12331 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
JIUI LDING PROJECT 1 DENTI FI CA Y PERMIT NUMBER
ADAPPLICATION & PE IT 12331
ADDRESSDRESS
JI G BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
rvER'S PLAN CHECK VALIDATION
"ACME(' QTY. ELECTRIC PERMIT FEE "
_To,VI
l•tiYil ouE /D �g(L..,-x\
CONTRACTOR'S
NAM UTLETS-SWITCHES-RECEP 10.00/1.00
OS
NTRA LIC.NO. L IGHTING FIXTURES 10.00/1.00
ADRESCTOR's
DPPLIANCES-RESIDENTIAL 4,00
CO
IS IS,
rl FHONEZ_4 0C PANELS 10.00 DATE OF APPLICATION
ARCHITECT ANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P. NO.
OR
ENGINEER r �.
-LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. 500 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
i0 EMP.METER OR POLE INS. 20.00 n n )
AT9 MOTORS SEE FEE SCH. ✓K U-�'0.��
ADDRESS OOREss
SERVICE CHANGE 20.00 D
Woo LICENSED CONTRACTORS DECLARATION E
a W~j I hereby affirm that I am licensed under provisions of Chapter 9 1 7SUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
De: Professions Co d my license is in full forSe xyd�fle I BLDG. ELECT. PLO. MECH.
z o`� License Class - Lie.Number `I ZYSS O.
aY Dale Contractor
¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
¢ u, y INFORMATION
M
G I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
P VALUATION /FT.
H .. oj Law for the ityfollowing reason-(Secuiresa,erminesand Profcvions PERMIT ISSUANCE 10.00 '
� wi
POST THIS C •RD NEAR FRONT OF. BUILDING
t'�-•t PERMIT NUMBER
CITOOF CUPERTIN-O 12331
INSPECTION DIVISION
JOB INSPECTION RECORD
PERM IYEXPIRATION.
JOB ADDRESS O 0 - - LOT#
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
CONTRACTOR
OWNER
INSPECTION DATE I INSP CTOR INSPECTION RECORD 180 DAYS•OF PERMIT ISSU-
FNDATION .Z-(Y'S'7 G► .FsOC;" ANCE OR 180 DAYS FROM
oyUR y-I6 Tx. �I LAST CALLED INSPECTION.
PREGUNITE -'L$ G �K -E �- PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED7
r'c S S
UNDERGROUND /SLAB J '/ 7
PLUMBING v/�7 .It`d y .�DII"•
ELECTRICAL T _G ( ISSUANCE DnTE
MECHANICAL - ^ p,iy �GZ �� , eLoa ELECT. —PLG-.'-,l MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � -/N�C' y BUILDING PERMIT
_ INFORMATION
WOOD FLOOR �-'�� VALUATION S/FT,
PLUMBING 5-•20.- o'"
9� ^
MECHANICAL Ch�L� / 9RP r ~• - rJ
PERMIT TO
ELECTRICAL
jaw
FRAMING - O TZ'2L?c7: �N .ih''G
INSULATION STORIES TYPE CONSTR.
6-Y1 h7 SC�(�t- D—[
1T �Ide�pe'.TT
T$ASS IT�I �K OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 6 "746
sa.Pr FLOOR AREA TOTAL ACBeAce
ROOF Isr #,C F/A ;AM
DIAPHRAGM. Bw LDINe USE
RES IND CON PB 00",
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARC EL NO.
ROUGH - 2:0 moi,.. S{u' l Y
PLUMBING
TRACT NO. PARCEL'NO.
GAS TEST
MECHANI CALPm4n f
ELECTRICAL FINALS DATE INSP. ^cc.DATE ACC.FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION - PLUMBING ,
il2c r10 Ott i3 cns _
FIRE SPRINK ENERGY FQ<
MECHANICAL Y ❑ NE] Y ❑ N[D
COVER NO WORK UNTIL.ABOVE HAS.BEEN SIGNED HEATING
�-.-^ FLOOD ZONE A.L.U.C.
LATH-INTERIOR . .'-_,-�'�„ ;' ELECTRICAL
LATH-EXTERIOR �� _gJ FIRE DEPT. Y❑ NO Y ❑ N❑
SHEETROCK ,57-FYpp S /S GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING „ +-
SHEAR EXTERIOR TEMPORAR APPROV L
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY UMECHANICAL
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR,
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O'� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL -
CALLING FOR FINAL INSPECTION.
OFFICE COPY