HomeMy WebLinkAbout3134 SHARON LN - Building PermitsCITY OF COSTA MESA '
(,OSTa R'F4q BUILDING DIVISION
A
r gig" 77 FAIR DRIVF, COSTA MESA, CA 92526 - (714) 754-5273 - Fax (714) 754-4856 - www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P11-00107
PERMIT TYPE PLUM
STATUS: ISSUED
APN: 14102307
DATE ISSUED: 06/22/2011
PHONE:
ISSUED BY: KJB
JOB ADDRESS: 3134 SHARON LN CM
Suite/Unit:
Vicinity:
CARBAJAL, MARIO
SCOPE OF WORK: REPLACE 40 GALLON WATER HEATER. SAME LOCATION
OWNER:
VELEZ, REYNERIO SIMS TR
Address:
3134 SHARON LN
PHONE:
714.546-7846
City/State/Zip:
COSTA MESA, CA
APPLICANT:
CARBAJAL, MARIO
Address:
6250 PARAMOUNT BLVD
PHONE:
213-746-4689
City/State/zZip:
LONG BEACH, CA
CONTRACTOR: RELIABLE ENERGY MANAGEMENT
License No. 704414
Address:
7201 ROSECRANS AVE
'. PHONE: 562-984.5511
City/State:
PARAMOUNT, CA ZipCode:
90723
CELL:
ARCHITECT;
License No.
PHONE:
ENGINEER:
License No.
PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
-i
TOTAL FEES: $35.80
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 volt result in the expiration of this permit.
CODE 4. INSPECTION TYPE DATE INTMALS CODED INSPECTION TYPE DATE IN ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final - 208 Final Plumbing '
200 Final Re -Roof 210 Final Electrical
201 Final 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
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 workerscompensation 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 ar
Carrier: Sku 6VIkCQ 30,y`tld Lit -
(Tnis sector need not be completed d the ppermrt is valued at one hundred Collars ($100) a less )
Policy Number: W C4nS3 1001111
❑ 1 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' co-nsation provisions of Section 3700 of
the Labor Ciaete, I shall f wit with these provisio s.
pgtwnt's Sigy Dal
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 ilsin f II force and effect. A�
Lic. # V L4 f 14 Class # I "4
care Dale
CONSTRUCT O�I .L'ENDING 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, Gvil Code).
Lender's Name:
Lender's Address:
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 (S500).):
❑ 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:
30574613/071
Owner ID verified by driv,. .cense. ❑ 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:
❑ 1 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, The 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.
ApWrarn s 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 feel 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
hazamous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
S. 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.
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 property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
SignawImir Legal Owner s Date
Z 1
Andlor Aulno Date
f�-ThescriUti�e Certificate u('
Residential Altarntiunc
i.
.� I'roj ecl Nnmc:
�13L1 S6u,wi
�Rcsidential
CF -I R -A LI'l- ---. 1
'Pn'_e 1 ui'5) 1
p of Stories
U
General Lilurmatiou
_Elpfly uB:54['iaCe i)Btat)S
A IS I C j 1) 1 C
Site Address: JJ4L
L
Lnl'orcement Agency: Late: / ..
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Standard
Building'! ype Singlc Palnily ❑ INulti Family
Circle the Fronl Orientation'. N, E, S, V,', w degrees
- "Drained Continuous - • JA4 -
1'rc jccl Type: D Alterations D Envelope D Fenestration D Roel' D HVAC
_Framing
Tagg/ Assembly Name Material -_ Spacing,
ID or Tyoet and Size'-- or Other?:'
Conditioned Fluor Area (CFA)'
Replacement or Change Our D Duce Replacement 'Water Heater'
Assetbbly
U -factors
;NOTE: This fnrn) isnot to lit., user) jar Newly Construcled Buildings at Addhirins
insulation Values Far Opaque S'uifaces (for Furring use the Mass and Furring Sir ips Coast,twiio, table hclow)
Assembly Alteration - -
V
D Opening of framed eavity :done- Aherali nis; Ilia/ involve the Opening of the fralned cavil), (?)"0 wall, ceiling, or floor mist install the
mandololt, merlin ou het'nlarlmi valaC per" §)JO )oithe all6)'ed,as'sambl)l Fill In Columns A —C' and elder mandOlon, i)iSGlanO), 1;0111C it? CO11fI111i H
D ReplacentenI of entim ass dill y- Replace ... Cal q1 air erilh c Wal), ceiling, qi fioo' amemrli,, LCIub'ai The installalio, of Component
Package- D irixularion values in Table 151-C.. Fill. in. Columns A _ J:,,
For thc.furred portinueil of Mass Walls see Tiurnng Stripe Construction Tnblr.'lielow: " --
A IS I C j 1) 1 C
F C H 1 .1 1 1C
L
. 1'.ro rased -'NMI ::.: ,. -
Standard
Values From JA4 Table
_ Thickness,
- "Drained Continuous - • JA4 -
Prvpvsed
_Framing
Tagg/ Assembly Name Material -_ Spacing,
ID or Tyoet and Size'-- or Other?:'
U-
-factor".'.
JA4 Table Cavity .Insulation - Assembly
.Nutnbers R -values R -Value''" Cell' Values .
Assetbbly
U -factors
V
New For furred assemblies, accoun,ins for Covo nous Insulation R -value, see Page JA4-3 and Equation 4-1. For caladating finned walls use the Mass and
i r`nrrino Cousnvciinn mhle beton',
1. o Tag/ID indicate tine idenlificmion name that matches the building plans'. "
For
2. Judicate the Assend)h� Numr, m type: Raoj/Ceiling, Walls, Floors, Slabs', Crawl Space, Doors and ere ... Indicate the Frame type and Size: For
Woad, Metal, Metal Buildings, Mass, elver 2x4, 2sA, or etc... sec JA4 for other possible frame r tric assemblies.
3. Enter the thickness for' muse' in inches at Spacing between f inning members Bruer; ] 6 "or 24 "OC; or Other _jo' all other assembly deso-ifinon
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and are....
4. Bused on the Climate Zane; enter the Siandm'd U -factor f Om Table 151-8, C orD for each d fferem assembly Name or, Ope.
5. Enter the Table number that close(, resembles the proposed assembly.
6. Enter the R-vaiuc that i.e being installed in the wall caval, ar between the fT'aming; othmvisc, enter "0'".
7. Enter tire Continuous Insulation It -value for the prepared assembly; otherwise, enter "0
b'. Eater the rnty and collum, of the U-famm vale based on Colman F Table Number and enter the Assembly U -factor' in Column 'I
). The P, oposed Assunrbh' U -tach,. Cnhunn .J, mus' be equal in or less than the Siandnrd U -(attar in Coburn, E m conrol v.
Fuiring 5'mfrs COI1S miction TableFor lvl'dss Walls Onh,
A IS I C j 1) 1 C
F C H 1 .1 1 1C
L
M
I'ruposed 1'raperlics nl Masuuly'and Concrete
Added Interim or Exterior Insulation
Wally lironl Reference
in Flirting Space from Reference
.loin( A )Icuda'fnblr4.3.5. 4.3.6. 4.3.7
Joint Aplicildix Fnblc 4.3.13
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Filial
Asmublv
Nass
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Comment
Regislrulion Number: Ilegisunlion Date/J'inrc:
2(1(18 Residemial Colnpliancc Forms
HERS Provider:
August 2009
Prescriptive Certificate of Cornpliance- esident'ial CF -112 -ALT'
Residential Allerations ' f Climate 4 of S)
1'rgjecr-Nam u'Lonc it R o1'Stmiea
y - �_-
I"IV'AC SYSTEMS- HEATING
Distribution Type
(Standard, RCelrenlahil )'
Minimum
Tank
Capacity (gal)
Duct m Piping
-
Configuration
Renting Equipment
Efficiency
Distribution
1161'nlatlml
Thermostat
(Centrad, Split,
I y pe and Capacity1'z's
(AFUE m HSTF)
Type and Lou tion"
R -Value
I Y pe
Space, Package rn 1-ly(11011ic)
1. hndicale Flealing 7jgpe(Central Furnace, Wall Furnace, Heal pump, /]oiler, Elect ic' Resislonce, etc.) ;
2. Electric resistance healing is allowed only in Component Package C, or except wherc'elecn"ic heating is supplemental (i.e., if local capacn),
< 21CN'.or 7; 0011lydhr electric heating is corm alled by a rime -limiting device na exceeding 30 minwav). See §J51(I)J3 exceptianr.
3. Refer la the HERS Yerificaliar .rection on Page 4 of the CF -1 R -ALT Farm for additional requirements and checJ: npplicnble boxes.
g..Arcfica(e 7jrpe or Location (Ducts, H),drmrie in Floor, Rothmans, etc.) -
•HVAC SYSTEMS - COOLING -. W - .:_ .. .. ....... ... . _ -
:
--'Ductor Aipitigt . .. �
_
.. Conf� oration :..._.-.-
-.:-.
-''• Cooling Equipment ,;'; _ ,' (SEEIUEER or
.' !)istributioit "' Lpsulahon ,Thermost tl,
,. (Cep6'al, Split . -,. .
and Ca pncity�'': "• - COP),.
. Type and Location" — R -Value -T e
Space, Packs e or Hvdronic)
1'.IndicaleCooliing,Type(A/C,'Beat pump, Evap.:Cooling,'etc)'" - = •-�. - - -:^ -"- -
2. Refer iov;he HERS Verification se`ction'on Page 4 of fhe CF=1 R -ALT Forni for additional requirements and cb6ck applicable boxes.
3: Indicate Tvae of Location (Ducts, Hvdrarric in Floor, Radiaant etc.)
r"A'ATE
R HEATINGwater healers and boilersfarboth domestic hal waler (DHW) heaters and hpdronic space healing. Individual dwelling DHW hearers must be a' propane fired, and map not exceed 50 gallons. Hot water pipe insuldtion from the DAN' healer to the kachen(s) and on all underground waxer pines is re uired in all canoonenr packages in all clinmte zones.
I
i
�I
ii
Water Henter Type/Fuel
Type$
Distribution Type
(Standard, RCelrenlahil )'
Number In-
System
Tank
Capacity (gal)
External Tank
Energy Factor or Insulation
Thermal Efficiency R -Values
I�
h
i,
i. 1. Indicale Type (Sarage Gas, Heal Pump, Ifratania nexus, etc.) I'
2. lieeirculnling,sisicnty saving multiple dwelling units shall nice! tine recirc larion iequirennems af,¢150(n). The Prescriplive reyuiremenls do
' nal allow the insln/talion of a recirculatirng water hearing s;paaem for single dwelling rails. ,
3. -The external water hearing iatric and pipes shall be inculaled to meet the reaun-cmews of ,0306). j
SPECIAL FEATURES The enfm'cenenl agency should pap special aaenlion to fhc Special Features• specified in This checklist below.
These ilennr map require wrillen jusiihcanion ane) docwnewation ands• pecial verification.
NEW ROOF ASSEMBLY -Radiant Barrier
The ❑ulimu barrier requirement of §151(1)2 does nol aptly to roof altcrMions.
Slab b;tlgc (I'arimetur) Ltsuhtliun
DYES D NO
YES: hi Cli nitc Zone 16 iu Component Pucleages D, R-7 insuhRioo ie required.
llcated Slnh Lrsulaliun DYES D NO
YES. Slab etl}au insulation ret Unctl for all ncotcd ;;lobi, in all Clhnatu Zoues. See details In Toblc I I1; -A of tbc. sumdurds.
Raisatl Slnb Lnsul;dlou D YES D No
YES. In Climate Zones 1, 2, H. 13. 14 L 16, 1d -l; insulation is requlrcd: in Climate Zones 12 & 15, R-4 is required under component Package D.
Thermal Mass
To obutin Compliance Credit for the Installation or tbernpal mass, use the Pcrfor mace Approach.
Registration Number:
20013' Residential C'amplicrnce Farms
Registration Dae/Tinje.:
HERS Provider:
August 2009
h4ftDdal:Or-y Measures SummaryMF-IR
(I ell a
Resietil — (Pare I of 3)
Site Address: EnforcernenI Agency: llate:
NOTE: Low-rise residential buildings subject to the Srandw cis nnhsl comply with all applicable mandatory measures listed,
regardless of the compliance approach used. More siringehv enerL measurer listed on the Certificate of Compliance (CF -IR,
CF -IR -ADD, or CF -IR -ALT Fmvm) .shall supersede the items marked with on asterisk (`) below. This Mandatory Measures
Summary shall be inco7porated inn the pernhil docunnents oval the npp[icablgfenuu ershill be considered bP all paries as mininnun
compohenl/ierfo'mcmce specifications whether they are shown elsewhere in the documents o- in this summary. Submit all
applicable sections of the MFJR Form with Plans.
DESOUPTI ON
..Jluildin;,, Envelope Measures: .. .. .. -._ ........_._
§116(a)l: Doors and windows Between c6liditioiied and unconditioned spaces are manufactured to limit air lealeage.
§l 16(x)4: Fehestrdtioii'productss"(eacepCflef8=fa6ricateil'wiiid'dd%s)'hiive L label listing the certified U -Facto', certified Sol it=Heat Gain CoeflleienG_ -
(SHGC), and infdtiation that meets the rectinements ol'$10-1-11(a). -
§717:;tEatenor-doors; antl:wwdowsnre: weatbec-stripped; all.joints.and penetrations me.caulked.antl sealed .. _._..... . _
§19 8(0): lltsulation'speeified or insmlled$Seets Standards for7li'snilating Material. Indicate type and include .ou CF -6R Form. ,
§118(i): The thermal-emittzbce and solar-tellectance values of the cool roofing material meets the requirements of § 11 t;(t)-wheq th installation of,
a Cool Roof -is s pecifiecl on the CF -112 Form.. -
*§150(a): Minimttiii R-19 insolaiion in wood -frame iieiling 61' equivalent U -factor.
§150(b):' Loose fill insulation I. -.shall conform .11 with manufacturer's inistailed'design labeled R -Value. .
*§I50(c): Minimum R-13 insulation in wood -frame wall or equivalent U -factor.
*§I50(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor.
§150(f): Air retarding wrap is tested, labeled, and installed according [0 ASTM E1677-)5(2000) when specified on the CF -1R Fomt.
§150(8): Mandatory Vapor barrier installed in Climate Zones 14 of 16.
§150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeanee rate is no
greater than 2.0 perm/inch and shall he protected from ohvsical damage and UV light deterioration.
Fireplaces, Decorative Gas Appliances and Gus Log Measures:
§150(s)IA: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)IB: Masonry of factory -built fireplaces have a combustion outside an intake, which is at least six squareinches in area and is equipped
with a with a readily accessible, operable, and ti hl-fittin control
dam er and or a combustion -air d,evice.
150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a fuebox jacket, when that indoor air is venter) to the outside of the
building, are prohibited.
Space CouditionhiL, Waterlicatin{t and I'lumbinp System Measures:
§110-4113: H VAC equipinctit, water healers, showerhends, faucet:: and all other regulated appliances arc certified by,the Lnergy Commission.
.§113(c)S: Water heating recol:ulation loops serving multiple dwelling units and High-ltisc residential occupancies meet the air release valve,
bacltflow prevention, ninth isolation valve, and recirculation loop connection requirements of 41 13(c)5.
§1 15: Continuously burning pilol lights are prohibited for natural gas: fin -type central furnaces, househol(I cooking appliances (appliances with all
electrical supply voltage Connection with pilot lights that consume less than 150 Btuhir are exempt), and )001 and s pa heaters.
I50(h): Heating andlor cooling loads are calculated in accoidanuc with ASI-IRAE, SMACNA or ACOA.
4150(i): Beating syslents are equipped with thermostats that meet thesetback requiienienls of Section 112(c).
§ 150(j)l A: Storage gas water heaters rated with an Energy pactur nu greater than the lederal minimal standard are externally wrapped with
insulation having an installed thermal resistance of H-12 or greater.
§ I SO0)1 L': Unfned storage tanks, such a;: storage amts or bacluap tanks for solar water -heating systcnp, 01 other indirect hot water tanl(s have R-12
external insulation or It -16 internal insulation where the internal insulation Ii -value is indicated on the exterior of the tan)(,
k;1500)2: First 5 feel of hot and cold water pipes closest to waist heater tun)(, 1101) -recirculating systems, and entire length of recirculating section
of hot water Jupes are insulated per Standards Table 150-B.
§1500)2: Cooling system piping (suction, chilled water, or brine linespod piping insulated between heating source and indirect hot water lank
shall be insulated it) 'Table 150-B and Equation 15(1-A.
§150(j)2: Pipe insulaliou fm steam hydrunic healing systems of hot wales systems %15 psi, meets the requirements ol'Standard!a Table 123-A.
§I50(j)MA Insulation is protectetd from damage. including that duc to sunlighl, nwislnc, equipment nutintenaucc, and wind.
§1501 1)3A'. Insultuiun lbs chilled water piping and rcingertmt xucliou lines Includes a vapor retardant or is enclosed enthely Yn conditioned space.
2008 Residential Conhpliallee Fornhs August 2009
Prescriptive Certitic:ate of Ctmlpliance: Resi(Icntial CF -IR -ALT
Residential Alterations (Page 5 of 5)
Prgjecl-(Varriy' _ n r _ r-1-Cunrate ZnneN tltof Stories
HERS VERIM CATION SUMMARY' The erl(orcement ngeneP slrmdd pqv syecial ctflervion m the F/ERS A%eusnu ea'specifiecl in this
checkhrt helmr. i1 congrleted curt/ a'igner/CF-4Il Frunr fan' all the nreuaxrrrr syieciJied .ilial/ be snLrrriucrl to rhe h:rildireg inspector' before /inn!
inspection.
Duct Sealing & Testing HERS verification is regai) edfoi this measure.
❑ YES ❑ NO YES: ht Clinmte Zones 2 and 9-16, if more than 4D linear feel of new or replacement (fuels are installed in unconditioned
space, the ducts are to be sealed per §I52(b)1DJ and the newly installed ducts tae to be insulated per 1+151(1)10.
❑ LXCEI" P10N: Existing duct systems itu,( it extended, which are cunstrit cted, i us 11 In tell or sealed with asbestos.
❑ YES ❑ NO YES: In Climate Zones 2 and 9,-I6, if tile existing space -conditioning system (1-1VAC equipmenl and ducting) is replaced, the
..(fuels areto.besealedper§152(b)1Di.
❑ YES ❑ NO YES. Ili Climate Zones 2 and 9-I6, if the existing HVAC cquipmem 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 ate to b,e
..-... . sea led. per .§ 152(b) l E..,..:....,---
❑ EXCEPTION: Duct -systems th tt a(,'(IoLffiuinted to hiive been prevumsly smiled conlL'med through IIERS,
- verification in accordance with procedures in the Reference Residential Appendix RAS. - '-
" -' - - --- ❑-* rXCEETION':-D`nct-syluems with less than 40 linear feet in unconditioned space.------ (
'❑ 'EXCEPTION: Ezfstiiiv`duct syste hs'consmucted, insulated or sealed with asbestos.
Ret"rigerant Cliwrge =Split System - HERS -verification is mquiredfor,lhis » iea.sure
r
-❑ YES ❑ NO YES: Ili Climate Zones 2 and 5-15, when the existing HVAC equipment is teplaced,(mcludiin, the replacement of the air,
handler; outdoor condensing all il'of a split system A/C or heat pump, cooling or heating coil or the finnxce heat
.
exchanger) a refrigerant charge measurement shall be verified Oct § 152(6) IF.
Central Fan'Integrated (CFI) Ventilation System alit] Fan Watt D'raH
The ventilation requirements of §150(o) do not apply to existing residential homes. '
Ducted Split Systems - Air Conditioners and Heat Pumps: Airtlow HERS verification is required for tris nicas'ure.
❑ 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 -Der §1 52(b)) Ci to meet the requirements of §151(f)7B,
r -'—
Documentation Author's Declaration StatementrAddi
certify that this Certificate of Com liance documentation is accurate and conmlet .
;MCI
rl�
any:ess:
��y� 1f' Applicable ❑ C A or ❑ CEPE
�� WJ(.0%ir1 (CerliGcatiOil 4):
City/State/Zip:(�//�
q Phone'
` A , 1, Wvi
Responsible Building Designer's Declaration Statement
• I am eligible nuclei Division 3 of the California Business and Professions Code to accept responsibility for the huil(Iiug design identifi ell tin
this Certificate of Contplionuc.
- I cerlifl' /hal the energy f1cutnreS and performance specifications for the building design identifmd on this Certlfleale of COMI)IMncc confman
LO the requirements of Title 24, Pails I and 6 of the California Code of Regulations.
• 'Phe iiuilding design featw'es Idcnlihed on this Cerlifmate of Compliance tire cousislent with the inlbrnuttion provided to dueumeul this
building design On the 011ier applicable compliance forms, wodcshects, calculations, plans and specifications submittal to the enforcement
agencv for approval with this building permil appficaljon.
Name:
Siguauue.
Company:
Date'.
Address:
License.
City/Stalcizip:
Phone:
For assistance of questions regarding the Enm'[')' Standards, contact the Lnerep Hotline. at: 1-800-772-3.3110.
Heg'i,xlralion Number: Regisrranou Un1C/Time: HERS Provider:
2006' Res'idenlial Consj)lionce Forms August 2009
Applicant
to fillip all spaces except those within heavy border lines and sign all appropriate declarations.
6327 8/27/=7 _ f I c,-
-
CITY OF COSTA MESA CONST/R'UCTI/OWN PERMIT, ' '
Project Address, 5/-34 SIJp�/Ch 4v '? Zf asla �'�js.(,..,/. ",',-
PERMIT.NO.
& a901 b �
TRACT NO.
LOT NO.
UNIT NO.
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
Applicant's MailliingAddress �' .per%a%1 f9 � u.le�U•'7LQ rya
Owner's Names -/tel e�,ro S+ s� eieZ �•- �
yl ' - / /�� hone
Address -.ir%' 5�7�'rdl� �"�"%P`+.4gS- L�� -
A.P. #
Zone
S
Main Building:
Accessory Building:
Arch/Eng. License No.
Address
TYPE OF PERMIT ❑ GRADING
❑ TENANT ❑ ELECT R AL
OTHE
El FOUNDATION STRUCTURAL
❑ PLUMBING ❑ MECHANICAL
T
Front
ZO
BA
Rear
N
Contractor's Nam Phone -
- -
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I.am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
License Class License No.
-
PROJECT DESCRIPTION 5 F OCCUP i�c�'—�
r OD
CONSTRUCTION TYPE UATION J 0 ,
- ZONE GRADING CU.YDS. ACR ��-�
C
Right
-
N
g
Left
G
R
Ping. Ref. #
Parking Req./Provided
E
I
Remarks: ' M a C SX j/
Planning Notes:
M
%'-%i1(, -� IO (�•1-
T
S
PLUMBING FEES
Date Signature _
Bar Sink. •
Showers -
ELECTRICAL FEES
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) - —
J. Backflow Preventer
Service Sink
Automatic Washer
Transformer ❑ 15-50 KW
_ Backflow Irrigation
-
Sewer Ca P
Policy No. Company
eCertified copy is hereby furnished. - t'
Certified copy is filed with the city Building Division.
Construction Pole Sub.
El50+ KW
_ 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).
I certify that in the performance of the wor or I h this permit is issued,
shall not mpl�ny person in anYan r so s b oma subject to the
Worker tion Laws of Cali r
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains Solar Tank
Fan
Motors ❑0-1 HP ❑1'f.-8
Floor Drains
Swimming Pool w/Spa
F.A.U. -
Inc. -So lar C39-15 HP E]16-15+NOTIC
•5
Date Signal ura.
: If, after making this declaration, you Should be me Subject to the
Workers' Compensation provisions of the Lab Or Code, Von must forthwith
comply with such provisions or this permit shall be deemed revoked.
Floor Sinks
Urinal
Fixtures
Micro Wave
Gas Service Outlets
Water Closet
Device Boxes
Pole Light
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance
Interceptors
p
Water Heater
Outlets
Range
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Kitchen Sink
Water Service -
Switches
Sign
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city Or
Lavatories
Auto -Wash
Garbage Disposal
_
Standing Sections
P—Trap
Laundry Trays
YGenerator'❑0.5
KW 05-15 KW
Trash Compactor
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/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 70exe of
Division 3 of the Business and Professions Code) or that he/she is exempt
Roof Drains
-
-
- -
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 I, as owner of the property or my employees with wages as their sole
cdmpensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or IM-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con.
tractor(sl license pursuant to the Contractor's License Law). am aware that
proof off their Worker's Compensation insurance should be provided to me.
Cl I am exempt under Section— B. & P. C. for this reason
-4-
ReinspeMiOn Fee
$15 Issue Fee $ 3
Reinspection Fee $15 Issue Fee $ 3
MECHANICAL FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date (G�
y t �' T 6
Applica�on Issued By - Date
Boiler
Hood or Type I ❑
Canopy Type I I ❑
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0-100-000 BTU 0100,000BTU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
- - ELECTRICAL
'GRADING
PLAN CHECK 50%
MAHANICAL
P CHECK 25%
SUMMARY
$
$
$
$
$
$
$
$
-OF FEES
SMIP $ • SO
PERMIT
ISSUANCE $
ENERGY P.C. $
$
MICROFILM $
TOTAL FEE $ sTfJ n
Exhaust System ❑ Multiple ❑
-
System epair/Alteration E p
Firepl/Fact. Bit. ICBG #
Fire Dampers V)S eC
10(1
1
Date Owner
I herecertify•that I have read this 1polication an state that the above
information is correct. I agree to comply with all city nd county ordinances
and state laws r sting to uilring construction, and hereby authorize repre-
sentatives of t (1 city o ante upon the above-mentioned pr perty`for
inspection r 96 s. / �i,.. /lis
Signatur X Date I"
Drivers' License or'SS
Heating System & Ducting
00-100,000 BTU ❑100,000BT
Registers
_ SIB
Reinspection Fee $15 Issue Fee $ 3
:MF 0865-46, rev. 10/84 White - - Applicant; Pink - Accounting;
Goldenrod - Assessor
,
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
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-
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVALTO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrg'rnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
-
60. Backwash Lines, P -Trap, ❑ 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
14y 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
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas El Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑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: (�
34. Final Heating & Air Conditioning
07 �-
35. Final Gas Pipe -Test
'
36. Hood or Canopy
37'. Final Factory Fireplace
38. Fina 1. PI umbi ng
Aj
39. Water Service-Final.All
40. Gas Service -Final
41. Solar Domestic -Final
-
42. Backflow Preventer
'43. Backflow Irrigation
44. Landscape Irrigation System
-
45: Sound Attenuation
w p
46: -Handicap Regulationslilcomp
(et inspections
47, FINAL STRUCTURE & BUILDING
-
48. Special. Requirements Completed
--
L)a e
K•
49. E lectrivRe lease to Edison
: f
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY,
No. Date
'
vtj,
r>t>l,r
JOB ADDRESS
VALUE
PERMIT NO.
AP No. LOT 04 TRACT4355 , FIRE ZONE DESCRIPTION OF WORK Nes•wfaLL.ua
INSPECTIONS Signature
DATE
GROUYZ�-&J TYPE V 70 4E
SoilPER
Gas / L!1
SUBCONTRACTOR
vIlTS ISSUED
DATE
NUMBER
Water
`
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing S
Miscellaneous
Prop. Swr. Line Pi -House Con. St. Swr. B
�i,3
1Gzi3
_ _
d -.76 - .7
/✓9_
Sprinkling System
Lons�truchon Pole
Underground ❑ Power ❑
Rough Wiring
renches Forms Wr- Steel ReinF. ❑ _
/�//—(,3
Floor System
Bond Beam ❑ Steel Reinforce ❑ _
Sheathing
@Tame and Flashing
y-2-;?
Gathing — In gr Out m/
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ Final
Heating. Final
Plumbing Fixtures, Final i
�•F-� g
Final Gas Test 6-,4L
Electric Fixtures, Final
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDINGADDRESS lti
COSTA MESA. CALIFORNIA
F ��CEIVED
Lot 84, Tract 43551 lan 500-D111962
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
Harbor Hall of Fame Homes, Inc.
RECEIPT NO. PYNc. /T(3
OWNER
MAIL P.O.BOX 2066
RECEIVED BY I DATE RECEIV D., GATE ISSUED
ADDRESS
/o�ZZl 6 ZX CEC j 1U0
(�
Santa Ana
BUILDING
CITY NOIII /-220
Jamison NoL544-0040
COSTA MESA. CALIFORNIA
ORCENGICT INEER
225 11D" St., Tustin
FIRE
ADDRESS
ZONE TYPE GROU401'
Residential Bldg Corl
APPROVED
CONTRACTORLifetlme
BY DATE
ADDRESS 28 2131 So. Artesia
ZONING
ZONE FLA OF j USE OF NEW S qy
q N. 4
I PUN9 L BUILDING 'v/.
Santa Ana
CITY Y—�
STATE208676 TEL KI 9-2204
LEGAL / y 7R V 3 j y^
DESCRIPTION c
SIZE 6ow, ,I NO. OF BLDGB.0
OF LOT Now ON LOT
A. P. NO.
USE OF -None
YARDS EVES
EXISTING BLDG.
APPROVED ALLOWED
BHTBACK LINE PROM 52-1611Z(tl OI
l
ICENTER LINE ST.)
CENTER OF STREET REAR YARD
FRONT FT. IN.
51
51
ISIDE
S—
YARD LEFT
RIGHT
R. BIDE FT. '�IN.
DESCRIPTION OF WORK
— —
L. SIDE FT. IN.
NEW I XII
ALTERATION ADDITION I
(/
REAR 3 / IT. IN.
REPAIR I
II MOVING DEMOLISH I
APPROVED DATE
�3
NO. OF
E
SSIZBUILDING I7 0, ROOMS 10 STORIES 1
EXTERIORW ( ROOF
Y�aSter Shake
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Sin le famil residence
1 HEREBY ACKNOWLEDGE TH 1 HAVE RGD THIS APPLIGTION
AND STATE THAT THE ABOV 1E CORRECT AND AGREE TO COM.
THE AMOUNT SHOWN ER VALUATION IS FOR THE
PLY WITH ALL CITY O A CEB AND BT GULAT G
PURPOSE OF EBTABL HIND A PERMIT FEE ONLY.
VALUATION
PERMIT FEE $/
BUILDING CONSTRUCTI
SIGNATURE OF
PERMITTE
)�_
/
$ / j
PLAN CHECK $
]
AUTHORIZED AGENT
TOTAL FEE sO