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3155 ^' CITY OF CUPEIM110 I11SPECTIOL' RECORD (Office Copy)
315-5- ze
PCPMT N0. SANITARY DISI. NO. LOT No. ADDRESS
—TMA RazZ�+2r
PROJECT OWNER JOB SITE P11014E NO.
PERMIT ISSUED Date ELECTRICAL
Ruildi_np, / -y3 Date Insp.
1:1e_ctrical Power Pole_
1,Lumbinr -- — ----
Undcr
licchanical, Rough Wiring
'Temp. (ins/1?lcct. Ila U.s _--
Solar Cciling
Fire S rinkler Fixtures int/Ext _
Sign Hotors
Grounding
Hisc. Temp. Power _
FINAL. IUSPECTIONS Not Approved _
Date Insp.
r'`s PLUMBING
Electric Date Lnsp.
1'Limbin . Backflow
!1echanical Underground
Solar Underfloor
Pool Partial. Rough
�y Gradin , Rough Complete
I'Lanning, Solar Rough
Fire Dept. Water & Insulation
Health Dept. "fain Drain
Building R/of/S Drain _
Otlier Gas _
Other
BUILDING Not Approved
Date Insp.
Pad Certification 11ECNANICAL
Foundation Date Insp.
Pre-GUnite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers _
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Di_aphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Ual.Ls-Panels Flues & Comb. Air
Frame 2-/7-93 Other
Lath d Not Approved
Uallboards Int/Ext .
Firewalls
Other
)Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
P oIBU I LDING PROJECT I DENTIFICATI ON PERMIT u
XaVILDING APPLICATION & PERMIT I [5
ADDRESS
110130
930 5-t ra •T _ 15 5
7' fIcYY` ��/Jn�l/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S -- _ - - _ PLAN CHECK VALIDATION
NAME u. o (fr� /^j'n QTY. ELECTRIC PERMIT FEE
�DiT AJ „ CITY.
CONTR CTOR'S
_ NAME (/.�F� -Iq UTLETS-SWITCHES-RECEP 5.00/1.00
�'i urN LIC.NO. �O�Y LIGHTING FIXTURES 5.00/1.00
-CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
AOo Ess C
r PANELS ° 5.00 - DATE OF APPLICATION
ARCn ITECT SIGNS ' ' - - 6.00 PLAN CHECK FEE C.NO.
OR
ENGINEER "
uc.No. SIGNS TRANS. 3.00
ARCHEOR ENG. SPECIAL CIRCUIT - -5.00 PERMIT VALIDATION
SS
ZIP ITEMP.METER'OR POLE INS. 15.00 '
aPP eEssTs �. MOTORS SEE FEE SCH,
SERVICE CHANGE _ 10.00
Woo LICENSED CONTRACTORS DECLARATIONF. C r� 0
rt u u I hereby affirm that I am licensed under provisions of Chapter 9 1 LIPS N
ur (commencing with Section 70001 of Division 3 of the Business and
¢z n BLDG. ELECT. PLG. MECH.
O z Professions Code,a my license is in full force an 1. ❑
z O'$, - License Isss r 'Lie.Number ��[(-- p« _ - ©C�
a, H Date
CL of mctor_Tg11? R I, We
a m f -a - - - t BUILDING PERMIT
¢ ¢ a OWNER-BUILDI7R DECLARATION ,
o is ° MISC.- REFER TO ORD INFORMATION
E:
; LL N 1 hereby alfrm that I am exempt from the Contractor's License VALUATION S/FT.
H LL O a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00
Code:Any ci y or counly which requires a permitlo eonstruet,alter. a
� ELEO.CONTR. - LIC.NO.
a M ¢ 0 improve,demolish,or repair any structure,prior to i6 ivuance,also ELEC. / - -
d y o¢ -requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of the Contructor's License p S.
HZ>
Law(Ch opler9(commencing w i l It Sect inn 7000)o f D iv is it)it 3 o lt he Rr'>'9y/t,„ Rue;
4 o Business and Professions Code)or IIfat he is exempt therefrom and QTY. PLUMBING PERMIT FEE v
W H $ the basis for the alleged ex cm pt for.Any violation of Sect ion 7031.5 1 STORIES TYPE CONSTR.
i ; - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not mare than five hundred dollars(S500L):
❑ 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 Jo the work,and the structure is not -
intended or offered far sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONIC. 4.00
Code:The Contractor's License I.uw does riot apply to an owner of
property who builds Or improves thereon,and who docs such work _ FIXTURES-PER TRAP 4.80 S0.FT.FLOOR AREA TOTALACREAGE
himself re through his own employees,provided however.
such Improve-
mentsareno,inlendis or employee sale.provided
that suh,building GAS-EA.SVSTEM-11NC.40UTLETS 4.00
'or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 100 BUILDING USE
builder will have the burden of proving th . .
at he did not build or im- . RES IND CON PR Omer
.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 2000
❑ I,as owner of the property,um 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:The Contractor's License Law does not apply
to an owner of Property who builds or improves thurcon.and who 0'�
RS-OVER 5(EA.I 1.00
contracts for such projects with n contractor(s)licensed purstant to '
the Contractor's license Law. Y-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,L&P.C.for this W/VENT 4.00reason
Dale Owner .4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION G EQUIP, 4.00 - ..
I hereby urinal that I have it certificate of consent Io sclGinsure, ZONINO ENG.SITE NO.
or a.certhicate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Lab.C.l. -7 lP)t•
Policy No. Company
❑ Ccrti Gcd copy is hereh'(umishcd. FIRE SPRINK ENERGY T44
Z Z k CertifiEJ will the c�tY inspenimt division. -
Applicunt MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
~ rn PERMIT ISSUANCE 6.00
�'- CERT P I: I: IN FROM WORKERS' FLOOD ZONE A.L.U.C.
W _ M1IPF.NSATIOM1'INSURANCE; PLG:CONTR. LIC.NO. PLG; Y.❑ N❑ Y C] N❑
CL
(This section recd,not be completed If the permit is for one TOTAL
Z hundreddollars IS 100)or less.)
'V O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shill not employ any person in any manners.us to
U become subject to the Workeri Compensation Laws of California.
ELI Dare Applicant '- ALTER OR ADD TO MECH. 4.00 BUILDING 3` a
} N NOTICE '1'0 APPLICANT: If,after making this Certificate of Ex-
F.Z emption,you should become subject to the Workers Compensation APPLIANCE ' 4.00 PLAN CHECK -
provisions of lire Labor Core, YOU runt forthwith courtly withFEE
CJ such provisions or this Permit shall he dccmcd revoked,' AIR HANDLING UNIT(TO 10=C.F.M.) -3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000QF.M.) 5.00 SEISMIC FEE ,fa
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issuer(Sec. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ' ELECTRIC ,
- I certify that I have read this application and sv:to that flat above VENTILATION FAN (SINGLE) 3.00
ablarnatlon is correct,I agree to comply with all city and county PLUMBING
vdinancrs and state laws relating to building ConSIRIClion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
1ereby authorise representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
ebovc-mentioned property sin •,tion purposes.
(We) greet sav n emn fy nJ keep Imrmless rhe City'of MISC.- REFER TO ORD.
Caper ra I 'a "i ,jud 1s, costs and exp, ses which PERMIT ISSUANCE .3.00 CONST.TAX
may n I iWt S' I City in cons of Luce I 'tile
Stan rig, n -,S MECH.CONT' a�. LIC.NO. MECH. '
7(/I/�Yw f' T TOTAL
Sign to, A lican ntracka are Lif '
OFFICECOPY