1798 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Xn
BUILDING PROJECT IDENTIFICATION PERMITUAPPLICATION & PERMIT 798 F ' emlmec I 98 JO
ao s
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL -
ER'a PLAN CHECK VALIDATION
4N DTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR OUTLETS-SWITCHES-RECEP 5.00/1.00
GC/ uc.No2���1�' LIGHTING FIXTURES 5:00/1.00
r.ONTRACTOR's APPLIANCES-RESIDENTIAL 4.00
PHOrvE✓tee -J�VO PANELS 5.00
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE % .
OR SIGNS 6.00
NGINEER Ir
LIC,No. SIGNS TRANS. 3.00 0.
ADDRESS ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADORE Its q/ yam/
' SERVICE CHANGE 10.00
atz
H
02 LICENSED CONTRACTORS DECLARATION
a Uw I hereby affum that I am licensed under provisions of Chapter 9 ISSUANCE DATE
1- (commencing with Section 7000)of Division 3 of the Business anJ
¢ MECH.
IT ELECT. PLG.
H O i Professions Code,a my license is in full for' ❑ ❑ ❑
i
c 0 s0.o{ License Cl a Lic.Nunsber
H Dam"c _g�_Contradomsr
H
a sc BUILDING PERMIT
¢ a OWNER-BUILDER DECLA ATION
s o e- u INFORMATION
IL y 1 hereby collo that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O¢ Law for lye city
m in reason.(Sec.requires
a,permit
to construct,nd Professions -
VALUATIO� $/FT.
H _ � a PERMIT ISSUANCE 6.00
3 Code:Anyciryor county which structurep prior to uarce,leq
F M 4 improve,demolish,or re air:In 'structure, riot to its issumice,also ELEC.CONTR. LIC.NO.
¢ E ¢ O P P Y P TOTAL
i O a- requires the dp pursuant
for such permit to fill a signed statement that. TOTAL n PERMIT TO
1- $ he is licensed pursuant to the provisions of the Contuactor's License f
H z i Law(Chapter and 9(commencing Code)or Section 7000)oisesemf t theref oofthe
f 4 0 'Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ I- g the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TV E CONSTR.
n ; § by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 / �3ti-!/
of not more than fivchundred dollars(SSOOL)
❑ 1,as owner of file property,or my employees with wages as BACK F LOW PROTECT.DEVICE 200 OCC.GROUP RE;UNITS
their sole compensation,will do file work,and the structure is net . /
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 ✓j�
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 4.00 SO,FT.FLo R AREA TOTAL ACREAGE
menta are not hrough
ownneferedI Employees,provided ho ever,the
improve- GAS-EA.SYSTEM-11 4.00
mems are not intended or offered fo..ale.If,however,such
improve-
ments
or 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 that lie did not build or mi- RES IND CON PB Omar
prove for purpose of sale.). I NO USTR I A L WASTE I NTER. 20.00 ��
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec..7044,Business LAWN SPRI LERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law does not apply A '
to an owner of property who builds or improves thereon.and who LAWN SPRI -OVER 5 (EA.) 1.00 Y .� w/
contracts lot such projects with a contractorls)licensed pursuant to SEWERSA ITAR 6 EA.200ft/8.00 000///
the Contractors -
License Law. TRACT NO, PARCEL NO.
❑ lam cxempf under Sec. B.&P.C.for ibis yyATER H /V EN
Rason 4.00
Date Owner WATERSYSTEM 4.00 ACC.PATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TR TINGE
1 hereby affirm that I have a certilicme of eons.Or to Selman c•,
or a certificate of Workers'Compe lion Insurances o a certified ' ZONING ENG.SITE NO.
F t r:Y_L alnp.
r
Z ❑ Cc,( co iss filed/by fats shed. FIRESPRINK ENERGY T 24
H ZO Cert'ie y is
W.IT 'y1�t� hrrs� "visi=n. MISC.- REFER TO ORD. Y%k N�
Applicant' ` fi464-
'LU y> �� Cl/` ' I I CO]v OF EXEh1PT1( FROM WORKERS, PERMIT ISSUANCE 6.00
W FLOOD ZONE �erte:4e�'
'-.,- COMPIiNSA'1'ION INSURANCE PLG.CONTR. LIC.NO.
CL Z (This section need not be completed if tile LJ
e permit is for one TOTAL Y❑ I-I w
hundred dollars IS 100)or less.)
U OI 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not enIPIOy any person in any manner so as to
U become subject to the Workers'Compensation Laws of Culitornia. f�
O a Datc Applicant BUILDING ao a�
} m NOTICE TO APPLICANT: If,offer making thin Certificate of Ex. ALTER OR ADD TO MECH. 4.00
F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
-
Toro
,{/visions of the Labor Code, you must forthwith comply with &
U Such provisions or this permit slall be deenmel revoked AIR HANDLING UNIT(TO 10000C.F.M.) 3.00 FEE �` �S
CONSTRUCTION LENDING AG17NCY AIR HANDLING UNITIOVER 10=C.F.M.) 5.00 SEISMIC FEE x .16
I herchy affirm that there is a construction lending agency Rx 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 HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
('certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct I agree to comply with all city uctl county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating TO ly Willi construction,andoo, and
hereby authorox, representatives of this city to eater u on file BOILER-COMP (Over t00A00 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(Wel ce to save. indemnify and keep harmless e C" of MISC.- REFER TO ORD.
OmpeR m gains, liabilities, 'udgments, costs and ce nu. umn PERMIT ISSUANCE 3.00 CONST.TAX
in y way c rue a i t said in con nen' of the N
/ gra If this L MECH.CONT, LIC.N0. TOTAL
TOTAL
I I / tactor /Date/
OFFICE COPY
M.l�Oa2`� ( l'I'Y 01' CUpE.RTLNO INSPECTIOV RECORD (Office Copy) "
1g98 10301 Vicksburg Dr.
PEPdIIT 1,10. SANITARY DIST. NO. LOT 140. ADDRESS
Addition Phil Howard 354-3603
PROJECT OWNER JOB SITE PHONE NO.
PPfRMIT ISSUED Date ELECTRICAL
1S11i7dine _ 5-11-72 Date i.nsp.
Electrical - ice Power Pole
1'lumhLug _ Underground
Ito cIinn i.caI Rough Wiring y 4E:--
Temp. Cas/lacct. lial .s
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Si .n llotors
Grounding
hist. Temp. Power _
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
PLUMBING
Electric
Date Insp.
Plumbing Backflow _
Mechanical Underground
Solar Underfloor
Pool Partial Rough -(0-
Grading Rough Complete
Planning, Solar Rough
Fire Dept. Water & Insulation _
llealth Dept. Main Drain
PUfldinp R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundations ( -�^l, Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Ilembrane Ducts & Insulation _
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & flood
Tiedowns One flour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels F].ues & Comb. Air
Frame Other
Path _ Cif Not Approved
Ilallboards
Firewalls /N S'PZ c 'r! o i( ct CT.
Other
Not Approved
BUILDING
t
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
i-