14218 POST THIS CARD NEAR FRONT OF BUILDING , .
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 14218
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 2.2051 HIBISCUS DRIVE UNIT# LOT#
'PERMIT EXPIRES'IF WORK
OWNER �CHRIS ORR ,CONTRACTOR - - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR ry INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ! �„ /!. 0 /t ?- Y rf `ANCE OR 180 DAYS FROM
UFER B/ LAST CAL LED I NSPECTI ON:,
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _-- i6 ^ --
UNDERGROUND /SLAB _ t'`• -"
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL - BLDG. ELECT. PLG. .MECH.
❑ ❑ ' ❑ 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION
MECHANICAL
ELECTRICAL.
PERMIT To
v FRAMING
INSULATION -° ' - srORIEs• TYPECONSTR. ,
- - OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT FLOOR AREA TOTALACREAGE
DIAPHRAGM
BUILDING USE.
RES IND CON PB 011ier
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑, ❑ ❑
ROUGH ', —/O `" au59E5SOR5 PARCEL NO.
PLUMBING L •
GAS TEST - TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL F
INALS FINALS ACC.OATS ACC,FILE NO.
DATE INSP.
FRAMING � - '
INSULATION ING .- zow Nc .ENG.SITE NO. ,
ANICAL FIRE SPRINK ENERGY T@4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED NG Y ❑ N❑ Y ❑ NLATH—INTERIOR RICAL FLOOD ZONE a,L.0cLATH—EXTERIOR EPT. Y ❑ N❑ Y ❑ N❑SHEETROCK FEE SUMMARY
SHEAR INTERIOR - BUILDING
SHEnR'EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS - - ELECTRIC PLAN.CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
I
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
IMPORTANTI 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
BU LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
11I11ING APPLICATION & PERMIT
�1 ADDRESS -11051 1- 4 Z.1 8
( bl V r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNEH'S
NAMEPLAN CHECK VALIDATION
FPHONE
rr 73q- 6777 QTY. ELECTRIC PERMIT FEE
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
CONTRACTOR'S LIC.NU LIGHTING FIXTURES 10.00/1.00
ADDRESS - APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT
OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
Llc.No. SIGNS TRANS. 3.00
AENG.
ADDRESS SPECIAL CIRCUIT 5.00 'PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
avvucamrs
AooREss MOTORS SEE FEE SCH. n
-
ooSERVICE CHANGE 20.00
i / p
'09 LICENSED CONTRACTORS DECLARATION
v,z w I hereby affirm that I am licensed under provisions of Chapter 9 IS UANCE DATE
H 4 (commencing with Section 700e i of Division 3 Of the Business and BLDG. ELECT. PLG. MECH,
H . z Professions Code,and my license is in full force and effect.
G i=o License Class CLin..r Number - ❑ ❑ ❑
w I_ Uele Contractor -
y g
. ¢ w OWNER-BUILDER DECLARATION BUILDING PERMIT
w ;�,H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
n. o4 Lawforthe followingreasom.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION
,A Code:Any city or county which requires permit to construct,alter, 10.00
Er M 4 c' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG NO.--TE,EC.
y O u requires the applicant for such permit to file a signed statement that OTAL
X
m y he is licensed pursuant to the provisions of the Contractors License ^ PERMIT TO
Laza Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -//� p
g i o Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE
�'H o the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
a3e9 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN of not more than five hundred dollars(S500).): (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 TOrAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 .
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IPA 1 2.00 BUILDING USE
prove for purpose of sale,). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB acne.
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,BusinessLAWNSPRIN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law does not apply ..-r ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN'SPRINKLERS-OVER 5IEA.)� 1.00
contracts for such projects with a contractors)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORMEA.200ft/10.00 U-' [FIRE SPRINK ENERGY T-24 TRACT NO. PARCEL NO.
❑ 1 no axem t under Sec. ,B.&P.C.for this
reason WATER HEATER WIV ENT 6.00
Owner Dat WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 -
I hereby affirm that I have a certificate of consent to self-insure, ,
or a certificate of Workers'Compensation Insura
copy thereof(Sec.3800,Lab.CJ. nce,or a certified ZONING ENG.SITE NO.
s-- /
Policy No. Company -
O ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy Is Bled with the City Inspection division. y E:] N Q. Y [3 NC:]F O Applicant � MISC.- REFER TO ORD.
CL: LO CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 G - FLOODZONE A.L.U.O.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. _
1 0 (This section need not be completed if the permit is for one TOTALa� Y N Y ❑ N
� Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued, I shall not employ any person in any manner so as to
0 W become subject to the Workers'Compensation Laws of California.
A. Date Applicant ALTER OR ADD TO MECH. 5.0011BUILDING
}.W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this perAit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000C.EM.) 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. MICROFILM
3097,nder's .am • HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name '
Lender's Address HEATING UN IT(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 PLUMBINGqOV
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of [Itis city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(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 in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grant this permit MECH.PONT. LIC.NO. MECH.
'� TOTAL TOTAL
SSgnatmeof Apphcanl/Contractor Date
OFFICE COPY