13897 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
-,.` CITY OF CUPERTINO 139 '
INSPECTION DIVISION
JOB INSPECTION RECORD,
1
PERMIT EXPIRATION
J013 At ADRESS •10582 T.nNNA T.ANF. UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER HSICH HO CHU CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE•OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PR EG UNITE PERMIT VALIDATION -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 4
UNDERGROUND/SLAB
• PLUMBING
ELECTRICAL W+ ISSUANCE DATE
MECHANICAL P'JG, ELECT. I PLG. MECH.
El ;El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - 01
C1� • ',ane INFORMATION T
WOOD FLOOR 11 ATIDN siFT.
PLUMBING - -
MECHANICAL
ELECTRICAI, IT To
FRAMING
• INSULATION STORIES TYPE CONSTR.
OCC.GROUP AESI UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- SO.FT.FLOOR ARE4 TOTAL ACREAGE
ROOF
•• DIAPHRAGM '
BUILDING USE
RES IND CON PB Omer
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 0 El El
r ASSESSORS PARCEL NO.
ROUGH
PLUMBING* -
- - TRACT NO. PARCEL NO
GAS TEST :
MECHANICAL
- ACC.OATE ACC,FILE NO.
ELECTRICAL FINALS DATE INSP. a
FRAMING- SAN #
'INSULATION
S ZONING ENG SITE NO,
PLUMBING
GAS 7.
MECHANICAL ^ FIRE SPRINK ENERGY T 2
Y ❑ N❑ V 1 N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING,
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U,C.
LATH-EXTERIOR FIRE DEPT. v Q Nv I] NF]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR - - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
_ FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE ON PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE'
UCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
. H ONE WORKINGDAY BEFORE REQUIRED INSPECTION. PLUMB(NG. c
0� PLEASE GIVE'JOB ADDRESS WHEN PHONING.
Z MECHANICAL
= SEE PERMITTOR EXPIRATION DATE—
IMPORTANT! CONST.TAX .
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
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BUILDING - APPLICATION & PERMIT
PIZ
ss _ 13897
�, yLe BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
PLAN CHECK VALIDATION
TV. ELECTRIC PERMIT FEEPHONEACTOR'S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 '
LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS rDR's APPLIANCES-RESIDENTIAL 4.00
PHONE - PANELS 10.00 DATE OF APPLICATION
ARCHITECT
OR PANELS IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OR ENG.
ADOREss ,- SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
- - ZIP TEMP.METER OR POLE INS. 20,00
ADDRESSTs MOTORS SEE FEE SCH, a <
z
SERVICE CHANGE 20,00 �aY/� 7
w a
's O o LICENSED CONTRACTORS DECLARATION
a 0 U I hereby affirm that I am licensed under provisions of Chapter 9
N<a (emirISSUANCE DATEmencing with Section 7000)of Division 3 of the Business and
H h w Professions Code,and my license is in full force and effect. BLOC. ELECT. PLG. MECH.
i m c Date Class Lie.Number--
❑ ❑ q ❑
m f j Date Contractor J[x
Y f J
K ¢ w OWNER-BUILDER DECLARATION BUILDING PERMIT
K
;u w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
u O er Law(Or the following reason.(Sec.7031.5,Business and Professions VALUATION
t — PERMIT ISSUANCE 10.00 SIFT.
� w� Code:Any City or county which req Hiresapermit toconstructalter,
Ie re o 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC.
Penn
ic requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w $ he u licensed Pursuant to UR'provisions of the Contractor's Lice],at _
Hid Law(Chapler9(commencing with Section 70excor lvision3of the pkd C�
n o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE `•f
Ie I-$ the basis for the alleged exemption.Any violation of Section 7031.5 ,STORIES TYPE CONSTR.
by any applicant foratoadre subjects theapplicant toncivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not maze than five hundred dollars(Er,em:
❑ 1,as owner of the property,m my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
It 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 F IXTUR ES-PER TRAP 5.00
himself or through his own employees,provided that such improve-
SO,FT.FLOOR AREA TOTAL ACREAGE
mentsare not intended or offered for sale.If however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder .will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other
131,as owner of the property,am exclusively contracting with
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 nal apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-O 1.00
contracts for such projects with a contraclons)licensed pursuant to
the Comraclnr's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 Q TRACT NO. PARCEL NO.
❑ la w Apt under Se ,B.&P.C.for this r
\, reason •_ _ WATER HEATER WIV,ENxTj \_ . 6.00
n Owner Date WATER SYSTEM �'" 5,00
,ACC.DATE ACC.FILE NO,
WORKfi R,'C MPENSATION DECLARATION WATER TREATING E I,P, C\] 6f O
I hereby ufl'irm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
- copy thereof(Sec.3800,Lab.CJ,'
Policy No. - Company
O ❑ Certified copy is hereby furnished,
Z ❑ Certified copy is tiled with the city inspection division.
FIRE SPRINK ENERGY T-24
O Applicant MISC.- REFER TO ORD. Y [:] NE] Y C] N� '
K CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 u FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE. PLG,CONTR. LIC.NO. PLG. �1
Q. o (This section need not be completed if the permit is for one TOTAL C> Y� N� V N�
U O hundred dollars($100)or les s.
1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of Califomia,
4 Data ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE:TO APPLICANT:
i f fix-
f,after making This Certificate o
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must 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 10PMC.RM.) 6.00 SEISMICFEE
I hereby affirm that there is a construction lending agency lot EXHAUST HOOD(WITH DUCT) 5.00
the perl' nn
oance of the work for which this permit is issued(See. 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.19.50 ELECTRIC
. I 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-COMPO H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH, MECHANICAL
(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 o way utero gainst sa' City in consequ me o the PERMIT ISSUANCE 10.00
gmahn [hisp our p MECH.CONT. LIC.NO. MECH.
`.
22 ? TOTAL TOTAL
Si store of
App lic 1/Contractor Date
OFFICE COPY -