12678 POST THIS CARD NEAR FRONT OF BUILDING
• PFRMIT NUMBER'
CITY OF CUPERTINO ry(� Q
7
INSPECTION•'DIVISION 1267V d"
JOB'INSPECTION RECORD
,a• d _ _ ,- �. 'a; PERMIT EXPIRATION,
JOB ADDRESS 10480 A1nSwortfi Dr i up UNIT#1 LOT# PERMIT EXPIRES IF WORK
OWNER Ravmond 'Reed ;E CONTRACTOR D.G. Brown (See Oriein31) IS MOT STARTED WITHIN. -
INSPECTION DATE , INSPECTOR INSPECTION RECORD - 1' 180,DAYS OF PERMIT ISSU-
• ' ANCE OR 180 DAYS FROM
FOUNDATION -. - " - I� LASTCALLED'INSPECTION.
UFER
1'PREGUNITE ` - � , _ PER MIT VALIDATION �•
1 I PAID4 i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I, s '•. � •��il 7 � '
UNDERGROUND /SLAB 4 f
PLUMBING, . ; - •'.I _ p�{y ,
•TS's3 af•C4RertinD
ELECTRICAL -
(" I ._I ANCE OA E
IMECHANICAL .- BLDG, EL OT: PLG. I MECH. ,
00 NOT POUR FLOOR UNTIL(ABOVE HAS BEEN SIGNED - I BUILDING PERMIT
I WOOD FLOOR INFORMATION ,,;
VALUATION
I PLUMBING '-^ •,T:.
MECHANICAL MIT To
ELECTRICAL ]' l�PE 9 r
(FRAMING _. '1': 1 I •I /,. `•
(,INSULATION' -
STORIESkkk TYPE CONSTR.
I :I •r• .
OCC.GROUP RES UNITS ,
I .
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I - - f
SO FT FI OOR AREA TOTALACREAGE
ROOF I `. I
(DIAPHRAGM ' ^ 1 -
•. I , � 1 � euao( ..rvc USE •. --..
RES IND CON PB 0l , '
I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I ti'❑ ❑ 0 6 F] ' ❑
I ROUGH \ ASSESSORS PPARCEL NO.
(PLUMBING
1 GAS TEST rHACT NO PARCEL NO
IMECHANICAL - 1 - I- I •. ' I '
ACC DATE ACC FILE NO,
.. - (ELECTRICAL• .. . , 1. . . � � FINALS DATE INSP. !- ,
(FRAMING I _ _ ' ]SAN # !
20rvING ENG SITE NO
` ] INSULATION I'
I , I, IGAS 7
I. I- IMECHANICAL' I I ❑, Y [] N❑
FIRESPRINK , 'ENERGY T 2e
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I Y ❑ N'HEATING' r � ! FLOOD zorvE A.L uc
'ILATH C-
,—INTERIOR „ I,ELECTRICAL 15--/ --J /�1� !
(LATH—EXTERIOR - _ ]FIRE DEPT. I - /l ! Y❑ "NE) Y �] N❑
ISHEETROCK 1GRADE '1 I FEE SUMMARY
ISHEAR INTERIOR „ _ BUILDING
ISHEAR EXTERIOR - E I' TEMPORARY APPROVALS BUILDING
IFIREWALLS ]ELECTRIC PLAN CHECK,
1 I IGAS
FEE
I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY ' SEISMIC FEE 1'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~�
let, WORKING DAY BEFORE REQUIRED INSPECTION' PLUMBING-
;' z PLEASE GIVE JOB ADDRESS WHEN PHONING.^
= SEE PERMIT FOR EXPIRATION DATE -. MECHANICAL
IMPORTANT! coNST.TAX
PLEASE READAEVERSE SIDE BEFORE � :"r" TOTAL
.' • CALLING FOR FINAL INSPECTION. �
' , OFFICE COPY — - ---- - - -- ----
I �
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALLPOINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATI N PERMIT NumeER /
nURDRJG APPLICATION & PERMIT
AO RESS /
p0.f ills. / ( 61-51, — V- • . BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S I d 1A-J 0 .. PLAN CI�F�I$V®ATION
NAM�j�<.,�fr.v era!rJ �/o3S'�e� g
PY �fnaa�IDl�.lte!-0 3� QTY. ELECTRIC PERMIT FEE
PHONE
Go �)
NAME pA/c)/ - OUTLETS-SWITCHES-RECEP 10.00/1.00 APR
6, C3Ya wnl LIC.NO LIGHTING FIXTURES 10.00/1.00 JUU
CONTRACTOR'S • APPLIANCES-RESIDENTIAL 4.00 coy Of CO P
ertO
QJJ T 6.21 PRONF p 7�— (PANELS 10.00 DATE OF APPLICATION
ARCHITECT (PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO
OR
ENGINEER
LIC NO SIGNS TRANS. 3.00 ,
ARCH OR ENG SPECIAL CIRCUIT 5,001 PERMITVALIDATION
ADDRESS
ZIP EMPOR.METER OR POLE INS. 20.001,
ADODR 1 ' •'y
APPLICANTS rs I-' . MOTS SEE FEE SCH.1
ESS
SERVICE CHANGE 20.001 Z
00 . LICENSED CONTRACTORS DECLARATION
¢U v - 1 hereby affllln that I in 1¢enud unde[prun5lons of Chapter 9 �1 ISSUANCE DATE
' N a Le efcmma nahng wish Section 7000)of Dnnsuu,3 of it,,Business and BLDG. EL T. PLO. MECH.
t- w z Professions Cod and my license h,in full force and effect.
z O m- .License Class_ "! Lie.Number 'r
0'e Data _ _ J- -B''-Contractor- .u.,�¢ j, J� (i(i to
a C///lll �r-•-• _/i ee � BUILDING PERMIT m
INFORMATION
w ;LL y 1 hercby.al'l irm that 1 am exempt from the Contractor's Li ense MISC.- REFER TO ORD yn
r u.,04 Law for the following ,,,On (Sec.7031.5,Business and Professions I' PERMIT ISSUANCE 10.00I�U� VALUATION $/FT
in Code'Any city or county which requires a permit to construct,alter ___
ca ¢ Improve,dLn01151,or repair JOY slrlClnrC,pfhnr IO IIS ISSpllee,also ELED CONTR LIC.NO.Q - I ELE. '
u requires the applicant for such permit to file a signed statement that TOTA Y PE MIT TO
K$ he is licensed pursuant m the provisions of the Contractor's License 'j��l
i c
Business aadrProf'ssi Professions shat lie is exempt there fromfanA CITY. PLUMBING PERMIT FEE I� - / f
¢ h-$ the basis for the alleged exemption.Any isolation of Section 7031.5 STORIES 'TYPE CONSTR. -
i ; � by any applicant for a permit subjects the applicant to a moil penalty
of not more than five hundred dollars(5500)1 - ALTER-DRAIN& VENT-WATER (EA.) 5.00 I
❑ 1,as owner of the properly,or my emhployees with wages as
BACK F LOW PROTECT. DEVICE 4.001
their sole compensation,will do the work,and the structure is nit OCC.GROUP RES UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.001
Code:The Contract.,',License Law does not apply to an owner of
property who builds Or Improves thereon,and who does such work I FIXTURES-PER TRAP. 5.001
himself or through his own employees,provided that such improve so.FT FLOOR AREA TOTAL ACREAGE,
memos are not Intended or offered for sale If,however,the building) GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.001 .
/ or Improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or im- GAS'-EA.SYSTEM-OVER 4 (EA.) 2.001, BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 S IND CON PB Drbe,
❑ I,as owner of the property,am exclusively contracting with 1 I ❑ ❑ ❑
licensed contractors to construct Om project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.001 -/ ASSESSORS PARCEL NO
and Professions Code-The Contractor's License Law does not app);
ow I
In an owner of property who builds or improves thereon,unit who LAWN SPRINKLERS-OVER 5(EA.) '1.001
i con Ira cis for such projects with a cottontails)licensed pursuant SEWER-SANITARY-STORM EA.200ftI10.00+
the Contractor's License Law. 1 TRACT NO. PARCEL NO.
❑' I:un exempt under Sec. B&P.C.for this WATER HEATER W/VENT 6.001 II
reason 17
Own,-, Data 1 WATER SYSTEM 5.001 ' ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.001
1 hereby affirm that I have a certificate of consent to self-insure,
or a,certificate of Workers'Compensation Insurance,or a certified - 11+ I ZONING ENG.SITE NO.
copy thereof(Scc 3800,Lab.C.). , I
- Policy No. Company
O ❑ Certified COPY a hereby furnished. I I FIRE SPRINK ENERGY T-24
Z p /,ARPhcu ufed copy Is fled with the city,inspection diviamt. MISC.- REFER TO ORD. v� N] Y N1]I
~ rn F PERMIT ISSUANCE 10.00
� CCRTIPICCOMPE COMPENSATION INS FROM WORKERS' FLOOD ZONE AL U.C.
W COMPENSATION INSURANCIi PLG.CONTR LIC.NO. PLG_
1 O, (This section need not be completed if the pefntit n for one I TOTAL v❑ N 1] Y N1]
:D Z hundred dollars IS 100)or less 1 - '"--'-
U O 1 certify that in the performance of the work for which tlhis per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY -
W H mit Is Issued,I shall not employ any person In any manner m as to
O becon s cI,{o�the Workers'C pa ion Lew fcalifornia _
0 a Dot " �{�Apphcanl (!IC 9-(? h 1ALTER OR ADD TO MECH. 5.001 BUILDING
} m NOT CE TO ,CPPLICANT: If,alter making this Certificate of Ex
Z em poor,you should become subject to the Worker,'Compenmtion I APPLIANCE 5,001 '� PLAN CHECK
p,omsicas of the Labor Code, you most forthwith comply with FEE
U such provisions or Iles permit shhall he deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.001
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM.) 6.001 I SEISMIC FEE
I hereby' anion that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.001
the performance of the work for which this permit Is issued(Sec. MICROFILM
3097,Civ C,) I 1 I H EATING UNIT ITO 100,000 B.T.U.) 8.001
Le Lender's Add'°
nder's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9,501 1 ELECTRIC I•
'• _ _
I certify that I have read this application unit state that the above 1 VENTILATION FAN (SINGLE) 4.001
information is correct.I agree to comply with all city and county PLUMBING
' ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.001
hereby authorize representatives
ins Of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH,1 I MECHANICAL
hereby mentioned property for inspection purposes. 11
(WE) agree to save, indemnify and keep harmless the City of 1 MISC.- REFER TO ORD. '
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the I I
granting of this permit MECH.CONT. LIC.NO. MECH
a' TOTAL TOTAL
Signature of Applicant/Cnntmcmr' Data
OFFICE COPY /
I