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HomeMy WebLinkAbout1965 BALEARIC DR - Building Permits CITY OF COSTA MESA ^rw'"Fs,9 BUILDING DIVISION F ,i 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 4, FOR INSPECTIONS CALL: (714)754-5626 st°--;;; De D PERMIT NUMBER: B10-00084 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 13943143 DATE ISSUED: 0410112010 ISSUED BY: KJB • JOB ADDRESS: 1965 BALEARIC DR CM Suite/Unit: Vicinity: • Squares: 3400 • Valuation: $14,200.00 SCOPE OF WORK: TEAR OFF SHAKE ROOF.'RE-SHEATH AND COVER WITH 50 YEAR CELOTEX PRESIDENTIAL CLASS A COMP. APPROX 2200 SQ FT/ROOF PITCH IS 5:12. 1200 SQ FT FLAT ROOF AREA:TEAR OFF AND RE-ROOF WITH BUR CLASS A GLASS CAP. OWNER: WILSON,WILLIAM MARTIN TR Address: 1965 BALEARIC DR Unit: PHONE: City/State/Zip: COSTA MESA,CA • APPLICANT: WILSON, ERLEEN Address: 1965 BALEARIC DR Unit: : PHONE: 714-751-1747 City/State/Zip: COSTA MESA,CA - • • CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State/Zip: • CELL: • ARCHITECT: License No. PHONE: • ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $251.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $252.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-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 holidays New Years Day, Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California 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 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 the expiration of this permit. CODER. INSPECTION TYPE DATE INTITALS CODED INSPECTION TYPE DATE INTEDALS 1616 Fixed System Final Fire Prevention [�JJLLt�� 206 Final Mechanical 1266 Pool Spa Final 14"i1 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive, .,,tcense. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-.property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized (� by this permit,and that no building structure,scaffolding.falsework,or demolition Carrier: V or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (This section need not be mmple a per rt is valued atone ntlred Mlldrs(5100)orless.) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). olicy N ber: ❑ As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless issu , I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' c�bm�,p,ensattf�ooj� laws of California, and agree that if I should become -object to t"work¢rs' pensation provisions of Section 3700 of Appllcanrs Signature Date the Lab e,I Ifo f'iwit mply with these provisions. / —/D Division of Industrial Safety Permit Number: allakant't&Sgnatuie CSC HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No Lic.# Class# (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contractors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? CIYes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature , Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? El Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes El No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8liance from the appropriate air pollution (If' es", attach certificate of compliance employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not b ild or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and as owner of the property, am'EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. �f ENSED CONTRACTORS to construct the project(Sec. 7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Co c a to enter upon the above-described property for / inspection ` agree not to 29ccupy or allow occupancy of any building authorized -•.u- rmlt unti al i S c Ion. ( 6saterort enrl vnl:Ocia js2 Date 3057-46(3/071 Andbr Authorized APPLcant Dal¢ —__ ` City of Costa 914esa BuigdingDivsion — 77 Fair Drive, Costa Mesa, CA 92626 Costa Mesa 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # B/ 0 - O u V ekt Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in youy me listing your IfaS the builder of the property improvements specified at / 'Co C C7/'1/oc1 2 ic We are providing you with an Owner-Builder Acknowledgment and Information Verification 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 approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION 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- 8/Older" 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 willfully acting as an Owner-Builder an aln aware of the limits of my insurance coverage for injuries to workers on my property. L l,(;2. I understand building permits are not required to be signed by property owners unless they are 4 responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _,_ C '3. 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 her name instead of my own. '1 or understand Contractors are required by law to be licensed and bonded in California and to list their licen a numbers on permits and contracts. k `5' I understand 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 bec nsidered an "employer" under state and federal law. 6 I 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. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family 4 . 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 --- I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held Ijable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. rA. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: ( c1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide 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 information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public, If you contract with someone who does not 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. 1gnature-of-property owibr )G� CDate-v 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: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally 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 to verify the property owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 ,Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential}Alteration Alterations' (Page 1 of 5) Project N;r Climate Zone k Ktones . (/v 15 OIC (S9 ' • General Information ,y Site Address: I S Valu tf C Enforcement Agency: I Date: Tc . i , J0 Building Type 0 Single Family 0 Multi Family Circle the Front Orientation:N,E,S,W,or degrees • Conditioned Floor Area(CFA): • Project Type: 0 Alterations D Envelope 0 Fenestration 0 Roof 0 HVAC Replacement or Change Out 0 Duct Replacement 0 Water Heater NOTE:This form is not to he used far Newly Constructed Buildings or Additions . - Insulation Values For Opaque Surfaces(far Furring use the Mass and Furring Strips Consiniclion table below) Assembly Alteration 0 Opening of framed cavity alone—Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the mandatory minium , insulation value per§1.50 for the altered assembly. Fill in Columns A—C and enter mandatory insulation value in Column H. 0 Replacement of entire assembly—Replacement of an entire wall, ceiling,or floor assembly requires the installation of Component Package-D insulation values in Table 151-C. Fill in Columns A—J Opaque Surface Details For the furred portioned of Mass'Walls see Furring Strips Construction Table below. .. 'A B I C . I) - E • . F _ C .. ...H I_ _ I .. ,L.......... .._ _.. ... Proposed See Nate Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly IDI or Type and Size or Others factor' 1 Numbers R-value _ R-Values Cell Value" U-factory • Note:For_furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculatingfinred walls use the Mass and ;Faring Construction table below. " 1.For Tag/ID indicate the identification name that matches the building plans. 2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors, Slabs, Crawl Space,Doors and etc—Indicate the Frame type and Size:For Wood, Metal, Metal Buildings,Mass,enter 2x4, 2x6,or etc... see JA4 for other possible fame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24"00;or Other for all other assembly description such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc.... 4.Based on the Climate Zone;enter the Standard(Hector from Table 151-B, C or D for each different assembly Name or type. 5.Enter the Table number that closely resembles the proposed assembly. 6. Enter the B-value that is being installed in the wall-cavity 0r between the.framing;otherwise, enter "0". 7. Enter the Continuous Insulation R-value far the proposed assembly;otherwise, enter "0". 8.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U factor in Column J 9.The Proposed Assembly LI-factor, Column.1, must be equal to or less than the Standard U factor in Column E to comply. • Furring Strips Construction Table for Mass Walls Only A ( B C D ( E FIGLIIII 13 K _ L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5,4.3.6.4.3.7 .print Appendix Table 4.3.13 V ri J' - u '; U I N :C e Assembly 2_ u L c '° F- t, o m•m 2''u .c ` Final Muss Name or JA4 Table ., _ ✓ v = E ,E-i' o E V ? o p ; Assembly Thickness' Type' Number' < ' 4 w & a` g if N ¢ j m r U-factor°3 Comment i I r 1 Registration Number: Registration Date/Time: HERS Provider 2008 Residential Compliance Forms August 2009 . Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 3 of 5) Project Name: r , LClimate Zone# Co #of Scl:{ �J t SO\ .ROOFING PRODUCTS(COOL ROOFS)§157(012 When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000 ft', whichever is less,the nein roofing area must meet the roofing product"Cool Roof'requirements of 152(b)IHi,152(b)IHii,or 152(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof"requirements.Note:If any one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in i§1 (i)are not applicable.Do no!fill table below. ool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch. ool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less than 5113/ft2. Alternatives to§152(b)1 Hi and§152(b)Hii,Steep-slope roof(pitch>2:12) ❑ Insulation with a thermal resistance of at least 0.85 hrti'':°F/Btu or at least a 3/4 inch air-space is added to the roof deck over an attic;or ❑ Existing ducts in the attic are insulated and sealed according to§151(010;or '_CO"1n climate zones 10,12 and 13,with I 112 of free ventilation area of attic ventilation.for.every 150 ft.of attic floor area,and,.. where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or ❑ Building has at least R-30 ceiling insulation;or ❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or ❑ Building has no ducts in the attic;or ❑ In climate zones 10, 11, 13 and 14,R-3 or greater roof deck insulation above vented attic. Exception to§152(b)111iii,Low-slope roof(pitch<2:12) ❑ Building has no ducts in the attic. • Other Exceptions • ❑Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Coo]Roof criteria. 0 Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft2 is exempt from the below Cool Roof criteria. ' - Note:If no CRRC-I label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise, Check the applicable box below if Exempt from the Roofing Products"Cool Roof"Requirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number' < 2:12 >2:12 < 51b/f12 > 516/ft2 Type2 Reflectance3'4 Emittance SRI5 ❑ ❑ 0 0 . ❑4 0 0 0 0 04 ❑ ❑ ❑ 0 ❑4 O 0 0 0 ❑4 ❑ ❑ ❑ ❑ ❑4 I. The CRRC Product ID Number can be ohrained.6am the Cool Roof Rating Council's Rated Product Directory at www.coolr'oofs.org/products/.seorch.nhn 2.Indicate the ape of product is being used for the roof top,i.e.single-ply roof asphalt roof metal roof etc. 3. If the Aged Reflectance is not available ui.the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value(nm the some directory and use the equation(0.2+0.7(pindird—0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4-Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI-W'or'ksheet at http://wwm.energtaca.gov/lrle24/arid enter the resulting value in the SRI Column above and attach acopy of the SRI-Worksheet to the CF-I R. To apply Liquid field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coaling: ❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms ' August 2009 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations (Page 5 of 7) Project Name: ( 5 Climate Zone ti /' 1:of Si.. es 1 (fin/ O� • HERS VERIFICATION SUMMARY' The enforcement agency should pit'special attention to the HERS Measures specified in this checklist below. A completed and signed CF-4R Farm for till the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verificanor is required for this mea,rznrc. 0 YES 0 NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned space,the ducts are to be sealed per§152(b)IDii and the newly installed ducts are to be insulated pet 1;151(1)10. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES 0 NO YES:In Climate Zones 2 and 9-16, if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the ducts are to be sealed per§152(b)lDi. ❑ YES 0 NO YES:In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced(including the replacement of the air handler, outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be sealed per§152(h)1E. ❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS • . . - - •verification in accordance with procedures in the'Reference Residential Appendix RA3. ._. 1 ' •- •- . 0 EXCEPTION:Duct systems with less than 40-linear feet in unconditioned space.. . ._ O EXCEPTION: Existing duct systems constructed. insulated or sealed with asbestos, Refrigerant Charge - Split System HERS verification is requiredjar this measure. o YES 0 NO YES:In Climate Zones 2 and 5-15,when the existing HVAC equipment is replaced(including the replacement of the air handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat exchanger)a refrigerant charge measurement shall be verified per 61521bl1F. Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw • The ventilation requirements of§I50(o)do not apply to existing residential homes. Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. - 0 YES 0 NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is . replaced.the airflow and fan watt dray. shall he verified per§152(b)I Ci to meet the reounements of§151(fl7B. ocumentation Author's Declaration Statement . • I certify that this Certificate of Compliance documentation is accuraty"nt3 coi-1r nlete. 7) Name: efC�� Q ✓t t Si'� ��e_g.�---' Company: Date: /' / /3 • Address: L 9Ca (n /n K/ - If Applicable❑ CEA or 0 CEPE V! r/( ( xal" 1 G (Certification 10: City/State/Zip: Phone: �iOS l�2�s� 7/C1( 1S/ l7`f 7 Responsible I3uildinq Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to de:requirements of Title 24,Pans 1 and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms,wo).sheets,calculations,plans and specification::suhmitted to the enforcement agency tot approval with this building permit application. Name: Signature: Company. Date: • • Address: . License: City/State/Zip: 1 Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: J-800-772-3300. Itegistrant»?Hi ether: Registration fiate/Timc': HERS Franider: 200h Residential Compliance Forms August 2009 1980e 1 • COSTA MESA BUILDING-SAFETY DEPARTMENT FEE R E C t I V E D • P.O.BOX 317 COSTA MESA,CALIFORNIA .. dII R 1 0 'g, • For Applicant to Fill In Completely ����� PERMIT Tr. 4341 TYPE OR PRINT Lot 44 CITY OF O98WIPWS.A )(/_ ry(kAte 1 �l\ft� �l For Office Use only. M�11�R^W,�'u ADDRESS I F CT�� ,Q Y`4'`A,e �'l!/ + '1 �� sub RECEIPT NO. PE COSTA MESA, CALIFORNIA RECEIVEDDY- /DATE RECEIVED ATE 66t`'3 OWNER Grove Park Construction,Inc., lV !v-/ k- JU�1 d BUILDING 4-_--MAAIaEss 1653 Minorca Drive ADDRESS 6v .9 /....t : '' r TEL.KI-90395 ZONE TYPE GROUP / . FIRE CITY Costa Mesa NO. i - ARCHITECT OR ENGINEER E. G. Kaltenbach TEL NO. 772-3361 AByPROVED DATE ADDRESS 9772 Katella Ave.,Anaheim. . ZONING ' / G `/I I. PNO.LANS USE OF G 7 CONTRACTOR Mesa Verde Development Co. 1111 '� iN LEGAL 1-� I ADDRESS hamI653 Minorca Drive DESCRIPTION `'./. `—'� ti. /' r,I vim- (, ` •CITY Costa Mesa A.P.NO. c / j STATE 181322 TEL. KI—90395 SrTE: NO EAVE OVERHTO SIDE a REAR P.LNG SHALL BE LESS THAN LIC.NO. _ - NO. EAVES OSIZE LOT F 81 X 108 I NOW ONLOTNO.OP GS 0 ALLOWED • (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF- --- MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM/C,/L STREET) SETBACK LINE FROM 45 42 FRONT t--5 FT. FT. CENTER OF STREET REAR YARD . j`J SIDE YARD .LEFT 23 I RIGHT . 12 R.SIDE IZ FT. Fr. , DESCRIPTION OF WORK L.SIDE a 3 FT: Fr. NEW ^ ALTERATION ADDITION . REAR 4, Ff. Fr. ' DISTANCE BET. BET.MAIN& • REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BNO OF VAR.# - DATE SBU-DING 2082 s,f. ROOMS 7 STORIES 2 C.U.P. APPROVED EXTERIOR WALL wy�ood ft ROOF . si,akee,, & APPRO �//�l/I/��I�.,I 6 -�.y -` ? COVERING stUCCO COVERING slit ngle BY' ,� I� Ij j�.`/L� DATE J USE OF BUILDING AND WORK TO BEP RFORM D IIITTT single family resedence and attached garage..�� . Plan 2 C . . • . f/l /s< D. 75174q• 9%2.024>> I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE TH HE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE, ONLY. O PLY WITH AL CI ORDINANCES AND STATE LAWS REGULATING VALUATION .S A q BUILDING CO :TRU•.ION. J �j�q�I PERMIT FEE $ �/N •T•' SIGNATURE O' a . ' / - �X['L'�.tE / PERMITTEE �^'S��^^"VV��fr� //(/. S") %1( GL0 F $ �//v J LAN C G O AUTHORIZED AGENT / TOTAL FEE $//J "