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14258 POST THIS CARD NEAR FRONT OF BUILDING `� , • - PERMIT NUMBER CITY OF , CUPERTINO {: �) INSPECTION DIVISION `j4 14258 JOB INSPECTION RECORD PERMIT EXPIRATION JOB"ADDRESS 10391 HENEY CREEK UNIT# LOT# PERMIT.EXPIRES IF WORK OWNER JOHN KELLY ' CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR � INSPECTION RECORD 180 PAYS OF PERMIT ISSU. ,44 FOUNDATION g ANCE OR 180 DAYS FROM I r L LIFER •LASTCALLED INSPECTION. � �► � PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ` PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT, PLG. MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING .ERMIT WOOD FLOOR INFORMATION CY PLUMBING' VALUATION SIFT. MECHANICAL ELECTRICAL ., PERMITTO FRAMING - INSULATION STORIES TYPE CONSTR, OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF BD,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Olne. APPLY NO ROOFING UNTIL ABOVE HAS BEEN"SI;G_NED ❑ ❑ ❑ ❑ ❑ •ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST - TRACT NO, PARCEL NO. MECHANICAL - ELECTRICAL FINALS DATE INSP. ACC.OATE ACC.FILE NO. FRAMING SAN * ZONING ENG.SITE N0. INSULATION - PLUMBING GAS. MECHANICAL FIRE SPRINK ENERGYT24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ N❑ Y ❑ N❑ ' LATH-INTERIOR - ELECTRICAL „�(� FLOOD ZONE A,LU.C. LATH-EXTERIOR FIREDEPT. Y❑ N❑. Y ❑ No SHEETROCK. GRADE FEE SUMMARY SHEAR INTERIOR BUILDING ' SHEAR EXTERIORTEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BYBUILDING INSPECTOR. MICROFILM -ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� 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 IJ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY P^, r BUILDING PROJECT I DENTIF[CATION PERMIT NUMBER 'CUILDING - . APPLICATION & PERMIT 14258 a00RE55 O / ane pmt /i BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'$ L /• PLAN CHECK VALIDATION "aME1 • yg` DTV. ELECTRIC PERMIT FEE ✓otI Kelley PHONE CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIC.NO. LIGHTING FIXTURES 10.00/1,00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS , PHONE PANELS 10.00 DATE OF APPLICATION on PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER ' LIC.No. � SIGNS TRANS. 3,00 ARCH.OR ENG. ., 5.00 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS IMOTORS SEE FEE SCH, ADDRESS �N SERVICE CHANGE 20.00 tel/ /F "09 LICENSED CONTRACTORS DECLARATION L1 I ��( • is u I hereby affirm that I am licensed under provisions of Chapter 9 I SUANCE DATE Q y (Commencing with Section 7000)of Division 3 of the Business and ELECT, PLG. MECH. r N Z Professions Code,and my license is in full force and effect Mula ❑ El Z O a - License Class Lic.Number - 0 Z r O Dale Contractor. r '" - -BUILbiNGPERMIT It Mw OWNER-BUILDER DECLARATION INFORMATION wCLL, I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LLO Low for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT. F _ PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit reconstruct,alter, rt it Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w $ he is licensed pursuant to the provisions of the Contractors License I Z Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of Rol more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP REB.UNITS (heir 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:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such Improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 . or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other 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 License Law does not apply , to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 the contracts License with acontractolls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00 TRACTNO. PARCEL NO. the Contractor's License Law. ❑ lam exempt under Sal.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason caner = Date/ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, W KERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent tosel Ginsure, ZONING or A certificate of Workers'Compensation Insurance,0, a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. Applicant Y❑ N❑ Y ❑ N[]F- y CERTIFICATE PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W W COMPENSATION j EXEMPTION FROM WORKERS'_ INSURANCE PLG.CONTR. LIF N0. PLG. Y❑ NE] Y [:] NE]O (This section need not be complete) if the permit is for one TOTAL D Z hundred dollars(S 100)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 manner so as to U become subject to the Workers'Compensation Laws of California. 0 w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE.TO APPLICANT: If,after making this Certificate of Iflx- H Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will', FEE (� such provisions or this pemSit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 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. HEATING UNIT(TO 100,000 B.T.U.), 6.00 MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is cornet I agree to comply with all city and county BOILER-CQMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws rotating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may ' any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 grant of lhi9 permit MECH.CONT. LIC.NO. MECH. �' / L3 TOTAL TOTAL Sig are of Applicam arrector Uaf OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO P(M'JII NUAIHFII INSPECTION DIVISION _ 14258 JOB INSPECTION RECORD PERMIT EXPIRATION Ao JOB ADDRESS /O�'��/ �EN•`4� � _K—/_e UNIT4 _LOT F! l(/ PERMIT EXPIRES IF WORK OWNER o C L.C-c. CONNAACTOR I IS NOT STARTED WITHIN INSPECTION TE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER -_ PiRMIT VALIOATIUN PREGUNITE D POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB n , PLUMBING ' 11 ELECTRICAL Cy17.1{1110 ISSUANCE DATE IILUG. ELECT PLG. . MECHANICAL MECH Ppl ❑ I ❑ 1 ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT Oy INFORMATION WOOD FLOOR V ALl1AlIl1N 5/FT. PLUMBING h� 01 pBftlnO MECHANICAL vIty P ELECTRICAL 1 HMIT TO FRAMING ^"� INSULATION STUDIES TYPE CONSTH. OCC,GROUP RES.UNITS PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FL.GLOOP AREA TOTAL ACREAGE DIAPHRAGM ROOF BUILDING.USE NES INV CON PR Olnei APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASS E SSOH 5 PA H C E L NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ACC.DATE ACC.LICE No. ELECTRICAL FINALS , DATE INSP. FRAMING SAN 0 INSULATION PLUMBING ZONING ENG.SITE NO. GAS FIRE SPRINK ENEHGV T 74 MECHANICAL Y ❑ No V ❑ IN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICALFLOOD ZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT. -/� Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. ('' PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX N-EASE f-':EAI itEVERSF SIDE BEFORE �! � ;;`��„�� r.`,+.'�•.IF} TOTAL LALLIR:G FOH FINAL 3NSPECTION. 'V _