14614 POST THIS CARD NEAR FRONT OF BUILDING PE RMITNUMBER
CITY OF CUPERTINO 14614 j
INSPECTION DIVISION
n JOB INSPECTION RECORD '
PERMIT EXPIRATION.`
JOB ADDRESS 862 BRENT AVE. UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER M/M PICHON CONTRACTOR ANTIQUE TERMITE AS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-:
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: : <. ,LASTCA LLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED +'
PREGUNITE 'TO COMPLY.WITH THE APPROVED PLANS AND CITY OF PERMITVALIDATION
CUPERTINO STANDARDS. ,
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
`
UNDERGROUND /SLABy
PLUMBING - - • - ylr�r'/�' `
ELECTRICAL likkVIs DANCE DATE
-MECHANICAL LDG eLE PLG. MICR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUIL PERMIT y,
ATION
WOOD FLOOR %Tj ALUATION SIFT.
PLUMBING - -
MECHANICAL #L'
PERMIT TD .
ELECTRICAL.
FRAMING ' ) 2i 10 7' STORIES
INSULATION TYPE EcoNSTR.
♦ OCC-GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_ 50 (i FLOOR AREA TOTAL ACRf AGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
-BUILDING USE
ROOF-SHEATHING
'-RES IND CON PB 0",
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El .ASSESSORS
ASSESSORSPAH CEL NO
ROUGH - SAN.#
PLUMBING . ELECT.ENERGY
TRACT NU. PARCEL NO
• TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECR ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING.ENERGY - - -
FRAMING &4 ELECT.FINAL TEST ZONING END SITE NO,
INSULATION IPLUMBING GAS TEST GAS -
FIRESPRINK ENERGY T.29
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "� Y El N�
. EXTERIOR SHEAR
ELECTRICAL RELEASE - FLOOD ZONEALUC
INTERIOR SHEAR S&"4- Z&LFIRE DEPT. v N� v I] NET
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING3zFwft
INTERIOR LATH • TEMPORARY APPROVALS BUILDING,-' -
SCRATCH COAT ELECTRIC - - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
111 11, ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
2 MECHANICAL
' SEE.PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE.COPY ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION I - PERMIT NUM BE
Jo BUILDING APPLICATION & PERMIT 1 1
ADDRESS _I 1
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwxER's ` PLAN CHECK VALIDATION
"`ME IJ�� QTY. ELECTRIC PERMIT FEE
\
:'_` -•`V/` PHONE.CONTRACTOR S '�^ /-�
NAM94
E, ,� ` abi 1( LIGHTING
-SWITCHES-RECEP 10.00/1.00
LIC.NO.p LIGHTING FIXTURES 10.00/7.00
r, T&;%l roR �^ 7(�/1� � -01gS APPLIANCES-RESIDENTIAL 4.00 '
PHONE PANELS tO.00 DATE K APPLICATION
agcRlTecr PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.No.
ENGINEER
Llc.rvo. SIGNS TRANS. 3.00
n"Do eons ENG. _ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPUCArvrS 1MOTORS SEE FEE SCH.
ADDRESS �, g,
SERVICE CHANGE -20.001��
O¢ 2Q
,02 LICENSED CON'1'RACI'ORS DECLARATION
¢u v I hereby affirm that I am licensed under provisions of Chapter 9 SUANCE DATE
W Iu (commencing with Section 7000)of Division 3 of the Business and
Q H BLDG. ELECT. PLG. MECH.
r 7 z Professions Code,' d my license is in full furc I I eff c ❑ ❑ ❑
G 0 N w License CI' s Lie.Number 7.3_
Dale Conlruaor- p
er y E'.J+ ' ^' UILDING PERMIT
X o d 'owNER-BuaoeR DEcl.naanoN INFORMATION
w 5¢ I- I hereby affirm that I am exempt from the Contractors License MISC.- REFER TOO p
VALUATION $/FT.
1- 0< Law for the following reason. 703 L5,BusinessandProfessions PERMIT ISSUANCE �(
w /Cade:Any City or county which requires permit to construct. - J
r yk
a 2¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. /4r
44
wO or requires the applicant for such permit to file a signed statement(hat - TOTA fitlW PERMIT T
$ he is licensed pursuant to the provisions of tire Contractor's License
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the TC -tlTc
4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H the basis for the alleged exnnption.Any violation of Section 7031.5 STORIES TY CONSTR.
byany applicant ford permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of no(more than five hundred dollars(S500).):
❑ 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 to(Sec, 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds of improves Ihereon,and who does such work FIXTURES,PER TRAP 5.110 - ' SO:FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6,00
mems are not intended or offered for sale.If,however,the building -
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int. BUILDING USE
RES IND CON PB Other
• prove 1,as owner
of sale.). INDUSTRIALWASTE INTER. 30.00
❑ d as owner of the properly,he exclusively .7044, ins with '❑ ❑ ❑ ❑ ❑
licensed contractors t0 construct the project(Sec,7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL rv0.
and Professions property
The Contractor's License Luw docs not apply
to tr owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 _•
tEe Contract.,',
oct5forsuchprojectswithacontmemrts)licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00
llic GOntradD!s License Law. TRACT N0. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00 '
reason
Owner Dale WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPF-NSATION 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 Insman or a certified
-s copy theyq.LS;rCvv,,3800,Lah.C.j�py�
Policy N137 {2t.Company�'L _�
Q O Certified copy ishereby furnished - FIRE SPRINKP ENERGY T-24
Z Z 0 Certifie copy Is filed ifh the citY_ins�pection division. MISC- REFER TO ORD.
O T Applicant_ f V❑ - N❑ -.. V ❑ N❑
y CER'fIFICA" :Olt 17XEMP'TION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need not be completed if the permit is for one TOTAL ,V❑ N❑ Y ❑ No
Z hundred d.IIms(S100)or less) -
L) O I Certify that in the performance of the work for which this pet- CITY MECHANICAL PERMIT - FEE FEE SUMMARY
U. F mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
W Date • Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} y NOTICE TO APPLICANt': If,after making this Certificate of Ex
h-, Z Caption,you should become Subject to the Workers'Compensatirrn APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply.wi(h FEE
V such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,00DC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY I AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is o construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CiyC.). HEATING UNIT(TO 100,000 B.T.U.) .8.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and slate 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 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTUI 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 is any way accrue against midCityin consCl en of t e "
rantip Of this permit. MECH.CONT. - LIC.NO. MECH.
q TOTAL TOTAL
Signature o pphcant/Contractor Date
OFFICE COPY