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.APP!_ICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT !"EN d.%JLY
6
1UILDING�?!OJECTIDENTIFICATION.
LI APPLICATION&PERMIT
UILDING- ELECTRICAL- PLUMBING - MECHANICAL
aER3M3IT NUMBER
1240 6
W160ING\
s
OM or;,
OWNERS
N" a reD
OTYELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
`
co TAcrOR
NAME
UTLETS- SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
LIC. NO.
/(p�
CONTR
ADDREACssroR's
opRE
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
PRONE
DATE OF APPLICATION
ARCHITECT
O
OR
ENGINEER
LIC. NO.
PANELS (OVER 200 AMP) 26.06
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
aA HE OR ENG.
:IP'
SPECIALCIRCUIT 5.06
MIT VALIDATION
r % Ok,
l?
EMP. METER OR POLE INS. 20.00
ADDRESS
ADDRESS
- MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
p �s' 'y Cu 1n0
CAJ
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lic. Number
ISS NGE DATE
BLDG.
ELECT.
PLG. MECH.
❑
Date Contractor
'
OWNIi Rtl U1LDF.R DECLARATION
I hereby affirm that I am exempt from the Cons and Contractor's License
Professions
Law forth):ity owiounty which requires
a,tlmit no
Code: Any mulish cor my it any structure,
permit to consuanc , ter,SISO
improve, demolish, or repair any structurq prior to its issuance, also
requires tiro applicant for such permit to file a signed statentent that
he is licensed pursuant to Ilia provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or Ilial he is exempt therefrom and
BUILDING PERMIT
INFORMATION
[MISC. REFER TO ORD
PERMIT ISSUANCE 10.00
VALUATION S/FT.
3 HiQ nA..1
ELEC. CONTE. LIC. NO.
-
ELEC.
TOTALC''�
PERMIT TO
S��
-
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars (55001.):
ALTER -DRAIN (EA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
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.
ments are not intended or offered for sale. If, however, the building
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
K 3
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. '5,00
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00
SO. FT. FLOOR AREA
/
u!"
TOTAL ACREAGE
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
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
aulLatNG USE
RES IND CON PB Omar
❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 3000
.
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
toan owner of property who builds or improves thereon, and who
LAWN SPRINKLERS -I INC 5 V.B. 6.00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
ASSESSORSPARCELNO.
3 -3�- QOS
contracts for such projects with a contractor(s) licensed pursuant to
the Contra icenre xw.
❑ Ian pt un'c ,or this
BAP.C. f
reason
SEWER -SANITARY -STORM EA. 200ft/10,00
TRACT N0.
PARCEL NO.
WATER HEATER W/VENT 6.00/Q
Owner Date
WATER SYSTEM 5.00
/
1QaRKERS OMPI:NSATRATION
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
1 hereby affirm dual I have a certificate ofconsent to self-instim,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copyahereof(Sec. 3800, Lab.C.L
Policy NO, Company
❑ Certified Copy is hereby furnished.
• Applicant Certified copy is filed with the city inspection division.
FIRESPRINK
Y ❑ N ❑
ENERGY T$4
I Y ❑ No,
MISC. REFER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10,00
FLOOD ZONE
A.L.U.O.
COMPENSATION INSURANCE.
o
(This section need not be completed if the perma it for one
V ❑ N ❑
V ❑ N ❑
PLG. CONTE. LIC. NO,
PLG,
TOTAL
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per-
RED is issued, 1 shall not employ any person in any manner so as to
CITY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
become subject to the Workers' Compensation Laws of California.
Date Applicant
'f0
ALTER OR ADD TO MECH. 5.00
NOTICE APPLICANTr If, after making this Certificate of Ex.
emption, you should become subject to the Workers' Compensation
- APPLIANCE 5.00
PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
FEE
AIR HANDLING UNIT(OVER I0)000C.FM.) 6.00
SEISMIC FEE
a
CONSTRUCT ION LENDING AGENCY
1 hereby from 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.
3097, CIv.C.), I
MICROFILM
"
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address
HEATING UN IT 100,000 B.T.U.)9,50
ELECTRIC
VENTILATION FAN (SINGLE) 4.00
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and slate laws relating to building construction, and
PLUMBING
BOILER -COMP(3 H.P. or 100,0008.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby au0rorire representatives of this city to enter upon the
above-mentioned property for inspection Purposes.
(We) agree to save, indemnify and keep harmless the City of
C!
Cupertino agai st liabilities, judgments, costs and expenses which
i ay c e against said City' 1in1 consequent f the
granti ( pe W (J �I14
W
MISC. - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
99 p
A O
MECH. CONT. LIC. NO. MEETAHL
TOTAL
/c�„ j
Signa u pp, c t DEC r Date
vFFlce cvPr
110S'f THIS CARD NEAR FRONT OF BUILDING
CITY OF CUKRTINO
-' INSPECTION DIVISION
JOB INSPECTIO�N- RECORD
JOBAODRES/S., 21890 RAINBOWAbA&*ECIk UNIT#
OWNER FID CONTRACTOR
FOUNDATION — Ip -f3 -sr% TO I-V
UFER
PREGUNITE / - S
'McC." . — v 'j'LJT OK 1
LATH—EXTERIOR
SHEETROCK
SHEAR INTERIOR
SHEAR EXTERIOR
L
SAN C 1.E
PLUMBING
GAS
MECHANIC
HEATING
ELECTRICP
FIRE DEPT.
GRADE
BUILDING
I li-T
PERMIT EXPIRATION
LOT# 21 ... \.
PERMIT EXPIRES IF WORI
IS NOT STARTED WITHII
i 180 DAYS OF PERMIT ISSU
L ANCE OR 180 DAYS FROA
LAST CALLED INSPECTION
u
IT VALIDATION
��raa
(Ii `)I �rU(SSUAIDAIE
NLU ELECT. PLG. I MEC
RES
FIRE SPRINK ENERGY T )<
Y ❑ N ❑ V ❑ N
FLOOD ZONE A,LUC,
Y❑ No Y❑ N
i
BUILDING
OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUIL Nd SPECT NiICRO
ARRANGE FOR INSPECTION BY PHONING 252-45b5, E' TIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. p I o
PLEASE GIVE JOB ADDRESS WHEN PHONING:
-SEE PERMIT FOR EXPIRATION DATE - E HANICAL
IMPORTANT! CONST. TAXA4 low
PLEASE,READ REVERE sIbE.BEkbht TOTAL
CALLING FOR FINAL INSPECTIbN.
OFFICE COPY
UNDERGROUND
PLUMBING
ELECTRICAL
MECHANICAL
i NOT,, Re VILTl
U U 1fff On
WOOD FLOi
PLUMBING
MECHANICAL
ELECTRICAL
IL
FRAMING
INSULATION
ROOF
DIAPHRAGM%A14
�G'
h
ROUGH
PLUMBING
GAS TEST
MECHANICAL
ELECTRICAL
LATH—EXTERIOR
SHEETROCK
SHEAR INTERIOR
SHEAR EXTERIOR
L
SAN C 1.E
PLUMBING
GAS
MECHANIC
HEATING
ELECTRICP
FIRE DEPT.
GRADE
BUILDING
I li-T
PERMIT EXPIRATION
LOT# 21 ... \.
PERMIT EXPIRES IF WORI
IS NOT STARTED WITHII
i 180 DAYS OF PERMIT ISSU
L ANCE OR 180 DAYS FROA
LAST CALLED INSPECTION
u
IT VALIDATION
��raa
(Ii `)I �rU(SSUAIDAIE
NLU ELECT. PLG. I MEC
RES
FIRE SPRINK ENERGY T )<
Y ❑ N ❑ V ❑ N
FLOOD ZONE A,LUC,
Y❑ No Y❑ N
i
BUILDING
OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUIL Nd SPECT NiICRO
ARRANGE FOR INSPECTION BY PHONING 252-45b5, E' TIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. p I o
PLEASE GIVE JOB ADDRESS WHEN PHONING:
-SEE PERMIT FOR EXPIRATION DATE - E HANICAL
IMPORTANT! CONST. TAXA4 low
PLEASE,READ REVERE sIbE.BEkbht TOTAL
CALLING FOR FINAL INSPECTIbN.
OFFICE COPY
7Cit-4 of Cuptil
10300 Torre Avenue P.O. Box 500
Cupertino, California 95014 Cupertino, California 95015
Telephone: (408( 252-4505
DEPARTMENT OF PLANNING AND DEVELOPMENT
September 9, 1991
SUWECI: 21690 Rainbow Court
Ho residence
Permit(s) #14168, Swimmninq Pool
12406, Single Family Dwelling
16264, 81 fence
The following information is per Jim Jones, Building Inspector, regarding
the aforementioned permits.
Re: Permit #14168: There were no insections, according to our
records, on the swimming pool. They did call for a
i "final" on the pool, however.
Permit #12406: Single Family dwelling. This was not finaled as
there were some problems in the basement area. The
problem existed with the firewalls of the
mech/electric room.
Permit #16264: 8' fence. There was never a footing inspection on
this fence to any recollection.
Again, this inspection permit information is per Jim Jones, Building
Inspector. These statements were compiled for informational use only, to
be docLmlented in the City of Cupertino building file of 21690 Rainbow
Court.
In July, 1991, Sandra Vasques of the'building division had conversation
with Mrs. Ho of the subject address. Ms. Vasques informed Mrs. Ho that
none of the above permits (3) would be "finaled" by the City of Cupertino.
Mrs. Ho acknowledged the fact, and co=ented that she understood they
would not be finaled with the City.
Building Division
Documented September 6, 1991.
"' LTR-H0-R1Bf4(BLDG2)