15228POST THIS CARD NEAR FRONT OF BUILDING
..
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS 1198 Elmsford Drive UNIT# _LOT#
OwrvEH Rayma and R.J. Mann corvTRacroR
PERMIT NUMBER
15228
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM LAST CALLED INSPECTION.
'
INSPECTION DATE I INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND -DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PREGUNITE
,. PCRNIT VALIDATION
ISSUANCE DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
Pi
R G .ELECT I
❑
PLG MECH
❑ ❑
R F
DO NOT POULOOR UNTIL ABOVE HAS BEEN SIGNED
�11N
LDING PERMIT
I FOR "TION
WOOD FLOOR
PLUMBING
CIV
CUpB�IROj VALUATION
SIFT.
MECHANICAL -
ELECTRICAL
-
Peamn ro
`
FRAMING
INSULATION
STORIES
TYPECONSTR
OCC GROUP
HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID,
SO. ET FLOORA[IEA
TOTALACREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING. use
HEIS IND CON P9 Open
❑ 11 El E ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH
SAN.N
ASSESSORS PARCEI. NO
PLUMBING
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO
PARCEL NO
MECHANICAL
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
acc ogre
ACC FILE No
FRAMING
ELECT, FINAL TEST
INSULATION
PLUMBING
zON1NG
ENc. SITE No.
GAS TEST
GAS
MECHANICAL
PINE SPH Irvrc
Y ❑ N❑
ENERcv r.Za
` ❑ N❑'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE .�p,
PLooD -ZONE
v ❑ N❑
AL_uC
Y ❑ N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING
BUILDING
/
INTERIOR LATH
TEMPORARY APPROVALS .
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
�- T
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505,
0-0ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
CONST. TAX
TOTAL
OFFICE wry
APPI (CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.J
• BU I LDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
'PERMIT NUMBER
15228
BUILDING
ADDRESS
8 �
OwN .2
\I
I 1 V PHONE LzJ�S
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION.'
COONTRACTORs
LIC. No.
UTLETS-SWITCHES -RECEP 10.0011.00
LIGHTING FIXTURES 10.00/1.00
ADDRESS DR's
PHONE
APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ORRCHIi ELT
ENGINEER
LIC ND.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ADDRESS ciao
zIP
SPECIAL CIRCUIT 5.0Q
PERMIT VALIDATION
0
ISSUANCE DATE
-91-DG, ELECT, PLG. MECH.
TEMP. METER OR POLE INS. 20.00
APPLICANT'S
AGOG ESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CON'I'RACTURS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and illy license is in full force and effect.
License ClassLie. Number
Data Contractor
OWNER -BUILDER DECLARATION
I hereby arrant that am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5.Ousincssend l'roRuioos
Code: Any city .,County which rcquiresa permit toconstrucL alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to flle'a Signed Statement that
he is licensed pursuant to the provisions of the Contractors License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the Alleged exemption. Any violation of Section 7031.5
by any applicantfor a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(8500).):
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work. and the structure is not
intended or offered for of, (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
mentsarenotintended or off'ered for sale. IL however, tie building
Or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that h e did not build or im-
prove for purpose ofsale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to comtrun the projrel (Sec. 7044, BusinessLAWN
and Professions Code: The Contractor's License Law does not apply
to un owner of property who builds or improves thereon. and who
contracts for such projects with a conlractm(s) licensed pursuant to
the Contractors License Law.
❑ lam,xe 9t under Sec. ,B.&P.C: Ibrthis
reason
Q__
UN
u
BUILDING PERMIT
FORMATION
DATION $/FT.
(J/
MISC.- REFER TO ORD
PERMIT ISSUANCE
ELEC. CONTR. LIC. NO.
,�A_
ELEC. / Ci u 6
TOTAL ( L
PERMIT TO _
S�/L
�]
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 5.00
BACK F LOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,CON D. 5.00
FIXTURES - PER TRAP 5.00
So. FT FLOOR AREA
TOTAL ACREAGE
GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00
-
GAS EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Omer
INDUSTRIAL WASTE INTER. 30.00
.
SPRINKLERS- 1 INC 5 V.B. 6.00
ASSESSORS PagcEt. No.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT No.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner t dr-"--
WATER SYSTEM 5.00
'
/ �i�
WORKP S'COMPIiNSAT1UN Dec LA RATION ad
I hereby affirm 1hal I have a cortitic,le of consent to sell insure,
or a certificate of Workers' Compensation Insurance, or a certified
Copy thereef(S,c. 3800, Lab.C-).
Policy No. Company
ACC. DATE
ACC. FILE N0,
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
MISC. - REFER TO ORD.
❑ Certified copy is hereby furnished.
❑ Certified copy is Filed wish the city inspection division.
Applicant
FIRESPRINK
Y E) N�
ENERGY T-24
Y N[3
CERTIFICATE OF IiXEMPTION FROM WORKERS"
COMPENSATION INSURANCE,
(This doll:.n sed not be completed it the pcnnit is for one
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner sir as of
become subject to the Workers' Compensation Laws .(California.
Dat`
PERMIT ISSUANCE 10.00
FLOODZONE
Y ❑ N
aL.U.C.
Y OUN 1
PLG. CONTR. LIC. NO.
PLG.
TOTAL
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
�/��
Almbc°m
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should hecome subject m the Workers' Compensulmr,
Provisions of the Labor Code, you must forthwith comply wilh
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec
3097, Civ.C.).
Lender; Name
Lender's Address
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
AIR HANDLING UNIT (TO 10=0C.F.M.) 4.00
AIR HANDLING UNITIOVER 10=1C.F.M.) 6.00
SEISMIC FEE
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UN IT (OVER 100,000 B.T.U.)9.50
ELECTRIC
rte,
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
(We) agree to Save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which
may in any way acaoe against said City in consequence of the
•ton i this pcnnit. �a
VENTILATION FAN (SINGLE) 4.00
BOILER- ODMIP(3 H.P. or 100,000 B.T.U.) 6.00
PLUMBING
BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
MISQ - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. LIC. NO.
MECH. TOTAL
TOTAL
137 _
Ig alar (Applicant/Contractor Date
OFFICE COPY