HomeMy WebLinkAbout456 ABBIE WAY - Building Permits� CITY OF COSTA MESA �
BUILDING DIVISION
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: BC10-00349
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 09121I2010
� ISSUED BY: KJB
�06 a�oRess: 456 ABBIE WY CM Suite/Unit:
APN: 11737201 �- Zoning:' , , , , ,-
Vicinity: � �� � � - , ` -Primary Occ: - "�
Const Type: V-B ', SQ. FT: 524 Valuation: 548,417.60
SCOPE OF WORK: ADD 524 SF FAMILY ROOM AT THE REAR OF RESIDENCE: WITH 1 FIRE PLACE, ALT DUCTING SYSTEM,
20 LIGHTS, 16 OUTLETS, 8 SW ITCHES' UP.GRADE AND RELOCATE ELECTRICAL SERVICE TO 200 AMP, 4 HOSE BIBS, 3 GAS
OUTLET(1-4). `
_, .., „'� �
OWNER: KIRKLAND ALAN'G AND-SUSAN E M Address: 456 ABBIE WAY a „, - '+„�. Unit:
Phone: 714-815•2816�, •; �"� . ��. . .Ciry/State/Zip: COSTA MESA, CA'• � � . '� �.,
.'c � , - _ . � _
. _ .: .�. . �... �.
, , .. ... , -_ . , ..
APPLICANT: PHILNIELSEN ,.�,c { �" Addiess: `� ` -. � � ' .. �, , . c: -�. .v Unit: :
Phone: 714-717-1416-� - .r. -- Ciry/State/zZip: .. _.. � .
. �:. .� .:;' .. � . _ " � .. .
CONTRACTOR: .�.: ` .:��: . ..,, �-__ _..,r.:., . .........-,,.�_ �,LicenseNo.�..- .. . .�._.. ��.
Phane: , - � � � � . - Address: Unit: . � � .� �� . - - � . - � '
Cell: � City/Statef�� � � � � �- � . ZipCode
ARCHITECT: ��- �. � ,� � �- LicenseNo. � �
ENGINEER: JOSE ABARQUEZ 191 �� � , License No.51994 � �
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $41220 „
Building Fees: � � �� � $634.15 � , , �
Electrical Fees: . � -$102.40� .-�> - , - ... . .
Mechanical Fees: $47.85 �
Plumbing Fees: � _ $68.85_ ,;-
SMIP Residential: , „ $4.84 .
' . ,'� � PHONE: �
� . ,. PHONE:714-277-9895
SMIP Commercial: $0.00, _ '
Bldg Std Admin Fund � $2.00
TOTAL FEES: 51�,272.29 "� � . . � � �.�
'•Refer to fee recei ts tor all fees aid for ro'ect � �
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/1812010 - PER CMMC Sec. 13-279
Monday thru Frlday • 7:00 am thru 7:aa pm. Saturdays• 9:u0 am thru b:oo pm. Pfohibited all hour5 - Sunday5 and the following Federal holidays:
New Years Dav. Memorial Dav, Independence Dav, Labor Dav. Thanksaivina 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. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in fhe expiration of this permit�,,
CO�E . INSPECTIONTYPE OATE INIIPRLS CODEO INSPECTIONTYPE DRTE INi111RL5
1fii6 Fized System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Eleciriwl
201 Final Block/Retaining Wali 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site ,_ J
204 Final Demolition 250 Final Builtling/Occupancy ���'1
M
WORKERS' COMPENSATION DECLARATION: -
I he�eby affrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain v✓orkers' compensation insurance, as required by
section 3700 of the Labor Code, for the pedormance of the work tor which this
permit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carriec
(This secYron neetl nof 6e mmpletetl Alhe peimd is valuetl at one huntlretl dollars ($f00) or IessJ
'�olic umber:
I certify that in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject fie workers' compensation provisions of Section 3700 of
the Labor Co s tl forthwith comply with these prov' 'on . /,
V
- qalure le�'
�y...
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT 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 affrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in (ull force and effecl.
Lic. # CIa55 #
Gonvactor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a construction lending agency for the
peAormance of the work ta which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name: '
Lender'S Atldress:
SignaWre Date
OWNER-BUILDER DECLARATIONS:
I hereby a(frm that under penalry of peryury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, tlemolish, or repair any shucture, prior to its
issuance, also requires the applicant for such permit to file a signed statement
Ihat he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is ezempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicanCto a civil penalty of not more than
five hundred dollars ($500).): ,,
❑ I, as owner of the pmperty, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered tor sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, providetl that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
compleC n, the owner-builder will have the,burden of proving that he or she
did n uild oi improve for purpose of sale.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LIC NSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contrac[ors License Caw dces not apply to an ovmer of
property who builds or improves thereon, antl who conl2c[s for such project with
a contractor�s) license pursuant to the Cont2ctors License Laws,).
❑ I am exempt untler sec. '
Business and Professions Code for this reason:
�l'�I�(J
Slgrcamrc-.`, �t . ,
305]A6 (3/Ol)
Owner ID verifed by dr��ense. ❑ Yes ❑ No
Dnver's License No. Expires:
Verifcation of Ownership by (type of document, i.e. - property tax bill o� deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy that no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connection with vrork authonzed
by this pertnit, and that no building structure, scaffolding, talsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 347, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
ApPlicanl's SignaWre Oale
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or tuture building occupant need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505�of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to fle
a regishation form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business �which at any one time has on hand a quantity of acutely
hazardous materials.equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
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 materials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Safety Code provitles that Ihe
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
lo register awtely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupant require for
the vrork which is the subject of this application a permit tor such construction
or modifcation from the South Coast Air Quality Management District or from
any other air pollution control distnct or agency? ❑ Yes ❑ No
(Sectbn 65850.2 of the Califomia Govemment Code requires that [he reques[ed
information be fumished on applications fa non-residential building permits).
6. Will any part ot the facility to be constructed under this permit.be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If'yes", the facility must meet the requirement of Sections 25534 and 42303
o( the California Health and Satety Code).
7. I! a permit from ihe South Coast Air Quality Management District or other
air pollution control dis[rict or agency is required for the work which is ihe
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from ihe appropriate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Slgnawre Date .
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury that I have read this application and state that
the intormation given is correct. I agree to comply with all state laws antl city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed pmperty for
inspection pu oses. I agree not to occupy or allow occupa y of an building
authorized �h' permit u�I final inspection.. /� , �,`
�, � l.l
' 1Gredf-ee��^Ms� �ate,
Antl/o� Au1M1o�izetl Applicant
� ;f�+,
`�1 City of Costa �I�lesa Build�ing I�ivision"
77 Fair Drive, Costa Mesa, CA 92626
C�S�CZ esa 714-754-5273 / Fax 714-754-4856 �
OWNER BUILDER VERIFICATION
Permit # � l� �� - Oh 3��
Disclosures 8� Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner: �.
An application for a building permit has been �[�itted � yo�r n�a Jme listing yourself as the builder of the
property improvements specified at �,7 (� /—K>/Q��d�� /
We are providing you with an Owner-Builder Acknowledgment and Information erification Form to make you
aware of your respon5ibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�w,hunderstand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
B ilder' building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
2 I understand building permits are not required to be signed by property owners unless they are
sponsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
��.�-lrunderstand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I r`hay protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�:'�' ` I understand Contractors are required by law to be licensed and bonded in California and to list their
lic nse numbers on permits and contracts.
�� �
�5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
aMd the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer' under state and federal law.
�6. I understand if I am considered an "employer" under state and federal law, I must register with the state
d federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
��7-lfunderstand under California Contractors' State License Law, an Owner-Builder who builds single-family
re�idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
314830 CALBO Jan t, 2009 OB Packet template 1 of 2
� 8'�I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be he'Id �liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
�'��9 I understand I may obtain more information regarding my obligations as an "employer" from the Internal
ReJenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) a4 1-800-321-CSLB (2752)'' or www.cslb.ca:gov for more infotmation
about licensed contractors.
�, ���10' I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�A�-11'. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
�bide by all applicable laws and requirements that govern Owner-Builders as well as employers.
`, , : ' �. , . ,,� ,��._::�r � ',�:-� . .''
i�c��12--I:agree to notify the issuer of this form immediately of any adtlitions, deletions, or changes to any.of the
ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contrect with someone who does not have a license, the' Contractors' State License Board may be
unable to assist you with ahy financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may' be iri civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while wo�king on your property, you may be held
liable for damages. If you abtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage. '
Before a building permit can be issued, this form must be completed and signed by the property owner
and retumed to the. agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarizaiion, or other verification acceptab/e to the agency is required to be
presented when the permit is issue to verify fhe property owner's signature.
3i rtature�of:r.pr,operty�owner �����iL,// �Qate`:: O
6.9 -' �..� , �/�
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of th�e property owner to apply for a construction permit for the Owner-Builder. "'
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I/��
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents .
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work): Y
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copyofthe owner's dnver's license, form ;�
notarization, or other verification accepta6le to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
314830 CALBO Jan 1, 2009 OB packet template � 2 Of 2
.r��.✓N; 4'a�—r'r��M'd
DEPUTY 1 INSPECTIOi� SERVICE INC.
25121 DE SALLE ST, LAGUNA HILLS, CA 92653
1- 800 - DEPUTY 1=1 - 800 - 337 - 8891
BUilding Piermit No. I�uO
Job Indentification / Address
General C«�ntractor/Address
Sub - Contractor! Address _
Structural Engineer/Address
SPECIAL INSPECTION REPORT
No.
Arch.
DEPT�OF�BL G. & SAFETY
CITY OF'—��A
COUNTY OF
Date I I�
REINFOF�CED CONCRETE f MASONfiY HI-TENSILE BOLTING CHEMICAL ANCHORS
PRESTRESSED CONCRETE WELDING GYPSUM CONCRETE OTHER
DATE I Reg. � OT I Time In I Time Out I I Grout I Mortar I Concrete I B}ock I Density
All inspections based on a minimum of 4 hours & over 4 hours - 6 hours
minimum. Any inspection extending past the noon hour will be biiled as 8
hour�minimum. In addition, any inspection e�ctending past an 8 hour pr
riod, or Saturday inspecfion will be billed at time and a halt.
ATTORNEY'S FEES - If any action at law or in equity is brought to enforce or interupt the terms of this Contract, the prevailing party
shall be entitled to reasonabl attorney's fees, costs and necessary disbursements in addition to any ther relief to which such party maybe
entitled.
SP CIAL INSPECTION REPOR
Inspector's Name: ` �^� Inspector's Signature:
I.D. No. "� � has been filed and it states that the above work to the best of his/her knoovledge complies ivith the
provisions of the Uniform Buiid'.g'Code and meets approved pians and specifications.
!� Respectfully Submitted,
Approved by: �.,��1� /
� ProjeetSuperintendent '� ' .
RE BAR
N50°10'45'W 20.00'
' o
0
� �'
�
�rr SPIKE � w
1 � eo
� � �
� �
.,
�❑T SURVEY `�:.s�;s�»
0F� 456 AB-BIE WAY n�"
COSTA MESA, CA SCALE 1•=zo�
��T 20, TRACT N�, 1174
I PREPARED BY;
Z RdM SURVEYING INC
23010 LAKE F�REST DRIVE# 409
� SPIKE LAGUNA HILLS, CA 92653
I C9493 858-2924
.
.
' � --- — -- ------- —
� � RON MIEDEMA L.S, 4653
I �� �tGO �,AND S(�,9
.� � L
' � V� F�
.� � RON MIEDEAAA �
; 5.9' �,II, * Exp. Date 9/30/11 *
. �y, No. 4653
o -------� �00� N�,9 ��Q' .
��I I �� I �F� �FOQ'
� � 3y F �Al.
WI I GARAGE � `;8�,
� I I �
��
o�� L-------J �.
;r ` LEAD QN T.C.
� ' \
M �
♦
Z. ----� �
, �-- ,
i i •, ,
I I_ I �
� i i
� � �
� ,
� 45`50'10'%
� — � L 1 40.00'
� I RESIDENCE � R=50,00' . �
� I I f 3Q
� � . I / ���
,
� 1' I,P,-5_�_.--..._. � — � —�� -- ' ��
� _ _ 8 1' �
� 25.2 �
N50°10'45'W 110.15' LEAD �N t.C.
^s,nfY,�r„r��_ ,.r.
DEPUTY 1 INSPECTIOI�
;25121 DE SALLE ST, LAGUNA HILLS, CA 92653
� 1- 800 - DEPUTY 1= 1- 800 - 337 - 8891
Building P�ermit No�1�-��.�(9• .�O
Job indentification % Address �L'..
General C�ntractor/Address (7
Sub - Contractor / Address
Structural Fngineer/Address J�
INC. � DEPT. OF BLDG. & SAFETY
CITY OF /�fii', M �ca
COUNTY OF
SPECIAL INSPECTION REPORT
�_Job. No. Date �i al I�
� , �.,. . .
Arch.
REINFORCED CONCRETE f MASONRY HI-TENSILE BOLTING CHEMICAL ANCHORS
PRESTRIESSED CONCRETE WELDING GYPSUM CONCRETE OTHER
I DATEOFINSPECTbN � � . DESCRIPTION OF WORK INSPECTED I
�
DATE , Reg. I OT I Time In I Time Out I I (�.,�out I Mortar I Concrete I�B��ck �' Density
All inspections based on a minimum o( 4 hours & over 4�hours - 8 hours
minimum. Ang inspection extending past the noon hour will.be billed as 8
hour minimum. In addition, any inspection e�ctending past�an 8 hour pe-
riod, or Saturday inspection will be billed at time and e hali.
ATTORNEY�S FEES - If any action at law or in equity is brought to entorce or interupt the terms of this Contract, the prevailing party
shall be entitied to reasonable attorney's fees, costs and necessary disbursements in addition to any other relief to which such party maybe
entitled. I
i SPECIAL INSPECTION REPORT-�
c c.1�
Inspector's Name: M'1^P Inspector's Signature: 1 __
I.D. No. "5 ;�"�"�'� has been filed and it states that the above work to the best bf his/her knowledge complies with the
provisions of the Uniform Building Code and meets approJed plans and specifications.
f� �%�/ e'" Respectfully Submitted,
Approved by,:_-
Projeet Superintendent �� �
�
�._ . Y �� „^ �„-y.},�V CITY OF COSTA MESA . .
.
F `' ` � � ' � �BUILDING DIVISION
� � 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
�a°"°""°�� PERMIT NUMBER: BC10-00229
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 0 5/2 612 01 0
ISSUED BY: RMD
JOB ADDRESS: 456 ABBIE WY CM SUlte/Unit:
APN: 11737201 � Zoning: , I. , ' ,
Vicinity: ' Prfmary �cc�` *. . '
Const Type: V-B SQ. FT: 0 Val�2tiorl �` $40,000.00 •
w ,. t.
SCOPE OF WORK: INTERIOR REMODEL OF 1-STORY SFD. MINOR KITCHEN REMODEL TO'INCLUDE FRAME UP OF (1)
EXISTING WINDOW AND FIXTURE CHANGE OUTS AND INSTALL A NEW 4'X10' BEAM BETWEEN KITCHEN AND DINING AREA;
FRAME UP A NON-STRUCTURAL WALL TO CONVERT AN EXISTING BEDROOM INTO:A UTILITY ROOM FOR WASHER DRYER,
FRAME UP AN '-. '%
(E) WINDOW OPENING AT NEW UTICITY AREA AND INSTALL A NEW SKYLIGHT (NO CU,TTING RAFTERS); RELOCATE AND
INSTALL TANKLESS WATER'HEATER AT ATTIC AREA; INSTALC A NEW FAU < 100 K BTU'TO ATTIC AREA; INSTALL NEW
DUCTING THROUGH OUT NOUSE; FRAME UP A NEW COAT CLOSEj 24 LIGHT FIXTS; 24 OUJLETS; 12SWITCHES;
FAU a 100 K BTU, NEW DUCTING, MECH.GAS PIP, KITCHEN HOOD, 2 VEN7 FANS; 1 DISHWASHER; GAS OUTLETS (1-4), 1
SHOWER, 1 WASH BA$IN, 1 WASTE AND`VENT, 1 WATER CLOSET, 1 TANKLESS WATER`HEATER,"1 WATER PIPING FOR
REFRIG, WATER REPIPE. COMPCIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER: KIRKLAND'ALAN G AN� SUSAME.M Address: - 456 ABBIE WAY � ^" �� ��� Unit:
Phone: 714-Bt5•2816 - , - . City/State/Zip: COSTAMESA,�CA - - � -� -- .�
APPLICANT: KIRKLAND ALAN � � � - .Address: 456 ABBIE WAY � � .� .. ' � Unit: :
Phone: 714-815-2816 � � , , Ciry/State/zZip: COSTA MESA, CA - , � . . . . .
CONrRACTOR: OWNER-BUILDER- -:. License No. 000000
Phone: � , � . „ � Address: , Unit•' � , - � �
Cell: - , � , . City/State: . - � � ' ZipCode
ARCHI7ECT: - � - ' � LicenseNo;� -. � � � PHONE:
ENGINEER: -� , License No.�, � ' _ � �„ _, � �: � PHONE:
,.. . . .. : �.... _.:, . - -
COMBINATION PERMIT FEE SUMMARY , .
Building Plan Check: $88.28
Building Fees: - $54325
Electrical Fees: $86:54.
Mechanical Fees: $83.50
Plumbing Fees: $117.85
SMIP Residential: $4.00
SMIP Commercial: $0.00
Bldg Std Admin Fund $2.00
TOTAL F�ES: $925.42
ripts tor all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY:
«Tne
0-
the
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
LODEp INSPBCTIONTYPE ,
1816 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 � Fir�I�acbryFirePlace
��� . �.�
203 :Final$ign •
204 Final Demolition
DATE INTITIRLS CODEt INSPECTIONTYPE
206 Final Machaniwl
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
r
. 222 , FinaLSit2' .^ ��
� �., �p�
250 Final Builtling/Occupancy
OATE INTITIqLS,�
� iX ' /� ��
2--� -�- �3
N
WORKERS' COb1PENSA'GQN DECLARATION: ,�
I hereby affrm under penalty of perjury one of ihe following declarations:
Q I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as provided foc by,section 3700 of the Labor Code, for the
peAormance of the wrork �or which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
s@ction 3700 of the Labor Code, for the peAortnance of the wurk for which ihis
permit is issued. My workers' compensation Insurance carrier and policy
nUmber are:
Carriec
(ihis seGon need rrot be cnmpletM illhe ce�rt 1s valued at one hunareddollars (81001 a IessJ
Pnlicy Number:
'[j�%Ycertify that in lhe performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree that if I should
become subje5ito t e workers' compensation provisions of Section 3700 of
the Labo� e al orthwith comply with these provisi ns.
.0
Applicanl,�s, ig� ,�le 1,
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION 70 THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, 1MEREST, AND
A770RNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. # Class #
Contrac�ors SiB�aWre Oale
CONSTRUCTION LENDING AGENCY:
[] I hereby aKrtn that there is a construction lending agency for the
peAormance of the work for which this permit is issued. (Sea 3097, Civil Code).
L�nder's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby aKrm lhat untler penaLLy of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applican[ for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt therefrom and
lhe basis for the alleged exemption. Any violation of Section 7037.5 by any
applicaN for a permit su6jects the applicant to a civil penalry of not more than
fiVe hundred dollars ($500).):
❑ I, as owner of fhe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the struclure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not appty to an owner of pmperty who builds or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such imprpvements are not intentled or offered for
s81e. If, however, tbe building or improvement is sold within one year of
completioq the owner-builder will have the burden of proving that he or she
did not builtl or improve for purpose of sale.). .
�s owner of the property, am EXCLUSIVELY CONTRACTING WITH
CENSED CON7R4CTORS to crnstroct fhe project (Sec. 7044, Business and
Professans Code: The contractors License Law tloes not apply to an owner of
Property who builtls or improves thereon, and who cont2cts for such project with
a contractor(s) license pursuant tothe Contrectas License Laws.).
❑ I am exempi under sec.
Business and Professions Code for this reason:
� 5��
� rIL7Te
3p5]36 �3/0]) ���f
Owner ID verifled
—��"__ 6cpires:_
Verifica[ion of Ownership Gy (type of documen[, i.e. - property tax ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � �
❑ I hereby certrfy that no excavation fve (5) or more feet in depth into wiiich a
person is required to descend, will be made in connection with wnrk authorized
by this permit, and that no building structure, scaFfoltling, falsevrork, or demolition
or dismantling thereof, vnll be more than thitly-six (36) feet high. (Chap. 32, Gry
2, Art 2, Sec. 341, Ttle 8, California Administrative Code).
❑ As ownerbuilder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Appllcanl's SigneWre
Division of Industrial Safely Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will [he applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Heal[h and Safety Code requires, with some
exceptions, that a Business Plan be (led with [he Cosla Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will ihe applicant or present or future building occupant need to Ne
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure�.
3. Does a will the applicant or present or future building oc�upant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazartlous materials)? [] Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require Ihe preparetion, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Heallh and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or luture building occupant require for
the vrork which is the subject of this application a permit !or such construction
or modifcation from the South Coasl Air �uality Management District or from
any other airpollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that ihe requested
infortnation be fumished on applications for non-resitlential building permits).
6. Will any part of the facility to be constructetl under this permit be within
1000 feet from�lhe outer houndaries of a school? ❑ Yes .❑ No
Qf "yes", lhe facility must meet the requirement of Sections 25534 and 42303
of Ihe Cali�omia Health and Sa(ety Code�.
7. If a permit (rom the South Coast�Air Quality Management District or other
air polWtion control district or agency is requiretl for the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from Ihe appropriate air pollution
control officer). ��
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
SignaWre �ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
the infortnation given is correct. I.,agree to comply with all state laws and city
ortlinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-tlescribetl property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by t' lfmit u til final inspection. t
S� 7
�' Sig of alOwn r(s�- �'�}�
Analor Aut�onzetl Applicant
r,-�
�---_��
Costa Mesa
�
City of Costa �l�lesa BuiCding 1�ivision �'
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
:
Dear Property Owner: �
An application for a building permit ha� be�n su mitted in your n`_ lme listing yourself as the builder of the�
property improvements specified at Q��_ b�L r.�.�
We are providing you with an Owner-BuSder Acknowledgment and Infor ation Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the `�
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
Read and initial each statement below to signify you understand or verify this information.
F,�1'Vunderstand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner'sins� nce may not provide coverage forthose injuries.�l am willfully acting as an Owner-Builder
and `a'm.awa��erof fhe limits of my insurance coverage for injuries to worlCe�s.on my progerty.
�I understand building permits are not required to be signed by property owners unless they are
r�'ponsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
��I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
� o�: ,,,1 understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
d�th2 total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
�I understand if I am considered an "employer' under state and federal law, I must register with the state
a� &` federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contributs to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
+, '� l understand under California Contracrors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licens2d subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan t, 2009 OB Packet template 1 of 2
•,
j�8�1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
+�9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
+��
�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
a ide by all applicable laws and requirements that gove�n,0y' ner-B�ilde�s as well as employers.
n..•• s ,;' • ' :i i �.�.tG ;V�7 . • ,'yr; r . .
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
in ormation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'.
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and retumed to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license; form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify the property owner's signature.
Signatt+ce�of,prpperty owner D 4
.
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.-',
Excluding the Notice to Properry Owner, the execution of which I
hereby authorize the following person(s) to act as my agent(s) to
necessary to obtain an Owner-Builder Permit for my project. �
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of quthorized Agent:
Address of Authorized Agent:
�my personal responsibility, I �'�,
sign, and file the documents
Tel No
I declare under penalty of per' �y that I am the property owner for the address listed above and I personally filled
out the above information d certify its accuracy. Note: A copy of the owner's drrver's license, form . .,
notarization, or other v fication acceptable to the agency is required to be presented when the permit is issuetl
to venfy the prope owner's signature.
Property O1Ya¢r's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2
. •I Prescrintive Certificate o1' Comnliance: Residentia] CF-IR-ALT
General Information
Building Typa�4`ingle Family �❑ Multi Familj Circle the Front Orieniation:
Conditioned Floor Area (CFA): �� Projeci 7ype: ,�'Alteralion
Replacement or Change Out
NOTE: This Jnriu i.e no� to be ��sed /or Ne�vlr ConstructeA6uildings nr Additions
Climale Zone #
Late: Z
, S, W, or degrees
Envelope � Fenestration
�Duct Reolacemen�Ll Water
ii of
Roof � HVAC
lnsulntion Vnlues Far Opnguc Sur/aces (Jor Fen�r•neg use thc Mas.r and Furring Sirips Consiramtio�e �able 6eloH+J � ' � �� ''
Assemblp Alteratiun
❑ Opening o1'tl•amed cavit�� alone—A6erations thal involve the opening of thefi�mned caviry� o�cr wall, ceiling,�orJloor mus! ins�a/! the
maiodam�7� n�i»imum insulnlim� valueper §J50 for t/ve ahered ase•emblp. Fill in Columns A—C and'enter mundator7� insulation va(ue in Colemva /l.
❑ Replvicemen[ of entire assembly—Replacemen� ofa�� en�ire wall, cei(ing, orjloor assembl�� reyuires !he ins�allatiae q(Component
PackaPe- D insulntian va/ues in Table 751-C. Fill in Coh�mns A— J.
Assembly Name
C
Material
ed aTMass Wulls see
D E
Standard
kness,
cine, U-
Insularian
Cunstruction Tnble beloh�. � �
G __.__ ".� .H I
Nramed � Contmuous JA4
7A4 Tabie Caviry Insulation Assembly
Numbers R-value� R-Value° Cell Value
see Page JA4-3 and Eguation 4-1. For calculaling(m�red walls use
J-�-- h -
L Fm� Tag/ID indicate the ident�ica�ion name tha� mn�ches !he building plans. �-
2. Irvdicate the Assembly Name or rype: Rooj/Ceiling, Wal(s, Floors, S/a6s, Crawl Space, Doors and etc...lndicaie the Frame type and Size: For
4i�ood, Metal, Metal Buildirtgs, Mass, enter 2z4, 2xG, or e�c... see JA4 fa- other possi6/e f'ame rype assemblies.
3. En(er U�e thicimess for muss in inches or Spacing benveen f'aming members eNer; 16 "or 24 "OC; or Other for a!l od�er assem6lp descriptiwi
such as Canerete Sandwicl� Panel, Spandre7 Panel, Logs, Sb�am Bale Pane/ a�vd elc.... .
4. Based a� the C(imate Zone; en�er the Standard U fac�or fi�om Table I51-B, C a� D for each differen( assemblp Name or rype.
5. Enrer [he Table number thal closel>> resernbles the yroposed asa�embl��.
6. Ln�er Ihe R-value 76at is being installed in the wall cavin� or between the.fi•nming; o�he�wise, enter "0 ". .
7. Ln�er (he Con(inuous Ir�s¢datim� R-value {or the yropased ussembl��; otherwise, emer "0".
6'. Emer the roN� a�d colurnn of Ihe U-fuclor value Gased on Columu FTaG(e Number and enter Ihe Asse»tbl�� U-juctor in Column J
). The Yrunosed Asse�nb(�� U-(acior, Cdtmm J, nms� be eqiml lo a� less• Ihan the Standard U-jacta- in Column E to compl��.
Furring Strips Constniction Table fm Mass Walls Only
A B C D L. F G H I J IC L M
Propused 7'ruperties of Masonrp and Cuncrete Added Interior or �xterior Insulation
Wnlls rrom Reference in rurring Space t'rom Reference
.Ininl A>>endia Tablc 9.3.5, 4.3.6, 4.3.7 Joini A�enUis 7'able 4.313 , �
U VG p y �.A.+ 1:' a�
m N p, .0 4q � w
l�ssembly �" � `o .° � �'"' v ° m�� .c e� ,� �� Final
Mass Name oi' JA4 Tablc �� 'v ffi� � R o '= A d. � � A Assembl�y''
Thickness T c° Number a� � �ii � � �� i:. � Q U-factor � Comment
kegi,su�u�inn Numher: Regisvrutinn Ua�elTime: HE2S Prnvider:
200b' Xesidentiul Compliunce Forms fiugtts7 200J
Prescriptive Certificate oi� Cumpliance: Residential � CF-IR-ALT
Reside�ztia/Alteratians: (Pa�e 5 ��'j)
�,r`���'�I[�� ��\�'. No.� � . .. . ��,+��T,`� I ��s'�t�r.�
H�P.S V'�P�IFICAT101�' SUMMARP The eqforcen+e�v ngencl's7ioidcl pnr specia7 nrlention to ffie HERSiYleasnn'e.r speci/ied in tivis
checldisl below. sJ canyleled cmdsieneA CF-4R Form for nl/ (he measw'e.r spcci/iedshnll be submined �o ihe building insyector Leforc Jinal
DIlC1 SeNIIRe � TeStltl�' HERS�i�vr�ijical'ion Le rcqaiirvd,for Ilvi,y� measzu'e. .� �
❑ YL,S ❑ NO�YCS�, ln Climate "Lo��as Z nnd 9-16, if more than 401inear feet of new or replacemem clucts zire ins)allecl in uncondititined
� space, the ducts are to 6e seeded per §152(b)1Dii and the newly installed ducis�m�e to be insulated per §151(1110.
�❑�XCL,PTJON: �xisting duct spstems thnl are extended; wliicL sve cuustructed, insultuetl m� aenleel witli asbestos.
� ❑ �'P1,S ❑ NO ]'L5:7n Climate'Lones 2 and )-]6, ifYl�e existing speee-conditioning system (HVAC equipmem and ductingj is replaced, the
duc[s ure to 6e sealed per §] 52(b)7Di, � �
❑ Y�S ❑ NO Y�S: ln Climate Zones 2 and 9-] 6, if the eaisting NVAC equipment is replaced �(includiiig the replacemeni o1� the air handler;
outdoor condensing unit of n spli� syslem, cooling or henting coil, or tl�e fumace heai excl�anger) the ducts �re lu be
. sealed per'§]52(b)lE. � � �
� ❑�XC�PTION: Duct systems that are documented tu have Ueen previoush� senled confirmed tLrou;li HGRS
..r' --- —�-� - - verification in accordance with prucedures in the Reference ResideMial Appendix P.A3. � '
, . . . .. . . _ _.. - . . ...
_„ . ❑�IC�PT10�': Duct sVstems with less than 4U linear feet in unconditione� spuce. ' . - �� �
❑ ERC�PTION: �xistinc duct svstems constructed, insulated or sealed with asbestos.
Ref'riverant Charge - Split System HERS veri/icalion is reguirecl for this measzme
❑ YES ❑ NO YLS�. ln Clitnate Zones 2 and 5-15, when the existing HVAC equipment is replaced (including the replacement of�tfie air
., handler, outdoor coi�densin; unit of a split system A/C or I�eat pump, cooling or heating coil; or the iumace heat
exchaneerl n refrieerant charee measurement shall be verified per §152(b11F.
Central Fan Integrated (CFI) Ventilation System and Fan R'att Draw
The ventilation remiirements of F 150(0l do not aoolv tn existine residen[ial homes.
Ducted Splif Systems - Air Conditioners and Heat Pumps: Airtlow HERSvw'ifica(ion is reguired for this measure.
❑ Y�S �❑ NO YES: ln Climate Zones 1 b through 15, wlien the existing space-conditioning system (HVAC equipmei�t and ducting) is
� renlaced; Ihe airflow and fan watt draw shal l be verified per § 1 S2(bl l Ci to meet the renuirements of § 151(f17B.
Author's Declaration Statement
Company:
Address:
Date:
�
• �v I
�onsible Building Desiener'�Declaratiun Statement � � �
1 am eligible under Division 3 of t6e Celiiornie Business and Professions Code lo accept responsibility for the building design identiLed on
this CertiScate of Compliaiice.
] ceriify thal lhe energy featw'en und ped�ormanee specifmalions ior [he building design identi5ed on this GerliLoate oT Compliance conform
tn thc requirements of Title 24, Yzris 1 and 6 of [he Culi9'ornia Code of Regnlations.
The building design femurea identi6ed on this CeriiLcote of Compliance are consis�enl wilh Lhc infonnation provlded to ducumem thi5
building design on the other applicable complianee lorms, worl:sheeis, calculations, pl�ma and specifica�ions xubmiued tu the enforceinent
ucencv fi�r ai�nrnval with this buildin�� nermil annlication.
1Vame'
CompEml'�.
CiudSta�elZip:
Signature:
License.
Fnr assisumce nr questions re�,�ardin� ihc Energi� Sumdarr(.r, contacl tl:e Erverbr Flotli��c nt: 1-b'llll-772-�3(/0.
I(e�, ia'iranion Id mnber' Regisu�m(on Loie/Tin�c � NERS' I'ronider:
200d' Resicler�iia) Convplia»ce Fornta� , Az�gus! 30(/J
Mandatory Measures
Residential '
Solar water-heatint; systems and/or collec[ors�are certified bY.[he Solar
1VIF-1R
'a�e 2 of 3
Ducts and Fans Measures: � � �
§150(m)1: All air-dis[ribution system ducis and plenums installed, are seale8 and insulated lo meet�the requirements of CMC Sections 601�, 602,
. 603, 604, 605 and Standard 6-5; supply-air and return-air duc[s and plenums are iusulated to a minimum inslalled level of R-42 or �
enclosed en[irely in conditioned.space. Openings shall he sealed with mastic, [ape or other duct-closure system that meets the applicahle
. requirements of UL 181, UL 181A, or UL 1S1B or aerosol sealant [hai meets the requirements of UL 723. If mastic or tape is used to
seal openings greater than 1/4 inch the combination of mastic and either mesh or tape shall be used
§]50(m)1: Building eavities, support platforms for air handlers, and plenums defined or constmcted with materials other than selled sheet metal,
duct bozrd or flexible duct sl�all not be used for conveying conditioned aic Building cavities and support platforms may co��tain duc[s.
Duc[s installed in cavities and suppor[ platforms shall not be compressed to cause reduclions in the cross-sectional area of the ducts.
§ 150(m)2D: Joints and seams of duct systems and tlieir components shall nol be sealed with cb[h back rubber adhesive duct [apes unless such tape
is used in combination wi[h mastic and draw bands. �
Exhaust fan svstems have back dreft or automa[ic
§ I50(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ���
§150(m)9: lnsulation shall be protec[ed from dainage, incWding tliat due to sunlight, moisture, equipmentmai»tenance, and wind. Cellular foam ��
. � insulation shall be protected as above or pain[ed�with a coating tliat is water retardant and provides shielding�from solar radia[ion,tha[
can cause deeradation of the material. � �
§ I50(m)]0: Flexible ducts cannot l�ave porous inner cores. . �
§ 150(0): All dwelling uni[s shall meet the requirements of AN51/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoor Air Quality in
Low-Rise Residen[ial Buildings. Window opetation is not a permissible method of providing [he Whole Building Ventilation required in
Sectinn 4 nf that Standard. �
Poal and Spa Heating SYstems and Equipment Measures: �
§ 1]4(a): My pool or spa heating system shall be certified m have: a thermal efficiency that complies witli the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater; a permanent weathelproof plate or card with operating insvuc[ions; and shall not use
elec[ric resistance heating or a pilot li�ht. �''
§ll4(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and retum
lines, or built-uo connections for future solar heatine �� . .
14(b)2: Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
14(b)3: Pools shall have directional inlets Ihat adequately mix the pool water, and a time switch that will allow all pumps to be set or
� � programmed to run only during of6peak electric demand periods.
50(p): Residential pool systems or equipment meet the pump sizing flow rate, piping, filters, and valve requirements of $ I 50(p). �
:sidettd�Il�hhnQ"�"s'Mea'��s: — -
50(k)l: High efficacy luminaires or LED Light En�;ine with ln[egra� Heat Sinlc has an efficacy that is no lower Jhan the efficacies contained in
� Table' I50-C and is mt a�low efficacv luminaire as soecif�ed bv & 150(102.
shall
§I50(k)4: Ballasts for fluorescent lamps rated 13 Watts or �reater shall be electronic and shall have an ouiput frequency no7ess Ihaii 20 kHz.
§ 150(k)5: Permanently installed night lights and night Iights integral to � permanently installed luminaire or exhaust fan shall contain only higl�
efficacy lamps meeting [he minimum efficacies contained in Table 150-C and shall nol conlain a line-voltage socket or line-voltage
lamp holder; OR shall be rated to consume no more [han 8ve watts of power as determined by §730(d), and shall not contain a medium
screw-base socket. �
to exhaust fans. in rooms other than kitchens, shall meet the
§I50(k)7: All switching devices and controts shall meet the requirements of §I50(Ic)7.
§ l50(k)8: A minimum of 50 percent of thc total rated wattage of pennanently installed lighting in kitchens shail be high efCicacy. ,
CXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 fl2 or 100 watls for dwelling units larger than 2,500 flZ may be exempt
from the 50% high ef5cacy requirement when: all low eff�cacy luminaires in the kitchen are co��trolled by a manual on occupanl
sensor, dimmer, energy managemenl syslem (LMCS), or a multi-scene programmable control system; and all permanently installed
luminaries in garages, Iaundry rooms, closets greater Ihan 70 square feet, and utility ruoms are high ef5cacy und controlled by a
manual-on occupant sensor. �
§ 150(k)9: Permanently installed lighting that is internal to cubinets shall use no more than 20 watts of power per linear t�oot of illuminated
Permanen[ty installed luminaires in bathrooms, attached and detached garages, Jaundry roans, closets and utilit�� rooms
2005 Residentiu/ Convpliance Forms Augusl
Residential
Measures S
�
1l�F-1R
'aae 3 01' 3
EXCEPTION l: Pennanently installed low efficacy luminaires shall be allowed provided that [hey are comrolled by a manuxl-on
�' occupant sensor certified to compty with the applicable requirements oC §I I9. -
EXCEPTION 2: Permanen[ly instulled low efficacy luminaires in closets less tlian 70 square feet are not required to be cond�olled by
. mnnual-on occimant sensor.
I50(IQ1 I: �Permanently installed luminaires located in rooms or araas other than in Icitche��s, bzthrooms, garnges, laundry rooms, closets, �nd u
rooms shall be high efficacy luimnaires. � . .
EXCEPTION 1: Pennanently installed low efGcacy luminaires shall be allowed provided they �re controlled by either:a dimmer sw
�_ ' that coinplies with the applicnble requiremen[s o1'§I 1 J, or by a manual-on occupam sensor that complies wi[h the
� applicable requirements of § I 19. . �
�� EXCEPT]ON 2: Lighling in detached storage building less than 1000 square feel located on a�residential site is not required to com'
� � with 4150(k)ll. � . •
50(I:)13:
14:
Luminaires recessed into insulated ceili»gsshali be Iisted for zero clearance insulauon contac� (IC) by Underwrriers Laboratones or
o[her nationally recogiiized lesting/raling laboramq; and hnve a label [hat certifies Ihe lumiunaire is airtighl with air leaknge less then �
2.0 CFM at 75 Pascals when tested in accordauce with ASTM E283; and be sealed with a gaskel or caull< between Ihe luminaire housiiig
and ceiling. �.
Luminaires providing outdoor lighting, including lighiing for private patios in low-rise residential buildings with Tour or more dwelling�=�
units,.envances, balconies, and �orches, which are permanently mounted to a residential building or to. other buildings on [he same lot "
. . . . . . -.-. - �-•-" .... . .. . _.. . .
sliall be high efficacy. � ' � � � �. . �
EXCEPTION I:�Permanently installed outdoor low efficacy lwninaires shall be allowed provided that they are controlled by a manual �
on/off switch, a motion sensor no[ having an override or bypass switch that disables the motion sensor, and one of ihe
. , following conirols: a photocontrol noi having an override or bypass switch [hat disables [he photocontrol;, OR an �
� � astmnomical time clock not having an override or bypass switch that disables the astronomical time clodc, OR an
� � energy management-control system (EMCS) not having an override or bypass switch that allows t6e lqminaire to be
always on
EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch I,
. wliich bypasses the mo[ion sensing function provided that the motion sensor is automatically reactivated wi[hin six
hours.
EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other locatiou subject m Article 680 of
the Califnmia F.lectric Code need not he hieh efficacv luminaires.
wat[s of power as determined
OR not contain u screw-base socket, and consume no more
15: Lighting for parking lots and carports with a rotal of for 8 or more vehicles per site shall comply wrth the applicable requirements in
Sections 130, 132, 134, and 147. Lighting for parking garages %r S or more vehicles shall comply with the applicable requirements of
shall be high efficacy luminaires.
EXCEPTION: Permanently insr
the
200b' Residen�iu/ Compliance Forma�
spaces of low-rise residential buildings with fow� or more
[hal [hey are contmlled by.an occupant sensor(s)
Augusl 2009
rtive Certi6cate c
Iand3-7
ResidentialHI�ACAltera. CF-IR-ALT-HVAC
, ' � Enforcemenr
E ui ment T e' Lis! Minimum Efficienc ` Floor Area
❑ Packaged Unit
�mace ❑ AFCJE?�� ❑ COP Served 6 system
❑ lr�door Coil OSEER � ❑ HSP� � sf
❑ Conde�sing Unit ❑ EfiR _ ❑ Resistance
CVv�,
Ductinsi
require.
Over 40 f
addedy r
'�n fiditio�ii
b rcz
f n ❑ Setback
ace ���110� °���endp present. nms! be
insmlledJ
3-S)
/. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-ll
2. Minimum Equipment Efficieucies: 13 SEER, 78% AFUE, 79HSPF for typical residential systems.
system.
Contractor (Documentation Author's /itesponsible llesigner's lleclaration Statement)
• 7 certify that this CeRificate of Compliance documenta4on is accurate and complete.
• 1 am eligible under Division 3 of the Califomia Business and Professions Code [o accept responsibiliry for the design identified on this
Certificate of Compliance.
• I certify that the energy features and perfomiance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the Califomia Code of Regulations. .
• The design fea[ures identified on this Gertificate of Compliance are consistent with the information ducumenmd on other applicable
wmpliance foims, worksheet�, calculations, plans and specifications submitted tu the enforcement agency for appmval with the pescnit
Name:
2005' Residential Con�ptiance Fonns
Signamre:
License:
Mm'ch 20J 0
. ... _ . ._. _ ... Y._ , .. _....a.., .. _, . .... _.__n _ _ _ _ .. _ M_ .--.�.-m.,,.
- � . .rm�r.��,,�,."", .. , m—�—"-
(ENRORCEMEN�T AC'rE1VGY
CA1 v. CUSTONIIZE : ArITH LEZ"L'E'RI3E�/SEAL)
2008 Building Energy Efficiency Standards Residenfial HV�1C Alter�tipns,-•�, >> �
'� ,_;,.�„ Climate Zones 1 and 3 througi�.7. �:' ���:�6i� �Gdfr� �Psh�
('�i �:'� ;. C , +
BUSINESS AND PROFESSIONS CODE. SECTION 7110 �
Willful or deliberate disregard and violation of the building laws, including the Califomia Building Code, and
local permit requvements cons[itutes a cause for disciplinary action from the Conhactors State License Board
working in conjunction widi the local building departme�t. This ac[ion may wnsist of fines up to $5,000 per
violation or suspension/revocation of a contractor's license.
V��HEN IS A PT,RNIIT REOUIILED?
A written conshuction permit shall be obtained from the enforcement agencyprior to the erectlon, construction,
reconstruction, installation, reloca[ion, or alteration of any mechanical system, except as pernutted �in Appendix
Chapter 1, Section 112.2 of the 2007 Califomia Mechanical Code. Projects requiring perntits include, but are not
limited to:
• Ne�� HVAC instaliation
• HVAC Changeout
• Replacement of fumace, coil, FAU, or condenser
-• Relocation of an existing HVAC unit
• Adding or replacing more than 40fr ducting in unconditioned space
l. Heating equipment must have a mmimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central a'v conditioners & heat pumps less than b5,000 Btu/hr must have a minunum 7� SEEI�,� � y�; ."° Y
3. Newly installed or replaced ducts musi have a minimum insulation value oAl�j4j2. •�%� ,�'%t;'�7-�"'� �`�:� ��
4. A setback type thermostat (24 hr clock with four set po�ts)�sequituJ for al1 altera{ions. .� ,�',.i ; j,,;�
5. New��repla�'@�hllduct�`t�l�sfineet the mandator'X reqi»}� Cnt3 of Section 150(m):
�"''' AYI jo�ts and�openui�s ul the in the HVAC system must be sealed.
1 Only UL 181, UL 1 S1A, or-UL 181B approved tapes or mas[ic shall be used to seal duct openings.
�• Connections of inetals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sieevelcoupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal mns with no more than 2"
of sag between supports and 6 fr. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contrac[or. The Inspec[or wil] collect
this form and verify that the model numbers are the same as the installed equipment.
.__._... .___..._..... �_......._...�_.._ _--._..._........ _ . . ..__:.,..m..�_......____,.__._.... .
. .__.,..__
.,». §: .�...,.�—; r'�y. ."—�--.a..n..:a._.�o.:�**�,.2""�:,, ... •.:.:i ._....
MURTAUGH MILLER MEYER & NELSON LLP
ATTORNEVSATLAW
p IIMITEO LIABILITV PARTNERSHIPINCWDING
- 2603 MAIN STREET, 9TH FLOOR
IRVINE, CALIFORNIA 92614-6232
TELEPHONE(949)794-4000
FACSIMILE (949) 794-4099
MA�ELYN A. ENRI�HT
PARTNER
MENRIGHT@MMMN.COM
November 29, 2001
Costa Mesa Departrnent of Building & Safety Division
77 Fair Drive
Costa Mesa, CA 92628
LOS ANGELES OFFICE
444 SOUTH FLOWER ST., STE. 5OO
LOS ANGELES, CA 90011-2906
(213)622-2101
Re: Public Records Act Request Pursuant to California Governmental
Code §§6250-6258
To Whom This May Concem:
This letter is to inform you that Dana Black has authorized her attorneys in the
law firm of Murtaugh Miller Meyer & Nelson LLP to make a formal request under the
(California Public Records Act California Governmental Code §§6250-6258). We
request that copies of the following documents be provided to us as described below:
❖ Plans, inspection applications, permits, notes and memorabilia including but
not limited to reports made by Gary Hook for the following two addresses:
a. 469 Abbie Way, Costa Mesa, California 92663, and
b. 456 Abbie Way, Costa Mesa, California 92663.
❖ Letters from Linda Maher to Costa Mesa Department of Building & Safety.
We have enclosed a check in the amount of $25.00 to cover the cost of producing
these documents. In the event that the cost is more than this amount, please contact us
immediately and we will forwazd that amount to your agency.
74916.doc
�
November 29, 2001
Page 2
Should you have any questions or need any additional information, please feel
free to give me a call or my associate David Davidson.
Iu/:\ .�Ti . �
Enclosure
74916.doc
Very truly yours,
MURTAUGH MILLER MEYER & NELSON LLP
Costa Mesa Building Department
. 117 T 20th STREET
COSTA�A� CALIFORNIA
FOYt APPLICANT TO FILL IN
No• �
Lic.
No.
Clty
No.
Deseriptlon I No. _ I B�ock
(qttach metesand eounda) // 7- 3 7�2 —
/ No. of Bli
Size of Loty�'+�/icx/sS.r /3r� Newon L
Use of NO. 01
Existing Bldg. Fatnilies
PPLICATION FOR PERMIT
BUILD�LNG '�
r�OR OFFICE USE ONLY
. Receipt No. permit No.
�a3v
ed by Date Rec'd. Date IsvuW
;� a - 6-� 6 �- 6 -� �
Address
Costa Mesa, California
Cross St.
PPans
Bu�lding / ,` � No.of
Size rZ� /( i7 Rooms Stories
Exterior Wall I Roof
covering covering App�`7��'
Use oT New
Butldin9 C/�}� D/QT �D%�/'r//�% �FoundatlonLxation Irrepecto
Forms, Materfals,
� G ,Q-Q�-�%C F Under-Pinning
Frame: Fire Stops,
Bracing, Bolta
I hereby acknowledge that I have read this Application Lath. Int
and state that the above is coTTect and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building constru on. _ /� //
SignatureolJ�_l�• ��GGL�Y/GCiC� Plaster.lnt.
PeYmittee . f �
Masonry Reinforced
Valuatlon Permft Fee $ , O O
/ / Plan Chack $ � Bond Beam
$ SyJO Total p
Fee $ � FINAL
FORM 204 G-H 2M 6-54
D31e
o gr .
� � � . ,:.
H _ -- � _-.� _..--��-- — ,
� �o
� .
� d .-
J , c _' _
n
a . . J � �I. � . .
o a J-
a a t�/�129GE _
r
. ' . r�I� -G-�e�pcosra 33� '�:•�::,•. � i1.f�0
HESA
! ' ' _ •
• •__.��---•--!^L' ' .
.' , ' '' ' .' . .
< .._ _. . _ . ' -' . . .
f(o u S t= . - - — - - - . .. .
,. _
, ..
— •, . ..
� : . - - � Street.` • � . .. . � . . ,_ .
�: �it �
i.
� _ ' _._ -- ---;=' -' ." r_'. ' —: '. � --
-- --- - PLOT PLAN . . C. , . . ',,.�:,_ ,
.-- - ..
8how locatlon and dlstancea irom � - � -. � � ' � � •
property line and between bulldings. ,���,�rn.47 ���•
� .' . .
L-•__ ' ._' ._ _ ' _ _ . �_ ._ _ �. , . _ � - � � , ' ,
i � .. i.. . ! . , ..
"'_ _ _ "_ ..�� � - . ..
.�.. �:' �� � . .� . . .. .
' . . ..11. �, .. �
.
, ' ' .
' ._ "' ". ' ' _' ". .. .. . _ . ..... . " "
. . ., � ' . �, . � p �, t,. , i t ' . . . ' . ' ' ,
' ' :i ..i• '. .. . , .
., � ,.. . „ _ .
' �
..... -�.��,
', �,�)ni � , . � ' . • _ . ,
, r �
i.
' ' _'. _ ' . .'_ ... . ' "_ . ' __"_ _ . t.. •�.�
OWNER $RUYNEEL��DENNIS—A, � DATE 2-6-56
JOBADDRES3 )��6 Abbie W8� "-� / BUILDING PERMIT NO. Z33O
GENERALCONTRACTOR Owner-builder VALUE�$ 56�.�� �
�" AP 117-'i72-1 e�ocK TRACT Carport addition to garage
GROUp f
�INSPECTIONS
Footing Trench
�Foundation Forms and.Gra
Rough Framing
P!!i�^hing� Rough t0 Slab
Plum4ing, Rough Camplete
Temporary Pole
Wiring, Rough
Heati�g, Rough
Heatirlg. Final
Sewep youse Se�
Septic Tank or Cesspool
La"`�g, In O
P�, ing
Plumbing, Final, Fixtures 1
Plumbing, Fin,al Gas Test
Wiring, Final
Occupancy
.�-.,� m n n u i �nn i cc
TYPE p
DATE
� e� ' cl
to Garaae
ZON
SUBCONTRACTOR
FIRE DI6TRICT '2"�SfS
PERMITS ISSUED
DATE I NUMBI