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HomeMy WebLinkAbout1672 MADAGASCAR ST - Building Permits CITY OF COSTA MESA • BUILDING DIVISION >: DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 '111K0 . PERMIT R40417 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1672 MADAGASCAR ST Status: ISSUED Suite No Applied: 10/04/2004 Issued: 10/04/2004 Vicinity: REAR OF PROPERTY Parcel Number: 13913427 ISSUED BY: Applicant: FINICUM,DAWN Address: 1672 MADAGASCAR ST Phone: 714-556-7388 COSTA MESA,CA Zip: 92626-2318 Owner: FINICUM, PATRICK M Address: 1672 MADAGASCAR ST Phone: COSTA MESA,CA Zip: 92626-2318 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT ADD NEW A/C UNIT AT REAR OF PROPERTY. FEE SUMMARY Quantity Quantity ISSUE'FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refdg Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace 50.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 - 15 To 30 hp/1,000 k BTU ' $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU - $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $14.70 1 Smoke Dampers - " $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent • $0.00" 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.20 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(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one of the following declarations! t ❑ 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. ❑ 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 looted. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) I�b•• ..II rEify that in the performance of the work for which this permit Is Issued,I shell not employ any person In any manner so es to become subject to the workers' �?�� compensation laws of California,ono agree t $(If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith oomph with th �epfo�• Mons. � I U St-. Stgnatur --1 1p�W {( Datt'v,n --'-\ O WARN .FAt ORE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CPIIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(s100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Llc.# Class a 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 end 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 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.). ' 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 cense Laws.). ❑ I am e ,••• under sec. Business and Professions Code for this reason: Bahr, a ILA.s,.. .A_ a DaPati: 7i 0 -q -U� Owner ID verified by driver's license. 0 Yes 0 No ,DD? r' LLiiceenn 0.NO. lie's: -�-'U'-0 Verification of Ownership by(type of document,i.e.-property tax bill or ddedy 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 Safely 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 Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Flre 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 end 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 0N (Section 25534 of the California Health and Safely 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 0 No _....____ ..__.___ forth_._...._-...hi....._i..__ __.._ _._ _...___ _. .__ _._ . 5 Does the will the oast Air art Quality a art emen building occupant at any eair the work ontch the sor OI this a estion eggermit lar such construction or modification from South Coast Air Quality Management District or from other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). _......_...�._ �_ _ -. o_.— 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 foT 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 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 ins ctign purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S(gnature QfLegal Owner(s),_ LDatao- .f And/Or Authorized Applicant Date CODE I INSPECTION TYPE WI ILLS COOP INSPECI1ONTYPE /1)-421C(1616 Fixed System Final Fire Prevention 206 Final Mechanical Y ar 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 , -1'“' LCITY OF COSTA MESA• 4 alIIgq.DING DIVISION ::j •.,,,. ..�i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ut t PERMIT • �" "t E04-0"762 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1672 MADAGASCAR ST Status: ISSUED Suite No Applied: 10/04/2004 Vicinity: REAR OF PROPERTY Issued: 10/04/2004 Parcel Nunmber: 13913427 Applicant: FINICUM,DAWN ISSUED BY: Address: 1672 MADAGASCAR ST Phone: 714-556-7388 COSTA MESA,CA Zip: 92626-2318 Owner: FINICUM, PATRICK M Address 1672 MADAGASCAR ST Phone: COSTA MESA,CA Zip: 92626-2318 Contractor: Address: Phone: " Zip: License: SCOPE OF PERMIT ADD NEW NC UNIT AT REAR OF PROPERTY. ' FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 - - - Temp Dist System/Lighting $0.00 0 Temp service test $0.00 - Busway/100 ft $0.00 0 Res.a/c package $54.50 Standing Section $0.00 0 , New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 . 0 Recept Outlets. . $0.00 0 - up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0:00 . 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a _ - $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp 50.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 - 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $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 2448-46(GVW) . DECLARATIONS 1 •I WORKERS'COMPENSATION DECLARATION: „ X I hereby affirm under plalty 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. ❑ 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: Carder: Policy Number: (Thi action need not be completed if the permit is valued et one hundred dollars($100)or less.) edify that in the performance of the work or 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 aura at If I should become subject to the workers'compensation provisions of Section 3700 of the La r Code,I shall forthwith comply with th visions. ppFcant'Si-Prato :-7 l Q.r.tiy`� 7V�!->`i �1 ate:' it'�. -0 r WARNING. AIDE T CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EmeLoYER'TO'CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COU-ARE(S100,000),IN ADDITION TOME 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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a cdnstruction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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 sate(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.). • IJ s 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 Contractor License Laws.). ❑ I am eunder sec. , - Business and Professions Code for this reason: _e np rgdature,: 'aC. i f � -. - - ( :E�pigs;.0-') -0 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(6)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(38)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: I WIII 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 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 en 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? U Yes Li No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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 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 a state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov -- ribed property for ins ction purposes.I agree not to occupy or allow occupancy of any building authorized by hispermituntil�al inspection. w.�_ A...."----------" �, t"h LT l __....-1.--k SlgRatrure OfLegal Owner(s) 02.51_51:_z__, ,47: And/Or Authorized Applicant Date ;ODE 1 INSPECTIONTYPE PAIL INTRIALS CODE I )NPECTION TYPE PATE IIf®ALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final . 208 .Final Plumbing 1� I 4 200 Final Re-Roof 210 Final Electrical 10t—Lel 0 ®S 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 !saw if 1 • •t L itay °j 7,?Zeaa 'uit'di�s� VwcQioct kiktos ,lap - OWNER-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. Ipersonally plan to provide the majdr labor and materials for construction of the proposed property improvement. ❑ Yes 1472cNo �1 (have have not) 1-1' t v i signed an application for a building permit for the proposed work. ®I have contracted with the followinglperson (firm) to provide the proposed construction: i Name AL-15-0/ Ale,I, {-�ee �t_ ' ((���� n Address c-x`1,7 310 MCN 1�A £k LIS 1Uflf ity Math ,.11E ILI: 'EA Phone O�y 5r -a03 -p l��) j� � I Contractor's Lic. No. Sa(y t:7-(i 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address 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 1092.46 (REV.999) PROJECT ADDRESS: 1672 MADAGASCAR ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 048555 OWNER'S NAME: FRANK TARCZA ADDRESS: 1672 MADAGASCAR ST PERMIT NO: B 048555 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA .f CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT 4ti '' ARCH/ENGINEER: ( 714 ) 546-6088 REG.NO.: JOB DESCRIPTION : REROOF WITH 25YR COMP SHINGLES SQ FT: 3, 550 ADDRESS: UNIT: u CLAIM VALUE: 3, 550 . 00 CALC—VALUE: 3, 550 . 00 GROUP OCC : R-3 /M-1 PERMITTEE: ALL ASPECTS OF ROOFING ( 714 ) 646-0706 ADDRESS: 160 E. 163RD ST COMMENTS ; SMOKE DETECTOR(S) REQUIRED IN HOME. GARDENA CA 90248 ****************************** ***aL+eer****yt*eLer**sin*********yr**x******eE*********+r LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R EQU IR EMEN TS 7000)of Division 3 of the Business and Professions Code,and my license is in tug force and effect. S ET B ACK S Date: : 044958 STATE uc.:47072 c/J,pcsn: C-39 Data:$•�1 L(—'�a Signature: C���kVAn,_."... MAIN BUILDING ACCESSORY BUILDING '7RIIERS'COMPENSATION DECORATION: Ihere affirm that Inave a certificate of consent to sell-insure or ace cate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN npensaUonlnsr c r c ted copy thereof(Section MOO,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN ,nICYNO.:WO ° 88 EAP.DATE: 04 /10/91 COMPANY: CA COMP PARKING REQ: PROV: PARCEL: 13913427 ZNE: REF NO: ❑ Certified copy is hereby furnished. I Certified copy is Ned with the city Budding Division. PLANNING NOTES> Date: -i ti -? ° ApplicantCee� '�- p *********** E:******************************************************************* xEMPRON FROM WORAERS'COMPENSATION DECLARATION: (this stencil reed in ce completed if the permitistut ore hue red(5100)or less). D E V/E L OP MEN T SERV ICES REQUIREMENT 'S I ceniy i that in the performance of the work for which this permit is issued,I shag not employ any person n any manner so as to become .i subject to the workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: NOTICE:If,after mating this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: ��' "�, DATE: g'— I �O which this permit is issued(Section 3097,Civ.C). ************f):********* . . . •-*•-" . •-.•.3` . • • . . . • !•1�^'. . • • **************** ** LENDER: ************ **********************************,******************************* ADDRESS: LEGALIZATION :N F E E SUMMARY STRUCTURAL 'SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l 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: My city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 63 . 00 5 0 repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of DNislon 3 of the Business PLAN SMIP/NON—RES and Professions Code)or that he/she Is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than lie hundred dollars($500). ISSUE FEE 1, 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 13 structure a not intended or offered for sale(Section 7044,Business and Processional 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 himselfinerself 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 TOTALS--> COLLECTED: 63 . 50 OVER/SHORT• ,00 Improvement sold within one year of completion,the owner will have the burden of proving he/she did not build or improve forthe purpose al sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 - 5 0 ❑ and Professions Code: The Contractors'Sate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projectswth a=Pectoris)license pursuant to the Contractors'Sate License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR E AK D OW N ❑ I am exempt under Section: 8.8 P.C. n for this reason: TYPE QTY D E S C R I P T I O• N UNIT COST TOTAL COST Date: Owner: SFR 3550 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3, 550 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant wiMwill not(circle aro)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from r. Cthese provisions. '7 Date: Applicant: ' I hereby certify that I have read this application and state that the above information is cornet.I agree to comply with at city and county 7. ordinances and stateWading laws relating to ding construction and hereby auttOrae representatives of this ve ns city to enter upon the abo -mentioned C".- /'1 propertyfor inspection purposes.s.Q �(//I f Date: S.— _G� SipnaSignature: "��`�--�— � _.:_e_04--?,1 o/J ,,,z 01 00067.40 L10067=11 1'07 Driver's License or Social Steady x: DATE: 08/14/90 TINE; 13:37 1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor -ear CONSTRUCTION AND PLANNII.., JOL& SPA APPROVALS Permit # Date Inspector APPROVALS Permit #_ Date Inspector 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 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 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 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 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil - 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing f_224t bce,64- -73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro - 26.'T-Bar Ceiling (Structurall & Monocoat - 75. Dry Chemical 27. Frame and Flashing _ - 76. Dry Standpipe . 28. Lathing & Siding 77. • FIXED SYSTEM FINAL 29. Insulation _ 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 1 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 3 LZ--IJ©., . 5 ,...,_,O4t,P 34. Final Heating & Air Conditioning - . Dom- ��� 35. Final Gas Pipe-Test - 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing ._-, /39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations J i 47. FINAL STRUCTURE & BUILDING ./ / .%: hl _ 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Z0 CJ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address' i107z hag ag PMaRSGA4 $;Z 100 2353 . 40 -- Applicant's Mailing Address 5Ana TYPE OF CONSTRUCTION K NEW ❑ ADD U ALTERATION U REPAIR Fi4Q A7/•( 77 ACLA Phon9SVIC4O S4 ❑'CONVERSION ❑ DEMOLISH ID OTHER A.P..�6I ' 1 —* 2...7 At _ Zone I Owner's Name DESCRIPTION OF WORK/USE OF BLDG. ✓ ! •� l s,1 In } r' ` _ ^ • Address /A72 /7AOA 441, CAR 1 i' S Main Building: 163%4 NI{ Sess°I Building: Z • Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING El FOUNDATION El STRUCTURAL T Front "� f. -.. rte Address ❑ TENANT ❑ ELECTRICAL I_0 PLUMBING ❑ MECHANICAL 8 Rear .� P'' rj (.5(�yy[I,• l y� N Contractor's Name Phone �'OTHER .... FT. $-T/A'f-L C Right ,f.� si I" 00 _- 'll ' N • �/7�] PROJECT DESCRIPTION SQ. FT. OCCUPANCY Kit. ,y G R Address mailing) 01 11 / CON$T RUCTION TYPE - VALUATION$ I�Lkl� $ Left + Co ': City License No. ZONE GRADI NG CU.YDS. ACRES • PIng. Ref.# irkinii g Req./Provided E LICENSED CONTRACTOR DECLARATION // Q I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: e_Q j 1 F �I ci 2- U j L Planning Notes: �7 L. Q r 6i'' 1/t ;;5J: M with section 7000) of Division 3 of the Business and Professions Code, and - e� sr Go "�� [J'- T my license is in full force and effect. License Class License No. Date Signature PLUMBING ��yy�-''}}�.��// FEES • WORKERS'COMPENSATION DECLARATION ,Bar Sink Showers �'/ / ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-Insure or a certificate - / / ' Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Servl mk 100, Lab. C.) - - _ Automatic Washer _ Transformer 0 75-50 KW PolicyNo. Company `:Backflow Irrigation pe ,Ca 0 50+ KW 9 py P Construction Pole Sub. BCertified copy is hereby furnished. cc Certified copy is filed with the city Building Division. ,' Bathtubs SevenEpt Cooking Unit Meter ❑up to 100 amps Date Applicant ///���/V EXEMPTION FROM WORKERS'COMPENSATION DECLARATION • Clarifiers Y`l tipl Cole LO Dishwasher Meter Dover 100 amps (This se need not be completed if the permit Is for one hundred ($100)or �ftJ less). • Dishwasher S Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I R( • shall not employ any person In any ma er so s to b�emu° subject to the • Drinking Fountains �/ olar Tank Fan Motors 00-1 HP 01%-8 - Workers' p nsation Laws of Ca Ifo la. _ Date Signator ✓ Floor Drains / G Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE: f,a ter making this declare Ion,you should become jest to the v// Workers' Compensation provisions of the Labor Code, you must forthwith ! Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes PDI¢ Light ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections fallowing reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit Generator 0-5 KW 5.15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law (Chapter 9 (commencing with Section 7000)of - Division 3 of the Business and Professions Code) or- that he/she Is exempt 'terefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil � •natty of not more than five hundred dollars ($500). $ 3 SI�Xqq I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee corhpensation, will do the work,and the structure is not Intended or offered Reinspection Fee 1 $15 Issue Fee - $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ern Law does not apply to owner if a property or who builds or improves DEVELOPMENT SERVICES REQUIg EMENTS: thereon, and who does such work himself is el/ or through his or her own Hood or Type 0 : p, employees, provided that such improvements are not intended or offered for BoilerypZoning Approved By Date rX S-C'/� sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ p , the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By ( - Date prove for the purpose of sale). x(1 J ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By bi Dat 7 tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMAR`�OF FEES So builds or improves thereon, and who contracts for such projeie cts with a con- — tractor(s) license pursuant to the Contractor's License Law). I am aware that 0 MultipleBUILDING PERMIT $ 41. SMTP S O-- proof oftheir Worker's Compensation Insurance should be provided to me. Exhaust System 0 System Repair/Alteration MIT ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLAN CHECK $ ���" PER CE $ PLUMBING $ DateOwne � � Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby c�ert(ify__that I have read this application and strwie that the above 00100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ ''i sentatives of this ty to ter the above-mentioned pro ert for I inspection p rp en2 S 6� MECHANICAL $ TOTAL FEE $ 6 A IS Signature AA,.t... Date . Drivers' License or SS if Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ i CMF 0865-46,rev.10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 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 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings �.: , r • 58. Electrical Conduit-Undrgrnd. 8. Foundation i. 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Ondrgrnd. 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 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 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping.O Gas 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Underrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75.'Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. 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: pi--7_ a k_ 34. Final Heating & Air Conditioning 2� ,r„--54-7- 7--/‘-17;e7 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water-Service-Final 40. Gas Service-Final 41. Solar Domestic-Final •42. Backf low Preventer .43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE 8/BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY:. No. Date _ • TYPICAL 611 CONCRETE BLOCK FENCE Cement Coping Optional :-1g' _in INI _ GENERAL- NOTES Channel Block With 1-3/8 TS 1 1 ' � ., '' Horizontal Top of all Fences MORTAR: One part Plastic Cement, and H _��_ GROUT: Three Parts Sand For Fences 5'or Less COne Part Cement Three and �+ One Half Ports Stand Vert.Bars 3/8"0 at 4' -0"O.C. 3El _ � �'- COPING: One Port Cement, Three For Fences Higher Than 5' Lli cc°' o , - Parts Sand Vert.Bars 3/8"¢ at 32" O.C. '¢ w --- CONCRETE: Weil Mixed 1:2-1/2: 3-I/2 = Max. of 7- I/2 Gallons of Fill Cells Solid With Grout > II z " I Water Per Sack of Cement Where Steel Occurs > - Reinforcing Steel Shall f I • GROUT MAY BE POURED FROM THE TOP Conform to Sec.A-15-39 ill • w O — _ __ ' _ _ OF THE FENCE IN CELLS WHERE STEEL I� - - - OCCURS. A.S.T.M. 1- z , CELLS AND AREAS OF HORIZONTAL REIN- FORCEMENT• SHALL BE CLEAR,CLEAN& 24"or to Code i� I. I FREE OF ALL MORTAR DEBRIS,ETC. NATURAL GRADE 1I I f TWO 3/8"$BARS '�s Gn r b • ♦ . . - a CONTINUOUS TOP I . . _. . . & BOTTOM 1�-WIDTH a - TO 16 O.C. MAX.III I SEE CHART ♦ ♦ �. .HORMSTEEL MUST BE TIED IN BELOW ' ;� . DEPTH OF E ARTHTCOTH PLACE AT TIME OF TRENCH el y .�. 1/3 THE HEIGTH OF FENCE INSPECTION. L . .-"B OW BOTTOM OF FOOTING. • �O'_l ,- 1Os T2..--1 SCALE. 1/2" = I' • FOOTING REQUIREMENTS CHART 1 WALL HEIGHT . 6 ' 5' ! 4' 3' WIDTH ' 14" 14" _12°,_, . . _ 12" ' • THICKNESS . ',..ii 'IA" 10" f3 " 8 " DEPTH OF EARTHTOOTH . . . 24." . . . 20" . . . . 16" . . i 12" SPACING OF EARTHTOOTH. . 12' 14' 16' . . 16' OWNERS NAME: _ City of Costa Mesa, California . FORM T DNUMBER `� SIGNATURE: Building Department _ _ _ -- _ __ _ _ _ _ _ _ _ v y : .._,. i_. .. (LEVI`hP_D NOV.at • Th1 i , ,' PROVED . _.... OF COSTA MESA -7!,. $ APPefitiVE0 PIANNING DEPT. City of Costa Mesa Buitdina Dept. SUBJECT TO BIOG. DEPT- EC-0. BY....e4r......... DATE_ 6- E B„. _ SA D ATE.2,(c. 1 9 8e DIRECT) OF PUNNING . Pr1 _ 13 S 2A(St V.* . 2 Tkrif11FS1.111`,11:' I- CY.—..: :.:" ,' r,: , ' .:-.7 .."-R•IS..SVAL OF • NOTE . ,. . . , .... . 4 T.:C.DE EiR I.: '.c. R .• % • • ADDITIONS, DELETIONS, OR CORRECTIONS SHALL TF;E ISSUANCE or BE APPROVED BY THE PLANNING DEPARTMENT A FI: ,T Eil,Er; kj :E.• , 7:,v,E /ND ii SPECIEITS&T:ONIS T.:H AH. I•IOR nISVE:•:•! Hil SI '..;E•CiAL FRONR INFS.:AI YEE RCCEYTIlt•.G 11-:E TEGTIRESIARN RS: IEREO: ::, IN SAD PLANS AR.ID SFER:hCATIORS OK ri.!cno, PREY I.IIING WILDING OPERATIONS BEING /EARNED ON THEREUNDER WHEN IN:VIOLA:110N OF THIS CODE OR OF ANY OTHER cen:^JANCE OF •- ,. . • • • Id lb 1 -11.) RESIDENCE RESIDENCE RESIDENCE RESIDENCE F. s. go7a tu la . I., , e tu I I- du"• e fin F. t......S* fn . ll . - . fl'-S' i . \b., t• 8' -,,,- • lel pAaAsa4 it . S TREE T 6 . • • • CITY OF COSTA MESA BUILDING DIVISION OWNER-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. 1. I personally plan to provide the major labor and materials for construction of the pro- posed property improvement. 0 Yes 0 No 2. I (have/have not) 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 City Phone ( ) Contractor's Lic. No. 4. I plan to provide portions of the work,but I have hired the following person to coordinate, supervise an rovide theinajorwo�_R - Name /171/7 y Address /67Z /VR Ola,445C City Cast# /1/55/9- Phone 1 5A- Phone ( ) JSy'6^ 60 8 81 Contractor's Lic. No. 5. I will provide some of the work but I have contracted(hired)the following persons to pro- vide the work indicated: Name Address Phone Type of Work 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 ve completed the above information to the best of my per- sonal knowledge, i mplianc with t ' iSta law. Sign �i/f Date: 2J//6/8.6,y Name: /-&4 A)k . /f-5 /gC 4/4 / (Printed or Typed) C.D.L. # or S.S. # 754-5273 1042-46 PARTY HAIL AGREEMENT • THIS AGREEMENT, made and entered into this I )� day of jy , 1988, -by and between ' ti1c,--,i k hereinafter referred to as "LAND CANER", and `14 hereinafter referred bp-as -"ADJACENT PROPERTY-OWNER". It is hereby agreed that a party wall will be constructed on the property line between / (,, -72 /21 aJt- .F C.tL'i, ( ress of Atifoining Properties) 3 / gq in the City of Costa Mesa, County Orange, State of California, as per map recorded in Book — , Page—le-of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS I4IEREOF, the parties hake entered into this Agreement the day and year first above written. • LAND CANER ADJACENT PROPERTY OWNER 0- kitti,Lc-C ignature) (Signa ure) • /5e,47 t( �g 2P. r,a TU 1, c'_ . 146 6.0 Name (Typed or Printed) Name (Typed or Printed) /67,2 /194 amgie 312c( Sc ; ly (Address) (Address) STATE OF CALIFORNIA ) ss. COUNTY CF °RAN(£ ) On before me, the undersigned, a Notary Pub c in and_ for the County of Orange, State of California, personally appeared known to me to be the person(s) whose name(s) is subscribed to 'e within instrument and acknowledged to me that (he/she/they) execut-• the same. WITNESS my hare] and'official seal. (SEAL) Signature Name (typed or printed) STATE CF CALIFORNIA ) ss. COUNTY CF ORANGE ) On , before me, the undersigned, a Notary public in and for the Co . ty of Orange, State of California, personally appeared known to me to be •e person(s) whose name(s) is subscribed to the within instrument and a, -cwledged to me that (he/she/they) executed the same. WITNESS my h-rd and official seal. (SEAL) (Signature) Name (typed or printed) OWNER SUMMERLAND LAND CO. DATE 5-3-57 _ JOB ADDRESS 1672 Madagascar Street BUILDING PERMIT NO. #4970 GENERAL CONTRACTOR Owner Bldr. VALUE $ 10,909.00 AP. No. LOT , ho TRACT 2353 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar. GROUP T & ,T TYPE V ZONE R1 PLAN NO. 5020 I•'"PECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER 1._.,ches Forms Steel tr....W/8i -/l�'% Floor System Steel Reinforce Chimney Re-Rod Bond Beam %-1 Frame and Flashing 8 -]t-5 7 Lathing, In X Out X /te -„U"j Plaster, brown coat6. `/O 1-57 Underground soil6 S7iite. V/ Pipe TesIllAeS 3s/S=.S Top Out ` hi c 5 8-a/-d' . Furnace Odil'1� 1,,..5 X-. /.-.5-7 0., A - Cerwih7..c±!i 6-/C-.-,--1 / 0 -Grpp / Gas Vents ✓ Rough Plumbing TLiFT ,}-&nn- ...47- 3--5 7 9 r;Z 6-7 ./ Cesspool Septic Tank n / rim. Swr. Line i,House Coag St. ,ildrS 40-3-YJ7 (7 e�a-1 3 -C-57 Y' 55 y Sprinkling System / Heating Final 134.L S /,/-2.4-s7 I ,/�//�/'jJ Plumbing Fixtures, Final MA c 1 I/-;-L-49 �( //,7' - l� 74----7� (�/�J% X Final Gas Test 7s `YLL.GS ,A ' .-f'-. C CL.i, .-C c-r. / /` r= `ruction Pole JUN 7 1957 VCU /44' -e�c�-7✓^' 4,_e/ '6-/ L Cr? L/ ,A-1,,,,i L .aground Power . • Rough Wiring 7J.T 7-JL--')C_ . '�1'%c/lee -e/i—. - 7.--'7'S'7 .5-1,?../ I Fixtures. Final n _ /- /4- /9SY ger (t .. r51....,_,‘ " r `) 4/' OCCUPANCY }'y?...r .,.,at. V/-2a=3') Form 210-5M-1-57 ' 5020 FEE RECEIVED COSTA MESA BUILDING DEPARTMENT 2-) I c1( 1 ek P.O. BOX 317 FINANCE DEPT. COSTA MESA. CALIFORNIA OF C MESA A FOR APPLICANT TO FILL IN APPLIICATIONTFOR PERMIT ADDRESS 1672 Lnda.;ascar Street BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. 41. 70 OWNER Sim-rip-1,1 nna T.pnd no. _ RECEIVED BVDATE RECEIVE DAATE ISSUED MAIL .�.7,� 1/4-7;"0?- VI MAY J 195,JIIII ADDRESS TEL. BUILDING CITY Los !tn^pips rInl ifs NO. ADDRESS ARCHITECT LIC. COSTA MESA. CALIFORNIA OR ENGINEER �•'i l l 'j nntg NO. FIRE ADDRESS ZONE S77mme. land LanC ONE NO.OF TYPE U./ GROU CONTRAC70ft r T ro.TY NO. `Jl1) 12- PLANS / OR /� TEL. APPROVED W ADDRESS Tnc 'lnvnl 0 cy nal i fNO. BY DATE LEGAL LOT DESCRIPTION NO. II0 BLOCK TRACT 2353 A.P.NO. SIZE NO.OF BLOCS. OF LOT 6n.l^n Now °NLOT none USE OF Cr EXISTING BLDG. SETBACK LINE FROM CENTER OF STREET 6n I REAR YARD 2'5I SIDE YARD RIGHT C 1 LEFT r. 1 DESCRIPTION OF WORK NEW 7 ALTERATION 8 ADDITION IyI REPAIR MOVING I DEMOLISH BUILDING NO.OF II'IUI SIZE 1205 ROOMS Cj STORIES 1 EXTERIOR WALL , ROOF COVERING r 1unon COVERING :nc' USE OF NEW BUILDING Si nnln 17n- i iv r"rni 1 inc 1 7_7R Q.-.001• r, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORREC yAND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND ST7 $E LAW. R ULA TIN• :UI IN CONSTRUC• VALUATION T DN / PERMIT FEE $ 2 .00 SIGNATURE OF i PERMITTEE C TOTAL FEE S /O PLAN CHECK $ 1' .nn • _ c 70 39.00 loth AUTHORIZED AGENT