HomeMy WebLinkAbout999 MODJESKA CIR - Building Permits(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 999 MODJESKA CI
Suite:
Vicinity: ROOF
Parcel Number: 42205230
Applicant: DICK MADISEN
Address: 12511 PUTNAM
Zoning:
Phone: 562-696-9857
WHITTIER, CA Zip: 90602
Owner: BIG SKY FAMILY LTD PARTNERSHIP
Address YoBRENT MAHON
COSTA MESA, CA Phone:
3075 PROMENADE Zip: 926263053
Contractor: DICK MADISON ROOFING
Address: 12511 PUTNAM
WHITTIER, CA
Zip: 90602
Nch :
Address:
Phone: 562-696-9857
License: 416797
Eng:
Address:
Phone:
Status: ISSUED
Applied: 03/27I2003
Issued: 03I27I2003
�. /
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Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1/2" CDX PLYN/00D, 30 YEAR, COMPOSITION SHINGLES, CLASS A. 21 SQUARES INCLUDES
ATTACHED GARAGE.
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
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0- 0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
ReQuired: 0
FEE SUMMARY
PLANNING 8 ZONING
LeH 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Righl 0- 0
sa,asz.00
$a,as2.0o
�I NO710E: 7he work authonzed by this permN shall comply with all applicable handicap access requirements under Califomla statutes and retated
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: Thls permit shall automatically expire end become void Ii work is not commenced within 180 days, or il work is suspended or abandoned
lor a period of 1 BO days.
INSPEC710NS: In order for the work authorized unGer Ihis permit to be considered legal, such work must comply with all applicable codes, an0 all
required inapectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
zaaaae �aroo�
WORKERS�C`QMPEIy$ATION DECUIRATION: ./
I hereby atlirtn under penalry of perjury one ot the tdlowing tleclaretions: �
❑ I heve a�d will mainteln e certificate of consent to selt-Insu�e tor workers' compensatlon, es pmWded lor 6y SeCtion 3700 ot Ihe lebor Code, tor ihe peAormance of Ne
work to! which Ihis permit i5 Issued.
� I have e�tl will maintain workers' compenSaUon urenco, as requiretl by section 37�0 at the lBGor Cotle, lor the paAo�mance ol tt�e wwk tw vrhkh this pBnnit is 155u0d.
My wQ� mp satlon Insurar7Ce cam poliry number are: �/ // C/ �
Certler,C S��! �%��r Policy Number. �7 ��7 / � �
(ThIs secfion need nof be com0� ed /� (he perm/f is valued et one huntlretl dollars ($100) or /ess.)
❑ I cenify Ihat in Ihe Dertortn. o� Ihe work lar whic� Ihls permit is issue4 I shell not employ eny pereon In eny manner so es to �ecome subleM to tha workers'
compensetion laws ol itomi entl9 re het II I s�oulE become sub�ect lo t�e workers' compensetlon provi5ions o1 Section 3700 of Ne Lebor Cotle, I shall lorthwlth
comply wl�h� e pr/py� lons. //
AppllcaNSignaNr$� �_ ]���y� / �� Dete: r' ��—��%�i �
WARNINO: FAILURE TO SECURE WOid(ERS' COMPENSATION COVEMGE IS UNLAWFUL M!D $W1LL SU91EC� AN EMPLOYEF TO CRIMINAL PENALTIES ANO CMl FlNES UP TOONE HUNDRED
THOUSAND DO��qE �5100,OD�, IN i1Wrt10N TOTHE CA5i OF COMPEIJSATON, DAMAGES AS PHOVIDED f-0P IN SEGTION 3]OB OF THE IABOH CODE, IMEREST, AND ATfORNEY'S FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby eXirtn that I em
torce entl effect. Llc. a_
Contrectors 5igneWre:
af Chepter 9(Commencing with Sectlon 7000) of DlNslon 3 0l iha Business �I Pr ,�s�ns CoAe, end my Iicense is In tull
Class M l /�
oa�a: � —��7 _ n•2-
CONSTRUCYION LENDING AGENCV:
❑ I hereby eHirtn ihat t�ere is e construction lending egency for the pedormance ol Ihe work for whic� ihis permit is Issued. (Sec. 3097, Civil Cotle).
Londor's Neme: Lender's AtlOress:
SlgneWre: Date:
OWNER-BUILDER DECLARATONS:
I hereby ettirtn thet under penelry oi pe�ury t�ai l em EXEMP7 FROM THE CONTRACTORS LICENSE LAW lor ihe �ollowing reason (Sec. 7031.5, Business entl Profess�ons
Code: Any ciry or wunty which requires a permlt to construct, fllter, improve, tlemollsh, or repair eny strucWre, pnor to Its issuance, alsa reqWres 1ha epplicant ta� wch pemut
to lile e signed stetement ihat he or she is licensed pursuent to ihe pmvislons oi Ue Contractors License Law (Chepter 9(commencing with Sectlon 7000) of DMsion 3 ot Ne
Business end Professions Code) or Ihat he or she Is e:empt therelrom end the basis lor Ihe ellegetl exemptlon. Any violetian of Sectian 7031.5 by any applicant for e permit
sublecis Ihe aPPlicant to a civll penelry of not more ihan fve hundred dollare ($500).):
❑ I, es ow�er ot ihe property, or my employaes with weges as iheir sde compensetion, WILL DO THE WORK, entl the siructure is not Intentletl ar ottere0 for sale (Sec.
7044, BVsiness and Protessbns Cotle: The Contractors License faw does noI apPly to an owner of property who Duilds or improves ihereon, end who does suc� work
himselt Or herselt or through his o� her own employees, provided that such Impmvemenis are not Intended ar o%ered for sale. tl, however, the building or improvemeni is
soltl with�� one year of completlon. the owneo-builder will ha�e ihe burtlan ol pmving that he or she tlitl no� build or improve for purpose ot ule.). �
❑ I, es owner of the properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to conswct the pmject (Sec. 7044, eusiness and Professions
Cotla: The contractors Ucense Lsw tloes not eppty to an owner ol property who Duiltls or improves thereon, end who coniracts tor such project with a contractor(s)
license pursuant to the Contmctors License Laws.).
❑ I am exempt under sec. Business anA Professions Cotle for �his reeson:
Signature: Date:
Owner ID venfied by driver's Ilcanse. ❑ Ves ❑ No Drivefs License No.
Verllicatlon ol Ownership by (type oi tlaument, i.e. - properry tax bill or tleed):
Expires:
DIVISION OF INDUS7RIAL SAFETV PERMR CER7IFICATION:
❑ I hereby cenity that no excevatlon Me (5) or rtrore teet In depth into which e person 15 required ro descend, wlll be made in connection with work euihodzed by this
pertnit, end that no huilding sWcture, swttdding, lalsework, or demolition or dismantling ihereot, will be more than thirry-six (36) leet high. (Chap. 3.2, Gry 2, An 2, Sec.
341, 71tIB 8, Celltomie AdminislretNe Cotle).
❑ As owna�-builder, I will not employ enyone to tlo work which woultl require e permit Irom Ihe Divislon ol IndusMel Safety, es nated ebave, unless such person hes e
permlt to do such work Irom the division.
SignaWra: Date:
Dlvlsion ot Industnal Salery Permil Number:
CERTIFlCATE DF COMPUANCE AND AUTHORVA710N OF EMHY: I certiry under penalry of perjury that I have read this application end stata that the inlortnation given is
correct. I agree to comply wil� all stete laws entl Uty ordinences relating to bulltlinp wnstmction, end euthodze represematives ol the Clry ol Costa Mesa to enter upon the
ebove�descnbed propeny lor inspectian purpasas. I egree not to occupy or allow occupancy of eny building euthorized Dy Ihis permit until tinel inspeciion.
COOE 1, iueeeM10NTYPE
1616 Fiaetl System Finel Fire Prevenuon
1288 Pool 5Da Finel
200 Finel Pe-Roaf
201 FIne191ocWRetelning Wall
202 Final Feciory Fire Place
203 Final $ig�
204 Finel Demolition
PdIE It�ELi
�'W ` c�li
CODE1 INsrecnoNrrve �
206 Finel Mechenlcal
20B Flnal Plumbing
210 Finel Eloctrical
212 Pinel Fire Prevention
220 Flnal Planning Approvel
222
250
Final Sl�e
Final BUIIEIng/OCcupancy
QdTF II�LS
_ .TY DF COSTA ME� .
ewu�oRnu a2eaa �.o. wx �200
FROM TME OFFICE OF TME DIRECTOR OF BUIlDINO BAFETV
Project Address � / �O,D��S'•r i.9
Project Name ��U �
O�.mers Name �%OR6�/� �7 Gy� �fld,�2teo
O�mers Address ��"�"� �=
Oaners Telephone� lOf-f,j /},j �oS
Permit t �� � 7-3
ZYPe b�-� "
City Use (k�ly
i�/�Gf (ro!<SS.F L as a�er, Contractor, Age�t (strike out all
except one) do hereby attest that e�loyrt�ent of any person, or petsons, is not
anticipated at the tvne of see]cing the abovrreferenced permit. In the event that
any person, or persons, are e�layed �mder the prwisions of this pezmit, I shall
im�diately cause a valid Certificate of Fbrlarens Carq�ensation to be filed with the
Costa Mesa Building Division.
I agree to defercl at my own mst, arcl to indemnify and hold hazmless, the City,
its offioers, agents and/or �loyees, fran and against, any and all liability,
danage, costs, losses, claims and expenses, howscever caused, resulting directly
or indirectly fram, or oonnected with the improvarent iuxler this petmit.
Z further state that I have tead arrl fully imderstarrl the vr�lications arc3 rr
spo:is:bilities of the above stat�nents, and will crn�ly with all provisions of the
Contractors State License Iaw found under the Business arrl Professions Code,
Division 3, Chapter 9, of the State of California.
CMF 0777-A6
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I�te
' •Size:B'zl4'Oval(7'f0'xt3'l0')
• 5ize:8' Octagonal
� DeOtn: 36^ g a t'
y� ��-�„ ������
Z�'IYtT'�C� �---��
• Size: 6vz'Oclagonal
• DeOtR 38'
Size: 8' Round (7' 10')
Oeplh: 36' 8 4 7"
I
�• Size: 7'h' Square w/Lounge
,• Depih:36"
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• Size: 7'h' Spuare
• oepm: 36•
NO.
THE SP/�► COMPANY I-I
630-6971
� 3142 E. lA PALMA, ANAHEIM
Pii
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APPRovEo
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• Size: 5' a 7' Rectangle
� PRODUCT DESCRIPTION — fu7 . RIG
SPA MODEL SARATOC.A ��
S�f//�/i(/[7� ti %i��//'� . .
PUMP � /7 P �
FILTER � 2 � Q F� I
AIR BLOWER // f�� �
HEATER �1. S ODO T li(�
HYDRO JET SVSTEM �
TILE SELECTION O��N Ia� 9 s
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i STRUCTURAL APPROVAL ONLY
� SEPARATE PERA9ITS ARE RE�JIRED '
' FOR �+ECTR?SAI., P�iIP.7Rif�f, �
� HEATI::G, ':'tl.`' ' � ;,:G AND �
REFRIGE�;TIOiV ��aZK �
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� ��d :�:� �_sv r 73
' THIS �:J:'�_R "t5l „GGO:Ar;�.P:Y �
fiLL IPlSPECT101� REQU�STS
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�,.. i .:. , .' : �.,3 ,,RE 70— �,
_-'`i iN.,T THc
��. �. .... D�J,SAA OF � ,
� ,., �. S F�T'. ;,. �;,,;dS1LTED FOR
' •. : EQU!'EMEN7S. ` I j
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�P��o�r�o
City of Costa Mesa� B�ilding Dept.
iHESE PL4NS MUST BE ON J06 AT AlL i1ME5
NtaKE MO ChiANGES WITHOUT PRIOR .RPPAOVAL
OF DEPT.
(HE iSSUAfV�E OR GRApTING OF A PERMIT OR APPROVAL
' t; I,AtlS AND SVff,If1CATI0N5 SHALL N0T BE CONSTRUED
Iu BE A PEF.:vl;T FOR, QR 4N APPROYA7. Of, ANY YIOLATION
Of r:.NY Of ..iE PROVlS!Q\Y Ltf iN15 COOE. 'r70 PERMIT P8E•
SUMItiG it Gh:E AUiNORiiY TO YIOIATE OR CANCEL THE
PS^!'1�',^.NS OF TN�S CDDE SHAII BE YAL16, EXCEPT IN SO
f4R AS TNE 1Vi 4X 6A USE WH(CH 17 AUTHOfli2ES IS L1WNL
7NE ISS[t4NCE OF A.^EaMIT BASED UPON PLAN$ AN9
�ATiOPF SHAU NOi �R£VEi{7 iHE BUiLDING OFFICIA�
''NESfA�ifq R£Q(1(RING i;i CORRECiSOW OF ERflORS
� Pi,q;¢.: •,;;7 5,':CIF7CATIOt4S OR FROM PREVENTING
•crcSTlCu: BEING CARRtEO ON THEREUNDER WHEN
� -,.^.�pF pR �F ANY OiHER ORDINPNCE
�
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AP No. 422—
I :CTION!
Pool Loca2ion
Forms
ain Drain
teel Reinforce
Elec. Bond
�Approval to Cover
� oinderground Elec{ric _
�Gas Piping Test
Filtering System Lines _
d
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final _
�F' - System Final
B,._..wash and Recep. Final
Fencing Final
Approval for Finish
BUILDING PE
tallation DESCRIPTION of WORK Private
2ACT 9592 FIRE ZONE VALUE $ 2'.
�g at�re Dare GROUP R-3 TVPF V
G o� � SUBCONTRACTOR
Electric
v 5:
Plumbing -�
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� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX7200 COSTAMESA,CALIFORNIA92626
For Applicant to FID in Completely — Use Ink Only
ADIDRESS���� /-��5�/7
OWNER OR T��R//-/ f/ � C��/� �rCJ� `�
TENANT
MAI LI NG /�
ADD RE55 ���.�5`y%�v-
CITV ( .{�iJ/�' �/��/-'lJ/� NOL� �,f
CONSTfiUCTION
BRANCH
ADDRESS
ne cnirTeicco �
ADDRESS�(f//'�CUf/7V �'�
CONTRACTOR ���,/ �S�/'� ��T
ADDRESS ��� � L L✓ J� A� '
� TEI.
CITV ��SJ / `K� NO.
STATE �J`/�y � CITV
LIC. NO. �� LIC. NO.
SIZE NO.OF BLDGS
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowletlBa tha[ I heve reutl ffiis epplication end rtete
that the ebove Intormation is corract antl apree to comply with
all laws raguleting building conrtructlon, antl I shell not amploy
any Oerwn in violaiion of the workman's compensation laws ot
the State of Californla.
I hereby cartify that I am properly Iicensetl as a contractor under
the State of Calitornle Business entl Professions Cotle, Division 3,
Chapter 9, antl th ch lice ere In full torce enE atfect, or I
am exempt iro th provisi n t the State of ellfornia Business
and Protassio Co , Dlvi n, ier 9.
$IB�ature of
Permlttee
O! r . �l 6 `Q �)
Agent
'/799 5/29/90 �605� TL
APPLICATION FOR STRUCTURAL PERMIT
RECEIVEO PERMIT
/. w s v t� 3
A.P. NO. / Yi�•--•O%' /� � �
BUILDING ��L"/ /�O I� �S
ADDRE55 ( / � a
UNIT OR
SPACE NO.
NEW I ADD IALTER IREPAIR IMOVING�DEMOLI
OWNER VOiO/'7W CYGtw�Or
/� r
USE
SNG�. VAWEs '
APP
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ED
ACTION
OATE
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SQ. FT. I- ` O � N
7
TNE AMOUNT SHOWN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
VA�UATION PERMIT FEE S a
m
�y PLAN CHECK E _ � a
/ � /�
TAX b , �^� F
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TOTALPAID E S • C'A
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� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAIIFORNIA 92626
For Applicant to �F/il�l �in Comj�pletely�Use ink Only A
BUILDING f z l �"��,���Z
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OWNER J.H. Gregory
ADDRESS�1S7 ��Ci�� Airway Ave.
CITV C�`Sta Mesa NO�J�--3
� oER`�fi"eat Western Svgs & Loan
BRANCM 8�8� Wilshire Blvd
AooaessBeverly Hills, Ca.
ARCHITECT Tanit Hcc�hnv� T.l"KQ-ni
.� Suite
CONTPACTOR �J.}j. c;regor� cons
ADDRES53187 ���i�� Airway AVe.
TE
CITV �i0$f.'d Mesa N f
�;� No. z85-981 ����N0008179
OF LOT 3500Sq. ft.averag OWONLO S O
USE OF
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORn
I hereby acknowletlge thut 1 hava reetl this application antl state
thet tha ebova Informetion Is eorrect end eB�ee to comply with
ell lows reguloting bulltlinp conztrucclon, entl I shall not employ
eny panon In violntion of Ne workmen's compenmtion laws of
cho Smro ot Celifornle.
I hereby cartify thot I am properly Iican es e contrector untlar
ihe SWto of Callfornlo Buslne s antl Pt e Ions COAe, Division 3,
Chaptar 9, enG t�at such Ileo ws n II forca antl oftact, or I
em axo t fr the provlsi ns e te[e of Callfornia eusinass
ontl Pr essiona ode, Olvi. n 3 tar 9.
Permittee
�RZS'il��.u��i�±19:} du�ZZn.n�
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY DATE RECEIVED D TE ISSUEC
!.1_�� �
BUILDING
ADDRESS
TRACT
OWNER �.tt. ureeorv
VALUE
�se Sin�le Fam Res s 35.700
FIqE V I&J
ZONE T GflOUP r
APPROVED _ ___ �� �n'%'
N �J NO.OF USE OF NEW
• C/� PLANS � BUILDING
YARDSAPPROVED VARDSAPPFOVED
MAIN BUIL�ING ACCESSORY BUILOING
IOM C/�L /gT�q+EF�7
�NT �IJ FT. L D✓rSF�'�7
:,�F y� ��� �i.� �r
DISTANCE BET. BET. I
MAIN BLDGa. ACCE
VAR.#� , �/� DATE
C.U.P. # ^ n APPRI
APPROVEDL �/L �
��
HOLD FOR SPEC AL I
�—/S�• %
-� z -� �.
1406 SQ.FT. J=449 sq.ft.
THE AMOUNT SHOWN UNDER VALUATIO
TFIE PURPOSE OF ESTABLISHING A PERMR FE
VALUATION PERMIT FEE S
�} PLAN CHECK E
535�(OO�OO TAX E
TOTALPAID § �
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n
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IS FOR �
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ONLY: �
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