4372 CITY OP CUPE1t11NO INSPECT101: RECORD (Office Copy)
4372 19876 Beekman Pl.
PEPIIIT PLO. SANITARY DIST. NO. LOT tdO• ADDRESS
• Shower Pan Shears
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
Buil dinr Date Insp.
Electrical Power Pole
PlumhiTIC' Underground
Plcchanical Pou h Wiring
'lemP. Gas/1Clcct. la S
Solnr Ceiling
Fire Sprinkler Fixtures Int/Ext
Sis'n llo`ors
Grounding
Ilisc. Temp. Power
Other _
FINAL. INSPECTIONS Not Approved
Date Insp.
r,;s
Electric
PLUMBING
Plnmbin , Date Insp.
Backfloc;
Mechanical Underground
Solar Underfloor
Pool Partial Rough
C,rarling Rough Complete
Planning Solar Rough
Fire Dent . hater & Insulation
llealth 'Dept. Main Drain
Buildin R/of/S Drain
Other Gas
(ether
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Danpers
Underfloor Girders Fireplace
Floor Steel Crease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
11alls-Panels Flues & Comb. Air
Frame Other
Lnth Not Approved
Wallboards Int/tixt.
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI. POINT PEN ONLY
F.
ING
BUILDING PROJECT IDENTIFICATION
PERMIT NUMBER
gpop,NG APPLICATION & PERMIT 4372
s L BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
Owry 'S PLAN CHECK VALIDATION
"AM CITY, ELECTRIC PERMIT FEE
• PHON I
CO RACOR'a OUTLETS-SWITCHES-RECEP 5.00/1.00
PAID
uc.ry LIGHTINGFIXTURES 5.00/1.00
.o CT S (� PPLIANCES-RESIDENTIAL 4.00 EP 261983
ADDRESS �Vo
� I /
�(/I�2HOrvE PANELS 5.00 GATE OF APPLICATION
A CHITECT PLP $F P.C.NO.
DR slcNs 6.00 City 01
�upeltl
ENGINEER
uc.rvD. SIGNS TRANS. 3.00
ADDRESS ENG. J SPECIAL CIRCUIT 5.0o P R IT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT'$
ADDRESS MOTORS SEE FEE SCH.
U
SERVICE CHANGE 10.00
o o LICENSIiD CON'(RACTORS DECLARATION I V
a u I hereby al7inn that I am licensed under provisions of Chapter') - uANCE DATE
Z4
w (commencing with Section 7000)of Division 3 ol'the Business and G < A BLD . ELECT. PLG. MECH.
H z Professions Cgk1e,'nd my license Is in full fa c and UI'e�.r)
Ey i m W Licen C/JPaAss'�/O/ D/ii Lic.Number �L.Q_L -
F N J Dalc+ � Contractoryl✓'h'0
a r r BUILDING PERMIT
ce -OWNER-BUILDER RRUILDF.R DECLARA'T'ION -
A o a u INFORMATION
X g LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- _ REFER TO ORD
FUO ] Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - VALUATION $/FT.
S Code:Anycity orcoumy which requiresu permit mconstruct,alter, 6.00 /
QO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
au requires the applicant for such permit to file II signed statement that TOTAL PERMIT TO
E:
$w he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter 9(commencing with Section 7000)of Division 3ofthe
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
,-$ the basis for the alleged exemption.Any violation of5ection 7031.5 _ STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4,00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec,7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND, 4.00
Cade:The Contractor's License Law does not apply to on owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 60.FT,FLOOR AREA TOTAL ACREAGE
• meets are not
hde ownemployees,fors,Provided.I , o ever,hat the
improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 4,00
mems are nm intended or offered for sale.If,however,the building
or improvement is held within one year of completion.ion,the owner-
builder will have the burden of proving that he did not build or inn- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDINGUSE
prove purposeof sale.). INDUSTRIAL WASTE INTER. 20.00 E IND El ON PB ower
1,as o
❑ wnerer of the property, exclusively contracting with 13 El
licensedd as ocontractors to construct the
project La 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Codegrope The who
bildsContractor's License s thereon,
Joos not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 7.00
contracts for sus 11 projects with a contractot sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 4.00
ason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Q Applicant Y ❑ N� Y ❑ N�
~ va PERMIT ISSUANCE 6.00
LU CF.RTI PICATE-COMOPEXEMPTION FROM WORKI>RS' FLOOD ZONE A.L.u.c.
'W -COMPENSATION be
INSU RA NCI: PLG.CONTE. LIC.NO. PLG. Y[] No Yp As
2 (This section Send not be completed if the Pennil is liter one TOTAL
Hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL E mit is issued,I shall not employ any person in any manner so as to
O wbecome subject to the Workers'Compensation Laws of California.
y Dat° Applicant ALTER OR ADD TO MECH. 4.00 BUILDING TO
>- rn NOTICE 'f0 APPLICANT': If,after making this Certificate of fix
Z emption,you should hecomc subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10jI00C.EM.) 5.00 SEISMIC FEE 5D
I hereby affirm-that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
toinformation is correct. I agree to comply with all city and county PLUMBING "•
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (O,er 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Caper'tino against liabilities, 'udgments, costs and bxpenses which PERMIT ISSUANCE 3.00 CONST.TAX
ma n any way onto a ,nsl aid City in consequence of the
g [i ,of thisI it. MECH.CONT. LIC.NO. MECH. � �/)]
i ri TOTAL TOTAL (VJ
Signature of Ap I ont n[ractor Dn
OFFICE COPY