C 9074 POST THIS CARD NEAR FRONT OF BUILDING+ f` T
NUMBER '
CITY6F COERTII & 9074'
INSPECTION DIVISION
J INSPECTION RECORD
l
• PERMIT EXPIRATION +
JOB ADORES U LOT#'
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN .
I ON AT ECTOR INS CTI N RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
UFER LAST CALLED'INSPECTION.�
PREGUNITE PERMIry ALIDATION
t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
- PLUMBING
ELECTRICAL . " � suamcE ATE
MECHANICAL - LD LE PLG. MEW.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMI
W
W
FORMATION'OD FLOOR L00R
4P
VALUATION
PLUMBING
MECHANICAL / +
ELECTRICAL - RMI T ,
FRAMING -
INSULATION T IES E
OCC.GROUP RES. ITS,I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT.FLOOR AREA TOTAL ACREAGE
�I DIAPHRAGM
- BUILDING USE
RES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 ❑ ❑ O
ASSESSORSPARCELNO.
ROUGH ' -
PLUMBING
GAS,TEST ,TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL (P_ _56 FINALS DATE - INSP. ACC,DATE ACA.FILE No.
FRAMING . PeSAN * ZONING ENG.SITE NO.
INSULATION ' PLUMBING y( '
GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YO: NO Y O NO
LATH-INTERIOR ZDE
FLOOD ZONE A.I.U.C.
LATH-EXTERIOR •v NO 'v NO
SHEETROCK FEE SUMMARY
SHEAR INTERIOR -yb -
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLSELECTRIC - PLAN CHECK
' GAS - FEE "
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
F�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
' Z - SEE.PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!. CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
.CALLING FOR FINAL INSPECTION.' /-
OFFICE COPY '
' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
e "BUILDING PROJECT 1 DENTI FICAT PERMIT NUMBER
„i Bu,WING APPLICATION & PER
Ao 10 Ar r-b &- l�fl �n7 9074
J BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S Of vOr �Z•J�- PLAN CHECK VALIDATION'
T NA�}eTY ELECTRIC PERMIT FEE 7
CONTRACTOR UTLETS-SWITCHES-RECEP 10.0011.00
RAVkTAuc.No. LIGHTING FIXTURES 10.00/1.00
CONTRAsTORS r 9 PPLIANCES-RESIDENTIAL 4.00
I07 US•4Ar 6 PHONE - {� PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK Fff7 C.NO,
OR PANELS (OVER 200 AMP) 20.00 ,
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ADDRESS ENO' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPucANT's
APPLICA MOTORS SEE FEE SCH.
1
ONA7A c4,A74 SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 y
a u w I hereby affirm that I am licensed under provisions of Chapter 9 1 I SUANOE DATE
n (commencing with Section 7000)of Division 3 of the Business and
6 w BLDG.{ E MECH.
r 7 z Professions Code,and my license is in full force and effect L.�1, 0 e `❑ ❑
o 0 License Class Lic,Number Il
Data-Contractor
a Y f BUILDING PERMIT
M rc ¢ OWNER-BUILDER DECLARATION
M a u INFORMATION
w; 1- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
In VALUATION S/FT.
Faoa Law for the following reason.(Sec.703 L5,Business Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter.
2 a,¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ requires the applicant for such permit to file a signed statement that TOTAL
K
m A he is licensed pursuant to the provisions of the Contractor's License N PERMIT TO ✓G
r i.i Law(Chapter 9(commencing with Section 7000)ofDivision3ofthe
a Business and Professions Code)or that Ise is exempt therefrom and QTY. PLUMBING PERMIT FEE
F$ the basis for the alleged exemption.An
ge p it violation applicant
tSection 703L5 STORIES TYPE CONSTR.
by any more
forit permit subjects S5 applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred Dollars(5500).):
9�1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 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. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
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 no- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
Er 1,as owner of the property,um exclusively contmcting with ❑ ❑ ❑ ❑ ❑
licensed contractors Ir construct the project(Sec. 7044,Business LAWN SPRINKLERS-i INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Pmfea,mrs Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 I
contracts for uch projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the t'Ontra,I s Liccnsa L' TRACT N0. PARCEL NO.
❑ I am e m order Se . _,B.&P,C.for this WATER HEATER W/VENT 6.00
reason
Owner Uute WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COh S TION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure' ZONING ENG.SITE NO.
I or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
1 Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-74
Z 0 Ll Certified copy is file) with the city inspection division.
Applicant V MISC.- REFER TO ORD. E] N V N❑ ❑ ❑
~ vaPERMIT ISSUANCE 10.00 FLOOD ZONE •A.L.U.L.
W - COMPENSATION
EXEMPTION FROM WORKERS'
CLO COMPEE NSATION INSURANCE PLO.CONTR. LIC.NO. TPEG
OTAL Y[:] N❑`- Y [:3 N❑
:) Z (This section need not he completed if the permit is for one
hundred dollars(E 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued, I shall not employ un person in any manner so as to
O w become�sub��'gqcy�jJyytitle Workers'Co o La of California Q
a
DE
ALTER ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT': If,sf makin li Certificate of Cx-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
CJ Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 - SEISMIC FEE
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.). -r HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name s
Lender's Addressn r HEATING UNIT(OVER 100,000 B.T.U.)9.50 ' ELECTRIC
I certify that I have read Ibis application and stale Ihm the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,010 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuamol
bilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
maa nunst rid City in consequence of the
grait. MECH.LONT. LIC.NO. MECH.
Ir _/ TOTAL - TOTAL
S' /Co [r ctor Data
OFFICE COPY t,