13977 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
1397 INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 21836 HYANNISPORT UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER DAVID GLENDAY - CONTRACTOR ALL WEATHER HEATING IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
�ASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL I ISSUANCE DATE 1
MECHANICAL •BLDG/ ELECTl,l;PLGJ EC
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMI
WOOD FLOOR INFORMATION
PLUMBING VALUATION $IFT.
MECHANICAL
ELECTRICAL PERMIT TO
Y,
FRAMING �
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF SQ,FT.FLOORAREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON P9 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL FINALSDATE INSP. ACC.OATE ACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T.}4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ Y ❑ N❑ Y ❑ IN
LATH-INTERIOR ELECTRIC L FLOOD ZONE A.L.uc.
LATH-EXTERIOR - FIRE DEPT. Y❑ N❑ Y ❑ No
SHEETROCK - GRADE
SHEAR INTERIOR FEE SUMMARY
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 NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JORADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL l
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS
f_-+•- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL . 1 397
OWNER'S PLAN CHECK VALIDATION
NAME - QTY. ELECTRIC PERMIT FEE
p RUNE
ranine Agfr L)2(LA'�1R1" UTLETS-SWITCHES-RECEP 10.00/1.00
1 JAiirarqj4C.No. SO�q ILIGHTING FIXTURES 10.00/1.00
CONTRACT 's 1 ADDRESS PPLIANCES-RESIDENTIAL 4.00
((��
rPHONE Jq -&�1
I PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
O
ENGINEER
uc.No. SIGNS TRANS. 3.00
too ESS END,
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIv TEMP.METER OR POLE INS. 20.00 .
AMOTORS SEE FEE SCH. \�
ADDRESSDDRESS
SERVICE CHANGE 20.00
,_00
0o LICENSED CONTRACTORS DECLARATION
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and Btpp. ELECT. PLG.
H w i Professions Code•and my license is in full force and effect. M
1YJ/'� LCA
❑ -❑
z o m- License Class Lie.Number
-
0 va H w Date Contractor
QMM
O w OWNER-BUILDER DECLARATION BUILDING PERM
MISC.- REFER TO ORD INFORMATIO
F.
3 u I hereby affirm that I so exempt from the Contractor's License VALUATION $/FT.
F u o j Law for the following reason(Sec.703 t,5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
ic Q M¢o improve,demolish,or repair any structure,prior Un its issuance,also ELEC.CONTR. LIC.NO. ELEC.
LL requires the applicant for such permit to file a Signed statement that TOTAL
n w er m Inc is licensed pursuant to the provisions of the Contractor's License PERMIT TO
ta Asa Law(Chapter 9(cmnmenciage,ith Section 7000)of Division 3 ofthe
s z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
T I- m the basis for the alleged exemption.Any violation ofSection 7031.5 STO IES TYPE CONSTR.
a- by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER IEA.) 5.00
of not more than Ove hundred dollars(S500).1:
❑ 1,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 TOTALACREAGE
himself or through his own employers,provided that Such improve.
ments arc not intended or offend for sale.11,however,lire building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4(EA.) 2.00
builder will have tile - .e burden of proving that he did nor build or im- BUILDING USE
Prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of the properly am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,BusinessLAWN 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 contractorts)licensed pursuant to
file Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
mason am exempt under Sri._,B&P,C.forthis WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.OATE ACG FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to xelGinsurc.
or a certificate of Workers'Compensation Insurance.or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished.
Z O Certified copy is filed with the city inspection division. FIRE SPRINK ENERGY T-24
MISC:- REFER TO ORD. ❑
O Applicant Y N V N
CC y CE RT I F KATE OF EXEMPTION FROM WORKERSPERMIT ISSUANCE 10.00
F LOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL (This section need pot be cmnpleled if the permit is for one TOTAL Y❑ NEI Y [:] N
2 hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per-
LL I- mil is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY
O W become subject to the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQO(1OC.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.0.), 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 1 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ec this city es erect upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. 0
above-mentioned property for inspection purposes. MECHANICAL d
(We) agree to Savc, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which ►DUG CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
granting of this pennlL MECH.CONT, LIC NO. MECH.
Signature of TOTAL TOTAL 1200,
Appilcunt/Contractor Date
OFFICE COPY L