13701 POSTTHISCARD NEAR FRONTOF BUILDING
PFHM1IIT NUM1IB[q
CITY OF CUPERTINO 13701
INSPECTION DIVISION
. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS10534 METEOR PLACE UNIT# LOT
PERMIT EXPIRES IF WORK
OWNER ALLEN SNEIDER CONTRACTOR PAYNF F7FATTATr IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LAST CALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /I
PLUMBING Ib &_ 7
ELECTRICAL ISSUAN DAT
RLOG. ELECT. PLG, M C
MECHANICAL - - El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMI
INFORMATION
WOOD FLOOR �Q,J VALUATION SIFT.
PLUMBING u
MECHANICAL
IT To
ELECTRICAL 0,. .
FRAMING J •,' O1neORIE
STORIES TYPE CONSTR,
INSULATION
DEC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' • ROOF SO.FT.FLOOR AREA TOTAL ACIif AGE
DIAPHRAGM
BUILDING use
RES IND CON Re 00—
El El El 1:1 11
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
AS EES50R5PARCELNO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRES PRINK E"L.U.C.
MECHANICAL r ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - FLOOD ZONE LATH—INTERIOR ELECTRICALLATH—EXTERIOR FIRE DEPT. `' N�
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRICPLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
IL ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL••..�r•
- SEE PERMIT FOR EXPIRATION DATE -
CONST.
TAX
IMPORTANT!
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
I -BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING '/ APPLICATION & PERMIT
A7D 3 /' e r I BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13701
OwrvER'S /JC(/'[ / l/ 7PLAN CHECK VALIDATION
NAME .72 QTY, ELECTRIC PERMIT FEE
PHONE / J L^
C
ONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
2 LIC.NOS3.� LIGHTING FIXTURES 10.00/1.00
ONT ACTORS PPLIANCES-RESIDENTIAL 4.00
DDRs
PIIONQ -/J- 1 PANELS 10,60 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN-CHECK FEE P.C.NO.
OR
ENGINEER
uc.NO SIGNS TRANS. 3.00
ARCR.DR ENG. 566 PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
N.4 ZIP TEMP.METER OR POLE INS. 20.00
APPucANrs h MOTORS SEE FEE
?as
ADDRESS t-' n
SERVICE CHANGE 20.000.00
0 etet o �J
LICENSED CONTRACTORS DECLARATION 7111 7
< I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
vHi Q i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H y'z Professions Code, d I7)1{T�cense is in f all lure c ee ❑ ❑ ❑
oi w C License Cla /dL Lia Number
Pm j Date_ -_Contractor
* a w¢ OWNER-BUILDI>R DECL RATION BUILDING PERMIT
o a O MISC.- REFER TO OR
INFORMATION
. 5 LL N 1 hereby affirm that 1 am exempt from the Con Naaor i License VALUATION SIFT.
v sL o In Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct.alter,
¢ ¢ Q Q improve,demolish,or repair any structure,prior to its!,,mare,also ELIC.CONTR, LIC.NO. ELEC.
o LL requires the applicant for such permit to file a signed statement that TOTAL pERt,1IT TO
a w m he is licensed pursuant to the provisions of the Contractors License C,_`�yvf/
H z e, Law(Chapter 9(commencing with Section 7000)of Division 3 of the
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ _$ thebasisfor the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
A3 ^ of not more than fiivetindred dit ollars(ects(he$500)P).cam toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 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,AR EA,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 5,66 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meats are not intended proffered forsale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have lire burden of proving that he did not build or am- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 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.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 IEA.) 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.
O I am exempt under Sec. ,BAP.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of commnt to self-insure. ZONING ENG.SITE NO.
certificate of Workers'Compensut inn Insurance or B cf,t,f,cd
or I IH+o
copy thereof(Sec,3800, .Cd1*46- C4z
Policy N
ny_ I
Q ❑ Ce, CCompammpm -
lillopy is hereby(urm9 'dWC^ `l� FIRE SPR INK ENERGY T 24
Z Z O Certifed 1 is ti� with he tonspeclipn division. MISC.- REFER TO ORD. v ❑ N❑ Y ❑ NAl li ❑
CCrn CERT KATE OF Ex, PTI NFROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.Uc.
UJ > COMPFNSA'1'ION INSURANCE PLG.CONTR. LIC.NO. PLG, y❑ q❑ Y ❑ N❑
CL 0 ( ot'Phis section need nbe completed if the permnes
it is for p TOTAL
::) Z hundred dollars(5100)or less)
U O 1 certify that in the performance of lire work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
U become subject to tlm Workers'Compensation Laws of California. BUILDING
UJ
Dates Applicant ALTER OR ADD TO ME 5.00
5.00
�- m NOTICE 1'0 APPLICANT: If,after making this Certificate of E,,-
Do w"
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 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 10=C.F.M,) 4AfJ
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F,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 p0 MICROFILM
3097,Ci,C.).
Lender's Name HEATING UNIT(EVER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
1 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEESCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,jud mems,costs and expenses which CONST.TAX
Amay !n any way accrue ago art Id City an consequence f the PERMIT ISSUANCE 10.00 Ip,OU
gra ngof uspcnm. MECH.CONT. LIC.NO. MECH.
TOTAL O pc) TOTAL
Sign re of Applicant/Contractor
OFFICE COPY