HomeMy WebLinkAbout210 FLOWER ST - Building PermitsCITY OF COSTA MESA �
��pM BUILDING DIV/S/ON
i�, � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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� FOR INSPECTIONS CALL: (714) 754-5626
��"""`°� PERMIT NUMBER: P09-00156
PERMIT TYPE PLUM
APN: 42540402
JOB ADDRESS: 210 FLOWER ST CM
Vicinity: METER TO HOUSE �
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unitc
ISSUED
12103I2009
RMD
SCOPE OF WORK: REPLACE GAS LINE FROM METER TO HOUSE FOR A SFD.
OWNER: UT7ERBACK, EUGENE L��, Address: 2336 PURDUE DR
PHONE: � City/StatelZip: COSTA MESA, CA
APPLICANT: BANGERT, WILLIAM . Address: PO BOX 12 :
PHONE: 714-838-0937 City/State/zZip: TUSTIN, CA �
CONTRACTOR: MBTJ BANGERT INC License No. 752497
Address: PO BOX 12 PHONE: 714-838-0937
City/State: TUSTIN, CA ZipCode: 92761 CELL:
ARCHITECT: - License No. ' . PHONE:
ENGINEER: License No. � PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$33.30
$33.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(omia 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 appliwble codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in lhe expiration of this permit.
LOOEp. INSPEGPONttPE DATE INTITIAlS CODE% INSPEGTIONTYPE �AIE INiITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical .
1266 Pool Spa Finyl 208 Final Plumbing � fi
200 Final Re-Roof 210 Final Electrical
201 Final BIocWRetaining Wall 212 Final Fire Preven�ion
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalty o( perjury one of the following declaralions:
❑ I have and vrill maintain a certificate of consen[ to self-Insure for workers'
wmpensation, as provided for by section 3700 of the Labor Code, for ihe
peRormance of the work for which this permi[ is issued.
�I have and vnll maintain workers' compensalion insurance, as required by
sectbn 3700 of the Labor Code, for lhe perfortnance of the vrork for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: (^
Carrier� II,I� �i�%�CL�IC�—
� s seqion neetl ipt be comdeled d the pe�m� is valuetl �afy ine �un0�e0 tloNars (5100) w less.)
Policy Number: �.1�%P ^ �� �`S7 I 3 U�?i
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❑ 1 certify that in lhe peAormance ot the work for which this permit is
issuetl, I shall nol employ any person in any manner so as to become subjecl
to the vrorkers' compensation laws of Cali(omia, antl agree that if I shoultl
become subject to the workers' compensation provisions of Section 3700 of
the Labo e, hall (orth � h comply with these provisions.
U 1\ 3 `� C
AOPhraplls5ipn ure Dae
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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
($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:
1 hereby affirtn tha[ I am licensed under provisions of Chapter 9(commencing
with Seclion 7000) of Division 3 0( the Business and Professions Code, and
my license �is7 in full force a�nd1 effect.
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CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm lhat there is a construction lending agency for Ihe
peAortnance o� Ihe v.ork fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre
OW NER-BUILDER DECLARATIONS:
I hereDy a(firm thal under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit to
constmct, alter, improve, demolish, or repair any strucWre, prior to its
issuance, also requires the applicant for such permit ro fle a signed statement
thal he or she is licensed pursuant to [he 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
the basis for [he alleged enemption. Any violation of Section 7031.5 by any
applican� (or a permit subjects ihe applicant to a civil penalty ot no� more Ihan
fve hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and the structure is not intended or
oftered for sale (Sec. 7044, Business and Pmfessions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
lhereon, and who does such vrork himself or herself or through his or her own
employees. provided that such improvements are not inlended or oftered for
sale. If, however, the builtling or improvement is sold vrithin one year o(
completion, the owner-builder will have the burden of proving that he or she
did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not appty to an owner of
property who builds or improves thereon, and who contracts for such pmject with
a coniractor�s) license pursuaN to the Contractors License Laws.).
❑ 1 am exempt under sec.
Business antl Pro(essions Code for this reason:
Owner ID veri(ed by driver a license. ❑ Ves ❑ No
Driver's License No. Expires:
Verifca[ion o! Ownership 6y (type of document, i.e. - pmperty tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in dep�h into wfiich a
person is requiretl to descend, will be made in connectbn with wnrk authorized
by this permit, and that no builtling siructure, scaffdding, falsev.ork, a demolition
or dismantling [hereof, will be more ihan thirty-six (36) feel high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Cali(omia Administra[ive Code).
❑ As owner-builtler, I will not employ anyone to do work which would
require a permit fmm the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work trom the division.
Applicanl's Signalure Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will the applicant or present or future building occupant need to �ile and
certify a Busmess Plan for emergency response to release or threatened
release o( a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Safety Code requires, wi[h some
excep[ions, [hat a Business Plan be filetl vrith ihe Costa Mesa Fire
Departmen[ by every business which has at any one time dunng a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperature and pressure).
2 Does or will Ihe applicant or present or fuWre building occupant need to file
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Sec[ion 25533 of the Califomia Health antl Safery Code, wilh some
exceptions, requires registration wilh the Costa Mesa Fire Departmenl 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
temperature and pressure).
3. Does or will the applicaN or present or future building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Safety Code provides Ihat lhe
Costa Mesa Fire Depanment may require the preparation, certifcation and
fling with Ihe Fire Department of an RMPP by businesses which are required
ro register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Sec[ion 25534 of Ihe California
Health and Satery Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of [his ap0liwlion a permil fo� such cOnS[ruction
or modifcation from the Soulh Coast Air Qualiry Management District or from
any other air polNtion con[rol disMct or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requires ihat the requested
infortna[ion be fumished on applications fv non-residential building pertnils).
6. Will any part of the facilily to be constiuctetl under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meet !he requiremen[ o( Sections 25534 and 42303
of the Califomia Health and Satety Cotle).
7. If a permit from the South Coas[ Air Quali�y Managemenl Dis�nct or other
air pollution control dis[rict or agency is required for l�e work which is the
suhject of this appliwtion, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate ot compliance from the appmpriate air pollulion
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is covect. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state tha(
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building conswction, antl authorize representatives of
the City of Costa Mesa to enter upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
awre o� Legai Owner�s) Dat
SignaWre Dale � I Z ' �(�
305]-06 (3/01) N^"
�A 0/orAu etlAuplit'an� IDale �
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�OWNtK
JOB AC
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WOOD, $, J.
IS 210 Flower St.
)NTRACTOR Owner Builder
-17 -02 LOT TRAC1
5 Si nati
ROWH PLUMBING -
PROP. SWR. LINE Q HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGN HEATING AND AIR LONDITIONING
TEMPORARV SERVICE OR POLE �
UNDERGROUNO � POWER �
ROUGH WIRING
TRENCHES � FORMS STEEL REINF.
FLOOR SVSTEM
BON� BEAM � STEE� REINFORCE ❑
SHEATMING
FRAME ANO FLASHING �� -
LATHING — IN I]�✓ OIIT "
N� a, VENT., REFRIG, pND A.
F IG, FINAL ANO GAS TEST
CPF[IGI FFOIIIRFMFNTS
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35735
COSTA MESA BUILDING-SAFETY DEPARTMENT,
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� Applicant to Fil/ in Completely
BUILDING ' „ _� _, .
OWNER H. J. 41ood
ADDRESS 212 Flower Street
c�T� Costa Mesa
WN�RUCT,ON _e_
� cninca
BRANCH
ADDRESS
CONTRACTOR
ADDFESS $
GTV
oF�or 50.44 x 125
VSE OF
exisriNc s�oc. 2 resi d
SIZE OF
No`.' 5484039
TEI..
NO.
CITY
LIC. NO.
INO. OF BLDGS.
NOWONLOT 3
�ts - detached 9arac
NO.OF /
ROOMS STORIES
ROOF
60VEpING
K TO BE PERFOR ED
I hareby acknowled8e that I have reatl this application and stete
Mat the above information is correct antl agree to comply w(th
all laws regulatinB builtlin8 �onstruction, antl 1 shall not employ
any Oerson in violation of Me workman's comp8n5ation laws of
the Siate ot California.
1 hereby certify t�at I am properly licensed as a conVactor untlar
Ma Steta of California Business and Profeulons Cotle, Divisicn 3,
Chaptar 9, antl that such licenses are In full force and ef4xt, or 1
em exampt trom the provisions of the State ifornia Business
antl Professions Cod , Division 3, Chapter 9
SiBnature of j/_�/
Permfttee �
Authorizetl Apant -
C�_'1�1 r; C'�����.:.'� '.:'
t!J� f I,JI�.�N�
APPLICATION FOR BUILDING PERMIT �
RECEIVEDBV; DATERECEI_VED DAT SUED
' �� .�" '
A.P. NO. � �
— OZ PER J J �
BUILDING /1 1 !`. F �O W � ��%�
ADDHESS d Lv
OWNER
FIRE
ZONE
APPROVED
DATE II �
ZONE �� IP�� � I BUILDING EW
VARDSAPPROVED VARDSAF
1
REAR 'I Q
DISTANCE BET
MAIN BLDCS.
vna. �
C.V.P.�
AR'ROVED �
THE AMOUNT 51
THE PVRPpSE OF
VALUATION
���0�
��
$
� �
BET. MAIN &
ACC6S. BLDGS.
DATE
APPROVED
�� 2) �
l .STN'�
Q
�
7AX o
IN UNDER VALUA IS FOF �
ABLISHING A PERMR F O V: Q
� m
PERMIT FEE $ �
]-
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PLAN CMECK $ E
`a
LL
TOTAL FEE $