HomeMy WebLinkAbout3143 MADEIRA AVE - Building Permits •
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PRA: OREss: 3143 MADEIRA AV 0NIT CITY OF COSTA. MESA' - .BUILDING PERMIT PERM NO: B 044696
O% "AME: EDMOND FERRIS
ADDRESS: SAME . PERMIT NO: B• . 044696 PLAN CHECK NO: N GOVT• : N SUPP : N
CONSTRUCTION TYPE: • PERMIT TYPE• : STR PURPOSE: ' OTI3
-ARCH/ENGINEER:' REG.NO.: JOB DESCRIPTION : REROOF ,CLASS. A FIBERGLASS 'SHINGLES SQ FT:- 3, 169
ADDRESS: UNIT: _ .
CLAIM VALUE: 3, 1.69 . 00 CALC-VALUE: 3, 169 . 00 GROUP ,OCC: R--3 /
PERMITTEE: CRANK BROTHERS ( 714 ) 548-5569 . • _
ADDRESS: 126' COMMERCIAL WAY COMMENTS: 2475 SF REROOF
C.M. CA 92627 ************************>E********** ***:r�E*****x**N**a�at*x** **�tx•.******** ****x*N
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU IR EMENT S
7000)of Division 3 of the Business and Professions Code,and my lice e is in full force and effect.. SETBACKS
CITY UC.:005 93 . STATE LIC.:O /C .
Date: %o— �`) (Signature: �.A/� MAIN •BUILDING ACCESSORY 'BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I h. . .certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT . IN
ompensation Insurance,or a certified copy thereof(Section •:., Lab.CI. LEFT: FT IN RGHT: FT . IN . 'LEFT: 'FT IN RGHT: . FT IN ,
Duct'NO.: 28922489 EXP.DATE: 01 /01 /90 i
cDMPANY:STATE PARKING REQUIRED : ' PARKING PROVIDED : PARCEL : 13912316 ZONE:
❑ Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES> : .
Date: Applicant: • 7 *****************************************;**********************************pF***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E L O P M E N- T S E R V. I C E S , REQUIREMENTS ,
I certify that in the performance of the work for which this permit is iss •i I shall not e i':. •�• person in any manner so as to become .
subject to the coo ers'Compe(n�,/atigo�n Laws of California. ZONING APPROVED BY DATE:
•
Date: (O 2_, v` Signature: .r/ I t— . - , . _ ..
NOTICE:If,after making this declaration,you should b- Mme subjec - e Workers Compensation provisions o1 the Labor BUILDING APPROVED DY : . DATE:
Code,you must forthwith comply with such provisions or this'i, shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY: I hereby affirm that then a construction lending agency for the performance of the work for APPLICATION ISSUED BY: 410 a DATE; c7��
which this permit is issued(Section 3097,Civ.C). . ********************** - - ********** iF f7F 1F** •
LENDER: **********************************************'********************************* I
ADDRESS: - -- LEGALIZATION:N . . 'F E E S 'U M M A ROY -- - - STRUCTURAL SEGMENTiY
. . . t
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES . GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT • 63 . 00 - . 50
repair any structure,prior to.its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed _ • SMIP/RON--RES .
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000/of Division 3 of the Business r
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($50)). ISSUE FEE
I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING'-DIV--> PERMIT ISSUE PLAN-CHECK TOTAL PAID . DUE '
structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS-----> 63 . 50 - _0 . 00 0 . 00 63 . 50 63 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ' . •,
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the budding or REVENUE DIVISION TOTALS--> COLLECTED: 63 . 50 OVER/SHORT00
-Improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve • '
tor the purpose of sale). • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK -
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' 6 3 . O 0 . 50 r'
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon '
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware •****-X******************************************)E*******************************
that proof of their Worker's Compensation insurance should be provided to me. - I N D I V I- D U A L F E E B R E A K D O W N
o I am exempt under Section: B.&P.C. •
for this reason: , • TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST •
•
Dale: •
Owner: i • SFR 3169 REROOF BY VALUE RESIDENIAL - NOZONE 1 . 00 3, 169 , 00
I do hereby certify that I am awaie of and understand the requirements of California Health and Safety Code Sections 25505,25533,antlEND OF FEES '
25534 and that I or any future building occupant will/will not(circle one)need to domply with said state codes and the requirements for a . . •
permit for construction or modification from the Air Quality Management District Residential construction applications are exempt from •
these provisions. lI
Date: Applicant: .
. I
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and her thorize rep?sentative of this city to enter upon the above-mentioned , . r
property forfoinspection�� purp�os�ees./-�Je�-�
DateliC --7 �/ ! /Signature. _ / - -('.(.n- -'C -F';-rT
' I ,. : 6,-h..,S _
Driver's License or Social Securityx: : ,-,Es, -':•' r' •lir*_ u
1641-46 While—Building:Green—Code Enforcement: .nary—ADolicant:Pink—Revenue:Goldenrod—Assessor . . - . - '
CO+USTRUCTION AND PLANNING - .SOL& SPA
Date Inspector Date Inspector
AFTPROVALS Permit# - APPROVALS Permit #
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 • .
-7'.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, 0 Undrgrnd., Test r
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 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 I
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
18. 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 - - i 70. Underground Hydro
22. Ducts, Ventilating -'71. Product Piping 0 Gas 0Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing - 73. •Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing _ ' - 74. Overhead Hydro
26:7-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical
27.-Frame and Flashing - 76. Dry Standpipe '
28. Lathing &Siding . - - e . - 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 _ 4 -
40. Gas Service-Final - -
41. Solar Domestic-Final -
42. Backflow Preventer .
43. Backflow Irrigation- '
44. Landscape Irrigation System - _
45. Sound •Attenuation - - -
46. Handicap Regulations -
. 47. FINAL STRUCTURE & BUILDING - 'IA
- .%{1( n
48. FINAL PLANNING " l Y
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY .
No. Date
%ROJECT ADDRESS: 3143 MADEIRA AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 058632
OWNER'S NAME: FERRIS ESMOND D'
FERRIS,3143 MEIRA AVE PERMIT NO: B 058632 PLAN CHECK NO: 03131-92 S GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
( 714 )I57A76 REG.NO.: 10977 JOB DESCRIPTION : 144#SF PATIO COVER & KITHEN ALTERATIONS S FT: 294
ARCH/ENGINEER: DAN RICHARDSON & ASSO. Q
ADDRESS: 461 CHABELA DR UNIT:
MANHATTAN BEACH CA 90266 CLAIM VALUE: CALC—VALUE: 4, 351 . 20 GROUP OCC: R-3 /
PERMITTEE: L.A. CONSTRUCTION ( 310 ) 546-7704
ADDRESS: 117 30TH ST COMMENTS: TRELLIS TYPE PATIO COVER & KITCHEN REMOD
MANHATTAN BEACH CA 90266 SF+eSr*SrSFSFRrx*+tSF*Se**SF***SFSrTt**********SF**stsEr*****SFSr************SF*St*Rt****Sr*RPStRFSF***Sr*SF
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITY GC.:056780 summ.:466241 CLASS: B
Date: Signature MAIN BUILDING ACCESSORY BUILDING
Date; s'COMPENSATIONDECLARATION: Innaturereby agirmthouhaveacenificateofconsenttosen-insureoracenificateofworkers' FRNT: 20 FT IN REAR: 14 FT IN FRNT: FT IN REAR: FT IN
WORCompensation Insurance,or a certified copy thereof(Section 3800.Lab. C). LEFT; 50 FT IN RGHT: 7 FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ PROV: PARCEL; 13912316 ZNE• R1 REF NO:
' 7 Certified copy is hereby furnished. ❑ Centred copy is filed with the city Building Division. PLANNING N tES> INTERIOR MODIFICATION TO EXISTING KITCHEN AND ADD I T ION OF
> 144 SQ FT, PATIO COVER.
********************* *****.*****************************************4Elk*********
Date: Applicant,- —,.-
EXEMPTION FROM WORKERS'COMPENSATION DECIARATI . (This s tion need not be completed if the perm for one hundred($100)or less). D E V E L 0- 13 -M. Els]._T SERVICES R E Q U I R E M E N ,T S
I certify that in the performance of the work for which this permit i ssued,I shall py employ ny per in any manner so as to become ;
subject to the Workers'Compensation Laws of California. / Tllc /� ZONING APPROVED BY .- S C-C DATE; "�>7/7/9• ,
'lj2
Date: A—/7signature: Awe
CC BUILDING APPROVED BYDATE:
NOTICE:If.after making this declaration,you should become subject to the orkers'Compensation provisions of the Labor 2i,//7k2.
Code.you must forthwith comply with such provisions or this permit s a deemed revoked. //
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED 'BY DATE: iiiFFFNr / '
which this permit is issued(Section 3097,Civ. Cl. I *********************' * * ***** ** **** **************** * ***
LENDER: ******************************************* **********************************
ADDRESS: LEGALIZATION;N F E E S U M MAR Y STRUCTURAL SEGMENT:Y
'
OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC; MECHANIC FIRE SM I P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 . 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed $MIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 46 . 80
and Professions Code)or that he/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). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 72. 50 0. 00 - 46 .80 119, 30 1 19. 30 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through I
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 119. 30 OVER/SHORT: 00
improvement is sold within one year of completion,the owner al have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 r 50 46. 80
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon S
and who contracts for such projects with a contractor(s)license pursuant to be C.. .ctors'State License Law).lam aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provide. •. INDIVIDUAL F)E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C. ! lir
for this reason' TYPE QTY D E S C R I P T I _O N ', UNIT COST TOTAL COST
-- Date: owner: � SFR 150 DWE—INT, ALTER TYPE V—WOOD FR —GOOD 14 . 80 2, 220.00
I do hereby certify that l am aware of and understand the requirements of Catifornia Health and S.re Sections 25505.25533,and SFR 144 RES—PATIO COVER—POST & TRELLIS 14 . 80 2, 131 . 20
25534 and that I or any future building occupant will/win not(circle one)need to comply with said -.e codes and the requirements tor a END OFA, FEES
permit for construction or modification from the Air Ouabty Management District.Residential construction applications are exempt from
these provisions. i'
I,;,
Date: Applicant: 77
I hereby certify that I have read this application and state th. a abs information is correct.I agree to co with all city and county vd L
ordinances and state laws relating to building construction an,hereby thorize represe a. es of chi icy toe er upon the ave-mentioned •r /H
property lar specbon purposes.
tiitile
Date: —/7' /qZ Signature: - '� C'4. n i ii.r '- 7 --
' Driver's License or Social Security e: - x :'_' ;'i t - — T ' _ . :
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor r
i CONSTRUCTION AND PLANNING P00 SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
" - 1. Temporary Electrical Servrce or Pole 52. Pool & Equipment Location
2. Soil P pe Undrgrnd. s 53. Steel Reinforcement
X.Mectricat Corjdtit,Utility-Ondrgrnd. 54. Forms
..+.h. EiktritaOC-ortduiY-Undrgrnd. 55. Electrical Bonding
4S c -
`r 5.?Sfeel Ygre.^t`er tt 56. Rough Plumbing & Pressure Test -6
a$..- •-EI@ctricgtiVFE•RGnd. 57. APPROVAL TO COVER-GUNITE .-
tri'FTnotir t„:“7,,t.2”t• '; G L -58. Electrical Conduit-Undrgrnd. a
S. oundatlaa..._. : vj ` 59. Gas Pipe, 0 Undrgrnd., Test - t
▪ -I
9. Water Pie-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. ' Ill
10. Structural Floor System '7161. APPROVAL TO DECK
11. Property Sev✓ r Lin'& Ho-ose Connection j 62. Backwash & Receptor-Final �--.
12. S6Esiver Cap 63. Heater & Vent-Final
� w
13. Roof Drains ie. 64. Plumbing System • Final
"Cr-- r
14. Rough PIumB'irjg a11111 65. Electrical-Final - - ' " j IIII
15. Rough Electrical-Conduit - 66. Solar System-Final .1
16. Rough ptectric Wiring ' 67. Fencing & Access Approval , 47
4
17. Rough Wiring sign 68. APPROVED FOR PLASTERING;'•
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
-' - '.r. ry . -r :U
20.r11oGjh F.�ctofy FFA lace I x' -. x r. -IC
TX PPROVAt.CPerriiit# R _ r
tt
21,:.Duc`ts, irtStp'_ctufe,K '. .;s •• -> - :• % `70. Underground Hydro M
s -' . -
22. Ducks, ”nt tins: i t ,. 1'? -` -71. ProducQ ping 0 Tas IJQil
23,:-:Gailipi2Ro.Lijgh &• est I `» rs - -C4. -.72. Undergrotfid Flush; t J:
o.:
24; o6f F aming C< i-64 -•.- < :. C - r lc573yUndergrn Stor'�gRaahk�[-JGas•❑0114-
I
25. Ro S athin '` '3 x r r , :•:z .- g
9t 9 ;s y -r 74r:Qverbead Hiydroo
26:.T-Bar Ceiling (Structural) &:Menocoat - •.. _ t ' :." p 75. Dry Chemical
27:Frame and Flashin .csJ ;s „ • L .fJ42.i.. ;. 76. D-rY giandpipe _a
,•28.""Latbing.& Sidingi7. 'A r.,'r%i.'` 'u, I 77!- FIXEDSYSTEN[RNAL- s'y__
'29. Insulation =n ' •:" i�• i[ 9 .. ;: :: 78�;FIRE PREY. FINAL z :
30. DrywaltNailing ; Y: l oil- 1.4 r - HEALTH�DEPT'R"EQUIR E.ME NT
r
:-31. Plaster 8}owriCoats' _ r '- : I M t79. FINALINSRECTIQN _ ' u'"
. _ �,fl
-32.-Electrical Power Mete[ Final 80-rFOOD CERTIFICATE ISSUED
., - T r f
33Fincl E(ectrir ', .-Cr---L I ) 1.. -_ Notes: (1 T, v _ . : c, '�J
;;34. Final He@tinrl`& Air&onditionsu --,: ., • - �` r ! -'i - -
35.,f'nit Gars Pipe-Testy ^, `(s •.at a,--- $ -re i;2 X64 t
R
x36 THood or_Canopy,t x y t r . `' tif. .7 .n_ r c-- - •'t'' ‘eg-
:
'31.7
7,-Fina1 Factory Fire) �"
�ace 1 `L ' '' ( , r > + r r ;,r,
7..38:Finaj Plumbing n .t .J ' i4. S . M.- i
:."39. Wat€r Service:Fin:I* r I c ?-4 . .n t :C a
40.. as Seruue-Final ` --"� - _ .. ±, ._
s41, Solar Domesstic-Froth • .- - -
•-42:'Backflotid Preventer'. . ,, L M
43. Backflow Irtigationd - : 5 L ' .c: = l'
ri. 7... t i s C
,44. Landscape Iisigatign Systentr,,j j - r. - +. r. ; • - �,',
' :°
Z45_Sound VAttenuatior* '�' •r - ^ cc
•> •r r� , .. 'CI',"
Cu R - Cr Q • 4
?46:7HandicaP Regulatiohs - •• -' ;; •j -_
-▪ ;FINIAL STRUCTURE & BUfLDING ^ in,*
- !.;ci -
48:fIt' LPLANNING - I -
• v. r- ✓v
.-49.---.Electric Release to Edison i - 1
. - *: :- >. r,
50..Gas.Rele.ase to Southern California Gas Co : I 1 ii:
. :t t - -1_ n
'51. CERTIFICATE OF4OCCUPANCY r; 4 '- c - ro - -
No. Date
ti
'PROJECT ADDRESS: 3143 MADE3RA AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 058634
OWNER'S NAME: FERRIS ESMOND D
ADDRESS: 3143 MADEIRA AVE PERMIT NO: P 058634 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH
( 714 ) 957-0276
ARCH/ENGINEER: DAN RICHARDSON & ASSO. REG.ND.: 10977 JOB DESCRIPTION : 144#SF PATIO COVER & KITHEN ALTERATIONS SQ FT:
ADDRESS: 461 CHABELA DR UNIT:
MANHATTAN BEACH CA 90266 CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /
PERMITTEE: L,A, CONSTRUCTION ( 310) 546-7704
ADDRESS: 117 30TH ST COMMENTS; RE; B58632 PRIMARY BLDG, PERMIT,
MANHATTAN BEACH CA 90266 *************************�r�r�t�rst�r�tiE�r�E�r�E�t�E*ye�E *****+E*yr****************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LIC.: 056780 STATE LIC.:466241 cuss: B
Date_ Signature: MAIN BUILDING ACCESSORY BUILDING
Date. S'COMPENSATIONDECLARATION: Ihereby affirm that Ihave acenificateofconsent toself-insure oracertificateofWorkers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C).
POLICY ND.: EXP.DATE:
COMPANY: PARKING REQ• PROV; PARCEL; 13912316 ZNE: REF NO:
] Certified copy is hereby furnished. ❑ Certified copy is Med with the oily Building Division. PLANNING NOTES>
>
Date: Applicant: ***********************************************.********************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: is sec'•n need not be completed if the permit) r one hundred(81W)or less). DEVELOPMENT SERVICES: REQUIREMENTS
I certify that in the performance of the work tor which this p rmit is i•.ued.I shall no moldy an erso ny manner so as Io become
subject to the Workers'Compensation Laws of California. ' ZONING APPROVED BY DATE;
rk �
Date: V�r7^� Signature: BUILDING APPROVED BY : DATE:
NOTICE:If.after making this declaration,you should be•/me subject to t-e Wo •rs Compensation provisions of the Labor -
Code.you must forthwith comply with such provisions or this permit sh I be .'emed revoked. ,
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a consbu lending agency for the performance of the work for APPLICATION ISSUED B Y; ntl • ** DATE• J4'ct
which this permit is issued(Section 3097.Civ.C). ************************ * ****'** *** **** ************* * *****
LENDER: ************************************************ *****************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 6,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN
and Professions Code)or that he/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(S500). ISSUE FEE 3.00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
TOTALS——--> 6. 00 3,0 0 0. 00 9 , 0 0 9 . 00 , 0 0
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 9. 00 OVER/SHORT: 00
orthe purpose of sale).improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Ior
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 9 .00
❑ and Professions Code: The projects
State License Law does not apply to an owner of property who buildsorLaw)
thereon *******************************************************************************
and who contracts for such projects with a e tor(5)license pursuant to a Contractors'State License Law) am aware
that proof of their Workefs Compensation insurance should be Drovitl • INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
lor this reason: //�,I TYPE QTY DESCRIPTION UNIT COST TOTAL COST
bit ' 4
rt Date: f_/le- Z —
� Owner: PLU 1 DISHWASHER 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and'afety C'ie Sections 25505,25533,and PLU 1 SINK KITCHEN 2 .00 2 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with sai'Sta• odes and the requirements for a PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 00
Permit for construction or modification from the Air Quality Management District.Residential co : ction applications are exempt from END OF FEES
Nese provisions.
Date: Applicant:
I hereby certify that I have read this application and stale the bye information is correct.I agree to ply with all city and county
ordinances and stale laws relating to building construction nd here authorize rept a tativeso city ler upon ¢above-mentioned
property for
orr inspection purposes. ♦ r
\_ Date: • ^/74y Signature: (//*4,e. .
Driver's License m Social Security w: •1 -f •m . - - _ '
1164146 White—Building:Green—Code Enforcement:Canary—Applic ,Pink—Revenue:Goldenrod—Assessor
NII
CONSTRUCTION AND PLANNING POI 4 SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
r
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. '' 53. Steel Reinforcement
> 5' _
1. ElSctrica Cor�,llyit_l iility-Undrgrnd. 1.• 54. Forms '
- 4. ElectrieaLCorfduit-Undrgrnd. 55. Electrical Bonding
Y
f 5:!Steel Rcrnf 4e ertt; 56. Rough Plumbing & Pressure Test2.
. t 6. -'tectrtcai 6E134 Grnd. 57. APPROVAL TO COVER-GUNITE
„(,fiaotir i, -?t.,:'- : 58. Electrical Conduit-Undrgrnd. -:
,$:-Foundatioq a• - c --. 59. Gas Pipe,0 Undrgrnd.,Test
>J. . - - __
9. Water Pipe-Und&grnd. . " 60. Backwash Lines, P-Trap, 0 Undrgrnd. .
10. Structurii Floor System 61. APPROVAL TO DECK r '
11. Property Sewer Ling& Hoose Connection 62. Backwash & Receptor-Final;
12. Sower Cap a., a 63. Heater & Vent-Final
13. Roof Drains'• ' �- -
Ir 64. Plumbing System - Final l
-
14. Rough Plumbing 4�i�gZ.% 6€0 65. Electrical-Final r •
15. Rough Ejectricit-Conduit 66. Solar System-Final . 1 •
16. Rough ElectricWiring - 67. Fencing & Access Approval -- _-
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- J r - - - - t" IT -?7...,:- -C - _ o
20.•Rou'1jh F.3ctory F etplace i -c_ _; -S -r ^ .APPRDVALSt CPeridit# * ?' _ _ =
.c -� .0 K' __` r .i, t .• K ' L C.\ - -_ > •' .... _
21._DuETs,q St yictucer `. _ - - -t « X70. Jndeiglioun. Hydro < JY
r, I
22. Ducts, entitating•r• int:; « _ S !2 C =71. Produc ing CStr'ys 0.0)1
23.7Gas`PipeSRos9h &•Test ; ; ' 7 - _.r, : :72. Underg i tmd Fliustr a t_+
24L-Roaf Framing ..r.' :-. • - - -r "A -: « ' .73rri}ndergrnd'.Storag6:Tank'tlGas 0011-"
25. Roof Sheathing t • 7 ; .v. . '74cOverhead1iydrq:"
Hs
26..,T-Bar Ceiling (Stcuatural} & lonocoat '- c 'c k 75t Dry Chemical - s - - -'- i
27. frame and FlashZ b r b. . 'G:"'Try StantqSie •J_Yn. s r VS •:
7 _ g .. .7
„C't
-28. Latbing'S Sidings. • : r +- c ° ••1 « 4 77c F:;;_D SY TElyc flj3AL4 i _ ",
'29. InsulatiVirt r; s ; ` i I 't It 78z FIRE PREY. NNAL - -
:f30. DrywalL'Nailing -- r. - •L^ -, -.- 1.
REQUIREMENT
.031. Plaster Bioviin Coit,' r1; j; .« r79 F1fVAL INSP.) CTI$N R J 'T S
32 _Electrial Power Meter-Final < a. c80•rF000 CERTIFIOCR`rE ISSUED
X33 Firi-4.1 ElesCtrirs i I - �•NQIes.. -t>
r
r C - i..� I .. a. - c
.:-q34€-Finale.:-q34€-Final Heating& Air.Conditionipg, I. ". 1 I a 1 , > s.
35.!Firial Gay Pick-Test'- - - Cillaz e,E� �, sir - _
-36.) or:canopy .'s '4• 1 r - - - .f> >r .
` S -
-37.
7..Fin5l Fagtory Fired1ace. • ! - r
_38. Final Plumbing >, _ l�(� 4 �0 r - i " i -
I739. Water Service-Final" I I- r- " .- n
r,40. Gas Seri*ce-Final . .r , :r t I:
¶41. Solar Domestic-Final - - I ti. : I 1r- '` -
-42."Backf low Preventei ' - " i I I, 7 ,, '7� '
> - _
43. Backflow Irt atiorf .ti '` - '^'
r i. : .
-44. Landscape Iriigatiop Systenv -, - -
- .. -
r • :C .l ^ .- . -
- . - E'
45.`Sound Attenuation - - - - s
4.
. . .
- •. - - d _
-46: Handicap Regulatigns •- ^ Z. .t. Cc' ^ ,-
.- I •
C
'47.,FINALSTRUCTURE & BUCLDING I I ' - •. - - '� -
48:-FIPFALPLANNINd ` Ir .•
c e� • r f -
-
•
_49_,Electric Release to Edison • I it _ v
j. • ?
.50.,Gas-Release to Southern California Gas Co i I j. . ' - - - -
: x
51. CERTIFICATE OF OCCUPANCY' `r c a o
No. Date
ePROJECtADDRESS: 3143 MADEIRA AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 0581333
=mum FERRIS ESMOND D
AD
ADDRESS: 3143 MEIRA AVE PERMIT NO: E 058633 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
(714 )957-0276
ARCH/ENGINEER: DAN RICHARDSON & ASSO. REG.NO.: 10977 JOB DESCRIPTION : 144#SF PATIO COVER & KITHEN ALTERATIONS SQ FT:
ADDRESS: 461 CHABELA DR UNIT:
MANHATTAN BEACH CA 90266 CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
PERMITTEE: L.A. CONSTRUCTION ( 310) 546-7704
ADDRESS: 117 30TH ST COMMENTS: RE: 858632 PRIMARY BLDG• PERMIT.
MANHATTAN BEACH CA 90266 ****************************�FRr+ERrRF�FSE*RE****�E* *******************RE***********¢¢+FRF*
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 of the Business and Prolessions Code.and my license is in full force and effect. SETBACKS
CITrLIC.: 056780 STATELIC.:466241 Cuss: B
Date: Signature: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consento selhinsure or a certificate of Workers'
Compensation Insurance.or a certified copy thereol(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: EA?.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 13912316 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified My is tiled with the city Building Division. PLANNING NOTES>
Dale: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO (Thi ction need not completed if per for one hundred(Mbar less), DEVELOPMENT S 2' R V I C E S REQUIREMENTS
I certify that in the performance of the work for which t permi ss issued,I sh no employy per •, /any m.•ner so as to become
me
subject to Workers'Compensation Laws of California. (�/T,J�j_, - ZONING APPROVED BY DATE:
Dale:_d.1714Z Signature: BUILDING APPROVED BY DATE:
NOTICE:II,after making this declaration,you should ecome subject o the rkER'Corm ensation provisions of the Labor
Code.you must forthwith comply with such provisions or flus permi shall deemed revoked. '.r/•n/�/ (/ 7/(G
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: Le \r-/ 29n DATE: �lh/*7tiF
Cwhich ONSThis permit i5 issued(Section 3097.Civ.CI. EE***DISSUED******* ** * ih1F�t**** * SSSS ****iF************ * SSSS*
UNDER: ********************************************* ********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 38 75
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed t 0 Z SMI P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Prolessions Code)or that he/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(3500). ISSUE FEE 1500
00
I. as owner of the property or my employees with wages as their sole compensation, wit eo the work, ono the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 38 . 7 5 15 . 00 0 • 0 0 53. 75 5 3 , 7 5 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for safe.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 53. 75 OVER/SHORT• 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of 5a1e1-
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 53. 75
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of properly who builds or improves thereon •
and who contracts for such projects with a coniractor(s)license pursuant tot e Contractors'State License Law..I am aware ****E****E*EEE**E**************************************************************
that proof of their Worker's Compensation insurance should be provided to ����// INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.& C. .9 Fes/
Mr reason: _ TYPE QTY DESCRIPTION UNIT COST TOTAL COST
ar
Date: Jr/
�J q2,-- Owner: / ELE 12 FIXTURES LIGHTING 1 ST 20 EA. . 75 9 . 00
I do hereby certify that lam aware of and understand me requirements of Cal irnia Health an.Safet ode Sections 25505,25533,and ELE 10 RECEPT/OUTLET 1 ST 20 EA. . 75 7. 50
25534 and that I or any future building occupant will/will not(circle one)need to comply with 5 id :e codes and the requirements for a ELE 5 RECEPT/SWITCH 1 ST 20 EA. . 75 3 . 75
permit for construction or modification from the Air Oualdy Management District.Residential traction applications are exempt from
(hese provisions. ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 . 50 18 . 50
END OF FEES
Date: Applicant:
I hereby certify that I have read this application and state tha e above formation is coir ct.1 agree to co with all city and county
ordinances and state laws relating to building construction and ereby aut .nae represen of tea pup y to a non the ve-mentioned
property for inspection purposes.rp�
`414
NW 8^17-14— Signature: 11111r gr r 1 l,l,^'1, i—'].'1".'J' • _ _;
Drivers License or Social Security a: _..',/
,
1641.46 Whilo—Building:Green—Coda Enforcement:eanarv—Aoolicant:Pink—Revenue:Goldenrod—Assessor
.10
CONSTRUCTION AND PLANNING POO SPA
�.,,, APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
r
1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location '
2. Soil Pipe•Undrgrnd. - 53. Steel Reinforcement '-
:.6tectrrcal,Cokdriit.ctilityUndrgrnd, 54. Forms -
4. Etectrlcat.Coaduit-Ubdrgrnd. 55. Electrical Bonding
5.S{eel Reinf@rE�me-:riy 56. Rough Plumbing & Pressure Test -
r�ctrtc .t�F'$:Grnd. rr• 57. APPROVAL TO COVER-GUNITE
Q ^tirtFgotirLgro fir , rt - 58. Electrical Conduit-Undrgrnd.
8 Foundat ort;-,-, ?c 59. Gas Pipe, C Undrgrnd., Test .
r -
9. Water Piee-Undigrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. -
10. Structural Floor System 61. APPROVAL TO DECK
11. Property-Sevier Linti& House Connection 62. Backwash & Receptor-Final -
12. after Cap
a.' j, 63. Heater & Vent-Final •
13. Roof Drains•A_ c' -, 64. Plumbing System - Final ' -, r
14. Rough Plumbing ` i - '! 65. Electrical-Final
4
15. Rough EJectriral-Conduit yy�� i 6�6. 'alar System-Final _
9 g /-2 i((ear-�'^---� g r
16. Rough Electric Wirin 7. F nein & Access Approval {
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrics-1-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air ConditioningFIRE DEPT. REQUIREMENT
:S _ G- r- n _ st x _ - r
20.11Rotigh Dctoty f-eplace 'o r1 4 u 0 :- x r rAPPROVACS;DOPermit # x
.0 ' . : 4 Fa i c•r :S X , r 4 a. „ :.d.. 7 -c
y ty YX cy x ! x t s Sr,-.r r r r
21,.-Du'is, in,Strycttle.: S n S a( _70. UndergrotmdHydro oc
s
22. DuEts, Venti1atirig1A t�`, x .- cr P 5: : .271. ProduccP ting Elcas QOiI
23.'Gas:PipeCRorujh&•'Test ` _' - r � -�`
•r,5 ir, - = 04c ,c ‘-‘72. Underground Flint
S.c L. -•,i .w rs-'
24xRodi Framing F.;x . ----- X -- s s �; •Z'' 3:732Undergrnil.Stora9 Tank°CGas 001P -
25. Rog.) Shdathin a -'J X :r .r1 0 ,V X x ' O v -
4 9 t'' �'s a '74.Overhead Hydro-
26.T-Bar CeilingStraetural _ 75.-Dry
a - -
( I &ivlonocoat r 2 ��� ' 75'3 Dry Chemical _9'n x r-r n r
27;Frame aria Flash,t �,L - i J3., 7BJDry Stantfpige X
i r;.,. ,,..#.
1-28. Lathing'& Siding,-,..r. -: i Z_ r X. ••% * 77C FIXED SY•STEI4FNAL% r, r•r
^29. Insulatin I J�fi- -
�:. S � '� 78•=FIREPREV. FINA�L � .c �� ..
r30. Drywall_•Nailing rc< x + x HEALTI-tDEPTc REQUIREMENT
-31. Plaster Brovtn Coale r r t I r a .79.-FINAL INSSECTIQN
r.
-32-Electrical Power Meter-Final s .� �/I .. r80.r,F00D CERTIFtCAT-E ISSUED- _
s33 zFi till Electric ' r !Q/�4/�l- 'Not"es: - y , t ;
'34;-Final Heti g& Aiq Conditi0nrg: �a' M * u; • .? is e < • -�S
357.Final Gal Pipe-Tea: :. c - - • 5 a• r- s C •? - . r J
r.
-r36. Hood or_Canopy-.7* -,:::1" r - - f Ir. i ,� :..
37,7Final Factory Fire131ace - ° r I I ` g _ '"o
38. Fina) Plumbing _ r.� - I s t. a C L a
39. Water Service-Final 0 - • X v. ..-
,..40. Gas Sery ce-Final • _ '' ,r ,• ,. . 1 :, - t
r ,... �-S _ .-
>•41. Solar Domestic-Fineli C' r --; - -
d s. r + % .r
•-42'Backf low Prevente t- -v c , , •_ "� ._ '.
43. Backflow Irrigation ..c S - , > -s:-: _ --
Y R ^ 1
r 44. Landscape lirigatir rt System, .-j - w - J - ",ic . r .0 % % s - -
1.45-Sound Attenuation 'r ' '
- : , S'r. - - L • J
_''-46• .;Handicap Regulatiq`ns - _ r ., .. s _ .. i t''
47.-5'NAL STRUCTURE & BUILDING J 1 I II: T i• S
r r * r
48:'FINAL PLANNIN(ta. Ir• r ' - .y -
r .� I Ir: f r i
049.:Electric Release toiEdison t t I 1• ,' - ^ J:.
• r• t
507-Gas Release to Southern California Gas Co - I I I, , • " = - -
:51. CERTIFICATEOFMCCUPANCY q , ;�
No. Date
OWNER SYCAMORE LAND CO DATE 6-29-59 _
JOB ADDRESS 311[3 Madeira Ave. BUILDING PERMIT NO. 9761 ,---
GENERAL
GENERAL CONTRACTOR Maigren Const. VALUE $ 17,322
AP. No. LOT 83 TRACT 33 C3 FIRE ZONE DESCRIPTION OF WORK res att gar
INSPECTIONS ,Ls' DATE GROUP I & J TYPE V ZONE pi
U: ground Soil7 'J7U.G. waterW 9�<(� SUBCONTRACTOR PERMITS ISSUED
Un._.ground Gas �� 7.5 _ DATE NUMBER
Overhead Water and Gas
Rough Heating toe_ Q 3/. . . e, iQu a, ie _,E2&_0€2_-'�4'tJ'
Rough Plumbing W (( , _ -i5_ti_y /�99/ 6t
Miscellaneous _ _ 1 „ �b1
Prop. Swr. Line House Cory/ Sl. SWr� �)-/E-� e� fa:� 9 �/�i.�/ �-/�-.'�� /fiH97 lhJ-'1/��y y
Sprinkling SystemH (/
PlumbingFi ixt 2 -q Cho �J
Plumbin Fixtures ����/ __ R,B�.
Final Gas Test //,4- w4P-Q4% '
Construction Pole >j cte2-122C 2U�,1�ir,5.-/3 U ? ¢2�(�
Underground Power )� ,�/ -� �1— _
Rough Wiring . / 3c c ; S 5c, 71gc u� e,17,aAit. •--�-� Me fr .3 v
Trenches,fe' Forms$'/'!5Steel,d/6'%L_1-!t-'if
Floor System /j! j.-4-,Si _
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing �1 Q-'r-F/
Erne and Flashing -,/- Q-29-q
L ig, In Out a /0-/5-3
Plaster, brown coat 1011 fj 11-1'1"
Plumbing Fixtures, Final - e
Electric Fixtures, Finalm - A
Building, Final P /v4 f'o 0
OCCUPANCY I
Form 210-3M-4.59
9761 -
2 • :'I\'30 1°59
1-:MCF [1EPT.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA, CALIFORNIA 01' . 11 .r•'I I: 'a{ZI,.y
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
//�� TYPE/. OR^ PRINT /1�/'T BUILDING
BUILDING ADDRESSa 1T. 3 / //�/np-i tzA �V(C.
COSTA MESA, CALIFORNIA FOR OFF/CE OSE ONLY
OWNER Sycamore Land. Co. RECEIPT NO. _GERM T N j
MAIL 10835 Santa Monica Blvd- RECEIVE.,IBY •ATE RECEIVED DATE ISSUED
ADDRESS � - 6
0 a --
i �J
TEL. BUILDING
CITY NO. ADDRESS .
ORAR` WT NEER L.C. Major NO. COSTA MESA. CALIFORNIA
XXY$ 11015 S . Paramount Bl . FIRE
ADDRESS malgren COnsttTATt53335 zoNE 94-,L,
• CONTRACTOR LIC.NO. APPROVED
AP DATE
ADDRESS10835 Santa Monica Blvd.. ...AAA ZONING
( LEGAL LOT 83 .I3363 ZONE //� I NO.OF I USE OF NEW �I)
DESCRIPTION NO. BLOCK TRACT Y///(` PLANS BUILDING (/t�V`O
• A.P.NO. BPPROV ED DATE 4
Y
A' / t
SOFLOT 100.00 X 70.00 W FONB LLDTSO YARDS
REQUIRED EVES
ALLOWED
USE OF (CENTER LINE ST.))/��7
EXISTING BLDG. FRONT d (/ FT. IN.
SETBACK LINE FROM I
!'T—
CENTER OF STREET REAR YARD - R.SIDE 'r FT. IN.
SIDE YARD I LEFTS I RIGHT 5 ,'
L.SIDE )� FT. IN.
DESCRIPTION OF WORK REAR /9S`I/ FT. IN.
NE,. I X II ALTERATION I If ADDITION - V
REPAIR I II MOVING 1 It DEMOLISH I
BUILDING 1746 NO.OF
ROOMS 6 STORIES 1
EXTERIOR WALEtUCCO ROOF wood. ShinglE
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Dwelling new construction
3AR Att. Gar.
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION (S FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUC //� VALUATION
SIGNATURE OF T �p////C/�D� PERMIT FEE $
PERMITTEE A4-- %/B/�',�L•2 LY®�"�-L ��l PLAN CHECK $ f fb
AUTHORIZED AGEN'�e�����/ C �-^� $ 17
/ !/ ��
TOTAL FEE $