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Home My WebLink About208 FLOWER ST - Building PermitsCITY OF COSTA MESA �pMF BlIILDING DIV/SION Ft �y. 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �. � B FOR INSPECTIONS CALL: (714) 754-5626 ��"°"°"°fi PERMIT NUMBER: P09-00155 PERMIT TYPE PLUM APN: 42540402 JOB ADpRESS: 208 FLOWER ST CM Vicinity: METER TO HOUSE � STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 12/03/2009 RMD SCOPE OF WORK: REPLACE GAS LINE FROM METER TO HOUSE FOR A SFD. OWNER: UTTERBACK, EUGENE L Address: 2336 PURDUE DR PHONE: City/State/Zip: COSTA MESA, CA . APPLICANT: BANGERT, WILLIAM Address: PO BOX 72 : � PHONE: 714-838-0937 City/State/zZip: TUSTIN, CA - CONTRACTOR: MBTJ BANGERT INC Address: pp BOX 12 City/State: TUSTIN, CA ZipCode: 92781 ARCHITECT: ENGINEER: License No. License No. License No. 752497 PHONE: 714-636-0937 CELL: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $33.30 . TOTAL FEES: $33.30 PHONE: PHONE: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statWes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) - EXPIRATION: PERMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DAiE OF LAST INSPEC710N. 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 resWt in the expiration of this permit. COOEk. MSPEPONiVGE OATE INTITIALS GOOEC INSPECTIONTYPE OpTE INTI71pL5 1616 Fixed System Final Fire Prevention 206 Final Mechani�yl 1266 Pool Spa Final 208 Final Plumbing Z e� �I - 200 Fina! Re-Roof 270 Final Elechical 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 Finat Building/Occupancy WORKERS' COMPENSATION DECLARATION: 1 hereby aKrm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sel�-Insure for workers' compensation, as provitled for by seclion 3700 of the Labor Code, for the peAormance o( the work for which this permit is issued. I have and will maintain vrorkers' compensation insu2nce, as requiretl by secfan 3700 of the Labor Code, for the peAortnance of the work (or which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: carri� �� v �l q /�/ C/C (This seIX.on need rro16e wmdefed Rl�e peimR is vaWeO at one huntlrzN tldlars (5100) a less ) " cr��co��t3ov PolicCN mber: ❑ I certify tha[ in [he pedormance of the vrork /or 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 California. and agree thal i( I should become subject to the workers' compensation provisions of Section 3700 of Ihe L� or Cotl , shall (orthwith comply with [hese plovis' ns. � � 2 J n�.x.' Wre �eS�7`'� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmfessions Cotle, and my license is in full force antl effect. I LiC.�.#�!i'�> ' � C��iss # � � b J �,e,utr 1's Sign � r l Uat ".-_4 K... V CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm thal [here is a construction lending agency fw lhe peAortnance of the wvrk fa which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalty of perjury that I am EXEMP7 FROM 7HE CONTRAC70R5 LICENSE LAW (or Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement lhat he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and Ihe basis for the alleged exemption. Any violation of Section 7031.5 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 property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, and the structure is not intended or oKered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who tloes such work himsel( or herself or through his or her own employees, provided that such improvements are not intended or offeretl for sale. If, however, the building or improvement is sold within one year of completioq the owner-builder will have Ihe 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 UCENSED CONTRACTORS to construct Ihe project �Sec. 7044, Business and Pmfessions Cotle: The contractors License Law does not appty to an ovmer of propeAy who builds or improves thereon, and who coniracts for such project wiih a contracta(s) license pursuant to the Contrectas Ucense Wws.). ❑ I am exempt under sec. Business and Professions Code (or this reason: 305]-46(3/0]) Owner ID venfietl by tlriver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (rype of tlocument, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cert'rfy that no excavation frve (5) or more feet in depth into wfiich a person is required to descend, will be made in connectbn with work authonzetl by this permit. and that no building s[ruclure, scaffdtling, (alsework, a demolition or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sea 341, Title 8, Califomia Administrative Code). ❑ As ovmeo-builder, I will not employ anyone to tlo vrork which would require a permit from Ihe Division of Industrial Safety, as noted above, unless such person has a pertnit to do such work from [he division. Applicanl's SgnaWre Date Division of Indus�rial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle and certify a Business Plan (or emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia 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 quantiry of hazartlous materials equal ro or greater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas at standard temperature and pressure). 2. Does or will the applicanl or present or future building occupant need to file a regis[ration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of [he California Health antl Safery Code, with some exceptions, requires registration with the Costa Mesa Fire �epartmeN by each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or greater than a weight o( 500 pountls, or a volume ot 55 9allons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Pmgram for acutely hazardous materials)? � Yes ❑ No (Section 25534 ot Ihe Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing wilh the Fire DepaRmen[ of an RMPP by businesses which are requiretl to register acutely hazardous materials with the Fire Depanment. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Safety Code 6een fully complied with? ❑ Yes ❑ No 5. Does or vnll the applicant or present or future builtling occupant require lor Ihe vrork which is lhe subject of lhis application a permit for such consWclion or motlification from the South Coast Air Qualiry Management District or from any other air polWtion contml dislrict or agency? ❑ Yes ❑ No (Section 658502 of [he Califomia Govemment Code requires ihat Ihe requestetl infortnation be fumished on applications fa nomresidential building permits). 6. Will any part of the facility to be constructed under this pertnit be within 1000 feet from Ihe outer boundaries of a school? ❑ Yes ❑ No (If 'yes", the faciliry must meet the requirement o( Sections 25534 and 42303 of the Calitornia Heal[h and Sa(ety Code). 7. If a pertnit from the South Coast Air �ualiry Management District or other air pollution control tlistrict or agency is required for the work vfiich is the subject o( Ihis application, have all of Ihe disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appropnate air pollution con[rol otfcer). CERTIFlCATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcl. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signalure CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this application and state that Ihe information given is correc[. I agree to comply with all slate laws and city ordinances relating lo builtling cons[ruction, and authorize representatives of ihe City of Costa Mesa to enter upon the above-described property /or inspection pu se . agree not to occupy or allow occupancy of any building au�ho � ed by � e it uNil fn � sy pection. � SignaWreo Lega er�s) Dale rv� �YS !-Fn (o.e.n.t L � y u� rbda AutliOniltl AOd��nl %Da��l�e t..G/a�J'� �p._'