HomeMy WebLinkAbout979 GOLDENROD DR - Building Permits�
�
CITY OF COSTA MESA
4�,0�j1pMFS,9 B!/ILDING DIVISION
�� 0 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�. I� � FOR INSPECTIONS CALL: (714) 754-5626
�`°'•°�°"� PERMIT NUMBER: P10-00160
PERMIT TYPE PLUM STATUS: ISSUED
APN: 41217805 DATE ISSUED: 12I13I2010
ISSUED BY: RMD
JOB ADDRESS: 979 GOLDENROD DR CM Suite/Unit:
Vicinity: GARAGE
SCOPE OF WORK: PLUMBING PERMIT TO CHANGE OUT WATER HEATER AT EXISTING GARAGE LOCATION. COMPLIANCE
FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: KLARER, FR4NZ
PHONE: 714-024-9924
APPLICANT: LITTLEFIELD, SCOTT
PHONE: 661-259-7131
Address: 979 GOLDENROD DR
City/State2ip: COSTA MESA, CA
Address:
City/State/zZip:
CONTRACTOR: AFFORDABLE WATER HEATERS AND PLUMBING License No. 627368
Address: 24663 RAILROAD STREET
PHONE: 661-259-7131
City/State: NEWHALL, CA ZipCode: 91327-1742 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
NOTICE: The work authorized by ihis permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
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 work authonzed 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 expiretion of this permit.
COUE N. INSPECPONTYPE UATE INTTA�S COOE/ INSPECTIONTYPE ORTE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �jj�� /�
1266 Paol Spa Final 208 Final Plumbing � �� G'� i(/UL !W
200 Final Re-Roof 210 Final Elecirical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Finat Site
204 Fina� �emolition 250 Final Building/Occupancy
WORKERS' COMPENSq710N DECIARATION:
I hereby aKrm under penalry of perjury one ot the following declarations:
❑ I have and will maintain a certifcate o( consent to sel(-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for Ihe
pertormance of the work for which this permit is issued.
❑ I have and vrill malntain workers' compensation insurance, as required by
section 3700 of the Labnr Cotle, for the pedormance of the work for which this
pertnit is issued. My Workers' compensation Insurance carrier and policy
number are:
Ca� rn'�er. �z P.1 �-�' �
(This secfnn neetl not De �mp'efed d Me peimrt rs valuetl at one �untlretl aollars (5100) oilessJ
� Z� ,/
POlicy Number �r'� r('�l �� L� Y
❑ I certi/y �hat in the pertormance of [he work for which this permit is
issued, I shall not empl0y any person in any manner so as ro become subject
to the workers' compensation laws of California, antl agree that if I should
become subject to the workers' compensa[ion provisions of Sec[ion 3700 of
the Labor Code, I sha I forthwith comply with these provisions.
e¢�� i3-l3-�D
�A i_ w _nfs Signawre ' rPdtel
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SE�TION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm Ihat I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) o( �ivision 3 of the Business and Professions Code, and
my license is in full tome and eflect.
i
LI�}F���P2 P�F' Glas's.#s-• �-' is
<L_-- ia-i3-�0
� ectofs'SignaWre Dem�
CONSTRUCTION LENpING AGENCY:
❑ I hereby aKrtn [hat there is a construclion lending agency (or [he
peAormance o! Ihe v.ork for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Slgna�ure Date
OWNER-BUILDER DECLARATIONS:
I hefeby affirm that unqer penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or wunry which requires a permit to
construc�, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires me applicant for such permit to fle a signed statement
that he or she is licensed pureuant to Ihe provisions of ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Pmfessi0ns Code) or that he or she is exempt theretrom and
the basis tor 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 ihan
frve hundred tlollars ($500).):
❑ t, as owner o( the property, or my employees with wages as their sole
compensation. WILL QO THE WORK, and the slrucNre is nol intendetl or
offered for sale (Sec. 7044, Business and Professions Cotle: The Contrac[ors
License law does not appty to an owner o� 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 (or
sale. If, however, the building or improvement is sold within one year of
completion, Ihe owner-builtler 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 CONTR,4CTING WITH
LICENSED CONTRACTORS to cons[mct the pmject (Sec. 7044, Business and
Professions Code: The conhactors License Law does not apply to an owner of
pmperty wfio builds or improves fhereon, antl who contracts tor such project with
a contractor�s) license pursuant to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for ihis reason:
305]-46 (3IQ1)
Owner ID verified by driver's li ense. ❑ Yes ❑ No
Driver'S License No. EnpireS:
Verification of Ownership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify �hat no excava[ion fve (5) or more feet in depth into which a
person is required to descend, will be made in connection vrith v.ork authonzed
hy [his permit, and that no building strucfure, scaHolding, falsework, a demolition
or dismantling thereo(, vnll be more than thirty-six (36) feet high. (Chap. 3.2, Gry
2, Art 2, Sec. 341, Ttle 8, Califomia Adminis�rative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from [he Division o( Induslrial Sa(ery, as noted above, unless
such person has a permit lo do such work from the division.
Appliwnfs SignaWre
Division of Industrial Satety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle and
certify a Business Plan for emergency response to release or Ih�eatened
release ot a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health and Sa(ery Code requires, with some
excep�ions, lhat a Business Plan be (iled wifh the Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantiry of hazardous ma[erials equal to or greater Ihan a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard tempereture and pressure).
2. Does or will the applicant or present or fuWre building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, wim some
exceplions, requires registra[ion with [he Cosfa Mesa Fire Departmen[ by
each business which al 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 antl pressure).
3. Does or will Ihe applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Program for awtely
hazardous maferials)? ❑ Yes ❑ No
(Section 25534 of [he California Health antl Sa/ety Code provides Ihat Ihe
Costa Mesa Fire Department may require Ihe prepara[ion, certifiGa[ion and
(iling with the Fire Department o( an RMPP by businesses which are requiretl
ro register acutely hazardous materials with Ihe Fire Department.
4. If an RMPP is p�esently required, has Seclion 25534 0( the California
Health and Safety Code been fully complietl with? ❑ Yes ❑ No
5. Does orwill the applicant or present or (uWre building occupant require for
lhe work vfiich is the subject of this application a permit (or such construction
or modification from the South Coast Air Quality Management District or from
any other air pollWion contml district or agency? ❑ Yes ❑ No
(Section 658502 of the California Govemment Code requires that the requested
infortnation be fumished on applications tor non-residential builtlinq permits).
6. Will any part of the faciliry to be consiructed under ihis permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(I( "yes", [he faciiity must meet Ihe requirement of Sections 25534 and 42303
of the Cali(omia Heal[h and Safery Cotle).
7. If a permit from the South Coast Air Quality Management District or other
air pollulion control districl or agency is required for the vrork which is the
subject of this application, have all of the tlisclosures prescribed by California
Health and Safe[y Code Section 42303 been made? ❑ Yes ❑ No
8. Q( "yes", attach certificate of compliance from the appropriate air pollution
conhol officer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury [he
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SgnaWre Daie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty o( perjury that I have read lhis application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to builtling construcfion, and authorize representatives of
the City of Costa Mesa lo enler upon the above-descri6ed property for
inspection purposes. 1 agree not to occupy or allow occupancy of any builtling
authorized by ihis permit until fnai inspection.
SignaWreofL galO�s� Daie
,eE �a-r3,.io
�An IOM tbonzed ApplicenC' 7�=Dete-
r
��ia� �sa-sz�s • Fe,c (�ia� �sa-aess
CITY OF COSTA MESA
BUILDING DIV/S/ON
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
JobAddress: 979 GOLDENROD DR
Suite:
Vicinity: HOUSE & GARAGE
ParcelNunmber: 41217805
Applicant: KLARER, FRANZ
Address: 979 GOLDENROD DR
COSTA MESA, CA
Owner: KLARER, FRANZ
Address 979 GOLDENROD DR
COSTA MESA, CA
Contractor: �y�� N ��
Address:
Zip:
Arch :
Address:
BUILDING PERMIT
Zoning: R1 R1
Phone: (714)424-0050
Zip: 92626
Phone:
Zip: 92626
Phone:
License:
Eng:
Address:
Phone:
PERMIT NUMBER
i .
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 06/22/1999
Issued: O6/22/1999
ISSUEDBY: d/ � /
Phone:
Zip License: Zip: License:
SCOPE OF PERMIT
REROOF - T/O, INSTALL NEW 5/8" SHEATING, 1 LAYER OF 301F FELT & NEW ICBO #ER-2093 MONIER LIFETILE
PREMIUM DURALITE LIGHT WEITH TILE ROOF.
Plan Check: $0.00
Permit: $137.25
SMIP Res: $0.75
SMIP Cam: $0.00
Other: $0.00
Inspection: $0.00
Total: $138.00
SETBACKS
ACCESSORY
PARKING
NOTES:
Front 0- 0
Front 0- 0
Existinq: 0
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
LeH 0- 0
LeN 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0-0
s�,soo.00
s�,soo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 e penod 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
I required Inapeetlons and tinal approvel must be obtained. Feilure to obtain inspections and final epprovel will result in the expiralion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION: 7�
I hereby attirm under Penalry of perjury ana of the following declaratlons: �
[� I have entl will maintain e certificate af consant to self-Insure br workere' compensation, es O�ovideC tor by section 3700 of Ihe Lebar Catle, for Ihe performance of the
work lar which t��s permi� is issuetl.
❑ I have entl will maintain workers' compensation insuranca, as required 6y section 3700 ot Ihe labor Cotle, for the pertortnance of the work lor which Nis pertnit is issued.
My workers' crompensatlon Insurance carrier and policy number ere:
Carrier: Policy Number:
(Thls sectlon need not be cromplefed i! (he permlf Is valuetl at one hundred dollars ($700J ar less.)
❑ I ceRity that in the pertormance of ihe work tor whlch this permit is issued, I shell not employ eny person in any manner so as to become sublect to the workars'
compensetion Iaws ol California, and agree ihat If I should become subjea to the workers' compensation provisions of Section 3700 of the Lebor Cotle, I shall forihwith
comply with these provlsions.
Applicant Signeture: Date:
WARNING: FPIWRE TO SECURE WORKERS' COMPENSATION COVEMOE IS UNUWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENNLTIES AND CIVIL FINES UP TO ONE HUN�RED
THOUSAND OOILARE (5��.�). IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SEGTION 3]W OF iHE LABOR CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy eNirm thet I 9m licensetl under provisions of Chapter 9(commencing wi�h Section 7000) of Division 3 of the 8uslness and Professions Cotle, end my license is in full
farce and effect. Lic. # Cless N
Contrac�ofs Signatur9: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby aHirtn tpet there is a constmctlon lending egency for Ihe pertortnance ot tha work for which this permit Is issued. (Sec. 3097, Civil Cotle).
Lentler'S Neme: lendefs Atltlress:
Signeture: Date: �
OWNER-BUILDER DECLARATIONS:
I hereby aftirm ihat under penalty of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or county which requires a pertnit �o cons�ruct, elter, improve, demolish, or repeir any strucWre, pnor to i�s issuance, elso raquires Ihe eppliCant for such permit
to file a signed statement �hat he or she Is licensetl pur5uam ta the Dmvisions of Ihe Contractore License Law (Chepier 9(wmmencing with Sectlon 7000) of Dlvlsion 3 of the
Business and Profess�ons Cotle) or that he or she is ezempt therefrom and Ihe basis for Ihe elleged exempiion. Any violellon of Section 7031.5 by eny epp�icant tor a permit
sulyects lhe applicant to e civil penalty of not more then Bve huntlred tlollars ($500).):
� I, es owner of the propany, or my employees with waqes es their sole compensation, WILL DO THE WORK, and tha structure is not intended or oNeretl for sale (Sec.
7044, Business end Professians Code: The Contrectors License Law tloes not epply lo en owner ol proparty who builds ar improves Ihereon, antl who does such work
himself or hersaR o� through his or her own employees, provitled �hat such improvemenls are not intended or oflered tor sale. If, however, the bulidinp or impmvement is
sold within one year of completion, ihe owner�builtler will heve ihe burtlen of proving that he or she did not builtl or Imp�ove for purpose of sale.).
❑ I, as owner of ine propeny, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the proJect (Sec. 7044, Business antl Professlons
Code: The contlactors License Law does not epply to an awner ot pmperry who �ullds or improves thereon, end who conirecis for such pro�eM with a coniractor(s)
license pV�suant �o the Contry3cto� License Lews.).
❑ I am exe t u r�syc; � 8usiness and Pmfessions Cotle for ihis reason:
Signeture: �r� _ . i Dete: -
Owner ID venfie y d��efs Ilce e. ❑ Ves � No Dnver's License No. �� �� �� Expires:
Verilicetion of Ownership by (type ot dwument, i.e. - property tex bill or deed): .
DIVISION OF INDUSYRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereDy certify ihat no ezcavetlon ilve (5) or more feet in tlepth Into which e person Is requiretl ro descend, wlll be matle In connection with work authonze0 by this
permit, end ihat no builtling siructure, ScaHolding, falsework, or demolition or tlismantling thereol, wlil be more than ihirry-six (36) feet hlgh. (Chep. 32, Grp 2, Art 2, Sec.
341, T�le B, Calliomla Administrative Code).
❑ As owner-builtleL I will noI employ anyone to tlo work which would require a permit from t�e Division ot Industrial Safery, as noted above, unless such person has a
pertnit to do sucn work tmm the division.
SigneWre: Date:
Divlsion of Industnal Sefery Permlt Number:
CERTIFICATE OF CO L�ANCE AND AUTHO N OF EMRY: I cehity under penalry ol perjury that I have read this appliwtion and state that ihe information given is
correct. I agree to co y with all stete lews a c y rdinences relating to builtling constructioq ana authorize reDresenlatives of Ihe Ciry of Costa Mesa lo enter upon the
above-tlescnbed prope or i ection purpos . I g ee n t o occl PY or al w ocapancy of eny building euthorized by ihis ertnit until finel inspec'
��. 22 . ��
SipnaWre Of Le9 I Owner(s) Dale
COUE t. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
1266
200
201
202
Pool Spa Final
Finel Re-Raof
Final BIocWRo�eining Well
Finel Fectory F�re Place
203 Finel Sign
204 Final Dem
2046A6
Q�, INf1I1AL5
R�[ / �� c�
COOE 1 INSPECTION TYPE
208 Final Mechanicel
208 Final Plumbing
210 Final Electrical
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Buildinq/Occupanry
Aoplicant lo flll in all svaces exceot tnose witnin neavy bortler lines ana sign all apo�aoriate aeclarations.
CtTY,oF COSTa /M]ES/A] CONST UCTIO PE MIT
Project Address —1�7 �! �9 c��.r� rr�� . r�
AppiiCant'S Mailing Add e55 T. ' I,
Owner's Name � hon�Y
Address �
� �
Arch/Eng. License No.
Address
Contractor's Nam � � Phone
Address (ma�l�ngl ��
City Licens= No- � ��%��5
LICENSED CONTRACTOR DECI,ARATION
1 h¢reby atti�m that I am licensetl untler provislons of Charte� 9(commencing
with section 7000) ot Division 3 of the Busine55 antl Professlons Cotle, antl
my license is 1� �ull force antl effect. ' �
Licen s i n N.
Da[e – Si9�ature
WORKERS' GOMPENSATION DECLARATION
' hereby afflrfn that 1 have a certificale of consent to Selt-insurc or a Certificate
Workerz' Com�pe/n�s�ati'oIn (I�nsurance, or a certltietl copy thereoi (Se tlon
J00. Lab. C�1M � �+IhU �7� �
�olicy No, �—r��_ Company
•� eriitietl eopy is hereby fumishea.
Date�rti c Y�f fite0 with the City ' tli i' n.
��_ ADPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis section �eetl noi be complete0 if the permit I5 for one huntlretl ($300) or
less).
I certify that in the performance o/ the work tor which this perm�t is issuetl I
shall nol emp�oY any person in anY manne� so as to become su�ject to t�e
Workers' Compensation Laws of Caliromia.
Date Si9naturo
NOTIGE:Jt, 3�ter making this declaration, you shoultl becomo subject to the
Worke�5' Cort�Pansalion provi5ion5 of the Labor COtle, You mus[ forthwl[h
comply with zucn p�ovisions or [his perml[ ihall be tleemetl �evoketl.
CONSTRUCYION LENDING AGENCV
1 nereby afflrm Ihat there is a consVuction lentling a9ency tor Me pertormance
of the woru for which this permit is fssuetl (Secbon 309]"Civ. C.)
Lentler's Name
. Lentler'S Atldfess
OWNER BUILDEN OECLARATION
I here0y af11Ym that I am exempt frOm the COnlractor'S LlcenSe Law for (h¢
following reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or
county whlcn requires a permit to constru<t, alter, improve, tlemolish�or repalr
any strucWre, prior lo its issuance, also requires the applicant for such permit
t0 file a signCtl slalement that he/50e is licensetl pur5ua0t to the provisions of
the ContractOr'S License Law (Chapler 9(mmmencing with 5ection ]000) of
pivizion 3 01 the Business antl Protessions Catle) or that ne/she is exem0�
�erefrom antl [he basis for the allegetl exemp[ion. Any violation of Seclion
)31.5 by any applicant for a Permit subjects the appllcant [o a civll
Jenalty of no� more man tive nunarea tlollars (5500).
❑ I, as �owner of [M1e pioperty or my employoos with wages as their solo
compen5atiod, wl�� tlo the wo�k, a�tl Ihe structure i5 not intentletl or ofteretl
'tor sale (Sec��on 7044, �Buziness antl Pw(essional Cotle: The Contractor's
License law tloes not a001y to an owner of a proPerty who bulltls or improves
th¢reon, antl who tloes such work himselt/herself or ihrough his or her own
employees; provitletl that such imOrovements are not intentlotl or otterea for
sale. If, howR�eq [he builtling or imProvement is soltl withln one year oi com-
pletion, Ihe Owner will have the buraen ot proving he/she tlitl not buila or Im-
prov! for the Pu�Oose ot sale).
❑ I, as ownC/ of [he O�oOerty, aT exclusively con[racting wlth IicenSetl con-
tracrors to co�strucl Ihe project �Section 7044, Business antl Protessions Cotle:
The Contractar's License Law oes not apply to an owner ol property wno
builtls or improves thereon, antl who wnbacts for sucn projects with a<on-
tractor(z1 I¢e�se pursuant to the Coniractor's �Icense Law). 1 am aware that
proot of tne�r Worker's Compensatlon insurance shoultl be provitled to me.
❑ I am exemP[ untler Section B. & P. C. for this reason
Date Owner
I hereby cert�fY that I have reatl ihis appliCation an0 state that the above
information i5 correct. I a9ree to comO�Y `�+ith all city antl coun[y ortlinances
antl state laws �elating to builtlin9 consbuction, antl hereby authorize repre-
'sentatives ot is <it o�enter up n the abOve-mentlOnetl �o ty for
InsOectiOn pu1 0 5. //� � �—i%�
Signature Date 0
Drivers' Licenu or 55 � � � �
TVPE OF CONSTRUCTION IJ NEW LJ ADO LJ ALTERATION ,�'3iEPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ F.OVNDATION LJ STRVCTURAL
❑ TENANT ❑ ELEGTRICAL � PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. Fr, oCCUParvCv_
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Pre�enter
Irrigation
Drinking Pountains
Floor Drains
Floor Sinks
Gas Service Outlets
I ncerceptors
Ki[chen Sink
Lavatories
Roof Orains
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
'Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
A.P. � _
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
• � Cooking Unit '
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
F i xmres
Device Boxes
Outlets
$witch¢5
Garbage Disposal
Generetor �0-5 KW C
Reinspection Fea � $15 I I Issue Fue . I $ 3 I
MECHANICAL � PEES
Duct- Under Ground
Duct - Struc W ral
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heatin9 System & Ducting
❑P700,000 BTU �700,000
Reinzpaction Fee � 515
CMF 0865-96, rev. ]0/84 White - Builtling; Canary - Appli<ant; Pink - Accountin9: Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampe�s _
Registers
laue Fee I S 3
2021 2/09/87�
Zone
Parking Req,/Provided
ELECTRICAL�
Trans(o�mer � 15�50 KW
❑S�+KW
Meter ❑upro,100amps
Me[er ❑over 100 amps '
Sub Panel
Motors00-1 HP�iX-8
Inc.Solar �9-15 HP �16�75+
Microwave
Pole Light
Sign
Standing Sections
15 KW Trash Compactor
Fee � S75 � � Issue Fee
DEVELOPMENT SERVICES REDUIREMENTS:
Zonin9 APProvad By
Building Approved By �-
5.00 TL
FEES
tl
S 3
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N
I
N
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$
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ �� ;���— PERMIT -
PLUMBING � $ =_��-' ISSUANCE $
PIAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL . § � GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ 0� '�
Ptf+N CHECK 25% $
Ca
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
i. Temporary Electrical Service or Pole 52. Pool & Equipment Location�.c'
��.
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 yest
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd�:�•;
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK
71. 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
75. Rough Electrical-Conduit 66. Solar SYstem-Final
i6. 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
79. 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 O Gas ❑ 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 (Structuraq & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. f-INAL
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 6 � `'' ���
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 Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date '
OWNER �qgWIN So. Cal.
JOB ADDRESS q�
GENERAL CONTRACTOR c�
A� "o. LOT 11�
II -CTIONS
SOIL
GAS
WATER
ROUGH PLUMBING �
PROP. SWR. LINE HOUSE CON.
SPFINKLING SYSTEM
MISCE�LANEOt15
ROUGX HEATING AND AIR CONDITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIRING�
TRENCNES FORMS STEEL REINF.
FLOOR SVSTEM
BOND 6EAM ❑ STEEL fiEINFOPCE n
SHEATHING
FRAME qND FLASHING
LATHIryG - IN OUT
PLASTpq, BROWN COAT
5" TURAL, FINAL
DAit
SUBCONTRACTOR
3b�!r S Nn�i
LOSTAMESABUILDING•SAFETYDEPARTMENT �:�11-7`��?;-OO (SS�% �''=''r��Z.CF
4�1 AR p O gOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
FECEIVE BV D 7ERECEIV D p.�7, � SU O•
BVILDING 979 Goldenrod Drive � ���� � '�K�� ����
ADDR�SS
PERMIT NOI
OWNER Larwin Southern California �+�P�NO. �{-./�/IR
MA I L BUIIDING �
Z .
ADDR�SS 16255 Ventura BLVd, ADDRESS �
ac"'.> cirv Encino, Calif. nTio�'986-8890 7RACT�SSJ—B LOTL1S e�ocK
Zz
¢ conisraucrioN Larwin Southern California W A� P
O N LENDER
',� BRANCM 16255 Ventura Blvd, /I /1�
� OWNER G.����N S C�J�/C/
` � ADDR�SS Encino, California � VALUE �L
JQ ARCMITECT �yy-�,�1R S. Calif TE`.273-4464 � "s �~//GA $ �
N OR EN INEEfl N.
FIRE
wCL ADDR�SS 9100 Wilshire BLVC1.� B2V. H111S ZONE TVPE GROUP - K
� W APPROVE
J O CONTRACTOR Larwin Southern California BV DATE - �
m z
�� ADDR�SS 16255 Ventura Blvd.
w w TEL. Z�NE NO.OF USE OF NEW,S S W
�= cirv Encino, Calif. No. 956-8890 — P��"Zi BUILDING S�
z�
-� STATE CITV �'ARDSAPPFOVED VARDSAPPROVED
y� �ic. No. 191311 LIC. NO. $-1 MAIN BUILDING ACCESSOflV BUIIDING
�� SIZE NO.OFBIDGS. (FROMC/LSTREET)
OF l0T J9 X Hl NOW ON LOT O RONT FT. FT.
USE OF
EXISTING BLDG. 5 FT. � L FT.
F- S12E OF NO. OF
z NEwe�oc. 1784 ROOMS STORIES 1 L.SIDE FT. FT.
a EXTEFIOR WALL ROOF
V COVEqING SCllCCO COVERING WOO(1 shin 12 REAR �#FT. FT.
J USE OF gUILDING AND WORK TO BE PERFORMED DIS7ANCE BET. BET. MAIN &
a MAIN BLDGS. ACCESS. BlOCS,
a
0 Construction Single Family Residence CURP qW APPROVED
N APPROVED � O��?
J
O HOLD FOR SPECI L g
VI heraby ecknowletlBa [hat I heve reatl this application antl state
� Shat [he above intormallon i5 cOrrec[ entl agrBa to comply wifh �
� all lawg reBulaxing builtlinp construction, antl I s�all not employ
any petson in violetion of the warkman's compensation laws of
z the Stare of California. / �Q,� 'n
�
� I hereby certify that I am properly licensed as a contracto� under SQ. FT. O
the State of California Business antl Professions Cotla, Divisicn 3, HE AMOUNTSH N UNDER VALUATION IS FOR �
Chepter 9, antl that such licanses are In tull force antl etfect, or I THE PURPOSE OF ABLISHING A PERMIT FEE ONLV: ¢
am exempt from the provisions of the Stete o( California Business V AIUATION
antl PrOtes5ian5 Cotle, Division 3, Chapter 9. 9[�. QQ °�
PERMIT FEE $ c'
7
SiB^atu�e ' m
Pa�mltt� ��� �� � D. Downs $ 2�7 � 9�0 P�,p,N CHECK $ 47•00 E
»�
0
AuMar�zetlAgent L�FL.�� LL
TOTAL FEE $