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14097 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION 14097 ". JOB INSPECTION RECORD PERMIT EXPIRATION 21332 MILFORD DRIVE JOB ADDRESS UNIT# LOT# pERM1T EXPIRES IF WORK OWNER RON 'GRACE CONTRACTOR JERRY FOURNIER IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION �_I l �-£ � �. ANCE OR 180 DAYS FROM t LAST CALLED INSPECTION. UFER PREGUNITE ' - - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOV,.EH'ASI-B„EENljSIGNEO,1, UNDERGROUND /SLAB PLUMBING - JF7 ,111% 417�✓ _ ELECTRICAL _ ISSUANCE DATE MECHANICAL ELECT. vlc. yyECR. ❑ ❑ d qd U00'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING ' MECHANICAL ELECTRICAL PERMIT TO, � - - I , rJ FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM — C_ BUILDING USE fIES IND CON PIT Otner ,rAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST - TRACT NO. r PARCEL NO. MECHANICAL- - ACO DATE ACC.FILE N0, ELECTRICAL — ;:_S,FINALS '? 1iC)ATE INSP. ,. FRAMINGSAN # 20NING ENG.SITE N0. INSULATION ^ PLUMBING GAS MECHANICAL. FIRE SPRINK ENE RGYTN COVER NO WORK UNTIL ABOVE HAS'BEEN^SI'GNED..,'a HEATING �9LAG ❑ N❑ [:] ❑ FLOOOZONE A.L.U.C. LATH—INTERIOR - ELECTRICAL _ v� N� v �] N❑ LATH—EXTERIOR .� —� FIRE DEPT. SHEETROCK - - I ' GRADE _ FEE SUMMARY _ SHEAR INTERIOR 'I BUILDING, — SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRICPLAN CHECK C. GAS FEE' N0 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 ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX ^-PP,LEASE READ REVERSE SIDE BEFORE TOTAL, CALLING FOR FINAL INSPECTION. OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN REO LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER SUILDIN! APPLICATION & PERMIT ApORESS (M1U1"� �)p BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 14097 •.Y OWNERS I11(, lit' PLAN CHECK VALIDATION �`I' DTV. ELECTRIC PERMIT -, FEE �J 'f ��1 C71'"'f1 ri PHONE / /^C coNTRAcroR's O7 OUTLETS-SWITCHES-RECEP 10.00/1.003 NAME ^7 LIGHTING FIXTURES 10.00/1.00 - �/ -r roNrnacroR's 4114 APPLIANCES-RESIDENTIAL 4.00 noon ss �l �T�f Ctr PHONE / �I Ld PANELS 10.00 DATE OF APPLICATION ARCHITECT PANESLS (OVER 200 AMP) 20,00 PLAN CHECK FEE - P.C.NO. OR C,54 E lk � . I � SIGNTRANS. 3.00 LIC.NO ARCH OR ENG, 1 y �a �Jf �AG�M SPECIAL.CIRCUIT 5.00 MIT VALIDATION ADDRESS I1 ✓11!` G 6 V ZIP J TEMP.METER OR POLE INS. 20.00 ,{ ADDRESrvrs MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION , a u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. 0 i Professions Code, Sd my license is in full force Z 0 `� - License Class-11 Lic.Number�_ ©. - o t-� Data Contract.,_�y4�1 p � - 2m - �. { ITnD ✓Gic s se a a OWNER-BUILDER DECLARATION BUILDING PERMIT - o d MISC.- REFER TO ORD INFORMATION w ;¢y I hereby affirm that I am exempt from the Contractors License VALUATION S/FT. H w o a'. Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 la '-' Code:Any city or county which requires a permit to construct.Slier, 2 Sriw¢ i improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. / IS E G ¢ requires the applicant for such permit to file o signed statement that TOTAL PERMIT TO is$H he is licensed pursuant to the provisions of the Contractor's License / 7� A_6,' w, s0 Law(Chapter 9(emnmencing with Section 7000)of Division 3 ofthe i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. w. by any applicant for a permit subjects the applican(toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 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,AR EA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsare not intended oroffered for sale.If,however,the building GAS-EA.SVSTEM-11NC.4OUTLETS 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 the burden of proving that he did not build or im- 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 Llc se Low docs Sol nifft 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ to exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO, WORKFRS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 r whereby affirm9f or I have ace ¢ate ofconsent to s certified ZONING or a certificate of Workers' � ution In�su�rlance,or a 1cr(il ied ENG.SITE N0. copy thereof ' Q N E 1v.• v� I Ii C Policy No, pang �__. O ❑ Certified copy is hereby furnished. FIRE SPR INK ENERGY T-24 ❑ Cerlified co s filed Ith the ci ly inspe lion it isiun. Z g--' Applicant __i 3 I CLi.. - r4 AZI1�iT MISC.- REFER TO ORD. v ❑ N❑ v❑ NO NPERMIT ISSUANCE 10.00 Lu CERTIFICATE COMPFNSATION INSUR OCWORKIiRS' PLG.CONTH. LIC,No. PLG. D FLOOD ZONE A.L.U.C. CL O (This section need not be completed if the 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 O W become subject to the Workers'Compensation Laws of Culifornia. Date Applicata ALTEROR ADD TO MECH. 5.00 S` BUILDING 6 .� } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- y" 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.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 SEISMIC FEE 3 d7� 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that l have read this application and state that theabove VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and COUBty PLUMBING ordinances and state laws relating to building construction, and BOILER-OOMP(3H.P.or 100,000B.T.U.) 6.00 hereby authorize representatives of this city 10 enter upon the I - above-mentioned property for inspection purposes. BOI BOILER-COMP (Over 100,000 BTU)BEE FEE BCH. MECHANICAL OCc-7 (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 G CONST.TAX may in any way accrue,against said City in consequence of the grunting of[hiper ti ^ MECH.CONT. LIC.NO. MECH. TOTAL 43 TOTAL 7J_ure of Applicant/ ontractor Date OFFICE COPY