12960 POST.THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY OF CUPERTINO
PERMIT
K - INSPECTION DIVISION
JOB INSPECTION RECORD
1 PERMIT EXPIRATION
JOB AODR ESSl071S S. Blaney Ave nue UNIT# LOT#
• - 'PERMIT EXPIRES IF WORK
OWNER SOdn Underwood CONTRACTOR Calif. Kitchens ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180•DAYS FROM
LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB '
PLUMBING
ELECTRICAL ISSUANCE DA
MEC HANICALBLOC. ELCCT 'T PLG. E
CH
• i LT7fyJ Ilr�/iJ IRr�Xj
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vnwnnoN, 5/FT.
PLUMBING
MECHANICAL. •,
ELECTRICAL - 'PERMIT TO
FRAMING
STORIES TYPE CONSTR,
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
) � ROOF 16-LO -LNz _ _p SO FT FLOORAHEA TOTALACREAGE
DIAPHRAGM A AM o AL BUILDING USE
RES IND CON PB O,h.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ As0ssoR0ARcEL 0 0
ROUGH
PLUMBING '
GAS TEST TRACTNO. PARCEL NO.
MECHANICAL •
ACG DATE ACC.FILE NO.
ELECTRICAL - FINALS DATE INSP.
FRAMING S SAN # _ -
INSULATION ' PLUMBING
zoNlNc ENc.siTENo.
GAS
MECHANICAL - FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I,HEATING "F] "0
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. /
LATH—EXTERIOR FIRE DEPT.
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR - BUILDING
SHEAR EXTERIOR TEMPO RARY.APPROVALS BUILDING
FIREWALLS - ' ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, t ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Il
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL Pf
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADDRESSS APPLICATION & PERMIT 12960
v, 07/ 3�
r S. MAIg c BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
/ OWNER'S PLAN CHECK VALIDATION
fx NAME of�� /� ,,��/� ^J t/ Q TV. ELECTRIC PERMIT FEE
%& UN46e ZAVOb PHONE (, 7� .1/[
NorMERacroRs UTLETS-SWITCHES-RECEP 10.00/1.00 d --
e/7l1.r4X4 //if/ x//C//E Ic.No. /$�1`11LIGHTING FIXTURES 10.00/1.00
nooness TORS Sava /MR A1/ PPUANCES-RESIDENTIAL 4.00
(/), PHONE y/r'e/7�/ PANELS 10,00
DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
ENGINEER JARS/ `IWe3/+ee AAID CO PANELS(OVER 200 AMPI 20.00
LIC.NO, SIGNS TRANS. 3.00
ADDRESS ENG.'6 k�tF fQD. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
AODRE55 >
CNAECr7N0
Ifoldf TEMP.METER OR POLE INS. 20.00 W
AvvLICANT•s J,lqo 5 1 MOTORS S E SCH. �
ADDRESS MFl 140
aM6CXC0.f11- eA IN60 L SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION S sa'/ 7
'F z w I hereby affirm Osm I'am licensed under provisions of Chapter 9 ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r �i Professions Code and mLlicense is in full force at ffgct / ❑ ® ® ,�-,q
0 O y - License lass L+ Lic.Nmnber 7 7 I`l')•'Q`
o H w Date_J_y_ Contractor
< x BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
o a u INFORMATION
'w ;LL E. 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
H -w� Code:Anycity orcounty which requires a permit to construct,alter, PERMIT ISSUANCE 10.00 O
Q Q O� improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC.CONTE. LIC.NO. ELEC. 'r
u requires the applicant for such permit l0 file a signed Statement that TOTAL a,� .� PERMIT TO
A w m he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
It F. the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
n ; - by any applicant for a permit subjects the applicant me civil penalty ALTER-DRAIN -WATER IEA.) $.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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,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 does such work FIXTURES-PER TRAP S.00 - SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.if,however,the budding GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
Or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-O A.1 2.00
builder will have the burden of proving that he did not build or no. BUILDING USE
prove for purpose of sale.), RES IND CON PB OtM1er,
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE ER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 IN 5`V 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 SPRINKLE goEA 5(EA.), 1.00
contracts for such projects with a contractor(s)licensed pursuant to License Law.
the Contractor'sSEWER-SANITARYR V 0.00
TRACT NO. PARCEL NO.
❑ [am exempt under Sec.-,BAP.C.for this WATER HEATER W/ 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I,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,La i.0.).
Pot o, Company
O Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Carte 'opy is Bled the sissy inspection division.
O Applicant wM�•�g� MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No
Sy CE IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ,d FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. ��,q (
CL a (This section need not be completed if the permit is for one TOTAL =V^� Y❑ N❑ Y❑ N❑
::) Z hundred dollars($100)or less.)
U O I certify that in the performance of she work for which this Per- OTY. MECHANICAL PER 1 O FEE FEE SUMMARY
LL F 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.
t Date Applicant • BUILDING
} Do NOTICE TO APPLICANT: If,after making this Certificate of I. ALTER OR ADD TO MECH.
2 Tdw
emplion,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply withFEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO-W.F.M.) 10 0
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1 .00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH D 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). s HEATING UNIT(TO 100,000 B.T.U-) 8.00
Lender's Name�
Lender's Address HEATING UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
it I certify that I have read this application and state that the above Ii VENTILATION FAN (SINGLE) 4.00
A information is correct. I agree to comply with all city and county PLUMBING `ZT�
ordinances and state laws relating to building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for representatives
of
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 Q '- CONST.TAX
may in any way accrue against said City in consequence of the
granting Of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL /7V" TOTAL 0'd
- Ignature of Applicant Contractor Date
OFFICE COPY