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Home My WebLink About3205 NEBRASKA PL - Building PermitsCITY OF COSTA MESA �,O'�pMFs,p BDILDING DIVISION Ft�� 77 FAIR DRNE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • uw+nv.ci.costa-mesa.ca.us `+ � FOR INSPECTIONS CALL: {714) 754-5626 `°°^��°`'' PERMIT NUMBER: B11-00192 PERMIT TYPE B_ROOF2 APN: 13908219 � ,,�_.. JOBADDRESS: '3��2 NEBRASKA�P_LCM^�•�� Vicinity: HOUSE AND GARAGE ROOF Squares: 2900 STATUS: , DATEISSUED: ISSUED BY: Suite/Unit: i Valuation: -� � �. � ,ISSUED , U6/27/2011 RMD $8,380.00 ' ' � ` -"'• SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 1 LAYER OF 15 # FELT ON A 4:12 PITCNED ROOF AND REROOF WITH 30 YEAR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 29 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. NOTE:RESID�NTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for venfication of the installation of smoke and carbon monoxide alarms by the City Inspectoc See Attachment wllnspection Card OWNER: CISNEROS, VICTOR PHONE: APPLICANT: PAVELOFF, RON PHONE: 714-744-5996 CONTRACTOR: SOUTH COAST ROOF INC Address: 1132 W BARKLEY AVEUnit: CitylState/Zip: ORANGE, CA 92868-1213 ARCHITECT: ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Rerwf Permit Fee: $167.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 Address: 3205 NEBR4SKA PL CitylState/Zip: COSTA MESA, CA Address: City/State/Zip: - License No. License No. PHONE:` — - � � � License No. 7'14-744-5996 CELL: Unit: ` Unit: - . ; �� , ��' : • � , 365271 � PHONE: PHONE: 4L FEES $168.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3118/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm, Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal New Years Day, Memo�ial Dav, Independence Dav, Labor Dav, Thanksgivinq Dav and Christmas Dav NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all required inspections and final approvai must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permrt. CO�EN. ,INSPECilONlypE DATE INTITIrllS LOOER INSPECTIONTYPE DATE INTI71A1.5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final ��q��,ry� 208 Finai Plumbing 200 Final Re-R0o( � �:Jr1L`—� 210 Final Electrical 201 Final Block/Re�aining Wall 212 Final Fire Prevention 202 Final FactOry Fire Place 220 Final Planning Approval 203 FinalSign � ' 222 FinalSife � \ 204 � Firial-Demolition � , � 250 Final B�iltling/Occupancy , �. . 0 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 sel4lnsure for workers' compensalion, as provitletl for by section 3700 of the Labor Code, for ihe performance of �he vrork 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 pedormance of the work (or which this pertnit is issued. My workers' compensation Insurence carrier and policy number are: I \ T� Carrier 5�� V�4/ (Thrs seUbn nCCd�pf nbP rw�m,.p�let�ed AfNe pCrm� is7vaWed a! Me hund2tl fbllars (5100) a less.) 'PolicyNumber. OI.A_JU L--l.�— L��,� ❑ I certify that in ihe 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 lhe workers' compensation laws of California, and agree Iha� if I should be 6j t e workers' compensa[ion provisions of Section 3700 of t La r o, I sh II forth il compty with these pmvisions. / (a-27-i� AOo��canl'sSgn re Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION 70 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR4TION: 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 "�M II f e and eftect. Lic. # Class # ��/ ��' �1 '� ( ConVac�or's Signature �Date to-3l- t2 CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that there is a cons[ruction lending agency for Ihe peAortnance of the wurk for wfiich this permit is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: Oate OWNER-BUILDER DECLARATIONS: I hereby aftirm Ihat under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a permit to consiruct, alter, improve, demolish, or repair any stmcture, prior to i�s issuance, also requires the applicaN for such permit to file a signetl statement Ihat he or she is licensed pursuant to the provisions of Ihe Contractors License Law (Chapter 9(commencing wiM Section 7000) of Division 3 0( �he Business and Professions Code) or that he or she is exemp[ therefrom and the basis for Ne alleged exemption. Any violation of Sec�ion 7031.5 by any applican[ for a permit subjec[s the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as ovmer of the property, or my employees with wages as Iheir sole compensa[ion, WILL DO THE WORK, and the slrucNre is not intendetl or otfered for sale (Sec. 7044, Business and Professions Code: The Conhactors License Law does not apply to an owner of property who builds or improves lhereon, and who does such work himself or herselt or through his or her own employees, provided that such improvements are not intended or oRered (or sale. I(, however, the building or improvement is sold within one year of completion, the owner-builder will have Ihe burden of proving that he or she did not build or improve for purpose o( sale.). ❑ I, as owner of ihe property, am EXCWSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS [o consWct the project (Sec. 7044, Business and Professions Code: The contractws License Law dces not apply m an ovmer of pmperty who builds or improves ihereon. and who contracis for such prqect with a confractw�s) license pursuant Io the Conlractors License LawsJ- ❑ I am exempt under sec. Business and Professions Code for this reason: 3057-46(3/0]) Owner ID ve�i(ied 6y drive� .. ,�cense. ❑ Ves ❑ No Driver's License No. Ezpires: Verifcation of Ownership by (type of document, i.e. - pmperty tax biil or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I here6y certify that no excavation fve (5) or more feet in depth into which a person is required to descend, will be made in connec[ion with work au�honzed by this permit, and that no building stmcture, scaffolding, falsework, a demoli�ion or dismanlling thereof, will be more than thirty-six (36) fee[ high. (Chap. 32, Gry 2, Art 2, Sea 341, Title 8, Cali(ornia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from ihe Division of Industrial Safety, as noted above, unless such person has a permit to tlo such work (rom ihe division. Applicanfs SgnaWre Division o( Industnal Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applican[ or present or future building occupant need to file and certify a Business Plan for emergency response lo release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be fled with [he Costa Mesa Fire Depariment by every business which has at any one time during a reported year a quantity of hazartlous materials equal to or grea[er ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaNre and pressure). 2 Does or will the applicant or present or future building occupanl need to file a registretion form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of Ihe Califomia Health and Safety Code, with some exceptions, requires registration with the Cos�a Mesa Fire Department 6y each business which at any one [ime has on hand a quantiry of acutely hazardous materials equal to or greater than a weiqht of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicanl or present or future 6uiltling occupant neetl to prepare an RMPP (Risk Management and Prevention Program /or acutely hazardous ma�erials)? ❑ Yes ❑ No (Section 25534 of [he California Health antl Safety Code provitles that the Costa Mesa Fire Department may require the preparation, certification and fling with the Fire Department of an RMPP by businesses which are required to register aculely hazardous materials with the Fire Deparlment. 4. If an RMPP is presently required, has Section 25534 0( Ihe California Health antl Safety Code been fully complied wi�h? ❑ Ves ❑ No 5. �oes or will Ihe aDPlicanl or present or future building occupant require for lhe work which is the subject of this application a permit (or such cons[mction or motlifcation from the South Coast Air Quality Management Districl or from any other air polWtion coNrol tlistric[ or a9ency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires thal �he requested infortnation Oe fumishetl on applications fa non-residential building permits). 6. Will any part of the facility to be constructed untler ihis permi� be within 1000 feet fmm !he outer boundaries of a school? ❑ Yes ❑ No Qf'yes", �he facility must meet the requirement of Sections 25534 and 42303 of ihe California Heal�h and Safety Code). 7. If a permit from lhe Soulh Coast Air Quality Management District or olher air pollution control district or agency is requiretl (or the work which is Ihe subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Ves ❑ No 8. Qf 'yes", attach certificate o( compliance Gom Ihe appropriale air pollu[ion control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree �o comply w�th all state laws antl city ordinances regarding Hazardous Materials and Emissions. SlgnaWre Daie CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty o( perjury lhat I have read �his application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to builtling conswction, antl authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. i agree not ro occupy or allow occupancy of any building authoriz� y� it until fnal inspection. Si nai e fL gat wner(s) Da�en � �L�' �� Antl�orAuthorize� OPlicant Date 4 Prescriptive Certificat Resideniiu/ Alierreti�nze of Comn��ance: Residential � CF-IR-ALT (YaQe 1 oS 5) iimate Zone N Q N of Stories -s � • . v. � ._� � . � � nneaue Surl�ace D0ta115 ror tf�e f�rred pm•tioned of Mass Walls see Furrin� Strips Constructiun Table beloe•. � A I +� I � Pro oseds��rvo�� Framing Tag/ Assembly Name Material ID� orTy e� andSize1 No�c: Fw�(uri�edassembLee, accouniingforCm� D � � � R � G � H... .� _ .�. , � Stnndard Values From JA4 Table kness, Framed Continuous JA4 cing, U- �r]A4 Table Caviry �nsuiation Assembly see Pnge JA4-3 mvd Equaiiai use 1. For TngllD indica�e the identifica7ion name thai mntches the building plans. 1. Lvdica�e �he Assem6lr Nume or rype: Roo(/Ceiling, Walls, Fioors, Slaba�, Craw1 Space, Doors and e�c...lndicate lhe Frame rype and Size: Fm� Wood, Meml, Metal Buildinga�, Mass, en�er 3z4, ?xb, m� etc... see JA4 jor o�herpossible f"ame tyye assen;blies. 3. En�er Uie thichness for mass' in inches or' Spacing 6etweeri framing members en�er; 16 "or 24 "OC; or O(herfm� al! other assembly descriplimi such as Cnncrete Sandwicli Panel, Spundrel Pane7, Logs, SrraH� Bale Pane! and e�c.'.., !\- ,,� 4. BuseAon die C(ima�e Zane; en�er the S�andard U facior fi�om Table I51-li, C or D for eaclv differeni assemblp Name m� rype. ' 5. Emer �he Table num6er U�o/ closelp resem6les dve proposed oaa�emblr. G. L•rner ihe R-naluc tha� is Leing ins9ulled in the wall cavirr or Leiween die f�aming; a�her�vise, en�er "0 ". 7. L•nler Ihe Cavinunu.c /nsidatimi R-ialue (or Ihe proposed ossembl��; olherryvise, eiaer "0". b'. Lmer tlre row and colunm o(dve U facior valuc based mv Calurnn FTable Num6er and emer the Assemblt� U-fucior in Colunvi J J. Tlve Propaserl da�e�emb(r U-(ucimt Colunn� .l, n:usi be eqiml �o or lesa ihmi die Standnrd U fuc�or in Column E �o compl��. Fun'inF Strips Construction Table for Mass W alls Only � A IS C ll � F G H 1 J I< L M Prupused Yruperlies nf Masonry• and Cuucre[c Added In[erior or Ex[eriur Insulatiun W:JIs Rrum Reference in Rurring Space irom Reference Juint A endix'i'ablc 4.3.5, 4.3.G. 4.3.7 Joint A endix 9'ablc 4.3.13 U ✓G V 1 � U u� ti O, '^ L 2' J ti Asscmbly �. � � �° �- �' c m,�� , _ Final Mass Nume or JHQ Tablr ti_ � 'v u= F F o 't N o- �— ASsembl Thickness� l' c' Number' �� c � `'r �? C � � rt �J-faCtol'�� Commen� I I Xegi.rn�ulinn Nunvbe�r Reyi,sn'�tion Dafe/Time: IiGI1S Prowdei�' 200b' Res[denliul Conapliunce Forma� fiugtt.s! 2009 1 Of Residential CF-IR-ALT 'Lonc #� � �# of Stories .� r ROOrING PRODUCTS (COOL ROOFS) §I51(p!2 WHe�i �he areu q(nx�criar rnof surfare m be replaced rxceed.r iaorc lhan 50% of the existing rnnja'ren, or �eore�fdmi I,ObQ f�, rvhichever is less, Nie ne�n ronfing area niusl wee� N�e roa�ng praduct "CnolRoof'requiremenrs of§I52(bJIHi, 152(bJlHti, or 152(AJ]Hiii. . Check applicaGle alterwrttive nr ecception GefoH� if 1he rnof aLera�ion ir ezempi fi•om �he roofing produer "Cool Roof" reyuirements: Note: l/'ony one of ihe alternativea� or excep�ion Ge(a�+� i.s checked, �he dged Snlar ReJlecmnm and Thermal Emi�mnce requiremen�s jor roofing praducls in ,�'ll8(i) are noi applicab(e. Do na,ft(! m6le belom. ❑ Cool 2oofs Not Required in Climate Zones 1-12, 14, anA 16 with a Low Sioped. Less or2:12 pitch. `S�Gool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Itoofs (pitch greater than 2:12) and product unit weight less �han 516/ft�. Alternatives tn §152(b)1Hi and §152(b)Hii, Steep-slape roof (pitcl� > 2:72) � ❑ lnsulation wilh a thermal resistance of at least 0.85 hrfl��°F/Bh� or at least a 3/4 inch air-space is added ro[he rooFdeck over an ariic; or ❑ Existing ducts in the attic are insulated and sealed according m§151(�10; or ❑ In climate zones I Q 12 and 13, with 1 ft.of free ventilation area of apic ventilntion for every I50 ftZ of attic floor areu, and where al Icast 30 pement of the free ventilation azea is wilhin 2 feet vertical distancc of the roof ridge; or ❑ Building has at least R30 ceiling insulation; or ❑ Building has radiant hazrier in [he attic meeting the requiremenu of §I51(�2; or ❑ Building has no ducts in the attic; or � In climare zones I Q I 1, l3 and 14, R-3 or greater roof deck insulation above vented attic. Ezception to §I52(b)1Hiii, Low-slope roof (pitdr <2:12) ❑ Building has no ductt in the attic. Other Exceptions .❑ Roofing area covered by building integrated; phorovoltaic panels and solar thertnal panels are exempt from the helow Cool Roof criteria. . � Roof consimetions that have thermal mass over Ihe roof inembrane with at least 25 Ib/ft is exem t from the below Cool Roof criteria. - Note: If no CRI2C-1 label is available, this compliance method cannot be used, use [he Performance Approach ro show compliance, otherwise, Check the a licable box below if Exem t from the Roofin Products "Cool Roof' Re uirement: RoofSlope Product Weighi Product Aged Solar Thermal � CRRC Pmduct ID TJumber� < 2:12 > 2:12 < SIb/fr' > 516/ft� T e' Reflectance3'd Emittance SRIS 27 ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ �4 ❑ ❑ ❑ ❑ �4 ❑ ❑ ❑ ❑ ❑4 I. 7'he CRRCYraduci ID Nun�ber can be obmined fi�am die Cool Boof Ra�ing Couttci!'s Raied Producl Direcmp� a! wwm.coolraafa.are/nroduc�s/search.nhn 1. ludico�e !he ry/ie of produce is Geing trsed,(nr tl�e roof mp, i.e. single-ply roof asphall roaf, welal roof, elc. ./f flte Aged Re/!ec/mrce i.e nol availaLle iitlhe Coo! RoojRaling Cmmcills Raled Produc( Direcmry� Ihen use Ihe7ni(ia( HeJ/eclmme vafue j'om Ihe sanm dir'ec�or�� and use U�e equq�ion /0.2+p.7(P;rrn�nl— 0.2) io ohmiu n calculaied aged valne. WGere p is �he /nilial Solar ReJlecmnce. 4. Check Loa iflhe dged ReQeclmice ia' n culc�Joled value using !hc equation above. 5. Calcidaie U�e SRI value Lr using Uie SR!- Workaheei ai hnp�/hvnni� enerm�.ca.¢nv/(illc24/and emer �he resul�ing volue iri dre SRI Column above and ailach acop)' af llie SRl- INorksheer lo tl�e CFJR. To apply Liquid Pield Applied Coatings, the coating must be applied across lhe entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performanee requirements lis[ed in § 118(i)4. Select the applicable coating: ❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other Regisfrution Number: Regisnntian Daie/Time: FIEXSProvider: 2008 Residential Compliance Fnrms � August 2009 CerYiiicate nf -] 32-ALT Residentitd.4lterntirnvs � (PaF�e � uf YrnjeGlVi�me: ��_ ClsA1��u I,Climatr'Lunc� ^ � t;ufitnrie: �v ��.�.cl_77 1��i HL�'RS V�R1F7 CATIOI� SUMIIIARY The enlorcemen� ngenc.�-should yq�� syeciul �iiremiai io 7he HE/iS Measw�e.x specified in this chec/dis� belon� fl compleied tmd signed CF-41( Form.for n11 �hc rnenaure.r specilied sh�Jl Le submived w ii¢� building inapeclor befm�e Jmul DIICl Sed�lfle 6; ��B6iillp HG/tSverfjicnlim� Fsrequn-ed%w'fhi.� mcnsure. � ❑ 7'�'-S ❑ NO 1'I�,S: lu Climate 2ones ^ and 9-I G, if more [ha�i 4D linear feel of new or replecemenl clucis tu-e instEilled in uncondiiiuned - space, the ducts aix �o be se.ded per y15"l(b)1Dii and Oie newdy iusmlled ducts are tu he insulalecl pei { I51(1'll b. ❑ LaC�I'TIOK: Lxisfing duct srstems tlml are extended; whicli xre cuustrucxed, insul�ucd ar sealecl witli nsbestos. ❑�'�S ❑ NO 1'LS: ]n Climate `Lones 2 nnd )-16, if the existinE space-conditioning system (HVAC equipmeni and duciingj is repluced, the � ducts are to be sealed per (iS2(b)7Di. � ❑ Y�S ❑ NO ]'�S: ]u Climate Zones 2 and 5J G, if the existiug HVAC equipmenl is repluced (including tlie replacemeN of t6e air handler; � outdoor condensing unii of n splii system, cooling or he�ting coil, o+ the furnece heat exchaoger) tlie ducts are to be sealedpei §152(b)IE. ❑ E�CEPTIOR: Ducr spstems that are documenteJ tu Lave been previ�uslt• sealed eonfirmetl thruugl� HLI2S - verificatiou in accurdance with procedures in the Referenee Residential Appendix P�A3. � �� D�7iCEPTJON: buct systema }vith less than 40 Iinear teet in unconditiuned space. . . ❑�XC�PT10�: Existine duct svstems constructed, insulated or sealed with asbestos. RefrtgeranY Charge - Split S1�stem HERS veri�icatiwv ir requirecJ,for �hi,r measurc. ❑ YES ❑ NO Y�S: ln Clima[e Zones 2 and 5-15, when the existing 1-IVAC equipmeN is replaced (including the replacemen� of the air handler, onidoor condensing uni� of a spJi� system A/C or l�eat pump, cooling or 6eaiing coil; or the furnace hea� Central Fan Inteerated (CFI) Ventilation SYstem and Fan Vr'att Draw The ventilation renuirements oT F I50(o) do not anolv tn existine residential homes. Ducted Splii Systems - Air Conditioners and Heat Pvmps; Airflorr HER:S veriJica+ion is regun�ed jor thia� measure. ❑ 1'LS ❑ N 0 YES: ln Climate Zones 1 U through 15, wl�en the existiog space-conditioning sysiem (,H VAC equipment and ductine) i5 replaced. the eirflow and ian watt draw shall be verified ner §152(b)1 Ci to meet the renuiremencs of & ti 1(�7B. Address: � � n � .J Declaration Statement documentetion is accurate � � 2� �� ❑ CEA or � CEPE �r '�' ' '�- Responsible I3uilding ])esigner's Leclaratiur, Statement � �] um eligiblc under Division 3 of ihe Culifornia Business ancl 1'rofessions Code tn xecepi responsibiliq- tor the building design identified on thls CerliLcole of Complianec. • ] cenify thai the energy fea�ures and pertormanec specificatiorc: 1or the building de;sigu identified on this CeniLcate of Compliance confonn tu [hc requircmenls oTTiqc 24, Par�s 1�md G of tlre Culifornia Cnde of Regula�ion:;. • Thc building desi@n features idemiGed on thie. CerliLcate nf Coinpliuncc arc consisienl wilh thc inlonnation pravided tu ducumem thi:�, 6uilding design on th� olher ;ipplic;ible cumpliunce fonns, worlshee�s, calcula�ions, plan:; anJ specificatiom: submilted la lhe enti�rceineni aeenc�� fm annruv�il with thls buildin� nermii aunlicution. Ntinte. ��ontDtlnl': Signawre: TJate: Phmle: Tnr aatsisumcc rn� que�vtirnts regardin� ihc Lnerg�• Suuidard.t�, cnnt�ec! 11ic Lnerg' Notlinc tu: 7-XO(1_i i2-i300. Icegie�i�enian h4unber: /tegi.ru�mion Luie/Time: HEI;S I'rm�icier: 200f,' 1(es�dential Coi�zpliaiecc Fnrnrs �lug�erl 3(10% (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626 JobAddress: 3205 NEBRASKA PL Suite No Viciniry: Parcel Number: 13908219 Applicant CLENNEY, CARLA Address: 12922 HARBOR BL GARDEN GROVE, CA Owner: CISNEROS, VICTOR Address: 3205 NEBRASKA PL COSTA MESA, CA � Contractor: EMPIRE PLUMBING Address: 12922 HARBOR BL GARDEN GROVE, CA MECHANICAL PERMIT Status: ISSUED Applied: 11/13/2002 Issued: 11/13/2002 ISSUED BY: � Phone: 714-530-7320 Zip: 92840 Phone: Zip: 92626-2217 Phone: 714-530-7320 Zip: 92840 License: 794154 SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 VENT FAN/SINGLE DUCT. ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Healer $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.25 so.ao $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 FEE SUMMARY Repair I Alt Absorbtion Unit Repair / Alt Refngeratlon Unit Ventillation System Evaporative Cooler CommerGal In cinerator Domestic Incineretor Compressors / Absorption Svstems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES Quantity $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $30.75 NO710E: The work authonzed by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this Dermit to be considered 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 result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2946i8I6/00) WORKERS' COMPENSATION DECLARATION: t� � I heraby eflirtn unOer penelry ot perjury one of t�e following declarations: ❑ I heve end will malntein a cenllicate of consent to selt-Insure for workers' compensetion, es provitletl tor by sectlon 3700 of ihe Lebor Code, lor Ihe peAortnence of the work for which It+�s permit is issued. i%I have entl wlll maintain workers' compensation insuranca, as required by sectlon 3700 of Ihe LeDor Code, for the peAortnance ot ihe work for whlch Nis p0�nit Is issued. My workers' compensation 1 surance carrier and p/o*liry numbe( are: /��/,/ � / Certler:%��1 n.h 1�[ ��rQrI,CR� (� o.F JJ . Y. Poliry.Number. � P IO —/ /'] "j ;4TAissec6on need not be comp/eted i! Ne pertni[ is valued at ane huntl e�00J oNess.) ❑ I ceriity ihat in ihe peAormance of Ihe work for which Ihis permit is issue0, I shell not employ eny Dereon in eny manner so as to become subject to the workere' compensellon lews of California, end egrae that it 1 shoultl become sub�oct to Ihe workers' compensallon pmvislons of Section 3700 of the Labor Code, I shall torthwllh comply with ihese provisions, /y �A�pp�lic��em'Sign�_ture: � v C' �Ds��-� �, I� �� 7� fWAiiNINO.`FAILURE TO SECURE WORKERS' COMPENSATION CA GE IS UNL4WFUL AND SHALL SUBJECT M! EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE MUNDqED TIqUSANDDOUARE(St�.�),INA�DIiIIXJTOTHECOSTOFC ENSATIIXJ,DAM4GESASPROVIDEDFOliINSECilON3]WOFTHELABORWDE,INTEREST,ANDAITORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: of Chapter 9(commencing with Section 7000) ol Dlvislon 3 oLhe Business antl Prc CClass p._1 �� /.,,..�r _ n�m. //— /� .- CONSTRUCTION LENDING AGENCY: — ❑ I hereby altirm ihat ihere is e construction lending agency for the pedormenca ot the work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lentler's Neme: Lender's Adtlress: Signature: Oate: OWNER-BUILDER DBCLARA710NS: I hereby ettirm thet under penalty of perjury t�at I am E%EMPT FROM THE CONTRACTORS LICENSE �AW tor the followinq reason (Sec. 7031.5, Business entl Professions Go�e: Any city or counry which requires a permil to consirucL alter, improve, demollsh, or repair any siructure, prior to its issuance, also requires the applicant ior such permit ta tile a signetl stalem�nl Ihat he ar she Is Ilcensed pursuenl to Ihe provisions ol Ihe Contrectors License Law (Chapier 9(commencing with Section 7000) of Divislon 3 0l t�e Business and Prolessions Code) or Ihet he or she is enempt therefrom entl the �esis for Ihe ellegea exemption. Any Noletion of Section 7037.5 by any epplicent for a pertnit subjects Ihe apPlicent W e civil penalry of not more Ihan �ive huntlred dollars ($500)J: ❑ I, es owner ol ihe pmperty, or my employees with wages as their sole compensation, WILL DO TT1E WORK, and Ihe strucWre is not intendetl or ofleretl for sale (Sec. 7044, Business antl Professions Code: Tha Contractors License Ww does not apply to en owner ot properry who builds or improves Ihereon, antl who tloes such work himsell or herself o� through his or her own employaes, provided �hat such improvements ere not Intentletl or offered for sala. If, howaver, the building or improvement is soltl within one year of completion, the owner-buiider will heve the bmden of proving that he or she did not builtl or improve tor purpose of sele.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe projact (Sec. 7044, Business and Profeasions Cotle: The coniractors License Law does not epply to en owner ot propeny who bulltls or Impmves ihereon, antl who contracts for such pmject wit� e coniractor(s) license pursuant to the Comrecrors License Laws.). ❑ I am e:empt unda� sec. Siqnature: Owner ID venfied by dr��ers license. ❑ Ves Veritication of OwnersPip by (typa af document, i.e. Business end ProfeSsions Cotle lor thi5 reeson: ❑ No Drivels License No. pmperty tez bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: Date: Expires: ❑ I hereby certity thel no excavetion five (5) or mora �eet in depih into which e person is requiretl to tlescend, will ba matle in connection with work authoAzetl by this permi�, en0 ihat no building strucWra, scaHoltling, falsework, or demolition or tlismantling ihereof, will be more Ihen thirTy-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 3d1, Title 8, CeIIlPrnla AdmInlSlreiive Code). ❑ As owner-bulltler. � will not employ anyone to do work which woultl requlre e Oermit Irom the DiNsion ot Indusirial Satery, es noted ebave, unless such person has e permii Io do such work irom the divisian. Signeture: Date: Division at Indusirial SB�ery Permit Number: CERTFICATE OF COMPLIANCE AND AU7HORIZA710N OF ENTRV: 1 certify under penalry ot perlury iha� 1 have read ihi5 epplication and steta �hat the Informetion given is correct. I agree to comply with ell sta�e lews ena ciry ordinances relating to bullding construction, end euthonze representatives of the Gry of Costa Mese�m enter upon the above-descnbed prope�y �or inspection purpwes. I egree not to acupy or allow occupency ot eny building eutharized by this permit until tinel insDedion. COOEI, INSPECTIONTYPfi 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rool 201 Final BIocWRe�aining Wall 202 Final Factory Fire Placa 203 Finel Slgn 204 Final Demoliti0n pdg �g yypE� ixsrecnonr,ve 208 Final Mechanical 208 Flnal Plumbing 210 Final Elecirical 212 Flnai Flre Prevention 220 222 250 Final Planning Approval Final Site Final Building/Occupancy PAIF QIt�wtELfl N115/0� � �or 23 - TRACT 3�25 � g�� C057A MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 GOBTA MEBA. CALIFORNIA For Applieont fo Fill In Complefely TYPE �R PRINT BUiLotN� 3205 NEBRASKA PLACE ADDRE66 COSTA MESA. CALIFORNIA bWNErt KENKOL CONSTRUCTION C0. MA�� 555 PLqC�NTIA AVENUE ADDRESS c1TY � NEWPORT BEACH No�I 6-�Zi K.W. Ko�� CONTRACTOR ADDRESS � 5 PLACENTIA AVENUE C�,n, NEWPORT BEACH� CALIF. • STATE 6�i95 No: Mi 6-322� uc. No. 6iZE 8O X 7O IRREG I NO. OP B1D08. 0 OF L�T wow �u i m BUILDING zoHe I� I�'� �I" � "�1"I _`� ��tl.. ��yJ �J 1'�II f��. J,' �-i3-N� �11�14�(;'¢ L�� APPLICATION POR'PERMtT ^� � r,nv ur t,uo�:, �-.E�. BUILDING For Office Use Only NlCEIPT NO. PlRMIT NO. COSTA MESA. CALIFORNIA ZONING NO.OP � I_U9E OP NEw ruxe /�"euauwc . {}p¢gTM ZO � REAR YARD 27 t �uMCP LINe BT.1 FRONT t t I LEFT ,� RIGHT , 0 R. SIDE DESCRIPTION OF WORK I X II .. __�._,,.., I II . ��._...,, � L. SIDE BIIILDING i6� �.'7 SF NO. OF 6 - � 812H I ROOMS 6TORIES PJ[TERIOR WALI�TUCCO ICOVERRGCK COVERING USE OF BUILDING AND WORK TO BE PERFORMED NGLE- AM LY ES DENLE AND ATTACHED GARAGE PLAN �-H II HEPBBY ACNNOWLHOO¢ THAT I XA 8 RBAD TH�B MP4GT�ON AND BTAT6 THAT sN6�7e OV6 IB C 6R ANO ORHH TO COM- PLY WITH ALL flfSV\O�ay,NANC¢9 � 8}�RHOULATNO BUII,DINO CONbrnucYiol�. !r-�f 1 AU7HORIZED s_ii TX6 �MOUM 6HOWN UNDEH VALUATION 18 FOR TN¢ POPPOBH OP FBTABLIBNING A PBpMIT PEH ONU'. VALUATION � / — PERMIT FEE $ �� N $ / J�/� PLAN CHECK $ /�� F rc TOTAL FEE �— � n