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Home My WebLink About3137 MADEIRA AVE - Building Permits 4 F 9 CITY OF COSTA MESA BUILDING DIVISION : 9 tesmaarer , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t• t wrasa t PERMIT 1.11.4 ""opp1A PO4-00825 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3137 MADEIRA AV Status: ISSUED Suite No Applied: 12/06/2004 Issued: 12/10/2004 Vicinity. C/ ISSUED BY: v// Parcel Nunmber: 13912315 Applicant: CULLIGAN WATER Address: 502 S LYON ST Phone: 714-750-2233 SANTA ANA,CA Zip: 92701 Owner: SCHNOEBELEN, VIRGIL L Address 3137 MADEIRA AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: CULLIGAN WATER Address: 502 S LYON ST . Phone: 714-750-2233 SANTA ANA,CA Zip: 92701 License: 663091 Arch / Eng : - Address: • Phone: Zip: License: SCOPE OF PERMIT • INSTALL WATER SOFTNER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446.48(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. V,]I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. M/workers'compensatlor9lInsurance carrier and poll number Br$: ECarirer.' et)rJl P� /Lnt-ere/t fl t�/ ..NS Lt Pailicy+n er: t t/(° 3 r7 3 O df S to o & (TMs action need not be completed it 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 California,an agree that I should bec me subject to the workers'compensation provisions of Sectl n 3700 of the Labor Code,I shall fdrthwith comply with the visions. ^ / ( ,Appllcanl'SignaJ fur: �'/ /S L//() O ■ -WARNING:FAILURE TO SECNRE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1 000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION:1706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I herebyraf(kmtttall am licensed under provl ions of Chapter 9(commencing with Section 7000)of Division 3 of the Busin@ss and Pr essions Code,and my license is in full forijandeffect'Lic.# (4J 6 30q ( i IC-61 N? (1 `5 5 Contractor' ignature: • a • A 1-e- . •-, . ► tronte: /Y//O/y 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). 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(5500).): 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 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 properly 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. ❑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,Grp 2,Art 2,Sec. 341,Title 6,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? ❑Yes 0 No (Section 25505 of the California Health and Safely 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 ❑No (Section 25533 of the California Health end 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? ❑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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L-I Yes Ll No (Section 65650.2 of the California Govemment 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? ❑Yes ❑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 California Health and Safety Code Section 42303 been made? 0 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 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. Sig re Of L gal wner(s) Date /.2//v �5! nd uthorized-A pncant -Date • •• INSPECTIONTYPE BATE 1NTTAL5 o0mEr INSPECTIONIYPE INTH1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 0711D _ 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 • ,51 Fr CITY OF COSTA MESA 4 @ BUILDING DIVISION f•'m.,I $ DEVELOPMENT SERVICES DEPARTMENT PER NUMBER I. ®C PERMIT _+row 04-01353 r (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3137 MADEIRA AV Status: ISSUED Suite: Applied: 07/29/2004 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 07/29/2004 Parcel Number: 13912315 Zoning: R1 R1 Applicant MC CARL, TIM ISSUED BY: Address: 126 COMMERCIAL WY Phone: 949-548-5569 COSTA MESA,CA Zip: 92627 Owner: SCHNOEBELEN,VIRGIL L Address 3137 MADEIRA AVE Phone: COSTA MESA,CA Zip: 92626 Contractor: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING Address: 126 COMMERCIAL WY Phone: 949-548-5569 COSTA MESA,CA Zip: 92627 License: 828379 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF WOOD SHAKE,SHEATH,COVER WITH 30 YEAR COMP SHINGLES. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,196.00 Permit: $153.25 - Claim Valuation: $7,196.00 SMIP Res: $0.72 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $153.97 .- • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0. ACCESSORY Front 0-0 Rear 0-0 Left 0-0 , Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 ' NOTES: , 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 fora 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(x'00) DECLARATIONS 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 self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the wo. or which this permit is issued. Ittr ave 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. i My w rs'icompepsation Insurance carrier apolicy number are: Carrier: ^l, 111 '� • Policy Number: 1.`-1 Z 6 %cl Z- 'Zo o (This section need not be completed if f e permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the rformance of the work for which this permit Is Issued,I shall not employ any person in any man er so as to become subject to the workers' compensation law f al o la,anda if I shryryryry....IIIIId become subject to the workers'compensation provisions f Section 3 00 of the Labor Code,I shall forthwith complywith e: ro isi 7M j n� Applicant Signature: f G-0 Dare: !\ J1 WARNING:FAILURE TO RE WO ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR] NAL PENAL ES AND CVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 ,ODD),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am II sed 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.it Class A Contractors Signature: Date: =warn CONSTRUCTION LENDING AGENCY: 0 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 properly 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Drivers 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,Grp 2,Art 2,Sec. 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 end 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 Califomia 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Govemment 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 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? 0 Yes 0 No B (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. AgriSig o: Of Leg-O• ner(s) ') ��j= !/nd/Or Authorized A.,Iicant nate CODE• INSPECTION TYPE PATE Mal CODEIISPECTO'ITYPE IIOUAI§ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 1—/z—O4 o 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 _ OWNER SYCAMORE LAND CO DATE 6-29-59 JOB ADDRESS 3137 Madeira Ave. BUILDING PERMIT NO. 97601- GENERAL CONTRACTOR Malgren Const. VALUE $ 16,936 AP. No. LOT 82 TRACT 33 63 FIRE ZONE DESCRIPTION OF WORK res att gar INSPECTIONS / 4{/ DATE GROUP I & J TYPE V ZONE Rl I.' -ground Soil 7.flJU.G. Water kw "Ito? PERMITS ISSUED I.J.;. :ground Gas 4/ h-3-41 SUBCONTRACTOR DATE NUMBER Overhead Water and Gas •Y E Rough Heating W • -.pin. . .. , 4E-.1.1- L-7 a OLO_ Rough Plumbing LY SME s i.,�� yam• `-SY /9/� O V 6° Miscellaneous / rn _ Prop. Swr. Line House Con/ St. S7. 7(.-9-/4-.5, hiw/:? f' e�r c y 7-/6-sk, ? � P.6 v y / Sprinkling System 0 0 ' Heating, Final kit' J-9-co Plumbing Fixtures / 1(G LiS-CB Final Gas Test tic,d:tt pr, 9_943-914 Construction Pole Underground Power /, gQ Rough Wiring /V/ 1, 2 2 350 Vii. �J.z.e, 6'ite_ —/— 9-A?-5- 2 /o a 5 D gi Trenches/1)M" Forms t7ZSteel//5 '7-'f-97 Floor System (' 9 1 . cr4'-5'Q Steel Reinforce Chimney Re-Rod Bond Beam Sheathing • 4./ 'jr}- q -(<( ,i _ Fra+ne and Flashing Ind (1-9q-'1 L g, Indy Out t9%- to 45-5'7 Pl . er, browncoat 0tth- II-' '3-1 Plumbing Fixtures, Final , be. B r-OO Electric Fixtures, Final Building, Final 1Iv� f# 1,`J'GO OCCUPANCY Form 410-3M-4-59 9 60 . se,..( If COSTA MESA BUILDING-SAFETY DEPARTMENT -•3 0 195g P.O.BOX 317 COSTA MESA, CALIFORNIA 114 1r .,,err DEPT FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FORIPERMIT TYPE OR PRINT- p BUILDING BUILDING ^/37 /9^OE/e ^ d!17-2. • AODREss COSTA iMESA, CALIFORNIAr ' N FOR OFFICE USE ONLY OWNER Sycamore Land. Co. RECEIPT NO. I ,A�RMIT NOO MAIL 10885 Santa Monica Blvd- RECEIVE yG BY ATE RECEIVED V/DAATEII1SSSSUEDD.--fie. ADDRESS j� 9 -f 0O ]l / �9 5 y �j `+ LOS Angeles 25 TECr23287 BUILDING / CITY NO. ADDRESS . ARC'"T ENE LIC. COSTA MESA, CALIFORNIA OR CTERL.C. Major C. 11015 S . paramount Blvd.. FIRE , / `/ A- ADDRESS ZONE {� •y(j Malgren Const STAT) 3335 CONTRACTOR LIC.NO. APPROVED BY DATE ' ADDRES$10835 Santa Monica Blvd.. ZONING ' LEGAL LOT 82 o G ZONE NO.OF USE OF NEW ac DESCRIPTION I NO. I BLOCK I TRACT 36. �/ PLANS I BUILDING APPROVED L A.P.NO. BY DATE 4/,yk 7 EVES OF LOT 100.00 X. 70.00 NNOW OF N LOTSIZES 0 YARDS REQUIRED ALLOWED I J USE OF (CENTER LINE ST.)T • EXISTING BLDG. FRONT ' 1'✓ FT. IN. ` SETBACK LINE FROM 50 26 CENTER OF STREET ' REAR YARD R.SIDE �+ FT. IN. SIDE YARD I LEFT 5 I RIGHT 5 L.SIDE .] FT. IN. DESCRIPTION OF WORK REAR 1F0 FT. IN. NEV I X I ALTERATION I II ADDITION I REPAIR I I MOVING I II DEMOLISH I S ZIEDING" 1707 NO.OF JJ ROOMS 7 STORIES 1 EXTERIOR WALLStUCCdROOF wood shinglf COVERING I COVERING USE OF BUILDING AND WORK TO BE PERFORMED 4C Att. Gar. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING p PERMIT FEE ONLY. PLY WITH ALL CITY DINANCES AND STATE LAWS REGULATING BUILDING CONSTRU I N. ,I////,/)/� VALUATION // PERMITTEF: SIGNATURE OF �� Qn.z. C".�- 47 PERMIT FEE $ �y '/�/ / ede _ Si j/ /� PLAN CHECK $ AUTHORIZED AGENT ��J/7/n/� %/niWZ-/J''L�_ /K/_ _ TOTAL FEE $ 6-44--