14445 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBi RT
CITY OF CUPERTINO
4445
INSPECTION DIVISION
ti JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10534 CYPRESS DRIVE UNIT# _LOT# pERM1T EXPIRES IF WORK -'
OWNER -WILLIAM RIEGER CONTRACTOR VALLEY HEATING IS NOT.STARTED WITHIN
INSPECTION .DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYS FROM
NOTE:
' UFER �' ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.'
` PR EGUNfTE _ TO COMPLY-WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION .
CUPERTINO STANDARDS. .,
GARAGE'SLABS Ty
POUR NO CONCRETE UNTIL-ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
r
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT PLG. MTOR
❑ ❑ o a
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL- - -
FRAMING - -
STORIES TYPE CONSTR.
INSULATION '
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO•FT..FLOORAREA TOTAL ACREAGE
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I - HIS 'IND, CON PS - om., j
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11' ❑ 11 ❑
ASSESSORS PARCEL NO.
ROUGH SANM .
PLUMBING - ELECT.ENERGY -
TUBS&SHOWER PAN - PLUMBING ENERGY
TRACT No. PARCEL-ND.• '
MECHANICAL MECH.ENERGY - /.�J-��. ACC DATE ACC.FILE NO
ELECTRICAL , BUILDING ENERGY
FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION . PLUMBING- �-
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ N�
FLOOD ZONE
EXTERIOR SHEAR ELECTRICAL RELEASE
NL NE]
INTERIOR SHEAR - - - FIRE DEPT, ' �
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH IBUILDING,Aleoicamimmet - 3
INTERIOR LATH. - TEMPORARY APPROVALS BUILDING
SCRATCH.COAL ELECTRIC ' PLAN CHECK
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNE6 BY BUILDING INSPECTOR. MICROFILM
LU- ARRANGE FOR INSPECTION BY=PHONING.
ELECTRIC
ONE WORKING DAY BEFORE REN. PLUMBING
/ Z PLEASE GIVE JOB ADDRESS WH- SEE PERMIT FOR EXPIRMECHANICAL
CONST. fAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL }
OFFICE COPY
APPLICANT TO FILL IN INFORMATIONVITHIN RED LINES -.USE BALL POINT PEN ONLY
AUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 14445
V^ ll, l`-+ Ll�+\_J\,J BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
'COM.`'gym �\ PRONE QTY. ELECTRIC PERMIT FEE
w
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.0011.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR' (1 1 _ _ APPLIANCES-RESIDENTIAL 4.00
ADD
PRONE" - - PANELS 10.00 DATE OF APPLICATIONon .
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS: 3.00
AARCH,OR DDRESS ENG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS: 20.00 �PvAD
APPucANT'S MOTORS SEE FEE SCH. /�. CTI./ J
O Ca-,pL
ADDRESS ,1 pp pp
SERVICE CHANGE 20.00 MAR J -- n900
'02
LICENSED CONTRACTORS DECLARATION 319 1O 8
a L,w I hereby affirm that I am licensed under provisions of Chapter 9
(commencing wit Section 7000)of Division 3 of the Business'and - BLDG. ELECT. PL reprfinn
0 N z Professions Cod ,' d se isN full f ❑ ❑ ❑ V
0 i m o Licen 1 Lir.Number /T/!I
Datc�=J Contractor
u LT BUILDING PERMIT
a w u OWNIi R-WILDIiR DECLA INFORMATION
wOI. MISC.- REFER TO ORD
;u y I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT:
r c, 0 ar Law for the following reason.(Sec.703 1.5,Businessaod Professions PERMIT ISSUANCE 10.00
y Code:Any city or county which requires a permit to construct alter
2• improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
0 M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w$ he is licensed pursuant to the provisions of the Contractor's License
Rir Law(Chapter 9(commencing with Section 70000of Division 3ofthe
a Business and'Profeesions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
r$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
d; by any applicant fora permit subjects the S500),applicant loacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more owner
five hundred dollars(my em):
❑ I,as owner of the properly,or my employees with wages aBACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
(S
their sole compensation,will the work,and the structure is nalt
intended or offered for sale(Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an acne(of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SD,FT,FLOOR AREA TOTAL ACREAGE
himself reor'throughinto his own omred for sale.provided that such improve.
oments rImprvemenntendedor withinroneyearoIf,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or Improvement will have
is sold within one year of completion,build
o r im- GAS-EA.SYSTEM-OVER,4(EA.) 2.00 BUILDING USE
prover will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove 1.aso nee of theJ. INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. does Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cole:The Contractor's License Law does not apply
to antr owner of property who builds or improvesthereon.p,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such License
with a contructorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
C I am exempt under Sea _ ,B.&P.C.for this, WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM - 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION - WATER TREATING EQUIP. 5.00
I hereby uIfinn'that'l have a cerlificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compen ation Insurance,�j_r�a/yc�ertified
copytI - [�ss�.
Policy
O rtified copy is he, furnished. FIRESPRINK ENERGY T-24
Z Z Cc, is is It
e e ty inspection division.
O APPlicant-VT�- '' .'Ir�4n�r MISC. REFER TO ORD. v❑ N❑ v ❑ N❑
F rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CC CERTIFICCO O N Ii AI EXEMPTION INS PROM.WORKERS'
W �_ COMPENSATION INSURANCEPLG.CONTR. LIC.NO, PLG,
n'
CI mend0 need not be completed if the permir,is In, one - TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollar.,(5100)or less.)
U O 1 certify that in the performance of the work for which this per QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- not is issued,I shall not employ any person in any murmur so as to
U become subject to the Workers Compensation Laws of California,
n - DateApplicamALTER OR ADD TO MECH. 5.00 BUILDING
} (D NOTICE 1'0 APPLICANT: If,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
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO I0=C.F.N0 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10,000C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a colistruction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) . 8.00
Lender's Name HEATING UNIT(OVER 100,000B.T.U.19.50 ELECTRIC
Lender's Address
I certify that l have mad this application and state that the above VENTILATION FAN (SINGLE) 4.00
information'is correct.I agree to comply with all city and county PLUMBING /8, 00
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 100,000BTU)SEEFEE 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 ezpenses which CONST.TAX
may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00
ra in this permit, NT - LIC.NO. ' MECH. M
TOTAL ! U w'.' TOTAL �B
OU
ig a reo Applicant)COntmctor Date
OFFICE COPY