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Home My WebLink About3333 BEAR ST - Building Permits (50)e � _ CI�'Y OF COSTA _MI" ,,A � Development Services, Division of Building and Safeh� CERTIFICATE OF O,CCUPANCY This certificate is issued pursuant to the requirements of�tfie Uniform Building Code, Section 308 adopted by the City of Costa Mesa certifies that at the Hme of its issuance the building structure herein below described was inspected and approvedforoccupan�yasfollows: , � � BuildingAddress 3333 Bear St. , Ste 124 Use Sunglass retai�l (894 s.f.) Group M _ Type of Construction _ S th C t P1 BIdg.PermitNumber BC08-00082 1-A ' FireZone XXXXXX UseZone pDC OwnerofBuilding ou oas aza Address 3315 Fairview Rd., Costa t4esa, CA BUILDING OFFICIAL-K�7driI1 Q. NgUyeri, C.B.�. Tenant SUNGLASS HUT Date 08/07 \ REQUIRED TO BE POSTED IN A CONSPICUOUS PLACE / L I _ - /-�--��' - CITY OF COSTA MESA. � BDILDIN6 DIVISION . 77 FqIR DRIVE, COSTA MESA, CA 92626 •(714) 754•5273 • Fax (714) 754-4856 • www.ci.cosWmesa.ca.u��8-�� 0 POR INSPECTIONS CALL: (714) 7543626 Job Address: s�ae: Vicinity: Parcel Nunmber: Applicant: Adtlress: Owner: Address Contractor. Address: Plan Check: Permit: Other: Total: FIRE SUPRESSION PERMIT 3333 BEAR ST ,_ '124 ' SPACE 124, SUNGLASS�HOT . . �� - '�/.� � ' _. . 41249207 ,' ' . ZOnln DEBOS, WYBRAND :' �{ i .. .,.y , �'� '{=l� Phone: _ � Zip: .I� , ✓�,- .-, . i, . SOUTH'COAST PLAZA , C'J SEGERSTROM AND SONS � COSTA�MESA,CA� ' -- Phone: 3315FAIRVIEWRD - Zip: �m��e� �'�� 7701 , SEQ IAAVENUE�', . _ "=� . f� , :. _. .. _.r� ..�., ��, .. � ;;, . ' 714•712-3672 . '��:{ . ; , j ,r� ...,' ,.!r .. : i� 92626_ �_ ,. Status: ISSUED nPPi�ea: osnanooa Issued: O6I71Y2008 � , _ - � . Phone. 714-870-1010 - , , , ORANGE, CA �•� - Zip: 92686 _ , ' � �' � � . . � . . --� � �-��License: � 802591.•;� , iY� �'I , ... i r�., . ,i �"¢`.; i SCOPE'OFPERMIT FIRE SUPPRESSION PERMIT TO RELOCATE 17 SPRINKLER HEADS F,OR�AN INTERIOR STORE TI FOR "SUNGLASS HUT" IN SOITE 124. REF#: BC08-00082 = ' � ',!r . ,- :' . . ' ' �FEESUMMARY'''� 363.21 , . _ . . $97.25 30.00 $160.46 �" �r ` , .' � • �� , � -. , � (2�o�Rn Q v Cv �yy bi - j�-, --1 I 1 b I O$ Calc Valuaaon: 53,�eo.00 `�Claimed Vatuation: 53,�eo.00 NOTICE: The work auNonzed by thls pertnit shall comply wilh 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 LA3T INSPECTION. INSPEC710NS: In order for the work authorized under this permil to be considered legal, such work must comply with all applicable codes, and ali required inspedions and final approval must be obtained. Failure lo obtaln inspectlons and fnal approval will resull in the expiration of Nis pertnit. LOOE/, ixsrecnoxTrve p�g �S �j INSPECTIONTYYE p� IN7fIUL5 1818 Fixed System Final Fire Prevention 208 Final Mechanical � 7286 Pool Spa Final � 208 Final Plumbing 200 ' Final Re-Roof � 210 Final Electrical 201 Final Block/Retainirg Wall 212 Final Fire Prevention � �� 202 Final Factory Fire place � 220 Final Plannin8 ADG�'a� 203 Final Sign 222 Final Sita 204 FinalOertalition 250 Final BuiltlinyOccupancy WORKERS' COMPENSATION DECLARATION: I hereby affirm untler penalry o( perjury one of the fouowing tleclaretions: ' ❑ I have and will maintain a certifcate of wnsent lo self-Insure for workers compensalion, as providetl for by section 3700 of the Labor Code, for �he peAormance o( the work for which �his pertnit is issued. � (�—hhave and will maintain Horkers' compensation insurance, as required 6y section 3700 01 Me Labor Code, (a the peAormance of lhe v.ork fa vfiich this pertnit is issued. My workers' wmpensation Insurance cartier and policy Came�re/aAl�lC�.l �m� AStuti�cE W (Thrs secAun neetl rot De cwndaredsthe perma'a vaNeC et we nurMretl cbnars (Sf oo) w bu ) PolicyNumber: WG ��Gh7� ❑ I certi(y Ihat in the peAortnance of the work for which lhis 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 ihal if 1 shoultl become subjecl to lhe wnrkers' wmpensation provisions of Section 3700 0l the Labor,Cod�ha�rthvq{h compry with Ihese provisions %V i�-- !/ O� icam s Siqnawre � e � �_ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE 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, INTEREST, AND AiTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under Drovisions of Chapter 9(wmmencing� with Section 7000) of Division 3 of Ne Buslness antl Professions Code, and my license is in tull lorce qand eflect. Li`c..#—�� Z�i / Class#- ` G—G�D G1i _� {�!////�J ( nuaaalsSpeuwre i` Oate_.. ll CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn Ihat there is a constmction lending agency fa the performance of Ihe v.ork ta wfiich this permit is'ssued. (Sec. 3097, Civil COCe). Lentler's Name: Lentler's Address: $igrialure OWNER•BUILDER DECLARATIONS: 1 hereby affirm that under penalry of perjury Nal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for t�e (oliovring reason (Sec. 7031.5, Bu5in855 and Professions Code: Any city or county which requires a permit to construct, aiter, improve, aemolish, or repair any sWcture. prior lo its issuance, also requires the applicantlor such pertnit lo file a signed stdtemenl that he or she is licensetl pureuanl lo lha provisions of the Contractors License Law (Chapter 9(commencing wit� Section 7000) of DiviSion 3 of the Business antl Professions Code) or tha� he or she is exempt therefrom antl the basis lor the alleged exemption. Any violalion ol Section 7031.5 by any appliwnl for a permit subjects the appliwnt lo a civil penalry of not more t�an five hundred dollars (5500).): ❑ I, as ovmer ol lhe properly, or my employees with wdges as their sole wmpensation, WILL DO THE WORK, and tha structure is not inten0etl or oHereO lor sale (Sec. 7044, Business antl Prolessions Code: The Contractors License Law does not appty to an owner of property who builds or improves thereon, and who does such wark himself or herself or throuqh his or her own employees. Drovitletl Ifiat such'improvemeNs are not intended or oHerad for sale. If, however, lhe building or improvement is sold within one year of completion, the ovmerbuilder will have lhe burden of proving Ihat he or she tlid nol build or improve for Durpose of sale.). � ❑ I, as,owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo construct the pmject (Sec. 7044, Business antl Pmfessions Code: The�contractors License Law dces not apply to an owner of property who builtls or improves thereon, and who coniracts for such project wilh a cmt2clw(s) license pursuant to [he Contractors License Laws.). � ❑ I am exempt under sec. BuSiness and Professions Code for Ihis reason: 305]-46(J/O]) Owner ID ven(etl by dmc ise. ❑ Yes ❑ No ' Dn'ver's License No. Expires: Verificalion of Ownership by (type of document, i.e. - proPeM lax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: . ❑ I hereby certAy lhat no excavation frve (5) a more feet m depth into vfiich�a person is requiretl ro tlescend. will be made in connection with work authorrzed by this permit, and that no builtling swcture, scaffdding, lalsework, a demolition or tlismantling thereol, will be more than thirtysix (36) teet high. (Chap. 3.2, Grp 2. Art 2. Sec. 341, Title B, Califomia Atlministretive Code). ❑ As owner-builder, I will not employ anyone to do vrork which would require a permit from the Division of Intlustnal Safety, as notetl above, unless such person has a permit to do such vmrk from the division. Appliram's Signalure Division ol Industnal Safely Pertnit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant neeC to file antl certify a Business Plan for emergency response to release or threatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of Ihe Califomia Health and Safey CoCe requires, with some exceptlons, that a Business Plan be fled wit� the Costa Mesa Fire Department by every business which has at any one lime tluring a reported year a quantily of hazartlous materials equal lo or greater than a vreight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet ol compressed gas al standard lemperature and pressure). 2. Does or will the applicant or present or luture building occupant need to file a registration (ortn lor acutely hazardous materials� ❑ Yes ❑ No (Section 25533 of lhe Califomia Health antl Safety Cotle, with some exceplions, requires regisVation wilh the Casta Mesa Fire Department by each Dusiness which at any one time has on hand a quantiry of acutety hazardous matenals equal to or greater ihan a Neight ot 500 pounds. or a volume of 55 gallons, or 200 cubic feet of wmpressed gas at sWntlartl temperature antl pressure). 3. Does or will the applicant or present or future building occupant need [o prepare an RMPP (Risk Management antl Prevention Program for awtely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Heal[h and Safery Code provides mat tne Costa Mesa Fire Department may require the preparation, certificatlon and filing with Ihe Fire Departmen[ o( an RMPP by businesses which are requiretl lo register acutely hazardous materials with the Fire DepaNnent. 4. If an RMPP is presently required, has Section 25534 of the Califomia Heallh and Safery Cotla been fully complied wilh7 ❑ Yes � No 5. Does or vrill the appliwnt or present or (uture building occupant reduire for Ihe v.ark whith is the subject of lhis apDliwtion a permil fOr SUGh con5lmGliOn or motlifitation ffom lhe South Coast Air Ouality Management Distnct or from any alher eir pollution control Cistnct or agenCy? ❑ Y85 ❑ No (Secibn 65850.2 of the Cali(omia Govemment CoCe require5 that the reduested infOrmalion ba lumi5hed on applications for ran-resbential builtling permits). 6. Will any part of the facility to be constructed under t�is permit be within 1000 faet from the outer boundanes of a schooll ❑ Yes ❑ No Q! "yes", the faciliry musl meel the requirement of Sections 25534 and 42303 o( ihe Calilomia Health and Satery Code�. 7. If a Dermit (rom the South Coast Air �valiry Management Dislnct or other air pollution wntrol district or agency is required tor the work which is the subject of Ihis application, have all of t�e Cisclosures presuibed by Califomia Health and Safety Code Seclion 42303 been made9 ❑ Ves ❑ No 8: •pf'yes", atWch cenifcate of compliance from the appropriate air polluGon control oKcer). . . _ CER7IFICA7E OF COMPLIANCE: I certify that under penalty ot perjury tha information given above is cortect. I agree to comply wiih all slate laws and city ortlinances ie9artling Hazardous Materials and Emissions. • CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty ot perjury that I have reatl this appliwtion and state that the information given is correcL I agree to comply with all state laws antl city ordinances relating to building construclion, and authorize representatives ot me Ciry ot CosW Mesa lo enter upon the above-described property for inspection purposes. I agree not to occupy or allow xcupancy of any builtling aulhorized by this permit until final inspection. _ � SipnaWreolLegal mer(s) e y� J/�V /� 4` A dAN�onzeOAppl�can� � -D .atpf �_ —_ "_ � : _; -.. , � CITY OF COSTA MESA " . BYILDIN6 DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • wwv+.ci.wsta-mesa.ca.us � �, FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER: BC08-00082 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 0,5/0212008 ... . ISSUED BY: �� j JOs ,4�ortesS: 3333 124 BEAR ST. CM' ' �� Suite/Un�it: �.,124 APN: 41249207 � ` �,' . �. Zoning:. Q � . � ' ' , Vicinity: SUITE 124 SUNGLASS HUT,� � �� - . � � �� .�. �Primary` Oca� ;M,,��, � ConstType: I-A ! -�� SQ�FT'. + " 0 ;-u' ',ValuaHon, $225,000.00 !*7` , ,+,. '_ f_ •��- . .. . ... SCOPE OF WORK: INTERIOR STORE TI FOR "SUNGLASS HUT" IN SUITE 124. ELEC: 37, LIGHT FIXTURES, 76 OUTLETS, 6 SWITCHES; ; MECH: 1 VAV, BOX, 1 VENT. FAN; PLUMBING: 1 P=TRAP, t WATER HEATER;, . „ OWNER: SOUTH COAST PLAZA � . Address: .%C J SEGERSTROM & SONS ~��'' � Unit COSTA MESA, CA �`j , � � . " , � �. : .'- � . . � �� . .. �. Phone: •, - ''�. ; "City/State/Zip: -3315 FAIRVIEW RD�; � _ " � ,.t� ` .i � � , __ - ^� � ��, . _ ti �,+� ' , ' �';. � APPLICANT: PORTZ,DEAN '+-`� Address: �� Unit: : Phone: 469-693-0457 �:'• . �." `�. . " Ciry/State/zZip: . _ . � . � . , 'f'�, � . •,' . i - ' ., _ - .. . .. �`�'s. , _, � CON7RAC7oR: DAVACO,INC �;� - � " ' License No. �914434� � � Phone: 214-373-0700 � _ ;,�; � - � Address: 6688 NORTH CENTRAL�EXPSWAYUuit: �.- .SUITE 1400 � CeIL �t` � - � . _ �CitylState:-DALCAS,TX . ' . , . ZipCode 75206 � s._.� '.. .. . -_. . � . _ _ . ARCHITECT: � , ; -;.�- `� - , License No. � � � ' =PHONE: ° ENGINEER: ' - License No. _- " "_ � �_FHONE:� COMBINTATION PERMIT FEE SUMMARY : . . . . Building Plan Check: � � ' $27524 , - � - � � � Building Fees: � �-+ . , $1,69375 .. - . - � . � Electrical Fees: " . $127.39 � � � Mechanical Fees: . - $41.40 . , _ .- : � �� . . ' � Plumbing Fees: � - - �� $43.10 � ' � . - . SMIP Residential: � � $0:00 -, � ' ". SMIP Commercial; $47.25 � - f< � TOTAL FEES: � $2,228.13` = . ^Re/er to fee receipGs for all fees paid for project �� -� ' NOTICE: The work authorized by this permit shall wmply 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 musl comply with all appliwble codes, and all required inspections and final approval musl be obtained. Failure to obtain inspectlons and final approval will result in the expiration of this permit. 40DE t. INSPECTION TYPE 1fit6 Fixed System Final Fire Prevention 7286 Pool Spa Final . 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 204 Final Sign Final Demolition- � IN7ffIALS CODEt IN P C NTYP 206 inal Mechanical P/� 208 Final Plumbing 210 Final Electriwl 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �1�I�� 7 3 oB : � .:1� �� WORKERS' COMPENSATION DECLARATIC I hereby aKrm under penalty of perjury one of the tollovring declarations: ❑ I have and will maintain a certificate of consent to setl-Insure for �wrkers' compensalion, as provitled for by section 3700 of the Labo� Code, for Ihe peAormance ol the work for which ihis pertnit is issued. C�� I have and will maintain �wrkers' compensation insurance, as required by saction 3700 of the Labor Code, for the performance of the work tor which this pertnit is issued. My wnrkers' compensati n Insurance carrier antl policy number are: / D /,//�/(� / CCamer:Z / �( ��C � / ' / �.ia L (Tlrix seCbn nee0nof Ee cpnpletetl/Vle pemH B wNetl al ma hixMiatl tl�0ars (St001 a ressJ Policy:Numtier:� 3� 9�.�- 9( 5 7 ❑ I certify that in the per(ortnance of [he work for which this permil is issued, I shall not employ any person in any manner w as to become subject to the vrorkers' compensation laws of Califomia, and agree Ihat if I should bewme suDject to the v.orkers' compensation provisions of Section 3700 of the LaDor Cotle, I shall forthwith wmply vrith Ihese provisions. ApplitanlS $ipnJWre WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL 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 LA80R CODE, If�fTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm thal I am licensed under provisions of Chapter 9(commencing vrith Section 7000) o( Division 3 of the Business and Professions Code, and my license � ful' f e a d e((ecl. �t- . � GYa�ss'#_� � ConUanN . iG«� ._ � – ta J CONSTRUCTION LENDING AGENCY: ❑ I here6y aftcm that lhe2 is a consWction lending agency for lhe peRortnance of the v.ork fp which tltis permit is asueC. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby aHirtn ihat untler penalty of peryury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the lollowing reason (Sec. 7031.5. Business and Professions Code: Any ciry or wunry which requires a permit to wnstruct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires me appliwnt for such permit to file a signed statement Iha� he Or she is licensed Oursuant to the provisions ot the Contractors License Law (Chapter 9(commencing wiN Section 7000) ol Division 3 of the Business and Professions Cade) or mac he or s�e is exempt t�erefrom and the basis for the alle9ed exemption. My violation o( Section 7031.5 by any applicant for a permit subjects the appliwN to a civil penalty of not more t�an fve hundretl dollars ($500).): ❑ I, as owner o( the proDerty, or my employees with wdges as Iheir sole compensation, WILL DO THE WORK, antl lhe slruclure is not inlendetl or ollered lor sale (Sec. 7044, Business and Professions Code: The Conlractors license Law dces not apply to an owner of property who builds or improves thereon, and who dces such wark himsell or herself or ihrouqh his or her own amployees, provided ihat such improvements are nol intendea or oflered for sale. II, however, the building or improvement is sold wilhin one year of complelion, the ovmer-builder will have Ihe burden ol proving that he or she did not build or improve for purpose of sale.). � ❑ I, as owner ot the.property, am EXCIUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business and Pmfessbns Cotle: The contractors License Law does iwt appy lo an ovmer of properly who builds or improves thereon, and who contracls fa such project with a contractor(s) license pursuant to the Contractors License LavS.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre J057<6 �3IW) , Owner ID verifed by c ; lice. ,] Yes � No Driver's License No. E�cpires: Verificalion of Ownership 6y (�ype o/ document, i.e. - property tax bilt or tleed): OIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby cenify that no excavation frve (5) or more feet in depth into v.fiich a person is required to tlescend, will be matle in connection with work authorized by lhis pertnil, and ihat no builtling sWcture. scaftdding, false�wrk, or demdition or dismantling thereof, will be more than Ihirty-sa (36) feet high. (Chap. 32, Grp 2, Art 2, Sea 341, Trtle 8, Calilomia Administrative Cotle). ❑ As owner-builder, I will not employ anyone to Co work whic� wnuld require a permit (rom Ihe Division ol Industrial Safety, as note0 above, unless such person has a permit to do such work from the division. Appiwnl's SIB��ure Division of Industrial Safety Permit Number. _ HIIZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the appliwN or present or future builtlinq occupant need to file and certify a Business Plan lor emergency response to release or threatened release o( a hazartlous material7 ❑ Yes ❑ No (Seclion 25505 of the Calilornia Health and Sa(ely Cotle requires, wiN some exceptions, lhat a Business Plan be filed with I�e CosW Mesa Fire Depariment by every business which has at any one time during a reponed year a quantity o/ hazartlous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas at 5tantlard lemperature and pressure). 2. Does or will Ihe applicant or present or future Guiltling occupanl nee0 to fle a registra[ion form tor acutely harardous materials? ❑ Yes � No (Section 25533 of the Califomia Health antl Safery Code. wilh some exceptions, requires regisiration with the Costa Mesa Pire DepartmeN by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater lhan a weigM o( 500 pounds. or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard lemperature antl pressure). 3. Does or will ihe applicant or presenl or fuNre building occupant neetl to prepare an RMPP (Risk Management antl Prevention Prog2m for acutely hazartlous matenals)? ❑ Yes ❑ No (Section 25534 of Ihe California Health and Safery Cotle provides Ihat Ihe Costa Mesa Fire Department may require lhe preparation, certification and filing wi[h the Fire Department of an RMPP by businesses which are requiretl lo register awtely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 0( the Califomia Health and Safety Code been lully complietl wi1h7 ❑ Yes ❑ No 5. Does or will Ihe applicant or presenl or fuNre building occupanl require tor the wVrk which is Ihe subject o( Ihis appliWtion a peAllit for 5uch COnslNction or modifitalion from the Sout� Coasl Air Oualiry Management DisVict or (rom any other air pollution Gontrol dislrict or agency? ❑ Yes ❑ Na (Section 65850.2 of the Calitomia Govemment Cotle requires that Ne requestetl information be fumistred on applications for ron-resitlential builtlirg permils). 6. Will any patl of ihe facility to De consWcteA unCer this permit be wilhin 1000 feet from Ihe outer boundanes of a school? ❑ Yes ❑ No (If'yes', ihe facilily must meet the requirement of Sections 25534 and 42303 of Ihe Cali(ornia Heallh and Sa(ety COde�. L If a permit from the South Coasl Air Oualily Management Disiricl or other air polNtion control disMcl or agency is requiretl for the xqrk which is the subject ot lhis appliwtion, have all of the tlisUosures prescribed by Calilomia Health antl Safety Code Section 42303 been made7 ❑ Yes ❑ No 8. pf yes", allach certificate ol wmpliance from the appropnala air polWtion conUol officer). , � CERTIFICATE OF COMPLIANCE: I cenity that.under penalry of perjury the inlormation given above is correct. I agree to comply with �all sWte laws and city ortlinances regarding Hazardous Materials and Emissions. � . Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty o( perjury that I have read this application anC state Ihat lhe information given is correct. I agree to comply with all state laws antl ciry ordinances relating to building construction, and authorize representaGves of the City of Costa Mesa to enter upon the above-0escribed property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permil until final inspeclion. SgnalureolLe I r /p�te AnE/wAu�wizetl icani — (—pei _ � CITY OF COSTA MESA � � BlIILDING DIV/S/ON 77 FAIR DRIVE, COSTA MESA; CA�92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us , FOR INSPECTIONS CALI: (714) 754-5626 , PERMIT TYPE APN: 41249207 Zoning: , PERMIT NUMBER: B MISC STATUS: DATEISSUED: ISSUED BY: BX07-00162 ISSUED ioiosnoo�.' RMD e JOB ADDRESS: 3333 124 BEAR ST CM.",. ':`,,�.' ,' ,�' Suite/Unit: 124 Vicinity: STORE FRONT .�" Primary Occ:� -� -_ Const Type :?? SQ. FT: 0 �"" �� Valuation: , E2,400:00 : �,{,�. , , _ . _ SCOPE OF WORK: INSTALUITION OF A 7 SF.�ILCOMINATED CHANNEL tETTER SIGN FOR "SUNGLASS HUT", SPACE 124. 1 SIGN CIRCUIT. i'-.",' ��: . ,_ ✓�1�" , .'e : b��r T? - � �- , , _ . OWNER: SOUTH COAST PL,'AZA. ��,�i:�,�.' � Address:: %C J SEGERSTROM B.SONS � t�.� Unit COSTA MESA, CA � ''. f" '. . . . City/State: 3315 FAIRVIEW RD �� `� �� Zip Code;,.,....92626 : , . ... ':Gr , . Phone: .. . , . . . . 5. '_ . �;_ . . - . -� , .. • ' . APPLICAN7: DUDDEY, BOBBIE� � . " � � �,,,' � ' Address: 2778'POMONABWD ` � � Unit: � City/State: POMONA, CA ' ' ��:, � � � ,;,, Zip Code: 91768 - � , . , " Phone: 909-592-0870, � � � CONTRACTOR: Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: Phone FLUORESCO�SIGNS 2778 POMONA BL�' � � POMONA,CA � 91768`' �. .. . -�- • - . License No. - 736628 ^ Unit: . , .. " - .. . � � � . ; : , - _. , , - Phone ��909-592-0870 � � Cell: � License No. � _ , , , License No. FEE SUMMARY Building PIan,Check: ; $54.11 Building Permit:,.,-� '- $83.25 � Electncal Permit:� �., �, $48.10 " -' ' SMIP Residential �` , .. , $0.00 � . � SMIP Commercial � = . . , � � $0.50 . , - $0.50TOTAL FEES ' " � 5185.98 i' - 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 inspeetions and final approval must be obtained. Failure to obtain inspections and final approval vnll result in the expiration ot this permit. C D�Et. INSPELlIONTYPE � IN711UL �OOEI INSPEC110NTYPE D�TE INlI11A15 7616 Fixed System Pinal Fire Prevention � 208 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ' 210 Final Electncal 201 Final BIocWRelaining Wall 212 Final Fite Prevention 202 Final Factory Fire Place �� 220 Final Planning Approval 203 Final Sign v/"• � 222 Final Site 204 Final Demoli�ion ' ' 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATON� I hereby aKrm untler penalry of perjury one of the following deClareUonS: ❑ I have and will maintain a certificate of consent to self-Insure lor workers' compensation, as provided lor by section 3700 of the Latior Cotle, for the eAortnance ol l�e�work for which Ihis Dermit is issuetl. I have and will maintain workers' compensatan insuranca, as required by sec n 3700 W the Labor Cotle, fw lhe peAortnance of ihe work fa which this permit is i55ued. My worker5' wmpen5ation Insu2nce carrier and policy numberare: • �1. - Carrier:ii l�I.v�IG �.�fe-`�^'� � —(7hi_5 setlivn n naf �be mtmplet Ihe p�er/m� is f ona �untlretl dollars (b100J oNessJ Po� Iicy,Number�� W a 7 4 2s �� D Z � I certify that in the pertortnance of the work tor which this permit is issueG, I shall not employ any person in any manner so as to become subject to ihe wvrkers' wmpensation laws of Califomia. and agree lhat if I should become subject to the workers' compensation provisions of Section 3700 of or Code, I shall fort 'N co i y wiN t�ese provisions. ,—/_fl� �Appticam's5ipnaWre �_ - Date WARNING: FAILURE TO SECURE ORKERS' CAMPENSATION COVERP.GE IS UNL4WFUL AND SHALL SUBJECT 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 L460R CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm ihat I am licensed under provisions of Chapler 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a/nd _eflect. � r��ic'#_ _ Z7l � C ss#. �Y i� . . �b_S�� Convactor'sSip�ature �_ Da� � __ CONSTRUCTION LENDING AGENCY: ❑ I hereby affvm that Nere is a crostruction lending agency fa the peAortnance W the �wrk la wfiich tNs pertnit is issued. (Sec. 3097. Civil Code�. Lender's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby affirtn that under penalry of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW /or the (ollowing reason (Sec. 7031.5, Bu5in855 antl Proles5ion5 COde: Any ciry Or COunty Whlth fequifQs a pQfRlit to construct, alter. improve, demolish, or repaii any sWctura, prior to its issuance, also requires the applicant for such pertnit to Ole a signed statement t�at he or she is licensed pursuant to the provisions of [he Conlractors License Law (Chapter 9(commencing with Section 7000) o( Division 3 0( the Business and Profassions Code) or that he or she is exempt therefrom and Ne basis (or ihe alleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit subjects the 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 iheir sole compensation, WILL DO THE WORK, and the structure is nol intended or oflered tor sale (Sec. 7044, Business antl Professions Code: The Contractors License Law does not aDDly to an owner of property who builds or improves thereon, and who does such wnrk himself or hereelf or throu9h his or her own employees, provided that such improvements are not intended or oftered for sale. If, hovrever, the buildinq or improvement is sold within one year of completion, the ownervbuilder will have the burden ot proving that he or.she ditl not build or improve for purpose of sale.). � ❑ I, as ovmer of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044. Business and Professbns Cotle: The contractors License Law dces not apply to an ovmer of property who builds or improves lhereon, and who contracts (or such project with a cant2ctor(s) license pursuant tothe Contractors License Laws.). � ❑ I am exempt under sec. Businass and Professions Cotle for this reason: SignaWre . . , Date 305]36(Y0�) Owner ID verified by dnv�. ❑ Ves ❑ No `� ""' � - Driver's License No. Expires: Verification ot�Ownership by pype of tlocument, i.e. - property Wx bill or deetlj: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:. . � ❑ 1 hereby certily thal no excavatbn frve (5) or more feet in dep[h into v.hich a person is required to descend, will be matle in connection with v,nrk authonzed hy this pertnit, and that no building slruclure, scaffdding, talsev.ark, or tlemolition or dismantling lhereof, vrill be more Ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Title 8, Califomia Adminis[rative Code). � � As owner-builtler, I will not employ anyone to do work which would require a pertnit from the Division of Industrial Safety, as noted above, unless such person has a permit to tlo such work from the division. AOW��'s Sipnalure Da1e Division of Industrial Safety Pertnit NumDer: 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 Ihe Calitornia Health and Safery Code requires, vnth some excep6ons, that a Business Plan be filetl with the Costa Mesa Fire Departmen� by every business which has at any one time tlunng a repohetl year a quantity of hazartlous matenals equal to or greater than a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas at standard temperature and pressure). 2. Does or will the applicant or present or tuture building occupant neetl to f le a registration fortn for acutely hazardous materials? ❑ Yes � No (Section 25533 of the Califomia Healih and Safety Code, with some exceptions, reQuires regisVation wilh the Costa Mesa Fire Department by each-business which at any one lime has on hand a quantity of acutely hazardous materials equal to or greater lhan a weight of 500 pounds, or a volume of 55 gallons, or 200 cuDic feet of compressed gas at sWnCard temperature and pressure�. 3. Dces or will tha applicant or presen� or future builEing occupant need to prepare an RMPP (Risk Management antl PrevenUon Prog2m for acutely hazardous matenal5)7 ❑ Y85 ❑ No (Section 25534 of the Califomia Health and Safety Cotle provides tha[ Ihe Costa Mesa Fire Depanment may require the preparation, certification and filing with the Fire Department o( an RMPP by businesses which are required to register acutely hazaMous materials with the Fiie Department. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Safety Code been (ully complietl with? ❑ Yes ❑ No 5. Dces or will the applicant or present or (uture building occupaN require for the work which is ihe subject of this applica[ion a pe�mit for such cons[mction or motlification (rom the South Coast Air Qualiry Management District or from any other air pollution control district or agency7 ❑ Yes ❑ IJo (Section 65850.2 of ttre Calitomia Govemment Cotle requires that the requested infortnation be fumished on ap0lications for rron-resitlential buildi� permits). 6. Will any part of Ne faciliry to be consWctetl under this pertnit be within 7000 feet from the outer boundanes of a school? ❑ Yes ❑ No (If'yes", the tacility must meet Ne requirement of Sections 25534 and 42303 of lhe Califomia Health and Satety Code). 7. If a permil from Ihe South Coast Air Quality Management Districl or other air polWlion control district or agency is required for the vrork vfiich is the subject of this application, have all of the disclosures prescnbed by Califomia Health and Safery Code Section 42303 been made7 ❑ Yes ❑ No 8. pf'yes", attach certificate of compliance from the appropriate air polWlion control oKcer). . . CERTIFICATE OF COMPLIANCE: I certify ihat under penalry of perjury tha information giveri above is correcC I agree to comply with all state lav.s and city ordinances regarding Hazardous Materials�and Emissions. •� Signalure _ �ale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity untler penalty�of pery'ury that I have read this applitation and sWte lhat the infortnation given is wrrecL I agree to comply vrith all state laws antl ciry ortlinances relating to building wnstruction,-and authorize representatives of the City of Cosla Mesa to enter upon the abovedescribed propeny (or inspection purposes. I agree not to occupy or allow occupancy.of any building au[horizetl by this permit until final inspection. Sipnalure0/LepxlOwntt�s) Da�e ..0.�•� 0 , cQ ,. � .l-0_S -b � MWorAN�onzeCAppliwnl l.—.__Dale � L__ _. . - _�