14434 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT 4434
�. NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
•_ PERMIT EXPIRATION
JOB ADDRESS 789-1 FIESTA T,ANE 'UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER MIRE SHUM CONTRACTOR ` IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: • LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
• PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT vAL1DATIDN
CUPERTINO STANDARDS. .t
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /SLAB _�A�
PLUMBING �.
ELECTRICAL' nF �� ISSUANCE DA IC
MECHANICAL al_DG, EC I. PLG. mRCR.
:1tv a �� ,n ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - ,BUILDING PERMIT
INFORMATION
WOOD FLOOR v LUAIION SJFT.
PLUMBING .16
MECHANICAL
ELECTRICAL PERnm TO
FRAMING, —4'-E
INSULATION STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INS°.SHALL BE MADE BEFORE SI' IT FLOOR AREA ra rA�ACR EACE
110- DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING � ITS INu Cory Pe 0111.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ .[I
ROUGH SAN.k ASSESSORS PAHCELNO
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No PAHCEL NO
MECHANICAL MECK ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T.24
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "[] ` [:) "�
EXTERIOR SHEAR I ELECTRICAL RELEASE F LOOD ZON I: A U,C.
INTERIOR SHEAR FIRE DEPT. v❑ "❑ Y ❑ NO
SHEETROCK I GRADE FEESUMMARY
EXTERIOR LATH . BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING ,
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC .
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
• Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- 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
BCI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BOILDINGAPPLICATION & PERMIT
ADDRESS ''')Q l O l �a.�` B14434UILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 1 p •lo PLAN CHECK VALIDATION
NAME �I//��If�` `i OTyJ�' ELECTRIC PERMIT FEE
• O \�✓�� •x'�/ PHONE Z53 833 ./
NAMERACTDes UTLETS-SWITCHES-RECEP 10.00/1.00
sec,ND. LIGHTING FIXTURES 10.00/1.00
ADDRESS APPLIANCES
PPLIANCES-RESIDENTIAL 4.00
CONTRt
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PD.NO.
ENGINEER
LIC.NO, ISIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS - SPECIALCIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S
AOORE59 MOTORS SEE FEE SCH.
' SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARAt'ION ` /517
a v w 1 hereby.aftimr that I din licensed undeeprovisionsof Chapler9 , ISS ArvCE DATE -
m < m (commencing with Section 7000)of lu,isimm 3 of the Bminess and BLDG. ELECT. PLG. MECH.
F m z Professions Code,and my license is in full force and effect r O. ` -
o 0 w o License Clas Lia Number - b - --
a Y 5 j Datc Contractor p
¢ ¢ w a OWNER-BUILDER DECLARATION �1 BUILDING PERMIT
o a u r INFORMATION
F
g; w w 1 hereby affirm that I am exempt from the Connector's License MISC.- REFER •ORD
F LL O a Law for thyfollawing reason(Sec.7031.5,Businco and Professions PERMIT ISSUANCE- 10.00 /CJ- VALUATION 5/FT.
Code:Any city or county which requires a permit to construct,alter,
2 ce Q Q improve,demolish,ar repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
0 u requires the applicant for such permit to file a signed statement that TOTA
w $ he is liccmed pursuant m the provisions of Contractor's LiceL PERMIT TO
nse �
Law(Chapter 9(commencing with Section 7000) fDi,,i.o 3ofthu
a Business and ProfL•4ions Code)or that he is exempt therefrom and
et F the basis for the alleged exemption.Any violation of QTY. PLUMBING PERMIT FEE ��
Section 7031.5 STORIES TYPE CONSTR.
a _ by anyapplicantfora permitsubjects $510).): um toucivil lmenalty ALTER-DRAIN -WATER (EA.) 5.00
of not mom(hon five hundred dollars(5500).1:
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole inupen,tion,will do the work,and the structure u not
intended or offered for sale (Sec. 7044, Business mW Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law dos not apply to an owner of
property who builds or improves thereon,and who dos such work FIXTURES-PER TRAP 5.00 $O,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided that such improve-
mentsamnot intended oroffered 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 owncf GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im BUILDING USERES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed 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 Limuse Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsuch projects with a contructogs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
rca
Date WATER SYSTEM 5.00 ACC.DATE Asa FILE No.
WORKI.RS'COMPENSATION DIiCLARATLON WATER TREATING EQUIP. 5.00
1 he¢hy affirm that I have a certificate of consent to w1f-insum, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certifed
copy 0mmut(Sim.3800,L b.C.).
Policy No, Company
O ❑ Cevifedampyishurehyfundsfud' FIRESPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspuction division.
O Applicant MISC.. REFER TO ORD. Y ❑ IN v ❑ N❑
~ w PERMIT ISSUANCE 10.00
- CERTI PIGON O. SAX I KION FROM WORK ERS' FLOOD ZONE A.L.U.C.
W > CO MPF:NSATION'INSURA NCE PLG,CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
::) Z hundred dollars(S100)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 nunner so as to
O w become subject to the Worker,'Compenvnion Laws of Cnliocaniu.
y Date-Applicant t ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE '1'0 APPLICANT': If,after making this Certificate of fix- _
� Z cmption,you should become subject in the workers'Compensation APPLIANCE 5.00 PLAN CHECK
pro
visions of the Labor Code, you must lorthwith comply with FEE
U such provisions or this Permit shall he deemed revoked. AIR HANDLING UNIT(TO 1OSMC.F.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby aft-inn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pcffonnance 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's AJdress ELECTRIC
I cnrtiiou I;l I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
ordinamorninces n cornet. 1 agree to comply with all
city and courtly gpILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 PLUMBING
ordinances and vote lows relating'W building convruction, and
hereby authorise representatives of this city to enter upon the ED LE
(Orel 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree t save, indemnify and ktcp harmleM the City of MISC.- REFER TO ORD.
ulsertino a liabilities,judgments, costs and expenses which CONST.TAX
in a y accrue ugainsl said City in consequerme of the PERMIT ISSUANCE 10.00
got t1s per I MECH.CONT. LIC.NO. MECH,
IZ L TOTAL TOTAL
SignaturcidApplicant/Contractor Ilate
OFFICE COPY