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Home My WebLink About622 BROOKVIEW WAY - Building Permits9 mxartcinooeEss: 618 BROOKVIEW WY OWNER'SN�ME: HROOKVIEW CONDO HOA pofl"Ess. 630 PA[3LARZNO , CM., CA., 92627 � (719) 587-0399 RFG.ND.: UNIT: UNIT: 1 """"EE:MESA ROOFING CORPOAATION (714)548-3012 nooness: gq3 W, 17TH ST COSTA NESA CA 92627 ❑C SEO CONTBRCTOfl DECIARRTION: I �ereby aHirm Nat I am Iice�seG untler provisions ol Chapter 9lcommencing wi�A Section 7 I ot �msion J oi f�e Businest ane Rofessrons Cotle, aob my tice -' rrtNW ruc.: ( i sTereuc.:5691 euss: Date: Signai � WOP8Efl5' COMPENSPT70N DECIAPATI�N: 1 �ereby ath inat 1 have a cerli5icate o� consent to Se�i-intme or a Ceniticate oi Worker5' Compensation Insurance. or a cenilied copy I�ereol (Seclion 3800, la�. C). roucxHo.: PWC24167500 EXP.DATE: O%/OS�94 camvnxr: GOLDEN EAGLE ❑ Cenilietl coDY �s �ere0y tumishea. [� CerliiieA co ' wiln Ine ciiy Builamg '' Date: � �� L/ J ppplia �_ �� /� _- f%EMPTION Fft�M WOflREftS' CUMPENSATWN OECLAN0.TIUN�. Q�is uctian neeA nal0e wmpleteG il the t i5 �Ur Un¢ hu�Gretl (E1W� or @55�. I cetlily ��at in Ihe petlormance af ine woB for whic� Ihis pe�mii i5 issuetl, I s�all not employ any person in any manner so as l0 6ttome su�lec� �a �he Workers' Compensalion Laws oi Califomia. Date: Signalure: NU710E: It. alier making i�is tleclaralion, you s�ould �ecome sublect lo Ihe Workers' CAmpensation Omvis�ons N Ihe Labo� CoOe. you musi lort�wrt� Comply wiID Suth pmvisions or I�is permit Shall be deeme0 revoke0. COkSTBUCiION LENOING AGENCv: I hereby aflirm inat there is a cons�mction IenOinq agenry lor Ine pedormance ot the work for whith IhiS permil is ii5uetl (Setiion 3097. Civ. C�. LENUFF: ADONESS: OWNEN BUILOEB OEClAM710N: I here�y afhrm ihatl am exempllmmt�e Contractors' S�ate Lwense lawlo< <�e follovnng reason (Section 7031.5 Business and Pmlessional Code: Fny ciiy o� county w�ic� requires a Oermi� to con5iruc�, alter, improve, Oemolis�, or repait any simcWre. O�ior to ils issuance. also requires Ne aVo�icant lor SucA permit to file a signeC statemenl ��at hPJs�e is 1¢ense0 puuuam to �ne pmvisions ol ine Comrapors' State ticense Law (CAapter 9 Rommencing vnth Section 7000� of Drvision 3 oi tne Business ana Protesvons Cotle) or thai �e/S�e rs eKempi �herefmm anE Ih¢ basis tOr Ih¢ allege0 evemD�ion. My Nola[ion ol $eCiion 70.3L5 �y any applicant for a permil su�jecis Ihe applicanl to a civil p¢natly o5 nol more ITan 5ive n�ndrt0 doilaR �5500). ❑ I, as owne! of ihe pmoerty or mY emoloyees witn wages as ineir sole comoen52tion, will Oo Ihe work, ana Ihe simcmre is not inlentleA or ofieretl for sa�e (Section 704G. Busness antl Pmlessional COUe: T�e Gontractors' State License Law does no� appry m zn owner af a pmpeny who builtls or impmves ihereon. antl who Eces such work hlmsel�/hersell or through �is or Oer own employees, pmviDed t�al such Impro�emems are not intenAed or oflere0 tor sale. ti, however the boil0ing or improvement is solE wrt�in one year of completion, fhe owner will have Ihe 6u�tlen ot prohng he/she Oi0 not �uild or impmve lor ihe purpos¢ ol sale�. I, as owner of ihe pmpeny, am excNsively coniracting vnih license� coniractoR lo consimtt tAe prole�� (Section 7044, Business ❑ and Pmfessions Coae: T�e Coniractors' Stale �icens¢ 1aw Ooes not apO�Y �o an ovmer oi prope0y who builds o� improvet the�eon anE wI10 CUnViC�S IOt sucll 0�01¢d5 wii� a COnifdti0��5) Iicen3¢ p114udni fo �bP CAnlfdtf0f5' $tdi¢ Lit¢f15¢ Ldw�. I 8m 2wal¢ Ihal O�ool oi Ineir Worker'S Compensation insurance shoul� �e D�ovitled lo me. � I am exempt under Seclion: B. 8 P. C. lor Inis reason: Oa:e'. Ownec I tlo Aereby certily that I am aware ol antl untlers�and t�e reQuiremenls ot LalNomia Healt� and Safety Cotle Seciions 25505, 25533, and 25534 and inai I oi any WWre �uilamg occupant will/will nol �ci¢i¢ one� need to comO�Y ��h Sdi� state co0es antl ine leQuiremen6 for a permit lor tonsimc�ion or moaihcaiion Immihe Air �ualily Management Oisiric�. flesitlenlial constmclion applicaiions are exemp� irom IhPSC plDvi5i0�5. Dale: hVN��ant I here�y cetlity ��al I ha�e rea0 �nis aOPlica�ion an0 slale IAat the above intorma�ion is correct. I agree to camply wiih all ciry an� counry oiCinancesantlslatelawsrelalinglo�tlildingconsiNclionantlOer �� ' ��ivesofinis[ifyloen�erupOnlheaUove�meniipned O�apeiry �for inspecuon purposes. Dale: 7� —�, � L� Si na � OriverS License or Sonai Security a: 164t�d6 Wlnte—Bmltl�ng'. Green—Coae EnlorcemenC Ca�ary—AOP��an�: Pink—Revenue. Golaenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMZT PERM NO: B 06403 PERMIT NO: H 064033 PLAN CAECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE; n� PERMIT TYPE: STR PURPOSE: OTH [" JOB DESCRIPTION ; T/OFF,'�i-6 REROOF W/COMP SHINGLES SQ FT: 8,645 CLAIM VALUE: 8,645.00 CALC=VALUE: 8,64�5�O�,GROUP OCC: A-3 /M-1 ��+�r*x*****w**�***i��**�r��*��**lr�r**�r�w�w�r�*��w�� **�*�w�*�r�r+r+rxr��ex��r**�r� 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 ii£AR: FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LBFT; FT IN RGHT; FT IN PARKING REQ • PROV; PARCEL: 93405065 ZNE; REF NO: PLANNING N6TE5> ' ..;, . iFiFiFMftlEitlFiE1E:-kklflfklfMMMlfitMkiflffflFlfiF1t1f1fifififlEiEMlfk1f1F1flfiflFMiflFifM1E1FMMk/F1fiE7f1E1EMifiEMlfIfIFMiEifIf1E%MMif 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£ MI E�N. T S y.. ZONING APPROV6D BY DATE: BUILDZNG APPROV�D HY ; DATEe/ ' ''� APPLICAYION ISSUED BY; L DATE: ��A{��1�� MMMIfiEMMkifMMMitlfiflfifiFiflFiEM 1f�fiFlFMItIEffMM f IE MiE1E1fM7fMMMffMffififMMMiFMMiEiffflfMMMifiFiFMMkiElfklflfifiFMifMMMMiEiF1fM1FM1EMMMIfiF/EifiEiF/t1tklEfFMiFif fklFifiFMMitif LEGALIZATION;N F E E S U M M A R Y STRUCTUEtAL SEGMENT:Y BLDG PMT PLUHBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 108,00 86 PL� SMZP/NON—RES ISSUE FEE BUZLDING—DIV—> TOTALS----> PERMIT ISSUE PLAN—CAECK TOTAL PAID DUE 108.86 0.00 0.00 108.86 108.86 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 108,66 OVEK/SE{ORT: .00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 108,00 ,86 iflkil'1fffIhMlE�tMikiFltMi41t1f�fMMlkiflfififlkitil'klfiEitMlflflFMifMiflFMYMkMMM1f1EMM1F1f1fiFklflflfM1F11'1fMM1flFifMlFi1'fflflfMifMlh I N D I V I D 0 A L F E E B R E A K D O W N TYPE (jTY 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 SMOKE DETECTOR -REQ�IRED c� eo,4-;��-:�:-,;>>=z, Ti�T ?��.Z: bAFF.: U';'!?t!9s T:hE� ii:53 % Propert! Owner Permit No. R �'T�� 3 Contractor State Contractor License Number Classification � —�"/ I hereby certify that I have installed, or caused to be installed, a minimum Class C rooi 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. �I further certify that I am the owner of the property. (Owner-Builder permittee only). I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company q❑� Limited partner of the company lq� Officer oi the corporation \ I certify that as an authorized officer or agent of the company or corporation, 1 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: �Ll�-e ��j� li3 Initial �al� V � �,1 � N►i.. I� /1 1�� - . �: ♦ . '; � � _ .N. �1.►�� I