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Home My WebLink About395 BROADWAY - Building Permits�C,,,�v,rYjl �� __ �; COSTA MESA BUILDING-SAFETV DEPARTMENT P,O, 90X 1200 COSTA MESA, CALIFORNIA 92626 Z . ww a U Z ZQ O v~i am J � J N Q W ¢'] J • ¢1 J Q U N ZQ W � d W W Z J 0 m Z J � w w � Z � w� �O H Z Q U J a a Q O H N Z O H U � � H ti z OWNER MAIL TEL. cirv i.os Aneeles_ CA 90038 No. BRANCH Main Branch ADDRE55 600 S. SprinQ St., L.A. 90054 OR ENGINHEfi�' 121d5 & Silverman No��653-016 nooaEss 113 N. San Vicente, Beverly Hi CONTRACTOR GeorQe J. Heltzer AooAess 740 N. La Brea Avenue TEL. cirv Los Angeles, CA 90038 No. 937-217 STATE CITV uc. No. 3144 uc. No. SIZE I NO.OF B�DGS. OF lOT NOW ON lOT �On USE OF EXISTING 9lDG. SIZE OF NO.OF Z NEW BIDG. ROOMS STORIES EXTERIOP WA�laster COVOEpING wOOd COVERING USE OP BUILDING AND WORK TO BE PERFORMED Res'dential l- ��/U l %`S - . �` _ [�{`!Li I hereby aGknowletlge [hat I have reatl Ihis application antl sta[e ihat the above information is correct antl aeree to camply with all laws regulating builtling consvuction, antl I shall not employ any Oersan i violation of tbe workman's compensation laws ot Me State oi California. I hereby certify ffiat I am oroperly licensetl as a coniracmr untler Me State o� California Business antl Professions Code, Divisicn 3, Chapter 9, antl that such licenses are in tull torce and eHect, or I am exemot from the provisions of the Srete of California Business antl Protessions Cotle, Di''/4j/on 3, Chapter 9. Signamre o� f� / � Permittee . ' /�`��— : .; L Authorizetl p.9ent � , ' R APPLICATION FOR BUIIDING PERMIT DDfiESS TRACT FIRE ZONE T APPROVED BV NO.OF , I �t• P�� , VAftDSAPPROVE� MAIN BUILDING (FROM GL STR�ET) F LOT DAT B USEOFNEW�. ��i(�J� BUILDING { Z�: AjL.. YARDS APPROVED REAR �F ±FT. FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCFSS.BLDGS. CURP#C�L—/_7"� APPROVED�—iC.(..�'�. nwaoveo '�/�9�5Q.� THEAMOUNT THE PURPp$EI VAIUATION $j��;��- T. l7� n _/,,4 0� . . , SHOWN UNDER VALUATION IS FOR IF ESTABLISHING A PERMIT FEE ONLV: PLAN N 0 7 m a LL „ctS'auoaess: 601� BROOKVIEW WY OWNER'S N0.ME: S� KV I EW CONDO HOA nooness: 630 PAULAAINO CM., CA., 92627 (714) 587-0399 AfltNIENGINEffl: AOOXESS: NEG.NO.: uxir: UNIi: PEflMITTEE: MESA ROpFZNG CORPORATION ( 719 ) 548-3012 I AUONESS: 843 j�(, 1'7'I'j{ $'[' COSTA MESA CA 92627 LICENSEO LONTNACTOB OECIAXATION: I here�y afOrm Inai I am hcensed untler pm�isions o� C�apter 9 �commencing wil� Seclion %W�1 ot Oiv6lon 3 0l Ine Business antl Pmlessions Cptle. and my I¢e�se 6 in ane eHect. ciTru/c.: 035681 srnreuc.:5691 cuss: C-39 —Date�G �� fC Signatur'— _ WON RS' COMPENSpTION DECUIHATION: I �ere�y aihr ��al l �ave a cem e oi consent t selt-in re or a cetlilic2�e of Work¢rs' Comoensaiion 7�5�!��,ry� of �cp�Wie� yppg I�ereol (Secuon 3800. la� G� � � O 1/ 9 4 POLILY NO.. YWI.L 9 O/ V V EXP. OATE: U comcnxv: GOLQEN EAG�yLE � ❑ Cenifietl capy is hereby fum6�etl. l9 Cenified CaNt+afil wiln tA¢ ciry Buildi 9ie . �-j 2 c Da1e: � � + J ApDlicam � � � — El(EMPTION FflOM WONNEPS' COMPENSATION OECUIIATIO . IThiS 5e[;ion ne¢4 no� be CompleleE R t�e Oermi� is lar ane IImGr¢d 15100� or 1¢55�. I ceNly t�at in Ihe Dedormance ol Ihe work lor wh¢� Ihis permii is issuea. I Shall no� employ any per5on in any mann¢r SO a5 io betome suh�ect ro lhe Wo�kers' Campensat�oa Lawi o� Caldomia_ Da�e. SignaNre: NO7ICE: �l al�er making ihis declaration. you shoNa �ecome sueject to the 1Yorke�s' Compensation provisions oi ihe labor Code. you mus� brt�wit� comD�Y �'iit� Such 9�ovi5bn5 o� this pe�mit 5Ra11 he deemetl revoRed. CONSTflI1CTI0N LENOING AGENCY: I hereby attirm ��a� ihere is a consimtlion lending agency �or I�e pedarmance o� ��e work tor wmtn Ihis permn i5 i=suea �Setiion 3097. C��. CI. LENOEN: AUOflE55: OWNEF BWLOEH OECLABRTION: I herehy allrtm t�at I am exem0� ��om t�e Cm�raclors' State L�cense Law tor I�e �ollowing reason 4?clion 7031.5 Business an0 Pmfessional COOe: Any oty ol coun�y w�ic� reUuires a permrt Io consvuct, alter, impmve. tlemolish or �ppart any stNCWre. prior lo ils i55uanW. al5o reQuires ��e aOP�¢ani tor such permil io lile a signea sta�ement Iha� �p/she is lip¢nsed aursunm m me o�avisans ol Ine Comractors' Slaie License Law IC�apter 9lcommencing wiih Secllon 7000) o� Drvisian 3 0l ihe Business an0 Pmtessons Cotle) m Ihat �elshe is exempllheretio�n anO the �asi5loi fie allegetl e*em➢iioa pny violation oi Section 7631.5 �y any apphcant lor a permi� SuDjects I�e appl6anito a crvil Denaliy ol nol more Ihan tiv¢ �undre� dollars (55001. I. as owner ol t�e Wopeny or my emoloyees wiin wages as t�eir sole comDensation, wili ao ine work. ane ihe ❑ simcwre is nm inten0e4 0� oi�etetl tof sale �SecUon 70e4. Busmess afd Pmfessional Cmde'. The Con\tx\o5' Sta\e licen5¢ Law tloe5 noi apply Io an Dwnef oi a Dmperty who builas or imOmves ��ereon, and who tloe5 5uch work himself/hersell or Ihwu9h nis or Aer own emoloyees. pmviaetl Ihai suc� improvemenis ar¢ nat in�endea or oHered for sale. I�. Aowever ihe �uilOmg or � imDrovemenl is sold wii�in one year of com0leiion. ;he owner vell have I�e �ur0en o� pioving he/s�e did not budd or impro�e Io� �ne owpose ot saiel. I. as owner ol ��e property. am exdusiv¢ly coniracting wnh hcensea coniracrors lo tansimc� Ihe pmle�� (Section 70C4, Business ❑ an0 Pralessons Code: The Cantrac�ors' Siate License La++0oe5 noi aDD�)' �o an owner oi pm0eny who builds or impmves tAereon and w�D conirads lor Sucn p�o{eqs wiih a conUaqor(S116en5e pursUan;lo ��e COniractars' S�aie Utense Law�.l am awa�e ihat pmol ol I�eir WOBe(5 Compen5a�ion Inmrance S�ouIG �e oro:i0e0 ;a me. � I am eK¢mp1 uo�er Sectlon' B 8 P C lor I�iS reason. 7a�e O�+:ie� i;,o nere�y cernty inaf I am aware o� ana unoersiana ihe requir¢ments o' Camo�mx Healtn anC Safely Code Seqions 25505. 25533, and 2553n antl that I o� nm future �wltlinq occu0�ni willlwdl not Icncle one� neea m comply wrtn saio siale coaes ane Ine ieQulremems lor a pc,.im� Im consVULUon or mo4AIWUon Irom Ihe Au Ouahiy Managemenl pisinct. Resitlenlial Gonsimction applica�ions are exempt Irom :nese promsions Oate Aun��cam i nereby cerhty ihal I have reatl �his appbcallon antl slale I�at I�e abawlnfo�maiion is carrect I agree �o comply wiih all cily anp counly yynanc?s antl slaie laws relatmg lo tiwlding ronsimction ana �eie� -^'�ir � � Ihis nry �o enter uPon Ihe above-men;ion¢U ;'o0e�ty �lai ms�enion purposes �,r—' ' � ,..,... �7alE � — [.�_� �� Signdiwe �� rner s �icense or Sociai 5ecwny =- :��<5 Wnne—Bvilpmg: Green—Co�e Enbrtemen; Cana:y—NOPi¢an:. amt—Revenue: Goltlenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064027 PERMIT NO: B 064027 PLAN CHECK N0: N GOVT: N SUPP: N CONSTRUCTI013 TYPE; � PERMIT TYPE; STR PURPOSE: OTH JOB DESCRIPTION ; T/OFF, � 6 REROOF W/COMP SHINGLES SQ FT: 8,645 CLAIM VALUE: 8,645.00 CALC—VALUE: 8,645 00 GROUP OCC;�R-3 /M-1 �_�, COMMENTS: REROOf W/COMP SHINGL6S INCLUDfi?�603-605-607-609-6118�290K�IEW WY IfMlEkff1f1t1t1E1fMMkkifMMMflMkkiflfMitMMlflFifM;hMftk4kMMMM 1FMM1fIfMMkkMlFlffElEiFMM /tiEitMMMMiEiEifM Z O N I N G R E Q U I R E M E N�I' S S E T B A C K S ------------ MAIN BUILDING ---------- FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 93405061 ZN£: REF NO: PLANNING NOTES> > 1f k ff 1fk 1f �f 1f 1f 1f ft it 1t if k1f 1k k kif 1f If k 1f iEiE 1f Ik 1E 1k if 1f if if 1Eif iF �f If k if k N iE if k k k k if 1F kif 1f if if if it iE1E 1E1E 1f M iE iE if ik 1F K 1F 1E if 1E 1f % ik k if D E V E L O p M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPR6VED BY DATE: BUILDING APPROVED BY : DATE; APPLICATION ISSUED BY: DATE; J 1fM/tMitMlffhMitftMkMM1tMMMMMk M1flFifififitkiflt�i M1t ftftlF%MMMM1t�tlFMM#kifkMMMltMifkkMfEffMffkkiEfElFkfkkkklkifklkkkkkkkklfififkifkiEiEklElEiElEkiElEk�klEkiFiEMIEifKiE�E1F LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 108.00 .86 SMIP/NON—RES PLAN ISSUE FEE BUILDZNG—DIV—> TOTALS----> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 108.86 0.00 0.00 108.86 108,66 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 108.86 OVER/SHORT; .00 BLD08p00 pLQMBING ELECTAIC MECHANIC FIRE SMIP1T86 GRADING PLAN—CHECK lfkffklfMMMlFiEfhlfMkklFMklkkff7tkMM1fkklfkkkklFk7Ek1k1EkikkkiflfifltkkkkMkklkkklklF1E1E1E1Ek1EiF1FM1f1f%%%1flFifkMif I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 8645 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 8,645.00 END OF FEES �iv�J`r�E G�7EC1G�� R�QUIREC �:�,�,�y�� v_ -- �- COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 Fo� A plicant to i i mp te, BUILDIN ) . , d " _ " I z . ww d U �- Z Z Q o v~i d m J � J N Q W o] J - p] J � U � Z Q W � d W wZ J � m z J � W w ❑ _ z� w� �O H z Q U J a a a 0 � N z Q H U � � � N z OWNER HEL'1'ZEN ENTERPR15E5-BR00] MAIL aooRess 740 N. La Brea Avenue cirv Los Angeles, CA 90038 No coNsra�crior�nited California Bank I FNIIFR BRANCH Main Branch ADDFESS 600 S. SprinQ St., L.A. 90054 ORENGWEERt'�eld5 & Silverman ,�vo�'653-016 ADDFESS 113 N. San Vicente, Beverly Hi CONTRACTOR GeorQe J. Heltzer ADDFESS 740 N. La Brea Avenue TEL. arv Los Angeles, CA 90038 Na. 937-217 STATE CITY uc. No. 3144 LIC. NO. 512E I NO. OF BLDCaS. OF LOT NOW ON LOT NOTI USE OF EXISTING BLDG. SIZE OF NO. OF ,z NEW BLDG. ROOMS STORIES EXTERIOR WA ROOF COVERING `�'laster COVEflING WOO(1 USE OF BUILDING AND WORK TO BE PERFORMED Res'dential L�/(l ./ >`"S . �G �%lc'.f�![� :>> ; �:��.�,,, �,a�,. s�:: �;,-.:;; � APPLICATION FOR BUILDING PERMIT R BV DATE ECEIV DATE ISSUEI � r PERFAI A.P. NO. �p� —C?3 f J BUILDING � �� ADDRESS TFAC7C"�?Y� l07 BLOCK OWNER FIRE ZONE APPFOVED E NO.OF 3—� PLANS ^, YARDSAPPROVED MAIN BUILDING REAR ✓�±FT.[ DISTANCE BET. MAIN B�DGS. VAR. # �.�.P. # �� 73 APPROVED USE OF NEW� [.pF�'J BUILDING „��A�� YAR�SAPPROVED ACCESSORV BUILDING BET. MAIN & ACCE55. 8LDG5. AP ROVED il � —� 1 hereby acknoW�etlge that I have reatl this appliwtion and state �-b 1 that ffie ebove i�fotmation is correct and a8ree m comply wiih � � all laws regulatin9 builtling connruction, antl 1 shali noc employ � , t any pe�son in vla�ation ot the workman's compensation laws ot � the State of Cali�o��ia. �/ A� � C�.,� AX m / � /�� ,�i-� � I hereby rerti(y that I am properly licensetl as a contractor untler �� SQ. FT. � i S O the State of Calitornia eusiness antl Ptofassions Cotle, Divisicn 3, THE AMOVNT SHOWN UNDEP VALUATION IS FOR Chapter 9,.antl that such licenses are in full torce antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt trom the provisions of the Stete of California Business � antl Professions Lotle, Di�'�ion 3, Chapter 9. VALUATION ' l PERMIT FEE $ ♦ ] Signature ot �� f�/�� ._ �"G" �y m Permittee � � ��'/�`�" �' G $ 1 / �/ /I�� p�qN CHECK 5 / ��/ E G �G �� Authorizatl ABeni LL TOTAL FEE 5 A ' CITY OF COSTA MESA � suno�N� o�v►s�oN 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 PERMIT NUMBER�08-00067 PERMIT TYPE PLUM APN: 93405059 JOB ADDRESS: 605 BROOKVIEW WY CM Vicinity: LAUNDRY ROOM STATUS: DATEISSUED: ISSUED BY: Suite/Unit: ISSUED 03/06/2008 RMD SCOPE OF WORK: WATER HEATER CHANGE OUT LIKE FOR L1KE, SAME LOCATION (LAUNDRY ROOM) FOR A COMMERCIAL BUILQING. OWNER: PHONE: APPLICANT: PHONE: VENEZIq, TRACY MORGAN,GEORGE 323-777-0106 Address: 605 BROOKVIEW WAY #59 Ciry/State/Zip: COSTA MESA, CA Address: 6558 WEST BOULEVARD CitylState/zZip: LOS ANGELES, CA CONTRACTOR: GENERAL INSTALLATION CO License No. 151839 Address: 655$ WEST BOULEVARD PHONE: 213-753-2541 City/State: LOS ANGELES, CA ZipCode: 90043 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: $0.00 $35.80 $35.80 1 � NOTICE: The work authOrized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EkPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed 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 expiration of this permit. LOOE/. INSPEGTIONTYPE DATE INR11AL5 COOEA INSPECiIONTYPE � INPTIALS 1616 Fized System Final Fire Prevention 206 Final Mechanical ' 1266 Pool Spa Final , 208 Final Plumbing p/A �" /' ��Z�[ (l 200 Final Re-Roof 210 Final Eleclntal 207 Final Block/Retaining Wall 272 Final Fire Prevention 202 Final Faclory Fire PIaCe 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building�Occupancy WORKERS' COMPENSATION DECLARATION� I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of wnsent to self-Insure for workers' compensation, as providetl (or by section 3700 of the Labor Code, for the peAormance of the work for which Ihis permit is issued. ❑ I have antl will maintain v,�rkers' compensation insurance, as required by sectbn 3700 of the Labor Code, tor the perfortnance of Ihe v.ork for which this pertnit is issued. My workers' compensation Insurance carrier and policy numberare: �' ` Carrier: �G �� S �'�, . (�nisse bnneediarbemmpe✓red4theperm4kvalveoalmenurMreticbttars(EfoO)wless.l PolicyNumber: �%�%1 �/� � ZF�O� T �� ❑ I certify that in tha peAormance of lhe work for which lhis permit is issued, I shall not employ any person in any manner so as to become subject lo the workers' compensation lav5 of California, and aqree I�at if I should become subjecl to the vrorkers' compensalion provisions o( Seclion 3700 of the Lab de, I shall fonhwith comply with these provisions. ✓� .3�� ' , pplicanl's5ignaWr Da�e 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, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code, and my license is in tull torce and eflect. ( Lic. # �� j Class # � ^/ � r � r(O �� CanV tor's �gnaWre �'a�e CONSTRUCTION LENDING AGENCY: ❑ I hereby affum that Itiere is a construction lentling agency fa the peAortnance of Ihe v.ork (a v.fiich this permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lentler's Address: OWNER-BUILDER DECLARATIONS: I hereby affrm that untler penalry of perjury Ihal I am E7(EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to conswct, alter, impmve, demolish, or repair any sWCNre, prior lo its issuance, also requires the applicanl for such pertnil b file a signed statement thal he or she is licensetl pursuant to Ihe provisions o( the Contraclors License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Professions Code) or Ihat he or she is exempt therefrom and the basis (or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicaM to a civil penalry of not moro than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees vrith wages as their sole compensation, WILL DO THE WORK, and the struclure is not intended or oRered 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 dces such vrork himself or herself or through his or her ovm employees, provitled that such improvements are not intentle0 or offered for sale. If, however, the building or improvement is sold wilhin one year ot completion, lhe ovmer-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 pmperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construcl lhe project (Sec. 7644. Business and Pro(essions Code: The contractors License law dces not apply to an owner of property who builds or improves thereon, and v.fio wntracts fa such project with a contracta(s) license pureuant lo the Contractas License Lav.s.�. ❑ I am exempt untler sec. Business and Professions Code for this reason: Owner ID verified by driv. ,ice�._�. ❑ Yes ❑ No Driver's License No. Expires: Venfication of Ownership by (type of document, i.e. - property lax Gill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thal no excavation fNe (5) or more feet in deplh into wfiich a person is required lo descend, will be made in conneclan with vrork authonzed by Ihis pertnit, and that no building structure, scaffdding, false�wrk, or demolition or dismantling thereof, will be more than thirty-siz (36) teet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Ttle 8, Califomia Administ2tive Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require a permit from the Division of Industrial Safety, as noted above. unless such person has a permit to do such vrork from the division. Appli[anl'S SignaWre Date Division of Intlustrial Safety Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupani need to file and certify a Business Plan for emergency response to release or threatened release ot a hazartlous material7 ❑ Yes ❑ No (Section 25505 of the California Healih and Safety Code requires, with some ezceptions, ihat a Business Plan be fletl vnlh the Costa Mesa Fire Department by every business which has at any one time during a reportetl year a quanlity of hazardous materials equal ro or qreater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressetl gas al standard temperature and pressure). 2. Does or vrill the applicant or present or tuture building occupant need to file a registralion form for awlely hazartlous malenals? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Code. vrith some exceptions, requires regis[ration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantiry ot acutely hazardous materials equal to or greater than a weig�t of 500 pounds, or a volume o! 55 gallons, or 200 cubic teet of compressetl gas at s[andartl lemperature antl pressure). 3. Does or vrill the applicant or present or fuNre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous matenals)? ❑ Ves ❑ No (Sec[ion 25534 of the Califomia Health and Safery Code provides tha[ the Costa Mesa Fire Department may require the preparation, certifcation and (ling with the Fire Department of an RMPP by businesses which are required to register aculely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Calitomia Health and Safety Code been fully wmplied vnth? ❑ Yes ❑ No 5. Does or will the applicant or present or fulure building occupan� require for the work which is Ihe suDject of this application a permit for such construction or modification fmm the South Coast Air Quality Management District or from any other air pollution control distnct or aqency? ❑ Yes ❑ No (Section 65850.2 of the CalAomia Govemment Code requires that the requested inlortnalbn be (umishetl on applications for non-resdential builtlirg permits). 6. Will any part of Ihe (acility to be constructed untler this permi� be vrithin 1000 feet from lhe outer boundaries of a school? ❑ Yes ❑ No pt'yes", the (acility must meel lhe requirement of Sections 25534 and 42303 ol the Califomia Health antl Safety Code). 7. If a pertnit from the South Coast Air Qualiry Manaqement District or other air pollution control disinct or agency is required for the work which is Ihe subject of this application, have all of the disclosures prescri6ed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. pf yes', anach certificate of compliance from the appropriata air pollution tOntrol oKter). CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the infortnation given above is cortect. I agree to comply with all state laws antl city ordinances regarding Hazardous Materials antl Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read Ihis application and state that the infortnalion given is correct. I agree to comply with all s[ate laws and city ortlinances relating to building wnstruction, and authorize represenWtives of the Ciry of Costa Mesa to enter upon lhe above-described property tor inspection purposes. I agree not to occupy or allow occupancy ot any Duilding aWhorized by this permit until fnal inspection. �/JJp� S�,gn�aw�re af L al Ovmeqs) Da/�e /+ Signature Dale .��LiC.O"��%i��w�'� � �(� —� b 305]-<6�3101) AnEI AulM1ariieC AOW� �� Dale