16689 ' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER.
CITY OF CUPERTINO 16689
INSPECTION DIVISION
'JOB INSPECTION RECORD
— PERMIT EXPIRATION
JOB ADDRESS a"t ec S'" O'"�J'�WU/ V2{l1I /.N UNIT# 'LOT# '
PERMIT EXPIRES IF WORK '
OWNER CONTRACTOR �f=�,o_L�wf-y IS NOT STARTED WITHIN .
INSPE TION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION !•�
.ANCE OR 180 DAVS•FROM
_ - NOTE: LAST CALLED INSPECTION.
UFER " ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE, - TO COMPLY WITH THE APPROVED PLANS AND CIN OF PEHN�n VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. -
' � � .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -
UNDERGROUND /SLAB
'F PLUMBING
ELECTRICAL ISSUANCE LATE
" MECHANICAL - Bwa: ELECr. PLc. MECH,
. " ❑ I ❑ I ❑ _
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - .,, BUILDING PERMIT,
INFORMATION
WOOD FLOOR - VALUATION slFr.
PLUMBING - -
r
MECHANICAL _ T
ELECTRICAL - , ,�J�,PERMIT
.EER M[ILT�TO
Me
FRAMING cT r
INSULATION
STORIES TYPE CONSTR.
� � -
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ID IT FLOOHAHEA IOTAl ACH1:AGE
ROOF-* - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
i, DIAPHRAGM THE CONSTRUCTION TAX IS PAID-
"I BUILDINGUSE
ROOF SHEATHING _ ReS IND , CON PB, 01,11-1 '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. EL ❑ .I
' ASSESSORS PARCEL NO
ROUGH SAN.# ' '
PLUMBING ELECT.ENERGY '
THACT NO PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECK ENERGY
ELECTRICAL - BUILDING ENERGY - ACC.DATE ACC PILE No
FRAMING - - ELECT.FINAL TEST
rtE NOA;
'
INSULATION � � PLUMBING � ,^
ZONING ENG.S
GAS TEST GAS V '
` FIK ENERGY T 2N
r MECHANICAL 1� '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ "� ° "�
EXTERIOR SHEAR, - ELECTRICAL RELEASE ,,- FLo��1,e , A.L uc.
INTERIOR SHEAR FIRE DEPT. OOfn. N,[ Y L7. N❑
SHEETROCK GRADE FEESUMMARY.
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC - PLAN CHECK : I
GAS
FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTI LBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR,INSPECTION BY PHONING 252-4505, ELECTRIC
#F"n 10
00 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING "
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
' •1 Z — SEE PERMIT FOR EXPIRATION.DATE - MecHANIcnL d�t
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
1 BUILDING PROJECT lDENTIFICATION PERMIT NUMBER
APPLICATION 81 PERMIT s _
f
ADDRESS
21885 Garden View Lane BUILDING - ELECTRICAL-PLUMBING-MECHANICALli 16689'..
ONNER'B PLAN CHECK VALIDATION
NAME pTV. ELECTRIC PERMIT FEE
i Jud Kirkham PRONE 253-682
]� COMRACTORS
t, NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Dial One Buffal0w_%o. - LIGHTING FIXTURES 10,00/1.00
ouTRACTOR'a _ APPLIANCES
4.00
/tg t1�1 ADDRESS' -
1245` S ace Park Wla E 961-755 PANELS 10.00 DATE OF APPLICATION P "
- ARCHITECT PLAN CHECK FEE P.C.NO.
OR . - PANELS (OVER 200 AMP) 20.00
ENGINEER, uc.No. SIGNS TRANS. 3.00 '
ARCH.
oo'ESS E�G' ' . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPOCANT's -
ADDRESS MOTORS SEE FEE SCH. -�
`^
SER VICE CHANGE 20.00
d-
F O O
LICENSED CONTRACTORS DECLARATION
iu I hereby affirm that I am licenv.-d under provisions of Chapter 9 ISSUANCE DATE L.v
(commencing with Section 7000)of Division 3 of the Business and
7'�' professions Cn license 11 in full furnni off L, BLDG, ELECT. PLG. MECH.
LiL<nse.('I�sY Lic.Number L-S}S�fS
N H Date LL Contractor
BUILDING PERMIT
¢ ¢ w a
OWNER-BUILDER DECLARATION
o a INFORMATION
X ; LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
uOj Law for the following nvusu.(Sec.7031.5,Busincstand Professions VALUATION $/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,.In,,
¢ ¢ ¢ 0 improve,demolish,or mpai,any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a
o LL requires the applicant for such permit 1D file a signed statement that TOTAL w $ a he is licensed pursuant to the provisions of the CoutmPERMIT TO
i clor's License M /r
s- zLaw 9(commeneing with Section 7000)of Division 3 of the
5 i o Business and Professions Code)or Ihat he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d ; - by any applicant for a permit subjects the applicant too cRilpenalty gLTER-DRAIN& VENT-WATER (EA.) 5.00
of not mom than five hundred dollars(55001.1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole contpunmlion,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND.- 5.00
Code The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So.ET FLOOR AREA TOTAL ACREAGE
Rinsch throughhis own ffered for If,
however.the inch
improve
r orments
Imp,renot intended or within Offered yearsole.l f,howevec t the o 6cr- GAS-EA.SYSTEM-11NC.4OUTLETS 8.00
or Inlpmvll av is held within one year of he did
the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
FS 3� builder will have the burden of proving that he did not build or int- BUILDING USE
�Af prove for purpose ofsale.). RES IND GOry PB Osner
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 Q El ❑
licensed cmitmo r, to corsDuel the project(S,-Z. 7044, Businem LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors 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 a contractors)licensed pursuant to
the Contracmr's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec ,B.hP.C.for 00is WATER HEATER W/VENT 6.00
ten
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORT:F.RS'COM PENSATION DECLARATIONWATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent to vlf-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy Ihereof(Scc 3800,Lab.C.).
Policy Nc(51c 1 ng /l�IwnYd-p-�f
Q ❑ Cerlil7ed copy hereby meshed. FIRE SPRINK ENERGY T-10
F ZO EXCclicant ilsect file 4th tl c' - Ilion division. MISC.- REFER TO ORD -� ry r N
Applicant ❑ ❑ ❑
y C17RTDs1CATE 0171 XE:MPI'ION FRO.' CORKERS' PERMIT ISSUANCE 0'00 FLOOD ZONE A.L.U.C.
UJ CL Q COMP)N'SA'1'ION INSURANCE PLG.CONTR. LIC.NO. rornL �QO, N Y ry�
(This section ed not be con fd tcd if the permit is for one \ ,
Z hundred dollars(5100)or lussJ �.�;,
U O 1 certify that in the perfomunce of the work for which this per- OTY MECHANICAL PERMIT s FEE SUMMARY
CLU mit is issued,I shall not employ any perwn in any intoner so as to
become subject to the Worker'Compensation Laws of California. -
Ed Dulc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING _
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emptfun,you should hecume subject m the Worken'Compensation APPLIANCE - -5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
'I U such provisionsur this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=CF.ML)' 4.00
CONS'I'RUCIION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00CEM) 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(Sea MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4=
Lenders Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC ,
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 '
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building nmstmction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby alahorire representatives of this city to corer upon the
BOILER-COMP (Over 1170,000 BTLO SEE FEE SCH. dU
"-q abovementiriord property for inspection purpoxs. 'MECHANICAL \f
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cutter agui t liahili[ics,judgments, costs and expenses which CONST.TAX
I
may in any y accrue gaimt said City in consequence of the PERMIT ISSUANCE 40-66
renting s purmiL MECH.CONT., LIC.NO. MECH.
I I #- TOTAL p1�� TOTAL
Slgnelure of Applicant/Contmdor Date -
OFFICE COPY