HomeMy WebLinkAbout419 ENCLAVE CIR - Building Permits� CITY OF COSTA MESA
F BI/ILDING DIVISION
i` 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
' �
� FOR INSPECTIONS CALL: (714) 754-5626 FO%-OOZ22 '
�`"'^^*�°"'� FIRE SUPRESSION PERMIT
JobAddress: 419 ENCLAVECI
Suite:
Viciniry: ' �
Parcel Nunmber: TPN007043 .
Applicant: KIRK HEMANS
Address:
Owner: THE IRVINE COMPANY
Address 1101NNOVATION
Zoning:
Phone: 714-666-8450
Zip:
Phone: 949-720-5536
IRVINE, CA Zip: 92612
Contracror: RESIDENTIAL FIRE SYSTEMS INC '. '
Address: 2871 E VIA MATRENS
ANAHEIM,CA '
Phone: 714-666-8450
Zip: 92806
License: 786965
Status: ISSUED
Applied: 06/27/2007
Issued: '07/03/2007
SCOPE OF PERMIT
PHASE 3, INSTALL 353 OVERHEAD SPRINKLERS FOR NEW 24,867 S.F. MFD, TYPE 3A, 28 UNITS
FOR "ENCLAVE APARTMENT HOMES"
FEE SUMMARY
Plan Check: $0.00 -
Permit: $0.00
Other: $0.00
Total: $0.00
rrc�- cW -��n ia�
Calc Valuation: so.00
Claimed Valuation: so.00
NOTICE: The work authorized by fhis permit shall wmply with 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 wmply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the expiration of this permit.
COOE t. INSPECl10NTYPE OATE IN7111�L5 CODE1 INSPECPONTYPE U�7F INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BIocWRetaining Wall 212 Final Fire Preventi0n
� � �I �l' �dQ i�iiii�"
202 Final Faclory Fire Placa 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demoli�ion ' 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrtn untler penalry of perjury one of the following tleclaretions:
❑ I have and will maintain a certificate of wnsent to sel4lnsure (or workers'
compensation, as provided for Dy section 3700 of the Labor Cotle, (or the
performance of the work (or which Ihis permit is issue0.
��. I�have and will maintain v.orkers' compensation insurance, as required by
5ectqm9700 of the Labor Code. for the peAormance of the vmrk fw which this
pertnil is issuetl. My workers' compensation Insurance carrier antl policy
�immberare;Z --�
ame,�-=���1-7� �NJ
(This setl.bn neeE ipf Oe mnpefe0l ilre pmn� is vaNiM al wre �wx1iM �ars (Ef001 a less.)
a�c,rnn„oe�:«-.Go/3SS3— 2�'7
a �,:.
--1 ce ify tfiat in the peAormance of the work tor which ihis permit is
issued, I shall not employ any person in any manner so as to become subject
ro the workers' compen etion laws of California, antl agree that if I should
become ubject to 1 vorkers' compensalion provisions o! Section 3700 of
the La bde, I forthwith comply wilh these provisions —
'"A�ti��nfs5ignalur�e-��-ii.:,+S.� yP>'�otOe1
�.i-. +1:;
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000�, 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 aKrm that I am licensed under provisions of Chapter 9(commencing
wilh Seclion 7000) of Division 3 of the Business and Pro(essions Code, antl
my licens�e i7s in full force and eRect. �-�—^ /!
Lic.# ._!� - ,�CII� ass� � C.G
�, �
dk i„!;:. _ � Q
�Co tor'zSigiature.��-,�^"-0-^+ pDa�'_�„���
yM � '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn ihat there is a constructbn lending agency tor the
perfortnance of ihe work fa v.fiich [his pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
LenCer's Adtlress:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby affirm that untler penalry of peryury t�at I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the followinq reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a pertnit to
construct, alter, improve, tlemolish, or repair any stNCWre, prior to its
issuance, also requires the appliCanl for such pertnit to fle a signeC statement
that he or she is licensed pursuan� lo lhe provisions of lhe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Busines5 and Pro(e55ion5 COde) Or that he or She i5 exempi therefrOm antl
the basis for the alleged exempGon. Any violation of Seclion 7031.5 by any
applicant tor a permi[ subjects Ihe applicaM to a civil penally of not more than
five huntlretl tlollars ($500�.�:
❑ I, as owner of the propeAy, or my employees with vlages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business anG Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, antl who does such wnrk himself or herself or t�rough �is or her own
employees, provided that such improvements are not intended or offered tor
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builder will have lhe burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo construct lhe project (Sec. 7044, Business and
Professbns Cotle: The contractors License Law dces not apply to an owner of
property who builtls or improves thereon, and who contracls fw such project with
a cont2clor(s) license pursuant to the Contractars License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-a6(3/0))
Ovmer ID verifed by driver s b. .a. ❑ Yes ❑ No
Driver's License No. Expires:
Venficalion o( Ownership by (type of document, i.e. - property tax 6i11 or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certdy thal no excavation (rve (5) or more feet in dept� into wfiich a
person is requiied to descend, will be made in connection with vrork authonzetl
by this permit, and that no building sWclure, scaFfdding, falsework, ordemolition
or dismantling ihereof, will be more ihan thirty-shc (36) feet high (Chap. 32, Grp
2. M 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As ovmer-builder, I will nol employ anyone to do work which would
require a permit trom Ihe Division of Industrial Safery, as notetl above, unless
such person has a permit to tlo such vrork fmm lhe division.
Apoliwnfs Slgnalure Dale
Division o( Industrial Safe�y Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or present or future building occupant need [o file and
certify a Business Plan for emergency response to release or ihreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of lhe California Health antl Safery Code requires, with some
exceptions, lhat a Business Plan be fletl with the Costa Mesa Fire
Depahmen[ 6y every business which has at any one [ime dunng a reported
year a quantity of hazardous materials equal [o or greater Ihan a weight of
500 pounds, or a volume o! 55 gallons, or 200 cubic feet o( compressed gas
al standard temperaWre antl pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous ma[enals? ❑ Yes ❑ No
(Section 25533 of the Cali(omia Health and Safety Code, vnth some
excep�ions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials 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
temperaNre and pressure).
3. Does or will the applicant or present or future building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Seclion 25534 of the California Health antl Safety Code provides Nat the
Costa Mesa Fire �epartment may require the preparalion, certification antl
filing with the Fire Department of an RMPP by businesses which are requiretl
b register acutely hazardous materials wiM the Fire Department.
4. I! an RMPP is presently require4 has Section 25534 0( t�e Califomia
Health antl Safe[y Cotle been fully complied with? ❑ Ves ❑ No
5. Does or will ihe applicant or present or (uture building occupant require for
the work which is the subject of this application a pertnit for such consWction
or motlification (rom the South Coast Air �uality Management District or from
any other air pollution conlrol district or agency? ❑ Yes ❑ No
(Section 658502 of Ihe Califomia Govemment Cotle requires Ihat Ihe requested
inlormatbn be fumishetl on applications for rwn-residential buiWing pertnits).
6. Will any pan of the facility to be consiructed under Nis pertnit be within
1000 feet (rom lhe outer boun0aries of a school? � Yes ❑ No
(If "yes", �he facility mus� meet the requirement of Seclions 25534 and 42303
of Ihe Califomia Health and Safely Code).
7. I( a pertnit from the South Coasl Air Quality Management Distnct or other
air pollution control disMcl or agency is required for the work which is the
subject of this application, have all of the disclosures prescnbeC by Califomia
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certifcate of compliance from the appropriate air pollutlon
control oHicer).
CERTIFICATE OF COMPLIANCE: I certify lhat under penalry of perjury ihe
infortnation given above is correcl. I agree to comply with all state lav+s antl
city ordinances regartling Hazartlous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cetlify under penalry of perjury that I have read ihis application and slate that
the in(ortnation given is conecL I agree to compty with all state laws and city
ordinances relating ro building construc[ion, and authonze representatives of
the Cily of Costa Mesa to enter upon ihe above-descnbed property for
inspeclion purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until final inspection.
SignaWreo eBalOwner(s) �31e
, And/ �AulhOnz¢EApdifanl �'+- r �Dd """ n/.
'���...a:�2f._.-^�•� I ' '.F
CITY OF COSTA MESA
BUILDING DIV/SION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax Q14) 754-4856 • vnvw.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626 FO7-0O.3OH
FIRE SUPRESSION PERMIT
Job Address:
Suite:
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor:
Address:
419' ENCLAVE CI Status:
. . . - .. � �� Appiied:
. - . Issued:
TPN007043;;:, * . Zoning:
VICTOR BALANCIO , , "
17992 CON/AN -
PhOne: �949-474-0555
IRVINE,-CA "` � Zip: 92614 � �� � - '�� '
THE IRVINE:COMP,ANY, „ - '
1101NNOVATION - - -
- Phone: 949-720-5536 �- � � �
IRVINE,�CA . -._ Zip:.... 92612.. . � .- . . . " � �� -
i` `- ' ' - - ' " = � � ` ` '
THE GREATER ALARM CO INC
17992 COWAN' .. .' " . - . � .
�_:; � :,�� �. ����PHooe: 949-4740555�. .� ��- � .i:'
IRVINE CA � - , ' � � Zip: 92614 -' . ' , ,
�-`
� License: 4690466 - , � � ,
ISSUED
10/31 /2007
11/OS/2007
SCOPE OF FERMIT
FIRE ALARM SYSTEM FOR PHASE III: NEW 24,867 S.F: MFD,.TYPE 3A, 28 UNITS FOR "ENCLAVE
' � APARTMENT..HOMES”. REF#: BC07-00061 ` . � - - � � �
�,�, . . . " .. . �
FEE'SUMMARY
Plan Check: $0.00 ,' '. . Calc Valuation: go.00
Permit: 9 " . ` ` . ` Claimed Valuation: $o.00
Other: $0.00 _ . .
TotaL• _ _
FrP-cw - e, �, lo�d
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.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply 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.
COUE p. INSPECiION TYPE
1616 Fixed System Final Fire Prevention
i266 Pool Spa Final
200 Fina� Re-Roo(
201 Final Block/Retaining Wall
202 Final Factory Fire Piace
203 Final Sign
204 Final Demolition
DATE INTITIALS CODEtl INSPEC710NTYPE
206 Final Mechanicat
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 FinalPlanningApproval
222
250
Final Site
Final Building/Occupancy
�ATE INTITIALS
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalty o( perjury one o( ihe followinq declarations: -
❑ I have and will maintain a certifica[e of consenl lo self-Insure (or workers'
compensa[ion, as provitletl for by section 3700 of the Labor Code, (or the
pertormance of Ihe work !or which this permil is issued.
I have and will maintain workers' compensation insurance, as required by
s � n 3700 ot tha Labor Code, for the performance of the work for which this
pertni[ is issuetl. My workers' compensation Insurence carrier antl policy
number are1-:��r�� , y � , 1,,
Ca�rier:�.� I�l.ftil/�NH�— � �-�.�• GU •
`—�rhasecnonneee o�bemmpletea�tnevTm!rt1a�va.luetlatwehuntlredOollars(SIDO)orless)
Poi IicyNumber. �3�c�cl��
❑ I certify that in Ihe peRormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the worker ' mpensation ws of California, and agree that if I should
become su 'ect the worker ' compensation provisions of Section 3700 of
the Labor ha I forthwi .comply_y�ith these provisions.
1/-�i.-n�
. gna rqi � ��:
WARNING: FA7LUfZE'f0 S�URE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SWILL 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, IMEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn Ihat I am licensetl untler provisions of Chapter 9(commencing
vri[h Section 7000) of Division 3 of the Business and Professions Code, and
my license is in 11 force and effect. � /��
Lic. #— 'UId55 #� � V� �'Ci�
� __ • .6
or'sSi Wre a�e �
CONSTRUCTI E AGENCY:
❑ I hereby aKrm that the2 is a construclbn lending agency for the
pertortnance of [he work far which IhiS permit is issued. (Sec. 3W7, Civil Code).
Lender's Name:
Lender'S Address:
OWNER-BUILDER DECLARATIONS:
1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe (ollowing reason (Sec. 703L5.
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any stmcture, pnor to its
issuance, also requires the applicant For such permit to Ne a signetl statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chap[er 9(commencing with Section 7000) of Division 3 of the
eusiness antl Professions Code) or ihat he or she is exempt iherefrom and
the basis for the allegetl exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).�:
❑ I, as owner of the pmperty, or my employees with wages as their sole
compensation, WILL DO THE WORK, and ihe structure is not intended or
offered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law tloes not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or Ihrough his or her own
employees, provided Ihat such improvements are not intended or offered for
sale. If, however, Ihe building oi improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.). �
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not apply to an owner of
propetly who builds or improves lhereon, and who contracts for such project with
a contracta(s) license pursuant to Ihe Contraclors License Lavrs.�.
❑ I am exempt untler sec.
Business and Professions Code for this reason:
305]-06 (3I0�)
Owner ID verifed by driver's . ,e. ❑ Yes ❑ No
Oriver's License No. Expires:
Verifcation of Ownership 6y (type of document, i.e. - pmperty tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certrfy that no excavation five (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection with work authonzed
by this pertnit, and [hat no building stmcWre, scaffolding, falsework, v demolition
or dismantling thereof, vrill be more than thitly-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will no[ employ anyone to do work which would
require a permit from the Division of Industnal Safe[y, as no[ed above, unless
such person has a permi[ to do such work from the division.
Appliwnfs SignaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant neetl to (le antl
certify a Business Plan for emergency response to release or threa[ened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, vrith some
exceptions, that a Business Plan be fled with lhe Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantiry ot hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperaWre and pressure).
2. Does or will Ihe applicant or present or future builtling occupanl need to file
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of ihe Califomia Heal[h and Safety Code, with some
exceptions, requires regisiration with the Costa Mesa Fire Departmen[ by
each business which at any one time has on hantl a quanti[y of acutely
hazardous matenals equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at sWndard
temperaWre antl pressure).
3. Does or will ihe applicant or presen[ or (uture building occupant neetl �o
prepare an RMPP (Risk Management and Prevenlion Program (or acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health and Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing wi[h [he Fire Department o( an RMPP by businesses which are required
to register acutely hazardous materials with ihe Fire Department.
4. I( an RMPP is presently required, has Section 25534 of lhe California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applican[ or present or fu[ure building occupant require for
ihe work which is the subject of ihis application a permit for such construction
or modi(cation from the South Coast Air �ualiry Management District or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requires that the requested
intormation be fumished on applications fa nornresidential builtling pertnits).
6. Will any part of [he facility [o be cons[ructetl under this permit be within
1000 fee[ from the ou[er boundaries of a school? ❑ Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit (rom the Soulh Coast Air Qualiry Management Dislricl or other
air polNtion control district or agency is required for the work which is ihe
subject ot this applicatioq have all of the disclosures prescribetl by California
Health and Sa(ery Code Section 42303 been made7 0 Yes ❑ No
8. (If'+�es", attach certifcate of compliance from the appropriate air pollution
contml officer).
CERTIFICATE OF COMPLIANCE: I ceAify that under penalry of perjury the
infortnafion given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions. '
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihal I have read this application and state that
the information given is correct I agree to comply with�all state laws and city
ordinances relating to building constmclion, and authorize representatives of
lhe Ciry of Costa Mesa to enter upon the above-describetl property for
inspec[ion purposes. I agree nol to occupy or allow occupanGy of any building
authorized by Ihis permit until fnal inspection. .
SignaWr IOwn Date
� 1` •�
Antlbr t rrzetlAppliwn Ddle,
CITY OF COSTA MESA
BUILDING DIV/SION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
F07-00222
Job Address�.
Suite:
Viciniry:
Parcel Nunmber:
ApplicanT.
Address'.
Owner
Address
Contractor.
Address.
FIRE SUPRESSION PERMIT
419 ENCLAVE CI " Status:
`=� � - Applied:
, t Issued:
TPN007043 ' ' :Zoning '_
DOUG BROZOVICH =''
1202 EAST HUNTER�A�VE��
- Phone �,�714-231-0139 , �`"�'�
SANTAANA,�CA: - Zip �92705" ,
ys ` _ .
TNE IRVINE�COMPANY
110:INNOVATIONG .. � ' � �
. - . Phone: 949-720-5536 �
:� . �. � s ,�.,
IRVINE CA �.: �: '. ...,.. �.,.,(.,.Zip,.".:':92612 . ....:..... . ..�_:' . ;'....., �,,
BAKER COMPANY CONSTRUCTORS INC
1202ERSTHUNTERAVE:.�� - �- �
"Phone 714-835-8572�'� . �
SANTA ANA CA�, .. Zip: 92705 i--.. �- �
. License�. 822444�'".- � f -
4'
PHASE 3, INSTACL 353 OVERH
FOR "ENCLAVE APARTMENT F
�.r;.ouvrr. �r..e�rtrvu � . : ....,
D SPRINKLERS FOR:NEW.2,4,867 S F �M�FD, TYPE 3A� 28 UNITS
AES"`;.: - -_ �
ISSUED
osiz�izoo�
07/03I2007
rtt SUIVIIVIHKYG
Plan Check: $0.00 ' � ' ' �� ��Calc Valuation: $o 00
Permit: $0.00 �`� � �° � �'-`�" Claimed Valuation: $o.00
Other $0.00
Total: $0.00
�rP-cw-�Ii`t �G`'d
NOTICE: The work authonzed 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. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiralion of this pertnit.
OC OEM. INSPECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Pinal �
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Finai Factory Fire PlaCe
203 Final Sign
204 Final Demolilion
OATE IN1111FL
0
OOEA'� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212
220
222
250
Final Fire Prevention
Final Planning Approval
Final Site
Final euilding/Occupancy
DATE M71M�5
G'%�% L�g �Ya�(iGh
WORKERS' COMPENSATION DECLARATION:
I hereby affrm untler penalty of perjury one of ihe fa�uwing declarations:
❑ I have and will maintain a certifca[e of consen[ to sel4lnsure4or workers' �
compensation, as provided for by section 3700 0( ihe Labor Cotle, /or the
peAormance o( Ihe work for which this permit is issued. ,
I have and will main�ain �wrkers' compensation insurance, as required by �
C an=3700 of the Labor Code, fw the performance of the work for which this
permi� is issued. My workers' compensation Insurance carrier and policy
num6erare: � ^�1p� ^ ^
/CaMei: `5_ �� �n�Y
�jThrssecfunnee0irol�emm leletldthepermdrsvaluIed,at ehmW�edtlollars(5f00)orlessJ
PoticyN���� ��Y�
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� I certify thal in the performance of the vrork for which this permit is
issued, I shall nol employ any person in any manner so as to become subject
to [he vrorkers' compensation laws of Califomia, and agree [hat if I shoultl
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Cod I �co�m - �lh lhese provisio s.
_l— — —�'Sc � �1 'J 0
�s5ig.aWre�.r-,=� �ate —
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 aKrm ihat I am licensed under provisions o( Chapter 9(commencing
wi[h Sec[ion 7000) of Division 3 of the Business antl Professions Code, and
my license is in full force and eRect.
S
Lic. # � �- Class # �'_`. �
_ �
� vactor'sSig awre _ a a�e -'.
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a construction lending agency for the
performance of tlie work fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
Dale
OW NER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pro(essions Code: Any ciry or county which requires a permit to
consWct, alter, improve, tlemolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
[hat he or she is licensetl pursuan[ to the pmvisions of the Contractors
License Law (Chapter 9(commencing wiN Section 7000) of Division 3 of the
Business and Pro(essions Cotle) or tha[ he or she is exempl lherefrom antl
the basis (or [he alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry o� not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the sirucWre is not intended or
oftered for sale (Sec. 7044, Business antl Professions Code: The Contrec[ors
License Law does not appty to an owner of property who builds or improves
thereon, and who does such vrork himself oi herself or through his or her own
employees, provided that such �impiovements are not intended or offered foi
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
did not build or improve for purpose of sale.). �
❑ I, as ovmer of�the:property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to consWc[ [he prqect (Sec. 7044, Business and
Professions Cotle: The contractors License Law dces not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Con[ractors License Laws.�.
❑ I am exempt under sec.
Business and Professions Cotle for [his reason:
Owner 10 venfied by drivi nse. ❑ Ves ❑ No
Driver's License No. Expires:
Verifcaiion ot Ownership by (type o( document, i.e. - property tax bill or deetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' �
❑ I hereby certrfy ihat no excavation five (5) or more feet in depth into which a
person is required [o descend, will be made in connection with work authonzed
by ihis permit, and that no building structure, scaffdding, falsework, a demolition
or dismantling thereof, vrill be more than ihirty-six (36) (eel high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Atlminisl2tive Code�.
❑ As owner-builder, I will not employ anyone to tlo wark which would
require a permit from the Division of Intluslrial Safety, as noted above, unless
such person has a permit to do such work fmm Ihe division.
Appliwm's 9gnamre
Division of IndusMal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or /uture building occupan[ need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quan[ity of hazardous materials equal [o or grea[er [han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature antl pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hanC a quantiry o( awtely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future builtling occupant need lo
prepare an RMPP (Risk Managemenl antl Prevention Program (or acutety
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of the California Health an0 Sa(ety Code provides [hat the
Costa Mesa Fire Department may require the prepara[ion, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to regisler acutely hazartlous malerials wi[h the Fire Department.
4. It an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied withl ❑ Yes ❑ No
5. Does or will the applicant or presen[ or (uture building occupant require tor
the work which is the su6ject of this applicalion a permil for such cons[ruction
or modificalion from �he Soulh Coast Air Quali[y Managemen[ District or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Section 658502 of [he Califomia Govemment Code requires [hat the requested
infortnatian be (umished on applications for non-residential building pertnits).
6. Will any part of Ihe faciliry to be constmcted under this pertnit be within
1000 feet trom the outer boundaries of a school? ❑ Yes ❑ No
(If'yes", the lacility musl meet the requirement of Sec[ions 25534 and 42303
of ihe Califomia HeaIN antl Safery Cotle).
7. If a permi[ lrom the South Coasl Air Quality Managemen[ Distnct or other
air pollution control district or a9ency is required for the work which is the
subject ot this application, have all of the disclosures prescri6ed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from the appmpriate air pollution
control offcer). . . � � �
CERTIFlCATE OF,COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Ma�erials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihat I have read Ihis application and s[ate Iha[
the information given is correct. I agree to comply with all state laws and ciry
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa ro enter upon Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhorized by [his permit until final inspection. .
' SlgnaWr ga 2r�5 ao
SignaWre - , , Date [ '
JOS]-46 (JIW) - "
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