1493A
0
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY / "a
BU I LOING PROJECT IDENTIFICATION
APPLICATION &PERMIT
ING1 -MECHANaICAL
PLUMBING
L. OILNGy1 -ELEDI.ECLTfERCIFTCELECTRICAL-LUMMITB-
PERMIT MB
J J
BUILDING
ADDRESS Edi/
OWNER'S
N�-W
iyI�
TVFig'
PLAN CHECK VALIDADL TION
DATE OF APPLICATION
CONTRACTOR 'S�iy fL77u��
NA E �^"�
J lAof� LIc. ND
UTLETS-SWITCHES•RECEP 5.00/1.00
64GHTING FIXTURES 6.00/1.00
CONTRACTORS Of 0i
ADDS OQ q460IPNaG°NE
PPLIANCES- RESIDENTIAL 4.00
PANELS 6.00
ARCHITECT
OR
ENGINEER ��
LIC. No.
SIGNS 6.00
PLAN CHECK FEE C. NO.
3.00
SIGNS TRANS.
ADDRESS ENG.S.00
ADDRESS
ZIP
SPECIAL CIRCUIT
PERMIT VALIDATION
ca
r/�0�
�J
EMP. METER OR POLE INS. 15.00
APPLICANT'S
ADDRESS
IMOTORS SEE FEE
SERVICE CHANGIFI O
LICENSED CONTRACTORS DECLARATION
1
1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
ISSUANCE DATE
BLDG. ELECT., PLG. MECH.
Professions Code, my icense is in full fore a e t
License Class Lic. Number
® ❑ ❑
VAID
Date.�ComDECL
OW R�BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Businessand Professions
Code: Any city or county which reIt ool�struct'alter.
improve, demolish, or repair any structure, prior to it f y[uance, a1s0
requires the applicant for such rmit to file a signed s men) that
MISC. - REFER TO ORD
..;r.
as;�fhBU1L' DI NO FERMIT:a:
u,`X„"P,wFS j�INFORMATION�->rsttA
VALUATION
1 �Q
Ov
SIFT..
PERMIT ISSUANCE 6.00
ELEC. CONTR. LIC. N0. ELEC.
TOTAL
PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License.,v,
Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
/��•P/.}/.�
STORIES TYPE CONSTR.
,;, 2 ., 4 ,.
- 14.+ ` I�-'' r +
STV. 'PLUMBING PERMITt ,,FEE
.rS;,'yr ''af "<„1, _sa..,,,=: d i4,/es: Lg._.... R1t:Li3- 5
byanyapplicant for a permit subjects the applicant ma civil penalty
of not more than five hundred dollars (S500).1:
ALTER -DRAIN -WATER
BACK FLOW PROTECT. DEVICE 2.00
OCC.GROUP
RES. UNITS
Cl I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is net
intended or offered for Sale (Sec. 7044, Business and Professions
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon. and who dues such work
FIXTURES - PER TRAP 4.00 -
aD. FT. FLDOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve
menta are not intended or offered for sale. If, however, the building
GAS • EA. SYSTEM - 1 INCA OUTLETS 4,00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (See. 7044, Business
GAS • EA. SYSTEM -OVER 4 IEA.1 1.00
BUILDING
RES IND CON
❑ ❑
USE
pit Other
❑ ❑
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
ASSESSORS PARCEL NO.
and Professions Code: The Contractors License Law does not apply
to an owner of property who builds or improves thereon. and who
LAWN SPRINKLERS - OVER 5 MA.1 1.00
contracts forsuch projects with a contraclods) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/6.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 4.00
❑ lam exempt under Sec. .B.&P.C.ForthiS
eason
Dam Owner
WATER SYSTEM 4.00
ACC. DATE
ACC. FILE NO.
WORKF.RS'COMPF.NSATION DECLARATION
WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate ofconsent to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof l Sec. 3800. Lxb.C.).
Policy No. Company -
❑ Certified copy is hereby furnished.
FIRE SPRINK
ENERGY T-24
❑ Certifie D is flflse'I�iLtl�tp ;ity iais�on.
Applicant !! .s
Y N �
V N
❑ ❑
MISC.- REFERTOORD.
PERMIT ISSUANCE 6.00
a0a0 ZONE
Y N [3Y
A.L.u.c.
C]N F1(This
CERTIFICATE OF EXEMPTION FROM KERS' g
COMPENSATION INSURANCE
section need not be completed if the permit is for one
LIC. rvO
PLGTffie
PLG. Q•e
TOTAL
Cry sf. ..s a,, I' ads . r� - ksi.,,t:
- •„) has 4 .
GTY MECHANICAL PERMIT FEE
- �r A:'.:
j'13,
FEE SUMNfiARY
c + '!4V
�-
alks"=.p
hundred dollars (S 100) or less.)
1 certify that in the performance of the work for which this per.
p
mit is its d, I all not employ any Person in nnY anner so as to
mica t ormpl Law 'f r
Date 4r�j'I(cant
NOTIC TO A (CANT: I , ma mg this U Ica a of Ex-
emption, you should became subject to the Workeri Compensation
BUILDING
ALTER OR ADD TO MECH. 4.00
APPLIANCE 4.00
PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 1OX0 C.F.M.) 3.00
FEE
AIR HANDLING UNIT(OVER 10,1100C.FN1) 5.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
1 hereby affirm that the is a construction lending agency for
the performance of the work or which this permit is issued (Sec.
3097, Civ.C.l.
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT IOVER 100,000 B.T.U.)7.50
ELECTRIC
Lender's Name
Lender's Address
1 certify that I have read this application and stile that the above
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 3.00
BOILER- COfvtP(3 H.P. or 100,000 B.T.U.) 4.00
''BOILER -COMP (Over 100,000BTUI SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon the
above-mentioned property fur insp - ion Purposes,
f e) agree to save, indemnify n keep harmless the City of
C Lino against liabilities, udgm 1 costs -and expenses which
ay in any way accrue ag 'nst sal ity inconsequence of he
grant his permit
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 3.00
E �ONT. LIC. NO,
MECH.
TOTAL
ie ITOTAL'
V:WI
`='' !•s�'Sy Cifxatr
53 co
-
Si r p n ICon nor Date
J
OFFICE COPY
1493
PLe'.:!il' ::0
Repair
CITF OF CI .. - .O _ :SPEC-- , 3ECCRD (Office Copy)
10296 Plum Tree Ln.
SANIT_ASY DIST. "0. LOT 'TO. ADDRESS
Betty Schuster 257-1044
PROJECT JOB SIE-
Date
Ir
Date
Buil d.'_^?. 1-28-82
Electrical
Plumb in 7-
:'.echanical
Temp. Gas/�iact.
Solar
`-re °n-cinkier
Sion
1`AL I::SPEC-IO?'S
Date Insp.
=1ect-ic
P, „mb i , 2
'ceche-.- -
ca -
Sotar
Poo1
Gran int
P1anr_n¢
Fire Deon.
Heath Dent.
iuildim�
Other
STRUCT-U 7�.L
Date Insp.
Pad Cert'-iCaCiOR
Foundation.
•-
Slab-:'!em.brane
Bond Be -=m
Under'ioor Girders
_loor Steel
Tiadowns
Diaphra^,s
Seismic Bracin.g
T:alls-Panels
a^..e
Lech
;allboaroS _nt/F—::.
Firewalls
Other
'ot Approved
<<
°ower Pole
Underrroun.c
?oueh I,7ir4,
!'al s - -
Ceilin2
Fixtu-es int% -?:C
:'IoCorS
Groundi^.2
Temp. Power
Other
Not Approved
ELECTRICAL
PLL^!B I`iG
Date !-ISO.
Date in. Sp.
3a -cc 4 low
Underground
Under=loon
Partial Routh
Routh Complete
Solar Rough
[dater C Insulation
"lain Drain
R/o=/S Drain
Gas
Not Atnroved
Date Insp.
Underfloor S.`(.
Ducts & Insulation
Fire Dampers V
Fireplace
Grease Duct rood
One Hour S'h-="
Condensate Drain
Eouimnent Anchorage
Flues �: Como.
Other
:'IOt ,On-oVeo