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Home My WebLink About446 19TH ST - Building Permits�— PNOJECTROONESS: 446 E 19TH ST awxen•s nnmc: KAYLOR JACK N TR nooAess: 4 q 6 E � 9TH ST COSTA MESA,CA 92627 AflCN1ENGMEEX: � 714 � S4a—S823 ROONE55: NEG.ND.: UNIT: UNIT: PENMIiTEE: CRANK BROTHERS ROOEING ( 714 ) 548-5569 aooeess: 126 COMMERCIAL WAY COSTA MESA CA 92f��7 LICENSE� CONTflACTOB OELLANATION: I �CmUy a�lirm I� am licens¢a un0e� prOvi5i0n5 a apl¢r 9(comm¢ncing wil� $eClion 7000� ot Drvision 7 ollnC Business an0 Pmfessions Cotle. tl y license is In lullforce an ItecL CITY LIL.: STRTE llt.: ClA$S: OS 93 408677 C Daie:_ '?.�T Signamre:— _ . _ _ _ WOHNEBS' COMPENS�TION DEClABR710N: I here u that 1 �ave a ceniliw�e of consent ro ulf. or a ceniliwte o1 Wofners' Campensation Insurance, o� a cenilie0 cooY ��e�eo e on 3800. LaU. C�. roucvno.:2g5-93UNIT00 EXP.�ATE:OI�OII9�I comraxr:STATE FUND ❑ Ce Yietl coDY �s �erepy lumis�ed. � Cetlilietl copy A ��e c BuilAing Oivision. c 1 Da�e � �"�' NpWicant� ��/ S F%EMP�ION Fl10M VNflNEqS' COMPENSIITION DKUNATION: (TNs seniai nee0 noI Ee comqeteG ii the pcmt b Iw me MWreG (5700) or kss�. I cenity t�ai fn ��e De�ortnanc¢ of I�e work lor whic� IAis De�mii is issue4 I SAall ml ¢mplay a�ry person in any manner so as lo �ecome su�laci �o t�e Workers' fpmpensation LawS af Calilamia, pale: Signalure: NOTICE:I1. ailer miW�g tAis tleclaration, you SAoultl become su61e�� o the Warkers' Campensation D�ovivons oi tAe Labor ' Code. you mu51 IOqMnI� compN �lh Sut� pmvisions or Ihis Dermii S�all �¢ Oe¢meU fevake0. LONSTflUCT10N LENOIqC RGENCY: I hereGy atfirm Illal l�ere is a[anSVuctiOn lentling aqency lar t�e pedormance al I�e work �or wnicn tAis permit is issuep (Section 3097. Civ. C�. LENOEX: I FODHESS: . OWNEB BUILDEP DECU�ppTIDN: I �ereby allirm I�al I am exemp( Imm ��e CanlraCl0r5' State License Law lor Ne lollowinp reason �Section 7U71.5 BusinesE anG Pmlessbnal Cotle�. Pny cily ol county w�ic� 24uires a Derrtut to wnstmct. alte�, improve, AemolisR or reoair any simcmre. o�qr ia its issuance. also repuires t�e aDPlicant br suc� Derrtni to lile a siqned statement that �eJs�e is IicenSeA Oursuam io ��e om�4ons ol t�e Coniractors' S�ate License Law (C�ap�er 9(commencing wil� Section 1000) ol �ivision J ol tAe Business ana Pmlessions Co0e) o� inat he/s�e is ezem0� �Aerelmm and ihe Oasis for I�e allepee eremOtian. My Nolation of Section 7031.5 oy any aDd��m tor a per�t su0jects t�e apptiunt io a civil Denalry of not mwe ttun live �unUreC Uollars (55001. 1, as owne� ol tAe pmperty or rtry employees with waAes as t�eir sde wmpensatqn, will Eo the work, anE t�e ❑ stmcmrt a nol intenEetl or oBere0lor sale �Section 704a, Business anA Pmlessbnal Cotle: T�e Contractors' State License Law does not aODh �o an owner oi a DmDe�Y w�o �uiltls or impmves thereon, anU vrtw aoes suc� work himsell/herself or throuAh his or ner own emoloyees, pwviae0 inat sucn imD�ovemems are not intenUeO or ottereA lor sate. Ii, however tAe building or impmv¢menl is 501a withm ane year 01 tampl¢Iion, Ih¢ owner will �av¢ IAe UUrCen 0� pmvinq �¢/She tli0 noi �uild Or Impmve lor t�e purpose ol Shce�. I, as owner ol IAe Droperty, am excluSiveN mntracling wit� licensed wntracmrs Ia consvuci lhe pmlect �Secuon 70aa, 8usiness ❑ anG Pmlessun5 COEe: Ttk Conttacmrs' Slate License Law eces w� appry m an ormer ol property wAo bwWs w impmvw thereon aM wtq ConVatls lor suc� prol��s vn�� a conVaCtOr(5)litense pur5uanlio Ihe Controt�otS' SIaIB Lltense law�. I am aware t�a� 0�� ol t�¢ir WOM1er's Camce�sation insurance 5�ou10 be provrEed to me. � I am eeempt untler Sttiiore 9. 8 P. C. tor mis reazon: Dale: Oaner. I Lo ne2Dy cently Inal l am aware ol antl unOer51an0 t�e reQoirements of Califomia Heal(� aM Sdfery CoOe Seteiorl5 25505. 25533, alltl 255J< anG Ilui I or any tulme EuilOing acu0anl vnllhvill not (ti��le one� nee0lo compty vni� 5aN slate coGCS anA Ihe reQuirtmen�s loi a perml br construcuon or moGi�iatiw �mm t�e Ai� ualay ManaAement Oisinci. qevUential conttmction appliations are eeem0� ��om Ihe1e Omvi5ion5. Odle: ppp�icanC _ I hereby ceildy that I IWve rea01hi5 appiicalion and slale or0inances an0 slate Wvn r¢Wlinq to UudGing cw�slmction �� pmperly la inspec�ion Ourposes. Oate: ' 'Z' � Sig r omer's License or $oqdl $eturiiy •: i64n<6 wnne—Bunaing; abave inbrmalion is 'I cily and counly above-menlioneU Canary—Applicam; Pink—Pavenue: GolOenroC—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO; B 062686, PLAN CHECK NO; N CONSTRUCTION TYPE; 5-N PERMIT TYPE; STR JOB DESCRIPTION ; REAR FLAT:T/06INSTALL'HOT SYS.'/GRAVEL PERM NO; B 062686 GOVT; N SiIPP; N PURPOSE; ALT SQ FT; 1,598 CLAZM VALUE; 2,598.00 CALC—VALUE; 1,598.00 GROUP OCC; R-3 /M-1 COMMENTS• REAR FLAT AREA ONLY COVERED BY THSS PERMIT, �'��Tcl�Trlp i!ilkitiFitkitififitiFMifiEkiFikkititilifkikiEiFkiFitilklFikiEilitikikkkikiaiEkilililiFifiFkiFiFilitkik ��ir��tiF�/fl 'L O N I N GS ERTEBQAUCIKRSE M E N T S REQUIRED ------------ MAIN HOILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEFT; FT ZN RGHT; FT IN PARKING REQ • PROV: PARCEL: 42631111 ZNE: REF NO; PLANNING Ni31'ES> .i �� if iF iE if if if If If k M �E �k ik if 1t If if iE ik iE iE * �E �E 1f iF if� if 1k if iE k 1E it it iF �f �F 1k if iF ik iF iE 1E iF 1E iE if if k k k iF iFiE i! iF if iE iE k 1F 1F iF iE 1F i61FiF 1F iblk IE iF ik k IF k D E V E,,L O P M E N T S E R V I C E S R E Q U I R E M E N-1' S / i ZONING APPROVED BY DATE; '�1� HUILDING APPROVED BY : DATE: ,�% APPLICATION ISSUED BY: � DATE: 6' ' 3 1EiFiki!ltikifilifiFiFifikifiFkkifililiflE . iFifiFitiflFiF1Fl6iF iEk ifikififkififMkkifiEMifkiFiElfilif3fikklkkilififkitkftikkiFikifiliEikiFilififlt lflf�kiliFiFklkififiF�f�kifltiFiFikik�EiEifjFklkkifiF�F�F1liEiF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMHING ELECTRIC MECHANIC PERMIT 37.00 . PLAN ' �' ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 37,50 0.00 'r 0.00 FIRE SMIP/RSS� GRADING SMIP/NON—RES TOTAL PAID 37.50 37.50 REVENUE DIVISZON TOTALS--> COLLECTED; 37,50 OVER/SHORT: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING 37.00 ,50 D00 , � � PLAN—CHECK if 1E iE iE 1F 1f 1f iE if if 1F iE k 1E 1E iF k if if If 1E iF k iE 1E it )f iE iE 1E iE ik 1E iE if if iE iE iE if k iE iE 1E If 1F k ik �k iklf if it if iklE iFlf iF if IE IE iF �E iE ik ik 1E 1F iE �f if if if 1E iF iE 16 ik I N D I V I D U A L'j F E E B R E A K D O W N TYPE QTY D E S C R I P T I O,N UNIT COST TOTAL COST SFR 1598 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 1,598,00 ENf OF FEES !• .F � 01 �0141401—OD1414D2 T C�T �ATE� O6/?2/93 TIflE: 11:06 37,50 �� CONSTRUCTION AND PLANNING POOI PA APPROVALS Permit qW �•Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Elettrical Ser�ice or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. . ' 53. Steel Reinforcement � 3. Electrical Condu7t Utiiity•Undrgrnd. 54. Forms - 4. Electrical Conduit•Undrgrnd. 55. Electrital Bonding � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electritai UPER Gmd. - "- 57. APPROVAI. TO COVER�GUNITE 7. footings �. � . 58. Electrical Conduit�Undrgmd. •- 8. Foandation . 59. Gas Pipe, � Undrgmd., Test 9�. Water Pipe-Undrgrnd. 6p. Backwash Lines, P-Trap, Q Undrgrnd. � 10. Structural Floor SYstem 61. APPROVAL TO DECK . 11. Property Sewer Line & House'Connection � 62. Backwash & Receptor�Finai 12. Sewer Cap � � ' 63. Heater & Vant•Final 13. Roof Drains • 64. Plumbing Systam - Final � 14. Rough Plumbing v, 65. Electrical-Fi�al 15. Rough Electrical-Conduit 66. Solar System•Final ' 76. Rough Electric Wiring 67. Fencing & Access ApProval 77. Rough Wiring Sign 68, qPPROVED FOR PLASTERING 18. Rough Electrica.t•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIR� DEPT. REQUIREMENT _ 20. Rough Factory Fi1eplace ' , " ' . APPROVALS 'Permit # 21. Ducts, in Strvcture � 70. Underground Hydro 22. Ducts, Vfln[ilatiny. � , '' _ t71, Product Pjpin9 �Gas ❑Oil 23. Gas Pipe-Rough & Test ' _72. Underground Flush -' 24. floof Framing . � � � �' � �3. Undergmd,. S[orage Tank O Gas ❑ Oil 25. Roof Sheathing . �- 6 74. Overhead Hydro 26. 7-Bar Ceilin9 (Structurall & Monocoat l� 75: .Dry Chemical - 27. Frame and Fiashing ,: , � � 76. Dry Standpipe 28. Lathing&Siding '�' ' ' , - '�� ,' 77,- FIXEDSYSTEM_F1NA� 29. Insulation �' 78� FIRE PREV. FINAI '30. Drywall Nailing ' I" - HEALTH DEPT: REQUIREMENT 31. Plaster Brown Coat I � �79. FINAL INSPECTION 32. Electrical Power Meter-Final, • I^• � 80. FOOD CERTIFIGATE ISSUED 33. Final Electric ; ( - Notes: (.C� 34. Final Heating'& Air Cond�tioning � �� 35. Final Gas Pipe�Test , ' 36. Hood or Canopy � , ' ; � � .� , - 37. Final Factory Fireplace � . .. 38. Final Plumbing • � � ` � ' 39. Water Service-Final , � - � . 40. Gas Service-Final� � � � � 41. Solar pomestic-Final � � 42. 8ackflow Preventer 43. Backflow Irrigation . , � • - 44. Landscape Irriqation $ystem � � � - • � � . . � � 45. Sound Attenuation '• � 46. Handicap Regulatiohs�' '� - . : - � ' 47. FIN%aL STRUCTURE & BUILOING 'f�C/� ' _� 48.�FINALPIANNIN6- � ^ ` . . 49. Elearic Release 2o:�disAn � ` � I 50. Gas Release to Southern Galifornia Gas Cn � � �� 51. CERTIFICATE OF OCCUPANCY • • ' No. Date / 5/ �- � COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MBBA. GLIFORP��A For Applieant fo Fill In Complefely TyPE OR PRINT BUILDING J! Y(� ADORH68 7 COSTA MESA. CALIFORNIA ■ BIZE 9�`�' Sf. TEI. ` . S cL r+o. i A-_ 7EL. NO. — �i.ct / cYe r �/ �='� S�', i l_a�i7. TEL. f p NO. � I 4 �� 7 � I NO. OR BLDGB. 66TBALK LINH FliOM � �� ceNtBx op eTsteeT � � REAR YARD SIDE YARO Il.EFf I� , I RIGHT / DESCRIPTION OF WORK J NO. OF � FE RECEgs tu � APR 26 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only �EG61PT Njl.' P[jIM � � ` 7 / � Y RECEIrED �Y OA qE V O D TH 89UEO L� �. eui�oiN� C � ADDRESS i COSTA MESA. CALIFORNIA APPROVED �FI ✓� _'__O..iL� ZO�C � � I PLANB �B ILDIN �BaI.� l � � /O � D28CRIPTION IL' YARDS � � ZS � APPROVED (CENTHR LINB BT.1 � EXTERIOR WALL �J ROOF COVERING SJILL'C COVERING USE OP BUILDING AND V✓ORK TO B QEIiFORMEP - ' A� _ tjD 1 HERBBY ACKNOWL8D6H THAT 1 MAVH RHAD TH19 APPLIGTION 1XE AMOIINT BXOWN UNDEN V�LYATION IB FOR TN8 AND BTATfi TXAT TX8 A90V8 IB CORRECT ANO AOR6H TO CON- pU1a08E OP ¢9TASLIBNING A PEPNIT FEH ONLY. PLY WITH ALL C1T! OItD�NANGC9 AND BTAT¢ 1.�W9 i166ULATN6 eu�t��Na coNeflturnoN. VALUATION �j 91GNATURE OF � ! PERMIT FEE S �7` _7 '�� PERMITTE � / $ � yOO � pLAN CHECK S /((� � � AUTHORIZED ACENT C \ TOTAL FEE L COUNTY OF ORANGE .BUILDING DEPT. 636 Ko. $roadway • Santa Ana� Califarnia Phone: KI 2-6211 `-D �� Application for Building Permit AND FOR A Certificate of Use and Occupancy � Permit No.__..�1�-5---�-�- Dace.---'-��/�/ �------------'----'-----'- 1. OWNER'S NAME_------CQA�r--ORA►�-M�F{�L�B----------�--------�-------�---------------- -- - ---- PHONE:Be$fl0II__Bi9�. 2 3 4. MAILING ADDRESS-------iBB._H�i•.__i�I'�1__SLl'99L----.------------ ......................... . CITY -----._OQB�(i. M9�A------------------ Namt ... Address c�Y ..--- S[a[e Lic No. (Arthicecc or Engincer) Phone ___.. �am(}9or�v_2_i. Hoietein__t� Sone ----------'_--'----_'--" (Concrattor) Address _'_I�ET�...E�---Z%�'1__�t2�80t-----------'---'--"-------- c��r ----Co4ts _?•teea- ------- -----� ...... . .. ...._ -----------•-------- $tate Lic No�i9w�SO_--'--" B,�. -------- PhoneAoaaon--8297--- PROPOSEDUSE: -- -R98ia0T100-- -------- -- ------------ _- ---- ----- ------------ ---- ----------- - -... .. ...... ------ -- -- - ------ ---� --- JOB LQCATION --- '7!'S/G------------- - -------/J ---- =-` r--'--- --- ------ � ----QOBCA -I'i0A8-- --------------- ---- --- -------- (House No.) (Name oF S[reet) (Town or School Districc) LEGAL DESCRIPTION: Lor - ---./�.--- --- ---------- ---Block ------- --- � --- --------------Traa ._l.c�.8�- - - ------•-------.. (Meres and Bounda Description—Use resene side of form) CORNER LOT ( ) IIVTERIOR LOT (✓) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZHOF BLDG.:___-?G_Y_'�+�LAREA:______.g``___._.___SIZE OF LOT:._.GZ.k./.�.�AREA:__%.7�l-D---____...... 6. HEIGHT OF BLDG.:.__._�A�______..____._______.CEILING HEIGHT:.____.._89_..____...._..___. NO. OF STORIES._____�._...: _.... 7. NO. FAMILIES ..__________1..._..._.....________. Size of Smallest Bedroom:_.9X_./Q_`._.._ Size of Kicchen: ...d. _X._/!�_G_. 8. EXTERIOR WALL CONSTRUCTIOIV�._$tiLLCQO________.INTERIOR WALL COVERING._._____P�g8�Fr8I`-.--._---.- (FramP. Sn�«n. F �.1 � fPlaaoenDrvwalL Etc.l 9. SETBACKS: Front Yard from Cen[er Liae of Nearest Side Ynrd _._____.__�.�.__�..: Reat Yard ____T�_,_.. Distance in Fcet Betwcen Bldgs. on Same I.ot __d.Q._�.__.... . IU. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES A[VD USE OF EACH. lL For (a) Footing: Width._.___1gM ................___.Depth in Ground....._.._1QR Widch of Wall.._.....gA. . ....._.._... - "' ...... Accessory Bld s. and b Size of S[uds:..._ B p_-___--_--__. "CC Material of Floor _�QO.A------ -------_.-- Similar ( � 2_.'Jj._�.___"_".Spacin8-'�,8-. $tru[tures: (c) Sizc of Floor Joiscs: _�--�j-B......"-"'-'-'--..Spacing _---' �A-.-,--'__------_"CC (d) Size of Raftcrs: -----'S-$--�---.....----'-'--Spacing --.....E�»..----`-`----��CC 12. VALUATION OF •PROPQSED WORK: Induding alt labor, plumbing, eleurical wiring, heating, fire sprmk(ers, paint- in and sewa e dis osal � g s P �---� � �9=---- --- ------------- l;. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS �CORRECT AND THAT THE CONSTRUCTIOIV WORK WILL CONFORI�i TO ALL LAWS OF THE COUIVTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. ��' � i rj� � wner) Plans Filed:._-----------------------`�...`�.----------`--------`-- BY�------------ - -'--'�---�.--�""-'-- -- - - -"---------'- (Auchorize Agenc) FOR DEPARTME[VTAL USE ONLY FEES: Bldg. Permit Plan Check Total - - Receipt No. Paid to Date --'--'----- � GROUP--------�,.�--- _'-. �---- T"] PE ---'------- ��----'------ e-- y'o DIST. ----�-- ��---- MAP.---- - ------ -- -----�-------- _ SHEET NO._.....✓........__ DATE.------------ - ------------------------- -- --- lM-9-'JO , CH CKING BY APPI.ICATION _. _. HEALTH _.._._.._..._.._..____. FIRE ZONILVG..------ -- ---- MARSHAL. ------------------- PLANS AND SPEC'5.---�-------------------.. STATE ---------------•---- ---- CORREGTIONS ENGINEER VERIFIED .-- -------- - �---- CAL..----------------------- ---�- PE SSI�EDBY:•,-- ��;�;v BUILDING '. �.'�. Ll� � .� . _� �NoPLCTOR -------- ---- ---------------�------------------ ---- - - --- - - - ----------------- --------------�--- o�Purr h I �� COUNTY OF ORANGB BUILDING DEPT. 636 No. Broadway Santa Ana� California Phone: KI 2-62I1 Application for Building Permit AND FOR A • Certificate of . Use and Occupancy Permic No.------�� S -z �_' Date_------------/�---- S-�'�-�-------------- I. OWNER'S IVAME----.COA.�.__�AiN�Pi.-ACREa------------ ------=-----------�--------------- -._...._-- PHONEH@$0013-8��--- NIAILING ADDRESS.---•--�OIS- ''�---L�LiI--$L3�86L------�----------- ----------------._ CITY .G08trQ'--�aAOtt----------------------- Namc Address City--- " --------- ---` $[ate Lic. No._-----'-----' or Engineer) Phone NameMww�w..O�i'.��10�Cb'�cc� -�i�-'--'--"---"-'_ ��A��.� Addro:s .%Qi�..E•--�.�.�il--BLliilit---------------------------- Ciry _QCOi'ra -! $tate Lic. Noll�'�( Phone PROPOSED USE: .-- -GARA(}b'. --...------ ---------- ---- --- _---- ----- - ------- ---- - -'- -� - - - --- ---- -- - --- ------ z. Jos �ocnTroN --- - -'`'��----------- ----------,E_---�y.--�---•-- - - ----- -----�Q�sCa -Ile.sa_------- - ----- ------------------ (House No.) (Name of Strect) (Town or School Disnic[� 3. LEGAL DESCRIPT'ION; Loc ------_-/�----------_-_---___-----Block .-_-____ -------_ ----_____---_-Trac� ..--],��.- - --- --- ------- - - (67etes and Bwnda Descripcion—Use rexrse side oE Eorm) 4. CORNER LOT ( ) INTERIOR LOT (✓) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG.: -�---ii--QU_,--- AREA:-_$�Q__�--:'�_.--.SIZE OF LOT: _�..Z.X._/ T�AREA: .Z..Z_✓_U.__-_-----_- 6. HEIGHT OF BLDG.:._14�-_--_--------------_----CEILING HEIGHT: NO. OF STORIES._� ________________ 7. N�. FAMILIES ---"--"------'---'---__"_"._Size of Smallest Bedroom: ----------_-_-'_'.._..... Size of KitcFun:._..-------------'--"_-"'_" S. EXT6RIOR WALL CONSTRUCTIOIV:.�ji��_.$��..___SNTERIOR WALL COVERING ..................___.______._______.: (Frnme, $cucco, Em.) • • � (Plmrer�Drywall. Em.) 9. SETBACKS: Front Yard £rom Center Liae of Street__"-"'-"/�-�--_'_'--"'_"""----'--'_------..."""--------"---'------'---"'-"-----" � i r Nearest Side Yard __...w�.. .__.__...Distance in Feet Between Bldgs. on Same L,ot ..... ..Q ............ .. .. ----'--'_Rear Yard.-'----------- 1U. A COMPLETE PLOT ALAN IS REQUIRED, SHOWING ALL STRUCTURES AIVD USE OF EACH. l l. For (a) Footing: Widch .-.14M-'----_--------------- Dep[h in Ground.---�M-_._-'-_----_-.Width of Wall ---gs._._ _--.-_--. Actessory / B(dgs. and (b) Size of Smds: __..Z..Jr.__:5j: S acin �(�._____..__"CC Matcrial of Floor Similar --------- P 5------------ -- �QOA02Kiti9- $tructures: (c) Size oE Floor Joists: ---.-"--"--._ Spacing ..-_-- -'---'----'--" "_-__-'- "CC ....-""""'_'-..._ (d� Size of Rafters:'----".-t�i-$--�----------"'-'-'.Spacing --'--�--�11.--"-'-------._"CC 12, VALUATION OF PROPOSED WORK: Including all labor, plumbing, ele<trical wiring, heating, firt sprinklers, paint- ing and sewage disposal y�_____ .Z � . - __________'_ . . O____�."'_'_____' li. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTIOIV WORK WILL CONFORM TO ALL LA\��S OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Sigr Plans Filed:------1�_�_-3.- -T�------------------------- FEES: Bldg. Permit - Plan Chcck - To[al - - - Receipc No. - Paic{ ro - DA SM-) SO $- FOR DEPARTME[VTAL USE ONLY �� GROUP----- --T ----- ---: '- _'-'-'_A---'---- .. � �-------- TYPE.---------�-------------- ~ffi-�---------� DIST. ifj ,� S� � MAP--�-------��-- ----------- - - --' -- ----- SHEET NO---------------------- -G _ cb C�i'w`— ING BY APPLICATIOc�� J�� HEALTH-----------------------.. FIRE ZONING ......................... MARSHAL PLA[VS ALVD --'-' --- SPEC'S---------------------- - STATE ------------------------- CORREC'I'lONS E[VGINEER PERMIT FSS - ED;BY: . , , . .. / CO'J;'-� BVILDIfYG l�. `:�1. � _� ' . . ' .�._?_GTOR -- -------- �------- ---- - ---------------------------- --------- - - � - - - -- ---------- - --e -- - - DcPUTY yc4ii:r,�j3.r ,�',�'�. • i "�� i ' � � _. CITY OF COSTA MESA BIIILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC07-00493 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: OS/14/2008 _ ;' ISSUED BY: RMD �oa ,nDOREss: 446 W 19TH ST CM -. Suite/Umt -,, APN: 41920516 �x �' ��ZOning . . . . VicinitY :'�.' '''' -" • � . ;Prima'ry Occ B'��' �' Const T e: V-N ,��.5' � yp � $Q.FT 0 Valuafion: $8,500.00 � . , %: SCOPE OF WORK: EXTERIOR REMODELI�NG*TO REPLACE EXISTING CANOPY WITHJILE�CANOP,Y. REPLACE HVAC SYSTEM AND GLAZING. DEMOLISHiALL'_IJON-LOAD BEARING INTERIOR WALLS AND RESTROOMS WITH 2:LIGHT FIXTS, 1 OUTLET, 1 SWITCH, 1 MOTOR TO 10',HP;.1 COMPRESSOR 3-15 HP, 1 WATER PIPE, 1 WATER.SVC�=NO.FLOOR`AREA ADDED. REF: BC07-00490 � � .� .. ;: x -.. � . — i' � � � � : i'�',. ,f,sl „ ' OWNER: HERBERTS,�CURTIS A��;� � - -��Addresa `2290`CHANNEL RD TS� �. ,�1� Unit: < PhOnO: '��'�� 'S"r.,j r^'�' �� Cify/St3t0/Zip: BALBOA. CA � ��`', �_' t � :}'� J„ h'r . �c'` , . \ �� , :.�.i � . APPLICANT: MOORE, f EFF, � � _ Address: - . . . � ' . r�; Unit: : Phone: 951-756-3918� � ' City/State/zZip: - � -- � , . � - , cONTRAC7oR: ROSEEN BUILDERS INC License No. 813939 � ' Phone: 949-716-7900 ' " . _ ' � Address: - 23011 MOULTON PARKWAYUnit: �, ' �. � � Cell: �i�� ' ,�. a.- , City/State: ��LAGUNA HILLS, CA . ZipCode 92653 „'i, ; ` _ . . . � ,,:: , . , . ARCHITECT: EHDAIE, BEHROUZE''' � � _ - License No.C�4284� �- ' � ' � �� PHONE:949-497-1935 ENGINEER: ,:�,-:. �z��.,. ', LicenseNo.�� , � � � � '�PHONE: . . -. . � ., � .. , � _�� . COMBINTATION PERMIT"FEE SUMMARY � Building Plan Check: . -, � $108J1 - , - - . _ Building Fees: $167.25 Electrical Fees: $40.20 _ _ Mechanical Fees: " �. $50.65 � � " ' Plumbing fees: $43.10 ` ' SMIP Residential: �.; $0.00 . - SMIP Commercial: $q,7g � . ' � TOTAL FEES: $411.69 "" " — ••Refer to fee receipts for all fees paid for project 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 wmply with all applicable codes, and all required inspections and flnal approval must be obtained. Failure to obtain inspectlons and final approval will result in the expiration of this permit. cooe�. ixsaecnoxme 1818 FixeE System Final Pira Prevention 1288 Pool Spa Final . 200 Final Re-Roof 201 Final BIocWRefaining Wall 202 Final Factory Fire Place 203 Final Sign 206 Final Dertrolition o� ixL� cQo� iNsvecnoxrne 208 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 FinalBuilding/Occupan�y P� INTIiULS ' �� WORKERS' COMPENSATION DECLARATION: I here�y aflirm untler penalry of perjury one of the follovring declarations: � ❑ I have and will maintain a ceAifcate of consent to self-Insure for workers' compensatioq as provided for by section 3700 of the Labor Code, for the pertormance of the vrork for which this permit is issued. ❑ I have and will maintain workers' compensation insu2nce, as requiretl by section 3700 of the Labor Code, fa the pedortnance of the v.ork for which this pertnit is issued. My workers' compensation Insuranc carrier and policy number are: �� Cartiel 1�� (ThBsetlionrieetlrotEecanpeteC�e/p�emr:is eqafwenuMredCollarslEt00)wkss.) �Policy�Number: Q "J ( % ❑�cel rti� that in the performance ot lhe vrork for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of Califomia, antl agree that if I should become subject to the workers' compensation provisions of Seclion 3700 of the Labor Code, I shall torthvrith comply with these pmvisions. �/1�/11��- 5�/f�OB � Applicanl'iSignaWre Dai te—� � WARNING: FAIIURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SU&IECT 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, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby amrm that I am licensetl untler provisions o! Chapter 9(commencing wit� Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and e(fect. � n C .� L'ic.�.� Class#� �- `�.riY-a8 `�ConVatlor'sSignaWre Dale =� CONSTRUCTION LENDING AGENCY: ❑ I hereby affmn tha[ [here is a wnsWction lending agency for the peAortnance of the v.ork fa wfiich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby aKrm iha� under penalty of perjury thal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7W7.5, Business and Protessions Code: Any city or county which requires a permit lo wnstruct, alter, impmve, tlemolish, or repair any s[ructure, prior to its issuance, also requires the applicant for such permit [o file a signed sta[ement that he or she is licensed pursuant to the provisions of the Contraclors License Law (Chapter 9(commencing wilh Section 7000) of Division 3 ot 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 (or a permit subjects �he appliwnt to a civil penalty of nol more Ihan five hundred dollare ($500).): ❑ I, as owner of the property, or my employees vrith wages as their sole compensation, WILL DO THE WORK, and the structure is not in[ended or ofleretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dces not apply lo an owner of property who builds or improves thereon, and who does such vrork himself or herself or ihrough his or her own employees, provided that such improvements are not intended or oHered for sale. If, however, [he building or improvement is sold within one year of completion, the ovmer-builder will have the burden o( proving that he or she tlid not build or improve (or purpose of sale.). ' ❑ I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWct the project (Sec. 7044. Business and Professions Code: The contractors License Law dces not appy to an ovmer of property who builtls or improves ihereon, and vfio cont2cts fa such project with a contractor(s) license pursuant to the Contractors License Lavrs.). ❑ I am exempt under sec. - Business and Protessions Code for ihis reason: Si9^a�ure Date 305]-i6 (3ro]) Ovmer ID verifed by driver's lice ❑ Yes ❑ No Dnver's License No. Expires: '' Verification of�Ownership by pype of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certdy [hat no excavation five (5) or more feel in tlepth into wfiich a person is requiretl to descend, will be made in connectbn with work authonzed by Ihis permit, and that no building s[ruc[ure, scaffdtling, falsework, a demoli�ion or dismantling ihereof, will be more than thiAy-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TUe 8, Califomia Administrative Code). ❑ As owner-builtler, I will nol employ anyone to tlo work which woultl require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such vrork from the division. Ap0licanl's Signalure Dale Division of Industrial Safe[y Permil Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre building occupan[ need to file and certify a Business Plan for emergency response lo release or lhreatened release of a hazartlous material? ❑ Yes � No (Seclion 25505 of the Califomia Health and Safery Code requires, with some exceptions, Ihat a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reportetl year a quantity of hazartlous matenals equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas at standard temperaWre and pressure). 2. Dces or will lhe applicaN or presen[ or fuWre building occupant need to file a registration form for acutely hazardous materials? ❑ Yes � No (Section 25533 of lhe Califomia Health and Safery Code, with some exceptions, requires registration wilh the Costa Mesa Fire Deparlment by each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or grealer than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperaWre and pressure). - 3. DoeS or will Ihe applicant or Oresent or luture building occupanl need lo prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Safery Code provitles ihal Ne Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are requireC to register acutely hazartlous materials wilh the Fire Depanment. 4. If an RMPP is presently required, has Seclion 25534 01 the Califomia Health and Satety Code been fully wmplied with? ❑ Yes ❑ No 5. Does or will the appliwnt or present or future building occupant require for the work which is the subject of this application a permit for such wnstruction or motlification from t�e South Coast Air Qualiry Management District or from any other air polNtion wntml tlisMct or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires that the requestetl infortnatbn be fumished on applications (a non-residential building pertnits�. 6. Will any part o( the facility to be consWcted untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No pf �yes", the facility must mee[ the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7. If a pertnil fmm the Sout� Coast Air Quality Management District or other air pollution control disMct or agency is required for the v.ark whiGh is the subject of this application, have all of the disclosures prescrihed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of wmpliance from the appropnate air polWjion control oKcer). , CERTIFICATE OF COMPLIANCE: I certify tha[ under penalty o( perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • � Signawre �aie CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cerlify under penalry of perjury that I have read this appliwtion antl state that the intortnation given is covect. I agree ro comply with all state laws antl city ortlinances relating to building consiruction, and authonze representatives of the Ciry of Costa Mesa to enter upon the above-descnbetl property for inspection purposes. I agree not to occupy or allow occupancy of any builtling authorized by this pertnit until final inspection. SignaWre af Legal Ovmer(s) Date �---Q�I%i�.�- �' i � a F� `—A / .AulborileaApdican�� Dale ___� a p 'WF � p o. ' � 6 r J : o1.� � "�o.mw p � � CITY OF COSTA MESA BUILDING D/VISION . 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.wsta-mesa.ca.us PERMIT TYPE: B COMBO Sub Type: COM_ALT FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC10-00166 JOB ADDRESS: 446 W 1;9:CH:S"LCM APN: 41920515 Zoning: , , Vicinity: Const Type: V-B SQ. FT: 550 STATUS: ISSUED DATE ISSUED: 06129/2010 ISSUED BY: RMD Suite/Unit: Primary Occ: Valuation: $25,000.00 SCOPE OF WORK: 550 SF INTERIOR TI FOR "WHOLESALE NUTRITION CENTER". CONSTRUCTION OF NEW NON-LOAD BEARING PARTITION WALLS'FOR A NEW RESTROOM AND UTILITY ROOM, NEW COUNTERS, SALES AREA, AND FINISHES. 14 LIGHT FIXTS, 14 OUTLETS, 4 SWITCHES, 2 MOTORS TO 1 HP, 1 SUB PANEL, 1 REPAIR/ALTER COOLING/HEAT, t VENT FAN, 1 FLOOR DRAIN, 1 FLOOR SINK, 1 SVC MOP, 2 TRAP PRIMER, 1 WASH BASIN, 1 WATER CLOSET, 1 WATER HEATER. OWNER: SOMERS, LAWRENCE ORIN TR Phone: APPLICANT: FRIES, CHARLES Phone: 909-730-4539 Address: 471 OLD NEWPORT BLVD #301 City/State2ip: NEWPORT BEACH, CA Address: Ciryl$tate/zZip: CON7RAC70R: B FRIES CONSTRUCTION INC License No. 735157 Phone: 909-930-2848 Address: 1802 E CEDAR STUnit: Cell: City/State: ONTARIO, CA ARCHITECT: EHDAIE, BEHROUZE ENGINEER: COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: Litense No.C14284 License No. $254.31 $391.25 $98.70 $44.45 $101.90 $0.00 $5.25 $1.00 $896.66 Unit Unit: : SUITE E ZipCode 91761 PHONE:949-497-1935 PHONE: HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3I18/2010 - PER CMMC Sec. 13-279 Montlay thru Fritlay- 7:00 am thru 7:00 pm. Saturtlays• 9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the tollowing Federal holidays: NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under California sfalutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: PERMIT EXPIRES'I80 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order (or 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 obWined. Failure lo obtain inspections and final approval will result in the expiration of this permit. COUE t. 1878 1268 200 201 202 ixsvEcnox ttre Fined System Final Fire Prevention Pool Spa Final Final Re-Root Final BIocWRetaining W all Final Faclory Fire Place 203 Final Sign 204 Final Demolition D� INTf7IAl5 cooe� ixsrecnoxrne 206 Final Mechaniwl 208 210 212 220 222 250 Final Plumbing Final EleciriCal Pinal Fire Prevention Final Planninq Approval Final Site Final 6uiltling/Occupancy P� rz" ix'nn-��-s^ - -�70 �V �/"'�' X �19 -i0 �N O"� 1G SS' 4 -X� �_ov�^s- �� g��l �Il� g�1J La-"'� � WORKERS' COMPENSATION DECLARATION: I hereby aHirm under penalty of perjury one of the following tleclaraGons: ❑ I have antl will maintain a certificate of wnsent to self-Insure for vrorkers' compensation, as provided (or Dy sedion 3700 of the Labor CoEe, for the per(ormance of the work for vfiich this permil is issued. }ir�1, I have and will maintain Norkers' compensation insurance, as required by seLtion 3700 0( the Labor Code, for lhe peAormance of the v.ork for vfiich Ihis pertnil is issue0. My workers' compensation Insurance carrier antl policy nua�mb�er=re: � ��, (ThiS SedUn nBM rpl pp (Y]I�1�IG!!tlGI fhe ppl/m1 C vdh�CE al pM Ilu/IORN WINS f51001 a leu ) POIIc4Num �er: (�JOU � p� tl�Z. V C� Qj ❑ I cenify that in the perfortnance ol the wolk lor which Ihis permit is issued, I shall not employ any pe son in any manner so as lo become subject lo the vrorkers' 1ompensation I of California, and agree I�at if I shoultl become subje to !he kers' ompensation provisions of Seclion 3700 of the Labor , s all f� ' h o y_wilh lhese provi ons. 2�� ( � A00 n' ` � � e� 0�,� WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF TNE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby a((rm that I am licensetl untler provisions ol Chapter 9(wmmencing with Section 7000) of Division 3 of the Business antl Professions CoOe, ana my license is in tull for e antl eHect. � ��— - ' 3 � I S '7 ��a9c-5� � -�R. � G, Z c� �CSriiranor's Sipnature l�Da1 CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a constructbn lending agency fa the perfortnance of the work (p v.fiich this pertnit is issued. (Sec. 3097. Civil Code). Lender's Name: Lender s Atltlress: OW NER-BUILDER DECLARATIONS: 1 hereby a(firm tha[ under penalty of perjury ihal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or Ihe f011owing rea5on (Sec. 7031.5. Business antl Prolessions Cotle: Any city ar county which requires a permit to consWct, alter, improve. demolish, or repair any sWcture, prior lo its issuance, also requires the appliwnt for such pertnit to file a signed statemenl that he or she is licensed pursuant lo the provisions of the Contractors License Law (Chapter 9(wmmencing with Seclion 7000) of Division 3 of the Business antl Prolessions Cotle) or Ihal he or s�a is exempt therefrom and ihe basis tor the alleged exemption. Any vio�ation of Section 7031.5 by any applicant (or a permit subjects the applicant to a civil penalty of not more than fve hundred dollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl lhe structure is not intended or offered lor 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 tloes such work himself or herself or throuqh his or her own employees, provided thal such improvements are not intended or offered for 5ale. It, however, Ihe builtlinq or improvement is sold wiNin One year of completion, the owner•builder will have the burden of proving thal he or she did not builtl or improve for purpose ol sale.). ❑ I, as ovmer of the property, am El(CLUSIVELY CONTRACTING WITH LICENSED CON7RAC70RS to construct the project (Sec. 7044, Business and Professions Code: The cont2ctas License Law does not apply to an avner of property who builds or improves thereon, and who contracts tor such project vnth a contractor(s) license pursuaN to Ihe Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SiB�aWre Date J05]<6 (3/0]) Owner ID veri(ed by driv�ense. ❑ Yes ❑ IVo Onver's License No. Expires: Venfication of Ovmership by (type of document, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certAy lhat no excavation frve (5) or,more feet in tlepth inro vfiich a person is required to descend, will be matle in connection with wvrk autMrizetl by this pertnit, and that no builtling structure, scaffdding, falsework, a tlemolitbn or tlismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 311, Ttle 8, Califomia Administrative Code). ❑ As owner-builtler, I will nol employ anyona to do work which would require a pertnil from the Division of Industrial Safely, as noted above, unless such person has a permit to do such work trom the division. ApdiWm's SignaWre Division o( Induslrial Safe�y Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or (ulure building occupant neetl to file and ceAily a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of Ihe Calilornia Health antl Satety Code requires, with some ezceplions, Ihal a Business Plan be fled with the Costa Mesa Fire Depanmenl by every business which has at any one time tluring a reported year a quantity of hazardous materials equal to or greater than a weighl 01 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Dces or vrill the applicant or present or fulure building occupant neetl to file a regislration form for acutely hazardous matenals? ❑ Yes ❑ No (Seclion 25533 of lhe Califomia Health and Safety Code, with some exceptions. requires registretion with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous matenals equal to or grealer than a weight of 500 pounds, or a voluma of 55 gallons, or 200 cubic feet of compressetl gas at standard temperature and pressure�. 3. Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management antl Prevention Program for acutey hazardous materials)7 ❑ Yes ❑ No (Seclion 25534 of the Califomia Health antl Safety Code provitles that the Cosla Mesa Fire Department may require the preparetion, certification antl filing with the Fire Department of an RMPP by businesses which are required [o regisler acutely hazardous materials with Ne Fire Department. 4. I( an RMPP is presently required, has Section 25534 of lhe Califomia Health antl Safety Code been fully complied vnth7 ❑ Yes ❑ No 5. Does or will the applicant or present or tuture building occupanl require for the work which is the subjecl of this applicalion a pertnit for suc� construction or motlification from the South Coast Air Quality Management District or from any other air polNtion control district or agency? ❑ Yes ❑ No (Sectbn 65850.2 of the Califomia Govemment Code requires that the requested infortnation be fumished on applications for rron-resitlential building pertnits). 6. Will any pan of the faciliry to be construcled under this permit be vrithin 7000 feet (rom the ouler boundaries of a school7 ❑ Yes ❑ No pf yes", the faciliry must meet the requirement of Sections 25534 and 42303 of tho California Heall� and Safely Code). 7. If a permit Irom Ihe South Coast Air Oualiry Management District or oNer air pollution control district or agency is required for the work whic� is Ne subject ot this application, have all ol the disclosures prescribetl by Califomia Health and Safety Code Section 42303 been made? ❑ Ves ❑ No 8. (If'yes', atlach certificale ol complianca from the appropriate air pollution control offcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty o( perjury the inlormation given above is wrrecL I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penally o( perjury that I have read this application antl state that the intormation given is correcl. I agree to compty with all state lav5 antl city ortlinances relating to builtling consiruction, and authorize representatives of the Ciry of Cosla Mesa to enter upon the above-described property lor inspection purposes. I agree not to occupy or allow occupancy of any builtling authorized by this permit until (inal inspection. �Sig re Legai Owner(s) ate /� � 4 \ _[fG C �FMbPAGihorizetl ApPlicanl �pat-.�„�y./'