3999 CITY 01' CL'I'E&T1N0 INSPECTIM! RECORD (Office Copy)
I y
399910649 iIaplewood "C"
PEPJIIT NO. SANITARY DIST. 140. LOT NO"_ ADUI' SS
RE;IODEL P,",OPERTY SERVICE
PROJECT 01-I1JER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Buildinr. - Date Insp.
Electrical Power Pole
I'Lumbinr Underground
Mechnnical Routh Niring
Temp. Gas/Elect. ilaI s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Ga.s PLUMBING
Electric - 1 Date Insp.
plumbing Backflow
Nechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
I'lanninp Solar Rough
". � Fire Dept. [dater & Insulation _
Ilealth Dept. 'lain Drain
Buildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation _
Bond Beam Fire Dampers
Underflnor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
calls-Panels Flues & Comb. Air —�—
Frame Other
Lath Not Approved
11allboards Int/Ext.
Firewalls
Other
Not Approved
i
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTI FICAT. ON PERMIT MEER
ASUILDING �, C APPLICATION & PERMIT 3999
ADDRESS BUILDING —ELECTRICAL—PLUMBING—MECHANICA
OWNER'$ PLAN CHECK VALIDATION
N OTY. ELECTRIC PERMIT FEE
COl�CTORS
NAME �e,2ui�e PHDNE �SG9a -_
NTRAroRs OUTLETS-SWITCHES-RECEP 5.00/1.00
NA
LIC.NO. LIGHTING FIXTURES 5.00/1.00 WV
corvrRAcroas p`� APPLIANCES-RESIDENTIAL 4.00
ADDRESS
IF CV
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
AR. ENG. 600 PERMIT VALIDATION
ADDDDRESSSS SPECIAL CIRCUIT .
ZIP TEMP.METER OR POLE INS. 15.00
APPLac ANT'S MOTORS SEE
ADDRESS )))
SERVICE CHANGE 1 F.
�pP/
00 LICENSED CONTRACTORS DECLARATION 0/
u u 1 hereby affirm that I um licensed under provktuns at Chapter`J AUG ISSUANCE DATE
Nay (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MEOH.
F w z Professions Code,and my license is in full force and effect ❑ ❑ ❑ ❑
z O m - License Class Lie.`umber
Date Contractor. BUILDING PERMIT
le 4 OWNER-BUILDER DECLARATION INFORMATION
U REFER TO ORD
K
3 LL m 1 hereby atF..D that I tun exempt from the Contractor's License MISC.— VALUATION $/FT.
u o a Law for the following reason.(Sec.7031.5.BusimcssmW Pro l'essions PERMIT ISSUANCE 6.00
Hy Code:Any city or county which requires a permit to construct.alter.le ,ry QD
2 1 O improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. n 1,w
Ea P, requires the applicant for such permit to file a signed statement that TOTAL 04 'J4 PER.
PERMIT TO
a m he is licensed pursuant in the provisions of the Contractor's Llccose
La j
La Law(Chapter 9(commencing with Section 7000)at Division 3 of the ef...
i D Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FWJ
Ce I- $ the basis for the alleged exemption.Any violation of Section 703 L5 -STORIES TYPE CONSTR.
d �
by any applicant for a permit subjects the upplicanrloa Civil penally, ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(55001.):
❑ 1,as owner of the property,or my employees with wages az BACK F LOW PROTECT. DEV ICE 2.00 C . RES.UNITS
their sole compensation,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 Contractor's License Law docs not apply to an owner of
property who builds or improves thereon.and who does such work FIXTURES-PER TRAP 4.00 SOFT.FLOOR AREA TOTALACREAGE
meat,are oti intended
ownemred lorssle,It,however,
improve- GAS-EA.SYSTEM-1 INC.40UTLET$ 4,00
cents are not inlml dud w offered for svle.If,ed that S the oprobuilding
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 of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORSPARCEL NO.
and Professions Code:l'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
Contracts for such projects with it cuntmclono licensed ptmumu to
the C'ontractor's License Law. SEWER-SAN I TARV-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ Inc exempt under see. .B.RP.C.Tim this WAT ER HEATER W/VENT 4.00
a
Datere
— -Ow"E WATER SYSTEM 4.00 ACC.DATE PCC.FILE NO,
WORKERS'COMPENSAf ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certifcam of Workers Compensation Insurance,(or a certiticd ZONING ENG.SITE NO.
copy flerenf(See 3800,Lab E.).
Policy N'o. Company
O ❑ Cetlifed copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled will the city inspection division. MISC.- REFER TO ORD.
O Applicant v ❑ N❑ Y [:] "❑
� T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
n- 0 of section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
::) Z hundred dollars IS 100)or less.)
V OI certify that in the performance of Tho work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H rot Is issued,I shall not employ ony person in any manner sea it,to
VW become subject to the Warken'Campen,a ioa laws of California. OV
Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
f" 2 cinplion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must torthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 3.00
CONS'I'RUCTION LENDING,AGENCY AIR HANDLING UNIT(OVER 10)DODC.F.M.) 5.00 SEISMIC FEE Lf�
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 HEATING UNIT(OVER 100,000 B.T.U.17.50 ELECTRIC a
Lender's Address -+-.�
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county BOILER-CONT(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby auourri,v representatives of this city to Enter upon file BOILER-COMP (Over 100,000BTUISEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hunnles, the City of MISC.- REFER TO ORD.
..penin. aguinat Iiahilit iea igen ts, casts and expense,whirl CONST.TAX
m ay accrue � •ait.t � d Cit in conscyuence of the PERMIT ISSUANCE 3.00
Ingo VermiI MECH.CONT. LIC.NO. MECH.
l�3 TOTAL TOTAL 3 S�
Signature of Ap cant/Ccia Date
OFFICE COPY