The URL can be used to link to this page

Home My WebLink About2852 PINECREEK DR - Building PermitsCITY OF COSTA MESA BUILD/NG DIVISION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www ci costa-mesa.ca.us� y FOR INSPECTIONS CALL: (714) 754-5626 �"°'�* PERMIT NUMBER. E08-00316 PERMIT TYPE ELEC APN: TPN007230 JOB ADDRESS: 2852 PINECREEK DR CM vicinity: . � SCOPE OF WORK: 100 AMP. METER FOR AT&T COMMUNICATION BOX. STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 0810612008 V� REF: PS07-00812 : � � , ' ENCROACHMpNT PERMIT 70 EXCAVA7E IN PARKWAY TO PLACE CONDU77S AND AN ABOVE GROUND CABINET "ALP-248C". ATBT ; y�� . . . .. , OWNER: CITY OF COSTA MESA � . � � Address: Unit: PHONE: � � � . - City/State/Zip: -. , f-�, ., F�` � . APPLICANT: THOMAS,'DELEN � .: -��,�. Address: �� Unit: PHONE: 909 9523253 � . City/State/zZip: � CONTRACTOR: HHS COMMUNICATIONS � License No. Address: 305 N SACRAMENTO AVEUnit: .. �-. � PHONE: City/Slate: ONTARIO, CA ZipCode: 91764 � CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspectioh Fee $0.00 TOTAL FEES $54.00 913107 909-230-5170 .4 `.', NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremenls under California statutes and relaled regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTION$: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, and all required insppctions and final approval must be obfained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CODE/. INSPECTONT9E QR�F INTRULS COOE/ INSPECiIONTYPE QAT� INIfMLS 1616 fized System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final . 208 Final Plumbing q �,j� � � 200 Final Rg-Rool 210 Final Electriwl [��(r�d� ,(3C //Ht�CJ 7'� —�— 201 Final BIp�WRetaining Wall 212 Final Fire Prevention 202 Final Fa�yory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final BuilOing/Occupancy WORKERS' COMPENSATION DECLARA710N: I hereby aKrm under penally of peryury one of [he following declarations: ❑ I have and will maintain a certifcate of consent to self-Insure �or workers' compensation, as provided for by section 3700 of the Labor Code, for the pertor nce o( the work tor which this permit is issued. I have and will maintain workers' compensation insurance, as required by secl'an 3700 of lhe Labor Code, for the perfortnance of the vrork for which this permil is issued. My workers' compensation Insurance carrier and policy number are: , /� � � �/ �^ Carrier: _� �G. a� .Vt i D/i �7 �Q� (This sectar neetl ipt �e mnple?tetl acf-�Te pemu! is valuetl af one nundrcd WNars (Sf00) aless.) Policy Number. � 72. JJ v� ❑ I certify that in Ihe pertortnance of the work for which this pertnit is issued, I shall not employ any person in any manner so as to become subjecl to the vrorkers' compensation lavrs of California, and agree that if I should beco uDject to Ihe workers' ompensation provisions of Section 3700 of th abor �o , I shall t�' comply with these provision .. Appi�anYSSiBnalure D� O WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOIIARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE U+BOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing with Seclion 7000) ol Division 3 ot the Business and Pmfessions Code, antl my license is in full force and eflect. / Lic. tt / b class # l� / Contrettor'S SignaWre Date CONSTRUCTION LENDING AGENCY: � I herehy aHirm Ihat lhere is a consiructbn lending agency for the peAortnance of lhe �+ork fa v.hich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Da�e OWNER-BUILDER DECLARATIONS: I hereby affrm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the (ollowing reason (Sec. 7031.5. Business and Professions Code: Any city or counry which requires a permit to construcl, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant lor such permil lo fle a signed sta[emenl that he or she is licensetl pursuant lo the provisions of the Con[rectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business antl Pmfessions Cotle) or that he or she is exempt there(rom and the basis for [he alleged exemption. Any violation of Section 7031.5 by any applicanl (or a permit subjects Ihe applicant to a civil penalty o( not more [han fve hundred dollars ($500).): ❑ I, as owner o( Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intendetl 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 lhereon, and who does such work himself or herself or through his or her own employees, provided that such impmvements are not intendetl or oftered for sale. If, however, the building or improvement is sold within one year of completion, the ovmer-builder will have the burden of proving that he or she tlid not build or improve for purpose of sale.). ❑ I, as owner o( Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RAC70RS to conslruct Ihe project (Sec. 7044, Business and Professions Code: T�e cont2ctors License Law dces not apply to an rnmer o! property who builds or improves thereon, and who cont2cis ta such project with a cont2ctor(s) license pursuant to the Contractors Ucense Lavrs.). ❑ I am exempt under se� Business antl Professions Code tor this reason: Ovmer ID venfietl by tlnver's lic. ❑ Yes ❑ No Drivei s License No. Expires: Verifcation of Ownership by (lype ot document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: , ❑ I hereby certify Ihat no excavation fve (5) or more teet in depth into which a person is requiretl to descend, will be made in connection with work authorized by this pertnit, and that no building sWcture, scaffdding, falsewnrk, or demolition or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2. Art 2. Sec. 341, Tlle 8, Califomia Atlminisl2tive Cotle�. ❑ As ovmer-builder, I will not employ anyone to do work which would require a permit !mm the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Ap01iwn1's Signalure pale Division of Intlustrial Salety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will Ihe applicant or presenl or future building occupant need to (le and certify a Business Plan tor emergency response to release or threatened release ot a hazardous matenal? ❑ Yes � No (Section 25505 0! the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business wliich has at any one [ime during a reported year a quamity of hazardous materials equal to or greater than a weigM of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard lemperature and pressure). 2. Does or will the applicant or present or fuNre builtling occupant need to fle a regisiration form for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of ihe California Health and Safe[y Code, wi[h some exceptions, requires registration with the Cosla Mesa Fire Department by each business which at any one time has on hand a quantity ot acutely hazartlous matenals equal to or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure�. 3. Does or will the appliwnt or present or fuNre builtling occupant need to prepare an RMPP (Risk Management and Prevention Prog2m for acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the Cali�omia Health and Safery Code provides lhat the Costa Mesa Fire Department may require lhe preparation, certifcation and (ling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous matedals with the Fire Department. 4. If an RMPP is presently required, has Section 25534 01 the Califomia Health and Safety Code been fully complied vrith? ❑ Yes ❑ No 5. Does or will the appliwnt or present or fuWre building occupant require for the work v+hich is the subject of this applica[ion a permit for such wnsWction or motlification from the South Coasl Air Quality Management DisMc[ or from any other air pollution conlrol tlislrict or agency? ❑ Yes ❑ No (Section 658502 of ihe Califomia Govemment Cotle requires that ltie requestetl intortnation be fumished on applications for non-residential builtling permits). 6. Will any part of the (acility to be wnstruc[etl under this peimit he wilhin 1000 feet from the outer bountlanes of a school? ❑ Yes ❑ No Qf yes", the (acility must meet the requirement of Sections 25534 antl 42303 of the Cali(omia Health and Safery Code). 7. If a permit from the SoWh Coast Air Quality Management District or other air pollution conhol district or agency is required for the vrork which is Ihe subject of this appliwtion, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certificate of compliance from the appropriate air polWtion control offcer�. CERTIFICATE OF COMPLIANCE: I certify tha,t under penalty of perjury the information given above is cortecL I agree to compty vrith all state law3 antl city ortlinances reqarding Hazardous Materials and Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penally of perjury that I have read Ihis application and state Ihal the informalion given is cortecL I agree to comply vnth all state laws and city ordinances relating to builtling construction, and authorize representatives of Ihe Ciry of Costa Mesa to enter upon lhe above-described property (or inspeclion purposes. I agree not to occupy or allow occupancy of any builtling authonzed by Ihis pertnit until final inspec[ion. `� ' nawre a . � �eqs� �e Sgnalure Date / �l 905]a6 (]10�) 10 V An0/aAul�onlpEApPhWn� Datp