14277 >r ,
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14277
INSPECTION DIVISION /
JOB INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADDR ESS 20771 SCOFIELD DRIVE UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER ENGLISH CONTRACTOR A-ACE PLUMBING IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
UFER LASTCALLE TION..
PREGUNITE - PERMIT VALIDATION
JANL
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED s City UNDERGROUND /SLAB y ofCUp@rti00f
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL. - BLDG. ELECT, I PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -BUILDING PERMIT
INFORMATION
WOOD FLOOR vn wnnoN s/FT.
PLUMBING -
MECHANICAL
ELECTRICAL PERMIT To
FRAMING •-�
INSULATION - STORIES„ TYPE CONSTR.
" UCC.GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF S0,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
'
RES IND CON PB 'Otlun.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO PARCEL No.
MECHANICAL
-
ELECTRICAL FINALS..."x DATE INSP. ACC.DATE ACF FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION - PLUMBING - g •
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y (:j N E Y [D NE:]
FLooD ZONE A.L.u.c.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT, Y NC] Y 0 N�
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING 3- 3.
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN,CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
FW-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN.PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 1( r
CALLING FOR FINAL INSPECTION. /
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUIDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
U/nLDING - APPLICATION & PERMIT
ADOR ^/1 �O '• BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14277
owry s •/ / PLAN CHECK VALIDATION
NAME f �1, 1) �� p/ QTY. ,: ELECTRIC PERMIT FEE
f il-J! r PHO O[�
CONTRACTOR 4SIGNSTRANS.
UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
uc.NO IGHTING FIXTURES 10.00/1.00
-orvTR croRs PPLIANCES-RESIDENTIAL 4.00
AOORE55
PHONE , aANELS 10.00 DATE OF APPLICATION
ARCHITECT ANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No. 3.00
ARCH,
OPENS. LIOATION
ADDRESS SPECIAL CIRCUIT 5.00filwff
ZIP TEMP.METER OR POLE INS. 20.00
APPUCANrS MOTORS - SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 f nl/ rJ lJN,
wooF LICENSED CONTRACTORS DECLARATION Ck It � ltm
1 hereby affirm that I am licensed under provisions of Chapter 9 ^�99 ISSUANCE DATE
io <y (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, I PLG. MECH.
H Di Professions Co ,a d y license is in full for p t
0 O l2- License Class Lia.Number E3 ❑
0 L - Dale Contractor,,, r-n
¢ x E BUILDING PERMIT
¢ ¢ w Q OWNER-BUILDER DECLARATION
" MISC.- REFER TO ORD INFORMATION
w 3 u I hereby affirm that i am exempt from the Contractor's License VALUATION $/FT.
u0Q'
Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
wig Code:Any city orcounty which requires a permit to construct,alter, _
¢ ¢ Q D Improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. I.C.NO. ELEC.
ac 0 LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$m he is licensed pursuant to the provisions of the Contractor's License
Fzr
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ = the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CO
by any applicant for a permit subjects the applicant Uncivil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollurs(8500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4,00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the strtmlure,is not
sole nded or offered for sale (Sec. 7044, Business and profession% 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 does such work FIXTURES-PER TRAP 5.00 $0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
Giants are not intended or 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
builder will have the burden of proving that he did not build or Go. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the property,am exclusively contracting with p ❑ ❑ ❑ ❑
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 docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with u conNactorfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor's License Law. TRACT N0, PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT, 6.00 -Oil
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a Certificate ofamosept to self-insure, ZONING ENG.SITE NO.
or a certificate 0 orkers'Compensation Insurance,or a rertil'icA
copy a f c J 00,Lah.C.)
Polis ora an
P Y
O ❑ Ned copyi hereby l' rnished. - FIRE SPRINK ENERGY T-24
Z Z O •rn -eI opy s fled with the city inspection division. MISC.- REFER TO ORD.
Q Applicm tY N❑ w ❑ N❑
cCI' IFICATE OF EXEMPTION FROM WORKERS• PERMIT ISSUANCE 10.00 QQOD ZONE A.L.U.C.
W COMI'1?NSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG ❑ NO Y ❑ N❑
a O ('I his section need not bn completed'if the permit Is for one TOTAL .tJV
0 Z hrmdred dollars IS 100)or less.)
V O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,1 shall not employ any person in any manner so as to
O W become subject tothe Workers'Compensation Laws of California. !SEISMIC
ILDING
y Dale Applicant ALTER OR ADD TO MECH. 5.00
} a NOTICE TO APPLICANT': If,after making this Certificate of Ex
F.. ? caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 AN CHECK
provisions of the Labor Code, you must forthwith comply with E
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 - FEEI hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the error ince of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) B.00CROFILM
Lender's Name H EATI NG U N IT(Q VER 100,000 B.T.U.)9.5D
Lender's Address ELECTRIC
. I certify that 1 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 PLUMBING UV
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino age' st liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
nay in any w accrue against said City in cajsequcnec of the
ling of this p mit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Qp
Sill ore of Applicant/Contractor Date
OFFICE COPY