13700 POST THIS CARD NEAR FRONT OF BUILDING
PF'EMIT NUMBER
CITY OF CUPERTINO 13700
INSPECTION DIVISION
JOB INSPECTION RECORD
7573 DUMAS DRIVE PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER DAV117 POON CONTRACTOR SWAN POOLS IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUN DATION
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 41-14_ ISSUANCE
DATE
MECHANICAL BLDG, ELECT, I PLG. MECH.
IV l9p w
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $IFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING �L�'j,_,�%/At ,M•(&
STORIES T ECONSTR.
INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
~� DIAPHRAGM
BUILDING USE
HES IND CON PB Otna
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ El ❑ Q
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL '
ACC.DATE ACC.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS 1
Li FIRE SPRINK ENERGY T 24
MECHANICAL v [:] N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,� ❑
LATH—INTERIOR ELECTRICAL ELooD ZONNEE A,L.u.c.
LATH—EXTERIOR FIRE DEPT. N[] r NE]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING13i2
SHEAR EXTERIOR T MPORARY APPROVALS BUILDING v
FIREWALLS ELECTRIC i PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
lwLU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGell
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT! CONST.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
.rBUILDING PROJECT I DENTI FICATI ON -PERMIT NUMBER
RG;LmNG APPLICATION & PERMIT
AOOREse 73 Oom.4-5 QX BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 13700
OwNER'S PLAN CHECK VALIDATION
NAME 1J ��. \ PRDNE�_ OTY. ELECTRIC PERMIT FEE
.1 2S'L'►4v
CONTRACTORS
NAME �\f UTLETS-SWITCHES-RECEP 10.00/1.00
TN 7aly_S LIC.NO(:nOo14 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS s� PPLIANCES-RESIDENTIAL 4.00
ADDRESS /� /yJ (� .n
) 4Ar,44A �V- PHONE - /jW PANELS 10.00 DATE OF APPLICATION
ORRCXITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ARCH Os ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESZIP EMP.METER OR POLE INS. 20.00
ADDRESS rs MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION !y'
a u I hereby affirm that I am licensed under provisions of Chapter 9 E I DANCE DATE
at "' (commencing with Section 7000)of Division 3 of the Business and
¢ a� BL ELECT. P MECH,
H N z Professions C e license is in full f�y�' affeaa�sl� _TL.,AYI_
Z o m - Liter CI iC '" Lia Number' -f�f
o z r Date Commit'.
a m a BUILDING PERMIT
¢ c a L' OWNER-BUILDER DECLARATION ' INFORMATION
w ; I hereby affirm that I am exempt from the Convactor's License MISC.- REFER TO ORD
u o v, Law forthe followingreasoa(Sea 7031.5,Business and Professions pERMIT ISSUANCE 10.060-
.12
0.00 EVALUATION 5/FT.
r - Code.Any city or county whichrequiresa permitto construct,alter, /L
¢ ¢¢2 improve,demolish,or repair any structure.prior to its issuance,also FLED.CONTR. LIC.NO. ELEC. U-_5
DLL requires the applicant for such pemsit to file a signed statement that TOTAL v �- PERMIT TO
te pursuant he is licensed puuant to the provisions of the Contractor's License
Hii Law,(Chapter 9(commencing with Section 7000)of Division 3 of the �Cf/�/�(// ��O'O�
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation o'Scetion 7031.5 STORIES TYPE CONSTR.
a by any applicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 �y
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG 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-
mentsarenotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 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 im-
proveforpurposeofsale). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
. .
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ El
licensed contractors to construct the project(Sec. 7144,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
- and PmRssions Coda 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 contructods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
D lam exempt under Sec,-,B&P,C,for this WATER HEATER W/VENT 6.00
a n
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or e certificate of Wo�rkem'Compensation Insurance,or a certified / ZONING ENG.SITE NO.
copy the
a&&,. ^' }, J�-rlw,,.' d,- 0- r'- 0
(] ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy is tiled with the city inspection division. FIRE SPRINK ENERGY T-24
Applicant_ 'qg� �2e1pi,� MISC.- REFER TO ORD. YE] IN E] Y ❑ NQ
Fy PERMIT ISSUANCE 10.00/0-
Lu
0.00 0- FLOOD ZONE AL.0 c.
Lu CERTIFICATE PE EXEMPTION FROM WORKERS'
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
O This section need not be completed if IIIc permit is for one TOTAL -� v❑ N v N
2 hundred dollars($100)or less)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any mann..s,as to
U W become Subject to the Worked Compensation Lows of California.
a BUILDING
Datc Applicant //
>_ 0NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 �j10
I'- ? emption,you should become subject to the WorkersCompensation 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. IAIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY, AIR HANDLING UNff(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there IN 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.) Q00
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)8.50
Lender's Address ELECTRIC
1 certify that I 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 BOILER-COW I3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL �U
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judginents, costs and expe es which CONST.TAX
may in any way accrue agains said Ci y N nxq a of the PERMIT ISSUANCE 10.00 O-
gT min his pentut MECH.CONT. LIC.NO. MECH.
TOTAL 02,�' TOTAL /� 6
I ure of Applicant/Con actor Dalc
OFFICE COPY