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Home My WebLink About1782 Placentia Ave - Building PermitsCITY OF COSTA MESA BUILDING DIVISION /- PEUFIMI DEVELOPMENTSERVICES DEPARTMENT8-00524 rPERMIT 714)754-5273 • Fax(714)754-4856 ELECTRICAL PERMIT Job Address: 1782 PLACENTIA AV Suite No Vicinity: Parcel Nunmber: 42405116 Applicant: KONWISER,JOHN Address: Phone: 833-2704 Zip Owner: DAISY 1 ASSOCIATES Address 4120 BIRCH ST SUITE 104 Phone: NEWPORT BEACH,CA Zip: 92660 Contractor: HOWARD ELECTRIC Address: 12042 JANETTE Phone: X714-530-2933 GARDEN GROVE, CA Zip: 92840 License: 675467 SCOPE OF PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED l GY Applied: 06/08/1998 U Issued: 06/08/1998 STATE HEALTH AND SAFETY CODE SECTION 116049.1 PUBLIC POOL GFCI INSPECTION. INSTALL GFCI FOR POOL LIGHT. 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) 7546626 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 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 1.00 1 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 Wiring System / Ckt 0.00 0 Service to 200a 0.00 0 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 1 hp 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 23.00 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) 7546626 91 1 DECLARATIONi WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a codificate 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 workerscompensation Insurance comer and policy number are: Carrier: Policy Number: This section need not be completed /f the permit Is valued atone 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 SUSUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECRON 3706 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. N Class 0 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 Code). Lenders Name: Lenders 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 wlthl voneVear 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, es ownbr of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License s not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the COMEont ors Licen Lews.). 1 am exonlid urider se Business and Professions Code for this reason: Signature: / Date: Owner ID v es No Drivers License No. Expires: Verificatio f Owne hip by (type of document, i.e. - property tax bill or deed): DIVISO OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: f 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 bythispermit, 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, An 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. 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 certity 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 standard temperature and pressure). 2 Does or will the applicant or present or lutura building ocapant neetl to fila a registration form for acutely hazardous materiels? Ves 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 1Section 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 bapartment 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 a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes a No Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 WII any pan 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 appermit from the South Coast Air Quality Management District or other air pollution control district or agency Is repulred for the work which Is the subject of This appllcatlon, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made'! Ves 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 compy *rh alfsfe[8'I cos and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above- ascribed prQ r inspectionDu oses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Of Legal Cwner(s) ( 9 Qa§- And/Or Authorized Applicant Date INSPECTION TYPE PAM a0IDA65 CODE f INSPEGTIONTYPE PATE IBTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - 7 200 Final Re -Roof 210 Final Electrical 1 i 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 2"a 6