15430 POST THIS CARD NEAR FRONT OF BUILDING I
PERMIT NUMBER
_ CITY OF CUPERTINO• 15430
INSPECTION.DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 20682 Scofield UNIT# _LOT#
PERMIT EXPIRES IF WORK.
OWNER Farran CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE,OR 180 DAYS FROM
,NOTE:
' UFER � � � � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
' - GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND /SLAB `�� r//////� _J ...✓
PLUMBING �
ELECTRICAL ISSUANCE DATE '
MECHANICAL BLuc ELECT PLc;. mecR
o ❑ Q ❑ .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD-FLOOR - INFORMATION
_77T
ALUATION SIFT.
PLUMBING
MECHANICAL '
ELECTRICAL PeRmlr To
FRAMING .'rte
INSULATION STORIES TVPF.CONSTR.
OGG GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - P.•� Ct'. .
• ROOF. 50 FT FLOOR PREA TOTAL ACREAGE
NOTE:NO FINAL INSP.SHALL BE MADE•BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING �' ' RES INouIL CON USE
NG PB Umw
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH $AN.N
ASSESSORS PARCEL NO
� --b
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - ACC DATE ACC,FILE ND.
BUILDING ENERGY
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING' mwNc INC,,SIE NO,
GAS TEST GAS ' '
MECHANICAL
FIRE SPRINK ENERGY T-24
"- � -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING I Y ❑ NO Y ❑ N❑
FLooD zoNE A L U c .
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. 'Y❑ .N❑ Y ❑ NEI
SHEETROCK ` GRADE * FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COATELECTRIC PLAN CHECK
GAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGE FOR INSPECTION BY PHONING.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
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATION - '_PERMIT NLMBEE
BUILDIINNB}
LA
BUILDING
G(]��]7 \• PP ,�' APPLICATION & PERMIT 1 5430 43O
- ELECTRICAL--PLU_MBING-MECHANICAL
OWNER'S n� q ��(. , - PLAN CHECK VALIDATION
NAME hluL ELECTRIC PERMIT FEE -
I4 • PHONE
NANE cro(R/�s\ ��'��'JJJJ// /j OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME l + V� ✓`i . r^�-
uc. LIGHTING FIXTURES " - tF 10.00/1:00
CONTRACTOR'S �y,,L- APPLIANCES-RESIDENTIAL 4.00 -
ADDREas
( ,LyHONE �gs•611 PANELS 10.00 OATE OF APPLICATICI
ARCHITECT ,^ PANELS (OVER 200 AMP)' 20.00 PLAN CHECK FEE P.C.INO.
OR !Y I
ENGINEER F
LIC.NO. SIGNSTRANS. 3.00
ADDR.ORENG. ^ - SPECIAL CIRCUIT w- 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS' 20.00
AR ' , MOTORS SEE FEE BCH.
ADDRESS ^W '� /0
c� 'itir 4'ii' d/ SERVICE,CHANGE 20.00 3/r� ({�-r' ,
wo o LICENSED CONTRACTORS DECLARATION / pK 0'�Q
a 0.,j, I hereby affirm that l'am licensed under provisions of Chapter (",LANCE DATE'
y<w (commencing with Section 7000)of Division 3 of the Business and ,BLDG. .ELECT. PLG. ;MECH-
F,N Z Professions Code o Ipy license is in full torcpp♦r II fe _ ,
Z ou,- License usy Lic.Number"1(
o Z r o Date Centmdor C/pT El
ZZ
EJ,. BUILDING PERMIT
¢ w OWNER-BUILDER DECLARATION INFORMATION '
woa- MISC.- REFERTOORD
3 eL _ I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
04 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Cotte:Any city nr county which requires a permit to construct,alter,
BC ¢ improve,demolish,or repair any s'Imcture,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.BE -
a"
O BErequires the applicant let such permit to file a Signed statement that - TOTAL -
w m n' he is licensed pursuant to the provisions aPme Contractor's License PERMIT TO.
'HZi
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe L•��
_ Q Business and Professions Code)or that Imis exempt therefrom and GTY. PLUMBING PERMIT FEE
r c the basis for the alleged exemption.Any violation of Section 7031.5 STORIES - TYPE CONSTR.
d3f' by any applicant her a permit subjects the applicant to a civil penally ALTER-DFIAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 DEC.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,CONDE 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 5.00 1 SO.FT;FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
m - -
ents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4OUTLETS 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 Ile did not build or tm- - RES IND CON PB ' Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. _ 30.00
. ❑ I,as owner of the property,am exclusively contracting with _ ❑ Or ❑ ❑ ❑
licensed Contractors it, construct it,, 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 ILAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forSuch projects with a contractors)Iteensed pursuant tO SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
' u❑nl a m exempt Under Sec. ,B.&P.C.for this WATER HEATER W/VENT
re „ 6.00
Owner - Date WATER SYSTEM V'4 j+x°"5.00 ACC.DATE.. ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _
Ihereby affr •a artificate of consent to self-insure, U h- ZONING•
or a certifies[ f s'Cc ITpw tion Insomn n,or a certified W%Mk 4 ENG:SITE NO.
copy memo Sec 0,Lab .).J(4�f_ Ci'1 .�. _ lfGt.T!'�^�
PolicY'No. p y C✓/ CC// �q lr '.'-
O ❑ Ce if ied S er yfurnished, p'�1 'U FIRE SPRINK ENERGYT-24
Z Z ❑ Rifie tied - - .
iz O Ap,h nl - MISC.- - REFER TO ORD. Y ❑ "PI Y ❑ N❑
ir w CE/4AT' F EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 (� FLOOD ZONE A1.U.C.
W C PIiNSATIONINSURANCE PLG.CONTR. '• LIC.NO. PLG. _
}
Z ('Chis section need not be completed i the • hit or one - TOTAL S(J Y❑ N❑ V❑ N❑
hundred doff R($100)or less.)
U O 1 certify that in thno erform.1 k for w I this per- 1 MECHANICAL PERMIT FEE FEE SUMMARY
ly„ F mi[is issued,I shall noT empl an J :oy I nee
U bee
so a T.o or s'Co I Wv rem.
w Dat °Appli ant BUILDING 1
a ALTER OR ADD TO MECH. 5.00
} u! NOTI E TO APPLICAN : If, t a ing this 'ertificate of P.x- '
F ? emPtimn,YOU should becomes hj ct to the We, ersCompensation APPLIANCE 5_.00 PLAN CHECK '
provisions of the Labor Code, you must forthwith comply will" FEE
U such provisions or this permit shall be decried revoked. AIR HANDLING UNIT(TO 1000011F.M.) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DOUC.F.M.) 6.00 SEISMICFEE ,
Thereby 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(Sea MICROFILM
3097,Civ.C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's AddHEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
ress
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
n information is correct. I agree to comply with all city and county�. BOILER-COMP13 H.P.Or 100,000 B.T.U.) 6.00 - PLUMBING ordinances and state laws relating to building construction, and'
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)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. -
r,ertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONSTJAX
may in any way accrue against said City in consequence_of the '
landing of this permit MECH.CONT. LIC.NO. MECH. .
TOTAL TOTAL
Signature of Applicant/Contractor Dade
OFFICE COPY