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Home My WebLink About3333 BEAR ST - Building Permits (31)0 o � > _ � J p •�'oqnyyAM1V T (714) 754-5273 • Fac (714) 754-4856 JobAdd�ess: 3333 BEARST Suite: 106 Vitinity: SPACE 106 Parcel Number: 41249207 � CITY OF COSTA MESA BIIILDING DIVIS/ON ' DEVELOPMENT SERVICES DEPARTMENT PERMIT Applicant: JAMTGAARD, PAUL Address: 1340 VALlEJO ST. SAN PRANCISCO, CA SUITE 6 BUILDING PERMIT Zoning: Phone: (415) 775-2277 Zip: 94109 Owner: SOUTH COAST PLAZA Address %C J SEGERSTROM 8 SONS COSTA MESA, CA Phone: . 3315 FAIRVIEW RD . Zip: 92626 Contractor: C�� _ � � (_F Y Address:.� �Pw�D� G.�-- �JI.IIT� 20�v Pnone Zip: �uiZLl�4i�%1��GA License: %4'%C�'YJ% -1 Arch : Eng: Address: - Address: Zip: Phone: License: SCOPE OF PERMIT 1,400 SF INTERIOR STORE T.I. FOR "GAZOONTITE.COM" (SPACE 106). FEE SUMMARY Plan Check: $206.99 Permit: $1,27375 ' SMIP Res: $0.00 SMIP Com: $31.50 Othec $0.00 Inspection: $0.00 Total: $1,512.24 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Ezistinq: o NOTES: 0 � Rear 0- 0 Rear 0- 0 Required: 0 PLANNING & ZONING left 0- 0 Left 0- 0 Proposed: 0 PERMIT NUMBER I 699-01443 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 ; Status: ISSUED Applied: 9/9/1999 Issued: 10IB11999 Phone: License: s�so,000.00 siso,000.00 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 void if work is not commenced within 180 days, or if work is suspended or abandoned for a period 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 Inspectiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS'COMPENSAnON DECLARAnON: I heraby aflirm undar penelry ot perjury one ot Ihe bllowing declaralions: - �I heve antl will maintein a certificate of consent to self-Insure for workers' compensation, es proviaetl tor by section 3700 of the Lebor Cotle, for the pertormance oi the work for which Ihis permit is issueU. ' ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for [he performance of the work for which this permit is issuetl. -My w ers' compensetion Inscu-r,a._nc..e, c�arrcier antl licy number are: - �/ Carrier. �� 3� b"7 �- �S�J PolicyNumber: ��G�S2��6 (This secf/on need not be complefed il the permif is valuetl et ane hundred dollers ($100J or less.) ❑ I certify ihat in Ihe pertormance of the work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workers' compensation laws of California, and agree that ii I oul ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shail forihwith compiy wit ih ro isions. //�(� ApplicantSignature: .��10� �—� - oate: f0 —�'`��I WARNING: FAILUPE TO SECURE WORKERS' COMPEN ION COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYEF TO CPIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSANDDOLI.ARE($100,000),INADDITIONTOTHE STOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]060FTHELABORCO�E,IfJrEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am torce antl ettecL Lic. N Contracbr's SignelOfe:i Chapter 9(commencing with Section 7000) ot Division 3 of the Business�gl Protessions Code, and my license is in full qass a �`� — �oate:_ �l9�'8'r-�Q CONSTRUCTION LENDING AGENCY: ❑ I hareby aflirm that there is a consiruciion lentling agancy for the pedormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Signature: _ OWNER-BUILDER DECLARATIONS: Lentlers Address: Date: I hereby aHirm that untler penalty of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit �o consiruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires tha applicant for such permit to file e signed statement t�et he or she Is licensetl pursuant to ihe provisions of ihe Comractors License Law (C�apter 9(commencing with Seclion 7000) of Division 3 oi Ihe Business and Professions Code) or ihat he or she is ezempt therefrom and Ihe basis tor Ihe allaged exemption. Any violation oi Section 7031.5 by any epplicant for a permit subjects the applicant to a civil penalry of nol more than five �untlred Dollars ($500).): ❑ I, es owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, anU the stmcwra is not intended or oHeretl for sale (Sec. 7044, Business antl Professions Cade: The Contractors License Law tloes not epP�Y �o an owner of property who builds or impraves thereon, and who tloes such work himself or herself or Ihrough his or her own employees, provided ihat such improvemen�s are not intended or oRered for sale. It, however, the building or improvement is soltl within one year oi completion, the owner-builder will hava �he burden of provinq that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consirucl the project (Sec. 7044, Business and Professions Code: The contractore Licensa Law does not appty to an owner oi property who builtls or improves thereon, antl who contrects tor such projec[ with a contrecbr(s) license pursuent to the Contrectore License Laws.). ❑ I am exempt under sec. Slgnature: Owner ID veritied by dnver's license. ❑ Ves ❑ No Business and Protessions Code for ihis reason: Venfication of Ownership by (type of document, i.e. - property tax bili or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION: Dnver's License No. Date: Expires: ❑ I hereby cenity that no ezcevation tive (5) or more teet in tlepth into which a parson is requiretl to descend, will be matle in connection with work authorizetl by this permit, and Ihat no builtling simcture, scaBolding, falsework, or tlemolition or tlismentling thereof, will be more then ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Administrative Code). . ❑ As owner-builtler, I will not employ anyone �o tlo work which would require a permit from iha Division of Industnal Safety, as noted above, unless such person has a permit to do such work from the tlivision. Signature: Date: Division ol Indus�rial Safety Pertnit Number: CER7IFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I certity under penalry oi perlury ihat I have read this application antl state that the infortnation given is correct I agree ro comply with all state laws and city ordinances relating to building conswction, and authodze representatives of the Ciry of Costa Mesa to enter upon �he ebove-described prop�rty tor inspection purposes. I egree not to occupy or allow occupancy oi eny builtling authorizetl by this pertnit untll final inspection. COQE t. INSPECTIONTYiE �jF IMRIRLS 1616 Fixed Sys�em Final Fire Prevention 1266 200 201 202 203 Pool Spa Final Finel Re-Roof Final Block/Retaining Wall Final Fedory Fire Place Finel Sign 204 Final Demolition 2448-46 �V � 6 De/ / i Date CQOEy INSPELTIONTYVE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy Ij�, NI TRIRLS � � p pME o �> _ J�� (714)754-5273 • Fax(�ia��sa-aass �. Job Address: Suite No Vicinity: 3333 BEAR ST 106 SPACE 106 Parcel Nunmber: 41249207 � Applicant: SHAHAN, MIKE Address: 25 EDWARDS COURT CA BURLINGAME CITY OF COSTA MESA BUILDING D/V/S/ON `' DEVELOPMENT SERVICES DEPARTMENT PERMIT Owner: SOUTFi COAST PLAZA Address %C J SEGERSTROM & SONS , �COSTA MESA, CA� _ 3375 FAIRVIEW RD ELECTRICAL PERMIT Phone: (650) 3733930 Zip: 94010 Phone: Zip: 92626 Contractor. CONTI-HURLEY ASSOC, INC Address: 25 EDWARDS COURT . CA � , . Phone: (650) 373-3930 - BURLINGAME , � . 'Zip: 94010 . , � .license: 747287 � PER T NUMBER 1/E99-00933 � 77 FAIR DRIVE, COSTA MESA, CA 92626 d- \ , � ISSUED BY: Status: ISSUED Applied: 10/11/1999 Issued: 10/11/1999 SCOPE OF PERMIT ELECTRICAL PERMIT FOR STORE T.I. FOR "GAZOONTITE.COM" (SPACE 106). INSTALL 65-LIGHT FIXTURES, 36-OUTLETS, & 4-SWITCHES. REF:899-01443 ISSUE FEE Temp service test Res. a/c 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 t000a Service over 1000a MotoB to 1 hp Molors to 10hp Motars l0 50hp Motors to 700hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pale 523.50 50.00 so.00 $0.00 $0.00 $0.00 $52.85 $31.68 54.a0 30.00 $0.00 50.00 50.00 50.00 50.00 $0.00 so.00 50.00 50.00 so.00 50.00 50.00 50.00 S0.00 50.00 Quantity 0 0 0 65 36 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Cirws ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 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 $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 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 5112.43 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable hendicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectlone end finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSATION DECLARATION: - I hereby ettirm untler penelry oi perjury one ol the tollawing tleclarations: ❑ I heve end wiil maintein e certificate of consent to sell-Insure for workers' compensation, es providetl for by sectlon 3700 oi t�e Labor Code, for the pertortnance ot the work for which ihls pertnit is issued. � �I have end will maintain workers' compensatlon insurence, as reduired by secUon 3700 oi the Lebor Cotle, for Ihe peAormance oi the work for which this pertnit is Issuetl. My wor ars' compensetlon Insurence cerder entl policy number ere: Cerrlar: QAN!?�' Si� '��s po��cy Numbec (�GS03- � Z9SS (Thls sectlon need not be camp/eted I! fhe peimit l},�velued et one huntlrea tlallars ($f 00J or less.) . ❑ 1 tertlty ihat in Ihe Applicant Slgnature:/ WARNING FAILURE TO THOUSANDDOLLAPEf: � whic� t�is permit Is issued, 1 shall not employ any person in eny manner so as ro �ecome subject to the workers' fl I should becoma subject to ihe workers' compensation provisions of Sectlon 3700 of Ihe Labor Cotle, I shall forthwith ��(a _ Date: __ /O —/�^� i WORKER$' COMPENSATION COVEMOE IS UNLAWFUL AND $MALL SUflIECT AN EMPLOVER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TOONE HUNORED IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3'!OB OF THE LABOR CODE, IMEPEST, AND ATTORNEV'S FEES. LICENSEO CONTRAC70RS DECLARA710N: I hereby aHirm lhat I em license under provlslons C pter 9(commencing with Section 7000) ot Divislon 3 oi the Busines7� d Prolessions Cade, entl my Iicense is In tull force entl ettect. Lk_tl,� ��/i�% Cless p D ContractofsSigneture: Dete: �C:J"� -991 � CONSTRUCTON LENDING AGENCV: ❑ I hereby aHirtn that there is a canstruction lentling apency lor the pertortnence ol Iha wark for whic� this permit is Issued. (Sec. 3097, CMI Cotle). LenOefs Neme: Lentler9 Atltlr055: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm t�at untler penalry ot perjury that I em EXEMPT FROM THE COMRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires e permit to consirucL alter, impmve, demolish, or repeir eny siructure, prior to Its issuenca, alsa raquires the epplicent tor such pertnit to file a signed statement that he or she is licensetl pursuant to the provisions ol the Coniractors lJcense Lew (Chapter 9(commendng wit� Section 7000) of D'Msion 3 ot Ihe Business and Professions Catle) or thet �e or she is exempt t�erefrom and Ihe basis lor Ihe ellegetl exemptlon. Any Wolatlon of Seclion 7031.5 by any eppliwnt tor e permit subJects the applicant to a ciWl penalry of rrot more then liva hundretl tlallars (5500).): ❑ I, es owner ol Ihe praperry, or my employees with wages es their sole compensation, WILL DO THE WORK, entl Ihe swcture is not intended or oHeretl tor sale (Sec. 7044, Business end Prolessions Cotle: The Contrectors License Lew does not epply to an owner of praperty who builtls or improves thereon, antl who tloes such work himselt or hersetl or Ihmugh his or her own employees, pmvitletl that such impmvemenis are not intendetl or oHeretl for sale. If, however, ihe building or impmvement is soltl within one year oi completlon, the ownerbuilder will have the burtlen of proving thet he or she did not build or imprwe tor purpose ot sale.). ❑ I, as owner at the properry, am EXCLUSIVELY CONTFiACTNG WITH LICENSED CONTRACTORS to construcl the project (Sec. 7044, 8usiness anA Professions Cotle: The coniredors Licensa Lew does noi eppty to an owner at property who �uilds or Improves ihereon, and who contracts tor such projed with a contractor(s) license pursuant ro the Contrectors License Laws.J. ❑ I am e:empt untlar sec. Business entl Professions Code for this reason: Signawre: Date: Owner ID ventietl by tlrivers license. ❑ Ye9 ❑ No Drivers License No. Ezpires: Veritication of Ownership by (type ol documem, i.e. - properry Ws bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hareby cenity Ihet no e:cevatlon INe (5) ar more feet In tlepth Into whicli a person Is required to descend, will ba matle in connection with work aut�orized by thls permit, antl thet no builtling structure, scettoltling, telsework, or DemWitlon or dismentlinp ihereof, wlll be more than thirty-six (36) feet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Atlministretive Cotle). ❑ As owner-bullder, I wlll not employ anyane to do work which would reqWre e permit Irom the Divlslon of Industdel Safery, es notetl ebove, unless such person �as a permit to da such woB from Ihe tlivision. SlgneWro: Date: DIN51on of Intlustriel Sefery Permlt Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF EHTRV: I certiy under penalry of perjury thet I have reed Ihis application and sWte Ihat Ne intortnation given is correcL I agree to wmply all state laws end dry orGinflnces relating to Ouilding consiruction, antl authorize represeniatives of the Ciry of Costa Mesa to enter upon the above-Cescdbe0 prqpe lor In eypn purposes. I egrae nm ro occupy or allow occupency ot any bullding euthodzetl by this permtl untll 11na1 inspection. COOf �. INSPECTION TYVE 1616 Fixatl System Finel Fire Preventlon 1266 Pool Spa Finel 200 Final Re-Rool 201 Finel Block/Retelning Well 202 Flnel Fedory Flre Plece 203 204 2448�4fi Finel Slgn Final Demolitlon ».U�CIh1/1R', Date / /��. COOE� INSVECTIONTVPE 208 Finel MeCheniCel 20B Finnl Plum6ing 210 Final ElecMcel 212 Finel Flre Preventlon 220 Finel Planning Approvel 222 Finel Site 250 Final BuilOing/Occupancy � � II�iV'I� • y��'. � •..:..:s: � ' �; (714)754-5273 • Fax(714)754-4856 � Job Address: 3333 BEAR ST Suite No 106 Vicinity: SPACE 106 Parcel Number: 41249207 Applicant: SHAHAN, MIKE Address: 25 EOWARDS COURT CA BURLINGAME CiTY OF COSTA MESA BDILDING DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT owner: SOUTH COAST PLAZA Address: °hC J SEGERSTROM 8 SONS COSTA MESA, CA " 3315 FAIRVIEW RD MECHANICAL PERMIT Phone: (650)3733930 Zip: 94010 Phone: 2ip: 92626 Contractor: CONTI-HURLEY ASSOC, INC Address: 25 EDWARDS COURT CA Phone: (650)373-3930 BURLINGAME Zip: 94010 . License: 747287 Aroh I Eng : Address: � " Phone: Zip: License: 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 10/11/1999 Issued: 10/71/1999 SCOPE OF PERMIT MECHANICAL PERMIT FOR T.I. FOR "GAZOONTITE.COM" (SPACE 106). INSTALL 1-NEW VAV BOX & ALT/REPAIR 1-HEAT/COOLING SYSTEM TO ADD 6-OUTLETS 8 3-INLETS. REF: 899-01443 ISSUE FEE Inst FAU <700 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Hantllers > t0000ctm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 873.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.65 $0.00 $0.00 50.00 $0.00 50.00 $0.00 30.00 $0.00 $0.00 Quantity 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation System Evaporative Cooler Commercial I ncinerator Domestic Incinerator Compressors I Absorotion SVstems Uplo3hp/100kBTU 3To15hp/500k8TU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 7,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 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 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 547.65 NOTICE: The work authorized by this permit shall comply with all epplicable handicap access requirements under Califomia statutes and relatad regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for Ihe work authonzed under ihis permit to be considered legal, such work must comply with ell applicable codes, and all requl�etl Inapeetlone and flnal approvel must be obtained. Failure to obtain inspections and final approval will result in Ihe ezpiration ot ihis permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKEPS'COMPENSAnON DECLARAnON: I hereby affirm under penalty ol perjury one ot the lallowing tleclaretions: ❑ I have end will meintain a certificate of consent to self-Insura for workers' compensation, as provided for by sectlon 3700 0l Ihe Lebor Coae, for lhe pertortnance of the �work for which Ihis permit Is issued. I have entl wlll mainialn workers' compensatlon insurance, as requiretl by section 3700 of Iha Labor CoAe, for Ne pertormance of the work tor which this pertnit is issued. My wo rs' compensatlon Insurance wrriar end policy numbar ara: Cemer: e%Q��/V/'rG S'Jl �f1LS' PolicyNumber.LU� SO�I Z l�S� (This section neetl nof be comp/efed 1! fhe permit is velued et one huntlre0 tlollars ($700) or less.) ❑ I certity thet in the pertortnence of t e w �qfor which Ihis permit is issuetl, I 5hall not employ eny person in any menner so es to become subject to Iha workers' compensatio laws of C ifornla, a agr e het it I shoultl hecome subject to ihe workers' compensation pmvislons ol Section 3700 ot the Le6or Code, I shall forthwith comply with Ih r' , �f L� ^//^Q � Applicent Signature: f.L.�LO•—h-� Dete: ! WARNING FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUT AND SHALL SU&IECi AN EMPLOVER TO CRIMINA� PENALTIES AND CNIL FINES 11P TOONE HUNDRED THOUSAND DOLI.ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIOEO FOR IN SECTION 310fi OF THE LABOR CADE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm Ihat I am licensed�y� r pmvis i Chepter 9(commencing with Section 7000) of Division 3 of ihe Business ged Professlons Code, antl my license is In full force entl ettect. Lic. V-� ��Y- .L�� Cless # « Coniractors Signature: �' (� 1_6��f_I,l.L� Date: �-, �O^// -� CONSTRUCTION LENOING AGENCV: ❑ I �ereby effirm Ihat there is a construction IenAinq agen�y for Ihe pedortnance of Ihe work for which t�is pertnit is issued. (Sec. 3097, Civil Cotle�. Lenders Name: Lendets Atldress: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat untler penalry of perjury thai l em EXEMPT FROM TME CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to consWcL alter, improve, demolish, or repair any sirucwre, prior to Its issuence, also requires the appliwN tor such pertnit lo file a signetl statemen� ihet he or she is licensetl pursuent to t�e proNslons of the CoNractors License Law (Chapter 9(commencing with SecNon 7000) oi Division 3 of ihe Business antl Professions Code) or that he or she Is exempt thereirom end ihe basis lor Ihe allegetl exemptlon. Any violation at Sectlon 7037.5 by eny epplicant for a permit sub�ects the applicant to a clWl penalty oi not more than live hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, entl the structure I5 not intentletl or oHered for sale (Sec. 7044, Business end Prolessions Cotle: The Conirectors License Law tloes not appty to an owner of property who builds or improves thereon, end who does such work himself or herself or Ihrough his or her awn employees, provided lhet such improvements ere not intended or oHered lar sale. If, �owever, the builtling or improvement is sold within one year oi completion, Ihe owner-builder will have ihe burtlen of proving ihet ha or she did not �uild or improve for purpose of sale.). ❑ I, es owner ol Ihe properry. em E7(CLUSIVELY CONTRACTING WITH LICENSED CONTiiAGTORS to conSiruCt the pro�ect (Sec. 7044, Business antl Protession5 Code: The conireciors License Lew Coes noI aDP�Y �o an owner of properry who builtls or improves thereon, antl who coniracis lor such project with a coniractor(s) licanse pursuant to the Contrectors License Lews.). ❑ I am exempt untler sec. Business and Professions Code lor ihis reason: Si9nature: Date: Owner ID verified by driver's license. ❑ Ves ❑ No Drivefs License No. Expires: Venfication ot Ownarship by (type of tlocument, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION: ❑ I hereby certity ihat no excavatlon tive (5) or more taet in tlep�h Into which a person is requiretl Io Gescend, wlll be made in connectlon with work authorizetl by Ihis permit, entl that no building structure, scattoltling, felsework, or damolition or dismantling thereof, will ba more then Ihirty-six (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TiNe e, Celifomia Atlministretive Cotle). ❑ As owneahuiltler, I will not employ anyona to do work whic� woultl require a permi� imm the Division of Intlustrial Setery, as noted above, unless such person has a permit to tlo such work from the division. Signeture: Date: Division of Industnal Sefery Permit Number: Will Ihe epplicant or present or fuWre building occupant neetl ro tile antl ceriity a Business Plan for emergency response to release or threatened release oi a hazardous material? ❑ Ves ❑ No (Section 25505 oi the Califomia Healih and Sefery Code requires, with some exceptions, �hat a Busineu Plan ba filad with the Costa Mesa Fire Depariment by every buslness which hes at eny one lime during e reported year a quantiry of ha�rAous matenels equal to or greater Ihen e welght ot 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressetl gas at standard temperature and pressure). Does or will ihe epplicam or present or fuWre building occupaN neetl m tile a registration form for ecutely haeardous matenals7 ❑ Yes ❑ No (Section 25533 of the Californie Healih and Safery Cotle, with some esceptions, requires registralion wiih the Costa Mesa Fire Department by each business which at any one time has on hantl a quantlty of acutely �eiartlous meterials equal to or greater than e weight oi 500 pountls, or a volume of 55 gallons, or 200 cuDic feet of compressed gas et standard temperature end preuure). Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acWely halartlous matenals)? (Section 25534 of iha Califomla Health and Safery Cotle pmvides ihat Ihe Cwta Mau Fire Depariment may reqNre the preperatioq cetlification and liling with the Fire Department of an RMPP by businesses which are required to register ecutely hazartlous matenals with �he Fire Depanment. If an RMPP is presently required, has Section 25534 0l ihe Califomia Healih and Safery Cotle 6een fully complietl with7 ❑ Yes ❑ No Does or will the epplicant or present or luture building occupent require for the work which is the subject ot this e plication a germit for such construction or modification irom tha South Coast Air Ouality Manegement District or from any other air polWtion control distdct or agency7 � Ves LJ No (Saction 658502 ot the Califomia Government Cotle requires that Iha requested information be tumished on epplications for non-residentlal building permits). WIII any part of the fecilify to be consinictetl untler ihis permit be within 1000 feet from the outer bountlarles of a school7 ❑ Yes ❑ No Qt yes", ihe tacllity must meet the reqi tl e permit from �he South Coast Air epplication, heve ell ot the disclasures (II yes", attech cenificate of c a CERTIFICATE OF COMPL GE: c rery7rdingl�ag¢dous Me a /// A Signawre: L' / / 1 of Sectiore 25534 and 42303 oi lhe Celifornla Health end Safety Cade). danegemenl Dis�nct or other air pollutlon con�rol dis�nc� or egency is reauiretl tor �ha � ad bv Celifornia Healih end Safetv Code Section 42303 baen made7 ❑ Ves ❑ No ihat under penalry of perjury ihe informetlon given above is correct. I egree to comply with ell state laws antl ciry ortlinances ns. � oe�a: GD —�i _� � CERTFlCATE O COMPLIANCE AND AUiHORIZATION OF ENTRV: I certily unaer penelty of perjury that I have reatl �his epplication and state thet Ihe intortnation given is correcL I agree omply with all state laws and ciry ordinances relatinq to huildinq constmction, end euthorize representetives of the City of Casta Mesa to enter upon ihe ebove-descnhed property tor Inspection purposes. 1 egree not to occupy or allow occupancy oi eny builtling authorizetl by this pertnit untll tinel Inspection. Signature Ot Legal Owner(s) And/Or Authodzed Applicant 40DE t. INSGECiIONTYVE 1676 Fixed System Final Fire Prevention 1266 Pool SOa Finel 200 Final Re-Rool 20/ Final BIacWRetaining Wall 202 Finel Factory Fire Plece 203 Final Sign 204 Final Demolition 24a6d6 pdjg RL COUE 1 INSPECTION TYVE 206 Final Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Final Fire Prevention 220 Final Planning Approvel 222 Finel Site 250 Final Buildiny0aupency Date Date � ,:, - y��'. i ::�::� ; : � CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PEFMIT (714)754-5273 • Fex(714)754-4856 Job Address: 3333 BEAR ST Suite: 106 Vicinity: Parcel Number: 41249207 App�icant: FIDEL TORRES Address: 818 N GRAND AV COVINA,CA Owner: SOUTH COAST PLAZA Addfe55 °hC J SEGERSTROM & SONS COSTA MESA, CA 3315 FAIRVIEW RD Zoning: Phone: (626)913-6720 Zip: 91724 Phone: Zip: 92626 Contrecroc ALLREADY FIRE SPRINKLER CO Address: 818 N GRAND AV COVINA,CA Phone: (626)913-6720 Zip: 91724 License: 358795 SCOPE OF PERMIT 22 FIRE SPRINKLER HEADS FOR "GAZOONITE.COM". REF:B99-01443 Plan Check: $54.11 Permit: $83.25 Other: $0.00 Total: $137.36 FEE SUMMARY PER IT NUMBER 9-00240 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10I5/1999 Issued: 10/14/1999 ISSUED BY: �0 � I Calc Valuation: Sz,zoo.00 Claimed Valuation: sz,zoo.00 NOTICE: The work authorized by this permit shall comply with all applirable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced wilhin 180 days, or i� work is suspended or abandoned for a period o� 180 days. INSPECTIONS: In order tor the work aulhorized under this permi� to be considered legal, such work must compty with ell applicable codes, and ell requlred Inepectiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARATON: I hereby aHirm under penairy of perjury one of t�e follawing declarations: ❑ I have end will maintain a certificate oi consent to self-Insure for workers' wmpensation, as provitletl lor by section 3700 oi iha Labor Code. for Ihe pertortnance of the work lar which ihis pertnit is issuad. ❑ I have and will maintein workere' compensation insurance, es required by section 3700 of ihe Labo� Cotla, for the peAortnance of the work for which Nis pertnii is issuetl. My workers' compensetion Insurance cerrie� and policy number are: Carrier: Policy Number: (This sectlon need not be completed il lhe Oermif is veluetl et one huntlretl dollars ($100) or less.) ❑ I certiy that in the partormance of the work for which this pertnit is issuetl, I s�ell not employ eny person in any manner so as to becoma subject to the workers' compensetion laws of Calitomia, antl egrgge t�etJ'f I s�o�/ulObecome subject to Ihe workers' compensetion provislons of Section 3700 of ihe Lebor Code. I shall foM1hwith comply with these provisio . 'E� / Applicant Signeture: I Ai � ( .r�rr/7�f Date: /� � / �— � � WARNING: FAILURE TO SEC WORKERS' WMPENSATION ODVERFGE IS UNLAWFUL AND SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND G'!IL FlNES UP TOONE MUNORED T/KK15rW D OOLLARE (5100.0OO�.IN ADDRIIXJ TO THE WST OF COMPENSATION, DAhNGES AS PRONOED WR IN SECTION �W OF THE IABOR COOE, INrEREST, AND ATTOiiNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn tha: I am licensetl untler provisions oi Chepter 9(wmmencing with Section 7000) ot Division 3 oi ihe Busineu and Professions Cotle, antl my Iicansa is in full force end eMect. Lic. k Class p �/ � Contractofs SignaWre: ,� � �i--G—�� Date: / (J — / �/-- �i G --7 CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm thet Ihere is a consWction lending egency lor ihe pertortnance of tha work for which ihis pertnit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lendefs Address: SiqnaWre: Date: OWNER-BUILOER DECLARATIONS: I hereby eNirtn �hat untler penalry ot perjury t�at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to consirucL elter, impmve, demolish, or repair eny structure, prior to iis issuance, also requires the applicant for such permit to tile e signed statement ihat he or she is licensed pursuent to the provisians of Ihe Contractors License Law (Chapter 9(commencing with Section 7000) ot Dlvislon 3 oi the Business end Professions Code) or Ihat he or she is exempt Iheretrom and the basis far the allegetl exemption. Any violetion ot Sectian 7031.5 Dy eny epplicent for a pertnit subJects t�e applicant to e civil penalry oi not more than iive hundretl tlollars (5500)J: ❑ I, es owner of the property. or my employaes with wages as Iheir sole compensation, WILL DO THE WORK, end lhe structure is not intendetl or o@ered for sale (Sec. 7044, Business entl Professions Cotla: The Contrectors License Lew tices not apply to an owner of proPerty who builtls or improves thereon, end who does such work himself or herself or through his or her own employees, providetl lhat such improvemenis are not intendetl or offered for sale. If, however, the builtling or imprcvement is sold within one year oi comple�ion, the ownerv6uiltler will have ihe burden of pmving that he or she did not 6uiltl or improve tor purpose of sale.). ❑ I, as owner of the properry, am EXCLUSIVELV CONTRALTING WITH LICENSED CONTRACTORS to consiruct ihe project (Sec. 7044, Business antl Professions Code: The comractors License Law does not epplY to en owner ot property who builtls or improves thereon, end who wntracts for such project with e contractor(s) license pursuant to Ihe Contraciors License Laws.). ❑ I em ezempt under sac. Business antl Professions Code for this reason: Signature: Date: Owner ID venfied by driver's license. ❑ Yes ❑ No Dnver's License No. Expires: Venfication of Ownership by (rype of document, i.a. - propetly tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PEFMITCERTIFICATION: ❑ I hereby ceniry that no excavation five (5) or more feet in depth Into which a person is requlred to descend, will be matle in conneciion with work euthonzetl by ihis permit, entl that no building struaure, scaXolding, falsework, or demolition or tlismaniling t�ereol, will De more t�an Ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tiile B, Caliiomia Atlmini5trative Cotle). ❑ As owner-builder, I will not employ anyone to do work which would raquire a pertnit from the Division of Intlus�rial Safery, as noted above, unless such person has a permit lo do such work irom the tlivision. Signature: Date: Division ol Indusinal Safety Parmit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMRY: I cenity under penalry ot perjury that I have read ihis application and state that Ihe infortnation given is correct I agree to comply with all state laws end ciry ordinences ralating to huildinq construction, anA euthonze representatives ot the Ciry of Coste Mesa to enter upon the a6ove-tlescribed property lor inspection purposas. I egree not to occupy or allow acupancy of any 6ulltling euthonzatl by this pertnit until final inspaction. � / ign uF§ OI Legal ner(s) Date — �� O� �rz/-�_�=--� � - And/Or Authorized Applicant Dat GOpE�, INSPECTIONttPE 1616 Fi:etl System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWRetaining Wall 202 Finel Fectory Fira Placa 203 Finel Sign 204 Final Demalition zat&as RIpL CS1U�� INSPECTIONTYPE �� '% � 206 Final Mechanical 208 Final Plumbing 210 Finel Elec�rical 212 Final Fire Preveniion 220 Final Planning Approval 222 250 Flnal Site Finel BuildinglOccupancy QgjE NTI RIALS //399 �