10089 (2) ArPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI )G PROJECT I DENTI FICATION PERMIT NUMBER n
7� BUILn,rv�- APPLICATION & PERMIT 1 OOOJ
/ Aoofl s _
L LI&V L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OAMIEOOO _
PLAN CHECK VALIDATION
'Y' ,►OEIRA( It_ J,gA"-: 5, PHOrvE Tf0 x3ys OTY. ELECTRIC PERMIT FEE
NRMpRAcrORs- OUTLETS-SWITCHES-RECEP 10,00/1.00
IfOFF,Er Coa97/Ail,o7!e.ry LIGHTING FIXTURES 10.00/1.00
CODREAcroH's
ADDRESS N- $� J0 APPLIANCES-RESIDENTIAL 4.00
,A MC
��
P/Fy PHMC4/6-34136 PANELS 10.00 DATE OF APPLICATION
ARRCHITECT "PANELS (OVER 200 AM 20,00 PLAN CHECK FEE P.C.NO.
ENGINEEfl d
ELVIA4 LL LIC.N0. ( 7l7 SI GNS TRANS, 3.00
ADDRESS ENG. SPECIAL CIRCUIfieV1 S,QQ PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRessrs MOTORSly Ul 141AMPOR SCH,
'L/ Z 41AIAP L( L Al SERVICE CHANGE 20,00
w w o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 NOV
L4/MlJ�
Se
�•
i v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANC GATE
a i (commencing with Section 7000)of Division 3 of the Business and we G. I MECH.
H D i Professions Code,and my license is in full force and effect. G O.C. 7 OUC.
oz y D License Class Lia Number .
m H_ w Date Contractor _
a Y J
¢ 24 OWNER BUILDER DECLARATION BUILDING PERMIT
w; D INFORMATION
0 H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F LL m J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 . VALUATION S/FT.
Code:Any city or county which requires a permit to construct,alter, ,j ��a
IS <0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _Q(Gw (O
y iL m u requires the applicant for such permit to file a signed statement that TOTAL(3P PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
'i
Law(Chapter 9(commencingwilhSection 7000)ofDivision3oftlteSCtJiH L
i o Business and Professions Code)or that he is exempt Therefrom and OTY. PLUMBING PERMIT FEE M'w t?- ��
IS the basis for the alleged exemption.Any violation or Section 7031.5 STORIES TYPE CONSTR.
ow. 3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 nn
of not more than five hundred dollars(5500).): bLNI Z(-
❑ Las owner the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
Their sole compensation,will The work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
, Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees.provided however,
such improve-
ment,
re building
mmselfe not intended oroffered emploeesale.provided
that sthebudding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner
-
builder will have the burden of proving that he did not build of ire- GAS-EA.SYSTEM-OV .) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTEI 30.00 RES IND CON PB Omar
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ 0
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLER N 5'V. -06,00 ASSESSORS PAR C E L N O.
and Professions Code:The Contractor's License Law does not apply
to an owner of prop rly who builds or improves thereon,and who LAWN SPRINKLER - E EA.) 1.00
contracts fo uch ojems wi a contractor(sl licensed pursuant to
the Con Dr's a SEWER-SANITARY- R 0.00 TRACT NO. PARCEL NO.
a ex• t er -B.&RC.for this yyATER HEATER W/ 6.00
on
0 e -O WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKI?P, COMPENSATION D17CLARATION WATER TREATING EQUIP. 5.00
1 hereby affix that I have a certificate ofconsent to self-insure,
40 or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy(hereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy.is hereby furnished. - FIRE SPRINK ENERGY T"24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y N C] Y ❑ N[3
~ �+ - PERMIT ISSUANCE 10.0
� - CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT 20NE A.L.U.C. '
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ` O _ N❑
CL 2( This section need not he completed if The permit is for one TOTAL
Y N v
hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
U. out is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
C'. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Ile, �'U,
} N NOTICE TO APPLICANT: IL after making this Certificate of 14x-
F ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK71
�j
provisions of the Labor Code, you must forthwith comply with ?T-
FEE
U such provisions or This permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUC .00
the performance of the work for which this permit is issued(Sec. 100MICROFILM
3097,Civ.C.). HEATING UNIT(TO ,000 B.T.U.)
Lender's Name H EATING UN IT(OVER IO - 9:50 ELECTRIC __7lits
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.0
information is correct.I agree to comply with all city and county tIPME PLUMBING
ordinances and state laws relating To building construction, and BOILER-CON>P(3 H.P.or 100,0 .-Q
hereby authorize representatives of this city to enter upon the BOI LER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL s 74'
above-ment a property for inspection purposes.
(We) re o save, indemn' and keep harmless the City of MISC.- REFER TO ORD.
Cap rest liabilities ' gments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
a way a cost said City in consequence of the
�grgan
a ng thi r 't. - MECH.CONT. LIC.NO. MECH.
TOTAL/S TOTAL
ureo Applin on(rac[or ` FDa/ce O
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER '
CITY 0F,,QUPERTlN0
INSPECTION DIVISION'
JOB INSPECTION RECORD .
PERMIT EXPIRATION
JOB ADDRESS11N, IT - LOT# '. `ti' +- '
PERMIT EXPIRES IF WORK
OWNER Dhn CONTRA croR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I CAYSPECTION'RECORD 180 DAYSOF PERMITISSU-,
FOUNDATION - ANCE OR 180 DAYS FROM
LIFER1 . ' .' 'LAST CALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
-'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 4 - / /L
PLUMBING l/
ELECTRICAL - - resuANCE oarE
MECHANICAL - - Lo FLL. PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR -
PLUMBING VALUATION SJFT.
� - - � ,
MECHANICAL
ELECTRICAL'
- FRAMING •
INSULATION
ST RIES TYPE CONSTR.
. - -
OCC.GROUP RES.UNITS
-PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
SO.FT:FLOOR AREA TOTAL ACREAGE
�• DIAPHRAGM , ROOF BUILDINGUSE
.HE ,.IND , CON 'PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑" ❑ ❑ ❑
ASSESSORS PARCEL NO. .
ROUGH
PLUMBING
GAS TEST _ - TRACT NO PARCEL No.
MECHANICAL
ACC.DATE ACG FILE NO.
ELECTRICAL. -FINALS DATE INSP.
FRAMING SAN # '
ZONING ENG.SITE NO:
INSULATION PLUMBING
GAS L
MECHANICAL FIRE SPRINK ENERGY,T-24 -
_ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ - "❑ ° ❑ "❑
FLOOD ZONE A.L.U.C,
LATH—INTERIOR - - ELECTRICAL
LATH—EXTERIOR FIRE DEPT. - .Y❑ ' "❑ Y ❑ •N❑
SHEETROCK . GRADE- - - FEE SUMMARY
SHEAR INTERIOR BUILDING .
SHEAR EXTERIOR TEMPORARY APPROVALS ' BUILDING
FIREWALLS - ELECTRIC . PLAN CHECK '
GAS7 FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE - '1• , , 'I
OCCUP,ANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING F.INALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. • PLUMBING
z� -PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT:FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR-FINAL INSPECTION.
- OFFICE COPY