HomeMy WebLinkAbout1860 ORIOLE DR - Building Permits •
CITY OF COSTA MESA
Acosta, BUILDING DIVISION
o �_F I - 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
A`°4.-;i)°°2 PERMIT NUMBER: M11-00134
PERMIT TYPE MECH STATUS: ISSUED
APN: 13952104 DATE ISSUED: 11/22/2011
ISSUED BY: RMD
JOB ADDRESS: 1860 ORIOLE DR CM Suite/Unit:
Vicinity:
SQ. FT: 0
SCOPE OF WORK: MECHANICAL PERMIT TO REPLACE DUCTING FOR SFD.COMPLIANCE FORMS ATTACHED TO CITY
PERMIT AND JOB CARD.
OWNER: STAPLETON, FRANCIS DEAN Address: TR Unit:COSTA MESA,CA
PHONE: City/State/Zip: 1860 ORIOLE DR
APPLICANT: ZAMORA, CARLOS Address: Unit:
PHONE: 818-735-7876 City/State/zZip:
CONTRACTOR: SERVICE CHAMPIONS License No. 799170
Address: 22911 SAVI RANCH PKWYUnit: PHONE: 714-777-7777
City/State: YORBA LINDA, CA ZipCode: 92887 CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $37.20
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $37.20
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 I. INSPECTIONTYPE DATE INTITIALS CODE# INSPECTION TYPE DATE INP,T1,A/LLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical X Z -221 —h N .y
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivel .,license. D Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax 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. •
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 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
n NtJ✓ Nh by this permit,and that no building structure.scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not be completed d the permit is valved at one hundred dollars(5100)or less.) 2,Art 2,Sec.341,Title8,Califomia Administrative Code).
Policy Number: LA) G t f ccd Z 6o
_. - 0 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 . person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' comp-' ation laws of California, and agree that if I should
become subject to 'e rkers'compensation provisions of Section 3700 of Applicant's Signature Date
the Labor Code,I all with comply with these provisions.
iii
(I-1.21( Division of Industrial Safety Permit Number:
.•4
Ap. 'Signature iDates_ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one 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 fullllforce and effect. a registration form for acutely hazardous materials? 0 Yes ' 0 No
tic.#- - '7"1'7 tQ Ctass ft
CLO (Section 25533 of the Califomia 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
•_ Cord ors ig 1t 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,Ovil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the Califomia 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 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment 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? ❑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? 0 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 o egal er(s) Date
Signature Date //7Z 2.1/
3057-46(3/07) /
And/or Aut onz Applicant - Date
-
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 8
Site Addr Infnreement Avenev' I Date: P
16(00 OVI o re ( �� o f Co,l-(u e tes i /Liz-up 1 r I I tet/` J
Equipment Type List Minimum Efficiency` Conditioned Floor Area Thermostat
❑Packaged Unit
❑Furnace 0 AFUE ❑COP Served by system Op-Setback
❑Indoor Coil ❑SEER ❑HSPF 1500 sf (/ not already present must be installed)
❑Condensitng Unit ❑EER ❑Resistance
D Other atocf
1.Equipment Type:Choose the equipment being installed if more than one system use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are three HVAC alteration Options. The installer decides what work is being
done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form
was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no
hand filled CF-4Rs allowed)are filled out and signed. Beginning October I,2010,a registered copy of the CF-1R and CF-6R shall
_also be on site for final inspection.
'1.HVAC Changeout Required Forms:
• All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS
replaced CF-4R forms: MECH-25
• Condenser Coil and/or
CF-6R forms: MECH-25-HERS
• Indoor Coil and/or CF-4R forms: MECH-25
• Furnace
'For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units: No testing required
❑2.New HVAC System Required Forms:
• Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-HERS
new ducts:(all new ducting CF-4R forms: MECH-25
and all new equipment)
For Split Systems:RC,CCA>_300 CFM/ton,TMAH.
For Packaged Units:No testing required
0 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new CF-6R forms: MECH-25-HERS
ducting and/or outdoor condensing unit CF-4R forms: MECH-25
and/or indoor coil and/or furnace. Not all
equipment changed.
For Split Systems: RC,CCA>_300 CFM/ton,TMAH
For Packaged Units:No testing required
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on
this Certificate of Compliance.
I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance ate consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enfor , nt agencyJ/ for approval with the
permit application. 1ate' o
Name: CqV(D5Hn r7✓u Signature:
Company: A
S ✓ C nfOIOKf / Z /
Address: ZZq () License: 1 4 g I Z D
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City/State/Zip: .fy D y b ct. j�l i, d A r A (f-7 5 -7-- Phone: / .777
2008 Residential Compliance Forms March 20/0
Lot 22 - 94043 CITY 9 C3STA MESA
Tr. , 5781 1 ,
COSTA MESA BUILDING-SAFETY DEPARTMENT .
MMAY 1 1965
P.O.BOX 317 COSTA ESA,.CALIFORNIA
•
For Applicant to Fill In Completely . AI}P.CI(;/NOF PERM
TYPE OR PRINT
For Office Use Only
BUILDINGADDRESS 1860 Oriole Drive
RECEIPT NO. 2{ IIR43
COSTA MESA. CALIFORNIA ///��� >,/_(.1.L� .,</
R6CEI QBY RE IVEIy DATE ISSUED
OWNER Pemba Subdividers . Inc . - J /�' fo f6, MAY 1 31965
MAIL ADORE 8 i 7 bo Op I 0 L1= -p a'
ADDRESS 2850 Mesa Verde Drive
FIRE 7 •
CITY Costa Mesa noI5490395 - ZONE 7 TYPE CROUP''{- _
APPROVED '
ARCHITECT
OR ENGINEERS.G. Kaltenbach T4E0'a478046 BY DATE
ADDRESS 1823 E . 17th St . Santa Ana ZONING pi
.t._
NO.OP ^1 UBE OP N 1"��
i 4 PLANS /' I BUILDINQ. •
CONTRACTOR Pemba -Subdividers, Inc . ���/// 111 l 1-0 o- �/V
LEG
AL T ` ` 7
ADDRESS 2850 Mesa Verde Drive DE°`Rlrrl°" L V
CITY Costa Mesa A.P.NO. tV...
•NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.STANo . 187318 ' rNiO..'549-0395 90'TO SIDE&REAR P.L.
EAVES
OSIZE
F LOT 73 X 115 I NOW ON LOTNO.OF S O ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED'
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET
•
SETBACK LINE FROM FRONT ,r OFT. FT.
CENTER OF STREET 20 REAR YARD 42
SIDE YARD I LEFT 5 I RIGHT 10 R.SIDE/0 FT. FT.
DESCRIPTION OF WORK I..SIDE�
(f )
NEW X ALTERATION ADDITION REAR a ✓ F/T. FT.
DISTANCE BET. BET.MAIN d
_ MAIN BLDGS. ACCESS.SLOGS.
REPAIR MOVING DEMOLISH ---- -
BUILDIN(� rah
- VAR.# DATE
SIZE 58 x 52 ROOMS 9 STORIES 1 C.U.P.# APPROVED /
EXTERIOR WAL{, ROOK wood APPROVED lF\1,,, ,. 'I (/ / (�—
COVERING stUCCO I COVERING .shingles BY Y�YL1/"�1 DATE L Vd r ti
USE OF BUILDING AND WORK TO BE PERFORMED 7 VVV ��`�TT
Single family attached garage "'6
U��
%�`fOM - 4i l6 !a SQ.Fr. 437 3- ii-2_ Nit u
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- - PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION F7O //AA....
BUILDING CONSTRUCTION. - -y �`KJ N
SIGNATURE OF PERMIT FEE . $ / L
SIGNATURE
E �'nL'+ ���� 2 2j $26 LA C EC 56 OGT s
AUTHORIZED AGE 0, to 2
TOTAL FEE $ /0L+.
- . _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate tlecla ratio ns.
CITY OF.C€STA MESA CONSTRUCTION�/71PERMIT PERMITNO.NO. TRACT
fNO. LOT NO. UNIT NO. - � AN
PfdjeEl�Address f f�60 (4/2 f O L1• e , M. �G _ �� �O9 S'`� s,• 2�•
Z to ,
TYPE OF CONSTRUCTION LI NEW L i ADD }&ALTERATION H REPAIR
Applicant's Mailing Address , S.14,1-1,C . /+q e �( ii�1iIyy�
Owner's Name �T}1T'LG-TF)r-( Phone 432-.7 7jZ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A-R# 139 ,. `7/I — 04- APS IdLor7owty
• DES�Ca❑•�R�IPTION OF WORK/USE OF BLDG. • J `7
Address d3 reJF . cNCL(9SE" Gi7K C/1 /O micerifsr mice—sLay; Rid• S Main Building: Accessory Riiildina:
❑ FOUNDATION STRUCTURAL Front ll r MESA Z
Arch/Eng. - License No. TYPE OF PERMIT ❑ GRADING ❑ �MECHANICAL g �/ � OC COSTA Sfl/�A o
`/A- . Gosigr, ❑ TENANT ❑ ELECTRICAL 1111 PLUMBING A /IC N
Address ///��� Rear. 45
, Contractor's Name .?1-t-1 x.. PhoneQ -n7&,o ❑ OTHER - p C Right ///���t� N
Address(mailing) • d`� l Y - -irk . / - •• PROJECT DESCRIPTION SQ. F1•, �Z OCCUPANCY� at K g • , G
So 33Z CONSTRUCTION TYPE 17-N VALUATION /, 412 � s Left R
City License No. ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking R¢q./Provided
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: c nc pxi \ M
with section 7000)•of Division 3 of the Business and Profe sBi Cyr nd �-f - -I1 `�!` 7¢y''y
my license is in full force and effect. n bL� PC* 2 0'7_ ee S` /� iJ�r,,���XX�' ` , '^n morn /"�/�(� •
-Ts-
-La
License las 7 -t _ icense N. -a.--__ / COrKe a,Y It �1V L-w v el ✓acorn c11.Q-6_.
Date -� Signature •<�• PLUMBING I FEES J 1 `YCd 1• '-'1 .
WORKERS'C•MPENSATION DECLARATION Bar Sink .. Showers - ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate _
•of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink _
3800, Lab. CJ Automatic Washer Transformer.0 15-50 KW -
Policy No. Company Backflow Irrigation Sewer Cap ' - Construction Pole Sub. El 50+ KW
❑ certified copy is hereby furnished. - - -„
❑ Certified copy is filed with the city Building Division. Bathtubs •Sewer Connection Cooking.Unit Meter Dub to 100 amps •
Date • Applicant _ -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers •
Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping . Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person'in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 01%-B '
Workers' o en otic Laws of Calif nia. _ •- •
Date r t '�$' Signature 9,1YJ1- • f,- •� Floor Drains Swimming Pool w/Spa ' - F.A.U. - `— Inc.Solar ❑9-15 HP 016-15+
NOTICE:I,after making this declarat n,you should become subject to the -
Workers' Compensation provisions.of the Labor Code, you must forthwith Floor Sinks Urinal Z Fixtures Microwave • / • SD
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ' ,Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) ' - -
Lender•s Name - � 1�.� _Interceptors e . �,r,,.• - Water Heater r3. Outlets Range ' 2 ZS
Lender's Address • - /u!/I-/� Kitchen Sink ;, Water Service - Switches - 2 2S
Sign
OWNER BUILDER DECLARATION t - -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash -4 Garbage Disposal • Standing Sections •
following reason (Section 7031.5 Business and Professional Code: Any city or t`' - —
county which prior es.a permit to construct,alter,improve,demolish or repair P-Trap '� �' -r'--'+i •• Laundry Trays Generator 00-5 KW❑5-15 KW Trash Compactor .
any structure, prior to its issuance, also requires the applicant for such permit _ - - I
to file a signed statement that he/she is licensed pursuant to the provisions of Roo!Drains 1
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt - - -
•
therefrom and the basis for the alleged exemption. Any violation of Section '
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more lhan,five hundred dollars ($500)- $ 3 /S
' I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee •
compensation, will do-the work,and the structure is not The intended or offered - Reinspection Fee -I $15 Issue Fee $•3. --
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ' . •-
thereoe Law does does ply to an owner of a property who builds or improves - r
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: /
- employees, provided that such improvements are not intended or offered for Boiler Hood or Type ❑ •=1-MAP)sale. If, however,the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date iii
prove the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ) Date
prove for the purposew llof sale). -
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property whoDuct-Ventilating Doi 00,000 BTU ❑1oo,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust SystemMultipleSystemRepair/AlterationBUILDING PERMIT $ ft00 SMIP , $ 0,5-2,.
D ❑ ''LL•3� PERMIT
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ G T'
❑ 'I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner • Heating System& Ducting Registers PLAN CHECK 25% $ • - ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0-i00,000 BTU ❑100,000 BT ELECTRICAL $ .2�. 40 GRADING $
information Is correct. I agree to comply with all city and county ordinances �j
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ ' , •0c. MICROFILM $
sentatives of tills city to enter upon the above-mentioned pr Percy for D D
1Signatturen putt.(1 c -Dater."( (0/ $' MECHANICAL $ TOTAL FEE $ �1 7•Cl 7
'2,./
Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ •
'
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
.
.CONSTRUCTION AND PLIANNING ' i :r ,Sti POOL &SPA •
APPROVALS Permit I - ' I Date I Inspector APPROVALS Permit# Date Inspector
-
1.. Temporary Electrical Service or Pole • 52. Pool & Equipment Location•
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms I ray
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1 ..C7 1 .
5. Steel Reinforcement 56'. Rough Plumbing & Pressure Test .2-'
1. a
6. Electrical UFER Gr .:
nd57. APPROVAL TO COVER-GUNITE
7. Footings i r t 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gad Pipe, D Undrgrnd.,Test •
9. Wate(Pipe-ynd'irgrnd. . . -60. Backwash Lines, P-Trap, D Undrgrnd.'
. •
10. Structural Floor System 61. APPROVAL TO DECK : i. ,
- 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final!' ' I •
'
12. Sewer Cap 63. Heater & Vent-Final - -
13. Roof Drains 64. Plumbing System - Final al •
14. Rough Plumbing - - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring Ll 2Curbrr- h wlt 67. Fencing & Access Approval '
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL f I
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT HI.' t
41-
20. Rough Factory Fireplace APPROVALS Permit# - -
21. Ducts, in Structure 70. Underground Hydro - r
22. Ducts, Ventilating 71. Product Piping D Gas 1:10i1 _ T
23. Gas Pipe-Rough & Test 72. Underground Flush 1.1
24. Roof Framing 73. Undergrnd.Storage Tank D Gas D Oil •
25. Roof Sheathing ,74.. Overhead Hydro 'i • . . . -
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 1- -, f
27. Frame and Flashing 5 ,�/S8 76. Dry Standpipe •
c' 1 A
28. Lathing & Siding / /S c 04t 77. FIXED SYSTEM FINAL .1 .
„
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing 78949,-
8 00- HEALTH DEPT. REQUIREMENT -
31. Plaster Brown Coat /86 0-- 79. FINAL INSPECTION L r •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Sja 7/% Notes: -.
34. Final Heating & Air Conditioning' IS
35. Final Gas Pipe-Test -
36. Hood or Canopy ' .
37. Final Factory Fireplace ii"' •
38. Final Plumbing i &
39. Water Service-Final - .r
40. Gas Service-Final
."41. Solar Domestic-Final " -,p
I
42. Backflow Preventer '' i , .
143. Backflow Irrigation - I �.
x,44. Landscape Irrigation System _
45. Sound Attenuation { - I :
46. Handicap Regulations _
47. FINAL STRUCTURE & BUILDING WI& _
48. Special Requirements Completed
49. Electric Release to Edison-3,y . "-
50.-Gas Release to Southern California Gas CD ' /a / (_
51. CERTIFICATE OF OCCUPANCY " �1 / �•
No. Date
i
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate.declarations. -
CITYtF.COSTA M�S r CONSTRUCTION PERMIT� ,^, !ISM!ll NO. TRACT NO. LOT NO. UNIT NO.'roject Address, ��'4/ 'X91 uo-e_� arA�e.,e > G —3Z 909I "y 78' �s��
-"cant's Mailing Address ` 1't '" TYPE OF CONSTRUCTION . H NEW ❑ ADD X ALTERATION H REPAIR R �� •
1 - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # °i:4 I --I a _ ••_ i :'2,_,. �•' Zone
."^r's Name - Phone DESCRIPTION OF WORK/USE OF BLDG. - . .
e Address E.uC_n�'F Co r. (-LtiY=GF{ /w1c4.'r, 1: 4/✓• eL/• E Main Building: Acce �(�L Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION STRUCTURAL T Front , r•"i-• an Yyl [O
Address r. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name '-' - ----- Phone ' ... . ❑ OTHER p N
I f„ PROJECT DESCRIPTION SQ.FT 1/2 OCCUPANCY Re de K Right �:
Address(mailing) " • ' �' l' G
• City License No. -s7 � =G CONSTRUCTION TYPE J' 'tI VALUATION $ 7 A2 S Left
ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided E
CI
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: / " " r. -I I . M
with section 7000) of Division 3 of the Business and Professio�n$$Cy�; lid • '
my license is in fulforce and effect. J,S(7`•6•L j,J�-• 2 O7- �� RS i �' _ S
License Class - I License No.- '-- J ,a( .s
Date ' = 7 Signature • . PLUMBING FEES , , "� - r, � - f ) - /� '
•
WORKERS'COMPENSATION DECLARATION -
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
• 3800, Lab. C.)• Automatic Washer • Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation 0 50+ KW
g Sewer Cap Construction Pole Sub.
8 Certified copy is hereby furnished.
Certified copy copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors ' Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
• ( I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as td become subject to the Drinking Fountains Solar Tank • Fan
Workers' Compensation Laws of California. Motors❑0.1 HP ❑1%-8
' Date I F / ' ' Signature - / ' ' Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar❑9-15 HP ❑16-15+
NOTICE:If,after making this declaration, you should become•subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks
comply with such provisions or this permit .shall be deemed revoked. Urinal Fixtures /
Microwave
•
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater ^
Lender's Name �7&7� pOutlets Range
Lender's Address ti
.Kitchen Sink ■ Water Service • _� Switches r- �?
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ■ Auto-Wash ■■ Garbage Disposal - Standing Sections ■
following.reason (Section 7031.5 Business and Professional Code: Any city or ••
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor any structure, prior to its Issuance, also requires the applicant for such permit P
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains '
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
• therefrom and the basis for the alleged exemption. Any violation of Section •
7031.5 by any applicant for a permit subjects the applicant to a civil '
penalty of not more than five hundred dollars($500).I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 /r
compensation, will do the work,and the structure Is not intended or offered Reinspection Fee $15 Issue Fee $4
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: //� -!�
employees, provided that such improvements are not intended or offered for Hood or Type I 0
Approved ByDate t, � •- �'
sale. If, however,the building or Improvement Is sold within one year of corn- Canopy Type II 0 Zoning pp t
pletion, the owner will have the burden Of proving he/she did not build or im- n
rove for the purpose of sale). Building Approved By J �/ Date y�/�o /�Q
I, as owner of the property,am exclusively contracting with licensed con- a Refrigeration System Application Issued By Date �1'
tractors to construct the project (Section 7044,Business and Professions Code: r r
The Contractor's License Law does not apply to an owner of property who a ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES '
builds or improves thereon,and who contracts for such projects with a con- �7
• - tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ gy•!1n •• SMTP $ Or <..
proof of their Worker's Compensation insurance should be provided to me. System Repair/Alteration
PLAN CHECK $ l Lf.-?r--• PERMIT
0 I am exempt under Section B.& P.C.for this reason :a Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers _II PLAN CHECK 25% $ ENERGY P.C. $
.l hereby certify that I have read this application and state that the above 00.100,000 BTU ❑100,000 BT .-7 / GRADING $
, information is correct. I agree to comply with all city and county ordinances • ELECTRICAL $ _
and state laws relating to building construction, and hereby authorize repre- - PLAN CHECK 50% $ '�•OG MICROFILM $
sentatives of this city to enter upon the above-mentioned property for _ `?7•d'�
• inspection purposes. MECHANICAL $ TOTAL FEE $
' Signature , . _ . Date' '
Drivers' License or SS qct ` •
Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ •
RUCTION AND PLANNING POOL& SPA
AP ALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. •
117 F8i Dia 57. APPROVAL TO COVER-GUNITE
7. Footings 4 S T<_ t�('"(II� � Did 58. Electrical Conduit-Undrgrnd.
8. Foundation - `� 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ Undrgrnd.
10. Structural Floor System Leh-48g .2* 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit / 66. Solar System-Final
16. Rough Electric Wiring µ/u/ _ 7. Fencing & Access Approval
17. Rough Wiring Sign • `/ ( 68. APPROVED FOR PLASTERING •
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
2.2. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
•
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. ,Frame and Flashing -- 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation - 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
'-33. Final Electric Notes: 3' /�, VW GrY-,,.'-*
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
•
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backf low Irrigation
44. Landscape Irrigation System '
45. Sound Attenuation •
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
•
49. Electric Release to Edison
50. Gas Release to Southern California Gas CO
51. CERTIFICATE OF OCCUPANCY
lo. Date
P JECTADDRESS: 1860 ORIOLE DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT 1'nttr5 NU: n VCJJuv /
OWNER'S NAME:STAPLETON, FRANCIS DEAN
ADDRESS:TR PERMIT NO: B 063047 PLAN CHECK NO: N uuVJ.; Lv Suri-; Lv
• 1860 ORIOLE DR
%' COSTA MESA, CA 92626 CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE: ALT
432-7752
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMPOSITION SHINGLES SQ FT: 8, 500
ADDRESS: UNIT:
CLAIM VALUE: 8, 500 , 00 CALL—VALUE; 8, 500 . 00 GROUP OCC; R-3 /M-1
PERMITTEE:CHAMPION ROOFS ( 213 ) 898-8600
ADDRESS: 3257 VERDUGO RD COMMENTS; REROOF 3600SF RESID & GARAGE W/COMP SHING SMOKE DETECTORS RE UIR Fl
LOS ANGELES CA 90065 ***************************iE�ex,E*N*********�ENs6+uxK***k*** tiE*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R E U I R E M E -N T S
MORtbt edit 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY uc.:02725 STATE uc.429481 CLASS:C39 MAIN BUILDING ACCESSORY BU.EIR(�
LED---
Dale'. — /1 l� Signature:_` � :P — FRNT; FT IN REAR: FT IN FRNT; FT IN REAR ; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensatiorp' y t2. r6 8eyi21 copy thereof(Section 3Bo0.Lab l j/0 1 /94
POLICY NO.: 1.L G2O L EXP.DATE:
COMPANY:
GOLDEN EAGLE PARKING REQ: PROV: PARCEL: 13952104 ZNE; REF NO;
❑ Certified copy is hereby furnished. n Certified copy is filed with the city Building Division. PLANNING NOTES>
>
._-r - / s -9Th `—t-\ e ' **k**************************************i(-*N•3F1E**3EMM*******#IE**if*****it*'*********
Dale. ( 7 Applicane_ DEVELOPMENT SERVICES R E Q U I R E M E N-T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less).
I cedify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; -
Date: Signature: BUILDING APPROVED BY : DATE: ,
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor - '0
Code.you must lorthwdh comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y• 5 DATE• / 4.4-1CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is tssued(Section 3097.Civ.C). ******************************************'• ***r—,.,e****Fe************
LENDER: ********************************************************************iE,**********
ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL r SEGMENT; Y
•
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 108 . 00 ,•-,. 8 5
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN -qt.:
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PEAN=CHECK TOTAL PAID _ DUE
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 108 . 85 0 , 00 0. 00 108 . 85 108 . 85 - . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through / '' 'Me
his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 108 . 85 OVER/SHORT: „,/ 0 0
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING /PLAN—CHECK
fur the purpose of sale).
108 . 00 / . 85
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business -'-�
❑ and Professions Code. The Contractors'State License Law does not apply to an owner of property who builds or improves thereon r
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware ****************'***********************'****************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUA L” F E E BREAKDOWN r
❑ I am exempt under Section: B.&P.C.f •
or this TYPE QTY D E S C R I P T I .O N UNIT COST ..-TOTAL COST
•
Dale_ Owner: SFR 8500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 • 8 , 500 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES ,
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification Irom the Air Duality Management District.Residential construction applications are exempt from - f
these provisions. �.,
Date: Applicant: -
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. /•� • •
Date: —1 —iJ — 9.11.1 Signature: '"--I-1 r Can.-/
Drivers License or Social Security 01 _00142921-00142922 TOT 108.85
1641-46 White—Building:Green—Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor DAT07/15/93 07/1)/95 TIME: 12:00
% •
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. . 54. -Forms
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding .
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
_
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK "
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 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. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # ' .
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating , i. ' 71. Product Piping 0 Gas 0 Oii
23. Gas Pipe-Rough& Test - 72. Underground Flush
24. Roof Framing , . 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuratl & Monocoat 75. Dry Chemical
27: Frame and Flashing - - 76. Dry Standpipe
28. Lathing & Siding ` • •
I I 77. FIXED SYSTEM FINAL
29. Insulation I78. FIRE PREV. FINAL
30. Drywall Nailing• I II I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat _ I 79. FINAL INSPECTION
32. Electrical Power Meter-FinalI 1 80. FOOD CERTIFICATE ISSUED
33. Final Electric I
I. Notes: ��y Sr/?2 •11 aat,t' _lGY
34. Final Heaun &An Conditioning g 1 T//7/73/1
35. Final Gas Pipe-Test I {
36. Hood or Canopy I I
37. Final Factory Fireplace J -, I -
38. Final Plumbing . 1
39. Water Service-Final
1
40. Gas Service-Final I -
41. Solar Domestic-Final it I
42. Backflow Preventer 1 - -
43. Backflow Irrigation - . .�
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations I / -1
T
47. FINAL STRUCTURE & BUILDING740, t-" lftic
48. FINAL PLANNING - I
49. Electric Release to Edison 1 I •
50. Gas Release to Southern California Gas Co1
51, CERTIFICATE OF OCCUPANCY
No. ' Date
City of Costa Mesa INSULATION CERTIFICATION . Building Safety Division ..
1.
Number and Street City County
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material Brand Name
Thickness (inches) • Thermal Resistance (R Value)
EXTERIOR WALL ,f7 /�
Material X - /-
'Me<j'sf Brand Name
Thickness (inches) Thermal Resistance (R Value)
CEI LING
Batt or Blanket Type _ 0 Brand Name
Thickness (inches) Thermal Resistance (R Value)
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags _ Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
FLOOR,SLAB
Material - Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
(eN 1 'v DUB/C7�G2r 7Z7(22._eral Contractor(Builder) License Numberum
✓,%eeni"
'7.rt
siedL
Signature and Title Date
Sub Contractor(Insulation Applicator) License Number
Signature and Title Date
CMF 1106-46