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6073 j/21/81 306.5� TL�
COSTA MESA BUILDING-SAFETY DEPARTMENT ApPLICATION FOR STRUCNRAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFOflNIA 92626
RECEIV D PERMIT "
For Applicant to Fill in Complerely — Use Ink Only N� 4 7 7 9 9
ADDRE55 3461 Wimbledon Way A.P.NO. /�L/a —OY� �S
OWNER OR AODRE55
TENANT Wimbledon Assoc. 3461 Wimbledon Wa
MAILING 5 A'CE NO.
ADDRE55 147� Jamboree RCZ 25
TR.NO. LOT BLK.
ciTv Newport Beach No540-6800 10275 25
CAN5fRUCTION NEW ADD ALTER REPAI0. MOVING OEMOLISH
LEN�ER Imperial Savings & Loan X
BFANCH Pasadena Wimbledon Assoc.
OWNER
ADDRESS pRp VA�UE -8-�-�}�j-
ORENGINEeRCorbin/Yamafuji TE '49-7124 VSE S � ZZ
ADDRESS 17992 Mitchell .SO. � Irvine ZONE � � VPE V�� GROVP 1�—�
APVRpVED 2� n
CONTRACTORMCLdlll DEV. CO. BV DATE o
ADDRESS 1470 Jamboree RCZ
CITV Newport Beach No`640-6800
STATE z73875 CITV 188-73 APPROVEDSETBACKS �
LIC. NO. LIC. NO.
SIZE NO.OFBLOGS (FROME'!�q="==T)
OF LOT NOW ON LOT 0 NT.�' /� OFT.
USE OF
EXISTING BLDG. �
Separate perrttits are required for L SID �`J FT
electric, plumbing and heating work: REAq ��y
FT.
USE OF BUILDING AND WOflK TO BE PERFOFMED PLP,NNING ACTION
PRD - New Construction l/ oATE �/ �j
— ��'7 APPFOVED �` ��- [
Single-family dwelling naa�v� '� � 20 g
!SOLD FOR SPECIAL REO
1 hereby aeknowledpa thet I hava reatl this applicetion antl rtete
that Na ebove Informallon Is correct antl epree to comply wlth
all laws regulating DuIlAInB �onrtruc[ion, antl I zhall not employ
eny person in violation of the workman's compenwtion laws of
tho Stata of Cnlifornla. '
I heroby eartify thet I am properly Iicensetl es e contrector untlar ���� SQ. FT. ��
the Stata of Callfarnin Busine33 and Plofessions CoEe, Dlvislon 3, THE AMOUNT SHOWN VNDER VALUATION IS FOR
Chepmr 9, anE Mat such licenaes are in full forca antl effxt, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
em exempt from t�e provisionf of the Sto ot California Business VALUATION PERMIT FEE E� �
entl Profecsiona Cotle, ivlsion 3�r . .
PLAN CHECK $
SIB�atura of
Pormlttea � 5G0� w^� TAX E s
or e1��'
Authorizatl Agont Data � TOTAL PAI D E
�•�
�h
V`
OWENS•CORNING
�iberglas - '
�lanket Insu
,,
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thecmal performance and that the Blanket Insulation is in-
stalled in conformance with current energy conservation regulations,
California Administrative Code, Title'25, State of California, in.the building
located at:
�/// / %rrnl'r"i�%i'jv / �i.u. '��'� /�v2 ��
Sireet � �� . " � Cot7Number . � hact Number
� 'erior Walls , ,% ,�
� ns=Corning Fiberglas Blanket.lnsulation �.�/� 1�
- . . . Thickness -R-Value
,�
Ceilings � - � _ � ��� � / , �
Owens-Corning Fiberglas Blanket Insulation .,. C� � ,��
�" ' ' - 'v . ' - Thickness R-Value
4 .
'
Floors . �;� y
Owens:Corning Fibe'rglas Blanket lnsulation
� � ,�� � . . �i , Thickness � R-Value
� •
� � � �
Foundation Walls ;
Manufacturer' � Type �Thickness .. R-Value '
I
General Contracror License No.
By - ��� Title Date
�SignaNre) ,/j
�nsulati ontr tor �����%�'-^`� ��✓��!1����-'*f''%��LicenseNo._�-'���J�'S
r -� �
.By_ . _ _ . �'�Title � �/' Ji Date � ���~�/
. ISignawrel . . . .
Homeowner�Copy (Whi(e) ;
State Copy (Yellow) . .
Builder Copy (Pink) � �
Pub. No. 16-B1�699SF Li��o In LLS.A.. July 19])
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division �
Fiberglas Tower, Toledo, Ohio 43659