12531 'POST THIS CARD NEAR FRONT OF BUILDING'
CITY ,OF-CUPERTINO PEHS9IT LUMBER
.12531
INSPECTION DIVISION.
JOB INSPECTION RECORD
+2,,v, \4 • . •- I- •. - - 'PERMIT EXPIRATION -
`.- JOB ADDRESF, ZL540 Addiniton Court` • KNIT# LOT#
PERMIT EXPIRES IF WORK
DINNER - -Max Roth - ' CONTRACTOR Craig, Phelps ' IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION - I ANCE OR 180 DAYS FROM '
LASTCALLED INSPECTION.
UFER
PREGUNITE - PFRMITVAUOAnoN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I " UNDERGROUND•/SLAB , °4 J
IPLUMBING ,, r.
(ELECTRICAL " I ISSUANCE DATE'
"IMECHANICAL v BLDG ELECT I PLC MECR
0 * ❑
100 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1 BUILDING PERMIT �I
' I INFORMATION
WOOD-FLOOR I ,;VALUATION l I SIFT.
PLUMBING
(MECHANICAL
'• (ELECTRICAL I s•, + PERMIT •,
IFRAMI NG -
INSULATION STORIES TYPE CONSTR
d
OCc.GROUP RES UNITS
I PLACE NO•SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I''
Y I - 'ROOF. SO IT FLODR AREA TOTAL ACREACE
- '[DIAPHRAGM
�I RES INDUILOCONUSEPB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I El ❑ ❑ E 07'
ASSESSORS PARCEL NO
ROUGH . I
IPLUMBING
GAS TEST,
TRACT NO PARCEL NO,
( " ; I '" - ,
[MECHANICAL �. I x I; -
ELECTRICAL ACC DATE ACC FILE NO
.•I '• I _ I FINALS DATE INSP. I„ '
FRAMING • I ISAN #
ZONING ENG SITE NO
( INSULATION' I I '^ IPLUMBING I' ,,
I • b i I ' ;.I GAS
IMECHANICAL I FIRE SPRINK ENERGY.T.20
I COVER NO'WORK UNTIL ABOVE HAS BEEN SIGNED 1,HEATING F1 ZONE AL'U,C
Y 0 'N❑• Y NI]
0 (' FLOOU
I LATH-INTERIOR E
• • . (ELECTRICAL
ILATH-EXTERIOR • • (FIRE DE:��.'.•.•T� �/ YED NNC] Y NE)
ISHEET,ROCK (GRADE 11 FEE SUMMARY
SHEAR INTERIOR ., IBUILDING' . ' "•I.'` • I- '' ,BUILDING cA,,, a-r.l
ISHEAR EXTERIOR I - I TEMPORARY APPROVALS_
.✓ IFIREWALLS I I ' ELECTRIC PLAN CHECK
IGAS -,-. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED +OCCUPANCY I SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. -MICROFILM
• • ARRANGE FOR INSPECTION BY PHONING 252-4505, " ` ELECTRIC I :`
LU ONE.WORKING DAY BEFORE REQUIRED,INSPECTION. "., PLUMBING '
Z PLEASE GIVE JOB ADDRESS,WHEN,PHONING.
- � -SEE PERMIT FOR EXPIRATION'DATE = - MECHANICAL'
_
9 IMPO CONST.TAX
RTANT! .•�" I
PLEASE•READ REVERSE SIDE BEFORE TOTAL%, ' �1
CALLING FOR FINAL INSPECTION. ,
' OFFICE COPY " '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALLPOINT PEN ONLY .
r BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
mpL.ING ' APPLICATION & PERMIT
�IA/GTON CT (BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 .2531
O.NER I PLAN CHECK VALIDATION
f�����]�III QTY. ELECTRIC PERMIT FEE
PHONE �?.�
Ory Aa�T/oRE�� �J,B •�C OUTLETS-SWITCHES-RECEP 10.00/1.00
7(Aiq rlmol. J Lm No LIGHTING.FIXTURES 10.00/1,00
f-ONTRACTOR's APPLIANCES-RESIDENTIAL 4.00 '
' 2AooR Eva 1�/{1 cr \\ MT/�r - '
oS�ov '/W Fi.STEF / PHONE,�2e ,�l PANELS - 10.00 DATE OF APPLICATION
j AORRCN EC -r— PLAN CHECK FEE I P.C.NO
' _ PANELS (OVER 200 AMP(,. 20,00
c.rvo . SIGNS TRANS. -3.001
A H G PERMIT VALIDATION
A P�RES� -/ SPECIAL CIRCUIT 5.00
1 - a j pA/ S IP���O TEMP.METER OR POLE INS. 20.001 ,
APPLICANT s I MOTORS " SEE FEE SCH.F /�1z1
AoORES /� `1 /firr - 'I (/
Z� . &6 WQT Oil 7Jf7�7 SERVICE CHANGE ' 20.001
r i
o o CENSED CONTRACTORS DECLA
LI RATION I
a u w 1 hereby affirm that I am licensed under provisions o'Chapter 9 1 ISSUANCE DATE
y a n (commencing with Section 7000)of Division 3 of the Business and B DG. ELECT PLG. MECH,
H H i Professions Cod•yard l liccse n m full fo a�L ,� I '❑ ❑ I ❑
z D License ass ��LL L Lo Number 11
O z F D Date#p, Contractor' [
= 111 ,,,,,, BUILDING PERMIT
E X a a' OWNER-BUILDER DIiCLA RATION �' INFORMATION
-W D a m 1 hereby affirm that 1 am exempt from'the Contractor's Licensed MISC.- REFER TO ORD -
LLVALUATION
o at Law for the following reason (See 7031.5,Business and Professions sERMIT ISSUANCE 10.00
in Code:Any city or county which requires a permit to construct,alter,
R ¢Q 0 improve,demolish,or repair any structure,prior to Gs Issuance,also ELEC.CONTR. LIC NQ ELEC.
D a requires the app Leant for such permit to file a signed statement that I TOTAL ,^PERMIT TO
he is licensed pursuant en the provisions of the Contractor's License
Z ¢ Basin
mess anidrProfessions l nCode)olr Section
hat he us exempt ther,"O'and IOTY. PLUMBING PERMIT FEE L
r r m" the basis far the alleged exemption.Any violation of Section 7031.5 STONES TYPE CONSTR.
1. a 3 - -by any applicant fora perms subjects the applicant loacivd penalty
ALTER-DRAIN&VENT-WATER (EA.) 5.00
{' of not more than five hundred dollars(450014: ' ' I
❑ Las owner of the property,or my employees with wag"as I IBACK FLOW PROTECT.DEVICE 4.00 ) oc DROOP RES UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (Sec. 7044, Business and'Prolssions I (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 I 1FIXTURES-PER TRAP 5.00 I SO,FT.FLOOR AREA( TOTAL ACREAGE
slhimself or through his own employes,provided fiat such nupr0vo
'=rents are not intended or offered for sale.I L however,the budding, 1GAS-EA.SYSTEM-i INC.40UTLETS 6.00 I `
�1 ,or improvement Is sold,within one year of completion,the owner
` e builde will have the burden of proving that he it of not hurt(]or im GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
N Io.. oN o °ED
prov for purpose of sale). INDUSTRIAL WASTE INTER. 30.00
I, contractors of the property,he ex ject(Sy contracting with as
and Pro colons od to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 / ASSESSORS PARCEL NO
and Professions property Contractor's o License Law does not apply
to an owner
for such projects with ha contnmra)liensed ursta who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the coot Ict such projects with a contractorts)licensed pursuant to
I. me Con ant c. mLicense l:a v. - SEWER-SANITARY-STORM EA.200ft/10.00 1 TRACT NO. PARCEL NO.
. ❑ Lune •m tmuter c ,PAP(.for this WATER HEATER W/VENT 6.00 I,
reason _
t�Owncr Ua[e ACC.DATE ACC.FILE NO
I (WATER SYSTEM 5.00 '
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certillcale of consent to self-insure, ` ZONING ,ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy lhemof(Sec.3800,Lab.C.).
Policy No. Conipanv -- - -- - - - -
0 ❑ Certified copy is hereby furnished. y I 1 FIRE SPRINK ENERGY T-24
Z Z 0 Certified'copy is filed with the city Inspection division
O Appticun I MISC.- REFER TO ORD. I YE] N❑ Y N1]
ir r2 CERTIFICATE OP EXEMPTION I'ROM,WORKERS' PERMIT ISSUANCE 10.00 1 FLOOD ZONE AL.U.C.
LLI > COMPENSATION INSURANCE PLG CONTR. LIC.NO. (PLG. I YI] N1] y N1]
Q. O (This-wetturrueed not be completed if the permit Is for one TOTAL
D Z hundred dollars IS 100)or less) . I '1
U O. 1 certify that In the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY 11
LL U m0 is issued,I shall not employ any person In any Pumper so as to
become sub)eCt to the Workeri Compemaoon Laws of Cal for is
OL Dmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING,
r m NOTICE 10 APPLICANT. If,after making this Certificate of Ex
F-. ?
cartoon,you shmlld become sul,rct to the Workers'Compensator I APPLIANCE 5.001 PLAN,CHECK
provisions of the Labor Code, you must forthwith comply with --- - - -- - - - -_ -- - - - - _ FEE
C„) such provisions or this permit shall be deemed revoked. r I AIR HANDLING UNIT(TO 10=11F.M.) 4.001
CONSTRUCTION LENDING AGhNCY I AIR HANDLING UNIT(OVER 10=C.RM.) 6.001 SEISMIC FEE
I hereby affirm that there Is a construction lending agency for I EXHAUST HOOD (WITH DUCT) 5.001 f
the 3097 CIV performance of the work for which this permit is Issued(Sec.I HEATING UNIT (TO 100,000 B.T.U.) :8.001 . i MICROFILM
Lender's Nam-
Lender's Addis== I HEATI NG UNIT(OVER 100,000 B.T.U.)9.501 I ELECTRIC
'
I certify that I have read fits application and state that the above VENTILATION FAN (SINGLE) 4.001 f
ofornabon Is correct I agree to comply with all city and county PLUMBING
ordinances and state and relining to building,construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.1 6.001
hereby authorize representatives of this city to enter upon the
above I BOILER-COMP(ova',100,000 BTU)SEE FEE SCH.1 MECHANICAL
p-•P)u' mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of 1 MISC.- REFER TO ORD.1 ' f
f)llPerlln0 against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.001 CONST.TAX
may m n �waye said City in consequence of the;I tin o h MECH CONT. LIC.NO. MECH.
T°TAL TOTAL 1 3 9°2 Slgna r of r /Dxt
OFFICE COPY