HomeMy WebLinkAbout877 LIARD PL - Building Permits` �� CITY OF COSTA MESA
t�,��pMFq BlIILDING DIVISION
F�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754-5626
'a•��°'� PERMIT NUMBER. B11-00150
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 41806408 DATE ISSUED: O5I0512011
ISSUED BY: CAC
JOB ADDRESS: 0�;877;�LIARD�PL='� C� M�
vicinity:
Squares: 0
Suite/Unit:
Valuation: $8,985.00
SCOPE OF WORK: TEAR OFF WOOD SHAKE INSTALL 7/16" OSB INSTALL 30LB FELT AND LIFE TIME COMP SHINGLES. FAMILY
DWELLING AND GARAGE
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/lnspection Card
OWNER: CHOI,TONY
PHONE: 714-847-9693
APPLICANT: BRIAN WOLSKY
PHONE: 7'14-847-9332
CONTRACTOR: TOM BYER ROOFING
Address: P O BOX 771Unit:
City/State/Zip: HUNTINGTON BEACH, CA
ARCHITECT:
ENGINEER:
FEE SUMMARY
;.� �
Reroof Plan Check: $0.00
Reroof Permit Fee: $167.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 877 LIARD PLACE
City/StatelZip: COSTA MESA, CA
Address: P O BOX 771
City/State/Zip: HUNTWGTON BEACH, CA
License No.
License No.
PHONE:
Unit
.:R,,;p�.i�f:.:�:�
' Unit:� :
License No. 575002
714-847-9332
92647 CELL: "
PHONE:
PHONE:
CS. r'!Air/I.i.'I
: +�; �: r:�,
r.:s: �:•�t C tr:
:�ii�.
TOTAL FEES $168.25 � ='
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
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 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 fnal approval will result in the expiration of this permit.
-CO�E p. INSPECTION TVPE
�1616 fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
,203 Final Sign
Q04 Final Demolition
OpTE INTITIALS
x �-� 91 i rn��
CO�Ep INSPELPONTYPE
206 Final Mechanical
208 Final Plumbing
270 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
DATE"��"�' � INTITIpLS
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WORKERS' COMPENSq710N DECLARATION:
I hereby affrm under penalry af perjury one of the following declarations:
❑ I have antl will main[ain a certifwte of consent [o self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, /or the
pe ormance of the work {or which Ihis permit is issued.
1 have and will main[ain wnrkers' compensation insurance, as required by
se tion 3700 ot the Labor Code, for ihe per(ormance o( the work for which this
pertnit is issued. My workers' compensation Insurence carrier and policy
Carriec � I
T' tl raf be�mpletetl Aihe peimrt is valoetl at one nundretl tlWlars (5100) or less )
olicy Number: t� I V��
certify that in the performance of the vrork (or which this permit is
issued, I shall no[ employ any person in any manner so as to become subject
lo [he workers' compensation laws of California, and agree that if I should
become su6ject to Ihe Workers' compensa[io �' o( S ction 3700 0(
the Labor CoOe, I s 311 fbrth ' i co , these provisions.
� �
AOPliwnl's.- naWr
WARNING: FAILURE TO S WORKERS' COMPENSA ION COVERAGE
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 SECTION 3706 OF THE IABOR CO�E, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 oi the Business and Pmfessions Code, and
(� m is in tull force and effect.
�" �00'Z c�ass �� 3 �
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Dai_
CONSTRUCTION LE NG AGENCY:
❑ I hereby aKrm that there is a constructbn lending agency for the
pedormance of ihe aork for wfiich ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Sgnalure Date
OWNER•BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTR4CTORS LICENSE LAW (or Ihe following reason (Sea 7037.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improVe, demolish, or repair any stNCWre, pnor to its
issuance, also requires the applicant for such permi[ to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of ihe
Business and Pro(essions Code) or Ihat he or she is exempt therefrom and
the basis for ihe alleged exemption. Any violation of SeCtion 7031.5 by any
applicant (or a permit subjects the applican[ to a civil penalry of not more than
five hundretl dollars ($500).):
❑!, as owner o/ the property, or my employees witb wages as their sole
compensation, WILL DO THE WORK, and Ihe strucWre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner ot 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 oftered for
sale. If, however, the buitding or improvement is sold within one year of
compietion, Ihe owner-builder will have the burden of proving that he or she
did not build or improve �or purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
pmperty wfio builds or improves thereon, and who cont2cts for such project with
a contrector(s) license pursoant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Protessions Code for this reason:
SgndWre oa�e
005]-4fi(9/0])
Ovmer ID venfietl by dri., , ncense. ❑ Yes ❑ No _
t
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property taa bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:-
❑ 1 hereby certify that no excavation Me (5) or more feet in depth into wfiich a
person is required to descend, wiil be matle in connection wi[h work authonzetl
by this pertnil, and thal no building structwe, scaflolding, falsework, a demolition
or dismantling thereof, wili be more Ihan thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As ownerbuilder, I will not employ anyone to do work which woultl
require a permit from the Division of Industrial Satety, as noted above, unless
such person has a permit to do such work from [he division.
Appl¢anCs SignaWre Date
Division of Industrial Satety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or presenf or future building ocwpant need to fle and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safety Cotle requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cu6ic feet ot compressed ga5
a[ standartl temperature and pressure).
2. Does or will the applicant or present or (uWre building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceA��ons, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity ot acu[ely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
temperaNre and pressure).
3. Does or will the applicant or present or fu[ure building occupant need lo
prepare an RMPP (Risk Management and Prevention Pmgram for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certiication antl
fling with Ihe Fire Department of an RMPP by businesses which are requiretl
to register awtely hazardous materials with the Fire DepaAment.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Code been fuily complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
me vrork which is lhe 5ubjeCt of Ihis appliCation a pertnil (of SUch GonSlmction
or modification from Ihe South Coast Air Qualiry Management Dis�rict or from
any other air pollulion control districl or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications fa nornresiden[ial building pertni[s).
6. Will any part of lhe facility to be constmcted under Ihis permit 6e within
1000 feet from the outer boundaries o( a school? ❑ Yes ❑ No
Qf'yes", �he (acility must meet �he requirement of Sections 25534 antl 42303
of the Califomia Health and Safery Cotle�.
7. If a permit (rom the South Coast Air �uality Management DisMct or other
air polWtion control district or agency is required for the work which is the
subject of this applicatioq have all of the tlisclosures prescribed by Califomia
Health and Safety Code Seclion 42303 been made? ❑ Yes ❑ No
8. Qf "yes", a[tach ceAifcate of compliance from the appropriate air pollu[ion
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ormation given above is correcL I agree ro comply vrith all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceAify under penalty of perjury that I have read this applica6on and state that
the information given is correct. I agree to comply wiih all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed pmperty for
inspection purposes. I agree not [o occupy or allow occupancy of any 6uilding
authorized by this permit until final inspection.
- rretore'NLegaFBwner(s) te
� ��
AnGlor Aul ze0 AOO�i
Prescriptire Certiiicate ot' Compliance: Residenti
Residentia/ ALterutirnis'
.]'rujec� Namc: C7 '7 T �\ G tC f
Climate Zone i!
:F-1R-ALT
P��e l of 5)
N oT Storics
� �paque SuYl�ace Detail5 For the furred purtioned oTMass N'alls see Purrin�, Strips Construction Table belnw. �
r �A T U � C — D E . . F G H . - . .�. �- --J
Framing
Tag/ Assembly Name Material
ID� nr Tvoe� and Size'"
Nole: Far (orred nssembltes, accounting foi'
Thiclmess, Framei
Spacing, U- JA4 Table Cavity
or Othe�. facror' Numbers R-value
Insula�iort R-value, sre PaRe JA4�3 amd Eq:mtion 9-1. F
Insulation I Assembly I Assembly
R-Value' Cell Values U-facror°
use
l. Fa' Tngl/D indicate !he identi�cation name dxai mntches the building plans.
3. /ndica�e the Assemblr Nnme or ,rype: Roof/Ceiling, Wqlls, Flnors, Slabs, Craw! Spare, Doors and etc..lndicaie 1he Frame rype and Size: For
Waod, Mem(, Metal 13uildinga�, Mass, eiuer ?s4, ?x6, or elc... see JA4 (a� o�her possible framc ryye assemblies.
3. Exter �he tl�iclmess fa� muss in inches m� Spacing Genveen ('aming members emer; 1 G'ar 24 "OC; or Other for a(1 oNier assembly descrip�ion
such as Cnncrele Sandwich Pane(, Spandrel Ponel, Logs, Sn'aN� Bale Panel and e�c....
4. Bused on �he Climate Zone; enier the Standm�d U facia� fi�om Table 151-I3, C or D fm� each d�ererat assernbf�+ Name m� rype.
5. En�er Ihe Table num6er (hn1 closel7� resembles �he proposed ossembh�.
6. L•n�er �he 2-nalue Ura� is being insta!led in �he wa!l cpvitr or be�ween (he ('nrning; o(henvise, en�er "0 ".
7. En�er the Coniirtuous Luida�iar R-nalue jor (he proposed assemblp: otherwise, emer "0 ".
d'. L•nier �Ge rnN� and cnfumn of/he U-fac�or value Gased a� Calurnn FTuble Number and enier �he Assembly U-juc�m� in Column J
). The Yrapnsed Assemblr U facior, Cofwnn J, musi Ge equal tri or less �han rhe Siandard U-(acior in Column E io complr.
Fu�ring Strips Constniction Table for Mass Walls Onlv
A K C D E F G H ] .1 K L M
Propused Pruperties of Masonn• and Concrete Adde� Intei•ior ur I?xterior Insulaliun
N'ally i'rom Reference in Purring Space (rom Reference
Juint A entlix Table 43.5, 4.3.G. 43.7 Aoinl A iendia Table 4.313
U � u < V
m V O� 42 �
Aescmbly �- j �`c � F � � a,'� �' _ Pinal
u q u ..0
Maxs Nuine oi JA4 Table �_ �v � F q R o '� A Q_ " � Assembly
Thickness' 7' c� Number' S> _= ui = � 5 ,'_ r Q'" � c U-fuctorG'� Comment
� I
I I
Regi.sun�inn Numher: Registru�ion Uu�e/fime.' HGRS Pi'nvidcr:
200b' Residentiul Campliunce Fw-ms Augusi 1DOy
Prescriptive Certificate of Com�
Residentia! Alterations
Projec� Nnme:
Residential
Climere $one #
3 of
ROOrINC PRODUCTS (COOL ROOFS) §I51(n/2
Wlree Nre nrea of erterior rnajsurfitce m be repluced �ceed.r nmre tlrau SO% ajt/re eristing �oojarea, or nrore t/ran 1,000 j�, �vhichever is
lesa', (he ne�v roofing are�i mus/ uiee� the rnofing praduct "Coo! Roof' requirements oj§152(b)IHi, 152(b)IHii, or I52(bJlHiii.
Check app(icahle alternntive or ccception below if �he roojaheration ir ezempi fi�om the roofing produc� "Cool Roaf' requirements. Note: lJany
one oflhe alterna(ives w� �cepliae below is checked, Ihe AgedSolar Reflectance and Thermal Emifmnce requiremenis for roofingproducts in
1 8(i) are noi app(icable. Do noi fill mble be(ow.
ol Roofs Not Required in Climate Zones i-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
ool Roofs Not Required in Clima�e Zones 1 thmugh 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
Allernatives to §152(b)IHi and §I52(b)Hii, Steep-slape roof (pitch> 2ill)
❑ Insulation wiNi a thertnal resistance of at least 0.85 hrft��OF/Bni or at least a 3/4 ineh air-space is added to the roof deck
over an attic; or
❑ Lxistiog ducts in the atlic are insulated and sealed according to § 151(�10; or
❑ In climate zones 10, 12 and 13, with I ftZ-of free ventilation area of attic ventilation for every I50 ft of attic floor area, and
where at least 30 percent of the �ree ventilation area is within 2(eet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has fadiant bazrier in Ihe attic meeting the requiremenu of §I51(�2; or
❑ Building has no ducts in Ihe attir, or
❑ ln climate zones 10, 1 I, l3 and 14, R-3 or greater roof deck insulation above vented attic.
Ezception to §152(b)1Hiii, Low-slope roof (piceH <2:12) �
❑ Buildine has no ducts in the attic.
❑ Roofing area covered by building integrated; photovoltaic panels and solar thennal
, O RooT constructions tha� have thermal mass over the roof inembrane with at least 25
Notc: lf no CRRC-I
Product ID Numba�
�mpliance method cannot be used, use
t from the Roofin Products "Cool Rc
RoofSlope Product Weighi
< 2:12 > 2:12 < 516/ftZ > 516/
❑ ❑ ❑ ❑
�
0
0
0
�
�
0
�
�
0
0
0
u
v
v
0
are exempt 4om the below Cool Roof criteria.
ro
Aged Solar Thermal
'.eflectence�'4 Emittance
SRIS
TLe CRRC Pi'oduc� lD NumGer can Le obmined frorn U�e Conl ftoof Ra�ing Council's Raled Praduc! Direcmry al ww�v.rnolrovLs.orn/nroduc�s/searcH uhn
Indicale Ihe rype of prndircl is being used,for d�e roof lop, i.e. single-plp roof, aspha0 roof, u�em! roof, elc.
/flhc Aged Re/let�ance is nol availoLle in.U�r. Cool RoafRa�ing Cowrcil's Ra�ed Pr'ad�m! Direciop� Ihen use �he Ini�ial ReJleclance va(ue fr'om �Ge same
dir'eclnp� and use ihe equmion (0.1+0.7fpm�nr.l— 0.1J io obiain n calcula�ed aged vahrc. WXere p is �he Iniliol Solar Reflecmnce.
Check Goa' ifdie Agad Re/lec�ance is n ca(cula�ed v46ic using Ihe eguo�iw� above.
CalmJa�e Ihe SRl value br using Ihe SRI- Worksheel al hup'/hv�v r enerm�.ca rnv/�itle74/ond emer Ihe resu((ing value in Ure SR/ Cofumn a6ove and ar�acH acc
Ure SRI- IVorkshee� io ihe CF-1 H.
r apply Liyuid �ield Applied Cuatings, the coa�ing must be applied across the entire roof surface and meet the dry mil thickness or coverage
eommended by lhe coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
Aluminum-PigmentedAsphalt RoofCoating
Cement-Based Roof Coating
Other
Registrutiai Nnmber: Registration Date/7'ime: FlEItS Provider:
2008 Residen�iu( Compliance Fmms ' August 2009
� -.
Prescri tive Certificate oi�
Residential Alterations
. . Yrujecl Namc: T � �
�� d
ential
Climate
1 R-ALT
(Pa<�e � u1 5)
I �% uf $tories
H�I:S \'�I:1F1 CATI01� SUMMA3ZY Tl�e enforcemenr ngcnc;r shmdd pap specia! <me�v�ia1 +0 1he HL/iS Measia�es speciJiec! ur �hi�
checklis� l�elom. A ca�rpfeiedcrndsi�nad CF-4R Form fa� nl/ 1hc• mena�m�er e7�ecijieds6n// be subinived io fi��a bui/di�tg ineyecior LeI��"t- Jin�l
Duct Sealing � Te5t171b HL/iS „eri/iccnion is reqzrired fm �his mensure.
❑ i'CS ❑ NO l'c5: lu Climate Zoi�es'_' and 9-16, if' more tlian 4U linear feet of new or replacement ducis are insitilled in unconditioned
� space, the ducts ure to be see�led per §152(b)IDii and [he newly insiulled ducts are m be insulateA pei § 151(1110.
❑ L' XCEI'TIO�': Lxistine duct systems ti�a1 are ez[euded, rvhicii :u'e coustructed, insWa[ed or sCuled �vith asbestos.
❑ 1'�S ❑ NU )'ES�. ]u Climate Zones 2 and J-] G, if'the existin@ space-conditioning svstem (HVAC equipmem and duciingj is replaced, the
� ducts are m be sealed per § 152(b)1 Di, �
❑ PES ❑ NO Y�Sc ]�� Climate Zones 2 and 9-16�, if the exisling HVAC equipmeni is repleced (includmg the replacemen� 01 the air haodle�;
' outdoor condensi��g unil of a splii system, cooling m' heating coil, or the furnace liea� exchanger) tl�e ducts are to be
sealed per §152(bpE.
❑ EXCEPTION�, Duct systems thst are ducumented to I�ave Ueen previously sealetl confirmed tl�ruurli $�RS
- verification in vcca'dance }vitL prucedures in the Reference Residential Appendix ItA3.
� � ❑ EXCEPTIO�: Duct systems with less than 40 linear teet in unconditiuned space.� . .
❑ ESC�PTIOn: Existin� duct s��stems construc[ed, insulated m� sealed with asbestos.
Re1'rigerant Charge - Split System HERS veri/ica�ion is reguireci for �his measwe.
❑ YES ❑ NO YES: ln Climace Zones 2 and 5-15, wl�en the existing HVAC equipmeN is replaced (including the replacement of the air
handler, outdoor condensine uni� of a spli[ system A/C or heat pump, cooling or heatin� coil, or the fumace heat
exchanneri a refrieerant charee measuremene shall be verived ner §152(6pF.
Central Fan Inteerated (CFI) Venfi3ation S,ystem and Fan �'att Draw
The ventilation reauirements of F] SD(ol do not aoolv to existine residentiel homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: AirfloN� HERS,�eri)icmim, is reguired Jor this n,eosum.
❑ Y�S ❑ NO YES: In Climate Zones 10 through ] 5, when the existing space-conditioning system (H VAC equipment and ducting) is
renlaced. the airfloW� and ian watt drav,• shall be verified ner §] 52(b)1 Ci to meet the renuireinents of & 1� 1(f17B.
Locumentation Author's Declarafion Statement �
I certif�� that this Certificate of Compliance documentetion is accurnte and compleYe.
Name: � � q� , Sign
����f.�v� W
Company: -�
C✓ 00 r
Address: If Applicable � CEA m� � CEPE
� (CertiScation t!):
City/Staie/Zip: Phone:
Responsible Buiiding Desinner's Declaratior, Statemeut
� 1 am eligible under Divisimi � of the C�lifornia Business ancl 1'rofessions Code to accept responsibiliq� lor the 6uilding design identified on
Ibis Certificate of Compliance.
• 1 cerLify thai thc energy fea�uros encl performance speciGcltions for the building desipn identiiied on thia Cer�Ificate of Complieince conform
to thc requirements of Tille Zq, Par�s ] and G of the Calilbnil.i Code of ]te�ulations.
• The bu'dding design leatures ideniified on this Cenifmate otCvmpliance arc cunsisiem with the inionnation provided w ducumem this
buildin� design ou th: other applicable complianec fonns, woii:sheets, calculations, plans and specifma�iom: submlucd tu the enforcement
aeenc�' 1or approval with this buildinr permit applica�ion.
N;mic: Signaturc:
Companl': � Uate:
Hddress: � License�.
Cit}s�3tate/Zip: � Phmie:
Tnr rtr.ri,tzruree nr yuestrmrs regr�rdinb thc Lne�g,r Staridard.t, cnn�ucl !!ie E�eero r Hotline at: 7-b'0(Yi72-330(1.
Ifegis�rntion ldumGer: Ifegerrr�unn Darc/Timc: HEI;S' f'ro��iaer:
2(IOf! kc.s'icle��iiul Complia�cr Forms Auotr.s� 300J
�
il WILLIAMS INSULATION COMPANY
OF CALIFORNIA
1201 E. Hunter Ave., Santa Ana, California 92705
(774) 547-5148
THERMAL INSULATION CERTIFICATION
THIS IS TO CERTIFV THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
CURRENT ENEFGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24 STATE
OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Tract Name:
n
Lot No. �9 Tract No. �'��Z' Block No.
Street PL� ! .N� City
EXTERIOR WALLS:
Mfg. "T r� ��?� Thickness/Type
Ceil i ngs:
Batts:
Mfg. `�"�'= C�`��`•+ Thickness/Type
Blown In:
Mfg. Thickness/Type
Sq. Ft. Covered _
Floors:
Mfg.
Other
Mfg.
General Contractor
No. of Bags Used
Thickness/Type _
Thickness/Type _
California Contractors License No.
�et
SU
Date
R—
Value
R—
Value
R—
Value
R—
Value
R—
Value
R—
Value
�.i
Williams Insulation Co. of California ., .
California Contractors License No. 267522 Date "'"'"�f
;'/ /'
� )~�'� �''�i� Ss��:.
� Signature Title
JOB COPV-WHITE
BUILDING DEPARTMENT-PINK
GENERAL CONTRACTOR-VELLOW FILE COPV-GOLD
s��7�ti�g . -- .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
3357 � .2/a 3/.79
335i '2/13/79
3357 '0000447438
(��7�. 47C K TU
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APPLICATION FOR STRUCTURAL PERAfIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVEDBV DATERECE�VED DATEISSUED
BUI��ING �
ADDRESS
(+/O�� PERMIT NO.
OWNER j''O e Construction iA. II1C A'P' NO' �S 2.
MAIL BUILDING �/ �
ADDRESS 2101 E. Fourth St. 100 �+DDRESS �
TEL. TRACT LOT BLOCK
c�Tv S�ipta Ana No. 543-997
CONSTRUCTION W AD A P
LENDER
X
BflANCH
OWNER F'�01.2 Constsuction CO. IS1C.
ADDRESS VALUE //'�)�
ARCHITECT TEL S � 5 �'��
OR ENGINEER �teS—�11 ston ' S47-086
ADDRESS 777 S. Mdlil St.� �ZOS� OidR 2 ZONE TVPE GROU
/�y,�„., APPROVED
CONTRACTOR a'dnPS/+�c��lO�L' BY DATE
ADDRESS SaIi�
TEL. ZONE � NO.OF USE OF NEW � �
CITV
S� NO. P�� BUILDING
STATE CITY VARDSAPPROVED VARDSAPPROVED
UC. NO. Sa� LIC. NO. MAIN BUIIDING ACCESSORV BUI}L�DING
512E NO.OF BLDGS O (FROM C/LST,R�ET) L �ar r/
OF LOT NOW ON LOT RONT � kf' P Fr.
USE OF
EXISTING BLDG. N A S T O FT.
% /{
Separate permits are required for L SIDE � FT. V FT.
electric, plumbing and heating work. �
REAP FT. D FT.
USE OF BUIIDING AND WORK TO BE PEFFORMED OISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCE55, BLDGS.
[�(721 t of 41 S ZE—f GURP.� APPROVED
detached residence imits. �Rov _ r� 7
I �oreby eeknowladBa me� i n�a �aaa cnt. oacu�acio� ana sc,ce � LD FOR SPECI \L RFOUIRE\1FNTi
thet Me abova Informatlon is correet antl aprea to comply with
all laws reguletinp builtlln8 �onstruction, antl I shell not employ
any person In vlolation of Me workman'a eomponseNon lawa of
Mo Stato of Celifo��le. � /�
1 hareby cettify that I am properly Iicansetl ea a eon[reecor undar 2 549 SQ. FT.
tna Smto of Califo���a eusiness antl Profeulons CoCa, Dlvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapt6r 9, entl Net suc� Ileanses ate In f�ll tOtee antl Bt}eet, or I TiE PURPO6E OF 6TABl5HING A PERMR FEE ONLY:
am oxompt trom Ne provisions of iheState of Calitornle Buelnen VALVATION PERMIT FEE E
ontl Protessiona Code, Division 3, Chep r9. �r�
7� ///��. PLHN CHECK E ��
Slpnoturo o(�Z�w / � [
Pmmittoe � �� � � TAX E �
Authorized ABa^t TOTAL PAID E/ ��9
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�7 8-�3%21/79 245..00 -1u '
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COSTA MESA BUILDINGSAFETY DEPARTMENT �� oUYU44749tl �'M
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 � '''"' "-" '��
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVEO DATE ISSUED
BUILOING �
ADORESS
PERMIT NO.
OWNEfi A.P. NO.
MAIL BUtLDING
ADDRESS ADDRESS (' � ,��.tj
TEL. TFACT LOT BLOCK
CITV NO.
CONSTRUCfION W A P
LENOER
BRANCN %'
OWNER
ADDRE55 VALUE
ARCHITEGT TEL. 5 S
OR ENGINEER
FIRE
AD�flESS ZONE TVPE GROUP
APPROVED
CONTRACTOR BV ' DATE
ADDRESS
TEL. Z�NE � I NO.OF `1 USE OF NEW
CITV NO. P�� �' BU�LDING w,`���
STATE CITY �'ARDS APPROVED VARDS APPROVED
IIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILOING
SIZE NO.OF BLDGS (FROM C/lL S�TF3EET) U'QY PI
OF LOT NOW ON LOT FRONT TU
O" FT. FT.
USE OF �� O
E%ISfING BLDG. T F
Separate permits are required for L, SIDE cs � FT. o vT.
elec[ric, plumbing and heating work. 1
REAR FT. a FT.
VSE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BlDGS. ACCESS. BLOGS.
VAR. # DATE
C.U.P.�'+ APPFOVED
APPROVED %� � �i(.7
.7 ('I
I hereby acknowledpe ihat I heva raatl this applieation antl rtate °
�
t�at tha ebova information Is eorract entl aprea to comply with a
ell laws repuleting builtlln0 construction, anE I shall not employ
eny person in vlolation of Ma workmen'� compnnsallon lawa of �
the Stete of Cetitarnle.
I heroby certify t�et I em ptopnrly Iicensatl es e contractor untlar S0. FT. c
ihe State of Celifornie Businasa entl Professions Cotle, Dlvislon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOfl o
Chapter 9, entl Net �uch Iicenma era in f�il force enA eftect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONIV: `
em exampi from Me provlsiona of the Stem of Catifornia B�sinau ;
VALUATI PERMIT FEE E
entl Profasslons Coda, Divlalon 3, Cho vr 9. u
C
PLAN CHECK S ^
Sipnaturo of �
Permlttee $ TAX 5 u
�
Authorizetl Agant TOTAL PAID E 5