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HomeMy WebLinkAbout3090 MURRAY LN - Building PermitsAODRESSOiBNLqNO: �� � OWNERSIUMEIFIWOqN: GUL �Do�� 2 8 9 'O�TA MESA, f_'A �cr�. rmwo.00�m \ Mvnnnz i,rv p�; RD, GARY T FLOOli: H 96 LI REALTY PRUP MGMT ESA VERDE bR �t6 9�626909 7359115 urcxrz[cT on �+c�r+�nn: uc. w.: urcx on w�•s �ss: uxr: CHAPIN CONSTRUCTION (714)831-5300 t0N1P"BT0"S""�` 24906 EASTVIEW Rb "'^""T0""'"""'0 LAGUNA HILLS CA 522793 '°°"Ess: 97653 u°."°'` uxt: ucwseo contn�c'rons oeeun�noN: i n�y en:m ��a. ca,�y a c«n,�y nw i� ic.we ��w« ao.mao d cn.q« v (mmmeM'vq wu� Section )Ooo) d Drv»ion a d �he &eims eM Pmfendma COEs. aM mY�lkww o in IWl,lores end Woq. CRY LJC. NO.: � LIQ C1A55: �" — L 7 LIC, NO.: `� G�JL l i L AY : Dme: /'Z / / Cmlreaa: // � OWNEP BUILOEN DECIAPRTION: I hemby elfi�m unEer penely d p9rp�ry �he1 I em sumqJ m iM Coniretlas Limn�e lew lor iM Idbvnq immn (5epion )W 1.5 Buaieaa enE PMmaom Cade: MY ^�Y rc onm�Y xfiidi nVuim� a V�n lo mretrun. Mer. impm+. demoleh, or repei eny evucture, pr'v io il� seuvice, ebo reqWne IM ¢pp��i la euch pmnn io fib e eg�roE etetemenl ihtl M a eM ie IicenaeE W�uent �o tha provieione d IM Coni�enon Licenae lew �C�epter 9(mmmemi�q vmh Satlion )OW) oi Di+ebn 3 d ib Bu�inea uM Protenone Code� or ihel M a ehe is eiemq iMrehom eM the bnaia la �ha ellepeE memqbn. Nry vo4tion d Swion ]0]t.5 by enY eDd�^� 1« e pmmil wbjene IM apd�� to e rivil per�¢ny d m� mae ihen Me hurd�ed ddlen �55WD. � I, u awner d ihe qwMy or my employees wth xnpea m �hei eob �pM�p�, ��I Ao iM xwk, vd �M nrvnun e ral bNantled a oMerod Id Wa (SxYion 1006, Buvnea erM Prdosnana CoCe: T� �i�eqon licenae Lewdoee �wl epplyto en owneral property wla bulde a mporea �Mmon. eM Ma Eum eutli Mv�k limmtl a Mnel a ihrwph he a hx oxn ampbyer. pwketl ihel ach �aw«��a... �a �iawea a a�«.e �«.w. u.noc.s.«. me a,m�o «mw��+o.da.unm oo. v� a�w�. m. owrcrbuilder �.ill heve ihe burden d pv+inq M ar eha d'M ria byy� a impwe ta tM qnpms d vab�. � 1. m ovmer d �he propaly. om utluervely mnlred'np wilh licensed mnirMae to w�rue ihe prqetl (Setlian 10M. BueLs� e�d VMmeiona Code: Tte Coniemm Lieann lew Eoe� nol eOVM W an owner d pW�Y Wa duW a imp�wse Ihaesan ud Mn contrecu In w� PMa� w4h e auareCa(a) fv.w.aed Mswm lo �M Caprmaa limnaa lewl. � I em eaemq uMer Secibn: ' B. 8'P.Q. br �nb raman: �� Daie: � tand etd CITY OF CQSTA MESA —�UILDING PERMIT PERM NO: H UtijbGU PERMIT NO: B 083620 PLAN CHECK NO: 02651-9'7 L GOv'1': N SUYY: rv CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION : 59 LIN FT BLOCH WALL TO CITY STANDARD 5Q FT: 59 CLAIM VALUE: 1,000.00 CALC—VALUE: 1,080.00 GROOP OCC: R-3 / COMMENTS: "GULDJORD RESIDENCE BLOCK WALL" ��c*�*���r�*����r�r�*�E*x�*�****�****��*�*�******�**�***��+�****��*�:�***�x�*****����� Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT SN REAR: FT IN FRNT: 59 F'!' IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PAACEL: 19104505 ZNE: R1 REF NO: PLANNING NOTES> CONSTRUCT' S4 LF, 6' HIGH BLOCK WALL (46 LF ON SIDE PROPERTY > LINE �F 9 LF RETURN) ?E # iF iF if if if iF if iP �F * iE 1f if 1E if iE if 3f ik iE iF iE i! ik if �1f ik 1E �E iE iF � iE �f iE 3E if 1E iE if iE �E iE?F!F �E iE iE i! iE iE i'?E if �%ik ie iE at ie if iF ib ik if if if # if dE dE jF �E dF if # if D E V E L O P M E, 'N1 T S E R V I C E S R E Q 0 I R E M E N T S ZONING APPROVED bY 1NLlC— DATE: 7-' 2'�% BUILDING APPROVED BY :_��j DATE: �J�Z"'�� APPLICATION ISSUED BY• i�`r +F DATE: 1� Z—g`� ?EiEikiEif3fiElE3E�f3E�FiEitif*ififif3fifif n ���ii1E1E3EiEiEiEaEiF1E1Eic���r i4+F LEGALIZATION:N F E E S U M M A R Y STRUC?ORAL SEGMENT:Y I Eo neraM csnM �het I em ewme d eM urden me na�.em«m a cauom�e Haeen ene sdwv cods sww um. zss;u. t5534arMNml«em/MunWildirpocaqemrM/wiinal�'vcbona�needlocanpywiheaNaateoode�mdtlr�eywiamrrobr HLDG PMT PLUMBING ELECTRIC A7ECHANIC FIRE SMIP/RES GRADING epemintumntMonanwESreiianhan�MAr�iyl.renepenaNpy�iy,pesidMmloonqeuduneppf�etbmenwmqlmm�hua j�ERMIT 37. 50 . 50 pa�ritiona. 5MIP/NON-RES oae: �od� PLAN 24.38 WONKEN'S COYPENS�TION OKLUi�TON: I IereEy elfum utls pmaQy d pajuy ms N iM bYor.'vq bdxtliwv: I S S U E F EE � � IheveeedwilmeinleneeanAiuiedaonemi�osellirounbr��•�p��qp�,npovidadtntry6etlim�]OOdtMlebor BUILDING-DIV-> PERMIT ISSUE P�LAN-CHECIC TOTAL PAID DUE coae.�orrt»wn�ed�wod�«�nws�es�o�e, TOTALS----> 38.00 0.00 29. 38 62, js 6"l. 38 .00 :a I Mw eM N meimen weFa�' mm0�mion iwvvu. m nPmaE h' Sedion 9lao d Ms lebo Cods. b IM M� d tM �x�«wn�inxv�aamwd.Mvwo�rerexnvp�saz��rana�t�br�dpor�y�mn«are: EXPIRES REVENUE DIC�ISION TOTALS--> COLLECTED: ' 62. 38 OVER/SHORT: .00 Cuner: 'l'10-0'�n/�I1'IC9A� 01/01/98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECH Pan'"w^""' 37. SO . 50 29 .3t� (ir,ia . tiar neea na w canderoa / m. v�t o k, an. nuneiee eaws R�ou/ w rma.) � I cerlM �� in ihe perloimence d IM wak lor whc� ihia pe�mil p iseuaA. 1 e1Wl rw� ampby eiry penon in vry menMr o d to beeam wbHd �o iM hoMe' ewnVevetion bwe d CNilm6e. uM e0ree Nel X ehouM beeome wMb Io IM xvrkees' eomw)���o�n Jwo+uon+ sloo d �ne Lem. eme. �.nan �mnemn ��o n m� ion.. De�e: /'7 � ��_ ACCliem: Wamlrp: F�llun ro s�eun woKpi romprwtlon rov�np l� unld�ry�, ��tl MNI sW 1�n w�nplonr ro alMnl pwltlu uM clvll flrcs iq ro an� hintlrW flauunOOallen (J/O[{OWA M uHlrye� b Ns cw! ol ronpw�fbrt a�pu u pvHtlM br In Swtlon J106 0l Ns Le6or COW, Infenq md ettomsy'� I�aa. CONSTiIUCTION LENDINO AOENCY: I haab/ atfrm uMm pmeAy d per'nuy ttiq Ihwe u e oomtiutlbn Wdiep pxiey M the cenamao d iAe .,at �« wnkn iAe w�� e u«,w (seem ]os). cM. cl. LENUEF'S NAME: LQlOEX'S MDFE55: 1 eenily thm I hera meC Inc epplieNion eM pete the� Ns ebwe iNamu�inn e eonen. I apiae to romply wGh ell �Yy and wueay adinenus eM stale 4vn relelip lo WiWip confV�Mwn eM hneb/ aulhoriie �p�eg��pjypg d Ihia �'Ay la enlm upan iM ebove�meNioned paperly ���+v«+�w�w.e•.TED CHAPIN oma: � 2— (5t51-a8.WP) M/Ms-Buid�q65elay:OrserFle:Cenvy-.App6ra'tl:P"vik-Rewive:adEervoa-A�waor if �i if iE iE iE 1f iE 3E af if iP jf �E 1f if ik iE iE if aE iE iE iE if if iE 1F jf �E jE �f iE if ia if ak iE iF 3� iE iE iE if 1E iE iF jf 3E iE i' jE �E i! fF 3! ik �E �lf df if?E � iE if iE iF iE?F fb iE iE it i(� 3t )e iE if iE I N D I V I D U A f; F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TGTAL COST SFR 54 RES—CONCRETE BLOCK WALL / FT. 20.00 1,080.OU END OF FEES EXPIRED DATE '" ��J, � <"-� c-+.� S`'�. ���.`' �t� JUL 0 21997 !--`.. � Cli�(i 9f. COSTA MESA CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspec[or AppROVALS Permit # Date inspector 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. 54. Forms 4. Electrical Co�duit�Undr9r�d. 55. Electrical Bonding 5. Steel Feinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. /// 57. APPROVAL TO COVEfi:GUNITE � 7. Footings 7�' q] 58. Electrica� Conduit-Undrgmd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � - 60. Backwash Lines, P•Trap, O Undrgrnd. 10. Svuctural Floor System ' 6t. APPROVALTO DECK � 17. Property Sewer Line & House Con�ection 62. Backwash & Receptor-Final �Q, $ewer Cap - � 63. Heater & Vent�Final . � • 13. Roof Drains , 64. Plumbing System � Final ' ' 14. Rough Plumbing 65. Electrical-Final � 75. Rough Electrical�Conduit ' 66. Solar System�Final 16. Rough Electric Wiring 67. Fencing & Access ApProval 77. Rough Wiring Sign � 68. APPROVED FOR P�ASTERING 18. Rough Electriwf-T 8ar Ceiting � � -69. POOUSPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE OEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21, pucts, in Structure 70. Under9round Hydro 22, pucts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe•Rough & Test 72. Underground Piush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. 7-Bar Celing (Structural) & Monocoat 75. Dry Chemiwl 27, Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation "� 78. FIRE PREV, FINAL - 30. Prywall Nailing ' HEALTH DEPT. REQUIREMENT j..s� �` 37. Plaster Brown Coat . 79. FINAL INSPECTION � . 32. E�ectrical Powe� ��leter-Final S0. FOOD CERTIFICATE ISSUEO ' � � .�_ 33. Final Electric Notes: '7 /C/�'7 ��� �-- �.� I_7�_� 34. Final Heating & Air Conditioning � �� 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Factory Fireplace 38. ��nal Plumbing 39. Water Service�Final _ 40. Gas Service-Final 41, 5olar pomestic-Final 42. Backflow Preventer 43. 8a[kflow Irrigation ,., t: 44. Landscape Irrigation System . _ 45. 5ound Attenuation ��. - 46. HandicapRegulations � '- 47. FINAL STRUCTURE & BUILDING - � ` 48. FINAL PLANNING :;, 4g, �lectric Release to Edison • , 50. Gas Release to Souther� California Gas Co � � 51. CERTIFICATE OF OCCUPANCY No._ Date DNISION OF BUII.DING SAFETY CITY OF COSTA MESA APPROVED �,/�� o�e %� Z This set ot plans and speafirations MUST be kept on tlns job �� an times a�d it is unlawtui to make any chanqes or aiteraliorr at same wilhout wriqen permisswn from the Didsion af B'u�d'ing and Safety, City of Costa Mes� The �y �f thfs �an aiW � SHALI NOT be held to permit or to be an appmval d tt�e vidntia� af any prov�aa d any City ot Cash Mes: Ordina�e anNor State law. These p�ans and permrt shafl e�ire bY leniibion �ntl become nuil �ne �o�a it !tw_ bu� or worlc �s nrn cammenc� and m�intained zctive oF� URf 03o,t Id) with 180 days �rt issuana. 0 ncsiocMcc NOTE ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNIfdG DIUISION 7� / ■csiocMCE 30�0 � � ��� S'� U= �uZ�=��'�' ����� CI7Y OF COSTA MESA PLANNING DIV. S BJECT TO BLDG. DE�. REG. BY� DATE �2'� � REfIDEMCE STREET A . _ ` _ 30� o N�uR�� L�I 11ff10(MC[ sU ��� o� � � �FpL� o�� b�,ou� w cu,t, TYPICAL 6�� CONCRETE BLOCK FENCE Cement Coping Oot�onal � Channel Block With t-3/8� Horizontal Top of all Fences For Fences 5' or Leu Vert. Bars 3/8" �i at 4' -0" O.C. For Fences Higher Than 5' Vert. Bars 3/8"� at 32" O.C. � Fill Cells Solid With Grout Where Steel Occurs Reinforcing Steel Shall � Conform to Sec.A�15-39 A.S.T.M. All Steel to be Lapped 24" or to Code NATURALGRADE TWO 3/8"t5 BARS n n CONTINUOUSTOP � , . &.,BOTTOM ' ' _ , . , ,o,. D�' HORIZ.STEELMUST BEiT1ED•IN �. � � ,,. I ' P.LACE AT TIME OF TRENCH ,,~� i f INSPECTION. p L _ � - 21, � . '.' �;t.' . - . , �. �_� . . . . a.. � �J'_, �L � 9 I—!�—WIDTH SEE CH[ 8E LOW a ,., r � ;. ^'I � t� � ` � � ... . .. , ♦. . . FOOSiNG REQUIREMENTS CHART GENERAL- NOTES MORTAR; p�e part Plastic Cement, and Three Parts Sond GROUT; One Part Cement Three ana One Half Ports �and COPING: One Part Cement, Three Parts Sand CONCRETE: Well M�xed 1:2-V2:3-I/2 Maz. of 7- I/2 Gol�ons of �/Vater Per Sack of Cement GROUT MAY BE POURED FROM THE TOP OF TME FENCE IN CELLS WHEHE S7EEL OCCURS. CELLSAND AHEASOF HOHIZONTAL REIN� FORCEMENT SHALL BE CLEAR, CLEAN & FREE OF ALL MORTAR DEBRIS, ETC. �H OF E4RTHTCOTH �/? 7HE, NE�IGTN Of FENCE �BECOW BOTTOM OF FOGTiNG. SCALE: I/2��= I' WIDTH 14" . . . . . . . . 14.. ._......�2.... ;. � 12�� � � ,. . ` THICNNESS -Y . -. �. ,. ' . ' 10�� . . . . . . . . . . . 10° . . . . . . . e\'. � . . . 8 ,� DEPTH OF- EARTHTOOTH� '.� . 24�� . . . . 20�� . . . 16" . � . ' . 12�� . ,SPACING OF EARTHTOOTH.��. '12' . . . . . . . . . . .14' . I6'. 16' City of Costa Mesa, California �j�� �U2�,y � Building Department ., h�FV.�SEP NOV.82 ' ?�'_ ' ' . ' " _ '_ _ '� �i <� . . r ' R .,, ,�� PARTY WALL AGREEMENT THIS AGREEMENT, made and entered into this day of 3vly /�_ / , by and between ,�/L�.�S�l ���r"�--- T hereinafter referred to as "LANDOWNER;' and _!�lrr(� ���F����__ hereinafter referred to as "ADJACENT PROPERTY OWNER" It is hereby agreed that a party wall will be constructed on the property line between in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Book , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS WHEREOF, the parties have entered into this Agreement the day and year first above written. LANDOWNER (Si natme) ' . /'�v,�iEL C � �'Gc tz Name (Typed or Printed) i /�� �L� ii.=.. t /� / / � i I �i; i 1906 d6 ADJACENT PROPERTY OWNER Name (Typed oi Printed) fNOTARIZATION RE�UIRED y'. � State of (,�/i k County of �c�-n ;�,p �e On� J�t before me,��pAr� �/�rt��fr'.T�A.��'( 1 ATEI _ n INAMERITLE Of OFFICER+.a.VANE DOE. NOTMV PUBLIC� personally appeared ��� fC �.0 C� �i9�P r' �� �� INAMEISIOF NERI511 O personally known to me -OR� .`�'r� 7' �7 • �' a 7'�.1 Of �G � �[ �• ��y �'� C 1�?�, ,� . .-�. �. �:i� •- [ •� ' � ��f .. proved to me on the basis of satisfactory evidence to be the person(sl whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityliesl, and that by his/her/their signature(s) on the instrument the person(s1, or the entity upon behalf of which the person(s► acted, executed the instrument. my hand and officiaf seal ATTENTION NOTARY . ,., The intormation requested beiow and in the column to the right is OPTIONAI. Recording ot this tlocument is not required by law and is also optional. It could, however, prevent iraudulent attachment of this certiticate to any unauthorized dotument. iMISCERTIFICATE TMewTypeolDocvmm G�r � YN MUST BE ATTAGIED /� C'j/; TO TIE OOp1MENT NuMer ol Pepn _� Date ol Doeurtant Y- V � 7 OESCRIBED AT RIGHT: Sipror��� Other Than Named Abow WOLCOTTS fORM E77�0 tW. ��P� Ioric� cle� B-]A1 �1 YY< WOLCOTTS F01tM5. INC. ALL OUqPOSE �CKNOWLEpryAENT WITX SIGNEfl CwVAC1TYlflEPRESENTwT10NlLWO FNGERVWNTS r HIGHT THUMBPRINT �OD��eI) �ACITY CLAIMED BY SIONERfbI DIVIDUALI51 CORPORAlE OFFICEHI51 ❑PAflTNERISI ❑LIMITED �GENERAL OATTORNEVIN FACT 07AUS7EEIS1 i]GUARDlAN/CONSERVA70R ❑orneA: SIONEN IS NEYRESENTINQ: (Neme ol Psnonl�l or Entity(ie�) RIGHT THUMBPRINT �Optiondl CAPACfTY ClA1MED BY 616NERI51 OINDNIDUAU51 OCORPORATE ocF�rtis� '�' �.�„�� ❑PARTNERI51 ❑LIMITED OGENERAL QATTORNEY W FACT ❑7RUS7EE151 OGUARDIAN/CONSERVATOR OOTHEN: SIONER IS NEGHESENTINO: (Name ol Personp� or Entirylw�� � 11111111111111�1161111111I�I118 Costa Mesa Bnilding Department - P. O. Box 3!7 COSTA MESA, CALIFORNIA � FOYt APPLICANT TO FILL IN nddre� 3090 Murray Lane Cc�sta Mesa, California Nearest Fairview & Baker Cross St. owne� College Mesa Company Mail 1777 W. Lincoln Avenue Address :�PPLYCATION FOR PERMIT BUiLD1NG ' FOR OFFICE USE ONLY by Date Rec'd. Date Issued � 02-�3 -S FEB 1 4 1 Address Costa Mesa, California Anaheim Te1•KE. 3-3161 � crou st. City No. rZone I No. ArChitect or Lic. engineer Quigley & Clark tdo. 08884 Address 1323 No. Broaduay� Santa Ana City Lic. contrector The Hale CompanyNo. 342Zt n�dress 1777 W, Lincoln Ave,� Anaheim Leg�al I Lot I � Description No. 114 Block I Tract ZB7 (Attach Metes and Bounds) No, of Bidga Size of Lot 64 x 100 Now o� �ot None l�seof I No.of I No.ot Existing Bldg. Familles Rooma 6 5n � Side New � X � Alteration � � Ad Sii�e �ng 1321 Rooms 6 Stories 1 Exterior Wall I Rbof Covering $tUCCO COvering Rock UseoiNewsin le famil suiiainy B Y dwelling with e ac e garage, CORRECTIONS APPROVALS in Location Inspecto Materials, �inning ire Stops, . Bolts I hereby acknowledge that I have read this Applicution � - and state that the above is correM and agree to comply Lath. int. with all City Ordinances and State I.aws regulating building construction. �ath. Ext. Signature of Permittee - Tf1E A.F, CnKpANY—�_ � Plaster.lnt Valuation PermitFee$ 2$,�� Plan Check $ 14.00 S 11,368,00 Tota� 42,00 Fee $ : r n � 0� �� i 0 , .. �, t , , • , u a yvi a �uii. _ 6how locatlon and distancea from ' �; property Iine and between bulldinga < �_ � _. ,. ll. rti . . IJ i_� q• t Hy strict application of the Zoning Q�de, this additian v.ould not be ��++�; tted sinoe the width of the addition exoeeds 33-1/3 pesoent of the width of the lot. i�ver, Staff approval is being granted (without appxwal of a variance) on the basis that the building area Pncinaching into the re- quired �j� foot rear yard does not exoeed the building area that �.vuld be peanitted tn encivach into the required zear yazd if the add.ition was no wider than 33-1/3 percent of the width of the lot. OWNER COLLEGE MESA COMPANY DATE 2��� � JOBADDRESS Qn�f�tirr•3�/-Tana BUILDINGPERMITNO. � ���j2(� GENERALCONTRACTOR Tha v.,lo C ............. VAWES ll_�tFR_nn � LOT � BLOCK TRACT Q(']], S].I1g1B res. w/det..�aY'_ GROUP I& J TVPE V ZONE FIRE DISTRICT J,i�Q2 PERMITS ISSUED INSPECTIONS I DATE SUBCON7RACTOR DATE I NUMHER Grade to Plumbinu, Rough to Slab IT.aT� "vi. << I°"s-. �= �!�41.... _,Y.m,,. iW�,,.-.,1�,,.... 1.1 ;-2/— S71 R'o 0 0 Heating, Rougl Heating, Final Sewer, House � Seotic Tank or 6: Plumbing, Final, Fixtures Complete/rJ ,S g'/j1-$'7 � Plumbing,Fin.alGasTest �S— /Yi/fS 9-/8-s� ` ,� ` Wiring,Final � � _/ � �� Occupancy .� 1 � y _ (G�_�7 / � fORM 210 3M 10-i5