Unit: Phone: 310 373-2797 EXT. 202 City/State/zZip: CONTRACTOR: License .No. - - Phone: Address: Unit: Cell: - City/State: - .' '; - - ZipCode ARCHITECT: License No. - 'PHONE: ENGINEER: - . - License No. PHONE: COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $573:14 Building Fees: $881.75 Electrical Fees: $0.00 Mechanical Fees: $0.00 Plumbing Fees: $33.30 SMIP Residential: $0.00 SMIP Commercial: $17.64 TOTAL FEES: $1,505.83 "Refer to foe receipts for all fees paid for project 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE 1, INSVEc710N TYPE PAR L Inr s CODE 11 INSPECTION TYPE DATE INTMA 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 Black/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign f 222 Final Site 204 Final Demolition PIA- / /I" lw/llx� 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION I hereby affirm under penaltg of penury 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: (iris sertion nailnot he cam*ted/thererma is valuedatmehur iainatn(5100) ,less/ Policy Number: ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' Compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply with these provisions. Applicant's Signature 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: 1 hereby aKrm 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 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. IL 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.). "1, as owner of the property. am EXCLUSIVELY CONTRACTING WITH ICENSED 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: r nawre Date ]OS] -d6 (3/0 Owner ID verified by drit Driver's License No. Ce ❑ Yes ❑ No Expires, Verification of Ownership by (type of document, i.e.-ProDerty tax bill or deed): V. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, Tile 8, California Administrable 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. Applicant's Signature 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? ❑ 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 feel 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? ❑ 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 ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for ran -residential building permits). 6. Will any part of the facility to be Contacted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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 ❑ 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. SigraWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that 1 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 thWirerts) a to enter upon the above-described property for ingree no to occupy or allow ocdupancy of an building ot I ins ection. S IOwnerts) Date Andlor Aulhonxed AppLrant Date