13499 POST THIS CARD NEAR FRONT OF BUILDING'
'- PERMIT NUMBER
"" -CITY Of -CUPERTINQ,
d
INSPECTION DIVISION 149
JOB INSPECTION RECORD .
- PERMIT EXPIRATION
20031 SUI N DRIVE'
JOB ADDRESS UNIT#- LOT# ' -PERMIT EXPIRES IF WORK
DUANE BLOCKER !'
OWNER{° CONTRACTOR'•' - + IS .NOT STARTED WITHIN'
-INSPECTION DATE INSPECTOR INSPECTION RECORD IOU UAYS,oF PERMIT ISSU.
FOUNDATION
ANCE OR 180 DAYS FROM
T ,LASTCALLED INSPECTION.
v. UFER
'PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED P 1r r
• "" ' '' UNDERGROUND /SLAB,
PLUMBING _ .1. .i - n,t 1(0 (�. tail f".
4.
�.., .
ELECTRICAL; - YIJ. _ ISSUANCE DATE F'
l MECHANICAL ' .,.: O�aw ELE❑C', v�. MECH.
A I
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
INFORMATION
WOOD FLOOR . \ ";" VALUA )ON . SIFT.-
" PLUMBING
' MECHANICAL''• - �-
PERMIT TO
' ELECTRICAL
FRAMING.
Y� INSULATION - ' • STORIES TYPE CONSTR.
- 0CC.GH_OUP r RES.UNITS _
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1 ROOF - n ' ` , SO,FT'FLOO,i AH EA TOTALACREAGE.
LO DIAPHRAGM • I
BUILDING USE
RES IND CON P❑B Om„
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' �'" SL Q" ` '
ASSESSORS PARCEL NO,
Vc
ROUGH
PLUMBING', 'I
GAS TEST TRACT No. PARCEL No, 7
MECHANICAL "^. �' .
I «I
ACC.DATE' ACC.FILE NO.
ELECTRICAL - FINALS. DATE INSP. '4
a ,FRAMING a, SAN #,; I ..r,` ZONING . ,ENG.SITE NO.
INSULATION '" " PLUMBING
-•.' -
GAS , -
_ FIRE SPRINK ENERGY T 2
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1
FLOOD ZONE A,LU.C.
- LATH—INTERIOR ELECTRICAL ' '- _ �.0, ru� Y � N❑r
' LATH-EXTERIOR a FIRE DEPT.
SHEETROCK • - - " GRADE ' FEE SUMMARY
SHEAR INTERIOR' BUILDING -
v.
SHEAR EXTERIOR - TEMPORARY APPROVALS + ' BUILDING
FIREWALLSELECTRIC PLAN'CHECK,
GAS _ FEE . ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY': SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED'UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM '
t :
I
ARRANGE FOR.INSPECTION"BY PHONING 252-4505, ELECTRIC
F0 ONE'WORKING'DAYBEFORE REQUIRED INSPECTION
PLUMBING '
„ z . PLEASE GIDE JOB'ADDRESS WHEN PHONING.
- SEE'-PERMIT FOR EXPIRATION DATE' ME---- L
CONST,TAX
IMPORTANT!
PLEASEAEAD REVERSE SIDE BEFORE NOTAL
CALLING EOR„FINAL,INSPECTION. ( ,
+ ,�F OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
nDIEDING BU I LD ING PROJECT I DENTIFICATI ON. PERMIT NUMBER ,
- APPLICATION & PERMIT _
ADDREsg 1309
�G>✓� �,r BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S &tpL - PLAN CHECK VALIDATION
• v NAME OTY. ELECTRIC PERMIT FEE
Duda �/ Y Io ker PHDN 5 V I
CONTRACTORS
NAME UTLETS-SWITCHES ECEP 10.00/1.00 /to
NAME
LIC.No IL LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S. ppLIANCES
-RESIDENTIAL 4.00
ADDR Ess '
PHONE PANELS -10.00 DATE OF APPLICATION.
ARCHITECT PANELS (OVER 200 AMP). 20.00 PLANCHECKFEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AnCH.OR ENG. - - SPECIAL CIRCUIT S.QQ - PERMIT VALIDATION
ADDRESS -
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANTS- MOTORS SEE FEE SCH.
ADDRESS
- SERVICE CHANG .f,tSt 20.00
GO - LICENSED CONTRACTORS DECLARATION P t `
7
Q U w I hereby affirm that 1 am license.) under provisions of Chapter 9 - 'nO • ISSUANCE DATE
H Q H (commenting with Section 7000)of Division 3 of the Business and - v BLDG. ELECT. PLG. MECH.
H 0 z Professions Code,and my license is in full force and effect ❑ ❑ ❑
z
0.- License Class Lia Number
r Date Contractor - '
a u s ' ;; > - -BUILDING PERMIT
rz ¢ OWNER-BUILDER DECLARATION ' INFORMATION
E 0 a o - MISC.- - - REFER TO ORD '
E
;u.y I hereby affirm that I am exempt from�,lhe Contractor's License VALUATION ••$/FT.
FLLN ¢ Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE - 10.00
Code:Any city or county which requires a permit to construct,alter,
Q 2 Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ���""t1 �
- O S, requires the applicant for such permit to file a signed statement that - TOTAL ty-�' PERMIT TO
e m" he is licensed pursuant to the provisions of the Contractor's License
La '
La Law(Chapter 9(commencing with Section 7000)ofDivision 3ofthe
'
¢ Business and Professions Code)or that he is Cxempf therefrom:rad QTY. PLUMBING PERMIT FEE
rc r 0 the basis for the alleged exmnption.Any violation of Section 7031.5 ' - ,
STORIES TYPE CON$TR,
a3 � by any applicant fora permit subjects the applicant tua civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
^ $$ 1,as owner of the property,or my employeeswithwages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
th7 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:Tlm 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 So.Fr.FLOOR AREA "TOTAL ACREAGE
himself or Through his own employees,provided that Such improve-
memsara not intended or offered for sale.If,however,the.building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
or improvement is said within one yea of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.)' 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Other
❑ 1,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
wntracls for such projects with contradorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N0. PARCEL N0.
the Contractor's License Law.
❑ I um exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT ' 6.00 II
reason _
owner Date WATER SYSTEM 5.00
ACC.-DATE ACC.FILE N0.
WORKERS'COMI'- ATION DECI!ARATION WATER•TREATING EQUIP. 5.00
I herehy affirm that I hove o certificate of consent to self-insure,.
or a certificate u(Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
- copy IImmol(Sec.3800,Lab.CJ., ..
Policy No. Company `
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with .the city inspection division. MISC.- - REFER TO ORD. -
0 Applicant Y ❑ N❑ Y ❑' N❑
LC a CFKI'IFICA7'EOI'Ii XliMPTION FROM WORKI;RS; - PERMIT ISSUANCE - 10.00 FLOOD ZONE- a.L.U.C.
ALU > COMPENSATION INSURANCE PLG.CONTR. .LIC.NO. PLG. ` -
CL O (Phis section need not be cmbdrhad if the pen»II is for one TOTAL L - Y❑ N❑ Y❑ • N❑
Z) Z hundred dollars(S100)orless.) "
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued 1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
W Date-Applicant ALTER OR ADD TO MECH. - 5.00 BUILDING
} tail NOTICE '1'0 APPLICANT: If,after making this Certificate of Ex.
? 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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 .
CONSTRUC1-10N LENDING AGENCY. AIR HANDLING UNIT(OVER 10=C.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,Civ.CJ. ' HEATING UNIT(70100,000 B.T.U.) 8.00
Lender's Name HEATI NO UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC. �Q
Lender's Address
1 certify that Lhave 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• BUILER•COMP13 H.P.Of 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 100,000BTU)SEE FEESCH. MECHANICAL
t above-mcotioned property for Inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 'I
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE' 10.00 CONST.TAX
may in anyway accrue against said City in consequence of the
gr ting of this perm't. MECH.CONT. LIC.NO. MECH.
TaTAL, TOTAL
Sign ul'APPlican nlractor )ate -' -
` OFFICECOPY