14853 POST THIS CARD NEAR FRONT,OF BUILDING eRMlr NUMBER
CITY OF CUPERTINO � 485�
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
21461 'Milford' Drive
JOB ADDRESS UNIT# LOT.#
PERMIT'EXPIRES IF WORK
OWNER Sue. Hauser• CONTRACTOR., IS NOT STARTED WITHIN -
INSPECTION DATE ;INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISsu-
FOUNDATION � ANCE OR 180 DAYS FROM .
NOTE:. LAST CALLED INSPECTION.
UFER - - ALL-GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND*CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING �.•,
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG ELECT. PLG. MEG.
Q . ❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
l `� INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL - Y '
PERMIT,TD 1'
ELECTRICAL •v
FRAMING
INSULATION
STORIES TYPE CONSTR.
' "• � _
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD 11 FLooR ARBA . TorAL ACR EACE -
DIAPHRAGM THE CONSTRUCTION FAX IS PAID
BUILDING USE
ROOF SHEATHING HES IND CON PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 13 ❑ ❑ � ❑
'ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING . . "ELECT.ENERGY
.
'
TUBS 6SHOWER PAN � - PLUMBING ENERGY S' - � -TRACT N0ARCEL NO
MECHANICAL MECH.ENERGY
ACL DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG,SITE NO.
• INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK - ENERGY T24
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N[] NE]
.
- ,EXTERIOR SHEAR ELECTRICAL RELEASE _ ROOD ZONEAL OC
n„
• INTERIOR SHEAR' ` - FIRE DEPT. Y❑. "❑ Y ❑ N❑
SHEETROCK' GRADE., FEE SUMMARY
EXTERIOR LATH BUI LDIN
BUILDING '
. INTERIOR LATH' _ TEMPORARY APPROVALS ,S4 74
. SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVEI'HAS BEEN SIGNED OCCUPANCY, SEISMIC FEE y
OCCUPANCY.OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS.SIGNEDBV BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
~� ONE•WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE ,GIVEJOB ADD RESS.WHEN•PHONING.
1' Z MECHANICAL
—.SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL ' •1 -
CALLING FOR FINAL INSPECTION.
1
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
'--BUILDING PROJECT IDENTIFICATION APPLICATION PERMIT NUMBER -
ADDRESS 7 AOILDISS
/d x(4(0 DQ. BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 14853
OWNER'S -
NAME PLAN CHECK VALIDATION
• QTY. ELECTRIC PERMIT FEE
PRONE
NOAMT6ActOR's - UTLETS=SWITCHES-RECEP 10,00/1,00
> tQl 6 r atcmLIGHTING FIXTURES 10.00/1.00
ANTRACTOR'S
ADDRESS 1 APPLIANCES RESIDENTIAL 4.00 ,
Oc 6 �6 1 PHONE -• qZ
PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR - PANELS (OVER 200 AMP) 20.00
ENGINEER• `f
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS -J SPECIAL CIRCUIT 5.00 -
�1 ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS - SEE FEE SCH.
V E SERVICE CHANGE 20:00
w 0 O LICENSED CONTRACTORS DECLARATION
Q U u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE -
. N Q y (commencing wimYSe[lio0 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
e.-i Professions Code,a d icense is in full force,$n`it eIT
0 o License Class7t, 9 Lie.Numberas � E3 ❑
O Date nr�r Contractor e
a u f'� rt� _��I �r a BUILDING PERMIT
rca OWNfiR-dUILDP.R DECLARATION W a w v - INFORMATION
w a-a U. H hereby nollo that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
the VALUATION $/FT.
F L O J Law fornycit following Count which
perBusmit
tocnd Processions PERMIT ISSUANCE - 1
ice Code:Anycitycounpair any structurep prior to
G(,0
. X40 improve,demolish,or repair any structure,prior 10 cls issuance,also ELEC.CONTR. LIC.NO. ELEC. �M1
isO u requires.lhe applicant for such permit to file a signed statement that TOTAL IN -PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License '�s
rii - Law(Chapter 9(Commencing with Suction 7000)ofUivision 3 ofthe �}��.,(��'�^,a
F 4 04 Business and Professions Code)or that ht is exempt therefrom and QTY. PLUMBING PERMIT FEE - ' "- 'AkdO�f B I'e+
GE I- $ the basis for the alleged exemption.Any violation of Section 7031.5 _ STORIES TYPE ONSTR.
n ; byanyapplicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,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-FLOORROOF,AREA EA,CONIC. 5.00 '
Code:The Contractor's License Law does not apply to an owner of -
property who builds or improves Orcreon,and who docs such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such impmvu-
ments are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM•1 INC.4 OUTLETS 6.00
of improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- - BUILDING USE
prove for purpose of sale.). RES IND CON PB' Ocher
11I,as Owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors no construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law does not apply
to anownerof property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.0.0 -
contracts for such projects with a contractor(s)licensed pursuant In
the Contractor's License Law: • „ SEWER-SAN IT,ARY-STORM EA.200tt/10:00 TRACT NO. PARCEL NO.
C. I am exempt under See. ,BAP.C.for this WATER HEATER W/VENT - 6.00 '
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I heicby affirm that 1 have a certificate of consent t0 scl-insum, ZONING '
Or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE N0.
'opy,thereof(Sec.3800,Lab.C,).
Policy No. Company ''s;
O - ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
IApplicant - - Misc.- REFER TO ORD. Y ❑ N❑ Y ❑ No
T PERMIT ISSUANCE 10.00
W — CIiRTIFICC0 ONSWI EXEMPTION NS PROMWORKI>RS' FLOOD ZONE A.L.IAC.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not,be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ 'N❑
hundreel dollars($100)or less.)
U 0 I certify that in the performance of the wort'f which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- ' mit is issued I shall not employ any p so In an manner so as to
O w beco a subject he Workers' t Ion La s f California.
Dat Applicant BUILDING 1,( CO.
a - - ALTER OR ADD TO MECH. 5.00 r
} N NOT CE LICANI': If,a cr ing t is CerNficaic Of Ex- '-�
? emption;you should became subject to the Workers'COmpensalion APPLIANCE 5.00 'PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE -
U suchprovisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p00CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE
Ihereby affirm that there is a construction lending agency far 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 UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state ilial the above VENTILATION FAN (SINGLE) 4.00
40 information is correct. 1 agree in comply with all city and county PLUMBING,
ordinances and state laws relating to building construction, and BOILER-OOMPI3 H.P.op100,000B.T.U.) 6.00 -
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
t above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City Of MISC.- REFER TO ORD.
Cupertino against liabilities,p gments, costs and expenses which - CONST.TAX
may in any w a me ago' st smA City in consequence o the PERMIT ISSUANCE 10.00
ranting , t p ,1�i/ ' MECH.CONT. LIC.NO. MECH. �O
1 TOTAL TOTAL
Signature of phcant Contractor Date; I
OFFICE COPY