1428 CANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALI. POINT PEN O
BU I LDING PROJECT I DENTIFI ON IsR IT NUMBER
'BUILDING APPLICATION & POIT
7 1428
ADDRESS q
I8vo W, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
NAME S vJ PLAN CHECK VALIDATION
I. n��l"3�I�Z DTV' ELECTRIC PERMIT FEE
N
( / t✓I I C V M PHONE Ia✓
CONTRACTOR s —�' C OUTLETS-SWITCHES-RECEP 5.00/1.00
GULS �//Cue.ND.3yJ O LIGHTING FIXTURES 5.00/1.00
]c ADDRBAcrDR3 APPLIANCES-RESIDENTIAL 4.00 f
ADDRESS �T �1
S1;'RA S'YVL P....26oL_gg0o PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLANCHECK FEE P.C.NO.
OR
ENGINEER LIC,NO, SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00 91i�
ADDRESS MOTORS SEE FEE SCH.APPLICA
SERVICE N P 10.00 ��Y/,/q�,
U 0 o LICENSIiD CONTRACTORS DECLARATION
DEC
/�0
a �u/ 1 hereby affirm that I am licensed under provisions of Chapter 9 ��
w< v0 (commencing with Section 7000)of Division 3 of the Business and I) ISSUANCE OATS
F o 2 Professions Cade,,nd my lice tle Is in full fu •• s.Ft� BLDG. ELECT. PLG. MECH.
Licen Class Lic.Number 3
O m= Dale(iV�ContraelorVl.�—=Y --._.-
a >: f BUILDING PERMIT
Ea a a OWNER-BUILDER DECLARATION.
a to U - INFORMATION
wg. y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
F [Loa' Law for the followingreason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 6.00 VALUATION E/FT.
WNu Code:Any city or county which tequiresu permit to constrict,alter, ,per
re a ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �/ �O
a a requires the applicant f or such permit to file a signeA statement That TOTAL ,
a w he is licensed PmSuanl to The provisions of the Contractor's'License PERMIT TO
Fi >m Law(Chapter 9 (commencing with Section 7000)of Division 3 ofthe �OdL .SLI La
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
R f $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3 by any applicant for a permit subjects the applicant toa civil penally ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(5500).',
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE
their sole compensation,will do the work,and the structure is not 2-6Q OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professlons DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves Ihereon,and who does such work FIXTURES,PER TRAP 4.00 SO,PT FLOOR AREA TOTALACREAGE
himself re through his own employees.Provided that such ibuildi r .
or nts Unprovemenotnt is Sold or within
one year e.
If,however,the theo nee. GAS-EA.SVSTEM-11NC.40UTLETS 4.00'
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA ) 1,00 BUILDING USE
builder will have the burden of proving that he did not build or ire- GAS . - .
- RES IND CON PB Omar,
prove for purpose of sale.). INDUSTRIAL WASTE INTER2000
U 1,as owner of the property,am ex Clasively contracting with . .
Q El 0 ❑ ❑
licensed contractors to construct the project(Sec. 7044,RUsincss LAWN SPRINKLERS-1 INC-5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner Of Properly who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects will,'a connotations)licensed pursuant Do
the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/8.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under S11._,U.811'.C.for fix WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMI-ENSATION DECLARATION WATER TREATING EQUIP. 4.00 '
I hereby affirm that I have a certificate of Conten....telt-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy Thereof(Sec.3800,LWC.17 j�H ICa2
Policy No. Company ff
O ❑ CertifiedcOpylsllerehyfurnislled. FIRE SPRINK ENERGYTY4
Z Z �Cenified 'o, fil1eed with th+:7s;ilY inspection division. Y N� Y N�
O Applicant�,ljyl.lt'�Yp �//- MISC.- REFER TO ORD.
~ �+ PERMIT ISSUANCE 6.00
Lu CERTIFICATE CENEXEMPTION NS PROM WORKERS' FLOOD ZONE A:LU.C.
W � COMPIiN&U'ION INSURANCE: PLG.CONTR. LIC.NO. PLG,
1 O ('This section need not be completed if the permit is for one TOTAL O� Y❑ N Y ❑ N❑
Z hundred dollars(S 100)or Ions.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
W I— mil is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
U d Date Applicanta ALTER OR ADD TO MECH. q•QQ BUILDING
} W NOTICE '1'O APPLICANT: If,after making this Certificate of lix-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shalLbe deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.EM.) 5.00 SEISMIC FEE
I hereby affirm that 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 HEATING UNIT 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I certify that I have read this application and. style Ihut Thu above VENTILATION FAN (SINGLE) 3.00 information is correct.I agree to comply with all city and county PLUMBING Cj
ordinances and state laws relating to buildingconstruction, and BOILER-COMP(3H.P.Or 100,000 B.T.U.) 4.00 ,
hereby authorize representatives of this city to enter upon the BOILER-COMP IOVC(100,000 BTU)SEE FEE SCH, MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue gainst said City in consequence Of the pp
in of 11's it MECH.CONT. LIC.NO. TOTAL QJ
/2-29—�/ r
ig atureol'Applicand dntructor nmB TOTAL
OFFICE COPY
l g 8 � w sz�,ti e�
� \ \j\
V�
CITY OF CIORTINO INSPECTION RECORD (Offi*opy)
+ 1428 21886 Wilson Ct.
PER11IT NO. SANITARY DIST. NO. LOT 110. ADDRESS
Pool Solar Linthicum 255-3402
PROJECT OWNER JOB SITE PHONE NO.
Date ELECTRICAL
Bluilding, 12-29- 1 Date Insp.
Electrical 12-29-81 Power Pole
Plumbing 12-29- Underground
Mechanical Rough Wiring
Temp. Gas/Elect. Malls
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sign Motors
Grounding
Misc. Temp. Power
Other
FINAL INSPECTIONS Not Approved
Date Insp.
Gas
Eectrl
ic PLU11B ING
Electric
' Plumbing Backflow Date Insp.
Mechanical Underground
Solar 3C-9Y Underfloor
Pool Partial Rough
Grading Rough Complete
Planning Solar Rough
Fire Dept. Water & Insulation
Health Dept. Main Drain
Building R/of/S Drain
Other Gas
Other
STRUCTURAL Not Approved
Date Insp.
Pad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Hembrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & Hood
Tiedowns One Hour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
[falls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Wallboards Int/Ext.
Firewalls
Other
Not Approved
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS