0629 (2) CITY OF CUP ERTINO INSPECTION RECORD (Office Copy)
Ou29 � 1127 Hunterston_ Pl. -
PCPd1I'T No. SANITARY DIST. NO. LOT 1 _70 ADDRESS
Reroof._ 'James R. .Duport 446-1973
PROJECT OWNER JOB SITE PHONE NO.
PERMIT ISSUED Date ELECTRICAL
BuiJdinc - - Date Insp.
Electrical Power Pole _
Plumhina Underground
1[cchanica.lRough Wirin
Tem), Gas/Elect. Ual.7.s --
Solar Ceiling
Fire Sprinkler Fixtures Int Ext
Sign Hotors
Grounding
Misc. Temp. Power
Other _
FINAL INSPECTIONS Not Approved
Date Insp.
Cos _
Electric PLUMBING
Plumbing Backflow Date Insp.
:techanical Underground
Solar Underfloor _
Pool Partial Rough
Grading 0, Rough Complete
'lipPlanning Solar Rough
fire De t. water & Insulation
Health De t. `fain Drain
BuildingR/of/S Drain
Other&RAN Gas .
Other
BUILDING Not Approved
Date Insp.
Pad Certification MECHANICAL
Pre-Gunite Underfloor S.M. Date Insp.
Slab-Membrane cts & Insulation Du
Bond Beam
Underfloor Girders Fire Dampers
Fireplace
Floor Steel _ —_
Tiedowns Grease Duct & hood _
Diaphrams One (lour Shaft
Condensate Drain
Seismic Bracing Equipment Anchorage
FrameUalls-Panels Flues & Comb. Air
Mth Lh Other
LaNot Approved
Wallboards Int/Ext.
Firewalls
Other
• Not Approved
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL 1 T PEN ONLY
E PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
a DDING 0629
'
ADDRESS
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
•
Z/
w E - PLAN CHECK VALIDATION
NAME QTY ELECTRIC PERMIT FEE
ONE
ACTO 3
NAME
NAME �f UTLETS-SWITCHES-RECEP 5.00/1.00
VALsC� 00P-1,`No. S59SU LIGHTING FIXTURES 5.00/1.00
CON E9TORS PPLIANCES=RESIDENTIAL 4.00
1 `
Z��r 7 PHONE g ZO PANELS 5.00
GATE OF APPLICATION
ORC IiECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Lac.NO, SIGNS TRANS. 3.00
ARCH OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
RESS
TIP TEMP.METER OR POLE INS. 15.00 /'\/�//[j/`1��J(
APPLICANT'S V
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
O o LICENSED CONTRACTORS DECLARATION
a atay 1 hereby affirm that I am licensed under provisions of Chapter
2ISSUANCE DATE
y Q�e (commencing with Section 7000)of Division 3 of the Business and
D i Professions Code nil "cosi is in full force f crj.- BLDG. ELECT. PLG. MECH.
L
0 m o License I' s �- Li,.Number
In
R j Uate Contractor
¢ ¢ w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
- INFORMATION
X ; ¢ 1 hereby affirm that 1 tun exempt from the Contractors License MISC. REFER TO ORD
VALUATION S/FT.
u O a Law for the following reason.(Sea 7031.5.Businessand Professions 6.00 O
- PERMIT ISSUANCE -1
ec Code:Any ciryor coumywhichreyeturcp riorttocoisstrum.aaeq
¢ ¢ O improve,demolish,erection repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. /
O IS reunites the applicant for such permit to Ole a signed sbitement that
n w Cs TOTAL he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �C�Or Res
Era Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I-m the basis]or the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ; _ by any applicant for a permit subjects the applicant tea civil penalty gLTER-DRAIN 8, VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the properly,or nny employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole comp,nsation,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 Fiction,and who does such work F IXTUR ES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve-
ments are not intended or offered for sale If.however.the building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
or improvement is sold within one year of completion, the owner-
GAS-EA.SYSTEM-OVER 4
builder will have the burden of moving that he did not build er im- (EA.) 1.00 BUILDING USE
prove for purges,of .L.) INDUSTRIFa7fAW 2000 RES IND CON PB Omer.
❑ I,as owner of the property,am exclusively'contracting withAla
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
El 0 El 0 El
and Professions Code The Contractor's License Law does not apply
to an owner of property who holds er improves thereon.and who LAWN SPR I RS A.I 1.00
contracts for such projects with a cnntractodsl licensed pursuant to
the Contractor's License Law. ' SEWER-SANITAR V-ST RM EA.200f1/6.00 TRACT No. PARCEL No.
❑ l an exempt under Sri.-,B.&1'.C.for this WATER HEATER
reason4.00
Date Owner WATER SYSTEM - - 4.00
ACC.DATE ACC.FILE NO.
WORK f'RS'COIPBNSA'I'ION DECLARATION WATER TREATING EQUIP, 4.00
♦ I hereby affirm Ous, 1 Imve a certificate oI consent to v.9.insure.
.ter/ or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thareuf(Sec.3800,LaNCJ.
Policy No. Company
O ❑ Certified copy is hereby furnished.
Z Z O Certified <upY is fled with the city inspection division. FIRE SPRINK ENERGY T 24
F' O Applicant MISC.- REFER TO ORD. Y ❑ N E) Y ❑ N[
Cr rn CERTI FICA 11;01'EXEM P IION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTE. LIC.ND. PLG.
6. O (This section need not be completed if tine Permit is for one TOTAL v N V ry
UO hm.dred dollars(S 100)or less.)
Certify mat in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
U mit is issued,I shall not employ any person in any LAA
so as o
been sl�11pQQ������ec�}he Workers' n tion s u lifor p
te a, Date D. Applicant ALTER OR ADD TO MECH. q,p0 BUILDING
} co N'OTIC. f0�APIILICANT: IL after m n flux rtif a of lix-
F 2 ,mp1i n,you shoulJ become subject r e Workers-C ompensation APPLIANCE 4.00 PLAN CHECK
L.) ;uohvisions
sof tire
re tLsbor Code, you must forthwith comply with FEE
p permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that There is a construction I,nding agency for EXHAUST HOOD(WITH DUCT) 2.00
(he performance of the work for which this permit is ivvued(Sc,. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Nene
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify that I have read this application and state tial The above VENTILATION FAN (SINGLE) 3.00
information is correct, I agree 10 comply with all cHY and count Y' PLUMBING
oNinances and state laws relating to building consliner. and BOILER-COMP(3H.P.O-100,000B.T.U.) 4.00
hereby authorize representatives of this city eo enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH.
chose mcmioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cuperl' againsT liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
may ton way ampere a s Suri City in cn osequm v the 3.00
grant g of Inns pt, n I MECH. ONE. LIC.NO. MECH.
�, / x • TOTAL
Signa o Applic nt/Coulramor ate l E/n. TOTAL 3p Q-�
0�
OFFICE COPY