HomeMy WebLinkAbout3220 PARK CENTER DR - Building Permits�
PPOJECT AOUPESS: j z Z O PARK CENTER DR
OWNEX'SNAME: C,S SEGERSTROM b SONS
aoueess: 331� FAIRVIEW RD
COSTA HESA
CA 92626
APCM/ENGINEEfl: ( 71 9� 54 6—� 11 Q
AOOflESS:
flEG.NO.:
UNIT:
UNIT:
°E"mmEE:DIVERSIFIED PACIFIC CONST (714)833-9070
aooecss: 1300 NORTH BRISTOL 160
NEWPORT BEACH CA 92660
LICENSEO CONTNRLTOfl OECLAIiATION: I �ereGy afiirm inai I am Ikense0 un0er provisions ol Cnapter 9(cammentlnp wit� Section
70001 0l Uivision 3 of Ilie Buvness arq Protessions COGe. anA my li[enSE s m INI lorce anE eflect.
ciTru�17�R1 aT"Teuc.`427949 ss: g �
Oa1e: Signamre: _
WOBeEPS'CO PENSa710NUECLRHFiION: Inere�yallirm�natlna.eacenJrca� ofconsenuosell-insureoracertificateofWorkers'
Compen5alian Insurance. o� a cetlified copy Ihereot (Seclion J800. LaE. C�.
aoucrxo.: 1200657-91 EXP.ORTE: OB/OSI92
carnPnxv: STATE FUND
-p Cenifie0 coOY is hereby �uma�etl. Ij� Cenilied copy i5 IAeG wilh �he 'ty BuiINnA OiWsio .
Uate: _� � � AOVlicant ���
E%EMPTION OM WOXKEXS' fAMPEN5RTI0N DECUIIATION: (TNs seciion ntt0 rot De .. peleU ii Ne puml is ta one hunGreG (5700� or kss�.
I ceriify ihal in ��e pedormance of I�e work lor whic� ��is permit a i55ue0. I s�all not employ any person in any manner so as �0 6ecome
subl�� �o �tle Workert' ComDensation Laws ol Califomia.
Dale: SiAnamre:
NOTICE: I�. atter making this declaralion, you 5hou10 Eecome suGl¢tt to t�e WOAers' Campensaiion provisions o� Ihe Labor
Cotle. you mu51 fori�wil� wmDly wii� Sut� provision5 Or IN5 Dermii S�atl Ue A¢emeA revake0.
CONSTflUC7lON LENOING AGENLY: I nerehy allirm itW1 ihere is a constmction lendinp apency lor ine petlormance ot ihe work for
whic� this permi� is is5ue0 (Section 9W7. CivaC�.
LENOEfl: THIS PERMIT IS NOT A
nooness: CONSTRUCTION PERMITI 1 !
OWNFB BUIIOEP UECIABRTION: 1 hereEy allirm tlwi I am exempl Imm I�e Contractors' State License Law for ihe lollowing reason
(Section 7Q71.5 Bu9ness an0 Proleuianal COEe: My ci�y ol county whk� roQuirtt a De�mil to consiNcl, alter, impmve, Gemolish, or
r¢�air any stmclure. prior to ils i5suance. a150 reQuirts Ihe aDClicanl lor such permil to lile a sipneA stalement Inal he/she is licensee
pursuant �o Ihe provisions ol t�e Contra[lors' S�ale LianSe Law (CnaO�er 9(commencinp wii� Sec�ion 70W) o� OiviSion 3 0l �Ae Business
an� Proless�ons CoOe� or Ihai �e/5�¢ i5 ecempi Iherelmm an0 lhe Ea5i5 lor tlle alleA¢0 eKemp�ion. Any viola�ion o� $eclion 7031.5 by
eny apphcant for a permil suDlecls Ille aOVliWnt to a civil penalty al not more IOan live �unAreO Oollars (E500�.
I, as avmer of ��e pmpeny or my em loyees wii� vraAes as tAeir sde campensalion, will ao Ina work, anE tAe
❑ strucmre is no1 imen0etl or offe�etl la� ule I�tian 70aa, Busmeu anG Pmlessional CaOe: T�e Cantractors' State �icense Law
Eoes not aDP�y to an owner of a D�optny wlq WilOs ar imp�ove5 ihereon, an0 vAio Goes suU1 wafk Nmsdf/hersell or t�muAh
�a or her own emdWees. provitled lnai suc� imD�ovements a�e not intenOeO or olhred br sale. II, twwever ihe huiltlinp or
� impmvement is sola wit�in ane year ol comDletan, t�e owner will tuve I�e DurOen ol pwvinp �e/she Eitl nat OuilU or impmve
la� ihe purpose ol Shcel.
�I. as owner ol ine O�openy, am exclusiveN caniractinp wit� IicenSeG coniracmrs ia consirud I�e prole�� (���� ��4, Business
ES '8'ane vrmessions coae: me Coniractars' State Liceiae Law Ooes rrot appy �o an ovmer ol Droperty wtq bm1A5 0� im0��s lhereon
� an0 w�o wniracts b� suc� O�WKts xi�� a convaaoqs� license purswnl ta i�e Comractori State License Law). I am aware
Ihai proof of I�ei� WOrker'S fAmpEnSatun inturaMe StnWO Ee proviOeE IO m2.
� I am exempi vn0er Sec�ion: B, d P. C.
lor Ni5 r¢ason:
Date:
Owner.
1 eo nereey cenity tnat I am aware ol arM unaerstantl Ihe r¢Quirzmints ol Calilornia Nealtn anU $afety CoOe SecliOns 25505, 25533, anA
25594 an0 Inal I or any luture OuilOing o[Cupant wilVwin nol �cirde ane) neeG lo comOH m�� �iC slale toaes anA Ihe repuiremenis for a
permil lor conslmciion or modilitairon Irom I�e Air Oua01y Manaqemenl Dislrici. fleSiEentul mnSlNciion aOPliWiions are exemp� Irom
IhCSC pf0VIS10�5.
Oaie: AOVlicani:
1 here�y certdy inat 1 have reaa ih4 apDticalion ana stale Itul Ihe a0ove intormdtion 6 cor2ct. I agr¢¢ to wmply witn all ciry antl cowty
or0inances ana state Wws retaling lo builtlmq co�imction aiM �er¢Gy auihar'v repr¢Senlativ¢s ai t' ci Io enier u0on the above�mentioned
O�opeity lo1rinspection purposes
�al¢: �jf_�� Si9�lur2: � — - - — — — -
�river's license or Social Sewriiy �:
t6aba6 W�ile—Builtling: Green—Cotle Enlorcemem; Canary—Ap0licant; Pink—Revenue: GOIEenroE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 055014
PERMIT NO; B 055014 PLAN CHECR NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: 1FR SP PERMIT TYPE: STR PURPOSE: DEM
JOB DESCRIPTION ; DEHO INTERIOR TENANT SPACE FOR NEW T.I. SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC; B-2 /A-3
COMMENTS; DEMO TO PREPARE FOR "AMICI TRATTORIA"TI
+r*��*�r+r�***�r**+t�t*r**r+t*r�r�tr****�t*�t�t*x*�r�*�t�c*�r*�r*�r�e**+t***�r*�e�*�*�r+t+t**�r+r�r**�t****r
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BOILDING ---------
FRNT: FT IN REAR; FT IN FANT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ• PROV; PARCEL: 41049149 ZNE; REF NO:
PLANNING NOTES>
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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 APPROVED BY
BUILDING APPROVED BY :
APPLICATION ISSUED BY• 6
iE iE ff �E �E iE it iE it it If IF 1E 1t iE iE If if iF iE ii k
�k 1E 1F iF if iE iF 1F k ik iF k ii iE iF iF iF iF 1E iF iF iE iE iE 1E M if 1f 1f iFif iE 1E if iE if if �F k iF
I,EGALIZATION:N F E E S U
BLDG PMT PLUMBING ELECTRIC
PERMIT 25,00
PLAN
ISSUE FEE
DATE;
p DATE:
DATE • i 8- �
��r�e*��x*K�e �r*
****�r**��r��t*+t+t*�t*�r�t*��r�rr�e*�e*�t*�r�r�+r�r*
M M A A Y STRUCTURAL SEGMENT:Y
MECAANIC FIRE SMIP'/RES GRADING
, SMIP/NON—RES
.S�
BUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID�A DUE
TOTALS----> 25.50 0.00 0.00 25,50 25.50�a .00
__ n
REVENUE DIVISION TOTALS--> COLLECTED: 25.50 OVER/SHi
BLDZSp00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT� G;
1tiEMit3fitkifiFifiFMlfiFlF�FiF1E3fiFkiElfMiFltkjk�f�tifikifMffMMkifiFiFiflf3FMlfiF�fMklfMMiFiFafifatitMil:aF�
I N D I V I D U A L F E E B R E A K D O W;1
TYPE QTY D E S C R I P T Z O N UNIT CCYS'
. NO FEES WERE SELECTED FOR THIS PERMIT
�'
6
EXP{RED
� �SpSCt�Otli '
� — _ ! � ��
t
y
,00
PL�w-cxscx
TOTAL COST
C"��r.•�14 f i . L . _. ... .
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