HomeMy WebLinkAbout296 BROADWAY - Building Permits(714) 754-5273 • Fax (71q) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 296 BROADWAY
Suite:
Vicinity: ROOF
Parcel Number: 11721312
Applicant: STUPIN, DAVID
Address: 1E03 CALIFORNIA ST
HUNTINGTON BEACH, CA
Owner: PAYNE, DONALD W TR
Address 1968 POMONA AVE
COSTA MESA, CA
Contractor. R R R ROOFING
Address: 1803 CALIFORNIA ST
HUNTINGTON BEACH, CA
Zip: 92645
Arch :
Address:
Zoning:
Phone: 714-53G6890
2ip: 92648
Phone:
Zip: 92627
Phone: 714-536-6890
License: 709223
Eng:
Address:
Status: ISSUED
Applied: 10/77/2002
Issued: 10/77I2002
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Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL WITH 3 TAB OVER 15# FELT AND USE EXISTING SHEATHING. 1.250 S.F. FOR RESIDENCE ONLY.
Plan Check: $0.00
Permit: $50.95
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $51.45
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0.0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
s�.aoo.0o
$1,400.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis untler Calilomia statutes and related
regulations. (O�d. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 180 days, or if work is suspended or abandoned
tor a period oi 180 days.
INSPECTIONS: In order for ihe work authorized under ihis permit lo be considered legal, such work must comply with all applicabla codes, and all
reQulred inspeetlona and }Inal epproval must be obtained. Failure to obtain inspections and final approval will resul� in the expiration o1 this permit.
FOR INSPECTIONS CALL: (714) 7545626
:99tl�4tl (fYW)
WORKERS'COMPENSAnONDFCLAiiAnON:
I hereby aHirtn under penalry ot Oery'ury one ot Ihe tollowing tleclarations:
❑ I heve entl will mainteln e cenificate of wnsent to setl-Insure lor workers' compensetion, es provideC tor by sectlon 3700 ot Iha Lebor Cotle, for the pertormence oi the
� �work tor which this pertnil is �suetl.
�y.f- "I �ave and vrill malntain wakBrs' compen5atbn �nsurenca. es requiretl by sectim 3700 ot Ne LebOr COEe, for Ne pBAortnance of Ihe work tw whitii Ws pertnit 15 155uetl.
My workers' compensation IrGsurancs carrler entl polity number are: // �' L��� ` /
Cenie'c C Polky Number: � T A
(This sectlon need not be complefod i) (he permitls valued et me hwMred dW/ars (S 100) or IessJ " %P�
❑ I certity that in Ihe pedortnan� ol the work br which IhLs pertnit is issuetl, I shell not employ eny perean In eny manner so as ro become sub�ect ro the workere'
compansation laws at Calilomle, enC egr e that It I shoula became sublect to the workers' compansellon provislons oi Section 3700 of the Lebor Code, 1 shall fonhwit�
comply with Ihese provislons. �
"Applicanl Signature: t Dete:� �� "� %'—'�
� WARNINO: PAILURE TO SECURE WORI(ERS' COMPEI AiION COVERAGE IS UNUWFUL ANO SHALL SU8IEGT AN EMPLOVER TO CRIMINAL PENALTES AND qVIL FlNES UP TOONE HUNDRED
THWSAN� DOLL�IRE �5100,000), IN A�DITIIXJ TO THE CQST OF �MPENSATION, DAM4GE5 AS PROVIDE� fOR IN SECTION 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEVS FEES.
LICENSEO CONTRAC70RS DECLAHATION:
I heroby eNirm Ihat I em licensed under pmvislons ol Chepter 9(commencing wilh Section 7000) ol Divlslon 3 ot the Buslness entl Professions Code, entl my license Is in lull
lorce and effect. Lic. a Class a
Contractor's SigneWre: Date:
CONSTRUC710N LENDING AGENCV:
�❑ I hereby eHirtn t�at there is e consW ction lending eBency tor ihe peAortnance ol Ue work br which this Dermil is issued. (Sec. 3097, Civil Cade).
Lentlefs Name: Lender's Address:
Signature: Date:
OWNER•BUILDER DECLARATQNS:
I hereby aNirtn thet under penelry ot per�ury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslness and Prolessions
Cotle: Any ciry or cuunry which requires a.pertnit to construct, elter, improve, demolish, or repair eny swcWre, pdor to its issuance, elso requires �he epplicem tor such pertnit
to tlle a signed stetement Nat he or she is Ilcensatl pursuant to tha provisions ol tha Cantrectors License Lew (Chepter 9(commencing with SecUon 7000) of DMsion 3 of U�e
Busineu end Professions Cade) Or thet he or she is exempt therefrom and the basis br the allegetl exemption. Any violation oi Section 7031.5 by eny eppllcant lor a pertnit
sub�ects the apPlicani ro a civll penalry ol nol more Nen live hundretl Oollars (5500).):
G,
❑ I, es owner of ihe property, or my employees with wages as their sole compensatlon, WILL DO TME WORK, and Ihe siructure Is not intentleC or oHeretl tor sale (Sec.
7044, Business antl Professions Code: The Contrectors License Law dces not apply to en owner ol proporty who builds or improves thereon, antl w�o tloes such work
himself or herselt or through his or her ov.•n employees, proviaetl that such improvements are not Intended or oNered �or sele. If, however, Ihe building or improvement Is
soltl within one year oi wmpletion, the owner-builder will have the burden of proving that �e or she did not build or improve for purpose ol sale.).
❑ I, as owner of the property, qm E%CLUSIVELV CONTRACTING WIT}1 LICENSED CONTRACTORS �o construct Ihe praject (Sec. 7044, Business enE Prafessions
Code: The contractors License Lew tloes no� eppry to an owner ot properry who builds or impmves thereon, entl who contracts tor such project with a coniractor(s)
license pursuant to the Contraaors License Lews.).
❑ I am exempt under sec. Busineu antl Professions Code lor ihis reeson:
Signature: Oate:
Owner ID verilied by drivefs licenSe. ❑ Ves ❑ No Drivefs License No. Ezplres:
Venfication of Ownership by (rype ol tlacumem, I.e. - property tac bill or deetl):
DIVISION OF INDUSTRIAL SAF�TY pERMR CER7IFICATION:
❑ I �ereby certity thet no excavetion tive (5) or more leet in depth into which e person Is requirea to descend, wlll ba metle In connection with work euthoAzed by this
pertnit, end �hat no builGing girucWra, scafloltling,lalsework, or demolition or dismantling t�ereoi, will be more I�en thirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tnle B, Calilomle AtlminislretNe Cotle).
❑ As owner-builder, I will not employ enyone to tlo work which would requlre e permlt irom the Divislon of Intlustriel Selery, es noled ebove, unless auc� poraon �es e
permit to tlo such work from the tlivision.
Signature:
Divislon of IndusMal Salery Permi� Number.
Date:
HAZARDOUS MATEPIALS AND EMISSIONS CERTIFICATION:
1 WIII the eppllcant or preseni or luWre building occupem naed to file end cenity e 8usiness Plan tor emergency response to release or threatenetl releese oi e hezerdous
materlel? ❑ Ves ❑ Np
(Secilon 25505 ot Ne Celifornie Healih end Satery Cotle requires, with some exceptlons. lhet e Buslness Plen be filed with the Coste Mesa Fire Depflrtmont by every
business which has a� any ane time during a reponed year a quentity ot hezartlous meterials equel to or greeter ihan e weight oi 500 pountls, or e volume ot 55 gallons,
�or 200 cubic feet of compressad gas et standard temperatura anC pressure).
..................'— __ '_.'__'.....—"'..__�........................._..__............................................................ —"......
2 Does or will Ihe applicant or presem or tuNre builtlinp occupent need to lile e reB���ation torm for ecutely hazerdous metedals7 ❑ Yes ❑ No
(Section 25533 0l the Califomia Heelt� enA Safery Code, wlth some eace�tlons, requlres registratlon wilh tha Costa Mesa Fire Depanment by each business whic� et flny
one time hes on hantl a qugntlry ol acutety �alardous meterials eque to a greater than e welght of 500 pound9, or a vdume ol 55 gellons, or 200 cubic fee� of
compresseC gas at stendard Iempereture enA pressure).
" .............."".._..._'_'_"""'__' __�._.........._.__.._._.._....... . . ................_............_........—"_'........ ..._._,__"
3 Does or will the applicant or present or tuture bulldinp occupent need to prepare an RMPP (Risk Manegement antl PrevenOon Progrflm tor ecutely hazertlous meierlals)9
❑ vos ❑ No
(Sectlon 25534 of ihe Calitomia Healt� entl Setery Coda provides thet the Costa Mese Fire Depenment may requlre ihe preparation, certification enO filing wlih the Flre
oepartmen� ot an RMPP by busineues w�lch ere requlred to register aiutely hazardous metedals with the Fire Department.
_ ................................................_.........................._._...........................................................................................................................................................................................................................................�__.......
4 It an RMPP is presently required, has Sectian 25534 0l Ihe Califomia Heelth and Salery Cotle been fully complietl with? ❑ Ves ❑ No
................................................................................................................._...................................................................................................................................................................................................................................................""......,
5 Does or will the applicem or present or fuNre Cullding accupant require tor the work which is the subJect ol Ihis e,pplication e Pertni� tor such conswction or modllicailon
irom the South Coest Air Quality Menegemem Distdct or trom any other air polNtion mNral distdct or egency7 LJ Yes LJ No
(Section 850502 of t�e Califomia Govemment Code requires ihat t�e requesied infortnation ba furnished on epplicatlons tor non-resitlential Dulltling pertnits).
..........................................................................................._........................._........................................._................................................................................................................................_....._.................................'_".......................'_
8 WIII eny part of the tadliry to be wnstructed under thls pertnit be wit�in 1000 feet from the outer boundades ol e schooll ❑ Ves ❑ No
Qf yes", the faciliry musi meet t�e requiremem of Sections 25534 and 42303 oi iha Calitomie Heelth and Satery Cotle).
.....................................................................__�_'.....__...—.................................._'_._..................__..__........................................................................................__._—............._...........—._..___
7 If e pertnit Irom ihe South C�s� Air Oueliry Menagement District or ather alr pdWtion cantrd disMct or agency is raquired for Ihe work whith IS NB SUD�ett ot NIS
epplication, have ell ot the tlisclpsures prescdbetl Gy Cellfomia Heelih and Safety Cotle Secilon 62303 been made7 ❑ VBS ❑ No
.......__'�.._".... _ ..__..._....__............_ .............._.."""'_..._'_"
B (It yes', atlach ceNficate of complience Irom Ihe appropriate air pollutlon control oMcer).
CERTIFICATE OF COMPLIqNGE: I ceriity that under penalry of perjury ihe infortnation given ebove I5 correct. I egree to comply with all5taie IawS end tiry ordlnances
regarding Hazardous Materials entl Emissions.
Signawre: Date:
CERTIFlCA7E OF COMPLIANCE qND AUTHORVA710N OF ENTAV: I certiy under penalry ot peryury that I have raetl Ihia epplication entl steta that the inlortna�lon piven is
correcc I egree to compty with ell stete lews en0 dry oNinences relating to building consWc�ion, an0 euthodze representatives oi ihe Ciry oi Costa Mese to enter upon Ihe
above-descnbed properry �or inspbction purposes. I egree rw! to accuAY oi allow occupancy of any buiMing authonzed by this permit uniil fina! inspection.
CODE 1, INSPECTIONTYVE
1818 Fixetl System Final Fire prevention
1268 Pool Spa Final
200 Flnal Re-Root
201 Flnal Block/Relaining Wgll
202 Final Fectory Fire PWce
203
204
FIrtelSign
Final Demolltlon
PAIE ItII�Li
i ��ir ,:r�
CODE 1 INSVECTION TYPE
208 Finel Mechenicel
20B Finel Plumbinp
210 Final Eleclrlcal
212 Flnal Fire Preventlon
220 Final Planning Approvel
222 FinelSite
250 Flnal Bullding/Occupenty
Date
!G-i�-vz.
� -"Date
QAIE I�L$
vrvn�rc YAY
�.
J08 ADDRESS
GF�ERA�CON
C�. ., ,ro. 117-2
IN��ECTIONS
SOIL
GAS
W FTER
ROUGH PLUMBING
PROP. $WR. LINE
SPRINKLING SVST
MISCELLANEOIIS
��liF�1:7_�iii�L��yI:7
ROUGH HEATING ANo AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUND � POwER �
ROUGH WIRING
TRENCHES � FORMS � STEEL RE
FLOOR SVSTEM
BONO BEAM ❑ STEEL REINFORCE �
SHEATHING
FqAME AND FLASHING
LATHING — IN OUT
P.v,�,;,_`�,;,ER, BROWN COAT
5'�';-=-=TURAL, FINA�
HEATING, VENT., FEFRIG. ANO A.C., FI
PLUMBING, FINAL AND GAS TEST [-]
ELECTRIC, FINAL
BUIL�ING, FINAL
UAIt
SUBCONTRACTOR
T
'` COSTA MESA BUILDING-SAFETY QEPARTMEM
P.O. BOX 12W COSTA MESA� CALIFORNIA 9Z62E
Foe AppllcaM ro Flll In Cemplefdy
TYPE OR PRIMT
COSTA MESA, CALIFORNIA
MAIL
APp:t:: ,.7-�QO 986 �*****3.00
I,rPLICATION FOR PERMR
BUILDINa
Fo� OHIn Ur� Only
nicai►r no. �i
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ZONING
ho.or u�cor
run� � �uacu
CITY � A. P. NO. // —.1 � o`
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OF LOT � ' - MOW ON 1AT
YAHDfAPPROVBD YARDBAPPROVHD
USEOP MAIN BUILDINO ACC8880RY BUILDINO
EXISTINQ BLDO. � S l.. C
(FROMGLR )
eenwcK urva rnor �R NT FT.
c[NT[p oplTRe¢f RRAR YAR
CID YAi1 LR1T NIaNT R.DID IT.
DESCRIPTION OF WORK �. e�c Srr. rr.
1 , R6AR PT. FT.
/ V �LT6R�TI�N ADDITION
ROOP
1 H6R'LOY ACKNOWL�DO[ iXAT.I XI�V6
AND 6TI�iE TNAT Tli AOOV[,19 CORRI
PLY WITN �LL CITY ORDI f8 ry0 1
OUILDING CONH}pYCT10M.
H16NATURC OP
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AUTXORIZ[D AOHNT
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PURP09[ O! fRTMLIGHIHO A P6f1Y1T PHt ONLY. �
VAWATION �� �
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TOTRI PEE � �
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OWNER PAYIGE� J. W. v DATE 8—�-74
JOBADDRE8S 296 Broadwa.y BUILDINGPERMITNO. 443
GENERALCONTRACTOR
VALUE S 6,SI1�.��
` 11 BLOCK G TRACT 59� Res. & Det. Garage
INSPECTION8
Footing Trench �{O-U-� (iv
Foundation Forms and Grade to
Rough Framing /��
, Plumbing, Rough to Slab
Plumbing, Rough Complete �
Temporary Pole
. Wiring� Rough
Heating, Rough
Heating, Final
Sewer }/I/i,�-a�/ .�2
Septic Tank or Cess�p-o�o-l� �
l-" 'l19/R/ �Cll <<
P. ering %j�a�cxav —�
Plumbing, Final, Fixtures Comp
Plumbing, Final GasTest �_� �1
Wiring, Final �Gt���
Occupancy �%iL(iJ
Form 21J GFI IM 1&63
DATE � SUBCONTRACTOR
PERMITSISSUED
DATE I NUMBI
/D —
Costa Mesa Building Department
� 111 EAST 20th �STREET
- COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
Building � � � B�OADldA�
Addreu
Costa Mesa, California
Nearest
Crossst. ,SAA/TA %lA/A
Owner e/ � (d/� / �/ /�C
Mail Z� O O/QO�iD �✓/� }� L•�
Address
Tel.
City COfiT.{ /i%l=.S/d No.
Arohitect or Lic.
Engineer No.
iress
-� /� Cit�
Contractor Nei.V C��.1/A/.P No.
Metes and Bounda) /
Setback Line from
Bullding
9 O� Side Vard J'
�oN oF woRg -
Alteration I I Addit(on I
Moving I I Demolish I
,.i No. of
•r+ Rooms Stories
APPLICATION FOR PERMbi T _-T
i2 BUILD�NG '�' •
�OR OFFICE USE ONLY
ReceFipt No. Permit o.
����I l J Y � �
Received by ate Rec'd. Date Issued
8 �'�'o�"� r(�- ,� - S�
Building � �7�
Address �:k- %i�% ��t�raa�-. �'�i/C-a �Q.ev�'
tOCosta Mesa, California
Nearest �/ {%
Crow St. ��;�.,.'tst�h-�� .04Y12�-�
2one� � A I No. of � I TYPe � I GrouP �
•r Plans I
Building � � Foundatfon Locatlon �1i
- Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge ihat I have read this�Application Lath. Int. �_
and state that the above is correct and agree to rnmply Lath. Ext. '
with all City Oxlinances and State Laws regulating _
btilding cronstructi�onj �
Signatureof /!y �'� � Flaster, Int. � _
Permittee C/Jn/L i� �� E '
� �, � Plaster, Ext. �
Authorized Agt. ���.. ' "
Valwation Perm
/ �/ Plan
$ t� /0• �0 Total
Fee
iM1HM 2�6 G-M 2M 5-56
�ontl Beam
FINAL
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