HomeMy WebLinkAbout631 DARRELL ST - Building Permits�
CITY OF COSTA MESA ' ' ' �
B!/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M11-00055
PERMIT TYPE
APN: 42215313
MECH
y y�. s.���� 4 �1�, .
JOB ADDRESS• ' 631�Di4RRE�L�S'fa�CNl��`�
vicinity: � � _
SQ. FT: 0 � ' �
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
04/07/2011
CAC
SCOPE OF WORK: HOUSING PROJECT TO TO CHANGE OUT FAU < 100 K BTU: COMPLIANCE FORMS ATTACHED TO JOB
CARD. "
OWNER: LARSON, RqE ANN ,� Address:
PHONE: . , . . . � City/State/Zip:
APPLICANT: HUFFMAN,.RICK - Address:
PHONE: , . - City/State/zZip:
CONTRACTOR: HUFFMAN CONSTRUCTION
Address: 1181 ATLANTA WYUnit: PHONE: 714.397.4707 .. �
City/State: COSTA MESA, CA ZipCode: 92626 -
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: , � $0.00
TOTAL FEES: $38.30
"': �
R'
631 DARRELL ST Unit: � �
COSTA MESA, CA ; _. �.
Unit:
' ' � . ,li � 1 •...1i.i ir o7 ri
License No. 427295 � ,_;y, .
CELL:
.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 lo oblain inspeclions and final approval will result in the expiration of this permit.
LODE�. INSPELTIONTYPE OATE INP11RL5 LOOEN INSPEC110NTVPE �DRTE� ��� ��IN7111AL5
1616 Fixed System Final Fire Prevenlion 206 Final Mechanical X �'/�l'—// ml� �1�
1266 Pool Spa Final
200 Final Re-Roo(
201 Final8lock/Retaining Wall
202 Final Factory Fire Place
203 FinalSign
'204 FinalDemoli�ion
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATIO�
I hereby aKrm under penalty ot perjury one ot the tollowing declarations:
❑ I have and will maintain a certifcat@ of consent to self-Insure for workers'
compensation, as provided for by secRon 3700 of the Labor Code, for [he
peAormance o( Ihe work (or which Ihis permit is issued. .
❑ I have anC will mainlain wnrkers' cpmpensation insurance, as required by
seclan 3700 of [he Labor Code, (or [he peAortnance of the work for which [his
permit is issuetl. My vrorkers' compensation Insurance carner and policy
number are:
Carrie[
(IDis seclnn nee0 rrol �e mmdetetl �(he pemi� is valuetl at one hundred dollars (5100) w less )
Policy Number:
I certify that in [he peAormance of the vrork for which this permit is
� issued, I shall rrot employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
th,,e ��La,,bo,,r ,,C//ode, I shall forihwilh omply with these provisions.
���4� H-7—//
fam�ure�f CDale�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5700,000), 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 DECLARqTION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Code, and
my license is in full force and eKect.
L�#'� �� 2C1 � �Elass�#• �
�,,..�i /1_—#—_..�c..-- .7i _1� �� -' �
� ontrao�or'sSignaWre ����ale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm lhat lhere is a consWctqn lentling agency for the
peAortnance of the work fv wfiich lhis permi[ is issuetl. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
SignaWre Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm ihat under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Busine5s antl Profes5ions Cotle: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any simcNre, prior to i[s
issuance, also requires the applicant for such pertnit lo file a signetl statement
that he or she is licensed pursuant to the pmvisions o( the Contractors
license Law (Chapter 9(commencing With Section 7000) of Division 3 of Ihe
Business and Professions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation ot Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty o( not more than
five hundred dollars ($500�.):
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, antl the slructure is not intendetl 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 vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year of
wmpletion, lhe owner-builtler will have the burden of proving that he or she
did nol build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS ro construct the project (Sec. 7044. Business and
Professbns Code: The contractors License Law dces no( apply lo an owner of
property who builds or improves thereon, and who contracts (or such project vnth
a contraclw(s) license pursuant to the Contractas license Laws.).
❑ I am exempt under sec.
Business and Pro(essions Cotle for Ihis reason:
305]�46(3/01)
Owner ID verified by dri. , iicensc. �] Yes ❑ No '
Driver's License No. Expires:
Verification o( Ownership by (rype of tlocumen[, i.e. - propeAy lax bill or deed�:
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify thal no excavation frve (5) or more feet in tlepth into wfiich a
person is required to descend, will be made in connection with v.ork authonzed
by this permit, antl lhat no buiiding strucWre, sca(fdtling, falsewurk, a tlemolition
or dismantling thereof, vnll be more than thirty-six (36) teet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administrative Cotle).
❑ As owner-builtler, I vnll not employ anyone to tlo work which woultl
require a permit from the Division of Industrial Safery, as noted above, unless
sucb person has a permit to tlo such work from the division.
Applicanl's Signalure
Division o( Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle and
certify a Business Plan tor emergency response to release or threatened
release o( a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, wi[h some
excepiions, that a Business Plan be fled with the Costa Mesa Fire
DepaAment by every business whic� has at any one time during a reported
year a quantity of hazardous matenals equal to or greater man a weigM 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 builtling occupant neetl to fle
a registracion form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 0( lhe Califomia Health and Safely Code, with some
exceptions, requires registration with the Costa Mesa Fire Departmem by
each business which at any one time has on hand a quantity of acutety
hazardous malerials equal [o or grealer than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at slandard
temperature and pressure).
3. Does or will ihe applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals�? ❑ Yes ❑ No
(Sec[ion 25534 0( the Califomia Health and Safery Code pmvides Ihat the
Costa Mesa Fire DepaAment may require the preparation, certification and
fling wilh lhe 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 Section 25534 0( the Califomia
Health and Sa(ery Code been fully complietl with? ❑ Yes ❑ No
5. Does or vnll the applicant or present or future building occupanl require for
the work which is the subject of this application a pertnit for such constmction
or motlifcation from the South Coast Air Qualiry Management District or from
any other air polWtion control tlisirict or agency? ❑ Yes ❑ No
(Section 658502 of the Califwnia Govemment Code requires lhat the requesletl
information be (umished on applications for rron-residential huiltling pertnits).
6. Will any part of the facility to be consWcted under this permit be within
1000 (eet from the outer boundaries o( a school? ❑ Ves ❑ No
Q( "yes", the faciliry must meet the requiremen[ of Sec[ions 25534 and 42303
of the Calitomia Healih and Safety Cotle).
7. If a pertnit from the South Coast Air Quality Management DisMct or other
air pollution control tlistrict or agency is required tor [he vrork which is the
subject of this application, have all ot the disclosures prescribetl by California
Health and Safety Code Section 42303 been made? ,❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air polWtion
control officer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is cortect. I agree to comply with all state lavrs and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPIIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is cortecL I agree to comply wilh all state laws and city
ordinances relating to building construction, and authonze representatives o(
the City of Costa Mesa to enter upon Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until fnal inspection.
� Sig�ol L al Owner(s) Date
�7'7, f�
—� AnQIW Au�ItOnz¢0 Fpplicanl � D3�¢
��
�
X e.side�iti�d AlY.erntions
�1'c`uiecl.N�uuc:—_
_ m II-ad65'' '��
otiam c.,. I:esidcu lial
Cmieral ln(urmation
Si1cAdAress: ��l �L0.1&LL 5T
Building Type � Singlc F�mily ❑ Ivlulti P�mily
CundiiioneA Pluor Airoa (CfA}:
li�il�w'cemen� Ageucl':�
� CI�-132-AL'I'
(Pti;te 7 u1�5)
neir- /� . � 1{ uf' Siuri¢s�
b �
. . , . .. . . .�-�
�llate 5t -l� - �0 1�
Circle ti�c ProN Griemation�E, S; VJ; cSr degrees
I��rql��l Type�. ❑ Alicraiiuns rJ Envelope O Fenesvation ❑'kaol� � I-IVAC
kenlucemeN or Chanet OW ❑ Ducl ke»lacemenl 8 N�ater He�ter
� NO%'L %7uc /n+nr is nn� m bc u.+eAfiirNe�vh� Cnnstrxrterl/tuilthnA,s m�lddibm�s ' ' '��.
.' Imidtuinn VnLies'Fnr Opnquc Sur/aces ((br r��,�,�,,,� u.���- ri,�� na�,.,�, «„�r r•����,,,,� s„ r�>.�� co„s�„��,�n�,,, ;�r�i� „�i�„�l .� .. .-. .. . _� ' I'"
�
, .. �A�aembi� Alt�i ifiun� . - . � - - � � .. . . . �
., l7 Oyeuino o1'frauied cavitl' iJone-Aherniioi�a'th'oi irennlvcll�c openidg o/IheJrumed cnnlq+o(c� mdll.'ceiliivg:�o�./lorir nrint/ instull Ihe
. . . ..... . ., � � � :.
',:man�11nm7' iirintnv�nrrDm�idniion val�ie per'§JJ(1 for �hc nl�eratl as.xemblp. Fifl ir? Colunmstl -C and en�er md��dam{�i' ii�sufnlioi� nalt�c in Colunnr H. -.. -
' ��Repl.i�ementofentire'nssenthlp-Replucernei�/oj�cmemire�enall reilino.a:/Inm�asa�embl7�rega�ires.(heirt.siallatinnnjCom��anewt�� ��
�. �. .,. _'Paclaigi�-'L'in'sldmion'i%n7�iies�in.TaLIe�=I57 C-:�:Fil6frv Cohmir�s'vJ _ 7� �. . . ..... .' . -.
_. _ , ... . _ _. . .. .. . . ..... . , , . .
.�) AquP.,,_9ut'1tiL'e IDeta1IS Tor the Lm'red portinned uf Mns.k �A':�11s s�n I'un�in�;�Strips ConstructioirT�nUle' lielud, . ��"' " "'" �'�`` '�-"��"
. A'.:. ��;��, ,. ll .,� . .;. ;C ,_. -___...__U.... ,- . .�r�.,.'.� �:.;..r...... .. C.._::: _ _-_FI:...,�.:: j�..-:X: . : � 7'-::_ �
--'
. . . scenmi ' . .::, . �. . . .�. :t. .__. .
...Yropused :� .;>:c.' ..:I�Stimclurd�.'I -.. �.:Values�FromJN4�?able:-� ���
, . . ... .. . ... .. . .
� � Frami�ig Thicluiess �'I:. - ` ' ��" � ���" "--Frumed - �Coniinuous-- � ��'9H4' - � --�Yroposed ��� �
,. . . . . _. , . �. ..: ._ .
. Ta�/ „ AssemblyName � Nlatenal �. Spucma - �� U- � '�, JA4Table� � Cavity ]nsulation- Assembl� � Assembly: , "��.
.
� ]D�..'.:: � --.,oi Type� � �and Size'` - - � :or Other ��� �• �-fxctor° ��. Num6eis : R-value� �- --R-Value° ���''�Cell Value� i U-factory � "
� �. . c..'�.. �.'�.. .�.��:� . -.. -_. ..
. - - , '... . ... - . . � .: . . ..-.::. . :� . . _.. :: . . .:_.._.
. ' '.. �_.. . . ... .. .... .. . _ .
- - � . . , . - .. . . . .
. � � �
.Noic Far l�i�'�'ed assemGlies, nccoumine iar Continuous Jnsula�ia� It-valuc. see Page JA4-3 and r`.qimnan S-1. Fm' cale�daling (nred ivolfs use �Ite Moeu mtd -
iFm'rin Ca�.vruaim�iab(e6elo�r. �
1. Fa� Tag/ID indica�e die idemi/icntion name tha! mn7ches Ihe bui(ding plans, ���'' �' .
?. Indicnie �he Assembh� Nume or ryye: Roof/Ceiling, Walls, Floore�, SIa6r, G'awl Space, Doors and etc...lndicate (he Frame qPe and Size: Fm�
B'ood, Meml, Mei41 Buildinga, Nloss, �enter 2z4, ?zG, or e�c... see JA4 (a� o0ier possible f'ame �pe assemblies. " "
3. Liver.�ihe �hickness 7or nius�� in inche.r or Spacing 6enree»j��aming mem6err� euter, 1 G'or 24 "OC; or Ot)aei _jor all otker assembl�� descri�tion
sucli ns Cnner'e�e Saidrvic6 Panel, Sparxdrel Paic!, Logs, Stru�+� Uule Pa�el and c�c.... '� ,.. .. . .
4. Dcr.setl on !be Climaic Zo��e; enler the Standm'd U-(acior fi�om Tabla 151-D, C w�D for euch differew! assemblp Name or hrpe.
5. Gnier tl�e Table nwnber diai closeh� reswn6les ll�c prnposcd us.smnbh�,
C. Lnler Ihe R-i�alve thctl i.e be9ng instqlled in lhe ivall ctn,irn nr belv��ec+n lhe f'amiivg: olher'vnisc, cnier "0" - ��
� 7. Lnter !he Cn���inunus Ins��rlcrtion R-��alue (a� the Jn�oposecl a.xsembl��; o�herwi,rc, enter "0 ". �
' d'. G�v�er rha rm�i� cu�d cnlunu� af Uve U facim� valaie Laa�ed on Coh+i��n F Tcd�le Nnunber aivd en(er O�e A.t•.sembh� U-jacim� in Colaimiv .7
J, ThL' Propna'ed dan'emhlr U-fiminr. Colz�n�n .l, mu.rr be equol In nr lesa' thmt 1he Smndmvl U;(acror in Colimin G to compip. �
P�n'ring Strips Construction Tubl: for Ivlass W nlls Onh� . . .. . ..
A � IS C ll R f� G I�7 I :� if L � M
Ih'apurced ]'rupertiex of M:isann' �md Cuncrete Adtlul 3nterior ur Exterior7nsulxtiun �
\��:dlsTrnmlte(ereuce inliurring5p�iccl'rom Refereuce
Juinf A i reudia'I'ablr 43.5 A.3.G. 4.3.7 :fuini A��cutlia "P:�blc 4.313
_ ;, _ _
�y � 1 m
�J ry � .� u .u. _
� u �<
�; . c � ^ V•..m T'IIli1�
hsvcmhly -Gc..4 _ = c.` F- � o m� o c _' �,�
Idnst N�nneni JA4'Inblc �= � ' �' E E o t� .. _ m.,m AtiScrtll)ly
'I'hiclmcs�'.� '�ypc' , 1Jmnirei' �"�_ � iii = S LL G r'_ G =� ��i, c ��-faClol�'� Cumnlenl
_ �,—I� il � ,_�
-�-I i � I -�
I I i I � I
7(egintra�ionTJeunbur: Ifc�i.sirniion Uaie/Time: HEIfS l'rovider:
'100b']te.rideiititd Con�plianceTnrms �lz�giea�l "100J
P
ve Certificate o1'
N
liu. . Resio_..ci.tl
4C S�'ST�MS - HLATING
Miuimum
HentingLquipmem Ef6ciency
Uuc� or
Distribution lns
�e aud Locntiott^ R-
0
CT-7_P.-AiT ,
fYa�e 4 oi 51 • ~
uc ir
� ' ' � Configuration
Thermuami (Central, Split,
TYPc Snvice, Pecl<aee ortly�
2pGtYw+�nR4 � Cr,vcqqt
. . ... I. . .. . � . �. � . .. � .
�� �� �l: �b�dic�ur�l-leniing 7j��i:(Cenn�ul Pm�nuce.J4�all.Gmnnce, Hecu pump, 7toiler, Elecu�ir.� Resisiaice, eic.J ; � . ... . . .. .—.
�. C' IL'CII'IC )'CSI,S/GI1CC I]L'Cllllib 1.4 GIIOWL'A011I)+�in Componenl Puckuge C, a� eccepi where elecu�ir heniing ia� supplememnl (i.c., i%�oiaf cupnciq�. . .. .
.. �.: < 2ICN� or 7;OOb Uiu/In� eleciric healing is conu�olled (i�� u time-limiiing device no� exceeding 30 iniiiuiea•). �See §15J (b) � escepiiai... _ , .
� , �.i.�lte/er m�lhe HLRS Verificouon sectiai on Pnge 4 qf /he CFJR-AL7'Fornr for nddi�ional rcqa�iremervs emd checl; npp(icnble bosea�. � �
. .. .: 4. Indicu(G:T)/ie w� Locaiia� (IJuds, Hydiro��ic iml7ow', Rudininra. e�c.J . :: .�. . �� � �. �' . � .:, -
H\�AC �SYS'f�M5 - COOLING ;: ; . ," , ,..... .. . . . .. ....
'
.. :r.� � . ,., .. � :- �Minimum �.. � :. .. ... ', � � . _.. ---' . _.. . .. . ...
_ �=, 1,., . `-. _. . . _. _� _. �.._ . . , .. , . .
—... � � .. �---' '- -''Efficie�icy� - —.. .._ .. � � -:--Duc�orPiping . ._-„ :.....�-._ :�... . .. _-.Cm�figurat�on� ., -
, .�. . ._ -.: . -_... . . , .........
� 'CooliiigEqwpinenf: ;. .'(SGER/CER"oi ;�� '�� Disu'i6ution • � � - 1�;sulTtion . � :Thermostat ' _ _ "; (Ceni�al -SpGI - . � "
� �' i���Type�and CaVbcit ���Z� � . "COP)- : ;°Type and Locnuon� �� � --� -R-Vniue� - �� � �Ty e '� � S� ace, Package or Hydronic) � - ' '
. . .;: :: . . . �,:. "_:._ . - � � -- -'-`._.,... . ..'.
, , � ,... . :;..:�.
. ,..,. �,. : ... - . , .. . ' • ... .-�..
- - .. . . , . - , .. - . . I � " . . :: - , ... . . ; . �
. _.. . .. ... . . .... . . . _ .
� � • 1-.Indica�e CoohngType (A1C. Hea(pennp, Eva/� Cooling. ere). �� �-- -: �— - . .: ... - - ;: . .
'- 2, Refer' �o�Ihe HERS Verificatiai seciibn on Page 4 af �he CF-1R-ALT Farm jor addmaial requu�einents.qnd checic apyhcable bozes � � -
� 3. Indicnte Type a�Locnlinn (Ducis, Hvdroiiic hf Rloor, Radiaiors,.etcJ - � � � - � � �'� � �
r�, �—.._'_: � .
l�'AT�R H�ATING
Lisi wnier hen�er.s and 6oilers (m� bath domeslic hoi waier (DHWJ heaiers and hydronic space healing. Ledii�idual dH�elling DHN' l�ea�er's mus7 be -
gas or �v opmie f�'ed, attd ma�� no� esceed 50 galfons. Ho� wa+er prpe inserfdtio�r fi onr 1he DFIN' hearer to �he hiichen(sJ aiir/ on a!! znidergrorrnd
ho� waier niues is renuired in al! comuonen� noclmaes in nl] cliuiate zones. ' � � �
N�ater Heater Type/Fuel � � Distribution Type Nmnber ln Ta�4: � Energy Factor or .�Insulation
Tvoe� (Standard. Recirculatin�)Z Svstem � Canacip' (Ral) Thermal Efficiencv R-V alue�
r1�H
1 Jndicaie Tj��e (Siorage Gas. Heai Pmnp, Jnsiamaneous, elc) . . ... .
2.liecircodniing.rv.vem.s serving mu6iplc dwelling uni�a� shnll mee� die recirctdaliai rey��iremems of§150(n). The A�ea•cripiive-reyuiremenhr dn
mm �llom ihe in.i•iallation ofn recii�ciJuling wa�er heaiing .�;vsiern for single dwelling imiia. . .
3. 7he ez[ernu! wa�er ItealinJ; �anl� and piPea�.vhnl! Le ina�:�ltNed m nvee� Ihe re4+�ire�uenl.�� o/.4�lSO(j).
. . � . . .. ..c-- �
'SPI:Elfil� f�ATUl�S The en/nrcemenr a�;enep.shoarld pnpspccia! allen[ion lo Ihe Speciol Fealure.r.i/�ecified in dria' checicli.rl Gel�w. ���
Thase ileni,e rrvul' reqtrire Hn•illen I�.ctl�calinn and dnciuneivinlinn mul.speciul veriTcalim�.
Nld1§' k001� ASSLMBLY -k:idi:utl llarrim'
Thc rtidinnl 6tirrier requiremenl of' §I51(112 doex noi upph' to roof �ilLer�tions.
SI;i6 lidgc (1'crimeter) Insnlntion O)'�S ❑ NO
1735: Li Climatc "Lonc Ib in Canponcnl Pt�cic�ges D� ]I-� 111511IllUUD IS 1'L'l�llll'(:(I.
llenled Shih L�snlntinn ❑ 1'ES ❑ NO
1'L5: Sltib edpe inhul�lion required fiir all het�led slabs in �ill Climote Zmies. Se
R:iiscd Sl;ib in+id:�liun ❑ YGS ❑ NO
details iu Table 11 S-A of thc
1'CS: ln Climatc Zones 1.2. I l. 13. 14 &]G, li-R insulalion ix required: in Climate Zones 12 & I5, lt-4 is
7'herninl Mua�s
To obl��in ComDliancc Credi� 1or the installaGon of lhermul mass, use the Performanee AP�ro�ich. _
undcr
ll.
Ilegi.rlralion N¢anher: liegia�lruliav Du7e/7'inte 1'ILNS' Prnvider:
2b08 Rea•ideniiul Comp(iunce Fornts fiugusi 200J
]'rescripCivt Certiiic�te uf Compli.u�ce: ResidenCi.il
lte.��ide�ttitd Alternlions ' �
8
CI -1
Suf�)
H2:RS \�ERIFI CA Tl ON S UMMAI2�' Tlrr en�a'ceneen/ agenei� sl�oz�ld /�qr speciul uueution /o llu HGRS Measfu�e.r e��eciJiec/ iii 7/ria�
c6eclrlisi belo�r. �J cnn�pleled ond s'igned CF-4P Fm�m for cdl ihe men.sure.r s��eci/ied a•ho/I he.submilled �o Uie 6uilding ir�spec�orGcfora Jinnl
1)uCt Se.tlulg S 7�eSflilg � h7ERS veriJicuiion is reyuired for ihia nrenxm-a � . ." .
❑ Y�S ❑ NO )'CS�. lu Climntc Zones 2 tmd 9-I G, if mare lhtin 40 linenr feet of new ur repl�mement ducts ,ire iiis�fllled in uucandiLioned
_ sp�ice, lhe ducls a�re to be seeded per § 152(b)I Dii and lhc newly installed ducts ure tu bc i�isulntecl pei § I51(1)10.
❑�XCEI'7'10�: Iszisting duct systema� tii�d :u'c exlcuded; which are cuustructe[l, insulnted iir se:iled �vith :�s6estus .
❑)'ES � ❑ NO YGS: In Climnic'Lunes 2�nd )-16, if thy existing space-eondhioning system (HV!AC equlpmeneand ducting) is replaced, the
.. � .., '.ductstucto�bcscaleA.per§1�2(b)IDi. � . . .' . . .. ... . . .
❑ 1'iS ❑ NO YGS: In Climate Zoues 2 aiid 9-16, if the existing FIVAC equipmem is replaced (including the, replacement oT the air, h�indler;
� ' �� : uutclooc con�ensing unii of zi split sYstem; eooling or heatino coil, nr the furnacelient excl���mger) the duets�are to be
. .. -...... _. . .,:,sealed.�>e�,§152(b}IL' ..�.. . . .. .�
� . . ,... , , ...... ....... .. ... _ ......, . ......... .. ,
.. _ . . . ., . ..... . ... . .:
. . .. . , - _ . .:.. .,.,
..... ,.� ... �.. L�3+CL1,'T10N: lluct systems th it ;ve ducmnented ta h rve Leen pre� rousi�' se;iled confirmed.thruiigh HGILS `��
�
� � , � -verificntion imaccurdance with prucedures in tlic Relerenre Itesidential Apj�endia P.A3. � . . _. ..., ..... .
.:.__. ...� _ _ � . . _ . ... . -: �- .:.
�� � .- .. ❑�'.P�aC�PT�ONi lluet sVyt��»� witli less-th m 40 Ime:u i�el� m uucuud�tioned sptice
� �-� � ❑,��CEPTIO� Cx�st�u � duct e�stems-consvucted, inSuLited.or sealt,d with�asb�titos. - � -
Refrieei'atit Ch.�t ge - Split SysEem HERS ve�r)rcnnoiris ier�:rired jo� rkis meaazuc -
❑ Y�S `� �NO YGS: ln Climate Zones 2 and 5-15, wl�en the'existing HVAC equipmeni is replaced,(uicludin�g tt�ea'eplacement of,the.air �
_.� .� ±;: handlei;� outdoor condensing univof � spli� system A/C or heat pump, cooling or heatii�g coil oi tYie-furnace he9t -� �� �
� � exchan�er) a refrieerant charge measuremem shzll be Jerit"ied per (152(b)1F. - �' -���� '
Centi•al Fan Integrated (CFI) Ventilation System and ran V�'att Draw ' ""' "
The ventilation req�iirements of FI SD(o) do not apply tn eaistine residentia) homes. � � �� � �� � � "
Ducted S}>llt S,ystems - Air Conditioners and Heat Yumps: Airiloh� HERS reriJicatiaa is reguired_(or (his measure. �' ".
❑ Y�S ❑ NO ]'E5: In Climate Zones 10 through 15, when the existing space-conditioning system (HVAC equiptnent and ducting) is
� � reolaced. !he airfloH• and fan wan draw shall be verified per § 1 S2(b) I Ci to meet the re�uireinents of 6151(fl7B.
• I
Name:
Company:
ation Statement
Compliauce docu�
rM�N ��
VG_'�ldN
l�!eY
is acc�rntc und
Date:
y'( —2oi1
.ablc � CEA or O CEPE
ILeapunsible Auililine� llesivuer's Decla?atinu Stntemcn( �
� I um uligible uuder Divisiou 3 afthe Culi1'arniii Business and Professions Cude to Eicco�ri responsibili�y for thc building design idemiGed on
[his Ccrtilicatc of Compliancc.
• 1 cerLify lhal ihe enm�gl' (c�uures amd performanec speciLcations fnr lhe buildiug dcsign identiGed on lhis CerLificute of Complianec cunform
w thi: rcquiironients of 9'itlu 24, Pm1s I nnd C, of the Ctillfornie Cade of Regulu�ions.
• Thc huilding design 1�eaWres idcmi6ed on Ihis CertiLcate of G�mpliu��ce.n�c consisicni wilb thc intnrina�i�m provided tu duci�mem tliix
building desigu on thu nlher applicable complianec forms, wurl<sheets, calcul�itions, pinns zmd speciLcti�ions submilied ln thu enforeement
;iucncv (i�r annroval �viqi this buildinu ncrmii �inulic�ilion.
Ntime.
Comp�iny.
Address.
Signature:
Iiaic:
License:
Pnr a,+•.sistanee m� tp�eslinns regnrding the lnm•gi� St�u:dnrrLs, cnntael /he L�aergp Flntli�ve ar: 1-b'(ll1-772-.430G. .
Kegia�voliou IJwnber: l(egia�trniion Drue/Timc; 1/Lli ;' Frm�iderr
20bt; Residei�lial Compliar�ce Forntt� �li�gttt�l 300J
n�AnQ3�t�er•}� I�,�e�sures Sxtman�ry
]tes�denYia� -
Site Addrexs: lnfiirceumuf Agmici':
7)ntc:
] 01'
NOTE: Low-ri.se re�idemial buildings si��jecr �o the Stm�dru cl.i'naus� enmplp wilh nl! npplicable rnnndalor)' mcuszu�es lisied,
regcu-dlesa of Jhe canpliw�ce upprnuch used. A9a'e sfri»ge�al ei�eig�7� measure.e listed ar dte Ce�9ijicate qf Complicmce (CT-1It,
CF-llt-ADD, nr CF-IR-dLT FornQ .rhnl/ supersede Ihe ilems ma�lced ��oith nn ua•�eri.��lr (") belo��i�. Tl�is A�undutorp Measio�e.r
Swnnuirr.vl�all Ge inco�ynrnted inm !he permi! dncumenls nnd dic upplicable fentiu�er.sl�n// Ge caisidered t�y nl/ purties crs mininvxun
ca�tponeitl �iei jormnnce e/�eciJrcnlions rvhether Ihey n��c shrnvn elsewhere in the dr�cwne�vs or im>hi.s ,sznmm�rp. Szrbmil ul/.
�+PPficuble sec(irms ojlhe A9FJlf Gnrm rrid� plurts. . . . � . . . . .
llESCP.IPTJ ON . .
.. ,� :.,. . _ .. . _ ..� ._ _._
---� . . ..... .. . . . : _. . _
� ]Suildin{! �nveln �c R'lu�siires: . - . - ' . . � • ' .
.. .- .. . � . ..._ .. ......... .... ... . ... .:...
.,'. ..... .. :. §I 1 G(�ip: Doo�a und winAbws 6elween cw�ditioiied aiad uncondilioned syaces zre minuf�ctwed tn limii air leal:a�e. -.. .. ...
-�� '-�§l 16(ti)4.` Fenestratipn; pioducts.(ezcepi fie(d=fa6ricaLeil'windo��s).fi�rve.0 I�bel Lsiiiie Ihe ceni5ed U-racto�5,certi5ed Solar'�Hetu Gam.CoePLcii.m� �
�� ��'�' (SNGC,aiidmfiltra[ionthntmaets:the�.reiuiremenisol��1�-111(a).:-. . ,., ... �. ... --��.:�:` . , ...
, . .:
. . . .. . ,- ; . . . . . ..... -�...��_ .. ._- � :�.
, "_-. -,§I�77�-:=bx�erior doozS:and;N'indnw.rare:weather-stripped; all_joints and �enetrauons nie cauiked.and sealed . -- __.... - ...... . _ .
... . . ,. , . „ .. . _ ._— -- � - .. ` _ ... ... . _—
- �`. . hl9 S(a)�, InSulnuon�specified or insmlled-maeis`Staiidai'ds (orliisulati�ig Matennl InBicate type�and:include.on-CF.6R Form..;-: �
��§I I8(i)i The�thennahetnittanceand solar�reflectance�values-ofihe cool�roofm6 materinl��nieeis the re�miements of,�§11 �(i)'y�lren Ihe msiallaumi of �" '
� - ' ��� '�- "� a Cool Roof:is s �eciLed�on�the GF'IR�Eorm . :.�_ � � ' ' � � � � ' � � � � �� � � � � � � � � �
• . � ,. . . , .. .:.. �... .. � .
.�... . .. . . � � . . . . � . .. . .:".- ` - ..::._ _. ._...
- � - �*§ 1 SO(a}:'Minimum R-19 insulation m �vood-frame eeilin: or eqiiivalent U-factor. � � -.�..:. :. ,._, ,' • � - � .
.... . . .� . -
-. �: :: �,... - .. .... . .,..,. .. : : _..... . . _.... . . ,.�
- ¢15U(6}: Loose fill�insuletioashall conform with mzniifaoturer's i�istalied:design labeled R Veiue: -' � �'�
' � . � . . _ . .. _ . ,. -... .. . . . .:. .. ._, _ .. .. .. . . . ._ ..
... � � *§I50(c): Minimum�R-13.insidation in wood-frame wall or equivalent U-facror. ' � � ' � � .
*§15G(d): Minimum R-13 insulation�in raised wood-frame tloor or equivalent U-factor. � � .
.....:.... ,.
§150(�: Air retarding wrap is tested, labeled, and iastalled according ro ASTM E1679-)5(20D0) when speci5ed on the CF-1R Forni. �
. . . . _. : : � . _ . .. . . . .. .. .. . .
.� ¢750(g)�. Mandatop� Vapor bamer iustalled in Cliinate Zbnes 14 oi� I G. �� � .
§15D(I): W ater absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeance rnte is no
� �reater than 2.0 pern�linch and shall be protected from uhysical damaee� And UV li�hi deterioration.
., �• I Rireplaces, Decorative Gas Appliances and Gas Loe Measures: . � �. . � .
- § 150(e)IA: Masonp� m' factoq�-built f�replaces have a closaUle metal or glass door covering the entire opening of the fvebox. �
§150(e)IB: Masonp� or feclory-buil[ 5replaces l�ave a eombastion outside air intalce, which is ai least six square inches in area and is equipped
with a wiH� s readily accessible, o erable, and tighi-fiitin damoer and or n com6ustion-air control device.
{ I SU(e)?: Continuous burning piloi lights and the use of indoor uir for cooling �i Lrebox I�eket, when that indoor air is vented io the ouiside of thc
, buildin{;, arc prohibited. . .
Snncr. CnnditiuninC, VJ:rter Ncatin� and 1'Iumbi�iC Syslem Ne;�si�res: .. . . .
. -� 110-4113: HVAC equipmen�, w�ier henters, showerheads, f�wceu; and �II nther regulaied appli�mces are certified hv the Lnergl' Ciiinmission. ,
� .§ 113(c)5: Watcr henting recirculation loops serving multipic dwelling units and High-Risc residenlial occtq�ancics meet the air releasc v�lve,
bacicflow revention, mm � isolntion valve, �md recirculation loo � eonnec�ion re uirements of §I 13(c15: -
§ I I St Continuously burning pilol lights ,irc prohibited for nnturJ gas: Ism-typc ceutrul furnaces, household cool<ing nppliances (npplinnces with an
clecp�ic;il su �Uh� volta �e connecGon witli �iloi li �htti thn� consume Icss thein 15D Btu/fir �ire exem �Q, +mcl iool and s�a he�tcrs.
� � I50(h): l-Jenting and/m� couling Inads nre etdculnled iu ticeord�wec wilh ASI-IIiAL, SMACNA or ACCA,
?� I50(ij: Fienting syniems are cquipped tvilh fherinusttits lho( ineel lhe selbscl: retµiireinentx of Sectian I 12(e).
41 i(1(I)I A: S�oragc gns �vtiten c�alcrs riled wit6 un Gncrg)' Ptictur no grcatcr Lhnn Ihe Icderil mluimal stand,ird tll'C L'XlC1�IlilII1' N'1'il�J�iL'(I q�llll
insiil�itiun havinE un iusl;dled thermtd resisl�mce ol'1i-12 or @re�rier.
1 I SOQ)I P: Un(ned titorage tnnl<s, sueh as stnrn�.e lamL•s or f>•acicup lanLti fnr sol�v water-he�iting system, or other incfirecl i�oi water Iunles have 1t-12
ericrntil insulation or I6)6 iniernal insulation wherc the iniernal insula�ion 12-valuc is indlcaled on thc extcrior of thc tanl:.
1 I50(j)2: Pirsl 5 feel ol'hol aind culd wtuer pipes closesl to wa�er hea�er tanl:, non-recirculaling systems, and cntirc length of recirculaiing sections
of' hni waier �i �es are insuiated �er Standards 7"abic 150-B.
t� I50(jJ2: Cooling sys�em piping (suction, chilled water, or �rinc lines).und piping insulated between hcaling sourcc and indirec� hoi watci �ank
shall be instdaled tuTti�lc ]511-U und E<untion IS(1-A. .
� G15U(i)2t Plpe insululion 1'ur stenm hydrunic heating xys�ems or hol wtucr systems> I:i psi, mce�s lhe requiremems ol' Stnnd,n�ds Table 121-A.
415U(I)3A: hisulation is protecicd (i�om d�imugc, includin� thai duc tu xuulighi, muislurc, equipmem muintenomce; and wiud.
, �I SO(I}3A: Intiidtuion (br chi�led wa�er piping �md ref'rigerani suetion lines includes a v�ipur retardam or is enclosed entirely in cundiiioned space.
. 200R lie.sidenliul Compliunce F'onn.r dugua�r 20(l.J
CITY OF COSTA MESA
Neighborhood Improvement Program
Work Write Up
Bids due to City 11/12(2010
Return to Dan Baker 714-754-5330
Name: Rae Ann Larson, 631 Darrell Street Home Phone: 949-722-0925
All work is to be done per City of Costa Mesa Building, Planning and Public Works Codes. In order to establish standards
of quality, the detailed specifications may refer to a ceRain product by name and/or from a major manufacturer. This
procedure is not to be constned as eliminating from competition other products of equal or better quality by other
manufactufers. The Contractor shall fumish the list of proposed desired substitutions prior to signing-the contract. All
items listed on the work description, unless otherwise specified, shall include all patching and finish work, including trim,
hardware, patching and finlsh painfing anNor staining. The Contractor is responsible tor al! permits, fees, City business
licenses, plans, etc.
City of Costa Mesa Standard Rehabilitation Specifications applies to all items Iisted on work description.
Termite Fumipation: Treat entire structure for the presence of both dry
wood and subterranean termites. Tenting is recommended for full $155�
abatement.
Wood repair: Repair and or replace all deteriorated wood and trim. �$600 `� ���"� �
Replace with in kind material and spot prime before painting
Exterior Paint: Power-wash existing home and prepare entire $300
structure for painting. Spot prime all bare and repaired areas with �_
applicable primer. Paint under eaves using Dunn Edwards paint.
Homeowner to select color from samples provided by contractor.
Swf`�`�i �orr=�6
Ctean-out: Contractor to provide and instal� new clean-out in front $600
Planter areas that has been previously marked.
Roof: Remove and dispose of ALL existing roofing material down to the $$100
sheathing on (both the house and garage). Install A_S.T. waterproofing
felt as required per U.B.C. and a new 30-vear architectural laminated
shinqle roof (Owens Corninq brand or epual Class A fire rated to
current U.B.C. Code and manufactures standards. Include new drip
edge and flashing. Install new metal valley pans. Install new metal
flashing on every pipe and vent. Seal and paint alI vent and pipes.
Reolace alt damaaed starter board and fascia with in kind material.
Homeowner to select cofor of roof from samples provided by the
contractor. Provide and instali three roof vents place� evenly across roof.
Remove existing old roof vent.
Motion Liqht near qaraqe door: Provide and install new motion light near $350
garage door. Provide complete electrical installation including switch.
Material allowance not to exceed $75 for light.
Garaae Door; Remove and dispose of the existing garage door and install �1000
a new ( 16'0"x 7'0") non-insulated (Clopay or equai) 24 gauge minimum,
steel sectional rofl-up garage door with lock release mechanism to
manufacturers specifications. Instaliation to include ALL hardware and
weatherproofing. Contractor to use existing garage door if appiicable.
�'f i-Pitil d
:�
Water heater: Remove existing water heater and install new 40 gallon
water heater to code with approved type pressure relief valve with
discharge line, seismic strapping, and new gas line as needed. Also
inciude all plumbing hardware, water inlet lines as needed and shut-off $1000
valve. Obtain permit.
Backvard landscapinq: Remove existing patio cover and replace with
alumawood patio cover. Cover to be roughly same size as existing. $3900
Follow manufactures instailation instructions and pul( all applicable
permits.
Ceilin4 repair: Repair and secure all loose water stained areas of ceiling
in living room and front bathroom. Prime areas with KILZ stain blocking $250
primer. Retexture areas to match existing.
Interior Paintinq: Prepare all rooms and interior living space except back
bathroom for painting. Sand and scrape all loose paint and fill all holes •
with appropriate spackling compound. Prime all bare areas that have
been sanded or repaired, Retexture areas where applicable. Paint all
bedrooms and living areas with flat Dunn Edwards or equal interior paint $3000
including all ceiling areas. Front bathroom and kitchen to be painted with
semi-gloss. Owner to select color from samples provided by contractor.
Central heatinq furnace: Provide material and labor to replace existing
furnace and thermostat with new fumace (Carrier or equal) to same location. $2500
New furnace is to have the minimum BTU rating per size of the home. - Use
existing registers and ducting where possible. Obtain permit
Windows: Ail windows, slider and trim to be removed and disposed off off
site.. When removed, replace with vinyl nail-on/or retrofit windows $7675
(contractors choice) sized properly to fit openings. Ensure window
instaliation in bedrooms meet current egress requirements. Installation
to include any applicable siding repair or trim replacements. Windows and
slider are to be Milgard or equal; dual glazed throughout entire house,
weather-stripped and have appropriate finished interior and exterior trim to
fully encapsulate ail metal portions of lead containing portions of windows
and trim.
Kitchen: Remove existing free standing range and install new General $1050
Electric free standing range or.equal. Contractor to verify if gas exisits for
appliance. Color to be biack. Material Price not to exceed $750.
_ , ,.
. .,. k` ... � . . .. �
Hail Bathroom: remove existing and provider and install new tub/shower
valve. Model to be American Standard or equal. Material allowance not to $675
exceed $175. if new valve cannot be installed than, provide alternative to
fix water flow.
1. 1. Additionally, provide and install new ceiling exhaust fan. Style
to be Braun or equal. sone leve! not to exceed 3. Installation to $�50
include appropriate ductwork and electrical hook-up per
manufacture and building code guidelines
Carpetirtp: Provide material and labor to remove and dispose off-site
,
existing carp id p. all areas. Install medium gr, aad , .:arpeting
($ 40 /yard installed) where removed including closets. Install carpet with $4600
minimal splices and properly hot taped. Owner to make final approval on
carpet, pad, and color. Do not install carpeting in dining room area and
hailway.
Laminate-Provide and install new laminate flooring in dining room area $1500
and haliway. Material to be Mohawk or equal. Price to include
underlayment and floor prep. Bid to include all new baseboards where
new flooring is to be installed if applicable.
Total � $42fi0
$1500
I have reviewed the above work description and understand that any changes, additions
or deletions shall have prior approval by the City of Costa Mesa Neighborhood
Improvement Personnel.
Rae Ann Larson, 631 Darrell Street
CITY OF COSTA MESA ...'
`��pMFq BUILDING DIVISION
i�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us -
° � FOR INSPECTIONS CALL: (714) 754-5626
'�°"°^°�°"`� PERMIT NUMBER: P11-00074
PERMIT TYPE PLUM
APN: 42215313
.,w,,oytwir:•�ii �` <�,.`�iS:"„e'F;ytd •'aT.wiw
JOB ADDRESS: ;,� 631 DARRELL�ST�GM
. �.. �.� ..>�a ,.
Vicinity: �,
STATUS: ISSUED
DATE ISSUED: 04/07/2011
ISSUED BY: CAC
Suite/Unit:'
SCOPE OF WORK: HOUSING PROJECT TO CHANGE OUT WATER HEATER. COMPLIANCE FORMS ATTACHED TO JOB
CARD.
OWNER:
PHONE:
�APPLICANT:
PHONE:
LARSON, RAE ANN
HUFFMAN, RICK
CONTRACTOR: HUFFMAN CONSTRUCTION
Address: 1181 ATLANTA WY
City/State: COSTA MESA, CA ZipCode: 92626
ARCHIiEC7:
ENGINEER:
Address: 631 DARRELL ST� -
City/State/Zip: COSTA MESA, CA _ ,
Address:
City/State/zZip: -, �
License No. 427295
� - PHONE: N4.397.4707
CELL: •
License No.
License No.
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
TOTAL FEES:
$35.80
PHONE:
PHONE:
Y
. '�..�;,7,);;� r �,.
,.-�:i . ,., ., _ ,
, :, i't ;;'i :,
:'.:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DqYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be wnsidered le9al, such work must comply with all applicable codes, antl all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will resWt in the expiration of this permit.
LODE p. INSPECTIONTYPE DATE IN1111AL5 CODEp INSPECTIONTVPE OATE ���` INTITALS
t616 Fixed System Final Fire Prevention 206 Final Mechaniral �/ ,1 �
1266 Pool Spa Final _ 208 Final Plumbing ^�—� "/' � � 1�' b
200 Final Re-Roof 210 Final Electncal
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final P�anning Approval
203 Final Sign 222 Final Site �'
204 Final Demolition � ' ' 250 FinalBuitding/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby a((irm under penalry of perjury one of Ihe following tleclarations:
❑ I have antl will maintain a certificate of consent to sel(-Insure (or workers'
compensation, as provided for by section 3700 of Ihe Labor Code, (or Ihe
performance of the work for which Ihis permit is issued.
❑ I have antl will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the peRortnance of the vrork for which [his
pertnit is issuetl. My workers' compensalion Insurance carrier and policy
number are:
Carrier.
(This sedion neetl �rof De mmpeted d Me peimrt is valve0 at one huntlred tldlars (5100) orless J
Polqicy Number:
G/, s I certity that in �he perfortnance of the work for which Ihis permit is
I%i�ued, 1 shall not employ any person in any manner so as to become subjecl
to the vrorkers' compensation laws of California, and agree thal i( I should
become subject to the workers' compensation pmvisions of Section 3700 0(
ihe LaborF ode, I sha I fonhwit wmply with these provisions.
�"'I � �_�'ll
�Applicanfs SgnaWre C..�ate>
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLLAF2S
(8100,000), 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 aKrm that I am licensed under pmvisions of Chapter 9(commencing
wilh Section 7000) of Division 3 of Ihe Business and Professions Code, antl
my license is in full force and effect.
Licr#� '�i� 7 :- 9 � rClass # �
�—�2.���] r�'� ��1-=1-�I
Co�`trac�or'sSignaWre � �-Wte
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn that there is a wnstructbn lending agency for Ihe
peAormance o( the work for vfiich ihis pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby af5rm that unaer penalty of perjury that I am EXEMPT FROM THE
CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county vmich requires a pertnit Io
consWcl. alter, improve, tlemolish, or repair any structure. prior to its
issuance, also requires Ihe applicant for such permit to fle a signed statement
lhat he or she is licensed pursuaN to the provisions of ihe Con[ractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( [he
Business and Professions Code) or that he or she is exempt thereFrom and
the basis for the alleged exemption. Any violation of Section 703L5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as Iheir sole
compensation, WILL DO 7HE WORK, and the stnicture is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her ovm
employees, provided that such improvements are not intended or oRered for
sale. If, however, Ihe building or improvement is sold within one year of
wmpletion, the ovmerbuilder will have the burden of proving that he or she
ditl not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to consiruct lhe project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply to an ovmer of
property who builtls or impmves thereon, and who contracts for such project with
a cmtractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code tor �his reason:
309�a6 (3I0])
Owner ID verified 6y drio... ., iicense. t] Yes ❑ No t`
Driver's License No. Expires:
Venfication of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certdy that no excavation frve (5) or more (eet in depth into wfiich a
person is requiretl lo descend, will be made in connectbn with v.ork authorizetl
by Ihis permit, and that no builtling structure, scaFfdding, talse�wrk, ar demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Atlminislrative Code).
❑ As owner-builder, I will not employ anyone lo tlo work whic� woultl
require a permil from [he Division of Industnal Safe[y, as noted above. unless
such person has a permit ro do such vrork from the division.
Applicants SignaWre Dale
Division o( Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will ihe applicant or present or future building occupant need to fle antl
certify a Business Plan for emergency response to release or Ihreatened
release of a hazardous malerial? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health and Safety Code requires, vrith some
excep[ions, that a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one lime during a reported
year a quaNity of hazardous materials equal to or greater ihan a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will lhe applicant or preseM or fuNre builtling occupant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
tempereture and pressure�.
3. Does or will the applicant or present or future builtling occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Sec[ion 25534 of the Califomia Health and Safety Cotle provitles that the
Cos[a Mesa Fire Department may require Ihe preparation, certifca[ion and
fling wilh lhe Fire Department of an RMPP by businesses which are requiretl
to register awtey hazartlous materials with the Fire Department.
4. I( an RMPP is presently required, has Sec[ion 25534 of the Cali(omia
Health and Safery Code been fully complied vnth? ❑ Yes ❑ No
5. Does or will Ihe applicant or present or future building occupant require for
the work which is [he subjecl of this application a permit for such cons[ruction
or modifca�ion fmm [he South Coast Air Quality Management Dislrict or (rom
any other air pollution control disMct or agency? ❑ Yes ❑ No
(Seclion 658502 of the Califomia Govemment Code requires ihat the reques[ed
infortnation be fumishetl on applications fa non-residential building pertnits).
6. Will any part of Ihe facility to be constructed under this permi� be wi[hin
1000 feet from [he outer boundanes of a school? ❑ Ves ❑ No
Q('yes", Ihe faciliry must meet the requirement of Sections 25534 antl 42303
of the Califomia Health and Safery Code).
7. If a permit from the South Coast Air Quality Managemen[ District or other
air pollution control district or agency is required for Ihe vrork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", atlach certificate of compliance fmm ihe appmpriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
infortnation qiven above is correcL I agree to comply with all state laws and
city ordinances regarding Hazartlous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
Ihe information given is covecL I agree to comply with all state laws and ciry
ordinances relating to buildinq construction, and aWhorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy ot any building
authorized by this permit until final inspection.
AgnaWre of Legal Ovmer(s) � �ate
tQ `�Ti'i..�—,�-- h -7 - i �
nOlorAu�M1orizeEAOP��m�� L���=
��
CITY OF COSTA MESA
Neighborhood Improvement Program
Work Write Up
Bids due to City 71/12/2010
Return to Dan Baker 71A-754-5330
Name: Rae Ann Larson, 631 Darrell Street Home Phone: 949-722-0925
AII work is to be done per City of Costa Mesa Building, Planning and.Public Works Codes. In order to establish standards
of.quality, the detailed specifirations may refer to a certain product by name and/or from a major manufacturer. This
procedure is nol-to be consWed as eliminating fmm competition other products of equal or betler quality by other
manufacturers. The Contrador shall fumish the list of proposed desired substitutions pnor to signing-the contract. All
items listed.on the work description, uniess otherwise specified, shall include all patching and finish work, including trim,
hardware, patching and Finish pairrting and/or staining. The Contractor is responsible for all permits, fees, City business
licenses, plans, etc.
City of Costa Mesa Standard Rehabilitation Specifications applies to all items listed on work description.
Termite Fumiaation: Treat entire structure for the presence of both dry
wood and subterranean termites. Ten;ing is recommended for fulf $�550
abatement.
Wood repair: Repair and or replace all deteriorated wood and trim.
Replace:with in kind material and spot prime before painting
Exterior Paint: Power-wash existing home and prepare entire
structure for painting. Spot prime all bare and repaired areas with
applicable primer. Paint under eaves using Dunn Edwards paint.
Homeowner to select colorfrom samples provided by contractor.
5w�s5 �or—r'�c
Clean-out: Contractor to provide and install new clean-out in front
Planter areas that has been previously marked.
$600 � � �'�� �
$30 �> p"
�— i
$6��
Roof: Remove and dispose of ALL existing roofing material down to the $g�00
sheathing on (both ttie house and garage). Install A.S.T. waterproofing
felt as required per U.B.C. and a new 3D-vear architectural laminated
shinale roof fOwens Cornina brand or eaual Class A fire rated to
current U.B.C. Code and manufactures standards. Include new drip
edge and flashing. instail new metai valley pans. Install new metal
ffashing' on every pipe and vent. Seal and paint ail vent and pipes:
Replace all damaqed starter board and fascia with in kind material.
Homeowner to select color of roof from samples provided by the
contractor. Provide and install three roof vents placed evenly across roof.
Remove existing otd roof vent.
Motion Lipfit near qaraqe door: Provide and install new motion light near I$350
garage door. Provide complete electrica! instailation including switch.
Material allowance not to exceed $75 for light.
Garaqe Door: Remove and dispose of the existing garage door and insta!I $1000
a new { 16'0"x 7'0") non-insulated (Clopay or equa� 24 gauge minimum,
steel sectional roll-up garage door with lock release mechanism to
manufacturers specifications. Installation to include ALL hardware and
weatherproofing. Contractor to use existing garage door. if applicable.
Windows are allowed. �
Jr
Water heater: Remove existing water heater and install new 40 gallon
water heater to code with approved type pressure relief valve with
discharge line, seismic strapping, and new gas line as needed. Also
include all plumbing hardware, water inlet lines as needed and shut-off $1000
valve. Obtain permit.
Backvard iandscapinq: Remove existing patio cover and replace with
alumawood patio cover. Cover to be roughly same size as existing. $3900
Follow manufactures installation instructions and pull all applicable
permits.
Ceilinp repair: Repair and secure all loose water stained areas of ceiling
in living room and front bathroom. Prime areas with KILZ stain biocking $250
primer. Retexture areas to match existing.
Interior Paintinq: Prepare alI rooms and interior living space except baCk
bathroom for painting. Sand and scrape all loose paint and fiil all holes '
with appropriate spackling compound. Prime all bare areas that have
been sanded or repaired. Retexture areas where applicable. Paint all
bedrooms and living areas with flat Dunn Edwards or equal interior paint $3000
including all cei{ing areas. Front bathroom and kitchen to be painted with
semi-gloss. Owner to select color from samples provided by contractor.
Central heatinca furnace: Provide material and labor to replace existing
fumace and thermostat.with new furnace (Carrier or equal) to same location. $2500
New furnace is to have Yhe minimum BTU rating per size of the home.- Use
existing registers and ducting.where possible. Obtain permit
Windows: All windows, slider and trim to be removed and disposed off off
site. When removed, replace with vinyl nail-on/or retrofit windows $7675
(contractors choice) sized properly to fit openings. Ensure window
installation in bedrooms meet current egress requirements. Installation
to include any applicable siding repair or trim replacements. Windows and
slider are to be Milgard or equal; dual glazed throughout entire house,
weather-stripped and have appropriate finished interior and exterior trim to
fully encapsulate ail metal portions of IeacJ containing portions of windows
and irim.
Kitchen: Remove existing free standing range and install new General $1050
Electric free standing range or.equal. Contractor to verify if gas exisits for
appliance. Color to be black. Material Price not to exceed $750.
Hall Bathroom: remove existing and provider and install new tub/shower
valve. Model to be American Standard or equal. Material allowance not to $675
exceed $175. If new valve cannot be installed than, provide alternative to
fix water flow.
1. 1. Additiona{ly, provide and install new ceiling exhaust fan. Style
to be Braun or equal. sone level not to exceed 3. Installation to $�50
include appropriate ductwork and electrical hook-up per
manufacture and building code guidelines
Carvetinq: Provide material and labor to remove and dispose off-site
�
✓
existing carpe .i pa all areas. Install medium gra� ad s arpeting
($ 40 /yard installed) where removed including closets. Install carpet with
minimal splices and properly hot taped. Owner to make finai approval on
carpet, pad, and color. Do not install carpeting in dining room area and
hallway.
$4600
Laminate-Provide and install new laminate flooring in dining room area $1500
and hailway. Material to be Mohawk or equal. Price to include
underlayment and floor prep. Bid to include all new baseboards where
new flooring is to be installed if applicable.
Total $421b0
�, y ��
$1500
I have reviewed the above work description and understand that any changes, additions
or deletions shall have prior approval by the City of Costa Mesa Neighborhood
Improvement Personnel.
Larson, 631 Darreil Street
Date
[
CITY OF COSTA MESA
t�STUMpQ BUILDINN. DIVISION
F�� 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.costa-mesa.ca.us
� g FOR INSPECTIONS CALL: (714) 754-5626
'�°�°•°�`°�' � PERMIT NUMBER: B11-00079
PERMIT TYPE B_ROOF2
APN: 42215313
JOB ADDRESS: C631�°UARRELL STYCM
Vicinity: �'`��
Squares: 2500 .
STATUS: �
DATEISSUED:
ISSUED BY:
Suite/Unit:
Valuation: "
ISSUED
03/14/2011
KJB
$5,672.00
SCOPE OF WORK: REMOVE EXISTING ROOF. COVER WITH 30 YEAR, CLASS A COMP SHINGLES. ROOF PITCH IS 3:12. APPROX
2500 SQUARE Ff. INCLUDES ATTACHED GARAGE.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provicJed for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card
OWNER: LARSON, RAE ANN , . ,
PHONE:
APPLICANT: MARTIN, GERALD � � . -
PHONE: 714-044-1002 ' -
CONTRACTOR: MARTEC ROOFING CO �
Address: 3103 GINGER AVEUnit: '
City/State/Zip: COSTA MESA, CA 92626 �
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: 63'I DARRELL ST � ,
� City/Slate/Zip: COSTA,MESA, CA , � -
Address: 3103 GINGER AVE - ..
City/State/Zip: COSTA MESA, CA
License No. 752008
UNITA � PHONE: 714�44-'1002
CELL:
License NO.
License No.
9
PHONE:
PHONE:
Unit:
Unit: :UNIT A
TOTAL FEES 5126.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N812010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Years DaV, Memorial Dav. Indeoendence Dav, Labor Dav. Thanksqivinq Dav antl Christmas Dav
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California staWtes 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 atl applicable codes, and all
required inspections and final approval must be obtained. Failure lo ob�ain inspections and final approval will result in lhe expiretion of this permit.
GOOE N. INSPECTION TYPE OATE IN1111RL5 CO�Ek INSPECTION TYPE DATE IN71TIpL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ^ 208 Final Plumbing
200 Final Re-Roof X 3-zz- i I m� ��
INv` 210 FinalEleclrical
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:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certifwte of consent lo sel6lnsure (or workers'
compensation, as providetl for by section 3700 of the Labor Code, for the
pedormance o/ the work for which this permit is issued. '
❑ I have and will maintain workers' compensation insurance, as required by
secfan 3700 of the W bor Code, for [he perfortnance of the vmrk for which this
permit is issued. My workers' compensation Insurance cartier antl policy
numberare: c . � �� ,
Carrier U `� � � C� �� �
(IDis sec(on neetl rrof be comde(etl Athe pe�md is val al one hunAmtl Edlars (8f00) or less.)
PolicyNumber: U�����9���
❑ I certify tha[ in the peAormance o( the work for which this permit is
issued, I shall n�t employ any person in any manner so as to become subject
to lhe vrorkersbcompensation laws of Cali(omia. and agree that if I should
become subject to he worke �� compensation provisions o( Section 3700 0(
the Labor C e. I� i I-t h lh comply with these provisi ns.
; �; � �
' ppi¢anfs Signawre ale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), 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 affirm that I am licensetl untler provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Cotle, antl
my license is in full force and eftect. q
Lic. # 1- � Class # G— 3/
oi rtactor's Sigrewre - �'D�
CONSTRUCTION LENDING AGENCY:
� I hereby aKum that there is a conswction lending agency fw the
peRortnance of ihe woAc fa which this pertnit is issue0. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature �ate
OWNER-BUILDER DECLARATIONS:
I hereby affrm ihat untler penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or [he following reason (Sec. 7031.5,
Business antl Professions Code: Any ciry or counry which requires a permit to
cons[mct, alter, improve, tlemolish, or repair any strucWre, prior to its
issuance, also requires the applicant tor such permit ro(le a signed statement
thal he or she is licensed pursuant lo lhe provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business and Pmfessions Cotle) or that he or she is eaempt theretrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects ihe applicant to a civil penalty of not more than
five hundred dollars (5500).):
❑ I, as owner of the property, or my employees with vrdges as their sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
oftered for sale (Sec. 7044, Business and Professions Code: The Conirectors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, providetl that such improvements are not intentled or offered for
sale. If, however, the building or improvement is sold within one year of
completion, Ihe owner-builder 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 CONTRACTING WITH
LICENSED CONTRAC70RS to construct the projec[ (Sec. 704-0. Business and
Professbns Code: The coniractors License Law dces not appty to an owner of
property who builds or improves Ihereon, and who cont2cts for such project with
a contracta(s) license pursuant to the Contractors License Lavs.).
❑ I am exempt under sec.
Business and Professions Code for ihis reason:
305]�46 (3/0])
Owner ID verifed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
� Veri(ca4on of Ownership by (rype of document, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection vAth v.ork authonzetl
by Ihis pertni[, and that no building s[rucWre, scaHdding, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Cali(omia Atlministrdtive COtle).
❑ As owner-builtler, I wiil not employ anyone to do work which woultl
require a permit from ihe Division o( Industrial Safety, as noletl above, unless
such person has a permit to do such work from the tlivision.
APO�����'s5lgnature -� _ �a�e
Division of Indusirial Safery Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release o( a hazardous malerial? ❑ Yes ❑ No
(Section 25W5 of the California Health and Safery Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one lime during a reported
year a quantity of hazardous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant neetl to file
a registration form for acutely hazartlous materials? O Yes ❑ No
(Section 25533 of lhe Califomia Healih and Sa(ely Code, with some
exceptions, requires registralion with the Cosla Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons. or 200 cubic feet of compressed gas at standartl
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of ihe Califomia Health and Safety Cotle provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safe[y Code been fully complied wilh? ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupant require for
the vrork which is the subjec[ of this application a permit for such construction
or motlificalion lrom the South Coast Air Qualiry Management Dis[rict or (rom
any other air pollution control tlisMc[ or agency? ❑ Yes ❑ No
(Section 658502 0! the Califomia Govemment Code requires that the requestetl
information be (umished on applications for rwrnresideNial building permits).
6. Will any part o( Ihe facility to be constructed under this permit be wilhin
1000 (ee[ from [he outer bountlaries o( a school? ❑ Yes ❑ No
Qf'yes", the facility musl meet [he requirement of Sections 25534 antl 42303
of Ihe Califomia Health and Safe[y Cotle).
7. If a permit from the South Coast Air Quality Management District or other
air polWtion control dishict or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate ot wmpliance from Ihe appropriate air polWtion
control officer).
CERTIFICATE OF COMPLIANCE: I certify Ihat untler penalry of perjury ihe
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
� � Signalure
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury that I have read this application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances rela[ing to building constmction, and authonze representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purpose I agree no[ to occupy or allow occupancy of any building
authorizetl by th' p mit u til final insp ction.
ur gal w¢r s ale
/l ��
An0/or Aumonzea AOOliwnt Date
Prescriptive CertiSicate uT
Residenflu! Alieration,s
� J . �
C2.� �
,���
CF-1R AI
(Pa�e 7 of
Climate Zone N �" � �# of S[orie!
General Inlormatiu❑ .
SiteAddress: 63� ��.�•fCtL �niurcemeniAgwcy: Date: 3(� jl
Buiiding Type �.Single Famil�� ❑ Multi Family Circle the Front Orientation: 1�, E, S, N�, or degrees
Conditioned Floor Ana (CFA): Projeci 7ype: ❑ Altera�ions ❑ Envelope � Fenesiration �CRooT � HVAC
- Replacemem or Chan e Out ❑ Duct Re lacemem ❑ Water Heater
NOTE: Tl�is jorm is nnt �n bc used /rn Ne�vlr Cnnstrnctetl lluildings m� Adrlitions
Insuln[inir V�dues Fnr Opnquc Sur(nces (/ar Fvrring use the Mass and Furring Sh'ips Consn-uc�ion ��ble below)
Assemblq AI[eratiun - -�
❑ Opening of framed cariq• alone-ALeraions (hn7 involve die opening of the fi�amed cavi�� ofn wo[l, ceiliivg, orJloor mus� ins�all the /�
munduiorn minimnmi ina�ulnfion vnlve per �750_fm� the altered assembh�. Fil! in Coiumns A-C ond enter mandaom insulatiai va(ue in Colnm�e H.
❑ Replacement of entire assemblp-Reyfucement ojon e�nire waf1, ceiling. or'Jlom� assemblp reguires !he insiaflotion ofComponent
Pucku e- D insulation valves in Table 151-C. Fi(1 in Cohimns A- J.
O a ue Surf'ace Details For the turred
A B C
Pro osed °c r:o�.�
Framing
'I'ag/ Assembly Name Material
ID� orTy e� andSize'
No�e: For fun�ed assemblies, accours�ing for Ca�tinu
tioned of Mass Walls see Furring St
D E F
Standard
fhickness,
Spacing, U- ]A4 Table
or Other} factor" Number'
ree Page JA4-3 and
Construction Table 6elow.
!. . u... . . .
Caviry
Assembly � Assembly
�ell Values U-factorv
use
l. ror Tng/ID indica�e die idenlificatiai name 1ha! nmtches the building plans.
?. /ndico�e �he Assemblr Nume or ,rype: Roo(/Ceilrng, Walls. Ffaors, Slabs, Craw! Space, Doors and etc...lndica�e !he Frame rype and Size: For
N�ood, Me�al, Meial Buildings, Nlass, enter 3x4, ?x6, or etc... see JA4 for oiher possible franve rype asserrblies.
3. Enier !he dviclmess for' mass in inches m' Spacirg Lenveen froming mem6ers en�er; 1 G'"ar' 24 "OC; or Other jor p][ other assembly dee'cription
such as Cnncrete Sandwich Panel, Spandrel Panel, Logs, StraN� Bale Pane/ and etc.... .
4. Based o�a the Clinm�e Zone; emer the StondarA U facmr fi�am Table 151-B, C or D ja' ench diJfernni assemb/�� Name a� rype.
5. Enter theTaGle num6er 1ha� closel�� resemGles �he yroposed asa�embh�.
6. L+ver �he R-value tha ie� 6eing instaUed in �he wall canirr m' berwee�� Ihe fi�mning; olhe�wise, enler "0 "'.
7. En�er !Im Continuous Insula�ion R-value for (he proposed assemb/7�; otherwise, enter "0".
8. Ln�er !he raN� and cnlunm o(dae U-factm� volue 6ased on Column F Tu61e Num6er and enter !he As.rem6l�� U faclor in Column J
). The Propnsed AssemLlo U-fuclor', Colttmn J, musi Ge eqzml !n w� less than the Standnrr! U-jucior in Colunm E to cornp7p.
Fun'ing Strips Construction Table for Mass Walls Onh� -
A B C D G F G H I J K L M
Propnsed Yroperties of Masonry an�3 Cuncrete Added Interior or Exlerior Insulatiun
Walls Prom Reference in Purring Space from Referencc
Juint A endia 7able 4.3.5. 4.3.6. 4.3.7 Joint A endis Table 43.13
_ ^u - ' _
U � j Y v" � U
�. � o � `-' P �
Assembly " j �`e � F' ~ c y,"m " °'- Final
L�v G'� rt U'O G� L.�v � N
Muss Nxmc or .IA4 Tablc ti= I'_, _ v F ' o 't � �, � v � ASsembly
'Phickness� 'I� e Numhei' �� i� ui 5 LL � 5 i' C Q^� uEi r �)-fac[m�''� Commeni
�I
I
RegLsn�uoai Numher: � Registratian Daee/Trme: NEILSProvider:
200d'Residei�tial Conaplicu�ce Fa�ms ' � Augusl 2009
Residentia! Alteratlons
Proiect Name: .
Fi!
CF-IR-ALT
q of Stories
ROOFING PRODUCTS (COOL ROOFS) §I57(n12
When the areu ojrxterior roofsrmjare [n bc rep(aced exceeds uiore than 50% of the exrsling roojarea, or uiom tl:un 1,000 jt, ivhichever is
less, Uie ne�o raofing aren must aieet the raofiug produc� "Cool RooJ" requiren+ents of §152(b)IHi, ]52(b)]Hii, or I52(b)IHiii.
Check applicaGle a!(ernarive or excep(ion be(ow if the rooJa/ieration is ezempt jrom the roofingproduct "Coo/ Roof" requirements. No�e: /f any
one af �he ulternatives or exceptiaa below is checked, ihe Aged Solar Reflecmnce and Therma! Emittance requiremenis for roofing products in
,�118(iJ are nol app(icable. Do not f/I table below. �
�,�pol Roofs Not Required in Climate Zones 1-12, 14, and l6 with a Low Sloped. Less or 2:12 pitch.
�Cool 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
AI[ernatives to §152(b)1Hi and §352(b)Hii, Steep-slope roof (pitcli > 2:I2J
❑ Insulation witli a thertnal resistance of at least 0.85 hr�ft �°F/Bhi o� at least a 3/4 inch air-space is added ro[he mof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §I51(�10; or
.❑ ln climate zones 10, 12 and 13, wiih 1 R''-of free ventilation area of attic ventilation for every 150 ft of attic floor area, and
where at least 30 perceni of the free ventilation azea is within 2 feet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insula[ion; or
C] Building has radiant bazrier in [he attic meeting the requirements of §151(�2; or
❑ Building has no ducts in the attic; or
�I In climate zones 10, 11, 13 and 14, R3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hiii, Low-slope roof (pitch <_ 2:12) �
❑ Building has no ducts in the attic.
Q RooSng area covered by building integrated; phorovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria_
Q Roof constructions that have thermal mass over the roof inembrane with at least 25 Ib/ft is exempt from the below Cool Roof criteria.
Note: If no CRRG I label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise,
Check the a licable box below iTExem t from the Roofin Products "Cool Roof' Re uirement:
� Roof Slope Product Weight Pmduct Aged Solar Thermal
CRRC Product ID Number� a 2:12 > 2:12 < Slb/frz > Slb/ft2 T e� Refleetance''° Emittance SRIS
❑ ❑ ❑ ❑ p^
��
�C
�C
�C
Tl�e CRRC Producl /D Nu�xGer' can be abininedJrom Ihe Caol RooJ Ro(ing Uouncil"s RaledYraducl Ulrectory al v ol f e/p d(/ � l h
/ndimle 16e type afproduc! is being useAfor dre roofrop, i.e. single-pl�� raof, aspha!! roof, meml roof, etc.
IJlhc Aged ReJlecla�rce is no! avai/aGle iu.0ie Coo/ RoofRanng Co�mcil's Raled Producl Direcmp� /hen use Ihe Inilial Reflecmnce value fi�om the same
dir'ec�ap� and use Ihe eg�m�imr (01+OJ(P��������— 0.2J �o ob�ain o calcula�ed oged vaL�e. Where p is �he Ini(ia! Solar ReJlecmnce.
Check Gor rf Ihe Aged Re/leclonce is n calcu(aled value using Ihe equofion above.
Calc�dale !he SR/ value Gr asing Ihe SRI- Wa�ksheel ol lvllo'//�vmu-.enerm�.ca ¢ov/(itle14/and emer !he resulfing value in !he SR! Coluiror obove and ortqcl� uco�v
l4c SR/- N'orksheello rhe CF-1 R.
o apply Liquid Rield Applied Cuatings, the coating 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 §I 18(i)4. Select the applicable coating:
Aluminum-PigmentedAsphalt RoofCoating
Cement-Based Roof Coating
Other
Regis7rution Number: 2egisaa�ion Date/Time: HE/LSProvider:
2008 Residentia( Comp(iance Farms
Augusi2009
Certificate oi'
Residentird Alternti�ms
Yrujecl Name:
idential
CI�-1 R-AL
(Pa��e j u1 :
.Gimate'Lone� I �:uf5turies
HERS V�P�IFICATION SUMMARY The enforcemerv ngencr sho�dd ynrsuecial n�temion « i 1hc HLRS Nleasw�e.s specified in this
checldisl Gelow. fl complered unc! si�ned CF-4R Fw�m for nll �he mea.r�n�e,r specilied shnfl be suGmit�ed �o Ii�c buildmg in�pec�or be/a�r Iinnl
J111C1 �iealllle & TeStillg HEltS verificcnion u� re9zm�ec(for�hi� mansure.
❑}'�S ❑ NO l'C5: lu Climate Zones � and J-1 G, if more tha+v 4(l linear feet of new or replacemem ducts au�e insinlled in unconditim�ed
� space, the ducts ure to be sealed per g152(b)1Dii and the newly inswlled ducts are tu be insulaled pe� { 151(1)10.
❑ EXCEI'T10�': Lxisting duct systems Uist are eztended; wLich �u�e cunstructed, insultued m� sealed with nsbestos.
❑ Y�S ❑ NO 1'L.S: ]n Climate Zones 2 nnd 9-] 6, i1� tl�e existinE space-eonditiouing system (HVAC equipment ancl duainaj 3s replaced, tlie
� ducts are to bc sealed per §152(bpDi. �
[7 �'Ei S ❑ NO YES: ]n Climate Zones ."'. and 9-16, if the existing HVAC equipmem is repluced {including the replacement o1 the air handler,
� ou�door condensing unii of a split system, cooling or heating coil, or the furnace heai exchaneer) the ducts are to be
sealed pe� §152(b)lE.
❑ EXCEPTIOA': Duct sysiems tknt are dncumented ta huve been previousl�• sealed confirmed through HLRS
_ - verificatimi in accordance witli prucedures in the Reference Residential Appendis P�A3.
- --- ❑ EXCCPTION: Duct systems with less than 4U linear feet in uncunditiuned space.- . .
❑ L�XC�PT10�: L�xistin; duct svstems constructed, insulated or sealed with as6estos.
Ref'rigerant Char;e - Split System NERS veri)ication is reqi�irecY(a this nveaswe.
❑ 1'�S ❑ NO YCS: ln Climare Zones 2 and 5-15, when the existing HVAC equipment is replaced (including the replacement of Yhe air
hai�dler, outdoor condensing unit of a split system A/C or heat pump, cooling m� heating coil; or the furnace heat
exchaneeri a refriaerant charee meesumment shall be veri&ed per §li2(bllF.
Central Fan Yntegrated (CFI) Ventilation S,ystem and Fan �'att Draw
The ventila[ion renuirements of 615Dfo1 do not ano]Vtn existine residential homes.
DuCted Split Systems - Alr COndifioners and Heat Pumps: AirfloN' HER:S ��erilication is regurred./orthrs measure.
❑ i�S ❑ N 0 YES: In Climate Zones ] U through ] 5, when the existing space-conditioning system (H VAC equipment and ductine) is
renlaced. the airflow and ian watt draw shall be verified ner § 152(b)1 Ci to meet the reouirements of & 151(f17B.
Documentation Author's Declaration Statement �
• I cerHf�� that this Certificate oT Compliance documentation is accurate and com ete.
Name: � • Signamre:
c-�n- �n�rt��.c
Company: Date:
'-¢ (�,6v,F �'O . • f f � I 1 (
Address � lf Appiicable � CEA or � CEPE
3ib�i�� G(1V(S�-� �'�Ve (Certificationt!):
City/Sta�e/Zip: Phon^�
C�STYt V��`S�i Crq- %�oZ.(� Z�'E ��`E-(00 Z
Responsible Building Desi�ner's Declaratior Statemenf �
e 1 am eligible uuder Division � of the California $usiness ancl 1'rofessions Code to accept responsibility 1'or the buildi��g design identified on
this Certificate of Compliance. �
• 7 ceriify tha� thc energy feowrea and performance specifications for t6e building design identified on ihis Certificnte of Compliance conform
tu t6e requircments ofTitle 24, Pnrls 1 eind G of tlie Calilbmit� Code of Regula�iuns.
• The building tieslgn feawres iden�iGed on lhis Cenificate of Compliancc arc consisiem with thc information provided to ducumeni this
buildii�g desigy� on th� other tipplicable compllancc lorms, worl:shcets, calculations, plans and speciLca�ions submitted u� the eniorcement
u�eucv for npproval with this buildln� permit applicaiion.
Namc� Si�nature.
COmuanl': Uute:
Address� - License�.
CIt�d9tatelZlp: � Phone:
Trn� a.�'.cistrmce nrguastion.e regarding fhe Energp Stnndrn�ds, cmelacr [hr Liverdr Notline at: 7-8/10-i72-�300.
1<e�ia�inuiou l�hunber: Regi,siraiinn Lae/Time: HEIiS' (rm�icier:
ZOOf; 7;esidentiul Con�pliaice Forms
Auott.s'! Z00J
CITY OF COSTA MESA
BUILDING,DIVISION
ROOF COVERING CERTIFICATION
Property Address /� � I
L
. �. �� "� � •�
Owner
Contractor 1M �T�� I�-� F�NL� C O _
State Contractor License Number % S 2- �d� Classification G— 3!
I hereby certify that I have inslalled, or caused to be installed, a minimum Class B roof coveriny at the above
address in conformance with Chapter 15, of the latest adopted edition of the California Building Code, and the
installation instructions of the manufacturer.
�
�
■
I further certify that I am the owner of the property. (Owner-Builder permittee only).
I further certify that I am:
❑ Owner of sole proprietorship company
� Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
ey:
Initi � ! ate �
0990-46MW6/OB WMte-Builom9Drv.;Ganary.Comractor,Pmk-Owner
iM�fi',� Il,�.� Co .
Company o�C rate Name
3�03 ^r� ����z. A-vr
Address
�sr� c �- uZ.�
C� 3 f y ri
Signature Da e
�
Cj criA-�D tN / Vlf1s�-\ // J
Printed or Typed Name
owxEe Santa Ana Ranchos DATE 9-30-58
JOB ADDRESS bj], 0'7. Darrell Street BUILDING PERMIT NO. %C7E>2 �`
GENERALCONTRACTOR DlkB & C012�tOJ2 VALL[E$ � - 1j,919.0�
AP. No. LOT 9 TRACT 221rj FIRE ZONE DESCRIPTION OF WORK S711�,+1E R25. Att,. G3T.
GROUP I& J TYPE V ZONE ' RI{ PLAN NO. '
INSPECTIONS I DATE I I PFRMITRIRSL1Ef]
SUBCONTRACTOR
coa[
Final Gas Test
DATE
C�
�� ���;��� F�E RECEIVED
COSTA MESA BUILDING DEPARTMENT �-30'S�
' P, O. BOx 31 � _���� ��
COSTA MESA. CALIFORNIA . � �� �
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING 6 1�i. Darrell St. BUILDING
A�DRE55
COSTA MESA.,CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. P0�/fi�1j(j
MAIL
ADDRE55 I
CITY �
ARCHITECT
OR ENG�NEER
ADDRE55,
CONTRACTOR
LEGf�L
DESCRIPTION
A.P. NO.
,a Mesa, Calif• TNO.
LIC.
� �i°e�ook ��.
denp�Grove
� p[ CITY LIC.
olPgrove� Inc "�
TEL.
�1. Crr...v� NO.
9 a�o�K
II � �W ' IfIOW ON LOTS
USE OF
EXISTING BLDG.
SETBACK LINE FFOM ' ^�'
ccnrcA or sraEEr REAR VARD L
g� 15�
SIDE YARD RIGHT LEFT
DESCRIPTION OF WORK
NEW � ALTERATION AODITION
REPAIR MOVING OEMOLISH
SIZELDING 1365 Sy 1U ROOMS 7 STORIES 1
E%TERIOR WALL t ROOF �
COVERING S4UCCO COVERING CO
USE OF NEW _ _ _ _
OUILDING
ADORESS
FIRE
ZONE
COSTA MESA. CALIFORNIA
• DATE
CORRECTIONS
with attached ara e
P1an110S&
I HEREBV ACNNOWLEOGE TMAT 1 MPVE REAO THI$ FPPLICl�TION AND '
STPTE THAT TXE ABOVE I$ CORRECT FNO AGREE TO COMPLV WITH FLL .
CITY OflDINANCES 4Np STAT PWS RE6ULATING BUILUING CONSTRVC�
TiOrv. VALUATION
SIGNATURE OF PERMIT FEE S 2�00
PERMITTEE /y�
Tt 1,�,. I'u� T_S 13,919�yv . PLAN CHEGK s16�W
AUTHORIZED AGENT 1�16c CC COZBgiOVB� �1a,C• TOTAL FEE $�j,g�yy
yBM{