0280 (2) CIFY OF CUPERT'INO INSPE.CTIOt RECORD (Office Copy)
0280 10580 Glen View-.-
m:pi 'T P10. SANITARY DISI. NO. LOT NO. ADDRESS
lip Plumbing Cortney 257-1710
PROJECT 01-11TER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
5u LI din f,, Date Insp.
Electrical - Power Pole
Ptumhinr 9-1-81Underground
1lcchanIcal Rou th f•liring
Temp. Gas/1',Iect. fJnIs
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext
Sin Ifotors
Grounding
Hisc. Temp. Power
Other
FINAL 111SPECT10NS Not Approved
Date Insp.
r,a.s
PLUPfBING
Electric Date Insp.
Plnmbin , Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Gradin Rough Complete
•
Planning Solar Rough
vire Dept. Nater & Insulation
Health Dept. 'fain Drain
Puildin R/of/S Drain
Other Gas
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Poundatinn Date Insp.
Pre-Gunite Underfloor S.M.
Slab-liembrane 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
halls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
llallboards Int 1',xt .
Firewalls
Other
Not Aproved
s
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_
BUILDING PROJECT IDENTIFICATION PERMIT U B
BUILDING o
APPLICATION & PERMIT 20
•
DOBE
Q BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 8
OwNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00
.no LIGHTING FIXTURES 5.00/1.00
ADDRESS
PPLIANCES-.RESIDENTIAL 4.00
ADDRESS
PHon 1� PANELS 'n 5.DO DATE OF APPLICATION
oRRCmTECt •
SIGNS 600 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC,No. SIGNS TRANS. 3.00
moo EOS,SS ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
'ZIP EMP:METER OR POLE INS. 15.00
APDRESSILICANs MOTORS SEE FEE SCH.
AD '
SERVICE CHANGE 10.00 -
Oo LICENSED COWRACTORS DECLARATION
A u u I hereby affirm that I am licensed under provisions of Chapter 9 EpF ISSUANCE DATE
Na (commencing with Section 7100)of Division 3 oLthe Business and
Q - - -
r 0 i professions Code,and mBLDG. ELECT.y license is in full force and effect. El 1:1PLG. MECH.
❑z 0 R- License Class Lic.Number r j
Q z R w Date Ciamouctor t
a r BUILDING PERMIT
wu OWNER-BUILDER DECLARATION - INFORMATION
S ry H I hereby affirm that Im cw
�aexempt from the Comrur's LiceMISC.
nse REF D VALUATION 5/FT.
Law for tire re
e following ason.(Sec.7031.5ess
.Businand Professions PERMIT ISSUANCE' g,00
� mw Code:Any city or county which requiresa Permit toconstnleL alter,
st0 nnpr0va,Demolish,Or repau any stmcture,poor 10IIS Iswanea,x150 ELEGCONTR. LIC.NO. ELEC.
o u regmprt the applicant for such permit to file a signed statement that TOTAL
w$m he is licensed pursuant to the provisions of the Contractor's Licence PERMIT TO
F z r Law(Chapter 9(commencingwith Section 7000)o(Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
u ; by'any applicant fora permit subjects the applicant toacivil penalty
ofnot more than fivehundred dollars(S510).): ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 2.00 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. 4.00
Code:The Contractor's License Law does not apply to an owner of
property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE
. himself or through de own employees,provided thin such improve-
mcnL�amnot immnhisownemreoyees,sale.11, that
gthc building. ' GAS-EA.SVSTEM-11NC.40UTLETS 4,00
or Improvement A sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 1,00 BUILDING USE _
builder will have the burden of proving that he did not build or iIn RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the prolway,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licemed contractors to construct the project(Sec. 7044.Business 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
reason exempt under Sec. B.&P.C.fur this WATER HEATER W/VENT 4,00 eQ
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 -
1 hereby affirm that 1 have a cenifeme of consent to sell-insure.
m�Payycertificate of Workers Compensation Insurance,or a tt4thled ZONING ENG.SITE NO.
CP>F 1hercot(Se 61m247 11 bpab y 1
oto n iV
O Cert died copy Hhereby Immshed. 'FIRESPRINK ENERGY T 24
Z Z Cenif,ol led with the city inspection division.
_ -JY.f:•_ MISC.-' REFER TO ORD.
O pplicun[ _ y❑ ry❑ y ❑ N❑
XT CER'HFICAI'EOF E%EMPHON FROM WORKERS' - PERMIT ISSUANCE 6.00 FLOOD ZONE AL.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. _\
OL O (This Section deed not be completed if the vcmut Is for one TOTAL O wCJ v❑ N❑ Y ❑ N❑
Z) Z hundred dollars(SHOO)or less)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any Perron in any manner ro as t0
become subject to the Worker,Compensation Laws of California.'
O CL Date Applicant ALTER OR ADD TO MECH. 4-00 BUILDING
} 0 NOTICE '1'0 APPLICAN'1: 11,after making this Certificate of Es-
FZ emptian,you should become subject to the Workers'Co-Nn,nion APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must torthwith'comply with FEE
U such provisions or this permit shall he deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M) 3.00 '
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 1000C.F.M.) 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
Leader',Name H EATI N G U N IT(O V ER 100,000 B.T.U.)7.50
Lender,Address ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 Or7
information u cornet.1 agree to comply with all city and county PLUMBING .
inform do and state laws relating-to comply
with l city and c, andmy BOILER-COA9P 13 H.P.or 100,000 B.T.U.1 4.00
hereby authorize representatives of this city to enter upon the
above mentioned progeny for inspection purposes. 'gO1LER-COMP (Over t00,0000TU1SEE FEE SCH. MECHANICAL
(\1'e) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupedlno egnmt liahilitics,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the 'PERMIT ISSUANCE 3.00
' Go it. MECH.CONT. LIC.NO. MECH.
OTAL
TOTAL
7Y.gWA"p4, can/ ontmctor ate
- OFFICE COPY _ /