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HomeMy WebLinkAbout1036 PALMETTO WAY - Building Permitsj CITY OF COSTA MF' O p MFS BUILDING DIVISION i a 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us r � FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC10-00544 PERMIT TYPE: B_COMBO Sub Type: SFD—NEW JOB ADDRESS: 1036 PALMETTO WY CM APN: TPNO08034 Zoning:, Vicinity: Const Type: V -B SQ. FT: 2644 STATUS: ISSUED DATE ISSUED: 01/04/2011 ISSUED BY: RMD Suite/Unit: Primary Occ: Valuation: $216,500.00 SCOPE OF WORK: PHASE 2: PLAN 1 TYPE 1 BR CONSTRUCTION OF A NEW 2,165 SF 2 -STORY SFD WITH A 54 SF PORCH AND A 425 SF ATTACHED GARAGE WITH 1 FAU < 100 K BTU, 1 REFRIG SYS < 100 K BTU WITH NEW DUCTING, 1 HOOD W/MECH EXHAUST, 1 FACTORY FIRE PLACE, 3 VENT FANS, NEW ELECTRICAL FOR A 2,165 SF SFD, ELECTRICAL FOR A/C PKG, 2 LIGHT FIXTS, 4 OUTLETS AND 1 SWITCH FOR GARAGE, 2 BATH TUBS, 1 DISHWASHER, GAS OUTLETS (1-4), 1 GAS SERVICE, 1 LANDSCAPE IRRIGATION, 1 LAUNDTRY/TUB WASHER, 1 SHOWER, 1 KITCHEN SINK, 5 WASH BASINS, 3 WATER CLOSETS, 1 WATER HEATER, 1 WATER SERVICE. FIRST FLOOR - 958 SF SECOND FLOOR - 1,207 SF REF: PA -05-29, T61917 3 BEDROOM, 1 BONUS ROOM, 2 1/2 BATHROOM SFD. OWNER: Phone: APPLICANT: EMERSHAW, KIRSTIN . Phone: 949-873-2718 CONTRACTOR: T R CO Phone: 949-719-4975 - Cell: ARCHITECT: ENGINEER: HUAN NGUYEN COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: Address: City/State/Zip: Address: City/State/zZip: License No. 832198 Address: 160 NEWPORT CENTER DRIVEUnit: City/State: NEWPORT BEACH, CA License No. License No.C64238 $267.95 $1,648.95 $215.60 $110.05 $211.05 $21.65 $0.00 $9.00 $2,484.25 Unit: Unit: STE 240 ZipCode 92660 PHONE: PHONE: 'Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday- 7:00 am thou 7:00 pm. Saturdays -9:00 am thou 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day 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. INSPECTION TYPE DATE INTITIALS CODE INSPEC11014 TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical JZ /�/ / (4,0 1266 Pool Spa Final 206 Final Plumbing i 04- 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy 40 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarpns: h I l have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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 permit is issued. My workers' compensation Insurance carrier and policy number are:I T C . arrier:�'z Co e a-1]750."l�ov\ (This si need raf be oamp'ef the perms a value) al one hunered "am (5100) orless J Polic`y'Number.— ❑ 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth 'lh comply with these provisions. P DLL I ILi ) It Appliwors Signature"' JDi 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Lim.# `-, 3,k$ Cf. =B_ Cpntrecta.'s signature- 4Date CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or 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 compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (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 does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the 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 contracts for such project with a contractor(s) license pursuant to the Contractors License Lays.). ❑ I am exempt under sec. Business and Professions Code for this reason: 00 Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: ;— Verification of Ownership by (type of document, i.e. - prpperty 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 authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to 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 the division. Appl¢ant'S Signature Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a 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 applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (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 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). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the 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. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety 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 the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet 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 Safety Cotle), 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes', attach certificate of compliance from the. appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date 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 correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of 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 O er(s) Date Signature Date �-'� _ \ Iu{ I It 3057-46 (3/07) VM"r A�nnozeO'Appti t fes / NEWPORT -MESA UNIFIED WiOOL DISTRICT N26998 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AS 1600 AND AB D To: ( '") City of Costa Mesa Q J� \% District Receipt No. �y ( ) City of Newport Beach N p 4 P -)&10T •sy ' ( ) County of Orange �A Plan Check No._1J c Applicant: ©y6O W �at I LLC_ Cr GOO Address: loo Net�Do/1 f � ow � srke. ?_"o KkW. Qdc to tli , CA q2.&(,o Telephone Number: `l ct /��,V - 1-, q q "l Tract/Parcel and Lot Number(s): n- I�,, (� � I- N UV 'U - ON Location of Project: u_t) r - W G"m Number of Square Feet of: Residential Space I x $1.84 Total 3 9 3 • LE Z% Commercial and Industrial Space x $ .30 Total Commercial/Industrial Project is: (Check One) Warehouse Motel Preschool R $ D Bank Auto Repair Movie Theater Neighborhood Shops Hospital Mini -storage Racquet/Health Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in ' mphance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed develop nt may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified School District. ey: Aulhonzed Ra five The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: (A /11 441,_4�2 z4o ApplieeM GOUVISH119-o caving eansulouggroup, mc. SHEET: JOB NO.: 61944 DATE: 03/08/11 CLIENT: TRCO Development if 103 f - Tv wa`t zcta oosq-, INSTALLATION CERTIFICATEI CF -6R -ENV -01 Envelope —Insulation; Roofin • Fenestration rate): (Pae 1 of 3) Site Address: Lot 5 Enforcement Agency: 1 2. SLAB FLOOR/PERIMETER Permit Number: ,,\ -lo54 Material: Brand Name: Material: Brand Name: Ifmare Nan one person has responsibilityfor installation ofthe items on this certificate, each person shitll i)repare and stgn a certificate applicable to rhe portion of consbuction for which they an responsible; alternatively, the person with /ef�espawibiliryjor cavtruction shall prepare and sign this certificare for the entire construction Ail applicable MandatoryMeasures with ch ckl bases require to be checked to enure Description of Insulation 1. RAISED FLOOR Material: Brand Name: Thickness (inches): Thermal Resistance (R-1 rate): 1 Thickness (inches); Thermal Resistance (R -al Cl §150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor, e) : 2. SLAB FLOOR/PERIMETER 4- FOUNDATION WALL Material: Brand Name: Material: Brand Name: le): Thickness (inches): Thermal Resistance (K-1,al ); Perimeter Insulation Depth (inches): 5. CEILING 0 §150(1): Water absorption rate for the insulation material alone without facings is no greats n 0.3%; water vapor permeance rate is no greater than 2.0 pemvinch and shall be protected from physical damage and W ligial dt teriorstion 3. EXTERIOR WALL e): 30 d ight/W .462 Ib a. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) a. Thermal Resistance Te aloe): 13 Batts mN 0 §150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor. b.. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) b. Thermal Resistance -alue): V 6. ATTIC ROOF INSULATION ANDIOR ATTIC RADIANT BARRIER Brand: certainTeed f Spray/Loose fill) Installed Actual Thickness Spray/Loose fill) Material: Brand Name: (inches): 3 . s, Contractor's min installel eight/fla _Ib Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Vale ): ❑ §15D(c): Minimum R-13 insulation in wood -frame wall or equivalent U -factor. II Exterior Foam Sheathing (rigid Insulation) Material: Brand Name: 1 Thickness (inches); Thermal Resistance (R -al e) : 4- FOUNDATION WALL Material: Brand Name: Thickness (inches): Thermal Resistance (R- ); 5. CEILING Batt or Blanket Type: Batts Brand Name: certair e d Loose Fill Type: B1 -own insulsa a Thermal Resistance (R- I e): 30 d ight/W .462 Ib Spray Foam Type: Brand Name: certai Installed Actual Thickness (inches): Batt 10"/Blow 11.75 "Contractor's min installe Te Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Val e) 30 0 §150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor. 6. ATTIC ROOF INSULATION ANDIOR ATTIC RADIANT BARRIER Material: Brand Name: Material: Brand Name: Thickness (inches); Thermal Resistance (R -V ): ❑ §I18(a): Insulation installed meets Standards for insulating Material. ❑ § 150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16 1008 Residential Compliance Forms I i August 21 T'd SbE96899T6 XHd 13CN3Sd-1 dH Wd9S:T 0102 D6 daS ('Site Addrem: Lot 5 I Enforcement Agency: I jI Permit Number. ' Overview—In order for batt and blown in insulation to work correctly the insulation must flit the walllpQiry and touch the air bavi with no gaps or voids. Ceiling and raised floor ban and blown in insulation most not be compressed and have an gaps or voids. Qll Insalation Stage Checklist V FLOOR INSULATION LI ® ❑ ❑ All floor joist cavity insulation installed to uniformly fit the cavity side-to-side an¢ end-to-ead. (NA if floors slab Yes No NA on grade). ❑ ❑ ❑ ❑ Insulation in full contact with the subf3mr, NO gaps. g P (NA if floors are slab o g e). Yes No NA ❑ ® ❑ ❑ insulation in contact with air barrier on all five sides. (ends, sides, back). NA f fl rs are slab an grade. Yes No NA ❑ No ❑ NA ® ❑ No ❑ NA Batts cut to fit around wiring and plumbing, or split (deleminated). (NA if loo c II, SPF, or slabon grade). BATTS, voids/depressions less then 314" allowed as long as the area is not get atc, ❑ ❑ Ban insulation has continuous support. (NA ifloose fill, SPF, or slab on grad ). NA for each stud bay. (NA if loose fill or SPF). No NA I 0 EEEI ❑ ® SPF (Spray Polymethane Foam Medium Density) Insulation the average this a isequalmorgreaterthanthat No NA listed on the CF -I R and the minimum thickness shall be no mora than 'h inch ss than the required thick=$ for SPF insulation properly adhered to avoid gaps and provide an air seal (NA for otl}er forms of insulation). Yes the R -value. NA for other forms of insulation). NA ® ❑ ®s I Insulation R -value same or greater than listed on the CF -I R. Yea No ® ❑ ❑ SPF insulation properly adhered to avoid gaps and provide an air seal (NA for r forms of insulation). Yes No NA ® ❑ L3 For SPF list the required floor cavity R -value from CFAR, R - Yes No NA List tested average depth of insulation (inches) _ X 3.8 (R-value/inch for a density SPF) to proper R -Value. ® (R -value). This is the installed R -value and must be equal to or greater than li toon CF -IR (NA for other forma All skylight shells and attic oncewalis mentioned with minimum R-19. Yes of insulation). NA i ® ❑ LI Standard depth cavities insulation rills cavity and touches air barrier on all six id's. (NA if SPF used and meets Yes No NA the required R -value). 23 ❑ ❑ All double we]Is and trump -outs, the insulation fills the cavity or additional air 'cr installed so Thai the Yes No NA insulation rills the cavity. Insulation touches all six sides. (NA if SPF used m is the required R -value). ® ❑ Behind tub/shower, walls under stairs, and fireplace, insulation touches airbar 'er�on the sides. Not required to Yes No fill the space. Cavity required to be air tight ® Yes ❑ No ❑ NA BATTS, not a single void/depression deeper than %" in ANY stud bay. (NA it Jo( se fill or SPF) 13 ❑ ❑ BATTS, voids/depressions less then 314" allowed as long as the area is not get atc, than 10%ofthe surface area Yes No NA for each stud bay. (NA if loose fill or SPF). ❑ ❑ 0 Loose Fill no gaps or voids of any depth allowed. (NA if butts or SPF). Yes No NA ❑ ❑ ® SPF insulation properly adhered to avoid gaps and provide an air seal (NA for otl}er forms of insulation). Yes No NA ®s 13 Any gaps between studs or insulation larger than 118" must be filled with ins ti u or foam. ®3 NO All Rim joists to the outside insulated. I ®E3 Special attention mast be paid to comer channels, wall imersections, and behi d Wbishower I an en closures Yes No to proper R -Value. ® ❑ ❑ All skylight shells and attic oncewalis mentioned with minimum R-19. Yes No NA ® ire. ❑ +.,_ ❑ wtw [nsuletio i n fuB too ed w th wall or wall fin rhes of skylight shahs and a b eewalis. Regdnrvrion Nwtber: Registration Dare/Time: 2008 Residential Compliance Forms March 2010 I F - d SbE98899I8 XHd 13CH3SU-1 dH Wd9S:l O102 06 daS Y 11Yes No Wall insulation same or better than what is listed on the CF -I R. ❑ ❑ ❑ M SPF list the required wall cavity R -value from CF -IR, R- . List t t d average depth of Yes No NA insulation (inch) _ X 5.8 (R-valuelinch for medium density SPF) = I(R-value) This is the BATTS voids/depressions less than 3/4" allowed as long as the area is not m r than 106A of the surface area installed R -value and must be equal to or greater than listed on CF -1R N for other forms of for each stud bay. (NA if loose fill or SPF). insulation ❑ ❑ ❑ ® SPF (Spray Polyurethane Foam Medium Density) insulation the average llie a is equal to or greater than that Yes No NA listed on the CF -I R and the minimum thickness shall be no more than 'h inch ssi the required thickness for All ceiling insulation installed to uniformly fit the cavity side-to-side and en -to end. the R -value. A for other forms of insulation No ✓ CEILING INSULATION El ❑ BATTS there must not be a single gap/void/depression deeper than Y.". (NA if [base fill or SPF). Yes No ® ❑ BATTS voids/depressions less than 3/4" allowed as long as the area is not m r than 106A of the surface area Yes No for each stud bay. (NA if loose fill or SPF). 12 ❑ ❑ or voids allowed for loose fill and SPF. (NA if batts). NO gaYes No NAps ® ❑ All ceiling insulation installed to uniformly fit the cavity side-to-side and en -to end. Yes No Yes No ❑ Insulation in full contact with the ceiling, NO gaps. ® ❑ Insulation in contact with air barrier on all five sides. Yes No ❑ ❑ ® Yes No NA and plumbing, g' split ( (NA for Batts at to fit around wiringors delaminate fill or SPF). El ❑ ❑ Bans taller than the trusses must expand so that they touch each other over U ic t sses. (NA for loose fill or Yes No NA SPF). ❑ ❑ ❑ Yes No NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA r tither forms of insulation) ❑ ❑ M Insulation fully fills cavity below any plywood platform or cat -walk. If SPF then minimum Yes No I NA 1 3 inches. A if no platforms or cat -walks Yes � Attic access gaskered 13 Cl Attic access insulated with rigid foam or ban insulation using adhesive or mu clu Pical fastener, Yes No R -value same as ceiling R -value listed on CF -I R B ❑ Recessed light thrums covered full depth with insulation. if SPF used then c the forms of insulation used to Yes No cover or enclosed in a box fabricated from ii -inch lywood, 18 ga. sheet to 1, 14 -inch hard board ordrywall ®s 0 Roof insulation same or better than what is listed on the CF -IR ® ❑ ❑ Loose Fill Insulation at proper depth — insulation rnkn visible and indicatin isr lope depth and R -value for Yes No NA blown in insulation. A for batts or SPF). ❑ ❑ ® Loose Fill Insulation anifarmly covers the entire ailing (or rool) area from o side of all exterior wells. (NA Yes No NA for bans or SPF), Looso-fiU insulation meets or exceeds manufacturers minimum weight and I hiclaiess requirements for the target ❑ ❑ ® R -value. Target R -value. Manufacturer's minimum required weight for the & xglt R -value (pounds -per -square - Yes No NA foot). Manufactnces minimum required thickness at time of installation. M ujacturers minhmmmi required settled thickness. Note: To receive compliance credit the HERS rater shall v mift' that the manufacturer's minimum weight and thickness has been achieved for the target R -value. (Nfdr batts or SPF). Registration Nronber: Registration Datelflme: rERSProvlder: 1008 Residential Compliance Farms March 7010 6-d S46969991:6 X1:33 131'd3SH-1 dH Wd9Srl 0100 06 daS INSTALLATION CERTIFICATE 1 CF -611 -ENV -22 -HERS uality 7nsulationInstallation II - Insulation Stage Checklist(Page ediaveralle 3 of 3 Site Address: Lot J Enforcement Agency: NA 1 1 Permit Number: ® ❑ ❑ SPF list the required ceiling cavity R -value from CF -IR, R- . List to ediaveralle depth of insulation Yes No NA in X 5.gR = R this is the installed R -value and must be equal to or gre 11al than listed on CF -IR (NA tar CSLB License gg9739 other forms of insulation Position With Company(Title) Projec O ❑ ® SPF insulation must be covered with other forms of insulation or enclosed ina x fabricated from'/. inch Yes No NA plywood. 18 gauge metal. % inch hard board or drywall. The exterior of the may then be insulated with SPF. ❑ O 123 SPF insulation the average thickness is equal to or greater than that listed on he CF -IR and the minimum Yes No NA thickness shall be no more than f, Inch less than the required thickness forth kvalue. (NA for outer forms of insulation ✓ GARAGE ROOFICEILING INSULATION FOR TWO STORIES no conditioned ce over garage) E3 I ❑ ❑ Insulation installed at joists against the air barrier in the garage to house trmi iti n. All wall insulation Yes No NArequirements above most be met (NA if conditioned space over garage). I ✓ GARAGE ROOFICEILING INSULATION FOR TWO STORIES conditioned spa cc bver ra e ®s If insulation is to be installed at subfloorthen the insulation must also be insl died atjoisas against the air barrier In the to house transition. All ceiling and wall insulation requirernrnt s♦;ovc must be met. (NA if no No NAgarage conditioned space over e e). ® ❑ ❑ If insulation is to be installed at ceiling of garage then the joists to the oursidt m t be insulated and all the Yes No NA insulation mqubcmems listed above must be met. (NA if no conditioned spage er e). DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the Stare of Califar ie, the information provii • 1 have read the High Quality Insulation Installation Procedures (Residential Appendix, RA3,5), in understand that there are additional requirements than must be met than those listed on this CF -61 • All rows In this document have been checked and all answers are yes or NA • I sat eligible under Division 3 of the Business and Professions Cade to accept responsibility representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on i conforms to all applicable codes and regulations, and the installation is consistent with the plans e enfomtnent agency. • 1 understand that a HERS rater will be checking the installation and that if such checking identifie corrective action at my expense. If the installation is part of a sample group for TIERS verificatio the requirements of such quality assurance checking, additional checking/testing and repair ofoth sample group will be required at my expense. I understand that the HERS provider, and Energy also be performing checks of the installation on jobs trot tested by the HERS rater. • 1 reviewed a copy of the Certificate of Compliance (CF -I R) form approved by the enforcement al requirements for the installation. I unify that the requirements detailed on the CF -I R that apply • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or permit(s) issued for the building, and made available to the enforcement agency for all spilli that a signed copy of this Installation Certificate is required to be included with the docume building owner at occupancy. I will cusum that all Installation Certificates will come fmm a III multiple orientation alternatives and on October I, 2010, for all low-rise residential buildings. this form is true and correct ud these procedures, and or an authorized (the installation) ins approved by the cts, I am required to take the installation fails to meet allusions in the HERS issioa mtrrrsentativ will that identifies the specific installation have been met. available with she building inspections. I understand n the builder provides to the rovider data registry for Company Nairne: (Installing Subcontractor or General Contractor or Builder/Owner) Walldesign Inc. Responsible Person's Name: Responsible Pers rgnatum Fletcher Fasick CSLB License gg9739 .Date Signed:6. 7. 11 Position With Company(Title) Projec min. Registration Nwnber: Registration DareiTtme: 2008 Residamial Compliance Forms bid Sb ES6899i6 XHj 131783SH1 JH Provider: March 2010 Wd9S:l 0102 OE daS l©310 Pa(,M.-rno U)a { Scto oust IQ ROBIN B. HAMERS & ASSOC., INC. CIVIL ENGINEERS' PLANNERS • SURVEYORS 'I ... since 1981 June 3, 2011 City of Costa Mesa Building Dept. 77 Fair Drive Costa Mesa, CA 92626 Attention: Grading Inspector Subject: Civil Engineer's Final Grading Certification Reference Project Address: 1036 Palmetto Way Lot 5, Amended Tract No. 16917 234 E. 17TH ST., SUITE 205 COSTA MESA, CA 92627 Phone 949/548-1192 Fax 949/548-6516 I hereby approve the final grading for the referenced project in accordance with my responsibilities under the Orange County Grading and Excavation Code. Final grading and drainage of the lot has been completed substantially in conformance with the approved Grading Plan as determined on May 31, 2011. Sincerely, ob'n B. Harriers R gilstered Civil Engineer RCE 31720