HomeMy WebLinkAbout3062 MADEIRA AVE - Building Permits •
111
O"„" 'tee CITY OF COSTA MESA '
BUILDING DIVISION
1-SS i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
•
PERMIT E03-00972
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 3162 MADEIRA AV Status: ISSUED
Suite No Applied: 10/16/2003
•
Vicinity: Issued: 10/16/2003
Parcel Nunmber: 13913205
Applicant HENDERSON, RANDALL -- ----._ ISSUED ISSUED BY:
Address: 2133 1/2 ORANGE AVE //�-'-�C - ="�_��' �,
92626 C;2• c"-- i :I 949-722-7147 `-��
COSTA MESAA(CA (3L-1 Zip:' 92627 (( I / i/A^`. �;�-
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Owner: BORST, RANDALL o ` �%�, v�`\ \\ \
Address y/3162 MADEI/�AVE c5,--"" ,-----------
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/(71 N//)// Phone: �N \ /2 �°
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/ /;� COSTA MESA;CA Zip: 92626-2324 \y�� / / .Vv, \
/ Contractor:j HENDERSON ELECTRIC I II'I -- - �- A A' \
1 Address: 21331/2 ORANGE•AVE 4`
I r fll r/ t !1 I I-
4' / / 92626 ( �� t� •- Phone I 949 722 7147 r I ( .:\‘‘ `c\
i/(.r ( 0� v v'=A �i
+ •/ �-.,._ ,. //COSTAiMESA.CAS r _�'.--Zip`:-=92627 U- -:-- \ �'-`�, 1 1
r /� �� License: 627409 ---t,�•,;i \,.-7‘...',- t\
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(.7--) (. , iI - I.� ,
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_=SCOPE`OF PERMIT==- _,
;SERVICE UPGRADE'TO 200 AMPS/1 ' ''_ PIP(
LII ll V� „�)�i� ' � : .3 ', •��' l
��' /fir � u..0 c it +Ll�ll' s. 1c1f11e 171L'1._ .. � � J
I�i f Illi i I ._._ � �_� -� ,r. I._ --I
\, _l ,;),.\,...1 r ,FEE SUMMARY /\'
1. , ' \\',,‘„f' Quandt r_y- '� i /I (o-. QuantityUr' i '
\ ISSUE FEE-, \ r $23.50 h >4• -.�CTemp Dist System/Lighting $0.00 0 // '
Tem service lest\ $0.00 Buswa /100 ft f I $0.00 0 /i• l, ; '
'Res a/c package v\'`'t
k 0 $0.00 Standing:Section L. $0.00 o y,/ j '�.>> �,t,
New.Res(1-2 units)\- t\% $0.00 0 Misc Electrical Equipment $0.00 0/7/,, rte- , i.I ;
New Res`(3+units)`) .\� $0.00 0 Transformers up to-1 kva/kw $0.00 01// I E' /
Pool/Spa, -V'� / $0.00 0 ....,,-.277,7- up to 10 kva/kw $0.00 0/ <�C� /c
Lighting,Fixts \-/ \1,$0.00 0 r v 0_ 1„"<:‘,_up to 50 kva/kw $0.00 .;21,/,/10 � 4' /
Recept Outlets A �$0 00 0 �r� - uplo,100 kva/kw $0.00,E/2 0 if)/
Switches`� ; $0.00 1. 0 e'1�' ?s u c -"1' eover100.kva/kw > „$0.00/7/ 0 '-may /, i '
Non Res Appy '1 ,,7-$0.00'V'-1.:,
$0 00D d.. n=
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sell-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.
❑ I 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'compentation Insurance carrier and policy number are:
Carrier: Policy Number:
(This s tion need not be completed if the permit is valued at one hundred dollars($100)or less.)
certify that in the performance of the work for w.ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
L.--"compensation laws of C: . .,and agree ._:t I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr.-sion /
-ApplicenDSignaturea", '> Date: . /V/�,/'ZoCI
WARNING:FAILURE.TO ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALTI�S AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1%,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I ereby-affirmthat 1 am licensed under prow ions 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 p-=--b 0 7 Class
-Contractors-Signature: (Date:• -r' /OA Z/920 j
CONSTRUCTION LENDING AGENCY:
O 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).
Lenders 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).):
O 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 havethe 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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 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,Gm 2,Art 2,Sec. 3
341,Title 8,California 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 ❑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? 0 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 Cede 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appprmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U 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"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 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 AUTHORIZATION 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 state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
.� i.. .. - •wne s) Date,
%//�j 3
D
t And/Or Authorized Applloant.-.-'-' r• .�—• '
CODE I INSPECTION TYPE DATE INITIAL* CODE! INSPECTION TYPE - "PATE - INRI1AI.2 -
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing • 2
200 Final Re-Roof - - 210 Final Electrical (0 al3
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
t _
r- _ •
.. . _ . .Applicant to fill.in all spaces except those wit(6neayy border lines and sign all appropriate declarations' .. - , , .. _. . _ ..y_. .
CITY OF COSTA MESA. E .� • i: PE MIT NO. n TRAI* • LOTtNO.. t 'BLDG.INO. /4 • • : •• I ' t I + r
CONSTRUCTION PERMIT • t ' ' ' ' a. ' 'i + "c I ' ' "' . -6505 r3/I9/84 21.50` T .
•
Project Address 3o tz'1 / �� 17p'rl- 'c ; �i/Cv1/T / TYPE•OF CONSTRUCTION + ❑ NEW ❑ ADO,!��'j}�ALTERpz=�ION ❑"REPAIR11• • - -
( 8 ` "- it' -E-G• , ss ❑ CONVERSION ❑ DE OLI H ❑ OTHER Pp('L1r
Applicant's Mailing A//ddress: - S 3 L' V41. ry7t ` .( «- ""' A:P.# - I • I Zone- <
1\L/, �1�/& •A •/ ,•DESCRIPTION OF WORK/-rte I•L %0 - 0 urn f.0 r-oa hi d� +
Owner's Name �� //,,hl, •[l F Phone• f : _ -' S' Main Building: - i Accessory Building:; _ • .r .Z
Address 30?C f•'_l.'F lite
. . , ' ' _ .. . E ) _ Q
TYPE;OF PERMIT. ' LI GRADING ❑ FOUNDATION ❑.STRUCTURAL . ,T Front , _ N
Arch/Eng. ` p •
Lice a Noo ❑ TENANT ❑ S1/r�CT�RICA ❑ PLUMBING ❑ MECHANICAL B •, ' . 7 • I
Address /�7'3•ll e ' L/ L• ¶4,nl/T/1(/g• `G ' '❑ OTHER , • /CCy oar. ' I , :A Reaf N ;
• 9 ,
• Contractor's Nam- ' f Phon __ PROJECT DESCRIPTION SQ. FT. �� G� - OCCUPANV K; Right •
' CONSTRUCTION TYPE VALUATION$:J//. U d d t' Left • •. - ,
Address lmailing) is- se 't� oaf t �- � � � ` -S.
,/ ZONE GRADI NG CU.YDS • ACRES Ping: Ref.# • Park.Fees $ " • Q
City License No. - - - - - .
LICENSED CONTRACTOR DECLARATION / Remarks: ' + i - • , ' !' Parking Req./Provided . , •
itereby.affirm that I am Iicensed•under provisions of,Charter.9(commencing - - - - I
with section 7000) of Division 3 of the Business and Professions Code, and , s i •. , • • Use of Building: { - s • - • R ,
my iicenselis in full fore n efect. ; ) r - E
L •
icense Class �J • lc: se No.29/47 /• • - _ ' PLUMBING - ' FEES ;Planning Notes. i M•
Date - /BM Signature 4z ,/.�lL_a.d- -c��
'(KERS'COMPENSATION DECLARATION ' -: Bar Sink • - . Showers ,
s- ,,�� � . 1 T
aby affirmthatl have acartl fleece of.consanfto self-Insure or a certificate-
Norkers' Compensation Insurance,:or a certified, copy thereof (Section Backflow Preven[er' Service Sink } • - - - - S t
3800;Lab. CJ Backflow irrigation „ Sewer Cap ` "ELECTRICAL 4.17. (FEES,
Policy No. ', , - . 1 Company . •
] , r .I
El Certified copy is hereby furnished - • III'
(, • Bathtubs Sewer Connection Automatic Washer •, + ,Transformer 0 15-50'KW
Certified copy is filed with the city BUIItlin9,Division. I l' i - .. + I ❑ 50.+KW I
' + : ' - .' Clarifiers Solar Collectors
Construction Pole Sub. _ ....y.. ,._._.:. ; -
..Date- ,Applicant -. _ .... -.. -- .. ...e.. .. . . . �. _� .. .._ _ _....
•
(Thieasectlon neetlPTION 0 of WORKERS'etetl COMPENSATION
lf the permit�tf or one hundredDECLARATION
l ($300)'or• t R Dishwasher iPiping ,Cooking Unit t• ' 'f Meter ❑upl.to 100 amps+ - _ -
Solar ,
,less), - . .-e, • 4 :,( . . • `, • ,
I certify:that.in the'performance of the work fso as t h this Permit Ist Issued, I Drinking Fountains t ' '.Solar Tank • '! . + , • i Dishwasher 1- 7• ' • •• t_ ; Meter Dover 100 amp i t '
shall`not employ any person In any ner so.as to come subject to te ' - - ,
ork Cgrppens�at Laws of Cy l�re]��.� t _ Floor Drains . '" •Swimming Pool w/Spa '< Dryers ❑Gas ❑Electric • 'Sub Panel 1 ' • 1 I i'
mate /- A9_Iry -SignaturK•\=A i"VCT- _ - _ - i ,
*NOTICE:'If,after making this declaration,you should become subject•to'the" '- - Floor'Sinks - - 't`^. `-. - -Urinal _ :4: - Fant/ + -- • 7 'i" 'Motors.Do 1•HP 01"A '8 '''i ':` '•'• 4
.Workers',Compensatlon provisions of the Labor, Code, you.must forthwith. •k. , ' - - -� - - 1
.• -comply +with such provisions on.thlsppermit shall be deemed. revoked: , Gas Service' ;• Outlets r•' Water Closet! - I t- =%`" +'CONSTRUCT.ION.LENDING AGENCY' 1 - _ F.A.U: IncI :Solar ❑9-15 HP 016-15+ .ti 1 -
• I hereby'affirm that thele is a'construction lending agency for the performance._{ „•i Interceptors : ,• ) •*Water Heater l•'• .^ Fixtures i' ; Microwave .' i
•
.of the 1wark,for which' this permit'i5•Issued (Section 3097 Civ C3' - - _ - '= •
Lender's, Name 't •' - --- ,_ ,. r - Kitchen Sink a. , r Water-Service Device Boxes• ]"' - Pole Light ' •,& -
frc9
'I Lender's •Address ` ' _ - - -
�` $OWNER BUILDER DECLARATION .j ' : z 1 1 :! r C3•!' f • "'1 .L '..• . { H z -- - 1' • . _ Outlets 1 +•' Range •. i '
I hereby;affirm that I am exempt from the`Contractor%•License Law for the'
followingreason{(Section 7031.5,Business and Professional,Code:-Any city.or.-'. 1 I. P-.1-553. : t''• ! n �, - , 4•`F i•',1s '' ,, .,.kr- .-3 , Switches," 1 , i Sign; •. - ! I I '
• county which requires a permit to construct,alter,improve;demolish-or repair .3 - - _ _ _ - '
‘any'structure, prior to its Issuance,also requires the applicant for such permit' + + Roof Drains �'n" tm. , uz , ' ° ' ] , + Garbage Disposal .Standing Sections I •
. +" Elie a•signed.statement;that he/she is licensed pursuant to the'provisions of • _ + ' •
s ,ontractor's License Law:(Chapter 9(commencing,with,Section:7000)of i .3 i 'i<.I -t `. i - Generator 00.5 KW 05115 KW 'Trash Compactor
ion 3 of the Business and Professions Code),or.that he/shelisl exempt - s r• f - 1 , + P ,
from-and the basis'for.the alleged exemption:'Any-violationrof,Sectlon ;t _ ;$ -
'f, .1:5 by-any,applicant for a, permit•subjects'-the applicant to a civil .+• 4. • ' ••••• • „ I. •f+ . - '
tpenalty.of not more than five hundred dollars($500): ,, , i I ,• _Reinspection"Fee ••s t� ,,,i$25 . ,• b Issue Foe'-" 'C S 3; j-•. , ' I 1- - F
01
I,•'as'owner,of,the:property'or•myemployees,with wages•as'their sole . •s r e • Reinspection Fee: $25 -issue'Fee , i'4\-7-1"` $' 3'
compensation, will do the work, and the•structure is not intended or offered I _ I s- _ s. MECHANICAL ••. _ FEES
for sale'(Section7044, Business'antl .Professionai.Code:.The.Contractor:$ " ., • PUBLICSERVICES'REQUIREMENTS: .,I•;. '•'1', I "• •
License Law does.not apply,to an"owner of a property:who builds or improves ' , Boder K-: i ' , Hood or Type I - ❑ 'r "- e 1.
'thereon„and;who)does such work himself/herself or through his or her own , • - •... I{: • • Zoning Approved'By- - Date _
employees, provided-that such improvements are riot intended or offered for i- Canopy Type II. ❑ ) , . f .., ... -
sale:If, however,the building or Improvement is sold within one year.of cam .• Duct'-'Under Ground a . i „ ' i" Building Approved By• • " " L ' - Date 1 "' .
' pletlon,,the owner!will have the burden of proving he/she did not build or im- . - / '..44.-1
` O
rove,for the purpose of sale):,+r t"' '(. L.. . i •t , ' a Duct Structural a , ' Refrigeration System ' 'r ` s . Application Issued By--' /9 I( '-lL�' t - ^ ^Date,3'-/9-P'y
U I„as owner of the property, am exclusively contra`cting•with•Iicensed con- t 1 _ ❑4100,000 BTU• ❑100,000 BTU • i .-• / •
tractorstd construct-the,project (Section 7044,Business and Professions Code:--t1 Duct Ventilating._,_,L _ _ -f_- , ,-_ :SUMMARY OF FEES f� '
The Contractor's License.Law:does'not apply.to an owner of property who ` - t .Y , y r BUILDING PERMIT 1$ a;7')Q.1 - SMIPr 4 �� •
builds,or improves thereon,and who contracts for such projects with a con- .1. Exhaust •System ❑ Multiple 0; System Repast/Alteration• ' t •,, $ ' 1
tractor(s)• license-pursuant to,the Contractors License Law). .• t I , - - - ,_PLAN CHECK . ,l $ - r PERMIT f .], } '}• _
• ❑ I am exempt under Section B.&.P.C-for this reason ' Firepl/Fact.Blt. ICBG# '1 ' I • r ISSUANCE $' --
] PLUMBING I $' :�
Date•- ) '• ' • -owner, •i - r. HeatingSystem&Ducting. i• t ENERGY P.C: ' $ '
_ '. ` .. „ PLAN CHECK 25% rr$. '
I-hereby certify that i-have read- this`applicatlomana-state-that•the'a ' 00-100,000 BTU 0100_,000 BTU -' - - '- . .....--• l :GRADING' ' $ '
Information Is correct. I agree to comply with all city and county ordinances - r I I . t 1.-!s a •ELECTRICAL l ,$,� ' - I C.
_ '� I
A ' and state'laws relatingIto building constructs above-above-mentioned
author ze repro- • i. • - t ! •] 1 l « I r,' ; - PLAN CHECK -50%':$ - • . MICROFILM $ ' �' �' I '” I
, •sentatives of rthis city; to en :r•upon the above-mentioned -property for 'I - . f qq
InsOectl•n.p .•ses. ' . 1 +• i I 0j9y ` ' - MECHANICAL •I '$ - _ oc7 _�O
Signator.' •_ r' / Q,�'Y -e1 Date -5--, (- • I I , - r + TOTAL FEE �$ "�
Drivers'License or SS • ✓ - - f• I Reinspection Fee:- $25! y_ Issue Feet $ 3 f 'PLAN CHECK 25% ,$ -
, CMF 0865-46 rev.12/83 . White-Building Canary-Applicant Pink-Accounting;Goldenrod-Assessor .. , - - -
•
=+ ("CONSTRUCTION/AND/PLANNING- i' + - ti $.? ,In. YPOO 'PA 3 i -eW I_ , 2 E eSN V n
'- t'� 1• - = c r.. -Date , Inspector ° •' S-- " I °a . .E Date Y Inspector I rt,
y ;APPROVALS • Permit.# ex 'APPROVALS PermrY# _ - 1 ,24....a„1,
xl Rel nom _. C. 2
r•1w1Temporary•Electrical Service`or Pole r:.i `II o9. ;+52.�Pool &Equipment'Location '='a- ' ` s ••" ;,c•r,, ! _I
2:1 Soil Pipe-Undrgrnd. • • ( P ` 53t'Steel Reinforcement r.`' •': `x y ( 8 • x Y i >
372 Electrical Condwt Utilit Undr rnd.rd--" • 1 ;;;; :1", lni 54 Forms'?-1 x . 3,:,1t11";1!::„;.' - ' ' ` "! `
I '� m
r F J ' M r:j'• • , . - L'- vit., "•€,.-44".i:',..., e; f/ k _• .4,3,I -
N4rtElectrical Conduit-Undrgrnd. ^ r 'Y- ^t; 55 Electrical-Bonding . z - - >.r = r 'c I ..
SL Steel Reinforcement' 1 Jx `. � s 1 i L:- :° ; ;2, : ':561 Rough P.lumbirg^& PressureTest ;.• 1 , „ 11 :'
6. Electrical LIFER Grnd.I • '' G-, • 1, 1. ! .• „ 57 APPROVALO_V
TO.CER GUNITE 4 '`� 1 ' . ' 3:1
7. Footings - - �" ' : :58.' Ele rig - " ;i•� w. "'i' { ' ` I�'.� •E
.i � _ » �,`,�• ct cal Condurt;Ondrgrnd :<t` « � i `r?>c i � ,
8. Foundation' I t 11'•' '!59 Gas Pipe;(] Undrgrnd• Test o 1 I H1 m
9. Water Pipe Undrgrnd i --,E _ '} ,60. Backwashil Lines°1,P-Trap,t0'Uydfgrnd."< < .i • 1 r
„
r
10. Structural Floor System t1 1 - '
- � - n " L
61. APPIROVAT :D
OECK `'5'T Ems' i- ` -II =
11. Propeity'SewerLine &HouseConnection - 62. Backwash'.&:Recepfo�r.Final_?_$;, 5f ' "ti.,r; ,;, �II °.
12. Sewer•C• ap . ' - s c' i 63.. Heaters&Vent-Final;. °. , v1°' 1' L. r -G•' i ii ?
13. Roof'Drains •" i ' M - '
1 _ i i _ ,.64. PlumbingfSystem, Final ;any Y I 1 'av• ,1 ^
14. Rough Plumbing ,' - - 65. Electrical=F!nal' -- ti' <.?` ='i ":.' '1 11
n
t15? Rough-Electrical-Conduir '- , - - - - �-{-� - -66.j Solaf1SysfemfFinaf�'- ,T-"' 17,--r- 7--71 i;
r
a16. Rough,Eleci ic,Wiring., , F i ! ' ' ;-,`: :I : t t_-'- b'_ t_,I ! ' `•. :=: .i',"t-..t_.. ._I---t'-I ii
-T�: �67" Fencing &.Access�Approyal�' - ,_
_1 `17.-Rough Wring Sign ;.: 4 ;,1 1 I ` _ ! ••• F 1 6PROR PLASTE
8 1 APVED FOR 1:: 1 ' i 1, I A
918. Rough Electrical:T Bar:Ceiling , :II !• ; I I , m; • 69.*P00 1/SPA SYSTEMSFINAL I ; ` + ';I .. 1r'? r 1 I 't
I !,19' Rough Heating & Air Conditioning' i :•1 'I I i : 1 , I I FIRE DEPT.RE i UIREMENT6 1 1 c i E I 1 P ! 1 Hr
IU
1 ,
yN20. Rough Factory Fireplace" • I • ' 1 APPROVALS! I Permit)# '• ]1 ` I •t?' ! !
t rh. I I 1 +-moi 1 r i , ! I i I. : 1,.. 1._ ) n . . I
. '!21. Ducts, in Structure, ' • ' t i ! 1 I ' I •• I ' 70.I Underground Hydro- ij ;! i I - a �' "'; i ! I
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122. Ducts, Ventilating e I ', I! I i 1 i 1 71.1 Product Piping O GLOM Oil I 1 -1' ! ; 'Y' '
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Gas Pipe-Rough&T_est !1 ! i 1 : ! 1 72 I Underground Flush! lin,' T 1 1 f !. 1 .1 1^
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}7i. Roof;Framing' r, , _ ',} 1 r I 73 ! Undergrod Stoiage Tank,Loic ko,pil a i- 1 , i i I i
'Hoof;Sheathing • t"• - i ; $ 74 10verhiead Hydro ,;[i p °' • I .3 v i f- •;
OWNER SYCAMORE ALDN CO DATE 6-29-59 _
JOB ADDRESS 3062 Madeira Ave.. • BUILDING PERMIT NO. 9733 _
GENERAL CONTRACTOR Malgren Const. VALUE $ 16,9) 6
•
AP. No. LOT 55 TRACT FIRE ZONE DESCRIPTION-OF•WORK res a tt gar
I' HCTIONS 7-,7%S9 • DATE I GROUP I & J TYPE V ZONE R1
L.....,rgrcund Soil/VJ./-, U.G. Water (I/ � �"�,.�,,�7�7y' PERMITS ISSUED —
Underground Gas �`�! SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas 777 nn
Rough Heating /CO/fia,A( .,--t..., .._ L4&--. c.26-S-A
Rough Plumbing L 1,(7_ 17 A tny-:(o'w ' . Y-/3-S? /Zs' -
Miscellaneous / �, i
Com/Prop. Swr. Line/ House ConSt. Swg,L// ei-/h of �„#7,,2 'k (:(� 9-ie -,57 /e76:p p-p}�g /
Sprinkling System (f '— _ AllrWl r
Heating, Final i-W 12 g6-5y _ ��••���'""" `d
Plumbing Fixtures ,� ,z /-2a-(-n_ �. L
Final Gas Test t 4- /r. (.!) 1-9 4-/4.+
Construction Pole _
Underground Power
Rough Wiring 7,44,--7,44,-- %-3-J1 %rir, k.(<./ 0eJF-7nic, 2-7-_% /DG_S_5-V
Trenches RQ et Formsik Steel/Q II IF 1-G--7
Floor System /i' 9f- 7.2- 7
Steel Reinforce Chimney Re-Rod
Bond Beam
_Sl?T`:vxa,bing #39d- 26-51
, .
8-i-$ and Flashing { d'741- G-N- 5-_
LiThTng,In !t Out 11 d'N 71-ii- 77
Plaster, brown coat ,Q 1.31I-• II- 3- >V
Plumbing Fixtures, Final / n- /2('_‘,d
Electric Fixtures, msfik 1r ,p,
Building, Final vv- '2 "40
OCCUPANCY I
Form 210-3M-4.59 - .