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Home My WebLink About3304 HARBOR BLVD - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 3304 HARBOR BL TPN00030 Status: �SSUED Applied: 07/19/2002 Issued: 07/19/2002 c_ • Applicant LYLE COOTER -- __ ISSUED BY: >� -, _%� -,. . , _ Address: 188TECHNOLOGY �-"�: ;� f��= -- -- � " " _ ' . SUITEC /� �/�� "` . �Phone: (949)4538500 ��-� �_- / IRVWE . ��%.= = "-_ � Zip: 92718 . ,'`�:��;�r-�. i� . - � , . � . '. . . _ .� " . ', , . ' .� %'`� �\-_�� / � , . . . .' _ _ ` _ ' � i .,✓ /'!`- �.� ,, -. -: - ' � , , ��` ,� � Owner. �HENRY T SEGERSTROM PROP LLC ` - - � � � �� \i \ �� Address- �3315FAIRVIEW.RD;,� - - � - � ,�� ,A� � �. /,� / i ��`". � � ,� . �� ' � � Phone: �� / � �� i , . . . '-�� . A %- � ' COSTA MESA CA Zip: 92626-1610 ��'�` �� / � �'�A � / , :�;�. .r .��A. �.. � , i � . , . �� : � . . , ' � _ Contracror: � SR�BRAY CORP/DBAPOWER•PLUS TEMP UTILITY SERVICES ,�'i �`: ��'�,..-' ' �'� , Aildress: ,681 �S PARKER �ST - "��`�. � ` . ' . � � � . . �,��. � � � � � . . STE 300 , � � � ,�„-Ph ne �714-764 0020 , . ' � ' � }` 1 , ��,: �` 1\\ �t , -� ,ORANGE. CA r � ��" `"= Lp. -92868 �- � � � � `� ` , , � _ _ _ -�. i � - ,� '�, � . � , o - � \ � License: 523596 � ��:�� ` ,. // \�\,- � >�' � ., '. �'. , � �.. "'� , , . _ . . " i �� . „ . � � SCOPE OF PERMIT , / ` / � TEMPORARY POWER POLE AND 1"SUBPOLE. � ' ��=_ - �� ' � � 4�- - ��. .. ,�.., ._ �._, __....._'o ..._.. . . 7/29/02: CORRECTED CONTRACTOR'S INFORMATION. . . . , � , �-�, _ � � , �. . „ �. .- ,. .. _ ., � �' -" `�`FEE SUMMARY- :,�� . "I�I � �t = � ' '-- . ii � a . � � � Quantity // ,� QuanGty '- , , � � ISSUE FEE � $23.50 � Temp Dist System / Lighting � _ $0.00 0 � � � " , � Temp service test - $0.00 Busway /700 8 ' � $0.00 0 , � . ' � Res. a/c package � ,; $0.00 Standing Section " .$0.00 �0�. � � i� New Res (1-2 units) ; - $0.00 0 �.,:j'bMisaElectrical Equipment ,$0.00 i�0/� „ , ,'� New Res (3+unit5) ' , $0.00 0 " � ' �Transformers up to 1 kva/kw $0.00 !' 0 Pool / Spa� � ,, �"-,$0.00 � 0 '' �`"'., � ... .. ......up to,10 kva/kw $0.00`",j � �0 � � Lighting Fixls;- A $0.00 ., 0 ;�. ., , % � ..: ............up to�50 kva/kw :_ . $ODO�� 0 , ,��. � - ReceptOutlets '`� . $0:00� � -..� 0` " .L..".�„ � : � .up to>100 kva/kw � $0.00 0 � � t � � Switches �'- � � �,�,�$0 00�; 0 .:... � . over 100 kva/kw �� $0.00/ ,� 0 j� � � Non Res Appl � �,,� � � $0 00 ' � �� 0 ' ; �.� � � Low Voltage Equlpment - _,: $0 00-� � 0. / � /� Res Appl �� -. � � ' $0.00 � �' 0 �" - Low Volt Wiring�System / Ckt �' $0.00 ��, 0 �%� � Serviceto200a �- � . $0.00�- �0� -- _ _ Misc.Condult -- - � , ,$0,00'� �" 0 . �/ Service to 1000a $0.00 � � .0 - - � Misa Conductor . � , � ` '$0.00 � /-0, �/ Service over 1000a � ' $0.00, `, " '� 0 - � _ - Circus ( gen or ride) , ,� i$0.00 , -� j 0%� Motors to 1 hp "$0.00 `� ' i,-0' i' � � Circus (mech ride or lighis) :"$0.00%i/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- ; ";_ :� ��,r-' $OAO Motors over 100hp $0.00 ��-0� - -- - - - _-�i,!; �' Communication drops $0.00 0 � : ' � - � Irtvestigation Fee � � $0.00 Sub panel to 200a $0.00 0 � �-Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES $59.30 Intermed Pole $72.30 1 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related I regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandonad for a period ot 1 BO days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlona and final epp�oval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this pertnit. _- FOR INSPECTIONS CALL: (714) 754-5626 r�..�..;. ;. �'� 1 WORKERS'COMPENSAnON DECLARATON: I hereby attirm under penalry at perjury one of Ihe tollowing daclerations: � � - � "� � I have and will meintain a cenificate of consent to self-Insure for workers' compensation, as provitletl for by section 3700 of the Lebor Code, for tha pedormence of the ��ork tor whic� this permit is issued. .[J I hava entl will maintain workers' compensatlon insu2nce, es requiretl by section 3700 of ihe Lebor Code, for the peAortnance of tha work for which Nis permit is issued. My warkers' com ensation Insurence wrrier end policy number ere: . Certier. �'� �.n nJn Policy Number: � S� J�/J (This secfion neetl no b� e campletetl i! the permit is valuetl af one hundred dollars (5100) or less.) ' ❑ I certity that in ihe pertortnance of tha work tor which Ihis permit is issued, I shall not employ eny person in any manner so as to bacome subject to the workers' compansetlon lews of California, end at if I shoultl become sub�ect to Ihe workere' compensation provisions ol Section 3700 of Ihe Labor Coae, I shell forthwith comply with these provisions. � �� L . Applicam Signature: �� Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUT AND SHALL SU&IECT PN EMPLOYER TO CRiMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED THOUSAND DdlARE (5100,000), IN ADDRION TO THE WST OF COMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 31080F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm t�at I em licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Prolessions Code, antl my Ilcense Is in tull force end ettect. Lia a��'tT g Class x /'�z o Contractofs Signeture: � Date: 7� �-r Dar� CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that Ihere is a construction lentling egency for ihe pedormence of lhe work tor which this permit is issuetl. (Sec. 3097, Civil Cotle). Lendafs Name: Lendefs Address: Signature: ' Date: OWNER-BUILDER DECLARATIONS: I hereby ettlrm ihat untler penalry ot perjury Ihat I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professlans Code: Any ciry or counry which requires a pertnit to construcf, atler, improve, tlemolish, or repair any struclure, pnor lo its issuance, also requires the applicant tor suc� permil to file a signetl stalement ihat he or she is Ilcensed pursuanl to Ihe pwvisions of Ihe Contractore License Law (Ghepter 9(commencing wit� Sectlon 7000) of Division 3 oi Ihe Business end Professions Code) or that he or she is exempt Iherefrom and the basis tor the allegetl exemption. Any violation ot Sedian 7031.5 by any epplicant far a permit subjecis ihe applicant to a civil penalty of not more than five hunCretl dollars ($500).): ❑ I, as owner ot the property, or my employees with weges as Iheir sole compensation, WILI DO 7ME WORK, antl ihe structure Is no1 Intentletl or ottere0 for sele (Sec. 7044, Business end Professions Code: The Contractors License Law does not apply to an owner oi property who builds or improves thereon, antl who tloes such work himseN or horself or through his or her own employees, pmvitled thet such impmvemenis ere not Intended or oflered for sale. If, however, the building or improvement Is sold within ona year of completion, the owner-huilder will have ihe burden of proving Ihat he or she did not build or improve tor Durpose of sele.). � I, es owner of the properry, am EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business ana Professlons Code: The contrectors License Law does not epply ta an owner of propeny who 6uilds or Improves thereon, end who coniracis for such projed with e contrector(s) licensa pursuent to the Coniractor5 LicenSe Laws.). ❑ I am exempt under sec. Business entl Professions Code for this reason: Signeture: Date: Owner ID ventied by drivers license. ❑ Ves ❑ No Dnvers License No. Expires: Vedlication af Ownership by (typa at document, i.e. - property tez blll or deetl): DIVISION OF INOUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity that no exwvetion five (5) or mora teet in tlepth into which e person is required to descand, will be made in connection with work aut�orized by this permit, end Ihat no building structure, scattolding, felsework, or demolition or dismantling thareol, will be more than ihirry-six (36) feet high. (Chap. 32, Carp 2, Art 2, Sec. 341, Tltle B, Calitornia Atlminisirelive Cotle). ❑ As awner-builder, I will not employ anyone to do work which would require a permit irom the Division al Industrial Satery, as noietl ehove, unless such person has e pertnit to tlo such work From the tlivision. Signeture: Date: Division ot Industriel Sefety Permit Number: CERTIFlCATE OF COMPl1ANCE AND AUTHORVJITON OF ENTfiV: I cenity under penalry ot perjury Ihat I have read this applicetion antl state ihat the inlormation given is wrrect. I egrea to comply with all s;ate laws and ciry ordlnances relating to building construction, and euthonze representatives ot Ihe Ciry ot Costa Mesa to enier upon iha ebove-descnbed proDerty for inspection Ourposes. I egree not to occupy or ellow occupancy of any building authorized by this permit until finel inspection. GOOE �. INSFECTONTYPE 1616 FIzeC System Final Pire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel BIocWReWining Well 202 Final Factory Fira Place 203 204 Final Slgn Final Demolition Owner(s) App'cant PdIE 1[�l5 Date � 7 �� ate � CODE� INSPECTIONTYPE � 206 Final Mec�aniCal 20B 210 212 220 222 � 250 Flnel Plumbing Finel Electricel Final Fire Prevention Final Planning Approval Final Site Final Builtling/Occupancy PAg It�l� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,lobAddress: 3304 HARBORBL Status: ISSUED Suite No Applied: 07l19/2002 Vicinity: Issued: 07/19/2002 Parcel Nunmber: TPN00030 6 Applicane LYLE COOTER Address: 'IBSTECHNOLOGY _- �; � . � � _ � _ _ �, . SUITE C � � Phone: (949) 453-8500 '� IRVINE,-".� . , � � Zip: 92718 � � : �-.,�� , _ . � � / % ' • � � Owner.' HENRY T SEGERSTROM PROP LLC -' Address ;; 3315 FAIRVIEW RD- � � Phone: �� COSTA MESA CA Zip: 92626-1610 Contractor: ' KEMNITZ A/C & HEATING Address: �188 TECHNOLOGY � - -� � SUITE C' , � - Phone: (949) 453-8500 - IRVINE . � Zip: -92718 � . � . � � License: 695874 ISSUE FEE Temp service tesl Res. a/c package New Res (t-2 units) New Res (3+units) Pool / Spa , � Lighting Fixts Recept Outlets Switches Non Res Appl � Res Appl Service to 200a\ � Service to 1000a � �� Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole � Intermed Pole ISSUED BY: V �" ' , - , SCOPE OF PERMIT TEMPORARY POWER POLE AND 1 SUBPOLE. - -• . ' � Quantity - $23.50 $0.00 $0.00 $0.00 0 $0.00 0 $0.00 0 $0.00 0 � � $0.00 0 $0.00�. i�.-;•,.�r. - �$0.00� � � 0 � $0.00 � :��0 ' $0.00 �� 0. $0.00 ' 0 � � $0.00 � � 0 � � $0.00� � 0 , $0.00 ' "'0 = $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $23.50 1 $12.30 1 FEESUMMARY - -- � - . . Quantity � � � Temp Dist System / Lighting $0.00 0 Buswaylt00ft $0.00 0 Standing Section $0.00 0 ' Misc Elechical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 .. ..:.......: � �- {::...:,:.;,....up to 10 kva/kw $0.00 . �.: 0' . , ". � -. -' .........:....: .up to 50 kva/kw $0.00 � 0 - � � .............".:..up to 100 kva/kw $0.00 � -' 0 .� � .....:............over.100 kva/kw � - .,$0.00 � � 0 ' � " Low Voltage Equipment ' � $0.00� 0 � Low Volt Wiring System / Ckt '$0.00 �' 0 Misa Conduit � , $0.00 : ,0 Misa Conductor � , � $0.00 0 � � Circus ( gen ar ride) - , $0.00 0 � � Circus (mech ride or IighLs) ` - $0.00' : - 0 ChristmasTreeStand� . $0.00- � 0 � � � FireworksStand � ' $0.00' .' 0 ' Other ElecVical Fee . $0.00 Investigation Fee - � $0.00 Plan-Check Fee ' $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $59.30 COMMENTS / SPECIAL CONDITIONS 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 il work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized unde� this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapettio�s and fl�al approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL• (714) 7545626 _ � zaae-ae Pvau7 WORKERS' COMPENSAnON DECLAfiAnON: I hereby eHirtn under penalry of perjury one oi the following Oeclereilons: �I � I �eve entl will melntein e certificete af consent to self-Insure for warkers' compensatlan, es providetl for by section 3700 ot the Lebar Cotle, for the peAormence of the work far which ihis pertnit Is Issuetl, . �I hava antl wiil mainWin workers' compensation Insurence, es requiretl �y section 3700 of Ihe Lebor Coda, for the pertortnance of Ihe woAc for which this permit is Issuetl. My workero' compensetlon Insurence carrier and policy number are: � 1'.'/� CaMer. U N L Policy NumbA�� )�7�� _ (Thls sectlwr neetl not be comp/efetl i! the pertniNs e a d d /ars (Sf 00J w Iess.J �� ❑ 1 certily that in the pertortnance of Ihe wo or which this pertnil is Iuued, I shall not employ eny person in any manner so as to become subjed to Ihe workers' carJr 'on laws of Cellfomia, end eg thet II I should Decome subject to the workers' wmpensation proNsions of Sectlon 3700 of Ihe Lebor Code, I shall fohhwlih es6 provi5i0n9. Icent Si e: � � � /q � W ILURE TO SECURE WORKERS' PENSATION COVEMOE IS UNLAWFUL AND SHALL SU&IECi AN EMPI TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TF70USAND OOLLARE (5100.000), IN ADDITION TO THE COST OF COMPENSATION, DAALIGES AS PROVIDED f-0R IN SECTION 3]OB OF THE LABOR CODE, INTEREST, fWD ATTOfiNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 �ereDy eNl I am Iicensed u er provisions ot Chapter 9(commencing with Section 7000) at DlWsion 3 ot the Business entl Professions Code, antl my license is in full rorce en tt Lic. a e _ ��/q P 2,0 r n�.o�rn .•CTnnann� �F �^ _ i /: � e� 4c.2� �sr CONS7RUC710N LENDING AGENCY: � ❑ I hereby ettirtn thal there is e construdion lendinp egency br ihe pedormance of iha work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: LendeYs Address: Signeture: De�e: OWNER•BUILDER DECLARATIONS: I hereby atHrtn that untler penalry af per�ury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor t�e following reason (Sec. 7031.5, Business end Professions Code: Any dry or couny which requires e pertnit to construct, alter, improve, tlemolish, or repeir eny sWCNre, pdor to its issuance, elso requires the epplicent for such pertnit to file e signed statement that he or she is I�ensed pursuent to the provislons ot the Contrectors License Lew (Chapter 9(commendng wiih Section 7000) of OMslon 3 of Ne Busineu enA Pmfessions Cade) or that he or she is e:empt therefrom and the basis for t�e ellegeG e:emption. Any Woletion of Section 7031.5 by any applicam for e pertnit SUD�eCts the applicant to a Clvil penelry ot not mofe ihen five hundretl Gollers ($500).): ❑ I, as owner af ihe properry, or my employees wit� wages es their sole compensation, WILL DO TME WORK, end Ihe structure Is not intended or otlered far sale (Sec. 7044, Business and Professions Code: The Conirectors Llcense Law tices not epply lo an ownar of proDerry who builds or improves theraon, and who does such work himseli or herself ar Ihraugh hls or her own employees, provided ihet such Improvements ere not intentled or oNeretl for sele. If, however, Ihe bullding or impravement is sold within one yeer oi completion, Ihe owner-builtler wlll heve the burden of proving thet he or she ditl not build or improve for purpose of sele.). ❑ I, es owner of iha property, em E%CWSIVELY CON7RACTING WITH LICENSED CONTBACTORS to construct the project (Sec. 7044, Business end Prolessions Code: The contractors License Law tloes not apply ro en owner oi properry who builds or impmves thereon, end who comracts for such project with e contractoqs) license pursuant to ihe Comrectors License Lews.). ❑ 1 am exempt under sec. Signature: Owner ID verifiad by dnver's liCenSe. ❑ VB5 ❑ No Business end Professions Code lor Ihis reason: Vedlication of Ownerehip by (rype of dwument, i.e. - properry ta: blll or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATION: Driver's License Na. Date: Ezpiras: ❑' I hereby certity Ihat no excavation five (5) or more feet in depth into which e parson Is requlred to descend, wlll be mede In connectian with work euthorized 6y this pertni6 end that no building sWcture, scaHolding, falsework, or demolition or dismantling ihereol, will be more than ihirty-six (36) teet high. (C�ap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Calitomia ACministralive Code). ❑ As owner-builder, I will not employ enyone to do work which would require a permit Irom Ue Division of Indusinel Safety, es notetl above, unleu such person haz e partnit ro do such work irom the division. Signelure: Date: Division ot Intlustnal Sefety Permit Number: ICER7IFlCATE OF COMPl1ANCE AND AIJfHORIZA710N OF ENTAY: I cenity under penalry at perjury that I have read this application and state that the infortnatlon given is I wrtect I egree to comply with sll state laws and ciry ordinences relating to builtling constructlon, end euthorize representetives ot the Ciry of Coste Mesa to enter upon ihe ebove-described property for inspection purposes. I agree not to occupy or ellow acupancy ot eny building authorized by Ihis permit until finel inspection. COOE 1. INSPECTIONTYPE 1618 Fixed System Final Fire Prevention �z�� 200 Pool Spa Final Finel Re-Roof 201 FIneI BIxWRetaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Final Demolition [Idjf, INfR1AL5 £Qy�� INSPECTIONTYPE 208 Final Mechanlcal 208 Finel Plumbing 210 � Final Eleciricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PAg e+�lELfi � ��a) �sa-sz�s • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE. GOSTA MESA, GA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 3304 HARBOR BL B TPN00030 Applicant: COOTER, LYLE Status: ISSUED Applied: 07129/2002 Issued: 07/29/2002 O ��, / � ' �� Address: 188TECHNOLOGY �_ -,.�.!_ - � �- --, STE C � �� - � Phone: 949-453-8500 ��_ � � � , , \ IRVINE, CA: i'. �" - � � Zip: 92718 �� ."� � � �. � , ��. �� '� � � �� - � - _ _ . �/, � , i' �� i - � . �- � _ ) i �� Owner. ' HENRY T SEGERSTROM PROP LLC �- �, Address - 3315 FAIRVIEW RD -� - � � � � � �� , . ., � -�- i ' , � � , , � . � Phone: � _ , ' ' COSTA MESA CA Zip: 9262G1610 � i - � , �, . � � � � ., `, . - �,� Contrector. SR-BR,4Y CORPIDBAPOWEF��PLUS TEMP UTILITY SERVICES Address: � 681 S PARKER ST ,ti " . , i - - � STE 300 � �Pfibne: 714-764-0020 , � " , / . ORANGE,CA � ' �." �_ � Zip: 92868 , .� � � , � � - �� - - License: 523596 - � i i � SCOPE OF PERMIT 1 TEMPORARY POWER POLE j . � � / � ' � �� V � �' . .. ._ . . v' ' _ . _. !._ . . � ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighling Fizts � Recept Outlets Switches ; Non Res Appl � �� - Res Appl Service to 200a � Service to 1000a � � , Service over t000a Motors to 1hp � Motors to 10hp ' Mo[ors to SOhp Motors to 700hp Motors over 100hp Communication drops Sub panel l0 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Quantiry -_ � $23.50 $0.00 $0.00 � $0.00 0 $0.00 0 50.00 0 $0.00 0 - �'„50.00 0 , \$0.00 0 . $0:00 � � --' 0 so.00 � , o $0.00 0 - $0.00 .��0-� , -$0.00 , 0 � . $0.00 0 � � 30.00. � 0 � - 50.00 - �.' . 0 , - `50.00 �. � 0 . 50.00 0 50.00 .. �=. p ..- � 5000 ��-0 FEE SUMMARY „ . , . . , , ., puantity . ; Temp Dist System LLighting . $0.00 0 Busway /100 ft - $0.00 0 � . Standing Section .., $0.00 0 Misc Electdpl Equipmenl �'$0.00 0 � Transformers up to 1 kva/kw $0.00 0� . �� .....:..........up to 10 kva/kw 50.00 0, �, � ...........:.....uP to 50 kva/kw $0.00 ' �0 � � .................up to.700 kva/kw $0.00` , "0 � ..................over 100 kva/kw �. $0.00� 0 � ' � � Low Voltage Equipmenb ��" � - � - �50.00 � 0 � . Low Voll Wiring Syslem / Ckt $0.00 ; �� 0 Misc: Conduit - = 50.00 ;� 0 - Misa Conductor " . � $0.00 ; 0 � Circus ( gen or ride) * $0;00�. 0� � Circus (mech ride or lighls) � � $0.00 � .-0 " ' Christmas Tree Stand � � $0.00 , - � 0 Fireworks Stand, , . � 50.00,: /0 � Other Eleclrical Fee , $0.00/' $0.00 0 ' �. �� $0.00 0 $23.50 1 $0.00 0 i � - � `Investigation Fee _ -' ��" � $0.00 _ _ Plan Check Fee �. - . ' 50.00 � � Reinspection Fee - � " 50.00 TOTAL CALCULATED FEES f47.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requlrements under Califomia statutes and related regulations. (Orcl. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatica�ly expire and become void it work Is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order lor ihe work aulhorized under this permi� to be considered legel, such woAc rtwS� Comply with all applicable codes, and all required inapectlone and finel approval must be obtained. Failure lo obtain inspections and final approval will result in the expiration of thls pertnit. FOR INSPECTIONS CALL: (7/4) 7545628 :Zg!:�r:!(:rb➢ WORKERS'COMPENSAnON DECLARAnON: . � � I hareby aHirm under penalry of perjury one oi Ihe following declarations: � '. _ ❑ I heve erid wlll meintain a certilicate ot consem ro sell-Insure for workers' compensetion, es provided for by section 3700 af the Lebor Coae, for the pertarmance of the wark for which ihis pertnit is issueC. � I �ave anO will meintain workers' compensetion insurance, as requiretl by secfbn 3700 of the Latwr Code, for Ihe pertortnaxa ot the work lar which ihis peimit Lv IsweC. My warkers' com satlon Insurence renfer and poliry number ere: ) Certier. 4T� ✓� �� Polity Number. � S� �� `� (Th/s secfion need nat be comp/eted �7 Me pemut is ve/uetl ef one hundred dollars (S I00) or less.) ❑ I certity thet in Iha paAortnance ol the work tor which t�is permic is issueq I shall not employ eny person in eny manner so as to became suD�ect to the workers' compensallon laws of Celifomia, entl egree thet it I shoulC bewme sub�ect to the workers' compensetion provislons ot Sectlon 3700 at t�e Lebor Code, I shell forthwith comply with Ihese pmvisions. � /] S �-7 Applicant Signature: Dete: / L / � WARNINO: FNLURE TO SECURE WORKERS' ENSATION COVEMOE IS UMAWFUL AND SNML Sl/B1ECT Ml EMPLOYER TO CRIMI PENALTIES AND CNIL FlNES UP TO ONE HUNDRED T/MJUSAND OOLLARE (5100,000), IN ADDITIIXJ TO THE CQST OF OOMPENSATIIXJ, DAM4GES AS FROVIDED f-0R IN SECTION 3]OB OF 1HE IABOR CODE, INTEPE5T, AND ATTORNENS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn Ihat I em lorce end eNett. Lic. k_ Contrectofs Signamre: Chepter 9(commenGng wlih Section 7000) of Dlvislon 3 of the Business enC Pro ess na Catle, and my Ilcense Is in full i a_ cless a ��— Date: `7�� T -�— CONSTRUCTION LENOING AGENCY: ❑ I hereby eMirm thet there is e construction Iending egency for the pertormence ol the work lor which this pertnit is issuad. (Sec. 3097, CiWI Code). Lenders Name: Lentlels AtlOress: Signawra: ' Date: OWNEH-BUILDER DECIARATIONS: I hereby eMirm ihat under penelry oi pehury ihat I em EXEMPT FROM 7HE CON7RACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business en0 Protessions Code: Any ciry or counry which requires e permit to consiruct, elter, imprwe, tlemolis�, or repair any sWctura, pnor to its issuance, elso requires the applicant for such permit to file e slgned stetement that he or she Is Iicensad pursuent to ihe pmNsions ol t�e Contrectors License Law (Chapter 9(commencing wiN Sectlon 7000) ot Dlvision 3 of the Business entl Profeuions Code) or Net he or she is exempt therefrom and the besis for the allegeA e:emption. Any Woletlan ot Sactlon 7031.5 by any applicent far a pertnit subjecis the epplicent to e civil penalry oi not more than live hundred tlallers (5500).): ❑ I, as owner ot Ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the sWcture is not Intendetl or oXared lar sale (Sec. 7044, Business end Professions Code: The Contrectors License Law tloes not apply to an owner of properTy who 6uilds or improves Ihereon, and who does such work himsetl or hersell or through his or her own employaes, D��ded that such imprwements are not In�ended or oHered for sale. If, however, Ihe 6uilding or Imprrnement is soltl within one year of completion, the owner-builtler will �ave ihe burden of proving that he or sha did not build or improve for purpose of sale.�. ❑ I, as owner of the property, am E%C�USIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business and Professions Code: The contraclors License Lew tloes not epply t0 en owner of pro0erty who �uilds or Improves Ihereon, antl who conirecls for such projed with a conlreaor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt untler sec. � Business and Prafessions Code for this reason: Signature: Date: Owner ID venfied by drivels license. ❑ Ves ❑ No Orivers License No. Venticetion oi Ownership by (rype ol tlocumant, i.e. - property ta¢ blil or Ceetl): Expire5: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I �ereby cently that no excavation Me (5) or more teet in depth into whlch e person is required to descend, wlll be matle In connectlm wilh work authorized Dy this pertnil, and �hat no building structure, scattolding, telsewoAc, or tlemolition or dismantling Ihereol, will be more �hen t�irry-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia AtlmiNstrative Cotle). ❑ As owner-bullder, I will nat emplay enyone ro tlo work w�ich would requlre e Dermit imm the Division of Industriel Sefety, es notetl ebovo, unless such peraon hes e permit to tlo such work Irom the tlivision. Signature: Date: DiviSion ot Indu9lnBl Sefe�y Permil Number: CERTIFlCATE OF COMPLIANCE AND AUTHOFiIZATION OF ENTRV: I certify untler penelty ot perjury thel I have read thls epplication entl stete thet ihe infortnation given is correct. I egree to comply wlth all s;ete lews end ciry ortlinances releting to Dulltling constructlan, entl euthonze representatives ol the Clry of Costa Mesa to enter upon the above-descriDed property to ' pection purposes. I egree not to occuDY or ellow occupancy ot eny building authorized by Ihis permit until linal Inspection. � ignaWreOt �al� ner(s) Date �_�� T�� AnNOrAuth, plicent —��—� ate COOE �. INSVECTIONTYVE 1676 Fixed System Final Fire Preven�lon 1288 200 Pod Spe Finel Finel RaRoo1 201 Finel BIocWRetelning Well 202 Finel Fectory Fire Place 203 Final Sign 204 Finel Demoli6on . Q� �� f,� INSPECTIONTYYE 206 Finel Mechanlcal 20B Finel Plumbing 270 Final Electdcal 212 Final Fire Preventlon 220 Finel Planning Approvel 222 Finel Site , 250 Final Building/Occupency �g �