12513 POST THIS CARD NEAR FRONT OF, BUILDING
PFHMIT NUMBER
CITY OF CUPERTINO 12513
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 20395 Clifden Way UNIT# LOT It
.. PERMIT EXPIRES IF WORK
OWNER Zuanik CONTRACTOR Anthon .Pools IS NOT STARTED WITHIN
If INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-' I'
FOUNDATIONANCE OR 180 DAYS FROM
UFER - -, •LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED APR 2 2 887
UNDERGROUND /SLAB
PLUMBING - c*�/I,�.rL_
ELECTRICAL "•� ISSUANCE DATE
il
MECHANICAL BLe\ ELecy.
DO NOT POUR FLOOR UNTIL ABOVEHAS BEEN SIGNED 7 BUILDING PERMIT
INFORMATION
WOOD FLOOR $/FT.
PLUMBING IvnwAn ON r f N 1
MECHANICAL _
TT
ELECTRICAL - '
FRAMING
INSULATION - - - STORIyS TYPE CONSTR.
I
I - OCC.GROUP RES.UNITS,.
II// Xn
A'�6M OPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF' SO,'T•FLOUR AREA TPTALACREAGE,
F DIAPHRAGM
BUILDINGUSE
I" li NO CON PB Omer
"'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E 0 o 0
ASSESSORS PARCEL NO.
ROUGH
PLUMBING -
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE •INSP. Acc.DATE ACC.FILE No.
FRAMING SAN * .ZONING ENG.SITE No.
INSULATION PLUMBING
GAS
FIREESPRINKENERGY T3<
MECHANICAL YQ v0 N�COVER NO WORK UNTIL ABO.VE HAa,aEEWSIGNEO HEATING
FLOA.L.0 C.
LATH-INTERIOR L I^,F'✓K'� .'r ELECTRICAL
LATH-EXTERIOR --" 'tom"" FIRE DEPT, v.❑ v �] No
SHEETROCK GRADE xfwl=79— FEE SUMMARY
SHEAR INTERIOR, BUILDING i
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING f,
FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
ILNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTEDU NTILB UILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING G _
PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ;
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE- S
CALLING FOR FINAL INSPECTION: TOTAL
QFFICE COPY
dJ
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 200
PERMIT NUMBER BUILDING PROJECT IDENTIFICATION APPLICATION & PERMITBUDIDLg /�
Q.3 - �/ F N r-W DING-ELECTRICAL-PLUMBING-MECHANICAL I L J I
' OWNER'S C• �� - + PLAN CHECK VALIDATION
NAME QTYELECTRIC PERMIT FEE
.
! PHONE
CON TDB's - UTLETS-SWITCHES-RECEP 10.00/1.00
/ NAME / 0 S
/�/ a .NoLIGHTING FIXTURES 10.00/1.00
CONTRACTOR f.ln APPLIANCES-RESIDENTIAL 4.00 I
CON A(llLi
PHONf'M!6PANELS 10.00 DATE OF APPLICATION
A HITECT PANELS (OVER 200 AMP) 20,06 PLAN CHECK FEE P.C.NO.
OR
ENGINEER r
G LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PE ATION
ADDRESSR SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 APR 2 2 1987
APPLICANT'S
aooREss MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 Of/�r.if��
o o LICENSED CONTRACTORS DECLARATION
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H <a (Commencing with Section 7000)of Division 3 of the Business nd 62. 1ELECT. PLG. MECH.
r w i Professions Can license is in full for ft27-7
Z o,u.-w License C ss Lic.Number
O F Date% Contactor
a YV air I BUILDING ERMI
¢ ¢w OWNER-BUILDER DECLARATION ! 9;4, - INFORMATION
w0 e N 1 Imreb affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 u Y p VALUATION E/FT.
HLLOJ Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00
w'^ Code:Anycity orcounty which requires a permit to construct,alter,
Ks a 2 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
io om requires the applicant for such permit to file a signed statement that TOTALPERMIT TO
X$ he is licensed pursuant to the provisions of the Contractor's License )
=�H Z> Law(Chapter9(commencingwith Section7000)of Division3ofthe
¢e Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
ac I- the basis for the alleged exemption.Any violation of Section 7031.5 LAIFO ES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
./� of not more than five hundred dollars($5000.):
"l ❑ 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 no[
intended or offered for sale (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 or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE 4
himself or through his own employees,provided that such improve-
mentsareno(intended or offered for Sale.If,however,the building GAS•EA.SYSTEM-11NC.40UTLETS 6.00
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- R IND CON PB Odour for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ Cl
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 contractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00'
the Contractor's License Law. 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.DATE ACC.FILE N0.
WORKFRS'COMPE-NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of conyyPPIto sell', ural ZONING ENG.SITE NO.
or a certificate of Workers'Compe Sa InsuyT3Ks� c
T c h e 1 0O f �
a
0 a Certified t0 if hereby furnishe / ��• FIRE SPR INK ENERGY T14
Z_ ❑ Certified copy is Bled with the city inspection division. MIS REFER TO O594
Applicant - Y❑ N❑ Y❑ N❑
CC CERTIFICATE:OI'EXEMPTION'FROM WORK17 S' PERMIT ISSUANCE 1FLOODZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one IOTAy❑ N Q Y ❑ N❑
Z hundred dollars($100)or less.)
L) O I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Worken'Compensation Laws of California.
C a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: 11,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 FEE
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 10,000C.F.M.) 6.00 SEISMIC FEE f
1 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.0.). HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lenders Name
Lender's AddHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ress
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comely with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILEfl- MP(Over 1 ,000 BTUI SEE FEE SCH. ECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of ISG JIEFER TO ORD. 1
Cupertino against liabilities, " dgments, costs and expenses which CONST.TAX
may i way accrue at st s 'd City in consequence of the M ISSUANCE - 10,00
_ ran ' g thispermil. - MECH.CONT. Y LIC.NO. TMECH.
TOTAL TOTAL Ir
nature of Applicant/Contactar Date ,
OFFICE COPY