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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 .