15396 POST THIS CARD NEAR FRONT OF BUILDING
PERM IT NUMBER
CITY OF CUPERTINO 15396
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10121 Westminister Court UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER . Nanci Goldman CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSV-
FOUNDATION AIC OR`180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEWSIGNED ' L
UNDERGROUND /SLAB
PLUMBING �
ELECTRICAL �,S"• - H � I' ., issuance DATE �
MECHANICAL �,`1, xLnG ELECT PLE .- .nnECR.
me-Ad Ago- ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUATION $SFT.
MECHANICAL
ELECTRICAL PERMIT TO f
J `J. / � 4—
FRAMING
INSULATION STORIES TYPE coN$TR.
- OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE 10 FT FLUnR AREA LATAE AcgEACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
flUI LOI USE
ROOF SHEATHING RES SND CON PR um,•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO 'PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC GATE ' ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT,FINAL TEST - '
INSULATION PLUMBING Iff )606 ZONING ENG SITE NO.
GAS TEST .JS- _A GAS ��_
MECHANICAL FIRE$PRINK , ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING OOL y . ❑ N❑ r E] N❑
FLOOD ZONE A L U c.
F/ EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. ° ❑ N[] ° L7N❑
SHEETROCK GRADE FEE SUMMARY
.EXTERIOR LATH BUILDING _
INTERIOR LATH TEMPORARY APPROVALS BUILDING ! 7._. 4
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING .
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
''N -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
• IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE. TOTAL «'l
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.BUILDING PROJECT IDENTIFICATION PERMIT NUMBER : .
BUILDING APPLICATION & PERMIT 15396
ADDn ss y
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
GwNEH'a PLAN CHECK VALIDATION
OTV. ELECTRIC PERMIT FEE d 8
CONTRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00
No. alp LIGHTING FIXTURES 10.00/1.00
ADDRESS NTRACTORs S /1�� . PPLIANCES-RESIDENTIAL 4.00
/8a5 HONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 -
ENGINEER
sec.NO. SIGNS TRANS. 3.00
aooa'EssYE"a SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
7�,/QW TEMP.METER OR POLE INS. 20.00 -
APPLICANT 9$I�SO MOTORS SEE FEE SCH.
APPLICA p
2��,' / SERVICE CHANGE 20.00 `++ x Al
� 02 LICENSED CONTRACTOR TCLARATION Lr` ,. C
a u I hereby affirm that I sen licensed under provisions o(Chapter 9 4F LLQ O aL t ISSUANCE DATE
,HA O1 Icommenein with Section 7000)of Division 3 of the Business and
¢ c g 1- BLDG: ELECT. PLG. MECH.
H y 2 Professions Code and my license is in
d m ce
fill)bf�and
(fe
r _
- El 1:1o i Lic.Nwu
ss
an EWJData Conr OOWNER-tlUIINFORMATION❑n
¢ a i : BUILDING PERMIT
0 c v
❑
w ; ¢
H. I hereby affirm floor I am exempt from the Contractor's License MISC.- REFER TO ORD
F LL O j Law forthe following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 O VALUATION SIFT.
Code:Any city or county which requires a permit toconstruct,altef, I,I
Q M ¢ 0 improve,demolish,O!repot!any SIrIICInrL`,prior l0 IIS issuance,llISU FILED.CONTR. LIC.N0. ELEC.
u w m S, requires the applicant for such permit to file a signed statement that TOTAL 1/ - PERMIT TO.
he Is licensed pursuant to the provisions of the Contractor's License
HZQ
Law(Chapter 9(commencing with Sceflon 7000)ofDivision 3 ofthe SW1h'1_l1,,/C�00�+
f 4 O 1{usiness and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
the haeis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; by any applicant for a permit subjects the applicant too " it penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
O I,as owner Of the properly;or empl es with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do IT the structure is not
uncurled or offered for sale (Set.)0 usiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License w es not apply to an owner of
property who builds or improves ercon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own a oyces,provided that such improve.
ments are n/sold
d or coed for sale,If,however,the building GAS-EA.SYSTEM-1 INC. OUTLETS 6.00
or improved [fin one year of completion, the ownerbuilder willNenofproving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
RES IND CON PS Dun,
prove for puale.). INDUSTRIAL WASTE INTER. 30.00
O I,as he property,um exclusively wntracting withlicensed coio construct thetproject(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
nnJ ProfessiThe Contractor's License Law docs 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 contrnetorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Con tractor'st unLaw. TRACT NO. PARCEL NO.
❑ lam exempt under
r Sec. ,e.&P.C.for this WATER HEATER W/VENT 6.00
'
..,on
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF--NSATION 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'CompSnor a c
&Rrlsm Insuranc ertificJ
copy thereof(Sec.3800,Lab.C.r euL U
Policy No. Company '
O Certified copy is hereby Efniched. FIRE SPR INK ENERGY T44
Z 2 I rtifiet py is filet ith he city nspe1'1fion division.
O Applicant x�", MISC.- REFER TO ORD. Y ❑ N Y [-] N[3
CCN CERTI FICATE OF EX IiMI'TION 2 WORKERS' PERMIT ISSUANCE 10.00 Q - FLOOD ZOrvE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. z;* ❑ ❑ ❑ ❑
Z (This section need not be co plemd if the permit is for one TOTAL '/ N Y N
hundred dollars(5100)or Icss.l
U O I certify(hat in the performm of work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not en I ercon in any manner so as to
Q w become subject to the War fpensation Laws of California. / S
Dare Appbr ALTER OR ADD TO MECH. 5.00 BUILDING
C. L
} N NOTICE TO APPLICA . If after making this Certificate of Ex
F LE eruption,you should come object to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
proe a
visions of thbor Code, you must forthwith comply with - - FEE
U such provisio r this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTIO LiNDIN '17NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /7S
I hereby affirm that oh Vel' strr� uction lendingagency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of thew which this permit is issued(See. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 3'
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 `-
inl'orn.afirm is correct.I agree to comply with all city and county PLUMBING A W
ordinances and state laws relating to building construction, and BOILER-CONIP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over to0,0008TU)SEE FEE SCM. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and.keep harmless the City of MISC.- ea REFER TO ORD.
o pertino against liabilities,judgments, costs unit expenses which W CONST.TAX
may b, way,accrue against said C' in consequence of the PERMIT SSUANCE 10.00 O
m 1 aItis permlL ECH.CONT. LIC,NO. MECH. C
TOTAL TOTAL 7/"�S^
muce pp t Contractor Dat
OFFICE COPY