15473 - •v '''� POST THIS CARD NEAR,FRONT'OF. BUILDING, . .
� �' • � - ' ,1'LHM1IIT NUMBER
CITY OF -CUPERTINO 15473
INSPECTION DIVISION„
"r'="':+. _i-• JOB INSPECTION RECORD - -
PERMIT EXPIRATION
F •,. 1 7.791 Orion Place
JOB ADDRESS - UNIT# _LOT# - '+
PERMIT EXPIRES IF WORK
OWNER .;_ -Kenneth. Kimi i` Jr. CONTRACTOR +,• IS .NOT. STARTED WITHIN
INSPECTION DATE INSPECTOR ORD isoDnvSOFPERINII {ssu-
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 - •K - APR ISSUANCE unre
MECHANICAL 'HLc . MecH.a
'L� O , PERMIT-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - J L BUILOINGINFORMATION
,WOOD'FLOOR vnwnnoN - y SIFT.
PLUMBING -
MECHANICAL �
ELECTRICAL 'PElm+n TO
FRAMING f' 1 ... n .
- Si OHI1'S TYPE CONSTR,
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED A
17E\ SO,Fr,FLOOH aRtn ro?n L ACREAGE.
ROOF NOTE:NO FINA 'NSP.S A BE ADE BEFORE . '{
DIAPHRAGM THE CONSTRU ION T 5
M " BUILDING USE
ROOF SHEATHING HES IND - CON , PB OR,.
-APPLY NO'ROOFING UNTIL ABOVE HAS BEEN SIGNEDFI E INS El `�
ASSES' PAHCEI.NO.'
ROUGH N.N -
PLUMBING - - - EC GY ' - - -
TRACT NO. :PARCEL NO.
TUBS B SHOWER,PAN - - P EN
1 I,-
MECHANICAL •' H,EN
ACC-unre ACC.FILE No.
ELECTRICAL - UILDING Y
.FRAMING" _ ELECT.FINAL TEST ZONING ENG,SITE NO.
INSULATION,. IPLUMBING -
GAS TEST • GAS '
FIRE SPRINK ENERGY T,:24
- - MECHANICAL - -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ❑ ' - ` El NQ
Il FLOOD ZON.EE n.I.U.C.
' EXTERIOR SHEAR ' ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. ❑' ' N�
SHEETROCK ' - GRADE • FEE SUMMARY
EXTERIOR LATH BUILDING '
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK.
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 'SEISMIC FEE
-- OCCUPANCY OFBUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY�BUILDING INSPECTOR, MICROFILM -
ARRANGE FOR INSPECTION BY PHONING'252-4505,
ELECTRIC '
t2 ' F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� ` PLEASE'GIVE JOB'ADD RESSWHEN , CT'
Z - MECHANICAL.
SEE PERMIT FOR-EXPIRATION DATE'— ``
IMPORTANT! consT.TAX
'PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR, FINAL INSPECTION. I1: hii
OFFICE COPY ' , '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT'PEN ONLY; J
BUILDINGP.ROJECT IDENTIFICATION 'PERMIT NUMBER i
BUILDING APPLICATION & PERMIT
AODRESB - 15473•:
'� Q 1 /�--;' F'�� BUILDING -.ELECTRICAL-PLUMBING-MECHANICAL
4' OWNER'S vl �dqq''tt// PLAN CHECK VALIDATION
N"jsE "�4cT`7"1`I��k OTY. ELECTRIC PERMIT FEE
.Ill'�Ir�'L'\ ml PH ON E'T�I'1-�OWZ�
NCONTRACTOR S
AME OUTLETS-SWITCHES-RECEP 10.00/1.00
r .
' LIC Net LIGHTING FIXTURES 10.00/1.00
ADCRESs CTORs PPLIANCES-RESIDENTIAL • 4.00
OOREs
?HONE PANELS 10.00 DATE OF APPLICATION '
ORCHITECiPANELS (OVER 200 AMP) - 20.00
uPLAN CHECK FEE SPA,NO.
OR
ENGINEER -
- c:NO. SIGNS TRANS. 3.00
ARCH.OR ENG. - P.ERMIT'VALIDATION
ADDRESS. SPECIAL'CIRCUIT 5.00 F _
ZIP TEMP.METER OR POLE INS. 20.00 ❑
APPLncANTs MOTORS SEE FEE BCH. PI\ !�- 1 _
ESS
aoDR
SERVICE CHANGE 20.00 �I♦��wwA~"
w o o LICENSED CONTRACTORS DECLARATION _ C'LJ V1, CuD_4•!�`I S$,.
a u 1 hereby uI ion that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y a N (commencingwith Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
H D z Professions Code,rand my license is in full force Oda ffect. ❑ ❑
z o - License Class Lie.Number
o F w Dale Contractor
a y E BUILDING PERMIT-
¢ w a OWN ER:BUI LDER DECLARATION INFORMATION
o a U MISC.,- REFER TO ORD
I hereby affirm tial I:on exempt from the Contractor's License VALUATION .S/FT.
, .. O¢ Law for the following mason.(Sec.703 1.5.Business and Professions
PERMIT ISSUANCE 10.00
Code:Any,city or county which requR,,u permit toconstrucL alter, '
¢ to x¢ 2O improve,demolish,or repair any structure,prior to its issuance,also ELEG CONTR, LIC.NO. ELEC.
or
-0¢ requires the applicant for such permit to fee a signed statement tial TOTAL - PERMIT TO
wm he is licensed per Imm to One provisions of tine Contractor's License ,
Hzi
Law(Chapter9(conmmncing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and QTY. - PLUMBING PERMIT FEE
ESD
rc H m the basis for the alleged exemption.Any violation nfSalmn 703 LS STORIES TYPE CONSTR.
a - by any applicant for a pemlit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
o t more than five hundred dollars(55000.):
Ixn I,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 On sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND.. 5.00 ,
Cade:The Contractor's License Law does not apply to an owner of -
prp(CIIY who builds or improves thenen,and who docs such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
binnself or through his own employees,provided that such improve-
mentsarenotintendednroffered for sale.Il',however,the building I GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 [Q,
or improvement is sold within one year of connplelion,the owner. GAS-EA.SYSTEM-OVER 4(EAI) 2.00 BUILDING USE
builder will have the burden ol',proving that he did not huild or im-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 ; R❑1 ❑ ❑ ❑" 1:1IND CON PB, Omer
❑ I,as owner of the property,am exclusively contracting with -
licensed contractors to construct the projeet(Sec.7044,Business LAWN SPRINKLERS,- 1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code:The Con(ractoi s License Law does or apply
to an owner oI propert1 who builds or'improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contructorls)licensed pursuant in - -
the Contractor's LicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO.
❑ lura exempt under Scc. .B.&PLC.O.r this WATER HEATER W/VENT 6.00
on
Owner - Date WATER SYSTEM 5.00
.ACC.DATE ACG FILE NO,
WORK ERS'COM PENSAT'ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby alfuni that I have a certificate of consent to sel6lnsum. ZONING ENG.SITE NO.
or a:certificate of Workers Compensation Insurance,or a certified
mpyribereof(Sec.3500,1ab.C.).
Policy No. Company
O O,Cetlified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is tiled with to.• City inspection division. MISC.. REFER TO ORD.
Applwant� Y❑ N❑ y El No
)- a PERMIT ISSUANCE 10.00 IO,0 FLOOD ZONE A.L.U.C.
Lu � •'f-Ii RTI II COIi ENSA ION INS PROM WORKERS'
IL ;COA1PIiNSAI'ION INSURANCE PLG:CONTR. LIC.NO. ,• PLG.
d 0 ITh
: is section need not be completed if tire m e permit is form TOTAL Iv,O Y El, NNE] Y ❑ ,N❑
• Z) Z- hundred dollars(S 100)or less.), -
U•O I h rlity thm in the performance of the work for which this per- DTV. ` MECHANICAL PERMIT FEE FEE SUMMARY
LL H' mit is issued,I shall not employ any person in any manner so as to
0 became subject to the work'ers'Conlpensation Laws of California.
O w Date Applicant BUILDING'
a. ALTER OR ADD TO MECH. 5.00
} rn NOTICE 1'0 APPLICANT'.: If,after making this Certificate of Ex-
Z emption,'YOU Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
ornvishms ofithe Cabor Code, you must forthwith comply with FEE
U such provisinns or this permit shall be deaned revoked. AIR HANDLING UNIT(TO 10,00DC.F.M.) 4.00
' CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
',I hereby affirini that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the perormance of Ile 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 I0 VER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
' I certify unit I have re.dahis applicati o"and state tid We above VENTILATION FAN (SINGLE) 4.00
information is correct-I'agree to comply with all city and county PLUMBING pp� a�qJ)�
mdtnances and state laws relating to building construction, and BOILER-ODMP(3 H.P.Or 100,000 B.T.U.1 6.00 I(OsW
hereby authorize representatives of this city to enter upon the 'BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned Property for inspeclinn purposes.
(We) agree io save, indms ify and keep harmless lire City of MISC.- REFER TO ORD.
Wyy8way
ainst liabilitie>, udgmm�ts, costs and expenses which - CONST.TAX
Y
ace ai st sail ty in const uc 'e of the PERMIT ISSUANCE' 10.00
lnis coni �/yy . MECH.CONT. LIC.N0. MECH.
u Ap- 1 TOTAL TOTAL Applicant 'pt
Date uv �•D
OFFICE COPY