HomeMy WebLinkAbout1776 NEWPORT BLVD - Building Permits •
'� .'• CITY OF COSTA MESA
VI/Ws
a, BUILDING DIVISION
a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
!tsteti� FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B10-00031
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42544317 DATE ISSUED: 02/0312010
ISSUED BY: RMD
JOB ADDRESS: v1776'NEWPOR BLT BLT C Suite/Unit:
Vicinity: COMMERCIAL ROOF
Squares: 0 Valuation: $15,411.00
SCOPE OF WORK: T/O EXISITNG ROOF MATERIALS, INSTALL NEW BUILT UP ROOF FOR ON A COMMERCIAL BUILDING"PROJECT
HABIT BOUTIQUE AND GALLERY",APPROX 46 SQUARES. ROOF SHALL COMPLY WITH T-24 COOL ROOF
REQUIREMENTS FOR COMMERCIAL BUILDINGS. COMPLIANCE FORMS ATTACHED TO JOB CARD AND PERMIT.
OWNER: STILLEY LIMITED PARTENSHIP Address: %CALVIN STILLEY Unit: SANTA
ANA, CA
PHONE: City/State/Zip: 10982 HUNTINGTON HORN DR
APPLICANT: D GALLA-RINI Address: 239 S WILLOW SPRINGS RD Unit: :
PHONE: 714-244-6567 City/State/Zip: ORANGE,CA
CONTRACTOR: MILES GALLA-RINI License No. 663983
Address: 239 S WILLOW SPRINGS RDUnit: PHONE: 714-244-6567
City/State/Zip: ORANGE,CA 92869 CELL: •
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $265.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $266.25
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE S. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE Al INIRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 120____Eigal Plumbing
200 Final Re-Roof i)C f I- 23- (0 H 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive.a license. ❑Yes ❑ No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ""'
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,or demolition
;i7/1:s
r �..Z or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be pefed Alhe cenna is valued at one hundred dollars($700)or less.) 2,M2 Sec.341,Ttle 8,California Administrative Code).
Poi Number: 00a 3534,
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California. and agree that if I should
becom subject to the workers' compensation provisions of Section 3700 of
the L or Code,I-shall forthwith comply with these provisidns. - Applicant's Signature Dale
Division of Industrial Safety Permit Number:
•Apdi 'J 9nature �fe ` HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Cede, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No
L :rfi.> moi_ j C)�'ssi�' ` / (Section 25533 of the California Health and Safety Code, with some
hh exceptions, requires registration with the Costa Mesa Fire Department by
..L . each business which at any one time has on hand a quantity of acutely
gnrF.T?. ,;;,,•- ..e � A„_ 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
CONSTRUCTIO LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application. have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of LegarD:mer(s) 9 ate
signature Date rate
305]-4613/07)
0r Aulhenze0 Applicant
tr
CERTIFICATE OF COMPLIANCE ENV-1C
AND FIELD INSPECTION ENERGY CHECKLIST (Page 1 of 4)
, I t r (Project Nvnc: Date: ' Climate Zm
1770 I I Ro NFuI0'C z 3 l0
4'roject Addresa: Condition d Floor Area:
Adn—
General Information
Building Type: 0 Nonresidential 0 High-Rise Residential 0 Hotel/Motel Guest Room
❑ Schools(Public School)0 Relocatable Public School Bldg. 0 Conditioned Spaces 0 Unconditioned Spaces
❑ Skylight Area for Large Enclosed Space>8000 ft2(If checked include the ENV-4C with submittal)
Phase of Construction: 0 New Construction 0 Addition Alteration
Approach of Compliance: 0 Component 0 Overall Envelope 0 Unco iditioned(file affidavit)
Front Orientation: N, E, S, W or in Degrees: _ r
FIELD INSPECTION ENERGY CHECKLIST
OPAQUE SURFACE DETAILS
YD DO
CI e e
o � c —
v v '.m i v e v ' o 'Pa
ppmN U V _ I 2,1 'J r. .. �'. L W Z =h VI F L
C ` ` Ca Cv i. G n L' ? ..r
Tag/ Assembly z a in us O Z U c' U ? rat ce = c°. re U CA ct a°'. t
ID Name Frame'1•ype Pass Fail
❑ 0 0
❑ 0 0
❑ 0 0
0
❑ 0 0
❑ 0 0
1.Indicate the idemting name of the Assembly name(i.e. Wall-I,Ceiling-I.Roo -I,and Floor-I).
2.Indicate type of Assembly Type such as Wood 2x4 or LW CMU 8". For addith nal other assembly types see Reference Joint Appendix,JA4-1.
3.Enter theframing aming material type(wood or melal)and refer to ENV-2C Furr. g Snips Construction worksheet.
4.Indicate.ftnving R-value when furred wall are being used.
5.Indicate Status of fenestration(New,Existing or Upgrade).
6.Indicate Special Feature on Page 2 of the Inspection Checklist Form I tow.
7.If Fail, then describe on Page 2 of the Inspection Checklist Fnrm en take appropriate action to correct. Verify building plans if necessary.
FENESTRATION SURFACE DETAILS
c
c w v U en c
v % . `o C7 o m ° —'w
U V •C I a. V �. U .0 ea
Tag c c L a, of x c x v> 1... v '' E 2
Fenestration `o c c a`, c
/IUr Type2 <n ¢ yr O Z x G c G rn O U via Pass Fail6
❑ 0 0 0
❑ 0 0 0
❑ 0 0 0
❑ 0 0 0
/ ❑ ❑ ❑ 0
// 0 0 0 0
I.Indicate the identifying nane%f the frame type(i.e. Window NI).
2.Indicate type of construction Type such, Window,Glass Door,Curtain wall,Skylight,or other
3.Indicate Ville efficiency values ane from the NFRC Label Certificate or Timm the CEC Default Values. Enter NERC or CEC(FC-I and FC-2).
4.Indicate Slattms offenesniation(New.Erisring or Upgrade).
5.Indicate Special Feature on Page 2 of Me Inspection Checklist Farm below.
6. If Fail then describe on Page 2 of the Inspect/nn Checklist Form and take appropriate action to correct. Verifi'building plans if necessary.
2008 Nonresidential Compliance Forms Angus!2009
E\VELOPE COMPONENT APPROACH (Page ] of 4) ENV-2C
Project Naine: Date: Climate Zone:
) 774 f770 l 7 £ tJ t z zoo 4
• 1 EXTERIOR ROOFING PRODUCT(COOL ROOFS)- See Section 3.3 in the Nonresidential Manual and§118(i)and 043(a)/A in the
Energy Standards for further description about exterior roofs and mandatory requirements for Cool Roofs.
(Note if the roofing product is not CRRC certified, this compliance approach cannot be used). Go to Overall Envelope Approach or Performance
Approach.
CHECK APPLICABLE BOX BELOW IF EXEMPT FROM ONE OF THE ROOFING PRODUCT MINIMUM PRESCRIPTIVE REQUIREMENTS:
❑ Roofing compliance not required in Climate Zones I andl 6 with a Low-Sloped. 2:12 pitch or less.
❑ Roofing compliance Not Required in Climate Zone I with a Steep-Sloped with less than 5 lb/ft2. Greater than 2:12 pitch.
❑ High-rise residential buildings and hotels and motels with low-sloped roofs in Climate Zones I through 9, 12 and 16 are exempted from
the low-sloped roofing criteria.
❑ Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted solar relectance and thermal emittance or SRI that have a U-factor
of 0.039 or lower. See Opaque Surface Details roof assembly below,Column H.
❑ Low-sloped Metal framed roofs in Climate Zones 3 and 5 are exempted solar relectance and thermal emittance or SRI that have a U-lactor
of 0.048 or lower. See Opaque Surface Details roof assembly below,Column H.
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempted solar relectance
and thermal emittance or SRI.
❑ Roof constructions with thermal mass over the roof membrane with a weight of at least 25 lb/ft2 is exempted from the Cool Roof criteria.
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Numbert < 2:12 >2:12 < 5Ib/ft2 > 51b/ft2 Type2 Ref1ectance2'4 Emittance SRI'
❑ ❑ ❑ ❑ ❑4
❑ 0 0 ❑ ❑4
• 0 0 0 ❑ 04
O 0 0 0 ❑4
❑ 0 0 ❑ ❑4
1. The CRRC Product ID Number can be obtainedfnona the Cool Roof Rating Council's Rated Product Directory at
www.coolroofs.orgioroducts/search.oho
2. Indicate the type of product is being used for the roof top, i.e.single-ply roof asphalt roof metal roof etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value frau
the same directory and use the equation(0.2+0.7(pr„I„ot—0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at http://www.energy.ca.gov/title24/cad enter the resulting value in the SRI Column above
and attach acopy of the SRI- Worksheet to the ENV-/C.
To apply Liquid Field Applied Coatings,the coating must he applied across the entire roof surface and meet the dry mil thickness or coverage •
recommended by the coatings manufacturer and meet minimum performance requirements listed in§I I 8(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
•
2008 Nonresidential Compliance Forms August 2009
1 CERTIFICATE OF COMPLIANCE ENV-1C
AND FIELD INSPECTION ENERGY CHECKLIST (Page 2 of 4)
Project Name: Dale Climate Zone:
17791� I7gD N pia z l( ")
ROOFING PRODUCT (COOL ROOFS)
(Note if(he roofing product is not CRRC certified, this compliance approach cannot be used). Go to Overall Envelope Approach or
Perfnnnctnce Approach.
CIIECI4 APPLICABLE BOX BELOW IF EXEMPT EROA THE ROOFING PRODUCT"COOT.ROOF"REQUIREMENTS:
( Pass I Fail' I NA
❑ Roofing compliance not required in Climate Zones 1 and 16 with a Low-Sloped. 2:12 pitch or less.
❑ Roofing compliance not required in Clinmre Zone I with a Steep-Sloped with less than 5 Ib/F1'-. Greater than 2:12 pitch.
❑ Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted solar relectance and thermal emittance or J ❑ I ❑ I ❑
SRI that have a U-factor of 0.039 or lower.See Opaque Surface Details roof assembly,Column Hof ENV-2C.
❑ Low-sloped Metal framed roofs in Climate Zones 3 and 5 are exempted solar relectance and thermal emittance or ❑ 0 0
SRI that have a U-factor of 0.048 or lower.See Opaque Surface Details roof assembly below.Column H of ENV-2C.
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are ❑ ❑ ❑
exempted solar relectance and thermal emittance or SRI.See spredsheel calculator at mn'm.energ'•ca.gnv/title24/
❑ Roof constructions that Iave thermal mass over the roof membrane with a weight of at least 25 lb/ftp is exempt from the ❑ 0 ❑
Cool Roof criteria below. _
❑ High-rise residential buildings and hotels and motels with low-sloped roofs in Climate Zones I through 9, 12 and 16 are exempted from the low-
sloped roofing criteria.
1./f
Fad then describe nn this page of the Inspection Checklist Foran ant!take appropriate action to correct. Verify building plans ifhecessarv.
CRRC Product ID Roof Slope Product Weight Product Aged Solar Thermal Special
Number' 5 2:12 >2:12 < S1b/ft2 > Sib/ft' Type2p Reflect)alccen Eml
(miitanee SRI5 Feature& Pass Fai
v676-Ogg ` ❑ 0 aLt'` ❑' '10.1 r 01 4.0_ ❑ ❑ I ❑ _
❑
0 0 0 ❑°
0 ❑ I ❑
❑ ❑ ❑ 0 r04 ❑ ❑ ( ❑
0 ❑ 0 ❑ 04 ❑ ❑ ❑
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at ma'n'.coolroaR''.orq/prodacts/seorch.php
2.Indicate the type of product is being used for the roof top.i.e.single-ply roof asphalt roof,metal roof,etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value front the some direcron'
and use the equation(0.2+0.7(pinitiel-211 to obtain a calculated aged value. IVlhet'c p is the Initial Solar Reflectance.Front the Cool Roof Inning Calmed's
Rated Product Directory.
4.Check bar Ore Aged Reflectance is a calculated hnhte using the equation above.
5.The SRI value needs to be calculatedfont a spredsheet calculator at lutp://www.enegy ca.goi/tille24/
6.Indicate Special Feature on Page 2 of the Inspection Checklist Foran below.
7. If Fail then describe on this page of he Inspection Checklist Farm and take appropriate action to correct. Verif'building plans if necessary.
To apply Liquid Field Applied Coatings,the coating must he applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(04. Select the applicable coating:
0 Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
SPECIAL FEATURES INSPECTION CHECKLIST
The local enforcement agency should pay special attention to the items specified in this checklist. These items require special writer,justificatitm
and docunhentatiort, and special verification. The local et,fct'cetnent agency determines the adequacy of the justification, and tngo reject a building
or design that otherwise complies based on the adequacy of the special justification and documentation submitted.
Discrepancies:
2008 Nonresidential Compliance Forms August 2009
CERTIFICATE OF COMPLIANCE ENV-1C
AND FIELD INSPECTION ENERGY CHECKLIST (Page 4 of 4)
Project Naine: Date: Climate Zone:
Documentation Author's Declaration Statement
• I certif'that this Certificate of Compliance documentation is accura d complete. '.
XName: Signature:
Company: /� �j,� '` `,
C Oth - 1� \s( P1 rna,Q Date: 3—C)
Address: If Applicable:
,9363 s. Mil DIA/ ale(,: 6 01 CEA Il
CEPS H
City/State/Zip. /I\ ' n / . Q� ry>n Phone: 7/' (r-s y1 /y�z
Principal Designer's Det eclaration aration Statement / (� 7 /y y(li�
• I at, eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design.
• This Cei 'ate of Compliance identifies the envelope features and performance specifications required for compliance
with Title 24, -, is I and 6 of the California Code of Regulations.
• The design features ;'resented on this Certificate of Compliance are consistent with the information provided to document
this design on the other al i cable compliance forms, worksheets,calculations, plans and specifications submitted to the
enforcement agency for approv 'th this building permit application.
Name: Signature:
Company: Date:
Address: �/� License p
! i City/State/Zip: Phone:
i
Envelope Mandatory Measures
Indicate location on building plans of Mandatory Envelope Measures Note Block:
INSTRUCTIONS TO APPLICANT ENVELOPE COMPLIANCE & WORKSHEETS(check box if worksheet are included) -
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms.please refer to the Nonresidential Compliance
rMannal.
O ENV-1C Certificate of Compliance and Field Inspections Energy Checklist. Required on plans for all submittals.
❑ . ENV-2C Use with the Envelope Component Approach. Optional on plans.
❑ ENV-3C Use with the Overall Envelope TDV Energy Approach. Optional on plans.
❑ ENV-4C Use when minimum skylight requirements for large enclosed spaces are required in climate zones 2 through
15. Optional on plans.
2008 Nonresidential Compliance Forms August 2009
Cool Roof Rating Council Page 1 of 1
jeer
•
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Rated Products Directory: Search Results [new search]]print friendly
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(last updated 1 Feb 2010 11:43 PST)
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Company: GAF Materials Corp
Product Type: Built-up Roofing(incld asphalt and coal tar pitch)
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0676.0021- ,GAF Materials GAFGLAS EnergyCap BUR Built-up 0.80. 0.63 0.90 0.87 Low
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About the-CRRC I Product Rating Program I Rated Products_Directory I CRRC-Members CRRC News
Become a Member I How Poi I Contact Us I Cool Roof Links. Home
http://www.coolroofs.org/products/results.php?keyphrase=&select type=select&type%3... 02/03/2010
CITY OF COSTA MESA •
•
4 BUILDING DIVISION
>°ar: ,, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
4. FOR INSPECTIONS CALL: (714)754-5626
� •
p9 1 PERMIT NUMBER: BC09-00040
0 `
PERMIT TYPE: B_COMBO ' STATUS: ISSUED
Sub Type: COM_ALT DATE ISSUED: 02/26/2009 .
ISSUED BY: kjb •
•
JOB ADDRESS: 1776 NEWPORT BL CM Suite/Unit:-
APN: 42544317 Zoning: - , ,
•
Vicinity: 'Primary Occ:. M
• Const Type: V-B SQ. FT: 3065 Valuation: $30,000.00
•
SCOPE OF WORK: 3065SF INTERIOR STORE TI TO UPGRADE TWO BATHROOMS TO COMPLY WITH ACCESSIBILITY
REQUIREMENTS AND REPLACE T-BAR CEILING. ELEC: 31 LIGHTS FIXTURES, 24 OUTLETS, 13"SITCHES, 2 MOTORS TO 1 HP,
2 NON RES APPL; MECH: 1 FAU AND NC < 100 K BTU, 2 VENT FANS SINGLE DUCT; PLUMBING:2 WASH BASINS, 2 WATER
CLOSETS, 2 WATER HEATER(INST HOTS) •
OWNER: STILLEY LIMITED PARTENSHIP Address: %CALVIN STILLEY - Unit: SANTA ANA,CA
Phone: ., - . - _ City/State/Zip: 10982 HUNTINGTON HORN DR -
APPLICANT: MICAHEL VANDERLAAN : . Address: _ Unit: :
Phone: 949-830-4100 City/State/zZip:
CONTRACTOR: HERITAGE CONSTRUCTION License No. 759293
Phone: 949-830-4100 . -- - Address: 18 RANCHO CIRCLEUnit: - -.
Cell: City/State: LAKE FOREST, CA - ZipCode 92630
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $71.86 - -
Building Fees: $442.25 - .
Electrical Fees: - $102.25 - _ . . ' -
Mechanical Fees: $74.60 , - •L "
Plumbing Fees: .. $88,45 •
SMIP Residential: $0.00 ,
SMIP Commercial: $6.30
Bldg Std Admin Fund $0.00
TOTAL FEES: $849.04 - ,
"Refer to fee receipts for all fees paid for project . •
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28.§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE A ININ$PECPIN;i 1 gam lNlfAL6 CODER 1656E0106M6 6 g6IE . OII L6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 10L�
200 Final Re-Roof 210 Final Electrical i/ :r • •••Pr r/AZl
201 Final Block/Retaining Wall 212 Final Fire Prevention •
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy 9-17-07 b7 /Tf/ ,
WORKERS'COMPENSATION DECLARATION: • Owner,ID verified by driver.,.,cense. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership
compensation, as provided for by section 3700 of the Labor Code,,for the b Y(type of document,i.e.-property tax bill or deed):
performance of the work for which this permit Is issued.
O I have and will maintain workers'compensation insurance,as required by '
section 3700 of the Labor Code,for the performance of the work for which this VISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carder and policy certify that no excavation five(5)or more feet in depth into which a
number are: P t d t• descend,will be made in connection with work authorized
by his /r-• o b it ing structure,scaffdding,falsework,or demolition
Carrier permdc valued at one hundred dxars(Etee)wtess.) n dismantle 1. eof,. , I e than thirty-six(36)feet high.(Chap.3.2,Grp
(Tis sedan need riot be turn teddmeY- 9
2,Art 2,Se/`341:'ill:•.:,Calif a Administrative Code).
Policy Number:
❑ As owner-bur der, of employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
•
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to tile and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No
Lic.# Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,CMI Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
That he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
'thereon,and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for 8. (If"yes",attach certificate of compliance frointhe appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she 'CERTIFICATE OF COMPLIANCE: I certify that under penalty of'perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws-and
city ordinances regarding Hazardous Materials and Emissions.
❑ I, as owner of'the property, am EXCLUSIVELY CONTRACTING WITH ..
•
LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and
Professions Code:The contractors Ucense Law does not apply to an owner of • Signature r Date -
property who builds or improves(hereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF'ENTRY: I
a contractor(s)license pursuant to the Contractors Ucense laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
•
Signature of legal Owner(s) Date
Signature Date .
3057-46(3107)
And/or Authorized Applicant Date