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Home My WebLink About3333 BEAR ST - Building Permits (112)Job Address: Suite No Viciniry: 3333 BEAR ST 3RD LEVEL, NORTH END Parcel Number: 41249208 Applicant: GEOFFREY JUWONO Address: Owner: Address: Contractor: Address: MECHANICAL PERMIT Phone: 562-944-6341 Zip: SOUTH COAST PLAZA %FEDERATED WESTERN PROP DIVISION ACCOUNTING DEPT CINCINNATI. OH 7 W SEVENTH ST 17TH FL JUWONO,GEOFFREY Phone: Zip: 45202-2424 Phone: Zip: License:198827 Status: ISSUED Applied: O6/04/2004 Issued: 06/08/2004 ISSUED BY: � SCOPE OF PERMIT ADD 5 AIR CONDITIONING DIFFUSERS TO EXISTING SYSTEM FOR "CRYSTAL COURT' LOCATED ON 3RD LEVEL, NORTH END. . . ISSUE FEE Inst FAU <700 k BTU Insl FAU >100 k BTU Repair I Alt Cooling/Heat Inst / Rep. Recess Wall HU Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan I Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers � t0000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspend Heater $23.50 $0.00 30.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 30.00 $0.00 $0.00 $0.00 $0.00 50.00 Quantity 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair I Alt Refrigeration Unit Ventillalion System Evaporative Cooler Commercial I n ci ne rator Domeslic Incinerator Compressors / Absorptian Systems Upto3hp/100kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee ReinspecGon Fee TOTAL CALCULATED FEES Quantity 30.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 ao.00 0 $0.00 0 $0.00 0 $0.00 0 ao.00 0 E0.00 $49.50 50.00 E86.70 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 voitl if work is not commenced wiihin 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply wiih all applicable codes, and all required Inspectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aaa+e la�ao� D_ECLARATi�-ONS WORKERS' COMPENSATION DECLAFiATON: I hereby effirm unCer penalry af perjury one oi tha lollowing tleUarations: ❑ I have end will maintein e ceniticete oi wnsent to selt-Insure tor wwkers' campensatlon, es provided tor by sedion 3700 oi the Labor Code, tor Iha peAortnance ot the work tw w�kh IN5 permll I5 issued. �1 heve entl will meNtein wwkers' compensetlon insurence, es required by section 3700 at Ne Lebor Cotle, for ihe pertormance ot Ihe work tw whkh Ihis permit is luued, My workers' compensation Insurence carrier and policy number era: %�'l�E�lZ S aor" I/7�cTu6 Z395L<j233o3 Certier. ¢y Number: lTtiLa.socei8n nead not be cwnnlefea ll fhe nerm/f is valuetl et one hundretl tlWlars fS100) or IessJ ❑ I cenily thet in Ue peAormence o1 the wark tor wnich thls pertnit is issued, I shell rrot employ any person in eny manner so es to become sub�ect to the workers' compensetlan �ews of Celllomla, enE egree thet II I ahoulA become sub�ect to t�e vrorkers' compensetlon provlsions of Sectlan 3700 of t�e Lebor Code, I shell torthwith compty wit� t�esa pmvisions � I� /U � App1lCe�peture:---�--_ � !'Deta:— WARNINCi: FAILURE TO SEGURE WORKERS' COMPENSATION COVEM�E IS UNLAWFUL M1D SNALL SUBJECf AN EMPLOVER TO CRIMINAL PENALiIES AND CMl FlNES UP TO ONE HUNDRED TMOUSAND DOLLARE R��•�I• IN A�DITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIUED WR IN SEGTION 3]OB OF THE IABOfi CODE, IMEREST, AND RiTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I em Iicensed underprovisiorys oi Chapter 9(cwnmencing wlth Sectlon 7000) of Dlvlslon 3 of Iha Business and Protessions Code, enA my license is in full CONSTRUC710N LENDING AGENCY: ❑ I horeby ettirtn ltiet there is e canstruction lending agency tor Ihe peAormance of Ihe work tor whic� ihis permil is issued. (Sec. 30W, Civil Codo). Londer's Neme: Lendots Atltlross: SigneWre: Date: OWNER•BUILDER DECLAfiATIONS: I hereby flillrm t�et unAer penalry ot per�ury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW ior ihe following reason (Sec. 7031.5, Buslness end Prolessions Code: My dry w counry which requires e pertnit to tonstrutt, elter, Improve, demolis�, a repelr eny structure, pnor to Its issuance, also requlres t�e epplicant for such pertnit ro lila e signetl statement t�et ne or she is Ilcensetl pursuant lo the provisbns at the Contrectors Llcanse Lew (Chapter B(commendng with Section 7000) 01 DlNslon 3 0l the Business end Protessions Cotle) or t�at he or she is exempt therelrom end the hesis lor t�o elleped exemption. Any videtion of Section 7031.5 Ey eny epplicanl lor e pertnit sub�ects the epplicem to a dvil penalry of not more t�an tive hundred ddlars (5500).): ❑ 1, as owner ot t�e properry, or my employees with wages es thair sole compensatlon, WILL DO THE WORK, and ihe structure Is not intentleA or oilered tor sala (Sec. 7044, Business end Pmfessions Code: The Contractors License Law does not eppty Io an owner ot properry who bullds or improves Iheraon, and w�o tloes such work himself or hersell or through �Is or �er own employaes, provided ihat such Imprrnaments ere not intentletl or oNeretl for sale. If, however, Ne builtling or improvement is soltl within one year of completion, the owner-builtler will have the burtlen oi proving that he or she ditl not build or impmve for puryose of sale.�. � ❑ I, as owner ot the praperty, am E%CLUSIVELY CON7AAGTNG WfTH IICENSED CONTRACTORS to construa ihe project (Sec. 7044, Business entl Professions Cotle: Tha coniractors Ucense Lew does not apPly to an ownar of property who bulltls or Improves thereon, end who contracts for such project wlih e contrector(5) license pursuant lo the Contractora lJcense Laws.). ❑ I em exempt undor sec. Businass end Prolosslons CoOe for Ihls roeson: Signature: Date: Ownef ID ve�itietl by dr��ar'b IlcenSe. ❑ Yes ❑ NO Dnver'9 LiCen90 N0. Expires: Vorllication at Ownership by (type ol tlocument, i.e. - property tax blll or deetl�: DIVISION OF INDUSTRIAL SAFETV PEflMiT CERTIFICATON: ❑ I hereby certity Nat no excevetion live (5) or more feet in tlepth into which e person is requlratl to tlescentl, will be matle in connection wlth work euthorizetl Dy this pertnit, an0 that no building slrudure, scaMoltling, talsawork, or demditlon or tllsmantling t�ereol. will Oe more then Ihirry-siz (36) feet high. (C�ep. 32, Grp 2, An 2, Soc. 341, Tltle B, Calitomla Atlministretive Cade). ❑ As ownor�Duilder, I will not employ enyone to do work which would requlra e permit Irom the DMsion o1 Industrfel Sefery, es notetl ebove, unless such percon �es e permit to do such work Irom tha divlslon. SignaWre: Date: Division of IiWustrial Safery Permil Number: ICEHTIFlGATE OF COMPLJANCE AND AUTHORVA710N OF ENTRY: I certify under penelry of porjury thet I heve read Ihis apD��ion entl state t�at the inlormation givon is I correct. I agree to Comply wilh ell stete lews end city orCinances relating to bulltlinp construGion, and eu�hodzo reDresentetives of ihe Ciry of Casta Mese to enter upon Ihe ebove-doscribed pmpelty tor inspoction puryoses. I egree not to occupy or ellow occupancy ot eny building eNhodzed by Ihis pertnit until finel inspection. _ Signeture Oi Legnl Owner(s) COOE 1. INSPECTIONTYPE 1676 Fixetl System Final Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Root 201 Finel Block/Fletaining Well 202 Final Fectory Fire Place 203 Finel Sign 20a Finel Demdition �g �� ate ��f- _ (_Dat ' yODE� INSVECTIONTYPE 206 Finel Mechanical 208 Final Plum6ing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planning Appraval 222 Finel Site 250 Finel Bullding/Ottupenq � (714)754•5273 • Fex(714)754-4856 Job Address: 3333 BEAR ST Suite: 3 Vicinity: 3RD FLOOR Parcel Nunmber: 41249205 Appliwnt: EMMA KLEYMAN Address: CITY OF COSTA MESA . BUILDIN6 DIVISION DEVELOPMENT SERVICES OEPARTMENT PERMIT FIRE SUPRESSION PERMIT Owner: SOUTH COAST PLAZA Address °hCARTER HAWLEY HALE STORE 3880 N MISSION RD PROPERTY-T/UC DEPT Zoning: Phone: (714)874-8770 Zip: Contractor. G.F.P., INC DBA: GARVIN FIRE Address: 501 W SOUTHERN AV OR4NGE CA Phone: Zip: 90031 Phone: 714-974-8770 Zip: 92665 License: 702554 SCOPE OF PERMIT 235 FIRE SPRINKLER HEADS FOR 3RD FLOOR (NORTH END). RE:898-02180. FEE SUMMARY Plan Check: $186.71 Permit: $287.25 Other: $0.00 Total: $473.96 NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 03/12/1999 Issued: 04 28/1999 ISSUED BY: _ Calc Valuation: szo,000.00 Claimed Valuation: Szo,000.00 NOTICE: The work aulhorized by this permit shall comply with all epplicable handicap access requirements under Califomie statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall aulomatically expire end become void if work is not commenced within 180 days, or if work is suspendad or abandoned for e period of 180 days. INSPECTIONS: In order for the work authorized under this permit ta be considered legel, such work must comply with all epplicable codes, and all required Inapectlone end finel epproval must be obtained. Feilure to obtain inspections and final epproval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSA710N DECLAqAT10N: � . I hereby efllrtn untler penelry of per�ury one of t�e lollowing 4eGaratlons: - ❑ I heve antl wlll melntein e certifcate ot consent to selt-Insure tor workers' comperisation, es proNded tor by secUon 3700 of Ihe Lsbor COde, for Ne pertormance of the work for which this pertnit Ls iswed. ❑ I heve ar�d wm melnte�n workers' cqmpensatirn insurence. es required Dy section 3700 of Me Lebor CoGe. fw the pertarmence of the work far vMlc� tNs pertnit Is issued. My wq� rs' compensation Insuranc¢ carrler tl pdky numbar eren� , �j carr�er. �4 'ht PR�cCI.t.c.. C R.i �O OF .PoLf d /lGo �f� PonqNumoer. �G �06 / � 404Q�3 (lh/s aection need nol Oe mmpleted if Me permltls ve/u e! one huntlred d rs(Sf 00) or less.) ❑ I ceNty t�at in Ihe peAortnence ot the work tor w�ich t�is permit is Lxaue4 I shall not employ eny person in any manner so es to become aub�ea to the workers' compensetlon laws oi CeliloMa, entl a8ree that If I shoultl Decome suD�ect to the workers' compensetion proNsions ot SecUon 3700 ot the ISDor Cotle, 1 shell lorthwith comDN �+'�th t�ese proNsions. � � D , , ��Q�� Date: �' Z 7 , �� Ap0licant Signeture: L�Cs1 WARNING: FAILURE TO SEWRE WOfO(ERS' �..1PENSATION MOc IS UMAWFUL AND SHML SUBJECT PN EMPLOVEF TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TiKK1SAN0 DOLIAFE (S� W.OW),IN ADDRIQV Tb THE 00570F WMPENSATION, DAMAGES AS PROVIDED FOR IN SEGTfQV 3]W OFTNE NBOR CODE, IMEREST, AND AT70itNEY'S FEES. LICENSED CONTFiACTORS DECLAHqT10N: I hereby eHirtn t�at I am force en0 eHect. Lic. a_ conirectors slgneture: Chepter 9(commendng wilh Seciion 7000) af Division 3 of ihe Busines�nd PraJesslons Cotle, entl my Iicense Is in tull Cless x ��= �o //J2�2�c— oa�a: Z 7. CONSTRUCTON LENDINO AGENCY: ❑ I hereby eHirtn that there Is e cronstruction lontling egenry lor the peAortnance ol the work lor which this pertnit Is issued. (Sec. 3097, Civil Code). Lendefs Neme: Lentlers Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalry at perJ�ry Ihe� I am EXEMPT FROM THE CON7RACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness enC Prolessions CoCe: My Gry or counry which requires g pertnit to consWct, elter, Improve, demdis�, or repeir eny struCWre, prior to its issuance, elso requires Ihe eppllcant lor such permit to flle e slgneA stefemeni ihal he or she fs Ifcensed pursuent to Ne provisions oi Ne ConlreIXore LJcense Lew (Cheptar 9(commendng wlth Settion 7000) ol OiWslon 3 0( I�e Buslness antl Prolessions Code) or the� he or she is a:empt Iheretrwn end Ihe besis for the allegetl axemption. Any viWeOan ot SecUon 7031.5 by eny appllcaN tor e pertnit sub�ects t�e epplifant to e Gvil penelry of not more then Me �undred tlollers (E500).): ❑ I, as owner of Ihe properry, or my gmployees with wapes es Ihelr sde compenselion. WILL DO 7HE WORK, end ihe slrunure i5 not inlended or oXeretl for sale (Sec. 7044, Buslness end Professions COAe: The Contractors License Lew tloes not apply to en owner ot propeM who builds or improves thereon, and who does such work �Imselt w herselt or through his or her own employees, proNded Ihet sucli Improvemenb ere not Intendad or oflered tor sale. If, however, the building or Improvement is sold wlihin one year of completion, Ihe owner-6uilder will have Ne Durden o1 proNng Ihat �e or she tliC not 6uiltl or improve tor pur{wse of sale.). � I, as owner of the property em EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS ro construct the pro�ect (Sac. 7044, Business end Pwlesslons Cotle: The contrectors Llcense Lew does not eppry to en owner ot O�aPerry who builds or improves thereoq entl who contrec[s for such pro�ect with e contrectoqs) Ilcense pursuaN to Ihe Contrectors Licensa Lews.). ❑ I em exempt under aec. 6usiness and Proleuions Catle for this reason: SigneWre: Deta: Owner ID veAfletl by drivefs license. ❑ Ves ❑ No Drivors LJcanse No. Verificatlon of Ownership by (rype oi documenl, I.e. - property tax bill or deed): Evplres: DIVISION OF INDUSTRIAL SAFE7Y VPRMIT LERTIFICATION: ❑ I �ere0y certlly the� no excaveNon live (5) or more leat In tlepth inlo which e peraon is requlrad to descenQ will be made In connection wlth work euthodzotl by t�is porm7t. end thet rro bullCirtg stnecture, aceRolding, fe7sewark, or demolttbn or tltsmantllnp thereot, wtll De more then thirry-aix I�) �ee! �IBh, (Chep. 32, Grp 2, Art 2, Sec. 341, Tille e, Celitomia Administratlye Code). ❑ As owneo-builtler, I wltl not employ anyone to do work which would requlre e pertnil trom the Dldsion ol Industdel Safary, es notetl eDove, unless such person hes e permit to do such work irom tha diVlsion. � Signature: Date: Dlvisfon of Industdal Safery Pertnit Number. CERTIFlCATE OF COMPLI/WCE AND AU7HORQATON OF EHTAV: I tertlty untler penalry ot per�ury lhat I heve reatl I�is appllcatlon and state Ihat Ihe Inlarmetion given is conect. 1 egrae to compy with ell stete lews and ciry ordinances relating to Dulltling mnsirucUon, end authorize representetives of the Ciry oi Costa Mese lo enter upon the ebovadescrlDed property for inspection purposes. I egree not ta occupy or allow oau0anry al eny bulldinp euthoAzed by Ihis pertnit untll Ilnal InspecUon. �� I n Wre Ot epel Owner(s) � Z� �� n r � %� 1 i � �1 dOr Authonzed AppliCant Dete COpE �, INSPECTIONTYPE Qd¢ 1818 Fixed System Final Fire Preveqtion -�� kk 1266 200 201 202 Pool Spe Flnal Final Re-Roof Flnal BIocWRetalning Wall Flnal Fectory Fire Place 203 FinelSign 204 Final Dem zsae-se � � COOEt INSVECiIONTYPE � 206 Final MeC�eniwl 208 Final Plumbing 210 Final Eleancal 212 Final Fire Prevention 220 Finel Plenning Aoprovel 222 Flnel Site 250 Flnal Bullding/Occupan[ QLffi Iti�65 (714) 754-5273 • Fax (714) 754-4856 Job Address: Suite: Vicinity: CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT FIRE SUPRESSION PERMIT 3333 BEAR ST 3 NORTH END OF THIRD FLOOR Parcel Nunmber: 41249205 npp�icant: SAMUDIO, SUE Address: Owner: SOUTH COAST PLAZA Address %CARTER HAWLEY HALE STORE 3880 N MISSION RD PROPERTY TAX DEPT Zoning: Phone: (714)974-8770 Zip: Contrador: G.F.P., INC DBA: GARVIN FIRE Address: 501 W SOUTHERN AV ORANGE CA Phone: Zip: 90031 Phone: 714-974-8770 Zip: 92665 License: 702554 -.s PERMIT�IdUMBER � I�F99-00082 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/1 211 9 9 9 Issued: OS/18I7999 ISSUED BY: _� SCOPE OF PERMIT 708 FIRE SPRINKLER HEADS FOR THE "SOUTH END" OF THE THIRD FLOOR. RE:898-02180. FEE SUMMARY Plan Check: $462.96 Permit: $712.25 Other: $0.00 Total: $1,175.21 Calc Valuation: s�t,aoo.00 Claimed Valuation: s�i,eoo.00 NOTICE: The work authorized by this pertnit shall comply with all eppliceble handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if xrork is not commenced within 180 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all required Inapeetione end finel approvel must be obtained. Feilure to obtain inspections and final epproval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WOqKERS'COMPENSAnON DECLARATON: — I hereby flBirtn under penalry of perjury one of Ihe following dedaratlons: � I heve and will maintain a certHicate of consent ro self-Insure for workers' compensetlon, as provided br by sectlon 3700 of Ne LeDor Cotle, for �he pertortnence of Ne work for wNch t�is pertnit Is Issued. 1 have end will mainlain workers' canpensatbn insurence. fls repulretl by se�tan 3700 0l tha Lebor Coda, fa Ure pertormance of Ne wwk fw whkh Mis permit is L�s'we/d. My wo rs' compensation Insurance ceyier end policy number ere: �, C � �6 � 9j�pSy� . Cerr(er: �/LiC �0.�% ��45 • Gd � Poficy Number: �L (Th15 sedion need no! be wmpleted ll the permi( ls velued et one hundred dW/ars ($7 or less.) ❑ I cerlity that in the pertortnance ol the work tor which ihis pertnit is Issued, 1 shall not e loy any person in eny menner so es to becwne sub�ect to the workers' compensetlon laws of Califwnie, entl agree Ihet It I should becnme sub�ed to the worke compensetion provisions ot Senlon 3700 of the Labor Cotle, I shall forthwl(h comptywilhthese visions. j n q � App�icant Signa 1 Date: S6� �� W�NIN�: FAILURE TO SE RE WOfU(ERS' COMPENSATON COVERA(3E IS UNUW FUL AND SMALL SUBJEGf AN EMPLOVER TO CRIMINAL PENN.TES M!D qVIL FlNES UP TO ONE HUNDqED T/i0U5FND DOLLME (5100,000�, IN PDDfTION TO THE CW^i OF G�OMPENSATION, UAAIFGES AS PROVIDEO FOR IN SEGfION 37060F 7HE LABOR COOE. WiEREST, MID ATTORNEY5 FEES. LICENSED CONTRAC70RS DECLARATION: I hereby etFirm that 1 am licensetl under provislons o hepter 9(commencing with Sectlon 7 0) of Divlslon 3 of the Buslness end fom� entl eXect. Lic. # � � '�'v `�_ � � Class # � _ J Contractols Signatur��— Oata: / Code, ana my Ilcense is In full CONSTRUCTION LENDING AGENCY: ❑ I hereby atfrtn Ihat there is a construction lentling egency for ihe peAortnance of ihe work for which this permit is iuuetl. (Sec. 3097, Civil Code). Lentlers Name: Lendets Address: Signeture: Dete: OWNER-BUILUER DECLARATiONS: I hereby effirtn that under penalry of perjury iha� I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Buslness and Professions Code: Any clry or wunry whlch requires a permit lo constmd, elter, improve, demolish, or repfllr any slrucWre, pnor lo its issuance, fllso requires the eppllcant lor such pertni� to file e signed stetemem Iha� he ar s�e Is licensed pursuent to the provlsions oi Ne Con[reMow LJcense Lew (Chepter 9(commenGng wilh Section 7000) of Division 3 ot ihe Business antl Protesslons Code) or Nat he or she is exempf therefrom antl fhe basis for the ellegeA exemptlon. My violatlan of Sec(ion 7037.5 Oy eny epplicaM (or e pertntl subJects the epplicant to e civil penalry of not more than tive huntlred dollars (5500).): ❑ I, es owner of the properry, or my employees with wages es their sde compensation, WILL DO THE WORK, and the siructure Is not intended or oflered for sale (Sec. 7044, Business entl Professions Code: The Cantrectors License law does not epply to en awner of proDerty who builtls or improves t�ereon, and who tloes such work himself or hersell or through his or her own employees, provided that such improvemenls are not intentled or oftered tor sale. It, however, the buildinp or imprwement is sold within one year of completlon, Ihe owner-bulltler will have lhe burden of proving thet he ar she did not build or imD�ove tor purpase of sale.). ❑ I, es owner of t�e property, am EXCWSIVELY CONTRAC71N0 WITH LICENSED CONTRACTORS to cons[rucl tha project (Sec. 7044, Buslnesa entl Professions Code: The comrectors License Law doas not appty to en owner of proPerty who builtls or improves thereon, end who contracts br such Oro�ect with a conirador(s) Iicense pursuant to ihe Contradors License l.awsJ. ❑ I em exemp� under sec. Business end Professians CodB for this reason: Sl9newre: Date: Owner ID vediietl 6y tldvers license. ❑ Ves ❑ No Driver's License No. F�pires: _ Venlicatlon of Ownerehip by (rype of tlocument, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby caritly Ihef no ezcaVetion fiva (5) or more feet fn depth info whlch e person Is requiretl ro tlescend, will ba mede fn wnnectlon wlth work euthodzed hy this permit, end thet no builtling sWcture, scefloltling, falsework, or tlemolition or tlismen0ing Ihereof, will be more than thirty-siz (38) feet high. (Chep. 32, Cary 2, Art 2, Sec. 341, Title B, CalHomle Adminisirative Code). ❑ As owner-builaer, I will not employ enyone Io tlo work which would require e permit irom ihe Division of Intlustnal Safary, as notetl aDove, unless such person hes a permit to da such work fram the tlivision. Sig�ature: Date: DlNgion of Intlustdel Satey Pertnit Number: CEp71FlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I ceRily under penalry of per�ury that I heve read thls application and stete Ihat the iniormation given is cortect I egree to comDly with all state laws antl dry ordinences relating lo bullding wnstructlon, end euthotlza representaWes of the Ciy ot Costa Mese to enter upon the above-descrlGetl property tor inspection purposes. I agree not to acupy ar allow acupency ol eny building authorized Dy t�is pertnit until finel Inspection. 1616 1266 200 201 202 203 204 �»•o<o INSPECTION TYPE Fixed System Finel Fire Preventian Pool Spe Finel Finel Re-qoof Finel Bixk/Retelning Wall Finel Fectory Fire Place . Flnel Sign Finel Demolitlon � � �� COOE� INSPECTIONTYPE 206 Ftnel Meclienicat 200 Finel Plumbing 210 Final Electricel 212 Finel Flre Prevention 220 FIneI.Plannin8 ApProval 222 Finel Slta 250 Finel BuildinglOccupancy �g �� '•^