2431 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BU I LDING PROJECT I DENTIFICATI ON PE N MBER
BDITHING APPLICATION & PERMIT BE �]
`
ADDRESS _ G J
BUILDING -
ELECTRICAL-PLUMBING-MECHANICAL
�. NAMER's "n'� n/•/ PLAN CHECK VALIDATION
f.9c.wL/ /z�'-fy3/ QTY. ELECTRIC PERMIT FEE
pW'1eS PHONE
.' CONTRACTOR. OUTLETS SW ITC HES-RECEP 5.00/1.00
NAME nn//��
INOSPZ X38 LIGHTI NG F INURES 5.00/1.00
CONTRACTOR IS APPLIANCES-RESIDENTIAL 4.00
ADDRESS ,,n ,/�p p
2I 8 C GVA/VC+ IfUPPHONE TOO CIL PANELS 5.00 DATE K APPLICATION
ARCHITECT SIGNS 6.D0 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
r 2 ADVIIC.NO. SIGNS TRANS. 3.00
ARCH 08 ENG. 2-ZS CAL CIRCUIT 5.00 0 .� PERMIT VALIDATION
G.I �d L A� zIv EMP.METER OR POLE INS. 15.00
AvvL c rs MOTORS SEE FEE SCH. VT�
AO 5
SERVICE CHANGE 10.00
wo o LICENSED CONT TORS DECLARATION t� --- r
¢U u I hereby affirm than I .m licensed under provisions of Chapter 9 CI ISSUANCE DATE
H< m (commencing with Section 7000)of Division 3 of the Business and B�L�D'GI. ELECT. PLG. MECH.
,-,w Professions Co I d my license is in full fo ef' hI ❑ 1:1 ❑
z o u, Licen Class Lle.Number '.1
9 - o at - Contractor- A
a y s -a - BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION
O MISC.- _ REFER TO ORD INFORMATION
R
3 LL I- 1 hereby affirm than 1 am cxrn,,t fro,,the Contractor's License
LL o a Law I'Ot the following reason.(Sec.7031.5.Businessand Protcssions PERMIT ISSUANCE VALUATION S/FT.
� - Code Any city or county which recluiresa permit toconstrucn,alteq 6.00
¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D , requires the applicant for such pernut to file a signed statement that TOTALPERMIT TO
w$" he is licensed pursuant to the provisions of the Cootrnetor:s Licenw
HiQ
Law(Chapter 9(commencingwith Sectim,7000)of Division3ofilm
Business and Professions Code)or than he isexcmpl therefrom and QTY. PLUMBING PERMIT FEE
¢F Do the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m by any applicant lora Pontin sobjeetsthe applicant oa civil Penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred doll...(550003:
❑ 1,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,AR EA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own emPloyces,provided that such in -
me 1,are intended orol'fcrcd l'm,A,.I(',however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
of 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 What he did not build or ire- RES IND CON PB OR.,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ I,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 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such Projects with u cnntrachorfs)licensed purnu.nt no
the Comment.'.License Law. SEWER-SANITARY-STORM EA:200ft/8.00 TRACT NO. PARCEL NO.
❑ I:un ex.mpt under See .B.&P.C.for thus WATER HEATER W/VENT 4.00
Datea
DOwner WATER SYSTEM 4.00 ACC.DATE ACG FILE NO.
N'ORKERS'COMPENSA PION DECLARAI'ION WATER TREATING EQUIP. 4.00
I hereby.!firm that I have a certificate of consent to Ulf-insure. ZONING ENG.SITE NO.
or a certificate of Workers'LamppnsnJiD n;u ru ee.or n cert it icd
copy theyo d=p ,
Cc,t,i ,e FIRE SPR INK ENERGY T74
Z Z ❑ Cert '- i I ecy �y � _. MISC,- REFER TO ORD. ❑ ❑O Applicant /7"!rye-s" V N V ❑ N❑
N CFR- IFICAI'1:0I7EXF.MPTI N FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.O.
Ill >_ COhl1'ENSATION INSURANCE I.G.PCONTE. LIC.NO. PLG.
1 0 ('this section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
2 hundreA dollars(5100)or Ics,.)
U O 1 certify that in We performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
mm
it is issued, I shall not employ any person in any manner so m'to0 U become .bj,ct no the Worker,Cunmc...in on Luw,of Culitumiu. NpD
w Da« Applicant BUILDING
a ALTER OR ADD TO MECH. 4.00
} to NOTICE TO APPLICANT: If,after making this Certificate of I!x-
F2 emption,you should become subject to the Worker,Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed ravokcd. AIR HANDLING UNIT(TO 11 3.00
CONST'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby .(firm OUT there is. construction lending agency III, 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 HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC (O A'A-
Lender's Address
I certify that l have read this application andstatI that the above VENTILATION FAN (SINGLE) 3.00
information is correct I agree to comply with all City and county PLUMBING
nces and Ratelaws relining m building cnn,vtruokm. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
''ouby it
representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL
abuv entirned property for inspection purposes.
(We) agree no save, ind Try and keep harmless the City of MISC.- REFER TO ORD.
Cupert against liabilitt j dgments,costs and expenses which CONST.TAX
IIID m ny ay .g.mst said City in �i n,vqueocc of the PERMIT ISSUANCE 3.00
gr nt gHft SPIT dt. MECH.CONT. LIG NO. T0TnA1L TOTAL Ob
��
gn lure of App an/Cob acntr Date
OFFICE COPY
GI'I'Y OF CUi'ERI'LNO INSPECTION Rl?CORD (Office Copy)
-54FSi )4•`j--
2431 10983 N. Wolfe Rd. _
PhPdII'r N0. SANITARY DIST. NO. LOT NO ADD1:1`S5
•r ADP James Walsh
PROJECT OIdNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuildinC 8-31-82 Date Insp.
Flectrical 8-31-82 Power Po_te _
I'lumhina 6-Rz-y2, Underground
ilcchanLcal Rou--F h Wiring
Temp. Cas/Elect. 11alls
Solar Ceiling
PLre Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power _
Other
FINAL, INSPECTIONS Not Approved
Date Insp.
"s PLUMBING
Electric Date Insp.
Plumbing Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Gradin , Rough Complete
• Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Buildin R/of/S Drain
Other Gas
Other _
BUILDING Not Approved
Date Insp.
Fad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracinf, Equipment Anchorage
(falls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/F.xt.
Firewalls
Other
Not Approved