HomeMy WebLinkAbout2002 BALTRA PL - Building Permits� >
CITY OF COSTA MESA
�o�""'FSQ BlIILDING DIV►SION
Ft�� 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754-5626
'`°°°°�°�'' PERMIT NUMBER: B11-00231
PERMIT TYPE B_ROOF2
APN: 13944303
JOB ADDRESS: 2002 BALTRA PL CM
Vicinity: HOUSE AND GARAGE ROOF
Squares: 2500
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
08I0312011
RMD
$6,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALI 1 30# FELT ON A 4:12 PITCHED ROOF AND REROOF WITH
30 YEAR COMP SHINGLES ON AN ATTACHED HOUSE AND GARAGE, APPROX 25 SQUARES. REPLACE SHEATHING .
AS NEEDED. COMPLIANCE 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 Ciry Inspectoc See Attachment wllnspection Card
OWNER: RODRIGUEZ, STANLEY ELMER
MESA,CA
PHONE:
APPLICANT: BENIT�Z, HERIBERTO
PHONE: 323-806-0959
Address: TR
City/State/Zip: 2002 BAHRA PL
Address:
City/State2ip:
CONTRACTOR: LEO MAX ROOFING AND WATERPROFFING
Address: 1012 W BEVERLY BLVDUnit: STE 330
City/State/Zip: MONTEBELLO, CA 90640
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$0.00
$15325
$0.00
$1.00
License No.
License No.
Unit: COSTA
Unit: .
License No. 924201
PHONE: 323-806-4959
CELL:
PHONE:
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3I1812010 - 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 holidays
New Years Day, Memorial Day, Independence Dav, Labor Dav, Thanksqivinq DaV and Christmas DaY
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia staNtes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 160 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 ihe expiretion of this permit.
CODE1. INSPEGiIONTVPE DRTE INiIiIRLS CO�Ep INSPECTIONTYPE DAIE INTITIRLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Poot Spa Final Q 208 Final Plumbing
200 Final Re-Roof � v���' �� i✓�� 2W Final Electrical
201 Final Block/Relaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Fina� Demali�ion � 250 Final Building/Occupancy
WORI(ERS' COMPENSATION DECLARATION:
I hereby a(firm under penalry of perjury one of the following declarations:
❑ I have and will maintain a certi(icate of consent to selbinsure for workers'
compensation, as providetl for by :ection 3700 of lhe Labor Code, for the
p�er/formance of [he work for which ihis permil is issued. �
� I have and will maintain wurkers' compensation insurance, as required by
section 3700 0( [he Labor Code, for the pertormance of the work for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and poiicy
number are:
IGarrier C/l� �U Yi �
�--^(This secfron need rrol be cu!mplpefetl J(he peimR is valvetl af one �untlretl tlollars (8100) o� less.)
Policy�Number: 1 C'I � 2 rJ �j�
�-
❑ I certi/y that in the peAormance of the vrork for vuhich this permit is
issued, I shall no[ employ any person in any manner so as to become subject
to ihe workers' compensation laws o( California, and agree that if I should
become subject [ he vrorkers' compensation provisions o! Seclion 3700 of
the Labor Cod ; ANwiEla�comply with these provisions.
3 //
Ap icanfsSignaWre Oa1e.
�
WARNI G: 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
(y100,000), 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 aNirm ihat I am licensed under provisions of Chapter 9(commencing
wi�h Section 7000) of DiviSion 3 0( lhe Business and Pmfessions Code, and
my license is in �fu/li force and effect.
Li�# / Z ( Class # �
— -- �— _�. /
` nraclor'sSignawre �—Oale
CONSTRUCTION LEN�ING AGENCY:
❑ I hereby affrtn that there is a construction lending agency for the
pedormance of the wvrk fa which [his pertni[ is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atltlress:
OWNER-BUILDER DECLARATION$:
I hereby affirm lhal untler penalty ot 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 ro
cons�ruct, alter, impmve, tlemoiis4, or repair any struclure, prior lo its
issuance, also requires Ihe applicaN for such permit to (ile a signed s�atement
Ihal he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Sec[ion 7000) of Division 3 ot the
Business and Professions Cotle) 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 lhe appiicant to a civil penalty of nol more Ihan
(ive hundred dollars ($500).):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL 00 7HE WORK, and ihe structure is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Conlractors
License Law does not apply to an qwner 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 builtling or impmvemen[ is sold within one year of
completion, [he owner-6uilder will have [he burden of proving that he or she
did nol build or improve tor purpose bf sale.).
❑ I, as owner of the property, am EXCLl1SIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construc[ the project (Sec. 7044, Business and
Pmfessions Code: The contractors License Law does not apply ro an owner of
propeAy who builds or improves thereon, and who contracts for such prqect with
a conlractor(s) license pursuan[ to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre Dale
905]-d6 (3I0])
Owner ID verifietl by tlriver s license. ❑ Ves ❑ No
�Driver's License No. Expires�.
-�Verification of Ownership by (rype o( document, i.e. - property �ax bill or deetlp
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
� I hereby certi�y that no excavation (rve (5) or more (eeI in deplh into which a
person is required to descend, will be made in conneclion vnlh work au[honzetl
by Ihis permit, and that no building structure, scaffdding, falsewnrk, a demolition
or dismantling thereof, will be more than thirty-six (36) (eet high. (Chap. 32, Grp
2, M 2, Sec. 341, TUe 8, Califomia Adminis�rative Code).
� As owner-builtler, I will nof employ anyone ro do work which would
require a permit from the Division o( IndusVial Safety, as noted above, unless
such person has a permil to tlo such vrork fmm the division.
ApoLrant's SignaWre Dale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or presenl or (uture builtling occupant need to file and
certify a Business Plan (or emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Calilomia Health and Safety Code requires, with some
exceptions. that a Business Plan be filed with the Costa Mesa Fire
Depariment by every 6usiness which has a[ any one time during a reported
year a quantity o/ hazardous materials equal to or grearer than a weigM 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 applican� or present or future building occupaN need to f le
a reqis[ralion (orm For acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Heal[h and Safery Code, with some
excep�ions, requires regisVation with the Costa Mesa Fire Department by
eaCh bUsine55 which al any One lime has On hand a quan�ity of aCU[ely
hazardous materials equal �o or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at stantlard
IemperaWre and pressure).
3. Does or will the applicant or present or (uWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cotle pmvides that the
Costa Mesa Fire Department may require Ihe preparation, certi(cation and
liling wiM the Fire Department o( an RMPP by businesses which are required
to register acutely hazardous materials with Ihe Fire Depariment.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safery Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
the work which is the subject of this application a permit for such construclion
or motli(ication from the South Coast Air Qualiry Management Dis[rict or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications fa non-residential building permits).
6. Will any part of lhe (aciliry to be construcled under lhis permit be within
1000 fee[ from the outer boundaries of a school? ❑ Ves ❑ No
(If'yes", the (aciliry must meet Ihe requirement o( Sections 25534 and 42303
o( Ihe California Health and Safery Code).
7. If a permil from the South Coast Air Quality Management District or o[her
air pollution control dishict or agency is requiretl !or the work which is lhe
subject of this application, have all of the disclosures prescribed by California
Heal[h and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the appropriate air pollution
control oHcer�.
CERTIFICA7E OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaNre oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read ihis application and state that
the intormation given is correcL I agree to comply with all slate laws and city
ordinances relating to building constmction, and authorize representatives of
the Ciry of Cosla Mesa to enter upon the above-described property for
inspeclion purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until final inspection.
�
�i r�of Legal Owner(s� a�e
� �Antl/orAulborixe0A0Plican� ' dle
c CerYificatc uf
Alterntin�:.e
General ]nfnrma�tion
SiteAddress: ZvO`L Pe-� YC/� `9L
Building Typ�Single Tamilp ❑ Multi Family
Conditione<I Floor Hreu (C�A):
TI»s (nrur is uni Ir� 6c used
ClimaLc 2onc �I
Lniorcemenl Agency' •��
Circle the From Grientaiion: N, E, 5, Vd, or degrees
Proleci 7ype: O Alterations D Envetopc � Fenestration�
- ReplacemeN or Chan�,e Oui ❑ Duct Ileplacemeni ❑ Water
Cnnstrimicr(11ui(dittes m� Additinns
7 oi'
��
/usuln�inn Yrtluea� For Oprcqrrc SYq•/uces (for Fm�rrng use the Agas.s unc! Fzaring S7ripa� Cwest�zrc�iar raLle belowJ
'hssembl)' AI[erntion ��-
❑ Openine ol' L'amed ca��it�• alone- Aheraiions fhn� involre Ihe opening oJihe fi�mned cavip� o(n wall, ceiling, m..Jloor mus� insmll the
qiGtllIG101'1' mininnnn insuluiinn vnlue per ,¢lSO.jor ihe n6ered aaa•emblp. Fill in Colunms d-C and en�er mandmor7� insula�iai value in Colimm H.
❑ Replacement oT entirt assemhlp-Reylucemeni o/�an emire wa71, ceiling, or,/loor assembf�� reguires (he insiafla�ion ofComynnen�
P.,ck�,oe- D insuln�ian va/ues inTable 157-C. Fill in Columns A- J. .
Def1i15 Por the turred
A � D
Y
Tag/ Assembly l�ame
ID� orTy e�
Note: Foi;lu�red arsembfies, ai
af Mass Walis sec Rurrin
�I_ � �F
ed ' "'"" 5tandard
Framing Thickness, -
Material Spacing, U-
and Size� or Other� fac[or"
beinw.
G I H
Velues From JA4 Table
Framed Continuous ]A4 Proposed
JA4 Table Cavip� ]nsulation Assembly Assembly
Numbe�' R-value� R-Uatue' Cell Vzlueb U-factory
see Page JA4-3 m:d Equotion 4-J.
use
1. ror Tng/ID uedica�e d�e iden�ifca�ion name Ihai nm�ches fhe building p(ans.
2. Indica�e ihe Assem6lv Nume a� Type: Raq(/Ceiling, Wa➢s, Floor-s, Slabs, Crawl Space, Daors and e�c...lndica�e Ihe Frame rype and Size: For
N�ood, Me�al, Me�al Buildings, Nlass, e�uer 2s4, 2x6, or e1e... see JA4 for olher possible jrame rype assemblies.
3. E�ver Ibe lhiclrness:fm' mass iu inchcc m� Syacine 6efwee�i framing members enier; 1 G"ar 29 "OC; or Other jor al! otber assen�bl�� descriptian
such as Cnnere�e Sandwidr Panel, Syandrel Pm�el, Logs, StraH� Bale Pane! and e�c....
4. BaseAon Ihe Cfimaie Zone,- en�er �he Slandm�d U facia' fi�om Table I51-D, C or D fm� euch d�erem assemblp /Jame a' rype.
5. Enter the ToGle number Ihoi close[p resemGlea Uie yroposed assemblp. �
G. L•n�er tl�e R-nalue fhal is being ins�ulled in �he wall cm�ip� or' be�ween �he f+'nming; o�her-wise, emer ..0,..
7. Ln�er !he Continuous h�sndation R-i�alue (m' �he propased assembl�; o�he�m�ise, eirrer "0".
8'. L•mer die rma� and colwnn ojd�e U-facior valuc Lased on Cotwmi FTnblr. Num6er and enier (he ds.tembli� U-(ucmr ir� Colimm J
). The Propnsed d.ssemblv U-(nciort Colunm J, nuisi be e9ua1 io or less ihan !he Smntlnrrl U-{uclqr in Colunm E to contph�. �
7tegiam�uiinu 1JumLer: liegisira�ion Uaie/T'ime: HLKS 1'rnvider:
"LO(l7; 72esideieiiul Cou�plicmce I'rn�m,v Augus! 200J
nt' Comnlii Itesidential
7wmc /4 � _ I tl
:i ot'
ROOrING PRODUCTS (COOL ROOP'S) §151(p!'
When �he nraa nf rx�eriar rnqf xrqface m 6c replaced rxcaeds morr. tLnn 509b nf tl�e existittg rnnf area, nr mnre lhnn I,D00,/Y, iuhicl�ever is
lesx, d�e nn.in rr�nftnA nren iutra� �nee� the rnnftxg prndec! "Cnn/ IlnoJ" raquiramenrs of§I52(6Jlfli, 152(bJIH(i, m� 152(LJIF/iii.
Ched� app(lcaGle nf�arxrttive or eccaptinn Le/ou� l��he roof alierotion ia� esemp�fr�om (he ronfing produci "Cool konj" requirements�. No�c: l�any
� 1„e ojrhr: afiernative.r nr ezcep�inn Gn.lor�� i.c checked �hr, dged Solar IieJlec�anec and Theru�al L•'mtrtance requirement.v for rno�ng prnduc�.v in �
§J 18(i) nre nar a��p!lcahlc. Uo nm, fil! �ahle helnw.
�1 Cool Roofs N�t Required iu C�imnte Zonex I-12, 14, and IC with n Low Sloped. Less or 2:12 pitch.
�Conl Roofs Not Iteq�ired in Climatc Zones I Ihrough 9 nnd I( with a Steep-Sloped Roof.e (pi[ch grenter thnn 2:12) and product unit weight IesF
Alternt�Yives tn §152(b)1}Ii nnd �152(h)Hii, Steop-alopc rnnf (pl[dr > 2:12)
-� lnsulntion with a thermnl rexistunce of ai least O.RS hrfl'�"F/Rni or nt lenst u 3/4 inch air-spacr, ie ndded to the ronf dedc �
over nn �ttiir, or
O Existing tlucts in Ihe a[tic arc insulateA and senled according to § 151(� 10; or
❑ In climate zones 10, 12 and IJ, with 1 tt�.of frec ventilation areu of attic ventilntion for every ! 50 ft' nf ettic Floor �ren, and
where aL leusl 30 percent of the free ventilation aren is within 2 feet venicaf distance of the mof rid�e; or
❑ Building has al least It-30 eeiling insulation; or
❑ Building hes radiant barrier in the attic meeting tlic reyuiremen�s of § I51(Q2�, or
❑ Building has no ducts in tlic auic; or
❑ ln climate zones 10, I 1, l3 and 14, R-3 or greocer rnof cicck insidacion above vented attic.
�xception to �152{h1lHiii, Lnw-sfop� rnof (pi�cli <?:12)
O Huilding has no ducts in thc attic.
Other �xceptinns
❑ RooSing area covered by building integrated�, phomvoltaic panels and solar thermal panels arc exempt from the below Cool Roof criteria.
❑ Roof constructions that have thermal mass over the roof inembrane with at least 25 Ib/fi� is exempt from the helow Cool Roof criteria.
Note: If no CRRG 1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise.
Checl< the a licable hox below if Exem t from the Roofin Products "Cool Roof' Requirement:
Roof Slope Product Weight Product Aged Solar Tnertnal
C:ItaC: Prnduct ID Numher' < 2: t2 > 2:12 < Slb/ft� > 516/ft' Type� Reflectance�'tl Emittaoce SRIS
❑ ❑ O ❑ p^
�i
n
u
r_
u
G
C
�
�Q-�
�o��
�0��
�o��
The CRRC Produci ID NwnLer can 6e obinined fi�aru tlie Cool Roof Ra(ing Council's Ra�ed Yrnducl Uirectory at www.coolrnoLs orr/nroducrs/seor•cl� nlro
lndreale rhe ype oJproduci is Geing use� jor Ure raoJrop, i.e. sirtgleyfJ� inoj, aspl+al� roof, nreta( roof, elc.
I�O�e Aged Repecmnce is nai availablc in.�he Coo( Roa%Raiing Com�ci!'.r Rated Produc� Direcmr7� Ilien use Ihe Ini(ial Reflecmnce value fr�om !he same
direcrnr�� and use �he eqim�ian (01+0.7(P�����;��— 0.2) ro obiain n calculated aged va6�e. Where p is Ihe Inilia( Solor ReJlec�ance.
Chech ho.r i/!he Aged Re(lecfm�ce i.s n calculaied value using Ihe equotion aGnve.
Calculate !he SRI va(ue L,r using Uie SRI- Worksheel af I�ttn�//iv�m�� enerm� caenv/lide24/mid emer Ihe resulling value in Ihe SR! Calumri abm�e and atmch �cop�� of
Ihe SRI- INnrlrsheet io 1he CF-1 R.
� apply Liquid rield Applied Caatings, the cooting must be applied across the entire roof surface and meet the dry mil thickness or coverage
commended by the coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating:
Aluminum-Pigmented Asphah IZoof Coating
Cement-Basecl Roof Coating
O[her
Regisrrution Nimiber: Registration Da�e/Time: FIE25 Provider:
2008 Rea•iden�iul Compliunce Forms -
Augusi 2009
of Comn]i:mce: Residential
-7 I2-ALT
Residential Alzera2ion,s � (Pa��r � oT i)
Yruje�crlVi"Ile: ^ I�l/ I Cliinatc'Lunc� �� I$'CU)'-ituries�
�tCv �
H�kS VEI2IFJ CAT10f� SUMA4AP��' The en(a�ceme�v ngenc.r should pm� s��eciul unervion m Ihc HL1iS hAeasm�e.s s'peciJied ur lhis
checldis� Lelmr. A emnple�ed und si�ned C!'-4J( Fm'nr fnr nIl the mea.r�n�ea� a'pecilied sh�Jf be.submiiied m ihe building inrpeclor beJorr jino!
vllCl Stn�lnp b 7�BSillle HL'RSVL'1'1fICC1110013 )'L'(�ill)'L'LI�OI'/IILti II1L'LISLU'C. �
❑}��S ❑ NO �'GS lu Climme Zuues ° nud 9-1 G, if more ihau qb linear feei of new ur replaccmeni elucis are insttdled in unconditioned
� spsice, the duclx �re �0 6e setded per g152(b)IUii vnd the newll' inswlletl ducis nTe m be i��sulateA pei § 151(i:110.
❑ EXCLPTIO�: Lxisting duct systems thnt ure estended, aLich are cuushvc[ed, insWaud ur xculed with asbesws.
❑ Y�S ❑ NU )'i5: Li Climate "Lones 2 and 9-1G, if �tlie existing space-conditioning system (HVAC equipmeni and ductinel is replaced, the
� ducts are to be sealed per § 152(b)7Di. �
❑ Yi5 Ll NO Y�S: ]n Climale Zoues 2 and 9J 6, if the exisling HVHC equipmenl is repluced (including the replacemeni o1�t6e ai� handler,
� owdoor condensing uni� of a spJii syslem, e��ling �r beatii�g coil, or tl�e furnaee Jiezi exchangerj dit duets nre io he
sealed per §152(bpE.
❑�XC�PT10�: Duct systems tLat are ducumented tu La��e been previuuslp sealed coni�rmed thruurL H�ILS
_ � verification iu �ccurdnnce with prucedures in the Reierence kesidential Appendix RA3.
� �� ❑��XC�PTIOA: Duct systems with less than 4U�linear feet iu uncauditianed spuce. . � .
❑ TXCL�➢TIOn: R.xistin�� duct svstems construeted, insulated or senled with ashestos.
RefYigerant Charee - Sp11t S,YstCm HERS verijicatia� is'r'equiretl im �hi.r mcasm•c,
D Y�S ❑ NO YLS: ln Climate Zones 2 and 5-15, wl�en the existing HVAC equipmeni is replaced (including the replacemem of the air
handler, outdoor condensin; unii of a splii system A/C or heat pump, cooling or heating coil; or tht fumace heat
exchaneeri e refriserant charee.meesurement shall be veriiied per §752(61IF.
Central Fan Integrated (CF'I) Veniilation System and Fan �'att Drah�
The ventilacion renuirements of �I SOf oj do noi apoh� to existine residential homes.
Ducted Split Systems - Air Canditioners and Heat Pumps: Airflov�� HERS veri/icaiia� is reguired Jor thts meaa•ure.
❑ YLS ❑ NO YES: ln Climate Zones 10 through I5, wl�en the existing spece-condi[ionino system (HVAC equipment and ductingj is
replaced, the airflow and ian watt drau� shall 6e veri$ed ner §152(611 Ci tn meet the renuirements of § 151(f17B.
Name:
Auti�or's Declaration Statement
Certificate of Compliance doeumentetion is.accurxte and
i „-, � Signature:
�
�/3///
]f Hpplicable D .CEA or ❑
(CertiScaiion 91J:
Phone: . ,_
��iblc Buildine Desi�,ner'ti Leclaratiun Statement �
] am eligib)c under Dn�ision � of lhc Calilornia Busines:, antlTrofessions Codc in �ccepl responsibiliiy (or thc building design identi5ed ou
thic Certif�cate of Cmnpliance.
) cerLify lhal the energy lealure:, un[I perlormanec speeiLcalions: im�lhe bullding design IdentiS'ied oo this Cer�ii�icate of Curnpli:�nec conform
tu llic requircments o1'Tiqc 24, Yxrl;; 1 emd G of tl�c Culilbrnla Codr of ILegulaliun�.
The buildmg design lealure;; identiGed on thic CerLii�icale nl'Contplltince .u'c cunsislenl wilh lhc inlimnatiun provided tu ductunen� Shir.
6uilding tlesign on th� other sippllc;i6le curopli�ncc lonnc, worl;shee�s, culculalionz, plun:; und specific��lion:; subn�iil�ed tu the enforcemcN
auener for annruv�il with lhis buildin:� nemiil .muliculion.
:.ompany:
Hddress.
IJate:
License:
I'hone:
For us,t•istrmce r�r gue.eliniic regnrrling fhc Enr.rbp 51m�dru•ds, cnn�acl ihc Enerbr Hotlittc at: 1-h'0(I-7i2-."i3110.
��.......,...��"," p1,"„�,�,�� Itc�i.��u�unonGuie/Time: 1-/EP,:; Prnvicier:
Applicant to fill in all soaces exceot those wiMin hea'vy Eoraer lines antl sign all approo��ate tleclarations.
CITY OF COSTA /M�E�S�A7� CO//.py-�(S�T� UCTIO PERMIT PERf� NQ.� ^^ u TRACT NO. LOT NO. UNIT NO.
PlojectAddress '�/flU1L��' —� �
-' S e
Applic'�YrMailing Address
Owne�Name ^ one�J.���J%
Address 2 ��! � �'�"�b� ���f [ p � OG'�'� 'i"1YS�i
Arch/Eng. License No.
Address
Contracmr's Name Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
1 he�eby affirm that 1 am licensetl untler provi5ion5 of Charter 9(commencing
with section ]000) of Division 3 ot the Business antl Professions Cotle, antl
my license is in tull force antl efiect.
Ucense Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
'�ereby aftirm that I nave a certificate o1 consent to seli-insure or a certificafe
Workers' Compensation InSurance, or a cerfi(�etl copy thereof (Section
00, Lab. CJ
Policy No. Company
eCertifietl copy is hereby fumishetl.
Certifietl copy is tileE with tM1e city Builtlin9 Division.
Date Applicant
EXEMPTION FROM WORKERS' GOMPENSATiON DECLARATION
(This section neetl not be complet¢tl if the permit is for one huntl�etl ($100) o�
less).
I certi(y tha[ in the performance of the work !or Which this perm�t is issuetl, I
snall not empl�� o�ny person in anY man so,ab� b o� sqbjectAT �e
Worker ' e i Lon Laws o( Califor // V
oate y Signa[ure �VA A�A/,/�,:,.��
NOTIC . If, af er making this tleclaretion, you sho become su t to e
Workers' Compensation provisions of the Labor Cotle, you must forthwith
comply wi[h such provi5ion5 or this permit 5hall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I herety affirm that ther¢ 75 a cons[ruction lentlinq 39ency far the performance
of the work for whicM1 [his permit is issuetl ($ection 309] Civ. C.)
LenGer's Name
Lentler's Atl��ess _
OWNERBUILDEH dECLARATION
I hereby affi�m lhat I.am exemp[ f�om the Contracto�'s License Law for the
following reason (Section 7031.5 Businesz antl Protessional Cotle: Any city or
county which requires a permit to construct, alterr �mprove, demolisn or repair
any structure, prior to its izsuance, also requlres IPe applicant tor such permit
to fiie a si9neG statement that ne/she is licensetl pu�suant to the provisions of
ihe Contractor'S Lfcense Law (Chapter 9(commen��ng wiih Section 7000) ot
Division 3 ot the Business antl Prote55ions Cotle) o� that he/she is exempt
the�efrom antl the basi5 for th¢ alle9etl exempfion. Any violation of Section
�031.5 by any applicant for a permit subjects tne applicant to a civil
:Jtrlty of not more than five huntlretl tlollars (g500).
,/ I as owner oi the property ' ' le
�pa�sat�on will tlo the wOrk, antl the 5[ructu�2 is not intentletl or o(feretl
/ orf sale (Section 7044, Business antl Professional Code: The Contractor'S
�,License Law tloes nol apply [o an owne� of a p�operry who builtls or improves
� thereon, antl who does sucn work himself/herself or through his or her own
employees, provitled tM1at such improvements are not intentletl or offeretl for
sale. H, M1owever, Ihe builtling o� imp�ovement is soltl within one year of com-
pletion, the owner will have the burtlen ot provinQ he/zhe tlitl not builtl or im-
prove tor the purpose of sale).
❑ 1, as owner of the property, am exclusivery contracting with licensetl con-
Vactorsto wnstruct the project (Section 7044, Business and Professions Cotl¢:
The Contractor'S LicenSe Law tloe5 not appry to an owner of property wM10
builtls or improves thereon, antl who wntracts tUr such projects with a ron-
tractor(s) 1¢ense Dursuant t0 the Contractor's LiGense Law�. I am aware tbat
proof of tM1eir Worke�'s Compensation insutance ShoWtl be provitle0 to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date
I Si9nature ixw,�.�r
� Drivers' LicenSe or 55 q/
CMF 0865-46, rev. 10/84
i state tl�dt tne above
antl countv orainances
TVPE OF CONSTRUCTION LJ NEW LJ ADD LI ALTERATION L�'YF
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/I/ O BL T �
/
TVPE OF PERMIT GRADING ❑ OUNDATION TRUCTV RAI.
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ M HANICAL
❑ OTHEF �
PROJECT DESCRIPTION 511. FT._ _ 'oCCUPANCV
CON $TRUCTION TVPE VALUATION $ �
ZONE GRADINGCU.VDS. ACRES—
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavamries
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact. elt. ICBO #
Heating System & Ducting
❑ ai oo,000 eru � i oo,000 ar
Reinspection Fee � $15
�_ _ _ — _
White - BuilOing; Canary � APPlicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration SyStem
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
R
FEES
$ 3
$ 3
A.P. �f`-
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
D ishwasher
Oryers �Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
O utlets
Switches
Garbage Disposal
Generator DO-5 KW C
fee
� �C% �� � L,./: -r .
Zone
Accessory Building:
Z
�
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meker ❑up to 700 amps
MeCer ❑over100amps
Sub Panel
Motors �0-1 HP 01 h- 8
InaSolar �9-15 HP 016-15+
Microwave
Pole Ligh[
Range
Standing Sections
5-75 KW Trash Compacior
$15 Issue Fee
DEVELOPMEN7 SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By �\
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PIAN CHECK 25% $
FEES
$ 3
FEES
- SMIP $ � `� �
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $ � � �Jj
TOTALFEE $ �
CONSTRUCTION ANDPLANNING POOL&SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation i 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains . - 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PIASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # -
21. Ducts, in Structure 70. Underground Hydra �
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
24. Roof Framing 73. Undergrrid. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocbat 75. Dry Chemic�l
27. Frame and Flashing , � 76. Dry Standpipe �
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation 78. FI�RE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ��($ g8
34. Final Heating & Air Conditioning ,
8
35. Final Gas Pipe-Test �
36. Hood or Canopy '
37. Final Factory Fireplace . '
38. Final Plumbing '
39. Water Service-Final
40. Gas Service-Final , ,
41. Solar pomestic-Final �
�j,42. BackflowPreventer `� , � _ ,
43. Backflow Irrigation ; -,
44. Landscape Irrigation SYstem � •
45. Sound Attenuation
46. Handicap Regulations _ �
47. FINALSTRUCTURE&BUILDING �p � � � ' _'
48. Special �Requirements Completed
49. Electric Release to Edison ' �, f
50. Gas Release to Southern California Gas Cn � f
51. CERTIFICATE OF OCCUPANCY �
No. Date
: / .,: �� I 9 I i�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 9f7 GOBTA M86A. CALIFORNIA
For Appllcant to FIII In Comple►ely
TYPE OR PRINT
no a�ss eZoo-2 Y3a�E�"i i��'
COSTA MESA, CALIFORNIA
MXIL
ADDRESS norca Dr.
�„ti. Costa Mesa rT,
OR EN'G N ER Kaltenbach fT,
ADDRE59 97. Katella Anahei
CONTRACTOR �di'o5 I.and Compa
ADDRES9 1653 Minorca Dr. �
CITY Costa Mesa
u� No. 18766 No � KI 9
OF LOT % JG U � I No'
USE OF �
EXISTING BLDG.
6ETBACK LINE FROM /
CENTER OF BTREET SO REAR
/
SIDEYARDI LEFT /O R16HT
DESCRIPTION OF WORK
(o � � on�nr�.�c
USE OF BUIL�IN
Residence
3361
�E ��C�9�lr�
MAfl -2 2 issa
FINI�fdCE DEPT.
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDIN(i
For Offiee Use Only
p6CEIPT NO. PE9MIS NO. _
ZONING
NO. Op U6E
PLAN9 7 � BOII
YAROSAPPROVEO
MAIN BUILDING
( FROM G/L STREET)
tD�F�6 �� FRONT Ff.
� � R. SIDE -FT.
L. SIDE O FT.
/' /�
IN REAR FT.(O
DISTANCE BET.
MAIN BLD65.
SH
VAR. 3C
RIE9 ^� C. U. P.
, � AP�!t . I l � w..n
I HEREBY ACI(NOWI.EDUE THAT � XAVE PBAD TXIB APPLICATION THE AMOUNT eHOW
AND 6TATE THAT TH8 RBOV6 IB CORRECT AND AGREE TO COM. PURPOSE Op E6TA
PLY WITH ALL CITY ANCEB AND 8TAT8 LAWB RE6ULATINO ypLUATION
BUILOING CON6TRU 10 .
SIGNATURE OF
PERMITTE �-
s,��yis—
AUTHORIZED AGENT
c�reiseueo
••o o „ ._
'/ i JV^IY�7y
SHALL BE LESS THAN
VARDSAPPROVED
AGCESSORY BUILOIN6
BET. MAIN
ACCE55.9
DATE
�
�� n i �
n
VALUATION IB FOR TH8 F
A PEFMIT FEe ONLY. �
� �/— O
e �
IT FEE $ j
C� m
cHecK S � l — �
0
/J n
_ FEE $ �/ l
OWNER PACESEPTER WESP JOINT VENTU'RE DATE 3-22-63 __
JOB ADDRESS 2002 Baltra Place BUILDING PERIV4IT NO. 19173
INSPECTIONS
'�m -
VALU� $ 24, 415.00
FIRE 'LONE D�SCRIPTION OF WORK
GROUP �J TYPE V ZON
�PE�R1�J
- SUBCONTRACTOR n� s.�.F
G�1
����.: Zii�i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX H17 COHTA M6HA. CALIPORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDIN6
ADDRESS
COSTA MESA. CALIFORNIA
TEL.
' LIC.TNO.Dt � � �J tJ NO. r-i�X .
, SIZE I No.
� BETBACK LINE FROM
EhT �� - I' RIGHT
DESCRIPTION OF WORK
F�E RECEIU�D
FIN�AIV�E1DE�? �
�,���LfCATtt7 fVT'FOR `PERMIT
BUILDING
For Office Use Only
RBCEIYI'NO. PENN
�V D' pAT611tC[IV6q �
iz iz G3 i2-
BUILDINO �% D �
A�DR859 IV
FIRE
ZONING
NO.OP UB80FN!
��LANe '� / BUILDINO
LEOAL
YARD3APPROVED
MAIN BUILDIN6
( FROM C/L�$TREET�
�/ RONT �J Ff.
, w ains �.0 rrr�' I
BUILOINB NO.OP
SIZE ROOMS 8TpR1E9
EXTERIOR WALL I ROOF
GOVERING COVERIN6
USHOF;UILDIIVBANDWO KT BHPERFORMED
� ,.,e.ae
: u
�`,�.�
I NEREBY ACKNOWLEOOB THAT I XAVE RGD TH�e APPLIC�TION
AND 6TATE THAT THE ABOV! �B COqRECT ANO AOREE TO COM.
PLY WITH ALL CITY OqO1NANCiB AND BTAT6 LAW6 pQ6ULATING
BOILOINO CONBTHOCTION. ^
SIGNATURE OF �� _� / A� �/T' /� _
PERMITTEE —��/"�� �•���
AUTHORIZfiD A6ENT �j� �f.✓j)—y���/
VAR. SR
C. U. P. JC
APPROV6D
J
-_�
_ BE LESS TFIAN
U.B.C.RE�UIREMENT.
YARD9APPROVED
ACCESSOftY BUILDINO
DATE
�
ea. �. �
TX8 AM011NT BHOWN UNOER VALIIATION 18 FOR TH8 �
p11RP066 OF 68TABLIBHINO A pERMIT FEE ONLY. �
VALUATION Qp m
PERMIT FEE $ � �
S�/f �"V ,
m
$ V/� �_ A C 1 . 0
LL
L�
TOTAL FEE $ �
OWNER
GENERAL CONTAACTOR
Forms ❑
VALUE
SUBCONTitACTOR
PERMIT