HomeMy WebLinkAbout135 COMMERCIAL WAY - Building Permitsp5�p N6
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PERMIT TYPE
M .
CITY,OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 www.ci.costa-mesa.ca.us,..;
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: G10-00014
GRADE STATUS: ISSUED
DATE ISSUED: 10/25/2010
ISSUED BY: ??
JOB ADDRESS: MM ERCIAL W.Y GME2
Vicinity:
Cubic Yards:
Suite/Unit:
Valuation: ??
SCOPE OF WORK: PRECISE GARDING PERMIT TO INSTALL 4 INCH AC OVER 6 INCH AGGREGATE BASE, 3 FOOT WIDE
CONCRETE GUTTER, DRAIN, BASIN A METAL TRENCH DRAIN ANDA-W''I f
ZL. NO OTHER WORK IS PERMITTED.
OWNER:
COMMERCIAL WAY PARTNERS LLC
PHONE:
949-642-0660
APPLICANT:
PAUL TAYLOR
PHONE:
949.642-0660
CONTRACTOR:
Address:
TOTAL FEES:
City/Stale:
ZipCode:
ARCHITECT:
ENGINEER:
GRADING PERMIT FEE SUMMARY
Grading Plan Check:
$15.28
Site Improvement Plan Check:
' $72.31
Total PC Fee:
$87.59
Grading Permit Fee:
$23.50
Site Improvement Permit Fee:
$111.25
TOTAL FEES:
$222.34
Address:829 W 17TH ST STE 5
City/Stale/Zip: COSTA MESA, CA
Address: t:
City/State/zZip:
License No.
PHONE:
CELL:
License No.
License No.
PHONE:
PHONE:
F.
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day, Independence Day, labor Day, Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE t, INSPECTION TYPE DATE INTMALS CODE! INSPECTION TYPE DATE INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
,201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval n�
.203 Final Sign ' 222 Final Site X'I 16110-.fJPAr
i204 Final Demolition 250 Final Building/Occupancy
..,... . -,. ter..
WORKERS' COMPENSATION DECLARATIO16
I hereby affirm under penalty of perjury one of the following declarations: '
Q 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.
Q 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:
(This section need Trot Oe completed eche permit is valued a( one hundred dollars (3100) or less.)
Policy Number:
Q I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Applicant's Signature
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 DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. #
Contractor's Signature
Class #
Date
CONSTRUCTION LENDING AGENCY:
Q I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name:
Lender's Address:
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).):
❑ 1, 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.).
[��, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
IjLICENSED 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.).
❑ f am exempt under sec.
Business and Professions Code for this reason:
3b5716(3/07)
Owner ID verified by dnv cense. (❑�es ❑ No
Ddy�a"-L- -cense No.
(,E�xpves:_yZ`3�` L
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby cedify 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, An 2, Sec, 341, Title 8, California Administrative Gode).
❑ 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.
Applicant's Signature
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 fled with the Costa Mesy. F-iCe
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 of 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).
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
fling 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 this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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 and
city ordinances regarding Hazardous Materials and Emissions,
Signature Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1
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
Ittt€T.ity of—fbst tsa to enter upon the above-described property for
inspection purposes. I a not to occupy or allow occupancy of any building
out tori by aWaspection. / C
$bgpat th of Legal Ownens)
And/or Autbonaed Applicant
Date
• CITY OF COSTA MESA •
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 - Fax (714) 754-4856 - www.ci.costa-mesa.ca.us
0 FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BX10-00181
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 42536116 DATE ISSUED: 08/18/2010
Zoning: I ISSUED BY: RMD
JOB ADDRESS: 135 COMMERCIAL WY CM Suite/Unit:
Vicinity: FRONT OF PROPERTY Primary Occ: _ Const Type :??
SQ. FT: 0 Valuation: $7,500.00
I
SCOPE OF WORK:
INSTALLATION OF A65 LF; 8' HIGH CONCRETE BLOCK WALL LOCATED AT FRONT OF COMMERCIAL PROPERTY.
OWNER: COMMERCIAL WAY PARTNERS LLC Address:: 829 W 17TH ST Unit STE 5
City/State: COSTA MESA, CA Zip Code: 92627
Phone: 949-642-0660
APPLICANT: TAYLOR, GRAHAME
City/State:
Phone: 714-240-0481
CONTRACTOR:
BERG CONSTRUCTION
Address:
1275 LONGVIEW DR
City/State:
FULLERTON, CA
Zip Code:
92831
ARCHITECT:
Phone
ENGINEER: TODD L LACHER
Phone 714-630-6100
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit:
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address:
Zip Code:
License No. 814377
Phone 714-879-4691
$99.61
$153.25
$0.00
$0.00
$1.57
$1.00
License No.
License No. 67656
Unit:
Unit:
Cell:
TOTAL FEES $255.43
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE/. INSPECTION TP DATE INTMAL CODED INSPECTION TYPE DAL INTITUL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site }-
204 Final Demolition 250 Final Building/Occupancy
I r
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penally 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: ���y✓�,�
amen
`ThjseciMnb4r04x,OomP1e1ea Afhe pe'rmi is vola of one hundred 4pars (Side/dlea)
Policy.Number:
❑ I certify that in the performance of the work for which this permit is
issued, I shall not mploy any person ut an manner so as to become subject
to the workers' m nsalion laws of lifomia, antl a that if I should
become subjec a workers' co anon pray sof Section 3700 of
the Labor Cod II Ort 't with th provisions.
iom's $lgreture
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CML 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, INTEREST, AND
ATTORNEY'S FEES,
Owner ID verified by drivers license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document. i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature
Division of Industrial Safety Permit Number:
Dale
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 riled 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code. and 2. Does or will the applicant or present or future building occupant need to file
my licens ' in full fort nd effect. 117 a registration form for acutely hazardous materials? ❑ Yes ❑ No
�� Section 25533 of the CaliforniaHealth and Safety Code, with some
Class#� Cn (J CS( Y
exceptions, requires registration with the Costa Mesa Fire Departmenty
i Y each business which at any one time has on hand a quantity of acutely
_ontrar]afs .ele.c�J e�� hazardous materials equal to or greater than a might of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affmn that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued. (Sec, 3097, Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lenders Address: 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.
Signature Dale
4. If an RMPP is presently required, has Section 25534 of the California
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 appy to an owner of
property who builds or improves thereon, and who contracts for such project with
a contracta(s) license pursuant to the Contractors License Lam.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
&9nkure
](15716 (M7)
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 this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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 lam and
city ordinances regarding Hazardous Materials and Emissions.
Signature
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 wilding construction, d authorize representatives of
the City of Costa esa to enter upon above-described property for
inspection purpo I gree not to or allow occupancy of any building
authorized by IN It until final inspe ton.
;, CITY OF COSTA MESA
o BUILDING DIVISION
w
iA 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • ww.ci.00sta-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754.5626
*�""'�� PERMIT NUMBER: BC10-00215
PERMIT TYPE: B COMBO
Sub Type: DEMO—ALL
JOB ADDRESS: 135 COMMERCIAL WY CM
APN: 42536116 Zoning: ,
Vicinity:
Const Type:
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 05/1912010
ISSUED BY:
Suite/Unit:
Primary Occ:
Valuation: $20,000.00
SCOPE OF WORK: DEMO EXISTING COMMERCIAL BUILDING AND EXISTING CONCRETE, CHAIN LINK FENCE AND REMOVE
AND REPLACE CURB AND GUTTER`_CAP SEWER, WATER, GAS AND EL. APPLICANT TO CONTACT AQMD DIRECTLY
OWNER: COMMERCIAL WAY PARTNERS LLC Address: 829 W 17TH ST
Phone: 949-642-0660 City/StatelZip: COSTA MESA, CA
APPLICANT: LAMANSKI, CATHERINE
Phone: 949-642-0660
CONTRACTOR: OWNER -BUILDER
Phone:
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 4700 ALTA AVE
City/State/zZip: CARMEL, CA
Address: Unit:
City/State:
License No.
License No.
$208.81
$321.25
$33.30
$0.00
$43.10
$0.00
$4.20
$1.00
$611.66
License No. 000000
Unit: STE 5
Unit: :
ZipCode
PHONE:
PHONE:
'Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE a, INSPECTION TYPE DATE INTMAL CODES INSPECTION TYPE DATE INTIMLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign yv, - e . 222 Final Site
204 Final Demolition Y 4 1 0 n (`� 250 Final Building/Occupancy
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:
(Twseamneedr herpletedlthepem iswbl atanehmMred F*;(Sr00)aless)
PolicyNumber:
F❑,_ certify that in the performance of the work for which this permit is
tissued, 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, 1 shall forth comply with these provisions.
6�� a - & S-1 4-1
U110-
train's Signature 5
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 DOLLARS
($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 Of the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class #
Contractor's Signature
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).
Lenders Name:
Lender's Address:
Signature Dale
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 vAlh 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).):
■ ires 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:
rm�( L
3057.46(3107) �1e
Owner ID verified by drivw'
—y[es/ I
Ve cation 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 We (5) or more feel 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, a 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.
Apphmnt a Signature
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 fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the 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
fling 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 this application a permit for such Construction
or modification from the South Coast Air Quality Management District or from
any other air pollution Control district or agency? ❑ Yes ❑ 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 tlistdcl or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safely 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 slate that
the information given is correct. I agree to comply with all slate 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.
/ q. �ure o1 Legal Ownerls�� �_ r t�
ta7k6rifaftJfihlofrnz�ed- AppLwnt (�yjT
OWNER WELCHIS COASTAL CONCRETE DATE 2-14-58 _
)OB ADDRESS .135 Commercial Way BUILDING PERMIT NO. 6)11,9
GEN RAL ON CTOR Cwner—Bllllder VALUE $ ------
P. o. T 9i TRACT p.t'6FIRE ZONE DESCRIPTION OF WORK Demolish structure u' -fo
fra—
m1
GROUP F? TYPE V ZONE C2 PLAN NO. rX2CT COUCH .B
INSPECTIONS DATE SUBCONTRACTOR I PERMITS ISSUED
/DATE NUMBER
Trenches Forms Steel
coat
UNT.1
Applicant to fill in all spaces except
CITY OF COSTA MESAJ�p� N�STR UCTION PERMM�sII�T����
Project Address
Applicant's Mei In�Aoddress
Owner's Nam�i1e Pho
Address
Arch/Eng. License No.
Address
Contractor's Nam %rte
Address .mailing)_ rd -A(1'1112 -
City License No 7_?i
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 70001 of Division 3 of the Business and Professions Code, and
license is In f T ce a ys�ffec[. � e�Y•-�� � Q�
In Clas !/ r(/ Lic se NOSFL7—
_...r� Signature
• WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to selftinsure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800 ,Lab. 0.
Policy 5 Compeer,
Polity No.
Certified copy is hereby furnished.
art Ifie❑ copy ❑ with the city B sloe
Date��� Applicant
EXEMPTION FROM WORKERS' COMPENSATION DEG RA 0 7
(This section need not be completed if the per is for oA hentl ❑ 'y10 or
less).
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.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
h.ereby affirm that I am exempt from the Contractor's License Law for the
owing reason (Section 7031.5 Business and Professional Code: Any city or
my which reaulres a Dermlt to construct. alter, improve, demolish or repah
�'\:be7efrom antl ,the basis for the alleged exemption. Any viola ion of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty 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 (Section 7044, Business and Professional Code: The Contractor's
License law does not apply to an owner of a properly who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
sale. If, however, the building or Improveent Is sold within one year of com-
pletion, the owner will have the Bm
urchin of proving he/she did not build or Im-
rove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of properly who
builds or Improves thereon. and who contracts for such oroiects with a con-
tra Ctor(S) license pursuant to the Contractor's License Law). I am aware that
pr, f of their Worker's Compensation Insurance Should be provided to me.
❑ `(-am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and State that the above
Information Is correct. I agree to comply with all city and county ordinances
and stale laws a Ing [o bul.tling construction, and hereby authorize repre-
sentatives 0 s i l0 er upon the above-mentioned property for
Signature Date /
Drivers' License or SS 9f
,
within heavy border lines and sign all appropriate declarations.
TACT NO. I LOT NO. I UNIT N0.
TYPE OF CONSTRUCTION L1 NEW LJ ADD
ElCONVERSION ElDEMOLISH 1:1OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATION LJ REPAIR
TYPE OF PERMIT _ LI GRADING LI FOUNDATION LJ STRUCTURAL
❑ TENANT/art: ELECTRICAL -1 GRADING
1-1 MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION $
ZONE GRADINGCU.YDS. ACRES
Remarks: L7 . rs-s .r ,s 11-...k�� / ..� ./��.. 1^%M �T
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P -Trap
Roof Drains
Reinspection Fee
Boiler
Duct - Under Ground
Duct - Structural
$15
Exhaust System LJ Multiple
Firepl/Fact. Bit. ICBG 4
Heating System & Ducting
00100,000 BTU 11100,000,000
Reinspection Fee 1 $15
0865-46, rev. 5/88 White - Building; Canary - Ape llwnt; Pink - Accounting; Goldenrod - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type I ElCanopy Type 11 El
Refrigeration System
00-100,0008TU 0100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
P. qW
A.
S Main Buildi
E
T Front
B Rear
A
C Right
K
Left
Ping. Ref. dl+
Planning Notes:
Zone
N
I
N
G
R
Seq./Provided E
D
M
T
S.
$ 3
01 00020922-00020028 TraT ZZ. 150
DATE: 11/21/88 TI11E: 04:11
ELECTRICAL
FEES
FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50+KIN
Cooking Unit
Meter up to 100 amps
n
Dishwasher
Meter Dover 100amps
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors E30-1 HP ❑1%-B
F.A.U.
Inc.Solar 1:19.15 HP 016-15+
•
Fixtures
Microwave
Device Boxes
Pole Light
Outlets
Range
Switches
Sign
Garbage Disposal
Standing Sections
Generator 005 KW 135-15 KW
Trash Compactor
Reinspection Fee
$15
Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
Application Issued By Data
LJV
$ 3
FEES
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$
$
$
$
$
$
$
$
OF FEES
SMIP - $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
TOTALFEE $
$ 3
01 00020922-00020028 TraT ZZ. 150
DATE: 11/21/88 TI11E: 04:11
'CONSTRUCTION AND PLANI
• APPROVALS Permit # �i
.•
Date
Inspector
& SPA
APPROVALS .,ermit =I#
[lisle .
Inspector
i
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe Undrgrnd. ",
-
53. Steel Reinforcement,
-
3., I£ ctrical CondurtlUfility-Undrgrnd
54. Forms
4. 'FIectr;caliConduii Ugdrgrnd.
55. Electrical Bonding
�S. Steel Reinforcement 1 I
56. Rough Plumbing & Pressure Test
'
ElectricalUFER;Grridr
57. APPROVAL TO COVER-GUNITE
7.; Footings •;`�
I
58. Electrical Conduit-Undrgrnd.
t-
8.' Foundation i
`•'
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
;. - 4
60. Backwash Lines, P•Trap, ❑ Undrgrnd.
10. Structural Floor Systfm
'I
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12' Sewer,Cap :.' ")
63. Heater & Vent -Final
13.,Roof.Drains
� '
'•
,
64. Plumbing System -Final
14. Rough Plumbing'-.
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17., Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
' 19! Rough Heating & Air Con itioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20'. 'Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas []Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing -
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & 4 onocoat
75. Dry Chemical
27. Frame and -Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing r
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat '
7 FINAL INSPECTION
32. Electrical Power Meter -Final
�y
FOOD CERTIFICATE ISSUED
33. Final Electricotes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
'
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
,
J
6418 -FEE RECEIVED
COST
A
MESA BUILDING DEPARTMENTP, 0 BOX 317
COSTA MESA CALIFORNIA•
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
e^^eDING �,•jC _ Ass�dJ1J'Yl.A �.2s 7 /n �.. BUILDING
\
COSTA MESA. CALIFORNIA '• -
FOR OFFICE USE ONLY
RECEIPT NO.
PERMIT N�
OWNER
, jN
S
MAIL
RECEIVED BY
DATE RECEIVLD.1
DATE ISSUED(
-11
ADDRESS
/ /J
�- TNO
CITY'
/_S{//�
ADDREISS
ARCHITECT"uC?,•
OR ENGINEER
NO.'
COSTA MESA, CALIFORNIA
FIRE
ADDRESS
20NE
[
O/e
NO. OF
TYPE GROUP
CITY LIC.
��� `
�7
PLANS
CONTRACTOR
�- G�/{/ " NO
�/ /�/
i
.TEL. I
APPROVED
ADDRESS
NO,
BY DATE
LEG"L
�/
�—
CRRECTIONS
O
DESCRIPTION
DE
BLOCK
TR
A.P. NO.
0 O /
SIZE
NO. OF 9L.G5.
OF LOT
/y
�Soc D NOW ON LOT I
USE OF
U I�
EXISTING BLDG.
N
SETBAC. LINE FRG I
{ CITY Or `STA MESA
CENTER OF STREET
REAR YARD
�—
SUBJECT TO BLDG. DEPT. REG.
SIDE YARD �-RIGHT
LEFTS'
DESCRIPTION
OF WORK
BY O= L
NEW
ALTERATION
ADDITION
PLAN TcC
REPAIR
I MOVING
-
DEMOLISH
BUILDING
NO.OF
'
SIZE
ROOMS STORIES
EXTERIOR WALL
ROOF
COVERING \.•
_COVERING
USE OF NEW
BUILDING
1E V CN
LE HAT I HA E EAD THIS LICATION AND
STATE TH T THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL
CITYORDINANCES
AND $T TE lA W$ REGULATING BU ILOING CONSTRUC
.,
TION.VALUATION
PERMIT FEE IS
SIGNATURE OF
PERMITTEE
PLAN CHECK S
TOTAL FEE $c-'2 o
AUTHORIZED AGENT
��"_•
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