HomeMy WebLinkAbout3044 MADEIRA AVE - Building Permits1
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AOP��cant to fill in all spaees except inose wilhin �eavy bortler
oF cOsrn MESn CONSTRUCTION PERMIT
Project Address 3� y� m�� �'�'�
Applican�'sMailingAddress �8�2 H19m/cTprJ //1✓/niC �J�7/`/
Owner's Name iT0/i.V i3/iR/`�� S Phone ��G -✓��/:
Addreu .�n �/°/ /Y1/a0 t2f-�
Arch/Eng. License No.
Address
Contracmr's Name � TOtC �00�/bG Phone-��-��22 �
Addresslmailing) 3k/Z /�ffl�i/c�.J isl✓i.aE • yz7/Y
City License No. � 2� L�.3
LICENSED CONTRACTOR �ECLARf1TION
I hereby affirm that I am licensetl vPtl¢r proviSiOns ot Ctlarter 9(commencinq
with section �00�)'ot Divislon�3�o1 the Bu4ness antl Professionx Gotl¢, antl
, my license is in (ull force antl ettect. '
u�ense ciazs C' 3 CI ' � �ite�N o: 3�7✓r8f3�i
oate /O—// -�i�l�''<a+.� � �XT���P./
WORKERS' COMPENSATION DEC�4AR71TION
I nereby aifirm that I have a certiticate of consent to seli-insure or a certificate
' workers' Compensation Insuiante, or a ceriifietl copy thereo( (Settion
�0, Lab. C )
���%v rio. lc O 6 f?63 —�63� conioa�v .S'T'.i7� Fi/w,o "
�Certifietl cooY is hereby fumished.- .
Certifietl cop i3 file0 witn the citY �B -�I�tllnp DIvI on.
Date �O'//'� V ,ApPlicant .J "'�'` �CO�/�G
EXEMPTION FROM WORKERS' COMPENSATION DEGLARHTION
(This section neetl not be campletetl if the permit is (or one huntlr<tl ($300) or
less).
I certify that in the Oerformzrice of the work for which this perm�[ is issuetl, I
shail not employ a�y person in any manner So a5 to become subject to the
Workers' Compensation Laws of Cal�fomia. �
Daie Signature
NOTICE: It, a(ter making ihis tleclaration, you shoultl become subject to tne
Workers' Compensalion provisions of tne Labor Cotle, you must forthwitb
tomply wi[h such provisions or this permit snall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCY
I nereby affirm that there is a constructlon Ientlin9 agency tor lhe ver(ormance
of the work for which tnis permit is issuetl (Section 309] Civ. C.)
Lentler's Name
Lentler'S ACdr¢Ss
OWNER BUILOER OECLARATION
I hereby af(i�m that I am exempt t/om the ConVactor's License Law for th¢
following reason (Sec[ion 7031.5 Business antl Protessional Cotle: Any ci[y or
county which iequires a pe�mit to construct, alter, improve, tlemolish or �epai�
any structure, p�Io� lo its i55uance, also requires the applicant to� such permit
to /ile a signetl statement that he/sne is licensetl pursuant to the provi5ionsbt
the Contractor'S License law (Chapter 9(mmmencinq with Section 7000) o(
DiviSion 3 of the'Business and PrOfessiOns Cotle) or that M1e/SM1e I5 ezempt
�herefrom antl tbe basis for the all69etl exemptlon. Any violation of Section
`31.5 by any applicant Por a permlt Subjects the applicant to a civil
�alty of not more ihan five huntlrCtl tlollars ($500). .
,' I, as owner of the p�ope�ty or my employees with wages as thei� sole
COTp¢OSa[iOn, will tl0 tM1¢ wOlk� dOtl LIl¢ stluctule IS OOf IOf20tl¢tl O( Ott¢f¢tl
lor sal¢ (Section 7044, Business antl Profe55ional Cotle: Tne Con[ractor's
License Law tloes mt apply to an owner of a property wno builtls or improves
lh¢reon, antl wM10 tloes such work himselt/hersel/ or through his or her own
employee5, pwvideE Ihat Such improvemen(5 are not intentletl or ofteretl tor
sHle. If, however; the builtling or imPravement is soltl within one year ot com-
pletion, the owne� will'have the bu�tlen ot proving he/she tlitl not builtl or im-
�rove tor tne purpoze ot sale).
I, a5 owner of the 0/operty, am exclusivery cont�actin9 with Ilcensetl con-
tractors to construct the project (Section 7044, Business antl Professions Cotle:
The ConVactor's License Law tloe5 mt aoPry to an owner of property who
buiitls or improves ihereon, antl wHo contracts tor such projects with a con-
tractor(sl iicense pursuant to the eOntractor's License Law). I am aware that
p�oof of th¢ir Wo�ker's'CompenSaUon insurance shoultl be prOviDetl to me.
❑ I am exempt unCer Section— � B. & P. C. for this reason
Date
I hereby certify tM1at I
information is correct.
antl state iaws relating
sentatives of thi5 <ity
inspection pJygOses.
Owner
have reatl Mis applicaiion antl state that the above
agree lo compty with all city antl county ortlinances
o builtlin9 Lonztruction, ana hereby authorize repre-
[o n er uPon the above-mentionetl property for
Date //'�
�
anC si9n alt appropriate tleclarations.
TYPE OF CONSTRUCTION LI NEW� yL.� ADD LJ ALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH LJ OTHER -NC�✓ �LOOF A P�
DESCRIPTION OF WORK/USE OF BLDG. %Z��°oF OF H�m i �✓i7/1
G/�+ /BE�2 6Gq55 C L/iS5 N iQ�= S/N6GE E Main Building:
TVPE OF PERMIT GRADING FOUNDATION STRUCTVRAL T Front
❑ TENANT ❑ ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear .
❑ OTHER %�
PROJECT DESCRIPTION SQ. FT. Z/U OCCUaAn�CV C Right
K
CONSTRUCTIONTYPE VALUATION$ 3�/0a�� S Left
ZONE GRADING CU. VDS. ACRES Ping. Ref. �
Remarks: � PldllOiOq NOL25:
3ar Sink
3ackflow Preventer
3ackflow Irrigation
3athtubs � �
�larifiers
�ishwasher .
�rinking Fountains
Roor Orains
Floor Sinks
uasService Ootlets
Interceptors
Kitchen Sink '
�avarories
P—Trap
Roof Drains
Reinspaetion Fee $15
Boiler
Duct-UnderGround '
Duct - Structural
Duct - Ventilating
Ezhaust System � Multiple
PirepUFacL Blt. ICBO #
Heating System & Ducting
❑aioo,oao sru Oiao,000
LDrivers'rcefise9(55 � - I I Reinspaction Fea
CMF OB65-46, rev. ]0/B4 White - BuilGing; Canary - AOP��canh pink - Accountlng: Goltlenrotl - Assessor
$15
Showers.
Service Sink �
Sewer Cap
Sewer Connec[ion
Solar Collectors �
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000er� �ioo,000
System Repair/A�iteration
F ire Dampers
Registers
Fee
Aummatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures .
Device Boxes
OuLIetS
3133 9/15/B6
Zone
Actessory Building:
ELECTRICAL
Trans(ormer ❑ 15-50 KW
� ❑50+KW
Garbage Disposal
Generator �0.5 KW �5-15 KW
Meter L.lup ro t00amps
Meter �over100amps
Sub Panel
Motors �0.1 HP �i'h - 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pale Light
Range
Sign
Standing Sections
Trash Compactor �
$ 3
Reinspection Fee $15 Issue Fea
FEES
�DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approved By
Building Approved By
Apaliwtian luued Bv �
$ 3
0
24.5(1 TL
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMM RV F FEES -y,
BUILDIN� PERMIT $ SMIP $ • � V
PLAN CHECK $ PERMIT �
PLUMBING $, ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ � �GRADING $ �
Pt7itTCHECK 50% $. MICROFILM $
MECHANICAL $ TOTA� FEE $ �
PLAN CHECK 25% $ �
CONSTRUCTION AND PLANNING POOL & SPA
AP�PROVALS Permit # Date Inspector p�PpROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � , 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing SYstem - Final
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
� 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19; Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# -
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTankOGas ❑Oil
25. Roof Sheathin9 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ;
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final �
40. Gas Service-Final
41. Solar pomestic-Final
�l ,
42. Backflow Preventer '
43. Backflow Irrigation i P � R E p
44. Landscape Irrigation System ��pmplete ►ns
45. Sound Attenuation 3 SI$ ��s�
46. Handicap Regulations ' �;
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed �
49.'Electric Release to Edison '
50. Gas Release to Southern Califomia Gas Co �i ,
51. CERTIFICATE OF OCCUPANCY �
No. Date _
SYCAMORE LAND CO
JOB ADDRESS �
GENF.RAL CONTRACTOR 1�
ItUILllING PERi\4IT N0.
INSPECTIONS �p,(! I DATE � GROUP S
SUBCONTRACTOR
17,322
' " 9'73�0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 317 GOSTA MESA. CALIFORNIA
fOR APPUCANT T0 f/LL /N COMPLETELY
TYPE OR PRINT
9UILDING ���
ADDRESS
COSTA MESA, GALIFORNIA
MA1L_ _ lOH3S Santa Monica BZVC�..
11015 S. Paramount Blvd.. �FIRE
ZONI
Malgren Const. srarE 153335 .ee.
�EGAL. . ' ILOT SH
NO. OF BLDO9.
aETBpGK LINE FROM
DESGRIPTION OF WORK
� X �� � ��
IE
NO.OF
SE
wood.shingl
HEREBY AG1(NOWLHDGE TXAT 1 XAVE FEAO THIS APF
.Ntl STATE TH�T THE ABOVE IS CORRECT ANO �GREE
'LY WITH ALL CINbHDINANGEb ANO STATE LAW RE�
N�L�ING CONSTR/�J/�7 10N.
3NATURE OF!! _ .. �
AGEN7
', a:.��...' . ,. '
_ i �lUi�' p 1959
�;�r�,:;� ��Pr.
����, , ,.�, „ =c,.
APPLICATION FOR PERMIT
BUILDING
FOR Off/CE USE ONLY
� RECEIPT NO. � �PERMIS
COSTA MESA. GALIFORNfA
ZONING
20NE ' I NO. OF I USE OF NEW
�pLpNS BUILOINO
APPROVED
BY DATE
YAROS EVES �
REQUIRED ALLOWED
(GENTER LINE 6T.)
FRf1NT C � � CT
��M. THE AMOIINT SHOWN UNOEN VALUATION IS FOR TH6
l�NG PUHPOS¢ OF EBTABLISHING q PERMIT FEE ONLV.
I VALUAiION
PERMIT FEE $b.�'7
S�'"J� Ji � PLAN CHECK S�(P �
L �
� TOTAL FEE 5
JOB ADDRE6S -jUU4 MdQlEP8 AVe. BUILDING PERn4I9
GENEItAL CONTRACTOR Superior Fence CO. VALUE S �0.00
AP. No.113- 1-0 LOT TitACT FIR� ZONE DESCRIPTION OF WORK
DATe � GROUP J TYPE III ZONE R1
---I SUBCONTRACTOR I _ __ �'ERMITSISSUED_^
OCCUPANCY
Form 210—SM���.59 S�B P . 12898
� �`,
12$`•38
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 31] CbSTA MESA,CALIFORNIA
fOR APPUCANT TO F/t[ /lY COMPLfTECY
TYPE OR PRINT
BUIL�ING �1j� , /' `�� /F y� � , �JL•
ADDRE55 �J�/ y y (W
COSTA MESA. CALIFORNIA
■ MAIL
TEL.
I ADDRE55 _KLiC�L!!J-P��.
ADDRESS I �fa�
LEGAL LOT I�.�Yj ,,�_]
DESCRIPTION I NO. L/ (J I BLOCK I� R'���
A.P. NO. � ` � / � �/
FEE RECEIVED
FfC��n�� +P� 2 61980
APPLICAj'�f�SV�'F'01i �IT
BLI1��Ii�A MESA
FOR OFF/CE USE ONU'
FEGEIPT NO. I ���I�T�1(J
JIA
REGEryED BY DATE RECEIVE� DATE ISSUE
_ ,�� � 9-�t� - �o I 9-aE-e
BUILOING
ADDRE55
COSTA MESA, CALIFORNIA
FIRE �e �G Group
ZONE
APPROVED
BV DATE
ZONING
ZONE I NO. OF USE OF NEW �
PLNNS BVILDING
BYPROVED .L. I`/. `%—�V
f1GTF
SIZE o.oF BLDGS. � yqRDS
OF LOT tuow orv Loi REQUIRED
USE OF (CENTER LINE STJ
EXISTINGBLDG. �/7�///-y(O_ FRONT
SET9FCK LINE FROM v ��
CENTER OF SiftEET REAR VARD R. SIOE
// //
SIDE YARD LEFT � IRIGHT L.SIDE
DESCRIPTION OF WORK
REPAIR I IIMOviNG I IIDEMOLISH
BUILDING NO.OF
SIZE ROOMS STORIE
EXTERIOR WALL IROOF
COVERING COVERING
I 1�IEREBY ACKNOWLEOGE TNqT 1 HAV'E READ TMIS APPLICATION
RNO STRTE THiIT THE ABOV� IS CORRECT ANO AGNEE TO COM-
PLV WITH RLL CITY OROINAryGES AND STATE LRWS REGULATING
BVILOING CONST�tiT10�./ % /��� C�
iI
i AIJTHORIZED AGENT
�
THE RMOUNT SNOWN UNOER VALUNTION 19 FOR THE
PUFPOSE OF ESTABLISHING A PEFMIT FEE ONLY.
VALUATION �
�Q� PERMIT FEE $
�f � �.
, ,\/ _._.
� L V � PLAN CHECK $
L� d-i
TOTAL FEE $ / "