13550 �. . POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 113550
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS .21663 CASTLETON ST UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER BOBBY JOHNS CONTRACTOR DELETE-A=PEST IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER . - LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
Apr,d pU4*L f,+r A, T- �.1✓.�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,0A-- ?
UNDERGROUND /SLAB 3 _sc0 u0 _FL 8q-TN
PLUMBING - PaM'< pftt kF OK. 'Ca. /ANCE/ATE�
ELECTRICAL ` g}��'(�L �. N' r IS
MECHANICAL ELECT. PLG. MECH.
OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION S/FT.
PLUMBING Ci
MECHANICAL_
PERMIT TO
ELECTRICAL. _
FRAMINGpx
rE-
INSULATION STCR(ES TYPE CONSTR.
-- OCC.GROUP RES.UNITS
11,107 CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR ARE/ TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES INDCON PB Otl",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑
ASSESSORS PARCEL NO. -
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL N0.
MECHANICAL
ELECTRICAL FINALS DATE INSP. qCC.DATE ACC.FILE NO,
FRAMINGSAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING � ,
GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
•
COVER NO+,WONRcUNTI L,,'ABOVE•HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL - FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y 0 N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING 1
SHEAR EXTERIOR TEMPORA P OVALS .BUILDING
FIREWALLS ELECTRICPLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE J
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. MICROFILM
1
'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� 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
' w BUILDING PROJECT IDENTIFICATION PERMITNUMBER
BUILDING APPLICATION & PERMIT
ADDRESS 2-%CC 3 Cs{,�.�� si-' 13550
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
Il,
It NAME OWNERS
. PLAN CHECK VALIDATION
DTV. ELECTRIC PERMIT FEE
�I t�'obb Sohves PNDNE
NAMERACTOR's IOUTLETS,-SWITCHES-RECEP 10.00/1.00
J/C,Ck -12� c LIc.No.O$QO LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
DRESS
ACnr� � PPLIANCES-RESIDENTIAL 4.00
PHONE If.S(2 PANELS 10.00 DATE OF APPLICATION
onnCHITECT PANELS(OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. ISIGNS TRANS. ' 3.00
ARCH.OR ENG. SPECIALCIRCUIT 5,06 PER MIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 /t
APPLICANT'S
ADORERS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 `O
w o O LICENSED CONTRACTORS DECLARATION 1714-7
<i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
04
n (commencing with Section 7000)of Division 3 of the Business and ,BIpG. ELECj, PLG. MECH.
o i Professions Code and my license is in full fore and (feet ❑ ❑
Z,o y License Class ''•7 Lic.Numher Sl
B w L w0 Date �'T Conlracto -
< m s BUILDING PERMIT
son 0 OWNER.BUILDER DECLARATION ` INFORMATION
w ; t; 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Fun4 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
i m w Y Cade:Any city or county which requires permit to construct,alter, TO
Iz rt 4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e. w 8 m he is licensed pursuant to the provisions of The Contractor's License
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Q ,L'
4 0 Business and Professions Code)or that he is exempt therefrom andOTV. PLUMBING PERMIT FEE TE.2/Ly�7d= 9y
f $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
y ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCD.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 F IXTUR ES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
_ himself or through his own employees,provided that such improve-
ments are not imended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 IEA.) 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 Omer
❑ I,as owner of the properly,am exclusively contracting with ❑ ❑ 0 ❑ 0
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 conlractogs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec., ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
f copy thereof�(�ec�8 0 bF.Js
�/- Policy NsASL�lL�rSn�ao J 5Aeo,
Q ❑ Certified copy is hereby famished. FIRE SPflINK ENERGY T-14
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. � �
Applicant Y N Yo No
CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
ION
11.1 , (This Section need not beTcompleted iftire
permit is for one PLG.CONTR. LIC.NO, TOTAL Y 0 N❑ Y❑ N E]
LG
CL D
Z) Z hundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per- (ITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL mit is issued,I shall not employ any person in any Insurer so as to
O Wbecome subject to the Workers'Compensation Laws of California. t -)
0- Date Applicant BUILDING fi �_
>_ to NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 O
? emplion,you should become subject to the Workers'Compensation APPLIANCE .5.00 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 10,000QF.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=r-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 HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CY.CJ.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U39.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
\ information n correct, 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER
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 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(WId agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue agar s[ said City in consequence of the PERMIT ISSUANCE 10.00
g D([his permit MECH.CONT. LIC.NO. MECH.
A I TOTAL TOTAL 9
r- O
/ Sig re of I plicanl/Co tracmr Dat
OFFICE COPY-__