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15251u POST.TH,IS CARD NEAR FRONT.OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15251 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION ' / yY JOBADORESS ��Q��`-'f'�' Vif-7;�- u UNIT# LOT# PERMIT EXPIRES IF WORK OWNER '^.�'� 7JN/_(' da, v L, CONTRACTOR IS NOT STARTED WITHIN' 100 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION.' INSPECTION DATE SPECTOR INSPECTION RECORD FOUNDATION .. Z NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF UFER. � _ PREGUNITE - - PERMIT VALIDATION CUPERTINO STANDARDS. ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED o_Q_j6 ooI DheakoA)j�OX VC.. UNDERGROUND /SLAB PLUMBING' - - - •. �,1 ELECTRICAL: - MECHANICAL ELL.: ELECT. PLG. MELD DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _v BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION �, 4j} PLUMBING -IS-81Ef•�+ p �= 3 •MECHANICAL ELECTRICAL PERMIT TU A.��l�a+v/ FRAMING _0171A INSULATION -22 — FINALED IN STORIES TYPE CONSTR. ..rm ' C OCC, GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO Fl P. S RE THE CONST 50 Fi fLOOH'ANEA TOTAL ACREAGE , DIAPHRAGM ' BUILDING USE ROOFSHEATHING. - RES IND. CON PB Ume 0 0 I] • ❑ APPLY-NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO - MECHANICAL MECH.ENERGY ELECTRICALRUILDING ENERGY ' ACC DATE- ACC. FILE NO., FRAMING 'Z ELECT. FINAL TEST - INSULATION ® PLUMBING ZONING ENG. SITE NO. GAS TEST - GAS MECHANICAL FIRE SPRINK v N ENEAQY LjG v N❑f COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR -SHEAR' ELECTRICAL RELEASE FLOOD ZONE r� NQ A.L U C. Y� N[:]INTERIOR-SHEAR.. FIRE DEPT. SHEETROCK GRADE FEE SUMMARY - EXTERIOR LATH BUILDING - - BUILDING SIR INTERIOR LATH . TEMPORARY APPROVALS SCRATCH COAT I ELECTRIC PLAN CHECK FEE - - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT.PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC (f _ ILL! F ONE.WORKING DAY BEFORE REQUIRED INSPECTION. 'o _ PLUMBING ,PLEASE GIVE JOB ADDRESSWHEN PHONING. MECHANICAL , -SEE'PERMIT FOR EXPIRATION DATE - CONST. TAX IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY i-' AP,P6ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �I 0 M z Foo Fiwa -y2 2 z. .00 Q y f J a OILC' wa.IL4 H LL 04 s ¢140 ao u w As y aCa ¢r$ n 3 .- G O _Zz N X LU >_ aO Z) z 00 LL U Ow h ? A .BUILDING PROJECT IDENTIFICATION - APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER'; 15251 5 BUILDING ADDRESS '/ r Y�� /P -D N AMER s n '� p PHON nSa S� .n ELECTRIC PERMIT FEE �� PLAN CHEC��'''jjj'''ALIOATION l0 ONTPACT R's , ,',sy) NAME (�(l„'� UTLETS- SWITCHES -RECEP 10881-1.00 acpO. LIGHTING'FIXTURES ioenr 00 14 CONTRACTOR' ADDRESS PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 _ PHONE DATE OF APPLICATION ' OOPRcnrtacT ENGINEER LIC.NO. - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .CnNO. SIGNS TRANS. 100 ADD ESS ENG SPECIAL CIRCUIT 5.00 PERMIT PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 • iIP - ADDRESS - ADDREES/��"''/1 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 � ✓,-/Gf1y tq- LICENSED CONTRACTORS DECLARATION I hereby affirm (hat I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class Lie. Number ISSUANCE DATE ELECT. PLG. MECH. - Date Contractor OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec 7031.5, Businessand Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that to Ing provisions of the)twistContractor's License he is license(Chapter 9 (commencing Caw (Cha Icr 9 (CommenCn with Section is exempt therms 3 and Business and Professions Code) or that he is exempt therefrom and UftDING PERMIT INFORMATION 'MISC. - REFER TO ORD SIFT. PERMIT ISSUANCE' yo,aB. �t3 ELEC.CONTR. LIC. NO. ELEC G s� TOTAL Q PERMIT TO / O V PLUMBING PERMIT FEE STORIES TYPE CONSTR. lye basis for the alleged exemption. Any violation of Section 7031.5 malty byany aore tint fora ]Hundred dmlatsthe $5000.licunlroacivil penalty , of ore than five hundred dollars (my ALTER-DRAIN-WATER(EA.) 5.00 em): 1, as owner of the property, or my employees with wages as their sole compensation, will the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC: GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for salt (Seca 7044, Business and Professions (S Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who docs such work himself through his own employees, provided that such improve- mentsare renot intended or offered lot sale. If, however, the building � FIXTURES -PER TRAP 5.00 SQ FT. FLOOR AREA , TOTAL ACREAGE GAS - EA. SYSTEM -1INC. 4OUTLETS 6.00 or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or im- proveforpurposeofsale.)., ❑ I, as owner of the property, am exclusively Contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 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. ❑ I cxemplunder Se ,B.&P.C. 'art is WATER HEATER W/VENT' 6.00 mason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP.: 5,00 WORKERS'COMPF,NSA'I'10 iCLARATION 1 hereby affirm Ihmt I have a Certificate ofccusent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified - ZONING ENG. SITE N0. copy thereof Sec. 3900, Lab.C.). Policy No, Company ' ❑ Certified COPY is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPANK y ❑ N ❑ FLOOD ZONE -ENERGY T 24' Y ❑ N❑ A.L.U.C. MISC. - REFER TO ORD. ' .6ERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 4t�- COMPENSATION INSURANCE (This section need not be completed if the permit is for one PLG. CONTR. PJC, NO. PLG, TOTAL oZ`I` y_❑ N❑ Y ❑ N❑ hundred dollars IS 100) or III 1 certify that in the performance of the work for which this per, mit is issued, 1 shall not employ any person In any manner so as to DTV. MECHANICAL PERMIT FEE FEE SUMMARY - BUILDING CJ73 01 become subject to the Workers' Compensation Laws of CBliturnia./ Dam Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=11C.F.M.) 4.00 PLAN CHECK FEE emption, you should became subject to the Workers' Compensation provisions of the Labor Coda, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10MC.RM.) 6.00 SEISMIC FEE ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending ugency for EXHAUST HOOD.(WITH DUCT) 5.00 tile 3097, Cie.C.). ce of the work for which this permit is issued (Sec. MICROFILM - HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC'. ANam Lender's Add 1 certify Dmt I have read this application and xtute that the above VENTILATION FAN (SINGLE) 4,00 fZ information is correct. I agree to comply wish all city and county ordinances and -stale laws relating to building construction, and PLUMBING BOILER -OOMP 13 H.P. Of 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MECHANICAL s� BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MISC. - REFER TO ORD. - CONST. TAX (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts and expenses which may in any way Bcc ag nM s In City in consequence of the ra . of If Perot PERMIT ISSUANCE tj - MECH. CONT. LIC. NO. MECH. TOTAL 0Z.S q TOTAL Signatureo Applicant/Contractor o It OFFICE COPY 0 E City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 Dear Sir, R. Dennis Houlsby 10255 Mira Vista Road Cupertino, CA 95014 (w)408-235-3518 (h)408-253-5452 February 20,1991 CITY 0F, CUPERTINO OUILOIt'� DEPT. I write you this letter to request a six month extension of my building permit, #15251, dated 6-24-88. I need this extension because my last inspection was in August of 1990, almost six months ago, and I have not been able to complete the addition during the winter months to the extent that I can call for the Final Inspection. I still have to finish the tiling, install plumbing fixtures and add door knobs and molding to the interior. With daylight savings time just around the corner, I will be able to complete the addition ,this summer for the Final Inspection. Thank you for considering this request. Sincerely, — ---- Da R. Dennis Houlsby / E X ?eN S/ a A) of PP n o U Pv 72, ZS -9