14507 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
•
'BU I LDI NG PROJECT IDENTIFICATION PERMIT NUMBER,',
BUILDING - - - APPLICATION & PERMIT -
'
ADORE a� I C1L� L r •, 1 1/�
- ' L , BUILDING -ELECTRICAL-PLUMBING-MECHANICAL _ ,1 4501
OWNER'S
AME /� PLAN CHECK VALIDATION _
O�'rl,�.� QTY. i ELECTRIC PERMIT FEE
10 I _
PHONE
CDNTflAcroRs
NA ' UTLETS.SWITCHES-RECEP 10.00/1.00
-- m m���_Lic:No. � �� LIGHTING FIXTURES . . 10:00/1.00
f,ONTRACTOR'E
;AD �E 1 ' M�, _ �jZk•••� - PPLIANCES-RESIDENTIAL 4.00 -
J N vHON PANELS 10.00
ARCHITECT - - DATE OF APPLICATION.
OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
Llc.rvo. SIGNS TRANS. 3.00
ARCH.Ofl ENG.
ADOREss SPECIAL CIRCUIT 5.00 PERMIT VALIDATION -
AZIP EMP.METER OR POLE INS. ,20.00 -
ADDRESS MOTORS SEE FEE SCH. �n:QW1 l
SERVICE CHANGE 20.00 / v
'02 LICENSED CONTRACTORS DECLARATION =/•/9 %�
< v w I hereby affirm that I am licensed under provisions of Chapter 9 v _
Q (commencing with tion 7000)of Division ess and ISSUANCE DATE '
r D i Professions Code, I license is in full tot n BLDG.. T. PLG. - 'MECH.
.,z O 8'c License la Lic Number ❑ 1:14 N J�7( Date Contracts _ \
Q'w NCR-BUILDER UCCLARATION v+� G PERMIT
A;LL H I hereby'affirm that I am exempt from the Contractors License MISC.- REFER TO ORD ORMATION
.H u-oJ Luw(or the following reason.(Sec.7031.5,Business andProfessions 1000 VALUATION $/FT.
tf N w PERMIT ISSUANCE
Code:Any city or county which requiresa permit toconsiruct,al(eq
It at 0 improve,demolish;or repair anyetruc[ure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
Lc wm u requires the applicant fur such permit to file a signed statement that TOTAL
m he is licensed pursuant to lhe.provisions of the Contractor's Licenu PERMIT TO
za Caw(Chapter 9(commeneing with Suction 7000)ofDivisimi of the -
Business and Professions Code)or that lie is exempt therefrom and OTY. PLUMBING PERMIT FEE 6V
/7�' ��'
¢'� $ the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty STORIES TVP CONSTR.
of not more than five hundred dollars($500),): ' ALTER-DRAIN&VENT-WATER (EA.) 5.00 `
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE
their sole compensation,will do the work,and the structure is not 4.00 OCC.GROUP RES.UNITS
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 io an owner of
Property who builds or improves thereon,and who docs such work - FIXTURES-PER TRAP 5.00
himself'or through his own employees,provided that such Improve. 50.FT.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 -
or improvement is sold within one year of completion, the owner- _
- builder will have the burden o(proving t at he did not build or int- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove far 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND - CON PB Omar
❑ 1,as owner of the property,am exclusively contracting with .0 ❑ O ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License law docs not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5,(EA.) 1.00
contracts For such projects wimh a contractur(s)licensed pursuant to
the Contractor's License Law. SEWER'-SAN ITARYSTORM EA.200tt/10.00
reason WATER
am exempt under See,.,B.&P.C..for this TRACT No. PARCEL NO.
WATER HEATERW/VENT '
6.00
Owner Date WATER SYSTEM -
S.00 ACC..DATE ACC.FILE NO.
WORKIiRS'COMPISNSAI'IUN DECLARATION WATER TREATING EQUIP, 5.00 . '
thereby.affirm ihatlh ca�ate ofconsent to self-insure,
ora ce�1[77ftl1tate f I 4nion Insurance,or cern ficd ZONING ENG,SITE N0.'
' copy lhyM1r�S `7 a 1
Policy NNbb Company L�12-IV
0 ❑ Certified copy is hereby furnished.
Z ❑ Cetli ed CO y i5 filedw�I I , City inspection division. FIRESPRINK ENERGYT.24
O Applicant 1!f_-1 talL_
- REFER TO ORD. Y N Y N�
� y CCR' CATE OF EXE TI F MWORKERS' IT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU O , COMPENSATION R NCE LIC.NO. PLGZ (Phis se do need not bC cont a the pennil is for aneTOTAL Y N Y ry
Ohundred d (5100)ar Iess.)I certify that in the performance a the work for which this per- FEE SUMMARY ,
LL F mit is isslmd, I slot[not employ'any person in any mnner so as toMECHANICAL PERMIT FEE0 become subject Io the WorkeriCompensation Laws ofCalifornia.
DuteApplicant R OR ADD TO MECH. 5,00 W NOTICE TO APPLICAN f: If after making this Certificate of Elieruption,you should become subject to the Workers'CompensationIANCEprovisions of the Labor Codc, you must forthwith comply with '' 5.00 PLAN CHECK
such provisions or this permit shall be deemed revoked. NDLING UNIT(TO 10MC.F.M.) 4.00 FEECONSTRUCTIONLENDINGAGENCY NDLINGUNIT(OVERIOAOOC.RM.) 6.00 SEISMIC FEE1 hereby affirm that work is a construction IcnJing agency for' UST HOOD (WITH DUCT) 5.00the performance of the work for which this permit is issued(Sec. MICROFILM
3097nder's .am ING UNIT(TO 100,000 B.T.U.) 8.00Lender's Name
Lender's Address ING UNIT(OVER 100,000 B.T.U.)9.50 }
ELECTRIC
1 certify that I have read this ap comply
and slam that the above VENTILATION FAN (SINGLE) , 4.00 -
information n correct Faulaws
ree to comply with all city and county PLUMBING
ordinances and state lows relating to building construction, and. BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorin representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTUI'SEE FEE SCH. MECHANICAL
(We) agree id save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and cx nses w rich
ay in any way true ainst said City in consey nce PERMIT ISSUANCE 10.00 CONST.TAX,
to mg ft isr ` MECH.CONT. LIC.NO. - MECH.
I'
TOTAL TOTAL o-0
lure of APPlica ac or Uat -
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
P[RMIT NUMBER
CITY OF CUPERTINO � ����
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION '
JOB ADDRESS .23007 CRICKET HILL'
UNIT# _LOT.# PERMIT EXPIRES IF WORK
OWNER_ DAVID TOOTIL CONTRACTOR J&M TERMITE IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU,
FOUNDATION -ANCE OR 180 DAYS FROM '
NOTE: - LASTCALLEDINSPECTION.
LIFERBALL GRADING AND DRAINAGE SHALL BE INSTALLED - ''•
TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT V'AIUDATION
PREGUNITE - CUFERTINO STANDARDS. '
GARAGESLABS �'�''nn
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - -
PLUMBING. ., L�n - -91988r'C -
ELECTRICAL - EUAre
MECHANICAL ', I PLG. MECR '
V ❑ .0 i
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUILDING PERMIT
WOOD FLOOR INFOR ATIONK,
PLUMBINGVALUATION 'SIFT.,
' - - � .. - ,
MECHANICAL' t� '
ELECTRICAL TO
FRAMING
INSULATION - STORIES TYPE CONSTf,
OCC GROUP RES UNITS
„".P,L'ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.- .. ' SO fi FLOOR PNEG TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOFSHE RES IND BUILDING use"a alp.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH sAN.a ASSES SO HS P AHCEL NO.
PLUMBING ' - 1 ELECT.ENERGY. -
TRACI NO, PARCEL NO
TUBS&SHOWER PAN - ' PLUMBING ENERGY -
'` MECHANICAL MECH.,ENERGY
, '
' ELECTRICAL `� � � BUILDING ENERGY ACC DATEACC.FILE NO,
FRAMING 'ELECT.FINAL TEST
INSULATION PLUMBING zorvlNc ,ENG,SITE NO.
GAS TEST - - GAS
FIRES"PINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ V ❑ N❑
EXTERIOR SHEAR ELECTRICAL•RELEASE FLOOD ZONE 4.L UC
INTERIOR SHEAR, FIRE DEPT. Y.❑ N❑ Yo No
~, SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH' BUILDING
INTERIOR LATH f,%wtR ,3_ TEMPORARY APPROVALS 'euILDwG
SCRATCH COAT ELECTRIC - PLAN CHECK'
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED -OCCUPANCY,, SEISMIC FEE . M
• OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
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. v
OFFICE COPY'