HomeMy WebLinkAbout161 LEXINGTON LN - Building Permits PROJECT ADDRESS: 161 LEXINGTON LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 056931
OWNER'S NAME: BROUSARD ROLLEN N TR
ADDRESS: 2139 ANNiVERSARY LN PERMIT NO: B 056931 PLAN CHECK NO: N GOVT: N SUPP : N
NEWPORT BEACH, CA 92660
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : INSTALL ONE SKYLIGHT ( ICBO# 2469 ) SQ FT: 475
ADDRESS: UNIT:
‘11,31” PERMITTEE: SKYLIGHT SPECIALTIES ( 714 ) 645-8645 CLAIM VALUE: 475 . 00 CALC—VALUE: 475. 00 GROUP OCC; R-1 /
ADDRESS: 660 W 17TH ST 37 COMMENTS: NO CUT RAFTERS
COSTA MESA CA 92627 *>F******4****** ****SE*x***aE**aE*>f*+HSE+E******+tr*****aE*+e>ETHa6>F>E>E>E*>E****x.*SEkE*+6*x*NSE***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG R E Q U I R E M EN T S
7000)of Division 3 of the Business and Professions Code,and my license is in full orce and effect. SETBACKS
CITY LIC.: 027519 STATE LIC.:395551 CLASS:
i/��yti Signature: — MAIN BUILDING ACCESSORY BUILDING
r Date:
Y,.-7C1 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have ertificate of consent to sell-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
Compensation Wsyraaep pE i ewtlliel copy thereof(Section 3800,1.•.&1.4 /0 4 /9 3
POLICY NO.: VV oo O0 7 1 7 7 EXP.DATE:
COMPANY: STATE FUND,sS� PARKING REQ PROV: PARCEL: 41916423 ZNE: REF NO;
❑ Certified copy is hereby furnished. L•] Certified copy is fi 'th Se��'y Building Division. PLANNING NOTES>
Dale: / /U�IL' Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECEARA : (Tiffs rot be completed if me permit is la one hundred(s1C0)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 penormance of the work for which this permit is d,I shag not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY •
. DATE:
Date: Sgnature: BUILDING APPROVED BY ; DATE;
NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. //? p
r/
APPLICATION ISSUED BY: i
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for r DATE• O / Z
which this permit is issued(Section 3097.Civ.C). ************************ ** ** s t *# ** *** ' e*** ***************** * * *****
LENDER: 22"X22" SKYLIGHT ********************************************* ********************* **********
ADDRESS: NO CUT RAFTERS LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for 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 15 . 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 SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/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(5500). ISSUE FEE
I. as owner of the property iso my employees wile 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—--—> 15. 50 0 , 00 0 . 00 15. 50 15 . 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.It,however the building or REVENUE DIVISION TOTALS--> COLLECTED:_ 15. 50 OVER/SHORT• 00
for the purpt is soldfs le)hm one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK
for the purpose of sale).
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15 0 0 S0
❑ and Prorcoiona sd o The projectswithState Law doespursuant to ownertictorssrty ate builds Law).Il improves thereonr ******Ie***le*3F*IP*************36**************************************************
and who contractso Ifo such with a contractor(s)Licensewidoesenot ly to the Contractors'State uildseLaw). em aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E S BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale: Owner. SFR 475 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 475 . 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 Mil/will not(circle one)need to comply with said state codes and the requirements for a
permit lot 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 state that the above''ormation is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby. 'rue representatives of this city to enter upon the above-mentioned
property for/inspection purposes.
r Date: Y//O—f 1-- Signature: L/ " - L:: 1 .,.•• -_ 7 ..
Driver's License or Social Security u: Ory TE! , '1-' .r; - -
. i
1641.46 While—Building:Green—Code Enlorcemen. .nary—Applicant:Pink—Revenue:Goldenrod—Assessor
s' •
CONSTRUCTION AND PLANNING POOL & SPA
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. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd.
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
131 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 ❑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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final i • - 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
48. FINAL PLANNING //f/fi,
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
rC{Da5A _.r_.tc ;i�r /_
J;k%;':_/G-- - _lecitir; -; --1305-' ��- ` s, !(r �1
C.n. tic. = o%i5rci `
. I
APPROVED
City of Costa Mesa Buildin, Dept. I
BY VS\k DATE Hktfl 19 12- ?emit
THESE. PLANS MUST BE ON JOB".T ALL TIMES MAKE
—�'r '
NO CHANGES WITHOUT PN:OR APPROVAL OF DEPT. THIS NUMBER MUST A .COMPANY
THE ISSUANCE OR GRANT;u= OF A PEP.MIT CR ARP:ie.:1AL OF ALL INSPECTION RE ;UESTS
PERMIT 101. OR AN APPROVAL 02. ANY VIOLATiilrl 'O,.
THE PRO [.-?NS.OF THIS COE_ :O PERM!_PRE".':r.::O .)GIVE
CODE 9Ht:_ !3a'VALID EXCEPT IN SO FAR i-S i'.E.C:'..:.^F C1:1 USE
WHICH ITE:.-' '17 nr^'c I pVVGG p
THE I°.'-ONCE OF A PERMIT BASE ,/N �y ,�,�
SPECiFtCsa 07171- HALL_ Lc; PMevav, r .p . h`t'-•^
I:471....g. Ln..;,RS N
FP.O:d 1HEfi-AFTER REi:UIR:I:G TFiE CORR - ✓ �IIUC.+
SAID FLAN ED =''EC: S
:' `r'n" nR ..!cr. f� 1 .__ LA
au:DING G:ER/a;0*!S EEINC CARRED ON TIiPRDJi;DEh'.ACN
N
iN Vi('DTIC.1 CP THIS CODE.OR OF ANY OCHE'.CR:OiN.C;;Cti OF '7/Y_
I11
2Z,
127:
air fio VA-171F A, � o 151-i-
/
•
pl,/ ,,,Ai/ )15In4- SPVfFr ipiP9
• l UH/i-Ou j /�P, et kT �`' FOR INSPECTIONS
c�(c-iel /,(it/ CeLL
2 s 6 Lt'oua ( 4)2is 754,5626
'r✓ I/A7 j'v C:4::- /200c �CM F 754-5627
r
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PRovirr NO. • TRACT NO; .
LOT NO. 'BLDG.NO. - TI.
CONSTRUCTION PERMIT SS— 3 3 Q•dt=7 H /11:712 I: oSO
Project Address 161 Lexington, CM - TYPE OF CONSTRUCTION - - • . - - ' • -.
•
Owner Lilla T. Scally Phone,49--;534 0 NEW 0 ADD0 ALTERATION C4/J, 0 - • ,
Address 161 Lexington, CM • 0 REPAIR 0 CONVERSION ❑DEMOLISH �F~ -
Arch/Eng. License No `�r7`�V .OTHER ` ZONING REGULATIONS
DESCRIPTION OF WORK 'LC K�' 5 A.P.
Address " ZONE PLNG. REF.If ' '
•
Contractor (nj4-j,�/Q - /dor jyl3 Phone(ny2�'Z�,�TVPE OF PERMIT - BUILDING 'rp BMJILDI NG
,AddressSETBACK C/L ST. PROPERTY LINE •
37 ( 33 ft . /0c.0-3�U ri. 6 tccc /'1 • ❑ GRADING " ,❑ FOUNDATION 0STRUCTURAL SIDE YARD '
LEFT '
LICENSED CONTRACTOR DECLARATION 0 TENANT ❑ .ECT IISL DPLUMBING ❑MECHANICAL SIDE YARD -
I hereby affirm that'I am licensed under provisions of Charter 9 (corn- /F� -rJ RIGHT
mencing with section 7000) of Division of the Business and ❑ OTHER REAR YARD(TOP L
Professions Co annQQ y 1l cense q ful forcejaggtl Spit.
/ ) - . -
p l I`1.•�• /`i + PROJECTE . DESCRIPTION _ -
License C ass �e se No. O' c PKG.SPACE REQ. PROVIDED-
Date Signature '�!� -/ SQ. FT. OC� `e s7 • � . _ _
WORKERS'COMPENSATION DEC ARATION - OCCUPANCY J� CONSTRUCTION TYPE STREET WIDTH PARK FEE$
I hereby affirm that I have a cert" icate of consent to self-insure or a - VALUATION# C/b°`—' ZONE ZONING'APPROV ED BY •
-I%
I DATE
certificate-of Workers“Compensation Insurance, or a certified copy
thereof (SecItatil ULgb`,C.)•- ' L`j ; e.. -1 • GRADING CU.YDS. ACRES SPECIAL CONDITIONS: -
o Policy No. 77 TT11 a LL V (Cls-1 U �� (00 le- -
r❑Certified copy is hereby furnished. REMARKS:. '
upCertified 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. • UW tLLINIa (aA HHbt
Date Signature BATHTUBS SHOWERS SO.FT SO FT • - _
NOTICE: If after mzking 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 LAVS APPLIANCE
revoked. - . 5
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 ' - L.
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 TUBE SIGNS - •- -
_ f
OWNER BUILDER DECLARATION - - INTERCEPTORS CLARIFIERS - - POLE LIGHTS ' ' _.
I hereby affirm that I am exempt from She Contractor's License Law for • "'- . ' ' - ,
'
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP : LONSI NUL]IUIN
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 applicant 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 3000) of Division 3 of the
Business and Professions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT • "' • -
basis for the alleged exemption. Any violation of Section 7031.5 by - '-" _ -
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS -" '- '
of not more than five hundred dollars ($500):
-
❑ I, as owner of the property, or 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 SYS. • ISSUE FEE ` - - ' -Contractor's.License Law does not apply to an owner of a property - APPLICATION APPROVED BY -- 'DATE
who builds or Improves thereon, and who does such work himself or ISSUE FEE
through his own employees, provided that Such improvements are not
Intended or offered for sale. II, however, the building or improvement MECHANICAL PLAN CHECK _ SUMMARY OF FEES. '
is sold within one year of completion,the Owner will have the burden
of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0100,000 BTU SMIP BUILDING ' /.— �� -•
_ PERMIT $ $
El I, as owner of the property, am exclusively contracting with AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000 +BTU PLAN CHECK $ PERMIT'
and Professions Code: The Contractor's License Law does 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) licesned pursuant to SYSTEM - - GRADING $" '"
the Contractor's License Law). 100,000+BTU PLAN CHECK $ ,
❑ I am exempt under Section B:& P.C.for this ' $
BOILERS BTU. ELECTRICAL $ .
reason " . MICROFILM $ -
SYSTEM REPAIR,ALTERATION PLAN CHECK' $
Date Owner - , . . TOTAL FEE$ '
MECHANICAL ,
I hereby certify that I h.ve r-ad thY.pplication and state that the above EXHAUST SYSTEM MULTIPLE PLANCH ECK $ LANCE PC S
information is correc•. I agree comply with all city and county
ordinances and f e,.w elati;• to construction,and hereby authorize - -
representative . ,,hi: cit to enter upon the above mentioned /�SO
property fo �� •. �, ••j, /�/ _ - FINAL FEE f/ '
Signature /+� ,f/�/`^�
Date - $
Drivers' Licen or S'S , ISSUE FEE - - _ -
CMF 0865.46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING I POOL&SPA ! ,
APPROVALS Permit# 8:1533 Date Inspector APPROVALS' . Permit# Date - Inspector
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-Undrgrn46. .Electrical Bonding_, -- - - •
5. Steel Reinforce . 47. Rough Plumbing &Pressure Test - - . - . - . - __- - -,
6. Electrical UFER Grn48. APPROVAL TO COVER-GUNITE • - -
- . . .
7. Footings _ _ - - _ - - 49. Electrical Conduit-Undrgrn ' - - . .
8. Foundation _ _ 50. , Gas Pipe, ❑Undrgrn,?est • - .
9. Water Pipe-Undrgrn. - .. . 51. Backwash Lines,P-Trap. ❑Undrarn °- -• - -
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. . . .. 7 55 Plombina System -Final - - -- -
14. Rough Electric-Conduit • - :56. Electrical-Final ,
. 15. Rough Electric-Wiring. _ _ -- 57.- Solar System-Final _ ,
-16. -Rough Heating&Air Conditioning - _ 58._ 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 I - - - - -- -
41. Gas Release to Southern California Gas Co. - . _
42. CERTIFICATE OF OCCUPANCY -. _ - „
-No ' ' -' Date .__ . • '.. .,
ADDRESS OF BOILBNO: 161 LEXINGTON LN °NT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF KNOWN; BROUSARD, ROLLEN N TR
Awn"' 2139 ANNIVERSARY LN PERM N(1• R 077?90
NEWPORT BEACH,CA 92660 PERMIT NO; B 072290 PLAN CHECK NO; N GOVT; N SUPP: N
MML.YAIUND ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE : STR
PURPOSE: OTH
ARCHITECT OR ENGINEER: "c 10 JOB DESCRIPTION T/OFF SHEATH 6 REROOF W/COMP SHINGLES SQ FT : 2, 924
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE; 2, 924 . 00 CALC—VALUE: 2 , 924 . 00 GROUP OCC ; R-3 /
cCNfumwsNAI•E: STOUT ROOFING INC ( 310 ) 923-6775
CONTRACTORS MNLMD P 0 BOX 4309 COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 91 UBC
ADDRESS: DOWNEY CA 1.1":” 402536 ***********+A****s*********+r******+r+ *********;c**w-*+r***+r*********r ****K-*********
90241 War: Z ON ING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that I am licensed under provisions of Chapter g SETBACK S
(commend •g wish Section 7000)d Div son 3 al the Buelross and Prdsaabns end mY license e le fult tom effect
CITY LIC."o.: 059377 u0'° C 39 uc.No.; �5 E'",ia : 10 /9 MAIN BUILDING
ACCESSORY BUILDING
Dae: 'ti / 9 a
Cor .aor: i � / d , FRNT: FT IN REAR; FT IN FRNT : FT IN REAR; FT IN
OWNER BUIL ER DEC RATION:I hereby affirm under pasty d perjury that em exempt from the Contractors Li., a Law for the LEFT; FT IN RGHT: FT ID] LEFT: FT IN RGHT: FT IP]
following reason(Section 7031.5 Business and Professors Code:Any city or county whim requires a permit to.. ., .alter,improve.
demolish,or repabmy structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she PARKING REQ• PROV; PARCEL : 41916423 ZNE; REF NO;
ie 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]or that he or she a exempt therefrom and the basis for the alleged exemption.My violation of Section
7031.5 by any applicant for a permit subjects the appfraa to a dvi penalty of not more than live hundred dollars 1$500¶. >
❑ I.mownerdlM property or my employees with wapmmiheir sole compensation,will do the work end meawctunlsnot intended **3E�E****1f**1f- *Ar**Iflfif-IE***YafiFjsjiiE{FiFaflfiEiEjEjEiFjEiFiE�4ifiFlEK******4—ifafjfjfi4ifi41M1iFaE*{fic�f-1Fi ********M
oroffered for side(Section 7044.Business end Prdmemm Code:The Contractors License Law does not
� of property DEVELOPMENT SERVICES R EQUIR EME I' S
who builds or inproves hereon,end who dies such work Himself or berme or through his or her own employees.
improvements are rot intended or offered for sale.lf,however,the building or improvement is sold within one year of completion.the -
owner.builder will have the burden of proving he or she did not build or improve for the purpose of sale). ZONING APPROVED BY DATE;
❑ I.es owner of the properly.am exclusively wincing with licensed contractors to construct the protea(Section 7044,Business and -
Professions Code:The Contractors License Law atom not apply to an owner d property who builds or improves thereon and who BUILDING APPROVED BY DATE:
contracts for such projects with a mermo(s)licensed pursuant to the Contractors License Law).
❑ Ianexempt uderSsnon: e.aP.c..rowareason: APPLICATION ISSUED BY ; L DATE: 5 2 415------------
Date: Owner: ************************************* * *tlaFiiaF11•*****iF*x*++*1f1fiF******i4 * * •
fr
!do hereby<rtily that Iamaware dand.S sndOrrxpenmermolCatfomiaHealthandSafetyCoM ectiaa25505,25533and
LEGALIZATION; N F E E ("SUMMARY M A R Y STRUCTURAL SEGMENT :Y
25534,and that I or any Mure building occupant will/will ml(circle one)need to comply with said ase codes and the requirements for
e panne for cnstructionor modification fromme AiGhality Menagensa Dolma.Rssoraal mmtadionappimtom ars exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prONss' PERMIT 54 . 00
Date: Applicant: 5 0
SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjurymd
e the following dsderakrs:
PLAN
❑
have and wit maintain a certificated s
consent to ed'inras e for workercomprwaion.as Provided kr by Sectiond 3700 the Labor ISSUE FEE
Code.for theperfrmancedmeworktorwhchthispermeimwd.,('
BUILDING DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DOE
Ihave and evil naintein workers'compensation wm
irenoe, rparsd bySedim 3700 of the or LabCole.for the performance OrmerKa tTOTALS----> 54 50 0 . 00 0 00 59 50 54 50 00
work for which this permit is issued.My workers compensation insurance canter end policy number are:
°° ° ?SIC EXPIRES REVENUE DIVISION TOTALS —> COLLECTED : 54 . 50 OVER/SHORT: 00
Policy Number: r- "nPnn 05 /19 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not becompleted ithe demi lsfort»nonZre ctoakaMOO)rwm.)
54 , 00 . 50
❑ I certry that in the performance of the work for which this permit S®cod - not employ any person in any.•annex so as to
become subject to the workers'compensation laws of California.and .. that if I • • become w•',.I o the workers'
compam p/ •s�Sect the Labor Code.I shstf' with,.i/-provisions. r / **************irk******************************************if*********x*****+c*****
Dale: 9 Applicant: / /r " • INDIVIDUAL F E E BREAKDOWN
Warning:Fal to'taco wonta.:compensation coveagels unlawful,and shallre/ect an employer to criminal• roes and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one handfed thousand dollars/3104000),M add/don to the cost of compensation,damages as prodded for In
Section 3706 of aha Labor Cods,Interest,and attorney's less.
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjurythat then is construction consttion lending agency for the SFR 2924 AEROOF BY VALUE RESIDENTIAL A]O Z ONE 1 . 00 2 , 929 , 00
performance of the work for which this parrotaissued(Section 3097,Chi-C). END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and date that the above information is crnea.l agree to comply with all sty and county ordnancee
and state levee nit to building construction hereby authorize representatives a ivthy to enter the e above menliuned property
for inspection (poses.
/
404ev! `' Dae:—y�� 05/12/95DATE0181131TIME:1815 1 o 35
54.50
Signature of GnndAgentiAppinanvContnrr
(5151-46.WP) White-Bulking&Safely.Green-Rle;Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING -
eoOL & SPA
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. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test •
6. Electrical UF ER 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 Updrgrnd.
10. Structural Floor System 81. APPROVAL TO DECK = •
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final •
12. Sewer 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 Appioval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricat-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 0Gas.0Oil
25. Roof Sheathing ap 1 T &_c.4c 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 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 & BUI LDI NG f(-2.- '5 6w41
48. FINAL PLANNING r
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
2779€ PAID
110V 13-67«sAOO 534* ****58.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 9252¢ -
r.
• For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
5. ■uILDING '/ ( 4) 1� /, For Office Use Only
K ADDRESS L- Iv"C, r s-�zi.�e� R¢e[Irt NO. �'r�IT�
,* COSTA MESA, CAL} ORNIA G ( 90
, EICOD, DATE RIC v DISeu
s, OWNER San Vis to Bldg. Co. /0 -4/ 1 5
MAIL Drive, BUILDING
MALDR2249 Wanderer ADDRESS �} `
FIRE
62r-
-'77
/��y
' CITY car DaArn
TEL
833-3320 zoNE TYPE ' DRouPC U//
r, ARCHITECT TEL eYPROVED DATE
.' OR ENGINEER $13 Clif Olsten No. 923-1221
ZO
`t ADDRESS 90?53 P FIOrrnre Downey zo4:E)�1 NO.or �NINOorHEwnjti� l
ej--- PUNS sunIXNO�. u/
corm:maps Same �! AMM
LEGAL /
ADORES) Same D[¢CR1moN` LAs( 1 � -����
/
;; CITY Same A.P.NO. I - f —.717 -3'
NOTE: NO EAVE OVERHANG SMALL BE LESS THAN
STATE TEL SO•TO SIDE a REAR P.L
LIC.NO. NO.
1. EAVES
:r SIZE �T ��[[2y. INO.ON-2/ Ow— ALLOWED (U.B.C.REQUIREMENT)
�� OF LOT�-TO/� 0 't-21 10 NOW ON LOT
----- YARDS APPROVED YARDS APPROVED
USE OPMAIN BUILDING ACCESSORY BUILDING
EXISTING-$•DG -
(FROM C/L STREET)
err O - FRONT C) FT. PT.
CertRR OF STREET REARM P
SIDSYARP�LEPT ..Ttta R..SIDR () PT, PT.
DESCRIPTION OF WORK L BIDE () FT. PT.
` 0 F
NEW ALTERATION ADDITION REAR PT. FT, z
DISTANCE BET. BET.MAIN& ILI
REPAIR ,_MOVING DEMOLISH
MAIN BLDQS. ACCESS.SLOGS.41
? BUILDING NO.OF VAR.�j DAT[ (/7
r SIZE UO{.�•fQ2.A o0MB STORIES 1 C.U•P•# fl � 7 7- APPROVED -R "..J a
r EXTERIOR WALI.),I ,- ROOF -._ /� AFFRO /11, l'mti O-3a-G7 d
COVERING VrU.r/YI COVERING 1 Ride Ry' 1�\`L3A I DATE / J
CC
US(OF BUI LOINS AND WORK TO Bt PER ORMID I 0,
U / I • �� 0 p-14,
4. l dyevBQ.FT. g _iv,
I HEREBY ACKNOWLEDGE THAT.I NAVE READ THIO APPLICATION THE AMOUNT SHOWDER VALUATION IS FOR THE O n:
AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO COIL PURPOSE OF ESTASUSHING A PERMIT FEE ONLY. 1
PLY WITH ALL;CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 7O
BUILDING CO UC ION•
SIGNATURE OPJ/'�'�.yA PERMIT FEB $ 37 Eq
AUTHORIZED A NT �
$ /�'� 6I PLAN CHECK $ hy�y"�� wO
I'- _,. _ ..-.. ..<,•,..,^ .., TOTAL PEE S Sd