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Home My WebLink About993 PAULARINO AVE - Building PermitsCITY OF COSTA MESA �,��pMFy BUILDING DIVISION F`�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • vnvw.ci.costa-mesa.w.us � FOR INSPECTIONS CALL: (714) 75d-5626 4y�ofi PERMIT NUMBER: E09-00092 PERMIT TYPE ELEC STATUS: ISSUED APN: TPN007222 DATE ISSUED: 04/2012009 ISSUED BY: CAC JOB ADDRESS: 993 PAULARINO AV CM Vicinity: SCOPE OF WORK: 100 AMP SERVICE ON AT&T PEDESATL. OWNER: CITY OF COSTA MESA PHONE: Suite/Unit: Address: Unit: Ciry/State/Zip: APPLICANT: JIMGRABER Address: P 0 BOX 20047 Unit: PHONE: 714454-1276 City/State/zZip: FOUNTAIN VALLEY, CA CONTRACTOR: BAR NONE COMMUNICATIONS License No. 881063 Address: P O 80X 20047UniC PHONE: 714454•1276 - City/State: FOUNTAIN VALLEY, CA ZipCode: 92728 _ CELL: pr . :,l ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES $54.00 -r,•1-000t�z .. . .; ..1J �'.1 t� 61 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related iegulations. (Ortl. No. 92-28, § 1, 12-21-92) i EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In ordei for the work authonzed under this pertnit to be considered legal, such work must comply with all applicable codes, and all �required inspections and final approval must be obtained. Failure to obfain inspections and final approval will result in the expiration of this permit. OEt. INSPECiIONTYPE DRTE IN7171R15 COOEt INSPECTIONTYPE ORTE INiRIRLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20B Final Plumbing �f_L � 200 Final Re-Roof 210 Final Electrical y �� 207 Final Block/Retaining Wall 212 Final Pire Prevention 202 Final Factory Fire Place 220 Final Planning AOProval 203 FinalSign 222 FinalSite -'s+i;j�� 204 Final Demolition 250 Final Building/Occupanty WORKERS' COMPENSATION DECLARA71bN: I �ereby affrm under penalry of perjury one o� the follovnng declaralions: ❑ I have and will maintain a certifcale of consent to self-Insure for vrorkers' compensation, as provided for by seaion 3700 of the Labor Code, !or the performance of Ihe vrork tor which this permit is issued. I have and will maintain workers' compensation insurance, as requiretl by se tbn 3700 of the labor Code, !or the peAormance ol the wnrk for which this pe is issued. My workers' compensalion Insurance carrier and policy be are: � , s+A�� Fuwn �edion need no10e cnmpletetl illhecp�erm'Rl is �vialued al one huntl�etl dollars ($f 00) or less J mber: �/3� � � 1 7 '/ � ❑ I certify that in the peAormance of lhe work for which this permit is issued, I shall not employ any person in any Manner so as to become subject to the workers' compensation laws of Califqrnia, and agree that if I should become subjecf to [he workers' compensati0n provisions o( Section 3700 0( the La or Code s lal orthwith comply with these provisions. , -og p4ra ' Signature e ARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNU+WFUL AND SHALL SUBJECT qN 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 LqBOR CODE. IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn that 1 am licensed under provisions o( Chapter 9(commencing �ction 7000) of Division 3 of the Busihess antl Professions Code. and nse is in full torce and e(fect. Lic. # � � � C-10 C^ � � — C°� — omr's aWre Date NSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn ihat there is a cons[ructbn lending agency fa ihe pedormance of Ihe work fa which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OWNER•BUILDER DECLARATIONS: I hereby affrm that under penalry ol perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or County which requires a permit to cons[ruct, alter, improve, demolish, or repair any slrucWre, prior to its issuance, also requires the applicant lor such permit to file a signed statement Ihal he or she is licensed pursuant to tha provisions of the Contractors License Law (Chapter 9(commencing wilh 9ection 7000) ot Division 3 of the Business and Professions Code) or that he or she is exempl therefrom antl the basis for the alleged exemption. Any vi0lation of Seclion 7037.5 by any applicant for a permit subjec[s the applicant to a civil penalty of not more than five hundred tlollars (3500).�: ❑ I, as owner of the property, or my employees with wages as their sole wmpensation, WILL DO THE WORK, and the structure is not intentletl or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or hersetl or thmugh his or her own employees, pmvided that such impmvements are not intended or ofleretl for sale. If, however, the buildin9 or improvement is sold within one year o( completion, the ovmer-builtler will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the pmperty, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct lhe prqect (Sec. 7044, Business and Professions Code: The contractas License Law tloes not apply ro an owner ol property who builds or improves lhereon, and who contracts for such project with a contractw(s) license pursuant to the Cont2ctors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SlgnaWre Date ]OS)-46�3/O)) Owner ID verifed by drivei a license. ❑ Yes ❑ No Driver's License No. Expires: Veri(ication of Ownership by (type of document, i.e. - pmperty [ax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CER7IFICATION: ❑ I hereby certify that no excavation frve (5) or more feet in depth into which a person is required to descend. will be made in connection with work authorized by this pertnit, antl that no building swcture, scaffdtling, falsework, v demolition or dismantling Ihereol, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 347, Ttle 8, Calitomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permil from the Division of Industrial Sa/ely, as noted above, unless such person has a permit to do such vrork from the division. AOPliwm's SignaWre Date Division of IndusUial Sa(ety Permit Numbec HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicanl or p�esent or (uNre building occupant neetl to fle and certify a Business Plan !or emergency response lo release or threatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of the Calitornia Health and Sa(ety Code requires, with some exceptions, that a Business Plan be filetl wilh the Costa Mesa Fire Depariment by every business which has at any one time during a reportetl year a quantity of hazardous matenals equal to or greater than a weighl of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard remperature antl pressure). 2. Does or will the applicant or present or fWure building occupanl need to file a registration form for acutely hazartlous materials7 ❑ Yes ❑ No (Section 25533 of the California Heallh and Sa(ety Code, vrith some exceptions, requires registration vrith the Costa Mesa Fire Department by each business which at any one lime has on hand a quanliry of acutely hazardous materials equal to or greater than a weight ot 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressetl gas at sfandard temperaNre and pressure). 3. Does or vnll ihe applicant or present or fWure building occupant nee0 to prepare an RMPP (Risk Management and Prevention Program br acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provitles [hat Ihe Costa Mesa Fire Department may require the p�eparation, certifca[ion and filing vrith Ihe Fire Department of an RMPP by businesses which are required to regisier aculely hazardous materials with the Fire Departmen[. 4. If an RMPP is presenUy required, has Section 25534 ot the Calitomia Health and Satery Co�e been fully complietl with? ❑ ves ❑ No 5. Does or will Ihe applicant or present or (uWre building ocwpant require (or the work which is Ihe subject of Ihis applicalion a pertnit lor such construction or modification from the South Coast Air �uality Management Dislrict or (rom any other air pollution coNml dislrict or agency? ❑ Yes ❑ No (Seclbn 658502 0l the Calitomia Govemment Code requires that the requested information be fumished on applicaiions ta nornresidential building permits). 6. Will any part ol the facility to be constructed under this permit be within 1000 leet from [he outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the facility must maet the requirement of Sections 25534 and 42303 of the California Health and Safety CoOe). 7. If a permit from the SOWh Coast Air Quality Management Dislrict or other air pollution contml tlistrict or agency is required for the work which is the subject of this application, have all of lhe disclosures prescribed by California Health and Safery Code Seaion 42303 been made? ❑ Yes ❑ No 8. Qf "yes", auach certifcate of compliance from the appmpriate air pollution control o�cer). CERTIFICATE OF COMPl1ANCE: I certify that untler penalty of perjury the information given above is correcl I agree to comply vrith all state laws and city ordinances regarding Hazardous Materials and Emissions. SignaWre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty o( perjury that I have read lhis application and s[ate that the information given is correct. I agree ro comply with all state laws and ciry ordinances relating to building constmction, and authorize representatives of the Ciry of Costa Mesa lo enter upon the above-described property for inspeclion purposes. agree not to occupy or aliow occupancy o( any huilding authori y ih' e�f unlil final inspection. natore of Legal Ovmer�s) Oale h,. GRA - li—�-?(`Z-=�% Anp/OrAumon nl ��oa�e