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Home My WebLink About619 18TH ST - Building Permits. � . � e. i : � c �.o�m � • PERMIT TYPE � C�F COSTA MESA � ' ' BIIILDING D/VISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wiw.ci.cosla-mesa.ca. s FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E07-00894 ELEC STATUS: DATE ISSUED: ISSUED BY: JOB ADDRESS: 619 W 18TH ST CM ." Suite/Unit: Vicinity: PUBLIC RIGHT OF WAY, :- --. � -� � - � . - � ' ". .� � � , � SCOPE OF WORK: INSTALLATION OF A NEW 100A SERVICE METER PEDESTAL FOR "AT&T'. r OWNER: CITY OF COSTA MESA, - ' PHONE: APPLICANT: WILLIS, JANAE M PHONE: 909•946-0905 - , i Address: City/State: VCITELECOM 1921 W 11TH STUnit: UPLAND,CA Address: City/State/Zip: +,, � Address: � '� City/State/zZip: PHONE: 909-946-0905 ZipCode: 91786 ELECTRICAL PERMIT FEES ' --- � Electrical Plan Check Fee: $0.00 Electrical Permit Fee: . $54.00 Reinspection Fee , �: $0.00 TOTAL FEES ' $54.00 � ISSUED 1 111 3/2 0 07 RMD Unit: Unit: License No. 765716 � CELL: � �� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulafions. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 1NSPECTIONS: 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 antl final approval must be obtained. Failure to obtain inspeclions and final approval will resu�t in the expi2Uon of this permit. CODE1. INSPEL710NTYPE DRTE INTITRL CQOEt INSiECTONTYPE ORTF INIITIRLS 1616 Fixetl System Final F�re Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing // % � 200 Final Re-Roof 210 Final Electrical 201 Final BIxWReiaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Appmval 203 Final Sign 222 Final Site 20a Final Demolition ' 250 Final Building/Occupanc/ WOR{(ERS'•COMPENSATION DECLARATION: � I hereby aKrm under penalry of peryury one of Ne (ollowing deGarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provitletl for by seclion 3700 of the Labor Cotle, for the peAormance o( Ihe work (or whic� lhis permit i5 issued. �I have and will maintain workers' compensation insurance, as requiretl by n 3700 of ihe Labor Code, (or the peAormance of the work for which this permit is issued. My workers' compensation Insurance carrier antl policy number are: c��:� �al P�or�r ohl; c (ih65MUI1�BBd(I�IdbnP�q�..� M/IIIOP�d2Sv,NeY�MBIbIBIIIY�MdNdISISIWI0Ik53I Policy Number: /�l�l�CJI_ `�i� i A)'7 � � C� J ❑ I certify ihat in the perfortnance o( tha work for wtiich this permit is issued, I shall not employ any person in any manner so as lo become subjecl to the workers' compensation lavrs of Califomia, and agree that if I should b oM1SB`� bject to the workers' compensation provisions ol Section 3700 of e Labor ode I shall torthwith comply with these provision . � �� ApplionYs SB^aWre le- �— � � WARNING FAILURE�TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMl�GES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, IMEREST, AND A7TORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I here6y aKrm that I am IicenseC untler provisions of C�apter 9(commencing with Section 7000) of Division 3 of the Business and Pro(essions Code, and my license is in lull force and effecl. �� Lic. #-7 C� -1a55 #� � C Z O � � onva s5ignaWre 'Date— �_i CONSTRUCTION LENDING AGENCY: ❑ I hereby affum Ihat there is a consWction lending agency for lhe peAortnance of the v.ork fa wfiich tNs pertnit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Atldress: SiBnalure Dd1e OWNER-BUILDER DECLARATIONS: I hereby aKrm lhat untler penalry of perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which requires a permit to construct, alter, improve, Cemolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to file a signed slalement thal he or she is licensed pursuant to Ne provisions of the Conlraclors License Law (Chapter 9(wmmencing vrith Section 7000) of Division 3 of the Business anC Professions Code) or ihat he or she is exempt therefrom and lhe basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit subjects the applicant to a civil penalty ot nol more lhan five hundred tlollars ($500).): ❑ I, as owner of the property, or my employees with wdqes as iheir sole compensation, WILL DO THE WORK, and the structure is not intentled or oReretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves lhereon, and who tloes such work himself or herself or through his or her ovm employees, provitle0 that such improvements are not intended or oKered for sale. If, however, lhe building or improvement is sold within one year of completion, the owner-builtler will have lhe burden o( proving lhat he or she tlitl not build or improve for purpose o1 sale.). ❑ I, as ovmer of lhe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo constnut the project (Sec. 7044, Business antl Professbns Code: The contractors License Law dces not appty to an ovmer of property who builds or improves thereon, and wfio cont2ct5 for such project with a conlracta(s) license pursuant to the Contractors License Laws.�. ❑ I am exempt untler sec. Business an0 Professions Code (or Ihis reason: 3057A6 �3I0]) Ovmer I�d by drive� ❑ Yes ❑ No � � Driver's License No. Expires: Verificalion ol Ownership by (type of tlocument, i.e. - properry tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certily Ihat no excavation frve (5) or mwe feet in deplh into wfiich a person is required to descend, will be made in conneclbn wilh vrork au[horizetl by this permit, and that no building stmcWre, scaffdding, falseworfe, a tlemolition or tlismantling ihe�eof, will be more than ihirty-six (36) feet high. (C�ap. 3.2, Grp 2, M 2, Sec. 341, Tille 8, Cali(wnia Adminis[rative Code). ❑ As owner-builder, I vrill not employ anyone to Co work which would require a permit from the Division of Intlustrial Safety, as noted a6ove, unless such person has a permil lo do such vrork from Ihe Givision. AppllcaN's SignaWre Division of IndusMal Safety Pertnit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or tuture building occupant need lo file and certify a Business Plan for emerqency response lo release or threatened release o( a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe Calilornia Health antl Safery Code requires, vrith 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 reportetl year a quantity of hazardous materials equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperaNre and pressure). 2. Dces or will the applicant or Dresent or future building occupant need to fle a registration form for acutely hazarCous materials? ❑ Yes ❑ No (Section 25533 0l Ihe Califomia Health antl Salety Code, with some exceptions, requires registration vnth the Costa Mesa Fire Department by each business which al any one lime has on hand a quantiry of acutely hazartlous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 3. Does or will the applicant or present or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials�7 ❑ Ves � No (Section 25534 of Ihe Cali(omia Health and Safety Code provides that the Costa Mesa Fire Department may require Ihe prepa2Gon, certificaUon and filing vrith the Fire Department of an RMPP by businesses which are required to register awtely hazartlous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 ot lhe Califomia Heal[h antl Safe[y Code been (ully complied with? ❑ Yes ❑ No 5. Does or vdll the applicant or preseN or future building occupant require for Ihe work which is the subject of this application a permit lor such consWction or modifwlion trom ihe Soulh Coasl Air Quality Management Disirict or Irom any other air pollution con[rol dislric[ or agency? ❑ Yes ❑ No (Section 658502 0! the Calitomia Govemment Code requires that tha requested inlortnatbn be (umishetl on applicalions far ran-residential buildirg pertnits). 6. Will any paA of Ihe facility [o be wnstructetl untler Ihis pertnit be within 1000 feet from t�e outer houndanes of a school7 ❑ Yes ❑ No (If'yes", lhe faciliry must meet the requirement of Sections 25534 antl 42303 ol the Calitomia Heallh and Satety Code). 7. I( a permit from the South Coast Air �uality Management District or ot�er ai� polWtion control district or agency is required (or t�e work which is iha subject of this application, have all of the disclosures prescribed by Califomia Health antl Safety Code Section 42303 been matla7 ❑ Yes ❑ No 8. (If'j�es", attach certificate of compliance from the appropriate air pollution wnirol offcer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the infortnalion given above is cortect. I agree lo comply with all state laws anC city ortlinances regartlinq Hazardous Materials and Emissions. SiB�alure Oate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ceRify untler penalty ol perjury that I have read this application and stale thal the informalion given is correcL I agree lo comply wilh all state laws antl ciry ordinances relating to building conslruction, and authorize represenUtives of me City of Costa Mesa to enter upon lhe abovedescnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit unlil final inspeclion. Sigwwre ol egat Owneqs) �e . -��. 2� - �3 (� ? �AnC/wAultwrizedApW¢ant�.- Dale