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Home My WebLink About190 LEXINGTON LN - Building PermitsApplicant to fill In all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PEBy4{ANO. TRACT NO. LOT NO. BLDG. NO. CONSTRUCTION PERMIT /L ��UY TYPE OF CONSTRUCTION NEW ❑ ADD ❑ ALTERATION ❑REPAIR El CONVERSION ❑DEMOLISH ❑ - ' �•�.-� �' 1 _29_26_ 3/06/62 6.00 ZONING REGULATIONSOTHER Project Address Z,-) Owner J �x . Phor�el5y❑ Address (� T -i w, Arch/Eng. License No. DESCRIPTION OF WORK A.P. 5P Address _ ZONE PLNTTGo.. REF. - Contractor. An . _ —' / _ —P ne r9W2,)0 TYPE OF PERMIT ❑ ❑ SETBACK C LST. PROPEIRTVNGLINE.- Address ,� S'� `fG�J ^ GRADING FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA SIDE YARD LICENSED CONTRACTOR DECLARA ION 'I hereby afflrm that I am licensed untler provisions of Charter 9 (com- 51p HTA RIG mencing with section 7000) of Division 3 of the Business and -❑ OTHER -- - _ Professions Code, 'antl my license is In full force and effect. REAR YARD (TO P/L) _ '`)z PROJECT DESCRIPTION Ucense Class License No, PKC. SPACE REQ. PROVIDED j- —'L e -��(� %LBP SQ.FT. Date Signature 6 OCCUPANCY—CONSTRUCTION TYPE _ STREET WIDTH PARK FEE $_ ,WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure ora - VALUATION ZONE - ZONING APPROVED BY - - DATE :. certificate of Workers' Compensation Insurance, or a ert1fTI d copy _ ..__ .___ -T .. �._ -thereof (Section 3800, Lab. C.). /� �ira/ GRADING CU: YOS. ACRES SPECIAL CONDITIONS: Polity No. en ��L//r-o mpany ❑ Certified copy is hereby furnished. REMARKS: - - - - — '❑ Certified copy is filed with the city -Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the permit is for one hundred - (E300) or less). -, II tertrty 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. BATHTUBS SHOWERSI qQ.FT SO- FTM Date Signature NOTICE: if after making this declaration, you should became 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 10-50 KW_50 + KW revoked: KIT. SINKS DISHWASHERS MOTORS 0-1 HP -1-10 HP CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the per- HF!- -50 formance of ,the work for which this permit is Issued (Section 3097 FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Civ. C.). 'Lender's Name Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION I hereby affirm that -I am exempt from.the Contractor's License Law for INTERCEPTORS CLARIFIERS POLE LIGHTS the following reason (Section 7031.5 Business and Professions Cotle: SWIMMING POOL P TRAP Any city or county Which -requires -a permit to construct, alter, -POLES METERED SUB WATER SERVICE ALTERATION PANELS MAIN SUB improve, demolish or repair any structure, prior to its Issuance, also re- quires the.applicant for,such permit to. the a signetl statement that he GAS SERVICE OUTLETS 'SERVICE AMP is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9. (commencing .with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT t ' Business and professions Code) or that he Is exempt therefrom and the basis for the alleged exemption.. Any violation of. Section 7031.5 by. SEWER CONNECTIONS any applicant for a permit subjects the applicant to a civil penalty of not more -than five .hundred dollars ($500). SOLAR TANK L-L-ECTOR - ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, -and the -structure isnot intended ,CO -- - - or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. G,%4i. 60 ISSUE FEE - Contractor's License Law does not apply to an owner of a property ISSUE FEE �, GU APPLICATION APPROVED BY DATE who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES ' intended or offered for sale. If, however, the building or improvement IS old within one year of completion, the owner will have the burden s of proving he did not build or improve for the purpose of sale). HEATING_SYSTEM 0-100,000 BTU BUILDING PERMIT $ _ . SMIP $• ❑ I, ai owner of the property, am exclusively contracting with AND DUCTING licensed contractors construct the protect ( Section 7044, Business __ 100,000+BTU_ PLAN CHECK �� : License Law does not apply to and Professions Code: The Contractor's 6 .PERMIT _ ISSUANCE $ _ a owner of property who builds or improves thereon, and who con- improves REFRIGERATION 0-100,000 BTU PLUMBING ) - tracts from such projects with a contractor(s) IiceSnetl pursuant to tracts _ SYSTEM -- GRADING" $ the Contractor's License Law). _ 100,000+ BTU PLAN CHECK $ ❑ 1 am exempt under Section B. & P. C. for this BOILERS BTU ELECTRICAL $ $ reason _ - SYSTEM.REPAI R, ALTERATION PLAN CHECK $ MICROFILM $ - Date - - - Owner _. -' EXHAUST SYSTEM - MULTIPLE - MECHANICAL $, TOTAL FEE $ LE55 AD - 1 hereby certify that I have read this application And state that the above information is correct. 1 agree to comply with all City and county PLAN CHECK $ VANCE PC $ ordinances and state laws relating to construction, and hereby authorize representatives of this city [o enter upon the above mention d property for purpgsses 7 �in/spectl Signature �` ��C� �//t Af l 'r , Date _ FINAL FEE $ Drivers' License or 55 9P ISSUE FEE - CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLAN APPROVALS Permit # Date POOL & SPA Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location`' 2. SoilPipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. - Electrical LIFER Grn 48. APPROVALTO COVER-GUNITE. 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap, 1:3ndr rn ' 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 - 14. Rough Electric -Conduit :56. Electrical -Final ' 15. Rough Electric -Wiring - _ 57._ Solar System -Final 16. Rough Heating & Air Conditioning _ _ _ encing & Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING . 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing 60. _ POOL/SPA SYSTEMS FINAL . 21. 22. Roof Sheathing Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding ' 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric " 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing �-- 32. Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison ' • 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 190 LEXINGTON LN UNIT: OWNM'S NAME:• MARTINEZ, CARLOS H TR ADDRESS: 190 LEXINGTON LN COSTA MESA,CA 92626 ARCHIE NGINEEfl: 546-7291 flEG.NO.: ADDRESS: UNIT: PERMITTEE: WESTERN COOLING (714)776-1168 ADDRESS: 628 S. EAST ST ANAHEIM CA 92805 LICENSED CONTRACTOR DECLARATION: 1 hereby affirm I"'18 at 1 am - rsed u der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my'license is full force of. 'IT' LIC.: O4 ,3 ST ATE LIC.: 52501 SS: C 0 Dote• Signature: WORNERS' C PEN ATION DECLARATION: I hereby atfi that I nave a ceml a of consent to self -insure or a cc l l Compensate Insurance. or a oertlfied cony thereof (Se on 3800, Lab C POLICY NO.: EXP. OAT COMPANY: ❑ Cenilied copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Dale: Applicant: EXEMPTION FROM WORXERS' COMPENSATION DECLARATION: (This I certify that in the p ormance of the work for which this perms rss subloct to the Wo ers' Co enation Laws of California. a Signature: N071 E: I. alte king This detlaralion, you s d ame sr Code. u mu footman comply with such pro sio or Ihis T CONSTRUCTION LENDING AGENCY: I hereby affit I there is a which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: permit is tar we hundred (510D) or less). Troon in any manner So as to become lending agency for the performance of the work for OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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 helshe is licensed pursuant to the provisions of the Contractors State License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business 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 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 11structure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law 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 awn 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 will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively9 contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. B P. C. for this reason'. Date: Owner I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that for any future building occupant wiNwill not (circle one)need to comply with said state codes and the requirements for a permit lar construction or modification from the Air Duality Management District. Residential construction applications are exempt from (hese provisions. Date. I hereby certify that have read this applicat ordinances and state laws relating to buitI properly for inspe mn u sel O'ate: Driver's Lite se or ocial Security p: 164146 While—Building: Green—Code Applicant: land state that above informatio is co 1. 1 agree comply with all city and county nstruction and rebyautherlIe rept enl vies of this city to iter upon the above-mentioned Pink—Revenue: Goldenood—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 052938 PERMIT NO: M 052938 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH JOB DESCRIPTION CHANGE OUT FORCED AIR UNIT SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR REgUIRED IN THE HOME Z O N I N G R E Q U I R E M E N T S S E T B A C K S ----------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT" FT IN LEFT: FT IN RIGHT. FT IN PARKING REQ• PROV: PARCEL: 41916442 ZNE: REF NO: PLANNING N TES> iE iE iE1E if 8E BF fE iE iF BE iE iE iE BE iF lE iE iE if iF 3E iE 1F iE ie iF iF 1E iE * iE i6 * * * i6 * iE 3t 9f ae 8E iE * jE * iFiE iF iE * N iE 8E iE fE iP 3f 9E 9F iE if iF iE 9E iE iE fF iE ♦E * XE SE iF * J6If iF 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: —7—,1d(--- If RE if iF * JF * JE iE iE * iE iF aE IF iE iF 3F iE * * iE iE 1E 9E * iF IE 3F 3E JF JE7F�'£iF9F N- **iF j6 aF 1E 1E ik iE iF lE iF of 9F IE 7E IE iF iE ie lE iE 3E iE iF iE kiE iE aF iE iE 3e*9E 3E#*iE 3F 3E 8f BF BF jE iE iEiE*iE*-lt iE*9E BF*JE*iE BF 1E iF 1F iF iE iE iE RiE*aF**MJE Je%iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 9.00 25t SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 9.00 15.00 0.00 24.00 24,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 24.00 AE if*1f iE*iF 9E of If iF TP**)E 3f iF 3E tt**iF TE ik iE 9E iE 8E 9F IF iE 3Eie 1F iF*3E iF iE*iE*iF aE*rtiE iE iF*3F 9fXE iE iE*IE 6F 1E 3E BE 4 Jf 3E iF *iF iE iF iE )F iE XL *ib iE s�*i4 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9.00 9,00 END OF FEES 01 G13092s53 , C.7 .,:CLI P?.T= 3_!,'1;19'L T t'tE' 12,1'.4 /I CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location +'. 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 LIFER 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 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 APPROVALS ' Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground. Hydro 22. Ducts, Ventilating 71. Product Piping OGas 001 23. Gas Pipe -Rough &Test 72. Underground Flusli 24. Roof Framing 73. Undergrnd.Storage-Tank OGas OOil 25. Roof Sheathing X74. 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 I I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32..ElectricatPower Meter -Final+ 80. FOOD CERTIFICATE ISSUED 33. Final Electric I Notes: 34, Final Heating & Ain, 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 - i 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 I I i ( 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 190 LEXINGTON LN UNIT: 0 OWNER'S NAME: MARTINEZ ADDRESS: SAME AS ABOVE 714/546-7291 ARCHIENGINEER: REG.Il ADDRESS: UNIT: PERMITTEE: NOCK PLUMBING (714)895-1246 ADDRESS: 11610 SEABOARD CIRCLE STANTON CA 90680 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70110) of Division 3 of the Business and Professions Code, and my license is in full force and effect. cITY uc.: 0 5--0 3 8 6 STATE saC-:511971 cuss: C — 3 6 7 I —�— � C7 Signature: �i(ERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent to self -insure or a cergficate of Workers' WUDenuiian Insurance or a certified copy thereof (Section 3800, Lab. Q. CYI 1167992-90 EAP. DATE: 03/01/91 COMPANY: STATE FUND ❑ Certified copy is hereby furnished. ® Certified copy is file with the city BB/uilydinngg(DNi�s//iy/n. Date: - _ S ~ Apo licant �.yVVI Lm e EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I cervi fy that in the performance of the work for which this permit is issued, I shall not employ any person in any manner was to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If, 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. 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 (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State Licensa Law (Chapter 9 (commencing won Section 7000) of Division 3 of the Business and Protessions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ,y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the DmDeM or my employees with wages as their sole compensation, will do the work, and the .� structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law 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 improvement is sold within one year of completion, the owner will have the burden of Droving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects cith a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof at their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: S. 8 P. C. for this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant wiNwill net (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouality Management District. Residential construction applications are exempt from thew provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and stale laws relating to building construction and hereby authorize representatives of the o enter upon the above-mentioned property for inspectan purposes. Date: —7— — / V Signature: Driver's License or Social Security x: 164146 Nine—Building; Green —Cade Entoroement; Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 047970 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE; PLU JOB DESCRIPTION ; WATER HEATER REPLACEMENT CLAIM VALUE: CALC—VALUE: PERM NO: P 047970 GOVT: N SUPP: N PURPOSE: OTH SQ FT: GROUP OCC: / COMMENTS: # Z 0 N I N G R E Q U I R E M E N T S S E T B A C K 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: 11910302 ZNE• REF NO: PLANNING NOTES> > 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 ISS*D#B**####DATE: 313F3�tF ## LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2200 5% SMIP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 2.00 3.00 0.00 5,00 5.00 ,00 REVENUE DIVISION TOTALS— > COLLECTED; 5.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.00 ############################################################################### I N D I V I D U A L F E E B R E•A K D 0 W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT 2.00 2.00 END OF FEES 01 170065568-00056563 T07 DATE: 07/31/90 TIME: 15:01 7,015 CONSTRUCTION AND PLANN APPROVALS Permit # Date - Inspector JOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ED Gas 0Oil 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 Drown 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 % qd C." 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 ADDRESS OF BMLUM110: 190 LEXINGTON LN UNIT: ONNERS NAME IF IOCyM MARTINEZ, CARLOS H TR A0°"E 190 LEXINGTON LN COSTA MESA,CA 92626 APPL. MAILING ADDRESS: ARCHITECT OR ENGINEER: UC. NO.: NCX.OR ENG.'S ADDRESS: UNIT: CONTRAOTORSNAME STOUT ROOFING INC (310)923-6775 CONIRACMA'S MMUNG; P O BOX 4309 M11m DOWNEY CA UL ND: 402536 90241 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby Affirm under penaly of Ismary thin I am teamed under prwisian d Chapter 9 (commencing wth Section 7000) of Di 3 of the Business and Professions Co and my Isress is in full fares mos. Cm UC. NO.: 9 7 Uc cuss: C 3 9 uc. NO.: 4 5 E X . 10/ 5 Dere: ✓ ��"— �� Gotnredor: OWNER BUILDER DECLARATION: I hereby affirm under Penely of penny that I am exempt Item the Contractors Licana w the e fdow reason (Section 7031.5 Bsinoes and professions, Code: AM cry or poorly which requires a permit to mrebu e. er. hmprae, demolish, or repair my structure, prior to As Issuance, also requires the apptiCwt for such pwmit tp fib a aigsd swement that he or she is licensed pursuant Mo the provisions of m the Commegors Lissa Law [Chapter 9 (mmenon with Semon 7000) of Division 3 of the Business and professors Cade] or that he or she is exempt therefrom and the basis for Me alleged exemplion. Arty violation of Sermon 7031.5 by any applicam for a pwmh suppose the epFliewl to A evil Pertly of W more than Me hundred "Ices ]5500D. ❑ 1. as owner ofthe property or my empbyees cath wages w their sole oempormation, will do Ne work, ant the structure a net intended off r orerndfwsab(Ssnon70Aa,Bsine mdProfessiore Code: The Contractor License Law does not apply per tow bwnerd proty r� wino Wilda or irnprovs thereon. ant who does such wank himself or hereat or through he w her own employ.. pwided tet such T impoemnant. are not intended w offered for ade X. however. the buikitq w knp onament b add within ore d m year mplmcn, the owner-0uiker will have the burden d pwirg he or she did nod WiM or improve for the purpose of sole). YI, as owner d the mmem, ser ex babay marsekdl with lmensed corlramore to mss ruct the project (Section 70se, Business ant Pref. Code: The Cmtm aws License Law dos rat appy to en owner of M.P." she Wide or knpss thereon std who contracts for such projects with a moractor(sl licensed Pmuam to the Connmon Losses Lew). ❑ I am exempt under Semon: B. A P.C.. Ino this reason; Dole: pwmr 1 do hereby candy Nat I am ewers of end understand the neeuirementa of Calilwnie Health end Safely Code Seeiom 25505. 25533, end 25530, and Meet I or any More W icing eep pent will / will net (circle one) need Mo campy with sad mole oods ant the requirements M a permit for msuucticnwmndi&olonham theAr ray wngement District. Residential construction appkoliwn w exempt from thou pwep a. Dole: Aloomw WORKER'S COMPENSATION DECLARATION: 1 hereby effirm under penalty of perjury one of the Worst, Micheal ❑ I have and ail mdntdn a mdA"e d mnsnt io aeX-inwm ler waken' mmpenwon, s pawed Ino by Section 3700 d the Labor Cade, for the We.. of the work for Mnich this permit is issued. I have and wil maintain workers' compensation imando e. s required by Section 37M of the Labor Cods, hx the perfwmernoe of the work for which this permit is issued. My workers' oDmpensetion mammas carrier and pe ie, number ere: carder: �Tr EXPIRES um Policy Nber: =e" ° c " 0 5 / 19 / 9 5 (This section meed no, be completed d Ne permit is AGI one hundmd sober 1$ 1001 or hum.) ❑ 1 canify thin in the performance d the work for which this parent is issued. I sell net employ any person in amy manner s as Mo becwne subpm to the wwkeri mmpansation laws d Cddorms. a roe that d I should bemm bpct to the workers' cwmwu tismprmiy d Bem!37 the labor Coda. 1 shell I xit mmply r' l Inose pmviai ole c S L/ App, 1 WmesM: Femurs is secure woMerw'roMMmaw m oe"noge Is un/eMvl, and wall "Ject An wmploywr to CH -Al peneltls and clvll Arras up to caro huncomf theuasod dollen ($1 AD 000)r In aMftn W Me cost of comwr, puwtion, damgleeru provided for In Section 37M of Me Labor Code, Interest, end attorodYll I -A. CONSTRUCTION LENDING AGENCY: 1 hereby affirm under penetry of perjury thet tare isa construction lendtq e'enoy ler Me performance d the work for which this perm) is awed ISecton =F'. Cb. C). LENDER'S NAME: LENDER'S ADDRESS: I certify the I have read Nis Application erd mere that the above infwmolion is correct. I agree to campy nth ell dry end munty ordireres and We laws rearing tboiling corryction she hereby authorize representdivea dl his my to enter upon the above mentioned propend for inspersion garposes1 / — /. / _ n Data: _ S �` ~ (5151- .WP) Whits-Buildng A Safy: Gnen-FIe: Carey-Applcent; Rnk-Rmanue; Goldenrod-Aesesw CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 072282 PLAN CHECK NO: N OPPM hin. R n79"lNJ GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION ; T/OFF SHEATH 6 REROOF TW/COMP SHINGLES SQ FT: 2,924 CLAIM VALUE: 2,924,00 CALL—VALUE: 2,924.00 GROUP OCC: R-3 COMMENTS: SMOKE DETECTORS ARE REQUIRED PER 91 UBC iF * if 4F iF'IF iE 1f iF 9F iF a4 i� iF eF iF iF 1F iF if iF Y * �' if'IF'1F HF 1F iE-1F iF iF'f(-iE iF iE 141E iP 1F iF iF iF iF iF Hf dF iF if ii 1F i(' i4 K dF 1F HE iE jF iF irk �F If iF ♦F ice Y 5F iF Y- 1P iF rF aF k=iF iF iF Z O N I N G R E Q U I R E M E N T S S E T B A C K S —//--------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- ERNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IPI LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41916442 ZNE: REF NO:. PLANNING NOTES> > K K of iF iF 1p HF * HF mF iF JF {F iP jP 3F iF iF 3F iF iF iE iE iF ie iE')F dE if iE 1F iF 3F RF irk if dF iF dF iF iF aF iF aF HF iE jF'IE iF if iF 1F {4 if-iF iF iF if 1f iF'k' iF iF #w i!i4 aF iL ii- if iF ## {F K {F aF rf(� iF aF 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 BUILDING APPROVED BY APPLICATION ISSUED BY: *iF HF if if RF RF*iF iE iE iF iF iF iF iF *RF iE iE aE SE sF sF -IE iF nE +F Yr iF iF LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 54.00 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 DATE: DATE: DATE: J� a iEiFiFi4Y-YiFiFiFM FSFe iF i f STRUCTURAL SEGMENT:Y SMIP/RES GRADING .50 SMIP/NON—RES TOTAL PAID DUE 54.50 54.50 ,00 54,50 OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK .50 iE iF if sF*YdE iF iF+EiF#iE iF tf iF 43F%:FiF*-oaf if iE if jF if Hf iE*de iy is MiF iciflF if it Ak irk#fFY.iF?FaFrF SF it iF HFMY41P iF+FiF 7F aF aF#traF iF iF iF iF if iF if if if* I N D I V I D U A L F E E B R E A K D O Tit N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,924,00 END OF FEES Ci OC1E181C COlEi8i1 TOT 54.50 DATE: 05/12/95 TIME: 15:34 CONSTRUCTION AND PLANNING APPROVALS Permit # I, Dar"' , - inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pboi & 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58, Electrical Conduit-Undrgrnd. r 8. Foundation 59. Gas Pipe, O 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 14. Rough Plumbing 65. Electrical -Final 15. Rough Electricai-Conduit - 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrica6T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioni6g FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank ❑ 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 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 ' (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 190 LEXINGTON LN Suite No Vicinity: Parcel Nunmber: 41916442 Applicant: EASTMAN, RONNIE Address: 7229 VARNA AVE NORTH HOLLYWOOD, CA Owner: MARTINEZ, CARLOS H TR Address 190 LEXINGTON LN COSTA MESA, CA Contractor: ALAP ASSOCIATES GP Address: 7229 VARNA AVE NORTH HOLLYWOOD, CA Arch / Eng : Address: PLUMBING PERMIT ISSUED BY: Phone: (800) 444-8865 Zip: 91605 Phone: Zip: 92626 Status: ISSUED Applied: 04/10/2001 Issued: 04/10/2001 Phone: (800)444-8865 Zip: 91605 License: 771905 I Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGEOUT FEE SUMMARY AMT � 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 l 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 (14 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 2a46.4e (woo) DECLARATIONS WORKERS' COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 _ ork for which this permit Is Issued. _ 11 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My workers' co ,saItlon Insurance car r a d policy number are: -Cartier: �Ye ��" r Polity Number: �� 9201— -- (This section neetl not be completed i/ the pe 1 Js valued at ane 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 become subject to the workers' compensation laws of California agree that if I she ICb c me subject to the workers' compensation provisions of Section 370 I the Labor Code, I shall forthwith comply with Ihese promsio Y Applicant Signature: al ,� Date: 7/o /Cl'4 WARNING: FAILURE TO SECURE l49 RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES IES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE 15100,000), 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 license under pr ' i s f apter 9 (commencing pth Section 7000) of Division 3 of the Business a Professs Code, and my license is in full force and effect. Lic: 4 A Class if Contractor's Signature Date, CONSTRUCTION LENDING AGENCY: ❑ 1 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: Data: 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 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 tloes not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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: ❑ 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, 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, 1 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? ❑ 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 standar.__ 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? ❑ Ves ❑ 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. ...........................................................t-ly..................................................................................ifor. i'a".................a'n"....................................'e-n................,.,....................................................................................................................................... 4 II en RMPP is presently required, hes Section 25534 of the......rnia...... antl Safety Code been lully complied with? ❑ Ye9 ❑ No .................&r_..___.................................._..esento.._,—___..ildi.................pant r...............fort..._..................__......................__._......................................................................_......................................__..............__._.......... 5 Does or will Iha applicant u present or future building occupant require for the work which is the subject of lois a�Jplication appermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Byes L7 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 laciliry to be constructed under this permit be within 1000 feet from the outer boundaries of a school? E] Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................_....._.................................................._.........................._..............................-......................._..........................................................................................................................................................._.. 7 II 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 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 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 final inspection. Sign ture Le gate And/Or AuthorFzod Applicant t, Dat. r CODE I. INSPECTION TYPE PeIE' IIIIIDALS CODE r INSPECTION TYPE OATS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Slock/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 BuildingJOccupancy OWNER SAN VISTA Rd1fling Co. DATE OCT 3 U lssi AP No LOT 144 TRACT Slgl1 FIRE ZONE DESCRIPTION OF WORK INSPECTIONS Signature DATE GROUP I&J TYPE VZONE - 1, _ SUBCONTRACTOR PERMITS ISSUED Gas DATE NUMBER Water -z-S- Rough Com. Refrig. F1 Air Cond. D Rough Heating - - >. i - a,lJ-!cN 757/ Rough Plumbing j -13.,6 Miscellaneous Prop. Swr. Line D House Con. ['St. Swr. ❑ vC_ Cn.,,�-t NOV 1 3 196 7'. Sprinkling System Construction Pole Underground .0 Power D Rough Wiring Trenches 10 Forms D Steel Reinf. D Floor System Bond Beam D Steel Reinforce D Sheathing✓ - Frame and Flashing Lathing — In D Out D Plaster, brown coat G - Refrig. D Air Con. D Final ;Heating, Final y Plumbing Fixtures, Final Final Gas Test /,3Electric Fixtures, Final Building, Final 7" " OCCUPANCY gem Form BU4-51d a-63 -B P HULU t'UK Wbv-LAL KMVUarc Ww I" los o FEE RECENEU SGP 2 6 iJud 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 166 BUILDING For Office Use Only BUILDING 190 Lexington Lane RIC HIPT NO. COSTA MESA, CALIFORNIA Rec3rvH HY DATE RECEIVED own OWNER San Vista Building Co. - OCT 3 BUILDING MAIL 1166 E. 58th Street ADDRESS l D Anl]RR98 ARCHITECTOR ENGINEER Raymond Levanaa TELrDR 37010 BY DATE ADDRESS 3432 Via Oporto, Newport BeaC ZONING NO. OF USE OF N CONTRACTOR San Vista Building Co. FLA"° eDILDI "GAL Tract 5160 - Lot 166 ADDRESS i CITY Los Angeles 11A. P.O . NO. NOTE: NO SAVE OVERHANG SHALL BE LESS THAN LICATE . E 192782 NEL AD 37187 30' TO SIDE 9 REAR P. L. NO EAVE EAVES SIZE NO. OF BLDGB. ALLOWED (U. B. C. REQUIREMENTI OF LOT 2O X 7O I NOW ON LOT O YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. None (FROM C/L STREET), CENTER OF STREET' 13, REAR YJ'2 FRONT FT. FT. SIDE YARD LEFT 0 I RIGHTDE FT. DESCRIPTION OF WORKDE FT. NEW ALTERATI N ADDIT FT. FT. ANCE BEr. BET. MAIN Be REPAIR M VING EMO BLD S.ACCESS. SLOGS. a. $i DATE BUILDING NO. OP SIZE 2O X 27 ROOMS ST. P. APPROVED EXTERIORWALL StUCC4 Shingle ROOFRI,,,, BYCfW DATE ITION YJ Sc1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICAAMOUNT SHOWN UNDER VALUATION I° FOR THEAND STATE THAT THE ABOVE I° CORRECT AND AGREE TO POSE OF ESTABLISHING A PERMIT FEE ONLY.O PLY WITH ALLCITYOR CBS AND STATE LAWS REGULABUILDING CONSTRUCTI ISTA BUILDING COPERMIT FEESIGNATURE OFPERMITTE PLAN EC G+l O AUTHORIZEDAGENT a es N., Starb ird