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Home My WebLink About2436 ANDOVER PL - Building Permits' CITY OF COSTA MESA sva��N� c►�v�s►oN 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: B10-00128 PERMIT TYPE B_ROOF2 APN: 14144128 JOB ADDRESS: 2436 ANDOVER; PL CM Vicinity: HOUSE AND GARAGE ROOF Squares: 2800 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ,. Valuation: ISSUED 05111/2010 RMD $4,400.00 SCOPE OF WORK: TEAR OFF EXISTING MATERIALS, INSTALL 2 LAYERS OF 15# FELT ON A 4:12 PITCHED ROOF AND REROOF WITH 30 YEAR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 28 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO J08 CARD AND CITY PERMIT. OWNER: EDMISTEN, HARRY L TR PHONE: 714-335-0406 �- APPLICANT: EDMISTEN, BRIAN � PHONE: 714335-4406 ' ' CONTRACTOR: OWNER-BUILDER Address: Unit: City/State/Zip: ARCHITECT: ' ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund $o.00 $111.25 $0.00 $1.00 Address: 51 GRANT ' , CitylStatelZip: IRVINE, CA � , . , Address: � _ - � , , City/State/Zip: - - � License No. License No. License No. 000000 PHONE: - : . � , CELL: . PHONE: PHONE: Unit: Unit : TOTAL FEES $112.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3H 6/2010 - 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 the following Federal New Years Dav. Memorial Dav. Indeoendence Dav. Lahor Dav. Thanksaivina Dav and Christmas Dav NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(omia 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 wnsidered 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 ezpiration of this permit. CODE p. INSPEC710N TYPE 1816 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 FinalRe-Root 20t Final BIocWRetaining Wall 202 Final Factory.Fire Piace •c 203 Final Sign "'; 204 Final Demolition DRTE IN701AL5 -��~ )O �" J / OOE INSPEGPONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecUical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy DATE IN7171AL5 WORKERS' COMPENSATION DECLARATION: � I hereby aKrm under penalty of perjury one of the tollowing declarations: ❑ I have and will maintain a certificate of consent to self-lnsure for workers' compensation, as provided for by seclion 3700 of the Labor Code, for the petlormance of the vrork for which Ihis permit is issued. � ❑ I have antl will maintain vrorkers' compensation insurance, as required by sectwn 3700 of the Labor Code, for the peAortnance of the work for which this permit is issuetl. My workers' compensation tnsurance carrier and policy number are: Carrier: (This section neetl not be mmplefetl �the permAis valuetl af one huntlred tlollars (5100) a IessJ qvPo��lipq. Number: -IJ I certify Ihat in the pertormance of [he work for which lhis permit is issuetl, I sball 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 ihe Labor Code, I shal fo hwith comply with these provisions. /1 � /�Jr� 5�.��1 � � / SAp�ljf6canfs5ignature '�ate WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P�NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3�06 OF THE LABOR CODE, INTEREST, AND AT70RNEY'S FEES. � LICENSED CONTRACTORS DECLARATION: I hereby affvm that I am licensed under provisions of Chapter 9(commencing vnth Section 7000) of Division 3 of the 8usiness antl Professions Code, and my license is in full force and effecl. Lic. # Class # GonVacbr's SgnaWre Date CQNSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that there is a consiructbn lending agency fa ihe peHormance of the xork (a which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: lenders Address: OWNER-BUILDER DECLARATIONS: I hereby affrm tbat under penalty of perjury iha[ 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, alte�, improve, tlemolish, or repair any structure, pnor to its isauance, also requires the applicant for such permit to fle a signed statement t�at he or she is liceosed pursuant to Ihe provisions of the Contraclors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Code) or that he or she is exempt theiefrom and th� basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than fve dred dollars ($500).): as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl lhe structure is not intended or oflered for sale (Sec. 7044. Business and Protessions Code: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who does such woric himself or herself or through his or her own employees, provided lhat such improvemenls 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 diq not builtl 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 dces not apply to an owner of propeAy who builds or impmves thereon, and who contracts for such project with a tontracta(s) license pursuant to the Cornractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Slll.,L10 3�. W �^°�— 'bale"w OS]-06 (3I07) Owner ID verified by driJ�i `s llcense. es ❑ No ` � Driv S�L(�`'e`�i5'eNo. �i'�,jCs:� Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY �ERMIT CERTIFICATION: ❑ I hereby cert'rfy that no excavation fve (5) or more feet in depth into wfiich a person is required to descend, will be made in connection vnih work authonzed by this permit, and that no building structure, scaffWding, �alsework, or demoGtion or dismantling Mereof, wiil be more than fhirty-siz (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, Ttle 8, Califomia Administ2tive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a peimit from the Division of Intlustrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicanl's SignaWre Dale Division of Industrial Safety Permit Number _ HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle 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 Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by avery business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will ihe applicant or present or future building occupant need to file a regisUation form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with Me Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or grealer than a weight o( 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or wiif tAe applicant or present or luture building occupant need fo prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Heaqh and Satety Code provides lhat ihe Costa Mesa Fire Dep2rtment may require the preparation, ceAification and fling with the Fire Department of an RMPP by businesses which are requiretl to register acutely hazardous materials with lhe Fire Department. 4. If an RMPP is presently required, has Seclion 25534 of the California Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or fuNre buildng occupant require for the work which is the subject of this application a permit for such construction or modification fmm the South Coast Air �uality Management Oistrict or from any other air polWtion control district or agency? ❑ Yes ❑ No (Sectan 658502 of the Califomia Govemment Code requires that the requestetl in(ormation be fumished on applications fa non-residential building pertnits�. 6. Will any part of the faciliry to be constructed under this permit be within 1000 feet from the outer houndaries ot a school? ❑ Yes ❑ No (If'yes", the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safery Code). 7. If a permit from the South Coast Air �uality Management Disirict or other air pollution control disMct or agency is required for the vrork which is the subject of this application, have all of the discbsures prescribed by Calitornia Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If'yes", attach certifcate of compliance from the appropriate air polWtion control oKcer�. CERTIFICATE OF COMPLIANCE: I ceAify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signawre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certi(y under penalty of perjury that I have read this application and state that the information qiven is mrrect. I agree to comply with all state laws and city ordinances relating to huilding constmction, and authorize representatives of the City o( Costa Mesa to enter upon the above-described property for inspection purposes. f agree not lo occupy or allow occupancy of any building autholiz� yth�permitunti� Nins e£tion. / ^ / S� %/ /� '/ $jp,��lut ' e � r�s) Da e Antllor Aulhorizetl ApOlicanl e CertiFicate oT fllterations Yruject Nnme: General lnform��tion BuildingType'�i�SingleFamily ❑MultiFzmily Conditioned Floor Area (CFA): ltesidential Climate Zone #� ^ I# uf Stories EnSorcement Agency: Circle the Front Orientation: N, E, S, W, or degrees S/i Projecl Type: ❑ Alterations L7 Envelope � Fenestretion �Aoof [ Reolacement or Chane.e Out ❑ Duct Replacement � Water Heater �TE: This form is �io� to hc used %rn� Ne�vlr Cnnstrncted /3uildings or Addifian.s lirsulation l�alues For Oparyue SrrrJaces (/or Fanrhio uce the Masr and Fzrrring S1rip.s Consnvctime table be(ow) ' � Assembl}� Alteratiun ' � � ❑ 6pening of framed cavit�� alone-A1lerutions tlmr involve Ihe opening af�he fi�amecYcaviry� ofa wall, ceifirg, orJloor musl insrall the munduiorp minimmn inezilaiimi value per §I SG for the al�ered assembl��. Fill in Colamtt.s A-C and en�er mandalor�� insulatio�� value in Colunva H. ❑ Repfacement of entire assembly-Replucemenl ofan emire wa17, ceilirtg, orJloor aa�sembl�� re9uires the installa�ion ofComponenr Puckuee-DinsuintionvalvesinTa61e751-C. Filli��ColumnsA-J. . � ' SuCfaCC ID0tal15 For the furred portioned oTMass Walls Assembly Name or Tvoe� Noie: For ed'"`""" Standard Framing Tl�icknass, Material Spaciag, U- and Sizez or Other� factor" 7'nble beloa�. F I G Values Fro�n JA4 Table Framed Continuous ]A4 � i Proposed 7A4 Table Cavity Insulazion Assembly Assembly Numbers R-value� � R-Value° Cell Values U-factor° see PnRe JA4-3 ond use l. For Tag/ID indicme the identi/icatiap name that mmches Ihe building plans. 2. Indica�e the Assembir Name m� type: Roo(/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors• and ete.,.Indica�e the Frame type and Size.� For Wood, Mem/, Meia/ Buildings, Mass, enter 2x4, 2x6, or e1c... see JA4 far other possible,fr�ame ryye assembliu. 3. Eiv�er !he tliiclrness: far mass in iuches ar Spacino benveen framing membe�s enler; 1 G"or 24 "OC; m� Other for al1 other assembl�� de.xcriptian such as Concrete Sandwich Panel, Spandre! Panel, Logs, Sn�aw Bale Panel and etc.... . 4. Based on the Clinm�e Zone; enter the Standard U factor fi�om Tab1e I51-B, C or D for euch differe��t assembly Name or type. 5. En�er the Tuble number that closelp resembles the proposed as•sembli�. . G. En�er !he R-i�alue dial is being installed in the wall cavim or benveen the f�aming,- otherwise, enler "0 ". 7. Enier Ure Contiiiuous ]nsulnlio�� R-value for the yroposed ussembly; alherryvise, enter "0". 8. Lmer die rma� and colunm of /Me U-factm� value bused ar Colunm F Table Number and en�er the Assembl�� U-fuctor in Column J 9. Thc Propos'ed �Is•seinbh� U-Tnc(or, Calxrmn J, »rzrs� be equal to a� lers� than Ihe Stairdarrl U jacta� i�r Colunv� E to carepl7�. Furrin Strips ConsVuction Table for Mass Walls Onh' A B C D P� F G H 7 J K L M Propused ]'ruperties ut Masonr)' and Cuncre[e Added Interior or �xterim� Insulatiun N�alls Frum lieference in Purring Space 1'rom ReTerence Auint A�endix Table 4.3.5, 4.3.G, 4.3.7 Joint A endix Table 4.3.13 u �`c � c k9 E• m U � o j � v�� ': U R � o` o ci., �' v., Final Asticmbly �. � � o.� h" �`o ou_ �e� ,_'u Mass Name or JA4 Tablc �= ;, �� E � o t A �? $ r Assertlbly Thickness' 7' e' Numher' 4 j G ui = � �i 3 u° ce Q i � C U-fuctoi�'� Comment � Regi.ro�ution Number: Regisa�ation Daie/Time: HERS R�ovider: 200d' Residentia! Compliunce Farn�s fiugusl 2009 : Certificate of Residentin! �4lterations ROOFING PRODUCTS (COOL ROOFS) §IS](n12 areu of erterinr roof stmjace ta be repl¢ced erceeds nmre lhan 50% less, tlie ne�o roofing aren uuest niee! the rnoftng produc! "Coa[ CF- or area, or �nore thuu I,000 f'f, rvhichever is 'i, 152(b)IHii, or 152(b)IHiii. Check applicab/e ulternntive m� eeceptiou below if the rnof a/teration is esemplfron� the raofingproducl "Coo/ Roof" reguirerpents. No�e: If any one of (he adernalives or exceptime belom is checked, �he Aged Solar Re�leciance a�vd Thermal Emittance reguirements jor raofittg praduc�s in §118(i) are not applicab(e. Do no� Tll tab/e below. ❑ Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 witl� a Low Sloped. Less or 2:12 pitch. � . ' �£ool Roofs Not Required in Climate Zones J through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less -pr��ternatives to §I52(b)1Hi and §152(b)Hii, S[eep-slope raot (pitch > 2:12) �—U Insulatioo witli a thermal resistance oTat least 0.85 hr� °F/Bhi or atJeast a 3/4 inch air-space is added to the roof deck over an adic; or ❑ Existing ducts in the attic are insulated and sealed according to §I51(�10; or ' 0 In climate zones ] 0, 12 and 13, with 1 fi� of free ventilation area of attic ventilation for every 150 ft of attic floor area, and where a[ least 30 percen[ of the free ven[ilation area is wi[hin 2 fee[ vertical distance of the roof ridge; or . ❑ Building has at least R-30 ceiling insulation; or ❑ Building has radiant bacrier in the attic meeting the requirements of § 151(�2; oc ❑ Building has no ducts in the attic; or ❑ In climate zones ] 0, 11, 13 and 14, R3 or greater roof deck insulation above vented attic. Exception to §152(b}1Hiii, Low-slope roof (prtelv S I:I2J ❑ Building has no ducts in the attic. O[her Exceptions - ❑ Roofing area covered by building in[egrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria. ❑ Ronf ennstmctinns that have thermal mass mer the roof inembrane with at least 25 Ib/ft is exemnt from the below Cool Roof criteria. no CRRC Product canno[ be used, use the Performance Approach to show compliance, otherwise, Roof Slope Product Weight 2:12 > 2:12 < Slb/ft2 > 516/� ❑ ❑ ❑ ❑ Product Aged Solar Thermal T e2 Reflectance3'4 Emittana ❑4 ❑4 o^ SRIS The CIUtC Product ID NurnGer can be abinined fivrn Ihe Coal RoofRating Council's Rafed ProductDirectap� at ww�v.coolrnotr.nre/nroducts/sem�ch.nhn lndica�e l6e iype oJ'pruduci is Geing used (or !he rooJmp, i.e. sing/e ply roof, asphall raof, rneml roof, elc. //'1de Aged ReAec/ance is na� av�ilaGle in.lhe Cool RoofRpiing Cotmci!'s Raled Producl Dirrector�� then use Ihe Ini�ial ReJleclance value from die some direclm_p and use Ihe equalinn (0.2+0.7((1;,��— 0.2) io oblain n ca(culaled aged value. Wliere p is Ihe Initial Solar ReJlec[ance. CHeck bas iJtlre Aged Relleclarec ia n calc�dated nalue using O�e equolion aGove. Calculale fHe SR/ value bp using Ihe SR/- Wm�kxhee! al hWr//wmm enerev.ca.gnv/1i11e24/and en(er fhe resulting value in /he SXI Column ubnve and anuch acopr dx- SR!- 17�m•kshee� 101he CP-lR. � apply Liquid Tield Applied Coatings, the coating must be applied across [he entire roof surface and meet the dry mii thickness or coverage commended by [he coatings manufacWrer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating: Aluminum-Pigmented Asphalt Roof Coating �❑ Cement-Based Roof Coating . �❑ Other Regisn�ution Number: Registration Date/7'ime: 2008 2esidentiul Campfiunce Forms ' FIERS Provider: August2009 Prescriptive CerCificate ni' CumU��»�e: Residentia] R-ALT a 5 af' S) H�RS VL',RIF] CATl01� SUMMARP The en{orcernerv ngervcr sl�oadd pap syeclal c�uerviwv io Uie HCRS' lvleusm-ea� specijied in this cheddis� Gelow. �J comyl e�ed nnd signed CF-4R Form for nl! the measeu'e.r ayecilied shnll Gc su�mined u, tiie buildi�vg inspeclor Gefore Jl r�ul Duct Se8ling S. TeStillg HLIL,°�mri/icn�fo�� is reytm-ect/or�hi.r measanr. ' ❑ 1'L' S ❑ NO YCS, lu Climate Zones 2 and <)-16, if' more than 40 linear feei of new or replacement ducts �re inst�illed in unconditioned spnce, the ducts ure to be sealed per y152(b)1Dii und [he newly insWlled ducts m'e m be insulated per §151(1j10. ❑�XC�PTJO�: Lzisting duct systems tf�at are extended; whicli nre cunstructed, insulated m� sevle[I with t�sbestus. ❑ YiS ❑ NO 1'L�S: ]n Climate Zones 2 nnd 9-] 6, if'tl�e existing space-conditioning system (HVAC equipment and ductingj is replaced, the �ducts ure to be sealed per §152(bpDi. ❑ YES ❑ NO ]'L5: In Climate Zones 2 and 9-] G, if [he existing HVAC eqtiipment is repluced �(including the replacement of the tiir handler, oetdoor condensiitg onii of n spli! system, cooling orbeating coil, orTl�e funtece ]�ezl exchnnger) tl�e ducts are tu be sealed per §752(b)lE. ❑�XC�PTION: Duct systems that are ducumented tu have Ueen previousl,y sealed confirmed througL HLlRS . � veriticatiomin accurdance witL procedures in the Reference Residential Appendix RA3. , . .. .. . . � � � � - ❑�XCEPTIO�': Duct systems with less than 4U�linear i�eet in unconditionecl space. --.�� ..-.. . _.. ❑ ERCEPTIOR': Existin� duet svstems cunstrucYed, insulated ar senled rvrth nsbestos. Refrivei'ant Charge - Split Systero HERS verijicalioiv is r'egi�ireclfor rhis measaire. ❑ 1'ES ❑ NO YLS: ln Climate Zones 2 and 5-15, when the existing HVAC equipmen! is replaced (inclvding the replacement of tUe air hai�dler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coi1; or the fumace heat exr.hanveri a refrinerant charee measurement shall be veri$ed oer §152(b11F. Central Fan Tnteerated (CFI) Ventilation System and Fan VVatt Draw Tlie ventilation renuirements of F150(ol do not apolv to existine residential homes. Ducted Split SYstems - Air Conditioners and Heat Pumps: Airflow HERS veri%�coiion is required Jor this measurc. ❑ Y�5 ❑ NO Y�S: In Climate Zones 10 through 15, when the existing space-conditionine system (HVAC equipment and ducting) is � replaced; the airflov.� a�d fan watt draw shal I be verified aer � 152(bi l Ci to meet the renuirements of & 1� 1(f17B. • I certlfi� thal tliis CertiFicate of Comi Name: dt��4� �wl1S�'{v. Company: Address: 2� 3L ,Q,..�a/'er- City/State/ZiP�. � _ „, Ik q 26 2G Date: S//' / , n J If Applicable O CEA or (Certification i!): 33s-'f %nsiblo Building Desicner's DeclaraYiim Statement A J om eligible underDivision 3 aftlie Califomiu Business and Professions Code to �ccept res��onsibility for thG building design identifiecl on this Certificate of Compliance. � ] certify thal the energy feaWres encl ped�m�mancc speei5calions inr the Uuilding tlesign identified on ihis CerliLc�ite of Comyllance coni'orm to Ihe requircments of Title 24, Pnrls 1 Emd 6 of the Culiforni�i Code of Regulatim�s. . The building design fealw�es idenliGed on this Certificatr, nTOom�llance 2ro consis�enl with Lhc in'fonnation prnvided to ducumenl this buildin� design on the olher xppllcable compli�nce fonna, worl:sheets, calculoGons, plans and specif�ctilions subnulted tu Lhe enforcemenl u�ene�� for apnrovul with this buildln��Permi� auP�ication. N�ime Compen�e Hdd�e55'. Signature: Dale: License: Tnr assi,stance nr guestious i�eb�urrlin� thr Lnerbi� Sinnrinrd.ti�, cmvi¢cl the L•nerer Hotli�vc at: 1-b'00-772-33I10. I<eg9siru�inn 1Juntber - kegi.su�uiian Dcue/Time: HL''RS' Frm�idw�: 200E' Res'idetttial Con�pliance Fnrnvs . . Azrgus/ 3b09 �'�� Cit o Costa �I�lesa �uildin �ivision --,._�, � y f � Costa Mesa �� Fair Drive, Costa Mesa, CA 92626 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Pe�m�t # 1 - D 1 Z Disclosures 8 Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPER7'Y OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at �4 �ib �.��!' Q\ We are providing you with an Owner-Builder Acknowledgment and Information Verifcation Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approva! of the permitting authority. DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. /��.I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Bwlder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am wilifully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. `�d� I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their %license numbers on permits and contracts. nderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. , understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. nderstand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. . I understand I may obtain more information regarding my obligations as an "employer' from the I�ternal eve ��Service, the United States Small Business Administration, the California Department of Beneft Payments, and the California Di'vision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. \� ' ir � � f" � �10. I am aware' of,erid consent to an Owner-Builder building permit applied for in my name, and understand ket iam the party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I wiil itle by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the o a$o I^have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does riot have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. smr-�im-�a� . ••- Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personalfy filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form . notarization, or other verification acceptable to the agency is required to be presented when the permit is issued fo verrfy the property owner's srgnature. Property Owner's Signature: Date: 314830 CALBO Jan 1, 2009 OB Packet template 2 Of 2 ApPlicant to fill in all spaces except those within neary bortler 1{nes CITV OF COSTA MESA CONST�fiUCTION PERMIT Projec[ Address ' c4�o Hirc�Wei- ur. ApplicanYs Mailing Address , �26 COlII/OBr'ClQI D/aV,' .C: M. 926� Owner'sName �f¢rrv Edmiston ohoneSS%-83�7 Addreu 51 Grant /rvie CA 92714 �, Arch/Eng.. License No. Address Contractor'sName (�J"17/�� Rrnc- Rnnfinn C:nphone 548-5569 Addreulmailing) ]� rnmmorrinl Wnv_ Cnci-o MPRn 9�F�i7 City License No. �5,oc�� LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensetl untler provislons of Charter (commencing wi[h section ]000) of Division 3 of [he BuSinesS antl Profe i ns Cotle, antl my license is in tull� r� nd ettect. 677 LI<ense Class Date � �'�� Si9na '�ORKEftS' COMGENSATION LARATION . ' �ereby aHirm that I have a cer icate of consent So self-insure or a certificate - ,,1 Workers' Compensation Insurance, or a certitieC <opy Ihereot (Section 3800, LaG. CJ � aou�y No. �75774 Company Zen i i'h �Certifietl copy is hereby furnishetl. ' Cer �]i yis tiletl with the city uiltli vision. Date �/��µ APpliCant �ranii �ros. Roof.inq G�.- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (7his section neetl not be completea ii the permit is tor one huntlretl ($100) or less). I certlfy'that In the performance of the work for,which this perm�t is issuatl, I shall not employ any' person in any manner so as to become s�bject to the Workers' Compensation Laws of California. Date Si9nature � NOTICE: If,iatter makin9 this Aeclaration, you shoultl become subject to the Workersl Compensation provisions ot the Labor Cotle,.you must,fortnwitn � compty �w(th such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCY � . I hereby affirm that there is a constructiorolentling agency tor She performance�, � of the �work for which this permit is issuetl (Sectton 3097 Civ. CJ� Lentler's Name LenGer•s Atlaress ' OWNER BUILDER DECLARATION � ' � I hereby affirm �that I am exempt from the COMractor'S License �aw tor �the foilowing reason (Section 7031.5'Business antl ProfeSsional,Cotle: Any city or county which requires a permit to construct, alter, impro4e, tlemolish or repatr � 'any structure; prior to Its issuance,.also requires the applicant for such permit ; t4herefroin antl the basis for the aliegetl exemption. Any vlolation of, Section �7031.5 by any aoo��cant for a permiY subjects the applicant to a civil �enalty of not more than five huntlretl tlollars ($500). .• � LJ I, �as owner oR the pioperty or my employees with wages as their sole compensation, will tlo the work, antl the structure is not intentlerl or otferetl for sale �(Section 7044, Business antl Professional Cotle:' The Contractor's License Law tloes not apply to an'owner of a propertywho builtls or Improves thereon, antl who tloes suth work hlm5¢IT/h¢r5¢If or through his or her own ¢rtlployees, p�ovitletl thdt Such Improvements are noS Intentletl O� OfTe�<tl tor sale. If, however, the builtling or Improvement is soltl within one year of com- D�etion, the owner�will have the burtlen ot proving he/she tlitl not builtl or im- �IOVB foI the pulpo5e of Sale). � LI I, as owner ot the property, am exclusivery contracting with IicenSeC con- � tra<tors t6 construct the project (Section 7044, Business antl Professions Cotle: � The Contrattbr'S Litense Law does noi apply to an owner of property who bulltls or improves thereon,'antl who contracts for such proje<ts with a con- tractor(5j Ilcense pUrzuant to tn¢ Contractor's �icense I..aw). ' ' ❑'I am exempt untler Section B. & P. C. for this reason • Data Owner I hareby �cartify that I-have reaG this appli lomantl state that�the��above� ; Informati�rre<t. 1 agre � mply w h all city antl county ortlinances antl state laws relating to b i constr t n, anG heraby authorime repre- ' senta t� Shis city' t e t r upon above-mentlonetl property for ' Insp ctlon p sg�� n ��/n ' , Drivers• I�JE�fise ar'S5 � .� CMFO865-46 rev.12/83 White-Bulltling; of TYPE OF CONSTRUCTION ❑ CONVERSION ❑ DI �ESCRIPTION OF WORK all apPraO��ate tlecla�ations. REPAIR TVPE OF PERMIT LI GRADING L� FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5q. F7._2750 � ocCUPaNcv S�� CONSTRUCTIONTVPE reS• VALUATION$3�..1'�S_� ZONE ' GRADINGCU.VDS. ACRES— Ramarks: //�� „ _ Sink Preven2er � � Irrigation Drinkin9 Founteins • Floor Drains • FloorSinks � � � - Gas Service Outlets Interceptors ' ' KiTchen Sink ' Lavatories � . . P—Trap• • Root Diains Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet - Water Heater . Water Service _ FEES Reinspec[ion �Fee �$25 � ' laue Fee , '� - $ 3 .. . _ _ � ' MECHANICAL . FEE Under Graund Exhaust5ystem ❑ Multiple Fiiepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 6100,000 BTU � 100,000 �{ . I I peinspection Fea Pink -Accountin9; Goltlenratl -Assessor $25 Hoad or' Typel ❑ , , Ca�nopy Typell� ❑ , Retrigeration System ❑6100,000 BTU 0100,000 BTU System Repair/Alteration , laua Fee $ 3 (J: A.P. # S Main Building E T Front A Rear C Right _ K g Left Ping. Ret. # Parking Req./Provi Use of Building: Planning Notes: Automatic Washer Construction Pole Suh. Caoking Unit Dishwasher - Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches � Garbage Disposal � 4832 7/25/84 2one ELECTRICAL � Transformer ❑ 15-50 KW ' ❑ SO+KW Meter ❑up to 100 amps . Meter ❑over 100 amps Sub Panel Motors�0.1-HP�1X-8 ' Inc.Solar �9-15 HP �16-15+ � Microwave ' �� Pole Light !' �� " Fiange Generator �0.5 KW 05-15 KW � Reinspection Fee PUBLIC SERVICES REQUI Zoning Approved By _ Building Approved,By _ Standing Sections � ! iTrash Compactor "_ r.i,� Issue.Fee ��oC�� ?t O N � N G R E Q U I R E M E FEES r $ 3 —Date � . SUMMARV OF FEES � —� ' � BUILDINGPERMIT $ Z7.S0. SMIP; . $ �S�' � PLAN QHECK $ � PERMIT i , PWMBING� $ ISSUANCE '� $ • , PLAN CHECK 25% $ ENERGY P.C.� .$ � GRADING� ' '$ � ELECTRICAL � $ ., PLANCHECK 50% $ � MICROFIL'M: $ MECHANICAL $ _ TOTAL FEE �$ � Z�' -�C� PLAN CHECK 25% $ . • . . - POOL,sSFA ��r *-, �� - , . •r-. CONSTRUCTION AND PLANNING : ; - ' - � -. �, - � : � ; - � ` , � Date Inspector , �' � � ' ` � : '' �,'Date � Inspectoi i ' APPROVALS Permit # �-� APPROVALS Permit=# - � . 1 �. 4" C i� Temporary Electric8l $ervice or Pole �- ' 52' Pool & Equipment Location �'� � � - ;-, �: � ' , 2, "Soil��Pipe-Undrgrnd. , � - _ , - � .53_� Steel Reinforcement'� � . _ ' �� r � 3. Electrical Conduit Utility-Undrgmd: � ' ��54:� Forms_; -' � � � . �� ' - _ +� � i - , ' 4. Electrical Conduit-Undrgmd. - " �55. Electrical;Bonding: � � '- . ''�- � - 5. Steel Reinforcement - 56. Rough Plumbing &�Pre'ssure:Test � � �., � � . ! � o :. 6. Electrical UFER Gmd. • ` �� 57: APPROVA�L TO�COVER-GUNITE� - . �' i. 7. Footings ' . �- ' ' � 58. Electrical'Conduit=Undrgrnd.. ' ' � � -'' t �� 8. Foundation � ' �.59. Gas Pipe, 0 Undrgrnd., Test ' �= �� i 8. Water Pipe-Undrgrnd. `� . :60. Backwash Lines, P.-Trap,'�' Undrgrnd. � %. _ ' , � � � l0. Structural Floor System ` 61. APPROVAL TO D,ECK �~� : � 11. Property Sewer Line & House Conriection 62. �Backwash & Receptor-Fina! � -_ � � 12. Sewer Cap �''63. Heater &^Vent-Final . _ 13. Roof Drains 64. Plumbing.System.- Final. , �' , �� i 14. Rough Plumbing ��65. Electrical-Finab - - � � - � � � � rO 15. Rough Electrical-Conduit � - - - - �'66.� Solan,SYstem-Final i^ � � � ' ---r � � - ' �-- � �� 16. Rough �Elect_ric Wiring , , � - � � ' 67YFencing�& Access Approval. ,� � - - -. �" �� " ;'- ` � � �� 17. Rough Wiring Sign �' � 68: APPROVED POR PLASTERING ' j� i �. 1$. Rough Electrical-T Bar Ceiling � , '69. POOL/SQA SYSTEMS fINAL ��' i: � � 19. Rough Heating & Air Conditioning � � � �FIRE DEPT. REQUIREMENT ' _ � � � , � � ' '^ 1 � - � � - ' 20. Rough Factory Fireplace � � , ' APPROVALS ; Permit # � , x � � ! � y 21. Ducts,�in Structure � 70.� Underground Hydro � � , j�, i � I ' 22. Duct , Ventilating ' ; � ,71, Product Piping OGasC,OOiI , • ' � ` � , 23. Gas �e-Rough & Test � . . i 72. Underground Flush � . ! ' ; i i 24. Ro 'aming � � � � 73.' Undergrnd. Storage Tank O Gas: � Oil. '''�� ' I � 25. Ro� ,heathing - �, �; � ,74., Overhead Hydro . � ` ' ` � � • , , 26. T-B Ceiling (Structural) & Monocoat ' � 75. DryChemical � ' ' � 27, Frame and Flashing � - , 76. Dry Standpipe � �' ` � ' . ' ` ' 28. Lathing & Siding � J7.� FIXED SYSTEM FINAL �,! '' q � 29._Insulation , 78: FIREPREV.FINAL ;i ,. , ' ` 30. Drywall Nailing ' � � HEACTH DEPT. REQUIREMENT' � � 31. Plaster Brown Coat � � 79., FINAL INSPECTION ' ' �� 32. Electrical Power Meter-Final , 80. FOOD CERTIF.ICATE ISSUED �' � � � 33. Final Electric . ' 'Notes: � ' i ' � � 34. Final Heating & Air Conditioning �- ' , ' . � ,� 35. Fina! Gas Pipe-Test � � , ' � � ' � � ' ' , . _ . . 36. Hood or CanoPY � I � . ` . { � � � , - � ' . • � ' ' � �� - ' • - 37. Final Factory Fireplace � � � ' - � ' � ' � �' � � . ', �, � ' ' 38. FinalPlumbing � . � . ' ' , � ',•. . , '�'. „ �� _ I 39. Water Service-Final ' . � , � � � ' � �� ' ' ' , . 40. Gas Service-Final � � � . � � � i ' ' ' � � �� ' 41. Solar pomesticFinal � � - - .- -�- - - . - ' � � � ' . � � 42. Backflow'Prevenier' , ' j .. __ - ' � . . � � .,I [ i � � . - 43. Backflow�lrrigation � � - , � _ � . j .�� . ' � 44. ,Landscape Irrigatio�System � - � , : - �' . ' � , �G"�n � u - � � , .. . . � c 45. Sound Attenuation . ' , � • , � � . , � • • ,� �, 46. Handicap Regulations � ' � - -' � ' � ' ��i ' ' r � .- � n- 47. FINAL STRUCTURE & BUILDING, ' 3' � � ; � ey� �y}rl1/ ¢-��{Z 48. Special Requirements Completed' 1 � � ' (� �k/ ��0� ; � , ' ' " � 49. Electric Release to Edison ; ' - "� � - ' , � �� - I' � •-�i` ' ;, ; � I ' 50. Gas Release to Southern Califomia Gas Co � . �� ' � � � ' ' , � ' , • - � 51. CERTIFICATE OF OCCUPANCY _ -` ' __ '- ' . , _ ' , • .' _ 1 1 No. � � Date " . : . �l__ ' ' ' " .. . . _..... ,... . . _ . .. _ __L_. ... _ .. .. . , . . _ ._ _ .. . •�� •� I � ! 7�� COSTA MESA BUILDING DEPARTMENT P.O.6�% 31] COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN 6UILDING n' A�DRE55 2�36 KtldOVEZ� Place COSTA MESA. GALIFORNIA OWNER Columbia Homes� Ti1�J• MAIL �G� �'• 1/tirl U�• ADDRE55 CITV Costa� b�iesa TNO.�• 0�1�. ARCHITECT � $On LIC. ORENGINEEqr�_ie�_i_____�_ NO. � ADDRE55 Garden Grove U1KE,' 6C CITY LIC. g/1 CONTRACTO NO. 4 I, G r-� f • r1 11 AO�RE55 W�-9 E• 11ti�1 S�♦ TNO.�• 0�11 LEGTL LOT oesceivnoN Na. 54 BLOCK TRACT 7 A.P. NO. $IZE �'12 X 10�] NO.OF 0LOG5. nOne OF LOT � F �lOW ON LOT USE OF EXISTING BLOG. SET9ACK LINE FROM CENTEN OF STFEET SO� REAR YARD 33� ' SIDE YARp RIGHT V� LEFT G�V � DESCRIPTION OF WORK NEW X p�TERAYION ADDITION REPAIR MOVING DEMOLISH SIZIEDING 16�1 n�q• f'BiO MS V STORIES 1 E%TERIOR WALL ROOF I COVERING StiUCCO COVERING COTRTJ♦ USEOFNEW S1nP1e familv residence BUILDING � � � . �1� �� .i � AUG 2; �j "" `-, -, �� r"1�rin.. n.-�� I l.ft� .��;� ` ` APPLICATION FOR PERMIT BUILDING ' FOR OFFICE USE ONLY RECEIPT NO. PGOMNnY6 �;�� I U'�3�-d"�'I pV� LDING 1RESS � COSTA MESA. CALIFORNIA FIRE ZONE ZONE APPROVED BV �rith attached double garage. P12n 75oD I HEREBV /�CKNOWLEDGE TMAT I HAVE FEA� THIS APPLICATION ANO STPTE TNAT TNE PBOVE IS COFRECT hND AGREE TO COMPLY WITH qLL CITY OR�INRNCES TN� ST 1�A1N5 REGULATING 9UILOING CONSTRUC- T�� 5�� _ � VALUATION SIGNATURE OF T / $16,168.00 IALITHORIZEO AGENTL�-ke & Colegrove� ITlC• K CORRECTIONS PERMIT FEE S �J�OO PLAN CHECK $ �"��OO TOTAL FEE 8 S!�OO yBMf .,. . . , ... -OWNER [±�l vmhi a Anmaa.i � Tnr -- - _- _-- - DATE 8-2�� •. _ JOB ADDRFSS 2436 QndOver Pl, ,, ' BUiLDING PERIWT NO.' 739H GENERALCONTRACTOR Dike &.Colegrove� Inc. VALLIE$ '1 ,1 :00 AP. No. LOT 54 �r.cT 2954 � zoxE DESCRIPTION OF WORR ReS. W�att. g3r3ge ��1[P I& S TYPE V ZONE Rl PLAN NO. DATE I 6UBCONTRACTOR �oat PERMITSISSUED