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Home My WebLink About850 19TH ST - Building Permitsi� CITY OF COSTA MESA BUILD/NG D/VISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 PERMIT TYPE ELEC APN: tpn007166 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT • www.ci.costa-mesa.ca.us 'j. NUMBER. E08-00063 :,:. STATUS: ISSUED _, _ ., DATE ISSUED: 02I20I2008 - -- ;:_`ISSUED BY: „ , ' ' ` `` �- JOB ADDRESS: 850�,W�19TH ST�GM� . Suite/Und :t . Vicinity: _ , ��y; � . , SCOPE OF WORK: ADD NEW.METER AND�SUBPANEL TO AT AND T CABINNET �� ' 'y' � (y/ ti � ��1 �' , . .i,. . . .. . OWNER: � CITY OF COSTA MESA' .- �"„ �Address: . Unit: - - - PHONE: . - - .. - �-..Ciry/State/Zip: "- . - . . ,. . . .. . , ; �. . ' APPLICANT: LANGFORD ERIN, ;; � - . - "-�qddress ' = 2131„SOUTH DUPONT,DR Unit: PHONE: 714-560-8222 - City/State/zZip: ��-'ANAEHIM,CA , , .- �'�,�'� �i�,. . � it'� � CONTRACTOR: TAIT ENVIRONMENTAL-MANAGEMENT INC ... .. .. ,-,_ �License No. � 588098,=� � "- � Address: 701 NORTH PARKCENTER�DRUnit` �� ' " � ,� -.- � !� t "�`PHONE: 714c560-8222 �. _ �.. _ , . _ ..� _ , . Ci /State: SANTA ANA, CA' � ZipCode: 92705 = ' - _. � � � CELL: ' ';, � � --- . ty . - -- . . .. � . . .. `-i �' _.� _ . ELECTRICAL PERMIT FEES- �- _ . Electrical Plan Check Fee $0.00 Electrical Permit Fee: '1:.,;-$84.50 �{ Reinspection Fee <;: $0 00 ''- � TOTAL FEES - y $84.50 :r 1 � � _ � l _ ' '. - :(r°. � � .. - - '�'- � _ _ • f"._ r :`I . . '- . . . : , �• __:. . - -.�-. . ..-. . ...._': -" .. .....,. ..t.:"t}_. � ,%`t'�'9}.J �� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: 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. oC DEt, ixsrecnoxme 1816 Fixetl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Final Re-Roo( Final Block/Retaining Wall Final Factory Fire Place Final Sign Final Demolition DATE INTTALS COOEk INSPECTIONTYPE 206 Final Mechanical 208 Final.Plumbing 210 Final Electncal 212 Final Fire Prevention �o 220 222 250 Final Planning Approval FinalSite Final Building/Occupancy ORTE INTITIALS /i7,� �� WORKERS' COMPENSATION DECLARATION: ' I hereby affrm unde� penalty of perjury one of the following tleclarations: ❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers compensation, as provided tor by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. � � � ��have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for lhe peAormance of the wurk for which ihis pertnit is issued. My vrorkers' compensa[ion Insurance carrier and policy number are: �a.�:=2vc�icvr American �nsui4ne�',Co. (This setl.on neetl rrol �a mmpleleJ!(he peimd is valuetl al one huntlretl �Ilars (Ef00) w less.) Poticy:Numtier: �`UQ % �J]l�U 2 ❑ I cetlify thal in lhe peAormance of the work for which [his pertnil is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the vrorkers' compensation provisions of Section 3700 of the Labor Co �, I hall fort Nith co� with these provisions. - - 2/Z0�6,� � ppiicanl' gnaWre Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERP,GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER 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 license is in full force and eRecL � � Q ��n� eaass:u�A 13 hSR fifYZ � � 2/20/G`! Gon�SlgneWre GOate � CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constmctbn lending agency for the peAortnance of ihe work fa which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre OWNER•BUILDER DECLARATIONS: I hereby affrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE U1W (or the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to construcC alter, improve, tlemolish, 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 antl the basis for the alleged exemption. Any violation of Seclion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fve hundred dollars ($500).): ❑ I, as owner of the property, or my employees wi[h wages as Iheir sole compensation, WILL DO THE WORK, and the structure is no[ intendetl or offeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided [hat such improvements are not intendetl or oftered 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 tlid not build or improve for purpose of sale.).� . � . ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct [he prqect (Sea 7044, Business and Pro(essbns Code: The contractors License Law does not apply to an owner o( property who builds or improves thereon, and who contracts for such project with a cont2ctw(s) license pursuant to ihe Con[ractors License Laws.). ❑ I am exempt under sec. - Business antl Professions Code for this reason: 3051-46(3/0]) Ovmer ID venfied by drive� nse. ❑ Yes ❑ No � • Driver's License No. Expires: � Verifcation of Ownership by (rype of document, i.e. - property taz bill or tleetl): DIVISION OF INDUSTRIAL $AFETY PERMIT CERTIFICATION: ❑ 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 connectan with work authorizetl by this permit, and that no building slructure, scaffdding, falsework, or demolilion or dismanHing thereof, vnll be more than thitly-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8, Califomia Administrative Code). � ❑ As owner-builder, I vrill not employ anyone to do work which would require a permit from the Division o� Industnal Safety, as noted above, unless such person has a pertnit to tlo such work from the division. ' Applicanfs Signature Da�e 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 (Seclion 25505 of the Califomia Health antl Safety Code requires, vrith some exceptions, tha[ a Business Plan be filed with [he 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 fuNre builtling occupanl need b file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Heal[h and Safety Code, with some exceptions, requires regis[ra[ion wiM lhe 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 standartl temperature and pressure). 3. Does or vnll the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous malerials)? ❑ Yes ❑ No (Section 25534 0( tAe Ca7ifomia Health and Safery Code provitles that the Costa Mesa Fire Department may require the preparation, ceAification and flling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous malerials with the Fire Department. 4. If an RMPP is presently required, has Sec[ion 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or wi0 the applicant or present or fuNre builtling occupant require for ihe work which is the subject of this application a permit for such construclion or motlification from the South Coasl Air Quality Management Districl or from any other air pollution control tlisMct or agency? ❑ Yes ❑ No � (Seclion 65850.2 of the Califomia Govemment Code requires that t�e requesled informatbn be fumished on applications fa non-residential building pertnits�. 6. Will any part of [he facility to be cons[ructetl under this permit be within 1000 feet (rom the outer boundanes of a school? ❑ Yes ❑ No (If "yes", lhe facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safery Code�. 7. If a permit from the South Coast Air Quality Management Districl or other air pollu[ion control district or agency is required for the vrork which is ihe subject of this application, have all of the disclosures prescribetl by California Health and Satery Code Section 42303 been made? ❑ Yes ❑ No 8. pf yes", attach certificate of compliance from ihe appropriate air polNtion coMrol offcer). � ' � � CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury lhe information given above is correcL I agree ro comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. � SignaWre Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury that I have reatl this application and state that the information given is correct. I agree to comply vrith all state lavrs and city ordinances relating to builtling consiruction, and authorize representatives of the Ciry of Costa Mesa to enter upon the above-tlescribetl propeAy for in5pection purposes. I agree not lo occupy or allow occupancy of any building aWhorized by lhis pertnit unfil fnal inspection. SgnaWr tLegal ner(s) �ate 1 2�ZU/(J� Andl Authori Appll�znl �Oate—�— r— — � �—