HomeMy WebLinkAbout133 YORKTOWN LN - Building Permits CITY OF COSTA MESA
c�� `i BUILDING DIVISION
i y .�.. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us
-1 n '�..:. +
4.�l FOR INSPECTIONS CALL: (714)754-5626
`* .0 PERMIT NUMBER: BC07-00064
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 06/20/2007
ISSUED BY: SOK
JOB ADDRESS: 133 YORKTOWN LN CM . ' Suite/Unit:
Vicinity: BATHROOM Primary Occ: 'Const Type: V-N SO.•FT- 0 Valuation: $4,000.00
SCOPE OF WORK: INTERIOR BATHROOM REMODEL/REPAIR DUE TO TERMITE DAMAGE.'
OWNER: VANDERWARKER, ORRIN H 3RD i Address: 133 YORKTOWN LN Unit:
PHONE: - - - City/State/Zip: COSTA MESA, CA
APPLICANT: ROBERT LUCE Address: "=Unit: .
PHONE: 909-717-8262 • City/Slate/zZip:
CONTRACTOR: LIBERTY CONSTRUCTION _ . License No. 640562 '
Address: 427 N CITRUS AVUnit: PHONE: 818-445-4439 .
City/State: LOS ANGELES,CA ' ZipCode: 90036 CELL:
ARCHITECT: - License No. PHONE:
ENGINEER: License No. , ' • PHONE:
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $0.00-
Building Fees: $97.25 - . . . '-
Electrical Fees: $33.40
Mechanical Fees: $0.00 - -
Plumbing Fees: - $62.70 -
SMIP Residential: • $0.00 + . ..
SMIP Commercial: $0.00 . .
TOTAL FEES: $193.35
••Refer to fee receipts for all fees paid for project
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE I INSPECTION TYPE gek.Th INmPt5 CODE{ INSPECTION TYPE DA NI TI9Al
1618 Fixed System Final Fire Prevention 208 Final Mechanical C .,V.d/I�.`�r.,,.,r`
1268 Pool Spa Final 208 Final Plumbing 7 7D176.7_
? �C -- <Ad'"/
200 Final Re-Roof 210 Final Electrical 71-7 /O 9 `-44- 1
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 9J/y/2 (a— CASA,�/1`
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivel se. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
00-Phave and will maintain workers'compensation insurance, as required by •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
•
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: ./ person is required to descend,will be made in connection with work authorized
number are:
by this permit,and that no building structure.scaffolding,falsework,or demolition
�rt1e or dismantling thereof,will be more Than thirty-six(36)feet high.(Chap.3.2,Grp
T sseao,neednor becornpleteddhe Demi, al one nun&edaxars(fido)or fess.) 2 Fvt2 Sec.341,'itle6,California Administrative Code).
P.olieyNumber:,- f 11 S O
\^ 0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the work' -' compensation laws of California, and agree that if I should
becomes ct to the workers' compensation provisions of Section 3 00 of Applicant's Signature Date
the Labo• e,, shall forthwith corn with these provisi ns.
/ 7� Li _..2.-it l U� Division of Industrial Safety Permit Number:
�A/'r p�dirarn's Signature L:-Oamr HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. r a registration form for acutely hazardous materials? 0 Yes 0 No
.#`F - Cla`ss'.# ' A cetio 25533 the CaliforniatinHealth and SafetyCode, with some
—7 exceptions,(Sorequires3ofregistration with the CostanMesa Fire with Department by
r / each business which at any one time has on hand a quantity of acutely
contractors Signature., vva1 hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lenders Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
That he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the Califomia Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No,
thereon,and who does such work himself or herself or through his or her own 6. (If yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE-OF.COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ 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 doesnot apply to an owner of .. Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Cos . Mesa to enter upon the above-described property for
inspection pu .. es. I agree not to occupy or allow occupancy of any building
authorized b . s permit until final inspection. -
f. a mss) Date
Signature Date3057-46(3/07) OA 6/00/9
NMler'Augiored Apperant-, (_Dale_
•
1
501 CITY OF COSTA MESA
BUILDING DIVISION
. • ..: ,I DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
J. Wia PERMIT
Po .4% P07-00221
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBIJob Address: 133 YORKTOWN LN Status: ISSUED
Suite No Applied: 04/11/2007
Issued: 04/11/2007
Vicinity:
Parcel Nunmber: 41916249 /
Applicant: JOSH KEATING ISSUED BY: Ills /
Address: 30300 PUERTO VALLERTA
Phone: 800-727-0977
MENIFEE,CA Zip: 92530
Owner: VANDERWARKER, ORRIN H 3RD
Address 133 YORKTOWN LN
Phone:
COSTA MESA,CA / Zip: 92626-6564
Contractor: ALL STAR WATER HEATERS INC '
Address: 30300 PUERTO VALLERTA
Phone: 800-727-0977
MENIFEE,CA Zip: 92530
License: 812894
SCOPE OF PERMIT -
CHANGE OUT WATER HEATER
. _ 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 $0.00 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 Bkftow(1-4) $0.00 0
Connect(Ice,Soda,etc) S0.00 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 $12.30 1
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 $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor , $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe ' $0.00 0 Spa(private) ' $0.00 0 VIOLATION ' $0.00
Gas Service $0.00 0 , Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
•
COMMENTS I SPECIAL CONDITIONS
• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(NW)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
L1$, 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'cam.:nsation Insurance :rrier and policy number are: •
r4_ /16
�/45,
CerJCa ec./ _ r_ ■ a - rho- NuNnmtier�.
-(This section nee:not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and 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.
Apptican181gnature:—.- I1 Date: . �• 7•U
C -WARNING!FAILURE'TO BJ
SECURE WORKS COMPENSATION GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S1030001 IN ADD ION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provi ''ons 9f Chapter 9(commencing with Section 7000)of Division 3 of the.Business and Professigns Code,and my license is in full
f roe and effecttLLk.a g r 2 g`7 c I Class p j/1 3(p
C
-Contractor's5)gnature:_ �l (De "Nr/� -O 7-
CONSTRUCTION LENDING AGENCY:
O 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: 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 tile 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).):
o 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 property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers 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.lltle B,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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia 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,ora 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 end 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 application apPernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? EU Yes LJ 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 facilityto be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If Nes',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 6,1 sO,2s) Date
Yil- °
rAnd/Or t orized Ap_pa6ant 1 .,.1,,;_� Date
CODE I ItISPECTION TYPE 2Am INTRIAL$ VODFt INSPECPONTYPE PATE-" INTIMLff
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 44-67 7 —_
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
•Imri
�D 1PLCW° 133 YORKTOWN LN UHT CITY OF COSTA MESA - BUILDING PERMIT
O"NERSNANEU100W": VANDERWARKER, ORRIN H 3RD PERM NO: B 073595
mat"' VANDERWARKER, HELLA E
133 YORKTOWN LN PERMIT NO: B 073595 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
APPL.IAUUNEADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENVIER: sic.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 999
ARCH.OR E"0.5 ADDRESS: UMT:
CLAIM VALUE: 2, 999 . 00 CALC-VALUE: 2, 999 .00 GROUP OCC: R-3 /
CONTRACTOR'S EWE STOUT ROOFING INC ( 310 ) 923-6775
CONDUCTOR'S MAILING P 0 BOX 4309 COMMENTS : SMOKE DETECTORS ARE REQUIRE PER 91 UBC
ADDRESS: DOWNEY CA uc.No.: 402536it*****x**********+tRE+t+t*iFRt*****Rtx********x**sr* EAE*+E***x**+c*st***SE*x******x******xst*
90241 we ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Allem under penait Miry that I em licensed under provisions of Chapter 9 S E TB ACK S
(oommendnp wish Section 7000)d Dlvtson 3 d Ne Business end PWes end m license u in lull end effect,
clrYsic.NO.: 059 77 sic.tune: 39 sic. 02 36 ' : 1 ' /95, MAIN BUILDING ACCESSORY BUILDING
� � RNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor �� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby arm under pertaity of perjury that I em exempt Iran the Contractors •. .a Law for We
rwlowing reason(Semon 70315 Business end Professions Code:Any city or county which requires a permit to conetru.,exec improve, PARKING REQ• PROV: PARCEL: 41916249 Z N E: REF NO:
olish,or repair any structure,prior to as issuance,also requires the applicant for such permit to file a signed statement that he or she •
*need pursuant to the provisions of the Contractors License Law[Chapter S(commencing with Section 70th)of Db"a"ion 3 of IM PLANNING NOT E S.>
.sines and Professions Code[or hat he or she is exempt therefrom end the basis for the alleged exemption.Arty violation of Section >.
7031.5 by any applicant for a permit subjects the applicant to a civil penalty d not more than IN.hundred defiant(S500. *******************************************************************************
o I,as owner d the property or my employees with wages as thei sole compensation,will do the work,end the structure i not intended D E V E,.L OPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply loan owner o1 properly
who buids or inprovee thereon.end who does such wok himsel or hereof or through his or her own employees.provided that such i"
improvements are not intended at offered for sale.If.however,the building or improvement is soli within one year of completion,the ZONING APPROVED BY DATE: /''
owner binder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.s awnet d the pr°party.am enkl amy eantracshg with licensed`arena`mee t°nanatrua the pmjed(Sedan 7O44'Suswlees and BUILDING APPROVED BY •: DATE: / s
Professions Code:The Contractors License Law does not apply man owner of property who builds or improves thereon and who
contracts for such poem with a contractor(s)licensed pursuant to the Contrasts License Law), h 4
o Iamexemqunder Seam: B.AP.c.. «thtsreason: APPLICATION ISSUED BY: ��� DATE: %' 95
************************************************* ************* **
Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of end understand the requirements of California Neagh and Safely Code Sedans 25505,accn3,and
a5e3..and thmltarryMtdlcati fomthenttuywa not(circletDiaaddm<tngw.neaidappicat amtroremptemmthfor
se BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
e perms Itconstruction atIort sire bitionkoctheni it/will
noregemao Diana. to comply
etas id state
a code and
en exempt from these
Provisions. PERMIT 54 . 00 . 50
Date: Applicant: PLAN SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under peaty of perjury one of the following declarations: ISSUE FEE
❑ Ihaveandwlmaint°nacendvtedoonaentmsen;neuretrwotkers'wmpenmis..aeproidedfobySeaion37OodtheLabo BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.ltthe°°d"me°°"the work It Penni'"ap« '°°d. TOTALS----> 54 . 50 0 .00 0 .00 54 . 50 54 . 50 . 00
n I have and til mainly workers'compensation insurance.as required by Sedi n 3700 04 the Labor Code.for the performance of the
7� work for which this pent is issued.My workers'compensation insurance carrier and poky number are:
Carrier: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: .00
Policy Number: 04494U1004b8 / 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(Jags section need not be completed if the perm(is for one hundred dollars/SI00/or less) 54 .00 . 50
❑ I comfy Out in t e perm ante at the work for which the permit u ...,I shalt not employ any person' • manner so as 10
became subpa to the ordure camperamion sus d Cald0ma. ree that ' I should bac ,e 7•".• to the *******************************************************************************
compensationPp+ d 37°°d n /�I INDIVIDUAL F E E B R E BREAKDOWN
Date: A --' '' 9 4 Applicant: I Q ��.e rI
Warning:Failure toto secure workers'compensation coverage b unlawful,and shell subject en employer to cring pe antes and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines w as one hmdrad thousand dollar*(5506000),In a I&n fa the cost of compensation,danMgee worded far In
Section 370DottleLabor Code,Interest end attorney's feu SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 999 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a°mansion lending agency for the END OF FEES
performance of the work for which this permit is issued(Sedon 3097,ay.C),
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and date that the above information is coned.I acne 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 property
for inspection purposes
RLENE BURFORD
/�i Af�a ' °"93.-.7
/J9� O1 08/04 03187649 T39:(j 54.50
/�/y'�y{ Date: /Y DATE: 08:04'°5 TINE: 79:ISE
pnmure d Owner AgenUAppbcan redo
(5t51<eWP) While-Building A Saffety:Green-File:Canary-Applicant;Pink-Pavane:Goldenrod-Assessor
' ' _ CONSTRUCTION AND PLANNING P90' SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
,
'11 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. " 53. Steel Reinforcement "
--3. Eiectrical Conduit Utility-Unjrgrnd. 54. Forms .
- =4.7Electrical Conduit-Urisdrgrnd. 55. Electrical Bonding -
-. -
'5'-Steel Reinforcement 56. Rough Plumbing & Pressure Test
• --6.'•
Electrical UFER:G+nd. 57. APPROVAL TO COVER-GUNITE -
a
- _7 'Footings - 58. Electrical Condint.Undrgrnd.
8. Foundation • a 59. Gas Pipe, 0 Undrrnd.,Test
``?J7 Water Pipe-Undrgrftd. _ 60. Backwash Lines, P-Trap,0 tir drgrnd. I
I0.-Structural Floor System - 61. APPROVAL TO BECKt - , . - - - -
C A,
11-'Property Sewer Line & House-Connection .62. Backwash & Receptor-Finl
1:2. Sever Cap63. 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 v _ 68. APPROVED FOYPLASTERING
18. Rough Electricalj Bar Ceiling' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air tConditionngr d. FIRE,DEPT.,REQUIREMENT
20. Rough FaFtory.Fir�pftace '2.r 3 Tr r'APPR'OVR{;S',.; Permit#
21. Ducts;in'Strunture : •• •• - - `.y ; 70. 'UnderWouEtl Hydro
22. Dycts, Ventilatiing., -z. :
OWNER AN SVSRTA Building Co. DATE OCT 3 0 1963
JOB ADDRESS 133 Ynrxtown Lane' BUILDING PERMIT NO. 20677
GENERAL CONTRACTOR an vista Bu11dthg_Cr0. VALUE $ 14,835.00
AP No. LOT p87 TRACT 516n FIRE ZONE DESCRIPTION OF WORK Res.v/att.gar.
I 'ECTIONS Signature DATE GROUP 18r,J TYPE if ZONE R-3
sc... -7-0 PERMITS ISSUED
j al SUBCONTRACTOR
Gas DATE NUMBER
Water ' ( /1/2-a
Rough Corn. Refrig. ❑ Air Cond. ❑ •
Rough Heating ri _id " fe-j' Et1c7 '>ett `' tet I -6.104{ 2
Rough Plumbing -�jf. 'S' F1f SM\-k`F,2t�) lf\ —\. ri 3 '`1 2
Miscellaneous ���,,,ppp
Prop. Swr. Line 0 House Con. �Y //St.•Swr. ❑ G_ J_ _et/ (Le.,-,...e- e., -ate _Nov 1 3 1963 a i Xr. .
Sprinkling System ✓ �/ .4 /,y"r
Construction Pole .IIIc
Underground 0 Power ,D
Rough Wiring ed . Jr r - r 0-1C-C-r.P9. A-&-lri-k 2rOC-1Z'
Trenches 0 Forms 0 Steel Reinf. 0 c /. -6
Floor System
Bond Beam 0 Steel Reinforce 0 _
Sheathing 69
Frame and Flashin l G.l A sire.'�
Lathing— In, Out e ' t/1.7
— VPI
P' `er, brown coat o �/` y y 4./y p i
1 p Air Con, �p Final ` r
Heating, Final 30 G�
Plumbing Fixtures, Final a y' 4fFinal Gas Test ,,f 7� / 6�_ ` O� 77'/dY /� 4bElectric Fixtures, Final #7;
� __'"�
Building, Final ¢/4 z-#7;
OCCUPANCY / HOLD Feat SPECIAL RE
Form BU4--5M�-83-5-H P vT.Jll(hMk1V IS
20677 FEE RECEIVED
SEP 2 6 190
` COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 317 COSTA MESA,CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT Lot 287 BUILDING
For Office Use Only
BUILDING
ADDRESS 133 Yorktown Lane RECEIPT NO. P7I,J{6 / 7jEL..�
COSTA MESA. CALIFORNIA
RECEIV BY DATERECEIVED ....DATE ISSUED
OWNER San Vista Building Co. .BUILDING //� /�9-21/4C-4.5 I 0 1963
MAIL 1166 E. 58th Street ADDRESS /el c/ pcllo(�/
ADDRESS ',/,//
CITY Los Angeles 11 NEE`AD 37187 ZONE TYPE GROUP
FIRE
t/Lir
ARCHITECT Raymond Levans TEL37010 APPROVED DATE -`
OR ENGINEER NO.
ZONING ki
ADDRESS 3432 Via Oporto, Newport Beach ._'...
ONO.OU6E• I,/
CONTRACTOR San Vista Building Co. �� PUNS I IL•1 '� Ira
r . B-3
ADDRESS 1166 E. 58th Street DESCRIPTION •
L ' /Tract 5160 - Lot 287/
-
CITY Los Angeles 11 A.P.NO. f'/( 3�3 ' /
NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
STATE 192782 TEL AD 37187 80'TO SIDE&REAR P.L.
LIC.NO. NO.
EAVES
SIZE 20 x 70
I NO.OF BLOCS. 0 ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF None MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L EET)
SETBACK LINE FROMI 1 II
CENTER OP STREET 13 REAR YARD 6 10 i FRONT FT.
SIDE YARD LEFT 0 I RIGHT 0 • R.SI E FT. FT.
DESCRIPTION OF WORK L. DE BT.
NEW X ALTERATION ADDITION RHA FT. FT. /.
DISTANCE BET. BET.MAIN Q
REPAIRI
MOVING q�.1 OI,Ig MAIN BLOCS. ACCESS.SLOGS.
BUILDING
20 x 32 NO.OF 5 1'ltlll 2 VAR.# DATE
SIZE ROOMS STORIES C.U. s. APPROVED
EXTERIOR W L ROOF APP V 1 �
COVERING �iUCCO I COVERING Shingle gr DATEc f 1
USE OF BUILDING AND WORK TO BE PERFORMED l�
Residence and Carport '
WO a./9---./ei>"_.
Q /3G,SQ.FT./�/I^/ ya
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOpUG UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDI )ICES AND STATE LAWS REGULATING II,
//�
BUILDING COrvSTRUCTlO VALUATION PERMIT FEE $ `"�jr �' N
SIGNATURE OF S ISTA BUILDING CO. m
PERMITTED / .1 / A/l $/9-
I n/3� I ��,_ G
AUTHORIZED AGENT aures N. Starb itd _ \\ /I (/y / ..
TOTAL FEE $ 707