14520 POST,THIS CARD NEAR FRONT OF BUILDING- PERMIT NUMBER
CITY OF CUPERTINO 14520
INSPECTION DIVISION
JOB INSPECTION RECORD j c +� {
" PERMIT EXPIRATION
JOB ADDRESS 19624 'Homest6ad Road UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER United Medthodist -ChurChTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANC E' OR 180 DAYS FROM
T
NOTE: LASCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGONITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERM17 VALIDATION
CUPERTINO STANDARDS. I.
-
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED !
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL �+ "�" f�
ISSUANCE DATE
MECHANICAL L� .g eq,s-F 51n^e o.111 ,a BOG... -ELEc r. vLG. NEC.
CL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING vJ . ,
MECHANICAL
ELECTRICAL - PC FART TO
FRAMINGi - 7fT..L +' .yP Fi'c:.�•f
STORIES TYPE SOUSED
INSULATION � EXPIRE
X 1PI occ GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sa Fr.FLOOR APEA Ta TAL ACREPCC
' ROOF � NOTE NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION-TAX IS PAID '
ROOF SHEATHING -f BU OON NusE va Dn,o,
S INO B
RB
APPLY NO ROOFING UNTIL ABOVE HAS 13CEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ .❑
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY - -
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. _ PARCEL NO
' MECHANICAL MECH.ENERGY -
ELECTRICAL BUILDING ENERGY - ACC.DATE ACC PILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG,SITE No.
GAS TEST GAS _
MECHANICAL FIRE SPRINK ENERGY Tp4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ N❑ Y ❑ DID
EXTERIOR SHEARELECTRICAL RELEASE - FLOOD ZONES ALU.C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y 01 E]
SHEETROCK GRADE
FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS _ BUILDING
SCRATCH COAT 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 ISSIGNEO BV BUILDING INSPECTOR. MICROFILM '
LU
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� ONE WORKING DAY BEFOREREQUIRED INSPECTION. PLUMBING
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 !
- r
APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADOREss
aODRESS APPLICATION & PERMIT ^O
qL �� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL G
/ OWNERS PLAN CHECK VALIDATION
TNAME G/�iirafJ QTY. ELECTRIC PERMIT FEE \ P 37 _ n
y "NONE V�/I-.``_.
NAMERAcioRs UTLETS-SWITCHES-RECEP 10.00/1.00
•4p uc.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ORs - APPLIANCES-RESIDENTIAL 4.00
-� CONTRA
Q OrvE 5 PANELS 10.00 DATE OF APPLICATION -
A CNI ci PLAN CHECK FEE P.C.NO.
OR ✓SND0 PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS,TRANS. 3.00
ADDDRESS ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
zm TEMP.METER OR POLE INS. 20.00
APPLI EMOTORS SEE FEE SCH.
ADDRDDRESSSS
SERVICE CHANGE 20.00 E' r ,,:L.i (
Foo LICENSED CON'I'RACTURS DECLARATION - '1 (n1 (I
a u w . 1 hereby affirm that I am licensed alder provisions t Chap ler 9 �'. '� ( J j_ ISSUANCE DATE
w 2 vt (commencing with Section 7000)of Division 3 of the Business and _ BLDG. ELECT. PLG. MECH.
m z Professions Code,and an,license is in full force and effect.
icenu Cl
Lie.Numbe,
, =/� P-1�1 'f T❑' _"^ LI❑IT ❑ ❑
F ut F J. Date-/.-Q-RConlmclnr�[ ,_3, /_/j�pj-_ '
i.,
w OWNER-BUILDER DECLARATION l�tT BUILDING PERMIT
w0 LL H 1 hereby ulirm that 1 ono exempt from the Contruclor's License MISC.- REFER TO ORD INFORMATION
F a. 0Q Law furthe following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION g/FT.
Code:Any city or counly which requires a permit construct,alter, 10.00
or u o improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR.• - LIC.NO., ELEC,
E D 2 requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n m u- heis licensed pursuant to the provisions of the Contractor's License
to HiQ
Law(Chapter 9(commencing will Section 7000)ofDi,Pma Sof the Rod r- c4aw/ '
s i D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE /
•.
n- pthe basis for the alleged exemption.Any violation of Sectiom7031.$ STORIES TYPE CONSTR.
m
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500).).
❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 .
their sole compensalion,will do the work,and the structure is not OCC.GROUP RESUNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREACOND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
menuarenotintendedoroffered for sale.If,however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that h -e did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer
❑' 1,as owner of . .
the property,am exclusively contracting with 11 El El 1:1 El
contractors to construct the project(Sec. 7044, Business LAWN'SPRINKLERS-1 INC5 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
contracts for such projects with a contructous)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT N0. PARCEL NO.
❑ 1 um exempt under Sec. ,B.&P,C.for finis WATER HEATER W/VENT
reason 6.00
Owner Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORK FRS'COMPEN$A'NON DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have acertificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,Or u cerlified ZONING ENG.SITE NO.
copy thenific [c.�$�,�ab.C.).��- 8
rohry No. tan M1x...✓. //C- /AL1=w,V( -
Q ❑ Certified copy' h shy fur :heJ. FIRE SPRINK ENERGY TZ4
z ❑ Certified fled T h 1 division.
F � Applicant p-,l� �. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
V N Y N
ir rA CERTIFICATE 01'Ii. F. PION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE q.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLC.
d 0 This section need ml he completed if file PCrnit is for one TOTAL Y❑ N❑ Y ❑ N
Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
U_ F mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. p
U E) NApplicant ALTER OR ADD TO MECH. 5.00 BUILDING /
E) [)IllNOTICE TO APPLICANT: II,annus making this Certificate of Lx
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with. FEE
U "left provisions or this permit shall he deenu.•d revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO)000C.EM.) 6.00 SEISMIC FEE ��
I hereby atlirm 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.
3097,Civ.C.), HEATING UNIT-ITO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify the(huve read this application and state the We shove 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-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representative, nl this city to enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(we) agree to save, indenmify and keep ha nn less the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which mCONST.TAX
ay in any 41accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranti par.t MECH.CONT. LIC.NO. MECH.
alk,
i_2d_og TDTAL TOTAL 9Ct67
\ /j &gnatura Of Appl artI ontractor Date
�(/ OFFICE COPY