13498 POST THIS CARD NEAR FRONT OF BUILD Q/ P�ERM
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CITY OF CUPERTINO nMIT NDMeINSPECTION DIVISION - �JOB INSPECTION RECORDnPERMIT EXPIRATION
JOB ADDRESS ZDbJ$ ; fTc_V--vrC4AA./UI KNIT# IT EXPIRES IF WORK
OWNER . \ CONTRACTOR ,NOT STARTED WITHIN
INSPECTION.'- q,, DATE, , INS ECTOR 1 ' '�1 P,ECT OWRECO Q1,-j"albj, Fr, 180 DAYS OF PERMIT ISSU.
FOUNDATION –]„�, ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
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n
PREGUNITE / PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL n1`rJ `.I "@IL•'oa. BEET. PL❑c. Ma.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDC'y\y of Pt I,IN DING ORMATIONT I
WOOD FLOOR VALUATION 7IFT.I
PLUMBING
MECHANICAL
v RMIT ro
ELECTRICAL
FRAMING
sTOnles TYPE coNSTR.
INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED FINALED IN
SQ FT,FLOOn AnEA TOTALACREAGE
ROOF
DIAPHRAGM
."_ ^: m
BUILDING use
�/ / RES IND CON PQ Olb
APPLY NO ROOFING UNTIL ABOVE HAS BEEN,SIGNED GATE / T" 0 0 ❑ 0 Cl
_ n55E550R S PARCEL NO.
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PLUMBING fT;,, ,
_ TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICALZ—�— i 'U;•.FINALS:14r�s3. '�S,iDATE mNsPiv,.
FRAMING 2•T—off SAN # ZONING, ENG.SITE NO.
INSULATION PLUMBING -
GAS
FIRE SPRINK ENERGY T"24
MECHANICAL Y [] No Y ❑ ND
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED":',, HEATING
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.u.c.
LATH-EXTERIOR - -� FIRE DEPT. vo N� v FIE]
SHEETROCK GRADE '" r�'ti";n E BUMMARY•4,'j_;
SHEA:9 INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
. GAS FEE -
NO TAPE OR PLASTER UNTN ABOVE HASAEEN SIGNED OCCUPANCv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM '
ARRANGE FOR INSPECTION BY PHONING-252-4505, ELECTRIC
FW-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE - I
CONST.
ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY
_ POST THIS CARD NEAR FRONT OF BUILDING
• reanui Nun+eery
CITY OF CUPE.RTINO 349$ .
INSPECTION DIVISION
`` JOB INSPECTION RECORD
I` 10805 'S STEVENS CANYON ROAD PERMIT EXPIRATION
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER D. M. SAYRE CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPE TOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
l ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /-SLAB - ry: �j��•/
PLUMBING
ELECTRICAL kAFIesuANCE DATE
MECHANICAL - oc. ELECT. PLG. MECH.
❑ I ❑ L ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR
. I FORMATION
• p
PLUMBING noN /Pr.
MECHANICAL
PERMIT TO
ELECTRICAL
.FRAMING - • E -tf C `✓
STORIES �V1,.IPCIF TR,
INSULATION - I+�LG/J/'�lll-
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDING USE
HES IND CON PB OUw,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING , -
GASTEBT _ TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS ' � DATE INSP. ACC:DATE ACC.FILE NO.
.'
FRAMING 7 SAN #
ZONING ENG.SITE NO,
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T2
MECHANICAL - ,Y E-] N� r ❑ N�
40,=VER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING
LATH—INTERIOR � ELECTRI FLOOD 20 NE A.L.U.C.
LATH—EXTERIOR —Z FIRE DEP 44 43 Y❑ N❑ Y ❑ N�
SHEETROCK G - .FEE SUMMARY
SHEAR INTERIOR B l G
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Irk F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE — MECHAwcnL
CONST,TAX
IMPORTANTI
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
0
PERMIT NUMBER
BUI LOI AG PROJECT I DENTI FICATION
BUILDING APPLICATION & PERMIT A ^
\ ADDRESS I y
lel d J. Jf✓G BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
1✓��`i .\ NAMER s PLAN CHECK VALIDATION
+ CITY. ELECTRIC PERMIT FEE
4 � � PHory 3-G�Y
! CONTRACTOR'S
t�.,Nt NIL
AME UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTORs
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CH CK FEE P.C.NO.
OR
ENGINEER
LIc,No. SIGNS TRANS. 3.00
ARCH.OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS _k7e
SERVICE CHANGE 20.00 /G q
o o LICENSED CONTRACTORS DECLARATION - k/�(0 /
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y< N' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H D z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ .
Z, O w- License Class Lic.Number
o z r w Date Contractor
¢ y s BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
¢ w u INFORMATION
X 3 a a 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F u o a Law for the following reason.(Sec.7031.5,Business and Professions pERM1T ISSUANCE 10.00PAI
VALUATION $/FT.
Code:Any city or county whichrequiresa permit to construct,alter, �Q
a ¢¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
G u requires the applicant for such permit to filen signed statement that ALAI I r p 'p r,J PERM}?TO
9 he is licensed pursuant to the provisions of the Contractor's License -�� JIIG,-'�IVYi -
F z a Low(Chapte,9(commencing with Section 7000)of Division 3 of the /� A/s'2
z o Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT F s
¢ H the basis for the alleged exemption.Any violation of Section 7031.5 V RIE 'L..� TYPE CONSTR.
a 3 � by any applicant fora permit subjects the 0),): am toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 v/9
of not more than five hundred dollars(5500)J:
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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,AR EA,COND. 5.00
' L 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 SD.FT.FLOOR AREA TOTAL ACREAGE
s himself or through his own employees,provided that such improve-
ments arenot intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
w.
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 s 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 Omar
❑ I,as owner of the property,am exclusively contracting 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 a contractons)licensed pursuant to SEWER•SANITAR V-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ I am exempt minder Sec. ,B.&P.C.for Nis WATER HEATER W/VENT 6.00
reason
Owner Date Dnte WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERTCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z p Applicant❑ Cetified copy is filed with tire city inspection division. MISC.- REFER TO ORD. Y ❑ N E] ❑ N❑
Y
~ y PERMIT ISSUANCE 10,00
-
CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LLI >_ COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
CL O e(This section need not be completed if the permit is for one TOTAL Y❑ IN V ❑ N❑
=) Z bdndred dollars 1$100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U be6nic subject to the Workers'Compensation Laws of California. /D -�
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE 1'0 APP L[CAN'f: If,after making this Certificate of Ex-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE <O
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE
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. MICROFILM
3097,CiL.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
n
~y I certify that l have read this application and state that the aboveVENTI LATION'FAN (SINGLE) 4,00 i
l) information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P. 100,000 B.T.U.) 6.00
1•r hereby authorize representatives of this city to enter upon the
�A.ry0 BOILER-COMP (Over 100,000 Brul SEE FEE BCH. 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,judgments, costsand expenses which - CONST.TAX
may in'any way accrue against s.1id City in consequence of the PERMIT ISSUANCE 10.00
gran' or this permit {r MECH.CONT. LIC.NO. MECH.
•(C/lI B'9 TOTAL TOTAL 7
'ignature of Applicant/Contractor/7- Dire/
OFFICE COPY