HomeMy WebLinkAbout183 ADMIRAL WAY - Building PermitsCity of Costa Mesa
.;Building Safeti,Department CERTIFICATE O'F O CC,U'P''A N -C Y
P.O. Box 1260
Costa Mesa; California
The.Building located at 1RI Mnir;
hasi,been inspected and found to com
for a Group P—'4 t tot -1 Occupancy.
Use of'Building_
Legal Descriptio
(See reverse sine for Metes and Bounds)
Building Permit No kgs ` Electrical,Per_mit No. 48429 Plumbing Permit No. 78679
t+N umbar of apartments —0— and/or'guest'rooms - —0—
ISSUED TO:
Building Official,
-,�
(} 1'. by !/.iG9iCG�2
P., I. &.d1. / >`S�ORPORAI2D Victor G':.I ri-Dixector Building_ Divi:S+cr
1 Date C1nfnMr. 1091
This Certificate of Occupancy SHALL -BE posted im.a conspicuous place7on the,pire'nlises and SHALL NOT .BE•removed except 6y the,
Building Official of the City -of Costa Mesa under Sec: 306 lel U.B.C. '(' -
0
Form'Bt1'34 Rev. 11/70 �" •
into 3586
with the provisions of all City of Costa Mesa Ordinances applicable thereto
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COSTA MESA W -A` ING-SAFETY DEPARTMENT API ATION FQ�(,4,TRUCgjURAA PERMIT1,1'2s 99 TL
P.O. BOX 1200 L#irSTA MESA, CALIFORNIA 92626
Fj
RECEITC& PERMIT / 4 ?P / r7
For Applicant to Fill in letely - Use Ink 0
\1lff T r (.
BUILDING /A
A.P. NO.
27- 28
ADDRESS i�Vl7'
_
BUILDING
OWNER OR
ADDRESS
TENANT p, I. & I. Inc.
MAILING
UNIT ``
/// <fA
ADDRESS 13919 Struikman Road
SPACE NO..
TR.NO. T BLK.
L
10957 7
CIrYCerritos, CA 90701 NO. 926-440
NEW ADD ALTER REPAIR IMOVINGI DEMOLISH
CONSTRUCTION
LENDER
X
BRANCH
OWNER P. I. & I., Inc.
ADDRESS
VALUE
_
USE S.F. residence -V4
ARCHITECT TEL.714)
ENGINEER NO. 979-69Rg'2--
r``'//nn %C
� L v
ADDRESS 3184-B Airway,Costa Mesa 92626
ZONE /"" TYPE GROUP
APPROVED
CONTRACTOR
BY DATE
ADDRESS
TEL.
CITY NO.
STATE CITY
APPROVED SETBACKS
LIC. NO. LIC. NO.
SIZE NO. OF 72"IF
1.606 2
ROM C/L STREET)
OF LOT acres NOW ON LOT
FRONT FT.
USE OF S.F. residence
EXISTING BLDG.
S T.
Separate permits are required for
L. SIDE
electric, plumbing and heating work.
REAR
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING CTION
residential condominium unit, garage &
i -{�4 / 7
DATE
APPROVED
carport trellis
APPROVED,4 0BY
DATE /
O iJ
I hereby acknowledge that I have read this application and state
3
that the above information Is correct and agree to comply with
all laws regulating building construction, and I shall not employ
p, /1i pq
6X
any person In violation of the workman's compensation laws of
/A/_•� /l C�7�/�'�+
the State of California.
/ SQ. FT.
I hereby certify that I am properly licensed as aconvactor under
the State of California Business and P f UPode, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that s h icon are In ce and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from s of th allfornia Business
VALUATION
PERMIT FEE $
and Profess!
PLAN CHECK $/ Q
Signs -0
Perml
/'�
or
3 /
Authorized Agent Da
TOTAL PAID $ ��-
Fj
ue
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www costamesacaoov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E12-00005
PERMIT TYPE ELEC STATUS: ISSUED
APN: 43929307 v DATE ISSUED: 01/04/2012
ISSUED BY: KJB
JOB ADDRESS: 183 ADMIRAL WY CM 'Suite/Unit
Vicinity: a'
SCOPE OF WORK: REPLACE FAU, ;COIL AND A/C UNIT. NO RELOCATION OF FAU OR A/C UNIT -REF: M12-00003.
Iitectrical Plan Check Fee:. $0.00
Electrical Permit Fee: $35.80
Reinspection Fee $0.00
TOTAL FEES $35.80
Al,
FF
A:
'z.
'NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
tkgulations. (Ord. No. 92-28, § 1, 12-21-92)
PPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
1INSPECTIONS: 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.
ODER. INSPECTION TYPE DATE INnTIALS LODE% INSPECTION TYPE DATE INnTIRLS
.1616 Fixed System Final Fire Prevention 206 Final Mechanical
.1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical •%,�
201
Final BlocWRetaining Wall
202
Final Factory Fire Place
203
Final Sign
OWNER: JURGENSON, SHARON r'"
Address:
183ADMIRALWAY'Unit' •
PHONE:,.'City/State/Zip:
„ COSTA"MESA CA-
APPLICANT: LUCEY, STEVEN ...
Address:
144 S VALENCIA;,Unit:SUITE B
PHONE: 626-963.8383City/State/7Zip:
.GLENDORA-, _CA
CONTRACTOR: COMFORT ZONELicense
No. 760955
Address: 144S.VALENCIAUnit: -SUITE B
-., - ,. `
PHONE: -: -626-963.8383 `--
City/State: GLENDORA, CA " ZipCode: 91741
CELL,
ELECTRICAL PERMIT FEES
,.
Iitectrical Plan Check Fee:. $0.00
Electrical Permit Fee: $35.80
Reinspection Fee $0.00
TOTAL FEES $35.80
Al,
FF
A:
'z.
'NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
tkgulations. (Ord. No. 92-28, § 1, 12-21-92)
PPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
1INSPECTIONS: 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.
ODER. INSPECTION TYPE DATE INnTIALS LODE% INSPECTION TYPE DATE INnTIRLS
.1616 Fixed System Final Fire Prevention 206 Final Mechanical
.1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical •%,�
201
Final BlocWRetaining Wall
202
Final Factory Fire Place
203
Final Sign
:204
Final Demolition
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
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WORKERS' COMPENSATION DECLARATION:
I hereby affirm 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 workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number
Carrier5
Policy Number: W Y—y`•(
❑ I certify that in the performance of the work for which this parr
issued, I shall not employ any person in any manner so as to become st
to the workers' compensation laws of California, and agree that if I s
become subject to the workers' compensation provisions of Section 37
th1JgbwX,eJe, I shall forthwith comply with these provisions
Applipanis Signa Date
WARNING: FAILURE TO SECURE WOR ' COMPENSATION COVEF
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIB
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLT
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGE
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (comm
with Section 7000) of Division 3 of the Business and Professions Cod
my license- isinfull foMS
ate and effect.
Lic. # '[ Class# z"
antraDate
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency f
performance of the work for which this permit is issued. (Sec. 3097, Civil C
Of
AS
the
Lender's Name: I
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penally of perjury that I am EXEMPT FROM ITHE
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, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that heor 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 exempt therefroml and
the basis for the alleged exemption. Any violation of Section 7031.5 by, any
applicant for a permit subjects the applicant to a civil penalty of not more (than
five hundred dollars ($500).):
❑ I, as owner of the, property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply town owner of property who builds or improves
thereon, and who does such work himself or herself or through his or herlown
employees, provided that such improvements are notintendedor offered for
sale., If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he ori she
did not build or improve for purpose of sale.). '
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (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 contracts for such project with
a contractor(s)license.pursuant to the Contractors License Laws.).,
❑ lam exempt under sec.
Business and Professions Code for this reason:'
Signature
3057-46(3/07)
r1
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):-
.. , r
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is, required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six:(36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, 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.
Applicant's Signature Date
Division of Industrial Safety 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 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 of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure):
2. Does or will the applicant or present or future, building occupant need to file
a registration 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 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 the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the,,,preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? [],Yes , ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application'a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of 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 requirementof Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? [IYes ElNo
8. (If "yes', attach certificate of compliance from the appropriate air pollution
control: officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. Itagree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ofperjury that I have read jthis application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the. City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
aLaga�a� y D Ie 1 C--.
And/or Authorized Ap0l,cant a Data
CITY OF COSTA MESA
4�0"pMF1q BUILDING DIVISION
fp 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www costamesaca.aov
FOR INSPECTIONS CALL: (714) 754-5626
`Oaeowrto
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4
PERMIT NUMBER: M12-00003
PERMIT TYPE MECH
STATUS: ISSUED
APN: 43929307
DATE ISSUED: 01/04/2012
202
;�`. `ISSUED BY: KJB
JOB ADDRESS: 183 ADMIRAL WY CM
Suite/Unit
Vicinity:
Final Demolition
SQ. FT: 0
SCOPE OF WORK: REPLACE FAU, COIL'AND A/C UNIT. NO RELOCATION OF FAU OR A/C UNIT:' REF: E12-00005
OWNER: JURGENSON SHARON.. -
.Address: - 183 ADMIRAL WAY-:Unit'�. '
PHONE:' -
City/State/Zip ,: COSTA MESA,CA-
APPLICANT: LUCEY, STEVEN ,/•-' ` '.- , "'^`
Address ::.- S VALENCIA Unit:SUITE B
_:-
PHONE: 626-963-8383 - -
_.'144
City/State/zZip: GLEN DORA; CA
COM
CONTRACTOR: COM
- - License No -- 760955 - -, e
Address: 144 VOARENCOIAUnit: SUITE B '.
,
- - PHONE. '.„626-963.8383
City/State: GLENDORA, CA' - ZipCode: 91741
- -' 6. ; ` ""CELL:
Pt
�1.
is
MECHANICAL PERMIT FEE -SUMMARY
MECH ITEM FEE: '`, $53.10
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $53.10
CL
AQ;
Ci,
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
rpulations. (Ord. No. 92-28, § 1, 12-21-92)
gPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
lIkSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
tRquired inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
EObE N. INSPECTION T•L DATE INTITIALS CODE Y INSPECTION TYP DATE INS$
.'1'}}616 Fixed System Final Fire Prevention 206 Final Mechanical
f266 Pool Spa Final 208 Final Plumbing
200
Final Re -Roof
201
Final Block/Retaining Wall
202
Final Factory Fire Place
203
Final Sign
2114
Final Demolition
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
• •/
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a c'artificate of consent to self -Insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, fort the
performance of the work for which this permit is issued.
❑ I have and WE maintain workers' compensation insurance, as requiretl by
section 3700 of the Labor Code,'for the peiformance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number auil ,i I
Carrier: -> I\rCJ4•t�"
(This section need nor be cumpletedj/the permd is valued at 4re hundred dollars
Policy Number: W
❑ I certify that in the performance of the work for which this per
issued, I shall not employ any person in any manner so as to become s'
to the workers' compensation laws of California, and agree that if I s
become subject to the workers: compensation provisions of Section 3S
the Labor C9 e, I shall forthwith comply with these provisions
Applicen lure Dale'
WARNING: FAILURE TO SECURE KERS' COMPENSATION COVE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIT
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGE
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (com
with Section 7000) of Division 3 of the Business and Professions Cr
my license is in fullforceand effect.
Lie. # Class #
ontra�tDIN
Dale
CONSTRUCTION LE:
❑ I hereby affirm construction lending agency
performance of the work for which this permit is issued. (Sec. 3097, Civil
Lender's Name:
Lenders Address:
Signature
Date
OWNER -BUILDER DECLARATIONS: '
I hereby affirm that under penalty of perjury that I am EXEMPT FROM
CONTRACTORS LICENSE LAW for the following reason (Sec. 70
Business and Professions Code: Any city or county which requires a parr
construct, alter, improve, demolish, or repair any structure, prior t
issuance, also requires the applicant for such permit to file a signed state
that he or she is licensed pursuant to the provisions of the Contra
License Law (Chapter 9 (commencing with Section 7000) of Division 3 c
Business and Professions Code) or that he or she is exempt therefrom
the basis for the alleged exemption. Any violation of Section 7031.5 b)
applicant for a permit subjects the applicant to a civil penalty of not more
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their
compensation, WILL DO THE WORK, and the structure is not intend(
offered for sale•(Sec. 7044,; Business and Professions Code: The Contra
License Law does not apply to an Owner of property who builds or impr
thereon, and who does such work himself or herself or through his or her
employees, provided that such improvements are not intended or offers
sale., If, however, the building or improvement is sold within one ye
completion, the owner -builder will have the burden of provingthathe of
did not build or improve for purpose of sale.)' '
I
Owner ID, verified by driver's license. ❑ Yes ❑ No
Driver's License No.
Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY•PERMIT FERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure, scaffolding, falsework, or demolition
or dismantling thereof, will be more than thirty-six(36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
— ❑ As owner-bui(der, I will not employ anyone to do work which would
is require a permit from the Division of Industrial Safety, as noted above, unless
ct such person has a permit to do such work from the division.
Of Applicant's Signature .
III
the
.5,
to
its
the
and
any
or
for
r of
she
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Businessland
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature Date I
3057-4613/0]
Division of Industrial Safety Permit Number:
Date
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 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 I'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 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 futurelbuilding occupant need to file
a registration 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 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 the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the, preparation, certification and
filing witti the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency?'. []Yes ❑ No
(Section 65850.2 of the California Govemment Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of 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
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality'. Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes",, attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE -OF COMP11 LIANCE: 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 and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building .
authorized by this permit until final inspection.
'1 of Legal Ownens) Date
And/or Authenzed Applicant T\ a Date
Simpli('iell Presariptivr CertiilcnCr. o'f Cnntpki�tnc:'L'I�(lf; Itv,videntirrl f11'il C.'Altrvvttion,r CT-;112-AL`7'-IIYAC
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J. Louipmenl 7;1'pe: Choose the equipluenl being installed; if more than my :system, use wtolber Cp-llt-Nil 4)VAC lar each. system.
2. (vituinutal Equipment �flicimmies:, P SEER, 98'iL ATM, 7.711SPF fin' Typical ralodcntinl syslems. .
'Call lrnctnr �1)li ClllTleni:7ltinll Alit�tllf �ti.t].ZCS)10I1S1�71�1�)e810RIL'I'�ti])eClllrlltlbll St11CBI11 L`]li:� -
• I certity that this CerliGcale of Camplimtce documentalimt is accurale and complete.
am eligible under [Division l of the California Business and: Profession,. Code to accept respunsi6jiiq Sor the dtsi6m identified on this
Certificate of Compliance.
I certify Thal tilt enerM, feature:: and perfprnwnee speciflcnlienc fur the desip identified on this'Cenificme of Comphanct wnfomi to lilt
requirements of'TittCL2A' Puny: 1 aiid L of the Californul Code of Ilegulatimu:.
• . Tilt desipi fenmres idemilled.on flus Cerllflcate of Compliznee are consistent with hie information documented on other,applicahle,_....
compliance ibrms wprlsheelw,eale Ilahone, plans and specifications submitted -to lilt enforcemeni a n •y for approval with Itie_pesmuil . . .
llame. .:... .`�, _ .. ,
,Si mato,_: ... .... .. .. :: _. ..
.Company: ... ._... . •. -. .._:.. _ .. ..... - Late .
.. hddress:' .. ..,�... _.. LStF•+.KUIN ..........:. ..... ..License:
'-} to oa SSS
' .CitylStale/Zip. G ' L_ J.3GU�1/1 - :. :. ,. .' . Phone: - Z—U
NO,'; 1(esitlentiol Compliunce, Forms 10urch -M 10
t.�r v� ,.aut...vn!ct�^wu fr us6nut ,,! • _
G'A11t,Gtd�; x'<)AIIZE' PPIZ4r1 L`L'2�'E,!.ZZFIE'flZJ7S��X11;) - '
2008 Bi.didino Diet(— L'ECicienv), ,Standards .Re.gidentialTi-NAC:.Alter atinns IE
C&irrtai:c Zoites 1 and 3 throttnh 7 C z•-( < �astrll.�rFs
13119INESS AND PROFESSIOM CODE.9ECTION 7:1.10
Willful or deliberatebisragarrl ;nd'violatiou of the huildint, laws, including the California Building Code, and
tocaLp7miC.mquiraments cdnsdtutea a cause. for disciplinary action fromthc Contractors Stan. L.icenae Board
working in ctuijunetipn with the local building department. This action may consist of fines up to,T5,000 per
violation or suspension/revocation of it contractar's license. • �� _ -
W11E1 IN IS A PERIYT T I2G0111RUM?
A written construction permit shall bt; obtained from the, enforcement agency prior to the erection, construction,
recougtructiou, ineut0aiiun,,relacation, or sutet•atiou of any mechanical sys;tam, citcept as permitted hC&ppeadbx
Chapter 1, Section I t2.0 of the 2007 California Mechanical Code. Projects requirin , pe mita include, but ai•e. not
limited te:
• New HVAC installation
• MVAC Changenut
Replac6menl of fltrnacc, suit, PAU, or,condeuser
• Relocation of an existing ENAC unit .
Adding or replacing more thati 40fl ducting in unconditioned space.
2009 BUILDING Et NEI EPPIC FICC'I STANDAIMS (T9t1c. A Part 6) RL',01MMVMNTS NCLU �I
1. Heating equipment must have a rnirtunum 78P/i AFUE (Exception: Wall k floor furnaces; room heaters). j
2. Central air: conditioners L heat putrps-.to sthan 65;000 Eitu/hr must have a minimum t 3 SEER.
3 Newly installed e'i',replaced ducts must have a minimum insulation.vatue of R-4.2:
4. A setback type. thermostat (24.1@. clocic'M'ith four set points) is required fotrall alterations. t ., ;
i New or replacement ducts must meet the mandatory requirements of Section 1.50frn?
All ,joints and opening's inRlie in the HVAC system must be sealed.
• Only UL 191,,. UL, 19hA., or -UL 191B approved Capes or mastic, shall be.use'il to seal duct openings. ! "
Connecti6ns of metals ducts and the inner core of flex, ducts shall 'o mechanically fastened. Flex: ducts
must be, connected using a metal sleevelcoupling.
Flet, ducts that arc suspended must be supported every 4ft. max for horizontat runs'with no more than 2"
of sag between supports and 6 ft. mar, for vertical runs.
6. The CF-GR-MLCU-p4 must be. completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
I
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FEuc£
6E ttr--Ypt_ V Aa"(
Farr"
City of Costa Mesa Planning Div.
Subject to Building Division Regs.
Any Revision must be approved.
Required Prior to Building Final:
DYES f NO Zoning Inspection
❑YES 1 NO Trafficl Park Fees
By: Date: tl�l1Z
n0re,_1=1e,iE
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