13283 POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 13283
JOB INSPECTION RECORD
\ PERMIT EXPIRATION
/ JOBADDRESS .lO4OO RIDGEVIEW UNIT# _LOT# ,-
PERMIT EXPIRES IF WORK
OWNER TANDEM — CONTRACTOR REDWOOD CITY .ELECTRI ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE r PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS'BEEN SIGNED,'.
UNDERGROUND /SLABr
PLUMBING
fill
ELECTRICAL �ISSUANC-diUA•eA
'MECHANICAL .. JE�. ELECT. PL❑c., _,MEOCR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT /
INFORMATION
WOOD FLOOR VALUATION $/FT,
PLUMBING -
MECHANICAL
• ELECTRICAL � � � - � � ', �r��PERMIT TO
� l -
FRAMING LJ
INSULATION STORIES TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - '
ROOF • SD:FT FLOOf1 AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
' RES • IND CON PB Oteer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SP
n55E5EQR SPaRCEL NO,
ROUGH
PLUMBING
GAS TEST - TRACT NO, PARCEL NO,
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL ',„,FINALS.;., ^4,` DATE INSP.
FRAMING SAN *
ZONING ENG.SITE NO.
INSULATION � PLUMBING
GAS .
FIRE SPRINK ENERGY T 2
MECHANICAL Yr I]' N.� Y ❑ N[-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ;1' HEATING
FLOOD ZONE. A.L.U.C. ,
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. Y 11 N� Y I] N�
SHEETROCK GRADE ;FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR - - TEMPORARY APPROVALS .BUILDING
FIREWALLS - - - ELECTRIC, ' - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGN ED,OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTEDUNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
* H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
I 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!/ CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ' TOTAL /f
CALLING FOR FINAL INSPECTION'.
OFFICE COPY.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
I) >BUI LDTNG PROJECT I DENT ICATION PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT
ADORES
3283
BUILDING
- BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
"AM J, QTY. ELECTRIC PERMIT FEE
•Y OS IV� PHONE
CONTR TOR's ETS-SWITCHES-RECEP 10.00/1.00
NAM -
C LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
A7PANELS 10.00 DATE OF APPLICATION
A CNIT T PLAN CHECK FEE P,C.NO.
OR _ PANELS (OVER 200 AMP) 20,00
EN mme;�riy>rs-� LI o. SIGNS TRANS. 3.00 _
AIT CH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 -
1
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTSMOTORS SEE FEE SCH. L I.
ADDRESS
SERVICE CHANGE 20.00
w o o C
1,fC,y . . ,•.0
LICENSED CONTRACTORS DECLARATION OI
'Q u I hereby affirm that I am licensed under provisions Of Chapter 9 ISSUANCE DATE
vHi 0 w (commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG. MECH.
F y i Professions C.oh;� d nse is in full force y 0.
z O w- License Class C _`y Lic.Number �` [ ❑
4 w Daley onlrac ��
¢ m f (�� COI° B LDING PERMIT
¢ ¢a WNE B LDF.R D AR T
o w U INFORMATION
K ; ,H 1 hereby affmm that 1 am exempt from the Commelor s License MISC.- REFER TO ORD
w
U. A Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 _ VALUATION -
� - Code:Anycityorcounty which requires2 permit to construct, U
LI N0.
¢ ¢ ef improve,demolish,or repair any structure,prior to its issuance,also ECONTR. P ELEZIP
a O u requires the applicant for such permit to file a signed statement that E�Gef�GO C / PERMIT TO
B- he is licensed pursuant to the provisions of the Contractor's License
rz > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
gi0
¢ by basis for the alleged exemption.Any violation oto action malty STORIES TYPE CONSTR.
i ; .. by any applicant for u permit subjects the applicant W e civil penalty
of not more than five hundred dollars 0504): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as ,BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner or
property who builds or.improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotilRendedorofferedforsale.ll',however,the holding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4(EA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
Prove for purpose Bristle.). INDUSTRIAL WASTENTER. 30.00 RES IND CON PB Other
❑ 1,as owner of the property,am exclusively cunlracling with ❑ ❑ ❑ ❑ ❑
licensed contractors to 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 u contruct000 licensed puraumtl to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO, PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner /J'/ Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
Y�ir : YL'6M ;N VRATION WATER TR EATING EQUIP. 5.00
hereby alhart that'1 have a cenilic:de of consent to sell'-inswa,
or a certificate of Workers'Compensalian Insurance,or a cerlil'ied ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ. �
Policy No. C mpuny_ ✓
O O Certified cop is here y r Ishcd. RE SPRINK ENERGY L24
ZO ❑ CertiI Is IBI the lily pcction division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant V N V N
~ rn ERMIT ISSUANCE 10.00
- CERTIFICATIi OI' iXF.MPTION I' WORKERS' FLOOD ZONE A.L.u.C.
LU COMP. SATION INSL NCI: PLG.CONTR. LIC.NO. PLG.
CL Q (This section need not be completed if the permit is for one TOTAL Y❑ N❑ _ Y ❑ N❑
D Z hundred dollars 1$100)or less.)
U O 1 certify that in the performance ol'the work I'qr which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f mit is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensution Laws of California. BUILDING
Q.
Date Applicant ALTER OR ADD TO MECH. 5.00
} w NOTICE TO APPLICANT: If,after making this Certificate of Es-
F ? Cmptlon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,OODQflM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 3097,performance of of the work for which this permit is issued(Set. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name H EATI N G UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
• 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize representatives of this city m enter upon the BOILER-COMP IOesr 100,0o0BTU)SEE FEESCH. MECHANICAL
above mentioned property for inspection purposes.,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino al; nst liabilities,judgments, costs and expenses which CONST.TAX
ma a accr ainst sai City i consequence of the PERMIT ISSUANCE 10.00
gran thi permi MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of ApPlican ontractor Dnte
- OFFICE COPY