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HomeMy WebLinkAbout3307 SUSAN ST - Building PermitsCITY OF COSTA MESA B!/ILDING DIV/SION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E07-00853 PERMIT TYPE ELEC STATUS: ISSUED DATE ISSUED: 1 011 512 0 0 7 - ISSUED BY: SOK JOB ADDRESS: 3307 SUSAN ST,CM ,- �'. Suite/Unif:`.�' vicinity: � . - , , _ � , SCOPE OF WORK: INSTALL 200liMP�METER FOR.TRAFFIC SIGNAL LOCATED ON NORTHWEST CORNER OF SUSAN ST. j:, .... .. . - , �,� . � . . . _ .; "."'�" , - � - � � � . ;:r" . . . OWNER: GTY OF COSTA MESA �, ' Address: Unit: '' ' PHONE: ' ,' ,_ � � _ _ City/State/Zip: ; � � �, _� APPLICANT: DON RIGGINS, � �, � �,,:'- : ` . �Address: ' � . 4580 E EISENHOWER CI Unik PHONE: 714-693-4637 � � . - . - City/State/iZip: ANAHEIM, CA � , � ; ti � _ � , . . . . -����� , CONTRACTOR: MSL ELECTRIC INC ,� ` License'No. 822450 _. ';+, Address: 4580 E EISENHOWER ClUnit �, -- _ . ,. . ' - ';'- PHONE: ` � City/State: ANAHEIM, CA ' � ZipCode: 92807♦, ; - �� - . � � - �� CELL: - � � �i .. . _ . . i ' " . �'_' , ... . , , . . _ _'- �_ . . _ _ _ ,..... . .._, ..,i ., ' . ' ,. �.1' ELECTRICAL PERMIT FEES ' ��,. ` °" �'"',� Electrical Plan Check Fee: $0.00 � Electrical Permit Fee: - $0.00 - Reinspection Fee ,. $0.00 TOTAL FEES • � , $0.00 � � � ';-t, . . � ', . � � , ,. ,.�� '�r . � . .. _ . . � . � . . c 'l.. - , � . . _- .. . . . , "i e NOTICE: The work aut�orized 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 EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPEC710NS: 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 expiralion of this permit. cooe�. �NsrEcnoNlrve pn� �xT1iIRlS CODE� ixsrecnoxrvre o� iN7IMlS 1878 Fixed S}5tem Final Fire Prevention 206 Final Mechaniwl 7288 Pool Spa Final 208 Final Plumbing 7 � Z00 Final Re-Roof 270 Final Electriwl ��Yy�rv� 207 Final BIocWRetaining wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Dertrolilion ' 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 certifiwte of wnsent to self-lusuie !or workers' comp sa[ion, as provided tor by section 3700 of the Labor Code. for lhe pe rmance o( Ihe work�lor which this permit is issued. � I have anC will maintain v.orkers' compensation insu2nce, as required by ectbn 3700 of the Labor Code, for the pedortnance of the wurk fa which this permit is issued. My wnrkers' compe� Insurance carrier and policy numberare: ("'� Carrier L�!«7� (This SeCion neetl nof DeBvn�etl��� f� �� �Bars (S� 1 W) a leu.l �� Policy Number. O�� ❑ I cenify that in lhe peAormance of the work for which this permil is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, antl agree that if I should become sublect to the workers' compensation provisions of Section 3700 of r Code, I shall forthwith comply vnth these provisions. /D -lf °G7 irant4 �gn Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE 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, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code. antl my license (is� in full tor'c1e and eftect. Lic. # D�ZT SD Class # L' � � /D � S`'07 nVatlar' Sign Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constructbn lending agency tor the peAormance of the v.ork ta wfiich this permi[ is issued. (Sec. 3097, Civil Code). Lenders Name: Lentler's Address: SignaWre Da1e OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty o( Derjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5. BUSineSs antl ProfeSsionS Cotle: Any Ciry or wunty which requires a pefmil [0 consWct, alter, improve, demolish, or repair any structure, pdor to its issuance, also requires tha appliwnt lor such pertnit to file a signed sta[ement [hat he or sha is licensed pursuant to the provisions o( lhe Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Code) or that he or she is exempt there(rom and t�e basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of lhe properry, or my employees with wages as their sole compensalion, WILL DO THE WORK, antl the structure is not intentled or ofleretl for sale (Sec. 7044, Business and Profassions CoCe: 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 Ihrough his or her own employees, provided t�at �such improvemenls are not inlended or offered for � sale. If, however, the buildinq or improvement is sold within one year o( complelion, Ihe owner•builder will have lhe burden of proving ihat he or s�e ditl not build or improve for purpose of sale.). " � ❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to constmct lhe pmject (Sec. 7044, Business and Pro(essbns Code: The wnt2ctors license Law dces not appty to an ovmer of property vmo builds or improves thereon, and who contracts for such project with a contractw(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business antl Professions Cotle for this reason: Owner ID venfetl by Criver's �. _. ❑ Yes ❑ No Driver's License No. Expires: Venfication ot Ownership by (type o( document, i.e. - properry tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,� ` ❑ I hereby certAy that no excavation frve (5) or more teet in tlepth into wfiich a person is required to descentl, will Ge made in connection with wnrk authorizetl by lhis pertnit, and that no building sWGNre, 5cafidding, false�wrk, a demolilion or tlismantling thereof, will be more Ihan thiAy-siz (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, Califomia Adminis[ralive Code). ❑ As owner-builder, I will not employ anyone lo do work which woultl require a permit lrom the Division of InOustrial Safely, as noted aDove, unless such person has a permil lo do such vrork from the division. Applifanfs SignaWre Dale Division of Indusirial Safe[y Pertnil Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to file antl ceAify a Business Plan for emerqency response to release or threatened releasa o! a hazardous material? ❑ Yes ❑ No (Sec�ion 25505 of ihe California Heallh and Sa(ety Coda requires, with some excep[ions, Ihal a Business Plan be filed wilh lhe Costa Mesa Fire Department by every business which has at any one time durinq a reported year a quantity of hazardous materials equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standartl tempereture and pressure). 2. Dces or will the applicant or present or future builCing occupant need lo file a registration fortn for aculely hazardous matenals? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Satery Code, vnlh some exceptions, requires registration with the Costa Mesa Fire Depanment by each business which at any one [ime has on hand a quantiry of aculely hazaMous materials equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet o! compressetl gas at standard temperature and pressure�. 3. Does or will Ihe applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials)? ❑ Yes ❑ No (Section 25534 0� the Califomia Health and Safety Cotle provides that the Costa Mesa Fire Department may require ihe preparation, certificalion anC filing with the Fire Department o/ an RMPP by businesses which are requiretl ro register awtely hazardous materials with t�e Fire Department. 4. If an RMPP is presently requiretl, has Section 25534 0( the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will ihe applicant or present or future builtling occupant require for the vrork which is the subject of lhis appliwlion a permit for such consWction 0� mOdifcation (rom lhe South Coasl Air �ualiry Management District or (rom any other air polWtion control dislrict or agencyi ❑ Yes ❑ No (Seclion 658502 of the Califomia Govemment Code requires that the 2questetl information be fumishetl on applicalions fa ran-resitlential building permits). 6. Will any part of Ihe facility to be constmctetl untler this permit be within 1000 feet from Ihe outer boundaries ot a school7 ❑ Yes ❑ No Qf yes", the faciliry must meet Ihe requiremenl of Sections 25534 and 42303 ot the California Health and Safery Code). 7. If a permit from ihe South Coast Air �ualily Management District or other air pollution coMrol districl or agency is required for the work which is the subject o1 this application, have all of the tlisclosures prescribed by California Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", atlach certifcate of compliance fmm the appropnate air polWtion control oKcer). � � � � � , ,. CERTIFICATE OF COMPLIANCE: I certify thal untler penalry of peryury the � information given above is correct. I agree to comply with all state laws and city ordinances regarding�Hazardous Materials and Emissions. '� , . i Signawre Dale . CERTIFICATE OF COMPLIANCE AND �AUTHORIZA710N OF ENTRY: I certify under penalty of perjury that I have read this application and sWte that the information given is correcL I agree to comply with all sWie laws and city ordinances relating to building consWction. antl authorize representatives of the City of Costa Mesa to enter upon the above-0escribed property for inspection purposes. I agree not to occupy or allow occupancybf any building aWhorized by this permi[ until final inspectioa _ _ Si nature of Legal Ovmeqs) Date 1 � Signawre . Date. , �—`� �J 305]<6 (3I0)) .. _ . • Antl/0/ Aulh ' ¢tl A � pat�