HomeMy WebLinkAbout3136 AIRWAY AVE - Building Permits2 . .
1-1 4) CITY OF COSTA MESA ir-c.7...
Development Services, Division of Building and Safety
CERTIFICATE OF OCCUPANCY
This certificate is issued pursuant to the requ�ents`of,the Uniform'Building Code,Section 308 adopted by the City
of Costa Mesa certifies that at the time oiits issuance the.building stiuctuie herein below described was inspected and
approved for occupancy as follows:' z' ��i� %/. '.
N /� \ �;-' /\\• X
Building Address 3134 Airway ,Avenue . . Bldg, Peimit Number 803-00979
��f'y, rf! /�/.\ : l �
Use Commercial/Office c-� -�h,. - ---- a:-",2\
I':> '/JNrJ <V'
Group V-N Type of Constructiom7.-845'2- . �i.Fi e-Zone Use Zone
Owner of Building Kevin Coleman ,Ac-V,2\--,•••7-Thr 7/�Tenant **
Address 3140 Airway Avenue;\Costa Mesa, CA 92626 t/ii
.i
�� „,
I BUILDING OFFICIAL-Rick', ` BroWn1 C B.O. >E:1/Petr s, Chief of Inspection
U�' <u
i/ Date %:-'2/0 /04c c:
I — . REQUIRED TO BE POSTEIDLINT A CONSPICOUS PLACE
CI
Fri CITY OF COSTA MESA i
Development Services, Division of Building and Safety
•
CERTIFICATE OF OCCUPANCY
1 /'' -,c; ,,
This certificate is issued pursuant to the requirementsof the Uniform'Building Code,Section 308 adopted by the City
of Costa Mesa certifies that at the time diits issuarice the building structure herein below described was inspected and
i approved for occupancy as follows \n �� ;/C(i' .
A
j
Building Address 3136 Airwav"Avenue .. .Bldg.-Permit Number B03-00979
Use Commercial/Of fice°� � 6 __ - ;f���✓)\ \ -�1
Group v-M Type of Construction7B/SF2.• rc;x. ,Fire?one r - - ' Use Zone
Owner of Building Kevin Colemans' .}y`^`,'^Tenant ** r,- `r
ycamA _ _ tea _ .
l
Address 3140 Airway Avenue' Costa -Mesa, CA 92626 ,1Y � /
i
l BUILDING OFFICIAL-Rick A. BIoWh;C.B.O. ,,E t'et/ j•s, thief of Inspectiun
-,„,/,/(<��cz� Dated ../2'(93/04 L
1178)
REQUIRED TO BE POSTED IN A CONSPICOUS PLACE
C
ova MFS CITY OF COSTA MESA
4 q: ' - BUILDING DIVISION
H .►• I DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER
PERMIT
4,Ay 4-00161
i
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-m .'eUPRESSION PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3136 AIRWAY AV Status: ISSUED
Suite: Applied: 05/10/2004
Vicinity: Issued: 06/01/2004
Parcel Number: 42708306 Zoning:
ISSUED BY:
fa
Applicant: PARZ, JAYNEE ' "
Address: 10692 STANFORD AV,-;7' 1"
". Phone: 714-260-0101 '
GARDEN GROVE;CA ' Zip: 92626 -
Owner: LABONGE,yDENIS. '
Address/, 3130 AIRWAY AVE - - - . -
,
i - Phone: _. - , -
".,7COSTA MESA,CA: Zip: 92626-4610
Contractor: FIRE SPRINKLER SERVICE CO. '-\ ti`s',; , 2
Address: 18030BROOKHURST ST
#8/,)%; Phone: (714)894-9414 - �-
. ;' FOUNTAIN VALLEY,CA Zip: 92626
- "License: 663648 ,�,
SCOPE OF.PERMIT
• _-
" OVERHEAD FIRE-SPRINKLERS. REF: B04-00826.
' ..t
FEE SUMMARY
Plan Check: $45.01 ,; -a--:, y (--\ -_:• _• ti, i Calc Valuation: $2,000.00
Permit: i $69.25 \-1.! J. - - - ' - -
-- . - - ' Claimed Valuation: $2,000.00, '
Other: $0.00 - - -
,
•
Total: $114.26 - � ,_
�i
_ /2 ., - .
.N t' -
- - 'o:
i, - _ i
ii
V C/ 7 v / /
7
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 withall 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
wfor 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 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 Califo ia,and:• -- - ' should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these prows) '1 ---0
Applicant Signature: C Date: \--
WARNING:FAILURE TO SECU WOR S'COMPE • • COY ' LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL NES UP TO ONE HUNDRED
THOUSAND DOLLARE($100, ),IN ADDmON TO THE T OF e• • SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am li et.
•'r pi,visions• (commencing with Section 7000)of Division 3 of the Business an. Professions Code,and my license is In full
force and effect.Lic.N — .0. a - — Class s —
Contractors Signature: ' Sia- 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).
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 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 contractors)
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 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 end 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 agpermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u 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? ❑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 ❑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.
Sia..: • Legal Owne s) . Dat:
.-IS 1 - •
• An• or
orize,••licant rate
CODE# INSPECTION TYPE WV INTITIAL$ CODE• INSPECTIONTYPE DATE INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
��JJ
200 Final Re-Root 210 Final Electrical U"i
201 Final Block/Retaining Wall 212 Final Fire Prevention i/�a I tirerg
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
BUILDING-DIVISION
>:l,,,,1. ..4.1 DEVELOPMENT SERVICES DEPARTMENT P�AMIT NUMBER
PERMIT E04-00591
ikvbancnin et
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
. ELECTRICAL PERMIT
Job Address: 3136 AIRWAY AV Status: ISSUED
Suite No Applied: 05/21/2004
Vicinity: Issued: 05/21/2004
Parcel Nunmber: 42708306•
rAApplicant: SANCHEZ,PHIL ISSUED BY: � °
Address: 540 N.GOLDEN CIRCLE#205 , - \/
• Phone: (714)647-1791
SANTA ANA,CA. . Zip: 92705 ,
Owner ,/LABONGE, DENIS .' _ , .
Address, 3130 AIRWAY AVE, ' - - ,
Phone:
' 'COSTA MESA,CA- Zip: 92626-4610 - . '
Contractor: PACIFIC ORCA CORPORATION
Address: 540.N.GOLDEN CIRCLE#205
0,2:
Phone: (714)647-1791
SANTA ANA,CA Zip: 92705
License: 644807 ,
SCOPE OF PERMIT
B04-00826. 18 LIGHTS, 18 OUTLETS;6 SWITCHES,7 COMMUNICATION DROPS.1-UP TO 5HP FOR
THE AIRHANDLER.. - . _ _
FEESUMMARY ,.
• Quantity ' -'--""'- - - - - -; 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 Standing Section $0.00 0 .
New Res(1-2 units) . $0.00 0 Misc Electrical Equipment $0.00 0: ._
New Res(3+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 , $19.80 18 1:-:•; up to 50 kva/kw $0.00 `' 0
•
Recept Outlets 419.80 18 - up to 100 kva/kw . $0.00 '. 0
Switches ' $6.60 - ".6 '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 System/Ckt ,: 40.00 0
Service to 200a $0.00 0 Misc.Conduit _ 0
Service to 1000a ., . $0.00 - -0 - ‘.Misc.Conductor $0.00 0
Service over 1000a N` ,� $0.00 0 •_ - - Circus(gen or ride) '- -$0:00 ' 0
Motors to 1hp ' , $0.00 ' , 0 - Circus(mech ride or lights) v ' , $0.00 -,0,,-/Motors to 10hp ,,';$12.30 - ' 1-; - - Christmas Tree Stand , '$0.00 ,0
Motors to SOhp N$0.00 , 0 ` ' 'Fireworks Stand : $0.00 " ' 0
Motors to 100hp $0.00 - . 0' Other Electrical Fee $0.00-
Motors over 100hp $0.00 0- -- . . . '
Communication drops $7.70 7 - _ Investigation Fee $0.00
Sub panel to 200a $0.00 0. -- _ - - - .PIan,Check Fee-1 : - $0.00 '
/
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,of it-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 /
2446-481&00
. ,
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:
Carder: Policy Number:its section need not be completed it the permit is valued at one hundred dollars($100)or less.)
'L j� certify that in th o ante of he work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
((( compensation laww9p Ca mia, , d agree that If I should become subject to the workers'compensation provisions of Sect n 3100 of the Labor Code,I shall forthwith
comply with the$p d vissi s.
.AppfcanfSlg an Wre: \777 ' Date— 5I vA
i
WARNING:FAILURETO( SECURE WORKERS'.. PE COST COVERAGEIS UNLAWFUL AMAGANASHALLiDED SUBJECT IN PENAL CO ES AND CIVIL FINES UP HUNDRED.
THOUSAND DOLLARE(S1Do,cao),IN ADDITION Q E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31080E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLAR ON:
1 herebyaffi thaL6em.8cens d rte.( r vislAn of Chapter 9(commencing with Section 7000)of Division/Sof the Busines2an irofessrrns Code,and my license is in full
li
force amend effect:Licrff L 1 ( Class M .1 LI rel I
//� Conuactor`sSlgn`aiure:
J ZI (I
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction len ' gency 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 penally 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 drivers license. 0 Yes ❑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 Wit 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,ore 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 (Tan RMPP is presently required,has Section 25534 of the California Health and Safely 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 e
application aarmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j5 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 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.
Si at 0 egal ner(s) to
5 I Liol
And/ r Authorized nth %ate`
CODE I INSPECTION TYPE r PAIL Ri=mELU CODE II INSPECTION TYPE IMIE I(TTle4$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing n
200 Final Re-Roof 210 Final Electrical v(�r-L/'
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
BUILDING DIVISION
04 OnitLY;\
q4' DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER
F' -
PERMIT
G
4ittvatarrno sF 04-00354
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
•
Job Address: 3136 AIRWAY AV Status: ISSUED
Suite No Applied: 05/21/2004
Issued: 05/21/2004
Vicinity: /////�v2,)��.�
Parcel Nunmber: 42708306 ISSSUED'BY // / N
Applicant: SANCHEZ,PHIL U
Address: 540 N.GOLDEN CIRCLE#205
i - Phone: (714)647-1791
SANTA ANA,CA Zip: 92705 .
Owner: '.LABONGE, DENIS'- .
Address 3130 AIRWAY'AVE -
Phone:COSTA MESA,CA Zip: 92626-4610 •
Contractor: PACIFIC ORCA CORPORATION
Address: 540 N.GOLDEN CIRCLE#205 -
Phone: (714)647-1791
' , SANTA ANA,CA Zip: 92705
License: 644807
Arch/ Eng : _ . . . .
•
Address: -. . - - - ,
Phone:
Zip:
-- - -License: - --- -
SCOPE OF PERMIT
B04-00826.
, `, '1 BAR SINK. - - ,
-'FEE SUMMARY - ,
AMT: QTY • , AMT QTY AMT QTY
ISSUE FEE ' ' $23.50 - -.Laundry Tub/Washer $0.00 0 ' - " Sump Pump - $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer - ,"$0.00 0. • P-Trap • ' $0.00 0 ' 'Trap Primer - $0.00 0
Bathtub Soo' .'
0.00' ., 0 Pressure Regulator $0.00 0 _ 'Urinal- - . $0.00 0
Clarifier System H .\ $0.00 ' 0- �'Process Piping(per 10 ft)' $0.00 0 ' , ' ,Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc)�'- '$0.00, 0 Receptors - - ','$0.00 0- Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units v $0.00 - 0 •' ,,• . ..,Septic Tank - _ $0.00 0 , Wash Basin-; / $0.00 0
Dishwasher \\$0.00 0 . - Sewer Cap for Demo _ $0.00 i0. ..Wash Basin,Set $0.00 0
Drain, Floor $0.00 0 - Sewer Connect . '$0.00 _0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 ' Sewer Private Line - $0.00 0 - Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0' Shower $0:00 0 . ' Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 - "Sink,bar $9.80 T ,1 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial - _ - -$0.00 0 Water Re-pipe $0.00 0
i
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
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 JWili f esult in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 1
244646(6/00) /
I
DECLARATIONS j
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 if the permit Is valued at one hundred dollars($100)or less.) • '
'❑I I certify that In the•erforma i e of e work for which this permit is issued,I shall not employ any person in any manner s as t ecome subject to the workers'
/1'- compensation la . •f alit.•ia, ' agree that it I should become subject to the workers'compensation provisions of S ctlon 700 of the Labor Code,I shall forthwith
comply with these p islon. /'
Appllc�,Signature: A_:_ r_—Date. c 111 v1
WARNING:FAILURE TO SE URE WORKERS'•• PE ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERSO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
'THOUSAND DOUARE($1X. ),IN ADDMON TO f. COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARAT Ie.
I hereby affirm that I am licensed nd r ovisio of Chapter 9(commencing with Section 7000)of Division 3 of the.Busine 1d crgfessions Code,end my license is in full
force and effect:Li`:M,a, �1 rclass.x� j \ (�
Contractor's Signature: � ' Date: L, V'
n
!✓
r CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending a''cy 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 wit 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 Driver's License No. Expires:
Verification of Ownership by(type of document,Le.-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 B,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 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 0 N
(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 aEEermit 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 ryes",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 at 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 pup es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
I nate f Le al wner(s) (—Dat
.D j21 lint
Or u herized Ap t at
;ODE 4 1NSPECTIONTYPE 1NTITIALS CODE# INSPECTIONTYPE 4 PEIEt:r—iR!-
1616 Fixed System Final Fire Prevention 206 Final Mechanical 7O �/
1268 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
fy CITY OF COSTA MESA
04 BUILDING DIVISION
F i ,I0 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
'kroamce M04-00271
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 3136 AIRWAY AV Status: ISSUED
Suite No Applied: 05/21/2004
Issued: 05/21/2004
Vicinity: ///I1�
Parcel Number 42708306 ISSUED BY: /// / 0
Applicant: SANCHEZ,PHIL
(71
Address: 540 N.GOLDEN CIRCLE#205 ' tr
Phone: (714)647-1791. -
SANTA ANA,CA Zip: 92705
Owner • LABONGE, DENIS
Address:;'3130 AIRWAY.AVE '
- „ - Phone: -
COSTA MESA,CA Zip: 92626-4610 '
Contractor: PACIFIC ORCA CORPORATION
Address: 540 N.GOLDEN CIRCLE#205 ,
Phone: (714)647-1791
SANTA ANA,CA N ' • Zip: 92705 '
License:644807 '
SCOPE OF PERMIT
, B04-00826.
1 ALT DUCT SYSTEM AND 1 AIR HANDLER<10000CFM
•
FEE SUMMARY
Quantity . 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 - , ' Ventillation System $0.00 0
Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Cornmercial Incinerator $0.00 0
Refrig Sys<100 k BTU , $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU , $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 ' $0.00 -'0 Over 50 lip/Over 1,750 BTU - $0.00 0
Appliance ' $0.00 0 , Boilers
Fire Dampers ' ' , $0.00 0 Up to 3 hp - $0.00 0
Smoke Dampers . $0.00 . 0 - 3 To 15 hp : $0.00 0
Inst or Relocate AppI Vent ,$0.00 0 - - 15 to 30 hp to 30 hp - - - - $0.00 0
Air Handlers< 10000cfrn, $10.65 . 1 - . - . 30 to 50 hp- - ' - / $0.00 0
Air Handlers> 10000cfm N $0.00 - 0 - Over 50 hp ,, - : . - ' $0.00 0
Floor Furnace $0.00 - 0 - - Other Mechanical Fee ,
Floor or Suspend Heater $0.00 '0 Investigation Fee', i, $0.00
Plan Check Fee , ' $0.00
- Reinspection Fee, - - $0.00
" " -TOTAL CALCULATED FEES $47.85
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 shrill come void If wor
ll automatically expire and become is not commenced within 180 days,or If work Is suspended or abandons
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.
❑ 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:
( his section need not be completed if the permit is valued at one hundred dollars($100)or loss.)
'�D_V/``}certify that In the p:.o an“of the ork for which this permit is issued,I shall not employ any person in any manner so as to b come subject to the workers'
C7- compensation laws if :Ilfa ,and-•ree that if I should become subject to the workers'compensation provisions of Se- Ion 3 of the Labor Code,I shall forthwith
_ �
comply with these• • i ons. '-. f (il
Applicant Stature: I 11. / Date: ✓�Z' " /
•
WAftHwErFNLURE TO SECU•E WORKERS'•• M
SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT NJ EMPLOYER TO CRIMINAL PENALTIES AND CL FINES UP TO ONE HUNDRED
C -THOUSAND DOIURE(3104000),IN ADOmON T• •.T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA'
11
I herebyaffirm-tha�.f�l'am•-Iicen .'• �`[ayisions of Chapter 9(commencing with Section 7000)of Division 3 of the.Business a r esslons Code,and my license is In full
-fdk`e.and-effecl7C�.- r u V k ��'"Class.x_ .— L
Contractors SSgneture: ��`�-- l•------D�\ 5 Z tl`'f
j__---- CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construcli••ding agency for the performance of tie 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 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,es 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 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(38)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 Safely 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).
...._ _ _ ..to fire_.......__i_ _ _....__...._ _..__
2 Does or will the applicant-tit;present or future building occupant need to lila a registration form for acutely hazardous materials? ❑Yes ❑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 0 No
.......__
5 Does or will the applicant or present or future building occupant require for_ m
the work which is the subject of this a plleation akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district Or agency? Yes U 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 Ls
correct. I agree to comply with all state laws end 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 ree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatu a egZ Own (s) to
11 lM
And/Or prizedd-Applica e ,ate l
COOS t, INSPECTIONTYPE r PICOPPs g1SPECRON TYPE RAIL JL�LS
1818 Fixed System Final F reMIDALB
Prevention 206 Final Mechanical /'ol
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
i
CITY OF COSTA MESA
•
4
BUILDING DIVISION
, :� DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
F tPERMIT
J: B04-00826
4111
(714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3136 AIRWAY AV Status: ISSUED
Suite: Applied: 04/30/2004
Vicinity: Issued: 04/30/2004
Parcel Number: 42708306 Zoning:
Applicant: SANCHEZ,PHIL ISSUED BY:
Address: 540 N.GOLDEN CIRCLE#2.05 -
Phone: (714)647-1791 ,
SANTA ANA,CA,-. Zip: 92705
Owner: LABONGE, DENIS -- ' '
Address 3130 AIRWAY AVE' ' _ - .
.COSTA MESA,CA - - Zip: 92626-4610 .
Contractor: ,PACIFICORCA-CORPORATION
Address: 540 N. GOLDEN-CIRCLE#205 -
�� i' Phone: (714)647-1791 -
SANTA ANA,CA
Zip: . 92705 : I License:- 644807 . _ ,
Arch : - - - Eng:
Address: , , • - - Address: .
- 4 Phone: -- - Phone: . -
Zip: License: License:
- SCOPE OF PERMIT -
INTERIOR WORK TO CREATE TWO OFFICES AND THE'INSTALLATION OFA DEMISING WALL TO CREATE A STORAGE WAREHOUSE FOR
CARS. - - . .. . . _ � .
•
'REF:ZA-04-25. \ _ .-
FEE SUMMARY
Plan Check: $63.58 Calc Valuation: $25,000.00
,Permit: - $391.25 . _ Claim Valuation:: $25,000.00
'SMTP Res:, ' $0.00
SMIP Com:' ` $5.25 .
`�-Other:. ' -$0.00 ,'-
Inspection: $0:00 �"
\- %J
Total: $460.08
' ''PLANNING=&.ZONING _ ' , - - ;/
SETBACKS -
MAIN STRUCTURE 'Front's'',0-0 ' Rears 0 0 Left 0 0 _ ,r" Right' 0-0-,/ 7,7
-
ACCESSORY Front .0-0 Rear. -0-v-b? Le ' - -0 Right '0-0_ -
PARKING Existing: 0 Required: - 0 Proposed: 0, .
r
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. / I
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,
❑ 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:
Cartier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.) '
I certify that in the p o man e of th ork for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
7.0
compensation laws lifo 'a,and ee that If I should become subject to the workers'compensation provisions of S 370 of the Labor Code,I shall forthwith
comply with these o ons.
.A ppucentfSignature: '— Dete: "s Secti
2 1 ) U'
WARNING:FAILURE TO SECURE WORKERS'COMPEN TI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm ihaLl.am licen -d underaro I•ns of Chapter 9(commencing with Section 7000)of Division 3.of.the Business a Pro essions Code,and my license Is in full
force andref�fectrLic N l +� I ss R ' arid.
1
Con GtoYe'Signature: 11fl 1 Date: S'7 I by-1
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction -••ng 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 ❑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: Dale:
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 tile 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 end 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 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? j�Yes D 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? ❑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 •;ty ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. (=gree not to occupy or allow occupancy of any building authorized by this permit untilnd
•;tinspection.
Sign tlr Of al :r : 5_1 LI
1LI dAnd/ r Authorize •• nt te
CODE E, INSPECTION TYPE DATE INTRIAL$ CODE( INSPECTION TYPE PAIS INTITIAL$
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 BlocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site —/� i
204 Final Demolition 250 Final Building/Occupancy /