HomeMy WebLinkAbout543 VICTORIA ST - Building PermitsciTY'oF CosTA,nnEsa' . rCONSTR�UCTI ON. PER MIS
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' P�o;a�L Add�es=. _�W 3 v �c-roa,cA s-: ° a�U� 1°
Applicnnt's MailingAtldress , ZO�O �r�JSN�IcS,'S cf2 �C2. ��60
' S.e1/INo Gf�[
Owner's Name� ���+k'�a�t�a�_.Phone ��co y
Addresa �'%� � t
Arch/Eng.�+(fr]N� �-fii�r25 �•��•LicenseNo. �
� Address .�-_LL� �✓. ICr1f& L.Fk � -gZ��� 1
Convactor's Name �L�� C��i�� � 'Phone u �F.�__�zooy,
Address (mailingl � ��M� � � 'J ' �
)� L
City License No. —i �'+�""� � - ^ j th
� LICENSED CONTRACT00. DE[L'ARATION , � ]. „ �) � �� (
I nereby afiirm t�at I am IlceniM untler provislons ot Charter 9(commencin9 .
with sectlon 7000) of Divislon 3 al lhe Business and ProfeSSlons�Cotle; antl
my Iicense is in f W I torce ana ellect. '^' � 4 i �
UC¢f158 CId55�J,r� ¢ SC N. � ��' � {
Date �—'� p.z�— Si9nature � � �� �
WORKERS' COMPENSATION O�CLARATIe=�> a ���: �
I hereby afBrm tnat I have a<ertlficate of consent to selt-insure or a,certlfl<a[e �
oi Workers' Compensation Insurance, or a certifietl cop�thoreot (Section
3800, Lab. 0.) L�
Policy No. Company -? /�/'C f{J/�. f� L-�
�C¢rtHietl copy ii hereby fumish¢a. 'J ,"� f
Cerli(ietl co�py c��flletl�with l�e citY By�iny�vl n y /' '�' �
oate � K,y— APOlicant `% 4 �����,�- ��': .
�/,1 EXEMPTION FROM WORKERS' CO�ENSATION D CE LAf3AT10N ,�
1� (This SeGtlon'neetl not b¢�completotl I� Ihe pa�mit is for OnO�huntlretl (5300) or• �
IBSS). ~ J�•�:� ]
,j^� I certify that in [he pertormanta of [he work for wnich thls parmR Is lssuatl; I' .
�j..J ihall not employ any pErson In any mdnn¢� so as to beCome SUbjecYto�the
Workers' Compensation Lzws o/ California. �"�, �. .�-� •�L'`'
Date - Si9nature ''��' � t'
NOTICE'It, aftei m5king this Geclaratlon, you shoultl `become sublect to the '
Workers' Compensation �provisions ot the Labor Cotle; you must forthwith '
(� comply with such p�ovizion5 or [hI5 pa�mit snall ba tleomoU �ovokatl.
CONSTRUCTION��ENOING AGENCV
1 hereby aillrm lfiat [here I5 a construction lentling-agency for the pertormance
ot th0 work' for'wnich Ihii permit IS Issuetl (Secllon 3097 Clv. CJ
� Lpntler's Name �`''
� Lentler'i Atlilress;� - � � � �
OWNER BUIL'OEH-�ECLARATION ,
I hareby aiflrm that�l�.am'exemo� irom tho Contractor's Licensa Lnw lor the
following roason>(Section 7031.5 Businesz antl Prot¢sslonal Cotle: Any city or
countY wtilch �equir¢i,a'pe�mll b�.ConSVucl; aller, improve, tlamolisbbr repai�
���,����. cey. � un.nnavy.euraer-..dai+�' ayM�wv��a�e m�.0 .uwu.
PERMIT NO. TRACT NO. LOT NO' y UNIT NO'.
8'32o6S 345 'POR II a,a,c,a,c F
TYPE OFCONSTRUCTION EW ADD ALTERATION REPAIR
y'0 CONVERSION ❑�DEMOLISH ❑.O.T.HER A p .ny � .:.I ^
, DESCRIPTION OF WORK/USE OF BL•DG. S Main Buildi
TV,PE.OFPERMIT GRADING FOVNDATION STRUCTVRAL � ;T Front �
•-�iT[NANT, ❑ ELECTRICAL ❑ PLUMBING � MECHAtvICAL 'B Rear
".4��.,o'rHeH - ` . .. � .. a
PROJECT DESCRIPTION SQ. FT. OCCuaAriGv C Right
K
,tCONSTRVCTIONTVPE V�N � VAWATIONS 'S left
�20NE _, GRADING CU. VOS. ACRES p�ng.�Ref. # L
Remarks: �, �$� Z[� � Q 7 d . ' „'Planning Nores:
O . ... �
a , . PLUMBING - � � ,
. Showers • '
� Service Sink � '
� SewerCap
Sewer Connection
� Solar Collecrors
; Solar Piping
� Solar.Tank
, Swimming Pool w/Spa
: itr�oar(' �
�_
Prevenier � .�
Irrigation � � '
e. '
Fountains ,
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Levatories
P—TroP •
Fioof Droins'
'Yt
Division 3 ol�tne Buzinoss ana aro�ossions�coae) or marnoisna rs aamN� � , � �
therclrom antl tbe�basis for the allogntl exemptlon. Any vlolation of Sectlon . �
7031.5 by any applicant tor a permit su�jects lho aDPJ�canl ro a clvil
�enalty �� noCmore [ban tive huntlretl tlollars.(E500).
1, as owno� o(� [he property nr my omPloyees wilh wdga5 as thal� So18 ROInSpOctian Pee $15
tompensatlon; willltl0'Itta work, antl tho structure ii not Intentletl or of/eretl
1or'sale (Sectlon �049, BUSiness antl-Protessiondl COtlO: Thc�CmtractOr's �
Llconse Law tloes not app1Y to an owner oi a Droper[y wM10 builtls or Improves
lharoon, antl w�o tloes sucM1 work himself/herself or through hii or her own Bailer '
employaus, provltletl tha[ such Improvements are not intontletl or ofteretl lor . •
'� Sale: If,'however; Ihe�bWltling Or ITProvement IS SOItl within one year O/ com-
�,plelion, the;Own¢r.will have the burtlan of proving he/sne tlitl nol bulltl or Im- DUCI � Und¢f GroUnd
prava lorthe purposa of sale). '
❑.I, as owner of the�property, am exclusivey contracting.wilh Iiconsetl con- Duct-Siructural
traclorsto tonstruct the�projecY(Sectlon 7044, Business antl Professions:Cotle: '
ThmContractor's Licensa Lsw dOes not aOPty to an Owner ol p�operty who Duct � Ventilating
bullGs�or� Improves thereon, antl wno Wntracts for such,projacls with a.con- � '
' tractor(sl uconse^Oursuanbto tne C6ntractor'S�-LiLense �aw�. 1 am'aware�tha( ExhaustSystem ❑ Multiple ❑
proof o( their Worker's Compensation insurance shoultl bo provitletl to ma. _
❑ I�am axempt untler Sectlon ' '��8. & P. C. /or this rcason' Fi�epl/Fact. Blt. ICBO #
Oaie � �Owner ' ' ` � Heating Syscem & Ducting '
1,heretiy.certify..ehai-I have reztl thls.applicatlon antl state'that the above �0.100,000 BTU'0100,OOOBT
inlormation is:coirect:.l agree to comoly wi[n;all city antl county ortllnances - -�'- - -
antl�'state• laws. elaHng lo iltl{i 9 consVuciion, tl hereby authorize repre-.. �. �� -, .
sentatives oi' �is it t� nt t upon the ab ve-mentionetl" property� for ' ^
InSpection p ,
. Siynature ' Date '�� �� � � _ ' ' . �
':Orivers' Li L �. � � �Rainspeetion Fee S75'
� CMF 0865-4fi, rev. 10/84 White - Bulltling; Canary - Applicanh Pink � Accountlng; Goltlenrotl � Astessor
; Water Heaeer �
; � . Issue Fee
c� _FEES
�
. �� �..
'. . i
�,:; FEB•-1 i9E8 �
�.,�, ,
` � Ji'!n�^ V /.d�td i
���
II� i'b �.b1
��8, ,
� ���: ,.
.ro 3 - �o�.d�f'�D rr
—��i�: L a/']'�'.' .
. AuromaticWasher�.
� � Construction Pole'SubS+
� Cooking Unit '
_ : � 7 Oishwasher _
Diyers-�Gas ❑Electric
�Fan ,
� F.A.U.....� . � . _I
�.
Fixtures
� Device Bazes
Outlets
S 3
Hood or Type I ❑
Canopy Type II ❑
fiefrigeraiionSys[em , '�
�0-100,OOOBTU 0100,OOOBTU
Sy'stem RepairlAlteration
F.ire Dampers '
o__..._,_ �f � . � .. �
..� . : � r .. :
�"z�� � � Isue Fee
$ 3
'1 ':.�r;� _ I_ � � Zone
Accessary Building: , �
ELEC7'RICAL
Transformer ❑ 75�50 KW
❑50+KW ,
' Meter Dup to 100 amps
Me[er �over 100 amps _
Sub Panel
Moton �0.1.HP � 1 R- 8
Inc.Solar �9�15 HP'016-15+
' Microwave
+ Pole Li9ht'
.. I Sign'_ ' '
� Garbage Oispowl � �; .
� Generator 00�5 KW �5-16 KW
.._. .. . _ �'.� ., .
� I Reinspection Fee
—
DEVELOPMENTSER
2oning Approved By _
� Building'ApprovadtBy
Auplication Issued BV_
'� '
ISSUB•FBB
, U MARV�F FEES � �7� 16
� BUICDING PERMIT $. = '" ' SMIP $ � �--.p —
' ' PLAN CHECK $ �'g� �=• � PERMIT ,
PLUMBING�� � $ ��UANCE $
PLAN CHECK 25% $' ENERGY P.C. $
ELECTRICAL $ � ` GRADING $
PLANCHECK� 50% $' MICROFILM $ ��
�� MECHANICAL � $ TOTAL PEE $ ���
! PLAN CHECK 25% . $
J' ---- POC SPA ' �
VSTRUf:TI(Sf� AND PLANNING I � I
.,�iOVALS �Permit# Date Inspector� qpppOVALS Permit�r` Date Insper.tor
1_ _Temporary Eiectrical Service or Pole 52. Pool & Equipment Location :•
2. Soil Pipe-Undrgmd.' � 53. Steel Reinforcement - . ,
I
3. Electrical Conduit Utility-Undrgrnd. 54. forms
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding ."
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER GmH.. Z Q�. 57. APPROVAL TO COVER-GUNITE
7. Footings ' � � �- 58. Electrical Conduft-Undrgind.
S. Foundation� � ' � � 59. Gas Pipe, � Undrgrnd., Test� - .
9. Water Pipe- ndrgrnd. ., 60. Backwash Lines, P-Trap,.O Undrgrnd.
10. Scructural Floor System 6 61. APPROVAL TO DECK .
i l. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
.
12. Sewer Cap 63. Heater & Venx-Final , � '
13. Roof Drains 64. Plumbing System - Final • .
74. Rough Plumbing 65. Electrical-Fina! _
15. Rough Electripl-Conduit 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ; �
�'.
78. Rough Electrical-T Bar Ceiling 69. POOVSPA SYSTEMS FINAL •+^ �
i9. Rough Heating & Air Condiiioning FIRE DEPT. RE�UIREMENT ,' �`-�
20. Rough Factory Fireplace APPROVALS Permit # _ ..
<:, . .
21. qucts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush ,
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil _-
25. Roof Sheathing 3� 74. Overhead Hydro ' �
26. T�Bar Ceiling (Struc[ural) & Monocoat 75. Dry Chemical ;
27. Freme and Flashing -1 � � p�- 76. Dry Standpipe ' �
28. I_athing & Siding 7 y7 � 77. FIXED SYSTEM FINAL ��
29. Insulation ( �8 � 78. FIRE PREV. FINAL
30. qrywall Nailing `� 6�. � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ��(1j p 79. FINAL INSPECTION .• � �
32. Flectrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED `
33. Final Eleciric Notes: .
�
34. Final Heating & Air Cqnditioning � .� �� ' p� � . 4 . ..
C
35. Final Gas Pipe-Test �,
36. Hood or Canopy ' 3, 5 F$ G'�qGi� �,.¢A�,,,,5 �s.N'
37. Final Factory Fireplace � � �p � �o ��, . ��-- "
i
38. Final Plumbing �' ) 6 K Pa � �5 J � ,y�� ' � �
39. Water Service�Final ' '
/
�40. Gas Service•Final � " / � •�
� 41. Solar pomestic-Final � '
42: Backflow Preventer ' � • �
43. Backfiow Irrigation _ ' '
44. Landscape Irrigation System � , ., . �
45. Sound Attenuation • , �
46. Nandicap Regulations , - ' '
�47. FINAL STRUCTURE & BUILDING ( • . ' i . • �
i , f�
48. Special Requirements Completed ��- p_ -(,��y,� ' ' � ' . ' � 1
49. �lec[ric Release to Edison - � ' ' •
i
50. Gas Release to Southem California Gas Co - ' Jr
51. CERTIFICATEOFOCCUPANCY ]� ;
No� Date " . .�� �.
City of ('qs2a Mesa
Development Servites Depariment
Building Safety Divisi0n
P, O� Box 1200
Costa Mesa, Califom4e
CERTIFICATE OF OCCUPANCY No. 00�3�47
The Building located at 5A3 V1.ctnt-1 t+ Strcis+h. Rni lAi n� A1 , nni tv A.�R.('.11, R. R
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R1 Occupancy. ,
Use of Building Aoartments �
Legal Description 422-021-07
(See reverse side for Metes and Bounds)
Building Permit No B 32065 Electrical Permit Nok�32514. E323°p�umbing Permit No. P 32] A2
Mechanical Permit No. M 34307, M32358 Number of apartments 6 and/or quest rooms
ISSUED T0:
ASA Enterpriaee, Inc.
[UbG ki1391r1i38 Center DC.> 81 U
Irvine, CA 92715
Building Official William T. Howard
by ��l .� %��� ---
Date Januecy 13� 1989 •
This Certificate of Occupancy SHAIL BE posted in a conspicuous place on the premises and SHALL NOT BE �emoved except by the
Building Official of the Citv of Costa Mesa under Sec. 307 (e) U.B.C. �
CMF 1o15-a6 rev. 1/83 White - Owneq Canary - Numerical File; Pink - Bldg. Permit File
.
�'+Y} � �
� CITY OF COSTA MESA
�'DyYAMps,9 BUILDING DIVISION
F`�� 77 FAIR ORNH. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.aov
�y�,�e FOR INSPECTIONS CALL: (714) 754-5626
'� PERMIT NUMBER: BC12-00074 �
� •;, • .
PERMIT TYPE: B COMQO STATUS: ISSUED '' � s
Sub Type: RES_AL7 DATE ISSUED: 02/1312012
��� ISSUED BY: KJB
:ios A��rtess: 543 E VICTORIA ST CM Suite/Unit: E
iIPN: 93411015 Zoning: , ,
Vicinity: BATHROOM Primary Occ:
Const Type: V-B SQ. FT: 0 �Valuatiort:' '$7,000.00 � -
, �.
SCOPE OF WORK: NON-STRUCTURAL BATHROOM REMODEL. DRY WALL REPAIR, NEW TILE, NEW SHOWER PAN AND HOT
NIOP. ELEC TO INCLUDE: 1 LIGHT, 1 SWITCH, 1 OUTLET. PLUMBING TO IN INCLUDE t SHOWER, 1 SINK AND 1 TOILET.
OWNER: CADDES, ELIZABETH
Phone: 949-515-2107
APPLICANT: GRINBAUM, RAZ
Phone: 818�48-1355
CON7Rac7oR: LIBERTY CONSTRUCTION
Phone: 888-741$370
�ell:
Jt
Building Plan Check:
9iiilding Fees:
Electrical Fees:
Mechanical Fees:
Alumbing Fees:
SMIP Residential:
�SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 543 VICTORIA ST
City/State/Zip: COSTA MESA, CA .
Address:
CitylState/zZip:
License No. 640562
Address: 427 N CITRUS AVUnit:
�City/State: LOS ANGELES,�CA ' � �'
��J : j i
•/'�. � .
License No.
license No. �
$0.00
$139.25
$26.80
$0.00
$52.90
$0.70
$0.00
$1.00
$220.65
Unit: UNIT E
Unit :
ZipCode � 90036� � �
PHONE:
PHONE:
�Monday thru Friday-7:00 am ihru 7;00 pm. Saturdays-9:00 am thru e:oo pm. Prohibited all hours - Sundays and the (ollowing Federal holidays:
�ii
Af:
�F
:.'
�NOTICE: The work authorized by this permit shall wmpty with all applicable handicap access requirements under Cali(ornia statutes and related
�iegulations. (Ord. No. 92-28, § t, 72-21-92)
}EXPIRA710N: PERMIT EXPIRES 780 DAYS FROM DA7E OF ISSUE OR DA7E OF LAST INSPEC710N.
iN5PEC710NS: In order for the Work authorized under this permit to be consitlered 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.
�[�
'CTO�E/. INSGELTIONIYPE � N RL SQpj,j INSPEC710NTYPE Q/j[ N AL
,M1816 Fixed System Final Fire Preven6on 2�6 Final Mechanical
1P66 Pool Spa Final 208 Final Plumbing %�,S• � Z i�_
+'.
200 FinalRe-ROoI 210 FinalEleClriWl X__3�_13 �_
I201 Final BIocWReWining Wall 212 Final Fire Prevention
�202 Final FaIXory Fire Place 220 Final Planning Approval
�203 Final Sign 22z Final Site
� X�y �M�
:204 ' Final Demalitlon 250 Final Building/Occupancy
i:. ( ,
�
WORKERS' COMPENSA710N DECLARA710N:
I hCreby aKrm untler penalty of perjury one of the following declarations:
❑ I have antl will maintain a certifcate of consent to self-Insure for workers'
compensation, as pmvided for by section 3700 of the LaDor Code, for the
eryormance of the work for which this permit is issued.
I have antl will maintain workers' wmpensatian insurance, as required by
5 tion 3700 ot the Labor Code. for t�e pertortnance of the work for which Ihis
permit is issued. My workers' wmpensatian Insurance carner and policy
number are:
Carrier. �p�l.�� 11 •
(inlssacnonneeaye 000ma'eredattaammareh.aaeraronuiwiedmwrs(s�oalahsa.)
(
Policy Number: �/�_,�__Y__ ) r_O-c� � K''�
❑ I teni(y that m Ihe peAormance ol the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
10 the workers' compensalion laws of Califomia, and agree that if I should �
beCome subject to the vrorkers' compensation pmvisions ol Section 3700 of
Ihe Labor Code, 1 shall forthwi a� with these provisions.
Ap .onl'sSignaWw �++.J Il'� -
WARNING: F RE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWF AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000), IN ADDfT10N TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn that I am licensed untler Drovisions of Chapter 9(Commencing
vrith Section 7000) of Division 3 ot the Business and Professions Code, and
my license is in (ull force and eflecl.
Lic. # � �$G�— Class # �
�1��.lIU'
Cmu ip . �1Da��—
CQNSTR TIO NDING AGENCY:
❑ I he affirtn that there is a conswctian lending agency kr the
peHormance of Ne work for which ihis permit is issued. (Sec. 3097, Civil CoCe).
Lenders Name:
lender's Address:
Sigristura Dam
OWNER-BUILDER DECLARATIONS:
I hereby aKrm tha� untler penalry ol perjury t�at I am EXEMPT FROM THE
GON7RACTORS UCENSE U1W (or the following reason (Sec. 7037.5.
Business and Pro(essions Cotle: Any ciry or wunry which requires a permit to
consWct, alter, improve, demolish, or repair any sWcture, prior to it5
issuance, also requires the applicant (or suth pertnit to fle a signetl statement
Ihat he or she is licensetl pursuant to Ihe provisions ol Ihe Contractors
Lieense Law (Chapter 9(commencing vrith Section 7000) ot Division 3 of the
Business and Professions Cotle) or that he or she is exempt iherefrom and
the basis !or lhe alfeBed exemplion. Any violation of Secfion 7031.5 by any
applicant tor a permi� subjects the applican� lo a civil penalry o( not more than
��p hundred dollars (5500).):
❑ I, as owner ot �he properry. or my employees with wages as their sole
compensalion, WILL DO THE WORK, and lhe structwe is no! intendetl or
oftered for sale (Sec. 7044. Business and Professions Cotle: The Contractors
License Law does not apply to an owner of property who builtls or improves
th@reon, and who does such work himself or herself or lhrough �is or her ovm
employees, provided ihat such improvemenis are nat intenAed or oHered tor
sale. I(, however, t�e building or impruvement is sold within one year of
completion, the owner-builtler vrill have the burden of proving that he or sne
dip not build or improve for purpose of sale.).
❑ I, as owner of t�e property am EXCLUSIVELY CONTRAC7ING WI7H
UCENSED CONTRACTORS to consWq the project (Sec. 7044. Business and
Prnfessions Code: The conVactors License Law Cces not appy to an ovmer ot
property who builds or improves thereon, and who contracts far such project with
a contractor(s) license pursuant to lhe Contractors License Laws.).
❑ I am exempl under sec.
Business and Professions Code tor this reason:
Signemre
30$�.46 (3N7)
�
Owner ID veri(etl by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
VeriFlcation ot Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certiry that no excavation fve (5) or more feet in depth into which a
person is required to descend, will be made in connectian with work authonzed
by t�is pertnit, and that no building structure, sWHolding, falsevrork, or tlemoGtion
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Ar12. SeC. 341, Title B, California AdminisUative COtle).
❑ As owner-builder, I will not employ anyone to do work w�ich vroulC
require a permit from lhe Division of Industrial Satety, as noted above, unless
such person has a permit to tlo such work from ihe division.
ApPlicaOts SignaWre Date
Division o! Industrial Safery Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or future builtling occupant need to file and
certity a Business Plan for emergency response to release or lhreatenetl
release of a hazartlous material? ❑ Yes ❑ No
(Seclion 25505 of the California Health and Safery Code requires, wilh some
exceplions. that a Business Plan be fled with the Costa Mesa Fire
Departmenl by every business which has at any one time during a reported
year a quantity of bazardous materials equal ro or greater ihan a weight ot
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at slandard temperature antl D�essure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutety haZardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safery Cotle, vrith some
exceptions, requires registration vrith the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutey
hazardous matenals equal m or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or vrill the applicant or present or fuNre building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that the
Costa Mesa Fire Depanment may require the preparation, certifiwtion and
(iling with the Fire Department of an RMPP by businesses which are required
to register awtely haxardous materials vrith [he Fire Department.
4. I( an RMPP is presently required, has Section 25534 of t�e California
Healt� and Safery Cotle been fully complietl with? ❑ Ves ❑ No
5. Does or will Ihe applicant or present or future building ocwpant require for
Ihe work which is the subject ot this application a permit for such con5tructian
or modification from the Soulh Coast Air Oualiry Management District or from
any other air poflolion conlrol disfncf or agency? ❑ Yes ❑ No
(Seclion 65850.2 of the Califomia Govemment Code require5 [hat the repuestetl
infortnation be (umished on applica�ions for non-residential buildiig pertnits).
6. Will any part of Ihe facility t0 be consWctetl under this Dermit be vrithin
1000 �eet trom the outer bounCanes ot a school? ❑ YeS 0 No
(II'yes', ihe facili�y must meet Ihe requirement of Sections 25534 antl a2303
of the California Health and Safery Cotle).
7. I( a permit fmm the South Coast Air �ualiry ManaBement District or o�her
air pollution control district or agency is requiretl fur the work which is tne
subject of Ihis applicalion, have all of ihe tlisclosures prescribed by California
Health and Satery Code Section 42303 been made? ❑ Yes ❑ No
8. Qt'yes', atlach certificale of compliance fmm t�e appropriate air polWlion
contml oKcer).
CERTIFICATE OF COMPLIANCE: I certify ihal under penalry of perjury ihe
information given above is correct. I agree to wmply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury Nat I have reaa this application and state that
ihe information given is correct. I agree ro comply wiN all state lavrs and ciry
orUinances relating to building construction, and authonze represen[atives of
the City of COs�a MeSa to enter upon lhe above-0esCribed property for
inspection purposes. I agree noi to occupy or allow occupancy of any building
authonzed by this permit unUl fnal inspection.
SignaWreoi er(s) Uate
� 1 �
umorizea npplic¢m oa�e