15303POST THIS CARD N'EAR.FRONT OF BUILDING'
-
- CITY 01 CUPERTIN0 '
INSPECTION DIVISION'
,J' O- B INSPECTION,RECO,RD- ,:
0 �OK C- %i�
JOB ADDRESS UNIT# LOT#
,
OWNER' :� /✓E -V
TR( FACTOR q�'
PFRMIT Nl1MBER
15303
PERMIT-EXPIRATION
,,.i
PERMIT,EXPIRES IFWO'R`K'
IS NOT STARTED WITHIN '
18UDAYS OFPERMIT ISSU'' {
OR 180'DAYS.FROM '
LAST CALLED INSPECTION.
- INSPECTIONS • DATE" INSPECTOR
INSP TI ON. RECORD
FOUNDATIONANCE
'
NOTE: 'e•
ALL GRADING AND DRAINAGE SHALL •BE INSTALLED
WITH THE APPROVED PLANS AND CITY,OP
CUP.ERTINO STANDARDS.'
LIFER•-
PREGUN'ITETO'COMPLY
'
7 PBRAVT VALIDATION
'
-mss ''"
�. rE �.✓a,5 } /q E•
ISSUANCE DATE
GARAGE SLABS,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,•:.=
.UNDERGROUND/SLAB:
PLUMBING
- -
ELECTRICAL
MECHANICAL
.. , -
BLDG.
El
ELECT.
El
, PLG. MFcR.
El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT' ',1
INFORMATION,;
WOOD FLOOR
PLUMBING
'.:
� , -
f
VALUATION_
,
S/FT.
MECHANICAL
."ELECTRICAL--
0
�PERMIi U
,,TT
.4 C•��j�"'//
FRAMING
' INSULATION
RIES
TYPE CONSTR.
-
.. -.
]CC,:GROUP
. RES UNITS
PLACE NO SUBF.LOOR UNTIL ABOVE HAS BEEN SIGNED
' •
ROOF ' � � . �
NOTE: NO FINAL INSP. SHALL BE MA EFORE .
THE CONSTRUCTION TAXIS PAID ..
,.
$O. FT `FL(IOR AREA
�
TOTPLACNEAGE
•
DIAPHRAGM .. -
' -
ROOF SHEATHING
RES, •'INBUILDINNG USECONPB",
APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED -
FINAI 'DATE,':; a ".INSP.,.
ROUGH
SAN.q
ASSE SSORS PARCEL NO.
PLUMBING -
-
ELECT. ENERGY
TUBS &SHOWER PAN
PLUMBING ENERGY'
TRACT NO,
PARCEL NO,
MECHANICAL-
MECH.ENERGY -
ELECTRICAL..
BUILDING ENERGY
.ncc:Onre_
- +
Acc. FILE NO
FRAMING -
ELECT. FINAL TEST
INSULATION",..
PLUMBING
ZONING
ENG. SITE NO.•
GAS TEST _
GAS -
- -
-
MECHANICAL , -
FIRE SPRINK
Y ❑ ' NO
ENERGY Rdq
❑ ND
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR•SHEAR-
ELECTR CAL. RELEASE
FLOODZONC
Y 0.NO
- A.LUC.
Y ❑ N❑"
INTERIOR SHEARFIRE
DEPT:
SHEETROCK-,. -
GRADE -
FEE SUMMARY '
EXTERIOR LATH ••
BUILDING �=
-
BUILDING,
•' "
INTERIOR LATH • ' -
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
t„
.
-
GAS -.
NO TAPE,OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING I NSPECTORI
MICROFILM
ARRANGE FOR INSPECTION.BY PHO NI NG' 2524505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
o:� PLEASE GIVE JOB ADDRESS, WHEN PHON,ING.,', '
z
= SEE PERMIT FOR EXPIRATION,DATE —
ELECTRIC" "
PLunnelNG'
MECHANICAL,
CONST. TAX
IMPORTANT'!' ": >
PLEASE READ REVERSE SIDE BEFORE h.y
CALLING FOR FINAL INSPECTION. '.
.'TOTAL
OFFICE COPY'
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENT] FICATI ON
-
APPLICATION &PERMIT.
BUILDING —ELECTRICAL— PLUMBING — MECHANICAL
I PERMIT NUMBER
_ �, C 0 .
i'ae J
XIiAl ss -
NAME R'S
NA
TPHONE �.J
Y. - ELECTRIC PERMIT ' FEE .I
PLAN C HECK VALIDATION
.. -
+
DATE OF APPLICATION.
C TR ACTOR
NAME _ ��
�kLIE. No L'?hVL)
OUTLETS LSWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES. .10.00/1.00
coNTRADTOR's -
R, I, l:�k PHONE Q
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
CHRo SET
OR'
ENGINEER
LIC. NO
PANELS (OVER 200 AMP)- 20.00
PLAN CHECK FEE P.C. NO.
ISIGNSTRANS. 3.00
ARC .EOOR. ENG_
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
"
'ISSUANCE DATE _
BLDG. ELECT. PLG. MECH.'
[-1 ❑ -❑
TEMP. METEWOR POLE INS. 20.00
APPLICANT'S
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 2600
LICENSED CONTRACTORS DECLARATION' -�/,/�
I hereby affirm that I am licensed under poo' islonsof Chapter9
(commencing with Section 7000) of Division 3 of the Business and
Professions Coda, a d ny I' me is in full force en e
License C ass Lie. Number
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm [earl am exempt from the Contractors License
Law for the following reason. (Sec. 703 L$, Rusinessi nd Professions
Code: Any city or county which regmiresapermit to construct, atleq
Improve, demolish, or repair any structure, prior to Its Issuance, also
requires the applicant t t Such permit to filo o signed statement that'
pursuanttothe provisions of the Contractor's License
he is (Chapter
- law (Cha nd ProcommeoC de) or Section is 00) exempt theref om the
Business and Professions Code) or that he Is exempt therefrom and
and
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500)J:
❑ 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_sale (Sec. 7044, Business and Professions
Code The Contractor's License Law does not apply to an owner of
prOperty who builds or improves th ClCml, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. If, however, the 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 im-
prove for purpose of sale.).-
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law doesnotapply
to an owner of property who builds or improves thereon, and who
contracts for Such projects with a contraetor(s) licensed pursuant to
the Contractor's License Law.
❑ l am exempt under SeC. ,B.&P.C. for this
reason
�r
_ -
BUILDING PERMIT
- INFORMATION
MISC. — REFER TO ORD
'
PERMIT ISSUANCE - 10.00
VALUATION
.
$/FT.
ELEC. CONTE. V LIC. NO.
.
ELEC.
TOTAL
PERMIT TV
•C`�L��.VK// '
QTV. PLUMBING PERMIT FEE
• STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER IEA.) 5.00
. .
BACK FLOW PROTECTDEVICE 400
, OCC. GROUP
RES. UNITS
_
-
DRAINS -FLOOR, ROOF, AREA,COND. 5.00-
FIXTURES -PER TRAP - 5.00
GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6.00
SQ. FT. FLOOR AREA
G
_
TOTAL ACREAGE;
GAS - EA. SYSTEM -.OVER 4 (EA.)- 2.00
BUILDING USE .
RES IND CON PB otne,`
RE 1:1"
INDUSTRIAL WASTE INTER. 30,00
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00ASSESSORSPARCEL
_ No.
LAWN SPRINKLERS- OVER 5 (EA.) . 1.00
SEWER -SAN ITAR V -STORM EA'; 200ft/10.00
r TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Date
WORK IIRS'COMPENSATION DECLARATION,
1 hereby affirm that I have a certificate ofconsent to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
Copy mei& •.' `„14bfQss
Policy N -p_
❑ S,Citified copy is hereby furnished. - �
et %_ cr nqK is `ed witl�ctyy v -tion division.
Applicant Ali\ Is 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be cormleted if the panni[ is for one
hundred dollars IS 100) or less.) I
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Dalc - Applicant
NOTICE TO. APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must I'utlhwith comply with
such provisions or this permit shall be deemed revoked:
- CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, .
Lender's Name
WATER SYSTEM - ,' 5.00
ACC. DATE
ACC. FILE NO.
-
^END.
WATER TREATING EQUIP. 5.00 -
ZONING
SITE NO.
� �� � �`
- FIRESPRINK
, V N
-ENERGYT-24
V N
D
MISC. -'- 'REFER TO ORD
PERMIT ISSUANCE
FLOOD ZONE
NEl
A. L. U.C.
V ❑ N
PLG. CONTR. - LIC.PO.;
r - °
PLG. - r`
TOTAL .
_ \
QTV. MECHANICAL PERMIT A 5E
a _
FEE SUMMARY
BUILDING
ALTER OR ADD TO MECH. 5.0
APPLIANCE 5.00
PLAN CHECK
FEE
y
AIR HANDLING UNIT (TO 10)000C.F.M.). 4,00
AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00
SEISMIC FEE
'
EXHAUST HOOD (WITH DUCT), 5.00
HEATING UNIT (TO 100,000 B.T,U.) 8.00
MICROFILM
'
am
Lender's Address
I certify that l have read this application and state that fire above
information is correct. I agreeto comply,with all city and county
ordinances and state laws relating building construction, and
m
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
uertino against liabilities, judgments, costs and expenses which
y
main y way accrue against said City in consequence of the
rantir Itis pen 'L %�
1
HEATING UNIT (OVER 100,000 B.T.U.)8.50
ELECTRIC
VENTILATION:FAN.(SINGL'E) 4.00
BOILER-COMP13 H.P. Dr 100,0008.T.U.) 6.00
PLUMBING
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
'MECHANICAL
MISC.'- - REFER TO ORD.
PERMIT ISSUANCE10.00'
-
CONST. TAX
-
E CONT. LIC. NO. - MECH.'
GTAL
TOTAL
Sig a re of Applicant/Contractor
v OFFICE COPY .