13054 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
-CY1 CITY OF CUPERTINO 13054
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
L JOBADDRESS 7457 DEFOE DRIVE UNIT# Lor#
. PERMIT EXPIRES IF WORK
OWNER EGIL ANDERSON CONTRACTOR JENNINGS CONSTRUCTION I IS -NOT STARTED WITHIN
INSPECTION DATE IP CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ,yam �• ori ANCE OR 160 DAYS FROM f
LIFER IvI4�y� a LAST CALLED INSPECTION. •
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB --•
PLUMBING
ELECTRICAL J y1— ISSUANCE DATE
MECHANICAL 01 ELECT. I PLG. MECH.
❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $IFT.
MECHANICAL
ELECTRICAL 7PPE7RMITT�TO
FRAMING — PDI 1 I ad
INSULATION IP/ STORIES TYPE CONSTR.
' 2 OCc.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I• J ROOF SO.FT,FLOG.AIIEA TOTAL ACREAGE
/ DIAPHRAGM
" f E
IIDUSE
RES IND CON PB 00—
APPLY NO ROOFING UNTIL ABOVE HAS BE SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO,
MECHANICAL
ELECTRICAL ACC.DATE acc.F
FINALS DATE NSP.
ILE NO,
—U� �J I
FRAMING R-3 SAN *
INSULATION — 7 PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK I ENERGYTI<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ v ❑ NO
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ IN
SHEETROCK GRADE — -
FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALBUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEENSIGNED OCCUPANCY SEISMIC FEE /
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _
ONE WORKING DAY BEFORE REQUIRED INSPECTION. qMECHANICAL
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE—IMPORTANT!PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY
_APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�. BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING, APPLICATION & PERMIT
y ADDRESS
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13054
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE �y
a G IL r-)bCe O HONE -7oy3 ro -
M�% CONTRACTOR'S
NAME L[OUTLETS-SWITCHES-RECEP 10.00/1.00 _ � 73
-7-t AAs LIc.NC.39gS -Z ILIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 sd -
ADDRESS
woo G¢u Ye LJf• PHON 5g-&62 1PANELS 10.00 DATE OF APPLICATION
OR RCRrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
E NGINESR
uc.No. SIGNS TRANS. 3.00
AARCH,OR DDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 PAIS)
acvucANrs MOTORS 91FE SCH.
ADDRESS "l
SERVICE CHANGE 20.00,
woo LICENSED CONTRACTORS DECLARATION I-..vf / 2, D1
M' I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANC OAT
m z a (commencing with Section 7000)of Division 3 of the Business and ,
Lilly U1 V tl l l BLDG. ELECT. 'PLGY N 10
r w i Professions Co and my license is in full for and�f ecLs ❑
0 i h o License Class Lic.Number '
i4 H w Dalc __Commctor TZ.'rrtT1+:.l2 "+
Q Y J BUILDING PERMIT
¢ ¢w< OWNER-BUILDER DECLARATION El
INFORMATION
w;,'�m I hereby at that I am exempt from the Contractor's License M ISC.- REFER TO ORD
H A o Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT.
0.00
,A Code:Any city or county which requires permit to construct,alter, O t
arec a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. EIEC. /
ar 0,LL requires the applicant for such permit to file a signed statement that TOTAL r0
w 8 he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe ,J J STC O�
er Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ��'VVVV
szD
¢ H$ the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR.
by any applicant fora permit subjects S500).licant to a civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 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 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
himself or through his own employees,provided that such improve-
ments are not intended or offered for Sale.If,however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 VB600 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply V.B. .
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)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
reason❑ l am exempt under Sec..,B.&.P.C.for this WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO,
copy thereof(Sec.3800,Lab.CJ. ii
Policy No. Company �jYR-r& Fx1"!>
0 - O CerllDe copy Is reby furnished.
Z
Pn�Cerlifie c I filed wYh the city inspection division. FIRE SPRINK ENERGY T-24
0 AI'Plrcant MISC.- REFER TO ORD. YL] NY NF
N CERT( CATEEXEMPTIO FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.ILC.
Uj �_ COMP NSATION INS ANCE PLO.CONTR. ❑C.NO. PLG.
d ❑ (This section need not be completed if the permit is for one TOTAL Y[:] N C Y N
Z hundred dollars IS 100)or less.)
U Or I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
Q. Date BUILDING
Applicant - / S�
>- m NOTICE. TO APPLICANT. If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 p
F Z', eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE / 6-e
I 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(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 0�0
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
•._
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU) FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
m in any ay accwe against said City in consequence of the
gr ti� Of t i permit. MECH.CONT. LIC.N0. MECH.
6V
d7 S7 TOTAL TOTAL P,/ /9'
azure o plicant/C tractor Uale
OFFICE COPY -�