4528 CI'F'i OF CUT'171'11NO INSPECT10:: RECORD (Office Copy)
4528 933 Providence Courx
PI:PIAT 110. SANITARY DIST. NO. LOT N0. ADDRESS --
• Solar System Trujillo
PROJECT OWNER JOB SITE PHONE NO.
PER?IT ISSUED Date ELECTRICAL
Buildinc Date Insp.
Electrical Power Pole
Plumhinc Underground
Mochanical Rough Wiring _
'lean. Jas/I7,lcct. I;aIIs
Solnr Ceiling
Fire Snrinkler Fixtures Int/Ext
Sie.n Hotors
Grounding
Misc. Temp. Power
Other _
FINAL. INSPECTIONS Not Approved
Date Insp.
s PLUMBING
Electric
P1umbin , Date Insp.
Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Crarling Rough Complete
• Pinnnin . Solar Rough
Fire Dent. Plater & Insulation
Health Dept. Main Drain
T'uildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Ilembrane Ducts & Insulation _
Bond Beam Fire Danpers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One (lour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls
Other
Not A?nroved
BUILDING
•
ELECTRICAL
PLUMBING
MSECBANICAL
MISCELLANEOUS
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALI_ POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILOIYG APPLICATION & PERMIT 4528
AI
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
O ry PLANCHECK VALIDATION
NAME� TY. ELECTRIC PERMIT FEE
P XO
CONTRACTOR� ^ UTLETS-SWITCHES-RECEP 5.00/1.00
rp N LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 t�t
RE f
'�17�. PANELS 5.00 GATE OF APPLICATION ION
A CMTECT SIGNS 6.00 PLAN CHECK FEE P,C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADR, S ENG. 500 PERMIT VALIDATION
ADRESs SPECIAL CIRCUIT .
ZIP TEMP.METER OR POLE INS. PAILIJO
MOTORS SEE FEE SCH. /
ERV ICE CHANGENOV 1 10.
0 o o LICE CONTRACTORS DE( ARATION
Q u I hereby affirm that I am licensed under provisions of Chapter 9 CI y of Cuperti io ISSUANCE DATE
w lcommcncing with Sect'
00)of Division I( m ui un
y2 Professions d i ase is in lull lilt n BLDG. ELECT. PLG. MECH.
z o m Li certsu Class Llc.Number_ _ - - ❑ '� ❑
o Zt t Date_ Cmurielor_ _
BUILDING PERMIT
¢ Q wa (yW PR-BUILDER DECLARA'110 MA
U REFER TO ORD
K
LL I- I hereby infirm Thal I am excm Pt Isom the Conlr 'or's Liccree MISC.- L IO /FT.
F LL o a Law for the following reason.(Sec.7031.5,Business d Professions PERMIT ISSUANCE -6.00
Code:Any city or county which requires permit to construct.alter.
¢ o cuper inn..-
R< improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. �L= 1
E ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
m¢ he is licensed pursuant to the provisions of the Contractor's License (l
F z a Law(Chapter 9(commencing with Section 70001of Division 3 of the tY/�d�C fT
4 D Business and Professions Code)or that he is ev empl therefrom sod CITY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN -WATER (EA.) 4.00
of not more titan five hundred dollars($500).)'.
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended nr offered for sale: (Sec. 7044, Business .,at Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'['hc Contractor's License Law does not applY In an owner of
property who builds o mprovm'there0n,:md who docs sact,work F IXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
. himself or through his own employees,Provided Ota,such improve-
GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
ents are not intended or offered far.]].It,however,the building
m
or improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving that he did no,build or inn RES IND CON PB Omer
prove for purpose of sale.). INDUSTR I A L WASTEINTER. 20.00 E] E] ❑ E] C:)❑ I,as owner of the properly,am exclusively contracting with
Licensed contractors to construct ,he project(Sec. 7044.Business LAWN SPRINKLERS- 1 INC 5V B 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's Unease Law does not apply
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 contraclorto licensed pursuant,o
SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ tutu exempt under Sec. .B.&P.C.far this WATER HEATER W/VENT .00
reason
nate Owner WATER SYSTEM 4.00 ACC.-DATE ACC.FILE N0,
WORT:E RS'CONPENSYIION DECLARATION WATER TREATING EOUI
1 hcrcby ulllnn that I have a •rlil'icule con. to s IGinsure, ZONING ENG.SITE NO.
or x cerlificate of Workers-Co tP sa,ion uunm c, eertifi
copy 1 city cuperfilia
,here 1 - 00,Lab.0
Policy No: an Pant
❑ Cer,ibeit is here yfarmsh d. FIRE SPRINK ENERGYT24 -
Z 2 ❑ Cerlified coy is f •d wiOl m4ity inspection Division. MISC.- REFER TO ORD. y [:] N❑ y ❑ ry❑
Applicant
�zPERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U .c
fl - CERTIFICATE OF h."ENIPTION FROM WORKERS'
LU CONPENSATION INSURANCE PLG.CONTR. UC.NO. PLG
TOTAL Q Y ❑ N❑
CL O (This section need not be completed if the permit is for one ❑ N❑ Y
Z) 2 hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work I'or which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t- mit is issued,I shall not employ any person in any manner so as to
Qw become subject to the Workers'Compensalion Laws of California. BUILDING
a
Date Applicant ALTER OR ADD TO MECH. 4.00 T 7�
} to
NOTICE 'TO Should
if,after making,his Certrs'Coripe of fix-
F ? emotion,you should become subject to the W forthwith
Co"'ply with
APPLIANCE 4,00 PLAN CHECK
provisions of the Labor Cit shout
you mus, forthwith comply with FEE
U such provisions or this permit shall bu Jcuencd revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 3.00
CONSTRUCTION LENDING nCliNCy AIR HANDLING UNIT(OVER 10pO0C.F.M.) 5.00 SEISMIC FEE
I Hereby affirm ,hal there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
0 Information is correct, I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING d
ordinances and slate laws relating 10 building construction, and
hereby authorise representatives of this city to enter upon the BOILER-COMP Owl,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
Clq(We3 a c save, indeamify and keep harmless the City of MISC.- REFER TO ORD.
erlin again liabilities,judgments, costs and expenses which CONST.TAX
may in Cy sea accrue against s<City in conset Ience of tl PERMIT ISSUANCE 3.00
gr:mlin oI Ibis o Ruit. MECH.CONT. LIC.NO. MECH.T
r
TOAL TOTAL
Signature of Apel nt ntr:m[r D too
OFFICE FQPY