HomeMy WebLinkAbout621 BROOKVIEW WAY - Building PermitsIOJECTIIDONE55: 6S3 BROOKVIEW WY
�WNEfl'SNRME: BROOKVIEW CONDO AOA
�onness: 630 PAULARINO
- CM., CA., 92627
(719) 587-0399
RNCH/ENGINEEB:
pODflESS:
HEG.NO.:
UNIT:
UNIT:
PE""uTTEF: MESA ROOFING CORPOAATION (?14)598-3012
FODFESS: H43 W. 17TH ST
COSTA MESA CA 92627
IILENSEO CONTNRCTOP OECIAPATIDH: I �ereDy atlirm tlut I am Gcensed unOer prmisions ai Cluple ,¢clion
70001 ol Div,sion 3 o��he Business ana Pmlessions COEe. ana m I� .
enruc.: _� g sTeTeuc.:5641 cuss:
Odte: Signa�uee: _ � _ � �
'WOBNFBS'COMPENS�TIONDELLAPATION: Iherehy u itutlnaveaceN , wnsenttosell-inwre acerlificatealWOM1ers'
Lompentation insurance. m a ceNiieO coDy I�e�eot �Seclion ]800. LaL. C).
voucrHa.: PWC29167500 E%P.U�TE: O%IOS�94
taMrnxr: GOLDEN EAGLE
� Cehdiea coOY is �e�e0y lumis�ea. � Lenilie0 y is �IeU vnt� tlre ary Bu' ' s�o
Da�e: � G-�J ��� Av ' � � �_
EJIEMP7IONFflOMWOflKEPS'COMPENSATIONOECUMTION: QNssec�ionMCArolGecomD���illAepermnisloroneAuntlreA(E100�orless�.
I certi�y ��at in the oetlormance of ihe wo�k lor whic� [Ns Dermit is ¢sue0. I stull no� employ any permn in any manner so as to become
5u01eci lo Ne Workers' ComOensatioa Laws Oi Galifomia.
Oate: Signature:
NOTICE: II, afler making l�is Oetlaration, you 51wu10 6ecome subjed lo tlre Work¢rs Compensation Orovision5 0l the Labor
CoAe. you mu5i Iorl�wii� ComDty Wiih Suth pwvisions ar �Ois perrtni Shall Ge C¢¢med revok¢d.
COhSiBULTION LENOING RGENCY: I �ere0y a��irm tAai t�ere 6 a mnstructan IenGinO aAe�Y �ar Ihe peAarmance oi [Ae work lor
wnich Ihis De�mil is issuetl (Setlion 3097. Gv. C�.
lENOEfl:
qU0HE55:
OWNEP BUILDEN OECLABp710N: I �ere�y athrm that I am eaempt imm Ihe Coniractors' State License Law for the tollowinA �eason
ISeciion 7031.5 Business an0 Pmlessional COGe: My city oi wunty wAicA reVuires a permit to wnstmct, alter, impmve, tlemolis�, or
repair any stNcime, pcio� to iis Rsuance. also requi�es f�e aDD�cant tot suM petmit to tile a Sipn¢d statemen\ ihat helshe is ��censed
pursuanl to Ihe omvisions ol tne Conttacwrs' Sia�e Littns¢ law 1C�apter 91�mmencinp witn Sectbn 7000� of Oivivon 3 al the Busineu
an0 Pmlessions Coae) or t�at �e/s�e is e*¢mpi roerefmm anG I�e Gasis lor tM1e ail¢geA eMemDi�on. Any Wolation ol Section 703L5 Oy
any apDl¢ant lor a permii suGjetls t0e apulicant lo a civil pemliy o� not more Ilun liv¢ �untlreE Gollars (f500).
I, as owner ot i�e Dmpeny or my em loyees wt� waAes as t�eir wle compensation, will do Ihe wark, antl ihe
❑ stmctwe is no� intenae0 ar o11ereE for sale (�ciion 70aa, Busineu aM Pmfessional CoOe: The Contractors' State licenre �aw
does not apply to an owne� ol a D�a�e.rty wlw �uilds w imprOves ttMt¢An. aad wh0 does SUGh w�(k RimSelU�erseA o� t�mu9h
�i5 Or �er Own emDloyees. D�Ovi0e0 IAdi Sutli imprOvem¢nt5 are MI inlend¢G Or Otler¢0 tof Shc¢. I�. froweV¢� IIM �uildinB or
improvemem is soiG witnin one year ol completion. t�e owner will luvx �he Gurden ol Orohnp �e/sne aiE not build or impmve
lor t�e ourpo5e al Sale).
I, as awner of Ihe D�openy, am eMclusively coniraning wit� ticense0 coniractors io constmct the pmjen (Section 7044, Busineu
❑ antlProle55i0n5Coa2: T�¢Coniratlors'SIaleLicenleLawOo¢snoldpplyloanOwnerolprope�y wli0�uilUSa�improveSNerton
antl w�o coniratls lar Su[� O�Ole��s willl a fAn(tatl0r�s) Iitt03¢ W�sUanl IO Ihe fAn�HtlorS' Slaie Li[ense Law). 1 am awar¢
Inat pmof al tAeir Worker's ComDensation insurance s0ou10 Ee D«tled to me.
� 1 am ecemDl unaer Section: B. 8 P. C.
I0� tni5 �eazon:
oate: Psner.
1 eo nere�y cenity mat 1 am aware ot ana un�ersixn6lne reaoirements oi CaMmnia Heahh ana Sate7y Cotle Sec9ons 25505. 25593. antl
2553d an0 Inal I or any lulure �UtlOmg Otcupant wilVwill nol (ci¢le one) nee0 to compy ml� SdiG state coaes antl ihe re0uiremenis lor a
p¢rmil lor conslNclion oi modilicalion irom Ine Frt Ouaiily Managem¢nl OiSinci. fle5iden�ial conslNclion app�icaiions are eeempi Irom
tnese Omvisions.
. Oaie: ADP�icanc
I 1 hereby cemfy ihai l �ave reatl IhiS applitalion antl Slale iluf f�e a�ovBlntomuiion is
ordmances dn0 sla�e laws relaling �o �uilEing conslmqion an0 �ereey aul
propetlqy lorinspeclion purposes
�Date: '/ ��_��� Siqnamre.
�river s License ar Sacui Securny +:
ta cumplY vn�h allcily an0
t5u1<6 Wnne—Bulleing. Green—Gotle Enfo¢emem; Wnary—Apd��r,[ Pink—R¢venue: GolEenrod—Nssessor
CITY OF COSTA HESA - BUZLDING PfiRMIT PERM NO; B 06402
PERMIT NO: B 064028 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE: �y� PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION ; T/OFF,-�H 6 REROOF W/COMP SHINGLES SQ FT; 8,645
CLAIM VALUE: 8,645,00 CALC_VALUE: 8,645.0��6a0UP OCC: R-3 /M-1
l'� � ' `
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Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAA: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV; PARCEL: 93405055 ZNE: REF NO;
PLANNING NOTES> _,r.
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D E V-E: �L O P M E N T S E R V I C E S R E Q U I R E M E'� T S
20t3ZNG APPROVED HY DATE: � %
BUILDING APPROV,�D BY ; DATE / � %�
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APPLICAYION IS$UED BY; DATE; J,'� p
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LEGALIZATION:N F E E S U M M A R Y..� STRUCTUR.4L SEGMENT:Y
BLDG PHT pLUMBING ELECTRIC MECHANIC • FIRE SMIP/RES GRADING
PERMIT 108.00 - 86
p�� SMIP/NON-RES
ISSUE FEE
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 108.86 0.00 0.00 108.86 108.86 .00
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REVENUE DIVISION TOTALS--> COLLECTED: 108.86 OVER/SHORT: 00
HLD08p00 pLUMBING ELECTRIC MECHANIC FIRE SMIP/T86 GRADING PLAN-CHECK
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 8645 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 8,645.00
END OF FEES
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Property
Owner
Contractor
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. � �o `t'd 2 �j
State Contractor License Number
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
Q, I further certify that I am the owner of the property. (Owner-Builder permittee only).
r� I further certify that i am:
❑ Owner of sole proprietorship company
❑ �ull partner of the company
limited partner of the company
Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, whiCh shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
By:
Initial � Date �
�'�
i nemr ua�e
`R�C` �LQ �
Printetl or typetl name