HomeMy WebLinkAbout244 BUCKNELL RD - Building Permits! �
CITY OF COSTA MESA
4 os`""'FS, ` � B!/ILDING DIVISION
F�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
° 4 POR INSPECTIONS CALL: (7'14) 754-5626
°`��°"` PERMIT NUMBER: 610-00362
PERMIT TYPE B_ROOF2
APN: 41913502
JOB ADDRESS: 244 BUCKNELL RD CM
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 2500
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
11/2912010
KJ B
Valuation: 55,500.00 ,
SCOPE OF WORK: TEAR OFF EXISTING ROOF. APPLY 2 UIYERS OF #15 FELT. COVER WITH 30 YEAR COMP SHINGLES. ROOF
PITCH IS 3:12. APPROX 2500 SQ FT. INCLUDES ATTACHED GARAGE.
OWNER: CIRINO, RICHARD N
PHONE:
APPLICANT: THORIN, ADAM
PHONE: 714-965-0245
CONTRACTOR: ADAMS ROOFING
Address: 3435 S SILVER SPURUnit:
City/State/Zip: SANTA ANA, CA 92701
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $125.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 244 BUCKNELL RD
City/State/Zip: COSTA MESA, CA
Address: 3435 S SILVER SPUR
City/State/Zip: SANTA ANA, CA
License No.
License No.
PHONE:
License No. 524341
714-965-0245
CELL: 562•961•9299
PHONE:
PHONE:
Unit:
Unit: :
TOTAL FEES $126.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3H8/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thr4 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitietl al1 hours - Sundays and the following Federal
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relaled
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 auihorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and £nal approvai must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOEi. INSPEC110NTVPE ORTE INTITIpLS CODER INSVEGiIONTYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pooi Spa Final �/ i 208 Final Plumbing
200 Final Re-Roof /� 1�' ���� � 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Finat Site
204 Final Demoli�ion 250 FinalBuilding/Occupancy
WORKERS' COMPENSASION DEdLARATION.
I hereby aKrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certifcate of consent ro self-Insure for workers'
compensation, as pmvided (or by section 3700 of Ihe Labor Cotle,'(or Ihe
��ance of [he work for which this permit is issued.
�Irha�e and will maintairl workers' compensation insurance, as required by
�`section 3700 of the Labor Cqde, (or the performance of the work for which this
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
�number�are: S / �7 � �
�err+er:— ✓ 1 �' 1 l� `-� G1
(This secton need nol6e mlmpefed d(he permR is valuetl af one huntlretl cbllars (5100) a less J
� yNumber: �SC�D � yn
❑ I certify that in the p@rformance ot the work (or which this permit is
issued, I shall not employ any person in any manner so as lo become subject
to lhe workers' compensation I of Califomia, and agree thal if I should
6ecome sub�ect the workers' compensation provisions of Section 3700 of
the Labor Code� shall forth� comply with these pr���s. O
l
�SrAi,e—. � a<e-�
WARNING PAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FIN�S UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTOR$ DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
wi[h Section 7000) of Divisipn 3 of the Business and Professions Code, antl
my license isc�i—n fu�lljf/or�c>e ,an!q eff/e� t. �^
�,Nc,.il--J SK 7S'7%/ a�E�ass.#.--� ` �
�'ou� �I' / 2g /�
�„EgnvacmYSSlgne�ure 05tg,��
CONSTRUCTION LENDING pGENCY:
❑ I hereby affrcm that there is a construction lendmg agericy for the
perfortnance of �he woric fa which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Da�e
OWNER•BUILDER DECLARATIONS:
I hereby aKrm that under penalry of perjury that 1 am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 703L5.
Business and Professions Code: Any city or county which requires a permit to
constmct, alter, improve, demolish, or repair any s[rucNre, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant fo the provisions of the Contractors
License Law (Chapter 9(commencing with Secfion 7000) of Division 3 of the
Business and Professions Cotle) or Ihat he or she is exempt there(rom and
the basis for ihe alleged exemption. Any violation o( Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
fve hundred tlollars ($500).):
❑ I, as owner of ihe property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the strucWre is noi intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vroM himself or herself or thmugh his or her own
employees, provided that sUch improvemenis are not intended or offered for
sale. If, however, the builtling or impmvement is sold within one year of
completion, the ovmer-builtler will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTOR$ to construct the projec! (Sec. 7044, Business and
Pmfessbns Code: The contractas License Law dces not apply to an ovmer of
pmperty who builds or impmVes thereon, and who cont2cts for such project vnth
a contrdctw(s) license pursuant to the Contraclors License Laws.).
❑ I am exempt untler sec.
Business and Pmfessions Code for ihis reason:
Signalure
305�46 (3ro))
Ovmer ID verifed by dri. .,;ense. ❑ Yes ❑ No
Driver's License No. Expires�
Ven(ca(ion of Ownership by (type of tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certdy that no ezcavation frve (5) or more feet in depth into which a
person is required to tlescend, will be made in connection wiih work authonzed
by this pertnit, and that no building sWcture, scaffolding, falsework, a demolition
or dismantling ihereof, will be more than Ihirty-siz (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Administrafive Cotle).
❑ As owner-builder, I wiil not employ anyone to do work which would
require a permit (rom the Division o� IndusVial Safe�y, as noted above, unless
such person has a permit to do such vrork from the division.
Appliwnfs Signa W re
Division ot lntlustrial Safely Permit Number _
HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuNre building occupan� need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be fled with [he Cos[a Mesa Fire
Depahment by every business which has at any one time during a reported
year a ouaNity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, wi[h some
exceptions, requires registration with the Costa Mesa Fire Department by
each 6usiness which al any one time has on hantl a quan[ity of acutely
hazardous materials equal to or greater than a weight o! 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at stantlard
lemperature and pressure).
3. Does or will ihe appficant or present or fuWre builtling occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Cotle provides that the
Costa Mesa Fire Deparlment may require the prepare[ion, certifca[ion and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Secfon 25534 0( the Califomia
Health and Safety Cotle been fully complied wilh? ❑ Yes ❑ No
5. Does or will Ihe applican[ or present or fuNre building occupant require for
�he work which is 1he subject of this application a permi[ for Such cOnst�ucli0n
or modificalion from the South Coast Air �ualiry Management District or (rom
any other air polWtion con[rol district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumished on applications fa non-resitlential builtling pertnits).
6. Will any part of the facility to be constructetl under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meet Ihe requirement o( Sections 25534 and 42303
of the Cali(omia Heallh and Sa(ery Code).
7. I( a permit from the South Coast Air Quality Management District or other
air polWtion contml district or agency is required for the vrork which is the
subject of this application, have all of the tliscbsures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from ihe appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: 1 certify that under penalty of perjury the
information given above is correcL I agree to comply with all state laws antl
city ordinances regartling Hazardous Malerials and Emissions.
SgnaWre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correcL I agree ro comply with all state laws and city
ortlinances relating to building consiruction, and authorize representa�ives of
the City o( Costa Mesa to enter upon ihe above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until fna inspection.
SignaW olLegalOw qs) Oa�e
fr �/ a') /a
PMlor�O�Z¢pA�SpRcanl , .�� .
��I
Prescr�infive Cerfificate ui'
' Re,�•identiul.Alteratinns
. tl3rojecf � �ime: '7
� yy
Gencral 1nlnrm:�Ciun
� �S,nc.A'ddi�ess: 2 Cf[i 4C
nce: Residential
c���
L.nfurcemeni Agencp:
Climatc Zone �
I1fl1C:
lingle Tamily ❑ Multi Family I Circic ihe Froni Gricntat(m�: 1J, E, S, U�, or deprees
Yrqjeei "J�y�>e: D Alieralions L7 Lnvelope � Fem;stration Q_
Areu (CPAJ: L7 �C v keplacemem or Change Gm ❑ lluci keplacement ❑ Water
i.c nnt m Lc uaet! fnr Nc�vA� Consrructcd lfnildii:g.c m' ffdditione'
� CF-i R-ALT
(Ya��e ] oi �1
� � 1! a1' Storie5
l�i,sulnlian Nntues Fnr Oparyur S�q�Iaces' (Jor Fvrrfrtg u.se the Mas.s and Furring Su'ips Concu�uc�ion mGle Gelow)
Axsembl)' Al�cration '
❑(}peuing ofYramed cnviq' alune- Alrerations 1ha� imrolre d�e opeiring ofthejromed covir�� oja wa71, ceifiieg, or;/loor musr insm!/ �he
monduia�r mininnnn insidaiion ��nluc per,¢J5� jor ihe ahered aea�emblt�. Fill in Columns 4-C und emer mundoinn� ittsulofinn oalue in Column H.
❑ Heplucement of entire s�ssembip-Reylucemen� o/an emire wall, ceiling, or _/loor assemLl�� reyuirea �hc insmlloiion ofCmnponem
Puckaea- L insnlatinn volues in TaLle I57-C. Fill in Columns A- J. _ __
1 a ueSurl'aceDeta
p U
Y
?ag/ Assembly Name
]D� orTvae�
Noic:
ror t6e lurred purtioned of Mass W alis see Furring Strips Cunstruction T'able belnN•.
c n � r c a r.
iored s�� n�,.� ' Standord Values From JA4 Table
Framing Thiclaiess, Framed Continuous ]A4
Meterial Spacing, U- ]A4 Table Cavip� ]nsulatimi Assemoly
andSiz=_' orOther' factor° � Number° R-value� R-Value' Ce]IValue
accouniing
see Poge JA4-3 m�d L•9�iatia�
use thc Mass and
1. For Tng/ID indicaie (he idemi�cmion name iha� mmches !he building plans'.
?. Indica�e ihe Assembh� Nume or ,rypr: Roo/7Ceilirtg, Walls, rfoors, Slabs, Craw! Spare, Loors and etc...]ndica�e !he Frame rype and Size: Fa�
N�ood, Meiaf, Metal Bi�ildings, Mass, enter 2x9, 3xG, or etc... see JA4 ja� o�her nossible framc rype assemblies.
3. Eivrer rhe diic/rness (m� mas.+ in inches or Snacing 6enveen {rmning members enier; ]G"or 24 "OC; or Uther for all oiher� assentbl7� descrfniion
such aa Cnncrete Sandwid� Panel, Spandrel Panel, Logst Srraiv Bale Paree/ and elc....
4. Bu,aed on ihe Clinmie Zone; e�iter the Siandm�d U faciw :{�om Table ].i 1-B, C or D jar each d ffererv assembfp Narne a� q pe.
i Enter Ihe Tablc uumber Oial closett' resemLles Ihe yr'opo.roed aa�a'emblv.
(, L'n+er !he R-nolue Ilm1 i.r Leiug inslalled in �he wall cm�ip� m� between die fi�pming,- olhc�wise, e�vnr "!1 ".
Z Emer the Coniittunus lnsidaiion R-nalue for �he proposed assemblp; o�herwise, en�er "0".
d'. Ln�ei� t6e rm+- mid cofunm of �he U-fac�or valuc 6ased a� Co(unm FTuble Number and enier Ihe dssemblp U-jacior in Co(unm J
'). The ProP��.�erl Assenrbh� LI-f�ciw�. Calcunn.l. mus! be equal ln m� les.r Ihun �he S[undard U-(ucior in Cohmin E m comnh�.
Fun�in� Strips Consiruction 7�able Tor Masx VJu)Is Gnly
A R C ll l F G N I .1 IC L M
I'rapnsed I'r uperties of Mnsonry und Cuncrete Added Intc�'ior or �xterior ]nsul:dian I
V1'allx Prum Rcicrcnce in Tun�ing 5pare f'rum Itelerencc '
Juinl A�neudia'1'ablr 43.5. 4.3.G. 4.3.7 .loinl A>>endis "I'able 4313 I
U � m 1 : - U i
u I G� V �^ L J
hsscmblp � I, ° �.� F- H c V� �_ <"u _'
Final
� " c� c = - - � � Assemblv
Mus:. Nume oi .INA Tablc '' g � = c rt � r A ,.� _
Thiclu�e5s' l� p:' IJumhcr � - � ui � i`_ � 5 � c t' � r . ��-f�C[Oi�� Commcm
� II I I I
I ! � i � �
� � � � ; I
i � � I � I
l:egi.xiruonn ivumLer: Ifegisu'mion Uuie/Timc: FIEKSPrnvider:
?0(11; 11ea�ide�atial Crn»pGc�nce Farms �ugu.rl 201)9
�
oTCumpli :: Residential CT-IR-ALT
Resitlentia/Alterati9ns ' � (PaRe3o1'
�'�'�i�cl Nume: ' � Climnte'Ln�nc 8 � �# oFS[orie!
P_OOFING YP.ODUCTS iC�JOL I200FS) §157(/�L
N4ie�+ Ihe nrea aJceterior rnnJ'sur�nce m hr replaced ecceed,r ��ro�c umn 50,6 �fu,� �r.s��„b rnnf Prer; or more 1Lun 1,0!!0 f�, �vhicLever t.r
les.r, the ne�o ronf��b' �+�'en iuusi meet Uie mofnb produc! "ConlRnnf'rer�uireu�enLr oI§I52(b)]Hi, I52(L)lNii, nr IS2(hJlHiii. �
Checl� npp(icaGle niteruntine ar r�cep�ioi+ Lelo�+• if �he irooJalreraiion i.e ezemp/ fi�om Uie roofing prnd+�a "Coo/ Ronf.'. ��equi��emenrs. Nnre: /jan�,
m�c njdre a(�ernative.v or exceptiar below is checked, d�e Aged Sa(ur Re//ecmnce and T/�ermu/ Emiltancc re9uirement.v jnr roqfing prnducr.r in
18(iJ m�c no� applicable. On »ai rll mble belnn�.
oo) Roofs N�t Required iu Climate Zones I-12, 14, and IG with a Low Sloped. Less or 2:12 pitch.
Cool lioofs Noi Required in Climate Zones I lhrough 9 and I G wiih u Steep-Sloped Roofs (pitch greater thun 2: I2) and produci unit weight less
than S16FH�.
Alternatives tn §152(L)1Hi and §]52(b)Hii, Steep-sfnpe rnof fpirdr > 2:12J
O Insulation wilh a thermal rosistance of at least 0.85 hrft �°F/Bni or at least a 3/4 incli air-space is added to the mof deck
over an attic; or
O Existing ducis in the attic are insulated and sealed according to §I51(�10; or
O In climate zones 10, 12 and 13, with I ft�. of free ventilation area of attic ventilation for every I50 ft� of anic Floor nrea, and
where ut least 30 percen� of the free ventilation area is within 2 Ceet venical distance of thc roof ridge; or � - -- . ��
❑ Building has at least R-30 ceiling insulation; or
❑ Building has rudiant ba[rier in the attic meeting the requiremenu of $I51(�2; or
❑ Building has no ducts in the attic; or
O]n climate zones 10, 1], l3 and IS, R3 or greeter roof deck insulation above vented attic. .
Exception tu §152(b)1Hiii, Low-slope roof (pitd� 5 2:12J �
❑ Building has no ducts in Ihe aitic.
Other Ezceptions
❑ RooLng area covered by ouilding integratee; phomvoltaic panels and solar-thermal panels are exempt from the beloa Cool Roof cri[eria.
❑ Roof constructions that have thermal mass over the roof inem6rane with at least 25 Ib/P' is exempt from the below Cool Roof criierix.
Note: If no CFLRC-1 label is available, inis compliance method cannot be used, use the Performance Approach to sho��� compliance, oihenvise,
Check the apnlicabie'oox belov� iSExemnt fmm Yne Roofm Products "Cool Roof' Itequirement�,
Roof Slope I Product Weight Product Aged Solar Thermal
CRRC Product ID Number� <_ 2:12 > 2:12 < Slb/fr' > 516/ft' T e� Reflectance3'd Emittance SRJS
❑ ❑ I ❑ ❑ p^ �
❑ I❑ I❑ I❑ I 10"
� I° I � I� I I�"
❑ ❑ ❑ ❑ 04
o i o i o i o i i❑^
1. The CRRC Pinduc! ID NuniLer car Le oGrainedJrwn lne eoni �mo/ l(anng L"musi!'s 1(med Prntlua Direcmrp ai w�n�r.rnolrooLr.arv/nrnauc�s/.rearclt nhn
2. Indica�e 1he q�pe OJp�'ndncl ix being uaeeV jnr d�c raof roy, i.c. single-plp roof, aspGal� rno/ meml raof, e�c.
I. 1/ihc dgeAltepeciance i.r iro� ovoilable in.tlie Caol Raof Rming Council'.s Raied Prnducl Direc�arp Umrr use tlic L�i(ia/ ReJleclmice valuc fi'am !he samc
dir'ectnr;p and uselLe equalion (01+0,7(/1��������— 0.2) ro abmirr n calcula�ed aged vuh�e Where p ir �he Lii�in/ Solar lieJlec�nncc.
4. Check Ga�' i(�he dgad ReJleciance i.�� n culculaied vaLie usirrg !he eyimiion ahove.
5. Calc�dme tlie SRI volue Lr vsing Ihe Slil� Worksheei al M�p:U�nmuteirere��.cn ¢nv/litle24/ and emer Ihe re,s�diing vnh�c in dre SR/ CnLunn aLnve and nttoclr uco
ihe Sft/- 14orkshee� m the CG-Nt.
To apply Liquid Pield Applied Cuntings, Ihe coating must be applied across lh� entire roof surface and meet the dry mil thickness or coverage
recommended by lhe coatings manufacturer and meel minimum performance requirements listed in §] I8(i)4. Select the appliceble coating:
Aluminum-PigmentedAsphalt RoofCoating
Regisb�uiinn N�nnber:
2005 Residen�inl Compfiance Forms -
Cement-Based Roof Coating
2egisu'aiion Daie/Time:
Uther
FIEILS Provider:
fiugus� 2009
7'rescriptive Cerfiflc�te ol� Cumpliance: It�sidenfial
k esidcntinl ,91ter¢t:ons
Jh'ujecl IV;ime:
" Cr-1 i:-ALT
(Pa�e � uf �l
Cliw�ic `Lunc rt � � oi Sturies
I-I�ILS Y�I:IF] CAT10f� SUMfl1AP�1� Tire errJorcemem ngencr shoidd pm� a:necial ouenuoir in ihr HGl(S h9eus<u�rs e�pecifiecf in tn�a
Cbecld�si belmr fi conrpleic�i nnd si�ned CF-4R Fornr !or nl/ �hr niena�eu�e.r specilied.shnH bc ruLmn�ed �n �iic Guildmg uiapecmr bel���c� )rnol
�)I1CI SL'il�IIIe' b' � CStlllo HG'/l� �mri/icnlion is rcgtnre[�/a' IIvA meusure.
❑�'L' S ❑ NU �'CS: In Climaie Zones � and 9-I G, if more tlun� 4b linear feei of nr.w ui replucemem ducix w�e insieilled in uncmidnioucd
spnce, Ihe ducu. ure io IlC SCfIIC(I �]CI \�IS�III�ILII illl(I lI1C IIGN'I�' IIISI'JIIC(I (JIICIG �TC l(1 bt insul;i�ed pei {�I51(1�1)0.
� L'XC�1'TJO�': Laisting duc� 51•stems tb%�i are esleuded, �vliich :n'c cuustructed, inxul:ued ar sculeA �vith :isbestas.
p P�S ❑ NU 1'LS�. ln Climute "Lonec 2 and 9-1G, if the exisiin� space-condiiiouing sys�em (}-1VAC eqwpmeni and ductin�l ic repinced; th:
ducts are to bc sealed per { 152(6p Di. �
❑ 1'�5 ❑ NCI 1'�5: Jn Climnte Zones 2 �nd 9-16, if the er.istiu� HVHC equipment is mpinced (iucludm� the replacem�m o1 the nii handlei;
owdom condensiug unii d a solii system: cooling or heuing coil, or the iimiace liem er.changer) the ducts ;n�� to 6e
sealed pei § 152(b)1 E.
❑�XCEPTIU�: Duct System� thai are dncwnented w liave Leen previuusly se�ded confirmed tLruu�l� HGP.S
� verlticetion in accurdnnce �vith prucedures in the Relerence Residential Appendiz iiA3.
, ❑�XC�PTIO�: Luct srstems with less tl�an 4U linear teet in uncondi[ioned spuce. �.: -� -- � �-
❑�}:CLPT70�: �xistin� duci svstems cons[ructed, insulated m� sealed �vith asl�estos.
keiriverant Charee - Split S,l'Stem HERS veri/icntiar is requirec{for �his measure. �
Q Y�S ❑ NO YES: ln Climate Zones 2 and R-I5, when the existing 1-]VAC equipmenl is replaced (including the replacemeni oPthe air
handler, outdoor condensing uni� of a splii system A/C or heat pump, cooling or heating coil, or th� tumace heat
Central Fan Inte�rated (CFI) Venfilation STstem and Fan �h'att Uraw
The ventilation reauirements of §I50(o) do not aooh� tn ezistin¢ residential homes.
l)ucxed 5plit Systems - Air Canditioners and Heat Pumos'. Airfloh� HERSve:�iiicaiia+� u regui�-ec(_Jor thas measurc.
❑ Y�S ❑ NO 1'�S: ln Climate Zones 70 t6rou�h 15, when the exisciag space-condi[ionino system (HVAC equinment and ducting) is
replaced. the airflow and iau wen drav.� shall be verified ner §152(b)1 Ci io meet the renuirements of G1�1(fl7B.
iation Author's lleclaranon State�
fr that this CerfiScate oT Comuliance
�y L/1 OG� �'��
T�/cule,a., S � o i� � �i
� �l .� S` s,' /�,� �
4� �q •� �I °� -
//�� 9�/O
1f Hpplicable rJ CEN oi O CEPE
(CertiGcatiou N):
Rhm� ,/ �% � /�
6
Responsiblc.73u'sldine Desirucr's Lcclaratioc St;+tcmem '
� 1 un� elipible imderUivision ; ol the Culiiornia BuSines:�� uud 1'wfession: Code tu nccepi responsibiliq� Im� ihe building desi@n identif�ed ou
this GcniLeaie nf Compliancc.
• 1 cmiiiY thai �hc energy tea�ures and perSormance specific�tion:� for the building desi�i�'itluntifieel nn ihis Ceruflcate of Cmnpl�mncc coni'orm
to thc requiremenu, ol'7i�lc 2a,1'art:: 1 tind G of Ihc Culiiorniu Cndr of ]legulatiun:.
• Thc bulldmg desigu fenwre:�, idcntiGed an �hi:�. CeniLeme nfCompliunec;ire wnsisiem wiih lhc inlormaiiun pri�vided ti� ducumeni thi:.
Uuiiefin� design on ih� alherupphcaUle cumpfiunce fonm.. woi'hahcets, adcuYntiona, pl�in:, und speci'ficauon:. suUnnucd ti� LLc enfurecineni
aeencv fm� tipProval with this buildinr pennii upphculion.
IJ�nnc�. Si�natwc�
CumpnqY
Hddrvs.:.
:;m;'titaul"Lip�
Laie:
Licens�:
For a.s.si.rumcc nr quca'tinn� regurdbi� thr E�rergr Slandm�d�, coni�ecl lhr Enm•gr Nntlii�c nz: 1-8011-; ;2- �311(1.
Itc�tia�iruiinn l��umbcr /(c���.sirmum Luie/Timc HLI;S Prm�¢im�
2(1(17:7cc:r¢ien�iul Cuinp(ioncc Fnrm:, /ugu:rt 3(10J
� �� ,. � 8�5"�
�OSTA MESA BUILDING DEPARTMENT
P.O. BOX 31]
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
ADDREI55 � B11Cti11� lYl.
COSTA MESA. CALIFORNIA
OWNER $ J. Y118IIC19�
MA!,�«< 1555 Placentia.
CITV Nez ort Beach Cal. TNo:
ARCHITECT 9$j�je LIC.
OR ENGINEER NO.
ADDRE55 68IDe
CiOilSt� W� CITV LIC. 1�y7
LEGPL LOT 7�
oeswirno� NO.
A.P. NO. . .
size 62 x loC
OF LOT
USE OF
'EXISTING BLDG.
SE?BACN LINE FROM
CENTEN OF STPEET
, � .G ISc7 ��
-;i ,�4- i-
�.,. i .�... t.
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIGT NO. pERMIT NO
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
FIRE
ZONE
TEL. APPROVEp
$Rle NO. H&TR6 BV
2029
BLOCK TRACT
I�� NO.OF BLDGS. O
NOW ON LOT
5O REAR VARD
DESCRIPTION OF WORK
NEW qLTERATION ADDITION
REPAIR � MOVING DEMOLISH
BUILDING NO.OF
SIZE ROOMS �j STORIES
EXTERIOR WALL _i_____ ROOF y_y ___
�iucaa�o
Plan 1—A
CORRECTIONS
The Amount shown under valua!ion is for the
I HEREBV ACI(NOWLEDGE TMAT I NAVE NEAD TNI$ APPIICATION AND �1u�DOy`8 � esa is mg a permi ee ony.
ST�TE TN�T TME �BOVE IS CORFEQ nN0 �GNEE TO COMPLY WITH 4LL r
CITY ORO�NANCES D STRTE L�WS REGULATING BUILOING CONBTRUG
iION. V A W ATION
SIGNATURE OF PERMiT FEE S OO
PERMITTEE �]
15,962��� pLHNCHECK 5 �`��O
s
AUTHORI2ED GeNr TOTAL FEE 5 2,SO
r��
JOB ADDRESS
GENERAL
AP No.
INSPECTI(
Soil
Gas
�Water ^
A
Final
or
[PTION OF WORK
Date I GROUP J
SUBCONTRACTOR
24684
CQ�A MESA BUILDING-SAFETY DEPARTMENT
�� P.O. BOI 91] C09TA M69A. CALIPORNIA
For Applican► fo Fill In Completely
TYP� OR PRINT
BUILDINO
ADDRE55
COSTA M�SA, CALIFORNIA
CITY V
STATE TEL. /
LIG.NO. NO. �� S�O Li "1
6cZE � ll ��� � up�o^ aLDoa.
nr I. 9--A Y lAA-n
SETBACK LINB FROM �y � � �
CENTER OP 9TRE8T "1 qeAR
l
61�EYARDI LEFT � �� R16HT
DESCRIPTION OF WORK
BUILDINO � 1� 1
SIZE - (
EXTERIOR WALL
CITY OF C,rsSTA MfSA
SEP 7 1965
APPLICATION FOR PERMR
I F�BE(t�Dl��nlv
��
__ P6C[II� NO. PI
APPROVED
O�� I I PLANB 1� I OUIL�I�NO� ��""� 1/
f 1/
�°�� 1. 0 7 S�7 r �2 a o�
D88CPIPTION
A. P. NO. / �F / ` G.0 !I� � O �
•- �'r—Te
NOTH: NO EAVE OVERHANG BHALL BE LES3 THAN
YARD9APPROVED
MAIN BUILDIN
( FROM C/L 8T
S+D�� � NT
�,�i R.eioa 3rr. fi
1 HEflEBY ACKNOWLlDOB THAT 1 HAVB qGD TN19 APVLIWTION
ANO 9TwTE THAT TMH �B V8 IB CORflER AND AOREB TO COM•
PLY WITM �LL CITY ORDIt NC88 �NO BTAi6 L/�WB PHOULATIHO
BUILDINO CONSTHOCiION. '
SIGNATURE OF
PERMITTE `
AUTHORIZHD A6ENT f/ �� � •
VAR. ik
YARDSAPPROVED
ACCESSORY BUILDINO
DATE
e
n
60. FT. �
TH8 AMOUM BHOWN UNDHP V�LIIATION IS FOR TH! _
PtIPPOSB OP HBTABLIBXINO • PEHMIT FE6 ONLY. �
_UATION +� �{Jp N
PERMITFEE S C7 j
�da ;
9ar ' 4