HomeMy WebLinkAbout168 LEXINGTON LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 168 LEXINGTON LN
Suite No
Vicinity:
Parcel Nunmber: 41916435
Applicant: CANDY NOCK
Address: 11612 KNOTT ST
SUITE 217
GARDEN GROVE, CA
Owner:, LENN,LISAA
Address 168 LEXINGTON LN
COSTA MESA, CA
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST.
SUITE 217
Arch / Eng :
Address:
GARDEN GROVE, CA
PLUMBING PERMIT
Phone: (714)895-1246
Zip: 92841
Phone:
Zip: 92626-6500
Phone:
(714) 895-1246
Zip:
92841
License:
707775
Phone:
Zip:
License:
SCOPE OF PERMIT
CHANGE OUT WATER HEATER
ISSUED BY:
Status: ISSUED
Applied: 08/04/2004
Issued: 08/05/2004
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
FEE SUMMARY
AMT
QTY
AMT
AMT
QTY
ISSUE FEE
$23.50
Laundry Tub / Washer
$0.00
_QTY
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 Brk_r Bkflow(14)
$0.00
0
Connect (Ice,Soda,etc)
$0.00
0
Receptors
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00
0
Septic Tank
$0.00
0
Wash Basin
$0.00
0
Dishwasher
$0.00
0
Sewer Cap for Demo
$0.00
0
Wash Basin Set
$0.00
0
Drain, Floor
$0.00
0
Sewer Connect
$0.00
0
Waste and Vent System
$0.00
0
Drain, Rainwater
$0.00
0
Sewer Private Line
$0.00
l)
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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 he rid 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
rk 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:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 1 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 be me 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 Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: ai Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL FS At CML RNA. UP TO ONE HUNDRED
THOUSAND DOLLARE (S1OO,ODO), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 Code, and my license is in full
force and effect. Lia p Class N
Contractors Signature: i,V Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of 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 contractors)
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. ❑ Yes ❑ 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:
❑ 1 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, lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, TIf1e 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Pemlil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
...........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the Calitomia 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).
............................................ ........................................... ...................................................... ............................... I............................................... ..............................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
......................................_..............................................................................................................................................................................................................................................................................................
presently q ry y p Yes
❑ No
4 II en RMPP is resent) required, has Section 25534 of the California Health and Safe Code been full Complied with?
..................................................................................................................... ildi............................................................................................................................................................................................................................................difi...............
5 Does or will the applicant u present or future building occupant require for the work ontch Is the subject of this a plication off rmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Ves 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
................................... ......... ................................................................................. ..... .......................................................... .................................................................................... ............................ ..................................... .... ............. .................. I.......
7 If a pernit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
............................_........................._..._..—.___.................................__................_..._.___.._.................._.-............................._.............................___..........._.__.............._............... _................
8 (If yes", attach Certificate of compliance from the appropriate air pollution Control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to Comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances rotating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) to
AnWQr Authorized Applicant I Dat
CODE f, INSPECTION TYPE PAIL INITIALS CODE INSPECTION TYPE DATE INTITIELfl
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing — /— O
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Well 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
ADDRESS OFBUILDING: 168 LEXINGTON LN
OWNER'S NAPE IF KNOW ANDREW, BERNICE L TR
ADDRESS: 2416 RICHMOND WAY
COSTA MESA,CA 92626
AML. MAIUNO ADORES3:
A MECTORENGINEER:
UICN. OR ENG.'S ADDRESS:
DDNTRACTOSSNAME: STOUT ROOFING INC
CONTRACTORS MALING P O BOX 4309
ADDRESS: DOWNEY
90241
UC. NO.:
UNIT: CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 072294 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: SIR
UNIT: JOB DESCRIPTION : T/OFF SHEATH & REROOF W/COMP SHINGLES
(310)923-6775
CA "C"0' 402536
UNIT:
LICENSED CONTRACTORS DECLARATION: I hereby aff'vm urdor penaly d duty that I am Scarcest n d e t under provisioChapter 9
(mmmmrdp with Section 7001)) d Oiroion 3 of the Bueimva enol PMes a, end my licorue is in lull force and effect.
CITY LIC. N0.:05 477 UC.0 S: C 39 LID' 02 6 E 10 95
Date: Contact.:
OWNER BUILDER DECLARATION: 1 hereby dfim miler, pene3y all perjury that 1 an exempt form IN,
Ccntredgn Lew for Me
following reason (Section 7031.5 Business and Pronasions Cada: Any city or county which reeuirea a penny to constructAffer, improve,
damolin, or repair any structure, Dolor to Its'wumos, also reduires the applicant fa such penes to fib a signed statement that he or aha
as licensed pursuant to the provisiom d the Contrectas License law ]Chapter 9 (mmmanring nsh Section 7000) of DMIsicn 3 of the
Business and Professions Cade] or thel he a she is saempt Iharedmm sold the basis for the alleged exemption. Any violation of Sedion
7031.5 by any applicant for s perms subjects the opplkant to a dent penalty of no more than five hundred dollars ]45001).
❑ I, as caner of the pra,my or my employees seh wages N their sole oompeme on, will do the work, and the slmcture 6 not Mterded
or offered for sale (Section 7044, Business and Professions Coda: The Connectors License law does not aptly to an owner of p"n,
who Wilds a inprwae thereon, sM who does such wwk NmseW a herself or Mraplh hIs or her own empla ear e, pmM d that such
improvements are no, intended a offered fa tale. W, however, the buiNirq or hnproyment is sold within ores year of completion. Ues
owmrbuider will have the burden d proving he or she did nor build or improve ler the purpose of sate).
❑ I. m owner d the property, on, wdusieety eontnctkq with li®mad contractors to NIwMIQ the prgea (Satlun 7040, Business ant
Protections Code: The Contndone Licerue law does not apply to an owner d powr7 who builds or improves thereon And arta
contracts M such project, with a contractorls) licensed pursuant to the Contractors Lioeme law).
❑ I mi exempt under Section: B. A P.D.. for the reason:
dare: Caner:
sanity that I ane aware of end understand the requirements of Cali I IasAh and Safety Code Sections 2 %S. 25533, And
this I or any Matra binding occurrent will I all not (ci ors) need to cowry wkh said mate codes ant the requiremerua for
constructionormodificabon9gmIMAir mamount District. Residential construction appicatimw.ro exempt from these
L%t.: ApNita d:
WORKER'S COMPENSATION DECLARATION: I hereby aMRn under penalty of perjury ores of Ma fdiowip detlaratiom:
❑ 1 have and will mantein a contains, of consent to teff -insure for wwkere'rompemation, as Provded for by Section 37M of the Labor
(code, far the perforreance of tha work far afech this pants W issued.
have and will maintain workers' oompemetian insurvim. m required by Section 3700 of the Labor Cade. M the performance of the
work for which this peons is issued. My waken' compensation Mwrarese carrier and Dol' y number ere:
semen: A L; EXPIRES
Policy Number:05/19/95
fih's asol n need trot be canpMed 11M parrot Is Mom hurbrod dollars (5100 a lose.)
❑ I mnffy that in the padomame d the wak fm which cots isms i, i. shell nit em oy any person in ginner so w to
become subject to the eorkan' wmparamion laws d 1 wif ie, res Mm ff I d become to the
comers atlon W dna of action 3700 h i labor ('Ade. shall h hone pmwsaes.
Dab: Apptiaanl:
Weming: Fellun o eseuro rprksrs'rompemstlon covaaps le unbwNl, mtl sMll ertlfect en employx b cWMns ena0lva end
civil floe rpt b one hundred thousand dolma (5101;000), M oci to Me cwt of ac a omen Wiry damepes es dried ear In
Swoon 3706.1 Me labor COW, Interval, end effomay. has
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of Periury, lied there Is e construction lere inq agency M the
Mdormance of the work fa which the pemle Is Issued (Section 3097. Cw. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I comfy that I have reed this application ant mete thel the above information is honed I pee to rompy with all city oral county odimnces
end statelawsgto Widsq conmructim anal hereby eurhqo a. repreaenlativet ofth. dtl'to/(star upon the above-mentioned popery
for inspacrion Dur m I. r �i
(515145WP) Whits -Building 6 SmAy: GnaoRie: Canary- Applicant: Rnk-Revenue: Goldenrod -Assessor
FpM Nn. p7.94
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT: 2,924
CLAIM VALUE: 2,924,00 CALC—VALUE: 2,924.00 GROUP OCC; R-3 /
COMMENTS; SMOKE DETECTORS ARE REQUIRED PER 91 UBC
of ?tf aE 1f if M if if dE iF is if 14 YE 3R if Y -if if if iE if if if iE if if jf if if if iE 1t iR df iE iE df jf of K14 if M iF i4 3f iE if iA �E 1A Af aF if �F M iE jE if i( -if if iR of iE iA Jf a iR �R N1FX fF* 1f iE 1F
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN
BUILDING ----------
---------
ACCESSORY BUILDING---------
FRNT; FT IN
REAR; FT
IN
FRNT:
FT IN REAR; FT IN
LEFT; FT IN
RGHT: FT
IN
LEFT;
FT IN RGHT: FT IN
PARKING REQ:
PROV:
PARCEL;
41916435
ZNE: REF NO:,
PLANNING NOTES>
>
if ji iE ff dfiEie***i4%-4E iFeEiE**iE
4E*9f 4f%#`if**df yf?,9E*if RE df RF*4448*iE iF dA lR dE iF-IR iiE
iE*KKI k-4 if if iE iE ipJf%*4E 4R eF 1f-,Ril if it aE iE *iE iil4iE
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
ZONING APPROVED BY
DATE;
BUILDING APPROVED BY DATE;
APPLICATION ISSUED BY; DATE;
44 it dF iE d4 dE 94 i4 i4 R4 oft {4 R4 it+F it*ie nilx jt it SF �e 4�iTiF iF�7Fa1F;[iFie iZ' 'ic aFiFr�i�'i�*a w4 iF aE SF rtc iF'iFit iE xac ail �r-„�e a: a, a. N+-�7t- N
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54,00 50
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS ---- > 54,50 0,00 0,00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
54,00
TYPE
SFR
QTY
2924
SMIP/NON—RES
TOTAL PAID DUE
54,50 54,50 ,00
54.50 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN—CHECK
.50
w'+F rt iF it irk if iE it iE iE * iE it in if i! if #` # iE jt 44 nt irk *'IF nE M dF it if 14 iE * nt it * it-+I� M if if fE if iE {c nil iF ir+f an+t # lF ilif tf ?F is+E if iE iE
I N D I V I D U A L F E E B R E A K D O W N
D E S C R I P T I O N UNIT COST TOTAL COST
REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
1,00 2,924.00
01 00181840-007.81841 TOT 54.50
DATE: 05/12/45 TIME: 15:42
CONSTRUCTION AND PLANNING`•
APPROVALS Permit #_--
Date
" F. _ & SPA
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-Urcirgrnd,
55. Electrical Bonding
-
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57, APPROVAL TO COVER-GUNiTE1
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, C 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
i
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 Approval
-
17. Rough Wiring Sign
66. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd.Storage Tank OGa's O:Oil -
-
25. Roof Sheathing r
Z,oT-, �!
GLvk'
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
EH
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
48. FINAL PLANNING
49, Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER GAN VISTA 'Ruildino Co, DATE OCT 3 0 1963
JOB ADDRESS _ 1-68 Lexinaton_Lane_ _.- ______.__ __ __ _ _ BUILDING PERMIT NO. ang"
GENERAL CONTRACTOR
AP Nn T.(iT l RO TRACT Cll<dl FTRF WWR T11;LQCRTPTT()N ()F W(1RK
INSPECTIONS Signature
DATE GROUP J&j TYPE V ZONE p
�UED
Soil
- 7
SUBCONTRACTOR
PERMITS
ISS..
_
NUMBER
Gas
DATE
Water
Rough Com. Refrig. ❑ Air Cond. El
Rough Heating
Rough Plumbing
- 4
,p - 3i- 63
3 6 6
Miscellaneous
f
Prop. Swr. Line 0 House Con. eSt. Swr. ❑
- �L,�..�—�+--�-c
iUj 1 3 1963
Sprinkling System
Construction Pole
Underground 0 Power 0
_
Rough Wiring
Trenches ,0 Forms 0 Steel Reinf. 0
1 1A
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In &}--Out
Plaster, brown coat
Refrig. 0 Air Con. ❑ Final
G '
Heating, Final
-
Plumbing Fixtures, Final
Final Gas Test 0,
Electric Fixtures, Final
Building, Final
OCCUPANCY
Form Bus-sm�-B P We%T-n FOR SPECIAL RJVU1KWv1rAV 10
2asa3
COSTA MESA BUI, G -SAFETY DEPARTMENT
P.O. BOX 217 ( COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT Lot 159
BUILDING
ADDRESS 168 Lexington lane
COSTA MESA, CALIFORNIA
OWNER San Vista Building Co.
MAIL 1166 E. 58th Street
MAILADDRESS
CITY Los Angeles 11 mo'AD 3718ARCH7
TECT
OR ENIGI EER Raymond Lev na NO. R 37010
FEE RECEIVED
_cP 2 6 1y6S
FINANCE DEPT.
CWLIRTATFY7R WMIT
BUILDING
For Office Use Only
RECEIPT NO. I Pi
J
'4D BY OATH gEC81VE0 DA
9
340 SO. FT. f-2-0 y o
MACKNOWLEDOR CKNOWLEDOB THAT I HAVE READ THIS APPLICATION
THE ABOVE 1E CORRECT AND AGREE TO COM-
LL CI Op D1NANCEE ANO BTAiE LAWE p[DULATINO
u i 'VISTA BUILDING CO.
OF
THE AMOUNT BROWN UNDER VALUATI0N�I8. FOR THTHAT
PURPOSE OF HSTABLISHINO A PERMIT FEE ONLY. O
ZONING
PERMIT FEE $Jj/nE
8432 Via Oporto,
Newport Beach
ED H James N. Starbird
W
TOTAL FEE /
ADDRESS
Z
NO. OF
PLANS
I
USE OPH
BUILD NO
4
CONTRACTOR San Vista
BuildingCo.
"GALLot 159 - Tra t 5160
DESCRIPTION
ADDRESS
1166 E. 58th
Street
CITY
Los Angeles
11
A. P. NO. 1-0-3
NOTE: NO SAVE OVERHANG
SHALL BE LESS THAN
STATNO.
192782
TELAO 3718)
90'70 81D89 REAR
LIC.
EAVES
SIZE
2O 70
HQ`y O
ALLOWED
(U. B. C. REOUIREMENT)
OF LOT
X
Q,�w-B-
YARDSAPPROVED
YARDS APPROVED
USE OF
None
MAIN BUILDING
ACCESSORY BUILDING
EXISTING BLDG.
( FROM C/L STREET)
SETBACK LINE FROM '131
CENTER OF STREET
6'10"
REAR Y RD
FRONT FT.
PT.
SIDEYARDI
LEFT 0
RIGHT 0
R. SIDE FT.
FT.
DESCRIPTION
OF WORK
L. SIDE PT.
FT.
NEW
i
ALTERATI
N
ADDITION
REAR FT.
FT.
DISTANCE BET.
BET. MAIN d
MAIN SLOGS.
ACCESS. BLDGS.
REPAIR
M VING
DEMOLI
8n
VAR.#
DATE
BUILDING
RITE
NO.OF
2O X 32 _ Rn,I. 5 pTnPlca 2
n 11 P At
APPRnVED
9
340 SO. FT. f-2-0 y o
MACKNOWLEDOR CKNOWLEDOB THAT I HAVE READ THIS APPLICATION
THE ABOVE 1E CORRECT AND AGREE TO COM-
LL CI Op D1NANCEE ANO BTAiE LAWE p[DULATINO
u i 'VISTA BUILDING CO.
OF
THE AMOUNT BROWN UNDER VALUATI0N�I8. FOR THTHAT
PURPOSE OF HSTABLISHINO A PERMIT FEE ONLY. O
yALUATION
//
PERMIT FEE $Jj/nE
' / �s/ONST
A 0
ED H James N. Starbird
W
TOTAL FEE /
9