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Home My WebLink About420 CABRILLO ST - Building Permitse , . CITY OF COSTA MESA > _ � Bl/ILDING DIVISION ; DEVELOPMENT SERVICES DEPARTMENT � � PERMIT PERMIT NUMBER �� 698-01772 ✓ (714) 754-5273 • Fex (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 420 CABRILLOST Suite: Vicinity: Parcel Nunmber: 11732205 Applicant: SKIRZYNSKI, JOHN Address: Owner: Address Contractor. Address: � HODGES, WILLIAM TR 420 CABRILLO ST COSTA MESA,CA � - SHARP ROOFING 10782 S. MEADS AV BUILDING PERMIT Zoning: Phone: Zip: Phone: � , .- ' Zip: 92627 � . . Status: ISSUEDn1�/� Applied: 09/30/1998 Issued: 09/30/1998 Phone: . ORANGE CA Zip: � 92869 . � � � License:• 571575 � Arch /.Eng : . . : � "' "' � � Address: � � / � ^ � " � �. . "Phone:_ _ �. . - . � Zip: . License: ' . SCOPE OF PERMIT •T/O SHAKE AND REROOFWITH HEAW "B" SHAKE PER SPECS. WEIGHT PER SQ. IS UNDER 6�LBS. • - ROOF CERT ATTACHED TO PERMIL � � � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $162.25 $0.95 $0.00 $0.00 $0.00 $163.20 ' SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: � FEE SUMMARY , " � ;� � . _ _ --' Rear 0- 0 Rear 0- 0 Required: 0 PLANNING'8 ZONING LeR 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-.0 $9,500.00 $9,500.00 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapections and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARATION: _ � I hereby aHirm under penalry of perjury one of the following tleclarations: ❑ I have and will maintain e certificate ot consent to seN-Insure tor workers' compensation, as provided tor by section 3700 of ihe Labor Code, tor ihe pertortnal�e oi ihe work for which ihis permit is issuad. ❑ I have antl will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, tor Ihe pedortnance of the work for which this pertnit is issued. My workers' compensation Insurance carrier end policy number are: Cartiar: Policy Number. ' (Triis section need not be completed il the permit is valued one hundred dollars ($f00) or less.) ❑ I certity ihat in tha pertormance f ihe w r for ic ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C'fom�ntl a i I s uld become subject to the workers' compensetion provisions of Section 3700 of Ihe Lebor Code, I shall forthwith comply with ihese pr'o% s' ns. / (' cc�p ApplicantSignaWre: v . Date: v J��. �( I Ci WARNING FAILURE TO SECUR ORKEFS' CAMPENSATION CAVEPAGE IS UNL4WFUL AND SHALL SUeJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDRED THOUSANO OOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDEO FOF IN SECTION 3lOfi OF THE LABOR CADE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRAC I here6y aHirm that I an force end eftect. Lia x Contractor's Signawre: (commencing with Section 7000) of Division 3 ot Ihe Business and Professions Code, and my license is in tull � Class k Date: � "� � r % CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn ihat there is a wnstmction lending agency for the pedortnance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Signature: _ LentleYs Atldress: Date: OWNER-BUI�DER DECLARATIONS: I hera6y aHirm Ihat untlar penalty of perjury ihat I am EXEMPT FROM 7HE CON7RAC70RS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any city or county which requires a permit to constmct, altar, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit ro tile a signetl statement ihat he or she is licensed pursuant to ihe provisions ot ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Businass and Professions Code) or ihat he or she is e:empt therefrom and the basis for ihe alleged exemption. Any violation oi Section 7031.5 by eny applicant for a permit subjecis the applicant to a civil panalry of not more Ihan five hundred dollars ($500).): ❑ I, as owner oi iha property, or my employees with wages as iheir so�e compensation, WILL 00 7HE WORK, end ihe stmcture is not intentled or oflered for sale (Sec. 7044, 8usiness and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who tloes such work himself or herself or through his or her own employees, provided Ihat such improvements are not intended or ottered tor sale. tl, however, the building or improvement is sold within one year of completion, ihe owner-builtler will have the burtlen oi proving Ihat he or she did not build or improve for purpose oi sale.). ❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the prolect (Sec. 7044, Business and Professions Code: The coniractors License Law does not apply to an owner ot propetly who bui�ds or improves ihereon, and who con�rads for such project with a contracror(s) license pursuanllo the Contractors License Laws.). ❑ I am ezempt under sec. Business and Professions Code tor ihis reason: Signature: Date: Owner ID verified by dnver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (rype ot document, i.e. - property tac biil or deed): OIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICA710N: ❑ I hereby certity ihat no ezcavation five (5) or more feet In depth into which a parson is required to descend, will be made in connection with work authorized by this permit, and that no building simcture, scaRolding, telsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, Title B, Calitornia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a pertnit trom ihe Division of Intlusirial Satery, as notetl above, unless such person has a pertnit to do such work iram Ihe division. � SignaWre: Date: Division of Industrial Satety Permit Number: CERTIFlCATE OF COMPLIANCE AND AIJTHORIZATION OF EMRY: I certity under penalry of perjury that I have read Ihis applicalion and state that the intormation given is corred. I agree lo comply with all state laws and ciry ordinances relating to building construction, antl au�horize representatives of the City ot Costa Mesa to enter upon the above-described property for in�pec�ion ppryoses. I agree not to occupy or allow occupancy of any building authorized by Ihis permit until tinal inspection. GO�E 1 INSPECTIONTYGE 1616 Fixed System Final Fire PreveNion 7288 Pool Spe Final , 200 Final Re-Root 201 Final BIwWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 24463fi Pd7E UITIDEIS � � J �ep�` 3v. °i s S`? Date CO�EY INSPECTONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Eledncal 212 Finel Fire Prevention 220 Finel Planning Approval 222 FinalSite 250 Final Building/Occupancy � I� �osta Mesa, Building Department APP CATION FOR PERMI� �� 117 EAST 20th STREET �C[�S B U I L D l N G �� COSTA MESA, CALIFORNIA enwu �na r-u 2M s-sa ..5 . /�'. .a....J - Show locatlon and distances �irom property lina and between buildings. ' ' ' ' ', . : . ' . ' '_' ._. . ' _ ' ' �.'. . � ..c : . . i�� _ I .. . _"t ' � �.ae rs-sSPDy�5��1o4a ��35.00 ., , ; , - . .. . ' „ . . .. �� . , . a .