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HomeMy WebLinkAbout3077 MADISON AVE - Building Permits •i[ CITY OF COSTA MESA e'-;41r1 sifts BUILDING DIVISION fN -�) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www,costamesaca.00v 111P411 . FOR INSPECTIONS CALL: (714)754-5626 4'"°""° PERMIT NUMBER: E11-00269 PERMIT TYPE ELEC STATUS: ISSUED APN: 14159504 DATE ISSUED: 1 2/1 312 01 1 ISSUED BY: KJB JOB ADDRESS: 3077 MADISON AV CM Suite/Unit: Vicinity: • SCOPE OF WORK: CHANGE OUT FAU AND DUCTS.ADD A/C UNIT. FAU IS 90K BTU. FURNACE WILL REMAIN IN SAME LOCATION. REF: M11-00142 OWNER: VU, PHONG Address: 3077 MADISON AVE Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: BRENNAN, KEVIN Address: 1571 S SUNKIST ST Unit:STE J PHONE: 714-633-8892 City/State/zZip: ANAHEIM,CA CONTRACTOR: ALPS AIR CONDITIONING AND HEATING INC License No. 667953 Address: 1571 S SUNKIST STUnit: STE J PHONE: 714-633-8892 city/Stale: ANAHEIM,CA ZipCode: 92806 CELL: 714-633-8887 Ai ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $41.70 Reinspection Fee $0.00 TOTAL FEES $41.70 1,4 • a ny • }i Ar P: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related .tegulations.(Ord. No.92-28,§ 1, 12-21-92) 1EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. [INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all ivquired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. ,Cl'eODE* INSPECTION TYPE DAT INTITIAI$ CODER INSPECTION TYPE gem N TIL :16,16 Fixed System Final Fire Prevention 206 Final Mechanical .. I •1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical X 5 I' -).Dlr/'1- 07 201 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are' person is required to descend,will be made in connection with work authorized Carrier: �Yl�r'G7a/2G� C. —� by this permit,and that no building structure,scaffolding.falsework,or demolition 66 or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (]Ms section need not be competed d the permit is vol at one hoaered dollars(8100)or less.) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy Number: WKK--) /4/,—,3/6-,— Z 0 As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless i sued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should• become subject to the work s' compensation provisions of Section 3700 of Applicant's Signature Date the Code, I sh with comply with these provisions. —y_/z l/�// Division of Industrial Safety Permit Number: Applicant's Si tura D to HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# - 91 3 Class# 2.0 (Section 25533 of the California Health and Safety Code, with some ��I exceptions, requires registration with the Costa Mesa Fire Department by / _ /2/AV// each business which at any one time has on hand a quantity of acutely Contr.'tor'. ig :tura hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct. alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes', the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safely Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If'yes', attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for • sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. ❑ I, as owner of the prop e LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not appy to an owner of signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owner(s) Date Signature Date 3059-06(3I07) And%or Authorized Applicant Date CITY OF COSTA MESA oa 5-na sets,� BUILDING DIVISION •- e 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov 8 FOR•INSPECTIONS CALL:(714)754-5626 • PERMIT NUMBER: M11-00142 PERMIT TYPE MECH STATUS: ISSUED APN: 14159504 DATE ISSUED: 12/13/2011 ISSUED BY: KJB JOB ADDRESS: 3077 MADISON AV CM Suite/Unit: Vicinity: SQ. FT: 0 SCOPE OF WORK: CHANGE OUT FAU'AND DUCTS.ADD NC UNIT. FAU IS 90K BTU. FURNACE WILL REMAIN IN SAME LOCATION. REF: E11-00269 OWNER: VU,PHONG Address: 3077 MADISON AVE Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: BRENNAN, KEVIN Address: 1571 S SUNKIST ST Unit:STE J PHONE: 714-6334892 City/State/zZip: ANAHEIM, CA CONTRACTOR: ALPS AIR CONDITIONING AND HEATING INC License No. 667953 Address: 1571 S SUNKIST STUnit: STE J PHONE: 714-633-8892 City/State: ANAHEIM,CA ZipCode: 92806 CELL: 714-633-8887 Ar MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $52.00 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 R€INSPECTION FEE: - $0.00 • L[ TOTAL FEES: $52.00 f- E;L iar ttIOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related • ..'r gulations. (Ord.No.92-28,§1, 12-21-92) (EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ASPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all Required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. 511 CODEI IN$PECDON TYPE DATE INPTAL$ CODE$ INSPECTION TYPE RATE IN1117AL$ -1k16 Fixed System Final Fire Prevention 206 Final Mechanical h 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical tor. 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 _ WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. cy7 I have and will maintain workers'compensation insurance,as required by Yr Section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition Carrier ��—� valued —� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This semen need not be""co�mpletedethe perm,'is valued atone bu fired tlWars(5100)a less) 2,Art 2.Sec.341,Title 8,Califomia Administrative Code). Policy Number:l.og4 /Q/cS/ c. — 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should' become subject to the wor. 'compensation provisions of Section 3700 of Applicant's Signature Date the L-..r Code,I shfwith comply with these provisions. — /Z /�/y/ Division of Industrial Safety Permit Number: N/ Appli .riYs'Cure - ate HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# C 79 -3 Class SF 20 (Section 25533 of the California Health and Safety Code, with some 441.1.1 +/ _ . / exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely cont.ctor• - •tr Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lenders Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required. has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes',the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and slate that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature of Legal Owner(s) Date Signature Date 305746(3/07) And/or Authorized Applicant Dale Simplified Prescriptive Cs. rificaleofCompliance: 2008Residential Iil!4C/I/terauni.v CF-IR-AIII-II VAC Climate Zones 8 MU—bD r(74a— Silerlddresc' , - Cn)ncement Agony: Dare: ler mil 8: 3077 Imp/soh,.r 4-u. Cos-rte a A /27/3//I etiipment Type List Minimum l illiciency' Conditioned Floor Area Thermostat Packaged I Ink Indoor 6 AIU IJt_Z ©C'ol' • Servedb system -clhack Indoor Coil ❑SLlilt ❑IISI'P y'y' Condensing Unit B fil:R _._ ❑Resistance ---sr //Jour a/r.mhymrevm.curer be unt.dl. 11 Other I. Equipment Type:Choose the equipment being installed if more than one system use another CP-I It-AL f-IIVAC Err each sestets. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUIi,7.711S1'F lir typical residential systems. II ERS V FIt I FI CA•I'ION SUMMARY Listed below are three Ii VAC alteration Options. "Ike installer decides what work is being done end picks one of the appt opria(C Options. Each Option lists the I I F.ILS measures that must he conducted.A copy of the lin u¢Stell lie left on site for final inspection and a copy given to the homeowner. At final,the inspector verities that the work listed on ibis linin was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-Olt and registered('f-d It limns(mi hand tilled CF-IRs allowed)arc tilled out and signed. Beginning October I,2010,a registered copy of the(:E-I It and ("E-oft shall also be on site for final inspection. ❑ I. I IVAC Changeout Required Forms: • All I IVAC Equipment CF-LR limns: MIiC1 I-UI.MSCI I-25-I IERS replaced CF-(11t Conus: MSCI I-25 • Condenser Coil and/or Ch-Glt Forms: MECI l-25-I IIiRS • Indoor Coil and/or Cf-4R limns: MECll25 • I'm mace ---- For Split Systems: RC, CCA > 300 CPM/Ion,TMAI I --__--� For Packaged Units: No testing required ❑2. New IIVAC System Required Forms: • Cut in or Chaugenut with Cl--OR limns: MFC11-04, MFCI I-25-111325 new ducts: (all new ducting CP-•112 limns: IMECI I-25 and all new equipment 1 For Split Systems: RC,CCA> 300 CPM/fon,THAI I. For Packaged Units: No testing required kir;. New Ducts with Replacement Required Forms: • Includes replacing or installing all new CF-OR limns: MFCI 1-25-I IliliS dueling and/or outdoor condensing unit CI?-4R limns: IMECII-25 and/or indoor coil and/or menace. Not all equipment changed. For Split Systems: RC, CCA >300 C FM/fon,'fMAI I -- For Packaged Units: No testing required Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate nfCuntplianee ducutnenUniun is accurate and complete. • I :un eligible under Division 3(lithe Culititrnia Business and Prolessi nus Code to accept responsibility lir the de sicn ileohied on this Cell if irate of Compliance. • I cerlity that the energy lealures and perlirmmnee specifications li 'the design identified on This Certificate oit'omplianre condos to the requirements of t itle 24, Parts I and b of the Culiliinlia Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the iW emanon doruntenied on other applicable compliance Forms, worksheets,calculations, Plans:mil specifications submimed to the rnlitrceu lite;gtpiav:d .cilli the permit il :tUtlintlion. Norm:: 4."–Vitti RierAhtl4--A ) Sign.] i le. — Conipan)'f hate: / 4/ P/e- ? /t%G /AJC . ,ZA3/ / — AJJmss:/S7/ s• t sTE Liecasc. Sc��1 iL'ts i S— '� GG 75s 3_ City/Stater/.ip: A.A. �r • /t �t • Q 2 54 Phone:7/+, 633 -@5? a. 2005 Residential('omp/ianre Points .Vtrrtl/ 2nlit ALPS ALPS Air Conditioning Air Conditioning & Heating Co. a Heating ALPS PLOT PLAN REAR YARD P/L s s 1 1 D 30+ E �� sor E C , - t")c,sTi Ul✓ A� ear. as-✓GZ. A A SINGLE FAMILY DWELLING D D P P naNsrri L I���P�NONG ONWERNAME? "''L ULC- APP OVAL ADDRESS-3077 rnP,--b'Sa-ki ' C . Wk . PHONE # Sc"2/ Zit9 City of Costa Mesa Planning Div. Subject to Building Division Regs. „I Any Revision must be approved. I1J to Building OYESNNO ZoningInspection L ( 0Q' OYES NO Traffic/Park Fees DaBYte.� 1'() Alps Air Conditioning & Heating SIL \N� 1571 S. Sunkist St., Ste. J Anaheim, Ca. 92806 (714) 633-8892 Fax (714) 633-8887 REGUV Li) 17049MAY 17 1961 COSTA MESA BUILDING-SAFETY DEPARTMENT F�N�r°�� DEPT. P. O. Box 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT • LDING —, 7UILDING ADDBUIRESS Al Q di 3nn 4 - COSTA MESA. CALIFORNIA For Office Use Only R PERMIT NO. OWNER ()rnidPrital Lnan (:nmpnny I RECEIPT NO. PEQtQ ADDRESS 2501 Benedict Canyon LriVf MAIL RECEry D BY ..4-D,tTRE 62 dDATIBSUED �� I `�A 7 O2 I aiX 3 1 1962 CITY Beverly Hills NO. 89 BUILDING 3077 Madison Avenue ADDRESS ARCHITECT TEL. OR ENGINEER -- NO. COSTA MESA. CALIFORNIA -- FIRE o ADDRESS ZONE TYPE l/ GROUP �..- � / ir- CONTRACTOR Alfred A. Ede) Bohn APPROVED BY DATE ADDRESS 2_901 Benedict Canyon Dr. , ZONING ZON NO.OF USE OF NEW Sr.; 4i..,�. CITY Beverly Hills, California —I ( PLANS 2. ( BUILDING 4,/ `' STATE TEL. / pt[]11^ LEGAL LIC.NO. 141355 NO. CR.-6-8940 \ DESCRIPTION Lot #22 TR-4607 SIZE {� NO. OF BLDOS. OF LOT 62X100 I NOW ON LOT 0 ` A.P.NO. USE OF YARDS EVES EXISTING BLDG, -- APPROVED ALLOWED SETBACK LINE FROM LINE ST.) CENTER OF STREET 3O 1 REAR YARD 32 t FRONT S 0 FT. ------ IN. SIDE YARD I LEFT 51 I RIGHT 51 R.SIDE 3 FT. ^_ IN. DESCRIPTION OF WORK NEW I �/ L.SIDE `/ FT. IN. X II ALTERATION I VI ADDITION I REAR -Z J -2.- FT. -L / IN. REPAIR �I II MOVING I II DEMOLISH I APPROVED ✓,4fA0 DATE -/G/�Z SIZE DIN2XII G1 RNO. OF OOMS 6 STORIES 1 °�'I EXTERIOR WAL`k.. ROOF COVERING I}.ISlCCO I COVERINGWOO5 & Panic USE OF BUILDING AND WORK TO BE PERFORMED 1 - Fam Rea w/attached Gar P? ( lY I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO N 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 STATE LAWS REGULATING BUILDING CONSTR CEION. ,(/ VALUATION �J SIGNATURE O / C /// PERMIT FEE $ / N PERMITTEE *� �)l/% �� /Cj 6-2 W a $ 15 , 55.00 PLAN CHECK S ' r I AUTHORIZED A NT TOTAL FEE . /J 0 D x