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Home My WebLink About310 MEADOWLARK LN - Building PermitsJob Address: 310 MEADOWLARK LN Phone: 714-315-6437 - Status: ISSUED Suite: $2,673.75 Applied: 05/24/2007 Vicinity: TRIPLEX " Issued: 07/12/2007 Primary Occ: R-1 Hotels/Apts/Res >10 Occ Type of Construction: V -N Address: Parcel Number: 43923107 Zoning: Applicant: DICKENSON, DAN Phone: 949-858-1800 , Address: $4,451.69 COTO DE CAZA, CALIFORNIA Zip: 92626 License: C22162 - Phone: 949-355-9644 ISSUED BY: ". -Zip: Owner: CHEONG LEE FAMILY LLC, Address THE 0-0 Left 0-0 - Right 0-0_ - ACCESSORYFront SANTA ANA, CA Phone: - Right '0.0• - PARKING 3518 LAKE CENTER DR #C - Zip: 92704.6979 Contractor: DICKENSON CONSTRUCTION Address: 11 BARONESS LN SCOPE OF PERMIT 1934SF TRIPLEX TENANT IMPROVEMENTS: WORK TO INCLUDE REPLACE FLAT ROOF WITH GABLED ROOF AND REPLACE ALL EXISTING WIN WHICH WILL MEET CURRENT LIGHT, VENTILATION AND EGRESS REQUIREMENTS. UNIT A: DEMO 187 SF AND CREATE A OPEN PORCH AREA. REMOVE EXISTING SKYLIGHT AND FIREPLACE. RELOCATE ENTRY DOOR. UNIT B: RELOCATE ENTRY DOOR. NO INCREASE IN THE NUMBER OF BEDROOMS FEE SUMMARY Plan Check: $1,737.94 Phone: 714-315-6437 - Calc Valuation: $400,000.00 LAGUNA NIGUEL, CA $2,673.75 Claim Valuation: $400,000.00 Zip: 92677 License: 633934 " Arch : TEALE, MARK Eng: CURTIS A. COOMBS Address: 2900 BRISTOL STREET Address: 12 BENT OAK SUITE A203 Phone: 949-975-0123 Phone: 949-858-1800 , COSTA MESA, CA $4,451.69 COTO DE CAZA, CALIFORNIA Zip: 92626 License: C22162 - .92679 License: C57811 SCOPE OF PERMIT 1934SF TRIPLEX TENANT IMPROVEMENTS: WORK TO INCLUDE REPLACE FLAT ROOF WITH GABLED ROOF AND REPLACE ALL EXISTING WIN WHICH WILL MEET CURRENT LIGHT, VENTILATION AND EGRESS REQUIREMENTS. UNIT A: DEMO 187 SF AND CREATE A OPEN PORCH AREA. REMOVE EXISTING SKYLIGHT AND FIREPLACE. RELOCATE ENTRY DOOR. UNIT B: RELOCATE ENTRY DOOR. NO INCREASE IN THE NUMBER OF BEDROOMS FEE SUMMARY Plan Check: $1,737.94 Calc Valuation: $400,000.00 Permit: $2,673.75 Claim Valuation: $400,000.00 SMTP Res: $40.00 SMIP Com: $0.00 Other: $0.00 Inspection: :, x$0.00 , Total: $4,451.69 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0 -0 -Rear 0-0 Left 0-0 - Right 0-0_ - ACCESSORYFront " 0-0 Rear �0-0Left 0-0' - Right '0.0• - PARKING Existing: 0 Required: 0 Proposed: 0 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 if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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 final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446.48 (600) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affinn under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, forme performance of the work for which this permit Is Issued. My workers' compensation Insurance carrier and policy number are: 4= � _ �� (This section need not be completed if the permit is valued at on dollars ($100) or less.) ° I cortity that In the liprformancill, of th c for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation IswsJrf Californti, nd g e that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thes ovisions. APplmsnl Signaturey Bar -jam I Z( Zm 7 WARNING: FAILURE TO SECURE WORKERS ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE (SlMODO), IN ADDITION TO THE 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 Iicond r err pr visls of Chapter 9 (commencing with Section 7000) of Division 3 oLtho-Business and Professions Code, and my license is in full (oN e�`�nd en�t Ljb-#, !.If 11 0S3 r 1 N I L __Contractors Signat u=e: ata �i� ZLID 7 �nC•O'NSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not appy to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not 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 Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, I.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: I HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to 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). ........................................................................................................................................................... ........... .... ............. .......................................................................................... ................. ............................ ................................. I........................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to 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). ._..._......_...._.__................o_........or present future.uildin...............____..................._.......__._.__...................._.__...__.................................._............................_.__..................____._.............._._............... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management end Prevention Program for acutely hazardous materials)? ❑ Yes ❑ N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................................................................................................................................................................................................................................................................................................................................................................................ 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the opplicanl or present or future building occupant require for the work which Is the subject of thisa plication a armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agenc- 5 Yes � No on app (Section 65850.2 of the California Government Code requires that the requested information be furnishedlications for non-residential building permits). ..........__....................................._......................................................................._.............................._.__........._._................__................................................... ....__._............................__..........._..__.............. _............. 6 Will any part o1 Aha facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............._..... .................................. __....................... .................................................................................. ..__.................. ........................ __............................................................................................... __................. _..................... _................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......................................................... .............................................................. ............................................ ............................................................................................................................ ............................................................. I .............................. 6 (It yes", attach certificate of compllance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: 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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above- ascribed property for ins action purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Vigtature Of Legal Owners)S J � I Zf 7 -co'? And/Or'Authorized Applicant, —_—,—a_ W.. Date--.__.� CODE °. INSPECTION TYPE gdg, INTITIALS CODE INSPECTION TYPE gsjf, fB$(A,L$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retalning Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 FinalBuilding/Occupancy. ZT� CITY OF COSTA MESA BUILDING DIVISION FA 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �.o�. FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBE EO7-00813 PERMIT TYPE ELEC STATUS: ISSUED DATE ISSUED: 09/19/2007 ISSUED BY: RMD JOB ADDRESS: 310 MEADOWLARK LN,CM, Suite/Unit:- I Vicinity: TRIPLEX - S` SCOPE OF WORK: ELECTRICAL'PERMIT FOR A.1634SF TRIPLEX TENANT IMPROVEMENTS: WORK TO, NCLUDE: 1 NEW SERVICE TO 200A, 3 SUB PANELS, 50 LIGHT.F,IXTS, 35 SWITCHES, 56 OUTLETS, 9 CEILING FANS. REF#:,B07-00723. OWNER: CHEONG LEE FAMILY LLC,`-• ----,Address: THE Unit:SANTA ANA, CA PHONE: - - , .. :` City/State/Zip: , 3518 LAKE CENTER DR#C, APPLICANT: DICKENSON, DANI -_ - Address: 11 BARONESS LN Unit: - PHONE: 949-355.9644 City/State/zZip: LAGUNA NIGUEL, CA ' CONTRACTOR: DICKENSON CONSTRUCTION % Licene", o. 633934 Address: 11 BARONESSLNUnit PHONE: 949-355-9644 City/State: LAGUNA NIGUEL, CA ZipCode: 92677 _ CELL: ELECTRICAL PERMIT FEES, Electrical Plan Check Fee: ` $0.00 Electrical Permit Fee: $277.20• •• Reinspection Fee $0.00 TOTAL FEES $277.20 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: 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 final approval will result in the expiration of this permit. CODE INSPECTION TYPE DATE INTITIAL CODE/ INSPECTION TYPE DATEN11i TIALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electncal 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign I 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I' I hereby affirm under penalty of perjury one of the following declarations: Q 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Q I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy nu7,4 rm need nor be comgefed d the dermad valued at one hundred"am fs r00) or less.) P'li y/Numb re 01 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compLnsraflonws of California, and agree that if I should come Sula tc thcompensation provisions of Section 3700 of t Labor C d I s taomply with these provisions. 9.20.L9-7 flta is Signature'^- Date - 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 LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and license is in fill force and effect. .2 L : # �. Class # 0 • t 9.7 0 ontrabtor:s signature CONSTRUCTION LENDING AGENCY: Q I hereby affirrm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade). Lender's Name: Lenders Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 compensation, WILL DO THE WORK, and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). Cl I, as owner of the property, am EXCLUSIVELY CONTRACTINGWITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not 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 Contractors License Laws.). C] I am exempt under sec. Business and Professions Code for this reason: 3b57.46 (X07) Owner ID verified by driver Driver's; License No. -rise. ❑ Yes ❑ No Expires: Verification of Ownership by (type of document, i.e. - property lax bill or deed):: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding. falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to 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). 2. Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions. requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to 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 will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8: (If "ye 's", 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 correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. . Signature Date 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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy of allow occupancy of any building aut prized by this peT u til final inspection. Sig atu of L t mer(s) Date w\ MNai - rued Applicant - G'' e v CITY OF COSTA MESA F BUILDING DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �•m fi •• FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. E07-00765 PERMIT TYPE ELEC STATUS: ISSUED DATE ISSUED: 08/24/2007 ISSUED BY: RMD JOB ADDRESS: 310 MEADOWLARK LN CM Suite/Unity Vicinity: - SCOPE OF WORK: TEMPORARY POWER POLE FOR TRIPLEX IMPROVEMENTS. REF#:, B07-00723. OWNER: CHEONG LEE FAMILY LLC, Address: THE Unit:SANTAANA, CA PHONE: City/State/Zip: 3518 LAKE CENTER OR #C APPLICANT: DICKENSON, DAN PHONE: 949-355-9644 CONTRACTOR: DICKENSON CONSTRUCTION Address: 11 BARONESS LNUnit: PHONE: 949-355-9644 City/State: LAGUNA NIGUEL, CA ZipCode: 92677 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $47.00 Reinspection Fee $0.00 TOTAL FEES $47.00 Address: 11 BARONESS LN Unit: City/State/zZip: LAGUNA NIGUEL, CA License No. 633934 CELL: a 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: 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 final approval will result in the expiration of this permit. CODE I INSPECTION TYPE DATE INTMALS CODE I INSPECTION TYPE DATE INTMALa 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical_ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuildingfOccupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance Cartier and policy number are: Carrier: (Tnts seem neM nct Da mrip'efed d Ilse pemY a � of ane numbedddars ISr00) a lest ) Polic umber: —1 -certify that in the performance of the work for which this permit is �Issued,-j shall not emnlowany person in any manner so as to become subject to a vrorker comp tion laws of California, and agree that if I should N me subj t th rkers' compensation provisions of Section 3700 of Ih abor Co I hall o hwith comply with these provisions. �% S z / ADPit ant's SlBroture rDal. _) 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 LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) ivision 3 of the Business and Professions Code, and k,cenye iii IQ full f c and effect. LIE `' D C tors Sigta a Date— CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec 3097. Civil Code). Lender's Name: Lender's Address: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 compensation, WILL 00 THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to ConsWct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not appy to an owner of property who builds or improves thereon, and who contracts for such project with a Contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signgture Date 3057.46 (M7) Owner ID verified by driver', se. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection vnth work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present Or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires. with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to 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). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to 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 will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 0f the California Government Code requires that the requested information be furnished on applications for iron -residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (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 correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date 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 with all slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in$@pection pyyrposes.((��afree not to occupy or allow occupancy of any building atXhodzed bj(thjs pe{dpit jlnlil final inspection. M1 r_ pl g I Owner(s) D-7 Mo/m. Whonxe0 Appliwnt Wr� CITY OF COSTA MESA toBUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7544856 • www.d.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER:' M07-00489 . PERMIT TYPE MECH 'STATUS: ISSUED DATE ISSUED: 09/19/2007 ISSUED BY: RMD JOB ADDRESS: 310 MEADOWLARK LN CM Suite/Unity :. Vicinity: TRIPLEX SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT FOR A 1934SF TRIPLEX TENANT IMPROVEMENTS. WORK TO INCLUDE: 3 FAU < 100 K BTU, 4 VENT FAN, 3 EXH HOOD. REF#: B07-00723 OWNER: CHEONG LEE FAMILY LLC, - - - - Address: THE Unit:SANTA ANA, CA PHONE: . , City/State/Zip: 3518 LAKE CENTER DR #C APPLICANT: DICKENSON, DAN Address: 11 BARONESS LN Unit: PHONE: 949-355-9644 City/State/zZip: LAGUNA NIGUEL, CA CONTRACTOR: DICKENSON CONSTRUCTION - License No. 633934 r Address: 11 BARONESS LNUnit PHONE: 949-355.9644 * ' City/State: LAGUNA NIGUEL,. CA . ZipCode: 92677 - - CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $128.85 PLAN CHECK FEE: - $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $128.85 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: 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 final approval will result in the expiration of this permit. CODE I, INSPECTION TYPE DATE INTMALS CODED INSPECTION TYPE .// /n/ 04 NPA 1616 Fixed System Final Fire Prevention 206 Final MechanicaY(IP,r.n /f.r' 1/..J/Q- 1266 Pool Spa Final 208 Final Plumbing /" _"'^^^"""""'^""111""^^`--"""111 200 Final Re -Roof 210 Final Electrical 201 Final Blook/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 1 220 Final Planning Approval UV 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ _ WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:. ❑ 1 have and will maintain a certificate of consent to self -Insure for workers compensation, as provided for by. section 3700 of the Labor Code, for the performance of the work for Which this permit is issued. [] 1 have and will maintain workers' compensaffon insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this Permit isXsued. My workers' compensation Insurance carrier and policy at one hundred "an; I certify that in the performance of the work for which this permit is sued, I shall not employ any person in any manner so as to become subject t0 he workers' Cor nsalion laws of Califomia, and agree that if I should be me suD' ct to workers' Compensation provisions of Section 3700 of the a e r C c I sl I forthwith comply with these provisions. 9.20.07 I!cwt5 S ithalure Dale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 410ENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full tome and effect. 1L ..fi Clash s-#-;3 - > 9'20:07 cantradtas$ignature CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the Performance of the work for which this permit is issued. (Sec. 3097, Gvil Code). Lender's Name: Lender's Address: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 Compensation, WILL DO THE WORK, and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, Provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Completion, the owner -builder will have the burden of proving that he or she Did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an comer of Property who builds or improves thereon, and who contracts for such project with e conlractafs) license pursuant to the Contractors license Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature Dale ae5746 (3te7) w• Owner ID verified by drivense. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' Cl I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be made in connection with work authorized by this permit, and that no building structure, scaffolding. falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to 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). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to 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 will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be Constructed under this permit be within 1000 feet from the outer boundaries of a school? []Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (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 correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Date 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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins echon purposes. I a ree not to occupy or allow occupancy of any building at orizetl b his ertni n i final inspection. . Si atu g mer(s) of LeDale �l 2D - 07 AndrorP ortzed Awficant �Dmi j CITY OF COSTA MESA 0 BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 (714) 754-5273 •Fax (714) 754-0856 www.ci.costa-mesa.ca.us �•w FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER• PO7-00508 PERMIT TYPE PLUM STATUS: ISSUED DATE ISSUED: 08/24/2007 ISSUED BY: RMD JOB ADDRESS: 310 MEADOWLARK LN CM Suite/Unit: r Vicinity: TRIPLEX SCOPE OF WORK: WATER,REPIPE FOR TRIPLEX IMPROVEMENTS. WORK TO INCLUDE: 4 -WATER CLOSETS, 4 BATHTUBS, 4 WASH BASINS, 3 DISHWASHERS, 3 WATER HEATERS, 6 HOSE BIBBS, 5 GAS OUTLETS, 1 WATER SERVICE, 3 WATER REPIPE. REF#: B07— 00723. OWNER: CHEONG LEE FAMILY LLC, ' PHONE: 3518 LAKE CENTER DR #C APPLICANT: DICKENSON, DAN PHONE: 949-355-9644 - - - - CONTRACTOR: DICKENSON CONSTRUCTION Address: 11 BARONESS LN City/State: LAGUNA NIGUEL, CA ZipCode: -92677 PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $306.15 TOTAL FEES: $306.15 Address: THE ---SANTA ANA, CA City/State/Zip: 3518 LAKE CENTER DR #C Address: 11 BARONESS LN : ' City/State/zZip: , LAGUNA NIGUEL, CA License No. 633934 - . - PHONE: 949-355-9644 -_ -. -- CELL: ' 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: 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 final approval will result in the expiration of this permit. CODE t. INSPECTION TYPE DATE INTMAL5 CODE INSPECTION TYPE DATE/ INTMAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 41y�_ 200 Final Re -Roof 210 Final Electrical 201 Final Blotk/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 ,Final Oemofifion 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance o1 the work for which this permit is issued. My workers' compensation insurance carrier and policy Humber are: tCer:_ u need ndl ompkfed/Naperm/awarueda hundredabAars(Ered)arbss.)mber.I certify that in the pe tante o1 the work for which this permit o issued. I shall not employ any person in any manner so as to become subject to the workers' Ala sation laws of California, and agree that if I should be me su jectworkers' compensation provisions of Section 3700 of the abor d , rthwith comply with these provisions. A 's Cwgrature Dale 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 LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my icense is in full r and effect. c = Class# '8•-4•D7 C tractor's Stg�ture lOate \ CONSTRUCTION LENDING AGENCY: ❑ I hereby arm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SigneWre Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish. Or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not 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 Contractors License Laws.). ❑ I am exempt under sec` Business and Professions Code for this reason: Signature Date W5746 (W7) Owner ID verified by drive Ole. ❑ Yes ❑ No Drivers License, No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding. falsework, a demolition or dismantling thereof, wll be more than thirty -sic (36) feel high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applimnt's Signature Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety 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 reported year a quantity of hazardous materials equal to 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). 2. Does or will the applicant or present or future building occupant need to file a registration roan for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to 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 will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and riling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will,any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (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 correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date 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. 1 agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I�9re not to occupy or allow occupancy of any building authgrized by If perm) 'iI final inspection. Signt r o1 Le eqs) to _t1 S 0_7 AnU,xAu rimedApplm pate--�