HomeMy WebLinkAbout137 LEXINGTON LN - Building Permits paw M 9 • CITY OF COSTA MESA
;, � BUILDING DIVISION
F •,: I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
it rat • PERMIT
°`a+.0,,,,go P07-00250
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 137 LEXINGTON LN Status: ISSUED
Suite No Applied: 04/23/2007
Issued: 04/24/2007
Vicinity:
Parcel Nunmber: 41916373
Applicant: LITTLEFIELD, SCOTT ISSUED BY: C
Address: 24707 SAN FERNANDO RD
Phone: 661-259-7131
SANTA CLARITA,CA Zip: 91321
Owner: CLARK, SANDRA LYNN
Address 137 LEXINGTON LN
Phone: 714-641-2722
COSTA MESA,CA Zip: 92626
Contractor: AFFORDABLE WATER HEATERS AND PLUMBING
Address: 24707 SAN FERNANDO RD
Phone: 661-259-7131
SANTA CLARITA,CA Zip: 91321
License: 627368
SCOPE OF PERMIT
REPLACE WATER HEATER
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 , Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 .- Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00. 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 -0 Waste and Vent System $0.00 0
Drain,Rainwater . $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower • . $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar - $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 ; - Sink,kitchen $0.00 .0- - Water Softener $0.00 0
Gas(Over 4 outlets) $0.00' 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) 50.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
COMMENTS I 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 it 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
2446-46(600)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
( :Fr) I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is iccued.
My workers'compensation Insurance carrier and policy number are: _
-Cartier.- C ' 1nl'T01 tilt
?O.
-(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California, d 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 Signature: P LTA- F- L Date: -I-13 o
-WARNING:FAILURE TO SECURE RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 em 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
,fore°and effect.Llc.# C.-Class# C- -b
-Contractor's Signature: (-e:y' A�.Date: '
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 end 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 en 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers 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 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person hes a
permit to do such work from the division,
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one 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 0 N
(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 apermit 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 0 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 feat from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescnbed 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.
Signature•)/Legal O ner(s) Date
• brG 13- D7
rAn• • 'uthorized Applicant L -Date-—
CODE I IBSPECTION TYPE OAIE UIIQIALS CODE it INSPECTION TYPE Qag RRIII$LS
1616 Fixed System Final Fire Prevention 206 Final Mechanical p
1266 Pool Spa Final 208 Final Plumbing R-(.1)-o'7 171Y
200 Final Re-Roof 210 Final Electrical
201 Final BIocldRetaining 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 Bullding/Occupancy
•
t , CITY OF COSTA MESA
• 4 @@ BUILDING DIVISION
.•0-, • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F t )us
PERMIT
bonnet se 1602-01289
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 137 LEXINGTON LN Status: ISSUED
Suite: Applied: 08/16/2002
Vicinity: ROOF Issued: 08/27/2002
Parcel Number: TPN98078 Zoning: /,j//����-
Applicant: BLANKS, JERRY ISSUED BY: //
Address:
Phone:
Zip:
Owner: MONTICELLO COMMUNITY ASSOC.
Address 150 VALLEY FORGE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PREMIER ROOFING AND BUILDING CO INC
Address: 17501 NORWOOD PARK PL
Phone: (714)573-0155
TUSTIN,CA
Zip: 92780 License: 634404
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF FOR 137-145 LEXINGTON LN.INSTALL 1 BASE,4 PLY WITH HOT ASPHALT THEN FLOOD
WITH ASPHALT AND ROCK."MONTICELLO"
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $13,490.00
Permit: $237.25 Claim Valuation: $13,100.00
SMIP Res: $1.35
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $238.60
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
NOTES:
• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(6/00)
DECLARATIONS
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
Iwork 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 permit is issued.
My workers'compensation Insurance carrier end policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performan•: of the work for which this•:reit is issued,I shall not employ any person in any manner so as to become subject to the workers'
•,•••• -• .. of Callfo la,and agree at' sh/•J•r become subject to the workers'compensation provisions of Section 3700 of the tabor Code,I shall forthwith
Applicant Signature' Laill air
3! P�lE
"T-I•ING:FAILURE TO SECUR- r" RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALT S AND CIVIL RIVES UP TO ONE HUNDRED
THOUSAND DOUARE(5100.000). ADDRION 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 he :• : • . am licensed der•ov'.io•s of eater 9(commencing with Section 7000)of Division 3 of Iness9g d P. fps6ions Code,and my license is in full
•rte ••
: _:....,,o. Ic.N 0 Class# C- .77
. - '.nature: /.�t�i
rfr
CONSTRUCTION LENDING t'GENCY:
❑ 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: Lenders 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 property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of 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. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Titte 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one 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 axupant require for the work which is the subject of this implication aPPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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 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? 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.
_
,/
Jam. And/e—.-ut•• ' .. 'pplcant •,te
INSPECTION TYPE CODES INSPECTION TYPE all PIIIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re-Roof �f OL (# 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: 137 LEXINGTON WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069638
OWNERS NAME: BRADBURNE, JULIE ANN
ADDRESS: 137 LEXINGTON LN PERMIT NO; B 069638 PLAN CHECK NO: N GOVT; N SUPP; N
'N. COSTA MESA,CA 92626
'R CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : T/O RESTH & REROOF W/COPM & 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 COMMENTS : REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE, REQUIRED
aE
DOWNEY CA 90241 ***** **4**************yr*************�r� ********************err*** *+e******kF*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU I R EMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full foece and effect. SETBACK S
CITY LIC.: 0 5 7 STATE LIC.: 4 0 2 3 • cuss: C 3 • EXP : 10/95
Date: 10 Signature: I _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPS SATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT a FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
Compensation) u ne p a e ifiedcopythereof(Section3800,Lab.C. LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: `P0'22b'9 EXP.DATE : 65/19/95
COMPANY: AIG PARKING REQ• PROV; PARCEL: 41916373 ZNE: REF NO;
Certified copy is hereby furnished. I Certified copy is filed with the city Building Division. PLANNING NOTES>
iDfcgU >
Date. Applicant: *******************************************************************************
DEVELOPMENT SERVICES R E Q�1 U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred 1$100)or less). K
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:
Dale: Signature' BUILDING APPROVED BY : DATE:
NOTICE:If.oumaking this ywideclaration.you should become subject mif the Workers'
me emDensalion provisions of the Labor 0,7-71—
whichCode,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:
which this permit is issued(Section 3097.Civ.C). ************************* *** ********************************** ** *. **
LENDER: ************************* ****************************************************
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 Meowing 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
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SM I P/NON—RES
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 five hundred dollars($500). ISSUE FEE
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----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
does not apply t0 an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or hen 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
fortheepurp is soldf le)hin one year o1 completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK
for the mends of sale).
I.as owner o1 the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 4 . 00 50
❑ 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).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR E AK D OW N
❑ I am exempt under Section: B.8 P.C.
tor 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 that I am 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 wilVwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and stale 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 of this city to enter upon the above-mentioned
:� 01 00170676-00170677 TEST °' 50
property for inspection purposes.cyaveyy DATE: 10/23/91 TIME: 13:27
Date: Signature
Driver's License or Social Security 4:
1641-46 While—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
4
CONSTRUCTION AND PLANNING POt. ( SPA
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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. I 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 Plumbing65. 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 " ' ,APPROVAL& .• Permit #
21. Dues, in Structure; 70. Underground)Hydro
22. Ducts, Ventilating.. • - 71. Product'P ,ing 0 Gas 0 Oil
23. Gas Pipe-Rough&Test . - T 72. Underground Flusts
.
24.-Roof Framing. - ) 73.'Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing _ 2.-1;-45" /Wbc- 74. Overhead Hydro-„
26. T-Bar Ceiling (Structural) & Monocoat - . . . 75.'Ory Chemical • •
27. Frame and Flashing " - 76. Dry Standpipe r: 4.
28. Lathing Si Siding 77. 'FIXED SYSTEM'F1NAL` "
29. Insulation .' ' , 78. FIRE PREY. FINAL
30. Drywall Nailing i. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . I 0• : ' 79. FINAL INSPECTION - '
32. Electrical Power Meter-Final • ' . I + .80. FOOD CERTIFICATE ISSUED
33. Final Electric .. 'Notes: •
'34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test " - I „
36. Hood or Canopy . . • . ,
37. Final Factory Fireprace ..
_
38. Final Plumbing ' • - ..
39. Water Service-Final _ -
40. Gas Service-Final , -• ' - '
41. Solar Domestic-Final ; ' '
F
42. Backflow Preventer I
43. Backflow Irrigation . . •
44. Landscape Irrigation System -
45. Sound Attenuation - - - '
•
46. Handicap Regulations . - • -
47. FINAL STRUCTURE& BUILDING 6-7_gj
48. FINAL PLANNING t L r_
49. Electric Release to Edison i
50. Gas Release to Southern California Gas Co ' ' /•
� ,
51. CERTIFICATE OF OCCUPANCY
No. Date
27788PAID arttrir
NOV 13-67DN—SA00 525* 58.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92920 .
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 131 .-1) /J..cs8. For Office Use Only
ADDRESS db
RECEIPT NO.
. P "NOA
/COSTA MESA. C LIFORNIA
— RICE! ,L /oE RE,
D4_ NRIaMe
OWNER San Vista Bldg. Co.
MAIL BUILDING
ADDRESS 2249 Wanderer Drive ADDRESS
FIRE
TEL ZONE TYPE 'GROUP
City San Pedro in- 833-3320►
ARCHITECT T8L ABTPROV[D DATE
OR ENGINEER Clif Olsten 7 ' 923-122 •
ZONING
ADDRESS 90251/2 E. Florence, Downey ///��� Ct�f�
Same p No.o L. usE or
CONTRACTOR � •'y^- L ''� 1,. _'}�
LEGAL .S- SV ' i`L`•C�-S(OD
woDAEB* Same DESCRIPTION
CITY Same A.P.NO. W -7c7 /-3
NOTE: NO EMI!OVERHANG SHALL BE LESS THAN
STATE TEL 90•TO SIDE&REAR p.L
LIG.NO. NO.
_ EAVES
F
OLOTI/O,C u-4-7-7.,20 I
NOW ON LOT ^- ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OP �- MAIN BUILDING ACCESSORY BUILDING
EXI STI Na'BtDG.
(FROM C/L STREIT/
SETOAe FRONT D PT. PT.
CENTER OF STREET REAR YARD
SIDEYARD1 LEFT I RIGHT R.SIDE (`) Pr. FT.
DESCRIPTION OF WORK LSIDE 0) PT. PT.
NEW y ALTERATION ADDITION REAR PT. RT. F
DISTANCE BET. BET.MAIN& Z
REPAIR MOVING DEMOLISH MAIN 61-10013. ACCESS.BLDOS. IU
d
BU ILD IMNP{i NO.OF '3 C.u.r DATE 4. /d_G UJ
SIZE HID X Z- 12�•Z-X7r'�OOMS STORIID I C.U•P•�F / 1/41-Ci APPROVED y�
EXTERIOR W ROOF //�+ APPROVED V 1 .
COVERING .r1 COVERING Iyl ET C.� _ MMM�lA-171 DATE /0' 30 - G-7
US[OF DUI IN AND WORK TO BE PE FORMED y 41
a
IA,l,Q� M �U«�
(S) 1
_ I Stav fV° 1 I,
BG.FT. w
D.
I HERESY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IE FOR THE C WI
AND /TATE T AT THE ABOVE.18 CORRECT AND AGREE TO CON. PURPOSE OP EGTAOLISHINO A PERMIT PEE ONLY. a
PLY WITH A ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING C• ON. o` PERMIT PEE $ 39-- E o
SIGNATURE
PERMITTE —%�id -T Q
s , •�56y� PLAN CHECK $ /2 g ',
✓ O
AUTHORIZED l r
B���li2. 1 TOTAL PEE $ .o(S/�.J D