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Home My WebLink About3009 CLEVELAND AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRNE, COSTA MESA, CA 92626 BUILDING PERMIT ` Job Address: 3009 CLEVELAND AV Suite: il Viciniry: i Status: ISSUED Applied: 08/30/2004 Issued: 08/30/2004 Parcel Number: 14114132 Zoning: App�icanr. GADBERRY, HANSEL DUWAYNE & TERRI --_ ISSUE� sv: Address: . 867 N. LINCOLN STREET , -� � � � - `- � � � ' ., - - Phone: 714 997,5089 , � - ORANGE,CA %"'�- � Zip: 92867 � - ' � - , �� i� Owner GADBERRY, HANSEC DUWAYNE & TERRI � � � � �� Address � 867,N LINCOLN STREET- " _ - . � _ - _ - �, . � . , \ � i / ^ / �^ �i . '_ - Phone: 714 9B7 5089 _-_ �_ --�, �_ � @ ' � `� iORANGE,CA.'� � � Zip: 92887 � ,�" >; , . , . , , � �, �_. Contrecror: ' � . .�<"� � - �Address: � �. - ' - ' - Phone: . � �� . , � �� , �' , �-� Zip: � . . � License: � , . - - � ' ' '.� �- • , _ * . , ' , . _ � , � .Arch� :- .� �=,, . , i � � ' .Eng: � � . , . �, �\ � Address: �, . . � � _ � �� " � - - � - . Address: � � � � . �, , � � i�. _ . � � � ' _I ' ° Phane. �_ . �- i Phone: - - ' - ' - � �� . �.� �: �� . Zip: � � � � License: , License: � ' , , . \ � �,--: � ,�� SCOPE OF PERMIT . .,- , REROOF: T/0 EXISTING ROOF ASPHALT.SHINGLES, REPAIR SHTG. AS NEEDED, & WSTALL 25 SQR'S OF 40 YR. ELK FIBERGLASS '� � SHINGLES. - - i �. - - � ' , . FEE SUMMARY ,' ' � Plan Check: $0.00 - " - � _ - ' - - Calc Valuation: � $z,000.00' ' Permit:' � $69.25 � ` ' � ' Claim Valuation: ; � g2`,000.00 ^,SMIP Res: �� ` $0.50 �� _ � _ � i' , i $MIP Com> ; $0.00 � r` _ , � Other: `� . $0.00 �-i/�' �� 'Inspection $000 �� ';.; , �; � . � , ,� ,. Total: ` �: $69.75 _ _ ' � � � � . ,. . • - ' '�� ♦ ' : ' � PLANNINGRZONING �= / ^ ii%� ,/';'� SETBACKS�`�� `�� . .` ' � �� _ �� ✓ � '�� - _� - ' � . MAIN STRUCTURE� Fmnt 0-0 I , Rear - 0�0 -� �� Left - 0�0�.�— �l / Right 0-0� �,�_.J j" \ ��1 / i•�i�/ ACCESSORY Front , 0- 0 _ � , Rear - 0- 0 . Left . 0= 0, , ' � � � Right �0-,0 �� `i _ � , . _ . - � � -_ ,-� �. � , , .. . . � i" . PARKING Existing: o�'.,�- Re uired: �0 : '. Proposed: -o' �� i1. ,. . - � _ . . - - . - -%�- 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, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned I for a period of 180 days. � • , INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all required Inspections and finel epproval must be obtained. Failure to obtain inspections and final'approval will result in the expiration of this permit. IFOR INSPECTIONS CALL: (714) 7545626 2446ifi (8�00� � WORKERS'COMPENSAnON DECLARAnON: I hereby aHirtn under penalty of parjury one oi Iha following declaretions: " ❑ I heve flntl will meintein e ceRitiwte of consent to selt-Insure for workers' compensatlon, es provided for by sectlon 3700 of the Lebor Cotle, for Ihe peAortnance of Ihe work far which this permit is issued. ❑ I have end will malntain workere' compensation insurance, as required by section 3700 of ihe Labor Code, tor the pedortnance of Ne work for which thls pertnit is Issuetl. My workers' compensation Insurenca carrier en0 pollcy numbar are: Cerrier: Policy Number: (Thls section nee0 not be completed i/ the pertnit is valued ef one hundred tlallars ($100) or less.) ❑ I certify Ihat in ihe pertormance of the work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workars' compensetion laws oi Celifomie, end egree that ii I shoultl become subject to the workers' compensation provisions of Sectlon 3700 of the Lebor Cotle, I shall fort�with comply with these provisians. Applicent SigneNre: Date: WARNINO: FNLURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHALI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVII FINES UP TOONE HUNDRED TFqUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]Ofi OF THE LABOR COOE, INTEREST, AND ATTORNEI"S FEES. LICENSEO CONTRACTORS DECLARATION: I hereby ettirtn that 1 am licensetl untler pwvisions of Chapter 9(commencing with Section 7000) of Divlsion 3 of Iha Business antl Pmfeuions Cotle, end my license Is in full force and ettect. Lic. M Cless % Contractors SlgneNre: Date: CONS7RUCTION LENOING AGENCY: ❑ I hereby aHirtn that thare is e wnstruction lending agency tor the pertormance of Ihe work tor which this permit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lender'S Atltlress: Signature: Date: OWNER-BUILDER DECLAR��ONS`� ,� I hereby eRirm thet under penelry ot;Der7ury,thai I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business entl Pmtessions Code: Any ciry or counry whlch reqmieae pertnit to construct, alter, improve, demolis�, or repair any strucNre, pnor to its issuance, also requires the applicaN tor such permit to flle e signed stetement't�et he or she Is IlcenseE�pursuent to the provisions ot the Contracrors License Law (Chapter 9(wmmencing with Section 7000) of Division 3 oi the Business and Professions Cade) ar that he oi she Is eaempt thereirom and ihe basis for the allegetl exemption. Any violatlon oi Sedion 7031.5 by any epplicent for e permlt subjects Ihe epplicent ta e civil penelry oi not more tAen"tive hundred dollers ($500).): �I, s owner of lhe ro e � � p p rty, or my amployees.wit� wages as their sole compensation, WILL DO TI1E WORK, antl ihe sWcture Is not Intended or ottereC for sele (Sec. /'7044, Business antl Professions Code: The`Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, pmviCed that such improvemenis are not Intended or oflered for sale. If, however, ihe building or improvemem is sold within one year of cnmpletion, the ownerbuilder will have �he burden oi proving that �e or she did no� build or improve for purpose ot sale.). • ❑ I, es owner of the proparty, am EXCLUSIVELY CONTRACTING WITH LIGENSED CONTRACTORS to construct the project (Sec. 7046, Business antl Professions Coda: The conirectors License Law tloes not epply to an owner ot pmperty who builds or improves thereon, and who conirecis tor such pro�ect with e comractoqs) . license pursuant b lhe Contrectors License Lews.). �jl.am�exempt un e c. Business and Professions Code for Ihis reason: SignaNre:� � L. � i"7—.<�- �Dat�e: i�- - 0 5- Own�D venfied by tlnvers license. (��es ❑ No �Diivefs L�cense No. ��-�'�---� �Expires: �� C�f- Verifiwtion of Ownership by (rype af document, i.e. - proparty �a�c bill or tleetl):_ DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: ❑ I hereby certity thet no excavation five (5) or more feet in tlepth into which a person Is requiretl to descend, will be mede In connection with work euthorized by ihis pertnit, antl Ihat no building siructure, scaHoltling, falsework, or demolition or dismantling thereof, will be more Ihan thirty-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 7121e e, Califarnia Adminisire�ive Catle). ❑ As owner-bulltler, I will not employ enyone to do work which would require a pertnit irom the Division of Industnal Satery, es noted ebove, unless such person has e permit to do such work from ihe division. Signature: Date: ' Division of Industnal Safery Pertnit Numbar: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAY: I certify untler penalry of perjury that I have rea0 this appliwtion and state thet ihe intortnation given is wrrect. I egree to compl with all state laws en0 city ordinances rela�ing Io building consiruction, end authorize representatives of the Ciry of Coste Mesa to enter upon the above-described prop or in� pection purposes. I agree not to acupy or allow occupancy of any building euthorized by this pertnit until finel inspection. �"'�1 % / /,- � J 2 � � �- ?_ � _ oY �� on� an.�ire Of Leaal Own�sl � Dat And/Or Au�honzed Applicant Date FQ�E I. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 200 Pool Spe Finel Final Re-Root 201 Finel BIocWRetaining Well 202 Final Factory Fire Place 203 Final Slgn 204 Final Demolition PAIE INTmAIS �•:7 �� e �� L .1►��7/,"•.� �� I COUE 1 INSPECTION TYGE 206 Final Mec�anical 200 Final Plum6ing 210 Final Electnwl 272 Final Fire Preventlon 220 final Planning Approval 222 Final Site 250 Final Building/Occupency P�g 1�LS Lor 15 TRacr 4 9 COSTA MESA BUILD N6-SAFETY DEPARTMENT P. O. BOX S77 C06TA MEBA. CA�-IRORNIA For Applicanf fo Fill In Compleiely TYPE OR PRINT ■ BUILDING COSTA MESA. CALIFORNIA ■ MAIL ■ 6TATE � 86TBAGK LINB RROM TEL. N�. �� TEL. no. ri i. '� �� I. � _ �NO. OP BLD09. NOW ON LOT NONE � .n�... ....... /S DESCRIPTIOtd OF WORK 1 EXTERIOR WALL ROOF COVBRING STUCCO COVERI! USE OF BUIL�ING AND WORK TO 6E FEE RECEIVED JAN 3 11962 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT eua�iN� For Office Use Only RECEIPT NO. P¢I(M� �i BY COSTA MESA. CALIFORNIA APPROVED ZONING ZONE .I � NO. OF U6E OF NEW SMy ��. `-� I PUNB Z I BUILDINO cv/ �4 � z / � o¢sraimmu LO%� /J %/� `/39-s YARDS APPROVED (CENTER LINE 8T.) C� FRONT � R. 61�E � L. SIDE 3 REAR z (l 3 7 6 �/36/6 1 HEREBY ACKNOWLEOOE THAT 1 XAVE PlA� TMIB MPLIWTION 7H�AMOU�XOWN UNOER VALUATION IB FOR THE AND eTATH THAT THH ABOVE 18 CORREGT ANC AGREB TO COM- PURFOBE OP, EeTABL18HIN0 A PERMIT FEE ONLY. PLY WITH ALL CITY ORpiNANCEB AN� 9TAre LMW6 REpULATIN6 PE N.InNaE EOON�TRURION. . VALU 1 ION / PERMIT FEE $ ,� �� $ /' / �/�/ � PLAN CHECK $ / � AUTHORIZED AGENi \i/ 1 TOTAL FEE