HomeMy WebLinkAbout1964 HARBOR BLVD - Building Permits . ADDRESS OFBUILMNG: 1964 HARBOR. BL UMT: CITY OF COSTA •MESA - BUILDING PERMIT
OWNERSNAMEIFIDam, DAVE RUFFELL PERM NO: B 07589_
.- -,scr" ADDRESS 1922 HARBOR BL
C.M. 92626 PERMIT NO: B 075895 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAIM ADDRESS: CONSTRUCTION TYPE: V-N - • PERMIT TYPE: SIR PURPOSE: OTH
ARCHITECT ORENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF & REROOF OF ROOF W/BUR SQ FT: 1 , 715
ARCH.OR END'S ADDRESS: UNIT:
CLAIM VALUE: 1 , 715 .00 CALC-VALUE: 1, 715 . 00 GROUP OCC: B /
CONTRACTOR'S NAME CRANK BROS ROOFING CO (714 ) 548-5569 •
A CONTRACTOR'SMMUNG 126 COMMERCIAL WAY COMMENTS : X
ADDRESS: COSTA MESA CA uCNo.: 408677 ################################################x##############################
92627 wit ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penally of Perjury that I ant licensed under provisions of Chapter g SETBACKS •
(commending with Section 7000)of Division 3 cf the Business and Professions Code,and my license is in full force and effect. '
CTtLIC.NO.: 005993 =CLASS: C39 UC.No.: 40867 EXP: 06/96 MAIN BUILDING ACCESSORY BUILDING
/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
CDm / 9= '9 Contractor: � �, �.�.4 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
0 NER BUILDER DECLARATION:1 hereby affirm under penally d'perury that I am exempt from the Contractors License Law for the '
'dlowi g reason(Section 7031.5 Business and Professions tegerAny city or county which requires a permit to construct,alter,improve, PARKING REQ: PROV: PARCEL: 00000000 Z NE: REF NO: •
rmolsh,or repair any structure.prior to its issuance,also requires the appliant for such permit to fib a signed statement that he or she PLANNING NOTES> '',licensed pursuant to the provisions of the Contractors License Law)Chapter 9(commenting with Section 7000)d 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 applcantfor a permit subjects the applicant to a civil penalty dnotrmore than fore hundred dolrs)$5001). ####################r###########################################################
o t.as owner d the property or my employees WO wages as their sole compensation,will do the work,end the structure is not intended DEVELOPMENT S E R V I C E S REQUIREMENTS
or offered ler sale(Section 7004,Business and Professions Code:The Contractors License Law does not apply to en bwnad prove*/
who builds or improves thereon,and who does such work Nmsef or herself or through his or her own employees,provided that such
improvements are not intended or offered for side.If, the building or improvement is sold within one year o completion, ZONING APPROVED BYE DATE:
ownenbuilder wit have the burden of proving he or she did not ped build or improve for the puree sate). -
❑ I.as owneroftheproperty.amexclsiveycontractkgwithlicensedcontractorstoconstructtheproject(Section7044,Businessand BUILDING APPROVED BY. : DATE:
Professions Code:The Contractors License Law does notappy to an owner d property who builds or improves thereon and who APPROVED .
BY.
for such projects with a cantsctor(s)licensed pursuant to the Contractors License Law). /� � ' • 6
o Iamexempt under Section: Et.A P.C.,for this reason: • APPLICATION ISSUED BY: DATE:
Date: Owner:
LEGALIZATION:N • F E E . SUMMARY STRUCTUR • SEG ENT:Y
I do hereby certify that I ant aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534.and that I or any Mure building occupant willaaty not(circle one)need to comply with said state codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a Permit for construction or modification from the Air u-O-Thnenagementnee.Re°idmply construction applcationsareexempt from these •
provisions. PERMIT 41 .00 .
Date: Applicant SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSU - . 50
ISSUE FEE
❑ Ihave and will maintain acertificate dconsent toself-insure for soothers'compensation,es provided for by Section 3700of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for m
lnepenoa .dmewwkmrwMphh.Pemn .i..aee. TOTALS----> 41 . 50 0 . 00 0 .00 41 . 50 41 . 50 .00
InI have and wit maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,ler the performance of the
work for which this permit is issued.My workers'compensation insurance carder and policy number are:
Carder STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 41 . 50 OVER/SHORT: . 00
i Policy Number: 8c-9hONTT974 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING "PLAN-CHECK
(mis section need not be completed 1 the pane]is for one hundred dollen/$t00)or less.) 41 .00 . 50
❑ I wally that In the performance of the work for which this permit is issued,I shall not employ arty person in any manner so as to
subled to the workers'compensation laws of California. and apse that H I Mould become subject to the workers' ###############################################################################
coon ion °ions d ion 3700 d the labor Code, hwnh comply 'h these provisions.
INDIVIDUAL F E E " BREAKDOWN •
atj � g� - Am( -4j' 0447av_n
Warning:Failure to securewodredcomperuatlon coverage is unfswhd and shall stelae!anemployer to criminal penalties and TYPE QTY - D E S C R I P T I O, N UNIT COST . TOTAL COST
civil fines up to one hundred thousand dollars(5/04000A In addition to the cost of rompansatlon,damages as Provided ler In
Seddon 3705 oI the Labor COW,Interest,and atromsy'a less, . SFC 1715 REROOF BY VALUE' COMMERCIAL NOZONE 1 .00 1 , 715 . 00
• CONSTRUCTION LENDING AGENCY:I hereby effion under penalty of perjury that then is a construction lending agency ler the " END OF FEES '
performance of the work for which this permit is issued(Section 3097,Civ.C).
LENDER'S NAME:
' LENDER'S ADDRESS:
1 certify that I have read this application and stale that the above information is correct,)agree to comply with all oily and county ordinances - .
and state laws relatleg to building construction and hereby authorize representatives of this city to enter upon the above•mentioned property I 01 00197992-00197993 TOOT 41.50
for inspection purposes. t s DATE: 01/09/95' TIME: 13:53
JIM CRANK ,
'riot Name
3 /
`� Date:
( //
Sig dllr!oi Owwr/Agent/Applcant/Cydtrador
(515146.WP) While-Building&Safety;Green-File;Cavy-Applicant;Pink-Revenue;Goldenrod-Assessor • ,