0268 CITY OF CUPHLT'INO INSPECTIOU RECORD (Office Copy)
• '0268 _ 10210 N.- Foothill-Expressway
PUP11IT NO. SANITARY DIST. NO. LOT NO. ADh16',SS
Reroof Residence `7.C. Johnson
PROJECT 01•INER JOB SITE PHONE NO.
PERMIT ISSUED Date I ELECTRICAL
Buildinr. h-1B_8] ;II Date Insp.
Electrical Power Po_te
Plumhinr Underground
iicchnnical Rough Wiring
Temp. Cas/Elect. llarUs
Solar Ceiling
Fire Sprinkler Fixtures Int/Ext i
Sipn Motors
Grounding
4lisc. Temp. Power
Other
FINAL. INSPECTIONS Not Approved
Date Insp.
PLUMBING
Electric Date Insp.
Plumbing Backflow
Mechanical Underground
Solar Underfloor
Pool Partial Rough
Grading Rough Complete
Ptanning Solar Rough
• Fire Dept. Water & Insulation
Health Dept. Main Drain
BuiIdinp R/of/S Drain
Other Gas
Other i
B(JILDING Not Approved
Date Insp.
Vad Certification MECHANICAL
Foundation Date Insp.
Pre-Gunite Underfloor S.M.
Slab-Membrane Ducts & Insulation
Bond Beam Fire Dampers
Underfloor Girders Fireplace
Floor Steel Grease Duct & hood
Tiedowns One flour Shaft
Diaphrams Condensate Drain
Seismic Bracing Equipment Anchorage
Balls-Panels Flues & Comb. Air
Frame Other
Lath Not Approved
Uallboards Int/Ext.
Firewalls .
Other
Not Approved
BUILDING a
ELECTRICAL
PLUMBING
MECHANICAL
MISCELLANEOUS
4. FjLLICANzf TO FILL IN,INFORMATION WITHIN RED LINES '- USE BALI_ POINT PEN ONL
pi 7
'BUILDING P.,ROJECT IDENTI FICATION - P IT NUMBER
An .I1a
G , ;t
LAPPLICATION & PERMIT • . (�
ADDRESSO . 6 u
ILDING - ELECTRICAL-PLUMBING-MECHANICAL O8
OWNER'S - --- --- -
NAME � „ - PLAN CHECK VALIDATION
. CITY. ELECTRIC PERMIT FEE
J. . .
NAMERncraRs PHONE
w OUTLETS-SWITCHES-RECEP 5.00/1.00
LIGHTING FIX- S 5.00/1.00 '
CONTRACTOR'S
,ADDRESS a/� (/+ I ' ��'( /J q APPLIANCES-REST TIAL 4.00
PH.Na J�`��/ PANELSf S.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.D.NO.,
OR SIGNS 6.00
ENGINEER
uc.NO, SIGNS TRANJb J 3.00 '
AR H.
ervc. SPECIAL CIR 5.00
PERMIT VALIDATION
zip TEMP.METER oWf4u INS. 15.00
APPLICANT'S - MOTORS SEE FEE SCH.
ADDRESS �` '
J, l ry SERVICE CHANGE 10.00 //,
00 LICENSED CONTRACTORS DECLARATION 4//
FU w - I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE ATE
a (commencing with Section 7000)of Division 3 of the Business and BLDG. -ELECT. PLG. MECH.
F! N i Professions Codd a� use is in full for fL t1
z o m- License s 6• Lic.Number
w= w
Data Contractor ,
a m s - , BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
o t v INFORMATION
X1.
.LL r 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u O 1 Law for the following reason.(Seo:7031.5,Business and Professions VALUATION $/FT.
I- - PERMIT ISSUANCE 6.00 p
w Code:Any city or county which requires a permit to construe.alter, .• - s0 2 0
IS ¢ a improve,demolish,or repair any structure,prior to its issuance;also ELEC.CONTR.., .,LIC.NO. - ELEC.
y W m LL requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
rza Law.(Chapter 9(commencingwith Section 7000)of Division 3 of the C-�OQC Aof
f 4 Q Buse
ness and Professions Code) that he is exempt therefrom and OTY. PLUMBING PERMIT FEE /l
¢ H a the basis for the alleged exemption.Any violation of Section 7031.5 " STORIES TYPE CONSTR,
by any applicant for a permit subjects the applicant toacivilpenalty igLTER-DRAIN&VENT-WATER (EA.) 4.00
f not more than five hundred'dollars($500),):
❑ I,as owner of the property',or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GRDUP RES.UNITS
eir Sole compensation,will do the work,and the structure is not
tended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND.'4.00
ode'.The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who dines such work - FIXTURES-PER TRAP 4.00 SQ.FT.FLOOR AREA TOTAL ACREAGE_
r himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-Ek SYSTEM-11NC.4OUTLETS 4.00
t..mr.mprovement is sold within one year of completion,the owner. GAS EASYSTEM OVER 4 (EA) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or ion - . - .
for RES IND r CON PR 'Omer
prove 1,aso neeose of sale,). INDUSTRIAL WASTE INTER., 20.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the property,he exclusively contracting with
licensed contractors to construct the Livens(Sec.7044,Business LAWN SPRINKLERS-i,INC 5 V.B. 5,00 ASSESSORS PARCEL NO.
and Professions Codec The Contractors License Law does not why
to an owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 7.00
contracts for such projects with a conhoctor(s)licensed pursuant to '
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/6.00 TRACT NO.- PARCEL No.
❑ I am exempt under Sec. : ,B.&P.C.lin this WATER HEATER W/VENT 4.00
reason
Date Owner WATER SYSTEM 4,00 -. 'ACC.D.ATE ACC.FILE NO.
WORK ERYCOMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Wor mpense u Insurance, r a certified
c the f b.C.1 .{tp.
.. P W omPany an tl
0 ❑ ertlfle apy =hereb}fuEnished. O " - FIRESPRINK ENERGY T-24
Z Z t1fi cap is f d vlth the ty 1 p a division. ,
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
~rot PERMIT ISSUANCE 6.00
K CF,RTIFICATE OF EXEMPTION 'ROM WORKERS' r � - FLOOD ZONE A.LU C.
W ? COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
Q. Z( This section need not be completed if the permit is for one TOTAL ❑ N C] Y❑ N❑
hundred dollars IS 100)or less.)
U O I certify that in the performance of-the work for which this per- CITY MECHANICAL PERMIT FEE - FEE SUMMARY
LL H mil is issued,I shall not employ any person in any Gunner so as to - -
U become subject to the Workers'Compensation Laws of California.
U IL Date Applieent ALTER OR ADD-TO MECH. 4.00 BUILDING T�
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- S
F 2 emption,you should become subject to the Workers'Compensation' APPLIANCE 4.00 PLAN CHECK
provisions,of the Labor Code, you must forthwith comply with FEE 1-
U such provisions or this permit shall be deemed revoked. "AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE JY
I hereby affirm that Blare is a construction lending agency for ,EXHAUST HOOD (WITH DUCT) 2.00 '
The performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name . .H EATI N G UN IT.(O V ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
Lrerlifythat l laveread this application and state Unit the above VENTILATION FAN (SINGLE) 3.00
information is correct.1 agree to comply with all city and county - - PLUMBING
ordinances and state Taws relating to building construction, and 'BOILER-COMP(3H.P.Or100,000B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000'BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
It (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against said City in consequence or the -
.1 gr ing is it. MECH.CONT. - LIC.NO. MECH, _ - -
/ TOTAL TOTAL. SLS G 0
v Signal r of Applicant nhactor J Date
- OFFICE COPY, - - '