HomeMy WebLinkAbout3033 MADEIRA AVE - Building Permits PROJECT ADDRESS: 3033 MADEIRA AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06 /220
OWNER'S NAME: TROM, CHARLES J
• ADDRESS:
3033 033AMADEIRME , AAAVE
92626 PERMIT NO: B 067220 PLAN CHECK NO: N GOVT: N SUPP ; N
CCONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
714 ) 546-5806
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL 4 ' X4 ' SKYLIGHT, ICBO# 4063 _ SQ FT : 1 , 000
ADDRESS: UNIT:
CLAIM VALUE: 1 , 000 . 00 CALC—VALUE: 1 , 000 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: BRENT OWENS ROOFING ( 714 ) 978-2075
ADDREss: 12901 BUUBBLING WELL ROAD COMMENTS : REF: B-67178
SANTA ANA CA 92705 ***>Far*N-**x-�6�E-*****�r36*+r*IL**+rx*-�6 �EN-*�E+PSE*+PN-3E�E *x6�t-x***->F-x->F+r+Er*Ir+ ***x-*�6*-�E****** -***>F�E
LICENSED C T CLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S
70001 of Di o siness and Professions Code, and my license is in full force and effect. SETBACKS
_` STATE LIC.:
600402 c s, 3 9
S�iy�y signature MAIN BUILDING ACCESSORY BUILDING
r , ERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selhinsure or a certificate of Workers' pp •� FT IN REAR: FT IN FRIT: FT IN REAR: FT IN
Compensation eisgran BS a2c2tiie.6 ropy thereof(Section 3800.Lab.F.'.2 /01 /95 L T FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE: dTi �3
OMPANY: o±ATE P'FJNt1,,yy VfiAMI�YRG5AgtES> PROM PARCEL: 13917217 ZNE; REF NO;
C aired copy is hereby furnished. Ill Certified copy is filed with the city Buildin son.
ti
tig>
Dat CeeApplicant: DEVELOYPMENT SERVICES R E Q U I R E M E N;�T S
EXEMPTION FROM CRIERS'COMPENSATION DECLARATION: (This section need not be completed if the permt is for one hundred W)or less). .!
as
.!I certify that in the pedormance of the work for which this permit is issued,I shall not employ any person in any manner so as to become ZONING APPROVED BY �'
subject to the Workers'Compensation Laws of California. t DATE: i
Dale. Signature: BUILDING APPROVED BY
DATE:
NOTICE:N,Aust making this declaration,wicop should becomert subject mit s the a Workers'meempensation provisions of the Labor �.
CTRUyou mLEtDINGGI hersuch provisions
Inis pa cnssnaiinending revoked.anytAPPLICATION ISSUED BY: 41
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the pedormance of the work for DATE
which mispermnisissued(Section 3o97,Civ.C). **'*'*'************'*'A'*"#** **' *****'**** * ****** '*'**** i"�-'t' *'
*******************************************************************lE****** ****
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT :Y
W/TILE
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 25 . 0O . 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section ID®)of Division 3 of the Business PLAN _
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(S500).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS————> 25 . 50 0 . 00 0 . 00 25 . 50 25 . 50 . 00
structure is not intended or offered for sale(Section 7044,Business and Professional Cade: The Contractors'State 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 employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 25 . 50 OVER/SHORT : 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale). 25 . 00
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 O
❑ 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 *'**'***"**-*****-***'*********iE'M'*'** N'i('if*'*H'*****'lE****-'N'**'#*****ir'******'*****************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ t am exempt under Section: B.8 P.C.
tor this reason: TYPE QTY D E S C R I P T ION UNIT COST, TOTAL COST
Date: Owner: SFR 1000 •
ALTER BY VALUE RESIDENTIAL ' NOZONE , ' ' . 1 . 00 1 , 000 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and E811\45
�E S _
25534 and that I or any future building occupant will/will not(circle one)need to compfy with said state codes and the requirements for a
•
permit lot construction or modification from the AirOuality Management District.Residential construction applications are exempt from 1p s L"'110""
these provisions. ��• �,�v 1 Lyra'
Date: Applicant: REQUIRED
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 stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
p- r rinspecv n pu ses.
\ 01 0016037-0016D738 TOT 25.50
S _i 4_ Signature:—V DAT£: D5/18/94 TINE: 14:39
Ori s License or Social Security d:
164446 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •
LiENSTRUCTION AND PLANNING -----_ -_- Pt & SPA 1 - `-
APPROVALS Permit ;P Date Inspector I Date Inspector
APPROVALS Permit tt` -
i1. Temporary Electrical Ss.:^ce or Pole ,� 52. Pool & Equ'pment Lucat o I •
2. So.; Pipc-Undrgrcd. i 53. Steel Reinforcement _ -��
H_ ____ -I- -
3. Ficctrica! Conduit Ut it"Undrgrnd 54. Forms -__- __ -
4. Electriccl Coeduet-Und'm^d. II 55. Electrical Bonding
5. Stye Rr,nforcement --- I 56. Rough Plumbing & Prcovrc Tait i -'
-4- -
6 E'ectr,eal LIFER Grnr; i 57. APPROVAL TO COVER-GI/ E
7. Footings 58. Electrical Conduit-Und';rr.:..
I .
8. Foundation . 59. Gas Pipe, ❑ Undrgrnd , Tes! t
9. '':.ater P!pe•Undrgrnd. - _-- r , 1 60. Backsvash Uncs,P•Trap. E Uri"%r-,:i. 1
10. Structural Floor System ' 61. APPROVAL TO DECK .
11. Property Sevier Lina is H: .Rr.Concoction62. ducky/ash & Roc-:.ic' t-I
12. Sewer Cap 63. Heater & Vent-Fir.:!
13 Root Mains --if 64. Plumbing S`/stem Fr^ci
14. Rough Psumbir. �-____
g' 7 I 65. Electrical-Final tI
15. Rough Eiectricai-Coniu.t T. � --_- 66. Solar Systar...F,r' i __I----i--_---
16 Rough Electric Wiring67. Fencing & Accass Aporo.ai ' ~
I
17. Rough Wring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ce. mg 69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & A.r Cor.d t'onmg FIRE DEPT. REQUI^ECSC?:T
I
20. Rauh Factory -
9 F�,awa_e APPROVALS Pei � 1
21. Ducts, Structure 70. Undergrohno Hy u•o --I - -
----- --- .--I- --- -- -- --- ----- - t
22. Duns,Vent.lat;,-y - 71. Product Pn:nn - 11:; -'O i--
-i-
23. Gas Pipe-Rough & Test . I 77. Under,trc;. rd flu...
_------ - _ _______ -_ .______ __ - - _ 4 -
24 Roof F'am,ng I 73. Undcrtyrni.Sr a T„t... ,-.:r,,, . i
25. Roof Sheathing - - -- - 74 Uw^ngad tiyn..•
- ----- - -- --- - -- --- - - - - - -`t - ----
r-
26. T•Bar Ceiling ISI-ucturuh L. '.Sonocoat I --- -- 75' Dry Cheri-its _-- - -
27. Frame and Plashing
5--(7--w! 44.1! 76. Dry Standn,pr
28. Lu'h:ng & S:ding . 1
i 77. FIXED SV'STc`. FINAL
29. insulation. -- 7E. FIRE PREY. F !II At_ I __--L
i
30 ^-/,:.e', Nc.ang --- -- -- I ---- --- HEALTI: DEPT. RECUIRE.r.:ER'T-- -- -- - --
31. 7 .t 3ro..n Ccat 179. F".A! I 'SPI C' ;'. I
32. E.ertr.cal Pot'oer 1 1 30 ' COD CL fi ii Ir .r' F r}t k U
{
33. Firm E'ectr.c I Nota-
------- ----- ---- - ---�'--- - - ------ - -- - - --- - t_-- -- - - -----
34 F•r_! Heating & A r Curftc':•r5
- - - --1 - 1 S
35. Fir.cl Gas Pipe-Test / , -\
36. Hood or Canopy - ------ - - -- - - . - -- - - - - - - - - - %
-
37. Fr al Feete•V F ren!:,�. --- - ----- �- _-- ----- --_ --- II ;- ---__ -
38. Firm Plumbing 5
39. V:atr Seri/ice-Final -- - - -- ---, ` _-- -----
40. Gas Sere:ca.-Final -
7 � I
41. Solar Dome,t.c-Fmc: -
42. Btc.cf log/ Preventer I_ _ ___-_f
HI
43. 8ackf:oa• Irrgat;on ------ - - ---- ----- --------- - - - - ----
44. L..rdscapc Lrrnat er Syste - I
45. Sound Attenuaticr
46. Handicap Regulateurs ---- T--- I ------------ --- -
47. FINAL STRUCTURE & 9UILDING r�9,(1 � - --- '
48. FINAL PLANNING - _ .
49. Electric Release to Edison '
50, Gas Release to Southern California Gas Co i
51. CERTIFICATE OF OCCUPANCY !r, - -----i
No. Date
\.e: �. � 3 033 #t�.� lr�° ..
4b�3 zdsf-a( 1re5y
. fr ,/
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1•
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DIVISION OF BUILDIN /
CITY OF COSTA AAE '` /
APPROVED
9i
A A �76-O
fib set of plan and tlyta0pns Igi 4 7,
er10 8Is uNawful ro make q aA lfle /A�cf `S lin
ud
Permission from the 01 +u+ay,a .
psa�p q a. /
orbmesa apDf01 ance a hem° OW.NOT
,�� \ � 4--// �n
nese pans and permit /
•'�+MerSloe / /
to wearo«wok�rpt � w0 / /
00 vain 180 days alsttmlcq et • f: /
wed
IB 0 i 2 7,i)
�Cr in G eefi at c Aaa / ra 7/texcf.
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•
PNOJECTAODRESS: 3033 MADEIRA AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 067178
1t1wxER•sNAME: TROM, CHARLES J
4 ADDRESS: 3033 MADEIRA AVE PERMIT NO: B 067178 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: 714 ) 546-5806 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : T/OFF RESHT. REROOF W/COMP SQ FT: 8, 250
PERMITTEE: CLAIM VALUE: 8, 250 . 00 CALC-VALUE: 8, 250 . 00 GROUP OCC : R-3 /M-1
ADDRESS: BRENT OWENS ROOFING ( 714 ) 978-2075
12901 BUUBBLING WELL ROAD COMMENTS : SMOKE DETECTORS ARE REQUIRED IN BEDROOMS & HALLWAYS " 1991 UBC "
SANTA AA CA..92705 **rr-+r********�rifkr-+t*�P�E**********�E**TE*************�E�E*******+e�6*EE******+6+E***�E***�6****
LICENSED CONTRACTO DECLARATION: hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
7000)of Di ' In Business and Professions Code.and my license is in full force and effect. Z ON I N GS EREQUIREMENTSCIT LIC.: 1STATE LIC.: CLAS •
600402 2
ate JS Z Signature:— MAIN BUILDING ACCESSORY BUILDING
AKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate o onsent to selbinsure 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 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 0682522-94 EXP.DATE: 02/01 /95
COMPANY: STATE FUND_, PARKING REQ: PROV; PARCEL : 13917217 ZNE: REF NO:
7 Certified copy is hereby furnished. 4( Certified copy is filed with the Build' Division. PLANNING NOTES>
yRa StSI?v Applicant: 1 ati, *******************************************************************************
•'• PTION mOM W 'COMPENSATION DECLARATION: (Tris section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N'T 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: Pi-
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.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y:
DATE: 9
which this permit is issued(Section 3097.Civ.C). ****************************Fx **
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
W/TILE
OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed PERMIT 108 . 00 8 3
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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 penalty of not more than live hundred dollars($500). ISSUE FEE SMOKE DET C���
I. as owner of the property or my employees with wages as their sate compensation, win do the work, and the BUILDING—DIV—> PER /��I�GTGUi P J- HECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 108 E )1 N f.iOED 0 . 00 108 . 83 108 . 83 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through �R V E 1 ,
his or her own employees,provided mat such improvements are not intended or offered for sale. If,however the building or
improvement is said within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED:. 108 . 83 OVER/SHORT• 00
torthe purpose ofsale). BLDG PMT PLUMBING ELECTRIC MECHANIFIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 108 . 00 . 83
❑ and Processions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
that whocontracts for such projectsCoensatoansuraace (s)should be prpuovided to o the
Contractors'Blare License Law).l am aware *******************************************************************************
andat phot of races Worker's ojecwith insurance Shots is prursuan It me.
❑ I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN
for this reason: TYPE QTY DESCRIPTIO N UNIT COST • TOTAL COST
Date: Owner:
I do hereby certny that l am aware of and understand the requirements of Cantomia Health and Safety Code Sections 25505,25533,and SFR 8250 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 • 8, 250 . 00
25534 and that I or any future building occupant wilUwill not(tache one)need to comply with said state codes and the requirements for a END OF FEES
permit ler construction or modification from the Air Quality 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 authorizer resenlauves of the qty to enter upon the above-mentioned
rty for inspe lion p rposes.
Oal
Signawre: _
/ s/s/ K 01 00160524-00160525 TOT
DATE: 05/16/94 TIME: 03:21 108.83
river's License or Soul Security ,.
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
•r CONSTRUCTION AND PLANNING PO- r SPA - I.
Date ( Inspector Date I Inspector I
,
APPROVALS Permit APPROVALS Permit 1 I 1
1. Temporary Elect-:ca; Ser..c=or Paw I i 52. Pool & Equipment I_ocet.on I ___L____----
2. So'' P1na-U^c-i-rd. - I - I 53. Steel Reinforce:r'e-rt 1
3. E::-t. a' Cr-. ... L- 1.!• .. ; - 54. Fo•'na
4. E' ,.tr:cal Can❑u.!.U.-C , --- - - ----1 55. Electrical Bottling ------ - ----- -- ' -_
I- t-
5. St,a, he'inforcemunt 1 56. Rough Plumbing & PRu rfai st I
6 n._n ea! Or-ER L.rd ------ - -- --� 57. APPROVAL TO COVE IR.GI I':Cr 14 ------ - ---
7 Fu mer;s 1 1
yII 53. EIestricul Cot r•u -.0 -I^d in.
- .. -- _ _ __._.,_
B Fa..-d_tion 1 - 5E. Gas Pipn, Ur C'r t
___ _
9_- er P_tarlre";: '°__ - -_ . 60. Bac:ttvusil L_u . P 1•,,,c. ^- .
10. Structural Fiacr Syster-• , T • I I 61. APPROVAL TO DEC't<
1i. Preprrty Scc.er Lir.: & Hmt. line- .Lan : 62. Bee't':+ash & R• ^•; . - r. '
12. S,•.ve` Clip L 63. He,:ter & Vant'-:r, '. i__
I
13 RoC4 Diu:n, 64. Plumbing System- f • 1 - 1 --� -14. F.C..a 1 1 65. Electrical-Fina'
}--- -------- --- ---- ------- - - - - -
15. Rocgn E.,:ctv'ca •Curd..' - - - I 66. Solar Systen•Frn..:
16. no,,gc Electr c 'la r.ng I 67 Fencing & Acc's'. A
17. Rout, kV r ..a Sun I 168. APPROVED FOR 2,l'ST'-RH:5
18 Flc.:3h El:c+,rcal-T Ear CI rq I 69. POOL/SPA SYS`L ,3 FIF:ia.- --- ---
:
19. Routh Heating & A.- Cc• d t O%.gI FIRE DEPT, RCOUIti Eh.l Eii T
20. Rough Factory Fireplace j r APPROVALS Porno t
1 y_
21. Ducts, in Stnr_'rure I
I 70. Undcrgrosa6 Sty:
22. D Y-ntl____ 1 �71. Prt duct P',• nr, J-_ _ _.. _--_--i
_ I _
23. G.; P- Rc & 72. L'rciergrou
24 Hes F..:-.^r,' I l 173. Undergrnd. Sin,;. .. .,.
25. t_t„ir Sn. .t° --- -- - - - - 5-417-9`t ' 6c.4.41-- 1 74, Overhead I+,te,
- - - -
L26. ' •ii •. Gcilire 'Stfuet:'J :cn_. I I is. Dru b nntr.
23 L:.: 1 ;:.. So' .y ---- - - -- - - +� --- - t- -- 71. F'IxE'�tS'. 5t-F?.4 .:?t,ll- - -- -- - - -
.
------------ --- - -- - �-- - � ------ r- --r; -r& - ----1
23. in.ua how. -I 1 -- I 78. F IREtdn'E'�t_'• p_- - - - - -
I---- -}- - --- - - - - - ' - -
I is ^�- - - - - --- - i - I ----- 1/4---1-1E;711-1-1 DEPT REOLik,'_'1E'' :
__- _ _ __- - . - T._ __ rt - _ - T _ 0Lti
33. Fu.aI tloctr.c I_ I Notes: 1_y
34 f^tat FlcuLny i A;- CO: „t t i
L...•
-_
_ - -, -___�___. ___- _____ter- .
r_
35. F•nal Cis P ...Ts t __ _ __ - _ ._ . .^
1 30. F'ocr or C.^:-py I - - --
i--- - -- - -- --
TI
- -t- - -- - - - - - - - - - - -- - - - - - - -
37. !".-cl F I .c-\ c.._,- 1 I---
38. F•ni1 P,u-nb1. g - -- - I I ---- --- - - - - -- --- ---- - -
39. . atim
r 5erve•Fire: i
:
40. Gas Service-Final _---_ - --- - - - ---- - - - - ------ -
41. So'ar Domest.C-F,r.a:
<2. Bac crlo": Prece^.ter - -----1 1-
-- -- - -- - - - -- - --- - -----
43. 3a:<flo:. 1.. - !!on - - I t---- ---------- -- - - - --
o/. L ."diclp. li'•gatic^ 5` .'r : 1
• Saurd Attenutt:or -- - -- - - - - -
- - --- ^----- - - - - - - - - - -- --- -
46 1-'a,-dic,tiu
p 'le 'at,ar.
47, 1-11e.),L STRUCTURE Ft tUl _DI'.G c-/q_l oar.
48. r :NALPLANNING T _
L.118.49_EleCric Rete .c to Edlsnn --- I- - n ----- --- ------ --- --
_r
50. Gas Release to South.rr Cs!.to-n:i Gas Co ti
-
51. CERTIFICATE OF CCCU'A1Cv 1
No. Date _--
•
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 3033 MADEIRA AV CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 063251
ADDRESS: TROM, CHARLES J
3033 MADEIRA AVE PERMIT NO: M 063251 PLAN CHECK NO; N GOVT; N SUPP; N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: S—N PERMIT TYPE: MEC PURPOSE: OTH
ARCH/ENGINEER: ( 714 ) 546-5806 REG.NO.:
JOB DESCRIPTION : FORCED AIR UNIT CHANGE OUT SQ UNIT: Q FT:
PERMITTEE: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /M-1
OODRESS:GRAHAM BROTHERS ( 714 ) 546-1653
2952 CENTURY COMMENTS : CHANGE OUT ONLY
COSTA MESA CA 926?6 ******sE##xx+ETH##-x##******�E##�E***********xxx-x*x##*�Ex>Ex�Lx.x#�cxxxx##�Ex�E1L.xxx-Lx #x-##;Ex
LICENSED CONTRACTOR DECLARATION: I hereby affirm tha I am licensed under provisions of hapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions •.•.an, • icense is in full force and a ect.
CITY LIC.: STATE LIC.: CLASS: S it T B A C K S
00 . 63 24 604 , C— 0
Dater•- rl• `1"j Signal :` moi _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: thereby affirm that I have a certificate 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 3800.Lab.CI. LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.:WC7161030226012 EXP.DATE: 08/01 /93
COMPANY:LIBERTY MUT IAL PARKING REQ PROV: PARCEL; 13917217 ZNE; REF NO:
❑ Certified copy is hereby furnished. Ki Certifier :.r 'ed with the city Build'•• Division. PLANNING NOTES>
. • • >
oate.f •2.4CI • et 7'— A•di .nt: - - ******************************JP**#JP**�.*-*****************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLA•' : :—(This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E R- 1 I C E S REQUIREMENTS
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 j
DATE;
Date: Signature:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; (AAA DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued(Section 3097.Civ.CI. APPLICATION ISSUED BY: //J�1� '!, DATE• /'7 -
****IE*1E*********#******x*e-*** c— * ie,^k#*/ k-xk#***k*ir kit iE#**#***#x'iE **
LENDER: ***************x-*********#***x-**#***�6*#****' E******##********iE**#3f***#*****##*
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9 0 0
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business '54 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 penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID ' ' • DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 9 ,00 15 . 0 0 0 . 00 24 , 00 24 . 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.If,however the building or
1 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: 24 . 00 OVER/SHORT• ,00
' for mepurpose olsale). 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 24 . 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.*,x*.x#.***.**.*.****.*.**.**x,*.**x***x.**.*1t.x,*x.x.*****x,*'1(,********x,********#*#**k**#*
that proof of their Worker's Compensation insurance should be 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 MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 , 00
25534 and that I or any 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 Quality Management District Residential construction applications are exempt from
these provisions.
Date'. Applicant:
I hereby certify that I have read this application and stab • .:• 'information is correct I agree to comply with all city and county
ordinances and state laws relating to building constr , m and hereby auth.•e representatives of his city to enter upon the above-mentioned
property for inspection purposes. e-
- Dale: 1 • 2.29 ` 1 '� C4 01 00143854-00143854 TOT 24.00
Driver's License or Social Security•: , DATE: 07/29/93 TIME: 14:35
_
1641.46 White-Building;Green-Corte Enforcement:Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
' CONSTRUCTION AND PLANNING POO,_ SPA
I Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
I 2. Soil Pipe•Undrgrnd. - • 53. Steel Reinforcement •
1 3. Electrical Conduit Ut;'ity-Undrgrnd. 54. Forms .
4. Electrical Condult-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56, Rough Plumbing & Pressure Test •
S Fear a' UFER G•nd. 57. APPROVAL TO COVER GUNITE
7 Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Vater Pipe-Undrgrnd. , 4 60. Backwash Lines, P-Trap, 7 Undrgrnd. _
10. Structural Floor System 61. APPROVAL TO DECK
11, Property Sewer Line & House Connection ' 62. Backwash & Receptor-F,nal
1
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System Final
4. Rouen P 1umb1n
9 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. Rouyn, Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping []Gas 0011
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing 73. Undergrnd.Storage Tank []Gas 0 0,'
25. Root Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Ivlonocoat 75. Dry Chemical 1
27. Frame and Flashing
� 76. Dry Standpice
28. Lathing & Siding I 1 I 77, FIXED SYSTEM FINAL 1
29. Insulat.on 1 1 78, FIRE PREY. FINAL 1
30. Dryv,all Nailing ' r I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I 79. FINAL INSPECTION
32. Electricc' Potroer Meter-Final - 80. FOOD CERTIF ICATE ISSUED • I 1
33. Final ElectricI -•�s Notes: _J
34. Final Heating & Air Conditioning 9/�/q1��c'� - - i
35. Final Gas Pipe-Test / I
--S-
3 6.
'-36. Hood or Canopy
-} - --
37. Final Factory Fireplace I '
i 1
38. Final Plumbing I i
39. Water Service-Final 1 i �^
I
•
40. Gas Service-Final i
L41. Solar Domestic-Final
I1
42. Backflow Preventer
43. Backflow Irrigation -111I
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
OWNER SYCAMORE LAND CO DATE 6-29-59
JOB ADDRESS 3033 Madeira Ave. BUILDING PERMIT NO. 9741
GENERALCONTRACTOR M;1pren Const. VALUE S 16,9/16
AP. No. LOT "I TRACT 336' j FIRE ZONE DESCRIPTION OF WORK res att gar
INSPECTIONS DATE GROUP I & J TYPE V ZONE R1
Underground Soil -/6-47U.G. Water Lie/ _f-eaPERMITS ISSUED
U,, -°aground Gas SUBCONTRACTOR DATE NUMBER
ot:lead Water and Gas ���
Rough Heating �•L{7 l6- y., .-2 .5 �� -_ -4JU1"� /— ,_LOf 7
Rough Plumbing - S JZai-%//�,,¢' -' 7- ?-s2 /99,2,.a_ r
Miscellaneous --,
Prof. Swr. Line House Con.' St. SttifL(�i7-4-59 .I7t1/4e a.,7`4 CA.-ode/ r /1.-5 I Se
Sprinkling System / /J _ __ _
ilo
Heating, Final IV--/-97` _
Plumbing Fixtures �// W /-�J'no ` ,f
k
Final Gas Test r 1. / G!/ r=,P.h%G� , 1
Construction Pole Se.'.L?ull�nZ o..-,�1' _EE.5-.59_..8�{.Z
Underground Power 7
Rough Wiring !7///h A II K� t a i/ ✓ , 9-17-3- /00 6 j-
Trenches �Cj��Forms S%� S.._9_1__ !_)}re (\1?l1-k"�•1—
Floor System _
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing ,02_6_±,V___? -7 -51
Frame and Flashing /3,J /C-/4/y7
Lathing, InR Out 6 6 ri, .Y•`�$'
Ph ,'., brown coat /l3;b- /(-Q -b
Plu`;:°51ing Fixtures, Final t it., —'..
Electric Fixtures, Final ('//'e /r7 c C`_
Building, Final �p(J
OCCUPANCY I
Form 210-3M-4-59
974.1 - itLU. • i -
COSTA MESA BUILDING-SAFETY DEPARTMENTtfUNzn 1959
P.O.BOX 317 COSTA MESA. CALIFORNIA I i../ilr Inr DEPT
FOR APPLICANT TO FILL IN COMPLETELY .
APPLICATION'FOR,.PERMIT
TYPE OR PRINT BUILDING
=RD=a / //F)-p sc he/J,4 jfr.—.
COSTA MESA. CALIFORNIA FOR OFF/CE USE ONLY
RECEIPT NO. I -pE�l
OWNER Sycamore Land Co. 4,
MAIL 10835 Santa Monica Blvd.. RECEIVE`Y I �TE RECEIVED I DATE ISSUEl
ADDRESS 10835 -//�-- q- -
Los Angeles 25_ TEBtr23287 BUILDING
CITY NO. ADDRESS
[ARCHITECT
Llc. COSTA MESA. CALIFORNIA
R ENGINEERL. C Major NO.
DORESI101S S . Paramount Blvd. FIRE , / /ZONE TYPEI� GROUP �J(/ /Malgren Cons t STATE 153335 APPROVED///'ONTRACTOR LIC.NO. BYNDATE
DDRESS�33c_Saxi}-a Monis B1 vti ZONING
ZONE NO.OF USE OF NEW an"-
1 DESCRIPTION NOT 63 !BLOCK TRACT336= R I (PLANS I BUILDING/4.>217/mo
A.P.NO. BYPROVED/� DATE l� V.
105 .43 x. 70.50 ! 0 6/
SIZE NO.OP BLDG5, YARDS EVES
OF LOT NOW ON LOT REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT C.7? FT. IN.
SETBACK LINE FROM30
('�'
CENTER or STREET 50 REAR YARD R.SIDE J FT. IN.
i
SIDE YARD I LEFT 5 e
RIGHT 5 L.SIDE ! FT. IN.
DESCRIPTION OF WORK
REAR j0. FT. IN.
NEW I x II ALTERATION I II ADDITION I }.r{
REPAIR I Il MOVING I II DEMOLISH I
BUILDING 1693 NO.OF 6 1
SIZE ROOMS STORIES
EXTERIOR WALLStuccgROOF wood. shingle --
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Dwelling new construction
1CR Att. Gar.
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION AMOUNT SXOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM- THE E OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY O-• RANGES AND STATE LA 5 REGULATING
BUILDING CONSTRUCie. VALUATION
SIGNATURE OF / ` PERMIT FEE $ 3�
PERMITTEE -� 4-a-e%/�./. ' '�n,1-4, 1/� //' y/�/�{ / /}
/ LI E/ ��' ...e.J/F $ / 7'/ / / 6 PLAN CHECK $ /e
AUTHORIZED AGENT \ TOTAL FEE $ 5 9