HomeMy WebLinkAbout1056 SANTA CRUZ CIR - Building Permits CITY OF COSTA MESA
05-cp44. BUILDING DIVISION
•FA• sq�! 77 FAIR DRIVE,COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov
i „rag9 FOR INSPECTIONS CALL: (714)754-5626
442100 n,rt0`1'1
PERMIT NUMBER: B12-00029
4
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 41206119 DATE ISSUED: 02/14/2012
ISSUED BY: KJB
•
JOB ADDRESS: 1056 SANTA CRUZ CI CM Suite/Unit:
Vicinity: RESIDENCE ONLY •
Squares: 1200 Valuation: $4,000.00
'SCOPE OF WORK: TEAR OFF EXISTING ROOF. REPAIR/REPLACE SHEATHING AS NECESSARY.COVER WITH CLASS A COMP
SHINGLES. ROOF PITCH IS 6:12. RESIDENCE ONLY.APPROX 1200 SQ FT.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to-dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card
OWNER: BLAKE, DORIS M TR Address: 1056 SANTA CRUZ CIR Unit:
PHONE: - City/State/Zip: COSTA MESA,CA
APPLICANT: LLAMAS, DOMENIC Address: 633 W KATELLA AVE Unit: :SUITE F
PHONE: 714-731-3425 City/State/Zip: ORANGE,CA
CONTRACTOR: WATHERLINE REROOFING AND REPAIRS INC License No. 933810
Address: 633 W KATELLA AVEUnit: SUITE F PHONE: 714-731-3425
City/State/Zip: ORANGE,CA 92867 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY •
Reroof Plan Check: $0.00 •
Reroof Permit Fee: $97.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $98.25
qp 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
P;( •
!NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
,fegulations.(Ord. No. 92-28, § 1, 12-21-92)
rth(PIRATION: 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.
600E k. INSPECTION 1YPr DATE INTITIALS CODE k INSPECTION TYPE Rolm lNimAL>;
*6 Fixed System Final Fire Prevention - 206 Final Mechanical
h'266 Pool Spa Final {��L 206 Final Plumbing
200 Final Re-Roof X oR-adi• JA INTI 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
'202 Final Factory Fire Place 220 Final Planning Approval
1203 Final Sign 222 Final Site
1204 Final Demolition _ • 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION: • Owner ID verified by driver's license. ❑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.
O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend, will be made in connection with work authorized
2 i _ A v�.N by tis permit,and that no building structure,scaffolding,falsework,or demolition
Carrier
section need not tcompleted dine permit is valued at one hundred dollars(8f00)orless) or dismantlinghhereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number: WC.--"" ¢ -467310/-6.0
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance 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 person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should•
beco •_ subject to the workers' compensation provisions of Section 3700 of Date
the /•r Code, I shall fort t comply with these provisio/nnis
r — 2/ ' Applicant's Signature
i , _ Division of Industrial Safety Permit Number:
V
Applicant 5 nature D e 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? ❑Yes ❑ 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 Business 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 effect. / a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# 3Q 'EQ Class# C,3 (Section 25533 of the California Health and Safety Code, with some
.�rz jam/ exceptions, requires registration with the Costa Mesa Fire Department by
♦ate n- �`J each business which at any one time has on hand a quantity of acutely
acYdrS n ��"Z1 gate 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 ❑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? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for 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? ❑Yes ❑ 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? ❑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
am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
IDproperty,I, as owner of the
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
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
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Signature pt Legal (s Dale
Signature Date `� •y/ /�
3051-46(3/07)
And/or Authorized Applicant D.e
73/2- d-ci
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations Page 1 of 5)
Project Name: Climate Zone ft N of Stories
Clavi, 106(o Santa Cruz UIC LVA. i-testi- (0
General Information
Site Address: ID% 5trkkut, G'Y Enforcement Agency: Date: 4 114 Ia.
Building TypeSingle Family ❑Multi Family Circle the Front Orientation:N, W,or degrees
p Project Type: 0 Alterations Envelope Fenestration Roof❑HVAC
Conditioned Floor Area(CFA): ��4 1 �'1't• Replacement or Change Out Duct Replacement❑Water Heater
NOTE:This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑Opening of framed cavity alone-Alterations that involve the opening of the framed cavity ofa wall,ceiling,orfloor must install the
mandatory minimum insulation value per§150 for the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column H.
❑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. Fill in Columns A-J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A F B 1 . C I D E F 1P C I H
Prosed s"N°" Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- 1A4 Table Cavity Insulation Assembly Assembly
ID' - or Type and Size' or Other' factor° Numbers R-value6 R-Value Row/Cols U-factors
Note:Forfurred assemblies,accounting for Continuous Insulation R-value.see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Construction table below.
I.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs.Crawl Space,Doors and etc...Indicate in column G the Frame
material 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 for mass in inches or Spacing between framing members enter;16"or 24"OC;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc....
4. Based on the Climate Zone:enter the equivalent U-factor found in JA4 Table based on the R-Value from Table 151-B,C,or D
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 framing;otherwise,enter "0".
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 be equal to or less than the Standard U-factor in Column E to comply.
Furring Stri s Construction Table for Mass Walls Only
A B C D r E F _IG I DI I J 1K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.35,43.6,4.3.7 Joint Appendix Table 43.13
- T ,"2 9
u
w oo a r�
Assembly �a th `p.o u F- o m u_ =v Final
Mass Name or JA4 Table c e `u o o E ' au Assembly
Thickness' Type' Number' a> $ c p F 3 'a Q > W y U-factors'' Comment
Registration Number: RegistrationDate/fime:. � • - .. . ..
FIERSProvider:
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations Page 2 of 5)
Project Name: 6I^v e -DOr Climate Zone# (#of ones
Moss and Furring Strips Construction(footnotes)
1.Indicate the type of assembly to include;Hollow Unit Masonry Walls,Solid Unit Masonry,Solid Concrete Walls,Etc. Additional assemblies can
be found Reference Joint Appendix JA4.
2 This is the U-Factor based on the thickness of the assembly in inches.
3. The R-value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R-Value is the R-value of the furred out section of the assembly.
1-6.The Final Assembly is calculated using Equation 4-2 or Equation 4-4ofthe Reference Joint Appendix JA4. The equation is the inverse of Column
D added to Column L. Column K is the inverse from column J.
7.Insert the calculated LI-factor value on to the Opaque Surface Details in Column J
FENESTRATION PROPOSED AREAS
❑Replacing window alone—Replacement windows shall meet the U-Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements ore not applicable.
❑Adding 50ft2 or less of window area—Newly installed windows shall meet the U-Factor and SHGC Value requirements of Component
Package D in Table 151-C.
❑Adding more than 50ft3 of window area— Newly installed windows shall meet the U-Factor and SHGC Value and the Fenestration
Area requirements of Component Package Din Table 151-C.Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF-1R-ALT
Orientation
Fenestration Type and Frame (North,East, PropsedAreaI Maximum Maximum NFRC or Default
(Window,Glass Door or Skylight)_ South,West) (Itz) U-faetorz3 SHGC;3•" Values
I.Fenestration area is the area of total glazed product Be.glass plus frame). Exception:When a door is less than 50%glass, the fenestration
area may be the glass area plus a "2 inch frame"around the glass.
2.Enter value from Component Package D Requirements in Table 151-C.
3.Actual fenestration products installed and as indicated in CF-6R-ENV Form shall be equivalent to or have a lower U-factor and/or a lower
SHGC value than that specified on the CF-I R ALT Form.
4.Submit a completed WS-3R Form if a reduced SHGC is calculated with exterior shading.
5.11 applicable at this stage enter"NFRC"for NFRC Certified windows or are CEC"Default"values found in Table 116A or B.
ALTERED FENESTRATION ALLOWED AREAS(Complete if more than Soft offenestratlon is added)
A B C D E F G
CFA of Allowed Existing Allowed
Entire %of Fenestration Area Fenestration Area Proposed Area"
Dwelling CFAz 3 Area" Removed' Area Added` (A x 13) (E-D)+C
Total Fenestration
Areaz(0)
West Fenestration Area
(Required In - >
CZ's 2,4&7-15) _
1. The Proposed West Fenestration Area includes West-sloping skylight area and any other skylight area with a pitch less than 1:12.
2. Enter 20%when no West orientation restriction or 15%when West fenestration is being installed in Climate Zones 2, 4, &7-11 Note that the
maximum allowed fenestration can only be 5%of the CFA as indicated in Column F.Column G must be equal to or less than Column F.
3. In climate zones 2,4. 7-15,no more than 5%of the CFA is allowed for west facing glazing.
4. Existing Fenestration area must be counted toward the maximum allowed 15%or 20%of the whole building and calculated in Column G. The
Proposed Area must be less than or equal to Column F.
5.Enter the fenestration removed as part of the alteration if any in column D.
6.Enter the Fenestration area that is being added as part of the alteration.
:RegtstratiogNumber: ' ' � ReglstrgtionDate/T{me: •. ,� : � : -HERS Proyider: '-
2008 Residential Compliance Forms March 2010
•
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 3 of 5)
•
Project Name: Climate Zone# #of Stories
IMOg t j:Du115 (11
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 1,000J?,whichever is
less,the new roofing area must meet the roofing product"Cool Roof'requirements of§152(b)111i,152(b)lHii,or 152(b)1Hiii
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 Emittance requirements for roofing products in
§/18(1)are not applicable.Do not fill table below.
U Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 51b/ft3.
Alternatives to§152(b)1Hi and§152(b)Hu,Steep-slope roof(pitch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hrf12-°F13tu 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§I51(010;or
'❑ In climate zones 10, 12 and 13,with I f12 of free ventilation area of attic ventilation for every 150 fl2 of attic floor mea,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
In Building has at least R-30 ceiling insulation;or
❑ Building has radiant bather in the attic meeting the requirements of§151(02.;or
In 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)1Hiil,Low-slope roof(pitch S2:12)
❑ Building has no ducts in the attic.
Other Exceptions
0 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/f12 is exempt from the below Cool Roof criteria.
Note:If no CRRC-t 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/ft > 51b/ff Type2 Reflectance" Emittance SRIF
•
❑ 0 ❑"
❑ ❑ 0 0 ❑r
❑ ❑ ❑ ❑ ❑r
❑ ❑ 0 ❑ ❑t
0 0 ❑ ❑ ❑a
I. The CRRC Product ID Number can be obtainedfrom the Cool Roof Rating Council'Rated Product Directory at www.coolrours.om/araducts/searrhoha
2.Indicate the type of product is being used for the rooftop,i.e.single-phi roof 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 valuefrom the same
directory and use the equation(0.2+0.7(pinmat-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4.Check box if the Aged Reflectance is a calculated value using the equation above.
S. Calculate the SRI value by using the SRI-Worksheet at http://unnv.eneryv.ca govhitle24/aid enter the resulting value in the SRI Column 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§118(i)4. Select the applicable coating:
❑Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating In Other
Registration Number: • Registration Date/Time: - HE_RS Provider:
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations (Page 4 of 5)
Project Name: D� Doi-1S
Climate Zone H of Stories
D
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacityr2•3 _ (AFUE or HSPF) Type and Location' R-Value Type Space,Package or Hydronic)
1.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance,etc.)
2 Electric resistance healing is allowed only in Component Package C,or except where electric heating is supplemental(i.e.,Dotal capacity
<2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(6)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity'3 _ COP) _ Type and Location R-Value Type Space,Package or Hydronic)
1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling,etc)
2.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating)2 System Capacity(gal) Thermal Efficiency R-Value
I.Indicate Type(Storage Gas.Heat Pump,Instantaneous.etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§150(1).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation and special verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151(f)2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation OYES LINO
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation El YES ONO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation LJ YES NO
YES:In Climate Zones 1,2, I I, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
.._ .. _ . ,_
Registration Number: • � � • • -�� " •Registratioh Date/Time:. ��� � • .:PIERSSProvider - •
2008 Residential Compliance Forms March 2010
•
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations Page 5 of 5)
Project Name: 6�P�tk, Ports
• Climate Zone# #of Stories
•
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measres specified in this
checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing& Testing HERS verrficationisrequired forthis measure.
❑YES ❑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§152(6)1 Dii and the newly installed ducts are to be insulated per§151(010.
O EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
OYES ONO YES:In 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)IDi.
OYES ONO 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 per§152(b)IE.
❑ 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.
n EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
Refrigerant Charge-Split System HERS verification is required for this measure.
❑YES ❑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§152(5)1 F.
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 for this measure.
❑ YES ❑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)1Ci to meet the requirements of§151(f)7B.
Documentation Author's Declaration Statement
• 1 certify that this Certificate of Compliance documentation is accurate complete. e—
Name: I Si
Domeruu L Curnsts
Company: •
t eat flea- Ol l{'1t) b Y1P1� • �Qiit 41 ta•
Address: �O �J w Katz'La Ave • C F _I' IfApplicableUCEAor❑CEPE
(Certification#):
City/State/Zip: 0t-a/NC t C.9 g2 8 671 Phone: 1'4)131 3'fa 5
Responsible 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 on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information 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: -
City/State/Zip: Phone:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300.
Registration Number: - . : Registration Date/time: - -ITERS Provider:
2008 Residential Compliance Forms March 2010
/ AOEpESSOFBUILdlO: 1056 SANTA CRUZ CI urn CITY OF COSTA MESA - BUILDING PERMIT
OWNEWS NAME IFmOWIN: BLAKE, DORIS M FLOOD: AH-38 PERM NO: E 083870
ADDRESS: 1056 SANTA CRUZ CIR
COSTA MESA,CA 92626 PERMIT NO: E 083870 PLAN CHECK NO: N GOVT: N SUPP: N
549-0974
APPL.MARINO ADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE PURPOSE: ALT
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : UPGRADE ELECTRIC SERVICE SQ FT:
ARCS OR ENa'S ADDRESS: ural:
CLAIM VALUE: CALL-VALUE: GROUP OCC: R-3 /U-1
CONTRACTORS NAME: MICHAEL MADRID ELECTRIC ( 714 ) 722-7399
CONTRACTOWSMMUNG 2517 16TH ST COMMENTS: INSTALL CONDUIT FOR FUTURE SPA
ADDRESS: N.B . CA uC.NO.: 575895 *****************************************************+r+r**+E+E+E*r****AEAE***********
92663 gMr: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 of the Business find Professions Coda,and my license is in lull force end effect.
CITY LIC.NO.: UC.CLASS: C 10 UC.No.: 575895 EXP: MAIN BUILDING ACCESSORY BUILDING
�_ _�� � EC.T FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
DatContractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:thereby affirm under penally of perjury that I am exempt tram the Contractors License Law for the
'following reason(Section 7031.5Bueinass and Professions Code:Any city rcounty which requires apermit loconstruct,alter.improve, PARKING REQ: PROV: PARCEL: 41206119 ZNE: REF NO:
demdah,or repair any structure,prior to is issuance,also requires the applicant for such permit to file a signed statement that he or she
PLANNING NOTES>
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commandos with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis dor the alleged exemption.Any violation of Section > '
7031.5 by any applicant for a permit subjects the applicant to advil penalty d not more than five hundred dams[S5001). *******************************dF***********************************************
❑ I.as owner of the property o my emplwees with wages as the:sale compensation.will do the work,and the structure is net intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not appy to an owner of propend t.
who bolds or inproves thereon.end who does such work himself or herself or es or through hher own employees,provided that such
improvements are not intended or offered for sale.f.however.the building or improvement is sold within are year ofcompletion,the ZONING APPROVED BY .•
I- DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
0 I,as owner of the propend,em exdusivey contracting with licensed contractors to oanatnm the project(Section 7044.Business and BUILDING APPROVED BY DATE:
Professions Code:The Contractors License Law does not apply to en owner of properly who bunds or improves thereon and who
contracts for math projects with a contractor(s)licensed pursuant to the Contractors License Law). ,
❑ I am exempt under Section: B.&P.C.,for this reason: APPLICATION ISSUED BY: 56 DATE: 24 L. l
Dater °nB1 LEGALIZATION:N F 'E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby certify that I am aware of and understand the requirements of Callrnia Health and Safety Code Sections 25505,25533,and
25534,and halt or any future building occupant will/will not(circle one)need to campy with said state codes and the requirements for
apermf for canvuctionor modifcationhsthe ArQualityManagement Nelda.Reddenlidrmrtmd'ocat
n depiionw
exempt ban these PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions,
Date: Applicant: 5 0t SM I P/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedaratiom: ISSUE FEE 22 .00
0 Ihave and will maintain acenifrateoaesentto.eff-meare for workersoomaenwion,asprovided for bySection 37000fthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.f«mewdamd
mae9eworfawNissued.
TOTALS----> 43 . 50 22 . 00 0 .00 65 . 50 65 . 50 .00
❑ I have and coil mainten workers'compensation insurance,as required by Section 3700 of the Labor Code,ler the performance of the
work for wits,this permit n issued.My workers'compensation insurance carrier and policy number are: -
Canier: REVENUE DIVISION TOTALS--> COLLECTED: 65. 50 OVER/SHORT: .00
•
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
...(TThis section need not be completed r the venni is for one hundred dollen(SIM or nes.) 65. 50
www
yy, I certify that in the performance d the work for which this permit is issued,I shall not employ any person in any manner so as to r.
' become subject to the*rakers'compensation laws of California,and agree chat B I should become subject to the workers' *******************************************************************************
m
compensation pwaiona o Section 3700 of the Labor Code.t shall forthwhh comps*eh those provisions. - INDIVIDUAL -FEE BREAKDOWN
V `Dale: i-2-4--4,1 Applicant: ne\AC-WA-Et— Wll°rQQ.,2j)
Warning:Fro r•t0 man Waken'comprraatlpn C0yalapela unlawful,and shell subject an employer to criminal wattles and TYPE QTY DESCRIPTIO. N UNIT COST TOTAL COST
civil linos up fl)one hundred thousand dollen 15104000A M addition to the cost of compensatlon,denwses as provided ler In
Section 3706 of the Labor Cods Interest,andaf/omey'a lees. ELE 1 SERVICES BELOW 600 . V & BELOW 201 AMP 27. 25 27. 25
CONSTRUCTION LENDING AGENCY: I hereby elfin^under penally of Perjury that there na dion long agency f«the ELE 1 MISC SC CONDUIT NOT LISTED REQ PERMIT 16. 25 16 . 25
pertonanceDI the work fix which this prmi (Section END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
9 eerily that I have read this application and rale that the above inlamation' .I agree to oomph/with all Uy and county ordinances
and state laws relating to building construction end hereby authorize reprep eaves of this thy to enter upon the above-mentioned property '
for inspection purposes.
MIC AEL IRD
Print a 07-24-1997/12:39 9.50
��/ �, 7 - ` 1 RCPTR:081-1L09624
Dale: f�Z PERMIT:070
Signature /Agee Mani/Contractor
'r
(5151-46.W P) White-Builds&Safety:Green-File:Canary-Appiwm:Pink-Revenue:Goldenrod-Assessor l
•
CONSTRUCTION AND PLANNING PO ' SPA T
'i Date InspectorDate Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
1•
Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 1
•
•I•y3'.IElectrical Conduki
it, lity-Undrgrnd. 54. Forms 1=
;'?; F{1ectrIca I ConduiVUndrgrnd. 55. Electrical Bonding
C
, 5;-Sfeel Reinforcement 56. Rough Plumbing & Pressure Test • c.
'�6?PElectrical UFERGYnd. 57. APPROVAL TO COVER-GUNITE
j7;tFootings �,-g 58. Electrical Conduit-Undrgrnd.
"=8? Foundation ;: 59. Gas Pipe, 0 Undrgrnd., Test X
t' .
°' 9. Water Pipe-Undrgrnd.2 ! 60. Backwash Lines, P-Trap, 0 Undrgrnd. I
-' 10" Structural FloolSystem 61. APPROVAL TO DECK
11.-Property Sewerfli.ine-& House-Connection 62: Backwash & Receptor-Final •
12.Sewer Cap - - eJ 63. Heater & Vent-Final
J3. Roof Drains r 64. Plumbing System - Final
X4. Rough Plumbing. 65. Electrical-Final
115. Rough Electrical'Conduit a 66. Solar System-Final •
0,6. Rough Electric tiririg 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
98. Rough Electrical=T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air"Conditioning FIRE DEPT. REQUIREMENT :
r•,- n + . rr+r-, ,re 71 t b! -'1 .1't r+ S,-•+;]r' .}, 1.-1 ,T1-r1
20.,.t�of�h Fsctoiy Fve lace 'r4 e- APPS'OVAL)er.., Pelmit# •,1•
tr.-1 f :21,iDucs, irrStticturEx , • • t - z ; :
_ R . 70.lUnde9'r4-1 l Fx_ K, C 1, , _ _, _ ..__,
22.„Ducti, Ve`ti ing,`; S +" S S• ' yr,-
" ft)Oil
, {t ,,, -a , .- .t; ,7 - 4: , 71. Prodtipt e,iping glias ,
23. -Gas Pipe-Rough & Test ry.. 3 T 3*' I- 72. Underground Ftvs'h r •
`
-,4 Yt
"
24..RooY-Fr( 1in • St: , -,:, --' x ., e z _ *'
g :u# 7,, x c, ,,.,% , 73 Undergrhd.Sto;Tan I{0 Gas OOII
25. Roof.,Sheathing _ •r v . * y ' ,� ^i, 742 Overhead Hydr W
26.:T-BaPP Ceiling (Str ubtural) & Mitdoioat k '' `L-''1'. 75: Dry Chemical t-„ + -, `i th,-,
27.-Frame and Flashing, .�; -1 cr 5.. :wry 76. Dry Standpipe`-'r -t �• >^
28.yLathing Fd Siding;: ::, r. ';;;_c,--,:.: J ▪. g ..I '.p tg
", 77y FIXED` 1=,STs•^ INA
29. Insulation -' _ •• 1 (a' 7S FIRE PREY. FIfiFAL w=
• 30. Drywall Mailing �, A ,_, ! I t; s HIE ALTidpEP, .-REQUIFlE_IC,IENT
31. Plaster Brown Coat. t- is : ri 79. FINAL EI.S.PECTTOrN v Y
.y+_. ...a7 i t i
32._EiectricaaPoG r Metye�-FAclal 7'. • ?7 ' 8Q; FOOD CERTIF2CA?E IPSUEDA 'bt,7
1 2�
33.�ffinal Ele�'ctric. al a: M G I• I ) r t ' • No. • 7 v�7 `] <
- 4' _ , .. ' / r`r2,i -y 7`.1-../,�l Ute.-G'-��.-.4�,,'�.'frAfr/Lf�� I"'Ci
.. . t }. ;1 NUM jYQSc' A1- A /:�� 0 jrfT Uri
K%J
i/
/' 34..FintHeating& AirConBitioni4Si :"
•• T - 1 Ji iri ,+ 'i1
35. FinarGarPiP�TeS .ck pa c: .-: --) 6:+ 1. L.
t. f-''.._,�:'
' xTry ~ "
• 36. Hood.ornCanopy C T"% - 4 i4. Sr17
S rtV
_
-rr :r. I ft' !r X.7 Y m 'L-Y
' 37.`F.inALFactory Fireplace _._ e1 r.
�., x CCU.
• 38. FinarPiumbing -• x '- • -. •" - n
- t • .- Cr' 4 •,.Ti
39. Wate?Service-Final z o ,;. ._ [i >
-� •' y "<.'
rl. .r:
• t 40. Gas Service-Final .. to <rn;r 3 ,-t I ,ir ''_-cru a n. a Cr L.
r- - r I-,L. rr. m .t: . :--.', c cr;
41. Solar Domestio-Fina II (t' -7a r e
�. . . 1 ar -70 * 'w
42. Backflow PreventerM ; f• _ k t-* j .
t 'S - r - i' Ri ?iL.' * -
43. Backflow lrr gationl.: 'S a▪ X 4 p. ••.: 1 • • l
J
.1- a g1 Cling ai Cu J `S ti
L J.A
-- t E tM L.4 ti 1---i C'11 4 R.
%45.iSound A;tenuation 1 r .n t-. crl+ ,o, 4 • „_.J x
-46.tHandicap•Regulations ri x. 's ' .s: S 'Jo +.
r.T47.,`FINTSL STRl3£TUf'E & BUILDING4 ;, u :.
ppr •
48.'fINA'L PLANNING. • -+ :-1 fkE .--i
t .rl N -- t Q;
49, Elect?ic Relea;e to Pt{ficon `; s t ,C, _,
-.50,. as,Release to,Southern California Gas Co a ti: a = ' '-'a e r-'
:51. CERTIFICATE OF OCCUPANCY - + ' - -
No. Date
OP IN CITY OF CO^TA MESA
Qa\ BUILDING IVISION• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
•r.* PERMIT
606-00535
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesagaJf 01 G PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1056 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 04/11/2006
Vicinity: ROOF Issued: 04/11/2006
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 41206119 Zoning: R1
Applicant: PAUL POWDERLY /
Address: 8111 COMMONWEALTH ��
Phone: 800-400-7692 ISSUED BY:
BUENA PARK,CA Zip: 90621
Owner BLAKE, DORIS M TR
Address 1056 SANTA CRUZ CIR
Phone:
COSTA MESA,CA Zip: 92626-1618
Contractor: ROYAL ROOFING CO
Address: 8111 COMMONWEALTH
Phone: 800-400-7692
BUENA PARK,CA
Zip: 90621 License: 678705
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL BUILT UP ROOF SYSTEM,BASE,2 PLY-CAP. 1,600 S.F.INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,800.00
Permit: $97.25 Claim Valuation: $3,800.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
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.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
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 are:
Carrier: Policy Number: '
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
iW .certify,ihat'. • rformance of ork for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensa of California, 0 that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
T
comply with :: e provisions. ` /
4Ap licant,Slgnature:c Li • R I 't .�1-- LA Date: l'� 1 ( '- 0 co
,ZWA99NltW.FAILURE'TOSECURE WORKE'c COMPENSATION COVERA WFUL AND SHALL SUBJECT AN EM1),p TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED
THOUSAND DOL ARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirmfthat I am Iige05gdygec.yr si�Chapter 9(commencing with Section 7000)of Division 3 of the Bus',' a s aptRrbfgssions Code,and my license is in full
orceend effect.Lie. O (.r`5 L Class'#`Lri�
C
Coolie or's'Slgn�ture. ante: C
. _ Qom . ______
CONSTRUCTION
-��
CONSTRUCTION LENDING AGENCY:
❑ I 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).
Lenders 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 tile 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:
Owner ID verified by driver's license. 0 Yes 0 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,Tule 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.
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? 0 Yes 0 No
(Section 25505 of the Califomia 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? 0 Yes 0 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 Califomia 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 Cede been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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? 0 Yes 0 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 0 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: Data
CERTIFICATE OF COMPLIANCE MID 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.
Signa ; of`::. •wner(s) '-C _1 ( �,Qat�
KJ
, a '. th'ori "'tTh— Date---„�.
CODE* INSPECTIONTTPE''r - DATE - - INTITIALS CODE I tflSPEVTI011TYPE Ma INSmULS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final p 208 Final Plumbing
200 Final Re-Root ( ",3-BO 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
���,
` +> CITY OF COSTA MESA
ya) BUILDING DIVISION PERMIT NUMBER
ti "•""-J' 'J DEVELOPMENT SERVICES DEPARTMENT
PERMIT
VB99-01031
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1056 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 07/06/1999
Vicinity: REAR&LEFT SIDE PROPERY LINES. Issued: 07/06/1999
Parcel Nunmber: 41206119 Zoning: R1 R1
ISSUED BY:
Applicant: REYNAGA, RUBEN •
Address: 9002 BRIGHT AVE. -
CA - Phone: (562)698-2535 "
WHITTIER Zip: 90602
Owner: BLAKE, DORIS M
Address '1056 SANTA CRUZ CIR
Phone:
COSTA MESA, CA Zip: 92626
Contractor: R C MASONRY
Address: 9002 BRIGHT AVE.
CA Phone: (562)698-2535
WHITTIER
Zip: 90602 License: 619912
•
Arch : Eng:
Address: - Address: ,
• Phone: Phone:
. Zip , License: Zip: License:
SCOPE OF PERMIT "
. 81 LINEAL FT. OF 6'HIGH BLOCKWALL LOCATED @ REAR AND LEFT SIDE PROPERTY LINES. •
FEE SUMMARY , ,
, Plan Check: , $0.00 Calc Valuation: $1,620.00
_ Permit: $54.00 • Claim Valuation: $1,620.00
SMIP Res: $0.50
.SMIP Corn: $0.00 -
Other $0.00
Inspection: $0.00
Total: $54.50
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
•
e
•
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
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.
FOR INSPECTIONS CALL: (714)754-5626
1 •
DECLARATIONS
WORKERS'COMPENSATION DECLARATIO,..
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 carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
O I certify that In the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agre hat if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these vis' ns.
Applicant Signature: M 17,1 /
Date: 7-F,— 9
WARNING:FAILURE TO SECURE WORKERS'COMPE SATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($I00,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.a ,/e Class k ( —2 O'/
Contractors Signature: J.g449 /f CDate: -6-PC(
CONSTRUCTION LENDING AGENCY: ()
❑ I 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).):
O 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:
Owner ID verified by driver's license. 0 Yes 0 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 6,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.
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? 0 Yes 0 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? 0 Yes 0 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? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication appermit for such construction or modification
from the South Coast Air Outility Management District or from any other air pollution control district or agency? 0 Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any pan of the facility to De constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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? 0 Yes 0 No
B (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: Date:
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 properly for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
'l�r. re Of Legal Owner(s) Date
An.,•r Aut Irize,Applicant Date 7_6.—C7
ODE t INSPECTION TYPE PAIS Ri1IDEL$ CODE INSPECTION TYPE PATE INIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
2001 Final Re-Roof/Rf 1 /b & 210 Final Fiectrical
re Prevention
Final Block/Retaining Wgll 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
2446.46
I
NOTE . .
ADDITIONS,tDE.ETIIO TF ORLCOIRREC'TIDON S SNALU
•TID5liI�Eta IS'FOR INFORMATIONAL •SOLID WALLS/FENCES BETWEEN 2'fi'&6'IN HEIGHT SHALL
O AP.PLIEANHS'RESPONSRit FORPROVIDING
BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE.
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOTA)WALLS/FENCES SHALL NOT EXCEED 2'6'IN HEIGHT
WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN 10'OF THE FRONT PROPERTY LINE(NOT CURB LINE).
81 LE (y / kir. •VERIFY DISTANCE FROM CURB TO PROPEKIY LINE
AND SHOW ON PLAN. VERIFICATION FROM THE CITY'S
APPRI.C� •yam i ENGINEERING DIVISION IS REQUIRED. CALL(714)754,5343
4 l 1- POR INFORMATION.
CITY OF COSTA MESA
PLANNING DIV.
SCT TO BLDG. DEFT, REG.
Bf LI'‘-^ " �0 /1
Ei
x
RESIDENCE � [� 6
k� 1
61 I
ow 1 I
et feet-
.
cct 1
n I
1
1I I
i I
s I
. y Q `
0 IFg 1 a
I
RESIDENCE RESIDENCERE90ERfF RESDERCI I
gI I I I
" TOS(; :
W
W
• 6' 1•pl @Lox t4} Qi sb(
\ /
\
!OSIS Sa`Izz Cr.
vZ c STREET 6 .5E0c-1 hl e20 -
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION _
` J ��I_Illr_:_
, /
TYPICAL 6U CONCRETE BLOCK FENCE
Cement Coping Optional 0 N, --- =II U=� GENERAL- NOTES
Channel Block With 1-3/e
Horizontal Top of all
Fences fl t- . INII- MI MORTAR: One Part Plastic Cement, and
Three Parts Sand
For Fences 5'or Less :91 GROUT: One Part!' �ICement,
Three and
_ II -, � Sand
a
�, '- One Half Parts S
Van.Bars 3/B"¢at 4'-0"O.C. in o COPING: One Part Cement, Three •
For Fences Higher Than 5' I Li. v � - Parts Sand
Vert. Ban 3/e"0 at 32" O.C. Y w - - - CONCRETE: Well Mixed 1:2-1/2: 3-1/2
II
a = Max of 7-1/2 Gollcns of
Fill Cells Solid With Grout ;II a „ Ill-'
Where Steel Occurs (n�� , z _ _ Water Per Sack of Cement
Reinforcing Steel Shall (t1���,� 4
1 'e : GROUT MAY BE POURED FROM THE TOP
Ir■I �_ . OF THE FENCE IN CELLS WHERE STEEL
Conform to Sec.A.15.39 11 w O - OCCURS.
A.S.T.M. 1'�t 2 —' �'� CELLS AND AREAS OF HORIZONTAL REIN
1 'Si n FORCEMENT SHALL BE CLEAR,CLEAN&
All Steel to be Lapped I. --_ --- — -- -
24"or to Code iN ' ' FREE OF ALL MORTAR DEBRIS,ETC.
11111 IIIII
NATURAL GRADE =II " III
,c.� ;W//.', FS ,d.
- �� � .
TWOOINUOS BARS • t� ttt C.
CONTINUOUS TOP
•
&BOTTOM II1111
1—e--WIDTH TO 16 0 C MAX
11
SEE CHART
HOQIZSTEEL MUST BE TIED IN BELOW DEPTH LF EARTHTCOTH
PLACE AT TIME OF TRENCH I/3 THE HEIGTH OF FENCE
INSPECTION. SLOW BOTTOM OF FOOTING
1_,..19:_l
lo" 2" SCALE: 1/211 . 11
FOOTING REQUIREMENTS CHART
[ I WALL HEIGHT 6'
14" 5 41 31
WIDTH14" 12" . - 12"
•
1
THICKNESS . .10" 10" 8 " 8 "
DEPTH OF EARTHTOOTH 24" 20" . . 16" 12"
SPACING OF EARTHTOOTH 12' 14' 16' 16'
all
`- BUILDING DIVISION
4!r
• � J
CITY OF COSTA MESA
`>y . BUILDING DIVISION
t' `"'••j., ' DEVELOPMENT SERVICES DEPARTMENT
t)• Walt 4, , PERMIT PERMIT
'*•o.mw B98-01544
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1056 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 08/26/1998
Vicinity: Issued: 08/26/1998
•
Parcel Nunmber: 41206119 Zoning: R1 R1
Applicant: LINES, DAMOND
Address: - .
Pbone:_'949-361=1615 . _
- Zip: ' - "
,
Owner BLAKE=DORIS•M _ , "
Address 1056 SANTA CRUZ CIR . - ,
COSTA MESA,CA - Zip 92626
Contractor: LET IT RAIN,ROOFING .
Address: 139 AVE DE LA,GRULLA " ':
• ' = Phone: 714-361-1615
" SAN CLEMENTE,CA Zip 92672 t
License 735125
Arch/Eng : - -- iv--4
Address: ` vim-"/ ;n.__ . �,. ,� t
..!�, . „'Phne.`: °. .. . - }
4.ri." I Zip: _ -�
License:
SCOPE OF PERMIT
,T/O EXIST FLAT ROOF1500SF AND INST NEW#28-BASE'MOP DOWN TWO#11 PLYS AND IMBED W/
#5 GRAVEL FLAT PORTION ONLY. = ' : _
,,
:.,, FEE SUMMARY/'f,,,
Plan Check: , $0.00 -° -- r - -Calc Valuation: • $2,500.00
Permit: • $74.75 -- -- --- -,,,/ Claim Valuation: ' • $2,500.00
SMIP Res: $0.50 ��
SMIP Com: $0.00
,. Other: • $0:00
Inspection: $0.00
Total: -$75.25
, PLANNING&ZONING': , " - ,
SETBACKS
MAIN STRUCTURE Front- 0-0 .: ' . - Rear 0-0 Left 0-0 Right , 0-0
ACCESSORY Front 0-0 - Rear 0-0 Left , 0-0 . . Right -,-.0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES: •
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. -
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.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS! • v
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have 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
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'ctmpensallen Insurance carrier and policy number are: 'I�� n 7
Cartier: •' / • Policy Number: C-11Si
(This section need not be completed it the permft is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which thi •-•••• ' ' tied, I shall not employ any person in any manner so as to become subject to the workers'
compensati•• : . • -'•••a and agree that if I sh•:-...: • e sub ect •,the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
I.the : provisions. ^ �Z / ' ' ! ,
plicent S ure: 0 Date: _6, /lY
:FAILURE TO SECURE WORKER- ••VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDrTION TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm Mat I am licensed under pr. s•• o mencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
\ (�Crce an. . : . • . • $� � Class#
o r actors Signe• • � �.�� Date: e-2 (2-@
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI 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 nerself 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:
Owner ID verified by driver's license. 0 Yes 0 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,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.
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? 0 Yes 0 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? 0 Yes 0 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ 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? 0 Yes 0 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 0 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: _ Date:
CERTIFICATE OF COMPUANCE 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.
And/Or Authonze Date
(((! CODE I ItlSBECII{ '�— BATE MEW GOOEY IlSPECTION TYPE PAIS SDIDAU
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / /, 208 Final Plumbing
I � O
200 Final Re-Roof / -9` w"- 210 Final Electrical
201 Final Black/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
2446-46
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.. 7826 8/01 /85- (,,)� n y
CITY OF COSTA MESA CONSTRUCTION PERMIT Lo I Z g _®,_ I 46221 TI
Project Address /G S6 San tnrr Chu z G(r. • 1 1
Applicant's •Mailing Address res lPLn-Ya 0/-, U TYPE OF-CONSTRUCTION NEW DDUALTERATIONUREPAIR •
-
-
El CONVERSION El DEMOLISH OTHER q,p,# _, Zone
Owner'sName Ocl•l5 �I••2((('e PhoneSyk-OV7y DESCRIP,TIONOFWe%If/USE OF BLDG. �2.-e -PLANCt=
Address /0 S(, ri>n.f a Ce-11 .2. Cit I - • a a. m.-- Oka 1 - .E Main Building: - • Accessory Building: Z
Arch/Eng. — License No. TYPE OF PERMIT N GRADING N FOUNDATION I• STRUCTURAL ' - T Front.: - p
Address �2 ❑D TENANT El ELECTRICAL ❑ PLUMBING Ell MECHANICAL - I B Rear ______._...->.. N
Contractor's Name'Wt -(7.5 )3ei._et 6e �/ ' Phone/17'4/13 0 OTHER - C Right N
y 03 'IctC PROJECT DESCRIPTION SQ. FT. OCCUPANCY g / G
Address(mailin I$ �Cl P�3Ya UMan crP CONSTRUCTION TYPE ' • • VALUATION $ It boa -S Left / '
City License No. / ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION 4 Ping. Ref.# / Parking Req./Provided ' - E
I herebyaffirm that-I am licensed underprovisions of Charter 9(commencing Q
( Remarks: at •T�-i �Tr�f— ci Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and I I T
my license is in full force and effect.
'cense Class C- 2 Li(yense Nye O O S
.nate 8"''1 85 Signature i !7 t PLUMBING FEES •
WORKERS' COMPENSATIONLARATION Bar Sink Showers
I hereby affirm that I have a cer ate of consent to self-insure ora certificate ELECTRICAL FEES
of Workers' Compensation In •rance, or a certified copy,thereof (Section Backflow Preventer - Service Sink ' - . - - •
3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap ' Construction Pole Sub. 0 50+'KW
Certified copy is hereby furnished.
• R.
Certified copy is filed with'the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant - '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • Dishwasher . Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or '
less). Dishwasher Solar Piping Dryers ❑Gas ❑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 beco/-
subje to the Drinking Fountains Solar Tank Fan Motors❑O-1 HP ❑1'/z-8
Worker C mpensatio Laws.of Cali,R nia.
Date -�- Signature Altai. -� Floor Drains Swimming Pool w/Spa F.A.U. Ina Solar 09-15 HP 016-15+
'NOTICE: If,after making this decla • on, you should become subject to the _
Workers' Compensation provision • the Labor Code, you.must forthwith Floor Sinks' Urinal - • - Fixtures - - - - - - -
comply with such provisions 'o this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
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 hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash -
'Mlowing reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 1Standing Sections ,
unty which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays '
y structure, prior to its issuance, also requires the applicant for such permit • y - t Generator ❑0-5 KW ❑5-15 KW Trash Compactor
u file a signed 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
. penalty of not more than five hundred dollars($500). -
o 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 . ! $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES ,•
License Law does nobapply 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 .Hood or Type I 0 .
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date-.
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground V a�. �.�,�- _-'�
prove for the purpose of sale). Building Approved By e..- _ �% Date
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By I-NV"t pate' �I S
tractors to construct the project (Section 7044,Business and Professions Code: -' V
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMAR]-'OF FEES _ I
-builds or Improves thereon,and who contracts for such projects with a con- - - - - - - • - - t�
tractor(s) license pursuant to the Contractor's License Law). I am aware that •
Exhaust System ❑ Multiple 0 System Repair/Alteration • BUILDING PERMIT. $ ZG Ufl SMIP $ . S p
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ 1'I - 7-3 PERMIT,
0.1am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers— PLUMBING $ ISSUANCE $
•
Date -• Owner Heating System&Ducting. Registers . ' • PLAN CHECK ' 25% $ ENERGY Pt! $'
I hereby certify that I have read this application and state that the above - 00-100,000 BTU 0100,000 BTL— -- . • - • - GRADING $' '
ELECTRICAL
information is correct. I agree to comply with all city and county ordinances $ -
and state laws relating to buildin• •nstruction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to enteon th; above-mentioned property for e
inspection p •oses.
Signature V_i.- .L /!!i bate 7,--/- rS MECHANICAL $ TOTAL FEE $' 14 •2-
Drivers' Luse dr SS+ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
. s
CMF 0865-4- ev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANN )OL&SPA
APPROVALS Permit# _ _ Date Inspector APPROVALS Permit# Date Inspector
-1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit'Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement bigv par, 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. 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 D 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 & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. -Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: i.
_ I.�.0 2 �S
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
43. Backflow Irrigation
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING %/¢� isys
48. Special Requirements Completed A
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
,. No, Date
OWNER ji j,TZER ENTERPRISES - C,M. DATE 9-26-69
JOB ADDRESS 1056 Santa Cruz ' -cle BU'' -ING PERMIT NO. 30873
GENERAL CONTRACTOR Same DESCRIPTION of WORK .esidence W/Attached Garage
AP No. - LOT 18 TRACT 6638 FIRE ZONE VALUE $29,563.00
INSPECTIONS Signature Date GROUP I Er, j TYPE V ZONE R-1
SOIL Al `il'/ 7O' SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
WATER�/G , ..1-70 Pei
�, Plu ing
ROUGH PLUMBING r� �y/JIG -(-'JO Ia/-i - 21e 05i--
PROP. SWR. LINE 'HOUSE CON. u A4c4-rd. -7th �� I !OJ g o 5-5747, te
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING 714yL�5[�
L-'z--ta
TEMPORARY SERVICE OR POLE
UNDERGROUND fl POWER ❑ /
ROUGH WIRING 'L-it'?o Heating and ent.
TRENCHES ICI FORMS ® STEEL REINF. 5tJ 4_;-7 0 �/ u^/,V jam- cam.// Q,l�J/�
FLOOR SYSTEM tf-/'�-1° '.L[ii'd f' . MAOI-/eC fll• fii7S 7fry'/lj.•--
BONO BEAM n STEEL, R�INFORCE n -
SHEATHING a^,yn�-111 1° 5'477/A
FRAME AND FLAS 'N t ij//7'/
LATHING — IN OUT 44 7// I
PLASTER, BROWN COAT fr/1 re
STRUCTURAL, FINAL Ln Q` �J E�fc qq
HEATING, VENT., REFRIG. 4?H-y L q- A-titI LrJ iti. /5-/�T S/iy/.�
PLUMBING, FINAL AND GAS TEST n - --ine 249 / /
ELECTRIC, FINAL ��t fO /Q,4D
BUILDING, FINAL JnWI'^K'�L_ Wilt
J
30L3 1 PAID
COSTA MESA BUILDING-SAFETY DEPARTMENT
.16.If ?_-69cwsA00 408* ***152.25
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI D 8 D ERC ED DATE ISSUESS
BUILDING 1056 Santa Cruz Circle ' D41 C j SEP a 6 9
ADDRESS
PERMIT-(Y S73
OWNER Heltzer Enterprises-Costa Mesa A.P.NO. �— 6�
MAIL BUILDING �p'
ADDRESS 740 No. La Brea Ave . ADDRESS ��S-� i L
La i L.A. Calif. TEL. 213 6638 18
a U CITY NO. 937-2171 TRACT LOT BLOCK
f- Z
Z< CONSTRUCTION NEW ADD ALTER REPAIR I MOVING DEMOI ISH
O N LENDER United California Bank
a m Main Office
J D BRANCH
V)
6th and S rin L.A. OWNER / 7 L
CO J ADDRESS p g, VALUE C
J< OR ENGINEER Frank Gonzales TEFL' 532-6878 USE $ dn�'�(�
O
z a 1336 E. Chapman Ave . Orange,Cal. ZONE TYPEV. GROUIC /X
w CC ADDRESS U
a LLl APPROVED
IllJ O CONTRACTOR George J. Heltzer & Assocs. BY DATE
00
7 cc ADDRESS Same as Above Si,a 1� t ay.
W w TEL ZONE NO.OF USE OF NEW b
Zi CITY NO. EdPLANS 2 BUILDING Res. W�Att.Car.
STATE CITY YARDS APPROVED YARDS APPROVED
NCL LIC. NO. 201098 LIC. NO. 1707 MAIN BUILDING ACCESSORY BUILDING
7 O (FROM C/L SREETI
SIZE NO.OF BLOCS.
5 .T
OF LOT NOW ON LOT FRONT T. FT.
USE OF
EXISTING BLDG. R SInF IF—T. FT.
F SIZE OF NO.OF QQLI
Z NEW BLDG. ROOMS STORIES L.SIDE O• FT. FT.
U .1aEXTERIOR WALL ROOF
.1 "CET.
/
_ COVERING COVERING _REAR FT. 6 FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a
a MAIN BLDGS. ACCESS. BLDGS.
Q f VAR.# DATE
O C.U.P.# APPROVED
F Residence with attached garage APPROVED ii
/ s,/r
Z -HY WLD /� /,, DATE /I/ b /.6 /
O Plan No. 484— 5/03 !I�
UI hereby acknowledge that I have read this application and state
D that the above Information is correct and agree to comply with /4 Q A /-7
cc all laws regulating building construction, and I shall not employ 42•
41
I- any person in violation of the workmen's compensation laws of -
H the State of California. (� Q✓-� co
ZI hereby certify that I em properly licensed as a contractor under ��0 SO. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: r<
am exempt from the provisions of the State of California Business J ,A L/�/
and Professions Code. Division 3,C .ptar 9. V Lt , 6 a PERM"�T FEE $, 5 �- �Np7
Signature of ' , L� D
Permittee S-c9� PLAN CHECKS <- Q 7J
n 0,00
Authorized Agent /- TOTAL
O A /.3, j, rC