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Home My WebLink About373 FAIR DR - Building Permits� CITY OF COSTA MESA � , sva�►iv� o►v►s�oN F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • fax (714) 754-4856 • wv✓w.ci.costa-mesa.ca.us �, ` FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER E08-00001 PERMIT TYPE ELEC STATUS: ISSUED APN: TPN007245 DATE ISSUED: 01/02/2008 - ISSUED BY: SOK JOB ADDRESS: 372 FAIR DR CM � Suite/Unit� Viciniry: . SCOPE OF WORK: INSTALL NEW 100 AMP�SERVICEMETER PEDESTAL FOR"AT,AND T" :�� `' -`��;.'+ ,.. � OWNER: CITY OF COSTA MESA � .. Address: Unit: - � PHONE: �. �� . � City/State2ip: ' ��- . APPLICANT: JANAE WICLIS �.� �, ,. - . Address: 1921 W 11TH�ST Unit: PHONE: 909-946-0905 ' � - -� � City/StatelzZip: -�. UPLAND, CA , � , I , y" " , .. , CONTRACTOR: VCI TELECOM License No. 765716 Address: 1921 W 11TH STUniL PHONE: 909-946-0905 � � CitylState: UPLAND, CA ZipCode: 91786 � CELL: ELECTRICAL PERMIT FEES : Electrical Plan Check Fee: $0.00 Electrical Permit Fee: ' $54.00 � Reinspection Fee $0 00 , z .: TOTAL FEES � $54.00 " .' , NOTICE: The work authonzed 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 fnal approval will result in the expiretion of this permit. U/. INSPEC710NTVPE OA INTITI�LS CODE/ INSPECl10NTYPE UR ,T INTITIALS 1818 Fized System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final . 208 Final PlumDing W�'�`� 200 Final Re-Roof 210 Final Electncal � 201 Final BIocWRelaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSign 222 Final Site 204 Final Demolition 250 Final Building/OCCupancy WORKERS'COMPENSATION DECLARATION� I hereby affrm under penalty of perjury one of Ihe following declaretions: ❑ I have and will main[ain a certificate of consent ro self-Insure for vrorkers' compensalion, as provided !or by section 3700 of Ihe Labor Cotle, for the peAormance of the vrork for which this permit is issued. ��ave and will maintain workers' compensation insurance. as required by n 3700 of the Labor Code, for the pedormance of lhe v.ork for which Ihis pertnit is issued. My workers' compensation Insurance carrier and policy numDer are,:� p^1, � � Cartiei:� l E J �lvU.� �� . �, �M1LC'�ee0'not/0e/romynett�INe/pe�rrtri4--i5value0atone�untlretlEOEarsf5100idk551 ' ol�icy'p` N�,u�m_ber_�. �,/"l�( .: J�� LJ ��^i ❑ I certify that in the peKormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject [o lhe workers' compensation laws o( Califomia, antl agree that if I shoultl become subject to the workers' compensalion provisions of Section 3700 of the de, I shall forthwith comply with Ihese pmvi �ons. -L� / D� � ��Apphcanfs5ipnaWre._ . .. te -� A G: 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 CAST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot ihe Business and Professions Code, and my license is in tull torce and effect. ..---ir! n C'7/ /„ _. -.._.il �/ - % /'� ) ip�',.� ::�...�-=._. .,-, .._. _, STRUCTION LENDING AGENCV: ❑ I hereby aKrm that there is a construction lentling agency for the perfortnance of the work for wfiich this pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: SignaWre OWNER-BUILDER DECLARATIONS: I hereby aNirtn that under penally of perjury thal I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for lha following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to consiruct, aller, improve, aemolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to (le a signed slatement lhat he or she is licensed pureuant to the provisions of lhe Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of Ihe Business and Pro(essions Code) or that he or she is exempt therefrom and the basis tor the allegetl exemption. Any violalion of Section 7031.5 by any applicant for a permit subjecls [he applicaM 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 wmpensation, WILL DO THE WORK, and the structure is not intended or ottered for sale (Sec. 7044, Business and Professions Code: The Contractors �icense Law tloes not apply to an owner of property who builds or improves Ihereon, and who dces such work himsel( or herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If, however, the builtling or improvement is sold within one year of completioq lhe owner-builder will have the burtlen of pmving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of ihe property, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRAC70RS to construct the project (Sec. 7644, Business and Pro(essbns Code: The contractas License Law dces no[ 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 Contrectors License Laws.). ❑. I am exempt under sec. Business and Professions Code for this reason: 305]�a6 (3roJ) Owner ID verified by driv. ' Dfrvbr'sLicense No. .ce... .. ❑ Yes ❑ No Expires: Verification of Ovmership by (type of tlocument, i.e. • property tax Dill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more feet m dep[h into which a person is requiretl to tlescend, will be made in connection with work authorizetl by IhiS pertniC and that no building sWCWre, scaf(dding, false�+ork, or demoli�ion or dismantling thereof, will be more than IhiRy-sa (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Tille 8, Califomia AdministraWe Code). ❑ As ovmer-buil0er, I will not employ anyone to do work which v,ould require a permit from the Division o( Industrial Safety, as noted above, unless such person has a permit to do such work fmm the division. APo��'s SignaWre Division of Intlustrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or pre5ent or future building occupant neetl to file and certify a Business Plan for emergency response to release or Ihreatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health and Safery Code requires, with some exceptions, lhat a Business Plan be filed with the Costa Mesa Fire Depanment by every business which has at any one time dunng a reported year a quantiry of hazartlous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas at stanaartl temperature and pressure�. 2. Does or will the applicanl or present or future building occupant need b fle a registration form for acutely hazardous malerials? ❑ Yes ❑ No (Section 25533 of the Cali(omia Health and Sa(ety Code, with some ezceptions, requires registralion with ihe Costa Mesa Fire Department by each business which al any one time has on hand a quantity of acutely hazardous matenals equal to or greater than a vreight ot 500 pountls, or a volume ot 55 gallons, or 200 cubic feet of compresse0 gas at standard tempereture and pressure). 3. Does or will the applicant or present or fuNre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)1 ❑ Yes ❑ No (Section 25534 ot the Califomia Health and Safety Code provides thal the Costa Mesa Fire DepaAment may require the preparation, certifiwtion and fling wilh the Fire Department of an RMPP by businesses which are required to register acutely hazardous malerials with the Fire Deparlmenl. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the appliwnt or present or fuNre building otcupant require (or �he work whic� is the subjecl of this aDPlication a permit for such consWclion or motlification from the South Coast Air Qualiry Management District or irom any other air polWtion wntrol districl or agency? ❑ Yes ❑ No (Secl"an 658502 of Ihe Califomia Govemment Code requires that Ihe requestetl informatbn be fumished m applicatbns for roo-resitlential building pertnits). 6. Will any part of the faciliy to be constructed under this permit be wilhin 7000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf 'yes", Ihe facility must meet the requirement o( Sections 25534 and 42303 o( Ihe Califomia Heallh and Safety Code). 7. I( a pertnit from the South Coast Air Quality Management Districl or other air pollution coMrol district or agency is required for [he work which is the subject of Nis application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 heen made? ❑ Yes ❑ No B. (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 correcL I agree to comply with all state laws antl city ordinances regarding Hazardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and 51ate that the information given is comecl I agree to compty with all state laws and city ordinances relating to builtlinq constroction, and authorize representatives of the Ciry of Cosla Mesa to enter upon [he above-described property (or inspection purposes. I agree not to occupy or allow occupancy of any building authorizetl by Ihis pertnit until final inspection. QSignalureo/Le9alO.mer(s) �{ Oate " _ I //�,�..J.:t�tMNorAumonzeaAp0liwm .." y��ale „', ��..v�...._.Y�� .i -. � }_. V �