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Home My WebLink About978 MODJESKA CIR - Building Permitsr •' � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COS7A MESA, CA 92626 JobAddress: 978 MODJESKACI Suite: Vicinity: ROOF Parcel Number: 42205222 ApplicanC ROBERT CLINE Address: 244 N OLIVE ST UNIT B ORANGE,CA Owner: TUCKER, DONALD STEVEN Address 978 MODJESKA CIR Zoning: Phone: 714-771-5514 Zip: 92866 Phone: COSTA MESA, CA Zip: 92627 Convactor: CLINE ROOFING AND CONSULTING Address: 244 N OLIVE ST UNIT B Phone: 714-771-5514 ORANGE,CA Zip: 92866 License: 807421 Arch : Address: Phone: Eng: Address: Status: ISSUED Applied: 11I06/2003 Issued: 11/O6/2003 ISSUED BY: ��1:/�� Phone: Zip: License: license: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 40 YEAR DIMENSIONAL SHINGLE, ELK, 30# FELT, AND INSTALL OSB. 20 S�UARES INCLUDES ATTACHED GARAGE. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $125.25 $0.51 $0.00 $0.00 $0.00 $125.76 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existin : 0 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,�oo.00 $5,100.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-20, § 7, 7241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7B0 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 Inepections end final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 z+asae (ryvo) WORKERS' COMPENSATION DECLARA7�ON: I hereby affirm under penalty oi perjury ona of the following declarations: ❑ I heve end will malntain a cenific0�e ol consent to self�lnsure for workers' compensation, es providetl br by section 3700 of Ihe Lebor Code, lor Iha pertormance of the work for which t�is pertnit is issued. ❑ I heve entl will maintain woMers' compensation insurence, as required by section 3700 ot ihe Lebor Code, for the pertortnance of the work for whlCh this pertnit is issue0. My workers' compensetion Insura�ce carrier end pollcy number are: Cerrier: Policy Number: (This section need nof be canpleretl il (he permif is valued et one hundred dollars ($100) or /ess.) � 1 certiry thet in t�e Dertormance o� the wo tor which lhis pertnit is Issued, I shall not employ eny person in any manner so es to become sub�ect to the workers' com ensatlon law lif�}niaJAntl� eB that II I shoultl bacome sub'ect to t�e workers' com nsatlon rovisions of Seciipp9n 3700 oj the Lebor Gotle, 1 s�all forthwit� comply with thes ro ' ioF;. �1 .//9 � � P / / ApplicantSignature: YSL.N� � Date: ��blo/ 0 3 WARNMG: FAILURE TO SECURE WORKERS' �MPENSATION COVERAGE IS UMAWFUL ANO SMALI SUBIECT AN EMPLOYER TO CR R41�NAL PENPLTI S AND GVII FlNES UP TO IXJE HUNDRED THOUSAND DOLLARE (St00,000), IN ADDITION TO ME �uT OF Cq1FPEN5ATION, DAMAGES AS PAOYI�ED WR IN SECTION 81080F THE LABOF CODE,INTEREST, AND ATfORNEY`5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm ihat I am foma ana eHecL LJc. x_ Comractor's Signature: with Seciion 7000) ot Divislon 3 of the B CI859 k Date: _ Code, and my license is in full CONS7RUCTION LENDING AGENCY; ❑ I hereby eHirtn Ihat there is a con8wction lending egency for Ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: LendeYs AtlAreu: Signatura: Date: OWNER-BUILDER DECLARATIONS: 1 hereby efllrtn thet under penalry of perlury that I em EXEMP7 FROM TME CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or wunry which requires a permit to constmct, alter, improve, demolish, or repair eny structure, pnor to its issuance, also requires the epplicant for such permit b tlle a signetl stetemenl Ihet he or she Is �Icensed pursuenl to ihe pmvisions ot Ihe Contracrora License Lew (Chepter 9(commencing with SBclion 7000) at Division 3 of Ihe Business end Professions Code) or iha� he or she is exempt therefrom and the basls for the alleged exemption. Any violation of Sectlon 7031.5 by eny applicant for a pertnit subjects the applicant to e civil penalty o� not mora then five hundred dollars ($500).): ❑ I, as owner of the pwperry, or my employees with wages as Ihelr sole compensation, WILL DO 7HE WORK, antl iha strudura Is not intentleC or otteretl tor sale (Sec. 7044, Business and Pmfessions Gode: The Con(racbrs License Law dces no� apply to an owner of property who builds or improvas thereon, entl wha does such work himself or herself or ihrough his of her own employees, provitled ihat such improvemen�s are not Intentletl or oHered tor sele. If, however, tha building or impmvement Is sold within one year ol completion, ihe owner-builder will heve tho hurden of proving that he or she did not build or improve for purpose of sele.). • ❑ I, as owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions Cotle: Tlie conirectors License Lew tloes not epply to en owner ol property who bullds or Improves thereon, antl who contracts br such praect with e coniractar(s) licensa pursuant to the Contractors Licensa Lews.). ❑ I am axempt untler sec. Business and Professions Cotle lor Ihis reason: SignaWre: Date: Owner ID verllietl by tlrivBr'Slitense. ❑ Ves ❑ No DnverS Litensa No. Expires: Venficetlon ol Ownership by (rype of tloCument, i.e. - properry ta�c bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity Ihat no excavation �ive (5) or more feet in tlepih Into which e person is required to descen4 will be made in connec�ion with work euthonzed by this permft, antl ihat no buitding strucW�e, scaffoltl'mg, falsework, or tlemoGlion or dlsmantling Ihereol, wiil he more �han ihirry-six t3fi) feel higR (Chep. 32, Grp 2, Art 2, Sec. 341, Tille B, Califomla Adminisiratl�e Cotle). � As owner-builder, I will nat employ enyone to do work whic� would require e permit from Ne Division of Industrial Setery, es noted ebave, unless such person hes e permit to do such work from ihe di�ision. Signature: Date: Division ot Intlustrial Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND A�MORVA710N OF ENTAV: I certi(y under penalry ot perjury that I have read ihis applicetion and stete Ihat the information given is conect I egree to compy with all state �aws anC ciry orGinances relating to building consWction, end authonze representatives ol the Ciry ol Costa Mesa to enter upon the ebove-descnbed property for i pection pur o es. I egree not to occupy or allow occupancy ot any building authonzed by this permit un�il final inspection. i g�� Owner(s) // (� 0 �te � And/OrAutharizetl Applicent Date CODE I. INSPECTIONTYPE 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200 Flnal RB-Roof 201 FIneI Block/Retaining Wall 202 203 204 Finel Feciory Fire Place Finel Sign Final Demolition PAIE nrrmn�s zs� � COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electricel 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSile 250 Final Building/Occupancy PASE I[1�1E1,4 Ciry u( Cusi;i Ma" Plunnui� Uupunmenl ��; �". ' Posl O(lit:u f.fox 1 i 7% f��it Urivc �`��4I1l 1I! Costa �9cxn, Culi(ornin 92G"LG �1�a��i�Qit�iL� �»n� �ef;�5zn� - _ l Tract No. 9592 Lot No. Z� REQUESTFOR OCCUPANCY (Sinyle Family Residential or Candominium Units) Date October 1, 1977 Address 978 i4odjeska Circle, Costa Mesa, Ca. The developer ot the above entitled tract desires to sell ihe above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this ayreement, acknowledges that (he, she, they)�_(was or were�_�,�advised that this tract has not been yiven iinal inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no li�bility for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undcrsi9ned ayrees to indemnify and hold the City harmless Irom any claim resulting in damayc or personal injury to the undcrsiyned by reason of the aforementioned uncom�>leted condition. gy � � .�� Purchusur BY Vl/ / l � Devoluper und or Auihorieed NepruSu0liiiivu BY Lentlur crnt- osc,e�zc G � � 43862 PAi� ,pa25-7,�,��,Qn,�io�:� ,.:��:z2'�.57 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICAT[ON FOR STRUCTURAL PERMIT For Applic 'll i Comp tely — Us Ink Onl RECEIVEDBV DATERECEIVED TEISSVED BUILDING �� ADDRE55 LOt. 2� Trac 2 //5— a3- ,oyo OWNER J.H. Gre or "�P�NO� MAIL r} BVILDING ADDRESS 3�-�! ��G�� Airwa �iVe• P.DDRESS CITY Costa Mesa NOL751-385 TRAC �J LOT BLOCK CONSTFUCTION W ADO ALT P LENDER �reat Western Sv s& Loan XX BRANCH 8484 P�ilshire BZVCI OWNER , , � ADDRE55 Be V H . C . VALVE AflCHITECT J3Ck HOStez' TE�759_021 se R. W Gar s'�6 660 OR ENGINEER co i p �ir. r.n au• F�RE V I&J ADDRESS NB O B C • ZONE TVPE GROUP APPROVED �^�I� CONTRACTORS.H. 2� C BV DATE a( � ADDRE55 1� ��G�� Airwa AVe. TEL. p Z O.OF SE O EW� CITY �i0$t'd. ��fesa NO 1— V1.�.Q PlANS UIL F STATE CITY �'�+ROSAPPROVED VAflDSA7PROVED s� ��c. No. 285-981 ��. No. 008179 MAIN BUILDING ACCESSORV BUILDIN �y SIZE r NO.OF BLDGS. IFROM C/ S EE S OFLOT�J��.�q.ft..average NOWONLOT � RONT F FT. a USE OF � EXI5TING BLDG. FT. y fSeparate permits are required for L SIDE FT. FT. � electric, plumbing and heating work. REAR / FT. � USE OF BUILDING AND WORK TO BE PERFOFMED f� DI5TANCE BET. BEf. MAIN & Qn MAIN BLIX'aS. ACCFSS. BLOGS. QSingle Family Res. CURP. � �(� OVE ,s= � APPqOVED 1r ^ !I r ' d" � w HOLD FOR SPECI L RE UIR � 1 hereby aeknow1atl00 thet 1 heve reatl this applieation end stete � N (y� that the above information is correct antl agree to comply with � � all laws reguletlnB builtling construction, antl I shell not employ z eny person in violation of Me workman's compensation laws ot � m the Stata of California. [ .� s 1442 SQ. FT. tT—�V7 sq. f �. � 3 I hereby certify ffiat I em proparly Iicansa as a contreetor untler the Staie of California Bustness entl Prof sions Code, Divtsion 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOF m Chepter 9, antl that such lice s e i �II iorce end aifect, or I THE PURP06E OF ESTABLISHING A PERMIT FE N�V: � am exampt the orovici ns f h tate of Cellfornia Businass a VALUATION PERMIT FEE $ �� end Prof sions ode, Divis n 3 h ter 9. �+ m Stgnet re of PLAN CHECK $ O m 0 Permittea g 36, 660. �Q TAX E � U r Authofiz tlA ant / TOTALPAID E �