HomeMy WebLinkAboutOld permits -`' `r.. Development Services Depaownt ia�
11 240 West Huntington Drive,: .,t Office Box 60021 PER1 NO. BOO-034-915
City of Arcadia,CA 91066-6021 Permit Type: Plumbing
Arcadia (626)574-5416,Fax(626)447-9173 ,
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
17765 6/21/2010 CM 10:21 6/21/2010 Issued
ADDRESS No. Dir.Prlx Street Name Street Suffix Project ASSESSORS PARCEL NO. GEO CODE
715 Encino Dr 5780-017-002
OWNER MAILING ADDRESS
Daniel& Debbie Bump 715 Encino Drive PHONE NO.
EMAIL ADDRESS: Inspector#: '
Arcadia, CA 91006 ?
Plan Chk#:
APPLICANT MAILING ADDRESS Plan#:
John Nelson Plumbing 2534 Foothill Boulevard PHONE NO. School Dist#:
La Crescenta,CA 91214 EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
John Nelson Plumbing 2534 Foothill Blvd PHONE NO. FAX NO.
La Crescenta,CA 91214 EMAIL ADDRESS:
License No. 518842 Type: C-36 Expires: 7/31/2011 12:00:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
SEWER LINE REPLACEMENT
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
COA4PL E TED
4t,A� 6-7-3-to \1W CCUPANCY: TOTAL VALUATION: $0.00
QTY UOM DESC AMT AMT PAW ACCT QTY UOM DESC AMT AMT PAID ACCT
I Flat Plmbg Issue A 42.25 42.25 01-3105
I each unit Sewer connec 28.25 28.25 01-3105
I each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $71.50 Total Amount Paid: $71.50 Paid Today: $71.50
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the RCCe1pt 0: 91486
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 01-3105 70.50
180 days from the plan application date. This permit expires and becomes null and void if any work 88-3027 1.00
authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been
verified by the City of Arcadia building inspector for a period of 180 consecutive days.
CALLS FOR INSPECTION INSPECTORS' OFFICE HOURS
4i
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m. to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
A•
�41P041y"+./
PERMS f/PLAN REVIEW AFr'LICATION
_.14p, Development Services Department, 240 West Huntington Drive, Post Office Box 60021
%.Iafty°` Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS' COMPENSATION DECLARATION
NIi4 I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9, commencing with Section 7000, of Division 3 of the Business and
Professions Cod n license is in full fire,— ff. ` 1/ J ❑ compensation,I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. Exp.Dat / as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature of Contractor
I have and will maintain workers' compensation insurance,as required by Section
OWNER-BUILDER DECLARATION 700 of the Labor Code,for the pector ante of the work for which this permit is
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My work n p u ber are:
License Law for the following reason(Section 7031.5, Business and Professions �a'►�tf 1 I` 1
Code: Any city or county which requires a permit to construct, alter, improve, Carrier ytt'VVV\�, QJ
demolish,or repair any structure,prior to its issuance,also requires the applicant Policy Number !((J/1y �
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less.)
7000)of Division 3 of the Business and Professions Code)or that he or she is ❑ I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of not employ any person in any manner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil compensation laws of California,and agree that if I should become subject to the
penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith mp with those provisions.
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for Date 2i t0 Applicant 'J1'
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING:Failure to secure workers'compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalities and civil fines up to one
completion,the owner—builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorneys fees.
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued(Section 3097,Civil
Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Owner Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required. The permittee may be entitled to reimbursement of the permit fees if the City fails to
conduct an inspection of the permitted work within 60 days of the request for final inspection.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal, stripping,
or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at
(909)396-2000 for further information.
_____Cordtacita
Name . . • '_. Title
PR I T NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the
owner. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
H21) 10
Signature Date
■ •. Development Services Departm nt
i;4:� • 240 West Huntington Drive, ")ffice Box 60021 PERI' NO. B0O-019_489
Arcadia,CA 91066-6021
City of (626)574-5416,Fax (626)447-9173 Permit Type: Plumbing
Arcadia ( ) yp
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
19/2004 9/2004 Issued
PROJECT ADDRESS � �„j, ASSESSORS PARCEL NO. GEO CODE
715 Encino Dr ','',,', 5780-017-002
OWNER MAILING ADDRESS
Bump,Daniel A And Lee Bump Deb 715 Encino Dr PHONE NO. Inspector#: DON
Arcadia,CA 91006 EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
#1 STATE PLUMBING 3636 Figueroa Street PHONE NO. (818) 566-1390
Glendale, CA 91206 EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
Number 1 State Plumbing 3636 Figueroa Ave PHONE NO. (818) 566-1390 FAX NO.
Glendale,CA 91206 EMAIL ADDRESS:
License No. 695125 Type: C Expires: 8/31/2004 12:00:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
COPPER REPIPE FROM MAIN WATER METER TO EACH FIXTURE AND VALVE AND REPLACEMENT OF WATER HEATER.
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 2,900.00 $2,900.00
OCCUPANCY: Dwellings TOTAL VALUATION: $2,900.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Bldg permit $120.35 $120.35 01-3104
Totals for: 01-3104 $120.35 $120.35 71W-9
1 Flat Phnbg Issue A $40.25 $40.25 01-3105 �t �^/
1 each Wtr htr/vent $14.10 $14.10 01-3105 /1', t,A.91' Airier eV& G/
Totals for: 01-3105 $54.35 $54.35
1 each SWMF 2 Auto $1.00 $1.00 88-3027
Totals for: 88-3027 $1.00 $1.00
Total Fees: $175.70 Total Amount Paid: $175.70 Paid Today: $175.70
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180
days from the date of plan submittal. This permit expires and becomes null and void if any work authorized by
this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by
a City of Arcadia building inspector for a period of 180 consecutive days.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
11P'
Requests for inspection should be made at least Monday—Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 9:00 a.m. 7:30 a.m.to 9:00 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
u uppew
PERIL.-. T/PLAN REVIEW AI'LICATION
et, irraWn
- 1j. Development Services Department, 240 West Huntington Drive, Post Office Box 60021
°''°LT• Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
.17(LICENSED CONTRACTOR'S DECLARATION WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9, commencing with Section 7000, of Division 3 of the Business and
Professions Code, n linse is in full fore effect. '/ ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class�[� �11Sa✓License No.!�Exp.Date -/ compensation, as provided for by Section 3700 of the Labor Code, for the
O performance of the work for which this permit is issued.
Signature of Contractor
!a I have and will maintain workers' compensation insurance,as required by Section
OWNER-BUILDER DECLARATION 3700 of the Labor Code,for the performance of the work for which this permit is
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My workers' pen atio suraace carrier and policy number are:
License Law for the following reason(Section 7031.5, Business and Professions Carrier ( /�(J
Code: Any city or county which requires a permit to construct, alter, improve, 393/-62
demolish,or repair any structure,prior to its issuance,also requires the applicant Policy Number /b.?
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less.)
7000)of Division 3 of the Business and Professions Code) or that he or she is ❑ I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of not employ any person in any manner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil compensation laws of California,and agree that if I should become subject to the
penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith compl with those provisions.
❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for
P Date 1/ Applicant-- ✓; /
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure workers' compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalities and civil fines up to one
completion,the owner—builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest,and
attorneys fees.
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued(Section 3097,Civil
Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Owner Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required. A Certificate of Occupancy must be obtained prior to use and occupancy of new
buildings and structures.
3. Per South Coast Air Quality Management District (AQMD) regulations, renovation and remodeling work that results in the removal, stripping, or
altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-
2000 for further information.
Name Title � ✓ed/:r
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the
owner. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature Date 7-1901
Qp
6*(9C
!OR ki
BUILDING & SAFETY DIVISION
�� ,,����,� 240 West Huntington Drive
/o" Arcadia, California 91006-3104 CL .. __
°00RATE9- ( 818 ) 574 - 5416
1'age l of 1
715 E ENCINO DR 01/29/91 14 : 16
Permit No. : A9100347 Autoproj No : AU006252
Status : APPROVED Validated by : CYN
Inspector area: 208
This type : Mechanical Project Applied : 01/29/91
Issued : 01/29/91
Parcel number : 5780-017-002 Finaled •
Group-occup/use: To Expire •
Owner : BOUD, ANDREW
Applicant : BRYANT HEATING & A/C
Applicant Addr : 1350 E LAS TUNAS DR SAN GABRIEL, CA 91776
Job Address : 715 E ENCINO DR
Phone number : 818-286-1141
Class code
Valuation 0
Construction : OTH
Permit to do : HVAC (5' MIN. SETBACK PER D.B. )
CONTRACTOR : BRYANT HEATING & A/C Lic. C 221751 818-286-1141
Fee description Units Fee/Unit Ext fee Data
Original Permit Issue Fee (YES/NO) 30. 70 Y
Forced-air Unit to 100, 000 Btu/hr> 1. 00 13 . 00 13 . 00
Boiler/Compressor to 3 HP 3105> 1. 00 13 . 00 13 . 00
*** Fees Required *** *** Fees Collected & Credits ***
Receipt No. Date Payment
01/29/91 56. 70
Fees: 56.70
Adjustments: . 00 Total Credits: . 00
Total Fees: 56.70 Total Payments: 56. 70
Balance Due: . 00
Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material
equal to or greater than the amounts specified on the Hazardous Materials Information Guide?
❑ YES ❑ NO
Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school?
❑ YES ❑ NO
Will the intended use of the building by the applicant or future building occupant require a permit for construction or mod-
ification from the South Coast Air Quality Management District (SCAQMD)? SEE PERMITTING CHECKLIST FOR
GUIDELINES.
❑ YES ❑ NO
I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my re-
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BUDDING AND SAFETY DIVISION ,rr.. BUILDING
City of Arcadia PERMIT
240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 As
� �'
Cding 7 c C j, O Q 21 /e U.B.C. 1Type Occ•
Edition Cnst. Group Address
'LotF. D.Appr. Date H. D.Appr. Date
Block Tract Required Required
Owner Use Zone Special Case No.
/q,4./02Ew
Mailing �� G/i1/0
DA,1 vE Homeowners Association Approval Date
Address `7/,3"'
ci TeI.�t�-Q c 4t ) 4 T p®61 -4-6-5. Sze
V cor Special
c n ,t M 4 G C cl n/S 7- Conditions
( Agir gsso �i FT/tid/01,6 NOTE: Include:
J JT /Z- ""Al-L.-L VALUATION Labor,Material,Plumbing, Etc. $IS.Z.25)
J !2 Ci q� I ZI7/tOO Tel. ,/ n_7-419 Misc. FEE „�,� �p .� '3
State Lic. p City .;10.:,,k•a ¢ �r Private
&Classif. 3 94 3 / Lic.No.106,3 8 , s Swimming Pool/Spa fl Public
-o Arch., Engr., i ` Sign-Pole❑ Wall ❑
Designer JUD iV
Address Tel. , MA Temporary❑ Projecting❑
I--s City Zip State, Fee Based on Total Sq.Ft.
Lic. No. -
1;J Proposed mm. PLAN CHECKING FEE �--
U construction �/V G L ase� o lee c i 3g 3
cn ,-N/sr,"LL o aC /19 �0Q -- �� _ S�am,IR
IN Ny. tv�`L c- , '; Permit Fee 3�
Floor 77`Main Accessory Total 7 .7 Processed by
/ TOTAL
New❑ Add.❑ Alter., Repair❑ Demolition❑ Permit No. Plan No. Date /1 85
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
l' I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section I hereby affirm that I have a certificate of consent to self-insure,or a certificate of
II)I of Division 3 of the Business and Professions Code,and my license is in full force and orker's Compensation Insurance,or a certified copy,tth/greof.(Seccr��3800,Labor Code")
effect. y 1_511:43""S1 Company / iI /q 7f: LLY�U S�
Policy No.
OWNER-BUILDER DECLARATION QI with is City. ❑Certified copy is Ex .Date
with the City. hereby furnished.
❑ I hereby affirm that I am exempt from the Contractor's License Law for the following CERTIFICATE OF EXEMPTION FROM
reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a WORKERS'COMPENSATION INSURANCE
permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance (This section need not be completed if the permit is for one hundred dollars($100)or less.)
also requires the applicant for such permit to file a signed statement that he is licensed
pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with El I certify that in the performance of the work for which this permit is issued,I shall not
Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt employ any person in any manner so as to become subject to the Workers'Compensation Law
therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any of California.
applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become
dollars($500)." subject to the Workers' Compensation provisions of the Labor Code,you must forthwith
comply with each provisions or this permit shall be deemed revoked.
❑ I,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY
o the work,and the structure is not intended or offered for sale."Sec.7044,Business and I hereby affirm that there is a construction lending agency for the erformance of the work
Professions Code:The Contractor's License Law does no;apply to an owner of property who on en g g y P
for which this permit is issued.(Sec.3097,Civil Code.)
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the Lender's Name a 0 building or improvement is sold within one year of completion,the owner-builder will have
the burden of proving that he did not build or improve for the purpose of sale." Lender's Address
❑ I, as owner of the property,am exclusively contracting with licensed contractor to
construct the project."Sec.7044,Business and Professions Code:The Contractor's License I certify that I have read this application and state that the above information is correct.I
Law does not apply to an owner of property who builds or improves thereon,and who con- agree to comply with all city and county ordinances and state laws relating to building
tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Low.'' construction,and hereby authorize re resentatives of this city to enter the above-mentioned
pignatty for insplican urposes.
''a,..44.4.41....0
1 am excempt under Sec.__—_—_—_,B.&P.C.for the reason Signature of Applican / , ate _ ��®�
Mailing Address 3 7 o LN a 6 4/1.t/A/Q 2K—,Q-c_
`Date_______ Owner City,State,Zip ,9'/2 e3•5).o/ t0 97 )n K
This is a building permit when properly filled out,signed and validated,
VSPECTOR COPY and is subject to expiration if work thereunder is suspended for 120 days.
Aloft INSPECTION RECORD
FOUNDATION: (Gr. Certif. Comp. Tests, Set- INSPECTION NOTES
backs,Forms,Reinf.Steel, Excavation.
FLOOR SLAB/JSTS., GIRDERS: Mesh, Vap.
Barrier,Blkg.,Spans,Access,Vents,Tr.Lmbr. ` � ,n
MASONRY: ,Bolts, Mortar Jts., Grout Lifts, ,,zti�fl
Clean-Outs,Bolts.
ROOF SHTG.:Nailing,Diaph.Blocking,Material
Grade and Thickness, Roof Drains.
FRAMING:Backing,Raft., hr. D Blocking,Bracing, /]/
Nailing,Backing,Dt.,Js Draft Stops. !//�"��
INSULATION: Thickness, R-Values, Piping, �' i ��/ 1
Sound Caulking. U
FIREWALLS: Material, Thickness, Dampers,
Doors,Closers,Fusible Links.
INTERIOR:-LATH/DRY WALL:Nailing,Supports,
Laps,Joint Reinf. •
EXTERIOR LATH/SIDING: Mesh, Fasteners,
Laps,Paper,Thickness,Backing. •
FINAL INSPECTION: Finish Grading Certif.,
Slope Plant., Energy Compl. Card Posted,
Pkg. Access, Fire Doors, Exit, Locking De-
vices, Landings, House Numbers, Weather
Stripping,PI./Engr. Clear. /� PI/15
SWIMMING POOL/SPA
EXCAV.REINF.SETBACKS:Radius Stl.,Bond-
ing,Exp.Soil,Ramp Loc.,Surcharge. •
FENCE/GATES: Height, Closers, Accessibility,
Latches,Stability.
FINAL INSPECTION:
MISC.
SIGNS:
RE-ROOF:
•
INSPECTION DATE INSP.SIGN.
B DING AND SAFETY DIVISION -- "'
.
- City of Arcadia ELEC./MECH./PLMBG.
240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT
Building - Q No. Description (Additions, Commercial, Industrial) I Fee Ni.
Address 7/.c ,.... N� Services 1
Owner 0 (Size' 1
I Outlets (
Moiling W 61 (Receptacles, Lights, Switches) 0 do
Address Fixtures
City I Zip I Tel.
N Motors
Contractor ^e / , J
/ (H P each: )
/C �= Q Other
Address / U (Specify: )
_
1
—1-"--- € - Sq. Ft. Area New �1
City Zip Tel. ._Cr Residential Bldg. 4�'
/Lja - . �+' _ 7�5 �' W Sq.Ft. Area New t 1
State Lit. City J
Res. Accessory Bldg.
C, t?,Clossif. 3 6 Lic. No.D ( , W
I�1 LICENSED CONTRACTOR'S DECLARATION
QMisc.
L1 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section
of Division 3 of the Business and Professions Code,and my license is in full force and Pool ELECTRICAL FEE /-„ 30
effect. Wiring L!J
t
.,.- OWNER-BUILDER DECLARATION No. Description No. Description Fee
r',' ❑ I hereby affirm that I am exempt from the Contractor's License Law for the following FAU to and induct, Boiler/Compressor
r__ reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a inic 100,000 BTU to and includ. 3 HP
permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance
also requires the applicant for such permit to file a signed statement that he is licensed W FAU over Boiler/Compressor
pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with 100,000 BTU over 3HP to 15 HP
Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt Cfl
therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any } Flr./Woll/Susp•/Pool Air Handler to and
applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred U)
I dollars(8500).' Heaters includ. 10,000 cfm
C I,as owner of the property,or my employees with wages as their sole compensation,will J Spray Booth / Air Handler
do the work,and the structure is not intended or offered for sale."Sec.7044,Business and V Exhaust Hood over 10,000 cfm
1 Professions Code:The Contractor's License Law does not apply roan owner of property who Vent. Fan Other:
builds or improves thereon and who does such work himself or through his own employees,
( ' provided that such improvements are not intended or offered for sale. If, however, the Q includ• Duct
building or improvement is sold within one year of completion,the owner-builder will have
the burden of proving that he did not build or improve for the purpose of sale." = Misc.
• 0 I, as owner of the property, am exclusively contracting with licensed contractor to W
construct the project."Sec.7044,Business and Professions Code:The Contractor's License
Law does not apply to an owner of property who builds or improves thereon,and who con- 1 MECHANICAL FEE
tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law."
11 I am excempt under Sec. ,B.&P.C.for the reason _ No Description No. Description Fee
Bathtubs Water Heaters
Date Owner W Showers Gorboge Disposals
WORKERS'COMPENSATION DECLARATION En Water Closets Laundry Trays
I hereby affirm that I have a certificate of consent to self-insure,or a certificate of ,
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) >"' Lavatories Clothes Washers
Policy No. Company
❑
Copy is filed Q Certified copy is Exp.Date C7 Kitchen Sinks Sewer Connections
with the City. hereby furnished. I I Z
CERTIFICATE OF EXEMPTION FROM m Dishwashers Sewer Cap
WORKERS'COMPENSATION INSURANCE Shower Pon Gas System
(This section need nor be completed if the permit is for one hundred dollars($100)or less.) j Replacement (No. Outlets: )
1 certify that in the performance of the work for which this permit is issued,I shall not J Swim. Pool Solar
employ any person in any manner so as to become subject to the Workers'Compensation Law d
Piping Installation
of California. Misc.
NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become IPLUMBING FEE
subject to the Workers' Compensation provisions of the Labor Code,you must forthwith 1 - -
comply with each provisions or this permit shall be'deemed revoked.
I certify that I have read this application and state that the above information is correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES oVp 00
agree to comply with all city and county ordinances and state laws relating to building 1
construction,and hereby au .. ize representatives of this city to enter the above-mentioned
property for inspectio ..nose . /
Signature of Appli .nt As _� _ ./Ai.��, Date 9,..B_3. TOTAL FEES a(= I i' )
,y ( .it/ ,- •
Mailing Address -/
Processed Date:
`City,State,Zip____ C/��.. d14...rlp By
INSPECTOR COPY This is an electrical/mechanical/plumbing permit when properly filled out, signed and
validated, and is subject to expiration if work thereunder is suspended for 120 days.
INSPECTION REC(. ... INSPECTOR NOTES
UNDERGROUND CONDUIT
ROUGH WIRING 0/r3
NEW SERVICE
sa FIXTURES
iii
J. FINAL ELEC. INSP. /�fy�3
TEMP. POWER POLE
OTHER
OTHER
ELEC. UTILITY CLRNCE.
U. G. DUCTS/REFRIG. LINES
RO. MECH. Ducts, Comb. Air,
= Supports, Vents
Z FINAL MECH. FAU/AC Unit
Vents, Shutoffs
9 OTHER
OTHER
U.G./UNDER FLR. Soil, Water,
Gas, Supports
Water, Gas, Vents,
RO. PLMBG.
{ Supports,.Flashings
GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM
FINAL PLMBG. Fixtures, Valves,
Services
WATER HTR. Vent, Valves,
OR Press. Rel. Valve
0 SEWER/PRIV. DISP. SYSTEM
OTHER
OTHER
GAS UTILITY CLRNCE.
BONDING
rn U.G. CONDUIT
GAS PIPING Material, Depth
GAS TEST
r HEATER Vent, Clearance, t
Location Shut-off
Yet FINAL POOL ELEC.
FINAL POOL PLMBG.
OTHER
INSPECTION DATE INSP. SIGN.
Location 7
/ ti/ c / h/ d 4O
Sewer Permit No. 6443 Co. No.
Lot -. Bik. /'TractI '� �p s• I Legend
Owner /Q , / ._a--/ S Length Date Insp.
Contractor E, I 3r i476/I-y 1
L
PL.
Pipe & Joinfs �GG —
7sz1 d•oN Nvnd 0 •04 zs--Et- t/ svo YS-E2-t/
Ili 1 olal33'13
,. '' �'
s3antw
vC.14 -CW •042 , a a pIf 9NiaiM
_S-// 0,..2 • r 0 r • • a3n3s-5735.3556'"763---L—�� • / 4Z7a I • / • c I DNI1v3H
.� .. . • sNlewn-Id
�) _ _
; '-1-11,95-- _ • -11 • ir flNIQ'11n9
-- O LC 1+LGo�$ ___
2----------
-- 2-g-‘,/-,4 a3NM0
S! 3
xoo-le 'Z° 10-1
s9�� twat
- , wiz✓ fpur ; ',�!
------- � � r � � S/ Noltvoo'1
0-40
0/ s 3 mvA .'�� .
Qo\
r'.M PA
0� /
j j t o r W
a1L
i A I
f
94a � w
le
N
1
h 4
LOCATION Ib L OWNER
DAT -SBUILDER' ���5 („�OSCnT/ri0
7�5 EhG O REMARKS
�� �� PERMIT INSPECTED �
POWER POLE . JG rt��. M+..
FO R M S__�_ /7/7 s _ /�`
RRO�.__--PLU ' 77 /
•
SEWER �i rl � VENT-if /O' /
FURNACE _..... �V' n< 4-0--
RO_WIRE
3 Y >1 r!_r/..�
RI____LI kVA= 7 ■
r/. / I�r j.4,
rRAME _.r..■
LATH__ , I�'
ELEC. FIX. y y I�� � �`
PLUMB FIX_ ,yI GAS .Z--1 3-3'Y— d -c
ELECTRIC iY
-.TRACTORS _/].._/p ...S"3,....-
ADDRESS'
U9 VWfl I h �O O CONTRACTOR • PLAN O. 03
STRUCTURE REMARKS
PERMIT INSP TED
pATn •
POW P -- /
I
FORMS �/
OA/ TO STREET
ROPL� IN BLDG.
_ W.C.
GAS-$--'�-
SEIRNACE VENT
ROUGH
FUR . ii '
RO. WIRE 0
t 77 ,
CURB4�
FRAME
LATH -------
ELE� Cam_" '
PLUMB FIX. GAS
ELECTRIC ^^Q
I ' 'I.