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Home My WebLink About390 FORD RD - Building Permitsi p MF O ,➢ t p °' b t �: � J.4v�mm A� • � � CITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wviw.ci.costa-mesa.ca.us . FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE APN: 41921204 Zoning: , JOB ADDRESS: Vicinity: SQ. FT: 0 B_MISC 390 FORD RD CM SCOPE OF WORK: DEMOLISH 2OX40 BUILDING FRONTI�NG FORD RD. OWNER: SUTTON, LARRY G City/State: COSTA MESA, CA � Phone: 949-5483777 APPLICANT: SUTTON, LARRY G City/State: COSTA MESA, CA Phone: 949-5483717 Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: Phone r, � i. OWNER-BUILpER FEE SUMMARY. Building Plan Check: Building Permit: Electrical Permit: SMIP Residential SMIP CommerCial Bldg Std Admin Fund TOTALFEES PERMIT NUMBER: BX09-00251 STATUS: ISSUED DATE ISSUED: 11/10/2009 ISSUED BY: CAC Suite/Unit: Primary Occ: Const Type :?? Valuation: E1,000.00 Address:: 891 JOANN ST Zip Code: 92627 891 JOANN ST Zip Cade: 92627 License No. 000000 'hone License No. License No. $25J 9 $38.75 $0.00 $0.00 $0.00 $1.00 $64.94 Cell: � Unit Unit: Unit l:nit Un�t• nn NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related iegulations. (Ord. No. 92-28, § 1, 12-21-92) �EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � � INSPECTIONS: In order for the work authonzed 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 fnal approval will result in the expiration of this permit. CODE/, INSPELIIONTYPE R�,F IN7171A�5 COOEI INSPEGTIONTYPE 0�, INiRIRLS .�.' 1fi16 Fixed System Final Fire Prevention 206 Final Methanital �� 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electnwl 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 BuildingiOccupancy � O� D �_�L�� WORKERS' COMPENSATION OECLARATION: I hereby aKrm under penalty of perjury one ol the (ollowing declarations: ❑ I have antl vnll maintain a c@rtificate of consent to self-Insure for workers' compensation, as provitletl (or by section 3700 oi the Labor Code, for the pertormance o( the work 1or which Ihis permit is issued. ❑ I have and will main[ain vqrkers' compensation insurance, as required by sec[bn 3700 of the Labor Code, for the pedormance of the work (or which this peRnil is issuetl. My wnrkefs' Compensation Insurance carner and policy number are: Cartiec (ihis sedion neediat be cnmde�� atM1e perma is valuetl at one hundretl tlolla�s (St00) a less ) Policy Number: ❑ I certify that in the peAormance of the vrork for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of California, antl agree that if I should become subject to lhe workers' compensalion provisions of Section 3700 of Ihe Labor Code, I shall forthwith Comply with these provisions. Appliwnl's SignaWre WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALI $U&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFtS ($100,000), IN ADDITION TO TH� COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37pfi OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aKrm that I am licensed under pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ef(ect. Lic. # Class # Contraclor s SignaWre Dale CONSTRUCTION LENDING AGENCY: � I hereby affirtn that there is a constructbn lending agency for the per(ormance of the wvrk fu wfiich this pertnit is issuetl. (Sec. 3097. Civil Code). Lender's Name: Lender's Atldress: �ale OW NER-BUILDER DECLARATIONS: I hereby atf�rtn that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LqW for the following reason (Sec. 703t5, Business antl Professions Cotle: Any city or county which requires a pertnit to construct, alter, improve, demolish, or repair any slrucWre, prior to its i55uance, also requires the appliCant for such permit lo (le a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) o( Division 3 of lhe Business and Professions Code) or lhat he or she is exempt theretrom and the basis (or [he allege0 exemption. Any violation o( Section 7031.5 by any applicant for a permi� subjects the applicaN to a civil penalty of nol more than five hundred dollars ($500).): ❑ I, as owner of the pmperty, or my employees with waqes as their sole compensalion, WILL DO THE WORK, and the structure is not intendetl or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply lo gn owner of property who builds or improves thereon, and who does such work himself or �erself or Ihrouqh his or her ovm employees, pmvided t�at such improvements are nol intended or ofleretl for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have Ihe burden of proving that he or she �tlid ol build or improve for purpose of sale.). I, as ovmer of the property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro Con5lruct the project (Sec. 7044, Business and Professions Code: The contractors License Law dces not apply to an ovmer o( property who builds or impmves thereon, and who contracls for such project with a cmtracta(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: R� %�i , i // i ��i / •—..yilnl. �� ' itY�-�. Owner ID verifed by driver�nse. � � No � D� er's Lic se No. �' ex es: O 7 ( 1�(a Ven ic� Ownership by (rype of document, i.e. - prop ax bill or Oeetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excava[ion frve (5) or more feet in depth into xAiich a person is require0 to tlescend, will be made in connectbn with work autMrizetl by lhis permit, and tha� no builtling structure, scaHdding, lalse�wrk, a demolition or tlismantling thereof, will be more [han thirty-s�c (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Ttle 8, Cali(omia Administ2tive Cotle). ❑ As owner-builder, I will not employ anyone to do vrork which would require a permit from the Division of Industnal Safety, as notetl above, unless such person has a permit to do such work trom Ihe division. AVPliwnfs SignaWre ., Dale Division o( Industrial Satety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: i. 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 ot a hazardous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health and Salery Code requires. with some exceptions, that a Business Plan be filed xith the Costa Mesa Fire Department by every business which has at any one time tluring a reportetl year a quantity of hazardous materials�equal to or greater than a weight o( SAO pounds, or a volume of 55 gallonsror 200 cubic feet of compressed gas at standard tempera(�e and pressure). 2. Does or will the applicant or present or fuWre building occupant neetl to fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Seclion 25533 of t�e California Healih and Safety Cotle, with some e�ptions, requires registration with the Costa Mesa Fire Department by each business;�vrich at any one time has on hantl a quantity of awtely hazardous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 9allons, or 200 cubic feet of compressed gas at standard tempera�ure and pressure). 3. Does or will Ihe applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program lor acutely hazardous malenals)? ❑ Yes ❑ No (Section 25134 0! the Califomia Heallh and Safety Code provides that the Costa Mesa Fire Depanment may require the preparation, certification antl filing with the Fire Department o( an RMPP by businesses which are requiretl to register acutety hazardous materiais vriM the Fire Department. 4. If an RMPP is presenlly required, has Sec[ion 25534 of Ihe California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupaN require for the vrork which is the subject of �his application a pertnil !or such conslruclion or modilcation from Ihe South Coasl Air �uality Managemenl Dislrict or (rom any o[her air pollution contml district or agency? ❑ Ves ❑ No (Seclion 658502 0! lhe Califomia Govemment Cotle requires Nat the requesletl infortnation be fumished on applications for nornresidential building permi�s). 6. Will any part of the facility to be constmcted under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the facility must meet the requirement of Sec[ions 25534 and 42303 of the California Health antl Safery Cotle). 7. If a permit (rom the South Coasl Air Qualiry Management Districl or other air polWtion control tlisMct or agency is required for the work which is the SUDjecl of Ihis application, have all of the disclosures prescribed by Califomia Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appmpnate air polWtion control aKcer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury lhe intortnation given above is cortect. I agree to comply vrith all state laws and city ordinances regarding Hazartlous Matenals and Emissions. Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ce�ify under penalty of perjury that I have read this application and state thal the information given is correcL I agree to comply with all state laws and city ortlinances relating to building construction, and authorize representatives of the City of Cosla Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy ot any building authorized by {�is ✓mit un i f V'11SD e n. �� LBgnat e L gal � e) a= An orAuthOnzeCAp06cdn1 al¢