14864 POST THIS CARD NEAR FRONT OF BUILDINGi
PERMIT NUMBER
CITY OF CUPERTINO
14864
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10317 Mirayist3 UNIT# _LOT# -
LL PERMIT EXPIRES IF WORK
OWNER Clough CONTRACTOR IS NOT. STARTED WITHIN I
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 q �p�
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND pju PERM 7 VALIDATION
CUPERTINO STANDARDS. /'
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -AP i �.I` i.; CCN' I%�6 I
UNDERGROUND /SLAB
N inn 1
PLUMBING
ELECTRICAL ISSUANCE DATE 8 T
MECHANICAL BLDG ELECT PLG, MEC
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR INFORMATION
VALUATION $IFT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
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 so.IT PLooR nReA TOTAL Acrmnes
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND CON PB 0".1.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SAN.N
ASSESSORS PARCE I.NO
` •
PLUMBING, ELECT.ENERGY
TUBS& TRACT�NO, PARCELNO
MECHA SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH,ENERGY •� .
ELECTRICALBUILDING ENERGY
ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG SITE NO.
GAS TEST GAS
FIRESPRINK ENERGY T 24
MECHANICAL v (] .• N� .v N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
ELOODZONE A.L U.C '
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y E] NF] Y ❑ rv❑
SHEETROCK _ GRADE ' FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK',
NO 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
' . Iw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
y PLEASE GIVE-JOB ADDRESS WHEN PHONING..'
Z'
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL It
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL Ir
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ,
BUILOING APPLICATION & PERMIT 14864
ADDRESS Id 3 1 7 ,V 1 1 15-T-.,�
l 1 ((/(L+- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
�Mvl
PHONE OTV. ELECTRIC PERMIT FEE
✓ ('(
NON O s OUTLETS-SWITCHES-RECEP, 10.00/1.00
I/IVO_uc.No �/`* l <� LIGHTING FIXTURES 10.00/1.00
C-ONTR CTOR's _ PPLIANCES-RESIDENTIAL 4.00
A _ ��ff
D 5 PHONE[„ PANELS 10,00 DATE OF APPLICATION
APRCHITEci PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.L.NO.
O
ENGINEER
' LIC.NO. ISIGNS TRANS. 3.00
ARCH,SS Exa SPECIAL CIRCUIT 5.00 VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00VI �
APPucalars MOTORS SEE FEE SCH. r OG/.FV'.L�{1�'
ODOR Ess
SERVICE CHANGE 20.00 Try of�P�Pt,11 ft/ 0
0 0 o LICENSED CONTRACTORS DECLARATION O WPP ilCi
a z w I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
4 (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MEC .
r w i Professions Cod em license is in full fo a d of t ❑ ❑ ❑
z O w - License C ss - Lic.Number 7z"F
O L Dale Comraclor
a y E r BUILDING PERMIT
Ic ¢ 4 OWNER-BUILDER DECLARATION
F o d U INFORMATION
X ; N 1 hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD VALUATION $/FT.
u_ 0< Law forthe followingreason.(Sec.7031,5,Business and Professions
- - PERMIT ISSUANCE 10.00
Code:Any city orcounty which SITUd Ure p prior
to construct,,also
fic to G 0 improve,domOlish,m repah any slnmlua,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
A wOtt requires the applicant for such pencil to file a signed statement that .. TOTAL PERMITTO
m he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter9(commencing wit It Sect ion 7000)of Division 3 of the
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundreddollars(5500).): ALTER-DRAIN III VENT-WATER (EA.) 5.00
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sale compensation,will do the work,and the structure is nal
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 does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
mems are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-I1NC.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
LD 1. PB Other
prove for purpose misaleJ. INDUSTRIAL WASTE INTER. 30.00 El 1:1 ❑ El 1:1I,as owner of the property,aexclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
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-OVER 51EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec..,BAP.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00
I hereby affirm That 1 have a certificate of cocsent to self-insure, -
or a certificate 01 Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
copy)her• BOO,Lot)C.I
I'olicY No�ComPuny _
Q ❑ Cetlifmd copy is hereby furnished. FIRESPRINK ENERGY T-24
FOppplicn fie c y pIc1L)yTth th� in +ectiew.d"i MISC!- REFER TO ORD. Y❑ N❑ Y ❑ No
n 1 Lent Cf! I?�1I
� N .CERTIFICATE OF EXEMP110N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CON IH. LIC.NO. PLG.
d o. (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z hundred dollars($100)or less.)
U O 1 certify that in the perl' ns
orance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Com pensa l ion Laws of California. -
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ to NOTICE TO APPLICANT': ll'
,:iter making this Certificate of Ex-
F- Z emption,you should become subject to file Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
U such provisions Or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000CflM.) 6.00 SEISMIC FEE
I 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.CJ. 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
I certify that I have read this application andstat,mal tlm 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 state laws rotating to building COB5IrBCIIOn, and (/
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUISEE FEE SCH, MECHANICAL
4buve-mentioned properly for Inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
CUPcrfirto against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 �Q� CONST.TAX
may i any way accme against said City in consequence of the
anti f this permit. MEC NT LIC.NO. MECH.
20 WZ �j _W72 TOTAL I TOTAL its
SiNnaturc of Applicant/Contactor Date (//V/l�+ s</(�/ 111/!/YY�s
OFFICE COPY