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Home My WebLink About212 CABRILLO ST - Building Permits: .. � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 212 CABRILLO ST Suite: Vicinity: ROOF Primary Occ: R-3 Dwellingsl Cong Res <10 Type ot Construction: V-N Parcel Number: 42539209 Zoning: Appticant: CHURCHILL, RICHARD Address: 4425 FOREST GLEN RD ANAHEIM,CA Owner: NICOLAOU, TOM TR Address 21202 LOCKHAVEN , HUNTINGTON BEACH, CA Contrector: CHURCHILC CONTRUCTION Address: 4425 FOREST GLEN RD ANAHEIM,CA Zip: 92807 Arch : Address: Zip: Phone: LiCense: Phone: 714-974-0456 Zip: 92807 Phone: . Zip: 92646 Phone: 714-974-0456 License: 660990 Eng: Address: ISSUED BY: Status: ISSUED Applied: 01/03/2006 Issued: 01/03/2006 Phone: License: SCOPE OF PERMIT TEAR OFF EXISTING. INSTALL 1 LAYER.OF 30# FELT, 30 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEETING AS NEEDED. 1,200 S.F. FOR S.F.D. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $97.25 $0.50 $0.00 $0.00 $0.00 $97.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Exisiina: o , „ , Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0- 0 $3,670.00 $3,670.00 NOTICE: The work authorized by ihis 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 it 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 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: (714) 7545626 ?uc-as (woo) WORKERS' COMPENSATION DELLARATION: _ I hereby aNirm under penalry of perjury one of the following declaretions: � q I have and will maintain a certificate ot consent to self�lnsure tor workers' compensetion, as providetl tor by section 3700 of the LeDor Code, for Ihe paAortnance of the work tar which this permil is issuetl. ' I�ha � antl will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, tor ihe peAortnance of the work for which this pertnit is issued. My w ker ' compensatlon Insurance carrier antl policy number are: �2 � /–yr Garrier. .`-:�' ��j�� /�(%/V p .�, Po11cy�Numbei: � J � I 6 3 G76is aecfion'need not be complefed i! fhe permi( is valuetl at one huntlred dollars ($100) or /essJ �' e"�"'�"` ` ❑ I certify thet in the paAormance of Ihe work for which this permit is issueQ I shall not employ any person in any manner so es to �ecome subject �o the workers' compensation laws of California, end agree ihat If I should become subject to iha workers' compensation provisions of Section 3700 oi ihe Labor Code, I shall forthwith C011fp1ylOhh'ihB9�1�i910f18... %�� qppliceniSignaWi��<,�(.:"t`��.#��""�'✓V�� Dafei'��.�- �-3—d� ARNINO: FAILURE TO SECUFE WORKEFS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPID' VER�TO'CRIMIN PENALTIES AND CIViI FINES UP TO pNE HUNDRED THOUSAND DOWRE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 31060F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: �apter 9(commencing with Section 7000) of Professions Cotle, and my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aHiRn Ihat there is a construction lentling agency br ihe performance of ihe work for which this permit is issued. (Sac. 3097. Civil Code). lendar's Name: Lende�s Atltlress: SiB^ature: OWNER-BUILOER DECLARATIONS: Date: I hereby affirtn that under penalty ot peryury ihal l am EXEMP7 FROM THE CON7RACTONS LICENSE LAW ior ihe tollowing reason (Sec. 7031.5, eusiness and Professions COde: Any ciry or counry which requires a permit to consWct, alter, improve, demolish, or repair any siructure, pnor lo its issuance, also requires Ihe applicant tor such pertnit b file a signed statement that he or she is licensed pursuant to iha provisions of ihe Coniractors License Ww (Chapter 9(commencing with Section 7000) of Division 3 of ihe Bosiness antl Professions Code) or that he or she is exempt therefrom and Ihe basis for the alleged eaemptio�. Any violation oi Section 7031.5 by any applicant fo� e permit subjects the appliwnt to a civil penalty of not more Ihan five huntlred dollars ($500).): ❑ I, as owner ot the propehy, or my employees with wages as iheir sWe compensation, W ILL DO 7HE WORK, and iha struaura is not intantletl or oflaretl tor sale (Sec. 7044, Business and Professions Cotle: The Coniractors License law does not appty to an owner oi property who builas or improves Ihereon, and who tices such work himself or herselt or through his or her own employees, provided lhat such improvemenis are not intended or oHerea lor sale. If, however, the building or improvement is sold within one year of completion, t�e owner-builder will have ihe burden of pmving that he or she did not builtl or improve tor puryose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (SecJ044, Business and Profess�ons Cotle: 7he co�tractow License Law does oot apply to an ownar oi property w�o huilds or impmves thereon, and who contracts for such proiect with a contractor(s) license pursuant to the Comractors License Laws.). ❑ I em axempt under sec. Business and Professions Code for this reason: Signature: Date: OWnar ID verified by drivers license. ❑ Ves ❑ No Driver's License No. Veritication oi Ownership by (type of document, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I herehy certity that no ezcavation five (5) or more teet in depth into which a person is requiretl to descentl, will ba made in connection with work authorized by this permit, and �hat no building stmcture, scallolding, falsework, or demolition or dismanHing thereof, will be more than ihirty-six (36) feat high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calibmia Atlminisirative Code�. ❑ As ownerbuiltler, I will not employ enyone to do work which woultl require a permit irom the Division of Intlustriel Sefery, es noted above, unless such person has e permit �o do such work fmm the tlivision. Sig�ature: Date: Division of InduSirial Safery Permit NumOer: CEqTFICATE OF COMPIIANCE AND AUTNORIZATION OF EMRY: I certity u�er penalty ot pe�ury that I ha�e reatl this app�icalion aod stata that the intortnatirn given is correct. I agree to comply witlt ell stete laws end ciry ordinances relating to building consiruction, end authonze representatives of ihe City of Costa Mesa to enter upon the abo�e-described proparty for inspection purposes. I agree not to occupy or allow occupancy of any building aufhonzed by this permit until tinal inspection. 4QQ�, INSPECTIONTYPE 1 fi18 Fixed System Final Fire Prevention 1268 200 zoi Pool Spa Final Final RB-Roof Finel BIocWRetaining Well ppp Final Factory Fire Place 203 Final Sign 204 Final Demollllon i 1 / i >�u/ 1 ' '.I./v /.� �. � �� COOE 1 INSPECTION TYVE 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 272 Finel Fire Pravemion 220 FinalPlanning Approval 222 Final Site 250 Final Building(Occupa�y .