14105 POST THIS CARD NEAR FRONT OF BUILDING _
m PERMIT NUMBER'
CITY- OF .CUPERTINO'
INSPECTION DIVISION 4105
JOB INSPECTION RECORD .
PERMIT"EXPIRAT.ION r
JOB ADDRESS '7912 AUGUST LANE.' .
UNIT# - ^_LOT# ' - PERMIT EXPIRES IF WORK
NAGYr.
jFOUNDA
comTRAcmR A ACE 'PLUMBING : IS NOT STARTED WITHIN ,
PECTION" DATE • INSPECTOR",x INSPECTION RECORD i80,DAVS OF PERMIT ISSU-
N - u ANCE{OR 180 DAYS FROM
LASTCALLED INSPECTION.
PERMIT VALIDATION
ONCRETE UNTILABOVEHAS BEEN SIGNED UNDERGROUND /SLAB
ELECTRICAL. , •. ' •. tM.�' AI, • .
ISSUANCE DATE
MECHANICAL - , '- ,v, BLDG. ' ELECT. PLG. MECH.
El I'D El
00 NOT POUR FLOOR UNTIL ABOVE HAS,'BEEN SIGNED' . _ g ' �' }i BUILDING'PERMIT
WOOD FLOOR V S ,INFORMATION,
5 pi
PLUMBING
VALUATION $/FT
- • ,- .� �
MECHANICAL -
^' ELECTRICAL - v ., PERMITTO
FRAMING'
INSULATION, STORIES- -- '• TYPECONSTR'
- OCG GROUP - NITS.RES,UNITS
PLACEN 1 0 SUBFL06R UNTIL ABOVEMAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL NCREAGE.
Ir
DIAPHRAGM _
.. BUILDING USE -
RESr IND- CON PB DO—
APPLY NO ROOFING UNTIL ABOVE HAS•BEEN SIGNED
❑ '❑ El 1:1 E]
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - TRACT NO. PARCEL NO.,
MECHANICAL Iv
ELECTRICAL'', • ACC DATE ACC.FILE NO.
- ., - u . FINALS 'i DATE
FRAMING• - SAN
r- INSULATION - - PLUMBING ZONING ENG.SITE"NO,
GAS
MECHANICAL. FIRE SPRINK ENERGY T 2
COVER NO WORK-UNTIL ABOVE HAS,BEENrSIGNED HEATING' YD NEI Y ❑ NEI
LATH—INTERIOR", ELECTRICAL FLOOD ZONE A.Luc.
LATH—EXTERIOR - Y'] N❑ Y I] NSHEET ❑.
FIRE DEPT:', Y _ ,
SHEARRNTERIOR OCK GRADE — ' s`":
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
11 BUILDING PROJECT I DENTI F[CATION PERMIT NUMBER
AD�F55 �L APPLICATION & PERMIT 14105
• T BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER S } PLAN CHECK VALIDATION
NIN
- QTY. _ ELECTRIC PERMIT - FEE
PHONE
RAT OUTLETS-SWITCHES
-RECEP 10.00/1.00
Pl,, fLIC.No f. LIGHTING FIXTURES 10.00/1.00
RA OHS r APPLIANCES-RESIDENTIAL 4.00
AO RESSC a` p -
1 25 .5:11 144-5- PH '81O I PANELS 10.00 GATE OF APPLICATION
RcnrtscT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
Ofl
ENGINEER
LIC.No. SIGNS TRANS. . 3,00
ARCH.OR ENG. $pEDIAL CIRCUIT 6.60 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION17 -
a is u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANC DATE
vv, "' (commencing with Section 7000)of Division 3 of the Business and
¢ n BLDG. ELECT. PL MECH.
F w, Professions Cody 1910 license is Nn full foPe� ❑ ❑ ❑
' 0.- License Cl ` Jf0 Lic.NumberfL•
Dale_ g.��Contracror.
a Y E BUILDING PERMIT
le ¢ w ¢ _ OWNER-BUILDER DECLARATION INFORMATION -
oA0 MISC. REFER TO ORD '
E:
3 LL H 1 hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT.
F LL o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
� alIt 0 improve, or repair any structure,pnorto itsissuanCe,also ELEC.CONTR. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
$w he is licensed pursuant to the provisions of the Contractor's License
HZ>
Law(Chapter 9(commeacingwith Section 7000)of Division 3 ofthe. -
I i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING.PERMITFEEfr
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant(..civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their aide compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SD,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve'
mems are not intended of offered fo..ale.'IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 (EA) 200
builder will have the burden of proving that h - . . .
In,did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Othar
111,as owner of lite property,4m exclusively contracting With ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-'1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions code: file 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 contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.QOOftI10.00
the Contractor's License Law. TRACTNO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this , t WATER HEATER W/VENT 6.00 QQ
eosin
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPFNSA'1ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy ih 3 00,Lab.C.).
Policy,.,yg 7 Company
O ❑ Cell❑ill copy is he by furnished. FIRE SPRINK ENERGY T-34
Z Z ❑ Certifiedc Is B 'd with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y❑ N❑ Y ❑ N❑
F rnPERMIT ISSUANCE 10.00 O
W ; CERl'll'O MP17FROM WORKERS'NSATON INNSURA CEPLG.CONTR. LIC.NO. PLO. .60 FLOOD ZONE A.L.U.C.
CL 0 IThis section need not be completed if the permit is for one TOTAL iN Y[0:JN❑ Y E] N❑
Z) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work'for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued. I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensation Laws of California. BUILDING
d
Date-Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE 'I'O APPLICANT: If,after making this Certificate of Ex
♦- ? caption,you should become subject to the Workers'Contpensetim, n APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
tile 3097eCiv Cane of the work for which this permit is issued(See. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name H EATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above 1 1 VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city nn and con"
oly PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMPI3 H.P.O/100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the gOILER•COMP IOvar100,000 BTU)SEE FEE$CH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino agaJsB.1a bilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00CONST.TAX
may any wccrue against said City in consequence of thegran(i fthiit. - MECH.CONT. LIC.NO. MECH.
AaL� 17-L9/�/ TOTAL TOTALSignal of Appant on tractor Dale E /
OFFICE COPY _ -