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Home My WebLink About912 PAULARINO AVE - Building Permits;.. _ .. i. -- CITY OF COSTA MESA • BUILDING DIVISION � � 77 PAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax Q14) 754-4856 • www.ci.costa-mesa.ca.us �, FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER: E09-00015 PERMIT TYPE ELEC STATUS: ISSUED APN: 7PN007076 DATE ISSUED: 01/15I2009 ISSUED BY: RMD JOB ADDRESS: 912 PAULARINO AV CM ` Suite/Unit: Vicinity: PUBLIC RIGHT OF WAY � , . � - - . � � SCOPE 4F WORK: ELECTRICAL PERMIT fOR A 100 A PANEL FOR A NEW AT&T PEDESTAL LOCATED ON PUBLIC RIGHT OF WAY. OWNER: CITY OF COSTA MESA� �Address: Unit: . PHONE: ; . ' CitylState/Zip: � , - APPLICANT: HARPER, BART -" - � . - ' Address: � 704 DRY GULCH PLACE Unit: PHONE: %�-520-0434 � �---� _� - City/State/zZip: -NORCO,CA�-� � . CONTRACTOR: HARPER.ELECTRICAL CONTRACTORS INC Address: 704 DRY GULCH PLACEUnit: � ." ' -� � ' � . � � City/State: NORCO,CA - ZipCode: 92860 - �- ELECTRICAL PERMIT FEES Electrical Plan Check Fee' _ $0.00 Electrical Permit Fee: $54.00 Reinspectian Fee $0.00 TOTAL FEES $54.00 License No. 779882 � PHONE: 95'1•520-0434 CELL: a NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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. IN5PECTIONS: In ader tw the work autborizetl under tbis permit to be considered legal, such work must wmply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE p. IN PEC710N TYPE OATE INTITIALS C0� INSPECTION TYPE �A�„F INIIML 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing `� 200 Fihal Re-Roof 210 Final Elecirical 2 5-0� 201 Flnal Block/Retaining Wall 212 Final Pire Prevention 202 Final Factory Fire Place 22o Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy „ , _,, WORKERS' COMPENSATION DECLARATION: I hereby affirtn under penalry of perjury one of the following declarations: ❑ I have and vrill maintain a certificata of wnsent to self-Insure tor workers' compensation, as provided tor by section 3700 of the Labor Code, for the performance of the vrork for which this permit is issuetl. � ❑ I have and will maintain workers' compensation insurance, as required by sectbn 3700 of the Labor Cotle, !or the pertortnance of the wnrk for which this permit is issued. My workers' compensation Insurance carrier and policy number are:,, J �Carrier.,, I�=N��G2_ / ��+�% �(ihusecfbnneednotbemmple(etltltheperm(dis�valuedafon undretl�llarz(8100)aless) Policy.Number: � C��7��J��( ❑ I certify that in ihe performance of ihe work for which [his permit is issued, I shall not employ any person in any manner so as to become subject to lhe vrorkers' compensalion laws of Cali(ornia, and agree that if I should become subject t the orkers' compensation provisions of Seclion 3700 of �he Labor OFiRwilh mply wi�h �hese provisions. � � � % /5 �j ppliWn(s g ur � Da�e � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensed under provisions o! Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full fpor.pce antl effect. Lic.#_._ . OOZ class#�/ � � ��s �� r'sSignaWre Date , CONSTRUCTION LENDING AGENCY: ❑ I hereby affrtn iha[ there is a consWc[ion lending agency for the peRormance of the work for which this permit is issued. (Sec. 3097, Civil Code�. Lender'S Name: Lender's Address: OWNER•BUILDER DECLARATIONS: I hereby affrm that under penalty of perjury Ihat 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 consWct. alter, improve. demolish, or repair any structure, prior to ils issuance, also requires the applicant for such permit to fle a signed slatement lhat he or she is licensed pursuant to the provisions of the Con[ractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code) or lhal he or she is exempt lhere(rom antl ihe basis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant for a permi� subjec�s the applicant �o a civil penalry of not more Ihan fve hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the stmcture is not intended or offeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, and who�does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, Ihe building or improvement is sold within one year of completioq the owner-builder will have the burden of�p}oving that he or she did not build�or improve for purpose of sale.). ❑ I,�as owner of�the property; am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractas License Law dces not appty to an owner of property who builds or improves thereon, and vfio contracts for such project with a cm�2c[Or(s) liten5e pursuant to the Con[ractars License Lavrs.). ❑^ I'am ezempt under sec. Business antl Professions Cotle for this reason: ' SignaWre ” Dale 305'l-46(3/OJ) Owner ID verifietl Dy dnv� � Driver's License No _.:ense. ❑ Yes ❑ Nc.... _ Expires: Verifcation of Ovmership by (rype of documen[, i.e. - properry tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �' ,� ❑ I hereby certify that no excavation frve (5) or more feet in depth�into vfiich a person is required to descend, vnll be made in connection with vrork authonzed by �his pertnil, antl lhat no building sWcture, scaffdding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) teet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, THe B, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work fmm the division. Ap0licanl's Signa�ure Division of Indusirial Sa(ety Permit Number. _ MAZAROOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicam or present or (uture building occupant need to file antl certity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe Califomia Health and Safery Code requires, with some exceptions, that a Business Plan be filed wi[h [he Costa Mesa Fire Depanment by every business which has at any one time dunng a reported year a quantity o( hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard [emperaNre and pressure). 2. Does or will ihe applicanl or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Ves ❑ No (Section 25533 of the Califomia Health and Safery Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of awtely hazardous materials equal to or greater than a weigh� of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will Ihe applicant or presen[ or (ulure builtling occupan[ need to prepare an RMPP (Risk Management antl Prevention Program for acu[ely hazardous materials�? ❑ Yes ❑ No (Section 25534 ot the Califomia Health and Safety Code provides Ihat Ihe Cos[a Mesa Fire Department may require the preparalion, certifica[ion and fling with ihe Fire Department of an RMPP by businesses which are required to register awtely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Safety Code been fully complied wi[h? ❑ Yes ❑ No 5. Does or will the applican[ or presen[ or (uture building occupant require for the work which is lhe subject of this application a pertnil for such wnstruction or modification from ihe South Coast Air Quality Management Dislrict or from any other air polWtion control tlisMct or agency? ❑ Ves ❑ No (Section 65850.2 of lhe Califomia Govemment Cotle requires Ihat ihe requesletl infortnatan be fumished on applications for non-resitlential building pertnits). 6. Will any part o( lhe facility to be constructed under this permil be within 1000 feet from the outer 6oundanes of a school? ❑ Yes ❑ No (If'yes", the tacility must meet the requirement of Sections 25534 antl 42303 of Ihe Calitornia Health antl Safety Code). 7. If a permit (rom the South Coast Air Quality Managemenl District or other air polWtion control disVict or agency is required for the vrork which is the subject of ihis application, have all of ihe tlisclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certificate of compliance fmm the appropriate air pollution contml oKcer�. � .� "' � - . CERTIFICATE OF COMPLIANCE: I certifyYhat under penalty of perjury the intormation given.above is correct I agree to compty with all stale laws and city ordinances regarding Hazardous Materials�and Emissions. r • , SignaWre ' Date CERTIFICATE OF COMPLIANCE AND-AUTHORIZATION OF ENTRY: I certi/y under penalry of perjury that I have read this application and�state Ihat the information given is wrrect I agree to comply vrith all state laws and ciry oitlinances relating to building consWction, and authorize representatives of the Cily of Costa Mesa to enter upon the above-descdbetl propeng for inspection purposes. I agree not to occupy or allow occupancy o( any builtling authorized by this permit until final inspection. � , awre r Ow er(s) Date � � , �5-�j Antlb/ on 2tlApOLcan� �Ddl¢ /