1375 CITY OF CUPERTI`70 I.7SPF.CTIOii RECORD (OHice Copv)
1375 1098 Hunterson Pl.
PLEytIT c7O. SANITARY DIST . 270. LO'L "0. ADDRESS
Plumbing King 297-8107
PROJECT OI:�?ER JOB SITE PHOc,E V0.
Date ELECTRICAL
Buildi.-n Date Insp .
Electrical Power Pole
Plumhin, 2-22-82 Under round
iecnanical Rougn .,' - no
Temp. Gas/Elect. alts
Solar Ceiling
ire Sm inkier Fixtures Int/Ert
Sign :Iotcrs
Grounding
isc• Temp . Power
Other
FINAL INSPECTIO`!S Not Aoproved
Date Insp.
has
Electric
PLLD IBING
Plumbing Date Insp .
Bac'.c=Lo,;
Solar olr ical Underground
Underfloor
Pool Partial Ronan
Grar.tne
Piann_n"
Rough Complete Pzre Solar Rough
Dent. '
lleallh Dept
r� iia ter & I.isolation
Building Main Drain
Omer
R/0*/S Drain
Gas
Other
STRliCT_U P�AL ',-or il0nroved
Date Insp.
Pad Certiication
roundauon 7CArL71C=.i.
PTe-GC31 to Date -nsp.
S1ao-iiemorane
underfloor S .'.I
& Insulation
nsulation
Bond Beam _
JnderFire Dampers,.loer Girders
Fireplace
Floor Seel
r_
=_doc.ms Cease Duct Hood
DiaphTrms
One Four S'r.e=t
Segsg
Condensate Drain
!?a11s-tanels Equipment Anchorage
frame
Flues - Como. ?ir
Latn Other
�
., ..ot -purovee
I:allp0?_ras int, .._._t.
Firewalls
/ Otner
Not Approved - —
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
P RM BER
' BUILDBUILDING PROJECT IDENTIFICATION ING APPLICATION & PERMIT
AD E BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 1375
OWNER / - PLAN CHECK VALIDATION
NAME TY. ELECTRIC PERMIT FEE
PROD
W�ACYOR
OUTLETS-SWITCHES-RECEP 5.00/1.00
uc.NO LIGHTING FIXTURES 5.00/1.00
ADDREs PPLIANCES-RESIDENTIAL 4.00
PANELS 5.00 DATE OF APPLICATION
OC D
RCi SIGNS 6.00 PLAN CHECK FEE P.C.N0.
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH ORDRESS ENG' SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 15.00
Ars
ADDRESS MOTORS SEE FEE SCH.
DRESS E55
SERVICE CHANGEpp _ 10.00
oo LICENSED CONTRACTORS DECLARATIONQp O
a ND
it I hereby affirm that I am licensed under pouvokions of ChapterH
y< H (commencing with Section 7000)of Division 3 olthe Business Bnd ISSUANCE DATE
r D Z ProfessionCod• ry
beer
ice use is in full f f, L BLDG. ELECT. PLO. MEC..
z o w License lass_ Lie.Number
p Z o
Date Cmltractor
,aFw
a m BUILDING PERMIT
K 0 w ¢
OWNER-BUILDER DECLARATION
°ntr MISC.- REFER TO ORD INFORMATION
K
3 LL H I hereby alfinn that 1 am exempt from the Contractor's License
VALUATION $/FT.
FwOj Law for the following reason:(SBL703La;o,rm tocnd Professions PERMIT ISSUANCE 6.00
w > Code,t,Je ty bcountywhiIy rcquimsop priori otsessruner,also
0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. TE LEC.
ca p LL requires the applicant for such permit to file a signed statement that TOTAL
ea m he is licensed pursuant to the provisions of the Contractors License t� PERMIT TO
rzi
Law(Chapter 9(c0mmeneiagwith Section 7000)0(Division 3 ofthe y��� ��
Business and Professions Code)or that lie is exempt therefrom and QTY. PLUMBING PERMIT FEE l
aa 10. the basis for the alleged exemption.Any violation of Section 7011.5 STORIES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more titan five hundred dollars(5500),1'.
❑ 1:as owner of the properly,or my employees with wages as BACK F LOW PROTECTru .DEVICE 2.00 DCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stcture is not
intended or offered for sale (Sec. 7044, Business.,,it Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractors License Law docs not apply to an owner of
Property who builds or Improves thereon,and who flocs such work FIXTURES-PER TRAP q.QQ SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
orimprovemenLevels are not mmndedor off withinroneyearoIf,however,the the owner- GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
or improvement is sold within pr year of clic did ion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00
builder will have Dle burlun of proving that he did not build or ins- - BUILDING USE
Prove for Purpose ofsale.). INDUSTRIAL WASTE INTER. 20,00 RES IND CON Pe Omer
❑ 1,as owner of the property,am exclusively contracting with ❑ 0 0 0 ❑
licensed comment-, to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Commelor's License Law does not apply
to an owner of property who builds or improves thcR•on.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a'comreaor(e)licensed pursuant to
the Contractor's License,Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ Iwo exempt under Sec.,B.&P.C.for this WATER HEATER W/VENT
reason4.00
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK IiRs'COn1PIiNSn'ITON DECLARATIONWATER TREATING EQUIP., 4.00
1 hereby affirm that I have a certificate ofcorsent to selploanre.
or a certificate of Workers'Compensation Insurance, certified 1 ZONING ENG.SITE NO.
PolicoPY V -
0 ❑Y died copy s her ILookovd. FIRE SPR INK ENERGY T.
Z Z ❑ Cert} �j�pry�is ji1Jd I the Ity inspection division. 24
FO Appli,m, ,(Ci2' -/'�C� MISC.- REFER TO ORD. Y0 N[D Y ❑ N[]
T CERTIFICATE OF EXENIM ION FROM WORKERSPERMIT ISSUANCE 6.00 FLOOD ZONE A,Lu.c.
W COMPENSATION INSURANCE PLG.CONTR, uC.ND. PLG.
CL O ('Phis section need not he completed if the permit is far ane TOTAL v N❑ V El N
� Z hundred dollars($I00)or less)
U O I certify that in the performance of,the work for which this per-
CITY
MECHANICAL PERMIT FEE
F mit is listed, I shall not employ an rum in un manner so ua I. FEE SUMMARY
LLU poY' YPe }'
O W berm is rc,Ibjc,t to the Workcre'Compensation Laws of California.
D- Date.Applicant
} 0. NOTICE TO APPLICANICAN T:: If,alcor making This Certificate of 1!x-
ALTER OR ADD TO MECH. 4.00 BUILDING
F. emption,you should become subject to the Workers'Compensation. APPLIANCE provisions4.00 PLAN CHECK
of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000QF.NL) 3.00 FEE
CONSTRUCTION LIiNUwc nGliNcv AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby alfinn that there is a construction lending agency !or EXHAUST HOOD(WITH DUCT( 2.00
the performance of the work for which this permit is issued(Sec.
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
Lender Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
1 ctrtity-that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 ,
information n cornet. I agree to comply b with all city unit county PLUMBING
uNinmmcs and shite laws relating to building oust nlc P.'n and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 4.00
hereby authorise representatives of this city' to enmr upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Savo, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cup int against liabilities,judgments, costs and exp0nses which
nm any way accrue against said City i consequence of the PERMIT ISSUANCE 3.00 CONST.TAX
gra ti g of Ihi p m MECH.CONT. LIC.NO. MECH.
TOTAL 0 ��
Si tore o pit /Contractor TOTAL
ITA
'OFFICE COPY