HomeMy WebLinkAbout3057 MADEIRA AVE - Building Permits •
• . ..
. .
i . -' W CITY OF COSTA MESA
,4 : BUILDING DIVISION
P 4�1... I a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us ` •
• o- FOR INSPECTIONS CALL:(714)754-5626 , , '
. •• PERMIT NUMBER: B08-00308 . .
PERMIT TYPE B_ROOF2 STATUS: ISSUED .
AP N: 13917221 DATE ISSUED: 11/03/2008
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_ ISSUED BY RMD
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JOB ADDRESS: 3057 MADEIRA'AV,CM 1,-,.-.. rg, I.:, � i Suite/Unit `;,,. .•
Vicinity: HOUSE AND GARAGE ROOF , t::::-.1,5,•,,--...--: 1'M1,, {„
• ' .
Squares: • 000 s -:,;:::::,:fie-43::C:::::'----"- ' ' .Valuation er $5-000.00
SCOPE OF WORK: TEAR OFF,;(E)WOOD SHAKE MATERIALS, INSTALL 1 LAYER OF 30#FELT QUA 5 121PITCHED ROOF AND
REROOF WITH 30 YEAR GAF TIMBERLINE(CLASS"A"ASSEMBLY)ON AN ATTACHED HOUSE ANDYGARAGE, .".y;,' ,
APPROX 2,000 SF. REPAIR AND REPLACE SHEATHING AS NEEDEDt4 . t _
(� r4i' -OWNER: ' WALLER,EDWIN J•TR (0..-....e. '1417-1 Addess; 3057 MADEIRAAVE 1 y Unit
PHONE: kk1 ;I:Vi, ' r 'y.,City/State/Zip ICOSTA MESA CA 1,°�. . ' • •
APPLICANT: LACUNAS,FRANCISCO ' �' , Address: 711 MONROE WAY '=%','��y` , 'f , Unit:
-PHONE:. 714-986-9920 _ , r� c' -` City/State/Zip PLACENTIA CA.r ,1 v_ ro %
CONTRACTOR. CAL,STATE ROOFING : r a ( t License Not 801616
Address: 711 MONROE`WAYUnd,,,i'._ , ,, "` " � '" 'PHONE - 714-96699201 `. - qi -
City/State/Zip:. PLACENTIA4 CA a E 92870 r -:y x r r.yr CELL '
'i } ' F R :.ct y .... 1 : 'l - -• , . :
ARCHITECT: 41 1 ^"t ' t. License No. a " irf• PHONE'`
ENGINEER: " =� ' LaicenseNo .c,'...',..-!,,,,T
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PHONE
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FEE SUMMARY n '117,7(.
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Reroof Plan Check: 4,$0•OO ' .. j �k-c
Reroof Permit Fee: $1.1.V.254: y442../F' •
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Reinspection Fee: _ • $000 , `�
•
� s &5 0', , y� ., ..
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TOTAL FEES $111.25 a - , r _ bk9:
s 2 s.. .,, ...s .. .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
. regulations. (Ord. No.92-28,§1, 12-21-92) , . ,
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .. ..
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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit,
CODE I. INsnncnosTYPE MTF INTI➢ALS . , CODEC INSPECl10NTYPE , ' OATF ' • ' INnnas
1616 Fixed System Final Fire Prevention . 208 Final Mechanical . .
1266•• Pool Spa Final_ .. ' ` ' ' •
/,..,., 208 Final Plumbing - '
200 Final Re-Roof I Y(3-Or � ` 210 Final Electrical . . .
201 Final Block/Retaining Wall . . . - ) 212 Final Fire Prevention .
202 Final Factory Fire Place 220 Final Planning Approval
• 203 Final Sign .. 222 Final Site
204 Final Demolition 250 Final Building/Occupancy . • - .
if- ,
AiWORKERS'COMPENSATION DECLARATI t Owner ID.verifed by bense. ❑Yes ❑No `R `
I hereby affirm under penalty of perjury one of the following declarations:, Drivers License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' 'Verification of Ownership by(type of document,i.e.-property taz bill or deed):
compensation, as provided for by section 3700 of the Labor Code,,for the.
performance of the work for which this permit is issued. _
• ❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carried or dismantlingthereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm
S U� c
V4LI-is section need ria be competed Afhe perm/is value tone hundred dollars(Sf00)wless.) 2,Art2 Sec.341,Title 8,Califomia Administrative Code).
g
Policy C R-M-M- (O5 —C' ?s
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the La ode,1=hall forthwith comply with these provisions.
Applicant's Signature Date
(,� / `�2_o f� Division of Industrial Safety Permit Number:
Applicant' S natures \ Date.. V
v.m+---` � HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
. LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is
ininfull���force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No '
rLicr#— ..e O \ sp n 1/rr'1 (.......,_}Class#, `-- (Section 25533 of the Califomia Health and Safety Code, with some
4r� \I\ N� I C� exceptions, requires registration with the Costa Mesa Fire Department by
1 \ i- . - ` * each business which at any one time has on hand a quantity of acutely
Contractor's Signal e'" (_Dale '" - hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to ister acutely hazardous materials with the Fire Department.
Signature Date
:"`I. RMPP is presently required, has Section 25534 of the California
alt ' nd SafetyCode been fullycomplied with?
OWNER-BUILDER DECLARATIONS: P El Yes 0 No
I hereby affirm that under penalty of perjury thatmEMPT PROMy+THE tlU5 pries or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the„t tsil tg re.,so2.itc.Z031 5�, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any f r o pty r ich•requse a.permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, dem lip, or;epan-a tructure4rior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requirapP licpprmrt' Ile a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is li nsed urs ang
t tot visions of the Contractors information be furnished on applications far non-residential building permits).
L
Btcense Law usiness andCap iv,Phofessiothe
-,' mme) or that the or she ish Section exempt therefrom of Division 3 f and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the Califomia Health and Safety Code).
❑ •I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No
thereon,and who does such work himself or herself or through his or her own " ' . . - -
employees, provided that such improvements are not intended or offered for 8. (If"yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement,is sold within one,year of control officer). - .
completion, the owner-builder will have the burden of proving that he or'she' CERTIFICATE'OF.COMPLIANCE:if certify-that under'penalty of perjury'the
did not build or improve for purpose of,sale.). : . , , . information given above is.correct. I agree.to comply with allstate laws-and
❑ I,•as owner of the property,'ern EXCLUSIVELY CONTRACTING WITH • city o�Jt1+•0ances regartlip\g azar ous Materials and Emissions. -(
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and '— �_ r v
Professions Code:The contractors License Law does not apply to an Owner of • • Signature
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I ag ee n t to occupy or allow occupancy of any building
authoriz by thiss=ermi ntil nal inspection . C-,
Signature of Legal Owner(s) Date
• ' Signature Date . . . '
3057-46(3/07)
Andlw Authanzed Applicant ;-'bdte
F CITY OF COSTA MESA
4 9 BUILDING DIVISION •
>b. :j r„z' DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
iiig"1 1riuff �ti PERMIT
vl P03-00287
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 3057 MADEIRA AV Status: ISSUED
Suite No Applied: 05/06/2003
Issued: 05/06/2003
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Vicinity:
Parcel Nunmber: 13917221 �---- - ,..._ - ISSUED BY:
� - --
ie\ ~- , �Applicant: SZABO, KEVIN/ " J( r- � `
l�C'=
Address: %�i' ) 1 1 iV�-. _-,„\
<;71;;I<--"-\\,.� �� \ Phone? t rte✓
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t\ \. /, _.--;,--_____„>.---„, -,-.,:,,T.:
' -.,•'! ter �`� `�` \J ' ���JJJ'��\
A ; �.��•a= � •
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Owner: WALLER, EDWIN- TR --
Address 3057 MADEIRA-AVE \
r ,./4„:V/ Phone: \\� \_/
q / t COSTA/MESA,CA Zip:^'.92626 ��V %�\} \ •
1"..(7 /lei N A � �nA fr-*-------......„,‘}`,\\ S ;_ \\-.,.) ��
Contractor: COAST ROOTER PLUMBING/HEATING &AIR.CONDITIONING
r ne, CAdd-resst 12/737/SrCRO7DDY� at li7-'a ,_ -__2� �'--
I0 /)vS iE D) C oo -�-� Phone: (714)241-1414------ Lc�� ).�
X
/ ' 11�SANTA ANA,.CA Zip: 92704 \�/ `\ �I :%
��� ° ./ �,��j _ _ A -f X11 i i I
r, /) ) Pte, _ c/ License: 529127 ,Li T,
. U I /--1 j i(f! ; �/r �°)==�y—, _ .J_��'�]J'_jj.._.J� ARTS
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`I (Arch / EnBI'(1 (°CI :'L OF THE ART �i ii c kJ)
',tA�, A`'� 12 SCOPE OF PERMIT 1 �;/' J��,'j !n' /
- \`�\, ��\-2 \ \ATJ R HEATER .;�•cmx., ��~__.`”. I �//r `"� i/ /1-',‘, / %
\J\ ./ \\.\\<\), I FEE'SUMMARYy.
rp I , -/ %l�%/
c\ �A-i AMT\1 QTY -47.,.-v-1"'c'-C o AMT- QTY ' ,, AMT QTY
ISSUE FEES tr- $23.50` �� (j,,- ''Laundry\Tub//Washer ( °�$0.00)Z40,r5,'T.tp-I.SumplPump f /t J$0.00 0
Backflow irrigation $0.00\.\..,,,. w 'Landscape'Imgation0PB (.$000 -Ore., "/i Swimming.Pool ;)/ $0.00 0
Backflow Preventer $0:00 ON �P Trap�'n G' r. "r'0' $6:00 ,a 0 'Trap Pruner' 0' $0.00 0
Bathtub v� �$0 002 0 \Pressure-Regulator `"' 0 o ,$6:06 ° e04. /�UrinaD-�i ,/ $0.00 0
Clarifier System x-3„..\ $O.Oo�O Process Piping(pent0 ft), e.>,$0.00�0 2 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc)\$0:00 0� Recept'ors�^�c.. ..-2„ -;_$0:00 0 Vacuum.Brkr,Bkflow(5+) $0.00 0
Dental Units x$0.00 .,Septic Tank" =-----=---;$b:60----0 C`\Wash Basin)'? $0.00 0
Dishwasher \$0.00\ 0��) Sewer.)Cep for Demo .$0.90 (0- U\ Washaasin Set $0.00 0
Drain, Floor $0:06::a.,\0 Sewen Connect;.�(-11_, i$0:00._\0 \ J\ Waste and Vent System $0.00 0
Drain, Rainwater $0.o00\ Sewer Private Line, $0.000/ /Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 ,^Shower--J I„/', $0.00 0_%iWater Heater/vent $12.30 1
Drinking Fountain $0.00 0 \�,Slnk,-bar�` $0.00.,,--;',0f,;--7",,..-------Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 \Sink,commercial_„cCe$0:000Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0:00 0 Water Service $0.00 0
• I
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NOTICE:. The work authorized by this 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 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 inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/e0)
DECLARATIONS `('l • I fl .
WORKERS'COMPENSATION DECLARATION: - -
I hereby affirm under penalty of perjury one of the following declarations: . '
❑ I have andwill maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
_ work for which this permit is issued. ,
cliI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensationnpeInsurance carrier and policy number are: 6
-Carrier:' %j TY+-� ( T/J r Policy Number: 1 yb2-3 el —0
(This section neednot be completed if the permit is valued at one hundred dollars($100)or less.)
.
❑ I certify that in the performance'of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomia, n agree that if I Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. rr
Applicant Signature: .--V Date:'T 5 _U3
WARNING:FAILURE TO SECURE WORKERS' PE SATION COV GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
-force and effect.Lic.N I l 21 Class N �
Contractor's Signature: {�, .r.... �!) r-'t Date:- -. s-6-Q"
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and 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,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
r.
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gry 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: - Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). .
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of .
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
- 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'ryes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND , ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all stat: aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr.pert for inspe io purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
. Sin. . c,f L::al Owner(s) Date
4
'S.--6'o-5
I n. •r •uthorized Applicant ( Date _J •
CODE, INSPECTION TYPE PAN INITIALS CODE, INSPECTION TYPE LAM INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical G � �
1266 Pool Spa Final 208 Final Plumbing V'Q• ) = 4
•
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition - 250 Final Building/Occupancy • •
4
OWNER SYCAMORE LAND CO DATE 6-29;59
JOB ADDRESS 3057 Madeira Ave, BUILDING PERMIT NO. 9745
GENERAL CONTRACTOR Malgren Const, • VALUE $ 16,936
AP. No. LOT 67 TRACT 3.34.3 FIRE ZONE DESCRIPTION OF WORK res att gar
INSPECTIONS J_/?QST/ DATE GROUP I Sc J TYPE V ZONE Rl
l /�
rground Soils U.G. Water /�4 'Agc.49 PERMITS ISSUED _
\ ,rground Gas SUBCONTRACTOR DATE _ NUMBER
Overhead Water and Gas _ _
Rough Heating k(,// / C__ ___.� .,'
Rough Plumbing C�/ Ay`7_„e ,� 1,-di7-/ '.S�'_ _/ y E___ / _
Miscellaneous / �f T—
Prop. Swr. Ling House Con/St. Sw,,}7j� �/-/F-tip , y,�p,, -y. ('-7 ! /'/6 -0 J,1'-78i/� .1I _ 0
Sprinkling System _ - ,b
Heating, Final
Plumbing Fixtures 1./ �-/ _ —~
___/-tat,
Final Gas Test r /i/ /Sri-Ca •
Construction Pole sl ,G ,m.e.ndo:a.,n.r�i__$_,j 9_Q'4{3 /
Underground Power (
Rough Wiring /J2Z '3/4 W i /
Trenches es, Forms/(8'g Steel ,q,g 7-100 � 7 c f _ - _200 L/
Floor System - / _ _
Steel Reinforce _ Chimney Re-Rod _ _
Bond Beam - _
Sheathing _: r/1l} (i•-‘1.-51Fra - and Flashing /('_ q-'7-'S1_
JUT La n ! Out /fell Q-30-51
Plan...., brown coat ,+Q eill 0-9'-)q -
Plumbing Fixtures, Final /,y 0 lb%o I
Electric Fixtures, Final / fil'/J o
^
Building, Final ( /Dlr `/7 CC
OCCUPANCY _ _
Form 210-3M-4-59
•
� �J =EE RECEIVED
aiut,3
COSTA MESA BUILDING-SAFETY DEPARTMENT �'rowninFintit 8EP? •
P.O.BOX 317 COSTA MESA, CALIFORNIA ,
. , CM OF t•2?a .. A
FOR APPLICANT TFILL /N COMPLETELY APPLICATION FOR PERMIT .
. TYPE OR PRINT " BUILDING • '
BUILDINADDRESS Ay�/ asilea4FO-r/�
COSTA MESA, CALIFORNIA R Off/CE USE ONLY •
RECEIPT NO. ERMIT NO.
OWNER Sycamore .Land. Co. . - - Y7 1/4,5
MAIL 10835 Santa Moniva Blvd.. RECEWED BY 1 DATE RECEIVED „DATEIED
ADDRESS •Alt i t' `�g 7Uf ISSU
i9
. Los Angeles 24 TELr2328i BUILDING
•
CITY .. NO. . . ADDRESS . '
ARCHITECT. uo. - COSTA MESA. CALIFORNIA
OR ENGINEERL•C': Ma]OL NO.
11015 S . Paramount Blvd.. , FIRE l/ / // _
_
ADDRESSZONE I' 74
Malgren Const. BTA453335 APPROVED {{
'CONTRACTOR - LIC.NO: 1 BY DAT
ADDRESS 10835 Santa Monica Blvd. ZONING
LEGAL LOT 67 33�ZONE• NO.OF USE OF NEW
DESCRIPTION NO. BLOCK TRACT R/ PLANS A BUILDING / .
APPROVED / �L' DATE 4/�1(•�y
SIZE i NO.OF SLOGS.OF LOT 99-.85 X. 67 .76 NOW ON LOT ` ((( '
YARDS EVES
O YARDS ED ALLOWED
USE OF (CENTER LINE ST.) ( "
EXISTING BLDG.' FRONT . S�
FT. IN.
•
SETBACK LINE FROM ''JJ��--,, (�
CENTER OF STREET SO REAR`VARD l R.SIDE
SIDE YARD (LEFT 5 (RIGHT 'S J L.SIDE ..r" FT. IN.
;DESCRIPTION OF WORK .
y
REAR /ly, 1FT. IN.
NEW I XII ALTERATION I I ADDITION
REPAIR I II MOVING I II DEMOLISH ' I"
SIZE DI NG 1707 - • ROOMS 6 STORIES1 • .
EXTERIOR WALLS ROOF wood shingle - -
IS - .
COVERING • . COVERING
USE OF BUILDING AND WORK TO BE PERFORMED',
Dwelling new construction.''
2CCR Att. Gar. . -
•
I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE.AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY O,•INANCES AND STATE LAWS REGULATING • PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. "
BUILDING CONSTRU y/� n VALUATION
SIGNATURE OF "n7.__ / PERMIT FEE $ 3�j
PERM ITTEF_: Q �G4�f/'f •'TJ / . •
$ G� 9 PLAN CHECK $ / er
AUTHORIZED AGENTVOS; a • TOTAL FEE $ ¢