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Home My WebLink About2973 HARBOR BLVD - Building Permits 4`p5� 9 CITY OF COSTA MESA BUILDING DIVISION F•to am:tetra/, DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER et jar PERMIT *3/4,e1.00eF • B05-00237 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2973 HARBOR BL Status: ISSUED Suite: Applied: 02/07/2005 Vicinity: Issued: 02/07/2005 • Parcel Number: 13920323 Zoning: CL CL Applicant: ADRIAN RODRIGUEZ ISSUED BY: ✓// Address: 1019 W 20TH ST Phone: 714-285-1919 SANTA ANA,CA Zip: 92706 Owner SAMMARA DEVELOPMENT CO Address 2973 HARBOR BLVD COSTA MESA,CA Phone: BOX 349 Zip: 92626 Contractor: CIMACM&D Address: 1019 W 20TH ST Phone: 714-285-1919 SANTA ANA,CA Zip: 92706 License:' 757047 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 1,120 S.F. INTERIOR TENANT IMPROVEMENT FOR"UPS STORE 247" FEE SUMMARY Plan Check: $353.11 Calc Valuation: 540,000.00 Permit: $543.25 Claim Valuation: 540,000.00 SMIP Res: $0.00 SMIP Corn: $8.40 Other: $0.00 • Inspection: $0.00 Total: $904.76 • PLANNING & ZONING SETBACKS - MAIN STRUCTURE Front 0-0 -Rear 0-0 Left 0-0 - Right 0.0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right - 0-0 PARKING Existing: 0 Required: 0 Proposed: .0 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 end 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(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 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 orll for which this permit is issued. iri a‘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'co r•ens tion Insuran : :rrtrerr tan Iicy number are: /- / �7 —Cartier: ' .. Awl'' / ' PCifcy'Numbe, '674 j// ,(.Thlrsectrooh need not be completed I the permit is valued et one hundred dollars($100)or less.) ' " ''121.'/, o I certify that In the performanc-lof the w• for which this permit is Issued,I shall not employ any person in any manner so as t ecome subject to the workers' compensation laws of Cali i •a,and ag :e that if I should become subject to the workers'compensation provisions of tic 700 the Labor Code,I shall forthwith comply with these provisl.• (r Appllcem'Sfgnetu'reS—"'-- f--Date:.. 7oS F4ILURETo sECt1-= COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO 2AIJ4AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DCLLARE(5100,000)IN••'t•ON 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 h -PMimn.that l.ani censetl updity• . • Ions• •••er 9(commencing with Section 7000)of Division 3.of-the'Buslness rofessions Code,and my license is In full orce and effect.Lic.NU- .� trJ! gala -4-C) \ // _..onhectd :..'••.••..•..- , Dat ^'",C4 7/U CI CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a const I ion 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 penally 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.). o I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I wit not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ! 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). app ...._..._.. _......._.._ __ _ 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 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit 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 LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 8 Will any part of the cilityto be constructed under this permit be within 1000 fafeet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for thil work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree n• to occupy or allow occupancy of any building authorized by this permit until final inspection.n. Signature2 Of � Ovr(s i ,/,r - � -` e r •„• • • t , ... —m —��` rDate -- y CODE t INSPECTION TYPE DAIS Ifil➢AL5• ODE.t INSPECTIONTYPE MI al 1616 Fixed System Final Fire Prove '• 206 Final Mechanical 1288 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 e _ 204 Final Demolition 250 Final Building/Occupancy Se" RIE 44`, ' CITY OF COSTA MESA - .-. BUILDING DIVISION Y . �,,,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 4 A�. I PERMIT - E05-00089 (714)754.5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2973 HARBOR BL Status: ISSUED Suite No Applied: 02/07/2005 Vicinity: Issued: 02/07/2005 Parcel Nunmber: 13920323 e / Applicant: ADRIAN RODRIGUEZ ISSUED BY: "AlliirV Address: 1019 W 20TH ST Phone: 714-285-1919 SANTA ANA,CA Zip 92706 Owner: SAMMARA DEVELOPMENT CO Address 2973 HARBOR BLVD COSTA MESA,CA Phone: BOX 349 Zip: 92626 Contractor: CIMACM&D Address: 1019 W 20TH ST Phone: 714-285-1919 SANTA ANA,CA Zip: 92706 License:757047 • SCOPE OF PERMIT 1,120 S.F.INTERIOR TENANT IMPROVEMENT FOR"UPS STORE 247"REF.:B05-00237 ELECTRICAL TO INCLUDE:ADD 12 OUTLETS ELECTRICAL TO INCLUDE: , - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to10 kva/kw $0.00 , " 0 Lighting Fixts $0.00 0 up to.50 kva/kw $0.00 0 Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res App! $0.00 0 Low Voltage Equipment $0.00 - ,0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit - $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) ' $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand, $0.00 " 0 Motors to 50hp $0.00 0 , Fireworks Stand - - ' - $0.00 0 Motors to 100hp $0.00 " 0 'Other Electrical Fee $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 $0.00 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244616(WOO) DECLARATIONS . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CI ye and willymaintainrQpworkers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of Irye work for whichis unit Is issued. - Ca ' / ens Ion Insure_/_(.','mer qn ollcy number are: 643 - --(ihltt section need rtof be completed itihe pe r'tyIs/valued at one hundred dollars(5/00)or less.) �� Ll ❑ I certify that in the performance of th= for whi7h this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,an•'L• .e that I should become subject to the workers'compensation provisions of Section3J— ( /070 of hetLabor Code,I shall forthwith Ply-w h.Na ePr �•rovsans. // kantS nyre::- :.r •t y/ ` Uate: "- D. /!/ (/ FAILURE TO SECURE WORKE•.'COMP-'SATION COVERAGE IS UNLAWFUL AN D SHALL SUBJECT Ni EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE($I00.000),IN ADO1TI•, • E COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 31090E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 4 I° . pier 9(commencing with Section 7000)of Division 3 of the Busines Professions Code,and my license is In full Cforce and effect.LIc pT"� / i�i' Class d"'Kontr SlgnatOre""_'"^^"r -• n I _ mete:=�!�r� cC ////OS `CONSTRUCTION LENDING AGENCY:1V ❑ 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 fore 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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,end 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Yes ❑No 5 Does or will tho 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 ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No __ 8 (If yes%attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE 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 purpos ...11/agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signalureof IYc9--•/. • )? �1/j!� C� And/0 Owner(s) _ nt .•• ','Tr,. �j /Y/ t� J t-, CODE I 162011121:110 //" PATE ECM CODE I rNSPECTION TYPE. —` PAM IHIIDALS 1616 Fixed System Final Fire Preva tiod 206 Final Mechanical 1266 Pool Spa Final ' 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7-14-0C 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' CITY OF COSTA MESA . BUILDING DIVISION r� •,,,' ; k• : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1 PERMIT GSRpff11 —0 - O I • (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTKIOI gA+U AEJ2626 SIGN PERMIT Job Address: 2973 HARBOR BL Status: ISSUED Suite: Applied: 05/07/2003 Vicinity: Issued:05/07/200033 Parcel Nunmber: 13920323 Zoning: CL CL ISSUED BY: Applicant: RICHARD BENSON Address: Phone: Zip: Owner SAMMARA DEVELOPMENT CO Address 2973 HARBOR BLVD COSTA MESA,CA Phone: BOX 349 Zip: 92626 Contractor: ELRO MANUFACTURING CO Address: DBA:ELRO SIGN MFG CO GARDENA,CA Phone: (310)880-7444 400 W WALNUT Zip: 90248 License: 418025 Arch/Eng: - - Address: Phone: Zip: License: SCOPE OF PERMIT INSTALL A 26.5 SOFT.BUILDING SIGN TO REPLACE AN EXISTING BUILDING SIGN. 18'WIDE BUILDING ALLOWS A 13'LONG SIGN—SIGN IS 179'LONG.LETTER HEIGHT OK PER PSP. FEE SUMMARY- Plan Check: $29.15 Calc Valuation: $1,200.00 $0.00 Permit: $44.85 Claimed Valuation: $1,200.00 SMIP Corn: $0.50 Other: $0.00 $0.00 _ Inspection: $0.00 $0.00 $0.00 Total: $74.50 PLANNING &ZONING NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(Woo) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. • cz I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Cartier: 71,47E5n c Policy Number: 200202-$/7-_02- (Phis section need not be completed if the permit Is valued at one hundred dollars($100)or loss.) ❑ 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,end agree that if I should bec9me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision Applicant Signature: 4 - .._ Air- Date: 5 -7—03 WARNING:FAILURE TO SECURE WORKE- COMPENSATION COVEGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Ilcensey under provisions of Chapter 9(commencin. ith Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Llc.a 'at in0 2 Class a C 4- Contractor's Contractor's Signature: e - - - -- Date: 5--7 —03 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 end 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 under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 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 live(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,fatsework,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-bulider,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: I Will the applicant or present or future building occupant need to filo 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 Safely 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,hes 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 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 conStnrcted under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 N0 (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _._ ._..._. __i_ __..........._r..__ 7 a a permit from the South Coast res Oescri edManagement al or other airtpollution ooncontrol district3 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californiaia 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Caura Of Legal Owngr(5y Date And/Or Authorized Applcant Date CODE I INSPECTION TYPE pd1E IMO CODE! INSPECTIONTTPE f7AIE I1�L5 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 ______T� 220 Final Planning Approval _ 203 Final SignI—IaLV-+ 250 Final Be 204 Final Demolition �f`� 250 Final Building/Occupancy or= 3le"144s W., s;Kiszer.: 17-9" I ~srr�i:" 9, L 1_9a 1111 ®_ ..w" 1i wore 10'-3" YIfmblvmin•n.n[MCI • It•ia - r� " FS 2'-1" • MUS aR.w.n...w.wn" _ _ �wTJcjçaiJP $ - uwi1egcmn"nwusu 11 reg. .W Wig 11 ".1 pt.W.Cr I'BROWN[Wn Troop - auNa«E, Ll:,Q, s , b :;.-.•rxx•:- r ,,_",t.: DIV ISION O ' *c • MESA n►�u► CITY • PROVE I 12._0.. .-_-_ k l"_ ' �. *VIED A .t iyb CITY OF COST r•,.; ,a, :oMpLIANT �� x An3rn� I • r, ^- � � PLANNING DIVISION • �� ;-•s taro "�* ,-.a,g�.,m4 --d Iril CH; NN a : a- a ca a-, �,p,4 .� �,,�,,....► F \ sdo1PS��I�MpUNI@CIANNELLETTERS ,r �1 Scale_3/8"= 1'-0" � " • • - • ,.itlFl .yl -c. - ,.`/ � 2n%4 wry;• .."+�•4 • , v o AI��I -RL�': • Ping' ,. qua] � �'�r , d•��,,YTT�- 'L'N,_ v� ,,�,� - „r,. ,. . .. . � I... 0 A$4�2��E�� ING DIV. ob P. -p w t'" - -''" •. .,:y4r r<-itrry. , : • 4 WHITE SEAMLESS LEXAN / 84" ,- OPAQUE UPS I 43 BROJJN VINYL 11 • 12" The UPS Stor• �+ - - ups II ✓`� J' SIGN FACE 501-1-3°4165N° MANUFACTURING O0 Q •�' 9 ' 1' SPECIFICATIONS DIVIS11SD PANEL REFACE-D/F Fl� ps Scale: /.'=1'-0- �T ,II : ureter' I PANEL REFACE NTS All workmanship, materials and wiring . , t190!it 5• Dr " are U.L. listed and labeled��a ' r� rut r -' HAWAIIAN GROCERIES ... _a �� s.r..• Y' �' r.,1.�r`, FOOD COURT ffio131 d �r-est, :fid, +p cnkM`') — _ �" -— - _ to „ aatoy1 F" YR�ytm - �, , w ma'' l The UPS Store ' i.: II DRY MARUKAI, ` I LOANS `` HAWAIIAN CROCIRIIa t I - l•fir' I _ MAIL BOXES i?C. ;i Iy�, /� � _. a oar OUM99- lily L , 1 t Ead2 l9 " Lae F 0o DENTIST III -- - ----- - - - - --_-_ _ _Cf fir: ALTERATIONS ALTERATIONS II _ _ _ H� 2965-2975 ofI 1 I 2965 - 2975 �� ..r 'rte'=: ¢-,� r „Y' " Existiny - NTS Proposed PANEL REFACE Scale: 318"=1.0'• .This Is an original unpublished Client UPS-MBE Changeout drawing created nig Eire Signs.H b �� ry o �c^ REVISIONS submitted for your personal use In [d!A4 II O (Ii _ NO. COMMENTS DATE wNunctlon with . re Sig being e u Address 2973 Harbor Blvd..Costa Mesa CA 92626 plannwt«you.Itbnot tobeearn Design No. 18418 Store No. 247 to anyone outride Your organization CM10 & oEMDw nor b R to be used, reproduced• mw.eReu*Ie u.sum 2FkI ss'°hN>�cGA Scale:_ As Noted • Sheet 2 of 2 copied or exhlbtbd In any fashion a09�'$"" "t' " Dmwn By REB Date 3.2343 without the express written consent IceRu`eetlr'maR Rn1�ysanE8t0 CWpWTEM of Elresroro. aplrllWBIN•T:(lIIl ORIX43 Icci"I;w aaaa Approved By Date 'Y • if a.: i `i V;.1I` f ..Yid' nrl CN' I • r A � o � _ I la_�Y s8 1 >a r6 o r ! 1 1 , - '- I N 2. :r j' -girl-AM 7,i1 ' E �\ S5I1� � ! k {�(II l .t � NNyU -'. 0 1 .. F�,u:.E. • t.^ Pi(nSS :sit ,: : 1 —.., , N N. \ a Fuy,, el _ ,1)16�jVV4 1'_ ---4 b< } i I 8 i.'5 -- r 1 I., ,,,...—.L, : J ; a. s xacj 1 I vvJ „3h 1 1: ii ^1 1; lc 111 ftt N r. i �`�vl