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12634 ` POST THIS CARD NEAR FRONT OF BUILDING ' Atl CITY OF CUPERTINO 1'FRMIT NUMBER INSPECTION DIVISION. 12634 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 11053 Bel Aire Court UNIT# LOT# - `" A PERMIT EXPIRES IF WORK OWNER Stephen Durham CONTRACTOR Rodger Wooley IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 1880 DAYS OF PERMIT ISSU FOUNDATION -30 7 t g vv-& Lbp- OPdtr pCNCE OR 180 DAYS FROM LIFER CAST CALLED INSPECTION. PREGUNITE _ PERMIT VALIDATION D ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p� UNDERGROUND /SLAB - PLUMBING `•///� ELECTRICAL Y NZ Tr7 MECHANICAL PJ E 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu1LDINc PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING SO MECHANICAL I G ELECTRICAL PP/REMIT ro /�'1/ FRAMING 0 �.P✓��"r INSULATION STORIES TYPE CONSTR. :y ' 'v,L OCC.GROUP RES.UNITS \ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED i ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM to RUILDING USE RES IND CON PD Olein APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL N0. MECHANICAL ACC.DATE - ACC.FILE NO. ELECTRICAL - FINALS DATE INSP. , FRAMING — SAN# ZONING ENG.SITE NO. INSULATION PLUMBING GAS MECHANICAL - FIRE SPRINK ENERGY T�24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] "❑ E] J LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.0 C. LATH-EXTERIOR FIRE DEPT. -/u' Y❑ IN[3 Y 0 N❑ SHEETROCK - 2 GRADE FEE SUMMARY SHEAR INTERIOR BUILDING /y, SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING _ FIREWALLS ELECTRIC PLAN CHECK- GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 7 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, gjLECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 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 RUI LDwNG PROJECT I DENTI FICATION PER MIT NUMBER But G APPLICATION & PERMIT. ADDRESS �Q 12634 053 BBL A' G�f' BUILDING -ELECTRICAL-PLUMBING-MECHANICAL t OWNER'S NAME PLAN CHECK VALIDATION OTV. ELECTRIC PERMIT FEE CJS' RONE NAMERAcaOR's a OUTLETS 10.00/1.00 p i( 1 1g17G E'!( tu//aL � F,-f/�/^ 3 /V FT CONTRACTORS uc.No'"_ � / LIGHTING FIXTURES 10.00/1.00 �IO ' AO/oREss / APPLIANCES-RESIDENTIAL 4.00 C3 /// T PANELS 10.00 DATE OF APPLICATION OR RCRITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. N EER / LIC.NO.�w-/uOs ''SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00PERMIT VAI ZIP TEMP.METER OR POLE INS. 20.00 J I N87 O 19 ADDRESS 'L MOTORS SEE FEE SCH. r� - JO/ APPLICA [,QS S CA qg'p22 SERVICE CHANGE 20.00 *W/0/O p",,,,,yino woo LICENSED CONTRACTORS DECLARATION (/�y/0 a i U I hereby affirm that 1 am licensed tinder provisions of Chapter 9 (� ISSUANCE DATE at <w (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. H m, Professions Code, d my license is in full for a and effe L ®_ F z o w Daens Class Con Numbe 9 w_`; Date - r r Contractor city of Cupertino+;n0 PERMIT w ¢ OWNER-BUILDER DECLARATION d o A o INFORMATION Pe ; w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD IL Ove Law for the following reason(Bea 7031.5,Business and Professions VALUATION $/FT. H _ PERMIT ISSUANCE 10.00 O �� 4wrf Code;Any city or county which requires upermit to construct,alter, ar Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O LL requires the applicant for such permit to file a signed statement that TOTAL j�PERMIT TO w - $ he is licensed pursuant to the provisions of the Contractor's License �'(/ d r7lo'�/ fzi Law(Chapter9(commencing with Section 7000)of Division 3 ofthe f 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE j M 1- S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. 1 a3 by any applicant for a permit sobjects the applicant to a civil penalty y of not more than five hALTER-DRAIN (EA.) 5.00 hundred dollars($500).1' ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 .00C.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not ,r -� / intended or offered for sale(Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AREA,COND. 5.00 K Code:The Contractor's License Low does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 b SO.FT.FLOOR AREA TOTAL ACREAGE f himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00 I builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). RES IND CON Pe Other ❑ 1,as owner of the property,am exclusively contracting with IINDUSTRIAL WASTE INTER. 30.00 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 contractons)licensed pursuant to SEWER-SANITARY-ST OOft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. C) I am exempt under Sec, ,B.&P.C.for this WATER HEATER W/V 6.00 reason Owner Date WATER SYSTEM g+ 5.00 ACC.GATE ACC,FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATIN E 1 5.00 1 hereby affirm that I have a certificate ofconsenl to self-insure, ora certificate of Workers'Compensation Insurance,or a certified )no ZONING ENG.SITE NO. re copy thereof(Sec.3800, trany Lab C) Policy ere 00 I 0 ❑ Certified copy is hereby furnished. Z 2 ❑ Certifie copy is Bled with the city pectiort division. FIRE SPRINK ENERGY T-24 Fp Applicant MISC.- REFER TO ORD. YE] N Y ND c N CERTIFICAAE OF EXEMPTION FROM ORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C. " W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL C)( This section-need not be completed if the permit is for one TOTAL �16 Y E] N� V [:] NC] hundred dollars(S 100)or less.) L) 0 1 certify that in the performance of the work for which this per, CITU. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. a Date Applicant - BUILDING 9 z � >_ N NOTICE TO APPLICANT: If,after Disking this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 SCO I... ? emption,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. ( AIR HANDLING UNIT(TO 1 C.F.M.) 4_.00 CONSTRUCTION LENDING AGENCY - AIRHANDLINGUNIT(OV 1J .`.)„ .00 SEISMIC FEE ,3r�_7 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WI C ) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM - 3097,Civ.C.). 1 HEATING UNIT(TO 1tl0,000 Lender's Name H EATI NG U N IT E R B.ITOL-.50 Lender's Address ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILEfl-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating l0 building construction, and *"11 hereby authorize,representatives of this city W enter upon the BOILER-COMP(ober 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. 's (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. r.. Cupertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 •y CONST.TAX may in any way accrue against said Ci[ in consequence of the gra0I of th' ermit.n / ECH.CONT. LIC.NO, MECH. J W D^ TOTAL DZ TOTALS s Signature of pplicanl/Contractor Date OFFICE COPY