HomeMy WebLinkAbout3327 NEVADA AVE - Building Permits�-- .� CITY OF COSTA MESA
4�• pMFq BUILDING DIVISION
F, �p 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
° „L,•x�•, g FOR INSPECTIONS CALL: (714) 754-5626
a`�Po� fi
PERMIT NUMBER: B10-00087
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 13957229 DATE ISSUED: 04/O6/2010
ISSUED BY: RMD
JOB ADDRESS: 3327 NEVADA AV CM
Vicinity: FLAT AREA ONLY � � " _ - �
Suite/Unit:.
Squares: 900 �- � � - �� � ` . Valuation: � $2,985.00
SCOPE OF WORK: PARTIAC REROOF OF FLAT AREA ONLY. TEAR OFF EXISTING MATERIALS, INSTALL NEW 2-PLY MODIFIED
BITUMEN BY GAF ON FLAT ROOF ONLY, APPROS 900SF. REPAIR AND REPLACE SHEATHING AS NEEDED.
COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. �, � �
OWNER: DUNHAM GREGORY S/MC�NAB CAROLINE A� Address: 3327 NEVADA AVE � Unit:
PHONE: 714-546-7842 - ' . , - -CitylState/Zip: COSTA MESA, CA � . ,
APPLICANT: HAMMARSTROM,HAKAN
PHONE: 800-655-2231 ,
CONTRACTOR: ABSOLUT ROOFING INC
Address: 18903 SAN CARLOS STUnit: �
City/State/Zip: FOUNTAIN VALLEY, CA . 92708 �
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
Address: 18903 SAN CARLOS ST � - � Unit: :
City/State/Zip: FOUNTAIN VALLEY, CA
License No. � 761118
PHONE: � � . 800-655•2231� - �
CELL:
- License No.
. License No. �� �
$o.00
$8325
$0.00
$1.00 - � � . �
cc, ec . . - , �
PHONE:
PHONE:
r�v�.��v���+ vii i� cerro�cviv-r�.r�a.mrvw.�c�,. irua
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Suntlays and the following Federal
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksoivino Dav and Christmas Dav
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 fnal approval will result in the expiretion of this permit.
LOUE t. INSPECTION TYPE DATE INTTIRLS WOE i INSPECTION TYPE DAIE IN1111AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof y-(�,�O�y�_�� 210 Final Elecirical
201 Final BIocWRetaining W all 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSqTION DECLARATION:
I hereby affirm under penalty of perjury one of Ihe following declarations:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as provided for by sec[ion 3700 of Ihe Labor Code, (or the
performance of the work /or which this permit is issued.
� I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the perfortnance of the work for which this
permit is issued. My wqrkers' compensation Insurance carrier and policy
number are: /
Camer:..�%1' 961ii�
(Th5 section need irort be cpmpleted Athe permd is valued at one hundred cbllars ($100) oi less J
P,olicy Number: � J ��� �
❑ I certity [hat 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 [he workers' compensation laws of California, and agree that i( I shoutd
become subject to the w rkers' compensation provisions o( Section 3700 of
the r tle hall f thwith comply wi[h these provisions.
L/' �o' �(%
Sig�aWre �pate
t--�..
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SEC710N 3706 OF THE LABOR CODE, I�fTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby affrm that I am licensed under provisions of Chap�er 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in (ull force and effecl. �^��
Lic^tku.�.�. CI�sN.#
l/ Q Li � �o - id
� GonVactofs °ignaWre �Date'
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a construction lending agency for the
peAortnance oi the wnrk f�r which �his permit is issued. (Sec. 3097, Civii Code).
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby affrm Ihat under penalry of perjury Ihat I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 703L5,
Business and Professions Code: Any city or county which requires a permit to
construct, al[er, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signetl statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chap�er 9(commencin9 with Section 7000) of Division 3 of the
Business and Protessioqs Code) or tha[ he or she is exempt therefrom and
[he basis for [he alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant m a civil penalty of not more than
fve hundred tlollars ($S00).):
❑ I, as owner of Ihe property, or my employees wi[h wages as [heir sole
compensation, WILL DQ THE WORK, and the structure is not intended or
offered for sale (Sec. 70qq, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or ihrough his or her own
employees, provided that such improvements are not intended o� offered for
sale. If, however, the huilding or improvement is sold within one year of
comple[ion, the owner-builder will have [he burden of proving [hat he or she
tlid not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct ihe 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 con[racts for such project wilh
a contracta(s) license pursuant tothe Contractors License Laws.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-46�3/0])
Owner ID verifietl by drivc. .. iicense. ❑ Yes ❑ No —
r ,
Driver's License No. Expires: �
Verification o! Ownership by (type of document, 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 authonzed
by �his pertnit, and that no building s[ructure, scaffolding, falsework, a demolilion
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-6uilder, I will not employ anyone [o 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 Ihe division.
Apphcanfs SignaWre
Division of IndUstrial Safety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or presen[ or future 6uilding occupant need [o fle and
certify a Business Plan for emergency response to release or threatened
release ot a hazardous material? ❑ Yes ❑ No
(Section 25505 0( Ihe California Health and Safety Cotle requires, with some
exceptions, lha[ a Business Plan be fled with the Costa Mesa Fire
Departmen[ 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
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 applican[ or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Heal[h and Safety Code, wi[h some
ezceptions, requires regis[ration with the Costa Mesa Fire Department by
each business which a[ any one time has on hantl a quantity of acutely
hazardous materials equal to or greater [han a weight of 500 pounds, or a
votume ot 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or fuNre buiiding occupant need to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation antl
fling with ihe Fire Department of an RMPP by businesses which are required
to register aw[ely hazardous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the California
Health antl Safe[y Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is �he subject of this applica[ion a permit for such constmction
or modifcation from the South Coast Air Quality Management District or fmm
any other air polWtion contml district or agency? ❑ Ves ❑ No
(Sec[bn 658502 of [he California Govemment Cotle requires tha[ the requestetl
information be (umished on applications for non-residential building permits).
6. Will any part of the facility to be constructetl untler this permit be wi[hin
1000 fee[ 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 Sa(ety Code).
7. If a permit from the Sou[h Coast Air Quality Management Dis[ric[ or other
air pollution conlrol dis[ric[ or agency is required for the work which is the
subject ot this application, have all ot the disclosures prescribed by Califomia
Health and Safety Code Section 42303 6een made? ❑ Yes ❑ No
8. (If'yes", attach certi(icate o( compliance from the appropdate air polWtion
conVol officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given ahove is correcc I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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 correcL I agree to comply with all state laws and city
ordinances relating to building constmction, and authorize representatives ot
the City of Costa Mesa to enter upon Ihe above-described property (or
inspection purposes. I agree no[ to occupy or allow occupancy o( any building
authorized by [his permit untfl final inspecfion.
aWre gal Owne '� �^ D�/D
6
C1Cn�A�(M1onxetl'Appl Iranl Oa�e
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vc Cerfificatc u1' ComPlian
l Aheratin�es
Ih'oject
Ccneral I�dornmtia�
Sitc AdArexz: •ZZ
Building Type �Single Pumily ❑ Multi Family
Conditioned Ploor Aren (CFA). � �OW
ia nn� rn he uxetllin� Ncrvli� Cnnstruacd
Agencl':
Circle the FroN
cr-i a-w�T
(Parc 7 uT 5)
Clim:nc Zune � � q uf Stnrics
�
�/� �-)0
, S, W, or degrees
Yrojeci Type: ❑ Alierations O Envelope O Fenesvation �(I ltoof [
Replacemem or Chanee Om ❑ Duci Repiacemem ❑ N'ater Heaier
rilAines nr fl dditionx
ln.euln(imi V�dur.e� Fm� Oparpic S7ir/i�ces (/or Furring uxe �he Mass und Furring Srrips Consn�n�aior� �uGfe befoHJ
Assemhh' Altcrntian
D Opening nf frnmed cavi�p nlune-A6erarions dmi involre ihe openino of �hef�a„�ed�avu,� ofo wull, reiling, orf7oor mus! irumll �hr.
mnnduinrr minimvm insviniinrr vnhie per §I50 (or lhe a6ered assembl��. Fill in Coh�mns A-C mid emer mandamm insula/ion value in Cofumn H.
❑ Replacement of entire assemblp-Replocement ofun emire ival(, ceiline, m� flnor assemblp re9uires the ins7alla(ion ofCompo�tenl
1'ucknce- D ins�dntion values in TaLle I51-C. Fil/ in Coh�mns A-J. .
�
veLa1�5 Rur t6c furrcd
Assembly N�me
of Mass N�alls see Furrin� Svips Construction Ta61e belnH'.
C 1 r I C H I
Framiug Thickness, rrnmetl
Material Spacing, U- 7A4Table Cavity
and SizeZ or Other� facmr" Numbers R-valUe
Foi;jrr'r'ed nssemGlies, accounling for Cavtinuaus Insulafian 2-value, see
]nsulation I Assembly
n .,_�__� �_�� .,_�__
use
1. For TQg/!D indicate the identificaiim� name tha� matches the building plana�.
2. Indicaie �he Assembh� Nume m� rype: Rooj/Ceiling, 4i''alls, Floora�, Slabs, Crawl Space, Doors and e�c...lndicate ehe Frame type and Size: For
Wood, Metul, Meta/ ➢ui/di+igs, Masa', enter' 2z4, 2x6, m� e�c... see JA4 (or o�her possible {'ame t�/�e ossemGlies.
3. Erver 1Re d�iclmess for muss' in inche.r m� Spacine between {'arning members en(er; 16'br 24 "OC; or Olher for al! odie�� assembl�+ des'criplion
a'uch as Cnncretc SandwicH Pane(, Spandre! Punel, Logs, Strae� Bale Panel a�d e�c.... .
4. Based a� lhe Giniale Zone; enter lhe Standa�d U-jac�a� fi�om Table I51-B, C or D fm� eacG d�erem assembl�� Nmne or rype.
5. Emer d�e Tahle mm�ber lhat closelr r'esernble.s �lie yroposed asa'embh�.
G. L' IllG'!' II�C X-vdIUL' UtPI I.e I�L•111�+ IIIS[GIICCIII] iHC w4II Cq1+ItY or Le�ween the (�aming; othe�wise, emer "0 ".
7. Enrer ihe Comi»uous Ine�nla�iou R-,�aluc jm� �he yropased ussembl,p; atherzvLse, enter "0 ".
8'. Enier Ihe row m�d cnlunm of �he U focior value based mr Column F Table Number and en�er !he Asa�em61�� U foc�or in Column J
I. The Propn.red dssemLlr U faclor', Column ./, nms! be equa! fo or less thun rhe Sfanrtard U-fucmr in Coh�nm E �o camph�.
Furring Strips Construciion Table for Mass Walls Only
A It C D C F G H 1 :1 IC I, M
I'rapused 1'ropertirs of Mnsonry �nd Cnnm�etc Added Interim� or Cxterior Insulutiun
W;�IIs �rom Iteference in Turring Sp:�ce frum Referenee
Juinl A i�cudin 91�b1e 43.5. 4.3.G. 43.7 Joinl A� mndix Tablc 43.13
V V� u 1 � — V
V �', GG
v� {F G C � ' r�i�i
r;���i
Aszcmbly �' '� �.` 'R ~ o� 011� q c' � �.=. ��
Mass Namcor JA47able Q= � � E E o '� � o� ` � nssemb�y
'lhickness' 7' c' Numbei3 4�F - _ �; =' � � 5 •= c `` � m r Uductoi�'� CommeN
I � I I ! !
ltcgi.sirulinn N'unvber: Kegistralian Uuie/Time: HEIt.S 1'rnvider:
200d' Residential Contp(iunce Form.s dugu.t�t 200y
�
Resirlenlia( Alteration+
33 2'� N�,tIADA /��/G
CF-1 R-ALT
# of Sluries_
1tOO�INC PRODUCTS (COOL ROOI�S) §15](n12
WGeu U+c aren ojci[erior rnof surJace tn Gc replaced ucecd.e �uorc tlmn 50% nJ�he rxisting ronjaren, or rnorc �han /,000 j�, ivlricl�ever is'
Irss, tdc nerv roofing aren nuc�T n�ee� Uac rnnfing produc� "Cool Rnnf'requireu�en�e' oj§152(b)lHi, /51(b)1Hii, nr ]52(b)IHiii.
Check applicaGle a6erimtive or caceptiou befow if �he roojalreration is exempr jrom �he roafing produc� "Coo! Roof' requiremen7s. Note: /jany
one of dm ullerna(ives or ezception belom i.e checked, Ihe Aged Solur ReJlectance and ThermalGmi(mnce requirements jor roofing produc�.s in
§J /8(i) ara no1 �ppficab(e. Uu no� jill(able belnw.
�Cool Roofs Not RequimA in Climate Zones I-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch. ' ,
ool Roofs Not Required i�� Climate Zones I ihrough 9 and I G with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less
� Nternntives m§152(bpHi nnd §752(b)Hii, Steep-slope rooC (pitch > 2:12)
❑ Insulation with a thermal resistance of at Icast 0.85 hrftZ�°F/13tu or a[ least a 3/4 inch air-space is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed acwrding to §I51(�10; or
-- ❑� ln climate zones 10, 12 and I3, with I ft'' of free ventilation area'of attic ventilation for every 150 ft� of attic floor area, and �
where at least 30 percent of the Gee ventilation erea is within 2 feet vertical distance�of the roo(ridgr, or
❑ Building has zt least R30 ceiling insulation; or
❑ Building has radinnt bartier in [he attic meeting [he requicements of §151(�2; or
❑ Building has no ducts in Ihe attic; or
❑ In ciimate zones ] 0, 11, 13 and 14, R3 or greater roof deck insulation above vented attic.
� �zception tu §152(b)1Hiii, Low-slope roof (pr�cli 52:12)
❑ Building has no ducts in the attic. �
.� d Roofing area covered by building integrated; photovol[aic panels and solar thermal panels are exempt fmm the below Cool Roof criteria.
! ; d Roof constructions that have thertnal mass over the roof inembrane with at least 25 Ib/fl is exempt from the below Cool Roof criteria.
� Note: If no CRRGI label is ¢vailable, this compliance method canmt be used, use the Performance Approach m show compliance, otherw
Check the a licable box below if Exem t from Ihe Roofin Prodacts "Cool Roof" Re uirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Produci ID Number� < 2:12 > 2:12 < Slb/ftZ >_ Slb/ft� T e� Refleetanee�'4 Emittance :
❑ ❑ ❑ ❑ p°
�00�
�QQ�
�00�
��0�
17"
O"
�a
/Ne CKIfCYi'oducl /U Nwnber can be obininetlJrom !He Cool HoofRaling Council "s !(aled /'roducl Direcmry al �vw�n.caolr00%s.orv/nroduc�x/.seprdi.nhn
I�idicore Ihe ��gre af producr is Geing used,(or U�e rnof iop, i.e. sircgle-pl r raof, asphalr roof, nrcml rooj, erc.
/ftlm Aged ReQecim�ce i.r nol av��i/oLle iri.the Coo( RoojRaling Cmincil'e� Ra/ed Producl Uireclary 16en use Ihe Iniliul ReJlec(ancc vnlue f'oni !he snrrie
direclnq� nnd use die equniimi (01+OJ((1�����;�,�— p1) m obmir+n cn(culaled aged voluc WGere p is !he /ni(inl Solm' ReJleclmme.
Check Gna iflhe �lged /tellec�nrice is n cnlc�Ju�ed vnhm usii�g d�e eq�mlinu above.
Cnlcidole (he SR/ volue tm using Ihe SRI- Worhedreel nl hu/a�/%v�v � ei�errv en.env/(ide24/and enter Ihe resrdling oolue in !he SRI Cnhumi abnve and nl(ach aco�n� oj
d�e SRI- N'orksheei m d�e CF-1 R.
� apply Liquid Rield Applicd Cuatings, the coating must he applied across lhe entire roof surface and meet [he dry mil [hickness or coverage
commended by [he contings manufacturer and meet minimum performance requirements listed in 41 I S(i)4. Select the applicable eouting:
Aluminum-Pigmented Asphalt I2oofCoating �❑ Cement-Based RoofCoating �❑ Other
Regisu�u�ian NuinGer: 2egi.r�ru�ion Daie/Time;
2008 Kesidentiu( Compliance Forms '
HL/tS Provider:
August 2009
1'rescriptive Certificate u1' Cumplinnce: i2esidenli.il
Residential Alterntiuns
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Climste�Zonc Y�
,r-i iz-n�.T
Fa�e 5 of 5)
i; uiSturies
�
F1�R5 \'�P.IF7CAT10N SUMMAR]' The enforcemen� agencr slvmdd ya�� syecial c+nervlon ru �he HERS Neusiu�e.r speci)ierl in tivis
chec/rbs� Lalaw- fJ cauple�ed Undsigned CF-97! F�n�� for u/1 thc measurer e7>ecijied s•hc+/1 be submived ru tlie biiilding nva�pec�or befm�e Iinul
DUCI Sea11A� S 7�e5YlJle HL•KSnerificulionisreq�.�ired,fm�d�u�measnre.
❑�'�S ❑ NO 1'CS: ln Ciimate "Lo�ias 3 end 9-16, if more than 401inear feet of new or replacenteni ducts �ire installed in uneonditioued
� . space, the duc�s ure to be sealed per §752(b)1Dii �nd the newly i�stulled ducts ure to bc insulaled pe� ,(tJ 51(1110.
❑ LXCliI'T1G�: �xisting duet systems thal arr. eztended, which are cuustructed, insulated m� sealed witl� asbestus.
❑�'�S ❑ NO 1'E5: ]n Climate Zones 2 and 9J 6, if the existing spacr-conditioning system (H VAC eqtiipmem and ductingj is replaced, the
duets are to 6e sealed per §]�2(b)1 Di.
❑ PES ❑ NO ]'�S ]n Climate Zones .°, and 9-I G, if ehe e�isting HVAC equipmem is repluced (including tl�e replacemeN of� the air handler,
outduor condensing unii of n split system, eooling or heating coil, or the fiirnace heni exchan2er) the ducts are to 6e
sealed pei §]52(b)lE.
❑ E�CEPTION: Duct systems th:d are ducumented to have Leen previousle se:ded cunfirmed thruugii HGP.S
� � �� veviticatinn iir:�ccurdanco �vith prncedures in the�Reference Residenti�l Appendia 1:A3. , .
� �� ❑�XCEPTIO�': Duct systems with less Chan 4U linear feet iu uncondiPioned spxce. � .
❑�XCLPTIO�: Existim� duct sVs[ems construc[ed, insidated or,sealed with asbes[ns.
Ref'ri�pera��t Charee - Sj�lit S}'s[em HERS veriJicntion Ls reguirecl,for thLr meosm�c.
❑ Y�S ❑ NO YGS: In Climate Zones 2 and 5-15, wl�en the existing HVAC equipment is replaced (including the replacement of the air
handlei; outdoor condensine unit of a split system A/C or heat pump, cooling or ltepting coi1, or the fumace heat
exchaneeri a refri�eront charoe measurement Shzll be vetii"�ed oer Fli2(b11F.
Central Fan Intedrated (Ci+I) Ventilation S)'stem and Pa�� Watt Draw
The vemilation renuirements of FI SD(ol do not anolv tn existine residential homes.
Ducfed Split $ystems - Air Conditioners and Heai Pumps: Airflow HERS ver-ifco�ion is reguiredfor rnis mcasiire.
❑ Y�S ❑ NO 1'E5: In Climate Zones 1 U through li, when the esistine space-conditioning system (HVAC equinmenl and ductiug) is
reolaced, the aitflow and ian watt draw shall be verified oer § 152(b)1 Ci to meet the renuireinents of § I S i(fl7B.
`JT'ROV�I
Company:
/NC�,
Address.
occurnce and
�— �'
CEA or i7 CEPE
Resynnsible 73uildine Desiguer's Declaratiun Stzitemenf � "
0 1 um ell�iblo undei Lh�ision 3 af tha Culifomia Busi�ess nnd Professions Codc to accepl responsibiliq� toi lhe buildine design identiGed on
this CertiLcate of Coinpli�mce.
• 1 ccnify that the eneigy feuun�es and perlormancr specificntion:. fbr the building design identified on this Certifictim of Cmnpliance conform
to [hc requiruments ofTido 24, Pnr�s I and ( of thn Cali!'orni� Code of Re�ulations.
•'fhu building design �eaLures Idenlified on this Certiticatc of Compllunce arb eonsistenl with tho ini'orm�tlon provided to docwnenl this
buildint design on ihe other ,ipplie��bie camplianee i'orm;, warLsheets, calculations, plans uud specific�uions submil�ed w the enfbrcement
�i�eue�� for eonroval wiih thin 6uildinu nermit �iuolicution.
N�imc:
Coaioam''
kddress
Cii�s'State7Zip:
Signa�we:
I�ar tee.cisumcc ru' quesfiora,e regtu�t(in� flic L�nergp S�mulrn�d.t, cmvlacl Uu Lnta�bt' Ijatfine at: 1-b'00-i77-:i300.
kegie�trcuian IPumLer: /Cegi.svu�ion Un�e/Timc: lIEI�S' 1'roi�ider:
200E Rc.sid��ntial Cwttpliar�ce Forn�s Ai�o�us� 3009
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT N0. 6 6�J LZ-
LOT N0. //
ADDRESS � � Z � i'(.(�/ j��_�rP`
�- N%,
DATE 1 Z� L� -� Q
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
C \ n s�_
�� Lender
PqQIELTAOUXESS: 33'z7 NEVADA �ij% UNIT:
OWNEN'SNAME: SOMERS, WILLIAM ROHERT
aooxess: SOMERS HEATHER R
313 RO�INHOOD LN
COSTA MESA[, CA 92627
RNCNIENGINEEfl: �719�696-3LSH flEG.N�.:
� nooness: uNir:
�
: PENMITTEE: �7�ACIO ROOFING ( 714 ) 983-8423
' AODflE55: 67'�3 ASTER CT
�� CHINO CA 91710
UCENSEO CONTHACTOfl OECIABAT10N: I �ereby a��irm �Aa� I am IicenSeU untler pmvisions of ChaO�e� 9 I�ommencing wiih Sec�ion
70001 0l Oivision 3 of I�e Business antl Professions Cotle. antl my license is in full �orce an0 eilec�.
cinuc.: 054626 sT"TEuc.:439685 cuss: C3
Datei 3� 2� ^ 92 Signature: __ �
WOBKEHS' COMPENSATION OELLABFTION: I �ereby aifirm �hat I �ave a cenilicate ol consent to sell�insure or a certiticale ol Warkers'
Compensalion Insurance. or a certilietl copy Ihereol (Sec�ion 3800, lab. C).
eoucrxo.: 1034005-91 E%P.DRTE: Q%/zJ/9z
camPnxr: STATE FUND
� Cehi�ietl copY is hereby lumished. � Certilied copY is �iled with IAe ciry Builtling Divisian.
Oa�e: 3' 2� � / 2' ppplicanC /C��6/�Q/6'�al
E%EMVTION FflOM WOBNEBS' COMPENSATION OECIAflPiION: Rhis seqian nee0 noi be com01ete0 if �he permii is �a one �uMred (5100) or less�.
I wrlily Ihai in Ihe peAormance ot the work �or which �his permii i5 isSueU, I shall not empioy any person in any manner sa as �o become
su�lec� �o �Ae Workers' Compen5aiion Laws ol California.
Oale: Signamre:
NOTICE: II. alter making this Ueclaration, you shoultl become SuEject to Ihe Workers' Compensa�ion Owvisions af I�e Labor
Code. you mus� fonhwil� comply wi�A suc� pmvisions or Nis Dermil shall �e Oeemea revoke0.
CONSTBUCTION LENDING RGENCY: I hereby allifm ��a� Ih¢re is a tonstruttion 1¢ntling agenty lof Ihe pedofmanCe ai lhe wOrk for
which ��is permit is issuetl (Seclion 3097. Civ. C�.
LENDEN:
AUOPESS:
OWNEB BUILOEB �ECLAflRTION: I here�y alli�m Iha� I am exempl irom t�e Coniractors' Stare License Law for tAe followinp reason
�Section 7031,5 Business ana Prolessional Cotle: Any cily oi county which reQuires a De�mit to construct, aller, impmve, Jemolish, or
repair any stmcNre, prior lo ils issuance. also requires �he apolicanl for such permit to file a signed statement that he/sne is licensetl
pursuam to tAe provisions of t�e Contmctors' State License Law (Chapter 9(commencing wiU Section 7000) ol Division 3 0l ihe Business
ana Professions Cotle) or�hat he/she is exempllherelmm antl Ihe basis brthe alleged exemption. Hny violation of Section 7031.5 by
any applicant lor a permit sublecis the aDPlicant to a civil penalry oi not more than five hundre0 Oollars (5500�.
I. as owner of ihe pmpeny or my employees with wages as iheir sole compensation, wi0 do the work, and Ihe
❑ s�mcmre is not intentletl or oifered lor sale (Section 7U44, Business antl Pmiessional Code: The Comractors' State License Law
Ooes not aDVly to an owner oi a pmpeny who builJs or impmves Ihereon, and who tloes such work himself/herseli onAmugh
his or �er own emDloyees, pmvitlea ihat such impmvemems are not inlentle0 or oifered for sale. II, however the builOinA or
impmvemenl is so10 wi��in one year ol completion, the owner will have Ihe hurUen ot proving �e/she tlid noi builtl or imDmve
for ihe purpose ol sale�.
I. as owner o� the pmpeny. am exclusively conlrac�ing wit� licensed contractors to cons�mc� �he D�ole�� (Sec�ion 7044, Business
❑ antl Pm�essions Cotle: The Coniraclors' S�a�e License law tloes not appty to an owner o� O�oOeny who Uwltls o� impmves lhereon
an0 w�0 tonlratts Ior SUt� Omlect5 wi�h a ContraCloqs) litense pUrsuantlo Ihe ConiraClors' Sla�e LiCense LaW). I am awafe
��at D�ool of I�eir Worker'S Compensalion insurance shoultl �e pmvidetl �o me.
� I am exempl unGer Section�. B. 8 P. C.
lor inis reason:
Date: �wner
I Uo hereby cenily ihat I am aware ol and unUers�antl �he requiremenls of Califomia Heal�h antl Salery Cotle Seciions 25505, 25533, and
25534 antl ��at I or anV �uture builtling occuDanl willlwill nol (circle one) need lo comply wiih 5ai0 s�ale cotles antl Ihe reQuiremenls lor a
�ermit lOr conS�mclian or motldica�ian �mm Ihe Air �ualiry Managem¢n� Oislrici. Fe5i0en�ial Cons�mC�ion apDliCati0n5 are exemD� ��Om
inese D�ovisions.
Da�e: NOPlicam:
I �ereby cerlity �hat I have reatl Ihis application and slale Ihal ihe above iniormaiion is rorrecl. I agree lo comply with all city ana counry
ordinances antl s�ate laws rel�ting lo butltling conSVuction antl hereby aWhariie representa�ives oi �his city to enter upon Ihe above�mentianetl
propetly �orinspection purpases. ��
�
�ate'. � � Z-� �� Signature:
�nver's License or Sotial Seturity
t64t�a6 While—Bwltlmg�, Green—Cotle EnlorcemenP, Canary—ApplicanC Gink—Revenue; GoltlenmC—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 05670
PERMIT NO: B 056"!09 PLAN CHECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : T/O OLD, REROOF W/COMP 6 SOME 'HOT MOP' SQ FT: 9,900
CLAIM VALUE; 4,900.00 CALC—VALUE; 4,900.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME,
*****�rx�x����r�r��r�t�t*�t�r�rr�t***�e�t�t�r *�t�t�t�r*�r��r*��t�r***�r**�e�t*�t*****+r�t�*�r**�r+r�t*�******�e*
2 O N I.N G R E Q U I R E M E N T S
sEraAcxs
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 13957229 ZNE; REF NO;
PLANNING Nt51'ES>
i •
if iF 1E iF iE it if i! 1Eif if if if �! iF iE aE iE it 1E k ik if k if 1E 3f iE iE k it if ik iE �F k 1E if if k iE aF i! iE 1f iE if if 1F ik If iE iF if ik k k iE if iE aE iF iF if iE if if if if if iF if k 3E jE 3FyE iE �f
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY .
BUILDING APPROVED BY ;
if iF if iE iF iF �f �F if ik If iF jE iF iE k ik ik iE iE iF 3F if if 1F iF if if jf iF 1F iE if iE
LEGALIZATION:N F E E
BLDG PMT PLUMBING ELE
PERMIT 72,00
PLAN
ISSUE FEE
DATE; �
DATE;
iFiFiE±E±F iE iEiEiFiFitiEiEjtifififiFiEiEiEiE�IFiElkiFiF%if�iFiFiEiE
iEiEiE!! iE3E *1E�EifaEiFiFifikifiF3fiEiffEiEaE�EiEifikjF3f�EiE1E�F1Elf3F�FiFaFiE�lf
S U M M A R Y STRUCTURAL SEGMENT;Y
TRIC MECHANIC FIRE SMIP/RES� GRADING
50.�
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID ��' DUE
TOTALS----> 72.50 0.00 0,00 72,50 72,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 72,50 OVER/SAORT: ''! ,DO
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
72.00 ,50 '
if iE iE iE iE iE * 3E iE 3E 1F iE af iE 3F if ik if 3F IE k iE 1E �E 1E �E If IE 1f �E iF iF iE �f iE if 1E iE iE jF iF 1E 3F iF iF 1f if �t aE iE 3f �f if iE iF 1E 3F iF ik if if if �1f� iE iF �E jF IE iE iE iF 3E�E iF iE �E 1E iE �1(�
I N D I V I D U A L F E E B R E A K D O W N ., ��'
TYPE QTY D E S C R I P T I O N UNIT COST �1`OTAL COST
.�h
SFR 4900 REROOF BY VALUE RESIDENTIAL N020NE 1.00 •4,900.00
END OF FEES
�d� �0711�i'?:—�.f.1'.i�ii
'1 I (3��1L e9iEe 0's ,'„ � ;:: i r; � ^ -, -
I7
CONSTRU�fIONAND PLANNING P0. S SPA :�
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
t. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. SoilPipe•Und�gmd._ - 53. SteelReinforcement
3. Elect�ical Conduit UtilitY�Vndrgrnd� � 54. Forms
4. Elect?ical Conduit-Undrgrnd. ' 55. ElecVical Bonding
5. SteeJ.Reinfortemehi � 56. Rough Piumbing & Pressure Test
6. Etectr(cal UFER Grnd. � 57. APPROVAL TO COVEq-GUNITE
-� 7. Footings 58. Electrical Co�duit-Undrgrnd. �
8, fo;indation 59. Gas Pipe, a Undrgrnd., Test
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
70. Structurel Floor SYstem _ 61. APPROVAL TO DECK �.
7 7. Property Sew¢r Line & House Connection � 62. Backwash & Receptor-Final . "
12. Sewer Cap i 63. Heater & Vent•Final
13. Roof Drains • 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrica6Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 � FIRE DEPT. REQUIREMENT
20.�Rough Factory Fireplace � ��" Z � _ ;APPROVALS, �� Permit# � -
21. Ducts,in-Structure ,> . ` - a70. Underground.Hydro
22.Oucfs,Ventildting, - ':77. Product.�PCping�GOs ❑Oil
23. Gas Pipe�Rough & Test .`. , - i � J72, Underground Flush. -. " •
24. Roof Framing� '_ ' ��73r Undergrnd. Storage�Ta�k � Gas ❑ Oil
25. Roof Sheathing , _ ;; '74.:qverhead Hydro-
26. T-Bar Ceiling (Structural) & Monocoat ' �- ' * 75;=Dry Chemical - ''�
27. Frame and Pleshing - ,- 76. Dry Standpipe �� -
28. Lathing & Siding �� � - � 77, FIXED SYSTEM�. F WAL _ -
'29. Insulation " � � � � 78�FIRE PREV. FINAL � -� � •
� 30. Drywall Nailing • . � HEALTH�DEPT'. REQUIREMENT
31. Plaster B[own Coat � " 79.^FINAL iNSP.ECTION �'
. 32. Electrical Power MetervFinal - - '." : SO..�FOOD CERTIFICATE ISSUED �
i
33. Final Electric � � J . � �Notes: , -
.q34;-Final Heating & Air.Conditioning. - � � � ' �� . . - ,
35:':Final GaS PipO�Test' _ � - � - ' -
� , � . .
,i36. Hood or CanopY �- . - ! `' � � , - � �
�
37.'Finai Factory Fireplace " ` ' ..,," � -
38. Final Plumbing � . . � � . c
.39. Water Service^Final � • � �
.y
40. GasService•Final� , , . , . , ' � ,� '
47. Solar pomest�c-Final • �• '
42.�BackflowPreventer „ . '
43. Backflow Irrigation - � - � ��
44. Landscape IrFiqation System� - , - . . .
�45. Sound Attenuation • � � � - ,
46.,Handicap Regulations � �' � , � - � .
47. •PINAL STRUCTURE & BUItDING _ -7 Gw�- � _ . �,f__ ���^
. � rt ��.�� �__,
48. FINALPLANNIN(�i ' ' . �, ,�, � ��"
49.. Elec[ric Release to Edison � • ��
50..Gas Release fo Southem California Gas Co ! i i- `' _ ; . �
51. CERTIFICA7E OF OCCUPANCY -_ . _
No. Date
OWNER ApOLIA DEVEIAPMENT DATE 4-20-70
JOB ADDRE55 3327 Nevada Avenue BUILDING PERMIT N0. 31666
�5�71
GAS
W ATER
PROP. SWR. LINE �/ HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AN� AIR CON�ITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCHES CA1 FORMS STEEL REINF.
FLOOR SVSTEM
FRAME ANO FLASHING
LAiHING — IN GRI
TING, VENT., ftEFRIG. ANL q.C., F
MBING. FINAL ANO GAS TEST �Y
DUP I d .7 TYPE
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
C
a�n2z-�o`=1°Ooiz�a� �**14t.o0
CqSd
ForApplicant [o Fillin Completely APPLICATION FOR BUILDING PERMIT
FECEI D DAT�F��VED ppTE �'g�Ep
BUILDING p� /�
ADO(iESS 3327 Nevada Avenue `1 �` �
PERMIT'NO�`
OWNER A ollo Development Cor . �+.P. NO. .g E'.�riEJ
ADDRESS 1104 E 1 th Street
AD'DFIEss 3327 Nevada Avenue
TEL. TRACT 6694 LOT ]_], BLOCK
CITV Santa Ana No� 547-9673
CONSiRUCiION W P
LENDER �1. S. National Bank
X
BRANCH Main Office
ADDRESS 190 S, Broadway, San Diego OWNER A ollo Develo ent Cor .
ARCHITECT TEL. S Residence VALVE
ORENGINEER Kermit DOI1llS N. 675-1164
FIRE
AD�FESS3�.11 2RCI AV2.. Corona Del Mar ZONE TVPE GROVP
APPROVED
CONTRACTOR A 0�.�.0 Develo ent CiOT . B�' DATE
ADDFESS 1104 E, 17th Street
TEL. Z E NO.OF USE OF NEW W
CITV Santa Ana� No.547-9673 � P��'1/ BUILDING
STATE CITV VARDSAPPROVED VARDSAPPROVE
uc. No. 2525�+9 �IC. NO. MAIN BUILDING ACCESSORV BUILDING
S12E NO.OF BLDGS. (FROM C/� TREET)
OF LOT SS X LOO NOW ON LOT -- FROM FT. FT.
USE OF _� /y
EXISTING B�DG. 51 V FT. FT
SI2E OF NO. OF
NEWBLDG. �-782' SF qOOMS $ STORIES 1 L.SIDE FT.� FT.
EMERIOR WALLP�ans ROOF Wood Shin �.2
COVERING GOVERING S REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORME� DI5iANCE BET. BET. MAIN &
MAIN BLDGS. ACC65. BLDG a.
VAR. # DATE
C.ORSiL�llCt I12W residence C.V.P.#�' APPROVED
with attached garage. �ROVED �
�
I hereby acknowl¢tlge ffiat I have reatl this application and state
that the above iMormation is carrect antl agree to comply with
all laws raBulating builtling construction, and I shell not employ
any person in violation of ihe workmen's compensetion laws of
the State ot Calitornia. / �� ,�'
I hereby certlty thet I am properly litensetl as a contracior untlar ���n• FT. L
the State o( Calffornla Business entl Professlons Cotle, Dlvlsicn 3, THE AMOVNTSHOWN UNDER VALUATION IS FOR
Cheptar 9, antl thei such licenses are In full torce antl affact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am enempt from the provisionc ot t�a Stete ot Callfornia Bus(neas VALVATION
entl Profosslons Code vielon 3, Cheptar 9. PERMIT FEE S � � OO
s�enecu.o or v� �lD, !�/ �0 �// L'L7
Permi<tee 5 PLAN CHECK $ �
Authorizetl Apent TOTAL FEE § // � �' �
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COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING .��/J7 "�v�pA /�vE
ADDRESS L. N y /�
OWNER I—�GG(i/7 . V'E�yF1C3P/A�L� `-OL�?
ADDRESS I�O� �_ 1( ' �
CITV �Q�—� ��d No`�4T-�o4'f
CONSTRUCTION� ).�. � \�r101�}GY_ � YJ6L)L�
I FNfIFR V 4J
BRANCH
ADDRESS
I -�I43!
ADDfiESS
CONTRACTOR ��vNE(-�
ADDRESS .�]M�.
TEL.
CITV NO.
LIC.NO. G✓�✓i� IICYNO. 16qO
SI2E NO.OF BLDGS.
OF LOT I NOW ON LOT (
USE OF
EXI5TING BLpG.
SI2E OF NO. OF
NEWBIDG. ROOMS STORtES
EXTERIOR WALL FOOF
COVERING COVEliING
USE OF BUILDINCj AND WORK TO BE•PEqFORMED
"'ayrT � l.l�cu - 4' Rc�-Y �voc
:��T�-, 3` 1�raiu��� Ferzr-iN�
_ .1—� � � /' � � .-. c� ) �
NAY—S"7(�jPA70OO 114 cJ,��***5.0�
CN54
APPLICATION FOR BUILDING PERMIT
RECEI V O B DATE RECEIVED DATE ISSUI
'%� S-.% %�J .-_ � �
A.P. NO. I c�� ���
BUILDING �rj�y NEV�Q
ADDRESS ./J / AV�.,
TRACT 669 Y �LO'f� I BLOCK
OWNER
FIRE
ZONE
APPROVED
1 NO.OF
PLANS �
VARDSAPPROVED
MAIN BUILDING
30M C/L STFEET)
7M ��FT.
SIDE -�� FT.
V AR. qW
C.U.P.qW
VALUE
s
—
GROUP
DATE S�—
USE OF NEW•
BUILOING
VARDS APPROVE
BET. MAIN
I hereby ecknowlatlBa that 1 hava reatl this applicatlon antl state
thot the abova informe[ion Is correc[ antl agree i0 comply with
nll laws regulating builtlin8 constt�ction, anC I shall noi amploy
any parson In viOlotian ot the workman'c comp¢nsatlOn laws of
t�e Stata of Celitomla.
I hereby cartify thet 1 em proparly licensetl as a conKactor untler SQ. FT.
[he Steto of Californlo Businass entl Ptofess(ons Cotla, Divicicn 3, TNE AMOUNT SHOWN UNDER VA
Chep[er 9, entl the[ such licanws are in tull force entl affect, or I THE PURPO6E OF ESTABLISHING A P
am exampt fro�vislons ot th 3 ta of Celifornta Businosa VALUATION
nnd Profassions Cotle, ivisl �, C r 9.
0 PERMIT FEE .
SIB�atura of �j` � �
Permittea �% � $ / S 0 PLAN CHECK '
r o\.
Authorized ABont TOTAL FEE 5
—�D
W
0
ATION IS FOR ^
NR FEE ONLV: �
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