HomeMy WebLinkAbout308 ALTA LN - Building Permits� CIT� OF COSTA MESA �
�,��'TpMFs'q BUILDING DIVISION
t
F�gg 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.costamesaca.aov
� � 6 FOR INSPECTIONS CALL: (714) 754-5626
�°"°�^`°`� PERMIT NUMBER: M12-00058
PERMIT TYPE MECH
APN: 93420014
JOB ADDRESS: 308 ALTA LN CM
Vicinity: HALLWAY CLOSET
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 04118/2012
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT FAU < 100 K BTU LOCATED IN HALLWAY CLOSET.
COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER:
PHONE:
APPLICANT:
PHONE:
Address:
City/State:
EDSON, CYNTHIA MARIE
MC KENNA,VANESSA
949388-9484
POLAR BEAR HEATING AIR
34593 CALLE PALOMAUnit: UNIT B
DANA POINT, CA ZipCode: 92624
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
Address: 308 ALTA LN Unit:
CitylState/Zip: COSTA MESA, CA
Address: Unit:
City/State/zZip:
License No. 968411
PHONE: 760-712•0746
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(omia statules and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
Oy �F }, INSPEC710NTYPE DRTE INIRIALS GO�Ep INSVEG110NIYPE �. ,o�� �T IN�A/LS �/�
1616 Fixed System Final Fire Prevention 206 Final Mechanical �—r U �` � Z v
1266 Pool Spa Final 208 Final Plumhing
200 Final Re-Roof 210 Final Eiectrical
201 Pinal BIocWRetaining 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:
I hereby affrm uncfer penalry of perjury one of �he following declarations:
❑ I have antl will maintain a certi6ca�e of consent to self-Insure for workers'
compensation, as piovided (or by section 3700 of the Labor Code, for the
pertormance o( lhe work for which ihis permit is issued.
❑ I have and will maintain vrorkers' wmpensation insurance, as required by
section 3700 of the Labor Cotle, for the peAormance of the work for which Ihis
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier. _S'l�1 � �U�� h
��(TM1ia'sedion nretl iroat be mmpeted A(hepermit is value0 at or�e huMred dollars (8100) orless )
Policy,Number �/ ��� �� Z�� ��
❑ I certify that in the performance of ihe work tor which this permit is
issued, I shall not employ any person in any manner so as to become subject
to ihe workers' cpmpensation laws of California, and agree that if I should �
become suEject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
�`���- `a � / ���
`� ^P�Iicanf5Si8^aWre r-'D'a�e _,
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
($700,000), IN ADpITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED POR IN SECTION 3706 OF THE LABOR CO�E, INTEREST, AND
ATTORNEY'S FE�S.
LICENSED CONTRpCTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 o(ihe Business and Professions Code, and
my license is in full force and effecl.
'�/� J
Li�r-(' � " �- �� �CIaSs;fta.• G 2
����'-�-- �i,�i .F// —
Con�rac�orsSignawre (y.�ate �
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that [here is a wnsWction lending agency for the
pedortnance of ih� work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lendefs Name:
Lender's Adtlress:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm �hal under penalty of perjury that I am EXEMPT FROM THE
GONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
constmct, alter, impmve, demolish, or repair any s�mcture, prior to its
issuance, also requires the appliwnt for such permi[ to file a signed statement
�hat he or she is licensed pursuant to lhe pmvisions of the Contractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of ihe
Business and PrOfessions Code) or that he or she is exempt lherefrom and
�he basis for the alleged exemption. Any vi0lation of Section 7031.5 by any
applicant for a permit subjecls the applicant �o a civil penafly of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business antl Professions Code: The Comractors
License Law does nol appy to an owner of property who builds or improves
thereon, and who does such work himself or herself or ihrough his or her own
employees, provided that such improvements are not intended or oftered for
sale. I(, 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 EXCWSIVELY CONTRACTING WITH
LICENSED CON7RACTORS to construct the project (Sec. 7044, 8usiness and
Professions Code: The coniractors License Law does not appty to an ovmer of
property who builcls or impmves thereon, and who contracis for such project with
a coniractor(s) license pursuant to lhe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
309-06 (3I0])
Owner IFi verifetl by tlrivers�e. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N:
❑ I hereby certify thal no excavalion fve (5) or more feet in depth iMo which a
person is required to descend, will be made in connection vnth work au[honzed
by lhis pertnit, and tha� no building structure, sca%olding, falsework, or demolition
or dismantling thereo(, vrill be more [han thirty-six (36) feet hi9h. (Chap. 32, Gry
2, Art 2, Sec. 341. Ti�le 8, California Atlministra[ive Code).
� As owner-builder, I will not employ anyone to do work which would
require a permit from lhe Division of Industrial Safety, as noletl above, unless
such person has a permit to do such work from the division.
Signalura Date
Division of Industrial Safery Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certi(y a Business Plan for emergency response to release or ihreatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ety 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 ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperaWre and pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for awtely hazardous materials? ❑ Yes ❑ No
(Section 25533 o( the California Health and Safery Code, with some
exceptions, requires registration with �he Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal �o or grea�er than a weight of 500 pounds, or a
volume ot 55 gallons, or 200 cubic teet ot compressed gas at standard
IemperaWre and pressure).
3. Does or will the applicant or presenl or future huilding occupant neetl to
prepare an RMPP (Risk Managemen[ and Prevention Pro9ram for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the California Health and Safery Code provides ihat the
Costa Mesa Fire Department may require the preparation, cerlifcation and
filing with lhe Fire Department of an RMPP 6y businesses which are required
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
lhe vrork which is the subject of this application a permit for such constmction
or modification fmm the South Coast Air �uality Management District or from
any other air pollution con[rol tlistnct or agency? ❑ Yes ❑ No
(Section 65850.2 of ihe Califomia Govemment Cotle requires Ihat Ihe requested
information be fumished on applications for non-residential building permits).
6. Will any part of the facility to be constmcietl under lhis permit be within
1000 (eet from the outer boundades of a school? ❑ Yes ❑ No
Qf "yes", the (acility must meet ihe requirement of Sections 25534 and 42303
of �he California Healih and Safery Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control districi or agency is required for the work which is the
subject of lhis application, have all of the disclosures prescribed by California
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from Ihe appropriate air polWtion
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perlury the
information given above is correcc I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
� SignaNre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certiry under penalty of perjury that I have reatl ihis application and stale ihal
the information given is conect I agree to comply with all state laws and ciry
ordinances relating to building construction, and authorize representatives of
ihe City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by [his permit until final inspectio,/n.
�i1 /1 t1�3n M C A�I i�
Signat e of Legal Owner(s) � Date
`�„ �'I�/ �� /Z
AnElor'AWM1orix^eOApPIIwnL.,. /Dale ' ^
Siv�pliiicd 1'ruscriPfivr CerCiCicalr of C
Climuln'Lunea i uuU 3- 7
�kn L� n�
cr.:2111181Cc�eidci:ti�dF.71'AC'Aluu��ctiuu,r CT_:I.1:-AL7�-:ET1'AC
L»lorcaiucm
��I �%i1��`l.
Cnnthiionetl �Lucl msulauui�
Equinmcul Tyv � Litii Wiininuuu EflicicncP� �luni in�ex renuiremen� i 'Phem�oslal
O Pxcl:�iFeA Umi �l Gver 4(I 1( duc e
B Purnucc �I AFUL O V D CO7'_ � Q,��- ❑ Selb;icl: �
Sefved�bgeNs�cm added ireilpa. , m �
❑ L�duorCol LISEL'R ! D HSI'P ' % �` y (//nmah�eadp/u�o.rvnt �mr.v Lr
❑ Cnndeusiug Unii ❑ E�k _ .� lte::iauumr. s � nf .Fu�auditio�C��'Spnec wainHu�ll �
❑ Ullic� . y�5 J. fi(CL l. i�-S)
!. lqu[pmenl'I'YPc�. Choos:: lhn cqu�pmdnl bein�l uutt¢dled; if murr. lhmi un,.sYcwni, usc «uoUinr CI�- I11-/il.'1�-h1 VAC' ioi nach.spmnm. � .
"L IY11ni�utnn Ltp+ipmeu� �fC�ciuucier.�..17� SEE[l, 7Y'iw APUL. "1,741SPP ti�rlypici�l rnaideulial ;:gStenu. ... . .. . .... � '.
Cuntrnctm� (ll�icmna�Cntly�i �AntLur's {]lesponsibleDesieuer'��17eciurntim� Stf�tetnent) . ,
� I cerliip tlim [his Cerliiicme o(Gomplhmee documemaiiun is accuraic und complete. � - .���. -, -. �.
• I um eligible underD��visiou :t�of Oie Cn1llonu�i busines,; vn� hraiessimis Code tu �ccepi respousiUiliip for Ihe desi�,m idenliiied�on this
CeniLcaie of Compllance. � � � � � � � � . .
I cedity �hm ihe ener6�� fenwre.:: nnd perinnnnn�e specif�cn�ium: Sm� Ihe tSesi.�,�i idenliLed ou ihis'Ceriiiicale aP Campiiancc coniomi tn�ihc
- - requirements oi'7itle 2A, ]',�r1;i I and G of tl�r CaliGomia Codc of ltegula�iunc. � ' ' � . . - - _. . .
�. The design ienm*ec identified�on tlus CerliLcate oFCumpliances�re consisient wiih iVie mfutmafimi Jucumemed on olhei,applicuble�_��. --
complience ibrms_ worlsY.ir�i�w culculalion� pl•ans and speciGeatiuns Submitted�tu"tlle eniorcemeni ngency (or�ppprovat witli tlie,p.e,imj�. .
_ � . . ... ._.. .. � . ... : . ,
ao4licaqun: . . . � . . . . - ... . .. . .
�Name: G'I !1'C S S . �. /.'•.,i _ C h 2�f9 � i � � � .SiNmmme:. .,. .. . . . .. .. .. . ... . . _. �:: ._ .
, � ... . .. .. .. .. . � ._. �.
�.Companp�� I - _ .. . ... :.. . ....:.:.. . .: _ .. �. . . .. . _.. . bare: -
�2 / G G� .�G.�. !�7 v��- r"�� . ./i rr' . . . . -::�(.: � (.. �., Z U.��._.. .
Hdnrea� I ��%.� ._.. C �.�.I <. Q (n'. lGh'1 a(� � . ..__...;:. .... .j�Lmense:� W � � ��r - -. -
I
.C�ty/Siaie(Zip�. �II {'� � ,r �c i .�� . C'� . . � ,Z �:`2 `' . . . Phone�. �i k 4 � 3 � Y j �( �' �-1 �
.;
'L(1(li; ISeeidenlitd Con�pliancc Furi�u 64u���L'mrn
1'i'�/lbVJ/V(1)%Vp /II�T,'u'l.Vl.'1
Ddh��Ci��;'TG>,�..�I�!£; ��i�IT1:I L`L'�,�'TE'.Tt£-IL'fLL�`S23r�
�(IUR I:uilc[ir2!,� L�rier�;,',.1' L7f.'�I�ici�ric•�� ,5't:t�nd:�rc[� i�e.s�itl�;ni:ixl L7Vi� C' f�.I�Ce;r�.itiou,t�
Cdirr<<o.i�.c��. Zor�es 7 aud 3 Clirutt�*h 'I G z' (, .- �.nsti�,..��'sr�
P,US'IN�S6' dN77 Y120TI9SSION� COD� SL;C'ITON 7:l:lfi
\%+iilf'ul or deliheraie dinreµnrd and violation of'Yhr. huildinp, Iriw:;, mr.ludii�g th;: Cafi'f'orni:� @luiVd'in� Cudu, �ind
Inenl pennir requrremenGe conetiwtea a oauec, f'or diaoiplinnry� aetion fi�om thr. Gunu�acior;: Sta6c l.,iceuse Finnrd
worlung in coi?luncuon wllh lhr. local �uildnig department. "I�l�iis ucuon may r.ansisi af finrs� up tu .115,U00 pe,r
viol�uinu or.vuxpr.namn/rr.vonavon Af a r.onfruotor's licr,nsc. �
l4�LCC,t� fS A 1'GILMI'f KL;OLIA�]lY
A wraten consu�uction pernvi sht�ll ba: ohC�ined fi�om the e,nforcemnni a�;r.nr.y prior tn tl'ia erer,tion, r.onFnvelitm,
rcr.onser��et�on, met�iV6�tinn, retocation, nr ateerution tSf nny mer,hanrcal syetem, eace��i u�; perinitt�ed ai�i p�ppendb;
Cl�u��cer 1, Section I l"l.^ o( Ihc'l00 % Cailiforniu Ma:cho-micul Codc. I'rojecu; requirin��, permits inol��de, i�m nrn noi
limitcd ta
• lUew ENAC insCallalion �
• FiUAC Chan�;enul
� 1Zeplacem�N nf iurnucc, c,oit, PA.U, or cnndeuser
�• Reloc�tion of nn oxieting I•i\/AC unil
�• btd�ding nr replueing more than-40Y� duefin6"in uncorrditionecl spucr�
200F 7:TTIL,7)I1JG L;N�RCI' EPrICI�N.C�' �Tf�NDt1I',S]5 (Titlr. 2!, J'nn (1 ItL'C1UI1:�fV�T�lT4 II+1GLLllDL'
L Eleating� equipment must have a minimum 78°/� AFUB (Er,6eption� W all�k�. tlnor fiirnaaes; room hcaters).
2 Central air.ronditioneea S: heat pumps lees Phairh�,000IItiu/hr must havc a minimum I; S�ER. � �
�. Ne.wly installed or replaced ducts must 6ave � mi[umum insul�tion value of lt-4.2. -
4. f�. setnxcl: type thermostaf (2A hr clocl; wit6 Eour set poutts) ts reqttired for all altecutiotts.
S. 1Jaw or replacemen� duetfi muFi meef the mandator�� reyuirements of Scceiou 150(m i�
•e All joinCs and opemngs in ttie '�n Yhe FNAC syetem must'oe sealed.
�o Unly UL 181, UL I G1A, or UL 1 F 1B approved tapes or mastir. .shall be used to .eal ducl openings.
�� Gonnearions of inetals ducts and thc inner core of�fle;; ducts shall oe meciianically fas�ened. Fle>�. ducts
musl he connected �sino �i metal slesve/coupiing.
�� Flex dur,ts [nat are susoended mus� he supported everv 4ft. m�u: for i�iorizont�il runr. with no morc than 2"
of sag be.cween supports and 6 h. mar, Yor venical runs.
6. "Cne CF-GIt-fYI�CII-114 must he completed and sio ed by ths mstallint wnttaet�n�- 'Phe Inspee[or will collect
this forn� and verify tnat the model numbers are [he same as the installed equinment.
PAI� +,�"�ir
308� I. "AY 15-75��..cnOO 651 � 2�1.�i8
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
Fo pl' ant to 'l/i C pletely APP�ICATION FOR BUILDING PERMIT
RECEIVEDBV DATERECEIVED D�T��I$S�EG75
BUILDING 1 �y
ADORESS �
OWNER 5L / � �
A.P. NO.II -3 �'O O� PER�IA O �
n BVILDING ,// /�
ADDRESS J. � 1/' /"� . �� �' P.DDFESS �O� /T' C./
Z . /�
/ / [ ACT �7 LOTR BLOCK
d U CITY NOL,� �L'��j
Z Q CAN5iRUCTION W ADD A P
O N LENDER
am �
J � BRANCH ' q ..,
J N OWNER O}�'E'�-%/L��
m J AODRESS VALUE
m HITECT n TEL. � q SE �
J a OR EN INE I � �K ry,��/ y00L
Z Q �,'/ /� FIRE
W 2 ADDRESS/ % /'S ZONE VPE� ROVP T
a w APPROVED '
J O CONTRACTOP G �/ B�' DATE �
m� ADORESS/ �' �� ��
W W � TEL. Z E NO.OF USE OF NEW
z= CITV �� NO.� %)� P�� BUILDING
H
w O STATE CITV VARDS APPROVED VAROS APPROVED
N(L UC.NO. ,�Q�� f LIC,NO. MAINBUILDING ACCESSORYBUILOING
7O � (FFOMC/�5 EET)
SIZE � � �� �a / NO.OF BLIX'>S.
OF LOT NOW ON LOT FRONT FT,
USE OF �j �/ '/
EXISTING BLDG. C4/Y� SI FT ii � /
H SIZEOF / /` NO.OF .7f/ �S /
Z NEWBLDG! f� ROOMS✓�'� STORIES / L.SIDE FT. FT.
a EXTEFIOR WALL t��6 ROOF
V COVEflING GIX30 COVERING/Il-L� REAq FT. FT. -
J USE OF BUILDING ANO WORK TO BE ERFOflM��� DISTANCE BET. BET. MAIN &
a MAIN BlOGS. ACCESS. BLDGS.
a
Q VAR. �1`- DATE
O Q� � C.U.P.#`- APPROVEO
F . / APPROVED� � ��
N
p t40LD F�Oit SPE IAL R �N'!a
UI hareby acknowledge that I have reatl this aOP�iwtion and state �, �/ L
� ihat the above i�tormation is correct end agtee to comply with Q
a. all laws regulatin8 b�iltling construction, end I shall noi emplDy ,
F any person in violation of the workman's compensation laws ot
m
y the Sxate ot California. �
? I hereby certify tM1at I am properly licensetl as a contractor under SQ: FT. - C
the State ot Calitornia Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
m
C�apter 9, and that such licenses are in tull torce antl effett, or I THE PURPpgE OF ESTABLISHING A PERMIT fEE ONLV: Q .
am exempt trom the provisions of the State of CalitOrnia Business
antl Professions Lode, Division 3, ChaPter 9. VALUATION ��� ry�
, PERMIT FEE $ ]
Signat�re of I/� t,./ ���- ^/?N, wr�- f : E
Permlttee � 7 $ � �Ll/�11 PWN CHECK $ (d ; .
��v cJ � a
Authorizetl ABent -''•. • . ��' ... •,:.;,;::LL
TOTAL FEE: $%_�. :� 'E' -