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10227POST THIS CARD NEAR FRONT OF BUILDING CITY OF * P CU ERTINO. PERMIT NUMBEF � 0227 INSPECTION DIVISION JOB INSPECT RECORD l + PERMIT EXPIRATION JOBADDRESS .UNIT #, 'LOTwjm # ..i + + PERMIT EXPIRES IF WORK OWNER - CONTRACTOR 5 IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPEC ION RECORD 180 DAYS OF PERMIT ISSU-' FOUNDATION ANCE OR 180 DAYS FROM UFER - LASTCALLED INSPECTION. PR EGUNITE PER MITjVALIO TION w POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ! - ELECTRICAL - -ISSUANCE DATE MECHANICAL - BLDG. LECT. PLG. MECH. ...t"� ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR -, INFORMATION PLUMBING - VALUATION $/FT. MECHANICAL - ELECTRICAL - - PERU o FRAMING - ' INSULATION - .. - - S TORIES' VPE CONSTR. OCC. GROUP RES.UNITS , PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED. 'TOTAL +y ROOF SO.FT.FLOORAREA ACREAGE DIAPHRAGM BUILDING USE • RES IND, O PB 00,P, APPLY NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED - ❑ ❑ ❑ ROUGH -, ASSESSO 5 ARCELNO. - PLUMBING - GAS LEST ., TRACT N0; PARCEL N0. MECHANICAL ' ELECTRICAL ,�'/-g FINALS DATE INSP. ACC•DATE ACC. FILE NO. , FRAMING SAN # INSULATION � - PLUMBING - ZONING' ' ENG.'SITE'NO. GAS MECHANICAL FIRE SPRINK ,ENERGY T2. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ No ❑ NE] LATH -INTERIOR ELECTRICAL FLOOD 20NE A.L.U. C, LATH—EXTERIOR - FIRE DEPT. E 'L y ❑ N -° ❑ NE] SHEETROCK GRADE FEE SUMMARY " SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING - - FIREWALLS ELECTRIC PLANCHECK - GAS ., .{. ,. FEE .. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM; ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC UJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PwMew'c PLEASE GIVE JOB ADDRESS WHEN PHONING: IJ —SEE PERMIT FOR EXPIRATION DATE — MECHANICAL - IMPORTANT! - '.CONST. TAX PLEASE READ REVERSE SIDE BEFORE', TOTAL CALLING FOR FINAL INSPECTION. .• OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .6UI LDI NO PRWECT I DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMITNUMBER 1 10227 DILOING,y��11f - ApoREss SAS✓ ✓Ciivw/ /Q,O . OWN En'a PHONE 'dTRACTORS OTY. - ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NAME a2,SJ- LIc. rvO. OUTLETS-SWITCHES-RECEP 10.00/1.00 ,p LIGHTING.FIXTURES 10.00/1.00 CONTRACTOR'S AooREss PHONE A Fin LIANCES-RESI DENTIAL 4.00 g,pp PANELS 10.00 ogcHlrecT p,-'� �� SNC' F✓ ENGINEya✓Ix/C//ti Jtt+e✓ [y TYL' 62!x. NG. ar-%96 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ' SIGNS TRANS. 3.00 ADDRESS ENO 9)� TµU �G4T�q 141J 4-1 519 nP r'/S SPECIALCIRCUIT 5.00 PERMIT VALIDATION PAID ryryt /U�I IIILC-,i CIV of u8ertino SUANCE ATE BLDG. ELECT. PLG. MECH. I ryTl LW EMP. METER OR POLE INS. 20.00 APPLICANT $ ADDRESSMOTORS 4W 4 -ADDRESS 'Z SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON 'PRACfORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ]00e)i of Division 3 of the Rosiness anti Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason.(Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit reconstruct. alter, improve, demolish, or repair any structure, prior to its issuance, also mouims the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basic(or lhealleged exemption. Any violation of Section703L5 by any applicant for a permit subjects the applicant tqa drcivilpenalry of not more than five h med dollars (5500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intruded or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to an owner of .properly who builds or improves thereon, and who does such work himself or though his own employees, provided that such improve. +Its are not intended or offered for sale. If, however, the building WId1' provement is sold within one year of completion, the owner- er will have the burden of proving that he did not build or int. prove for purpose of sale.). ❑ 1, as Owner of the property, am exclusively contracting with licensed contractors to construct the project (See 7044, Business and Professions Code: 9'he Contractor's License Law does not apply to an owner of property who builds Or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sec.., B.&P.C. for this reason TEMP. POLE 30.00 ` Q ertino BUILDING PERMIT BINFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 1 19-1 G-/ $/FT.Y ELEC. CONTR. LIC. NO. ELEC. '/ TOTAL / 07,00 PERMIT TO CITY. PLUMBING PERMIT FEE' STORIES TYPE CONSTR. ALTER -DRAIN -WATER IEA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ROOF, AR EA,CON D. 5.00 FIXTURES - PER TRAP 5.00 SO. FT, FLOOR AREA TOTALACREAGE GAS- EA. SYSTEM- 1 INC.4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND c N PB Omer INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSo SPARCELNO. - LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/1 O.DO TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 1 Owner 0ute.21'yld WORK FRS'COMPENSAT' N DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab.C.E Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 I ZONING ENG. SITE NO. MISC- REFER TO ORD. FIRE SPRINK Y E] N � ENERGY T -Z4 Y ❑ NE] CERTIFICATE OF EX17MP-FION 17ROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall nor employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00 FLOODZONE Y [] N� A.L.U.C. Y [] N� PLG. CONTR. LIC. NO.PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after noting this Certificate of ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONS'fRUCI'ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name Lender's Address -,`J certify that I have read this application and stare that the above '+formation is correct. I agree to comply with all city and county �nces Ind state laws relating to building construction, and )authorize representatives of this city to enter upon the mentioned property for inspection purposes. A (rv,) agree to save, indemnify and keep harmless the City of 64pertino against liabilities, judgments, costs and expenses which may in any way n true a•ainst said City in consequence of the gating of this To L a f. i APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4,00 AIR HANDLING UNIT (OVER 10PWC.F-M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER- COMM H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. N0. MECH. TOTAL TOTAL g9 X16 z iggaatum of Applicant/Cont ctor - Date OFFICE COPY