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Home My WebLink About995 MODJESKA CIR - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.c�.�LDING PERMIT �� FAIR DRIVE, COSTA MESA, GA 92626 JobAddress: 995 MODJESKACI Suite: Vicinity: ROOF Parcel Number: 42205229 Applicant: ROBERT CLINE Address: 244 N OLIVE ST UNIT B ORANGE,CA � Owner: HARDING, KIM DAVIS Address 995 MODJESKA Zoning: Phone: 714-771=5514 Zip: 92866 Phone: - COSTA MESA, CA . Zip: 92627 Cont�actor: 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: 06/23/2003 Issued: 06/23/2003 ISSUED BY: Phone: Zip: , License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 40 YEAR, E�K PRESTIQUE, 1/2" OSB BOARD, AND 30# FELT. 20 S�UARES INCLUDES ATTACHED GARAGE. � ' -' - - AMENDED 7/7/03. INSTALL HARDIE SIDING (REPORT NUMBER NER-405) AT FRONT OF RESIDENCE NEAR DOOR AND AROUND 2ND STORY BAY WINDOW, AND FIRST FLOOR BAY WINDOW ALSO. 3 SQUARES OF SIDING TOTAL . VALUATION OF SIDING IS 1200.00 PER CONTRACTOR. -. � Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.51 SMIP Com: $0.00 Other. $0.00 � Inspection: $0.00 Total: $125.76 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 m Rear 0- 0 Rear 0-0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 ss,oso.00 $S,Oso.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: 7his permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned tor 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 inspectlons and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (Z14) 7545626 zaas�as (doo� I • WORKERS' COMPENSATION DECLARATON: I hereby aHirm unde� penalty of perjury one of ihe follow'ing tleclara�ions: ❑ I heve entl will melntaln e cetlificete of consent to self-Insure for workers' compensetion, es proNded br by section 3700 of the Lebor Code, tor the peAormanca oi Ihe work 1or which this parmit is issued, I ❑ I have erM wlll maintain workers' compensatlon Insurance, as required by sectlon 3700 oS�he Labor Cotle, tor the peAormance of t�e work tor which ihis pertnit is issued, My workers' compensatlon Insurance cerrler and policy numbe� ere: + Cerrier. I� Policy Number. (Thls section need nof be comp/efed i! the permif Is valued e( one hundred dollers ($100J or less.)� ❑ I certity Ihat in the peAormence of the work for which this permit is issued, I shell not employ,any Derson in eny mannar so es to become subject to the workers' compensatlon laws of Celifomia, end agrea t�at if I s�oultl Cecome sub�ect fo the workers' compensation pmWslons of Saction 3700 ot Ihe Labor Code, I shell Iorthwith comply with Ihese provisions. Applicent Signeture: � Date: WAiiNING: FAILURE TO $ECIIRE WOPKERS' COMPENSATIQY COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINr1L PENALTIES PND CIVII FINES UP 70 ONE MUNDRED TFKKISAN� DOLURE (5100,000). IN ADDITION TO THE WST OF COMPENSATIIXJ, DAAMGES AS PFOVIDED FOR IN SECTION 3/060F THE LABOR CODE, IMEREST, AND ATTOFiNEY'S FEES. I LICENSED CONTRACTORS DECLARATION: I I hereby ettirtn that I am licensed untler provislons ol C�apter 9(wmmencing wilh Section 7000) of Division 3 0l the Business and Prolessions Cade, and my license is in full force antl eflect. Lic. x I Class a CONractors5ignaWre: i Date: CONSTRUCTON LENDING AGENCV: � ❑ I �ereDy attirm ihat ihere is e wnsiruction lending egency for the peAortnence of tha work for�w�ich t�is permit is issued. (Sec. 3097, Civil Cotle). Lentlers Name: Lenders Address: ' Signature: I Date: u . OWNER-BUILDER DECLARATIONS:��.-, I hereby ettirtn ihat untler penelry ot per�ury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE U1W tor Ihe following reeson (Sec. 7031.5, Business entl Professlons Code: Any ciry or counry which reQuires e permit to consiruct, elter, impwva, demolish, or repair ariy structure, prior to its issuance, elso reduires ihe epplicflnt lor such pertnit to lile e signetl stetement that he or she is llcensetl pursuant to ihe provisions of the Contractors License Lew (Chapter 9(commencing wlth Sectlon 7000) ot Divislon 3 ai the Business antl Protesslons Cotle) or thet �e or�she Is exempt therelrom entl the 6asis for the elleg i d exemption. Any Woletion oi Sectlon 7031.5 by eny applicant for a pertnit subJacts the epplicent lo a clvlt penalry of not more Ihen five hundred dollers ($500).): ❑ I, as owner ol the property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, end ihe structura Is not intentled or oHeretl lor sale (Sec. 7044, Business entl Professlons Code: The Contracbrs License Lew does not apply to an owner of propetly who builds or improves thereon, entl who does such work himsell or hersell or through his or her own employees, O�ovidad ihat such improvements are �not imended or oflered for sale. If, however, ihe builtling or Improvement is sold within one year o� completion, the owner-builder will have.the burden ot proving that ha oi she did not builtl or improve for puryose of saleJ. ' ❑ I, es owner ot Ihe property, am E%CLUSIVELV CONTpACTING WITH LICENSED CONTRAGTORS to construct the pro�ect (SecJ044, Business entl Professions Gode: The contractors License Lew tloes not apply to en owner of property who builtls or improves thereon, and who contrects lor suc� project wlth e contractor(s) license pur5uant to (he CONreclor5 Licen58 Lews�. ❑ I em exampt under sec. Business and Professions Code for this reason: Signature: I Date: Owner ID vedfied by drlver511Cen58. ❑ Ve5 ❑ No Driver's License No. � Expires: Verification of Ownership by (type of tlocument, i.e. - properry tex blll or deetl): � DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: �, ❑ I hereby certify that no ezcavation five (5) or more leet in depth into which a parson is required�to tlescend, will be mede in connedion with work authorizetl by this permiL antl that no builtling sirucNre, sceNoltling, lalsework, or demolition or tlismantling thereoi, will 6e more than thirty-siz (36) feet high. (Chep. 3.2. Grp 2, Atl 2, Sec. 341, Ttle 8, Celilomia Administretiva Code). I ❑ As owner-Duiltler, I will not employ enyone to tlo work w�ich would require e permit from the Division of Intlustriel Safery, es noted above, unless such person has e pertnit to do such work from the division. � Signature: Date: Division of Industnal Satety Parmit Number. I ' HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATON: I 1 Will the applicant or present or future bullding acupant need to fila end cartiy e Business Plan,tor emergenry response to release or threatenetl releese ot a hazerdous metedal? ❑ Ves ❑ No (Section 25505 oi Ihe Celifomia Heelth entl Setery Code requires, with some excepiions, �hat'a Business Plan be liletl with the Coste Mesa Fire Depariment 6y every business which has et any one time dunng a repoM1etl year a quantiry of hazartlous materials eQual to or greater then a weight of 500 pountls, or a volume ot 55 gallons, _or 200 cubic leet oi compreuetl gas at standard temperature and pressure). . .. .. . ................................................................._..........................................................................................................................._t..............................................................................................__....................................................__...... 2 Does or will Ihe aDPlicent or presenl or luture building occupant neetl to tile a registration fortn for acutely harartlous metenels? � Ves ❑ No (Section 25533 of Ihe Celifomia Healih antl SefeN Code, with some exceptions, requires registration wfth Ihe Cos�a Mese Fire Depertment by eech business whlch et eny one time has on hand e quentity of ecutely hezerdous metedals equal to or greater t�en e weight ol 500 pounds, or e volume of 55 gallons, or 200 cubic feet of compressetl ges et stantlartl tempareture entl pressure). 'i ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the a plicant or present or luture building acupant neetl to prepare an FMPP (Risk Manaqement en0 Prevention Program lor ecutely hazardous matenals)? ❑ ves ❑ �o (Section 25536 of Ihe Califomla Health and Safety Cale provides that ihe Casta Mesa Fire Department may require Ihe preparation, certitication and filing with Ihe Fire Department of an RMPP by businesses which ere required to register ewtely hezardous matenels with Ihe Fire Depahment. ............................................................................................................................................................................................................................:.......................................................... ......................... ..................................................................... 4 II an RMPP Is presently requiretl, �as Section 25534 ot the California Heelth entl Safery Cotle �een tully complied with7 ❑ Ves ❑ No ............................................................................................................................................................................................................................:................................................................................................_............................................................. 5 Does or will ihe applicent or present or luture building acupant raquire for the work which is t�e subject of this a plication a ermil tor such consvuction or moditice�lon Irom the South Coest AU Ounllty Menegement Distdct or irom eny other eir pollution contwl district or egencJl � Ves � No (Section 65850.2 oi the Californie Government Code requires ihat ihe requested iniormation be furnishetl on epplicetions for nornresitlentinl building permits). ............................................................................................................................................................................................................................_.......................................................... ....................... ................................................................... 6 W III eny pen ol the faciliry to be consiruc�ed untler ihis pertnit be within 1000 feet irom ihe outer tioundades ot e school? ❑ Yes ❑ No (If yes", the laclllty must meet ihe requirement ot Sec�ions 25534 entl 42303 ot the Calitornia Health antl Safery Code). ...........................................................................................__..................................................................................._......................................................................................................................................k_...ry ...„.:....._^_...................__r ...„_ .... 7 If e parmit from t�e Sou�h Coest Air Oueli�y Menagemeni Distnct or other air pollu�ion con�rol tlistrict or agancy Is requirea �or Ihe wor w ic is t e subject o � i5 application, heva all of Ihe disclosures prescrl�etl by Calllornia Healih end Safety Cotle Section d2303 been mede? ❑ Ves ❑ No ........................................................................................................__............................;_................................_................................................i ........_................................................................................................................................................... 8 (II yes", attech cenilicate ol complience Irom Ihe eppropnate air polWtion conirol oNicer). CERTIFICA7E OF COMPLIANCE: I certity that under penalry oi perjury the informa�ion given eDove is correcl I egree to comply with all state laws and city ordinances regartling Hazerdous Materials entl Emissions. I Signalure: Date: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF EMRV: I cenify under penalry ot peryury ihet I have read this application and state thet Iha infortnation qiven is correct. I,agree m comply wlih all stete laws end ciry ordinances relating ro builtling consirucUon, end au�hodze represenietives ot Ihe Ciry ol Coste Mesa to enter upon Ihe above-des5ribed property lor inspection purposes. I agree not to occupy or allow occupancy oi eny building aWhorized by Nis permit until final ins0ec�ion. � \ Signature Oi LeBal Owner(s) , Date i � And/OrAut�orized Appliwnt � Date CODE t. INSPECTIONTYPE QAIE IIiLA4S �,j INSVECiIONTYPE PAIE Ii� i 1816 Fixetl System Final Fire Prevention 206 Final Mechaniwl i 1266 Pool SOa Finel � • 208 Final Plumbing i 200 Finel Re-Roof � � G 1- 70 Final Electdwl 201 Finel BIocWPelaining Wall � �12 Final Fire Prevention 202 Final Factory Fire Plate 220 Final Planning Approval 203 FIneI Slgn 222 iinal 5ite 204 Finel �emolition � � 250 Final Buildinq/Occupency i I 9 ( (714) 754-5273 • Fax (714) 754-4856 • w�wi.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 995 MODJESKA CI Suite: Viciniry: ROOf Parcel Number: 42205229 Zoning: Applicant: ROBERT CLINE Address: 244 N OLNE ST . UNIT B � Phone: 714-771-5514 ORANGE, CA 2ip: 92866 Owner: HARDING, KIM DAVIS Address , 995,MODJESKA 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: Zip: Phone: License: Eng: Address: Status: ISSUED Applied: 06/23/2003 Issued: O6/23/2003 /� i �: �h � Phone: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 40.YEAR, ELK PRESTIQUE, 1/2" OSB BOARD, AND 30# FELT. 20 SQUARES INCLUDES ATTACHED GARAGE. Plan Check: $0.00 Permit: $125.25 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 Existino: o 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 $5,060.00 Ss,osO.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calilornia statutes and ielated regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned tor 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 requlred inapectiona and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 2ad646�N00) . . , WORKERS' COMPENSATION DECLARATION: � I hereby attirtn under penalry of perjury one of the following declarations: ❑ I �eve entl will meintain a cenificata of consent to self-Insure tor workers' compensation, e i proWtletl tor by section 3700 ot the Labor Code, tor the performence of the work for which t�ls parmit is issued. ❑ I have entl will maintain workere' compensation insurance, as required by sectim 3700 of,Na Labor Coda, for Ihe perfortnance of the work for which ihis pertnit is issuetl. My workers' compensation Insurence carner enA policy number are: • Cerrier: policy Number. (lhls sect/on need nof be completed i1 the permit is velued af one hundretl dollars (3100J or less.) (� I cehtly ihat in ihe perfortna e ot the wo tor which this permit is issued, I shall not employ any person in any manner so as to becoma subjact to the workers' V� compansetion lews lif i an ag thet If I shoultl become subject to the workers' compensetion provisions ol Section 700 of th La6or Code, I shall forthwith compty with these rovi o . �� Applicent Signeture: Dete: ��7� WARNING: FAIWRE TO $ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL EP NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000). IN ADDITION TO TME COST OF COt.1PEN5ATION, DAMFGES AS PfiOVIDED WR IN SECTION 310fi OF THE IABOR CODE, IMERESi, AND ATTOiiNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereby aHirtn t�at I am licensetl under rov/isio�ns apter commencin with Section 7000 ot Division 3 of the Busineu ednn P te ions Cotle, and m license Is in full tOrCB entl BNBCL LIC. M 07�i! / /l 9 ' Gass k C_��7 T��s,7 /�— Y Coniredofs Slgnaiure: — Da�e: V/ �// l/ 7 CONSTRUCTION LENDING AGENCY: I ❑ I hereby eHirm ihat there is e constmction lending egency for ihe peAormance of ihe work iir which this permit is issued. (Sec. 3097, Civil Cotle). Lentler's Nema: I.enders AOtlress: Signeture: � Dete: OWNER-BUILDER DECLARA710NS: II I hereby eNlrtn Ihet under penelry of perjury ihat I em EXEMPT FROM 7HE CON7RAC70R5 LICENSE LAW tor the following reason (Sec. 7031.5, Business end Protessions Co4e: Any ciry ar counry which requires a permit to construcl, elter, improve, demolish, or repair any structure, pnor to its issuence, also requires the applicant tor such pertnit ro file a signed statement that ha or she is Iicensetl pursuant m Ihe pmvisions of Ue Contractors License Law (C�epter 9(commencing with Sectlon 7000) ot Division 3 of the Busineu end Professlons Cade) or thal he or she is exempt therefran and ihe �asis for the elleged ezemption. Any violatian ol Section 7031.5 by any applicant tor e pertnit subjecis the applicent lo a civil penalry of not mora t�an five hundred dollars ($500)J: I ❑ I, as owner of the property, or my employees wlih wages es thair sole compensatlon, WILL DO THE WORK, and the strucNre is not intendetl or oMeretl for sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law dces not apply �o an o'wner of property who builds or improves Ihereon, and who does such work himsell or hersell or ihrough his or her own employees, provided ihat such improvements ere noi IMended or ottered lor sale. H, however, the building or improvement is sold within one yeer of completioq Ihe ownarbuilder will have ihe burden of prov'�ng ihat he or sha did no� builtl or improve for purpose ol sale.). � ❑ I, as owner of the property, am EACLUSNELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the Droject (SecJ044, Business and Protessions Cotle: The coniractors License Law tloes not apDly to en owner of pwpeny who builds or Improves thareoq antl who contracts br such projact with a coniractar(s) license pureuant to the Contracbre License Laws.). ❑ I am exempt untler sea eusiness and Pmfessions Code t I r this reason: Signature: � Date: Owner ID verllied by driver5 licen58. � V85 ❑ No Orivefs License No: Expires: Vedficetlon oi Ownership 6y (lype oi tlocument, Le. - property teu bill or deed): � i DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: I ❑ 1 hereby certify thet no exwvation tive (5) or more teet in depth into which a person Is required to tlescend, will be matle in connectlon with work authonzed by Ihis permit, entl that no building sWcture, scattolding, talsework, or demolition or dismantling ih ireot, will be more than t�irty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirelive Code). ❑ As owner-builder, I will not employ enyone to do work which would require e parmit from the Division of Intlusinal Sefery, es noted ebove, unless such person hes e permit to do such work trom the tlivision. I SignaWre: Date: Divisian of IntlusMal Satery Pertnit Number. I - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the epplicant or presant or future Duiltling occupaN need to file entl wrtiry e Business PII n br emergency response to release or threetenetl release ot e hazartlous meterial7 ❑ Ves ❑ No I (Section 25505 of the Calilornie Haelih and Setety Code requires, with some exceptions, thel e Business Plen be filetl wilh ihe Gosta Mesa Fire Depariment by every business which has et any one time dudng a reported year a quantiry ol hezerdous meterials!eQual ro or greater than a weight of 500 pountls, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas at stantlard temperaWre antl pressure). � ............................_..............................................................................._......................................................................................................................................................................................................._............._................_..............._................ 2 Does or will ihe epplicant or present or fuNre building occuDant need to file e regislration lormjbr ecutely hazardous meterials7 ❑ Ves ❑ No (Sectlon 25533 ot the Californle Healih entl Salety Cotle, wlth some exceptlons, requires reglsiretlon with ihe Cosia Mesa Flre Department Dy each business which at eny one lime hes on hend a quantiry of ecutely hazardous metenals equal to or greater then a welght oi 500 pounds, ar a volume oi 55 gallons, or 200 cubic feet ol compressetl gas at standard temperature end pressure). � ........................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will ihe applicant or present or fuNre bulldinq acupant need to prepare en RMPP (Ri ik Menagemem antl Prevention Program tor ecutely hazerdous materials)7 ❑ Yes ❑ No (Section 25534 of ihe Califomia Health anC Safery Code provides that ihe Costa Mesa Fire Depanment may require the preparation, certification and filing with the Fire Department of en RMPP by 6usinesses which ere required to register acutely hezartlous matenels with the Fire DeOartment. .....................................................................................................................................................................................................................:.................................................................................................................................................................... 4 Ii en RMPP is presently required, hes Section 25534 of ihe Californie Heallh entl Safety Gotle been tully complietl wit�? ❑ Yes ❑ No ......_ ......................._._............................................"'.............................._.............................._._._..................................................._.:............................._..........................................._................................................................................._.. 5 Does or will tha appliwnt or present or tuture Culltling occupam require for t�e work which is t0e subject of this a plicution a permit for such conswdion or motliticatlon Imm the South Coest Air �ueliry Menegement DlsMct or irom any other air pollutlon convol tli5inct or egenc�/! � Ves �J No i (Section 65B50.2 of ihe Califomia Govemment Coda requires Ihat ihe requested inlormetion be tumished on applications for nomresitlentiel builtling Dermits). ...................................................................................................................................................................................................................:..........................._................................... ...................... ................................................................... 6 Will eny pert ot the lacility to be constructed under this permit 6e within 1000 teet Irom t�a outer boundanes of e school7 ❑ Ves ❑ No (II yes', the faciliry must meet the requirement oi Sections 25534 antl 42303 of the Califomia Healih and Safety Code). ........................................................................................_.........................................................................................................................._:.......................................................................................... ............................. 7 It e parmit from the South Coast Air Ouality Menagement Distdct or other elr pollutlon control tlisirict or egency is required br Ihe work whiCh is Iha subject of Ihis epplicaHoq hava all of the disclosures prescnbetl by Californie Health end Safery Code Sectlon 42303 been made? ❑ Ves ❑ No ........................................................................................ _........................................................ _...................................................................:......................................... _......................................................................................................................... B QI yes", ettech certificate of compliance Irom the eppmpriate air pollu�ion control oMicer). CER7IFICATE OF COMPLIANCE: I certily Ihet under penalry of perjury the inbrmation given above is correa. I agree to comply with all state laws end ciry ordinences regarding Hazardous Materiels and Emissions. Signature: Date: CERTIFlCATE OF COMPLIANCE AND AUfMORIZATON OF ENiAY: I certify under penelry of perjury that I have read �his a071iw�ion ana state that ihe iniormation given is cortecL I egree to comply with all tate laws antl ciry ordinancas relating to huilding constructioq antl euthorize reprasentctives at Ihe Ciry ot Costa Mesa ro enter upon the ebove-tlescnbed pro erty or ins ction purposes. I agree not to occupy or allow occupancy of eny building authonzed by Ihis Dermit until fnel inspection. g ure OI Legal Owner(s) h (/ And/Or Au�horized Applicant Data COUE 1. INSPECTIONTYPE 1616 Fixetl Sys�em Final Fire Prevenlion 7266 Paol Spe Final 200 Final Re-Root 201 Final Block/Retaining Well 202 Finel Factory Fire Place 203 Final Sign 204 Final Demdition PAIE 1t�Bkfi 206 20B 210 272 220 222 250 INSPECTON TYPE Final Mechanical Final Plumbing Final Electncal Final Fire Prevention Final Planning Approval Final Site Final Building/Occupancy PdIF II�ELS December 15, 2005 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92629-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Kim Harding 995 Modjeska Ci Costa Mesa CA 92627-3909 PERMIT NUMBERS: FOR: PROJECT ADDRESS: 603-01064 Re-roof 8� Siding 995 Modjeska Ci., Costa Mesa Our records indicate the above listed permits were obtained for propeRy improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, piease contact this office so we may correct our records. If you need to request an inspection please call our Inspection Request Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and fisting an estimated date of completion. If you do not have an approved final inspection, your permits will expire on December 30, 2005. If you have any questions, please contact the Buiiding Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, �� Ma Jane Weidenkeller Office Specialist II cc: Cline Roofing & Consulting 244 N Olive St, Unit B Orange CA 92866 Builtling Division p14) 754-5273 • Code Enlorcement (714) 754-5623 • Planning Division (71d) 75a-5245 FAX(774)754�856 • TDD(774)754-5244 • wvnv.ci.costa-mesa.ca.us i:�. f � (714) 754-5273 • Fax (774) 754-4856 . www.ci.costa-mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 .lobAddress: 995 MODJESKACI Suite: Vicinity: MASTER BEDROOM Parcel Number: 42205229 Applicant: HARDING, KIM DAVIS Address: 995 MODJESKA COSTA MESq, CA owner: HARDING, KIM DAVIS Address 995 MODJESKA COSTA MESA, CA Contracror: OWNER-BUILDER Address: Zip: . Arch : Address: Phone: Zoning: Phone: (949) 645-9530 Zip: 92627 Phone: (949) 645-9530 Zip: 92627 Phone: License: 0 Eng: Address: ISSUED BY: Status: ISSUED Applied: 10/16/2000 Issued: 70/16/2000 Phone: Zip: License: License: SCOPE OF PERMIT INSTALL NEW BAY WINDOW IN EXISTING MASTER BEDROOM. . Plan Check: $21.22 Permit: $32.65 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $54.37 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Lek 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0-0 Right 0- 0 $�so.00 s�so.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 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 requlred Inepectiona end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. F.OR INSPECTIONS CALL: (714) 754-5626 244646 (fi�00) WORKEflS' COMPENSATION DECLARATION: I hereby aHirm under penalry of perjury one of ihe �ollowinq declaretions: ❑ I have antl will maintain a certifica�a of tonsen� �o self-Insure tor workers' compensa�ii wark for which this permii is issued. ❑ I hava antl will maintain workers' compensaGon insurance, as requiretl by 58ctlon 3700 c My workers' compensation Insurence carrie� antl policy number are: Certier: (This sectian need not be cromp/eted i/ the permit is ve/ued el one hundred tlollers (5700) or ❑ I certity Ihat in the peAormance oi �he work for which this pertnit is iuued, I shall not e compensation lews of Calibmia, and agree Ihat il I shoultl becoma sub�ect to ihe wof4 comply with ihese provisions. Applicent Signeture: WARNING: FAILURE TO SECURE WORKERS' COMPEN5�1T1IXJ G1�VEMOE IS UNIAWFUL AND SHALI THOUSNND DOLLAPE �E100,000�, IN ADDITIIXJ TO TME GOST OF COMPENSATION, DAMAGES AS PROV pmvided for by section 3700 0l the Labor Code, for the pertortnence ot the Labor Code, for Ihe performance of the work for which this pertnit Is issued. Policy Number: �y any person in eny manner so es to become subject ro t�e workers' compensation provislons of Sectlon 3700 of the Lebor Cotle, I shall lonhwith Date: ECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED FOR IN SECTION 3]060F THE LABOR CODE, ItJrEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLAFiA710N: I I here6y aHirm ihat I em licensed under provislons ol Chapter 9(commencing with Section 7000) of Division 3 of the 8usiness antl Protessions Cotle, entl my license is in futl force and aHect. Lic. k I Class p Conireciofs SigneWre: Dala: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm Nat ihere is e construction IenOing agency for the pedormance ot Ihe work Lender5 Name: Lender's Adtlress: Signalura: which Ihis permit is issued. (Sec. 3097, CiHI Code). Date: OWNER•BWLDER DECLARA710N5: I I hareby aHirtn that untler penelry of perjury thet I am EXEMPT FROM Tt1E CONTRACTORS LICENSE LAW for �he lollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requiraz e permit to construct, alter, improve, tlemolish, or repair any strucWre, prior to its iuuance, also requires ihe applicant for such permit to file e signed stetement that he or she is licensetl pursuent to t�e provisions of the Contrectors Licanse Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business entl Prolessions Code) or ihat he or sh6 is e:empt ihewfrom antl the �esis tor the allegetl axemption. Any violation of Section 7031.5 by any epplicant for a permit subjecis ihe applicant to a civil penalry of not more ihan five hundred dollars (5500)J: I —` ❑ I, as owner ot the propeny, or my employees with wages as their sole compensation, WILL DO TNE WOFiK, antl Ihe structure is noi iniended or oHeretl tor sala (Sec. �7044, Business and Professions Code: The Contractors License Ww does not apply to an o'wner of properry who builds or improves thereon, and who tloes such work himself or herself or thmugh his w her own Bmployeas, pmvided that such improvements are not imentlatl or oNered for sale. If, however, Ihe builtling or improvement is sold within one year ot completioq the owner-builder will have the burden of proving that he or she did not build or improve tor purpose of saleJ. ❑ 1, as owner of the pmperty, am EXCLUSIVELY CON7RACTING WiTH LICENSED CONTRACTORS to consimct t�e pmjed (Sec. 7044, Business and Professions Code: The conirectors Ucense Law does no� appty to an owner ot properry who builds or im iroves thereoq and who contracts 1or such pmject with a contractor(s) license pursuant to ihe Contractors License �ewsJ. ❑ I am ezemq� untler sec. Business and Professions Cotle for this reason: �,,,,,,.,,.e_ /5�.... D_ ...� I � �,.,.. �n_ i� -a Ownet ID veritietl 6y tlrivefs license. ❑ Y�cl ❑ No Verification ot Ownership by (rype ot documeni, i.e� - P�operry tau bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ I hereby certiy tha� no exwvation five (5) or more feet in tlepih into which a person Is required �o tlescend, wlll ba made in wnnection with work eut�onzed by this permit, and that no builtling siructure, scaffolding, talsework, or tlemolition or dismantling ihereof, will be more lhen Ihiny-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomie Atlministretiva Code). I ❑ As ownerbuilder, I will not employ anyone to do work which woultl require e pertnit Iwm permit to do such work trom the division. Signa�ure: Division of Indusinal Safety Permil Number: HAZAROOUS MATERIAI.S AND EM�SSIONS CEATFICAnON: 1 W III the epplicant or present or Wture builtling �upant need �o lile end certiy e Business PI material? ❑ Yes ❑ No (Sectlon 25505 of the Califomia Health and 5afery Code requires, with some exceptions, th business which has at any one time tlunng a reported year e Quantity of hazerdous matenals or 200 cubic leet of compressed gas at standa�d temperature antl pressure). ........................................................................................._....................._................................................................................................. 2 Does or will the apPlicant or present or futura builtling occupant need to file e registration forrt (Sectlon 25533 0l the California Health antl Sefery Cotle, with some azceptions, requlres regi: one time has on hantl e quantiry of acutely haiartlous matenels equal to or greater Ihen 3 Dces or wlll the applicant or presen� or future Dui�oing occupaN neetl Io prapare an HMYP (Hlsl ❑ Ves ❑ No (Section 25534 of the Calitomia Heallh and 5afery Code provides that the Costa Mesa Fire D� Departmant of an RMPP by businesses whicd are required to register acutely hazerdous materi ........................................................................................... _....... _. _.,.................................... _. _ _............................................................... 4 tl en RMPP is presentty required, has Section z5534 of the Calibmia Health and Safety Coda 0 ........................................................................................... _....."""............... _.. _...' _ _'............................... _................................. 5 Does or wlll the applicant or present or tuture building xcupant require for the work which is tl irom �he Soulh Coas� Air �uality ManagemeM Disiria or tmm eny other air polWtion comrol Elst (Section 658502 0l the Calitomia Govemmenl Cotle requires �ha� Ne requested inbrmation be ...................................................................................................................................................................................................................... 6 Will any pan of the faciliry to be consiructetl untler this permit be within t0001eet from the outei Qt "yes", the faciliry must meet the requiremen� of Sections 25534 and 423W of the California H .............................................—..........................................._—._....�—..._.._................................___.......................................... 7 I� e parmi� irom !he Soulh Coasi Air Queliry Manegement Distnct or o[her eir pollution conV appliwtion, have ell ot the tlisclasures prescnpad 6y Califomla Health and Safety Code Section ............................................................................................................................................................................... 8 QI'j�es", attach cehificate of compliance irom �he apP�opnate air polWtion crontrol aHicer). CERTIFICATE OF GOMPLIANCE: I certity tdat under penalty ot perjury the information given regarding Hazartlous Materials and Emission5. Signature: Division of Intlustnel Sefery, as nated above, unless such person hes e Date: lor emergency response to release ar ihreatened releese ol a �eiardous Business Plan be liletl with the Casta Mesa Fire Department by every al to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, itely hazartlous meterials7 �J Yes �J No with ihe Costa Mesa Fire Department by each �usiness whlch et any Iht of 500 pountls, or a volume ol 55 gellons, or 200 cublc feet of acutely ha¢artlous may require ihe preparation, cenifica�ion antl tiling with ihe Fire e Fire Depahment. .......................................................................................................................... _.............. ompiied wi�h? ❑ Yes ❑ No ......................................................................................................._...............__..........._. ot Ihis a plication a Permit for such consvuction or modllicelion ncy7 � Yes �J No On eD0lications lOr non-resitlentiel builtlinp permits). iaanes or a scnaor! u res � and Sate�y Code). ................................... ��irict or egancy is requirad far ihe � 3 6aen made? ❑ Ves ❑ No is correct. I agrea to comply with all state laws antl ciry ordinances Date: CERTFlCATE OF COMPLIANCE AND AUTHOR17AnON OF ENTAY: I certify under penalty of perjury that I �ave rea0 this application and state that the intormation given is correcL I agree to comply with eli state laws end �iry ortlinances relating to buiiaing consimction, and authorize rapresentatives of the Clty ot Costa Mesa to enter upon the ebove-described property for inspection puryoses. � agree nol to occupy or allow occupency of any building authorized 6y Ihis permit until final inspection. � I /a -/6 -a u S[gnawre,Oi.Legal Owne" _ -. Date _ - And/Or AuthonzeA ApO�icant Date COQE �. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Finel 200 Final Re-Roof 201 Final Block/Retaining Wall 202 Final Factory Fire Placa 203 Final Sign 204 Final Demolition PAIE ... LNNIID..�LS COOE I 206 208 210 212 220 222 250 Mechanical Plumbing Elecirical Fire Preven�ion Plenning Approval Site Building/Occupancy PAIE ItR�dii =x�s-r,.�� 2>'� ✓iF�r,iJ(E FKFMINC �•ti LED�,,SF.� SKtPT � �/iq,RN%�– S�nE�Ev1 �—_v�STi�Jv _�Je< 93 I 82 ��- rnis r,u7k and � Ct tl z-z�8 u+Mwars a� Q.o.- 89x�i�%2 D1ViSION Or F'ili1LLiING SAFETY CITY OF COS!A �ESA API'F2()�J3:1) � CiryolC tai�esa. �00 �"l (p s I I,II_ i� ot Ihis n arrJ s;.ecifi iior: SHALL � T bo yeld to nnA or to he ppmv:'., ,,;�n of a � pro�vions any Cty ct . s;a Mesa Or 80CR 80(1�0' fii* !;' � � �:ki� . s and pe i� siiall eepi � y!imAalion x. i hecnm; r.�� nd void i( t�.e': � �' - : :,nunen dan�maittl2i �Gdve{�r�.:C;303(d}�,r ir.lap:�a;so!: s�xn.. SPa2-tlToP �/�C�J _ � S� 3%i � � �: �� ° :x'I �i�Arr•,i�.;/� (�. c K: _.�i I�,Y� c,, I � :.:�� ° ��e7 � Vh:.,vJG� �y�r=��K - �2� �x-r. FL� J ��3 ° �-13 r=/C� I�SJ�rt7 i �rJ PLANNING DIV. SUBJECT TO B�DG. DEPT.REG. BY,��_DATE / � � 'Q,� �,Q�ur_ (' � !a �� a� �� i��eaa �'ui�'d.i� Diuidio� OWNER-BUILDER VER(FICATION . _,. . . . , A city or county, which is required to give no[ice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the'completion and require the Fetum of, an owner-builder verification. Attention Property Owner. An `ownervbuilder' building permit has been applied for in your name and bearing your signature. Please comple[e and retum this information in the envelope provided at your earliest oppoaunity to avoid unnecessary.delay in processing and issuing your building permit. No buildine nermi[ will be issued until this verification is received. L I personally plan to provide the major labor and materials for conswction of the proposed property improvement. �[, Yes ❑ No i ' 2. I(have/have not) �%�"l/� signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address Phone ( ) City — Contractor's Lic. No. 4. 1 plan to provide portions of the work, but f have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City — Convactor's Lic. No. 5. I will provide some of the work but 1 have contrac[ed (hired) the following persons to provide [he work indicated: Name 10a2-a6 (REV. 9/98) Address Phone Type of Work • � I hereby affirtn that I have received a copy of the information set forth in Section 19830 of the State of Calefornia Health and Safety Code and have completed the above information [o [he best of my personal knowiedge, in compliance with this State law. Signed: ��rils� Q Date: /O —/G -U o Name: �11�h �- �A.�D/NG (Printed or Typed) C.D.L. # OR S.S. # For more information call City of Costa Mesa Building Division at (714) 754-5273. 1062y5 (REV.9RB) � �3�b9 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applica �ILiaC�letely/� Use k (�y, � P�j�y �n BUILDING T_. nn m� `i// T:. F+ � a a ti � S F G W F Q L] .-a Q 7 ..1 a w o. � � 4 z � m 3 OWNER J•H MAIL ADORESS �ZH CITV COS BRANCH ($ ADORESS B AFCHITECT ��1 Jack Hester CONTRACTOR J.h� � ADDRESS3iaq ��rr�� 1i CITV �i0St.3 Mesa �� No. 285-981 OF LOVSOO SCl. ft. 3 USE OF ;� � F='°�Oia�7: ��p2!,.57 t� z � 7�rF�:' APPLICATION FOR STRUC7'CiRAL PERMIT RECEIVEDBV DATERECEIVED nnTF�csucr BUILDING AVe. ADDFESS TEL TRA( NO. �,— � N W ADC vgs & Lo X� lvd OWNER � TEL!)C(1_021J S Re$ N !J7 .I: ..�U. FIRE �a ZONE APPROVED nyc. NOL�751-3 LICYNO. OOHl. INO.OF LB�DGS. NOW ON LOT O Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Single Fanily Res. I hereby acknowladee that I have reetl this eppllcation antl state that the ebove information Is corract and apree to comply with ell laws reBulatin8 builtlin0 construetion, entl I shall not employ any person (n v(olation of the workman's compensetion lews of the Stata ot California. I hereby certlfy thet I am properly licensa as e contrector under tha Stata of Californie Businezs antl Prof ions Cotle, Dlvision 3, Chepier 9, entl thei such lieenaes er i II forca entl effect, or I om axempt from the provisi 's ot ete ot Celifornia Business end Professi s tle, Divisi n 3, er 9. Signatura Parmlttee � Authorized AOe t YARDS APPF MAIN BVIL TVPE V GROUPI&J DATE � � OF _ USE OF NEW ( , VAR.� �/ � C.U.P. ( APPROVED HOLD FOR SP 144Z SQ THEAMOUN THE PUFP�E VALUAT�ON $ 36,660.00 & N n m i m J=467 sq.it. � VN UNDER VALUATION IS FOR m "AB�ISHING A PERMIT F E ONLV: � PERMIT FEE § d v� n PLAN CHECK S ^� /O a TAX 5 2 LL / f U TOTAL PAID E �2