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Home My WebLink About870 BAKER ST - Building PermitsCITY OF COSTA MESA BUILDING D/VISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.cosW-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E08-00318 PERMIT TYPE EL,EC STATUS: ISSUED APN: TPN007216 DATE ISSUED: 08106/2008 • - ISSUED BY: YH JOB ADDRESS: 870 BAKER ST CM ' Suite/U�it: � vicinity: %`� �. : • � . . , .. . , .. . , SCOPE OF WORK: 100 AMP. METER�FOR ATBT COMMUNICATION BOX. �- '� � i. . . ' . ' . , . REF: PS07-00806 .. . .� `"� � ENCROACHMENT PERMIT TO EXCAVATE IN LANDSCAPE AND SIDEWALK TO PLACE CONDUITS AND AN ABOVE GROUND CABINET "ALP-248C , � � ' ` � . ii' ' . . � . . . - � , i . OWNER: CITY OF COSTA MESA-.� �� Address: Unil:, ' ' PHONE: . . �.` J �- - � CirylState2ip: , . . , � .°� i3 i i APPLICANT: THOMAS; D�LEN ' � -. , � - Address: � Unil: ' PHONE: 909952-325j � �� CitylSfate/zZipi. �. � -^��- . . � CONTRACTOR: HHS CQMMUNICATIONS , . Address: 305 NSqCRAMENTO AVEUniC -� - - City/State: ONTARIO, CA Y'� . ZipCode: 91764 ELECTRICAL PERMIT'FEES - Electrical Plan Check Fse: �0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES ` $54.00 - - . • License No. PHONE: CELL: 913707 909-230-5170 �•:=r NO710E: The work authonzed by this permit shall comply with all applicable handicap access requi�ements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: In order for the work authorized under this permil to be considered legal, such work must comply with all appliwble codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiretion ot this permlt. LODEt, ixsrecnonrme p� iN�6 � INSPEC710NTYVE p�g � 1616 Fiaed System Final Fire Prevention 206 Final Mechanical 126fi Pool Spa Final . 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical A�16� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 22o Final Planning Approval 203 FinalSign 222 FinalSite ,' 204 Final Oemolilion 250 Final Building/Occupancy WORKER5' COMPENSA710N DECLARA710N: I hereby aKrm under penalry of perjury one of the following declarations:• ❑ I have and will maintain a certifiwte o( conseN to selt-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the perfortnance of the work for which this permil is issued. @�ihave and vrill maintain v.orkers' compensation insurance, as required by sectbn 3700 of Ihe Labor Code, fa the performance of the v,ork for which this pertnil is issued. My worker5' compensation Insurance carrier and policy number are,:� / Carrier. NG.�D/IG�/ ��/�/1 � _ (Thks bnnoetlrzot m^m'�pet A?Na�penri/i�sv7a/uaCatorie�untlieE49ars(Ef00)alessJ Policy Number: �! Z c JJ� d ❑ I certify lhat in the peAormance o( the work for which this permit is issued, I shall not employ any person in any manner so as to become subjecl to the vrorkers' compensation laws of California, and agree that if I shoultl bec�ubjecl lo Ihe v.orkers' compensation provisions of Sec�ion 3700 of I�e b Cod , I shall fo ivn � comply with Ihesa provision . AOG ��'s Signawre D �e O WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm thal I am licensed under provisions of Chapter 9(wmmencing vnth Section 7000) of Division 3 of ihe Business and Professions Code, and my license is in full force and eftact. Lic. # 0 Class # 0 Gmt2cto �gnawre ate CONSTRUCTION LENDING AGENCY: � I hereby aHirtn Ihat there is a consWction IerWirg agency for the peAortnance of the work for v.fiich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender s Address: Date OWNER•BUILDER DECLARATIONS: I hereby affirm that under penalry of perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7W1.5, Business antl Protessions Code: Any cily or couny which requires a permit to cons[ruct, alter, improve, demolish, or repair any sWcture, pnor to its issuance, also requires Ihe appliwnt tor such permit to file a signed statement that ha or she is licensed pur5uant to �he provisions of the Contracbrs License Law (Chapter 9(commencing wi�h Section 7000) of Division 3 of Ihe Business antl Pro(essions Code) or t�at he or she is exempt l�erefrom and the basis for lhe alleged exemption. Any violalion of Seclion 7031.5 Dy any appliwnt for a permit suhjecls the applicant ro a civil penalty of not more than five huntlred tlollars ($500�.�: ❑ I, as owner of the property, or my employees with xages as their sole compensation, WILL DO 7HE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business anC Prolessions Code: The Contractors License Law does not appty to an owner of property who builds or improves thereon, and who dces such work �imself or hersell or lhrough his or her own employees. provided that such improvements are not intended or oHered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-Duilder will have the buraen of proving that he or she dia not build or improve for purpose of sale.). ❑ I, as owner o1 the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS to conswct the project (Sec. 7044. Business and Pro(essions Cotle: The contractors License Law dces not appy to an owner of property who builds or improves lhereon, antl vfio conUacts for such project with a contracta(s) license pursuant to the Contractors License LawsJ. ❑ I am exempt untler sec. Business antl Pro(essions Code lor Ihis reason: J09A6 (3IW � Owner ID verifetl by driver s lice ❑ Yes ❑ No Drivers License No. Expires: Verification o( Ownership by (type of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . ❑ I hereby certify thal no excavalion frve (5) or more feet in tlepih into v.fiich a person is requiretl to descentl, will be made in connection wilh v.ork autFrorized by Ihis permit, and that no building slrucWre, scaffdding, false�wrk, a demolition or dismantling thereof, will be more than �hitly-su (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Administ2live Cotle). ❑ As ovmer-builder, I will nol employ anyone to do work which woultl require a permit from the Division o! Industrial Safety, as note0 above, unless such person has a permit lo do such work from the division. Ap0liwnfs SigwWre Date Division of Intlustrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicaN or present or future building occupant nead to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material7 ❑ Ves ❑ No (Section 25505 of the Califomia Health an0 Safety Code requires, with some exceptions, that a Business Plan be fled vrith lhe Costa Mesa Fire Department by every business vmich has at any one time during a reported year a quantity of hazardous matenals equal lo or grealer than a weigN of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressetl gas at standar0 temperalure and pressure). 2. Does or will Ihe applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Cali(omia Health and Safery Code, with some eaceptions, requires registration with the Cosfa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous materials equal to or greater t�an a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standartl [emperature and pressure). � 3. Does or will the applicant or present or fuWre building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Healih and Safery Code provides [hat the Cosla Mesa Fire Department may require the preparatioq certification antl filing wilh the Fire Department of an RM11PP 6y businesses which are required to register acutely hazartlous matenals vnth the Fire Department. 4. If an RMPP is presently required, has Seclion 25534 of the Califomia Health and Satety Code been fully complie0 vrith? ❑ Yes ❑ No 5. Does or will the applicant or present or luture building occupant require tor the work wliich is the subject of this application a permit for such construction or modifcation from the South Coast Air Qualiry Management District or (rom any olher air pollution conlrol distnc[ or agency7 � Yes ❑ No (Section 658502 of the Califomia Govemment Cotle requires that the requested informatbn be fumis�ea on applicatbns (a non-residential building pertnits). 6. Will any part of tha taciliry to be wnstructed under Ihis permit be wilhin 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the tacility must meet the requirement of Sections 25534 and 42303 of lhe California Health antl Salery Code). 7. If a permit (rom the Soulh Coast Air Oualily Management DisMcl or oNer air pollution control dislrict or agency is required for the v.ork which is the subject of this application, have all of the tlisclosures prescribed by Califomia Health and Safery Cotle Section 42303 been made? ❑ Yes ❑ No 8. Qf yes', altach certiftate of compliance from the appropriate air pollution coNrol officer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the information given above is wrrecl I a9Pee lu comply wiN all state laws and city or0inances regarding Hazardous Materials and Emissions. SipnaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the infortnation given is correcL I agree to comply with all 5tate lav5 and tity ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the aDoveCescnbed property for inspection purposes. I agree not lo occupy or allow occupancy of any building authorized by �his permi� until fnal inspection. ignat of Legal e 4te Date � p _ L.�./J� Mola Apino iea aoo��mnl Date