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Home My WebLink About334 16TH PL - Building Permits0 t(O�p MF'q9 o �> ". : L' V � Q •4a.�Rn � • R . � � � � 1 � CITY OF COSTA MESA BI►ILDING DIVISION 77 FAIR DF�IVE, 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: P09-00152 PERMIT TYPE P�UM APN: 42521219 STATUS: ISSUED DATE ISSUED: 1112312009 ISSUED BY: BJK JOB ADDRESS: 334 16TH PL CM Suite/Unit: Vicinity: SCOPE OF WORK: GAS REPIPE FOR AN EXISTING RESIDENCE. OWNER: KOGA. JEFFREY K Address: 334 E 16TH PL PHONE: Cily/State/Zip: COSTA MESA, CA APPLICANT: KOGA, JEFFREY K Address: 334 E 16TH PL : PHONE: 714-309-0303 CirylStatelzZip: C08TA MESA, CA CONTRACTOR: OW NER-BUILDER Address: CirylState: ARCHITECT: ENGINEER: ZipCode: License No. 000000 PHONE: CELL: License No. License No. PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: 50.00 $33.30 $33.30 PHONE: PHONE: NOTICE: The work authori;ed by this permit shall comply with all applicable handicap access requirements under California statules and related regulalions. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: In order for the work authonzed under this pertnit to be considered legal, such work must comply with 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. G OER. INSPECTIONiYGE Q�TF� IN 11R1 LOOE� INSPECTIONME OAjF� INT�7�ALS 1816 Fixed System Final Fire Prevention 206 Final Mechanical 126fi Pool Spa Final 208 final Plumbing �dY RA1 i�iiL� �_�� f 200 Final Re-Roo/ 210 Final Eleclrical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Pire Place 220 Final Planning Approval 203 FinalSign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy i � � WORKERS' COMPENSATION DECLARA710N: I hereby affirm under penalty of perjury one o( the following declarations: � I have and will maintain a certi(cate of consent to self-Insure (or workers' compensation, as providetl !or by section 3700 of the Labor Code, tor ihe per(ormance of the work for which this permit is issued. � I have and vrill maintain wvrkers' compensatbn insurance, as requiretl by section 3700 0( the Labor Code, lor the peAamance ol the work (a which this pertnit is issuetl. My workers' wmpensation Insu2nce carrier and policy numDer are: Carnec (Tnis sepun nee0 rpl pa comp'ete0llMµmN k vdqred al me �uMiN tlolarslEt001 akss ) Policy Number: ❑ I Certify Ihat in Ihe peAortnante OI Ihe wOrk lof wlliCh lhis pefmit i5 issued, I shall not employ any person in any manner so as to become subjecl to Ihe workers' compensation laws o( Califomia, and agree that if I should become subject to the workers' compensation provisions ol Section 3700 0( the Labor Cotle, I sha0 foAhvrith wmply with these provisions. Appiwm's Sigruwre Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO TNE 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 vnth Section 7000) of Division 3 0( the Business and Professions Cotle, ana my license is in full (orce and eBect. Lic. # _ _ Class # Convacbr's Signawre CONSTRUCTION LENDING AGENCY: � I hereby a((um tha[ there is a construction lending agency (or the peAwmance of the v.ork for v.hich this pertnit is 5sued. (Sec. 3097, Civil Code). Lender's Name: Lender'S Atltlress: SignaWre OWNER-BUILDER DECLARATIONS: I hefeby aHirtn that under penalty of perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for tha (ollowing reason (Sec. 70J7.5. Business and Pmfessions Code: Any ciry or county which requires a permit to consWct, alter. impmve, demolish, or repair any sWCWre, prior to its issuance, also requires Ihe applicant !or such pertnit to file a signetl statement thal he or she is licensetl pursuant to the provisions o! lhe CoNractors License Law (Chapter 9(commencing wilh Section 7000) ot Divi5i0n 3 0l Ihe Business and Pmfessions Code) or that ha or she is exempt therefrom antl the basis (or the alleged exemption. Any violation of Seclion 7031.5 by any applicant for a permit subjects �he applicant to a civil penalty o! not more Ihan five huntlied tlollars ($500).): '-� I, as owner ol lhe property, or my employees with vrages as their sole compensation, WILL DO THE WORK, anC the structure is not intentletl or oflered tor sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an ovmer of propeny who builds or improves thereon, antl who does such work himsell or herself or through his or her ov+n employees, provided that such improvements are not intended or oflered for sale. If, hovrever, Ihe builtling or improvement is sold vrithin one year of completion, the ovmer-builtler vrill have the burtlen o( proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACT�NG WITH LICENSED CONTRAC70RS lo conswct the project (Sec. 7044, Business and Pmfessbns Code: The contraclas License Law tices not apply ro an owner of property who builds or improves thereon, antl wfio wntracts for such project with a contracta(s) license pursuant ro the Com2ctors License Laws.). ❑ I am exempt untler sec. Business and Professions Code for this reason: /�k/l�lt�� c�. //• 7� •85 ��SignaWre '� Dale . .- JO -G61]/0)) � � + r , Owner ID venfied by driver s license. Yes ❑ No ��y �� v : ' Venfcation of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � I hereby cetlHy thal no excavation frve (5) or more (eet m depth into vfiich a person is requiretl lo tlescend, will be made in connectbn vrith aork authorized by this pertni�, and that no building stmcture, scaffdding, falsework, a tlemWition or tlismanlling thereo(, will be more Ihan thirty-sin (36) (eet high. (C�ap. J.2, Grp 2, Art 2, Sec. 341, Ttle 8, California Adminisl2tive Code). ❑ As ovmer-builder, I will not employ anyone to do work which would require a permit from the Division ol Industnal Salety, as noted above. unless such person has a permit to do such vrork (rom the tlivision. Applicanl's Signalurc Division ot Intlustrial Safety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. will the applicant or present or fuNre building occupant need l0 61e antl certily a Business Plan (or emergency response to release or threatenetl release of a hazardous malerial? ❑ Yes ❑ No (Section 25505 of the California Health and Satety Cotle requires. with some exceptions, thal a Business Plan be filed with Ihe Costa Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantity of hazardous matenals equal to or greater than a weight o( 500 pountls, or a volume o! 55 gallons, or 200 cubic teet of compressed gas atstandard lemperature and pressure). 2. Does or will the applicant or present or fuNre building occupant need to file a registration form for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Depatlmenl by each business which al any one time has on hand a quantity of awtely hazartlous materials equal lo or greater than a vreight o( 500 pounds, or a volume ot 55 gallons, or 200 cubic teet of compressetl gas at standartl temperalure antl pressure). 3. Does or will the appiicant or present or fWure builtling occupant need to prepare an RMPP (Risk Management antl Prevention Program for aculely hazardous materials�? 0 Yes ❑ No (Seclion 25534 0( Ihe California Health and Safery Code provitles that Ihe Costa Mesa Fire Depariment may require the preparation, ceAificalion and fling wi�h �he Fire Department of an RMPP by businesses which are required io register acutety hazartlous materials with the Fire DepanmeN. 4. If an RMPP is presenUy requiretl, has Seclion 25534 0l the Calilornia Health and Safety Code been lully complied with7 ❑ Yes ❑ No 5. Does or vnll the applicant or present or future building occuDanl require lor Ihe work which is Ihe Subjecl of thi5 application a permit for such construUion or modifcation from the South Coasl Air Qualiry Management District or Irom any o�her air pollulion contml district or agency? ❑ Yes ❑ No (Section 6585Q2 of the Califomia Govemment Cotle requires tliat tfre requested infortnation be fumished on applications fa rao-residential builtling permits). 6. Will any part ol the facility to be constructed under this permit De within t0001ee1 from the outer bountlaries of a school? ❑ Ves ❑ No (I!'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cali(omia Health and Safery Cotle�. 7. If a permit from the South Coast Air �uality Management District or other air polNlion Gontrol diSVitt or agency i5 required (or Ihe work which is the subject of Ihis applicalion, have all of the disclosures prescribed by Califomia Heallh antl Safety Code Seclion 42303 been made? � Yes ❑ No 8. Qf'yes", attach certificate of compliance from the appmpnate air polNtion wntrol otfcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the infortnation given above is wrrecL I agree to comply wiih all state lavrs and city ordinances regarding Hazardous Materials antl Emissions. SignaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury thal I have read Ihis application and state lhat the information given is correcL I agree to comply with all state laws and city ordinances relating lo building conslruction, and authonze representatives of the City of Costa Mesa lo enter upon the above-descnbed pmperty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pery it until final inspection. �il�/�i /C �� 2 �� nawreolLeBal qs) . Da�e AntllorAW�Onzed ApOL�anl