HomeMy WebLinkAbout2041 LAURIE LN - Building Permits 04
CITY OF COSTA MESA
A ,6 BUILDING DIVISION
r a l$ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: 13C09-00518
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 02/10/2010 -
ISSUED BY:
JOB ADDRESS: 2041 A LAURIE LN CM Suite/Unit: A
APN: 42619123 Zoning: ,
Vicinity: Primary Occ:
Const Type: V-B SQ. FT: 220 Valuation: $22,328.00
SCOPE OF WORK: ADD 220 SQ FT TO AN EXISITING DUPLEX. ADDED SQUARE FOOTAGE WILL BE FOR A NEW ENTRY WAY
AND EXPANSION OF AN EXISTING DINING ROOM. REMOVE BATHROOM SINK,TOILET SHOWERS AND KITCHEN SINKS AND
REPLACE. NEW EXHAUST SYSTEM IN THE KITCHEN. NEW OUTLETS IN THE ADDED AREA
1 KITCHEN 2 LIGHTS 4 OUTLETS 2 SWITCHES 1 BATHTUB 1 SHOWER 2 KICHEN SINKS 2 WASHBASINS AND 2 TOILETS
OWNER: ROTHSCHILD,TYRONE Address: 2041 LAURIE LN Unit:
Phone: 949-645-4222 City/State/Zip: COSTA MESA,CA
C09-00518
APPLICANT: ROTHSCHILD,TYRONE Address: 2041 LAURIE LN Unit: :
Phone: 949-645-4222 City/State/zZip: COSTA MESA,CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Phone: Address: Unit:
Cell: City/State: ZipCode
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $236.11 2t'
Building Fees: $363.25
Electrical Fees: $32.30 • 'EW ENTRY WAY
Mechanical Fees: $34.15 r'*-rd SINKS AND
Plumbing Fees: $78.40
SMIP Residential: $2.23 'i < f•OILL';'S
SMIP Commercial: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES: $747.44 .r
**Refer to fee receipts for all fees paid for project
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
'CODER. INSPECTION TYPE PATE INTRIALS CODER INSFECnON TYPE DA1F, IN''AL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical ,-.f.'T n.v 'i,f,y
1266 Pool Spa Final 208 Final Plumbing 1 I I
S 1 (o''/I
:200 Final Re-Roof 210 Final Electrical
'201 Final Block/Retaining Wall 212 Final Fire Prevention
•
7202 Final Factory Fire Place 220 Final Planning Approval
204 Final Sign222 Final SiteJ I -
204 Final Demolition 250 Final Building/Occupancy S I t7
e416
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver/:'. a license. Cas El Ncy
I hereby affirm under penalty of perjury one of the following declarations: Drive s.License No.( Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' c� ((
Verification of Ownership by(type of document,i.e.any tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(Thu section need nor be completed dthe permit is valued of one hundred dollars(5100)or less.) 2 Art 2,Sec.341,Title B,Califomia Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicants Signature Dale
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicants Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ElYes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. if a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attachmertificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
C'❑7
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
PP,' n _• ',- tej
. 2-4-1-1/)
//9 _4 natu�of • er( �Jo A Date `�
_ Sign t---- il—Date `J' I Pr 1 � 7// e
3057.46(3/07) ��'. Ghon i/ n1/
�.anaa�mm�onze•Applicant 1/4.—..:: ra
City of Costa JVlesa Bui&cfing Division
a........._
'
Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # E C og0(j h Ig
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit pas been submitted in your name listing yourself as the Wider of the p „/
property improvements specified at ;CO LI- I L Q U ( I P lame , (o S TA-s es& I ZQj7
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
11J0 t. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
uilder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
an am aware of the limits of my insurance coverage for injuries to workers on my property.
I understand building permits are not required to be signed by property owners unless they are
res onsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
1-1\J 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
dor tzt
r name instead of my own.
. I understand Contractors are required by law to be licensed and bonded in California and to list their
iic se numbers on permits and contracts.
. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
ber nsidered an "employer" under state and federal law.
a 7
we 6. I understand if I am considered an "employer" under state and federal law, I must register with the state
.nd federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
Al-2c . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
Si. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
c.n ruction defects in the workmanship or materials.
• 1 t. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
'evenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
Xabo t licensed contractors.
` I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financial) responsible for proposed structi tivity at the following address:
0 LI I L4c, (, e co ('n5-f "J4- • ( r�(�I�Co �
�(�l 1
( 11 . 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will
abi.- by all applicable laws and requirements that govern Owner-Builders as well as employers.
--\--•.4 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarizatio or other ver- - - ion acceptable to the agency is required to be
presented when the permit is - -d to v- - . e pr• •ert owner's s'. • -ture. /
Signature of property own-r- SOS" rDate: 2 i O /
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address: 20 4 1 ( GC (n_✓ 1 e L. N . CoS tA: nes 4 ,1C Q `7 zQ z f
Name of Authorized Agent: Pe fo �0 +1i A : L 0 Tel No V'tI7 lP U'/ 14222
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form
notarization, or other verification acceptable to the a•-• y is required to be presented when the permit is issued
to verify the property owner's signa -.
Property Owner's Signature' /y i __ Date: 2/ I 0 / I 0
3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2
/' '
CITY OF COSTA MESA
ffsuss BUILDING DIVISION
ge
Fy '-,)aS 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�. iFOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B10-00067
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42619123 DATE ISSUED: 03/11/2010
ISSUED BY: RMD
JOB ADDRESS: 2041 LAURIE LN CM . - Suite/Unit:':•
Vicinity: HOUSE AND GARAGE ROOF _ -
Squares: 3500 Valuation: $7,980.00
SCOPE OF WORK: TEAR OFF(E)'ROOF MATERIALS, INSTALL 1 LAYER OF 15#FELT ON A 4:12 PITCHED ROOF AND REROOF
WITH COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE,APPROX 35 SQUARES. REPAIR AND REPLACE
SHEATHING AS NEEDED.COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. - -
OWNER: ROTHSCHILD,TYRONE; ,, - • - Address: .._ 2041 LAURIE LN Unit:
•
PHONE: 9489-645-4222' '- ' - - City/State/Zip: COSTA MESA,CA
•
APPLICANT: HANSEN, DUKE - - ' Address: N6646636 -- Unit: :
PHONE: 714-412-7223 City/State/Zip:
•
CONTRACTOR: ROSS AND BARROWS INC - "- - License No. 327802
Address: 260 E ALTON AVEUnit: - - PHONE: 714-557-7440 -
City/State/Zip: SANTA ANA,CA 92707CELL:
ARCHITECT: License No. PHONE:'
ENGINEER: - License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00,,_
Reroof Permit Fee: $153.25 `
Reinspection Fee: $0.00 - -
•
Bldg Std Admin Fund $1.00 .
TOTAL FEES $154.25
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. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No. 92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t INSPECTION TYPE DATE INTITIALS CODE II INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final f 208 Final Plumbing
200 Final Re-Roof 3 JI tt_A(�j(_rLjtJ 210 Final Electrical
201 Final Block/Retaining Wall - 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver s license. ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: . Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend, will be made in connection with work authorized
C-arrier:�
77U<�) by this permit,and that no building structure,scaffolding,falsework,or demolition
(✓ 'P or dismantling thereof,will be more than thirty-six(36)feet high. (Chap. 3.2,Gry
(Th sepronn ed not be completed 4the pemsf is valued at one hundred dollars($100)or less.)
2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number: Ci��S .s S �Zit
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
th Code, I shall forthwith comply with these provisions. Applicant's Signature Date
w -7/ �jZ7 Division of Industrial Safety Permit Number:
Applicant' ignature / (fault.. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. �7 p a registration form for acutely hazardous materials? ❑Yes ❑ No
Z7 / i2Z Class`# % ! (Section 25533 of the California Health and Safety Code, with some
./ �` Dale
exceptions, requires registration with the Costa Mesa Fire Department ly
each business which at any one time has on hand a quantity of acutely
CCtntractor's Signature Dale 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement
(Secthat he or she is licensed pursuant to the provisions of the Contractors
infor ion 65850.2 of the Califomia Govemment Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the nformation be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044. Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees. provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of Legal Owner(s) Dale
Signature Date
3057-4613107) // !
Andlo `mthl"zed Applicant
•1'rescriirtive Certificate of Compliance: Residential CF-1.12-AL,T
Residential Alterations (Page 1 of 5)
14:J,I 711Ta ne� ,Q ablaut-It Zone N / I II o1 cries
/ L/dt/,t, e ✓✓• /C/
General Information
Sit ildress: ^t D lJ( 40_11.40,,e, A� I Lrioreement AgeiieJ•: MN z/_ Mutt: i/// //D
Building Type ertg7-7r-"Famig'' ❑Multi Family + Circle the Front Orientation:N,E,S,CW,00r degrees
Conditioned Floor Area(CPA):
Project Type: 0 Alterations 0 Envelope 0 Fenestration 6fhoof 0 HVAC
Replacement or Change Out 0 Duct Replacement 0 Water Heater
NOTE.'This_Jnrnr is vol iv he used fin Newly Constructed Buildings nr Additions
• Insulation Values For Opaque Surfaces(for Furring use the Mas.v and Furring Strips Construction table beton)
Assembly Alteration
El Opening of framed cavity alone-Alterations that involve the opening of the framed cavity ofa wall, ceiling, inflow-roust install the •
mandatory minimum insulation value per§1501or the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column H.
D Replacement of entire assembly-Replacement of am entire wall, ceiling,or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A-J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
•A 11 I C 'P ' I's ' - F I G { H 7 • ,1 •
Proposed bet hate I Standard i Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
ID' or Type' and Size2 or Others factor's • Numbers R-value'' R-Value' Cell Valuer U-factor9
' .Note:For jarred assemblies,accounting for Continuous Insulation 12-value,see Page JA4-3 and Equation 4-1. For calculating,furred walls use the Mass and
i Fuming Co:au-action table helm,.
I.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass,enter 2x4, 2z6, or etc...see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter, 16"or 2e"OC,'or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc....
4.Based on the Climate Zone,-enter the Standard U factor from Table 151-B, C or D for each different assembly Name or type.
5.Enter the Table number that closely resembles floc proposed assembly.
6. Enter the Ii-value that is being installed in the wall cavity or between dye framing; otherwise, enter "0",
7. Enter the Continuous Insulation 17-value for the proposed assembly; otherwise, enter "r
1
8.Enter the row and column of the U facto'value based on Colvin!)F Table Number and enter the Assembly U factor in Column J
9.The Proposed Assembly U facto, Column 1, tuns/be equal to or less than the Standard U-factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A ( It c u 1 It F 1 C 1 11 I 1 K L M
Proposed Properties of Masonry anti Concrete Added Interior or Exterior Insulation
Walls From Reference in'Furring Space trona Reference
Joint Appendix Table 4.3.5,4.3.6.4.3.7 joint Appendix Table 4,3.13
U itG 1 - U
--
Li.
Assembly . a ,e, ° I- G u,..= I Final
Mass HMV 01 JA4 Table .; ` 'ti. 5 2 R c Tr '_ ' Assembly
Thickness Type' Numb& _ •,': < g li; 2 ti G [ < T m r U-factor' Comment
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Registratum Number: Regisu'amun Doe/Time: HERS Provider:
2008 Residential Compliance Forms August 2(109
•
• Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 3 of 5)
1'rojeck-.Name: Climate Zone ti it of Stories
O (1 ( j-..4e/A-lee X-,J ko
.. ROOFING PRODUCTS (COOL ROOFS)§251012
When the area of exterior roofsotface to be replaced exceeds more that 50%of the existing roof urea,ar more than 1,000/12, whichever is .
less, the new roofing tree must meet the roofing product"Cool Roof"requirements of§152(h)1Hi, 1 S2(b)]Hii, or 352(b)1Hiii.
Check applicable alternative or exception below if the roof alteration is exempt front the roofing product "Cool Roof"requirements. Note:If any •
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in
,,§118(i)are not applicable.Do not fill table below.
0 Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
item of Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 51h102.
Alternatives to§152(b)1Hi and §152(b)Hii,Steep-slope roof(pitch>2:12) •
O Insulation with a thennal resistance of at least 0.85 hrft2•°F/Bm or at least a 3/4 inch air-space is added to the roof deck
over all attic;or
❑ Existing ducts in the,attic are insulated and sealed according to§151(010;or
❑ In climate zones)0, 12 and 13,with)ff offreeventilation area of attic ventilation for every 150112 of-attic floor area,and - - . .. -.._- ...
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
❑ Building has at least R-30 ceiling insulation;or
❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or
❑ Building has no ducts in the attic;or
❑ In climate zones 10, 11,13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§252(b)2Hiii,Low-slope roof(pitch 52:12)
O Building has no ducts in the attic.
Other Exceptions
0 Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
O Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft'is exempt from the below Cool Roof criteria.
- Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofing Products"Cool Roof'Requirement.
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number' < 2:12 >2:12 < 51b/ft' > 51b/ft' Type ReflectanceA Eminence SRI5
❑ ❑ ❑ 0 ❑4
❑ ❑ ❑ ❑ ❑4
❑ ❑ ❑ 0 04 .
❑ ❑ ❑ 0 ❑4
❑ 0 0 0 ❑4
• _ _, I L
I. The CRRC Product ID Number can be obtained frain the Cool Roar Rating Council's Rated Product Directory cut www.caolroofi'.orq/products/.rearch.plrp
2. Indicate the type of product is being used for the rooftop,i.e.single-ply roof asphalt roof metal roof etc.
3. If the Aged Reflectance is not available intlie Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value front the same
directory and use the equation(0.2+0.7(pemu&-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4.Check box if the Aged Reflectance is a calculated value using the equation above.
5.Calculate the SRI value Int using the SRI- Worksheet at hitt://wnv'.energy.ca Rne/tiac24/and enter the resulting value in the SRI Column abate and attach acorn of
the SIO-IVorksheet to the CF-11t.
To apply Liquid Field Applied Coatings,the coating must he applied across the entire roof surface and meet the dry toil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating I❑ Cement-Based Roof Coating 0 Other
•
• Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms • August 2009
_Prescriptive Certificate of Compliance: Residential CE-7R-ALT
_Residential A Iterations (Page 5 of 5)
ldrn eef uce / ! / / (jClirai-r'Zonc it /6 f 1,'i0]`s't�i•te
g t [ L.4 e/iLit /�1j,-
}1EI:S VE/OF1 CA Ti ON SUMMARY The enlo eenrem agency should pmt special menton in the HERS hdee surer specified iu this
checklist below. A completed and signed CF-41t Form for all the measurer specified shall be submitted In the building inspector before final
_inspection.
D uct Sealing & Testing HERS verification is requitedfor Ibis measure.
D YES 0 NO YES:1n Climate Zones 2 and 9-16,if more than 40 linear led of new or replacement ducts are installed in unconditioned
space,the ducts are to he sealed per {152(b)1Dii and the newly installed ducts are to be insulated per (:l51(1)10.
O EXCEPTION:Existing duct systems that are extended, which are constructed,insulated or sealed with asbestos.
❑ YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(}]VAC equipmem and ducting)is replaced, the
ducts are to be sealed per §152(b)1 Di.
❑YES 0 NO YES:In Climate Zones 2 and 9-I6,if the existing HVAC equipment is replaced(including the:replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
' ..''verification in accordance with procedures in-the Reference Residential Appendix i 3.
0 EXCEPTION:Duct systems with less than 40linear feet in unconditioned space.
❑ EXCEPTION:Existing duct systems etinstructed, insulated or.sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for this nreasLn'e.
0 YES 0 NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b11F.
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of I1150(o)do not aooly to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required.for this measure.
- D YES 0 NO YES:In Climate Zones /0 through I5,when the existing space-conditioning system(HVAC equipment and ducting)is
• replaced.the airflow and fan watt draw shall be verified Der§152(6)1 Ci to meet the renuirements of§l51(fl7B.
IDtcumentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and corn e.
Name: Signature:
Company:�a fs !/✓/�`�iDG� Laic: ���/ G _
Address: 6 s 77--- If Applicable 0 CEA or 0 CEPE -
Z ��l C /� l�- / (Certification II):
City/State/Zip: , Z '7 9 „09,,,27,.., C--✓� 7 7i-71� Phone:(>ty 53 7-7 o
Responsible Building Designer's Declaration Statemeal C/
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility For the building design identified on
this Certificate of Compliance.
• I certify that the energy Features and performance specifications for the building design identified on this Certificate of Compliance conform
to the tequirente is of Title 24,Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Conuplianec pre consistent will,the inlnrnrtnion provided lo dueument tins
building design on the other applicable compliance buns,worlslieets,calculations,plann and speuilicatiuns suhndtted w lbt: enforcement
agency lo: approval with this building permit application.
Name: l Signature:
Company: Late:
Address:: License:
License:
City/Sone/Zip: I Picone:
•
lot assistance or questions regarding the Energy Standards, contact the Energy Hotline at: I-80P-772-33011.
le P,',,lranall h4nnber . Regis iron on bene/Time• HERS P row ler:
OWNER SEWELL, Richard DATE 3-15-72
JOB ADDRESS 2041 Lauri me, A&B 1ILDING PERMIT NO. 34343
GENERAL CONTRACTOR Same DESCRIPTION of WORK Duplex w/att,garages
AP No. LOT 6 TRACT 7714 FIRE ZONE VALUE $ 32 000 00
INSPECTIONS Signature Date GROUP lea TYPE V ZONE R2-CP
SOIL
IV" ; 'YC—72_ PERMITS ISSUED
GAS SUBCONTRACTOR -
Date I Number Signature
WATER .li PI bing
ROUGH PLUMBING _ "!V/i/taJ!z�'yEt./✓�w , a`r , /�AQ- 01! 60/ 7 ,------
PROP. SWR. SLINE YSTEM SE C0 %�f/� / 'attics _v 7-a/-- /e /,
SPRINKLING SYSTEM Sc4 Z i ./ - • 6J�Q �9r (41sse ,,j�'
MISCELLANEOUS q� rt+ i /
ROUGH HEATING AND AIR CONDITIONING /r/ 3 3' It'-72.,
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER u
ROUGH WIRIN ' / " #•/ Heatin• an. lent., /`
TRENCHES AA FORMS 'A STEEL RE INF. Cr- - r- ' -r1 Lam / I�Jy,�IU :lrfi�'L�91.'6.F/Lii7.
FLOOR SYSTEM ° , i' igr Z�O /
BOND BEAM ❑ STEEL REINFORCE Fi
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' , ,F
SHEATHING / 4-FRAME AND FLASHINy' GLATHING -- IN ISI OUT [ ni"(PLASTER, BROWN COAT �
STRUCTURAL, FINAL
HEATING. VENT., REF RI G. AND A.C., FINAL M- �I�i-2---72, aler. I�'�� " 5 ,7 3•
PLUMBING, FINAL AND GAS TEST 1^1 el` F/�j y " Zi
ELECTRIC, FINAL A' c) IG ' '
n H. a ,i 2L
•
6 34343
PAI.
'AP 1 -72c�c-00 537* *** 161.99
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •
_
APPLICATION FOR BUILDING PERMIT—�� 7 Y
For Applicant to Fill in Completely RECE)VED BY DATE RECEIVED DATE ISS_ UEDBU _ _
ADILDING DRESS A07� /7 hi �.p/le, e. Zak es �Z-/ `A7�S�r-�/ ��
/nr // A.P.NO. PERM:54g .3
OWNER ./ l VC-VCJ e/ / / ,1��/7 r
MAIL 1 r j y ADDRESS „4.0e8 As ZAI)��E •G,'
ADDRESS ?� A /- /T S/
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00. Z CITY (yS'4G. /vtr✓c NO 5/' l TRACT //� LOT 6 BLOCK
Z Q CONSTRUCTION 7 NEW ADP._ ALTER REPAIR MOVING OEMOI ISH
ON LENDER
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J N BRANCH OWNER �s� 5E ^'r,/
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Q W ADDRESS err
/� �r �/'�( VALUE /J
m 03 ARCHITECT J1 ) c TE1yl,/,{�'( USE !/�h'�-/� $ :7),','�/`�.��--.�■_
JQ OR ENGINEER/ICC/ '44 d, NOf rani?
ZQ //. ,y , //'' FIRE ..yam• 7 \ /
W cc ADDRESS ,&d/G rn.„y�6//ry ,(,f ZONE TYPE J� GRO UP.T9
d W APPROVED
W Z CONTRACTOR �/ 'yer / BY DATE
J Q
m73 Q ADDRESS fi3y/ .1= /7 :97—Lu NO.OF �7
0 W / TE[l,.[, Z PLANS Z BUILDING USE OF NC ��
Z1- CITY ! Al7 NC 241,4e� �.�
W0 STATE j'{'//
y 2 CITY YARDS APPROVED YARDS APPROVED
LIC. NO.2 4.0,5-6P/ Y LIC. NO. MAIN BUILDING •CCESSORY BUILDING
D O SIZE NO.OF BLOCS. (FROM C/LL SSfT_REET)
OF LOT NOW ON LOT FRONT G./` FT.0 FT.
1/��/
USE OF
EXISTING BLDG. q SIDE 1.0 FT.
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE S FT. / _ FT.
UEXTERIOR WALL ROOF /0
_ COVERING COVERING - REAR FT. O FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& �/
CL ^I,(L/�/Il'�✓/,Js�/ rye—
_ MAIN BLOCS. I' ACCESS. BLOCS.
Q _cl V /� VAR.# DATE
OC.U.P.# APPROVED n//����,.
~ APPROV 7V
V) _$Y �/ DATE /2. 9Z
ZO STATES
UI hereby acknowledge that I have read this application and state r O'7//j/
that the above information is correct and agree to comply with f /�
CC all laws regulating building construction, and I shall not employ
I- any person in violation of the workman's compensation laws of TAS
N the State of California. n m
9� APA Y
Z I hereby certify that am properly licensed as a contractor under O1� SO. FT.(p] �/, f5D4 O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN U E,R VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLIS INC A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9. PERMIT FEE $/ •-•-n6 'D N
Signature of ��yi, O
Permittee 114_14_ Ate" �"- $ Cw PLAN CHECK $ �� Z� E
A mitre
nub!) FOR 5 fr. -lA KL,Q lAtMc.N. Ji N. 9 o
�n ✓ / TOTAL FEE $/5 �/ ..- LL