HomeMy WebLinkAbout3322 WYOMING CIR - Building Permits� CITY OF COSTA MESA �
BUILDING DIV/S/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754•5626 �
PERMIT TYPE B_ROOF2
APN: 13961116
JOB ADDRESS: 3322 WYOMING CI CM
Vicinity: _ . � � •
Squares: 0
PERMIT NUMBER: B10-00065
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:,
ISSUED
03I10I2010
CAC
. . Valuation: � $6,100.00
SCOPE OF WORK: TEAR OFF COMP AND CAP ROOF INSTALL 30 LB FELT 30 YR COMP ON PITCHED ROOF AND 3 PLY. HOT TAR
ROCK ON FLAT SURFACE. . � � � �
OWNER: OLIVER, RICHARD C TR Address: - 3322 WYOMING CIR - Unih
PHONE: 714•241•0613, � � " " , ' City/State/Zip: COSTA MESA, CA -
APPLICAN7: JENIFER COLE �� , �. Address: 9781 EASTWOOD CI � Unit: :
PHONE: 714-921-1500 . � City/State/Zip: VILLAPARK,CA �. . �_��r���y
CONTRACTOR: THE ROOF GUY
Address: 9781 EASTWOOD ClUnit:
City/State/Zip: VILLA PARK, CA 92861
ARCHITECT: ' � "
ENGINEER: -
J�
��:r
F,EE SUMMARY
Reroof Plan Check:
fteroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
�y.
$0.00
$139�25- ..
$0.00
$1.00
License No.
License No.
�icense No. 638593
PHONE: 714-921-1500
CELL
PHONE:
PHONE:
.,. �;�.r !';.•,
U.!rt:
TOTAL FEES g140.25 �
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTNE 3N8/2010 - PER CMMC Sec. 13-279 ,;,��t�. ;
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holi�
New Years Day, Memorial Day, Independence Day Labor Day Thanks iving Day and Christmas Day `� ��'•� �� �•'
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
IN§PECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable wdes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resull in the expiration of this permit.
�,�E . INSPEC110NTYGE Q�TF� INTITIALS COOE/ INSPELlIONTYPE DRTE ��;�IN7I71pL5
1818 Fixed System Final Fire Prevention 2o6 Final Mechanical
1268 Pool Spa Finai 208 Final Plumbing
200 Final Re-Roof !� � 210 Final Electrical '''
201 Final Bbck/Relaining Wall 212 Final Fire Preveniion __
202 Final Factory Fire Place 220 Final Planning Approval ' '
!t f �:a•..� p�r�6.^.';S:
203 Final Sign 222 Final Site '•�,� .�
204 Final Demolition 250 Final Building/Occupancy
� `
WORKERS' CpMPENSATION DECLARATION:
I her�by aKrm untler penal�y o( perjury one of the (ollowing declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
p,-e,/Aormance of the work for which this permit is issued.
�q I have and will maintain workers' compensation insurance, as 2quired by
section 3700 of the Labor Code, for Ihe peAormance of the vrork for which this
permit is issued. My workers' compensation Insurence carner and policy
� _5f/l �� �Uhr�
(ihis sedqn neetl ipt D/e /wmpleted� A7lh/e�pe�mrt is v^aluetl at one hundietlWllars (5100) w IessJ
Polic umber: ��/� i /7�-�/DZ��
❑ I certify Iha� in Ihe performance of [he work (or 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, and agree that if I should
become bject to Ihe workers' compensa[ion provisions of Section 3700 0(
the Labor Code, I shall (o4iwit comp y with these provisions.
� � / 3-�d-�o
litdn' nalure �
WAR ING: F ILURE O SECURE WORKERS' COMPENSATION COVER4GE
NLAWF�L A SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES A CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I he�eby affirm that I am licensed under provisions o( Chapter 9(commencing
with Section 7000) ot Division 3 of the Business and Professions Code, and
m ns �s in (ull force antl eRect. �^ /� j
ia # � �� � L �--Zlass # l . � �/
% .-CrC.�_ ' .3 /b-- �
/ C actor's gnaWre Date
, CONST UC N LE ING AGENCY:
� hereby a irtn ihat there is a construction lentling agency (or the
pedormance o( the �ork fa which �his permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OW NER-BUILDER DECLARATIONS:
I hereby affrm Ihat untler penal�y of perjury that 1 am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
cons[ruct, alter, improve, demolish, or repair any structure, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuanl to lhe provisions of the Contractors
License Law (Chapter 9(commencinq with Section 7000) ot Division 3 of Ihe
Business and Professions Code) or that he or she is exempt therefrom and
[he basis for the alleged exemption. Any violation o( Section 7031.5 by any
applicant tor a permit subjecls Ihe applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the pmperty, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and ihe strucWre is not intended or
oftered for sale (Sec 7044, Business and Professions Code: The Contracbrs
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year o(
completion, lhe owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business antl
Professbns Code: The contracfors License Law dces not apply to an owner of
property who builds or improves [hereon, and who contracls for such project with
a contractor(s) license pursuant ro[he Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code (or Ihis reason:
SlgnaWre
305]-a6�3i0))
, �
Owner ID venfied by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Venfication of Ownership by (type o( tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby certi(y that no excavation five (5) or more (eet in tlep�h in[o wfiich a
person is requiretl to tlescentl, will he made in connection wiih vrork authorized
by this permit, and that no building structure, scaffdding, falsevrork, or demolition
or dfsmantling �hereof, will be more Ihan Ihirty-six (36) tee[ high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Ttle 8, Cali(omia Atlministrative Code).
❑ As owner-builder, I will no[ employ anyone to do vuork which would
require a permit from �he Division of Industrial Safety, as noted above, unless
such person has a permit �o do such work from the division.
ApPhtanl's Signature
Division of Industrial Safety Permii Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicant or present or fuNre building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of �he California Health and Safety Code requires, wi�h some
excep[ions, that a Business Plan be tiled with [he Costa Mesa Fire
Department by every business which has a[ any one time during a reported
year a quantity of hazardous materials equal to or grea[er than a weight of
500 pounds, or a volume o/ 55 gallons, or 200 cubic feet o� compressed gas
at standard lemperature and pressure�.
2. Does or will the appliwnt or present or future building occupant need to file
a regis[ration form (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Healih and Sa(ety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acuiety
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
tempera�ure and pressure�.
3. Does or will Ihe applicant or present or fuWre builtling occupanl need to
prepare an RMPP (Risk Management antl Prevention Progrem for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code pmvides that Ihe
Costa Mesa Fire DepartmeM may require �he preparation, certifca�ion and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials wi[h the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the California
Health antl Safety Code been fully complied with? ❑ Ves ❑ No
5. Does or will Ihe applicant or present or (uture building occupant require for
Ihe vrork which is the subject of this applicalion a permi[ for such conslmction
or motliLcation (rom the South Coast Air �uality Management DisMct or trom
any other air pollWion control tlisirict or agency? ❑ Yes ❑ No
(Section 658502 of �he Califomia Govemmenl Code requires that the requesietl
infortnation be fumished on applications (a non-residential building pertnits).
6. Will any part of the facility to be constructed under this permit be within
1000 fee[ from the ou[er bountlaries of a school? ❑ Yes ❑ No
(I/'yes", Ihe (acility must mee� the requirement of Sections 25534 and 42303
of Ihe Cali(ornia Health and Safery Code).
7. If a permit (rom the South Coast Air �ualiry Managemen[ Dislrict or olher
air polWtion control tlisMct or agency is required for the work which is the
subject o( this application, have all ot the disclosures prescribed by California
Health and Satety Code Section 42303 been matle? ❑ Yes ❑ No
8. (I( "yes", attach certifcate of compliance from the appropriate air pollution
control oKcer).
CERTIFlCATE OF COMPLIANCE: I certify that under penalty of perjury ihe
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state Ihat
the in(ormalion given is correct. I a9ree ro comply with all state laws and ciry
ordinances relating to building construction, and authonze representatives of
the City of Costa Mesa to enter upon �he above-described property for
inspection purposes. I agree not to occupy or allow occupancy o� any building
authorized Dy mis permit until fnal inspection.
SignaWreolleg j�� �DDIe
��
� An0 AuN nzeE ApO����� Oa�e
�'1'BSL'1'1�)
KS'.�•ident
.Ih'uICCI TIN
irc rcr[ificatc uT
�d Altr rrttioiz�'
Gcncrnl Inliu�nuLLiuu
Si�c Address: •22 �
Building'fypc I�Siuglc Family � Mulii
Cqi� itioned Ploor Area (CPA):
NO"/l: 7'Li.v.lnrm i.v no! tu hn �
liavrintinn V�rLee.s Por OPnqu�•
�ZL`31(�L'IIL18�
En(urcemenl Ageucl':
Circic [he From Orientation: N, E, S, N�, or degrees
°a�e ] of'
1! uf Slurierc
IYrojeci Type: ❑ Altcratiuns O bnvelope � Fenestration ]toof 0 HVAC
Replucemeni a� Chnn�;e Oul D Duci Repl�cemeni D U�ater Hea�er
Ncrnlr Cmia'�r��cted Iiuilding.r nrfldditinns
Purring ua�e7he Ala.f•e� ancl Fnuri��g S7rip.v Cnnsu-a�c�Ion mble
T
❑ Opening nl' 17•nmed cm�h' alone-Aliercuions dmi invoh,e �he opening o/�heJrau�ed caviry� o/n wall, ceiling, a_./loor musl install !he
maiduinrr minimum insedaiiai vnluc per,�'I50 (or �hc n6ered asa•emGlr. Fi!l in Cbfunms A-C ond en�er manda�w�r insufalion va/ue ui Cofumn H.
❑ Itepl�cement oi� entire assemblp- Replacemen� ofm� e�vire .ra!(, ceiling. orJlnor ussemb(�� re9uires Ihe insiullmion alComponen�
!'ncAanr- U in.ndnlion vnluee� in 7'nLle I51-C'. Fill in Column.+� A- J. .
ue Surface DetBils Ror t6e fun�ed
Assembly Name I Material
or Tvoe' and Size'
0
Spacing,
or Other3
rams see �� urnm� �c
� . 7�
nd:vd
U- dAA Table
atcowuino Jor Cominuous ]nsulatiau P-value, see Pnge
Cunstruclion Tuble beloH�.
Values From JA4
Framed Continuous
Cav�p� Insulation
] � .7
nble
]A4 Yrop
Assembly Asse
Cell Value6 U-fa
walls use the Masa and
1. Fa� Tng//D indica�e ihe idervi/icniiar narne tlra� nmiches the building plans.
2. Indicnie �he dssemblr Nnme a' ry, ye: Rao�/Ceiling, Walls, Floors, Slabs, Crawl Space, Loors and eic,..]ndica�e the Frame rype and Size: For
N�ood, Me�n/, Metal Buildings, Nlass, enter 2s4, 2xG, nr etc... see JA4 fnr olher posa'ihle ��amc rypc assemblies.
3. Erx�er !Le dvidmess jor musa� in inches a' Spocino 6envee�a {r�uming members erver; 1 G"or 14 "OC; or OUiei :for all other assembl�+ descrip�ion
ruch as Cro�crete Saradwich Panel, Symidrel Panel, Logs, Su�aH� Bale Panel avd eic.... .
4. Based an die Clima�e Zone; emer �he S�andard U-(aciw :irom Table 151-B, C or D(m� euch dij%rem assembl�� Nome or ry pe.
5. L•nier tfie Tablc number �ha� closelt� rea�emGle.+� d�e yropo.ved aa•e�embh�.
!. L•rmer ihe R-nalue dmt ia� Leing insialled in the wull cai�im w� betH,een (he fi'nnring; o�herwise, emer ..0,,.
7. Gmer lbc Cavinumis Insvinlian lio�nlue,fa� Ihe praposed as.reurGl)'; nlhe�m�isc, emer .'(1 „
d'. Enier tl�e ro�� ond cnlunm q/�he U-(ac�w� value Lu.red on Cotunm F TuGle NumLer and enter Ihe �lsse�n6lv U-(uclor in Colimm J
). The lb�uun.cerf �l.ssembh� U-%i�cim�, Cokrnm J, nm.v 6e equal io or lera� dmn �be Stnndrvd U-fuc�m� irr Column E ro comph�.
Fnrrin� 9trips ConsCivction Tul�leim' Mass Wtdls Only
A Ii C D � F G H 7 :( K L � M
I'rupused )h'operlies of Mnsuurl':md Cuncrele Addetl Interinr or lxterim' lnsul:diun
V��IIIIti FI'11it1 RL'�L'I'L'lll'P 111 ��Ill'1'lllh Sp�me ti�mn Relerencc
Auinl A>>endix 7�sible A3.$, 4.3.G. 4.3.7 Juinl A �endia Tnblc 4.3.13
b
�1 VL � 1 V
U J V 4t �
�; �i � c t ",:
Assem6ly �. J �.� �„ r f- G o,�v �.� °_ F`Inul
Mass N�unror JAd'In61r. e_ �_.`; q E �'- � '_ F �_ �� AsSciAbl�•
'I'hicknes: 'I y re' Wmn6cr ' = ui 5 � �= �. �t = p w c , U-�aClm�'� Cmnnlenl
� _�
�
� I '. I
liegis�ralian IJunvher: Rc�ia�u�uiinn Uaie/7'imc: }IERSYrnvider:
'l(l081iea�identiul Cnmpliuncr.Gorms Augu.ti 2009
ve
ce: Residenti�l
CF
3 of
ROOrING PI20DUCTS (GOOL ROOTS) §ISI(n12
Wheii Nia nren af ccle�iar rnoJsrsrface tn 6c repluced exceeds more t/�mr SO% oJ'ilra eristirtg roaf urea, or� nmre thrm Z,000 ft�, rv/tleHever is
less, !he neiv ronfing nrea nuist meel tlic rnnfrwg praduct "Cool R�o/" rerp�iremeuLr of§I52(b)IHi, I52(bJZHii, m' 152(b)7Hiii.
C/veele nppliciible n(ternntive a� eccepliai belorv if l/ie roof a6eration i.t� ezemp! fi�onr tl�e rooJing produc� "Cool Roof" reyuiremems. No�e: !f uny
one of Iha aliernafivra� or ezceptiw� belpe� is checked, !he Aged Solar ReJlectance qnd Thermul L•m(�tance reyuireme�ats jor �roqfing prroduet.v i��
,�S]!8(iJ are nol npplicab}e. Dn nol Qll �ab1e belnw,
❑ Cool Roofs NotRequired in Climate Zones 1-12, 74, and 16 with a Low Sloped. Less or 2:12 pitch, �
❑Cool RoofsNol Required in Climate Zones 7 through 9 and I6 with a Steep-Sloped Roofs (pitcli greater tl�an 2t 12) and product�unii weight less
than 516/h�.
Alternatives to §152(b)1Bi and §152@)Hii, Steep-slope roof (pitcli > 2:I2J �
❑ Insulation with a thermal Tesistance of a� least 0.85 hrft��°F/Bni or atleast a 3/4 incli airvspace is added m the roof deck
over an aflic; or
0 Existing ducts in the a(nc are insulated and sealed according to §151(�10; or
❑ Li climate zones �10, 12 and 13, with 1�ft��of-Ree�ventilation area of attic ventilation for every 150 ft� of enic floor area, and
n�here at least 30 percent of the free vemilation area is within 2 feet vertical distance of the roof ridge; or
❑ Building has at least R30 ceiling insulation; or
❑ Building has radiant 6arrier in the atlic meetine [he requirements of §I51(fl2; or
❑ Building has no ducts in the attic; or
❑ L� climzte zones ] 0, ] 1, 13 and 14, R3 or greater roof dedc insulation above vented attic,
Exception to §152(b)1Hiii, Low-slope roof (pite7< <_2:12)
❑ Building has no ducis in the attic.
Other L.xreptions
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cooi Rooi criteria.
❑ Roof constructions that have thermal mass over the roof inembrane with at least 25 ib/ft' is exempt from the below Cool Roof cr.
Note: If no CRRCJ label is availa6le, [his compliance method camiot be used, use the Perfonnance Approach to shov,� compliance.
Check the a licable boa below if Exem t from the Roofin Products "Cool RooP' Requirement�.
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number� < 2:12 > 2:12 < 516/ft� > Slb/ft� Ty e� Reflectance3'� Emittance
D n n n D�
❑ ❑ ❑ ❑ oq
❑ ❑ ❑ ❑ 04
n ❑ ❑ ❑ o�
n ❑ ❑ ❑ o^
SRIS
The CRRC Pr-odemf JD N�unber eau be ublanied Jrnrrr tl�e Cuo! JiaoJl(aling CwmG/'a' liqled Produel Dn'eclap� ol inrv���.cnolrouL+'.ore/nrnd� ch/.ti'emnl�
L�dicalellve ppe oJ/�rnd+ic! i.r Leing ti.reAjorllu• rnoJlap. LC..SIA�IL �)II'!"OOJ, OSJlIl9I1)'00%!))C10I1'ODf L'1C.
lf tl�c dged lte/leclnncc ia� nol avail�6le in.fhe Coolltonf Raling Cm�ncil'.r Italed Pr'odum Duaclor�� tlien use lhc Inilial lieJleclance vu/ue (r�oni Ihc smae
di�'celnr�� and i�se !he cg+mlimr (01+0.7(/liniii�n— �.2J la ablain n c�lc�daletl aged vaLm. N�Here p is lHe7nilial3'olar /iepeclmica.
Cheeh, boa i71hr dged Re(feclmme i.e n calcidn(ed oa(ue using Ihc eqimlion aLnva.
Calndota i6e SR/ ouluc hi� n.eint: ll�c S'lil- hVorkvhcei nl h�in'//�i��vu•.erierer.ca.emdli�lc24/and emer tlie rea�ad�ing value in Ihc Slil Colmnn nbnve mrd atlach acopp q/
16e S21- 19''nr'Iceheer m Ihe CG-Ilt.
:i ePpl)' Liquid T'ield Applied Cuntings, the conling musl be ap��lied across the enti[e roof surface and meel the dry mil thielcness or coverage
.commcntied by thc coatings manuf�mturer and meet minimum perCormancc rcquiremcnts listed iu ¢118(i)q. Select [hc applicable coating.
Alumiuum-Pigir�ented Asphalt Roof Couting
Cement-Based Roof Coating
Otl�er
Regi.vrniion Number: kegisb�ulion Duie/Zirner HEILS Provider:
2005'Reside��tial ComplinnceForms �
Augus� 2009
Ce.ri�ificnte of Cumpliance; Rexideutixl
7 It-AL,7'
lles'itlr�ziial dllenziiure.c (l'are 5 of 5)
1'rujecicVtm�c?'"""- —C:Iimril�Zw��k.....�.._..__ �i�`i.irs,b,
��b�� �l��e� � � �I " r'� �
fl�ItS V�H11PlCAT10IC SUMMAI'.)' TGe enJorceme�v ngene�-should pn,psuecitd auemion u� ll�c HLI;S ldeusw-e.s syecijied iu �hia
cirecldi.sr Lelore, ! conryleied nnd si�nedCF-4Jt Farm fa� u]l ihc nren.s�n�e.e specified shnl! be su'vmined rn ri�c 6uildi»g inspcc�or beforc finol
Lue! Se9liiip d'• 7�eSlinn 1-JlJ2Snu�ifica�io�ii.rrrtquircd,forlbi.rmciia�vrc.
b�YLS ❑ NO 1'CS�. lu Climme 'Lunes 2 tmd )-1 G, if more thuii 40 linenr feei o1 n::�r or replacemeni duc�r..ire insialled in uncnnditioued
space, the ductx arc to he seuled per �;152(b)1lJii .md [he newll' iusitilled dueic are ta bu insuta�ed per §151(1�110.
��XC�7'TJOn': Lxisfing duct systerns thsi� :ire este�ided, �sbicl� ;n�c cunstrucie[l; insolr�tetl m� �emletl ivit6 asLestus.
❑)'�5 � NO YL+S�. Li Climate'Lonec 2 Tnd )-1 G, if [he exlstin@ spuce-conditioniug sys�en� (HVAC equipmeni and duciingj is repineed, the
ducts are to he sealed pei � 152(b)1 Di. .
L] YES ❑ NO 1'ES:In Climate 2mies � and 9-1G, if [he existing AYAC equipmen� is replaced (ine)udinp the �replucemeN of the eiir handler,
owdoor conde��sing unii of �i splii sysieai, cooling a� helting coil, m� thc furnact heal e>:ehnn�er) th� ducts iut Lu be
sealed per §152(b)lE.
' � �- ' ❑�XCLPT)On: Duc� systems tLa� are Jocumented tu Lm�e Leen previ�uslf'senled confirmed tiv�onrL H�P.S
� �� � �� -� verilicatimi in �ceurdunec witL prucedures in �the Reterenee Resideniial Appendix �IiA3. - �
���� ❑��XCL�PTION: lluct systems with less thnn 4U�linear feet in uncuuditiuned spxce. �.
❑�SC�PT)O�': Esistin� dve� svstems conatructed. insul�ted or senled with asl�estus. �
��frle'2I'ant Chare2 - Spllt SyStetn HERS verificniion is require� /or �his measw�c.
❑ Y�S ❑ NO YES�. ln Climate Zones 2 and R-15, wlien the existine HVAC equipmeni is replaced (including tl�e replacement of the air
handlei, outdoor condensing uni� of a split system k/C or heat pump, cooling or heating coil; w the fumaee heat
exchaneeri a refrieerant charee meesuremem sliall be veri5ed oer $1:;2(611F.
Central Fan Inte�rated (CFI) Ventilation System and Fan �'att Draw
Th.> ve.ntilation remiir^ments oT F150(ol do not anolv to exisiine residential homes.
bucted Splii S,ystems - Air Conditioners and I-lea[ PumpS: AirIlov�• HERS rerijicaiion is reguired.(ar �his measurc.
❑ Y�S ❑ NO YES�. ln Climate Zones 70 througli 15, when the existio� space-condieioning system (HVAC equipment ancl ductingj is
reolaced. Ihe airflow and ian wan draw shall 6e verified ner � 1 S2(bl l Ci to meet the renuireinents of & 1� 1(f17B.
eclaraiion Statement
Name, � /e
Company:
Hduress.
�i�
�rat^ and
Signamre:
Lat�:
3-io - io
�lf Applicable Ll CEH or � CEYE
(CerCificntion tl!)'
'��,°°�7�� -9ai-/sc
7Lespuusi6le 13uildine Desi�ner's Decl.u':itiun Stxtemeni
� 1.im eligible widerDii�Ssion � af the CulifarniE� Busines:: =ind Yi�fessions Codc ia seeepi respvnsibifity Ibr �hc buildiug design identified on
Wi:; CcrtiLcme of Compliancc.
• 1 certiiy thal Ihe energy leauire:: antl perlarmunce specit�icationa for the building design identiLed on this CeriiLc���e of Compli�mec conlorm
tu th<: ruquircincn�s ol�Titic:�4, Ymi:. 7 rintl G of the Culilbrnia Cotlr of llegulatinnt:. -
•'fhe bnildin,; design leawres iciemiGcd on tlfu: Certii�ic�le nf Coinpllance .ire cunslstum wilh the ininnn�tiun provided tu ducument this
huildlug design on lhe olher npplle�i6lc cumpliunce ionnc: worl:shee�c, culculiuiuns, plfln:�, und spuciLca�ion:: s�ihmitlud u� tht enfurucmcN
ueeucr loi ziunrnrnl with th�s huildinpP�nnii unniicution.
Nxmc:
Compuny.
Adtiresc.
r md tiwt�slLi p:
Signaiurc:
Lutc.
I'iinne:
T�nr �ax.ei.etancc rn� ques�ions reg« rdin� thr Enaroi� Stand�o�d:; conu�cr ihc Z;neror 1Jut(inr «t: J-Sl1U_: i1-3 i00.
Itrn,ie�iraiionlJuuibm- __1(eglsu'aiionUcua/Tin�c' 1-1i:7;SPrai�ider.
Aop���ant to fill in all spaces ezceot those within heavy bortler lines ana sign a11 aoP�opriate tleclarations.
CITY OF COSTA M�$3 ONSTRUCTION PERMJT PE IT O. TRACT NO. LOT NO. . , UNIT NO.
1
Project Address
Applicant's Mailing Ad ress � _ �
��rnr'S Phone � '{
Owner's Name
Addreu
Arch/Eng. License No.
Address —
Contraclor's Nam ^ � ,�/ 1�p) ne _
Addreu (mailing) � q g'L`.7�1L �
City License No. _3.(/ ,�_
LICENSED CONTRACTOR DECLARATION
I bereby altirm lhat I am Ilcensetl untler provislons o/ Charter 9(wmmencing
wi[h secllon 7000) of DlviSion 3 O/ lhe Bu5ine55 antl Protesslons Code, antl
my Iicense Is in full o e ntl elfecL [�
Llcense c n �•�
Date Signature _
W00.KE S' COMPENSATION DECLARHTION • �
�hereby aftirm tnal I nave a certi/icate ot consent to self-insure or a certificate
( Workers' Compens5lion Insurance, or a�cartllie COpy [hereof (Section
e800, Lab.�`�n�.%�o
Policy No. �7 � ompany
erti�ietl copy IS �er¢by fumishetl.
�Certl iC c py is Illetl with lhe city B' n i' n
Date APPlicant '
EXEM 10 FROM WORKERS' COMPENSATION DECLARATION
(Thi55ecliOn neeG not be <Ompleletl i� lbe 0¢rmll is tor one huntlretl (5100) or
less). '
I cer[ify that in the pe�iormance Of Ih¢ wo�k to� whicM1 [M1IS pe�m�t is i55uetl, I
shall not employ any person in any manner so as to become subje<t to the
Workers' Compensatlon Laws o( California.
Date ' Signature
NOTICE: If, after making this tleclaraUon, you shoultl become suoject to the
Workers' Compensalion prOvisions of Ihe L2bo� Code, you must to�tM1wilh
comply with such provisions or this permit snall be tleemetl revoketl.
CONSTRUCTION LENOING AGENCV '
I hereby afltrm that there is a consV ucUon lenaln9 a9ency tor the performante
of the wark �for �whlch this permlt i5 issuetl (5¢ction 309] Civ. C.)
l.eneer's Name
LenEer's ACtlress
OWNER BUILDER DECLARATION �
I hereby aHlrm that I am exempt trom the Contractor's License law tor the
following reason (Section 7031.5 Business antl Professional Cotle: Any cily or
county whith reqUi�es a p¢rmit to const�uct, alter, imp/ove, tlemolish or repair
any sVucture, prlor to its issuance, also requires the applicant for sucn oermit
to file a Si9n¢tl Slatem¢nt that he/ShC is licensetl pu�suant to th0 P�ovision5 ot
the Contractor's License Law (Chapter 9(commen<ing with Sectlon 7000) oi
"�ivizion 3 ot the BuSinesS antl Prolessions Cotle) o� Ihat h¢/The is exempt
erefrom antl the basis tor lhe allegetl exemptlon. Any violatlon of Section
J31.5 by any applicant for a pe�mlt Subjet[5 Ine appllcant to.a civll
�+¢ndlty of not more ihan five huntlretl tlollars (§500).
LJ I, as owne� of the prope�ly or my employees with wages as thei� sole
compensation, will tlo the work, antl the. structure is not Intenaetl or o(feretl
tor sale ($ection 7044, Buziness antl Protesslonal Cotle: The Contractor's
License Law tloe5 not apply to an owne� of a p�op¢�ty wno bulltlz or imprOvez
thereon, antl who tloes such work himselt/heRal( or tnrou9h his or her own
CmplOyees, provltletl [hal such improvements aro not inlentletl or otferetl for
sale. It, howeveq the builtlin9 cr improvement is soltl within one yeai of com-
pletlon, the owner wlll have the burtlen of proving he/sbe tlitl not builtl or im-
�rova for the purposa of sale).
LJ I, as owner ot the property, am ezclusivety contractin9 with licensetl con-
(ldC101S IO COOSL(l1Cl 1110 pIOj2CL ($CCIIOfI %OQ4� BUSIl1C52 dlld PlOiE5510f15 COdC:
The ConVactor's License Law tloes nol apply to an owner of property who
builas or Improves thereon, antl who contracts for such projects with a com
lractor(sl Ilcense pursuan'[�[o tne�Contractor's License Law). I am aware that
proof o� tM1ei� Worka�'s Compensatlon in5urance sM1oultl be p�ovitletl lo me.
❑ I am ezemp[ untler Section B. & P. C. for Ihis reason
Date Owner _
1 hereby certify that I have read tM1ls
InformaHon is corretL I agree to comp
antl statc laws relating, to builtling con
sentativas of this It [o ent r upor
InspeGtlon p ( 6 � �
Signature
Orivers' License ar 55 #
CMF0865-4G,rev.4/84 WM1i[e-Builtl'
-� a� �2-
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. - _
TVPE OF P.ERMIT LJ GRA�ING OUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL
❑ OTHER '
PROJECT DESCRIPTION SQ.FT. OCCUPANCV—
CONSTRUCTIONTVPE .VALUATION$
ZONE GRADINGGU.VDS. ACRES_
Remarks:
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks '
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Dreins
Reinspection Fee
$75
Duct - Under Ground
Duct - Structural
Duct - Ventilating .
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO # �
Heating System & Ducting
❑ 0-100,000 BTU � 100,000 BTi
Reinspection Fee � $15
Canary - Applican[; Pink - Accaunting; Goltlentotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Pipin9
Solar Tank
Swimminq Pool w/Spa
Urinal
Water Closet
Warer Heater
Water Service
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration System
❑aioo,000eru ❑ioo,000
System Fepair/Alteration
Issue Fee
FE
$ 3
$ 3
A.P. #
S Main Building:
E
T Front
8 Rear
A
C Ri9ht
K Left
S
Ping. Ref. #-
Planninu Notes:
Automatic Washer
Construction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Fixares
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW C
Fae
0493 9/19/85
• Zone
Accessory Building:
, Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW .
Merer ❑up to 100 amps
Meter �over100amps
5KW
515
Sub Panel
Mamrs �0-1 HP �1 %- 8
Inc. Solar �9-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor .
luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building Approved By �
SUMMARV OF FEES -
BUI�DING PEFMIT $ SMIP
PLAN CHECK $ � PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% 3 ENERGV P.C.
ELECTRICAL g GF±ADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK Z5% $
$
SoQ� TL
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
5.
CONSTRUCTION AND PLANNING P��' 'PA
'APPFiOVALS Permit# � Date Inspector p�ppROVALS 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 Bontling
� 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � , 58. Electrical Conduit-Undrgmd.
S. Foundation � � 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Pr6perty 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
� i 6. Rough Electric Wiring 67. Fencing & Access Approval
17�. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-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 OGas ❑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. FIXEDSYSTEMFINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL lNSPECTlON
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Fi�al Electric Notes: ��+f�.Bd (,�^G�, � pu �•S y�, L.L.D
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. Sqlar pomestic-Final �
42. Backflow Preventer �
43. Backflow Irrigation . , , .
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
46. Special Requirements Completed
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
a
c�mY or cosz�a rv�s� x��v��s�r roiz occvP�ncY
TRACT NO,`�LSLL�..—
LOT N0. ZS- '
ADDI2ESS o3 � 1 z__Li%',�� l/ ,
DATE �P - 'T� �/
s
The developer oi the above entiiled traci desi�:es to sel.l i.he
above set iort}i lot prior to the time that the tYact has been
completed and its str.eets accepted by the City of Cost� Nesa
The 'unclersigiied, bp executiny ti,i� uyreement, acknotaieciges
that (he sh -they) SI�Z { as or were) ._(a1'd� advised
thai: thi.s tract has not been given fin�l inspection nor h�s
it been accepted }�y the City of Costa Masa as havi_ng complied
with ihe conclitions of approval which ��rere imposed by the city
at tlie time the iinal ir�ct map �vas approved.
The city assumes no liabiliL-y for the eniorcement of the conditions
necessary for appr.oval other than those conditions pYotected by�
s urety bond,
The undersignecl agrees to,indemni£y and hold the city harmless
xYom any claim resulting in dumaqe or personal injury to the
undersi.yned by reason of �he.aforemention uncompleted condition.
BY�� _
Purchaser
B&
Develooer and oY authoriz?G
tepYesentative
BY .
�Lender
OWNER
DATE �_lg_�Z
BUILDING PERMIT N0. 34975
o. LOT 25 TRACT 6695 FIRE ZONE VALUE $ 300.00
GAS
W ATER
ROUGH PLUMBING
PROP. SWR. LINE � HOUSE CON. �
SPftINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUN� � POWER �
ROUGH WIkING
TRENCHES � FORMS � STEE� qE
FLOOR SVSTEM
BOND BEAM � STEEL REINFORCE �
SNEATHING
FRAME AND FLASHING
LATHING — IN n OUT n
r rco oonwu rner
,CTURAL, FINFL
HEATING, VENT., REFRIG. AN� A.0
PLUMBING, FINAL ANO GAS TEST �
ELECTRIC, FINAL
F INAL
SUBCONTRACTOR
_ � 34975 PF`�an,42L,�:: ,.:�{�ui:s.a2
' , i v - �� �.-�, �
COSTA MESA BUILDING-SAFETY DEPARTMENT �
P.O. QOX 1200 COSTA MESA, CALIFORNIA 92626
pPP IC TION FOR BUILDING PERMIT
For Applicant to Fill in Complete/y R c i e ev DATE RECEIVED DATE ISSUED
BUILDINO �7 q ' G �f
AO�RESS �J /- ' �,; �M[4 �O� �
OWNEF � A.P. NO. � PER JT J��
MAIL / ` BUILDING �' V�� ��G
Z ADDRES � ]i 7/ ADDRESS
aU CITV � NOL y''7 TRACT ��. LOT4� BLOCK
ZZ
Q CONSTRU ION W 'Q
O � LENDER
am
J � BRANCH �
-�N OWNER �
m J ADORE55 ALUE
m ARCHITECT TEL. O
J Q OR ENGIN ER N
U N FIRE
wa ZONE TVPE GROUP
2 ADDRESS
aW
APPROV
W 2 CONTRACTOR � BV ATE —
J �
m Z
J p� ADDRESS ��
Z� CITV NO. ZON� P�� � BUILDING EW�� Q �� '�
TEL.
w� STATE ' CITV YARDSAPPROVED VARDSAPPROVED
y Q LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
7� SIZE NO.OF BLDCS. (FFOM C/l5T T)
OF LOT NOW ON LOT ROM FT.
USE OF '
EXISTING 6LDG. FT.
F SIZE OF f �/ NO. OF —
Z NEWBLDG, ROOMS STORIES L.SIOE FT. FT.
EXTERIOR WqLL ROOF µ�',•
V COVERING COVERING REAp �I FT./�`�' � FT. '
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
a MAIN BLDGS. ACC65. BLpGS.
a
Q (/a _ � VAR. # DATE
O �aiµ(/��/ C.U.P.� APPROVED
y APPROVED. l
J
z
p STATE
UI hereby acknowledga that I have �ead this apP��cation and sta[e .
� that the ahove information is corract and aB�ee to comply with
� all laws regulating buildinB construttion, antl I shall not employ
F any person in violation of the wOrkman's compensation laws of
m
y the Stata at California. �
ZI hereby certity that I am properly licensetl as a contractor untler SQ. FT. o
Me State of Calitornia Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR �
Chapter 9, antl that such licenus are In full torce antl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt from the provisions of the State of California Business ¢
VALUATION � m
antl Profas:� otle, Division 3, Chapter 9. 6,.() pERM1T FEE $, �
Signature ,��-�/�yw' m
Permlttee $_,! A/ PLAN CHECK $ E
P... _ � o
LL
• Authorizeq ent TOTAL FEE $
Z .
aU
�z
Z �
ON
a m
J�
J N
n] J
J m
a
U �
Z a
W �
aW
W Z
�O
mZ
J �
W w
� _
Z F
W �
N �
� �
; �? �,
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COS7A MESA. CALIFORNIA 92626
��nv -�E-7�'��0� a� *** 141.00
For Applicant to Fi!l in Completely APP�ICATION FOR BUILDING PERMIT
RECEI D D� R€CEIV�q DATE ISSVED
BUILDING 3322 ydyoming Circle � ,��oi�- (/
ADDPE55
PERMIT NO.
OWNEF Modular Technology, IRC. /a�P�N�� �^��'��
MAIL A�DR'ESs3322 Wyoming Circle ' �
ADDRESS 1 E. 1 th St.
TEL. TRACT LOTQ BLOCK
CITV Santa Ana No. 547-9673 6
�ENDER�'�NU.S. N3�I'.10112.1 B8.I71� W A�
X
BFANCH M�.in Office
A�DRE55 1 0 S. Broadway San Diego OwNEP M u1 r Technolo Inc.
VALUE
ARCHITECT TE s Residence 5 15�7�0
OR ENGINEER D 1llS N'� -ii64
FIRE _
ADDRESS 11 �d Ave. Corona Del Mar ZONE TVPE G
APPROVED
CONTRACTOP OkT12T BV DATE
Same •
ADDRESS �
Sd[Ile TEL. ZO NO.OF U E OF N /
CITV NO. P�� BUILDING
STATE CITY n YARDSAPPROVED YAROS PROVED
���. No. 2525�+9 LIC. NO. 1 l� MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS. (FROM GL STREET)
OF LOT 5p X NOW ON LOT -- FRONT FT. FT.
USE OF
EXI5TING BLpG. � D T. FT.
SIZE OF 1'78'� 5 f' NO. OF g 1 V FT. FT.
NEWBLDG. ROOMS STORIES L.SIDE
EXTERIOR WALL ROOF
COVERING PL'Y' P1.3T15 COVEFING Wood Shin IE REAR � FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DlSTANCE BET. BET. MAIN &
MAIN BLIX3S. ACCE55. BLDGS.
Construct new residence with attached VAR.# DATE �"� ��
C.U.P.# — S—�/f(� qpPROVED —{qT((/
APPROVED _ 1 _ � T
o �J
HOLD FOR SPEC L RE UIR�'•.T� ;•� c
I hereby acknowletlga ihat I have reatl this evP��cation antl stata
thet the above intormation is carrect end aB�ee t0 comply with
ell lews regulating builtling consttuction, antl I shall no[ amploy
any person in V�olation of the workman's compensation laws ot
tne State of Cal�fornie. / 7�/� y�y�j
I hereby certHy ffiat I am properly licansatl es e contractar untler / I SQ. FT. �O ✓
the State of California B�sinesz antl Professlons Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOR
Chapter 9, antl thet sue �censes ara in full force entl effect, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV:
em exampt irom the ro sions of the Stec t Califomia Business VALUATION
antl Protessions Cotl , D' islon 3 apte 9y_
B PERMIT FEE 5
sleneture ot . / /2 �'y�
Permittee � $��/l �/ J PLAN CHECK $ �
Authorizetl ABe�t TOTAL FEE S///�