13644 POSTTHISD NEAR FRONT OF BUILDING • PFRMIT NUMBER
CITMF CUPERTINO
INSPECTION DIVISION 3644
JOB INSPECTION RECORD
. . PERMIT EXPIR&ON
JOBADDRESS 21325 RUMFORD DRIVE UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER BOB DENNISON CONTRACTOR - GREENHOUSE FTC IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
C ANCE OR 180 DAYS FROM
FOUNDATION / �/� ��� LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB �� `•G�' r
PLUMBING 1 1 4
ELECTRICAL <jq-.\ . ?- - .SSUACTNCE DATE
MECHANICAL - Ca Nua \ CE . PLG. MECH.
C�tY _ DC7 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING _
MECHANICAL
ELECTRICAL - /, ppPERMIT To
FRAMING 5, &/vozm Lc SNC L. .
STORIES TYPE CONSTR.
INSULATION
(CC GROUP RES_UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SQ IT FLOOR AREA TOTALACREAGE
ROOF
DIAPHRAGM
BUILDING USE
HES IND CON PB O�,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El 0 ❑ (] Cl
ASSESSORS PARCEL NO.
ROUGH
- PLUMBING
GAS TEST / - TRACT No. PARCEL NO.
MECHANICAL '
ELECTRICAL FINALS." DATE INSP. Acc.DATE ACC.FILE No.
FRAMING SAN #
ZONING ENG,SITE NO.
INSULATION PLUMBING ,
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL Y ❑ NE] YNE:]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , d HEATING
I
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.LUC.v� N� YI] NE)LATH—EXTERIOR FIRE DEPT. _
SHEETROCK GRADE - ,FEE SUMMARY
SHEAR INTERIOR' BUILDING - O- BUILDING
SHEAR EXTERIOR, TEMPORARY APPROVAL /l�
FIREWALLS ELECTRIC PLAN CHECK
GAS . FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE L�
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR. MICROFILM
y
ARRANGE FOR, INSPECTION BY PHONING 252-4505, ELECTRIC J
• o� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST,TAX
PLEASE CALLING FOR FINAL INSPECTION.
RE TOTAL
OFFICE COPY -
APPLICANT TO FILL IN INFOR ATION WITHIN RED LINES - USE B '. POINT PEN ONLY
^ryBUI LDI NG PROJECT I DENTI FICA I PERMIT NUMBER
BUILDING APPLICATION.& PERMIT
f ADDRESS 13644
WILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
. "AME WN-1ELECTRIC PERMIT FEE n
ONE /2/`�p[�
CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00
Nq '_
Ju lxr�3-+/C'/� LIGHTING FIXTURES 10.00/1.00
EONTRACTOR'sPPLIANCES-RESIDENTIAL 4.00
ADD ES�
' rQ K ONE 7i PANELS 10.00 DATE OF APPLICATION
nCHIT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
on O
ENGINEER
uc.No. SIGNS TRANS. 3.00
ADDRESS ENG. 5.00 CIRCUIT 5.00 PERMIT VALIDATION
ZIP rrEMP.METER OR POLE INS. 20.00
ADDRESSTs MOTORS _.SEE;FEE SCH.
SERVICE CHANGE 20.00
D
02 LICENSED CONTRACTORS DECLARATION r.1 (� 1 1 • I/#l ��
IC u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
M,
2 w (commencing with Section 7000)of Division 3 of the Business and PLG. MECH.
ve ¢a. BLDG. ELBC7 1L
F Professions Co a license is in full fort a eqt� (19v f1$ NinP Q
i0�- License Class�,ic.Number_���2�j%(/-�Q -
9 - w Datc Contractor
¢t2 L
, 2 ,BUILDING PERMIT
rc rt w OWNER-BUILDER DECLARATION " INFORMATION'
A.
3 A. H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD p +
uowreason. V A,L^'l1AT ION L),I�I ll $/FT.
¢ Law for requires a permit
to
Professions PERMIT ISSUANCE 10.00 Q `y '.;sL � l(fU
� La 2 Code: e,dem y demolish,
county whiny structure p prior
(o is issuance,alser,o
dl
¢ 2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
wO¢ requires the applicant for such permit to file a signed statement that TOTAL 917 PERMIT TO
$w he is licensed pursuant to the provisions of the Contractor's License ^�
Fi> La..(Chapter 9(commencingwith Section 7000of Division 3 of the ` I, ,rVaV�Uw•/ L�
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE v
M r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
T by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES,PER TRAP 5A0 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsamnotintendedoroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
EI 1,as owner of the property,am exclusively contracting with ❑ D ❑ D ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL N0.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ot'cOnSem m (-insure,
or a certificate of Workers'Compensation Insurance, a certified ZONING ENG.SITE NO.
copy lhereoGf 3$QQe{Zb Q) �
Policy No dlfj?Il({qty "'
O ❑ Ce ifled copy ishe y tat ed. N FIRESPRINK ENERGY T 24
F O Cer'fied copy is fie wi the city inspect OA ivisi n. MISC. REFER TO ORD.
App muni V 0 N V N
In PERMIT ISSUANCE 10.00
LU CERTIFICATEOFEXEMPTION FROM WORKERS' FLOODZONE a.L.0 c.
W > � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(L O (This section need not be completed if the permit is for one TOTAL Y❑ N Y C N F]
Z) Z hundred dollars($100)or less'.)
U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT - FEE FEE SUMMARY
LL I. mit is issued,I shall not employ any person in any manner So as to
O L) became subject to the Workeri Compensation Laws of California.
n Uate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING )
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- X.
I- Z ultmtion,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 IO=CF.M.) 4.00 p
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE 0
I hereby affirm 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19,50 oL
Lender's Address _ ELECTRIC
1 certify 11,311 have read this application and stale that the above VENTILATION FAN (SINGLET 4,00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-COMP(3H.P.Or IO0,000B.T,U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 STU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(we) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD.
Cupertino against liabilities,jmdgmy5FsNosts and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
Lgrantilngolfbis
y way accrue id Ci in co�=e� of the
p MECH.CONT. LIC.NO. MECH.TOTALTOTAL 113 ,34-o Applicant/Conlrac Uale
OFFICE COPY