HomeMy WebLinkAbout375 20TH ST - Building Permits�.
- CITY OF COSTA MESA --"
BlIILDING DIVISION
i` . � 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
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PERMIT NUMBER: BX09-00238
PERMIT TYPE B MISC STATUS: ISSUED
APN: 42630406 DATE ISSUED: 03/08I2010
Zoning: , ISSUED BY: �j3
JOB ADDRESS: �. _375 E 20TH ST CM i Suite/Unik
Vicinity: REROOF'REPITCH'SFD Primary Oca -� Const Type :??
SQ. FT: 0 Valualion: 515,000.00 , ., .
SCOPE OF WORK:
THE ROOF OF THE EXISTING SINGLE-STORY 1228 SF SFD WILL BE RE-PITCHED AND REROOFED. COVER WITH 30 YEAR
COMP SHINGLES. REF: BC09-00449
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
City/State: COSTA MESA, CA �
Phone:
APPLICANT: LAKE, LYDIA
Ciry/State:
Phone: 949-514-4066
CONTRACTOR:
Address:
City/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address:: 373 E 20TH ST
Zip Code: 92627
Address:
Zip Code:
- � License No.
Phone Cell:
License No.
License No.
$163.31
$251.25
$0.00
$0.00
$0.00
$1.00
Unit
Unit:
Unit:
TOTAL FEES $415.56
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3N8/2070 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Day, Memorial Dav. Indeoendence Dav, labor Dav, Thanksqivinq Dav and Christmas Dav
NOTICE: The vrork 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.
INSPECTIONS: In order for the work auihorizetl 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.
0/ INSPELTONTYPE OqTE INTI� � INSPEGiIONTYPE DRTE INiRIALS
1876 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 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 FinalSite �
204 Finat Demolition 250 Final Building/Occupancy X �g b b�
WORKERS' COMPENSATION DECLARATION:
I hereby a(frm under penai�y of perjury one of the following tleclarations:
❑ I have and wili maintain a certifcate of consent to sel4lnsure for workers'
compensalion, as pmvidetl for by section 3700 0( the Labor Code, for the
pedormance of �he work for which Ihis pertnit is issued.
❑ I have and vrill maintain vmrkers' compensation insurence, as required 6y
section 3700 of the Labor Code, for the pedormance of the work for which this
pertnit is issuetl. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier.
(This sectbn neetl rat be mmyetetl d the peimrt is valuM ai are hunOietl tldlars (St00) or IessJ
Policy Number:
.
�] I certify that in the peAormance of the work for which this permit is
issued, I shall not employ ny person in any manner so as to become subject
to the workers' compe a ion laws ol California, and agree that if I should
becom subject to the kers' compensation provisions of Section 3700 of
t e La r Co , I s�a f hwith comply with these provisio�nys. /�
/ � —Zl�' V
ApPI' nl's SiB�awre Date
WARNING FAILURE TO SECURE WORKERS' COMPENSATION 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 iHE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 0! the Business and Professions Code, and
my license is in tull force antl effect.
Lic. # Class #
GonVactor's Signalure Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that ihere is a construcibn lending agency fw (he
performance o( the v.ork (or which this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Address:
OWNER•BUILDER DECLARATIONS:
I hereby affrm that untler penalry of perjury that I am EXEMPT FROM THE
CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or county which requires a permit to
construcl, alter, improve, demolish, or repair any sWcture, prior lo ils
issuance, also requires Ihe applicant (or such pertnit to file a signed stalement
that he or she is licensea pursuant to the provisions of the Contractors
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
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applicant to a civil penalry o( not more than
fiv hund�ed tlollars (5500).):
.
I, as owner of the property, or my employees with vrages as Iheir sole
compensation, WILI DO 7HE WORK, antl the structure is not intended or
ottered (or sale (Sec. 7044, Business and Professions Code: The Contraclors
License Law tloes not apply lo an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her ovm
employees, provided that such improvements are not intended or o%ered for
sale. If, however, the building or improvement is soltl within one year o(
completion, the ovmer-builder will have the burden of proving that he or she
did not build or improvelor purpose of sale.).
❑ I, as owner o( the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to COnSWGt �he projeCl (SeC. 7044, Busine55 and
Professbns Code: The contractors License law dces not apply to an ovmer of
pmpeny who builas or improves thereon, and who contracis for such project with
a contracta(s) license pursuant to ihe Contractors Ucense Laws.).
❑ I am exempt under sec.
Business and Pro(e ions Code for Ihis reason:
I�2_ 3 -,�p - / U
SignaWre Da�e
905]-46 ( IO]
Owner ID verified by driver s iicense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify �ha[ no excavation frve (5) or more leet in dep�h into which a
person is required ro descend, will be made in connecfion with vrork auttrorized
by this permit, and that no building sWCWre, scaffolding, falsework, or demolition
or dismantling thereof, will be more �han Ihirty-six (36) fee� high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division o! Industrial Safety, as natetl above, unless
such person has a permit to do such work from the division.
Fpphranl's Siqnature Daie
Division of Intlus�rial Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicaM or present or fuWre building occupaM need to file and
certi(y a Business Plan for emergency response to release or threatene�
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Calilornia Health and Salety CoOe requires, with some
exceptions, that a Business Plan be filetl with the Costa Mesa Fire
Depariment by every business which has at any one time during a reportetl
year a quantiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume o/ 55 gallons. or 200 cubic (eet of compressetl gas
at standartl temperaWre and pressure).
2. Does or will the applicant or present or fuWre building occupant need to fle
a registration form for acu�ely hazartlous materials7 ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Satery Cotle, with some
exceptions, 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 materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressed gas at sWndard
temperaWre and pressure).
3. Does or will the applicant or present or fu�ure builtling occupanl need to
prepare an RMPP (Risk Management and Prevention Program (or acu[ety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provitles that the
Costa Mesa Fire Depariment may require Ihe preparatioq certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register acutety hazardous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 of the Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require (or
!he work which is the subject of this appliration a permit for sucn construction
or modification from Ihe Soulh Coast Air Qualily Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(SecCan 658502 of the Cali(omia Govemment Code requires that the requested
informa�ion be lumishetl on applications fa rwmresitlential building pertnits).
6. Will any part of the faciliry to be consWctetl under this permit be wilhin
7000 feet from the outer boundaries ot a school? ❑ Ves ❑ No
(I! "yes", the facility must mee� �he requirement of Sections 25534 antl 42303
of the California Health and Safery Code).
7. If a permit from the South Coast Air Quality Management DisMct or olher
air polWtion control district or agency is required for Ihe work which is the
subject ot this application, have all of the tlisclosures prescribed by Calitomia
Health and Safely Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifcate of compliance lrom the appropriate air pollution
control oRcer).
CER7IFICATE OF COMPLIANCE: I certify that under penalry of perjury the
in(ormation given above is correct I agree to comply with all state lavrs and
city ordinances regarding Hazardous Materials and Emissions.
SlgnaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalry o( perjury that I have read this application and state that
�he information given is correcL I agree to comply vrith all sla�e laws antl city
ordinances relating to building construction, and aWhorize representatives of
the Ciry o/ Costa Mesa to e r upon the above-described property for
inspec4on pu ses. I agree no t occupy or allow occupancy of any building
authori ed b t s per � �' inspection.
Slg re e vme (s) � Dat� ���
APOIi�'ant
/ � .
CITY OF COSTA MESA
��pMFs • ! BUILDING DIV/SION
t q � �
•
i�, . 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
4q��,i`�
PERMIT NUMBER: E10-00097
PERMIT TYPE E�EC
APN: 42630406
JOB ADDRESS: 375 E 20TH ST CM
Vicinity:
STATUS: ISSUED
DATE ISSUED: OS/27/2010
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: REVISION TO PERMIT ON 08/12/10 TO INCLUDE 3 ADDITIONAL LIGHT FIXTS AND 3 ADDITIONAL OUTLETS.
REVISION TO PERMIT ON OS/28/10 TO INCLUDE 200A SVC PANEL.
ELECTRICAL PERMIT FOR 7 LIGHT FIXT, 1 OUTLET AND 1 SWITCH FOR THE INSTALLATION OF A FAU IN NEW ATTIC SPACE. REF#:
M10-00050
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
PHONE: 949355-2522
APPLICANT: CHANEY, LYDIA
PHONE: 949-355-2522
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
CitylState: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $63.90
Reinspection Fee $0.00
TOTAL FEES $63.90
Address: 373 E 20TH ST Unit:
City/State/Zip: COSTA MESA, CA
Address: 373 E 20TH ST Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
.���������1�
�r;r��. �-� -
NOTICE: The work authorized by this permil shall comply with all applicable handicap access requiremenls under Califomia slatutes 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.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all ap0licable codes, and all
required inspections and fnal approval must be obWined. Failure to obtain inspections and fnal approval will result in the expiration of Nis permit.
CODE�. �NSvecnoNtwe
1616 Fined Sys�em Final Fire P�evention
1266 Pool Spa Final
200 Final Re-Roof
207 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
D�T IN RL CODEt INSPEGTIONTYPE
206 Final Mechanical
208 Final Plum�ing
210 Final Electrical
212 Final Fire Prevention
220 FinalPlanningApproval
222 Final Site
250 FinalBuilding/Occupancy
D� INiRULS
'WORKERS'COMPENSATION DECLARATIO�
I hereby affrm untler penalty of perjury one of Ihe following tleclarations:
❑ I have and will maintain a certificate of consent to sel4lnsure for workers'
compensation, as providetl lor by section 3700 0( the Labor Code, !or ihe
pertormance of the work for which lhis permil is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the LaDor Code. for Ihe peRormance of the wark (or NMich this
permit is issuetl. My workers' compensa�ion Insurance carrier and policy
number are:
Cartier:
(inis sertm neee not ee canpbteO/me pemia it vah�ea al me numred mlars (S�CO) a ieu )
Policy Number:
IO%I'certily that in the pedormance of the wnrk (or which this permit is
issuetl, I shall not employ any person in any manner so as to bewme subject
to the workers' compensation taws of Cali(omia, and agree that i( I should
become ubject to the w cers' compensation pmvisions of Section 3700 0l
Ih Lab Cotle. I s II to with comply with these provisions.
lR,..`_ i22�(U
Lp iantS B^a ure Dal '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT 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 LABOR CODE, INTEREST, AND
ATI'ORNEY'S FEES.
LICENSED CONTRACTORS OECLARATION:
I hereby affirm Ihat I am licensed untler provisions of Chapter 9(wmmencing
with Section 7000) of Division 3 of the Business antl Professions Cotle, and
my license is in lull lorce and eflect.
Lic. # Class #
Contraaa's Signature
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construc[bn lending agency (or the
per(ormance of the worfc fa which tltis pertnit is issucW. (Sec. 3097, Civil Code).
I.ender's Name:
Lender's Adtlress:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury thal I am EXEMPT FROM THE
CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Bu5ine55 and Profes5ions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any slrucWre, prior to its
issuance, also requires the applicant for such pertnit to fle a signed statemenl
lhal he or 5h8 is licensed pursuant to the pmvisions o! the Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Prolessions Code) or that he or she is exempt therefrom and
the basis for the alleged exemptioa Any violation ol Section 7037.5 by any
applicaM for a permit subjects Ihe applicanl to a civil penalry o( not more than
fve hundred tlollars ($500).�:
❑ I, as owner of �he propeny, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intende0 or
otfered (or sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an owner of property who builds or improves
lhereon, and who does such vrork himself or hersel! or through his or her own
employees, provided that such improvemenis are not intended or oftered for
sale. I(, hovrever, the buildinq or improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did ot builtl or improve lor purpose ol sale.).
� I; as ovmer ol the propeny. am EXCLUSIVELY CON7RACTING WITH
GCENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Professions Code: The cont2ctors License Law dces not aDPH to an ovmer of
proDerty who builtls or improves thereon, and who contracis for such prqect �dth
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
, 8 i ?OI�
SiBn mY�.�,_ �paeo-
305]-a8(3/Ol� �'—'-
Owner ID verifed by tlfri�ver s license. Ves ❑ No i
Dnver's.licenseNo. . [�c ires: I I I3
r�S." r � . .��- - --•-- G_" P.,,,....
Verification of Ownershi�y (rype � tlocument, i.e. ! property 2x bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation (rve (5) or more feet in depih inro wfiich a
person is required to descentl, v.ill be matle in connection with work authorized
by �his permil, and ihat no building strucWre, scaffdtlinq, falsework, a Aemolition
or dismantling thereof, vrill be more than thirty-s& (36) leel high. (Chap. 3.2, Grp
2, M 2, Set. 347, Title B, Calitdnia Atlminisl2We Cotle).
❑ As owner-builtler, I will nol employ anyone to do wvrk which would
require a permit Irom the Division of Industrial Salety, as notetl above, unless
such person has a permit to tlo such work from the division.
AppiwnYs SignaWie
Division ol Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or preseN or fuWre building occupant need to file and
certily a Business Plan for emergency response to release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Calilornia Health antl Safety Cotle require5, wilh Some
ezceptions. Ihat a Business Plan be filetl wit� the Costa Mesa Fire
Departmenl by every business which has at any one time during a reported
year a quantiry ol hazartlous materials equal to or greater than a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at stantlartl temperalure and pressure).
2. Does or will the applicant or present or tuture building occupant need ro file
a regis�ration form for aculely hazardous ma�erials? ❑ Yes ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, with some
ezceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry o( acutely
hazardous materials equal to or greater lhan a vreight o( 500 pountls. or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at standartl
temperature and pressure).
3. Does or will the appliwnt or present or future building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program (or acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, certi(cation and
filing with the Fire Department ol an RMPP by businesses which are required
to register acWely hazartlous matenals with the Fire Department.
4. If an RMPP is Dresently required, has Section 25534 of lhe Califomia
Health and Salety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or will 1he applicant or present or fuNre builtling Occupant fequifB f0�
the work which is the subject of this application a permit for such wnswction
or modifcation trom the South Coast Air Quality Management District or from
any other air pollulion control district or agency? ❑ Ve5 ❑ No
(Sectbn 658502 of the California Government Coae requires Ihat the requested
infortnation be fumished on applications fa noo-residential Duiltling permits�.
6. Will any part of the lacility to be constructed under this permit be within
t0001eet from the outer bountlaries of a school7 ❑ Yes ❑ No
Qf "yes". the lacilily must meel lhe requiremenl of Sec�ions 25534 and 42303
ol the Calilornia Health and Safery Code).
7. II a permil Irom the South Coasl Air Quality Management Disinct or other
air pollWion coNrol distdct or agency is required for the v.ork which is the
subject ol lhis application, have all of the disclosures prescnbed by Califomia
Health ana Safely Code Section 42303 been made? ❑ Yes ❑ No
8. Qf 'Yes", allach certificate of compliance from the appmpriate air polWtion
control ot(cer�.
CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the
information given above is correct I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I
certify untler penally of perjury ihat I have read this appliwtion and state that
the inlormation given is correct I agree ro compty vrith all sta�e laws and ciry
ortlinances relatinq to builtling consWction, and authorize representatives ot
the Cit of Costa Me to enter upon the above-tlescribed property for
' spec o i purposes. I a ree not to occupy or allow occupancy of any building
r b t' until final inspeciion. �
�� �Uz��l
S wWr LegalOwner�s) �-Da1e`
4�ii
AnOlorAut�orrze0Ap01iwnt Dale
. ._
1'rescriptive Certificate uT Cumpliance: Residenlial
Xe.sidcntiul Altraniiana
1R-t�LT
�e] uf'S1
� Oj)a({ue SUYf�aL'e Uetuil5 I�or the lun�cd purtinned of Muss N':�Ils sec Purrin{; Su'ips Cunsiruction Table belon•. �
r n � R .. . C U . E ' I� C ..,.'_� ,,,..__ H---� - -I I � .1 � .
6
Tag/ I Assembly Name
ID� orTvoe�
Consrn�ctiwi mbfe belam.
Framing
Material
and Size�
U-� Q JA4 Table � Cavity
see Page JA4-3 and Eq:iation 9-1,
:antmuous JA4
Insulation Assembly
n .,_,..? �_,� .,_,.._
ttre
1. For Tng/ID iivdicale (he idenliJicaliou name ihat motches the building p[atts.
2. Indim�e (he Assembli� Nome or rype: Roof/Ceiling, Walls, Floaa�, Slobs, Cr4w7 Space, Doors m�d etc.,lndicaie the Frome type and Size: For
Waod, Me�al. Me�a! Buildings, Mass, en�er ?z4, 2xG, or erc... see JA4 for od�er possible fi�ume p ye assem6lies.
3. Emer tire �hiclmess for mass in inches or Spacing benveen jraming mem6ers emer; 1 G'or 24 "OC; or O�her for all o�her assem6l�� descriptiai
.ruch as Concrete SartdwicH Pane(, Spandrel Panel, Logs, Sn�aN� Bale Panel and etc_.. ,
4. Bnsed an the Climaie Zone; enter Ihe Smndard C7-factor fi•om Tab(e 151-B, C ar D for euch differen� assemb/�� Name or rype.
5. Enter die To67c number �hat closeb� rea�embles die proposed ossemb/v.
G. E�ller die R-oalve (hu� is Geing ins[alled in ihe wqll cai�iq� or Leiween the finnring,- ofherwise, enler "0 ".
7. L'nlw' 7hc Conlinuous' Insulaiion R-value jor the propased assembl��; o�herwise, enter "0 ".
d'. Enler the row und colwnn of �he U.fac�or vulue Ga.eed on Co(unm F Tnble Nwn6er aul ettter �he �ls.semhl�� U-%ac(a� in Column J
). TGe Propnsed dea�emblr U fncior. Cnlwnn J, nrus'! be e9uol !o a� (ess lha� Ihe Slu�idnrd U-IuGnr in Colmim E!n comnl P.
Purrin � Strins Construction `Table for Mass Walls Onl��
A N C D L I% G H I ,1 li L M
1'roposed 1'ruper�ies of Mflwnr)' nnd Cw�crele Added Interinr ur Gx�erior L�.eulation
N':dlti Rrum Iteferenec in I�urrine Space fYum Heference
Juinl A ��endia 9lible 43.5. 4.3.G. 43.7 .loiul A ��eudix 9�ablc 4.3.13
_ "p � � A �, v
ow `p '� ._ c. L`, � ,V.,
Asscmbly 9., � L p.q F 4-� `o a,'_ `��°.0 ,%'o FIn:11
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Mass Nantc or 1A4 Tablc z,� �� E q o k R
4'hickness' '! e'' Numhe� — -'� � � � C a�° u� U-(acloi`'� Comi7lC�i
1
Xegisu-utinn A�umbm�: Regis�tr�tion DatalTime: HGRS Provider:
?DOb' Resideiitiu] CampliunceFarms Augu.r� 2009
ve CerYi�cate ot' Cumpliancc: Residential
�! Alterrdians
CIi`ate'Lunc.d / ^ I � uT
R-ALT
a i uf'�)
HERS V�1'�11�1 CAT101� S UM MARY The enforceme�i� ngenc;�� shoufd pqv speciu! nnervion ro �he HBIfS Meunu�e.r speci/ied in ihi�
r,hecldist GelnH�. �1 comp(e�ed unt! signed CF-4R Form for nll ihe nrenxurer s•peciJied shnll be.s��LnviLed m!he Guilding ina�pec�or Lefore Jinul
Ducl Senllite & 7�e5title HL'RS veri)irmion i.+� reqa�irad for lhi.c measw'c.
❑ 1'LS ❑ NO 1'c+5: ln Climam Ztines ? and 9-16, if more than 401inear feei of new or replucemem ducts are ius�tilled in uncondi�iuned
space, the ducts are to be se,ileA per §152(b)1Dii and the newly instrilled Aucis are to b: insulated per §151(1110.
O�XCEI'7'10�: Lxisting duci systems UuV ure extended; which :n�e cmi5�ructed, invW:ued m' se:iled with asbestus.
❑ YLS ❑ NO 1'ES: ]n Climpie Zones 2 and 9-)G, if Uie exisiing space-condi�ioning system (HVAC equipmem and ductin�j is replaced, Ihe
ducts are m be sealed per �152(b)1 Di.
❑ �'�5 ❑ N01'L�S: ln Climate Zones ^_ and 9-IG, if the existing HVAC eyuipmeN is replaced (includiug thc replacemem of the air handler,
ou�door condensing unit of a splii system, cooling or heating coil, or the furnace heai exchanger) the ducts are to be
sealed per §152(b)lE.
❑ LaCLPTIO�: Uuct systems thai sire ducumented tu haivc Leen previously sealed cunfirmed tivuugh HCP.S
, ., verificntimi.in accurdnnce with procedm�es in the Reterence Iiesidential Appendiz I�A3.
❑�XCEPTIU�: Duci svstems with�less than 411 linear fect in unconditiuned sp:ice. ' '�, .,
❑ EXCLPTIOR: Ezistin^ duci sNstems constructed, iusu)eRed or.cetiled rvitL nsbestos.
Rei'rigerant Charge - Split System HERS verifica�ion is regvirec! for thi.r nveasmc.
❑ Y�S ❑ NO YES: In Climate Zones 2 and 6-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensino unit of a split system A/C or heat pump, cooling or heatmg coil, or the fumace heat
measurement shall be veri5ed
Central Fan Infeorafed (CFI) Venfilation Spstem and Fan �'att Dran�
The ventilatinn renuirements of &150(0l do not aoolv tn e�:isdne residential homes.
DucTed Split Systems - Air Conditioners and Heat Pumps: Airflow HERS reriJication ir reguirec! for O�is measurc.
❑ k'�S ❑ NO ]'E5: ln Climat=_ Zones 1 U through 15, when the existiue space-conditioning system (HVAC equipment and ducting) is
� replaced. [he airflow and fan watt draw shall be verified ver § 152(bll Ci to meet the renuirements of & 1>1(f17B.
� ; �
Statement
documentation is accurnt=
Company:
Adtlress'. �}3
City/State/Zip: ��
(Certificntion
,�
v- �a�n i� ��,�,t �,n � v+o v � i i �-� ��5a - a- � o I-
I�puusiblc 73uildiug llesipnur's Declar:�tiun Statement --
• 1 nm eligi6lc under Division l of t6e Califomia BusineSs .ind Pmfessions Codc tu uccept responsibility lor the buildine dcsign identi5ed on
this Certificnte nf Compliance.
• 1 ccrtify that thc energy feutures aiid pedormance specificmioii:: for the building design ideniified ou this Certi(lc�ite of Compliance conlonn
tu [hc requirements ofTitle 24, Parts 1 tmd G of the Culiibrnia Code of Regulations.
• The building dexign tbnuves identified on this CertificMe nf Complitince ere consistem with the infonnation provided w documem ihis
buildin� desi�n on the other �ipplicn6le compliunce fbnns, worl;shects, calculations, pluns .md speciGca�iuns submiucd w the enfm�cemem
a�encr for npprov�d with this huildin^ pemii� a plicution.
N�une: Si�nauve:
Compwiy:
Address:
Uate;
I'hnne
ror aatri.suu�ce nr quactioris regartling ihr L�+eror Strmd�u�tls, cnrituci Ihe Energr Flntline r¢: 7-R011-; i2-i3Ull.
I(egrsv�uifnn A4mibee Ifeglsiraiimr Daie/Time. hlEliS Pro»fc(ei:�
200E kesicleniiul Conaplimtce Farms
Augusl 200%
Mandatory Measures Sa
§ ISOQ)4: Solar water-heating sys[ems and/or collectors are ccnified by lhe Solnr Raling and Certi6cntion Corporalion.
1VFF-1 R
'uLc 2 u1'3
•�Z 2D1�
Ducts and Rans Mcasures:
§I50(m)I: All air-distribuiion system ducts and plenums instnlled, nre sealed nnd insulaicd �o meei the royuirements of CMC Seetions 601, 6U2,
603, 604, 605 and Seandard 6-5; supply-air and retum-nir ducts nnd plenums arc insulnied to a minimum ins�alled level of R-4:2 or
enclosed entirely in conditioned space. Openings st��ll be ac�Jed witti mastic, tape or otlier duct-closure system tha+ meets the applicahle
. requirements of UL 181, UL 181 A, or UL 181 F3 or aerosol sealant that meeis Ihc requirements of UL 723. If mastic or mpe is used to
seal openings grea�er than 1/4 inch, the combinatian of masiic niid either mesh or tape sh;Jl be used
§ I50(m)I: Building cavities, support platforms for air handlers, and plenums defined or constructed witH materinls other than senled sheet metal,
duct 6oard or flexible duc� shull not 6e used for conveying conditioned uic I3uilding cnvities and support platforms may contain ducts.
Ducts inslalled in cavities und suppon pintforms shull no� be compressed m cause reductions in the cross-sectional vrea of the ducts.
§ 150(m)2D: Joints and seams of duct systems and iheir components shull noi be scaled wilh clotli 6nck n�bber adhesive duct tapes unless such tape
§I50(m)9: Insulation shall be protected from dnmage, inclu
insulation shall be protected as above or painted
ducts
� have either autonwtic or reudily nccessible, manually opemted dampers,
that due to sunligh�, moisture, cquipmeut maintenance� m�dwind. Cellular tonm
a coating Ihat is water remrdant and provides shielding (mm solar radiation �hat
All dwelling units shall meet [he reqmremenls ofAN51/ASHRAE Stantlard 62.Z-ZUU/ Ven[tlauon antl Acceptable InAoor A�r (juahty m
Low-Rise Residential Buildings. Window operation is not a pennissible method of providing the Whole Building Ventilation required in
§ 114(a): Any pool or spa heating system shall be ceni6ed to have: a thermal efficfency Ihat complfes with the Appliance E�c�ency Regulations;
an on-off switch mounted outside of the heater; a permanent weatherproof plate or card with operating inswctions; and shall not use
elecvic resistance heating or a piloi lighi.
§114(bp: Any pool or spa heating equipment shall be installed with at least 36" of pipe betwecn filter and heater, or dedicated suction and retum
or
e�cacy luminaires or L
; I50-C and is not a low
Thc
�, heater shall have a cover.
mix the pool water, and a time switch that wi
lemand periods.
mo sizine. flow mte, nioine. filters. nnd vnlve
� Engine with
luminaire as :
chall bc determined as
that isno-lower
pumps to be set or
Dallasts for fluorescent lainps mied 13 Waus or 6reater shall bc electrunic and shall havc .in ouq�ul frcquuncy no Icss thnn 20 kI-lz.
Permanently installed night lights and nighl lights int0g�al lo a permanenUy instnlled lumimiire m� cxhnus� fnn shnll can�in only bigh
eff�cacy lamps meeting the minimum efficecies contuined in 9'ublc I50•C and shall not conmin a lino-voltage sockei or line-vulwgc ,
lamp holder, OR shall be rated to consume no morc Uian frve wntts of pnwer .is de�ennined by § 130(d), and shall not contain u medium �
Ihun kitchcns, shall mect thc upplicublc rciiuircmcros of § I
§I50(k)7: All switching devices and controls shall meet the requiremenls of §I50(k)7.
§I50(k)8: A miniinum ot50 percent of thc total rated wau.igc of permuncn�l�� inst;Jlcd lighting in kitd�ens shadl bc high cffic.icy.
CXCEPTION: Up l0 50 watts for dwelling units less lhim or equal to 2,500 (� or 100 w�uts for dwclling units Inrger than 2,500 fl� nwy be exempt
from thc 50% high efficacy requircincnt when: all low efGcncy Imninaires in the I<itchen are coutrolled by a mamml on occupant
sensor, dimmer, energy managemcnt system (BMCS), or a multi-secnc progrmimable control system; .ind all permanently insmlled
Iwninaries in garages, laundry rooms, closets grcater lhan 70 syuare fcet, smd utility rooms rve high efficucy und cuntrolled by a
is internul to cubinets shall use no more thnn 20 w.uts of power per lineur foot of illumivated
in bathrooms, uttached and detacheA gurages, laundry ruoms, closets and u�iliq• rooms shall be
2005 Kesidential Complimice Forms Augusi
Mandator>> Measures Summa
Residenti�l' • •
-- . ��� 3�S G'2 0�
1ViF-] R
��:��� � or s>
3�c2�zo�o
�,
HXCEPTIO� I: Permtinently insmlled low eflicacy luminaires shall be zllowed prnvided that they ure comrolled by a munual-on \'
� occupant sensor cenified to comply widi the applicable requirements of § 1 19. �
IXCEPTION 2: Perutanently ins�alled lo�v efficacy luminaires in closets Icss ihan 7U square feet are not reyuimd to be conb�olled by a'
mamml-on occu am scnsor.
§150(I<)11: Permanently iostalleA luminaires IocateA in rooms or are�is othcr th�in in I<itchens, bnihromns, garages, laundry rooms, close�s, and utility
roonts shall he high e(ficacy luimntiires. � '
EXCEPTION I: Perinanently installed low efficacy luminaires shall be nllowecl proridcd Uiey :ire controlled by either a diinmer switcli
1 I lhal complies with [he applicable requirements of § I I J, Or by a manu;i6on oceupaiu sensor �hat coinplies with the �
( applicublc reqwreinents of § I 19. .
I BXCEI'TION 2: Lighting iu de�nched storugc huilding less thun 1000 squure fcet located on �i resideniial site is not required to comply
� with§I50(k)11.
-§I50(k)12: Luntinaires recessed into insulated ceilings�shal] be )isied fm� zeri> cle��r�nce insul�tinn wntact (IC) by Underwriters L:iboratw�ies or
� � other nutionalty recognized testin�/rating labomtop; �nd h:rve a lubel thai cer�iGes Ihc lumiunuire is uirtight with uir Ie.l<uge less Ihen
I� 2.0 CFM at 75 Pascals when tested in accordance with ASTM 8283; und be scaled wi�h a gaskm or caullc between the luminaire housing
(� and ccilin �.
i§150(k)13: Luminaires providing outdoor lighting, including lighting ibr private pntios in low-rise residentiul buildings with fow� or more dwelling
, units, entrances, balconies, mid.�orches,-which are pennanently mounted to n residential building or to other buildings on the same lot
,��` . . shall be high efficacy. � . . ...�. .. . ..�... . , . . . .. . ...- � .
� I EXCEPTION 1: Pertnanently i�istailed outdoor low efficacy Iuminaires stiall be allowed pmvided that tltey are controlled by a manual
II on/off switch, a motion sensor not having an override or 6ypass switch thm disables Ihe motion sensor, and one d the
i . followmg controls: a phowcontrol not havmg nn override or bypass switch that disables the photoeontrol; OR an
� � astronomical time clock mt having an override or bypass switch that disables the astronomical time clock; OR an
� l energy management control system (EMCS) not having an override or bypass switch Ihat allows the luminaire to be
' always on
! I EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to § I50(k)13 may be controlled by a temporary override switch
� which bypasses N�e motion sensing function provided Ihat tlie motmn sensor �s automatically reactivated wi�hin six
I;
hours.
i i EXCEPTION 3: Permanentty installed luminaires in or around swimming pool, water feamres, or other location subject to Article 680 of '
i the Califomia Electric Code need not be hi �h efficacv luminaires.
���, §150(k)14: Internally illuminateA address signs shall comply with Section 748; OR not contain a screw-base socket, and consume no more than five
�� watts of ower as determined accordin � to § 130(d).
(;§ 150(k) I5: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shnll comply with tlie applicable requirements in
, Sections 130, 132, 134, and 147. Lighting for parlting garages for S or more vehicles shall comply with Ihe applicable requirements of
�, Sections 130, 131, 134, and 146
;�, §I50(k)16: Pennanently installed lighting in the enclosed, non-dwelling spaces of low-rise residential buildings with fom� or more dwelling units
�l shall be high efficacy luminaires.
@XCEPTION: Permanently installed low ufficaey luminaires shall be allowed provided that they are controlled by.an occupant sensor(s)
certiGed to comply �vith thc a plicable re uirements of § I I).
�.....�._, �._
J
200E' Residential Canpliunce Fa�ms' Angusi 2009
� �
CITY OF COSTA MESA
��'�pMFq , BUILD/NG DIVISION
it�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.w.us
� �` FOR INSPECTIONS CALL: (714) 754-5626
Ryro�,F
PERMIT NUMBER: E10-00097
PERMIT TYPE ELEC
APN: 42630406
JOB ADDRESS: 375 E 20TH ST CM
vicinity:
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
05/27/2010
SCOPE OF WORK: REVISION TO PERMIT ON 05/28/70 TO INCLUDE 200A SVC PANEL.
ELECTRICAL PERMIT FOR 1 LIGHT FIXT, 1 OUTLET AND 1 SWITCH FOR THE INSTALLATION OF A FAU IN NEW ATTIC SPACE. REF#:
M10-00050 '
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
PHONE: 949-355-2522
APPLICANT: CHANEY, MI2fiREL �+l/�Gi���
PHONE: 949355-2522
CONTRACTOR: OWNER-BUILDER
Address Unik PHONE:
City/State: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $57.30
Reinspection Fee $0.00
TOTAL FEES $57.30
Address: 373 E 20TH ST Unit:
Ciry/State/Zip: COSTA MESA, CA
Address: 373 E 20TH ST Unit:
City/Slate/z2ip: COSTA MESA, CA
License No. 000000
CELL:
���� �(�� 1
�, J�[ 5 ���
�ATE: � Z�,. `
NOTICE: The work aulhorized by ihis permit shall comply with all applicable handicap access requirements under California statules and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In ordei 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.
CQ� INSPEG110NiYPE DRTE IN7Ii1RL5 C� INSPECTIONTYPE URIF INTIiI�LS
1616 Fized System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Elecirical
201 Final Block/Retaining Wall 212 Final Fire Preventian
202 Final Facrory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final 8uilding/Occupancy
a
WORKERS' COMPENSATION DECLARATION:
I hereby affrm untler penalry of perjury one of �he following declarations:
❑ I have antl will maintain a certificale o( consent to self-Insure for workers'
compensation, as provitletl for by section 3700 0l the Labor Code, for the
pedortnance of the work for vfiich this pertnit is issued.
❑ I have antl will maintain v.orkers' compensation insurance, as required by
sectan 3700 of Ihe La6or Code. (or the peAormance o! lhe w�rk for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(T sedionneedipfbemmpeteddlhepemMkvaluedefonenundied�llars(St00)aless)
Pol� y Number:
��`„Ircertify thal in Ihe pertormance o( the work tor which �his permit is
issued, I shall no( emplo ny person in any manner so as to become subjec�
ro the workers' compen ation laws of Califomia, and agree �hat it I should
b com subjecl ro the kers' compensation pmvisions of ection 3700 of
th La r Co all f hwith comply vrith these provisions.
-a o
Y:SIBn9lure� t '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIAIINAL
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 LABOR CODE, IMEREST, AND
ArfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed untler provisions of Chapter 9(commencing
wi�h Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effecl.
Lic. # Class #
ConVatlor's Signature Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn lhat there is a construction lending agency for �he
peAormance of the v.ork for wfiich ihis permi� is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Signawre Date
OWNER•BUILDER DECLARATIONS:
I hereby aKrtn Ihat under penalty of perjury that I am EXEMP7 FROM THE
CONTRAC70R5 LICENSE LAW for the lollovnng reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or counry which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the appliwnl tor such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Comractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or lhat he or she is exempl there(rom and
Ihe basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicaN to a civil penalry of nol more than
fve hundred tlollars ($500).�:
❑ I, as owner o( the property, or my employees with wages as lheir sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
oRered tor sale (Sec. 7044, Business and Professions Code: The CoNracrors
License Law does not apply to an ovmer of property who builtls or improves
thereon, and who does suc� work himself or herself or through his or her ovm
employees, providetl lhat such improvemenls are not inten0etl or oflered !or
sale. If, however, the building or improvement is sold within one year of
complelion, the owner-builder will have the burtlen of proving that he or she
did not 6ild or improve for purpose of sale.).
I, as owner of the property, am EXCLUSIVE�Y CON7RAC71NG WITH
LICENSEO CONTRACTORS ro consWct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not appty ro an owner of
property who builds or improves thereon, and wfio contracts for such pmject vrith
a contractw(s) license pursuant to the Contractors License Laws.).
� I am exempt under sec.
Busin �s and Pro(ess'Ons Code (or this reason:
/�� �
]-46( >)
Owner ID verified by drivet�se. ❑ Yes ❑ No �.
o i�e�s.�icense No. ��_� � ea. 7 �3 ZD��
Verification of Ownership bg(type of �ocument, i.e. - property taz bi I or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more (eet in depth into which a
person is required to descentl, will be made in connection with vrork authonzetl
by this pertnit, and that no builtling structure, scaffolding, falsevmrk, or demoliiion
or tlismantling thereof, will be more than thirty-six (36) feet high. (Cnap. 3.2, Gry
2, Art 2, Sec. 341, TiOe 8, Califomia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to tlo vrork which would
require a permil lrom Ihe Division of Intlustrial Safery, as noted above, unless
such person has a permit to do such vrork from the tlivision.
ADoi'iwnYs Signatore Da�e
Division o/ Industrial Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or present or fuNre building occupant need to file antl
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Cotle requires. with some
exceptions, that a Business Plan be filed vrith lhe Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous materials equal to or greater than a weighi of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressetl gas
at standard temperature antl pressure).
2. Does or will Ihe applicant or present or fuNre building OCGupant neetl to file
a registralion form for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the Calitomia Heal[h and Sa(ery Code, with some
exceptions, requires regislretion with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity o( acutely
hazardous matenals equal to or greater than a weigh[ of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl
temperature and pressure).
3. Does or will the applicant or present or fu[ure building occupant need [o
prepare an RMPP (Risk Management and Prevention Program tor acutety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe California Health and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, cenification and
filing with the Fire Department ot an RMPP by businesses which are required
lo register aculely hazardous materials vrith Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Heallh antl Safety Code been (ully complietl wiih? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre builtling xcupant require lor
Ihe work which is �he subject of lhis apPlication a permit for such construction
or motlification from Ihe South Coast Air Oualiry Management District or trom
any other air pollution control tlistricl or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia GovemmeN Code requires that Ihe requested
infortnation be (umishetl on applications (or non-residential building permits).
6. Will any part o( �he facility to be constructed under Ihis permit be within
1000 feet from the outer bountlaries of a school? ❑ Ves ❑ No
(If "yes", the (aciliry must meet the requirement of Sections 25534 and 42303
of the Calilornia Health and Safery Code).
7. It a permit from the Sou1h Coast Air Ouality Management District or other
air pollution contml district or agency is required (or Ihe vrork which is the
subject of this application, have all o! the disclosures prescribetl by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifcate of compliance from the appropriate air pollution
contml oKcer�.
CERTIFICATE OF COMPLIANCE: I certify Ihal under penalty ot perjury the
infortnation given above is correcL I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty o/ perjury that I have read Ihis application and 5tate Ihat
the information given is correcL I agree to comply with all slate laws and city
ortlinances ting to building nstruction, antl authonze representatives of
the Ciry o sta Mesa to ter upon the above-descnbed property for
ins ection p pos s I agree t to occupy or allow occupancy of any building
a y his i u inal inspec�ion. �
i
_ ' rer. ' e.lsf—�=�',_ �
An4lorAul�onzeC
� � � � CITY OF COSTA MESA �
� o a~Fq@@ B!/ILDING DIVISION
i� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
f
� � FOR INSPECTIONS CALL: (714) 754•5626
�"""'°�fi PERMIT NUMBER: E10-00097
PERMIT TYPE ELEC
APN: 42630406
JOB ADDRESS: 375 E 20TH ST CM
Vicinity:
STATUS: ISSUED
DATE ISSUED: 05127I2010
' ISSUED BY:
Suite/Unit:
SCOPE OF WORK: ELECTRICAL PERMIT FOR 1 LIGHT FIXT, 1 OUTLET AND 1 SWITCH FOR THE INSTALLATION OF A FAU IN NEW ATTIC
SPACE. REF#: M70-00050
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
PHONE: 949-355-2522
APPLICANT: CHANEY, MICHAEL
PHONE: 949355-2522
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
CitylState: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: 50.00
Electrical Permit Fee: $26.80
Reinspection Fee $0.00
TOTAL FEES $26.80
Address: 373 E 20TH ST Unit:
CirylState2ip: COS7A MESA, CA
Address: 373 E 20TH ST Unit:
City/State/zZip: COS7A MESA, CA
License No. 000000
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenLs under Califomia slatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiralion of this pertnit.
COpE p, INSPECTION TYPE �pTF� IN�AL$ �� INSVECTION ttYE DRTE INiRIALS
1816 Fixed System Final Firn prevention 208 Final Mechaniwl
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 2i0 Final Electrical
201 final Block/Retaining Wall 212 Final Fire Pr¢v¢ntion
202 Final Fattory Fire Place 220 Final Planning Approval
203 Final Sign 222 Fina15ite
20a Final Dertalition 250 Final Building/Occupanry
a
WORKERS' COMPENSATION DECLARATION:
I hereDy affirm under penalty of perjury one of ihe (ollowing Oecla2tions:
❑ I have and will maintain a certificate of consent to self-Insure lor �wrkers'
compensation, as provitletl for by section 3700 of the Labor Code, !or Ihe
pertortnance of the work for which Ihis permit is issued.
❑ I have antl will maintain workers' compensatbn insurance, as required by
section 3700 of the Labor Code, (or the pedormance ol the work for which this
pertni� is issued. My workers' compensalion Insurance wrner and policy
number are:
Carrier.
(ihk setlion need irof he rompetM a flie pe�ma is val�etl al ma huntlietlOullors (E100) w less )
P-o�lic/y Number:
�V'ce�ify ihat in ihe pertormance of the wnrk lor which this permit is
issued, I shall not employ an erson in any manner so a5 to 6ecome subject
to the rkers' compensati n laws of Calitomia. and agree thal if I should
b com ubje t to the vro er¢' compensation provisions ol SecCon 3700 of
th �a Cod , I shall fort ' wmply with these provisi ns.
Z(0 �.� ( �
Avo - m �i.e.y,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm thal I am licensetl under provisions ol Chapter 9(commencing
with Section 7000) of Division 3 0! the Business and Prolessions Code. and
my license is in tull (orce antl eHect.
Lic. # Class #
ConVaclor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lending agency /or the
peRormance of the v.ork fa which tltis permit is Bsued. (Sec. 3097, Civii Code).
Lender's Name:
Lender's AtlCress:
SignaWre Dale
OW NER-BUILDER DECLARATIONS:
I hefeby a(flfm lhat undef penalty of perjury lha� I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW lor lhe following re050n (SOC. 7031.5,
Business and Protessions Code: Any city or counry which requires a permil to
constmct. alter, improve, Oemolish, or repair any structure, prior to its
issuance. also requires the applicant /or such pertnit to file a signed statement
Ihat he or she is licensed pursuant to the provisions ot the Contractors
License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the
Business antl Protessions Cotle) or that he or she is exempl therelmm and
the basis for Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant lor a permit subjects the applicant ro a civil penalty of not more than
fve hunCred tlollars (5500).):
❑ I, as ovmer of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the structure is nol intended or
offered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does no1 apply to an owner of property who builds or improves
thereon, and who tloes such work himself or hersel( or through his or her ovm
employees, provided that such improvements are not iNended or offered tor
sale. If, hovrever, the building or improvement is sold within one year of
completion, the ovmer-builtler will have the burden of provinq that he or she
�LI�tlitl no uild or improve for purpose of sale.).
I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
ED CONTRACTORS to consWcl the project (Sec. 7044, Business antl
Prolessbns CoOe: The contractors License Law Oces not apply to an ovmer of
property wfio builds or improves thereon, antl who contracts fw such project with
a contracta(s) license pursuant to the Convactors License Laws.).
❑ I am exempt under sec.
Business and Profession Code tor this reason:
/
,� 5 �
��a6 (]/0])
Ovmer ID verified by
1 3 �S
Venfcation of Ownership by (type ol documenl, i.e. - property taw hill or deetl):
�IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlify that no excavation frve (5) w more feet in depth into which a
person is required to descend, will 6e made in connection with vrork authonzetl
by this permit, and that no building structure, scaffdding, falsev.ork, a tlemolition
or tlismantling �hereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title B, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from ihe Division of Industrial Safety, as noted above. unless
such person has a permit to tlo such vrork from lhe division.
Applifanfs SipnaWre Oa�e
Division o( Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or Wlure builtling occupant need to !le antl
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous matenal7 ❑ Yes ❑ No
(Section 25505 0l the Calilomia Health and Safery 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 quaNiry of hazar0ous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic teet of compressed gas
at standard �emperaWre and pressure).
2. Does or will the appiicanl or present or Wture building occupant need ro fle
a regis[ra�ion (orm for acutely hazardous materials? ❑ Ves ❑ No
(Seciion 25533 of the California Health and Safety Code, with some
exceptions, requires regislration with the Costa Mesa Fire Department by
each bU5ine55 whiCh at any one lime has on hantl a quantily o( acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressed gas at stantlartl
temperature antl pressure).
3. Does or will the applicant or present or fuWre builtling occupant need lo
prepare an RMPP (Risk Management antl Preven[ion Program for acutely
hazartlous materials�'t ❑ Yes ❑ No
(Section 25534 0( the Calilomia Health and Safety Cotle pmvides Ihat tha
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are require0
lo register acWely hazardous matenals with the Fire Department.
4. It an RMPP is presently required, has Section 25534 0( the California
Health and Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or wiu mo appiican[ or present or fuWre builtling occupaM require for
the work which is lhe subject of this application a permit for such constmction
or motlification from Ihe South Coast Air Oualily Management District or from
any other air pollution control tlistricl or agency? ❑ Yes ❑ NO
(Section 65850.2 of the Califomia Govemment Cotle requires thal �he reques�ed
inlortnation be lumished on applications far noo-residential building permits).
6. Will any part of Ihe facility lo be conslructed under this permit he within
1000 feet from Ihe outer boundaries ol a school? ❑ Yes ❑ No
Qf yes". the lacilily musl meet the requirement of Sections 25534 and 42303
of the California Health and Salety Code).
7. If a pertnil from Ihe South Coast Air Qualily Management District or other
air polWtion coNrol district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety CoOe Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", altach certifcate of compliance from the appropnate air pollulion
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury Ihe
infortnation given above is correcL I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalty of perjury that I have read this application and 5[ate Ihat
the information given is corcect. I agree to comply wit� all state lav5 antl city
ordinances relating to buil 'ng construction, and auttanze represenWtives of
Ihe Ciry ( Costa Mes o enter upon the above-descnbed propeny for
i specC r{ purp se . I a r e not to occupy or allow occupancy o any building
a � b t is il fnal inspection. � ��
a�r��' qs) i.�
Andl0rAul�OnxBaRD0lipn� Da�!
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CITY OF COSTA MESA
. BUILDING DIVISION
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: P10-00111
PERMIT TYPE PLUM
APN: 42630406
JOB ADDRESS: 375 E 20TH ST CM
Vicinity: REAR OF HOUSE
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
08/12I2010
RMD
SCOPE OF WORK: PLUMBING PERMIT TO CHANGE OUT AND INSTALL A TANKLESS WATER HEATER LOCATED AT REAR
OF HOUSE.
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
PHONE: 949355-2521
APPLICANP. LAKE, LYDIA
PHONE: 949-355-2521
CONTRACTOR: OWNER-BUILDER
Address:
City/State:
ARCHITECT:
ENGINEER:
ZipCode:
Address:
City/State/Zip:
Address:
City/Stale/zZip:
License No.
License No.
373 E 20TH ST
COSTA MESA, CA
373 E 20TH ST :
COSTq MESA, CA
License No. 000000
PHONE:
CELL:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
PHONE:
PHONE:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the 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.
COOEO. INSPEGTIONTYpE �RTE INTI71AL5 GOOEO INSPECTIONTYPE OnTE IN1111PL5
1616 Fixed System Final Fire Prevenlion 206 Final Mechanical
1266 Pool Spa Firyal 20B Final Plumbing
200 Final Re-Roof 210 Pinal Electriwl
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Faclory Fire Place 220 Final Planning Approval
203 FinalSign 222 FinalSite
204 final Demolition 250 Final Building/puupancy
�
WORKERS' COMPENSATION OECLARqTION:
I hereby atfirm under penalty of perjury one of the following declarations:
❑ I have and vrill maintain a cert�cate of consent to self-Insure for vrorkers'
compensation, as provided (or by section 3700 of the Labor Code, for �he
performance of the work (or which lhis permit is issuetl.
❑ I have and will maintain v.orkers' wmpensation insurance, as required by
sectbn 3700 of the Labor Cotle, (or the peRortnance of the v.ork tor which this
permit is issued. My workers' compenSalion Insurance carner and policy
number are:
Carrier:
(T�¢ sedion neetl ipl �e cwndeled d theperm4 a vaNetl al me nuMietl tlotlars (510�) aless )
Policy Number:
�.,�
Q.al-certify thal in lhe per(ormance Of the work !or which this permit is
issued, I shall nol empl any person in gny manner so as to become subject
to Ihe rkers' comp nsation laws ot California, and agree tha� if I shoul0
becom ubjecl lo Ih vrorkers' compensation provisions of Section 3700 of
the La Co , orthwith comply wi�h these provisions.
� � 1_lL�l '� �
f�bpl pfs ignawre bat`e '
��- ^
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOIIARS
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF 7HE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn that I am licensed untler provisions o( Chap[er 9(commencing
with Section 7000) ot Division 3 of the 9usiness antl Professions Code, antl
my license is in (ull force antl eNecl.
Lic. # Class #
ConUactor's SignaWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn ihat there is a gonstruction lending agency for the
pertortnance of [he v.ork (or which this pertnit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm Ihal under penalty of peryury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW fOr the (ollowing reason (Sea 7031.5,
Business and Pmfessions Code: Any city or county which requires a pertnil to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicant tor Such permi� Io file a signed sta�emen�
thal he or she is licensed pursuanl t0 the provisions of the CoNractors
License Law (Chap�er 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or thal he or she is exempt therefrom antl
Ihe basis for the alleged eaemption. Any violation o! Section 7031.5 by any
applicant for a permit suDjects the applicant to a civil penalty of not more than
Me hundretl tlollars (5500�.�:
❑ I, as owner of lhe property, or my employees vnth vrages as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
offered lor sale (Sec. 7044, Business antl Protessions Code: The Contractors
License Law does not apply to an owner of propeAy who builds or improves
thereon, and who does such vrork himself or herself or lhrough his or her ovm
employees, provided that such improvements are not intendetl or ofiered tor
sale. I(, however, ihe building or imprpvement is soltl within one year o(
completion, the owner-builder will have the burtlen ot proving that he or she
did not build or improve for purpose of sale.).
❑^�I,tas owner of the property, am EXCLUSIVELY CONTRACTING WiTH
LICENSED CONTRACTORS�to consWcl the project (Sec. 7044, Business and
Professions Code: The cont2ctors Licenge Law dces not apply to an owner of
property who builds or improves thereon, and who contracts for such pmject with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec.
Business a d Pro(essions C e for this reason:
/ iS ( %
Sig Wre Date
-a6 (3/0]) � f." �� �"
Ovmer ID verifed hy driver�nse. L7 res ❑ No
� %���L 6cpires; �
� �.
Verification of Ownership by pype of document, i.e. -property tax bill or dee0):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify that no excavalion frve (5) or more fee[ in tlepth into v.fiich a
person is required lo descend, will be made in connecl'wn with vrork authorizea
by �his permil, and that no builtling sWCNre, scaHdding, falsework, a demolition
or dismantling �hereof, will be more than thirty-su (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administ2tive Code).
❑ As ovmer-buil0er, I vnll nol employ anyone to do work which would
require a permit from the Division of IndusUial Safery, as noted above, unless
such person has a permit [o do such work from �he divi5ion.
Applicanfs SiB^aWre
Division of Indusirial Satery Permit Numbe[ _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need ro file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safery Code requires, with some
exceptions. lhat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time tlunng a reported
year a quantity of hazardous matenals equal to or greater than a weight o(
500 pounds, or a volume ot 55 gallons, or 200 cubic feel of compressetl gas
at stantlartl temperaWre and pressure).
2. Does or will Ihe applicant or present or future building occupant neetl to file
a reqistration form (or acutely hazardous materials? ❑ Yes � No
(Section 25533 0( the Califomia Health and Safety Code, with some
exceplions, requi�es registration with the Costa Mesa Fire Department by
each business which at any one lime has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feel of compressed gas at s[antlard
temperaWre antl pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevemion Program for acutely
hazardous ma�erials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health antl Safery Cotle provitles that Ihe
Costa Mesa Fire Department may require Ihe preparalion, ceRifiw[ion and
fling with Ihe Fire Department of an RMPP by businesses which are required
to regis[er acutely hazardous ma[erials wi[h the Fire OepaRment.
4. If an RMPP is presently required, has Section 25534 of lhe Califomia
Health and Safery Code been (ully complied wilh? � Yes ❑ No
5. Does or vnll the applicant or present or fuWre buildinq occupant require for
the vrork which is the subject o( this application a permit (or such consWction
or motli(cation from the South Coast Air Quality Management Dislrict or from
any other air pollution control disMcl or agencyl ❑ Yes ❑ No
(Sectbn 658502 0( Ihe Califomia Govemment Code requires that the requestetl
infortnation be fumished on applications lor non-residential building permits).
6. will any part ot the facility to be consWcted under this pertnit be wiMin
1000 feet from the ouler boundaries of a school? ❑ Ves ❑ No
(I( "yes", the faciliry must meet the requirement of Seclions 25534 and 42303
o( Ihe California Health and Safety Code).
7. If a permit from Ihe South Coast Air Quality Management DisMct or other
air pollulion conirol district or agency is required for Ihe work which is �he
subject of this application, have all ot Ihe disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certi(cate of compliance from the appropriate air polWtion
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the
in(ormation given above is correct I agree to comply with all state lavrs and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1
certify under penalry ol perjury that I have read lhis application and state that
the in(ormalion given is correcL I agree to wmply with all state laws and ciry
ordinances relating to building construction, and authorize representatives of
the Ciry of Costa Mesa to nter upon the above-descnbed property for
insp ction rposes. I gree t ro occupy or allow occupancy of any building
au Ze y hi5 e't-nnEi al inspection. , �__,�
(SiB - ui 1 Le9al wner(s) �I���� � I
Antllor Nul�onze0 A00�����
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Yrescriptivr CePti�cat
12asidentinl A(terations
ce: ]Lesidential
�G�
J -
CI;-112-A1,��-
� (Ya�r 4 of ��
�e.Zonek �.i:.a I ti nf�mri..
Lis� water heaters and boilers for bodr domest�c ha water (DH11'J heaters anAhydronic space heating. bidivipual dwellme JHI1' hemers niust bE
gas ar propane fired, a¢d mao qor exceed 50 gallons. Hol water yipe iruulatio�r.T+"om !he DHN' henter to the x2tchen(s) and on all �wdergrowid
hor water pines is renuired oi all comoorient oackn�es in a(I climnte zones.
Wa¢rHeater7ype/Fuel DistnbutionType N�mber Tanl: EnergyFactoror 7an}:lnsulation
Type'' (Standard, RecirculationY In Svstem Caoacih� (eap Thertnal ESicienev R-Value
r � n �
1. Gaaicate Type (Storage Gas�. Hea� Pump, lnstontaneous, etc.)
3. Thc neN� water heater 9+ye shall bc limiled to naiural gqs, liquefie�l pervolewn gas, or Jie esisti�vo /uel p+pe.
3. Reciral4tino svstems se�vin� midtiple dwe!li�ig units sha(I mee� ifie recircutaiion +'equiremenu o(F'I SOI�U. T'ne Prescr'ipeivc requiremenu d�
nor aAom the ins[allation oJp recircula(ing water heating svslem (or sing(e d�+,ellino mtitr. .
4. The external imater Gennn� tmik m�d nfnas'shall hc insidnied m meel the reauirements a(<<Y50(jl.
$1'$�,'1/iL rl',E1TU�S 7he en(aaenteN agenn• sho�dd pqv special atrentiorr ��o the Special Feaiums speci/ied ni Uifr checklist betn�+�.
These iiema mat� reouirr wri4en iu.nification mrd dncumenmiion and specia! veri/icminn.
NGW It00� ASS��IBW' - kadi:ml liarrier
The radianl barrier renuiremenl of F151(fl2 [loes not apph- to roof alterations.
Slab Ldge (Perimeter) Insulntion ❑ 1'CS ❑ NO
YCS: In Cllmate Zone 16 iu Componenl Yucl;ages U, R-7 insulntion is required.
]ir.;rted Sl�ih Insul;rtiou ❑ 1'CS ❑ NO
1'E5: Slah eAee insulatimi reoinred for all heated slabs in all Climate Zones. See details in Table I I}:-N of lhr stTndards.
It��ised SIa6 IusulaCimi ❑ l'gS ❑ NO
\'ES' In Climate 7ones I. 2. I 1. 13. 14 � I L. R-R inculatinn is renuired' in Climnt=_ 7.anes 19 R 15. R-4 is renuired under cmm�nnent Parl:;v.
Thcrmal B1xss
Tn ohtain Comnlianre Credil for Ihe ins�allaiion of �hemial mas:.. us= �he Performance
I(egisiraiion Nwnber: l(e�isnation Uaie.i7ime
20pd' Ifesidential Convpliance Fornu�
Hc1:5 Provlder�:
Mar
�
Lterntiun,c
IQunic:
nce: )Lesidenti.il
CT -1 R-F:LT
(Y����e � oi Sr
FI�ItS V�I'.IF1 CAT.101� SU714111AI��' 7'i�c enlorcemem agenersiiouldpm-sneciol unenum� in iiic NEI:S /VL'Cld'lll'L', d:pL'CIJIL'!/ )L iiiie
checldis� Lelnw. ii cmnplr.�ed nud e��gned CT-41f lorm lor ci71 dm nieti.rm'es specifictl.nc�ill be su�mniad io ii��• �u(Idmg ine�pecior Le1�»��� Iirnd
�liuCt SeHlirt� d'; Tustitte' P1LR;; nm�ijicu�lon i.a r�syuiredJm� rl�i.� mausaire.
❑ 1'I:S ❑ IJO 1'CS: Li Cliinme "Luue:.9 �md 9-I L, il inme tlmn 4U hneur feei of ne��• m iepiuceiueni duct:: �vr 6isialled iii uucondi�iuucci
� space, the ducl:: urc lo I)C SCiIIC(I �]CI' yI il(I��ILI� t111fI lll: IICN�II' instullcd dueu, ur. io 6c insuiamd pei p I 51(1_I I U.
O�XC�1'TJ01��. Lsisting duc� s��stems th:ii m�r extended, whicli are cmisu�ucted, insulatetl nr scniud u�ith :is6esw5.
O)'�S ❑ fJ0 YES: Ju Clima�c'Lone�'? nnd 9J 6, if tlie er.isting space-emiditiouing systero (}IYP.0 equipmani.and duciin,i is r�placed. thc
ducte ure to l�c s�aletl yei S 15'l(bpLi.
D 1'�S D NO Y��: L� Clima�e "Lunes� r�nd J-I G, if tl�e ezis�ing H\�AC equipin�m i:; repluced (including th� iepl�cen:n� of the tiii hundle�,
outduor condensin� unii of x sphi sy,tem; cnoling or heaiing coii, m� [he iurnace lieai e> enangeij [he ouca tn�� u� be
sealed per g152(b)lE.
. ❑�XCEI'T10�: Luct systems tl�nt au�e dncumented tu Lnve beeu previuusir senieJ confirmed 21u�uurL H�P.S
. . .veriiicntiou iu accorduncc with pcucedures in d�e Rclereucc 7<esidentl:J F�ppcndi>: 1V,i. . ... . .
� ❑��XCEPTIOA: Luct systems witli less tiien 4U�liueur ieet in w�coudiiiuned space. .
❑�XC�PT]On�. �xistine ducl svstems cunatructed. insulnted or senletl with ns6estos.
ReIrl�erAnt Char�e - �pllt Sl'Stem HERS verijicniion is requireci.Jor �hix measurc.
❑ YiS ❑ NO YLS: ln Climate Zones 2 anJ 5-15, wl�en lne esisting HV HC equiomen� is replaced (includine th� reolacement oi the air
handl�v�, ontdoor condensing unii of a splii system A/C or heat pump, cooling or heatin� coil; or tn� iurnxc� heai
Cent! al Fan
Ti�e ventilatio�
mcesureineni Shall be veri5ed ner
��eniilation S.l'stem and Fan Vt'ar D: aN�
to existinu residentisl homes.
Lucted Split S1'stems - Air Conditioners and Heat ?'umps: Airlloh� HEP.S verilicaiia� is reauired (or �nis measurc.
❑ YLS 1 NO ]'L�S: ln Climate 2ones 1 U througb 1:,, wlien the existing space-condi[ioning sysiem (HVAC equipmant aud duc�iugj is
renlaced. the airflov.� and ian wan drav.• siiall 6e veriiied n�r § 1 SZ(b)1 Ci to meet [he reaoireinents oi" 9lil (fl7B.
Locumemaiion Aui
• I cerNi�•}natthis
Company:
�
liai�: g.. ` 2: ?� I?
li Hpplicable � C5h or O C
(CertiGcation t!):
�SS -�� 2
l.espunsible L' uildinri Lesi�ner'c Iieclaratiun Stsrtement �-
•. ] am eligibl:: untlei Liviaiun i oi Ihe C;iliiomi�i busiueas nnd 17uJessinn: Cod:: io necepi respuusibiliiy Joi Ibc buildiu� de�ign idemified un
thi,: Cenificate of Compliance.
• ] ecniiy thai Ihr e:nergr Icaw�c:;:wd perlimm�mcc speciiic:i�itm:.lor Ihr. i�uildlm� denipn Itlen�iiied rn� thl:�. Ceriiiic�ac uf Cuinpliunec conform
to thcrequircinent:� ol'TiIL� 24, I'an:. 1 tmd G ul lhi� C.dilornia Ccidr oilleEulaliun::.
• Th�� 6nllelm,^ de,;ipu 1e�iun�e.� iciemiGed oi� liiie Certi1lea�c uf Gumpll�mue ��r;: cunsisieni v�ilL lh:: inlnrmu�ioi� provided u� ducumeni th{;.
huildm� ciesigu ni� lii. olher apphenblc cumph�mcr iorme.. worh:,6eua, c�dculntin��c, pf�in:: and :�pecilicauon:. sui�nutted io the enforecmem
uec;ncp lu, ul�nrnvul ��atL lhia iiuiiclue� ur,nnii xnnh::xuon.
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� CITY OF COSTA MESA
BUILDING DIVISION �
77 FAIR DRIVE, COSTq MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M10-00050
PERMIT TYPE MECH
APN: 42630406
JOB ADDRESS: 375 E 20TH ST CM
Vicinity:
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 05127I2010
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: MECHANICAL PERMIT FOR THE INSTALLATION OF NEW FAU < 100 K BTU TO BE LOCATED IN ATiIC
AREA WITH NEW DUCTING. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. REF# E10-00097
OWNER: CHANEY, MICHAEL AND LAKE, LYDIA
PHONE: 949-355-2522
APPLICANT: CHANEY, MICHAEL
PHONE: 949-355-2522
CONTRACTOR: OWNER-BUILDER
Address: Unit: PHONE:
City/Slate: ZipCode:
MECHANICAL PERMIT FE� SUMMARY
MECH ITEM FEE: $52.00
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $52.00
Address: 373 E 20TH ST Unit:
City/State/Zip: COSTA MESA, CA
Address: 373 E 20TH ST Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELI:
NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under California statutes and relatetl
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF I.AST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply wilh 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.
CODER, INSPECPONTYPE DRT IN7ITIALS CODEp INSPEC710NTYPE DRTE NITRIAlS
1618 Fixed Sys�em Final Fire Prevention 206 Final MeChanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Eiectrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign 222 FinalSite
204 Final Demolition 250 Final Builtling/Occupancy
. a
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one o( the follovring declaralions:
❑ I haVe antl vrill mainlain a Certificate O( cOnSenl l0 SeIFinSUre (Or workefs'
compensation, as provided for by section 3700 of the Labor Coae, for the
performance of the work for which this pertnit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 ot lhe Labor Code, for the peAormance ol Ihe work for which ihis
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier.
(This secfion neetl rpl �e oompeled d Me µvm9 is valuetl at me hu�Mretl tlalars (5f 00) a less.)
P—ol/icy Number:
Q�I certify Iha� in Ihe peAormance of the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensaYq� laws of Califomia, and agree that if I should
become pbjecl ro the wo c�rs' compensation pmvisions of Section 3700 of
th � Labo /Code, I sha I fo fiith comply with Ihese provisions.
�zs o c�
j�p �gnawre Da
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pro(essions Code, and
my license is in (ull (orce and effect.
Lic. # Class #
Contrac�or's Signalure Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a constmctbn lentling agency for the
perfortnance of the v.ork �a which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affrm lhat untlef penalry o( perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follOwing reason (SeC. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any strucNre, prior to its
issuance, also requires the applicant lor such pertnit to file a signed 5latemenl
that he or she is licensed pursuant to Ihe provisions of the Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 ot the
Business antl Professions Cotle) or that he or she is exempl lherefrom and
ihe basis (or the alleged exemption. Any violation o! Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve huntlretl tlollars (5500�.):
❑ I, as owner of the propeny, or my employees with vrdges as their sole
compensation, WILL DO 7HE WORK, and the struclure is not intentled or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
license Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herselt or through his or her own
employees, provided that suc� improvements are not intendetl or offered for
sale. I(, however, the building or improvement is sold wi[hin one year of
completion, Ihe ovmer-builder will have the burden ol proving that he or she
did not builtl or improve (or purpose of sale.).
•�as owner of the property, am EXCLUSIVELY CONTRACTING WITH
L10E�ED CONTRACTORS to construct Ihe pmject (Sec. 7044, Business antl
Professbns Code: The contractors License Law dces not appty to an ovmer of
property who 6uilds or improves thereon, and who contracts for such pmjec[ with
a conlracla(s) license pureuant ro Ihe Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Professi Cotle for this reason:
� 5�zo
nalur y.
305]-46��I0])
� .-
Owner ID verifetl by driver's license. Yes ❑ No
river'6.lice SeNo. ���� � E���: ( (3 ��
Verification of Ownership by (rype of document, i.e. - yroperty taz bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation (rve (5) or more feet in depth into which a
person is requiretl to descend, will be made in connectbn with work aut�orized
by this permii, and that no building strucWre, scaffdding, false�wrk, or tlemolitbn
or dismantling thereof, will be more lhan Ihirty-six (36) feet high. (Chap. 3.2, Grp
2. M 2, Sec. 341, Ttle 8, Califomia Atlministrative Cotle�.
❑ As owner-builder, I will nol employ anyone to do work which vrould
require a permit from the Division of Intlustrial Safety, as noted above, unless
such person has a permi� �o do such work from Ihe division.
nppiicam's Signawre
Division of Industrial Safety Permit Numher _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. will the applicant or present or fuWre builtling occupant need Io fle and
certify a Business Plan for emergency response to release or threatened
release o( a hazardous ma�erial? ❑ Yes ❑ No
(Section 25505 of the Califomia Health ana Safety Cotle requires. with some
exceptions, Ihat a Business Plan be fled vnth the Cosla Mesa Fire
Department by every business which has al any one time tlu�ing a reported
year a quantity of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons. or 200 cuhic teet of compressetl gas
at stantlard temperaWre and pressure).
2. Does or will the applicant or present or fuWre buil0ing occupant need to file
a registration form for aculely hazardous materials? ❑ Yes ❑ No
(Section 25533 of ihe California Heallh and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantiry of acutely
hazardous malerials equal to or greater [han a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
[emperature and pressure).
3. Does or vnll the applicant or present or future building occupanl neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that the
Costa Mesa Fire Department may require Ihe preparation, certification and
fling wi[h the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently requireQ has Section 25534 of the Califomia
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre Duiltling occupant require (or
the work which is lhe subject of this application a permit for such construction
or modification from the Soulh Coasl Air Qualiry Managemenl District or from
any other air pollWion control tlistrict or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that Ihe requested
information be (umishetl on applicalions (or nomresidential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
pf'yes". the facility must meet the requirement o( Seclions 25534 antl 42303
of the Calilornia Health and Safery Cotle).
7. If a pertnit lrom the South Coast Air Qualiry Management DisMct or other
air pollution control district or agency is required lor Ihe vrork which is the
subject of this application, have all o( the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been matle? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance (rom the appropnate air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all state lavrs and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CER7IFICATE OF COMPLIANCE ANU AUTHORIZATION OF ENTRY: I
certify under penalty of perjury thal I have read this application and state that
the infortnation given is c �ecL I agree to comply with all state laws and city
ortlinance relating [o bu ding cons[ruction, and aulhorize representatives of
he Ciry Costa Mes enter upon the above-descrihed property for
i specti urposes. I a r not to occupy or allow o�y of a� tling
a is p i il fnal inspection. �
igna ur er(s) __�_ .
�
AnElor ANbonzetl AOPIit'an�
"�� � Cit o Costa �l�tesa �uiCdin 1�ivision
_____� y f g
Costa Mesa �� Fair Drive, Costa Mesa, CA 92626
714-754-5273/Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit# �����SD v�g��,
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit h�s b}e �submitted 2 y�nasm� isting yourself as the builder of the
property improvements specified at -S E PP>t'
We are providing you with an Owner-Builder Acknowledgment and Information Verifcation 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.
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�, I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" 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
and 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
rpes onsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�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
or her name instead of my own.
��I understand Contractors are required by law to be licensed and bonded in California and to list their
icense numbers on permits and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
an :the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
I understand if I am considered an "employer" under state and federal law, I must register with the state
an —federal govemment, 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.
� I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
re e tial structures cannot legally build them with the intent to offer them for sale, unless al! 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 pertormed under contract with a licensed general building Contractor.
314830 CALBO Jan 1, 2009 OB Packet template 1 of 2
.- a � .
�.8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may he held liable
for'any financial or p�rsonal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
�. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
even�e 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 1-800321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractqrs.
�J�O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
thaYl-am the party legally and financially respgnsible for proposed construction activity at the following address:
- .. �.....T - •,
C-�� -]1}I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abiiie by all applicable laws and requirements that govern Owner-Builders as well as employers.
]2._I_agree to notiFy the issuer of this form immediately of any additions, deletions, or changes to any of the
in or �ation 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 /icense, form notariz tion, or other v ification acceptable to the agency is required to be
presented when the perm't is i sued to verif if property owner's signature.
SGgnatu�e�of-property ovd er ��'ate�-� D
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 OwnervBuilder.
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 tollowing 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:
Name of Authorized Agent:
Address of Authorized Agent:
No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally fillec
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 agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's SignBture:
Date:
3148-30 CAL80 Jan 1, 2009 OB Packet template 2 Of 2
2008 ResiJential
� ��ClimatcZonesland3-7
�/. � O� S` ��� I 6nforceu�er�t Agettcy'
�� �'(
Duct
xe • i .
u racrcagea unn r �
C�'F'umace ❑ AFUEZa�' ❑ COP Over40 f fduc p SetbacA
Serve 7 system added� r I 'n
❑ Indoo�Coil OSEER_�`3_ ❑ HSP� ( � (/(��mafreadrpresenl, nms�Ge
❑ Co�densing Uni� ❑ EER _ ❑ Resistance � sf nc 6ditio e pace „�ua(ted�
D Other
� R 6 (CZ !, 3-SJ
/. Lquipmenf Type: Choose the equipment being msta0ed; if morc than one system, use another CF-IR-AI.T-HVAC for wch sys�em.
2. Minimum Equipment Efficiencies: 13 SEEB, 78% AFUE, 7.7HSPF for typical rcsidential systcros.
Coutracror (Documentation Author's /Responsible Designer's Declaration S[atement)
• I certify that this Cenificate of Compliance documentation is acwrate and complete.
• I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the design identified on this
Cenificate of Compliance.
• 1 ccnify that �he energy featums and perCormance specifications tor the design identified on this Ccnificate o Compliance confovn ro the
requirements of Tille 24, Parts I end 6 of the Califomia Code of Regulations.
• The design Ceatures identified on tftis Certificate of Compliance are consistent with the � rmation docu rn ed on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted tP the e�reement agen r approval with the pem�it
���
��
200d' Residentia! Compliance Fornu
March 201Q
�(ENRORC&MENT AGENCI' "'
� • GAN,GU�ST:CJMIZEiN!1TfZLETTEIZFIE.4DYSEAL) � � �
2008 Building Energy Efficiency Standards Residential NVAC Alterations
Climate Zones 1 and 3 through 7 C,z-6 � �as'r�,-rP<sR�
BUSIN�SS AND PROFESSIONS CODE SECTION 7]10
Willfui or deliberate disrogard and violation of the building laws, including the Califomia Building Code, and
local permit requirements constitutes a cause for disciplinap� action from the Contractors State License Board
working in conjunction with the local bui{ding department. This action may consist of fines up to $5,000 per
violation or suspensionlrevocation of a contractor's license.
'N'H�N IS A PCRMIT RGOUIRED?
A written consauction permit shall be obtained from the enforcement agency prior to the erection, construction,
reconsvuction, installation, relocation, or alteration of any mechanical system, except as permitted �in Appendix
Chapter 1, Section 112.2 of the 2007 Califomia Mechanical Code. Projects requirina permits include, but are not
limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of fumace, coil, FAU, or condenser �
+ Relocation of an existing HVAC unit
�• Adding or replacing more than 40fi ducting in unconditioned space
2008 BUILDING ENLRGY �FFICI�IVC1' STANDARDS lTitle 24, Pnrt 6) REOiJIR�MENTS INCLUDE•
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central air conditioners d. heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. �
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandarory requirements of Section 150(m):
�• All joints and openings in the in the HVAC system must be sealed.
�• Only UL 181, UL 1 S lA, or UL 1 S IB approved tapes or mastic shall be used to seal duct openings.
+ Connections of inetals ducts and the inner core oFflex ducts shall be mechanica➢y fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supponed every 4ft. max for horizontal runs with no more than 2"
of sag between supports and 6 ft. max for venical runs.
6. The CF-6R-MECB-04 must be completed and signed by the ins[alling contractor. The inspector will collect
this form and verif�� that the model numbers are the same as the installed equipment.
Mr. Frank J, Hruza
City of Costa Mesa
Building Safety Supervisor
P.0 Box 1200
Costa Mesa, California 92626
�
October 12, 1970
Re: 375 E. 20th Street, Costa Mesa
Dear Sir:
Thank you for your letter advising me that my roof drain on the front house
is diverting water directly to the adjoining lot. We did not know this as
we purchased the property over a year ago, and there have not been any complaints.
However, we shall see that this matter is corrected.
Sincerely yours,
� 5����
ndrew Reina
10430 Adel Way
Whittier, Ca)ifornia
RECEIVi�D
BUILDING SAFETY DEPT.
OCT 14 197p
AiN „
'?'���9�1��ll�12i1i2i3'��, e
�
❑ BUSINESS CARD
CITY OF COSTp MESA ❑ DEVARTMENT CARD
Development Services DepartmenUPlanning Division
77 Fair Drive, Costa Mesa, CA 92626
(714) 754-5245
We are replying to your request/inquiry with the attached iniormation:
APPLICATION INFORMATION:
❑ Planning ActionlRelocation ❑ Sign Variance ❑ Encroachment Permit '
❑ Development Review ❑ Subdivision p Fee Schedule
❑ Zoning Administrator/ ❑ Rezone/General Plan Amendment ❑ Park Fees
Lot Line Adjustment ❑ Master Calendar
ORDINANCES/SUMMARY SMEETS:
❑ Commercial ❑ Home Occupations
❑ Industrial ❑ Landscape
❑ Fesidential ❑ Nonconforming
❑ Condo ❑ Planned Development
❑ Other:
STANDARDS/SUMMARY SHEETS:
❑ Commercial
❑ Industrial
❑ Residential
❑ Other:
❑ Comments:
❑ Accessory Apartments/Granny Flats
❑ Antenna
❑ Density Bonus
❑ Signs
❑ Sign Submittal
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If you need additional information, please call or write to the above address. It has been our pleasure serving you.
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ADDRESS
Costa Mesa
OF
VALUE
SUBCONTRACTOR
ZONE
�
�' 24469
� COSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O. BO; 917 COSTA M6HA, CALIPORNIA
Fo� Applicanf to F711 In Complataly
TYPE OR PRINT
COSTA MESA. CALIFORNIA
� MAIL
ARCHITECT .
O� ^INEER
7.�.�lo3s No'(ovG 539G
.
no. ov o�ooe..
��o< `� )il3e;la .�o�..o..�or
USE OF
EXISTINO BLD6. PIJCt-�-\ N L
BETBACN LINH FROM
DESCRIPTION OF WORK
� BUILDINO
USE OF BUILDINB AN� WORK TO
1_�l��j� . _ �/ fl�
�R-J�Gc Pn�.Ci�—
1 N¢REOY ACKNOWLHOOC THAT � H�V¢ ReAO TXIB �PPLICATION
AND BTRTE TH�T THH A90V[ �e COpqBCT AND AONEH TO COM.
PLY WITH ALL CITY OFOIN�NC88 AND BTAT[ LAWe RQOULATINO
BUILDINO CONSTflUCT�ON.
SIGNATUREOF �� �(� A��
PERMIITEF i ��+�
AUTHORIZED A6ENT
CITY �F L�STA MESA
JUL 27 1965
PIRH
LCaAL
�1
ZONIN6
iunsR 2 euiiciiva � �
G� 3 TiC z 7� ,
� — Z/s��. /3
VE OVERHANO BHALL BE LE89 TNAN
YARDS APPROVED
MAIN BUILDIN6
DISTANCE BET.
MAIN BLDG4.
VAR. #
YARDSAPPROVED
AGCESSORY BUILDINO
BET. I
ACCE
DATE
�Z7—«
n
go. �. �
TNE AMOYNT BXOWN UNOEp VALYATION 18 FOq THH £
PURP088 OP H6TABLIBHIMO • PEHMIT FH8 ONLY, p
VALUATION p� Q` N
PERMITFEE $ j
�^ °
S �'� E o
� ,� � � `
0
OWNER BALLREICH,--MRS; DATE 'i-15-Sy
JOBADDRES3 377 F',. 20th Street BUILDINGPERMITNO. #(y(97
GENERAL CONTRACTOR A. .T, W01.'ty
AP118-213-08
L BLOCK
INSPECTIONS
Foundation Forms and Gra
Rough Framing
Plumbina. Rouoh to Slab
Heati
Heating, Final
Sewer, House
SeDtic Tank or
L ig, In
Plumbing, Final, Fixtures
Plum6ing, Fin�al GasTest
Wiring, Final
Occupancy
FORM 310 9M 10�55
TRACT
V ZONE RLl
DATE SUBCONTRACTOR
_� �C'Ti
VALUE
PERMITS ISSUED
DATE � NUMBER
� .
- 4'755
COSTA MESA BUILDING DEPARTMENT
r P. o. eox 3 n
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
� � � 2oT[. 5 r
COSTA MESA. CALIFORNIA
MAIL [ �r
A�DRE55 � p
��r� � 0 5T,
ARCHITECT
OR F"'�INEER
ADORE55 �+J �a
LEG/L LOT
oescaivnow ryp,
A.P. NO. / �
SIZE �
OF LOT
USE OF
EXISTING BLOG.�
SETBACN LIrvE FFOM
� �= i %� rrEio: /e(6
LIC.
O, NO.
�d�%� � sr,�t?F `r.�i`o:I�q�v�
Y TA rE+o:G/ G 3i,
BLOCK TRACT
� � � � (
NO.OF 9LOG5.
G o /Nc now orv �or
_� %
/� O REAR YARO 3 O
SI�E YARD �j RIGHT._,� LEFT �/,.� ��C �
� DESCRIPTIO OF WORK � I`�
NEW /� ALTERATION AODITION
1
REPAi.. MOVING DEMOLISH�
BUILDING �ry 20 NO.OF � /
SIZE -V � ROOMS STO IES
EXTERIOR WALL� ROOF �� S N�
COVERING LH�Y COVERING [/�O� �Ii �E:
USE OF NEW .. _ _ � . // —i-
�E� RECEIVED
�� i�'-t�.�-S�
FINANC�E� DEP� F.�p
APF�Lj�a�flt�T�!'F'aR PERMIT
BUILDING
FOR OFFICE USE ONLY
/G'-'� i - / o �l J � N -o
eui�nir�c � - S � it_ �. -fF•
AD�RE55 � G
COSTA MESA. CALIFORNIA
FIRE
ZONE
NO.OF iYpE I GROl1P ,
PLAN$ �
��
APPROVED ••�
BY DATE' '� 1,1
� P
CORRECTIONS '
DA
r-✓.� � �` i� f'•d � � ' � � "/
%� �• / ,`A/ � — �'
!1 HEREBY �CHNOWLEO TN1T 1 XAVE flEAp TMI$ .�PPLICATION .�NO '
STRTE TXI�T TNE PBOV I$ COflFECT RN� RGREE TO COMPLV WITM iLL
CITY OROINANCE$ <NO $T>TE l<WS NEGULATING BVILOING CONSTRUC�
nor+. VALUATION �
� SIGNATURE OF PERMIT FEE S O O
PERMITTEE O B� �/�
��' PLANCHECK $ �ON'CG
. � �a
�AUTHORIZED AGENT TOTAL FEE S r� O� vM�
OWNER (;nSMCIS��,i_ ' DATE 8-12-5L�
JOBADDREBS �']� E. 20Lh St. BUILDINGPERMITNO. �(�(�
GENERALCONTRACTOR
TRACT Z%S
I
INSPECTIONS I DATE I SUBCONTRACTOR
Trench
:ion Forms and Grade
Plumbing, Rough Complete
Heatinp, Final
Se-"^. Tank or
L �g I
Plumbing, Final, Fixtures
Plumbing, Final GasTest
Wiring, Final
Occupancy
Form 210 GA lbf 1&63
IL
VALU
PERMITSISSUED
NUMBER
G�ta Mesa Building Department
/'� 111 EAST 20th STREET
� COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
Buildin9 37 y E� G1M
Address � � �-
Costa, Mesa, California
Nearest � „'
Crosa St. �U S / � / I
Owner „�, � O S �_/ � S �ln
Mafl 37S V ZO� �,.�it :
Addresa
Tel. L, /
c�tr G • � • No. � -G9
Architect or C� L� Lic.
Enufneer .7 No.
Size ot Lot
Use oi
New ��
Repair
Buflding _ _
bui
I hereby ackn�
and state that
with ¢ll City
biulding rnnst
Signature of
Permittee
•.w'7
�r y Bloek3UU
ounda) ���{ � `
No. ot BI
— I 3 Z n,ow o�
No. of
�Y/Y Familip
Rear V
��O Side Y:
[PTION OF WO
I
�ta>f
�_
Z
o. of
�oms
LS�-
ci
Alteratton I Addition � v
� Stories I
APPLiCATION FOdL PER �
4'�3 BUILD�NG
I FOR OFFICE USE ONLY
Received by
Address / � _
Costa
Nearest .�-
Cross St. l C1
DaYe Rec'tl.� Date issued
� �'f�� y S�
� �(J
Zesa. California
.C,O � Covering C�,e,gy� . AppgpVALS
11/l� US jZaaM Foundatian Location Inspector
Forms, Materials,
Under-Pinning
Frame: Fire Stopa,
Bracing, Bolts
that I have read Uus Applicatton Lath. Int.
ve is rnrrect and agree to comply Lath. Ext
ues and State Iaws regulating
� Plaster, Int.
$alu�tion �, / d " PermftFee $ —
/ (1, Plan Cheek $ � ^ Bond Beam
�y / Total p
Fen $ / � FINAL
FONM 2O4 G-H 2M 5•84
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1
T • � �
� PLOT PLAt.N � =i 'J = . . -
� Show Iocation and; di�anxa irom � . •
.
propeHy lina and'betiveen buildings .
, Do you carry Workman's ComAensatior� ' ' ,
', xneuranceY ' ' Yes n _ 1�0. � •
�.
I tlm nvrure nf ^rnv: ,: �_� ;.?�D o? the State
Lebor Cu�l,i ti.:.:. �`t r.� :.. _ ��;��ry ee�?loyer
to bo in::ur�,'l ���,,ZL�i.,:. liubillty for
irorl[m.::�' u¢ c�;� �u .: 4, t-.,
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