HomeMy WebLinkAbout1015 CONCORD ST - Building PermitsL 1
PLANNING
APPROVAL
City of Costa Mesa Planning Div.
Subject to Building Division RegsAny .
Revision roust be approved.
Re wired Prior to Buildinspection
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CITY OF COSTA MESA
(.q�'ip MFsq BUILDING DIVISION
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F ,,. ... 77 FAIR DRIVE, COSTA MESA, CA 92626 (714) 754-5273 •Fax (714) 754-4856 •www costamesaca.00v
v. � "� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT TYPE PLUM
APN: 14165223
JOB ADDRESS: 1015 CONCORD ST CM
Vicinity:
PERMIT NUMBER: P12-00089
STATUS: ISSUED
DATE ISSUED: 06/01/2012
ISSUED BY: MDM
Suite/Unit:
SCOPE OF WORK: MISC GAS PIPING FOR FAU
REF: M12-00082
NOTE: Final approval of permit shall not be granted until access to the dwelling unit(s) is provided for verification of the
installation of smoke and carbon monoxide alarms by the city inpsector. See attachement with mob card. (residential only)
OWNER:
RICE, CHRISTINE
PHONE:
APPLICANT:
CURT YAGER
PHONE:
714.289.8337
CONTRACTOR: YAEGER SERVICES INC
Address:693 N BIRCHWOOD ROAD PHONE:(714) 289-8337
City/State:ORANGE, CAZipCode:92869 CELL:
Address: 1015 CONCORD ST
City/State/Zip: COSTA MESA, CA
Address:
City/State/Zip:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $39.45
TOTAL FEES: $39.45
License No.:903595
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.
CODE #, INSPE0T 11 TYPE pAM INITIALS CODE p INSPE0n011 TYPE DATE INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing a
200 Final Re -Roof 210 Final Electrical
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 Final Building/Occupancy
p' WORKERS' COMPENSATION DECLARATIOP
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: /�
Carrier: 57z -e �LI .L /�
(This ,ado, need nor tre completed d (heperm4 is valued at one hundred sonars IS 100) or less)
Policy Number: �/ g I,7dlel -7,i1 Z_
❑ I certify that in the performance 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 workers' compensation laws of California, and agree that if I should
becomg,nbject to the workers' compensation provisions of Section 3700 of
the or Cotle, ehall
to c ply with thes provisions.
-� oG/Z
Applicant'Date
WARNING: FAILURE T9,iSECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND ISHALL 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 affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # D ?6_9,11i Class # C G7D
Contract nature Date
CONSTRUCTION L DING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code),
Lender's Name:
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT 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
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that 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
the 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 THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or 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 CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does 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 Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057-46(3107)
Owner ID verified by drivese. ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, i.e. - property tax bili or deed)+
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ 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 quantity of 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).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, 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
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
S. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (if "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that 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 construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Sign ure of I (I Date
I" Andlor Authonz dADDI¢ant Date
• CITY OF COSTA MESA do
(,��'�Q MFsq BUILDING DIVISION
o, ^c
x ..r C 77 FAIR DRIVE, COSTA MESA, CA 92626 (714) 754-5273 •Fax (714) 754-4856 •www costamesaca.00v
F •
�. � 6 FOR INSPECTIONS CALL: (714) 754-5626
4 oq��o fi
PERMIT TYPE ELEC
APN: 14165223
JOB ADDRESS: 1015 CONCORD ST CM
Vicinity:
SCOPE OF VVORK:1 LIGHT, 1 SWITCH FOR FAU
REF: M12-00082
PERMIT NUMBER: E12-00081
STATUS: ISSUED
DATE ISSUED: 06/01/2012
ISSUED BY: MDM
Suite/Unit:
NOTE: FINAL APPROVAL OF PERMIT SHALL NOT BE GRANTED UNTIL ACCESS TO DWELLING UNIT(S) IS PROVIDED FOR VERIFICATION
OF SMOKE AND CARBON MONOXIDE ALARMS BY THE CITY INSPECTOR. SEE ATTACHMENT W/INSPECTION CARD (RESIDENTIAL ONLY)
OWNER: RICE, CHRISTINE A
PHONE:
APPLICANT: CURT YAEGER
PHONE: 714.397.2189
CONTRACTOR: YAEGER SERVICES INC
Address: 693 N BIRCHWOOD ROADUnit:
City/State: ORANGE, CA ZipCode: 92869
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $25.70
Reinspection Fee $0.00
TOTALFEES $25.70
Address: 1015 CONCORD ST Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit:
City/State/Zip:
License No. 903595
PHONE: (714) 269.8337
CELL:
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.
CODE t. INSPECTION TYPE DATE INTMAL CODED INSPEcn0N TYPE MN INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electdcal x 6 - 7
201 Final Blook/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 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and brill maintain workers' compensation insurance, as required by
_11L ion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: �+
Carrier: 741rl�GI/t0
(This semw need not be ovnWeted d�th/e pe/rma a valued at one hundiatl tlt4ars ($100) or fess.)
Policy Number: l yL Q 7/ / / gal -z—
E]
❑ I certify that in the performance 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 workers' compensation laws of California, and agree that if I should
become ss ct to the workers' compensation provisions of Section 3700 of
the La 6r de, I hall fort c n ly with these ovisions.
Date Z
Appliran Date
WARNING: FAILURE TO CURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND S14ALL 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 affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # ,Class #
z -
Contra t r' ignature Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT 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
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that 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
the 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 THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder vrll have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does 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 Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature
3057-a6(3/07)
Date
Owner ID verified by drivertcense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed) -
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feel in depth into which a
person is required to descend. will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
AppliWnt's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safely Code requires, with some
exceptions, that a Business Plan be riled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
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 of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, 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
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Sgnature Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that 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 construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Si atur of Leg'Date
G /ate/z
Antllor AuthOnzeCA pLWnt Date
r �
CITY OF COSTA MESA 40
``OStRM.Q BUILDING DIVISION
o,
77 FAIR DRIVE, COSTA MESA, CA 92626 (714) 754-5273 •Fax (714) 754-4856 www.costamesaca.cov
FOR INSPECTIONS CALL: (714) 754-5626
as
PERMIT TYPE MECH
APN: 14165223
JOB ADDRESS: 1015 CONCORD ST CM
Vicinity:
SQ. FT: 0
PERMIT NUMBER: M12-00082
STATUS: ISSUED
DATE ISSUED: 06/01/2012
ISSUED BY: MOM
Suite/Unit:
SCOPE OF WORK:REPLACE FURNACE, RELOCATE TO THE ATTIC ON A PLATFORM, SUBJECT TO FIELD INSPECTION
NOTE: FINAL APPROVAL OF PERMIT SHALL NOT BE GRANTED UNTIL ACCESS TO DWELLING UNIY(S) IS PROVIDED FOR VERIFICATIO OF
SMOKE AND CARBON MONOXIDE ALARMS BY THE CITY INSPECTOR. SEE ATTACHEMENT WITH INSPECTION CARD.(RESIDENTIAL ONLY)
OWNER:
RICE, CHRISTINE A
PHONE:
CURTYAEGER
APPLICANT:
CURT YAEGER
PHONE:
714-289-8337
CONTRACTOR: YAEGER SERVICES INC
Address: 693 N BIRCHWOOD ROADUnit:
City/State: ORANGE, CA ZipCode: 92869
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$38.30
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES:
$38.30
Address: 1015 CONCORD ST Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit:
City/State/zZip:
License No. 903595
PHONE: (714) 289-8337
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
OE I. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re -Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
DATE INTRIALS CODE
INSPECTION TYPE
206
Final Mechanical
208
Final Plumbing
210
Final Electrical
212
Final Fire Prevention
220
Final Planning Approval
222
Final Site
250
Final Building/Occupancy
DATE li
10 - la r�
r,"
L
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
A� I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier: STiiTE FlT/L%i
(This section need not be mmpletebAvnb permit es valued atone hundred dollars ($tep) orless )
/
Policy Number: d R7/J %7 %' !f-QlZ
❑ I certify that in the performance 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 workers' compensation laws of California, and agree that if I should
become object to the w rkers' compensation provisions of Section 3700 of
the L r title. shat hwy omply with the provisions.
1
ApplicirAeSifiature Date
WARNING: FAILURSECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL A SHALL SUBJECT 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 affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. tt Class tt C` gD
Cwtlactorvs,16at.le Date
CONSTRUCTION LEPOING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT 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
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that 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
the 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 (5500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or 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 CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does 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 Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verified by driver 5 license. ❑Yes [I No
Driver's License No. Expires:
Verification of Ownership by (type of document. i.e. - property tax bill or deed):'
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection With work authorized
by this permit, and that no building structure, scaffolding, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Appllrant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ 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 quantity of 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).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, 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
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be fumished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally of perjury that 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 construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
vSigna a of Le t err Date
3057-46 (3101) moi(/
Signature Date /' G �/' G/ �
l� Q
And/or Autho edA ¢ r
ail Data
Simpfiflorl f'rumn'ipti)'rCurilicnl.r ui Gun)plinnttc:2001;Aen'icieniiul III */I( Ailr:)aumi,r C.I�If VA(
:'linwlr. Luum: I null ;1 7
.5llc /1!(lh'C.1'.t':
1:111 nr'L'rrN urn Jl �encl':
1,
Lrlln:
hur'n,ll �1.'
c tri r s1C.G
- o/ Z
CundumneU
I
ucl numlauui
y
Btnliulucnl I Yprl
Lug Iviinamint Etlicim(W ,
Plow Arc;,
rcauirenle I
. Themmauu
❑ Packaged Uml.
L11'1In111CL
�(
ya.i\PUE
0 LUh�
Served hl'
C)m 4111 f ducts
Arlt ill
.
r\"CIhI1Cl:
❑ lndool' Coit
❑SEER_
❑ HSPr
%yia il)
.430. of
nddtit I iC
J' J
mnqudiliu i,t pace
l,l no-el,nl•„r'e.,'ar)l. ra)rx! Irr.
❑ Condmusin' Unit
FJ BEI(
-D l(tsni tmec
/
lasrlllurh
❑ Uthei
J. Impllprimili J ype'. L_;t1nnFC IIa: Clpllpltlmll I)entl{ mrlalieii', if Mora (hall nl1C'nybail11, nnl'. ullutim CI, -I R-i1L'I -1'f\l ht: SUl' eaeib aVliltllll.
�. tNiuinnnn Louh)mmu Lrtficiuuuius'. I:':."uEEt{, 71"il. /\PIJL, '1.7i1$PP 1n1'.IYpICnt 1'Cll1dL`111111t F1'FIL'Illti -
Cuntractur (b faumentntimi lAnthor's llfespuusiblc!')esiduul°.f'becLu'ntion 6uttcmcut)
I cenify that this Certificate of Compliance documentation is occuratC hilt( complete.
• I um allgibie under pivisioh :tof file Gditonun Business: and; 11rolessiolls Code u) accept respousihiliy' for the deaip identified on this
Ceniflcate of Compliance. -
1 certify Ilial the enerb), immure:: and perl;pri m)cc slmulflcmium: fur flit tleaifm identified on ihirrCeniticale of Compliunet crosforni'to -ill t
requiremems ol'Tiile 2A, I'art:i I xiid G of the. CullWmin Codc'of ltegulotiuns. .. .
• , The design feamres id lrailled.on If & Certiflcatc cramphanec pm conalstem WWI Clic`inlunnalion docummried en o111oy,applica6lc......
compliance fame, wp7lslleefw.culculaGonc,,pluas had epecificntipnssubmitted tff"tltie eniareemeiil agency tornpprovel with t1��,pernfil, . .
-- uoolicoliml:
:Componyi :...'..�...... -. .. Daft/
f,. eg '.� 1(.(C%l liG .. .... ... , _
...hddress.. .. .......:.... . ..... . .. :. .. .........: .... ... Liceaae:
do �ne mew ilr o P/;!j o33�q ,
Il //Ml..li/1llLi%VI/ %I ul; /V..l.A
L'd:A4C'i'TSTGtA2. , hY1.7J.'lLF:T.'7L!YZJ'1Zi'il]9/SL'+rLL)
2001; B(.tildi.IIIo Lnerry L:"Ficienc•), Si:twdu.r•da .CCesiclenf:ial ET VA C itlt(!ra.tiI)I
C.1irn.2i.tv I mid 3 f:ltrnt,TT i -/ " /._ (' ::,ctsr,�+ ...)I— SA
RUNINDOF; rlNP9'It,OTUSSTONR CODI': R]hC.''I'ION7a'IU
Willful or deliherutedim•egnrd and Vitt tatioil n('timfill ildin(� Iitws, (licludiny�awCah(orntit ItuildiogCode ,:mA
IoenI permIr requirements constituter, a routine fmdisoipIinary action from the. Color DMOn: State. Lirenoc fAuu•d
wodung, in conjunction with the: Iooal building department. This action msy ronmst of Eutes up to 75,(1(10 per
vu/Innon b: toll 6( ;l (loll t'ranlor':; lircnsc.
\�rIIL N' l,S A VSIRJLT Rft0TJNUVI)?
A written conru'urtion pernui shall he: ebtuinc[I front the cnfprcemrnt aftenoy prior «I the erection, conan'uction.
rncon8n•u ction, In sulihni nn, rolucatiott, to altolati on of lit), mechunraal nystetn, except as permittad ill /tppeadir
Chapter I , Section 112.2 of ilw •2007 Califnrnin Ivlecholival Code. Prujeeta requiring, permits, include, hat arc not
limited to:
hle.w ETV AC iatnuAatlon
ETVAC' Chwpentn
• Replacement of tarnuee, coil, PA.U, nr condenser
lt.etocadoo of an eaiating I -TV AC una
Adding or repluciiig more tharr4011 duoting in tmcorrdiaioned spiwe
mu 1tTlII.,1)TNC; L;NI;12C1' l;F'i'ICIEN.CY STAPIDAIMS (Title. 24; fore 6TItr,()TTTREMENTR INICT.M.)-.
I. Heating equipment must have a minimum 711% AFUF. (Exception: Walk& flo n furnaces; room heaters).
Central an.conditioners L beat pumps leas thatr65,M) Fftulttr, must haus. a minimum 1 SEER..
Newly installed or replaced ducts must have minimum insulation value of R-4.2.
4. A sethacic type thermostat (24 hr.cloelc with four set paints) is required for all alterations.
5. New or replacement ducts muss meet the mandatory requirements of Section 1.50(rrt
All joints. and opening!: in the in the ENAC syntem must be;:ealed.
•• Only UL 181, UL )81A, or UL 181B approved tapes or mastic shall he used to seal duct openings.
Connections of metals ducts and the _inner core of flex ducts shall be mechanicatly fastened. Fter, ducts
must be connected using it metal sleeve/coupling.
• Flc>: duct:: that arc suspended must be supported every Oft. mm: for horizontal run: with no morn, than 2"
of sag between supports and 6 ft. max for vertical runs.
G. Toe CT-0-NUCEI-114 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify Coat the model numbers aT- the same ae the instatled equipment.
CITY OF COSTA MESA
`ogtaMF4,q BUILDING DIVISION
> 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.costamesaca.00v
FOR INSPECTIONS CALL: (714) 754-5626
'�"°°°"°'�' PERMIT NUMBER: E11-00231
PERMIT TYPE ELEC
STATUS: ISSUED
APN: 14165223
DATE ISSUED: 10/18/2011
PHONE:
ISSUED BY: KJB
JOB ADDRESS: 1015 CONCORD ST CM
Suite/Unit:
Vicinity:
SCOTT STRUNK
SCOPE OF WORK: SERVICE UPGRADE TO 200 AMP.
OWNER:
RICE, CHRISTINE A
Address:
1015 CONCORD ST Unit:
PHONE:
City/State/Zip:
COSTA MESA, CA
APPLICANT:
SCOTT STRUNK
Address:
13751 OLYMPIC AVE Unit:
PHONE:
714-865-1998
City/State/zZip:
COSTA MESA, CA
CONTRACTOR: SCOTT STRUNK
License No. 853672
Address:
13751 OLYMPIC AVEUnit:
'PHONE: 714.865.1998 '
City/State:
COSTA MESA, CA ZipCode: 92626
CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
M
cc
Ad
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.
CODE #. INSPECTION TYPE DATE INTITIALS CODE# INSPECTION TYPE DAFT INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
)7266 Pool Spa Final 208 Final Plumbing /
"t
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
r203 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 fallowing declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This sectio�n meed riot be co noW d the permit is valved at one hu re� ars (5100) prless )
Policy Num7er
I certify that in the performance of the wor for which this permit is
tssu d, 1 shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject o pthworker
'ation provisions of Section 3700 of
the Labor Code, sor
ith these provisions.
o
i Tpigiii's si nature C Pate
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 affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # C;RoClass #
ctprJ' t Dale
CONSTRUBTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT 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
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that 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
the 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 THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or 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 CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not appy to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature Data
305746 (3107)
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicant's Signature Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ 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 quantity of 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).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, 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
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management Distinct or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be fumished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feel from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that 1 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 construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzedrby this permit until final inspection.
o s'��"/'_-7t)a�rAthorizetl Applicant. Y— -
• I99�9
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX SIZ COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILD1NG
ADD ESS 10Z I
COSTA MESA, CALIFORNIA
■ ARCHITECT
STATE
LIC. N
SIZE
DESCRIPTION OF WORK
BUILDING TlL6
SIZE
EXTERIOR WALL
COVERING
USE OF BUILD it
II HEREBY THAT gD
AND BTATE THAT TH
PLY WITH ALL CITY
BUILDING CONST
SIGNATURER OP�
PERMITTE
AUTHORIZED AGENT
FEE RECEIVED.
' MF I e T lc�...' ERMR
f ^ B' DM16
Clf*r Olf"IheMew
RECIIPT NO, rPr
' RICEIV6OqP I pAfE=9CEIVI�_I JULE3BBp!1963
BUILDING
ZONING
tt gar. ZONE NO. OP UEE OF NEW �
R_1 PLANB 2 EGILDINGw/ a
r"GAL L. ,a_ 1.
OVERHANG SHALL BE LESS THAN
YARDS APPROVED
ACCESSORY BUILDING
BET.
ACCE
DATE
'p` N
4e_�W
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLYO
ALUATION ` �q PERMIT FEE $ �"
✓ H
C m
C EC /76 O
,V/, �a3—
TOTAL FEE
_� is -9,527
YARDSAPPROVED
MAIN BUILDING
I FROM O/rL STR EETI
FRONTJ. FT.�'R.
SIDL�.SIDB
171C.
FT.FT.OISTANCH
BET.
MAIN BLDGS.
VAR. #
U. P. At
YARDS APPROVED
ACCESSORY BUILDING
BET.
ACCE
DATE
'p` N
4e_�W
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLYO
ALUATION ` �q PERMIT FEE $ �"
✓ H
C m
C EC /76 O
,V/, �a3—
TOTAL FEE
_� is -9,527