14412 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT 1 DENT[FICATI ON PERMIT NUMBER
R„ILDI, APPLICATION & PERMIT
ADORES 14"412
' �58o ERInI I,/q BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
CRAI(o C r0A.., PRONE 2s3 Zb8 QTY. ELECTRIC PERMIT FEE
CONTRACTOR'S
NAME I 10 OUTLETS-SWITCHES-RECEP 10.00/1.00 /0-
Inc.No. LIGHTING FIXTURES 10.00/1.00 /Q -
ADDRESSroR's PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0.
oR /+ PANELS (OVER 200 AMPI 20.00
ENGINEER MILNA€ZKIN0"'1C4 C/3Z87 SIGNS TRANS. 3.00
NO.
ARCH.OR ENG,
ADDRESS SPECIALCIRCUIT 5.00
PERMIT VALIDATION
pflB0x 46-2- f1oo mitt' VIedI 21P91(Qyt - EMP. METER OR POLE INS. 20.00
AEr MOTORS SEE FEE SCH. O$ �
ADDRESS 55 E4,4,y
SERVICE CHANGE 20.00 1 3
02
0
Foo LICENSED CONTRACTORS DECLARATION „ ham. Qo
a i I hereby al'lirm that I am licensed under provisions of Chapter'I �;Sh1` ISSUANCE DOE�
ATE
y a T (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT'1 PLG. MECH.
H m z Professions Codc,and my license is in full force and effect. es 11 RQ• ��s�
Z o t'2r License Class Lia Number �) I-iri f�
y Date COnt cue, llrJ� lL�
�w¢ OWNER-BUILDER DECLARATION
BUILDING PERMIT
°' " MISC.- REFER TO ORD INFORMATION
w
if: H :I hereby affirm that 1 am exempt from the Contractor's License
u. 0¢ Ciiw for the followillreason.(See 7031.5.Businessand Professions VALUATION $/FT.
- g PERMIT ISSUANCE 10.00
Code:Any city or county which requirese permit to construct,al@q �/(f
RR¢ p improve,demolish,or repair any stneturc,prior LO its issuance,also ELEC.GDNTR. LIC.NO. ELEC. 'j/ `6/
0 a, requires tine applicant for such permit to file a signed statement that TOTAL 3 PERMIT TO
n w m w he is licensed pursuant to the provisions of the Contractor's License
HiQ
Last(CISP@r9(commencing with Section 7000)of Doox nSof the
i 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
I- o the basis for the alleged exemption.Any violation o(Section 7031.5 STORIES TYPE CONSTR.
A. ;m by any applicant for a permit subjects the applicant w a civil penalty
of not more than five hundred dollars(S500).) ALTER-DRAIN&VENT-WATE R (EA.) 5.00
❑ 1,as owner of Ibe property,or my employees with wr,sas BACK FLOW PROTECT4.
their sole compensation,will do tile .DEVICE 00e work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Cade:The Cont factor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such worki FIXTURES-PER TRAP 5.00 SO.FT.aooR AREA TOTAL ACREAGE
himself re through his own employees.Provided that such improve-
orunpmeant rovemennot ntcndedortlibioneyearsale.oIf,
complhowever,tion the budding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
Or improvement is sob within one year of completion,ire owner- GAS-EA.SYSTEM-OVER 4 IEq.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
"e L as owner of the construct
ane exclusively. 7044, ing with ❑ ❑ ❑ ❑ C1
licensed contractors: I he Contra the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Prowner of Code:The Contractor's License Law docs not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a ttntractolf sl licensed pursuant to
the Contractor's License Law, SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O 1 LLmpt a ler S•c. ,B.&P.C.ter this
reason __ WATER HEATER W/VENT 6.00
Owner Dur- WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
WOR!',"COh1 PENS ' ION DIiCLARKI'ION WATER TREATING EQUIP, 5.00
1 hereby affirm that 1 have a certificate of consent to xlf-insure
or a certificate of Workers'Compensation Insurance,or a"trifled ZONING ENG.SITE NO.
_- copy thereof(Sec.3800,Lab.C.). i
Policy No. Company
❑ Certified copy is hereby furnished.
r ? Z Z ❑ Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T-24
� p-... Applicant MISC.- REFER TO ORD. vEj NC] v ❑ N�
0 m CE RTI PICA'['G OF FX IiMPI'ION FROM WORKERSPERMIT ISSUANCE 10.00 Q PEOOD ZorvE A.L.000
LU > COMPENSATION INSURANCE. PLG.COKER. LIC.NO. PEG
CIL . r
0 (This section need not be completed if the permit is for one TOTAL �V �` Y 1:1NE] Y 0 NC]
::) Z hundred dollars(S 100)of less.) -
U O F I evitify that in the perfonaanec of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workcr.i Compensation Laws of California.
d Dat` Applin°nt ALTER OR ADD TO MECH. 5.00 hS - BUILDING -Qp
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emotion,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will,
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PWC.F.M.) 6.00 SEISMIC FEE
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.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC 31
I certify that l have read this application and state that me above VENTILATION AN (SINGLE) 4.00
informationrdicsn correct 1 agree t0 comply with all city and county PLUMBING
hereby
noes oil state laws relating to building construe inn, and BOILER-COMP(3 H.P.or 100,0006.T.U.) 6.00 �S
above authorize representatives for ins nl this city to anter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. Qd
above mentioned property for inspection purposes. MECHANICAL
(we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs anJ expenses which p CONST.TAX
may in any waycera against mid City in consequence of the PERMIT ISSUANCE 10.00 V
• ra t got ttiap I it. MECH.CONT. - LIC.NO. MECH.
TOTAL 9 (y
ign ure of Ap cant/Contractor a �--- // I TOTAL ��/Q
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14412
INSPECTION DIVISION
JOB INSPECTION RECORD
•� PERMIT EXPIRATION
JOBADDRESS 7580 Erin Way UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER Craig C. Forney CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFERALL GRADING AND DRAINAGE SHALL BE INSTALLED
ME
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (o 'as Ye A.
UNDERGROUNDIISLAB o r oY J
• PLUMBING '/"� -J �X
ELECTRICAL T r'
ISSUANCE DATE
MECHANICAL - \ eLnc ELEcr PLC, MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED u `� BUILDING PERMIT
WOOD FLOOR rY\•h�i C.' INFORMATION
PLUMBING
VALUATION SIFT.
�', 7
MECHANICAL
v.
ELECTRICAL !1 PERMIl TO
FRAMING �Z? XV,)1-r10A
INSULATION _2,.�� NTe 2ioro L�+�,c, :TORIES TYPE CONSTH
DCC.GHOUP RES UMTS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INS°.SHALL BE MADE BEFORE SO F r FLCIUIi AHLA rOTAI ACIIIAGL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
' 6 BUILDING USE
ROOF SHEATHING 4 HEs IND cON
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS FAHCEL NO
ROUGH SAN.N
PLUMBING - ay. ELECT.ENERGY
TUBS&SHOWERP N PLUMBING ENERGY TRACT No PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING — ELECT.FINAL TEST
INSULATION .��. PLUMBING ZONING ENG SITE NO. .
GAS TEST 1,7GAS
MECHANICAL FIRE SPRINK ENERGY T]J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ , ❑ N❑I
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL UC.
INTERIOR SHEARFIRE DEPT. Y❑ N❑ Y Ll No
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH IBUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING _
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o�• ONE WORKING DAY BEFORE REQUIRED INSPECTION. T
z
PLEASE GIVE JOB ADDRESS WHEN PHONING. . PLUMBING
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL r
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL .
CALLING FOR FINAL INSPECTION. J
OFFICE COPY