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Home My WebLink About565 PLUMER ST - Building Permits, , CITY OF COSTA MESA � , ' � � BlIILDING DIYISION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us �,�m� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. E08-00311 PERMIT TYPE E�EC APN: tpn050007 JOB ADDRESS: 565 PLUMER ST CM Vicinity: SIDE WALK . � STATUS: ISSUED DATE ISSUED: 08/01/2008 ISSUED BY: RMD Suite/Unit: ,, SCOPE OF WORK: ELECTRICAL PERMIT TO INSTALL A NEW 100 A SERVICE METER PEDESTAL FOR "AT&T', LOCATED ON THE SIDEWALK. . , , , � . ' OWNER: Address: PHONE: APPLICANT: WILLIS, JANAE M " .' � PHONE: 909-94fi-0905 � ,. CONTRACTOR: VCITE�ECOM Address: 1921 W y1TH STUnit City/State: UPLAN,D, CA � ELECTRICAL PERIVIIT FEES Electrical Plan Check F�e: Electrical Permit Fee: Reinspection Fee ' TOTAL FEES Unit: City/State/Zip: Address: �1921 W 11TN ST .Unit:. - , City/State/zZip: UPLAND, CA � PHONE: 909-946-0905 � ZipCode: 91786 $0.00 $54.00 $0.00 $54.00 License �No. 765716 CELL: NOTICE: The work authorited by lhis permil shall comply vrith all applicable handicap access requirements under Califomia 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. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applirable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this pertnit. t DE�. INSiECTONTYPE 0�T IN101pL5 CO�E1 INSPECTIONTYPE DRTE IN77iUL5 1616 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final . 208 Final Plumbing � 200 Final Re-Roof 210 Final Electncal 3 d '�1 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 � Final Building/Occupancy l � WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one of the tollowing declaretions: � I have and will maintain a certificate of consent to selt-Insure for workers' wmpensation, as provitleE (or Dy section 3700 of the LaDor Code, for Ne �p rmanca of Ihe work for which [his pertnit is issued. have and will maintain workers compensation insu2nce, as required by sectbn 3700 of the Labor Code, fw lhe perfamance of the Nork fa which this pertnit is issued. My workers' wmpensation Insurance cartier and policy Cartierrare: �� „n Cl n �u ��/(' �ii -t' (TNfSMunnepE�!�/p� mmn teJON mY'u�veluatl�etO�nehu�ndrtNtlotlars(ff00)aleu.) Policy Number: / I.1.1 ��J �� ` JV� �C Je� � certify ihat in the peAormance of the vnork br whlch this permit is IssueC, I ahall not employ any person,in any manner so as lo become subject to the workeri compensation laws of Califomia, antl agree that if I should becom ubject to Ihe workers' compensation provisions of Section 3700 of the Dor ode, I shall rth comply with these prov' ion AppllWntY SIOnaWm e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm lhat I am licensed under provisions of Chapter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Code, antl my license is in /fu^ll force antl eHect � / Lic. # �Y1- � Class # L _C� Con clor's SiB��ure te CON RUCTION LENDING AGENCY: ❑ 1 hereby affum that there is a construction IerMing agency fa the peAormance of the vurk for wfiich tNs pertnit is issued. (Sec. 3097. Civil Code). Lender's Name: Lender's ACdress: Ddie OWNER•BUILDER DECLARATIONS: I hereby affirm t�at under penalty ot peryury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW lor Ne following reason (Sec. 7031.5, Business and Protessions Cotle: My ciry or wunry which requires a permit to construct, aller, improve, demolish, or repair any strucwre, pnor to its issuance, also requires Ne applicant for such pertnit to fle a signed statement that he or she is licensed pursuant to lhe pmvisions of the Cont2ctors License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the Business and Professions Code) or that he or s�e is ezempt lherefrom and the basis for tne alleged ezemption. Any violation of Section 7031.5 by any appliwnt for a permit subjects the applicant to a civil penalry of not more than five hundrad dollars ($500).): ❑ I, as owner of the property, or my employees vrith wages as their sole compensation, WILL DO TME WORK, and Ne structure is not intenCetl or oftered for sale (Sec. 7044, Business anC Professions Code: The Contrectors license Law dces not apply [o an ovmer of properry v+ho builds or improves ihereon, and who dces suc� work himself or herself or through his or her ovm employees, provided that such improvements are not intended or oKered tor sale. If, hovrever, the 6uilding or improvement is sold within one year of completion, the owner-builder vnll have the burtlen of proving ihat ha or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to constnut ihe project (Sec. 7044, Business and Professions Code: The wntractors License Law tices not apply to an owner of pmperry who builtls or improves thereon, and who contracts fw such project vrith a contracta(s) license pursuant to lhe ConUactors Ucense Laws.). ❑ I am exempt under sec. Business antl Professions Code for Nis reason: 305]-06 (3/0]) Owner ID verified by tlrive .er. j Yes ❑ No Driver's License No. Expiws: �, Verification of Ownerehip by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I �ereby certdy tt�at no exwvation frve (5) w mae feet m depth into v.fiic� a person is required lo descend, will be matle in connection vrith work authorized by this pertnit, and that no building structure, scaffdding, falsewvrk, a demolition or dismantling thereof, wlll be more than thiAy-six (36) feet high. (Chap. 32, Grp 2, AA 2, Sec. 341, Ttle 8, Calitomia Atlministrative Cotle). ❑ As owner-builder, I will not employ anyone to do work which woultl require a pertnil trom the Division ol Intlustrial Safery, as noted above, unless such person has a permit to do such vrork from the division. Applicanl§ SlqnaWre Division of Induslrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' 1. Will the applicant or present or future building occupant neetl to file and certify a Business Plan for emergency response to release or threateneE release of a �azardous material7 ❑ Ves ❑ No (Seclion 25505 of l�e California Health an0 Safery Code requires, wiN some ezceptions, that a Business Plan be filed vnth the CosU Mesa Fire Department by every business which has at any one lime tlunng a reported year a quantity of hazardous materials equal to or greater than a v+eight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compresseC gas at standard temperature antl pressure�. 2. Does or vnll the applicant or present or future building occupant need to file a regisVation form for acutely hazardous matenals? ❑ Yes ❑ No (Section 25533 ot the Califomia Heal[h and Safety Cotle, with some exceptions, requires registration with the Cosla Mesa Fire Department by each business which at any one time has on hand a quantiry ot acutety hazardous materials equal to or greater than a vreight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressetl gas at sWndard tempe2Nre and pressure). 3. Dces or will the appliwnt or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 0! the California Health antl Safety Cotle provides that Ne Costa Mesa Fire Department may require [he preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Oepartment. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with7 ❑ Ves ❑ No 5. Does or will Ihe applicant or present orlulu�e building xcupant require for the work wtiic� is the subjecl of this application a permit for such conSWclion or modifcation from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes � No (Section 658502 of Ihe Califania Govemment Code requires Ihat the reQuestetl infortnation be fumished on applications fa norrresidential builtling pertnits�. 6. Will any part o/ [he facilily to be consiructed under ihis permil be within 1000 teet from the outer boundaries of a school7 ❑ Yes ❑ No (If yes", the facility must meet the requirement ot Sections 25534 and 42303 of [he Califomia Health and Safery Cotle). 7. If a pertnit from the South Coast Air Quality Management District or oNer air pollution wntrol district or agency is required for the �+ork which is the subject of this application, have all of the disclosures prescnbed by Califomia Health and Salety Code Section 42303 been matle? ❑ Yes ❑ No 8. (If'j�es", attach ceAi�cate of compliance from ihe appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify lhat under penalty of perjury the intortnation given above is correct. I agree to comply wiN all state laws and city ordinances regartling Hazardous Materials and Emissions. SignaWre Oare CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry of perjury that I have read this appliwtion and state that the information given is correct. I agree to comply with all state laws and city ordinances relatinq to building construction, and authorize representalives of the City of Cos[a Mesa to enter upon the above-tlescnbetl property for inspection purposes. I agree not to occupy or allow occupancy of any building aulhorized by this permit until fnal inspection. ignalu e of egai O� er(s) te C � AnElorAulhonzetlApplicanl DaL