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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 r � � 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 �--.�.l.,-'�,� ❑ 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 <.�... �--�:2...�. 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. �� / S � 1 Class;#. C' � � ( J ;`_._„ or's i w �'yOx�e 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 � . .__ �: �OWNtK JOB AC .� GENER � AP No. ��' <N" ' C, \ G. 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 UAIt BUILI SU,BCONTRAC.TOR Z . aV zz a � N am J � J � Q W p7 J -m J Q U Q Z� aW W Z J Q m Z J � W w 0 = ?r w� N Q �O F z Q U J a a Q � F ti z O F U � � r y Z 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 $ � ]- � m PLAN CMECK $ E `a LL TOTAL FEE $