HomeMy WebLinkAbout3036 COOLIDGE AVE - Building Permits. i .
CITY OF COSTA MESA
�,0�'TpMF$p B{/ILDING DIVIS/ON
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F� �r 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
`+, � ? FOR INSPECTIONS CALL: (714) 754-5626
``"^��°`"' PERMIT NUMBER: B11-00253
PERMITTYPE B_ROOf2
APN: 14114303
JOB ADDRESS: 3036 COOLIDGE AV CM
Vicinity: ROOF
Squares: 2900
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
Valuation:
ISSUED
08118I2011
RMD
$12,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIAIS, INSTALL 2 LAYERS OF 15# FELT ON A 2:12 PITCHED ROOF AND
REROOF W1TH UFETlME GAF COMP SHINGLES ON AN EX1S71NG ATTACHED 3-PLEX AND REROOF WITH ROCK
ROOF ON FLAT AREA (GARAGE), APPROX 29 SQUARES. REPAIR AND REPLACE SHEAHTING AS NEEDED. �
COMPLIANCE FORMS A7TACHED TO JOB CARD AND CITY PERMIT. '
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See�Attachment wlinspection Card
OWNER: CURRIE, GORDON Address: 18703 SAN MARCOS ST . y ' • Unit
PHONE: City/State/Zip: FOUNTAIN VALLEY, CA' '' '
APPLICANT: HANSON, MIKE Address: . � ' � � � Unik :
PHONE: 714-349-1J86 City/State/Zip: . � � " ' .
CONTRACTOR: ROOFING BY MIKE
Address: 5242 PRlNCETON AVENUEUnit:
CitylState/Zip: WESTMINSTER, CA 92683-2753
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $20925
Reinspection Fee: 30.00
Bldg Std Admin Fund $1.00
License No.
License No.
P, HONE:
4L FEES $210.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE
Monday thru Friday - 7�,00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00
New Years Day, Memorial Day, Indeperidence Day, labor C
License No. �427062
774-892-1649 �
` CELL:
. ' PHONE: -,
PHONE:
i
r
8/2010 - PER CMMC Sec. 13-279
bProhibitied all hours - Sundays antl the following Federal
Thanksgiving Dav and Christmas Dav •.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-26, § 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 anq final approval must be obtained. Failure to obtain inspections and fnal approval will result in the ezpiration of this permit.
GOOEp. INSPEG110NTYPE OATE INTITIALS GOOEN INSPEGTIONiVPE DATE iNTIT1ALS
1fit6 Fixed System Final Fire Prevention 206 Final Mechanical
�266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roo! ' �' � r��" 210 Final Eledrical
201 Final Block/Retaining Wall 2i2 Final Fire Prevention
202 Final Factory Fire Plare 220 Final Planning Approval
203 Final Sign ' � 222 Final Site
204 Final Demolition . " 250 FirtalBuilding/Occupancy
• �
WORKERS' COMPENSATION DECLARATION: .
I hereby aKrm under penalry of perjury one of the following tleclarations:
❑ I have and will main[ain a certi6cate of consent to self-Insure for workers'�-
compensation, as provided for by section 3700 of the Labor Code, for the
pertormance of lhe woB for which Ihis permit is issued.
❑ I have and will maintain v.orkers' compensation insurance, as required by
sectbn 3700 of the Labor Code, for the pertormance of the vrork for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: ��S i---��
[Camer �
(IDis sectwr needrol0e cvmpletM AMe ce�m� is valued al one hund�e� dollars (51001 a Ie55J
Policy:Number: �00 7�,5� C,
❑ I certify Ihat in the peAormance of the work for which Ihis permit is
issued, I shall not employ any person in any manner so as to 6ecome subject
to the vrorkers' compensation laws of California, and agree that if I should
become su6jec� ta the vrorkers' compens tion provisions of Section 3700 of
the Labor Code, I shall forthwith compl h these provisions.
�'—( �—��
pl nl's5ignaWr Cpale
WARNING: FAIIURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm [hal I am licensed under provisions of Chapler 9(commencing
wi�h Section 7000) of Division 3 of (he Business and Professions Code. and
my license is in (ull force and ef(ect. �
���_�.�... z� 0 6 z� . �5 �� 3�
� ,��/%-/(
n rocmr's Slgn re GDa�e
�+'_. _ _
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm [hat there is a construction lending agency !or the
peAortnance o( Ihe �+ark (a wfiich �his permit is issuetl. (Sec. 3097. Civil CodeJ.
Lender's Name:
Lender's Atldress:
SignaWre Date
OWNER•BUILDER DECLARATIONS:
I hereby aNvm Nat under penalty o( perjury lhat I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5,
Business and Professions Co(le� Any city or counry which requires a permit �o
construct, alter, improve, demolish, or repair any strucWre, prior to its
issuance, also requires Ihe applicant for such permit to fle a signed statement
�hat he or she is licensetl pursuant to the provisions of �he Con[ractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom and
the basis (or the allege0 ezemption. Any violation o( Section 70315 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
(ve huntlred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILI. DO THE WORK, and the stmcWre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The CoNractors
License Law tloes not apply to an owner of pmperty who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provitled ihat such improvements are not intended or oRered (or
sale. I(, hovrever, fhe building or improvement is sold within one year of
completion, the owner-builder vnll 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 CONTRACTING WITH
LICENSED CONTRACTORS to construct ihe projec[ (Sec. 7044, Business and
Professions Code: The contractors License Law tices not appty to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractws License Laws.).
❑ I am exempt untler sec.
Business and Professions Code for this reason:
Sgna W re Dal¢
305]-�6(3/0])
Owner ID verified by drivei � ucense. ❑ Yes ❑ No
Driver's License No. Eapires:
Verifcation of Ownership by (rype of document, i.e. - propehy �ax bill or deetl):
DIVISION OF INDl15TR1AL SAFEN PERMIT CERTIFICATION:
❑ I hereby ceM1ify Ihat no excavation fve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection with work authorized
by lhis pertnit, and �hat no building structure, scaf(olding, (alsework, a demolition
or tlismantling thereof, will be more than thirty-six (36) fee[ high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which vroultl
require a permit from Ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from me tlivision.
Apohcanl's SignaWre
Division o( Indusirial Safety Permi[ Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIfICATION:
1. Will the applicant or present or fuWre building occupant neetl ro file and
cetlify a Business Plan for emergency response to release or threatenetl
release o� a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, Iha� a Business Plan be filed with Ihe Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quan[ity of hazardous materials equal to or greater Ihan a weight 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 ihe applicant or present or future building occupant need to file
a regishation form (or acu[ely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of lhe Califomia Health and Sa(ety Cotle, with some
exceptions, requires �egiSlralion with lhe Costa Mesa Fire Department by
each business which aI any one time has on hand a quanti[y ot acu�ely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at standard
tempereture antl pressure).
3. Does or will ihe applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of Ihe Califomia
Health and Sa(ety Code been (ully complied with? ❑ Yes ❑ No
5. Does or vrill the applicant or present or future building otcupant require for
the vrork which is �he subject ot this application a permit for such consWction
of modifiCation fmm lhe South Coast Air �uality Managemen[ DiSlrict or (rom
any other air pollution conlrol distric[ or agency? ❑ Yes ❑ No
(Section 658502 of Ihe Califomia Govemment Code requires that the requested
in(orma�ion be fumished on applications (a non-residential builtling pertni�s).
6. Will any part o( the facility to be constructetl under this permit be within
1000 feet from ihe outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the faciliry must meet the requirement o( Sections 25534 and 42303
o! the Califomia Health and Safery Cotle).
7. If a permit from the South Coasl Air Quality Management District or other
air pollution conirol district or agency is required (or the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate o( compliance from the appropriate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: 1 certify lhal under penalty o( perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury that I have read this application and state that
the information given is correct I agree to comply with all s[ate laws and ciry
ordinances relating to building construction, and authonze representatives of
the Ciry of Cosia Mesa to enter upon the above-described property (or
inspec[ion purposes. I agree no[ to ocCupy or allow occupancy of any building
au[horized by �his permit un[il final inspection.
SlgnaWre ol Legal • s) DaieG
�'�O �/�
Pf,.or.'�NonzedAppllwm CSDaIe"'
Com»]iancc: J2esidentiu]
Namc:
lnim'ms�tiun
SitcAddress: ?D3! [�oo�-/XjC�
J (v
Buildiug Typc 0 Single Familp �Idulti Tamily
Conditioned rloor Hreu (C�A)�. - D"bU
I (Climate'Lonc 11/
L
linturcemenl Agencp: �� � Lnte:
Circle the Froni Orientaiimc )V, E, S,�or degrees
Yrojeci Typc:
i.e um tn Lc userllnr Nervh� CnnsL•ucted liuilding.t nrdddilinns'
"a�e ] 07
tll �1sStaries
aiion �'Knof ❑ HVAC .
� Water Heater
7nsu/ntinn Vnivac Fnr Opnrp�e Siufnces (jm�Fm•ring urr 1he A9os.s auclFurrmg Strips Cons�nm�ion mLle 6elow) ��`� �
Assemblg AI[erntion
❑ Opeuint of li�amed tavih' �lone- A1rer•ationa� llia� irrvoloe Ihe openixg ol �hcfi•a»eed cavi�� ojn walf, ceilreg, o� _�toor� mus� iirstal! !he
munduiorv mininumi insidn�ion i�nlue per §I Sb for 1he nhered ass•emblp. Fill in Colunms �1 -C and enier mandaior-p insulation value in Colimm H.
❑ Replacement of' entire nsxembip-Replucemenr q(an emire H�all, ceiling, nr floor ossemb(�� reguires Ihc insiaflation qfComyonen�
P�ckuae- L i»e'ulntian ualue+' in TnLle 1S7-C Fifl in Columns A- J. __ __ _ _ _ _
Surf'ace Details ro� ti,e furrea
➢ C
Framing
Assemblyldame Material
or Tvoe� and Size�
Nae: ForJmredw�semblira.
; Fmrine Cm�sir�stim� iable k
ed oTMass Vdalls sec Turring 5trips Construetion Table below.
D - E � -F G H... . .7 • ;1
Standarcl Velues From JA4 Table
�mess, Framed Continuous ]A4 Proposed
cing, U- )A4 Table Cavit�� ]nsulation Assembly Assembly
i[her3 factor° Numbeis R-value� R-Value' Cell Valueb U-factor"
I
alio�� R-value, sec Page JA4-3 ond Eguaiiai 4-1. For culculalinoJurred wolls yse !he Masa nnd
1. Fa� Tng/ID iredicaie Ilie identificalion name q�m mntches Ihe building plans.
1. lndica�e the Assemblv Name or Type � Roo(/Ceiling, Walls, Fl oors, Slaba�, Craw) Space, Doors and e1c...Indica�e the Frqme rype and Size: T•Tw�
Wood, Meial, Metal Buildinga�, Nlass, emer 2x4, 2x6, or e�c... see JA4 fa' olher possible.fi�amr. rype assen;blies.
3. Eiver ll�e tliiclmess for muss iu inches or Spacine 6eM+een {'aming members enter,- 1 G'ar 24 "OC; or O(i�er jor all otlier assemb(�� descriplimi
such us Cnncre�e Smidwich Panel, Syandrel Panel, Logs, SrroH� Bale Panel and eic.... ,
4. B❑sed a, O�e Clima�e Zone; enter the S[aidarA U-facia� fi•om Table I51-D, C a� D,/or each d�erenr assem6l�� IVmne or p pe.
5. L•mer tl�e Table number Iha� ciosel�� resemblea� the yroposed assemblr. �
G. Ln1er Ilre R-i�afuellrn� ir berivg ine7ulled iri �he n�a11 canin' or 6etweeir the Jimniug; o1he�-�vise, enter "0 ".
Z L• mer (he Coniinuous ]nsida�ion R-value for Ihe yroposed assern61,7�; olherM�ise, emer "(1 ".
8'. Lnler !he rm+� m�d colurnn a(Ihe U-JacAor vaJuc Lased mv Colunm F 7'able Num6er and en�er Ihe Asxemblr U-juc�or' in Colunm J
). The I'rapnserl Aa•semLh� i� fncmr, Cohumi J, musl Le equal �o or lesx than !he Standnrd U-/uclor in Colunm E lo enmpl��. '
Fun'in� Su'ips Construction TaU]e for 1Viass Walls Only
q Is C ll P F G t] 7 ;� 7C L M
)'ropnsed ]'ropertirs of Mnsonr,�• vnd Concrele Addetl ]nierim' m' �xterior lnsulntiuu
N';ills rruni Iteferencc in Turring Spsme lrom ]telerencc �
,{uinl A endia't�si�ic Q.3.5, 4.3.6. A.3.7 Joint A endir. 7'nbic A.3.13
m c 'N v b b T
V u �.-1 u '' �'- U '
, G 4G 1c
v, a. � C ^ U. �'
u P' .
Asscmblp �^ 7 � c�.. F' : o F�� �.' y =., Final
Mass i��mic oi .INA'(ublc �_ °' e � � E R o 't � r= `�. kssembl �
� r
Thicleness� 'I� pe' Numher �� � G ui ° u�- �i. G t.�. C � i In N U-��CL01� GO]pI1lCI11
I
I
� I
7iet:i.xu'ulio�i IJumber': 12egia•u�uliort Uuie/Time: }IEItS I'rovider:
,i,n o n_..:.r_..�.,J /'.,...nll.�nr n G'nrntc m�
/fv si 9l1/IU
Ihn�ecly'Numc:
.Iliracr. oi' Cutnpliut
ttinn.e
o�� �Do�-�
.�xidentiul
noorrNc. rRonucrs �cooL iioors�,�ts���rz
CP-IR-AL,7'
(Ya�� 3 01' Sa
tI of St1lrles
Whan IAc nran qJ'rxterinr rnnl����rfncr, tn hc repinced rxcaeds �nnrr. than SO% nJNic ex7sting rn�f nrea, m� mnre thnn 1,00l1,fi', rvhicha�ar i.c
I e.c.l�, rlie mm� rnn f7np nran nui.n �neer dae rno fi��g prndim� "Can( RnnJ" raquire�nencr o f§I52(6)1 fli, /52(bJ I Hli, nr ! 52 (b)1 FIBi,
Chec/< npp(IcaG(� nitarnrtAua nr cccaplinn be(ow If �he rnoJa(ieratian r.e esemp� fi�oni Uie rnqfing produci "Cnnll2nnf" r•equiremener. Naie: l/an��
nnc n/the uliernative.r nr esceptinn bn.lnw i.e r,heckad �he AAed.Salar ReJlecmnce anc( Thermal Gnatrmncr. r•equiremen�a• far rnqJirtg prnduct.e in
are nnl nppficahlc. Un nnr JI(I iah(rs balnH�.
❑ CoM RooSx Not ILequimd iu Climntc Zones I-I2, I4, und 16 with n Low Sloped. Lesti m� 2:12 pitch.
�Cool Itonfti I�i.i Required in Climatc "Lones I through 9 und 1 G with ei Steep-Sloped koofF (pitch grea�er thnn 2:12j and produet unit weight lesr,
thnn Slb/ft .
Alternntives to �152(b)1F11 nnd §152(h)FIII, 9teep-slopc rnnf �iltcli % 2:12)
:�^tiieulation with a tl�ermnl resismnce of a� IeaFt O.BS hr•ft��"P/Rni or nt leeat n 3/4 inch air-spnce, is ndUeA to thr. roof decl< ��
over nn attic�, or
❑ Existing duc�s in the ntlic arc insul¢ted and senled accordiug to § I51(�10�, or
❑ In climnte zones 10, 12 and 17, with I ft. nf free ventiletion nreu of attic ventilntion for every l50 ft� of atlic Flom� ureo, and
where a( lenst 30 perceni of the free ventilation aren is within 2 feet verticnl dismnce of thc roof ridge; or
❑ Auiiding hns at least it-3U ceiling insulntion; or -
❑ Building hes radiant bartier in Ihe attic meeting [he requiremen�c of § I51(1)2; or
❑ Building hus no ducts in thc attic; or
❑ in climate zones 10, I l, f 3 and 14, R-3 or grenmr roof decl< insulation abovc vented attic.
Exception tn §152(b)1.Hiii, Low-sVop^_ roof (pitcli <�:12)
❑ Building has no ducts 6� the attic.
Other Ezceptinns
❑ RooSng area covered by building integrated�, photovoltaic panels and solar [heemal pancls are exe
❑ Roof constructions that hnve thermal mass over [hc roo( membrane with at least 25 Ih/ft� is exemf
Nate: Ifno CRRC-I label is avnilaMe, this compliance method cennot be used, usc thc Aeriormance
Check tlie aonlicable hox helow if Exem t from lhe Roofm Products "Cool Roof' Re uirement
2oofSlooe ProductWeight Product
CIiRC Pmducl ID Numher� < 2:12 > 2:12 < 516/ft� > 516/ft� T DeZ
❑ ❑ l o I ❑ I
�00�
�DO�
�00�
�00�
from the below Cool Roof criteria.
R�7
A�ed Sofar Thermal
Refleciance''4 Emittanc�
o^
n4
o^
o^
Tl�e CRRC ProducllD NuniLer cart be obloirted f�om !he Coal RoofRaling Counci/'s RaledYroduclDireClory al wwro.coolrnofs.ore/nrnduct.daearcl n
Lidicaie ihe ry�e oJpr'oduc/ is being ua'eQfor Ihe roof �op, i.e. single-ply roof, asphah roof, rneml roof, e�c.
I(fhe Aged Re/1Ncla�se ix noi availaGle in.lhe Coo( Rao(Ra�ing Comicil'.r Rai¢d Praduc! Direcmr�� lhen usa Ihe Iniliol ReJlecmnce value fi•om !he same
direclorpand uscrheequaiian(02+p.7(p��������-0.2)roobminacalcufa�edagedvalue. Wderepislhelni�ia(SolorReJlecmnce.
Check Gos if Ihe �ged Re/leclmree ia� n caladaied vulve using !he egua(iai abnve.
G'alcula�e (he SIU wlue Lv urArg tlm SIU- Work,rhee� a1lr�ln'//wmm enert� ca.eov/lille24/mid en�er ihc resullixg valuc in llre SRI Columx above ond anaclr acopp of
ihe SRL f4orlcel�ee�m7heC�-IR.
i apply Liquid Tield Applied Cuutings, the coa[ing 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 § 1 I8(i�. Select the applicable coating:
Aluminum-Figmented Asphalt Roof Coating ID Cement-Based Roof Coating
Other
Regisn•ution Nnmiber: Regisb�ation Da�e/Time: FILRS Praviaer:
2008 Residential Compliance Forms � Augus! 2009
nf Comuli.mce: Residential
Residentin/ Alrw�nzi�ua.s�
yru,jecl �Wm�c: —�
Y; u
I.-ALT
+ � a1 i)
H�7:S \��P.ZFI CAT10h' SUMn�R)' The enlorcemenr ngenc;�� shrnJd pm� apeciul auemiar �o lhr HEIt� hleoa�eu�c.s speciJied m lhis
ebeclrfi.v Gelnrc. d campleied cmd s�gned CF-9l� Form /m nll Ihe mena�in�e.r e'yecified shal! Lc s•ubmiiied u, ihe b�iilding inapccim� Lefw�e /uml
Duct Sealing & 7CStllle tIL'RSreri/icn�ion isrcyuirecllm Ihi.� mvnsirre.
❑ Y�S ❑ NO f'CS�.Iu Climate'Lunes 7 and 9J 6, if morc thou 4U linear teei of ueiv or replacemeui 4ucts m'c insialled in uncnnditianed
- spuce, tlie duc�s ure �n be se�ded per (�152(b)IUii and Ihe newll' mslulled dncis aie tn 6e insulzLLeA pei ( I51(1j1 U.
IJ �XC�PT10�': Lxisting duct s��stems thal are estended, �vl�ich nre cuustructed, invWated ur eculed �vith asbesws.
❑ Y�S ❑ NCJ 1'L�S: ln Climate'Lones 2 and 9J G, i1'the exisq»g space-conditioning system (HVAC equipmen� and ductingj is replaced, the
� ducts are �o bc sealed per � 152(li)] Di. �
❑ Y�S Ll NO )'�S: ]n Climate "Lones 2 and 9J G, if [he existing HYHC equipment is replaced (iuciuding th� repiacemeN qf-thc t�ir handlet;
' owdoor condensi»g unil of a splil system, cooling or heating coil, or the Iiirnace Leai exehanger) ihe duc�s are to be
sealetl per §)52(b)]E.
❑ EXC�PT]On: Duct systems tL�t are documented to Lave been previouslp seTletl conlirmetl thruugL H�RS
_ � verlficatiou iu uccurdance �vitli procedures in the Reference ResidenYial Appendia P� 3.
� � ���RC�PTIOA: Duct systems wStli less thau 4U�linear feet in uncouditiuned space. � .
❑�XC�PT]0�: Existin^ duct svs[ems constructed, insulated or senled wlth a56esros.
Refrigerant Charge - SpIif System KE2S veriJicaiion is reguiret�,for /hia measurc.
D YES ❑ NO YLS: ln Climate Zones 2 and S- I5, wl�en the existing HVAC equipment is replaced (including tlie replacemem of the air
handler, outdoor condensing uni� of a split system AIC or l�eat pump, cooling nr l�eating coil; or the fumace heat
rxchanoeri � reiriee.rant chaiae mensuremenl S}121� be Ve�lllBd Pel' (�152(611F.
Centr•al Fan Integrated (CF+Tj Venfilation S,ystem and Fan V+'att brav��
Tbe vencilaeion renulremems oT f 150(0) dn no� apph� to existine residentiel homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airfloe� F3ERS veriiicaiiai is reguired {or rhis measure. I
❑ Y�5 ❑ NO YES: ln Climate Zones 10 through 15, wlien t6e existing space-conditioning system fHVAC equipment and ducting) is
reylaced. thc airfloN• and ien wan draw shall be verified ver � 1 S2fb11 Ci to meet the renuiremen[s of 61 � 1(fl7B.
Q v."�. ,
Declaration Statement
• I cerfiir thaf this Cerfifu
Name: A�
�CLK��
Compeny:��
Signamre:
�'— {�—(�
(Cer[ificalion il
Phone:
CEH oi � CEPE
(.l��i�-n �o�.STz-:i�- �`.1L yZ� � I %/i� ,5 Y l'�Sd"�
�onsiblr lluilding Desi��ner's Ledaratiur� SYntemenl
] am eligiblr. under Division 3 of the C�lilorniu Business �ncl ]'rofessions Codc lu uccepl respunsibility lor lhe building design identiGed on
thi:•, Ccnificu�e of Compliancc.
1 certify thul Il�e energ)' fealw'e:� untl perlormancc speciilcnliont� im'the bulldiug deslEii Identified on this Ceriii�icate oi' Gamplltq�cc coniorm
te� the roquirements ofTitle 24, Y�mlc 1 tmd G ol'the C�lii'ornia Code of ltegulalions.
Thc bnildmg dercign feaiure;�, IdemiGed un thic Certii'icate nf Cumpllanec ave cunsistem wilh Lhc inlorinntiun pruvltled tu ducume�u ihi:,
buiJdint desigu on lhe oU�ei ;ipplicn�lc cun�plinncc 9orm�, wurh.4heeu;, ualculationa�, plau;. und specific��iion:�. subin'ittcd lu q�c enibrcumeN
uuencr im �iPnrav�d with lhis buildln;� permii ��pplicalion.
IJt�mr.
�.U177�)flil�".
Hddres:
:;ny; SwttJ'Lip�.
Signauu'c.
D'JLC'.
L,ICL'lISC'.
Phone:
Tor u.rsi.ruuice ur gues(ir�its r•egnrdin� il�r Lnerbr Sumdru•ds, cnnincr flic Lnergr FI otline a�: 7-RIlU_; i"l-:;3(1(i.
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C�sfG �✓�/�s�
' APPROVED
CITY OF COSTA MESA
SUBJECT TOIBLDG. DE �NREG.
NOTE: ADDITION,B�-p
OR CORRECTION{� ���TIONS
APPROVED BY THE P S �,��"�;E /
�/�NING DIV.
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.LOT � TRACT 4Z8�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C06iA MEBA. CALIFORNIA
�
For Applicanf fio Fill ln Compleiely
TYPE OR PRINT
BUILDING /� /`
ADORESS iO�6 COOLIDCE AVFNIIF r•o ��
COSTA MESA. CALIFORNIA
_ .. _ KENNETH W. ,KOLL
NEWPOI�T BEACH� CALIF NpMI E)3Z
fBGT TEL.
GINHER NONE NO. -
SS__""'_'_'_'__"_"�_"_"'
�� F �E R�ECEIVED
� JAN 111962
FINANCE DEPT.
. �� . : �tnr:,oF cosTa MEs�
' `�" APPUCATION FOR PERMIT
BUILDING
For Office Use Cnly
PECEIPT NO. PERMIT 1
:GEI/A Br I D// ��e/ /.Ve/ / I U�TE 1II
COSTA MESA. CALIFORNIA
ADORESS ' E ZONING
ZONE I NO.OP '` ( I188 OF NEW T��
G'�T' E C /� � PLAN6 BUILOINOti
�C.TNO NO. I 6- 22 I.eow� / 1 J� %/� �/ L�l
ceecx�rr�orv 'w/
SIZE � � NO. OF BLD69.
OF LOT � 2O X O Now aN Lor O p, p. Np, ��
USE OF, ' VARDS EVES
E%18TING BLDG. � APPROVEO ALLOWED
HHTBACN UN[ PROM' / IC6NT¢R LINC 8TJ / .
CeNT6R OF BTRBET V � REAR YARD � � FRONT IO FT.
SIDE YARD I LEFT �! � I RIGHT � R. SIDE �� . FT.
: DESCRIPTION OF WORK 8 Fi. --
L.SIDE
NEW ' I X II ALTERATION I II ADDITION I REaR �'� L w'r ����`1
WALL
�rNO.OF N#�2
SFROOMS
0E
F
�/
/�9�c`
n
i H6RCGY ACKNOWLlDGE TXAT 1 HAVE 1t6AD TH19 MPLIGTION TXE AMOUNT BHOWN UNDER VALUATION 19 POH TH¢
AND'6TAT! THAT TXH ABOV6 �6 CORREGT ANO A6REE TO COM- pppp08H OF ¢BTA0LI6NIN6 • P6RMIT FEE ONLY.
PLV WITX ALL GIT' OIiDINANGEB I1ND BTATE L�WB R80ULATING
Bu1LDING CONBTRUGTION. j VALUATION
81GNATURE OF �/fL PERMIT FEE $ -5 n'�
PERMITTE ^ 5 �
' � . ' $ .J �I '/ ��� PLAN CHECK $ �� 'S � p
AUTHORIZED AGENT `�J S s
TOTAL FEE / �' —'� LL