14523 ' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14523
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
• JOB ADDRESS 10501 MADERA DRIVE UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER LAZZARINI CONTRACTOR SHARICK IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE'SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF IE.RMIT VAI,IDATON
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED `r
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL
RLUG ELECT PLG. MECII
El ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
WOOD FLOOR P O INFORMATION
qVAqLON SIFT.
PLUMBING - N191�V
MECHANICAL - V
Mu To
ELECTRICAL Vale
o'!
FRAMING C,
sroRlEs TYPE comsTR
INSULATION
UCC GROUP Ii ES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O ii FLOON AREA TOTALACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
DIAPHRAGM
• I BUILDING USE
ROOF SHEATHING I+El IND D PR ow..
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. LL
ASSESSORS PARCEL NO ,
ROUGH SANS
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS B SHOWER PAN PLUMBING ENERGY
II MECHANICAL - MECH.ENERGY
Acc OniE Acc.FILE No
ELECTRICAL BUILDING ENERGY.
FRAMING ELECT.FINAL TEST
IZONING ENG srtE No.
INSULATION PLUMBING
1 GAS TEST GAS
FIRE SPRINK ENERGY T]G
MECHANICAL v ❑ NL O N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
Rn(IU LUNE AL U
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. - v� N� vL N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
liul ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z rNSTHANICAL
. - SEE PERMIT FOR EXPIRATION DATE -
-- IMPORTANT! .TAXPLEASE READ REVERSE SIDE BEFORE OTAL
\ CALLING FOR FINAL INSPECTION.
\\ OFFICE COPY
APPLICANT TO FILL IN INFORMATION'WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ^
HONG APPLICATION & PERMIT
RD
BDDREss 14523
IQ M CJ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNE
NAMER S �• r ; PLAN CHECK VALIDATION
-7� I 1 tL\ C C,La. 40'� OTY. ELECTRIC PERMIT FEE
��j PHONE 1
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME 4� 3 3 3
E 1 LC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORs Loo J PPLIANCES-RESIDENTIAL 4.00
ADDRESS
DRE55 a5 }�$1
PHONE V� PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO,
OR
NGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
PPLICA r'a
DDR ESS MOTORS SEE FEE SCH.
A "
SERVICE CHANGE 20.00 G /�
wO o LICENSIi1)CON']RACfORS DECLARATION //�J
<v U, I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y<H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H m z Professions Code,and my license is in full force and effect. El El 11 ❑
z O g - License Class Lic.Number
z w Dafe Contractor
`a x f BUILDING PERMIT
U a OWNER-BUILDER DECLARATION INFORMATION
A 0 It MISC.- REFER TO ORD
EE 3 u-N I hereby affirm that I am exempt from the Contractors License VALUATION $/FT.
F .c o a Law fOr the following reason.(Sec.7031.5.Nosiness and Professions PERMIT ISSUANCE 10.00
Code:Any City or county which requires u permit tOcmnstruCL alter.
Ssol improve, or repair any structure.prior to its issuance.also ELEOCONTR. LIG NO. ELEC.
O u requires the applicant for such permit 1e file a signed statement that TOTAL PERMIT TO
u w $ he is licensed pursuant to the provisions of the Contractor's License
z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is excmPt therefrom and
¢ fp the basis for the alleged exemption.Any violation of Section 7031.5 DTV. PLUMBING PERMIT FEE STORIES. TYPE CONSTR.
to aa by any applicant for a permit subjects the applicant(oa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).1:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole colnpenmtion,will do the work,and the structure is not
intended Or offe,Cd for ale (Sec 7044, Business and PrOlessions 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 TOTAL ACREAGE
himself re through his own employees.Provided that such improve-
mentsarenotintendcdornftcrcd empor loyees,
provided that such
cmproe- GAS-EA.SVSTEM-l1NC.40UTLETS 6.00 6r_.
or improvement is sold within one year of completion,the owner-
GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or ire- RES IND CON PB Orne,
prove for purpose of wle.L INDUSTRIAL WASTE INTER. 30.00
V/ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'lie Contractor's Licensc Low dues not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVE .) 1
contracts for such projects with a contracmrts)licensed parsant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.20 0 -TRACT NO. PARCEL NO.
❑ I am exempt under Sce. ,BAP.C.tin this WATER HEATER W/VENT A 6.01(%0
reason
14- Owner Date O WATER SYSTEM ACC.GATE ACG FILE NO.
WORK ERS'COMPENSAT ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby:dfirm that I have a Ccrlificute Ofconsent to'elf-ins Fe, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or it certified
copy thereof(SeC.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy If hereby famished. FIRE SPRINK ENERGY T-24
Z Z ❑ Ct,Hvicd copy is filed with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y ❑ N❑ Y ❑ N❑
CC W CBRTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C.
QJ >_ (70,41'NSATION INSURANCE PLG.CONTE, LIC.NO. PLG.
0- o (This section need not be completed if lire permit 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
LL F mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NO1'ICF TO APPLICANT: If,after making this Certificate of Ex-
F ? emptier).you should become subject to the Workcrs'Compensation - APPLIANCE 5.00 PLAN CHECK
provisions of tin Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10{WC.F.11,11.) 4.00
CONSTR UcTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QF.M.) 6.00 SEISMIC FEE
1 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 HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Cs.C.).
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I-cnder's Address
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 a�
ordinances and state laws relating to building construction, and BOILER-CONIP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for inspection pugx)uc,u.
f We) agree to save, indemnify and keep harmless the City of MI SC-- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ranting of this permit. MECH.CONT, LIC.N0. MECH.
TOTAL TOTAL /
Sign�plicanl/�a e � /
OFFICE COPY