14691 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT N,umseR
CITY OF CUPERTINO 14691
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION'
JOB ADDRESS 10055 MILLER AVE. UNIT# _LOT#
_ - - PERMIT EXPIRES IF WORK
OWNER Kontrabecki Group CONTRACTOR Kam Electric IS NOT STARTED WITHIN I
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
• PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLHMFT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ve CQI 1
PLUMBING - (C P �' `'! 7
ELECTRICAL `. EDATE
MECHANICAL - / ElPLGmE l
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
• PLUMBING VALUA f4ft ��1,T,.
MECHANICAL II
ELECTRICAL PERMIT TO
14
FRAMING '
-INSULATION - STORIES. TYPE CONSTR
- -
()Cc GROUP. RFS,UNITS
PLACE NO SUBFLOOR UNTIL ABOVFHAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.Fa.11.00.ARTA rorAL ACRenee
DIAPHRAGM THE CONSTRUCTION TAX IS PAID _
ROOF SHEATHING a - - HES IND N Onm,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SAN.N
ASSE55UH5 PARCEL NO
PLUMBING ELECT.ENERGY , '
TRACT NPA- ^ y"PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL, MECH.•ENERGY
ACC DATE ACC FIL 'NO'
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ENG.SITE.NO.
INSULATION PLUMBING ZONING 'NO.
GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY T?a
- v � N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Nv
Z .
- EXTERIOR SHEAR � ELECTRICAL RELEASE FLOOD ONE AL.0 C
INTERIOR'SHEAR• FIRE DEPT. Y❑ N❑ Y L] N❑
SHEETROCK GRADE FEE SUMMARY
. ., EXTERIOR LATH BUILDING„ i.
INTERIOR LATH
TEMPORARY APPROVALS;.'_ BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS - - FEE
NO TAPE OR PLASTER UNTIL ABOVE,.HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE'
i OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING.FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, PLUMBING
ELECTRIC'
I" ' ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z�
PLEASE GIVE JOB ADDRESS WHEN PHONING.
—,SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
I
IMPORTANT! .
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL .
.OFFICE COPY
APPLICANT.TO FILL IN INFORMATION WITHIN,'RED LINES '- USE BALL POINT PEN ONLY
rn BUILDING PROJECT ID NTI FICATION PERMIT NUMBER -
BUILDINGgomusee"1 APPLICATION & PERMIT 1 �L+�1
ADDRESS I C7 I
too!Ss I�lltltYZ _ 6nnµh UILDING ELECTRICAL-PLUMBING,-MECHANICAL '.
oA - PLAN CHECK VALIDATION
•
'NAME
mE /, ��p OT ELECTRIC PERMIT FEE
AVMA PHONE
CONTRACTOR'S � �
NAME Z UTLETS-SWITCHES-RECEP 10.00/1.00
metria P1" LIC.No. L) LIGHTING FIXTURES 10,00/1.00
CONTRACTORS
ADDRESSuv1
PPLIANCES-RESIDENTIAL 4.00
'I;{o ELL paE- CPAW&Rilyp}/ '
PANELS 10.00 DATE OF APPLICATION
ARRCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE:' P.C.NO.
ENGINEER
UC.No. ISiGNS TRANS. 3.00
ARCH OR
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION'
ZIP TEmP.mETEROR POLE INS. 20.00 . '
APPLICANT'S
MOTORS - SEE FEE SCH.
ADDRESSDRESa
' SERVICE CHANGE � 20.00 ^s,/1/-'(^W-d'•-,�`� '
w D o LICENSED CONTRACTORS DECLARATION
<u
aOU I hereby affirm that I am licensed under provisions of Chapter 9. - 1/SSUANICE DATE
(commencing with Section 7000)of Division 3 of the Business and
a �t�G. ELECT. PLG. MECH.
H H i Professions Cade,end nty-license is in full fort _f rs 3 r
z i m 0 License Class E V Lic..Number
9 ,A H w Dale 2,_lef Contractor
er m f + .a BUILDING PERMIT
¢ ¢ a OWNEB-BUILDER DECLARATION ,tine
o t o - MISC.- REFER TOO INFORMATION
X ; 1- 1 hereby affirm that I am exempt from the Contractor's License
w w a-w VALUATION
F _0a Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 CJ -�
La
Code:Any city or county whichmquiresa permit toconstruct,alter,
a
¢ ¢ ei 0 improve,demolish,or repair any structure,prior to its issuance,also ELED.ODNTR. - LIC.NO. ELEC. / -
iL 0 w requires the applicant for such permit to file a signed statement that TOTAL r'a
e w $ he is licensed pursuant to the provisions of the Contractors License PERMIT TO
Z a
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthc
4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as t BACK FLOW PROTECT.DEVICE 4.00
their 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 docs 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-
ments amnot intended oroffered for sale,IL however,the building GAS-EA.SYSTEM-l'INC.40UTLETS 6.00
or improvement is sold within one year of completion,rhe owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not buildorim- BUILDING USE
RES IND CON PB Otha,
prove 1,aso nee of sale.). INDUSTRIAL WASTE INTER. 30.00 -
- ❑ d as owner of the property,he exclusively contracting with13 EI El
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 does not apply
to anowner of property who builds or improvesand who LAWN SPRINKLERS-OVER 5(EA.) 1:00
contracts for such projects with a contractor(s)licensedensed puu rsuant to SEWER-SANITARY-STORM EA.2001t/10.00
the m License Law. - TRACT N0. PARCEL N0,
laexe
❑ lam exempt under Sec..,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Data WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO.
WORKERSCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a Certificate of consent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.1.
Policy No. Company FA-Ln�,Aa-17 1•ISs.IAALC
Q ❑ Certified copy is hereby furnished.
IYCertifeCC NpK is city inspection division.
FIRE SPRINK ENERGY T-24Z6Applicant MISC- REFER TO ORD.
NO No Y [:] No
D: T . CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLO.
Z (This section need not be completed if the permit is for one TOTAL - Y❑ NO Y ❑ O
N
hundred dollars IS 100)or less.)
U Q 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued.I shall not-employ any person in any manner so as to
0,
become subject to the Workers Compensation Laws of California.y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
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 he deemed revoked, AIR HANDLING UNIT(TO 10A00OF.M.) 4.00
CONSTRUCIION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.F.M.) 6.00 SEISMICFEE
_ I hereby affirm that there is a construction lending Agency for EXHAUST HOOD,(W ITH DUCT) 5.00
the performance of the work for which this permit is issued ISec. MICROFILM
3097,CiYC.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG U N IT IOV ER 100,000 B.T.U.)9.50 6
Lender's Address - ELECTRIC
I certify that I have read this application and smtn that the above VENTILATION FAN (SINGLE) 4,00
.� information is correct.1 agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-0011 I3 H.P.or 100,000 B.T.U.) 6.00
hereby entioed repertyforins inspection
this citydo enter upon the 801 LER-COMP (Ove,100.000 STU)SEE FEE SCH. MECHANICAL
above-mentioned properly forinsp of
parlous.
(W"i.21
Inde ify anJ keep harmless the City of MISC.- REFER TO ORD.
upEhies, agree costs and expenses which PERMIT ISSUANCE 10.00CONST.TAX
e age i st s d icy in consequence of the MECH.CONT. LIC.NO. MECH. .
j Z-(x_bb TOTAL TOTAL
,\ ^ Si ure of Applicamij6haActor Date
- OFFICE COPY -