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Home My WebLink About991 MODJESKA CIR - Building Permits(714) 754-5273 • F2X (714) 7$4-4856 • www.ci.costa-mesa.c�.�LDING PERMIT n FAIH UHNh, GUS IA MESA, GA 92626 Job Address: 991 MODJESKA CI Suite: Vicinily: ROOF Parcel Number: 42205228 Applicant: ROBERT CLINE Address: 244 N OLIVE ST UNIT B ORANGE,CA Owner: WEDGEWORTH, JAMES W Address 991 MODJESKACIR Zoning: Phone: 714-771-5514 Zip: 92866 Phone: COSTA MESA, CA Zip: 92627 Contractor: CLINE ROOFING AND CONSULTING Address: 244 N OLIVE ST UNIT B Phone: 714-771-5514 012ANGE, CA Zip: 92866 License: 807421 Arch : Address: Phone: Eng: Address: Status: ISSUED Applied: 12/04/2003 Issuetl: 12/04/2003 ISSUED BV: �� Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL t/2" OSB, 30# FELT, AND 40 YEAR ELK P-t COMPOSITION SHINGLES. 20 SQUARES INCLUDES ATTACHED GARAGE. Plan Check: $0.00 Permit: $12525 SMIP Res: $0.51 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.76 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING �xi_ stinq: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $5,100.00 ss,ioo.00 �� NOTIC Th ork authqrized by this permit shall comply with all applicable handicap access requirements under California statutes and related �� regulations. (Ord. No. 92-29, § 1, 12-21-92) EXPIRATION: This permit shall automatically expiie and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 780 days. INSPECTIONS: In order Por tha work authorized undar this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 iCC64fi (�W) WORKERS'COMPENSATIONDECLARATON: I here6y ettirm under penalry of perjury one of t�e following tleclarations: ❑ I heve entl will maintain a certificate of consent to selbinsure for workers' compensation, as provided for by section 3700 of the Lebor Cod�lfor ihe pertormance of �he work for whiCh ihis permit is issuetl. - 1 ❑ I heve end will maintain workers' compensetion insuranca, as required by section 3700 ot the Lebor Cotle, for the pertortnanca oi the work for which [his pertnit is issued. My workers' compensation Insurance carner and pollcy number are: Cerrier: Policy Number. (This secNon need nof be completed i/ the permit is veluetl at one huntlretl dollars ($100) or /ess.) j1] I certity thet in the pertormanca o the ork for ich Ihis permit is issued, I shall not employ eny parson in any manner so as to become subjact to the workers' compensetion laws of i nia ntl re If I should becoma subject to Ihe workers' compensation provisions oi Section 37 0 of the Labor Cotle, I shell fort�with compty wit� these Dm ion . / /P /� ApplicantSignaWrd: � Date: / �/ �lv � WAiiNING FFILURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PE TIES AND GVIL FINES l/P TOONE HUNORED THOUSAND DOLLARE (5100.000�. IN ADDITION TO THE COST OF COA9PENSATION, DAMAGES AS PROVI�ED FOR IN SECTIpJ 3/060F THE LABOR COOE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aNirm that 1 am Ilcens�i� pQe�ipvysi� s qf C�hapt§%9 icommendng with Section 7000) ot Division 3 of ihe Business ar,�d �fassions Code, and my license is in full force entl eNect Lic. N YJ / LI // 11 ��// c�ass a Ci Contractor's SignaNre: Date: b CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm Ihat there is a constmction lentling agency for Ihe pedormance of ihe work br which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: SignaNre: Date: OWNER-BUILDEq DECLARATIONS: I hereby aHirtn that under penalry of perjury Ihat I em E%EMPT FROM 7HE CONTRAC70R5 LICENSE LAW for the toilowing reason (Sec. 7031.5, Business and Protessions Cotle: Any city or county which requires a permit to construct, elter, improve, tlemolish, or repair any simcWre, prior to its issuance, also requires the applicant for such pe�it to ille e signed statement that he or she is Ilcensad pursuant to the provisions of tha Contrectors License Law (Chapter 9(commencing wilh Sactlon 7000) of Division 3 of the Business end Professions Cotle) or ihat he or she is ezempt iherafrom and the basis for ihe ellegetl exemption. Any violation of Section 7031.5 6y any applicant for a pertnit subjects the applicdnt to a civil penalty of not more than five hundretl tlollars ($500)J: ❑ I, es owner ot ihe property, or my employees with wages as Iheir sola compensetion, WILL DO THE WORK, and the stmcture Is not in�ended or oHeretl for sale (Sec. 7044, Busine95 and Professions Cotle: The Coniractors License Law tloes not epply to an owner ot property who builds or improves thereon, and who does such work himself or herself or through his or her own employaes, provided that such improvements ere not imantled or offered for sale. If, howevar, the building or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purpose oi sale.). � ❑ I, as awner of the property, am EXCLUSIVEIY CONTRAC7ING WITH LlCENSED CONTRACTORS to construct the prqect (Sec. 7044, Busi�ss a� Protessions Code: The contrecrore License Lew tloes not epply to en owner of property who builtls or Improves thereon, antl who contracis for such Droject with a contractor(s) license pursuant to tha Contractors License Laws.). ❑ I am exempt Under sec. Business and Professions Cotle for ihis reason: Signatura: Date: Owner ID venfied by dnvers license. ❑ Ves ❑ No Drivefs License No. Expires: Veniication of Ownership by (rype oi document, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in dapih into which a person is required to descenq will be made in connection with work euthonzed by ihis permit, and that no building sWcture, scafloldinq, felsework, or demolition or tlismantling thereot, will be more than ihirty�six (36) fee� Ngh. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit from the Division of Intlustrial Safety, es noted above, unless such parson has e permit to do such work from Ihe division. Signature: Date: Division of Intlusirial Safety Pertnit Number: CEHTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF EMRY: I cenify untler penalry of perjury that I have read Ihis epplication and 57ate that ihe infortnation given is correct. I egree to comply with all state laws and ciry ordinences relating to building cons�ruction, antl authonze representatives ot Ihe Ciry of Costa Mesa to enter upon the ebove-descnbed pr erty for in�ctiOn oses. I agree not to wcupy or allow occupancy ot eny builtling authorizetl by this permit until finel inspection. // %/ 1� e t Legal Owner(s) /^ � And/Or Authorized Applicent ` Date COOE �. INSPECTION T'LPE 1816 Fixed System Final Fire Prevention 1286 Pool Spe Final 200 Final RaROo� 201 Finel Block/Retaining Wall 202 203 204 Final Factory Fire Place Final Sign Final Demoli�ion j1g¢, ' INiRIpLS � � COUEN INSPECTIONTVPE 206 Final Mechanical 208 Final Plumbing 210 Final Electricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PeIE INTfI1�Lg CITY DF C05TA MESA CALIFORNIA �2828 P.O. BOX 1200 � FROM TME OFFICE OF TME DIRECTOR OF BUILDING SAFETV June 12, 1978 Mr. Jim Gregory The Gregory Company 3187-G Airway Avenue Costa Mesa, CA 92626 RE; Grading of Tract 9592- Dear Jim: There have been several complaints of final grading on Tract 9592. The block walls were installed after the final grading inspection and may have caused grading changes. Efforts will have to be made to regrade those lots to prevent any damages of property in this tract. Mrs. Nancy Delava Mr. Ron Moss 991 Modjeska Circle� `'-- — -- - 995 Trabuco Circle are two properties where problems have occurred and been called to our attention. Please respond immediately. I will be available for further questions. Contact my o£fice with your action in this matter. . Sincerely, WILLIAM B. KUMER Assistant Suilding Director WBK/ajr AOPlicant to fill in all spaces ezce0� those within heavy OorAe� Ilnes an0 sign all apDropriale CeclaratiOns. CiTY OF COSTA MESA CON TRUCTION PERMIT Project Address Applicant's Mailing qddress J,/ �"� Owner's Name — / �Phone�,�.l�.�(p��0 Address Arch/Eng. License No. Address Convactor's Name � hone � Addresslmailingl �� City License No. �,�L�� LICENSED CONTqqCTOR�� E LARATION I hereby atfirm that I am licensetl untler provi5ion5 of Gharter 9(commEncing with section ]000) of Division 3 of the Business antl Professions Cotle, antl my license is in full rce antl etfect. Licen/5a/F la5(5{ �/pa/ se/,f'�(� Date`C�,/EyQ 5'9 I ' �+� U�-� WORYCERS COMPpNSATION DECLARATION I hereby atiirm ehat I have a certificate ot conzent to selt-insure or a certiticate of Workers' Comppnsation Insuranre, or a certifi¢tl cOpy �tM1ereof (Sect' n '�00, Lab. � licy No. �[�� Company � ertifietl copy is hereby turnished. Ge�,t�qfe }iletl with the cityy ��y^7� ij� n/// Date- y'y/'6�'�/ Applicant [.fG��jL[ -✓ �� EXEMVTI �O� FR�RKERS' COMPENSATION DECLA0.ATION (Thissection need �ot be comple[etl if the permit is fot one huntlretl ($100) or less). I cer[ify that in th@ perfo�mance of the wo�k for which [his perm�t is issuetl, I shall not employ any per5on in any manner so as to become subject to [he Workers' Compensation Laws of Calitomia. Daie Si9nature NOTICE: If, after rryaking this tleclaration, y0u shoultl become subject to the Workers' Compensdtion provisions of tM1e Labor Cotle, you mus[ forthwith comply with such provisions or this permit snall be tleemed revoked. CONSTRUCTION LENDING AGENCV "� I hereby afflrm that Ihere is a construction le0tling a9ency Por the performance of the wark for wbich this permit is issuetl, (Section 309� Civ. C.) Lentler's Name - Lender's Atltlress OWNER BUILDER OECLARATION I hereby affirm thgt I am exempt from the ConVactor's license Law For the followinq reason ($¢ction ]031.5 Business antl Professional Cotle: Any city or county which �eq4ire5 a Oe�mit to cansbuct, alteq improve, tlemolish o� repair any structure, prlo� to its issuance, also req4iie5lhe applicant for such permit to tile a signetl sta�ement tbat he/she is licensetl putsuant [o tlte prOvisions of tne Contractor's License Law (Chapter 9(commencin9 witlt $ectioT7000) of Division 3 of the Business antl Professions Cotle) or [ha[ he/she is exempt therefrOm antl the basis tor the allegetl exemption. Any violdtion of Section ]031.5 by any applican[ for a permit subjects the applicant to a civil �enalty of no[ more Ihan five huntlretl tlollars ($500). J I, as owner ot Ihe property or my employees with wages as tneir sole ompensa[ion, will tlo the work, antl the structure is not intentletl or offeretl . mr sale (SeCtion 7044, Business antl Prot¢ssional Cotle: The ConVactor's Liwnse l.aw does not apply to an owner ot a property who builtls or improves �� thereon, antl who GoeS such work himself/herself or Ihrougn his or he� own Iemployees, provitlotl that such improvements are nOt Intentletl or offeretl fo� sale. If, however, tne builtlin9 or improvemen[ is soltl within one year of com- I pletlon, the owner �yill have the burtlen oi proving he/she tlitl mt builtl or im- p�ove for the purpose of sale). ❑ I, as owner of the property, am exclusively cont�acting with licens¢tl con- tractor5to consVuct the project (Section ]044, Business antl Profession2 Cotle: '. The Contractor's License Law tloes not appty to an owner of property who builtls or improves thereon, antl who caniracts tor sucn proiecls with a mn- Vactor(5) license pursuant to ihe Cont�acior's Litense Law). I am aware that proof of Iheir WGrke�'s Compensation insurance shoultl be provltletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date _ I h¢reby informatic antl state 52t1{dt1VC5 inspettion Siqnature Drivers' L — Owner . I have reatl I agree to c to bwltlmg to enter� or $5 � this application antl state that the above �mpty witn all ciry antl county ortlinances Sonstruction antl hereby authorize �epre- ipon t above-mentlOnrtl Property. for ' a�Datu ., �-� .:_ P 3 aEb� TYPE OFCONSTRUCTION ❑ NEW ADD ALTERATION REPAIR� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT GRADING O�FOUNDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAI. IJ�PIUMBING ❑ MECHANICAL A Rear ❑ OTHER � PROJECT DESCRIPTION Sq. FT. oCCUaArvcY C Right 'CONSTRUCTIONTVPE VALUATION$ S L¢ft ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: Planning Notes:• $ink Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks ' Gas Service Outlets Interceptors Kitchen Sink - Lavatories Roof Drains , Reinspection Fee � $75 Boiler Duct- Untler Ground Duct - Structural Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/Fact Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU O100,0006T Reinspection Fea � S15 CMF 0865-46, rev. 10/g4 White - Building; Canary - Hpplican[; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping � Solar 7ank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auro-Wash Laundry Trays Issue Fee Hood or TYPeI ❑ Canopy Typell ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BT System Repair/Alferation Fire Dampers Registers luue Fee FEES $ 3 FEES $ 3 ' i , �TL Zone Accessory Parking Req./Provided ELECTRICAL � Auromatic Washer Transformer ❑ 75-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets • Switches Garbage Disposal Generator �0-5 KW �5-75 KW Meter Uup to 100 amps Meter ❑over100 amps Sub Panel Motors QO-1 HP O 7:4 - 8� Inc.Solar �9-15 HP 016�15+ Microwave Pole Light Sign ' Standing Sections Trash Compactor I Reinspection Fee I$15 ' I luue DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building Approved By APolicafiOn IssUBd By � FEES 3 2 O N I N G R E Q M T $ SUMMARV Of FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ S -0O ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING 3 PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ CONSTRUCTION AND�PLANNING APPROVALS Permit�# 1. Temporary Electrical Service or Pole I2. Soil Pipe-Undrgmd. ;- �� 3. Electrical Conduit Utility-Undrgrnd. ! 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement i 6. Electrical UFER Gmd. . 7. Footings S. Foundation 9. Water Plpe-Undrgrnd. - 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap � ' 13. Roof Drains 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring �-- 17. Rough Wiring Sign - 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Siructure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing � 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 37. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System _ 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Date � Inspector !-Lar� � LF,� POO L & SPA _ , , APPROVALS Permit #� �� ; Date 52. Pool & Equipment Location 53. Steel Reinforcement � 54. Forms "55. Electrical Bonding ' 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgmd. . 59. Gas Pipe, � Undrgrnd., Test �� 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK � 62. Backwash & Receptor-Final, 63. Heater & Vent-Final • � 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. F'encing & Access Approval . 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 70. Underground HYdro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank L� Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical � - ' 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECT,ION . 80.� FOOD CERTIFICATE ISSUED Notes: " 0 Inspector Q� 438b8 �"�s-,��;.—':o0,��,6> ��s�.oe COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 F � a ¢ y � 2 F G F Q C 3 > r .� � � a O �i 4 � � � 3 For Applic �'ll ii letel � Use Ink nly sui�owc t 2 rac 95 ADDRESS OWNER J.H. Gregory MAIL 3187 "G" Airway Ave. AD�RESS pTY Costa Mesa NE��'� Jrl_7 J L�ENOEq��eat Western Svgs & Loan BRANCN 8484 Wilshire B�.Vi� ADDRESS B@VeY�l�/ H1�.ZS � Cia.. ARCHITFCT _ _ __ . TEL_�_ _ . Lr. r� �u ADDRESS ADORESS 31�7 ��G�� Airwav AVe. TEI. aTr Costa I�ftesa No.751=38 lC No. 285-981 LICVNO. OOSZ( SIZE NO.OF BLDGS. oF�oT350osq.ft.averageNowoN�oT 0 USE OF EXI.STING BLDG. Separate permits are required (or elecVic, plumbing and heating work. USE OF gUILDING AND WORK TO BE PERFORMED Single Family Res. I hereby ecknowlatlpe that I havo ruetl this applicetion nntl staie thet the obova Info�metlon ie cortect ontl egroe to comply with ell lawa rBBuletinp bulltllnB �Onstruction, nnd I shall nOi amplOy eny person in vlolatlon ot the workman's compensation laws of Me StaM of Calitornie. I hereby tertify thai I am prOperly lican s e tonttactor unGet the Siste ot CallforNa Bucinesa and P�o lona Code, Divisinn 3, Chapter 9, end that such Iice ses i ull forca antl affect, or I am exam m che rovisi ns h tato of California eusiness P P enA Prof ssion Cotle, Divisl n 3, pter 9. Permlttea APPUCATION FOR STRUCTURAL PERMIT RECEIVED BY DATE RECEIVED �DTF ic�ucc BUILDING ADDRESS TRR XX OWNER J.H. Gre �sE Res 'N/Gar FIRE E NO.OF PLANS � VARDS APPROVED MAIN BUILDING DISTANCE BEf. MAIN BLOGS. VAR. c.u.v. = ,�Ao�Eo r. VALUS (�.Z � HOO USE OF VARDS API ACCESSORV 1! �-Y' SQ. FT. J—�S7 S 7!-!E AMOUNT SHOWN UMDER VALU. THE PURPO6E OF E5iABLISHING A PER� VALUATION PERMIT FEE $ Q PLAN CHECK $ 5�21 UQQ• �Q TAX E TOTALPAID S FT .ft. f. 0 n C m m m N � m m O f U