3320 E. Miraloma Ave.
I
::::: ::RR~:T NO. BLD2004-03312' 4~~iE'f~~~~:
Storage Racks CITY i;;\"N~HEIM
"DATE: 10/8/2004 '\,>~;" ~"::t;:r~!ljl:'>_:fi
JOB ADDRESS: 3320 E MIRALOMA AVE / . "":~.;;;':6>"S;\;' .
. '. . ""_...--~' ~,-~
'. .'. - 1
LEGAL DESCRIPTION: KRAEMER TR BLKK LOT 16 POR LOT ANcr
APPLICANT: JAMES. MCCOMBS
. \
OWNER INFORMATION: CONTRACTOR INFORM;"TION:
Concourse Joint Venture MC COMBS WALL, INC t
720 E Wisconsin Ave 12634 HOOVER ST _ ~
MilW;3ukee, WI 53202 GARDEN GROVE, CA 92891. 0000 .
__ BUSINESS PHONE: 714 8S!O-6600
JOB DESCRW\:K)""^Ag 8~8f8gJc la~ t
VALUATION: 790,000.00 L PROCESSED BY: M.JL
C OWNER-BUILDEiLqECId\RATION . -'J
I nerebyafflrm under penalty of pe~ury that I am exempt from thf! Contracto:r's LjCense :"aw for the foJlowli1g reaspn (Sec. .7031.5 Busif'less and Profe~ions.
Code: anydty or county which requires a permit to construct, aiter; improv€,_'d~i:f.,oHSh or rt3pa.lr any structure, priQr to its b'Suance, al~o requires the applica.n~
fOl'sum permit to file a signed statement that he is licensed pur~uat1t to: t~te,pr0\'i:lslbns of the Contractor's License Law {Chapter 9)(oommer.cing with Section
7000 .of Division -3 of the Business and Professions Code} oflhat:he' is"eXempt ti:. ere~lc';n <:Ind thz basis .for the atteged exemption. Any violation cf Section
7031.q- by any applicant for a permit sutljec;tsthe applicant to a,yivll P€narty'cfn\~tmore than five hundred dollars ($500). .
. . ." . .
.0. i, ~s owner' of propertY, ~r my employees with wages 2S th~ir soie .c.::>lllPenliol\ 'Nil! dO' the work, and th~ $tru~iiJre is not intended or'offeil':'.d for sc..Ie .
(Sec. 7044 Business-and professions Code: The Contractor's Ucellsd Law doe{flot apply to an owner of propeity who builds,or improves thereon, ,aao VA1Q
does such "work himself oi herself or through his or her own eMp:oyees, prO'!ideiithat :-;uch !mprovements are not intended or off~r:ed for sole. if, h0wever, 'he
building or improvement is soldYvith one year of c.ompletiOfl. the :l,^,ner~bufide! ".,:;.:: h;')ve the burde!1 of proving that he did_ net build or impfove for the purpcse
. of sale). .:, " ~ ..' . .\: '. .' . , :.
D i, as the owner of the property, am exchJstvely contract:ng with licen::.0d co<'tr:ctOi~ tv cor'suuct the prOject {Sec, 7044 BUSlf'6SS and ProfHSSlo!'ls CedE:::
The Co:ll.racior's Ucense Law does not apply to an owner of proLerty wr~o b!.'lfd~b: lm~r0v25 thereon, and who contracts for sud': projects with.:: contractor(s)
~nsed pursu3nt to the Contractor's License Law) , " ,_ iI
LJ I am exempt under Sec.' " '_.. ,B,& P.C. for th!s reasor.: ,,---L.___
Dote: , " OWner:" ," - 'b
L .. . WORKER'S COMPENSA Tlal-! m::CL!<R.^.TiO;'J ~:c::_. :l-
I hereby aff:r.m 'under pen~ltY of perjury one of the fOI!O\1"-ing ~ecl~r:~tions: ~
o I have'and will maintain a'cer.tificate of consent to self-insure fo! iN.)rker's ~x};;pen~;atio'l, ,"s
. pf-oyjded.for by Section 3700 of-the Labor COOP., for the perror:11alice of the Wrir':-::)Ui wh!c;:t':.thi3
.~1e itiS.lssuP-d. " . '- _,- . "1 --,
,I have and will m. aintain worker's oompensation insurance, as, required by Sqction 2,100 of ihe
al50r ('..ode, for the performance of the work for which this permit Ii) iss~Jed. My'~(;n~G.r's
ompensation insurance carrier and poliCY are: .;
'Carrier: ACORD Policy Number: 3900042:~t:704",.
,
This section need not be .completed ifth~ permt is for one hun-drcd dollctrs {$100)'~r less.
[J I certjfy ~hat in 'the performance of th,e work for wtlich this per:mit is iss,ued, ~,'fhal: not >imp[oy
anyperS.on in anymanner so as to become subje.ct tothe _\f.{Orker's compensatio,i I~...JS cf Ca:i:bmia,
and agree that if I shoufd become subjecqo the worker's compen~tiqn prcvisio!(:. of ,3ection 3700
oftheL~borCode, IshaUforthwithcomplyw' ose'P'P.V.ision~../ IY/1, ....
Date: 10/812004 Applicant: ~' ~
WARNING: FAILURE TO SECURE R'S COMPENSATIONCOV~RAG~ IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLQYCRIMINAL PENALTIES AND CIV;L:fIN~S UP TO
ONE HUNDRED THOUSAND DOLLAR ($100,000), IN ADDITiON TO THF. emT OF
COMPENSATION, DAMAGES' AS PROVIDED FOR IN SECTION 3706 OF THEILASOR CODE,
lNTEREST AND ATTORNEY'S FEES.
I . . . .' . CONSTRUCTION LENDINGf-GENCY_o . ..
-.l her~bY,!~J'f.lr!!Ll,!!}<;f~r."p~-"-alt'{gf j)J~d!-HYJt:li:!p_h,3:[f'~tsacQnst~J &tionJ;:;riiii.nx: 3gen~f9rJbe~~ _~ ~__
perfofn"lance-of the work for lNhich this pennit-is issu~ (Sec.3097 .Civ.C):~ '-~ '. ~..
Lender's 'Information:
BUILDiNG DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 -,4626
CENSUS CODE: 437
QUARTER SECTION: 144
ARCHITECT/ENGINEER INFORMATIO"l:
SAL E FATEEN
161 ATLANTIC ST.
POMONA, CA 91768
<~
'k/
~CENSEDCONTRACTORS bECLARATIOlFf
" ' ,i hereby affirm 1Ji1d&~' pen81tYof pe~ulY that i am _.'
I liceflsed under provi.:;;ions of ciJaptei' 9 (cummencing ..'Vi.t:;_
Section.7UOO)ofr:.iV 'on 3-af;:he Business '
. Profession C
10/8/2004.
Date:
NUMBER
706423
TYP~
EXPIRATION DATE
513i120C5
D21
Construcror: Types: '
VN, ,
Fire Sprinklered?
Yi::S
I certify'that! have' read this applicatio'n and state !hat the above in'tonnation is CcrrkCt. I agree to
comply'with'all city ordinances and state laws relating to building construction, and'hereby authorize
repr sentiv of this city to enter. upon th ove mentioned property for inspection purposes.
Date. 10/812004
Fees paid for Permit: .
Total:
11.981.78
Signature of App lean or Agent
The rmitshall expire by limitation ilnd become null and void ifthe building orwork has
not passed final inspection 365 days from the date of pennit issuance. A new permit is
required to commence or continue work.
INSPECTION RECORD .
. INSPECTION .. .. . DATE INSPECTOR.
T .mpora,.y Power Pole . .
Plumbing (Drahl/Waste Pipe) .
E"ctrical Ground EI.ctrodelUfer
. SetbacklFormsfTrenches (FootingS) .
.
Do not install subflooror pour floor slab untilth.
following applicable items have b~en sIgned:
Plumbing (Wat" Pip'.Sprink"r Valv.s)
tIIechanicill(Grou ndwork) .
E"ctrical (Underground Conduit)
Pre-slab (CompactionlM,,",br~ .R.. nt.
Underpinning (Floor Joist/Girders)
lXl not cov" or con""al the work below until the
following appll.cable items have been signed:' . . . .
1 st Floor Sh.ar . . .
Fiiesprinkler (Rough)
2nd Floor Shear . .
RQof (Sheathing/Diaphragm/Frame)
. Masonry (ReinfJBond BeamlPr...GIO\II) . . . .
Rough Plumbing :(Top Out) .
Rough Mechal)ical .
Rough ElectrICal (DryWall) . ..
Rough Electrical . . .
Framing. {Only after Plbg:, EJec.. Mech and Firel
Insulation (Sc;wndlEnergy) . I
Do not tape or pfaster until the following applicable .
items hay. been signed: . , . .. I
Drywall . .. . .
Penetrations (Fire Rated) Electrical . .
. Penetrations (Fire. Rated) Mechanical . I
Penetrations (Fire Ratell) Plurnbir!!!
Interior Lath . .
Exterior Lath .
. . GENERAL ITEMS. . ..
Exterior Plaster (Brown Coat) .. .
T -Bar Electrical
T -Bar Mechanical . . .
,T-Bar.Structural
Sewer . .
Water Engineering Backflow
Water Service .
FINAL INSPECTIONS Date ' Inspector' ,
Electrical, Final
Plu!t1bing Final, :
Mechanical Final . .
.',
Gas Test ..
Engineering/Grading Final 765-5126
Fire DepL Final 765-4040 ' ,
Water E,ngineering 765-5268
Sub List/Business 'License 765-519 ,
Zoning 765-5139 .
Building Final ~ast Inspection- Only , ~hr Pw,Cb
fter Above CO,mplete) ,
PARtiAL INSPEC ONS "
BuildinQ Inspections
,. MechanicallnsDections
Plumbina Inspections
Electrical Inspections
rf7V""~'" I
~~d~~~ 0Im3.'320__mmE_'m_mU2_4:~<:UYJA-__ CITY D~:A~TMEN~ OF
Jff-Site. BUILDING AND SAFETY
'abdcator ___S-~_;-.tSvL,-.DEI2-S- ________m__m__ BUILDING INSPECTION
~':;;;:~~r _n~~_p(;_;?,p.o5l-=__~q72,.,----- DATE OF I~JR5IC ~ 4
REGISTERED DEPUTY BUILDING INSPECTOR'S CERTIFICATE OF COMPLIAHCE
TO THE SUPERINTENDENT OF BUilDING: CITY INSPECTOR:
I hereby certify that the following portions of the work at the above address which
required continuous inspection, and which I was employed to inspect, were inspected by
me and comply with the provisions of the Building Code applicable thereto:
Type of inspection:
D Masonry 0 ReBar Placement 0 Concrete or Mixer
D Welding 0 Concrete Placement 0 Gunite
o Hi-Ten Bolts i 0 Tendon Placement 0 Other ___mn____m___ ._____________n___
Description and location of work completed: __t?_~:rPd.l....-_'1_I'!_J$_4m_______nmmnnn________
___________'L_?_J____!'._'2.I,.,._ld.m""S.m__4""_t;;,~_____g_______'$._'_~_3;;Z!J_~.Q__________
_____g____f!e_~~_'i.n5~~m~m.B~m__~!!?:::~m_PJ.f:L__!?_,g!.b~~~___________mmm"__
____m7t2_m_SPE..c./E:t..~D.____.L)~_,_______~______________m___m_mm_m____nmmm_nmm____
nmm_m4_K4.__m.LS._'_n___:LA-r__~m.et.A:r:e-mmm--ctO).-n1L~L-m--"-
n_nnmn_'fi)/._s:___nLS_L__n!!lnA/I~n_EAU/.-mel..J!t7:Enn--m-f?-(;?)---..rz:mtl.Lnm___
___n___________n__n___n_n__n___n__~n__n_______n_____n__n_______________n___________~nn_n____n________________.---------------.
n_mnnnS.tm-PSC>>-lnn.J;;;:e-C>:by.mmAEY?Ll-S/)~-----"-----nmm--mn------____m___
n_______Ili.L___MO_(,._r;;:;S_____J::UlLL l i;;;D __:nB._LO-'-<-2_Jnm CL_k,,;-AAi_m_"_m__
n_m.___~.!.T:.H._____Ca_l'YlPJ!E!E:S9:D-----A~nn~L/ I t::O.m__J;;-LUS4-m-m--
_nm__m0::!._I_EPCti'rLn_nnn_____nmn_m____n_-------m--n--'--n-mmn_mnnn_mmm___m________n_n___
._______n______n_n____~u_____~________~n_nu__~_nu_n__n_nn__n__n_____n______~_______~__u___n__'n__n_n~nn_________n____n
Size 01 Structure __ _COm_m_5ecJA:kn__m____________ Time Arrived mn.njO_4!1'1___n ----00----00--------
No. 01 Stor;e, m___mnm__m__mm_nnnmn__mmnn_mmmn_m____ Time Left Job ___mm12A1ao_,.J_mmmn'_
Cone. Mix Design No. ___'mnn_________nnmnmnn Psi nnm_nn____ Swimming Pool n_.___
, had sufficient time to inspect all materials used and placed.
I was not employed blthe contractor, subcontractor or material vendor.
_m_mm____mm__neQ_LB3_"'-Zmmmm_n_mm_m
Registration No.
. ,
G.I'lVY':.I.O Go:L~
.
P.l
DEANA DRAKE
15046 OCASO A n:.
T-A MIRADA, CA 90638
PH.H71./-739-187S
EACH INSpeCToR MUST COMPETE "O'IIS RIlPORT AND MAlL IT 'I"() TKE DISTl{t<. 'T OFFICI': 01' THE
BUILDING AND SAl'ETY DIVISION.
WEEKLY 0
FINAL 0
V7"<-I .,. n-
TOTAL TlME ON JOB (IN DAYS) ,. .lc::..... Dlm . DING PERMlT NO ~t}Z;DrSTlUCT NO
JOB ADDRESS: _..>?"?20 HI ({Prl.fJ.U.Il;' ~ CA- '12~
GENERAL CONTRACTOR: -:PA:Il.A-ht~ ClJ1Jsmucrll)t J
SIZE OF BLDG, ._ TYPE OF WALL NO.OF STORIES
TYPE OF WORK: REINFORCP.OCONCRETE D MASONRy 0
HI-TENSILE BOLTING Cl
PRESTRESSED CONCRETE t:J WELDING A. GYPSUM CONCIU::TE lJ
DES<;,RlPTfONOFWORKINSPECT. ED; -.C-oun4/~tltl . /NSFGe.t70A.} 0UR/M?j Rei
_'(U{>;U)/!j' OF wt;;l.E: 7x 4r.? '.R. F'R4MI'-I~ 0"'- ci2. A../au .
_. t1P~" J/M J 'h.' /rl--1<---wt!lb,. <; 1/-..$. p~, LI17J~ v-.SP&.' ~ -r~A-t/...K' ./J.Y
uflk . 5~ mJ r7D(. c;- .
-. ~=-o fjHV~~yJ., ~L..et'~;1[)6'_:g-N:;/J?. Htoc.ess~At
rer~ _~'I;)-
REMARKS:
,
s = ---p~l.-"
/A.J~L:IR. td4u...
?--/57 ....
LOCATION IN STRUCTURE:
OP,6V /.#9- '\
3/::;7
All \\"ork 00 lhisjob to date h:l& i:xx:n S3tisfnctoriJ)' cUlupJcaed a.ld ~ufunm; to lhe appt"o,"'1.:d pJMIS and requirements ollhe
A.I.S.C, and USC 97l11ld 01.12000.
Oq /ID;0;
Date I J
S~=r~
r I\JJ 1:l
,,'.
~ .-" '
TYP;::-OF PERMli
Tenanl.lmprovemenl (Extensive) C I'TV
DATE: 9/27/2004
JOB ADDRESS: 3320 E MIRALOMA AVE
'::;~i~1':';~;2"',
l~j,(1<J ,lrNfiHEI M
\, \ I$ ~S,;;::?f:'.f '
'\ ~, ,/jj"~:&'Yi l
'(~~YFtt:~'~,i~';t'
BUILDING'DIVISION
200 S, ANAHEIM BLVD,
,(714) 765,5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 144'
BUILDING PERMIT NO. BLD2004-02972
LEGAL DESCRIPTION: KRAEMER TR BLK K LOT 16 POR LOT AND',
i
APPLICANT: VINCE MASON i
OWNER INFORMATION: CONTRACTOR iNFORM,~TlON:
Concourse Joi'ntVenture PARADISE C<?NSlRUCi1jl'ON,INC
no E Wisconsin Ave ' 7241 GARDEN GROVE #F
Milwaukee, WI 53202.' , GARDEN GROVE, CA 92$f';10000 '
. ,', BUSINESS PHONE: 71479,:3239' '
JOB DESCRIPTION;enant Improvement. OfficeTI, conVert portion of wareno,,:i\e too -office and new mezzanine., (EXpress. PIC)
VALUATION: 720,000,00 \ ..' PROCESBED BY: MSM
I, . , , OWNER-BlJILDER'bECLARATloN'
I hereby a'ffirm under penalty of perjury that lam exempt from the Contract,' j \:~icense ,Law for the following reason (Sec. 7031.5 Business and
Professions cod e:~ ny city or county which requires a permit to ccnstri..ICt, '" /t,_in?8rovf)"demOlish or repalr any structure. pripr to its issuance, also
requires the applicant for such perl1}it to tile asigned.statementtha.tQG:,i~_!il~_sed"PW~Lia,[1t',tO)tleprovisions of the,Contractor's LIcense Law (Chapt~r
9)(commencing with Section 7000 of DiVision 3 of the}~usiness arid 'PrOfe$3j_l'nsGodeY~r t~a.Lne is exempt therefrom ~r.? the basis ,~or ~e alle!;jed ':
,;;emption; Any violation of Section 7031.5, by any applicant:,for a_permit SUBfGts the-applicant ~o a <:!vil pel'lalty of not more than five hun,dred dollars . .
[]O?,~~s owner, of p~. operty; or my emPloyeo~wfih wa,;j'" os thelrsorccom~.~~,;,'~.,",at,..;on, wiildo \ne work, and th" stru"tu,. is noi Intended br Offe...red for,,' .
sale (~ec. 7044, BUSlne~s and ProfeSSIons Code: The Contractor',') License .tJt,W:does net apPJY to an owner or propelty who butlds ormproves . .'
tt'"lereon, el1dwho does such work hims:12!1f or herself or threugh his or her 0\ynlnpfoyues. provided that such jmprovements mE: not intende~:or._ ..'.:>
: otfcre~ ,f9[ sa Ie.. _ If, .~o~-e~r, the build ing '.0~. imprg~ement is. sold with ''Jne 1-; :r' .)f co mpl e~i"n, the owns r-bu i!der '!" il! h av~ the burden of Proving' tnaJ, h~:::
did not l:)uiJd orirnprove for-the purposeof~le), ',,-:~>_; . _ ,~::'i" . . ., _ . . .
D, I,,,~'~n~owner of the property; am exClusively, c~\':tlact!ng with _J'iC:flnc'e~;~ prltrartors toconsrruct th~ prClject (Sa::: 7044 -B'usin~s and-Profession;:.
Code: . Th'i9r>..~tractor's Licen~_,.~~w does' ,':l9t ~PPly' to ano~wner Qf rror~rt:( )10. blliid:: 'or 'Improves thereof', and' who c.:mtrac~s for such -proj~~.:~~ll
~u::oi1tractor(:sj:J:cens_ect'pur.suant totheCcntractor's License La'!....). ~.' , ' _:.
LJ. ! am e;xenipt under. Sec. ~__~,' B '&?:C. for this reason: ___~._~_~_.__..
DatFi:' . ,.<: Ow:ner: . . _ _ ' l
[ ,"/" .',. WORKER'S COMPENSAtIONDECL,.'\RATI()t~-~___.....,,:..J
I herGbyaffirm under perral~fperjury ond of the,following dec!Rrations: .i- ' > .
LJ' I have .and w'iIJ mai~tai~ ,8 certificate of co~:~~nt t~ self-insu;'e for V.'or!<e-;'~-comr;ensatJon,
:3~ provid~. fO.. rby Se,ct, ion 3700 of the Labor Code. for the peiformanO'::;.OHr:_f'''vo~ fon.....h=d'
}. permit IS IS$l.Ied., . ..t
. I r~ave and will maintain worKer's compe~satloriirisUlance, as roqu:red iJr $p.ction- 3700 of
.: the Laber COd:e, for the performance of the 'workfor which this Dt)rrni[ is iss\JJ:! My worker's
CompensatiOn insura-nce carrier and policy are:' ..' 'i
~h~~~:ti:::: ~~~:;;::~~f:U:~~nnil is fO:O:~CYh:~~~e:OI:~ ~;2;,:t:~eSS
o I certify that in the per.fom1a~'d;ciithe Vo!9.f,k for ;"hrc!iJ'~'1S p:ermi~ iSis5.:~s}.;tt~hali not
employ any person in any manner so as to b~come subject tothework~r~)~t:~?:~ns~tion I~ws I
of Ca_lifomia, and agree thaf if I should ,become subje~ to the.wor:ker's G~.(O~ps~tiQn . '
provisions of Section 3700 ot"the Labor Code, hall forthwith comply with '~~~j:;e'proviG;ons..
Dat~: 9/27/2004 . Applicant: ~ "i
, WARNING:, FAILURE T.O SECU E WORKER'S COMPENSATION COV"f'~GE .IS ,
, UNLAW.FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINi\L PENA\:l:ES AND CiViL
FiNES UPTO ONE HUNDRED THOUSAND DOLLARS ($100.000),INAQP':l'Ot~ TOTHE'
COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI<;:f!J;~706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES "" " .
I ' " CONSTRUCTION LENDING AGENCY \.{ ,
I hereby ~ffirm llnder.penalty ofperj,~_rythatthere isa G()n~trt!qtio~_lend.ing;'.~~r:;.':lcy for the
-!Jljl'fOl~{nafrce-br1ff>1worif'ft}rwhiCli tnlS permit IS]S$Ueu.l$ec.3U97 .GjV~Gj:- - -^,,~-...,..------'--
Lerider;s Information: .
ARCHITECT/ENGINEER INFORMATION:
I LICENSED CONTRACTORSDECLARAT.!S>N .J
r I hereby affirm under penalty of peljllrYtHSt j Clr!i :".
I licensed under 'prov~it,ns of-chapter 9 (commencing .
1 '~ithSection,7000) of D'''''~.,.d "c.
I professiol~ " ',.' :
9/27/2.004" . . "
Date: 'Contractor.. .
-
NUMBER
797875
TYPE
'TYPE
EXPIRATION DATE
7/31/2006 .
B
MIC
Construcion Types:
VN, ,
Occupancy Groups:
B, B, , ,
fire Sprinklered?
Number of Stories
New I Additional Area:
T,I.Ar.,;,:
YES
1
4,966
5,115
I certify that I have read th)s application and state that the above information is correct. I
.agree to comply with all city, ordinances and state laws relating to building construction, and
. her by authorize representives of ~his ci~ to enter upon the above mentioned property for
ins ecti pu ~s~~ -~.
,. ~. 'Date: 9/27/2004
, _Signature of Applicant or Agent ,
.The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
6.869,55
Temporary Power Pole
Plumbing (DrainNVaste Pipe)
Electrical Ground Electrode/lifer.
SetbacklForms11'renches (Footings), 9.1~ -" M.: - .J
Do not install sub floor or p()ur floor slabunti I the
following applicable.items have been si,gned:
Plumbing (Water Plpe.SprinklerValves) .
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-sla.b(CompactionlMembrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unto! the
following appli.c_C1ple items have been signed: ".
1 st floor Shear .
Firesprinkler ,(Rough)
2nd Floor Shear
RQaf (Sheathing/Diaphragm' Frame)
Masonry (ReinfJBond BeamIPre-Gl'O\It)
, Rough Plumbing (Top Out) , '
Rough Mechanical '
I Rough E1ectncal(Dry Wall)
Rough Elecirical . ,
Framing (Only after Plbg.. Elec."Mech and Fire) U_q,...6~
Insulation (SoundlEnergy)
, Do not tape or plaster until the following applicable
items h.ave bee-~ signed: ' "~'
Drywall .', . '11(0/0,/ ~
,Pei1etratiOll$, (Fire Rated) ElectriCal ., . .
Penetrations ,(Fire Rated) Mechanical .
Penetrations (Fire Rated) P1umbil19
Interior Lath
Exterior Lath
, .
,
INSPECTION ,RECORD
.
INSPECTION
,
DATE'
'. GENERAL ITEMS
Exterior Plaster (BlOWn Coat)
T -Bar Electrical. . "
T-BarMechanical ..
T -Bar 'Structural
Sewer
Water Engineering Backflow
Water Service
f
.
INSPECTOR
'~
JV.
. .. "
,
~
1Jf. r~ . ,
1/
"
~.1.-1.."" /115,.,.~ '
,
.,
,
FINAL INSPECTIONS
,
.
,Da,e In~clor '
lmetl/'II.. ~ ~--"
II.tJI.fJ '/(~
r::r.;r ~ ~
\ ~
Electrical Final
,
Plumbing Final
Mechanical Final
Gas Test
Engii1eeriilg/Gracling Final 765-5126
Fire Dept. Final 765.'4040
Water E,ngineerilig 765.-5.268
.
1--1 "O't IP-K
,
,
Sub Lillt/BusinessLicense 76.5"5.19 Ii ~.Jo ~ SN/~/
Zoning 765.-5.139 A -
Building Final fLast lnspection- Only, "''"'7 _oU I ~ ~ j
)\fter Above Complete) I&' L I, (/ .1' ~
PARTIAL INSPECTIONS D .'
BuildinQ Inspections.. " .' '" ' , ' .
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1"PhimbinqlnSDections
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ElectricallnSDections
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