14222 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14222
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 10385 CHERRY TREE :LANE UNIT# LOT#
PERMIT EXPIRES IF WORK'
OWNER JOHN LITTLE CONTRACTOR CIRCUIT PRO ELECTRIC IS.NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1.8.0 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 DATE'F
C
MECHANICAL BLDG, ELECT. PLG. MECH.
Li0 ❑ ❑
DO NOT POUR'FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
MATT ON
WOOD FLOOR INFOR
'`VIALUATION s/FT.
PLUMBING 4HII� !'i 1 �4".
MECHANICAL
PERMIT TO
ELECTRICAL L,;• C `r
FRAMING —
STORIES TYPE CONSTR.
INSULATION
DEC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED
SO FT.FLOOR AREA TOTAL ACREAGE
•
DIAPHRAGM ROOF
BUILDING USE
RLS IND CON PB Otner
APPLY NO ROOFING UNTIL ABOVE'H'AS BEEN SIGNED', � � ❑ E-1 ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO. .
GAS TEST
MECHANICAL -
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS -DATE INSP.
FRAMING SAN #
IZONING ENO.SITE No.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY LI<
MECHANICAL v N� v ❑ N�
COVER'NO WORK UNTIVABOVE;HAS BEEN_ SIGNEDI:k; HEATING
LATH—INTERIOR ELECTRICAL FLOOD zorvE ' A.L.u.c.-
LATH—EXTERIOR FIRE DEPT. r N� v I - NC]
SHEETROCKGRADE FEE SUMMARY
SHEAR INTERIOR BUILDING -
SHEAR EXTERIOR
TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC 'PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE INS
• O~� PLEASE GIVE JOB ADDRESS WHEN REQUIRED PHONINGPECTION. PLUMBING
Z. - MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT!
CONST.TAX,..'
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY - .I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI IsDING PROJECT I IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 14ZZZ
jt)j 9s E
UILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER PLAN CHECK VALIDATION
AME OTY. ELECTRIC PERMIT FEE
PHON�14^D
NAMERA R ` UTLETS-SWITCHES-RECEP 10.00/1.00 O'-
/ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
DBEs 'r/hl
G�P4� PHoxE PANELS 10.00 DATE OF APPLICATION
ARcxlrec PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
i
LIC.NO. SIGNS TRANS. 3.00
ARCH.oR ENG' SPECIALCIRCUIT 5,00 PERMIT VALI DATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 /1
APPLICANT'S MOTORS SEE FEE SCH. I gis...Lti�
ADDRESS 7''`''' _
SERVICE CHANGE 20.00 �p
1- Mai - LICENSED CONTRACTORS DECLARATION !/ / `l 7
a v 1 hereby affirm(hat I am licensed under provisions of Chapter 9 ISSUANCE GATP
w
<,-. (Commencing with Section 7000)of Division 3 of the Business and BLDG, ELECT. PLG. MECH.
r Professions Code, license is in full for a 11 g r❑I ❑
z z License las Lic.Nwnbe�� i ❑ if ❑
O y r w Ua[e Contractor
BUILDING PERMIT
¢ M w¢ OWN iR-BUILDER DECLARATION INFORMATION
ata " MISC.- REFER TO ORD
w g w w 1 hereby affirm that I so exempt from the Cors and is License
u_o ¢ Law for the following reason(Sec 703 1.uincxa,permit
to and lucL ahel, PERMIT ISSUANCE 10.00 vnwnnoN I SIFT.
20 Code:Any city county which structure permit toconsuanc alter, U T_
> ELEC.CONTR. LIC.NO. - Q (7M1
2 rt 0 O- improve,demolish,or repair any structure,prior m its issuance,also EOTA
T.D u requires the applicant for such revisit to fele a signed Statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of theContractor'sof
License EL[��7
r i > Law(Chapterand
Professions
ncing Code)or Section is exempt
t therefrom the
and
a a:o Business and Professions Code)or that he is exempt therefrom and CITY ` PLUMBING PERMIT FEE
W H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
im applicant by any applicant for a permit subjects the applicano a civil penalty gLTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
(heir sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law does no(apply to an owner of
• property who builds ar improves thereon,and who does such work FIXTURES,PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLET$ 6.00 .
or improvement is said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove far purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑.l am exempt under Sec.-,B.&P.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
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.L
.� Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Cerllfl'J copy is fled with the city inspection division.
P: 2->
REFER TO ORD.
O Applicant Y . N❑ Y [:] N❑
rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LuCERTIFICATE E SATIOTINS FROM WORKERS'
W _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (1 his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars($100)or less.)
U O 1 certify(ha(in the performance of the ork for which this per- TY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mi(is issued, I hall not employ ny er an manner so as t
U becol j t e Worker' La sof California.
y Dale pplicanI ALTER OR ADD'f0 MECH. - 5.00 BUILDING
} to NOT T PPLICANT: I ,a ler m ku is Certificate of ' -
F ? emotion;you should become subject to the Workers'Compens lion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply BIT FEE
U such provisions or this pervilt shall be deemed revoked. AIR HANDLING UNIT(TO iOMC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 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. MICROFILM
3097,Civ.CJ: HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
. 1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4,00
information is correct.1 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 BTU)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 CONST.TAX
may in any way c against said City in c sequence of the PERMIT ISSUANCE 10.00
Soo 'ng fisc mil. MECH.CONT. LIC.NO. MECH.
JTOTAL TOTAL
ignalure p Iront/Contmc or Da b
' OFFICE COPY