14246 POST THIS CARD NEAR FRONT OF BUILDING
N,EAR
NUMBER
CITY _OF CUPERTINO
INSPECTION DIVISION ' 4W
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 20988 'FATRW_O-OIZ.S couger UNIT# LOT#
PERMIT EXPIRES IF WORK
. OWNER H.W. ASSOC CONTRACTOR HURD IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT ViDATION
1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- UNDERGROUND /SLAB
PLUMBING /
I
ELECTRICALIssUANCE DATE
MECHANICAL
BLDG. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED pm. BUILDING PERMIT-
WOOD FLOOR INFORMATION
VALUATION .
PLUMBING - SIFT '
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - � _`-•
INSULATION
STORIES TYPE CONSTR.
OCC.CROUP RES.UNITS
_ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF i
( So.FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM 17'6&- f.`NT Are OK Wd
- RUILDING USE
RLS IND CON PO Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑
ASSESSURS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL No.
MECHANICAL
ELECTRICAL - FINALS DATE INSP. ACC.OATE ACC FILE-No,
FRAMING SAN # -
INSULATION PLUMBING ZONING ENC SITE NO.
GAS
MECHANICAL . FIRE SPRINK ENERGY T'N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE Y ❑ ❑
EL000 za
LATH-INTERIOR ELECTRICAL A.L.u.c.
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ v 0 N❑
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING
TEMPORARY APPROVALS BUILDING
SHEAR EXTERIOR - —
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I� o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 'IPLUMewG
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL / -le"
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
BUILDING
ADDRE O �woa� C7 BUILDING– ELECTRICAL–PLUMBING–MECHANICAL 14246
OWNER PLAN CHECK VALIDATION
NAME CITU. ELECTRIC PERMIT FEE
- w K. ^/ 'i SO G, PHONE
NAMERacroRs UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CON TFACTORS APPLIANCES
IA
ADD RESS
SO 3 C �Sk"J0 gEe–L_ PHONE37/4 PANELS
SY DATE OF APPLICATION
ARCHITECT AN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP
ENGINEER
Iso.NO. 4 SIGNS TRANS.
ARC eec. SPECIAL CIRCUITPERMIT VALIDATION
ZIP EMP. METER OR POLE IADDRESS MOTORS ADDRES9 SERVICE CHANGE
o o LICENSED CONTRACTORS DECLARATION
Ci v I heneby affirm that I am licensed under provisions of Chapter 9 s w I
w z t ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
H Professions CW n my license is in full fore ��d�Ijl L gI.OG.� E}ELT. PLO. MECH.
Z o,� – License lass Lic.Number, y eh'L1 J
o y Datc��– – Contractor
a y .A BUILDING PERMIT
¢ ¢ ce < OWNER-BUILDER DECLARATION
E:
n I hereby affirm that I am exempt from the Contractor's Lic<rue
MISC.– REFER TO ORD INFORMATION
uOj Law for the following reason.(Sec.703 LS,Businessand Professions VALUATION $/FT.
– PERMIT ISSUANCE 10,00 -
ELEC.
so Code:Any City or county which reyuion B permit to construct,alter,
2 rt ¢ 0 improve,demolish,or repair any structure,prior to its Issuance,also ELIC.CONTR. LIC.NO. (O ��b
– o LL requires the applicant for such permit to file a signed statement that TOTAL /
u w S he is licensed pursuant to the provisions of the Contractor's License - PERMIT TO
r z a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
4 ct Business and Prefcomm,Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5
by any applicant for a permit subjects the applicant Ica civil penalty STORIES TYPE CONSTR.
of not morenfive hundred dollars( c ):
ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
❑ I,as owner
my of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
they 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:'Phe Contractor's License law does not apply to an owner of
properly who builds or improves Detroit,and who docs such work FIXTURES,PER TRAP 5.00 Sa.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improvo
menu are Poli otended or olt'ered 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- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- B W LDING USE
prove for purpose of.IE). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with - El 1:1 1:1 0
peened contractors to Construct the project(See. 7044,Business LAWNSPRINKLERS-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 u contmetons)licensed pursuant to
the Contractor's License LBw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&Y.C.for this
mason WATER HEATER W/VENT 6.00
Owner D.He WATER SYSTEM 5.00 Acc.DarE ACC.FILE NO.
WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP, .5.00
1 hereby affirm that 1 have a certificate ofennsent to self-insure,
or a certificate of Workers'Compensation Insumnec,or a certif d ZONING ENG.SITE NO.
copy thereof(Sec.3800,Iab.C.) -
Policy No. Company_ fid/
❑ Certi fed copy is hereby fur IsIIed. FIRE SPRINK ENERGY TYa
Z 2 ❑ Certific,k�'y s filed wi he city i petition division.
� O Applican(_J '– `—\�� MISC.- REFER TO ORD, y NF Y ❑ N�
� = CE RTI 171CATI:OP#:Xf MPTION FROM WOR PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
11J > COMPENSATION INSURANCE PLO.00NTR. LIC.NO. PLG.
CL O (This section nccd not be completed if the permit is for one TOTAL Y❑ N[] V N�
= hundred dollars IS 100)or less.)
U O 1 certify that in the perform once of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL I– mit is issued. I shall nor employ any person in any manner so as to
O become subject to the Workeri laws of laof California.
U i nam Applicant ALTER OR ADD TO MECH. 5 BO BUILDING J�
} to NOTICE,TO APPLICANT: If,alter making this Cenificmc of Ex-
Z
sorption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the LaborCCde, you most forthwith comply with
U such provisions or This pandit shall be deemed rovoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNrr(OVER 10=C.EM.) 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.0). ) HEATING UNIT(TO 100,000 B.T.U.) 8.00
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 VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and stale'laws relating to building construction, and BOILEA-COMP(3 H.P.or1D0,000B.T.U.) 6.00
hereby authorize repertylotiin of this city es enter upon'the BOILER-0OMP (Own 100,000 BTU)SEE FEE SIGH. MECHANICAL
hereby autio riz property lar vett of inspection purlmses.
(We) Bgrce to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupcnino against liahilines,ju ents, cost, and expenses which CONST.TAX
may in any way accrue again r 'd City in consequence of the PERMIT ISSUANCE 10.00
granting of this permit, MECH.CONT. LIC.NO. MECH.
�Z_� „ TOTAL TOTAL
]N Signatum of Applicant Etmctor Dat, c�
/ \ OFFICE COPY