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Home My WebLink About1206 BRISTOL ST - Building Permits CITY OF COSTA MESA 4 ` BUILDING DIVISION - > . ', F t � ! DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0 rvr‘Rei' • PERMIT E03-00827 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 1206 BRISTOL ST Status: ISSUED Suite No Applied: 09/12/2003 Vicinity: AIRPORT IRVINE ANIMAL HOSPITAL Issued: 09/12/2003 Parcel Nunmber: 43932108 / ler Applicant: GOGNE, BRAD - - ISSUED BY: .�'�_ Address: 106 OCEANFRONT - - ,. _ - ...0017/ ',-7 - Phone: 949-400-1904 - NEWPORT BEACH,CA, Zip: 92661 Owner/<RADOVICH;WILLIAM-A ' • Address;i%AIRPORT IRVINE ANIMAL-- N \ /17/;'7 /COSTA MESA,CA- " Phone: - ` ' 1206 BRISTOL ST Zip: 92707 - A ,., . - ,"i�� , , Contractor: OWNER-BUILDER Address: . ..- - Phone: _ — _ - Zip: ' . � - License: 000000 ' " - • N " / _ v SCOPE OF PERMIT • ' ELECTRICAL PERMIT IN'CONJUNCTION WITH THE INTERIOR'4150 SF'TI FOR"AIRPORT IRVINE . ANIMAL HOSPITAL"FOR DR.WILLIAM RADOVICH.WORK TO INCLUDE-REMOVAL OF A NONBEARING WALL IN THE LOBBY,ADDITION OF 5 SHEETS OF PLYWOOD PLUS-5 SHEETS OF DRYWALL IN THE ' RECEPTION DESK AREA FOR SHELF SUPPORT,CHANGE-OUT OF LIGHTING(T12 CEILING TO T8 COVE. - . 119 LIGHT FIXTURES,6 OUTLETS,6 SWITCHES , • REF:B03-01405 - . ' - % . FEE SUMMARY ' - �, �, �� '�• Quantity Quantity , , ISSUE.FEE ' $23.50 ' Temp Dist System/Lighting $0.00 , y 0 ' Temp service test ' % $0.00 . ' Busway/100 ft', $0.00, ' ' 0 , Res.a/c package- • \$0.00 Standing Section 1' _Y•,_. $0.00' 0 " . , New Res(1-2'units) $0.00.' 0 Misc Electrical Equipment._ $0.00 0 New Res(34-units). . % $0.00.; ' 0 , Transformers up to 1 kva/kw " $0.00 ' 0 ' Pool/Spa ' $0.00 ' . 0 up to 10 kva/kw $0.00 ' 0 Lighting Fixts $94.27 -,119' , up to 50 kva/kw ' $0.00 0 ' ,'/ Recept Outlets $6.60' i 6 - up to 100 kca/kw $0.00" 0=- Switches $6.60 6 - . , ' over 100 kva/kw"' '$0.00- -0" • Non Res Appl "N '.$0.00 , - '0 - ' Low Voltage Equipment • $0.00 ',0%� Res Appl $0.00 ' 0 ' Low Volt Wiring.Systeni/Ckt - $0.00 0 Service to 200a "'$0.00' • 0 i Misc.Conduit -$0.00,,' 0 Service to 1000a $0.00, 0 - \Misc.Conductor. ; $0.00 0 Service over 1000a $0.00 ' - 0--..' '- ` Circus(gen or ride) -;.-- ''. --'.---'$0.00 0 Motors to 1hp $0.00 "0 _c.�. Circus(mech ride or lights)" $0.00 0 Motors to 10hp $0.00 0 ` -- ,___ -=Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 - Fireworks.Stand $0.00 0 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: 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. r 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 obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/62) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury 0110 of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the peri mance of the • work for which this permit Is issued. ❑ I have and will maintain workers' su ante casaInsurance,nu requiredrae: by section 3700 of the Labor Code,for the performance of the work for which Ws permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier Policy Number. (This section need not be completed if the permit Is valued et one hundred dollars($100)or less.) "lc? 1 certifympthat in the performance the ek for I s this permit is issued,i shall not employ any person in any manner so as to becomef subject to the;I hars' compensation laws r California,,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code;I shall forthwith comply with these pr to Applicant Signature: Date: • (-) 9-f2 -09 1. WARNING:FAILURE TO S RE ORKERS'COMPENSATION COVERAGE 15 UMAWFl1L AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO CNE HUNDRED THOUSAND DOLLARE($103,000),IN ADOri1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,MID ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.N Class N Contractor's Signature: Date: • • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Ls sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). i X• has owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am examun er sec. Business and Professions Code for this reason: O Signature: ({/'p/(14 Date:1 Owner ID verified by ' ars license. ,&Yes 0 No Driver's License No. Expires: 1 6 1 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work adhorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Adminlstretie Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with 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 reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). , 2 Does or will the applicant or present or future building occupant—need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by midi business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). I ___...._..r_future._ _ .. .__.........t.._..._. �t.___._.__ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management end Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. • 4 If an RMPP is Presently required,pas Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No _ nt_...r....._....en.__....0tur._�._.....__p__—r._....._.__ _._ 5 Does e Will the applicant or present or emen building asoman other require for the work which is the subjectage of this Ll estion a permit for such construction or modification from the South Coast Air Quality Management Dlsirkt or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). within 1000 feet _._ 6 Will any part of the facility to be constructed under this permit be within 1000 fImm the outer boundaries of a school? ❑Yes 0 No i (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7_.._ ___..._... ._. _ __..air._.._._ _.._ h is ubect 7 If a permit from the South Coast Air Qpr scri ed byga eal or dother et pollutiondecontroltion district03or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californialofa Health and Safety Code Section 42303 been made? ❑Yes 0 No I e (If'yes',attach certificate of compliance from the appropriate air pollution control officer). I CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Cost'Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date I 9-a -G3 And/Or Authorized Applicant Date ;4 ;ODE I INSPECTION TYPE DATE =NJ Oat INSPECTION TYPE l DAiN. MGM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ �I 200 Final Re-Roof - 210 Final Electrical Jn I I 17 .7' 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval I 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy 1 t - r ' \ 4"`mow CITY OF COSTA MESA 4 BUILDING DIVISION 0 a.� I "..: � i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT -`9Mo.mrs B03-01405 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.rJ LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 - Job Address: 1206 BRISTOL ST C Status: ISSUED Suite: Applied: 08/18/2003 Vicinity: AIRPORT IRVINE ANIMAL HOSPITAL Issued: 09/12/2003 Parcel Number: 43932108 Zoning: Applicant: GOGNE, BRAD - - ISSUED BY: /�l/ .... Address: 106 OCEANFRONT • - - ' " . - - `-- // -r - - Phone: 949-400-1904 NEWPORT BEACH,(-6A Zip: 92661• / - .mo Owner RADOiRT-IR WILLIAM A Address PoAIRPORTIRVINEANIMAL- . COSTA MESA,CA - Phone: - - - - 1206 BRISTOL ST r,. Zip: 92707 -;' //6t9 ' ',\ Contractor: 'vOWNER=BUILDER6'" ' ,v /Address: ii ' 4 • v I r . �/-,i� Phone: `-' A Zip: 'n License: - 000000 ' - - ` - Arch.: ' -- I Eng: -- Address: - ?,,�" . � Addressi - -_. . "' Phone: - Zip: r/ . , License:- License: - �- \ SCOPE OF PERMIT - ` INTERIOR 4150 SF TI FOR"AIRPORT IRVINE ANIMAL HOSPITAL"FOR DR.WILLIAM RADOVICH:.WORK TO INCLUDE REMOVAL OF A •, NONBEARING WALL IN THE LOBBY,ADDITION OF 5 SHEETS OF PLYWOOD PLUS 5 SHEETS OF DRYWALL IN THE RECEPTION DESK AREA \FOR SHELF SUPPORT,CHANGE-OUT ' OF LIGHTING.(T12 CEILING TO T8 COVE. 'FEE SUMMARY - ` 'Plan Check:', ,$117.81 • -� Calc Valuation: $9,975:00 :v. -Permit: $181.25 �� -_ Claim Valuation:;' $9,975.00 + '.SMTP Res:,. ',','$0.00 - ,x ` ' 'SMIP Com: \;$2.10 ,\;:Other: v$0`00 Inspection: $0.00„ - !4 �' Total: $301.16`4. \`. .\ i, 4/ - - � PLANNING &ZONING SETBACK �C- / MAIN STRUCTURE Froot- •0-.„0 '_ // rRear. :0-0 Left 0,0 , , Right 0-0 7 ACCESSORY Front 0-0Rear 0-0 - Left 0-0 _ Right, 0.0 >-- _ -- 1 , Al . . - ' - ' /7 PARKING Existing: 0 - --Required: ,,0 - - - Proposed:_, :0 - - • 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: 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. 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 obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6ro0) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is'issued. My workers'compensation Insurance carrier and policy number are: Carrier Policy Number: (This section need not be completed/t the permit is valued at one hundred dollars($100)or less.) ` I certifythat in theperformance of the work for which thispermit is Issued,I shall not employ r c any n person In any manner a as to becomef subject to the I haforthwith laws of California, nd agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi Applicant Signature: Date: Qcie /2-Q 3 WARNING:FAILURE TO SECURE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN AD ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.LJc.# • Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: • • OWNER-BUILDER DECLARATIONS: I hereby affirm that under.penally;f.perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of 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 fora permit subjects the applicant to idyll penalty of not'mbfethan five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Ls sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 11I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exem t un er sec. Business and Professions Code for this reason: Signature: Expires: O Verification of Ownership by(type of docCrnen_t,i.e.-property tax bill or deed): • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). I ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number I HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with 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 reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No I (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and 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 materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Flre Department may require the preparation,certification and fllirig with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No ._._—___ _.._ _._...._..___e— .._. ___.._...._._..____..__..._.,.____. ._. _. 5 Does or willo dee—applicant or a ar emen bustling occupant at y efor the work which is the subject of this Pi estion aDarnit for such consimctlon;or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L]Yes LJ No (Section 85850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No • • • (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If apermit from the South Coast Air Quality ManagementDistrict or Distor other air pollution control district or agency Is required for the work which is the subject of this application, ication,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yet,attach certificate of compliance from the appropriate air pollution control officer). • CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with at state laws andlcity ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. I lure Of Legal Owner(s) Date 5—/2-0.3 nd/Or Authorized Applicant Date c cogE$, IItSPFCTION TYPE 2611 IlIIO cORLE INSPECTION TYPE 261E IDES 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy