14306 i
POST THIS CARD NEAR FRONT OF BUILDING
•
CITY OF CUPERTINO ' PERMITNUMBER
' INSPECTION DIVISION
JOB INSPECTION RECOR_ D
`.' PERMIT EXPIRATION
JOB ADDRESS BLANEY & BOLLINGER uNlr# _LOT.tt
PERMIT EXPIRES IF,WORK
i..
owrvEH DAVID WALLACE corvTRACTOR IS NOT STARTED V(ITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD - 180DAYS OFPERMIT ISSu-
FOUNDATION - -- ANCE OR 180 DAYS FROM
NOTE: -
UFERLAST CALLED INSPECTION.
. ALL GRADING AND DRAINAGE SHALL•BE INSTALLEDe
PREGUNITE• TO COMPLY WITH THE APPROVED PLANS AND CITY OF _ PERMIT VALIDATi ON
CUPERTINO STANDARDS. -
GARAGE SLABS - •
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB' '
PLUMBING ._ - / j {;, 7
ELECTRICAL - -
MECHANICAL eLDc ESLEC7_1 PLG MEGH
, . p� - 1:1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1�ik. tit I
BuaolNPERMIT=
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/PT:
MECHANICAL - -
ELECTRICAL - PERMIT rO
FRAMING
INSULATION sroHlEs ivPE CONSTH, .
.. - UCC GROUP RES.UNITS
-;� PLACE NO SU BFLOOfl UNTIL ABOVE HAS BEEN SIGNED - - -
sa.FT LLooR aNEa TOTAL ACHE AGE
(�, 1 ROOF NOTE:NO FINALTRU,C INS°,SHALL BE MADE BEFORE
/ DIAPHRAGM THE CONSTRUCTION TAX IS PAID I
ROOF SHEATHING - HesINOUILDCNONUSEPe 'Ori°•°
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS' DATE ' INSP.' El E] ❑ ❑ ❑
ROUGHSAN.N AssessOHS PARCEL NO.
' '
PLUMBING
ELECT.ENERGY -
` TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No
MECHANICAL - MECH.ENERGY
ELECTRICAL' - -BUILDING ENERGY - ACC.oATE - ACC FILE NO
FRAMING- ELECT,FINAL TEST -
INSULATION - PLUMBING ZONING' ENG.SITE NO
GAS TEST - GAS
MECHANICAL- EIRE SPR NK ENERGY T•za.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y El: N❑' Y.❑ N❑
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE
INTERIOR SHEAR FIRE DEPT, Y❑ N❑ Y ❑ N❑�
SHEETROCK . GRADE - FEE SUMMARY -
EXTERIOR LATH BUILDING
INTERIOR LATH. TEMPORARY APPROVALS BUILDING _
SCRATCH COAT ELECTRIC - /(,' PLAN CHECK,
GAS. - FEE. -
NO TAPE OR PLASTER UNTIL ABOVE-RAS SIGNED OCCUPANCY . SEISMIC FEE'
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
.• MICROFILM'
ARRANGE FOR. INSPECTI,ON BY PHONING 252-4505, . ELECTRIC
IW- ONE WORKING DAY BEFORE REQUIRED.INSPECTION.
O PLEASE GIVE JOB ADDRESS.WHEN PHONING. PLUMBING*
- SEE PERMIT FOR'EXPIRATION DATE - MECHANICAL'
I
IMPORTANT.! CONST.TAX
PLEASE READ'REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE.COPY
A*LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
Aoa�a:a F er 143 06
.T BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
rvnME (408)
' 4 PLAN CHECK VALIDATION
- QTY. ELECTRIC PERMIT FEE
e E .ass 763
PHONE
/t NAMER"croRs UTLETS-SWITCHES-RECEP 10.00/1.00 .
' uc.No. L'IGHTING'FIXTURES 10.00/1.00
ADDRESScroRs PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT
on
PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3,00
ADDRESS ENO' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT SSS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w 0 o LICENSED CONTRACTORS DECLARATION Y
¢u H. I hereby affum that I am licensed under provisions of Chapter 9 _ -
w a w (commenting with Section 7000)of Division 3 of the Bn5lnessand '� •� ISSUANCE DATE
F w 2 Professions Cele,and my license is in full force and effect. 1,
BLDG. ELECT. PLG. MECH.
o Z w W License Class Lic.Numher
Date Contractor C Q-
Q y f J �AI
¢ w
OWNER-BUILDER DECLARATION M. - 1-1 Ev
BUILDING PERMIT
wD a INFORMATION
g LL H, I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ,
u o¢ Law for the following reason.(Sec.703 L5,Business and Professions VALUATION
H, y m PERMIT ISSUANCE
E y, � Code:Any city or county which requiresa permit toeonstruct,alter, 10.00 ��.
S 2 Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO.
ELEG. (AI
o LL requires the applicant for such permit to file a signed statement that TOTAL G
a w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z Q
Law(Chapter 9(commenciagwith Section 7000)of Division 3 ofthe
s4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢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 to a civil penalty " ALTER-DRAIN& VENT-WATER (EA.) 5.00
of net more than five htmdred dollars($500)J:
❑ I,as owner of the property,or my employees with wageset - BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will property,
the work,and the s[with w is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
'ram Code: The Contractor's License Law Goes not apply to an owner of
'.\ M property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
\ himself or through his own employees,provided that such improve.
mems are not intended or offered for sale If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
1y r or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.1 2.00
Builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB Omar
❑ I,as owner of the properly,am exclusively contracting with - ❑ Q El
licensed contractors to construct the project(Sec.7044,otDines LAWN SPRINKLERS-1'INC 5 V-B: 6.00 ASSESSORS PARCEL NO.
and Professions of Code property Contractor's License Law does not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with n contmctoKs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200h/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under S c ,B.&P.C.for this
reason ..S ii r WATER HEATER W/VENT 6.00
7G Owner - .1 e - ,- WATER SYSTEM - 5.00
ACL.GATE ACC.FILE NO.
WORK IiRS'COMPENSA'p10N 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,Lab.C.).
Policy No..Company
O ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T-ZA
f" O Applicant MISC.- REFER TO ORD. Y ❑ N Y ❑ IN
CC T CE RTI FI LATE 01'EXEMPTION 17 ROM WORKERSPERMIT ISSUANCE 10.001FLOOD ZONE A-L.U.C..
LidCOMPENSATION INSURANCE PLG.CONTR.' LIC.NO. PLG.
Q' O (This section need not be completed if the permit is for one -TOTAL Y[:] N V ❑ N❑
Z hundred dollars IS 100)or I..)
L) O I certify that in the Performance of the work for which this per- CITY, MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil 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 Dale Applicant ALTER OR ADD TO MECH. '5.00 BUILDING
} to NOTICE TO APPLICANT, If,after making this Certificate of Ex- - -
F _ emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK '
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIRHANDLING 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 which this permit is issued(Sec. '
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Oa
I certify that I have read this application and stale that the aboveVENTILATION FAN (SINGLE) 4.00
information is correct 1 agree to comply with all city and county BO)LER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the r-
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs andexpenses which CONST.TAX
lay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 '
naming of this permitMECH.
. MECH.CONT. LIC.NO.
TOTAL
�9gnature of Applicant/Contsnclor Uate TOTAL
OFFICE COPY