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11486 (2) POST THIS CARD NEAR FRONT OF BUILDING 'CITY 01 CUPERTIN0. PIRMIrN BER INSPECTION DIVISION.. 11486 'JOB INSPECTION RECORD .� . y� EXPIRATION JOB ADORE SS�Q�� fe '`S s ' UNIT# LOT# " • - : PERMIT EXPIRES IF WORK ''IS .NOT.STARTED WITHIN. ov+ry ER corvTRAcmRSIS. yg0 DAYS OF PERMIT ISSU=' INSPECTION DATE INSPECTOR INSPECT RARECORD : IS, - . . ANCE,OR'180 DAYS FROM" LIFER. , . ,•. I LAST CALLED INSPECTION:- PR EGUNTE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB' L PLUMBING _ Y/A /0ELECTRICAL - IssurE MECHANICAL ,. - r BLD ELECT. PLG. MECH. • _ - F r 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED :,I-. + x' BUILDING PERMIT - INFORMATION WOOD FLOOR VALUATION: S/FT. ' PLUMBING 1 •1. - �'Q�. MECHANICAL ELECTRICAL - PERMIT TO FRAMING .INSULATION sroHles TYPE corvsTR.. . - ,• OCC.GROUP . RES,UN _ - P PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,. SO FT.FLOOF AREA TOTAL ACREAGE' ROOF ' °' ' r' DIAPHRAGM L.. BUILDING USE , •I" i; RES' IND CON - PB . O,hi., • APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 'ROUGH ' Assessoas PARCEL No ,• PLUMBING TRACT NO. PARCEL NO.� GAS TEST - MECHANICAL` DA - -•• 'ACC. TE �' - ACC.FILE NO. , ELECTRICAL - FINALS DATE INSP. - FRAMING SAN # ZONING ENG.slrE No. INSULATION e _ PLUMBING GAS FIRE SPRINK ENERGY T-24 I - MECHANICAL • " Y COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � ❑' .N� LATH-INTERIOR -ELECTRICAL FLOODZONE A.L.u.c y,❑ ' 'ryO •� � - LATH—EXTERIOR - - - � FIREDEPT. - yrN_ SHEETROCK' - GRADE FEE SUMMARY ' SHEAR INTERIOR - - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING' FIREWALLS ELECTRICPLAN CHECK - - - FEE' i..�.- GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MilCROFILM ^ 'ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC F-O ' ONE WORKING DAY BEFORE REQUIRED INSPECTI01 N. PLUMBING Z PLEASE-GIVE.JOB ADDRESS WHEN PHONING - SEE.PERMIT FOR EXPIRATION DATE —" onECHAniICAL �y • - - s CONST.TAX IMPOR.TANT'! ' " PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FORTINAL INSPECTION: OFFICE COPY- " - - - - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER, BDILDINGA 1m00 .S--rl -'� _� APPLICATION & PERMIT . �� J ADDRESS ELECTRICAL-PLUMBING-MECHANICAL r_(]xMMl++Ep'S��;(o bl�- PLAN CHECK VALIDATION .�„ CI{IlPTONE .S,7C` lKi CONTRACTOR'S - UTLETS-SWITCHES-RECEP ' 10.00/1.00 •' " jtTYELECTRIC PERMIT FEE NAM7 qq''��b�1 VI♦=S4S LIC.Nf�O of LIGHTING FIXTURES 10.00/1.00 -I CONTRACTORS Q = APPLIANCES-RESIDENTIAL 4.00 7 Ao q PANELS IO. .. OO DATE K APPLICATION • ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE. P.C.NO, OR ENGINEEfl , 6v ' LIC.No. SIGNS TRANS. ARCH.OR END. - SPECIAL CIRCUIT 6.006 PERMIT VAU DATION ADDRESS , ZIP EMP.METER OR POLE INS. 20.00 PAID aPPucaNrs . MOTORS SEE FEE.SCH: N ADDRESS SERVICE CHANGE 20.00 w a o LICENSED CONTRACTORS DECLARATION a a u I hereby affirm that ]'am licensed under provisions of Ch:Rmter 9 N a uAwi (commencins with Section 7000)of Division 3 of the easiness and - BLDG. E MCH. H m z Prolbssioms Code a I iniiilicerse ism full.( u t ❑ C,z,rUi o License ss_ Lia Numb• city 01 cupelfillo . p w Dale Contractor .Q L s �' BUILDING PERMIT ca OWNER-BUILDER DECLARATION INFORMATION w ;LLr 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO 0RD '0 Law Law forthe following reason. 7031.5,Business nland Professions PERMIT ISSUANCE s 10.00 vA LUAnON ' L_ _ Code:Any city orcoay which requiresu permit toconstruct,alter, Z'DO� 0 improve,demolish,or repertory structure,prior to its i"Han",also ELEC.CONTR. LIC.N0. ELECac . O¢ requires the applicant for such permit to file a signed statement that s TOTAL p2 PERMIT TO K m he is licensed pursuant to the provisions of the Contractor's License S? 's r z i Law(Chapter 9(commencingwith Section 7000)of Division 3ofthe I U ��` f i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE $ the basis for the alleged exemption.Any violation of Section 7031.5 i STORIES - TYPE CONSTR. . s3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN 5.00 of not more than five hundred.dollars(5500).): Cl I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 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. 5.00 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 5.00 SO.FL FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. meats are not intended or offered for sada if,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-,EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE ' builder will have the burden of proving that he did not build or im- RES IND CON PB mer prove for purpose of ride.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ El ❑' ❑ ❑ licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL and Professions Code:The Contractor's License Law does not apply' - • to an owner of property who builds or improves thereon,End who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contortions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 _ the Contractor's License Law. TRACT NO. PARCEL NO., ❑ 'd am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT - 6.00 ' reason ' Owner Date WATER SYSTEM 5.00 ACC.DATE ALL.FILE NO. WORKERS'COMPENSATION DECLARATION _ WATER TREATING EQUIP.' 5.00 1 hereby affirm.that I have a certificate ofcon5ent to self-insure, ZONING ENG.SITE N0. or a certificate of Workers'Com ensatiom Insurance,or a certified copy lh (��.0 ,La any �i LFI a C) Policy N V mpany r_A'14 Q Cer]l a up�11 her RnnishC _ FIRE SPRINK ENERGY TQ4 Z Z jE�Cert' co is f "I c' p on tlivision. FO Applicant. MISC.- REFER TO ORD. Y ❑ No 'Y ❑ N❑ . CC m CERTIFICATEOF EXF-MPTION FROM W ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION I NSURANCE PLG.CONTR. LIC.No. PLG. CL aZ (This section need not be completed if the permit is for one TOTAL Y E] NE] Y C] No hundred callurs($100)or less.) - U 0 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F - mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. w Ditc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING '�0 } W NOTICE TO APPLICANT: If,after making this Certificate of Ex. - - ' F Z emption,you should become subject to the Workers'Compensation APPLIANCE- 5.00 PLAN CHECK t provisions of the.Labor Code, you must forthwith comply with FEE OC�� .0 such provisions or this permit shall be deemed revoked' AIR HANDLING UNIT(TO 10)WOC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE I I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). t HEATING UNIT(TO 100,000 B.T.U.) 8.00 ' Lender's Name )8 HEATING UNIT(OVER 100,000 B.T.U. .50 Lender's NAddimames ELECTRIC =� 0= I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING mminances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby aalhorize representatives of Illi, city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep"harmless the City-ol MISC.- REFER TO ORD. Caper n against liabilities,judgments, costs and expenses which CONST.TAX • may n y way accrue against said City in el sequence of the PERMIT ISSUANCE 10.00 gran n (th' permi ME H.CONT. - LIC.NO. MECH. -7� TOTAL TOTAL P/ 0,2 Sig lure at A-pplicant7MIAractor DEC u" - • ..OFFICE COPY • - 1 '