HomeMy WebLinkAbout3367 WISTERIA CIR - Building PermitsCI OF COSTA MESA REQUEST FOR OCC' VCY
TRACT N0. DATE �
IAT N0. I L / .
3
The developer of the above er._itled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streeta
accepted by the City of Costa Mesa.
The under igned, by executing this agreemen:, acknowledges that
�}se—she—t��t)��� �W3S easrene) /(id�Lt.2, advised that this tract has
not been given final inspection nor has it been accepted by the City of Coeta Mesa
as having complied with the conditi�ns of approval which were imposed by the City
at the time the final tract map was approved.
� The City.assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
RECEIVED
C!TY OF COSLI ;l,E3
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BY LV-Q– �� �^ —_
Purchaser
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BY / �i�.c,'��' //L��� i
Developer and/or auLhorized
represencative
BY /(,�Lrti'C'�. ���
Lender
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COSTA MESA BUILDING-SAFETY DEPARTMENT
%OLARP.O.BOX1200 COSTAMESA.CALIFORNIA92626
dUr 15-72Pp'o001075� ***177.24
cnsn
APPLICATION FOR BUILDING PERMIT
For Applicant ro Fill in Completely
RECEIVED 8V �ATE RECEIVED DATE ISSUED
BUI�DING � � / j�7l.St � /
� ADDRESS l0
PERMIT NO.
OWNER Larwin Southern California �n(,`, A�P• NO. �_ '2� I
ADDRE S J 3(0 7
no"oaess 16255 Ventura Blvd. �
cirv Encino, Califomia nTio`.�986-8890 TRACT � LOT e�ocK
LE OER�'�N Larwin Southem C6lifornia W ADD A� R P
BRANCH 96255 Ventura Boulevard '/
OWNER %y � C � [�
ADDRESS � �y VALUE/Z �/�
ARCHITECT LARWIN TEL.�f73 AALA SE G� G�I� s��7//
OR ENGINEER N L �Y`}V`Y
FIRE
ADDRESS 9100 Wilshire Boulevard BBV. �"�I� ZONE TYPE GROUP�
APPR VE ��/'�7y,
CONTRACTOR Larwin Southern Q 1 Q BY DATE i. ���
ADORE55 16255 Ventura Boulevarel
TEL. ZONE NO.OF USE OF NEW S/N q2M
cirv Encino� Ca�ifornia No.986-5890 P�� � BUI�DING p
STATE CITY �'AADSAPPROVED YAROSAPPROVE�
��c. No. 191311 LIC. NO. B�� MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OF BLDCS. (FROM C/L STREET)
OF LOT 63 X LOO NOW ON LOT O FROM FT. FT.
USE OF
EXISTING BLDG. FT. FT
SIZE OF NO.OF
Newe�oc.z354 ROOMS STOFIES 2 L.SIDE .i FT. FT.
EXTEFIOR WALL SrUCCO R��F Wood Shingle REAR FT. FT.
COVERING COVERING
VSE OF BUILDING AND WORK TO BE PERFOFMED DISTANCE BET. BET. MAIN &
MAIN BlDCS. ACCESS. BLDGS.
Construction Sin le Famil Residence c�P # DAT
APPROVED� � r�1 � 7
C.�1J
I hareby acknOwl¢tlpo thnt I have reatl this application entl stete LD PECI
that tha abova intormation is <orrect antl agree co camply with
ell laws regulating builtling construction, antl I shall not amploy
any perwn in violation of the workman's cOmp¢nsatiOn laws of
Ma State of California. a
�}Q �
I hereby tertity Me[ I am properly licensetl as a convactor untler SQ. PT. U/ c
tha Stata of California B�siness antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VA�UATION IS FOR �
Chap[er 9, antl that such licenses ere in (ull force antl etfect, or I THE PUFPO6E OF ESTABLISHING A PERMIT FEE ONLV: Q
am ezempt from the provisions ot the State of California B�siness
ontl Professions Cotle, �ivision 3, Chapter 9. VALUATION I�.� p
PERMIT FEE $ �
SIB^ature of �� /J ��— �J� a
Permittee i(IYl+LL— D. DOWf15 $�/ A-1, p�p,N CHECK $� E
(0�/ (/ /n/ �
AuthoNzetl Agent T � �
TOTAL FEE S
�