14421 r� POST THIS CARD NEAR FRONT OF BUILDING
PERMITNUMBER , a
�t CITY OF CUPERTINO 14421 f
INSPECTION DIVISION
JOB INSPECTION RECORD
I
PERMIT EXPIRATION
JOB ADDRESS �
10056 CRESCENT ROAD _ \\
•�'_- ' UNIT# _LOT# PERMIT EXPIRES IF WORK
LINDA AND DAVID IWAHASHI M.0&SON BUILDERS
OWNER CONTRACTOR IS NOT STARTED-WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERII'IT ISSU-,
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER � � ALL GRADING AND DRAINAGE,SHALL BE INSTALL STCALLED INSPECTION.
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY PERMIT VALIDATION
CUPERTINO STANDARDS. ,
GARAGE SLABS —
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -I ,
o a�agQ 0
UNDERGROUND /SLAB �n41D �r en p o C OECUQe �U - '
: PLUMBING 1 �'�. • R
• ELECTRICAL ISSUANCE:DATE
RLOG. ELECT, PLG. MECH,
MECHANICAL _ T,k� ❑ ❑J:
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - vnw ATION SIFT.
PLUMBING'
MECHANICAL
ELECTRICAL - PERMIT To
FRAMING' —/-'f . "/
INSULATION STORIES TYPE CONSTR.
\ 4Tr
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
?-t ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - so.Fr FLOOR AREA rorAc ACR EACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID _
f„ a3BUILDING USE
ROOF SHEATHING, — Hes I IND CON PB om,•,
APPLY NO ROOFING UNTIL ABOVE HAS BE SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.a
PLUMBIN OWELECT.ENERGY
TRACT NO PARCEL NO
TUBS BSHOWER PA - -� PLUMBING ENERGY
MECHANICAL MECR ENERGY
ELECTRICAL BUILDING ENERGY ACC.DARE Acc.FILL no,
FRAMING 6— ELECT,FINAL TEST
. ZONING ENG.SITE NO.
• INSULATION 17, o? 10 PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY TPC
MECHANICAL -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v❑ NC] Z, [:] "❑
FLOOD ZONE A.L UIC'.
EXTERIOR SHEAR -1. - ELECTRICAL RELEASE --�
❑ NV
INTERIOR SHEAR FIRE DEPT. ❑ p NEI
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING _ IE
INTERIOR TEMPORARY APPROVALS ' BUILDING .�
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY "SEISMIC FEE jt
OCCUPANCY OF BUILDING IS NOTPERMITTEDIUNTIL BUILDING FINAL ISSIGNED BY.BUILDING INSPECTOR. MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 'v
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z_
O PLEASE GIVE-JOB ADDRESS WHEN PHONING.
z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
IcovsT.TAX
MPORTANT!
PLEASE READ REVERSE SIDE BEFORE fS 'I
TOTAL`S,
CALLING FOR FINAL INSPECTION.
OFFICE COPY r"`'
APPLICANTTO FILL IN INFORMATION WITHIN RED-LINES —'USE BALL POINT PEN ONLY
BUILDING PROJECT I DPERMIT NUMBER
ENTI FICATION - -
iL iNG ._ APPLICATION & PERMIT,
ADDRESS 14421
QQS"Y BUILDING -ELECTRICAL=PLUMBING-MECHANICAL i r
RwERs" PLAN CHECK VALIDATION
M 1 t
+, �N -. yA DTV. - ELECTRIC PERMIT FEE . / ,736b
PHONE
3 CONTRACTORM.�
G
rvaME Q•w ��OUTLETS-SWITCHES-RECEP '10.00/1.00 S
\'
• -
IcL NO G LIGHTING FIXTURES 10.00/1.00
1.ADDRESS TOR APPLIANCES-RESIDENTIAL 4.00
'S Q('� PHONE ,S'� PANELS - 10:00 „ DATE OF APPLICATION
ARCHITECT • PLAN CHECK FEE P.C.NO.
oR - PANELS (OVER 200 AMPI- -20.00
ENGINEER --v'- -
LIC.NO. SIGNS TRANS, 3.00 ARCH.OR ENG. PERf� ATION
ADDRESS - SPECIALCIRCUIT `5:00 F
AaZIP EMP:METER OR.POLE INS.00
AD
AODR as
MOTORS S L. �♦
DRH.
SERVICE CHANGE •2000
'0 2 LICENSED CONTRACTORS DECLARATIONC�� 9
¢�n u 1 hereby affirm that I am licensed under provisions of Chapter 9
.1n� ISS ANCE ATE
z w (commencing with Section 7000)of Division 3 of the Business and
G c 07LDG ELECT. 'PLG. MECH.
F N i Professions CoQ•,,and pay license is in full fort• e R
z O u,— License Class_�S^L—Lia Number '(1 i�1
9'z L w Uate_l7� D�,o�r-'G S Contractor t
a m _ - BUILDING PERMIT
¢ ¢ ¢- OWNER-BUILDER DECL ATIO - - -
o a u - - INFORMATION
w ;u s- 1 hereby at that I am exempt from the Contractor's License VALUATION
MISC.- REFER TO ORD '
F u.0¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q -- ,S/FT.
Code:Any city or county which requires a permit to construct,alter, yO
¢ ¢ ¢2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. ' 7/' �d
i w ¢ requires the applicant for such permit to file a signed statement thatP>R / - TOTAL r ! -
he is licensed pursuant to the provisions of the Contractors License SIL I PERMIT TO
i Law(Chapter 9(commencing with Section 7000)of Division 3 of the - {�—f��'/T�[).✓
E i,o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE" 1
¢1 the basis forthe alleged exemption.Any violation of Section 7031.5 STORIES- TYPECONSTR.
by any applicant fora permit Subjects the applicant too civil penalty ENT
ALTER-DRAIN VENT-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 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 Contractor's License Law does not apply to an owner of,
'• ;�:4 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 5.00 sD.FT.FLooR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
j ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4OUTLETS 6.00 -
or improvement is sold within,one year of completion,the owner- GAS EASYSTEM OVER 4 IEA)' •'200 BUILDING USE
builder will have the burden of proving that h - . - . .
e did not build or im- ARES IND :CON PB Omer
prove for 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-',I 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.) 4:00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law: SEWER-SANITARY-STOR J/,10.00 ,•TRACTNO. PARCEL NO.
' ❑ Iain exempt under Sec.—,B&P.C.for this W1.
ATER HEATER W/VENT 6.00 '
reason
- Owner Date WATER SYSTEM 5.00
ACC.DATE ACC FILE N0.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP- - p50
1 hereby affirm that I have a certificate of consent to sel Ginsum, - GVY. . ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG:SITE NO.
copy thereof( ,c._3800 Lab C.).
x X ,
�//�YY�� Policy bm Company
Q - ' ❑ Cerliedcopyisherebyfurnished. ° ' �. FIRE SPRINK ENERGYT-24
Z Z ❑ Certified ` py is filed w'h e cit ins action division. MISC.- REFER TO ORD: '
Applicant - _ - ' Y❑• N❑ Y ❑ N[]acCER CATS F EXEMPTION F WORKERS' PERMIT ISSUANCE '10.00 0. FLOOD ZONE A.L.U.C.,
LU - COMPENSATION INSURANCE PLG..CONTR. LIC.,NO.` PLG. 'O'u ❑ ❑ �' N❑
CL 0 (This section need not be completed if the permit is run onn TOTAL „ `_ Y N Y
D Z hundred dollars(SI00)or lessJp
U 0 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in day manner so as to
O 0 become subject to lire Workers'Compensation Laws of California. -
y i Date Applicant ALTER OR ADD TO MEC ♦ 5.00 ' 'BUILDING �"�f -"'
} m NOTICE TO APPLICANT. If,after making this Certificate of Pis-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with
V such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10p00G.FS[yl.)•1 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OV .''10 C.EM.) SEISMIC FEE
i ..
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH'DUCT .00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ C.k - HEATING UNIT(TO 100,01, :T.U.) 8.00 —
Leader's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC ,ICY.
Lender's Address S
1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBINGQ
, ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000B.T.U.) 6.00,
• hereby authorize representatives of this city to enter upon theBOI LER-COMP IOver.ID0,000 BTUI BEE FEE SCH. 1MECHANICAL
above-mentioned property for inspection purposes. _
(We) agree to save, indemnify and keep harmless the City of MISC.-*, REFER TO.OR D.
upertino against liabilities,judgments, costs and expenses which t CONST.TAX '
ay in any way accrue against s Cit consequence of the PERMIT ISSUANCE' 10.00 00 /011 --
MECH.of this permit. - `' MECH.CONT.. !LIC.NO. MECH.
4M&01q l A/i!'•GoHTICIuN [oTAL � " TOTAL `f 7-�i
gn rzeo liter COntracto Date -
OFFICE COPY 1