12667 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
-� INSPECTION DIVISION
12667
JOB INSPECTION RECORD
r.�
JOB ADDRESS 19320 Pruneridge UNIT# LOT# PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER Hewlett Packard CONTRACTOR Tprrnn rnnstruction IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 AVS FROM
FOUNDATION LASTCALLED NSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
`p n
• PLUMBING
ELECTRICAL ( IesuANCE DATE
MECHANICAL - C� ! ELECT. I PlG. Msy.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
PLUMBING WOOD FLOOR VALUATION $/FT.
MECHANICAL I ' J 0 '
PERMIT TO
ELECTRICAL
FRAMING STORIES
TYPE
�. y'T _
SCONSTR.
INSULATION
OCGGROUP RES,UNITS,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
Hi'SIND CON PH 00,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ 1:1
ASSESSORS PARCEL NO.
ROUGH Q
• PLUMBING bG 1r..0 al..(rvac� Dy. Zwi 2
GAS TEST TRACT N0, PAq CEL N0.
8 tiXev"rL#I%
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING pJ,� (�-yI.-$J SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
S ;e GAS'
_ FIRE SPHINK ENERGY T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NEI El_ "El,
.
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.0C.
LATH-EXTERIOR IRE DEPT. Y❑ No Y 0 N❑
SHEETROCK G DE FEE SUMMARY
SHEAR INTERIOR BUIL - •-1 �(
SHEAR EXTERIOR TEMPORARY APPROVALS _ BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE f
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING o� 252.4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL j
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT
DDR ss
V sa, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1266
OWNER'a PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
ONE
NAME ADTDRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIc.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S'oRs
ADDRESS Q APPLIANCES-RESIDENTIAL 4.00
A
o AV),.ONE IZ-7 6 PANELS 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
DR � PANELS (OVER 200 AMP) 20.00
ENGINC
Llc.rvO.0 SIGNS TRANS. 3,00
E l5
AARCKOR
DDRESS SPECIALCIRCUIT 5,60 PERMIT VALIDATION
p-1 A� ZIP EMP.METER OR POLE INS. 20.00
AOAPPLIC
ESST SQ l FT P 9 /N`e. MOTORS SEE FEE SCH. WV
SERVICE CHANGE 20.00 O'
w o D LICENSED CONTR ORS DECLARATION I,\�, a3��juu1 hereby affirm that 1 am licensed under provisions ofChapter 90CE DATE
< Ic (commencing with Section 7000)of Division 3 of the Business and LECT. PLG. MECH.
G D m Professions C e,a td m license is in full force and effect.
z o 2 z Licen ClassZ- y Lic.Number ❑ ❑ ❑
o N H Dale-Bey{--)mss,y�-Contractor-fip .E -
¢ y s 1-mss' • ' „" BUILDING PERMIT
¢ a a a OWNIi R-RUILDER DECLARATIO INFORMATION
wOy0 MISC.- REFER TO ORD
; I hereby affirm thou I am exempt from III,,Contractor's License
Iso ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 IZ� Q
VALUATION
E - 0� Cade:Any city orcounty which requires a permit to construct,after, 0'7-
$/FT.
2 Q ¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC. 1 '
C or requires the applicant for such permit to file a signed statement that TOTAL PERMIT
a w$ he is licensed pursuant to the provisions of the Contractor's License
F,zi Law(Chapter 9(commencing with Section 7000)ofDivision 3ofthe �V71 Q
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE / d
¢ r the basis for the alleged exemption.Any violation of Section 703L5 STORIES TYPE CONSTR.
d ;F by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5007):
❑ 1,as owner of the property,or my employees with wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONIC, 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 TOTAL ACREAGE
himself Or through his own employees,provided that such improve-
mentsara not intended a,offered for Sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 DR. RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
❑ I,as owner of lie property,am exclusively contracting will
licensed contractors In construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 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 5(EA.) 1.00
contracts for such projects with a contmctor/s)licensed pursuant to SEWER-SANITARY-STORM EA.200it/10:00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO,
WORK Ii RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby atfirm that [ have a certificate of consent to self-insure, ZONING ENG.SITE NO.
ora certificate of Workers'Compensation Insurance,or a certified
copy they 7800,Lab.C).r�p.r
Policy No. ompany
❑ Ce IiJ 0 reb
shey furnished. FIRE SPRINK ENERGY T-24
z ❑ Cc Iffle co Jed w' he city ins ' n division. MISC.- REFER TO ORD.
F APplicanl_ V C] N❑ V C] N❑
PERMIT ISSUANCE 10.00
Cr _ CERTIFICATE OF EXEM PROM WORKERS' FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG.
Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y'❑ N❑
hundred dollars IS 100)or less.)
U O d certify that in the performance of the work for which this Per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ an person in any manner so as t0
U become subject to the Workers'Com enation Laws of California.
O ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after m,king this Certificate of fix
emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, you nmol forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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 m for which This pennil is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name_ H EATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. information is correct.I agree to comply with all city and county PLUMBING
ordinances an tate laws relating 10 building construction, and BOILER-COMP 0H.P.or100,000B.T.U.) 6.00
y hereby Guth a repro tyforivesins inspection
this city es enter upon the BOILER-COMP (Ova,100,000 BTU)BE E F E E SCH, MECHANICAL
/ above-menti neJ roperse Porins of this
Purposes.
(We) reg e t save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino gain liabilities,judgments, costs and expenses which CONST.TAX
may ' an w accrue against said C' in consequence of the PERMIT ISSUANCE 10.00
gran n of hi CrmiL JJ MECH.CONT. LIC.NO. TOTALV!�(i/1 /
TOTAL
Signatureof plicant/Contractor Date
OFFICE COPY