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13952 ',-POST THIS CARD NEAR FRONT OF BUILDING rs., LFRMIT NUM R,EH J`, ; CITY OF CUPERTINO 13952 - INSPECTdONI•DIVISION . JOB INSPECTION RECORD - - ' '. • 21386 .AMULET' DRIVE' PERMIT EXPIRATION - JOB.ADDRESS UNIT# LOT# '.PERMIT EXPIRES IF WORK" . OWNER A."'ZTMMERMAN ' - - CONTRACTOR ." IS NOTE STARTED WITHIN INSPECTION DATE ,INSPECTOR. INSPECTION RECORD 780 DAV§IOF PERMIT ISSU; ' FOUNDATION ANCE'OR 180 DAVS FROM '{ UFER LASTCALLE D�INSPECTIONx PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - ` ^4Q1'+✓"T/(" PLUMBING - ELECTRICAL � - - ISSUANCEDATE MECHANICAL - - BLDG, ELECT. . PLG. . MECH.- ❑ El ❑1 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR U' INFORMATION ` PLUMBINGVALUATION EIFT. 'MECHANICAL. t ELECTRICAL - - - �.+'''PERMITTD l 'FRAMING INSULATION + - - ST ES TYPE CONSTR. OCC:'GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - f ROOF 7 SO.FT.FLUOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING.USE .RES IND CON PB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. - ROUGH ' PLUMBING GAS TEST " - ., - THACI NO. PARCEL NO. MECHANICAL R ' -ACC,DATE - ACC.FILE NO. ELECTRICAL ' - - FINALS"' ;w;# `.r DATE INSP. FRAMING - SAN #- ENG.$ITE'NGI. INSULATION PLUMBING ZONING,, .. GAS - V t MECHANICAL FIRE SPRINK . ENERGY T�24' ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED „ I HEATING, ° " Y " ' . LATH-INTERIOR . . .ELECTRICAL FLDOD ZONE AL.U.C. LATH-EXTERIOR . FIRE DEPT., - Y❑ N❑' ' ;v❑ "❑ SHEETROCK, - GRADE - -- - -- - SUMMARY SHEAR INTERIOR BUILDING. SHEAR EXTERIOR ^ ,,.y„'. , ” ' TEMPORARY,iAPPROVALS - BUILDING FIREWALLS ., ELECTRIC PLAN CHECK' I. GAS ' - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. ' MICROFILM _ ARRANGE FOR INSPECTION BY PHONING 252-4505,:" ELECTRICrjK'� . . ��, ONE WORKING DAY BEFORE REQUIRED IINSPECTION. PLunnBlNc, . Z PLEASE GIVE JOB ADDRESS WHEN,PHONING. — SEE'PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CON ST.TAx PLEASE READ REVERSE SIDE BEFORE TOTAL �1 CALLING FOR FINAL INSPECTION. X = OFFICE COPY, .. . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY- BUILDING PROJECT IDENTIFICATI ON r PERMIT NUMBER , FURRING - APPLICATION & PERMIT - aooREss •������� 13952 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL . OWNER'5 ((II • PLAN CHECK VALIDATION NAmE 'yb �Q QTY. ELECTRIC PERMIT FEE 4.zmI,47,esz !rt/ PHCN q CONTRACTORS NAME P 1 A OUTLETS-SWITCHES-RECE0.00/1-.00 LIC No LIGHTING FIXTURES 10.00/1.00 D 10.00/1.00 DCDREsa NTRaDTOR's APPLIANCES-RESIDENTIAL 4,00 PHONE, PANELS - 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC,NO, SIGNS TRANS.-, 3.00 ARCH.OR ENG. - " PERMILVAm DATION ADDRESS - SPECIAL CIRCUIT •r 5.00 M-llq,uC ZIP EMP. METER OR PO LE INS, 20.00 APPLICANTS MOTORS• - " ADDRESS a I SEE FEE SCH. \ - SERVICE CHANGE 1 20.00 �4r'r � , o o LICENSED 4 CONTRACTORS DECLARATION 3V OB rirnnrd:.. ( as '' la.172itillf Uw I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE y ¢ H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT I PLG. MECH. H z Professions Code,and my license is in full force and effect. _ - z 0 — License Class' Lic.Number 1' _ F i ae�tla ❑ 9 Zm— 0 Date Contractor F ac a:w a OWNER-BUILDER DECLARATION ' hBU LDINGbPE-EMIT E: ;LL r I hereby affirm that 1 am exempt from Ore Contractor's License MISQ.— REFER TO ORD £ ` w1.N FORMATION 1O LL 0 ¢ Law for the following reason.(Sec.7031.5,Business and Professions - Q VALUATION $/FT. H — PERMIT ISSUANCE 10.00 Code Any city or county which requires a Permit to construct,alter,' K Q improve,demolish,or repair any structure,prior to its issuance,Sign ELEC.CONTE. LIC.NO. ELEC. y alc u requires the applicant for such permit M file a signed statement that TOTAL p MIT.TO w m m he is licensed pursuant to the provisions of the Contractor's License r > Law(Chapter 9(commencing with Section 7000)of Division 3 of the ic Business and Professions Code)or that he is exempt therefrom and QTY. % a .,v<PLUMBING`PERIM IT` 1F,EE= H m the basis for the alleged exemption.Any violation of Section 7031 5 t' & N z = E `, •Y ' d P 9 ' S s , 5 to TYPE CONSTR. a 3 by any applicant for a permit subjects the applicant to a civil penalty ` of not more than five hundred dollars($500).): 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 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 r Code:The Contractor's License Law does not apply to an owner of. - - property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00. SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l 6,00 or improvement is sold within one year of completion,the owner GAS-EASYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- . BUILDING USE prove for purpose of sale.). INDUS RIAL WASTE INTER. 30.00 RES -IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ 1:1 ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6:00 - ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ' 0 tum exempt under Sec. ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00 I hereby affirm that 1 have a certificate of consent to self-insure, Or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.CJ. - Policy No: Company ' O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY R24 . Z Z ❑ Certified copy is filed with the city inspection division. , p: O Applicant MISC.- REFER TO ORD. Y [3 N� V ❑ N❑ CC T —OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 0 (This section need not be completed if the permit is for one TOTAL Y Y ❑ N LZ) Z hundred dollars(S 100)or Ieax) - yr - -;f • •> ) O I certify that in the performance of the work for which this Per- QTY,t . < MECHANICAL PERMIT '; 'FEE FEE SUMMARY LL I-4 mit is issued,I shall not employ any person in any manner so as to v '+ O W l` became u to the Workers' nl)1C1 diongLa�ws of California. - y Date,, �APDlicantii,7,, " BUILDING to TI APPLICANT: I ,of r 10Gng t ug a tl ma a of Lx- ALTER OR ADD TO MECH 5.00 H ? emption,you should become subj� to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE CJ such provisions or this permit shall be deemed revoked. 'AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 "CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.EM.) 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 which this permit is issued(Sec. MICROFILM 3097, .am - HEATING UNIT(TO 100,000 B.T.U.I. '8.00 Lender's Name HEATING UN IT 100,000 B.T.U.)9.50 ,0© Lender's Address - ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information 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.R icr100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon file BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. '(We) agree to save, indemnify and keep harmless the City of 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[he go,mingu4is permit - MECH.CONT. -LIC.NO. MECH. 10, o OTAL TOTAL ign o Apphcan o rector ate OFFICE COPY