HomeMy WebLinkAbout1724 MADAGASCAR ST - Building Permits CI di
CITY OF COSTA MESA
0501"'er BUILDING DIVISION
9
i I ?,r�.,�5'I` 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us r
4 trill FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: P10-00022
PERMIT TYPE PLUM STATUS: ISSUED
APN: 13913109 DATE ISSUED: 02/04/2010
ISSUED BY: KJB
JOB ADDRESS: 1724 MADAGASCAR ST CM Suite/Unit:
Vicinity:
SCOPE OF WORK: COPPER RE-PIPE.
OWNER: NEMZER,SIDNEY R Address: 1724 MADAGASCAR ST
PHONE: 714-751-7599 City/State/Zip: COSTA MESA,CA
APPLICANT: NEMZER,SIDNEY R Address: 1724 MADAGASCAR ST :
PHONE: 714-751-7599 City/State/zZip: COSTA MESA,CA
CONTRACTOR: License No.
Address: PHONE:
City/State: ZipCode: CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $43.10
TOTAL FEES: $43.10
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
SIDE$, IN$PECPONTYPE CAE INTRIAL$ CODE! INSPECPQN TYPE Dr INPPAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 2/23 f!D
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
WORKERS'COMPENSATION DECLARATION Owner ID verified by drive license. ❑Yes 0 No
I hereby affirm tinder penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and^ill maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, a4 provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. ,
El I have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy El I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This sedan need not be completed if the permit is valued al one hundred dolars(5100)or less)
2,Art Se0 341,Title B,Califomia Administrative Code).
Polio Number:
0 As owner-builder, I will not employ anyone to do work which would
0I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issu d, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the ers'compensation provisions of Section 3700 of Applicant's Signature Dale
the Lab coq I shall f tl 'th comply with these provisiorr�ts.
q�r/�� / 2/ LEI
I
\ Division of Industrial Safety Permit Number:
!J ( ' /Y II 3t ' lJ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE GWORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($1®,000), IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑ No
Lic.# Class# (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
Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
0 I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Dale
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the ba 's for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
appli•:nt for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
fiv: undred dollars($500).): of the California Health and Safety Code).
��et I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
pensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If yes-.attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer).
sale. IL 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to conshuct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of 1 Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspectio •ur•oses. I as a not to occupy or allow occupy cy of any building
authori 'bv is permi t til final inspection. o
f a ,�-,�,u� _l..) ��N_. Legal Otwer(s� Date_
C D WIY - UyS — Date
306746(won Andlpr AuttiOnzed Applicant Date
r ,,
_�^ City of Costa _Mesa Built ing Division
Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit# ` i o - 0 0 0 a
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at 7 a Li AA a& AS Ca. r
We are providing you with an Owner-Builder Acknowledgme t and Informationoderification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
C_ .
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Build r" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
A. ,2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
1 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
numbers on permits and contracts.
c I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
h total value of my construction is at least five hundred dollars ($500), including labor and materialsyl may
be considered an "employer" under state and federal law.
l► 6. I understand if I am considered an "employer" under state and federal law, I must register with the state
. . federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
cbntribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
r si ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
C -t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any .latent
onstruction defects in the workmanship or materials.
aC( understand I may obtain more information regarding my obligations as an "employer" from the Internal
\/' ve Service, the United States Small Business Administration, the California Department of Benefit
/ Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
c10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
1— am the party legally and financially responsible for proposed construction activity at the following address:
Ckb. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
ab Iy all applicable laws and requirements that govern Owner-Builders as well as employers.
CI 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notari ation, or other verification acceptable to the agency is required to be
presented when the permits issI d to v 'fy the property owner's signature.
f Signature of property owner /C -6---..____ ' Date: y I/D
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
3148-30 CALBO Jan 1, 2009 OB Packet template2 of 2
�F CITY OF COSTA MESA
t BUILDING DIVISION
>:r",,,I1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�
. c4 . PERMIT
® E06-00757
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1724 MADAGASCAR ST Status: ISSUED
Suite No Applied: 07/12/2006
Vicinity: - Issued: 07/12/2006
Parcel Nunmber: 13913109
Applicant: BISHOP, ROBERT `
Address: 5552 AMADOR AVE ISSUED BY:
Phone: 714-893-0130
WESTMINSTER,CA Zip 92683
Owner: NEMZER, SIDNEY R ,
•
Address 1724 MADAGASCAR ST
Phone:
COSTA MESA,CA Zip: 92626
Contractor BISHOP ELECTRIC
Address: 5552 AMADOR AVE
Phone: 714-893-0130
WESTMINSTER,CA Zip: ' 92683
License:763795
SCOPE OF PERMIT
RELOCATE AND UPGRADE SERVICE PANEL TO 200A AND 1 OUTLET LOCATED AT SIDE OF HOUSE.
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 $0.00 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 I 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 $1.10 1 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 $30.50 1 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 $0.00 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 .
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES . $55.10 ,
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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 end 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
2446-46(aroo)
a
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 is issued.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit Is 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 agr a that If I should become subject to the workers'comperisetlonprovisions.of.Sectlon 3700 of the Labor Code,I hall forthwith
comply with these Aprovl%jlon . 1� l�j /j_•
Applicant Signature: SE M. Date: i (O(Jr� 270 O l7
•
WARNING:FAILURE TO CURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ISICO.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am Iicen-•. u •:r• of Chapter 9(commenting with Section 7000)of Division 3 ol.the•Business and Professions Code,and my license is in full
force and effect..Li p.n - � [Glass'p—J C /0 /'
' 'Contracto,sSignature:l ��►�L#� Darts: y y 6 / I)//7 t;
„ :.__.
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,CMI 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 IJcense Law(Chapter 9(commenting 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 properly,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 exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
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(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(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:
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 somo exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 WDoes or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention-Frog-ram-I´ly hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 ermit 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 U 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? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
l_..t_...._..._.__ _._ _._..._..._..__._. __._.._._
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 penally 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
a
• eget Owner(s) D e
UNTIL_ _.itura a ?Y/io
' r i.And/Or AJ prized Applicant' 1 Date—..+
CODE I INSPECTION TYPE - PATE 1[iihlbLi CODE4 INSPECTION TYPE PAIS INTIMAL$
1618 Fixed System Final Fire Prevention 206 Final Mechanical /�/c��/q'-7'�,w'
1268 Pool Spa Final 208 Final PElectricag
l
�)�JJ _"
200 Final Re-Roof 210 Final Electricall���,--..
201 Final Block/Retaining Wall 212 Final Fire Prevention
Q
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 • Final Demolition 250 Final Building/Occlipency
ADDRESS Of[WILDING:, 1724 MADAGASCAE� ST WIT: _ ._ . .. _ __ . _ CITY OF COSTA MESA - BUILDING PERMIT _
CWNERSNAYEIVIGIWN:NEMZER SIDNEY R PERM NO: P 081898
AOOgss5:1.724 MADAGASCAR ST
COSTA MESA,CA 92626 1 9 - E PERMIT NO: P 081898 PLAN CHECK NO: N GOVT; N SUPP; N
751-7599
AP PL.NABDNGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: REP
ARCHITECT OR ENGINEER: uc.ND.: JOB DESCRIPTION : CHANGE OUT WATER HEATER SQ FT:
ARCM.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
caftRAcrars NAME COMMENTS : REPLACE WATER HEATER
CpBRACTOR5 MAILING ***************************************************************************if**1f
ADDRESS LIG.NO.:
at ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirmnd
m under paty perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 d the Business and Professions Code,end my license bin full force and effect
CITYUC.NO.: M.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT . IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
WNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I are exempt from the Contractors License Law for the
to5owing reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct alter,improve, PARKING REQ: P ROV: PARCEL : 13913109- Z N E: REF NO:
demolish,or repair any structure.prior to its issuance,also requires the applicant for such permit to fib a signed statement that he or she PLANNING NOTES>
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Drviion 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 permitsubjeds the applicant to a civil penally and more than fie hundred dollars RSoolD. ******1E'lE9fiflE1E1f1flElElffElffflklflflElElf')E****iflElEiEififfflklEfEiElEffiE1E*1k1f1E1E1k1f1ElEff{E{f1ElE1flElf{p.7p*{f9f#ff.IflflFif.{f{f{E{f{f.
❑ I,as owner d the property or my employees with wages as their sole compensation,will do the work,and the structure i not intended DEVELOPMENT SERVICES REQUIREMENTS
or altered for sale(Section 7044,Business and Professions Code:TheContractors License Law does not apply to an oscura of Pr9peM •
who builds or improves thereon.and who does such work Nmsei or herself p through hi osher own employees,Provided that such
improvements are nil intended or offered for sale.R.however,the building or improvement o sold within one year of complefm,the ZONING APPROVED BY DATE:
X owner-builder will neve the burden of proving he or she did not build or improve lar the purpose of sale). - ---
❑ I.as owrer d the properly,am°xcluenay mniradi g with licensed wntredon la conoid the project((Sectors 71344.Galina"and BUILDING APPROVED BY : /.:\ DATE:
Professions Code:The Contractors License Law does notapply to an owner of Prn ovewho builds or improves thereon and vitro 'J� /�
contracts for such projects with a contract:Ns)licensed Pendant to the Contractors License Law). f ` ' 'f DATE: ✓ ' - ✓�
❑ I am exempt under section: B. P.C.,for this iii-*APpiLEiIEiCEfAfi**OiNE*II*EISiUEiEED*BiYbfE**********************lr*1EiE *******1F**********************
jf
Dace �' / q7 °w"°` ��/ ��[(�C/l LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
I do hereby certify Mat l an aware of and understand the requirements of Cdaomia end Safety Cade Sed ion°25505,25533.and
25534,end Mdl o any future buDdiag occupant will not ore)need to comply with said state cdroud the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions.moauudion o modifi�ionhoorhe Aimanagement District.Residential constn,ain applications me sxamp from ties. PERMIT 11 ,00 _
25% SMIP/NON-RES
Dale: Applicant: PLAN ft"' -"I
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaby of perjury one of the following declarations: ISSUE FEE 22,00
❑ Ihave and veil mdnnoac°rttliuteoconsent loself-insure for workers'compensation,as provided lobySection 3700el the Labor BUILDING-DIV-> PERMIT ISSUE PIAN=CHECK TOTAL PAID DUE'
Code. pedonmemsedthe work l«wNah thispermuiiasued. TOTALS----> 11 , 00 22 .00 ; - / 0 .00 33 .00 33 .00 . 00
I I have and ail maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
work for which paned is this perieaued.Mywos compensationkecompensationp»ra
ion insurance and policy number are:
REVENUE DIVISION TOTALS--> COLLECTED : 33 .00 OVER/SHORT; 00
Policy`
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed if the pennk is for one hundred dollars/51001 of lose.) 33 . 00 !_
X❑ I codify that in the performance of the work/or which this ppmit is issued.I shall not employ any person in any manner ea as lo
become subject to the worker'compeneeton lawn of Califon,' and agree that if should become cabled to the workers *************************************W*****************************************
compensation provisionsofion 3700 d Me labor cora.I sit �h hy,lyltl those provisions. I N D I V I D U A L' :TEE B R E A K D O W N
Date: 3-4- I Applicant r 11155//_p%i'yc3tn,e,,
Warning:Callum to secure workers'compensation coverage la unlawful,and a subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines rag to one hundred thousand dollars(51040001,In addition to the cost of compensation.damages as provided ler In
Sectfon3706oftc
eLabo,cods,Intentsandattormey'slees. PLU 1 WATER HEATER AND/OR VENT 11 . 00 11 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there S a dostrudi°n lending agency for the END,-...OF F EES
performance of the work for which IS perms is issued(Section 3097.Cir.C).
LENDER'S NAME: y�.- I
LENDER'S ADDRESS: ' On
I certiy that I have read this application and date that the above information S coned.I agree to comply with all city and county ordinances
end sun laws relmitg to buiikq construction and hereby aWerie representatives of this cyto enter upon the above-mentioned property
for inspection ampoeeeSID NEMZER
P_ earn. 83-@4-1997/12:11 MV$33.80
.2; 2 11 f Dole: //3/j PERMIT0081898
Sign= ent/Ap ndContracor
..(5151"45.WP) White-Building&Safety:Green-Fle:Canary-Appicent:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLVININ. -- L& SPA
• APPROVALS Permit
Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - •
F3. Electrical Conduit Utility•Undrgrnd. 54. Forms - •
= ' 4'. Electrical Conduit-Undrgrnd. _ 55. Electrical Bonding .
•.S.Sic-e1 Reinforcement 56. Rough Plumbing & Pressure Test -
,75. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE tr:
•= 7:•Footings • 58. Electrical Conduit-Undrgrnd.
• 8•. Foundation 59. Gas Pipe,0 Undrgrnd.,Test '
' • 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing System - Final
14. Rough Plumbing • 65. Electrical-Final
•15. Rough Electrical-Conduit ' - I 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning r ti- FIRE DEPT.•.REQUIREMENT
- - r-: r- - r
20.TRough Factory Fireplace ' 71 -,y , -s ,-• APPROVALS;" Permit# -
- i
21:-Ducts,iri Structure• - '• cr. -, _ _ `.. '- 70^UndeYground Hydro r
22. Ducts, Ventilating ' `'` -k �, c - q. 71. Producti'iping E_Gas C Oil
23.:Gas-pipe-Roagh & Test _ 7,.1:-.7-: • -• c. _ :' ^_, 72. Underground Min • R
24:Roof Framing _. - - * ' 'j i.- 7a. Undergrnd.Stor49e Tank i]Gas El Oil
25. Roof Sheathing " . n 74. Overhead HydFa
2651-Bar Ceiling (StrLcfural) &-Monacoat 7 , Dry Chemical
m
27. Frameand Flashio9 = r z • - -" 76. Dry Stdpipe-T- x t
_ fr
28. Lathing.$[ Siding.: '' =t r ZIT r ,- :: . ,'' ii. FIXEUSVST hit.'N iL . .-
29. Insulation a - 78„FIRE.PREV. FINAL cr
30. Drywall:Nailing _ r_• ..7...%:.At j;,.,HEALTH DEPT":REQUIiREMENT
' 31. Plaster Brown Coat- - • rm t * '" 79. FINALINSPECTION * ki;
32._Electrical Power Meter-Final x 6.7. 84. FOOD CERTIFICATE ISSUED
33, (final Electric Notes- t `
_ 3-b_9Z-/(o_,:/�_cc.er%-Z . 46 W
34.'Fin'il Heating& Air4 Conditioning- . > ' 72 -
35.7-Final Gas Pipe-Testi :_ -‘ ft C = ^.-t
36. Hood or:Canopy r-• " 1 r- = :: ° ^ K
- 37.:Final Factory Fireplace,-.- - - r _ r"Sy'
y
38. Final Plumbing ` Cr75:-.14 11) x z' . '1' _
39. Water Service-Final , • t, S, ` Y Y;
' ,,
40. Gas Service-Final a' > •Ti - -
�-• 1 ,_ = L ? -1.
:, 41. Solar Domestic-Final- ;,.� > c 7.
42. Backflow Preventer" - p • -
r _ .r -r(�
'c x
_ ° 1
43. Backflow irrigation.. z o. : C
T44. Landscape Irrigation Syster» r - t •. - _ n: =`cc r M1 6 I
i ' r - 's 't- E'4.: i' - C,
-45-Sound Attenuation . .. r •-- t- - • :-•n
46. Handicap Regulations - c a: •," 71- 3' z.
47. FINAL STRUCTURE & BUILDING - r• -
48._FINAL PLANNING - - . -- r ill CI
- { a ♦ .- f`
{ `j-•
49. Electric Release to,Edison r;j -
'50._Gas:Release to Southern California Gas Co r - •-• C. =r-
p x rt1
51. CERTIFICATE OPOCCUPANCY t``- - `
No. Date
milmoFmom 1124 MADAGASCAR ST UM1 CITY OF COSTA MESA • BUILDING PERMIT
' OWNER'S NAIFIFpelt NEMZER, SIDNEY R PERM NO: B 074614
ADDRESS: 1724 MADAGASCAR ST
COSTA MESA, CA 92626 PERMIT NO: B 074614 PLAN CHECK NO: N GOVT: N SUPP: N
• 751-7599
APR.MAIUNDADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: 0TH
ARCHITECT OR ENCdtEER: UC.NO.: JOB DESCRIPTION T/OFF & REROOF W/BUILT-UP SQ FT: 1 , 340
ARCH.OR ENO.•s ADDRESS: uNt: CLAIM VALUE: 1 , 340 . 00 CALC-VALUE: 1, 340 . 00 GROUP OCC: R-3 /
ca"rnllcrorsmE: A PLUS ROOFING (714 ) 775-1947
CONTRACTOR'S KAIUNO 11237 SLATER AV COMMENTS : REROOF 3O0SF PATIO COVER W/BUILT-UP
FOUNTAIN VALLEY CA 675241 *********************************************************** �+4
ADDRESS: 92708 UC.NO.: Z ON INC R EQUIREMENTS O„€ D TG1.! I �e/�'
SETBACKSK S C/��
UCENSEO CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I ern licensed under provisions of Chapter 9
REQUIRED
I RED
(commencing with Section 7000 d Dwiaon 3 d the Butner end Professions 7 agd y Ibenae a in h0 face and ell/ • • �M
CITY Uc.NO.: O6O847 LIC.CLASS: C 39 LIC.NO.: 75141 E P: 11/95 MAIN BUILDING ACCESSORY' BUILDING - ----
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: 42/-7 /7 /9fS Comree«: / �.,.-"r LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
)W NER BUILDER DECLARATION:I hereby affirm under penalty of perjury hat I am exam front the Contractors License Law for the
.ollowing reason(Section 70315 Business and Professions Code:Any city or county which requires a pemm to construct,alter,improve. PARKING REQ: P RO V: PARCEL : 13913109 Z NE: REF NO: ..-
demolish.or repair any structure,prior to hs issuance,also requires the applicant for such permit to fib a signed statement that he or she PLANNING NOTES> ee
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 1000)of Division 3 of the > •
Business and Professions Code)or that or she S exempt therefrom and the basis for the alleged exemption.dollars
Any violation d Swan ****dE4EdEdEdEdEdEdEiE****IElE****iElEdE1Ej(-dEiFlEfElEfEflfEiE****iEaEif****3EdE*1EiE****i'iFdfiE****iE**WIE?E****1(iEi(-*
]031.5 by any rofesant for a permit had heeo the applicantt°a dog penalty d w more then fire hundred do0n. 155001).
❑ I.as owner of the property or my employees with wages as their sole compensation,will do the work and to structure is not intended D EVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en Owner of property
who builds or inproves thereon.end who does such vein himself or herself or through fm or her own employees.provided that such
improvements erenot intended«dleed for sale.E. the building or inprovememowki within one year dmnpletion,the ZONING APPROVED BY DATE: -i
ownebuldr will have the burden d proving he or she did not build or improve tor the mimosa of sale).
❑ I.as owner of the propery.amexclusively oontractbW
gwithlicensedcontractorstoconstntheproed(Section BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does w appy to en owner of omen),who builds or improves thereon and who I r,,
contracts for such projects with a contractor(sl licensed pursuant to the Contractors License Law). APPLICATION B Y: DATE: l`l
❑ l am exempt under Semian: B.A P.C..ler this reason: dE dE 3ELICdETjEON ISSUEDE,F£ {F3ic-
Date: Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,end
25534,and that l or any future building oocupant will/will not(circle one)need to cornplyweh said mate codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification hen the Ai3uatyT anagement District.Residential construction eppicatbro ere exempt from these PERMIT 33 . 00 50
provisions.
Date: Applicant PLAN SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty el perjury one el the following declarations: ISSUE FEE
❑ Ihave and will maintain acent-rate dconsent tosell-insure for workers*commpenulion.asprovided for bySection 3700dtheLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
palomino.Code,for the palonce dune work for which this permit is issued. TOTALS----> 33 . 50 0 . 00 0 . 00 33 . 50 33 . 50 . 00
-] I have end wit maintain workers'compensation insurance,as required by Section 3700 d the Labor Code.for the performance of the
work d«wnonnlspemissued. EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 33 . 50 OVER/SHORT: . 00
Carrier:CPolicyie Number 1JU1J1L—JJ
-' 05/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed i the perm]is for one hundred dollars(SIOo)or less) 33 . 00 . 50
❑ IuoA'that in the performance of the work for which the permit is ands I shall net employ any person in any manner eon to dE*****4EiElElEtE1ElE1E1E****-iEifiEiEIElfaE*tEfEfElElEi(-1E1E1EiE1E1E1EjFK-1EiE)f1E1E)EiE1Edf3ElE1E3E1E1EIfiEiEtE*********iFiElE1EiEif3E1E3E
become sutpd t°the ' the work for laws d CeJrmme,and agree E I bates aubied l°the workers'
compensation provisions of Section 3700 of the tabor Code.I shell 'h ply with IND IV IDUAL •F E E BR EAK DOWN
Date:E/•1 /7 /Ill Applicant: ceti
Warning:Failure to secure workswile'compensation coverage Is e I,and shall sub an employertocriminal penalties anti TYPE QTY DESCRIPTIONUNIT COST TOTAL COST
civil Ries up to one hundred thousand dollars(5104000),In addition to the cost of compensation,damages as provided ler In
Section 3701 of the Labor Code,Interest,and attorney's fees. SFR 1340 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 340 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097.Civ.C).
LENDER'S NAME: .
LENDER'S ADDRESS:
I certify that I have read this application and Yate that the above information is coned.I agree to comply with all dry and county ordinances
and state laws relat'eg to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property 1
f°r inspact'onpurposes. KEVIN KIRBY '
/�� 0!. :..i=. a. -1,'r72:O ^-,�-
/[�( +/ / 1 ea/A /7 �%y D(.TE: :`. 1 U. , 7I'';=r lir:Ua
+➢ J oa
7 Signature Owren/AganVAppMenUCmtrwr
(5t51<6.WP) White-Building A Safety;Green-File:Canary-Appicant;Pink-Revenue:Goldenrod-Assessor •
CONSTRUCTION AND PLANNING _ & 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-Fifa)
12. Sewer Cap . _ 63. Heater & Vent-Final r
13. Roof Drains64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final ,1
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 D Gas D Oil
25. Roof Sheathing /t-2o_-t5 kik_ 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:
34. Final Heating& Air Conditioning l d_Zc_9 r G�
35. Final Gas Pipe-Test t DD !
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. ystem
45. Sound Attenuation
46. Handicap Regulations , :�.
4T FINAL STRUCTURE if, LDING jQ,�„�(. 9V ('(,46
•
48. FINALPLANNING;'
49. Electric Release to 01,so
50. Gas Release to Southern California Gas Ce
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER GRANDOLPHO, F RANK AUG 1 0 1961 e' DATE 7-22-60
JOB ADDRESS 17214 Madagascar St. ma, 1 4 "62` BUILDING PERMIT NO.12589
GENERAL CONTRACTOR Loy Smith VALUE $600.00
AP.No. LOT 91 TRACT3363 _ FIRE ZONE DESCRIPTION OF WORK Patio Cover
INSPECTIONS DATE I GROUP S TYPE V ZONE R1
U" -'rground Soil U.G. Water PERMITS ISSUED
L :ground Gas — — SUBCONTRACTOR DATE NUMBER n' I
Overhead Water and Gas .
Rough Heating ,. ,' ^,
Rough Plumbing .Y ,
Miscellaneous
Prop. Swr. Line House Con. St. Swr. !1✓'- -'
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power f1
e---11-eel
Rough Wiringc}cob�, Q,It,.
Trenches Forms fj ,`4%'t_ f �- p
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing
Frame and Flashing
I '9g, In Out
F er, brown coat
Plumbing Fixtures, Final
Electric Fixtures,.Final / }; n /1
Building, FinalQkI /�in/¢,jj i /'tbl (fr-6 'Yf ' —
OCCUPANCY
Form 210-5M-11-59 SBP 12589
N
i589 F`.. RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT &h JUL 211960
P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APPLICATION QIbR WERrM�ITTA MESA
TYPE/OR'�JPRINT - BUILDING
BUILDING / -7?. �/?„/9 JqQ S- e lam_
ADDREss COSTA/ MESA. C'7ALLIFORNIA �,(I For Office Use Only
(, Al ..L!' RECEIPT NO. PERMIT NO.
OWNER/4-04/�-/ 1 /./l�]Y{IA�/'�w�� ��/�F.1,/I�q.'e�NW RECEIVED DAT.(
ADDRESS I 1 Ll t�,�(�`-�v �i '��.'_ • RAED BY I DATE 7 c2/�- 6 , DATE.'
DI/ ✓
r •V✓�"4� TEL.
NO. BUILDING /9£ '/ //J ale/.� ..i/A
CITY raf 4. ADDRESS L 7 �� (�LNi �'I��T��
ARCHITECT TEL COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS
40' FIRE //
1.--4,7•1..
,,/ ZONE TYPE [� GROUP is)
CONTRACTOR /r0 '1 APPROVED Vs- ` p
/y�� L BY DATE T
ADDRESS 1 if 1..1.14. t) \//`] Ei / 1 NTNG
CITY /_'n ) . V�/ . r ZONE I NO.OF I USE OF NEW/ , /n/•/'
A PLLANS . /7 BUILDIINN G.. / z6 N
y LEGAL / O (// , / 4 71n a3C
LIC.TNO. i 0 g { A/1. NO. DESCRIPTION-��(}��/ /�
SIZE `1/ NO. OF BLOCS. ✓
OF LOT,*'7c.2 Sr^ g NOW ON LOT A.P.NO.
USE OF / YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE BT.) n
CENTER OF STREET REAR YARD FRONT LA.7 FT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE J FT. / IN.
DESCRIPTION OF WORK ``xf L.SIDE �/ FT. N.
NEW I ALTERATION I I ADDITION I /, REAR /7 6^FT. .C.grt/ IN.
REPAIR J I II MOVING II DEMOLISH I BYPROVED/_c 1 / / - DATE '2- --- --(Q o
BUILSIZE DIN% /�''ay0• NO. OF�ROOMS STORIES ( (=Trill •
C-L���
EXTERIOR WALK✓ •41 ROOF ��n"'W i
COVERING (COVERING
USE BUILDING AND WORI.TO BE PPgBF MED
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT ANDSGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND ST TE Laws GU TING
BUILDING CONSTRUCTION. VALUATION
II
1124-9
SIGNATURE OF PERMIT FEE 5 /
PERMITTEF JJJJ U) _m
$ / p PLAN CHECK $ - it
AUTHORIZED AGENT (f 1-7L.
L/ c1--T2p
ITOTAL FEE $ 7 .
OWNER SYCAMORE LAND CO DATE 6-29-59
JOB ADDRESS 1724 Madagascar St, BUILDING PERMIT NO. 9769
GENERAL CONTRACTOR Malgren Const. VALUE $ 17,322
AR No. LOT 91 TRACT 33C 3 FIRE ZONE DESCRIPTION OF WORK res a tt P,T _
It ECTIONS W DATE
�,/}I GROUP T gr .I TYPE V ZONE R1
L. .rground Soil • c5 .G. Water `( 104-341i PERMITS ISSUED
104-341i
SUBCONTRACTOR
Underground Gas DATE NUMBER I
Overhead Water and Gas �I A'W/
Rough Heating 411/5 9 l6 L-.ii �, : ,, /, S
9- 7— (-C 7 .5-1-"--- 1
Rough Plumbing �yL_ '17-]q Jl /- -.. .GA / ,.sr6 0) J/j•S % _, G a .' -� ,
Miscellaneous / •� '
Prop. Swr. Liu4 House Cot. St. Sw.. /, - - (/�. /6-.5�_�/c am _1_1
Sprinkling System _ ✓ / i
Heating, Final La/_" ,1
Plumbing Fixtures �..,(l�f�—
Final Gas Test /h!i{r - ��a__
Construction Pole
Underground Power
Rough Wiring f4 G 759 - — r , At - 7-2-s--, toe, 9.2_.
Trenches,rk OP'UForms A4,11-Steel 85 (`d (1-';'-'-, L
Floor System • 4 til - 8-'t+- 51
Steel Reinforce Chimney Re-Rod
Bond Beam
Sh thingr$,GY/_ 9'/G-9'9
F ,die and Flashing (0'2-/-51
La ing, In Out 04 io-%y-
Plaster, brown coat 010/- pz-'9
Plumbing Fixtures, Final R•12.74;
Electric Fixtures, Final ,r.a, I ,L�
Building, Final yr, --' .- • 19"
OCCUPANCY I
Form 210-3M-4-59
•
•
• 9`769 ' ` ::U _, '
I • .4.f3u ...09
COSTA MESA BUILDING-SAFETY DEPARTMENT L aI l' ;^E .1EPf.
P.O.BOX 317 COSTA MESA.CALIFORNIA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
`7 /T�YPEE OR�PRINT �y/� p BUILDING
BUILDADDRESNG S •/ a--" l(QDrn An4�c S
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
I RECEIPT NO. I 9PEJIM�Nip
OWNER Sycamore Land. Co. //
MAIL 10835 Santa Monica Blvd- RECE`�IV[/p SY DATE RECEE`IVED ATE•I�SjSU ED
ADDRESS lY/P�� I /A � 7 -a &^,)'/
Los Angeles 25 TELBr23287 BUILDING l
CITY NO. ADDRESS
ARCHITECT LIC. COSTA MESA, CALIFORNIA
OR ENGINEER L.C. Maj Oi: NO.
ADDRESS 11015 S S . Paramount Blvd.. FZIRE ?f , p-
Malgren Const. STATE 153335 APPROVED
CONTRACTOR LIC.NO. BY DATE
ADDRESS ](M 10835 Santa Monica Blvd ZONING
LEGALLOT O ZONE NO.OF USE OF NEW
DESCRIPTION I NO. 91 I BLOCK ITRACT`136: 6 (PLANS I BUILDING �/`/
APPROVED
A.P.NO. By DATE /+
4. /
SIZE NO.OF BLOCS. YARDS EVES
OF LOT 96 11 }i R9 0) NOW ON LOTn REQUIRED ALLOWED
USE OF (CENTER LINE ST.)(._j7
S
EXISTING BLDG. FRONT Y FT. IN.
SETBACK LINE FROM 50 33 5
CENTER OF STREET REAR YARD R.SIDE FT. IN.
SIDE YARD I LEFT 5 I RIGHT 6 L.SIDE S FT. IN.
DESCRIPTION OF WORK !� ,
REAR - ! FT. IN.
NEW I X II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
SIZE BUILDING 1746 NO.OF�i ROOMS 6 STORIES 1
EXTERIOR WALL StuCfeOOF wood. shing�
COVERING I COVERING
USE OF BUILDING AND WORK TO SE PERFORMED
Dwelling new Cnx" trurticn
3AR ATT. Gar. '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUC. •N.
VALUATION
PERMITTE. Allir SIGNATURE OF ✓_` _t / ''J PERMIT FEE $ 49,
7 - E $ 3 Z Z. PLAN CHECK $ /�60�0
AUTHORIZED AGEN ten . / TOTAL FEE $ 5'�/