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Home My WebLink About909 19TH ST - Building Permitsi �. CITY OF COSTA MESA � � BYILDING p1VIS10N � • � � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca. FOR INSPECTIONS CALL: (714) 754-5826 PERMIT NUMBER: E08-00176 PERMIT TYPE ELEC STATUS: ISSUED APN: tpn007175 DATE ISSUED: 05/2812008 - -�= -ISSUED BY: RMD - . _� . � --t . ' .;�. JOB ADDRESS: 909 W 19TH ST..CM - `� F, � Suite/Untt .-` ViCinity: SIDEWALK ; , '� �'; � �- ' „_r � ; � . � SCOPE OF WORK: INSTALLATION�OF A 100�A SERVICE�PANEL ON SIDEWALK�FOR'AN�ABOVE-GROUND CABINET. � , - , _ . .- :;x.,:. - - ,, ' .: M . ,.Z..�. • � , f.-, � . V.- . . �;, OWNER: CITY OF COSTA MESA � �'Address: : Unit �,�' � -' PHONE: i,irJ .I � �.,CitylState/Zip: ; � .. ' ' `' n APPLICANT: ALAMIA, VINCE �.. �� " r �� ' Aiidress � 305 N SACRAMENTO AVE � Unit PHONE: 909-230-5170 � �'.' _ � City/State/zZip:�' ONTARIO,CA��',�" , -' � CONTRACTOR: HHS COMMUNICATIONS - -- - License No. 91310Z ,. Address: 305 N SACRAMENTO AVEUnit: � , � ' , - - � , _ ��' PHONE: . � � City/Siate: ONTARIO,-CA - . ZipCode: 91764 . � -- CELL: . - -. ,.., �.� . �� ;�, { �. � - i ' � . i `r , � j� . .. �i i ,� " ' � � . � . I . „ .�� .'f,. ELECTRICAL PERMIT FEES - Electrical Plan Check Fee: $0.00 � Electrical Permit Fee: , .'. 554.00 ; ' � ' Reinspection Fee :' $0.00 • " ., TOTAL FEES � $54.00 , . -.. � - � �� r�.-. , � ';� i. n•y'.� M_�.:��-{� � . J � . . : ` y'-.� . . . ,. :. . 9 NOTICE: The work authorized by this permit shall wmply wilh all applicable handicap.access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 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 oblain Inspections and final approval vnll result in the expiration of this permit. CO��. INSPEC110NTYPE D� I RL 4QQEj INSYECTIONTYiE - � �RTF IN 1� 1616 Fixed System Final Fire Prevention � � � 206 Final Mechanical - 12fi6 Pool Spa Final ' 208 Final Plumbing �� 200 Final Ra-Roof � " ' 210 Final Electrical 201 202 203 204 Final BIocWRetaining Wall Pinal Factory Fire Placa Final Sign Final Demolition , 212 Final Fire Prevention - 220 Final Planning AppiOval 222 250 Final Site Final Building�OccuOancy WORKERS' COMPENSATION DECLARATION: I hereby affirm underpenalty of perjury one of [he fo��.,wing declaralions: ❑ I have and vnll maintain a certificate of consent to self-Insure for workers' comDensation, as provided for by seclion 3700 0( the Labor Code, for the peAormance o( the work for which this permit �s issuetl. ❑ 1 have and will maintain v,orkers' compensation insurance, as requiretl by seclion 3700 of the Labor Code, for the peAortnance of the work (or wfiich this pertnit is issuetl. My workers' compensation Insurance carrier and policy p�ry� ber are: f (%a�rri�er Q✓�G/9� /�i-% 1 r/le� (This sequn rieM Cipl pp cpmp�etedeMe ce�d B rdlue0af ona nuiM�etl tldlars (f f00) wless ) Policy Number: / 7r� .�.J � 8 ❑ I certify that in the pertormance o( the vrork for which Ihis pertnit is issued, I shall not employ any person in any manner so as to become subject to the vror�ers' compensation lavrs ot Califomia, and agree lhal if I should become ubject t�e vrork s' compensation provisions of Section 3700 of the Lab r Code, I all tort �th comply with tfiese provisions. �5 d�',6� pliwnfs9gnaWre ' -oa�e WARNING FAILURE TO SECURE WORKER9' COMPENSATION COVERP,GE 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 ATTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm thal I am licensed under provi5ions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in full lorce and eflect. �c�� n.' 9! 3 a' =c�s55 u e/o ,Q � ��-a� nlydctor'sSipnaWre �� Oa�e CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that ihere is a consirucfpn lending agency fa the pertormance of the v.ork (or v,fiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signawre Da�e OW NER•BUILDER DECLARATIONS: I hereby aHirtn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair any strucWre, prior to its issuance, also requires the applicant (or such permil lo file a signed sta[ement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 of [he Business antl Pmfessions Cotle) or that he or she is exempt t�erefrom antl the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit subjects the applicant to a civil penalry of not more than five hundred dollars ($500�.): ❑ I, as owner of the properry, or my employees with vrages as their sole wmpensation, WILL DO THE WORK, and the structure is not intendetl or oHered for sale (Sec. 7044, Business and Pro�essions Code: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, and who does suth work himself or herself or ihrough his or her own employees, pmvided ihal such improvements are not intended or oHered for sale. If, however, the building or improvement is soltl wilhin one year of complelion, the owner-builder vnll have the bu�den. of proving that he or she did nol build or improve for purpose of sale.). ' ' � � �" ❑ 1, as ovmer of the property. am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS ro conslruct the projecf (Sec. 7044, Business and Professbns Code: The contractors License Law dces not apply to an rnmer of property who builds or improves lhereon, ana who contracts �or such project with a cont2cta(s) license pursuant to the Contractors License Laws.). � I am exempt under sec. Business antl Professions Cotle for this reason: SignaWre �051�46(3/Ol) Ovmer ID vedfieG by drivt �se. ❑ Yes ❑ No �� —� �� ° Driver's License No. Expires: Verificalion o( Ownership by (type of tlocument, i.e. - property taa 6ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: " ❑ I hereby certify that no excavation (rve (5) or more feet in depth into which a person is required to descend, will be made in connecl'an with work autho�zed by lhis permit, anA that no building sWclure, scaHdding, lalsework, or demolition or dismanlling Ihereof, will be more Ihan thirty-si�c (36) feel high. (Chap. 3.2. Grp 2, iVi 2. $EG. 3i�, ri�2 8, C.2�I�0lf113 %idRlll115II2i1VQ COdB�. ❑ As owner-builder, I will nol employ anyone lo do work which would require a permi[ from the Division of Intlustrial Safely, as noted above, unless such person has a pertnit ro do such work from the division. Applican(s Signature Division of Intlustrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or future builaing occupant need to fle and certify a Business Plan for emergency response to release or threatenad release o( a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cotle requires, with some exceplions, Iha[ a Business Plan be fled with tha Costa Mesa Fire Department by every business which has at any one time dunng a reported year a quantiry of hazardous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard temperaNre and pressure). 2. Does or will ihe applicant or present or future building occupant need to fle a registration (orm for acutely hazardous materials7 ❑ Ye5 ❑ No (Section 25533 of the Califomia Health antl Safety Code, wiN some exceptions, requires regislration with ihe Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous materials equal lo or greater than a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas at sWnaard temperature antl 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 malerials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides lhat Ihe Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are requiretl to regisler acutely hazarclous materials wi[h the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health antl 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 suhject ot this application a permit for such construction or modificalion from the South Coasl Air pualiry Management District or from any other air pollution control distnct or agency? � Yes ❑ No (Section 658502 of the Califomia Govemment Cotle requires that lhe requested inlortnalion be fumished on applications for non-residenlial buil0ing permits). 6. Will any paA of the facility to be constructetl under this pertnit be vnthin 7000 feet from lhe outer boundaries of a school? ❑ Ves ❑ No (If'yes", Ihe faciliry must meet the requirement of Sections 25534 and 42303 of the Califomia Heal[h and Sa(ely Code). 7. If a permit from the South Coast Air Quality Management District or olher air polNtion wntml district or agency is required for the work which is the subject of this application, have all of ihe disclosures prescnbed by Calitomia Health antl Satery Code Section 42303 been matle7 ❑ Ves ❑ No 8. Qt "yes", altach certifcate of compliance from the appropriate air polWtion, control offcer). CERTIFICATE OF COMPLIANCE:I certify that under,penalry.of perjury the, information giJen above is correct. I egiee to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. � - , SignaWre Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalty of perjury thal I have read ihis application and state Ihat [he information given is correct. I agree to comply with all state laws and city ordinances relating Io builtling construction, and aulhorize representatives of [he City o( Costa Mesa lo enter upon the above-described property for inspeclion purposes. I agree nol lo occupy or allow occupancy of any building authorized by this ermit until final inspection. Si amre of I Own ) � Daie ` � a�-�� An lo u� IzetlAPGIiC2n1 ._.Date