HomeMy WebLinkAbout3132 SAMOA PL - Building PermitsCITY OF COSTA MESA
A`gStu MF qMF q! BUILDING DIVISION
F ® 5 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: M10-00165
PERMIT TYPE MECH STATUS: ISSUED
APN: 13915409 DATE ISSUED: 12/17/2010
ISSUED BY: RMD
JOB ADDRESS: 31'32`AM6A_PL CM� Suite/Unit:
'Vicinity: CLOSET
SQ. FT: 0
SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT FAU < 100 K BTU LOCATED IN HALLWAY CLOSET,
COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
OWNER:
HAMMERSCHLAG, LYLE ADELL
PHONE:
714-546-5173
APPLICANT:
JACOBY, ERIC
PHONE:
818-735-7876
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
City/State: YORBA LINDA, CA ZipCode: 92887
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$38.30
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $38.30
Address: TR Unit:COSTA MESA, CA
City/State/Zip: 3132 SAMOA
Address: Unit:
City/State/zZip:
License No. 799170
PHONE: 714-777-7777
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE #. INSPECTION TYPE DATE INTn1Al5 CODE p INSPECTION TYPE �ATEINITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 10
1266 Pool Spa Final 208 Final Plumbing' -
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaming Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation s provided for by Beckon 3700 of the Labor Code, for the
perform of the work for which this permit is issued.
=have will maintain worker%' 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 are
.Carner:- Vi Z/ L
—(This secbon //V need�fte
nall be, completed if thheeepermit is valued attonehundred dollars ($100) orless )
�P310yy:Number. C/_ C-%1� �7-eh6 / j%
❑ 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 workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Co I shall forthwith �triply with these provisions.
u
AOOtr�?bfs SignatLw Date
may.
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, INTEREST, AND
ATTORNEY'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 issiin full force and effect. /�
Ic Claims #_L- -7-el.,
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature
Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury 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, demolish, or repair any structure, prior to its
issuance. also requires the applicant 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 Professions Code) or that he or 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 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 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, provided that such improvements are not intended or 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 or 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.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature - Date
305716 (3I1))
r 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 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, Califomia 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.
Apphcant a Signature
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 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
fling 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 feel 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 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 and Emissions.
Signature
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.
5 re of LeBa Q'r^�§ s Date
J`(( 7//�?%ld
N ::-.1+ pdzed APph �_ ( Date_'
Simplified Prescriptive Certific f Compfiancill 200&t71 ,
tesidential HVACA !inns CF -IR -ALT -HVAC
Climate Zones I and 3 - 7
Sits_Addr s,
Enforcement Agency:
Date:
I�
n u
Penult q:
-, �D
C 5
►v
Conditioned
Duct insulatio
Equipment T et
List Minimum Efficiene
Floor Area
r uireme
Thermostat
❑ P� kaged Unit
Ci AFU �6
❑ COP
Over 40 f f due
14'fumacc
O Indoor Coil
OSEER_
❑HSPF_
Served by system
��O
addedy re I n
fi ditio
flfnor alreadrpresent. must be
D Condensing Unit
D EER _
O Resistance
sf
rte a pace
� R 6 (CZ 1, 3-S)
installed)
D Other
/. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Pans I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
application.
Name: j G- G�yh
Signature:
Compan3 [ 2 `� G p, IOs
t.'
Date:
Address:c��— l'!��
C 11
License: O 7 U
City/State/Zip: 2 L_N 2 7
Phone: 7 7-;7-/-7'%
2008 Residential Compliance Fornr,s March 2010
(ENFORCEAdEVT.4 ANCY
CAN,C TOMYZE<N'ITK'LEYTERHEAD/SEAL)
2008 Building Energy Efficiency Standards Residential M7AC Alterations
Climate Zones l and 3 through 7
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building Code, and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of fires up to $5,000 per
violation or suspension/revocation of a contractor's license.
WHEN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection, construction,
reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU, or condenser
• Relocation of an existing HVAC unit
Adding or replacing more than 4011 ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REOUD2EMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings,
• Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2"
of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 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.
4b
CITY OF COSTA MESA
BUILDING DIVISION
4 p 1
> r 6 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M10-00168
PERMIT TYPE MECH STATUS: ISSUED
APN: 13915326 DATE ISSUED: 12/20/2010
ISSUED BY: KJB
JOB ADDRESS: 3135 SAMOA PL CM
Vicinity:
SQ. FT: 0
SCOPE OF WORK: CHANGE OUT FAU. 70,000 BTU
OWNER: REID, DAVID PAddress:
PHONE:
APPLICANT: JACOBY, ERIC
PHONE:
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
City/State: YORBA LINDA, CA ZipCode: 92887
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE:
$38.30
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $38.30
Suite/Unit:
3135 SAMOA PL Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit:
City/Slate/zZip:
License No. 799170
PHONE: 714-777-7777
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t. INSPECTION TYPE DATE INTITIALS CODE% IN SPECTION TYPE DATE INTI AL
1616 Fixed Syst@m Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final BloctURetaining 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
0
WORKERS' COMPENSATION DECLARATION:
I hereby affirm upder penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers'
compegs6tion, as provided for by section 3700 of the Labor Code, for the
ance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
se n 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 are:
Carrier:/ .rte 0 W �2
f7hs seoah needmat beslmnpleted d the Mahar is valuetl al me hundred dodars (Slog) orless.)
Policy Number: 40G/,* 2S10/6)
❑ 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 workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Lalagi Co shall forthwith comply with these provisions.
V
A cant's Signator Date
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, INTEREST, AND
AT'TORNEY'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. #-717 -70 Class # C_ 7_0
� i/W-4-4/i
Contrador' Si azure I Date
CONSTRUCTION LEN0NG AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature Data
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury 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, demolish, or repair any structure, prior to its
issuance, also requires the applicant 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 Professions Code) or that he or 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 penalty of not more than
five hundred dollars (5500).):
❑ 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 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, provided that such improvements are not intended or 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 or 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.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verified by driv�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 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 voth 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 or 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 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 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 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.
Sign tore gt6pI'gal 'Ow�eyd/s�/'' ate
Signature Date ��� �C�� —N 4
3057.46(3107) And/a, V.Idnzrd Applicant Date
ft
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACARerations CF -IR -ALT -HVAC
Climate Zones 1 and 3 - 7
SiteAddress:
Enforcement Agency:
Date.
permit H:
36- 5/4440A
ST sl 5
/ iG)
Conditioned
Duct insulation
Equip ment Type'
List Minimum Efficiency'
Floor Area
requirement
Thermostat
❑ Packaged Unit
o
8 /r
Over 40 R of ducts
M Furnace
®AFUI?
❑ COP
Served by system
added or replaced in
® Setback
El Indoor Coil
DSEER
❑ FISPI'
1300 sf
unconditioned space
(lfnot alrearhyiresenL rrrost be
❑ Condensing Unit
❑ EER _
❑ Resistance
❑ R 6 (CZ 1, 3-5)
Iw1alled)
❑ Other
1. Equipment Type: Choose the equipment being installed: if more than one system, use another CE -I R-ALT-1IVAC for each system.
2. Alinimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.711SPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and perlbnnance specifications for the design identified on this Certificate of Compliance confoml to the
requirements of'ritle 24. Pans I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms. worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
application.
Name: ERIC JACOBY
Signature:
Company: SERVICE CHAMPIONS a:1212012 0
Address: 22911 SAVI RANCH PKWY License: 799170
City/Sune/7ip: YORBA LINDA, CA 92887 Phone: 714-777-7777
2008 Residemial Compliance Forms A4areh 2010
FEE F.'J"EIVED
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
453
RECEIPT NO.
P
`f
MAIL�T
RECEIVED BY
(' OSTA
MESA BUILDING DEPARTMENT
LJ
112hADDRESS 12h JO Beverly
P.O. BOX 317
Q oZ ^7/ -,,F7
COSTA MESA, CALIFORNIA
FOR
APPLICANT TO FILL IN
BUILDING
ADDRESS
3/3 r7^
w COmnn Pl nnp
FEE F.'J"EIVED
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
OWNER Summerland Land Co
RECEIPT NO.
P
`f
MAIL�T
RECEIVED BY
DATE RECEIVED
._DATE ISSUED
I`ER
LJ
112hADDRESS 12h JO Beverly
Q oZ ^7/ -,,F7
2
TELCrest jew
BUILDING
CITY Los AnITPI njj NO. _
ADDRESS
ARCHITECT LICCOSTA
OR ENGINEER I' p NO.
MESA. CALIFORNIA
ADDRESS l2 e p. Q apt p
FIRE
ZONE
Summer and Lan
ZONE
TYPE GROVP
CITY LIC.
PLANS
CONTRACTOR (� NO//.��
1124 SO• Beverly TENres j 1'Y
APPROVED
_ADDRESS Q CPQ NO. 'J
BY DATE
LEGAL
LOT
ITRACT2151
CORRECTIONS
DESCRIPTION
NO. 111
BLOCK
A.P. NO.
SIZE
NO. OF BLOGS.
OF LOT 6onn
N LOT none
USE OF
EXISTING BLDG.
SETB<CK LINE FROM
CENTER OF STREET 1 REAR YARD 211 1
1
SIDE YARD RIGHT61 LEFT 5
DESCRIPTION OF WORK
NEW
ALTERATION
ADDITION
REPAIR
MOVING
DEMOLISH
OF IF GING
SRNO
120 ROOMS STORIES
EXTERIOR WALL btuco0
ROOF Composi tion
_COVERING q•(II TIC
COVERING l C1 DO
USE OF NEW
BUILDING Sinj7leFamily Dwell] a
^
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOV IS CORRECT ANAGREE TO COMPLY WITH ALL
CITY ORDINANCES O $TATE LAW$ REGVLATING BVILOING ONSTRVC-
VALUATION
TION.
SIGNATOR F 1/1
PERMIT FEE $ 26.00
PERMITTE
"�
$ /Q 6 U 6 _ PLAN CHECK $ 13.00
(�
AUTHORIZED AGENT �-(�� r
TOTAL FEE $ 3q' 00
,/
�aw;r
JORESS: UNIT:
S NAME: 3132 SAMOA PL
GDRESS: TR MERSCHLAG, LYLE ADELL
3132 SAMOA
COSTA MESA CA 92626
AflLX1ENGINEEfl: 714) 546-5173 flEG.NO.:
ADDRESS: UNIT:
PERMITTEE: SENTRY ROOFING CO (714)751-7663
ADDRESS: 3364 NEVADA
COSTA MESA CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that) am licensed under provisWNemmencing with Section
7000) of Division 3 of The Business and Professions Code. antl my license is in full forceCITY IC.: 0 09 9 STATE LIC.' 678801 cuss: .3
��Signature:///ggg000///RICER LOM NSATIO I DECLARATION: nereby affirm tnat have a cenilicoup of Toa certificate of Warkers'
Compensation Insurance. or a Certified copy thereof )Section 38D0. Lab. Q.
POLICY NO.: EXP. DATE:
COMPANY:
❑ Certified copy is hereby tarnished. ❑ Certified copy is filed win the city Bidding Division
Date'. Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be Completed it the permit r one hundred (SIDD) or less).
I certify thmn�th
an of the work for which this permit is issued, I shall not a Tploy any person - any manner so as to become
dialect to da on Laws ofCalifornia.� SiOTIing lots declaration. you should became subject t the Workers' Compensation provisions of the Labor
Cone.th comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby alfirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097. Cry. C).
LENDER:
ADDRESS:
DINNER BUILDER DECLARATION: I hereby alfirm that I am exempt Imm the Contractors' State License Law for the following reason
ISedtian 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior to its issuance, also requires the applicant tot such permit to file a signed statement that h rishe is licensed
pursuant Id the pros,) of the ContractorsStale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that Marsha 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 penalty of not more Than five hundred dollars ($500).
I. as owner of the property or my empployers with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered lot Sale(Bection 7044, Business and Professional Cade: The Contractors' State License Law
does not apply to an owner of a praperty no builds or improves thereon, and who does such work himsellonaself or through
his or her own employees. provided Thal such improvements are not intended or offered for safe. 11, however the btufthng or
improvement is sold within one year at completion, the owner will have the burden at proving he/she did not build at improve
for the purpose of sale).
I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who builds or improves thereon
and who contracts for Such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of Their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date: Owner:
I do hereby cetldy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant will not (cacle one) need to comply with sold state codes and the requirements for a
permit for consoucbpn or modification from the Air Ouddy Management District. Residential construction applications are exempt from
these provisions.
Dale: Applicant
I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county
ordinances and state laws relating To building construction and hereby authorize Ten ese native of this city to enter on the above mentioned
o arty for unseal pTpl}}��pses.
Dal _�C7e'_LLS Signalu
Driver's ecense GGT//Social Security p:
1641,46 While—Budding: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06713
PERMIT NO: B 067135 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF OVER SOLID W/COMP SHINGLES SQ FT: 4,531
CLAIM VALUE: 4,531.00 CALC—VALUE: 4,531,00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN
BUILDING
----------
---------
ACCESSORY
BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT;
FT IN
REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT IN
RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
13915409
ZNE:
REF NO:
PLANNING NOTES>
i
D E V E L O
P M E N
T S E R V I
C E S R
E Q U I R
E M E N.T S
ZONING APPROVED BY
BUILDING APPROVED BY :
DATE:
,y, DATE:
APPLICATION ISSUED BY: CAp _; DATE: (A l }
iEkK%jP*fElFiE*fe iE ar*fE it**iE ih as if a���rT��E i��r3F i��F�1FiF�f�f# iF iF�����;F�f�-������E�lf k 1(-1E 1F iF iE if iE if -k ATit3F if if
iE it iE it lE iF it * iF lE 9E it * iF 3r 1E it %* it * aE * * RF iF if iE if -if ie if iF * iE et• iE iF 9E iE aE ik it Rr if * ie aE iE ik iE * aE iE iE lE * * 1F * as iE iE * * it iE * iP if iE it iE it RF iE RG iE aE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72.00so
PLAN SMOKE DETECTOR SMIP/NON—RES
ISSUE FE
BUILDINGEDIV—> PERMIT ISSUE - PLREW RED TOTAL PAID DUE
TOTALS ---- > 72.50 0.00 0.00 72.50 72.50 .00
REVENUE DIVISION TOTALS--> COLLECTED; 72, OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC SMIP/TOT GRADING PLAN—CHECK
72.00 .50 r
iE iF iE iE**iE%iEfElE iE lEef 9E iF iP iF iE iF**ar 1E#Rr iF iF if it iE*fE*iE ie*iE IE iE*iE*ie it iF*iEie iF OE iE iE 1E fE*RrkeE ie it iE *ir ie ?F*iE it 4�E iE 3E ie #iE it iF*
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 4531 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 4,531.00
END OF FEES
01 00160384-00160385 TOT 72..50
DATE: 05/12/94 TIME: 15:25
AND PLANNING
POOL & SPA l
C NSTRUCTION
�Date
,PPROVALS Permit ;r '
�
Inspector
Date Inspector :
APPROVALS Permit ,P i
1. Temporary Electrical Servlca or Pole
-�
52. Pool & Equipment Location _ ---1
2. So.; Pipe Undrgrnd.
53. StSte-al Reinforce -,,,t l
J. Fectrlcal Cordcit Uti!,t11.U111grnd.
4. Elettrica! Conduit-Undrgrnd.
.�I
-1
I
54. Fo'11
55 Electrical Bonding
5, Staa: Re"nforcemen•
--
56. Ro.gh Plun,b r,, 2• ?,caare Ta,! l _
i
57. AIPRCVAL ,0 CC'--PG 1- 'i--� - --- --.
ctr,cal Cordu * Und•Grno.8.
u. F::c-ri a' UFER Gr,d
7 FootingsL59G,'s
Fou-dat!on
Pipe, "- Jr dn^ J
9 :tater Pipe-Und,grnd.
-
60. Brr'.c:'. csl: L;,,-
61. APPROVAL 70 :;F CK11.
62. Kct cash & Rca:I tr- Fw-,!
63. Hci tc. & Vent F ir;,'
10. Suuctwal Floor Systerh
Property Sewer Line & Ho, se.Connecticm
,�I
12. Se::er Cap -.
_
SV5!em f a -- -
65. Electrical Fine! -
66. Solar System-f:n, - _i
13 Roo* 0,a ns
_
14. Rough Plumb:ng
15 Rough F,ecv,cal-Condo t
I
67 Frnc!ng & Acc ss Apr'ovdl
16. Rough Eiectric!Yirin9
17. Rough %V.ri,'.g Sign
68. APPROVED FOR PLASTERING
18 Rough Electrical -T Bar Ceil,rg
69. POOL !SPASYSTL?.IS FINAL
FIRE DEPT REOUIREMEiJT �-
APPRCVALS - i'er.ait ,r_
70, Underground Hydro
P., duct P!mmq ' 1 G.a 1] Oil;
I 72 Ln:!e-prou. J
73. i; ndorgrnd. Stnr::q: ,,.nk . 'Gis
-
74. O•cnc�au !iyr ri,
19, Ro:gh Heaving & Air Cord,t on,ng
20. Ro'-gh Factory F;.ap!aee
21. Ducts, in Structure
22. Ducts. Ventilating
23, Gas Pipe Rough & Test
---�--71.
24 Roof Framing
25. Roof Sheathing --
/
S�J///U
26. 763r Cc,hnq ISruaural==_rocoat
-----_--
_ _ --_- --- -
75. C_y CLum:c-_---__-__-_--I-
76. Sta-•dp c- !
77. Fame and F!ash:r9
77. FIXED SYSTF'J "INAL
73. F;HE PREY f-:'•..`,'_
HEAL T" .DEPT. RF01113L' 3r.. - 1
7C. ;::'.'A[
28 Lath -rig & Siding
2.9. Insulat o,
.'a -
31. P e, 3ro;.n Ccat
_
32. E c,nc Po. e. f...:,- .,
32. 'r
gp. FC;�" CEH I i L ISSLI D
,\OIcP: r'
34 F heaOrc u A • Co, ..: c - ---{I-
I -- -
-- - - - - - - - -- - -- -- - -
-
r35. Fincl Gas Pip, Test
�-
----
E_.-. .,
-
CG. Hood r C. ,DPV
33. Final P!..mb.uy
:o ca: Se'v ce.F ,
- _-------_---- - - -
---__----- ----
-
- --
41. Soar Dome,t,c Fse;
42. Backflow Preventer
43. Backflor. Irrigation
-,rdscape lrnea[ion SYs[a:r
---
15. Sound Attenuation--
_--
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
r L
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER StINi[" RLM LAND CC, DATE 2-28-57
3i3?
JOBADDRESS 167 -Samoa Place BUILDINGPERMIT NO. #4183
GENERAL CONTRACTOR OWneT Bldr VALUE $ 1o,686.00
LOT 111 BLOCK TRACT 2353 Single res. Watt. gar.
GROUP 1 & J TYPE V ZONE FIRE DISTRICT h516
INSPECTIONS
DATE
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench
4 Q
Foundation Forms and Grade to Garage
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough JUNT1199577VVU
Heating, Rough
9 t/ 9 ,/
Heating, Fl nal )iL GS
IDS/S� 7
Z'
Sewer House- Sewer, St./1/69s
—r
Septic Tank or Cesspool
C
Lathing, In Out
Plastering
Plumbing, Final, Fixtures Complete
fil-
(L/t
%
Plumbing, Final Gas Test �(S
/O
Wiring, Final n
Anrnnannv YYJ ...'. Z/'"
b -j
/n_t<<
—
FORM 210 9M 10-e5