HomeMy WebLinkAbout170 LEXINGTON LN - Building Permits 1 lt• 1110
CITY OF COSTA MESA ,
4 BUILDING DIVISION
>:r,..,,,. 4 r $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�
1 iib . PERMIT
Stftunspe# P01-00537
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 170 LEXINGTON LN Status: ISSUED
• Suite No Applied: 09/06/2001
Issued: 09/06/2001
Vicinity: I //
ISSUED BY: �/
Parcel Nunmber: 41916436
Applicant: NOCK, RON ,
Address: ,
Phone: 714-895-1246
Zip: .
V' r
Owner: TROPEA, VIRGIL `• I�i
Address 170 LEXINGTON LN S �4 I' 0
Phone:
COSTA MESA,CA Zip: 92626 Qts
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
License: 707775
Arch / Eng: '
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
WATER HEATER CHANGE OUT.
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 Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 . 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0. Shower $0.00 0 Water Heater/vent $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 /SPECIAL CONDITIONS
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
244646(& )
DECLARATIONS /f )
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
�`'Orli for which this permit is Issued.
,2 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 work rs''ccompensation Insu nee carrier and policy number are: 3 p v
Carrier: 1•f'—[n (/)•-•-•.. Policy Number: -)C./19O O 66
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of •aria,and agree that if I should beco •,•act to the workers'compensation provisions of Section 3700 of t Labpr Code,I shall forthwith
comply with these pro -io •.
Applicant Signature: - Date: fd d
WARNING:FAILURE TO SECUR , CRIERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLIARE($1®,000),IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed un r 9&(ov iio s o h7�pter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force end effect.Lic.# U > Class# C',3s
Contractor's Sigoaturei - Date: Q/ef)l�� /
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).
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
Cale: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 pem4'
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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 properly 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 Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 lime 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? 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 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? 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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 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 at 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 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 finalfiinspection.
Si•nature Of Legal Own- - n_ �vajgr/0/
•
And/Or Authorized cont `(7// Datata
;ODE 1 INSPECTION TYPE QAIE QIIQ191.5 CODE( INSPECTION TYPE Pr,IE N=Aka
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbingdlb&l//ct
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
ADDRESS OF BUILDUP: 170 LEXINGTON LN WIT: CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF KNOWS TROPEA, VIRGIL PNM Mn. P 079295
ADDREss: 170 LEXINGTON LN
COSTA MESA, CA 92626 PERMIT NO: B 072295 PLAN CHECK NO: N GOVT : N SUPP : N
APDL.MMUNG ADDRESS: CONSTRUCTION TYPE; PERMIT TYPE; SIR PURPOSE: OTH
ARCHITECT OR ENGINEER: LID P : JOB DESCRIPTION T/OFF SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 924
ARCN.OR ENG.'S ROORESS: UMT:
CLAIM VALUE: 2 , 924 . 00 CALC—VALUE: 2, 924 . 00 GROUP OCC: R-3 /
commaONSNAIm STOUT ROOFING INC ( 310 ) 923-6775
cwmACTDRslfulmD P 0 BOX 4309 COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 91 UBC
ADDRESS: DOWNEY CA UC.NO.: 402536 *****'t*+t****its*,crag*et+f*+c***********;F+e****+r•********:*+ *mm.* ***+r*ir-ar*m.cu-*ar_a6*m men.a m*
90241 UNIT: Z ON INC REQUIR EMEN TS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 d the Bueineas and Prdessonsand my Immo a in full force and
CrrY sec.No.: 59377 uc.�c(u's,S/C 39 sec.No. Immo5 EXP 10/ MAIN BUILDING ACCESSORY BUILDING
Date: /2—�, \ troths«: 4/�� NT :
LFT IN REAR; FT IP7 FP,P7T; FT IN REAR: FT IP7
E. T: FT IN P,GHT; FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby elf under Peaty of perjwy that I an exempt from the Contractors w for the
' Mowing reason(section 7031.5 Business and Pmfessoas Coda:My coy a county which requires a permit to construct ere improve.
smash,or repair any atnicture.prior tob issuance.also requires the applicant nt for suchperm to fib a signed statement that he or she PARKING REQ• PROV; PARCEL ; 41916436 ZNE: REF NO:
s licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Seton 7000)of Division 3 of the PLANNING NOTES>
Business end Professions Code]or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section
7031.5 by any applicant for a permit subjects the applicanl toe rni penalty of not more than lee hundred down($500U. >
❑ I.asowner dlMptopedYa mit enpbyees with wages mtha sole compensation,all dolts svonk,and the structure end intended *********{f#**********XX *****ifaf**N-**************-N******************1,*Y*****4***i,
aoneredf«eate(Section 7o44.Business and PmlesexxnCatle:The C«nradon licereelawdma n«applytomownerdlaopetry D E V E L O P M E N T S E P. V I C E S R E Q U I R E M E N T S
who bolds or improves thereon.end who does such work*Mel or Mesa or though he or her own employees,provided that such
improvements are nol intended or offered for sale,I.however.the building a Snpoanent a sold within ors Year of mmption.the
ownerwieerwuMelMb denofproigM«eMdid awu«impoef«Ihewpoeeaeae), ZONING APPROVED BY DATE:
jl.
as owner of the property.am exclusively contmeig with licenced contractors to construct the project(Sema,7044,Business and BUILDING APPROVED H Y ; DATE :
[Professions Code:The Cadradas Luse taw does rna appy to en owner d progeny who builds or improves thereon end who
contracts for such projects with a contractor(s)licensed pursuant to the Cadredors License Law).
)atm swamp under Section: B.AP.G..for this reereason: APPLICATION ISSUED BY; DATE: ..
e:
Owner: ******************+tib*****4******** ******�******4{t******w+2-*****kf*#+E*te * ** •w**
SafetyLEGALIZATION:N FE G( SUMMARY STRUCTURAL SEGMENT; Y
I do hereby cents that I em aware of end understand the requirements Celfome Health and Code Sections usos us33.and
apens25534,endoatlaanyMaebuiionng o theAwdl/wllna(dmkone)nendkcomdlywtheaidapoica ns eeemptfinentesfor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
econnndthatvur anamoeibuiliin ° weyv�ot(circle
nee. to comply winamd state codes
t exemptfrom
««aeons. PERMIT 54 . 00 . 50
Date: ADDlikent
SMIPINON—RES
PLAN
WORKERS COMPENSATION DECLARATION:I hereby affirm under penally of perjury ahs of the following dedartans: ISSUE FEE
❑ I have and will maintain a certificate of consent to sef-sure for workers'mmpensaion.as provided for by Section 3700 d the Labor
Code.for the pedamanceof the work for which thimwtmtis issued.
BUILDING—DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
I have and wilmaintaihworken'wnpenscolon ins:Imes,asrepuited by Sedco 37004 the Labor Code,for the performance of the TOTALS----> 54 50 0 . 00 0 00 54 50 54 50 00
work for which permit h this pea issued.My workers'opmpenmon insurance cant end podcy number ere:
Caner. 2,T0. EXPIRES REVENUE DIVISION TOTALS--> COLLECTED- 54 . 50 OVER/SHORT: . 00
Policy Number. ca th this Go 05/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed s the pond is for one hundred avers($100/a less) 54 , 00 . 50
❑ I may that in the performance of the work for which this pent e'... ..•. riot employ any perm in .ane so as to
become Subject lo the workers'compensaton laws of California. and that N I should become Ato the re' ******iF*****4*************4*************************4**********if*************4*
become man ct to thus d kerio�n�/7lo�o ��Code.I thea fon with ......provisions.
Dale: 6 12 — ( J Applicant: ` / /� INDIVIDUAL F E E BREAKDOWN
•
Warning:Failure to secure workers compensation coverage is unlawful,and shall subject an employer to cdmlnelp AMOS and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines w to one hundred thoussd dollars(s104000),In addition to fhb coat of condensation.damages as for In
Section Ola of the Labor toes,Interest,and ahomwayaaa SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 924 . 00
CONSTRUCTION LENDING AGENCY:I hereby arum under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the pens is Issued(Sedan 3097,CMG).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and stele that the above information is correct.I agree to camply with all city end county ordinances
and state laws relate: •building construction and hereby a• .•.representatives of this city to en-r upon the above'mentoned propend
for inspection fur
rr /2 DATE: 05//12/62-9512 TIME: 15:47 TOT 54.50
- goat .d Owm/Agent/Appica^t/Ccetnda
(5151'46.W P) White-&tldig A Saey:Green-File:Canary-Appicart:Pink-Revenue,Goldenrod-Assessor
CONSTRUCTION AND PLANNING ." PO. - & SPA
. APPROVALS Permit # Date ._-r+e for - 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-Undrgrrid. 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, ❑ 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
•
13. Roof Drains 64. Plumbing System - Final
1 14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final I
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 Conditionidg 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 Sheathing 2 s-yy' 6tv. fr 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 PREV. 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 !l Z-�( ‘44711.--
48.
1'48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA'MESA - - - - ' - - PERMIT NO. TRACT NO. LOT NO. BLDG. NO. - - - '
1b 94'B5 10/G4/B4 •' 5.OG - IL
CONSTRUCTION PERMIT Y � 5 SSS" -
I Project Address ai /�v//-1 - s - )) TYPE OF CONSTRUCTION H NEW H ADD ❑-ALTERATI ON r U REPAIR '
Applicant's Mailing Address. /C4'41 /4 /_/././r74/.V p '❑ CONVERSION ❑ DEMOLISH ❑ OTHER- ' - - A,P,#, , r ' " Zone '
TiP0 AP.4 Phone9/9 l��ea DESCRIPTION OF WORK
Owner's Name c - - S Main Building: ' Accessory Building: . .- Z
Address SSA P✓/P • r ' - -t 0
• TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front' _ N •
Arch/Eng. License No. 0 TENANT 0 ELECTRICAL PLUMBING 0 MECHANICAL • - BA Rear . N
Address --r��a� ,,// J - ❑ OTHER -
Contractor's Nam¢Xdf ✓/S 7 &',' L✓/ TM Phone 2,1 35Y70 PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right - G
K Left _ _ R
\ J .CON ST RUCTION TYPE VALUATION$ $
Address(mailingl�T-J,3 It../L-/.4-ie.-(0�i.r/C�a/.✓ E
' • ��� r1 ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park:Fees $ 0
„/� City License No. J - '
\7f/ LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided I
•
I hereby affirm that,1,am licensed under provisions of Charter 9(commencing . . R
-.- with section 7000) of Division 3 of the Business and Professions Code,and , I I Use of Building: , , E
my license is in full forcee ntl effect.
3 LicenseGllass ` &p_ra�__Lice.se N+i0"24'•f 2 PLUMBING FEES Planning Notes: I • - M
•
Date / -2_ "_F Signature V//G�� AO %rs i_� - N
kt RKERS'COMPENSATION DECLARATION ' ' • Bar Sink Showers
i lereby affirm that I have a certificate of consent to self-Insure or a Certificate - T
"`U't Workers'"Compensation- Insurance,•or a certified copy thereof (Section - Backflow Preventer _ _ Service Sink _ _- _ - - S
3800, Lab. C.) r/ Backflow Irrigation I Sewer Cap ELECTRICAL 4 FEES '
Policy No. O ��7"0 Company�eR-✓e_T / uS'
lWI ,�,•ertified copy is hereby furnished. i - I . Bathtubs •• Sewer Connection Automatic Washer ,Transformer 0 15-50 KW
EI CerjJ..ttfled copy,u fl ed with the city Ilding Diwsi - '
Date `7'L&-X ga Q Clarifiers C] 50+ KW ,
Applicant' w A./ ./l p �iATIONo Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION D CLARATION" - - ' - - - - . . - - - - - - • - --
Dishwasher. ' Solar Piping Cookin Unit Meter ❑u to 100 airs s
(This section need not be completed if the permit is for one hundred($100) or , - 9 - _ P P ,
less).cer ' I ' DrinkingFountains I , Solar Tank j • Dishwasher I Meter '
I cert ify't hat.in the performance of the work fsso.as
t h this permit is issued I l Dover 100 amps
shall not employ any person in any manner so.as to become subject to the • - '
Workers' Compensation Laws of California., I Floor Drains! Swimming Pool w/Spa. I Dryers ❑Gas` DElectric .Sub Panel • I ,
Date Signature ' - — ' '
NOTICE:If,'after making this declaration,you should become subject to the _• Floor Sinks _Urinal _ Fan __ ;Motors 0.1 HP 01 -8
Workers' Compensation provisions of the Labor Code, yod must forthwith _
•
comply with such provisions or this permit shall be deemed revoked. , Gas Service . Outlets: Water Closet „, • F.A.U. Ino-Solar 09-15 HP 016-15+
CONSTRUCTION LENDING AGENCY • ,, - ' •' •
m
I hereby'affirthat there is a construction lending agency for the performance Interceptors • Water Heater, I 'v�- 0 0 Fixtures '
of the ,work for which this permit Is issued (Section 3097 Civ. 'C.) - - nn • Microwave
Kitchen Sink 'Water.Service - - - Device Boxes Pole Light ' ,
Lender's Name. I '
Lender's Address ' ' I
OWNER BUILDER DECLARATION ' - ' Lavatories . ' Outlets Range i I
I hereby affirm that I am exempt from the Contractor's License Law for the - - - - - ,
following reason (Section 7031:5 Business and Professional Code: Any city or P-Trap L _ - Switches Sign
county which requires a permit to construct,alter,improve,demolish or.repair i _ ' - - •
;any structure, prior to its issuance, also requires the applicant.fdr such permit Roof Drains _ .. _ - -, Garbage Disposal Standing Sections • , •
to file a signed statemenbthat he/she is licensed pursuant to the provisions of ' -
,*'de Contractor's License Law(Chapter 9(commencing with Section 7000)of , - - _ Generator 00-5 KW❑5-15 KW Trash Compactor
•• •
....,„,;vision.3-of the Business and Professions Code) or that he/she is exempt , _ , . - - ,
•'8111erefrom and the basis for the alleged exemption. Any violation of Section . ' - . - 1
7031.5 by.'any applicant for a permit subjects the applicant to 'a civil - • ( i - ,
enalty of not more than five hundred dollars ($500). - • -Reibipectian-Fee- $25• Issue Fee $ 3 --
.0 I, as-owner of the'property or my,employees with wages as their Sole - Reinspection Fee $25 Issue Fee I $ 3
compensation, will do the work, and the structure is not intended or offered • MECHANICAL - FEES -' I r -
for sale (Section 7044, Business and. Professional Code:; The Contractor's ' - PUBLIC SERVICES REQUIREMENTS: !
License Law does not apply to an-owner of a property who builds or improves Hood or Type I ❑ ' I
thereon, and who does such work-himself/herself or.through his or her own - Zoning Approved By - Date •
employees, provided that such'improvements are not intended or offered for ' Canopy Type II ❑ '
•
sale. If, however, the building or improvement isSold within one year of com- • Application Approved By - Date '
pletion, the owner will have the burden of proving he/she did not build or im- .- - i O/
rove for the purpose of sale). I I • eiSystem '.. Application Issued•By • (/'`x Date •
I,as owner of the property, am exclusively contracting with licensed con- ❑ 000 BTU ❑100,000 BTUtractors to construct the project (Section 7044,Business and Professions Code: • SUMMARY OF FEES •The Contractor's License Law does not apply to an owner of property who lbuilds or improves thereon,!and who contracts for such projects with a con- i El ■ •Rfrgeration
System Repair/Alteration - ':BUILDING,PERMIT $ i • SMIP, $ I_
tractor(s) license pursuant to the Contractor's License Law). 'PLAN CHECK $ ,Q PERMIT --4--i_l—_
❑)I am'exempt under Section B.& P.C.for this reason :• ! • PLUMBING $ _- "�' Gc'O ISSUANCE $ "J-'-�'�'�
Date Owner: • I• - • :PLAN CHECK j $ ' ' . ENERGY P.C. $ '
I hereby certify thatI have read this application and state that the above 00.10D000 0,160,000 E - GRADING I $
information is'correct: I agree to comply with all city and county ordinances- - • ELECTRICAL $
and state laws relating'to building construction„and hereby authorize repre- ' PLAN CHECK $ MICROFILM 4 $ I
sentatives of try�s:city. to enter upon a above-mentioned property for '
inspection put qrys es. /� '
Signature n I OC...i -44, 2_ : Date/ Z4'-FSS . MECHANICAL $•
i TOTAL FEE $ ` 1;
Drivers''License or SS* ' • Issue Fee . PLAN CHECK $ .
•
CMF.0865-46 revs 7/33” 'White,Building;'Canary-Applicant;Pink-Accounting;'Goldenrod-Assessor - '• - - - -- - - •
• CONSTRUCTION AND PLANNING • PO. A SPA •
, r• 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 UFER Grnd. 57.-APPROVAL TO COVE R-G UNITE
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-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 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 O Gas 0 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 PREV. 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: /WSOy /yd ONE/-10ME-LCFro?eo L.CO
34. Final Heating & Air Conditioning iy ilj5- No onCi4 mt.
35. Final Gas Pipe-Test - Q.#nc . , (as P Crt. .x.0.3 LI PG
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. FINALSTRUCTURE& BUILDING
48. Special Requirements Completed
49. 'Electric Release to Edison , •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY • •
No. - Date
OWNER SM VISTA Building Co. DATE OCT 3 0 1963
JOB ADDRESS 170 LexJgton e BUILDING PERMIT NO. 20644
GENERAL CONTRACTu Vista Buildipg_Go. VALUE $ 154735.00
AP No. LOT 160 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK Rea.w/gtt.gar
INSPECTIONS Si nature DATE GROUP TR.T TYPE V ZONE g
soil //-/-/7 PERMITS I USS ED
Gas 3-�-��/ SUBCONTRACTOR DATE NUMBER
Water 4;_g? !9/A-Ij-
Rough Com. Refrig. 0 Air Cond. 0Rouh Heating
,,/�
Rough Plumbing Bf�/ o"'���U:"2F /-,S'-6v de 77 C/ '-
g g 1711v`✓` I—/a,-(e/ X� J-t..tt'� i„ _ a —c3 9ti GA .�
Miscellaneous \
Prop. Swr. Line 0 House Con. p-St. Swr. 0 ?_�' 3—/ 47 3_ -e , 's_1 N53 'T�;�.7-
l
Sprinkling System /, '/ 4 0-yYA
Construction Pole /( 7
Underground 0 Power 01 / JIR
Rough Wiring /-157-44t ..e,„„)./‘ i . . ° 3- F se .�i7 c 8
Trenches 0 Forms 0 Steel Reinf. 0 o '
Floor System //— r 6 '3 .•,'
Bond Beam 0 Steel Reinforce 0 J .i.- U
Sheathing i Me- /3- - 7-7 /63 , II!, N"
Frame and Flashing o v- y rete ya „\I i • I'r
Lathing —In ��Out 0"� az ,z,/G/C41 Oilli y / [�Plaster, brown coat f' e_ 3-3/ uRefrig. 0 Air Con. 0 Final7iHeating, Final 7.e. '�- j 4/�
Plumbing Fixtures, Final ,�/# / G 3I// /S
Final Gas Test/50 /- j
Electric Fixtures, Final n/ _
Building, Final 61.X li Y i
OCCUPANCY .
Form HU4--6M�-83—S-n P • i - r• • . . ...
.. - • 20644 •
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT ggp 2 6 1953
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
•
, For Appli2ant to Fill In Completely APIIL(t 1Q1NCP61API
TYPE OR PRINT Lot 160 BUILDING
BUILDING For Office Use Only
ADDRESS 170 Lexington Lane RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA
RHCHIVt BY DATE RECEIVED 20544
OWNER Sm Vista Building Co. /g 20 OCT 3 0 1fl63
BUILDING
MAIL ADDRESS
ADDRESS 1166 E. 58th Street
FIREVil
' TEL. ZONE TYPE GROUP / •
, CITY Los Angeles 11 NO. AD 37187
if
ARCHITECT TEL. APDATE
OR ENGINEER Raymond Levans NO. OR 37010
ADDRESS 3432 Via Oporto, Newport Beach //////������ ZONING
ZAN6'J 3 I PLO.ANS I USE OF N BUILD' GI a i ( .
PCONTRACTOR San Vista Building Co.
LEGAL Tract 5160 - Lot 160 ' 7
ADDRESS 1166 R 'SRth street DESCRIPTIONC r j
CITY Los Angeles 11 A.P.No. T� " �� 2J� /
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL.
LIC.NO. 192782 NO. AD 37187 90'TO SIDE&REAR P.L.
EAVES
OF LOT 20x50 & 20x36 NOW ON BLOGS.n ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF None MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE
CENTER OF STREET FROM 13' REAR YARD 4'8" FRONT
SIDE YARD I LEFT RIGHT 0 • R.SIDE
DESCRIPTION OF WORK L.SIDE
NEW % ALTERATION _ ADDITION REAR
DISTANCE BET. BET. MAIN a
REPAIR MOVING p�y�g MAIN BLDGS. ACCESS. BLDGS.
1"luII 4 VAR.# DATE
SIZE
BUILDING 20 x 34 ROOMS NO.OF 6 STORIES 2 C.U.P.# ASM APPROVEDEXTERIOR WALLStUCCO I ROOF Shingle BYPR � DATEY
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Residence and Ca :ort A 'p.
rierfett,
O.Ff. T``//� N
n
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SH N UNDER VALUATION IS FOR THE S
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION N
± BUILDING CONSTRUCT
VISTA BUILDING CO. PERMIT FEE $ ,7 j
' SIGNATURE OF _�t
' PERMITTEF I ,, / V S
'-lJ✓L"$/5'73._— PLAN CHECK $ ��S ¢
AUTHORIZED AGE T .lames N. Starbir / / D
TOTAL FEE $ / /prJ `-