HomeMy WebLinkAbout889 CAPITAL ST - Building Permits� �
CITY OF COSTA MESA
�,0�'TpMFs,p BUILDING DIVISION
F` ; 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
'�°�-��^"' PERMIT NUMBER: B11-00405
PERMIT TYPE B_ROOF2
APN: 42239201
JOB ADDRESS: 889 CAPITAL ST CM
Vicinily: HOUSE AND GARAGE
Squares: 2600
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
11/15/2011
RMD
$9,999.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL A BUILT UP ROOF SYSTEM ON A LESS THAN 2:12 PITCHED
ROOF ON AN ATTACHED HOUSE AND GARAGE, APPROX 2600 SF. REPAIR AND REPLACE SHEATHING AS NEEDED.
COMPIIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment wlinspection Card
OWNER: SMITH,DORISA
PHONE:
APPLICANT: DICKEY, JOSH
PHONE: 562-944-5817
CONTRACTOR: CASSADY ROOFING INC
Address: 13021 LAKELAND RDUnit:
City/State/Zip: SANTA FE SPRINGS 90670
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $181.25
Reinspecfion Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 889 CAPITAL ST
City/State2ip: COSTA MESA, CA
Address:
City/State/Zip:
License No.
License No.
PHONE:
License No. 531906
562-944-5817
CEL�:
PHONE:
PHONE:
Unit:
Unit: :
TOTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3I18I2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and �he following Federal holidays
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksaivina Dav and Christmas Dav
NOTICE: The work aulhonzed by this permit shall comply wilh all applicable handicap access requirements under Califomia slatutes 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 ihis permit to be considered legal, such work must compty 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.
COUE R. INSPECPONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
2D0 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Pire Place
203 Final Sign
204 Final Demolilion
Da7E INTITIALS
�� �'� � /Y
CO�EI INSPECPONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
onte iximus
�
WORKERS' COMPENSATION DECLARATION: �
I hereby affirtn untler Oenalty of perjury one o( lhe following declarations:
❑ I have antl will maintain a certifica�e o( consent lo sel4lnsure for wvrkers:
compensation, as provitletl !or by section 3700 0l Ihe Labor Cotle, for the
peAormance o( the wvrk for which this permit i5 issued.
❑ I have and will maintain wvrkers' compensation insurance, as required by
section 3700 of the Labor Cotle, fw the peAortnance ol lhe work (or which lhis
permit is issued. My workers' compensation Insurance carner antl policy
number are: /�
Carrier. �' Q I i t'lli�l � q
(inu secfnn neetl nd ec cprpkletl /tfre pemN is vah�e0 al me nwqiM tldarslf I00) nku)
PolicyNumber: U/,S: Z2 $(670162
❑ I certify that in the peAortnance o( Ihe wvrk !or which this permit is
issuetl, I shall not employ any person in any manner so as lo become subjec�
to Ihe vrorkers' compensation laws of Calilomia, antl agree that if I shoultl
become subject to Ihe uorkers' compensation provisions of Section 3700 of
lhe Lab Cotle, I shall IoAhvrith wmply with these provisions.
. 1
APN�m��'s SgnaNre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm Ihat i am licensed untler provisions of Chapter 9(wmmencing
with Section 7000) o( Division 3 of the Business and Professions Code. and
my license is in full lorce and eflect.
Lic. # Class # C-3�I
Gomratlw's SignaWre �e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a wnstruction lending agency for the
peAormance of the v.ork forwhich tltis pertnit is'ssuetl. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Adtlress:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm Ihat under penal�y o( perjury thal I am EXEMP7 FROM 7HE
CONTRACTORS LICENSE LAW for lhe follOwing reason (Sec. 7031.5,
Business and Protessions Code: Any cily or county wt�ich requires a permit to
construct, alter, improve, demolish, or repair any sWCNre, prior lo iis
issuance, also requires Ihe applicant for such permit to file a 5ignetl 5talement
ihat he or she is licensetl pursuaN to the provisions ol lhe Contrac�ors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( the
Business and Prolessions Cotle) or thal he or she is exempt therefrom and
the basis for Ihe alleged exemD��on. Any violation of Section 7031.5 by any
applicaN for a pertnil subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wdges as their sole
compensalion, WILL DO 7HE WORK, and the strucWre is not intended or
offered for sale (Sec. 7044, Business and Prolessions Cotle: The Contractors
License Law tices not apply to an owner of property who builds or improves
thereon, antl who dces such work himsell or hersel( or through his or her ovm
employees, provided that such improvements are not iNended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burtlen of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as owner ol the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the Oroject (Sec. 7044, Business and
Professions Code: 7he contractors license Law dces not apply to an avner of
property who builds or improves thereon, and who cont2cts for such projecl with
a contractor(s) license pursuant to the Contractors License Laws.).
0 I am exempt under sec.
Business antl Professions Code for this reason:
Signawre
]OSl�afi�310�)
O'vmer ID verified by driv�ense. � Yes ❑ No
Driver's License No. Expires:
Venlication of Ownership by (type of tlocument, i.e. - propeny taa bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation frve (5) or mpe feet in depth into vfiich a
person is required to descentl, will be made in connectbn with work authorize0
by this pertnit, antl that no building strucWre, staffdding, lalse�wrk, or tlemolitbn
or dismanlling Ihereol, will be more Ihan thitly-six (36) feet high. (Chap. 32, Grp
2, M 2. Sec. 341, Ttle 8, Califomia Atlminist2tive Code).
❑ As ovmer-builtler, I will not employ anyone to do work which vroultl
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permil to do such work fmm Ihe division.
ApvbfJnl's SignaWre Dale
Division o( Intlustrial Safety Permit Number.
HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or luture builtling occupant neetl to file and
certily a Business Plan for emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 of 1he California Health and Satety Code requires. with some
ezceptions. thal a Business Plan be Ned with the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantiy of hazartlous materials equal to or grealer than a weight of
500 pounds, or a volume of 55 gallons, or 200 cuDic feet ol wmpressed gas
at standard IemperaNre and pressure).
2. Does or will the applicant or present or fuWre building occupant need to file
a registration form !or awtely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Satety Cotle, with some
exceptions, requires registration wi�h the Costa Mesa Fire DepartmeN by
each business which at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of wmpressed gas at standard
temperaWre and pressure).
3. Does or will the applican[ or present or fuWre building occupant neetl to
prepare an RMPP (Risk Management and Prevention Pro9ram for acutely
haZartlous malerials)? ❑ Ves ❑ No
(Section 25534 of �he Califomia Heal�h antl Safery Code pmvides thai the
Costa Mesa Fire Department may require the preparation, certification and
filing with ihe Fire Depahment of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire DeDartment.
4. If an RMPP is presently required, has Section 25534 of the Cali(omia
Health antl Salety Cotle heen (ully complied with? ❑ Yes ❑ No
5. Does or will the applicanl or present or luture �uiltling occupant require for
��e work whith is Ihe subject of this application a permil for such construclion
or modification from the South Coast Air Ouality Management District or (rom
any other air polWlion control districl or agency? ❑ Ves ❑ No
(Sedan 65850.2 ot the Califomia GovemmeN Code requires that the requestetl
in(ormati0n be fumished on applications far nomresidential builtling pertnits).
6. Will any part ot the facility lo be construcled under this permit be within
1000 feet from the outer bountlaries of a school? ❑ Yes � No
Qf "yes', the lacilily musl meet Ihe requiremenl of Sections 25534 antl 42303
ol lhe California Heallh and Salely Code).
7. II a permil from Ihe Soulh Coast Air Quality Management DiSMcI or other
air pollulion control dislrict or agency is required (or the wnrk which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Salety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf yes', allach certificate of compliance from Ihe appropriate air polNtion
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree lo comply wit� all state laws and
ciry ordinances regarding Hazardous Malerials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have reatl this application and siate that
the inlormation given is correcL I agree to comply with all state laws antl ciry
ordinances relating to building cons�ruction, antl authorize repreSenWtives of
the City of Costa Mesa to enter upon the above-described pmperty (or
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by Ihis pertnit until (nal inspetti0n.
gnaWreoiLegalOwneqs) Oate
i ^ ���
And/o� PulM1onreG Ap01¢ant Da�e
ve Ccrtiticate ui' ComPliance: Residential • . CP'-1R-ALT
ltesiderttird Alteratiuiis' (Ya��e 1 ut'
Prui��l Nr�me: _ , Clim:ite'Lone # � � N of Storiu
� nDaQUC .�11�'(dCC 7)CL:IIIS Ror the fun�ed por(ioned of Mass Walls sec Turrin� Strips Construction Tablu bClor•. �
Tug/ I Assembly Name
1D� orTvoe�
Nore: Fw�
Material Spacine, 0- JA4 Table Caviry
and Size'' or Other3 factor" Numbers R-value
�
rc�(orConlinuouslnsula�ionR-value,seePa¢eJA4-3andEqumion4-!. P
Assembly
1. For Tag/ID indicn�e the identificaiiai name thal i»atchrs Ihe bui(ding plans.
2. Indico�e the Assemb/r Nnme or rype: Rooj/Ceiling, N�'alls, Floas�, S(obs, Crow! Space, Doora� and etc...lndica�e the Frome type and Size: For
Wood, Meml, Metal Buildings, Mass, en�er 2z4, 2xG, a� eic... see JA4 (ar other possible fnme p ye o,ssemblies.
3. E�ver tHe thiclniess for mass in inches or Syacing benveen (raming mem6ers enter; 1 G'or 24 "OC; or O�herjor a!! other assemb(�� description
such ns Cnncrete Sandwich Panel, Spondr'el Panel, Logs, Su'aH� Uale Panel and e7c.... .
4. Based on �hc Climare Zone: enter the Standard U fac�orfi�om Tu61e 15/-!1, C m� D jar euch d f(ereN u.ssemGlp Name ar type.
5. Enter Uee Table numLer (ha1 closelr resemMes Uie yroposed assem6lr. �
G. Emer drc R-nalue Utat is 6eing insm((ed in �he wull caviry� or benveen the Jnming; o�herwise, emer "0 ".
7. Enier tlie Conti�iunus hrsedniion R-ralue jar �he proposed ussem6lp; othe�wise, enter "0 ".
b'. Emer ihe rmv and cnlumn ojdie U-(nc�or value Lased on Column F Tuble N�imber and cntm� d�c Assem6l�� U fncmr in Ca(unv� J
). The Prnpn.ved �.r,emblr U-(nctor, Colevnn ./, mus� be equal lo a� /es.s than die S�mulnrd U-fiic�or' in Co(umn E �n conmh�.
Purring Strins Construction Table for Mass Walls Onll'
A B C U I: f� G II 1 J IC L M
!'raposed 7'+'n��erliex ufMosonr5':ind Cnncr'eic Added Inlerior or Ezterinr Ins�dntiun
N'alls I�rum Kefercnce in I�urring Sp:�ce frum lic(crence
Juinl A � mndin'I'ablc 4.7.5. 4.3.G. 4.3.7 .Iuini A i mndix'I':iblr 4.3.13
u .c � _ � _
V � , 1 _+ - V
o, o � .`_' n L ,.,
m �, = v.
Asscmbly �- j ° o� i- a c m�a 2" �,." Final
Mass Nmne or JA4 9'able .i � �v o` � �E - o �t m o� � m ASSeIn��y
m` o — �
�(�Ilicklle55 �� C NUIThcI' �' = t�i � t- L 5 L C 4� la] C' U-�aCI01" �.Oi1110Cp1
i I
I
I I
I I I I I I
/:egiavro�ia� nh�mherr Registrutiun Daie/7'ime: HER$1'rovider:
200b' Re.rideittia! Compliance Fornt,s flugusi 2009
Certificate of Comuliance: Residential •
Residentdn! A[terations
, Project Name:
�
Clima[e 7.one # � # of
ROO�ING PRUI)UCTS (COOL ROOFS) §IS](�12
Whex !he nrea ojez�erior rnojsurjuce tn be repluced �ceed.s niore llian 50% of (he cris(ing mnf aren, or more lhun I,000,/t, rvhichever is
less, fhe ne�v ronfing aren ixus7 meel Ihe roofiwg produc! "Cool Roof' reyrtireinen(s of §!52(b)IHi, 152(b)IHii, or 152(b)IHiii.
Check app(icable niternntive or ecception below if the roojalteration is• exemp� from the rnofing product "Coo1 Xooj" requirements. Note: /jany
nne oflhe allernatives or exreplion Gelow is checked, (he Aged Solar Refleclance and Tliermu! Gmi�lance reyuiremems jor roafing producrs in
,�I18(i) are nor applicable. Ua not.�N mble helow.
Cool Roofs Not Required in Climate Zones L12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
❑Cool Roofs No� Required in Climate Zones I thmugh 9 and 16 with a Steep-Sloped RooPs (pitch greater than 2:12) and product unit weight less
ihan 516/tt�.
Allerm�tives [o §752(b)lHi and §I52(b)Hii, Steep-slope roof (pitdi > 2:12J
O Insulation with a themml resistance of at least 0.85 hrfi��OFBni or at.least a 3/4 inch air-space is added to Ihe roof deck
over nn attic; or
❑ Existing ducts in tfie attic are insulated and sealed nccording to §I51(�10; or
❑ In climate zones 10, 12 nnd 13, wi�h 1 ftZ of free ventilation area of attic ventilation for every I50 ftZ of attic iloor area, and
where at least 30 percent of Ihe free ventilation area is within 2 feet venical distance of the roof ridge; or _
❑ Building has at least R-30 ceiting insuiation; or
❑ Building has radiant batrier in the attic meeting the requirements of §151(�2; or
❑ Building has no ducts in Ihe attic; or
❑ ln climate zones 10, i i, 13 and 14, R3 or greater roof deck insulation above vented attic.
Gxception to §152(b)1Hiii, Low-slope roof (pitch <_ 2:12)
❑ Building has no ducts in [he attic. -
Ofher Excepfions -
.❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
i 0 Roof constmctions that have thermal mass over the roof inembrane with at least 25 Ib/ft is exem t from the below Cool Roof criteria.
�- Note: ]Fno CRRC-] ]abel is available, ihis compliance method cannot 6e used, use the Performance Approach to show compliance, othenvise,
Check the a licable box below if Exem t from the Roofin Products "Cool RooF' Re uirement:
Roof Slope Product Weight Product Aged Solar Thertnal
CRRC Product ID Number� <?:12 > 2:12 < Slb/ft2 > Slb/ft� T e2 Rellectance3'4 Emittance SRIS
❑ ❑ ❑ ❑ p^
❑ ❑ ❑ ❑ p^
❑ ❑ ❑ ❑ pa
❑ ❑ ❑ ❑ ❑^
❑ ❑ ❑ ❑ ❑"
1. 7he CRRCYrroduc� /U NwnGer can Ge o6minedfram �he Cao! RoofRa(ing CaunciPs Roled Produc! Direclor�+ut ww�v.coolrooCx.orc/nrndimts/.searclt.n�m
2. Grdicate dm p7ie ofprndrrer is Leircg ured for tlre ��nof top, i.c .ringle N!y roaf, orpholi rooJ, n:em/ r�oj e1c.
i. /f Ihe Aged Refleclonce is no1 ovnilab(e iu,U�e Cool lioof8oling Cam�cil'r Raled P�roduc( Dirmcroty 11ien use tl�c fnilin( lieJlecla�ce valuc finm Ihe snnm
direciory and use Ihe eyuo7ion (02+p](/)���i���l— 01) m obiain n cn(cula�ed aged vo6ie Where p is ihe Ini�iol Solnr Reflecmnec.
9. Check bos if!lre dgedReflecim�ce ia n calculured vafue using Ihe eqimlimi aGove.
5. Calcidoie Ihe S2/ volue GJ� �csing �Hr SRI- Workshee� al hmr/hv�v�v enerrr ca eov/litle24/and emer Ihc residling valuc iri �he SRI Column oLove and attach �coJrv of
die SRI- Warksheet m IHe CP-1 R.
o apply Liquicl Rield Applied Coalings, the eoaiing must be applied aeross the entire roof surSace and meet the dry mil thickness or coverage
recommcnded by the coatings manufacturer and meet minimum performancc requirements listed in ¢ I 18(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roo(Coating ❑ Cemeni-Based Roof Coating ❑ Other
Regislrul ion Number: Regisaa�ion Dale/Time: t1E/LS Provider:
2008 Resrdentiu( Compliance Farms August 2009
Certiticate nl�
Itesitle�nitd Alterntio�a,r
1'rnjecl Namc: � . .
ce: Residential
M\
CT-] R-AL,T
(Pa;,�e 5 u1� ti)
Climate'Lm�e r, ��! uf 3turies
H�I:S VPf.It1P7CAT101A' SUMMAP�)' 7'he enjm'cemen/ ngene�� shoidd yqr apecinl unentmn +u �lie HEItSl�Jeasin�es a�pecified in lhi.v
checldfst belmr. �l con>y(eled und signed CF-4]( Fmvn 7br a7! d�e measures spec jied s!m!f Ge submilred to the Guildiivg inspecmr Ge%wz- /ino!
nUCi �iBnlin6 � 7�BSt111g H6/CSverj/iculiar fs r'eqzm�ed,for!liis rnena�ure.
❑ YES ❑ NO YCS�. ln Climutc "Lones � amd )-1 G, if more than 401inear feet oTne�r or replacemeni d�cts are insttilled in unconditioned
spt�ce, the ducts are to 6e setded per § 152(bjiDii u�id the neu�iy instuiled duc�s are Co be insultrtecl per §751(1:110.
❑�aCCI'T10N: Lzistinp duct systems tha�l are exteuded; �v6icL nre cunsh'ucted, insulatud m'sealed with ushestos.
❑ �'�S ❑ NO YLS�. In Climate Zones Z anJ 9-1 G, if tl�e exis[iug space-conditioning syseem (NVAC equipmen� and duceingj is repluced; the
ducts are to 6e sealed per §152(bpDi.
❑ yES ❑ NO l'�S: ln Climate Zones ° and 9-16, if tlie existino HVAC equipmem is rep7uced (ncluding tlie repincemem of the- air handler;
omduor condensing unii oi� a split sYstem, cooling or hea[ing coil, or the 1'urnece heai e>:ch�nger') the ducts are tu be
sealed per ¢152(b)IE.
❑ E�C�I'TION: Duct systems that are dncumented tu hnve been previouslp sealed confirmed thruugh HGRS
veriiicatimi in accm�dunce �vith prncedures in thc Referenec Residential Appendia P.A3.
� � ❑-�XCL�PT10�: Doct svstems with less tium 40 linear feet in uneonditioned space. ..
❑�RC�PTION: Existin� duc[ sVstems cnnstnicted, insulated m� sealed �vith asbestns.
i.Ct�CloOt'3I11 [,'hdYef - SF1Ilt Sl'SiBID HEPS verificnlian is reguireci_fm� rhi.5 measm'e.
❑ YBS ❑ NO YES: ln Climate Zones 2 and R-15, wl�en ihe existing HVAC eguipment is replaced (mchding the replacement of [he air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or l�eatin� coil; or the iurnnce heal
be veriLed ner F152fo11F.
Central ran Integrated (CFI) Venfilation System and Fan V1'att Draw
The veniilation renuirements of § 1.SD(o) do not applv to eaisEinc residenEial homes,
Ducted Split SYstems - Air Conditioners and Heat Pumps: Airflow HERS veriJication is reguir-ec! jor this measurc.
❑ Y�S ❑ NO ]'ES: In Climace Zones 10 ihroagh 1 i, when tlie existiog space-conditioning system (H VAC equimnent and ducting) is
� reolaced. the airflow and fau watt draw siiall be veriLed ner § 152(bp Ci to meet the requireine��ts of 6151(fl7B.
Document�tion Author's Declaration Statement �
I certit�� thac this Certificate of Comnliance documentation is accurate and romolete.
Name: Signamre�. `
��osh �� G � _/�
Compauy: vate�.
CG55c, �� 11 15 I I
Adaress�. � " If Applicable O CEA or � CEYE
i3(:Z� (� �qnc� 2.c�� (Certificationi!):
City/Staie/Zip: Phone�
S�n1� Fe -� � s Ci� 906�0 (sbz) 9yy- 58 n
Respunsiblc Ruildin�; Desioner's Decl�raliuu Statemunt �
e J am eligible under Division 3 oi the Caliiorniti Business �ud Pirofessions Code lo accept responsibility for Ihe buildii�o design identified on
this CerliScate of Co�nplinnce.
• ] cenify thai thc ena'gy fcaiures and pertm�mana.; speci5cations for the building design id�ntified on this Cerlific�ue of Compliance conform
to [hercquireinents of Titic 24, Varts J wnd 6 oi�the Culifornia Code of ]Zegidaiions.
• The buildiug design fentm�ey IdentiGud on l6ie Cerlifica�c of Complianec are ennsis�em with thu lnlormatiun provided ta ducun��cm this
bulldinp dusign on lhe olher applicable compliunce'fotms, woi Lshecis, culculutlons, plans �ud spedd�ic�uionti submiucd L�� the enfureemenl
neenev far approval with thia buildine permil �pplication.
Namc� SignaLLirc:
Compun�c Date�,
Address�. License�.
CiqdState/Zip: I 1'hone:
Far as,si.stwicc or que,stimzc i�egurtling I)�r.- Lnergl' Stm�dnrds, cmiiacl lhc Enerb�P IHntlinc at: 1-B//0_772-:;300.
Regfa'n��ninn IJmntier: Re�+i.vrmimr Iiuie/7unc: HLIiS' Proi�icier:
200F,' Residei�tiul Con�piiunce Forms
Aaigu,s� 200J
�
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•ouw�ssaem�ara: 889 CAPITAL ST
avr�ewsruYEivicxowx:SMITH DORIS A
wa+css gg9 C'APITAL ST
COSTA MESA,CA 92627
548-8292
�va�. �uuxa woxEsx
�qCNRECT OR F1KiNFEP:
1
IJICN.OP FNO.'S AUOXES:
IIC. NO.:
UNT:
UNT:
caxm�crarsru�ISLAND PACIFIC ROOFING (714)637-2493
coxm�croas�mwc17762 CAMERON ST
wowess:H.B. CA ucxo.: 631472
92647 uen: 2
110EN5ED COMflACTONS DECL1fl�TI0N: I Mreby elfrm uMer p�y d pe�ury Nm I em liceneed uMer povieima d Gheqer 9
(mmmenaM wil� Saclion ]000) d Oirnion � d the Buainen eM Pmime'vm Code. eM mY Waiw e in IUA brte eid eHed.
cmuc.No.:p 77pg uc.cuss:C 39 �c.No 6�3�14 A }j�(p � OS/97
o,�,: � co�mm«�Tr�Nh.� •�il�//�i��i%,
OWNEN 8 LOEH OECLANATION: I he�eby dfirm under pene�y d pe�uy ihq I em exemq Irom �he Camreeon liunaa law ta the
Iabwna �eeson ISeaion ]mt.s &m:�ns mie Prdeaebm Code: nm civ v muNy wt:di recune e v�b �o cantue. ed«. imprm�e.
demdsh, a repei eny aVucNm, pv b Ca eauvm, eho iepwrm tM epp4rani trc mic� qmN to fJa e sqmd ntetemeni Mel he a sM
a r��e v����� �o ma mo�� a me coov,e� ��.. �.. �cnaa� a t�ma�oo wnn saa�, �aao) a or.s�o� a d �n�
e�sinen ene araesniom cadal «inal n. «ena u e.emq �nerehom ene ine msa �« �he eMpM ssemqon. Nn �olmun d smon
]031.5 by eny eppliuN ttt e perrtM subjeGf IM eppliceN to a uvil pp�¢yy tl rol mpa Ihen Ma huMred dollen �5500�.
❑ I. m ovmer W �M P�DehY «nrv �VM� wth wq�e.+es �Mi ede mmC��. r,ill do Ne wnY ud Ne eo-uctun e'wI vNeMed
«oRerad br seb (Section ]wa.8�aresv eM PMmsionsGotla: Tna Cont�mon Licenae lewdoea ro� wdYm en owmr M MODeM
wro wu. a mv� m�. �a.no ao�.�,d,.w ��n «naw a wo�,� ne � na o.�, emaor�. o�� �nm.�n
'unV�*mems me ml iNaMed n diaeE la eeb. C. however. �ha buitlu9 a inpow�en e wtl v.'vAin one Ymr d cande�ion. ihs
ow�rer-0uiker xill heva tM WMan d provinp M a ehe AN ral [v�lp ur impwe la tM WToee ol eeb).
❑ i. e. o.�,�, a ma o�wem..m e.a�r �w�.a:�u ,.w, u�..e �,v.�ia. m�m�a u» wwea �s«�� �a,. a�s��. �a
Fidea.ion. coae: me wvmea. Licmae ler aos �a VAN �o m, owm, d c�w�v'�,o wld. « impiwm �narem .nd v.+�o
contreae 1« vidi pqaea v.iN a mu�aea�s) Ibened punuem to Ine Comraeas licanaa lewl.
❑ I em uanp uMs SM'vi: B. 8 P.C.. br thq �¢�:
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WOHKER'S COMPENS�TON OECLAX�TION: I Mreby elhm uMm peruryy d pa"ryry wro d Ne bAowiip Aederetona:
� I �ew vd wil meimen e uMiWs G m�uenl io eatlinwn la v.pkye' wmpenuiion, u pwked la Ly Seaion 3J00 d ihs labor
Cotle, la tM pMmnerca d tln xwk In Mich Ihw pa�M o u�ued.
x❑ � no-b d,e xi� me���n worwn• mno�u� veuiena. m'+aim.e M swion aroo w dm t.ec. eod.. a me w�wmm,c. a �n.
�������p��~ GO�DEN EAGLE ���� EXPIRES
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ad� rmme�: 11 / 2 0/ 9 7
(Thia eenion nseC nd W mnd&W I �Ir prmt b M we nurMreJ adian l3tWI n bv.)
� I calN � in iM pe�lormerce d �he wark br whN thu pamu e uwed. I MeY nal emqvy anY Ca*o� in anY menns m ev io
baewypneu e bjea lo IM xvMra' oompme�ian lews d Cafdomu. eed prae Ihet X I ehwk beewna wbjeC lo IM woMeri
c±� 9eapnyp bn a�a0 d�Ir lebor Code. I. m lo in aomM �e /V/�� fj(p'�.. �
Dae: % � AVd �//'/� ///.��
Weminp: a0un ��cun wortwi rompeiwtlon covxp� I 4whq �M �htl/ utlNct an rr�vloyw ro cr/Mnl p�n�lUu entl
e/vll flris� up ro on� hunareE tMuurd oa/Yn (SI W POOA ��ltbn b M� cwf ol eomvwiutbn, Gmep� u poHCM br In
Sxtlon JIOS ollM LNor COM. Iirtusa4 ����Ys l�a.
CONSTHUCTION LENOINO AOENCY: I hereby dfi�m uMx pemryy d perjury ilu� �hen is e mutivabn bMi�p epency /a �M
paAamaKe d iM �wrk M wM1id� Ili'v Wrmi u uund (SW ion 309], Cv. Cl.
LENOEfl'S N�IIE:
LENOEN'S 1DDXESS:
� CBfll�)' 1�� � hBVB 10941�10 9FF�Y'.BIIG1 Bfl.'� tl810 �� dl! Btbl! CI�IXRIB�OII O G�MM. � 41�� �O MIIIPF/ W11�18� t]IY � MIIM% MiNGlIMe
9M nb�e 18w9 AIB��Ig b Glildvq CWC4W�M Bld �IBfebJ BNIIOfRe Ie�tlenietlMf tl lhp lily to BM9f upIX1 tM B60.B�111Bn�IXIBj pTpelty
������P�p�°��°�FkANK MORANDA
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CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: B 081912
PERMIT NO: B 081912 PLAN CHECK NO; N GOVT: N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION : T/O 6 REROOF W/HUILT—UP SQ FT: 3,700
CLAIM VALUE: 3,700.00 CALC—VALUE: 3,700.00 GROUP OCC: R-3 /
COMMENTS: REROOF i500SF RESIDENCE W/HUILT—UP
xx��*x��t***ft*�*�eft�r*x**it+r**��rit+r+r+�at�rit**x�r*�r*x�***�x��r*�r�r*x�*��**x�x*�rx�***it�tit*�+�+E�*�e*+r**
Z O N I N G R E(J U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARRING REQ• PROV: PARCEL: 42239201 ZNE: REF NO:
PLANNING NdTES> .'
>
1F iE 1E iF 1F ik iF 1E 1E 1E 1E 1E iF 1E 1E;E if �k ff i! 1E 1E It fE ik 1k �k fk IE 1E ff 1f 1f 1E If 1E 1E 1E 1E if 1E 1E 1E if iE 1E iE 1E �IE iE f! 1E if fE iE fF �E!(�!f iE if iE 1E iElE iElf 1E 1FiI� 1! 1f iF 1f if 1F ik IE IE
D E V E.L O P M E N T S E R V I C E S R E Q U I R E M E N'T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: DATE; 3�
ikikifiEif1E1k1ElE1E1E1E1E1E1E1E1fIf1E1F141f� iE1E1f1EifiFiElf�ii�! 1EiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL�'SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP:/RES GRADING
PERMIT 87.25 ',50
SMIP/NON—RES
PLAN
ISSUE FEE .�
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL ,PAID DUE
TOTALS----> 87,75 0.00 0.00 87.75 87.75 .00
REVENUE DIVISION TOTALS--> COLLECTED: 87.75 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIAE SMIP/TOT GRAD.iNG PLAN—CHECK
87,25 ,50'.
iE IE ik 1E 1k 1E iE k ff IElk 1F 1f If iflE iFlE if 1F 1E k iE 1E if iE 1E if iE iE 1E 1E fE iE k 1E 1E fE 1E fE 1E 1E 1E 1E 4 iE 1i k iE iE fF 1k 1E 1f if 1k k 1f 1E 1f ff 1E 1E iE 1E if iF ff iE IF fE 1F ik 1E iE iF 1E 1E iE
I N D I V I D U A L F E E B R E A K D O�W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3700 REROOF BY VALUE RESIDENTIAL NOZONE 1:00
END OF FEES
3,700,00
83-BS-1997/p9;82 Atl/fB7.75
PEkMI TPT981912
�
CONSTRUCTION AN� PLANNING P00� SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
i. Temporary Electrical Service or Pole- 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
- 3. Electrical Conduit-Ut"rlity-Undrgrnd. 54. Forms .
4. `Electrical Conduit�Uniirgmd. 55. Electrical 8onding
5. 5teel Reinfarcement 56. Rough Plumbing & Pressure Test �
��6' Etectrical UFER,Grnd. 57. APPROVAL 70 COVER�GUNITE �
� 7. Footings - 58. Electrical Con�uisUndrgrnd. '
.`�8-. Foundation " 59. Gas Pipe, O Undrgr�d., Test
- <.
9. Wa[er Pipe-Undrgmd. : 60. Backwash Lines, P�Trap, O Undrqmd.
10. Structural Floor''SYstCm 67. APPROVAL TO DECK .
11. Property Sewer,�Lin�& 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-Fi�al
15. Rough Electricai�Conduit - 66. Solar SYstem-F,inal
76. ftough Electric�QViripg - ' 67. Pencing & Acc'�ss Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. flough Electrical�T Ba� Ceilirig 69. POOUSPA SYSTEMS FINA�
19. Rougfi Heating & Air Conditioniag , F�RE�DEPT.REQUfREM£NT
20.-.44ou�h Factor.y Ficepiace _ .� - ' _ = APPROVqL$': ' Permit # - ^
21. Ducts, in5truc[ure � "' ' ' � 70.-Under rourid H dro
m c, _ �t 9� Y
22..Ducta, Venti�ating ; " , r. � :�' ` -. 71. Product'Piping �Gas OOiI
23. Gas-Pipe-Rough & T�est -, x�' v� • 72, Undergr&und FlusFr • -
24.'Roof Framing -� � . � = . 7.3, Undergrnd. StoCaE�Tank � Gas O-Oii
25. Roof ShEathing � _ �-6-�-7 �j' 74.; Overhead Hyclrp .
6
26. T•Bar Ceiling (Structural) & Monpcoat �� ' - 7fi._ Dry Chemical _� -
27. -Frame and Flashin9 " - A't 76. Dry Stantlpipe� _� "_ '
' 28. Lathing & Siding •; ' . '- ' " 77� FIXEDS`�!STEAk FINAL_
29. Insulation • � . � _ •� ' ' 7$. FIRE PREV. FIR1%�L � ` '
� 30. DrywaIl,C�ailing _, ` - ';� � '�NEALTki DEP,T. RE�UIREMENT
31. Ptaster Brown Coat+ � ' � �- 79. FINAL�I.NSPECT70N t
'; 32. E�ectricaiPower (�pYet�Finai �' '� � 8¢. FOOD CERT161CATE tSS�UEQ
-' 33._finahElectric z;. - � � Ptotes: - ' ' . '. ' '
' 34. Final� He�ating'-& Air'Conditioniiig= _ - ` � - 'r ` - -
y - C�
35. �Final Gas PiPe-Tes�, - .-. � � ' ' - - - - -
36. Hood o�'fanopy _ - . -. � , `� _ - ' ,_ "
- - �,
_ � . .
-� 37. Fina1 Factory Fireplace - .- - � � , •
• 38. Final Plumbing � � ' ' = �
" 39. Water Service-Final - - , � � � , ' . -
- 40. Gas Servlce�Flnal ' ' • "' - � � • - - "
� � 41. So�ar pomesT[cFinal '- _ ` .. - , ' _ - ;. -
42. Backf�ow Preventer> . � ' � � - -
, �` � . ' �
43. Batkflow Irrigation k ! . � . . . - � -`Z.. � 7 �- - L� Lo � ^ v
44. Landscape luigation System` � ' � � - _ ` ����n
R. � �1�.�{ - C"`'j� - !/�_�Ta�-L��
'45. Sound F}ttenyation _ . � " K. - ���v �: :[� �� 1!/
� y �.�1 �- �d�
46. Mandicap•Re9ulatio�s ' ' = - - - �
47.-FINALSTRUCTURE&BUILDING 3`LK_y7�W`1`�� `'
48.�FINAL PLANNING • ' � , '" - i
r-
:49.�lectiic Release to Edison , � " -
50._Gas�telease to Southam CalifomiaGasCo ' - � : =
} <
51. CERT�FICATE OF OCCUPANCY � ''� - � ' -
No. Date
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. ' J � I ` �2
PropertyAddress ��� �I I��L
Owner I/vN�+C� -
Contractor I SLA� D ��Gf (=jG ��Iv� _
State Contractor License Number �3 �`1'%Z Classification ��_ I
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
❑ I further certi(y that I am the owner of the property. (Owner-Builder permittee only).
❑ I further certify that I am:
Owner of sole proprietorship company
Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shali deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
ey:
�s�.- � l � l�7
� Initia� I � Date
099p<6 W�itnBuilGmg On: Canary�ConVecmr. Pmk-Owner
---jst.h-Aa �h�fii�(G ��(N�6
I���� �mpany o Corpp��m�
S
Mdress
�(� Ot� �+Z�1-�
�I
Sig_ nalurR� ��� , {�� Date
�-i�d�� �/N�I
Printed or typed name
J
� 685�
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING �fQ �
ADDRE55 Q fJ
COSTA ME A. CALIFORNIA
OWNER ✓�%iQ.
MAIL t
AD�RE55 � 7�� [
CITY ;tfLtiM�C.(jj L
ARCHITECT ��
OR ENGINEER
�
ADDRE55
LEGAI
DESCRIPTION
A.P. NO.
SIZE /
EXISTING OLDG.
SETB9CK LINE FROM �q % (j �
CENTEF OF STREET �(J � REAR YARD �(j
TEL.. �
NO. �,
LIC.
NO. ��
/ IBLOCK ~ ITRACTp�{,L
IO�R/ NO.OF BLDGS. 'm//
Q I S� �IOW ON lOT ✓
NEW
REPAIR
BUILDI
RIGHT � /„7 �� LEFT �J �� /�
DESCRIPTION OF WORK
ALTERATION ADDITION
MOVING DEMOLISH
NO. OF
ROOMS STORIES
L ROOF
/ ^�/� . COVERING �,d-G
-� "��
��� u��.�,d� ;�
FINAI�CE DEPT.
nf ^'1CTn P F �
APPLICATIONTFOR PERM T
� BUILDING
FOR OFFICE USE ONLY
RECEIGT NO. �E� I��
RECEIVE� BY pATE RECEIVE� DATE ISSVEO
_..._._..�1 /_ i /!_! :%� L — v � e—.c
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONE � NO.OF TYPE /
PlANS / /
(/
—Y
APPROVEO
BY DATE
CORRECTIONS
. M. �l.n° . ]� )� 2 !�t �i: v - � 5T
USE OF NEW � f • ? D� � ,
BUILDING � v
D/`� �
, 'c �� A/L
I HEFEBY ACHNOWLEDGE THAT 1 HwVE FEI�O iH15 APPLIGTION 4N0
STATE THAT TME ABOVE IS CORRECT PNO AGREE TO COMPLV WITH ALL
CITY OPOINFNCES PNO STATE LtWS REGVIATING BIIIL[IING CONSTRUC-
riorv. / �, VALUATION (
SIGNATUftE OF ` �/e / PERMiT FEE $ $ v � �
PERMITTEE R/l J1
/�VOd PLAN CHECK E �'. S a
$ � /
Al1THORIZED AGENT � ^ TOTAL FEE S S oZ . 5 D veMi
\