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Home My WebLink About1050 BAKER ST - Building PermitsKOLL, K. W. Mi GENERAL CONTRACTOR Edward Pacana AP No. LOT r TRACT 4232 FIRE ZONE IN'PECTIONS 250,25,11Signaturel DATE GROUP DATE 5-14-62 DESCRIPTION OF WORK TYPE 111 ZONE S I Gas SUBCONTRACTOR PER AITS ISSUED DATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑ Sprinkling System onstruction Pole Underground ❑ Power ❑ Rough Wiring Trenches ElForms ❑ Steel Reinf. Floor System Bond Beam ❑ Steel Reinforce — Sheathing Frame and Flashing Lathing — In ❑ Out ❑ Plaster, brown coat F .❑ Air Cond.❑ Final R. .ng, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final M —G OCCUPANCY t4� a MF CITY OF COSTA MESA BUILDING DIVISION Y DEVELOPMENT SERVICES DEPARTMENT J •� PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: 1050 BAKER ST Suite No Vicinity: MEDIA ONE CABLE BOX Parcel Nunmber: TPN990233 Applicant: MEDIA ONE Address: ELECTRICAL PERMIT Phone: Zip: PERMIT NUMBER E99-01139 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 12/1/1999 Issued: 12/1/1999 Owner: CITY OF COSTA MESA - Address'.:�" - - Phone: .. Zip: Contractor: THOMPSON AND THOMPSON Address: 1835 WHITTIER - COSTA MESA, CA Phone: (949) 548-1735 SUITE A-12 Zip: 92627 " - License: 550936 SCOPE OF PERMIT - INSTALL ELEC. METER FOR NEW CABLE TV.POWER SUPPLY FOR MEDIA ONE. FEE SUMMARY " " 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 W kva/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 System / Ckt $0.00 .0 Service to 200a $30.50 1 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 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp _ $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp _ $0.00 0 Fireworks Stand $0.00 0 Motors to 1 00h $0.00 0 Other Electrical Fee $0.00 Motors over 100hp - $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 - TOTAL CALCULATED FEES $54.00 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS CA,C, 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 DECLARATIONS , WORKERS' COMPENSATION DECLARATION: I hereby alliml 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. ❑ 1 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 carder and poli number are: Carder: {�.i�P �.0 ix".vD•�v�S _Z+.1(F) — Policy Number: (This section need not be completed if theparmit is valued atone hundred dollars ($100) or less.) ❑ 1 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 Section 3700 of the Labor Code, I shall forthwith comply with the Isio Date: �oc 1 X11 Applicant Signature!L�� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3105OF 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. Lie. /f ��-) 6 Class q (_"' % Contractors Signature .y�-,J r Date: /rel - / —- I CONSTRUCTION LENDING AGENCY: ❑ 1 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 ❑ 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 contra) tors) license pursuant to the Contractors License Laws.). ❑ 1 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 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 ❑ 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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 1 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 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). I 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? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agenc- 8 Yes 8 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 ❑ 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 end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: I 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. I zDa I ignature Ot Le ner(s) Date S /'R- /-cls' And/Or Authorized Applicant Date CODE.. INSPECTION TYPE 2Ay H INTITIBLS CODE I INSPECTION TYPE DAA INTITAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing n / 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining 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 2"6-46 i X01 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely - /0�1� OTYYPE OR PRINT I� BUILDIN6Y�� ADDRESS b-�— COSTA MESA. CALIFORNIA 7FE RECEIVED MAY 14 1962 ��// FIINANCE DEPT. APPLICATION FOR PjW&F COSTA MESA BUILDING For Office Use Only ee �'/I/ RECEIPT NO. PERMIT R i(� _ /ZZ t Jj�� A/��•/.1 /'!1 rADDRESS RECH ED BY I DA iCEI VSO TATE IBBUE� L/A /\%�_✓JF_ `�'(•�1� (I'v�.v ' A TEL. �~-'�^ � BUILDING / T � NO. ADDRESS ARCHITECT TEL' OR ENGINEE NO. FIRE COSTA MESA. CALIFORNIA it ADDRESS �–,• ZONE TYPE GROUP '• (� I CONTRACTOR I(.V�J T� APPROVED BY DATE ZONING v ADDRESS V J LTJ A-1 • ZONE_ I �B[\ ( LE AL DESCRIPTION +� I PLANE OF I USE OF BUILDING EW �f•� , o. ��! y 2 3 L — ^sf j 417 ' 7 1 z / •� /O ' ��I1'L CITY /V/V/• � / C. STATE / 17 0 1T NO.EL-� li J • �C'� %� SIZEI NO. OP SLOGS. OF LOT NOW ON LOT A. P. NO. USE OF EXISTING BLDG. YARDS APPROVED EVES ALLOWED SETBACK LINE FROM (CENTER LINE AT CENTER OF STREET REAR YARD FRONT..(- FT. IN. SC1 �AC � JR' I I SIDE YARD LEFT RIGHT R. SIDE L. SIDE �` FT. IN. - FT. IN. DESCRIPTION OF WORK I I I I NEW ALTERATION ADDITION REAR FT. IN. REPAIR i II MOVING I I DEMOLISH I APPROVED V' BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL (ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED In n n / �/ I L1 " .3 / s's 41- '' X 61 X 1,12 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP CATION AND STATE THAT T ABOVE IS CORRECT AND�AIiH E COM- PLY WITH ALL ORDINANCES AND STATE LAWS GULATIND THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONS UCTION. VALUATION �O-C�Ci(� f q PERMIT FEE $ SIGNATURE PERMITTE t,%� PLAN CHECK S -O AUTHORIZED AGENT TOTAL FEE SS