13668 `POSTTHISCARD,NEARFRONT OFBUILDING
PFRMIT NUMBER
CITY, OF ,CUPERTIN0, , 1;36x8
(INSPECTION DIVISION
JOB INSPECTION RECORD
' I "�' . PERMIT EXPIRATION •�
JOB ADDRESS�U �� �19 NJ�'�y "' '•UNIT#- L'OT#
PERMIT EXPIRES'IF WORK •oy,
owNER GONTRACTOF 'E aP� G - IS NOT STARTED WITHIN
INSP ION
/'DATE INSPECTOR' INSPECTION RECORD ^,• 180 DAYS OF PERMIT ISSU.
FOUNDATION,.. ae • -ANCE OR'180 DAYS FROM
- - ;.,�. , ',LASTCALLED INSPECTION.
LEER g
" PR E.G.UN ITE. �, _ _ PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �'.• l. ..•� " ^^
- UNDERGROUND,' SLAB h, •,- .• �,, ,rr
.. PLUMBING P -.
Pp
�Tr ELECTRICAL , 11), ISSUANCE DATE "
MECHANICAL .. ! - - BLDG ELECT. PLG„ MECH,
JUN 6 `.:�6 I] j ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. $ 14DINc'PERMI7• ` � s
„ WOOD FLOOR, . CI�JI 01 upeltlllFORMATION
VALUATION $/FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
V FRAMING - .,,,E L, dL. /, - -
`INSULATION i „�, ,. .STORIES TYPE CONSTR.
- � 1 OCC GROUP RES.UNITS '
PLACE"NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED:
1 ROOF $O.FT.,FLOOP AREA TOTAL ACREAGE '
1
DIAPHRAGM ' �`
BUILDING USE
- '•HES' IND CON PB Other
'APPLY"NO ROOFING UNTIL ABOVE HAS BEEN SIGNED" a •Y . {• '❑
ASSESSOEl RS PARCEL ARcEED
" •r - 'ROUGH' - a:. -
PLUMBING .V - *�
GAS TEST + TRACT NO:. PARCEL NO.
? MECHANICAL '. " r
ELECTRICAL �,FINALS""" ` 7 K,,tJ°DA>TiE"A .:.:INSP, ACC.DATE Acc.FILE NO,
' FRAMING '[ ` SAN -
. y- .ZONING ENG SITE NO:
.INSULATION PLUMBING, a
GAS
- FIRE SPRINK .ENERGY T 24
�.., MECHANICAL
ICOVER NO WORK•,U•NTIL''ABOVE.HAS'BEEN SIGNEOh-x1 HEATING; ❑ NE] ❑ ��
'LATH-INTERIOR" ELECTRICAL . FLOOD ZONE •n.Cu.c.
LATH:'EXTERIOR _ - FIRE`DEPT>:':
❑ N❑ Y
SHEETROCK _ 'y GRADE„� FEE SUMMARY]
SHEAR INTERIOR - BUILDINGl”
SHEAR EXTERIOR TEMPORARY APPROVALS Bul[nwG
FIREWALLS " ELECTRIC."j •:PLAN CHECK `
_ GAS. "e, -
:,FEE
0JAPE OR PLASTER UNTIL ABOVE HAS BEENISI,GNEDII OCCUPANcyY %�, *SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL'BUILDING FINAL IS SIGNED BK BUILDING INSPECTOR,;;MICROFILM
" ARRANGE FOR INSPECTION'REE ONING SPEC05, ELECTRIC k ; •�
1.. 'ONE WORKING DAY BEFORE REC UIRED LNSPECTION .PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN-PHONING:'
SEETERMIT FOR EXPIRATION DATE MECHANICAL '
,
IMPORTANT! CONST.TAX' .
PLEASE READ REVERSE SIDE BEFORE, TOTAL •
CALLINCrFOR FINAL INSPECTION:?,
OFFICECOPV •+ '' a
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . .
- -
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT
' Ru ILDING
ADDRESS 2 - ' 13,668
0✓$� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S ' I _ PLAN CHECK VALIDATION
NAME €' - `
A,/�y,G ELECTRIC PERMITp _ --FEE 7�
NAMERACTOR's ��/ OUTLETS-SWITCHES-RECEP 10,00/1.00, -
uc.No. :� LIGHTING FIXTURES 10.00/1.00'
COMIRACTOR'S
ADDRESS \C/t APPLIANCES-RESIDENTIAL 4.00 -
.y,�HONWil PANELS 10.00 S DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER ��-MI• e1M_0?
J1�A (m���i�q,.�/'R SIGNS TRANS: , 3.00
ARCH,OR ENG. p PERMIT VALIDATION
ADDRESS v Sll�{[E2. ,�AI , SPECIAL CIRCUIT 5.00 ,
Sk^1olp Ga zl EMP.METER OR POLE INS. - 20.00
ADDRESS MOTORS - SEE FEE SCH. (/E,gl•-7, y�,x�''.-`r'-'_
-
ADDRESS (� � (' I
0 .J �I ti SERVICE CHANGE - 20.00
w
00 LICENSED CONTRACTORS DECLARATION
w
G Z w 1 hereby gaffirmwith
dna[I am licensed under provisions of the of Chester 9 ISSUANCE DATE
y G $i (commencing with Section 700e)i of Division 3 of the Business and BLDG- ELECT. PLO. MECH.
F w z Professions Cod n my license is in full fore sSreflyet� 13. ❑ ❑
O Z m C License Cl s Lic.Numbe ST/Gl �J -.- " D
L r Date Contraclo -F
¢ z w¢ OWNER-BUILDER DECLARATION ' BU14, ING PERMIT?"
a " _}INFORMATION,. r *;
-is g;e N I hereby affirm that 1 am exempt from the Cmttlecmr"s License MISC.- REFER TO ORD
HUOM Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE IN VALUATION $/FT.
Code:Any city or county which requires permit to construct,alter,
¢ 2 Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC. '0. ELEC. n0
n X- O¢ requires the applicant for such permit to file a signed statement that 1313 TOTAL '
2 he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
iii Law(Chapter 9(commencingwlth Section 7000)of Division 3 fthe 5 - '- - - '
EE sr Business and Professions Code)or that he is exempt therefrom and QTY`S xy$:t PLUMBING'PEJ IT- " t -. FEE
¢ H m. the basis for the alleged exemption.Any violation of Section 7031.5 L T r '' - " y " " ' STORIES TYPE CONSTR.
s- 3 � by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(S500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00 -
❑ [,,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole Compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who buildsor improves thereon,and who does such work FIXTURES=PER TRAP 5.00 $0.FT.FLOOR AREA .TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS' 6.00
or improvement is sold within one year of completion, the owner-
builder will have the,burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) , 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL'WASTE INTER: 30.00 RES IND CON PB Other
El 1,as owner of the property,am exclusively contracting with
licensed contractors tD construct the project(Sec.7044,BusinessLAWN SPRINKLERS=1 INC 5 VB600 ASSESSORS PARCEL N0.
and Professions Code:.The Contractor's License Law does not apply V.B. .
to an owner of property who builds or improves'thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
-❑ I am exempt under Sec. 4 ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Dater _ - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATIONWATER TREATING EQUIP. -
- 1 hereby affirm that I have a certificate'of consent to self-insure,
or a certificate of 3800, a'Compensation ,Iy�,,n Or a certified ZONING ENG.SITE N0,
copy thereof(Sec.Work s'Com. GQQpq CJ
Policy No. Company KS
Q ❑ Certified copy i5 bereby,turrushed. FIRE$PRINK ENERGY T-Z4
Z Z d( Certif1 coy is fled with the city i spection division.
O Applicant MISC.-' REFER TO ORD. Y 1:1 NYE) N�
w
CERT AEVV E PTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
W COMPENSATION INSURANCE PLG.CONTE, LIC.NO, PLG.
CL (This section need'not be completed if the permit is for one . TOTAL Y 0 N Y N
0 Z hundred dollars IS 100)or less) -
U O 1 certify that in the performance Of the work for which this per. y,' { FEE SUMMARY
F mit is issued,I shall not employ an 07Y- MECHANICAL PERMIT ` FEE
LL p Y y person in any manner so as to - ' f r ;,
. Q w become subject to the Workers'Compensation Laws of California,
y Date Applicant ALTER.OR ADD TO MECH. 5.00 BUILDING
FN NOTICE,TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workers'Compensation' APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 110MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10ACC.EM.) 6.00 SEISMICFEE
17hereby.affirm that there is a constructiongending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance,of the work for which this permit is issued(Sec, MICROFILM
3097,Civ.C.). - ' HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 , ELECTRIC
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 - 1 -
information is correct, 1 agree to comply with all city and county BOILER-CUMP13 H.P.Dr 100,000 B.T.U.) 6.00 PLUMBING
ordinances and slate laws relating to building construction, and
herebyovauthorize representatives of this city to enter upon the g01 LER-COMP(Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(W ) agree to save; demnify and keep harmless the City of MISC.- - REFER TO ORD.
Cu rt no against Iia di ,judgments, costs and expenses which, CONST.TAX -
y.' any ac a gains[ said City consent ce of the PERMIT ISSUANCE 10.00 .1
a .g I is p MECH.CONT. ; LIC.NO, MECH. - "
}, TOTAL TOTAL
IT are of ica tractor Da '
OFFICE COPY
i.