13928 POST THIS CARD NEAR FRONT OF BUILDING '
' PF Rn11T NUMHER
CITY OF CUPERTINO3928
INSPECTION DIVISION
JOB INSPECTION RECORD
3 PERMIT EXPIRATION
JOB ADDRESS 10396 AMISTAD CT. UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER WILSON CONTRACTOR ANTHbNy PooT.q - IS NOT,STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION - LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
• - )-
POOR NO CONCRETE TIL ABOVE HAS BEEN SIGNED 1
.UNDERGROUND /SLAB
PLUMBING • I
ELECTRICAL ISSUANCE DATE
MECHANICAL EL DG.. •ELECT. PLc. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ INFORMATION
' WOOD FLOOR VALUATION SIFT.
PLUMBING -
MECHANICAL /�
ELECTRICAL �(M11 TO
A f
'FRAMING ' _eq
STORIES TYPE CONSTR.
INSULATION -
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF - sD.FT FLOOR ARE TOTAL ACREAfE
DIAPHRAGM T`/�
BU DING USE
RES IND CON PH OIM1uI
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑
ASSESSORSPARCEL NO,
ROUGH '
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST /
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP. ,
FRAMING SAN #
ZONING ENG.SITE NO.
- INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL v ❑ N[ v ❑ N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _
LATH-INTERIOR ELECTRICAL FLOODZONE ALUX,
.
LATH-EXTERIOR FIRE DEPT. Y❑ No Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR - - BUILDING p J .1T'
SHEAR EXTERIOR' - TEMPORARY APPROVALS BUILDING r.
FIREWALLS ELECTRIC PLAN CHECK
GAS - FEE ' I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE
• OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC �., •;�
w ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
H.
0- PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
= SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUI LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
RUILGING. APPLICATION & PERMIT
ADDRESS
M QT UILDING—ELECTRICAL—PLUMBING—MECHANICAL 13928
OwNER'a PLAN CHECK VALIDATION
NAME �r a/S`JO CITY. ELECTRIC PERMIT FEE
/t/ vHGNEJ /
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 Q '-
NA —�
C.N 79 '^ LIGHTING FIXTURES 10.00/1.00
r, TRAGrons s
aopd/ APPLIANCES,RESIDENTIAL 4.00
PRE
e � 7,r� PANELS I O.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIc. r.', SIGNS TRANS. 3.00
ARCH.OR END SPECIAL CIRCUIT 5.00 PPE VALIDATION
zIPSS
EMP. METER OR POLE INS. 20.00
'
APP ANrR nr , ..
a00RE55 - - MOTORS . SEE FEE SCH.
SERVICE CHANGE 20.00 I ,��7
w o D LICENSED CONTRACTORS DECLARATION CI J C�Qe
n
or¢ u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a e, (commencing with Section 7000)of Division 3 of the Business and LDG. LECT. PLG. MECH.
F y z Professions Cod '_d ¢' ansa is in full for d effe
z o w — License Class Lie.Number -
0 y F W DatC C11n IraCtOr
IN I El El 0
A, x
¢ ¢ ¢ OWNER-BUILDER DECLARATION ev—za BUILDING PERMIT
-
o s u INFORMATION
X ; a y 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u o Q Law for the following reason.(Sec.7031.5,Business and Professions' pERM1T ISSUANCE 10.00 G— VALUATION $/FT.
fw >f Code:Any molish countywhich requires tots issuance,
after,
¢ ¢ Q O Improve,demolish,or repair any structure prior[o its issummO,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL Q
w2 m he is licensed pursuant to the provisions of the Contractor's License P IT TO
Hz> Law(Chapter 9(commencing with Section 7000)of Division 3 of the
s i o Business and Professions Code)Or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
ce H$ - the basis for the alleged exemption.Any violation of Section 7031.5 TORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not 61=11
OCC.GROUP RES.UNITS
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
proPcHy wlm builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT FLOOR AREJk TOTAL ACREAGE
himself or through his own employees.Provided that such improve.
mGAS-EA.SYSTEM-1 INC /' ()Zy
mes are not intended or offered for sale.If,however,the budding INCA OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or am- B LDING USE
Prove for purpose ole.). INDUSTRIAL WASTE INTER. 30.00 RES IN .CON PB Omar r
❑ L as owner off the property, exclusively contracting with
`\ licensed contractors to construct the
project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
oA Professions Code:The Contractor's License Law does not apply
to an owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
fin1_ the Contract suchLicenects Lwithncomractar(s)licensed ursuantm SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's am exec License Law. TRACT NO. PARCEL NO.
E ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
con
reason
f�1 Owner Date. WATER SYSTEM 5.00 aCC.oarE ACC.FILE NO.
WO COMPrNSATION DECLARATION WATER TREATING EQUIP. 5,00
I hereby affirm that I have a curt ificate of consent toself-insure,
or a certificate of Workers'Qhmpcl at Cm Insurance, a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.) ,.
Policy No. Company -
❑ Certified copy"s her'0 fu lisit- FIRE SPR INK ENERGY T-24
Z Z Cl Certified co is I the i pec ,division.
p Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No
H C6 TIPI OF fi%IiMPI'ION FROM O ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG,CONTR, LIC,NO. PLG.
CL p I This section need not he completed if the permit is for one TOTAL Y❑ No Y❑ No
=) Z hundred dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I— mil is issued,I shall not employ any person in any manner so as to
Q W become subject to the Workers'Compensation Laws of Calfl'orniu. !
C_ Date Applicant BUILDING
} N NOTIC,TO APPLICANT: It',alter muk,I Crtffica[C of lix ALTER OR ADD TO MECH. 5,00
H Z_ emptio you should become sh tttS-1 to Workers'Compensation APPLIANCE 'r 5.00 PLAN CHECK
mowslon. f the te, you must forthwith comply with ,FEE
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for wjDch this per�ec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Leader'sA dress ELECTRIC
\ Icertifyt - read this application and state that the above VENTILATION FAN (SINGLE) 4.00
fnformatiun is correct. I agree to comply with all city.and county PLUMBING
ordinances and state laws relating to building construction, and BOILER•COMP(3 H.P. 100, OOB.T'U.) 6.00 •OD
hereby authorize representatives of this city to enter upon the BOILER-COMP (OVar 10 ,000 TU SEE FEE SCH. MECHANICAL <f
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertin against ties,ju Is, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
May
an way accrue ago' sI sa' C'y in consequence of the
grant g thispermfL MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of pplicant/Co lac or Dale - —'
OFFICE COPY