13257 + POST THIS CARD NEAR FRONT.OF BUILDING
I PFRMIT NUMBER
CITY OF CUPERTINO 13257
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 1106 HUNTERSON PLACE UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER AUSTIN SOMES CONTRACTOR AUSTIN SOMES IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
� � '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING i
ELECTRICAL
ISSUANCE DATE
MECHANICAL B GG. ELECT. I PLG. MECK
F-1 1:1 ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
ELECTRICAL PERMITTO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF 'SO.FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
• HES IND CON PB Ober
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 11 . 0 ❑
ROUGH ASSESSORS PARCEL NO,
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL '
ELECTRICALFINALS DATE INSP. ACC.DATE ACC.FILE NO,
FRAMING SAN #
INSULATION - PLUMBING ZONING ENG.SITE NO,
GAS
MECHANICAL FIRESPR(NK ENERGY T 2E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ Y ❑ NLATH-INTERIOR ELECTRICAL FLOE A,L.U.C.
LATH-EXTERIOR FIRE DEPT. Y ❑ Y ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
SHEAR INTERIOR
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CMECK
GAS I FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuagNcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. Cl,
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z
PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
F APC'LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13257
ADDRESS BUILDING LDING—ELECTRICAL—PLUMBING—MECHANICAL
O V O aG
O NER'S PLAN CHECK VALIDATION
NAE 11 QTY. ELECTRIC PERMIT FEE
sTih Salty, eS PHONE IS -O
COONTERACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAM
LIC.NO. ILIGHTING FIXTURES 10.00/1.00
CONTR
ACTORS
ADDRESS PPLIANCES-RESIDENTIAL 4.00
OORE55
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE -- P.C.NO,
OR
ENGINEER
' uc.No. SIGNS TRANS, 3.00
ARCRESS R ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION —7 8
¢i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Q A (commenci g with Section 7000)of Division 3 of the Business and BLDG- ELECT. PLG. MECH.
H e.i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
oz w o License Class Lic.Number
w H Datc Contractor
Q y f J
¢ ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT
6 a t U INFORMATION
X g LL h 1 hereby affirm that I am exempt from the Contractor's License MISC-— REFER TO ORD
F, LL o v, Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter,
¢ ¢ ¢ 0 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
eX e-e- he is licensed pursuant to the provisions of the Contractors License PERMIT TO
w, m Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
z E 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
to 3 m by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($5000.) ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC GROUP RES.UNITS
their sole compensation,will tile work,and the structure is not
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON D. 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.
mends are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 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 he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,ant exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El ❑ ❑ ❑ ❑
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 docs 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 contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Se . ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner _ Dade ] - WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of conical to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.),
Policy No.—Company-
0
ompanyO ❑ Certified Copy is hereby furnished FIRE SPRINK ENERGYT24
Z Z ❑ Certified copy is fled with dile city inspection division .
FO Applicant MISC- REFER TO ORD. YE] NE] YE] NEJ
My" CER'1'IFICA'IT301:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD 20rvE A.L.U.C.
W >_ COA1P1>NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CIL o This section need mDt be Completed if the permit is For one TOTAL V E] NE] V[] IN
Z hundred dollars IS 100)orless.)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California.
It. Date Applicant ALTER OR ADD TO MECH. 500 BUILDING n'
} W NOTICE' TO APPLICANT': If,alter making this Certificate of lix- .OV
F ? emplion.you should become subject to the Workers'COntpensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shelf be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE a �O
I hereby affom that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 500
the Pcrfnore nce of the work for which this perm .
it is issued ISce. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's 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.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of This city to enter upon the g01 LER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree To save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,Op CONST.TAX
may in anY way accrue a ins id City'in consequence of the
grantin of this ermiI. )c MECH.CONT. LIC.NO. MECH.
/ _ > / R TOTAL TOTAL
Si aTuure of Appli➢ rat Contractor ate j/
OFFICE COPY v