HomeMy WebLinkAbout3494 QUEENS CT - Building Permits�� CITY OF COSTA MESA
° BUILDING DIVISION
, ._
. � DEVELOPMENT SERVICES DEPARTMENT gq�p��S�
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�� PERMIT PERMIT NUMBER
(714) 754-5273 • Fex (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3494 QUEENS CT
Suite:
Ycinity:
Parcel Nunmber: 41204268
Applicant: MALONE. SEAN
Address:
Zoning: R1 R1
Status: ISSUED
Applied: 07I14/1998 �
Issued: 07/t411998
Phone:
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owner. COX, DONALD A�;'�.' � _ _
Address COX, BARBARA-V ; � % .
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COSTA�ME§A;CA �"�- ` Phone: _ _� ' � ( �- � _ >�
3494 QUEENS CT V �, � � _Lp - 92626 ' � ��; \ - �
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Contraaor.��A�PLUS RQOFING �. _ �-� � � � " - / � ����`
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Address: „ 11237 SLATER AV '��/ � � � � � � � � �� �
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,,, FOUNTAIN VALLEY CA Zip: 92708
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,�� �'�, � �: TIO SHAKE, IN FILL'SHEATHING, INST 2 LAYERS #30 ASTM EAGLELITE1C80.#4660. , .. �
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' � ,.�,.°�� `�_ _ FEE��SUMMARY :_ :.. � ` ,
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Plan Check: "" $0.00 - - Calc Valuation: .E�a,en.00
'` �Permit '$21225 ;r, J',�. Claimed Valuation: S�a,a�zoo
�SMIPRes: �,�$1.38 :-., ��.��, ��;v—�-- , ��.. •; ---
SMIP Com: � � $0.00 � -= � __ ; %��� � , � ,
; � Other.�� � $0.00 � � � . �
�' '$0.00 � � �
Inspection: . �,�. - ;'.t- �-- � i�. ,
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�.Total: $213:63 '
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�.`':A �` "`,� PLANNING�&ZONING ,'�''' � � � �
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SETBACKS � � �� �� ; � ,� � '�.� �, . � ' � ,� "�
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MAIN STRUCTURE Front - 0. 0 ��Rear � 0 0�, � l Left� , 0= 0� � Right 0 0 �/
' "1. �_ , ,� " , _, ,� „ _ _ . . .. �'�
ACCESSORY Front 0. 0 = Rear � 0. 0-� � -' CeR 0. 0. � Right � 0- 0 - �
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PARKING Existlnaf �0> ���'R�eauired: o�� � � Pr000sed:" o, � ; '
NOTES: � , �
EXPIRATION: This permit shall automatically expire antl become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 180 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 Inepectione and flnel approval must be obtelned. Failure to obtain inspections and final approval will result In the expiration of this pa�mit.
FOR INSPECTIONS CALL: (714) 750.5828
WOflKERS'COMPENSATIONDECLAPATON: ,
I �ereby eRrtn untler penalry ot perjury one W the following tlederetions: .•
❑ I �eve entl wlll meintein e cert�cate of cansent to seN-Insure for workers' compensation, es provided for by secllon 3700 af the Labor Catle, for the peAortnance of the
wo or which this pertnit is Issuetl.
1 heve end will melntein workers' compensation insu2nce, es required by seCtion 3700 0} the Lehor COGe, for Ihe partormance of ihe wak for which Nis pertnit is issued.
My workers' co n lon I uran�a�p er anC poli numDer era: �/' '
caMar: ��Zr7�0 -7—I�nr� Policy Number. 2�57 ' I�S C�yti� �,v,�i/OS�
(Thls secNon need n�6e,comp/efe0 i! Ne perm/t!s velued ef one huntlretl tlollars ($700) oNeu.)
❑ I certity that In the perto nce of e rk for whlch Ihis pertnit Is issuetl, I shall not employ eny person In eny menner so es to 6ecome aublect to the workora'
compensetlon lews of C ornla, e egre thet If I shau ec , subJect to ihe workers' compensetlon Drovislons at Sedlon 3700 of the Labor Cotla, I shell forthwith
. comply with these pra ns. �7 �j 2�
Applicent SlgnaNre: i. Dare: /—/� ` O
WFRNING:FAILURETO5ECUREWORKERS'COMPENSATI COVERAOEISUNIAWFULANDSHALLSUBJECTANEMPLOYERTOCRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED
T1qUSANDDOLLARE(5100.000),INADDff10NTOTHE OFCOMPENSATIIXJ,�AMAOESASPFmVIDEDFORINSECf1IXJ3]OBOFTHEL�BORCODE,INTEREST,ANDFTTORNEVSFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby effirm that I em Ilcensed�y^tle raAsions o1 Chepter 9(commendng wit� Section 7000) of Divlslon 3 af the Business entl Prof ssions Code, entl my Ikense is in full
force and ettect. Lic. a !� �� �/ / Cleu p �
CoNractors SlgneNre: � Dete: �%—i `� �
GONSTRUCTION LENDING AGENCY:
❑ I here6y eftirtn that there is a canstnidian lending egency for �he pertortnance ot the wark for whlch �his permlt Is issued. (Sec. 3097, Civll Cotle).
Lendefs Neme: Lendels Address:
Signeture: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby eHlrtn thet under penalry at perjury that I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for t�e following reeson (Sec. 7031.5, Business end Protessions
Code: Any dry or counry which requires a perm0 to wnstruc6 elter, Improve, demolish, or repair eny structure, pdor to its Issuance, elso requires the epplicant for such permit
to file e 5�9�� $�fltement that he or she is Ilcensed pursuant ta Iha provisions of t�e Contredors LJcense Lew (Chepter 9(commencing with Section 7000) of DMslon 3 af the
Business and Professlons Coda) or that he or she is ezempt theretrom and Ihe basis for ihe flllaged exemption. My violation of Section 7031.5 by any epplicant for e permlt
sub�ects Ihe ep011cant to e civil penelry af nol more ihen five hundred dollars ($500).):
❑ I, es owner of ihe property, or my employees with wages es their sole wmpensatlon, WILL DO 7HE WORK, end Ihe siructure Is not intended or oXered for sale (Sec.
7044, Buslness antl Professions Cade: The Contrectors Llcense Lew does not appy to en owner at properry who bulltls or improves thereon, entl who does such wwk
himself or herselt or Ihrough his w her own employees, provldetl that such Improvements ere not intentled or onered lar sale. If, however, ihe bulltling or Improvement is
solO wit�ln one year of campletion, the awner-builder will have the burtlen of praving that �e or she did not bulltl or improve for purpose al sale.).
❑ I, es owner of the properry• am EXCLUSIVELV CONTRACTING WITH LICENSED CON7AACTORS to construd the pro�ect (Sec. 7044, Buslneu flnE Professians
Cade: The conirectors license Lew daes not epply to en owner ot property who bulitls or Improves thereon, end who contrecls for such pro�ect with e wntractor(s)
license pursuent to t�e Conirecrore License Lews.).
❑ I em exempt under sec. Buslness end Protessions Code tor this reason:
SlgneWre: Date:
Owner ID verllled by tlAver's license. ❑ Yes ❑ Na Dnver's License No. Expires:
Vedficatlon ot Ownershlp by (type of documenL I.e. - properry t� bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
❑ I hereby cenify ihat no excavation Ma (5) or more feet In tlepth into wNch a person is reqWretl to tlescend, will be metle in connedlon with work eut�adzetl by this
pertnit, end that no building siructure, scaHolAlnp, felsework, or tlemolitlon or tlismaniling t�ereof, will De more than ihiny-six (36) feet high. (Chap. 3.2, Grp 2, An 2, Sec.
341, Title B, CelHomla Atlminisirativa Cotle).
❑ As ownervhulltler, I will nat employ enyone to tlo work w�ich woultl requlre a permfl from the Divislon at Indusidel Safery, as noted above, unless such pereon has e
permit to do such work trom ihe division.
SlgneNre: Date:
Division of �ndustrial Safery Permit Number:
CEHTIFlCATE OF MPLUWCE AND AIfTHORQATON OF ENTHY: I certify under penelry of perjury thet I have read this epplication and stete that the infortnetlon given is
cortecl. 1 egrea 1 mply vrit� al e end dry oNinences relating to building consWction, end euNodze representetivas of the Ciry of Costa Mesa to enier upan Ne
ebove-dascriDetl roperty tor in ecUon purp ses. I agree not to occupy or allow occupancy of any Dulldinp euthonzed by Ihis pertnit until final Inspeclion.
COUE �. INSVECTIONTYPE
7616 FIxeC Sys�em Finel Fire Prevention
1288 Pad Spa Finel `
200 Flnel Re-Raof
201 Finel Block/Retflining Wall
202 Finel Fectory Fire Plece
203 Finel Sign
204 Flnel Demolitlon
2u8de
�—/Y—�e�l o
Dete
COQEt INSPECTIONTYVE
208 Final Mechenicel
20B Finel Plumbing �
210 Finel Elecirlcel
212 Final Fre Preventlon
220 Finel Planning Approvel
222 Final Site
250 Finel BuilAing/Occupancy
GAff . II�915
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al Uy 'yt5 lu�tr r.��
�.; •
June.1.2._ 1998
Donald &-Hazbacs Cox �
3494 Queens Court
Costa Mesa, CA - 92626
Ac.: WA4BLEDON VILLAGE ASSOCIAl'ION
&equest_for_ Architectura! Change A¢proval IIIatedlune t0, 1498
Dear Mr. & Mrs. Cox:
As.management agrnt for the Wimbledon Yillage Aeaociatioa� I have been instryicted by the
Architectural Committee to eontact you regerding the approral of your acchitectural applicatian
dated ]une I0, I998 for the n-roofing af your home.
Pleasc be adviscd that the Architectural Committx has epproved the application so long as only
the Eaglelite ii006. (A.+ Knotwood) is used. Should you wish to use additionaL rqaterial6 and '
colors you must clarify your requesi and subm+t color broch�ues forreview and re-evaluation.
Attaehed is your architecturel change form for any updates you wish to make.
Ilyou have any questione, or if I can be of azsistence to you, please feel free to call me.
Sincerely,
VII.LAGEWAY MANAGEMENI', INC.
i�/7��'.
Jemes R. Santa Cruz, Community Associa5on Manager
At fhe Direction of the Board of Directors
ISG.
P.O. BOX 47p8, IRVINE. CN-IFORNL� g2816 (Z1 d) 553-1876
c:µssnv�rtamvn�a.m�ww.m.d � miwa m�eovu.en� o�aoc�i.
ax � 144 8 87 'u� �'
'�.� �` . . �rUk % 2' 19gg
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� WIM$LEDQN VB.LAGE ASSO�IATION
Arrhisedurat comminee
do.�illagevway Maua�mant: lac.
Post �ce Box /708
Irviee t:A 92716
Tel: (7l4) 553-1876 -
Fax:(714) 250-9009
-�oM:..�.�1a ..J a��ld.d Cex
aK'NER n • � �' � .
�TREET ADDRES,S
(7Ja-1 l 4l-7Siy
HOME TELEPHONE ��;
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Stapk
Samplaa
Here
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_ DATE:� J c�,M C %�
{> > a� 9 CY-,fJ ��
SUSIIVESS 1ELEYSOfii� / ,
;
S[JBJECT PROPE �� Q SLEVA170N ['� rick
MODEL (A,B,C D3 • [�� S��
[�l'w� aidiaa
1. E�7EAIOR PAIN7I�TG - Propoaed colon: iuClude paint sampla (attach above).
ITE1K COLOR PAINT NUMBER BRAND OF
PAll�ff
'Stuccolsidin�
Trim
Facia at roof liae
Sbutter/window
Dox .
Garage door trim . •
Gate Black - [equired- N!A N!A
colot :
• Stucto and siding eolor �ust c�oaely mAtch
•.iM�@OURQQIC.►�ALhY � .
��.+w .
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Fax � 7144978387 Jul 09 '98 10�17 P.04
[M.11Y, : • t : 1 1 �� � � -
Nefghbor Awarme�s (for acGerior additioos only)
Rig6t Side:
�
I;tft Side:
At-Rtar df Lot:
Directly Across
ttie Sttcet:
e
Address:
5gnan�re• �•
Name•
Add�+eas:
Sigaatare• t�te:
�
Deurip[ion of change(s) desired. Briefly describc purpose aAd/or reasoa of ext�unc. .
modifiwtion. For. strucaual.and laudscape-submit-two (2).utt of.architecmra! drawings.
Show locarion on iot. rhapges to'acterior walls, and eltvntion (�' appropiate).
�1'�vOo.� - OlJ roo� If VC4r/ba ON/ -.1[.lit�C[t� [4�-d p/�.
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, PROPOSED S?ARTIIVG ATE PROPOSED COMPLti,'1'ION DATE
1.. Date received by Mana�emept;
2. Date submltted to Architectural Committet;
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May 24, 1982
City of Costa Mesa
Dept. Building.& Safety
Costa N:esa, CA 92626
RE: Landscaping - Permit ��BP3360
Gentlemen:
I am aware that the patio post at ueens Court Costa
Mesa, California does not meet c�ty-�udg-aRd— roblem
it may cause in the future. This condition is acceptable
to me.
Donald A. Cox � L�/
Barbara L. Cox ✓v � � �
�—
���o�
R�c°
r APV���ant to fill in all i
CITY OF.CO�T,Q�;'v7ESA P�gxx IT NO.
CONSTRUCTION PERMIT �S�
Address
Address
Conbacto�
within heavy Cortler lines an0 sign all aOProp�iate tletla�ation
TRACT NO. LOT NO. BLDG.NO.
/0 2�5 /4
TVPE OF C�,.O,,/NSTRUCTION
❑ NEW bO ADD ❑ ALTERATION
❑REPAIR LJCONVERSION ❑DEMOLISH
❑ OTHER �
DESC(31PTIpNOF ORK
� �/ �s' �""^ ��O TVPE OF PERMIT,�% ��
Addf255 S [ 0 6%L ❑ GRADING IIG FOUNDATION '�$TRUCTURAL' '
LICENSED CON RACTOR DECLARATION ❑ 7ENANT O ELECTRICAL ❑PLVMBING ❑MECHANICP
I hereby af(irm Ih:.t I ary� Iicensed untler Drovisions of Charter 9(com- - � � •
mencing with sectlon 7000) of Division 3 of tne Buslness a ❑ OTHER ' �
Professlons Cotle, antl my Ilconse is In full r �
License ass n� � 1 7 lJcen� PROJECT DEl�SCRIPTIOM -��
Date Signature ���'' ' S r � 5�. FT: ��e� , pf/��Qj �f�� V� �
WORK RS' COMPENSATION DECLARATION� - � OCCUPANCV/y��,��t�.OpNS.�T�R�TION T.Y.PE
I hereby affirm that I havo a<ertlflw[e ot consent to solf-Insuro or a VALUATION�20NE
cortlticate ot Workers' Componsalion Insurance, or a tertllietl capy � r
theroof (Sec�t�l��n+ 3800, Lyb,I. �C.)� �.{+ , ' GRADING CU. NDS. ACRES
IICYNO.�rv`" Mn'+��mPdnY /i^n..6"....Vr�� T S�
Certltletl [Opy 15 h¢repy furNshCtl. REMARKS:
rti/IEtl COpy is Iiletl �vlth the Uty BUIItlin9 DivlSiOn. S
%EMPTION FROM WORKERS' COMPENSATION DECLARATION � - ' �
(T�is section-nee0 not ba completetl If tha permit 6 tor ono �untlratl _ _^
SE1001 or lessl. .
cert(fy Nat ln tho.pBrtOrmante OI the work tOr w�ICh.tNs Oermll is
isivatl, 1 shall not emQlOy any perion in any manner so as to batome PLUM6ING � PIAN CHECK
subjeCt t0 the WOrkCrz COmpensaliOn Ldws oi Cdlibrnid.
Date Signature � BATHTUBS SHOWERS
NOTICE: If alter making this tleclaratlon, you s�oultl Eecome suEjact TOILETS ' VRINALS
to [he Workers' Compan���on provislons of the Labor �otla, you muil .
for[hwith comply witn such proviilans or this permit shall be aeemetl LAVATORIES DOUBLE LAVS �
mvoketl. - ` KIT.SINKS � DISHWASHERS � -
CONSTRUGTION LEN4ING AGENCV '
I hereby afiirm tnat [hore I5 a construction lentling agency for tno per- SERVICE SINKS , SVMPS ' �
formance of the work �or whith this permit Is issuetl (SecUon 3097
Civ. C.). FLOOR SINNS FLOOR DRAl1Y5 � �
Lentler's Name
Lentler's AtlGrezs DRINKING FOVNTAINS �� -
OWNER BUILDER DECLARATION � INTERCEPTORS CIARIFIERS'
I hereby affirm that I am exemp[ from the Contractar'S Lirenzc Law lor
the following reason (Soction 7031.5 Busine55 antl Professlons'Coae: cwinnnnimr onn� oTana ' . --- '
any
�C�apter y�commenong w�th Secuon �000) ot oivision 3 ot t�e
Business antl Pro(essions COtle) or lhat he Is exempt lherGfrom antl t�e
basiz for the allegetl exemption. Any violation ot Sectian ]031.5 by
any applican[ for a permit subjGcts thC applicdnt to a civil pCndlty
ot not m0/C thdn live huntl�ed O011ars (§500).
❑ I, as owner ot lhe p�operty, or my employees with wages as tlteir
sole compen5dtion, will po the work, antl the scruciure is not intentl<0
or offeretl for sal¢. (SeCtiDn 7044, BuSin¢ss antl Prote55ions Cotic: T�e
Cont�attor'z License LaW tlo¢s�nol apply to an•ownlr Of a�p�o0erty
who builtls or improve5 thereon, antl who tloes Such work �ImTeH Or
lhrougM1 -his own�employee5, prOvitlCtl lhat Suth improvements dra not
in[Entletl or oiferetl IOr Sala. II, noweve�, the bulltling Or Improvamenl
Is Soltl within one year al Completlon, lha owner will hava lhe burtltn
ol prOvin9 he tlltl noi builtl or Imp�ove for the purposo 01 salo).
❑ I, as owner of' IhC property, ar11 ¢xCluSiv¢ly Conlracting wllh
Iicensetl contratlors lo Conslruct tne pro�ect (Sectlon 7044, BuSinoss
antl Professions Cotla: The Contra<tor4 License Law'doe5 not appry to
an owner ot p/operty wh0 bulitls or Improv¢5 th¢�eon, dntl who con-
tra<ts trorci su<h pro�ec[s witb a contractor(s) Ilcesnetl purzuant to
tne Contraclor's Li<enso �yw),
❑ I am exempl untler Settlon � B. d. V, �, tor Inii
reason
Date ' - Owner �
1 M1er¢by terUfythat �t hava watl INS appfl�atian antl siate t�dt Ihe dbOve
In�ormallon IS coneGt. I agreo to comply wit� all City an0 counry
ortlinances.antl state s relatlng to mnstruction, antl �ereby aut�orize
rOprostntative 5��(y10 ente,y upon lhe a�Ov¢ mentlonod
GASSERVICE
WATER HEATERS
R
SOLAR PIPING SVS.
ISSUE FEE �
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-I00,000 BTU_
ANO DUCTING �
300,000' * BTU _
REFRIGERATION 0-100,000 BTU_
SVSTEM �OO,OOO+BTV_
BOILERS BTU
SVSTEM REPAIR,AITERATION
EXHAVSTSYSTEM MULTIPLE
' 5027 b/23/82
A.P. �
ZONE
R[AR YARD (TO
PV(G. SPACE REO.
ZONING APPROVED H1
�SPECIAL CONDITIONS:
ELECTRICAL
PLNG. REF. �
PROVIDED
PARKiFEE S
PLAN CHECK
GENERATOR - 0-1 KW_1-10 KW _
TRANSFORMER
APPLIANCE 10-50 KW 50 � KW _
MOTORS ' ' 0=1 HP_1•30 HP _
(INC SOLAR) 10•50-HP_-50 � HP _
FIXTURES ' -OUTlETS SWITCHES
GAS TUBE SIGNS ' ' "
POIE LIGHTS -� � �
MAIN SUB
• AMP
35.�0 TLr
���
APPLICATION APPROVED BY DATE 2�
SUMMARV OF FEES� , � . �
BUILDING
PERMIT E� '� SN11P. , E_SZ SCi ',
PLANCHECK y /�•� PERMIT , �
•ISSUANCE E
PLUMBING E��•' GRADING- f '
PLAN CHECK S •
ELEGTRICAL S s �
y MICROFILM S i
PLAN CHECK E
MECHANICAL.E TOTALFEEE
LE55 AO-
,PLANCHECK S VANCEPC S_._ ' �
prope�ry � r �� �
Slgnature �—=���e Z - FINAL FEE E
Dr'vors' L'censeor � - ..( �SSUE FEE ' -
CMF 0865-46 Wnite-�uiltling; Canary-Appliwnt; Pin -qctounting; Goltlenrotl-Assessor
CONSTRUCTION AND PLqNNING 3 POOL & SPA �'"�'
APPROVALS Permit #��`-""� Date � I�nspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool &�Equipment Location
2. Soil ipe-Undrgrn � 44. Ste�l Reinforcement
3. Electrical Conduit Utili[y-Un rgrn 45. � Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
. tee ein orce 47. Rough Plumbin & Pressure Tesr
6. Elearical UFER Grn 48. A'PPROVAL TO COVER-GUNITE
7. Footings - c_j .�.� 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pi e, ❑ Undr rn,iest �� •
_9. Water Pipe-Undrgrn � � ,.,'. ��51. Backwash Lines P-Tra �� ndr rn -
10. Structural FloorSystem � 52. APPROVALTODECK -- -----`--�---• "� - - �- -
1 L, Property Sewer Line &_House ('qnnection .53. Backwash &,Rece tor-Final �
12. Street Sewer Connection 54. Heater & Vent�Final
--
13. Rough Plumbing � . •. � � - �-- -�•-----•- - -
14. Rough ElectricConduit - - 56. � -Elecuical-Final
15. Rough�Electric-Wiring" - � ' ' 57. Solar System-Final � �
16. -Rough Heating & Air Conditioning - - • encing & Access ADProval
17. -Ducts,.in Structure APPROVED FOR PLqSTERING
18. Ducts, Ventilating -
19. Gas Pipe-Rough & Test � � � 60. POOL/SPA SYSTEMS FINAL '
20. Roof. Framing ' •
21. Roof.Sheathin ' �
22. Frame and Flashin . NOTES: - � '
, 23. Insulation ,
24. Lathing & Siding � ' �
25. Drywall Nailing . � �
26. Plaster Brown Coat �' � �
� 27. Electrical Power Meter-Final ' • ' ' � '
26. Final�Electric '
29. Final Heating & Air Conditioning '
� 30. Final Gas Pipe-Test � � ' - - � -
'� 311 Final Plumbing •
32. Water Service-Final
'� 33. � � Gas Service-Final
' 34. Solar pomestic•Fina� � �
' 35. Landsca e S rinklin S stem'1 �
36. Sound Attenuation '; . �) � • '
37. Handicap Regulations
38. FINAL STRUCTURE & BUI�DING ��- t �
. 39. Special Requirements Comple[ed �
-40. Electric Release to Edison � � � . -- • -
41. Gas Release to Southern CalifOrnia Gas Co.
42. •,CERTIF�CATE OF OCCUPANCY
- , � No' Date • - .
OWENS-CORNING
Fiberglas
Blanket 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: '
pj"���r/v/�A.1m/�1•iT7�nT �% �d�%�
�et ` Lol Number Tract Number
Exterior Walls �� ��
Owens-Corning Fiberqlas Blanket Insulation �_ �
Thickness i7-Value
Ceilings „ �
Owens-Cornin� Fiberglas Blanket Insulation � �
Thickness R-Value
Floors
Owens-Corning Fiberglas Blanket Insulation
Thickness R-Value
Foundatiqn Walls
Manufacturer Type Thickness R-Value
General Contraator
License No.
By • �itle Date
�Signawre)
Insulati w./�o/ntr�actor���/���h��� y �'���-�-�����?'�LicenseNo..�/�l�'G�5'
By �'��.rC//�(.�52d[�CiYY� ^ Title �% � �- Date�P �f./ f��
r-r ���9�a��,a,
Homeowner Copy (White) � � .
State Copy (Yellow)
BUildO� COpy (Plnk) OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
v�o. No. �s�e��ssssn � �;�no;� u.s n, ��iy isn Fi6erglas Tower, Toledo, Ohio 43659
�:' <, n ..t. ` _ v . „":a. � Mi'-_: T. •-- ". . . ,-_ . .� , . .
"' ~ _ � 6077 1.2;1791 306.51;
� � � � -�- �,,.b.,- -•-_
COSTA MESA BUILDINGSAFETY, DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT �
N.o.t�oxizuu cosrnrviesn,cAurvHrviaaze�e
REGEIVED �' PERMIT "
For Applican[ to Fill in Completely — Use Ink Only N° 4 7 7$$
,BUILDING 3494 Queens CouYt A�P�N�� ('i�/' �/ d'yo�--�j�j
ADDRESS
OWNEROR ' ADDRE55 349�I
TENANT Wimbledon Assoc. Queens COUTt
MAILING 1470 Jamboree Rd SPACENCa.!}
ADD RE55
TR.NO. LOT � BLK.
c�T� Newport Beach No 40-6800 10275 14
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION .
LENDER T1li erial Savin S S Loan �{
BRANCH pasadena. � � Wimbledon Assoc.
OWNER
. A�DRESS ' PRD , VALUE �
OR ENGINEEaCoTbin/Yamdfu � i NE.'49-7124 use � s p
ADDRESS 17992 Mitchell .SO. , Irvine ZONErF�R- TYP /�-GROUP ^�
APPROVED /j
CONTRACTORMCL31I1 Dev. �Co. ' ev DATE � rLD (JI
ADDRESS'1470 Jamboree Rd �
cirv Newport Beach No`640-6800
STATE Z73875 CITV 18873 %�PPROVEDSETBACKS '
IIC. NO. LIC. NO.
SIZE NO.OF BLDGS. O .(FPOMr�'w'��++7i-�n PL
OF LOT NOW ON LOT ROMsiD � FT.
USE OF �
EXISTING BLDG. F .
Separate permits are required for _ � � sioe FT.
electric, pWmbing and heating work: �J :
REAR 1T.
USE OF BUILOING AND WORK TO BE PERFORMED . - P�qNNING ACTION -
��g� E— -3 � o�Eoa-a7 e.
PRD — New Construction navRov ` � `
Single—family dwelling y�pS,D FOR SPECIAL REO EMENT�
I hereby acknowletl8e thet I hava reatl this application entl state
that the above information is correct and agree to comply with
all laws regulating building construction,. and I shall not employ
any person in violation of the workman's compensation laws of
tha Stata of California. � � - � �^( ///
I hereby certify that I am proparly licensetl as a contrector untler � `� ' SQ. FT. ' 7((J `.�
the State ot California Business antl Professions Cotle, Division 3, THE AMOUNT 5 WN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full torce antl atfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am ezempt from Me provisions of the State ot California Business
antl Profes5i0n3Code, Division 3, ap r.9 ' VALUATION PERMIT FEE $ a �—
- PLAN CHECK $ '•
Signamre of A/ ,
Permittae �"Y $� D7 aa� TAX � E . �5 �
AutForizetl ABent Date � � TOTAL PAID '$ s`�
7�<<
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