HomeMy WebLinkAbout949 SERRA WAY - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
`7TY OF COSTA�M�E/ A CONSTRUCTION PERMIT PERM(jiNO , TRACT NO. LOT NO. UNIT NO. 161,E ��I '�_� �V 0 L' '
Address lit S€.�l—tik LAO AAL L/Q�J d 1
/Fpplicant's Mailing (215/ CS/ NV AttIU. L (j. TYPE OF CONSTRUCTION LI NEW .0 ADD LI ALTERATION KREPAIR
•
J. `/�r7 ❑ CONVERSION ❑ DEMOLISH OTHER
n A.P.# Zone
Owner's Name I ,�5• in7��I(o HT- Phone �'!< rLfrit? an=riernii.4--P%d _
�aqq s. c, t� DESCRIPTION OF WOR.pUSE OF BLD
Address 12-AAl tti cl /i' '! CmA- S _I, C_I29 -'.D j /.-- A( T S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT NM GRADING III FOUNDATION STRUCTURAL & T Front p
Address df ID TENANT T LI ELECTRICAL ❑ PLUMBING III MECHANICAL \\ / B Rear N
Contractor's Name 0I,S s ti ��' 6.0. Phone 6..3(0:170 ❑ 'OTHER A I
isr g PROJECT DESCRIPTION SQ. FT. OCCUPAN Y C Right N
Address(mailing) 106.164-//�� C�- ‘�" �+) n" K - G
�. �3 12 CONSTRUCTION TYPE VALUATION$ —p/ /V G $ Left
t r1 R
City License No. ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION Q
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: I RECEIVED J L — 9 lip( M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in I�{II force and effect. - t
1 License Class v— l '/J� Lic rise No.Ni-374 ,f S
N.. Date /'1'Sr7 Signature ieCWn 1-- ri-C-r? .CZ't PLUMBING FEES
`Il WORKERS'COMPENSATION DECLARATION Bar Sink I Showers ELECTRICAL FEES
�s I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - -
1 Automatic Washer Transformer 0 15.50 KW
3800, Lab. fySO/ f Z� ✓j (1
Policy No. l( Company Backflow Irrigation Sewer Cap0 50+KW
Construction Pole Sub.
I❑ Certified copy is hereby thehetl.
IQ
CeUjfieep�copy-I filed with the city BLG`� iVVisiF--r,t J% �� Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date —/-n j Applicant LJ /`-y V •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit is for one hundred($100) or
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel '
I certify that in the 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 Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'h-8
Workers' Compensation Laws of California.
Date Signature , Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
'NOTICE:If,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - --
comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ,Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater , Outlets
Lender's Name Range'
Lender's Address Kitchen Sink - Water Service Switches Sign
OWNER BUILDER DECLARATION - - I -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P s1 *Striding Sections
county which requires a permit to construct,alter,improve,demolish or repair
P—Trap Laundry Trays Generator ❑05 KW 05-15 KW -Trash Com Compactor
any structure, prior to Its Issuance, also requires the applicant for such permit - Pa
to file a• statement that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law (Chapter 9(commencing with Section 7000)of '
Division 3 of the Business and Professions Code) or that he/she is exempt - _ '
therefrom 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 1
penalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees..with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves _ • - ---
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:,
employees, provided that such improvements are not intended or offered for Boiler ■
sale. If, however, the building or improvement is sold within one year of com- 0 Zoning Approved By Date I
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under,Ground Building Approved By
prove for the purpose of sale). _ Date (�
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration Application Issued By
� Date /+ l
tractors to construct the project (Section 7044,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 0100,000 ,+fps SUMM�A(@(V 0,,,,,F FEES /�
builds or improves thereon,and who contracts for such projects with a con- }'s-3 OS(J-[Y� SMIP $ •�V
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ - ,. UI LDING PERMIT $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
O I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire ampers E D i
F X P I PLUMBING $ ISSUANCE $
Date Owner' Heating System& Ducting Registers •11(Amplete 1 SPeCtI IlS PLAN CHECK 25% $ ' ENERGY P.C. ,$
I hereby certify that I have read this application and state that the above- ❑0100,000 BTU 0100,000 BTI. - - ELECTRICAL $ GRADING $
information Is correct. I agree to comply with all city and county ordinances -
and state laws relating to building construction, an hereby authorize repre-
sentatives of' his city ttq en a .upon the abovypmentioned property for • Date _.� ig PLAN CHECK 50% $ S�
inspection Ur oses. C- Alit 4-- l_2-07 MECHANICAL $ TOTAL FEE $ 4�
Signature /,eve L— C Date IJ
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
0 .
ir -. . _
41NSTRUCTION AND PLANNING . POOL& SPA
�..� Date Inspector Date Inspector
i,PPROVALS Permit# APPROVALS Permit#
• ,...1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
'2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
s3. ' -trical Conduit Utility-Undrgrnd. 54. Forms
'4. trical Conduit-Undrgrnd. 55. Electrical Bonding -
5. Seel Reinforcement 56. Rough Plumbing & Pressure Test
2-.6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
17. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
:9. Water Pipe-Undrgrnd. 60. Backwash-Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final - .
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System•Final -
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure. 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
-
23. Gas Pipe-Rough & Test , 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
• 25. Roof Sheathing - _ 74. Overhead Hydro •�
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding77. FIXED SYSTEM FINAL o
29. Insulation 78. FIRE PREV. FINAL :.
- 30. Drywall Nailing HEALTH DEPT. REQUIREMENT •- ,
31. Plaster Brown Coat 79. FINAL INSPECTION at
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test ...._
36. Hood or Canopy
37. Final Factory Fireplace _
38. Final Plumbing
39. Water Service-Final --
40. Gas Service-Final
41. Solar Domestic-Final '
42. Backflow Preventer 2] t X P I R E D
ti - lncomplot Inspections
43. Backflow Irrigation TTI
5 1/gig
44. Landscape Irrigation System: vote -
45.,Sound Attenuation --t
46. Handicap Regulations t
ray
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed '
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas CQ ' •
51. CERTIFICATE OF OCCUPANCY
No. Date
Lot 71, Tract 4285', L�REIVED
15297 /L g SSSEEEP6 1961
COSTA MESA BUILDING-SAFETY DEPARTMENT / FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 949 Serra Way
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I 1 �RMf`��
OWNER Mesa Del Mar Development Co. 4,�yr'-1 •
ADDRESSMAIL 3800•E. Coast Highway RECEI ED BY DATE RECEIVED Zr� r- di-C/
DATE ISSUED
CITY Corona del Mar, Calif. No:OR 311220 BUILDIN
OB ENGINEER Macco Corporation Nt:OR 34220 COSTA MESA. CALIFORNIA
VFIRE
DSL /
ADDRESS 3800 E. Coast Highway ZONE TYPE GROUP✓I /
CONTRACTOR acro Corporation APPROVED
BY DATE
ADDRESS 3800 E. Coast Highway ZONING
Calif.
ION R�f / NO.OP __US
OP NEW"' -"'" �/
fyn
CITY Corona del ar, C �\ _/
I PLANS �� BUILDING �///1 -�Z, l
ucTNO. 98808-SB-1 No: OR 3-4220 LEGAL - g � ' i-s / -"V /J'
DESCRIPTION A' '1.0 T �(I
SIZENO. OP BLOCS.
OF LOT 6975 5 F NOW ON LOIT1OnC A.P.NO.
USE OFYARDS EVES
EXISTING BLDG. none APPROVED ALLOWED
SETBACK LINE FROM1 41 (CENTER LINE ST.)
CENTER OP STREET 1191 REAR YARD 2 FRONT SIC FT. IN.
SIDE YARD I LEFT 5I I RIGHT 1013t1 R.SIDE /'O FT. 3 IN.
DESCRIPTION OF WORK- L,SIDE S FT. IN.
NEW IXX II ALTERATION I II ADDITION I REAR Z3 FT. IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED LC/,(A DATE /fir/�/
SIZIPINGC9t9",['01 NO. OF It l0
77]] 9 77 / ROOMS 6 STORIES 1
EXTERIOR WALLSwood/ ROOF
COVERING tuCCO ICOVERING comp./gravel Living area 1652 5 F
USE OF BUILDING AND WORK TO BE PERFORMED
single family residence Garage area 1133 S F
w/attached garage Covered nor ch, etc. 21 S F
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THS ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION f/
SIGNAERM TUR -'esa D=. Mar Development Co, PERMIT FEE $ �d R
• By , / 1f % $17,769.00 PLAN CHECK $ 5/9C
AUTHORIZE. G S-� TOTAL FEE 55.50 O
LL
• CITY OF COSTA MESA .
fr0a6Aft, BUILDING DIVISION
FKrsi .tI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
-4. FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B10-00271
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 14155302 DATE ISSUED: 09/15/2010
ISSUED BY: RMD
JOB ADDRESS:- •-�9"4'9ESERRAIICM °o _°. 'Suite/Unit:
Vicinity: HOUSE 6 GARAGE ROOF
Squares: 2400 " Valuation: $5,702.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF MATERIALS, INSTALL 2 LAYERS OF 15#FELT ON A 3:12 PITCHED ROOF AND
REROOF WITH 30 YEAR COMP SHINGLES ON AN ATTAHCED HOUSE AND GARAGE,APRPDX 24.,REPAIR AND
REPLACE SHEATHING AS NEEDED.'COMPLIANCE FORMS ATTACHED TO CITY PERMIT AND JOB CARD.
OWNER: WRIGHT,JOSEPHINE BRIDGET Address: TR ' Unit: COSTA
MESA, CA
PHONE: ' City/State/Zip: 949 SERRA WY
APPLICANT: WHITNEY, ROBERT Address: Unit: :
PHONE: 714-434-9272 City/State/Zip: ,
CONTRACTOR: WHITNEY ROOFING License No. 406022
Address: PO BOX 15396Unit: PHONE: ' 949-548-0769
City/State/Zip: NEWPORT BEACH,CA 92659 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00 "
Reroof Permit Fee: $125.25 - .
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $126.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day,Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE II. INSPECTION TYPE DATE INTITIALS CODE It INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ,I 208 Final Plumbing
200 Final Re-Roof k q11-10 nm b 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
• a I
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No '
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Inyurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: c%i"-,�/NV) person is required to descend,will be made in connection with work authorized
Carzler..- alke by this permit,and that no building structure,scaffolding,falsework,a demolition
(This section need not be completed if the permit 6 valued at one hundred dollars($f00)or less.) or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm
9 2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number: L P/Q
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the perform. ce of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any •erso I in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compe : o• laws •f California, and agree that if I should
become subject t. e wo ers' co pensation provisions of Section 3700 of Applicant's Signature Date
the Labor Co.', shall f. 'hwith co ply with these provisions.
0 Division of Industrial Safety Permit Number:
gall/rt. Agnalure
[ ate_ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires, with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the :.siness and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effec. a registration form for acutely hazardous materials? 0 Yes 0 No
Liq�#arw" 4. r Class'#%> _` (Section 25533 of the California Health and Safety Code, with some
r..� exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
(contractor"Signature (0a e' hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued. (Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa-non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑ No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I, ree to comply with all state laws and city
ordinances relating to building's• s uction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesad ter pon the above-described property for
inspection purposes. .gre• not to o cupy or allow occupancy of any building
authorized by this :-rmit . til final i .pection.
Signature al0 ner. •. -
Signature Date 4 i r U
3057-46(3107) : __ . _..... . . _...
Ni41144A-fiolrme1'APPlicant epi.-•..
Il Pre}';criptive Certificate of Comp....nce: Residential 1 CF-IR-ALT
Residential Alterations (Page 1 of 5)
Cl'rojbeiNanrc: Cl��i�.a�e;,Lone W q o1'•Stories_
9((5 war 1 y f fi I j ,a.. .
.,
j.
„General information
Site Address:
titorcemeni Agency: ater%-
t`tOLI�`ir �L�,+!✓� � 9�� �d
Building Type Ingle Fancily D Multi Family Circle the From Orientation:N,E,S, Nr,or degrees ,/
Conditioned Plom Area to he Project Type: D Alterations D Envelope D Fenestration La'7toof }IVAC
Replacement or Change Out ❑ Duct Replacement D Water Heater
_
NOTE: This form i.s not to be used for Newly Constructer(lluilrlings or Additions
M Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Li=Assembly Alteration
L
D Opening of framed cavity alone-Alterations that involve the opening of the framed cavity ofa wall,ceiling, or:floor must install the
numdaiory minimum insulation value per 4'150 for the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column N.
D Replacement of entire assembly-Replacement of an entire wall, ceiling,or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C Faith Columns A-J
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
-A 1 1 u C D 'I E F ( G I - 11 - t_- F
_ Proposed See NOEL Standard I _ Values From JA4 Table _
Framing Thickness, Framed Continuous JA4 1 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
ID' or Type' and Size'' or Others factor' Numbers R-value R-Value' Cell Value° U-factor9
t
r
•
Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. Far calculating furred walls use the Mass and
:Furring Construction table below.
I.For Tag/1D indicate the identification name that marches the building plans.
2.Indicate the Assembly Manic or type:Roof/Ceiling, Walls,Floors, Slabs, Crawl Space,Doors and ete...lndicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness far mass in inches or Spacing between fanning members enter; )6"or 24"0C;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and ere....
4. Based on the Climate Zone;enter the Standard U factor from Table 151-B, C or D for each different assembly Name or type.
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the R-value that is being installed in the wall cavity or between the franning;other wise, enter "a".
7. Enter the Continuous Insulation R-value for the proposed assembly; otherwise, enter "0".
8.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J
9.The Proposed Assembly U-factor, Column 1 must tst be equal to or less than the Standard U-factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A B C 1) E F G H 1 3 IS L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
.Joint A rendix Table 4.3.5,4.3.6.4.3.7 Joint A r endis Table 4.3,13
U o - u v
2C
O G
, Assembly z' c `e 2 P r1•1 c a(`v G^ Final
Mass Name or .JA4 Table ' - F - `u = E F 9gg 43 Pi '`c m v _°o ` F. Assembly
Thickness' Typc' Number' S = m =Z st is 2 r e m r= U-factors''' Comment
I h I
i
I ( . I
RegistraLon Number: Registration Date/Tone: HERS Provider:
2008 Residential Compliance Forays August 2009
t • Prt;scriptive Certificate of Comp,.ance: Residential CF-1R-ALT •
Residential Alterations • (Page 3 of 5)
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ROOFING PRODUCTS (COOL ROOFS)§151012
When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area, or more than 1,000 ft', whichever is
less,the new roofing area must meet the roofing product "Cool Roof'requirements of§152(10111i, 152(b)l1fii, or 152(b)lHiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof requirements. Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Eminence requirements for roofing products in
;1'11��80)are not applicable.Do not fill table below.
Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
Moot Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than Slblft2.
Alternatives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pitch>2:12)
f
❑"Insulation with a thermal resistance of at least 0.85 lift•°F/Bm or at least a 3/4 inch air-space is added to the roof deck
over an attic;or
❑ Existing ducts in the attic are insulated and sealed according to§151(1)10; or •
❑ In climate zones 10, 12 and.13,with 1.112.of free ventilation area of attic ventilation for every 150 112 of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or .
❑ Building has at least R-30 ceiling insulation;or •
❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or
❑ Building has no ducts in the attic;or
❑ In climate zones 10, 11,13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(b)1Hiii,Low-slope roof(pitch<2:12)
❑ Building has no ducts in the attic.
Other Exceptions
. ❑Roofing area covered by building integrated;photovoltaic panels and solar-thermal panels are exempt from the below Cool Roof criteria.
.❑Roof constructions that have thermal mass over the roof membrane with at least 25 lb/112 is exempt from the below Cool Roof criteria.
- Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofing Products"Cool Roof"Requirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number < 2:12 >2:12 < 51b/ft2 >_ 5Ib/ft2 Type2 Reflectance3'4 , Eminence SRI5
❑ ❑ ❑ 0 ❑4
O 0 ❑ 0 ❑4
❑ ❑ ❑ ❑ 04 .
0 ❑ 0 0 ❑4
❑ ❑ 0 0 l 04
1. The CI/RC Product IU N unbar can be obtained front the Cool Roof Rating Council's Rated Product Directory at novw.caolroofs,are/products/.sgarelr,alm
2. Indicate the type Oviduct is being rued for the roof top.i.e.single-ply1'00f asphalt roof metal roof.etc.
3. If the Aged Reflectance is not available in.the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value front the sante
director' and use the equation(0.1+0.7(pi„taut—0.2)to obtain a calculated aged value. Where p ii the Initial Solar Reflectance.
4. Check bar if the Aged Reflectance is a calculated value using(he equation above.
5.Calculate the SRI value by using the SRI- Worksheet at hurt://wwu'.ocrm'.cn.gov/ti11e24/and enter the resulting value in the SRI Coition above and attach acopy of
the SRI- Worksheet to the CF-IR.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§1180)4. Select the applicable coating:
' 0 Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
Registration Number: Registration Date/Tine: HERS Provider:
• 2008 Residential Compliance Forms - August 2009
Prescriptive Certificate of Compliance: Residential CF-172-ALT
Residential Alterations (Page 5 of 5)
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HERS VERIFICATION SUMMARY The enforcement ogenev shmdd pen special attention to the HERS Measures specified in this
checklist below A completed mid signed CF-41(Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS rerifiaaion is required for this maosw'e.
• ❑YES 0 NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per(l521b)IDii and the newly installed ducts are to be insulated pei §J5)(1))0.
❑ EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
D YES 0 NO-YES:1u Climate Zones 2 and 9-16, if the existing space-conditioning system (HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b))Di.
D YES 0 NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler:
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be .
sealed pet §152(b)1E,
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
--verification in accordance with procedures in the Reference Residential Appendix RA3,
❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION: Existing duct systems constructed,insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required for this measure. .
D YES • 0 NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
• handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§752(b)IF.
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of§150(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required jar this measure.
- ❑YES 0 NO'YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced.the airflow and fan watt draw shall be verified per§152(b)1 Ci to meet the requirements of§I5 I(fl7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
LName: �A / Signature: ,
�f L
Company: G Late:
„Io
Address'. / ]f Appli ble CEA or 0 CEDE
D LS _(Certif ationll):
City/State/Zip: Phone:
f 7xu et �f'F �F3s 9272
tespunsibie.Building Designer s Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified ona.
this Certificate of Compliance.
• I certify that the energy features and performance specification::for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts I and 6 of the Califbrnin Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the in lormati on provided to document this.
building design on the other applicable compliance-forms, worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: Signature:
Company: Date:
Address: License:
Citv/State/Zip: I Phone:
For assistance or questions:regarding the Energy Standards, contact the Energy Bonin. at: 7-800-772-3300.
Itegntratin,,Humber Pegisuntira bete/Time: HERS[''t ot'icier:
200E Residential Compliance Forms August 2009