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Home My WebLink About1708 MADAGASCAR ST - Building Permits CITY OF COSTA MESA y :. �,� BUILDING DIVISION t ' DEVELOPMENT SERVICES DEPARTMENT �• PERMIT ,PERMIT NUMBER '�® ✓M99-00131 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1708 MADAGASCAR ST Status: ISSUED Suite No Applied: 03/22/1999 Issued: 03/22/1999 Vicinity: Parcel Number: 13913107 Applicant RICE, PAUL L Address: 1708 MADAGASCAR ST Phone: COSTA MESA,CA Zip: 92626 Owner: RICE, PAUL L Address: 1708 MADAGASCAR ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REPIPE GAS IN SFD. OWNER/BUILDER TO DO WORK. FEE SUMMARY Quantity _ Quantity ISSUE FEE $22.00 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 Refrig 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 $5.50 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 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 $0.00 0 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 $27.50 COMMENTS/SPECIAL CONDITIONS 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)754-5826 • 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. ❑ 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 Ls issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,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 DOLLARE($100,000),IN ADDITION TO THE MAT 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.Lie.N Class# Contractors 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). 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 sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemptc. Business and Professions Code for this reason: / Signature: c--/Gf WSJ Date: 5 Owner ID verified by driver's license. Yes ❑No Drivers License No. Expires: 7711;/91; /91; Verification o1 Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Celifomia 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,ora 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 ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j]No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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 of'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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 all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe pro for in ction purpo 21 agree not to occupy or allow occupancy of any building authorized by this permit until final ins ction. Signature Legal Owner(s) Dat And/Or Authorized Applicant Date CODES INSPECTION TYPE DATE INImaL4 5nDFT INSPECTION TYPF DATE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6-1-99 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 lir ° 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 proposed property improvement. g Yes ❑ No 2. I (have/have not) VI a/14--f_ , signed an application for a building permit for the proposed work. 3. I have contra/cte with the following person (firm) to provide the proposed construction: tr Name l/1/ A 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 and p ovide the major work: Name 4/. 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 1042-46 (REV.9/9B) i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 3536 14/21/137, CITY OF COSTA ESA CONSTRUCTION PERMIT - PERpr NtO. TRACT NO. LOT NO. UNIT NO. Project Address I : 44 , , / ,' #' 2 i . Applicant's Mailing A r9 s 'A C it/' �' TYPE OF CONSTRUCTION U NEW LI ADD U ALTERATION PAIR f # (! ❑ CONVERSION El DEMOLISH ❑ OTHER • - Owner's Name % Phone W DESCRIPTION OF WORK/USE OF BLDG. A.P.# I Zone Address t- -Li/ - • • r I � • S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADINGeOUNDATION ❑ STRUCTURAL E Front Z Arch/Eng:' License No. T 0 •Address Q,�/� �� E- l TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL 8 Rear N Contractor's Nam - -� . //• • AI 'Phonej p�j��y ❑- OTHER - C Right - N Address(mailing) I 7� �'. ��+/C PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G _ ,/ CONSTRUCTION TYPE • VALUATION$ • S Left City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION - _ Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code,and M • /� my license is In full f• c- . • effect. 1 T 1 ` License I 5 _ 4• �',ce)s- .6 ,e: • • PLUMBING FEES RECEIVEDS �O Date - •..CIG- signature ��[ • APR 1- g +986- I WORKERS'COMPENSATION DECLARATION ' 'hereby affirm that have a certificate of consent to salt-insui°e or a certificate Bar Sink Showers ELECTRICAL FEES • Workers' Compensalio rs0r a certif-• copy t e eof (Section - , 1 ,800, Lab. C.) Y� .�, Backflow Preventer Service Sink Automatic Waslier Transformer Policy No. !t i �' alt Company / �.I Backflow Irrigation - 0 15-50 KW A 9 Sewer Cap Construction Pdi Sub. • P 50+KW ertified •:py is hereby fu ished. �J\ ,T�/ • Cert' ¢'s.i.sfco s tiled with the city B/�g��'si-.:.rte! {{�'c ' Bathtubs Sewer Connection Cooking Unit .. Meter ❑up to 100 amps Date IftI', N - Applicant A'� .'I - EXEMPTION FROM WORKERS'COM-ENSATIONDECLARATION Clarifiers - Solar Collectors Dishwasher -t ❑ Meter over 100 amps ' " (This section need not be completed if the permit is for one hundred ($100) or . - . less). Dishwasher • Solar Piping Dryers ❑Gas'•BElectric Sub Panel ' 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 Drinking Fountains Solar Tank Fan _ - Workers' Compensation Laws of California. _ Motors 00-1 HP 01%-8 . Date -Signature Floor Drains Swimming Pool w/Spa • F.A.U. 'NOTICE: If,after making this declaration, you should become Subject to the — _. _ Inc.Solar 09-15 HP 016-15+ - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures ' comply with such .provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - • Device Boxes I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.)- Interceptors / Water Heater 'Outlets • Lender's Name - - Range 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-WashGafba a Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 P ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays Generator 0.5 Kw ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit ❑ '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 . lerefrom and the basis for the alleged exemption. Any violation of Section ' )31.5 by any applicantfor a permit subjects the applicant to a civil • ' 4nalty of not more than five hundred dollars($500). LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL Reinspection Fee I $15 Issue Fee $ 3 License Law does not apply to an owner of a property who-builds or improves - FEES thereon, and who'does such work himself/herself or through his or her own • iDEVELOPMENT SERVICES REQUIREMENTS:' i employees, provided that such Improvements are not intended or offered for Boiler Hood or' Type I ❑ ` sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ _ Zoning Approved By Date ' plebe'', the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground ' prove for the purpose of sale). Building Approved By ///�� Date �[ _-s p/ O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - • Application Issued By ' e/}L' Date 'T CCJ-O(O tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑o-100,000 BTU ❑100,000 BTU builds or improves thereon, and who contracts for such projects with a con- SUMMARY OF FEES. tractor(s) license pursuant to the Contractor's License Law). I am aware thatExhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT i O lam exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers - /1 1 PLUMBING $ lCP0 ISSUANCE $ Date i • Owner Heating System&Ducting ' Registers _ _ pL,gN CHECK 25% $ ENERGY P.C. $ • I hereby certify that s have read this application and state that the above 00-100,000 BTU 0100,000BTU _ I GRADING I$ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ - . and state laws relatin• to building construction,and hereby authorize repre- - • MICROFILM ;$ sentatives of - s • to enter •on the above-mentioned property for { I PLAN CHECK 50% $ 1, ' inspection pu :� �/ _ i ,�,/• �/ _ I • MECHANICAL $ TOTAL FEE $ 11w i Signature . �.,.1. Date / -i-6 Drivers' License or SS# �� Reinspection Fee s $15 Issue Fee $ 3 PLAN CHECK 25% $ , CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING POOL ,PA - 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 ' a. 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 Sign68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace APPROVALS Permit# 21. Duds,in Structure70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil "25. Roof Sheathing 74. Overhead Hydro . 26. 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 PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 7-)4-36 LEFT(AGO CV). 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy . ' - 37. Final Factory Fireplace ' 38. Final Plumbing ,'-2-S1 £10 . 39. Water Service-Final Crt 40. Gas Service-Final c%I 41. Solar Domestic-Final -^' II1 . • 42. Backflow Preventer 0 - 43. Backflow Irrigation Cr - i - , r it 44. Landscape Irrigation System 45. Sound Attenuation . 0 • 46. Handicap Regulations tap 47. FINALSTRUCTURE & BUILDING• . - 48. Special Requirements Completed 49. Electric Release to Edison - • - - - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • • No. - Date ' • . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 2086 I I /13/84 18050 IL _ CITY OF COSTA MESA C NS�TR�U/CT�ION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Projec4 Address4 /1Q �/ '�' -"""""c' 2 Yl._,1 ly 1htCC//__ Ci . • Applicant's Mailing Address (,5Y/4__01_ (�-.' 4t4' TYPE OF CONSTRUCTION LI NEW LI ADD LI ALTERATION LI REPAIR ,I Owner's Name G� Phone ❑ CONVERSION DI DEMOLISH ❑ OT R A.P.# Zone Address �70s � DESCRIPTION OF WORK/USE OF BLDG. -r 0 S Main Building: Accessory Building: Arch/Eng. License_ No. TYPE OF PERMIT ❑ GRADING DI FOUNDATION ❑ STRUCTURAL T Front Z Address 7• ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N Contractor's Name � / �Phone' 7-/J5r ❑ OTHER s SW A---- ,. [� / PROJECT DESCRIPTION SQ. FT- /0 U b OCCUPANCY �1�� C Right •• - G Address(mailing) 7- .Zan CONST RU CTION TYPE VALUATION $ 5-<-60, S Left • - City'LicenseNo_ z1SI ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided - E D I hereby affirm 7 that I am licensedion under provisions Charterroi (commencing, Remarks: _ - Planning Notes: • - M • my section full of Division 3 of the Business and Professions Code, and • T my license is in full f. ce ant e tett. �OD�� S License CI.55 I/ense No. Date ' tali Signature �`�L bI'Lize..-ed PLUMBING FEES - WORKERS'COMPE SATION DECLARATION Bar Sink Showers . _ . ELECTRICAL FEES ' I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance,:or a certified copy thereof (Section Backflow Preventer Service Sink3800, Lab. C.) -- - -. ' Automatic Washer Transformer 0 15-50 KW - -- - - - Policy No. Company Backflow Irrigation Sewer Cap • iConstruction Pole Sub. • 0 50+KW-' 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit 'Meter ❑up to 100 amps -- Date Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps ' (Thissection need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel • I certify that in the performance of the work for whit ,this permit is issued, I shall not emplo an son in any manner ecome subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01'4-8 ' Workers' Qv t w5 of California/4 ' Date // � f/ / Signature � ""'-"" ( Floor Drains, Swimming Pool w/Spa F.A.U. NOTICE: If,after making this declaration,you should become subject to the _ Inc.Solar ❑9-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks _ Urinal , _ Fixtures - __ comply with such provisions or this permit shall be-deemed revoked. - - . - 'Microwave - - - - --- — -- - CONSTRUCTION LENDING, AGENCY Gas Service '.Outlets Water Closet Device Boxes . 1 hereby affirm that there is a cnstruction lending agency for the performance 'Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Ran e Lender's Name - 9 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 following 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 ' - • Generator 065 KW 05-15 KW Trash Compactor 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 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 - 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 $ 3 IDi,-as'owner of the property or my employees with wages as their sole Reinspection Fee l $15 Issue Fee ' compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES p $15 Issue Fee' License Law does not apply to an owner of a property who builds or improves , SERVICES REQUIREMENTS: thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ • employees, provided that such Improvements are not intended or offered for • ypZoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 / p,,,/// pletion, the owner will have the burden of proving he/she did not build or In- Duct-Under Ground Building Approved By tide Date—7/ �� /� prove for the purpose of sale). ��A�,' Dat I( ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By [[� �V tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who , . Duct- Ventilating 00-100,000 BTU 0100,000 BTU • SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- , 5a tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ ( 'CO SMIP $ J proof oftheir Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration • PLAN CHECK $ PERMIT ❑ I am exempt under Section B.&P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BT ELECTRICAL GRADING • $ information is correct. I agree to comply with all city and county ordinances - $ and state laws relating to b 'Iding construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this c)) o t3 ter upon the above-mentioned propertytoy _,l inspection pureqses/ • / / / MECHANICAL $ TOTAL FEE $ k%-gt.) Signature [if 1 _ Date ///� Drivers' License or SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White . Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - / CONSTRUCTION AND PLANNING - - POOL ax SPA s. Date Inspector Date Inspector /. APPROVALS - Permit# - APPROVALS Permit# p"' 1:1'emporary Electrical Service or Role - -) '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 r 7. Footings - 58. Electrical Conduit-Undrgrnd. - - • 8' Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test - • 9. Water Pipe Undrgrnd. - - 60. Backwash Lines,P-Trap, ❑ 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 . 1d. 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 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 4 73. Undergrnd.Storage Tank ❑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 PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy ' • 37. Final Factory Fireplace - 38. Final Plumbing • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final ' 42. Backflow Preventer , 43. Backflow Irrigation . 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations ' , - 47. FINAL STRUCTURE & BUILDING 41 14: /W . ' 48. Special Requirements CompletedIJ , ' 49. Electric Release to Edison - - . - 50. Gas Release to Southern California Gas Co " 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA.MESAp- CONSTRUCTION{�yPERMIT PERrirw7kT NO. (/!� 7/ TRACT NO. LOT NO• . UNIT NO. . Project Address '/�t,1 _ !/(Q/.GC�-•/t j/J O r /,) • ��! • r7y/ Applicant's Mailing Address -law t- telare 7c e TYPE OF CONSTRUCTION ❑ NEW U ADD LJ ALTERATION L� REPAI R /�c h /)��,��e/� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P.# Zone Owner's Name (7 V-' / Phone`7 Y DESCRIPTION OF WORK/USE OF BLDG. Address Erni-C, • S Main Building: Accessory Building: • • Z • ❑ Arch/Eng. License No.' TYPE OF PERMIT GRADING y FOUNDATION ❑ STRUCTURAL T Front o ❑ TENANT ❑ ELECTRICAL 4u PLUMBING ❑ MECHANICAL BB Rear • N Address • QQQ��///}}}/� ` ❑ OTHER Contractor's Name 414 i /iLo - •"tie 0QJ - K Right • N �� % �! $'� J J. /�/ PROJECT DESCRIPTION 5a. FT. • OCCUPANCY Left • R Address(mailing) ,tG CONSTRUCTION TYPE VALUATION $ s City License No. 2 ZONE GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and 1�pQ T my license is in full o ..and effect. RECEIVED JUL 2 8 0��77 • License la 0^ ! Li ce ae N• imyc - f�G Qt Date ` signature/drift/ 4z PLUMBING FEES - f` CEIV (_(O` '1�� Signature /' WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES_ \ ' 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 Service Sink d00, Lab. C,}„�n n„�� Automatic Washer Transformer ❑ 15-50 KW • N.\ Policy No. /'�/� (�?Y CompanyOtt Backflow Irrigation ❑ 50+ KW 9 Sewer Cap • Construction Pole Sub. \ rtified copy is hereby furnished. LCerAtifie scoxp tiled with the city :n •o'l •- Bathtubs Sewer Connection Cooking Unit Meter Duro to 100 amps Date C Ci O Applicant - EXEMPTION FROM WORKERS'CO•PENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or — less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 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 Drinking Fountains Solar TankFan Motors Do-i HP 011/2-8 Workers' Compensation'Laws of California. - Date Signature Floor Drains Swimming Pool w/Spa F.A.U. - Inc.Solar 09-15 HP D16-15+ NOTICE: If,after making this declaration,you should become subject to the 1 . Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures . comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes - - I hereby affirm that there is a construction lending agency for the performance !1 Pole Light of the work for which this permit is issued (Section 3097, Civ. C.) Interceptors i Water Heater -1 ;� 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-WashGarbage Disposal Standing Sections following 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 Generator 0o-5 KW 05-15 KW ' ' any structure, prior to its issuance, also requires the applicant for'5uch permit to file a signed statement that he/she is licensed pursuant to theiprovisions 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 ierefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). • ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3 • compensation, will do the work,and the structure is not intended or offered - Reinspection Fee f $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type !! ❑ Zoning Approved By Date pe the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Dat_ prove • t for the purpose of sale). - ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat tractorsto construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES. , builds or improves thereon, and who contracts for such projects with a con- — tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT C I am exempt under Section B.& P. C.for this reason Firepl/Fact.BIC ICBG# Fire Dampers • PLUMBING $ vitt ISSUANCE $ 9 SystemDucting 9 Date Owner Heatin & Re isters PLAN CHECK 25% $ _ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,000BT ' GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for fey) inspection pur •-- - MECHANICAL • $ TOTAL FEE $ ,^.L�/ V Signature ✓ . %' ,-� � pains ection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ 01 IiRR jl1F.')R-00 i Drivers' License or SS# �;/� — 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's lectricalService or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms m , 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 00 5. Steel Reinforcement 56. Rough Plumbing & Pressbfe Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVEIt„GUNITE 7. Footings 58. Electrical Conduit-Undriggrnd. • 8. Foundatiori� (,,, 59. Gas Pipe, 0 Undrgrnd.�.Test 9. Water Pipe-Undrgrnd..) • 60. Backwash Lines, P-Trapit Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECKLI 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 I.. 23. Gas Pipe-Rough & Test 72. Underground Flush '' .9 24. Roof Framing. 73. Undergrnd.Storage Tank Opas O Oil 25. Roof Sheathing 74. Overhead Hydro i i 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ''--- 76. Dry Standpipe ' 28. Lathing& Siding 77. FIXED SYSTEM FINAL 4 i , 29. Insulation 78. FIRE PREV. FINAL CI (II - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT "-- t 1 31. Plaster Brown Coat 79. FINAL INSPECTION tri' ,, 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - 4:: 33. Final Electric Notesi G-NY Lir 64¢o. ‘. E,b - 34. Final Heating & Air Conditioning - - 35. Final Gas Pipe-Test . . - 36. Hood or Canopy - . 37. Final Factory Fireplace `/ .• 38. Final Plumbing Q/y/�'Y 39. Water Service-Final T - 40. Gas Service-Final - .-A . 41. Solar Domestic-Final ' 'L 42. Backflow Preventer - a 43. Backflow Irrigation • . ,'Z., 44. Landscape Irrigation System , '�7 45. Sound Attenuation . ' j' 46. Handicap Regulations - r� -34 47. FINAL STRUCTURE & BUILDING • - j 48: Special Requirements Completed 49. Electric Release to Edison . . 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ' No. Date _ ., \ ` . ,\ V. co Grill. w".. ....a. r ) 461isUL PROJECT ADDRESS: 1708 MADAGASCAR ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 064570 OWNER'S NAME: GISH, GLEN L ADDRESS: GISH, BEVERLY A PERMIT NO: P 064570 PLAN CHECK NO: N GOVT: N SUPP : N 1708 MADAGASCAR ST COSTA MESA,CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH ARCH/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : RELOCATION OF WATER HEATER SQFT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: PROGRESSIVE DESIGNED PLMB ( 714 ) 580-3500 ADDRESS: 6 VANDERBILT B COMMENTS: NO ' B ' PERMIT INVOLVED . IRVINE CA 92718 ******aF1r-i ********x-*** -*FF+F+r******IF-****1F************1F+F****+r****1t-n-+aFF**** *****1F*FF* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect SETBACK $ CITY LIC.: 04 45 STATE LIC.`334799 ` CUSSF 36 Date:—IC Signature: i_ ( MAIN BUILDING ACCESSORY BUILDING WORKERS'CO PENSAT N DECLARATION: I hereby affirm that I have a cenificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3600.Lab.C). LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN POLICY NO.: WC 1 2 0 7 1 7 0 4 6 EXP.DATE: 10/01 /94 coMPANY: VALLEY FORGE IN PARKING R9: PROV: PARCEL : 13913107 ZNE : REF NO: ❑ Certified copy. hereby f rnished. (}� Certified copy is filed with the city 7iilding Division. PLANNING NOTES> Date: o�Z 3 Applicant: NQS._. C ***********************************************:******************************** EXEMPTION FROM WORK S'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)mless). DEVELOP MEN T S E R V I C E S:`' REQUIREMENT S 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. ZONING APPROVED BY ' , DATE: Date: Signature: NOTICE:If.after making 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. x 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(Section 3097.Civ.C). APPLICATION ISSUED BY: DATE: O ******************************** * *********.*********************# ** LENDER: ***********************************************'******************************** ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or P ERM I T 7, 00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE 20 . 00 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILD ING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'Slate License Law TOTALS----> 7 . 00 20 . 00 0 . 00 27 , 00 27 . 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. II.however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 27, 00 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware .x,*,*,*.N,*,****, *,*,**,*****,*,*,***,*,***,****,********************************************** that proof of their Worker's Compensation insurance should he provided to me. ❑ I am exempt under Section: B.&P.C. INDIVIDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 , 00 25534 and that I or arty future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of Ibis city to enter upon the above-mentioned pmpeny for itnspeclr . purposes. // _ Date: Signature: sl 01 E 0/22/ 324 TI09ME TOT10:23 27.00 DATE:010/22/93940 - TINE: i0 23 Driver's Livens:or Social Se unity 0: 1641-46 white—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit-err` Date Inspector APPROVALS Permits 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 Condurt•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER 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 1 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final I 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 0 Oil 23, Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation I 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED 33.-Final Electric r Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test - 36. Hood or Canopy $7. Final Factory Fireplace 38. Final Plumbing Alf" C, I 39. Water Service-Final � I� l 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co • • 51. CERTIFICATE OF OCCUPANCY No. Date . 1 OWNER SYCAMORE LAND CO DATE 6_29-59 JOB ADDRESS 1708 Madagascar St. BUILDING PERiMIT Na 9771 GENERAL CONTRACTOR Malgren Const. VALUE $ 16,936 An No. LOT 93 TRACT 3363 FIRE ZONE DESCRIPTION OF WORK res att gar Ii ECTIONS L it/ DATE I GROUP I & J TYPE V ZONE ' R1 Underground SoilfA•ifU.G. Water R i✓_ Se/6 SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating /1/frc 9-30-5-{9 w ,�, , .i � e' Rough Plumbing L. W 9-/j-5'1 i1c li. 7-/2-SL c e l — Miscellaneous Prop. Swr. Line/ House Cony/St. Swga[/ -1-/6-57 /fro/Roto' city 9 ic-57_ (1_d_o/ - ..1- Sprinkling Sprinkling System _ / ' ��'6d Plumbing Heating, Final !�� Q —_1 Plumbing Fixtures ��h K/ Y Final Gas Test /b 4 /.e/��((( Construction Pole _ ' Underground Power -9--7,75--, Rough Wiring ,077A 7/; *77/2, 5577,, ,----, /e,c 9 /,i Trenches Forms Steel /• Floor System Steel Reinforce Chimney Re-Rod Bond Beam S ding Wel 11-11-59 Fi—le and Flashing //#1,)- rd-17- 0 Lathing, In/j'/9'/t1 Out , 9 r 'd-79 ->G Plaster, bro n coat /113/1, u_275' Plumbing Fixtures, Final t L�/ /t16 Electric Fixtures, Final f� � . D Building, Final )) iF_7 OCCUPANCY /(- / / 1 Form 410-3M-4.59 9`771 . . aI . COSTA MESA BUILDING-SAFETY DEPARTMENT " i _5c 'II P.O.BOX 317 COSTA MESA, CALIFORNIA - FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING BUDRESSoOp AADAO4SrAC sr COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. I P RMI / OWNER Sycamore Land. Co. IT T MAIL 10835 Santa Monica Blvd- RECEIVED BY DATE RECEIVED `ATE ISSUED �-� ADDRESS ,A/tom Ai _a/ --Si 4-.-5- 7 Los Angeles TELBr23287 BUILDING CITY NO. ADDRESS ARCHITECT LIC. COSTA MESA, CALIFORNIA OR ENGINEERL.C. Maj Or NO. ADDRESS 11015 S . Paramount Blvd. ZONE 1. ,i �9 Malgren Const. STAT -53335 APPROVED CONTRACTOR LIC.NO. BY DATE . ADDRESS 10835 Santa Monica Blvd. ZONING LEGAL LOTZONE NO.OF USE OF NEW I DESCRIPTION I NO. 93 I BLOCK I TRACT336:: � I PLAN$ I BUILDING A.P.NO. APPROVED/ //� //-� BY DATE G. 1 SIZE NO.OF BLDGS. - - EVES OF LOT 9R 63 X 71 sn I NOW ON LOT n REQUIRED ALLOWED USE OF (CENTER LINE ST.) s ''ll EXISTING BLDG. FRONT y FT. IN. SETBACK LINE FROM 50 25 CENTER OF STREET REAR YARD R.SIDE 1 FT. IN. SIDE YARD I LEFT 6 I RIGHT 5 L.SIDE S FT. IN. DESCRIPTION OF WORK REAR It. FT. IN. NEW I XII ALTERATION I II ADDITION I REPAIR -f I-s II MOVING I II DEMOLISH I SBIZIE LDING 170 ROOMS 6 STORIES 1 EXTERIOR WALLStUCCd ROOF wood. shingle COVERING (COVERING USE OF BUILDING AND WORK TO BE PERFORMED Dwelling new conotructcbn 2C Att. Gar. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LA REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUC ON. /A• VALUATION SIGNATURE OF 7 PERMIT FEE $ ,_.#3,41PERM ITTEF �.� O7(Yte '7 //'� $/l 9. �- PLAN CHECK $ if y//� AUTHORIZED AGENTi�%;fit`% � / 7. . /Y/ !/ TOTAL FEE S /