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HomeMy WebLinkAbout1514 BAKER ST - Building Permits I t• w ' 'CITYOF COSTA MESA 4 rBUILDING-DIVISION F ; ,) 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER V ^ %� ® -PERMIT "''Mo-mo44. E05-00940 .(71417545273-• Fax(714)7544856 • www.ci.costa-mesa€a TRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 1514 BAKER ST Status: ISSUED I Suite No Applied: 09/08/2005 . Vicinity: NAIL AND SALON Issued: 09/08/2005 Parcel Nunmber: 13920105 Applicant: THUY HO Address: 15151 MORAN ST _ - ._ �./ Phorie: 714-890-0932' - ISSUED BY: WESTMINSTER.CA 7,':. - Zip 92633 1 " '. - • -- • Owner: RICHARDSON,'SHIRLEY KTR - Address _ 400 CAROL LN EAST - Phone: ie'-, SA - 'QUINCY, "---',-;"<" - Zip: 95971 •• • -' 2 -7- � • - TS.i Contractor: T SIGNS . �t , Address: 15151 MORAN ST - Phone: .714-890-0932 , WESTMINSTER.CA , Zip: 92633 .-License:735992 .' - ;moi-^ ' SCOPE OF PERMIT '. �'ILL'UMINATED WALL SIGN FOR NAILS AND SPA.REF SB05-00110. . ', • .�- FEE SUMMARY v , '' Quantity, J-r r-. - -. - _ , Quantity . ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 : • .- - - - Busway/100 ft $0.00 0 Res.a/c package , ' $0.00 1 1, Standing Section --= $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 kia/kw - $0.00 0 Lighting Fixts. - $0.00 ' 0 . ' up to 50 kva/kw - $0.00 0 Recept Outlets- $0.00- 0 up to 100 kva/kw $0.00 0 . ' Switches $0.00 0 over 100 kva/kw •� $0.00 0 ' Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 . Res Appl $0.00 0 Low Volt Wiring Syitem/Ckt $0.00 0 . Service to 200a $0.00 0 _ - '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 1hpj ,$000 0 • _ - Circus(mech,ride or lights)_ _ $0.00271,7 0 - ',. , Motors to 10hp .. $0.00 - ,S %0` - -Christmas Tree Stand3;,,:'ct' `$0.00/ 0 - I, Motors to 50hp' %'- $0.00'•',; - 0'' - "�';' ,' Fireworks Stand - ' ;$0.00 - 0 Motors to 100hp '''`,- $0.00"-,...;--��0 _ : Other Electrical Fee- - `.y .$0.00( i Motors over 100hp ' ' $0.00.• ��0 'N Communication drops • ' $0.000 ,'".- Investigation Fee- - - , $0.00 ' '• - Sub panel to 200a '-$0.00 ,. . 0 -- - : - - Check-fie-7,1: � Plan - - "$0.00', -' Pole Light Pkg 0 $0.0 , / '0- � - .- -- Reinspection Fee ' ' $0.00 - •�. Sign Circuits . $24.60 '\ .// 1 �•'� "" Temp Pwr Pole N,$0.00.„` 0 TOTAL CALCULATED FEES $48.10 Intermed Pole $0.00- 0 - - ' ' . . -COMMENTS',SPECIAL CONDITIONS NOTICE: The work-authorized:by this-permit shall-comply with all-applicable handicap access requirements under California statutes and related • regulations.(Ord.No:92-28,1'1,"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 -fora period of 180 days. 'INSPECTIONS: 'In:order.for.the work-authorized.undenthis:permit tote-considered legal;such work'must.comply wih.all-applicable codes, and all required Inspections and flnai approval-must be obtained.Falture to obtain-Inspections and final-approval will result in the expiration of this permit. FOR INSPECTIONS'CALL:x(714)'75445626 2446-46(&00) DECLARATIONS (^• ("'‘ WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarationsi . ' O 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. ' • -: e 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. •y .rkers'compensation Insurance carrier and policy number are: 1 Car :r. I'1T Ft.) C� olicy Numb: : A (This se on need f e competed if the permit is valued at one hundred dollars($3 eNeS, " I] I certify that in the performance of the rk for whlcfi this permit is Issued,I shall not employ any personlin any mariner so as to become sobjeot to the worker? . • N:"-•:- ion laws of California,and eg ee that if I uld become subject to the workers'compensation provisions of Section 3700 of the Lebo Code,I s hwith c• ply wit, these provi io• //O •pl NG: I aRE TO � � C Date: R • ARNIAN FAILURE E( SECURE WORKERS' EN CAST N OFCO ERAGEMPENS IS UON,DAFUL MAGES A SHALL SuBFOR I N EmPLOECT1oN 37 TO THECRIMINAL R CO ES AND C�FINES UP TO ONE'SHUNDRED. THOUSAND OOLLARE(5100,000),IN ADDITION E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708OF THE LABOR CO INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereb :P :m licensed under•r• . • of hap r 9(co mencing w'th Section 7000)of Division 3 o Busines • d Pro: :ions Code,and my license is in full 0 if • e and eff: Lic.# - Class# o : •rs Signature' re. .....w .a. z ra ' ` CONSTRUCTION LENDING AGENCY:L .. ❑ 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 Seaton 7000)of Division 3 of the Business and Professions Code)or that he or she'is exempt therefrom end 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.II,however,the building or improvement is 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,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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative 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 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 (Section 25533 of the California Health and 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 I 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)? r ❑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,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�No (Section 65850.2 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? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",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 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 Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. — Signature Of al Owner(s) Date • An• O A :d A•'Roane .Da : ;ODE Y INSPECPONTYPE ' . ' . ' ' ' PATE' •. gITrtIAL* ' ODE 'INSPECTION TYPE 4 all R$DSLS 1616 Fixed System Final Fire Prevention ' ' ' ' 206• Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof • 210 Final Electrical '2©I fr. 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 ` • t •9 • c• r cSiit , - CITY OF COSTA'MESA'' - 4 , BUILDING`DIVISION ). :j a DEVELOPMENTSERVICES•DEPARTMENT' PERMIT NUMBER- f 1 Jri4 r PERMIT. 5B05-00110 (714)754-5273.• Fax(714)'754:485&••www-ci.costa-mesa.ca.uSIGN PERMIT 77 FAIR DRIVE,COSTA MESA;-CA 92626 Job Address: 1514 BAKER ST Status: ISSUED Suite: Applied: 09/08/2005 Vicinity: Issued: 09/08/2005 Parcel Nunmber: 13920105 Zoning: CL CL Applicant: UNKNOWN /���J/�"" Address: /) --....././. '- Phone ISSUED"BY: // r. Owner: RICHARQSON, SHIRLEY K'TR i,' ' Address 400CAROLLNEAST,; r y - - .. - .1 Phone. � ,.\ QUINCY CA Zip' 95971 - Contractor'' . T SIGNS „,p--i--,-;:-..---11-' Ni . 3> i.' 4Z •, � it Address: 15151 MORAN:ST:/ � ._i �,� li, '� Phone: 714-890-0932 - ,. . •WESTMINSTER.CA Zip: .92633 License: 735992 9 . . Arch/Eng: . ' / rt ._ - ,� "Address: "' . . .. r •.-, - SCOPE OF PERMIT -21 SQFT INDIVIDUAL CHANNEL LETTER SIGN. 1 - _ , . , .... ._._. Fa N41 LS. 0,14 \S -, --r h FEE.SUMMARY - Plan Check - $54:11 . , v- : /. -- l rr ter= _ .tLCalc'Valuation: • $2,200.00 �, $0.00 x,- ._ ._ . _, . . _ _ . / Permit: $83.25 ” .. Claimed Valuation: $2,200.00 SMIP Com:' . $0.50 �... .. . . =,Other: $0.00 - _- " _.. $0.00 - - Inspection: $0.00 . -' . . . - - ' ' $0.00 - _. ' $0.00 -Total: $137.86 ` t A''> 'PLANNING&ZONING.. m^7eY'Y .. / i / . .�C ,`•777":" %.7.-ai- . S !' r. �� � rte. • .NOTICE:. The.work authorizedby this:permit:shall:comply with'all applicable'handicap.access-requirements-under Califomia,.statutes-and related regulations:(Ord.No:92;28;§;1, 12-21-92) •EXPIRATION:-This':permit shall automatically expire.and becomevoidif work isnot commenced.within 180'days;or if work'is.suspended or abandoned i fora period of'180 days: 'INSPECTIONS: In order-for the:work-authorized.under this:permit to:be.considered:tegal, such'work,must comply with-all-applicable codes, and all ,requlred.lnspectlona.and.flnal 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(WOO) WORKERS'COMPENSATION DECLARATION: •- - . I.hereby affirm under penalty of perjury one of the following declarations: - :;1 . • • • , • ❑ I havb and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. - . ' , ave and will maintain workers'compensation insurance,as required by section 37'00 of the Labor Code for the y•ormance of the work for w c his permit is issued. M workers'compensation dIn—su�rance carrier and policy number are: A �f C rier' ednot bec '1-u N :r: �� O ' section need not be completed if the permit is valued at one hundred dollars($100)or less.) O I certify that in-the performance of the work for which this permit is issued,I shall riot employ any person in any manner so as to became syyyyyybject to the worker? '. ' c..... -tion laws of Califomia,end agree that if I hould# become subject to the workers compensation provisions of Section 3700 of th�Labor Cod I shall forthwith c•- •y i these Prov' ' '••ICaot - T: `M�r \ —DEA • 1 FAILURE: TO SECURE WORKER PENSA ON COVERAGE IS UNLAWFUL AND SWILL SUBJE VER TO CRIMINAL PEN11ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITI THE TMST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I y affir that I am licens visions of Chapter 9(commencing with Section 7000)of Divisio9�-eMlaBusiness a� •rofpssions Code,and my license is in full OM .Lic.# —7 `T�'B��"a"t"d' # J ontrectors Si e: .^ , .D 1 'J" CONSTRUCTION LENDING AGENCY:' ,". s ❑ 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: Lender's 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).): O 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 Is 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.). • O I,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.). O . I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: 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 authorized by this permit,and that no building structure,scaffolding,,falsework,or demolitionor dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O 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 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 (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one lime 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 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,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District 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). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",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 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 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. Signatu •Of Legal•,•, (s) Date- An• •r Author .. •pplicant Date CODE F. 'INSPECTION TYPE - " - "pr- " INTRIAI$ " - ' CODE# INSPECTION TYPE' - g'LTE 'II�AL5 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 Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 'Final Planning'Approval' • ' 203 Final Sign 2® • 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy '- ' 4;>511111r CITY OF COSTA MESA �'w`�fi~ • BUILDING DIVISION > I fir: ,i a DEVELOPMENT SERVICES DEPARTMENT PERM UMBER f 11"--1.1 4. PERMIT 5-01169 4424eoegrrep db (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BIHLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1514 BAKER ST Status: ISSUED Suite: Applied: 07/13/2005 Vicinity: FOREVER NAILS AND SPA Issued: 08/30/2005 Primary Occ: B Eat<50/Office/Bar<50 Type of Construction: V-N Parcel Number: 13920105 Zoning: CL Applicant: PHAN, SANG VAN Address: 1520 WESTSATE STREET �f�,/ Phone: 714-719-3624 ISSUED BY: W WESTMINSTER,CA Zip: 92683 Owner RICHARDSON, SHIRLEY K TR ` ' Address 400 CAROL LN EAST ... - _ ' Phone: OUINCY,CA . - , 4. Zip: 95971 : ... Contractor CUSTOM TECH DESIGN ' Address: ; 15201 WESTSTATE ST: , Phone: (714)891-7796 . . WESTMINSTER,CA .' - Zip: 92683 .. .. i License: 561816 _ Arch :, Eng: .. . . Address: - -, Address: ' Phone: - Phone: Zip: 1 License: License: SCOPE OF PERMIT 1139 SF T.I.FOR"FOREVER2NAILS&SPA".RELOCATE EXISTING RESTROOM AND MAKE IT DISABLEDACCESSIBLE.A STORAGE AREA WILL F THE EXISTING BATHROOM.A NEW BREAKROOM AND FACIAL ROOM WILL BE CREATED FROM THE EXISTING SPADE AND EACH HAVE THE A A . SINK.6 PEDICARE/SPA CHAIRS WILL BE-INSTALLED AND THEINTERIORWILL BE-REMODELED FOR FOREVER NAILS&SPA.. - - -_ - 'FEE SUMMARY% -• ' Plan Check: $320.29 Calc Valuation: : „ . $35,000.00 Permit ' $492.75 ' - - - Claim Valuation: $35,000.00 SMIP Res: $0.00 1 SMIP Com: $7.35 Other: $0.00 - Inspection:" '.:$0.00 .. , Total: . $820.39 , ' . s ' PLANNING&ZONING SETBACKS �. , MAIN STRUCTURE Front 0-0 - ' Rear 0-0, , Left 0-0 Right 0-0 - ACCESSORY Front ',0-0 �`', - `Reaar-- c0=0 , •-` Left 0-0'=s9= -. Right 0-0 PARKING Existihq:,;_ 0 *d�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 workLended or abandoned fora 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 244e-48 WOO) I • 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. ..0"-.1have 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: -f _ -CarieL.STflTh COM,C 'SfkSl u.J .a -R,T7t'CC f�L(p/) (PWicy.Number:-z/"J v/9 / - Loo} le '(This section need not be completed I/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of C • la,and agree that If f should become subject to the workers'compensation provisions of Sectiory3700 of the Labor Code,I shall forthwith comply with these proyi s. / w- Applicant Signature: y III Date: �� a WARNING:FAILURE TO SECURE WORKS c9M1IPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND OIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000),IN ADDITION--'(((((O THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S 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=L'jEit*.-'S• ( 9 16 cClessp—Y� �'ht�. ""- Cotitiactof s ignattuur Date:-'=T5/3J/e1' 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). Lender's Name: Lender's 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 is 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,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 em exempt under sec. _ _ Business and Professions Code for this reason: Signature: : Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. • Expires: 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 authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative 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? ❑Yes 0 No (Section 25505 of the Califomia 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? ❑Yes ❑No (Section 25533 of the Califomia Health and 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 Califomia 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,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_oPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 13 Yes LJ No (Section 65850.2 of the Califomia 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes El No .. a...certificate of o pncefom e.... 8 (If"yes",attach 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 all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTFICATE 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 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. Signature O I Owner(s) Date And/Of 4t>t�onzetl ,`' e »_%-`- -Date,_--� CODE F IMSPFC,TION TYPE PATE INTITIALE CODE F INSPECTION TYPE PAT& !MALE 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 Wall 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 1/YC-•,`— . I � , , f CITY OF COSTA MESA v..__ 4 BUILDING DIVISION erl tin. Y • ,., DEVELOPMENT SERVICES DEPARTMENT PERMIT N BER ti oft 0 . � WJ CITY OF COSTA MESA �� (714)754-5273 • Fax(714)754-4856 • www.ci.costa TtilCAL FEES ES I IMA I t 77 FAIR DRIVE, OSTA MESA,CA 92626 Job Address: 1514 BAKER ST • Status: ISSUED Suite No Applied: 08/30/2005 Vicinity: FOREVER NAILS AND SPA ParcelNunmber: 13920105 Applicant: PHAN1, SANG VAN Address: 15201 WESTSTATE ST �7 q n Phone: (714)891-7796 ISSUED BY: 1(/vY WESTMINSTER,CA Zip 92683 Owner RICHARDSON, SHIRLEY KTR Address 400 CAROL LN EAST y "'� _ . ""'' - Phone: .. QUINCY,CA - ' ' Zip: 95971 ' Contractor CUSTOM TECH•DESIGN - Y • " Address: ' 15201 WESTSTATE ST ` ' - - Phone: (714)891-7796 • WESTMINSTER,CA',; Zip: 92683 License:561816 SCOPE OF PERMIT ,Y� .ag 'PERMIT.FOR 1139 SF T.I.FOR"FOREVER NAILS&SPA".f - 2 • r ,. REF#:B05-01169; - j+ - WORK TO INCLUDE 51.LIGHTING FI8XTS,2RECEPT OUTLETS AND 10 SWITHCES:,, _. _ - . FEE SUMMARY Quantity Quantity . ISSUE FEE $23.50 - . • - - Temp Dist System/Lighting $0.00 0 , , Temp service test $0.00 ,r / Z " !Busway/100 ft - -'� , .� $0.00 0 v Res.a/cpackage.'" • $0.00 .1'.•;,,4. Standing Section t ' $0.00 ` 0 • ` - ''•'1 New Res(1-2 units) 3 $0.00 r -' ' - - Misc Electrical Equipment $0.00 - 0 ,, New Res(3+units), 1 $0.00 .- . 0 Transformers up tol kva/kw $0.00 0„',3. Pool/Spa , i $0.00 0 a up to 10 kva/kw < $0.00 ,R1,0 '" Lighting Fixts 4.) $44.63 ',94451,.., ,,,ls up to 50 kva/kw a $0.00 - 0 - "' Recept Outlets ='•.-% i $27.84 28� '^up,to 100 kva/kw "'$0:00 0,,'.2 ` " Switches, '. $11.00 , 10 over 100 kva/kw - - $0.00 ' 0 _ Non Res Appl ,_' ' $0.00 0 Low Voltage Equipment $0.00 0 Res Appy . . $0.00 0 Low Volt Wiring System/Ckt . $0.00 "0 Service to 200a . •i?; $0.00 1 0 Misc.Conduit ' $0.00 . 0 .. Service to 1000a `:: - WOO -;Misc.Conductor $0.00 . :'.0 Service over 1000a `''$0.00 ,I 0 _ - Circus(gen or ride) $0.00' °' 0 Motors to 1 hp - • . $0.00 0 . • Circus(machride or lights) $0.00 0 .- Motors tol0hp_" $0.00'.- ' 0 . _ 'Christmas Tree;Stand, $0.00 0 . Motors to 50hp „ . $0.00 n 0 9'`- - F• ireworks Stands--; .�,-$0.00 0 Motors to 100hp '.$0 00' r*0 - h> " '� Other.Electrical Fee .c-1('$0.00 -4 " • Motors over 100hp - "$0 00 ' 0 r Communication drops $0.06` 0 - Investigation Fee '- ,$0.00 ,,' Sub panel to 200a a $0.00 (/''''.2._ Plan Check'Fee d $0.00 Pole Light Pkg <" '• $0.00 .,'%';‘)0,;, Reinspection Fee a' $000 , Sign Circuits Temp Pwr Pole $600 0 ' / TOTAL CALCULATED FEES ,'$106.97 . Intermed Pole $0.007 0 w 1 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 2446-48(W00) 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`arid 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 carder and policy number are: � railer.;47:ii-TE_ eo-lp&%iC. 'n'op.1 s tftsrivcc &two 670icyNum6a-ri-./-741 04 / — 2-ocs (This section need not be completed if the permit is valued at one hundred dollars($100)or lass.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of C mia,an that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply withese pro slo s. 8/3 D O I— App6canrSlgnature: Dete""`^-�•-- WARNING:FAILURE TO SECURE WORKERS) ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(S/W,000),IN ADDITION T THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm lam 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 -.,r._ _.r. . . forcc.and effect. ic.a S 18 1 6 ('lass a'v- B ^ M' CentractotssgnaI iia • Gate: .R/z . / o l— 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). Lender's Name: Lender's 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 Is 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.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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: 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 authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative 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 Cale 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 (Section 25533 of the California Health and Safely 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 Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which ere required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 0l the Celifomia Health and Safety Cade been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Ig No (Section 65650.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes-,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 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 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. Signa Leal Owner(s) 40Daleocr Abar.AlAhortretl:Apt:AranT--~ 5 ( Date OPE E INSPECTION TYPE DATE ?MALS CON E INSPECTION TYPE PASS If0rIAL4 1616 Fixed System Final Fire Prevention 206 Final Mechanical F R U 1266 Pool Spa Final 208 Final PlumbingIT l/ i7f% 200 Final Re-Roof 210 Final Electrical cal f 201 Final Block/Retaining Wall 212 Final Fire Prevention P 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/Occupancy ,51' p >\ • CITY OF COSTA MESA BUILDING DIVISION >1� . . ,1 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t 1"'"--7' I®C 4 • PERMIT 05-00492 a.ano.4* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 1514 BAKER ST Status: ISSUED Suite No Applied: 08/30/2005 Issued: 08/30/2005 Vicinity: FOREVER NAILS AND SPA Parcel Number: 13920105 !CAD ', _ ISSUED BY: �I/��y"1 Applicant: PHAM, SANG VAN Address: 15201 WESTSTATE ST I , ' Phone: (714)891-7796 WESTMINSTER,.CA .r -„ Zip: 92683 .-- Owner RICHARDSON, SHIRLEY K TR • �.. Address: 400-CAROL LN EAST - - - • Phone:- -t _ - "QUINCY CA • "'1i Zip: 95971 ., -" ' • Contractor:. CUSTOM TECH.DESIGN Address: 15201 WESTSTATE ST ` Phone: ..(714)891-7796 WESTMINSTER,CA Zip: • 92683 - ' License:561816 i ,. °` SCOPE OF PERMIT ._ PERMIT FOR1139 SF.T.I.FOR"FOREVER NAILS8 SPA". - . : , r,REF#:B05-01169- -' ;• ,i�` --- 'a.,, . 'WORK TO INCLUDE:6 VENT FAN/SINGLE DUCT • .' FEE SUMMARY ? ) Quantity .. . .r': } Quantity ISSUE FEE. '""" -' , �' $23.50 Repair/Alt Absorbtion Unit - ' $0.00 0 ' Inst FAU<100 k BTU $0.00 0: , -- Repair/Alt Refrigeration Unit '- $0.00 0 Inst FAU>100 k BTU $0.00 0;, _ . :,Yeritillatign System „ • : 4 $0.00, 0, Repair'/Alt Cooling/Heat t ' $0.00 0 --- - ..- „-, Evapoiahve Cooler�'`'°�, • . , $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 ' 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator ; $0.00 0 Refrig Sys.>100 k BTU' ' -. .+7- $0.00 0 Compressors/Absorption Systems Gas Piping , $0.00 0 Up to 3 hp/100 k BTU $0.00 '0 Factory Fireplace $0.00 0 - - 3 To 15 hp/500 k BTU . $0.00 0 Hood w/Mech Exhaust - $0.00 0 '15 To 30 hp/1,000 k BTU -, $0.00 .0 VAV Box ;$0.00 0 (°-�`-' 30 To'50;hp/1,750 k BTU $0.00' 0 Vent Fan/Single Duct < $43.50 , 6 Over 50 lip?Oyer 1,750 BTU -- $0.00 0 Appliance Fire Dampers =° $0:00 0r ' ` . -•$k i' Up to=3 hp '"�'" / '.;$0.00 0 Smoke Dampers \ $0.00 0' ' ••- 3 To 15 hp - $0.00 0 Inst or Relocate Appl Vent . $0.00 0' - 15 to 30 hp ., $0.00 0 Air Handlers< 10000cfm ' - $0.00 0 e '30 t6'50 hp-_, . '. • . ' $0.00 0 Air Handlers> 10000cfm - $0.00 -"'0; - _ Ovai501i0--' $0.00 0 Floor Furnace , $0.00 ' 0' - Other Mechanical Fee- � - Floor or Suspend Heater ' $0.00 • /02 Investigation Fee $0.00 " ' ` ` 't ''Plan,Check Fee- ` - $0.00 Reinspection Fee $0.00 - ., TOTAL CALCULATED FEES $67.00 COMMENTS/SPECIAL CONDITIONS • • 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(6/00) 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. _0---ti 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: cedevS7 ' l70't1/'& 51��' J i�/5u(zh et- 14""( FciN() Potiy.a beeri`�A7-//4' / '- Z-ocF (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws a fornla nd a ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p vi ons. 7; / DS App lcl 'Signat t-r—e: " v✓� Date:--- WARNING:FAILURE TO SECGRE WORKE S COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPLOYER!TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO.LARE(5100.000),IN ADDITI TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro�vi/sions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full ivrce:and.–effect;12Ur J7� CClessp� g717"C Contractor'sgn�ture: lI 1D`tea•' B v 3 0 / 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). Lender's 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 end 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 is 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,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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: 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 authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative 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 end 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 (Section 25533 of the Califomla Health and 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 Fire Department may require the preparation,certification and filing with the Fire Department of en 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 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",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 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 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. ) Si•nature' f Legal Owner(s) Date •.Authortzed'Applicaht-""'" Da .y-----r' CODE t INSPECTIONTYPE PAIL INTMAL3 CODE* INSPECTION TYPE RAIl INIITtAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical II - 3-o5 An/ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 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 CITY OF COSTA MESA 4 BUILDING DIVISION • > .ia DEVELOPMENT SERVICES DEPARTMENT PERM! NUMBER t 1 a' 1.114-1.-"1.17 PERMIT OS-00664 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.6a.11SMBI NG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1514 BAKER ST r LU Status: ISSUED Suite No Applied: 08/30/2005 Issued: 08/30/2005 Vicinity: FOREVER NAILS AND SPA Parcel Nunmber: 13920105 Applicant: PHAM, SANG VAN n"^ Address: 15201 WESTSTATE ST ISSUED BY: l/� D Phone: (714)891,7796 1 WESTMINSTER,CA '.'Zip: :,r92683 Owner RICHARDSON, SHIRLEY K TR Address 400 CAROL LN EAST .- - ' Phone - Contractor, CUSTOM TECH DESIGN Address: :15201 WESTSTATE ST Phone: ''(714)891-7796 - WESTMINSTER,CA Zip: ,.92683 - -? License 561816 - ' SCOPE OF PERMIT PERMIT FOR1139 SFY.I.FOR"FOREVER NAILS&SPA". REF#:B05=01169 -• ., I WORK TO INCLUDE - -- - - � -%-'''' FEE = _% FEE SUMMARY - ., , , . AMT QTY "-- r�, - . - AMT. . OP( ISSUE FEE ' $23.50 . ' -Laundry Tub/Washer£; : $9.80 .1 - - Sump Pump - . $0.00 , 0 Backflow.irrigation - $000 -_- 6 -;. Lands"cape Irrigation $0.00" 0 ' Swimming Pooh..; $0.00 0 Backflow Preventer , $58.80 0 - -P-Trap - - .-$49.00 - 5 -- Trap Primer_ ' .$0:00 0 Bathtub '. $0.00,;,e, 0 ,.-- Pressure Regulator $0.00- 0 Urinal ' $0:00 0 Clarifier $0.00 r. 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4)-.' $24.60 2 Connect(Ice,Soda,etc) ; . $0.00 0• ._ Receptors 44$0.00 .0 Vacuum:Brkr Bkflow(5+) $0:00 0 Dental Units s0.00 0 Septic Tank $0.00 0 Wash-Basin " $9.80 1 Dishwasher. r. ' . • $0.00--- 0 , Sewer Cap for Demo_ $0.00 0 Wash Basin:Set .-,$0.00 0 Drain,Floor $0.00 . 0 Sewer Connect : " ,$24.65 1 Waste and Vent System r . $0.00 0 Drain,Rainwater' $000" •,A Sewer^PrivateLine ;.: $000:.,.0 WaterCloset(Toilet. •`,..$9.80 1 Drain,Roof \ $0.00 - 0 Showers>. -' :$0.001` 0 ,0,,Water Heater/vent „ $12.30 1 Drinking Fountain ,2'. $0.00 '"0 ,;Sink-,bar - .+ -`„$19.60, ' 2 > -Water piping Inst or Re $0.00 0 Expansion Tank ' $0'.00 • 0 ._'Sink,commercial s« D 9( -Rep.) ��-, .;'$29.40 3 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00" 0 "', Sink;'Floor;. . .$58.80, 6 ` Water Service $0.00 0 Gas(1-4 outlets) - $12.30 2 :.;`Sink:kitchen" .$0.00 . -.0 Water Softener $0.00 0 Gas(Over 4 outlets) --$0 00" I. 0 - _ Sink-servicelmop :,$0,00,,<;,. ',0 ' OTHER $0.00 Gas Repipe $0.00 .0. -:.-Spa(private) .•-::::-'71;:::10.00 - 0 „ VIOLATION ', ° $0.00 Gas Service $0.00 ?.?: 0 ,.Spa(public) $2.00,.. .,.0• . , ,PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 ..t.-- ,.0• t< , -' K. , -_1" `" REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 .:Of- , r , .0 - -ri". "-TOTAL CALCULATED FEES: $342.35 COMMENTS-/SPECIAL'CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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(6/00) 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 WOOL for which this permit Is Issued. 0have 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'coornpensation Insurerca carrier agd pollcy number are: • rti r -Gather,—,,S-Thi do,,Sl fUC%7OtJ J't/SUrPMi4C.� Fi.I"Ih) Polic"y"N mtier i7 1// f 7 !p / - " y (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Seeccy7ion 3700 of the Labor Code,I shall forthwith comply with these provsi .Applicant 8igneture:'" � (Date:SS 3 O/ y WARNING:FAILURE WARNING: DOLL ETO( SECU0),WORKERS' E ST O COMPENSATION. TI UN.DAMAGSAND SHALL DEDSUBJECT I N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FIAND A UP NAYS HUNDRED THOUSAND DOLLARE(5100,000).IN ADDITION TO TH COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license. oder•rovislo s of Chapter 9(commencing with Section 7000)of Division 3 of the Businessand Professions Code,and my license Is in full force and effect.Lia# A 6 ' 16 CIES Ni:- P' /7Y C I _CContraclor s.Signature: ..■ Da ?> — a 3 0/D S 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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(commenting with Section 7000)of DMsion 3 of the Business end 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 is 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,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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: 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 authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative 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 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 (Section 25533 of the California Health and 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 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,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Govemment 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 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",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 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 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. SigR4t reD Of Legal Owner(s) pate '^ )L � ! •D ,AuttiorizedrApplcant- CODE I INSPECTION TYPE PATE 11:0111ELE ;ODE( INSPECTIONTYPE PATE MOW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing � ('Ai -05 11 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 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