2159 ,APPLICANT TO FILL IN INFORMATIONVITHIN RED LINES - USE BALL POINT PEN ONLY
.' BUI LD1 NG PROJECT TI fel '" PERM, Nu
aO,LD,NG - . • APPLICA & PE T ' ' C
� ADDR,SSS u �O ',� 9
• ^Q BUILDING—ELECTRICAL—PLUMBING—MECHANICAL '
Ow E 'S a !/ MFEE. PLAN CHECK VALIDATION
"AM r DTV. ELECTRIC PERMIT FEE-
HONE
CONTR,ICTOR'S
NAME OUTLETS-SWITCHES-RECEP 5.00/1,00
LIC,NO. LIGHTING FIXTURES 5.00/1.00
ADDRESS S APPLIANCESRESIDENTIAL' 4.00
CONTRA •. • - '-
PHONE PANELS 5.00 .DATE OF APPLICATION
ARCHITECT - rPLAN CHECK FEE P.C9.NO.,
OR - SIGNS - 6.00 OtJ�
ENGINEER
- uc.NO. /�� SIGNS TRANS. 3.00
ADDRESS ARCH,OR PRO - _ SPECIALCIRCUIT S.00 PERMIT VALID
-ZiP TEMP.METER OR PO I •15.00•
APPLICANTS _ ^• E SC
MOTORS H.
- '
LAN
Q• - SERVICE CHAT 10:0
0
ADDfl EAA12 - PAD
0 o O LICENSED CONTRACTORS DECLARATION I
a u u I hereby affirm that I am licensed under provisions of Chapter9 �'e�no—' - �/'1 ANefbA'1'E"�
H < N (commencing with Section 7000)of Division 3 of the Business and _ ,SLOG.'. ELECT. PLG. MECH.
r D z Professions Code,and my license is in full force and effect.
o i w o License Class Lie.Number - If oaIO
0
Date Contractor
< x
e, -
¢ � � OWN ER-B UILUER DIiCLARA""PION BUILDING PERMIT
K w 1 hereby affirm that 1 am exempt 31,5 the Contractor's Pr License
MISC.— .REFER TO ORD _ �• INFORMATION
a•u o j Law for the following reason.(Set.703 1,5 Business and Pro(essinns VALUATION $/FT.
� - g PERMIT ISSUANCE 6,00
,�� Cade',Any city or county which reyuiresu permit to construct,alter, -
p.Q ¢ � ImprllVe,damO1SI1(O!(CpWl ally atfll{'.Il:re,IlrlOr lO It5144hlanef,aSl) ELEC.CONTR. LIC.NO. ELEC.' p•/ - '
n D ¢ requires the applicant for Such permit to file a signed statement that - TOTAL p7�
w m" he is licensed pursuant to the provisions of the Cort Division 3 License i n_ PERMIT
Law(ChapterProfessions
Codewith Section is 00)exempt therefool the V//(lI7�Ir y�E
4 0 .the ba is and ProfessionsxempYar that he is exempt therefrom and DTV. PLUMBING PERMIT FEE _
W F $ 'the bars for the alleged exemption.Any violation of Sectiolipenalt5 STORIES TYPE CONSTR.
A 3 _ by any applicant fora permit subjects theapplicam mucivil penalty ALTER-DRAIN & VENT-WATER (EA.) 4.00 %lh
of net than five hundred dollen[5500).):
❑ I,as owner of the property,or my employees with wages os BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS sole compensation,will do(he work,and the IT, re is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 �i3 / s
Code:The Contractor's License law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-,PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself'or through [its own employees,provided that such improve.
mems are not intended or offered for safe.If,however,the buildings GAS-EA.SYSTEM-l1NC.40UTLETS 4.00
or improvement is sold within one year of completion, the owner- GAS-EA,SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden o'proving that he did not build or int - RES IND CON PB Om..,
prove 1,as owner of Sthe.L - INDUSTRIAL WASTE INTER. 20.00 .keO 0 � '�
❑ I,as owner of the prupertY',am exclusively contracting with
licensed contractors to constmet'the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5,00 '
_ ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply ,5�6 /^
• to tract
owner of hroliertyproice s wi builds cont
improvescnsedthereon,tool who LAWN SPRINKLERS-OVER 5 (EA.) !1,00 Q/(
ireCon race such projects with a contmetots)licensed purs'uam m
he Contractors License Law. SEWER-SANITARY-STORM EA.2001L/8.00 TRACT NO. PARCEL NO. -
❑ lame tender$ ,B P.G ' rtlls WATER HEATER W/VENT 4,00 --
IeaSl)II
ate Owner WATER SYSTEM 4.00 ACC.DATE ACO.FILE NO.
w0 RIiRSConu'hNSn'f1ON DECLARATION WATER TREATING EQUIP. '4.00
I hereby atitin that I have a certificate of consent to s,If-insure,
or a certificate of Workers'Compensation Insurance,or a certified 'ZO�INN� ENG.SITE NO.
copy thereof(Sec 3800,Lab.C.). �-
Policy No. Company-
0
ompany -
O ❑ Certified copy is henel,furniahed. RE$PRINK ENERGY T-24
Z Z ❑ Certified copy I, Bledwith the city-inspection Jivisiml. IIMISC. REFER TO ORD.
O Applic:mt Y ❑ 1�5d ND
~ w PERMIT ISSUANCE 6.00
�'— CI!RTIPICCOMPEN AX [ON IONI:ROMWORKIiRS' ROOD ZONE ys-.Cel
W � COh1PIiNSATION INSURANCIi PLG.CONTR. uc-.No. - PLG. -
EL O (This section need not be completed if the permit is for one TOTAL"^ - Y❑i ❑
0 Z hundred dollars($100)or less.) r -
,U O 1 certify that in the perfornhance of the work for whichdhis per. DTV. ^ MECHANICAL PERMIT FEE - FEE SUMMARY-
LL P mit is issued. I shall not employ any person in,ray nh:umer so:Is to
O L) become subject to the Workers'Compensation Laws of California. -
y Date ApplicantBUILDING gg il
O
} m NOTICE'TO APPLICANT: If,after making this Certificate of Fa—
F_ Z emption,you should become subject In the Wnrkco'Conl..ematoll APPLIANCE 4.00 PLAN CHECK
provisions of Ilse Labor Code, you mus( forthwith comply with s J'
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO .) 3.00 F EE "n✓•4• Q
C'ONS']'RUC'I'PON LENDING AGENCY AlR HANDLING UNIT 1 C .00 SEISMIC FEE E y
I hereby affirm that there is a construction]coding agency for EXHAUST HOOD( .00
the performance of the workrfor which this permit is issued(Sec. MICROFILM '
3097,Civ.C.). . . �• HEATING UNIT(TO 0,00 .T.U. 4.00
'Lender's Addr HEATING UNIT IDV .50 0'n
Lender's Addnes - - ELECTRIC 5
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree-tn conhply with all city and county BOILER-C.OMP13 H.P.Or 100,000 B:T.U.) 4.00 PLUMBING
tordinances and state laws relating to building-cotulruction, ,nd
hereby authorivc representatives of' this city to enter upon the BOILER-COMP (Over 100,0130 BTU(SEE FEE SCH. •MECHANICAL above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep Ihann]eas the City,olMISC.- REFER TO ORD.
Lopertlno against Ilabllil He, .udg Cats, osis and expenses ehiclh PERMIT ISSUANCE 3.00 d,?. CONST.TAX
may i any way accrue again; said y in onset .Rcc..f the
rant.hg of this emit. MECH.CONT. -LIC.NO. MECH.
TOTAL 7 (I•� TOTAL �(,
nu lure oC Applicant/C tractor to s'/'g/ _ ,( 7�"�
- OFFICE COPY re I-ItEXC7 - J3-'•'_l
CIPY OI' CUPERT LNO INSPECTIOV RECORD (office Copy)
I
2159 10889 Barranca Dr.
1'I:1,NI'r NO. SANITARY DIST. NO. 70T PIO. A5-6Pf,SS - -----
Addition Joachim J. Uebel
PROJECT OWNER JOB SITE PHONE NO.
PEP21IT ISSUED Date ELECTRICAL
Bui]dinp 1-6-83 _ -- Date Insp.
.I.IectrIca1 1-6-83 Power Pole
I'LumbLng Ilnderfround
ttcchanica.1, 1-6-83 Rough Niring
'I'ernp. fns/Elect. I!al.l.s g, G,R� _�
Solar Ceilin —
Fire S )rinkler Fixtures int/Ext
Sinn tlotors
Grounding
hli.sc. P quer
PINAI. IUS1'EC1'lONS NoC Approved
Date Insp.
ElP.l.ec
--- PLUMBING
tri.c �/_ 'j- Date Lnsp .
PLimbin E, Backflow
Mechanical Underground
;alar Underfloor
Pool
Partial ILou,Oi
Gradin , Rough Complete
Plannin& Solar Rough _
Fire Dept . [later & Insulation
Health Dept. 'lain Drain
building R/of/S Drain
OLher
Gas —
Other.
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation
Pre-Gunite '—' Date Insp.
Underfloor S .M.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Danvers
Underfloor Girders Fireplace _
F.Loor Steel I Grease Duct & hood
Ti.edowns One (lour Shaft__ ---�--
D.iaphrams p",Npi, ,j Condensate Drain
Seismic Bracing Equipment Anchorage
!lal.ls-Pancls Flues 6 Comb. Air
Frame Other _ owP3
Path Not Approved
flallboards t 1?xt • 5-3- —
Firewalls "
Other wo-e1.e. _� _ S
Not Approved
a6 r
BUILDING
i
ELECTRICAL
PLUMBING
11ECHANICAL
MISCELLANEOUS
I i -
i -