3692 C1T1' OF CUP17•R1'INO IIISPL•CT101! RECORD (Office Copy)
3692 _ 7537 Dumas Drive
PEPJIIT 110. SANITARY DIST. 140. LOT 110. ADUIUSS
�. Shower Pan Jackman
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Buil din 6/14!83 .\ Date Insp.
Electrical Power Pole
PLumhinr Under -,round
1lechanical ! P.ou :h 11irin
Temp. Gas/Elect. is s
Solnr Ceiling
Fire Sprinkler Fixtures Int/Ext
Si ,n 1lotors
Grounding
Misc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
PLUMBING
Dl.ectric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
GradingRough Com Tete
Planning Solar Rough
Fire Dept. Slater & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas .
Other
BUILDING Not Approved
Date Insp.
Pad Certification 11ECIIANICAL
Foundation Date lnsp.
Pre-Gunite Underfloor S.H.
Slab-Ilembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood _
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing; Equipment Anchorage
Ilalls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext .
Firewalls
Other
Not A) roved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•BUI LID NGLJ12JELTIDENTI FICATION PERMIT NUMBER
BDILDINc APPLICATION & PERMIT �(�^(��
ADDRE
95 U J
BUILDING-ELECTRICAL-PLUMBING-MECHANICA
1 PLAN CHECK VALIDATION
"AM QTY. ELECTRIC PERMIT FEE
� a PHDNE -
coNrR cro s UTLETS-SWITCHES-RECEP 5.00/1.00
CO
LIC.ND. LIGHTING FIXTURES 5.00/1.00
ADDRESS I., PAID
ANTRAL o s PPLIANCES-RESIDENTIAL 4.00 -
lwazkk
� 1
PHONE PANELS 5.00 EMJ&OF4PPl_ICAJkEqiL
c irE r SIGNS 6.00 PLA dl. .No.
ONGINEERR
- sec.No. SIGNS TRANS. 3.00 la 11
R O
ARCH. ENG.
Try wpVuslu
ARCH.OR SPECIAL CIRCUIT 5,00
ZIP '• EMP.METER OR POLE INS. 15.00
APPLICANT'S MOTORS - SEE FEE SCH.
ADDRESS \`
SERVICE CHANGE 10.00
'00_ LICENSED CONTRACTORS DECLARATION
a I hereby affum thul I an licensed under I.... ram'of Chapter`) ISSUANCE DATE
a lconotencmg with Section 7000)of Division 3 of the Basiness and 8 DG. ELECT. PLG. MECH.
H N i Profession,Cody)a Nl my license is in(all forty upd.ffr't.
Z, o w -
Lice n ass y'L/ Lic.Number y(`IOL ❑ ❑ ❑
o y ° Dale �?j C.ht acha,A9 Sb1
A y E BUILDING PERMIT
c c w a OWNER-BUILDER UECLA RATION INFORMATION
on " MISC.- REFERTOORD
Ax ; 1 hereby affirm that 1 um exempt from the Contractor s License
G VALUATION $/FT.
FLLoa Law for the following reusun.(Sec.703 L5,Business Professions PERMIT ISSUANCE 6,00
Code'.Any city or county which requires permit to construct,alter O
re Q cpm c,demolish,or repair any structure,Prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /'
- D w u requires the applicant for such Permit to lite a signed statement that TOTAL PERMIT TO m he is licensed pursuant to the provisions of the Contractor's Llrcuse
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
1 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivilpenally ALTER-DRAIN -WATER (EA.) 4,00
Plural more than Five hundred dollars(5500).1:
❑ I,as owner of the property.or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compecoation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The hortl ld or License Law docs nut apply loan owner of
himself
who hnlh h Or Il n vrmrl ,l ,.Pr,and who does
uc such Wn[k FIXTUR ES-PER TRAP 4.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided Ihat such improve
mems are not intended or offered for ale.u;however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
or improvement is sold within one year of co ni lelimt the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1,00 BUILDING USE
builder wdl have the burden of proving that he did not build or int s IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 0 ❑ ❑ ❑
❑ L as owner of the property',he exclusively contracting with
licensed contractors to he
the project La 7044,of apply LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code I property Contractor's License rov Law Joos not apply
to d'owner of h priocy who builds tr improves p,and who LAWN SPRINKLERS-OVER 5 (EA.) 7.00
contracts for such proicctz with a contractions)Iiccn.aN pursuant to
the Contractor',Llcen.w Law. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT No. PARCEL No.
❑ lam exempt under Sec. ,n.&P.c,for this WATER HEATER W/VENT 4,00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKIiRS'COMPGNS\TION DECLARATION WATER TREATING EQUIP. 4.00
I he,ebv affirm that I have a certificate of consent to wlf-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certifiedENG.SITE NO.
copy thereof(See.3800.Lah.0 T
P I''y No. Co Pdny _
O Cert lyI, r yto...dhcd FIRE SPRINK ENERGY T'24
Z 0O ❑ftCe If de py ed w't he elly inspection divtsiun.an MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
I-- y PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.uc.
� CERTII'IGCO,Il OP SAI1 TION ERONI WORKERS'
CL 1 COd not
be c N NSd it the
PLQ CONTR. LIC.NO. PLG. Y� N❑ Y ❑ N❑
0 _ (This section S10 nm be completed it the permit is for one TOTAL
hundred dollars(S 100)or less-)
U O 1 certify that in ore performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL - mil is iswed,I shall not employ any person in any manner so as to
U U become subjecl m the Workers'Compensation Law,of Califomia.
y Datc Applicant ALTER OR ADD TO MECH. 4,00 BUILDING
} to NOTICE. TO APPLICANT'! If,after making On,Certificate of Ex-
� Z umption,you should become subject to the Workers'Compensation APPLIANCE - 4-00 PLAN CHECK
provisions of the Labor Code, you must forthwith congdy with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M) 3.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000C.F.M.) 5.00 SEISMIC FEE I
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which Himpermit is issued(Sec. MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Name„ ELECTRIC
I certify that I have read this applicaiion and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COAM(3 H.P.or 100,000B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTUISEE FEESCH, MECHANICAL
above-mentioned property for inspection purposes,
c) a to save, indemnify and keep hanales the City of MISC.- REFER TO ORD.
a trial Ind, ies 'udgments, costs and expenses which CONST.TAX
ma Ina way ac a inst said City in conscy rice of the PERMIT ISSUANCE 3.00
gr C go tis pent MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
ala f ant/Cnntmmor ate
- OFFICE COPY