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Home My WebLink About166 BROADWAY - Building Permits r 11L r4, CITY OF COSTA MESA 44?-at BUILDING DIVISION > ��..., ` DEVELOV-iMENIIIERVICES DEPARTMENT P MIT NUMBER 74. 1.1141 PERMIT B05-01781 y tbesvxarw 41* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BtLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 166 BROADWAY Status: ISSUED Suite: Applied: 10/05/2005 Vicinity: HOUSE ROOF Issued: 10/05/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number 42523324 Zoning: Applicant: ALEXSON, TROY Address: 1653 SUPERIOR AVE ,I ,t Phone: (949)642-7222 ISSUED BY: �✓V' COSTA MESA,CA `Zip 92627--- Owner: BROKAW, C PHILIP TR Address 215E BAY AVE • - Phone: - BALBOA,CA Zip: 92661 Contractor `LEE ROOFING OF COSTA MESA Address:. 1653 SUPERIOR AVE '. Phone: (949)642-7222 COSTA MESA,CA _ Zip: 92627 , License: 349686 Arch : - Eng: Address: Address: Phone: - Phone: Zip: License: License: SCOPE OF PERMIT T/O EXISTING CAR SHEET ROOF,INSTALL NEW CLASS"A"BUILT UP HOT MOP ROOF SYSTEM ON HOUSE ONLY, ROX12 SQUARES. FEE SUMMARY Plan Check: $0.00 Calc Val el..n: $4,000.00 Permit: $97.25 Claim Val Irn: $4,000.00 SMIP Res: $0.50 SMIPh $0.00 Other $0.00 Inspection: $0.00 tot Total: $97,75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 -- Rear 0-0 Left 0-0 .Right 0-0 PARKING - Existing: 0 Required: 0 Proposed: ''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 24/8-46(6/00) DECLARATIONS U WORKERS'COMPENSATION DECLARATION: \ I hereby affirm under penalty of perjury one of the following declarations: ❑ i have and this ea certificateisof consent to self-Insure for workers'compensati i,as prov7'ued for by section 3700 of the Labor Code,for the performance of the �"""Plc 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. y M�w.�er 'compensatjpn Insur ce carrier and policy number are: /�/(�((�{y�' Mo r7/�'(/� 'Gatti r: y1r_hGz ,1</lxvt 14 "�'QL V /'LV G" It (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the.erfor 1 ante of the,or or which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation l."t tsffti• e' if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith co`ply with these provis JJJ Apblicant.Siana ure. r. , �� ,Date:'_.. <7/6.,-)/ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN PENAL AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affi�hat licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of.the Bu ess and Professions Code,and my license is in full force and,effect l t- - Lga"'y'.r. — c CprirritaiiPftIgnalurer7 gra i _ Da 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 end 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.). • O 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: r. Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. `� '&1""' A Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thaliio 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 nSbuildtn'g structure,scaffolding,falsework,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,Californ'1 dministrative Code). O As owner-builder, II not employanyone 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: 4h'v Date: Division of Industrial Safety Permit Number? ' HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: q. 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 0 No " .-'i (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 future building occupant need to file a registration form for acutely hazardous materials? ❑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). 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a2ernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information 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? 0 Yes 0 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? 0 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. 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. t Signature teff.,e .. .er(s) D /6 :1 int ri^-:iV,CS'•OWdzm.-� '37 om CODE t. INSPECTION TYPE DATE INTUL$ CODE# INSPECTION TYPE all 1NTRIAL$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ,f 200 Final Re-Roof 'z-ZY-07 210 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 • 31340PAID r. JAN 29-7Carsi3Ou 935 ii*****5.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEILS); DATE RECEIVED DATE ISSUED BUILDING ADDRESS .,16e .49 J-a9-76 /-a9_ 70 / t0.4 dui 4 y OWNER D2,,Iiny 6-cla /2-70 a A e. A.P. NO.8 7-L2a-- /7 ty(41-r4b BUILDING a., MAIL z ADDRESS /b 6, "etc A d W41,/ ADDRESS /0‘e) /•.0,..4 d til 4 y LB LliTEL. • 0-C..) C I T Y 00,17;e9 Me c4.A NO.-4A0-39,0-1 TRACT 377 LOT 7 BLOCKS I- Z Z < CONSTRUCTION A.6y4 NEW ADD ALTER REPAIR MOVING DEMO!LSH 7.---- - I- LENDER 0 co A. 5 0- 03 _1 0 BRANCH , ter 11 . , -J La / /-e __ . ' _ < LSI ADDRESS i/ _- Ape._ # . OWNER 03 -I V•LUE -CO ARCH ITEC • , j TEL. SE AM- t e en e _1 < OR ENGINE ? - ii)fa al 7 No. 5 in Z < , , . FIRE ..4,‘. 6.5 ---,---- LL, cc ADDREssover La EA i 110N-00u1104 ZONE TYPE GROUP'S- 0- 1-171 0 ' APPROVED lil Z CONTRACTOR&b p /0 „),-,friy 00„6 BY . ADDRESS 7Q/ C90. DATE -I 0 03 z :I cr1,1)Q#11-127/fifeari-e /. Poe . _ w u, ZONIFE ... 4 NO.OF2 USE OF NEW•PatCe# 0 t TEL. Z E- CITY U)a,i)ten i v Ile.in NO. .o.c. LANS BUILDING e2c4__c_,t. - 0 STATECITY YARDS APPROVED YARDS APPROVED IL CJ)FE LIC. NO. ici„2 Veci‘ A'.. / iLic.N.,Rooq MAIN BUILDING ACCESSORY BUILDING 0 0 SIZE NO.OF BLDGS.o (FROM C/L STREET) OF LOT 3-7 X/ 33 NOW ON LOT 934reae• FRONT FT. USE OF EXISTING BLDG. a /7.-- AD . &SIDE FT. 6 FT_, 1••• SIZE OFin m it ei NO. OF „--''t -• Z NEW BLDG./afl, /0MF• ROOMS STORIES / L.SIDE FT. 02...7 FT. < EXTERIOR WROOF Ca) COVERING lf/c eciAledi COVERING O 4411 /11 • REAR FT. -J USE OF BUILDING AND WORK TO BE PERFORMED Q. DISTANCE BET. BET.MAIN IIL cr G. MAIN BLDGS. ACCESS.BLDGS. < VAR.# DATE O cer Q. a 4.1 1Z 0/. C.U.P.# APPROVED 1- AR yPPROVEDPAth 7_.4.29-___ 7e) v) z 0 P c.) I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not emPICW I-- any person in violation of the workman's compensation laws of CO the State of California. c0 Z C a- I hereby certify that I am properly licensed as a contractor under SQ. FT. 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 am exempt from the provisions of the State of California Business Cr VALUATION and Professions Code,Division 3, apter9. co PERMIT FEE $ N.,...1. 012 N Signature of .,j• . *4440. $ a a ,... D CF Permittee . / S?&I /.. PLAN CHECK $ ---.--" E ' 8 Authorized Agent TOTAL FEE $N._.g aTel OWNER MOORE. MARY E. DATE 1-29-70 JOB ADDRESS 166 Broadway BUILDING PERMIT NO.31340 GENERAL CONTRACTOR CaliforniaPatio Supply DESCRIPTION of WORK Patio Cover AP No. 117-122-17 LOT 7 TRACT 77 FIRE ZONE VALUE $ 420.00 e, INSPECTIONS Signature Dare GROUP T TYPE TV ZONE R-7 SOIL SUBCONTRACTOR I PERMITS ISSUED GAS Date Number Signa,, _ WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE 7 HOUSE CON. n SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR.CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND fl POWER fl ROUGH WIRING Heating and Vent. TRENCHES FORMS fl STEEL REINF. ItrA FLOOR SYSTEM BOND BEAM 7 STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN 7 OUT 7 PLASTER, BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST 7 ELECTRIC, FINAL BUILDING, FINAL erne a,5 D