HomeMy WebLinkAbout3260 NEBRASKA LN - Building Permits` �� • qTY OF COSTA MESA • I
�o�°NFs, BI/ILDING DIVISION
.
r� . � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ra.us
:
° � FOR INSPECTIONS CALL: (714) 754-5626
�4��,i�`
PERMIT NUMBER: B10-00190
PERMIT TYPE B_ROOF2
APN: 13906503
JOB ADDRESS: 3260 NEBRASKA LN CM
Vicinity: HOUSE AND GARAGE ROOF
Squares: 1700
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
O6/28I2010
RMD
$7,987.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTAIL A MINIMUM OF 2 LAYERS 15# FELT ON A 2:12 TO LESS
THAN 4:12 PITCHED ROOF OR INSTALL A MINIMUM OF 1 LAYER 15# FELT ON A 4:12 OR GREATER ROOF
PITCH, REROOF WITH 30 YEAR COMP SHINGLES ON AN ATfACHED HOUSE AND GARAGE, APPROX 17 SQUARES.
REPAIR AND REPALCE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: SALCEDO EDWARD JR AND JEANNE M Address: 3260 NEBRASKA LN
PHONE: CirylStale/Zip: COSTA MESA, CA
UniL
APPLICANT: HOLLEY, MIK� Address: 29222 RANCHO VIEJO RD Unit: :UNIT 125
PHONE: 949-548-5569 CitylState/Zip: SAN JUAN CAPISTRANO, CA
CONTRAC70R: CRANK BROTHERS ROOFING CO, INC License No. 903758
Address: 29222 RANCHO VIEJO RDUnit: UNIT 125 PHONE: 949-548-5569
City/State/Zip: SAN JUAN CAPISTRANO, CA 92675 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $153.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
License No.
License No.
PHONE:
PHONE:
TOTAL FEES $154.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/1812010 - PER CMMC Sec. 13-279
Monday thru Fritlay - 7:00 am fhru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Years Dav. Memorial Oav. Intleoendence Dav. Labor Dav. Thanksaivino Dav and Christmas Dav
NOTICE: The work authorized by this permil shall comply with all applicable handicap access requirements under Califomia slatutes and relaled
regulaGons. (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 (or thy work aulhorized 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.
C OE � INSPEC710NTYPE U�T NI 1f11AL5 LOOEt INSPECiIONTYPE OATE INiRIALS
1616 Fixetl Syslem Pinal Fire Prevention 206 Final Mechanical
7266 Pool Spa Final 208 Final Plumbing
Z00 Final Re-Roof �� Z,�� �� 270 Final Electriwl
201 Final Block/Re�aining Wall 212 Finai Pire Prevention
202 Fioal Faccory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
. . . .
WORKERS' COMPENSATION DECLARATION:
I hereby aKrtn untler penalty o! perjury one of the following declarations:
❑ I have antl will mainlain a certifcate of consent to sel(-Insure (or workers'
compensation, as provided for by section 3700 0( the Labor Code, (or Ihe
pertormance of Ihe work (or which ihis permit is issuetl.
❑ I have antl will maintain wrorkers' compensation insurance, as required by
section 3700 of the Labor Code, lor tne pedortnance of the work for which this
permit is issued. M workers' comp�nsation Insurance carrier and policy
number are: • //
Earrie[+� G �/GI/
(Thiss un eedrrothew,nmpietetlAmepennrtisvaWedatmenundmecbnars(StoO)aless)
Poficy-Number. ��/��r�7����
❑ I certify that in �he performance o( the work !or which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
lo lhe vrorkers' compensation lay �'s of Cali(omia, and agree iha[ if I should
become subject to the w�Ace, s%con pey sation provisions f Section 3700 ot
the Labo ode sh Korthw f c ly wit fiese prqvisi s.
L
'gppimm' ignaWre �e-^--._.
�---' - .
WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL UBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE L4BOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS �ECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Seclion 7000) of Division 3 of Ihe Business and Professions Cotle, antl
my license i(s%�/J full force an'd'"e(R/ect.
L'ic�#�`� � ! O �Glass�# �
_�- r
� . -
onv ors S r � ate
CONSTRUCTION LENDING AGE
❑ I hereby aRum lhal lhere is a� construcl'an lending agency fw the
peAortnance of the work lor wfiich this permit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
OW NER•BUILDER DECLARATIONS:
I hefeby a(flfm lhat under penalty Of pefjury �hat I am EXEMPT PROM THE
CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
constmct, alter, improve, demolish, or repair any strucNre, prior to its
issuance, also requires the applicant for such permit to fle 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 Ihe
Business and Pmfessions Code) or Ihat he or she is ezempt therefrom and
Ihe basis for the allege0 exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applicant to a civil penalty ot not more than
five hundred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and Ihe slmcNre is not in[ended or
oflered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an owner ot propeAy who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvemenis are not intended or oftered for
sale. If, however, the building or improvement is sold vrithin one year of
completion, the owner-builder will have the burtlen of proving ihat he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business and
Pro(essbns Cotle: The contractas License Law dces not apply to an ovmer o(
property who builds or improves thereon, and wfio contracts for such project with
a con�ractor(s) license pursuant �o the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre Da�e
]05]-46 (0I0])
� ,
Ovmer ID verified by tlriver's license. � Yes ❑ No ' '
Dnver's License No. Expires:
Verification of Ownership by (type of documenl, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby certify that no excavation frve (5) or more feet in depth into wfiich a
person is requiretl lo descend, will be made in wnnection with work authonzed
by Ihis permil, antl �hat no building s�ructure, scaFfdding, falsev.nrk, or Oemolition
or dismanlling Ihereof, will be more than thitly-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Calitomia Administ2�ive Code).
❑ As owner-huilder, I vnll not employ anyone �o do work which woultl
require a permit from the Division of Industrial Safery, as notetl above, unless
such person has a permit to do such work (rom the division.
Applitanfs Signalure
Division o! Industrial Safery Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl to file antl
certify a Business Plan (or emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the California Health antl Safery 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 quaNiry of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic leet of compressed qas
at standard temperawre and pressure).
2. Does or will the applicant or present or future building occupant need to (le
a reqistration form for awtely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Heal[h and Safery Code, with some
exceptions, requires reqistration with the Costa Mesa Fire DepartmeN by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal lo or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas al stantlard
tempereture and pressure).
3. Does or vnll the applicant or present or luNre building occupan� neetl to
preDare an RMPP (Risk Managemen[ antl Prevention Program for acutely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that lhe
Costa Mesa Fire Departmenl may require the preparetion, certifcation and
filing with the Fire Department o! an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the California
Health and Safety Code been (ully complied with? ❑ Ves ❑ No
5. Does or will Ihe applicant or present or fuWre builtling wcupant require for
the wrork which is the subject o! this application a permit (or such consWction
or modifica[ion from the South Coast Air Quality Management District or from
any other air pollWion control dislrict or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires [hat Ihe requestetl
in(ormation be (umished on applications for nomresidential building permits).
6. Will any part of the facility to be conswcted under this permit be within
7000 feel from the outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", the facili[y must meet the requirement of Sections 25534 antl 42303
of lhe Calitomia Health and Safery Cotle).
7. If a pertnit from the South Coast Air �ualiry Managemen[ District or other
air pollution control disMct or agency is required for the work which is the
subject of this application, have all of Ihe disclosures prescribed by California
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certifcate of wmpliance from the appropriate air pollution
conirol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the
information given above is correcL I agree to comply with all sla[e laws an0
city ortlinances re9artling Hazardous Matenals and Emissions.
SignaWre Oale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury Ihat I have reatl this application and state lhat
lhe information given is correcL I agree to comply with all state laws and ciry
ordinances relating to builtling cons[ruction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described propeny for
inspection purposes. I agree not ro occupy or allow occupancy of any building
authorizetl by this permit until fnal inspection.
�Wr olLegal � Dat
�A_.or'Aut�onr APGliwnt �--Oa�e-
�
ve Certifcate ut'
�! Alterntions
Prajeet N:ime:
General In�orm:i[imi
Site Address: -�^
Building Type C�Single Pamily ❑ Multi Family
Conditiuned Floor Area (CFA):
is iml (n be used
l�esulation Vnluea For
linliircemenl
Climate Zone N
Date:
Circle tl�e From Orientation: N, E, S, V�', or degrees _
Proieci Type: ❑ Alterations O Envelope � Fenestration
Constructed lluildings nr AAditinns
�w��'ing use tlie Mass mid Furring Sn'ips Consn-uction iaGle
R-ALT
: � or s�
HVAC
Assembl}� AI[eration
❑ Openin� of (rameA caviry• alone- Ahera�ions dia� invoh�e �he opening oj�he finmed caviry� of a wall, ceiling, orJloor mus� insm/1 the
ma�da�orv minimwn insidmian vn/ue per §I SO,fa' Ihe a6ered a.cxemblr. Fil! in Cofumns A-C and enter mandatop� insufaiion vnlue in Column H.
❑ Replucement of entire assemblp-Rep(acemenr ofun emire wall, cei(ing, orJlom� assembl�� reqmires lhe ins�ollarion o(Componeni
Packuee- D insulation va/ves in Table ISI-C. Fill in Cofumns A- J. _
A I �
P
7ag/ Assembly Name
ID� orTy e�
No�e: For (ur'red assemblir�, ct
For
of Mass Wulls see Furrine S[rios Construction Table beioe�,
Framing Thiclu�ess, Framed
Materiat Spacing, U- 1A4 Table Cavity
and Size� or Other� factor° Numbei3 R-value
ie for Con�inuaus lnsu(alion 2-value, mee Pa¢c JA4-3 and Equatia� 4-1. F
:ontmuous JA4 Proposed
lnsulation Assembly Assembly
R-Value' Cell Values U-fector°
use (he Mass ond
1. Fa' Tag/!D indicaie �he identi%icaiimr name �ha� nmtches (he 6uilding plans.
Z. Indicnte the Assemblr Nume or' rype: Roa%/Cei(ing, Walls, F7oora', Slabs, Crawl Space, Doors and etc...lndicate !he Frome rype and Size: For
N�ood, Metal, Metal Buildings, N(ass, enter ?z4, 2xG, or eic... see JA4 for oiher possible frame rype asserrblies.
3. Eia�er' the 1lviclmess,fm' mass' in inches or Spacing Genveen fi�aming members en�er; 16 "a� 24 "OC,- or Otherjor al! odier assembf�� descripiion
such as Conerete Sandwich Panel, Spandrel Panel, Logs, Sn'aw Bale Pane! and etc.... ,
4. Based aiv the Clinm�e Zvne; eriter �he Standm�d U jac�or fi•oni Table ISI-$ C a' D for each diJjererv assembl�� Name or' rype.
5. Emer the TaGle number lhai closel�� rea�emGles �he yroposed m�sembli�. I
G. Lnter �he R-nalue lhnl is being instalfed in !he wu11 cavitr or Le�ween (he j�aming; od�eiwise, enler' "0 ".
7. E�ner Ihe Cmitinuous Ine'vlattwi R-i�alue jor Ihe proposed ussem6lp; o(he�wise, en�er "0 ". '
d'. Ln(er dm rmo and cnlunm a(Ihe U-%ac�m' volue Lased on Colunm FTabfe Number and enter lhe Assernblp U fucior in Co[vmn J
). The Propn.red AssemGln U-jacmr, Colunm./, mus! Ge equal lo or less ihan !he Sfandard U-f�cfor in COlunan E lo complp.
FurrinF Strips Constniction TaUle for Mass Walls Only
A K C D Is F G H ) ,1 K L M
Propused 1'ruperties uf Masonry atld Concrete Added Interior or Lxterior Insulatiun
H'alls rrom Iteference in Furring Space trum Referenec
.luint A i endia 7'ablc 4.].5. 4.3.6. 4.3.7 doinl A endis 7'nblc 4.313
u '" _ >, _
u �c` % c
V � J Y � � V
�; um. `o _ c E
Axscmbl}• �- j � " — : � Fin21
u L u J .' 4 9 a.- F u.
Mass Nume or JA4 Tahlc a� v_ = E� c c �� e+ Q�°-J' � o ASSem61y
Thickness� T c' Num6cr' <" � "� a� �= t� ��
- _ �: '� � � � � r �v r U-factor • Commem
I _ �
�
� I I
lf egia�n�o�imi Nwnber: RegisU'ulion Dale!!'inte: HERS Prnvider:
200d' Residential Cnnep7iunce Forms Augusl 2009
Certificate of Compliance: Residential
im.•..�:�»�•- --
Prbject Name:
ROOFING PKODUCTS (COOL ROOFS) §I51(J}I2
CF-IR-ALT
(Paee 3 of 51
Wl�en Ute area o(exterior rnoJsurface !n bc repfaced rxceeds niore [han 50% oJfbe eristing roojareo, or uiore Niun 1,000 jf, rvhichever is
les.s, Nae ne�v rooftpg area nu�s( uicet lhe rnoftng prodnct "Cool Roof'requirenrents of§I52(b)IHi, ]52(b)1Hli, or 151(b)IHiii.
Check applicaGle al�ernntive or exception beloH� iJlhe roof afleration is esempl fi�om the roofingproducl "Cool koof' requiremei�ts. Noie: /jany
onp of /he a(lernalives or' excep(iav Ge/ow is checked, �he Aged Solar ReJlectance and Therma/ Emivance requiremen�s jor r•oofingproducts in
§ll8(iJ m'e nol applicahle. Do not.fil! �able below. �
ool Roofs Not Required in Clima�e Zones I-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
ool Roofs Not Required in Clima�e Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
h 516/ft�.
�Iternatives to §152(b)IHi and §I52(b)Hii, Steep-slope roof (pitch > 2:12)
Q Insulation with a thermal resistance of at least 0.85 hrft� °F/Btu or ai least a 3/4 inch air-space is added to the roof deck
over en attic; or
Q Existing ducts in the attic are insulated and sealed according to §151(�10; or
Q In climate zones 10, 12 and 13, with 1 ft''-of free ventilation area of attic ventilation for every 150 ft� of attic floor erea, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
Q Building has at least R-30 ceiling insulation; or
Q Building has radiant bazrier in the attic meeting the requiremenis of §I51(�2; or
Q Building has no ducts in Uie attic; or
Q In climare zones 10, 1 I, I3 and 14, R3 or greater roof deck insulation above vented ariic.
Exception to §152(b)1Hiii, Low-slope roof (pitd� <2:12J
L7 Building has no ducis in [he attic.
❑ RooSng area covered by building integmted; photovoltaic panels end solar thetmal panels are exempt from [he below Cool Roof criteria.
❑ Roof constmclions that have thermal mass over the roof inembrane with at leas[ 25 Ib/ft� is exempt from the below Cool Roof criteria.
Note: If no CRRC-I label is available, this compliance method cannot be used, use the Perfortnance Approach to show compliance, otherwi
Check the aoolicable box below if Exemot from the Roofinc. Products "Cool RooP' Requirement:
I RoofSlope I ProductWeight
Product ID Numher� 5 2:12 > 2: t2 < Slb/ft� > 516/fr�
Cli/iC Producl /D Nurribcr cmr Le
I����1����rl
❑�
Q
�
0
0
0
�
n
�
0
+
n
Product Aged Solar Thertnal
T e' Reflectance�'0 Emittanc
❑4
�"
❑4
�a
o^
SRIS
fndicale lhe type oJprnducl is heing �rsed (nrlhe roof rop, i.e. single-ply roaf, asplm(I rooJ, rneml roof, elc.
Ij�l�e Aged Rellec�ance i.s no� availuGle in.Uie Cool Roo/Ra�ing Cmmci!'e' Ra�ed Praduc! Direcroryllren use dre Inilial ReJleclance vuluc f'om Ihe snme
dirrcmp� and iue d�e equalion (01+0, J(Pi,,;�;�1— 01J �o obmin n calculaied aged va6re. Where p is ihe /ni(iol Solar Reflecm�¢e.
Cl�eck Goa if(he Aged Re/leclarce i.r n calcWaled rahe using Ihe e9ualim� above.
Calnda(e Ilm SR/ vo(ue Gr using Ihe SRl- Workshee! o! Ivtn'//wwu' enerm�.ca.eav/title24/ond emer Ihe ruul�ing value in Ihe SRl Colurror ubove and atmch aco,
rhe SRI- IVorkaheei �n Uie CF-1 R.
� apply Liquid Rield Applied Cunlings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
eommended by the coatings manufticturer and mee� minimum performance requirements listed in §118(i)4. Select the applicable coating:
Aluminum-PigmentedAsphalt RoofCoating
Cement-Based Roof Coating
Other
Registrulion Number: � Registration Datelfime: HERS Prm�ider:
2008 Residentiul Compliunce Farms ' Augusr 2009
.
�
�� .
Certitica�te uf'Cumplio-ince:
ALT
Reside�ztial A1lerntimmv (Pu;,�e � of" �)
ri�ujecl Nnme: �//� �� Clinuue "Lune n� I i; u1=Siuries
__ � r _ /
FiEPS ��GI21F1 CAT10t� SUM�IAR)" The enforcemeni ageiecr should pur eyecra! e�trentioir tu 7hc HG/IS A9euazrre,s apecrjied iii Ihrs
checklisi Lelon�. �1 comyleied und si�ned CF-412 Fonn.frn� all �he nrena�w�es speci/ied shnll Lr suGmiued m iiic Guilding inspec�m- bejmr Jinol
Duct Senline & TeStiue HERSreri/icmion is renzriredJortl�ia mensurc.
❑ i'L''S ❑ NO 1'C5: lu Climatc Zones'_' and 9-16, if mort than 40 linear feet of new or replucemeni ducts art installed in unconditioncd
� space, [he ducts ure to be sealed per y 152(b)1Dii and [he newl)' instulled ducts nre m be insuitLLed pei § I 51(1:11 b.
❑ LXC�1'TIO�: Lsisting duct s��stems that are extended; which :vc cuushvcced, in}Wmed ur scaled with asbestos.
❑ Y�S ❑ NU 1'ES: ]n Climaie Zones 2 and 9-1 G, if the exisiing space-conditiouing sys�em (HVAC equ[pmen� and ductingj is replaced, the
� ducts are �o be sealed per § 1 S2(b)1 Di. �
❑ 1'T,S ❑ NO YES: lu Climate Zones' and 9-]6, if the esisung H\+AC equipmem is mpluced (including the replacement ot the air handler;
� outdoor wndensing unii of a spin system; cooling or heating coil, or the fumace heai exchan�e�y the ducts are to be
sealedper §152(b)]E.
❑�XC�PT10n: Duct systems t6at are ducumented tu I�ave been previuusl�• sealed confirmed tivuurli H�RS
� verification iu accordance with prucedures in the Referenee Residential Appendis ItA3.
' ' ❑ EXCCPTIO�': Uuct systems with less than 4U linexr leet in unconditiane� spuce. - .
� EXCLPTIO�: Existin� duct svstems constructed, insulated or sealed �vith as6estos.
$Efflo0i.lflt Chet'ee - S}lllt S)'StClil HERS veri/icntion is'required for thi.r measime.
❑ YES ❑ NO YCS: ln Climate Zones 2 and 5-15, when [he existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensine unit of a spli� system A/C or 6eat pump, coo7ing or heating coil, or the fumace heat
exchaneeri a refrieerant charee measuremem shall be verified per § 152(bl]F.
Central Fan Inteerated (CFI) Ventiiation System and Fan VVatt Drah�
The ven[ilation mauirements of F150(o) do not apolv tn existine residential homes.
Ducted Splif Systems - Air Conditioners and Heat Pumps: Airilow HERS veri/ication is required /orlhis meosurc.
❑ YLS ❑ NO 1'ES: In Climare Zones 10 t6rough 1�, when the ezisting space-conditioning sysiem (H VAC equinment and ductino) is
renlaced. the airflow a�d ian watt draw shall be verified ver � I S2(b)1 Ci to meet the renuirements of & I� I(f17B.
Author's Declaration
this Certificate of
�
I( Applicable O CEA or
(Certification t7J:
Phone: _
� ii v i - -
nonsible Iluildine� Pes'tner's Declaratiur Statement � •� �- -,
1 um eli�!ible under Division � of the Californiu Business and 1'rofessions Code to accepi responsibiliq- for the buildine design iden[iGed op
[his CertiLcate of Compliance.
1 certify thai the energy fwuu�es und perlormance specificntions fnr the building desipn identiGed on this Certif�cate of Cumpliance conform
tu thc requiruments o(Ti�le 34, Pans 1 and 6 oI Ihe Calilbrniti Codr of 7dcgulz�i�nx,
Thc building desigu fe2tures ideniiGed on thie. CertiLcme of Compliancc tvc consistenl wilh thc iniormation provided tu ducumenl thi:�,
buildh�� design on th: oiher applicable cumpliunee fonne, woii;shce�s, culculations, plans und speciGcaiions submitted « � the eniorcemem
aeencr far annroval iviih this buildine nermi� annlicu�ian.
N�unc
Signature:
Tnr t+.s.�'i.siance nr quea'�inns regordin� the Energl' S[�utd¢r�Lc, cnnt[ic! Ihe Ene�'g)� Hndine ��t: 1-kDll-7i2-i3011.
I(egu'irtuion lJunrber: /fegisu'aiimt Laie/I'imc: HEI;S Prm�iaer:
200d' 1(ca�identir.d Compliuncc Forms
Aug�csi 20(IJ
(774) 754-5273 • Fax Q14) 754-4856 • www.ci.costa-mes����DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3260 NEBRASKALN
Suite:
Viciniiy:
Primary Occ: R3 Dwellings/ Cong Res <10
Parcel Number: 13906503
Applicant: PEITON, MIKE
Address: 915 LAKE ST
HUNTINGTON BEACH, CA
Owner: KNAPP, GERALD LEE TR
Address 3260 NEBRASKA LN
COSTA MESA, CA
Contractor: J K CONSTRUCTION
Address: 915 LAKE ST
HUNTINGTON BEACH, CA
Zip: 92648
Arch :
Address:
Phone:
Zip: License:
Type of Construction: V-N
Zoning:
Phone: 714-404-9846 CELL ISSUED BY:
Zip: 92648
Phone:
Zip: 92626-2253
Phone: 714-004-9846 CELL
License: 450297
Eng:
Address:
SCOPE OF PERMIT
REPLACE ALL EXISTING WINDOWS THROUGHOUT S.F.D. TO MEED 1997 U.B.C. EGRESS REQUIREMENTS.
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$153.25
$0.77
$0.00
$0.00
$0.00
$154.02
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0�
PARKING Existina: o
Rear 0-0
Rear 0-0
Reauired: 0
PLANNING 8 ZONING
�en o- o
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
Slatus: ISSUED
Applied: 03/31R006
Issued: 03/31/2006
Phone:
License:
$7,675.00
s�,s�s.00
NOTICE: The work authorized by ihis 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 consideretl legal, such work must comply with all applicable codes, and all
required inspeetions and final epproval must be obtained. Failure to obtain inspections and final approval will resWt in �he expiration oF this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereby attirm untler penalry of perjury one oi the Following tleclarations:
❑ I have and will maintain e certifiwte oi consent to self-Insure for workers' compensation, as providetl for by section 3700 0l Ihe Labor Code, for lhe perlormance ot the
work for which Ihis permit is issuetl.
0—I'beve and will maintain workers' compensation insurance, as raquiretl by section 3700 of ihe Labor Cotle, for the peAortnance of the work (or which this permit is issued.
�-My workers' compensation Insurance carrier and policy number are: {
Cenler:—�TFa1—� �U�� PolicyNumber: �bClCf� C('1�' Z.ZY> �?_
(Tbis�section need not 6e completed il fhe permit is velued ef one hundred dollars ($100) or less.) ��--^—'^ ^" '"'
❑ I certity that in the pedormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers'
compensation laws of California, antl agree ihat if I should bacome subjact b the workers' compensation provisions of Section 3700 of ihe Labor Code, I shall torthwith
comply with lhese provisions. l--��
_�-,- : w 3-30 � O �
Applltanl SignaWre; � . Date�_
WARHINGi FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL ANO SHALL SUBJECT AN EMPCOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,00p), IN AODITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PHOVIDED FOR IN SECTION 3]O60F THE L4BOR CODE, IMEFEST, AND ATTOflNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
of Chapter 9(commencing with Section 7000) of Division 3 of ihe,Bus`i�antl Pmfessions Cotla, and my license is in full
Class # _
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirm that there is a constmction lending agency for the peAormance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name: Lender's Address:
Signature:
Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that under penairy of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires a permit to constmct, alter, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicaN for such permit
b file a signed statement t�at he or she is licensed pursuant to the provisions of the Cantractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or that he or she is ezempt therefrom and the basis br the allegad ezemption. Any violation of Section 7031.5 by any appliwnt tor a permit
subjecls the applicant to a civil penalty of not more than five hundretl tlollars ($500).):
❑ I, as owner of the propehy, or my employees with wages as their soie compensation, WILL DO THE WORK, and �he simcWre is no� intended or oNeretl tor sale (Sec.
7044, Business and Protessions Code: The Con�ractors License Law does not apply to an owner of property who builds or improves thereon, antl who does such work
himself or herself or ihrough his or her own employees, provided ihat such improvements are no� in�ended or oflered for sale. If, however, �he buitding or improvement is
sold within one year of completion, the owner-buiider will heve the burden of proving that he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law tloes not apply to an owner oi proparty who builds or Improves ihereon, and who contrecis (or such prolect with a contractor(s)
ticense pursuam to ihe CoNractors License Laws.).
❑ I am exempt under sec.
Signawra:
Owner ID verifietl by tlnver's license. ❑ Ves ❑ No
eusiness and Professions Cotle for this reason:
Verification of Ownership by (type of tlocument, i.e. - property taz 6ill or tleed):
DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION:
Drivefs License No.
Date:
Ezpires:
❑ I hereby certify ihat no excavation five (5) or more feet in depth into which a person is required to dascend, will be matle in connection with work authonzad by this
permit, and Ihat no building simdure, scaHolding, falsework, or demolition or dismamling ihereof, will be more ihan thiny�six (36) feet high (Chap. 32, Grp 2, An 2, Sec.
341, Ti�le 8, California Adminis�rative Code).
❑ As owner-huilder, I will nol employ anyone to do work which would require a permit fwm the Division of Indusirial Safety, as notetl ahove, unless such person has a
permit to do such work irom ihe division.
Signature: Date:
Division of Indusinal Safety Permit Number:
CERTFlCA7E OF COMPLIANCE AN� AUhiORIZA710N OF ENTRV: I certify under penalty of perjury that I have read ihis applica�ion and state ihat ihe information given is
correct. I egree to comply wi�h ell stete laws and city ordinances relating to 6uiltling consimction, end authorize represematives of Ihe Ciry of Costa Mesa to enter upon the
above-describetl property for inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by ihis permit uMil final inspection.
CODE t. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
12fi6 Pool Spa Final
200 Final Re-Rooi
201 Finel Blxk/Relaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
� —'�O 'C�Y.Jte
�Da�e^-----__ __ _ "^
0 I INSPECPON TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevantion
220 Final Planning Appwval
222 FinalSite
250 Final Building/Occupancy
ylj� IMRIpL
� '0�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3260 NEBRASKA LN
Suite No
Vicinity:
Parcel Nunmber: 13906503
Applicant: SCOTT, JEANNETTE
Address: 502 S LYON ST
SANTA ANA, CA
Owner: KNAPP, GER,4LD LEE TR
Address 3260 NEBRASKA LN
COSTA MESA, CA
Contractor: CULLIGAN WATER
Address: 502 S LYON ST
Arch / Eng :
Address:
ISSUE FEE
BackFlow irrigation
BackFlow Prevent@r
Bathtub
Clarifer System �
Connect (Ice,Soda,elc)
Dental Unils
Dishwasher
Drain, Floor
Draiq Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaAhquake Valve
SANTA ANA, CA
INSTALLNEW WATER SOFTNER.
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
PLUMBING PERMIT
Phone: 774-750-2233
Zip: 9270�
Phone:
Zip: 9262&2253
Phone: 714-750-2233
Zip: 92701
License: 663091
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 P-Trap $0.00
0 Pressure Regulator $0.00
0 Process Piping (per 10 k) 50.00
0 Receptors $0.00
0 Septic Tank $0.00
0 SewerCapforDemo $0.00
0 Sewer Connect " $0.00
0 Sewer Private Line $0.00
0 Shower $0.00
0 Sink, bar 50.00
0 Sink, commercial $0.00
0 Sink, Floor $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: 03126/2004
Issued: 04/15/2004
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin ,
Wash Basin Set
Waste and Vent System
Water Closet (Toilep
Water Heater / venl
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0 �
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § i, 12-21-92)
EXPIRATION: � This �permitshall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 tlays.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compty with all applicable codes, and all
required inspeotions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expira�ion of this permi�.
FOR INSPECTIONS CALL: (774) 7545626
24d6d61fl�00)
WORKERS' COMPENSATION DECLAAAnON:
I hereby affirm under penalry of perjury one of the lollowing dedaratlons:
❑ I heve and will maintain a certifiWte of consen� �o self-Insure for workers' compenseiion, as proWtlatl lor by section 3700 0l the Lebor Code, for tha peAormance of ihe
wark tor w�ich Ihis permil Is issu9tl.
have antl will maintain workers' cbmpensation Insurence, as required by section 3700 of �he Labor Cotle, tor the perfortnance oi the work for which ihis permit is Issued.
My workers' compensetlon Insura�ce carner entl policy num6er are:
Carrier. Policy Number.
(This sectlon need nof be comp/eletl il (he permit is velued et ane hunaretl tlallars (5/00) or Iess.J
❑ I certify thet in the paRormence of the work lor which this permit is issued, I shall not employ any person in any manner so as to become subjeci to Ihe workors'
compensation laws ol Celifomia, antl e ee that II I 5 ould beco a sub�ect to Ihe workers' compansation provisions oi Sectlon 3700 0l ihe Labo((( Code, I shell lorthwith
wmplywithth pr visions� � �'' � JO\ I
`1
Applicam Signeture � ��/� Date: I
WARNING: FPJLURE TO 9ECURE WORKERS' �ti1FEN5ATION COVEMGE IS UNL4WFUL M'D SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDREO
T}1IX15AND DOLLARE(5100,000�, IN ADDITKMI TO THE Cp$T OF GOMPENSATION, DAMAGES AS PPOVIOED Wq IN SECTION 3]O60F iHE IABOR GODE. INiEflEST, AND AiiORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby effirm that I am licensed untler p�ovisions of
torce antl eHecL Lic. k��-
ConVactor's Signature: \l�nP r-./_I 1E/
(commencing with Section 7000) of Division 3 of �he Business antl Protessions Code, enA my license Is in full
� Class a
Date: _/ �
CONSTRUCTION LEPYbING AGENCY:
❑ I hereby aRirm that lhere is a cons��+ction lentling agency tor Ihe peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Coda).
Lender's Name: Lentler's Address:
SiqneWre:
OWNER•BUILDER DECLARA710NS:
Date:
I here0y ettirm tha� under penelry ot pe�ury that I em EXEMP7 FROM THE CONTPAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions
CoUe: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repaie any structure, prior to iis issua�e, also requires the applicaM fo� such pa'mit
ro file e signed statement thet he or sh� is licensed pursuent to Ihe provisions of Ihe Comractors License Lew (C�epter 9(commencing with Section 7000) of Divislon 3 of the
Bu5ine59 end PrOfeSsionS Code) or the� he or she is exempt therelrom and the basi5 lor Ihe ellegetl exemption. Any violation ol Section 7031.5 by any epplicent for a pertnit
sublects lhe aOPlicent to a civil penalty 0� not more than five hundred dollars ($500).):
❑ I, es owner of ihe property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, antl ihe structure is not intended or oXered lor sele (Sec.
7044, Business and Professions Code: The Contrectors License Law does noi apply to an owner of property who builds or improves ihereon, antl who doas such work
himself or herseli or through his or her own employees, provided that such improvemenis are not intentled or oHerea for sale. If, howevet. Ihe builtling or improvement is
sold within one year of completion, ihe owner-builder will heve the burden oi proving that he or she did not build or improve for purpose of sale.).
❑ I, es owner of the property, am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the prolect (Sec. 70d4, Business entl Professions
Cotle: The coniractors Llcense Law tloes not appty to an owner of propeny w�o builds or improves thereon, antl who contracis br such project wlth e contrector(s)
liten5e Dursuan� t0 the Con(racbls License Lews.).
❑ I am exempt under sec. Business and Prolessions Code tor Ihis reason:
Signature: Daie:
Owner ID venfied by dnver'Sliten58. ❑ Yes ❑ No Orivers License No. Expires:
Verification of Ownership hy (type ot document, i.e. - propeny taz blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cehity �hat no exwvation �ive (5) or more feet in depth into which e person is required to descend, will be made in connecUan with work euthorized by this
permit, and that no builtlinq structure. swNoltling, lalsework, or demolilion or dismantling thereof, will ba more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Calitomia AdminisiratNe Code).
❑ As owner-builder, I will not employ enyone to do work which woultl require a permit irom Ne Division of Industrial Satety, es noted ebove, unless such person has a
permit to do such wark trom the tlWision.
Signe�ure: Da�e:
DiviSion of Indusirial Sefery Permi� Number:
CERTIFlCATE OF COMPLIANCE AND A�7TMORIZA710N OF ENTTiY: I cenily under penalry of perjury Ihat I have read this epplication antl state Ihat ihe information given is
correcL I agrea to comply wlih ell state laws and ciry ordinances relating to builGing consiruction, antl authodze representatives of Ihe Clty ot Coste Mese to encer upon the
above-descnbed property for inspection purposes. I egree not to occupy or allow occupancy of any 6uilding authorizetl by this pertnit until final insDection.
CO��E Y�. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202
203
200
Final Factory Fire Place
Final Sign
Final Oemolition
PSjE IMIII�LS
� ' / ` / _ �q�
T U
Date
COOE I INSPECTION TYPE
206 Final Mechanical
200 Final PlumDing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupano/
�4.11iI:1uL161
� � _L
/I
Lor 77
rR 372z .
1.31�0
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA ME6A. CALIFORNIA
For Applieant fo Fill In Complefely
TYPE OR PRINT
BUILDING 3Z6O NEBRASKA LANE
ADDRESS
COSTA MESA. CALIFORNIA
OWNER K B� E DEVELOPMENT CO.� INC.
MAIL IS�rI PLACENTIA AVE
annwccc
s�=E 6oxioo ��. �F Be6a. o
OF LOT NOW ON lAT
USE OF
EXISTING BLDG.
SHT6ACN YN8 FROM r�O� 2� �
CetmR oP BTReHT l REAR YARD
91DE YARD I LEFf / I RIGHT �J��
DESCRIPTION OF WORK
NO. OF
EXTERIOR WALL ROOF WOOD SHINGLES
CAVERING ST11_C�Q COVERING
� USE OF BUILOING AND WORK TO BE PERFORMED
PLAN 1-B
I H¢REOY ACKNOWI.EDOE THAT 1 HAVE READ THIB APPLAGTION
ANO eTATE TNAT THE A90VE IB CORRECT AND AGHEE TO COM-
PLY WITH /�LL CIT' OROINANCEB ANO TE L/iW8 REQVLATIN6
BUILDINO CONBTRqF�T�ON.^ ('� ��
19
81GNATURE OF/N � �„ / X����n
IAUTHORIZED AGENT
FEE RECEIVED
�- OCT 241960
FINANCE DEPT.
APPLICATI��Y �R ��AI�ESA
BUILDING .
For Office Use Only
BY
BUILDING
COSTA MESA. CALIFORNIA
APPROVED
ZONING
ZONE NO. OF UBE OF NCW
R�t I pV�NB A OUILOINO W
1 12
LHGAL
�H6CqIPT10N T.nt 17� Tre�,
A. P. NO. I10T1E
YARDS EVES
APPROVED ALLOWED
tcer�Tert uHe er.> —
THE AMOUNT BXOWN UNOEH VqLU�TiON 19 FOR THE
PURP096 OR HBTABLIBMING A PERM�T FEE ONLY.
VALUATION �l ^
� PERMIT FEE $ �7J
$ ��-% � PLAN CHECK S /O �
�� �
i
0
u
�