HomeMy WebLinkAbout3333 BEAR ST - Building Permits (144)'"`� � CITY OF C� MESA • - —�
BYILDING DIVISION �
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 •�w+�v.ci.cosla-mesa.ca.us
�, FOR INSPECTIONS CALL: (714) 754-5626
y�v A,:
PERMIT NUMBER: BX08-00287
PERMIT 7YPE B MISC STATUS: ISSUED
APN: 41249207 DATE ISSUED: 09/30/2008
Zoning: , iSSUED BY: RMD
JOB ADQRESS: 3333 347 BEAR ST CM Suite/Unit: 347
Vicinity: SPACE 347 STORE FRONT Primary Occ: � . � ._. . Const Type :7?
SQ.FT: 0 _ � -� Valuation: 51,000.00, * .
SCOPE OF WORK: �
INSTALLA710N OF 1 NON-I�LUMINATED CHANNEL LETTER STORE FRONT SIGN�FOR�"ADIOAS", SPACE 347.
OWNER: SOUTH COASTPLAZA � Address: %C J SEGERSTROM & SONS Unit COSTA
MESA,CA • � � - ��� , � �
Ciry/State: 3315 FAIRVIEW RD'. _ Zip,Code: ..92626 ` �� �
Phone: . - . � . ' . . . ..
APPLICAMT: SMITN, LlNDA � �� � -��� �' � Address: 10980 80ATMAN AVE. '�. Unit
City/State: STANTON; CA �__ Zip Code: ;^, 90680 �' .
Phone: 714-761-8200,,. ' . . . , � •
CONTRACTOR: SIGNS AND SERVICES , License No. ' 624675
Address: 10980 BOATMAN AVE � � � � - - � . �, � .. Unit:
City/State: STANTON, CA __ _ � �- -
Zip Code: 90680 -= ,-Phone 714-761-8200 Cell: .
� ;
ARCHITECT: �, t. �--- � � . ., License No. �. _ : . �
Phone - _ _. .
ENGINEER; . - . . � License No. .. - � - � �
Phone ' . �� � � - .
FEESUMMARY" � �
Building Plan Check: $9.69
Building Permit: $38.75
Electrical Permit: - . - $0.00_ . .. � � • �
SMIP Residential � ' . - $0.00 � .
SMIP Commercial $0.50 ' -
TOTAL FEES � �'-548.94 � � - �
NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under Califomia staWtes and relaled
regulations. (Ord. No. 92-28. § 1, 12-21-92) ` ,
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPEC710NS: In order for the work authorized under this permil to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
COOE/, iNsr�cnoxTrre o� ixn i ygQ� ixsvecnoxrme � o� H�muis
1676 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Popl Spa Final 208 Final Plumbing � �
200 Final Re-Roof 210 Final Electrical "
207 Final Blak/Relaining Wall 212 Final Fire Prevention '
202 Final Faclory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site `�� V
204 Final Demolition 250 Final Builtling/Occupancy � j/1 �
!T �-/'/-
� ��.
WORKERS' COMPENSATION DECLARA710N: -
I hereby a�rm unAer penalry of perjury one of the folbwin9 tleUa2Gons: .
❑ I have and will maintain a certifiwte of wnsent lo self-lnsure for workers'
compensalion, as provitleC for by section 3700 of the Labor Code, (or the
peRormance of the work for which Nis permit is issued.
❑ I have and will maintain workers' compensation Insurance. as required by
secUon 3700 of Ne Labor Code, tor the pertwmance of Ihe v.ork for which tnis
pertnit is issued. My workers' wmpensa on Insurance wrner ana policy
num6er are: /�� �� �
Carrie� �`����CX> � .
(TnaseCionn nofDemmpetMllhepnmlisvaluatlala+ronuntl�e00ctlars(Si00JaMu)
c � �xx��B -�C`z�-i
Policy Number: �
❑ I certify Nat in the peAormance of the work lor which this permit is
issued, I shall not employ any person in any manner so as lo become subject
to the vrorkers' compensation laws of Califomia, and agree lhat if I should
become subject lo Ihe workers' compensalion provisions of Seclion 3700 0(
Ihe Labor Cotle, I s f hvnth comply with ihese provisions.
� ppilcan�'s61 aWr �_ le_
WARNI . 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
($700,000), IN ADDITION TO THE CAST OF CAMPENSP.TION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CADE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl untler provisions o( Chapter 9(commencing
vnth Section 7000) of Division 3 of ihe Business and Professions Code, and
my license is� ian f^ull, foSrce and eflect.
Lit;#-�"��//(/1�RSI15 �-Class#
�C act r's B wre . � oa
CONSTRUCTION LENDING AGENCY:
❑ I he2by affvm that there is a construction IerMing age�y ta the
peAormance of the v.ork (or which tttis pertnit is asued. (Sec. 3097. Civii Code).
Lender s Name:
lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereDy aKrm mat under venalry o( perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW lor the lollowing reason (Sec. 7037.5,
Business antl Professions Code: Any city or wunry which requires a permit to
wnstruct, alter, improve, tlemolish, or repair any sirucwre, pnor ro its
issuance, als0 requires Ihe appliwnt for such permit lo file a signed statement
lhat ha or she is licensed pursuant to the provisions ol the Conlractors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business antl Protessions Cotle) or that he or she is exempt therefrom and
Ihe Dasis for lhe alleged exemption. Any violalion ol Section 7031.5 by any
applicaN for a permit subjects the applicanLlo a civil penalty of not more than
five hundretl tlollars ($500).): �
❑ I, as owner of the p�operty, or my empioyees wilh wdges as Iheir sole
compensalion, WILL DO THE WORK, antl Ihe structure is not intended or
offered lor sale (Sec. 7044. Business and Professions CoCe: The ConUactors
License Law does not apply to an ovmer of propeAy who builds or improves
thereon, antl who dces such work himself or herself or through his or her own
emp�oyees, provitleC t�at such improvements are not intended or oKered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will �ave the burden ol proving that he or she
ditl nol build or improve for purpose of sale.).
❑ I, as�owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business an0
Prolessbns Code: The contractors License Law dces nol apply.lo an ovmer of
property who tiuilds or impmves Ihereon, and who contracts (or such project with
a cont2ctor(s) license pursuant to the Contractors License LawsJ.
❑ I am ezempt under sec.
Business and Professions Code (or this reason:
' 9gwture Da�e
]OS]�a6(1N])
� er ID verified by driv�cense. ❑ Ves ❑ No �
Driver'S License No. Expires:
Verifiwtion of Ownership by (rype of document, i.e. • property taz bill or Eeetl): •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certiry that no excavation frve (5) or more leet in depth into wfiich a
person is requiretl to tlescentl, will be made in conneCtiOn with work aulhoriZetl
by this permit, and lhat no builtling structure, scaHddifg, falsework, v demolition
or dismantling Ihereot, will be more Ihan thirty-siu (36) (eel high. (C�ap. 3.2, Grp
2. Art 2, Sec. 341, Trtle 8, Califomia Adminisl2tive Code).
❑ As owner-buildar, I will not employ anyone lo d0 work which woula
require a permit from the Division of Industrial Sa(ery, as noted above, unless
such person has a permil �o do such work from Ihe division.
AOW�uinfs Signatore Wte
Division of Intlustrial Safety Permit Number.
HAZAROOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or presenl or future building occupant neetl to file and
certily a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health antl Safery Code requires. with some
exceptions. thal a Business Plan be filed vrith the Costa Mesa Fire
Depanment Dy every business which has at any one lime tluring a reported
year a quantity of hazar0ous materials equal to or greater ihan a vreighl of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard femperaWra and pressure).
2. Does or will the applicant or present or fuWre building occupant need to file
a regislration torm lor acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Healt� and Safery Code. with some
ezceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater Ihan a weighl of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of wmpressed gas at slantlartl
temperature and pressure).
3. Does or vrill the applicant or present or Wture builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program for awtey
hazarclous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Cali(omia Health and Safety Cotle provitles that ihe
Costa Mesa Fire Department may require lhe preparation, certification and
filing wilh the Fire Department of an RMPP by businesses which are required
to fegi5tef aculely haZartlou5 malerial5 wiN the Fire Department.
4. If an RMPP is presenlly requireQ has Seclion 25534 of Ihe Cali(omia
Heallh and Salety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will Ihe applicant Or present or future builtling otcupanl require for
lhe work whiCh i5 the SUbjeCl o( Ihis appliG2li0n a p8frtllt (Of SUGh GOnSINttion
or motli(IC3tion from tha South Coast Air Quaiity Management Distllct or lrom
any other air polWtion conlrol disMct or agenty? ❑ Ye5 ❑ No
(Section 65850.2 of tho Califomia Govemment Code requires Ihat t�e requestea
informalbn be fumished on applications fa ran-residential builGin9 pertnits).
6. Will any part ot lhe laciliry to be conswcletl under I�is permil be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
Qf yes', lhe faciliry must meet the requiremenl of Sections 25534 and 42303
of the Califomia Heallh and Safery Code).
7. If a permit from ihe Soulh Coast Air Oualiry Management Districl or other
air polNtion control dislrict or agency is required tor the work which is the
subjed of this application, have all ot the disclosures prescribetl by Califomia
Health and Salely Code Seclion 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certificate of compliance from the appropriate air polWtion
wntml oKcer). � '
CERTIFICATE OF COMPLIANCE: I certify t�at untler penally of perjury the
infortnation given above is correcL I agree to wmply with all state laws and
ciry ortlinances regarding Hazardous Materials and Emissions. �
SignaWre Oale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this appliwtion and slate Ihat
the information given is correcL I agree to comply vnth all state laws and city
orGinances relating to building consiruction, antl authorize representatives o(
the Cily of Costa Mesa to enter upon the above-0escnbed property for
inspection purposes. I agree nol to occupy or allow occupancy of any huiltling
authorized by this permit unlil final inspeclion.
�- Si8^��ureolLQpal eqs) � Date
7 O
`nna u nonzeo ,ram Dat �y
�p-IS-v�f
CITY OF COSTA MESA �ya•� .�v`�
BUILpING DIVISION '� U
F � 77 FAIR DRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754d856 • www.ci.costa-mesa.ca.u�08-00213
'!w FOR INSPECTIONS CALL: (714) 754-S6Y8
'�m�o A�'
�ob,4daress: 3333 BEAR ST
Suite: 347
Vicinity: SPACE 347
Parcel Nunmber: 41249207
Appliwne WIDEMAN, IVAN .
Atldress: 4320 E MIRALOMA AV �
ANAHEIM, CA ',
Owner: SOUTW COAST PLAZA -
Address °/aC J SEGERSTROM B.SONS�
FIRE SUPRESSION PERMIT
Zoning:
Phone: 800-841-9696
Zip: 92807 ,
i
Slatus: ISSUEO
Applied: 08I28/2008 �
Issuetl: 09I07/2008
QOSTA MESA; CA � , Phone: � � ,
3315 FAIRVIEW RD - - � _ Zip: 92626 . � ' �
Contractor. CINTAS FIRE PROTECTION " ' •
Address: 4320 E MIRALOMA AV _- , , .�
- � . - -� � ` -Phone: -.-�800-841-9696 � � � ' �
ANAHEIM, CA '�. , _ . Zip: 92807 � ' . �, . ' .' .
''�; - , � License:�. '914328�..�
� ' SCOPE OF PERMIT
FIRE SUPPRESSION PERMIT TO ADD,6-FIRE SPRINKLER HEADS AND RELOCATE 1 FIRE SPRINKLER
HEAD FOR AN INTERIOR TI.FOR "ADIDAS', SBACE 347. REF#: BC08-00294 -
FEE SUMMARY
Plan Check: $41.05
Permit: $63.15
Other: $0.00
Total: $104.20
m
Calc Valualion: S�,aoo.00
Claimed Valuation: s�,aoo.00
NOTICE: The work authorized by this pertnit shall comply vrith all applicable handicap access requiremenls under Califomia stalutes and related
regulatlons. (Ord. No. 92-28, § 1, 12-27-92)
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 applicabie codes, and�all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in tAe ezpiration of this permit.
�QQ�}� p5PEL710NTYPE p� IN717UL5 � INSPELTONTYVE Q�/¢, INTfMlS
1818 FixeG System Final Fire Prevention 206 Final Mechaniwl
�288 Pool Spa Final 208 Final Plumbin9 "
200 Final Re-Root 210 Final Electncal '
207 F'mal Block/ReWinirig Wall 272 Final Fire Prevencbn • lii ��7 ���
202 Final Fadory Fire Pla�e 220 Final Planning ApDroval
203 FinalSign 222 FinalSite
204 Final Demolition 250 Final Building/Occupancy �
WORKERS' COMPENSATION DECLARATION: � . -
I hereby affirtn unCer penalry of perjury one of ihe foliowinq tleclarations: .
❑ I have and will maintain a certificate of wnsent to self-Insure for workers'
compensation, as provided tor by section 3700 ot the Labor Code, tor the
pe rtnance of the v+nrk for which this pertnit is issued.
I have and will maintain vqrkers' compensation insu2nce, as 2quired by
seclion 3700 of ttre Labor Code, ta Ihe peAormance of the work tw v.hich this
pertnit is issuetl. My workers' compensalion Insurance cartier antl policy
nu
� L sp�c,�iry !►us.
amer
�—(1 mtEecwndeleJll�eperm4� valuetlafine�uMrtWWAars(E100)wkssl
P ��YN� RwD 9Y35i�.3as
❑ I certify thal in the pertortnance of the work tor which this permit is
issued. I shall not employ any person in any manner so as to become subjecl
lo ihe workers' compensation laws of Califomia, and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
ihe Labor Cotle tYorth 'th comply vrith these pro isions.
'G�
ignaWre Daie
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, D�MAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
m� ense is in full force and eflect.
�ic. u C�ass e /6 �-(�
o O$
gnaWre Hal
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(fum that lhere is a consiruction lending agency for Ihe
perfortnance of [he v.ork for wfiich tNs pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Adtlress:
SgnaWre Date
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penalry of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS IICENSE LAW lor Ihe follovring reason (Sec. 7031.5,
Business antl Pro(e55ions Code: Any city or Gounty whith requifes a pefmil l0
construct, aller, improve, demolish, or repair any struUure. prior to its
issuance, also requires Ihe applicant for such pertnit lo file a signed slatement
ihat he or she is licensed pursuaN to lhe pmvi5ions of the Contractors
License Law (Chapter 9(commencing wilh Seclion 7000) of Division 3 of the
Business and Professions Code) or t�at he or she is exempt therefrom ana
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permil subjects lhe applicant �o a civil penalty of not more than
five hundred dollars ($500�.�:
❑ I, as owner of the property, or my employees with vrdges as Iheir sole
compensation, WILL DO THE WORK, and the slructure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contraclors
License Law does not apply to an owner of property who builds or improves
thereon, and who tices such work himself or.herself or through his or her own.
employees, provitletl that such improvements are not intentled or oReretl for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have ihe burden of pmving that he or she
did not build or improve for purpose of sale.).. ,
❑ I, as oviner of the pmperty; am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl
Prolessbns Cotle: The contractps License Law dces not appy lo an ovmer of
pmperry who builds or improves thereon, and who cont2cis for such project with
a cont2ctor(s) license pursuant to the Contractors License laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
Signawre
305]J6 (3/O)) .
Ovmer ID�verified by Arivei _..aense. ❑ Yes ❑ No
Driver s License No. Expires: - -
Verificalion of Ownership by (type of documen[, i.e. - property tax bill or,tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:� " �
❑ I hereby cetlify Ihat no excava[ion five (5) w more feet in Oepth into wfiich a
person is required to descend, will be made in conneclion wi�h work authorized
by this pertnit, antl lhat no building swcture, scaffdding, falsework, or demolitbn
or dismantling thereof, will he more Ihan ihirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Adminisirative Code).
❑ As owner-builder, I will nol employ anyone to do work which vrould
require a permit (rom the Division of Industnal Sa(e[y, as note0 above, unless
such person has a permit to tlo such vrork from the division.
Appli<anl'S SignaWre
Division of Intluslrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicant or present or future building occupant neetl to file and
certify a Business Plan for emergency response lo release or IhreateneC
release of a hazardous matenal7 ❑ Yes ❑ No
(Section 25505 0( lhe Cali(omia Health antl Sa(ery Code require5. vnth 5ome
exceptions, Ihat a Business Plan be filetl with the Cosla Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous ma[erials equal to or greatei than a vreight o(
500 pounds, or a volume of 55 gallons, or 200 cuDic feet of compressetl gas
at stantlard temperature and pressure).
2. Does or will Ihe applicant or present or future building occupant need lo file
a registra[ion form tor acutely hazardous malerials? ❑ Yes � No
(Seclion 25533 0( the Califomia Health and Safety Code, wiih some
excep�ions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pountls, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas aI standard
tempereture and pressure).
3. Does or will Ihe applicant or present or fuWre building occupan[ neetl to
prepare an RMPP (Risk Management and Preven[ion Program for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Health an0 Sa(ety Code provides tha[ the
Costa Mesa Fire Department may require the preparation, certification and
fling wi�h the Fire Department of an RMPP by businesses which are required
to regis[er acutely hazartlous materials with ihe Fire Department.
4. If an RMPP is �presently required, has Sec[ion 25534 of [he Califomia
Health and Sa(ety Code been (ully complietl with? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or Wture building occupant require (or
ihe work which is the subject of this application a permit for suc� construction
or motlification from the Soulh Coasl Air Quality Management DisMct or fmm
any olher air pollution control dislrict or agency? ❑ Yes ❑ No
(Section 658502 0( lhe Califomia Govemment Code requires Ihat t�e requesletl
informa[ion be (umishetl on applications for rwo-residential building permits).
6. Will any part of the faciliry to be wnstructetl under lhis pertnit be vrithin
1000 feet from the outer boundades of a 5chool? ❑ Yes ❑ No
Q('yes", the facilily must meel Ihe requiremenl of Sections 25534 and 42303
of the Califomia Healt� and Safery Code�.
7. I( a pertnil from �he Soulh CoaSl Air �ualily Managemenl Districl or Olher
air polWtion control districl or agency is required tor the v.ork which is me
subject of Ihis applicatioq have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been matle? ❑ Yes � No
8. Qf'yes", attach certificate of compliance from Ihe appropriate air pollution
contr0l oKcer�. � - � � '
CERTIFICATE OF COMPLIANCE: I certify tha[ under penalry of perjury lhe
information given above is correct. I agree to comply wilh all stare laws.and
city ortlinances regarding Hazardous Matenals and Emissions. . �
CERTIFICA7E OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of peryury that I have reatl this appliwtion and slate.tnat
the information given is cortect 1 agree b comply with all state laws and city
ortlinances relating to building construction, antl aulhorize represenlatives ot
[he Ciry of Cos[a Mesa ro enter upon the above�Jescribed properry,for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by [his permit until final inspec[ion. - �. �. . ,
Sign lure Legal Owner(s) bate
� O G
��b Q -
�Mtl� Au�M1onzMAGOwnI �Date
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e
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(714) 754-5273 • FB�c (714) 754-4856 • www.ci.costa-mesa.��,sCTRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3333 BEARST
suite No 347
Vicinity:
Parcel Nunmber; 41249207
Appliwnt: JEFF POLICH
Address:
� Phone: 626339-3070
, . . , Z�p -" � <. -
Owner: SOUTH COAST PLAZA
Address %C J SEGERSTROM 8 SONS
� COSTA MESA,�CA� � ,�
� 3315 FAIRVIEW RD � "
Contracroc ALL AMERICAN ELECTRIC
• Address: 279 E SAN BERNARDINO RD
COVINA, CA
Phone:
Zip: 92626 � �
Phone: 626-339-3070
Zip: 91723
License: 816336
- Status: ISSUED
Applied: 0926/2005
Issued: 09/262005
ISSUED BY: �
� , . a�.vrc vr r�rtiru � �
, ", ADD 1-200AMP SUBPANEL FOR "REPLAY' STORE TI, RE;BOS-01211, AND E05•00900 � -,
� FEE SUMMARY
. �ISSUE FEE . -
Temp service tesC
Res. alc package
New Res (1-2 units) : -
New Res (3+units) �
Pool / Spa � .
Lighting Fixts
Recept Outlets .,
Switches � .
Non Res Appl .
Res Appl
Service to 200a
Service to 1000a �
Service over 7000a � �
Motors to 1hp
Motors to 10hp .
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communicalion dr6ps �
Sub panel to 200a
Pole Lighl Pkg -
Sign Circuiis
Temp Pwr Pole
Intermed Pole
$725 ::
$0.00
so.00
so.00 `
$0.00"
$0.00
$0 00
$0.00
$0.00
$0.00 '
$0.00
$D.00
$0.00 :
$0.00
$0:00
$0.00
$0.00
$0.00
$0.00
$0.00 '
$30:50
$0.00
50.00
$0.00
50.00
Quantity; . ,
@.
`' " , "
0
0
''0
0
0. ...
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
� � ���-Temp Dist System / Lighting
Busway /100 fl �
� Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/Icw
. . .... ............up to 50�kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Volfage Equipment
Low Volt Wiring System I Ckt
Misc.�Conduit
Misa Conducto�
� Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand . �
Other Eledrical Fee
Investigation Fee
%. Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
30.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 537.75
COMMENTS / SPECIAL CONDITIONS
r
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall aulomatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In orde� for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inepectiohe and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
244&a8 (N00)
.�
�
WORKERS'COMVENSATONDECLARATON: � �
I hareby aflirtn under penalty ot perjury one of the following declere�ions: �
❑ I have entl wlll melnteln a cenificete of consent to self-Insure for workers' compensetlon, es pravitletl tor by section 3700 of the Lebor Code, for ihe pertormance of the
work for which Ihis permit is IssueA. �
'� I �ave antl wlll melntain workers' compensfltlon Insurance, es required by sectlon 3700 of the Lebor Cotle, For ihe peAortnance of Ihe work for which ihis pertnit is issuetl.
My worka m nsation Ins nce carrief �enC policy number ere: /y
Certier: �G.� � j�—� ✓ � Policy Number: �—/ � r S %'L �(
(Ihis sectlon neetl nof be completed /l Ne permit is va/uetl ef one hundred dollars ($100 or less.J �
❑ I cartify the� in
compensetlan
comply with th
WARNING: FAILURE i
TFKKISAND DOLLARE
01 the work for which Ihis pertnit is IssueQ I shell not employ eny person in eny menner so as to become subject to the workers'
�nd egrea thet If I s�oultl become sub�ect lo the workers' compensetlon provislans of Sealon 3700 of the Labor Cotle, I shell forthwith
f�Yi�— _ / Dete: —
WORKERS' COMPENSATIIXJ COVEMGE IS UNUWFUL M!D SHP11 SU6IECT Ml EMPLOYER TO CRIMII PENPLTI 5 M!D CML FlNES UP TO ONE
IN ADDfT1pN TO TME CQST OF COMPENSATIqJ, pAMAGES AS PROVIOED FOR IN SECTION 31W OF?HE LFBOR CODE, INiEREST, AND ATiORNEY'S F
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn that I em Ilcen upder rovisions of C�apter B(commencing wit� Sectlon 70001of DlNsion 3 of Ihe Busine anf Professions Code, and my Iicense is in full
forca and eHect. Llc. p �� b l Cless # � I�
Contradofs Signature: / Date: _ G%/� ��� 7
F7� '7 �
CONSTAUCTION LENDING AGENCY:
❑ I hereby ettirm Ihet ihere is a consiructlon lentling agency for Ihe peAormance of the work for which Ihis partnit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lentler's AtlGress:
Signeture:
Data:
OWNER-BUILDER DECLARATONS:
I hereby aftirtn thet under penelty ol pei�ury ihet I em E%EMPT FROM THE CONTRACTOHS LICENSE LAW for ihe following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires e pertnit to construct, alter, improve, Aemolish, or repair eny slrucWre, pnor ro its issuanca, also requires the applicant tor such pertnit
to file e signeA stetement t�at �e or she U,Iltensetl.pursuant ro the provlsions ol Ihe Cantradors License Law (Chepter 9(commenGng wiN Section 7000) of Dlvision 3 at ihe
Business and Pro1e551ons�Code) or t�at he or�she is ezempt Iheretrom end t�e besis for tha ellegetl exemption. Any violatlan of Section 7031.5 by any applicant far a pertnit
sub�ects Ne eppllcant to e civil penalry oi not mare then Me hundred dollers ($500).): .
❑ I, az owner oi the property, or my employaes with wages es iheir sola compensation, WILL DO THE WORK, entl the siructure is not intended or oflereO for sale (Sec.
7644, Business and Protessions Code: The Coniractors License Lew does not apply to en owner of property who builds or improves ihereon, antl who doas such work
himself or herself or Ihrough his or her own employees, provided that such impravemenis are not Intendetl or oflered for sale. It, however, Ihe building or Improvement is
sold within one year of completlon, Ihe owner-builder will have the �urden ol proving that �e or sha tlid not build or Improve for purpose of sale.). �
❑ I, as owner ot the properry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 70aa, Busineu antl Professions
Catle: The contractors License Lew tloes not epply to en owner at pmpery w�o builAs or Impmves thereon, end who contracts tor such projed with e wntraaor(s)
license pursuem to the Cantrectors License Lews.).
❑ I am exempt untler sec. Business end Professions Code tor this reason:
SignaWre: Date:
Owner ID venfietl 6y tlrivars license. ❑ Ves ❑ No Drivers License No.
Vedficetian of Ownarship by (type ol documem, i.e. - property tex blll or deed):
Expires:
DIVISION Oi INDUS7RIAL SAFETY PERMR CERTFICATION:
❑ I hereby certify that no excavetion tive (5) or more feet In depth into which e person is required to descend, will be mede in connection with work authonzed by this
pertni�, and �hat no 6uilding structurB, sceflolding, falsework, or demolition or dismantling thereot, will be mora then thirry-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title 8, Calilornla AdminisVative Cotle).
❑ As owner-Gullder, I will not employ enyone to do work which would require e permit trom ihe Divislon of Industrial Satety, as natetl ebove, unless such person has e
permit to tlo such work from Ihe division.
SigneWre: Date:
Division of Industrial Sefery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUfHORQATION OF ENTRV: I certify under penalry of Oerjury that I have read this application and state that ihe infortnation given is
cortecc I agrea lo compy with all stete laws end ciry ortlinences relating to bullding consWction, end authonze representatives of the Ciry of Casia Mesa to enter upon t�e
ebove-descnbetl properry tor inspection purposes. I agree not to occupy or allow occupanry of eny builtling authorized by this pertnit until final inspection.
COOE I. INSPECIIONTYVE
7616 Fixed System Flnal Fire Pravention
1266
200
201
202
203
Pool Spe Flnal
Final Re-Rooi
Final BIxWRetaining Well
Final Fectory Fire Place
Final Sign
204 Finel Demolitlon
5) / �
nt
Qdg � 4QQjj INSPECTIDN7YPE
206 Finel Mechanical
20B Final Plumbing
210 Final Elec�ncal
212 Final Fire Preveniion
� 220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy