13163 POST THIS CARD, NEAR FRONT OF BUILDING
r PERMIT NUMBER
171
CITY OF .CUPERTINO 1 �j
INSPECTION DIVISION • �� "�
JOB INSPECTION RECORD,
•. PERMIT EXPIRATION
• 10491 Oranee Ave. uNlr# -'LOT#
JOB ADDRESS PERMITEXPIRES IF WORK
• OWNER K CONTRACTOR Screen—A–Room.' IS NOT'STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD teo Dgvs oF.FERMIT lROM
FOUNDATION - - - ANCE OR•180 DAYS FROM
LASTCALLED INSPECTION. "
UFER _
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED \-
UNDERGROUND /SLAB
PLUMBING r '. - �' '/1 7 `
ELECTRICAL: •/'r ISSUANCE DATE
MECHANICAL - - I I ELECT. PLG. MECH.
�p ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGN EO I, a BUN QINMATIPER
ONIT
WOOD FLOOR JU'
Q� SIFT.
PLUMBING
MECHANICAL "
PERMIT TO /
ELECTRICAL
FRAMING "
—STORIES Trvpe corvSTW
INSULATION"
UCC,GROUP RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '•' - A GE
ROOF 5p"FT.FLOOR AREA TOTAL GE
J DIAPHRAGM - -
' ` , BUILDING USE
RES IND CON PB O11IYI
'APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED � - � • �
ASSESSORS PARCEL NO.
ROUGH . .
PLUMBING . -
' 'TRgCT NO. PARCEL N0,
GAS TEST
r
MECHANICAL -
ACC.DATE ACC.FILE N0.
ELECTRICAL FINALS - DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
'
INSULATION � � PLUMBING
GAS FIRESPRINK ENERGY T-24
MECHANICAL N� v NED.
r
COVER NO WORK UNTIL ABOVE HAS BEEN S GNED HEATING
r _ —FLOOD ZONE aL.u.c.
y., LATH–INTERIOR ELECTRICAL -
LATH–EXTERIOR - ) 'FIRE DEPT. - Y❑ NM Y ❑ No
SHEETROCK GRADE " FEE SUMMARY
SHEAR INTERIOR - BUILDING _
SHEAR EXTERIOR TEMPORARY,APPROVAL —
FIREWALLS ELECTRIC PLAWCHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ° _•
OCCUPANCYOF'BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR,INSPECTION BY PHONING 252-4505, ELECTRIC
uJ ONE WORKING DAY BEFORE•REQUIRED•INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING: '
? . MECHANICAL'
-SEE PERMIT. FOR EXPIRA'TION'DATE — .• ,
.IMPORTANT! CONST.TAX ;
" PLEASE READ REVERSE SIDE BEFORE TOTAL '.:. ( L`
CALLING FOR FINAL INSPECTION.
.. - OFFICE COPY. - - ,
APPLICANT TO FILLIN INFORMATION WITHIN REDLINES - USE BALL-POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
BDILDING •�- APPLICATION'& PERMIT
°°REEa 1316 3
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
A OWrvER G% /✓ PLAN CHECK VALIDATION
"AME DTV. ELECTRIC PERMIT FEE
n y
yeC PMON
NAMER croRs UTLETS-SWITCHES-RECEP 10.00/1.00 Q -'
LIGHTING FIXTURES 10.00/1.00
r-ONTHACTOR'S. APPLIANCES-RESIDENTIAL 4.00
ADDRESS -
PRON O PANELS 10.00 DATE OF APPLICATION
AR RI ECT - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
uc.rvo. SIGNS TRANS. 3.00 r
ARCR.OR $PE CIA L C I RCLIIT S.00 V PERMIT VALIDATION
' A°DRE
ZIP EMP.METER OR POLE INS. 20.00 b
ADDRESS ' 1 MOTORS. SEE FEE SCH. ✓�
_
ADDRESS
SERVICE CHANGE _AID 20.00'
oai _ �_! �y��(E' �%/b•17
0o LICENSED CONTRACTORS DECLARATION . �•" / ]/•;j•J:
a v w 1 herebymffirm that lam licensed under provisions of Chapter 9 la J IJL r SSUANCE DAVE
w a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. G. MECH.
H z professions Code, m license is in full foµy�t{Id effect /s�s� bt { in
z
00. - License CI�' Y Lia Number.2s2� Vlr7 Q IJ e LI
o w r w Date Contractor
a y f BUILDING PERMIT
6 0 w¢ OWNEi R-tl UILDIiR DE ARA'TION INFORMATION
w 3 n N 1 hereby affirm that 1 um exempt rem the Contractor' License MISC.-
REFER TO ORD
uo J Law for the following reason (Sec. 031.5,Businessand ofessums PERMIT ISSUANCE 10.00 VALUATION 8/FT.
Code:Any city or county which r uiresapermittom trucraltuq
H - U "� O
2 2< 2O improve,demolish,or repair any truclure,prior to its ssuance,also ELEC.CONTR. LIC.NO.. ELEC. �J Da(lI
O¢ requires the applicant fur such emit to file a signed.bodement that. TOTAL L} PERMIT TO
A w m a. hC is licensed pursuant to the revisions of the Co actor's License' �Z� T�C/
HiQ
Law(Chapter 9(commenct with Section 7000) Division3 oCl e Q e--1
Business and Professions C de)or that he is exe pt therefrom a it DTV. PLUMBING PERMIT FEE
¢ r $ the basis for the alleged a -mption.Any violati n of Section 70 .$ STORIES TYPE CONSTR.
STR.
a ; - by any applicant fora p mitsubjectstheapp cmntoacivilpe Ily ALTER-DRAIN&VENT-WATER'(EA.) 5.00
of not more than five h ndred dollars($500)
❑ I,as owner of a property,or my c ployees with w ges as BACK FLOW PROTECT. DEVIC 4.00 OCC.GROUP RES.UNITS
their sole contpensat' o,will do the work and the structu is not
intended or offers for sale (Sec. 7044 Business and Pr fessions DRAINS-FLOOR,ROOF,ARE (COND. 5.00
Code:The Contra or's License Law do not apply to an wner of
property who bu'Js or improves there u,and who does uch work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTALACREAGE
himself or thus h his own employee ,provided that so improve r
ments are not tended or offered to sale.If,however, he building GAS-EA.SYSTEM-11N .40UTLETS. 6.00
or improvense t is sold within one ear of completio the owner- GAS-EA.SVSTEM- ER 4(EA.) 2. BUILDING USE
builder will ve the burden of pr ving that he did d build or im- RES IND CON PB other
prove l'or pb pose III sale.). INDUSTRIAL WAS INTER. 3 .00
[1I,as owner of the proper ,am exclusively ntreming with ❑ C] ❑ El
licensed ntractors to constr I the project(Sec 7044,Business LAWN SPR INK RS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Prof ssions Code:The Co toam.r's License L does lot apply
to an o neo of property wh builds or improves hereon.and who LAWN SPRIN ERS-OVER5 IEA 1.00
contra is I..such pro w, it,a contractono I' emsad pnoo,Int to
SEWER-SA TAR V-STORM EA. Oft/10.00 TRACT NO. PARCEL NO.
the ntractor's License
❑ I am exempt under Cc. .B.&P.C.for Obis WATER EATER W/VENT 6.00
uc.. n
O Cr Date WATE SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W R C MPEN$a1,'jION I CLARATION WA R TREATING EQ 5.00 '
I her y at b t cot vL erns( l� f consent o set Ginsura _ ZONING ENG.SITE N0. '
' or a certificate of Workers Compenwtion Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Conbpany
0 ❑ Certified py is hereby furbshed. - FIRE SPRINK ' ENERGY T-24
Z Z ❑ CL-rlif' 'opY fit' 1 11' '-Y1iI i ti n division, v❑ N❑ v ❑ N❑
Applicant Is' MISC.- REFER TO ORD.
PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
LU CER'I:IpICATE OP 1 AX I PT10 OM WORKERS' _
11,1 _ COMPIiNSAI'ION URANCE PLG.CONTR. LIC.NO. PLG. b Y❑ N❑ Y❑ N❑
CL O (This section need not he mpleted if the pen is for one TOTAL
Z hundred dollars(S 100)m le'.
•U O ' 1 certify that in the p• ormance of thew.or r which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I.-, mit is issued.1 shall u employ any person uuY nbanner so as W
UW become subject to d Workers'Ccurmensat Laws of California. BUILDING �1 v'
u Dat, Applicant ALTER OR ADD TO MECH. 5.00
} W NOTICE TO 'LICANI': If,after mg oris Certificate of lix=
F2 emption,yo should became subjec o the Workers'Compensation APPLIANCE 5.00 ° PLAN CHECK .
provisions f the Labor Code, u most finthwith comply with - FEE
U such pr bsions or this permi I be deemed nvo B. AIR HANDLING UNIT(TO 100WC.F.MJ 4.00
CONST TI NLiNDING ENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.) 6.00 SEISMIC FEE
hereby affirm at there is is const coon lending age y for EXHAUST HOOD(WITH DUCT) 5.00
` the performance the work for whi' this permit is its ed(Seca MICROFILM -
3097,Civ.C.L - HEATING UNIT(TO 100,000 B.T.U.) 8.00
' Lender's Na HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC Aj'5�--
Lender's A cess _
(_v,
1 cer'y that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'x m5l
inforion is Correct. I agree to comply with all city and county PLUMBING
� ordinances and slate laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00
\ hereby authorize representatives of this city to enter upon the
i/b abovomentioned property for inspcaion purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
'
(We) agree to save, indemnify and keep hmndess the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way accrue,against sai 'City in consequence of the _ PERMIT ISSUANCE 10.00
granbi of this pefmil. MECH.CONT. 1 LIC.NO. MECH. ! b
TOTAL TOTAL
S azure 1 pplicant ont clor U to �� `
OFFICECOPY .