3254 Gll'Y 01' CUPERT'INO INSPECTIOt' RECORD (Office Copy)
3254 _ _ _10698 D Maplewood E/bI Dividers
1'EI'JII'1' N0. SANITARY DIST. 140. LOT NO. ADURFSS
Re-Model Property Services
' PROJECT OWNER JOB SITE PHONE NO.
PEP11IT ISSUED Date ELECTRICAL
BoLldint• 5/25/83 Date Insp.
IA ectr Lcal 5/25/83 Power Pole.
PLumhing Linder ,round
tlechanical Rough Wiring
Temp. Cas/Elect. 1 alas _---
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext _
Si .,n tlotors
Grounding
U.sc. Temp. Power _
Other
FINAL INSPECTIONS Not Approved _
Date Insp.
r, s —_ PLUMBING
Electric Date Insp.
Plumbing Backfloc.
1lechanical Uri der ,round
Solar Underfloor _
Pont Partial. Rough
• Gradin , Rough Complete --
I'.Lnnni.nr Solar Rough
Fire Dept. I-later & Insulation _
Health Dept. Main Drain
Building I0'f-2- R/of/S Drain _
Other Gas
Other _
BUILDING Not Approved
Date Insp.
Pad Certification IlLCIIANiCAL
Foundation _ Date Insp.
Pre-Gunite Underfloor S.M.
Slah-Llemhrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Ilood
Ti.edowns One (lour Shaft
Di.aphrams Condensate Drain _
Seismic Bracing; Equipment Anchorage _
Ilal..ls-Panels Flues & Comb. Air --
Frame Other
Lath Not Approved
Ual.lboards Int/I:xt .
Firewalls
Other
. Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN. RED LINES - USE BALL POINT PE ONLY
r
BUILDING PROJECT IDENTIFICATION RMIr NumDER
BUILDING t'oFr APPLICATION & PERMIT 254
ADDRESS EAraC$WFST BUILDING-ELECTRICAL-PLUMBING-MECHANIC
OWNER'S PLAN CH JDATION
NAME CITY. MAY
ELECTRIC PERMIT FEE
= NE - q
CON R CTORs 1983
NAME 2
OUTLETS RECEP 5.00/1.00
LIC NO LIGHTING,FIXTURES 5.00/1.00 ,C/{r,Of Cn
CONTR ons PPLIANCES-RESIDENTIAL 4.00 `J eAj
ADDRESS cup"
`ino
PHONE PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LOC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5,00 PERMIT VALIOATIO
ADDRESS
ZIP FrEMP.METER OR POLE INS. 15.00
APPLICANT S MOTORS . SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
'02 LICENSED CON'I'RACEORS UECLA RATION
M, u u I hereby affirm that I am licensed under provisions of Chapter 9 *ISSUANCE DATE
y a N (commencing will Section 7000)of Division 3 of the Business and B OG. ELECT. PLG. MECH.
H N z Professions Code,anA my license is in full force and effect.
z 0 m - License Class Lic.Number. ❑ ❑ ❑ ❑
q r °w D4Ic Contractor
Q y J
FLL .
BUILDING PERMIT
e OWNIR�BUILDER DEclnRnfloN INFORMATION RTOORDwu y I hereby affirm that I am exempt from the Contractor's License MISC.- REFE
VALUATION S/
FT.04 Law for the olowinfleasou.(Sec7031.5,Busnessandlrolesoos
PERMIT ISSUANCE 6.00
Code:Any city or county which requires a permit to construct,alter,
2improve,demolish,or repair any slmelnm,prior to its issuance,olw ELEC.CONTH. C.NO. ELE
O K requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w m n he is licensed pursuant to the provisions of the Contractor's License
HiQ
Law(Chapter 9(commencingwifh Section 7000)of Division 3 of the -
Business and Professions Code)Or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H 0 the basis for the alleged exemption.Any violation of Section 7031.5, STORIES TYPE CONSTR.
w. w- by any applicant for a permit subjects the applicant tua civil penally ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(S500)J:
❑ [.as owner of the property,or my employees with wages as BACK FLOW PROTECT, DEVICE 2.00 OCC.GROUP 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 I.aw 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 TOTALACREAGE
Ofntslf re through his own employees,provided that such ibuildi c-
memsaorth intended or offered for sale.If,however,the hmlding GAS-EA.SYSTEM-1 INC
Of 4.00
or impmvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING t15E
builder will have the burden of proving Thal he did not build or int- RES IND CON PR Omer
prove for purpose of sole.)' INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ I,as owner of the property',am exclusively contracting with
licensed confinetors to onstnact 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
to an owner of property who hudds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a etauractods)licensed pursuant to SEWER-SANITARY EA.200ft/8.00 TRACT N0. PARCEL NO.
the Contractor's License Law.
O lam enempt under Sec. .B.SP.C.I'or Ibis WATER HEATER W/VENT 4.00
on
Date � ic-Owner_ _ WATER SYSTEM 4.00 Ace.DATE ACC.FILE NO.
WORK1iRS'COMI'.NSAT ). I RAT UN WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a certificate ofconsent to sell'-insure. ZONING ENG.SITE NO.
ora certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Leb.CJ.
Policy No, Company
Q ❑ Certified copy is lmrcby lemishcd. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Applicant Y E] N❑ Y El -❑
F-' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
� - CIiRTIFICATF-OFEXEMPTiINSUROh1 WORKERS'
W >_ COh1PIiNSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
11 O (This section need not be completed if(be permit is for one TOTAL Y❑ N❑ V ❑ N❑
Z) Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F ...it is issued, I shall not employ any person in any rmnrc,so ns to .
O W become subject to the Workers'Compensation Laws of California. D
Uatc Applicant ALTER OR ADD TO MECH. q,pp BUILDING
NOT ICE; '10 APPLICANT: If,after making this Certificate of F;x-
F Z ,mplion. on should become subject les file WOrkeri Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply' with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=11C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that Owre is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec HEATING UNIT(TO 100,000 B.T.U.) 4.00 ' MICROFILM
3097,Civ.CJ.
Lender's NameHEATING UN IT(OVER 100,000 B.T.U.P.50 ELECTRIC
mss
Lender's Add
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
. inform oon is correct. I ci to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
nc
ordinaes and slate laws relating to building construction, and
hereby authorize representatives of this city to Inter upon the BAILER-COMP IOver 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes,
(We) agree to save, indenmily and keep hunnlms the City of MISC. REFER TO ORD.
Cnpurlino against liabilities,jud6mcnls, costs and expenses which CONST.TAX
may in any way accrue agal t said City in consequence of the PERMIT ISSUANCE 3.00
granting of Ibis'pcnniL /� MECH.CONI LIC.NO, MECH.
O .ak6 S C' _ TOTAL TOTAL
.
Signature o1 App Icant/ ontmctor Dale
13/2 V93 OFFICE COPY