13488 POSTTHIS C NEAR FRONT OF BUILDING PFAN11TNUMBEN
CITMF CUPERTINO C� 13488INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
21025 CLASSIC CT
JOB ADDRESS UMT# _LOT#- '
_ PERMIT EXPIRES IF WORK
OWNER BETTEN COURT CONTRACTOR ANTHONY POOLY IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU-
FOUNDATION - - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER '
PREGUNITE
PERMIT VALIDATION
jig _ - f
2 nc v- - ;\ F, .
POUR NO CONCRETE UNTIL ABOVE HAS BE IGNEO
UNDERGROUND /SLAB /
PLUMBING p
ELECTRICAL -� - - R \ ISSUANCE DATE
MECHANICAL. C'i�aL��L\\•�;� PL❑G. MECR,
in
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
'+INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING - /�•! yam • !°j
MECHANICAL
ELECTRICAL_ _ PERMITTo
-
FRAMING C5�/��/��•
. STORIES TYPE CONSTR.
I
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO.FT.FLOOR AREP TOTAL ACREAGE,
ROOF
DIAPHRAGM
BUILDINGUSE
RES IND CON PB One,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El ❑ ❑ 11
ROUGH ,ASSESSORS PARCEL NO.
PLUMBING
TRACT NO. PARCEL.NO.
GAS TEST
MECHANICAL '
ELECTRICAL %.,.0F. LS DATE INSP. ACC.DATE ACO.FILE No.
FRAMING SAN #
INSULATION PLUMBING // �3- - zoNlNc ENG.SITE NO.
GAS -/J -67
FIRE SPRINK ENERGY T�T<
MECHANICAL ' Y [] ' N[3 Y0, No
COVER-NO WORK UNTIL ABOVE HAS BEEN,SIGNEDX ', HEATING Qp / ,/3
LATH-INTERIOR ELECTRICAL / Y[]
ZONE A.L.u.c.
N[] Yo "
LATH-EXTERIOR FIRE DEPT. �
SHEETROCK - GRADE 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 OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
t
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ;
00
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 .e .,
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DE FICA ( PERMIT NUMBER
no' a[:: APPLICATION 13488
CJ ING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'6 C/ J �`7J�.� PLAN CHECK VALIDATION
NAME OFA TY. ELECTRIC PERMIT FEE 72_
- TTc�/ CC.eT 75=
/ CONTRACTOR'S / �//�
T NAME (/ OUTLETS-SWITCHES-RECEP 10.00/1.00
S LIGHTING FIXTURES 10.00/1.00
.orvTRAcroR's a 7� PPLIANCES-RESIDENTIAL 4.00
R.1) CIJ.�
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OP
ENGINEER
.No. SIGNS TRANS. 3.00
ADORESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. -
ADDR a
SERVICE CHANGE 20.00 T �
II:7
w o o 'LICENSED CONTRACTORS DECLARATION
m z w 1 hereby affum that I am licensed under provisions of Chapter 9 E[,l�7 2 s d 17, ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.1 'stf PLG. MECH.
zProfessions Code,- m j se is in full force fe t. IIS�II
o 0 12- License ass Lac.Numb _„ nI r
F w r J Date Contract p\\\�
BUILDING PERMIT
xw OWNER-BUILDER DECLARATION INFORMATION
`x O' I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFERsTOyORD
a.LL _ VALUATION $/FT.
u O Law for the following reason.(Sec.7031,5,Businessand Professions PERMIT ISSUANCE - 10.00 .�
� �� Code:Any.city orcounty which requiresa permit to construct,alter,
/�
7 t• f ELEC.CONTR. LIC.NO.
a: M at o improve,demolish,or repair any structure,prior to its issuance,also ELEC. qq
A a O¢LL requires the applicant for such permit to file a'signed statement that - TOTAL V PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License
Fii LawI(Chapter 9(commencing with Section 7000)ofDivision 3 of the V(,l/!!-/f--//N� 6�
at Business and Professions Code)or that he is exempt therefrom and QTY: PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR.
d ; by any applicant for a permit subjects the applicant toa civil penalty gLTER-DRAIN -WATER IEA.15.00
of not more than five hundred dollars($500).1:
❑ 1,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 sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 $O,FT.FLOOR AREA •TOTAL ACREAGE
• himselfmthrough his own employees,provided that such improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 BUILDING USE
builder will have the burden of proving that he did not build or im. RES IND CON Pe Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,em exclusively contracting with
licensed contractors to construct the project(Sec. 1044,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 contractor(s)license t to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 p TRACT NO, PARCEL NO.
❑ lam exempt under Sec. 'B&p
for this WATER HEATER W/VENT M3`Bi00
reason
Owner Date WATER SYSTEM �\Zv, a� 5.00 Acc.DnrE ACC.FILE NO.
RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cer'fic"e of concept t self-incur , ZONING ENG.SITE NO.
r a certificate of Workers'Com cation Insuranc a c 'fie
Rco f(Sec: 3800,Lab.0 (- 0
icy No. Compan
O� ❑ Cer redc is hereby furnished. FIRE SPRINK ENERGY T-24
Z O 1 ❑ Cert ied c is filed with h t action ividon. MISC.- REFER TO ORD. ❑ ❑
Applicant Y N V N
y CERTIFICATE OF EXEMPTION FROM WO(f�EJV. PERMIT ISSUANCE 10.00/0 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO: PLG. y� / nU
Q' o (This section need not be completed if the permit is for one TOTAL ! Y N Y ❑ N
Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f- mit is issued,I shall not employ any person in any manner so as to
U becom e_ct to the Workers'Compensation Laws of Culifornaa.
Is. Dat° A 1' ��' ALTER OR ADD TO MECH: 5.00 BUILDING //6.�'
} In NOTIC� : If,after making this Certificate of lix-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE '5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with �r FEE
1,.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.)'.6.00 SEISMIC FEE
1 hereby affom that there is a construction lending agency for EXHAUST HOOD(WITH DUCTR$' - 5.00
the performance of the work for which hist permit is issued(Sac. MICROFILM
3097,Civ.C.). + HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -� 100,000 B.T.U.19.50 ELECTRIC-
Leader'sAddress - HEATING UNIT(OVER 3411_'^
( certify lhaIf read this application and state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING O !e-
ordinances and state laws relating to building construction, and BOILER-COMP(3 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. S
Cuper2ohis
ainst Nobilities,judgments; and expenses which PERMIT ISSUANCE 10.00 Q oc. CONST.TAX
may iway accrue against id R- ' nseuencttof thegrant' permit. MECH.CONT. LIC.NO. MECH.
'flG TOTAL o2. TOTAL
Sig are of Applicant/Contractor D e
OFFICE COPY