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Home My WebLink About420 Brighton Springs - Building Permits (2)Aj. CITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.gov lz- , �ERMIT TYPE PLUM APN;; 93786031 JOB ADDRESS: 4201 Vicinity: SCOPE OF WORK: REPLAN TILE OR ENCLOSURE PER A OWNER: KOLDINGER: MARA PHONE: 714-801-5483("f' APPLICANT: COLE, RANDY PHONE:619-405-2648 , I" / - CONTRACTOR: US HOME.SERVI ANdress:405 STATE HIGHWAY. 121 BY[ Ci/State:LEWISVILLE, TXZipCOdei750 ARCHITECT: fti ENGINEER: I+ .. PLUMBING PERMIT FEE SU PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: I -ii C FOR INSPECTIONS CALL: (714) 754.5626 PERMIT NUMBER: P12-00190 ISSUED 10/24/2012 KJB BY THIS PERMIT. NO NEW Address::ii� City/State/Zip: i ;.License:No.:768707,1� 250 "" �' "'� — �- '`.PHONE:214-088.6300=._ CELL: I � ~ i7•' Jf i 1 If 0 license Nd PHONEI r License Na. PHONE: tRY n , CA GC Aft ' t.',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. PINSPECTIONS: 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 It. INSPECTIONTYPE DATE INTIMtsOC DEt INSPECTION TYPE DATE INmULS IF 1616 Fixed System Final Fire Prevention 206 Final Mechanical )''fi266 Pool Spa Final 208 Final Plumbing t8 / 13 Q4 x'200 Final Re -Roof - 210 Final Electrical x;201 , Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval z P?03 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy ,0 STATUS: DATE ISSUED: _,-,ISSUED BY: SPRINGS CM Suite/Unit 'ALVE'AND BATH TUB. NO OTHER WORK'AUTHOI ISSUED 10/24/2012 KJB BY THIS PERMIT. NO NEW Address::ii� City/State/Zip: i ;.License:No.:768707,1� 250 "" �' "'� — �- '`.PHONE:214-088.6300=._ CELL: I � ~ i7•' Jf i 1 If 0 license Nd PHONEI r License Na. PHONE: tRY n , CA GC Aft ' t.',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. PINSPECTIONS: 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 It. INSPECTIONTYPE DATE INTIMtsOC DEt INSPECTION TYPE DATE INmULS IF 1616 Fixed System Final Fire Prevention 206 Final Mechanical )''fi266 Pool Spa Final 208 Final Plumbing t8 / 13 Q4 x'200 Final Re -Roof - 210 Final Electrical x;201 , Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval z P?03 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy ,0 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. ❑ 1 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 ar Carrier: riohAw rOe •r—J-,�¢A (This aew'w needriof 6eowrWereO it tl/ro/pacer �imfbvalue0 of core huMreO tldlars (S100f wbss.) Policy Number: LA -t-7/ 7 Y of ❑ 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 fo hwith with these pro 'sion Z �2 Applicant's Signature Data 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 DOLLARS ($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 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. #3 Zc�?:ZClass # r7 K Conaactols Signature Data 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 OWNER43UILDER 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).): ❑ 1, 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 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 seq. Business and Professions Code for this reason: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): 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 Art 2, SDC. 341, Tft 8, vn,uD,m,a .Adminlstratva - w'c). ❑ 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. Applicant's signature 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 FitmDepartment 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 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. 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 application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 658502 of the California Government Code requires that the requested informe8on 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. (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. 1 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. Signawn, of Legal Owneds! Date (Z y Z Signature Data And/or Authorized Applicant Data 305746 (3/07)