3255 " CITY 017 CUI1B[1,1INO INSPECTI011 RECORD (OEfice Copy)
_355 — 59 C MApInwood E_/W Dividers
PCPJUT NO. SANITARY DIST. 140. LOT 110. ADDRESS
Re-Model Property Services
PROJECT OWNER JOB SITE PHONE NO.
PER11IT ISSUED Date ELECTRICAL
Bu [Idi_nr. _ Date Insp.
CJectrical 5/25/83 Power Pole
I'LumhiziS Under ,round
Mrchanical Rough Fliring
Temp. Gas/1;lect. fdal.Ls _
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Sign ilotors
Grounding
rli.sc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
r,rS
-- PLUMBING
Electric Date Insp.
Plumbin , Backflow
'lechanical Underground
Solar Underfloor _
Pool Partial Rough
•
Grading Rough Complete
PLinninf, Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain _
Other Gas _
Other _
BUILDING Not Approved
Date Insp.
Cad Certi.fication MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-1lemhrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Ti.edowns One (lour Shaft
Di.aphrams CondensaCe Drain
Seismic Bracing EquipmenL Anchorage
Ualls-Panels Flues & Comb. Air
Frame Other
Lath Not Not
Uallboards Int/Ext .
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1 BU I LDING PROJECT I DENTIFICATI ONLdF'C APPLICATION & PERMIT RMIT NUMBER
3255
BUILDING a�/
Aooncss �A57 4!✓ri-,T BUILDING -ELECTRICAL-PLUMBING-MECHANICA
e S
OrvNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
NT vHONE 1'Alp
c Rs
'AME UTLETS-SWITCHES-RECEP 5.00/1.00
NAME '
LIC.NO. LIGHTING FIXTURES 5.00/1.00 AY 2 5 1983
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS •
PHONE PANELS 5.00 C.tty Of P ICATION
ARCHITECT SIGNS 600 PLAN CH P.C.NO.
OR
ENGINEER
UC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT B,QQ PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 15.00
APPucnrvrs MOTORS SEE FEE SCH. O
ADDRESS
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
Quo I heresy affirm Thal I am licensed under provisions of Chapter`) ISSUANCE DATE
(commencing with Sec lion 7000)Of Division 3 of the Business and ELECT. PLG. MECH,
se w i Professions Code,and my license is in full force and effect. L
z o w - License Class Lie.Number ❑ ❑ 1:1
O as
as DaaF le Contctor
`a
C w OWNER-BUILDF;R DECLARATION BUILDING PERMIT
INFORMATION
E:
u H I hereby affirm that 1 am exempt from the Conlmctor's License MISC.- REFER TO ORD
u O 4 Law for the following reason.(Sec 7031.5.Businessund Professions VALUATION S/FT.
_ PERMIT ISSUANCE 6.00 n
Code:Any city or county which requires a permit to construct,alter. /®•1D'
2CQ �0 improve.demolish,or repair any structure,priorto its issuance.also ELEC.CONTR. LIC.NO ELEC.
LL requires the applicant for such permit to file a signed statement that TOTALa PERMIT TO
A w m he is licensed pursuant to the provisions of the Contractors License
iii Law(Chapter 9(commencing wall Section 7000)o1'Division 3 oftle '-
a Business and Professions Coho lir Ism he is cxcmpl Ihcrefront and CITYPLUMBING PERMIT FEE
E o the basis for the alleged exemplion.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ;'? by any applicant for a permit subjects the applicant to a civil penally gLTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S500b.)
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 ocC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is not
intended or offered for sole(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor i License Law docs ,of apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 so.FT PLooR AREA TOTAL ACREAGE
himsalf or lhroueh his Own employees,provide)that such improve.
ments are not intended or offered for sale.IL however,the bwlding GAS-EA.SYSTEM-11NC.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 of proving that lie did not build or int- RES IND CON PB Other
prove for Purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ 1,as owner Of the Property um exclusively contacting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V . 5.00 ASSESS l RS PARCELNO.
and Professions Code:The Contractor's License Law does not apply �J
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 Vel i
contracts for such projects with a conlmctorfs)licen.ad pursuant to
lire Cmvactor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT N . PARCEL NO.
❑ I an,cxcmpl under Sec.-,]I&PL.I'or Ill's WATER HEATER W/VENT 4.00
recon
Dale OwncrQ WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
L
W'ORKERS'COMXNIZ1'I N'DECLARAFON IWATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of ttmncnt IOSCILinsurC, ZONING ENG.SITE NO.
or a certificate of Workers'Compen.snlimt Insurance,or a certified
copy tlmrcof fScc.3800,Iab.C.).
Policy No. Company
Q ❑ CCrlllied Copy is hereby furnished. FIRE SPRINK ENERGY L74
Z Z D Certified copy is filed with the City inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ N❑ V ❑ N❑
= CERTIFICA'I'Ii OP 1 XIiMPI'[ON FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.u.c,
UJ >_ COMPENSATION INSURANCE PLG.CONTR. UC.NO. PLG.
EL o fl his section need not be completed if the permit is Por one TOTAL v[:] N❑ v ❑ NC]
D Z hundred dollars(S 100)or Ir"T
U O 1 certify that in the performance of the work far which this Per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall cat Cmploy any Person in any airliner so as to
Ow becnne uucetto the Workers'Congarsaoon Laws of California. BUILDING vd
Date Applicant ALTER OR ADD TO MECH. 4.00
} tan NOTICE 'IO APPLICANT: IL alter making alis Ceril ieate of Ex-
? eruption,you should become subject It,the WorkC,s Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith C.EIIPlywith FEE
U RICII provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10.)00C.F.M.) 3.00
CONS'LRUC'I'ION LENDING AG17NCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is u Construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the perfirnnance of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097,Civ C)
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.0.50 ELECTRIC v�
I certify that l havercad thiimplicetion and+late that the abase VENTILATION FAN (SINGLE) 3.00
ordinances a correct. I agree ti comply will all city and crounty BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
mor
or..occs and slate laws rola(,, m,imply
will construction. and
hereby aulhorirc representatives of this city to enter upon the BOILER-COMP(Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for Inspection purposes.
(We) agree to save, iamnanify 111111 kelp horn 1111 the City of MISC.- REFER TO ORD.
Cammlina against liabilitic+,jadgntents, cants and expenses which PERMIT.ISSUANCE 3.00 CONST.TAX
may in any way uccNe against said (:fly in lou ecuence of the
granting of this Permit. MECH.CONT, LIC.NO. MECH.
, elm
TOTAL TOTAL
rn3 S
S' nature of 'Pi,
tl tractor Da
OFFICE COPY