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15490v POST THIS CARD NEAR FRONT OF BUILDING - CITY OF CUPERTINO � • INSPECTION DIVISION JOB INSPECTION RECORD - JOB ADDRESS 21590 Fitzgerald Drive UNIT# LOT# OWNER Dickman CONTRACTOR PERMIT1"UMBER 5490 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- OR 180 DAYS FROM LASTCALAD INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION bANCE NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PR EGUNITE PERMIT VALIDATION p ' ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL q BLDGELECT. ❑ ❑ PLG. VECH. ❑.. ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOODTLOOR PLUMBING VALUATION G SIFT - ' MECHANICAL ELECTRICAL PERNIR TO L� J FRAMING INSULATION STORIES TYPE CONSTR. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ' OCC GROUP RES UNITS ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - SO IT FLOOR AREA TOTALACREAC.E DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB 0,I, ❑ ❑ ❑ ❑ 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.q ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY' ' TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO. FRAMING ELECT. FINAL TEST INSULATION PLUMBING ]-ONING ENG. SITE NO. a. GAS TEST GAS MECHANICAL FIRESPRINK Y ❑ "0 ENERGY 1q4 "El 'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FL000 zoNE Y "� ALac. ° ❑ "� INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING z, BUILDING S �. INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT IELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN'PHONING. —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.. I.� TOTAL OFFICE COPY W o at i FWo Q U V NZW n2 zoo Vr Q y E ¢Q W U w B:, I- HLL05 s' SE 0 m 0 0 n w m ca u ~ � Q SE i o 6 os� O Z F' -O CC T UJ - CL O Z U o LL U IL M H- z Ab APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BVI LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL -PERMIT NUMBER 15490 BUILDING ADDRESS _rZI NAME 's _ NAME ID, moyl, DNE - TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION 3 L� 1.14 DATE OF APPLICATION CONTRACTOR'S NAME %%9 UTCETS -SWITCHES-RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 MITL'No, �A ORs �M 1_ IRHONE' PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT 4 OR ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE FC. NO. SIGNS TRANS. 3.00 ADDRESS LNG SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 - Ar$ ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON' 1' RACTORS DECLARATION I hereby affirm that 1 an, licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prufe"mr, C<ss��yplD�) d my license is in full fa to License Q:ps Loc. Number/ ])are 4. Coolfactor=T0.y OWNER -BUILDER DECLARATION I hereby xftirin that I am exempt loom the Contractor's License Law for the followingreason,(Sec. 7031,5. Business and Professions Cade Any city orsourly whichregviresap mitmconstmct,al«q ISSUANCE DATE 1 BLDG. ELECT. PLG. MECH. ^� l T BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION 5/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL improve, deo mfish, or repair any struclarc, prior to its issuance, also requires the applicant for such permit to file a signed statement that lie Is licensed purso ant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) Of Division 3 Of the / 5 PERMIT TO ' T ez. /-/,f Business and Professions Code) or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE the basis for the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the apilicam to a civil penalty of not more than five hundred dollars ($5007.1: STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 ❑ L as owner of the property, or my employees with wages as (heir Sole compensation, will do the work, and the structure u not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA COND. 5.00 intended or opened for sale (Sec. 7044, Business and Professions Cale: 'the Contractor's dun not Law dunot apply to an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 SO, FT FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who des such work himself or through his own employees, provided that such improve- mentsarenolintendedorofferedforsale. ll. however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that tic did not build or hit- GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE prove for purpose ofusle.).s ❑ 1, as owner of the property, am exclusively contracting with RES IND CON PB Other INDUSTRIAL WASTE INTER. 30.00 licensed contractorsw construct the project(Sec. 7M4, BusinessLAWN and Professions Code: The Contractor's License Law dues nm apply to an owner of property who builds or improves ihcroan. and who SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects wish u contructorfs) IeCnkd Funuunt m the Contractor's License Low. ❑ I em exempt under See.-, 6,kP.C, for this rcusnn SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. r WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACO. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby al0rn that 1 have a certiriyj;ito or consent to wit -inane, ¢rtilicale of Workcri�ynjIMsn Insurance, or a Certified ZONING ENG. SITE NO. coa py Ihumn c.&30 ya C.).r POlicy Ns 'notary�ls�_ppc.a ❑ Certified copy is hereby furnished. ❑ Certified copy is tiled with the city inspection division. Applicant FIRE SPRINK Y ❑ N ENERGY T-20 Y 0 NE] MISC. REFER TO ORD. CERT119CC1'17 OP EXEMPTION FROM WORKERS' COMPENSWION INSURANCE (This section used not be completed if the permit is for one PERMIT ISSUANCE 10.00 FLOOD ZONE V "� A.L.U. C. Y N PLG. CONTR. LIC. NO. PLG TOTAL hundred dollars IS 100) err less.) I ccrtily that in the per('orne ner of the work for which this per- mit is imcd. I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING L �/ T t5� become subject to the Worker' Compens tion Laws of California. Da m Applicant ALTER OR ADD TO MECH. 500 . NOTICI' TO APPLICANT: If. after making this Certirery of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10SMC.F.M.) 4.00 PLAN CHECK FEE anption, you should become subject In the Workers' Compensation previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRucriON LENDING AGENCY AIR HANDLING UNIT (OVER 10=1.F.M.) 6.00 SEISMIC FEE S 0 1 hereby affirm that there is a construction lending agency for the performance of the work I'ar which this Nnmit is issued (Sec. 3097, Civ,CJ. EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T-U.) 6.00 MICROFILM lender's No.HEATING Lender's Address UNIT (OV ER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN(SINGLE) 4.00 Icertil'y that l have read this application and state hat the above inl'ormvtinn it correct. 1 agree to comply with all clly and c. ty ordinances and slate laws relating to building construction, and PLUMBING BOILER- COMPO H.P. Or 100,000 B.T.U.) 6.00 hereby authorize representatives. of this city to cn ler upon an above-mentioned property for inspection purposes. se BOILER -COMP IOr 100,000 BTU( SEE FEE SCD. MECHANICAL re (We) age to sive, indemnify and keep harmless the City of MISC. - REFER TO ORD. ape tioo ag at liabilities, judgments, Costs and experrnryjjsccces which ay in a vy v rue against said City in conse uer1ce of the ranting is 'r L PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL .SGS-�� r Sigh, r A cant/Conlranor OFFICE COPY