HomeMy WebLinkAbout910 20TH ST - Building PermitsC
CITY OF COSTA MESA
�o�`°"'Fs, BYILDING DIVISION
i`�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us
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" FOR INSPECTIONS CALL: (714) 754-5626
�`"°'�� PERMIT NUMBER: E10-00138
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42249443 DATE ISSUEO: 0 6/2112 0 1 0
ISSUED BY: KJB
JOB ADDRESS: 910 W 20TH ST CM
vicinity:
Suite/Unit:
SCOPE OF WORK: MISC. ELECTRICAL REPAIR WORK. SCOPE OF WORK TO INCLUDE: 3 LIGHT FIXTURES, 2 OUTLETS, 1 SWITCH.
MISC ELECTRIC.
REF: C10-0996
OWNER: DOLAN, EVELYN MURAY TR Address: 910 W 20TH ST Unit:
PHONE: 949-689-7922 City/State/Zip: COSTA MESA. CA
APPLICANT: FLORES, LALO Address:
PHONE: 909-464-9983 City/Slate/zZip:
CONTRACTOR: SAFE WAY ELECTRIC CO
Address: 13615 DAISY CTUnit: PHONE: 909d64-9983
City/State: CHINO, CA ZipCode: �91710
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $48.30
Reinspection.Fee $0.00
TOTAL FEES $48.30
Unit
license No. 809692
CELL:
NOTICE: The work authorizetl by this permit shall comply vrith all applicable handicap access requirements under California stalutes 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 fnal approval will result in the expiration of this pertnit.
CODEr. INSPEC7IONTYPE ORTE INTI71A15 COUE/ INSPEQIONTYPE O�TF IN7RUL
1616 Fixed System Final Fire Prevention 206 Final MechaniCal
1266 Pool SDa Final 208 Final Plumbing
zoo FinalRe-Rool zio FinalElectncal L-�dY�/J a;�i�[1,�z�
201 Final Block/Retaining Wall ' 212 Final Fire Prevention
202 Final Factory Fire PlaCe 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sel(-Insure for vrorkers'
Compen5ation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this pertnit is issued.
I have and will maintain v.orkers' compensation insurance, as required by
5 bn 3700 0( Ihe Labof Cotle, (or lhe per(ortnance of the work for whiCh IhiS
permit is issued.�ers' compe sa�surance carrier and policy
number are: _`__� U
Carrier: `Jl. C�
(Thksertimneetlmlbemmd�e/��dlhe/p�'eimlavalu1F�aIlmehuntlmlWBars(5f00)alessJ
Policy Number. �� 0� l��' 1 \� ��
❑ I certify that in the peAormance of the work for which this permit is
issued. I shall no� employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree that if I should
bewme subject to Ihe vrorkers' compensation pmvisions o( Sec[ion 3700 of
Ihe,Lap�G��, s�allforthwi�hcomplyvriththese rovis ns. �
l,u-1 � �
- m's90���e� Da�e
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 LA80R CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of 1he Business and Professions Code, and
my license is in I orce and effect. � I�\
Lic. # � Class # �J
t�%
�ot55iW'iatOre; Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn thal there is a constructbn lending agency for the
pedormance o( Ihe �rork fa v.hich this pertnit is issued. (Sec. 3097, Gvil Cotle).
Lender's Name:
Lender's Address:
Signature
OWNER-BUILDER DECLARATIONS:
I hereby affrm that untler penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovring reason (Sec. 7031.5,
Business and Prolessions Code: Any city or counly which requires a permit �o
consWct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant for such pertnit to file a signed statement
that he or she is licensed pursuan[ to the provisions ot 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 antl
the basis for the alleged exemption. My violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicant [o 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, antl the structure is not intentle0 or
offered for sale (Sec. 7044, Business and Professions Cotle: The 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 ovm
employees, provitletl that such improvements are not inrended or offered tor
sale. If, however, the building or improvement is sold within one year of
wmpletion, the owner-builder will have the burden of proving [hat �e or she
tlitl nol build or improve for purpose of sale.).
❑ I, as ovmer o! the property, am EXCLUSIVELY CONTRACTING WITH
UCENSED CONTRACTORS to wnswct the project (Sec.-7044, Business and
Professbns Code: The cont2ctors License Law dces not apply ro an ovmer of
property who build5 or improves lhereon, and who contracts for such project wi[h
a cmtractw�s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
3057-46�3/O])
Owner ID veri(ed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Venfication of Ovmership by (type of document, i.e. - pmperty tax bill or tleed�:
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connectbn with work authorized
by lhis pertnit, and that no building sWcture, scaffdding, falsework, a demolition
or dismanlling thereof, will �e more ihan Ihirty-six (36) (eel high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, TiUe 8, Calitomia Administ2tive Code).
❑ As ovmer-builder. I will not employ anyone to do work which woultl
require a permit from Ihe Division of Industrial Safety, as noted above, unless
such person has a permit to tlo such work from the tlivision.
APO�����'s Sigwlure
Division of Industrial Sa(ety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fWure building occupant need lo fle and
certiy a Business Plan for emerqency response ro release or threatened
release o( a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health and Safery 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 during a reportetl
year a quantity of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas
at standard temperalure and pressure�.
2. Does or will the applicant or preseN or future building occupant neetl to file
a regislration tortn for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of �he Califomia Health and Safety Code, with some
excep[ions, requires regisiretion with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity o( acutely
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 al standard
temperaNre and pressure).
3. Does or will ihe applicanl or present or fWure building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of lhe California Health and Safery Cotle provitles that Ihe
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
[o register acutely hazardous materials with the Fire Depariment.
4. It an RMPP is presently required, has Section 25534 of the Califomia
Health and Safely Code been fully complied with? � Yes ❑ No
5. Does or will the applicant or present or future huilding occupanl require for
the work which is lhe subjec� of this application a permil tor such constmction
or motlification fmm the South Coasl Air �uality Management District or from
any other air polWtion wntrol district or agency? ❑ Ye5 ❑ No
(Section 65850.2 of the Calitomia GovemmeN Code requires that lhe requestetl
infortnation be (umishetl on applications (a non-residential buildinq pertnits).
6. Will any part of the faciliry ro be construcled under Ihis permit be within
1000 feet from lhe outer bountlanes of a school? ❑ Yes ❑ No
(If'yes", the facility musl meet the requirement of Sections 25534 and 42303
o( the Cali(omia Health anC Safety Code).
7. If a permit from the South Coast Air Ouality Management District or other
air pollution control disMct or agency is required for the work which is the
subject of this applicalion, have all of the disclosures prescribetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
8. Qf yes", allach certifcate o( compliance from the appropnate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certi/y that under penalty of perjury the
infortnation given above is correct. I agree to comply with all state laws and
city ordinances regarding Haazirdous Materials and Emissions.
Signamre Da�e
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 wiih all state laws and city
ordinances relating �o builtling consWction, and authorize representatives ot
ihe City o( Costa Mesa [o enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorizetl 6y this permit until fnal inspection.
Sig a e o� �'M1 I Owneqs) � Da�e
� ��
tl/w�Au�M1 iedA001'ic2n1—.�! Da�2
OWNER g
JOB ADDRESS
GF ERAL COD
f �J�
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INSPECTIONS
SOLL
GAS
W ATER
ROUGH PLIIMBING
PROP. SWR. LINE
SPRINKLING SVST
MISCELLANEOt15
_�� LO7 TRACT FI
f_�1:1
UN�ERGROUNO U POWER �
ROUGH WIRING
TRENCHES n FORMS n STEEL REINF.
BONO BEAM U STEEL
SHEATHING
FRAME ANO FLASNING
P TER, BROWN COAT
:TtIRAL, FINAL
HERTING, VENT., REFRIG. RNO A.
PLUMBING, FINAL AN� GAS TEST
DATE
SUBCONTRACTOR
PERMIT N0.
346 I 7
PLIC
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COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant ta Fill in Completely
RECEyyED BV qy.T� RFCEIV�D DA.7E ISSUED
BUILOING j�� �` y�L�6 � IJ �I �
ADORESS C D i��� O + � 3��
_ �' PERMIT NO.
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(n CL LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
�� SI2E NO.OF BLDGS. (FROM C/L 5 RE T)
OF LOT NOW ON LOT RONT � FT.
USE OF %� / /f'
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F' S12E OF NO. OF
Z NEW BLDG. ROOMS STORIES L. SIDE � FT. FT. �' .
U EXTERIOR WALL ROOF / /I �\_ y
COVEFING COVEFING REAR �FT. :O FT.
J USE OF BUILDING AND WOPK TO BE PERFORMED DIS�ANCE BET. BET. MAIN &
a MAIN BLDGS. ACCESS. BLDGS.
a
Q � � II � VAR.# DATE
� v' v�' O L G'�, /`�I O C.U.P.# APPROVED
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UI hereby acknowletlge thac 1 have reatl this aDPlication antl state STATE
� thet tha abore intormation is correct anG a8�ee to comO�Y �+'�th �
� all laws regulating b�ildin8 construction, antl I shall not employ
r any perwn in viola[ion of the workmen's compensation laws of
y the Stace ot Califomia.
b
zI heroby certity that I am properly IicenseC es e contractor untler SQ. FT. j o
[ha State ot Calitornia Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA ION IS FOR �
Chapter 9, antl that such licenses are in full torce antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exampt from Ihe provisions ot the State ot Calitornia Business ¢
VALUATION �, �j�.` m
� antl Professions C de, Division 3, Chapter 9. PERMR FEE S �
%/� / �
Peemlttea ot //�� 4 v G^.rC// `-'��✓ h � _1 m
$/ �f' Mr I PLAN CHECK $ / E
�� (/ (l = `o
Au2horizaC Apent LL
TOTAL FEE $ / �
OWNER
JOB AC
LOT
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PROP. SWR. LINE U M01
� SPRINKLING SYSTEM
/N 5
ROUGH ME�TING �ND AIR
TEMPORAqV SERVICE OR
� UNOERGROUND � PO
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LATMING - IN OUT G
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5" 'TURAL. FINAL
h. NG. VENT., REFRIG. AN� �.C.
PLUM9ING, fIN�L ANO G�5 TEST [
ELECTRIC, FINAL
BUILOING. FINAL
DATE
SUBCONTRACTOR
�
��:�992
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
ADDRESS �/(J V V , (/� �-/ �
OWNER CV � IN 4-/LiL��
MAIL �^
ADDRESS S�Iv `E
CITV / (751� MC�`Y�1 NOL/�;�'�I
BRANCN
TEL.
aav �e-�7 „�°00 es7# *���60.50
FORSTRUCTURALPERMIT
DATE RECEIVED �eTF iccuan
BUILDING /O ' w'_
ADDRESS (/��
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ADDFESS <vrvc ♦rc . on��r�— . �
APPROVE [ �0���
CONTRACTOR �� � �,D BV DATE J / •
ADDRESS � �
TEL. ZON NO.Of. ^/ VSE OF NEW p,�RpG E
CITV NO. ��/ P�� /� BUILAING 9 L,
.Fi STATE CITV YARDSAPPROVED YARDSAPPqOVED
IIG. NO. LIC. NO. MAIN BVILDIN7�G ACCESSORV BUIIDiNG
�h OF LOT (��X � v/, NOW ON LO S I ( Ro� C/L S��F7.• L F
a USE OF � ��
.,N.. EXI5TING BLDG. � S
FSeparate permits are required for L. SIDE � O'� FT. F
� e]ectric, plumbing and heating work. REAR A7�p� F
[.. USE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BET. MAIN &
Q� Gfi/1 MAIN BLDGS. ACCEffi. BLOG
a/!/ C�/`� �/1i��7C � ���1 L^ G VRP.qW ,I APPROVEO
� X APPROVED ��✓�(v �
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� I hareby acknowletlpe that I heve reatl this applleailon entl stnta
y� Mat ihe ebovo Info�metlon is correct antl agrea io comply wiih
a ell laws re9uleHng bulltllnB conscrue<ion, entl I shall not employ
Z eny person In vloletlon o1 the workmen's compensation lawe of
TMe Steu of CalHornle. �
3 I heraby cenity thet 1 em D�operly IlcenuO ea e eon<ractor untler 54. FT.
tho Stnte of Californle Bucinan and Profesalons Coda, Olvlelon 3, THE AMOUNT SHOWN UNDEF VALUP
Chepier 9, entl thet auch Iic�ntef ere In futl forca entl offect, or I THE PURPOSE OF ESTABL6HING A PERM
em exempt from the provl�lons of ihe Smte of Callfornia Buainen VALUATION PERMIT FEE E
end Profasaione Cotla, Dlvlsian 3, Chepter 9.
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