HomeMy WebLinkAbout3162 MADEIRA AVE - Building Permits CITY OF COSTA MESA
.0► @ BUILDING DIVISION
r- • r.„r. .,,<; �'$ DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
1. 1
4•b PERMIT
603-01835
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.n,,a. ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 3162 MADEIRA AV Status: ISSUED
Suite: Applied: 10/21/2003
Vicinity: RESIDENCE AND ATTACHED GARAGE • Issued: 10/21/2003
Parcel Number: 13913205 Zoning: R1 R1
alrr
Applicant: HARRIS, NATE ISSUED BY: }AtA
Address: 63 VIA PICO AV
STE 433 Phone: (949)366-6597
SAN CLEMENTE,CA Zip: 92672
Owner BORST, RANDALL
Address 3162 MADEIRA AVE
Phone:
COSTA MESA,CA Zip: 92626-2324
Contractor: OZONE NETWORKING TECHNOLOGIES
Address: 63 VIA PICO AV
STE 433 Phone: (949)366-6597
SAN CLEMENTE,CA
Zip: 92672 License: 758431
Arch ; Eng:
Address; Address:
Phone: Phone:
Zip; License: License:
SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHINGLES,7/16”OSB SOLID SHTG, 1 LAYER 30#ASTM FELT,APPLY
"PRESIDENTIAL COMP SHINGLES WITH PERIMETER METAL AND NEW VENT FLASHINGS. 35 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $10,650.00
Permit: $195.25 Claim Valuation: $10,650.00
SMIP Res: $1.08
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $196.33
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21.92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(WOO)
WORKERS'COMPENSATI RATION: — V
I hereby affirm under penalty of perj onetof the following declarations:
0 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.
Eir 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 Insure'se earn r and policy number are: /
Carrier: STGft Policy Number: /73-3/ -Zco3
(This section need not be completed If the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in Me performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions./-� q� � /0-2
Applicant Signature: /-A'ti!P a/at 1Zj Date: !0 ' 2/- 6-3
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOL ARE(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed uncial provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.d St.__
8q'3% Class x ( 3 '7
Contractors Signature: /�/1'�r j G*�`� Date: /('l j 2 / 0 3
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code).
Lenders Name: Lenders Address:
Signature: Data:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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.). '
❑ t,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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers 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 feat in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial 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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet Of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 01 Yes I 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 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency i5 required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct, I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si nature Of Legal Owner(s) Date
/�/6UtYfrr� /0 —7 /—a5
And/Or Au horized Applicant Date
CODE t INSPECTION TYPE IIAIE =AU CODE INSPECTION TYPE PAIL 11
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
rC^SOF COSTA MESA CONSTRU TION PE IT PERMI O. TRACT NO. LOT NO. UNIT NO.
.Project Address 3/6'� .0 4S.J �' /9y�o 5162 12/03/85 5e 50 TL
Applicant's Mailing Address ,f' )� TYPE OF CONSTRUCTION L I NEW L I ADD L I ALTERATION LJ REPAIR
.. _ I3'1 Ares f ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.* Zone
Owner'sNamet.4 - DESCRIPTION OF WORK/USE OF BLDG.
Address3 l e� e'a/� o / cJ - �6 S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION L I STRUCTURAL T Front ZO
Address0 I ❑ TENANT 111 ELECTRICAL ❑ PLUMBING 111 MECHANICAL BA Rear N
Contractor's Name Phone ❑ OTHER
PROJECT DESCRIPTION SQ. FT.
CONSTRUCTION TYPE OCCUPANCY C Right
S N
Address(mailing) G
VALUATIONS L¢fl
City License No. .GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. R¢(.# Parking Req./Provided E
Q
I hereby al firm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: Mwith section 7000) of Division 3 of the Business and Professions Code,and - T
my license is in full force and effect. •
License Class License No. - S
Date Signature PLUMBING FEES '
WORKERS'COMPENSATION DECLARATION
tereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
4800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
8 Certified copy is herebyw thcity
thre
Certified copy is(ilea with the citBuilding Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred($100)or -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any anner so to be ne subject to the Drinking Fountains Solar Tank Fan Motors❑0.1 HP 1:11 c-B
Worke{ CompensalLon Laws of Calif a.^
DateyjoK- 3 ^Jf4 Signatur Floor Drains SwimmingPool w/S a -
'NOTICE: If,after making this declare Ion, you shout ecome subject to the _ p F.A.U. Inc.Solar 09-15 HP ❑16-15+
Workers' Compensation provisions of the Labor CO , you must forthwith Floor Sinks Urinal —
Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY / Gas Service Outlets �
Water Closet t// Device Boxes Pole Li ht
—
I hereby affirm that there is a construction lending agency for the performance / ' `• 9
of the work for which this permit is Issued (Section 3097 Civ. C.) Intercep tors Water Heater Otl
Lender's Name uets Range
Lender's Address Kitchen Sink Water Service
Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal !Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city-or
county which requires a permit to construct,alter,improve,demolish Or repair P—Trap LaundryTrays
any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑D-5 KW❑545 KW Trash Compactor •
to file a signed statement that he/she is licensed pursuant to the provisions Of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
vision 3 of the Business and Professions Code) or that he/she is exempt
-
refrom and the basis for the alleged exemption. Any violation of Section
31.5 byany applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). 3
mi, as owner of the property - Reinspection Fee I $15 Issue Fee $
tt will do tho work, and the structure is nt ntended or offered Reinspection Fee $15 Issue Fee $ 3
for sale (Secto
ion 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler Hood Or Type I 0
sale. If, however, the building or improvement is sold within one year of corn- - - -- - Canopy Type II 0 Zoning Approved By - Date
relation the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Dat ____e
prove for the purpose of sale). ` �� Lr
0 1, as owner of the.property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By .. Date 4l
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMTP $
proof o their Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ L so PERMIT
❑ I am exempt under Section / B.& P.P.C.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING $ t 5 V ISSUANCE $
PLAN CHECK 25% $
site -allraffintrainwner 7i7�rZ. ... O... Heating System& Ducting Registers ENERGY P.C. $'
hereby certify that I have read this application an-a.tate that the above 00100,000 BTU 0100,000 BTL. ELECTRICAL $ GRADING $
Information is correct. I agree to comply with all city .ntl county ordinances
and state laws relating to building construction,and hereby authorize repre-
sentatives of is city to - ter u•o the above-mentioned
— / Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK. 25% $
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
Date Inspector POC SPA
r/-n
APPROVALS Permit# APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
•
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.;Test
9. -Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12.-Seviwer Cap 63. Heater & Vent-Final ,
13. Roof Drains 64. Plumbing System - Final .
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit • 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION - .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test g/y�rf' la
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51., CERTIFICATE OF OCCUPANCY
No. Date
September 21, 1972
Mr. Robert German
3162 Mediera Avenue
Costa Mesa; California 92626 `
Dear Sirs \y`
• A building permit has been issued to Cal-Fun Pools to construct
`
a private swimming--pool on our property. �+
I In order that your pool w be a safe one and for the purpose
of advising you of your responsi ility regarding the requirements of
•the Costa Mesa Municipal Code, we refer you to Section 8107, a copy
4;of which is attach
This letter is ected to you in order that you will be aware
of our ordinances and c make a complete safety check of your pool
area.
Sincerely yours,
RICHARD HANHART
Building Safety Director
OWNER SYCAMORE LAND CO DATE 6_29_59
JOB ADDRESS 3162 Madeira Ave. BUILDING PERMIT NO. 97114 ---
GENERAL
CGENERAL CONTRACTOR Malgren Const. VALUE $ 16,9116
AP. No. LOT 5 TRACT 33 63 FIRE ZONE DESCRIPTION OF WORK �r{es att gar
INSPECTIONS may✓ DATE I GROUP 11 J TYPE ZONV E-1
Underground Soil fj- U.G. Water f, 9-t�JJ-j� SUBCONTRACTOR PERMITS ISSUED
I.'" ''rground Gas DATE NUMBER
(_ lead Water and Gas
sough Heating_ t lel " .. •., if -_ -:-- 9-/--5- 2 e 9S -
Rough Plumbing A_�Q .5 " air. _ _7rY�l. .ter 'r-,z t' 7-/2-.s5 -,-26 c
Miscellaneous
Prop. Swr. Lino' House Con/ St. Swet) 9:47.59 -X, 4 `wt n./E-57 ---1,57-C,," Pi
__
Sprinkling System ( ,6
6
Heating, Final ,L IU R9, o ,�
- - �-
Plumbing Fixtures 19_) ' A .-it, fr.6io
Final Gas Test 1---Gt/ Ked ,
Construction Pole i\i/e-.0m+Ai,al :,-...a• /7-,52 9S`v y '
Underground Power
Rough Wiring /.Y/) 'r!'W fr I c.r,[fZ- 9 166cio,-)V
Trenches OW Forms q1. SteellMbl- •1'4°- 4
Floor System Pt&1 '-'7• 5Y _
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing .Ci. _ r--\ , - _
Frame and Flashing9 ro-'18-1Q
Lathing, In Out (1-5-51 \
P' r, brown coat /{ r4- it-/e -1'9
Pr .ring Fixtures, Final ���x-Co
Electric Fixtures, Final ��lv", '' ).24'0
Building, Final J -1 % 5
OCCUPANCY 2Cr0
Form 210-3M-4-59
111.1.1
9"?1 L'. : h�de d 1'3'- 1949-.`
COSTA MESA BUILDING-SAFETY DEPARTMENT I!CE DEP'j
FI .
P.O.BOX 317 COSTA MESA. CALIFORNIA ' .I I, 1. I'HI', a" CC„
EOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT - •
BUILDING
BUILDING _+r// a- DIADE,],c4 Air
ADDRESS C.) 17is ONLY
MESA, CALIFORNIA FOR Off/CE USE ONLY
I RECEIPT NO. 1 PERMIT NO
OWNER Sycamore Land. Co. 77/7'
MAIL 10835 Santa Monica Blvd. RECEIVED/L. 1 DATE RECEIVED ATE ISSUED
ADDRESS ,,ss JI Cr'''..2. 4 9 ee)_�I-C�S
LOS Angeles Lb TEL. BUILDING BUI L_D IIN,G / -/
CITY - NO. ADDRESS
OFA ?INEERL.C. Major ECT NO ,C. COSTA MESA, CALIFORNIA
11015 EXPI S . Paramount Bl . FIRE
ADDRESS ZONE
Malgren Const. STATE 153335 APPROVED
CONTRACTOR LIC.NO. BY DATE
ADDRESS 10835 Santa Monica Blvd. ZONING
LEGAL LOT •A
e
(TRACT" 36•3 ZONER. NO.PLANB OF USEBUILDING OF NEW )n _
DESCRIPTION NO. IBLOCK / I ( /
A.P.NO.
APPROVED
DATE !l,I�4�1q/ic
BYSIZ
OF LOT 114.78 X 77 .30 NOW ON LOT •
YARDS EVES
0 REQUIRED ALLOWED
USE OF (CENTER LINE ST.) _)]
EXISTING BLDG. FRONT v FT. IN.
SETBACK LINE PROM n
CENTER OF STREET 50 REAR YARD 29 R.SIDE FT. IN.
SIDE YARD I LEFT 7 I RIGHT 5 L.SIDE r IN.
DESCRIPTION OF WORK
REAR 2 2,._? FT. IN.
NE, I X II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
BUILDING 1G 93 6
ROOMS
SIZE 6 STORIES 1
J
EXTERIOR WALL StUCOOOOF wood. shingle
COVERING I COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
_7!wiD ling new cflrstItCtifP _
1C Att. Gar.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM.
PLY WITH ALL CITY INANCES AND STATE LAWS REGULATING , PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRu I N. VALUATION
SIGNATURE OPERMIT FEE $3
PERM ITTEE -e,-. --724.'L-e) -oftoli
$ 4 fit PLAN CHECK $ ,(f,
AUTHORIZED AGENT ` • L/ i <-1-.--
TOTAL FEE $
OWNER GERMAN, Robert DATE 9/21/72
JOB ADDRESS 3162 Madiera Ave. BUILDING PERMIT NO. 35474
GENERAL CONTRACTOR Cal-Fun Pools DESCRIPTION of WORK Pvt. Swim Pool & Deck
AP No.119-119-05 LOT TRACT FIRE ZONE VALUE $ 2g00,00
P"°ECTIONS Signature Date GROUP ,T TYPE
. ITT ZONE R-1
SUBCONTRACTOR I PERMITS ISSUED
G^� � Date Number Signature
WATER /LP.0 Vat! ft/9 J0-?-72 Plumbing � /
ROUGH PLUMBING ffRl/-7(4,44, )-7.744477 O/����6/63 �/
PROP. SWR. LINE Q HOU E ON. !II ���K
SPRINKLING SYSTEM i.
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING •
Heating and Vent.
TRENCHES p FORMS 0 STEEL REINF. ISC}� ,Y, e T-Z} -7Z,.
FLOOR SYSTEM �'^'
BOND BEAM n STEEL REINFORCE fl
SHEATHING
FRAME AND FLASHING
LATHING — IN H OUT fl
PLASTER, BROWN COAT
STRUCTURAL, FINAL __electric
HF "NG. VENT., REFRIG. AND A.C.,-�FINAL ,V -''(� � .2., {J/C4 �j7JL,`/Y a/-��34 b44f
r
P INC,. FINAL AND GAS TEST I I 7,40›,„ I0/(�r[ 7�j�
ELECTRIC, FINAL . C
BUILDING, FINAL /0'
_IPS~ 35474PAID ***f
SEP 7_1 w 761* ****34.70
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECBV E REGEIV�� Dp=E ISSUED
BUILDING // Z 74 //CrI A ✓ Pi llllll......////AA1111 �YT9/ 7 D
ADDRESS V y/,/ 4
OWNER a O - - � ' it1 A.P.NO. 31- ji. OSS �""�`Tyr.L
MAIL �I BUILDING / /]
ADDRESS3A,�62 Ac / E•Y/Q AtIt- ADDRESS �Qr /eYN Alis
ilia; TEL
Z p
a U CITY CO Cita in[ S N NO.J') (� /I�O TRACT 33,"3 LOT A BLOCK
Z < CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
O LENDER
am (
_ID BRANCH C A SIT
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Q OR ENGINEER NO.
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W It ADDRESS ZONE T P�/ r GROU
0-IL APPROVED �J
J O CONTRACTOR (742- rr„ Ai H60.,,,,,ALS BY DATE �,&
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L11 W ZONEgJ NO.OF USE OF NEW &PT
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Z F CITU A JV an A e 1 kn...., NO. f b
W O STATE CITY YARDS APPROVED YARDS APPROVED
tn O LIC. NO.c,5 7 7 vs LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS (FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. V FT.d6
USE OFL
EXISTING BLDG. El-SIDE FT. S FT,.- `
I— SIZE OFi NO.OF -
Z NEW BLDG- 111-5-0 D ROOMS STORIES L.SIDE FT. FT./
<IEXTERIOR WALL ROOF /
0 COVERING COVERING REAR FT. 10 FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLDGS.
Q 7 •/ VAR. DATE
O lI . //// /NAyy C.V.P.# APPROVED 72
CO _ /- vn e^ /_ APPROVEDE�C����4./// DATE f—�/ /
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VI hereby acknowledge that I have read this application and state TE
that the above information Is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ Ea
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any person in violation of the workman's compensation laws of In the State of Californle. m'9
zI hereby certify that I am properly licensed as a contractor under SO. FT. C
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: bb
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am exempt from the provisions of the State of California Business VALUATION PERMIT FEE S 2and Professions Code,Division 3,Chapter 9. m
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Signature of c• .. e• / P �- 'rs,16'2
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Permittee f �/
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Authorized Agent TOTAL FEE $ 34 `. LL