13491 n
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 13491
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 7509 DUMAS DRIVE UNIT# LOT#
PERMIT EXPIRES IF WORK
owNEa GILCHRIST BRIAN CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB �V
PLUMBING
ELECTRICAL P ISSUANCE DATE
MECHANICAL ( BLDG. E EC PLG. MECFL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIODING PERMIT
WOOD FLOOR SiOPBILiNFORMATION
VALUATION S/FT.
PLUMBING
MECHANICAL -
_ - —vEamlr TO
ELECTRICAL
FRAMING j LC VL!lT -LG
INSULATION
STORIES TYPE CONSTR.
�
IOCC,GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF $O.FT,FLOOR AREA TOTAL ACREAGE
I �
1— DIAPHRAGM
BUILDING USE
RES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - El 0 ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST I TRACT No. PARCEL No,
MECHANICAL 16 _If
ELECTRICAL p_ FINALS DATE INSP. ACC.DATE ACG FILE NO.
FRAMING 6. SAN # '
ZONING ENG.SITE NO.
INSULATION � PLUMBING
GAS
MECHANICAL -� LT FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y Ej No Y E:] No
LATH—INTERIOR ELECTRICAL 1,94-1FLOODZONE A-L.uc.
LATH—EXTERIOR FIRE DEPT. Y❑ N[ ,Y0 NC]
SH EETROCK 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 ISNOT 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
L Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
a BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
EUILDIHG APPLICATION & PERMIT
AG7DREas 13491
5 q � '
aJhAS b2iyQ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OYIUER'S PLAN CHECK VALIDATION
' i•xNAME CITY. ELECTRIC PERMIT FEE
GIk-CHRrsr3RIRAJ 1HONE2S3- 95
CONTRACTOR'S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 /0 '-
LIC.No. 2 LIGHTING FIXTURES 10.00/1.00 (v
NTRAOMESOroR'S
ADPPLIANCES-RESIDENTIAL 4.00
CO
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIc,No, JSIGNS TRANS. 3.00
ADDRESS ENO' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00APPLIC4NT
ADDRESS Ta / MOTORS SEE FEE SCH.
SERVICE CHANGE .B,dQ 20.00
o o LICENSED CONTRACTORS DECLARATION P 1 r Ifo/ 6,- /•
a o w I hereby affirm that I am licensed under provisions of Chapter 9 r f. (� _- 'ISSUANCE DATE
as
as a N (commencing with Section 7000)of Division 3 of the Business and U J .. BLDG. ELECT. 4L9 CH.
F y a Professions Code,and my licenee is in full force and effect. I f
i i w o License Clan Lic.Number
o m H j Ume Contractor
a y x �+�� BUILDING PERMIT
a: I[ It u OWNER-BUILDER DECLARATION INFORMATION
ww I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
a- o 4 law for the(crowing
reason.(Sec.7031.5,Businessand Profusions VALUATION SIFT.
� - Code:Any edyorewnly whichrequiresapemlittoconstrve1,alter, PERMIT ISSUANCE 10.00 /d�-
rtu,s-o improve,demolish,or repair any structure,prior to its Pint also ELEC.CONTR. LIC.NO. ELEC. p
- D M requires the applicant for such permit to file a signed statement that TOTAL / - PERMIT TO
K
$ he B licensed pursuant to the provisions of the Contractor's Lirensc F-Z&Z7- 6 �/
H z t Law(Chapter 9(commencing with Section 7000)of Division 3 of the �7
Q Business and Professions Cade)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
or t S the basis for the alkged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
TR by any applicant for a permit subjects the applicant to a civil Penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,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 structum is not
intended or offered for sale(Sec. 7144, Business and Prof s0om 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 See 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 BUILDING USE
builder will have the burden of Proving that he did not build or ins- RES IND CON PB Osner
pr vc fo purposeas owner of Sale.).thep INDUSTRIAL WASTE INTER. 30.00 0 ❑ 0 ❑ ❑
I as owner of the property,em exclusively contracting with
he n d 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 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 SEWER-SANITARY-STORM EA.200ft/10.00
the Contactors License Law. TRACT NO, PARCEL NO.
❑ I am exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT•' 6.00
rtes on
Owner Date &. .,f.'� WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP.^' 5.00
I hereby affirm that 1 have a certificate of consent to sel GinNue. Is
-
.I a certificate of Workers Compensation Insurance,or a certified .r. P110e ZONING ENG.SITE NO.
copy thereof(See.3800,Lub.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished.
FIRE SPRINK ENERGY T40
Z 2 O Certified copy is filed with the city inspection division
O Applicant MISC.- REFER TO ORD. VE] N❑ Y ❑ No
F- y PERMIT ISSUANCE - 10.00 -
LU CERTIFICATE OP ETIFROM WORKERS' PERMIT ZONE A.L.U.C.
W > COMPENSATION INSURANCE
NSU RANCE PLG.CONTR. LIC NO. PLG, Z/L YE] NE] Y [] NE]
n- (This dollars SI not be completed if the permit is for rax TOTAL
� 2 hundred dollars lSl001 or rev.)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
,L F mit is issued,1 shall not employ any Person in any manner ser as to
0 C) become subject to the Workers'Compensation Laws of Califomia. BUILDING
a Date-Applicant ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers'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 UNItlab 10000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLINGIINIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that then is a construction lending agency for EXHAUST HOOD (W ITHxDUCT) 5.00
the eCiv.C.jnlx of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000'B: .U.) 8.D0 MICROFILM
3097,
Leader's Name HEATING UNIT(OVER,100,000 B.T.U.)9.50
Lender's Address ELECTRIC J/ 0410
_
1 certify that I have read this application and state that the above � VENTILATION,,F.4N (SINGLE) 4.00
information n correct. I agree to comply with all city end county PLUMBING _Vv
ordinances and state laws relating to building covtruetion, and BOILER-OONP I3 H.P.or100,000B.T.U.) 6.00 �S
hereby authorize representatives of this city to enter uvon the BOILER LOMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
uhove-mentioned property for inspection purpose.
(We) agree to save, indemnify and keep harmless the Cityof MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs end expenses which CONST.TAX
may in any way accrue against,said City in consequence of the PERMIT ISSUANCE 10.00 Q
llnVf this permit. - MECH.CONT. LIC.NO. MECH.
£ 1 L TOTAL /,�4� TOTAL 0
Signature of Applicant/L nlractar este
OFFICE COPY