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Home My WebLink About855 19TH ST - Building Permits(714)754-5273 • Fax(714)754-4856 - - CITY OF COSTA MESA � " BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Job Address: Suite No Vicinity: 855 W 19TH ST MEDIA ONE CABLE N BOX Parcel Nunmber: TPN990191 Appliwnt: MEDIA ONE Address: ' Phone: � - . . � . Zip: , . _ _ Owner: ,CITY OF COSTA MESA ; , � _ . Address'i`�i�_ . � � � _ . _ .. . � ' ^ . ' �/: � � ' Phone: � . i . �, ` �„ . Zip: Contractor: EVANSJE ENETERPRISES DBA: WEST COAST CABLE Address: 5425 BERRYHILI DR CA �; Phone:�.(774)985-0411 ,YORBA�LINDA. ; • ; Zip: 92886, � . , `� - ��License: 734530 , , PERMIT NUMBER E99-01163 77 FAIR DRIVE, COSTA MESA, CA 92626 SWtus: ISSUED Applied: 12/3/1999 Issued: 12/3/1999 ISSUED BY: �/ � / � f: ' � SCOPE OF PERMIT ', ' INSTALL ELECTRICAL METER FOR NEW CABLE T.V. POWER SUPPLY FOR -MEDIA ONE-. i � , w � � . .. � . . , . , . ' � ' � �fEESUMMARY � ISSUE FEE `Temp service test ' Res. a/c package New Res (1-2 uriits) 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 ihp � Motors to tOhp Motors to 50hp Motors to 100hp Motors over 100hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign CirCuitS Temp Pwr Pole Intermed Pole $23.50 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ��. Quantity �t' �� ..�' .. 0 - - 0 0 0 0 0 0 0 1 0' 0 0 0 0 0 0 0 0 0 0 0 0 _ Temp Dist System I Lighting �' Bu,sway /100 ft;' ; . � �' . ' -Standing Section Misc Electriwl Equipment Transformers up to 1 kvalkw ................up to 10 kva/kw ...........:.....up to 50 kva/kw .. .................up to 100 kva/kw :' � ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring� System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investi9ation Fee Plan Check Fee � Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 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 50.00 0 $0.00 so.00 $0.00 50.00 TOTAL CALCULATED FEES 554.00 COMMENTS / SPECIAL CONDITIONS . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. I INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inepectlons and tinal approval must be obtained. Failure to obtain inspections and tinal approval will resuN in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I hereby aHirtn untler penalry of perjury one of the following tleclarations: � � I have antl will maintain a certllicate oi consent to self-Insure tor workers' compensation, as provided tor by section 3700 of �he Lebor Code, tor ihe pertormence of the work for which this pertnit is issuetl. ❑ I have and will maintain workers' compensation insurance, as requiretl Gy secGon 3700 of Ihe Lsbor CoOe, for ihe perfortnance of the work for which Ihis permit Is issuetl. My workers' compensation Insurenca carner and policy number are: Carner. Policy Number. (This sectian need nof be completed ll fhe permit is valued et one hundred dollers ($f 00J or less.) . ❑ I certity that in ihe peAormence of ihe work for which ihis permit is issued, I shall not employ eny person in eny manner so as to become subject to ihe workers' compensa�ion laws of Calitomla, entl egrae that if I shoultl become subJect to the workers' compensetion provisions ot Section 3700 ot Ihe Labor Code, I shell forthwith comply with these provisions. p Applicant Signature: � ""� �'~`� Date: / 1- S � � ) WARNING: FAILURE TO SECURE WORKERS' COMPENSAiION COVERAGE IS UMAWFUL AND SHALL SUBIECT AN EMROYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TiK)USANO Dd1ARE (5100,000�. IN ADDITION TO iHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31O60F THE L4BOR OODE. INTEREST, AND ATTORNEVS FEES. LICENSED CONTRAC70R5 DECLARA710N: I heraby aHirm t�a� I am licensed under provisions of Chapter 9(commencing wi�h Section 7000) of Divislon 3 of �he Business and Professions Cotle, antl my license is in full force and BffBCL Lic. a CIa55 a C� I J Contrectorssignature: �.�.�1 .1>✓'ti"� Date: \`ZS `�� CONSTRUC710N LENDING AGENCV: ❑ I hereby aHirtn that Ihere is e conslruction lending agency for the peAormance of ihe work lor which this pertnit is issued. (Sec. 3097, Civil Code). Lendels Name: Lendefs Address: Signature: Date: OWNER-BUILDER DELLARATIONS: I hereby aflirm that under penalty of perJury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (SecJ031.5, Business end Professions Code: Any city or counry which requires e permit to conswct, alter, improve, demolish, or repair eny s�ructure, pnor to its issuance, also requires the applicant for such permit b file a signed stetement ihat ha or sha is licensed pursuent to Ihe provislons of the CONractors Llcense Law (Chapter 9(commencing wlth Section 7000) ot Dlvlsion 3 of the Business and Professions Code) or thet he or she is exempt Iherefrom end the basis for ihe alleped exemption. Any violation ot Section 7031.5 by any applicant for e permit sub�ects Ihe appliwnt to a civil penalry of not more than five hundred dollars (5500).): ❑ I, as owner of ihe property, or my employees with wages es their sole compensation, WILL DO THE WORK, and the siructure is not intendetl or oHered tor sele (Sec. 7044, eusiness antl Professions Cotle: The Comractors License Law does not apply to an owner of property who builds or improves thereon, and who tloes such work himself or hersetl or through his or her own employees, D�ovided thet such improvements are not intended or ottered for sale. If, howevar, the builtling or improvement is sold within one year of completion, ihe owner-builder will heve the burtlen of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the property, am E%LLUSIVELV CONTRACTING WI7H UCENSED CONTRACTORS to constmct Ihe pmject (Sac. 7044, Business entl Pmfessions Code: The contraqors Licensa Lew does not appty to en owner of DroOerty who builds or improves thereon, and who contracis tor such pmject with e conirector(s) liten5e Oursuant lo thB Contrectors License Laws.). ❑ I am ezempt under sec. Business end Professions Code for this reason: Siqneture: Date: Owner ID verifietl by driver's licanse. ❑ Yes ❑ No Dnver'S License No. Venlication ot Ownership by (type of tlxumenC i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATON: Expires: ❑ I hereby cenity Ihat no excavetlon five (5) or more feet in depih into which a person Is requlred to descend, will be matla in connection with work authorizetl by ihis permil, antl Ihat no building siructure, scaflolding, talsework, or Cemolition or dismantling thereof, will be more ihan thirty-siz (36) leet high. (C�ap. 32, Gry 2, Art 2, Sec. 341, Tile 8, Calitomia Adminisirative Code). ❑ As owner-builtler, I will not employ anyone to do work which woulC require a pertnit fmm the Division of Industrial Safery, as noted ebove, unless such person has a permit to tlo such work tram Ihe division. Signeture: Date: Division ot Indusinal Safety Pertnit Number: CER7IFICATE OF COMPLIANCE ANO AU7HORVA710N OF ENTAY: I certify under penalry of per�ury ihat I have read this eppiication and s�ate that ihe information given is correcL I agree b comply with all state laws and ciry ordinances relating to building construction, en0 emhorize representatives of tha Cily of Costa Mesa to enter upon the ebova-tlescribed property for inspection purposes. I agree not to occupy or ellow occupancy of eny building authonzed by this permit until finel inspection. Signature Of Leg:l Owner(s) Date "� cus y� i t- S-9C � NOr AuNorized Applicant �ate COOE �, MSPECTIONTYPE 1616 Fiaed System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Roof 20/ Final BIocWReteining Wall 202 Final Factory Fire Placa 203 Final Sign 20a Final Demolition 26a8>6 D1TE INTffIALS COOE� INSYECTIONTYGE 206 Final Mechanical 20B Finel Plumbing 210 Finel Electncal 212 Final Fire Prevemion 220 Final Planning Approval 222 Final Site 250 Finel Builtling/Occupancy � . �. � � 1/ ' ._�:Y�