14139 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO • 14139
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 21485 HOLLYOAK DRIVE' UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER ''JAMES N HAOALE CONTRACTOR - - IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED of - -/ , / // j`�,f- _.
UNDERGROUND /SLAB l3 1-1— o� GJf
PLUMBING
ELECTRICAL ( Q ISSUANCE DATE
MECHANICAL 11-11, ELECT, I PI_G.j MECR.
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - - INFORMATION
VALUATION
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
INSULATION „ STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ) „s Gt1`'
M,ty •' SO.FT,FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM - M
BUILDING USE
' HES IND CON PO Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
.
ELECTRICAL - FINALS DATE INSP. All.DATE ACCFILE NO.
FRAMING - SAN #
ZONING ENG.SITE NO.
INSULATION � PLUMBING
GAS
MECHANICAL SIRE SPRINK ENERGY T 44
• COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r❑ ".❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL
FLOOD ZONE A.L.U.C.
LATH-EXTERIOR - FIRE DEPT. Y❑ NY ❑ 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
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FI NAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ' ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
-.SEE PERMIT FOR EXPIRATION DATE MECHANICAL
CONST.rnx
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
BUI L DI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
a,ALm„ APPLICATION & PERMIT 14139
ADDREaa
�q S OLL K D ,� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'. - PLAN CHECK VALIDATION
NAME CS/o8) CITY. ELECTRIC PERMIT FEE
PHONE J _
aMERACTDRs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTon PLAN(OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.N0.
ENGINEER
r LIC.NO ISIGNS TRANS. 3.00
AARCHOR DDRESS ENG. SPECIAL CIRCUIT 5.0D PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT rvs MOTORS SEE FEE SCH. _ �)
ADDRESS '
SERVICE CHANGE 20.00 !�
.Doo LICENSED CONTRACTORS DECLARATION (/
iW I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH:
zProfessions Code,and my license is in full force and effect. _ ❑ ❑ ❑
,e B D License Class Lic.Number
aa
Date Contractor
x i BUILDING PERMIT
ec w U OWNER-BUILDER DECLARATION - INFORMATION
A.
I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
e. VALUATION SIFT.
FL0 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
m w Code:Any city or county which requiresa perm t to construct,alter,
5¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
O u requires the applicant for such permit to rile a signed statement that TOTAL PERMIT T
d w m he is licensed pursuant to the provisions of the Contractor's LicenseL,
F z i
Law(Chapter 9(commencing with Section 70001 of Division 3 of the w/I-T�-� �
a Business and Professions Code)or that the is exempt therefrom and OTY. PLUMBING PERMIT FEE
r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(1500).): ALTER-DRAIN -WATER IEA.) 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 Oce.CROUP RES,urvtTa
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(hereon,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-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA,SYSTEM-1 INC.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. ,90.00 flu
❑ I,as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑
licensed contractors (o construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC SA.BCc, "*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 -
contracts for such projects with a contsactons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,B.&P.C.for this. ' WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T44
Z Z Cl Certified copy is filed with the city inspection division. C- REFER TO ORD.
Q Applicant MIS
- Y ❑ N❑ Y ❑ N❑
CCy CIS RTIFICATE OF EXEMPTION I'I10M WORKERS' PERMIT ISSUANCE 10.00 ,0 - FLOOD zorvE A.L.U.C.
LU >_ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. �•<.
1 Q (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars(5100)or less.)
U 0 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.
O W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
1... Z emption,you should become subject to the Workeri CompensationApp LIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.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. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 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 construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00 /
hereby authorize representatives of this city to enter upon [be BOILER-COMP (Over 100,00013TUISEE FEESCH. 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 in any way accrue,against said City in consequence of the PERMIT ISSUANCE 10.00
g 'ng of II permit MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
nature of App icant o tractor T�Ue
OFFICECOPY ,