15057 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15057
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 19742 Drake Court uNlrit LOT#
PERMIT EXPIRES IF WORK
OWNER Mr. & Mrs . Thompson - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED I NSPECTION.
o PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PCRKIIT VAIJOATIION
CUPERTINO STANDARDS.
GARAGESLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
' PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL RLUG ELECT PLO. "EcR
❑ I ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MA BUILDING PERMIT
I WOOD FLOOR - O1 INFORMATION
PLUMBINGVALun TION S/FT6
qty iv -^<J
MECHANICAL
ELECTRICAL �Z/ . PERMIT ro
`
FRAMING or it /�' Alfjo
INSULATION STORIES TYPE CONSTR.
• OCC.GROUP RES UNITS
� I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO TT FLaIR AREA TOTALACRLAOE.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
CO
ROOF SHEATHING RES Inoeua CON USEPT
N on",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ Cl ❑ -IT. 11
ASSESSORS PARCEL NO
ROUGH SAN.#
T PLUMBING ^•/ ELECT.ENERGY '
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL �t fr BUILDING ENERGY ACC DATE ACC FILE No ..
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING
ZONING ENG.SITE NO.
'l.
GAS TEST GAS '
MECHANICAL
FIRE STRINK ENERGY T2E
Q
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD
N❑ ❑ NOD ZONE A L JC,
INTERIOR SHEAR FIRE DEPT. . Y ❑ N❑ r ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH •^I ,a�i TEMPORARY APPROVALS BUILDING %�
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ; > f
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
SEE— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL / /JCALLING FOR FINAL INSPECTION. �q(
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER '
Y 5UILOIND APPLICATION & PERMIT �O�i�
ADORE BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I
Cr
O'wrvERS PLAN CHECK VALIDATION
NAIVE
{/(_�`1(jQ� OTY. ELECTRIC PERMIT FEE
I,Er��{41p.�1� _ Tv� PHONE /-L 9%- 3/
lERAcroRa
rUTLETS-SWITCHES-RECEP 10.00/1.00
!' i/VSO" I t LIC.NO LIGHTING FIXTURES 10.00/1.00
ADDRESS Offs APPLIANCES-RESIDENTIAL 4.00
PNDNE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE KC,N0.
oRK"
>M ��&, ,US ANELS (OVER 200 AMP) 20.00
(C
ENGINEER •'
uc.No. SIGNS TRANS. 3.00
nooseSS ENG' SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
Awucnrvrs
ADDRESS MOTORS SEE FEE SCH. -
i
SERVICE CHANGE 20.00 �91�
a ¢ i /
F o D LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that I am Ii cen sed antler provisions of Chapter 9 ISSUANCE DATE
I
a (commencing with Section 7000)of Division 3 of the Busin s and LDG. ELECT. PLG. MECH.
y x Professions Cod• nd my license is in full farcy nd L ❑ ❑ ❑
i Cr - License C Lic.Number F 7
-O N F 0 Date COntraetUr 2k& e L I _
Q y J
¢ ¢ w 4 OWNER-BUILDER DECLARATION BUILDING PERMIT
MISC.- REFER TO R INFORMATION
E
3 n n I hereby atfirm Chat I am exempt from the Contractor's License VALUATION S/FT.
LL o vs Law for the following reason.(Sec.7031.5,Businessand Professions L - PERMIT ISSUANCE
Code:Any city or county which r vluires a permit to construct,alter,
2 a < o improve,demolish,or repair any structure,prior In its Issuance,also ELEC.CONTE. LIG.NO. ELEC. O-!
LL requires the applicant for such permit to IIIc a signed statement that TOTAL
a w m he is licensed pursuant to the provisions of tire PERMIT TO
e Contractor's License
H z i Law(Chapter 9(commencing with Section 7000)o'Division 3 ofthe T,? d,�EL
i o Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE
W
F the basis lin the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
A ; by any applicant for a permit subjects the applicant Hoa civil penalty ALTER DRAIN& VENT-WATER (EA.) 5.00
of not more than Ove hundred dollao($500).1:
❑ I,as owner of the property,or my employees with wages az BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their Sale compenmlion,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Businem 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 does well work FIXTURES-PER TRAP 5.00 SO.Fr.FLOOR AREA rorALACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,however.the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
/ or improvement is sold within one year of completion,the owner- -
builder will have Ono burden of proving that he did not build or inn- OVER-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
rove for ear RES IND CON PB Other
P s Pose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he project Se contracting Bu whh
licensed colons on to construct the project(Sec. 7044,Business•ss LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and n owns of Coda:Thu Contractor's License Law does not who
to an owner of progeny who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a amtruetorts)licenxd pursuant to
theLicense Law. SEWER-SANITARY-STORM EA.2001t110.00 TRACT NO. PARCEL NO.
1"it exe
❑ I vis exempt under Sec...BA P,C.or this
IeaSOn WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of emmooR to self insure.
or a certificate of Workers'Compensation Inwmnec,or a certified ZONING ENG.SITE NO.
copy thercof(Sec.3800.1ab.C.).
Policy No. Company
Q ❑ Certified copy ishereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection division. - �
F Applicant MISC- REFER TO ORD. y N[2V � N
= So CE R1'I FI CAT Ii O F Ex EM PT ION('ROM WORKERS' PERMIT ISSUANCE ,{ fr(y/.p PLOOD ZONE A.LU.C.N
MP
LCL U O no
COMPENSA'T'ION INSURANCE PLG.CONTE. LIC.NO. TPEG
OTAL L Y❑ N� v
(This section need not be completed if the permit is for o
::) Z hundred dollars(S I DO)or Ices.)
U O I certify that in the performance of Ile work r bleb this per- QT,e MECHANICAL PERMIT FEE FEE SUMMARY
ly U mit is issued,I shall not employ anyrvm in ny anner eat as m
become-syIIy� c Workco;(' proar
0 a Dam uy Applicant- e ALTER OR ADD TO MECH. 5.00 BUILDING
} W NO IN T APPLICANT. It.after eking this Certificate of Ex-
�. ? emption,you should become wbject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000OF.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PIXIC.F.M.) 6.00 SEISMIC FEE ^IQ
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that 1 have read this application and stale that the above oZ VENTILATION FAN (SINGLE) 4.00 `-
• information is correct. I agree to comply with all city and county PLUMBING
ordimi and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00
hereby mentioned
representatives of on city to enter upon the BOILER-COMP (Oxer 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned Property Toren .1 ith purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabiliti ,judge ts, costs and expenses whiph PERMIT ISSUANCE -1(y,pp CONST.TAX
may in any way acer against iJ ico In andconexpenses
of ne
nlingof thi per ECH.CONT. LIC.N0. MECH.
S y TAIL �v/d_ TOTAL 17d
Signature of pp ea Cont clnr
Dart, "b
OFFICE COPY