13883 POST THISD NEAR FRONT OF BUILDING PERMIT NUMBER
CIT F CUPERTINO 13883
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
1•
JOB ADDRESS DOROTHY ANNE WAY UNIT# Lor*V
PERMIT EXPIRES IF WORK
DINNER SEVEN SPRINGS CONTRACTOR GREGORY CROUP IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180,DAYS OF PERMIT ISSU-
FOUNDATION9-2,1--V71ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEPMIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL A ISSUANCE DATE
MECHANICAL ` BLDG ELECT PLG. MECH.
•BiwO ❑, '❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'i 7 BUILDING PERMIT
r INFORMATION
PLUMBING
WOOD FLOOR VALUATION $/FT.
' '
7 e
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING eT11 wwo'L
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDING USE
RES IND CON PB Oma
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E] ❑ I] ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST -
TRACT NO. PARCEL NO.
MECHANICAL
i ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN n
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
FIRE SPgINK ENERGY L]n
MECHANICAL Y ❑ NE Y ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR ELECTRICAL FLOOD ZONE TL.uc.
LATH-EXTERIOR FIRE DEPT. - y NE] y N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY 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
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFOATION WITHIN RED LINES - USE OL POINT PEN ONLY
BU LDING PROJECT I DENTI FICA PERMIT NUMBER
MU DING QDE� y hne APPLICATION & PERMIT
ADDRESS
13883BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'a ' fnC PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
M I
N
PHONE I,S�}
AME c.oR's UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
!94
ME LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
REZzo TW/Na
D .PNIQ DV- PPLIANCES-RESIDENTIAL 4.00
ADDRESS
( �y� �1
-4EPL. CI PHONE S J-ES`Z 0 PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
OR F-UTN ALIO GO/NG /NC PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AENG. ZA60 LUNDY A SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
S•S a S/3 ZIP EMP.METER OR POLE INS. 20.00 �7 �
ADDDRESS
ADRE NTS MOTORS SEE FEE SCH.
'
SERVICE CHANGE 20.00 r.,
�81�7
woo LICENSED CONTRACTORS DECLARATION V p nrtlilO
<u u I hereby affirm that I am licensed under provisions of Chapter 9 p an t) Vii-I DANCE DATE
Z w (commencing with Section 7000)of Division 3 of the Business and 'BLDG. ELECT. PLG. MECH.
N.'g�.� Professions Code,and my license is in full for"and effect. ❑ ❑ ❑ ❑
Z o w License Class Lic.Number
-
2 . Date Contractor
¢ y s BUILDING PERMIT
¢ ¢w u OWNER-BUILDER DECLARATION INFORMATION
wD H I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
3 u m VALUATION S/FT.
HLLDa law fornthe ycitllowingreuwmlh re 703La pemittocod Profusions PERMIT ISSUANCE 10.00
Code:Any city or county which sequinse permit to construct,alter,
¢ er Q Q improve,demo8sh,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
W
¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
E
" he is licensed pursuant to the provisions of the )omn¢wr's License
H a: r
Law(Chapter 9(cosions Code)or Section is exempt
��rq.,„/e W4 L.
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ r$
the ansa for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
i ; _ by any applicant fora permit subjects the 0H.)applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than Fivc hundred dollars(5500).):
❑ 1,as owner of the property,or my employes with wages as BACK FLOW PROTECT.DEVICE 4.00 OCc.GROUP RES.UNITS
their sole cumpensmion,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 docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 w.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employers,provided that such improve-
mentsarenot intended orofferedforsule.if.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or hmprovement 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 of im" RES' IND CON PB Oreo
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-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 properly who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5 (EA.) 1.00
cont cls for such projects with a mntreClol(s)licensed pursuant m
the ms's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ num rider Se ,B.&I'.C. uth' WATER HEATER W/VENT 6.00
eason
Owner DificT116197 WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to wif-insure. ZONING
or a certificate of Workers'Compensation Immtamce,or a eerlilied ENG.SITE NO.
copy thereof(Sec.38110,Lab.C.).
Policy No. Company
Q O Certified copy is hereby furnished. FIRESPRINK ENERGY T-74
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y N❑
CC CERTIFICATE OP
Fos PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.c.
EXEMPTION
W > COMPCOMPENSATIONTIONION INNSSURANCE PROM WORKERS' PLG.CONTR. LIC.No. PLG.
CL 0 (This section need not be Completed if the permit is for one TOTAL Y[:] N❑ Y❑ N❑
hundred dollars 1S 100)or less.)
U O I certify that in the performance of the work for which this per- DTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ any person in any manner so as to
U become subject to the Workers Compensation Laws of California.
O w Dutc Applicant DD TO MECH. 5.00 BUILDING J`?
o. ALTER OR A 'SU
} W NOTICE TO APPLICANT: If,after making this Cer ifi utc 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 3,Z
�1
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER I0=C.FAQ 6.00 SEISMIC FEE gS�
I hereby affimt 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATINGUN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
. I 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 PLUMBING
ordinances and state laws relating to building construction, and BOILEFRTf(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorise roperty ladies of this city to enter upon the - BOILER-COMP (Own 10,000 BTU)SEE FEE SCH. MECHANICAL
hereby
memionud property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
hignatum
ins against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
any way accrue.aga Its, sold City in w quence of the
( f this P m't. MECH.CONT. LIC.NO. TOTAL G,
TOTAL aJ �z
of Ap scan[/Contractor. Ue '
OFFICE COPY