HomeMy WebLinkAbout1784 PENINSULA PL - Building PermitsI
.PROJE.#a3DRESS: 1784 PENINSULA PL UNIT: 42 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: G 051185
OWNER'S NAME: KAUFMANN & BROAD
ADDRESS: 180 N. RIVERVIEW DR PERMIT NO: G 051185 PLAN CHECK NO: 00712-91 A GOVT: N SUPP: N
,SUITE 300
ANAHEIM CA 92808 CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
• 921-0500 •
ARCH/ENGINEER:
" MIKE WOODLEY REG.N0.: C19730 JOB DESCRIPTION : S$ AND GAR SQ FT: 2, 883
ADDRESS: 180 N. RIVERVIEW DR " ' 300 '
ANAHEIM CA 92808 CLAIM VALUE: 169, 417. 00 CALL-VALUE: 172, 190 . 60 GROUP OCC: R-3 /M-1
PERMITTEE:
KAUFMANN & BROAD (714 ) 921-0500
ADDRESS: 180 N. RIVERVIEW DR 300 COMMENTS: REF" PLN-CK 234-89 A
ANAHEIM CA 92808 ******************************************************* ***x*+r*** **r.*******+rr.*
LICENSED CONTRACTOR DECLARATION: I h• eby affirm that I am lice ed under provis of Chapter 9 •,mmencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Profe.ons Code.and my licens• is in full tote'and
tefffeeyp SETBACKS
CITY LIC.: 046894 STATE LIC.: 33 95 'MASS: B- / ` /
•Date: 3-(-2 /(
/ Signature: ,L_ /_Ltti As t - MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that . e a certificate Of consent to self-insure or a certificate of Workers' FRNT: 14 FT IN REAR: 10 FT IN FRNT: FT IN REAR• FT IN
Compensation Insurance.or a certified copy thereof(Section 380' ab.C). LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT T IN
I
POLICY NO.: 4189-1090 EXP. 'ATE: 03/07/91 LD FOR (,11tAtlJ�
COMPANY: TRANS. INS�•. PARKING REQ: 2 PROV: 2 PARCEL: 4245211'JZNE: PDDR- REF NO: PA-88-40
❑ Certified copy is hereby furnished. yE Cert •• copy is filed withth.city Building D 'sion. / // PLANNING N TES> NEW SINGLE FAMILY RESIDENCE WITH AN ATTACHED TWO CAR GARAGE.
> HALF OPEN PARKING SPACE PER UNIT PROVIDED ON-SITE,
Dale:_3- I - 7/ Applicant: // / ..411 _ Al_ .//.1%/_ �.... ************************************************************9*****************x
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This Sectio,yed -completed if the permit is for one hundred($100)or less) D E V E L O P. M" E 'NTT ' SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is iss,r.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY - , ty. ) b JL
DATE: UZ"Z?a)J
Dale: Signature:
NOTICE:II.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : 1..", ) C./ -) DATE
Code.you must lonhwilh comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tearing agency for the performance of the work for APPLICATION ISSUED BY: _ _"1S► DATE.
which this permit is issued(Section 3097.Civ.C). ********************** . . . . . . ._.-.�.-- .a4A _�.rr._. . . . ._ . . - ************,x,**-*******
LENDER: *********************************-3's * ************************************
ADDRESS: LEGALIZATION:N F E E S U MARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANICFIRE 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 895. 00 41 50 82:7A99 2 8 ,25 12 . 05
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed5Q Z L 5% $MIP/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 My violation of Section 7031.5 by PLAN 145 . 44 . . .
1y applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ISSUE FEE 3. 00 1 5;`•00 1 5, 00 . :' '
/ 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-- > 1059 . 79 33 . 00 145 • 44 1238 . 23 1238 . 23 . 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
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 1238. 23 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
895. 00 44 . 50 97. 99 4;3 . 25 12 .05 145. 44
❑ 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 ********.*{p******.**.**.*.**•******.*****.*..*********.*******.***.**.*.*.*.*..**.***{(.******.*.x*****
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL ':. F E E BREAKDOWN
o I am exempt under Section: B.8 P.C. -
for this reason: TYPE QTY DESCRIPTIO N� UNIT COST TOTAL COST
Dale: Ower SFR 2371 DWE-TYPE V-WOOD FRAME -GOOD 69 . 00 163, 599 . 00
I do hereby certify that t am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 76 RES-BALCONY, EXTERIOR STAIRWAY 13. 80 1 048. 80
25534 and that I or any future building occupant will/will not(circle one)need to comply wit said state codes and the requirements for a SFR 436 RES-GARAGES TYPE V
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from 17. 30 /, 542 . 80
mese provisions. ELE 2371 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT . 03 82 . 99
MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 900 9 . 00
Date: Apolic ' . MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9. 00 9 . 00
I hereby certify that I have read this dpplication and .te that the above dr motion is correct.I agree to comply with all city and county MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 3 . 00 3. 00
ordinances and state laws relating to building construction.•r hereby authority representatives of his City to enter ton the above-me n'med MEC 1 GAS PIPING SYS 5+ OUTLETS PER OUTLET 75 • 75
Property for inspection purposes. _ ,(� MEC 1 FACTORY FIREPLACE 6 . 50 6. 50
Date a` g�(` Signature: /(/ // // PLU 2 BATHTUB 2:::00 4 00
PLU 1 DISHWASHER `�V 2 ''00 = A=, €_ 2'. 00
Dover's License or Social Security V: Of OO& 1:.j4-O1i92,:,y't r f_.t 1_. -,..
164 146 while-Building:Green DATE: 03:Ci./41 .i+''j`' "11.4
6Code Enlorcemeni:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
' CONSTRUCTION AND PLANNING • 'OOl 'A
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
'
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I
• -
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical,Conduit Utility•Undrgrnd.' - 54. Forms
4. Electrical Conduit:Undrgrnd. 55. Electrical Bonding
.5. Steel Reinforc`ernenis 56. Rough Plumbing & Pressure Test
6. Electrical.UFER Grnd. 57. APPROVAL TO COVER-GUNITE
•
7. Footings•- , 58. Electrical Conduit-Undrgrnd.
8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test
• 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 4. _ 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit ' 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval '
17. Rough Wiring Sigri 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
-
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- >
20. 'Rough Factory Fireplace _ APPROVALS- Permit# •
21. Ducts, in Structure:, • .. . - _ .- . . 70. Undergrourid-Hydro -
22. Ducts, Ventilating.: - I _ ^ «" ' 71. Product Piping O'Gas 0 Oil
23.;Gas Pipe=Rough & Test ;. ,i - `. ', - 72. Underground Flush', ,l; -
24. Roof Framing - 1 ' 73.'Undergrnd:Storage,Tank 0 Gas ❑Oil ' i . -
25. Roof Sheathing 43 k/ � ` 74. -Overhead Hydro «
26. T-Bar Ceiling (Structural) & Monocoat • / ////, _ : - 75. Dry Chemical - a -
27. Frame and Flashing ' • L( -i'-' 76. Dry Standpipe •;,..._
28. Lathing & Siding - _1t/ : 2 •• •• /( ' 77. FIXED SYSTEM FINAL- -
'29. Insulation - - , ' - t'L ad 78.-.FIRE PREV. FINAL , , u ; - •
'30. Drywall Nailing -Ai ci • • HEALTH DEPT. REQUIREMENT_' -
-31. Plaster Brown Coat• . ` 2c: r cal . ,79.-•FINAL INSPECTION. - - _ - ,
' 32. Electrical Power Meter-Final :80. .FOOD CERTIFICATE ISSUED - -
_33. Final Electric !' ' 'Notes: ,`- ••• -
:34. Final Heating& Air,Conditioning. J. ! -. nil E SP A, '
35. Final Gas Pip -Test_ i OOO fO�Mw 1 /`
. . I r. o
36. Hood or Canopy
��
37. Final Factory Fireplace - t'' - rr
_ .x
•
38. Final Plumbing - ., - . - - -
-
39. Water Service-Final - - - _ - ,
i
40. Gas:Service-Final . . i-1; • " , - -
41. *Solar Domestic-Final • a _ • -
42: Backflow Preventers 'e";- .
-
43. Backflow Irrigation '
,44. Lari iscape Irrigation System, , ,Z i - , ,- `
-45. Sound Attenuation 1 �-•' • >
46. Handicap.Regulations •''' - - - - - -
.47. FINAL STRUCTURE & BUILDIN6 . Y/1q4( --
46. Ffr}Ai�Pt7tfViVIN6 �r7G, Vit. 1.) )r..7 -- % - .
-49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ' - - - - -
No. Date
•.PRD ca t.ADDRESS: UNIT:
OWNER'S NAME:
ADDRESS: PERMIT NO: G 051185 PLAN CHECK NO: 00712-91 A PAGE: 2
********+f******************************************************v**:BSE***********
ARCH/ENGINEER: REG.NO.: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
ADDRESS: UNIT:
PLO 1 LAUNDRY TUB OR WASHER - 2 , 00 2 . 00
PERMITTEE: PLU 2 SHOWER 2 . 00 4 , 00
• ADDRESS: PLU 1 SINK, KITCHEN 2 . 00 2 . 00
PLU 4 WASH BASIN 2 . 00 8 . 00
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section PLU 3 WATER CLOSET (TOILET) 2 . 00 6 , 00
7000)of Division 3 of the Business and Professions Code, and my license is In full force and effect. PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
CITY LIC.: STATE LIC.: CLASS: PLU 1 WATER SERVICE 2 . 00 2 . 00
Date: Signature: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2 . 00
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' PLU 1 GAS PIPING SYS 5+ OUTL-PER OUTLET . 50 . 50
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C) PLU 1 GAS SERVICE 2 . 00 2 00
POLICY NO.: EXP.GATE: PLU 1 SEWER, BUILDING / TRAILER 5, 00 5. 00
COMPANY: END OF FEES
D Certified copy is hereby furnished. D Certified copy is filed with the city Building Division.
Date: Applicant: --- _ 1�
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($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 J� 1
subject to the Workers'Compensation Laws of Cahlorma. •
_ r .
Date: Signature:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor !
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 r
which this permit is issued(Section 3097.Civ.Cl.
LENDER:
' ADDRESS:
. OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 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
• ny applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001.
I
I, as owner of the property or my I employees with wages as their sole compensation, will do the work, and the❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State 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 completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I,as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ 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). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
D I am exempt under Section: B.&P.C.
for this reason: •
Date'. Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
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
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. '
Date: Applicant: 01 000E1669-L003187E 7:31- A2,16,::
I hereby certify that I have read this application and state that the above information is correct.I agree to complywith all cityand countyDATE: 1 T
pp 9 03/05 51 IFiE: 05:22
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned •
property for inspection purposes.
•
Date: Signature'.
Driver's License or Social Security a:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING - _POG - SPA
APPROVALS Permit# Date Inspector 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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
14. 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
20.'Rough Factory Fireplace- - - APPROVALS Permit#
21:Ducts, in'Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 0il
23.:Gas Pipe-Rough & Test 72. Underground Flush
24..-.Roof Framing •- _ - -- •- 73. Undergrnd.Storage Tank 0 Gas 0 Oil •
25. Rodf Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &-Monocoat 75. Dry Chemical
27. Frame and Flashing` ;:" 76. Dry Standpipe
28. Lathing& Siding ..4 `. 77. FIXED SYSTEM FINAL
29. Insulation78. FIRE PREY. FINAL
30. Drywall.Nailing ,: - HEALTH DEPT. REQUIREMENT
31. Plaster Bow Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final • / 80. FOOD CERTIFICATE ISSUED
33.-Final Electric- ` ` � /��r7 iM �i1 l Notes:
34: Final Heating.& Air Conditioning - 5 "2141 COD
35.-Final Gas Pipe-Test . _ ZZWE*
Q1t�
36.:Hood or Canopy d• �
37.-,Final Final Factory Fireplace . + 21411 CAD,
38. Final Plumbing - ' ` CEO
39..Water Service-Final C/2/CA Gra
40. Gas'Service-Final
41.-.Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation- - -
44. Landscape Iiripatidn System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING cA„,\o
48. FINAL PLANNING CC
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF.000UPANCY -
No. Date
1 ♦ G1
CEIRTIFICATE OF COMPLIANCE /°67
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA// UNIFIED SCHOOL DISTRICT
Developer/Applicant : /c 6'cY)AN t I&P1A0
Address : /n0 AL i VF�1/�F� L1 ��IU�` RNAt+cIrn ('A `I s-2
Telephone Number : 7/2/ -%Z/-O5O)
Tract/Parcel and Lot Number(s) : € /3.2-24
Location of Project : ie 744 cr1eg&1 / SEF irLtriiC/IED BD F:rens
Number of Square Feet of
Residential Space do,. 305 x $1 . 50 Total 2095-7.50 _
Number of Square Feet of
Commercial and
Industrial Space x $0. 25 Total
Commercial/Industrial Project is : (Check One)
Mini-storage Motel Preschool
Movie Theater Bank Auto Repair
Racquet/Health Neighborhood Shops Hospital
Warehouses R & D Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial Office Park Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995 .
Checks are to be made payable to Newport-Mesa Unified School District .
Business nager
Newport-Mesa Unified School District
The above representation as to square footage is true . Developer/
Applicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the appropriate City/County shall be notified .
•
Date : . . � . = =�•�
Dev 7 r/Applicant
I PTA
IWA ENGINEERS
17390 Brookhurst Sheet,Suite 100
Fountain Valley,California 92708
(714)968-1221 •FAX(714)968-9286
July 26, 1991 . J.N. 207-05
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, CA 92628
Attention: Mr. Victor Clift
Subject : Fine Grade Certificate
Dear Mr. Clift :
I hereby certify that the fine grading for Lot 42 of Tract 13224
were graded as shown on the precise grading plans for said project .
et..... .a//t atie �'a
Llewellyn D. Incledon, R.C .E. 17593
, nr....1"ir TItir-zvir-rv.tc-Nr.rwar_vitrWL M-714?--ZIFtnirMr-4.11117-7-Sr---47.7.-7V.-;-V- 740
7\\N....,"ii.a4zaa.d.eaku �l�aces�;ads�..1e asti�•atSiie23
M
-..'� BN FORM 116 _
' I \ BIA FORM 1486 i i
\ INSULATION CERTIFICATION j1.4
• N�
\ This is to certify that, in conformance with the current energy regulations (California Adminis- i
1 "I trative Code, Title 25, State of California') and approved plans, insulation has been installed in .
• i the building located at: ; ' ''
yl ( COSTA MESA ORANGE i /l
city cam SEABREEZE
1784 Peninsula Place LOT 42 TR 13224-3B I
\ Street No. (II Available) StrStreet. IM Needs. TorIle. l)
(.) DESCRIPTION OF INSTALLATION
I ROOFS I :..1)
t•.\ Type of Material Manufacturer Thickness__R Value"_ , /1)
OWEINS CORNING
EXTERIOR WALLS I , .,
(t-.\ Type of Material FIBERGLAS BATI5 Manufacturer FI Thicknesc 3�.. R Value" 11
(Or TM. Mare) '
lei CEILINGS OWENS CORNING �N
BATTS: FIBERGLAS BATTS FIBERGLAS 6%" 1 •
I ,
Type of Material Manufacturer Thickness ° R Value19"—
•
;i , (Orr Tod. Merl
•., .4 Sq. FL Covered j :.
,y BLOWN:
ig Type of Material Manufacturer Thicknecc No.Bags_
'�\vt (Or Orae Name)
1./
Wt/Bag _ Sq. ft Covered R Value"_ .;''.
\ FLOORS
Type of Material Manufacturer Thickness R Value"-
1 (Or Ted. Nate) \$� 1
\ SLAB ON GRADE '_A
`: Type of Material Manufacturer Thickness R Value"_ � '
i:-' (Or Tv.a. Mare) I I. 1
( ' Width of Insulation Inches 1
.I
'' FOUNDATION WALLS (if required) . .
•
\••)
P/4
Type of. Material Manufacturer Thickness R Value's_
�'
/
(, I (a her Kari ,1
( '\ REMARKS (If desired) ��'
(i/ . \•,) •
( KAUFMAN & BROAD-SOUTHEAST '' )
/ I
General Contractor (Builder) I�e�l�x Number /l
.1 1
: . : By Title Date �if)
Sub-Contractor (Insulation Applicator) Accent Insulation Company License Number 274283 - '
°.Sotto,. bran b.l (Stab "SAME" N rine r Goya twirl .1.,
�� �.
I By hal Title /� f!, / Date 6-17-91
1•arrant.Ab.in4b.r.•Cao. en )
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o Ina.11eri« a Ierle r. • card of Uifororo
onn:,yiM Ma re M. r...i 4.taw I.r.11od M a roZolote.iM Ow:11.1 ,er lnr os M Oro ,orirre roll be wrlr.d W wooed by "W rd .s.•. of craw." r sinner sFFae ref • ~wry or. p))
M In.N.rr o..nr.fee end by M. bel ler. rue in:d.Nr oqr«o Soda bort. soar. oo.n. (u bre, boar et are aeNorol
red Oral bo reed re a a«•.ke.or Iona« .IMM Or dealer•') erre". le Mlrere dal ee bard by ..i • beildinb d•o.dvart -'
• I weer Mo Seaton of Iwo .meter S. ." - weer le•lai« r,
I l—e Y...• It A. ....... a Me MI.NW a • ...taw r by/rift .ordeal.etMldd Mr..et t*Is dyer:
rare..te the w••M•el taw.rye relator.veers II) .f«...erre \1J1
, m.•e«. a4b M loner or ql« M reborn f.rlM.) )I ;/ -
I
ti.:
Form 116 —m BUILDING NEM, INC., 3055 Overlord Ave, Los Angeles. Calif. 90034--(21318708871 rl).
I Form 1486-9 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC.,1571 Beverly Blvd.,Los Angela,Calif.90026--(213)6255771 >J)
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