HomeMy WebLinkAbout184 LEXINGTON LN - Building Permits f 'T
CITY OF COSTA MESA
BUILDING DIVISION .
Q
S• ; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • wvw.ci.costa-mesa.ca.us
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FOR INSPECTIONS CALL:(714)754-5626
'itsa.mm PERMIT NUMBER: M08-00104
PERMIT TYPE MECH STATUS: ISSUED
APN: 41916439 DATE ISSUED: 07/18/2008
ISSUED BY: YH
JOB ADDRESS: 184 LEXINGTON LN CM Suite/Unit:
Vicinity:
SO. FT: 0
SCOPE OF WORK: REPLACE FURNACE WITH NEW 70,000 BTU FURANCE IN SAME LOCATION.
OWNER: TRUSSELL ANDREA RUTH Address: 2821 EUROPA DRIVE Unit:
PHONE: 7 City/State/Zip: COSTA MESA„CA
APPLICANT: TRUSSELL ANDREA'RUTH Address: 2821 EUROPA DRIVE Unit:
PHONE: 714 662-5460 • City/State/zZip: COSTA MESA„CA
CONTRACTOR: License No. • : v$
Address: Unit: PHONE:
City/State: ZipCode: CELL:
MECHANICAL PERMIT FEE SUMMARY •
MECH ITEM FEE: $38.30 •
PLAN CHECK FEE: $0.00 •
INVESTIGATION FEE: $0.00 • •
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
1AOE1. INWECf011 YPE MT PI1mALs copEI iNSPEcnoN fP; N
1616 Fixed System Final Fire Prevention 206 Final Mechanical M-30-0(( \ zl
1266 Pool Spa Final 208 Final Plumbing
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 • -
WORKERS'c5MPENSATION DECLARATION: Owner ID verified by driv •rise. 0'Yes ❑No
9
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No? Expires: CI—41 —(
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. -
❑ 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: s
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
Carrier: by this permit,and that no building structure,scaffolding,falsework,or demolition
Trus seam need or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
( complete Demi c valued at hundred less 2,Art 2,Sec.341,Title 8.California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code,I shall forthwith comply with these provisions. Applicant's Signature Date
Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be fled with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
Lic.# Class# _ _ (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
contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes IDNo
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of properly who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8. (If yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the btlydeh of proving that he or she CERTIFICATE'OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all slate laws and
❑f I. as owner of the property,am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
C,LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
c p authorized by this permit until final inspection.
7/f 0/od Signature of L al Owner(s) Date
—1-1- \ Signature . Date r / /-�,.� // /
3057-46(107) �( �/V
And/or Au or ed Applicant r Date I
ADDRESS OF SLALOM: 184 LEXINGTON LN 0M1 CITY OF COSTA MESA — BUILDING PERMIT
D"NExs"'°'EI`looxy'' TRUSSELL ANDREA RUTHPRRM Mn, A 07,129d
ADDRESS 184 LEXINGTON LN
COSTA MESA, ,CA 92626 PERMIT NO: B 072298 PLAN CHECK NO: N GOVT: N SUPP : M
APPI.MAapc AaoRss& CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: OTH
ARCHITECT OfENDOIEEH: UC.NO.: JOB DESCRIPTION : T/OFF SHEATH E REROOF W/COMP SHINGLES SQ FT: 2, 924
&RCN.OR EN(L'S ADDRESS: WIT:
CLAIM VALUE: 2 , 924 , 00 CALC—VALUE: 2, 924 , 00 GROUP OCC: R-3 /
CONTBACTOWS"AYE: STOUT ROOFING INC ( 310 ) 923-6775
COfrtRAC7DR1 MARINO P 0 BOX 4309 COMMENTS: SMOKE DETECTORS ARE REQUIRED PER 91 UBC
ADUREss DOWNEY CA Knits.: 402536 'a*if*+*******************************iE,Fw+t+r•r*µ+c*,Esc****Ar c-rt*******TEs****4***.(*,cA***
90241 DMT: Z ON INC R EQU IR EMEN TS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally penury that I am licensed under provisions of chapter S SETBACK 5
(commencing with Section 7000)of Division 3 of the Business and Prolessi s e.and my license is in lull force d effect.
CITY UC.No.: 05Q, 37 ss: C 39 uc.N g025 6 EY ; , 95 MAIN BUILDING ACCESSORY BUILDING '---
Date: ' -)11.1P. —� sec Contractor FENT: FT IN REAR: FT IN FENT: FT IN REAR; FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury
that l am exempt from the Lice a Law for the LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
tolbweg tenon(Section 7031.5&aims and Profession Code:Any city or many*kids requires a permit to ,atter,impwe,
demolish,or repel any structure,prior to its issuance.also requires the applicant for such permit to fib a signed statement that he or she PARKING REQ: P RO V: PARCEL: 41916439 INE: REF NO
is loensed pursuant to the provisions of the Contractors License Law[Chips(9(commencing with Sedan 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged eaamgion.Any violation of Section >
-031,5 by any applicant for a permit subjects the applicant to a civil penalty of nor more than fife hundred dollars(MOD.
] I.as owner of the pdP?nlY Or my employees will wages as thee sole compensation,will do the work.and the structure bseal intended ****************************************************************4**********e'***
IIIII
orofferndforsale(Section 704A.Busimaand Professions Code:The Comrectors License Law does not apply toanOwerofproperly DEVELOPMENT SERVICES REQUIREMENTS
who builds or improves thereon,and cubo does such work tinsel or hersel or through hi or her own employees.prodded that such
• owneruildrwihavave the buurrdend tor sale.
he Of Mt build or impove f ruepurposeof dwosatae). veerofcomplamn,the ZONING APPROVED BY
DATE:
I,as owner of the property.am exdurinly contracting with licensed contractors to eonmUd the Aged(Sacton 7044,Business and
Professions Code:The Contractors License Law does net apply to an ower of property who builds or improves thereon and eta BUILDING APPROVED BY : DATE:
contracts for no,proects with a contrador(s)licensed pursuant to the Contractors License Law). -
amsaemptander5xton: B.AP.C.,fothis reason: APPLICATION ISSUED BY; Aor ` DATE: i//L/�/��/��// C
at•: Owner: *********************************'h** ******************************' ii. 4G .*�rJ;
Idohereby certify ua
wIamawareofdudw
requirementsersdthe of
Canmen
:aHeaendSafetyCodeSectionuw5,25533.and LEGALIZATION: N FEE S U M M A R Y STRUCTURAL SEGMENT:Y
25534.and that I or any Mere building occupant will/will not(circle one)need to comply with said Nate codes and the requirements for
a permit forwatruction or modifcmlon from the Airy enageent Diterick Resided construction are carnphpn these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Provisions, PERMIT 54 . 00 . 50
Dela: Applicanh
SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: PLAN
❑ IhaveandMImaintanacerNicateofconsenttoself-insurebrworkers'compenoSeo
lion Labor
ISSUEy FEE
code.fatheperformanceoftheworkforwhichthispenmti+icompensation, BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I have and wilm :,
aintaworker+compensation insurance.as required by Secn 3700 of the Labor Code.f r the performance of the TOTALS----> 54 , 50 0 . 00 0 , 00 54 . 50 54 , 50 , 00
work for which this permit is issued.My workers'compensation insurance=nix and policy number are:
Carrier: ATCEXPIRES REVENUE DIVISION TOTALS > COLLECTED: 54 , 50 OVER/SHORT: 00
Policy Number: '22
BLDG 05/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(chisseaKwneed not beaandeteermepxm.hmrdnehundred.. - 01aws.)
54 , 00 . 50
I I certify that in the performance of the work ler which this permit. .. .,WINS!nor employ any person in manner so as to
become subject to the workers'compensation laws of C,•• agree that'.
SWUM berme,, I.. to the
compensation pmvisaro of sect' 3(700tl.Ne Labor Code.l ply hthose. . ':. / ******************************************************************************
Del.: 1�'/,) 7J Appli an: � ,,, IND I V IDUAL F E E BR EAK DOWN
Wamhp:Faganfo&+cola workers'compensation coverage leunlawful,and shall ambled+n employer to sur, .penalties are TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines W to one hundred thousand dollars($t04000),ler addition to the coal of compenutIon damages provided for In
Section 3706 of las LWpr Code,Interest and attorney's fees. SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 924 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that the.,is a construction lending agency for the
performance as the work la wtdtltthis permt is issued(Section 3097.Ci..CI. END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I candy that I have read h applirmion and Nate that the above information is correct.I agree to comply with all thy and county ordinances
and state laws relating to ng oxd'ulruand hereby aWpria. ... . ...tati'es of this city to enter poi the above-mentioned propertyIo inspofion Wryoses, L
Are
Print am.'
-, '/'
•� Dela: t 7 /V DATE: 05/12 00181ES9 TOT 5: , a
Lie r /12. 9 TIME: 15:4b
S aW o • :r/Agent'Applicant/Contr • .
(5151d6.WP) While-Buldug&Safety:Green-Pie:Canary-Appicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING }OOL &
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 'r
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,.D Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DESK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final .•
t .
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
' � 1
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 rye, / 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing &n-(-c f 7r{!` 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. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING )/....2_9f �1441 6�
48. FINAL PLANNING i D
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
PROJECT ADDRESS: 184 LEXINGTON IN UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; P 059289
OWNER'S NAME: TRUSSELL ANDREA RUTH
ADDRESS: 184 LEXINGTON LN PERMIT NO: P 059289 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA„ CA 92626
CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE; OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : WATER HEATER CHANGE OUT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
PERMITTEE: GENERAL INSTALLATION ( 213 ) 753-2541
ADDRESS: 6558 WEST BLVD COMMENTS; SMOKE DETECTOR REQUIRED-MAIL IN PERMIT
L .A. CA 90043 *********************#***** ***********%***********I6##%%:rt6#*********x•# #*#+e###><
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: 006453 STATE LIC.:151839 CLASS: C 6 r
Date. Signature: `e& 0• s MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of cone to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensationlsy{apce,or acprt`(ied copy thereof(Section 3800.Lab. LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: 0Y b7-VUV4 EXP.DATE: Li 4 /01 /93
COMPANY: NMI C PARKING REQ: PROV: PARCEL: 41916439 ZNE; REF NO:
0 Certified copy is hereby furnished. IM Certified copy is filed withththe cit Buil ' ivision, PLANNING NOTES>
f/A/`� >
Dale: Applicant: ********#*%%**iE**#7F*##**iE***#**#*#*#%*##**#**#3F-3E#**#**#*##**##if*##*#*****3F*#3f**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1W)or less). DEVELOPMENT SERVICES. REQUIREMENTS
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 t0 the Workers'Compensation Laws of California. ZONING APPROVED BY DATE;
Date. signature. BUILDING APPROVED BY 1 •
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked, ..
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• 1a' a's! i• DATEwhich this permit is issued(Section 3097,Civ.C). ********.*************if—' • 1Wrv,...)/36%
LENDER: ************************************** . ********aF*****************************i!.
ADDRESS: LEGALIZATION;N F E E S U Tri M A R Y STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: t hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 7• 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% SM I P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PIAN
and Professions Code)ar 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($500). ISSUE FEE 20 . 00
I. as owner of the property or my employees with 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----> 7 . 00 2 0 , 0 0 0. 00 2 7, 0 0 27. 00 U 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.If, however the building or REVENUE DIVISION TOTALS--> COLLECTED• 27. 00 OVER/SHORT: 00
orthe purpose of sale).improvement is sold within 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 SMI P/TOT GRADING PLAN-CHECK
for
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27. 00
and ProfessionsoCode:toch projects wiStateLicenseLawdoespapply mo theowner tfproperly' aLicense Law).
improves as thereon ************************************** ****************************************
•
and wino contracts suchTContract with a e LicenserLawlicense not pursuant to Contractors'State builds
impro em aware '
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDO W N
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: PLU 1 WATER HEATER AND/OR VENT 7, 00 7 . 00
I do hereby certify that tam 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 will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives a ' city to enter upon the above-mentioned
Property for inspection rposes / /6/(9
Date V urate: _` - -
Driver's License or Social ecunty#' r - '
164Y46 Mae—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & S
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 Unclrgrnd.
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 ElectricabT 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 ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 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 I _ _; 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 r
38. Final Plumbing 1*Pr c-EO
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer I '
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 SAN Vista Building Co. DATE OCT 3 0 1963
JOB ADDRESS 181+ Lexington Lane BUILDING PERMIT NO. 20647
GENERAL CONTRACTOR San Vista Building Co. VALUE $ 12,635.00
AP No. LOT 163 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK Res.watt.gar.
INSPECTIONS Si:nature DATE GROUP 1W TYPE V ZONE R-3
Sr" '-Q /L O /e) PERMITS ISSUED
C /. SUBCONTRACTOR DATE NUMBER
3 l3-G4
Water "-- i"-- ii. S'
- /1- - 3
Rough Com. Refrig. 0 Air Cond. 0
Rough Heating ,_._. • /_ a/j-/it $7
Rough Plumbing S5 al(, \l-\-143 a3`l6L- r
Miscellaneous 4 SPI
�7iProp. Swr. Line ❑ House Con. E'St. Swr. ❑ d G 3-j �e„,..._ ,-,__c VOV 13 1963I
Sprinkling System "J
Construction Pole
Underground 0 Power 0 `71-11,
L p ; �'I G �Y3' �{
Rough Wiring 6,`t 7�f ? ,/ .3 n- L-✓ i- 3- E Y — / 7 '/
Trenches 0Forms ❑ Steel Reinf. 0 _ / ¢.- 11{ 4' 3 '
Floor System _ a- 1.2- T - 63
Bond Beam 0 Steel Reinforce ❑ pp _ -,-9."Sheathing tiv_ / - y f 3�e " ILt-
Frame and Flashing ,/Y�t''_�a- oc- Ect /6rL I [P
Lathing- In ❑ Out O ,)e�� - 12 C-� _ _ _ fr'
Plaster, brown coat t_ T - 291 - - u
Refrig. 9 Air Con. 0 Final
F 'og, Final �0 fi /i t
F. .oing Fixtures, kmal T?5 (� 7
Final Gas Test/�✓L` /J / L`s/
Electric Fixturt=s, Final ✓;y�j,,.';='. ,9 Y_g.A.,.-.,_G,� G/r,/¢y -XS
Building, Final /yt�k� / 1
Form BU4-5M-3-63—S-B P HOLD FUR-SPECIAL REQUIREMENTS
20647 FEE RECEIVED
SEP 2 6 1964
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O.BOX 317 COSTA MESA,CALIFORNIA
/ CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT Lot 163 BUILDING
For Office Use Only
BUILDING o1'
ADDRESS 1811- Tnl nM'nn Tpne.
RECEIPT NO. P 20647
COSTA MESA. CALIFORNIA ll////r]`]
RECEIVIIID BY D TE RECEIVED - DATE ISSUED
OWNER San Vista Building Co. — 'Y-074574(9OCL-3 0 1663
MAIL BUILDING
ADDRESS 1166 E. 58th Street ADDRESS �/
TYPE ✓ GRQUP di
IRE
CITY LTEL.
os Angeles 11 TNQ.E AD 37187 ZONE
ARCHITECT TEL•
APPROVED DATE /
OR ENGINEER Raymond Levans NQ OR 37010 BY
ADDRESS 3432 Via Oporto, Newport Beach ZONING 1
ZO H z NO.OF USE OF N.. ,
San Vista Building Co. �J I PLANSI BUILDI" p . r
CONTRACTOR u�
LEGAL
ADDRESS
1166 E. 58th Street DESCRIPTION Tract 5160 - Lot 163 /
CITY Los Angeles 11A.P.NO. / 71� 31,3 -f
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.NO. 192782 TEL AD37187NO. SO'TO SIDE a REAR P.L.
• EAVES
SIZE OT 20 X 70 NO.OF SLOGS. 0
NOW ON LOT ALLOWED (U.B.C.REQUIREMENT)
OF L
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. None
(FROM C/L STREET)
SETBACK LINE
CENTER OF STREET FROM
13 1 REAR YARD7 110" FRONT C'-iS. FT.
SIDE YARDI LEFT 0 I RIGHT 0 R.SIDE Fr. Fr.
DESCRIPTION OF WORK L.SIDE Fr. Fr.
NEW X ALTERATION ADDITION / REAR FT.
DISTANC ET. BET.MAIN&
MAIN BLOQS. ACCESS.SLOGS.
REPAIR MOVING DEMOLISWi2 r
BUILDING 20 x 27 NO.OF 5 r�lddiIIl iVt 2 VAR.# DATE
SIZE ROOMS STORIES C.U.P #L§tUAPPROVED �jl
EXTERIOR WACCO I COVERINGROOF
Shingle APPR 9
DATE -7 Q-63
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Residence and Carport - 1
de -1422 g [�' 612
//`/O 8Q.PT. /I / - ,O c
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOW UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE.ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION a
BUILDING CONSTRU VISTA BUILDING CO. N
SIGNATURE OF PERMIT FEE $
PERMITTEF / ` G•A/I A // m
.L
James N. Starbir IF/02, iP�✓� c E r c
AUTHORIZED AGF iT /3— E
TOTAL FEE 9 (O