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COSTA MESA BUILDINGSAFETY DEPARTMENT � APPLICATION FOR�STRITCTUIZAI:PERMIT�89•
P.O. BOX 1200 COS7A MESA, CAUFORNIA 92626 - -
RECEIVE BV, PERMIT � -
For Applicant to Fill in Completely — Use Ink Only N, 4 7 7 7 5
�AO'DRESS 3499 Wimbledon WaY A.P.N0.4SZ O/..kZ—s -
BUILDING ,-
OWNEROR Wimbledon ASSOC. ADDRE55
TENANT `
UNIT OR
MAILING 1470�-Jamboree RCl SPACENO.
ADDRE55
" TR.NO. LOT BLK.
c,T,, Newport Beach No540-6800 2 �
NEW ADD ALTER REPAIR MOVING �EMOLISH
�°"STR�°T'o" Imperial Savings & Loan
LENDER
BPANCH Pasadena .
OWNER
ADDRESS 61 S�. Lake AV2. VAWE . �
ARCHITECT Corbin/Ydmafit',i TE '49-7124 usE pRD
OR ENGINEER N p � y�
ADDRESS 17992 Mitchell .SO. � Irvine� zon,e��l'l�l� TVP �1� GROUP "— �
APPROVED
CONTRACTORMCLd1R Dev. Co. sr DATE � 2�%/B/
ADDRESS 1470 Jamboree Rd - � �
CITV Newport Beach -, No�640-6800
2,� 3$,� 5 APPRO V ED SETBACKS
IIC.NO. . LICYNO. 1HH%3 �
SI2E ' NO.OF BLDGS. (FROM.mt—^v::.'rc�r
OF LOT NOW ON LOT 0 FROM � FT.
VSE OF
EXISTING BLDG. E L T.
Separate permits are required £or L SIDE�, FT.
electriq plumbing and heating work: ,
REAR Z FT.
USE OF BUILDING AND WORK TO BE PERFORMED P�qNNIfJG ACTION'
PRD - New Construction %�.78-3�}. °a�RoveoZ Z
Single family CIW211.1I1CJ APPROVED � ���`
y9LD FOR SPECIAL REQU,REM .
I hereby acknowletlge that I have reatl this application antl stata
ihat the above info�mation is correct and agree to comply with _
all laws ragulating builtlinp construction, antl'I shell not amploy �
any parson in violation af the workman's compensetion laws of
ffie Staie af Califomia. � ^
d g 5a. FT. .sSs
I hereby certify that I am properly licenud as a conbactor untler
the Stare ot California eusiness entl Professions Cotle, �ivision 3, THE AMOUNT SH N UNDER VALUATION IS FOR
Chapter 9, antl that such licenses are in tull torce antl etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt from fhe provisions ot tha Siate af California Business VALUATION PERMIT FEE S
and Professions Cotle, Division , Cha ter�9. .
Signature of � PLAN CHECK E
Pe�mlttee � � . $����0` TOTALPAID 5 ~�/
or
Authorized ABent Date
OWENS-CORNING
�1�i@i'��aS
�lanket Insulation
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thermal 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:
-��/%y �.��6/���� �/ � / /rJ7�
` � Street � Lot Number � Tract Number
Exterior Walls ��/ �r
ms-Corning Fiberglas Blanket Insulation �. �
� Thickness R-Value
Ceilings � , �.
Owens-Corning Fiberglas Blanket Insulation O �%
Thickness R-Value
Floors
Owens-Corning Fiberglas Blanket Insulation
Thickness .R-Value
Foundation Walls
Manufacturer Type Thickness R-Value
, .eral Contractor License No.
By Title Date
(Signamre)a �-
Insulati ontr tor. � �`���� � /1/�Di9LfA..License Naf-�
��i � ��,,,� t ^
By— ��y��--�"-- Title �%+`�' Date�/d �/
�si;nawre)
Homeowner Copy (White)
State Copy (Yellow)
Builder Copy (Pink)
Pu�. No. 16-84699SA Li1M10 in U.5 A.. July t W)
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas Tower, Toledo, Ohio 43659