HomeMy WebLinkAbout222 FAIRWAY PL - Building Permits�
�oonessacem�arw: 2zz FAIRWIiY PL
OWNERSN41EIGqpWN: LAILLAW, SCOTT L JR
�0°"� iAILLAW CHERYL N
222 FAI�tWAY PL
����p� COSTA MESA,CA 92627
uxr: J �
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urcxnecron��nn: SCOTT LAIULAW °GND` C21tl61
eacx.one++o.�swoness: q10 W, COAST HWY °�` P
N.B. CA 926b3
C0N1""T01rs""'� DOHSON ENTERPRISE ( 719 ) 707-1105
CQAHICTORSY11lWG 26U31 DEL REY
'0°"� MISSION VIEJO CA "GN0' 717269
92691 u"� B
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CIT'/IJC.NO.: LIGCU144: LJC.
068093 B 717' •XP: 08/97
oma: S� '.0 I-r7'% c�,m�: i /
OWNEN BUILUEN OECIAHATION: I lareby elfirm unEer penelly rji m vapp t n tM Cartemaa lieaua lew la the
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�nolu�, a repai eny avuciure, prur lo Xa evuvim, ebo requiree �M epplicent Iw such pmnn io fik e agred etmmieni �het he a eM
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si�ww vd Rde»ons Godal a thm he a ehe u exemp Iherehom enC Ihe bmis lar tM NbpeE memplion. My vidmion d Seuun
ip]t.5 by enY aVD��^t la e permu eubjetle �M apd�� �o e mnl perielry d nal mora Ihen fxe huM�ed ddlara jfS00�.
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De�e: O+mer:
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e pamit InmmVuctcn u modifmionhan�MAi�iieTlyl.%�upen+ni DiYrid. RaddeNiel mMrvdian appf�ffiimaenexemq Iram iM1ws
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DW: �OOr�:
WONKEH'S COYPENSATION OKWI�TON: I Araby Nlvm wEw pruty W�wµvy wn d Ns b0ow�'vp dedumiwq:
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Poliry Number:
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�m py�siam a s.aian a�oo d in. lem. wes. � mR�mn wn,n i.�n mo.. o� ov.
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S�ctlon J)fb' o/ fhs labor Catls, Intwst, �ntl �ttomsY i/wa
CONSTNUCTION LENDINO AOENCY: I MroW alfirm uMer pereM1y W perjury IMt �Mro n e can��utlion bMi�p epenq la �M
parlormenm o� iM1a vroA br whi A ihe pe�mp ie ueued (�bn 3099. CH. C).
LENDER'S NAME:
LENDEP'S RDUflESS:
� I cerlity �t�ei I heve reed tha epplcmim enE Yele �Mt Ihe ebava in/ormetion ia ooriea. I epree to comply wilh ell r�ly enE caunry adineMee
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I GEOECE ENGELKE
om,: ��2� p7
(515f�18.WP) Wh�e-Buikip 8 Sefery: preerFle: Canvy-AppSeeni: Pink-Wranue: (3aldeneo�As+�r
�G�..�� O� CITY OF COSTA MESA — BUILUING FEF(MIT
` v
PERMIT NO: P u84428 �LAN CHECK NO; N
CONSTRUCTIUN TYPE: V—N PEkMIT TYPE: PLU
JUB UESCRIPTION : ADU 499SF DINING, M BELROOM ti HATHROOM
CLAIM VALUE: CALC—VALUE:
PERM NO: P 08442F
GOVT: N SUPP: N
PORPOSE: ADD
SQ FT:
GROUP OCC: R-3 /
COMMENTS: RE:#B89228
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Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ Mt1IN BOILDING ---------- --------- ACCESSORY BUZLDSNG ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING AEG� PROV: PARCEL: 43921311 ZNE: REF NO;
PLANNING Nf3TES>
i ', ,
i't'IF 3f'M' fE fi 1'F'ie')r �F iE'IF ie iE iI' iE IE iE'x"�e �h 1f if if if iE if iE iE ii �h'IF ie'Ic %E'IF iE i{ iE'x' iF 1F iE'IF'/E if'� if ie if YF if ii it iF iE �i'JE i'c'� i'e'1E iE 1h iE'iR'i!'lE ic'l"r'1h iF ic it if �lE jf lI-'li
„ 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 E M E N T S
ZONING APPROVED HY LATE:
HUILUING APPROVED BY ; ��, LATE:
APPLICATIUN ISSUEL bY: ' DATE; B� Z-� 1�I�I
i'tikiEiFiFiFil�iFil-ikifiFif�leiEi@ifr6iFifiFiF3FitTtfFil�it�;FiF�liFa��F%iF'R7F%iFitsex��cit'�'�ft iF;FiF%iFiF3EiE'iciE'K-iE'7EiEifi't� -h A'lei't
LEGALIZATION:N F E E ,•S U M M A R Y STRUC:TURAL SEGMENT:N
HLDG YMT PLUMBZNG ELECTRIC MECHANIC FIRE s'MZP/RES GkALING
PERMZT 37.25 r
25R SMZP/NON—RES
PLAN �
ISSUE FEE 22.00
BUILLING—DIV—> PERMIT ISSUE PLAN—CHECK TUTAL PAID LUE
TOTALS----> 37.25 22.OQ 0.00 59.25 59.25 .00
REVENUE LIVZSZON TOTALS--� COLLECTED: 59.25 OVER/SHGRT: .GG
BLDG PMT PLUMbING ELECTRZC MECHANIC FIRE SMIP/TVT GRADING PLAN—CHECK
59.25
if'1(' ft')f 1�' jf')l' i� jf' ]t jf lf ft'K-'lf 3f {(' �"!f'1f if Jf'1! lt *�'�f -R if if'N' jf lf T j!'� a! �t {�' 1f'1�' %E if lf lf �!'if'�'IE jt 1F-x' 1!'k a! iE �F if * 1f �(' lf * Yf i! )f ]t'!F 9�' � jl"�'�f jf')t Y�' �' N 1f
I N L I ti 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 UNZT CUST TOTAL COST
PLU 1 SHOWEk . 8.75 8.75
PLL1 1 WASH HASIN lSET) 8.75 8,75
PLU 1 WATER CL05ET (TUILET)� 8,75 8.75
PLU 1 WATER HEATER AND/OR VENT 11.00 11,�0
END OF FEES
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�8-�7-1997/02:35 Fr�/559.2�
PEkMI TPT08442g
CONSTHUCTION AND PLANNING P004�';s;_.t�eA
Date Inspecior �^���k= Date Inspector
APPROVALS Permit # APPROVALS Permit #
� t. Temporary Electrical Service or Pole 52. Pool & Equipment Location "
2. Soii Pipe•Undrgmd. 53. Steel Reinforcement - .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgmd. 55. Electrical Bonding �
5. Steei Reinfoccement 56. Rough Plumbing & Pressure Test
5. EtectricaVUFEAGrnd. 57. APPROVALTOCOVEfl-GUNITE
7. Footings - �58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. ' 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Svi�ctura� Floor System . 61. APPROVAL TO DECK
i t. Property Sewer Line & House Cpnnection 62. Backwash & Receptor-Finai �
12. Sewer Cap � � 63. Heater & Vent-Final
13. Roof Dra�ns . 64. Plumbing Syscem - Pinal -
14. Rough Plumbing , �7 , 65. Electrical�Final �
15. ftoagh E4ecerfcal-Conduit 66. Sotar SYstem�FinaY
76. Rough Etectric Wiring 67. Fencing & Access Approvai �
17. Rough Wiring Sign 68. APPROVED POR PLASTEftiNG �
18. fiough Electrical-T Bar Ceilin9 � � ��69. POOUSPA SYSTEMS-FINAL �
19. Roogh Heating & A'ir Conditioning � FIRE DEPT. REQUIREMENT '
20. Rough FBctory Fireplace APPROVALS Permit #
21': Dutts, in Structure 70. Underground HYdro
22. Duas, Ventilatin9 . 71. Product Piping �Gas �Oil
.23. Gas Pipe�Rough & Tesc 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank C;Gas ❑Oii
�- 25. Roof Sheathing � . 74. Overhead Hydro -
26. T-BarCeiling (Str�ctura3} & RAonocoat . - 75. Dry Chemical �
27. Prameand Flashing - 76. Dry Standpipe •
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � . 78. FIRE PREV, FINAL
30. Drywali Nailing HEALTH DEPT. flEQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTIOfd
32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED
33. Finai Elecvic ' . No���-t-er. �//��q (
34. Final HeSting & Air Conditioning . �/��y' 7 �� ���/�`��,�`j��.._ I
� -v rr,Q
35. Final Gas PiPe�Test �
36. Hood or Canopy .
37. Final Fadory Fireplace '
38. Final Piumbing .`� Z��'� - - -
39. Water Service�Final
40. Gas Service-Final .
41. Solar pomestic-Final '
42. Backflow Preventer �
43. Backflow Irrigation � �
44. Landscape Irripation System
45. Sound Attenuation '
46. Nandicap Regulaiions -
47�. FINAL 5TRUCTURE & BUILDING _ . • .
48. FINAL PLANNING -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �. '��
l.
- 51. CERT�FICATE OF OCCUPANCY "
Date - -
� AODPFSSJ,BNIDMG: 'z 2 2 FAI RWAY PL
r;v�a3ru�ec�aaxr+: LAIDLAW, SCOTT D JR
• �� 222DFAI�2WAYEPLL N
�vr�. wuuxo.�aess:
COSTA MESA,CA 92627
VNT:
AHCXRECTOHFHYNEFA: SCOTT LAIDLAW ����� C21061
JKN.OH EN0:4 AOOflE55: q 1 O HJ . C��1..�'J T HwY UNT: Y
N.B. CA 9'2663
CONfPdCTdf5N11�: �
CONiPACTORSYNIPlO .
1DDNESS 11C ND:
� • UMI:
LICENSED COMNRCTOFS DECLAHATION: I M�eby elfrm ivds perory M pe�uy Na I em Its�vetl uitlr prwuvo ol CMps 9
emmm.�+o .un sea�m �000l a oiveun a a me aeinen ene amie,aov coea. ene mv eosus e m nm �..ne aeae.
cm uc. No.: uc. cuss: :� uc. No.: E X P:
Dme: Contraaa:
OWNEfl BUILUEfl DECIANATION:lhereby
tdlowip reewn (Setl'an J031.5 Bueheea en
�emd'oh, a mpei eny elmduro. pna io ne c
� licenaed punuenl to iM Orovisione d Na I
Bueinen enE Prdeeviona Code�atheths a
)O�t.S Cy eny appirenl lor e partnil eubjatle i
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a dlmeE la mb (SxWn ]OU. Butlnes
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munty wfi'uA requlroe e pe
snl la euch oamN Io file e
penelly na mon ihan I'Ha huedre
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redas Lironae Law Iv Me
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imprv.emrua era nd iMeMeE a dMeE tor eeM. tl, lawever. tln Euttlup a mpovrnam e ea1E rA�in one yaer al campelun, iM
owror-0uiHx wiA haw iM buNen d pwiiq he n ahe dd m� duk a imprma la iM pvpwe W adel.
� I. m ovme� d �he D�GaN. em ududMY aonirednG wGh fKenaed conVectun b cmWutl Ns p9� (5etlion ]W�. &w'vma end
Pmlaaion� COCe: The CWreeon licenn Law dom nd aPWY b an owner d O�G�Y xM Wulds a imG�'M tMrson and who
wnirecb M v�M p4�a wiN a mureeMe) Icamed WisueN lo IM Conirma� liows lewl.
� I em e�emq u,Mfm : s, � B. 8 P.0 ,tar �'r
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I Eo wnily Nm I em awue d eM uMsstaM tln requiiamerva e11 h ud Sabty Coda Senioro 25505.?553]. enJ
. enE Nel I a vry Muia buJdirq omipenl wiil / wil m� (acb an) nestl lo campty wIh uk pets catlae W tlr �pu'vemrvs br
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Daie: Mp���
WOHKER'S COMpEN4�TON OEC Wi�T10N: I Mraby eH'vm wNs penMy d prjury ons d IM /dbwinp Aetluetiom:
� I heva uW hil meinten a ceM�a d conaenl to aeMinw�e lar Mvke�e' canpenwion, n paided In by Sarlion 3'!00 d IM lebar
CaEa. la IM peNormerce al the xvA br wNc� ihe pe�mil ie eaued.
❑ � nm,. ena wie mamein won�en� canw�.d� �ow,e�,ce. m rca��e M saaim a�ao d m. �aeo, coae. r« me wn«menon d m.
work ta w1iiM thie pe�mn ie iaeueE. My wakeie' compensation imurence ferrier uM poli�y number are:
Certier:
Policy Number:
m;, ..nlm ne.e �wr ne comdsrw r w v�x o roi are nurieiee edws Isiaol a bs..)
❑ I mnh uxt in Uie oxlwmence a ihe w«k ror wnicn �n'u w�� a musa. I ehM �w emqw e�Y caem w em m.nw m n to
Wrnm wbjetl to iM xoekme' canpenmtian bws M CeNanie, enE pne Net Y I Nwk bxme a�bjetl b IM xoM1w�'
�p.�..�� w�oo. a s.ao� a�ao d ms �no� cma. i.nw imn.an o�dr �� w�+.
ow: �:
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clHl Ilnu �q ro om h,nO�M tMuiud Aolpn (tI00,G00A „�l� b IM cml ol rompru�tbM1 Cu�rps� u prvvMW br In
Sectlon JTM ol tM La4or Cob. IMw�sa4 ���meYs lse�
CONSTRUCTION LFNdNQ AOENCY: I MeEy e15im uMm penelly d pmjury the� tMn u e cmmvaion bMifq perv.y br IM
panameMe a ine w«k �ar .nkn me w�� m m.�a Ismon aoe�. cw. cl.
LENUEfl'S NAME:
LENDEq'S ADONESS:
I canih �� I hwa reeE I�ia epplketim uM mme ihet iM ebova inlamdion ia camC. I ap�ee ta cpnply wilh dl ary rd mumy adi�aee
enC ele�e kv2 ielel'ep lo WiNip conNutlpn end hmeby aNMr¢e npeeentelivee d this tityb enla upon IM eEv.e-mentunetl popMy
lainapouion Wrpaeae.
CHERYL LAIDLAW
•
4-4
(St51-IB WP) WIiNe-Buiqiq 8 Seiery: GmerFFle; Cenery-AppSrant; Pink-Pevenue; Ookmrob-Aeaem
CITY OF COSTA MESA — BUZLDING PERMIT
PERM NO: B 08922
PERMIT NO: B 084228 PLAN CHECK NO: 02875-97 A GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
JOB DESCRIPTION : ADU 999SF DINING, M BEDROOM & BATHROOM SQ FT: 1,299
CLAIM VALUE: 30,000.00 CALC—VALUE: 41,468.50 GROUP OCC: R-3 /
COMMENTS: X
jf iE j! il� ik iF iE ik 1f 1k it if !F iE iE iE iF �f if �E fE �f jE iE fE if ff jf fE iE fE iE if if iE �E if iE iE 3E jE iF iE M iE iE * if iE jE ff jE iF il� 9f k iE ik 9! �)E IE iE iE �f if �F %iE iF fE fE if iF 1f 1E if jE if ik
2 O N I N G R E Q U I R E M E N T S
S E T B A C H S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: 14 FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; 16 FT IN LEF'T: FT IN RGHT: FT IN
PARKING REQ• .PROV; • PARCEL: 43921311 ZNE: R1 REF NO:.--
PLANNING Nb'I'E5�>' ADD�: MASDER �BEDROOM TO THE REAR AND A D"iNING ROOM TO THE
>-RIGHT SIDEiOF AN EXISTING SINGLE FAMILY RESIDENCE.
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D E V E L O P M 6 N,T .%� S E R V Z C E S R E Q U I R E M E N� T S
ZONING APPROVED BY �` � �� �A DATE; ! -
BUILDING APPROVED BY' � ' � " DATE: '
� !
APPLICATION ISSUED %bY: -' --�'%�� DATE: .-�i q
i(�iFilikifif�fiFiEififiFffiFjEfEiEiEff�ffffk3f7f��F�iF7FiF if3FR�iF�iF3F�iFir7Fi�iF�iFiF�iflF-%�EjEiEiF*if�E iEiE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
r '
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 502.75 `�� ' 9.15
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
81.%�
PERMIT ISSUE
506.90 0.00
- "•� SMIP/NON—RES
,1 �
PLAN-CHECIf TOTAL PAID DUE
�! 81.70 588.60 588.60 .00
REVENUE D NISION TOTALS--> COL'LECTED: 506,90 OVER/SHORT; .00
BLUG PMT PLUMBZNG ELECTRIC MECHANICr'; FZRE SMIP/TOT GRADING PLAN—CHECR
502.75 ' �� 4.15
1E �lk if if if ff iE iE iE if iE fF iF if� 3f �E 3E �f ik if 1E 1ElE i! 1f 1E 1E iE �f iE 1E iE if iE��IE iE �E�iE 1f fE iE iE iE if 3E iE iE if �f �E fE 1f fE �f �E iE iF iE iE iE IE fk 3f IE 1f iE iE �E if 9E 1F iE iE iF jE iF iE ik if
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 5 C R I P T I O'��N• .'� UNIT COST TO'fAL COST
SFR 499 DWE-TYPE V-WOOD FRAME -GOOD 81.50 40,668.50
SFR 800 ALTER BY VALUE RE�IDENTIAL NOZONE 1.00 800.00
� ND"OF FEES
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RCFT#:[1-6u1a76A
PEkI`iIT:0842'c'8
'
' CQfJSTRUCTION AND PLANNING
' APPROVALS Permit #
� 1. TemAn�ary Electrical Service or Pole
>
2. Soil Pipe-Undrgmd.
3. Electrical Conduit Utility•Undrgrnd.
4. ElectriCa� Conduit�Undrgmd.
5. Staet Reinforcement �
6. Electrical UFER Grnd. �
7. Footings S.
8. Foundztion � �y,�n g'
����/ �..'i.
9. Water Pipe-Undrgmd.
10. Structural Floor Svstem �
11. ProoertY Sewer Line & House Connection
12. Sewer Gap
13. Roof Drains
74. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring �
t7. Rough Wiring Si9n ,
78. Rough Electrical-T Bar Ceiling
19. Rough Heacing & Air Conditioning
20. Rough Facmry Fireplace -
21. Ducts,�n Structure . .
22. Dutts, Ventilating
23. Ga: Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathin9 g
26. T-Bar Ceiling (Structural) & Monocoac
27. Frame and Flashing ' , lE
28. Lathing & Siding `�
29. Insulat�on ./�
30. Drywall Nailing �
31. Plaster Brown Coat /�
32. Electrical Power Meter�Final '
33. Pindl Etectric '
34. Finai Heating & Air Conditioning
35. Final Gas,Pipe�Test ,
36. Hood or Canopy .
37. Finat Fattory FirepVace , .
38. Final Plumbing .
39. Water 5ervice�Final '
40. Gas Service�Final �
47. So1ar Oomesiic-Finat -
42. Backflow Prevenier �
43. BatkflOw Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING /)
�f.
48. FINALPLANNING
49. Eleccric Release to Edison
50. Gaz fielease to Southem Catifornia Gas Q
51�. CERTIPICATEOFOCCUPANCY
Date
Date
POO SPA
Inspector qppROVALS Permit#
52. Poot & Equipmei.t Locution
53. Steel Reinforcement
� 54. Forms
55. Electrical Bonding
rp,bLy� 56. Rough Plumbing & Prasmre Test
� 57. APPROVALTOCOVEfl�GUNITE
�. 58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgmd., Test
� 60. 8ackwasfi Lines, P�Trap, � Undrgrnd.
L' 67. APPROVAL TO DECK
� ' '62. Backwash & ReceptorFinal
63. Heater & Vent�Final
, 84. P1umt�ing System � Finat
65. Eiectrical-Final
66. Solar SYstem-Final
67. Fencing & Access Approval
68: AP�ROVE6 FOR PLASTERING
' 69. POOLISPASYSTEMSFINAI
FIRE DEPT. REQUIREMENT
�APPROVALS � Permit #
70. UndergsoLnd Hydru
". 71. Product Piping � Gas D Oil
72. UndergrounA Flush
73. Undergrntl. Storage Tank O Gas ❑ Oil
(L 74. Overhead Hydro
75. Dry Chemical
� 76. Dry Standpipe . �
% 77. FIXED SYSTEM FINAL
79. FIiiE PREV. FINAL �
� HEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: b �7•- 9%/ �/ /-�•l-S.v lu�1'
Date � InSpector
r
e
�
+ooncssaem�oua: 2<2 FAIAWAY P�,
oripeRsru�e�i a+arx: LHIULAW, SCOTT TJ JR
,�oxess LPILLAW, CHERYL N
222 FAIRWAY PL
• CG�TA 1dESA.CA 9�h27
. �w�.. Wmmo.noxEss:
�xcxrzecr ox u+m��+:
�xcx on �o.•s �oowess:
uc rw.:
COMNACTOIfS NAI�:
CONfXACTORS YYlII10
10UNER4: IJG ND.:
uxr. CITz uF CQS'Te� MESf� —&uILLIhi� PERidIT
PERMIT NO: 5 084717 PLAN CHECK NO: N
CUNSTRUCTZGN TYPE: V—N PERMIT TYPE: STR
urn:
mrt:
110ENSED COMflAGTOfl4 UECLAPATION: I Mraby ellim urwbr pe�yy d pujury tl�m I am I'emmd wder pmmme d Cheqr 9
(mmmeMiiq xi�� Senbn 1000) d Di�U�'vion 9 d �ha Buvrow ud P�q��s ��pa. yd mY �� 6 in Nll lace eM ellatl.
cm uc. No.: uc. cuss: uc. No.: EXP ;
Dara: Cmtrma:
OWNEP BUILOEF OECIANATION: I he�eby dfi�m wdr peeWy d pyjwy �� � y� yy�p /mn IM Cvnmfon liowa law trc Ihe
Idbwiq rseaan (5edion ]IXils Busiiasa eM Grdmiom Code: My ery a mueuy whid� reyu'vee e pmnG to eaneVueY. edm.'unpwa.
tlemdah. a rspai ary svuclwe, pior w u asue�ce, abo �apuiros iM epplirenl la urh pamE lo Ne a wprod dmwroni Ow M n�M
tiw�»e w�u �o me awv�a�. d m. cau�neon umva ie» �cneper s Immm«�o wnn saao� �000) a oi+so� a a �ro
�iiso W Frdmian Codel n tM he a ahe b uemq 1lwdmn� end �M !sa fa ihe elaped nrMion. MY vidd'nn d 6wun
At.S by vry nppY're�u I« e pmmC abjem �he eppliceM to e cri panelry d mi mora Nen fxe �unNed EaOen jf500p.
❑ i.�,ow��dmewowm«mr�dor�wmwac..ome:.d.c«�w��..;om�wax.�au..wn�.:oa�memad
w dl«ed I« eeb ISeeUon ]oee. Buai�ss vM Pminaane Catls: The Conireaae lieense Lew droe m� evW �oen ow�wa popeey
who Widf a inpm'ae Iherean, vd r.fio doee autli noek FimeeM v haser a N�a9h luf a ha own emVbt��. qa'� Ihet au l�
impovaneMs ve roi imeMeC a dlered la seb. 0. Mwwer. tM WiNirq a inpiwamaM b wM wilhin wY� d wmplMian. tM
x owMrbuiWr will hm �he buNen d pmneq M a Me EN M b�ik a impow la IM pcpaa d Wal.
� I. ea ownm o/ ihe propeM. � eRtlusively contreeiq with lioene� �Vec�ore lo canstrup iM1e O�lep (�� �. �ineee erd
VMeedona Code�. TM Contredon licenae Lew doae na eppy Io en owner d prtpeM � buiMe w Impovw Iherean eM who
convene for wcM1 prol�s �N e comrvfor�a) Ikenxd punueni io tM Cmumws licaae lew).
� I em paaemq undr SecYon: B. 8 P.C.. br Nq ���; n '
Data: 1'l �'a � Oc+nr. [��i a /�/� .
I Eo Mreby ceMy tIW 1 em ewere d enE uMenienE tM rparemmp o loniie MaaEh eM Selaty COEs Setliom tS505. 2:53�. e�d
15531. end Nm I u em tulure drikuq ocaqm xiA / wil mt (tlrcb Mel med lo comdv x'vh seid nme mde� ud iM nVUAmaps br
o�a: �vd�:
woRKea�s couvo�s,�non oecux�nox: i n..a.� we.r �,�eny a oem.y o�. a m. imo.mu d.a.m�+:
❑ in.V.w.um.w�.�.ne�.a�nw.w:�.ro�.,ona.•�w�.mwoaeadianrsw�sroowm.�
coe.. ia m. oa+� d m..oM e« �+:�n �m. w� a w�e.
❑ inab�a�i�m�wonan�v����,�.m,w���ews«,�ma�aoame�n«coe..m�inero��•wm.
wM lor whirh �I�ie pwmil ia iaeued. MY workers oompamelion imurencs urtbr vd pdiry numbar era:
c�:
Pofry Numbar.
s sonion rreM noi be comWered / �he pemirt u lw one AundroC yW� Rip�l a y,¢o.J
�J I ronity thm in IM perlormence M �M work la v.fiich ihie pertnM u��, I Mep iwl empby arry panan In ury manrror n m to
Eocane wbjee m tM �n�n wmaenama� V.. d cdnanie. ene mrea uw u i enowd n�m» wyx+ io ms v.a�w.�
�o�� wwivon. a s«lion mao a �n. L.no. cod.. �.nw �ann.'nn mm W..eh Noro powbn..
De�e: �OpfrsM:
W�mlip: F�xun ro weun raikMi mmpwwMon rornp� l. u�pM/y�, �q NyII �ub/�er in wnplqw ro enm4ul pw��ltlu �nJ
clHl flnu �p ro aw �u�erotl fhournC dalbn (S10qG00A M edNtlon b tM ewt ol mmprueWM1 danvpu � povW�L br In
Sztlon 9108 0/ tln LeOor Cotls. Infr��L ����Y i l�a.
CONSiAUCT10N LENDING AGENCV: I Mreby elfirm uder pxupy d per'Fvy �Mt ihae e a mMrvCun bnNiq apaicy b IM
pMwmariw W iM xork la w1iiM Ihe pertni u eeueE (Sedion �OB], C'v. CI.
LENDEN'S NAME
LENUER'S AOONE%:
I eeniry IIW I heve eeW No eppl'rstion ud mate Ihtl iM1e ebova inlamNon o eanetl. I epree lo eanply wuh eA ary eM oouMy adiwime
end etaie lewe rele�ip io Wikiq connruaian ard hareby eNharrze mpraeantmrvee d ihn rny m eMer upon ihe abwa�memund popeM
r«ms�a�o�w.roaa CHEkYL LAIUL[�.W
1 �� ♦ A. /i� _ Date: / � � �4' 1 /
Sie�ure dApenVRppYranUCantreep
(St51-,B.WP) �e-&+i1dM 8 Sefery:0eeemFle: Ceriery-Appfunl: Rnk-Revemn:4kanmE-Nxav
JGB DESCRIPTION : T/OFF 6 REROGF W/COMP SHINGLES
PERM NO: B G6471'
GOVT: N SUPP: N
PURPOSE: ADD
SQ FT: 1,500
CLAZM VALUE: 1,500.00 CALC—VALUE: I,500.00 GROUP OCC: R-3 /
COMMENTS: REROOF 15005F RESIDENCE W/COMP
� iE ie iE iP iF iE iF iE �E fi 3F iF iF iF fF iE iE if if iF if 3c ie jf ae ii jc iF iF if -1't �ri' #� iE ie i� �E iE �?E ii iE ie �E i't if� iE aE if ie if ie �F ic iE i� iE �k if iF �?E iF �1E af iF �E iE de iE �R if jf +E ie �F iF �%� �1'r
Z O N I N G R E Q U I R E M E N T S
S£ T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILUING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT ZN RGHT: FT IN LEFT: FT TN RGHT: FT IN
PAkKING REQ: PROV; PARCEL: 43921311 ZNE: REF NO:
PLANNING NOTES> �
> •
iF ie 3f'1f 1k if if iE iE if if 1f ih 1F 1F ii� iE <iE ii ir ii iE'k } ji' iE iF 3E iE ie'1 "c iE fElf Yf 1't 1'c iE if eF'1[ iF ik <iF jF iF ie 1F ie iE f! iF'1F �1!'k!i �1't ii iE 1E iE i4 ie fF iE ik if if jE'If jF iE �ii fF 3f )E �lE
U E V E L O P M E N T S E R V Z C E S R E Q U I R E M E N'-� S
ZGNING APPROVEU BY DATE; �
BUILLING APPROVED BY : DE.TE: ��. �
APFLICATION SSSUED BY: 2�. DATE: "�I—1 C1
iFiEi'rrEiiiFi��if�tieiFiEi'riiiEifieii�iiiFiFxse�exrc�rxn �e xi�n x�.�ex+rxx�c �e��cs. w x4iE'r'xiEieiiiid'eii+e+E �e�rt�i'rii
LEGALIZATION:N F E E S U M M A k Y SI'RUCTURAL SEGMENT:Y"
bLDG PMT PLUMbING, ELECTkIC MECHANIC rIRE SMZP/RES GRALING
PERMIT 48.SU _5p
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDZNG—DICr—> PERMIT ISSUE PLAN—CHECK
IOiALS----> 99."v0 0.00 0,0"v
REC%ENUE DIVISION TUThLS--> CGLLECi'EU:
BLLG P'rIT FLUMBING ELECTRIC MECHANIC
48.50
IOTAL PAIL DUE
49.60 49.OG .G"v
49.Ou GVEk/SFiURT: .Ov
FIRE SMIY/TOT GRAUING FLAN—CHECK
.50
ie t ie ic �R �F ic iE ie iE iE iE iF if ie if ie if ii ii iF i'r ii ie 3i �k if �'ti ii ii �i Yi ii ii ie ie iE i'r-1i s ii� ie ii� iE if ii ii� ii� ie 4 r ie'r. ii ic'r. ii ii� ii ii ie yE ie ie i'a iF ie iE i'r iE ii �.r ii� 3i ii it i' ii r.
I N L I V I L U A L F E E b R E A K L U W N
TYPE �TY L E S C k I P T 2 O N UNIT COST TGTAL CGST
SFR 150u kER�uF BY �ALUE kESIUENTIi.L NGcGNE l.t�u 1,5"v0.uv
END OF FEES
�9-16-1597/10:33 A,"�/843.C�
RCPTII:�il-;5123LE
PEFttiS'�:0B471!
. CONSiRUCTION ANDPLANNING � POOL 'A
• AP•'ROVALS Permit# Date Inspector AppROVAIS Permit# Date inspector
�:. Temporary Electrical Service or Pole 52. Poo� & Equipment Location
2, $oil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Condult Utility-Undrgrnd. 54. Forms � ..
4. Electrical Conduit�Undrgmd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbin9 & Pressure 7est -
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �
7. Footings . 58. Electrical ConduirUndrgrnd.
S. Foundation � 59. Gas Pipe, 0 Undrgmd., Test �
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, Ci Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection . _ 62. Backwash & Receptor-Finai
12. Sewer Cap � 63. Heater & Vent•Final
13. Roof Drains __ 64. Plumbing System - Final
14, flough Plumbing ' 65. Electrical-Final
75. Rough Electrical-Conduit- 66. Solar SYstem�Final
i6. Rough Electric Wiring 67. Fencing & Access ApA�ovai
77. 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. Rou9h Factory Fireplace APPROVALS Permit #
21. Ducts, in Sttucture 70. Underground Hydro
22. Ducts, Ventilating 77. Product Pipin9 Cl Gas ❑ Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergmd. S[ora9e Tank O Gas ❑ Oil
25. Roof Sheathin9 74. Overhead Hydro
26. T�Bar Ceiling (Structurall & Monocwt 75. DrY Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM1A FINAL
29. Insulacion 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final B0. POOD CERTIFICATE ISSUED
33. Final Eleciric 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. G9s Service-Final
q1, Splar pomestic-Final ,
42. Backflow Preventer
43. Backflow �rrigation
44. �andscape IrriFation System
45. SOund Attenuation
46. Handicap Regulations �
47,. FINAL STRUCTURE & BUILDING /y,-�} -'�'1 �"
�
48. FINALPLANNING �
49+. Electric Release to Edison
50. Ges Release to Southern California Gas Co •
5h CERTIFICATE OF OCCUPANCY
No. Date
1 ; • .,
WELLS INSULRTION COMGRNY, INC.
113E2 WESTMINSTER RVENUE
UNIT 6
GpRDEN GROVE CA 9c64�-maaa
INSULRTION CERTIFICRTE .
INSULfaTION IS INSTALLED IN THE STRIJCTURE DESCRIBED BELOW RS FOLLOWS:
COVERRGE AREA** ITEM INSTRLLED # OF BAGS
(BLOW ONLY)
SUBFLOOR 0� LIVING AREA-- R-19 Unf�ced Batts
DORENG 15477
JOB NqME SUB FLOOR
RDDRESS �22 FAIRWAY PLACE
COSTA MESA
DFaTE COMPLETED _��
WELLS INSULATION COMRRNY, INC. BY it4%f/ ��G�W
LOT#
-MDFESSOF�NLOWG: 2 2 1 FA I RWAY PL
OYMEA'SN.WEIFpqfIN: LpAIDLAW, SCHORTTy D JR
wo�ss L2IDLpWRWAYEPLL N
Z 1 FAI
• COSTA MESA,CA
APP�.YAIIPlG AUOPESA.
/iPtXRELTONENCd�EEP: SCOTT LAIDLAW
nncx.ox�ws�noxEss: q10 W, COAST HWY
N.B.
CONfNRCTOP'SNRNE:
caxm�crorcsxuuxc
/i0DPE55:
UNT:
92627
�� C21061
uHr: p
CA 92663
IlG NO.:
UNT:
LICENSED CONiPACTOFS OECLAflATION: I hareby tll'em unAar penety d pairyry ihet I em licanaed uMar pwienne d Cheq« 0
(rommem�q xilh Saction 10�q d Oireion 3 ot �he Busiiwes eeM Pmfmawp COEe, enE my Ike'ree o in lull brro uM eHea.
CRY LIC. NO.: 11C CLASS: LJC. NO.: EXP �
Daie: Comreaa:
OWNEN BUILDEN OECLGNATON: 1 hereby elfirm uMn penely d perjurv �� � am a<emq hwn the Caarenas limraa law for the
tdbwM �ea5on (Saqion )031.5 &niima erd Proleszons Cade: Am' ciy a ooun7 Mfiidi re9uitm e Da�� lo oorebucl. Ms. imMow.
Emmdoh, a repei eny sVuaure. q'v io Xs ewe�we, ebo m�uires Ihe epplireM la wch pmmd m fJe e a�ied aWemom tlW M a�M
b licenaed W��1 to Ihe povisvu d Me Conlredaa Licenae law �Cheqer 9(oommandiq wG� Sedion ]000) al Oiveion J d tM
'r�an eM Prdeaiwu Codel «thet he a ehe ia aiemq therelmn arM �M bmw la Ne dbo� uemqion. MV violelion d Saaon
i1.5 by enY aGW�t br a parmG subjatle �M eppliranl lo e tivY perally of nal mae �hen fxa huM2E Adlen �5500�)• '
� I.avow�wrdiMprwenyamyempbYee+whwepeemtheredammpensatian Nldothewak.eMtMe4ucYune�wlmlenEeE
wmr-0uiMer will heve Ihe buNen d qovirq M or e�e tlN � Wiltl a impwe tw tM1e Wm�a d eeb�. ' �
� I. ea ovmer d the properly. em ecduaively mntreqvq wnh licenaed contrmbn ro conehuq tha pajaq (�� ]�: �imse eM
a,wea.iom coee: rne com,eeon ucenee �e. ao.. �a epqr �o e� o.m« w o�wanr �o wiu. « imww.. �ne,.m .�a wno
convecb fa wdi o�M�s �n a contrenorte) licensed oureuent m ine conVea«s Liwme lew).
��l em exem uM`er� /Sectian: B. 8 P.C., M Nie reeean: ///� �/ ,/ H
a: �11 ��� Ovmer: ��� 0.� Y �Qd U'`. �"�/
by ceNty tl�e� I em ewere d eM ivdanterM t�e requiremenn d wnu Selety COEe SeUbne R5505, 2553�, enE
25530, eM thm I or eiry Mure buikirp oocupeM will / WI not (aicb me) neeG ro wmply wih aeid etme mda erd tM m�uiramanb lar
e pe�mil famrnvuuion«modifirelionhwn�haAi�eriepemeM D'otntl. Raekamiel const�ud'pn eppiritiaro va ecamq Immthna
ome: nvd�:
WONKER'S COYPENSRTION DECLARATIOM: I hereby el! uMx paiully d psjury ma d the idbxi�p dedarmum:
� I heve vd xil meinten a canifrma d mneenl to eeMinwie M xakera' campamelian. ro proridad la by Swim 3lW d �M lebw
Cede. lor the perlamarca d tM wA la wF'ch tMa pxmA b bsueC.
❑ � n....�,d �i� meima:� �n�• �v�on �nwranc.. es �ev��.e M smon a�oo a mme �eno. coee. a m. ro�a� a �n.
work la xfiidi M's P�� o esued. MY wvFare' oomWr�emion ivurarce urt's erd GawY number ere:
c�a:
Paliry Number.
sxfion neee iror ae cm�derea r me w�a u ror a�e nuneiae ea�ero /s�ool o.lnaa.)
I cerlily ihel in Ihe pMormerce d �M work br v.h'rh Ihis pe�mn ic iaweE, I Mell rwl emplry any pemn in ury menMr n m io
became nubl� to iM woMere' compeneetion kMe d Celibmie. eM eprae thel d I MouM became wEjetl lo iM wFen'
compenxlion o��a ol Sed'wn 3]0� N ihe lebor Cade, 1 ehdl lonhwnh cwnp�y xnh thme pwisian.
Deta: Appl'ranC
W�minO� F�llun ro�xun woitrxi compxuatlon rov�r�p� I� unNwful, �ntl �Ivl/ s��sef �n �mp/oyer b erlMnl pMUMH �nG
clv/I fliro� up ro ons hunJretl fM��entl tlo1Mr� (SI00,0001, In eOCltlon ro Ms ewt ol rompsiustlon,.Aunpa u poHtlM ror In
9xtlon Jl(K o/ tlre Le�or COW, Infsn�f, end atrornsy� /esw �(7^. �
CONSTNUCTON LENUING AOENCY: I Mmby elfirm undar panelry d parjury that iMre ie e oonsl�ud� bMinO eOeMy br Ne
pe�lormence d �he MOM tor wtiidi me w�mY ie owad (Sedion ao5). Civ. C�. -� i
LENDEfl'SNMIE: %� '
LENDER'S RDDPES9:
xl r
I canily Ihet I heve read Uo eppliraiion aM atme Ihet Ihe ebo+e iniametion is cortatl. I eprte to compy wilh ell tlly erd cauMy atline�au
arM ete�e kwa �elmfq lo WiWip conAruqion ud hxeby eNlwtae nqpemetivas d �hv oryb m�m upon IM abwe�msm'aied qaperly
lainspedion purposes. �',\b��+
CHERYL LAIDLAW r
d�
(5151-06.WP) WM1i1e-BuilEiq 8 Selery; G�aeMRle: Cenery-App5ran�; %nk-Revenue; GOMenro�Aaemw
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: E Un423
PERMIT NO: E 084230 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTIbN TYI�E: V—N PERMIT TYPE: ELE PURPOSE: ADD
JOB DESCRIPTION : ADD 9995F DINING, M BEDROOM &&ATHROOM SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: ELECTRICAL WORK
**�rat��**it*atitet�*�r*itat�**�**itat*+�**�r*�r�r**+��r*etx�*�**ie�****itat�it**ieit***atat�r�*�*�****�**ie
Z O 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 ---------- --------- ACCESSGRY HUILDING --------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REp• PROV; PARCEL: 93921311 ZNE: REF NO:
PLANNZNG N�iTES> ,
% -
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PLDG PMT PLUMBI
PERMZT
r
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE
TOTALS----> 55,25 22.00
�'.E" r S U M M A R Y
!-
ELECTRIC MECHANiC
55.25
508
2 2 , 0 0
PLAN—CHECK
O,OU
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
7%.25
DATE: �-y
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STRUCTURAL SEGMENT:N
FIFtE SMIP/RES GRAUING
SMIP/NON—RES
TOTAL PAID DUE
77.25 77.25 .00
77.25 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
if iP iE fk 1E iF dF af if 1f if iF iF iE �f 3E iF if fk if 1f iE iE iE iE �f iF iE iE iF �E iE if �E �F 1k i't iE 1f iE iF if �F if if fE �F iE fElE if iE iE iE at iF iF �1t �1i i4 iE if iE �1E iF if ik if iE �1f ii 1F �F �F af �f iE i6 iE
I N D I V I U U A L F E E H R E A K D O W N
TYPE QTY D E 5 C R I P T I O N UNIT t;OST TOTAL COST
ELE 10 FIXTURES, LIGHTING 1 ST 'l0 EA. 1.00 10.00
ELE 8 RECEPT/OCITLET 1 ST 20 EA. 1.00 8,00
ELE 10 RECEPT/SWITCH 1 ST 20 EA. 1.t�0 10,Q0
ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 27.25 27,25
END OF FEES
C9-14-1997/G9:05 qr"J977.2a
P E Fc Pi I T FT0842 30
CONr BTRUCTION AND PLANNING POOL 8� �4
APPaOVALS Permit # Oace Inspector qppROVALS Perm„ # Dace Ir�spector
`�i. Temporary Electrical Service or Pole 52. Pool & Equipment Locat�on
2. Soii Pipe�Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utiliry-Undrgrnd. 54. Forms
4. Elecirical Conduit�Undrgrnd. - 55. Electrical Bonding
5. �Steel Reinfo�cement 56. Rough Pfumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 5B. Electrical Conduit-Undrgrnd.
8, Foundation 59. Gas Pipe, O Undrgrnd.; Tes[
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Ploor System 61. APPROVAL TO DECK
7 1. Property Sewer Line & 4ouse Connection � 62. Backwash & Receptor-Final
72. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains - 64. Plum6ing System - Final
14. Rough Plumbing 65. Electrical-Final �� _ - -
� 15. Fough Electrical�Conduit 66. Solar SYstem-Final � �
16. Rough Eledric Wiring I - Fencing & Access ApProval
��/-�-- � .
17. Rough Wiring Sign � gg. APP,ROVEO FOR PLASTERING �
18. Rough Electrical-T Bar Cailing 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Pactory Fireplace � � APPROVALS Permit # '
21. Ducts, in Sttuaure 70. Underground Hydro
22. Ducts, Ventilating • � 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof framing� � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof_Sheathing �� 74, Overhead Hydro�
26. T-Sar Ceilin9 SStruccura{I & Monowat 75. Dry Chemicaf
27. F'rame and Flashing 76. Dry Standpipe
26. Lath�ng & 5�ding � 77. FIXED SYSTEM FINAL
29. Insulation � 78, FIRE PREV. FINAL
� 30. Dryw�all Nai��ng HEAITH DEPT. RE�UIREMENT
37. Plaster Bro�Nn Coat � � �'1. FINAL INSPECTION
32 Electrical Power MeterFinal `.?^. FOOD CERTIFICATE ISSUED �
//_1�._91 _ -.
33. Final Electric . ��u,� � � Notes: - _
34. Final Heating & Air Conditioning i
35. Final Gas PiPe�Test ' ; . '
36. Hood or Canopy , �
37. Finai FactorV Flreplece . �
38. Final Piumb�ng �
39. Water Serviee�Final � �
; 40. Gas Service-F�na� � . . �
41. Solar pomestiaFinal
42. Backflow Preventer F
� 43. Backflow Irrigation ; , �
44. Landscape Irriqation System � . �
45. Sound Att¢nuation - , ,
46. Handicap Regulations � ,
47. FINAL STRUCTURE & BUILDING � '
.-
48�. FINALPLANNING _ .
49. Hectric Reiease to Edison . � �
�
50. Gas Aelease to Soutfiern California Gas Co ��
� 51; CERTIPICATE OF OCCUPANCY
No. Date