HomeMy WebLinkAbout118 BROOKLINE LN - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT N O( / TRACT NO. LOT NO. UNIt D. 3414 5/2E/85 5.00 TI
Project Address A-4/1
Mailing • TYPE OF CONSTRUCTION LI NEW H ADD Li ALTERATION P REPAI R -
Applicant's Address. / 114_ ,....Af A • . - e' El CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name ` Phone
Address Oa, '
DESCRIPTION OF WORK/USE OF BLDG.
. S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING . ❑/�F OUNDATION Ell STRUCTURAL E Front O
❑ TENANT ❑ ELECTRICAL ✓_1 PLUMBING ❑ MECHANICAL B N
Address pp ��77^�s A Rear I
Contractor's Name II - nit ,/ A/ r Phone A '7(I5. ❑ OTHER C Right N
p. L ar 41 ,C - 1..... `.v PROJECT DESCRIPTION SQ. FT. OCCUPANCY K - G
Address(mailing) O l Left
�l/l f CON ST RUCTION TYPE .VALUATION $ R
City License No. �J(/ J 'ZONE GRADING CU.YDS. ACRES - E
LICENSED CONTRACTOR DECLARATION . Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Nila
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in f I.r e and effect. T
N License Co, . f
Date 3''///S Signature �' PLUMBING FEES •
WORKERS COMPENSATION DECLARATIO Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
NN of Workers' Compensation Insurance, or a certified copy thereof (Section -
3800, Lab. /, /1( �I /f f Backflow Preventer • Service Sink Automatic Washer Transformer 0 15-50 KW
Policy No. .? C3 n( /9/L)/ Company Rola-1 ruts ' Backflow Irrigation Sewer Cap Construction Pole Sub. • 0 50+ KW
Certified copy is hereby furnished.
.e.Certifie�9 py-is filed with the city Bpj� ilio d/ -1/ Bathtubs Sewer Connection Cooking Unit /t Meter ❑up to 100 amps
Date _I /' Applicant 1r4/p/fj/ - G(/'//�� /(
EXEMPT% N FROM WORKERS'CO ENSATION ECLARATION ._.. Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
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 Orin mr ountains Solar Tank Fan Motors ❑0-1 HP ❑1X-8
Workers' Compensation Laws of California. _
,Date Signature Floor Drains • Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+
'NOTICE:If,after making this declaration, you should become subject to the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal FixturesMicrowave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater Outlets Name Range
•
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal !Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW
any structure; prior to its issuance, also requires the applicant for such permit Trash Compactor
.,•to file a signed statement that he/she is licensed pursuant to the provisions of •
ROOF Drains
the Contractor's 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 five hundred dollars ($500). •
3
• I, as owner of the property or my employees with wages as their sole Reinspection Fee _
$15' Issue Fee $ - .
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
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 Boiler Hood or Type 0 ' DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered foryp Zoning Approved By Date
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0
pletion,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose he property,of oe). -
❑ t as owner tr thetexclusively 7044, cu ing with licensedioncon- Duct-Structural Refrigeration System Application Issued By Dat �✓
hetors construct the project (Section 7044, to
end Pf property
Code:
The Contractor'smproLicense Law does noteraapply to an owner je pro ithta who Duct-Ventilating 00-100,000 BTU 0700,000 BTU SUMMARY OF FEES
builds or improves thereon,''athe who contracts for such projects with a eon-
tractor(s) license pursuant to Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $ _
proof of their Worker's Compensation insurance should be provided to me. _Exhaust System 0 Multiple 0 System Repair/Alteration
O I am exemptLAN CHECK $ PERMIT
under Section B.& P.P.C.C.for this reason Firepl/Fact.BIL. ICBG# Fire Dampers ^� PLUMBING $ 500 ISSUANCE $
Date Owner Heating System& Ducting Registers _ PLAN CHECK 25% $ _ ENERGY P.C. $
•
I hereby certify that I.have read this application and state that the above - 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this i y to ter upon the above-mentioned prop rty for Co/�
Inspection p `J / / - TOTAL FEE $ 4J "
Signature J' /// i/II .1 Date c MECHANICAL $
Drivers' License or SS,-f' Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
1
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit 4,67-/•9°41-5 -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 UFER 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
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
-24. Roof Framing • 73. Undergrnd.Storage Tank O 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 s/ios t, 'j
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. Special Requirements Completed
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
,51. CERTIFICATE OF OCCUPANCY
No. Date
S PROJECT ADDRESS: UNIT: e
118 BROOKLINE LN CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06965_
OWNER'S NAME: NG THOMAS Y
. ADDRESS: 6812 GASLIGHT PERMIT NO: B 069659 PLAN CHECK NO: N GOVT: N SUPP : N
e HUNTINGTON BEACH,CA 92647
CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE: ALT
ARCHIENGINEER: REG.ND.: 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
�E
DOWNEY CA 90241 ******************************** yr�E**yE**;E+r,r�E*yr*�E**********r�t�r*** **************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 2 0 N I N G REQUIREMENTS
7000)of Division 3 al the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITvuc.:h0((( 559��1377 STATELIC.: 4025361�hnp�cuss: C 39 EXP : 10/95 •
Date:—I.Q� L) Signature:L� MAIN BUILDING ACCESSORY BUILDING
WORKERS'C MPE ATION DECLARATION: I hereby affirm that I have a certificate al consent to sell-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3500.Lab.CI. LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
nutria: 5822699 EXP.DATE: 05/19/95
COMPANY: AIG PARKING REQ1 PROV; PARCEL; 41916346 ZNE; REF NO:
❑ Certified copy's hereby furnished. EX Certified copy is filed with the city Building Division. PLANNING N TES>
>
Date:ID( Applicant: **************1t****************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). D E V E L 0 P M E N T SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become .
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE;
Date: Signature:
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; DATE; 1
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. / , r
•
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: AI . '+
which this permit is issued(Section 3097.Civ.C). **************************** * **********************************• * *
LENDER: *************************** * *************************************** **** ****
ADDRESS: LEGALIZATION;N E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from theContractors'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.ar 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 LAN SM I P/NON—RES
and Processions 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 ao 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 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
for theementleolsold sale).
at). one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
tor the purpose of sale,.
I. rotes of ts C property,amCo excltractsis'Sy ate License
withw lioessed not appy to
an to owner
construct property the p ho tb(Seills tionor ov, thereon
54 , 00 50
❑ and Code:whoCcntrafoTce ojectsaw'h aicLicenseLaw densnotrsuat onne Certft ' who icensor improvesIathereon
and who contracts for such projects with a contractor(5)1icense pursuant to the Contractors' tale 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 EAKDOWN
❑ 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 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 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
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection}y purposes.
Q' "I
Date: � U Signature:lA 00101706288-00170699 Ti)T F6.
Driver's License or Social Security M: DATE; TIME; 13:31
r
154146 White—Building,Green—Code EnlorcemenC Canary—Applicant:Pink—Revenue:Goldenrod—Assessor /
i
CONSTRUCTION AND PLANNING I-L JL & 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 UF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. 'Footings 58. Electrical Cendurt•Undrgrnd.
8. Foundation 59. Gas Pipe, 7 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 L
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit*
21. Ducts,in Structure • 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0.1-Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ( 73. Undergrnd.Storage Tank 0 Gas 0 O-I
25. Roof Sheathing 3-To rCtl bi„u' 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 Naiting HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 1' 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 � -7_q9 6
48. FINAL PLANNING '
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
a
•
' s. tCTADDRES5: 118 BROOKLINE LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BEP 051292
OWNER'S NAME: NG THOMAS Y
ADDRESS: 68'22 GASLIGHT PERMIT NO: BEP 051292 PLAN CHECK NO: N GOVT: N SUPP: N
HUNTINGTON BEACH, CA 92647
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PLU STR PURPOSE: REP
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REPAIR FIRE DAMAGED GARAGE ROOF & DOOR SQ FT: 10, 000
ADDRESS: UNIT:
CLAIM VALUE: 10, 000 . 00 CALC—VALUE: 10,000 , 00 GROUP OCC: M-1 /
PERMITTEE: ROBERT' S CONSTRUCTION ( 714 ) 537-7200
ADDRESS: 11781 CARDINAL CR COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
aE
GARDEN GROVE CA 92643 **** *iF*+e*********+ETE********** ******BETE*****+ ****+ *******yE***** •+E>F******* •*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY . : 024507 STATE uc.:389941 cuss. A
;ate:we:..—LIQ,/ sigretura _�
_ � MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: Ihereby affirms I have afenirwte of consent to sell-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof)Sectio 3500.Lab.CT LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY No.: 766893-90 EXP.DATE: 07/01/91
COMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 41916345 ZNE: REF NO:
❑ Certified copy is hereby furnished. W Certified copy is filed ' the city Building Divisi n _ PLANNING NOTES>
Date:—.]/_/ ��/ Applicant: ��^ ***************************************************************************-Y.***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thi section n not he completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
1 certify that in the performance of the work for which this per iit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE: •
•
Date: Signature: _
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. /
CONSTRUCTION LENDING AGENCY: I hereby affirm that(here is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: 'tam �� ' ��y 4 DATE. 31///// 9 j
which this permit is issued(Section 3O97,Civ.C). ********************** - - �• .a. ••T' -• • . • • ************iiiFFF**111FFF*"* ***
LENDER: ************************************** *MI�*************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 117.00 2 . 00 3 . 0 0 70
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)01 Division 3 of the Business 2 5 t 50$ SM I P/NON—RES
Ind Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
my applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00 1 5 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 122 . 70 18 . 00 0 . 00 140 . 70 140 . 70 . 00
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 wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 140 . 70 OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 117 . 00 5 . 00 18 . 00 . 70
❑ and Professions Code: The Contractors'Stale License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a coot/actor(s)license pursuant to the Contractors'Slate License Law).l am aware ******M*M**********************************if***********************************
that proof of their Worker's Compensation insurance should be provided to nte. INDIVIDUAL F E E BR EAKDOWN
❑ I am exempt under Section: B.&P.C.
for reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date. Owiter. SFR 10000 FIRE DAMAGE/VAL RESIDENTIAL NOZONE 1 . 00 10, 000. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 1 FIXTURES, LIGHTING 1 ST 20 EA. . 75 . 75
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 ELE 2 RECEP T/O{7TL ET 1 ST 2 0 EA. . 75 1 . 5 0
permit for construction or modification from the Air Ouatity Management District.Residential construction applications are exempt from
these provisions. ELE 1 RECEPT/SWITCH 1 ST 20 EA. . 75 . 75
PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
Date: Applicant: END OF FEES •
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 slate laws relating to building construction and hereby au rile representatives of - ,ily to enter upon the above-mentioned V
property for inspection purposes. •
Oate'.3'—1-(—ppf Signatur S J1 COC89Z33 -CDC 33" 1• •
Driver's License or Socia;Security ro: ,JnTi.; 03/:1'41 '1;;-• .1;72
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:-Pink—Revenue:Goldenrod—Assessor
f -
CONSTRUCTION AND PLANNING • POOL & 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-Undigrnd: 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. Footings I 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, C Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, C Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Anal
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 APPROVALS Permit #
1
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing - 73.-Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing r J2�j 41 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 76.-.FIRE PREV. FINAL
30. Drywall Nailing r HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat .79. FINAL INSPECTION
32. Electrical Power Meter-Final • - `` ,-' - 80. FOOD CERTIFICATE ISSUED
33. Final Electric • ,241CI !/Ir(/�. .- • Notes:
34. Final Heating& Air Conditioning fff///��� ___i
35. Final Gas Pipe-Test - - -
.36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 3-22-9
39. Water Service-Final
•
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System 1
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING ✓"'/.q7 4444
48. FINAL PLANNING - -
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No Date -
•
BUILDING AND SAFETY DIVISION
FIRE DAMAGE INSPECTION REPORT
(Required Prior To Permit Issuance)
Address: j// / 5' r c.c k Unit
/r" P
V
Owner: / C
Owner's Address (if different from above):
L � ?
Street • City State
• Structural permit required.
Repair or replace as necessary.
❑ Plans required.
Comments: r Y/ili r . G q r!5`' -- � r • , _ /fir r v
frc1
62- Electrical permit required.
JE Repair or replace as necessary.
Comments: f2/2, /� / r.c r 4f / 4;— / /,,e,5
E Plumbing permit required.
•
2 Repair or replace as necessary. •
Comments: / / /ir �e Al Ay)/
❑ Mechanical permit required.
❑ Repair or replace as necessary.
Comments:
•
./._4_,.,.,,i • /ITGi'/ 3—,f— q/ 7 c/ - 5---‘/7
Inspector Date Phone
`7e 1872-46 Triplicate:Original-Owner;Vel hater; Pink.Buileing Division
t
•
bUILDING AND SAFETY DIVISION
FIRE DAMAGE INSPECTION REPORT
(Required Prior To Permit Issuance)
Address: i /8' Wroc rc /r %t e Unit:
Owner: /V6
Owner's Address (if different from above): >
Street City - State
E Structural permit required.
Repair or replace as necessary.
❑ Plans required.
Comments: r r e G `r s .a G -e Err c.-. , _ iZ r v �-
�r. er
a Electrical permit required.
® Repair or replace as necessary.
Comments: �Jr, i e / re 4 s . 0T .1, -
0 Plumbing permit required.
®' Repair or replace as necessary.
Comments: L r 8 la <-€ /1 le',I/
❑ Mechanical permihrequired.
❑ Repair or replace as necessary.
. Comments: 1
•
.,.V A • 841Z— —S q/ 7 [ /- c(/
Inspector Date Phone
•
1912-46 Triplicate:Original-Owner;Yellow-Contrator; Pink-Building Division
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-64
JOB ADDRESS lltf Brookline Lane BUILDING PERMIT NO. 22170
GENERAL CONTRACTOR same VALUE $ 13,895.00
AP No. LOT 9 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res w/Btt aar
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R 3
SoilS SUBCONTRACTOR PERMITS ISSUED
Gas DATE NUMBER
Water A/ — `•Ira
Rough om. 'efrig. S Air Cond. 0
Rough bg 1 / 1/6` ' ,� „��n-p� ,?,°— ..�tii Sj-o26-foY' ex a
Rough Plumbing �/� /,/ �.t l./,.i,J J JJfJw 4-/.(n V d- S36d'
Miscellaneous J \
Prop. Swr. Line 0 House Con. G St. Swr. 0 ar ;Or _ € 7Y d DEC 9 1953 4 0 6 04 /
Sprinkling System
Construction Pole
Underground �0 Power 0 _ �/' iii 6�c c
Rough Wiring I !3 q'/--e'1 "7/'.- het Y c-[t 4',147-AZL <7 age —
Trenches 0 Forms 0 Steel Reinf. 0 •/��m�� 1�
Floor System .•J-n. , C
Bond Beam 0 Steel Reinforce 0
Sheathing LT,
4Frame and Flashingtc(ck/ (, \ ILathing — In�C7}�Out ( r c,Sc 1 / /�
Plaster, brown coat N/ J
Refrig. 0 Air Con. 0 Final f
Heating, Final J //-.‘-6•91 \,r/ 4
Plumbing Fixtures, Final ( •6 7
Final Gas Test L, S / '7
Electric Fixtures, Final .0 /• _ //- - \l
Building, Final J ' / -S- 'q
OCCUPANCY TOLD re I.
SrClAL RhQUIREMENTS
BU4-5M
Form BU4�SM�7-83—S-B P
. 22170 e•
.. FEE REcEIVED. .
11R
COSTA MESA BUILDING-SAFETY DEPARTMENT Y 1 9 1W
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
.,
For Applicant to Fill In Completely AI:lucid:61°6°R44ESA
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS 118 Brookline Lane
RECEIPT NO.
7714,0
COSTA MESA. CALIFORNIA
RECEIVE Y 3._Rip,„zysErs1u9E6D4_
OWNER San Vista Building Co.
MAIL
BUIL NO ADDRESS 1166 E. 58th Street ADDRESS
FIRE
TEL.
crmt Los Angeles 11, CalifNo.AD 37187 ZONE TYPE
APPROVED
NCEWMffss Raymond Levanas X-OR 37010 BY DATE
ZONING
•
ADDRESS 3432 Via Oporto, Newport Beach :0 3 HOOF '
ITILIN•
°DrNIE _•
Ifitralgt,
PLANS
CONTRACTOR San Vista Building Co.
LEGAL
ADDRESS 1166 E. 58th Street DESCRIPTION Tract 5160 - Lot 9
L 31/413 — (1
CITY Los Angeles 11, California A.P.NO. ) H —
NOTE: NO CAVE OVERHANG SHALL BE LESS THAN
STATE TEL. 30"TO SIDE a REAR P.L..
LIC.NO. 192782 NO. AD 37187
SIZE I EAVES
NO.OP SLOGS. ,., ALLOWED W.B.C.REQUIREMENT)
OF LOT 20 x 70 NOW ON LOT Li
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING 1%,
EXISTING BLDG. None
(FROM Cp....STREET)
SETBACK LINE FROM
CENTER OF STREET IS 111 REAR YARD FRONT FT. FT
t
SIDE YARD I LEM' 0 I RIGHT 0 R.SIDE r)Fenn. ,)
4
DESCRIPTION OF WORK L.SIDS C.)FT. Ft
r.,
REAR C I FT. PT
NEW x, ALTERATION ADDITION
DISTANCE BET. BET.MAIN 3
MAIN sLoge. ACCESS.BLIDGS.1
tz
REPAIR MOVING ,.._-DEMOLISH
ran-p i c VAR.# DATE ‘Pe 13 III
BUILDINGe2 0 x 33 NO.OF r (I C. P. q:c(
74.til
SIZE ROOMS , stomas 2 APPROVED
EXTERIOR
RGW int 1.1.C C S, I ROOF AP R
COVERING Shin'le BY /1:71+4444 DATE (5---4 5.--"‘" a
USE OF BUILDING ANT)WORK TO BE PERFORMED
it a
...-
Residence & 61e-ritt--- Lti
L2-4/40..29e. )desLA I ce
...]
/ 9:C
oi —
I L.)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT RHO N;UNDER VALUATION IS FOR THE i CL
AN WITH
ALTETLIA E Al9OVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY
0 (i)
'CI ORDINANCES AND STATE LAWS REGULATING VALUATION a gm
BUILDING CONSTRU ION.
PERMIT FEE $ 4r--- ji 0
SIGNATURE OF 3 D.
PERMITTEF ..41
, /Y en-_-- „LSD 7, o
... LA CHECK
AUTHORIZED AG T t...1
TOTAL FEE 5 47-5-6
SW r