HomeMy WebLinkAbout3050 MADEIRA AVE - Building Permits�OSTA MESA CO�Nj �S,,T�RUG,TION PERMJ IT
ProjectAddress ��� �-�^��-'��' �-Gi.G//1
ApplicanYs Maili`ng IAddress 93�! 6ce,�eAks• • ecUa
Owner's Name CdQL ��a�GN' Pho�ge�
Address 3050 MADE�2/i4 ��7 Sy�"�
ArchlEng. Licenu No.
Address � ' Q
Confractor'sName_ �� �C IN 0(2.phon
Address (mailing) � B R1LE - /35�
City License No. � d
LICENSED CONTRHCTOR DECLARATION
I hereby a/fi�m [M1at I am licensetl untl ovision5 of Char[e� 9(commencing
wi[h section 7000) ot Olvision 3 ot th usiness antl Professions Cotle, antl
my license is in ull orce ana ettect! O y^Q
License �55 � ¢lISC 7��
Date Signature ��
'vORK RS COMPENSATION DECLARA ION
�ereby af/irm ihat I have a certiticate of consent to solf-Insure or a certificate
, Workers' Compensa[i0n Insu�ance, o� a certi/ietl COpy Ihereof ($ectlon
3800, Lab.�1 q p� �� C �1,�
Palicy No. � l O J Ca ny {I
�Certitietl copY is M1ereby furnishotl. /
Cer i�etl c py is �iletl with the cit tli I n. ��)
Date 8 Applicant .
EXEM I FROM WORKERS' COMPENS ION DECLHRATION
(Thissection need nal be comple[etl if the pe it Is for one huntlretl (5100) or
less).
I certity tha[ in lhe performance ot [ne work fo� whlth this permtt is Issuetl, 1
shall not omploy any porson In any manner so as to become subjecl to the
Worker5' Compen5alion Laws of California.
Date Signature
NOTICE: If, after making this declaratlon, you should become subject to the
Workers' Compensalion provisions of the LabOr Cotle, you must forthwith
comply with such pwvlsions or this permi[ shall be Deemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby allirm lha[ the�e is a conitructlon lentling agency for the performance
of the work lar whiCh lhis permit is Issuetl (Section 3097 qv. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILDEH UECLARATION
I hereby atfi�m that.l.dm�exempl irom the Contracto�'S LlcenSe Law for the
followinq reason (Sectlon ]031.5 Busine5s antl Professional Cotle: Any city or
county which reqWres a p¢rml[ lo construct, al[ev, improve, tlemolish Or re0air
any Structure, p�io� to its'issuance, dlso reqW�es lh¢ appllcanl tor sucM1 permit
to file a siqnetl statement thal he/she Is licensetl pu�suant [o lhe p�ovi5ion5 of
�?'ye Contractor'S License Law (Chapter 9(commencing wltM1 Sectlon 7000) of
'`.'�,i;idision 3 of the Business antl Professions Cotle) or tha[ be/she is exempl
`F1'J31S bydanyhappfcan'lrforeallpe�mil%5 bpects IheYappl'cant to5a�civll
�¢ndlty of not more than five huntlretl tlollars (§500).
I, a5 owner ot the property or my employees wlth wage5 as their solo
comp¢nsalion, will tlo tne work, antl the 5[ructu�a is no[ Intentletl or offerCtl
tor sale (Section ]044, Business antl Protessional Cotle: The Contractor's
License Law tloes not apply [o an owner of a property who bWltls or improves
theraOn, antl wM10 tlo¢s sucn work blmself/hersolf o� through his or h¢r own
employces, provitletl tM1al Such improvemenls are not intentletl or offe�etl for
sdle. If, howeve�, the builtllnq or improvement Is soltl within one year of com-
pletioq tne owner will have the burtlen o/ proving he/she tlitl not builtl or Im-
Ip�Ove for [he purpose of Salc).
❑ I, as owner of the property, am exclusivety contracting with Ilcensetl con-
tractors to construct [he Oroject (Section ]044, Business antl Professlons Cotle:
The ConlracloYs License Law does not apply to an owner of Property who
builds or impwves thereon, antl who contracts for such projecls witn a con-
t�actor(sl I¢ense punuant to the Cont�actor's Lirnnse Law). I am aware that
proof of their Worke�'s Compensation insurance shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. fo� thi5 reason
Applicant to fill in all spaces exce0< those wit�in heavy �ortler lines antl sign all ap0�opriate Eeclarations.
PERMIT NO TFiACT NO. LOT NO. UNIT NU
Date
or
Owner _
ve reatl tnls
lhe
,tate that the abovo
tl county ortlinances
¢by autho�iEe reprC-
lonetl property for
o„a S�ds=s�
j3 3320Z. ,_. __
TVPE OFCONSTRUCTION NEW ADD ALTER T10 REPAIR
❑ CONVERSION ❑ DEMOLISH � OTI-{�R RE- /�O� i�
DE�CRIPTION�F 4�IORK/USE OF BLDG. lALf�i7rC.L G'GAdt A
!
TVPEOFPERMIT LJGRA�ING LJFOUNDATION L`75TRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
� OTHER
PROJECT DESCRIPTION 5�. FT. oCCUanrvGV �
CONS'�RUCTION TYPE �:cl�� VALUATION $ �ZC
ZONE GRADINGCU.VDS. ACRES—
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
yyeter Closet
Water Heater
Water Service
Auto-Wash
Laundrv Travs
Reinspectian Fee � $15 I I Issue Fee I $ 3
Boiler
Duct - Under Ground
Duct - Structural
Ouct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.6lt. ICBO #
Heatinn System & Ducting
❑0�700,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, rev. 10/04 White - Bulltlinq; Canary � Applicanq Pink - Accounting; Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Typell ❑
Fefrigeration System
❑0J.00,OOOBTU ❑100,OOOBTU
�ystem Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. #
5 Main Building:
E
T Front
B Rear
A
C Ri9ht
g Left
Ping. Ref. #
Planning Notes:
9277 4/25/�,��
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets �
Switches
Garbage Disposal
Generator 00�5 KW �5-15 KW
Meter Llup ro 100amps
Meter ❑over 100 amps
Sub Panel
Motors �0-1 HP � 1 X- 8
Inc.So�r 09-15 HP �i6-75+
Pole Ligh[
Range
Sign �
Standing Sections
Trash Compacmr
� Reinspection Fee $15 Issue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
Zonin9 Approved By
Building Approved By
Aoolication Issued Bv � =�'�
$ 3
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
� FEES
— SMIP
_ PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
— TOTAL FEE
72051 ii.
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
�
B
a y-2r-ss
$ • sr%
$
$
5
$
$ 72, . Sb
O/
�
� a -s�
CONSTRUCTION AIVD PLANNING POOL & SPA
APPROVALS 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. Electricai Conduit Utility•Undrgrnd. 54. Forms
;4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
�, 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
`6. Electrical UFER Gr:rid. 57. APPROVA� TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgmd.
8. Foundation �� • 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Und�grnd. '-� . 60. Backwash Lines, P-Trap, Cl Undrgrnd.
' -
10. Structural Floor System 61. APPROVAL TO DECK
11. 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 '
I•
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
: ,
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -•�: ,
," i
20. Rough Factory Fireplace APPROVALS Permit # �� �'
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating 71. Product Piping OGas ❑Oilr; �
23. Gas Pipe-Rough & Test 72. Underground Flush �-'�
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Struc[ural) & Monocoat 75. Dry Chemical �� �
27. Frame and Flashing " 76. Dry Standpipe i�• '
28. Lathing &�Siding 77. FIXED SYSTEM FINAL � �,y
29. Insulation 7S. FIRE PREV. FINAL t
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 �r �-
i
37.� Final Factory Fireplace •` '� �
i • b� ��
38. Final Plumbing ,/�� � ' `�� �
39� Water Service-Final I � � r �' � .� ''` ! ,`,r
40. Gas Service-Final ! = == � : . ' �'
.r _ 'z
� 41. Solar pomestic-Final _�_ �
42. Backflow Preventer � � � ' � �"' � -
a '�.
�43. Backflow Irrigation � � , ",
,44. Landscape IrrigationSystem ' � � ' '-y ' � '.'' , ;.�
45. Sound Attenuation ��; ' , : i � . . "
46. Handicap Regulations � �"�'' ' .
`47. FINALSTRUC7URE & BUILDING �� � ' '
. �; ,
48. Special Requirements ComPleted " � , i� '
I
49: Electric Release to Edison , � ' ,
50. Gas Release to Southern California Gas Co , „
51. CERTIFICATE OF OCCUPANCY .
No. Date '` �
�k`N�A evn���novT�na��r � DATE 6-29-59 _
JOB ADDRESS �pKp M.,APira 4�a BUILDING YERMIT 1V0_9�5
GENERAL CONTAACTOR Malgren OIISt, VAC.UE $ �(����_
AP. No. LOT S% TRACT FIRE ZONE DESCRiPTiON OF wOAK res att �ar
INSPECTIONS �_io_�e DATE I GROUP I& J TYPE V ZONE Rl
SU6GONTRACTOR
House
,-b ",
9���
,
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPUCANT TO f/C[ /N COMPLETECY
- TYPE OR PRINT
COSTA MESA,
10835 Santa Monica Blvd..
, dU�� 0 t��`J `
.>
.���'�,'';^� UEPi..
, :a_c.
APPLICATION FOR PERMIT
BUILDING
�oR afficF usF oNcy
e rsecerveo o�i
—�'1 4-.< � :
AR(' 'ECT ��c. COSTA MESA, CALIFORNIA
OR INEER T. _ C_ Ma� nr NO.
ADDRESS 11O1S � S. Paramount Blv ZONE TYPE y GROUP p�
Malgren CQil$t STArE153335 APPROVED
�fice� LOT �/ BLOCK TRAC�36
DESCRIPTION NO. S /
A.P. NO.
s�zE 97 .82 X. 71.45 I�O.OF BLDG6. O
OF LOT rvow orv �oi
USE OF
FFOM
I �EFT S I RIGHT �
DESCRIPTION OF WORK
r BUILD
APPROVED
REAR
ZONING
no. or use or Hew
PLANS BUILDIN6
a/
1 HEHEBY ACKNOWLEUGE TNAT � HAVE PEAD THIS APPLICATION
AND ST�TE THwT THE ABOVE �8 CORRECT �ND �GREE TO COM- THE �MOUNT BHOWN UNDEP V�LUwTION �8 FOR THE
PLY WITN ALL CITY O ANGES ANO STATE LAWS FEGULATINO PUHPOBE OF H6TABLIBHINO q pERMIT FEE ONLY.
DUILOINO CONSTRII VALUATION
SIGNATURE OF PERMIT FEE $ ��p
PERMITfEE / �� j
//'' �- PLAN CHECK $ ��
� � $ y� qqq
AUTHORIZED AGE � �—�
TOTAL FEE $