HomeMy WebLinkAbout1028 IRIS CT; ; 76-5890; PermitMODEL NO. 510
BUILDING PERMIT APPLICATION
City Of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. Phone 729-1181 Permit No.'.
JOB ADDR ESS ASSESSOR'S
PARCEL NUMBER
LEGAL
IDESCR. S95 73-39 {QSEE ATTACHED SHEET)
AA\ L ADDRESS
2 0mmm newic or aiui mmo, im mAmmm mm, an oxno nux si^-sote
CON TRAC TOR
3 800!
MAI L ADDR ESS STATE LIC. NO.
29^2115
CITY LIC. NO.
KA77
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE
4 mmm mem, loio wmm MUCB amaa, mau. AHA wm 839-4>eii6
LICENSE NO.
ENGINEER MAtL AODRESS LICENSE NO-
MAIL ADDRESS COMPENSATION INS. CARRIER
^ CVS ftlRlllUL OOnOOOSSXM^ WB iSKMUK
U SE OF BUILDING
7 smuB maur mnyutiB NO. BDRMS. 2 NO. BATHS.
8 Classofwork: [JNEW •ADDITION •ALTERATION •REPAIR •MOVE • REMOVE
10 Change of use from
Cliange of use to
11 Valuation of work: $ PLAN CHECK FEE S PERMIT FEE S
SPECIAL CONDITIONS; Type of
Const
Occupancy T_J
Group ~ "
MICRO FILM FEE
Size of Bldg.
(Total) Sq. Ft.
No. of
Stories
Max.
Occ. Load
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Fire
Zone
Use
Zone B-l Fire Sprinkiers yy
Required Qves l!jf No
No. of «
Dwelling Units *
OFFSTREET
No. 2
Covered
PARKINj^^l^
Sq. Ft.
PACES:
INo. Open
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-
ING, HEATING, VENTILATING OR AlR CONDITIONING.
THIS PERMiT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
i HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THiS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WiLL BE COMPLIED WiTH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Special Approvals
PLANNING DEPT.
HEALTH DEPT.
FIRE DEPT.
SOIL REPORT
OTHER (Specify)
ENGINEERING DEPT.
WATER DEPT.
.1
SIGNATURE OF CONTRACTOR X)R AUTHORIZED ACENT (DAT'E)
SIGNATURE OF OWNEW (IF OWNEK BUILDEPI (DATEI
Required Received Not Required
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
TOTAL FEES $.
INSPECTOR
6'/)-' %
MECHANICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 9200Q
Applicant to complete numbered spaces only. Phone 729-1181 Perm it No. ^y ^
JOB ADDR ESS
, LEGAL
I DCSCR. / ' ' /' t[IZ]^^^ ATTACHED SHEET)
MAtL ADDMESS
/ /v/y,
PHONE
r
CONTRACTOR MAIL ADDRESS STATE LIC. NO. CITY LIC. NO.
ARCfllTECT OR DESIGNER MAI L ADDRESS LICENSE NO.
MAIL ADDRESS LICENSE NO.
MAIL ADDRESS
USE OF BUILDING
8 Classofwork: C^NEW •ADDITION •ALTERATION •REPAIR
9 Describe work:
• s 1^' ' V
Type of Fuel: Oil • Nat.Gas • LPG. •
PERMIT FEES
SPECIAL CONDITIONS: No. Type of Equipment Fee
Air Cond. Units-H.P. Ea. $
Refrigeration Units-H.P. Ea.
Boilers-H.P. Ea.
Gas Fired A.C. Units-Tonnage Ea. J i
i Forced Air Systems-B.T.U. "/ ' M Ea. • ".J
APPLICATION ACCEPTEDBY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Gravity Systems-B.T.U. MEa. APPLICATION ACCEPTEDBY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Floor Furnaces-B.T.U. M
APPLICATION ACCEPTEDBY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Wall Heateri-B.T.U. M
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Unit He&ters-B.T.U. M NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Evaporative Coolers
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Clothes Dryers
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Ventilation Fan
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Range Hood
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Air Handling Unit— C.F.M.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Incinerator
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT OOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF CONtRACTOR OR AUTHORIZCD AGENT (DATE)
SIGNATURl OF OWNCR IIF OWNCR (UILDCRI
ISSUANCE FEE $
SIGNATURl OF OWNCR IIF OWNCR (UILDCRI (DATE) TOTAL FEES $ /9
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.o. CASH
INSPECTOR
PLUMBING PERMIT APPLICATION
aty of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. Phone 729-1181 Permit No:
JOB ADDR E$S
.LEGAL 1DESCR. 2 iS
MAI L ADDRESS
CONTRACTOR . ^AIL ADDRESS STATE Lie. NO. CITY LIC. NO.
ARCHITECT OR DESIGNER ^AIL AOORESS LICENSE NO.
ENGINEER MAIL ADDRESS LICENSE NO.
COMPENSATION fNS. CARRIER ^AIL ADDRESS
U SE or BU ILDI N G
8 Classofwork: CKNEW •ADDITION •ALTERATION •REPAIR
9 Describe work:
PERMIT FEES
No. Type of Fixture or Item Fee
SPECIAL CONDITIONS: X WATER CLOSET (TOILET) $ J
1 BATHTUB .fa-
I LAVATORY (WASH BASIN)
t SHOWER i
f KITCHEN SINK & DISP. t
DISHWASHER
APPLICATION ACCEPTED BY PLANS CHECKED 8V APPROVE DFOR ISSUANCE BY -LAUNDRY TRAY
t CLOTHES WASHER / Su
D AT E f WATER HEATER /
NOTICE URINAL
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
DRINKING FOUNTAIN THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A FLOOR—SINK OR DRAIN
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED THIS
APPLICATION AND KNOW THE SAIVIE TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS
/ sCiSTsiNK / PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED THIS
APPLICATION AND KNOW THE SAIVIE TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS
GAS SYSTEMS: NO. OUTLETS V /
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED THIS
APPLICATION AND KNOW THE SAIVIE TO BE TRUE AND CORRECT, ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS WATER PIPING & TREATING EQUIP.
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMiT DOES NOT WASTE INTERCEPTOR
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV OTHER STATF OR 1 Oral 1 AW RFRUL ATlNfi VACUUM BREAKERS
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAWN SPRINKLER SYSTEM
7 SEWER NUMBER CLEANOUTS ^ £
Jf-—>• / f
/^••" /••
CESSPOOL
IAJ ^ /I, A SEPTIC TANK & PIT IAJ ^ ROOF DRAINS
SIGNATURE OF CONTRACTOR OR AUTHOV%ED AGENT (DATE)
ISSUANCE FEE $
TOTAL FEES $ SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) TOTAL FEES $
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK. M.o. CASH
INSPECTOR
ELECTRICAL PERMIT APPLICATION
aty of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. PhOHC 729-1181 Permit No.
if. I.f
JOB ADDRESS
1006 Xrl0 C^isrt;
,LEGAL
1DESCR.
LOT NO. BLK. TRACT , ,
spiisate Hill mt >
OWNER
2
MAIL ADDRESS ZIP
Bciined n^lTle of CIA®O 7906 Comrcor Ccnirt Ssn ClAi ^ 9£rill 279-201^
CONTRACTOR MAIL
3BalGer Elsctapie* "Sm* 2180 lie
ADDRESS PHONE
r$vm Ave. Bi^iaaaiilo 7^*20Ca
STATE LIC. NO. CITY LIC. NO.
161756 15121
ARCHITECT OR DESIGNER
4
MAIL ADDRESS PHONE LICENSE NO.
ENGINEER
s
MAIL ADDRESS PHONE LICENSE NO.
COMPENSATION INS CARRIER
6 QB me
MAIL ADDRESS BRANCH
USE OF BUILDING
7 ^im^Smm
8 Classofwork: |^NEW •ADDITION •ALTERATION •REPAIR
9 Describe work: Rffilf^ & Vifiiiiti tfirjUiS
SPECIAL CONDITIONS:
APPLICATION ACCSPTSOBY: PLANS CHECKED BY APPROVEO FOR ISSUANCE BY
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM
MENCED.
i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
•/
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
PERMIT FEES
SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
No. Each
NEW SERVICE ON EXISTING BLDG.
FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA. AMPERE OF
INCREASE
TEMP. SERVICE UP TO AND INCLUD-
ING 200 AMP.
TEMP. SERVICE OVER 200 AMP.
PER 100
ISSUANCE FEE
TOTAL FEES
100 »25
Fee
25 00
27
0l>
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
INSPECTOR
I
LUT
BUILDING
FOOTINGS //^v/^^'
FOUNDATION
REINFORCED .STEEL
MASONRY
GUNITE OR GROUT
INTERIOR LATH & DRYWAL
PLUMBING
SEWER AND PL/CO
PLUMBING UNDERGROUND
COPPER
TOP OUT
TUB.AND SHOWER
GAS TEST
3WER
ELECTRICAL
UNDERGROUNI
ROUGH
DUND
CEILING HEAT
BONDING
MECHANICAL
DUCT & PLEM, REP. PIPING
HEAT—AIR
VENTILATING SYSTEMS'
FINALI I}