HomeMy WebLinkAbout3486 QUEENS CT - Building Permits,f
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CITY OF COSTA MESA
��pMF BUILDING DIVISION
i�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: M09-00025
PERMIT TYPE MECH
APN: 41204272
JOB ADDRESS: 3486 QUEENS CT CM
Vicinity: REAR YARD
SQ. FT: 0
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
03/16/2009
RMD
SCOPE OF WORK: MECHANICAL PERMIT FOR TO CHANGE OUT AN EXISTING 3 1/2 TON A/C UNIT (SAME LOCATION), REAR
YARD OF SFD.
OWNER: MC CLURE, JOHN C
PHONE: 714•668�1733
APPLICANT: JACOBY, ERIC
PHONE: 818-735-7876
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
CitylState: YORBA LINDA, CA ZipCode: 92887
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FE�: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
Address: 3486 QUEENS CT Unit:
Ciry/Stale/Zip: COSTA MESA, CA
Address: Unit:
City/State/zZip:
License No. 799170
PHONE: 714-777-7777
CELL:
N0710E: 7be work authorized by tbis permit shall comply witb all applicable handicap access requirements under Califwnia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeclions and final approval musl be obtained. Failure to obtain inspections and final approval vrill result in the expiration o( this permit.
CODE t. INSPECTIONiYPE D�TE INTIi1115 CODE� INSPECTONTYPE D�TE p INTRIpLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 3_�% _ O l �
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Raot p1p Final Electriwl
201 Final BlocklRetaining Wall ' 212 Final Fire Preventian
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/OccuOancy
� .�
WORKERS' COMPENSATION DECLARATIO .
I hereby affrm under penalty of perjury one of the lollowing declarations:
❑ I have antl will maintain a certificale of consent to sel6lnsure for wOrkers'
wmpensation, as providetl for by section 3700 of the Labor Code, for the
performance of the wnrk for which this permit is issued.
❑ I have and will maintain wvrkers' compensation insurance, as required by
section 3700 of the Labor Code, for Ihe pertortnance o( Ihe work for which this
permit is issued. My workers' compensation Insurance carrier antl policy
numberare: , _
,2ltler
µ��- -(T�hiss-e�dionnecwl PEecompletedAMepe�m�isvaluetlnlonelrundietltldlan($100)wless.)
uLCP y.Numtier i�. �/JO�� 7 S� %
❑ I certiFy that in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
ro the workers' compensation laws of Cali(ornia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor C I s all fo hwith comply vnth these pmvisions.
Applkan�Si ' Wre oDat/G 9
i
WARNING: FAILURE TO SECURE WOR ERS' COMPENSATION COVER4GE
IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AN� CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed untler provisions of Chapter 9(commencing
with Section 7000) o/ Division 3 of the Business antl Pro(essions Code, antl
my license is in (ull (orce and eHect.
Ctc. x--`w� _' D c�lass. �L'� C� 2� lJ
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d
! 1CoNwr�r's�5i ure � �' ale� 'r.F„
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CONSTRUCTION LEND G AGENCY:
❑ I hereby affrtn that there is a construction lendinq agency tor the
peAortnance of �he wnrk fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
Daie
OWNER-BUILDER DECLARATIONS:
I hereby aRirm that under penalty o( perjury Ihal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5,
Business and Pmfessions Code: Any ciry or county which requires a permit ro
consVuct, alter, improve, demolish, or repair any struclure, prior to its
issuance, also requires the applicant for such permit lo fle a signed statement
Ihat he or she is licensetl pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 0( ihe
Business and Professions Code) or that he or s�e is ezempt theretrom and
Ne basis for lhe allegetl exemption. Any violation of Section 703L5 by any
applicant for a permit subjects the applicant [o a civil penalty of not more Ihan
five hundred dollars (5500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and ihe structure is not intenCetl or
offered for sale (Sec. 7044, Business and Protessions Code: The Contractors
License Law does not apply to an owner of propeny who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered !or
sale. If, hov+ever, the building or impmvement is sold within one year of
completion, the owner-builder will have the burtlen of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
UCENSED CONTRACTORS to consWct the project (Sec. 7044, Business and
Professions Code: The wntradors License Law dces not apply to an ovmer of
propeny who Duilds or improves mereon, and who contracts for such projecl wilh
a contractor(s) license pursuant to the Contractas license Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
ignamre
305]-a6(3I0 )
i -�-
Owner ID verifetl hy tlr license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation o( Ownership by (type of document, i.e. - pmperty lax bill or tleed�:
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certAy that no excavation frve (5) or more leet in tlepth into wfiich a
person is required �o descend, will be made in connection with work authonzed
by this permit, antl that no 6uilding strucNre, scattdding, falsewark, or demolition
or dismantling thereol, vrill be more than thirty-six (36) feet high. (Chap. 32, Gry
2, M 2, Sec. 341, Ttle 8, Califomia Administ2tive Code�.
❑ As owner-builder, I will not employ anyone to tlo work which wnuld
require a permit from the Division of Industnal Safety, as noted above, unless
such person has a permit to do such work from the division.
AO�licanl's SignaWre
Division ol IndusMal Satety Pertni[ Number. _
HAZARDOUS MATERIAlS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or tuNre building occupant neetl to fle and
certi(y a Business Plan for emergency response ro release or threatenetl
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of [he Cali(omia Health and Safery Code requires, with some
exceptions, Iha[ a Business Plan be (led with the Costa Mesa Fire
Depariment by every business which has at any one [ime during a reported
year a quantiry of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard temperaNre antl pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Cali(omia Health and Safety Cotle, vrith some
exceptions, requires registra[ion with Ihe Cos�a Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous malerials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
�emperaNre and pressure).
3. Does or wili the applicaM or present or fuWre builtling occupant neetl to
prepare an RMPP (Risk Management and Prevenlion Pmgram for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safely Code pmvides that the
Costa Mesa Fire Department may require the preparation, certificalion and
filing with Ihe Fire Department o( an RMPP by businesses which are required
to register acutely hazartlous materials wiN the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 of the Calitomia
Health and Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or will ihe applicant or present or fu[ure building occupant require for
the wvrk which is the subject of ihis applica[ion a permit (or such construction
or motlifcalion from Ihe SouN Coasl Ain Qualiry Management Dislrict or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
intortnation be fumished on applica�ions ta nomresitlential builtling pertnits�.
6. Will any part o( the facility to be constructed untler this permit be within
1000 (eet from the outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", lhe laciliry must meet Ihe requirement of Sec[ions 25534 and 42303
of lhe California Health and Satery Code).
Z If a pertnit fmm the South Coasl Air Quality Management District or other
air pollution control diSMct or agency is required for the work which is lhe
subjecl of this application, have all of the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Q( "yes", allach certifiwte of compliance (mm Ihe appropriate air pollution
control o(fcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
SignaWre oa�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty o! perjury that I have read this application and state that
the information given is correct I a9ree ro comply with all state laws and ciry
ortlinances relating to builtling constmction, and authorize representatives o(
ihe City of Costa Mesa to enter upon the above-descri6ed property for
inspection purposes. I agree not ro occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
^ S'ignawre ol legal Owneqs) �a�e j
YlZ.�(. � ��
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PROPERTY DRAWING
Click on Che map below to open a new window which will allow you to place a mark where the A/C unit will be
placed:
Please describe any property line barrier which exis[s:
earrier type: 0 heiqh[: 0
If gate or bushes exists in side yard to screen unit, describe:
Gate or Bushes: ,�e5 � height: O
'y�,
No[es:
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fi le://C:\DOCU M E— I\E R ICJA-1 \LOCA LS— I\Temp\R7PHXM7Y. htm 3/ 14/2009
(7ta) �5a-52�3 • Fax (714) �Sa-ae56 • www.ci.costa-mesa.ca.us ii rnin univ�, i.w ir� niwr., �.n a�v�v
Job Address: 3486 QUEENS CT
Suite No
Vicinity:
Parcel Nunmber: 41204272
Applicant: HAUER, JACK
Address: 9911 LARSON AV
GARDEN GROVE , CA
Owner. MC CLURE, JOHN C
Address 3486 QUEENS CT
COSTA MESA, CA
PLUMBING PERMIT
Phone: (774)530-2440
Zip: 92842
Phone:
Contractor: A-AMES PLUMBING & HEATING
Address: 9971 LARSON AV
Arch / Eng :
Address:
GARDEN GROVE , CA
WATER HEATER CHANGE-OUT.
1 WATER HEATERNENT.
ISSUE FEE
Backflow irrigation
BackFlow Preventer
Bathtub
Clarifer System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drein, Roof
Drinking Fountain
Ezpansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
so.00
$0.00
§0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
QTY
Zip: 92626
Phone: (774)530-2440
Zip: 92842
License: 250307
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors 50.00
Septic Tank 50.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop 50.00
Spa (private) 50.00
Spa (public) 50.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: OB/28I2000
Issued: OB/28/2000
ISSUED BY:
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Close[ (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Sokener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
$12.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES: 535.80
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 780 days, or if work is suspended or abandoned
tor a period of 7 BO days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetiona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of �his permit.
FOR INSPECTIONS CALL: (714) 7545626
zaasas �sroo�
WORKERS'COMPENSAnON DECLARAnON:
I her eHirm untlar penalty of perjury ona of the following tleGaretions:
I have entl will maintain a certiticete ot consent to selFlnsure for workers' compensetion. es pmvided for by section 3700 of the Lebor CoCe, lor t�e pertortnence of the
wark tor which Ihis pertni[ is issue0.
❑ I have end will maintain workers' compensation insurance, as requiretl by section 3700 of Ihe Labor Code, for ihe pedormance of the work for which I�is pertnit is issuetl.
My workers' compensation Insurance carrier en0 policy number ere:
Carner: Policy Number.
(This section need no! be campleted 1! fhe permit ts valuetl ei one huntlretl tlWlars ($100) or less.)
❑ I cenity t�et in tne pertortnance of the work for which this permit is issuetl, I shall not employ any person in eny manner so as to become subject to Ihe workers'
compensetion 18ws of Califomia, end egree t�at If I should becoma subject to the workere' compensation provisions ot Section 3700 of the Labor Cotle, I shell forthwith
comply with Ih q si ns
ApPlicant5igneWre:�\' �%� Dete: O�� �`�� �.$p
WAiiNiNO: FAI�URE TO SEW�E WORKERS' CqMPENSATION COVERAGE IS UNLAWNLlWD SMALL SU&IEGT AN EMPLOYEP TO CRIMINAL ENALTIES AND GVIL FlNES UP TQ ONE HUNDRE�
THOUSAND DOILARE (5��. �. IN AODRION TO THE CQST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTIIXJ 3]08 OF TNE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that 1 am Ilcensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my license is in full
force ana eflect. lic. d qass a�
ConlractoYs SlqnaNr . Date: � lA .- �F,
CONSTRUCTION LENDII�G AGENCY:
❑ I hereby aHirtn tpat there is a construction lentling agency for �he peAortnance of iha work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Nema: Lendefs Adtlress:
Signature:
OWNER-BUILDER DECLARATONS:
Date:
I hereby eHirtn Ihal untler penelry of perjury Ihet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW br the tollowing reasan (Sea 703L5, 0usiaess anC Protessions
Code: Any ciry or cou�ry which requires a permit to construct, alter, improve, demoiish, or repair eny strucwre, D�or m its issuance, also requires the epplicant for such pertnil
to file e signed statemam thet he or s�e Is Ilcensetl pursuent b the provisions of Ihe Contrectors License Law (Chepter 9(commenclnq with Sectlon 7000) oi Dlvlslon 3 oi the
Business entl Protessions Code) or thet he or she is ezempt tharetrom entl the 6asis lor Ihe alleged exemption. Any violation of Section 7031.5 by any epplicent for e pertnit
subjects Ihe epplicant to a Uvil penelry of not more then five huntlretl Oollars ($500).):
� I, es owner ot ihe property, or my employees wiih weges as Iheir sole compensetion, WILI DO 7ME WORK, entl the structure is noi intentletl or oHeretl lor sale (Sac.
7044, Business and Professions Coda: The Coniractors License Law dces not apply to an ownar of properry who bui105 or improves ihereon, an0 who does such work
himself or harsed or through his or her own employees, providetl ihat such improvemenis are not imentled or ofleretl for sele. If, however, Ihe builtling or improvement is
sold wilhin one year oi comD�etion, the owneabuilder will have I�e hurden of proving that he or she tlitl not build or improve for purpose ot sele.).
❑ I, as owner ot thd pmperry, am E%LLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct thB project (Sec. 7046, Busineu end Protessions
Cotle: The comractors kimnse Lew tloes not appty to an owner ol property who bullds or Imprrnes thereon, and who wntrects br such prqect with e comrecmr(sj
license Dursuani to the Contraciors License Lews.).
❑ I em e:empt under sec. BuSinass anA Profe55ions Catle for thi5 reason:
Siqnature: Date:
Owner ID veritietl by tl�`/ar's license. ❑ Ves ❑ No Driver's License No. Expires:
Venficetion of Ownership by (type ol tlocument, i.e. - property tau bill or deed):
DIVISION OF INDUSYRIAL SAFE7Y PERMIT CERTIFICA710N:
� I hereDy certify inat no axcavation live (5) or more feet in depth into which e person is required to descend, will be made in connection with work euthonzed by this
permil, an0 that no building swcWre, scaHolding, talsework, or tlemolition or dismaniling �hereot, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Titla 8, Calitomia Administrative Code).
� As owner-buildel. I will nol employ anyone to do work which woultl require a pertnit from the Division of Intlus�nal Safery, as no�ed above, unless such person has e
pertnit to do such work from the division.
Siqnature: Date:
DiviSion of Industrial Sa�ety Pertni� Num6er:
CERTIFlCA7E OF COMPLIANCE AND AUTTIORIZATON OF ENTRV: I cenity under penalty of perjury that I have read ihis ep0�ication and stata that the information given is
wrrecL I egree to wmply with ell state laws end ciry ortlinances relating to huiltling construction, antl authorize representatives of the Ciry of Costa Mesa to enter upon iha
above-deseribed propeny tor inspection puryoses. l ag�ee oot to occupy or allow occupancy ot any building euttwrized by ltus parmit ualil final iaspeciian.
CODE �.
1616
1266
200
201
Fixed System Final Fire Prevenlion
Pool Spa FinAl
Finel R8-Roof
Final BIocWRalaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolitian
peg iHrnu�s
�. :
r' � � Y ' =
�' '
CODE 1 INSPECTION TVPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Preventlon
220
222
250
Final Planning Approval
Final Site
Final Building/Occupancy
�.I Jlib\�
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(714) 754-5273 • FaX (714) 754-4856 • www.CI.COSta-meSa.Ca.uS 77 FAIR DFNE, GOSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 3486 QUEENSCT
Suite:
Vicinity:
Parcel Number: 41204272
Appliwnt: SELL, RON
Address:
owner. MC CLURE, JOHN C
Address 3486 �UEENS CT
COSTA MESA, CA
Contractor: SELL ROOFING COMPANY
Address: 18032 LEMON
YORBA LINDA , CA
Zip: 92686
Arch :
Address:
Zoning: R1 R1
Phone: 528-1758
Zip:
Phone:
Zip: 92626
Phone: (714)526-1758
License: 323842
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: O6/04I2001
Issued: O6/O4I2007
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE SHAKE. COVER WITH FIRE FREE SHAKE. ICBO 5075. WEIGHT 4.75.
Plan Check: $0.00
Permit: $167.25
SMIP Res: $0.89
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.14
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0. 0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0. 0
$8,900.00
$8,900.00
� NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
'�, regulalions. (Ord. No. 9248, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commencetl within 1 BO days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized untler ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inepectlons antl final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
!696�96 (&00J
WORKERS' COMPENSA710N DECLARATON: '
�hereby affirm untler penalty of peryury one ol the followinq tleGarations:
❑ I �e end will maintein a certificate of consent to self-Insure for workers' compensatlon, es pmvided tor by sectlon 3700 of ihe Labor Cotle, for the padormence of the
ork for whith ihi5 pertnii is issued.
I have end will mainlein workers' �nSaXon insurance, as required by sectlon 3700 of the Labor Cotle, for �he peAortnante of lh=woM fo�wp(cq,(hi5 pertnit is issuetl.
My workers' compeQ.�euon In�ur�cQ car�r�nd policy number are: ' // p
Carder.
not
one
or less.)
Policy Number: _
❑ I certity that in the peAormance ol th work lor which this permit is Issued, I shall not employ any person In eny manner so as to become �bject to t�e workers'
compensatlon laws o1 Celifomia, an r a t�at it should be ome sublect to the workere' compensetion pmvislons of Sect� n��� �abor Co�e, I shelllorthwith
comO�Y with ihese provislons. / �
Applicenl Signeture: � De1e:
WARNIN(3: FAILURE TO SECURE WORKERS' WlAPENSATION COVE GE IS UNLFWFUL PND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT S ANp NIL FlNES UP TOONE HIINDRED
TFIOUSAND Dq1ARE (3100,000). IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMNGES AS PROVIDED FOF IN SECTION 3'lO60F THE IABOR CA�E, IMEREST, ANO ATiORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereDy eflirtn that I am licensetl un ro sls
force end eNect. Llc. x
Contrectors Signeture:
(commencing with Section 7000) of Division 3 of the Business antl Professions Code, end my license is in full
� CIa99 M
Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirtn thet Ihere is e construction lentling agency for the peAormance oi t�e work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Neme: Lender's Address:
Signature:
OWNER-BUILDER DECLARATONS:
Date:
I hereby eflirtn that under penalry of perjury that I em EXEMPT FROM THE CON7RAC70RS LICENSE LAW lor the following reeson (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requlres e permit to construct, alter, improve, tlemolish, or repair eny strucWre, prior to its issuance, elso requires the ep0licant for such pertnit
to tile e signed statament Ihat �e or she Is licensed pursuani to the prodsions ot the Contraciors License Law (C�epter 9(commencing with Section 7000) ot Division 3 oi the
Busine5s entl Professions Code) or lhat he or she i5 exempt Iherefrom end the basis tor the ellegetl e:emption. Any viotation of Section 7031.5 by any applicant for a permil
sublects iha epplicant to a civil penalry M not more than tive hundred dollers ($500).):
❑ I, as owner of the properry, or my employees wl�h waqes as their sole compensatlon, WILL DO THE WORK, and tha strucWre Is not intentled or ottered for sale (Sec.
7044, Business and Professions CoOe: The Contractors License Law does not apply to an owner ot property who builds or improves �hereon, and who tloes such work
himself or herselt or through his or her own employees, providetl ihat such impmvemenis are not intended or oNered br sale. If, however, the builtling or improvement is
soltl wit�in one year of completion, ihe owner-builder will have the burtlen of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner ot the pmperty, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Professions
Cotle: The contractors License Law tloes not apply to an owner ol property w�o builtls or Improves Ihereon, entl who contrects lor such project wlih a contractor(s)
license pursuant to the Coniradors License Laws.).
❑ I am ezempt under sec. Business and Professions Code for this reason:
Signature: Dete:
Owner ID verifietl by tlnveYs license. ❑ Ves ❑ No Orive/s License No. E:pires:
Verificetion of Ownership by (rype oi dacument, i.e. - property Wx bill or deed):
�IVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I herehy cetlity thet no excavation five (5) or more feet in depih into which a person is required to tlescend, will 6e made in connection with work euthonzed by this
pertnit, and that no bulldinp siructure, scattoltling, falsework, or damolitlon or tlisman�ling �hereol, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title 8, Calitomia Atlministrativa Code).
❑ As owner-Duilder, I will not employ enyone to do work which would require e permit Irom ihe Division of Intlustriel Sefely, es noted ebove, unless such person hes a
pertnit to do such work from the division.
SignaNre: Da�e:
Division ol Indusinal Safery Permit Number:
CERTIFlCATE OF COMPLJANCE AND AUTHORIZA710N OF ENTRY: I certify undor penalry of perjury lhel I have read this application antl state that the information given is
correct. I agree to comply with all st�te�iav�q� end ci ordinances releting to building constmction, end authorize representa�ives of ihe City of Cosla Mesa to enter upon ihe
ebove-described pmperty for insp r.ti n p r(�oses. I ree no acupy or ellow occupancy of eny building authorized by this permit umil linal inspection.
Si aWre egalOwn�sj� " � /�/� � Date
AnNOr Au�horizetl Applic� Date
CO�E N. INSPECTIONflVE
1616 Fized Sys�em Final Fire Prevenlion
1266 Pool Spa Final
200 Finel RB-Rool
201 Finel BIocWRetaining Well
202 Final Feciory Fire Place
203 Finel Sign
204 Final Demolition
QgjE INTff1AL5
(L-S o3 �L�
COpE I INSPECTION TYPE
206 Finel Mechanicel
208 Finel Plumbing
210 Finel Electdcal
212 Finel Fire Prevention
220 Finel Planning Approval
222 Finel Site
250 Finel Building/OCcupancy
P9IF IxrmA�S
Property Profile
�: .
Property Profi�e
Property Characteristics
Qedrooms: 3
Bathrooms: 2.0
Total Rooms: 7
Zoning:
Heating/Cooling:
Sale & Loan Information
Transfer Date: 03-26-1986
Transfer Value: $187,000
First Loan Amt: $85,000
Loan Type:
Page 1 of 1
DataQu�`c�k°r�r,
Wd W popMy OaN you cen Ou1W ar
Primary Owner: MCCLURE,TR
Secondary Owner:
Mail Address: 3486 QUEENS CT
COSTA MESA, CA 92626
Site Address: 3486 QUEENS CT
COSTA MESA, CA 92626
Telephone Number: (714) 751-4488
APN: 412-042-72
Reference APN:
Census Tract: 639.071
Housing Tract Number: 10275
Lot Number: 10
Page Grid Old: 27•E2
Page Grid New: 859-B3
Legal Description: N TR 10275 LOT 10
Subdivision:
Year IIuilt 1981
Garage:
Fireplace:
Pool/View:
Seller:
CosVSq Feet: $106.74
Lender. Gn Mortgage Coip
In[eres[ Rate Type: F
Assessed & Tax Information
Assessed Va]ue: $256,706
Land Value: $126,530
[mprovement Value: $13Q176
Percen[ Improvement 50.71
Tax Amount: $2,805
Tax Status: current
Square Feet: 1,752
Lo[ Size: 4,725 sq fr/ 0.11 acres
Nwnber of Units: 1
Use Code: Single Family Residence
Dowment: 0000119690.
Title Co.:
Last Trans W/O$: 10-20-2003
Last Trans W/O$ Doc: 0001291559
Homeowner Exemption:
Tax Rate Area; 15145
8 2003 qataQuick Infortnation Systems. This infortnation is wmpiled from public documents and is not guaranteetl.
[ Repor[ M_ enu ]
[ Select New Target Property ]
http://www.gotitle.com/cgi-bin/profile. asp?rmt=TOPS&graphic=%2Faccounts%2FT07378%2Fcompan... 11 /26/2003
CITY OF STA MESA PROPERTY DETAIL EPORT
Owner. Mc Clure John C Mc Clure Carol M
Resident: McClure, John C
Site Address: 3486 Queens Ct
City/Zip: Costa Mesa / 92626-1658
Parcelld: 412-042-72
Location: Costa Mesa City
Neighborhood: Unknown
Wealth Code: 8.0
Legal Desc.: N Tr 10275 Lot 10
Zoning: Unknown
Subdivision: Unknown
Usage: 122: Single Family Residential
Style: Unknown
Conslruction: Unknawn
Year BuiIC 1981
Stories: 1
3drms: 3
Baths: 2 Full
Heating: Unknown
Cooling: Unknown
Irc Lot Unknown
Terrain: Unknown
Water: Unknown
Sewer: Unknown
Sqft 1st:
Sqft 2nd:
Sqft Bsmt:
Sqk Total: 1755
Market Value: $246,739
Assessed Land: $121,629
Assessed Bldg: $125,110
Assessed Total: $246,739
Percent Improved: 51%
Delinquent Taxes:
Sale Date: Mar-06-1986
Sale Amt.: $187,000
Deed Type: Unknown
Volume & Page:
Seller:
Title Company: Unknown
Multi-Parcel: No
3486 Queens Ct
Costa Mesa, CA 92626-1658
Ttl. Rooms:
Bsmt. Type:
Bsmt. Fin.:
Gar. Type:
Gar. - Cars:
Gar. Sqft:
Roof Mater.
Roof Style:
Attic Type:
Condition:
Lot Dim:
Lot Size:
Lot Sqft:
Phone: (714)751-4488
Phone: (714)751-4488
Tax Address: 3486 Queens Ct
City2ip: Costa Mesa / 92626-1658
Own.Occ.: Yes
School District: Newport-Mesa Unified
CensusTract: 063907
Year Listed: <1993
7
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
Unknown
108 acres
4704.48 sq. feet
Gross Tax Semi Ann.:
H6920 Credit Semi.:
RB Credit Semi Ann.:
RBA Credit Semi.:
Homestead Exemption:
Spec. Assmt. Semi.:
Tax Semi Ann.:
Mortgage Date:
Mortgage Amt.:
Mortgage Type:
Volume & Page:
Lender:
Mortgage Term:
Mortgage Rate:
Blktop Paving:
Concrt Paving:
Carport:
Deck:
Patio:
Pole Barn:
Pool:
Fireplace:
Gas:
Electric:
Units:
$1,370.23
$1,37023
Unk.
Unk.
No
Unk.
Unk.
Unk.
No
Unk.
Unk.
The information is deemed reliable but is not guaranteed. 2001-2002 Tax Year Copyright 2003 Haines Printed Ju1-02-03
SOUTH ORANGE CA
0
Applicant to fill in all spaces exceDt those within neavy �ortler Ilnes ana sign all aoProvriate aeclarations.
CITY QF COSTA�F$� !CO�j$r�TRUCTION ETRMIT PERMIT NO. , TRACT NO. LOT NO. UNIT NO,
Project Address (-� b L9l U P�� y 1 ^
•ApplicanYs Mailing Addre s 7+a�in �a_1• :. ��i�pia..� ��'IU�12��.�,.�
Owner's Name �J� � L h� Phone �al,
Address �4_B�o ���ens.eT �os}�. /Ylesa. q.2%2�
Arch/Eng. � License No.
Address L' C/ n,
Contractor's Name1 � hone �1�17QII4aZ
Addresslm'�'�IaO�� L11.SC(�LOi4 .a2 Qn<he,�,.
City License No. n31rI P�4i
LICENSED CONTRACTOR DECLA0.ATION
I he�eby ai�irm t�a[ I am licensetl untle� provi5ions o� Charte� 9(Commencing
with section 7000) ot Division 3 Ot lhe Busineis antl Grotes5ion5 COtl¢, ane
my license is in ull forc¢ ana etfecL ��
License I ss �+yc No
. Date Signature
W00.KER5' COMPENSATION OE ARATIC
1ere�y attirm that I have a certificate of conzent to self-Insure or a ccrtlflcate
i Worke�s' Compen5dtion MSurante, o� a certiry¢tl COpy tM1e�eo( (SBCUon
3800, Lab. C.) � 3,� gb �^
Policy No. COmpan � � 1
�Certifietl copy is hereby fumisneC.
Ce ,�fieQ cqp le0 with Ihe tl[Y B tl n Divislo
Date �� APPlicant _�
EXEMPTION FROM WORKERS' COM ENSATIO ECLHRATION
(Thi55ection neetl not be completetl if Ihe pe�mil i5 r On¢ hund�etl (E300) or
Iess).
I tertify tM1at in the performance oi the wo�k fo� whiGh thi5 p¢rm�t Is ISSuetl, I
shall not employ any pe�son in any manner So d5 f0 become 5ubjett lo the
Workers' Compensation LawS oi Calitornid.
Date Signature
NOTICE: If, aiter making Mis tleclaration, you'snoulG' become subject to the
Worke�s' Comp¢nialiOn pmvlsions o� Ihe Labor Cotle, you mus[ Iorthwi[h
comvly with sucn provisions or this permit shall De tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby affirm Na[ there is a construcUon lentling dgency for the performance
Of [he work fOr whicM1 tbis permit is issuetl (SeCtion 3097 Civ. C.)
lPntler'z Name
Lentler's Atltlress
OWNER BUILOEN DECIARATION
I hereby affirm that I am exem0� from [he Con[racto�'S LicenSe Law tor the
tollowing reason (Section 7031.5 Business antl Protessional Coae: Any city or
county which requires a permit to construct, alteq �mprove, tlemolisn or repair
any st�ucture, prio� lo its issuance, dl5o requlre5 �he aOP�icant for sucb permit
�� lo fil¢ a siqnetl Slatement that he/Sbe Is licensetl pursuant to Ihe O�oviSions oi
'� the Contractor's License l.aw (ChaD�ar 9(commencin9 wltn Section 7000) of
7ivision 3 of the Busine55 antl Profe55iOn5 Cotle) pr lhat he/she I5 exempt
�e�efrom antl the basis tor tM1e all¢g¢tl exemptiOh, Any vi0latlon of SeC[Ion
/031.5 by any applican[ for a permit subjec[6 �he applicant lo a civil
penalty of not more [han tive huntlretl Gollarz (E500). ,
LJ I, as owner of the properry or my employees with wages as their sole
' Compensation, will Oo the work, antl Ihe st�ucturC I5 nol intentletl or Ofte�ed
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
License Law tloes nol apply [o an owner of a prOperty who builtl5 or improves
[hcreon, antl who tloes sucb work himself/h¢rselt o� LhrOugh hi5 or he/ own
employees, provltletl that such improvements are no[ IntCnAetl Or 011aretl for
sdlG. If, however, [he builtlin9 or Improvement Is SOItl witttin One yea� of cOm-
pletion, the owner will have the burtlen o/ provin9 hc/she tlItl nol bulltl o� im-
prove tor the purpoze of sale).
❑ I, as owner ot the property, am oxclusivery conlraCiing with IlcenS�tl con-
tractorsto construct tne project (Section 7044, Business antl Professions Cotle:
The ConVactor'S License Law does nol apply to an owner of p�operty who
builtli or improves lhereon, antl wha cont�acts IOr such projeClS wlth a con-
tractor(5) Imense pursuant to ttle ConlraC[or'S LiCense Ldw�. I am aware that.
proof of Iheir Worker's CompenSation Insurance shoultl be provltlCtl to m¢.
❑ I am exempl untler Section B. & P. C. for thi5 r¢ason
Date
I hei
Signature
0
Owner
I have reatl Ihi
[hat tho above
TVPE OFCONSTRUCTION LINEW� ADD lJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ OEMOLISH OTHfj
DESCRIPTION�} -OFw.1 O�RK/US OIF B DG. 1T '
�./SE L�S}(�..�r. �/` � '�' �2AG CG 1n�[../
TVPE OF PERMI7 ADING FOUNoaTio ❑ 57RVCTV aa�
❑ TENANT � ELECTRICAL ❑ PLUMBING �MECHANICAI �
❑ OTFiER
PROJECT. DESCRIPTION 5c]. FT. oCCUvnNCv
CONSTRUCTION TVPE VALUATION 5
20NE � GRADINGCU.YDS. ACRES
Remarki:
Bar Sink
Backflow Preventer
Backtlow Irrigation
Bathtubs
Clarifieri
Dishvrasher
Drinking fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceprors '
Kitchen Sink
Lavatories
Q�Trap"
Roof'Drains
Rainspaction Fea $15
Boiler
Duct-UnderGround .
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVPacL BIL ICBO #
Heating System & Ducting
❑ o-i oo,00a aTu O i oo,000
Reinspection Fee
I Drivers' LicenscL6r 55 �(/ /"� _ � � �
CMF 0865�46, rev. 30/84 White - Builtling; Canary . qppllcant: Pink - Accounting; Goltlenrotl - AssesSor
$15
nnu�aa
$howers
Servite Sink
SewerCap
Sewer Connection
Solar Collectore
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee �
FEES
$ 3
A.P. #'
S Main Buildin9:
E
T Front
8 Rear
A
C Right
K Left �
$
Pln9. Ref. 4p
Planning Notes:
Auromatic Washer
Construction Pole $ub.
Cooking Unit
Dishwasher
Dryers ❑Gas �Elec
Fan_
F.A.U:
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KW [
90?' �./i^/:
Zona
Parking Req./Provided
ELECTRICAL
Transformer O 15-50 KW
❑ 50 + IC W
Meter �up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0.1 HP �1 Y, - 8
InaSolar 09-15 HP �16-15+
Microwave '
Pole Light
Range
75 KW
Standin9 Sections
Trash Compacmr
Reinspection Fae I$15 I I Issue Fee "q �`J .
IANICAL FEES
Hooiior T DEVELOPMENTSERVICESRE�UIREMENTS:
YPe I ❑
Canopy Type 11 ❑ Zoning ApD�oved By Data
Building Approved By - � � Date
Refrigeration System
�0-100,000 BTU ❑�100,000 BTU �
System Repair/Alteration
Fire Dampers
Registers • r
Issue Fee � I(,, V� $ �
Z
O
N
I
N
G
R
E
�
M
T
S
FEES
SUMMARV OF FEES ,
BUILDINGPERMIT $ SMIP $ -
PLAN CHECK $ PERMIT •
PLUMBING $ ISSUANCE $ �
PLAN CHECK 25% $ �"� ENERGV P.C. $
ELECTRICAL . $ �,Z� GRADING $
PLANCHECK 50% $ MICROFILM _ $
MECHANICAL� $ � TOTAI.FEE $ �
PLAN CHECK 25% $ .
CONSTRUCTION AND PLANNING �- POOL & SPA
APPROVALS Permit�.# Date Inspector qppROVALS Permit# � Date Inspector
i
1. Temporary Electrical'Service or Pole � 52. Pool & Equipment Location ,'
2.� Soil Pipe-Undrgrnd. '� . . 53. Sieel 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. APPROVALTO COVER�GUNITE
7.�Footings , 58. Electrical Conduit-Undrgrnd.
S., Foundation ! 59. Gas Pipe, O Undrgrnd., Test
9. WaYer Pipe-Undrgmd. � 60`Backwash Lines, P-Trap, � Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. 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 �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush °•
24. Roof Framing 73. Undergrnd. Storage Tank O�Gas ❑ Oil
25. Roof Sheathiny 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 Nailiny HEALTH DEPT. REQUIREMENT _
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED � �
33. Final Electric �� (,� Notes:l{(�'�' 88 Gfr �o � Lr�l! �
34. Final Heating & Air Conditioning a� L� {j.!
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 pomestiaFinal � �
42. Backflow Preventer � � �
43. Backflow Irrigytion - - � � � -
44. Landscape Irrigation System ' ' �
45. Sound Attenuation - .
46. Handicap Regulations � �
�
47. FINALSTRUCTURE&BUICDING - � �
48. Special Requirements Completed • . -
49. Electric Release to Edison � � •
50. Gas Release to Southern California Gas Co � .. . - �
51. CERTIFICATE OF OCCUPANCY - �
No. Date � - �
'OWENS-COR/ ;
Fiberg�as
�lanlce# 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:
��lS/ �iio�iyz����;Zi�� /D lOd2�7S
- Street Lot Number Tract Number
Exterior Walls � ��
Owens-Corning Fiberglas Blanket Insulation � � /�
Thickness R-Value
Ceilings . /:- �
Owens-Corning Fiberglas Blanket Insulation /n �f •
Thickness fi-Value
Floors
Owens-Corninq Fiber las Blanket Insulation
Foundation Walls
Manufacturer
Thickness R-Value
Type Thickness R-Value
General Contractor License No.
By Title � Date
�g�9�a��,e, r ,�,cu,c��`.cri. 33�.D7S
InsulaC �/ntr�,�/ctor ��_/}�,�J/-+�%��J License No. /� �e�
By �����W/_�.z=-dl�aisn^�' Title V•- Date[L' �0 O�
�Si9natvre�
�
Homeowner Copy (White)�
State Copy (Yellow) .
Builder Copy (Pink)
Pub. No. I6-BL-699SA Lit�o In U.SA.. July t9)]
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas 7ower, Toletlo. Ohio a3659
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING 3486 ueens C011Yt
ADDRESS Q
OWNEROR Wimbledon ASSOC.
TENANT
ADDRE55 1470 Jamboree Rd
CITV Newport Beach NEoG,�40-6800
corasraucrioNimperial Savings & Loan
LENDER
BRANCH Pasadena
ADDRESS 61 S. Lake Ave.
OREN INEERCorbin/Yamafuji No`'549-712
aooRess 17992 Mitchell So., Irvine
CONTRACTORMCLd1R Dev. CO.
ADDFESS 1470 Jamboree Rd
aTv Newport Beach �n,o`640-6800
LIC.No. 2�38�5 LICYNO.1HH%3
SIZE NO.OF BLOGS. O
OF LOT NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work:
PRD — New Construction
Single-family dwelling
I hereby acknowledge that I heva reatl this epplicetion antl rtete
thet ihe above intormetion is corract antl apree to eomply with
all laws regulating building construction, antl 1 shall not ampioy
any parson In violation of ihe workman's eompensallon laws af
the Stata ot Californle.
I heroby certlfy t�et I em prope�ly licensatl es a controctor untler
thu State of Californle Businasa antl Professions Cotla, Dlvislon 3,
Chapter 9, and ihat such licanses ere In tull foree antl effact, or 1
em ezampi from the provisions ot the Steie of Celltarnla Businecs
antl Professions Cotla, Division 3,.Ch pte �.
SlOnetura of
Permittee
or /� �/
Authorizetl ABent Dato •Y
APPLICAT70N F61t��['R�1C�l1i�VL PERMIE44.30
RECEI ;E�BY PERMIT N� - 4 7 7 8 4
A.P.NO. `L l�— U��'CSJ
B UI LDI NG
nooaEss 3486 Oueens Court
UNIT OR
SPACE NO.
TR.NO. LOT E
10275 10
NEW ADD ALTER REPAIR MOVING DEMO
X
OWNER wimbledon ASSOC.
USE PRTI vA�UEE� l
h.:a-.�
ZONE r V R— TVP L/� GROUP �
APPROVED
BV Gii DATE I 'ZO�
APPROVEDSETBACKS
(FROM��.�p�,) PL ^ -
FRONTYt)*r'�b'FL ��
R.SIDE `� FT.
L. SIDE S FT.
REAR � FT. �_J.�(J
PLANNING ACTION
,Z� �%8'. �/ DATE �—�/
7 APPROVED
APPROVE
i�o8"�
:lQL9 FOR SPECIAL REQ
TL'
m
>
v
� ' �
SQ. FT. N �
THE AMOUNT SH N UNDER VALUATION IS FOR m �
THE PURPOSE OF ESTABlISHING A PERMIT FEE ONLV: � �
VALUATION PERMIT FEE § �' a \
� N \
/' PLAN CHECK E a
$��6�� TAX S J.3� � V
TOTALPAID 5��[��'3o U ��