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13255POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD - JOBADDRESS 10707 PINOLE COURT UNIT# LOT# OWNER - MATSUURA CONTRACTOR GIOTTA CONSTRUC. PERMIT NUMBER 13255 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION.' INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - UFER PR EGUNITE - PERMIT VALIDATION ls7 C+1sG�ir!1i�'DO POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - BLDG.. ❑ I ELECT. ❑ PLG. MECH. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION f ... d W s/FT. PLUMBING MECHANICAL ELECTRICAL - PERMIT TO 1 4A f,[Yf. FRAMING INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO, FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB OJnn. 1:1 Cl ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO PLUMBING GAS TEST TRACT N0. PARCEL N0, MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACC. FILE NO. FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO. GAS FIRE SPRINK Y ❑ N[D ENERGY T 24 YN� MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOODZONE YE] N❑ A.L.U. C. Y�, N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING r SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE , GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED jocCuPANcy SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM , ARRANGE FOR INSPECTION BY PHONING 252.4505, a�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT!' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL f OFFICC COPY o ¢ i "00 Be u u N D i a N� o?_Pl Be se F �J Be se 0 w U X r. F'LL N J Be Be 0 ca 0 $u a w �zQ Ber- 0 ¢1-$ s 3 O Z z) , CC Nj LU - ao z 00 LL U Owa } N A M APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION I APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13255 BUILDING ADDRESS ` h CC�I.�r OWNERS,C NAME OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHON DATE OF APPLICATION CONTRACTORS // uC.NU. f0 OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 DTRA - DRESS Rs AD PH°NE G7 PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECTPANELS Ofl ENGINEER LIC. NO. (OVER 200 AMP) 20.00 PLANCHECKFEE P.C.NO. SIGNS TRANS. 3.00 AARCH. 09 DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP.METER OR POLE INS. 20,00 ZIP APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 11 {7D� 19.7 J .1 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co and my license is in full fore d cc Licen Cl Lic. Number BLDG. MECH, ❑ ❑ ❑ ❑ Date _� Conl mctor �l_Q BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for thefollowingrwsan.(Sec.uires a,itoCndtruct,ssians permit priot o consuance, lter,also Code: Any city Or roup pair any reqstructure, improve, demolish, or repair any structure, prior n its issuance, also requires the applicant for such permit to file a signed statement i that he is licensed pursuant to the provisions of the Contractor's License l,aw (Chapterand t theren 3 from the Business and Professions Code) or that he is tion of therefrom and Procosions Codeng ) or Section is 00) exempt the basis for the alleged exemption, Any violation of Section 7031.5malty INFORMATION MISC- REFER TO ORD . VALUATION RT _ m $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIG N0. TOTAL TOTAL PER,�pIT TO s'T�/ / ICr J/� L DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. subjects 15000.licam tnacivil penalty by any applicant fora hundred of not mom than five hundred dollars (5500).): ALTER-DRAIN&VENT-WATER IEA.)5.00 ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do 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 sale (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 does such work himself or through his own employees, provided that such improve- meats are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-1 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- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon. and who GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. 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. ❑ 1 um exempt wider Sec. . B.&P.C. far this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACG FILE NO. WATER TREATING EQUIP, 5.00 WORKERS'COMPF-NSATION DECLARATION I hereby affirm that I have a certificate orcousenl to self -insure, or a certificate of Workers' Compensation Insurance, or n certified ZONING ENG. SITE N0. copy thereor(Sec. 3800, Lab.C.). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is fled with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC.- REFER TO ORD. CERTIFICATE OF 17XEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. PIA. CONTH. LIC. No. PLG. TOTAL COMPENSATION INSURANCE (This Section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ TY.OMECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any arson HI a y lean cq so as to beco su a he Workers' oat n La �fd rain. t� �)ApplicantBUILDING DateIC17 TO APPLICANT: TIALTER N TO APPLICANT: If, a et making this Certificate of F:x 0 OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK / emptlo you should become subject to the Workers Compensation prion, provisionn s of the Labor Cade, you must forthwith conpily with such provisions or this permit shall be deemed revoked. FEE f0 AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.NI 6.00 SEISMIC FEE ,7/7� v CONSTRUCTION LENDING AGENCY I hereby affirm that there is u construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT(OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city mol county Ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -COW (3 H.P. or 100,000 B.T.U.) 6.00 veBOILER-COMP (Or 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue -against saiddity 'n canseyuence of tire CONST. TAX PERMIT ISSUANCE 10.00 granting his pe it. MECH. CONT. LIC. NO. MECH. TOTAL TOTAL gra O ppl ant/ ontru Date OFFICE COPY