HomeMy WebLinkAbout1204 CITRUS PL - Building Permits(714)754-5273 • Fax(714)754-4856
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
ELECTRICAL PERMIT
Job Address: 1204 CITRUS PL
Suite No
Vicinity:
Parcel Nunmber: TPN98050
PERMIT N BER
E98-01276 ✓
77 FAIR DRIVE, COSTA MESA, CA 92626
Status:
ISSUED
Applied:
12/16/1998
Issued:
12/16/1998
Applicant: DAN FLYNN
Address:
'Phone: 949-476-5448
Zip:
Owner: LYON MESA COMMUNITY ASSOC.
Address 4490 VON KARMAN -
Phone:
NEWPORT BEACH,CA Zip: 92640 -
Contractor: '
Address: -
Phone:
Zip:
.License'
SCOPE OF PERMIT
100amp service for landscape irrigation at tot lot.
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
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.
FOR INSPECTIONS CALL: (714) 754-5626
4.
FEE SUMMARY
Quantity
Quantity
ISSUE FEE
$22.00
_ _Temp Dist System / Lighting
$0.00
0
Temp service test
$0.00
.-__
_
Busway /100 it • , ..
$0.00
0,
Res. a/c package
$0.00
C -Standing Section -
$0.00
0,
New Res (1-2 units)
$0.00
0
Misc Electrical Equipment
$0.00
0
New Res (3+units)
$0.00
0
Transformers up to 1 kva/kw
$0.00
0
Pool / Spa
$0.00
0
..........-....up to 10 kva/kw
$0.00
. 0
Lighting Fixts
$0.00
0
................. up to 50 kva/kw
$0.00
0
Recept Outlets
$0.00
0
............ up to 100 kva/kw
$0.00
0
Switches
$0.00
0
..:...............over 100 kva/kw
$0.00 -
0
Non Res Appl
$0.00
0
Low Voltage Equipment
$0.00
0
Res Appl
$0.00
0
Low Volt Wring System / Ckl
$0.00
0
Service to 200a
- $27.25,
1
-. . Misc. Conduit
$0.00
0
Service to 1000a
$0.00
0
- Misc. Conductor
$0.00
0
Service over 1000a
$0.00
0
Circus ( gen or ride) -
$0.00
0
Motors to 1hip '
$0.00
0
Circus (mech ride or lights)
$0.00
0
Motors to 10hp
$0.00
- 0
Christmas Tree Stand
$0.00,
0'
Motors to 50hp
$0.00
0
- Fireworks Stand
$0.00
0
Motors to 100hp
$0.00
0
Other Electrical Fee
$0.00
Motors over 100hp
$0.00
0
Communication drops
$0.00
0
Investigation Fee
$0.00
Sub panel to 200a
$0.00
0
Plan Check Fee
$0.00
Pole Light Pkg
$0.00
0
Reinspection Fee
$0.00
Sign Circuits
$0.00
0
Temp Pwr Pole
$0.00
0
TOTAL CALCULATED FEES
$49.25
Intermed Pole
$0.00
0
COMMENTS / SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
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.
FOR INSPECTIONS CALL: (714) 754-5626
4.
0
DECLARATIONS
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.
❑ 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: Policy Number:
(This section need not be completed i/ the permit is valued at one hundred dollars ($100) or less.)
❑ 1 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE (3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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. A Class 9
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Cade).
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 civ.] 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 contractor; 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 oder Business and Professions Code for this reas
Signature: Date:
Owner ID verified by driver'e license. �Q Yes ❑ No Driver's License Expires: 0i- 03
Verification of Ownership by (type of document, i.e. - property tax bill or dead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 pernit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
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 filed 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 stantlartl 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 Califomia 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.
....................................................................................................................................................................................................................................................................................
a 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 thisa plication aennit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Eye 8 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 (It'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.
Signature Of Legal Owner(s) / Dat
And/Or Authorized Applicant ((( r _ t Date
119211 INSPECTION TYPE DATE IKITTAL3 CODE INSPECTION TYPE gs¢ INTMAAL3
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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
2466-46