Loading...
14089 POST IS CARD NEAR FRONT OF'BUILDI• ' RMIr NUMBER ITY OF CUPERTINO - nRq INSPECTION DIVISION � """' , ,'• JOB INSPECTION RECORD PERMIT EXPIRATION JOB,ADDR ESS, 21.831 Lomita. 'UNIT# =LOT# •-� • PERMIT EXPIRES IF WORK, OWNERL 'BILL GIRLSNG CONTRACTOR - A$ NOT STARTED WITHIN - ' INSPECTION DATE I INSPECTOR INSPECTION RECORD 180'DAYS OFPERMIT ISSU- FOUNDATION DANCE-OR 180-DAYS FROM, • - . e. .. NCO -'LASTCALLEDIT UFER . . PREGUNITE ' - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDy ' -1 . - w L x � - :UNDERGROUNDS/.SLAB PLUMBING. ELECTRICAL - "' - - �.r ,'�+ set 1SSUANCE(oATE MECHANICAL' - - SBLDc.e1 'MECH. . IIELECT. PLG DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT `WOOD,'FLOOR '- INFORMATION - PLUMBING - - 1 -1 1 MECHANICAL • I •1' I - ELECTRICALPERMITTO FRAMING ` INSULATION 'STORIES TYPE CONSTR: ' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED fib ROOF_ • I SO. 5y00�i'AREA TOTAL ACREAGE DIAPHRAGM � � ' ,. ,BUILDING USE RES IND CON PB •Other - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ .•❑ El ❑ ❑ ' ROUGH - ASSESSORS PARCEL'NO."• , ' PLUMBING`- • — .. GAS TEST, TPACTNO. PARCEL NO., • r - - � x. , �'+ - ' MECHANICAL - ACC DATE ACC.FI LE NO ELECTRICAL ,;. c FINALS DATE INSP. , - FRAMING _j 1 .7 SAN #. ZONING 'ENG.SITE NO. 'INSULATION -- "_., PLUMBING. - =3 .. te GAS .. MECHANICAL jow, FIRE SPRINK ENERGY T:24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑- Y ❑ .N❑ , LATH—INTERIOR - ELECTRICAL - FLOOD ZONE A.L.u.a LATH—EXTERIOR FIRE DEPT '- �'+ :' - - Y❑ ' "❑ ,Y ❑ ^ No SHEETROCK {I ' GRADE • FEE SUMMARY I•. SHEAR INTERIOR " BUILDING �..", •- - 17 SHEAR EXTERIOR' _ TEMPORARY-APPROVALS BUILDING �" FIREWALLS ' ELECTRIC - PLAN CHECK ' • c7I'!, .. GAS - FEE' NO TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR: MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505,, ELECTRIC 0� ONE WORKING DAY BEFORE.REQUIRED INSPECTION PLUMBING, •� Z PLEASE,GIVE J68-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 I FORMATION WITHIN RED LINES - E BALL POINT PEN ONLY BUILDING PROJECT IDE ICATION PERMIT NUMBER BUILDING APPLICATION & PfRMIT ryADDRESS 1 31 cn.. BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 14089 OWry ER's - PLAN CHECK VALIDATION CITY. ELECTRIC PERMIT FEE cDNTnADTDR'S UTLETS-SWITCHES-RECEP 10.00/1.00 0 NAME LIC. D. LIGHTING FIXTURES 10.00/1.00 . ' r-ONTRACTOWsPPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS .10.00 DATEOF APPLICATION ARCHITECT. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER ' sec.NO, SIGNS TRANS. _ 3.00 ARCH OR END ' SPECIALCIRCUIT 5,00 PERMIT VALIDATION SS ZIP TEMP.METER OR POLE INS. 20.00 ///��r' 1 APPPLICANT'S ADDRESS MOTORS SEE FEE SCH. - Ulil �r�1 S01 SERVICE CHANGE 20.00 q w o O_ LICENSED CONTRACTORS DECLARATION oA. 7 <i T•i I hereby affirm that 1 em licensed under provisions of Chapter 9 _ � SSUAN E DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. z i Professions Code,and my license is in full force and effect. � r,7 f z 0'v'f License Class Lie.Number' -+I ^ "t w•'I.1,{ - (� ❑ 4 z w Date Contractor z`• . a y BUILDING PERMIT ¢ Be< OWNER-BUILDER DECLARATION INFORMATION w0T0 MISC.— REFER TO ORD ;w 1� I hereby affirm that I am exempt from the Contractor's License Fa.a. Law for the following reason. 7031.5,Businessund Professions PERMIT ISSUANCE 10.00 GVALUATI $/FT. Code:Any city or county which requires a permit to construct,alter, ` J O ac Q Q p improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTFL LIC.NO. ELEC. 0¢ requires the applicant for such permit[o file a signed statement that TOTAL O - PERMIT TO n w 8 a- he is licensed pursuant to the provisions of the Contractor's License > Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the �/V TEQ/O.Q /y4DE a Business and Professions Code)or that he is exempt therefrom and OTY- PLUMBING PERMIT FEE ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 ' of not more than five hundred dollars(55000.): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES:UNITS their sole compensation,will do the work,and the structure is not 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 C)I SO.(T.FLOOR AREA TOTAL ACREAGE himself or through his own employees.provided that such improve- j ypa��/\afT�l'-fr_fa mends are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00 O or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 . BUILDING USE builder will have the burden of proving that h .e did not build or int- RES IND CON PB Omer prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ 1:1 11❑ I,as owner of the property,am exclusively contracting with licensed contractors to consUuct•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 does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS'-OYER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. 00 I am exempt under Sec. • ,BAP.C..for this WATER HEATER W/VENT , 7 6.00 , reason Owner d Date WATER SYSTEM r ' "' ' 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMP SATION DECLARATION WATER TREATING.EO_UIP.,, 5:00 `I hereby affirm that I have a certificate ofconsent to self-insure, "•^"' or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3600,Lab.CJ. - - Policy No. 'Company Q ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T-24 Z 2 ❑ Certified copy is filed with the'city inspection division. .- REFER TO ORD. 0 Applicant MISC - Y❑ N❑ Y ❑ No w PERMIT ISSUANCE 10.00 L}� FLOOD ZONE A.L.U.C. CERTIFICATE OF EXEMPTION 17ROM WORKERS' W _ COMPENSATION INSURANCE PLG.CONTR. UC.NO. PLG. d 0 fThis section need not be completed if the permit is for one TOTAL — Y❑ N❑ Y ❑. N❑ 7 Z hundred dollars($100)or less.) U 0 I certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued.I shall not employ any person in any manner so as to U become subject to the Workers'Com enation Laws of California. 0_0 0. Date Applicant p ALTER OR ADD TO MECH. 5,00 BUILDING aZ tS } 0 NOTICE TO APPLICANT: If,after making this Certificate of fix- - z emption,you should become subject to the Workers'Compensation JAPPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with - FEE / U such provisions or this,permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p000.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE S� 1 hereby affirm that there is a,construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which Ibis permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.1 8.00 MICROFILM 3097,Civ.C.L Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 67-0 Lender's Address • I certify that I have read this application and state that the above VENTILATION FAN (SINGLET 4.00 information is correct. I agree to comply with all city and county PLUMBING UrdimnI 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 BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. - (We) agree to save, indemnify and keep harmless rho 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 granting of this permit MECH.CONT. LIC.NO. MECH. ' o Z TOTAL TOTAL n PP nCo tD to OFFICE COPY _ ..