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Home My WebLink About111 LEXINGTON LN - Building Permits ' CITY OF COSTA MESA 4' 444.111 BUILDING DIVISION >t i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :1 "'moiPERMIT P05-00365 4. rill riadiel I, . C_ (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 111 LEXINGTON LN Status: ISSUED Suite No Applied: 05/12/2005 Issued: 05/18/2005 Vicinity: Parcel Nunmber: 41916315 -_�, . . dr:,;� is _ _ ISSUED BY: e/ Applicant: SZABO, KEVIN K %:.. , --i�'"_ ' ' Address: • - -o, - i\\•�.r _ .. ., 'Phone:` . , '- - 'V . - --Zip ' - , V \i,*. _ -'' Owner: '' FRANCIS,,RICHARD-LEWIS ='c ; 5V"', Address 111 LEXINGTONiLN� • ' Phone: ' COSTA MESA,CA Zip: 92626-6528 • Contractor: COAST ROOTER PLUMBING HTG-&A/C - , ' 'Address: '17390 MT CLIFFWOO - - - - ' ‘, \ D I� Phone: (714)241-1414 - - ', , '\ ;FOUNTAIN VALLEY Zip: 92708 '- •-' - , - ' License: 529127 i SCOPE OF PERMIT - WATER HEATER CHANGE OUT(SAME LOCATION). - - - - - . FEE SUMMARY '., '- AMT QTY -AMT QTY AMT ;.QTY ISSUE FEE- $23.50 Laundry Tub/Washer $0.00 - 0 Sump Pump 1 $0.00.• . 0 Backflow irrigation ', ';;i '$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!•- -o $0.00 0 Urinal = ' ` $0.00' •• 0 Clarifier System ,. $0.00, 0 Process Piping(per loft) ' •$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 . 1 $0.00-` 0 Septic Tank ' - a.„ -$0,00 :0- Wash Basin ; ' $0.00 0 Dishwasher' $000':'''0. i^=.",^Sewer Cap.for Demo -$0.00 • 0 -''Wash Basin Set/ v / ,$0.00 0 Drain, Floor - $0,00 v;9'/ _ -Sewer Connect = $0.00 0 Waste and Vent System , $0.00 0 Drain,Rainwater' ',. /$0.00 0�-h,� Sewer Private•Line $0.00 0 ;Water Closet,(Toilet),! .',/' $0.00 0 Drain,Roof _ '"$0:00 , 0 -- . Shower _ v`, ..ii ' $0.00 0 =2.�-. Water eater//vent/. $12.30 1 Drinking Fountain ' } $0.00-'/, .0..i, Sink;bar - \ $0.00 '0--"- Water Piping'(Inst or Rep.) $0.00 0 Expansion Tank -$0.00y : o/,-Z1:7, Sink commercal .-,•C-.„--1,'.$0.00 - 0 -� 1.Water Re-pipe,; 50.00 0 Gas Earthquake Valve .`N.$0.00, �0 ' ' ' 1-c Sink, Floor- - . - - -$0.00` 0 Water Service $0.00 0 Gas(1-4 outlets) $0;00. x, 0" . ' ' ' -Sink,kitchen _ _ $0.00 .0 , i Water Softener $0:00 0 Gas(Over 4 outlets) $0.00,`=? 0 'Sink,service/mop - ''',r -$0.00 0. • OTHER / $0.00 Gas Repipe $0.00 �'-,0= Spa(private)• • $0.00 0 - VIOLATION $0.00 Gas Service $0.00 0�.Z Spa(public) - • N'.. ' $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 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 it 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 . 244648(8/00) 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 work for which this permit is issued. I have and wilt maintain workers compensation insurance,as required by section 3700 of the Labor Code,for performance of the work for which this permit is issued. • My work rs'cornnpeGnsat,ion Insurance carrierca ^and policy number are: I `� /�� Carrier: V�!J 1 '*C !- Policy Number: -7VV(",r(—J vW (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the perfohnaric of the w rk for which this'permit is issued,.1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cali and gr that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio s Applicant Signature: Date: (�i Q A0 WARNING:FAILURE TO SECURE WORKERS'/ PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DCLLARE(5100,000).IN ADDITI ONE 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 under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effLic.ect. e ` Class tl Contractors Signature: Date: S// CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a 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 Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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 B,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 ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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_ftermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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 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 QualityManagement 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? 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 final inspection. Ignatur Of gal Owner(s) /P_ate • nd/O thorized Applicant cfre Uate _ DOPEINSPEC110NTYPE ' ' ' CODE! INSPECTION TYPE ' - 'PAM 'It�A45 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing (^)IO R7c- 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 • PROJECT ADDRESS: 111 LEXINGTON LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069570 OWNER'sNAME: SNYDER, ROBERT C ADDRESS: SNYDER JANICE E PERMIT NO; B 069570 PLAN CHECK NO: N GOVT: N SUPP ; N 111 LEXINGTON LN COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE; STA PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; T/O RESTH 6 REROOF W/COMP 6 HOT MOP SQ FT; 2, 508 ADDRESS: UNIT: CLAIM VALUE; 2, 508 . 00 CALC—VALUE: 2, 508 , 00 GROUP OCC; R-1 / PERMITTEE: STOUT ROOFING INC ( 310) 923-6775 ADDRESS: DOWNEYP 0 BOX 4309 * ***** *** *L**E * * * * * **** * D* *A *MO** * ** * **D CA 90241 ** ** **** r rr ** * r * *** E *r ** * *** ** * * r* F***e *** r LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7003)of Division 3 of the Business and Professions Code,and my license is in full force and elect. SETBACKS CITYLIC.: 05�9/ 717, STATE LIC.: CLASS: C 39 EXP: 10/95 Date.t�(�`Pti Signature: �� MAIN BUILDING ACCESSORY BUILDING FANT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN WORKERS COMPE SATIONDECLARATION' IherebyaffirmthatIhaveacertificateofconsenttosell-insureoracerificateofWorkers' LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN Compensation IR611k 2e2ttc atified copy thereof(Section 3800.Lab.B'5/19 19/9 5 POLICY NO.: 7 O C L O EXP.DATE: COMPANY: EN PARKING REQ: PROV; PARCEL; 41916315 ZNE; REF NO; ❑ Certified copy is -reby tum'lied. EN Certified copy is Ned with the city Building Division. PLANNING NOTES> ******************************************************************************* Date: AODlicanl: /050/2,1/ EXEMPTION F'OM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R EQUIR E M E N' T S 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 Catitarnia. ZONING APPROVED BY DATE; Dale: Signature: BUILDING APPROVED BY : NOTICE:II.alter 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 B Y ; DATE: 0 eano which this permit is issued(Section 3097,Civ.Cl. ************************** ********************************r******* *** ** ** LENDER: ************************** ***************************************** *** ***** ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER OECLARATtON: I hereby affirm that l am exempt from the Contractors'State license Law for the lotlowing reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 , 00 5 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 54 , 50 0 , 00 0 , 00 54 . 50 54 . 50 , 00 ❑ 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 REVENUE DIVISION TOTALS--> COLLECTED • 54 , 50 OVER/SHORT: 00 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 sate), BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 0 0 5 0 ❑ and 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 with a contractor(s)license pursuant to the Contractors'State License Law).1 am aware **************************************************************************r**** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDOWN o I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 508 , 00 Ido hereby certify that I am aware of and understand the requirements of California Heath 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 Rom the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspecti/on,Lpurrpo es, Date: I Ditch '``—E Signature' 01 00170632-00170633 TOT 54.50 Driver's License or Social Security•: DATE: 10/28/94 TINE: 13:14 1641-46 Mae—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor WI, . CONSTRUCTION AND PLANNING PO. I SPA APPROVALS Permit# - Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. , ri 53. Steel Reinforcement 3.'Electrical Conduit Utility-Undrgrnd. - 54. Forms 4..Eaectrical Conduit-Lindrgrnd. 55. Electrical Bonding �5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 8. Electrical LIFER Grnd. 7., 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 Untlryrnd. 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 :•�, ..; - _ 1-APPROVALS Permit # • 21.'Duccs,in.StrUctu'e", r r .. .. _ ' t a 70. Underground Hydro 22. Ducts, Ventilating • - c ; , 21. Product'P}ping Glias 00i1 23.-Gas_Pipa-Rough &' Test n<• . ,• �_ _72. Underground Flush 24. Roof Framing : r �• •. // `'73:'Under grnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing '2 -2-?,- ce (0-170 l 74. Overhead Hydro ' 26.•I-Bar Ceiling (Structural) & Monocoat " 75: Dry Chemical . 27. Frame and Flashing 76. Dry Standbipe • ' 28. Lathing & Siding' �•I` . 9, . ^1 - '1' •• • 77t•; FIXED SYSTEM FINAL 29. Insulation ; ' • •' .. : ' I; . ' 78;-FIRE PREV. FINAL . . - -30. Drywall Nailing . . I-,-' Jr"-- HEALTH-DEPT. REQUIREMENT .31. Plaster Brown Coat __r. . ,.79. FINAL INSPECTION - _ 32. Electrical Power Meter Final • - ,80,,,FOOD CERTIFICATE ISSUED 33. Final Electric • r ' ' ''Notes: - - - , 34., Final Heating & Air Conditioning �, . : • ii 35''Final Gas Pipe-Test' ,I r I je , - ' - i. 36. Hood or-Canopy - - 37. Final Factory Fireplace _ ' - ° ' . i ` "38. Final Plumbing :• - 9. Water Setvice•Firial I • '. . • ,40. Gas Service-F-Inal' ", - - ,. . .. 41. Solar Domestic-Final •• - i i lit - "42. Backflow Preventers • i 43. Backflow Irrigation -' - - . - . 44. Landscape Irrigation System, - - • 45. Sound Attenuation - " '+ •- 46. Handicap Regulations -. _ . 47. FINAL STRUCTURE & BUILDING �p=7?C 4-7--e.,_.;9- .• , 48. FINAL PLANNING ; ' r • ' . • . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co �_, • -51. CERTIFICATE OF OCCUPANCY No. Date OWNER SAN t23PA BIITT.DTNG COMPANY . DATE 6-1-64 JOB ADDRESS 111 T.Pxington Lane BUILDING PERMIT NO. 22197 GENERAL CONTRACTOR same VALUE $ 1%8'5.00 AP No. LOT 36 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK ma Watt gar INSPECTIONS Signature I •T GROUP TRR.T TYPE y ZONE g->•3 Soil / //l' PERMITS ISSUED Gas .71/ SUBCONTRACTOR DATE NUMBER Water n ��J 1 /J Rough Corn. 'efri_. ■ Air Cond. 0 Rough Heating C/ G in,+� A 5G 2-/i / ,'f414/o2 Rough Plumbing - �/�J /Lt.7 tea/ i� !o-/-G 1 f0 3 ?i'S — 7` Miscellaneous UUU Prop. Swr. Line lE4Iouse Con. • St. Swr. ❑ 9 / ' • y- - CFC 9 1963 40635,19 Sprinkling System � Construction Pole _ Underground 0 Power 0 h Wiring a �i inn' //r Yfl7 - S-GcL, -2 5 /d �- Rou Trenches 0 Forms 0 Steel Reinf. 0 / yi7 n2- c, Floor System f%y , Bond Beam 0 Steel Reinforce 0 Sheathing ` . 45i Frain and Flashfn ¢. pa LathingIn, Out ak wit- • Plaster, brown coat Ref rig. 0 Air Con. 0 Final Heating, Final 7- q _ / Planning no. c� Kw.so- .Plum Plumbing Fixtures, Final Final Gas Test �0�, d Electric Fixtures, Final i• Building, Final l.--X /y 6. ,H I OCCUPANCY • Form BU4-SM-3-83—S-B P 221. 91 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT Y I g 1954 P.O.BOX 917 COSTA MESA,CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APFQ TOINCO kAP TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS 111 Lexington Lane RECEIPT NO. /p� p� PI V 1 COSTA MESA. CALIFORNIA 2L J Recti BY DATE.n {7D Jur 11115$64 U�fj64 OWNER San Vista Building Co. 5 / /fJ ulv y MAIL BUIL INO '/ ADDRESS 1166 E. 58th Street ADDRESSFIRE '�� / TEL ZONE TYPE V i GROUP:T:4 — city Los Angeles 11, Calif.No.'AD 37187 �1 ARCHITECT TEL. APPROVED DATE OR ENGINEER Raymond Levans NQ Or 37010 ZONING \^` ��)' ADDRESS 3432 Via Oporto, Newport Beech \((\\\``�fA' k M ZOx.F/�/ NO.OF I UB60F NE K.-3I PLANE I BUILDING,, �A CONTRACTOR San Vista Building Co. LEGAL / JJJ\�� 4/— ' DESCRIPTION Tract 5160 - T.nt 16 ADDRESS 1166 E. 58th Street j? / CITY Los Angeles 11 , Calif.- A.P.no. i11 ` 3 y J" \l' NOTE: NO EAVE OVERHANG SHALL BE LE�AA/S THAN STATE TEL. LIC.No. 192782 NO. AD 37187 90^TO 61DE8REAR P.L r EAVES SIZE No.of BLDGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT 20 x 70 I NOW ON LOT 0 USE OF YARDS APPROVED YARDS APPROVED EXISTING BLDG. None MAIN BUILDING ACCESSORY BUILDING 1 (FROM C/LSTREET) "',, ISETBACK LINE FROM CENTER OF STREET 13 I REAR YARD FRONT PT. r� FT. SIDE YARD I LEFT 0 -'- I RIGHT 0 R.SIDE OFT. FT. DESCRIPTION OF WORK L.SIDE 0 Fr. FT. e NEW X ALTERATION ADDITION REAR D FT. FT. DISTANCE BET. BET.MAIN R - ` REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.ALDOSE 2 BUILDING NO.OF �I D VAR.SF L �� DATE /' Q .2 SIZE .2O N 33 ROOMS .� STORIES 2 C.U.P.JF APPROVED (7 9 111 Cd EXTERIOR WALL, ROOF APPROU. COVERING StUCCO I COVERING Shingle DY I e��VAN DATE lJ "- 1) - 7 3 USE OF BUILDING AND WORK TO BE PERFORMED (VJ`-- Residence and: t l/ C2 CC �0 /So.Fr. / `• ICI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO N UNDER VALUATION IS POR THE F to AND STATE THA E ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL PITY RDINANCES AND STATE LAWS REGULATING VALUATION O BUILDING CONSTRUCT N. >� G. SIGNATURE OF I A��[� ��jj�� PERMIT FEE $ Y d m U. PERMITTEE \ 'L{ {'�'✓ \`\ S !3/ y q 0 /` 41295------- i AUTHORIZED GE T • /` O.Pa TOTAL FEE $ �/i� s.t