HomeMy WebLinkAbout3063 MADISON AVE - Building Permits •
may. CITY OF COSTA MESA
BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
Tee rita PERMIT
B99-00810
•(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3063 MADISON AV Status: ISSUED
Suite: Applied: 06/07/1999
Vicinity: LEFT& RIDE SIDE PL Issued: 06/15/1999
Parcel Nunmber: 14159508 Zoning: R1 R1 '''yyy�/��\
ISSUED BY:
Applicant: LE-KHAC, THI
Address: 3063 MADISON AVE
Phone:
COSTA MESA,CA Zip: 92626
Owner: LE-KHAC, THI -
Address 3063 MADISON AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor:
Address: - / •
-
•
• Phone:
Zip: License:
Arch : Eng: •
Address: Address:
• Phone: Phone: •
•
Zip License: Zip: License:
SCOPE OF PERMIT
CONSTRUCT 76 LF,6'HIGH BLOCK WALL ON THE LEFT SIDE PL&87 LF,6'HIGH BLOCK WALL ON THE RIGHT
SIDE PL(100'DEEP LOT).CONSTRUCT 18LF AT FRONT OF PROPERTY TO FILL IN EXISTING COURTYARD.
FEE SUMMARY
Plan Check: $64.84 Calc Valuation: $5,000.00
Permit: $99.75 Claim Valuation: $4,000.00
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
inspection: $0.00
Total: $164.59
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 13-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
•
EXPI II
DATE i/ ac, ov
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
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
work for which this permit is issued.
O 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'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed ii the permit is valued at one hundred dollars($100)or less.)
O 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100.000),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 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.Lie.4 Class R
Contractor's Signature: Date:
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 Processions 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.).
O I am exertt u1nder sec. Business and Professions Code for this reason:
Signature: .+-IAUA f7 11r1
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 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 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? 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).
pr a M- nag ... .. . re.. ....gra. eyh. materials)?
s?-
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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Li a plication 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 LJ No
(Section 65850.2 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? 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 California 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"OFIENTRY:'I certifyunder 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 clly.oidinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property r inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE INSPECTION TYPE DATE INTITIAI S CODE INSPECTION TYPE PAIS INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
•
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
2446-46
4 eadeet Nem Vier char Dia
0OWNER-BUILDER
VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the return of, an
owner-builder verification.
Attention Property Owner:
An `owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
I. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. jzi Yes ❑ No
2. I (have/have not) V e signed an application for a building permit for
the proposed work.
3. I have contracted with the following person (firm)to provide the proposed construction:
Name
Address \`'A--- City
Phone( ) Contractor's Lic. No.
4. I plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
Name
Address T City
Phone( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1042-46 (REV.9/98)
I
t'
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my personal
knowledge, in compliance with this State law.
Signed: 9 kX,(_ Ci. 1 Date: 4( 1 /1
Name: mit LE
(Printed or Typed)
C.D.L.#OR S.S. #
For more information call City of Costa Mesa Building Division at(714)754-5273.
1042-46 (REV.9/98)
NOaE
ADDITIONS, DELETIONS, CR CURPECTIONS SHALL
BE APPROVED BY THE PLANNING DIVISION
SICEPEPUISTER'QVfoRMATIONAMMIRP tk:s '' •SOLID WALLS/FENCES BETWEEN Y6.&6'N HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
N CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WALLS/FENCTB SHALL NOTE CCS Y 6'IN HEIGHT
WITH THE INFORMATION PROVIDED ON THIS SHEEP. WITHIN 10'OF THE FRONT PROPERTY UNE(NOT CURB LINE).
•VERIFY DISTANCE FROM CURB TO PROPERTY LINE
699 —
D O U/D AND SHOW ON PLAN. VERIFICATION FROM THE QTY'S
ENGINEERING DIVISION IS REQUIRED. CALL(711)754-5343
FOR INFORMATION.
A / 'U
-c •' ,Cu',
PL'N !NG DIV.
SUBJECT 3 BLDG. DEPT?
lila
JBE //7' Z`) rucri
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I
E RE9QRQ RESCOKX
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DIVISIO O BUILDING SAFETY I
CI Y u GO3
PPROVED
lite&of eland spe f tali^ '!UST to Yapt an Ubs ob a9 tunes end d is enlaaiel o
r,atw&riera,aerasi',ia nsai>E„rUto:Awrller.pern15 al toes' DMsfonalBL ` Z1:.
Id Safettryof Costa desa. -21 'k
he stamp. S9 apt be to pamutortots ent ppro:a .I
I the vioof any o:n' of any C h;of Costa Me 'Ordinance ander Stn!c law. h��3
'hese iged poet! ¢Ire 1 y lin Radon and be me nett aid void if the build n0 o 3U
NotP is n ^:encce nd nv t:ir.d active per UBC'303( withn 18a days of isst nce r —) g 3
AMONG( RE9QRQ I I RE90ENCE RESDEMQ
W I
I y
,, ,''• or MOI !too( RNA }Tfl asp( '•, I i
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BLOCK WALL LAYOUT OR,BUILD 8R I T
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•
PLANNING DIVISION
f .
TYPICAL 611 CONCRETE BLOCK FENCE •
Cement Coping Optional . a GENERAL— NOTES
Channel Block With 1.3/80 til ■, -- 1.111111 I �
Horizontal Top of all eUe I
Fences 0, '� � 1 MORTAR: One Part Plastic Cement, and
Three Parts Sand
For Fences 5'or Less to INf 2 GROUT: One Portf Cement, Three and
yen.Bars 3/8"0 at 4' .0"O.C. }el. o a
i
tl I One Half Parts Sand
1 It x COPING: One Port Cement, Three •
For Fences Higher Than 5' , u t- I Ports Sand
: I r ' CONCRETE: Well Mixed 1:2-1/2: 3-1/2
Vert.Ban 3/8"4 at 32" O.C. W -- - - - -
'BB ¢ _ " ' Max of 7- 1/2 Gahcns of
Fill Cells Solid With Grout > z Water Per Sock of Cement
Where Steel Occurs 1'�Bp11 r
Reinforcing• Steel Shall yYl f `P GROUT MAY BE POURED FROM THE TOP
Conform to Sec.A1539 IIW4i14 ilii W O •
- _ OF THE FENCE IN CELLS WHERE STEEL
A.S.T.M. i OCCURS.
III Z ~ I
t ' i� CELLS AND AREAS OF HORIZONTAL REIN
All Steel to be Lapped W n 111 FORCEMENT SHALL BE CLEAR,CLEAN&
24"or to Code FREE OF ALL MORTAR DEBRIS,ETC.
1 I 1. 1: �plr I
NATURcL GRA
wv\ E. ;^lYi/I PS v
t
•
TWO 3/B"0 BARS ' , O ,��
O
CONTINUOUS TOP I
6 BOTTOM I--.*---WIDTH 10 16 0 C MAX 11.
SEE CHART
HOQZBELOW I
STEEL MUST BE TIED IN DEPTH LF CARTHTCOTH
PLACE AT TIME OF TRENCH r I , 1/3 THE HE IGTH OF FENCE
INSPECTION. L -BE^LOW BOTTOM OF FOOTING
l.=o;_t1_12:41-
2..A__ SCALE: 1/2" = I'
FOOTING REOUIREMENTS CHART
I WALL HEIGHT 6 '
51-----r4 _ 3' 1
WIDTH14" 14 12". •. . . 12"
THICKNESS . . .10" . .10" 6 " 8 "
•
DEPTH OF EARTHTOOTH 24" . 20" . . . 16" 12" •
SPACING OF EARTHTOOTH 12' 14' . 16' 16'
•
04 i BUILDING DIVISION
�a
-
i •
ivI"� - . _ - -
• -September 6, 1974
- Mr. E. H. Chaun - - •
3063 Madison Avenue `
Costa Mesa, California 92626 _ •
Dear Sir: .
A building permit has been issued to Aquatic Pools- to.construct a
private swimming pool on.yo r property. -
- - • In-order that your pool will b a safe one and for the purpose of
-advising you of your responsibil ty regarding the requirmenta of - .
the Costa Mesa Municipal Code, we refer you to Section 8107, a
• - copy of which is attached.
'This letter is direr to you in order that you- will be aware of
•
our ordinances and can. ke a .complete. safety.check of your pool
- area. '
. Sincerely yours, .
RICHARD HANHART
- Building Safety Director -
- RH:cb -
• 40 2
. ' ���� lL 00 Twining Laboratories of�c1LTtIuz,= Lifitozni T, £Jnc.
—Cr0
41/1 r
�2gillAIL '1' FO. BOX 47 . 3310 AIRPORT WAY . LONG BEACH, CALIF. 90801 . 213) 426-3355 . 1213) 636-2386 . 1]14) 928-6432
,-nr:cr oa CEs•
TESTING
se-.,fr•,C. '. 0 1220 ,da' 7055 Recoem Are.PO,0c.41
171.1 031 204 lq p IQ., .eevn,C,' .90%01 12131 530.2386
October 3, 1974 Examination: SC74-5716
COMPRESSION TESTS ON GUNITE CYLINDERS
Mr. Errol F. Heesch
12921 Aspenwood Lane
• Garden Grove, California 92640
•
PROJECT Swimming Pool for E.N. CHAON 3/7%
ADDRESS 3063 Madison Ave. , Costa Mesa
SAMPLE FROM Gunite Swimming Pool
•
ARCHITECT CONTRACTOR
Aquatic Pools
ENGINEER SUBCONTRACTOR
Grove Gunite
SPECIFIED
MIX 4-1/2 to 1 STRENGTH 2,000 psi
DATE CAST 9-26-74 CYLINDER SIZE
DATE TESTED 10-3-74 .10-3-74 10-3-74
CYLINDER NO. I II III IV "HOLD"
V "HOLD"
COMPRESSION 7 Days 7 Days 7 Days VI "HOLD"
TOTAL LOAD, LBS. 115,500 126,500 115,500
POUNDS PER SO. IN. 4,085 4,123 4,085
SIZE: 6" x 12-1/2 6=1/4" x 12-1/2" 6" x 12-1/4"
COMPLIANCE 7 Day test complies with specifications.
- MADE BY DELIVERED BY RECEIVED ON
•
CYLINDERS Tom E. Heesch 9-30-74
DISTRIBUTION BUILDING SAFETY DEPT.
E.F. Heesch - 2
Grove Gunite OCT 111974
Costa Mesa Bldg. Dept. F:
tiff ' f} .
L. s ,. .. •.I . . . 0 ..r I .. _ '8,'S . .. PVeL C .NOO,05(L:r5
OWNER CHAON, LH. DATE 9-5-74
JOB ADDRESS3063 Madison Ave. BUILDING PERMIT NO. 389413
r`NERAL CONTRACTOR Aquatic Pools DESCRIPTION of WORK Pvt.Swim Pool
Ao.l41-595-0ti LOT TRACT FIRE ZONE VALUES 5,000.00
INSPECTIONS Signpture �JDatte GROUP J TYPE III ZONE al.
PoolLocation /�yf/)� 7'AoN/-7ci SUBCONTRACTOR PERMITS ISSUED
Date I Number Signature
Forms
Main Drain •
Steel Reinforce
Elec. Bond /,�"\\--.
Electric
Approval to Cover �� /'d'j7Y arts: `Y�o¢�q 9-5-7939936'
Ar d
Underground Electric 14 /0-V-7(
Plumbing
Gas Piping Test
Filtering System Lines trati ' IG cfr..6":- 7V d4/75-...----
Backwash Lines and Recep.
Electrical Final 7
•er and Vent Final \
Futer System Final \
Backwash and Recep. Final \\
Far...:..,. Final .
PAN
• 3874SCEP -5-74cnr00 248* *r.**44.UU
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
. PPL/IC TION FOR BUILDING PERMIT
For Applicant to Fill in Completely
cars OA
/� ss�1 REC 1 E.7 i DATE RECEIVED D E ISSUED
BUILDING ADDRESS 3oSa3 I/lgpi QeJ /fJ / ID_
yam/ /� I / ) P.
OWNER E. r l 1 l i...4 A•d sy A.P.NO. /471/ —.6-11-c-.0y YTS Spite/
BUILDING MAIL ADDRESS 4 .l /o G }7H' // 1.}000) ff(/ •Q
ADDRESS S�'k^`—.C
ZLa . 7
o_0 CITY E-0 STA M ES A NO. , /�� TRACT 1/1)ry� LOTZ-� BLOCK
ZQ CONSTRUCTION /�s1 [\�� NEW IADD ALTER I REPAIR MOVING DEMO,ISH
-I- LENDER KQu4\ 1C. L 0d` �/� `1/�� . l
BRANCH a .pJG-fkEls /�Li 14 CHAU'v
/^�l� OWNER
4 J ADDRESS ,3 J �z �"'�1(�- 1¢v���-I VALUE /
---
_1Q OR ENGINEER-CO ARCHITECT ll[3oa- G�lVTt1R. TNpL0��3(�� 7oaL $ 0Ns
N
wa Oto &1 C. LEA- FIRE T
Z < ADDRESS ZONE YPE "GROUPV
d W ^ !1 APPROVE /vTl
J Z CONTRACTOR r *`'( up...-7I G r—Ppe` BY DATE c~
G3 Z \`
J cc ADDRESS t �j4. S .Kjori..6=l_
w w TEL. ZONE NO.OF USE OF NEW
0= R/ PLANS 1 BUILDING 0O j
Z1- CITY NANt1 �_ NO. � Th80 G
w0 STATE CITY YARDS APPROVED YARDS APPROVED
j O LIC.NO. Z86 Zcts G-i3 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM C/L STREET) /_
OF LOT NOW ON LOT FRONT FT. /0 FT. l� W,1,)
USE OF
EXISTING BLDG. R SIDF FSS FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT. J FT.
Q EXTERIOR WALL ROOF
COVERING COVERING REAR FT. L. FT.
J E OF UIL ING SAND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0.
a •
.tl�q MAIN BLDGS. ACCESS.BLDGS.
LIiLWVVv/��rr
Q s VAR.# DATE
O L[')l C.U.P.# APPROVED
I— APPROVEDn P,O. ')
V) ABY WO _DATE -- S cif
Z
O CJ
O I hereby acknowledge that I have read this application and state
siMinigIS\ l ---
D that the above information is correct and agree to comply with
¢ all laws regulating building construction, and I shall not employ
I— any person in violation of the workman's compensation laws of
y the State of California.
ZI hereby certify that I am properly licensed as a contractor under SO. FT. TT'��� O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VA ATION. FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMTT'FEONLY:
EC
em exempt from the provisions of the State of California Business VALUATION /�
and Professions Code, ' ision 3, 9. 2 Or m
_x.) PERMIT FEE $ D
Signature of ------ 67.2N
Permittee Lapp
a PLAN CHECK $ Hi E
(�II 2 0
Authorized Agent TOTAL FEE $ /_.L ,J S-, LL A
•
17053 Lcuc u.
rE rit J
COSTA MESA BUILDIN -SAFETY DEPARTMENT V pIMAY 1 i 1981'
P. O. BOX 917 COSTA MESA. CALIFORNIA 1 iNi NCE DEPT.
c1, 1 OF
For Applicant to Fill In Completely APPLICATION FOR COSTA PERMITESA
TYPE OR PRINT
,F BUILDING
ADDRESSBUILDING 306 ,H 3/ ;�T /Spi, ~rt.
COSTA MESA. CALIFORNIA For Office Use Only
I
Y RECEIPT NO. P3
OWNER Accidental Loan Comnan n/
MAIL RECEIV D BY I O RECEIVED DATE ISSUED
ADDRESS 2901 Reneo i et C PnynnT�nni Melia_ At eL.6p I .1 J iTEL 17D2
CITY Beverly Hills NO. CR• -O- BUILDING 3063 Madison Avenue
��`T"^V
ADDRESS
AI 'ECT __
NO.
TEL. COSTA MESA, CALIFORNIA
O!. ..INEER
ADDRESS Z //
ZOO FIRE NE TYPE y GROUP
‘JA
-
CONTRACTOR Al PrP(] A wri el snhn BYPROVED DATE
ADDRESS 2901 Benedict Canyon Dr. ZONINGNO.OF USE OF Eins .44+%
CITY Beverly Hills, California ZONj -/ IPLANS IBUILDING
// �.., ,
STATE 1 TEL. LEGAL y,I '1
LIC.NO. l l3 ,5 NO. CR.-6-894o DESCRIPTION Lot ,l PA TP-4607
OV62}(100 NO. OP SWIGS f—
OF LOT A NOW ON LOT O ` A P NO.
USE OF -- YARDS EVES
EXISTING BLDG Z APPROVED ALLOWED
SETBACK PINS FROM 521 (CENTER
CENTER OP STREET REAR YARD 30 1 FRONT LINE STA 2._ FT. IN.
C
SIDE YARD I LEFT J 1 I RIGHT 5 1 q SIDE -.0 FT. IN.
DESCRIPTION OF WORK --
L.SIDE 3 FT. IN.
(
.J I X II ALTERATION I II ADDITION I REAR 33e,
FT. Z IN.
REPAIR 1
G. � O /1
ROOMS .�
II MOVING I II DEMOLISH I ABY
PPROVED �,9� DATE S///C -
6ZE DINh `} ROOMS O STORIES 1
EXTERIOR WALAOO COVEtu CCo I ROOF
COVERING RINGWood (4( Rock
USE OF BUILDING AND WORK TO BE PERFORMED
1 - Fam. Res. w/attached Gar.
/7 /If/ , J1 .
.JL /P6-7 `/ J• 4/Gs-A'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND ST - LAWS REGULATI
BUILDING CON- 'UCTION. VALUATION
PERMIT FEE S •39✓SIGNATOR /
PERMT :� .S v - - �� _ _ _
N
$ 19g55.o0 PLAN CHECK S 7 9,-; r
5-O
AUTHORIZE. AGENT ' TOTAL FEE J.//. 9 i
4