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Home My WebLink About3333 BEAR ST - Building Permits (151)CITY OF COSTA MESA � J Development Services, Division of Building and Safet� � CERTIFICATE� OF OCCUPANCY This certificate is issued pursuant to the requirements of the Uniform Building Code, SecHon 308 adopted by the City of Costa Mesa certifies that at the fime of its issuance the building structure herein below described was inspected and approvedforoccupancyasfollows: � Building Address 3333 BeaY St.l;Ste 1 32 � Bldg. Permit'Number BC08-00266 Use Retail Beauty ProAn�ta (�4F� g i+, ) Group M ` Type of Construction 1—A , Fire Zone xxx Use Zone PDC OwnerofBuilding South Coastr Plaza -_: Tenant PURE BEAUTY Address 3315 Faireiew Rd.;,.,Costa-Mesa, CA 926 , BY� BUILDING OFFICIAL-K�"ldrill Q. NgUyell, C.B:�.' ' Date � REQUIRED TO BE POSTED IN A CONSPICUOUS PLACE GTY OF COSTA MESA • BUILDING DIVISION y � 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us �, FOR INSPECTIONS CALL: (7'14) 754-5626 4�� F` PERMIT NUMBER: BX08-00206 PERMITTYPE B MISC STATUS: ISSUED APN: 41249207 v DATE ISSUED: 07/08/2008 Zoning: , � ISSUED BY: �-:, _- JOB ADDRESS: 3333 132 BEAR ST CM ," Suite/Unit: 132 Viclnity: �� '' , Priinary'Occ:' � � � ' Const Type :7? SQ. FT: 0 � ��-.� ` Valualion: ,, $4,500.Od. � �� _ SCOPE OF WORK: DEMOLITION OF SPACE IN PREF.FOR "PURE BEAUTY' STORE TI. RE;BCOS-00266. . r;, .: -' . ' - . � • � OWNER: SOUTH COAST�PLAZA- ��:'� Address: %C J SEGERSTROM & SONS; MESA,CA City/State: 3315 FAIRVIE'W RD ��_ , . Zip Code: .92626 °'�� Ph .. • Unit COSTA one. _ , APPLICANT: STEPHEN�GRUBB �'� r � �� : � Address: - - ' Unit: . . ,.:. � r, , : , City/State: ' � - � � �``-'°� � Zip Code > Phone: 253-709-0973 - �_ - � � ;�� _ �'}. - ,._ - __ - " . CONTRACTOR: HARDESTY AND�ASSOCIATES`INC. - . � � - � � � ' . - "�. License No. �.- 634021 � Address: 1991,VILLAGE�pARKWAY � � �-� � � - . , Unit City/State: ENCINITAS, CA-�� • _ . � - � . . � ZipCode: 92024:: � , "'�'� . ...� Phone' .Z60-944-0499 �, Cell: ARCHITECT: - -- ' �� LicenseNo. ' � Phone �,�� ENGINEER: � " , -,- . License No. ." - , . - Phone � - � `�'�' . . � � ' `� F,EE SUMMARX. �: Building Plan Check: � -� � . _ : $72.31 � " . � ' -� Building Permit �, � � - '.�$111s25 � � � ElectricalPermit: � . '^'.� . �$41.SQ-. • _ �- SMIP Residential ''� , ; ��. $0:00 �. SMIP Commercial ' �"� $0.95 � TOTAL FEES - - . $226.01 '�� ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulalions. (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 wnsidered 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 vrill result in the expiration of this pertnit. c� ixsvecnoNme 1616 Fined System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 202 203 204 Final BIocWRetaining Wall Final Factory Fire Place Final Sign Final Demolition o� ixnnn� cooe� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention � 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy onre ixnnnis WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one ot the following tleclarations: ❑ I have and vnll maintain a certifcate of consent to self-Insure (or vrorkers' compensalion, as provided for by section 3700 of [ha Lahor Code, for the pertortnanca of the vrollc for which ihis pertnit is issued. ❑ I have and will main[ain wnrkers' compensation insu2nce, as requiretl by sectbn 3700 of the Labor Cotle, ta the perfortnance o( lhe work for which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: Owner ID verified by drive, _.�cense. ❑ Yes ❑ No Oriver's License Na. Expires: Verifcation o! Ownership by (type of documant, i.e. - property tax.bill or tleed): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION: �- ❑ I hereby certify that no excava[ion frve (5) w more leet in depth into wfiich a person is required to tlescend, vrill be made in connection with wark authorized �� B �by this pertnit, and that no building strucNre, scaffdding, falsewnrk, a tlemolition Carrier. or dismantling thereof, will be more than thitly-six (36) feet high. (Chap. 32, Grp (This section neetl nof be mmdete�tl the peimrt is valued at one hundretl aollars (St00) orless.j I�/ �1 2, AA 2, Sea 341, Title 8, Califomia Administ2tive Code). PolicyNumber: W�� 300JOU 9.�'dVO� / ❑ As ovmer-builtler, I will not employ anyone to do vrork which vrould �❑ I certify lhat in the peAormance of ihe vrork for which this permit is �equire a pertnit fmm the Division of Industrial Sa(ety, as noted above, unless issued, I shall not employ any person in any manner so as lo become subject such person has a permit lo do such work (rom the division. to [he vrorkers' compensation laws ot Cali(ornia, antl agree that iF I should 6ecome subject to Ihe vrorkers' compensa[ion provisions ot Sec[ion 3700 of qppi,�„��s S�9nature oaie [he Labor Code, I shall forthwi�h comply with [hese pmvisions. l.,t M,,,,, / 7� �- � y rvision of Indusfial Sa(ety Permi[ Number: �{.-� CLQ6YL Aoolir n(a Simatura n�m WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL 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, IMEREST, AND ATTORNEY'S FEES. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or presenl or fu[ure building occupant need [o file and cerlify a Business Plan for emergency response lo release or threatened release ot a hazardous material? ❑ Yes ❑ No (Section 25505 of ihe California Heal[h antl Safety Code requires, with some exceptions, that a Business Plan be fled with the Costa Mesa Fire Depariment by every business which has at any one time dunng a reported year a quantity o( hazardous matenals equal ro or greater than a weigh[ of . LICENSED CONTRACTORS DECLARATION: S00 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby aKrm that I am licensed under provisions o( Chapter 9(commencing at standard temperature antl pressure). with Section 7000) of Division 3 of �he Business and Pmfessions Code, and p Does or will the applicant or present or future builtling ocwpanl need to fle my license is in tull force and eRecl. � p �registration form (or acutely hazardous materials? ❑ Ves ❑ No � Lic. # 6.3k Di � .�Class # J (Section 25533 of the Cali(omia Health and Safery Cotle, with some �,( � exceD�ions, requires registration wilh the Costa Mesa Fire Department Dy � �(L/Uu� /7—�'01� each business which at an one'time has on hand a Conlroclor'sSignaNre oa�e hazardous matenals equal lo or greater than a weight oQ500�Ipo nrdscoe1a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm tha[ there is a construction lending agency for ihe pertortnance of the wvrk for which this permit is issued. (Sec. 3097, Civil Code). Lender s Name: Lender's Address: [emperature antl pressure). 3. Does or will the applicant or present or future builtling occupan[ need [o prepare an RMPP (Risk Management and Preven[ion Program for acutely hazardous matenals)? ❑ Ves ❑ No (Section 25534 of the Cali(omia Health and Safety CoOe provides that the Costa Mesa Fire Department may require lhe preparation, certifcation and fling with Ihe Fire Department of an RMPP by businesses which are required to register acu[ely hazardous ma[erials wi[h [he Fire Department. Date 4. If an RMPP is presently required, has Section 25534 0( the Califomia OWNER-BUILDER DECLARATIONS: Health antl Safery Code been fully complied with? ❑ Yes ❑ No I hereby affirm that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construcl, alter, impmve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statemen[ that he or she is licensetl pursuant b the Drovisions of the ConUactors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business an0 Professions Code) or Ihat he or she is exempt theiefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applican[ !or a permil subjects the applicant to a civil penalty o( no[ more than fve huntlred tlollars ($500).): ❑ I, as owner o( the property, or my employees with wdges as their sole compensation, WILL DO THE WORK, and the structure is not intended or oHered tor sale (Sec. 7044, Business and Professions Code: 7he Coniractors License Law dces not apply to an owner of properry who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, provided that such improvements are not intendetl or oflered for sale. If, however, the huildinq or improvement is sold within one year of completioq the owneo-builder will have the burden of proving that he or she ditl,not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe prqect (Sec. 7044, Business and Professbns Code: The contractas License Law dces not apply [o an owner of property who builtls orimproves thereon, and who contracts for such project with a cont2ctw(s) license pursuant to the Contractws License Laws.). ❑ I am exempt under sec. Business and Professions Cotle for this reason: 5. Does or will the applicant or present or fuWre building occupant require for lhe vrork which is the subjecl o/ Ihis application a permit for such wns�ruction or modifcation from the South Coast Air Quality Managemenl DisUict or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 658502 of Ihe Cali(omia Govemment Code requires that �he requestetl infortnation be tumished on applications fa rron-residential building permits). 6. Will any part of the facility to be cons�ructed under this permi[ be within 1000 feet from the ou[er boundaries o( a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of [he California Health and Safery Code). 7. If a permit trom the South Coast Air Quality Management Districl or other air polNtion contml disMct or agency is required for Ihe work which is the subject of this appliwtion, have all ot the disclosures prescribed by Califomia Health antl Safety Code Section 42303 been matle? ❑ Yes ❑ No 8. (If'yes", atlach certificate of compliance from Ihe appropriate air pollution controloKcer). � ' � � �� ' � CERTIFICATE OF COMPLIANCE: I cerlify that under penalty�o( perjury the informalion given above is cortecL I agree to comply with all state lavrs and ciry ordinances regardinq Hazardous Materials and Emissions. � . Da1e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury tha[ I have reatl this application and state that the information given is correct I agree [o comply wi[h all state laws and city ordinances relating to builtling construction, and authorize representatives of the Ciry o� Costa Mesa to enter upon the above-descdbed property tor inspection purposes. I aqree not to occupy or allow occupancy of any building authorized by this permit until final inspection. . � � SignaWreo(LeBalOwner�s) / Dale Signalure Da�e . J051�46 (3/0]) AnE/o�Aul�onzCtlApO�ican� D21e � � � CITY OF COSTA MESA � BYILDIN6 DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us, FOR INSPECTIONS CALL: (714) 754-5626 � . PERMIT NUMBER: BC08-00266 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 07/17/2008 "`. .. ISSUED BY: RMD �oe nooaess: 3333 132 BEAR ST'CM "'` ''' ; Suite/Umt,'� ..132 APN: 41249207 -_ ,:. `ZOning: ', , � . .. . , .. Vicinity: 132 � ' _ .. � � ` Primary Occ: M�'�� ConstType: I-A '' ".' SQ: F.T:_-�` 1462 , Valuetion: $80,000.00 SCOPE OF WORK: 1,462 SF INTERIOR T.I: �FOR "PUREBEAUTY", SUITE 132 WITH 1 REPAIR/ALTER'HEATING/COOLING, 1 VAV BOX, 1 VENT FAN, 75 LIGHT FIXTS, 26 OUTLETS, 10 SWITCHES, 1 IAUNDRY TUBNVASHER, 1 SINK; 1 WASH BASIN, 1 WATER PIPING, 1 WATER CLOSET. - _ ; __�'�- � �- � _ ' ' . � ty OWNER: SOUTH COAST PLAZA,";.� J_ � -, Addrees: �0/,C J SEGERSTROM 8 SONS , � : Unit: COSTA MESA, CA . ,. _ - � . . . . . . Phone: �-� . . 'dJ..• -- City/State/Zip: 3315 FAIRVIEW RD _ -' - . . - - .. . _ '.i^. � . . . APPLICANT: GRUBB, STEPHEN - Address: � � �_ . , � - �1 Unit: : � Phone: 253-709-0973 . � � City%State/zZip:�� • � " cON7RnC70R: HARDESTY AND ASSOCIATES INC . License No. 634021 �'� � Phone: 949-735-2230` "Address'�; SOO�E�BALBOABLVDUoit: �� i��,� � � CeIL ` � �- � City/State.' NEWPORT-BEACH,CA � ��r,�ZipCode, 92065 � '' �, . � - r,: ARCHITECT: PHILIP BROUSSARD, '� License No.C23248 �� PHONE:�� ENGINEER: . License�No. �� ' � �PHONE: COMBINTATION PERMIT FEE SUMMARY Building Plan Check: $13874 `- � Building Fees: � . ".;- $853.75 . ' � . . ' �- - � , Electrical Fees: -� , $123.03' :'-.,- ;,;: Mechanical Fees: � ��` -`�: $55 10 ., . � _ - _ ,- r �' � Plumbing Fees: �- -.=,y$72:50- ��%' . � ,_ ' _ � " � SMIP Residential: _.,:$0:00 " SMIP Commercial: $16i80" � • � �� - . TOTAL FEES: $1,259.92 "Refer to fee receipts for all fees paltl for project ' NOTICE: The work authoriZed by this pertnit shall comply with all applicable handicap access requirements under Califomia staWtes 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 flnal approval must be obtained. Failure to obtain inspeclions and final approval vrill result in ihe expiraUon of this permit. WpEt. IMSGECiIONTYPE 1L1� IM1fML CiQ.Q%.j INSPECTIONTYPE Q�T� 1f111 1676 Fixed Systam Final Fire Prevention 208 Final Mechanical - `� 1266 Pool Spa Final 208 Final Plumbing P/� " � � 200 Final Ro-Root _ 210 Final Elettrical 201 Final Block/ReWining Wall 212 Final Fire Prevenli0n 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Dertwlition 250 Final Building�OccuOancy P/� � �� WORKERS' COMPENSATION DECLARATION:�� I hereby alfirm unCer penalty oi perjury one of the following declarations:. ❑ 1 have and vrill maintain a certifiwte of wnsent to seH-Insure for vrorkers' wmpensation, as provided tor by section 3700 0( the Labor Code. for the peAortnanCe of Ihe wOrk fOr wfiith thi9 pertnit i5 i55ued. ❑ I have and will maintain workers' compensation insurance; as requiretl 6y section 3700 of lhe Labor Code, fw Ihe peAortnance of lhe work for which Ihis pertnit is issued. My workers' compensation Insurance carrier and policy number are:/' �7 A nT Carrier: �9l��/t�.� l I Q � �/� � (Thksact neetlrptbe/7 mnpleietlil�hepermAureluetlalmehuntl�e0dalars(5�00)wless.J 'Policy Number: /J � i S H � 9/ 9 U U ❑ I certify Nat in the peAormance 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 Califomia, and agree that if I should become subject [o the vrorkers' compensation provisions of Seclion 3700 of the Labor Code, I shall forthvrith comply wilh ihese provisions. �r� -�,� 7- /7- aa Applrcams �gnaWre ; Dale 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 DOLLAF2S ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensetl untler provisions of Chapter 9(wmmencing wi[h Section 7000) of Division 3 of the Business and Professions Code, and my license is 7in Lfull force and eflect. �;Lic..# - G J 7 �id � Class # a ,/.�.vn .,�%NiU )- /i'bs' �� - Conlroctor's SignaWre ,� Da�e CONSTRUCTION LENDING AGENCY: ❑ I herehy affum �hat Ihere is a construclion lending agency (a lhe perfamance of lhe work ftt wfiich Utis pertni[ is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby aNirm that under penalty of perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the followin9 reason (Sec. 7037.5. Business antl Pro(essions Code: Any city or county which requires a pertnit lo wnstruct, aller, improve, demolish, or repair any siructure, prior to its issuance, also requires the applicant for such permil lo fle a signed stalement lhal he or she is licensetl pursuant to lhe provisions of ihe Contractors License Law (Chapter 9(wmmencing wiN Section 7000) of Division 3 of the Business and Professions CoCe) or that he or she is exempt Iherefrom and the basis for the alleqeC exemption. Any violation of Section 7031.5 by any applicant for a permit subjec�s Ihe applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, as ovmer of the property, or my employees with wages as their sole compensation, WI�L DO THE WORK, and lhe structure is not intended or oftered for 5ale (Sec. 7044, Business and Pro(essions Code: The Conlractors 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 ovm employees, provided Ihat such improvements are not intended or oflered for sale. If, however, the building or improvement is sold within one year of wmpletion, the ovmer-builtler will have the burtlen of proving Nat he or s�e did not build or improve for purpose of sale.). ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS ro construct the prqect (Sec. 7044, Business and Professbns Cotle: Tl�e contractors License Law dces not apply to an rnvner ot property who builds or improves thereon, and who contracts for such project with a caniracta(s) license pursuant �o the Contraclors License Laws.). ❑ I am exempt untler sec. Business and Protessions Code for lhis reason: SiB��ure ]OSI�a6 (10]) � Owner ID verified by driv�. .ense. ❑ Yes ❑ No Driver's License No. Expires: Ve�cation of Ownership by (rype of document, i.e. - property lax bill or deed): DIVISION OF INUUSTRIAL SAFEN PERMI7 CERTIFICATION: ❑ I hereby certdy Ihal no excavation frve (5) or more fee[ in tleplh into wfiich a person is requiretl to tlescentl, will be made in connection with work authonzed by Ihis permit, antl ihat no building structure, scaffdtling, falsew�rk, a demolition or dismantling Ihereol, will be more than thirty-six (36) fee� high (Chap. 32, Grp 2, fVt 2, Sec. 311, Ttle 8, Cali(omia Adminis[rative Code). ❑ As ovmer-builder. I will not employ anyone to do vrork which would require a permit trom the Division of Industrial Safety, as noted above, unless such person has a permit to do such work trom the division. Appliwnl's Signalure Division of Intlustrial Safety Pertnit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or fuWre building occupant need to file and certify a Business Plan for emergency response lo release or l�reatened release of a hazartlous matenal? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safery Code requires, with some exceptions, that a Business Plan be filed with the Cosla Mesa Fire DepaAment by every business which has at any one time during a reported year a quantity o( hazardous matedals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard temperature and pressure�. 2. Dces or will ihe applicanl or present or (uWre builtling occupant neetl [o file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 0( the Califomia Health and Safety Code, wilh some exceptions, requires registration vnth the Cosla Mesa Fire Department by each business which at any one time has on hand a quantiry of awtely hazardous materials equal to or grealer than a weighl of 500 pountls, or a volume of 55 gallons, or 200 cubic teet o( compressed gas at standard IemperaNre and pressure). 3. Dces or will the appliwN or present or fuWre building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of lhe Califomia Health and Safely CoOe provides [hat the Costa Mesa Fire Department may require the preparation, certification and filing vnth the Fire Department of an RMPP by businesses which are required [o regisler awtely hazartlous materials with the Fire Department. 4. I/ an RMPP is presently required, has Section 25534 0( the Califomia Health and Sa(e[y Code been fully complied wi[h? ❑ Yes ❑ No 5. Does or will lhe applicant or present or future builtling occupanl require tor Ihe vrork which is lha su�jecl of this application a permit for 5uch consWclion or motlification from ihe South Coast Air Quality Management District or from any other air polWtion control tlislrict or agency? ❑ Yes � ❑ No (Sectbn 658502 of Ihe Califomia Govemment Code requires that t�e requesletl infortnation he fumished m applications fm non-residential builtling pertnits). 6. Will any Dart o( the faciliry lo be wnsWcted under this permit be within 1000 feel (rom the ouler poundaries of a school? ❑ Yes ❑ No Qf yes", the faciliry must meet the requiremeN of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7. If a permit from the South Coast Air �uality Management DisMcl or other air polWtion control dislnct or agency is required for lhe vrork which is Ihe su6ject of this application, have all of Ne tlisclosures prescribed by Califomia Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 6. (If yes", atlach certificate of compliance fmm the appropnale air polWtion wntrol oKcer). " ' CERTIFICATE OF COMPLIANCE: I certify that untler penalry of. perjury the infortnation given above is cortect. I agree to comply with all sWte laws antl city ordinances regarding Hazardous Matenals and Emissions., � CERTIFICATE OF COMPLIANCE AND AUTHORIZATION' OF ENTRY: I certify under penalry of perjury that I have read Ihis application and state that the intortnation given is correcl. I agree to comply with all state laws and city ordinances relating lo building wnsWction, and authonze representatives of the Ciry of Costa Mesa to enter upon the above-tlescribed property (or inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until final inspection. 1 Si'gInawre oi Legal Ovmeqs) D/ale �/ G�hiYw—ELII�^onzNAPWican� � pa� `Od Md �