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HomeMy WebLinkAbout2812 SHANTAR DR - Building Permits 411 Ilb 1 t CITY OF COSTA MESA pMF BUILDING DIVISION • ,gia> a 77 FAIR DRIVE,COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FI mm.` .. 1.0411 1 FOR INSPECTIONS CALL: (714)754-5626 Naamrn`�'' PERMIT NUMBER: BC09-00180 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: . POOLSPA DATE ISSUED: 06/02/2009 ISSUED BY: RMD JOB ADDRESS: 2812 SHANTAR DR CM • Suite/Unit: APN: 13940306 Zoning:R1, Vicinity: - Primary Occ: R-3 - . Const Type: SQ. FT: ' 437 .Valuation: $40,000.00 SCOPE OF WORK: IN-GROUND GUNITE POOUSPA.400K HEATER. 2 ADDITIONAL GAS OUTLEiS.(1)TO BBQ, (1)TO FIRE PIT. 1 MISC ELECTRICAL FOR BBQ. - - . OWNER: IMPARATO, STEPHEN AND SUSAN Address: 2812 SHANTAR DR - Unit: Phone: 714-438-2402 " ', City/State/Zip: • COSTA MESA, CA • APPLICANT: SCHWARZ,JIM Address: PO BOX 28437 Unit: : Phone: 714-241-POOL City/State/zZip: SANTA ANA,CA CONTRACTOR: SCHWARZ CUSTOM POOL -. - - _ :_ License No. 770413 , . Phone: 714-241-POOL - (Address:" PO BOX 28437Unit: " ' Cell: City/State: SANTA ANA,CA ZipCode 92799 ARCHITECT: License No. PHONE: ENGINEER: TODD L LACHER License No.67656 PHONE:714-630-6100 • COMBINATION PERMIT FEE SUMMARY Building Plan Check: $353.11 . " - Building Fees: $543.25 _ . Electrical Fees: , - $9120 Mechanical Fees: • $60.75 . Plumbing Fees: • " ' 690.40: . . SMIP Residential: • $4.00 ' • SMIP Commercial: $0.00 Bldg Std Admin Fund -$2.00 ' • TOTAL FEES: $1,144.71 "Refer to fee receipts for all fees paid for project - - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this per CODE It INSPECTION TYPE DATE IN ALS CODER INSPECTION TYPE DATE -r 'ALS q 1616 Fixed System Final Fire Prevention 206 Final Mechanical I • �� 1266 Pool Spa Final 7/Ia(1' 208 Final Plumbing " .- .as h /1 200 Final Re-Roof 210 Final Electrical tet' 1 201 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 Owner ID verified by driver license. ❑vles 0 Mo s I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. M Expires: O 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 ❑ 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 Carrier 9S 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 this section need not be competed d the permit is valued at one hundred dollars(4100)orless.1 2 Art 2,Sec.341,Title B,California Administrative Code). Pot Number: 0 i Dk/LMZ' .5 — 2.67 ❑ 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 become subject to the workers' core ensation provisions of Section 3700 of Applicants Signature Date the Labor Cod ,I all forthwith corn ly with these provisions. 6. 2 • 0 ci Division of Industrial Safety Permit Number: ppuranf rogue- cWt^'� 1 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ 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 effecta registration form for acutely hazardous materials? ❑Yes ❑ No rL'ic• a -• 1 ¢Cfas •#. e—•S:_3 (Section 25533 of the Califomia Health and Safety Code, with some ti rte'-'^' exceptions, requires registration with the Costa Mesa Fire Department by --"Ir_ ti.L__... • 9 each business which at any one time has on hand a quantity of acutely e.mr2.• i5ionewie--- -7......_ Z •Q 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 ❑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 Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑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 fumished 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(5500).): 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 ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature 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 Contractus 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 of al wner(s) Date Signature Date (O/ , �1 . O 305]-46(3/07) AndlorA ad Appfimm cilia% � 1 c "D (�0 �� nada,* POOL AND SPA REQUIREMENTS The following information is required in a clear and legible manner. All information shall be complete and on the plans. Four sets of plans showing all of the following with measurements shown from property lines, buildings, patio covers or other structures. 1. Name, address,phone number of owner. 2. Name,address,phone number,type of license of any contractors or subcontractors. 3. Pool and/or spa location. 4. Equipment location. 5. Gas and electrical meter locations. 6. Overhead service lines and serving pole location. 7. Type of gas and electrical conduits to be used. 8. Size of main electrical service (if less than 100 AMP, service is probably inadequate and will have to be upgraded to minimum City requirements.) 9. Rating(horsepower,voltage,amps)of all electrical equipment. 10. BTU rating of gas heater. 11. Distance and size of gas line. 12. All electrical outlets within 15 ft. of pool/spa. 13. Capacity of spa(spas only). 14: Handrails, ladders, slides and diving boards(if any). 15. Location and details of solar panels(if any). 16. Location of doors and windows within 5 ft. of pool/spa. 17. The type of construction—gunite,poured concrete,prefabricated fiberglass or other. 18. The pool dimensions, including the depth and adequate cross-sections drawn to scale. 19. Computations, stress diagrams and other data sufficient to show the correctness of plans; including • reinforcing steel schedule and details. 20. A statement by the applicant concerning the anticipated nature of the soil under and around the pool structure (expansive, moderately expansive, non-expansive). (A soils report may be required by Building Division prior to permit issuance.) 21. The Engineer's wet ink signature is required on pool plans and calculations. 22. All semi-private pools and spas shall conform to California Administrative Code Title 24 handicapped requirements (hotels,motels, recreation areas for lease to public or publicly funded projects). 23. Where a permanently installed pool is constructed, at least one 120 volt receptacle shall be installed a minimum of 10 feet and not more than 15 feet from the inside wall of the pool and shall be protected by a ground fault circuit interrupter. 24. Indoor installation of spas and hot tubs, receptacles shall not be closer than five(5)feet to spa/tub. 25. Receptacles located within twenty(20) feet of a spa or hot tub shall be G.F.C.I. 26. Receptacles for spa/hot tub motors shall be G.F.C.I.protected. 27. Comply with Costa Mesa City ordinance 93-12 requiring protective bathers, fencing and/or enclosures. 1039-46 (REV.10107) GENERAL REQUIREMENTS • 1. If capacity is 750ga1. Or more,backwash and p-trap shall be installed. 2. All P traps shall tie in at lower terminus of house drain. - • 3. If permanent fill line is not installed, nearest hose bib shall have an anti-siphon valve. 4. All PVC shall be 18 inches underground. 5. Pressure test shall be required on entire system(35 P.S.I air test or water fill)prior to back fill. 6. PVC gas lines shall be tested at 60 P.S.I. 7. Pressure test required on entire system(35 P.S.I. air test or water fill)prior to back fill. 8. Overhead Edison drops shall be installed per NEC 680-8. 9. Clarification or additional information may be obtained by telephone: (714) 754-5273, between 8:00 a.m. and 4:30 p.m. REQUIRED SETBBACKS Pool Heater vent,outlet as per UMC 806.7: 1. 4ft from property line. 2. 4ft from doors/windows. 3. 4ft from attic vent. Pool/Spas: Above-ground pools and spas shall not be located in the required front yard setback from a public street and are subject to 5 foot and 10 foot yard setbacks for main structures. Any deck that is raised higher than 6 inches above grade, will also be subject to the 5 foot and 10 foot yard setbacks requirements. Please consult with Planning Division regarding any in-ground pool and/or spa that are proposed to be located in the front yard. 1. Overhead Edison drops shall be installed per.NEC 680-8. 2. It shall be unlawful for any person to install, remove, alter, repair or replace any plumbing, gas or drainage piping or any fixture, swimming pool heater or treating equipment in a building or premises without first obtaining a permit to such work from the Building Division. 3. Clarification or additional information may be obtained by telephone (714) 754-5273, between 8:00 am and 4:30 pm. • 1039-46 (REV.10/07) SPECIAL CONSTRUCTION 3105.4 Canopy materials.Canopies shall be constructed of a type of construction of isolated radio towers not more than 100 rigid framework with an approved covering that meets the fire feet(30 480 mm) in height shall be Type IIB. propagation performance criteria of NFPA 701 or has a flame 3108.4 Loads.Towers shall be designed to resist wind loads in spread index not greater than 25 when tested in accordance accordance with TIA/EIA-222.Consideration shall be given to with ASTM E 84. conditions involving wind load on ice-covered sections in localities subject to sustained freezing temperatures. SECTION 3106 3108.4.1 Dead load.Towers shall be designed for the dead MARQUEES load plus the ice load in regions where ice formation occurs. 3106.1 General.Marquees shall comply with this section and 3108.4.2 Wind load.Adequate foundations and anchorage other applicable sections of this code. shall be provided to resist two times the calculated wind 3106.2 Thickness.The maximum height or thickness of a mar- load. quee measured vertically from its lowest to its highest point 3108.5 Grounding. Towers shall be permanently and effec- shall not exceed 3 feet(914 mm)where the marquee projects tively grounded. more than two-thirds of the distance from the property line to the curb line,and shall not exceed 9 feet(2743 mm)where the marquee is less than two-thirds of the distance from the prop- SECTION 3109 erty line to the curb line. SWIMMING POOL ENCLOSURES 3106.3 Roof construction.Where the roof or any part thereof AND SAFETY DEVICES is a skylight,the skylight shall comply with the requirements of 3109.1 General. Swimming pools shall comply with the Chapter 24. Every roof and skylight of a marquee shall be requirements of this section and other applicable sections of sloped to downspouts that shall conduct any drainage from the this code. marquee in such a manner so as not to spill over the sidewalk. 3106.4 Location prohibited. Every marquee shall be so 3109.2 Definition.The following word and term shall,for the located as not to interfere with the operation of any exterior purposes of this section and as used elsewhere in this code, standpipe,and such that the marquee does not obstruct the clearhave the meaning shown herein. passage of stairways or exit discharge from the building or the SWIMMING POOLS.Any structure intended for swimming, installation or maintenance of street lighting. recreational bathing or wading that contains water over 24 3106.5 Construction. A marquee shall be supported entirely inches(610 mm)deep.This includes in-ground,above-ground from the building and constructed of noncombustible and on-ground pools;hot tubs;spas and fixed-in-place wading materi- als. Marquees shall be designed as required in Chapter 16. Pools' Structural members shall be protected to prevent deterioration. 3109.3 Public swimming pools.Public swimming pools shall be completely enclosed by a fence at least 4 feet(1290 mm)in height or a screen enclosure. Openings in the fence shall not SECTION 3107 permit the passage of a 4-inch-diameter(102 mm)sphere.The SIGNS fence or screen enclosure shall be equipped with self-closing 3107.1 General. Signs shall be designed, constructed and and self-latching gates. maintained in accordance with this code. 3109.4 Residential swimming pools. Residential swimming pools shall comply with Sections 3109.4.1 through 3109.4.3. SECTION 3108 Exception:A swimming pool with a power safety cover or RADIO AND TELEVISION TOWERS a spa with a safety cover complying with ASTM F 1346. 3108.1 General. Subject to the provisions of Chapter 16 and 3109.4.1 Barrier height and clearances. The top of the the requirements of Chapter 15 governing the fire-resistance barrier shall be at least 48 inches (1219 mm) above grade ratings of buildings for the support of roof structures,radio and measured on the side of the barrier that faces away from the television towers shall be designed and constructed as herein swimming pool.The maximum vertical clearance between provided. grade and the bottom of the barrier shall be 2 inches (5t 3108.2 Location and access. Towers shall be located and mm) measured on the side of the barrier that faces away from the swimming pool. Where the top of the pool struc- equipped with step bolts and ladders so as to provide ready ture is above grade,the barrier is authorized to be at ground .access for inspection purposes.Guy wires or other accessories level or mounted on top of the pool structure,and the maxi- shall not cross or encroach upon any street or other public mum vertical clearance between the top of the pool structure space,or over above-ground electric utility lines,or encroach and the bottom of the barrier shall be 4 inches(102 mm). upon any privately owned property without written consent of the owner of the encroached-upon property, space or 3109.4.1.1 Openings. Openings in the barrier shall not above-ground electric utility lines. allow passage of a 4-inch-diameter(102 mm)sphere. 3108.3 Construction.Towers shall be constructed of approved 3109.4.1.2 Solid barrier surfaces.Solid barriers which corrosion-resistant noncombustible material. The minimum do not have openings shall not contain indentations or 424 2007 CALIFORNIA BUILDING CODE SPECIAL CONSTRUCTION protrusions except for normal construction tolerances alarm shall automatically reset under all condi- and tooled masonry joints. tions. The alarm shall be equipped with a manual 3109.4.1.3 Closely spaced horizontal members. means,such as touchpad or switch,to temporarily Where the barrier is composed of horizontal and vertical deactivate the alarm for a single opening. Such members and the distance between the tops of the hori- deactivation shall last for not more than 15 sec- zontal members is less than 45 inches (1143 mm), the onds. in dwellings not required to be Accessible, Type A or Type B units, the deactivation switch horizontal members shall be located on the swimming shall be located 54 inches (1372 mm) or more pool side of the fence. Spacing between vertical mem- bers shall not exceed 1.75 inches (44 mm) in width. above the threshold of the door. In dwellings Where there are decorative cutouts within vertical mem- required to be Accessible,Type A or Type B units, bers. spacing within the cutouts shall not exceed 1.75 the deactivation switch(es) shall be located at 54 inches(44 mm)in width. inches(1372 mm)maximum and 48 inches(1219 mm)minimum above the threshold of the door. 3109.4.1.4 Widely spaced horizontal members. 2. The pool shall be equipped with a power safety Where the barrier is composed of horizontal and vertical cover that complies with ASTM F 1346. members and the distance between the tops of the hori- zontal members is 45 inches(1143 mm)or more,spacing 3. Other means of protection, such as self-closing between vertical members shall not exceed 4 inches(102 doors with self-latching devices, which are mm),Where there are decorative cutouts within vertical approved by the administrative authority,shall be members, spacing within the cutouts shall not exceed accepted so long as the degree of protection 1.75 inches(44 mm)in width. afforded is not less than the protection afforded by 3109.4.1.5 Chain link dimensions. Maximum mesh Section 3109.4.1.8,Item I or 2. size for chain link fences shall be a 2.25 inch square(57 3109.4.1.9 Pool structure as barrier.Where an above- mm square) unless the fence is provided with slats fas- ground pool structure is used as a barrier or where the tened at the top or the bottom which reduce the openings barrier is mounted on top of the pool structure, and the to no more than 1.75 inches(44 mm). means of access is a ladder or steps, then the ladder or 3109.4.1.6 Diagonal members. Where the barrier is steps either shall be capable of being secured, locked or composed of diagonal members,the maximum opening removed to prevent access,or the ladder or steps shall be formed by the diagonal members shall be no more than surrounded by a barrier which meets the requirements of 1.75 inches(44 mm). Sections 3109.4.1.1 through 3109.4.1.8. When the lad- der or steps are secured,locked or removed,any opening 3109,4.1.7 Gates. Access gates shall comply with the created shall not allow the passage of a 4-inch-diameter requirements of Sections 3109.4.1.1 through 3109.4.1.6 (102 mm)sphere. and shall be equipped to accommodate a locking device. Pedestrian access gates shall open outward away from 3109.4.2 Indoor swimming pools. Walls surrounding the pool and shall be self-closing and have a self-latching indoor swimming pools shall not be required to comply device. Gates other than pedestrian access gates shall with Section 3109.4.1.8. have a self-latching device.Release mechanisms shall be 3109.4.3 Prohibited locations:Barriers shall be located so in accordance with Sections 1008.1.8 and 1109.13. as to prohibit permanent structures, equipment or similar Where the release mechanism of the self-latching device objects from being used to climb the barriers. is located less than 54 inches(1372 mm)from the bottom of the gate,the release mechanism shall be located on the 3109.4.4 Private swimming pools(statewide). These regu- pool side of the gate at least 3 inches(76 mm)below the lotions are subject to local government modification. The top of the gate, and the gate and barrier shall have no applicable local government requirements at the time of opening greater than 0.5 inch(12.7 mm)within 18 inches application for a building permit should be verified. These (457 mm)of the release mechanism. standards become applicable commencing January 1. 3109,4.1.8 Dwelling wall as a barrier.Where a wall of a 1998,to a private,single-family home for which a construc- dwelling serves as part of the barrier,one of the follow- non permit for a new swimming pool has been issued on or ing shall apply: after January 1, 1998. I. Doors with direct access to the pool through that 3109.4.4.1 Definitions.Asused in this division, the fo!- wall shall be equipped with an alarm that produces lowing terms have the following meanings: an audible warning when the door and/or its APPROVED SAFETY POOL COVER means a manu- screen, if present, are opened.The alarm shall be ally or power-operated safety pool cover that meets all of • listed in accordance with UL 2017. The audible the performance standards of the American Society for alarm shall activate within 7 seconds and sound Testing and Materials(ASTM),in compliance with Stan- continuously for a minimum of 30 seconds after dard F 1346-91. the door and/or its screen, if present, are opened and be capable of being heard throughout the ENCLOSURE means a fence, wall or other barrier that house during normal household activities. The isolates a swimming pool from access to the home. 2007 CALIFORNIA BUILDING CODE JANUARY t,2008 ERRATA 425 SPECIAL CONSTRUCTION • EXIT ALARMS means devices that make audible, con- pool alarms"shall not include swimming protec- _ tinuousalarm sounds when any door orwindow that per- tion alarm devices designed for individual use, mits access from the residence to the pool area, that is such as an alarm attached to a child that sounds without any intervening enclosure, is opened or is left when the child exceeds a certain distance or ajar.Exit alanns may be battery operated or may be con- becomes submerged in water nected to the electrical wiring of the building. 7. Other means of protection, if the degree of protec- PUBLIC SWIMMING POOL means a swimming pool tion afforded is equal to or greater than that operated for the use of the general public with or without afforded by any of the devices set forth in items 1-4, charge,or for the use of the members and guests ofapri- and have been independently verified by an vote club. Public swimming pool does not include a approved testing laboratory as meeting standards swimming pool located on the grounds of a private sin- for those devices established by the ASTM or the gle-family home. American Society of Testing Mechanical Engi- neers(ASME). SWIMMING POOL or POOL means any structure intended for swimming or recreational bathing that con- Prior to the issuance of any final approval for the com- tains water over 18 inches (457 mm) deep. Swimming pletion of permitted construction or remodeling work pool includes in-ground and above-ground structures the local building code official shall inspect the drown- and includes, but is not limited to, hot tubs, spas,porta- ing safety prevention devices required by this act and if ble spas and nonportable wading pools. no violations are found, shall give final approval. Authority:Health and Safety Code Section 18942(b) Authority: Health and Safety Code Section Reference:Health and Safety Code Section 115921 18942(b) Ab 3305, Statutes 1996, C.925 Reference: Health and Safety Code Section 115922 3109.4.4.2 Construction permit; safety features AB 3305(Statutes 1996,c.925);AB 2977(Statutes required. Commencing January /, 2007, except as pro- 2006, c.926);AB 382(Statutes 2007, c.XXX) vided in Section 3109.4.4.5, whenever a building permit 3109.4.4.3 Enclosure; required characteristics. An is issued for construction of a new swimming pool or spa, enclosure shall have all ofthefollowing characteristics: or any building permit is issued for remodeling of an existing pool or spa, at a private, single-family home, it 1. Any access gates through the enclosure open away shall be equipped with at least one of the following seven from the swimming pool and are self-closing with drowning prevention safety features: a self-latching device placed no lower than 60 I. The pool shall be isolatedfrom access to a home by inches(1524 mm)above the ground. an enclosure that meets the requirements of Sec- 2. A minimum height of 60 inches(1524 mm). tion 3109.4.4.3. 3. A maximum vertical clearance from the ground to 2. The pool shall incorporate removable mesh pool the bottom of the enclosure of 2 inches(51 mm). fencing that meets American Society for Testing 4. Gaps or voids, if any, do not allow passage of a and Materials(ASTM)Specifications F2286stan- sphere equal to or greater than 4 inches(102 mm) dards in conjunction with a gate that is self-closing in diameter and self-latching and can accommodate a key 5. An outside surface free of protrusions, cavities or lockable device. other physical characteristics that would serve as 3. The pool shall be equipped with an approved handholds or footholds that could enable a child safety pool cover that meets all requirements of the below the age of five years to climb over. ASTM Specifications F 1346. Authority: Health and Safety Code Section 4. The residence shall be equipped with exit alarms 18942(b) on those doors providing direct access to the pool. Reference: Health and Safety Code Section 5. All doors providing direct access from the home to 115923 the swimming pool shall be equipped with a Ab 3305, Statutes 1996, C.925 self-closing, self-latching device with a release 3109.4.4.4 Agreements to build; notice of provisions. mechanism placed no lower than 54 inches(1372 Any person entering into an agreement to build a swim- mm)above the floor. ming pool or spa, or to engage in permitted work on a Pool or spa covered by this article, shall give the con- 6. Swimming pool alarms that,when placed in pools, will sound upon detection of accidental or unau- sumer notice of the requirements of this article. thorized entrance into the water. These pool Pursuant to existing law, the Department of Health alarms shall meet and be independently certified Services shall have available on the department's web to the ASTM Standard F 2208 "Standards Specifi- site,commencing January 1,2007,approved pool safety cation for Pool Alarms" which includes surface information available for consumers to download. Pool motion, pressure, sonar, laser and infrared type contractors are encouraged to share this information alarms. For purposes of this article, "swimming with consumers regarding the potential dangers a pool 426 JANUARY 1,2008 ERRATA 2007 CALIFORNIA BUILDING CODE .. Yage1ofS r 1 ti\ Jim Schwarz From: "BODENWEISER, GARY A(ATTPB)" <gb2435©att.com> To: "Jim Schwarz" <scpb@adelphia.net> Sent: Monday, June 01, 2009 8:51 AM Subject: RE: Pool at 2812 Shantar ' Jim: Per your request, AT&T does not object to constructing a pool within the easement per your statement below ( inside 6' but no more than 5' from the PL. ) Please be aware that AT&T will maintain the easement in its current form. You must notify Dig alert prior to digging and I suggest hand digging in the vicinity to avoid damage to AT&T facilities. As I stated previously, our records indicate buried plant and a pedestal in the yard you will be working in so I cannot stress enough the importance of protecting AT&T existing facilities. You and the landowner will be ultimately responsible for any damages caused and or any relocations necessary due to the proposed construction. Thanks for your inquiry Gary A. Bodenweiser AT&T Engineering Manager 714-237-6165 Original Message From: Jim Schwarz [mailto:scpb@adelphia.net] Sent: Friday, May 29, 2009 2:43 PM To: BODENWEISER, GARY A (ATTPB) Subject: Re: Pool at 2812 Shantar Gary, I was at the property today and did not see any pedistal in the yard. Everything appears to be overhead. I also noticed that both houses on each side have pools that appear to be only 3 feet from the P.L. We will keep the pool edge 5 feet from the P.L. Edison has reviewed our plan and 6/1/2009 t'agelotl Jim Schwarz From: "Barrios, Joe" <joe.ba rrios@twcable.com> To: <cchamoun@ci.costa-mesa.ca.us> Cc: <scpb@adelphia.net> Sent: Tuesday, May 26, 2009 3:26 PM Subject: 2812 Shantar To whom it may concern, In regards to the easement request for the pool to be installed at this address, we do have an easement on the poles in back&would need to keep it there. If the pool can be installed without any relocation, it would be ok to install it there. But if there are any relocations needed there, it would have to be at the expense of the owner of the property. Please feel free to contact me at 714-903-8337 for any further questions. Thank you & have a nice day. Joe Barrios d Go Green! Print this email only when necessary. Thank you for helping Time Warner Cable be environmentally responsible. This E-mail and any of its attachments may contain Time Cable proprietary information, which is privileged, conf or subject to copyright belonging to Time Warner Cable . - is intended solely for the use of the individual or enti it is addressed. If you are not the intended recipient c E-mail, you are hereby notified that any dissemination, distribution, copying, or action taken in relation to tt of and attachments to this E-mail is strictly prohibitec unlawful . If you have received this E-mail in error, ple the sender immediately and permanently delete the origir. copy of this E-mail and any printout . • 6/1/2009 rage t or 2 Jim Schwarz From: <Xuan.L.Ma@sce.com> To: "Jim Schwarz" <scpb@adelphia.net> Sent: Friday, May 22, 2009 3:52 PM Attach: Imparato CM.doc Subject: Re: Fw: Emailing: Imparato CM.doc 2812 Shantar Dr., Costa Mesa Ca 92626. 05/22/09 Subject: Easement. To Whom It May Concern, ,. I have reviewed the proposed pool plan and it seems it does not interfere with Edison facilities within the easement. Sam Ma Planner Pax 54614 or 714-895-0614 Huntington Beach S/C "Jim Schwarz" • To <xuan.l.ma@sce.com> <scpb@adeiphia.net> cc 05/21/2009 03:25 PM Subject Fw: Emailing: Imparato CM.doc 5/22/2009 Page 1 of 2 I Jim Schwarz From: "BODENWEISER, GARY A (ATTPB)" <gb2435@att.com> To: <scpb@adelphia.net> ' Sent: Thursday, May 28, 2009 12:50 PM Subject: Pool at 2812 Shantar • Jim: Regarding the project below, have you done any excavation yet? AT&T has a pedestal in that yard, are we in conflict? The usual stuff Gary A. Bodenweiser AT&T Engineering Manager 714-237-6165 SCE, Time Warner, AT&T, SC Gas We are contacting you regarding a utility easement at a house in Costa Mesa where we are going to build a pool. The city informed us that the easement is 6 feet from the rear property line. This is a narrow backyard and the pool was designed 5' from the P.L. to water. I attached the design for you to see. We are asking if you can provide a letter to allow us to be 4 feet from the P.L. The house also backs up to a park. Here is all the property information. Steve and Susan Imparato 2812 Shantar Drive Costa Mesa, CA 92626 Tract 4349 Lot 6 thanks for your help, Jim Schwarz (714) 241-7665 office 5/28/2009 • June 1, 2009 Schwarz—Custom Pool Builders 2812 Shantar Dr. Costa Mesa, CA. 92626 Attn: Jim Schwarz Subject: NON-INTERFERENCE LETTER FOR 2812 SHANTAR DRIVE, COSTA MESA,CA.92626 The proposed development of the above mentioned lot will not unreasonably interfere with the free and complete exercise of any easements held by Southern California Gas Company. There are currently no facilities owned or operated by the Gas Company within the easement dedicated for public utilities and incidental purposes lying within the above mentioned lot. This company has no objection to the proposed development of this lot. This letter should not be construed as a subordination of this company's right, title and interest in and to said easements, nor should this letter be construed as a waiver of any of the provisions contained in said easements. Sincerely, Mangione Mitchell Pacific Region Technical Services, Planning 310-605-7848 ,41 9 CITY OF COSTA MESA 4 66 BUILDING DIVISION ). �,' ..�i DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER PERMIT ROO E06-00189 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mes ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2812 SHANTAR DR Status: ISSUED Suite No Applied: 03/06/2006 Vicinity: BEDROOM Issued: 03/06/2006 Parcel Nunmber: 13940306 Applicant: VILLALVA, LIZBETH al Address: 19142 BEACH BL '` ISSUED BY: Phone: 714-965-1876 HUNTINGTON BEACH,CA ,Zip 92648 Owner IMPARATO, STEPHEN AND•SUSAN Address 2812 SHANTAR DR - - . - Phone: 714-438-2402. "COSTA MESA;CA, - • Zip: 92626 Contractor: IDEAL HOME IMPROVEMENT , Address: 19142 BEACH BL Phone: 714-965-1876 HUNTINGTON BEACH,CA Zip: 92648 License:790680 ' ' SCOPE OFPERMIT `CHANGE OUT 5 WINDOWS THROUGHOUT S.F.D.TO MEET 1997 U.B.C.EGRESS REQUIREMENTS. REPLACE WITH DUAL GLAZE, HEADERS WILL REMAIN THE SAME.REF.:B06-00370 ELECTRICAL TO INCLUDE: 1 SWITCH LOCATED IN A BEDROOM. FEE SUMMARY,-' - Quantity Quantity ISSUE FEE $23.50 ' Temp Dist System%Lighting $0.00 0 Temp service test $0.00Busway/100 ft ' $0.00 0 Res:a/c package $0.00 ) ._ ' ,-. Standing Section $0.00 0 ' ' - • New Rea(1-2 units)' ' $0.00 . -=-0- --- -- -- -- Misc Electrical Equipment $0.00 0 '.. • New Res(34-units) $0.00 • ` '0 -Transformers up to 1 kva/kw $0.00 0. Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 - 0 • up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 • Switches $1.10 1 over 100 kva/kw $0.00 . 0" , Non Res7Appf ., $0.00 0 7- . Low Voltage Equipment $0.00 ' 0 Res Appl . ' $0.00 0 " " Low Volt Wiring System/Ckt $0.00 0 Service to 200a ' ' $0.00 0 , Misc,Conduit. $0.00 - 0 Service to 1000a ' ' $0.00 0 : Misc.Conductor $0.00 0 , Service o'ver.1000a - ',$0.00 ---;-..l---.0 _. . ' Circus(gen or ride) - • -$0.00 0 , Motors to 1hp,1.\., $0.00,. - 0 ' - Circus(mech ride or lights) $0.00 0 Motors to 10hp ;/' $0.00 -c 0 Christmas Tree Stand $0.00/ 0 , - Motors to 50hp '$0.00 ` 0 - , Fireworks Stand $0.00 , 0 Motors to 100hp $0.00• 0. ' ' • Other Electrical Fee '$0.00 Motors over 100hp -, ,,;. " $0.00-, ; , 0 Communication drops` $0.00 0 Investigation Fee $0.00 Sub panel to 200a ':$0.00. ' . 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 - , -Reinspection Fee $0.00 Sign Circuits '$0.00 , '0 Temp Pwr Pole $0.00 • 0 - ,. TOTAL CALCULATED FEES' $24.60 Intermed Pole $0.00 0. COMMENTS/SPECIAL CONDITIONS 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 244646(6/00) . DECLARATIONS iTh r-1 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. t . 'I:bave 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 walk grs' om satlon nsurance carrier and policy number are: �1 / �]�—I '7 _Carrier: 1\(LI LIkI (-PoIICyNumbei::` 1 - —I/1 I' l 0 • -(This section need of be completed if the permit is valued at one hundred dollars($100)or less.) Lam'" ❑ I certify that in the•: 0 :nce of the work for c- is permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws 4 Cali orn`a,and ogre ,'t if I sh•uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p • is'. . ' {� /�, 1I /,I Applicent'Slg I • ' r0ate:-,•- "l u�1 v yP (.WARNING:FAILURE TO SECURE WO-I. - ' • PENSA .• ••' ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION 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 tic= id uncle royis,ons of Chapter 9(commencing with Section 7000)of Division 3 of the Business_pnd Professions Code,and my license is in full force and effect5Llc:# '^ airman 1.-77 A ///Classff�. C _Contractor'sSIgnato-. ie` airma Date:-- 3 U(pf fl(n . — .__ 111 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to fife 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,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? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 tor 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 0 No 5 Does or will the applicant or present or future building or'r-upant require for the work which is the subject of this application akPermit 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? ❑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? 0 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 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. _-. �j O'LPC wne'r(s9) / ") No n1 ,y ' '1ed,APP�nt_.. ' rIbeta.-- QQQLL INSPECTION TYPE Ong INTITIALS CODE I INSPECTION TYPE • PALI INTmAL$ 1616 Fixed System Final Fire Prevention ' ' • 206 Final Mechanical • . 1266 Pool Spa Final 208 Final Plumbing a z 200 Final Re-Roof • 210 Final Electrical m le Pr agir' 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 019 CITY OF COSTA MESA 4 BUILDING DIVISION f •n,an ,i DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER • PERMIT p,� B06-00370 omrs*`. (714)754-5273 • Fax(714)754-4858 • www.ci.costa-mesa.goyLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2812 SHANTAR DR Status: ISSUED Suite: Applied: 03/06/2006 Vicinity: Issued: 03/06/2006 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number: 13940306 Zoning: R1 Applicant: VA, LIZBETH 19142 BEACH 19142 BEACH BL Phone: 714-965-1876 ISSUED BY: HUNTINGTON BEACH,CA Zip: 92648 Owner: IMPARATO,.STEPHEN AND SUSAN Address 2812 SHANTAR DR ; ' " " Phone:. 714-438-2402 ;COSTA MESA,CA --- Zip:- '92626 . Contractor', 'IDEAL HOME IMPROVEMENT ' Address:/ 19142 BEACH BL-21./- Phone: 714-965-1876 HUNTINGTON BEACH,CA .. ' 'Zip: 92648?„,r -"License: 790680 - Arch : 7 Eng: • Address: Address: • - - • Phone:. ' , > , ' Phone: ' ' , Zip: - • License:" ' .. - . License: ' SCOPE OF PERMIT CHANGE OUT 5 WINDOWS THROUGHOUT S.F.D.TO MEET 1997 U.B.C.EGRESS REQUIREMENTS.REPLACE WITH DUAL GLAZE,HEADERS WILL REMAIN THE SAME. r ' -:" FEE SUMMARY - ' Plan Check: . $0.00 ' - Calc Valuation: • sil,000.00 • Permit: $195.25 = Claim Valuation: $11,000.00 SMIP Res: $1.10 „ ' SMIP Com:- $0.00 _- - ., . - , _ . Other: $0.00 .. . Inspection: $0.00 Total: : ; $196.36 - PLANNING &ZONING • SETBACKS - MAINSTRUCTURE• Front '• 0-0. -s-C- _-Rear ' 0-0 Left 0-0 :Right , 0-0 ACCESSORY' ,Front 0 0-.:\-:: '� Rear 0-0 ” ` - - Left 0-0 - Right 0-OC \' .' -r` ' PARKING ,'�,Existinqi%"'0- 'Requibired: . O 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 1-1 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. At—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. �tv1y work s'c mpeenns�ationlInsurance carrier and policy number are: -'1 [��I -Carder:,. s4 YwhJ Policy Number:, 112) 1 �" I 1 --zoo -(This.section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ 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 C lifornia,and a that i'Tshould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi i hs)., •L ) ,.� Applicant Signature: l / `/t, 4,4A.S rData:--.. '10(D' UIP AA���CC(- _WARNINGCFAILURE TO SECURE WO ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED T/10USAND DOLIARE 15100,000),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: • t hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3pf the Busines nd Professions Cade,and my license is in full force and effeCCLI'a-_' • I(e C .Gan sSl i coature: ._ .tea.�r�I rDate=') Q(O Q 14) 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).): ❑ 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 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: I 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,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .i.. ..r ... .. .fut 2 Does or will the applicant or present o or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. q�If an RMPP is presently required,has Section 25534 of the California Health and Safety Code 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 U a plication aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes U No (Section 65650.2 of the Califomia 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 ❑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. S n ure f Legal wner(s) to tip Ink o v riz _ plicant —�_ (s.;_ to oat INSPECTION TYPE ' ' 291:E INTITIALS - CODE( INSPECTION TYPE RAM IIlIIIIALS 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 �/� 6 204 Final Demolition 250 Final Building/Occupancy • PROJECT ADDRESS: 2812 SHANTAR DR UNIT: ' CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 050134 OWNER'S NAME: HOUK, VERNICE S ADDRESS: 2812 SHANTAR DR PERMIT NO: B 050132 PLAN CHECK NO:4 4 'N GOVT: N SUPE: N COSTA MESA,CA 92626 • 557-7287 • CONSTRUCTION TYPE: •t PERMIT TYPE: ,STR PURPOSE: .0TH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF 3300SF RESID S• GARAGE W/WOOD SHAK SQ FT: 11 ,500 . ADDRESS: ' - UNIT: , `,b0 CLAIM VALUE 11 , 500.00 CALC—VALUE: 11 , 500 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: HOMESTAR ROOFING ( 714 ) 538-1878 ADDRESS: 1539 ORANGEGROVE B COMMENTS• X OA p y . • ORANGE CA 92665 ***********************************3*******;P*************tP j•6'f*4Wit*E,X i (�J*(.��y�R LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R E U I R E M E N T S ' V 7000)of Division 3 al the Business and Professions Code,and my license is in lull force and effect S E T B A C K S r � a pC CITY LIC.:�9044971����, STATE LIC 1620 _ ASS: C�'39 LL i �IG�VIl �G® Date:_(o —� 4 �Signature:- /T'�1VC+�/-V". MAIN BUILDING ACCESSORY BUILDING . , ;,;;t WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent o self.i lire ora certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: • FT IN REAR: FT IN Compensation Insurance or a certified copy thereof(Section 3800. Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: 10 4 2 0 4 6-90 EXP.DATE: 09/01 /91 'COMPANY: STATE FUND PARKING REQ." PROV: . PARCEL: 1394.0306 ZNE: REF NO; Coped 2copy is hereby furnished. 1191 Dined copy i file i the city BuildMgx,Div�isioon. I • ' ANNING NOES> . Date: I '^7Q 10 1/Applicant: Q•— -zv TA ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if ttthhh///e per ..i4 is lot one hundred(S100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N" T S 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. ZONING APPROVED BY DATE: Date: Signature: - I NOTICE:If,alter making this declaration,.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : • DATE: ' Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. • /� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: J a DATE• \'1Pl PD ce which this permit is issued(Section 3097,Civ.C)• *********************************************tt****.*****.*******s.*4*.* *• * :i*** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E S U M 'M A R Y ' STRUCTURALS SEGMENT:Y • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason B LDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT . 1 3 5.0 0 81. repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed ' SMIP/NON-RES • pursuant to the provisions of the Contractors'State 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 PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE • ' •I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT • ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 135 . 81 0 • 00 0. 00 135. 81 135 . 81 ' • 00 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 e./..... improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE D I V I S ION,TU7-ALS--> COLLECTED: 135'. 81 OVER/SHORT: 00 ' for the purpose ofsale). BLDG PMT.--PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively'contracting with licensed contractors to construct the project(Section 7044,Business . 135_00 • 8 1 . 1, ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *********************************************************************W********* that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U' A L F E E B R E A K D 'O W N ❑ I am exempt under Section: B.&P.C. r" for this naso": TYPE QTY D E S C R' I P T I O N UNIT COSTTOTAL COST Date. Owner' SFR 11500 REROOF BY' VALUE RESIDENIAL NOZONE 1 . 00 11 , 500.00 I do hereby certify that I am aware of ant understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a 'r permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from •'• these provisions. ,• r"r Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building siruction and hereby a ihorize representatives of this city to enter upon the above-mentioned r property for inspection purposes.z� T O \ 01 00075322-00075323 TOT 135.81 • Date:2g_I J✓O-n6Signature: G / _ DATE: •11/30/90 TIME: 11:17 Driver's License or Social Security A: 1641.46 Mae—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor • CONSTRUCTI42N AND PLANNING - "-" PO(,_ sr SPA APPROOALS Permit# - - Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Servicff or Pole ,,d 52. Pool & Equipment Location -- •_ 2. Soil Pipe-Undrgrnd,n Cl - ' u� 53. Steel Reinforcement in'• ' ti .t'-,r- OtrJ r3=.Electrical Condtati.Uiility-Undrgrnd 54. Forms • • L/ - 4Electrical Gond Oiktiiidrgrnd. "' � 55. Electrical Bonding "-.:4 CU L'- rn iy E O7i;U i, t5e:l RlnforceCer^t x , 56. Rough Plumbing & Pressure Test mac- '- 57. APPROVAL TO COVER-GUNITE 6.nr .trical UFER;Grnd. r -4 ' footings OM L' 58. Electrical Conduit-Undrgrnd. i. LC tri --,. Cr'a C _ ra 08! Foundation SC r.a ' 59. Gas Pipe, C Undrgrnd.,Test i 9. Water Pipe-Undrgrnd. ' _; 60. Backwash Lines, P-Trap, 0 Undrgrnd. 54 10, Structural Floor System a, 61. APPROVAL TO DECK 11. Property Sewer Line& HotTse Connection s.. .. 62. Backwash & Receptor-Final 12. Se`4'ver Cap Cl.` ci/ - 63. Heater & Vent-Final ! •13. Roof Drains ` _ 64. Plumbing System - Final 14. Rough Plumbing; ru 65. Electrical-Final i__ 15. Rough Electrical-Conduit 66. Solar System-Final ,r . 16. Rough Electric'1Viring 67. Fencing & Access Approval 17. Rough Wiring Sr'gn 68. APPROVED FOR PLASTERING ri 18. Rough Electric4LT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL / 19. Rough Heating & Air'Conditioning / FIRE DEPT. REQUIREMENT - _ _ '- ^ _- . 7 "Sit-ti --. b: Zr (-, tV 20.•Rou-ghFa'ctor'yFire',lace II `t'1 * o -F . IAPPROVAtSUaCPermrt# ? SK m C 7 I SC•' R:�S S j ^ LTA # 0 cC CA!,••,h X Y u: i �'- tia t �^ , ,x a. ..j.- ;-i sir til 21.•Ducts, in Structure::: •. •. ,- s a S C -n s 4.-/0. Undergrotmd_:Hyd_ro * 22. Duc s, Ventilating' r 0C - S 5z z a71. ProducttPipir{g CUrGh's ❑'Oil a' rs.. r C O s .-.x s .a.. r ... 23.cGas,P,ipe7Rough &Vest pt y- * LT! e ,= rtx a r72. Underground Flush7w ar 24.cRoof:Framing• �t i i-E^ •••Z-- 4' > ^ r t ' `73.;Undergrnd?Storagf'-lank Gas Con' 25. Roorf,Sheathing :F ,y v :r< 6 tv t- x '-74.:,0_verhead Hydro(-i• t 26.-T-Bar,Ceiling (Structural) &,Monocoat ` m i=' LI:., y 75.r:Vrry Chemical. y'7 s *-+ L7 `A 27.:rame and FlIrshing? 0Ka Cr Cr 71- wt. :. !-y Pp •J ' S In a; 76. Dr Stand I e , 0 Lathing titSiding n ": w.. S. :- 77". F''FIXED SYSTEM- NAL _ I. '29. Insulatioli 0 `O S .. .. > y tr'i i i IN 78,q,FIRE PR EV. FINAL i > tk T p30. Drywall•NaihAg ' y _ ` i pNp' ie N HEALTH DEPTrREQUIREMENT C-31. Plaster grown,Coat:*. S r kr j trrr u I f x tr79."FINAL INSBF CT IO-,,N X -3 `r I J c32cElectrical•Power Meier:Final : 44 .: I • In ;$O.tiFOOD CERTIFICATE ISSUED -r -f T .33.`'Final,Elektricr '' I' .t to I •r` trNZS. - �` I . ,> * t^ i< Y' .3 .ALT: - t:l 0IT! 34.rFinal-Heatin9_& AirtConditionegc ci a I I &p t. x S .x ry S .:.C ..• .•• ) 4 x Ott J , 6..t1 m 35.tFinal'Gas Pipe Testt ' 133 •. -r I I t;L ,r.i 0 t- r pisCI -t ' t^ S0 -- .e `� :.. t,; •..t i .+_ t•. .t ry36."Hoocd or:-Ca no py :!. ! '7 • r n I i_ g ; F X no ^Jte . + 9-.. z,•P -re ren •37.'Fina11Faciory Fireplace' I •'; °' �+ t`t t. l7js :r s *4tr; r.n 1: u, t .. .. c' .. t., ' t+. ., ¢ S _ r38. FinebPlumbing 03 + + t!: x S rr x to C 39. Water Selo/ice- s_Final"- I it: i! h. 3n wtn etc _a j .--, c • X40. Gas Serv2e-F,tnal :r, ,., w, n Li: r' n i I ric .w ?f Oi a "' .s '41. Solar Domestic-Final :Si t: -• i- Cs I `f- .f; 'e s . t n: i F .. I. PI•-•• U' . '-42.-8ackflow:Preventert `- n' 4' ' I Ii >, '-- L..,.... • -.- - tV * t I It. x tc >` • . r. 43. BackfloW:lrrigationr• . . Di .r. `. Lj$4. Landsca a lrrigatiop.System- a,x - r- •`� '_ t v t: P Afri:J �x M Clv ... tll �. -ti C 545, Sound Attewation' -'JZ to ` S -'r ' ^, r -'L t[.; 3 •46.tlandicaP Regulations -, i; x 7. '' ; , s �, ' .•.s :, Ss�/I'C,/ ' 47.;F,INQL STRUCTURE& BUNIDING lt/U )sO / -+. '4443:-.:�_• ^i 1 48. �IN'AL PLANNING: F , of I -u r CV _ t. ,r, ..- F• -.t r49. Electric Release to Edison. .r- j --% * s ii.; moi x t J �-50. Gas Release t9 Southern California,Gas Co - '" 'I " r:a: • ". I 1F r. r o ota •,51. CERTIFICATE OF,OCCUPANCY' ;i o No. Date OWNER PACESETTER WEST JOINT VENIURE DATE OCT 2 3 Z62 JOB ADDRESS 2812 Shantar Dr. BUILDING PERMIT NO. 18052 GENERAL CONTRACTOR Andros Land Co. VALUE $ 15,681.00 AP No.139-1+03-06 LOT 6 TRACT 4349 FIRE ZONE DESCRIPTION OF WORKRes.W/att.gar. INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE B-1 Soil 4 //- -4-s-- PERMITS ISSUE SUBCONTRACTOR_' , y DATE NUMBEt. Water /-g'yL� - Rough Corn. Refrig. 0 Air Cond. 0 - Rough Heating :Fee fro- _ I, i , ' l.?-d7' � r 1 11 . Rough Plumbingeo -��f /1-��/ .�frlyr.., .; • //-/-(p a �� I'r- Miscellaneous _ % /� Q Prop.Swr.Line El-House Con. Q--St.Swr. 0 Sit /AVG 7 _ G _ 7s/L _ ✓r Sprinkling System r -167 onion Pole / n,j27 Underground ❑ Power Et Rough Wiring 24-7 /2-14.07 •ri/, (!.CSlc ".24.77--7nr—a /197/ 1/ trendies Q Forms -❑ Steel Remf. USH ft�- �-(.L Floor System M— 1I-!'42-- Bond Beam 0 Steel Reinforce 0 I_ Sheathing - �_cs-,.2-.6Z, Frame and Flashing �Z-�j Lathing - In g.---- Out C}-� prt rr- _rte p.t-/_i/_(.3 Plaster, brown coat 7SRN -, G-b2 Refrig. 0 Air Cond. 0 Final Heating, Final -7-/.0-7"63 Plumbing Fixtures, Final _ 2 Final Gas Test L.1 -�-/ ' Electric Fixtures, Final Z'5 *;42--:.C Building, Final eel 3 OCCUPANCY FORM BU4-5M - 7-61 I RU',? 7E RECEIVED 18052 OCT 231962 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT �. Lot 6 TYPE OR PRINT �ic fBUILDING BUILDING ADDRESS 2GJ2 .StT/„'nt, ✓e• ��i(�OETA MMEESSA./p�C�ALIF IA For Office Use Only 6J/J C,C (/Y. d I RECEIPT NO. ON//4 OWNER _ MAIL - RECEI ED BY D/�/��E RE IV •DATE i U11362 � q, O ADDRESS • / •.• • • / . • • A I ///': y Li^?G ,7' 17 y LL. L.--- TEL EIn ` CITY Newport Reach, Calif. NO. 161655 BA DU ,/ �.. , //(/ ARCHITECT TEL OR ENGINEER E. G. Kaltenback NO. 3361 COSTA SA. CALIFORNIA FIRE ,,ma�yy////���I ADDRESS 9777 Katella VP. . Anaheim ZONE TYPE GROUP� r CONTRACTOR Andras Land Company BYPROVED DATE ADDRESS 1453 Minors Drive ZONING /J'T' Calif. Zlyl� ` NO.OF USE OFNEW,./I CITY Costa Mesa, C 'I5//IIIJ PLANS BUILDING yr ll1 STATE TEL. KI 9_0395 LEGAL /LU/� LIC.No. 187166 NO. DESCRIPTION IL' 6 tq \\3 kt SIZE /�/� NO. OF BLGS. OF LOT 711 x 100' I D NOW ON LOT O A.P.NO. 3 c{ -r o .G� A USE OF - YARDSEVES +3 EXISTING BLDG. --- APPROVED ALLOWED • ' SETBACK LINE FROMryry / (CENTER LINE ST.) ,/ CENTER OF STREET, i`/ HEAR YARD/224; FRONT 4 / FT. IN. SIDE YARD I LEFT - RIGHT .,_1:".. e'RDR.SIDE G 49FT. IN. . DESCRIPTION OF WORK L.SIDE FT. IN. NEW X I I ALTERATION I I ADDITION I REAR ) 6 FT. ,/J�'�. ` IN. REPAIR ' I 1 MOVING I I DEMOLISH I APPROVED /c//p C/ �' "/TEI(� i)-3..�/ BUILDING NO. OF L L 1O SIZE ROOMS STORIES I EXTERIOR WALL WOOd ROOF COVERING.K �}I ICCO COVERING shakes USE OF BUILDING AND WORK TO BE patronmEa Single family residence with attached gig J _ /X.3s—p/ - 9c5'' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UND R VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE - S REGU TING BUILDING CONS p.N. / VALUATION SIGNATURE • './ ) �. PERMIT FEE $ 5i •� PERMITTEE �/tA,r.� .Ads,' a 3:d Q/ - ,{ ��`I D --:/I �,. , / $ /�/` O PLAN CHECK $ v�� r/ AUTHORIZED AGENT/ /// %`I> ` P/,W//,(/ £ R TOTAL FEE $ 7 .SIJ u