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HomeMy WebLinkAbout3094 MACE AVE - Building Permits CITY OF COSTA MESA t 0BUILDING DIVISION .AI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1":1 FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: M10-00061 PERMIT TYPE MECH STATUS: ISSUED APN: 13955108 DATE ISSUED: 07/01/2010 ISSUED BY: RMD JOB ADDRESS: 3094 MACE AV CM Suite/Unit: Vicinity: HALLWAY CLOSET SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT FAU < 100 K BTU, LOCATED IN HALLWAY CLOSET FOR UNIT A. COMPLAINCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. OWNER: STANDARD, LEE Address: PO BOX 2589 Unit: PHONE: 714-427-0538 City/State/Zip: COSTA MESA,CA APPLICANT: STANDARD, LEE Address: PO BOX 2589 Unit: PHONE: 714-501-1702 City/State/zZip: COSTA MESA,CA CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State: ZipCode: CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this tpermit. CODE S. INSPECTION TYPE DATE INTnIALS CODES INSPECTION TYPE DATEI TIDAL 9-a,-/n 1616 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 Final Site 204 Final Demolition 250 Final Building/Occupancy -• WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Driyg�s,Lic-ease,No. ( -rExpl[9s' 3//a... El I have and will maintain a certificate of consent to self-Insure for workers' ertiication of Ownership by(type of document,i.e.-property tax ill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. El I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (This secton need not be Completed if the permit is valued at hundred Collars($100)or less.) 2,Art 2,Sec.341,Title B,Califomia Administrative Code). Policy Number: ��G,� ❑ As owner-builder, I will not employ anyone to do work which would Y 1--certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code II G 'h comply with these provisions. tf Division of Industrial Safety Permit Number: Ape__ nt's4 re.-. •ate L. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one lime during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? El Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required • to register acutely hazardous materials with the Fire Department. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). a _ •Ptia owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other •' mpensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposewPsgree n.�.to occupy or allow occupancy of any building / authorized by t '--on. ..'. r=J, al inspection. i e. — Vq /D -ge �� 9 ryn9i" drCat' :er(sl :Rs© eat 3057-46 13/07) And/or Authorized Applicant Date - C4 City of Costa !Mesa Budding Division Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626 714-754-5273 / Fax 714-754-4856 OWNER BUILDER I 'VERIFICATION/ u Permit #v(A,Io�U( ( — I Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been subbnitted in your name listing yourself as the builder of the property improvements specified at qq / Cie 1414.Lite_, . We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1.)h1_f-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. 'jf„r._?) I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ]/�Th 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. 1/i=41 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. aa5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may Ibeecconsidered an "employer" under state and federal law. rc 6:1:understand if I am considered an "employer" under state and federal law, I must register with the state a d federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. e/2t 7._Ilinderstand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 o DP , 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable oY 1 any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. L 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal R'"Q en'ue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand th -I-am the party legally and financially responsible for proposed construction activity at the following address: r.� 1,1.11 agree that, as the party legally and financially responsible for this proposed construction activity, I will afi"e-by all applicable laws and requirements that govern Owner-Builders as well as employers. a12. I agree to notify the issuer of this form immediately df any additions, deletions, or changes to any of the info matin I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued erify t�• property owner's •gnature. Si _prperty6' r owner - ' gna re_ofoA IP Nib sate; / /0 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 Simplified Prescriptive Certific if Compliance: 2008 Residential HVAC A. lions CF-IR-ALT-TFVAC .. Climate Zones 1 and 3-7 3o.elIP AkeS lAv6 ^ '� Site At) L C- EnJ cemmu enc:: Date11 1I O Permit#: ACa_ C HI • Ss Duct insulatio Equipment Type' List Minimum Efficienp z Floor Area requireme l/p Thermostat • ❑Packaged Unit Over 40 f f due�i t Furnace PAFUE • 0 COP Setback re ❑Indoor Coil SEER V2) ❑HSPF�I: Served by system I n &not already present,must be 0 Condensing Unit ❑EER_ 0 Resistance '4 sf C,(] nc added$ditio a pace ii-malted) . O Other ft S aRb (C7 1,3-5) I. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. • • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. __ _ Name: Signature: X. ...e-a Company: I _ D . O wMLn-- taut 1trr.A— -7- - lb Address: ,, 11 License: 1. €tQ APf D CitylState/Zip: e crsmo MOSA 1 �. e1�-6 z6 Phone: -7r�, S-° l -I-7e2- • 2008 Residential Compliance Forms March 2010 ...__._...._....,_.,,__w,._,_. ..._._,,...... . (ENFORCEMENT AGENCY ' CAN:CuSTOMIZEVITHEMERFTEAD/SEAL) 2008 Building Energy Efficiency Standards Residential HVAC Alterations Climate Zones 1 and 3 through 7 GZ-6 = LaST'3 MPSFt- • • • BUSINESS AND PROFESSIONS CODE,SECTION 7110 Willful or deliberate disregard and violation of the building laws,including the California Building Code,and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action mayconsist of fines up to$5,000 per violation or suspension/revocation of a contractor's license. WHEN IS A PERMIT REQUIRED? A written construction permit shall be obtained from the enforcement agency prior to the erection,construction, reconstruction,installation,relocation,or alteration of any mechanical system,except as permitted-in Appendix Chapter 1,Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include,but are not limited to: • New 1-IVAC installation • HVAC Changeout • Replacement of furnace,coil,FAU,or condenser • Relocation of an existing HVAC unit . .. . • Adding or replacing more than 40fl ducting in unconditioned space 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REOUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78%AFUE(Exception:Wall&floor furnaces;room heaters). 2. Central air conditioners&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 mandatory requirements of Section 150(m): All joints and openings in the in the HVAC system must be scaled. • Only UL 181,UL 181A,or UL 181B approved tapes or mastic shall be used to seal duct openings. -• Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts must be connected using a metal sleeve/coupling. • Flex ducts that are suspended must be supported every 4ft.max for horizontal runs with no more than 2" of sag between supports and 6 ft.max for vertical runs. 6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 7 - r CITY OF COSTA MESA ''grwMF'q§§§ BUILDING DIVISION Fa�l) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1110511 . FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: M10-00062 PERMIT TYPE MECH STATUS: ISSUED APN: 13955108 DATE ISSUED: 07/01/2010 ISSUED BY: RMD JOB ADDRESS: 3094 MACE AV CM Suite/Unit: , Vicinity: HALLWAY CLOSET SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT FAU < 100 K BTU, LOCATED IN HALLWAY CLOSET FOR UNIT D. COMPLAINCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. OWNER: STANDARD, LEE Address: PO BOX 2589 Unit: PHONE: 714-427-0538 City/State/Zip: COSTA MESA, CA APPLICANT: STANDARD, LEE Address: PO BOX 2589 Unit: PHONE: 714-501-1702 City/State/zZip: COSTA MESA, CA CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State: ZipCode: CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE*. INSPECTION TYPE DATE INITIALS CODE* INSPECTION TYPE �/1e9DATE INTITIALS ,f-y 1616 Fixed System Final Fire Prevention 206 Final Mechanical — 9'-in (jy-�'b/ bid 1266 Pool Spa Final 208 Final Plumbing J 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 Final Site 204 Final Demolition 250 Final Building/Occupancy la WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers b"� ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax ill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,cc demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm (This section neednot be completed if the permit is valued at one hundred dollars($100)or less) 2,Art 2Sec.341 Title 8,California Administrative Code). Poli Number: , El As owner-builder, I will not employ anyone to do work which would e certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should ' become sub`% Simplified Prescriptive Certifica' r Compliance: 2008 Residential HVAC Alt 'ons CF-1R-ALT-HVAC . llClimate zones I and 3-7 3zI qt( Moves Ave R lib Site Addre s 11. 1Th L Enfylicement Afflict': - Datc: Permit Yl: Conditioned Duct insulatio Equipment Type' List Minimum Efficiency? Floor Area requireme �p Thermostat Packaged Unit l f�� Fumace .12 AFUE D COY Over 40/ue Setback Served by system added h ❑indoor Coil OSEER 1,� Q HSPF � 1) O uneynditio a pace (If 1101 already present,must be 0 Condensing Unit 0 EER 0 Resistance sft(�1T�/� Y/r"�R 6 VZ 1,3-SJ installed) O Other ).Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance, • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. -- _ Name: AQ-12. �77,..v(✓yu"""���C(( 1 Signature: 'IC ,�,e_ \ Company: �jII . - D : l Qwtvir-A- &i,.“ t?cn.— 7- I_ I d Address: License: 3r, 4L4' Ltnea- J.v - D City/State/Zip: 0-tics ka_Sl t C-o g2(e7.-b Phone: --2(1-1- I 1-102 • • 2008 Residential Compliance Forms Marcl,2010 • • 0 `9 CITY OF COSTA MESA 4illinkBUILDING DIVISION • F • - � $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT -`"°eMoosxannn�o 603-00480 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3094 MACE AV Status: ISSUED Suite: Applied: 03/25/2003 Vicinity: BALCONY Issued: 03/25/2003 Parcel Number 13955108 Zoning: R3 R3 ��� Applicant: STANDARD,VANESSA ISSUED BY: 9 Tip Address: PO BOX 2589 Phone: 714-427-0538 COSTA MESA,CA Zip: 92628-3496 Owner STANDARD, LEE Address PO BOX 2589 Phone: 714-427-0538 COSTA MESA,CA Zip: 92626-3496 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: % Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REPAIR BALCONY FOR"UNITS C AND D . REPLACE PLYWOOD,RAILING,AND RIM JOISTS.LIKE FOR LIKE PER 1997 UBC,SECTIONS 509.2 AND 509.3 • FEE SUMMARY Plan Check: $90.51 Calc Valuation: $6,500.00 Permit: $139.25 Claim Valuation: $6,500.00 SMIP Res: $0.65 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.41 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) K DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compeensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of 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 California,and agree that if I should becom act to the wo ars'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p Ars. �s��.E(_.' Applicant Signature: n R—'t'\ '1 4 Q Date: WARNING:FAILURE TO SECURE WORKERS'COMPEtHS`ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARS(E100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.M Class e Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 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 structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)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 7031.5 by any applicant for a permit sub cts the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. ,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or Improves thereon,end who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year 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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pu uant to the Contractors License Laws.). ❑ I am :x:met.nder sec. a ■Q Iusiness raw Professions Code for this reason: Signature: !� Expires: /// �/by Verification of Ownership by(type of d. m:.t,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 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 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 compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IU Yee U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential 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 (If yes",the facility must meet the requirement of 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 district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Cale Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws end city ordinanc relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov scribed pro arty for inspection pu es.I agree not cupy or allow occupancy of any building authorized by this p rmit until final inspection. /1 Signature Of Lea Own-e7a.1 7 Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE QATE 1NID1Ak$ CODES INSPECTION TYPE • PETE IMRIALS 1616 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 Final Site /S' 204 Final Demolition 250 Final Building/Occupancy 6-11-0Z 63 s1Jc`o �It + � A'�`' A t:?c s i . DIVISION OCITY OF BUILDISTA NG SAFETY — APPROVED -� 'I D BY C'JA,_C I?J� Date 3 �: — 1 - This set of plans and specifications MUST be kept on this job at all tines and d is unlawful to ^ ,-it make any changes cc*loafers cr safe*n,Ctan from the Division of Building L.. and Safety,City of Costa ktsa. The stamping otthis Oar,ape cpscEc-atSHALL NOT tehet lepermit ortobeanapproval of the violation of any provisions of a y Ci:;0 Costa Mesa Ordinance and/or State law. \�. r These plans and permit shall erp re by rated mNatan aM become nuit and von if the buiding or I , want is rat canmannxd and me rdarned ante per USC§303(d)within 180 days of issuance. e4 ` . 1pt „ oft ' tio t_ C I/ 11 APPROVED ��` CITY OF COSTA MESA M PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. /PA r L --� NOTE: ADDITIONS, DELETIONS, -G ` r �' OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING D2IV. BY. DAT ~ ,V . ` , s.. .. 3O`lq 1t aei2-- e ' MAR-25-2003 09 25 Uideo Applications. 714 508 2362 P.131 • DECLARATION OF AUTHORITY Bldg. Permit#tO3- ( FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Address:: s.. 001 `i MO Q_L �//� _ AP Number: t. I (we). .X Lee- S {)r"- ,-` Q , declare that I am the Owner of Title of the above referenced real property, and that I (we) /hereby authorize:eebbIyy / / Name: _ (N�-S�YI- �-! ' �'C'(C �7,/ Telephone Number: I I — / 7J — )y. I cci Street Address: IL9 ��D' �/� Gy City: �1�57 r Y Stale: ` 1 ` Zip: /a6Ci.a to obtain permits in my behalf, as owner/builder.for-h`CO at the above referenced property. 2. Should any porson become an employee engaged in the improvement of the property. I (we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to bo filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As ownorlbuilder In fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that t the foregoing is true and correct. Executed this / ' r"day of ' `�-- 20 03 , at G "77 tip , California. Print Name: �. Le 2_ S a,SL Signature: -LC. Dale: _ K 3/Q5-1e3 Note: This aulhori ation does not grant authodzaton to perform the work as owner. it solely provides for limited power of attorney to secure this permit in any behalf. 0179.03(re.:IiX) mac_'JC_02fiZ MC:DO 'lt A7,ZAAnci, '7G% P cu • MAR-25-.2003 TUE 10:42 Ari A MESA DEVELOP SVCS FAX NO. 71ti 41856 1)..• .91 i1 H 0 E • R--BUILDER • RIFICATIUN • - r A city or county, which is regnircd to gi e notice pursuant to Section 19830. shall attach to such notice,and. as a condition precedent to iisoing a b ilding permit, require the completion and require the return of, an owner-builder verification. Attention Propeny nwnci: An •owner•buildcr' building permit has b•en applied for in your name and bearing your signature. Please complete and return this iSftirma ;on in the envelope provided at your earliest opportunity to avoid unnecessary delay in prucessida hlid Lssui g your building pcmiit.No tuild i penntt will Ile issued ulltil this verification is received. I personilly plan:tu'providc the nujnr labor and materials for construction of the proposed properly.improvdi cm: 13: es '0 o av 2. I ( /have nit). P: ' , •• - •) signed an application for a building permit.for the proposed work. , 3. t have contracted Witthe ft towing person(firm)to provide the proposed construction: Name Address • g.- - - City . Phone( -•') Contractor's Lic. No. 4. I plan to proyidc portions of rc work,but 1 have hiredthe following person to coordinate. supervise and_pnwide the in jar work: Name_ Address • . . _� City -- Phone( ) . ' Contractor's Lie. No. 5. 1 will provide same of the work hut 1 have contracted (hired) the following persons to pr vine the work indicated : • Name - :Address Phone Type of Work • vvr+� iota YW� , NPR-25-2002 e9:22 2{47544956 95% P.01 City of Costa Mesa 2607 Building Safety Department CERTIFICATE OF OCCUPANCY N O P. O. Box 317 Costa Mesa, California The Building located at 31194 XtrC Amur/ AnD has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group a & J Occupancy. Use of Building 4 [nit AnalMing with aril cameos eM Ien;T,clry Legal Description Cp+ 62604 LCA- 5 (See reverse side for Metes and Bounds) Building Permit No. P%19 Electrical Permit No. 29733 Plumbing Permit No. 531169 Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments— it and/or guest rooms ISSUED ibyilding, _ARMOR i6�V(/ �- o!COMM by it1Q Date_ a].7 18, 1969 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e).U.B.C. Form BU34—tM-11-e3._ss a 29619 COSTA MESA BUILDING-SAFETY DEPARTMENT )Ni —6-6P9LAO 129 ***715.L` P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 • VFor Applicant to Fill In Complet ly APPLICATION FOR PERMIT TYPE OR PRINT /7- 0 BUILDING ADDRESS Vila AA�� /I A For Office Use Only ADDRESS T(�qQ ( /)LL �1., L•)V-C*I Ua COSTA MES- , I OR IA RECEIPT NO. 77161 to. / VED .07 a to. OWNER .�:'�I MMUS f�.FT,iltt. —_...:� . • R[C[/I1 .. y '�'.(}. —• .7C�,/^'-A.j' /n{-T{_Ie9� --4.. ADDRBSD{'( `I !. b (l Q ADDREISS FIRE 4 ?307 y' /,,v2 Oaciei/ A-•v CITY c (1(A-0 kk NO. P2/-1)433 ZONE ✓ TYPE // GROUP g IV- t -�--,•� APPROVED � Olin v. (AiV71 No 53)'2D 6,3 BY DATE bb •0ot j1 . Qna1101VII ZONING ADDRESS /� 11 �.//,, ZONE I NO.OF I YSIL I NEW 4 plex w/ CONTRACTOR<✓i(II P� L.J�//f I (f4 4[cif I{2(� R-3 Pula SUILBI /� 'f •1 1(� (-1/ ///� / LEGAL att S rar gar/ ADDRESS I T `I v �1 0 U C[�C, d DESCRIPTION hot •,0•) Tr. G269 CITY thI'C0I1 A.P.NO. none NOSTATE TEL. SOTTO SIDE a REAR P.E: NO RAVE L. SHALL BE LESS THAN LIC.NO. �� IUy� -�1 I� NQ� �7l- ��yy3�3� 7 vii I now91�4YY EVES SIZE HO OF GE. P ALLOWED (U.B.G.REQUIREMENT) OF LOT YARDS APPROVED YARDS APPROVED USE OF / MAIN BUILDING ACCESSORY BUILDING �'Z/ EXISTING BLDG. (PROM C/L STREET) SETBACK LINE FROM CENTER OF STREET ry'� y REAR YARD /D FRONT‘ t� Rr' FT' SIDE YARD I LEFT II RIGHT / R.SIDE J PT. FT. DES RIPTION OP WORK L.SIDE 71,7. FT. e TERATI N ADDITI N REAR /O Fr. FT. DISTANCE BET. BET.MAIN B MAIN BLDGS, ACCESS.BLDOS. REPAIR MOVING DEMOLISH BUILDING L [ D NO.OF p VAR.# DATE SIZE /OI+0 ROOMS / 9 STORIES �•� C.U.P.—i/ ,) APPROVED / EXTERIOR WALL I ROOFRING CA/ e7PROVEQ /e"�'�-.�' DATE/2- _yG _(O� COVERING/J.j.I�({ G(/F�� USE OF BUILDING AND WORK TO BE PERFORMED A, W I HE- BY ACKNO OE THAT 1 HAVE READ THIS APPLICATOR THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT E ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. R1 PLY WITH ALL CITY ORDINANCES AND RAT[LAWS REGULATING VALUATION l/3 /� 0 BUILDING CONSTRUCTION. PERMIT FEE .S /4 .50 SIGNATURE OF PERMITTEE �_ 7� ,`�f, g S�/) 9�� PLAN CHECK 5 �J�7/ ?/c��,-..�J✓ k' AUTHORIZED AGENT �, �� / TOTAL FEE $021 J •�/IL/