13979 'rte"la"Y POSTTHIS CARD NEAR FRONT OF, BUILDING_ .
'iPF R MIT NIIN'$IER
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CITY: OF CUPERTINO; 13979
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
doas522377 STEVENS 'CREEK
AODREuNlr# #'
Lor
• PERMIT EXPIRES IF WORK '
OWNER •B. 'MARGARETICH coNTRACTOR BLUE HAVEN"POOLS ', IS NOT STARTED WITHIN
. INSPECTION DATE INSPECTOR INSPECTION RECORD '180 DAYS OF PERMIT ISSU..
FOUNDATION - - ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION. -
UFER .
PREGUNITE PERMIT VALI1.DATION _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ' h' c
PLUMBING" p gSl1OY .��i.
I, ELECTRICAL •7J 4t0 ISSUANCE DATE
MECHANICAL - I, - + eLoc. ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
+WOOD FLOOR ',ry�' INFORMATION
VALUATION $IFT.-
PLUMBING " `�P+iI"" . .
MECHANICAL-
ELECTRICAL
.. FRAMING ,\i ^ i'C��p�'(�\l\o VS;'!l• 'e'. . .:•1�•C1�
INSULATION , - I, U,rly u• sroRlEs TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF 1' SO FT,FLOOR AREA 70TAL ACREAGE•
DIAPHRAGM
". + '9UILDING USE
- RES INO CON PB O,Oei
I El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SE El
- ASSESSORS PARCEL'NO-
ROUGH .
PLUMBING "
• GAS TEST ,I TRACT NO. PARCEL NO.
b—
• MECHANICAL
ACC.DATE ACC,FILE NO
ELECTRICAL, FINALS DATE INSP.
FRAMING - SAN # "^
ZONING 'ENG.SITE NO.
INSULATION PLUMBING
GAS -
MECHANICAL FI RE SPRINK ENERGY T"]4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "Y %" "�
FLOOD ZONE A.L.U.C.•
LATH—INTERIOR _ ELECTRICAL, . v � .' NQ vo No
LATH—EXTERIOR - FIRE DEPT. '
SHEETROCK GRADE ' FEE SUMMARY
SHEAR INTERIOR . - BUILDING t -
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS - - - ELECTRIC PLAN.CH ECK
.. , GAS FEE' I /J
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE i
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM -
w ARRANGE FOR INSPECTION BY PHONING 252.4505, "t. `ELECTRIC`.' xy
I—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. -' ''PLUMBING.
z PLEASE GIVE JOB ADDRESS.WHEN PHONING. _
SEE'PERMIT FOR EXPIRATION DATE MECHANICAL!
CONST.TAX
IMPORT'ANTI ^ '
4.
PLEASE READ REVERSE SIDE BEFOREE 1. 'w" ,#} TOTAL
CALLING FOR FINAL INSPECTION,
OFFICE COPY -
• . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
, BUILDING PROJECT IDENTIFICATION - - PERMIT NUMBER
BUILDING APPLICATION &-PERMIT '
ADDRESS 139-79
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
DWNER'S PLAN CHECK VALIDATION
NAME OTY. . ELECTRIC PERMIT FEE
PMON
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.N LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
P.ON53N.2SJ% PANELS 10.06 DATE OF APPLICATION
ARCHIrncT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER , yyff,,RR,np�
LIC.No. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG. SPECIAL CIRCUIT .S.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 C r; 1 1 r .1
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS .s
SERVICE CHANGE 20.00 yii •I+
0 0 0 LICENSED CON TRACTORS DECLARATION = .. cam �U
<u u 1 hereby affirm that I am licensed under provisions of Chapter 9 �[, d y LL-/N}"� 1S8UA NCE DATE
y a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
'F y Is.
Professions C y license is in full fu a
9 Oz H - License ss Lic.Numb• �r1
m H Dale - Contractor �Ii�1
0L BUILDING PERMIT
¢ I[ w ¢ OWNER-BUILDER DECLARATIO -_�Y'n„ INFORMATION
wa E. MISC.- %REFERLTO'ORD
a. e w I hereby affirm that I am exempt from life Contractor's License C.) VALUATION $/FT.
u o ¢ Luw f the following reason.(Sec.]031.5,Business and Professions PERMIT ISSUANCE .10.00
ryy � Codn', city or county which reyuiresupermit mcons'tract,ulleq
¢ 2¢ improve, tolish,or repair any stnmtum,prior to its issuance,also ELEC.DONTR. LIC:N0. ELEC.
IE w m¢ requires the a licant for such permit to file a signed statement Thal +• TOTAL C� PERyIT TO ..
he is licensed p Rant to the provisions of the Contractor's License
HiQ Law(Chapter 9(c mencing with Section 7000)o(Division3of the
i i c Business and Profess s Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE t.
- ¢ I- the basis for the allege emption.Any violation of Section 7031.5 STORIES j TYPE CONSTR.
byanyapplicantforaper 't subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.15.00 '
of not more than five hundrl dollars($500).1'.
❑ I,as owner of the Prope y,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP RES.UNITS
Ihcir mle compensmion,will do a work,and the structure is not
intended or offered for sale (Sec. 044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Co.Ruch.", License Law Gas not apply to an owner of
property who builds or improves there ,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,P sided that such improve-
ments.are not intendcA or offer ed for sale. however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or impm ill ha t'is Sold within one year of c pletion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) ' 2.00 BUILDING USE
builder will have the burden of proving•that he id.nol hui ld or im- RES IND CON PB Omar
prove for Purpose cfxid,). INDUSTRIAL WASTE INTER. 30.00 �.
❑ I,as owner of the property,am exclusively tmctinh with
licensed contractors to construct the project(Sec. 4,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code i The Co"rectors License Law dal. not apply ,
to an owner of Property who builds or improves Merron, nd who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(,)licensed puns ant to
Dc Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10:0_0 TRACT NO. PARCEL NO.
C1 am exempt under Sec. - ,li.&I C.for
lis' WATER HEATER W/VENT 6.00
reason
Owner 'Date WATER SYSTEM ' r^� • 'i 5.00
Y' I ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 ,,{
I hereby affirm that I have'a cerlificale ofconsent ta,cl GlnRue' •C•4V"C1��.110(I L)(ID ZONING ENG.SITE N0.
or,a certificate of Workers'Compensalion Insurance,or a certified g _
copy thereof(Sec.3800,Lab:+"Np A W_9ML4_ (-p Q
Policy No.ere Company_ ��1lll�p@"�''••
O ❑ �edified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z f1�Certr��Iy1��c9�py�iy fL,l��1Aw+th�,11t n Ivision. - MISC.- REFER TO ORD.
O Applicnnt_pi.�A-�w.A -CET'• •�/3_ Y� IN Y � N�
cc ti CERTIFICATE OF IAEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 O-" FLOOD ZONE A.L.u.C.
W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO, PLG.
CL Z 11' ' tion need nal he complete) if the permit is for one TOTAL
-�� Y❑ N❑ Y.❑ N❑
hundred do OOl Or less)
U O 1 certify Dat in t t ormance of'he work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,1 shall not ent t Person in any mannered as to
U become subject to be WnrkaW Came - bn Luw,of Cul 16itnia.
O w nate Applicant BUILDING
a ALTER OR ADD TO MECH. •, 5.00 O
} to N you
APPLICANT': If,after making OTIk a "-Ile of Ex-
emption,? you should become subject m Ise Workers'Comp n APPLIANCE + °°" 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply wits
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.1 4.00 FEE �
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOD60C.EM.) 6.00 SEISMIC FEE
1 hereby affirrn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)„
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CP.C.L �' HEATING UNIT(TO 100000•B.tIOT--8.00
'Lender's NameJ�Yd HEATINGUNIT(OVER 100,000 B.T.U.19.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information Is correct. I agree to comply with all city and county PLUMBING d
ordinances end State laws relating to building construction, and BOILER-COMP(3H.P.Dr100,000B.T.U.) 6.00
hereby.authorize representatives of this city to enter upon the BOILER-COMP 10ver 100,000 BTU)SEE FEE SCH. MECHANICAL �•-
above-mentioned property for inspection purposes. p
(We) agree in save, indemnify and keep harmless the City of MISC.- REFER TO ORD.VS-
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE. 10.00 Q �- CONST.TAX
may fit any way ac gainst Said City in consequence of the '
gra tl Ih er ( MECH.CONT. LIC.NO. MECH,
ue grunt
�- - TOTAL
. _•)f---_ TOTAL 4 a
IS'gnatur Applicant Contractor• - Date (.�
+ OFFICE COPY