HomeMy WebLinkAbout109 YORKTOWN LN - Building Permits 44.
p6111MF CITY OF COSTA MESA ~
a.epee BUILDING DIVISION
F y, I'8, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
v/a !C PERMIT
%gement) 04-00224
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,C TA MESA,CA 92626
PLUMBING PERMIT
Job Address: 109 YORKTOWN LN Status: ISSUED
Suite No Applied: 03/31/2004
Issued: 03/31/2004
Vicinity: .(11L___
ISSUED BY:
Parcel Nunmber: 41916241
Applicant: SCEARCE, DAVID
Address: 1556 S ANAHEIM BLVD
Phone: (714)758-7725
ANAHEIM,CA Zip: 92805
Owner: GRANNEMAN, SHERYL L
Address 109 YORKTOWN LN
Phone:
COSTA MESA,CA Zip: 92626-6548
Contractor: PACIFIC COAST COPPER REPIPE
Address: 1556 S ANAHEIM BLVD
Phone: (714)758-7725
ANAHEIM,CA Zip: 92805
License: 661428
•
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
COPPER RE-PIPE ENTIRE HOUSE FROM EXISTING SERVICE.
FEE SUMMARY
AMT QTY AMT QTY • AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation 50.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain.Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar • $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $9.80 1 r
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 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)7545626
2446-46(6IW)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ Dave 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.
l�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.
„CMy workers'compensation Insurance carrier and policy number are:
arer: t NiS C Orr umber: / /si
(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. Califor d 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 . Ions. p �J `f/
Applicant'Signature: l�-� (Date: J • %�r 0 •
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE 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 lice s d under ovisions 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.N u 7 L.
/Contractor's Signature: C LiDaj -3•3I-
CONSTRUCTION
-31-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).
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 License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or thiough 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ t am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 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(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? ❑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? ❑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? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No
(Section 65850.2 of the California Govemment 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 Califomia 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? ❑Yes ❑No
ce... fo.
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
3-31-0(1
r And/Or Authorized Applicant l/' Date
CODE r INSPECTION TYPE PAIL INTITIAIS CODES INSPECTION TYPE PAIL INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 1 -I -0 1 Ylt Y_
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
PROJECT ADDRESS: 109 YORKTOWN LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 069474
3WNER'SNAME: HUNTER, GEORGE
ADDRESS: HUNTER ANNE PERMIT NO: B 069474 PLAN CHECK NO: N GOVT: N SUPP; N
9851 KITE DR
HUNTINGTONBEACH,CA 92646 CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH & REROOF W/COP-M & HOT MOP SQ FT; 2, 508
ADDRESS: UNIT:
CLAIM VALUE: 2, 508 . 00 CALC—VALUE:Go im•-•19 2, 508 , 00 GROUP OCC; R-1 /
PERMITTEE: STOUT ROOFING, INC. ( 310 ) 923-6775
ADDRESS: 9700 WASBURN RD COMMENTS: REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE, REQUIRED
DOWNEY CA 90241 *******************AE***************************s6*+r**********ae******************
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 0l the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY c.: 059377 STATELIC.: 402536 cuss: C-39 EXP : 10 95
to/a C-P Signature;— — ._ MAIN BUILDING ACCESSORY BUILDING
MILERS' MPE ATIONDECLARATION: 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 INMILERS'
Compensation) u e o a tried copy thereof(Section 3800.Lab.Q.
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
POLICY NO.: j 0 2 �� EXP. OATS: x1 5/1 9/9 5
COMPANY: AIG ,--v PARKING REQ: PROV; PARCEL: 41916241 ZNE: REF NO:
r Certified co y— hed. LT Certified copy filed with the city Building Division. PLANNING NOTES>
a 24'
Applicant: *******************************************************************************
• EXEMPTION FROM WORN RS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1001 or less). D E V E L O P M E N T S E R V I C E S 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;
Date: Signature: BUILDING APPROVED BY
NOTICE: after making this ywideclaration. hu should become or spermit the Workers'mempensation provisions of the Labor DATE;
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. Q
CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; DATE; 47 ® 1 9
which this permit is issued(Section 3097.Civ.C). ************************************( *************.**.***.******** **
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby allirm that l am exempt from the Contractors'State License Lawlor 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 54 ,00 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
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My 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 I. as owner of the property or my em loyees 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----> 54 , 50 0 , 0 0 0 . 00 5 4 , 5 0 54 . 50 , 0 0
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 • 54 . 50 OVER/SHORT: , 00
improvement
e purpose of
within one year of completion.the owner will have the burden of proving he/she did not build or improve
lorthe BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 , SO
❑ 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). I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAK DOWN
❑ I am exempt under Section: B.8 P.C.
tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: OwnerSFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 002, 508 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
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
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned 01 00170467-00170468 TOT 54.50
Ior inspection Lir o5e5.
property o p DA7�: 10/28/94 TIRE: 12:I3
.- at '9l Signature'.
Driver's License or So sal Security of:
1641.46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
�_�CnNSTRUCTION AND PLANNING POOL ,PA
APPROVALS Permit Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3.1Eleci-ice! Condit {}tility-Undrgrnd' 54. Forms
4.
7 °4.,Elepirical Conduiti-Undrgrnd. - 55. Electrical Bonding
5..Steel Reinforcefi&nt 56. Rough Plumbing & Pressure Test
:4:6.EVectrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE .:
?.4Fdoi
�ings = r.. 58. Electrical Conduit-Undrgrnd.
•
g. Foundation "s• rO 59. Gas Pipe, 0 Undrgrnd., Test `
9. Water Pipe-Undtgrnd. 60. Backwash Lines, P-Trap, 0 Undryrnd.
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
rl 1
13. Roof Drains - , r - 64. Plumbing System - Final
14. Rough Plumbing " - 65. Electrical-Final I
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 Fir.eplace , -r,n; .r -) 4 0 •:2c} ' -sAPPRCIVAt :[
S ..."3Pernit # • - r• I
33.
211,-rDu4t_t,iniStructuCg, ;, -.3
_ r 1.-' 4133-j70. U 1dergreuj,d;Hy`5ro
22. Ducts, Ventilating.. i _ • .• •• ' • -171. ProduccPiping 09s 00011
23`Gas Pipe1Rou9h 8,7-Test ,,p ,1 _ f .,72. Undergrdpj,yi Flsish�-_ �'
24.-Bo Framing r:• ' r , - A • C. * o ,_;73.iUndergrnd:Ston CTank C Gas 0O'ii
25. Roof Sheathing - F ''74.=' verhead H dro i' -
26. T-8a{ Ceiling (Structural) & MOrlOcoat - -.;, �� nt * t 75.2Dry Chemical : . i
27. Frame and Flashing' mJ ' 't • 76: Dr Stand' i e '
.. cy
'
_28. lathin9;& Sidingq : ; ti4, - 77.0 FIXED _ MFINAL` '"
I. .-.
to
29. Insulation, „ _ C.1 1 I 1r ; 78.`FI RE PREY. FINAL I,
r30. DrywalliNai11i g ^ • - - • I* r HEALTH-DEPT*REQUJREMENT
-,31. Plaster Biowno3t, ._Cr I I I ' ,79.~-FINAL INSIgCTIQN e
32. Electrical;Power MSerjFinal I ' - •n I I ,t • ,i60..,fOOD CERTIFICATE ISSUED y
33. final Eleeiictric :3": ni ! C' ii 1 i . ; t�1Notps: y 11 , _-. 71 r
r :al
.34. FinaP Heating•& Air Cogditioni_nq. n * i 0„ # ,r, n r
35.,'Final Ga--ssPipee-Testy 1,1 1 ! 1 "' � ' ' --
,36.-Hood or CanopyLI, .� . ;-, �1'
I ... I � 1.10 • g I;c,
97.•Finat'Faciory Fireplace r1 J • t" i 1 1. 2: .) .- - _ _7�, I
I I c
38. Final•Plurnbing 3 , . y I I'. ~ • ,. .1
:39. Water Service-Final; I
I I t = • I:
“. 1 . .• I . 7- , 4 _,.I ._ _ _
40. Gas Service-Final .- it .-„ , a ,n I I Ira G •. ,
.
Ai
-41. Solar Domestic-Final 1' 1 I I' ` ' _
42.:Backflow Preventers F• ,; `' 1 I It A C
43. Backflow Irrigation• i':� .. , ' ' `^f"= - -
r - - t
44. Landscape Irrigation Systema T,- , ; p; , a -14. - 1=1
45. Sound Attenuation• '-;NI: r r F EL:* ' %-) H - rc:: ' I
36.`Handicap;Regulations � ' t ,r1 x
�i ■ 1,
47..F,INAL STRUCTt�'.RE& BUfl1DING l' t •t1 U:.;t
�lq-qs��, 1 - _
48. FINAL PLANNING •
, "'' 1 i • "J o'tvl 71 --1
_49. Electric Release to Edison I �, - a2 ry
50..Gas Release to Southern Califorgia,Ges Co = %* t : -2 1,4:
' ' -`:
51. CERTIFICATE OF OCCUPANCY' , , .4 '; na -
No. Date
OWNER GAN V2STA Aui]rling Co. DATE OCT 3 0 1963
JOB ADDRESS 109 Ynrktown Lime BUILDING PERMIT NO. 2085
GENERAL CONTRACTOR San_Nista-&t . .'- o. VALUE $ 12,.635 00
AI . LOT 295 TRACT MO FIRE ZONE DESCRIPTION OF WORK Res.Watt.gar•
INSrECTIONS Si:nature DATE GROUP Ha TYPE V ZONE R-3
Soil _:42 SUBCONTRACTOR PERMITS ISSUED
Gas .0./ . -13—ix/ DATE NUMBER
Water =/ , //-!o2
Rough Corn. Itefrig. ❑ Air Cond. ❑
Rough Heating x�l - - at ! • _ .yell - Chi . 3a
Rough Plumbing ,n7
-/3- • ./� //-i -6 3 Sy7 3 o —
Miscellaneous 1
Prop. Swr. Line❑ House Con. Int. Swr. ❑ !/-/r -/P-Lst' e,.—t-d-- ea.,- NOV 1 3 1961 `�,?, 4 (-
Sprinkling System /,
Construction Pole 1
Underground 0 Power Cl 7���
Rough Wiring Z/r Y 3-c`f' iNf' . �"/: .a
.a . rra , !-/ / J
/- 5i �i
Trenches 0 Forms 0 Steel Reinf. 0 _ t AC) - — 3
• Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing a. M -S . .
Frame and Flashin ,,,,i a 3 _ /7/G� ,1h r.'-
I '-ig— In, Out - Z— 17/6.cc . 1/`.
I. Jr, brown coat e S- J 3 /G V-
Refrig. 0 Air Con, 0 Finalrj(/
Heating, Final /Ofr
Plumbing Fixtures, FinalFinal Gas Test/SWY -i ( o< 7/� ifri _O �Electric Fixtures, Final
Building, Final !- 7 3pX77.
OCCUPANCY / ,
Form BU4-5M-3-B3--E-B P 14411 in FCIIF Cum Ar DP/1T IT DPMCNTC
20685 • FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT SBP 2 6 1963
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APFrOC A 4f Ol6A WOW
TYPE OR PRINT Lot 295 BUILDING
BUILDING For Office Use Only
ADDRESS 109 Yorktown Lane _ RECEIPT NO. PE
COSTA MESA. CALIFORNIA /ubcip�
r
RECEIVE BY yATI RECEIVED DATE ISSUED
OWNER San Vista Building Co. .-0?-ln.#J OCT 3 0 ma
MAIL BUILDING p
ADDRESSFIRE
1166 E. 58th Street ADDRES8 /�1 TEZONE2! 1ROUJ /
CITY Los Angeles 11 TNO EL AD 37187
ARCHITECT TEL APPROVED DATE
OR ENGINEER Raymond Levanas NQ• OR 37010 J
ADDRESS 3432 Via Oporto, Newport Beach ////^Z�T��ONING �- O
NO.O USE OF
CONTRACTOR San Vista Building Co. 15 I PUNS BDII.,DINocis
ir
ADDRESS 1166 E. 58th Street DESCRRIPTION Tractr5160 -(LLoo1 295 23
CITY Los Angeles 11 A.P.NO. i 1 f-3 La ' /
NOTE: NO EAVE OVERHANG SHALL g�LESS THAN
STATE 192782 TEL AD 37187 so-TO SIDE&REAR P.L.
LIC.NO. NO.
EAVES
SIZE 20 x 70 NO.or SLOGS.° ALLOWED (U.B.C.REQUIREMENT/
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
UBISTEOFING BLDG. None MAIN BUILDING ACCESSORY BUILDING
EX
(FROM C/L STREET)
SETBACK LINE FROM 13 lot, FRONT
CENTER OP STREET J REAR YARD
SIDE YARDI LEFT 0 I RIGHT 0 R.SIDE PT.-
FT.
DESCRIPTION OF WORK L.SI E PT. Fr.
NEW gI ALTERATION ADDITION - REA FT �•
DISTA BET.MAIN&
REPAIR MOVING MAIN BLDGB. ACCESS.SLOGS.
• ��n +�'�
VAR.* DATE
BUILDING 20 x 27 NB'°P 5 2
SIZE ROOMS STORIES C.U � APPROVEDEXTERIOR WALL...
I VE
F APP
COVERING SCOVERINGShingle aT DATE C^yQ 4 G -63
USE OP BUILDING AND WORK TO BE PERFORMED
Residence and Carport ,f
T/Jq / YePD�/- M
BQ.PT. O
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO UNDER VALUATION IS FOR THE 9
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. 0
PLY WITH ALL CITY O ANCES AND STATE LAWS REGULATING VALUATION p
BUILDING CONSTRUCT N. PERMIT FEE $ r n
SIGNATURE OF S VISTA BUI I GA i
PERMITTfiF 2/C S
•
`/�‘3s— — X
0
AUTHORIZEDAG T // °'
`� James N. Starbird TOTAL FEE $ (0.3