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HomeMy WebLinkAbout157 LEXINGTON LN - Building Permits n - `0ii-Jr. CITY OF COSTA MESA y' 'i, BUILDING DIVISION �� DEVELOPMENT SERVICES DEPARTMENT � /P98-00332 �•. ,; PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 157 LEXINGTON LN Status: ISSUED Suite No • Applied: 04/29/1998 Issued: 05/05/1998 Vicinity: Parcel Nunmber: 41916425 • Applicant: ELLEDGE, EVE A Address: Phone: Zip: • Owner ELLEDGE, EVE A Address 157 LEXINGTON LN Phone: , COSTA MESA,CA Zip: 92626 • • Contractor NOCK PLUMBING ' Address: 11612 KNOTT ST - Phone: 714 8951246 GARDEN GROVE,CA Zip: - 92841 . - • • License:707775 - Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT INSTALL DISHWASHER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 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 Bkflow(1-4) $0.00 0 Conned(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 $8.75 1 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 $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: $30.75 COMMENTS/SPECIAL CONDITIONS -Es ii I D EXPIRATION: This permlt 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 DECLARATIONS' r (� ( l • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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. ❑ 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 Insurance carrier and policy number are: Cartier. Policy Number. (This section need not be completed if the permit Is valued et 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 beco a subject to the workers' compensation laws of California.and agree that If I should become subject to the workers'compensation provisions of Section 37 of the bor Code,I shall forthwith comply with these provis!p0�^\ Applicant Signature: ' _ 7-' ( / Date: g WARNING:FAIWRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS($100,003).IN ADOITION 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cadeyyyaaand my license is in full force and effect.Lic.M Class Contractors Signature: Date: •l y x 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 Ls 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.). ❑ 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.). ❑ I 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,An 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 dMsion. \ 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 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 end 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 end 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 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 a eit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? U Yes UmNo (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? 0 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 Alr 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? 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 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 reed 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. tIft etr I • 5L . y ignat Legal / / Qi And/Or orized Applicant I Date Coos t INSPECTION TYPE DAM MALE GQDEl INSPECDON TYPE DATE It11TflAL& 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 1286 Pool Spa Final 206 Final Plumbing q-an-ny, ,M 40Ort: 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 2446-46 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO. ' . CONSTRUCTION PERMIT bSS3 I •` Project Adlress TYPE OF CONSTRUCTION - hi . I ' / /' i r '", T. 1-57 To#'ng tor, CM , . Owner Phon 0 NEW 0 ADO 0 ALTERATION - - •• Hugo FerDardos-Sairz �?� Address • - 0 REPAIR ❑ CONVERSION ❑DEMOLISH .... .^'s--. ;Arch/Eng. • . - License No.3 q 2 7 y l ❑OTHER ZONING REGULATIONS - 1 ' DESCRIPTION OF WORK 2 e oo \ Mn . A.P.4 ' Address ' - - - '- 'ZONE ' PLNG. REF.di s � Contractor r k+,�.../2ft' A'AIO t nc •Phone y A , ' YPE OF PERMIT BUILbING Tp ©t�1 DIN,— Address —1 \ �J y(�, SETBACK C ST. 7R OPE I3TV LINE - • -¶ / S e .3ra s"C. C'tr 400%+ IJ?Ir CN . 0 GRADING 0 FOUNDATION 0 STRUCTURAL DET YARD • LICENSED CONTRACTOR DECLARATION- ' 0 TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANICA SIDE YARD I hereby affirm th;.t I am licensed under provisions of Charter 9 (corn- • RIGH mencing with section 7000) of Division 3 of the Business and- ❑ OTHER ' '000":_..5� Professions Code, ousel - y license is ull force and effgppt. REAR YARD(TO P/L) . �' � n : se No.3N�-7N0 PROJECT DESCRIPTION- _ License las. PKG.SPACE REQ. PROVIDED Date Signature �� . - . .- • SQ. FT. '` r . WORKERS'COMPENSATION D C ARA ION I OCCUPANCY C STRUCTION TYPE STREET WIDTH PARK FEE $ .1 hereby affirm that I have a certificate of consent to self-insure or a Oo ZONING APPROVED BY DATE, • certificate-of-Workers' Compensation Insurance, or a certified copy VALU ATIONj�'7 — ZONE .. +`-•eof (Sett}Q�-111t21.0.C. SPECIAL CONDITIONS: 'a E Company' � ��� �1.17�1� GRADING CU. YDS. ACRES -ertified copy is hereby furnished.. , - REMARKS: y�.T o +U.�. - _ _ -. Certified copy is filed with the city Building Division. •\. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - - ' ' (This section need not be completed if the permit is for one hundred .., ($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 PLUMBING ` PLAN CHECK -. ELECTRICAL PLAN CHECK ' subject to the Workers'Compensation Laws of California. - W UtLLING GARAGt- Date Signature BATHTUBS '" SHOWERS e e NOTICE: If after making this declaration, you should become subject •TOILETS - URINALS GENERATOR 0-1 KW_1.10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER .forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW._50+KW revoked. _ CONSTRUCTION LENDING AGENCY KIT.SINKS ' DISHWASHERS MOTORS 0-1 HP ' _1-10 HP •I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS • SUMPS - - .(INC.SOLAR) 10-50 HP_50+ HP formance of the work for which this permit is issued (Section 3097 • Civ. C'.). FLOOR SINKS FLOOR DRAINS 'FIXTURES- . -OUTLETS • SWITCHES Lender's Name Lender's Address DRINKING FOUNTAINS •GAS TUBESIGNS • . OWNER'BUILDER DECLARATION INTERCEPTORS CLARIFIERS " POLE LIGHTS . "" • I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5.Business and Professions Code: SWIMMING POOL - • P TRAP _e e • Any city or county which requires a permit to construct, alter, 'POLES METERED SUB '- Improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN • - SUB quires the ap,licant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP' (Chapter 9 (commencing with Section 7000) of Division 3 of the • P --I ness and Professions-Code) or that he is exempt therefrom and the WATER HEATERS 'BTU OUTPUT - ' for the alleged exemption. Any violation of Section 7031.5 by - • . - applicant for a permit subjects the applicant to a civil-penalty SEWER CONNECTIONS - ' .Lot more than five hundred dollars ($500). ' ' ❑ I, as Ovines of'the property,br my employees with wages as their SOLAR TANK COLLECTORS - ' sole compensation, will do the work,and the structure Is not Intended ' or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING 5V5. • ISSUE FEE . 'Contractor's License Law does not apply to an owner of a property, APPLICATION APPROVED BY .who builds or improves thereon, and who does such work himself or ISSUE FEEDATE through his own employees, provided_that such improvements are not intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK OF FEES • Is sold within one year of completion, the owner will have the burden e ^ — of proving he did not build or improve for the purpose of sale). BUILDING ///''-- I; as owner of the--property, am exclusively contracting with HEATING SYSTEM 0-100,000 BTU PERMIT S ! J"-' SMTP $ licensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000+BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's Licensedoes not apply to ISSUANCE' $ - an owner of property who builds or Improves thereon,and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from-such projects with a contractor(s) Ilcesnetl pursuant to SYSTEM GRADING $— the Contractor's License Law). 100,000 +BTU PLAN CHECK $ ❑ 1 am exempt under Section ' ' B.8 P.C:for this ' $ BOILERS BTU ELECTRICAL $ • . reason - MICROFILM S. • Date _ Owner SYSTEM REPAIR,ALTERATION • PLAN CHECK $ TOTAL FEE $ I hereby certify that I ay- rear./his application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ LESS AD- ' • information is cors a ante to comply with all city and county PLAN CHECK $ - VANCE PC $ ordinances and t• r-wing to construction,and hereby authorize --St property representatives i - ity to enter upon the above mentioned ®, Jv property for �•j p. _ < Drivers' J/. •. ISSUE FEE - • - - ._ CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNINGQQI POOL&SPA ' APPROVALS Permit# N-55.5! Date Inspector APPROVALS Permit# - Date lrnk actor 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location -- 2. Soil Pipe-Undrgrn 44. Steel Reinforcement - - 3. Electrical Conduit Utility-Undrgrn - _ -. 45. •Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing& Pressure Test • •-• - • - - - -6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE- - - - • - • • 7. Footings 49. Electrical Conduit-Undrgrn 8. .Foundation 50. Gas Pipe, ❑Undrgrn,Test • 9. Water Pipe-Undrgrn 51. Backwash Lines.P-Trap.'❑UhdFgrn ` - • --- ' 10. Structural Floor System 52. APPROVAL TO DECK - .... . • 11. Property Sewer Line & House Connection 53. .-Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final - •- - •• 13. Rough Plumbing - _ 55- Plumbing System -Final • - 14. Rough Electric-Conduit '56. Electrical-Final •- 15. Rough Electric-Wiring 57. Solar System-Final • 16. Rough Heating&Air Conditioning bB. Fencing&Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation 24. Lathing &Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating &Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System - 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. • 42. CERTIFICATE OF OCCUPANCY • No Date - ADDRESS OF BUILDING: 157 LEXINGTON LN UPC: OMITS NAME IF KNOWN: CITY OF COSTA MESA - BUILDING PERMIT ELLEDGE, EVC.. A DrPM Mn. P 0779A4 ADDRESS: 157 LEXINGTON LN COSTA M£SA, CA 92626 PERMIT NO; B 072284 PLAN CHECK NO: N GOVT; N SUPP: N APPL.SWUNG ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: STR • PURPOSE: 0TH ARCNRECT OR ENGINEER: liC'NO' JOB DESCRIPTION : T/OFF SHEATH 6 REROOF W/COMP SQ FT: 2 , 924 MICR OR ENG.'S ADDRESS: UMT: CLAIM VALUE; 2, 924 . 00 CALC-VALUE; 2, 924 . 00 GROUP OCC : R-3 / CONIRACTOR'SNAME STOUT ROOFING INC ( 310 ) 923-6775 COMRACTORS MING P 0 BOX 4309 COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 91 UBC ADDREss: DOWNEY CA UC.NO.: 402536 +e**EE**4.***aa+F;EBF***+c*w.;ciax**EE******+r***w-*+cru*************+t**+r**N-+c+F*.,.....* E,F+F+r*Rc**** 90241 UM1 ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION;I hereby attire under penally ol perjury that I am Mend under provisions of Chapter 9 SETBACKS (commencing with Section 7000)d Division 3 of Me Business and Prelims/cats Code.and my license is in full forte and effect CITY LIC.NO.: 059��377/ uc class 39 LIc.NO.: 40 5./: EX/ 10 95 MAIN BUILDING ACCESSORY BUILDING Dat, V/ ContractorsL / - / INT; LEFT: FT FT IN REAR: IN RGHT: FT FT IN IN FRNT; LEFT; FT FT IN REAR; IN RGHT: FT FT IN D� LRH/ // IN OWNER BUIL R DEC ATION:I hereby affirm under Penalty of perjury that I em exempt Iran the Contractors . •`Law for the following reason(Section 7031.5 Business end Professions Code:Any city or county which requires a permit to construct after.improve. demolish.or repair anystnaeure,prior to esasuance,also requires the applicant for such permit to fib a Signed Moment like he Or she PARKING REQ: PROV; PARCEL : 41916425 ZNE: REF NO: is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business and Professions Code]a that he a she is exempt therefrom and the beer for the alleged exemption.My violation of Sedan > 7031.5 by any applicant la a coma subjects the applicant to a evil penalty d not more then fee hundred dollars($5001). . o Les owner of he propMyamy ami yi ees with wages mtls sole mml»metion,will do the work.and the etmclumenot intended ***********1F********************************ii***i'**********************rE******* or offered fasale(Section 7044.Business end Professions Code:The Contractors eeLwnot apply aul>OmreM�rth D E V E L O P M E N T SERVICES REQUIREMENTS who buids a improves thereon.and who does such work himself or hermit a through her improvements are not intended a offered for sale.1.however.the building or inprovemem is sold within are year of completion,the ownerbuilder wit have the burden of proving hes she did not build or improve la the purpose of sale). ZONING APPROVED BY DATE; o i.as owner of the property,as exclusively contracting with awned contractors to conbbuct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds a improves thereon end who BUILDING APPROVED BY : : - contracts for such projects with a contractor(*)lensed pursuant to the Contractors License Law). v o lamexempl under Section: B.AP.C..fathe reason: APPLICATION ISSUED BY: - We DATE: `�' ✓a ♦C Date: Owner: ************************************ * l -V'******M'********************** **** ir. Idohereby certify that lamaware dand understand the requirements dCalioniaHeath adSafety Code Sections 25505.25533.and LEGALIZATION: N F E E S MMARY STRUCTURAL SEGMENT:Y 15534,end that I or any future building occupantwill/will not(circle one)need to comply wah said state codes and the requirements for a penult for construdbnormoddcationfromthAs Ouabty Management Dwn&ReddanaSmanrdon moleskins are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING prON51ons. PERMIT 54 . 00 . 50 Dale: Applicant: SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby attain under penalty d perjury one of the following dederetiau: PLAN o l have end will maintain a certificate of consent to selimure fa workers'compensation,as provided for by Section 3700 d the tabor ISSUE FEE efor the maar dmceofthe work for which this came avd issued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE Iheve end w4 maintain endows'compensatiauimuraae,rosguird by Faction 3T0pd1M labs code.tor the perlamenoe of the TOTALS----> 54 50 0 . 00 0 . 00 54 , 50 54 . 50 00 work fa whin this panne is issued.My workers'ovnpensation insurance carrier and policy number are: core hr EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT ; 00 Policy Number. Cnmmt;OM 05/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not W complad t the perms a M erre hundred&Wiry/1100/or less) 54 , 00 • . 50 o candy that in theperformance ihe soak which this pante is empty person in mother ' become subject to the workers' omatio^lews d California. rae titatld should Scorns to the workers compersaf oroon00 careshall y ho„proapms. *********************************************************** **** *ta************** Data: /9- 47 , INDIVIDUAL F E E BREAKDOWN Warning:Fall le tO seaworkerscoroamation covnaga/s unlawful,and shall subject an employer to criminal Ides end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil Moos W to one hundred thousand dollars($104000),hi addition(0 the poet of compensation damages as sided for in Section 3706 of the Labor Code,Interest,and attorneys(sea CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is aw a cnaion landing agency for the SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 924 . 00 performance of the work for which the perms is issued(Sedan 3097,Civ.C). END OF FEES LENDER'S NAME: LENDERS ADDRESS: I certify that(have read this application end stela the)the above idamation is monad.I agree to campy with all ell,and aunty ordinances and state laws relating to building construction and herebyaaarrt���yyynnnaaaerepresentatives of the city enter upon the aboe.mentbnd property for inspection IrNea. �� II / J/�� 01 00181818-00181319 TOT 54.50 1 , , , .e)e: J-1 DATE; 05/12/95 TIME: 15:36 Signature of parr/Agent/A.. . . tractor (5151.46.WP) Whim-Building A Safi*:Green-Fee:Cauuy-Appicant:Pak-Revenue:Gddennod-Asmaea 11, • • CONSTRUCTION AND PLANNING 4'OOL oPA APPROVALS Permit # _ Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pale 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 a 56. Rough Plumbing & Pressure 'fest - 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-Fidel . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final • • 15. Rough Electrical-Conduit I 66. Solar System-Final 16. Rough Electric Wiring67. 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 Sheathing751 Gli,6L 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat t 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. 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 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 /1 74f 66 r.1/ 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ll 27788PAID 90.00 NOV 13-67ce`sA00 532* **** COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262E . For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING S 7 C(1 O For Office Use Only BUILDING ADDRESS I (/v��lr.�.• c:...(_G� REC[Irt NO. r[8A17F COSTA MESA, CALIFORNIA 7 (/ //(L7)c[jl RIM Y DAT REgCE VED y�i[fegllgRCl OWNER San. Vista Bldg. Co. ll nV 1 D 17U7 MAIL BUILDING ADDRESS 2249 Wanderer Drive ADDRH' CITY San Pedro 0;833-3320 FIRE /ZONE TYPE GROUP I. APPROVED II ARCHITECT ENGINEER n NO.EER Clif Olsten 923-122 BY' DATE ZONING ^ f ADDRESS 9025 E. lorence Downe I J} 'I , ZO 111 I, NO. S Il I vizor N , /' '^IW U�_II NLANS T/•` DUILPIN t:CI'I •, 'L, CONTRACTOR Same � �•, [� , I ( e, LEGAL Sallie DESCRIPTION '-'b+R I T / I n ,A• _Cao ADM- - / CIYY $$me A.P.NO. I 4 I - 7 0/ -- �' TEL NOTE: NO HAVE OVERHANG SHALL BE LESS THAN SIC.STATENTE 80•TO SIDE a REAR p.L _ • OSIZE 20 �1 O I ,h -nLYa•. EAVES FLOT NOW ON LOT ' ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OP 'C'` MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/L STREET) SETBACK LIME'Hum FRONT 40 FT. RT. CENTER OF STREET REAR • • T SIDE YARD LEFT RIGHT R. 'ID FT. DESCRIPTION OF WORK Lem OFT. PT. • i. Z a ✓ ALTERATION ADDITION REAR 0 PT. FT. _r,_-- w .( DISTANCE eHT. BET.C MAIN e REPAIR MOVING DEMOLISH .• MAIN BLDGS. ACCESS.SLOGS. a BUILDING/ NO.OF 14 y = VAR.# /\/`/ DATE /(/ / co 1 SIZE .•C.0� t O ROOMS I STORIES C.U.p.# 7 7 APPROVED - 0 �b 3 {LI EXTERIOR W r1 ROOF •f APFROV a L COVERING A �_ I COVERING,1�1 liall_ DATE /��3 a 6 i ., i2 Imo'...A. 1 Y:LLI/i'(.. 1 �� 9 C.7 �l3 ��� w l a • '' D: `/3m BO.FT./////•1 wo ` I HERESY ACKNOWLEDGE TIAT.1 HAVE READ TNI• APPLICATION THE AMOUNT SHpJFN UNDER VALUATION IS FOR THE 9 O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. • PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY MANGO AND STATE LAWS SEGULATING $I� Q BUILDING CONSTRU _ VALUATIONN Q — ,m O b SIGNATURE OF ✓. Q 'ERM IT FEE _ if:21 PH/MITTS : • /O//� >j a PLAN CHECK S r7 D .--- w AUTHORIZED AGENT �.,.. r rgj TOTAL FEE f 9,0D ---