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PROJECT ADDRESS: 121 LEXINGTON LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069580
**OWNER'S NAME: SOHRT HENRY DEAN TR
1 ADDRESS: 121 LEXINGTON LN PERMIT NO; B 069580 PLAN CHECK NO; N GOVT; N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH & REROOF W/COMP & 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: P 0 BOX 4309 ******** *** * ** ** * D* ** * **** * D* ** ** ** D** * * **DOWNEY CA 90241 ** ** * * * * ** * *** * * ** * * * ** ** * ******** **
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000(of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
mum: 059377 STaTEuc.: 402536 class: C 39 EXP ; 10/95
Dale:i a� Signature: — MAIN BUILDING ACCESSORY BUILDING
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm l ll have a certificate of consent to sell-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
Compensation Igtatle2%alvilied copy thereof(Section 3800,Lab.as 5/19
19/95
POLICY NO.: EXP.DATE:
COMPANY: AIG PARKING REQ: PROV; PARCEL ; 41916310 ZNE; REF NO:
El1-"
Certified copy is hereby furnished. ,.y PLANNING NOTES>
7 CertilieO copy is filed with the city Builtling Division.
Date: 10II licant: *******************************************************************************
YI / 1
IIINNN III AppDEVELOPMENT S E R V I C E S R E U IR E M E N •�T S
EXEMPTION FROM WO KERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). Q
I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • DATE; '+,
Date: Signature: BUILDING APPROVED BY ;
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor 1,s '�//ll DATE; �'
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
J(1- 10 J D gip
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction IenOinq agency for Inc performance of the work for APPLICATION ISSUED BY-
,
x'"'1111 UA
which this permit is issued(Section 3097.Civ.C). ******************++*************DA**** • • • �•
LENDER:
*************************** U***************************************44*** *****
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following 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 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/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 tor a permit subjects the applicant to a civil penalty of not more than five 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, will 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 sold within one year of completion,the owner wilt have the burden of proving he/she did not build or improve
IonBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK
Or the purposea 01 sale).
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 0 0 S 0
❑ and Professions Code: TheContractors'projects
wit state License Law does not apply to anownerf property who builds or improves thereon *******************************************************************************
and who contracts for such with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR E AK DOWN
❑ 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
I do hereby certify mat I an,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.
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 01 00170652-00170653 f't T 54.50
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned DATE; 10/23/94 TIME;
property for inspection purposes.
Date:1-00Signature II /
Driver's License or Social Security+:
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL& SPA
?APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service pr 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 Reinfordement 56. Rough Plumbing & Pressure Test
6.' Electrical UFER Grnd. •
57. APPROVAL TO COVER-GUNITE
7.:Footings 58. Electrical Conduit-Undrgrnd. •
B_ Foundation . 59. Gas Pipe, 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
20r,Rough FactotY Fireplace - APPROVALS._ . Permit#
21.'-Ducts,in.Structure, _ - ;70. Undergrotmd Hiro
22. Ducts, Ventilating - .• 771. Product Piping Glias GOil
23. Gas-Piped-Rough & Test 72. Underground Flush. _ t.
24._Roof Framing - • - •• 173. Undergrnd.StorageTank'0 Gas 0 Oil
25, Roof Sheathing 7,..--2,-95 4(,..•/AL, /j�t$�p' 74. Overhead Hydro- -
7/ /� 75. Dry Chemical r:
. ,
27. Frame and Flashibg r
,, 76. Dry Standpipe - ll -
r •
..
.28. 'Lagting_& Siding:• c. , •t •• • : L}t 77. FIXED SYSTEM FINAL}
29. Insulation , : - ,! 78. FIRE PREY. FINAL .•
r30. DrywalNailing - '
l HEALTHrOEPT-. REQUIREMENT
31. Plaster Brown Coat; '_.,t 79. FINAL INSPECTION ;, ' '
32.,Electrlcal Pot$er;Meter•Finah ; •80. FOOD CERTIFICATE ISSUED
.33.-Final Electric - T ' • I ` Notes: - '
':34.-Final Heating & Air Conditioning- . I • , - --
35,;FinalGas Pipe-Test' , LI 'I' - '
. -
,36.r Hood or Canopy, , , • .
-37. Final Factory Firedface . - . • ,
38. Final Pluinbing , , , •
39. Water $ervice•Final' - _ '' r•
„40. Gas Service-Final
41. Solar Domestic-Final . • '� r
•-42. Backflow Preventer
43. Backf low Irrigation ' '• ' - "_
.44. Landscape Iriigation System, - - - .
45. Sound Attenuation ' ' - _ '
.46. landicap,Regulations • •
.47. FIN-AL STRUCTURE & BUILDING C-12-,4.-' Gji- - •
46. .FINAL PLANNING t •
. 49. Electric Release to Edison •
•
50. Gas Release to Southern California Gas Co . -_- • . -- -,
51. CERTIFICATE OF OCCUPANCY k • .
No. Date
OWNER SAN VISTA BIItt.DTNC, COMPANY DATE 6-i-64
JOB ADDRESS 121 Lexi ngtnn Ince BUILDING PERMIT NO. 22192
GENERAL CONTRACTOR RAMP VALUE § 151715,00
AP No. LOT 31 TRACT .51(,0 FIRE ZONE DESCRIPTION OF WORK rpm rriritt grtr
INSPECTIONS Si:nature DATE GROUP TIGJ TYPE y ZONE gg33
Soil ', 07SUBCONTRACTOR PERMITS-ISSUED
Gas // , ; -1 - DATE NUMBER
Water } /�
Rough Com. Re r g. 0 Air Cond. 0
Rough Heating
Rough Plumbing Q i/ / -
om -- -
TrA./ !r/--a V v- 3 -c0
Miscellaneous 4p
i iv
Prop. Swr. [it
Li
ne House Con. pJ St. Swr. ❑ i q/// 44 &- .c e.„-,y . )Er 9 i%3 4 0 6n
Sprinkling System
Construction Pole
Underground ❑ Power 06
Rough Wiring FP et -ny oto+ me-Ain'lyte2 K--75-/-<L .-2,92.0.5—l'--
Trenches
LJ32c'S e
Trenches!❑ Forms ❑"- Steel Reinf. 0 ( e � ���/c `F-
Floor System 6
Bond Beam 0 Steel Reinforce 0
Sheathing o h'' ��
Frame and Flaslpbg d •r 4Si
Lathing— In Out e G 5r
Plaster, brown coat G / �C,
Refrig. 0 Mr Con. 0 Final /
Heating, Final .,�L �2- Ti / Pt nn:n9 c,,,
Fi
Plumbing Fixtures, nal / ./ M sem.PCa }auslied./
Final Gas Test/1:5-PP. 7,: A O ,in, F msa IYK i y
Electric Fixtures, Final ' ,al"' a- - ab• Wale I
Building, Final 64- . / ir i
OCCUPANCY / I, ,
Form BU4—SM-3-63—s-13 P 1-u'Wfl FUK SPB'I.IAL REVUIREMLL 7...
22192 . FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT NAY 1 D IAM
P.O.BOX 917 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APPC6AThh'IQ P FSP
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING/�l <�_ / �
ADDRESS o� e//1�/_y1,V�l
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA 77 I Cr)
, ` , /7 RECEI BY DATE R/qC ,2. DATE IBBUer
OWNER ...R(31-61.4. 0 G%Se I s76 ��` /��� 'ISN 1 1QSi4
BUIL ING
MAIL //6 4 (p- .ct4 �I rV`- ADDRESS
ADDRE88 / C'\ Ja 5y1 /{.�/� ' I�
CITY /. I // NE J/ ZONE TYPE GROUP T
ARCHITECT O-AJ�/l TE APPROVED TT
OR ENGINEERCCII/YLp-per NOOvU BY DATE
ADDRESS 3 3 V.-4/A�� ��.: QCJJ..e�Yn ZONING "" t ■`!
^`' ^ � �'T 20 NO.or 'l USE OFNH 1trd.
CONTRACTOR)./ . t 1 L 1 RO an - PUNS / Bu1LDlrvd. . /. �� •; L��
LEGAL
ADDRESS //(p 6 C- ,A Q- DESCRIPTION gL(MT'�L/S/��U.
1Ieht “3
L�
A.P.NO. 1` I -- .2) / �� LI
CITY �� �i // 1
/921 b7)-- 170540/g7/9-7 NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
STATE30"TO SIDE&REAR P.L.
LIC.NO.
EAVES
SIZE I NO.OP SLOGS.° ALLOWED (U.B.C.REQUIREMENT) N
OF LOT ,92/1 X 70 NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF4/i�Q,.� A MAIN BUILDING ACCESSORY BUILDING r./
EXISTING BLDG. _ I��
(FROM C/STREET)
SETBACK LINK FROM /3 / FRONT Fr. Fr.
CENTER OF STREET // REAR YARD 0
SIDE YARD I LEFT p I RIGHT 0 R.SIDE FT. FT.
/
DESCRIPTION OF WORK L.SIDE l/ FT. FT.
t/
NEW X ALTERATION ADDITION _REAR ' FT. FT. INS
DISTANCE BET. BET.MAIN& Z
REPAIR MOVING T,p DEM�QJ�LISH MAIN BLDGS. // ACCESS.SLOGS. 7 GI
BUILDING DATE
NO.OF iMSC /STORI - n CAU.P. I��C/ APPROVED c/&/) Ce
ta
SIZE ',,Zo Nal--ROOMS LO STORIES <p $gyp `/
EXTERIOR ISA-77-6 6.-1,61 COVOERING ,x(t @�,PROyiDt�41 DATE 6( 1S /C% -I
COVERING fl/O 1 / LJ
USE OF BUILDING AND WORK TO BE PERFORMEDLJ
901 i
6.3
91W144 . <
V 1 O ▪ k1
I HEREBY ACKNO DOE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ▪ In
AND BTATB THAT�.T H ABOVE IH CORRECT AND AGREE TO COM PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O aI
PLY WITH ALL CITY DINANCKS AN T T LAWS REGULATING VALUATION Cl W
BUILDING CONSTRUCT N. ��-
SIGNATURE OF ,(,/ PERMIT FEE
PERMITTER - t / ( /..t.'� - `� /J��/ /- +� B CI
A f/ ✓J / 3J PLAN CHECK S eQZ::/ �D C 0
AUTHORIZED GEN TOTAL FEE $ / 4 3 0 IL