HomeMy WebLinkAbout1797 PENINSULA PL - Building Permits MUMADDRESS: UNIT:
Cr 1PlIAME: 1797 PENINSULA PL 49 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: G 05167/,
O:IWERESS: KAUFMANN & BROAD
180 N. RIVERVIEW DR PERMIT NO; G 051674 PLAN CHECK NO; 01238-91 A GOVT: N SUPP ; N
, SUITE 300
ANAHEIM CA 92808 CONSTRICTION TYPE: V—N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
921-0500
ARCH/ENGINEER: NEG.NO.:
ADDRESS: MIKE WOODLEY C1 tlN�.30 JOB DESCRI TION : SFD AND GAR SQ FT: 2, 910
180 N. RIVERVIEW DR •
300
' PERMITTEE: ANAHEIM CA 92808 CLAIM VALUE: 169, 417 . 00 CALL-VALUE: 172, 657 , 70 GROUP OCC: R-3 /M-1
ADDRESS: KAUFMANN & BROAD ( 714 ) 921-0500
180 N. RIVERVIEW DR 300 COMMENTS; RE- PLN-CK 234-89 A
ANAHEIM CA 92808 ************* **************XX''ON'***N''N'*NE***N-4 *4'******N-M-xnN' **x ii ***wx.* .* *s* *
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full lorce and effect. S E T B A C K S
CITY LIC.: 6 `1/4 STATE LIC.: 3344 GLAS$: B-1 ,.
Dale. 441/7 Signature: -- __-__ _ — LII .— MAIN BUILDING ACCESSORY BUILDING --------•—
WORKERS' OMP SATIONDECLARATION: I hereby affirm that I ea certificate of consent to self-insure or a certificate of Workers' FRNT: 15 FT IN REAR: 10 FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 38 ab,C). LEFT; 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN
?OLICY NO.: 4189-1090 EXP.DATE: 03/07/92
'OMPANY: 'I` ANS. INS-, PARKING REQ: 2 PROV: 2 PARCEL : 42452123 ZNE: PDR- REF NO: PA-88-40
Certified coy is heeby furnished. 4{ Certified opy is filed wit the city Bgil 'ng Dlvisian PLANNING NOTES> SINGLE FAMILY RESIDENCE WITH ATTACHED 2 CAR GARAGE; . 5 OPEN
•� y`y � ���1 > PARKING SPACE/ UNIT PROV. 18 ' LONG DRIVE PROV, P ; ' F
Date: 4 /7 9/ Applicant: 'LLG v` /WL/i/ >**R**#N7F*1Fii******OU**4-**>E*lE?E*1ERf,IF****IE.**3f******3!-#*if*****#3i**Y. ****3E*if?F****AF***
-- EXEMPTION FROM ORXERS'COMPENSATION DECLARATION: (This. on need not be completed if the permit is for one hundred($1001 or less). DE V E -L OPMENT , S E R VICES REQUIREMENTS
I certify that in the performance of the work for which this permit is slued,I shall not employ any person in any manner so as to become -
subject to the Workers'Compensation Laws of California.
ZONING APPROVED BY DATE:
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers Compensation provisions of the Labor BUILDING APPROVED BY i ' ) DATE '
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
APPLICATION ISSUED BY:
- ....,.__..-- ......---____.,..---• ( FAQ
which this Permit is issued/Section 3097.Civ.C1. *****.**}'..N..*******.*****4 ,,,. ' • • +r,. `. `. - 7 .• • #ar*?EA*M:**DA**1r*.#.'{1= I-7I *..�:.*.
LENDER: **-*******************}'.** *********#b:****** .**********3E*****•****k3i A0N ***d(***
ADDRESS: 4
LEGALIZATION: N F E E S U M A R Y STRUct001 SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC :IRP N(�`
(Section 7031.5 Business and Professional Code: Any any of county which requires a permit to construct,alter,improve,demolish,or �.\L^y IIP/.SES GRADING
repair any structure,prior to its issuance.also requires the applicant for such permit to fife a signed statement that he/she is licensed PERMIT I T 895. 00 3 9 50 82 99 32,75 SQA 17, 27
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5$ '50% 25%
SM I P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 145 , 44 rV�'O O
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3,00 15 , 00 15‘41,\X
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECE TOTAL PAID DUE
f3 structure is not Intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law e
TOTALS---->> 106'7, 51 33 , 00 145 , 44 1245 , 9 1245 , 95
doesis not applywloan owner. of a properly who buildsmror improvessarthereon,oand who does such work. I himself/herself. owvr e or through or . 00
his or her own employees.provided that such improvements are not intended or offered for Sale. II,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; 1245. 95 OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 895 . 00 42 , 50 97. 99 47. 75 17, 27 145 , 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 aconlractor(s)license pursuant to the Contractors'State License Law),l am aware ,*-**.*******.**.**************************************** F**************-********4*rk,**
that proof of their Worker's Compensation insurance should be provided to me.
o I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN
for this reason: TYPE QTY7.11.4: R IP T ION UNIT COST TOTAL COST
Date: Owner: '
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Co Sections 25505.25533,and "SFR 2. f Cr, '1 ,'000 FRAME -GOOD 69 . 00 16j, 799 , UU
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state co s and the requirements for a SFR RES-BALCO' 11= EXTERIOR STAIRWAY 13 . 80 1 , 048 . 80
permit for construction Or modification from the Air Ouality Management District.Residential construction ppliwtlons are exempt from SFR RES-r• 'AG . TYPE V
17. 30 8r009 . 90
these provisions, ELE 2 _ AP WJE1T -•.a. .. .: FOR 1 OR 2 UNITS/ SQ FT . 03 82 , 99
Dale: Applicant: NEC d. INST FORC-AIR/GRAN FURN <= 100 E BTU 9 , 00 9 , 00
MEC ]. N RE G-a TION SYSTEM <= 100 K BTU/H 9 , 00 9 , 00
I hereby certify(hal I have read this application and Slat• • -: ore information is correct.I agree to comply with all city and county MFT (1 1. OF:MUM�r AR EPS ACC, r 6 . 50
ordinances and slate laws relating to buildingconslrucii •and hereby au 'rile representatives of • city to enter up•nlh'above'mentioned 11 JJ. 6 • -�(1
property for inspe ion Pur les. / j MEVENTILATION FAN CONN TO SINGLE DUCT 4 . SU 4 , SU
NECC 1 GAS PIPING SYS 1 - 4 OUTLETS 3 .00
Date: `Y" 9j Signature: ).. ./ii ,-. . � NEC 1 GAS PIPING SYS 5+ OUTLETS PER OUTLET • 75 3 .00, 7$
Driver's License or Social Security / PLU 2 BATHTUB 2 , 00 4 . 00
1641-46 White-Budding:Green-Codd Enforcement;Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING'. Pk 4 SPA
- ROMA LS Permit# Date Inspector APPROVALS Permit# Date Inspector
e1. Timporary 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 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 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 Oil
23. Gas Pipe,-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
^ (
25. Roof Sheathing - �3Ih( / 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat '+ 75. Dry Chemical
27. Frame and Flashing La'f t_ alihf 76. Dry Standpipe
28. Lathing& Siding G/2. ( J � 77. FIXED SYSTEM FINAL
29. Insulation 6.12-1 It- 78. FIRE PREY. FINAL
30. Drywall Nailing 612-5' e 1.i- HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat /t1 est
79. FINAL INSPECTION
32. Electrical Power Meter-Final ,.2 ••80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning f,6'4( La --
35. Final Gas Pipe-Test �-bct( CAW
HOLD FOR SPECIAL REQUIREMENTS
•
36. Hood or Conopy
ry Fireplace
` $r7.4l44 /'
'� !�/0/37. Final Factory Fireplace >o'zl � QJ(I
38. Final Plumbing '-i-C( [,e/)
39. Water Service-Final ‘1(4-411 I-to
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation •
46. Handicap Regulations
47. FINAL c,' 'f'Y STRUCTURE & BUILDING y (Z/j'(
48crO RiQJ<JW6 PEC;/: 4 •0 ' )`. c)!= <74;1i...
49. Electric Release to Edison .,
50. Gas Release to Southern California Gas Co /
51. CERTIFICATE OF OCCUPANCY
No. Date
P'1OJECT AQDRESS: UNIT:
OWNER'S NAME:
ADDRESS: PERMIT NO: G 051674 PLAN CHECK NO: 01238-91 A PAGE: 2
if*#**iFTiifiEifiE*.**of*3FiEiE****a:4f 3f ifiE#iEif*iEifiEiEitiE**iE*iEK 1iiEM:i?#**iF%iEifiEifkk-3EPit M#*OFififif I****KiiiS*Yi()E
ARCH/ENGINEER: REG.NO.: TYPEQ TY DESCR IP T ION UNIT COST TOTAL COST
ADDRESS: UNIT:
PLU 1 DISHWASHER 2 . 00 2 , 00
PERMITTEE.
PLU 2 SHOWER 2 . 00 9 , 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 0 0 6 . 00
7000)0l 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: PLO 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 '2 , 00
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I 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. 00 200
POLICY NO.: EXP.DATE: PLU 1 SEWER, BUILDING / TRAILER 5 , 00 5 . 00
•OMPANY: END OF FEES
J Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
Date'. Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it 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 10 become
subject to the Workers'Compensation Laws of California.
Dale: Signature:
NOTICE:rafter 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,Civ C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the.tollowing 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'Stale 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($50(1).
I. as owner of the properly 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 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. 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).
I.as owner of the property,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 properly 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.
LiI 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 Duality Management District.Residential construction applications are exempt from .
these provisions.
Date: Applicant'.
1 hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
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 k:
1641-4S White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
. - s a a .
,SONSTRUCTION AND PLANNING - F & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
s 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrrid. 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, O 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 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil •
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
•
, 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final -
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date _
•ERTIFICATE OF COMPLIANCE* / ()cc V
PAYMENT OF SCHOOL FACILITY FEES li
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
•
Developer/Applicant: (� (/F/py; j- 13FD(4[>
Address : N • K( VEP I//ELL) lie ST .?0
Telephone Number : 7/1/ 9a/ -0500
Tract/Parcel and Lot Number(s) : /,7 `/i// lig, �9
/ -}h _577'5E7-
Location
S'EE -Location of Project : _�T�"� F _ COS7-,q/4FSf}
Number of Square Feet of
Residential Space 7975 x $1 . 50 Total // OW, 0Z7
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 Manager
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 approp iate City/County shall . - notified .
•
Date : Y /0////5/ s . ' fru, Se
Dev - oper/Applicant
•
I / . IWA ENGINEERS
17390 Brookhurst Sheet,Suite 100
Fountain Valley,California 92708
(714)968-1221 •FAX(714)968-928o •
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 49 of Tract 13224
were graded as shown on the precise grading plans for said project .
. ViAesa-
Llewelly D. Incledon, R.C .E. 17593
(NrigNr-c-v--y--r-nrclr-L7TW-7r..7-Nr---Nr-741r-i77,--77-_.,..� �':Y 7. :.. -�.� t`Nak ata-Cas_ i..42s.s-�\.:l ltF�'S. :
BN FORM 116 ' -• - I
I.4
DIA FORM 1486 r I I}
l
t- INSULATION CERTIFICATION
j
i This is to certify that, in conformance with the current energy regulations (California Adminis-
i /.1 native Code, Title 25, State of California') and approved plans, insulation has been installed in
\!I the building loaned at: =
G./y( COSTA MESA ORANGE i
city County SEABREEZE /..)1797 Peninsula Place EOT 49 T 11 `R 13224-38 I •;
, sent Me. ret Available) StreitStreiten Nfni len Ind IN. I l(
H 1
�l DESCRIPTION OF INSTALLATION , r%i
i ROOFS I \ 31
4.\ Type of Material Manufacturer Thickness__R Value" /1
EXTERIOR WALLS OWENS CORNING i - '0.
.I
r Type of Material FIBERGLAS BATTS Manufacturer FIBERGLAS Thickness 31" R Value" 11 I , -
(Or TM. Na.)CEILINGS OWENS CORNING IINBATTS: FIBERGLAS BATTSFIBERt7 AS 6% 19Type of Material Manufacturer Thickness < R Value" I�(OrTrade Mini.) y 114.,
fall SQ. FL Covered ;
BLOWN:
i� Type of Material Manufacturer Thickness No.Bags '
' �) (Or Trade It.re.) f
l;/
Wt/Bag Sq. Ft. Covered R Value'•—
I've
FLOORS
-� Type of Material Manufacturer
Thickness _R Value s
[[�'��,, (Or Trot Name)s;i SLAB ON GRADE /.
1...K Type of Material Manufacturer Thickness R Value" l�\t�
(Or True. Mewl
Width of Insulation Inches
it
• / ! 11.x'1
FOUNDATION WALLS (if required)
\t 1' )
`�' Type of Material Manufacturer Thickness_____R Value"_ �'r
(O. TTM. Mania)
` ' . f l
REMARKS (If desired)__
(C/ !�3
KAUFMAN & BROAD-SOUTHEAST �T1
General Contractor (Builder) uceelnse Number /l.
ll
: . ' By Title Date i)9)
M :
Sub-Contractor (Insulation Applicator) Accent Insulation Company License Number 274283 .T,
n.sul.e.,, Yew, tr.) (State "SAME" M see/es'C.•.•I treaty)
� ���� j�.
By �.!/ Title /�- �!. / Date 6-29-91
I• (•GINr..• AI.Ni•p.r,.. Cede. E..ny t.nd.lt..St••sw.. Modern. atlirf trim. Sia. tun a M. N nlw sad S.r.ry Cade a t.. Si.. I�/1
• "Cearl:..e. U... .raleOne et w lestelleli.n a i..eI.t... . yard a CO:forsi.,
��////t snit,:..Men ho i.•.d.fr Is.be...Nw.tl.4 le tenten.wa..i* M.
AlI ,...i.. ..h a .1•••• nye as,... .WI be a..as.. W ...au d be ',An ..r.iSa'. el .aa...wy .r .;.1l•, en,sla tlen .Mt • meaty a. l)
M. 1,0.g, ...power and by M. bender. MsY.vd.11.. a wd:we showed betel, ...raaww
. •,. ry teen. . .r .M.. r.ad.w:a � -)
cant •tai w aired en . o..elre.e. I.a.M.* .IMI. M d.aliw.") ..el".. 1. S.tl..e.. emit M l..e•. by ..d, . beitei.. hp.rtewl
:II wed.. Se .n•••••• .t lent .eni.f Se wlr.... .e.., laudation;
1"r Vene. N Se ...we ef Sr .NLN..• .t a nie$.r4 .r IlelNiy .Melenle.stebil.t..d den....I.Ml.dowser."
linnevenn 1e M pew..e el been.Ile.ed.Neri erica II) el w.-arae \1 IT
•mM 0 1KIed• oey vete* ter reflective l. .) 1)I /'
n Form 116 -m BUILDING NEWS, INC., 3055 Overland Ave. Los Angeles, Calif. 90034-(213)870.9871 111:
1`` Form 1488-9 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC..1571 Beverly Blvd.Los An1elcs,Calif.90026-42131625-5771 Pi)
(, // f, -.1".: .gyp. M.. W. • M :nim.'.�} ✓s N ✓., 'P.. M. to w eA.