HomeMy WebLinkAbout418 20TH ST - Building Permits- ,
CITY OF COSTA MESA
�TpMFsq BIIILDING DIVIS/ON
i` � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us
:
°. � FOR INSPECTIONS CALL: (714) 754-5626
Rc+�amno A`.
PERMIT NUMBER: BC10-00403
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 09/07I2010
ISSUED BY: RMD
JOB ADDRESS: dSkS�Ei2OTF1'S�M
APN: 42624130
Vicinity: KITCHEN
Const Type: V-6
Zoning: , ,
SQ. FT: 0
Suite/Unit:
Primary Occ:
Valuation: $9,500.00
SCOPE OF WORK: MINOR INTERIOR KITCHEN REMODEL FOR SFD. WORK TO INCLUDE THE CHANGE OUT OF (1) EXISTING
WINDOW (NO CHANGED IN HEADER), REPLACE KITCHEN HOOD, 9 LIGHT FIXTS, 8 OUTLETS, 9 SWITCHES, 1 GARBAGE
DISPOSAL, 1 DISHWASHER, GAS OUTLET (1-4), 1 KITCHEN SINK AND WATER PIPING FOR ICE CONNECT.
ELECTRICAL MANDATORY MEASURES ATTACHED TO JOB CARD AND CITY PERMITT.
OWNER: MOSS, RONALD F
Phone: 949-548•2656
APPLICANT: RAZ GRINBAUM
Phone: 818-045-1355
CON7�tACTOR LIBERTY CONSTRUCTION
Phone: 618A454439
Celi:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Sid Admin Fund
TOTAL FEES:
Address: 478 E 20TH ST
CitylStatelZip: COSTA MESA, CA
Address:
CirylState/zZip:
License No. 640562
Address: 427 N CITRUS AVUnit:
City/Slate: LOS ANGELES, CA
License No.
License No.
$0.00
$181.25
$56.85
$34.15
$59.05
$0.95
$0.00
$1.00
$333.25
HOURS FOR CONSTRUCTION ACTIVITY: EFFEf
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm.
Unit:
Unit: :
ZipCode 90036
PHONE:
PHONE:
and the following Federal holidays:
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes antl related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
LOOE l. INSPECTION TYPE
7616 Fixed Sys�em Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
DRTE INTI� 4QO�N INSPEL710NTYPE
206 Final MeChanical
20B Final Plumbing
210 Final ElecUiwl
212 Final Fire Prevention
220 FinalPlanningApproval
222 Final Site
250 Final Building/Occupancy
DA7E INTITIRLS
X�1 !f h� lJ�
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty o( perjury one of the following declarations:
❑ I have and will maintain a certifcate o! consent to self-Insure for workers'
compensation, as provitled for by sectiqn 3700 of the Labor Code, for the
peAormance of the work for which this permit is issued.
� have and will maintain workers' compensation insu2nce, as required by
section 3700 of the Labor Code, !or ihe peRortnance of the vrork for which [his
pertnit is issuetl. My workers' compensation Insurance carrier and policy
number are:
r�a rier? )V�' G
(This s�eeE irof be completed AMe peimrt is valuetl af one �undretl0ollars (3100J orlessJ
Policy�Number �2�'��2�] Z.-� �
❑ I certify [hat in the pertormance o( the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree that it I should
become subject to the vrorkers' compengation provisions o( Seclion 3700 0(
Ihe Labor Code, I shal (orth ' with Ihese provisions.
- � gl7�io
AO c nl'S Signa u �Delp��,
4.J�-"'.__
WARNING: F RE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJEC7 AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($100,000�, IN ADDITION TO THE COST QF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby atfirm Ihat I am licensetl under provisions of Chapter 9(commencing
with Seclion 7000) of Division 3 of the Business and Professions Code, antl
my licens�e+ is in full force and eRect.
Lic,-V#:^,Ce� Cwss��
ghlm
C ecio/sBignature
-�'-..,.��°°i4,."�=�.�
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a constructbn lentling agency fw Ihe
perfortnance of the work fa which Nis permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby aKrm thal under penalty of perjury Ihat I am E7(EMP7 FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or counly which requires a permit to
construct, alter, impmve, demolish, or repair any sWCWre. prior ro its
issuance, also requires the appliwnt for such permit to file a signed statement
that he or she is licensed pursuant ro the provisions of Ihe Contractors
License Law (Chapter 9(commencing wiih Section 7000) of Division 3 of Ihe
Business and Professions Code) or Ihat he or she is exempt therefrom antl
the hasis !or Ihe allegetl exemptioa Any violation of Section 7031.5 by any
applicaN for a permit subjects the applicant to a civil penalry of not more ihan
five hundretl dollars (5500).):
� I, as owner of the property, or my �mployees with wages as their sole
compensation, WILL DO 7HE WORK, and the stmcture is not intended or
offered !or sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
lhereon, and who does such work himself or herself or through his or her own
employees, provided ihat such improvemenis are not intended or offeretl for
sale. If, however, the building or improvement is solC within one year of
completion, the owner-builtler will have the burden of proving that he or she
tlid not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS ro construct the project (Sec. 7044, Business and
Professbns Code: The conlraclors License Law dces not apply to an amer of
property who builds or improves thereon, and who cont2cis (or such project with
a contracta(s) license pursuant to the Contracfors ��cense Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-Afi(0I0])
Ovmer ID verifed hy driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by Qype of tlocument, i.e. - property tax 6ill or deed):
�IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlHy that no excavation Me (5) or more feet in tlepth into which a
person is required lo descend, will be matle in connection vnth wnrk authonzed
by this permit, antl �hat no builtling sWcture, scal(Wtling, falsework, or demolilion
or tlismantling thereof, will be more lhan thirty-sia (36) feet high. (Chap. 32, Grp
2, Ari 2, Sec. 341, Title 8, Califomia Administrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Industrial Safety, as noted above, unless
such per5on has a permit to do such work 6om Ihe division.
AOPiiwnfs 9gnature
Division of Industrial Sa(ety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to fle antl
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safery Code requires. wiM some
excep�ions, that a Business Plan be filed with [he Cos[a Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantiry of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard IemperaNre and pres5ure).
2. Does or will the applicant or present or Nture building occupam need to file
a registration form for acutely hazardous materials7 ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, vrith some
excepfions, requires regis(rafion vnth fhe Cos[a Mesa Fire �epartment by
each business which a[ any one time has on hantl a quantiry of awtely
hazardous materials equal to or greater than a vreight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feel of compressea gas at slandard
IemperaNre ana pressure).
3. Does or will the applicant or present or fuNre building occupant need lo
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Ves ❑ No
(Setlion 25534 0( Ihe Cali(omia Heallh antl Safely Code provide5 that �he
Costa Mesa Fire Department may require Ihe preparation, cenifcation and
filing with the Fire Department of an RMPP by businesses which are required
ro register acutety hazartlous materials with t�e Fire Department.
4. If an RMPP is presently required, has Section 25534 of lhe Cali(omia
Health and Satery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or (ulure builtling occupant require (or
the work which is �he subject of this application a permit for such wns[ruction
or motlificalion from the South Coast Air Qualiry Management Dislrict or from
any other air pollulion control district or agency? ❑ Ves ❑ No
(Section 658502 of Ihe Calitania Govemment Code requires that the requesletl
in(ortnalion be lumished on applications for non-residential building pertnits).
6. Will any part of the facility to be constructed under this pertnit be vnthin
1000 teet fmm the outer bountlaries of a school? ❑ Yes ❑ No
(If'yes", Ihe lacilily must meet Ne requirement o( Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control tlistrict or agency is required /or the work which is the
subject of this application, have all of the disclosures prescrihed by Califomia
Health and Satety Code Section 42303 been made? ❑ Ves ❑ No
8. pt'yes". attach certifcate of compliance from the appropnate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I cenify that under penalty of perjury lhe
information given above is correcL I agree lo comply wifh all state laws and
city ordinances regartling Hazartlous Materials and Emissions.
Slgnalure Oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cenify untler penalty of perjury that I have read this application and state that
the information given is correcl I agree to comply with all state laws and city
ordinances relating to building constmction, and authorize represenlatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree no[ to occupy or allow occupancy of any building
au�horized by Ihis permit until fnal inspection.
SignaWre ol Legal Ovmer pate
�T%7/!o
LAntlIofALIM1 AOF�ii'anl'.._ � Vpa1e� _�'�1`x
e Certificate oT Cumol. .e: Resi[lential . CN-IR-ALT
�h
Generol Infa�m:�ti0n
Site Addrevs: 1 �. �-
[3uilding 9�ype � Single Family ❑ Multi Family
Conditioned Floor Area (CfA)'.
%'his %orm is not 10 !re nser! )'or
ori Value.e For Onnrn�c Snr/ap
A};ency:
Circle the Fmnt Orieotation�.
"Lune #
f/�� v � nnic: RI1
VJ, or degrees _
� Alterations � Envelope O Fenestration ❑ Roof � HVAC
or Chanee Out ❑ Duct Reolacemem 0 Water Heater ,
Cnnstri�c�ed Uuildings nr Additinns
%anvine u.re !he Mass cmd Furrin,� Strrps Constnrc�ion table
Assem6lp Alter.�tion
❑-0pening of ir:�med cavity alone-Alrerations tbnt mvolre the opening ojthefi�oiired caviry� o/'n wall, ceiling, orJloor musl install dre
rnundcum�i� miniminn I�asvla�iorv vnlaie per' §I50 for the nher'ed assenvbh•. Fill irv Columns�l -C nnd enter niandatorp insula�ion value in Cola�mr� H.
❑ keplacemenl of entire nssemblJ'-Repluceneenl ofan entrre r��al(, ceiling. or Jloorass�ent6lp requires Ihe inslal(atron qjCompm�ent
Packnve- D±nsodntion va(ues i�r Tu6le l.i /-C. Fill in Columns A- J. '�
Nole.
Sll�'feCe D0t8115 Ror lhe 1'urred portinned of
13 C D"' "
Proposed S��rvm�
Framing Thickness
AssemblyN�une Material Spncing,
m-Twe� end Size� or Other3
Wails see Rurring Strips Cunstruction Table belnw.
fa tor"
uccaunling fm� Cauinuous Insulatinn R-volue, see Pnge
..._ .i �....
Values From JA4 Table
Framed Continuous JA4 Proposed
JA4 Table Cavity Insulation Assembly Assembly
Numbers R-value� R-Value' Cell Vatues U-factor9
I4-3 and EGriation 4-1. For calculalinr (n'red wa!!s use Ihe Mass m�d
(. Fa� Tng/IU irtdicate die idenitJicaiim� name ihu� mntches !he building plans.
?. Ladicate the Assentbl�� Nunve o;� {7pe.' Roqj/Cei/ing, N''alla�, Ploa�s, Slabs, Craw7 Spuce, Do�r,s ond elc...lndicale Ihe Frame type and Sizer Far
Wood, Me�al, Meta! Buildings, Mass, eie�er 2x4, 2x6, or elc... see JA4 (or odieryossible fr�4me type assemblies.
3. Enter !he thiclaiess {ar muss irt inches or Spacing be�veen f'aming members enter; 1 G'or 24 "OC; or O�her for all oU�er assem6l�� description
sach as Concrete Sandwich Panel, Spondrel Pane(, Lvgs, Sn�ae� Bale Panel and etc....
4. I3ased ar the Climate Zone; enrer the Standard U factorfi�onr TaEle 151-B, C m-D far each drfJ�eren� assemLln Name m' t�pe.
5. L' nter die Tab1e nvmber Ihm closeli� rea�embles the proyosed qsa�emb/r.
6. En�er lhe 17-value Ihai is being insta(led in !hc Hm// cm�itp or be�ween the fi�aming; olherwise, e�vter "0 ".
7. Eitier Ihe Coia�inuous Insadation R-i�alue jw� �hc proposed asse�ribl��; otherwisc, enter "0".
6. L'���er the r�w and cnlumn of �he U-factw� vafue ba.eed on Colun�ir F Table Num6er und enter' tlie Assenv6ly U-faclor' irv Columrr./
). The Propn.��ed dsxembh� U-(ac�or. Colunm J, nmsi be eqiml m or less than die Stundnrrf U-fuctor in Colanm E m rompl>>.
PutrinE Strips Construction Table for Mass W alls Onh� �
A 13 C D � P G H I J K L M
Propused I'ruperlies ot' M:�,sunrp and Conerete Added InWrior or �x[erior losulatinn
N'alls Rrom Reference in �urring Spacu 1'rom Helerener.
Joint A i�endix'I�able 4.3.5, 4.3.G. 4.3.7 .{uint A icndix'fable 4.313
U V� `� 1 i - U
v, {i " ^ � L L ' v
Assmnhly z� � � o.° � F' o a,'� �e __ Finid
Mass Nmnc or JA4 7ablc �� �, �`v = E E o L m �_ v-m Asselnh)y
Thickness' T e Numher' i � �i � � � 3 � z �'p i'.0 r U-factor�'� Commeni
I !
�
�
Regi,svuiion Numher: Registruiion Uaie//'ime.� H8K5 Pravider:
?0061ie,sidentia] Compliance Forn�.t� Fiugusi 2009
_J
CertiScate of Cu
cr-i
Res•ide�ztird �1lerrziiun.r� (P_t�L'e j n1�
Yrujecl•Namc: ' �� �� —C—liiii6te"'Lunu3! � � #fu7��rie:
�.--- �Q � � �
Fl�ltS VP61�IR1CAT10N SOMMAR]' The ei�%rcemen� ogenc;r should pa_r specinl twenuoiv ro (l�o HL'XS Aleasurea� spec�ied n� diia�
checld�si Lelati�. �l cnmple�ed and signed CR-47f Fmvn for nll �he mensiu�e.r specijied shnll be si�bmitied �o lhe bz�i7ding iivspecior beforr lintd
DuCiSenliReB&TeStiud NLRSneri/ica�iarisrequiredfordiisnreusure.
❑ Yl5 ❑ NO YGS�.lu Climaie `Lones 2 nnd 9-1 G, if more tLan 90 linear feei of'new or replacement ducts tire installed in unconditioned
sp�me, the ducts are to 6� sealed per ti 152(6pDii and the newly instnlled ducis are to be insulated pe� §I S I(f110.
❑ L''XCCI'TION: L%isliug ducf systemx thal are ezteiided, which .ire cuustructed, insul:�ted nr sealed �vith �is6es[us.
❑ 1�S ❑ NO YL+S, ln Climme Zoi�es 2 and 9-] 6, if tl�e esisuug space-conditioning system (NVAC equipmem end duciingj is r�pinced, the
ducts are m 6e scaled pei fi152(b)1Di. �
❑ YES ❑ NO Y�S: In Climate Zones 2 and 9-16, if the existin� HVAC equipm�nt is repluced (includint the replacement of-tiie �iir handler;
outdoor con�ensing unii of n splii system, cooliug or heating coil, or the Purnece lieai exchanger) the duc[s are ta be
sea]ed per §152(b)lE.
❑�RC�]'TIOn: Duci systems that aro ducumented tu htrvu been previuusly suded cuntirmeil tJ�rough HCRS
_ . . - verif�cation in �ccm'dance tvith procedures in the Reference Residential Appendiz P.A3.
❑ EXC�PTION: Duct systems with-less thau 40 linear feet in uncouditimied spuce. -� _.
❑ ERCLPTIO�': �sistin^ duct svstems constructed. insulated m� senlecl wi[h usbestns.
iZBfYle2t':1171� Ch3YaC - SFl�lt $VSfBICI HERS verificntioi� rs regvire� fm� this measm�c. � - �
❑ Y�S ❑ NO YLS: ln Climate Zones 2 and 5-15, wlien the existiog HVAC equipmen� is replaeed (inclnding the replacement of the nir
handler, outdoor conde�sing �unit of a split system A/C or heat pump, cooling or hea[ing eoil, or the furnace heal
be verified ner §I52(o11F.
Centrat Fan Inteerated (CF�l) Ventilation System and Fan Vs'att D; aw
The ventilatinn renuirements of &15D(ol do not aoolv tn ezis[in� residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow� HERS veriiica�io�� is reguirec! Jbr d�is measure.
❑ YES ❑ NO ]'ES: ln Climate Zones 10 through 15, wlien the existin� space-co��ditioning system (HVAC equipment and ductiug) is
reolaced. the airfloW and fan watt draw shall be verif�ed ner § 152(b)] Ci co meet the reauiraments of & 151(f17B.
• S certiip that this Certit
Name:
Q az G�;
Company:
�'�b
Addres�
City/Smle�Z�P: �
�_>
'Resoonsiblc 13ui
LU
Designer's Declaration Statement
irflte and
Signawre�.
L�
If Appiicabie G CEA or
(Certification d!):
Phone:
Qff4 _'ll�l
7 am eligible uiider Divisiou 3 oi Lhe Cali�fornia Business and Professions Codc to accep� responsibilfty for the bulding design identifiied'mr
this Cerlifieate of Compliamce.
] ecrlify thai thc energy feawres ancl performance specificaLions for Lhe building design identiLed on this Certiileate of Complianee coni'orm
tu thc requircments of Titic 24, 7';nis 1.md G of the Culiibrnia Code of Regulatiuns.
The building design feaun�es idemiGed on this CeniLeate of Compliance ar� cunsistem with lhe in(ormation provided w ducumem this
buildiug design on Ihe o�her sippiicabie cmnpliuncc ionns, worksheets, culcul�tions, 7iluns aud specifice�ions subnii��ed ta tlm en{brccmem
�ieenr.�� liu t�pnrovtd witli lhla buildlnp p::nnil �ini�licalion.
Name.
Company:
Hddress.
Citv;State!$ip:
Si�nativc:
Uate:
License.
Phmie.
Fnr assi.ctruice or ryue,t�tinna� reb�nrding the Lnerep SttmdartLc, conuec� die Li�ergr Hot(ine «t: 7-k0U-;72-iiGO.
I(egisa�ation A4m�ber. Regia�iruiinn Uaic/Tfine: 1�CI;S (r-ovider.
200E Re.ridert�ial Cm��plimice Forms Ai�gusi ZOOJ
Measures S
ISi[e�Add`ress:
L/ i. � �
�
rr��-2�
'xie 2 of 3
��
§150Q)4: Solar waterheating systems and/or collec[ocs are certified bY the Solar Rating and Certification Corporation- 1
and Fans Measures:
§ I50(m)I: All air-distribution systein ducts and plonums installed, are sealed and insulated to meet the requirements o1-CMC Sections 601,.GU�,
603, 604, 605 and Standard 6-5; supply-air and retum-air ducts and plenums are insulated to a minimum installed level of� R-42 or
enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duc�-closure system 16zt mee�s tl�e zppliczbJe
requirements of UL 181, UL I81 A, or UL 181B or aerosol sealant [hat meets the requirements of UL 723. If maslic or tape is used lo
seal openings greater than 1/4 inch the combination of mastic and either mesh or tape shall be used
§I50(mp: Building cevities, support platforms for air 6andlers, and plenums defined or couatmeted with materlals other than sealed sheet metal,
duet boacd or 1lexible duct shall not be used for conveying conditioned uir. Building cavities and support plxttorms may contain docrs.
Duets installed +n eavities and suppor� plaaForms shall not be eompressed �o cause reduc[ions in the cross-sectioi�al erea ot []�e duc�s,
§]50(m)2D: Joints and seams of duct systems and their eomponents shall not be sealed with eloth back rubber adhesive duct tapes miless sueh tape
is used in combi�ation with mastic and draw bands. -
§]]
�
§11
§ll
§Il
���
-Re
� § L'
Exhaust fan svstems have back draft or automatic
: Gravit�� ventilating systems serving conditioned space have either aummatic or readily accessible, manually operated dampers.
: Insulation shall be pmtected feom damage, including that due tn s�nlight, moisture, equipment m5intenance, and-wind.- Cellular foam
insulation shall be protected as above or painted with a coating Niat is water retardant and provides shielding from solar radiation ihat
can cause deeradation ofthe materia(.
0: Flexible ducts cannot have porous inner cores.
All dwelling units shall meet the req�icements of AiV51/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoar Air Quality in
Low-Rise Residential Buildiugs. Window ope�ation is not a pennissible method of providing the Whole Building Ventilation required in
Seckon 4 of that Stendacd.
1 Spa Heating Systems and Equipment Measures:
Any pool or spa headng system shall be certified to have: a thermal efficiency that complies with the Appliance Ef;iciency liegulations;
an on-off switch mounted outside of the lieater, a permanent wea[Uerpmof plate or card with operating instmctions; and sliall not use
Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, m� dedicated suction and retum
iines or built-up connections for future solar heati��g ��
Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or
nmerammed to ran onlv durine off-roeak elecvic demand oeriods.
Residential 000l svscems or eauinment meet the numo sizine, flow rate, n�U�n�„ filters, and valve requirements of
: High effieaey Iuminaires or LED Light Engine with Inlegral Heat Smlc has au eHicacy that �s no
Table ] 50-C and is not n low efficacy luminaire xs specified by § 150(k)2.
The wattage of permaneiitly inscalled luminaires shall be determined as speeiiied by §130(d).
8allasis for fl�oresceni tamps raEed 13 Watts or greaYer shall be electmnic aud shall have en output frequency no less than 20 kHz.
Permane�tly installed night lights and night ligh[s iiitegral to a permanenHy installed luminaire or exhaust Tan sliall contain only hlgh
effieacy lamps meeting the minimum efficacies contai�ied in Table ] 50-C and shall not contain a Iine-voltage sucket or line-voltage
lamp holder, OR shall be rared to consume no more than five watts of power as determined by § 130(d), and shall nol contain a medium
shbll meet the aoolicable reouirements of
¢150(k)7: All switching devices and wntrols shall meet the requiremenGz oC ¢ I50(Ic)7.
¢I50(k)8: A minimum of 50 percent of the total rUted wattage of pennanently instailed lightfng in kitehens shalf be high efGcacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal l0 2,500 fl� or 100 watts for dwelling unils larger tlian 2,500 ft� mey be esempt
from the 50% bigl� efficacy requiremem when: all low effic2cy lwninai��es in the kitchen are controlled by a manual on occupanl
sensoi, dimmer, energy management system (EMCS), or a multi-scene programmable cmitrol systent; end all ��crmanently installed
luminnries in garages, laundry moms, closets greater than 70 squa�c feet, and utility rooms are high efLcxcy and controlled by a
�s mtemal to
m
usc no more than 20 watts of pov.�er per
and detached gn�ages, laundry rooms, cloaets and utilig� rooms
2008 Residential Compliance Forms Attgue't
lVlandator�� Measures � nmary � � 1Vfi�-�I2
Residentiul (Pa��c 3 of'3
� Sile�Addi�essi �� Ivd�orcement Agencp:
`, lJ./,� � - Zo �� � �--=-�=-' .: .
GXCEPTIOt�' l: Pennanently insmiled low efficacy luminaires shall be allowed prorided that they are controllecl by n manunl-on
occupant sensor certified to comply with the applicable requiremen[s of §I 19.
EXCEPTION 2: Permanen[ly ins�ulled.lo�+' efficucy lumivaires in closeu less th,m 70 squ.�re feet are nol required lo be controlled by a
mnnual-on occupant sensor.
§15UQc) I I: Permnnently instedled Iuminaires located in rooms or xreax olher th,m in Icitchens, bathrooms, garages, laundq� rooms, closets, iind utility
rooms shall be high efficac�� luimnaires.
GXCEPTION I�. Permanently installed low efGcacy luminuires shull be �Ilowed provided they ure conlrolled by either a dimmer switch
that complies with the applicable requirements of § I 19, or by a manuul-on occupant sensor tliai complies with Lhe
applicable requirenrents of § I 19.
EXCEPT70N 2: Lightino in detached storuge building less than 1000 square 1eei loca�ed on a residentiul site is not required �o com}�ly
with §I50(k)I1.
§ ISUQ<)12�. Luminaires recessed into insulated ceilings-shall be listed for zeru cluarance iusidation aroteci QC) by Undenvriters Laboratories or
other nationally recognized testing/rating laboratoq; aud have a label [hnt certifies the lumiunaire is airtight with uir leal.age less then
?.0 CFM at 75 Pascals wheii tested in accordance with AS'I'M G2S3; and be sealed with a gasket or caulic be[ween Uic luminaire housing
and cciling. . .
§ I50(k)I3: Luminaires providing outdoor lighting, includinc lighting fbr private patios in low-rise residential buildings with four m� more dwelling
uuits, envanees, balconies, and porches, which are peemanently mounted tu u residential 6uilding or to other buildings on the same lot
� � shall be high efficacy. - � - � - �
EXCEPTION I: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are con[rolled by a manual
. on/off switch, a motiun sensur no� having an override or bypass switcli Iha[ disables the motia� se��sor, emd onc oCthe
following controis: a phomcontrol not having an override or bypass switch that disables the photocontrol; OR an
. astronomical time clock not having an oven�ide or bypass switch that disnbles the astronomical time clock; OR an
energy management controt system (EMCS) not huving an override or bypass switch that allows Ihe luntinaire m be
always on
EXCEPTfON 2: Outdoor luminaires used to comply with Exception 1 to § I 50(k)13 may 6e convol led by a temporary override swi[ch
�vhich bypasses tlie motion sensing tunction provided that the motion seiisor is aulomatically reactivated wetliin six
hours.
EXCEP"CION 3: Pennanently installed luminaires in or around swimming pool, water featw�es, or other location subject to Anicle 680 oT
the California Electric Code need not be hi h efficac � luminaires.
§I50(k)14: luternally illuminated address signs shall eomply with Section 148; OR not eontain a screw-base socket, and oonswne uo more than frve
watts of ower as determined accordin � to § 130(d).
¢ 15D(k)I5: Lighting for parking lots and carports with z total of for 8 a� more vehicles per site shall comply wi[h the applicable requirements in
Sections 130, 132, 134, and 147. Lighting for parking @arages for A or ma�e vehicles shall comply with the ayplicable requirements oT
Sections 130. 131, 134, and 146
§150(k)1 G: Pennanently installed lighting in the enclosed, non-dwelling spaces of low-rise residential buildings with four or more dwelling units
shail be high efticacy Iwninaires.
EXCEPTION: Penuanently installed low elricacy luminaires shall be allotved provided that [hey uce eontrolled by en occupant sensur(s)
eertified to comply with the a plicable requirements of � I 19.
2008 Residential Con�plia�ce Fornrs �liigus'l 200J
\
� CITY OF COSTA MESA
p~Fq B!/ILDING DIVISION
i� .. � 77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax pt4) 754-4856 • www.ci.costa-mesa.ca.us
:
�. � FOR INSPECTIONS CALL: (714) 754-5626
!�m t.'
PERMIT NUMBER: M10-00013
PERMIT TYPE MECH STATUS: ISSUED
APN: 42624130 DATE ISSUED: 01/29/2010
ISSUED BY: RMD
JOB ADDRESS: 418 E 20TH ST CM
Vicinity: ATTIC
SQ. FT: 0
Suite/Unit:
SCOPE OF WORK: MECHANICAL PERMIT CHANGE OUT AND RELOCATE A FAU < 100K BTU FROM HALLWAY CLOSET TO
ATTIC, INSTALL NEW DUCTING FOR A SFD. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. REF#:
E10-00012
OWNER:
PHONE:
APPLICANT:
PHONE:
MOSS, RONALD F
BEEKER,ANDREW
714-979-2070
CONTRACTOR: KLONDIKE AIR INC
Address: 1308 LOGANUnit: SUITE H
City/State: COSTA'MESA,CA ZipCode: 92626
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $52.00
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $52.00
Address: 418 E 20TH ST Unit:
City/State/Zip: COSTA MESA, CA
Address: 1308 COGAN Unit:SUITE H
City/State/zZip: COSTA MESA, CA
License No. 754456
PHONE: 714-979-2070
CELL:
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28. § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such vrork must comply with all applirable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
OUE . INSPELIIONME 9jE INTRU ' sooe� INSPECTIONiYVE �q�c�� �
1616 Fixed System Final Fire Prevention 206 Final Mechanical ��
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electnwl
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 FinalOemolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalty o( perjury one of the following declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for Ihe
pertormance of t�e work for which this permit is issued.
I have and will maintain Workers' compensation insurance, as required by
ectbn 3700 of the Labor Cod@, tor the performance of the v.ork for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier._ (`%� i2�� �J �/k 1'Z l�
�(ihi5 a2Uion neetl not Oe mmplet(bd Me peimrt is va�slu�,ed al one hru�ntlied ddlars (51CO) orless )
Polic�y+�Jumber. k�^WL (�L ���7
❑ I certify lhat in the peAbrmance o( the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
lo the workers' compensation laws of Calitomia, antl agree that if I shoultl
become su �the workers' co � nsation provisions of Section 3700 of
the Labor ode, I hall fortl i co pl� ilh these provisions.
� -'2_�(- I t�
App�nw's9�re f �ate��
{ _��i
WARNING: FAICURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER 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, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS pECLARATION:
I hereby a(frm thal I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Professions Code, and
my license is in full force antl ef(ecL �7�
Li�#—.%� �'i �S�J = Cf2557` C— W
�--�= ` .,.._..( , i -tq - r J
_cen�,.rt�dot�ia' wt¢� ' .�
� �_� =�
CONSTRUCTION LENDING qGENCY:
❑ I hereby aKrtn that there is a conswction lending agency for the
peAormance of the work for whi�h this pertnit is issued. (Sec. 3097. Civil Code).
Lender's Name:
lender's Address:
OWNER-BUILDER DECLARATIONS:
1 hereby affirm that under penalry o( perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE lAW for Ihe following reason (Sec. 7031.5.
Business antl Professions Coqe: Any ciry or counry which requires a permit lo
consWct, alter, impmve, damolish, or repair any strucNre, prior to its
issuance, also requires the applirant for such permit to (le a signed statement
thal he or 5he i5 litensetl pursuant to lhe provi5ion5 of Ne Contratlof5
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is eaempt lhere(rom and
the basis for ihe alleged exemption. Any violation ol Section 7031.5 by any
applicant for a permit subjects the applicant ro a civil penalty of not more Ihan
flve hundred dollars ($500�.�:
� I, as owner of ihe property, or my employees with wages as Iheir sole
wmpensation, WILL DO TH@ WORK, and the structure is not intentletl or
oHered for sale (Sec. 7044, Business and Pmfessions Code: The Contraclors
License Law does not apply to an owner of property vfio builds or improves
thereon, and who does such wprk himsel( or herself or Ihrough his or her ovm
employees, pmvided that such improvemems are nol intendetl or o(fered tor
sale. If, however, Ihe buil0ing or improvement is soltl within one year of
completion, the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.�.
❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS �o wnstruct the project (Sec. 7044, Business antl
,Piofessions Code: The conlraCtws License Law tloes not apply to an owner of
property who builds or improves thereon, and who contracts for such pmject with
a cont2ctor(s) license pursuant tothe Contractas License Laws.).
❑ I am exempt under sec.
Business and Prolessions Coqe for this reason:
5ignaWre oa�e
305]<6 (3I0])
Owner ID verified by driver's license. ❑ Ves ❑ No �
Driver's License No. Expires:
Verification o( Ownership by (type of document, i.e. - property lax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
❑ I hereby certdy that no excavation (rve (5) or more feet in depth inio wfiich a
person is requiretl to tlescend, will be made in connection with work authorized
by Ihis permit, and �hat no builtling slrucWre, scaffolding, falsev.ork, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 347, Titie 8, Califomia Adminrstrative Code).
❑ As owner-builder, I will not employ anyone to do work which w0ultl
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a permi� to tlo such work trom Ihe division.
Appliranfs SgnaWre
Division of Industrial Safety Permit NumDer: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file antl
certi(y a Business Plan (or emergency response to release or Ihreatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code 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 during a reported
year a quantiry of hazar0ous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o! compressed gas
al slandard temperature and pressure).
2. Does or will the applicant or present or future building occupanl need to fle
a regislration torm tor acutely hazardous matenals? ❑ Ves ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, vrith some
ezceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal Io or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure).
3. Does or will the ap0licant or present or fuNre 6uildinq occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health and Safety Cotle pmvides that the
Costa Mesa Fire Departmem may require the preparation, certifica[ion and
fling with Ihe Fire Department of an RMPP by businesses which are required
to register aculely hazardous materials with t�e Fire Department.
4. II an RMPP is presently required, has Section 25534 0l Ihe Califomia
Healt� antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicam or present or fulure building occupant require for
the vrork which is the subject of this application a pertnit for such construction
or mo0ifcation from the South Coast Air Qualiry Management District or from
any other air pollulion conlrol disMct or a9ency? ❑ Yes ❑ No
(Section 650502 of the Califomia Govemment Code requires that the requestetl
infortnation be fumished on applications for non-residential building pertnits).
6. Will any part of lhe tacility to be conslructed under this permit be within
1000 feet (rom lhe outer bountlanes o( a school? ❑ Yes ❑ No
(If "yes", the (acility musl meet the requirement of Sections 25534 antl 42303
of the Calitomia Health and Safely Code).
7. If a permit (mm the South Coast Air Quality Management District or other
air polWtion contml dislrict or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Seclion 42303 been made? ❑ Ves ❑ No
8. Qf "yes", attach certi6cate of compliance from ihe appmpriate air polWtion
control officer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is cortecL I agree to comply with all state lavrs and
city ordinances regarding Hazardous Malerials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceAi(y under penalry of perjury that I have read this application and state that
the information given is correcL I agree lo wmply with all state lavrs and city
ortlinances relating ro builtling construction, and authonze representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit uNil '� inspection.
Sie� ure ol Legai Own r Date
�� 1-79�
1An�/w wnoflzetl App�Rdnh�� � , UmE—�.
Certi�catc uf'
1'ruject N:m�c:
General Informaliun
Site Address: [i � �
P-nN 1'nOjS
Residential
No i�a�c(�-<,k� av41 - M�o -aooc3
CT-1 R-ALT
(Y:+�;e 1 of'S)
Climatc Znnc q tl nfSturies
Agenc}':
Duilding 7'ype B1 Single family ❑ Mulii ramily Circle the Fmnt Orientation: N, E(� W, or degrees
Conditioned �loor Area (CPA): � SOD � I'rojeci Type: ❑ Alteralions � Envelope O Fene:
Replacement or Change Ow ❑ Duct Replacemen
—ZY—Il7
❑ Water Heater
NOTE: TGis frirn� i.e no! !n hr. rcccA jnr Nervlp Co�cstrrrcfed !1 rrddrngs nr Additimu�
luavintiou Vnlucv For Oparp�e SurJiices (J'or• Fiu�riug ue�e die Mass aid Furring Sn�ips Consmuc�inri iuble belo�+)
Assembly Alterfltinn
❑ Openin�; uf G�mned c�vilp alone—Alrermions dmt invoh�e Uie opening ofthefrmned cavip� oja woll, ceilirtg, or floor ipusl insla(I Ihe
munda�a.�� urininurm insulntia> nalue per,6150jm rhe alre�ed nxsenrbly. Fil! in Cohmms A—C and enrer mundaror�� insu/uiion vulue in Co(umn H.
❑ Repincement of entire ��ssembly— Repincemenl nfun enlire wa(l, ceiling, orfloor u.rsemblp retprires I/ie inslalfulinn ofComponeni
%ackare- D instdatia� value.e in Tnble l51-C. Fill in Columns A—J.
� a ue Surt'dce DeYails Fnr mc furred
A 13 C
Pt'0 )05l'd : ac no�e
�n�ming
Tag/ Assembly Name Muterial
ID� or TYPe� and Sizc�
Fa' jurred nssem6lies, accounting for Cori�inuous
ed of Mass Walls see
D L
U-
SCP
Teni�
Values From JA4
Framed Continuous
JA4Table Cuvity Insulation
Numbers R-value� R-Value�
IA4
Assembly
use lhe Mart
l. Far TqgOD i»dica�e Ihe idenlificntia� name thaJ matches lhe bailding p[ans.
2. Irsdica�e dm Assemblr Nnme ar type: Roa%/Ceiling, Wal(s, Floars, Slabs, Craw! Space, Doars and e�c...lndicate the Frame type and Size: For
li'oocl, Mem(, Me�al Buildings, Mass, enier ?x9. ?xG, or e�c... see JA4 fa' other possible fra»te rype assemb(ies.
3. Emer �he dvic/mess (or masa� irr inchea� or Spacing benveen fi'mning membera� enler; 1 G'a� 24 "OC; or Otherfa� all niher assembl�� dercription
se�cl� as Concrere Sandwich Pane(, Spandrel Punel, Logs, Sn�aw Dale Panel and e�c.... _
4. Based on die Clima�e Zone; emer the Slandard U facmr fi�om Table I51-B, C or D jor each d�erett( assemblp Name rn' rype,
5. Enter 1he Table m�mber ilm� closelr resernhles ihe praposed assembh�.
6. Enier iGc R-value (hai is Geing insmlled in die wall caviq� or Lenveen �he f�oming; o(henvise, enter "0 ".
7. Emer �He Conlinuous In.eulu(iorr R-valuc fa� lhr. proposed ossembll�,- olhenvise, e�ner ..0".
S. En�er die ro�o nnd cohinui of die U faclor nulue Las'ed on Calurnn F Tab(e Number arad en�er !he ds.sentGl�� U far,lnr in Columi� J
J. The Prnpn.sed dssemblr U.fncior. Co(unm J, un�s1 6e equal to or less thm� l6e Standnrd U-faclor' in Column E In cornpl7'.
Fuirin Sll'i s Consvuction Table for Mass Walls Onl �
A B C D I�. R G FI I ,f K L M
N�ropused I'rnpertics nf M:inonry and Cnncrcic Added Interior or Lxterim� Insulation
Walls l�r�m !te(crc�ice in l�urring Spaice from Ne(crencc
Juint A i�endia'I'able 4.3.5, 4.3.(. 4.3.7 .loint A iendix 7'ablc 4.3.13
_ "L !' v — >. _
�' � � � " '= c�
, `m p ni A
Asscmbly �. ,� o o q FL- f=�o m�� �^u °'"hr Plne�
Mass Namcor lA4T'able a. _ "' 'v v„ � E o �E m R o v m A55mT�bIY
Thickncss� T c= Numher �O ^ �' > ° � � ��
Q' : Y � t:. K K'� ul U-�i1C�01' COII1r11Cill
lfegi.r�rnliai N�imber: Regi.siru�inn Dale/lime: HERS Provider':
2008 Residenlial Compliance Form.v �lugus12009
�
Ccr[ificatc uf Cumnliaucc: Residcntial
Namc:
4 uT
Lis1 water hearers and boilers ja� ba�h domestic ha waier (DNW) hea�ers and hydronic space henting. Individual dwelling DHN�heaters must be
gas ar propane /ired, and map not exceed 50 gaflons. Ho� water pipe insufarion jranr d�e DHN' hea�er m the ki�chen(s) ard on a!! widerground
ho1 woier uines is renuired in o(l conma�en! �ackn¢es in al! c(ima�e zaies.
Water Heater Type/Fuel � Distribution'Iype � Number ln � Tank � Energy Facmr or � lnsulation
l. lndica(e'1'ype (Smruge Gas, Heal Pwnp, lnsinnlaneous, etc.J
2. Recirculnring s��siems serving mu6iple dwel/ing uniis slrafl meei the recircula�ion requirenrenls oj§I50(n). The Prescriplive reyuirements do
,�.,� �u��„ d�� �,,.,r�druro,� �ja recircululiitg rraler kea�ing.f�ts�ent,jo+'.ringle dw�e!ling ta�ile.
3. The ex�ernn( wnlen c�nlina ltmk and nines' shal! Le irts�Jnled m meel !he r'eGuiremenls oj6150(D.
Regi,rtrn7inn NwnLer: Regiavrulion Du�el1'ime: F/GItS Prorider:
2008 Hesidentiul Convplia�ce Forms August 2009
. .I 7'rojecf N:une.
Certificate of Comuliance: Residential CF-
Fe!{71
5 oT
HGRS V GRII�'1 CATI ON S UMM ARY The enjorcemeni ngencr should 1>ap special n!(enlion lo !he HERS Measzn�e.r specified irv [l�is
checklisl bclow. ,A comple�ed und a�igned CF-4R Form for oll !he measin�ea� e'peciJicd shnlf Le suGmived m the building inspeclor Lefore finul
Duct �$081ins � 7'esti�l� FIGRS verifimtion is requiretl fw� lhis' naensra'e. � .
❑ PCS ❑ NO Y�S: ln Climatc Zones ? and )-16, if more thun 40 linear feet of new or ropleceme�u ducts ni�: installed in unemiditioned
spnce, the ducts are to be sealed per § 152(b)1Dii and the newly installed ducts are to be insulnted per §151(QIO.
❑ LXCGP"PION: ExisCing ducf xystems thnl are estendett, which are cunstnwlo[i, insulnled ur sealed wiUi asbeslos.
❑ 1'E$ ❑ NO 1'f?5: hi Climate'Lones 2 and 9-16, if [he existing space-conditioning system (HVAC eyuipment and ducting) is replaeed, [he
ducts a�e to bescaled per §752(b)IDi.
❑]'G$ ❑ NO YES: In Climate Zones 2 and I-16, iTthe existing HVAC equipment is replaced (including the replacement of the air handler,
� outdoor coudensing unit of e split system, cooling or heating coil, or the furnace hcat exchanger) the ducts ai�e to be
sealed per § I S2(b) l E.
❑�RCGPTION: lluct systems that are documented to have been previously sealetl cuntirmed thruugh HGRS
verificatinn in accm�dance witli proredures in thc Reference f2esidential Appendiz ItA3.
,... . ❑ CXCGPTION: Uuct systems wit6 Iess than 40 linear feet in unemidifiuned space.
❑ F.aCR.PTI(1N: 1%.xistinn Auct svstems cnns[ructed. insulated or seuled with asbes[os.
Re1'riger:mt Charge - Split System HERS verificurion is r'eguired for lhi,r measw�e.
❑ Y�S ❑ NO YCS: In Climate Zones 2 and 8-15, when the existing FNAC equipment is replaced (including the replacement of the air
handler, outdoor eondensing unit of a spiit system A/C or lieat pmnp, cooling or heating coil, or the fumace heat
Centrul Fan Integrated (CFl) Ventilation System and Fan �'att Draw
The ventilation reauirements of &ISOfoI do not anolv m existine residential homes.
Ducted Split S,ystems - Air Conditioners and Heat Pumps: Airflow HERS verification is reguiredfor d�is measure.
❑ Y�S ❑ NO YCS ln Climate Zones 10 through I5, when [he exisiing space-conditioning system (FIVAC equipinent and duc[ing) is
replaced, the airflow und fan watt draw shall be verified per § 152(b)1 Ci to meet the requirements of § I51(�7B.
Ducumentation Authm�'s Decl:iration Statement
• I eertifv thnt this Certifieate of Com �lianee documen[ution ic accurate and e te.
Nmne: � ^ ��� ���l� Sig�amre�
%}Yi �C/ �'
Company: Date:
�C r 1 N� I-z �-r O
AdAress: If Apptic. ble � CEA or � CEPE
� (7 g `�.} - L p(p ,Q-�,J (Certification i!):
City/Statc/Zip: Phonc:
• ✓t�t 426Z� �7 Y 4 ��r-z�zc�
Responsible 13uilding Designer'a DeclAration Statement �
• 1 am eligible under Division i of the California Business and YroTessions Code to accept responsibility for the buildin� design identified on
this Ccrtificatc of Compliencc.
• 1 cenify that the energy Ceumces and performunce specifmntions Tor the building design identi6ecl on this Certificale of Compliance conComi
to thc requirements oTTitle 24, Pa�is I nnd ( oTthe Celifornie Code of Regulations.
• The building design feaWres identified on this Certif�cate of Compliance are consistem with the infornmtion provided to document [his
building design on the other npplicable compliance formy, worl<sheets, calculations, plans nnd specilicntions submitted to the enibrcement
ngency for a� rovnl with this buildin � ermit ap �lication.
Nnme�. Signature:
Company: Date:
Address: � License:
Ciry/StatelZip: Phone:
I'or aa•xistnnce m� que,stiona� regardin�+ tl:e Gnergp Stru�dnrds, contnci !he Energp Hntline ni: 1-800-772-33/10.
Xegisb�alion Nmnbeic Regi.r�ration Du�e/Timc: HGRS Po'onider:
20/lE Re.ridenliul Comp/innce Forrns' Augus! 2009
lVieasures Surre
Residential
Sitc Address:
'-fi� E. Zo�
Enfnrccmcnl Agency:
1VIF-4R
�.��•� i �r 3
u:�«:
� —Z`?-I c7
NOTL•': Low-rise residentia/ Gaildings subject to !he Smitdurds mus� canplp milh all npplicuble nvunda�orj� nvensnn�ea� listed,
regm-dless of die compliance uppranch used. More s�ringem ener�� measures lis�ed av rhe Cerrificuie ojComp(iunce (CF-!R,
CFJR-dDD, a� CF-IIt-ALT Form) shnll supersede �he items murked Yvitli un nsterisk (*J beloH�. This• Mundata•i� Measure.e
Stunmurp shull be incoiporuted inla Ihe permi! documents und the upp/icable jeu�ures shnll Ge coiuidered bp ul! parties ns minimtun
componcn� yeiformunce eVeci�carians whether rhe�� nr'e shown elsewhere in (he dncumenls or in Ihi,s simvnur�t Subnrrl u!l
npplicnble sections ofthe MF-1 R Form milh p[un.s.
DG$CRIPTION
¢I 16(a)I: Dours and windows between conditioned and unconditioned l
§ I 16(a)4: Fenestrauon products (except field-fabrica�ed windows) fiave a
§ I 17: Exterior doors and windows are weathervstripped; all join�s and penetrations are caulked and sealed.
§I 18(a): Insulation speci5ed or ins�alled meets Standards tor Insulating Material. Indicme rype and include ou
§ I I 8(i): The thermal emittance and solar reflectance values of the cool rooLng material mee�s the requirement�
a Cool Roof is specified on the CF-I R Fonn.
*§I50(a): Minimum R-19 insulation in wood-Game ceiling�or equivalent U-factor.
§I50(b): Loose fill insulation shall conform with manufacwrer's installed design labeled R-Value.
*§I50(c): Minimum R-13 insulation in wood-frame wall or equivalent U-factor.
*¢150(d): Minimum R-13 insulation in raised wood-frame floor or equivalent U-Factor.
SI50lFl: Air remrdine wrao is tested. labeled. and i�stalled according m ASTM EIG77-95(Z0001 when snecifie
�
I G.
§ I 18(i) when the
on the CF-1 R Form.
§ I50(I): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeance ram is no
grener than 2.0 permlinch and shall be protected Gom physical dama�e and W light deterior�tion.
�irepluces, Decorative Gas Appliances and Cas Log Mensures:
§150(e)IA: Masonry or Cacwry-built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)IB: Masonq� or Sactory-built 5replaces have a comhustion outside air inmlce, which is a� least six squarc inches in aren and is equipped
with a with a readily uccessible, onerable, and tii�ht-fiuin¢ damner and or a combustion-air control clevice.
u
use
a
a�r �s vented to
S r.�ce Contlitionin , Water Heatin � and Plwnbin � Svstem Mcasw•es:
6� ��-S� �3: li VAC equipment, water he.ners, showcrheads, Pauccts and iJl olher regulatcd npplianccs t�rc ccrtiGecl by lhe L•nergy Cnmmission.
§113(c)5: W,uer heating recircultniun loops serving multiple dwelling units end High-Rise rusielential occup;mcies meet the uir rcicase valve,
backfloe� prevention, pump isolation valve, and recirculation loop connection rcquirements of 6113(c)5.
§ I I5: Continuously burning pibt lights are prohibitcd fm� natural gas: fan-type central furnaces, household cooking appliances (appliances with an
clectrical su Iv volta �e conneclion wi[h ilot li >hts lhal consume less than I50 Citu/hr arc exem t, an<I �ool ,ind s�n heaters.
§ I50(h): I-Icnling �nd/or 000ling loads nre calculated in accordance wilh ASHRAE, SMACNA or ACCA.
¢ I50(i): Henting sys�ems m�e equipped with thermosmts that meet the setbacl< requirements of Section I 12(c).
§I50(j)IA: Storagc gas waten c�alers rfited with an Lnergy Paotor no grcater lhun thc Ceder,J miuimal staud�vd are ezternally wrupped wilh
insulation havirtg an Htstalled A�er��ial resistance of R-12 or greater.
{ I50(j)1 D: Unfu�ed storage [anks, such as storxge t�nlcs or backup tnnl<s (or solar water-he:iting systein, or other indirect hoi water t�mks h.�ve It-12
external insulation or R-16 internal insulation wherc the internal insulation R-valuc is indic�ued on ihe extcrior of the tunk.
§1SD(j)2: �iisi 5 feel of ho� and cold wa�er pipes clnses� to water heater tank, non-recireulaiing sys�ems, and ontire lengt6 of recireulating seuions
of hot water i�es are insulated er Smndards'I'able I50-B.
¢150(j13: Cooling system piping (suction, chilled water, or brinc lines).and piping insulated between hcating source �md indirect hoi water tank
shall bc insulated to'I'ablc I50-B and E uation �I50-A.
§ ISD(j)2: Pipe insulation for steam hydronic heating systcros or hoi wnter systems >I S psi, meets thc requirements of Stnndords'fable 123-A.
§ I SOQ)3A: Insulation is protected from damage, including that due to sunlight, moisture, eyuipmcnt ms�intenance, and wind.
§I SO(j)3A: Insulation f�or chilled water piping and reTrigeran� suction lines includcs a vapor relardani or is euclosed entirely in conditioned spnec.
200h 2eside�atiul Comp(iance Forms Augusi 2009
datorv Measures Su
�( � g C.Z D�=
Agency:
§ I SOQ)4: Solar watervhea[ing systems and/or collectors are certified by Ihe Soiar Raling and Certification Corporation.
MF-1 It
'ase 2 or3
—/c'�
§150(m)I: Ali air-distribution system ducis and plenums i�stnlled, are sealed and insulated to meet the requirements of CMC Sections (01, 602,
603, 604, 605 and Standard 6-5; supply-air and return-air ducts and plenums are insulated to a minimum ins�alled level of R-4? or
� enclosed entirely in condiGoned space. Openings shall be sealed with mastic, tape or other duci-closure system that meets the applicable
requirements of UL 1RI, UL I81 A, or UL 1R tB or aerosol sc:Jant that meets the requirements of UL 723. I1'mastic or tapc is used to
seal openings greater than 1/4 inch the combinalion of mustic and either mesh or tape shall be used
§ I50(m)I: Building cavities, suppon platforms for air handlers, and plenums defined or eonsvucted with materiFds other than sealed sheet metal,
duc� board or 1lexible duct shall not be used for conveying conditioned uir. Building cavities and support platfonns may contain ducts.
§I
seams of duct systems
bc compresseA �o cause reductions in the cross-seetional urea of the ducts.
sh.dl not be senled with cloth back ruUber z�dhesive duct tapea unless such tupe
§ I50(m)7: Exhaust fan systems have back drafi or automatic dampers.
§I50(m)S: Graviry�ventiiating systems serving conditioned space have cither.auwmatic or readily accessible, manually, operated dampers.
§I50(m)9: Insulation shall be protected fmm damage, including that due to suniight, moisture, equipment maintenance, and wind. Cellulnr foam
insulation shall be pmtected as above or painted with a coating that is water retardant and provides shielding from solar radiation that
can cause degradation of the material.
§I50(m)10: Flexible ducts cannot have porous inner cores.
§I50(o): All dwelling units shall meet the requirements of ANSI/ASHIUIE Standard 622-2007 Ventilation and Acceptable Indoor Air Qualiry in
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 certified to have: a thermal efliciency [hat wmplies with Ihe Appliance Et7iciency Regulations;
� an on-off switch mounted outside of the heater; a permanent wwlherproof plate or card with operating instructions; and shall not use
electric resistance heatin or a ilot li ht.
§ I 14(b)1: Any ponl or spa heating equipment shall be installed widi nt Icast 36" of pipe between 51ter and heater, or dedicated suction and rewrn
lines, ar built-u connections for future solar heatin
§l 14(b)?: Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
§ I I4(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time swi�ch that will allow all pumps to be set or
nmerammed to run onlv durine ofGneak electric demand ocriods.
or eauioment meet the numo sizine, f)ow rate, oinine, filters, and valve reauirements of
§I50(k)I: High ef6cacy luminaires or LED Li@ht Engine wi[h Integral Heat Sink has an efficacy that is no lower than thc cfGcacies contained in
Table ( 50-C and is nol a iow efficacv luminaire as specificd by � I 50(kj2.
§ I50(k)3: The wattage of permanently installed luminaires shall be determined as specified by § 130(d).
§ I50(k)4: Ballasts for fluorescent lamps rated l3 Watts or greater shall be electronic and shall have an outpW Gequency no less Ihan 20 kHz.
§ I50(k)5: Permnnently insmlled night lighis and night lights integrul to a permanen�ly installed Iwninaire or cxhaust fan shull contain only high
efficacy lamps meeting the minimum efficacies contained in Table I SO-C and shall noi co�itain a line-vol�age xocket or line-voliage
lamp holder; OR shall be rated to consume no more than Gve watts of power as determined by § 130(d), and shall nol contain a medium
to exhaust Tans, in rooms
mcct
of
§ I50(kp: All switching devices and controls shal� mect the requiremenls of � I50(k)7.
§I50(k)8: A minimum of 50 percent of the total rated wautigc of permancntly installed lighting in kilchens shall bc high effmacy.
BXCL'PTION: Up to 50 watts for dwclling units less than or eyual l0 2,500 ftZ or 100 watts for dwelling units Im�ger than 2,SU0 f�� inny be esempt
(rom the SO°/� high ef5cacy requirement when: all low efficaey luminuires in the Icitchen are controlled by a manual on occupani
sensor, dimmer, enugy manxgement system (EMCS), or f� multi-scene programmable cam�o! system; :u�d �)I permanent)y ins�alled
luminaries in garages, laundry rooms, closets grwter thtm 70 square feet, and utility rooms arc high efficacy aud controlled by u
manual-on occupant sensor.
§ I50(k)9: Pcrmanently installed li�hting lhat is internnl to cabinets shnil use no more than 20 watts of power per linear (oot of illuminated
§ISD(k)10: Perm�nently insmlied luminaires in bathrooms, attached nnd detached gurages, I.mndry rooms, closets and utility rooms
2005 Residentiul Compliuttce Forms
Augi�.�7 2009
' CITY OF COSTA MESA
��`""'F, BYILDING D/V/SION
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
��n �f,'
PERMIT NUMBER: E10-00012
PERMIT TYPE ELEC
APN: 42624130
JOB ADDRESS: 418 E 20TH ST CM
Vicinity: ATTIC AREA
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
01/29/2010
RMD
SCOPE OF WORK: ELECTRICAL pERMIT TO INSTALL 1 LIGHT FIXT AND 1 OUTLET IN CONJUNCTION WITH THE RELOCATION OF A FAU
TO ATTICE AREA. REF#: M10-00013
OWNER: MOSS, RONALD F
PHONE:
APPLICANT: BEEKER, ANDREW
PHONE: 714-979-2070
Address: 418 E 20TH ST Unit:
� � City/State/Zip: COSTA MESA, CA -
CONTRACTOR: KLONDIKE AIR INC � �
Address 1308 LOGANUniC SUITE H �
City/Slate: COSTA MESA, CA ZipCode: 92626
ELECTRICAL PERMIT F�ES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $25.70
Reinspection Fee $0.00
TOTAL FEES $25.70
Address: 7308 LOGAN Unit:SUITE H
City/State/zZip: COSTA MESA, CA
- � License No. 754456
PHONE: 714•979-2070
CELL:
NOTICE: The work authorized by thi5 permit shall comply with all applicable handiwp access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21.g2)
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 vnth all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the expiretion of this permit.
CODEN. INSGECTIONTYPE DRTE IN1111RL5 COOEN INSPECTIONTVPE UATE INTITIRLS
1616 Fiaed System Final Fire Prevention 206 Final Mechanical
126fi Pool Spa Final 208 Final Plumbing ��
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Faclory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuildinglOccupancy
WORKERS' COMPENSATION DECLqRqTION: -
I hereby affirm under penalty o( perjury one of �he (ollowing tleclarations:
❑ I have and will maintain a certificate of consent �o self-Insure (or workers'
compensation, as provitled for by section 3700 of [he Labor Code, for the
performance of the work (or which this permit is issued.
[� I have and will maintain wotker3' compensation insurance, as required by
sectqn 3700 of the Labor Code, for the peAortnance of the vrork (or which Ihis
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are: I ' /
Carrier,T N�% Q 191J14� 1�
U(Tfiis sect.vn need rat be rompietetl nme,pe.mrt u valued �Qat o,ne hundre�tl Atlonars (31o0J w less.)
Policy�NUTmber: � L 1.., � l O v �� "1
��
❑ I ceAify ihat in the peRorman�e o( the work for which (his permit is
issued, I shall not employ any person in any manner so as to become subject
to lhe workers' compensation laws of Califomia, and agree lha[ i( I should
become ect b the workers' compensa[ion provisions of Section 3700 0!
the Lab r Co e, I shall forth �th o y with these provisions.n
�'Z"'t���
ApOUGan[s. naWre i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TU ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO 7HE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLqRqTION:
1 hereby affirm Ihat I am licensetl untler pmvisions o( Chapler 9(commencing
with Section 7000) of Division 3 ot ihe Business and Professions Code, and
my license is in full force and eHect.
Lic.����'%�{� � Ass# -ZC�
`��� 2q -r �
,omr 3gnaWre ,�4a14-
�,��
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn Iha� there is a consWctbn lending agency for Ihe
peAortnance of the wvrk fa which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm lhat untler penally of perjury ihal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or 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 simcture, prior to its
issuance, also requires the applicanl for such permit ro file a signed statemen[
[hat he or she is licensed pursuant to the provisions o( the Contraclors
License Law (Chapter 9(commenciqg wi[h Seclion 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempl therefrom and
Ihe basis for Ihe alleged exemption, Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicant to a civil penalry of not more than
fve hundretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and ihe structure is not intended or
oftered for sale (Sec. 7044, Business and Protessions Code: The Comractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or lhrough his ar her own
employees, provided that such imprvvements are not intended or oRered for
sale. If, however, Ihe builtling or improvement is sold wilhin one year of
completion, the owner-builder will have the burtlen of proving that he or she
did not build or improve for purpose o! sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRP.CTING WITH
LICENSED CONTRACTORS lo conswc[ the project (Sec. 7044, Business and
Professbns Code: The contractws License Law dces not apply to an ovmer of
property who builtls or impmves thereon, and who cont2cts tor such project with
a cont2ctor(s) license pursuant to [he Cont2c[as License Laws.).
� I'am exempt under sec.
Business and Professions Code for this reason:
305]-4fi (3I01)
Owner ID veritietl by tlriver s license. ❑ Ves ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cetlHy Ihat no excavation five (5) or more teet in depth into which a
person is required to descend, will be matle in connection with work authorized
by lhis pertni�, and that no building s�mcture, scaffolding, falsework, or demolition
or dismantling thereoi, will 6e more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administ2tive Code),
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permit fmm the Division of IndusMal Safety, as noled above, unless
such person has a permit to do such work from the division.
Applirant's Signa W re
Division of Industrial Sa(ery Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicant or present or fuNre building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be (led with [he Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature and pressure).
2. Does or will the appliwni or present or luNre building occupant need ro file
a regis�ration form tor acutely hazardous materials? ❑ Ves ❑ No
(Sec�ion 25533 of ihe California Health and Safe�y Code, with some
exceptions, requires regis[ration with Ihe Costa Mesa Fire Department by
each business which al any one lime has on hand a quantily of acutely
hazardous malerials equal to or grea[ei than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard
temperature and pressure).
3. Does or will the applicant or present or fuWre builtling occupant need �o
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Cali(omia Health and Safety Code provides that the
Costa Mesa Fire Department may requi�e �he preparation, certifica[ion antl
fling with the Fire Department of an RMPP by 6usinesses which are requiretl
to register acutery hazardous materials wi�h the Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 of �he Califomia
Health antl Safety Code been (ully Complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
the work which is the suhjec[ of this application a permit for such cons[mction
or modi(cation from the South Coast Air Qualiry Management Dislrict or (rom
any o[her air polNtion control district or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumishetl on appliwtions for nomresidential building pertnits).
6. Will any part o( lhe facility to be constructed under this permit be within
1000 /eet from the outer boundanes of a school? ❑ Yes ❑ No
(If "yes", the faciliry must meet �he requirement of Sections 25534 and 42303
of the California Health and Safery Code).
7. If a permit from the South Coasl Air Quality Managemenl DisMct or other
air pollulion control distric[ or agency is required for ihe work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air polWtion
control offcer).
CERTIFICATE OF COMPLIANCE: I certily that under penalty of perjury me
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signalure Daie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury lhat I have read this application and state that
Ihe information given is correct I agree to comply with all state laws and city
ordinances relating to building constmction, antl authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this ermit until fnal inspection.
ignaWre ilegalpvmer � oa�eQ
' �Z f � � �
FLutllo�,A�115ar1� ppfcani �(,1a1er�
Applicant to fill in all
CITY OF COSTA MESA
CONSTRUCTION PERMIT
Addrea
Daces wltM1in heavy �ortle� Ilnei antl sign all apOropriate tletlaralians.
I / ZT�B • �;0. BLDG.NO.
License No.
Address
Contrecmr 9 � Ph6ne
LICENSED CONTRACTOR DECIARATION
I h¢rl�y atfirm Ih:.t I am IlcenSGtl untler provi5ion5 of Charter 9(cOm-
MaflGln9"with iGCtiOn 7000) of Divislon 3 Ot tne Bu5ine55 antl
Profeszions Cotle, 'antl my Ilcense is in tull force antl etfect.
Llcense Class License No.
�ate Signature
W00.KER5' COMPENSATION DECLARATION
I hereby aftirm lhat I hav¢ a certHicate of consenl to self-insure or a
certificate of Workers' Compensatlon Insuranca, or a tertilietl copy
[hereof (Settlon 3800, Lab. C.). -
P^'icy No. Company
¢rtitiatl copy�is hereby furnished. .
,ertifietl copy I5 flletl with the dty Builtlin9 DivisiOn.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
�(This Sectlon neetl nat_be cOmpleted il,tha permit i5 (or one hundretl
(E100) or less). .
I certity Ihal in th¢ PmfOrTance ot the work tor which this per
Issuetl. 1 shall not emolov anv oersoD In anv manne[ so as30 be me
Da[¢ t%��f�Hy $Ignature��<� � �L
NOTICE: If after making tnis tleclaration, you
to [h¢ WOrkeR' Compen5ation p�ovl510ns ot [he
torlhwith compry witb such provi5ions or tnis (
revoketl.
CONSTRVCTION LENDING AGENCV
I hereby affirm lhat there Is a construction lentling agency for tbe per-
formanG¢ Ot tha work for whiGh thi5 p¢rmit i5 ISSuetl (Section 309]
Civ. C.).
Lentle�'s Nam¢
Lentler'S Atltlrezs
OWNER BUILOER DECLARATION "'
I hereby aHirm tha[ I am ezempt from the Contractor's License l.aw for
[h¢ lollowing rea5on (Section 7031.5 Bu5ine5z antl Prote55ion5 Cotle:
Any city Or County whiGh r¢pWrez a pe�mit to Construct, alte�,
imorove, aemollsn-or re0air any Sl�uGture, prior to its i55uance, also re-
quir¢5 [he ap� litant lor such pCrmil lo file a si9netl sta[ement that be
is Iirensetl pursuant to lM1e prodsions of tlte CoM�acto�'s License Law
(C�apter 9(commencing with Section ]000) of Oivision 3 of tne
Bu51ne55 antl P�dessions Cotle) or tM1at he ii exempt'therefrom antl lh!
basis for the allegetl exemptlon. Any violation of Sectlon 7031.5 by
a- •ppll�'ant fo� a pGrmit 5ubject5'the applicant to a civil penalty
'� more than five huntlretl tlollars (E500).
��. a5 owner o( lhe property, '
selEtomnerrfetivr, will tlo tM1e work, antl.the structure is nol intentletl
or offeretl for sal0. (SCctlon �044, BuSinMs antl Rofez5lons Cotle: The
Conlractor's License Law doas not apply to an owner of a property
who builds o� improves thCreon, antl who tloes such wotk himself o�
through his own employee5, provitlCtl lhat SUCh improvements are not
ini¢ntletl or oHer¢tl tor Sale. If, howev¢r, [he builtling or imp�ovement
is soltl within one year of completion, the owner will nave the burtlen
o/ provin9 M1e ditl not builtl or improve for lhe purpo5e of sale).
,0 1, as owner of -the property, am exclusively- contracting with
licenietl conVactors to consVuct tM1e prol¢CI (SeCtion ]044, Busineis
antl Rofessions Code: The Contracior's License Law tloes no[ appty [o
an owner of property wbo builtls or Improves tM1ereon, antl who con-
t�act5 t�om sucb projects with a Cont�acto�(s) IiceSnetl pursuant to
the ConVactor's License Law�. �O�y
❑ I am exempt under SeGtion 8. & P. C. for this
I
1Qd50l1
'o,�e g—ZIo—SZ ow„QrG�mK4�(LI .MJ��Ni�F4-fL�
I h¢r¢by ce��ify lhal I have reatl [his applicalion antl stat0 that the abov¢
information is mrrEct. 1 aqlee lo comply with all city and coun[y
ordinances antl state laws relating [o construction, antl hereby authoriza
�epresenlatives of this city 'Io 'enler upon thC a0ove men[ionetl
TYPE OF CONSTRUCTION
❑ NEW ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK � V G
TYPE OF PERMIS���,---,,,///��� /
❑ GRADING y�FOVNDATION �$TRUCTURAL
❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MEGiAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT.
OCCUPANCV_CONS�CTION TVPE
VALUATION� Q�ZONE
GRADING CU. YDS. ACRES
REMARKS:
PLUMBING
BATHTU85
TOI�ETS
LAVATORIES
KIT. $INK$
$ERVICE $INK$
PLANCHECK
VRINALS
DOUBLE LAVS
DISHWASHERS
SV MPS
FLOOR SINKS FLOOR ORAINS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOI
WATER SERVICE
GAS SERVICE
WATER HEATERS
SEW ER CONNECTION$
SOLARTANK
SOLAR PIPING SVS.
ISSUE FEE
CLARIFIERS
ALTERATION
OUTLETS
BTV OVTPVT
COL�ECTORS
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_
AND DUCTING 100,000 + BTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000+BTU_
BOILERS BTV
SVSTEM REPAI0.,ALTEFATION
EXHAVSTSVSTEM MULTIPLE
6762 B/26/82
A_P. ;
ZONE
REAR VARO (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
IAL CONDITIONS:
ELECTRICAL
REF. $
PARK FEE $
PLAN CHECK
GENERATOR 0-1 KW_1-10 KW
TRANSFORMER
APPLIHNCE 10-50KW_50+KW
MOTORS � 0-1 MP_1-30 HP
(INC. $OLAR) 30-50 HP 50 + HP
FIXTURES OUTLETS
GASTUBESIGNS -
VOLE LIGHTS
POLES METERE
PANELS MAIN
SERVICE
ISSUE FEE -
APPLICATION APPROVED I
29.37 TL
SUMMARV OF FEES �
BUILDING p �
PERMIT E_���/. V^� SMIP $ �t'�O
PLHN CHECK S—LL� � PERMIT
ISSUANCE $
PLUMBING $ .
PLANCHECK 5 - GRADING $'
ELECTRICAL $ ' §
PLANCHECK E MICROFILM E�—/y
MECHANICAL E ' TOTALFEES.G�
PLAN CHECK E LE55 AD- �
VANCEPC S_
Signaturel'�^� � ��1-U�������� Oate �1'b-8 . FINAL FEE
Drivers' License or SS �
�SSUEFEE
CMF 0865-•36 W�ite-BuilUinq; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
CONSTRUCTION AND PLANNING q i • ' .POOL & SPA . _ � , '
APPROVALS Permit #�LJ___ Date Inspector � AppROVALS �-. � Permit # Date Inspector
1. Temporary Electrical Service or Pole ` 43. Pool & Equipment Location" ' • �
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility;Undf9m. �--,. - 45. Forms - -
4._ ElectricaLConduit-Undrgm ' ' >", ' � 46.� Electrical Bonding � -
tee em orce .- � 47. Rough Plumbin & Pressure Test �
., f>. . Electrical UFER Grn � � - - 48. APPROVAL TO COVER-GUNITE - -�
7.. Pootings _�, � � - 49. Electrica� Conduit-Undr m - �
�6. Foundation - �' 50. Gas Pipe, ❑ Undr in, Test - �
_ 9.� Water Pipe-Undrgrn ' 51. Backwash tines P-Tra "❑ ndr rn � - - �- - '
10. _ Structural Floor System 52. APPROVAL TO DECK - -"
'� 11.�•'�Froperty Sewer Line.& House Connection. - 53.� Backwash &�Rece torFinal '
12. Street Sewec �nnection _ ' ' � - - 54. Heater & Vent-Final �
13. Fough Plumbing_ �- � - " " -
14. Rough ElecvicConduit � ' �56. Electrical-Final � �� . �
15. Rough Electric-Wiring � � - -- � 57. Solar SYstem-Final ' ' � ' - ' " '' ' �
16. Rough Heating & Air"Conditioning - . • encing & Access Approval �
17. Ducts, in Structure " � � - 9. APPROVED FOR P�LASTERING � '' � '
z•
� 18. Ducts, Ventilating � - � . ._ _ � .� . . �
� 19. Gas Pipe-Rough & Test- � � ' " 60. POOL/SPA SYSTEMS FINAL - ' ' ' �� � '
20. Roof Framing - _ ' � ' ' '
21 . Roof Sheathin ' � � - - � � � � � � � � � -
22. Frame and Flashin .- _ NOTES: "'
• 23.- Insula[ion ' � - - . -
24. Lathing &-Siding - � ' - - '
25. Drywall Nailing - - - ' �� � � � �
� 26. Plaster Brown Coat ' - ' � � �
27. Electrical Power MeterFinal - ' � � ' - �
� 28. Final Electric � -- - � � �
29. � Final'Heating & Air Conditioning � � - - ' � � � � � �
� 30. Final Gas Pipe-Test � � - � � `^�-,.-,��'�..
31. Final Plumbing � - �� � �
- 32.� Water Service-Final� - - � � �
'� �33. Gas Service-Final � � �
34. Solar pomesticFinal �^• ' ' � � ' '� ' � '
35. Landsca e S iinklin S siem ' � ' - "
36. Sound Attenuation ' � - ' �� � ' � � � � •
� 37. Handicap Regulations � i - -� �- � - � � ' � ��
38. FINALSTRUCTURE&BUILDING �� ' � ��:y, � ' ' ' '
39. SpecialRequirementsCompleted � � -� � �
40. ' Electric Release to Edison � ' �
- 41. Gas Release to Southem California Gas Co. '
42. CERTIFICA7E OF OCCUPANCY �
� No� Date - � - - �
�
' `
L �
�:- -
' �;��
G"x�ST/n/� ' :
..� L� . Y . .,
: .f��P� ��
. CIT`( OF COSTA 1ESA
PLANNING DE T•
� {IYUEC� TO BLDG. DE . REO.
DATE:_ �'/=
BY. nr��
. DIRLCTOI OF PIArFNINO
r i
/D : �' 4-
I T iv�G
e c��a�e` =ry-��
THIS ttiil"viBER nii!Si P
; ._ au. ir�tsPecrroN`: �E
i j�F;7:. �'.;i:1:;:_:51k'HEiiE�F'ER;
i � BE ,;, �°:f;y:'�� yYt Su5_ES
I j Si i, ^F � IFu'NIA L
F �� � $�. �_ :' F}TY_EF.Cnm
��
THE
oF
FOR
Exisr�NC
VJ/�l.l_
-^-rr-r-�-t-n 1
— � � i � i � i i i �_j i i_t7—I i i i lJ1
i .. i .
`— � �� 1 O/ ; � � ��g'—y.l
��
� . 'Dr�v2wn7 . - - . - : . .
, a: 1. _ : :r'. � o �I �
,� �`' .-` City of Cost Mesa Buil ing Dept.
_i
, er..... _���.L�_.-_.._. ...�...:o re�a� ,vb'
- � .. TNESE PIAN M ST BE ON J B AT ALL TIMES
�Ifi E. ZD' M�KE NO��CH NG WITHOUj� RIOR APPROVAL'
OF OEPT. ' � .
HESIDENCE .AESIDENCE ' .fiESIDENCE:
� � THE ISSURNCE OR G 7AiVTING OF A ERMIT OR APPROVAI
�� - Of PL0.NS AND SF CIFI ATIOMS SHAIIb N0T BE CONSTRUED
� '{-�-,I"a,3 �- TO BE A.PERMIT R, C 2 AN APPRO OF, ANY VIOLATION
� � CF ANY Oi THE P VGI AS OF 7HIS E NO PERMIT PRE-
R CANCEL THE
� v� - ^� t„ � . SUiyUNG TO GNt AUTH IRITY TO VI TE 0
_ �, JN�;� /0� SE7.A�s'C.�"` �RD� PROVISIONS OF, THIS C DE SHALL BE 'A.LID, EXCEPT IN SO
. -` .Sl ��t//t'�.'C^"� S�T•�Y%l�I' �. - f�R AS THE WORK OR eE 144ICH_ IT PU HORIZES IS LAWFUL
- T::fl i$<_'i:ANC� 0� A FEk�N1T BAS�D UPON PLANS AND
� � �-� A� �'^'""\?!C��.> SHAIL NJ( PREYENT TH- BUILGlYG OFFICI9.L
( � /'�" ',�/, fa�JG-�T �I� ��Y � � �Fl.R REQUIRING THE COR ECTION or- eaeoas
sGIUi+R1�X6 N"/.G� � L : / ��� � : �:'._ .,, -. ,
1 �',`j� � c�" .GJ}7�' _�^� �.SD S?ECIFlCATIO�� 0 FROM PREVENIING
�nic.K P�ti��7'��'' -" STREET Lt � _�� =^_TICVS OEING CPRRIED O iHEREUNDER WHEN
I' "�C��E OR OF AN OT!'.ER 0.4�!C�ANLE
- . ��T�� ' :�' ;_;� . - _
_ , . `'_ . . �.
!
, . .. . . _ ,
,�
.
�R��T� _
SEPqR . Rq� qpp -�_,
��
�;nP�T� P7RM�T� .a\C-�N�Y
:„
E Rc \
P✓ o
/`.. Nf,��;'.�;�'"' � �i�; �`�''8�'%VGRF
'•�'.i;o, „%G q
�. ,,; ��Rk ND
� ` .\
STREET �
TOP
TYPICAL
EW (�-3/8 Bar �-
4�� Blocks�����8°Blocks
I/4° 0 Pencil Rod �elow Top
Course Of A�1�Ferfces
4�� Concrete Block Fence With 8"
Pilasters. One 3/8�� Vertical Bar
Cqnfinuous From Eorfhtooth Thru
8� Pilaster.
3/8�� Vertical Ties 2� Long
HQoked In Footing, And Grouted In
4 Blocks 4 0/C Maximum.
Provide Cleanout And Inspection
Hole At Pilasters.
N NATURAL GRA
j FOR WIDTH SEE CHAR1
TWO 3/8 BARS CONT
4�� CONCRETE BLOCK FENCE
��
i
�i
i�
ii
o ; p' :��
i' �p�.
Y.. O �
�_�
i �,
NUOUS lo
I�
�a
i i
i i
i i
�
� i
� �
I
b.�o��.�.:p.pu'.�.On�P��'�.b..ip:� �0.,
;. •[, j'. .�rti'. , po o. o..� o::. OD el 1�;
O "�( 'V.'�i0',A'b,"'-��b;b,'., ��� 'D,
a� v".�J:IrOa :'�� ;k�,��': i: '..p_ al L2:
�� TO 16��O.C. MAXIMUM`
� �i
v,� I/ p 0:'".
i..• zf_eJ
`
Y
��GENERAL—NOTES��
MORTAR: One Part Plastic
Cement And Three Paris Sand.
6ROUT: One Part Cement And
Three And One Half Parfs Sand.
COPING: One Part Cement,
Three Porfs Sand.
CONCRETE: Well Mixed 1:21/2,
31/2. Maximum Of 7 I/2
Gallons Of Water Per Sack
Of Cement
REINFORCEING STEEL SHALL ,
CONFORM TO SEC. A-15-39 .
A.S.T.M. ALL STEEL TO LAP !
WHERE SPLICED, 2'-O��MINIMUM.
GROUT MAY BE POURED FROM
TOP OF FENCE IN CELLS WHERE
VERTICAL STEEL OCCURS. HOLES
SHALL BE CLEAR, CLEAN, AND
FREE OF ALL MORTAR, DEBRIS,
ECT. WITH INSPECTION HOLES
AT BOTTOM. BOND SHALL BE
PROVIDED BY LAYING BLOCKS
FENCE MAY VARY IN HEIGHT i°�" � DEPTH OF EARTHTOOTH I/3 ii'�� P`i IN STRETCHER COURSES SO
FROM 3� TO 6� I�%-�'� �,-6�D�
�,-'o.�al THE HEIGHT OF fENCE ic a:,'I THAT VERT. JOINTS ALTERNATE
I�- <a� BELOW BOTTOM OF i:i�.�+'i
STEEL MUST BE TIED IN PLACE ��•. •� FOOTIN6. I'o,en yi iN EACH couRSE.
AT TIME OF TRENCH INSPECTION Ln�• � � L�i� SCALE: I/2��= I�
3�� CLEARANCE FROM 80 �
ART
HEIGHT. . .. . . . . . .. . .. .. . . .. 6� . . . . .. .. .. . . .. . . 5�.. . . .. . .... .. . . . . . . 4�. . . .. .. .. ... . . .. . 3�
W I D T H . . . . . . . . . . . . . . . . . . . . . 14��. . . . . . . . . . . . . . . . 14". . . . . . . . . . . . . . . . . . 12�� . . . . . . . . . . . . . . . . I 2��
T H ICKNE SS . . . . . . . . . .. . . . . . .10��. . . . . . .. .. . . . . . . 10��. . . . .. .. ... . . . . . . . 8�� . . . _ .. . . . . . . . .. . 8��
DEPTH OF EARTHTOOTH . . . . . .24�� . . . . . . . . . . . . . . . 20��. . . . . .... . . . . . . . . .'16��. . . . . . . .. .. . .. .. 12��
SPACING OF EARTHTOOTH....12� ........ ........ 14�..................16�.. .............. 16�
City Of Costa Mesa, California
Building Department
Porm BU13-2M-4-da S-BP
OWNERS NAME+ _ _ _ _ _ _ _ _ _ _ _ _ _ _
JOB ADDRESS+ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
PERMIT NUMBER:_ _ _ _ _ _ _ _ _
SIGNATURE:
OWNER FA7RI.ANF HO}•,�S �� DATE i_���q _
IOB ADDRESS I,l A 9nt�ti C+..ee+e BUILDING PERMIT NO. RI�R9
GENERAL CONTRACTOR Ba.v Constr
VAL[lE
AP. No. LOT lZ. TRACT 259$P112E ZONE DESCRIPTION OF WORR Re3. att�gar
GROUP I& J TYpE V Z�� Rl PLAN NO. 8hA2
1� �ECTIO � I DATE I SUBCONTRACTOR DATE I NUM
coat
Gas Test
�
� `,.
: ' �+ 8��.'�
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31 ]
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
� 8 'z C1 T"�� �=f-
COSTA MESA. CALIFORNIA
OWNER
C�Tv /
ARCHITECT
OR ENGINE
A0. 55
LEG/�L
oescRiPriorv
A.P. NO.
size � f F
OF LOT �
USE OF
E%�ST�NG BLDG.
'��
TEL.
NO.
LIC.
N o.
No.oF o�ocs.
OW ON LOT
�i4, �i,��V...G V �ti'�
�F�N Z % �9$9�,✓
FIl��P�CE DEPT.
LI(Y C1'' �'1CTA �iCCa
APPLICATION FOR PERMIT
BUILDING .
FOR OFFICE USE ONLY
RECEIPT NO. pERMIT NO
BUILDING
�LZ� A�DRE55
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZOrv NO.OF iVPE
,� � PLPNS
APPROV O
BY DATE
�q F CORRECTIONS
SETBaCN LINE FROM
CENTER OF STREET �� REHR YARD ��
SIDE YARD RIGHT �. O LEFT S� �
DESCRIPTION OF WORK
NEW �" ALTERATION I ADDITION
REPA. MOVING IDEMOLISN
BUILDING / NO.OF
SIZE 0 O CJ ROOMS STORIES
E%TERIOR WALL ROOF
1
STTTE�TH6T THEV�BOVE IS CORNECT�ANp�AGREE TO COMPLV WITH ALL purpose of establishing a permit fee only.
CITY OROINANCES ANO STI.TE LwWS REGULATING BUIL�ING CONSTRUP
T�o�. VALUATION
SIGNATURE OF PERMIT FEE � � �O
PERMITTEE
5 �/� %/ 5� PLAN CHECK 5�7��(�
J /f� J
AUTHOftIZED AGENT TOTAL FEE S�� •S� v��
OWNER j°jAgIAi[JCCZ..;_NF'T.F.N DATE __8�1']�K9
JOB ADDRESS 1 iR E_ 9nth S},� BUILDING PERMIT NO. �Q�9�
GENERAL CONTRACTOR G. L. Cmover VALUE S 22B.Q0
TRACT FIRE ZONE
INSPECTIONS DATE _I GROUP J
T rground Soil U.G. Water —I SUBCONTRAGTOR
L.__er¢round Gas
L
410-3M-4-59 1019i
' . .. 1���u II
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORN{A
fOR APPUCANT TO f/LL /N COMPLfTELY
TYPE pR PR�IN�vT /
BUILDING ./ / I T '...'I" 4 A L
COSTA MESA, CALIFORNIA
TEL.
NO.
■ ARCHITEGT
8 LEGAL
NO. OR BLDGS.
e SETBACK LINE FROM
ILEFT .�� IRIGHT —
DESCRIPTION OF WORK
BUILOING NO.OF
SIZE ROOMS STORII
E%TERIOR WALL IkOOF
COVERING tOVERING
USE OF BUILDIl1G�I�fU W�K TO BE PERFORMED�
�'S�ii/ /c,/ L��PM/n.�r l
I HEFEBY ACKNOWLEDGE THAT I HqVE AEAO IS APPLICMTION
pNO STATE THAT THE ABOVE IS CORRECT ANO AGPEE TO COM-
PLY WITH RLL CITT ORDINANCE3 ANO STAiE Lr1W3 REGULATING
BIIILOING CON6TRVCTION.
SIGNATURE OF
PERMITTEE
AUTHORIZED AGENT / j— . ��� �� v
AUG 1 ? 1959
, �,,
APPLICATION FOR PERMIT
BUILDING
foR offic� usF oHcy
HECEIVE�
COSTA MESA. CALIFORNIA
ZONING
ZONE y� ' NO.OF USE OP NEW
� PLANS YI BUILDINO
BYPROVEH��.�. � �_ DATE i
6T.1
�� �.
`�_ Fr.
i..:���
TNE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
pURPO3E OF ESTAeLI6HING A PERMIT FEE ONLY.
VALUATION
PERMIT FEE $ � � �
a �� _ �
S PLAN CHECK $
TOTAL FEE S � � ��
JOB ADDRESS � v41S Eu 20th StrC2t BUILDING PERMIT NO. 25�0
GENERAL CONTRACTOR AiT Vent DESCItI�PTION OF WORK patio Cover
I. ECTIONS
Steel
'LONE
�UP J TYPE
SUBCONTRACTOR
. 25480
COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 1100 COSTA MESA, CALIFORNIA 91626
� For dppllcant fo F711 In Completaly
TYPE OR PRINT
BUI{.�INO
COSTA MESA, CALIFORNIA
_. Q c 2 n i c 1.l F
MAIL
BCTpACK LIH� PI10tl
OF
So-sybb
:�°,�.,°�w t°.o.. �
l• J
DESCRlPTION OF WORK
NO. OP
�ROO�MB
I ROOr
1 HBRUY ACKNOWL6D0[ THI1T I NAV[ RBAO TNI{ MPLICATIOH
ANO 9T�T8 THAT TX6 AGOV6 IY C011P[CT�ANO /�ORB[ TO COM-
PLY WITH ALL CITY ORDjNA11CY 11N0 �TAii LAW/ ptOYLATINO
ew�o�Ho coNarrtucnon.
BIGNATURHOP�,� — � '��
PERMITTEF
r(�� � Q
AllTHORIZiDAO[NT ��UC1i
CITY G M�SA
p�qR 241966
For Offlce Ure Only
R[C[I'1' HO. I�IAI�O
���t�
No.o�
•uns
� ^ � �—
9HALL �E L688 THAN
YAR�BAPPROVHD I YARDSAPPROVfiD
MAIN BUILDINO ACC8D80RY BIIILDINO
vwa. tf
DAT6
a
TX6 IIMOUMT CNOWN UNDBP V�Lu�TON IB IOn TN[ "j
•UPPO![ 0/ tPll.oL�eN�NO A P6PMIT PHB ONLY. =q
�����T�oN 3 m� �
PERMIT PEE p
t!O C
a 3¢Z �c� o� .� ....e�r e w
�