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Home My WebLink About939 GOLDENROD DR - Building Permits� � CITY OF COSTA MESA �,051pMFS,p BI/ILDING DIVISION i� �gg" 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us � ` • FOR INSPECTIONS CALL: (714) 754-5626 '"`�n'" PERMIT NUMBER: B11-00165 PERMIT TYPE B ROOF2 STATUS: ISSUED APN: 41221403 DATE ISSUED: OS/27I2011 ISSUED BY: KJB JOB ADDRESS: �839 GOLDENROD-DR.CM Vicinity: RESIDENCE AND ATTACHED GAR,4GE� Squares: 2900 Suite/Unit: Valuatlon: $6,820.00 SCOPE OF WORK: TEAR OFF EXISTING WOOD SHAKE ROOF. INSTALL OSB PLYWOOD/FELT AND COVER WITH CLASS A- 30 YEAR COMP SHINGLES. APPROX 2900 SQ FT . ROOF PITCH IS 5:72. INCLUDES ATTACHED GARAGE. NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for verifcation of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: CASTRO, ROBER7 PHONE: 774-925-2794 APPLICANT: CARDENAS, LUIS PHONE: 714-379-8522 CONTRACTOR: CONSUMER SERVICES ROOFING Address: 13632 CARROLL WqYUnit: City/State/Zip: TUSTIN, CA 92780 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permil Fee: $139.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 Address: 939 GOLDENROD DR City/Sfate/Zip: COSTA MESA, CA Address: 13632 CARROLL WAY City/State/Zip: TUSTIN, CA License No. License No. PHONE: License No. 905154 714379-8522 CEIL: PHONE: PHONE: Unit Unit: : AL FEES $140.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibilied all hours - Suntlays and Ne following Federal New Years Dav_ Memorial Dav_ Indeoendence Dav. La6or Dav. Thanksaivina hav anA Christmac nav NOTICE: The work authonzeq by this permit shall comply with all applicable handicap access requirements under Califomia slatules and relatetl regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and tinal approval must be oblained. Failure to obtain inspections and final approval vrill result in the expiration of this permit. L OE � INSPECTIONTYPE OATE INiRIALS CO�EO INSPECPONTYPE OAiE INiRIA�S 1616 Fixed System Final Fire Prev¢nlion 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof �� - �) �� 210 Final Etectrical 207 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final FactOry Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Si�e 204 Final Dem0lition 250 Final Building/Occupancy 4 WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalry of perjury one of the (ollowing tleclarations: ❑ I have antl will maintain a cenifcate ol consent to selhlnsure lor workers' Compen5a�i0n, a5 providetl lof by 5ettion 3700 of Ihe Labor Cotle, br the peAortnance of the work (or which this permit is issuetl. ❑ I have and will maintain workers' compensatbn insurance, as requiretl by section 3700 0( the Labor Code. for lhe peAortnancc o! Ihe v.ork fw vfiich this pertnit is issuetl. My workers' compensation Insurance carrier antl policy number are: �� . �� Carriec ��..�� (TNs setlm neM nol De mmdercU I fIre perrrq's rdA�Mar orre Mndetl ab/ars f5100/ n kss 1 Policy Number: , �' � � � / ❑ I cehify that in the pertortnance of the v.vrk (or which this permit is issued, I shall not employ any person in any manner so as lo bewme subject to the vrorkers' compensation laws of Calitomia, antl agree lhat i! I should become subject �o �he warkers' compensation provisions of Section 3700 0l the Labor Code I shall forth comply with these provisions. �. �+ t� ��_� 0 od�wms ignawre � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS ($100,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND AiTORNEY'S FEES. Owner ID verifed by driver�nse. ❑ Ves ❑ Na ,Dnver's License No. Expires: Verification of Ownership by (rype of document, i.e. - pmperty tax bill or deed�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation frve (5) or more feet m depth into vfiich a person is requiretl to descend, will be made in connectbn with �wrk authorized by Nrs Dem!�t, and thal no building sWCWre, scaffdtling, falsework, or tlemolition or dismaniling thereof, will be more ihan Ihirty-six (36) (eet high. (Chap. 3.2, Grp 2. M 2, Sec. 341, Ttle B, Califomia Atlministrative Code�. ❑ As ovmer-builder, I will not employ anyone lo tlo work which wvuld require a pertnil from the Division of Industrial Safety, as noted above, unless such person has a permit to Do such work from Ihe division. Appl¢Bnfs SignaWm Division of IndusMal Safery Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or fuNre building occupant neetl ro fle and certify a Business Plan for emergency response to release or threalenetl rPlease o( a hazardous matenal? ❑ Yes ❑ No (Section 25505 0l the Calitomia Health and Safety Cotle 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 reportea year a quanti�y o! haurdous materials equal to or greater than a weight ol LiCENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic teet of wmpressed gas I hereby aKrm thal I am licensetl un0er pmvisions ol C�apter 9(commencing at standard tempere[ure and pressure�. with Section 7000) of Division 3 of the Business and Prolessions Code, and my license is in tuli torce and effect. Lic. # � Class # __..�e-��_�. b Daie CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constructbn lentling agency (or the peAortnance of the wurk for which ihis pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Address: Da�e OWNER-BUILDER DECLARATIONS: I hereby affirm Ihat untler penalty ol perjury that I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permi� to construc�, alter, improve, tlemolish, or repair any sWcture, prior to its issuance, also requires the applicant for such permit lo �le a signetl statement that he or she is licensed pursuant to the provisions ol the Contractors License Law (Chapter 9(commencing vrilh Section 7000) o( Division 3 0l the Business and Professions Code) or Ihat he or she is exempt therefrom antl lhe basis (or the allegetl exemption. Any violation ol Section 7031.5 by any applicanl for a permil subjects the applicant to a civil penalty ol not more �han fve hundred dollars (3500).): ❑ I, as owner of the property, or my employees wilh v2ges as Iheir sole compensation, WILL DO THE WORK, antl the slructure is not intended or oflered for sale (Sec. 7044, Business an0 Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himsell or herself or through his or her own employees, provided that such improvements are not intended or offeretl for sale. If, however. the building or improvement is sold wilhin one year of completion, the owner-builder will have lhe 6urden of provinq that he or she did not builtl or improve for purpose of sale.�. ❑ I, as ovmer ol the property. am EXGLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70RS to constmct Ihe prqect (Sec. 7044, Business and Professbns Code: The contractors License Law dces not apply to an avner ot pmperty who builtls or improves lhereon. antl who contracts fa such prqect wilh a conl2cla�s) license pursuant to Ihe Contractors License Wws.). ❑ I am exempt under sec. Business and Professions Code lor ihis reason: Sgnawre 905]-a6l]/0]) 2. Does or vnll �he applicant or preseni or future building occupant neetl to file a regis�ration (orm for awtely hazardous ma�erials? ❑ Yes ❑ No (Section 25593 of the Calitomia Health and Sa(ery Code, with some exceptions, requires regisira�ion with ihe Costa Mesa Fire Depanmenl by each business which at any one time has on hand a quantity of acutely hazartlous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gailons, or 200 cubic leet o( wmpressetl gas at standartl temperature antl pressure). 3. Does or will Ihe applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program (or acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the Califomia Heal�h antl Safely Code provitles Ihat the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Depariment o( an RMPP by businesses which are requiretl to regi5ter acutely hazartloUs malerials wilh Ihe Fire DepafimeM. 4. If an RMPP is presently required, has Section 25534 of Ihe Calilornia Health and Satety Code been fully complied with4 ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for lhe work whiCh is �he 5ubject of lhis appli[alion a permil for such con5truction or motlification from Ihe SoWh Coast Air Quality Management Distnct or from any other air polWtion control tlistricl or agency? ❑ Ves ❑ No (Section 658502 0( the Califomia Govemment Code requires Ihat the requeste0 infortna�ion be fumishetl on applications fv ran-residential building permits). 6. Will any pan ol the facility lo be constructetl untler this permit be within 1000 (eet from lhe ouler boundanes o( a SChool? ❑ Ye5 ❑ No Qf'yes", the facility must meet Ihe requirement of Sections 25534 and 42303 ol lhe Califomia Healih antl Sa(ety Code). 7. If a pertnit from the South Coast Air Ouality Management District or other air pollution conirol tlistrict or agency is required lor the work which is the subject ol this application, have all of the discbsures prescribetl Dy Cali(omia Health antl Safe[y Code Section 42303 been matle? ❑ Yes ❑ No 8. Qf "yes", attach cetlifcate of compliance (rom Ihe appropriate air pollution control o/(cer�. CERTIFICATE OF COMPUANCE: I certi(y that under penalty ol perjury the information given above is correcL I agree to comply with all state lav5 antl cily ordinances regarding Hazartlous Materials and Emissions. SignaWre Uate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I certify under penalry of perjury that I have reatl this application and state that the information given is correct I agree ro comply with all state lav.s and ciry ordinances relating to huilding construction, antl authorize representatives of the Ciry of Cosla Mesa to enter upon the above-descrihed property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until fnal inspection. �ate ��S � � � Aoalicant ta fill In all spaces ezcept ihose witnin neavy EorCer Ilnes anG sign all aoVrovriate aeclarations. nin CiTY"OF cOSTn �S�39CON$7RUC�ION PERMIT ProjectAddress ��Idenre Applicant's Mailin Address � Owner's Name �eth FYiedenreich phone 545-9226 i1d(ifC55 Arch/Eng. License No. Address ,.7�� Contractor'sNam � H2dt & �ilr �.Qn"Plfofi��nv Address (mailing) 73�T,,,,.,.,.,�,,P1SYS2110 ��15% CityLicenseNo. O%7SS i.qr,ui�n T]l�lle]_, Ca. 92677 �ICENSED CONTRACTOR OECLARATIOfJ 1 hereby affiim thal I am Itcansetl untler provi5iOn5 of Chart¢r 9(commenCing with sectlon 7000) of Olvislon 3 of [he Business antl Profeisions Cotle, antl my license is in�ul�f rce antl efiect. � o License Class n icense No.dg�slg Date_4J_L�Y Signalurc WORKERS' COMPENSATION DECLAR ION ' hereby aHirm that I nave a cerUficate ot onzent to self-insure or a certlficate f Workers' Compensation Insurance, or a certifietl tooY ihareot (Sectlon aBOQ �ab. ) ,o„o, No. 091096-89 �om ,,,,, State Hiuul � Certiptri,e�tl COPYx �s f'Jetlbwithlthehc �tY B tlin9 i i ` oate (' ��5,� APPlicant i EXEMPTION FROM WORKERS' COMP NS TION OECLA0.ATION (Thi55¢clion neotl not be COmpletetl it the pe� it is for one buntlretl (5300) or Iess). I certify tM1al in the pe�(o�mdnce 01 the wo�k fo� wnich tnis pe�m�l i5 ISSuetl, I snall not employ any perzon In any manner so a5 [o beGome Subject to the Workers' Componsation ldws ot Califomia. �ate Si9nature NOTICE:It,a/tnr making tnis tlec�aration, you zhoula become sub�act [o tna Workers' Compensatlon provi5ion5 ot the Laoor Cotle, you must brlhwith comply wiln such prOVl5ion5 or [hls pe�mit shall be tleem¢tl ruvoke�. CONSTRVCTION LENDING AGENCV I ne�eby aitirm that lhGre 15 a const�ucUon lentling agency tor [he pe�lo�manca of Iho work br whicb this permit iz issuea (Section 309� Civ. CJ Lentler's Name Lenaor's aaaross OWNER BUILDEH UECLARATION I herpby a/tl�m that 1 am exemp[ IroT the ConVattor'S LicCnse Law for lhe /ollowin9 reason (Section 7031.5 Buslness antl Professional Cotlo: Any city or county whith requlres a permit to construct, alter, improve, tlemollsh or reoalr any sVucturn, prlor to Rs issuance, also requires the applicant lor such parmit to file a signetl Slat¢mCnt lhat he/5hE I5 IlcenS¢tl purSudn[ lo the plovl5iOn5 Of the Contractor's License Law (Chapter 9(commencin9 wi[h Saclion 7000) ol 9lvislon 3 of lhe Bu5ino55 antl PrOfesslons Cotl¢) Or tnat be/ih0 I5 azampt hcre/rom antl th0 basis for thC allegetl exemption. Any violation of $oclion 031.5 by any appliGanl IOr a permit subjects th0 applicant lo d Civll pcOdlty of not mora lhan flva huntlretl d011a�s (5500). ❑ I, as owher OI lho proper�y Or my emplOye05 wi�h waget a5 lM1oi� Sole compen5alion, will tlo tho work, antl the structure is nol IntenOetl or offoretl for�sale (Soctlon 7044, Dusinoss antl Protessional Cotle: The Contractor's License Law tlo¢5 nOl applY �� an owner o( a prOpe�ty who builUs O/ Imp�ovoi tnareon, antl who tloes such work nlmsell/herself or through hls or her own 2Tployoes, provitlatl lhdt SUCh Improvemenls are nOt intentlotl or oitOr¢G 10/ sale. It, nowevOr, Ihu �ulltling or imp�ovemen[ is soltl within on0 yaar ol com- O�etlon, lhC Owne� will have Iho burtlon ol proving he/she tlitl n0[ Dulitl o� Im- p/Ove tor lh0 Purpose oi Sale). ❑ I, as owner oi tne pro0erry, am extlusively <ontracting wit� Ilcensotl con- tractors to construct the oroject (Sectlon �044, Business antl vrofessions Coan: The ConVactor'S Licanse Law do¢i not aOPly lo dn owner Ot pro0erry wh0 builtls or improvat tneruon, antl who contra<ts for such pro�ecls with a con- tractor(s1 ucense pursuant to tne ConVa<tor's License Law�. I am aware Ihat prool o( lh¢ir WO/kor'S COTpensatlon Insu�ance Shou10 be provltl¢tl to ma. ❑ I am exempt untler Settlon B. 3 P. C. lor tnis rea5on Date I hereby cer[Hy t inlormaUon is on antl state laws el� SCiIId[)VBS OI IS inspection pur se Signature Driverz' LicenSe or _ Owner have reatl this application antl stata that the a�ove a9ree to comply with dll tlty anC couniy ortlinances y builtling construction, antl hereby auth orize repre- Jo entef upOn the abOve-menllonetl pjoper,y_fgr ..... _. .._. __. .._. .,,.,, �..,. M E 39Bg7 TVPE OF CONSTRUCTION NEW ADD ALT{� RATION REPAIR ❑ CONVER510N ❑ DEMOLISH ❑ O'T'QHER mSC311 ORe �1�Rlllld q p qy, qESCRIPJ Ofy�OF1(yO,�ijC /l��yEOFBIDG-a..nnn �T �'��G�" � t�ne (1� L(llU(1 ijU,(JU� $�J �jp1Yp7- S MainBuilding: E TYPEOF•PERMIT�y GRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT 'L'I ELECTRICAI ❑ PLUMBING � MECHANICAL B Reur ❑ OTHER %� PFOJECT DESCRIPTION Sp. FT. OCCUPANCV C Right COfJ'STRUCTION TVPE VALUATION 5 S Lef[ ZONE GRADINGCU.V�S. ACRES PIng.Ref.� aemarks: � Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishuvdsher Drinking fountains Floor Orains Floor Sinks GasService Oudets Kitchen Sink Lavntories � P-Trap Roof Drains Reinspection Fee §75 Boiler Duct- UnderGround Duct - Strucmrel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # 1 ating Syscem & Ducting �700,000 BTU 0700,000 peinspection Fee � $75 CMF OB65-46, rev. 30/84 Whi[e - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assezsor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wl5pa Urinal Wacer Closet Water Heater Water Service Auto-Wash laue Fee Hood or Type 1 Canopy Typell Refrigeration System Q0.100,OOOBTU ❑700,000 System Repair/Alteration F ire Oampers Registers Iswe Fee � 9 Automatic Washer • Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposol Generaror �0-5 KW C 2one Acceuory Building: Parking Req.IProvided ELECTRICAL Trensformer ❑ 15�50 KW ❑ SO+KW Meter Dup to 100amps Meter �over100amps Su6 Panel Motors�41 HP 1X-8 Inc.Solar �9�15 HP �16�15+ Microwave Pole Li9ht Range I I Standing Sections 5 KW � Trash Compactor � Reinspection Fee �$15 � � laue Fee DEVELOPMEN7 SERVICES RE�UIREMEN75: 2oning Appravad By BuildinB APP�oved By Applifation Issued By / FEES Z O N 1 N G R E � M T S 9. O SUMMARV OF FEES BUILDING PERMIT S SMIP S PLAN CHECK . $ PERMIT PLUMBING § ISSUANCE 5 � PLAN CHECK 25% $ � NERG� P.C. S �p ELECTRICAL g �-S RAD�NG S PLAN CHECK 50°6 $ —�j� MICROFILM 5 MECHANICAL $ �j�7�'��TOTALFEE S SS� 50 .� OO pLAN CHECK 25% $ ,. _.P.• J'.-.J ' _ " . ' ' " ' �� a�.. --'�� CONSTRUCTION AND PLANNING ' POOL & SPA APPROVAL�S Per�i•# 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 & Pressuie Test 6.� Electricai UFER G2nd. 57. APPROVAL TO COVER�GUNITE 7.' Footings 58. Electrical Conduit-Undrgrnd. 8'� Fou dation 59. Gas Pipe, O Undrgrnd., rest 9.`•'Wate��Pipe-Undrgrnd. 60. Backwash Lines, P-Trap; � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK .:'. 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. ElectriCal-Final 15. Rough Electrical-Conduit 66. Solar Sys[em-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 # _ 27. Duc[s, in Structure � 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. RoofFraming � , 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE �SSUED 33. Final Electric Gt 'j �! (�/f Notes:Ct�(.�f4 (r�r LA,Qp� (�M,Q ;�� 34. Final Heating & Air Conditioning (f T�1 (�� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Finai Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Compieted 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date G • '� � � � . .. ...' - I C� COSTA MESA IUCTION PERIVIIT 1 te fill in all spaees Wllh(n heavy DorEer lines antl si9n all a� PERMIT NO. �i TRACT NO. LOT Address C-�3y (�,�,p�,,�Qp"7 Arch/Eng. L PA� License Address ISS� � Qcf/Lc�rnr+.� I hereby affirm tfiat I am'Il�e�setl untler provisions ot Charter 9(com- mencin9 with sectlon 7000) of Divition 3 of tha Buslness and Aotezslons Cotla,^ ana mY ��cense is In full Torte an�E �e}7tect. Litense Class �-I�3 rT LICBnse No. �'�""'� WORKERS' COMPENSATION DECLARATION � ' I hereby affirm Ihat I havR a certificate of consent to selt-insure or a cerNfiwte o� Workers' Compensatlon Insurance, or a certl(IeE coOY tnereot (Sectlon 3800, Lab. CJ. /"� ^ n„— ., "y NO. ComPanY� 5[ l/Yldr. ertifiatl copy Is hereby hmishetl. �� ¢.- ertitietl copy Iz filetl wit� the city Builtling Divislon. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon neetl not be tomplecetl if t�e permil is for one huntlred (E100� or Ieu1. I certify that ln the pe�forrt�ance o} thG wo�k fo� whiGh thi5 Oe�Tit Is issue0, I shall not emPloy 0ny person In any mannar so as to become subject to Ihe Workers ComVensation Lzws af Californla. Date Si9nature NOTICE: I( aiter making t��s tletlaratlon, you shoultl become subjec[ to t�e Workers' CompensaUon provisions of tbe Labor Cotle, you must forthwith comply with such Drovlsions or this permit shall be tleemed �evoketl. CONSTRUGTION LENDING AGENCV I hereby aHirm that [hera IS a construction lentlin9 agency for the Oer- formance of the�v ork for- n�+hich this Dermit isj�y etl (Settion 3097. Civ. CJ. / \ �.I� 1_✓1�Q/N-Ci�.t 1 Lentler's Name � 1 _ r l Lender's AtlGress y U U� ''�^o— ��- OWNER BUILDER DECLARATION 1 hereby affirm that I am ex6mpt fromlhe Contractor'S License Law lor the following reason (Sect10� �o31.5 Business and Professlons CoOe: Any city or county which requlres a permit to construct, alter, improve, tlemoli5h or r¢pdir any strutture, prior to it5 issuante, dlio re- qulres the applicanl fo� suCn Pa�ml[ to fil¢ d Signetl statemen[ lltat h¢ is IicenSed pur5uant to Ih¢ OrovlSions of th¢ Contractor's Llcense Law (Chapter 9(rommencing w�th Sectlon 7000) of Divislon 3 of the Business antl Prdession5 Cotle) or that ne is exempt therefrom anE [he Y for the allegetl exemp��an. Any violatlon of Section 7031.5 by ppli�nt for a pe�mil Subjects [h¢ applicant (O a Uvil pendlty ,[ more [han five hundretl tlollars (E500). [7 I, d5 owne/ 01 IhG propFrty, o� my emplOyees with waq¢5 a5 lh¢ir soie compensation, will tlo the work, antl the structure is not intentletl or otferetl for ule. (Section 7046, Busines5 antl Rotessions Cotla: The Contractor's License Law tloei no[ apply to an owner of a Oroperty who builtls or improves �her¢on, antl who tlOes Such wo�k hlmsllt Or [hrough his own employee5, Provltletl that such improvements a�e not intlntletl o� off<r¢tl fo� Sale. ��, howeve�, Ih¢ bulltling o� improvemenl iz soltl within one year o1 cOmpletion, the owner will have the burtlen o( p�oving M1e tlitl not bu��tl o� irtlprOv¢ tor th¢ pu�pose Of wle). ❑ 1, a5 owner of tha O�aPerty, am exclusively conVaGtin9 wi[h Iicensetl conVactors to <onstruct [he projett (Sectlon ]044, BuSiness antl ProfGz5ion5 Cotle: The Contractor'S LiG¢n5e Law tlo¢5 not apply to an owner of property who builtl5 or Improves [hereon, antl who con- tracts from such projects wi[h a contractor(s) Iicesnetl pursuant to the Contracror's Llcense LaW). ❑ I am exempt untler Section B. & P. C. for this reason Oate Owner 1 hereby cerNfy that I have reatl this appllWtion an0 sia[e iM1at tbe above intO�maUon is correCt. 1 aqree l0 comply with all city antl munty ortlinances an tate by+s rel2ling to tonstruction,antl hereby authorize Y¢presentatl In�z dty [O antet upon [he above menHonetl property fo in b purposes. Signature Date �—�S� r Drivers' Lirense or SS BLDG. NO. T/�VPE OF CONSTRUCTION �a NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTION OF WORK TVPE OF PERMIT ,.y ' ❑ GRP.�ING ❑ FOUNDATION ID�57RUCTURAL ❑ TENANT � ELECTRICALJ�PLUMBING.�..MECHAI ❑ OTHER PROJECT DESCRIPTION 54. FT. �� OCCVPANCV� CONSTRUCTION TVPE VALUATIO � � ZONE GRADING CU. VDS. ACRES REMARKS: PLUM81 NG BATHTUBS TOILETS LAVATORIES KIT.SINKS SERVICESINKS ' FLOOR SINKS DRINKING FOUNTAINS GAS SERV ICE WATER HEATERS SEWEq CONNECTIONS SOLARTANK SOLAR PIPING SYS. ISSVE FEE MECHANICAL PLAN CHECK SHOWERS URINALS DOUBLE LAVS DISHWASHERS SUMPS FLOOR DRAINS CIARIFIERS PTRAP ALTERATION OVTLETS BTU OVTPUT COLLECTORS � PLAN CHECK I HEATING SVSTEM 0-]00,000 BTV _ AND OUCTING 300,000 + BTU _ REFRIGERATION 0-300,000 BTU_ SVSTEM 300,000 + BTV _ BOIlERS BTV SYSTEM REPAIR,ALTERATION E%HAVSTSVSTEM MVLTIPLE ISSV E FEE CMF 0865�46 White-Build��9: Unary-Applicant; Pink-Atcounting; Goltlenrotl-Assessor A.P. � ZONE e D S5EpTBACK C/L 5T. L5�EpFTYARD ' R�IGHT REAq YARD (TO i PKG.SPACE REQ. STREET WIDTH r � J 93i2 1fi5�oi - �NING REGULATIONS PLNTGp.gRUEFL.� PROPE�RTOY LINE _I '� PROVI�ED PqRK FEE 8 CONDITIONS: ELECTRICAL PLAN CNECK GENERATOR 0-1KW_1-lOKW TRANSFORMER APPLIANCE 30-SOKW_SO+KW MOTORS 0-1 HP�1-30 HP (INC. SOLAR) 30-50 HP 50 t HP FIXTURES �j( OUTLETS GAS TUBE SIGNS POLE LIGHTS PANELS MAIN SUB SERVICE AMP ISSUE FEE APPLICATION APPROVED BV � 164.A9 TI. SUMMARY OF FEES � BUILDING PERMIT S� SMIP S � PLP.NCHECK S� PERMIT ISSUANCE E PIUMBING E PLAN CHECK § � GRADING $ ELECTRICAL $_l"�" $ PLANCHECK g MICROFILM E MECHANICAL $ TOTAL FEE E PLAN CHECK E VANCE PC E FINAL FEE 5 rGy.�q ;,_ , a CONSTRUCTION ANDPLANNING APPROVALS Permit # - 1. Temporary Electrical Service or Pole Soil ipe-Undrgrn 3. Electrical Conduit Utility-Undrgrn - 4. Electrical Conduit-Undrgrn . tea ein orce - 6. Electrical UFER Grn 7. Footings 8. Foundation 9. Water pipe-Undrgrn 10. Structural FloocSYstem - 11.'•Property Sewer Line & House Connect 12. Street Sewer Connection � 13. flough Plumbing 14. Aough Electric-Conduit 15. Rough Electric-Wiring � 16. Rough Heating & Air Conditioning 17. Ducfs in Structure 18. Ducts, Ventilating 19. Gas Pipe-Rough & Test 20. Roof Framing � 21: Roof Sheathing 22 Frame and Flashing 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31: Final plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar pomestic-Final � 35. Landacape Sprinklina Svstem ' 36. Sound Attenuation 37. Handicap Regulations 38. FINALSTRUCTURE&BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas 42. CERTIFICATE OF OCCUPANCY No Date - Date � . POOL & SPA Inspector ' AppROVALS ' r Permit 43. Pool & Equipment Location 44. Steel Reinforcement 45. Forms 46. Elettrical Bonding 47. Rough Plumbin & Pressure Te� 48. APPROVALTOCOVER-GUN 49. EleMrical Conduit-Undr rn - 50. Gas Pipe. 0 Undrurn, Test �56. Electrical-Final 60. POOL/SPASYSTEMSFINAL NOTES: ., .. � . . � Date Insdector . � r �_-��_s�� • � ! _. r -3o-�t � .- tSc . Ss � OWNER JOB AC GENER AC ".. in c soi� — GAS W ATER PROP. $WR. LINE ��fl0U5E CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CON01T1 POWER L'G: FRAME ANO FLASHING LATHING - IN OUT PLASTER,BROWN COAT � ST 'U0.AL, FINAL HE. .G, VENT., REFRIG. AND A.C. PLUMBING, FINAL AND GAS TEST [L FINAI B111L01NG. FINAL DATE TRACT �SS�aFIRE ZONE SUBCONTRACTOR _ ' � • 3b437 � 301 gCO�TaMES�BUI�DING-SAFEoVDqPARqMENT Z . aU �- Z ZQ O �n am J � a J m Q U � Za W � d W WZ J � m Z J � W w o= zr w� �� o H z Q U 'a O F � z O H U � � �"' H z F'Ai� �r. �,-,��:� on �,�:e�:. .;.,.t: i5,,_3�, APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely REC V BV D TE RECEIV D DATE ISSUED BUILDING —�Q— �R 10 �9]3 ADDRESS 939 Goldenrod Drive PERMI��.e y OWNER Larwin Southern California A.P.NO. �L MA I L BUI LDING �"� ADDRESS 16255 Ventura BLVd. �+DDRESS 39 LQ�/��.OQ �j�' CITY Encino, Calif. No�' 986-8890 TRACT ]SSJ—B LOT LO�L BLOCK L�ENDEq�ION ��in Southern California W A° P BRANCH 16255 Ventura Blvd. /- /�� owNEa (�/�Cif//�✓ p C../� L ADDRESS Encino Califorrma VALUE ,�n � OFi ENGINEER Larwin S Calif nT,o�' 273-4464 S'SF�ES �'�T/ GA.fi 5 L'L FIRE � ADDRESS 9100 Wilshire, Beverly Hills 20NE VPE GROUP CONTRACTOR Larwin Southern California BYPROVED G DATE '�� ADDRESS 16255 Ventura Blvd. TEL. ZONE NO,OF USEOFNEWS RES cirv Encino, Calif. No. 986-8890 �-� P�� 7/ BUILDINGATT �A/� STATE CITV �'ARDSAPPROVED VARDSAPPROVED uc. No. 191311 LIC. NO. B-1 MAIN BUILDING ACCESSORV BUILDING SI2E NO.OF BLDGS. (FROM C/L STREET) OF LOT GO x 106 NOW ON LOT O R NT FT. FT. USE OF EXISTING BLDG. FT. SIZE OF NO. OF n,ewe�oc. 1987 ROOMS STORIES 1 L.SIDE FT. FT. EXTERIOR WALL ROOF COVERING t C COVERING WOOd shin le REA � �FT. FT. VSE OF BUILDING AND WORK TO BE PERFORMED OISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. Construction Single Family Residence cuRv�w qPPqpVED APPROVED , r ,0-�73 HOLD FOR SPECI QUI MCS I hereby acknowletlga ihat I have reatl ihis application and stare [hat [he ebove intormation is correct antl apree to comply with all laws regulating builtling construction, antl I shall not employ any pe�son in violation ai the workman's compensation laws ot [he Sta[e of Califomia. I he�eby ce�tity t�at I am ptope�ly licensetl as a cont�ac[o� untle� SQ. FT. Me State ot Califarnia B�sinass antl Professions Code, Divisicn 3, TH AMOUNT S N UNDER VALUATION IS FOR C�epter 9, entl [het such licenses are in tull torce and etfact, or I THE PURPOSE OF ABlSHING A PERMIT FEE ONLV: am exempt trom the provisions ot the State of Caltfornia B�sineu VALUATION antl Professions Cotla, Division 3, Chapter 9. PERMIT FEE 5 101. SO Sie�ature o�� D. DOW[1S 2.9 8�� 50. 75 Permlttee //L/� $ � PLAN CHECK $ Authorizatl Aeent TOTAL FEE $ 1SZ. Z.S b O � ¢ � m E `o LL OWNER MIRA TOM JOB ADDRESS 939 Goldenrod Dr. GENERAL CONTRACTOR Currv & Son Cont �{A' 412-214-0 LO7 104 TRACT JIN�rtCTI0N5 Si natu SOIL G AS W ATER ROUGH PLUMBING PROP. SWR. LINE � HOUSE CON. SPRINKLING SVSTEM MISCELLANEOUS ROUGM HEATING ANO AIR CONOITIONING TEMPOHARY SERVICE OR POLE UN�ERGFOUND � POWER � ROUGH WIRING TRENCHES FORMS ST@EL REINF. � FLOOH SYSTEM FRAME AND FLASMING LATHING — IN ❑ OUT n PV "-4R, BROWN COAT Sl URAL, FINAL HEAI ING, VENT., REFRIG. AND A PLUMBING, FINAL AN� GAS TEST ELECTRIC, FINAL awi niur, riuni DATE )UP ,7 TYPE SUBCONTRACTOR 10-4- � Z . d U ZQ O v~i am J7 J � < L J Q U N Za w� aW wz J Q mZ J � W W O= Z � w � � � H' z Q U Q � H N Z O H U � � � N z • :3737 % COSTA MESA BUILDING-SAFETY OEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely ADDRESS / J5 ��l.L��,D OWNER TM MI/�� MAIL Sl"IM E ADDfiE55 CITY �S /A MGS� NOL. CANSTRUCTION BRANCH ARCH ADOFESS CONTFACTOR CjjjlyQy � �6� �:U/�T�iiLT i ADDRESS Po, �3ox 8so I CITV/pU�ii�Al/�l V�� NOL�13d• STATE � �� / CITY LIC. NO. � � �IC. NO. SI2E � NO.OF�BLDG' OF LOT �y Q j� � A—O I NOW ON LOT USE OF p�S EXISTING BLDG. I� SIZE OF iA ♦. ih NO.OF USE OF BVILDING AND WOFK TO BE W BUILDING ADDRESS � TRACT OWNER FIFE �CT —4-73vaiu�0 209'.t :�f,��::�7.5� cis• FOR BUILDING PERMIT DATE v ZON NO.OF USE OF NEITP�C PLAN$ Z BUILDING �U� VARDSAPPqOVED VARDSAPPROVED MAIN BUILDING ACCESSORV BVILDI� (FROM C/L STREET) ^L�O FT. DISTANCE BET. BET. MAIN MAIN Bl.DGS. ACCE$$. BL VAR. # DATE C.U.P.� APPRpVED -'+ � 3 I hereby acknowlatlBe Nat I have reatl this application ana stare; that iha above intormation is mrrect and agree to comply with , all lows regulatinq builtling construction, antl 1 shall no2 employ' ony person in violation of the workman's compensation laws of the $tate ot Calitarnia. ^ m S b I hereby certify [hat 1 am ptope�ly licansetl as a conttacto� untle� �G � "n' FT. / o the Stete ot Calilornia Businass antl Protessions Coda, Oivisicn 3,_ THE 4MOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and tha[ such licenses are in full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exampt frorn U e provisions O/ the Sta[e o� Calitornia Business ¢ antl Protessions Cno , Division 3, Chapter 9. VALUATION m � PERMIT FEE $ � /J J SiBnature ot / m Permittae $ /� / PWN CHECK $ E / �]� Authorizetl Agent ( J LL TOTAL FEE $