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Home My WebLink About3532 MACARTHUR BLVD - Building PermitsCITY OF COSTA MESA . � t °MF9 BlIILDING DIV/S/ON F�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us °,�+'�o FOR INSPECTIONS CALL: (714) 754-5626 fi PERMIT NUMBER: E09-00192 PERMIT TYPE ELEC STATUS: ISSUED APN: TPN009009 DATE ISSUED: 07/16I2D09' ISSUED BY: BJK JOB ADDRESS: 3532 MACARTHUR BC CM , Suite/Unit: Vicinity: VACANTLOTATMAC,ARTHUR,AND.HYLAND� � - � ., . � � SCOPE OF WORK: CHANGE-OUT OF A SOA MYER'S BOX AT A VACANT LOT IN "HARBOR GA7EWAY.". OWNER: PHONE: APPLICANT: PHONE: SEGERTSTOM� � � - 714.4352053. _ BURTON,TOM 714-035-9124 CONTRACTOR: BURTONS ELECTRIC INC - Address: 3554 BUSINESS PARK�DRUnit. UNIT,D City/State: COSTA MESA, CA ZipCode: 92626 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES $54.00 � Address: 3315FAIRVIEW.RD Unik . - City/StatelZip: , COSTA MESA, CA � _ ', " ,�Address:� � 176738EECHST Unit: ��- Ciry/StatehZip: � � FOUNTAIN VALLEY,-CA . License No. 484782 - . - ' PHONE: N4d35-9025 CELL: � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 ortler 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. CODEt. INSPEL710NTVPE DpTE INTITIRtS COOE/ INSPECTIONTYPE DATE INIITIALS 1816 Fixed System Final Fire Prevention 206 Final Mechaniral 1266 Pooi Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electriwl 20t Final Block/Retaiping 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 WORKERS' COMPENSATION DECLARATION: I hereby affirm untler penalry of perjury one of Ihe following declarations: ❑ I have antl will maintain a certifwle of consent to sel(-Insure for workers' compensation, as provided for by seclion 3700 of Ihe Labor Cotle, for the peAormance o( Ihe work (or which this permit is issued. �i � I have antl will maintain wvrkers' compensation insurance, as required by sectnn 3700 of the Labor Cotle, for Me peRormance of the work for which this pertnit is issued. My workers' compensation Insurance wrrier and policy number are: / �� Carrier. .%i £L � r � n!-C S.f A�.�+ �t � (Thiss ronneetlirofbecomdeledilthepermrt6valuetlafinehuntlretl�llars(S1C0)aless) Policy�Numbec ��.� �� h 1'?_ e9 � 3 9� I i S ❑�I-certify that in the peAormance o� the vrork (or which this permit is issued, I shall not employ any person in any manner so as lo become subject to the workers' compensation laws of Califomia, and agree that if I should become su ct to the vrorkers' compensation provisions of Section 3700 of [he I shall fort ' i comply with [hese provisions. ��^ �f)/-O Apphanls ure •Dale� L� " 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, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereby aKrm that I am licensetl untler provisions o( Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license� i!s in full force and eHect. Lic.�#. `1 �� Class # C ^ l'� � �"� �^ I� �a —� � mracmf`sSiyroWre F oate�� CONSTRUCTION LENDING AGENCV: ❑ I hereby aKrm �ha� Ihere is a cros[ruction lending agency for [he peAortnance of the xork fa which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's AOtlress: Date OWNER-BUILDER DECLARATIONS: I hereby affirm lhal untler penally of perjUry [ha[ I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Set. 7031.5. eusiness antl PrOtession5 Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcWre, prior to its issuance, also requires the applicant for such permit to file a signed statement thal he or she is licensetl pursuant to the pmvisions of the Contrectors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the Business and Pmfessions Code) or that he or she is ezempt therefrom and Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hund�ed 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 oHered for sale (Sec. 7044, Business and Professions Code: 7he Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or hersel( or through his or her own employees, provided that such improvements are not imentled or offered for sale. If, however, the builtling or improvement is sold wilhin one year of completion, the owner-builder will have the burtlen o( proving that he or she ditl 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 Pro�essbns Code: 7he contractors License Law dces noi apply to an ownef of property who builtls or improves Ihereon, and who contracts tor such project with a contrector(s) license pursuant to the Contrectas License Laws.). ❑ I am exempt under sec. Business and Professions Code for �his reason: SiB^aWre Date J057-a6(3�01� Owner ID veri(ed by driver's license. ❑ Yes ❑ No Driver's license No. Expires: � Verifcation of Ownership by (rype oi document, i.e. - property [ax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certdy Ihat no excavation frve (5) or more feet in tlepth into which a person is requiretl to descend, will be made in connection with work authonzed by Ihis permil, antl that no builtling slrucWre, scaffdding, falsewurk, a demolition or dismantling thereof, will be more Ihan �hirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administrdtive Cotle). ❑ As owner-builder, I will not employ anyone lo do work which would require a permit from the Division of Industrial Safety, as notetl above, unless such person has a permit to do such vrork irom Ihe division. APO��nfs SignaNre Date Division o( Indus�rial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presem or fuNre building occupant neetl to file and certify a Business Plan for emergency response to release or threalened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Cali(ornia Health and Safety Code requires, wi[h some exceptions, tha[ a Business Plan be filed with the Cosla Mesa Fire Department by every business which has at any one lime dunng 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 compressetl gas at s�andard temperature antl pressure�. � 2. Does or will the applicant or present or future building occupant neetl to file a registration form for acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 0( the California Health and Sa(ely Code, with some exceptions, requires registration wi[h Ihe Costa Mesa Fire Departmenl by each business which at any one time has on hand a quantiry of acutely hazardous matenals equal to or grea[er than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas a[ standard IemperaWre and pressure). 3. Does or will ihe applicant or present or (uture building occupant neetl lo prepare an RMPP (Risk Management and Prevention Program /or acutely hazardous materials)? ❑ Yes � No (Section 25534 0( the Califomia Health and Safety Code provitles Ihat lhe Costa Mesa Fire Deparlment may require the preparation, certification and filing vrith the Fire Departmen[ of an RMPP by businesses which are required to register acutely hazardous materials wiih the Fire DepaRment. 4. If an RMPP is presently required, has Seclion 25534 of the Cali(ornia Heal[h and Safety Code been tully complied with? ❑ Ves ❑ No 5. Does or will the applican[ or present or fu[ure building occupant require (or Ihe work which is the subject of Nis application a permi� (or such construction or modification from the South Coast Air Qualiry Management District or from any other air pollution control tlistrict or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Cotle requires that the reques�ed information be fumished on applications for non-resitlential builtling pertnits). 6. Will any part of Ihe facility to be conslmcted under this permit be within 1000 feet from the outer boundanes of a school? ❑ Yes � No Qf yes", [he facility mus[ meet the requiremenl of Sections 25534 antl 42303 of the California Health and Safely Cotle). 7. If a pertnit from the South Coast Air Quality Management District or other air p011uti0n tonlrol 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 Safery Code Seclion 42303 been made? ❑ Yes ❑ No B. pf "yes", anach certifcate of compliance from the appropnate air pollWion conirol officer). CERTIFICATE OF COMPLIANCE I certify that untler penalty of perjury lhe information given above is correcL I agree to comply wilh all state lavrs antl city ordinances regarding Hazardous Materials and Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certiy under penalty of perjury that I have read this application and state thal the information given is wrrecL I agree to comply with all state laws antl city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa to enter upon [he above-tlescribed property (or inspection purposes. I agree not to occupy or allow occupancy of any building aut�orizetl by this permit until final inspection. Signe r o(Le8 r(s� / Dale �.5�-- 2-��--Dp Antllo�AUVwriz I�cant_ Dale-"�