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Home My WebLink About983 MODJESKA CIR - Building Permits(714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 BUILDING PERMIT Job Address: 983 MODJESKA CI Suite: Viciniry: Parcel Number: 42205226 Applicant: CLINE,ROBERT Address: 244 N OLIVE ST UNIT B ORANGE,CA Owner: YOCHAM, NIKKI D Address 983 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: Eng: Address: ISSUED BY: Status: ISSUED Applied: Ot/13/2004 Issued: 01/13/2004 Phone: Phone: Zip: License: License: - SCOPE OF PERMIT TEAR OFF EXIT. WOOD SHAKE INSTALL 1/2" CDX, 1 LAYER 30 L8 FELT AND 40 YEAR COMP. SHINGLES MIN. CLASS C. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $111.25 $0.50 $0.00 $0.00 $0.00 $111.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING - Existinp: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Righl 0- 0 Right 0- 0 sa,soo.00 $a,soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a pariod of 180 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectlons and flnal approval must ba obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 75h5626 2448-OB1fl�00) WORKERS"COMPENSAnON DECLARAnON: . � - I hereby attirm under penalty of perjury one of the tollowing declaretions: ❑ I have antl wlll maintain a certificate of consent to seif-Insure tor workers' compensation, as provided for by section 3700 of �he Labor Cotle, tor the padormance of ihe work for which Ihi9 permit is issuetl. � 1 have antl will mai�ain workers' compensation insurance, as requiretl by section 3700 oi the Lebor Code, for ihe pedormance of the work for which this permit is issued. My workars' compe�ation Insurance carrier antl policy number ere: Carrier: Policy Numbec (This sec(ion neetl not be campleted il the permif is valued et one hundred dollers ($ f 00) or IessJ certity Ihet in ihe performance of the wor for which thi ermit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws ot Califom , ntl gr th It I o I become subject b Ihe workers' compensation provislons of Secti n 370 ot the Labor Code, I shell forthwith mply with these provisions. � / y • pplicam Signature: � Date: �� WARNING: FAILUflE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMIN4L PENALTIES AND qVIL FWES UP TO ONE HUNDFED iHOUSAND DOILAFE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PfiOVIDED WR IN SECTIIXJ 3]OB OF THE LABOR CODE, INiEflEST, ANO ATTORNEY'S FEES. DECLARATION: with Section 7000) of Division'+nf the Business and my license is in full CONSTRUCTON LENDING AGENCY: ❑ I hereby attirm ihat ihere is a constmction lending agency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress: Signawre: OWNER-BUILDER DECLARATIONS: Da[e: I hereby ettirtn Ihat undar penalry ot perjury Ihat I am EXEMVT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a permit to consWc�, atler, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicant for such pertnit to file e signetl statement ihat he or she is licensetl pursuant to ihe provisions of Ihe Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Cotle) or that he or she is exempt therefrom antl I�e basis for the allegetl e:emption. Any violetion of Section 7031.5 by any applicant for e pertnit sublects ihe apPlicant to a civil penalry of not more ihan five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with waqes as their sole compensation, WILL DO 7HE WORK, and ihe structure is not intended a otteretl for sale (Sec. 7044, Business and Professions Code: The Contraqors License Law does not apply to an owner of Droperty who builds or improves ihereon, and who does such woAc himself or herself or ihrough his or her own employees, provitled that such improvements are not intended or oHered for sale. If, however, ihe building or improvemeni is sold within one year of completion, the owner-buiider will heve ihe burden of proving that he or she did not build or improve tor purposa ot sale.). • ❑ I, as owner of the propetly, am EXCWSNELV CONTRACTING WITH LICENSED CONTRACTORS b constmct the project (Sec. 7044, Business antl Protessions Code: The coniraCtorS LicenSa Law does not apply to en owner af pmperty who builds or impmves thereon, end who coniracis for such projecl with a coniractor(s) license pursuant to the Contracbrs License Lews.). ❑ I am exempt untler sac. Business and Pmfessions Code for ihis reeson: Signature: Date: Owner ID verified by dnver's license. ❑ Yes ❑ No Driver's License No. Verification of Ownership Dy (type of dwument, i.e. - proparty taz bill or Deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby cenify Ihat no excavation five (5) or more teet in depth into which a person is required to descend, will be made in connection with work authorized by Ihis permit, and that no building sWCNre, scallolding, falsework, or tlemolition or tlismantling Ihereot, will be more than thirry-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Title B, Califomia Adminisirativa Code). ❑ As owner-builtler, I wi0 not employ anyone to tlo work which woultl require a permit irom the Division ot Industrial Safety, as noted above, unless such person hes e permit to tlo such work from the division. Signature: Date: Division oi Industrial Safety Permit Number: CER7IFlCATE OF COMPLIANCE AND AUTHORIIATON OF ENTTiY: I certify under penalry of perjury Ihat I have read this epplication and state that ihe information given is correct. I agree to comply with all state laws and city ordinances relating to builtling construction, antl authonze represen�atives of Ihe Ciry ot Cos�a Mesa to enter upon ihe ebove-described proparty for inspection puryoses. I e9ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. COOE t. INSGELTIONTYPE -- 1616 Fizetl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Finel Re-Roof , Flnel BloCk/Retaining Wall Final Fectory Fire Place Final Sign Final Demolition ' �NTRIALS �� 2 _p G�� CODE� INSGECTIONTYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Final Building/Occupancy GAIE 1NIDISLfl � _ 43866 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applica �' I in let y— Use 1 k Only ADIDRESSLO� 24 rac 9 2 ' OWNER 'J•H. Gregory C MAIL 3187 "G" Airway Ave. ADDRESS CITV �'Q� Costa Mesa No�� 751-; BRANCH ADDRESS Jack Hester TE � i A ir. r.r. au. v�,� 'PR 25-77�„—..001414<: ***2z1'.S7 APPLICATION FOR STRUCfURAL PERMIT DRECEIVED BV DATE RECEIVEO �oTF issuar � XX a J.H. Res Vl/ AD�RESS1VeWU0Y��G neacn. 143. cvi.c APPROVED CONTRACTOR J.H. Gre �r Construction B�' ADDRESS31Hr "G" Airway Ave. TEL Z �.OF� cirv Costa D'Iesa, Ca. No.751-3840 11a"� LOT " BLOCK ory �°"'s 36,660. V GROUP I&J DATE �f �p� �/ �� / y- VSE OF N W � BUILDIN F STATE CITV [� �'P.RDS APPROVED VARDS APPF s� ��. No. 285-981 LIC. NO.00H1�7 MAIN BUILDING ACCESSORV B � SIZE 35oos . ft. avera e NO.OF BLDGS. O (FROM C/ T E C+ OF LOT q g NOW ON LOT RONT T FT a USE OF ,.�.� EXISfING BL�G. �FT. FT y �� FSeparate permits are required for � sioE `-+ FT. FT 0 electric, plumbing and heating work. REAR FT. FT � USE OF BVIIDING AND WORK TO BE PERFORMED F DISTANCE BET. BET. MAIN & QMAIN BLOGS. ACCESS. BL�GS. -� Sinele Famil Res. cuRP�"�r�/ APPROVE a � APPROVE a �. � .� a - � � I heraby acknowledBe thei I have read this application antl state � [4 that the ebava information Is correct antl agree io comply wlth a all laws reg�loting bulltlin8 construction, end I shall not amploy z .any person in violation of the workman's compensation laws of � the State of California. 1, I' 3 1 hereby certify thet I em properly Iicen tl as a contractor under �WZ SQ. FT. iT='-Y6 : the State ot Californla Business entl Pr ssions CoAe, Division 3, THE AMOUNT SHOWN UNDER VALVATI Chaptar 9, antl that such Ilcenses a5� ull force and effect, or 1 THE PVRPpSE OF ESTABIISHING A PERMIT am ezempt the provisi ns 1 tate of Californla Business VALUATION PERMIT FEE S 1 and Prof ons C tle, Dlvisl n 3 ter 9, SIO^atu of '/ P�N CHECK 5 � Pe�mltte� .� s 36,660.0o TAX : A�thorize A a TOTAL PAID E 2 n m i : ft• m N IS FOR m ONLY: � .�Q p n m ' QO m 0 r LL � _ U