HomeMy WebLinkAbout1852 Placentia Ave - Building PermitsCITY OF COSTA MESA
os , BUILDING DIVISION
K•,I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL:(714)754-5626
ft"`
PERMIT NUMBER: E09-00044
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42420116 DATE ISSUED: 02/26/2009
ISSUED BY:BJK
JOB ADDRESS: 1862 PLACENTIA AV CM Suite/Unit:
Vicinity: WAHOOS FISH TACO
SCOPE OF WORK: ELECTRICAL PERMIT FOR 4 PHOTOMETRIC EXTERIOR LIGHTS AT"WAHOO'S FISH TACO'
OWNER: LEE,CHEONG KWONG TR Address: 1862 PLACENTIA AV Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: DICKENSON,DAN Address: 11 BARONESS LN Unit:
PHONE:949-355-9644 City/State/zZip: LAGUNA NIGUEL,CA
CONTRACTOR: DICKENSON CONSTRUCTION License No. 633934
Address: 11 BARONESS LNUnit: PHONE: 949-355-9644
City/State: LACUNA NIGUEL,CA ZipCode: 92677 CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: 0.00
Electrical Permit Fee: 27.90
Reinspection Fee 0.00
TOTAL FEES 52.65
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.
CODES. INSPEC110N TYPE DATE INTITIAL$ CODES INSPECTION TYPE, DATE INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
y
200 Final Re-Roof 210 Final Electrical 41 ?f('
1
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
rRS'
COMPENSATION DECLARATION:Owner ID verified by drivers license. ID Yes 0 No
affirm under penalty of perjury one of the following declarations: Driver's License No.Expires:
ve and will maintain a certificate of consent to self-Insure for workers'
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
ation, as provided for by section 3700 of the Labor Code, for the
nce of the work for which this permit is issued.
ve and will maintain workers'compensation insurance, as required by
700 of the Labor Code,for the pedormance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
issued. My workers' compensation Insurance carrier and policy I hereby certify that no excavation five(5)or more feet in depth into which a
re: 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
Carrier:
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,GrpThissectbnneednotbecompletedtheperm4isvaluedatonehundreddollars(El eo)or less)
2,Art 2,Sec 341,Title B,California Administrative Code).
Policy ber:
As owner-builder, I will not employ anyone to do work which would
0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
is ued, I shall not em•loy any person in any manner so as to become subject such person has a permit to do such work from the division.
to the worker ' com•`n-=tion laws of California. and agree that if I should
b orae subj t • th.. workers' compensation provisions of Section 3700 of
Applicant s SignatureDatethLaborCo ,I I hal 1 o hwith comply with these provisions.
2 Z(0 .01 Division of Industrial Safety Permit Number:
Appli•.m's Signature
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes No
100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and
2. Does or will the applicant or present or future building occupant need to file
m license is in full(arc, and effect.
a registration form for acutely hazardous materials? 0 Yes 0 No
Lia". • 'i 9 Class 4'0. 1 Section 25533 of the California Health and Safety Code, with some
Z,7/O (21exceptions, requires registration with the Costa Mesa Fire Departmentbyeachbusinesswhichatanyonetimehasonhandaquantityofacutely
Co Pactor's Signature Date-_
a 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
I hereby affirm that there is a construction lending agency for the
3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code).
prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name:
hazardous materials)? IDYes 0 No
Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS:
Health and Safety Code been fully complied with? 0 Yes No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? Yes No
issuance,also requires the applicant for such permit to file a signed statement
ested
that he or she is licensed pursuant to the provisions of the Contractors
informatnion
65850.
2fu i
the California Governmentnot
Cos
d requires
dithnt
thee
mitreq ).
information be furnished on applications(a non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? Yes No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If'yes",attach certificate of compliance from the appropriate airpollutionemployees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer),
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon.and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.).
certify under penalty of perjury that I have read this application and state that
0 am exempt under sec.
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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
aut rized by this perm' u til final inspection.
Signate Q Le I eqs) Date
Signature
DateJ11a
j '1- p
305)-66(10])
And/or Auth axed Applicant_ Date
CITY OF COSTA MESA
i
BUILDING DIVISION
pi ' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
F .I .,..n"
rFOR INSPECTIONS CALL:(714)754-5626
rmd••
PERMIT NUMBER: B08-00347
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42420116 DATE ISSUED: 12/29/2008
ISSUED BY:BJK
JOB ADDRESS: 1862 PLACENTIA AV CM Suite/Unit: '
Vicinity: WAHOO
Squares: 2900 Valuation: $11,200.00
SCOPE OF WORK: REROOF COMMERCIAL BLDG(WAHOO'S); 16 SQUARES FLAT ROOF:T/O EXISTING B.U.R„ INSTALL NEW ONE
BASE 3 PLY+72#CAP SHEET W/HOT ASPHALT IN BETWEEN EACH LAYER CLASS A; PER COOL ROOF
STANDARDS, 13 SQUARES PITCHED-(4:12):T/O EXISTING COMP ROOF,REPAIR/REPLACE SHTG, 1 LAYER
30#FELT, INSTALL NEW 40 YR CLASS A COMP SHINGLES.
OWNER: LEE,CHEONG KWONG TR• Address: 1862 PLACENTIA AV Unit:
PHONE:City/State/Zip: COSTA MESA,CA
APPLICANT: ALMEIDA, CESAR Address: 177 RIVERSIDE AV Unit: :
PHONE:949-645-0104- City/State/Zip: NEWPORT BEACH,CA
CONTRACTOR: NEWPORT ROOFING INC License No. 524454
Address: 177 RIVERSIDE AVUnit: PHONE: 949-645-0104
City/State/Zip: NEWPORT BEACH,CA' 92663 CELL:
ARCHITECT: License No.PHONE:
ENGINEER: License-No.PHONE:
FEE SUMMARY
Reroof Plan Check: 0.00
Reroof Permit Fee: 209.25
Reinspection Fee: 0.00 - ,
TOTAL FEES 209.25
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t. INSPECTION TYPE ETI INTTALS CODEC INSPECTION TYPE lag INTRWL$
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
2
I/+
q
a sgs0 1
WORKERS'COMPENSATION DECLARA110 Owner ID verified by dense. Yes No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No.Expires:
O I have and will maintain a certificate of consent to self-Insure for workers'
Verification of Ownership by(type of document,i.e.-property tax,bill or deed):
compensation, as provided for,by section 3700 of the Labor Code, for the
p rformance 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' co pensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
lJ 1 by this permit,and that no building structure,scaffolding,falsework,ordemolitionCarrie%y
or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,GrpThissectionneednot/beeccoGmjpleted If the pennit is
valuedu-
1a/(
one hundred dollars($100)or less.)
2,Art 2,Sec.341,Title B,California Administrative Code).
Policy:Number: l0 7 / 61000G"1
As owner-builder, I will not employ anyone to do work which would
I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicants SignatureDaletheLaborCode,I sha - 'th comply with these provisions.
21/O cV Division of Industrial Safety Permit Number:
pph •l - •e
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? Yes 0 No
100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and( effect.
q
a registration form for acutely hazardous materials? 0 Yes No
cLic: Z7' ' `7/ctS / Class#_. `— 3 / Section 25533 of the Califomia Health and Safety Code, with some
7',/21j /O&exceptions, requires registration with the Costa Mesa Fire DepartmentbyreachbusinesswhichatanyonetimehasonhandaquantityofacutelyC; u Date--} 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code).
prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name:hazardous materials)? 0 Yes 0 No
Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 70315, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes No
issuance,also requires the applicant for such permit to file a signed statement (
Section 65850.2 of the Califomia Govemment Code requires that therequestedthatheorsheislicensedpursuanttotheprovisionsoftheContractors
information be furnished on applications for non-residential building permits).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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? Yes No
thereon,and who does such work himself or herself or through his or her own 8. (If yes", attach certificate of compliance from the appropriate airpollutionemployees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with
a contractor(s)license pursuant to the Contractors License Laws.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: .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) le'
24 ( j3057-46(3107)
Signature Date
Ando authorized Applicant...,_ Dale ;.)..
CITY OF COSTA MESA
r BUILDING DIVISION
F(77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
ia. FOR INSPECTIONS CALL: (714)754-5626
4bowro
PERMIT NUMBER: BX09-00001
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 42420116 DATE ISSUED: 01/0512009
Zoning: ISSUED BY: BJK
JOB ADDRESS: 1862 PLACENTIA AV CM Suite/Unit:
Vicinity: Primary Occ: • • - Const Type :??
SQ. FT: 2200 Valuation: 3,000.00
SCOPE OF WORK:
INTERIOR RESTAURANT DEMOLITION OF NONBEARING/DETERIORATED WALLS IN CONJUNCTION WITH THE 2200SF
INTERIOR
gC 8- SRESTAURANTTIFOR"WvAHOO'S FISH TACO."
teed / 00 J 7 .
OWNER: LEE, CHEONG KWONG.TR Address:: 1862 PLACENTIA AV- Unit
City/State: COSTA MESA,CA Zip Code: 92627-
Phone:
APPLICANT: RICK BROWN Address: 39793 PAMPERO WY Unit:
City/State: TEMECULA,CA Zip Code: 95292
Phone: 951-757-7449
CONTRACTOR: RICK BROWN License No. 303393
Address: 39793 PAMPERO WY Unit:
City/State: TEMECULA, CA '
Zip Code: 95292 Phone 951-757-7449 Cell:
ARCHITECT: License No.
Phone
ENGINEER: License No'.
Phone
FEE SUMMARY
Building Plan Check: 0:00
Building Permit: 83.25
Electrical Permit: 0.00
SMIP Residential 0.00
SMIP Commercial 0.00
Bldg Std Admin Fund 1.00
TOTAL FEES 84.25
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 IN1nIALS CODE* INSPECTION TYPE DATE INTmALS
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 7(
7p
250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION:Owner ID verified by drive,_.,cense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No.Expires:
O I h e and will maintain a certificate of consent to self-Insure for workers'
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
comp sation, as provided,for by section 3700 of the Labor Code, for the
pe rmance of the work Mr which this permit is issued.
I have and will maintain workers'compensation insurance, as required by
ton 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
Carrier'by this permit,and that no building structure,scaffolding,falsework,ademolitiont.Lrz
or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,GrpThissectionneedratberanteteetllhepemtasvaluedatonehundredradars(5)00)wleu)
2,Art 2Sec.341,Title 8,California Administrative Code).
Policy.Nurnber: 727g - f Oorj' c.(
As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's SignatureDaletheLaborode,I7Aforthwith comply with these provisions.
1,--------- S —Dy
Division of Industrial Safety Permit Number:
Applicant's Signature Date
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and
2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect.
a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.#
n -
317-7139 Classi# 3 Section 25533 of the California Health and Safety Code, with some
l '
exceptions, requires registration with the Costa Mesa Fire Departmentbyn^ —
941/
each business which at any one time has on hand a quantity of acutely
Contracmrs Signature Date,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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code).
prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name:hazardous materials)? 0 Yes 0 No
Lender's Address:
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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (
Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits).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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If'yes",attach certificate of compliance from theappropriale air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving-that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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 Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracta(s)license pursuant to the Contractors License Laws.).
certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
5jgr Wre g Owner(s) Dale
SignatureDate
r
i`-
01005]-06(310])
A(dlor Authorized Applicant Dale
114
40010
q CITY OF COSTA MESA
w c BUILDING DIVISION
i.1
DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER
PERMIT E00-00151
714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1852 PLACENTIA AV Status: ISSUED
Suite No Applied: 02/25/2000
Vicinity: MEDIA ONE CABLE T.V. BOX Issued: 02/25/2000
Parcel Nunmber: TPN99081
Applicant: THOMPSON, TOM
ISSUED BY:
Address: 1835 WHITTIER
COSTA MESA,CA Phone: (949)548-1735
SUITE A-12 Zip: 92627
Owner: CITY OF COSTA MESA
Address
Phone:
Zip:
Contractor: THOMPSON AND THOMPSON
Address: 1835 WHITTIER
COSTA MESA,CA Phone: (949)548-1735 .
SUITE A-12 Zip: 92627
License: 550936
SCOPE OF PERMIT
INSTALL ELECTRICAL METER FOR NEW CABLE T.V. POWER SUPPLY FOR-MEDIA ONE-.
FEE SUMMARY,
Quantity Quantity
ISSUE FEE 23.50 Temp Dist System/Lighting $0.00 0
Temp service test 0.00 Busway/100 ft 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 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 Wiring System/Ckt $0.00 0
Service to 200a 30.50 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 1hp 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
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: 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
DECLARATIONS i. :
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
for which this permit is issued.
0'; rhave 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.
Myworker compeensationInn urance carrier and olio number are:
Ca
be co
iy pdolicy Numbei:=/(9/3 7u^ CO
rMissection need not be completed if the permit is valu d at one hundred dollars($100)or less.)
r
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 subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with the vi o
n
AppttcaRnl igna 4 iC_.. _ _ale:_-, r&2 Uv
ING:JFAILURE TO SECURE WORKERS'COMPENSATION COVERAGE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($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 tha I3r0 I.icens ypder pr visions 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. ic:k 1 - O 6 CIa55,N) C - 7
trectors'Si nature: ate:g
s 2- 2f x
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).):
O 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.).
0 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: •
Signature: Date:
Owner ID verified by driver's license. 0 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:
O 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,taisework,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.
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? 0 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).
till will.
cu__ m.2 Does or will theaapplicant orpresent or future buildingoccupant need to file a registration form for acute) hazardous materials?pp p g y Yes 0 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).
or
r.
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.
fully4IfanRMPPispresentlyrequired,has Section 25534 of the California Health and SafetyCode been full complied with?q y p Yes No
5
il.l...t-
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g____ re.. which lub application r.__.const..modification
olilt
5 Does or willthe applicant or
Quality Ma a
emen
building occupantat y
other
for the work
ontch
isi that or
this 11 pliestion aggermit for such construction or modification
from the South Coast Air Management District or from any other air pollution control district or agency? Yes LJ No
Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6pay..to
il l
ct d permit 10 from und..- 6 Will any part of the facility to be constructed under this permit be within 1000 feet the outer boundaries of a school? Ves No
wilt
It"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7..-.....- from Management other district for....be._ fh..is..-.7
application,
If a
tion
the South CoastlosAir
prescribedri
eanygemenr
is Health
or
nd Safetyair pollution controln3 been agency is required for the work which is the subject ofthishaveallofthedisclosuresbyCaliforniaandCodeSection42303made? Ves No
attach
oft.
ncep.
r.
o.__
l.l.
u.
t.
ion r.).. .... ..-____
till..
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.
Signature Ot Legal Owner(s) Date
nAuthorized Applicant` — Date', a='_-
CODE C. INSPECTION TYPE DATE INTITIALS CODEX INSPECTION TYPE PATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
r p
200 Final Re-Roof 210 Final Electrical GICs 44 4/,
201 Final Block/Retaining Wall 212 Final Fire Prevention J"
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
02/25/00 14:11 e714 895 0188 ORANGE COAST LIS
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FAX COVER SHEET
SOUIIIERN CALIrtRN1.1
EDISON
sa gown rVi'MA iTh)SAI."(:.r.p:.r.
HUNTINGTON BEACH SERVICE CENTER
TO: Burt Morgan City of Costa Mesa
FAX NUMBER: 714-754-4856
FROM: Edison Planning Department
PHONE NUMBER: 714}895-0363
Edison Site Releases For Media One Cable TV Spots
P/S # Address
9 403 ylCIO trier
37 A- 2. 760 Rlurkire
ee 4 1198' iso s42n.o.
70 A I g15-2, PI 4.e, eb,eril'.
SptiOlA-e-ss
NUMBER OF PAGES INCLUDING COVER SHEET
Please notify sender if any pages are missing (714) 895-0244 -PAX 54244
SOUTHERN CALIFORNIA EDISON COMPANY
7333 Bolsa Avenue,Westminster,CA 92683 -FAX: (714)895-0188-PAX FAX: 54188