12905 (2) POST THIS CARD NEAR FRONT OF BUILDING
' CITY OF CUPERI�1( PFRMITNGMBER
INSPECTION DIVISI N � �" E TER 12.905
JOB INSPECTION REC04DM P U
_ a
11 - PERMIT EXPIRATIOtt!
JOB ADDRESS 21821 MONTE CT. u -
PERMIT EXPIRES IF WORK
OWNER J.H. Lewis CONTRACTOR J.H. Lewis IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION R CORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'V �( $'� - ^J / i ..moi" CE OR 180 DAYS FROM
LIFER N$UO fQit tl
� c�g q�c. LASTCALLED INSPECTION.
`�p2�G�J-pQ0 I4 � I (J
PREGUNITE {�-���J`��L�O IK/�+•-(-{F �GLN U�S (/j ,Jc1 PERMIT VALIDATION
POUR NO CONCRETE U TIL ABOVE HAS BE SIGNED f / '
UNDERGROUND/SLAB 6
4j)jPl �riF �l d `�" 14&-A
PLUMBING41 fi- N 9494hh9rt
ELECTRICAL x' n4p • ISSUANCE DATE
MECHANICAL p BLDG. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AO9 BUILDING PERMIT
pD�tfINFORMATION
WOOD FLOOR T T Df/ m 6K
PLUMBING 3' -68 INt z5hoxr K, heP o VALUATION SIFT.
MECHANICAL 7 — 0cf Ot
ELECTRICAL -5-g9 LnI 4t SEccwpswT PERMITTo
q
FRAMING -97 -I � � / , ' Y - -
STORIESS TYPE CONSTR.
INSULATION cp
OCO.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS B N SIGNED
• //'' SQ FT FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM I �n 1... BUILDING USE
- RES IND CON PB OUwI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO
ELECTRICAL FINALS DATE INSP.
FRAMING K SAN n
INSULATIO i
PLUMBI ZONING ENG.SITE NO.
YS o GAS INA
FIRE SPRINK ENERGY T 24
MECHA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATIN If YY ❑ No Y ❑ No
LATH—INTERIOR ELECTRIC W, T
PLOOOZONE - A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y ❑ NO Y L-1 NO
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR Z- BUILDING
SHEAR EXTERIOR TEMPORAR APP V L BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SI NED B U I IN CTOR. MICROFILM
Lu ARRANGE FOR INSPECT:EXPI
Y PHONING 2 5, ELECTRIC
ONE WORKING DAY BEFREQUIRED IN P CTj ' PLUMBING
r PLEASE GIVE JOB ADDRHEN PHONING.
— SEE PERMIT FORATION DATE — MECHANICAL
I
IMPORTANT!
coNST.TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL 77
S CALLING FOR FINAL INSPECTION.
` OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 12905
•�l
AD 0 ss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
f OWNER' PLAN CHECK VALIDATION
NAME TY. ELECTRIC PERMIT FEE 2
PHONE
LuNrRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 1tf
NATME __
LIGHTING FIXTURES 10.00/1.00 JO,
ADDRES:ADioR's PPLIANCES-RESIDENTIAL 4.00
ADORE
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHIECT PANELS (QUER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 �h.✓ �+2
O o o LICENSED CONTRACTORS DECLARATION
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
"' (commencing with Section 7000)of Uivisio f the Bui ss an
j i Professions Code, my license is in full f e BLDG. ELECT. PLG. MECH.
z O=- Licen Class Lie.Numbto, ®-
9 z f o Date ���-O�Com acid
a Y BUILDING PERMIT
¢ ¢w¢ OWNER-BUILDER ARATION INFORMATION
Oe.LI MISC- REFER TO ORD
'x ; 1- I hereby affirm that I am exempt from the Contractors License
wuoa Law for the following reason,(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 Q VALUATION SIFT.
HZ 0-I Code:Any city orcounty which requires a permit to construct,alter,
CM¢0 improve,demolish,or repair any structure.prior to its issuance,also ELE C TR. LIC.N0. ELEC.
o u requires the applicant for such permit to file a signed statement that PLIC TOTAL �C�.O Is TO
n w m m he is licensed pursuant to the provisions of the Contractor's License /.x J 7/u
Fi>
Law(Chapter 9(commencing with Section 7000Hof Division 3 ofthe J
¢ Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
their sole compensation,will do lite work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law docs not apply to an owner of
-� property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 - Sa FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-' GAS-EA.SYSTEM-11NC.40UTLETS 6.00
mootsz
are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or in RES IND CON PD Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ El El ❑ 1:1❑ 1,as owner of the properly,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply /qrrj
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3e.6- ` i 07oZ
contracts for such projects with a contractor(s)licensed printout to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL N0.
0 I am exempt under Sec.-,If&P.C.I'nr this WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM 5.00-
ACC.DATE AGC,FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent it sell'-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
coAthcr800,Lab. ).PolPO � e It 'she FIRE SPRINK ENERGY T-24
Z Z Dis it city in3peclion division. MISC.- REFER TO ORD. ❑ N❑ v N❑~ - A ` PERMIT ISSUANCE 10.00 O FLOODZONE A.L.U.C.
� F'OF F:%F:MPTION PROM WORKERS'
L COMP17NSATION INSURANCE PLG O/N�� �Q.�)�IC.NO. PLG. /
CL Z (This Section need not be completed if the Permit is for one /-���en/"e • TOTAL L rQ ^ Y❑ N❑ Y❑ N❑
hundred dollars IS 100)or less.)
U O 1 certify that to the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued, 1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING p�p(p
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 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(TO 10=C.F.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE S
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC ab
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply will all city and county PLUMBING 2
ordinances and state laws relating to building construction, and BOILER-COMPI3H.P.or 100,000 B.T.U.1 6.00 3
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000BTU)SEE FEESCH. MECHANICAL ��
gw�
erly for inspection purposes.
demnIfy a ecoharmlesstheCtty of MISC.- REFER TO ORD.
I e judg nts costs end expenses which PERMIT ISSUANCE 10.00CONST.TAX
again said By in Consequence of the MECH.CONT. LIC.NO. MECH.
L TOTAL .y� QD TOTAL �f77v�
ignature ofAl Data P)7& U
OFFICE COPY