HomeMy WebLinkAbout1789 PENINSULA PL - Building PermitsPROJECT ADDRESS: 1789 PENINS ULA PL - UNIT:
OWNER'S NAME: KAUFMAN & - BROAD
ADDRESS: 5500 SANTA ANA CANYON RD
ANAHEIM
ARCHIENGINEEB: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: TROPICAL PLAZA INC (714)533-9490
ADDRESS: 1445 S SUNKIST ST
ANAHEIM CA 92806
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under pr visions of Chapter 9 (commena11n
7000) of Division 3 of the sin and Professions Code, and my license is i� for e it effect.
/�
Cm uc.: 0 4 9 4 5 TATE LIC. 19398 Cuss.
Date: Signature:
WORKER OMgiPLEf A0.TION DECLARATION: I hereby affirm that l have a cenifinte of consent to selfinsure or a certificate of Workers'
Compensation 1s6aft gr A%nified copy thereof (Section 3900, Lab. 6)4/01/90
Jcr NO.: S T 1 bT 1F V tl EXP. DATE:
JMPANY:
rJ' Certilie0 copy here famished. ❑ Certified copy is filed h e city Building Division
Date: Applicant: _
EXEMPTION F OM WORKERS' fAMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or I.
I cedlfy that in the performance of the work for which this permit is issued, I shall not employ any person in any manner co as to become
subject to the Workers' Compensation Laws of California.
Date: Signature:
NOTICE: If, 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
which this permit is issued (Section 3097, Gv. C).
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
1, as owner of the property or my SmyIoyees with wages as their safe compensation, will do the work, and the
structure is not intended or offered for sale (?action 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a properry.who builds or improves thereon, and who don such work himselUherselt or through
his or her own employees. provided that Such improvements are not intended or offered fpr sale. It, 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).
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
Eland Professions Code: The Contractors State License Law does not apply tow owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason: '
Date: Owner;
Ido hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 255D5, 25533, and
25534 and that I or any future building occupant willlwlll not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant
I hereby cervi fy that ve to, is application and state that the above info tion is correct. I agree to
ordinances and state wsrel g tobuilding construction and hereby aulh re eunWtivesofthis atyto
Property for inspe on our seg.
DnveYs License or Social Secudty x:
164146 White—Buildina: Green—Coop Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 045914
PERMIT NO:B 045914 PLAN CHECK NO: 02425-90 A GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURP0ISE: ADD
JOB DESCRIPTION : 76SF POST & TRELLIS SQ FT: 76
CLAIM VALUE: 1,000.00 CALC-VALUE: 1,048.80 GROUP OCC: 11-3: /
COMMENTS: REFER TO P.C. 234-89A, PLAN 2C
Z 0 N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: 7 FT 6 IN FRNT: FT IN REAR! FT IN
LEFT: 38 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT:: FT, IN
PARKING REQ: PROV: PARCEL: 42442101 ZNE: PDRM REF NO:
PLANNING'NOTES> TRELLIS PATIO COVER TO BE ATTACHED TO THE REAR OF A HOUSE
> CURRENTLY UNDER CONSTRUCTION.
'>E**�Exst*>fir-J�-*Nstlt>f�+E+e*srye+t****�-**x�t�Fr*sEN'+t�tsEst+t*x'#**sE�ESE**yr**�r*��d**st*s<-id�E+tx�'xx'xiE�*��eif*x
D E V E L O P M E N T S E R V I C E S R E Q U I R.F. M F. N T'S,
ZONING APPROVED BYDATE: ` 2�_�
BUILDING APPROVED BY DATE:
APPLICATION ISSUED BY:DATE:�-��
♦E 1t iE iE if ie JE ie JE iE JE # 3E ie IE JE BF 3E Je * iE 3tiFiF-i� � �F3Fi��FiF��F'iF'���7F7FiFiF3F�FiFiFiF3F3f��if 1E iE it iE fF if it iE if JFlFlE It
Bk iE Jeff 3E BE 3E iE Je 4E iE 1E of iE k%ie eE JE iE iE aF iE 3E aE iE Jf ie fE K ie TE 3E * ik aE JE 4E Je 1E 4E 4E 4F ftr 4 iE eE iE k ae * fe �E fe * ie �e Je 4E aE * iE iE * iE 1E * * * 3E iE le JE aF JE BE * ie IE
LEGALIZATION:N F E E S U M M'A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 27,00 .50
'SMIP/NON—RES
PLAN 4.39
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 27.50 0.00 4.39 31.89 31.89 .00
REVENUE DIVISION TOTALS--> COLLECTED: 31.89 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27.00 .50 4.39
lE iE iF JEkkiE*ka4 iEM iE JE*iE 1E aE eE JE iE*1E iE 3e aE aE iF aE iE ie iE aE ie4e*J4if iE it 44 Bt 4E fait*iE*Maf 4IE 4F if JE iE iE JE 4F iE*♦EiE iE iF JF ie aE iE iE if iE i!*it iF dE ifk
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COSI'
SER 76 RES—PATIO COVER—POST & TRELLIS 13.80 1,048.80
END OF FEES
01 00053126-00053128 TOT '31.39
DATE: 02/01/90 TIME: 12:57
U
' CONSTRUCTION AND PLANNINCr, -
APPROVALS Permit #
�Dat,Tllspector
PMR & SPA
APPROVALS Permit #
Date
-
Inspector
1. Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
.2.i 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
p
^_6�- Electrical UFER;Grnd.
57. APPROVAL TO COVER-GUNITE
=
- ;7 -Footings
58. Electrical Conduit-Undrgrnd.
-
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
-- 9!Water Pipe-Undigfnd.
60. Backwash Lines, P -Trap, ❑ 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
APPROVALS= Permit#
20. Rough Factory Fireplace _. �.
21.- Ducts, Ducts, in Structure
70. Underground Hydro '
22. 'Ducts, Ventilatin 9,.X71.
-
Product.Piping OGas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush • - -
24. Roof Framing ._;'v
7
.73: Undergrnd. Storage Tank.O Gas ❑ Oil
25. Roof Sheathing = ..,
-'
74. Overhead Hydro '
26:-T•Bar Ceiling (Structural) &'Monocoat`:-
r ,
75. Dry Chemical
27- Frame and Flashing _ - -
76. Dry Standpipe -
-'28. Lathing & Siding,'
77. FIXED SYSTEM FINAL
29. Insulation - - -
78- FIRE PREY. FINAL
30. Drywall' Nailing--: •_ -
-
`
_ ,`HEALTH DEPT. REQUIREMENT
- 31. Plaster Brown Coat•..
-
79. FINAL INSPECTION �-
' 32. -Electrical Power Meter -Final
eSO.-FOOD
CERTIFICATE ISSUED. -
33.. Fi al Electric = + --
• i r
Notes:
_'34.,Final Heating& Air Conditioning ;'a
_
•7. a,
= ._ '�
35. Final Gas Pipe -Test
_
:'36. Hood or Canopy
^
- 37' Final Factory Fireplace-
• 38.. Final Plumbing
39. -'Water Service -Final
- 40. Gas Service -Final
T'
-41: Solar Domestic-Firial
42. Backflow Preventer
43. Backflow Irrigation-
` 44. Landscape Irriqation System 7
-
- - - -
45. Sound Attenuation
_
46. Handicap Regulations
"
._ 47: FINAL STRUCTURE & BUILDING :_
'`
-
48. F
�'
49. Electric Release to'Edison
50. Gas Release to Southern California Gas Go
-
51. CERTIFICATE OF OCCUPANCY
No. Date
- -
a
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY Oi"'COSTA MESA `-iC�ONSTRUCTIO IN�PERMIT PERMIT NO. TRACT NO. LOT NO. lIN1T Nn
Project Address 17f iE�jNSULR' YII4CF
Appf'iV,:JI0Jrg Address 180 N. RIVERVIED DR.
Owner's Name KAUFMAN AND BROAAone 921-
Address SAME AS ABOVE
Arch/Eng. MIKE WOODLE&enseNo. C15730
Address SAME AS ABOVE
Contractor's Name *et+B sa.uE Phone
Address (mailing)
City License No. 46894
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions Of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force 43sleffect. 334495
License ClasJ �� / e ce a /
Date i ilasy f7i—^ c„nae,,.a 71L� �a
RKE S' CFS OMPENSATI ONO
RATION
reby affirm that I have a certifica a o1 consent to self -Insure or a certiflcate
Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) _ 4189-1090 trans. ins. -
Policy VO. Company
Ified copy is hereby forms
Cerli ' op s !led with the Buil ng Divf io
Date KERS'a ni TION t_
EXEM PT
PT Oncom let COMP SATION DE L ATION
(This section need not be completed if the permit is for one hundred ($300) or
less).
I certify that in the performance the work for which this permit is Issued, 1
an
shall not employ any person in any so as [O become subject to the
Workers' Compensation Laws California.
orniaOrnia`
Date —Signature
NOTICE: Compensation after making this ions afithe you should become subject to the
Workers'ithSuhprprovisions Of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I herebyrthat there is a construction lending agency for the performance
work
Of the workk for which this permit is issued (Section 3097 Civ. C.)
Lender's Name none
Lender's Address on
OWNER BUILDER DECLAR TION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which repuires a permit t0 construct, alter, Improve, demolish or repair
5 Of
of
efrom and the basis for the alleged exemption. Any vlolatfon of Section
31.5 by any applicant for a permit subjects the applicant t0 a civil
Onalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who tloes such work himself/herself Or through his or her own
employees, provided that such imp r OvementS are not Intended or offered for
sale. 11, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im.
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Cede:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon. and who contracts for such Dialects with a Con.
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o/ their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Ownei
I hereby certify that I have rea
information is correct. I agree to
and stat lating to buildii
Sentativ pf th S city 40,entei
this
0-3? %37 I 13224 1 U-7
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
-OCP CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. SFD _
TYPE OF PERMIT LJ GRADING & FOUNDATION Z' I STRUCTURAL
❑ TENANT ® ELECTRICAL ® PLUMBING NO MECHANICAL
❑OTHER UNIT 1996, GARAGE 465, DECK 76
PROJECT DESCRIPTION SO. FT. SEE ABOVE OCCUPANC B=
CONSTRUCTION TYPE N7 VALUATION$�
ZONEf GRADING CU. YDS. —NA _ ACRES_N
Remarks:
Sink
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Root Drains
Reinspection Fee
Outlets
$15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG *13507
,H_eaa J System & Ducting
044100,000 BTU ❑ 100,000 BTI
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type ❑
Canopy Typell ❑
R�eration System
0,000 BTU ❑ 100,000
System Repair/Alteration
Fire Dampers
Registers
A.P.0 (../p/L-f- yam/ —0 / I Zone
S
Main Building: NIA Accessory Building:
T
Front 19 P,50 G E_
ARear
0
C
Right
K
S
Left
Ping. Ref. YhPR- Parking eq /Provided
Planning Notes: v^0 enVV1A1 nt;ntltREMEN
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 1:10-5 KW ❑5-15 KW
Sub Panel _
Motors ❑0-1 HP ❑ VA - B
Inc. Solar ❑9-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
4
N
G
R
E
Q
M
T
S.
I I Reinspection Fee 1 $15 1 1 Issue Fee I I
$ 3 DEVELOPMENT SERVICES REQUIR
Zoning Approved By
FEES Building Approved By kn,
T Application Issued By
fJ
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter ❑over 100 amps
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 1:10-5 KW ❑5-15 KW
Sub Panel _
Motors ❑0-1 HP ❑ VA - B
Inc. Solar ❑9-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
4
N
G
R
E
Q
M
T
S.
I I Reinspection Fee 1 $15 1 1 Issue Fee I I
$ 3 DEVELOPMENT SERVICES REQUIR
Zoning Approved By
FEES Building Approved By kn,
T Application Issued By
fJ
Signature Coate V �'
Drivers' Lice or SS — - Reinspection Fee $15 Issue Fee -
!1� _.
0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor -
FEES
SUM�rMGAy�R---7777Y
BUILDING PERMIT
$
nOO//F
SMTP
7 $
/Or O�
PLAN CHECK
$
02 +
PERMIT
PLUMBING
$
00
A7
ISSUANCE
ISSUANCE
$
PLAN CHECK 25%
$
ENERGY P.C.
$
ELECTRICAL fJ f(ar
GRADING
$
PLAN CHECK 50%
$
MICROFILM
$
MECHANICAL
$
4(O(O' 50
TOTAL FEE
$
95
PLAN CHECK 25%
$
Signature Coate V �'
Drivers' Lice or SS — - Reinspection Fee $15 Issue Fee -
!1� _.
0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor -
r�
'CONSTRUCTION AND PLANNING
APP♦ OVALS Permit #
l
Date
Inspector
P SPA
APPROVALS Permit #
Date
Inspector
1. T*porary Electrical Service or Pole
52. Pool & Equipment Location
2. S�l Pipe-Undrgrnd.
q-�bQ
L4FZ?
53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Condult-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
q -(o 8q
6007
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
/Z_6 8
(��
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
tit
3
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
1,8.,. Rough Electrical -T Bar Ceiling
69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
L40
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
'�/.L
L,01
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71: Product Piping O Gas ❑ Oil
23. Gas Pipe -Rough & Test _
_ _
72'. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank CGas ❑Oil r
25. Roof Sheathing
74. Overhead Hydro
. 26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lail in9 & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
9. FINAL INSPECTION
32. Electrical Power Meter -Final
FOOD CERTIFICATE ISSUED
'
33. Final Electric
,.
otes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
j2.-(r}i�/
Q SP M4 9MUMI
36. Hood or Canopy
7�lGTLS
37. Final Factory Fireplace
�f,q(
/�/'
vX
38. Final Plumbing _
r-lf-w
�
39. Water Service -Final
-
40. Gas Service -Final '
41. Solar Domestic -Final _
42. Backflow Preventer �-
,+i
43. Backflow Irrigation;,.-.
44. Landscape Irrigation: System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No Date
IWA EN@fNEERS
17390 Brookhurst meet Sulte 100
Fountain Valley, Callfomia 92708
(714) 9661221 • FAX (714) 96&9286
March 21, 1990
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, Ca. 92628
Attn: Mr. Victor Clift
Subject: Fine Grade Certification
r ---I
L_ ,
J.N. 207-03
I hereby certify that the fine grading for lots
2,4,5,6,7,8,9,10,50,51,52,53,54�55',56,57 and 58 of Tract 13224
were graded as shown on the approved precise grading plans for -
said project.
Llewellyn D. Incledon
R.C.E. 17593 Exp. 6-30-93
/ 789
LGT J[.tl(/ ( (4Ce"
H
A
BN FORM 116 CALIFORNIA SEABREEZE PHASE 1
BIA FORM 1496
INSULATION CERTIFICATION
This is to certify that, in conformance with the current energy regulations (California Adminis-
trative Code, Title 25, State of (oliforniciI and approved plans, insulation has been installed in
the building located at:
Costa Mesa
city
I?r69
Sb.M Ne. Ilt A.ailrbb)
ROOFS
Peninsula Place
sb..l
eaeny
L/ 7 13224
LrA Mumt,Y Tnd Ne.
DESCRIPTION OF INSTALLATION
Type of Material
Manufacturer
Thickness—R Value**—
Manufacturer
Thickness-- No. Bags_
EXTERIOR WALLS
(pr Tnd. 11. .)
OWENS CORNING
3i
1
Type of Material FIBERGLAS BATTS
Manufacturer
FIBERGLAS
Thickness R Value"—'
Manufacturer
Thickness R Value••`
(Or Tnd. Nam.)
(Ot Tnd. nue.)
SLAB ON GRADE
CEILINGS
OWENS CORNING
6411
19
BT pe FIBERGLAS BATTS
Type of Material
Manufacturer
FIBERGLAS
9I"
Thickness R Value•'_
30
(er Tnd. N+m.)
Type of Material
Sp. FL Covered
Thickness R Value**—
(0, Tn M.mel
BLOWN:
Type of Material
Manufacturer
Thickness-- No. Bags_
(pr Tnd. 11. .)
WL/Bag SQ. FL Covered — R Value**—
FLOORS
Type of Material
Manufacturer
Thickness R Value••`
(Ot Tnd. nue.)
SLAB ON GRADE
Type of Material
Manufacturer
Thickness R Value**—
(0, Td* N.onp
Width of Insulation
Inches
FOUNDATION WALLS (if required)
Type of Material
Manufacturer
Thickness R Value**—
(0, Tn M.mel
REMARKS (if desired)
General Contractor (Builder) Kaufman & BroadLicense Number
Sub -Contractor (Insulation Applicator) Accent Insulation Company License Number 274283
llewl.4w, YJ.aon ) (Stab "SAYE" N soon. a C.r,.n1 tntLn)
By f Title_ � � Date March 2, 1990
� IM1
10-110 nc. l,d.:ntabel:.. Cad.. G...y lnwtariw SIw/Yds, d.ttY.., E)tQarl A.. S.t. IVVs .1 M. N«IM cad $OtY, Csd..i IA. SIaN
wn, U. t.w.bf« N M in.Rlleli« ./ inul.Nw, . ted d C.IilYnq.
e.Nlyiy MY IA. I...Ieriw Ma b.« In+..IMd ti twl..w.nc..IM IM
rw.lnw..N .l Mn. ,..+I.+iw. rWll M nwsl.W .M ... w by n fy tw•
lib. Inu46w ..Nlmlr M by IW b.11dY. TAb !re.l.riw mmallene ~.d b.W, .✓d, ep.An.nl b«w, bw Y sMY mld«Fol
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awbu M. mMm a Iw+l +ati+no Ib. wl.i �..+ .nqy bubliw
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Form 116 —0 BUILDING NEWS, INC, 3055 overland Ave, Los Angeles, Calif. 90034-42131870-9871
Form 1486-0 BUILDING INDUSTRY ASSOCUTION OF CALIFORNIA, INC., 1571 Beverly Blvd, Los Angeles, Calif. 90026—UIM 5255771