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Home My WebLink About407 17TH ST - Building Permits.. . , « � M CITY OF COSTA MESA BI/ILDING DIYISION PERMIT TYPE . 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.wsta-mesa.ca. FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. E07-00772 ELEC r--�,.�,..- _ STATUS: ISSUED DATE ISSUED: 0813012007 ISSUED BY: BJK ,, JOB ADDRESS: 407 E 17TH ST CM � Suite/Unit: . Vicinity: SE CORNER 17TH ST AND TUSTIN AV ,. . i. ;� , � � � � SCOPE OF WORK: ELECTRtCAL PERMIT FOR A BUS SHELTER AT THE SE CORNER OF- EAST 17TH ST AND TUSTIN AVE. PERMIT INCLUDES CONDUIT, CIRCUIT, LIGHT.'� , , � . � , . OWNER: CITY OF COSTA MESA .;� . , � Address: Unit: � - PHONE: • , � �', CitylState2ip: � APPLICANT: MORRIS,.BARRIE � ,' PHONE: 714335-3233 , CONTRACTOR: B ELECTRIC .' ., Address: 4357 ORIVING RANGE RDUnit� ` Ciry/State: CORONA, CA - ZipCode: 92883 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: ` . $0.00 _ Electricai Permit Fee: $0.00 Reinspection Fee $0.00 TOTAL FEES $0'.00' � Address: 4357 DRIVING RANGE RD Unit: City/State/zZip; CORONA, CA License No. 458423 . PHONE: 774-3353233 CELL: 951-340-3178 s NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: PERMIT EXPIRES 160 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 will result in the expiration of this permit. CO�E1. INSVELPONTYVE Ij_pjg INIIMLS �OOE/ INSPEL110NTYPE on� iNnnn�s 1818 Fixed System Final Fire Prevention 208 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 270 Final Electriwl ��( 3�� Y—i_' 207 Final Block/Retaining Wall 212 Final Fire PrevenUon 202 Final Factory Fire Place 220 Final Planning Approval 203 Fnal Sign 222 Final Site 206 Final Demolition 250 Final Building/Octupanry WORKERS' COMPENSA710N DECLARA710N� I hereby amrm untler penalty ol perjury one of the following declarations: � ❑ 1 have and will maintain a certificate o( consent to sel(-Insure for workers' Compensation, as provided for Dy section 3700 of lhe Labor Cotle, for the peAormance of ihe work for vfiich this permit is issued. ❑ I have anC will mainlain Norlcers' compensation insurance, as required by Seclpn 3700 0( the LaDor Code, for the peAo�mance of the work for wfiich ihis pertnit is issued. My wvrkers' compensation Insurance carrier and policy number are: Cartier: (Thtr seciqn neatl rp1 p! OompYfad/f�e perm46 vaNM at orp �w�'etl tb0ars (Ef001 a lexs) policy Number: I certity that in lhe peAortnance of the vrork for which Nis pertnil is �ss ed, I shall not employ any person in any manner so as to become subject to lhe workers' wmpensation laws of Califomia, antl agree that if I shoultl me subject to the v.vrkers' wmpensation provisions of Section 3700 of � th L or e, I� II orthvnN wmply wilh these pravisions. � AOW� 's B a rl 9f ff IG e� �� WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE �S UMAWFUL ANO SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARS ($700,000), IN ADDITION TO TNE CAST OF COMPENSATION, DAMAGES AS GROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, INTEREST, AND AITORNEVSFEES. UCENSED CONTRACTORS DECLARATION: I hereby aKrtn that I am licensed under provisions o( Chapler 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle. and my license is in tull force and eflect. /^ Li . Class # �l_j — � � ' Yr]��C201 omraqo s9gnaWre Date � CONSTRUCTION IENDING AGENCY: ❑ I hereby alfirtn that there is a consWctbn lending agency for the peAormance of ihe �+ork fv v.hich this permit is issued. (Sec. 3097. Civil Code). Lenders Name: . _ . ___ __ -� Lentler's Atldress: SignaNre �ale OWNER-BUILDER DECLARATIONS: I herehy aKrm thal under penalty of peryury that I am EXEMPT FROM THE CONiRACTORS LICENSE LAW (or thB (o(lovnng reason (Sec. 7031.5, Business antl Professions Cotle: My city or county which requires a permit to construc�, alter, improva. demolish, or repair any structure, prior to its issuance, also requires the applicanl (or such permit to file a signed statemenl thaf he or she is licensed pursuant fo the provisions of the Contraclors License Law (Chapter 9(commencing with�Section 7000) of Division 3 of the Business antl Professions Cotle) or that he or she is exempl therefrom and the basis tor the alle9etl axemptlon. Any violation of Section 7037.5 by any applicant for a permit subjects the applicant to a cfvil penalry of not more than five hundred dollars ($500).): ❑ I, as owner o1 the property, or my employees with Hages as their sole wmpensation. WILI DO iHE WORK, and the structure is not intended or oHered for sale (Sec. 7044, Business and Prolessions Code: The Conlractore Licensa Law does not apply to an owner of properry who builds or improves thereon, and who dces such work himsell or herself or Ihrough his or har ovm employees, providetl tha! such improvements are not intended or oKeretl for sale. If, however, the building or improvement is sold within one year of wmplelion, the ovmer-builder will have the burden of proving that he or she did not builtl or improva for puryose of sale.). . ❑ I, as ovmer of the properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business and Professions Code: The contractors license Law dces frot apply to an ovmer of property who builAs a improves thereon, and who contracts tw such project with a cant2ctor(s) license pursuant to the Contractors License Laws.). ❑. 1 am exempt under sec. � Business and Professions Cotle (or this reason:� SIB��ure Daie ]OS]d8 (1J]) � Owne� ID ven(ed by dri se. Q Yes [j No Driver's Liiense No. Expires: Veriflcation of Ovmership by (lype of doCument, i.e. - properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that rro eacavatbn fNe (5) w mpe teet m tlepih into vfiich a person is 2quiretl to desceM, will be matle in conneclion with work authorized by l�is pertnit, and that no builtling swcWre, scaffdEing, talseu.ork, p demolition w dismantting thereol, vrill be more than ihirty-sa (36) feet high. (Chap. 3.2, Grp 2. M 2. Sec. 341. Title B. Califomia Admi�istrawe Code). ❑ As owner•builtler, I will not employ anyone to do work which would require a permit from tha Division of Industrial Safety, as noted above, unlass such person has a permit lo do such work trom ihe division. AppliUnl's $ign9lure Division of Industrial Sa(ety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or prasent or future builCing occupant neetl to file antl certily a Business Ptan la emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health antl Satety Code requires, with some exceptions, that a Business Plan be filed with Ue CosW Mesa Fire Department by every business whic� has at any one time during a reported year a quantity of hazartlous matenals eQual to or greater t�an a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard lempereture and pressure�. 2. Dces or will the appliwnt or present or future building occupant need to fle a ragistretion torm for acutaly hazarEous materials� ❑ Yes ❑ No (Section 25533 0l the Califomia Health antl Sa(ery Code, with some ezceptions, requires rcgistration with the Costa Mesa Fire Department by each business which at any one time has on �and a quantiry of acutely hazardous materials equal m or greater than a weight of 500 pountls, or a volume of 55 gallons. or 200 cubic feet of compressed gas at stantlard temperatwe and presswe). 3. Does or will the applicant or presant or fuWre building occupant need lo prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)7 ❑ Yes ❑ No (Section 25534 of Ihe Calitornia Health and Safety Code provides that Ihe Costa Mesa Fire Departmenl may require the preparation, certificalion and filing with the Fire Department of an RMPP by businesses wliic� are required to register acWely hazardous materials wim the Fire Department. 4. If an RMPP is presently required, has Section 25534 0( [he Califomia Health and Safety Code been fully compliatl with7 ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is lhe subject of this application a permit for such construction or mo0ification from the South Coast AG �uality Management DisMcl or trom any other air pollution control tlistrict or agency7 ❑ Ves ❑ No �Section 658502 of the Califomia Govemmenl Code requires that the requested intortnation be tumished on applications fa rwn-resbential builtling permits). 6. Will any part of lhe faciliy to be constructed under this pertnil be within 1000 feet (rom lhe outer bountlaries of a school? ❑ Yes ❑ No Qf yes', the faciliry must meet [he requirement of Sections 25534 antl a2303 of the California Healt� and Safery Code). 7. If a pertnit !rom the South Coast Air �ualiy Management DisMcl oi other ai� polWlion control distnct or agency is required ta t�e wnrk which is Ihe subject of this appliwtion, have all ol the disclosures presuibeE by Calitomia Health and Safety Cotle Section 42303 been matle? ❑ Yes ❑ No 8. pf yes", altach certifiwte of wmpliance (rom the appropriate air pollution control oNcer). � . . � CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the information given above is correcl. I agree to comply with all state laws and ciry nrdinances regarding Halardous Matenals and Emissions. SignaWre CER7IFICATE OF COMPLIANCE AND AU7HORIZATION OF EMiRY: I certify un0er penalry of perjury thal I have reatl this apDlication antl state that the information given is cortecl. I agree to comply wiN all state laws antl city ottlinances relating to building wnsiruction, and authorize representatives of tAe Ciry of Cosla Mesa to enier upon the above�escnbed Droperty for inspection purposes. I agree not to occuDY or allow occupancy of any building authorized by this permit unlil final inspection. �0^Q��e ol q uner(s) Uate �3-�fl -0� na/w n ea m Dale