14569 POST THIS CARD NEAR FRONT.OF.BUILDING PERMIT NUMBER
.CITY OF CUPERTINO 14569
INSPECTION DIVISION
• JOB INSPECTION'RECORD
_ PERMIT EXPIRATION
JOB ADDRESS 1217 WEymOth DYNE ` UNIT# _LOT#
LO - A. & H HEdt1II PERMIT EXPIRES IF WORK
OWNER CONTRACTOR EI IS NOT STARTED WITHIN
.INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. '
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER rnnr vn LlDntloN
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB '
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG ELECT, PLG. MECH
❑�. El El 'Ip
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
.PLUMBING VALUATION $/FT.
MECHANICAL
ELECTRICAL
PERMIT TO -1
- �
FRAMING - „ uiF-L .:i.
STORIES
INSULATION TYPE CONSTH, I
OCG GROUP RES UNITS.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
FLOOII AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.'SHALL BE MACIGBBOI�E" -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID rr 44 .
BUILDING USE
ROOF SHEATHING filtv
VM' IND CON PB om.-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE _11,11SP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.a ASSESSORS PARCEL NO
'
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO
_/ -
MECHANICAL MECH.ENERGY
ACC.DATE ACC FILE N0,
ELECTRICAL BUILDING ENERGY ; ' -
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY r29
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r Y ❑ No ❑ NF]
,
EXTERIOR SHEAR ELECTRICAL'RELEASE FLOOD ZONE A.L a c
INTERIOR SHEAR FIRE DEPT. Y❑ NO Y*L-1 IN C]
SHEETROCK GRADE EE SUMMARY
EXTERIOR LATH BUILL IN -//
INTERIOR LATH T MPORARY APPROVALS 10T
G
SCRATCH COAT ELECTRI - ECK .
GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY FEEOCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBYBUILDING INSPECTOR. LMARRANGEFOR INSPECTION BY PHONING 252-4505CLONE WORKING DAY BEFORE REQUIRED INSPECTION.~� G0 PLEASE GIVE J06 ADDRESS Wp�EN PWONING. ' ''" 'ZSEE PERMIT FOR EXPIRATION DATE - ICALAXIMPORTANT!PLEASE READ REVERSE SIDE BEFORE AL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY _
PERMIT NUMBER
BUILDING PROJECT IIDENTIFICATION APPLICATION 4569
BUILDING J o J
ADDRESS
BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
PLAN CHECK VALIDATION
"AME. //�� QTY. ELECTRIC PERMIT FEE
' UPHON � /
NAMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
G _C.NO,5D LIGHTING FIXTURES 10.00/1.00
CONRRCONTRACTOR.
ADDRESSAPPLIANCES-RESIDENTIAL 4.00
ADRAC
�PHONE ,o 0 PANELS 10.00 DATE OF APPLICATION
OR
PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEEP.C.NO.
RR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH Ess ENG. SPECIALCIRCUIT 5.00 PERMIT VALI DATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
,-02 LICENSED CONTRACTORS DECLARATION/ /
Fi w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE'
a n (commencing with Section 7000)of Division 3 of the Business and, BLDG. ELECT. PLG. MECH.
r y z Professions Codd t ease is in rnbe ur - ❑ ❑ ❑
Z'
z w 0 License C s Lic.Number
P In r j Date Contractor
aIS ¢ OWN1:R BUILDING PERMIT
o a D Bul u)ER DECLARATION INFORMATION
`x ;LL t- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
w 'A VALUATION $/FT.
Rw0 J Lew for the lollowing reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10.00
f yj0 Code:Any city orcointy which requires a permit to construct,alter,
rz ca
St, improve,demolish,or repair any structure,poor to ELEC.CONTR. LIC.NO.its issuance,also ELEC. -
wZ u requires the applicant for such permit to file a signed statementisLithat TOTAL PERMIT
$ re is licensed pursuant to the Provisions of the Contractors License
i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Ilusiness and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE /11
EE 0 the basis for the alleged exemption.An violation of Section 7031.5
p 8 p il STORIES TYPE CONSTR.
y ; m by any applicant fire permit dolhistile(S500phC9mt lna Clvl penalty ALTER-DRAIN 5,00
of not more than five hundred dollars(5500).): - ,
❑ I,as owner of Ilse property,of my employees with wagesas _ BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do.the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions 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 doesueh work FIXTURES,PER TRAP 6.00 SO.FT.FLOOfl AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsam"otintended or ffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Omar
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed'contractors to construct tile project(Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARGE:NO.
and Professions Cade:'I'he Contractor's License Law does riot apply
to an owner al'properly.who builds Or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor s)li caned pursuant to
the Contractors License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this
reason WATER HEATER WIVENT 6.00
Owner _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE 140.
WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00
I Hereby affirm that I have a certificate of consent toself-insure,
or a certificate of Workers Compensation Insurance,or a ratified I ZONING ENG.SITE NO.
/y,,�,`e 00,Lab.C... I IT F
O CCC��1 Certified copy i5 hereby lurni5h¢d/�/1Y)C19N1 FIRE SPR I NK EN ERGV T-24
Z Z Certhd is f)lcA with tete ty inspumion Ivlslon.
Allplicant!y.!Lh!_�I'.In/--1� MISC.- REFER TO ORD, Y E] N❑ Y E] N[3
~ Oy PERMIT ISSUANCE 10.00
� - CERTIFICATE OP Ii%IiA11'TION FROM WORKERS' FLOOD ZONE A.L.U.C.
LU I I COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG.
CL Q (This section need not be completed if the permit is for one TOTAL Y[] N Y[D N
Z hundred dollars IS 100)or less.) IkV
(_) O I certify that in the performance of the work for which this per- QTY. MECHANICAL ERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to n
O W became subject to the Workers'Compensation Laws of California.
0. Dale ApplicantBUILDING
} N NOTICE. TO'APPLICANf: If,alter making this Certificate of lix ALTER OR ADD TO 5.00
Z emption,you should become subject lO the Workers'Compensatio l APPLIANCE 0 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 IT 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C,FNL) 6.00 SEISMIC FEE
bhemby affirm that there is a construction lending agency for I EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 5
Lender's Address ELECTRIC
I certify that I haJ¢road this application and state that the ubovc VENTILATION FAN (SINGLE) 4.00
ordinarce, n correcState la agree to comply b with all city and county BOILER-OOMP l3 H.P.or 100,000 B.T.U.) &001PLUMBING
ordinunc¢s and slate lows relating to building construction, and
hereby authorize representatives of this city to enter Inion the BOILER-COMP (Over 100,000 BTU)SEE FEESCH.1 MECHANICAL S a
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, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
m y n any waK Acer a gainst said City in consequence of the
r n ng aof n lhls p¢face MECH.CONT. LIC.NO. MECH.
_ 7� TOT A S� TOTAL
signature of Apphcanl/Cont or Date „/ l� / 7 /
OFFICE COPY